HomeMy WebLinkAbout032-2070-30-001 (2)Department of Commerce
SafetyWiscoPRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
personal information you provide may be used for secondary purposes (Privacy Law s 15 04 (1)1rn))
Permit Holder's s Name
Doug & Aime Schoenborn crly Village Township
CST BMEIev TOWN OF SOMERSET
Insp SM Elev BM Descnphan
TANK INFORMATION
TANK SETBACK INFORMATION
TANK TO I P/L I WELL I BLDG I Vent to Air Intake I RDA
Septic
Dosing tl L[ I[
36'
PUMP/SIPHON INFORMATION
r 4 ( (y,P`�"
Manufacturer
De d
D U.LQS
M
Model Number 5-1
li lSystem
TDH Lift Friction Loss Head
[.� p
TDH or7 Ft
?3rg3
Forcem[D[ Pia tl Dsl to wen
38[�
SOIL N SYSTEM /Z'
IABSORPTION
BEDIT3 Lt Na Cf Trench s
DIMEN
ZlSETBM
INFORSystem
TO
P!L
BLDG
WELL
V�je�'4
75-'
129'
DISTRIBUTION SYSTEM
HeadaOlvlrifold D sv
u I[ D
Length Dia Lang
SOIL COVER
Depth Over
Bed[Trench Center
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
/�
Alt BM
i
J
� �I-t
J
Flniet
�q t
r
J
i�•SQ
Dt Inlet
7•90
Of Bottom i
lb S
�4�
�3 3o/
Header/Man
Dist Pipe
Bot System
7 �p
i Final Grade
St Cover
I-
r,
PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth
t AKE/STREAM LEACHING Manufacturer
CHAMBER OR
UNIT Model Number
o�.. _ G I r
x Hole Size x acing Vent to Air Intake
Dia Spacing
x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over -x Depth of xx Seeded. Sodded
Bed/Trench Edges Topsoil xx
P Mulched
Yes No Yes No
COMMENTS: (Include code discrepencies. persons present, etc) Ins action #1 2
p C. No tfeco�'to— Inspection #2
Location: 251 OLD SCOUT CAMP RD lyt5re-icm
1 ) Alt BM Description
2.) Bldg Sewer length = rt.
amount of cover = >'tq
3} OhSvrvu�Lsn �� ii•, XrI
Plan revision Requiredti Yes Nob�Z�� �Use other side Tar additional informati I "' � 4sZ/��
� �
SBD•667710 ((R 3W) - Date Insepcior's SignaCen Noture "
1,iaiE �y(9� C� AiN� w(tlti i� • T ul �! l L i S° il�s
<,AM"3._,�.` 0U1
� 7
ltdmary Services Division
Cry
.
4922 Madre Yards Way
j J
Madison, Wl 537U5
Samar Para Neanber (to be fillet m by Co )
r,lY t
P.O. Box 7162
trladi WI 53707- 2
'7 l �6
_
n
Cott Permit Application
Saterramaction Numb
la a000tdamx with 383.2I(2). Wis. Adm. Cod_ n bmiss ow of this form to the , nit
�-
as -wiled >>nor to obanung a —Ifty permit. Ntm : AMbeation form for mre-owocd =R ads iaw b
the matt of Safety and ProfesswW Serviexs. Personal ittkontion you may be used for ancandmy
is acoordence with the Law, s ISA4(I)(m). Scats
Peojm Addy= (if di tl�a �t7uig address)
I. Applicatim Iaformmhte - Please print All Iabrmatiso
&Ihif
arty Owners Name
Pared 0
Property Owner's Mains Address
ft Leon
Zeb, `77b6
/
• 30.
ove La
C'n"da
Y A6E St.6. „ 3
T N R E
City, Sane Zip Code
Phone Number
U. Type of Beald'mg (check all that apply)
Lot rl
101 or Family Dwelling- NtmeberofBe mmw
/
Subdivision Nye
Elk"wyCornwnercial — Desexrbe Use
Block /
of
tart Owned — Describe Use
Ivalalle of
CSM Number
:OT*mor
_
M.
