HomeMy WebLinkAbout032-2112-50-000 V
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
A
Owner %.`,7
Property Address
City /State
Legal Description: OPF,
Lot Block — Subdivision/CSM # Alf
,mil '/a - ' /a, Sec. �, T �N -R, &W, Town of !,�, ,kes rl PIN`` ' �' ` ; �
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer Size ST/PC,? / Setback from: House Z :LL Well ,5 PAL ys
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: /r/aco,J/J Width _�_ Length _ �.� J Number of Trenches
Setback from: House 9L Well ill P/L? _ Vent to fresh air intake f��
ELEVATIONS
Description of benchmark a / . Elevation /DD. 4
Description of alternate benchmark Elevation e
Building Sewer � — ST/HT Inlet ST Outlet �� PC Inlet 13,201
PC Bottom _ �'G. / 9 Header/Manifold /ten . 7 Top of ST/PC Manhole Cover
Distribution Lines () IM j f,I! () ( )
Bottom of System( eo, a Z O ( )
Final Grade O O ( )
Date of installation Zj ermit number 3,��ZV j State plan number
Plumber's signature License numbe ;: -2 ., 3 Date La
Inspector ` 14 jk-:2
Complete plot plan
1
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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a�
$s
=3e sir
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INDICATE NORTH ARROW
f WitconiO Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar .
Personal information you provice may be used for secondary purposes [Privacy I-Xv, s.15.04 (1)(m)].
f X9&r's )ft'D ESAIMERSijX ❑ Town of: State Plan ID No -:
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel .
1)c7 To sJiw_ r
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION f BS I FS ELEV.
Septic (� fj /0 o0 Benc rk �I 07 / OU
t /a • 0 or 2�
Dosing (,J 4 - 4 7 A A 1f ?, /r; Q 3.
Aeration Bldg. Sewer ;E 7 r? /;? .fig 3
Holding _,_.µ,.....,.,.. St/ Inlet /O A t/ )3 /
TANK SETBACK INFORMATION Outlet 1 6- 7- 1 1
TANK TO P/ L WELL BLDG. Aeintake ROAD Dt Inlet /D // .x- t
Septic tot, P .j/ NA Dt Bottom /0'7 /7
Dosing 7 fO Q f -7 , 7 NA Header /Man. y- �(� 160
Aeration Dist. Pipe
Holding Bot. System S G OQ, 0,3
PUMP/ SIPHON INFORMATION Final Grade
�b Manufacturer 6G�I Denn
�; Model Number G 3 PM
H TDH Lift j3 ..ZL Friction2 System 7" �
TDH � t
Q �.
oss Forcemai n Length O Dia. H �� Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width [ Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / DIMEN I N
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O � � r CHAMBER Model Number:
System: mm OR UNIT
DISTRIBUTION SYSTEM
Header / Man ifold (r Distribution Pipe(s) ( �� f x Hole Size x Hole Spacing Vent To Air Intake
Length 3 Dia. Z Length _(a_ Dia. Spacing f /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 11 .3 jy 0.19 y, ,N TTMiMiv��T7 , y S t W y 1 .� 6 + 21 70TH ST — PINE MEADOWS LOT 5
Ck f P,0.,J C ie
f �Tvk✓ �. Z ` `10 .�
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBO -6710 (R.3/97) Date Inspec ature Cert No
ADDITIONAL COMMENTS AND SKETCH `
SANITARY PERMIT NUMBER:
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' Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Vsconsin P O Box 7302
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County /J
than 8 112 x 11 inches in size. / fi r ✓
• See reverse side for instructions for completing this application State sanitary Permit Number
Personal rY purp ❑ Check if revlsio
Personal information you provide may be used for seconds ur ��lOUS 1
P � �
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 0 = 2- t� - 7
Prop y Owner me Property Location
1 14 1 14, S T Q, N, R E (orff
Property Ow er's Mailing Addre ;gi Lot Number Block Nu m er
City, to � Zip Code Phone Number Subdivision N e or CSM Nu ber
II. TY E F BUILDING: (check one) ❑ State Owned il Nearest Road
[] Village
Public 1 or 2 Family Dwelling
- No. of bedrooms —� Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1' 0, 19 I
1❑ Apartment / Condo d 3,A "- a I I a S r aim
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. E4 New 2 ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
- _____System ________System _____________Tank Only______________ Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued_ Permit Number Date Issued
V. TYPE OF SYSTEM (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 J) Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. inch) Elevation
fi 3 Feet eet
Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper.
