HomeMy WebLinkAbout032-2068-95-100 p N 00
a ~ U v)
or
cry 4 0
� a I
a
N
Q 3
y
ao m o
Go
0)
CL N
f0
._.Cl)
O i �C O I
O
I N N
W
O
Z N O V)
O O
C Z N C
LL. C C O
O =(0 U
N r �
Q O C m
3 �
z
C) w E
� N o
Z a m
N U
O Z C
V � � O v1
(%1 FZ-
C E
'0
h� N N O
�+J n a�
o 0 0 0
CD
• C. L R N N CD
Q tl 4U—" N N
0 Z M Z 0 0
N Z Z o 0
Its � E E
so Y
a.
cco o o a Q C
O
h o p m v) U) > U
a O
• � aaaa
CL c
rn
Vl J U 12 rn� rn a) I
to 00
N p O Cl O
` .-. Q E N N N N 1
L O O '� d 7 O N � N
O 'O 0 N m
N N N
M � � Q } fn N
16 O aw 0
v O Iy/! C
1� (� O N V O j N �!
O 'n r F- m m a� `m U a 0 0 °0 0 0 1
T p _ N c m , -O N N N N N
V c0 p y m ` O N 0000 'Z O
tH 00 N t a' N N Oi O O N r N
C
N 0 0 ` 0 ONi O W W C n O
•ray' O V) m Cl) O Z N R� 'E' co
0 at o I L
C m a
d`
t`1�l , 'c c ::M M a
t A U d 2 t o US u
FILED ,� 2 2000
t7 A r1 r ' 2 5 2000 1► 1
KATHLEEN H• SH ST. CR01X COUfVTY
1164 er of Deems
���� j, C E R T I SU EYOR'S RECORD AP g a 0
7
D IN THE SW 1/4 OF THE SE 1/4 OF SECTION 12, T30N,
R20W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN.
I UNPLATTED LAND
I z 33.5 S 87 0 05' 09" E 610.92'
° N 577.34'
I �I° LOT 1
�rn 1 o i
A V, o �
�"- jly 163,319 S.F., 3.749 ACRES
w INCLUDING EXISTING PORCH EXISTING p
pl \ m TOWN ROAD RIGHT -OF -WAY SEPTI
O TANK Q
Z EXISTING • EXISTING C%!
J
Q I \ \� \ \ - — - — _ - HOUSE M p
�\ \ 137,147 S.F., 3.148 ACRES Lij
�� \ �� \ \ \ \ TOWN R RIGHT-OF-WAY `SF CA: o
J
Q I \ C, `�� \ S 87 o SEPTIC EXISTIN o Z
\ -�-- _ ._05_09" E 251.37' — VENT °
�� \ \ \ _28TH STREET w v,
It
N 87 °05' 09" W 251.37'
\ w
A V)
_ w
\ N, , i—
\ � w
0
° UNPLATTED LAND
zwow — — — — _ — — — 3
m � � APPROVED S 62 °54' 35" W \ 00 Li w N ST. CROIX COUNTY 33.00' ` m
m o M Planning Zoning and Parks Committee
w z o POINT OF w o
Z= g z APR 2 5 2000 BEGINNING -- z Luj
QF -
- (nom I J
US o w a if not recorded within 30 days of
o W° w approval date approval shall be I a
Uj °D null-and �teiALE IN FEET 66' w
V) N
< V) I N
0 50 100 200 I 3
0
f °
0
LEGEND I o
z z
COUNTY SECTION CORNER MONUMENT, BERNTSEN CAP, FOUND. v
0 1" X 24" IRON PIPE WEIGHING 1.68.! /LINEAR FOOT SFT cal
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner
Address �49 VC®
City /State
k - 0 sr cR
Legal Description: �`, ��Nnk - , �/
Lot Block Subdivision/CSM # NGO � F �cE /�'':
%, � '/, , Sec. _�`'`
Ste, .� T aN RAW, Town of PIN # c
SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer ! - Size ST/PC Setback
from: House Well P/L, fsD
Pump manufacturer Model
Alarm location r
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width —� Length Number of Trenches
Setback from: House /(L' Well , /,gs� PAL ,Z Vent to fresh air intake
ELEVATIONS
Description of benchmark -�� y Elevation
Description of alternate benchmark G ,;,���,., // Elevation
Building Sewer 1 ST/HT Inlet ST Outlet - ? , .12 PC Inlet
PC Bottom Header/Manifold 9 5 719 Top of ST/PC Manhole Cover >!S 7 ,
Distribution Lines ( ) - 9
Bottom of System
Final Grade O yap q O ( )
Date of installation p mit number , State plan number
Plumber's signature / License number , y' Date
Inspector
Complete plot plan
6a y 'a nd Buil dings Dep artment of Commerce
dings D ivision PRIVATE SEWAGE SYSTEM Count
r•Safet'adings D y'
ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryJ1071y".
