HomeMy WebLinkAbout032-2108-00-000 ' ST. CROIX COUNTY ZONING DEPARTMENT
i' AS BUILT SANITARY REPORT
Owner
Property Address �•S �-
Ci ty /State C s r
Legal Description:
Lot Block ^ # Subdivisio
VOO ',, Sec. , T_2 N -, Town ALO� - -
of PIN # r"o
TAN DOSE CHAMBER -- HOLDING TANK INFORMATION:
// � r
Tank manufacturei< Size ST/Pr,/ 0 Setback from: House ,� Well
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: fresh air int Water Line
Meter location
Alarm loca
SOIL ABSORPTION SYSTEM
, ��.>`T� Width 3 L n S Number of Trenches
Type of syster V f 8
Setback from: House oe'3" Well P/L /�_ Vent to fresh air intake 41
ELEVATIONS
Description of benchmark Elevation , 0
Description of alternate benc Elevation
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifoldls 2 Top of ST/PC Manho a Cover
Distribution Lines
Bottom of System
Final Grade ( ) { ) ( )
Date of installation,/ numb State plan number
Plumber's signature License numberC% tll Dat b<ll
Inspector
Complete plot plan �
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
e
Two horizontal reference points to center of septic tank manhole cover.
•
Show alternate benchmark, if applica ble.
PLAN VIEW
t
y S
l.2G
INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
. ` Safety and Buildings Division ST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarys2rIPIN®:
Personal information you provice may be used for secondary purposes [Privacy LaX, s.15.04 (1)(m)).
18A ig,¢I,cp r,s 4414CE ❑ Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TWM.:.2108 -00 -000
OD
TANK INFORMATION ELEVATION DATA A9900055
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark +1,57 10IS1 L Tt).O r
Dosing
Aeration Bldg. Sewer
Holding Q /49L Inlet o Sg ,22
TANK SETBACK INFORMATION / It Outlet
TANK TO P/ L WELL BLDG. Air I ntake ROAD -ot !Rle4
Air
Septic ; >ZS ( NA D4 e"
Dosing, NA Header / Man. AZT , S -'S
Aeration NA Dist. Pipe 1 �x `
s- '► 76 , 3q
Holding Bot. System #' .o
� 9.2 T �. b Z
PUMP/ SIPHON INFORMATION Final Grade , (
Manufacturer emand
Model Number GPM
TDH Lift F ' n Syste H Ft ead
oss Forcem Length Dia. H Dist. To well
SOIL ABSORPTION SYSTEM
84EqYja Width Len th ji I No.OfTrenchesr PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man fa �j,�rer�•
SETBACK �fr�v�
INFORMATION Type Of r _ CHAMBER M del Number:
System: ul" • Z3 !�'0 11 ev OR UNIT dtc
DISTRIBUTION SYSTEM >I CW
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length Dia. Spacing _/
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx De Seeded/Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges opsoil ❑ s ❑ No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons pr ent� Y I•v`� 6 fol.Sl
LOCATION: SOMERSET 12.30.19,SW,NW 81 S LAKE LOT 20
P A* Bit 440 0", •i 9:v
', � �1a��t� �S � u J•o IS.o ..►.114- .s w�`��ievwln�c�.t4.4.,
aeU 64&
Plan revision required? ❑ Yes No
Use other side for additional information. ( al 6
Y, SBD- 6710(R.3/97) Date Inspector's Signature Cert No.
k
ADDITIONAL COMMENTS AND SKETCH !
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
.
• •
4 sconsin in accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. 4 r o 1K_
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes [.Check ,revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
1/a 1/4,S f� T ,N,R E(o W
Property Owner's Mailing ddr ss 0 Ya r Lot Number Block plumber
2
City, State n f Zip Code Phone Number Subdivision Name or CSM Nu ber
11. TYPE OF BUILDING: (check one) ❑ State Owned 0 City I Ne arest Fto
r^ p Village
Public or 2 Family Dwelling - No. of bedrooms �_ own OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo
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.'Je New 2_ ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
_______ystem System Tank Only ExlstingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number 3,?/-710 Date Issued 3 i
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12E�rSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 4 , , 43 ❑ Vault Privy
14 ❑ System -In-Fill
. / `i'
VI. ABSO RPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Reyt�
q. ft.) Proposed sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
6 Feet .3 Feet
VII Capacit
TANK in gallo Total # Of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existin structed
Tanks Tanksl Tanks
Septic Tank or Holding Tank A5670 ❑ ❑ I ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for instal! tion of the onsite sewage system shown on the attached plans.
