The URL can be used to link to this page

Home My WebLink About032-1011-50-000 ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT Owner MWK RO U , Property Address !r_ 57' City /State _ n` ,5a k Fl ►ti�'f L /Ozc� c Legal Description: Lot Block Subdivision/CSM # ' - �VL' '/4 JVL' /4, Sec. 5 , T - 'mil N -R /`? W, Town of - Arly -S5 0 P - 5D -On e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 14/ "CS Size ST/PC 16 601 Setback from: House S 3 Well PAL -&O() 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 " � �Q�NCI� &S �1 rT� �� f/i6f! �i9� /N'�LT �� Erb• 7K��1c �� Type of system Elu Width Length 36 Number of Trenches Setback from: House 9 0 Well — P/L /C'D ' Vent to fresh air intake ELEVATIONS Description of benchmark Of' OF Elevation /bn Description of alternate be nchmark Jot' of f uSE 9 c;0AW PT1 r t3LW Elevation 7 Building Sewer 10f. 6 ST/HT Inlet '7 , 7.3 ST Outlet 7?- SI PC Inlet PC Bottom --- Header/Manifold `� 7 , Z J Top of ST/PC Manhole Cover /66 /4 Distribution Lines (} q / (} ( ) Bottom of System () 75. 7 L'� () ( ) Final Grade ( ) Ire - O ( ) Date of installation / 1 , 311 6 4Permit number S 5 3Z :Z / State plan number Plumber's signatur I 1� ---k License number X20'2 z/ 2 Date / / Inspector � Complete plot plan Or 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 C, e 3� I NaUS� rl,CiiN'iAtZ�' I� -rr�r' f %+= BHS�'M�►:>� V'JALI INDICATE NORTH ARROW I F WU Wsconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM county: �fety and Buildings Division INSPECTION REPORT St, Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353271 Permit Holder's Name: ❑ City ❑ Village ❑ Tjkwn o : State Plan ID No.: Rodvold Mary & athv I Town of Somerset CST BM Elev. Insp. BM Elev.: BM Description: « Parcel Tax No.: IL r3 t �z • - CSC Q�+l �- 032 - 1011 -50 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark 346 ;� s - � Dosing " Alt. BM 8.9 114. x$ Aeration Bldg. Sewer(A 3-29 / - $ Holding St /Ht Inlet 3 ,qz, qq - - 3 TANK SETBACK INFORMATION St/ Ht Outlet �/� qq TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic r NA Dt Bottom Dosing . �� NA Header / Man. "o Aeration NA Dist. Pipe :�, /d Holding Bot. System • 9r }0 PUMP/ SIPHON INFORMATION Final Grade CV,p Manufacturer Demand St cover .ISS 101J0 r r Model Number GPM TDH I Lift Fric ' S ystem TDH Ft Forcemain Length Dia. Dist. To Well SOIL 6 TION SYSTEM f �,q 0 �6►u:.el = A.+1 •(bt.l TREN H idth Len th v No f renches PIT No. Of Pits Inside Dia. Liquid De h DIMENSIONS a DI E SION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO /aDr O j� �G OR UNIT Moe Numb System: �+ DISTRIBUTION SYSTEM Header / ani oid r, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length W Dia. JE Length Dia. Spacing r SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7Depth 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.) Inspection #1: 1 / 3 0 OVInspection #2: Location: 351 Polk/St. Croi oad, Som set WI 54025 (SW1 /4 NE1 /4 5 T3 IN R19W) - 5.31.19.67 1.) Alt BM Description = a A 2.) Bldg sewer length= -• l0� - amount of cover= 1 > 42. M i � Plan revision required? [ ® No 1 L 6 Use other side for additional information. o� SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: m < m 1 { a s a ! I IT E E -ALL _�- F e �_ t� � «u. � I I a { Safety and Buildings Division � - SANITARY PERMIT APPLICATION 201 W. Washington Avenue :il�isconsin P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, W1 53707 -7302 I • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. _ - Q • See reverse side for instructions for completing this application State sanitary Permit Number ,35 3P-�[ Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N , N tion Property Owner me tL SW1 e - yl c 1/4, S T � , N, R / E (or lVV Property Owner's Mailing.A9dress Lot Number Block Number J �"trt Ot State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Its N rest R d ❑ o age K T C�QG X �D Public 1 