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HomeMy WebLinkAbout028-1024-80-000 C -4 1A, , ST. CROIX COUNTY ZONING DEPARTM BUILT SANITARY REPORT I l Owner G z c. r Property Address ! s 3 v City /State n ��/�,„ h LA 1 Legal Description: Lot Block Subdivision/CSM # L-'' /a ' /4, Sec. T ?,? -R W, Town of l ? „s X /el'y'eze PIN # —Z SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer ”' Size ST/PC / Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: C o n u ttr t - ', N4 1 Width 5 Length 5 5 Number of Trenches 2. Setback from: House / v Well 1 5 O P/L Vent to fresh air intake ELEVATIONS Description of benchmark Z7 P c "n, Elevation 1 y Description of alternate benchmark r f 61 Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) 2 O ( ) Bottom of System Final Grade L 4 ( ) Date of installation /2 11 LI I YPermit number 3 7 d State plan number Plumber's S-Itynature 01—r fr:dL License number a 3 (o Date : Lli// f Inspector G ! M e , Complete plot plan Or 01r05r99 TUE 12:36 FAX 419 424 8302 HANCOR APP MARK 10002 1 , 11veh�0 /apy• /eea�et/sM • �/rot/eei� 401 Olive Street Findlay, Ohio 45840 To Whom I May Concern- I am writing in regards to the maximum burial depth for Hancor's EnviroCharnber. Provided the EviroChamber is installed properly, the maximum burial depth shall be 10'. The backfill material shall be at least a Class IVA material as specified by ASTM 02321. Enclosed with this letter, one shall find Hancor's published installation guide for the EnviroCharnber as well as a table to define various backfill classes and qualities. If you have any questions on this or any other matter, please contact me at 1- 800 -537 -9520 (ext. 296). Thank you, Bill Vanhoose Application Engineer 01.05.98 TUE 12:38 FAX 419 424 8302 RANCOR APP HARK 10004 • * ` `rancor, inc. Orarrrage , yandbook ° � ����.( C rr (L,r,��J` l..�Y tiCJ'1. `7L � ��An ✓..� �. � , �.1C� -lq rabli 2 8810fill Class and Quarry PIPE EMBEDMENT MATERIAL E' psi IkPa) For De es o! Emb,adfleenl C action ASTM 0241 AS AA Mu. Ssa. Preebr Q465 esa Oeued ' a Motet9ee Oe ri plea MN V yyee IjINtAoetiue* Nobwe Oenehy ( %1 Coss Oo. s`4kh abdarar i High Cpda- graded. WA Angular crusneo Stone s d COS 41%•n% 76% crusnee gravel, Clain S OumpaO �1- X00 'AN 1000 30M or tort. ;S manufactured crusnaa:ta4,;orge A 11 '8,9001 10•1011l 10.7001 10706 aggregates vdtOS wrap nneorno Met 8 Oohs* graded. WA Angular 4rvaRed stone 4 ::can a oatar Class IA manufactured. Mari and stonersand oroeessea mfxwfa =:Oils or no a to alas tines i It Clean. coarxiii GW Welt - graded gravel, 57 grained Sally graveVSandmtamres; 5 la.�rltl !:ttl*or na lines 20 GP Reor!vgn0ed g: ayela, gfewVsand mastYrea. Ir*Sa or RO hms r SVY We11- g►adadsan0s, gravelly sands, Ii or 1 Antilles 3P aeorlygfaada 44n44. grawlry Banos: 11t0e of C i' Coarsd. GM Stltygravale. graw+e0 sods .iravet 90% 9 WA wit 000 :OGC gravesaantuswr and r0 w1M N imp inu=res sand 4.9001 13.3GG -nth <10% I tines GC Cavev gr*v*Is. 4raveusandresay � . ^rnttwes i SM Sft sands, uanWswt mta0rfli � ` Sc Clayey sands, s*nd.trav mrtteires I i ` VA i norganic nna- ML tnargantc sells e very grimed sale fine sends. rOtk i1aVr WR k!R WR '076 sdW Of clay*, one b.ax saves, sots venal wgllt la u, % inef9antc cloys of lot, to medium plasucar, graway, sandy, or silly CIO ; lean cla s wa inorganic fine - fill" inarganK Sifts, gfvv+ad sOtts maeaceous Of I WR Wst WA �: dlamaceous nod sandy ors sous. aiesae sows CM ftfi me Clays or htgn Olasacr ,f tClaya V Organic or CL Orgamc SAL and htynly organic organic silly clays or WR IWR wR v foJS low li ON Organi etayS yr mealurh to ntgn alasocr . or 4064 :wts it oast and cater Nigh OF aroc Boris v.'R Use not recornmendefl by ASTM 0732' fOr DWI. of me oacchil enuefooe Aeter ;o ASTM 0132' fCr TGrZ cambete soul ceuf,ouens Use unaer the dlrectlan of a MIS expert 8 Nancor, Inc., April, 199" Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count • Safel add Buildings Division y ST . CROI X INSPECTION REPORT •GENE INFORMATION (ATTACH TO PERMIT) Sanitary3tw7t ft: Personal information you provice may be used for secondary purposes [Privacy LW, s.15.04 (1)(m)]. U� Ar'i''UL'1'� Na mes Ck tu_C] a/iUan Town of: State Plan ID No.: CST BM Elev.: j Insp. BM Elev.: BM Description:fttY tCl�7� Parcel T02W--;1024- 80-100 �� la v TANK INFORMATION ELEVATION DATA A9800616 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ," /DOv Bench mar l Dosing 14I W64X Aeration Ne Bldg. ewer Holding %,/ St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. 