Personal information you provice may be used for secondary purposes [Privacy La %X, s.15.04 (1)(m)].
P 13U1{g8H i s NEY ❑S�I/$P [] Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Descriptio Parcel TiGij12.:2068- 60-000
I IUD ''
TANK INFORMATION IfLEVATION DATA A9800144
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic t _ 116 Be nc g ar
Dosing 14AM (n) y cl +? 4P/ .2 1 -,b7 ''5., c /
Aeration Bldg. Sewer 6� q5 I q. - 7�x &
Holding St /4 Inlet 95. 01f
TANK SETBACK INFORMATION St /* Outlet 834 1
TANK TO P/ L WELL BLDG. Ai to ROAD Dt Inlet QQ
Air Intake fj3• y�' /�� S� ? Z . U%
Sep ' C"t U Z nt) NA Dt Bottom �.(� J r a09. 2 7
Dosi rtm I 1 p' 3 3 � N d A Header / Man. 1 o G.89 X13 � aj
Aeration NA Dist. Pipe m q2 W
/� B 2
Holding Bot. System /Co 91.5
PUMP/ SIPHON INFORMATION ,57 61 kvi Final Grade
Manufacturer C Demand 9 PH,,,, AJ 4.5 7,7o 73' - 7
Model Number WgOu11 GPM
TDH Lifta . Lrictio G System.. TDHa(p. F
Forcemain Length J v Dia. Z" Dist. To Well
5 BSORPTION SYSTEM '' [
BENCH Width Length No. Of Trenches PIT No. Of Pits iqui pth
DIMENSIONS / 5o -- DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
CHAMBER
INFORMATION Type O I� ��r `� / -� OR UNIT Moe Number:
Syst
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) ' L , r , x Hole Size x Hole Spacing Vent To Air Intake
Length � Dia. Length Dia. `'� Spacing AV Z?
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 12.30.20.767B SW, SE y 1 � 61 n 3 r - 28TH STREET
1 t A
A -f . r3 M, .- �r I (v; q j -wl I �j ICJ' �Yr>�� v�" v"�/d lAd i� ltiw(/L
Plan revision required? ❑Yes � No � (� �� � I J
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspectori Signature rt o
Vi sconsin SANITARY PERMIT APPLICATION 1E W shngtonAve
20 P.D. Box 79 79 69
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, 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 ernlit umber
you provide may be used b other government agency programs 7S
The information
Y P Y Y 9 9 Y P 9 ❑Check if revision to previous app Ication
(Privacy Law, s. 15.04 (1) (m)]. (�
U State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Prop y Owner Name Property Location
�1/4 - 1/4, S T , N, R or&
Propert 0 nfrs Mailinq,gd�dress _ Lot Number \ Block Number
SIA �
City, S to Zip Code Phone Number Subdivision Name or CSM Number
11. TYPE OF BUILDING: (check one) ❑ State Owned °❑ O Nearest Road
Public EY 1 or 2 Family Dwelling - No. of bedrooms M Town of -
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo /- 0. Q 0. 7(Q 7'6 0—?,,-2
2 ❑ Assembly Hall 6 E] 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. K New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an
------ System ________ System_____________ Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure d o t 42 ❑ Pit Privy
13 ❑ Seepage Pit (� o �- 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. /i ch) Elevation
QQ , S$ Feet Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. coy Fiber- Plastic Exper.
