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HomeMy WebLinkAbout030-2100-40-000 n CO) o ■ -0 o c c to o \ \ 2 k , w » E ® ■ z ° § 2 @ % S, % E (n a w - & § $ w & m g ; \ 7 \ / = F ° p. / k / 8 FS i;3 CL e Z e w \7 c / \ E ` e E E % 8 E e ) �. ° m @ *> E o' E 3$, e. >2 7 F / e \ _ \ § 2 / ® 7 \ ƒ / k k ( § E 00 00 � - E E 7 { o 0 o k l Z' - -n rc3: � § § � CD $ 2 (n CO) @ F � C 0 m 0) / ; CL CD 3 2 . : , CD rr I CL 0 g I k \ \ / \ } - f ) r / M m g - _ 0 , CD k \ _ CL f 2 ( @ � M k 0 k z © z � 7 z \ CD � . » � oq- wN) > '$CAE 2»o@ B . f�,..g c } // M /2� f ƒ [%& ) � ) Ea R_ » Er 21 CD o \ [2 � /\ b PC {k tA CD / eo �$ k� . �\ . � Wisco Department of Industry SOIL AND SITE EVALUATION / Labor and Human Relations Page of 3 D;visiop of Safety and Buildings in accordance with s. ILHR 83.09, Wis. i � I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purpose vacy Law, s. 15.04 (1) (m)). Property Owner ? Property Location 7,4- C /0 '/� k Govt. of 1/4 1 /4,S 32 T 3 N,R E (od5�V Property Owner's Mailing Address ti of B ock# Subd. Name or CSM# "u �T / (�� city State Zip C hoA� ember Nearest A4d , City ❑ Village [4 Town New Construction Use: Redden: t/ Number of bedrogs s Addition to existing building ❑ Replacement ❑ Public or dornmbrejat Dfst - e rl Code derived daily flow gpd - Recommended design loading rate bed, gpd/ft --L— trench, gpd/ft Absorption area required bed, 0 7.5 O trench, ft Maximum design loading rate — bed, gpd/tt — trench, gpd/ft Recommended infiltration surface elevation(s) 7 �P� 1l. 447. 90 9 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I �z S ❑ U ❑ S 0 U Os ❑ U I ❑ S 0 U I ❑ S O U ❑ S 0 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 13 /V F/7- q s IF , 93.5 Z 2 C F/Z c- -c 6 Ground , L _ _O ' elev. 9k-f -ft. 16 - Depth to limiting factor in. Remarks: 5` -3 fir 7210-',1 Boring # / 13 1- D 21 — L S 'Z - 90, 9 J 21 -P ;7. _ - - — LS SG 4a L G S D O Ground I?J- O 7 -5 elev. P�ft. Depth to limiting factor �— in. Remarks: 3 CST Name (Please Print) Signature Telephone No. OrL : , 36� 6 Address Date CST Number s 31 /VN w or g p At a • r \ y yob 1 �S oT s/g yow !'ce7x �otisT �•�� I B AA Tof' o S 14 I y PT►'t" �=ouu DAVE FOOLITy pu&WM Lo T e w EX *SS$I /NE le" UCWM*d Pork TedW & mbar 03233 #3299 IiO�d ROSE um C E've�'Rr'�fsu� 7'b sc���J 1 s 0 d 1� FILED M Nov a 1996 r M AY 1 � Kp•R,1lEENN.WAI.SN �� � -,;..: ReQ of Deeds _. �t,CrolxCo. 5 19ZO CD Z ° o Bearings are referenced to the ti o m west line of the NW)y of Section 0 o 0 32, assumed to bear N01 °48'04 "E. c 0 o z N 1 Iron Pipe Found ' CO ' - UNPLA I tD LANDS S20 ° 37 1 35 11 W, 0.49' M (so1 0 48'23 "w) - — of computed position. N01 0 4$'04 11 E West line of the NW>d ° n _ N01 0 48 1 04 11 E 531.04' N01 °48104 11E M c �' 773.29' / 0 o0 _ :� i o // 1304.33' II �ZZ� I�' / z to n K to Ui F m (� ,A / O 7 S O I S 0 (D a S01 °48'04 "W K Pi 265.02' N FJ- I �n / M 16 �y I° rnm �Nrr • I - h —I 33 W c C c i y IG� ��, 3 � a� o c m ct o W ct I l! I O ." r I< I W I 1 � ° u' o too N o c'o IQJ M fD CL r I -nN a - �Sr x I �� r z t1j I on _ I 1 W :4 1 m y - ^' 1 e t c I< IZ7 � M , I+, I cy �� ww 1 �o a -cam C1 W yo IrI;v d Cc) I�.1 Ir c x Iw Is (— _ Iw I— to 0 �ro IW � M n — o � �n ICS N y � S <o W 0 c o m° f z w [ rn n� z G J� r I r ...'