Plu ame: (Print) Plumber's Si e: {No p MP /MPRSW No: Business Phone Number:
Plumbe ' Address (Stet, ity, St e, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
(Approved ❑ Owner Given initial / Surcharge Fee) r� '
Adverse Determination �(/ !6D �[ ��it "'
X CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
i �(�oSlci>\r �oNi�vi. --, R /.vs�ystc.ED A cc_c�.�tNy - vo �LAtJ ,
z -j Gce fWbxT 3IJ C_jag-L, L F P, f- Ep A -C (AQ►IQ C AR P.
SBD- 6398 (R.11I97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
i
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 whenever
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:
1. 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.
PLOT PLAN
PROJECT Mike Ballard Jr. ADDRESS 1775 178th St. New Richmond Wi 54017
SW 1/4 NW 1/4S 12 /T 30 N/R W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/27/99 BEDROOM 3
CONVENTIONAL XXX IN -GRO ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18
IL BENCHMARK V.R.P. Top of Electrical Box ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 85
Alt. BM Top of White Stake @ 92.5 Vent
Sidewinder High
Pro 3 A6'Long Capacity Leaching
Bedroom Chamber with 31.8
House „ ft/ per chamber
10' ara a 34” Grade a t System Eleva on
25' g
120' 10'
B -1 80'
12%
Slope
w
2- 3' X 56' Infiltrator Trenches
. To
CD 165th
B -2 100' Ave
15'
Vents 15' Alt.
M.
500'
Property
Line
Area for
Replacement
System See Soil Test
by Gary Steel
on 4/17/97
140'
0 '
195' Property Line
15'
- Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Divisioh of 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 81/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference pant (BM), direction and ,'
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information Reviewed by Date
Personai information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
� � v Govt. Lot 1/4 ,V 12 T _30 ,N,R E (or W)
Property Owner's Mailing Address Lot # I Block# I Subd. NwYe or CSM#
l '-'q r-
d
City fate Zip Code Phone Number ❑ C Ullage Town Nearest Road
Construction Use: ,residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow �4A gpd Recommended design loading rate - 2 bed, gpd* - trench, gpd/ft
Absorption area required - A!�� bed, ft 5_jK3_ trerxh, ft Maximum design loading rate _ bed, gpd/ft =trench, gpd/ft
Recommended infiltration surface elevation(s) 95 ft (as referred to site plan benchmark)
Additional design/site considerations ,
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional I Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system s ❑ u �.4 ❑ U XS ❑ U S E] U ❑ S U E3 S J9u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
a] - Z _e
Bed ,Trench
O
a .a
Ground r7
elev. _ O
Depth to
limiting
factor
l ;�
y S Remarks:
Boring #
Ground
4 bepth to
limiting b
actor
Remarks:
CST Nam (Please Print) Si a Telephone No.
S t,-
Address Date CST Number
PROPERTY OWNE OIL DESCRIPTION REPORT
� Page of .
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GeDjft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground j 5:�: 7 , Pz hJ
- ft.
i
Depth to
limiting
Z /; or
� in. y
Remarks:
Baring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/
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
' Remarks:
SBD -8330 (R. 07/96)
Soil Test Plot Plan
Project Name Mike Ballard Jr. Shau
Address 1775 178th St.
New Ri Wi 54017 TM #226900
Lot 2 0 Subdivision North Bass Date 4/27/99
SW 1 /4 NW 1 /4S 12 T 30 N /R W Township Somerset
[:]Boring ()Well PL Property Line County S T. C ROIX
BM or VRP Assume Elevation 100 ft. T op of Electrical Box
System Elevation 85.8 * H R P Same a s B
Alt, BM Top of White Stake @a 92.5
Pro 3
Bedroom B.M
House
25' Wage
120'
B -1 5 ' 80'
30'
i
12%
bd Slope
P B -3
To
f D 30' 165th
B -2 100'
Ave
5 '
15' Alt. !�
.M.