Type of POW S Pe rvak (C*cck ekber -New- or nRcpiaeeseene' and other applicable oar Fmc A. Check one box on Ntte B. Caplets Ime C it
bk
AFD*w
stan
Sy
System Eldler Mladlficaboo in B-am System (exo—)
D
dditional Pnefsdnatat Ueoit (e�Fa>,l)
B
E)Wdmg Tapir
1n ('�roeord �1t�rade
❑Moor,d
hdivi�t Site Design
Type (tapgar)
C.
Rrncwat Before
[Olte� of Plumber
L"! 7-
rarufr�• to New
Pm km Permit Number and- Date
TV.
R!KHWS*VrrcXI
illsivat Area and Tank Inia mabion:
Desim flow (8td
D—V Sod Application Rmr(gpolst) D4essal Asa Required (st) Dispexsal Aron Proposed Syseem Elevation
Tank hlforertuion
Capacity in
Gtdlaas
Toni
Gallon
I
s
Units
� /
d S`Z5
New Tama
t�atile
Tasks
a i)
on a
Ca
L.6 C7
C.
Sepoie or Holding Tank
7
Dosing Chamber
—
�-��
V. ReMmusillmNy Stateme>At i. the aadasq.e4 as>atme far;mra�atioa of the Pt3RrfS slows on the attached pleas`
Pltssaber' ) •s
MPPMPRS Nmabtr
Business Pba : Nu bcr
Plumber's Addre$ (Street. City StaffZip Code)
2 n
Coax rtwent Une only
gpyrrwod
O
PezCtnit fee
P`r o D
Dace
Issuing Agent
❑ Owner civet Reason for Denial
g 1 Z
Conditions of Apprttval/Raons for Disapproval 3 5', S 14 cal. �S � SC rV`C
L P y> �F,{�1h
QJ-{p
�.
I STw'WU OWNER: -ltr �' / LV��`r- , ,� l y--Beek i. Septic to+tk,
efftveM filter and [ L
at nee manalr plan proe irttd by
7 A" Plumber:•
c('tbJr
j,,,v
rCOu •ments RMst be maintained
a!, uw 7np r ee, t rn(W/ord,rMrKft
W --"- P� � we sya{ero ale sisam1l M me Lallow only as F"W a" k a now a tor: r a Web he am
SBD-6399 (R. 03M)
- I 1 I ",-,I I I I-1
i
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I; III.
I , I
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I
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If
CONVENTIONAL COMPONENT DESIGN
Reskimfial Application
INDEX AND TITLE PAGE
Project Name:
Owners Name:
Owner's Address: /
Legal Description:
Township:
County:
Subdivision Name:
Lot Number.
Parcel ID Number.
Page 1
Index and title
Page 2
Plot Plan
Page 3
System Sizing
Page 4
System Cross -Section
Page 5
Filter Specs
Page 6
Maintenance & Management Plan
Page 7
Septic Tank Maintenance Form
Page 8
Warranty Deed
Page 9
GSM or PI
i� i�i
>�U��.� Lu�1•�rc
Designer/Plumber.
7J
License Number. j
Date:
-
Phone Number = j8
Signature
, 1�
pesigned pursuant to OW In -Ground Soil Absorption Component Manual For PCWTS Version Zo 5BD-10705-P (N.01101).
?age 1
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vwh Vat �e
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Find Glade
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� owa ief i of Commerce
mee SOIL AND SITE EVALUATION
of Safety and Build rips
Durealu of hateyrated 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. k
Page J_ of
-70- 30- 66 / A 7W
APPLICANT INFORMATION - Please print all Information. Reviewed by D7 l l 9
Personal inlorrmbon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (rn))•
Property Owner Property Location rr
Govt. Lot - 1/4 1/4,S T ,N,R E (orXjjP
Property OwmWs Mailing Address Lot 4 1 Block Subd. Name or CSMN
QY
City 5tat Z)p Code Phone Number ❑ City Village Town Nearest Rom
6 I i
® New Construction Use: ] Residential I Number of bedrooms Addition to xi ;Ong twi!'" '
❑ Replacement ❑ Public or commercial - Describe:T---i _
Code derived daily flower gpd Recommended design loading rate bed, gpdM2_—trench, gpd1W
Absorption area required bed, ft2 .Tl& trench, tt 2 Maximum design loading rate . iw b&d, gpoltl2—• 0 —trench, ppoltt2
Recommended infiltration surface elevabon(s) ft (as referred to site plan benchmark)
Additional design/site nsiderations
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 ®5 ❑ U ®S ❑ U ®S ❑ U 5 ❑ U ❑ S u l ❑ S U
Cnn nFQrQIPT1inN RFPt)RT
Boring #
l
Ground
elev.
