HomeMy WebLinkAbout030-2103-20-000 (2)030 , r)- t 0 -5 . ao -060
6 'T 'a
CIZOIX COUNTY ZONING DEPARTMENT
AS 13UILT SANITARY REPORT._
Owne
0I
r I ea-' A 10k,
N Ise,
•
Address III C_
10
City/State
Lcgal Description:
Lot Block —
Subdivision/CSM 8
V4 V4 AJL, S T N R �rj ) �:A V" ki LV
IN, Town of Q
EPTIC. TANK CIIAN
I - -I
E'R_-_1f_0_LD1NG T
011 RfCfiVEp \1*', 1:1I
g
ylNl'pRMATION:
Tank manufacVer ,, 10%, /X0 Size ST/PC
S S
etback from: manu ce House
.0,
I-) Well P/L
Alarm location <7 odel 3
(HOLDING TAN Ks 0,NLY)
Setbacks: Service road.
Meter location Vent to fresh air intike Water Line
Alarm location
Sin- ARS0BPTI0N SYSTEM
Type of system: Width 7 -50
Setback from: House WeU-t,/A Length Number of Trenches
P/L 2—AL Vent to fresh W-r intake / � 6
ELEVATIONS:
Description of beacbmark --I i2,
Description Of alternate benchmark Elevation IU6'
Elevation Zp.l
Building Sewer STD met �'`j� � ST Outlet. Yet, t PC ifflIet
PC Bottom It It Header/Manifold 9 c�S Top of ST/pC Manhole
Cover anh —7-5
T,(c
Distribution Lines Q� V
Bottom of System (�) _ � 5 ,15 (:� _r�, � . /S
Final Grade (/� �� � ' �� �p 2,�
9//1/��a%�6
Date of installation ? Permit number
State plan number
Plumber's signature License number Z? �-53 �
Date ! �%/ S'
Inspector
Complctc plot plan wr
NOTICE-: Picase provide t1te following:
A plan view sketch showing everything within 100 feet of the system.
Two liorizontal referencc points to center of septic tank manhole cover.
Show alternate. benchmark, if applicable.
PLAN VIEW
yy
INDICATE NORTH ARROW
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provice may be used for secondary purposes [Privacy Law, s-15-04 (1)(m)].
Permit Holder's Name: [I City El Village Town of
HENDRICKS, EDWARD ST. JOSEPH
CST BM Elev.: Insp. BM Elev.: BM Description,
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
Dosi ng
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P / L
WELL
BLDG.
Vent to
Air Intake
ROAD
Septic
NA
Dosi ng
5_0
> r
D
NA
Aeration
NA
Holding
PUMP/ SIPHON INFORMATION
Manufacturer Demand
Model Number 62o -3 it L— GPM
TDH Lift Friction System TDH Ft
I Loss Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches
DIMENSIONS
SETBACK SYSTEM TO P / L BLDG WELL
INFORMATION Type Of __ I ,
I System: '36 5-0> v- 5—
ELEVATION DATA
County:
Sanitary Permit No ST CRCI
338986
State Plan ID No.:
Parcel Tax No,.-
030-2103-20-000
A9900248
STATION
BS
HI
FS
ELEV.
Benchmar(: jZ
2..
_A4-, ate`
Bldg. Sewer
St / Ht Inlet
St I Ht Outlet
Header / Man.7'
Dist. Pipe
Bot- System
Final Grade
PIT
No. Of Pits
Inside Dia. Liquid Depth
DIMENSIONS
LAKE / STREAM
LEACHING
Manufacturer:
CHAMBER
Model Number:
OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
Length A Dia. Length --I- .. ia> I
. Spacing t
ow
SOIL COVER X Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over u Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil F-1 Yes F] No E] Yes E] No
COMMENTS: (include code discrepancies, persons present, etc.) A44K.Az 43.z% + ir - + -,
LOCATION: ST, J f
I q. 0 4- qf q- T (e7t_
19,834,NE,NE 1286 89TH STREET S
movo /6 ct
11414-1.1
Plan revision required? E] Yes it No
Use other side for additional information.
.
SBD-6710 (R.3/97)
C.-
Inspector's Signature Cert- No
Ix
v MAIN Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Department of Commerce In accord with ILHR 83-05, Wis. Adm, Code P 0 Box 7302
Madison, Wl 53707-7302
■ Attach complete plans (to the county copy only) for the sy ,,+v ss County
than 8 112 x 11 inches in size.
