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HomeMy WebLinkAbout032-2022-20-000 r O Vd QfL C n o I N I ~ I ~ I I I ~ I I I ~ I z c _ o C o I I ch a ~ I Z y W z = O z a m co H Z o I c C7 coi o z d c I' o y o m z d z mF-~ ! E a m cv M I CL a aoi ~ I y ~ ~ I y ~ C • ~ ~ N O N Ili ' ~ U L C C O U 0 Z H Z o Z N d L E m N y C - L R O d U N y d i N 2 O o y G G a N y_ `n E `N v) m u) E N CY) Vq E F- a cn 0 0 0 0 z o a U) U) 7 O N L !A U cp m rn } "V N rn ao o 04 a co r; E '-~I o 0 a~ m CL o C y N N o d=' ar o I N a~ 3 y y c ° ~ y c I O o¢ 3 c > o y U o a~ v n rr O N y d pOj O CL CL r- CN LO v O N O C O O 5 O Z N 'w C, C; a) a) co O . L L O • o c m E E 0 o U) Y o cA r r \ - £ v ~ E y I V~ uy`> m a dt EL L a r`1rj i 'c c `~1 A vILm Oinc°v r' ` FORM - STC - 1X AS BUILT SANITARY SYSTEM REPORT OWNER ,2L-Ll N TOWNSHIP SECTION T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION -LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N INDICATE NORTH ARROW BENCA"K: Elevation and description : T~ T_,zpi_ Q i n~ Alternate benchmark SEPTIC TANK: Manufacturer:tjjEO=r.5 Liquid Cap. 10,116 Rings used:j_Manhole cover elev: 03 Final grade elev: 1403.2,5- Tank inlet elev.: 00 Tank outlet elev.: /60, &Z No. of feet from nearest road:Front_x_, Side , Rear Ft.,SOO From nearest prop. line:Front Side, Rear Ft. /j)0 No. of feet from: Well , Building: 6 I (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAFER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: ump Size Elevation of inlet: Bottom ank elevation Pump on elev.: Pump o elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distanc ~ro nearest prop. line: Front, Side_, Rear-Ft. 'stance from: Well Building SOIL ABSORPTION SYSTEM Bed: Tr6nch:-Seepage Pit: Width: (5, Length Sp ' Number of Lines:_ Area Built X60 Exist. Grade Elev. 71911610 Proposed Final Grade Elev. Fill depth to top of pipe: 36 ~ AU&71,_x/yam go. feet from nearest prop. line:Front Side Rear_K_Ft./ No. feet from well: No. feet from building yQ HOLDING TANK Manufacturer: Capacit : No. of rings used: Elevation ottom tank: Elevation of inlet: No. feet from rest prop. line:Front , Side , Rear Ft. No. f from: Well , building , nearest road arm Manufacturer: INSPECTOR: DATE: 7-1 , PLUMBER ON JOB: LICENSE NUMBER: aZdS 6/90:cj l Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County- Labor and Human Relations INSPECTION REPORT 8t. Croix Safety and Buildings Division ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION NE4,NW4, ec.6,T30-R19, 32nd St. 149089 Permit Holder's Name: ❑ City ❑ Village kJ Town of State Plan ID No.: Melvin 1(riesel Somerset CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV. Septic p~~ Benchmark 30 w,C) Dosing Aeration Bldg. Sewer 3.lj Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom B sl ~ y'S 19 ' Dosing NA Header / Man. 7, yS Aeration NA Dist. Pipe 7/x ,0 ySS ~ ~7, 2' Holding Bot. System 'y7 AW-,4g~7y ~ :3W Final Grade Manufacturer Demand O /7 is 'Y1 Model Number GPM 'fV_- 0 P y c.~ TD-H, Lift Loss Sys TDH Ft Forremain Length Dia. H Dist. To I Sb1L ABSORPTION SYSTEM / TRENCH Width Length , No. Of Tren s PIT No. Of Pits Inside Dia. Liquid Depth N DIM M LEACHING a ufacturer: $ETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM #lIIFORMATION Type O C~.tl-. ! CHAMBER Mode Nu r: OR UNIT System: It IVIS L; -DISTRIBUTION SYSTEM ader / Manifold „ Distribution Pipe(s) f , x Hole Size x Hole Spacing Vent To Air Intake Length L Dia. Length Dia. Spacing t0 -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 Tench Center - ~ Trench Edges Topsoil E] Yes E] No ❑ Yes E] No -I- I COMMENTS: (Include code discrepancies, persons present, etc.) 4 ,X' Plan revision required? ❑ Yes 0''V0 PP Use otker side for additional information. ! ! SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION uN 77UILHR In accord with ILHR 83.05, Wis. Adm. Code co~r/~JryJyyy~~ • STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~~4a 8% x 11 inches in size. ❑ check h re4ision 4?11us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Lc Y4 Y4, S Tjj~) , N, R E (o PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # llz5ep E r~. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER T'LL N ,5V, a/ X30 -312 II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE : NEAREST 0D ❑ Public IN 1 or 2 Fam. Dwelling of bedrooms a PARCEL AX NU B R ) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 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 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. El Replacement 3. El Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 94, Z ELEVATION Y56 1 516 75-n P, AT,, !y © Q - _ Feet Feet VII. TANK CAPACITY Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncrete glass App. Tanks Tanks structed Se tic Tank or Holdin Tank _,X~ El 1 0 El Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb Signature: (No Stamps) MP/ RSW N Business Phone Number: A ~ - m~ ~s sy9 c~s~ Plumber's Address (Street, City, State, Zip Code): IX. C LINTY/DEPAR MENT USE ONLY itary Permit Fee (includes Groundwater a e ssue Issuing ent Sign Stam ) ❑ Disapproved S Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determin i CO X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber APPLICATION FOR GANITARY PERMIT • STC-100 This application form Is to be completed in full and signed by the owner(s) of the property being developed. Any lnadequacles will only result In delays of the permit Issuance. -Should this development be intended got tesele by owner/contractor,(spec house), then a second form should be retained and completed when the property Is sold and submitted to this office with the appropriate deed recording. Owner - - - - - - - - - - - - of property °-1 of 41 T eat4vt f k P- YY,/(ff Se- Location of property Pew 1~ /l, 8ectlon T.. S~..1l-M-~-Y Township SO bbf C 1^5eJ Melling address JaY~O 0,1 36,-4 t1V -57S Address of alto 30 4k Sf ►~ee SGu.~~4 OIL Rubdivlston name PIA • Lot number Previous owner of property , 6-e ''r? Act- Ue.A ' L e'e Total also of parcel '10 4 C ✓p S Date parcel was created CP_"& der' lo Ace all corners and lot lines Identifiable? on r,~10 „ate Is this property being developed tog gesale tepee house)? as Volume Zgand Page Number ~/22?'. as recorded with the Register of Deeds. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUDE WITH THI9 APPLICATION THE FOLLOWINGI A WAARAATY DEED which Includes a DOCUMINT NUmszR, vOLUMg AND PAC? Mfflgn, and the BRAL OF THE REGISTER OF DEED9. In addltton, a eertlfled survey, 11 available, would be helpful so as to avold delays of the revlewing process. It the deed description references to a Caitifled survey Map, the Certifled Server Map shall also be required. PROPERTY OWNER CERTIFICATION I(ve) certify that all statements on this form are true to the best of lay (Ogg) Wnowledgel that I (we) am (are) the owner(s) of the property described In this Information form, by virtue of a warranty ead recorded In the office of the county Register of Deeds as Document No. ) and that I (vet presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, ,to run with the above described property, toe the construction of sold system, and the same has been duly recorded In the ottlee Of the County Reglstec of Deeds, as Document q tuce of Owner gnatura of Co-owns s (1 OD loab s1 ' Fa-to tot11fgnstuse Date of Signature YI r = S "Lt 7- a~w•~•`j:~~-.--J~+r.».w..~i...,...'.. mew-•.d}.•e. . ;:..3...-- 77 9', i , 97G, T7T rob 6000b" MPWIP6 *1 016 Boot s,v►f it to --w-7-7 "419 satl. ss and ssstrietioas of dds .:...:........«'+1~ kf 740ko ..,r F * .......t...,«,.;t.» 15/RTT!!!'