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HomeMy WebLinkAbout032-2049-60-200 (2) I m c � 0 I o I 0 N N I C I i � I F. Z N � O o Z C U. c O p Q I Z +' o z O Z I 0 z a m 0 o z 7+' > W Z dt - _U O V1 I- r O m N Z c N co N C • N N °` L O _ — U 0 z N Z=z z Cl) N R E 'm N i J _ w � N� N d N O O O 0 0 a N N Z N> F F� Z E� N *� = d Z O O 0 0 0 • N E a a a y a r I U_ O a O O (n rn N = O O j N a m � d N I N R O O O O N C R N m 3 C') ° m 0 LO C5 04 0 1 W H >. N c U a p p O m N H C C tU (o N E2 . C N O O .0 CD "D w E N N N M N t2 cO O (n Q M O N Z of <o ca y t0 E `m I' k a A EL G V .0 C "�1 A c a o F Wisconsin Department of Industry SOIL AND S I ,� �1 A�T�I` REPORT Page of Labor and Human Relations hjvision of Safety & Buildings 3 in accor i ILHR A� QWis.d Code ;" �.� I COUNTY Attach complete site plan on paper not less than S 1/2 inches in size.,Plapr.rft�st i r , but St. rrnix not limited to vertical and horizontal reference point (B ) 'recti}}��d %`of sVt p s PARCEL I.D. # dimensioned, north arrow, and location and distance to rya est �Oad. 032-2049- APPLICANT INFORMATION— PLEASE PRINT AL j�ORMA°Wpt REVIEWED BY DATE T PROPERTY OWNER: LOCATION Harold i -/ F OT 1/4 1/4,S 14 T 30 ,N,R 19 f,(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 719 210th. Ave. 2 na Csm CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE UrOWN NEAREST ROAD V15) 247 -3746 [ New Construction Use k ] Residential / Number of bedrooms 3 [ ] Addition to existing building 1 1 Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ .4_ bed, gpd /ft gpd/ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate ,g bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 96.45 ft (as referred to site plan benchmark) Additional design/ site considerations alt. site system el. = 96.85' Parent material Pi tted glacial cI$fft Flood plain elevation, if applicable � ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem US El U 0 S El EI S ❑ U ® S El U ❑ S @U ❑ S I U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. .................. ................. .................. 2 8 -20 Ground 3 20 -40 5 r4 6 elev. 99 ft. 4 40 -78 5 r4 4 none Depth to limiting factor +78 Remarks: Boring # 1 0 -10 10 r3 3 €'< 2 2 10 -34 7.5 r4 4 none cm Ground 3 34 -82 7.5 r4 elev. 1 Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AM New Rich o I 5 O17 Signature: Date: 4 - - CST Number: m02298 e t STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Roland Belisle &Harold Rivard New Richmond, WI 54017 MPRSW 3254 �4�4 S14- T30N -R19W town of Somerset (715) 246 -6200 lot #2 -csm N 1 " =40' BM.= top of 2 pipe @ el. 100' Alt. BM.= top of 12 pvc pipe 1 -R el. 95.80' r r o ft A- t z 4 0 �h Gary L. Steel' 4 -23 -97 ST. CROIX COUNTY ZONING DEPARTMENT A. <� AS BUILT SANITARY REPORT Owner Address T — r r cFA,0M F` City /State — k,oLN' Legal • Description:` -- Lot Block ,d(- Subdivision/CSM # '/. A6E Y. AW, Sec. 1Y, T,7N -R,Ly W, Town of S�,I S, PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer __ W AEX S Size ST/PC A &W Setback from: House 3? Well P/L f ' Pump manufacturer_ k,4 Model Alarm location Ar 111111111111:11 llq111�zl..:�pjj qil NLY Setbacks: Service road air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: �TR��y, ,w Width 3 Length b'' /,2 S Number of Trenches 3 Setback from: House � Well P/L 1- Vent to fresh air intake /O,o - t ELEVATIONS Description of benchmark o _ E Elevation _ /000 Description of alternate benchmark 1T 2 'r P11,r o i g t Elevation _ U°" z f3 Building Sewer ZQ7 Yy ST/HT Inlet /Q ST Outlet_[ uD ' 3 7 PC Inlet &A• PC Bottom -Af,q Header/Manifold /d 6.0 3 Top of ST/PC Manhole Cover 106. Distribution Lines (/) fd0, 03 (�) fDd, (3y /d Bottom of System O ,F 7 Final Grade ( ) /0 / io /OZ O /0 ?o lOZ O w'7 io /02 Date of installation / / Permit number 31,5 State plan number Plumber's signature L A.,� - icense number -,Z-717y/ Date 2 //Syg Inspector AgdQLarA. (Complete plot plan sr •'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT Cou!