S,
See reverse side for instructions for completing this aR'�'cation State Sanitary Permit N tuber
• 1
6/,
Personal information you provide may be used for secondary purpose� 0 � Check it revision to previous application
[Privacy Law, s. 15-04 (1) (m)]. , 1� fate Plan I.D. Number
L APPLICATION INFORMATION - PLEASE PRINT'jA' R4C)
LL, , RM ADN
Pro oert Owner Na
1
Y. e
Property Locatibrf
ly, 3LO T 30
N R
D
lupc,� v►w+ner..q(1allingAddress
City, State
Zip Code Phone Number
<� i't n I I (40 � I --I Y
11. TYPE OF BUILDING: (check one} El State Owned
El Public C�l or 2 Family Dwelli - No. of bedrooms
Ill. BUILDING'US--E: (if building type is public, check all that apply)
_`,]LQt Nt
$-[on Name or SlruLber
P Cq— _ ( I
E] Cit
El Village
Nr Town OF
Parcel Tax Number(s)
Block Number
A.) A
Nearest Road
1 El Apartment/ Condo L n a c -- -;� o --a Q
2 E] Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 El Outdoor Recreational Facility
3 E] Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 El Church / School 8 E] Mobile Home Park 12 Service Station / Car Wash
5 0 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. NtNew 2, 0 Replacement 3. ❑[:] Replacement 4. ❑E] Reconnection of 5- E] Repair of an
System -------- System ------------- Tank Only --------------- Existing System --------- Existing System
B) A Sanitary Permit was previously Issued. Permit Number Date Issued
(.0 (7 17
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 [] Seepage Bed 21 [] Mound 30 E] Specify Type 41 [:]Holding Tank
12KSeepage Trenc 22 E] In -Ground Pressure 42 0Pit Privy
13 Seepage Pit 43 E] Vault Privy
14 [:] System-In-Fi I 1 40 -7 (P3 71, J6
V1. ABSORPTION SYSTEM IN ORMATION:
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 (Gals/day/sq. ft.) (Min./inch}
n./inch) I Elevation
-7. 7 Feet. &Feet
Vil. TANK Capacity
INFORMATION in gallons Total # of ' Prefab. site Fiber- Exper
'
New I-rxist*n Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App-
Tanks I Tanks9 structed
Septic Tail or T. k
�Ift Pump TaAT iphon Chamberl
gill. RESPONSIBILITY STATEMENT
1, the u nd ersi geed, assu me responsi bi I ity for i nsU
Plumber's Name: (Prin Plumber's Si natu
Plumber's AddressAtree City, State, ZI Code)- Q17,1_
i I I I 'k k tp It _ 1� AP "
�000c
�noo�
Itation of the onsite sewage system shown on the attached plans.
k No Stamps) M P/MPRSW No.-. Business Phone Number:
IX. COUNTY/ DEPARTMENTSEONLY
(Includes Groundwater —1 Dat Issued
V00� Disapproved Sanitary Permit Fee Surcharge Fee) 7 Iss Agent Si nature , oStan-M5s)
Approved [:1 Owner Given Initial 190, (1
C7
Adverse Determination 15 71,
X. CONDITIONS OF APPROVAL / REAS 0-NS FOR DISAPPROVAL:
SBD- 6398 (R.1 1/97)
DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
1 A sanitary permit isvalid for two CDyears.
2. Your sanitary I permitmaybenanemxedbefonetheexpirabondate'andatadrneofrenevva|anynevwcriteriainthe
Wisconsin Administrative Code will be applicable.
3. All revisions tothis permit must beapproved bythe permit issuing authohty.
4. Changes in ownershiporplumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6B99)tobesubmitted tothe
countypno,"omyu*na,u''
5. Onsite sewage systems must beproperly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usuaUyevery 2to3years.
6. \fyou have questions onsite sewage system,contact your local code administrator orthe State ot
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this .'sanitary permit application must include:
i Property owner's name and mailing address. Provide the legal description andpaneltaxnumber(s)ofvvherethe
system istobeinstalled.
U. Type ofbuilding being served. Check only one and complete #ofbedrooms if1or2Family Dwelling.
Ui Building use. )fbuilding type ispublic, check all appropriate boxesthatapply.
|\i Type ofpermit. Check only one online A. Complete line Bifpermit isfor tank replacement, reconnection, orrepair.
V. Type ofsystem. Check appropriate boxdependingonsystmmtype. .
Vi Absorption system information. Provide all information requested for numbers 1 through 7.
V|i Tank information. Fill inthe capacity of every new/orexisting tank, list the total gallons, number oftanks and
manufacturer's name, indicate reiabormeconmcructeoanotanxmoow./a/ Complete pump/siphon
u.".='"=p"�'...~
ho\dingtanksforthis' o
system -experimental approval only if tanks received experimental product approval from
D|LHR.