~+LGfR!!...Rlsl...7~OF,,,,a f., - oosiwowzo ~Mr t4 STAIS Of "Cnl [1/ P' St. Croix Cwt ' ohm m JOL i i STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER P el U l K Kr/ e S (al ROUTE/BOX NUMBER S V '5~rc e7' FIRE NO. CITY/STATE 5D A* e~J 2r &L) T ZIP J-yoa S' PROPERTY LOCATION: E 1/4 A) U.) 1/4, Section _ Co , T JX) N, R W, Town of ~So afe P7 1A , St. Croix County, Subdivision - - , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE p / Z ZZ St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address I DEPARTMENT OF RE==PORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION P.O. BOX 769 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN 'RE'LATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.: BLK. NO.:SUBDIVISION NAME: NE 1/ NW 1/4 6 /T30 N/1119)fnor► W Somerset n/a n/a , n/a COUNTY: /BUYER'S NAME: MAILING ADDRESS: St. Croix Melvin Kriesel 12588 Boutwell Rd., Stillwater, Minn. 55082 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: - PRO LIF DESCRIPTIONS: 1PERCOLATION TESTS: F esidence 3 n/a -New ❑Replace 4-11-91 n/a RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIO NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-,IN-FIILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U CAS ❑U ®S ❑U ❑ S S ~U ❑ S ®u conventional trench If PE:rcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the una r_1LHR 83.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 25 PmC BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I ELEVATION OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.33 99.76 none >7.33 .33bl.1. 1.25bn.l.s. 5.75bn.m.s. B-2 7.32 99.80 none >7.32 .42bl.s.1. 1.08bn.l.s. 4.83bn.m.s. 1.00r-bn.sil. 13_3 7.00 98.18 none >7.00 .58bl.s.l. 1.00bn..l.s. 5.42bn.m.s. B 4 6.41 95.77 none >6.41 .33bl.s.l. 1.17bn.l.s. 2.83bn.m.s. 1.08r-bn_c.s. 00 y5,58 none >7.00 .58bl.s.1. 1.42bn.l.s. 4.50bn.m.s. .50r-bn.c.s. 7. FB- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P RI PER INCH P P- P- -s a es gn ra a P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a I borings and the direction and percent of land slope. upper trench=96.26 SYSTEM ELEVATION lower trench=94.68- k 1 P D t li~N T t 'Id s 'ooof ti fl T -7 1:5 711 I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 4-11-91 _ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional)-. 1554 200th. Ave., New Richmond Wi.. 54017 2298,1 15-246-6200 a CST L21 - URE: u DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. M ; DILIIII -SBD 6395 (R. 10/83) -OVER i. Yq~ P - - - - - - p o0 2a K 0 4w o of " ~~~ar --J I - - - - - - w ,AA t T® fR - - - - E Q "0 0 ~ DEPAR:rMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVIEONNAM E: 1/4 Nw 16 /T 30 N/R19k(or) W Somerset n/a n/a n/a COUNTY: BUYER'S NAME: MAILING ADDRESS: St. Croix Melvin Kriesel 12588 Boutwell Rd., Stillwater, Min082 DATES OBSERVATIONS MADE USE NO PTIONS: E R O ATION TESTS: .BEDRMS.: COMMERCIALDESCRIPTION: ~esidence New ❑Replace PROF ILE DE CR IF 4-11-91 n/a 3 n/a RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: ViEDU CJ N-GROUND-PRESSURE: SYSTEM-IN-FILL HOYIS TANK: RECOMMENDED SYSTEM:(optional) ®S ❑U ®S ❑U ❑ S ~U ®U conventional _rench If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS age 25 PmC BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I LEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.33 99.76 none >7.33 .33bl.1. 1.25bn.l.s. 5.75bn.m.s. B_2 7.32 99.80 none >7.32 .42bl.s.l. 1.08bn.l.s. 4.83bn.m.s. 1.00r-bn.sil. B-3 7.00 98.18 none >7.00 .58bl.s.l. 1.00bn..l.s. 5.42bn.m.s. B 4 6.41 95.77 none >6.41 .33bl.s.l. 1.17bn.l.s. 2.83bn.m.s. 1.08r-bn c.s. B-5 7.00 95.58 none >7.00 .58bl.s.l. 1.42bn.l.s. 4.50bn.m.s. .50r-hn.c.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INCHES RATER INCHES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 P R D P- P- P- P Se esgrlrae P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a I borings and the direction and percent of land slope. upper trench=96.26 SYSTEM ELEVATION lower trench=94.68 m E _ - - I a EE f < 3 F i E E _ id~Z r `D 5 t _i.-t I, the undersigned, hereby certify that the soil tests rep on tN l,fgrm arer'e` de by i accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the eeziion of tKa tatts are ct to a est of my knowledge and belief. ~ J NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 4-11-91 ADDRESS: %C \ CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond Wi. 400,_.., " 2298, 15-246-6200 1 CST SIG URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER -