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HomeMy WebLinkAbout016-1058-80-000 o ~., ; O ° ~ I ~ h ti °' O~ +.~ ~ O ~ C h O N N i ~ v ~ '; I I a ~i I ti I I 0 Z m I ~ z° I C LL O 3 w I i a ~ ~ M ~ I I _ > ~ > Z r ~ ~ a `' " p ~ '° Z a am N~ i I o I Z v' o :. ~ ~ ~ I _ avi Z ~ c z l m r ~ E ~ I ~ ~' I .~ N ~r ~ I . Ai O o ~ o ~ QQ ~zz I N M i. o Z I o m ~' ~ N I I ~ y C G ~ ` a to ° I a ~$ Z r r ~ 3~ 3 a m Z o 3 O O O I •~w ~ I ~aaa ~, I a I O ~ ° N `~ tl) J U _ N N ~ r L }• ~ ~ ~ N M w N Z3 m Q m a d ' ~ ~ d ¢ Z to m I w _ y 7 ~ ~ O ~ O O H ~' ~ C V ~. O O ~ I w o ~ ~ ~~ H d w~ r> a.. '~ ~ ~ ~ p C N O y C ~ • ~ O N C7 '~, U M O Z C a ~ fn O ~ ~ ~ ~ ~, '~ ~ ~ a ,-, ~ dt a ° a ~` I • ~ °. m • °' m c A vat 03v~iv ~ Parcel #: 016-1058-90-000 12/05/2005 02:35 PM PAGE10F7 Alt. Parcel #: 27.30.15.4088 016 -TOWN OF GLENWOOD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -CHRISTENSEN, JAMES A & JOSEPH D JAMES A & JOSEPH D CHRISTENSEN 1319 300TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE SEC 27 T30N R15W PT SW SW COM SW COR SW Block/Condo Bldg: 1/4, TH N 825 FT TO POB: E 330 FT, TH N 165 FT, W 330 FT, TH S 165 FT TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 27-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 03/19/1998 575369 1307/115 OC 03/19/1998 575368 1307/114 QC 07/23/1997 497/639 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 46,900 58,900 NO Totals for 2005: General Property 2.000 12,000 46,900 58,900 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 12,000 46,900 58,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 526 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T` ~~ ' uQ SOIL AND SITE EVALUATION REPORT ,._~_ Page ~ of ~, L y„~ ~^ ^ ni acw~u wnn ~~nn oo.va, •.,~. ••~•~,~• •••••••> omN+nv+r or COUNTY r Wtb7fI,U~H1~61/AYW(eAYL~L~ but t include i Pl , an mus ze. Attach complete site plan on paper not less than 6112 x 11 inches in s PARCEL I # D not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or . . and location and distance to nearest road. north arrow dimensioned , , APPLICANT INFORMATION-PLEASE PAINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~ S f ~- GOVT. LOT /,~/ 1l4 S k j 1I4,S ~?T 3 D ,N,R /, f" .fir) W PROPERTY OWNER: S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER (6/ 9 1 ~ /78' z - ~ " ^CITY ^VILLAGE MOWN NEAREST R AD tea r"~: ~~. ~a G t e o d / , . 0 o P k ,C 5 . [ ]New Construction Use (XJ Residential I Number of bedrooms „~ [ ]Addition to existing building ]~ Replacement [ ] Public or oommeraal desaibe I , Code derived daily flow ~(~ gpd Recommended design krading rate LJ bed, gpd/ft2~,~trench, gpd/ft2 ~~ TT bed, gpd/ft2~,~.trench, gpd/ft2 _,,,~ Absorption area required ////2ss bed, ft2 DO trench, ft2 Maximum design loading rate Reoommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations %NO!!No/ .