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HomeMy WebLinkAbout032-2113-10-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner rTA M_ — S Property Address ,? 319, I /D T'S` 1 City /State Legal Description: Lot i Block _ Subdivision/CSM # ,G Cnr,z}Tt S 1 /4 5e-: 1 /4, Sec. - ,T- T3LN -R aW, Town of �,�'a�� =.esir PIN # Q32 —d2 //3 —, deao SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 404FzZ I Size ST/PC /DOD/ Setback from: House d Well P/L Pump manufacturer 444 Model Alarm location (HOLDING TANKS ONLY) Setbacks: fresh air ' ater Line Meter location Al SOIL ABSORPTION SYSTEM Type of system: Mj5MCR Width Length 57 Number of Trenches Setback from: House 8Z Well P/L _L Vent to fresh air intake 290 ELEVATIONS Description of benchmark To,o e F ! / UJ Ca2/y�,p �r,��,ac� 5 Elevation 10 0, 0 Description of alternate benchmark ff&L i qtr 13 i c 14 Elevation MY 13 ` Building Sewer 5" ST/H Inlet 9-3. / ,57 - - ST Outlet PC Inlet - IVA -- PC Bottom _ fA Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation 111J Permit number 3 yybB,S State plan number IVA Plumber's signature , - License number 2 �.[��[/ Date 111161 Inspector oty Complete plot plan � II I 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 N 6R k 5� z � 3xS7 _ 7R�N�H E S h Q 5� g �`d�� GRQwF� gd u�li P. L. INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y - Safety 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 ( 344685 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: Town of Somerset B Elev.: Insp. BM Elev.: BM Descriptio • Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic QQ� Benchmark Dosing Alt. BM pHold Bldg. Sewer St J Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet g.� Z, 8Z r TANK TO P/ L WELL BLDG. Air i to ntake ROAD _nt Inlet ir Septic y �$ S� ( r NA o om Dosing A Header/ Man. q.2 Z - 33 r LHI io NA Dist. Pipe Clz,z � ng Bot. System b PUMP/ SIPHON INFURIWA Final Grade Manu urer Demand St cover Model Number GPM TDH Li Friction TDH Ft L oss ea Fo cemain I Length Dia. Dist. To SOIL TION SYSTEM THE Width r Ler_Qtl , r No. f Tr ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 3 5 - F' DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man act rer: SETBACK ' S INFORMATION Type Of CHAMBER v I i Model Number System: ��Odl S OR UNIT - _C ",. DISTRIBUTION SYSTEM t-tZ Header /Manifold 4 DistributionPipe(s) x Hole Size Ix Hole Intake Length Dia Len Dia- Spacing 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 El El No E] Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: !/ /J8 /`1q Inspection #2: ! / Location: 2312 40th Street, Somerset, WI (SE1 /4, SE1 /4, Section 5 T31N -R19W) - 5.31.19.1045 Ac �bc�.`� P Use other side for additional info mat lan revision required? ❑ Yes X No / c rmion. �} by 1 J SBD -6710 (R.3/97) Date Inspector's Signature Cert No. Safety and Buildings Division *Isbonsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with Comm 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 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 INFORMATION Propert Owner Name Property Location 5 C--114 S 1/4, S g� T j / , N, R E (od Property Owner's Mailing Address Lot Number Block Number 3 s% Ci State Zip Code Phone Number Subdivision Name or CSM Number . TYPE OF BUILDING: (check one) ❑ State Owned ? ❑ !tr Nearest Road • Public 1 or 2 Family Dwelling- No. of bedrooms r.L Town OF 111 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 S ❑ 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 Sy/stem System _____________ Tank Only______________ Existing System ________ Existing System B) KA Sanitary Permit was previously issued. Permit Number _ j Vqf, B� Date Issued —%'p 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 %3 Seepage Trench 22 ❑ In- Ground Pressure c r 42 ❑ Pit Privy 13 ❑ Seepage Pit L L 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. A S YSTEM INFORMATION: 1. Gallons Per Day Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade quired (sq. ft.) oposed (sq. ft.) ( Is/day /sq. ft.) (Min. /inch) Elevation 4150 2. 