12108 4'2• u,6 Aeration NA Dist. Pipe 12.7 - q2 2( Holding Bot. System f3• T 13rj / % 9 0.6 PUMP/ SIPHON INFORMATION Final Grade 1{.V too /o2 b Manufacturer Demand i /2•j /Z , '?2, 2 Model Number 'K GPM TDH I Lift Friction,. Systems TDH '-X Ft Forcemain Length ,� Dia. IHf , Dist. To Weld SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION c�— DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type CHAMBER � »v 1 r e, Mo a Number: Syst m: f //p /L?'� T— OR UNIT r DISTRIBUTION SYSTEM Header / Mani old d Distribution Pipe(l) x Hole Size x Hole Spacing Vent To Air Intake Length L Dia. Length s7 Dia. 3`f Spacing g � f5 �e..- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: RUSH RIVER 15.28.17,SW,SE 1852 30TH AVENUE — LOT 1 4 e:� - F 6 t60 �` yZe i J 1) R, "0. U'1' l Q �u G ✓Gy'o� .CIv t vAeAjjVA,4t fe✓ 4 Gvray d , � 0 I Plan revision required . J( Yes ❑ No Use other side for additional information. I r v, ( kd we, SBD -6710 (R.3/97) Date Inspectors Signature Cert. N 14 1sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce P O Box 7302 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 sa f ermilit N mbar Personal information you provide may be used for seconds purposes El Check if revision to pre ious a p p lication [Privacy Law, s. 15.04 (1) (m)]. s PP State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Q Q A it/ 1 /4 S' 114, S l'$ T I f' , N, R l 2 ((or) W Property Owner's Mailing Address Lot Number Block Number Cit , Stat rzi Code Phone Number Subdivision Nam r C M Number fdw,`., f✓. S'Y ^yap ).. ( ?!s 2 as G /3 3'I 11. TYPE OF ILDING: (check one) ❑ State Owned E] ity Nearest Road Public or 2 Famil Dwellin - No. of bedrooms 3 r Tow OF /�43 �'��sR 3at �UK Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo / 5• A9. 1 N 3 1 3 O 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, N Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an ______System System Tank Only Existin S stem Existing System ------------------ y - - - -- ------- - - - - -- g- y-- - - - - -- B) E] A Sanitary Permit was previously issued. Permit Numbe Date Issued Q 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 E] In-Ground Pressure K r 42 E] Pit Privy 13 Seepage Pit 2- r / 43 ❑ Vault Privy 14 ❑ System -In -Fill 6AV ' VI. ABSORPTIONS YSTEMF 1. Gallons Per Day 2. Abs r ATIO 4 3. A i r a 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade 1,5 V Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) �i Elevation Y 63 5 _ 6 f � `��� Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of r Prefab. Site Fiber- Ex er. Gallons Tanks Manufacturers Name Concrete Con- steel Plastic p New Existin strutted glass App. Tanks Tanks eptic Ta Iding Tank .. ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ 0 ❑ 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) Plumb 's Signature: o tamps) r PIMPRSW No.: Business Phone Number: XG le- St 4 •� arc 23 y S t s - -- Plumber's Address (Street, C49, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Perm (Includes Groundw ter ate ssue Iss ng Agent S ature (No Stamps) Approved El owner Given Initial i/Fe Surcharg ee) Adverse Determination 13 U Z67 X. CONDITIONS OF APPROVAL / REASONS FUR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber v h M M M � 3 v �.