INFORMATION
gall Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic ng ank Z &W — ❑ ❑ ❑ 1 ❑ ❑
1 Pump Tank i on Chamber — — ® ❑ El 1 ❑ ❑ ❑
ONSIBILITY STATEMENT
1, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans.
:PI umb s Nam . (P Plumb SSICK o Stb ) MP /MPRSW No.: Business Phone Number:
Plumber's 'Address (St, C CO
ic
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Age i ature (No Stamps)
X Appr oved 5)1harge Fee)
pp []Owner Given Initial G� / /
Adverse Determination r
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
, 1
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal, Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenevei
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 - 3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section .
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) -all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
.and establishment of standards.
Safety and Buildings
' 15837 USH 63
HAYWARD WI 54843 -8107
Nvisconsin Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
Department of Commerce
February 16, 1999
CUST ID No.224263 ATTN.• POWTS INSPECTOR
ZONING OFFICE
KIM A O'CONNELL ST CROIX COUNTY
504 3RD AVE 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 02/16/2001 Identification Numbers
Transaction ID No. 210227
Site ID No. 167161
SITE: Please refer to both identification numbers,
Site ID: 167161 above, in all ;correspondence with the 'agency,
ST CROIX County, Town of SOMERSET; 70TH ST, SOMERSET 54025
Facility: BRAD PICKARD RESIDENCE SEPTIC SYSTEM 70TH ST, SOMERSET 54025
FOR:
MOUND SYSTEM, 450 GPD
Object Type: POWT System Regulated Object ID No.: 450725
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P. 0.
The following conditions shall be met during construction or installation and prior to occupancy or use: con d i
1. This plan action is subject to designer comments on the plan.?
2. The area 25' below the downslope edge of the mound must remain undisturbed. I " }
RTNN'
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to N Of AF
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 02/08/1999
FEE REQUIRED $ 180.00
i FEE RECEIVED $ 180.00
PATRICIA L SHA1� RF , POW S P N RE ER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633
RESIDENTIAL MOUND DESIGN
INDEX AND TITLE SHEET
Project BRAD PICKARD
Owner BRAD PICKARD
Address P.O. BOX
SOMERSET WI 54025
L;gal Description NW- SW- SEC11- T30N -R19W
Township SOMERSET County ST. CROIX
Subdivision Name PINE MEA Lot No. 5
N.T.S.
Parcel ID Number Tonally
Plan ID Number 4TYA
INDEX SHEET PAGE ONE MOUND CALCULATIONS PAGE TWO
MOUND DRAWINGS PAGE THREE
PRES. DIST. CALCS. & LATERALS PAGE FOUR
PUMP TANK DRAWINGS PAGE FIVE �1D
PUMP CURVE PAGE SIX
PLOT PLAN PAGE SEVEN
Designer KIM A OC NNELL License Number , �/, S
Signature o
L�
Phone No. 715 - 755 -3145
Date "_' 2 -99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in aisciplinary action under s. 145.10, Wis. Stats.
sso-1o462 -E (R.04197) Page 1 of 7
RESIDENTIAL MOUND DESIGN
Eight Bedroom Maximum
Complete information in red framed boxes as necessary.
(y or n) n Is the stem over creviced bedrock?
Slope 6 %
Number of ivdrooms 3
Wastewater flow rate gpd 17033 Lpd
Depth to limiting factor t 450
28 in 71.1 cm
In situ soil infiltration rate de) 0.4 l gpdAe 1 16.3 Llm
Contour line below the upslope a of absorption cell 98.3 It 29.96 m
Use standard fill depths? L.�.J OR Designer speed depth in cm
Place ?C M boor to use standard depths (1Z 24, A+4 inclusive) OR specify design rill depth.
Center or end man ifold (c or e) Estimated hole space 4 ft Not a final calculation.
