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HomeMy WebLinkAbout032-1027-70-100 M O M C Q� Ir C Q N I N I tl ' C4 I O z 5 O C Z 7 t6 LL O Q I 3 Cl) rn U £ z o 0 m a O C) W a m 0 O z _� N Q N N Fly � m O N Q U N O q z m z N zo v N CN E IL CL m 2 W d 2! N T O O O O G C CL m 0 0 0 N N N Q O N N N N � 'O V O O O !, Z > H H H .h_ N N N E 0 0 0 n m ° o 0 0 Z • U) CL CL CL CL try a .. g m ao Go N � o y o fA J U as rn O N 7 O LO (0 co m cF 0 o 0 0 O N N N CA C cu f0 N A ❑ -p 7 �+ O N N p C o c ! a c E 0 0 0 0 V O N pj N I � C � C N4 r - I O M 00 co 14 N W ! -O Q 0 0 0 �I N M Y ti a •° <a r • �' O <n Y r o 0 Z w U O V CL 0 `� 1 A U a '',', 0 m (3 • Wisconsin' Department of Industry 11 SOIL AND SITE EVALUATION r and H Page of Lalpuman Relations g Division of Safety and Buildings. - ance with s. ILHR 83.09, Wi Adm. Cod Attach complete site plan on p em:not le��jj �x 11 inie;; 'n size. Plan must unty include, but not limited to: verA c tand hots a erence poi�i ), direction and percent slope, scale or dimen>{ions, north arrow, and Itipn amid di tance to nearest road. 2 ,-„ _.. Parcel I.D. # cc APPLICANT INFORMA 115N - Plea$�gf al It, ation. R e Date Personal information you provide ma be mised for. ose dv by law, s. 15.04 (1) (m)). Property ner Property Location f� /� Govt. Lot �fi 1/4�� 1 /4,S T P ,N,R E (or� Property Owner's Mailing Address Lot # Block Subd. Name or CSM# City - S tatA Zip Code Phone Number ❑ City ❑ village Town Nearest Road -r New Construction Use: FR Residential / Number of bedrooms Addition to existing building ❑ Replacement ri Public or commercial - Describe: Code derived daily flow _ZZ gpd Recommended design loading rate 7 _bed, gpd /ft gpd/ft Absorption area required 25, bed, ft �trenc 2 Ma ximum desi g g / bed, gpd /ft trench, gpd /ft n loadin rate i -7 Recommended infiltration surface elevation(s) 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 I AT -Grade System in Fill Holding Tank U = Unsuitable for system 0S ❑ U r S ❑ U ® S ❑ U (0 S ❑ U ❑ S ®U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground elev. W ft• Depth to limiting factor Remarks: Boring # ........................: Ground _ 5 _ elev. Depth to limiting -M facto in. Remarks: CST Name PI se Prin) Signature Telephone No. Address Date CST Number :07—e ell ) ' 7 . . . . A z: 126- 1 // z 5� �1 2 le f j f a • y . CERTIFIED-SURVEY M-AP LOCATED IN PART OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER AND PART OF THE SOUTH— WEST QUARTER OF THE NORTHEAST QUARTER OF SECTION 10, TOWNSHIP 31 NORTH, RANGE 19 WEST, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. OWNER Joe Plourde UNPLATTED LANDS 220 CTY. RD. "I" 000 — SOMERSET, WI 54025 W N ..• u u u .West l i-ne of the S $ of • the• NE% w u+ H N00 ° 31 ' 01 "E 664 3' S / 454.06' 209.97' N / Z W N" -+ cv N IC 10 H -on W z Ir o w 1 m It v I--� W C lI m I� ° N ° ch O N O -10, c► ... .. v.0 y Id. >t<c Q. N W IV ° b N a. i c W p � o K to Ir ao O z ° u+o IZ / tn IZ ° oc c v IC7 w l=J IC o a = 1401 IC/) n / w IC/) ° O w a C d N Q 7 OHO O m II ! ct n w 411* O W ..� F m c N CO N O N N w W 7 t Q r r a [�4 F cn y w S00 0 35 1 00 11 W 230.00' N00 ° 33'00 "E i �. �... ; 131.3 ._. - -- °i <C O O ct 10 '° a a 0 IZ w r IlT1 - - (A 0 0 0 -w w ct II t g m >> a v o ca co N00 ° 35' 00 "E °; Z y IC/) ° o - o 0 0 Id w 284.00' w m i3 u ° 0 m w It— w In I 66.00 O S ' 11 -r ° 0 o n ° IZ �,+ I y n C� o 10 cv ° o .— rt fm 100 to ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Address 12,2Z n ?? j City /State S Esc `'�J� �j o /' �� -O NTr 1 Legal Description: Lot Block Subdivision/CSM # - - ' /.' /. Sec.,, TN -R��W, Town of y' PIN # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer e a !s Size ST/P� Setback from: House J0 ! Well 11g P/L -, ' J Pump manufacture_ r- 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: Width Length S Number of Trenches Setback from: House � Well _�1/b P/L T Vent to fresh air intake _ :z 7 D A/ ell ELEVATIONS Description of benchmark CZ o o k el 1 7 J '10 Elevation Description