► c ` 4 r rr o � M ti � r • z w i �F o 1 4 40 u u c�nn i Wiscor►,gin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 2 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental t3y Desigt Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# , APPLICANT INFORMATION - please print all information. Personal information you pravide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Re By D Property Owner Property Location Affolter, Ed Govt. Lot SW 1/4 SE 1/4 S 5 T 28 KR 17 W Property Owner's Mailing Address Lot # Block # Subd. Name S 1852 30th Av City State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Ro Baldwin W1 54002 Rush River , 30Th Av ❑ New Construction Use: ❑ 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/fP Absorption area required 643 bed, W 563 trench, W Maximum design loading rate .7 bed, gpd/ftz .8 tr ench, gpd/fF Recommended infiltration surface elevation(s) 90.80 ft (as referred to site plan benchmar Additional design / site consideration Parent material Loess over glacial outwash Flood plain elevation, if app licable ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ®S ❑ U M S❑ U ® S❑ u I ❑ S® U ❑ S ®U [Is 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/fF Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed T rench 1 1 0 -19 1Oyr4/4 - sl lmsbk mvfr cW 2f .5 .6 2 19 -74 7.5yr6/4 - s* Osg ml cw - np 5 ' 6 2 Ground 3 74 -120 7.5yr5/8 - s Osg ml - - 7 ; 8 elev 96.96 It Depth to limiting Y 5,6,7 see Comm 83.09(4m) factor >120" Remarks: * with bands of scl 5yr4/6 and s 7.5yr5/8 2 1 0 -10 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 10 -39 10yr4/4 - sil 2msbk mfr cw if .5 i .6 Ground 3 39-60 7.5yr5/6 - is 2msbk mvfr cwv - 7 ? 8 elev 98.10ft 4 60 -65 7.5yr5/6 - Is* 3mgr mefi* cw - np �,np Depth to 5 65 -135 7.5yr4/6 - s Osg ml - ' - .7 " limiting - factor N8 - Remarks: * discontinuous bands slightly cemented s 5 3/3 G CST Name (Please Print) Signature: �—' `�_t Tel Thomas C. Nelson 715 -2 !� Address Environmental 13y Design Date CST Num 1 1 1432 120th Street, New Richmond, WI 54017 11/24/98 2605 169 PROPERTY OWNER: Affolter, Ed SOIL DESCRIPTION REPORT ass Page 2 of 2 .4 P- Aceftb.# Environmental Bv Design Depth Dominant Color Mottles Structure GPD/ff Horizon Texture onsistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ' Trench 3 1 0 -6 10yr3/2 - sl 2msbk mvfr cw 2f .5 .6 2 6 -24 10yr4 /4 - sil 2msbk mfr cw - .5 .6 Ground elev 3 24 -55 7.5yr5/8 - is lmsbk mfi cw - 4 5 102.22 ft 4 55 -175 7.5yr5/8 - Is 2msbk mvfr - - .7 ' .8 Depth to limiting factor >175 Remarks: FS of site or the use of infiltrators required for deep site conditions Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks Ground elev Depth to limiting factor Remarks: •' E BY DE 51GN 1432120 STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 ED AFFOLTER oft* PAGE 3 SW '4 SE %, SECTION 9 T 28 N, R 17 W TOWNSHIP Rush River COUNTY St. Croix Wisconsin . L7 13 3 loft ��p�ACe rne�t S ysi 6ext r- ouc h0 uL SCALE 1" =40 Tom Nelson BM I. Top Vent Pipe Of 100' 227387 BM 2. Top Of Cleanout Pipe Elev 100.82 Viscon4h Department of Commerce SOIL ANDS is, tUb►Tt' 11� >>: Page 1 of 2 'Division of Safety and Buildings in accord vvith 'S 05, W16 Ad Environmental By Design Attach complete site plan on paper not less than 8'h x 11 inches in siz �i must include, but not limited to: vertical and horizontal reference point (BM), on and percent se, scale or dimensions, north arrow, and location and d' lop net to nrarest rgad i i PL CBE, I D # $t. Croix c!� , APPLICANT INFORMATION - Please print all in align. rod J ;, _FJJ — Personal information you provide may be used for secondary purposes (Privacy l w,, s .15.04 (1) (�jpt ;r� 0 eviewed By Date Property Owner Property Location Affolter, Ed SO4 Lot, ,W 1/4 SE 1/4 S 15 T 28 N,R 17 W Property Owner's Mailing Address Lott IN Subd. Name or CSM# 1852 30th Ay - I - City State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road Baldwin Wl 54002 Rush River 1 30Th Av ❑ New Construction Use: ® 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, gpdffl? .8 trench, gpd/fl? Absorption area required 643 bed, itz 563 trench, fP Maximum design loading rate .7 bed, gpd/fF .8 tr ench, gpdffP Recommended infiltration surface elevation(s) 90.80 ft (as referred to site plan benchmar Additional design / site consideration t Parent material Loes s over glacial outwash Flood lain elevation, if licable ft ble for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank itable for system ®S ❑ u ® S ❑ U ® S ❑ U ❑ S ® U ❑ S ®u ❑ S ® U SOIL DESCRIPTION REPORT Bonin Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDfff� 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -19 1Oyr4/4 - sl lmsbk mvfr cw 2f .5 i .6 2 19 -74 7.5yr6/4 - s* Osg ml cw - np 5 ' 6 2 Ground 3 74 -120 7.5yr5/8 - s Osg ml - - 7 7 elev 96.96 ft Depth to limiting 5,6,7 see Comm 83.09(4m) factor I I 7'1 >120" Remarks: * with bands of scl 5yr4/6 and s 7.5yr5/8 Z 1 0 -10 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 10 -39 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground 3 39 -60 7.5yr5/6 - is 2msbk mvfr cw - 7 8 elev 98.10 ft 4 60 -65 7.5yr5/6 - Is* 3mgr mefi* cwv _ np s,6 np 5,6 Depth to 5 65 -135 7.5yr4/6 - s Osg ml - - 7 i 8 limiting factor 135 y , l 6 . Remarks: * discontinuous bands slightly cemented s 5yr3/3 CST Name (Please Print) Signature: - _ Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 11/24/98 2605 169 ... ikr E BY D 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 ED AFFOLTER Wt , PAGE 3 SW 4 SE %, SECTION 15 T 28 N, R 17 W TOWNSHIP TROY COUNTY St. Croix Wisconsin t a�S ' ?06 ( Ta w o c. cX SCALE 1" =40 Tom Nelson BM 1. - to p o� �,� er n b kt" 100 227387 BM 2. j' b� U � ,� � 98, iu ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank. presently serving the residence located at: S - _ ;, S / 6 ;, Section (> , T ; b' N, R /? W, Town of - 4s� R0've 2 . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes_ No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete � Steel Other Manufacturer: (If known) /C S Age of Tank (If known): j o_e , �© e It 4 ignature) (Name) Please pri 5 (Title) (License Number) i� -I ? -zq Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. A Code (except for inspect' n open' g over outlet baffle). Name S ignature MPRS 2 3 q 5 / ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer, Fd /c C -f Mailing Address S 2 3 0 " 01 Property Address S ten• C- (Verification required from Planning Department for new construction) City/State R4 141 Parcel Identification Number Q?Y., -- Io2 K0 C �> LEGAL DESCRIPTION Property Location S &✓ %4, S L y Sec. ! S , T 2 ?' N -R I 1 W, Town of 1? s 4 IP u e i ? Subdivision Lot # Certified Survey Map # 5 .3 Volume f / , Page # 3 Z Warranty Deed # 5 `{ 1 Volume 2 b U , Page # S 3 Spec house ❑ yes Ern 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 masterplumber, 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. 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dayyss of the �three year expiration date. SIGNATURE OF PLICANT 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 AP VICANT 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 r- FILED t� DEC 1 3 1995 ► 10 KATHLEEN H. WAM ReOistet of Deeds c� SL Croix Co.. wt 1 ! 537433 CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE SE 1/4 OF SECTION 19, T28N, R17W, TOWN OF RUSH RIVER, ST.CROIX COUNTY, WISCONSIN. PREPARED FOR:EDW.QRD AND LYNDA AFFOLTER UNPLATTED LANDS I ' ..................... F- N 90 347. 15' ° z O LOT I 5. 00 ACRES ° o Z nj (217,815 SO. FT.) O Z r N :r NOTE: BEARINGS ARE REFERENCED TO • THE SOUTH LINE OF THE SE 1 /4. can > ( ASSUMED QEAR i NG ). m :m :Z EXISTING N Z :v WELL o :v 2 49, 9 35.92 ' 195 79 '.38 , 03 "w 35 67, 3 �5 0 SET I' X 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAR FOOT. UNPLATTED LANDS 1 ................... I 66' I x I O I 1 Ch ° a days of v � 55 �I � ", m � N � EXISTING ROADWAY EASEAENT VOL. 115 2 PAGE 4 5 1. w I Q. t i� w � L � � �� c� I i SE CORNER OF SECTION f R_ f rf)liNTY MONUMENT _ DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY &BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: W z , SE 4 ,Sec . 