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HomeMy WebLinkAbout032-2049-60-150 0. o c ° o M 0 0 c I ni a e y co N - I o 0 3 L a i ULL I � n I ) ti D Q) Mn 0 ayi y € Z a Z c a Z c _ U. c c R $ o E0 a o � I 3 i � o 3 co rn E E zz H Z a m € m c (9 o o z a c = U) F- c ai y a N y v (DI CD C 0 Q. C 0 ".. N O � N Q z m z Z m z O N Z .. R O CL M t CL LO � .az � n0) ° -O Z j c N N N EI L O O a o 3 3 3 a 00 o I 'N R aaa Emmm Z y 3 co N J V aZi OOi Z Z 0) 0) } C N ._- O CD 0 0 c N CO 0 N Q O N O O 'O E 0) '= ml y L z .2 L V N N m y �?� ¢ }(n 0 O O O y y H N v y C M y C O O 0 LO r R U y c U N y aO 0 O H L o c- R a� a� (� a ° ° U_ N O N y C w ri N O N O d N M fM0 y R w a 'O CO u) I cl E .. 7 Z .1^ • ,'�, M O ? p O (A R p co O O O O U I O O !n O Z N Z M O z_ Z (n CC I V = E = E +% of a m a € (L I L IL L CL CL t A ua. Oaiv OviC� t > d FILED g C . JUN 0 9 1997 ►► 3 8� --� c.) a v [ 1 01997 KA THLEEN H w ALS Fi 10 5606 o a. ST. CROIX COUNTY SURVEYOR'S RECORD N IMPLiTT TED LANDS c„ -- — — ° S00 ° 43'13 "W 564.04' a 0 M \ 523.62' 40.42 N o 0 ( � 00 m >�, fD r (� .mo 4 I � m rt -� b ° 00 � &, V > 0 > r G .BOA NA C DN H O m _ LA1 O O 0 O 'n x - O O_ O fi A fY A ( .1. F (11 I Ic - AM I 523.44' 41.21' �r., 0 I � S00 0 43'13 11 W 564.65' Z I iy IC 00 I I —� N Ir OD w W 00 Oo If �l I�7 I� Vt N O O ( (JI r 1 — I rr O I w n CA n c:) II >� N 0 I I � I 00 O tJl f to f'C -- 1 O O I J> I"h to y- c m cn -n x -n 0 o �+ p c IV) 0 c-) fi m 00 M 00 • IF z N ;V ° "I � 0 0 —1 L ~ ~ ~ m d 523.26' 2.00' S00 0 43'13 "W 565.26' I Q� CD C < \ IV s - IM < I w ...w w ►-' 3 . .I. I lfl a Un o w� to w' -�-I_ a) o I IC y O O 0 0 N 0 �, l � p O Im 0 I 1 C � • � ••1 chA fTA l •' 0 1 • 1 ff1 I En I 1 / N00 0 4 3 '13 "E 52 H w co NOCP4V02' � "= cD 207950 '– N00 °49'02 "E %5 .99' rt. m EAST LINE OF THE NE 1/4 OF THE NW 1/4 I �' DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILD LABOR & H`bMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVE. P.O. BOX 7969 BUREAU OF PLUMB( MADISON, WI 53707 I �� NE4,NW4,S14,T30N -4, U CONVENTIONAL ❑ALTERNATIVE S of Somerse t ❑ Holding Tank ED In- Ground Pressure El Mound III assigned) 160th Avenue NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Rivard Route 4, New Richmond, WI 54017 BENCH MARK (Pe(manent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumb— MP /MPRSW No.: County: Sanitary Permit Number: Donavin Schmitt I 3205 St. Croix 106096 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDEO: PROVIDED — ]YES ❑NO DYES ONO BEDDING. VENT DIA.'. VENT MATL. HIGH WATER NUMBER OF ROAD'. PROPERTY WELL: BUILDING VENT TO FRESH ALARM FEET FROM LINE AIR INLET OYES ONO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER J BIEDDING LIQUID CAPACITY J PUMP MODEL J PUMPISIPHONM NUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ❑NO OYES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. IIf soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO OF DISTR. PIPE SPACING COVER INSIDE DIA -PITS LIQUID BED /TRENCH TRENCHES MATERIAL PIT DEPTH DIMENSIONS - GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV. END'. PIPES FEET FROM LINE AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE J PIRMANENT MARKERS J OBSIRVATION WELLS ❑YES 1:1 NO ❑YES NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED =PIOIL SODDED SEEDED MULCHED CENTER. EDGES. OYES El NO DYES ONO 1:1 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MAHKIN(� ELEV.' ELEV.. DIA. ELEV.. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL PLANS LIFT CORRESPONDS TO APPROVED DYES ONO 1:1 Y ES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING' FEET FROM LI DYES 1:1 NO 1:1 YES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710 (R. 01/82) i DILHR S ANITARY PERMIT APPLICATION CO�� C.?