6�?4tt.
Depth to
Nmtfyng
factor
>//' in.
Mottles
Qu. Sz. Con Color
Structure
..........���
Remarks:
Boring #
Ground
at".
Depth to
Ikrlidng
in. Remarks: _
CST Name );Please Ijrint)_ 1
/��'! l fly �>i�i tl�J�l�a I!ltlla ��rs� frt�`
I�f`����
--r"c s
7� doe,; 410ai
p
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ti9 Rill
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7e
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LE" COVATION U& - P-a
Art/ wrYr� Tyr
n �Y1 �1/�YYr11Wl�� 1��
REAR HNATION i W -y.0,
rRDNT MZyATLON I/A' . I'-q
4-7 rOURID COW-IO~TION
9'- I PAr CMUNr MAW LEVEL
d- 119r CEILAIG 0 LTr!'E', Lr4m
FOR BIDDING ONLY
NOT FOR CONSTRUCTION
RIGHT E"AflON IAr - l -C
021-let
N
5
0
1
e..,r.r.r.rr.r.�rwrA
lti. T.rr •wr rrs �... ,1„ri
r srr rtir
rn.-��rrrwa.�r�
V�Trp Q
FOUNDATION MM IH' - I' -a
4'-(7rOURLD CONC, FOUNDATION
FOR BIDDING ONLY
NOT FOR CONSTRUCTION r
14
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C�� J
AN
Sol o
N
ROUGH rWrLACZ WALL DETAIL
Cr�rt r Y� irr �.r yY►��lyw�
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MAIN LML PLAN 1/4' - V4Y
V- I I W COLING O AMIN LNR
FOR BIDDING ONLY
NOT FOR CONSTRUCTION
/2WO)
g'
i
CAyMYr�1r~Y YI�4M�Yw�Iy����'Y��
CRd555[GTIDry ,�' � I'-U'
FOR BIDDING ONLY ��
NOT FOR CONSTRUCTION !Oil
m-bi -«16 a
ST. CR0 UNTY SANITARY SYSTEM Filet:
ol ,,,' OWNERSHIP/ADDRESS FORM CrmOfficea�o'nry
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer Doug & Aimee Schoenborn
Mailing Address 563 217th Ave
City/State/Zip Somerset, WI 54025
Phone Number (required) 651-323-7439-Doug
Email Address
Parcel Identification Number 032-2070-30-001
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location NW t/, , NE 1/4 , Sec. 13 , T 30 N R 20 W, Town of Somerset
Subdivision Plat: , Lot # 1
Certified Survey Map # Volume Page # &q
Warranty Deed # 6 ZO _ (before 2006)Volume . Page #
Number of bedrooms �� Spec house 0 yes 17 no Lot lines identifiable 0 yes O no
New Property Address
�u —
(Staff Initials)
Z5-) OU
OFFICE USE ONLY _ l
(p�� � ev
(verification of new address required from
Z-1 I 2Z
(Date)
Development Department for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd@sccwi.aov 1101 Carmichael Road. Hudson, WI 54016 www.sccwi.gov
n Department of Commerce SOIL AND SITE EVALUATION
Divisi of Safety" 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # - -�y
a fj _1 Cr — i .V r / f r,
APPLICANT INFORMATION - Please print all information. INLI;V2
C Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) !. /9
Property Owner Property Location 11 f I
_ Gov1. Lot - 1/4 1/4,5 T ? C ,N,R _ E (ord
Property Ow is Mailing Address Lot # Block Subd. Name or CSM# AS n,�y� (�
s `L 1 Y o
City Stat ' Zip Code Phone Number El City El Village 2 Town Nearest Road
� 5� 171P 1 5--_-/fJs- I (7/s )-71/7-lei .._— _z l I __y_ , C_ 1!,•_
�-
New Construction Use: m Residential !Number of bedrooms Addition to existing buildiflg
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate y7 bed, gpd/ft2____,f _trench. gpd/n2
Absorption area required _j�� bed, ftz 7-/2 trench, n2 Maximum design loading rate _i7bed, 9pd/ft2__ _, trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site nsiderations
Parent material , 3 ,ttaa�r� 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 El ®S ❑ U Q S ❑ U ❑ 5 0 U ❑ S 9 U
SOIL DESCRIPTION REPORT i f l�)li �r7-
Boring #
FA
Ground
elev.
fin.