`3 '- 6 0 41 O 0 0 °/ � y Z � 1 r 'r.. r � ate. c 7C 1 Ct . e. :�ofrm Mai cr CD o Parks Committoo GIF r iiSia y o = v / C o? O y « _ �o n 'U Wisconsin Department of Commerce P PRIVATE SEWAGE SYSTEM y Safet�pnd Buildings Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3d"NS: Personal information you provice may be used for secondary purposes [Privacy L I , s.15.04 (1)(m)). Permit DELTA IdCONSTRUCTION �4jy �UIgP Town of: State Plan ID No.: CST BM Elev.: �\ Insp. BM Elev.: BM Description: Parcel T0 -:- 2100-40-000 (VV 1 6 b 'V TANK INFORMATION ELEVATION DATA A9800134 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f2 00T_�) Bench ma ( .79 j .r 10() Dosing -� �j -99 - r 7- S/ Aeration Bldg. Sewer Holding O Inlet 7'ce> WI/ TANK SETBACK INFORMATION I 1\9,0 mow, d Outlet 9�. S TANK TO P/ L WELL BLDG. FAi,l,t ROAD Dt Inlet e tic 9,9' '� IC ' NA Dt Bottom Dosing NA Header / Man. •7,cr8 ,cf� 3 ,g3 Aeration NA Dist. Pipe $, �3 a , Holding Bot. System G12 PUMP/ SIPHON INFO MATION Final Grade Z Manufacturer Demand 476,-0 -0 Model Number GPM T I Lift L oss ric *on Syste TDH Ft Forcemain Length Dia. H Dis . To well SOIL ABSORPTION SYS EM TRENCH width , Length No. Of Trenches PIT No. Of Pits I e Dia. Liquid Depth D IMENSIONS �Z J DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Ma facturer: INFORMATION Type 0 ��++���� $ � � _� OR UNIT CHAMBER Mode N ben: SystemG% DISTRIBUTION SYSTEM Header / Man)fold h Distribution Pi s) q �, rI x Hole Size Hole Spacing Vent To Air Intake Length -Co— Dia. I e ngLth Dia. `7 Spacing � I �rSTM 15 x � [ `-1 I �� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center �v 3 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 32.20.19,SE,NW 410 126TH AVENUE gWd k,4 . m " P d a -ham a (o rru�. b a t I Plan revision requi d? Y Yes 0 No � I S I Use other side for additional information. SBD 6710 (R.3/97) Date Inspector's SisfnAure Cert. No. • ��� Safety and Buildings Division �• ■�tr■r. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • 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 The information ou p rovide may be used b other g overnment agency programs Y P Y Y 9 9 Y P 9 ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 410 pace Ave. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORM TION Prop y O er me roperty Location 1/4 j 1 /4, S Z T 3 , N, R E (or)07 Pr pert Ownerr sMailin Address Lot Number Block Number City, ate Zip Code Phone Number Subdivision Name or CSM Number ,Sfp ( M ) // II. TYPE OF BUILDING: (check one) ❑ State Owned El Cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �� 2 Io w a n OF ^ / III BUILDIN USE (If building type is public, check all that apply) Parcel Tax Numbe 1 ❑ Apartment/ Condo — 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV., TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. [71 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 ;3 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 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) EI ti n . . 7 7 ¢2. 