or 2 Family Dwelling - No. of bedrooms T OF _SD r1AF P, Sr I 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 63Z_ /0//'- 50 �Ob �. «• 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. g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System ________ System _____________ Tank Only_____________ Existing System ________ Existing System B) gA Sanitary Permit was previously issued. Permit Number 3 ;"Z 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:KSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 3 r S 6 "� / 43 ❑ V, aylt Privy 14 5 stem -In -Fill G1 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/da /sq. ft.) (Min. /inch) Ele ation T 5 _S� 9 5, 7 Feet (W Feet VII Capacit TANK in allo s g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /QO >�OG 1 ❑ ❑ ❑ 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) I Plumber's S' ature: o mps) MP /MPRSW No.: Business Phone Number: �iFc )ak And 0 2.3292 1 7)5 - 2-9y- 191 PI mber's Address (Street, City, State, Zip Code): M IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) pproved []Owner Given Initial surcharge Fee) . � l ' Adverse Determination /-3/— X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: X___ �= SBD -6398 (R. 4/99) 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 Admihistrattvei.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. if. 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. Vtl. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks arrd . 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 pumo manufacturer; D) cross section of the soil absorption system if required bythe 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. i r Furd�� I � �1�)lYt��IY !O GARS I /Cl lr�1L V��KS �FP %IC 7fln/K 1'�- st d /("a-/,z Ro O le 3 3 13r�1Rl.�V A &Wfl T6f' 6F / " A'1_ ZLCV 106 S /// ALi MFRS e�23z `/—Z 0 Q Eft/\CsME� BY C AR3 'S ECLE /G -2z- 99 d 6k l d CT 1 HA/I r _ _ W isconsin D epartment of Commerce SOIL AND SITE EVALUATION n Division of Safety and Buildings Page of Bureau of Integrated Services in accordance wit 0 r , is. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches i sib ",;I, la usl� County include, but not limited to: vertical and horizontal reference point ( W Rlirectio ( °e�; percent slope, scale or dimensions, north arrow, and location and isiAice to nearest road. Parcel I.D. # i APPLICANT INFORMATION - Please print all info station. `: ' Re ' ed by Date Personal information you provide may be used for secondary purposes (Priva�y Law, s. 15.044"+ 3 _ Property Owner Property Locayoa GUvt. L>at 114 114,S s T ,N,Ror 1� Property Owner's Mailing Address ck# Subd. Name or CSM# A l �. City State Zip Code Phone Number ❑ city ,® Town Nearest ty ❑ Village Road � 5 EK New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow °d gpd Recommended design loading rate 7 bed, gpd /fi 2 _,-';?_ trench, gpd /ft Absorption area required _f_ bed, ft 2 _ trench, ft Maximum design loading rate 7 bed, gpd 1ft gpd/ft Recommended infiltration surface elevation(s) ,9.5', 7 ft (as referred to site plan benchmark) Additional design /site considerations Parent material a& r -Z 6. -A Flood plain elevation, if applicable 4 — ft — S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for s [9 S❑ U 14S ❑ U [As El U Os ❑ U ❑ S 0 U ❑ S O 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 J Ground elev. qq� Depth to - limiting 6 factor > /,z5 - in. Remarks: Boring # Ground elev. fZ , Depth to limiting factor n. Remarks: CST Name PI se Print K I Signature + Telephone No. v Address Date CST Number I` PROPERTY OWNER _ 6 �AV SOIL DESCRIPTION REPORT Page C:2 of PARCEL I.D.# 1 S-2 Z "nd '-<n - 4= Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground r- J -� c�elpev..� , /-�,-1-ft. - — Depth to limiting �y factor 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) •�/�'1�JC �8�01�0/�O 56�� - 'i(/.� - sECS - 7....�//1� � /�!