Lateral spacing F Minimum dose >= 10 times void volume
Use a o lateral spacing for trenches. Pump tank elevation 88.3 ft Outside bottom of tank
Number of laterals 2 Force main diameter 2 in
Force main length 1 80 Ift Force main actual dia. 2.067 in
SYSTEM SOLUTIONS Inch - pounds Metric Cell media "x" one only.
Estimated daily flow ®gpd 1703 Lpd x ]Chamber Aggregate and pipe
quid pip:
Absorption cell
Design load rate & area 1.2 gpde 375.0 fe 34.84 m
Linear load rate 7.1 gpd/ft 88.0 Lpd/m
Design width (A) 6 ft 1.83 m
Cell length (B) 63.0 ft 19.20 m
Depth of cell (F) 9.9 in 25.1 cm
Sand filter
Upslope fill depth (D) 12.0 in cm
Downslope fill depth (E) 16.3 in 41.4 cm
Basal area required (gpolinfiltration rate) 1125 fe �30.5
04.52 m
Supporting components
6.0 in 15.2 cm
Topsoil depth
Subsoil depth at center 12.0 in 30.4 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.5 ft 3.20 m
Upslope toe length (J) 7.2 ft 2.19 m
Downslope toe length (1) 11.9 ft 3.63 m Includes basal adjustment
Total mound length (L) 84.0 ft 25.60 m
Total mound width (W) 25.1 ft 7.65 m
Project: BRAD PICKARD Page 2 of 7
Plan I.D.
MOUND PLAN VIEW
observation pipes (typical)
E l �
W 25 1 ft A A = 6.0 ft 1.83 m
7.65m B= 63ft 19.2m
g -- - -�-� K J= 7.2 ft 2.19 m
I = 11.9ft 3.63m
41, � K = 10.5 ft 3.20 m
84.0 ft
�` -- - -- L = 25.6 m typ. obs. pipe
A X B refers to absorption cell width and length (anchored securely)
J = upslope width
I = downslope width
K = end slope dimension 9' (150 mm)
MOUND CROSS SECTION
D = 12.0 in 30.5 cm
lateral topsoil G H subsoil cap E = 16.3 in 41.4 cm
invert 99.8 ft - - - 4 F = 9.9 in 25.1 cm
elev. 30.42 m see note G = 12.0 in 30.4 cm
H = Min 45.6 cm
1, D E T ASTM C33
Sys. ft
' Sand rill
99.3 %�
elev. 30.27 m 983 1 ,ft contour 6%
29.96 I m slope j �>
Note: Absorption cell media will
D = upslope fill depth plowed layer consist of aggregate and pipe
E = dow - dope fill depth or leaching chambers and pipe
F = absorption cell depth as specified x Aggregate
G = subsoil + topsoil depth at cell wall at right. Chamber
H = subsoil + topsoil depth at cell center
Designer notes:
If aggregate is used, it is covered with code compliant material.
Project: BRAD PICKARD
Plan I. D. Page 3 of 7
r
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 6 ft 1.83 m
Length (B) 63.0 ft 19.2 m
Lateral specifications _
Number laterals 2
Holestlateral 16 holes
Lateral length 60.0 ft 18.3 m
Perforation dia. 0.25 in 6.4 mm
Lat. dis. rate 18.64 gpm 1.2 Us
Sys. dis. rate 37.28 gpm 2.4 Us
Hole spacing 48 in 121.9 cm
Lateral diameter Pipe diameter teeignoo— o.a echoic.
Designer must 1 inf25 mm Place X in red
")C" one choice 1 1/4nr32 mm box of chosen
from the options 1 1/2n/40 mm X X diameter.
provided. an50 mm X
3in175 mm X
Manifold diameter Pipe diameter Designopxonc oesig,chace
Designer must 1 inM mm
wX" one choice 1 1/4n/32 mm Place X in red
from the options 1 1rzw40 mm x box of chosen
provided. 2in50 mm x x diameter
NnJ75 mm X
4nM00 mm X
Distribution system contains 2 lateral(s).
LATERAL DIAGRAM - END CONNECTION
Place correct lateral diagram by ticking in one of the drawings at right and dragging the diagram into this area.