15 , T 2 8- R17W (If assigned) Town of Rush River ❑CONVENTIONAL El ALTERATIVE 3 El Holding Tank ❑ In- Ground Pressure El mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: a7 3;o0 BENCHMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: PER PT. ELEV.: CST REF. PT. ELEV: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: IDalp- F_ Hildson 6629 �St- C-r n i s 116 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER I NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO I NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU ❑ YES El NO NEAREST —♦ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID I TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS (,P GRAVEL DEPTH FILL DEPTH DISTR. PIPE I DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUIL ING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: I ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST —� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: 0 � ❑ YES ❑ NO [- ❑ NO NEAREST----0 J J ( Sketch System on Retain in county file for audit. ..� J Reverse Side. SIGNATURE: TITLE: SBD -6710 (R. 06/88) SANITARY PERMIT APPLICATION ILHR I n accord with ILHR 83.05, Wis. Adm. Code COUN STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than f � k 8'f x 11 inches in size. ❑ c e if re is�o eviousapplication —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION lvfar a r• o e. ✓' S /-'!5r T Zf , N, R /7 5 (or W PROPERTY OWNER'S MAILING ADDRESS LOT # �� BLOCK #�� eY, CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM UMBER B0 /dw/ SS��Z 7ss 8y:?79 N� CITY L NEAREST ROAD II. TYPE OF BUILDING: (Check one) State Owned VILLAGE : /1 � � Pa us i•ey 3fl' v2 . ❑ Public Z1 or 2 Fam. Dwelling -�# of bedrooms A3_ PARCEL EL TAX NUMBER( 111. BUILDING USE: (If building type is public, check all that apply) (' e2 j /�I �3 31 1 El Apt/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 in line A. Check line B if applicable) A) 1. 0 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 ## — 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) .1 ELEVATION ��i' it e15 GZO • 73 9Z'37 Feet 5i Feet VII CAPACITY . TANK Prefab. Site in # of Fiber- allons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION New istin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Hoidin Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Prin Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Do le- Z_. t7ue50 x Z �er- e�Z /--5 Plumber's Address (Street, City, State, Zip Code): / SZ d /I azz S' a � Gvs i'I �.' . S` 7__ IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue 2�lssfll'A g ent Signature (No S mps) Approved ❑ Owner Given Initial d p Surcharge Fee) A v e De rm ti n X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber v Qa o Rz N �1 u o � 4 A 4c c c I I 4 \ �$ •o, Q O k \ to c ° • v 3 qj NZ ti -� qj 3 00 r TABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 k 1UMAN �'�ELATIONS MADISON, WI 53707 e ".- (H63.090) & Chaptor 145.045) ,LOCATION` SECTION: TOWNSHIP /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION N ME: `/z �' /a /5 /TZ�N /R /71(01 W �.s �'ver W COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: i S7 roi e e . �. u/i 5��t�L USE DATES OBSERVATIONS MADE NO. BEDRMS.TOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERC175LATION TESTS: Residence .f /� ,New ❑Replace �� /� rp� ""o RATING: S= Site suitable for system U= Site unsuitable for system / /� CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: S STEM -IN -FILOLDING TANK: RECOMMENDED SYSTEM (optional) ®S DU 2 DU OS DU DS ®U L H DS MUI co, If Percolation Tests are NOT require DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Z 7150 95 59 N erl? ? x. 5'0 Y 2 " - ' ?n / `Z B- 3 e, y'-,I one > 6 , 7/ � / •�� �n /s .. -1' �6p r»ea B- "/ / ©3 19 Xl at - 3,7s' 3 L�l 1 -e L3nsr' 3 'SC i � B- j G:33 /d'j��d/ d/1 � f .rf,��''� / /s: d• /I.?s� ffffs . - 92- En S A Z'Z5 -sC B- 515? A DO -7Z 5 133 AP 6 ls,° - /,5 B s: ' 1� PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER WELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P R PER INCH p_ 2 , „ z , P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 92 .. ..... ...... ...._ IN 4 i 3 y I ` I 1 I I 1 r 4 _ 1 I l I 1 i.. _ I F 1 ! I ^ cn STC - 105 r 1> SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County c G y OWNER /BUYER 1 Q ROUTE /BOX NUMBER /i,! Fire Number CITY /STATE c2/ ems %/I, �.