New Existin Gallons Tanks Concrete Steel glass App.
structed
Tanks Tanks
El El ❑ ❑
ift Pump Tank — ❑ ❑ ❑ ❑ ❑
VH — RESPONSIBILITY STATEMENT
I, the ndersigned, assume responsibility for inst lation ofthton sewage system shown on the attached plans.
Plumb r' ame: (P Plumb "s S atur o ps MP/Mr: No.: Business Phone Number.
– �X , "I V_:;.L, I
Plumber's A( dress treex�ity, S t , ip
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing gent Signature (No Stamps)
Surcharge Fee)
Approved ❑Owner Given Initial �� /
Adverse Determination OU
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
M -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
Te(�oos�o aP�oes.�'a
a J;I ( Ors 1 66vie
KmD at)
5 9f3
G' o
4x b �,
Il ran t�,r
13
op
v ly--
Wisconsin Department of Commerce SOIL ANQ_SLT.F,EVALUATION
Divisiori.ofSafety and Buildings Page of
Bureau of Integrated Services in accordaryes s:'ILHR 8 :.% Wis. Adm. Code
`� �f County
Attach complete site plan on paper not less than 8 1/2 x 11 iO{ hes In si , n;mlt 3t /
include, but not limited to: vertical and horizontal reference.. d*(BM), estiori a[�d
distance to nearest rod
percent slope, scale or dimensions, north arrow, and locati6n aAd
t r -o3 Parcel I.D. # /-
APPLICANT INFORMATION - Please print a/ fQrmatio� R 771 ed by Date
. __, � 9
Personal information you provide may be used for secondary purpose (lv y La (jQrzr�jF:
Property Owner
Property Location
' j Govt jeT' 1/4_. 1/4,S T 3 N,R_ ,L(or�
Property Owner's Mailing Address Lot # Block Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow l 06 gpd Recommended design loading rate , L bed, gpd /ft . :Q trench, gpd /ft
Absorption area required QS S-K bed, ft ��<5' trench, ft2 Maximum design loading rate bed, gpd/ff gpd/ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site c nsiderations
Parent material ? Eo Cif* 1�tS� —� �4_ 4. 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 ®S ❑ U 1 ® S ❑ U ❑ S IR U ❑ S ® u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench
,
- s — J
Ground
g elev.
Depth to
limiting
factor
Remarks:
Boring #
Ground
el
ft.
Depth to
limiting
factor
Z2Zin. Remar
CST Name (PI a�,int) Signature Telephone No.
I —
Address Date CST Number
��a "'� �c'x�/ ..s'c� � sk � s,�c ,l7• T.3�rY- �d u1
wk i�
Sd r
C
6 j
S
>- I�e �r %\
p 0,3
as
4
Qf
P A& E OF
• PUMP CHAMBER CROSS SECTION AND SPECIFICATIO
Xulsew
VENT CAP
� VE147 PIPE
WEATHERPROO APPROVED LOCKING
r JU WCTIOM BOX M COVLR WITH
? 2S' FROM DOOR, WINWING LABEL
WIMOOW oll FRESH It'MIU.
AIR INTAKE
I
GRADE
I y„ MIW.
le`nlu.