6 08 „Feet 9G, - VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Aper. Gallons T New Existing allos anks concrete strutted glass App. Tanks Tanks Septic Tank t�Fio}drn Tank ® I9 ❑ ❑ ❑ ❑ ❑ Li n Ch ber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI tier's Name: (Print Plu e s Signature: (No St s) M / PRSW N Business Phone Number: --` / - 5 k R - K / P umbe O ert7 r's Addre s (Street, State, Zip Code): Y �- / �.�. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued nt Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: r 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 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 S. Onsite sewage systems must be properly maintained. - The septic tank(s) must be pumped by a rcensed pumpe 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 be7nstalIed' - 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 nurriber 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 complefedimensions, loca'fion 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;_ P)_.cross.$ection of the soil absorption system if required by the cburity; E) soil test data on a'1 15 form; and Fy 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 t , : : T - r , ;: 1 , , , V Y , , 1 rvc - 7 1 _ y t ; Aa - -- - - - - -- -- - r 1 ; I I r- r 1 : z- , • (ZeviSed Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division 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 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 54 , C ra r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0.5 -2 -.2113- -0c oo APPLICANT INFORMATION - Please print all information. Rev ad by Date ,1 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). is Property Owner Property Location J B Govt. Lot 1/4 1/4,S �— T �� ,N,R ICj �reG Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# �?3 /.2 Q - / - A �, S` De er 4.d, L_ City State Zip Code Phone Number ❑ City [:1 Village Town Nearest Road gg New Construction Use: Residential / Number of bedrooms .3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd /ft -(�9 trench, gpd/ft Absorption area required GV3 bed, ft .i '6-3 — trench, ft2 Maximum design loading rate . 7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 1 Z 4 ,Y / L ft (as referred to site plan benchmark) Additional designlsite considerations / Te h4as bee," c.c. , f p / / a ✓ TO 5 0 1 0 '� �a Xe /► � � 1,� �u aT• `d H Parent material 04"-� e✓'a 5 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 XS ❑ U Rs ❑ U I W ❑ U ❑ S RU EIS 9U 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 14 4 _ e - 5 ;P-P - S' . 7�y AO a /3 --� S 6 k m4 -- s — _ 6 Ground +� S/ s/ /5� S vS h'► I,J . - 2 f e ev. AA L49 ft. a -r o v s/y Depth to limiting 7 i' factor Remarks: Boring # 2 17 - y1 © e S' f� - -- - - - - - - Cos es /n / C 41 '— . . -7 Ground 1 oe 70 s b ���- -- ��— �— . / , F elev. ft. C t Depth to limiting �� for in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 'M % Al, _To-n ,9,m v _ s'Yoas 0 01 , 12 ?V.) PROPERTY OWNER l /'� SOIL DESCRIPTION REPORT Page 0 2 , of PARCEL I.D.# A-0 00 Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 0 -6 0X 3/.2 5 ZPs4k r CS .2"p Ground s s S M'► s 7 Depth to limiting f , a oo c . t , o I r .. Remarks: Boring # y -? 