Lattrals canters Last hole drilled next to end cap Ow cal)
P
•
AM laterals are identical Holes drikd on the bottom of the lateral 5
eWah Spa-d
•
Force main oormatim Via we or cross to mand0ld at any Point. Laterals & force man of PVC Sch 40
• % permamm wW marker (per COMM Table 84.30 -5)
Inch-pounds Metric
Lateral length (P) 60,0 ft 18.29 m
Lateral spacin9 ( S ) 3 ft 0.91 m
Manifold length 3 ft 0.91 m
Hole diameter 0.25 in 6.35 mm
Lateral diameter 1.5 in 40 mm
Number of holes per pipe 16
Invert elevation of laterals 99.8 Ift F 30732 m
Project: BRAD PICKARD
Plan I. D. Page 4 of 7
Total dynamic head
System head = 3.25 ft 0.99 m
Vertical lift = 10.60 ft 3.23 m Are laterals the highest point in the
Friction loss = 1.85 ft 0.56 m system? Yes "X' here. L�J
Total dynamic head = 15.70 ft 4.79 m If no, what is the highest elevation
Dose Volume downstream of pump?
Lateral void volume = 12.7 gal 48.1 L Force main drain
Minimum dose = 127.0 gal 480.7 L back to tank? ('Y' one)
Drain track = 13.9 gal 52.6 L x Yes
Dose volume = 140.9 1 533.4 L No
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover
weather proof wMaming label and padlock
grade levels junction box � — grade levels
quick disconed __...
alternate
4' vent pipe electric as per NEC 300 and =_- - outlet
Comm 16.28 WAC \ location 18" (46 cm) min.
wall of pump approved _+
chamber or outlet
combination j oint
tank A 1/4" weep Grade levels
alarm on hole as pump lank nww6de - a• mim above f she.+ grade
pump on B MWAHIaary p+mp,ank man. - 100 mm min above frist- I grade
vat = 12' min. above 0rished grade
pt imp 89.2 ft C y vert = 30o mm min. above rrrrrmed tirade
of elev. 27.2 m
D
�.
3 " 75 mm of bedding under tank and anchor tank as necessary 88.3 ft Pump tank slow, -ion
26.9 m bottom of tank
Tank specifications: WEEKS
Pump tank = 18.04 galln
Pump tank volume = 800 gal Capacities: Inches Gallons
A= 24.6 468.7
Pump manufacturer: IGOULDS I B = 2 38.1
Pump model number: IWE0311L C = 7.4 140.9
D = 8 152.3
Project: BRAD PICKARD
Plan I. D. Page 5 of 7
I
- Pedormance
curves Pumps
METIERS fEET
- , -- --
t r- -, – DEL 3865
I f
25 _ _ -� -- ;SIZE' Solids
WE15H
TO
20 WXIOH - I
bu
H WE07N -
15
WEOSM
i0 -
10 30 WEOJM
pE03L
10 �?
0 10 20 90 40 60 b0 7u b0 SU 1 W 110 12Q GPM
0 10 20 a0 m'/11
CAPACITY
�, �;,�...N. ,., •t�. - - '-� - JULDS PUMPS. INC.
- .a�S�- .a.:r_i.L�a�.i. �.��.. j.J,.
METERS FEET
t20 — - rY;0DE 3885
- — — i SIZE';;" Solids
110 WE15HH
100 - --
-
o
15 I
� WE05►1M
20
s T� i
10 T
- -f -I-
0 O
p 10 20 30 i 0 yp (Q 70 110 1:U GPM
0
CAPAC, r r 30 ml/h
E .h ruy. 1
• 1 W8 Oouw Pumps, InC. C ] 4 A
'7
_x
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
,Divislor -bf Safety and Buildings Page / of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and \� "
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. If
APPLICANT INFORMATION - Please print all information. Re y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). • s /
Property Owner Property Location
Govt. Lot 1/4 / 1/4,S / T N,Ro
Property Owner's Mailing Address Lot If Block Subd. Name or CSM#
Q
City Stat Zip Code Phone Number
❑City El Village ® Town Nearest Road
New Construction Use:
®Residential /Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft
Absorption area required bed, ft .5'7_ trench, ft2 Maximum design loading rate bed, d /ft
g g gp _ trench, gpd /ft
Recommended infiltration surface elevation(s) �3 ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S ® U Jos ❑ U ❑ S ®U ❑ S ® U ❑ S JJ U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
f
Ground
elev.