V||| Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form,
IX. County/ Department Use Only.
X- County/ Department Use Only.
plans and spec\�cadonU
specifications inches must besubmbtedtothe county nsmust
Complete include thefo||mving~"' A) plot p—l�an, drawn to ��a1�or with complete dimensions, location ofholding tank(s)'
septic
tenk(s)orother treatment tanks; building sewers; wells; watermains/water service; streams and lakes; pump orsiphon
tanks' distribution boxes; soil absorption systems; replacement system areas; and the location ofthe building served;
B) horizontal and vertical elevation reference points; Q complete specifications for pumps and controls; dose volume;
elevation differences; friction loss;pump performance curve; pump model and pump manufacturer; O)cross sectionofthezoi|absorptnnsystem if r�quiredbythe county; B soil test data cma115form; and R all sizing information.
GROUNDWATER SURCHARGE
1'9���n�410i�m��cn����r�r����anum�of regu|ated practiceswhich can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
Lom, r i cjCS
36 LZ
Le k"C-4 ck&�k
SEPTIC TANK
PUMP CAMBEF,
CROSS SECTION AND SPECIFICATIONS
4 Cl VENT PIPE 12tl
MIN. ABOVE
GRADE
WEATHER PROOF*
2 S' FROM. DOOR 5 WINDOW
OR
JUNCTION BOX APPROVED
FRESH AIR I-NTAKE,.
WITH CONDUIT MANHOLE COVER
FINISHED GRADE
4" Cl RISER
W/ PADLOCK &
-WARNING LABEL
6" MIN.
..........
ABOVE �AD E
411 MINO
IN. 611 MAX*
7-7
I14LET
WATER TIGHT SEALS
GAS-
TIGHT i
1411 BA F F LE
CI PI PE
3 ' ONTO
SOLID
SOIL
PUMP OFF ELEV FTO
A SEA L
ALM
LON
C
0 �F
D
3" APPROVED BEDDING UNDER TANK
SPECIFICATIONS
APPROVED
JOINTS W/ CI
PIPE 31 ONTO
SOLID SOIL
RISER EXIT
PERMITTED ONLY
IF.TANK
MANUFACTURER
.HAS APPROVAL
CONCRETE PAD
SEPTIC DOSE %
TANK MANUFACTURER: /tZSCD) �lso Wt��NUMBER -DOSES PER DAY:
TANK SIZES: SEPTIC D�D40 GAL. DOSE VOLUME INCLUDING
DOSE _c) GAL. CK*
FLOWBA
GAL
ALARM. MANUFACTURER: -k"APAC I TI ES: A = Lct71NCHES
= sk/GALS
MODEL NUMBER:
SWITCH TYPE, Z: B = 2
INCHES = GALS
PUMP MANUFACTURER: a"i, c =
INCHES = \`, 0
MODEL 'NUMBER : rf P
SWITCH TYPE: D =
INCHES = r�-GAL.
REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER I LMR 16 o 23 WAC •
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE
# 0 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE
a 2,51 FEET
+ /,gD FEET FORCEMAIN X FT/ 100 FT* -FRICTION FACTOR
0 0 EET
T.OTAL DYNAMIC HEAD
FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH HWIDTH DIAMETER
LIQUID DEPTH
�X-1
0
SIGNED: LICENSE NUMBER: D�O =
DATE:
ir
A) VYN�yY Saco*' 90N IQ I (i c,.:
THE
�c-'urn.n7
sa,
INFILTRATOR Chamber
High Capacity Model
Side View
C
I
j� 75
End View
Product Features
)0 0 Lightweight units offer easy assembly and installa-Li'�_J' --1.
0 TM
Louvered MicroLeachingTM sidewall provides maximum infiltraUCEI.
• Open chamber bottom allows additional infiltra,4ive area.
• High -density PolyTuffTM polyethylene constructioln guar.
strength and durability.
A
N 34"
SYSTEMS INC
Leading the way in septic and stormwater chamber systems
4 Business Park Road * P.O. Box 768 e Old Saybrook, CT 06475
860-388-6639 e 800-221-4436 a Fax: 860-388-6810
High Capacity Infiltrator Chamber
Specifications
Size (W x L x H) 34" x 75m x 160
Storage 122 gal./l 6.3 ft3
Weight 31 Ibs.
U.S. Patents: 4.759,661- 5.()17.041: 5.156.4aa. 5.336.017; 5.401.116; 6,40I.459,5,511,903:5,588,778- 1,815.925.1.974.938.1.729.393-. 448,338 Canadian Patents: 1,329.959. 2-DU364 Other U.S.. Canadian. and foreign patents Fending
Infiltrator. Equalizer. and Side%nder are registered trademarks and the fallowing are trademarks of InSitrator Systems Inc.: Contour. MaxwroLzer, MaWrin, MicroLeaching, PoIyTulf, PL-werArch. and SnapLock.