~YS ~'M - Parentmaterial GL ,o P~ •4 L ,Y`~«~ Flood plain elevation, if applicable ""'-- ft S =Suitable for system CONVENTIONAL ^ S ®U MOUND ~ S ^ U IN-GROUND PRESSURE ^ S ®U AT-GRADE D S ~ U SYSTEM IN FILL D S ~ U HOLDING TANK ,~ S D U U=Unsuitable for s stem SAtt DESCRIPTION REPORT Depth Dominant Color Mottles Structure i t C B r>da Roots GPD/ft Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ence ons s ry ou Bed Ttertdt 1 0- o - SL s6/ M M~F /fS .d /O 2 S/C~ ~ S ~ ~ W 1~ d ,s SC ~ N6~f" ~ ~~ -~ ~- arks Rem : -~ o ~ / /~ ~'` ~ / d /~ - /a ~ S~e~ ~s6 M M~ A~w ~ . ,~ ~~ ~ (',~ i 8 "~ "a.~~-. ~ v -n .~' ~. 1 Remarks: .Sys ~ e ~ O Name: Please Print ~~ L ~ ~~~ ~~ ass: 3~ 2 ~ ff w ~~ /~ o C~ ature: ~~ ~ ~ y .l Xir/ Phone: 6s /~//.~ CST fm~0 PAOPERTY011YNER /~~1/SfCiVSaN SOIL DESCRIPTION REPORT PARCELI.D.l~ 4/b ~ IDS" - ~O Boring # ~~ :~ wf~:>E Ground elev. /OD~ft. Depth to limiting fac3 % ~~ Boring # .:.~~ ik :; ~• ~ Ground lev. 9 • ~ (f. Depth to limiting factor ~~ Boring # ~'.:::3:.:.. X%:4 :: <# r,. ~:ti~i'~•.:':':Z Ground elev. ft. Depth to limiting factor Boring # ~~ ''~ :~ Ground elev. ft. Depth to IimiGng factor Page ~ of ,~ Horizon Depth Dominant Color Mottles Texture Structure Consstence Borxxia Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trends -/ D ~ S/L ~ s6 v ~ ,4 2 ~ ...s 3 -.~' d .~ ~ ~ 6 e ~s -- - .s i r Remarks: .~~~ 1 e Ro ~ /-C A f ~'..~ ~~ O- D ~ S/L ~S6 /YI vFiQ ~ S 2M .~ , d ~~- ,.s' ~ L 3Q6i e F.~ ~ w •.~ Remarks: Remarks: _ ~ i - ~, - -- i , _ r ~ ~ ,- ~_ ~ ~o - ~~ ~ _ ; . , _ , ~ _ ___ ~ ~ ____ __ _ __ __ _I ___ __-,__ _ _ ___ _ __ __~ ___ ___ _ _ _ I , _ __ __ _ _ ~ _ _ _ __ _ ~ ~ ~ a ~ __ _ ! _ _ ~ __ _ ___ ~ C _ _ __ _ ___ . ~~ z__~ ___ __ __ __ _ __ ___ _ _ ~ ___._ ___ _ ____ __ - - - i ~ ~ ~ __ - - ~ . ~ ~ - - -- - -~- -- - - --- - - L- __ - - -- 1 -- --- - - --- - - - i ---~ --~ -~ __ _ ~ --~ _ -- _ -- --- ---- - , ~ -- ~ ;--1 -- ~ -i ~ -- - -- - ~ - - ~ ~ ~ _ ~`~ _._ __ I _ _ _ r __ _ I ~ O Q O - - ' - - -- 3 __- ~_ I I I A- - ; ~ ._... -- -- ~ _ -- ._i. -- ! -- ~ -~ ~ V - -1 ~ -~' ~ `_ i ~ G ~ f- - -i f - - - - - - - - /~ -- ~ - D - - - ____ -- - - - - ~-- ~ ~ -- - y __ - = ~ - - - - - --i --- - -- . - - . v - - --- . _ -- - ~ -- ~ --- = --- - I- -- _ - ~ -- ' - _ ~ 1 _ -- - ~ -~ - ---1 __ ~ :__ ~ -- - --- - - =-- __ ~- __ ~- ~ _ --- -- --- -- -- -- -- ~ - ' ,~ --- ~ ~ 1- ~-- 1 ~ t ~, - - --- - _ -- -- - C_ -- ;- --- -- - - ~--~ ~ ----- ~- ~ ~ -- f---~ - --- { I ~ I ~ - - - - ~- --- ~ -- i - -- -- --- - ; ~- ~1 - ~ -- - - - _ f ,-- - - --- ~- -- -- - ,-- _ ~_~ '__ _ - - - - ~ I _ _ - _- - r- - i- - -- - -- - ~ ~ i ~ -- - _ - - I ~_ - - _- i f----- - __ _- -- ~ ~-- j ~- - -- -- i- - ~ - - ~ ,- - - , -- - ~ ~ ~ ~ ~ --- - __ i i - - _- ~ -- ~. ~~ -- _ ~ ~ ' -__ ~__-_ . - L - _ ~_~ - - ~ I . ~ ~ _ -- -- - , - ,- isin Department of Commerce PRIVATE SEWAGE SYSTEM y 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)(m)]. 