HomeMy WebLinkAbout032-2044-20-000 f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 589730
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: City Village Township Parcel Tax No:
Richard Scherer & Shari McIntyre TOWN OF SOMERSET 032-2044-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
10106,-7 6 - 4 65( 12.30.19.647A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
Septic 1 es ~ 7,~ Z ~ Benchmark 13•7I -7
`7 Alt. BM eoj4A Y'
Aeration Bldg. Sewer
F:•~ 3 57
Holding St/Ht Inlet A •S 106- ,
St/Ht Outlet
TANK SETBACK INFORMATION bm of .5Z.
TANK TO ' P/L~ WELL BLDG. Vent t Air I take ROAD Dt Inlet
Septic A44- Dt Bottom
Dosing Header/Man.
.1/,69 ibis
Aeration Dist. Pipe
109 /6v, 3
Holding Bot. System
PUMP/SIPHON INFORMATION Final Graded,
/o$:q
Manufacturer Demand St Cover/t~ ~ //Z.
ff'"'
Model Number
/6l0
TDH Lift Friction Loss System Head DH' Ft
116.3
Forcemain Leng~- a.- Dist. to Well
T l3•~b /d 5.5
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length' No. Of Trenches r PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL SSS~~~(.JJJ LAKE/STREAM LEACHING Manufacturer: ~s
INFORMATION 11 1.~ Q CHAMBER OR .L /A~(~
C0 ; ~ ^ a j` ~ UNIT Model Number:
Type QtASyste 1~IVr / Ir l 4
DISTRIBUTION SYSTEM' 4-13
= 3 7 a d
Header/Manifold I Distribution x Hale Siz pacing Utiri!•ErAi
Pipes r
Length O~ Dia Length Dia Spacing C
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched
Bed/Trench Center ( Bed/Trench Edges Topsoil
Q No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 873 170TH AVE~ G~C,; OoS 10~!5 p
1.) Alt BM Description 664jQA,
2.) Bldg sewer length = = (01
- amount of cover ~I 5~~`•`" l Z ~Q~(d~'`~ y 774 Z
^ n
Plan revision Required? Yes /No
Use other side for additional information. Z`
SBD-6710 (R.3/97) Date Insepctor' Signatur Cert. No.
Safe C, I J W
L~! county
s 201 W. Wasfiington Ave., P.O. Box 7162
P Madison Sanitary Permit Number (to be filled in by Co.)
i S , 37 ~ 7~~ CC ~q 77
AUNTY J ! 7
,RnIX JO
Sanitary Permit A„„~~' Ty DEVELOPMt:N 1, State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A)Ar
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to oject Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(iXm), Slats. (7c;
1. Application Information - Please Print All Information GJ ~J e
Propert Owner's Name Parcel,#
Property Owner's Mailing Address / Property Location a _
Govt. Lot ' • 3(~ • f /
City, State Zip Cod Phone Number
La=- ~~',n, Section
cle one
T rs~G N; R E o
W~
IT. Type of Building (check all that app y) Lot
fj~l or 2 Family Dwelling -Number of Bedrooms 1 Subdivision Name
Block #
❑ PubliclCommercial -Describe Use
❑ City of -
❑ State Owned - Describe Use CSM Number ❑ Village of
Vo
3~-JtP
7Town of III. Type of Permit (Check only on boa on Complete tine B if applicabl
A.
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber Permit Transfer to New List Previous Permit Number and Date Issued
❑
Before Expiration Owner
IV. T e of POWTS System/Component/Device: (Check all that apply)
n-Pressurized In-Ground ❑ Pressurized In-Ground ade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 iq~o(' sgjl✓jC
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ treatmenhDevice (ex lain)
V. Dis rsal/I'rea ent Area Information: 7
Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ell
VI. Tank Info Capacity m Total # of Manufacturer
Gallons Gallons Units 2
New Tanks Existing Tanks
o v Y a 2
a U E r 7,5 w
_ e(,
Septic or Holding Tank (j4.,~ J
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POW 1 S shown on the attached plans.
Plumber's Name (Print) Plumber's St re MP PRS Number TBusiness Phone Number
--elW 11
Plumber's Address (Street, City, State, Zip Code)
PC:" A3o .
Vll"ountyy
!De artment Use Only
pproved Permit Fee ;X7 Issuing nt Signature
ven eason for e ` V IX. CondiAih*WReasons for Disapproval J~ ~f
is tahk,effluentlilteriftd 3 2. e o"i
fl ft l cell must all e roA s + by plumber. ~Jf, ~t
eeper3~±~tsagement plan pr~id ed byplumt~er.er. C/ q V 1+~'~. c~7G
2 AWA' t ~ls fnW.- r3 iTlaintz hied J
as per appkifte code I ordlnawA3. DCLN{/~.
