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Home My WebLink About032-2113-40-000 (2)ST. OROIX COUNTY ZONING DEPARTMENT AS BUILT SANI TARY REPORT Owner J/ _Y1 sr Property Address City/State Legal Description: Lot Block Subdivision/CSM ;9"CjZ:e Z"A '/4 1/4, Sec. T L_N-R_W, Town of PIN SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC,// / P/1L LLLI Setback from: House Well Pump manufacturer 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 Number of Trenches Setback from: House --z) 2 Well P/L Z�q�� Vent to fresh air intake ELEVATIONS: Description of benchmark Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 91, Zz ST Outlet s PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) Bottom of System ( ) -.,a 49,� ( ) Final Grade O 1:2.-.2" ior 2 ( ) I Date of installation P rniit number ��7 Y State plan number Plumber's signature License number Date Inspector. Complete plot plan wr � x NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 5 iG c;2 7, {1 . 1 INDICATE NORTH ow Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy LNv, s. 15.04 (1) (m)]. [3()MER,9ETe 0 Town of: CST BM Elev.:. Insp. BM Elev.: BIVI Description: TANK INFORMATION tLEVATION DATA TYPE xwwwwmw� MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANKTO P / L WELL BLDG. Ventto Air Intake ROAD Septic >-175 NA NA NA Dosing Aeration Holding PUMP/ SIPHON INFORMATION Manufacturer . ..................... Demand Model Number GPM TDH Lift W Fricti, n System TDH Ft ad Forcemain Len 'k gt I Dia. Dist- To Well CountyST. CROIX Sanitar�tM State Plan ID No.: Parcel —4 0-00 0 A-9900043 STATION B S HI F S. ELEV. Benchmark 61 5151 Bldg. Sewer 1),,3 -:5 • St/Ht Inlet "r7 Stl Ht Outlet X_ ql.q Dt Inlet 9ol Header / Man. Dist. Pipe Bot. System 1� Final Grade 0 SOIL ABSORPTION SYSTEM BED/TRENCH, Width Length No. Of Trenches PIT No. Of Pits inside Dia. 5�1.1 I I Liquid Depth DIMENSIONS clt_ - DIMENSION SETBACK SYSTEM TO P L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of /4,J CHAMBER Model Number: System: ize'vZt- 0 R UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia, Spacing 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 4 1 Bed /Trench Center Bed / Trench Edges Topsoil E] Yes ❑ Na E] Yes E] Na COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 5.31.19.1048,SE,SE 368 230TH AVENUE _4 Plan revision required? ❑ Yes No Use other side for additional information_ SBD-6710 (R.3/97) Date s oeck'or"s Signature Cert No NA21 SANITARY PERMIT APPLICATIONi isconsin In accord with ILFIR 83.05, Wis. Adm. Code Department of Commerce Attach complete plans (to the county copy only) for the system, on paper not less than 8 112 x 11 inches in size. See reverse side for instructions for completing this application Safety and Buildings Division 201 W. Washington Avenue P 0 Box 7302 Madison, Wl 53707-7302 County State Sanitary Permit Number Personal information you provide may be used for secondary purposes -I 10 U11 [Privacy Law, s. 15.04 (1) (m)]. El Check it revi�en�o rpr 1-ous applicatiori State Plan I.D. Numby-, I. APPLICATION INFORMATION - PLEASE PRINT ALL INF( RMATIC)N Property Owner Name Property Location I 1/4 1/4, S Propert Owner's Mailing Address Lot Number 3 / q --) ^ ;W'74, (_2 T Er " j I N, R Block NumVer �ta e IV! city, 5 a e Zip Code Phone Number Subdivislo Name or CS Number L) 'r 11. TYPE OF BUILDING: (check one) El State Owned ® cl.t Nearest Road l(age S ubd I v i' ❑ C a g V ilt( Public 1 or 2 FamilX DwellinQ - No. of bedrooms To 0 V1 Sa Town OF III. BUILDING- USE: (If building type is public, check all that apply) Parcel Tax Number(s) cl LtS 1 ® Apartment/ Condo ( �"" 2 El Assembly Hall 6 El Medical Facility/ Nursing Home 10 n Outdoor Recreational Facility 3 E] Campground 7 E] Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 E] Church/ School 8 E] Mobile Home Park 12 ❑ Service Station / Car Wash 5 0 Hotel/ Motel 9 El 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. p New 2. 