7nryk ellfl o- /l Q S rnS �s t6h .7 ..8 Ground 9 e lev. Depth to limiting actor 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 # '-- —� Co ©S C ci - s - yr- /� ;e s /6 s ©s A4 Ground 'i i ' " /� r 9 e ev. Depth to limiting factor /40�- _'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) I l l I ' i I I � �I �Alr CL i t . 7 Ar t3 i, I j i I I ' 7ok T"1 rO ��r �r 4t _ r v� s E v er - _ Gist/ ��� s 7 Ali siconsin Safety and Buildings Division SANITARY PERMIT AP IAI 201 E. Washington Ave. — P.D. Box 7969 Department of Commerce In accord with ILHR 83.05,�s X1aI. Code ' Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the syst r1 n pa It r Gb Cot-pv than 8 112 x 11 inches in size. _ - ` "� 4 ' itar P r • See reverse side for instructions for completing this applica i'orli a State Sa }' P ermit Numb � ��def ST i 40V i The information you provide maybe used y other governor a e y p gra s,,, ,'� COUNT �'p qk if revision to previous application [Privacy Law, s. 15.04 (1) (m)). r3 I t t Z L3 NINC; + FI r: at Ian I.D. Number I. APPLICATION INFORMA ON -PLEA PRINT L INE Al"T Property Owner Name ici e c /,S T 3 , N, R E (ORD Property Owngr's Mailin®cfdrgss Lot Numbj Block Number Ci , SState �/% Tf► j ZipCode I Phone Number Subdivision Name or CSM Number z. ii S ( ) C I 1111. TYPE OF BUILDING: (check one) ❑ State Owned CA Nearest Road ❑ Vil age 7 j v C Public 1 or 2 Family Dwelling - No. of bedrooms Town OF J NI. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) , �. I q6 1 ❑ Apartment/ Condo 03 'r // — ,1 0& 4 00 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. IK 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 12 ® Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill ' 3f �j'�" VI. ABSORPTION SYSTEM INFORMATION 1_ Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Sys 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 1 levation YS 563 17,2, 4 1 1 18 `Ia.6 74.0 Feet Capacit VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ ❑ 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) PI is Signature: (No St mp Business Phone Number: i - 1 21 , 5 = —46S Plumber's Ac dress (Street, City, State, Zip Code): E e IX. COUNTY / DEPAR MENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) e Po4pproved ❑ Surcharge Fee) Owner Given Initial Adverse Determination X�S NLZITION OF AP�ROV�AL / REA NS FOR Q15 PP A�L��S r tom+ wm U ;, " V SBD -6398 (R.11ft) DISTRIBUTION: Original to County, One copy To: Safety 6 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. 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. r , I ; i T I � , 4,97 t } S d��EZ Rr��t E Ar s a E T r r T __ _� i �__.. # - - -�. —` - -r - i -. _ + - • - -� - - ,2 i iN r r r ov T . P� �N T1 LR _ P � -- -- - -- — OPT - - -- -•- - _ , r r : r . i > I C r , � 1 1 -- -- -- -- - - , I r ' Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and .Human Relations Division of Safety & 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. Plan must include, but St. Croix not limited to vertical and horizontal reference point (SM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 032-1014– APPLICANT INFORMATION– PLEASE PRINT ALL INFORMATION IEWI=D BY DATE PROPERTY OWNER: PROPERTY LOCATION Gary Gifford GOVT. LOT SE 1/4 SE 1/4,S T AR 19 kor) W PROPERTY OWNER':S MAILING ADDRESS LOT A BLOCK # I SUBD. NAME OR CSM # 452 280th. St. 5 CITY, STATE ZIP CODE PHONE NUMBER C]CITY []VILLAGE MOWN NEAREST ROAD WT_ c;4n9n ( Somerset I 40th, [ 7f New Construction Use jx] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /11 trench, gpd /ft Recommended infiltration surface elevation(s) %.1 94. It (as referred to site plan benchmark) Additional design / site considerations 4�. 0 3 Parent material outwash qZ•r' g B 5 7 lood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U I CS ❑U ®S ❑U C1 CRU 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 jTwlch 1 0-17 7.5 r4 4 none ...:. ............. 