500'
Property
Line
Area for
Replacement
System See Soil Test
by Gary Steel
on 4/17/97
140'
60'
195' Prop Line
15'
Safety and Buildings Division
NVIA SC011SIn SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
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
than 8 1/2 x 11 inches in size. s C v
• See reverse side for instructions for completing this application State Sanitary Perm t Number
you provide may be used for second 1 o
Personal information
y p y ry purposes [I Check if revision to prevl us application
[Privacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property Owner Name �/ , ` Property Location
M /' ,� u. e� J,, S t /4 A /4, S Z T () , N, R 9 E (or)
Property Owner's Mailing Address / �� Lot Numbe_, Block Number
City, State _ Zi Code Phone Number Subdivision Name or CSM Nu ber
II. TYPE OF BUILDING: (check one) ❑ State Owned itr Nearest R p�
Public 1 or 2 Family Dwelling - No. of bedrooms ° Il w9 of a DT TV
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) D Q h
1 ❑ Apartment / Condo D .1 • 1 0 1
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. 0 New 2 ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
------ System System Tank Only 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 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12 S6eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit , / / 43 ❑ Vault Privy
14 E] System-In-Fill a — 3 V1 5 �, . j� ?Lr ^ � ' S
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. �em E;gev. 7. Final Grade
C1 o p 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) °�,v Elevation
I : 6 ? .r419ml� Feet 9 J Feet
Ca acit
VII. TANK in allo Total # of Prefab. Site Fiber Exper.
INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App
Tanks Tanks r
tic Tank Ing / OUP / [ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber El 1:1 11 11 El El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb ' Signature: (No ps) MP /MPRSW No.: Business Phone Number:
aacioo
PI mber's Address (Street, City, State, Zip Code):
313 -A- cle., -,_ 4
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin gent Signature (No Stamps)
,l I (Approved E] Surcharge Fee) Owner Given Initial // aD)
Adverse Determination ' /
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
4 L ✓97; f i1" % C OM J. WkA -, 6e I wS 'f° Its /tc
�w�`��y rwi.t•�' bv..�.c.'�' � � � S��r�c.;�iiolt�$
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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 whenever
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.
Vlll. 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.
PLOT PLAN
PROJECT Mike Ballard Jr. ADDRESS
SW 1/4 NMI 1/4S 12 /T 3 N/R 9 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 '� DATE 2 /1 7/99 BEDROOM 3
CONVENTIONAL XXX IN- OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18
IL BENCHMARK V.R.P. Top of SE Lot Stake ASSUME ELEVATION 100'
❑ BOREHOLE WELL *H. R. P. Same as Benchmark
Vent SYSTEM ELEVATION 94. 17
>12" Sidewinder High
of Cover Capacity Leaching
Chamber with 31.8
6' Long
16" ft ^2 per chamber
34" Grade at System Elevation
Pro Driveway
0 3 Bedroom
H ouse
30' 500'
Property
T Line
3%
100' Slope
B -5 B -4
2- 3' X 56' Trenches with 6' Spacing 2' Vents
140
Property
70' B -3 B -1 Line
N. Bass
Lake
B -2 3 '
AL 9'
40'
Alt. B.M. 139' B.M.
Property Line 18' 21' 6' 4'
' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of _,3 -
Labor a6d Human Relations
Division of Safety & Buildings in accord with IL-HR 83.05, Wis. Adm. Code
` COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Cro
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 2 Z��f- s ' ��
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Gerald J. Smith GOVT. LOT SW 1/4 NW 1 /4,S 12 T 30 N,R 19 YRRor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
1 na N. Bass Lake Estates
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QfOWN NEAREST ROAD
Elk River. MIN, 99_'310 k19)_4A1_ARRR Somerset I 85th. St.