'ermit Holder's Name: City Village x Township Christensen, James Glenwood Townshi .ST BM Elev: Insp. BM~JEIev: BMf,~De~sc,,ription: L~ 'ANK INFORMATION ar~~7, 7. 3 ~,,~n.,,,,,,.~ ELEVATION DA A county: St. Croix Sanitary Permit No: 363884 0 State Plan ID No: Parcel Tax No: 016-1058-80-000 TYPE MANUFACTURER CAPACI Y Septic ~ ~~ Dosing N w - / ~,,, (~,~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ( ,~ Dosing ~~ ~ 5 ~ f, ~ ~ / / Aeration Holding PUMP/SIPHON INFORMATION iManufacturer _/ ~ ',Model Number !/~/~,~m, TDH Lift 1 Friction Los S~ ,~j Forcemain Len / ia. `~ SOIL ABSORPTION SYSTEM ' c~ U errand GPM , t ~i~ `/"~, stem He d TDF{ o ~ Ft 2.. ~ (d . Dist. ta,Well ~~ ~ (~ ~ ~ ~'~ STATION BS HI FS ELEV. Be chm k `~~ v-t, ~ L /OS-- / i Alt. M o .0. I S~ l Bldg. Sewer ~ •oS S Ht Inlet SbHt Outlet Dt Inlet t Bottom ~ .z+~t. 9~ ~'lo - Header/Ma 2" 6~ ; _ ~r7 i •5 Dist. Pi l t~' Bot. System ~- • 2 Final Gra~e ~ y ~~~ st ~~ 3 ~! S. 5 . 2 ~l ~ . 0 1~ `~ ~ BED/TRENCH DIMENSIONS Width ~ / Lengt ~ No. Of Trenc es / 1 PIT DIMENSIONS ~ No. Of Pits Inside Dia. Liquid Depth ~ 1 Yy.G C1 ~ SETBACK INFORMATION SYSTEM TO P/L DG WEL 1 a LAK TREA LAC NG CHA ER OR Manufacturer: Type Of System: M ~~ ~ 1 ~ ~ ~~ ` " j '~ / O~ 1 D Model Nu er. DISTRIBUTION S.YSiTEM ,f l,~,~- •. ~~~ ~''.',; `r^"~"" 1r1 ~,o . ~Kt~~2.. Header/Ma Length ifol Dia n / (~ stribution Pipe(s) Length (~ ~ ~ r' Dia Spacing ~ x Hole Size +J~ J~ ~ ,/ ~ x Hole Spacing ~y / (5.. Vent t Air Inta e ~ t~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv /~7u.~ oJ1 i~ d~ ~ Depth Over ~ ~ Depth Over xx Depth of eeded/Sodded ulched B'e rench Center ~~ Bed/Trench Ed es Topsoil ~ p 16 ~j Yes j j No ~ !Yes ~=1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/~Z Inspection #2: 5 /~/ ~ Z Location: 1321 300th Street Glenwood City, WI 54013 (SW 1/4 SW 1/4 27 T30N R15W) NA Lot ~I,, Parcel No: 27.30.15.408A 1.) Alt BM Description = ~~° °~ A~~+ ~~ ~-~~ ~pr C~t~ d~ ~2err~' d [9~- vv~~~ cl G ~' *~.,,,r~ 2.) Bldg sewer length = ~ ~ N,,S~ ~~ ~ - amount of cover = ~ 3 / 3.) Contour = f' `o-f ~G"" ~G~C~~Ti~" ~~%C~C~~ ~ /7 -~9- rJ _ _ _ ----- 000 ___ ~~~ -r-- - -- ,-- T-; Plan revision Re wired? ~ Yes ~ ~ / ? ~~~/ ~/~~~ ' /~-~~~- ~ ~~~~ _; q I _~I , No `~ J I u ~.Y Use other side for additional information. i _______ ~I $ SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. ' PLOT PLAN PROJECT James Christensen ADDRESS 1319 300th St. Glenwood City Wi 54013 SW 1!4 SW 1/4S 27 /T 30 N/R 15 W TOWN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226900 CONVENTIONAL IN-GROUND PRESSURE 5/10/00 BEDROOM 3 DATE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 600 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 BED SIZE 8' X 47' BENCHMARK V.R.P. Nail in White Oa~p~~ /_ h ASSUME ELEVATION 100' ^ BOREHOLE O WELL sH,R,p, Same as Benchmark SYSTEM ELEVATION 100.1 /~~G ~ d 300th St. a ,~ ~ ~ - ~ '-~ !