(��; ZIP _5� PROPERTY LOCATION: , S� 1 4, Section / T Z,? N, R Town of 15✓ - er St. Croix County, Subdivision //� , Lot numbe Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you putt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior.to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic'tank.is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. �L SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property A�Gr9Q✓'C � o Ile of property � A4 1/9, Section �� , T 2 9 N -R 17 W Township /� ,'V 6 ✓' Mailing address _ y, / .8. /o/" �>� .5 Address of site Subdivision name Lot number Previous owner of property Total size of parcel lv� r �XC 19 Date parcel was created yah. 1 / Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house)? Yes o Volume Z� S and Page Number Z // as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. `/2 /O Z 2 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the M i t Jansky, Leroy, 05:22 PM 12/18/98, Chambers X -From : ljansky @commerce. state. wi.us Fri Dec 18 17:23:53 1998 Envelope -to: resling @pressenter.com From: "Jansky, Leroy" <ljansky @commerce.state.wi.us> To: "'resling @pressenter.com l" < resling @pressenter.com> Subject: Chambers Date: Fri, 18 Dec 1998 17:22:23 -0600 X- Mailer: Internet Mail Service (5.5,1960.3) Call be first thing Monday to discuss bury depth. Basically, what I have informed counties in this area is that 5 feet of cover shouldn't be a problem with most chambers and that we can accept that amount of cover routinely. However, I am concerned about greater depths that some of the contractors want to go to. There are two things to consider. One is the weight of soil over the chamber based on the width of the excavation. I have been sticking by my policy that greater depths require a written statement by the manufac urer st that the an be used for a particular application ( o v Ra required The second is that we are doing a grea sservice to owners by i�'ns�'drling systems at great depth. Soil absorption systems are biological systems and so is the soil. Therefore, keep the SAS in the area of greatest biologic activity. Just about anyone will tell you that shallow systems perform better over the long run because atmospheric exchange and reaeration of the infiltrative surfaces are better for shallow systems (and for trench designs too). The designers of such systems are building in early failure due to intense biologic clogging. There's probably lots of other reasons for shallow system installation too, such as better denitrification possibilities where there's still some carbon source in the soil (greater depth = less carbon). However, I suppose if the designer explains to the owner that deeper systems may reduce system life by a couple of years, and the owner accepts that fact then they get what they pay for. i N N .• ST. WISCONSIN NTY ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER r M r N 1101 Carmichael Road Hudson, WI 54016 -7710 _ (715) 386 -4680 February 15, 1999 Edina Realty Attn: Hank Fogelberg 400 S. Second Street Hudson, WI 54016 RE: Septic Inspection for Ed Affolter located at 1852 30th Avenue, Lot 1 Town of Rush River, St. Croix County, Wisconsin Dear Mr. Fogelberg: A septic inspection of the above referenced property was conducted on December 18, 1998. This property is located in the SW' /a of the SE' /a of Section 15, T28N -R1 7W, Lot 1, Town of Rush River, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sinc rely, Esl ger Assistant Zoning Administrator /sm ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r N s ■ ST. CROIX COUNTY GOVERNMENT CENTER some 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 February 19, 1999 Ed Affolter 1852 30th Avenue Baldwin, WI 54002 RE: Septic Inspection for Ed Affolter located at 1852 30th Avenue, Lot 1, Town of Rush River, St. Croix County, Wisconsin Dear Mr. Affolter: A septic inspection of the above referenced property was conducted on December 18, 1998. This property is located in the SW' /a of the SEA of Section 15, T28N -R1 7W, Lot 1, Town of Rush River, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 3864680. Sinc ly, Rod Eslinger Assistant Zoning Administrator /sm