�y . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitjrfr "n9jiNo.: Personal information you provice may be used for secondary purposes [Privacy aw, s.15.04 (1)(m)]. Permit Holder's Name: SOMtyR�E�T ge [I Town of: State Plan ID No.: USTIN, TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parc ,02u`p 049-60-200 I L6+ s -S& TANK INFORMATION ELEVATION DATA A9800208 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e ti '� Zn� Benc r 13.01 /.13. /oo Dosing Aci.4M �•` /0 Aerati n Bldg. Sewer 5 G /07. Holding S Inlet 7, TANK SETBACK INFORMATION t Outlet '74Z 053' TANK TO P/ L WELL BLDG. AirI to ntake ROAD pt -met -� w� irl � eptic �I NA Dosing NA Header /Man. Il.l$' Or. a rot's ation NA Dist. Pip M � -rZ iZ.�W Ape Ho Bot. System �= s PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand �I � 1 001, (o /Q. Model ber GPM TD Lift Friction S TDH Ft oss Forcemain ength Dia. Dist. To Well SOIL ABSORPTION SYSTEM BE RE Width Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM I N X 1. Z P, DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE / STREAM CHING Manu a SETBACK CHAM INFORMATION Ty O / m er: S st vu , � / -j OR UNIT DISTRIBUTION SYSTEM u - % ,,. C 6 Distbution Header / Manifold ri ipe(s) x Hole Size Hole Spacing Vent T y x o Air Intake �1 ` -r I �Coc Length LL Dia. Length l�• .Bie. 3`f Spacing fZ_ 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: SOMERSET 14.30.19,NE,NW 739 160TH AVENUE (-P ALI . P,�.�1 Plan revision required. ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. V is ' consin Safety and Buildings Division S ANITARY PERMIT APPLICATION Po E. Washin Ave. Department of Commerce In accord with ILHR 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 ��. than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other goverpme�acy programs ❑ Check if revision to previous application 7 [Privacy Law, s. 15.04 (1) (m)]. ,3 /'0 A-Vt! . /\/& State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name P o4erty Loc;�4, S T 3 o , N , R /Y E (ore Property 6can Address Lot Number Block Number A 10 D. Cit ,State Zip Code Phone Number Subdivision Name or CSM Number (7/ )1 « (V0& U II. TYPE F B ILDI G: (check one) ❑ State Owned o !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o Io w a n OF — Ty �U III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo /Y. 3 o • 19. 6 8a 6 I 03 ;Z-_2,-;P , 13P - 4 d — a? 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. ri New 2 Q Replacement 3, Q Replacement of 4. ❑ Reconnection of S. Q 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 5a Seepage Trench 22 ❑ In- Ground Pressure t ( 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 X - 5 43 ❑ Vault Privy 14 ❑ System -In -Fill V4 ax , 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) /Q0,7 9'817 Elation 6 100 , Feet EMI feet VII. TANK in Capacit Total # of Name Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Lift Pump Tank /Siphon Chamberl I 1 ❑ 1 ❑ 1 ❑ 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 Plu er s Signature: (No Stamps) fFRSW No.: Business Phone Number: umber's Address (Street, City, State, Zip Code): ; IX. COUNTY / DEPARTMENT USE ONLY ' ❑Disapproved Sanit Permit Fee (includes Groundwater ate Issued Issu g entSignature(NoStamps) Approved E] Owner Fee) Owner Given Initial � OV Adverse Determination v X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (8.11/96) DISTRIBUTION: Original to county. one copy To: safety a Buidmgs Division. Owner. Plumber , I I i r 1 r i U U Fr,1i/T i , I , , -j t I I i r 'y i �Dy� i ' t ' r , I r I r /N'F/L 02 I- , /©0O7 j I ` rR!A I , t s I y S ne? c�C i I , t1 i f f 1 j r t , i cr -die 1 Q ' r r r r a I ,( f r r Se I r r I I i Wisconsin Department of Industry SOIL AND SITE EVALUATION ? Labor artid Human Relations Page of �J Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. r 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 