[ New Construction Use [x) Residential / Number of bedrooms 3 [ ] Addition to existing building
() Replacement [ ) Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft - 8 trench, gpd /ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft2 •8 trench, gpd /ft
Recommended infiltration surface elevation(s) 95.00 ft (as referred to site plan benchmark)
Additional design /site considerations alt . system el.= 94.17'
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U E3 ❑U L1S ❑U El El
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>day Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITIrench
1 1 0 -12 10 r3 3 none sii 2
RENE 2 12 -24 10 r4/4 none sicl lcsbk mfr 9W if .2 .3
Ground 3 24 -80 7.5 r 4/4 none cos osg ml na na .7 .8
elev.
9 8.5 ft.
Depth to
limiting
factor
+8 0"
Remarks:
Boring #
1 0 -8 10 r3 3 none sil lcsbk mfr cs 2f .4 .5
2
2 8 -26 10yr4 /6 none sicl lcsbk mfr 9W if .2 .3
................
3 26 -33 7.5yr4/4 none sl lcsbk mfr gW if .4 i .5
Ground
elev. 4 1 33-81 7.5 r4 4 none cos os ml na .7 .8
98.4 ft. ,
Y
Depth to
limiting
factor
+8 1"
Remarks: M 601X
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200 ve. New R' ' d WI 54017 <`
Signature: Date: 4 -17 -97 CST �j: T?
PROPERTY OWNER Gerald J. Smith SOIL DESCRIPTION REPORT Page 2 of T 3 %
PARCEL I.D. # O 3 Z
,
Depth Dominant Color Mottles Texture Structure Consistence Roots GPDJft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trey&
't..3 1 0-12 1 4 e S1 2msbk mfr cs 2f .5 .6
2 12 -24 10 r4 4 none sl 2msbk MV Cfw if .5 .6
Ground 3 24 -82 7.5 r4 6 none cos 0SQ ml na na .7 .8
elev.
9 8.0 ft.
Depth to
limiting
factor
�31g
Remarks:
Boring #
1 0 -8 10 r3 3 none sil lcsbk mfr cs 2f .4 .5
4 2 8 -30 1 r4 4 none sici m na 9K if np n
,4416 3 30 -80 7.5 r4 4 none cos 0scr ml na na .7 .8
Ground
elev.
97.9 ft.
Depth to
limiting
factor
Remarks:
Boring #
- 2f .4 .5
5
if .2 .3
G round ? So 3 - os 0sa ml na na .7 .8
elev.
96 ft.
Depth to
limiting
factor
+801 lo$ ?
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05192)
Y
STEEL'S SOIL SERVICE
Gary L. Steel Gerald Smith 1554 200th Ave.
CSTM2298 WIWI S12- T30N -R19W New Richmond, WI 54017
MPRSW 3254 town of Somerset (715) 246 -6200
lot #20 -N. Bass Lake Estates
N
1 =40'
BM.= top of SE lot stake @ el. 100'
Alt. BM.= top of SW lot stake @ el.88.00
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13'1 19' J 21 160 4'
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,Gary L. Steel
4 -17 -97
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
/ �✓ �_ l
Mailing Address '� �c -c�/� PL/1 .s `ld I
Property Address
(Verification required f Planning Department for new construction) ,S
City/State /f/���J %Zug �_ Parcel Identification Number
LE GAL DESCRIPTION
Property Location—J /,, � '/4, Sec./2- , TAN -RAW, Town of
Subdivision yr ,� �� ���� , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 7 y0 0'/ , Volume 12-K:> , Page # S
Spec house ❑ yes,21 Lot lines identifiable yes ❑ no
SYSTEM 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 (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
/ '
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department."""