~ System is to be ~ ! installed along the a 99.1 Contour Line ~° Tank is to be properly bedded and o provided with a lockdown cover with ~ a approved warning label Alt. Huffcutt B 3 B - 4 B.M. Combo Tank ~ Pro 3 `~~ -~ Bedroom ~ House Q~~f_ dye ~"" B - 2 10% B -1 ,y,,o~ ` s Slope ~'~ 25' Below ~` System is to remain 600' '~~ * .M. 720' undisturbed v r- ~ ^ ~ Well is to meet all ~ ~~~ v ~ ~ ~ :1 setbacks found in --Iro ~~~~ a>S~ ~ ~ Comm 83 v/"- ~„' ~.c'~'~-crr~ . 31 a ~~v w ~ 660' ~~ o M .--i 1320' Pronertv Line /* '!+V'sconsinDepartmentofCommerce ~ PRIVATE SEWAGE SYSTEM .°~fety and Buildings Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: Christensen, James ^ City ^ Villa e ^ T n of: Ghenwood Township CST BM Elev.:. Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemai n Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary363884 0 State Plan ID No.: Parcel Tax No.: 016-1058-80-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade St cover BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu acturer: SETBACK INFORMATION TypeO CHAMBER Mo a Num er: System: OR 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 Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No I L~ d ic~ 111J GJG~:l1V11 Ttl. ylloy~.~+uval i~l.• C~MMENriT51~32[)n~3[OOt~i~ttleet,l~i~e>~iwoo~sC~ty; ~~~3~t'(~W11/4 5W 1/4 27 T30N R15W) - 27.30.15.408A 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ~~ ~ 8~ ~ ~~ Safety and Buildin s Division 9_ ~• SANITARY PERMIT APPLICATION 201 W. Washington Avenue ~~SC~ns~n P O Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code MadiSOn, WI 53707-7162 • Attach complete plans (to the county copy only) for the s e ~d pia@r ess county --- than 8 v2 x 11 inches in size. ,~ ,.~~ ', ~ i-~ ~ ~ • See reverse side for instructions for completing this a ~ do ~ . E r °• State Sanitary. Permit N tuber Personal information you provide may be used for secondary purpos ~ ^~~~ ^Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). u 1 rt ~, , ^~ ~; ~`t~'~~ ~ .fate Plan Review Transaction Number i ~;< I. APPLI ATI N INFORMATION-PLEASE PRIN L INF LION £ ~~' /-XFNS !~ = ~~ro~~o Property Owner Name 4" ,~U s ; y Lc~t~ion R JE (o W ~. a S T N ~,~ ~ , , Property Owner's Mailin Ad ress /l ~` Lot Num,J~eFq ~ ;` ' ' ' Block Number ~v ~ -- ~ , ~ ~ City, State (.' V Zip Codef ~ U - Phone Number ( ) on Name or CSM Number ,~~ II. F B I I ' (check one) ^ State Owned ~ yy ^ V Ilage est oa ~~ Public Famil Dwellin - No. of bedrooms wn OF ` , 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~~. ~j0. IS. ~ ~, '7 g O ~ ~l Q ~ l / ` ~ ~~/~ S~' d 1 ^ Apartment/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 ! Schoo! 