Depth to
limiting
factor
,-- in.
Remarks:
Boring #
I Z
LIZ
S �
Ground -
el v.
ft.
Depth to
limiting
factor
,_?�in. Re arks:
CST Name (PI se Pr' ) Signature / Telephone No.
i
Address Date CST Number
J ' - - 3
I
yG9,O ',�r� SOIL DESCRIPTION REPORT
PROPERTY OWNER
Page of
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
��ejllev. ,.. r
L ,s
Depth to
limiting
factor
_min.
Remarks:
Boring #
...........................
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
...........................
Ground
elev.
ft.
Depth to
limiting
factor
in ' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
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6L) su s
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I
Wisconsh0epartment of Commerce J S O IL AND SITE EVALUATION
Division of Safety and Buildings Page 4 of
Bureau of Integrated Services ffry2 6M dilCer ' h s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not in size�� n must County
include, but not limited to: vertical and BM), diY�cti and ���
percent slope, scale or dimensions, no on and distance'to n rest road. Parcell$. j1 �
1997 APPLICANT INFORMATION - matio►. - - Reviewed by Date
Personal information you provide may be use ,s„ 1 .04 (1) (m)).
Pr27 er Property Location
£ Govt. Lot At I 11! 114,S / T ,N,R F�(orxw
Property 6es Mailing Addr7 Lot # 1 Bioc Subd. Name or CSM#
Q�
C Stat Zip Code Phone Number
❑ Ci [:1 Village ®Town Nearest R
New Construction Use: EgResidential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate bed, gpd* ,. 5 trench, gp&*
Absorption area required _bed, ft 37.E trench, ft Maximum design loading rate _,� bed, gpd/ft? S___ trench, gpd/ft
Recommended infiltration surface elevation(s) 0K_ It (as referred to site plan benchmark)
Additional design/site considerations
Parent material - Flood plain elevation, if applicable ft
ej
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S [@ U LE S❑ U ❑ S R u EIS IA u I ❑ S 1A u ❑ s J29 u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/�
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
I
S� b
Ground
Alp
Depth to
limiting
factor
Remarks:
Boring #
X�
Ground ,y / �°
ev. ,
=ft.
Depth to
limiting
factor
Zin. Remarks:
CST Name PI e �t)l ' Signature r Telephone No.
�9 �_Y/
Address b Data CST Number
SOIL DESCRIPTION REPORT "
PROPERTY OWNER Page of -5 -
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
s � �
_.. ... S`/ I S�
Ground 7S _ 0 VZ
elev.
Depth to
limiting
factor
-eL- in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
a: a
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
131
Ground
elev.
tt. ,
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
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,(]CT -09 -98 10:02 PM BELISLE EXCAVATING 7132473039+ P.01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Lai :Fax d-le ricLa
Mailing Address 1 d a Aeon Le) Tb a2 e csgj t W T° S4 �
Property Address
(Verification required from Planning Department for new construction)
City /State J0'� of S � ' Parcel Identification Number
LE AL DEECMEII
Property Location 1� %4 1 /., Sec. IL T 3 4 .Rff - W, Town of �5 r ef
Subdivision pf-)ne- an! de)C JS _ . Lot # .
Certified Survey Map # , Volume Page #
Warranty Deed # 299 , Volume Page #
Spec house l3 yes no Lot lines identifiable �44:s O no
MIT_EM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes, Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) the on - site wastewater disposal system
is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 8111 of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, u set by the Department of Commerce and the Department of Natural Resources, S•ste of Wisconsin. Cerdficstion
stating that your septic system has been maintained trust be eotnpicted and returned to the St. Croix County Zoning Office within 30
days of the three year pins n date.
r
IONA 'RE Of APPLI ANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (Aft) the ownet(s) of
the property described s v by virtue of a warranty deed recorded in Register of Deeds Office. qq
1 &U "
T IONAtftM OF APPLICANT DATE
•'•••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zonin: Department.'