�ik In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # /Q [ O —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES I ��++ NJO PROPERTY OWNER PROPERTY LOCATION K#AW 80,462 g% XW %,S T ,N,R & E(or PROP OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME N,4 f} i ( A CITY, STATE ZIP CODE PHONE NUMBER EJ CITY NEAREST ROAD, LAKE OR LANDMARK N � VILLAGE : J ti f TOWN OFa 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family / �/ OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. X] Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: D � Minutgs p r inch): REQUIRED (Square Feet): PROPOSED (Square Feet): f D �r ,_ Feet [X Private ❑Joint El Public VI. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system howa2glblaftached plans. Plumber's Name (Print): Plu e s Signature: (No Stamps) / P W No - Business Phone Number: r J s Plumber's ddress (Street, City, State, Zip Cod Name of Designer: V ll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST# C A4 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: l IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial S rcharge Fee ` - Adverse Determination � 1'20 I / " X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 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 IGffA /�!7 /1 �t;,I k a Location of Property ---A _19 _-- ,�1 . Section , T - N- R L , �_ W Township Ci !failing Address j, y Address of Site Subdivision Name .Lot Number ,L4 Previous Amer of Property Total Size of Parcel 3A Cl? S Date Parcel was Created 1223 Are all corners and lot lines identifiable? x - Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number _ZL 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. H z H a ST C- 105 r r a ti SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z cy a OWNER /BUYER &ffAkQ ROUTE /BOX NUMBER /7 T, y Fire Number CITY /STATE 1L� �rjLif�i�wL� ZIP PROPERTY LOCATION: N �, Section ` , T '30 N, R _W, Town of , St. Croix County, Subdivision NA , 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 put 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. H E I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart - b 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. SIGNED DATE ;K ��� ,� � ✓ � 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. �I OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS 1N:DUSTf� C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W BOX 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNS H I P/MWNVAD000= LOT NO. NAME: NE 1 /4 N)/ 14 /T30 N/R 19 E (or) W Somerset n/a n/a COUNTY: OWNER'S 5886ff66>WE: MAILING ADDRESS: St. Croix Richard Rivard USE DATES OBSERVATIONS MADE ®Residence NO. BEDRMS,: COMMERCIAL New ❑Replace AL DESCRI TION: ROFIL IP ONS: R A ION TESTS: 3 n/a 12 -11 -87 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTI NAL: MOUND: IN -GROUN ESSURE: S STEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) NV Q S ❑U � ❑U C S 0 ❑ S E] U ❑ S gU step down conventional trench If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.1-163.09(5)(b), indicate: - -lass 2 I Floodplain, indicate Floodplain elevation: n/ decimal PROFILE DESCRIPTIONS page 34 OND2 DE BORING TOTAL tLEAT ION PT H T GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE OBSERVED EST, HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK -1 6.75 5 none >6.75 .25bl.1. 1.00bn.sil. 5.50 bn.cob. s.l. B-2 6.83 114.30 none >6.83 .50bl.1. 1.08bn.sil. 5.25 bn.cob. s.l. B - 3 6.67 113.35 none >6.67 .50bl.1. .50bn.sil. 5.67bn.cob.s.1. B 4 6.77 111.63 none >6.77 .67bl.1. 