2 17-84 7.5 r4 6 none ms osa m Ground elev. 9 8.7 ft. Depth to limiting fact 4 Remarks: Boring # 1 10-14 7.5 4 2 » 2 m1 na na .7 .8 Ground elev. 99.6 ft. D 0 Depth to , limiting Q '_ factor +841f —i .9 Remarks: CST Name: -- Please Print G L. Steel Phone: 715- 246 -6200 £ Address: 1554 200th..' New Rich on WI 54017 Signature: Date: CST Number: m02298 6 -30 -97 I � PROPERTYOWNER Gary Gifford SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D. # 032 - 1014 -10 Depth Dominant Color Mottles Structure GPD /ft Boring # FHori in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ti`..3.....' - none sl 2m r mvfr cs 2f .5 .6 2 12-20 7.5yr4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 20-84 7.5 r4 4 none cos o ml na .7 .8 elev. 97 ft. 'k Depth to b ov QZ limiting factor �tti +84 Remarks: Boring # 1 0 - 10yr3 /3 none sl 2csbk mvfr cs 2f .5 .6 2 16-34 7.5yr4/4 none sl 2csbk mvfr gw if .5 .6 Ground 3 134-8C 7.5 r4 4 one os 9 ml na na .7 .8 elev. 9 5.9 ft. o a Depth to d' limiting factor +80 Remarks: Boring # 1 0 -16 10 r3/3 none sl 2csbk mfr gw 2f .5 .6 2 16 7.5yr4/4 none sl 2csbk mvfr gw if .5' .6 Ground 3 36-8C 7.5yr4/4 none cos osg ml na na .7 .8 elev. 9 6.4 ft. Depth to limiting r10 factor +80 11 L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 1 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Gary Gifford New Richmond, WI 54017 MPRSW 3254 SE4SEq S5- T31N -R19W (715) 246 -6200 town of Somerset lot #5- Deer Run Estates N 1 =40' BM.= top of SE lot stake C el. 100 Alt. BM.= nail in tree el. 100.70' � p14- ' © _Sr3 r Gary L. Steel 6 -30 -97 I� r c°� De's e�oo� usuy SOIL AND SITE EVALUATION REPORT Page I of 3 Division of safety a suildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY �..... •E Attach complete site plan on paper not less than 8 1/2 x 1 i inches in size. Plan must include, but St. Cro not limited to vertical and horizontal reference point (BMA, direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWE BY DATE PROPERTY OWNER: PROPERTY LOCATION Gary Gifford GOVT. LOT 1/4 1/4,S T ,N,R 19 Ikor) W PROPERTY OWNER':S MAILING ADDRESS LOT x BLOCK # SUBD. NAME OR CSM # 452 28 0th. St. CITY, STATE ZIP CODE PHONE NUMBER []CITY (]VILLAGE :MOWN NEAREST ROAD { Somerset If New Construction Use (x] Residential 1 Number of bedrooms 3 [ ] Addition to existing building j ) Replacement I I ] Public or commercial describe Code derived daily low 450 gpd Recommended design loading rate .7 bed, gpd/ft trench, gpd/ft Absorption area required 643 bed, 9 563 trench, ft Maximum design loading rate _ bed, gpdM gpd/ft Recommended Infiltration surface elevation(s) 9f� = 1— .9- 93.9 .4 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitabl for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U- Unsuitable for s stem ®S ❑ U ® S O U ®S O U f3 S O U ® S O U O S C$U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell (u. Sz, Cont, for Texture Gr. Sz. Sh. Consistence BotYtdary Roots Bed Traxh 1 1 0 -17 7.5 r4 4 none S1 2cshk mvfr aw 2f -5 -6 2 17-84 7.5 r4 6 none ms Ground elev, 9Q. 7 ft. Depth to lirni ing - facto +84 01 Remarks: �. Boring # 2 r M. CZ m na na .7 .8 9 Ground elev. i 99. 6 [t. r Depth to limiting Mt fac S mcic FMCE Remarks: Z CST Name: -- Please Print Gary L Steel Phone: 715- 246 -6200 Address: 1554 206thAW., New RjchrtoW, WI 54017 Signature: r%7 -' Date: 6 - -97 CST Number: m02298 PROPERTY OWNER Gary Gifford SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D. t 032 - 1014 -10 r Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounft Roots GPD/ft, in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertrh C '3 — Si 2m r mvfr cs 2f .5 .6 2 12 7.5 r4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 20 -8 7.5 r4 4 none cos osg ml na na .7 .8 elev. 97 ft. Depth to limiting factor + 84 11 Remarks: Boring # 1 0 -16 1Q r3/3 none sl 2csbk mvfr cs 2f .5 ,6 2 16-34 7.5 r4 4 none sl 2csbk mvfr w if .5 .6 Ground 34 -8 7.5 r4 4 none cos os ml na na .7 .8 elev. 9 5.9 tL Depth to limiting factor +80 Remarks: Boring # 1 0 -16 10 r3 3 none sl 2csbk mfr gw 2f .5 .6 ,r5 2 16 -3 7.5yr4/4 none sl 2csbk mvfr w if .5 ` .6 <.:. 