•' Include with this application. a stamped warranty deed from the Register of Deeds office
a copy of the certified survey msp if reference is made in the warranty deed
"
ti'HLLEN H. WALSH
\\-A K R A N' I N 1) OF ILEDS
-;T. CkOIX l;U-, WI
oocur,tttiT r;.,
KICEIVED QR 9EC9Rr
V. a r k A Fagt-rlan a -larrit'd person. 3:30 4A
WARRANTY DEED
EXEMN I
CERT CON FEC-.
COPY FEE:
Bradle-y R. Pickard and T�ANSFIER �EE:
janelle M.. Pickard, busband and wife, ORDM FEE: 10.00
:Cat St Croix U, N Ij
1 IS r i NA
' LEI i 1 I-strccn & Ogiand
oot .�59
W1 54016
032-2112-50
Lot 5, plat of Pine Meadows in the Town of Somerset, St. Croix
County, Wisconsin.
is not
Easements, restrictions •rd rights-of-way cf record,
if any
December 98
jo
'lark N. Fajerland
G - 1 it L N T I C All ON ACI KNkl\\ L L 1) E
Cd 0-,
-December 8
Kristin6 0gland,
t I I U- MEMBER 1\.I E BAR OF V I�C !'iN
Attorn�y Kristina Ogl.nd
Hudson, WI 54016
11M
T• CROIX COUNTY, WISCONSIN- Regtstar of n eoa$
,ATTED LANDS
- - - - - - - - - FENCE 1 CORNER OF LOT CORNER E NO / _
FENCE CORNER IS NORTH 6' +/- Et /4 CORNER
OF LOT LINE SECTION 11
NOR L INE OF THE NWi /XOF THE SW1/ X TFENCE 'S3'30 "W
00 , X
- - 926.95
L11 �, 650.00'
M MARK
UM 1929
V. LOT 3 928.43
N J 1.3' +/-
6.367 ACRES R
Ln 277,334 SQ. FT. n
v
Lo
• / J .�� / N Z r f0
WATER AS OF 10/13/97
9w= w USGS DATUM 1929
® \ � m == � ELEV. = 926.77
3:
L36 58937'04 "E 571.25' I
251.94' (2Q 319.31'
BENCHMARK M
USGS DATUM 1929 n
ELEV. = 934.72 \ \
9
1 \`
3
' " N
N
33' 33' o� 50
S88i48'25 'E 26 8.95 ' LOT 4 N C
15: WIDE DRAINAGE EASEMENT 6.125 ACRES \ M AI
266,820 SQ. FT.
to NI
W wl
h _
N
I� J p N
M
o Q,I
M � Q
I
U I <� v� Z �I NUMBER DIRECTION DI
o L1 N89'37'04 'W 2c
d S89'37'04 "E 619.55' L34 L35 L2 N89'37'04"W 7 '
w L3 N00'00'14 "W 31
36' +/— L4 N49'09'49 "E 4
o I w !2 � L5 N76'30'47 "E 2'
~ n ` " L6 N4217'35 "E 2
0
I- i- L7 N19'S4'S8 "E 5
wl a I o L8 N81'07'S9 "E
U 2
Z � - 2��� w L9 S1 5.45'47 "E 3 p al o I-<• -- - L10 S25'03'1 3"W I
r
" wo L11 S89'53'30 "E 2
LOT 5 N� L12 S13'58'12 E `
� L13 S18'58'55 "W 1
5.260 ACRES o z L14 S14'43'06 "W
cn 229,117 SQ. FT. n w L15 S42'S3'37'W
r°I L8 F- L16 509'33'15 "W f
50' r o L17 S42'42'34 "W
� L18 500'16'49 "W
z L19 S15'26'27 "E
�� � � � N L20 559'20'11 "E
5 L21 S18'12'22 "E
O�A \- g�`ryo w L22 506 "W
° o � L23 S12 "E
— r ��' L2 S20'58'00 "E
— l2 _ — LT- L25 536'17'16 "E
L26 S10'30 "E
M o L27 S20'33'22 "E
n DEDICATED TO THE PUBLIC ------�-- L28 N40'36'50 "E
L29 N25 "E
L30 N16'53'55 "E
S89'37'04 " E 620.85' L31 N39'35'09 "E
L32 N12'13'51 "E
L33 N27'00'28 "E
L34 S89'37'04 "E
L35 589 "E
LOT _1 L36 S89'37'04 "E
L37 N01.01'18 "E