prkit ilik" 1 a'�wed by Date l Personal information you provide may be used for seconflary purposes ', caw, s. (m)). Property Owner " ° ; 3 w ?Mp rty Location ' v /D /_i ; 1�1 Gout. of 1/4 /4,S T 36 ,N,R fir) W Propert�y / Own er's Mailing Add ress Lpt # Block# Subd. Name or CSM# 7 �J / City State Zip tode Phone Numb�� Nearest Road t L.1 sy f1-_)Y City El Village Town New Construction Use: Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _0- 0 gpd Recommended design loading rate bed, gpd /fr _57t rench, gpd/ft Absorption area required 06 bed, ft ft Maximum design loading rate a V bed, d/ft gp _ e trench, gpd /ft Recommended infiltration surface elevation(s) �'& . Oa r, e / - .% ft (as referred to site plan benchmark) Additional design/site considerations _S _S�_7� 11 PA 1s iC &cC?w71q 6ec._.,.ra ®`r - 5 - loxe Parent material ,Di PG� �+ Ci C r c� l �� Flood plain elevation, if applicable /Yi4- ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system OS ❑ U Pa El U [as ❑ U I LAS ❑ U Nf S ❑ U ❑ S El U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Gr. Sz. Sh. Bed , Trench Al Ground _3 yr elev. loft. R1 i�'��� e Depth to limiting fac o 7R�in. Remarks: Boring #/ a7-� - s Ground elev. A I ?A Depth to limiting factor 'Lin. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number N /o / TM o� P 5 'Le e l /bf cor .57ta i sZ A � GorIvG7)e ,f Z, /00.00 g 7P o f 211 j 70 � 16 �11411� r 7 cl,3r� 103 ,30 - ZTo y /7`cr 'h ✓u c.J / n y Nc; y Nom. 7��ni�ei �S � S F6 t/ r/gy ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer --t�ev Au s�i.ri Mailing Address y� N ©� �,y f3 a �V D. sf-1 /J 102 �— Property Address - 73 2 / l� Tf{ ,¢U� Sc� .— T L / >, SY02 s (Verification required from Planning Department for new construction) {PE City/State _ce,c9/`�ER Parcel Identification Number 032-10 LEGAL DESCRIPTION Property Location &E %., " ;, Sec. T ?D N -RZLW, Town of Scyn --,L Subdivision Lot # Certified Survey Map # 5Z D / Volume l 't . Page # 3:2 7 Warranty Deed # �5� 6 Volume . Page # Spec horse ❑yes 19 no Lot lines identifiable J$! yes ❑ no SYSTEM.- UNCE Improperuseandnmhd =ofyourseptic conldresultisits ping oat the septic tank curry three fa$ime to handle wastes. Pmiuermarat�aaoe consists of pumping can affect the f pin gon of the y� or sooner, if needed by a licensed pumpe What you put into the system uP& tmk as. a stage in the waste disposai_system. The property owner agrees to submit to St. C mix Zoning Dement a certification foam, signed by the owner and by a = Plumbero r a Iiceosedpvmperverifying tint (l) the on-itb vrastewaterdisposd system aand/or (2) after hqccti and pumping y), the septic -tank is less than W dull of dudge. Uwe, the undemignod have read the above requiucm=ts and agree to maintain &C. private sewage disposal system with the standards set Wk herein. 'as set by the Department of Commence and the Department of Natural Resources, State of Wisconsin.. Certif stating that your septic system has been maintained mast be completed and retumed to the St. Croix County Zoning Office within 30 4,dlayos e t hree expiration dateF PLICANT DATE OWNER. CERTIFICATIiON 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 described above, by virtue of a warcaaty deed recorded in Register of Deeds Office. SIGNA 0 , ClLa� T OF APPLICANT DATE « « « « «« Any information that is mis4gxc ented may result is 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 36 a s � q s u ' FILED a >< g -- JUN 0 9 1997 lo 0 CL tea' �v 560681 1 al.cro 01.Wl 114PLATTEU LANDS w w S00 0 43'13 "W 564.04' S' N 0 1+ \ r e A N 1 ° 523.62' 40.42 d ( a I N rn m \ w w 4r w as' iy J I y O 8 V •R lOn Amai c H ' O -n Si n 8 8 M 8 rt n rr n 523.84' 1.21' ( Z O S00 0 43 1 13 "W 564.65' „ IC g m n � I W w p w $ 10 ` vi ° 8 o o er ZA 94 .X' z o K� S W) m � n o o 523.26' 42.001 H cn 500 0 43 1 13 11 W 565.26' w c I _.w w I 3 P h %a w n 7 7 o w H p N O CA p 3 rt n x Q N00 11 E 52 N l �n�owy