9 Ground 3 36 -8 7.5 r4 4 n one cos osg ml na na .7: .8 ele�r. 9 6.4 ft, Depth to imiting factor +80 Remarks: Boring # x. Ground elev. Depth ft. to limiting factor STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Gary Gifford New Richmond, WI 54017 MPRSW 3254 SASE'A S5 T31N -R19W (715) 246 -6200 town of Somerset ,y lot #5 Deer Run Estates N 1 =40' EM.= top of SE lot stake @ el. 100' Alt. ELI.= nail in tree @ el. 100.70' t �• (pow .00 ir oe Gary L. Steel 6 -30 -97 JUL -01 -99 68:23 AM CENTURY 1 PRENIER GROUP 715 485 9406 P. 01 It< hKtinalht7npnrin >dnir SOIL AND SITS EVALUATION R EPORT Pop . . - otJ., Labor 1 nd Human ri®lntlunn Division or Salary a avildifign in accord with ILHR 83.05, Wis. Adm. Code COUNTY S t . _ _C r Attach complote silo plan on paper not less than 8 112 x 11 Inches in size Plan must includo, but p7 S LQ. N not limited to vertical and horizontal reference point (BM), direction and % of slope• scale or dimensioned, north arrow, and location and distance to nearest road. 03 _-10-]_ =-- 10_. -- APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REVFtWf =O BY DATE PROPERTY OWNER: PROPERTY LOCATION Ga Gifl .... GOVT. LOT 1/4 1 14.S 5 T _ 1_N,R 1 W 9( °r) PROPERTY OWNER':S MAILING ADDRESS LOT 0 BLOCK O SUBD. NAME OR CSM 0 4 2 8 4th . S t_,.... - - -. __ tea— . -Run laths I STATE ZIP CODE PHOWE PdUMBER - ❑CI (Y OVILLAGE MOWN NEAREST ROAD I Somerset New Construction Use N Residential I Number of bedrooms 3 I J Addition to existing building () Replacement ( I Public or commercial describe - Code derived daily flow 45 0_ gpd Recommended design load rate �, . 7 bed, gpd /tt _ ..trench, gp d/tt 2 Absorplion area required 64 _ bed, It 563 trench, 11 Maximum design loading rate _ .7 bed, gpd /ft - trench, gpd/11 •• Recommended 'infiltration surface elevation .1 s) , 9E- �94 .- ,g3.9- 93..9 - -. ft (as ►e •erred to site plan bench Additional design / site considerations na _ - Parent material — _• autw __ _ _Flood plain elevation, if applicable nn S _ Suitable for system CONVEMIOt�AI MOUND 1N•GROl1h0 PRESSURE AT - GRA D E SYSTEM IN FILL HOLDING TANS( U= Unsuitable for s stem ®S O U ®S O U ®S Q U U S ❑ u ®S Ott [IS CRU SOIL DESCRIPTION REPORT Boring # Horizon Dep th Dominant Color Mottles Texture Structure Consistence Boix1ary Roots GPD /ft Mu n se ll Qu. Sz, Cont. Color Or. Sz. Sh, Bed I lTrerch In. 1<.. 1 0 -17 7. 5y r41 4 — ► Qtt A I 2csbk 2 17-84 7. none G r oun d f elev. Depth to limiting factor +841 Remarks' - - -• -. .. _ _ - -•- Boring # 2 m1 na na .7 .8 s' mitts c�sr} -- -• -- - - Ground - -- — - _ elev. 99 ; f1t. b -r• Depth to -- - _. I � - limiling rD '..I. wt — factor — ... ... � f Retlrtrks: � � CST N nn1C:•.PIC.1SC PI' n1 Gar L., Steel Phonic, 71 Address: 1554 2001h.i ye. Ncw Riche c,r1 i 1�'f 540 JUL-01-99 08:24 AM CENTURY 21 PREMIER GROUP 715 485 9406 P 0:31 PAXEL 1.1). -03 2 - 1 "'t- OSOOPIPTION nEPORT Boring # Horizon () Wt► Dominant . Colo in. Munself Mottles Texture structure Ou. Sz. Cont. Color Gr. sz. Sh. C0 swidaly Roots GPD/ij -.rV Sod 2 s 1 -, 2inq . 12-2 7. M V r rs Ground 3 — - none S1 2mg,r mvf r gw 1-2 — .6 i elev, ----no L, .6 .9 97 11. — -- _ M, na na • 7 .8 factor +84 Boring # Remarks: 0 ------- _1ar3/3 none 216 2cabk Mvfr C 6 2f 3 none -6 S1 2C.5bk mvfr w Ground 3 ,4 -8 7.5 r4 4 none if .5 .6 elev, cos o 95.9 M1 na na .7 Depth to limiting . . ............... factor Remarks, Boring # 0-16 1OYr313 none csbk mf .. . 