colJDUlr ` --
la`nIW. v ______
PROVIDE I
IAILE T AIRTIGHT SEAL I I
7
APPROVED JOINT A ( I APPROVED J011J1
W/ PIPE I I I ( w/ PIPE
EKTEN01W6 3' I I ALARM E%TEUDI►1G 3'
ONTO SOLID SOIL D 11
ONTO SOLID SOIL
I 1
ow
C
I
CLEV. FT. PUMP —� - -�
b o FF
0
CONCRETE BLOCK
RISER EXIT PERMITTED OIJL9 IF TAWK MANUFACTURER HAS SUCH APPROVAL
3" APPAoVEN BEDDING un dcr 'rrk►aK
SEPTIC E SPECIFICATIOIJS
DOSE J_
TAWKS MAWUFACTURER: i4Lz IJUMBER OF DOSES: PER DA-4
TAWK SIZE: G LLOUS DOSE VOLUME
-�{�
ALARM MAWUFACTURER: INCLUDING BACKFLOW: GALLONS � ■�= _G
MODEL 1JUMDEK: CAPACITIES: A UICAESOK GALLOus
SWITCH TYPE: LPL g = INCHES OR GALLONS
PUMP MAMUFACTURER: 1 ` C = 9 I►JCHES OR 17131 GALL0U5
MODEL MUMBER: 14 � �1 5 ���/� D- r INCHES OR L )6ALLOMS
SWITCH TYPE: 2L MOTE' PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE - GPM �!_2_ INSTALLED OM SEPARATE CIRCUITS
VERTICAL DIFFEILEUCE OETWEEW z�
PUMP OFF AWD DISTRIBUTIOW PIPE.._ FEET
+ MIIJIMLIM NETWORK SUPPLY PKE SSUKE . . . . . . . FCET
+ FEET OF FORCE MAIN X I- L- !Y,► T . FRICTIOU FACTOR.. ys FEET
TOTAL D'JUAMIC. HEAD — FEET'
IIJTERMAL DIME.IJSI S OF TAU ' LLCOGTM �1�/ LIQUID DEPTH
SIGIJEO: / LICENSE IJUMBER: OATE:�ey�� -�
Performance z>uumersme tinue
Curves s Pu m P
METERS FEET
90
25 MODEL 3885
�° SIZE 3 / 4 " Solids
WE15H
70
20 WEIGH
O WE07H
h
15 50
W E05H
40
10 WE03M
WE03L
S
10
0 0
0 10 20 30 40 50 T60 70 80 90 100 110 120 GPM
L L
0 10 � J
� 30 m'R1
CAPACITY
h'a'GOULDS PUMPS, INC.
METERS FEET
120 MODEL 3885
35 110 wE, SHH SIZE 3 /4 " Solids
100
30
90
25 80
70
20
60
O
h
- --I I
SO WEOSHH
15
40
10 30
20
S
10
0 0
0 10 20 30 40 50 60 70 60 90 100 110 120 GPM
L L
0 10 20 30 m'/h
CAPACITY
•1 HS Goulds Pumps, Inc. EIMCYve.July, 1M
C)II1'
i
DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY & BUILDINGS
INDUSTRY,
LABOR AND PERCOLATION TESTS 115 DIVISION
/ P.O. BOX 3707
HUMAN RELATIONS MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION:T2 e N O.: S
UNICIPALITY: LOT NO.:BLK. NUBDIVISION NAME:
%4 /I,f N ARo�DE (or 5C � o.., �r 5 e
COUNTY: OWNER'S BUYE 'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1 PERCOLATION TESTS:
L I Residence New ❑Replace I �1 ` 4
RATING: S= Site suitable f sys tem U= Site unsuitable for system 7
ONVENTIONAL: MOUND: IN- GROUND PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional CX OU
CZS JV
If Percolation Tests are NOT required DESIGN RATE: I If an portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH 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.)
aZ 7. 7
b r , /S 4,-
.,,t. >
b `lv e' 7d2 -6
B- �. - 5 /� 7,Z
B -5 702 �h.S
B-
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 PERIOD 3 PER INCH
0 u - L
P - G
P-
l
r 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 J�
Ad
kof
o
3
kon
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State ti O'c Parcel Identification Number
LEGAL DESCRIPTION
Property Locations '/ - 5,F '/4, Scc. � T 3O N -R- W, Town of
Subdivision — _ , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # ;�77/�,Q , Volume ,Page #
Spec house ❑ yes 0 no Lot lines identifiable ❑ yes B 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
masterpluntber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewat.. rdisposal 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 u-tdersigned 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 of the three year expiration date.
Ll
�+ AMk , C
SIGNATLUE DATE
OWNEI CERTIFICATION
I , .ve) 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 proper:, described above, by virtue of' a warranty deed recorded in Register of Deeds Office.
"916NATURIF,W APPLICANT / DATE
* * ** ** Any infnrmatinn that it mie rrprr { may result in the unitary permit being revoked by the Zoning Department. * * * * **
*• lnrintlr ��Ith Ihi� nitltlit �tlinn .I .f,uul J niarw dretl fiom fhr Rrf i.fri of Drrv1'; „fticv
a copy of the certified survey neap if reference is made in the waiTanty deed