0 Replacement 3. E] Replacement of 4. Ej 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 110 Seepage Bed 21 Mound 30 [:] Specify Type 41 E] Holding Tank 12 E] Seepage Trench 22 ❑ In -Ground Pressure C� 1 42 E] Pit Privy F1 13 ❑ Seepage Pit A 43 [:] Vault Pri,vy 14 E] System -In -Fill VI, ABSORPTION SYSTEM INFORMATION: '1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. late F. System Elev. 7. Final Grade Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (MinA ch) Elevation AFeet i 9L.� Cl Feet I l VI I. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab site Fiber- Plastic Exper- New Existin Gallons Tanks Concrete Con- Steel glass App. Tanks Tanks 9 strutted ,ic Tank oW A 14 pot4a"* VC/ 14 Lift Pump Tank /Siphon Chamber 1:1 _0 1:1 1:1 E] ❑ Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for stallation of the onsite sewage system shown on the attached plans. !Pl7ume/is Name- (P t) Plum Sigh (N MP/MPRSW No.: Business Phone Number: Plurfiber%Address (StTeie City, Stat Zip Code 00 IX. COUNTY TDEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater Date Issued lssulng�qe t Signature (No Stamps) :5,r Surcharge Fee) Approved ❑[:]Owner Given initial' n NS( Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S BD- 6398 (R. 11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber /%��l Li,Q�i �3�5' �-�.s�D J� oll Vi COL? L/ /S Y�L� f v 1 2 el *ffjsc'ns�n Department of Industry, Labor and Human Relations Division of Safety & Buildings SOIL AND SITE EVALUATION REPORT Pagel —of 3 in accord with ILHR 83.051 Attach complete site plan on paper not less than 8 1/2 X 11 inches in si not limited to vertical and horizontal reference point (W), direction an dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION —PLEASE PRINT ALL INFORM i Arlifinn to existing building New Construction Use 14 Residential / Number of bedrooms L I A Replacement [ ] Public or commercial describe Y trench, gpd/ft2 X610 gpd Recommended design loading rate bed, gpd/ft2 P; Code derived daily flow ft2 trench, ft2 Maximum design loading rate v7 bed, gpd/ft2 . g trench, gpd/ft2 Absorption area required bed, (8c. 6 ft (as referred to site plan benchmark) Recommended infiltration surface elevation(s) Additional design / site considerations Flood plain elevation, if applicable ft Parent material M IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL LL HOLDING TANK for system CONVENTIONAL MOUND as 0 u Os 2u IS su S suitable tem ZS Fu S l U HS OU U= Unsuitable fors WMEWW� SOIL DESCRIPTION REPORT Boring # Ground plov ,'14 f t. Depth to limiting factor 111 Boring # lc>_ ko Ground 4i-VL f t. Depth to limiting factor �" _77 L Remarks: Remarks: Dkr%na- 77-7, T— -2 C17e- PROPERTY OWNER ��/% C/yPrC,.? SOIL DESCRIPTION REPORT PARCEL I.D. # �.�Z - 2 1/,3— Y&J v Page 2 of Boring # Ground elev. 9L. b ft. Depth to limiting fac,�gr9 �a Remarks: Boring # y Ground elev. ft. Depth to limiting factor y1 Remarks: Boring # f C Si4 Ground l elev. �7.7ft. Depth to limiting 7 fap� Remarks: _ Boring # Ground elev. ft. Depth to limiting factor Remarks: _ SBD-8330(R.05/92) All [S asy rn� 4w M2 10 9 AL W_ Il _._ All IV Rat 335 0. -� He • C S�V2,7 L t 0 i mcx,of -A. ------------ ..•........ .ter.. "".' r � 4 r h ' t 1 4 ` i a + i � r tl CA Y C7CL i t , Syr ..._._.�. a .r // _ A, 10,0, 75 � h i .... .. ..... ........ . *. Wisconsin Department of Industry, SOIL AND SITE EVALUATION R EPORT Page 1 of 3 Lac or and Hyman Relations Div"Gion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. - Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # 0 PARCEL NTY not limited to vertical and horizontal reference point (BIVII), direction and % of slope, scale or CEL dimensioned, north arrow, and location and distance to nearest road. 032-1014-10REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY OP PROPERTY P PROPERTY LOCATION 1/4 T N,R 19 NX) W Go L GOVT. LOT SE 1/4 S E S 5 31 PROPERTY Gulifford PROPERTY OWNER-S MAILING ADDRESS LOT . -- T # BLOCK# SUBD. NAME OR CSM# 452 280th St. CITY STATE ZIP CODE PHONE NUMBER CITY STATF OCI 4 na CSM TY E]CITY E]VILLAGE iUOWN NEAREST ROAD 5 c —28357 sceola,. WI 54020 V15) 294 Osceola, 0 230th, Ave. Somerset S Pc] New Construction Use ij Residential Number of bedrooms New w Construction 3 Addition to existing building Replacement Public or commercial describe eni Replacement r Recommended Code derived daily flow 450 gpd [ design loading rate �.bed, gpd/ft2 F, trench, gpd/ft2 Absorption bed, fit _5 i3_ trench, ft2 Maximum design loading rate _'7 bed, gpd/ft2 trench, gpd,/ft2 Absorption area required _fL43— Recommended infiltration surface elevation(s) ft has referred to site plan benchmark) Additional design site considerations alt. area =_98.51 io n & 96-11 Flood plain elevation, if applicable ft Parent material ou t S=S i t' CONVENTIONAL Suitable I S = Suitable for system ERS EIU MOUND ER S 11 U IN -GROUND PRESSURE AT -GRADE k] S El U S 0 U SYSTEM IN FILL JZ] S o U HOLDING TANK EIS O U U = Unsuitable for system s �600X� Ground elev. 102.,-5— ft. Depth to limiting factor _+8411 Boring # 2 Ground elev. 102 J5 Depth to limiting factor I nnil SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Motties, Qu. Sz. Cont. Color Textu 1 0-6 10 r3 3 7.5yr4/4 none none none S1 is MS 2 6-12 3 .7.5yr4/6 112-84 Pommr1oz- re Structu Ire Gr. Sz. Sh. Consistence Ebindary Roots GPD/fte- Bed Trench 2cabk cs 2m .5 -6-- I OS mvf r w 1m .7 .8 osg ml na na- .7- .8 1 2 0-6 + 6-30 1 �O �r3 �3 '_7 c: " "4 'J'4 7 5_yX4/4 7.5_yr4/6 none none none S1 1S____ ms 3 30-82 Remarks: CST Name: --Please Print Gar L. Steel Address: 1554 200th. A New RichMOV4' W1 54017 Signature: Phone: 715-246-6200 Date: 4-9-97 CST Number: m02298 PROPERTYOWNER Gary Gifford __ SOIL DESCRIPTION REPORT PARCEL I.D. #2 Ground elev. 102., 0 ft. Depth to limiting factor if Boring # 4ell- Ground elev. 98.6 ft. Depth to limiting factor 1Q 1)11 Boring # 5 Ground elev. 98.6 ft. Depth to limiting factor " Boring # L•: Ground elev. ft. Depth to limiting factor Page � 2 of 3 Y Horizon 1 2 3 Remarks: 1 2 Depth i n . 0-6 6-171 17-8 0-5 5-82 Dominant Color M u nse l I wmw�Bed 19 r3 3 7.5yr4/4 7.5yr4/6 10 r3 3 7.5 r4 6 Mottles Ou. Sz. Cont. Color none none none none none Texture —Si 1 s ms sl ms Structure G r. Sz . Sh . 2m os g osg 2m r osa Consistence mvf r Roots gw lm G P Dlft .7 Trench .8 ml na na .7 .8 m of r m n �,� Q Remarks: 1 0-6 10 r3 3 none sl 2csbk 2 6-26 7.5 r4 4 none sl 2csbk 3 26-7 7.5 r4 6 none ms os Remarks: mvfr mvfr ml w w na 2m .5 .6 2m na .5 .6 .7 .8 Remarks: SBD-8330(R.05192) STEEL'S SOIL SERVICE Gary L. Steel Gary Gifford 1554 200th Ave. CSTM2298 SEkSEk S5-T31N-R19W New Richmond, W1 54017 MPRSW-3254 town of Somerset (715) 246-6200 lot #4-csm N 1 11 =401 BM.= top of tel, ped @ el, 1001 Alt. Bm.