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~d'ew 2• ^ Replacement 3. ^ Replacement of 4, ^ Reconnection of 5. ^ Repair of an -_____S~fstem ________System_____________ TankOnly_____ _______ Existing System ________ Existin~5~fstem 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 ^ Seepage Bed 2~Mound 0 ^ Specify Type 41 ^ Holding Tank ~, / 42 ^ Pit Privy 12 ^ Seepage Trench 22 ^ In-Ground Pressure r ~ ~~ 13 ^ Seepage Pit I -[ 43 ^ Vault Privy ll ° q 14 ^ System-In-fi ( „ 10 VI. ABSORPTIONS EM INFORMATION: 1. GaNons Per Day 2. Absorp. Area 3. Absorp. Area 4: Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade 6 Required s .) Pro,Rgsg~d (sq. ft.) (Gal da~L/sq. ft.) (Min./inch) Ele j ~ ~~ ~ '~ ~ ~ ~ / L~ Feet - F eet VII. TANK INFORMATION Ca ut in hallo s g Total # of Manufacturer s Name Prefab. Site Con- l S Fiber- Plastic Exper. N E i i Gallons Tanks Concrete tee glaze App ew x n st strutted Tanks T nks Septic Tank or Holding Tank ~ ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta ation of the onsite sewage system shown on the attached plans. Plumber's Na e: (Print) ~ ~ Plumber's S' n Stam ) MP/MPRSW No.: ~ Business Phone Number: ~ S ~ ~ /~ ~ L~ ~/ l r / c ~ , s Plumber's Address (Street, C~ y, Sta ,Zip Code ~ J ~ ~/~ IX. COUNT I DEPARTMENT USE ONLY ^ Disapproved S nitary Permit Fee I'n~'udesGroundwater ate ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial ~ Surcharge Fee) ~J~S r u ~ ` Adverse Determination J X. CON( DITI~S OF A~~PtP OVAL / REA$ON~ `FOR DI~VAL: S~ i rt/1~ SBD-6398 (R.12I99) DISTRIBUTION: Original to County. One copy To: Tafety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. .h 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-b399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of 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 and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. lll. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign.application form. IX. County/ Department ~1se Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building-served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps°and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SUR~HARGF , 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices_which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ., . , ' •• ,^: isconsin Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www. commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 17, 2000 OUST ID No.226900 ATTN.• POWTS INSPECTOR ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/17/2002 Identifi Transaction I o. 316926 Site ID No. 192 1 SITE: Please refer to both identification numbers, Site ID: 192321, JAMES CHRISTENSON above, in all corres ondence with the a enc . ST CROIX County, Town of GLENWOOD; CR OF 13OTHAVE & 300TH ST SW1/4, SW1/4, S27, T30N, R15W FOR: Description: MOUND SYSTEM FOR JAMES CHRISTENSEN Object Type: POWT System Regulated Object ID No.: 664009 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. CAUTION: Wis. Stats. 