Depth to
limiting
factor
>,/42-in.
Boring #
Ground
elev.
Depth to
limiting
factor
? f in.
anMunsell
-
Dominant Color
Mottles
Ou. Sz. Cont. Color
Structure
Gr. Sz. Sh.
Y
.
FrA
MAN
Remarks:
�
W ,ILIA
�
mm
Remarks.
PROPERTY OWNER
r PARCEL I.D.k
SOIL DESCRIPTION REPORT
Page . - of
Boring #
Ground
elev.
yaft.
-�Pt
Depth to
limiting
factor
,Jin.
Boring #
T
Ground
elev.
Depth to
limiting
factor
,-,K,ai n.
Boring #
Ground
Slay.
it.
D to
limiting
factor
,�-J,din.
Boring #
Ground
elev.
ft.
Depth to
limiting
Dominant Color
Mottles
Structure
Remarks:
Remarks:
WE[
Dominant Color
Mottles
lm�
Structure
MMOME
MM
—
=M��
MEN,�
Remarks:
factor
in.
Remarks:
SBD-8330 (R. 07/96)
PROPERTY OWNER
PARCEL l.D.#
SOIL DESCRIPTION REPORT
Page of
Boring #
12
Ground
elev.
Depth to
krnitirig
factor
in.
Boring #
Ground
�Lft.
Or. 4
Depth to
limiting
factor
.>XWe-in.
Boring #
Ground
Slay.
fa!� /ft.
6JP64 to
limiting
factor
Boring #
Ground
Nev.
-ft.
Depth to
limiting
factor
n.
®
s_„
Dominant Color
Munsal I
Mottles
Ou. S Z. Cant, Color
Hemarks:
Remarks:
®®
,•
StruCture
Gr. Sz. Sh
io.
�—
Remarks:
Remarks:
5BD-8330 JR. 07t%)
v
�dK���•g7-
e
-Y--
r I t
Parcel #: 032-2070-30-001
Alt. Parcel #: 13.30.20.770B
Current X
Creation Date Historical Date Map # Sales Area
00 0
Tax Address:
TERENCE L & CYNTHIA J STEINLICHT
PO BOX 165
SOMERSET WI 54025
Districts: SC = School SP = Special
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres:
SEC 13 T30N R20W NW NE LOT 1 OF C,S,M
411044 EXC PARCEL 770D
06/15/2005 04:48 PM
PAGE 1 OF 1
032 - TOWN OF SOMERSET
ST. CROIX COUNTY, WISCONSIN
Application # Permit # Permit Type
Owner(s): " = Current Owner
` STEINLICHT, TERENCE L & CYNTHIA J
Property Address(es): ` = Primary
ANDERSEN SCOUT RD
0-
5.900 Plat: N/A -NOT AVAILABLE
Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 160114)
13-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 705/483
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: ast Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.900 62,500 3,100 65,600 NO
Totals for 2005:
General Property
5.900
62.500
3,100 65,600
Woodland
0.000
0
0
Totals for 2004:
General Property
5,900
62,500
3,100 65,600
Woodland
0,000
0
0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Chargges
Total 0.00 0.00 0.00
lain's Drawing Roc
3
SL—(-ftA;C0UNTY
No. 644765
STATE SANITARY PERMIT
Z6) OW xe%-.4-6i Rd,
PI79 519-----
OWNER �b. of- kut St � oev+ 60,rn
PLUMBER k, M D �Con�cll LIC.# Z Z 21
TOWN OF Souw�.•te-1-
SEC ,
AND/OR LO i
PERMIT EXPIRES
-30 _N, R Zo EdD
BLOCK
SUBDIVISION
ISSUING OFFICER -
T
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit Is to allow Installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit Is valid and may be renewed for a
specifieI period.
(d) Changed regulations will not Impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal Is sought, and that
changed regulations may Impede renewal.
(f) The sanitary permit Is transferable.
History: 1977 c. 168;1979 c. 34,221; 1991 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
DATE RIZI
UNLESS RENEWED B
POST IN PLAIN VIEW
ZZ.
THAT DATE
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI 1/20)