Attach to complete plans for the system and submit to the County only on paper not less than 8 rn x 11 inches in size II t
11 ~ ~ t::~ti~l
SBD-6398 (R. 11/11 4) ~QQ J
O
l ~G 7 ,
.GU :3 '
~r
i 1
i
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(LG,
e~
N Qwithrnon~
M
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r
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Richard Scherer and Shari McIntyre
Owner's Name:
Owner's Address: 3451 Barons Way
Stillwater MN 55082
Legal Description: MN 1 /4 NE I /4 SEC 12 T 30 N R 19 W
Township: SOMERSET
County: St Croix
Subdivision Name:
Lot Number: 1
Parcel ID Number: 032-2044-20-000
Page 1 Index and title
Page 2 Plot Plan
j Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
j Page 5 Maintenance Information
Page 6 _ Management Plan
I Page 7 St. Croix Cty Septic Tank Maintenance Form
j Page 8 Warranty Deed
Page 9 CSM or Plat
I Attachments: Soil Test & House Plans
Designer/Plumber: Todd featherstone License Number: 242514
Date: Phone Number (612) 366-4100
I
Signature
i
i
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
I
Soll Absomdon Svskn Cross Sectlon
ft
4" Schedule 40 Grade
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber
system Elevation
ft ft
Soil Absomtion 3vstem Plan View
ft
s ~ ft .eft Leaching Trench 1 -EEM
Chambers
v~
4' Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leachina Chamber Specifications
Manufacturer And Model
EISA Rating sq It per chamber Soil Application Rate _ ~lgpd/sq ft
3 v gpd Design Flow L Soil Application Rate
EISA = 5 eZ 5_Chambers
rows of i .S chambers each.
Al Page of
i
1
X13 117o F
N Qwl►il~nrnon~~
I
i
i
~'i
ro
Installation and Maintenance Instructions
Installation
Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Step 2 If utilizing the additional single side support and the two bottom supports: While the case
is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the
hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press
:,.raight down until it locks into place
Maintenance
1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the
drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place.
5) Place the access lid back onto the tank ensuring it is secure.
Lifetime filter has a lifetime limited warranty:
Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of
time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was
not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not
be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained
properly will void this warranty. Lifetime filter assumes no responsibilit,, for labor charges, removal charges, installation or other
incidental or consequential costs.
Contact: mike C@lifetimefilterl-Ic.com Phone: 502-724-2231
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 121,
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity g ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units N,~A Pump Tank Capacity gal ❑ NA
Estimated flow (average) %vU gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA
Soil Application Rate gal/day/ft' Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L G~ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size %8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domes* _ vasteriater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Insect condition of tank(s) At least once ever ❑ onth(s) (Maximum 3 ears) ❑ NA
p y' year(s) y
Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: rl, 11 month(s) (Maximum 3 years) El NA
~`JJ year(s)
Clean effluent filter At least once every: . 1 Xmonth(s) ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page 7i of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T to ident fy -site
a o ding ank
aluati
be i e ai e '~~ZDi-ll~ IT~~ '~2 A/>6l~✓ Gal~.t5TRc1~?"l.D0❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal
of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
rXJ
Name Name
/
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.540), (2) & (3), Wisconsin Administrative Code.
Page Z of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properiy and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
- - • All -piping to tanks and pits shall be-disconnected and the abandoned pipe-openings sealed - - - - - -
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T
aluati ~ a o ding~ank
be i A e ai e - FfzDf-l18IT;:~ 1~b2- N CaNST?Z(JC71(7
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name T Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY `
Name Name U N 2(j/l~j~(l
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)Id)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROEK COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address 2 r%O•-c t Gv ~ ~
Property Aeddrhs 2 v +v ~vU c~rhofa
(Verification mTAred from Planning & Zoning Dept for new tiara.)
City/State NN ~ Khm (AIT Petrel Identification Numbers ~0 -.2V -L70 O
LEGAL DESCitTPTIUN
Property Locadon I► 41 y, , Sec, 11- . T 3 a N R V? W. Town of f~rkh rr s~"
Subdivision Plat: Lot #
Certi W Survey Map # (~0.~ pal Volume t .7 , Page #
warranty Deeed # [C) 7.7 7 (bed 2W7)Volume , Page #
Spat hoarseC6vsC]6o Gar lines idsntifiableXym0no
SYSTEM MAINTENANCE AND OWNER CBRTIFiCA 1QN
improper we and maintenance of your septic system could result in its premature fiihim to handle waeaes. Proper
mahonance consists of puriping oat the septic tank every three years or sooner, if needed, by a licensed pumper. *1w you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities we specified in $SPS. 383.52(1) and in Charter 12 - St. Croix County Sanitary Ordinance.
The property owner y agrees to submit to St. Croix County Planning dtZoonn Zoning Department a certification f ms, signed by the
owner and by a master pliimberj uune yman plumbs , restricted plumber or a Koemeti pumlier verifying that (1) *t on4ile
washer disposal system is in proper operating condition aadkir (2) after inspection and ping (of naessmy) the septic tank is
less than 113 fell ofsludg&
Uwe, the undersigned have read the above requirements and agree to maintain die private sewage disposal system with the
stsida set forth, herein, as set by the Department of Satiety And Profassponai Services and the Department ofNatuml Resources,
State of Wisconsin. Cerbfuabon SUM* that you septic system has been maimed must be compered and returned to the St. Croix
County Planning dt Zoning Department within 30 days of the throe yew expiration date.