01997 Infittralor Syst&-
71A
Effluent Purnl)
W�
METERS FEET
40 130
120
35 110
MODEL: 3885
30 IGO
LLJ 901
C.1) 25 80
a rHp
70
20
so
cc 15 so
40
10 30
20
10
n�
1
0 0 10 20 jo 40
L
0
L lu
50 60 Wj 100 110 120 130 140 PM
CAPACITY 20
Pump Specifications
Features and Benefits
'/3 through 1'/2HP
Up to 130 GPM
*All models feature silicon carbide
mechanical seal faces for superior
Maximum head to 123
Discharge size 2" NPT
abrasive resistance and extra
long life.
Solids: 1/4 11 maximum
Motor
Cast iron semi -open non -clog
impeller with Pump -out vanes
All motors feature ball
for mechanical seal protection.
bearing construction.
Available in Single and
• Rugged cast iron volute type casing
adaptable for slide rail systems.
Three Phase 115, 2007
230, 460, and 575V.
*Corrosion resistant threaded
All single phase models
stainless steel shaft.
have capacitor start motors.
Motor is fully submerged in high
Materials of Construction
quality oil for lubrication
and efficient heat transfer.
Cast iron
Stainless steel•
Optional silicon bronze impeller
available.
is CSA listed models available.
S Underwriters Laboratories
All Models are designed for continuous opera
METERS FEET
8
20
6
LLJ 5 15
4
10
im 3
J<
2- 5
0- 0
0
0 20 36 40 SIC
0 2 .4 6 8 10
CAPACITY
Pump Specifications
Features and Benefits
'12 HP
s Glass filled, thermoplastic vortex
Up to 75 GPM
impeller with stainless steel
Maximum head to 18
insert and Pump out vanes for
Discharge size 2" NPT
mechanical seal protection.
Solids: 2" maximum
*Rugged glass -filled thermoplastic
Motor
casing and base design provides
All motors feature ball
superior strength and corrosion
bearing construction.
resistance.
Single phase: 115V
Cast iron motor housing for
Materials of Construction
efficient heat transfer, strength
Cast iron
and durability.
Thermoplastic
*Corrosion resistant threaded
Stainless steel
stainless steel shaft.
o Available in automatic and manual
models.
*CSA listed models available.
Lion and feature stainless steel hardware.
SANITARY PERMIT APPLICATION
N)Fisc
Department of Commerce In accord with I LH R 83 .O 5, Wis. Adm. Code
• 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
Personal information you provide may be used for secondary purposes
[Privacy Law, s. 15.04 (1) (m)],
Safety and Buildings Division
201 W. Washington Avenue
P 0 Box 7302
Madison, W1 53707-7302
County _
State Sanitary Permit Number
3 ?�5rlts�
E]Check It revision to previous application
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
PropertvO .nor Name
I
. Property Location
U.�4. '' 1100%.
r P -,0 �,, a,--% A/IC..41/4 1/4, S IV ra T 3(D, N, R IYE (or
W— 20
Propert Owner' M 'ling Addre r r eA Lot Nu r BlocLNunjber
D
St tie �L� - A a fu A-
Ci Y, Zip Code TPWle qhm be r uion n Name or CSIVI er
U :Z
I &BMW I
—SD I Le Joni rt., 4
11. TYPE WFTUILDING: (check one} 0 State awned— El CiIt
Public S6 1 or 2 Family DweLjn �- No. of bedrooms El VII(age Nearest Road
&r Town 0 F.!;Z
III, BUILDINGFUSE: (If building type is public, check all that apply) 4rcel Tax Number(s)
1 Ej Apartment/ Condo 0
2 ❑ Assembly Hall 6 El Medical Facility/ Nursing Home 10 El Outdoor Recreational Facility
3 Campground 7 [:] Merchandise: Sales/ Repairs 11 F] Restaurant/ Bar/ Dining
4 Church / School 8 El Mobile Home Park 12 E] Service Station Car Wash
5 ❑ 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,. )( New 2. F] Replacement 3. Ej Replacement of 4. ® Reconnection of m Repair of an
System System 1 5 - L-..i
------ -------- ------------- 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 Ej Seepage Bed 21 ❑ Mound 30 [] Specify Type 41 E] Holding Tank
12-'0 Seepage Trench 22 In -Ground Pressure 13 ❑Seepage Pit (020 -3, Se 42 ❑0 Pit Privy
14 System -In -Fill I -lit dj A 43 Ej Vault Privy
VI. ABSORPTION SYSTEM INFORM—ATION-
1. Gallons Per Day 2. AbsorArea &70:5- 2,9t
3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Systez'
p. 71ev. 7. Final Grade
' Recuir q- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
Feet /164 (0 Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab Site Fiber- Plastic Exper
New Existin Gallons Tanks Concrete Con- Steel glass
Tanks-1 Tanks strutted App.