= top of tel. ped. @ el. 98.90, 4t Gary L. Steel 4-9-97 07//97 WED 15'1715 386 4686 ST CR-1 CO ZONING 023 FA- 0qpcLnrmnt of IndustrY. SOIL AND SITE FWALUATION nE!PORT Labor arxi Human Rala�nm n accord with 11-HR 83,05, Wis. AdM- C-0d@ DWWOO Of 83%rY & eu'li d"P Attar.h COMP10113 site plan on paper not less thtin 19 1 12- X I I iln&IRS'n size. Plan mu"e%t 'nclude , but nol 11"lod to ver�cal and hurizontal ref erenoe pol rt (SM), direction arv� cl'a of 840, scam Or d1monsionod, north arrow, and location and distanco to nearest road. APPLICANT INFORMATION- PLEA► E PRINT ALL INFORMAT10N aodng # Gruuod V. lo? .5 ft. Depth to limiting tactor -+84"-. [a o 0 2, Page of 3 Remarks: Boring ur # My-f —r _Q —rz 2 r3/3 rxgaa--� 7 vv� 0 3- cf. Inv T 2 -30 6 6 n a n a 7 18 ff33 8 2 7 i5X44/6 In �-g �2-5 none I Ground 102 JS ----------- 7 81 9 Depth to limiting factor KE11 U1 1821, F It , � I - Remaxks: Phone; 715-246-6200 ST CROIX UUUN i'Y C,ST Ficase Print Gary L. 1554 200th. A,�W,j� New Richrpopo, W1 540 rnD2299 S Sig tul4-9-97 =mom ignaturc-, 07/02/97 WED 15 : 14 FAX 715 386 4686 ST CRX CO ZONING [a 003 Page ' 3 SOIL DESCRIPTION REPORT .r. PR OnRT'Y OWNER f ford p �/fit i�e�h Dominant Color Imes Texture uetu re �r�!��y �� Roots �� Boring # Horizon r in. Munsell QU, Sza CQrTL �r 1 • 4ef 0_ 13� 1 Q r3 ri+ ne r CS 2 6-17 7.5Yr4/4 none,.? osg mvf r Ground 1 7— r / 6 none ms m1 na na -7 a8 Uepth to limiting factor _ Remarks: Bering # a 1 0-r5 10 r3 none r 2 5-82 ! ! Iw 11 one Ground pp �y4i Depth to i 'FF''' yr li miu fac}Lo 1r +821, Rem ar . Boling # 1 i/�y� r Rl i.� ��'j ii none i1 y C3 k m � T 7: �y��}* k`` Y 4• 6 r 13 �1 �� bk mv' f r ? m 2 6--26 7. 5r4 4 none t 3 2 6-7 7 . 5r4k none Mss n►1 x�. �. n a . S Ground s 9816 ft. Depth t limit ng tacV Remarks: Bodrg Gmu d i f NPb to Wrig facts 07/02/97 WED 15:14 FAX 715 386 4086 ST GRI CO ZONING 1@004 STEEL"S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Gary Gifford New Richmond, W1 54017 E4SE 4 S5-T31N-V,-19"K (715) 24&62-00 lot #4-art N 1 1} =4a 1 tip of tel . ped r& el. 100R A -it. Bm. = tOP Of t81. ped. C e1. bet Y �ry E � , 1 72, so r Gary L. Steel 4-9-97 ST CROIX COUNTY SEPTIC TANS. MAINTENANCE AGREEMENT AND OWNERSHIP qAj;UK�enTI.0grFORMde Owner/BuyerMAJ?K 335 Oakwood Terrace�_��9N Vadnaic HBlghts, U�55127 Mailing Address �3 S OAKI.✓ADi� A A/�q-c5 /�/ki$j N% � %9 7 Property Address Apt: , �'oorepstrr Grir Sy�as (Verification required from Planning Department for new construction) ��✓ City/State �rW_eSz7_, 4/17 Parcel Identification Number �. LEGAL DESCRIPTION Property Location 6E 1I4 5 C' '/4 See. 5 , 7 3 l N-R j 9 W, Town of ` ubdivisionN-A u S j , Lot # Certified Survey Map # Volume , Page # Warranty Deed # ��,�� _.� .�....�, Volume , Page # Spec house ❑ fires 9 no Lot lines identifiable N yes ❑ no SYSTEM MA NTENANCE Improper use and maintenance of your septic system could result in its premature failure to hand i wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. V hat 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 masterplurnL-er, journeyman plumber, restricted plumber or a licensed pumper verifying that (1 ) the on -site wastewater disposal syAem 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 refit! :rents and agree to maintain the private sewage dispos.,, 1 system with the standards set forth, herein, as set by the Department of Cu-.,coerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintaiiis:d must be completed and returnc;d to the St. Croix Cow-ilty Zoninj� Office within 30 days of the thr year expiration date. - 9 1 1 SIGNATUREU 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 property sc ' e above, by virtue of a warranty deed recorded in Register of Deeds Office. El 111�44 — 49 1 T1 SIGNATURE O] PLICANT DATE * * * * * * Any infonnation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. * * W '� * * ** 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 -4 ? f • � 7 OCT - !ga o2 : a 5pm MhuRy 21 SCF 715-4Q3-15 01 -,,. ....� It P . I,,, 1 r rr♦ � r 1 `■ `L wm 004 * 04 '# + 1() N` col 1 .r 1 � r � u01 * 01 >, 1 Sri � fib Aft ova r 4 ■ 4 +� 1 r + ■ `+ + r 0*2 me i ` f r r 9 opt - . 0 joop 40 r . • + • o f �' VI . I LU r i oss t M� Ma r rl its ■ Looms z I s y r■ • i . 1 I� r � r !r ■ r 'AP 1F i ISJw (AI 0; c z Pow In �1 ar