� �e D r y/ 3 2 1 8� Me Ax x o io - ate -99 n /eb 11 .4 a� V i sconsin Safety and Buildings Division W. SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with Comm 83.05, W' Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the sy paper nai - (e�ss% County than 8 112 x 11 inches in size. ( �y -' rt Cpw,"yt • See reverse side for instructions for completing this ap 'c ion I L7/ 5 to Sanitary Permit Number Personal information you provide may be used for secondary purposes DES ` ,.> , ,*� = gneck it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. _ ` ST '' x $t�te Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT A F N r Propert ` wner Name - s' Lo t19 N .+ 1-ATHV lib'ri'v��'�.I� �� y1i 1/4 � T ) , N, R 7� E (or V� Propert Owner's Mailing / r dre s L r Block Number A/ �l �fL 2 lb r � ._. Qty, State Zip Codl Phone Nu Subdivision Name or CSM Number N -�`3 Ccc� s (!mss I H1. II. TYPE F B IL ING: (check one) ❑ State Owned r� it� TNgrest ad Public 1 or 2 Famil Dwelling - No. of bedrooms _ T own OF _Syfik _!)L- I< 1 C' rznv kr_ III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo l °1 • �v 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. 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 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 120Seepage 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 L� Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation " ?OO bbd S `/'acv. 30 Feet ,g Feet Cap acit y VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin structed Tanksl Tanks Septic Tank or Holding Tank / c JC oc 17 ❑ ❑ ❑ Cl ❑ Lift Pump Tank /Siphon Chamber Fm I P of T K j ❑ ❑ I ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' ignature: No Sta ps) MPAA� RENO.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): X `� - y � =jam W) 6'-� � IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includ Groundwater ate ssue Issuing Agent Signature (No Stamps) 1;7 . Approved ❑ Owner Given Initial Surcharge Fee) ' Adverse Determination R , 2 ,5-. ' � �Z� . CONDITI NS OF APPROVAL / REASONS FOR DISAPPROVAL: q C( U� P�� I - � SBD -6398 (R. 4/99) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative ode 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 (SE -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. 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. y X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2x 11 inches must be submitted to the county. The plans must incTu7le the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tanks) 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 Trumps and controls; dose volume; elevation differences; friction 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. ---------------------------------------------------------------------------------------------------- GkOUNDWATER 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. 4 WW �- IC�� C3Dt/OLL) stf '�y A& �JyL T31 , if, I q yB 9yl Z 10 � - -T - TW S P F - REs LAKE, M 1J 5 5�Z-5 0 m�RsZZ DVIUC -WAI To - rZC K/-Sr C� 2aAt Rl� 3 REID-- Fb8m\ 1&Y D r-- AL SE PT 10- - rP, 0 K 0 0 _ CxARAl. a AL-v RCmo-tIMAR.K aFV ?8,7 Z — 5 ' x 7p '-mrkrr1 $ C i w Z d ,0 R,--NG'j-►NIAKK 7bt 6F l' A tLgv it) c) Wiscon$in Dep*tment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations DivisiorrofSafety & Buildings in accord with ILHR 83.05, Wis ,Adm.'Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plafi must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of lope, scale or PARCEL '1.D. # dimensioned, north arrow, and location and distance to nearest road. r " 032- 1011 -50 -000 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION' VIEWED BY DATE W. Z -15 PROPERTY OWNER: PROPER . I . lOi� Mark Rodvold GOVT. LOT SW 1/4 JqE , 1/4,5' 5 T 31 N,R 19 Ejor) W PROPERTY OWNERS MAILING ADDRESS LOT # - BLOCK # SUBD: NAME OR CSM # 4896 210th. St. N. na `' na: n;3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Forest Lake, MN. 55625 (651) 464 -1365 Somerset Polk St. Croix Rd. [x] New Construction Use [ x] Residential / Number of bedrooms 3 [ J Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd /ft - 5 trench, gpd /ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate •4 bed, gpd /ft - 5 trench, gpd /ft Recommended infiltration surface elevation(s) 96.30 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial drift Flood plain elevation, if applicablen ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem U S ❑ U CAS ❑ U U S ❑ U ® S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertch 1 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 1.6 2 9 -26 10yr4 /4 none sil 2msbk mfr gw if .5 1.6 Ground 3 266 = 65 5yr4/4 none sicl 2msbk mfr gw if 1 .4 1 .5 1 e • 4 65 -10 7.5yr4/4 none ms Osg mvfr gw na . 7 ':. 8 Depth to 5 100-140 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 limiting factor . 0 g +140" Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 <' ..2... 2 10 -22 10yr4/4 none sit 2msbk mfr gw 1f .5 .6 3 22 -32 7.5yr4/4 none sett 2msbk: mfr gw if .4 .5 Ground i e ' elev. 4 32 -54 5yr4/4 none sicl M na gw na - 1 t67 67 5yr4/4 none :sei+ 2msbk mfr gw na .4 .5 Depth to limiting 6 7.5yr4/4 none ms Osg mvfr gw na .7 .8 factor rr -1 0 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave N w Richmond W 54017 Signature: Date: 10 -22 -99 CST Number: m02298 it PROPERTY OWNER Mark Rodvold SOIL DESCRIPTION REPORT Pa 2 - 3 PARCEL I.D. # 032 - 1011 -50 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>day Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 3 2 9 -26 10yr4 /4 none sil 2msbk mfr gw if .5 .6 Ground 3 126-85 7.5yr4/4 none sici 2msbk mfr gw if .4 .5 elev. 1 4 85-115 7.5yr4/4 none ms Osg mvfr na na .7 .8 Depth to limiting factor +115 Remarks: Boring # 1 0 -10 10yr4 /4 none 1 2msbk mfr gw 2f .5 .6 4 2 10 -46 10yr4 /4 none sil 2msbk mfr gw if .5 .6 3 46 -78 7.5yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground elev. 4 78-110 7.5yr4/4 none is Osg mvfr na na .7 .8 99.7 ft. Depth to -- limiting factor Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 5 2 9 -26 10yr4 /4 none sil 2msmk mfr gw if .5 .6 3 26 -45 7.5yr4/4 none sl 2msbk. mvfr gw if .5 .6 Ground elev. 4 45 -72 5yr4/4 none scl 2msbk mfr gw na .4 .5 9 9.3 ft. 5 72-100 7.5yr4/4 none ms Osg mvfr na na .7 .8 Depth to limiting factor +100" Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Mark Rodvold 1554 200th Ave. CSTM2298 SW4NE4 S5- T31N -R19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 N 1" =40' / /BM.= top of 1° pvc pipe C el.100.00' /Alt. BM. = top of 1 pvc pipe @ el. 98,.70' IL 'k A po f fib° f „R0 2.5\ �. GAry L. Steel 10 -99 rnr,► % F Al PUMP CHA.M.P,ER CR655 SEC'IDcJ ANG SPECIFICtiTIGlk!S I { VE0.1T CAP 4 "C.I. VE'J:T PIPE WEATHERPROOF APPROVED LOCKIAIC.. > 25' FRO -' DOOR, JUAICT'ION BOX MAAJHOLE COVEF. WINDOW OR FRESH 12 "MIU. AIR IMTAKE I GRADE Y" MIN. COIJDUIT _______ 18 "MIN. _________ IAILET PROVIDE AIRTIGHT SEAL APPROVED JOINT A (� APPROVED JOINTS W/C.2. PIPE I I W /C.I. PIPE T 3' I I I ALARM EXTENDING 3' ONTO O SOLID SOIL B I II ONTO SOLID SOIL I 1 I ON . I I ELEV. FT. I PUMP --j OFF D Li CONCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E S PE C. IF I'CATI OKJ DOSE TAWKS MANUFACTURER: KS WMBER OF DOSES: `� PER DAy TAM 51ZE: 5T P66 Ed— GALLOIJS DOSE VOLUME -TAIJIC AL£YZ't IAICLUDING BACKFLOW: 1 21 ALARM MA►JUFACTURCR. GALLONS MODEL NUMBER: /D` r CAPACITIES: A =_, INCHES OR /� GALLONS SWITCH TYPE: As'IERCl1RY B = L INCHES OR yd GALLONS PUMP MANUFACTURER: C�dvLDS C = INCHES OR �� GALLONS MODEL NUMBER: 3f� ?I irt'U 4 D= 7 INCHES OR g � GALLONS SWITCH TYPE: R� UP�1 NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 30 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 15 FEET + MIAIIMUM NETWORK SUPPLY PRESSURE .. . — '+ 114 '' FEET j. SL Al) �D FT -F FEET OF FORCE MAIN X /Op ir FRiCTION FACTOR. �' Z FEET TOTAL Dt5JAMIC. HEAD = 11O L3 FEET INTERNAL DIMEIJSIONt OF TANK: LE'.:C.TH ;WIDTH ;LIQUID DEPTH SIG►JE LICEIJSE NUMBER: Z2�1 �I Z_ DATE: 1 MO • • P0i EP0 Su bmersible Effluent Pump LDS I # s ' I � a i METERS FEET 10 y MODEL: 3871 It �� i � � 9 30 8 ' 25 r x .'11.