8' Feet Feet VII. TANK Capacity INFORMATION in gallons . Total # of Manufacturer's Name Prefab. Site Fiber- Ex Gallons Tanks Con- Plastic er. p New Existin Concrete Steel glass App. Tanks Tanks I structed Septic Tank or Holding Tank Lift Pump Tank /Siphon Chamber & f f ❑ 1 ❑ I ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation 9flge onsite sewage system shown on the attached plans. Plu is Name: (Print) Plu 's Signature: (N mps) WfWMPRSW No.: Business Phone Number: �� ` - 2 fey —�0 S Plu er's Address (Stree , City, Stat , Zi Code): Gtr V.0 Z IX. COUNT [DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssue 1 1suling Agent Signature (No Stamps CKA roved d/ Surcharge Fee) pp El Given Initial ,�i Adverse Determination , 1- X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber } 09 V Ire j Y ■ 61r3 Lic -3nstd Pefk Tester & Plumber 03233 ;3259 �Fc 'Sfty S ne 3:;3hts Road ,F� tyvTS, WISdO Aid 023 Phone 749-3 �6 /, END V -T.F VY .3 I 6 a P"A Ave, 7a A/ Xevrv�wY A lil GAO 10, • _ �vuyv0 �� G+� l/ 0 job I , 4 i i !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 $M �� y Do r o SuvI/ r 's /boo('. p' 1221( INDICATE NORTH ARROW PAC F (; PUMP CHAMBER CROSS SEC T IGtJ AUD SPECIFICA VEQT CAP ``C.I. VENT PIPE - f� T WEATHERPROOF APPROVED LOCKMIG 25' FRO-A1 DOOR, JUUCTIOM BOX MANHOLE COVER WINDOW OR FRESH I2 "MIU. AIR IAJTAKE GRADE I 41 I `1" MIM. -T � -T - - 18" CO►JDUIT _ IB "MIIJ. ---- - - - - -- 11� IAJLET PROVIDE AIRTIGHT SEAL i III * A I I I I I ALARM 6 I II I I c *APPROVED I I ow . JOINTS WITH I I ELEV. FT. APPROVED PIPE I 3' ONTO PUMP � OFF D SOLID SOIL CONCRETE BLOCK " RISER EXIT PERMITTED OIILy IF TAUK MAULIFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFfCATIOUS DOSE TAWKS MAM UFACTURER: �� ��1 WMBER OF DOSES: Z PER OAy TAAJK SIZE : - GALLOAIS DOSE VOLUME ALARM MAMUFACTUREiR: Sl_ r� / IMCLUDIMG BACKFLOW: GALLONS MODEL IJUMBER: ld /7�fi�/ TG -.F ���� CAPACITIES: A= ZZ IUCNES OR Z_ GALLOWS SWITCH TYPE: -�S.Q� B=- _INCHES OR GALIO►JS PUMP /AAMUFACTURER: I: = INCHES OR 2.2 GALLO MODEL IJUMBER: D- !— INCHES OR d 2 GALLONS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO I,E MIAlIMUM DISCHARGE RATE yD PM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFEREMCE BETWEEM PUMP OFF ARID DISTRIBUTIOM PIPE.. FEET ' ~c Al + MIIJIMUM NETWORK SUPPLY PRESSURE , , , . . . . . C FEET -_ FEET OF FORCE MAIM X L FT,,/� O _ . � moo FxFRICTIOA! FACTOR..1c =- FEET TOTAL DIJ JA IC HEAD =- ti Z FEET IMTERMAI- DIMEIJSIOM& OF TAUK: E4T -}{- ;WIDTH �L- .;LIQUID DEPTH ' I-- 4 LICEIJ$ MuMeER: T Performance Submersible Effluent Curves Pumps METERS FEET 30 100 SERIES: 3885 l SIZE: 3 : SOLIDS RPM: VARIES i -► -5 GPM 80 1 'S i • - 5 Fr - ...1. .. .. ..._.. ..1_._ _. .. .... i ; l x 20 ;._ a •v i i i ; i j Z i a 40 f- S ! O ! F 10 i i ... : EVE i i ! ..... 0 00 20 40 60 80 100 120 140 160U.S. GPM 0 10 20 30 m /h FLOW RATE �GOULDS PUMPS. INC. WATER TECHNOLOGIES GROUP SENECA FALLS NEW YLJ11K 13148 METERS FEET 120 SERIES: 3885 1 SIZE: 3 /; SOLIDS 35- 110 RPM: 3450 I S I ! -► 5 GPM i : 30 100 i L 1 5 FT ! 90 I l a 25 L — x ! U 70 i Q 20 I ' I l ! z 60 - i I i -J 15 50 a I y .... i O 40 " G , .... ... - 10 30 ! i .... .......... . ....... __ ....:. _. . 5 20 .... i l .... ... L..._ - - . - - - - I ; l 1 10 ': . ._ ...... ... _ ....... . _ _ 0- 00 10 20 30 40 50 60 70 80 90 100 110 120 U.S. GPM 0 10 20 30 m /h CAPACITY FHtKaive July, 1993 «'i 1993 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. 