�Vptic Ta r t.4, -.0 110111 am k
/vAL5 C)
El El
Lift Pump Tank ISI-phon Chamber
El El El ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for Installation of the onsite sewage system shown on the attached plans.
Plumber' sName (Print) Plujpjber's Sig tur Sta s) MP/MPRSW No.: Business Phone Number:
A
Plumber's Address (street sty, te P Code).
'C
� I Q N kit. C
ICUQ-2 — I A L C.01
IX. COUNTY/ DEPARTMENT USE ONLY
E] Disapproved Sanitary Permit Fee (includes Groundwater Date-NS—Sued Issuing Age Signat re NoStarZips)
Approvedi [-] Owner Given Initial 0�1y/ Surcharge Fee)
Adverse Determination Ins
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.1 1/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
iV 3o 00 u..)
U.trh: vc1 �L�.� Ltd ti �d� 7� a
S-"T-
4 .p
.........
THE
INFILTRATOR
Chamber
High Capacity Model
G
YY Iv A rilck:
L6T-
Side View
Ac
a f _:_ �+ -
r
16"
_T
t
End View
A
'N 34
75
Product Features
)0 0 Lightweight units offer easy assembly and installation.
0 Louvered MicroLeaching TM sidewall provides maximum infiltration.
0 Open chamber bottom allows additional infiltrative area.
0 High -density PolyTuff TM polyethylene construction guarantees
strength and durability.
SYE;TEMS INC
Leading the way in septic and stormwater Chamber systems
4 Business Park Road 9 P.O. Box 768 Old Saybrook, CT 06475
860-388-6639 e 800-221-4436 • Fax: 860-388-6810
High Capacity Infiltrator Chamber
Specifications
Size (W x L x H) 3411 x 75"x 16"
Storage 122 gal./l 6.3 ft3
Weight 31 Ibs.
U.S. Patents: 4.7S9.661; 5.017,041- 5,156.488: 5,336,017: 5.401,116; 5.401.459: 5.5111.903; 5,588,778 - 1,815,925- 1974.938i1,729.383: "8,338 Canadian Patents: 1.329,959: 2.DO4.564 Other U.S., Canadian, and foreign patents pending.
Infiltrator, Equakzsr. and Sidewinder are registered trademarks and the following are trademarks of Infiftratcw Systems Inc.: Contouir, Maximizer, MaxWin. MicrolLeaching, PoIyTuff. PowerArch. and SnapLock. 01997 Infiftrator Systems Inc- Printed in U.S-A. CO60597AG
4
Wiscons' in Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
bivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code -
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (13M), direction and % of 'slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 030-2013-10
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
James Durning GOVT. LOT NE 1/4 NE 1/4,S 36 T 30 N, R 19 F4or) W
PROPERTY OWNER'-S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
7217 Courtly Rd. 2 na Durning & Lewis Addn.
CITY, STATE ZIP CODE PHONE NUMBER F]CITY []VILLAGE kTOWN NEAREST ROAD
WoodburZ,, M,, 55125 (512) 739-5208 St. Joseph Cty. Rd. "All
[:j New Construction Use [x] Residential / Number of bedrooms Addition to existing building
I I Replacement [ ] Public or commercial describe
Code derived daily flow 450 ar)d
ITJ F Recommended design loading rate .7 -bed, gpd/ft2 8 _trench, gpd/ft2
Absorption area required 643 bed, ft2 563 -trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 98-15 -ft (as referred to site plan benchmark)
Additional design / site considerations na-
Parent material stream terrace -Flood plain elevation, if applicablena. ft
S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING37dTANK
U = Unsuitable for system 1�1 S El U 31 S El U P9 S El U [N S 0 U EMS El U Os [3 U
I
Ground
elev.
102,4 ft.
Depth to
limiting
factor
+9011
Ground
elev.
101 8 ft.
Depth to
limiting
factor
i t-1 A im
SOIL DESCRIPTION REPORT
Horizon
izo
Depth
Dominant Color
Motes
Texture
Structure
Consistence
Boundary
Roots
GPD/ft2
Bed Trench
mmmm�
i n.