of alternate benchmark cv er v c Elevation Building Sewer ST/HT Inlet _S ST Outlet- PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover fl- Distribution Lines( ) __ Bottom of System () () ( ) Final Grade Date of installation e/, Wermit number 977 _ State plan number '— Plumber's si aturre'� License number Date � Inspector complete plot plan Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 3 P Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. / y �3 Permit KIRK, H PAUL & MELINDA l im m a ag e Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: �� Parcel �'��- 1027 -30 -000 TANK INFORMATION EL VATION DATA A9800186 MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi Benchmark /.-7 f 0/2 / c� Dosing At+ -AM F 47 Aeration Bldg. Sewer Holding Inlet (o•�� TANK SETBACK INFORMATION (!P1A Outlet 7.2-Z TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet A'rintake , i NA Dt Bottom Dosing NA Header / Man. Aerati n Dist. Pipe 7.7S r Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 7l q6 .q Manufacturer Demand �'1 y�/u�/e '(03 dIG . p7 Model GPM TD Lift Friction S ste TD L oss Forcemain Lengt Dia. Dist. To We SOIL ABSORPTION SYSTEM DIMEN T RENC H Width lZ , Length S R . No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I SYSTEM TO P/ L I BLDG WELL LAKE/ST EAM LEACHING Manuta SETBACK lr �O' CHAMBER er: INFORMATION Type O • _ � Syste DISTRIBUTION SYSTEM Header / Manifold 11 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Int ke Length _ Dia. Length Dia. L / Spacing 6!:: A- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over e , Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center34 q Be es U NO COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 10.31.19.130A,SE,NE 2268 CTY RD I Z. 7 7) Plan revision required? ❑ Yes [n No h g I Use other side for additional information. 0 SBD -6710 (R.3/97) Date Inspector's Signature ert. No. Safety and Buildings Division - SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue �scons�n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. sr- C f- / • See reverse side for instructions for completing this application state sanitary Permit Number 30779 Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. a a IR 4 c Ra X State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Pro erty Owner Name Property Location ac %, /itid w r SE 1/4 NE 1/4, S T 3 f , N R 19' E (or) Property Owner's Mailing ess Lot Number Block Number Citt! tate Zip Code Phone Number Subdivision Name or CSM Number /� rn -� J,1% . TYPE OF BUILDING: (check one) ❑ State Owned ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ,3 ❑ Town OF Al • 5VIVe r4r, t 4 , 2.P— Z III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) -70- /00 1 ❑ Apartment/ Condo /0. 3/. /J. 13 1 C b �� ^ l CA 7 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 E] Replacement 3. E] Replacementof 4. E] Reconnection of 5_ E] Repair of an ____System ________System Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check onl� one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 C4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit / 2- X w 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.) Proposedfsq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 7`� ( I 0 f e • 9.3. Feet feet VII Ca . TANK in gall ons ac t Total # Of , Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name concrete con - Steel glass Plastic App New Existin structed Tanksl Tanks eptic an �� ❑ ❑ ❑ 1:1 E] Lift Pump Tank /Siphon Chamb ❑ I ❑ I ❑ I ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. lumber's Name: (Print) Plumb Signature: ( Sqm ) rP/MPRS No.: I Business Phone Number: rI 4 /Lo 'r��r 33 / Plum ; Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Inciudes Groundwater ate ssue Iss ing A Sign ture ( q Stamps) Surcharge Fee) Approved ❑ Owner Given Initial g 6 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT PAUL KIRK ADDRESS 833 W. RIVERVIEW. SOMERSET. WI 54025 SE 1/4 NE 1/4S 10 /T 31 N/R 19 W TOWN N. SOMERSET COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 -� 5/24/98 BEDROOM 3 DATE CONVENTIONAL X IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 GAL LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 643 BED SIZE 12 X 54 BENCHMARK V.R.P. NAIL IN POWER POLE ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. SAME AS BENCHMARK ALT. BM BASE OF WHITE STAKE 96.9' SYSTEM ELEVATION 93.4 PL VENT 12" GRADE TYPAR COVERING 12' " SEWER R K 12' a PL 777 j/ PRO HOUSE - m P RO GARAGE o' 40' T 15' B -2 T. BM 60' B -1 0' -- - _----- RKI��- - - - - -- 1 - - - - - - -- - - - - -- 15' 30' ----- - - - - -- -- --- - - - - -- REPBA-3 15' B -5 60' -4 5' 173' V CO. ROAD I ' Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code 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 r p / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information R44Ned by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). C Property Own r Property Location t Q4 J / Govt. Lot �� 1/4j'�1/4,S/© T�/ ,N,R E (� 414 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# vcr rw IZ4 —' City State ®® � Zip Code Phone Number F city El Village OT n Nearest Road Y` e Gl/� ' 1 0,2 J /5-�ayJSEKoZ o M f New Construction Use: [,5k9esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: C� " Code derived daily flow 4,50 gpd Recommended design loading rate _ bed, gpd /ft - b trench, gpd/ft Absorption area required � bed, ft ,i E> trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 5?.?. - / ft (as referred to site plan benchmark) Additional design /site considerations / ^— Parent material r, Flood plain elevation, if applicable /vz!!� ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [ S❑ U PS — 1 U DO s ❑ U Rl S ❑ U ❑ S N U El S *!T U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench lAzx Ground 4 elev. y� --eft' Depth to limiting factor - ;>,g n. 5� Remarks: Boring # 0 g 10 r3 13 NoN 0'7m 2 mjc R_ I G 5' a �3a p r S /v �N 1� � a G 2 �►Gs C 5 N/4 • S , (C Ground elev. D p h'to limiting >� facto in. Remarks: CST Name (Plea Print) Signature Telephone No. Address Date CST Number Soil Test Plot Plan Project Name Byro ird Jr. Address ,� 3 � Z /g v , �a� CS #3479 Lot l Subdivision Date G/ , q - 1/4 1 /4S T N /R_ /��W Township � ❑ Boring O Well PL Property Line County JL BM or VRP Assume Elevation 100 ft Au. / ,� System Elevation *HRP 47 , Om Rai o4 c434,r Xc 54 / Its'/ �r ( � 6 rs' i 1 73 1 Scale 1/4" = 10 Ft. When Dimensions aren't stated O ��f MAal 15 98 05:54a Renee M. Bird 7152687616 P.1 , d ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address X33 l,J . kk i1eeu1 i e z LA-vJ F— Property Address 6 Cb R.At (Verification required from Planning Department for new construction) City /State 'Z)yme� W Parcel Identification Number 032 LEGAL DESCRIPTION Property Location - 1/,, NE 1 /4, Sec. 16 , T 3 N -Ri 3—W, Town of 5 Subdivision , Lot # Certified Survey Map # '� /,� 20 , Volume l , Page It 3 Warranty Deed # _:5�29 / D 9 , Volume Page # _q,:;8 - _ Spec house D yes �k no Lot lines identifiable `dyes 11 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 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. 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 days of the three year expiration date. QS- �A 1�� 5 /RR8 SIGNATURE OF 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 operty described above, b virtue of a warranty deed recorded in Register of Deeds Office. 5 SIGNATURE OF APPLIC 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 conv of the certified survey map if reference is made in the warranty deed -9 FILED JUL 0 7 1997 pp p KATHLEEN H. WALS 561970 cr mister of Deed SL Croix Co., W CERTIFIElf SURVEY MAP LOCATED IN PART OF THE $UTHEAST QUARTER O,.F,,THF.,-N0RTHEAST QUA P�ER AND PART OF ' TH ­ r — SCrUfH ­ — WEST QUARTER OF THE NOR EAST QUARTER OF SECTION 10, TOWNSHIP NORTH, RANGE 19 WEST, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. OWNER Joe Plourde UNPLATTED LANDS 228OCTY. RD. 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