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HomeMy WebLinkAbout032-1047-30-110 \¥ )7 ? \ / & \ o \ � ) � } 2 \ � 2 � \ \ � \ � 4 � \ � \ z ) ) k \ LL 0 a : » 7 � . � ! � / j \ E §\ �p ®§ $ \ CL k B \ 2 \ § Z E \ ! \ / } .� \ \ƒ ƒ ) ' 6 0 Q ) ) k ` ) � C 2 \ ) E ƒ \C CO co CD \ \ & k 2 ) A / @ 8 ƒ r} \\ k k k a_ co \\ j oo� & \ \ \ § \ \ \ k ƒ ti \ ) \ \ 2 \ ^ * co = - < >o « E o £ 2 / 2 a $ \ ) $ \ k :#M� \ / / \ — k\\ s { 2 w 7 G G \ \ \ $ / { 2 / % q ƒ \\ a < e a = / 3 a 7 , � § / / G § / \ 6 g o / $ } ) / \ § C � / CL j \ \ k L Wisconsin Ddpartment of Industry SOIL AND SITE EVALUATION Nnbor and Human Relations Page —L of 4 Division of safety and Buildings 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 5t - e v- o`t X 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 a _ 0 4 yb Dap te O O Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1 0 A an d Govt. Lot S E 1/4 5 1/4,S ' (p T 31 N,R ) 9 E (or)(5 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# a%'3o ct� T I v8 Pair D O , —* �o City 8tate Zip Code Phone Number ❑ City ❑Village © Town Nearest Road Scti. r •.t W 2 54ca (7I S )a y 7- 127 S Ct R Z ($ New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 5a gpd Recommended design loading rate . 7 bed, gpd/ft - Q trench, gpd/ft Absorption area required 12 y 3 bed, ft _ a42.5 ft2 Maximum design loading rate . 7 bed, gpd/ft •9 trench, gpd/ft Recommended infiltration surface elevation(s) •0 V ft (as referred o site plan benchmark) \ Additional design /site considerations \ Am k % \ L �5 Parent material 04kr. 0,M �_� ��> 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 1$ S ❑ U 1$ S ❑ U ® S ❑ U rA s ❑ U ❑ S ® u ❑ s (4 u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 046 3 S I F lnuFr .� .9 a -Z -7.5 Y e, g111 s Ground 3 - y 1,5 Q S/ - - S O- elev. -9 C ft. I m, Y/Y o Depth to limiting fa for in. Remarks: Boring # 0 -1t 1 C%< R S ea L S FS n►v F r Q F, In L C Lo 3 a u •33 7. S YK s4 S ©- Ground 33 - 1 b'19, y` �-� d ` elev. I , Depth to limiting factor _ O in, Remarks: CST Name (Please Print) Signature Telephone No. Too. V n44 S par 715 -a44 -3S88 Address Date CST Number S4 O':klo II jl� ol wi t IeL t� 4/6 Y C� - - - — - ------------- � c cs -L.J 60 "1 7 as+ rn OL 1* Y _Y -A 41 ---------- : Ll cy% f va. iL I o 0 3 7_12! 1 1 4 - - ------ ----- ------- RA C�d� a Al P I 1997 FILED c N... SEP 0 9 1997 ► ST. CROIX COUNTY ". KATHLEEN ' SURVEYOR'S RECORD �' C �t - Register of Deeds St. Croix Co., WI LOT 2 CSM VOL. 8, PG. "2116 --- - - -- - -- — - -- Z (N00 ° 1 6'30 "W 660.06 S00 041'21 "E 658.84' 159.51' 499.33' 94't co 1 r0 °'�'° 00 iv �-+ �0 �cn O -' L. O I o > X Ln � m cn 97't N yQ w N00 °24'51 "W 267.19' 9 0 z rn Ili - 0 ' 00 u+ (NORTH 268.10') -^ �.O N tt ct O N -. mm { t'' - n - n 4r CD w 1 O ° c ° c o m 00 1 0 00 C 2 0 V1 O w o m cn o n + n In F N N Ln W ' W O W ul I O v .� 1 ° to r IC z w ° -' o N V H t." n 10 00 N I , (1) w o 71 lr V1 � 1. I�N• 100 -,j °` 0 z —t _ •-~ 00' build se tba f rom R - - lb - o - n �� -- - -- W ZZ as fifi d N 0 n I� V � °°ice ~� b c o�� 1� c c O H Al ' 1 e CR ( � s m rn rn M-h O 1 i < 0 0. a C� p c t m 1 .22' 110.49' .. 0 (SO0 0 00'00 "W) 0 c y N00 °24'51 "W 00 °24'51 "W 274.71' _ °0 n 11 0 1, 3 (N00 000'00 "E 274.741) N00 ° 24'51 "W m ' j p W c 117.25' 00 N00 ° 24'51 "W " l0 / � N m 5C M.,. o N "' o 1063.50' 159 .71 ' C� N 0 0 East line of the SEk c ' ' 0 H lm En 0 m N00 °24'51 "W 2661.21' - N ~' c (N0 ° 00'0 0 "E 2663. 