Munsell
Qu. Sz. Cont. Color
Gr. Sz. Sh.
1
0-10
la r3 2
none
sil
lcsbk
mfr
crw
2f
.2 .3
2
10-30
10yr4, 4
none
none
sil
lcsbk
mfr
qw
if
.2 .3
3
30-90
7 r4/6
cos
osg
M1
na
na.
7 .8
Remarks:
1
2
0-12
12-32
10yr3/2
10yr4/4
none
none
sil
sil 4
lcsbk
-lcsbk
mfr
mfr
CIW
1M
if
.2 .3
03
3
32-84
7.5 r4/4
none
si
2csbk
mfr
5 06
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Remarks:
CST Name: --Please Print Gary L. Steel
Address: 1554 200ttK 2Ave-, New RiArWnd, )kl 54017
17
Signature:
ZONNOCIFFIL�r- /, /1`N
�'�' 1101,
Phone: 715-246-6200
'� � � � � ;� ��
Date: 5-13-97 CST Number: m02298
PROPERTY OWNER James Durnina
SOIL DESCRIPTION REPORT
Page2.of
PARCELIA#
030-2013-10
Depth Dominant Color
P
Mottles �
Texture
Structure
Consistence Bo
Roots
G P Dlft
Boring #
9
Horizon in.
Munsell
Gnu. Sz. Cont. Color
Gr. Sz. Sh.
Bed
Tr
•: ..........
1 0-g
10 r3 2
none
s i l
2m
ti: 3
2 8-28
10 r4 4
none
s i t
1 sbk
mfr
f
. 2
.3
1
Ground
3 2 8 -4 5
10 r4/4
none
s 1
2 c sbk
mvf r 9K
na
. 5
.6
elev.
101.7 ft.
4 45-84
7.5 r4 6
none
Cos
os
ml na
na
.7
.8
Depth to
limiting
factor
+
Remarks:
Boring #
1 0-12
10 r3 2
none
sil
2 r
mfr Crw
im
.5
.6
4
.... _::.
2 1-
l0 r4 4
none
Sic
lcsbk
mfr
if
.2
.3
3 23 -41
7.5 r4 4
n ne
na
.4
.5
Ground
elev.
4 41 -82
7.5 r4 6
none
cos
os
ml na
na
.7
.8
101.7 ft.
Depth to
limiting
factor
+82„
Remarks:
Boring #
............
1
none
s i
2msbk
mfr
if
. 5
.6
5
2 11-18
10 r4 4
none
sil
2msbk
mfr
if
.5
.6
3 18-30
7.5 r4 4
none
sl
2csbk
mvfr 9K
na
.5
.6
Ground
elev.
4 30-84
7.5 r4 6
none
cos
os
ml na
na
.7
.8
100.7 ft.
Depth to
limiting
factor
,f
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05192)
'16 . -.it L
STEEL'S SOIL SERVICE
Gary L. Steel James Durning 1554 200th Ave.
CSTM2298 MPRSW-3254 NE1-4NEl S36-T30N-R19W New Richmond, W1 54017
town of St. Joseph (715) 246-6200
lot #2-Durning & Lewis Addn,
N
111=40,
BM.= top of
2-" pvc pipe @ el, 100,
Alt. BM.= nail in Elm tree @ el. 102.10,
Gary L. Steel
5-13-97
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address ClilAi i v-> + -A
Property Address
Cf
(Verification required from Planning Department for new construction)
City/State QN I4r. 0\fj1'TParce1 Identification Number C, <1
LEGAL DESCRIPTION
Property Location t-%L' V4, 1/4, Sec. 11"wz., T N-R W Town of
T+�
Subdivision Du,244 i " v t,_i Lot #
Certified Survey Map # —1 - Volume Page # •
Warranty Deed # 1 4.2,;-P;7 1; -1 , VolumePage #
Spec house Dyes Xno
Lot lines identifiable #4 es no
Ayes
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prenmture 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 three year expiration date.
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 property described above, by virtue of a warranty deed recorded in Register of Deeds Off -ice.