I1we c artify the all statements on this are tree to the best of my/onr knowledge. Uwe ardere the owner(s) of the
property described above, by virtue of a deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S) DATE
••*Atry infi rewhon that is misrepresefted nay result it the sanitary permit being revoked by the Pha wing A Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy ofthe certified survey map if
reference is made in the warranty deed.
(MY. W2)
Wiscoryin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance-wftfi& ILHR83,09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan tttust County
include, but not limited to: vertical and horizontal reference point (BM), direction and r
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information.: Revie by ate
Personal information you provide may be used for secondary purposes (Prlyacy" . °i&wr) (m)) 1,4, lei 5 Ct
Property Owner Pr rty {,dea*n
/1 r ✓ , ^ z / 1 ¢(zvt dot 1/4/1) 1/4,S T 3 N,R ' E (o W
Property Owners Mailing Address Block# Subd. Name CSM#
City State , Zip Code Phone Number
City ❑ Village tK Town Nearest Road
New Construction Use: fiUResidential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
f
Code derived daily flow Jv gpd Recommended design loading rate bed, gpd/ft2 - trench, gpd/ft2
Absorption area required Z47a ad, ft2_,;:42_trench, ft2 Maximum design loading rate bed, gpd1f12----(._trench, gpd/ft2
Recommended infiltration surface elevation(s) RC," A V 1 0"'/1' 4 0 1, ft (as r ferred to site plan benchmark) /Vo /
Additional design/site consideration
Parent material Flood plain elevation, if applicable i'a ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U S ❑ U as ❑ U 14S ❑ U ❑ S U [:1 S x~! U
SOIL DESCRIPTION REPORT V TU Z(),} (-Boring # Horizon Depth Dominant Color Mottles Structure X-~'
47 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F Y~ may,-
R't
_3
Ground J r c/
I ev
Depth to
limiting v
factor
t'
'S Remarks: Z
Boring # 1) F"-V r- L aft I
C ;J/ 3 i
41
Ground
j 6L Z ilk
Depth to 68 i
limiting ie
~f ct9r
in. Remarks:
CST Name (Please Print) ignature/ Telephone No.
C'e
Address ~J Dat CST Number
PROPERTY OWNER 1 c (7 f ' ? SOIL DESCRIPTION REPORT
~ c__ • Page of
f
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.
Olft
Depth to
limiting
factor b •N
Agin. r'SL.
S • 2- Remarks:
Boring #
3 A14 "A~' 41,
Ground
elev.
left.
Depth to
limiting
f r
tin.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
I A.-
Boring #
-.27
J\ 12AlAd
'elev
ft.
Depth to
.limiting
f tar
,2 'n. Remarks:
Boring #
3
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
PROPERTY OWNER t~R t~%t o I SOIL DESCRIPTION REPORT Pa9a of
PARCEL t.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Roots Bed Trench
-3 LY~
Ground
elev.
Depth to
limiting
factor b.y
7/in. ~5(..
S L Remarks:
Boring #
Ground -
elev.
Depth to
limiting
f r
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # ~y~ u s 1 r
2- r s
' I
Ground
-elev.,
ftDepth to
limiting
_Z_ Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
'n. Remarks:
SBD-8330 (R. 07/96)
Soil Test Plot Plan
Project Name White Pine Inc. Shaun Bird/
Address P.O. Box 504'x.
Hudson Wi 54016
CSTM #226900
Lot 1 Subdivision Date 3/28/99
NW 1 /4 NE 1/4S 12 T 30 N/R19 W
Township Somerset
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Pipe
System Elevation 102.7/101.7 * H R p Same as Benchmark
Alt. BM Top of White Stake with Orange Ribbon @ 108.4
- B.M.
436' Property Line 30' Alt.
95'
JB-4
5B-2 Pri A Rep
15' B-3
10%
Slope
w
35' 1110.
b
0
N
B-1 30 B-5 0
tr ~
a
N
Parcel 032-2044-20-000 01/27/2005 11:42 AM
PAGE 1 OF 1
Alt. Parcel 12.30.19.647A 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
NALLEY, SHANNON
SHANNON NALLEY KUEHN ROSS
KUEHN ROSS
7609 CARILLON PLAZA E
WOODBURY MN 55125
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC (r
Legal Description: Acres: 3.230 Plat: 0861-CSM 13/3656
SEC 12 T30N R19W NW NE BEING LOT 1 CSM Block/Condo Bldg: LOT 1
13/3656
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/05/2003 748417 2469/333 WD
11/05/1999 613339 1468/453 TD
09/20/1999 610651 1457/484 WD
09/20/1999 610650 1457/483 TD
more...
2004 SUMMARY Bill Fair Market Value: Assessed with:
10948 57,900
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.230 49,100 0 49,100 NO
Totals for 2004:
General Property 3.230 49,100 0 49,100
Woodland 0.000 0 0
Totals for 2003:
General Property 3.230 49,100 0 49,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00