�V 7 Marlerl of Conshetion 5 Bra Mhermoplastic 5 15 Features and Benefits _> 4 EP05 •Top suction eliminates 3 ,o impeller clogging. 2 a<POa 5 • Corrosion resistant , construction. 0 30 00 5o US.G°M • Float actuated switch. o z a s e io 12 nan,r CAPACITY METERS FEET 7 25 MODEL DVP03 Pump Specifications Features and Benefits 5 20 O ho and' /2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect V 15 - -- - - -- Maximum head to 32' mechanical seal. 4 Discharge size 1'/2" NPT • EP05 impeller - enclosed design 3 10 — Solids: 3 /: ' maximum for improved performance. 2 _ __ • Rugged glass - filled thermoplastic 1 5 All motors feature ball casing and base design provides ° ° 0 5 ,o , 5 1 2s 30 35 ao u.s.°PM bearing construction. superior strength and corrosion Single phase: 115V resistance. o z CAPACITY s e , °mamr Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer MAW -t �,ATH-j Obv�:5�7 Mailing Address 4 IZ-- 2 / ,�) T �� r N FGRF_5 i L AKf M 1v S ZS Property Address : - f - IX-1c (Verification requirei from Planning Department for new construction) City /State Parcel Identification Number p 3 Z - t ° / (- So - &O LEGAL DESCRIPTION Property Location ZMU 1 /a, 1 /4, Sec. , T 2I N -R 17 W, Town of _S�rjwCZ_S , 6T Subdivision , Lot # -6 t" . NYp' Certified Survey Map # ^ �' , Volume , Page # Warranty Deed z.. , Volume Page # Spec house ❑ yes 04 no 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 o f .Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic s stem en intained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year, iration GNATURE OF APPLIC NT AD TE 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 describe above, b e of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICA 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 v STATE BAR OF WISCONSIN FORM 2 -1998 614992 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Lyle H. Palmsteen and Beverly Palmsteen, husband and wife, RECEIVED FOR RECORD Grantor, conveys and 12 -06 -1999 9:30 AM warrants to Marvin R Rodvold and Kathleen M. Rodvold. husband and wife as survivorshiD marital r rt WARRANTY DEED EXEMPT N Grantee. CERT COPY FEE: COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the TRANSFER FEE: 615.00 following described real estate in St. Croix County, State of Wisconsin (The RECORDING FEE: 10.00 "Property "): PAGES: 1 Recording Area Name and Return Address .j. KliTINA OGLAND l ).z, Estreen & Ogland P- Box 359 Hudson, Wl 54016 032 - 1011 -40 032- 1011 -50 Parcel Identification Number (PIN) This is not homestead property. W 'fi of NE 'A of Section 5, Township 31 North, Range 19 West, St. Croix County, Wisconsin EXCEPT Lot 1 of Certified Survey Map in Vol. 8, Page 2245, Doc. No. 460727. Subject a perpetual easement for ingress and egress over the West 2 rods of the NW 'A of NE 'A and the NW 'k of the North 2 rods of the West 2 rods of the SW 'A of NE 'A. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this _ day of December, 1999. * *Lyl . Palmsteen * *Beverly Pa ee ACKNOWLEDGMENT STATE OF WISCONSIN ) AUTHENTICATION ) ss. County ) Signature(s) Lyle H. Palmsteen. and Beverly Personally came before me this _ day of December Palmsteen, husband and wife, authenticated this , 1999, the above named to me known to be the day of December, 1999. person(s) who executed the foregoing instrument and acknowledge the same. * Kristin Oglan * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Notary Public, State of Wisconsin authorized by § 706.06, Wis. Stats.) My Commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAROF WISCONSIN FORM No. 2. IM INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 80055 -2021