1.25bn.sil. 4.75bn.cob.s.1. B - 5 6.75 112.06 none >6.75 .67bl.1. .25bn.sil. 5.83bn.cob.s.1. B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. p I D PERIO 2 PERINCH P- P- 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 y /JO`G _ I� T" Po 0 f r._ I n i ! _ -.__.. - : i : G : i r - I I i 10 6 i I I r II i II ,y i i I - - - I_ I 1 i I I I� r r s p P° I _ I , , poor o U r I f I � I I � i i I r - t I IGU Ole I � 1 PP -1105 � g - Q I r �1 tlChl`J114/(�Qi r aC7/3e!tS I ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Li�� Owner 'T P L) to— y I p Address m ✓v �, s� = �;xl City /State H w SD nr U 91 51 1 L COt1NTY ZpNING OFFICE. Legal Description: Lot I Block — Subdivision/CSM # U I �- 30, L ' /4 4�Q '/, 9 , Sec. f ,TAN -R 1I W, Town of S. PIN # -' SEPTIC TANK -- DOSE CHAMBER -- HOLDING_ TANK INFORMATION #,- /r01, �. Tank manufacturer Ou Size ST/PC / jjlL— Setback from: Housa Well P/L Pump manufacturer Model *� Alarm location (HOLDING TANKS ONLY) Setbacks: Serv' Vent to fresh air i Water Line Meter location Alarm locatio SOIL ABSORPTION SYSTEM Type of system: p Width Length �3 Number of Trenches Setback from: use o Well L b Q Vent to fresh air intake 3 S ELEVATIONS Description of benchmark Elevation C1 161 Description of alternate benchmark Elevation � 113.4 0ix- Building Sewer 0 ST/HT Inlet ST Outlet • PC Inle r13. 9 PC Bottom Header/M fold Top of ST/PC Manhole Cover �' �r•� r nu»ti�e-r- i n Distribution Lines ( ) ) ( ) -fv 414e DrvqNa( Bottom of System _ Final Grade Date of installation / / 6 mit numb .3� 7 � tState plan number Plumber's si ture License number '� Date (� / J 17 b Inspector Complete plot plan <Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ,.Safety and Buildings Division County: ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitardff?6% Personal information you provice may be used for secondary purposes [Privacy La X, s.15.04 (1)(m)]. mrpj.LH old g�wm' ❑ 1 []Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: ' l Parcel T�c�JQ_2049 -0 00 I S (o 1 9 � g i i 1n -ft./ �t oyt TANK INFORMATION ELEVATION DATA A9800026 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic N s 1 C> Benchm r /7o Dosing _ 2— f3 �! Aeration Bldg. Sewer -3.1 3 Holding Inlet '1 / /a. 1 TANK SETBACK INFORMATION St Outlet 5-/ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake �✓�,� Zo' Z 1 ' NA Dt Bottom Dosing NA Header / Man. Aeration A Dist. Pipe. Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade' Manufacturer Demand Model Num Gp TDH U I Friction I S m TDH Ft Forcemai Length ia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liqui epth DIMENSIONS IS S DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM ( CHING Manufacturer: INFORMATION Type0 r l ber Syste 3S �2 ^'G� UNIT DISTRIBUTION SYSTEM Header/Manifold �K Distribution Pipe(s) '' II x Hole Size Hole Spacing Vent To Air Intake Length Dia. Length Dia. 7 r Spacing � �ST^� S x . -'Z SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over �(/ Depth Over HT. xx Seeded/ Soddd x ex Mulched Bed /Trench Center �w Bed /Trench Edges oil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 14.30.19.682,NE,NW 743 160TH AVENUE n 17W Plan revision required? ❑ Yes No Use other side for additional information. `? SBD -6710 (R.3/97) Date Inspector's ignature ert No SANITARY PERMIT APPLICATION Safet eE an shngtonAvesion Ais In a with I P.O. Box 7969 accord Department of Commerce cod t LHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County c than 8 112 x 11 inches in size. C r10 [ • See reverse side for instructions for completing this application StateSanitary Permit Number 3 &74.o 3(a The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)j. 7y /� J� Q �.h �7h /}o (� . J State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Propert Location F 114 /a, S/ T 30 , N, R E (or Propeloy Owner's Mailing Address ' Lot Numbe� Block Number City, State Z / Phone Number Subdivisipn Name or CSM Number II. TYPE BUILDING: (check one) ❑ State Owned l il �- y Ne Roa Public J&1 or 2 Family Dwelling - No. of bedrooms 3 ❑ Town OF c/� e/' III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo ' ®' �• 8 a R `" 0�� 1� c� 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 stem -------- - ---------- -- -_ 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 11XSeepage 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 (s ft.) Propo a sq. ft.) (Gals/day /sq. ft.) (Min. /inch) / — Elevation J v / / 0 65eet Feet VII. TANK Capacity in gallons Total # of r Prefab, Site Fiber - Ex er. INFORMATION Gallons Tanks Manufacturers Name concrete Con- Steel lass Plastic Ap New Exist in strutted g pp" Tanks Tanks Septic Tank or Holding Tank 31 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i tallation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' i ature: (NoStam TP/MPRSW No.: Business Phone Number. �5 a 71.5 a6 - �6�Z Plum er's A ress (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY (Includes Groundwater ate ssue Issuin A nt nature oSta s ❑Disapproved Sa Mary Permit Fee 9 g > AA1 P 1' P ` roved [ Given Initial /j�' `/ Surcharge fee) p Adverse Determination (U� /' �`�?/( _yO X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber PLOT PLAN /� / f PROJECT S�� /i i�t �/ A DDRESS Af / NE 1/4 NW 1/4S 14 /T 30 N/R 19 W TOWN Somerset COUNTYST. CROIX MPRS Shaun Bird 3532 DATE 2/16/98 BEDROOM 3 CONVENTIONAL )000C IN- OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE > 10 ABSORPTION AREA 954 BED SIZE 18'X 53' BENCHMARK V.R.P. Top of Nail in Power Pole ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark VIM' SYSTEM ELEVATION 110.65 12" GRADE TYPAR COVERING 12" 3' 6' Q 3' 3'Q 3' ,o 0 ,� ' i SEWER R K 18 160th Ave A� "� I 12' B.M. 25' 55' 17' 15' 3 ' 106' Existing Fir 14' #743 2, # 7, 38' Alt. -5 B.M. B - 7% 5' 18'X 53' Vent 7' Slope Bed N -3 Driveway �\ 4 �B -4 25' B -1 T 10' Pro 3 Bedroom House W isconsira.Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page —/— of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 purposes (Privacy Law, s. 15.04 (1) (m)). Property ne Property Location Govt. Lot 1/4 `�; 1 /4,S J T N,R(or) W Property Owner's Mailing Address Lot # Bloc Subd. Name or CSM# 90 11 14 Z } Ci State Zip Code Phone Number Nearest Road El City Village Town r New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan bench ark) 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 [ S ❑ u ®S ❑ U [31 S ❑ U h4s ❑ U I [- [3 U ❑ S R 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 Ground L �,r' _ 3 ele Depth to limiting facto Remarks: Boring # WE >>: T 13. 199 Y Ground )NTY, elev. Depth to limiting factor in. Remarks: CST Name (P a Prin Signature Telephone No. _ Address 1 Date CST Number e l l vlc' t �s I G�'R"�1�� • � rJ.��O � /�,�;�Y � /l Gil ��- S.EC /� �'' ©.'� /R�j�(� ; + /fn / iY' / �".I-�'�i"��/'7.I•l r/J, /.y / U. /.L. f'?S /, /J /;4' l7- f t t ; _ • - 02 � �: 715' , , i REPORT ON, SOIL BORINGS AND SAFETY & BUILDINGS DIVISION PERCOLATION TESTS ( P.O. MADISON W1 79 (1-163.090) & Chapter 145.045) 10 • TOWNS HIP /M LOT NO.:BLK. NO.: SUBDIVISION NAME: 14 /T30 N/R 19 E tor► W Somerset /a n/a n/a _ 1OWNER'S/B8M6ff&5ftE: MAILING ADDRESS: oix Richard Rivard DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER IAL DESCRIPTION: ® ❑ PROFILE DESCRIPTIONS: PERCOLATION TESTS: dance 3 n/ New Replace 1 12 -11 -87 n/ a TING: 8- Site suitable for system U= Site unsuitable for system INVENT ONAL: MOUND: IN- GROUND - ESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑ U ❑'s ❑ V , � S ❑ U ❑ S ] U ❑ S [U step down conventional trench If Percolation Tests are NOT required DESIGN RATE: If an iFloo y portion of the tested area is in the under s.H63.09(5)(b ), indicate: class 2 in Floo elev n/a PROFILE DESCRIPTIONS page 34 OND2 BORING TOTAL ELEVATION DEPTH T GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 6.75 114.15 none >6.75 .25bl.1. 