20 1 ) �C C rt >> CTH I „ x cn o o o, O 0 N fi y cn - n - n r • f f � ° ° c , ° c ° c n m N b C 1 N ST. CROIX COUNTY ZONING DEPARTME A '' AS BUILT SANITARY REPORT «� `l 1 11 RECEME0 Owner __; U N Address oZ C J -� Sr cROlx -' COUNTY City /State \ 7- ONINGOFFICE 4 Legal Description: Lot .3 Block Subdivision/CSM # '/. '/, fE Sec. TAN -R4W, Town of Corr, r_�� PIN # 3?- /t� '- 30 — /ja SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer l� ` S Size ST/PC /® Pump manufacturer �-- Setback from: House Well 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: ge Width _ /,g?- Length �,�� Number of Trench Setback from: House 3/ Well o /L s �— w l/5 Vent to fresh air intake _ 3/ ELEVATIONS •�, �o l /D� o� s �� /h Description of benchmark Elevation r Description of alternate benchma C u� t? S� rev oS� Elevation Building Sewer o ST/HT Inlet ST Outlet PC Inlet PC Bottom I Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installatio Permit number ( State plan number Plumber's signature License numbe Date / A Inspector +� j 53a— ('omplcte plot plan � 1 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarXP�un }t1VQ.: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)], �errllitf3n1deF5 NarOTT C��SI�lIL []Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel /O� /oQ (o 'd �1047 -30 -110 TANK INFORMATION UIA: ELEVATION DATA A9800076 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Sep i GG 1000 Benchr- &-D /0(o• °d Dosing 44, 9,YA q 41 �G Aeration Idg. Sewer /. Gf 7 / � y q Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 2-o5- jq -O TA TO P/ L WELL BLDG. Aµeintake ROAD Dt Inlet Septic f` f f NA Dt Bottom Dosing NA Header /Man. IZ -�i� q 7 Aeration NA Dist. Pipe Holding Bot. System �o �'02 -S PUMP / SIPHON INFORMATION Final Grade /0•'7q 35 Manufacturer De nd �� /o• ��• Model Number Z GPM TDH I L' Friction System DH Ft cl Forcemain Len Fi D,st SOIL ABSORPTION SYSTEM DIM NSIO Width 1 L / Length S ,� No. Of Trenches p[ No. Of Pits Inside Dia. Liquid Depth DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION — Type O I CHAMBER Syste `L �" OR UNIT a Num DISTRIBUTION SYSTEM Header / Manifold I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length _ Dia. Length .�) � Dia. Spacing t W\ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only u � + Depth Over 1.�It it I Depth Over xx Depth Of - xx Seeded/ So Bed/ Trench Center W Bed /Trench Edges _ Yes ❑ N o COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 16.31.19.239A10,SE,SE 2124 CTY RD - X i ., ki . �5 M — Be 4 VIA 6� s fej Kl a leo ve b l a�9 5� wer I� gT4 , JWom ov+[4I D 6 Plan re isIo k ed Yes ❑ No Use other side for additional Information. (O SBD -6710 (R.3/97) Date Inspector's Sign � 7 SANITARY PERMIT APPLICATION 20 Safety and 1E Was B n g o ng A ve sion `•ISCOnS� In r P.O. Box 7969 Department of Commerce acco d with ILHR 83.05, Wls. Adm. Code 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. , C rt> • See reverse side for instructions for completing this application State Sanitary Permit Number The information y ou p rovide may be used b other g overnment a i nc p rogra ms D �7�.�3�p Y P Y Y 9 ,S1 , Y P 9 ❑Check if vision to previous a lication [Privacy Law, s. 15.04 (1) (m)J. a / a q � - Ty ^T State Plan I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATION Property Owner Name , n Property Location I f c_/ 1/4 E 1/4, S / T �l , N, R �� E (or OW Propety Owner's Mailing /idres /► J � Lot Number Block Number City, S atg Zip Code Phone Number Subdivision Name or CSM Number (,J 6s/,9_ 1 ( (O/ Z)vo26~ 569 CSM S o I 12 33 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It� Nearest Dad T . 3 VII age Public 1 or 2 Famil Dwellin - No. of bedrooms own OF a III. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment /Condo /& ' 3 /' 'q' A39A10 �! �ti) t/ 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 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 11,23Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , r 42 [] Pit Privy 13 E] Seepage Pit �Z' 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 Requ red (sq. ft.) P (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation b �- - J Feet Feet VII. TANK Capacity in gallons Total # of Site INFORMATION Gallons Tanks Manufacturer's Name concrete Con- Steel glass Plastic A pp r . I ng New Exis structed Tanks Tanks Septic Tank W d E49 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ J ❑ I ❑ I ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. y Plube 's Name: (PriaLL Plumber's S n e: (No Stam MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, Cit tate, Zip Code): 6 5Y0 I IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issui Agent Signature (No Stamps) A roved Owner Given Initial Surcharge Fee) pp ❑ 00 %a0 31 1 f 9B . CONDITIONS OF APPROVAL. A Sa°ffiiaw.c -� S1�s.vtcicta�5 St•croif~ Co�,L SBD -6396 (R.11/96) DIS 1.1 TION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT Scott Bickford ADDRESS 4790 Centerville Rd. Aot #213 White Bear Lake Mn 55127 SE 1/4 S E 1/4S 16 /T 31 N R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 3532 DATE /30/98 BEDROOM 3 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12 54' BENCHMARK V.R.P. Top of Survey Pipe ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL •H. R. P Same as Alt. B.M. SYSTEM ELEVATION 92.5 Alt. BM T op of Survey Stake/Fence Post @ 97.1 500' Prop Line VENT 12" GRADE . qTWAR COVERING 1 " 3 ' 3' R K 161' Alt. 267' Property Line 0 ' 5 ' B -2 30 ' B -4 130' i -� ent 601' Rep A S CCw); x OU NTI' Lin Pro p erty 0' N OFFICL B.M. 3 P p( 60 12' X 54' Bed L ine -5 B -1 5 ' 15' 1 30' 10' ro 3 Bedroom Driveway House County Road I PLOT PLAN PROJECT Scott Bickford ADDRESS 4790 Centerville Rd. Ant #213 White Bear Lake Mn 55127 SE 1/4 SE 1/4S 16 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 3532 DATE 3/30/98 BEDROOM 3 CONVENTIONAL M IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X54' BENCHMARK V.R.P. Top of Survey Pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P. Same as Alt. B.M. SYSTEM ELEVATION 94.5 Alt. BM Top of Survey Stake/Fence Post @ 97.1 500' Property Line VENT 12" GRADE TYPAR COVERING 12 °' 3' 6' 03' " SEWER K 12' 161' Alt. 267' Property Line 0' 15' B -2 30 ' B -4 130' ent 10% 601' ; ` Rep A S Property 0' Line B 3 B. M. 33' 60' Property Line 12'X 54 30' ed 1 5' 15' -5 B -1 15 T 30' 10' Pro 3 LV Argas-� Vj?A( Bedroom Driveway House County Road I Wiscontin 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 C r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # -� — ��7 / ' APPLICANT INFORMATION - Please print all information. Reviewed by Data Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I Property Owner (/�' Property Location 7 C.l. A' Govt Lot 1145 r— 1/4,S 1 T 3 ) ,N,R j E ( W Property Owner's Melling Address Lot # I Block# I Subd. Name or CSI# City State Zip Code Phone Number gam/ ❑qty 11 Village Teem Road //illf / 27 (r6 1) �.�fj . So New Construction Use: %Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: �( Code derived daily flow - 5-4pd Recommended design loading rate � � bed, gpd1V , v trench, gpd* Absorption area required 6 _ bed, ft 61 trench, ft2 Maiamu design loading rate _ bed, gpd* � - trench. gpd* Recommended infiltration surface elevations) ?r l /9 O A 9 0 2, , ' ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable on/ p► ft S = Suitable for system Conventional Mound In -Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system RS ❑ U 'K S ❑ U Ws ❑ U -0 S ❑ U 1 ❑ S ,K U EIS % U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/Ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B , Trench 1 0 -6 /O L v2 - i d r r /Z 1A1 r Ground elev , Depth to limiting factor / 3 .2 Remarks: Boring # + O_g a 8 Ground elev. �ft. Depth to limiting ;� facto in. Remarks: CST Name (Please Print) Sitinature Telephone No. Address Date CST Number Zi ��� 5�d�1 3-30 - 9� 9 Soil Test Plot Plan Project Name Scott Bickford Shaun r Address 4790 Centerville Rd. Apt # 213 W hi te B Lake Mn 55127 CSTM #3922 Lot 3 Subdivision Date 3/30/98 S E 1 /4 1/4S16 T 3 1 N /R W Township Somerset E] Boring ()Well PL Property Line County ST. CROIX J k BM or VRP Assume Elevation 100 ft. T op of Survey Pipe System Elevation 9 4.5/92.5 *H R p Same as Alternate Benchmark Alt. BM T op of Survey Stake/Fence Post @ 97.1 500' Property Line 161' Alt. 267' Property Line 0 ' 5 ' B -2 30' B-4 130' Pri A Rep A 10% 601' Slo e Property 0 Line B.M. 60' B -3 41111 Property Line 30' B -1 5' 15' -5 30' IF Pro 3 Bedroom Driveway House County Road I IT- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A Mailing Address Me ���� '�z ���� � ��� �5<7�� Prgperty Address (Verification required from Planning Department for new construction) City /State 5t>aerne�t (A_. L. Parcel Identification Number LE GAL DESCRIPTION Prop Location �S ' 1 T P Y /4, _ /4, Sec. N -R � W, Town o f���,, Subdivision Lot # Certified Survey Map # �-� , Volume ,Page # Warranty eed # �� �i `~ ty 7 ,Volume ,Page # Spec house ❑ yes.,4, no Lot lines identifiable l$yes ❑ 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. 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 of the ear expiration date. GNA 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 pr erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. � 3 /�Iol SIGNATURE 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 r� A x 4; SEP I 1 1997 FILED 9 sr. CROiz COUNTY U S E P 0 9 1997 SURVEYOR'S RECORD z III (Z KATHLEEN H. WALSH � I . 94 �i o 565 1.10 LOT 2 CSM VOL. 8 PG. '2116 IZ (NO0 0 16 1 30 11 W 660.06 x ra S00 0 41'21 "E 658.84' S �ti 1 499.33' 94't (A 0 w S.- I H x Ln O 3 r 'O On I N N O% o _ r N M �. I w r I Cl1 w 42* ln_ O C% L> O // � x N N A W 971t vl N00 0 24 1 51 11 W 267.19' G N - ' ( NORTH 268.10') I - o N m K cr N A^ O SS In 0 D y (A .'.. W IN -n 'n mm Z w . 10 O O tri � oo (y c'oc'a o o 'c' co N m to 0) N 7 A Iymr� L9 4- MID V1 �i O N N I En O co t :. w 00 Un w N N C� N Z Z .i W zn C W O V 10 10 o z w �o 0 10, M w 0 m , 100' build se tba - - f rom R` - - W fi b---4 A+ 3 � rr0 � m 00 CO ct !A o • C% O "'p t01 lD c c 0 ►'3 A) 7 ' 164.22' 110.49' ^' j a ° (S00 'W) J s o o o 00 00 N 0 NOOo24'S1 'W 274.71' 0 N00 024'51 "W N '" 0 M 0 rh 3 c 1 17.25' 00 00 E 274.74 ) 117.25' o =' N00 ° 24'51 "W cm 0 rn a _ 0 N00 24'S1 "W o o O P. rt 'C7 w 1063.50' s cow N D 0 M o p to East line of the SE4 1591.711 0 ¢' M m m N00 ° 24'51 "W 2661.21' °- 0 , c (N0 ° 00'0 0 "E 2663.2 p 0 m 10 C,T,H, „ � c=�'`� oa+' f K fim 0 cc g z O • ° c n z N CJ N