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potential for a lawsuit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installationloperation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, KEIT A WILKINSON , POWTS PLAN REVIEWER Integrated Services (715) 524-3630, FAX: (715) 524-3633 , M-F 7 AM - 3:45 PM KW 1LKINSON@COMNIERCE. S'I'A"1'E,. ~%I. US DATE RECEIVED 05/15/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 codes 7633 cc: JAMES CHRISTENSON ^ BOREHOLE O WELL *H.R.P. Same as Benchmark PLOT PLAN PRbJECT James Christensen ADD 1319 300th St. Glenwood Citv Wi 54013 SW 1 / a SW i / a s 27 /T 15 w TowN Glenwood couNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/10/00 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 600 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 BED SIZE 8' X 47' BENCHMARK V.R.P. Nail in White Oak ASSUME ELEVATION 100' SYSTEM ELEVATION 100.1 ~.©.V~l.T.~. Conc~i~io~~ially 300th St. DEPARTMENT OF COMMERCE DI`11SION OF SAFETY AND BUILDINGS / ~~,~ `~X C } ~~•~,aX ¢- n E:E CORRESPONDENCE 3Ib~t2~ ._~ '~ System is to be installed along the 0 99.1 Contour Line ~ Tank is to be properly bedded and o provided with a lockdown cover with ~ a approved warning label ~ o~`r Alt. ~ +" Huffcutt B-3 B-4 B.M. ^ Combo Tank Pro 3 Bedroom House B-2 10% B-1 Slope Area 25' Below System is to remain 600' _ I16.M. 720 undisturbed a~ Well is to meet all a setbacks found in Comm 83 ~ 0 660' o N M .--~ 1320' Property Line Desigasr~- _ Na C~OC f7 ~ ~ ~ liktta ~~ d ' t1 ~ 4" Observation Pipe Perforated Selov Fi1Cer Fabric . AS~lt C-33 S o n o "Top:olS _~,,.• ! a Y. Scope e 6:a ortJ~-2-: Droin Rock ton-Wrsven Filter Fabric ~IitrlDutiOr- Pipc G s~ _ Forct Moin From Pump Cross Section Qf A hound _Srsten+ Usit-Q -----~-- A Bed For The Absorption area A Q~~~ Ft. S ~~„~. Ft. ~~s-Ft. K1~Ft. L ~~Ft. w~/ F:. ~~ r ~ ~ 4~Obaervotiot~ Pipe ~.~..~._.."_ e ~ A ~ l~ W ~A ~~r~wr~ rw.. r.. .rr--r...=~ a~~~~.. ~,rr~..~~-rrr.rrr ~.• ~. p Distribution Bed Ot %~- 2 !Z , Pipe Droin Rotk I ~+~Gbcervotion Pipe Permanent Morker- Pi pes or Rods : ,~ flowed foyer D iE~~ i F _'~__ k '~ ,~ ~ u ~,~ _' K off'` 1~ ~\ .~ --• - . '\.Forct Main ~ From Pump Plon View Qt Mound Usinq A Bee for The Absorption Areo PAG~_,,,~C~.,,,,,~ I En ~ loco+td On f3e~toT, ~• t:quorlf Spocee FIRST tlot.t Nsx't' to tennat~~' to~+ Ne - " -'~ u~srnau+~0>t Pipe tcrOVt ____r_ Signed: License Num~eb~ ~~~~~1~ Date : .~ -'/d -~- ~ P ~s Ft. x s~~ InGhts -' Z ~ ~'~~~~ Y +~ inches 3~1~~ Nate Diameter ~~~- lnch 2 ~ Lateral ." '/Z inch(es) Mla~nifold Inches Force Main " Inches N of holes/pipe Invert ~ievation of ~.atrarat~/ dBFt. Pertara~ad wipe Qetoil ~~ SEPTIC TANK ~ FUMF CHAMBER CROSS SECTION AND SPECIFICATIONS u "~ VENT PIPE 12" MIN . AHOV E GRADE ~ >_ ' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE 4" CI RISER 6 " MIN . -------- ABOVE G ADE 18" IN . 