1.00bn.sil. 5.50 bn.cob. s.l. B -2 6.83 114.30 none >6.83 .50bl.1. 1.08bn.sil.. 5.25 bn.cob. s.l. B-3 6.67 113.35 none >6.67 .50bl.1. .50bn.sil. 5.67bn.cob.s.l. 13_4 6.77 111.63 none >6.77 .67bl .1. 1.25bn. sil . 4.75bn. cob. s .1. 13-5 6.75 112.06 none >6.75 .67bl.1. .25bn.sil. 5.83bn.cob.s.1. F PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P E R PER INCH P- P P_ P. i the hori- oercent AQ 2F E7 $ 1 � t s Itr lu °' r f # <rzt3C);) t � j 53 3 u. S rW N ., 0,. The uc i py A., STC -105 326 - 163s SEPTIC TANK MAINTENANCE AGREEMENT t St. Croix County OWNER/BUYER STL°yEN MAILING ADDRESS C 40P", ►" a le #4J ,56N 164' ", 6 PROPERTY ADDRESS f� /i V (location of septic system) Please obtain from the Planning Dept. CITY /STATE z- /"/ PROPERTY LOCATION 1/4,'&L—A/4, Section �T , T __jj _ N -R. W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME / AGE _ 4 LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: '2 — G +� St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 srt'c' —too 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 Location of property /41/4, Section W Township - S6 �-� c_ Mailing address 9 3 jGZ l �� Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property '2c Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes __ No Volume /v2 and Page Number 302 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 I 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 owners) 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. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Appl cant Co- Applicant 2- 58 Date of Signature Date of Signature G c ` roW 0 FILED �v� i o g CS°� . �:' rn f' a � 'm H v �_� �oy�= JUN 091997 0 c° ? ° L "' ° ` a ° n IfATHIEEN H. WALSFI 0 ` a w- N �' = 1� 560681 -� n E St. Cmh v ti v N UNPLAT i EC LA P-0 0 P - 564.04' :1 II N 0 \ e n a w 523.62' 40.42 m O rt p U R 2 W W j W 33' I -4> a r C • W 0 "0 O N N I•'i 0 -3 cn -1 m W o o O ° - x i fi c n O O rt o _ � � I z r� C- 523.44' 41.21 I O S00 0 43'13 "W 564.65' Z I iy rt C I oo —I fD �� ° 0 I z IM � I w w w w Ir r p'r O w D w D Q N �' N 0 4- In 6 II ' 00 O cn N N O O n ly h'11 In t7i c . m . m N °o o ° IC7 cn o ctt o ct o o IU) 0 e - ) m 00 M z 00 O• I E �, 0 I�7 T M 523.26' 2.00' H C/) S00 0 43'13 "W 565.26' I w C z < e I — i m 12 � � Ln N o. ° O ° N ko0 w0 – Un I ID 0 0 3 -3 ° w I� H 0 m � (D N co ' I m 0 co H' O O _ - n x -n 7 c IC ct m N00 0 4 3 '13 "E 52 H w � NO� CP4 Og 4 L ",750` — - - - W - rt N00 0 49'02 'E Sb-' .99' cn ST. CROIX COUNTY WISCONSIN ZONING OFFICE I NOR Ila an ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road "L Hudson, WI 54016 -7710 r-- (715) 386 -4680 July 30, 1998 River Valley Abstract & Title Inc. Attn: Roger Bevers 206 2nd Street Hudson, WI 54016 RE: Septic Inspection for Steve Matz located at 743 160th Avenue, Lot 1, Town of Somerset, St. Croix County, Wisconsin Dear Mr. Bevers: A septic inspection of the above referenced property was conducted on June 1, 1998. This property is located in the NE %4 of the NWA of Section 14, T30N -R19W, Lot 1, Town of Somerset, 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 ely, t o d Eslinger Assistant Zoning Administrator AM