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
' VOL PSI PACE 156
STATE PAR OF WISCONSIN FORM 2 - IQ92
57000 WARRANTY DF.Fl) 1 p
DOCUMENT NO. r:
_�nrESt.__Oaks_S�ndQS inc�,
-- - -- ----------- - - - - -- - -- DEC 1 1991
conveys and warrants to t ahwp _C.-- $3113rCl�ili�___ -- - - -- 9:30 ww,,,, �•
i rMVI r
-- sTfiwi fer -- ;-- $il-L3rd, -- husband -and -- 411 fer - - - --
O f C
— J J THIS SPACE RESERVED FOR RECORDING DATA
NAME AND nFTUnN ADDRESS
dw fullowrng described real rstair in County. K R ISTI NA OGLAND
Stare of Wisconsin: L1; :! a F , f Peen & Ogland
P.U. Box 359
Hudson, W1 54016
032 - 2108 -00 I
PAnCEL IDENTIFICATION NUMBER
Lot 20, North Bass Lake Estates
TRANSFER
This - . � 6�— — homestead property
a
(L (isTwx)
Exception J o w arranties: Easements, restrictions and rights -of -way of record,
if any.
Dated this day of Decem _ A.D 19 9
F Ee a cs on IaG .--
(SEAL) By __-. — _ (SEAL) r !
—— -- Ge a t h - -- -- — - y
- e
- -- -- (SEAL) - - - - - -- (SEAI )
t
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)— Gera ld_,7— .mtll]a.h___._ -__ -_ State of Wisconsin,
atllhcl\llralCd 1I�15 �- oayof - DeC2mbeL._.. I9. -�1 . rcr"ially castle More me this -_- clay of
^_ -- ---- ---- ____ - -• 19 r'le ahove named
Kristina O qVand -- - - -- - - - - -- ---- - - - - -- -
- - - --
TI I LE MEMPF_R STATE PAR OF WISCONSIN
(If not. -�- -- - - - -
authorized by §706 06, Wis. Stats) tom knoecll to be thr person . _ __ oho eseculcd Ihr (nreFoin�
instrument and acknowledge thr. saner.
THIS INSTRUMENT WAS DnfA. T1=D nY
A tt - orne __ %rtstina__Qg1and __ --
Rudsnn - WI— _a4016-
(Si�nanrres may be authemirated or ackn„w:eJgrd R „th are not "i comnnsdon is prrnlanrnt (I( not, state rspiralion da'r
• Namt. of trrwn. aiRniny in inp apx it ) ahr h, r� trd r•r pnnrrd rvlm. rhrrt nRn,vun c .
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1960 81h Ave-
St. Croix County Land and Water P.O. Box 95
Conservation Department
;t
Baldwin wt 54002
Phone: 715-684-2874 Fax: 715-684-2666
Erosion Control Plan for the Ballard Residence
As per plan:
Erosion Control
-All silt fence and erosion control fabric in ditch shall be installed prior to any construction
and maintained throughout the construction phase.
- Gravel drive shall be installed prior to any construction.
- Erosion control fabric shall be installed in drainage swale upon final grade.
-All cuts and fills shall be protected with erosion control fabric until they can be properly
seeded and mulched. (weather dependent)
Earthwork/Final Drainage
-All final grades shall be constructed to encourage sheet flow and infiltration of
stormwater runoff.
-Final impervious drainage shall be directed to drainage swale whenever possible. (to
include driveway, house and garage)
- Downspouts shall be directed to minimize concentrated flow and encourage sheet flow
and infiltration of stormwater runoff.
- A shoreline buffer zone shall be established to intercept and purify runoff water, hold
soil in place, and provide wildlife habitat. Vegetation removal shall not be allowed in the shoreline
buffer zone, defined as the area beginning at the ordinary high water mark of North Bass Lake
continuing inland for a distance of 75 feet. Two exceptions to this exist: 1) a 30 foot wide access
corridor and 2) routine maintenance, enhancement, and establishment of native vegetation.
A fact sheet, Erosion Control for Home Builders, has been included to assist the landowner in
proper installation of all erosion control practices.
l
I
50 0 50 100 150
P�
Scale 1" = 50'
v
TB PIPE
EL. =95.88
s S a s q�
Owl � \
x.5fi SILT FENCE
w a nAQi - fir;
4,
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R PROJECT
REVISIONS
DRAWN ev. ri
SHT. NAME SHT. N0.
DATE: ul Apsijem
DWG. NO.: A/
�as s
�cd
APPROVED BY: P,�
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