2 ....... r w 2 16-3 7.5yr4/4 none 2f -5 .6 2csbk mvfr Ground 3 gw if .5� � 4 4 ; .6 none cos MI 96. 4 na n a .7:: .8 Depth to limiting factor Boring # Remarks: Ground elev, Depth to ftiling factor r - JUL -k1 -99 08:23 AM CENTURY,21 PREMIER GROUP 715 485 9406 P.0 STEEL'S SOIL SERVICE 1' Gary L. Stec! CSTM2298 Gary Gifford 1 554 200th Ave, MPRSW -3254 SWEk SS- T31N -R19W New Richmond, Wl 54017 town Of. Somerset (715) 246 -6200 lot #5- Dee_ Run Estates N 1" =401 BM-= tOP of SE lot, stake C el. 100' Alt. Bm-= nail in tree C el. 100.70 Zo x 7 6 Z ' fo, 2 c' V - �s "3 Gary Y,, Steel 6 -30 -97 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer cIAML =S E t ce j y Mailing Address e 1,2 L ®� ST Property Address Q T (Verification required from Planning Department for new construction) City/State (5'0m kXe;r GU/ � Parcel Identification Number 032 LEGAL DESCRIPTION Property Location ,SE '/4, 54!5 `/., Sec. _,5 T_LN -Rj� _W, Town Subdivision _EE,_ 7 Lot # Certified Survey Map # 95,/S 6 . Volume N . Page # 32 y� Warranty Deed # b 2 2b . Volume .. , Page # Spec house ❑ yes X no Lot lines identifiable 19 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. Uwe, 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 g that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 , a;a of the three year piration date. 1 ! T'IIRE OF LI DAT8 ` WNER 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 roperty described ve, b ' e of warranty deed recorded in Register of Deeds Office. S TUR E OF ANT HATE . * * * * * * Any information that is mis -re resented 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 1444 19 ►•��� !TA'I'L MR O. MUCC14M $X" 2 - VW RE8 18M OF WARRAMM D= ST. CROIX CO.. This Deed, made betwe= - - River Hid Faswilr UML Garr E. EEXIrE! FN S MM Giffar8. Trudee g d IM ra J. GHfar L ,' QT % fm ifilf Iy KID Grantor, conveys and warrants to Jams B. Evtrh sod E crr I& FED Detwo M Evertr iw timid ad wth. iM 0 FEES 10.70 IiEMDM FEES 10.0 . Graatet. Mika: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described rest estate in . QMtK County, State of Wisconsin Recordiva (Phe "Property "). Ara NOW U d Rpm" too 188 032 -2113 -10000 iwcd wen;ficat;on Nwaber (P" Tba is not hour -qzW property. Lot S, Plat of Deer Run Estates, St. Croix County, Wisconsin. 'tubs certifies that all of the trustees with authority to snake conveyance are signing this Trustee's Deed and have full authority to do so under the terms of the trust. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this 19th day of July, 1999. River Hill Family Trust • • Gary E40 ifford, T tee • ' Lenora J. rd, T AUT1EUMCATION ACKNOWLEDGMENT Signatu e(sj STATE OF WISCONSIN } ss. sudwiticated this _ day of Polk . Couacy ) PermWly came before me this 19t1 dar • _ of July, 1999, the above mined River = Paraib TrUL Gan E. Gifford, T 3mke, and Lenora J. Gift" Thufas. TITLE: MEMBER STATE BAR OF WISCONSIN (It not, _ w me known to be the authorized by 1 706.06, Wis. Stats.) person(s) who exax►ted the foregoing instrtmaent arts- acknowied same. ;t:Y• P: THIS MMUMENT WAS DRAFTED BY Aftemey Kr kdna �W Hudson, WI 54016 ' Sidney (S3gmtures may be authenticated or ack.iowiedged. Bah are rut Notary P06c, Sate of a;.owin neoasaty.) My Commission is permanent. (if Dust, 9 - 5 , 99 .) t. % s *Names of persom signing in any cad,. ;.y st+t e r: w typed or priratd belo+e '.fair siSrat res YAalIAh ^ : E" aTAn L-,a (X" Wzk itfy FOAMI N. 2 - t748 a'BO�tM1T10,t r't *E33aC:i�1 � CCbir! 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