7 C
- 4! " " Z�
SIGNATURE OF 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
/0
14 23 7
STA I F BAR OF ISCO!"tSIN FOIC4, 2 - 1998
-WARKkNIA DEED
This Diet-d, made between Earl L. Mielke a married
man,
Grantor, and
_Edviard M. Hendricks and Lori L. Hendricks. huNhand and "ife
z its
survivorship marital r-!)L*rty,
Gr3j'to-, for a vahiable consideration, conveys and warrants to Grantee
the fbtlowLng described real ,:state in St. Croix Celtnty. State of Wiconsin (The
-Property"'i:
I& Ck 2 :3 CP �
KAT14LEEN H. Wi4LO'H
REGISTER OF DEEPS
ST. CROIX CO., W1
RECLVED FOR RECGRO
04-30-1999 9:30 41A
4APRANTY DEED
E X Ml' I
CERT COPY FEE:
UPY FEE:
TI-00VEk FEE: 254.7)
REMIS6 FEE: 10.N
PAGES: I
R Rr,rdins Area
Name and Return Addrevi
r
* 79
r.b r -Xii
54602-1868
0�2103-20
Par,xl Identification Nuintxr I PIN)
is not home teal pic-prerty.
Lot 2, Duming and Levx is Addition to the Town of St. Joscph, TOU rHER Wffli AND S(.'BJF--CT TO PROPOSED JOINT
DRI � FWA I' WITH LOT 3 OF SAID ADDITION.
Exceptions Io warranties: Easements, restrictions and r1,_,hts-of"-,Aay of rcw-Li. it,iny.
t"
Date,' this .
—day of April, 1999.
AUTHF_NTICATION
Earl L. Mi.-Me, a narried ni:in
authenticated this Jay of April, 1999.
TITI-F. NIE\lhf-.R STAIT BAR OF �VISCCNSIN
i It' not,
audhorized h� §
THIS INSTRIAH. V` DR,kri J-- P J{y
Attorney 'N-Tistina 0gland
Hudson, W1 54016
iSw-,.-njres mj5 he authcriticate-1 ;r 3Ck110A!CLlgCd. Both vo nt
nev.4,;ar, .)
Fart L. Nfi-�:!ke
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TREASURER
13-31 0TV RD V
FOR
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HUDSON WX Z4016
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0:50-2103--20-000
423 VALLEY
HUDSON WT
54016-0000
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M
DERRICK CONSTRUCTION Fax:715-246-4948 Jun 9 '99 16:53 P. 01/05
.1 'A
DERRICK
CONSTRUCTION
Residential
Commercial
Remodeling
1505 Hwy, 65
P.0, $cx A
New Richmond, W1 .5401 7/
(715) 246-2320
FAX, (715) 246-4948
FAX TRANSMISSION
DATE: TIME ik'\A
PLEASE DELIVER TO; �--Go : C s
COMPANY: 7-jc�4..1 i Q.-.n
FAX NUMBER:
TIICSE PAGES ARE FROM;
TOTAL # OF PAGES XNCLUDING COVER SHEET:
IF YOU DO NOT RECEIVE ALL OF TTIESE PAGES, PLEASE
CALL (715)246-Z320 AS SOON AS POSSIBLE. THANK YOU!
ADDITIONAL NOTES: R4F
DERRICK CONSTRUCTION Fax :715-246-4948 Jun 9 '99 16:54 F. 04/05
EROSION CONTROL PLAN CHECKLIST
%.P. I
V
Check (V) appropriate boxes below, and complete the site diagram with necessary information.
46
(S �, Site characteristics
)< Barth arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
X0 Location of existing drainag,-nways, streams, rivers, lakes, wetlands or wells.
F-7 X, Location of storm sewer inls-111,-
X Location of existing and pro ' �%sed buildings and paved areas-
)< The disturbed area on the 10-..
Approximate gradient and 6-act,
'Or' of slopes before grading oporations.
)< Approximate gradient and di-ection Of slopes after final grading operations.
Overland runoff (sheet flow) -mming onto the site frorn adjacent areas.
Erosion Control Practices
1.0cation Of temporary soil sinrage piles.
Nofe-- Soil storage piles should be Placed behind a sediment f8?nce, a 10 foot wide e road dr
vegetative strip, or should be
covered with a tarp or more than 25 feet from any L-jC)WnS1r)p
Location Of access drive(s). or ainageway.
Note: Access drives should have 2 to 3 inch aggregate stone laid at least 7 foot widLa and 6 inchU5 thick_
Drive,s should extend from the roadway 50 feet or to the 170usG foundation (Whichever is less),
Cl Location of sediment contro!S (filter fabric fence, straw bale fence or I 0-foot wide vegetative -
vent eroded soil from leavinc. the site. stri s that will
Location of sediment barriers around on -site storm sewer inlets.
Location of diversions_
Note., Althouch not specifically required by code, it
Is recOmmended that concentrated flow (drainageways) be
diverted (re -directed) around disturbed areas_ Overland runoff (shee W) 0 ac n areas greater than
10, 000 sq. ft. should also b6? diverted around disturbed areas, t f10 from adj e t
Location of practices that will be applied to control erosion on steep slope's (greater than 12% grade) -
Note., Such practices include rnainta, " exi
Infng sring vegetation, Placem
and re-veent of additional sedimer7t fences divers
getation by sodding or by seeding with Use of ercsiof7 control mats. Jonsf
Location of practices that will control erosion in areas of coricentraled runoff flow.