111IN f E11 IN U S A. 038853450 W, S, Labor and Human Relations Page / of s Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. ' Attach c6rnplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Par APPLICANT INFORMATION - Please print all Information wed by U® Tol Date � V IL Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). " `/� .a kwasi Property Owner Property Location S f / Govt. Lot "� �`i� E (o� Property Owner's Mailing Address Lot # I Block# City State Zip Code Phone Numbe 1 `G r b d st d p 1 o ( ) City ❑Village ' �( New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow &0 gpd Recommended design loading rate bed, gpd/ft gpd4t Absorption area required ZSZ bed, ft ),: O trench, ft Maximum design loading rate — bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) .41 o, ft (as referred to site plan benchmark) Additional design/site considerations Parent material �— Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U ❑ S m U OS ❑ U ❑ i s 0 U El 0 U [Is 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 IVJ Fie s F S 93.s z -z - F IF — 6 Ground / _ _ c y _ L _ _ O elev. 9( Depth to limiting factor in. Remarks: 5 ` -7 arr V 7ZCA0777 Boring # _D le _c SrL C_ S Ar A4,CIZ- L)3 s E -7 D - 21 CS Z 'o, y - .7. r– ! — LS 4a L G S O Ground �/ 0 S m�� — 1p 1eG � , Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. 4 D ' e? Avoou "r/,, Address Date CST Number /� o gElz L5 3 yaZ-3 b 2 d' 1 S OIL DE CRIPTIO REPORT PROPERTY OWNER Uf � T/� COtiS T Page - of � r PAOCEL 11MA Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots h in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ex < <.: 9zp 2 c r IF .J Ground _ L� F -- s O S G L <-S elev. f9 IS6' Depth to limiting ; factor Remarks: �opElt, - Lci �sc7 Boring # y � - VAY - L 59K M rC CS - 3 £ Az �3S 2 19-TS LS IS G M L CS Ground y G S S L elev. - ft. Depth to limiting factor in. Remarks: q 4t ? Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ' 0 -Y 1 .0 -1113 tL F F Ground 1 G L elev. ft-6 Depth to limiting factor in. Remarks: f� yERr/ TTAyI' Boring # 5 E - X ` 5 VOLE At-7 . 7-D 13 'F IP lox ;Wsxlez Ground O elev. ft. Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) K �3To' NN W r � Cdr g A a At A,w J' \ jig 90 � \ ,k # 3 J Irk DoT ���r�v �o�/sJ• � .4 = 8 M, To OF F, suRvey3 PrP tiouuil OAVE FOOMM KUMBM LOT < ORN�R� /¢SSt+�►E LlwnW Park TesW i pknd er 032Y33 I � = B99KZWC �� S. M SC IA = FmN.vD LoT <oi�NF Phone 749 -3656 5028 6 /lo /f� C ' F�ERyr,�sw� 7D ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer />dlr Mailing Address .' Property Address 1`Z (Verification required from Planni g Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 5; , 5 - '/4, 1 w '/4, Sec. , T _fo_ N -R W, Town of Subdivision e� 1/0/ 2 � 1'2 . Lot # 5 Certified Survey Map # , Volume i , Page # Warranty Deed # f'/ 5 - 1 5 - 3 , Volume /0 7-S ^ , Page # Q/ 8 Spec house ❑ yes 0 no Lot lines identifiable W yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 heeded by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the yeear :r t/ ' l Id l f� SIGNATUM 6F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p operty des gibed ove, by virtue of a warranty deed recorded in Register of Deeds Office. o SIGNATu 6F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed .� .i5btib`J � � � SSSf1i6V n w yu 51rll7, tap" "= .��•: -aI RIDGE MEADOW 4. 1 %_fAMp 1- LOCATED IN PART OF THE SWI /4 OF THE NWI 14 OF SECTION 32, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN BEING LOT 5 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 11, h IM•r' PAGE 3180 AT THE ST CROIX COUNTY REGISTER OF DEEDS OFFICE CUM mTA rM" wt win 1111, CMM (MID I Mt i ,Sri law raflerm •. �T M M um RN MISS NMf1 {tin WIN; win 1. fseylY J. i•YI• NO Ut.. rr.sy --ry .. 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