6" MAX . WATER TIGHT SEALS ~ •~- BAFF LE ~ A ~~ Ai Pi~V ~~NI a PIPE 3' 0 ~- 90LID SOIL ~ PUMP ©FF ELEV .I~FT. - --~-- D b ~n~ 7 ,~ CONCRETE PAD SPECIFICATIONS ~ = / S ~dtl~No SEPTIC / DOSE TANK MANUFACTURER N(IMBER DOSES PER DAY : ,~~ -TANK SIZES: SEPTIC ~D `GAL. DOSE VOLL3ME INCLUDING ~~'~ DOSE ~~'~. GAL. FLOWBACK: _~~ GAL. ALARM ~SANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER MODEL NtrMBER : SWITCH TYPE: ~~ APPROVED ALM JOINTS W/ ON APPi~D PIPE 3' C/NT0 SOLID SOIL OFF ~"~ RISER EXIT PERMITTED ONL': IF TANK MANUUFACTURER ETAS APPROVAL 3" APPROVED BEDDING UNDER TANK 35`1. 1 ~~,~,~~~~ CAPACITIES: A = INCHES ~ = _~~AL. ,~~. v r ,,ter ~~ ~ ~~ REQUIRED DISCHARGE RA 511 E F 4 0 WEATHER PROQE? JUNCTION BOX WITH CONDUIT APPROVED MANHOLE COVER W/ PADLOCK E WARNING LABEL " MIN. :; ~Z ~~ ! '~ GAS- ~ ` TIGHT i ~~ SEAL ~ ~ r i ~ 1 B = 2 INCHES = ZY,L ~~ GAL. C = ~ INCHES = `~i2~. ~ GAL. D = ~ INCHES = g~~ S5. ") ,ice-..-..GAL. PM 1 PUMP ~ ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETwEE~ OFF AND DISTRIBUTION PIPE ~ FEET ~~-~( + MINIMUM NETWORK SUPPLY PRF~SSURE - -- 2 . ~- FEET + ,SQ F£ET FORCEMAIN X ~, 62F~'/].00 FT. FRICTION FACTOR FEET TOTAt~ DYNAMIC HEAD = ~'~ =~- FEET INTERNAL DIMENS 0 OF PUMP TANK: LENGTH ~~ ~ ; WIDTH `~; DIAMETER ''~ LIQUID DEPTH y~ ~~ SIGNER: LICENSE NUMBER: ~~~a1 OGDATE: ~ ~~~~ .. ~ ~ ~ Soil Test Plot Plan -project Name JAMES CHRISTENSEN Byr ird Jr. / Address 1319 300TH ST. ~ GLENWOOD CITY, WI 54013 C M #3479 Lot ------ Subdivision ----------- Date 5/8/98 SW 1 /4SW 1 /4S27 T 30 N/R 15 W TownshipGLENWOOD Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.NAIL IN WHITE OAK System Elevation 99.1 * H R P Same as Benchmark Alternate Benchmark TOP OF WHITE STAKE ~~jw' ? 100 ST CROIX COUNTY SBP'TIC "TAAtK MA'iNTI~ANCE A(~RElaM1~N`C ANA OWNERSHIP CERTIFICATION FORM ~ / L ~~- OwaerBuyer l~~ Property Addt+ess ~o~ ~~ ~,' ~ Y~ 13 (Verificttion required Plattnfng Department for new constructioa)...._......./~~ °'~ ~ .,. aty~~te G~~.~.«~ - Pa~+eel Identification Number ~~b~l ~-56~,_' ~~ ~ 4 D Property Locatioa~~'/<, ~ ~/,, So~ l . T.~~ N-R,~~, Town of v/ Sttbdivisioa --- Lot # ~- ~~__ ~_. _ Cet~dt'ied Sarv~y M>tp # .Volume ~ . Page # Warrtu`!y Deed # S 7 ~ ~~ Volumo~ Page # /` Spec home C7~ Lot Iiaes ideatifiafal -yes Q as SYS3EM 1VL~~iN~l- Imptaperase sad Hof ya~ofr aeptic ay~tem conid result is its P~ fa~ar+e b ~dta ~frbea. Ptnpermsfaeftmaoe ooaa6Ks of pftaspfag ant the septic tank every :brae yracs ar sooner, if herded by a iica~ed pumaper. ~V6tft you pat lab rife sysoeta can affect the Ratctioa of tf:a saptie Oak as a treatment stage in the waste disposal Nstem- The propdty owner agrreea to snbasit m St. +~+oix Zouiag Department a certification tbcm, aigf~ed by the owner and by a atssterpla~ber, joamDeYm+aD-Plumbex, mstrlatedplumber or a liceasedpumpetverifyiag tfntt (Ij the oa~#ee w-aatevvat~rdispoat systeae is 9n pcvpa opetatittg coaditica and/or (2) after faspeciio~a and PanmPin6 (if accessary), the septic teak fs feaa than li3 fill] of ahtdge. Uwe, the uadertigaed Lave read tLe abovoc n~ and agree to tnaiataia the private sewage disposal ayaEem witL fife atandafds rot form, heraift, as set by the Uepsrtaseat of Ctimmaroo and the Departfae~ of Natural Resoiarea, Sdtte of Wia:oasia. Caetitlcstion static that your septic system ?ins been mainp-iaaf amat be cofapteted and retfuaod to the St. L~ Cotmty Zoning t>f~ee within 30 of the year floe date. ~c19L~ SIQNA OF APPLICANT DATE O)~RTEFICATit~lN. l (we) cxxtify that aU atfttt oa this form are true to the beat of mY (our) knowledge. I (wc) afn (are) the owaes(s) of the properly descrtbei a va, by of a warsaaty deed rec~sded in Register of Deeds Ofiice. st aTVits APPLicANT DATA •rR~R~Yt t be revoked 1~ Yi~r ~+~7N+~$ D~' ~tl R4! Any iatbaastiocf that is mis~represaated taay result f a the aaaitary permi Sag «« Include Nlth this application: a statrsped warranty deed from the Register of Deeds office a copy of the certified survey map if roference is made in tics wamaty deed ,, • )p.oo ~, • 81yRE BAA OF WI3CON~IN FORM 3 - iD96 DoCUMt-'l QUIT CLAIM DEED `'~` - - REGI FFICE ST. CR iX CO,, WI - Rats't! br t',tco~ quiltlaima to ~ ~ ~ IIVIAAR 18 1998 ~, ~ a:oo P ~ the folio described ted lstaM it Re a1N rrf DNa cout+t% SIaN of Wisconsin; . N TO , 1 X319 300 T~ s? .. Otte-IC58-$Ooo~ . ore-io5g~ .,__,.,,.~:rn~^_~,+_ .--.°~~.a."~~ ^----^r-.-... ~ ........~..,,..___~.., ~rcel ldentifiCalion Number ( N) (~1 ~ se~..~e (.~1 end s«~e ~° n Aso-io5e -70 t r.su~l o~ .~ ~.su~'1 a(ser~ n ~ Ts ~ t _ , wo ,re s: ~9.~ce s /~ { ~ ~ .~,. (sral m~ a~ ~ .~.a# q}nrfR.s (.s~1 r 1 TMas Aloath C.i~,t Ni.,dsed Troe-e~ F.r,~ (8251 ~t ~ pvLd o~ bayi PieP~i~ herrin dreaubed: 1l~.aea ~dat Tii,~ 1iit~ised rfritz`.~ (33e1 ~ ~fhence ,+~~. E3re .Nurdw.d ~~~ (mss! ~..~ r,~ ~ ~.. Ail.b.t 7~traq, (~1 ~ Tiit.~..~ .rual a. Afrardd .Sr~et~ Firs (ltisl ~..t i ~ .,ic ie~ jl.&~, _ .~~ ._ v . , .. , ~ , TNs _ homeafisad propertyt ct.) ,~, rr Dated this ~ 2 day d _~ ~ R t__1l ,19 ~_ . (sEAy , - (sue) '-~~~~ A. C ~lP~srl~~-t~i csEAU tsEAL) A1)1'HENT1C/t1'lON Signature(s) authenticated this day d ,1Y TITLE: MEMBER STATE BAR OF WISCONSIN (I! not, suthori2sd by §706.06, Wis. State.) Ty11S INSTAUl,tENT tAlA6 OtiAFTEQ 6Y . .~ ~Ps~ ~ ~1~I s -- (Signature may bs suthentlcatsd or edawwlsdged. 80th ere nW necessary.) ACKNOWLEDGMENT STATE tJF WISCONSIN f aa. C,ab\ ~ CO ~nqr, ,, 99 Personafhl came Debre me this ~ day d ''~L1.~.-C l/'~ ,19 ~^ tM above named t^/ S L N b me itnown to be Ute person who executed the loreypifp tnstrumau and acknowledge the same. Notary Pubyc county, Hrs. My Commission is permanem. (!t not, state szpiration de1K ~-3raoa~ ,14 .)