Note-- Unstabilized dral-nageways, ditches, diversions, and inlets should be Protected from erosion through use of
such practices as in -channel fabric Or straw bale barriers, erosion control mats, staked sod, and rock rip-rap.When used, a given in -channel barriershould not receive drainage from more than two acres of unpaved
area, or one acre of paved area. in -channel practices §—hO--q be installed 10 Perennial streams (streams
with year-round flow.)
Location of other planned practices not 21ready noted,
DERRICK CONSTRUCTION Fax :715-246-4948 Jun 9 '99 16:54 P.05/05
Q6 Indicate management strategy by checking the appropriate box-.
1 C!
�'a Management Strategies
Ll Temporary stabilization Of disturbed areas.
Note: It ,
Is recommended that disturbed areas and soil Piles left inactive for extended periods of time be stabilized
by seeding (between April Ist and September 15th), or by other cover, such as tar in or mulching -
Permanent stabilization of site by re-vegetati'on Qr other means as soon as poss[ble (lawn establishment
Indicate re -vegetation method: Seed X Sod El Other E-3
Expected date of permanent re -vegetation:
Re -vegetation responsibility of.
. Builder L3 Owneir/Buye)r<
Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? YOzS Ll No❑ ><
XUse of downspout and/or sump PumP Outlet extensions,
Note-, It is recommended that flaw from down -spouts and sump pump outlets be rooted through plastic drainage
pipe to stable areas such as establishedsod or pavement,
< Trapping sediment during dewatering operations.
Note: Sediment -laden discharge water from pumping OPer
mast of the sediment settles oations should be paraded behind a sediment barrier Lintil
ut.
Proper disposal of building Material waste, so that Pollutants and debris are not carried off -site by wind or water.
Maintenance of erosion control practices.
Sediment Will be removed from behind sediment fences
half the barrier q S height.
and barriers before it reaches a depth that is equal to
Breaks and gaps in sediment fences and barriers will be repair�d immediately. Decomposing straw bales will be
replaced (typical bale life is three months).
• AH sediment that moves off -site due to construction activity will be cleaned up before the end of the same workdcly,
All sediment that moves off -site due to storm events will be Cleared Lip before the end of the next workdav-
Access drives will be maintained throwghout construction -
All installed erosion control practices will be maintained until the disturbed areas they protect are slabilIzed-
For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwell'ing Code.
the DNR Wisconsin Construction Site Best Management Handbook, and UW—ExTension I
Home 80ders. Publication Erosion Control for
through State of W- erne Ha 00 e
The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Manag nt ndb k are available
isconsin Document Sales, 608/266-3558.
Erosion Conrrol for Home Builders (GWQOOJ) can be ordered through Cooperative Extension Publicatiorls, 608/262
cr the Department of Commerce, 608/267-2423. -3346
Ii7
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101
RoAp
• 41. DERRICK CONSTRUCTION Fax:715-246-4948 Jun 9 '99 16:53 P.02/05
"Standard Erosion Control Plan
for 1 & 2 Family Dwelling Construction Sites
According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa-
tion needs to be included on the plot plan which is submitted and approved prifor to the issuance of building
permits for I & 2 family dwelling units in those Jurisdictions where the soil erosion Control pr vision of th
-v�ded to assist in meeting
Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is pro 0
this requirement. I
instructions.,
Complete this plan by filling in requested informatio
on the Inside of this form, n, completing the site diagram and marking (/) appropriate boxes
2. In completing the site diagram, give consideration to potential erosion that may o, and czur before, Burin after
ge tly as grading.
Water runoff patterns can than significana site is reshaped, g
3. Submit this plan at the time of building permit aPPflcation.
Site r1iwirnnn
EROSION
CONTROL PLAN
LEGEND
PROPERTY
LINE
-now.
EXISTING
DRAINAGE
T D TEMPORARY
DIVERSION
FINISHED
DRAINAGE
LIMITS OF
GRADING
SILT
FENCE
STRAW
BALES
GRAVEL
V�GETATION
SPECIFICATIOry
TREE
PRESERVATICN
STOCKPILED
SOIL
Please indicate north
by completing the
grow below.
PROJECT LOCATION -0_"r09r_M*
lot tx1 Pock C--a
BUILDER
C„p�..� OWNER CId'
WORKSHEET COMPLETED BY r-)l -
DATE '-'i ci