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HomeMy WebLinkAbout012-1016-70-100 ST. CROIX COUNTY ZONING DEPARTME N g-= ' -�,�j` AS BUII,T SANITARY REPORT . r , EC EIVE0 Owner Property Address °g ST C40 City /State e / COUNTY zewGOFFICE Legal Description: Lot Block Subdivision/CSM # '/a ' /a, Sec. �, TkN -RW, Town of # ,ter SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC7 � Setback from: House - ,- 4 1 WeIP Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM ��_�� A / Width Len , 4 Number of Trenches Type of system: !r Setback from: House Zi Well /,00 /L Vent to fresh air intake _ �77 ELEVATIONS Description of benchmark ` f �� Elevation / Description of alternate benchmark Elevation OZr Building Sewer �✓ �� ST/HT Inlet '�` ST Outlet �y PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( j) �� �� (� _ Bottom of System 0 � � ( ( ) Final Grade) O ( ) Date of installation/�4� Permit number State plan number i' Plumber's si nature License number j 'tP'o�7 Inspector Complete plot plan Q x NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW y a L �r r s -- I 4 INDICATE RTH ARROW I 'Wisconsih Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353172 Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.: Town of Erin Prairie C T BM E P Insp. BM Elev.: BM Description: // Parcel Tax No.: ( CO . O 1 1 0 6 � � rp� o* l TANK INFORMATION ELEVATION D TA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic zoo Benchmark ( Dosing Alt. BM *2— o� P �- v Aeration Bldg. Sewer `I�•p$ Holding St /Ht Inlet T:63 TANK SETBACK INFORMATION St/ Ht Outlet 9 -$� TANK TO P/ L WELL BLDG. Airi to ntake ROAD Air I Septic !� 6 3C} --, NA 01 80ttVfi*e­ Dosing NA Header/ Man. 4 -3ro y 9y. 3 S Aeratio NA Dist. Pipe Holding Bot. System D• to PUMP / SIPHON INFORMATION Final Grade - r M Manufacturer and 9g, z Lf St cover Model Number GPM TDH Lift F n System Ft oss m ead Forc in Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM 2 coo S 12 RENCH Width Len th r No. f Trenches PIT No. O Pits Inside Dia. Liquid Depth DIMEN DIME I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING r' _ INFORMATION TypeOf CHAMBER Mo Number: System: }!� (� �- OR UNIT 0_ u DISTRIBUTION SYSTEM Header / nifoId N Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. f Spacing _ 132-1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Z 4 Bed /Trench Edges Topsoil E] Yes ❑ No E] Yes [I No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 547 County Road K, New Richmond, WI (NE1 /4, NW 1/4, Section 6 T30N -R17W) - 6.30.17.81B 2 44 . 113wL� Plan revision required? ❑ Yes Ef No E 5 Z 6 Use other side for additional information. 0 ( Q SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: � a r g F e I mm- �, , e.. ..v,.....�_� _s r e —;n H..., �. ;mm , ...... ....... h ....��p. .m.e ,. .,,..,��_...... d 8 s � I I <i E W� .. ..... x 1 l € s i E .fin. �....�....�...,�— y ... �$ ...�. 1 i E a a I Safety and Buildings Division *Isconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanit ry Permit Number 72 ,%;� tc�-Z Personal information you provide may be used for secondary purposes p Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner a Propert L cation i^DG 14 ra, S T a, N, R 1 E (or Property ner s Mailing Address of Number Block Number � G jo;ll T Ci tat Zip Code Phone Number Subdivision Name or CSM N tuber 1 I. TYPE OF ILD G: (check one) ❑ State Owned C it a rih Nearest Ro ad Public 1 or 2 Famil Dwe - No. of be drooms Town OF h /L 111. BUILDIN USE: (If building type is public, check all that apply) Parcel TaxNumber(s) 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/ School 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. ❑ New 2 eplacement 3, ❑ Replacement of 4_ E] Reconnection of 5 [:1 Repair of an ------ SYf tem ______ ystem __ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench E] In round Pressur 42 ❑ Pit Privy 13rSSeepage Pit 2 43 ❑ Vault Privy 14 ❑System -In -Fill g. - _ VI. ABSORPTION ST TION: 1. Gallons Per Day 2. bs 3. Abso Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requ sq. ft.) Proposed (sq. ft.) (Gals/day /s . ft.) (Min. /inch) Elevation Feet Feet VII. TANK Capacity in g allons Total # Of r Prefab. Site Fiber- Ex per. INFORMATION Gallons an Manufacturers Name Concrete Con- Steel glass Plastic App New Ex istin structed Tanks T nks Septic Tank or Holding Tank 6 Zr/G� t ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumb nature: (No St s} MP /MPRSW No.: Business Phone Number: U er's Address (Street, Cit , State, Zip C e): ,t t IX. - COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved E] S nitary Permit Fee (Includes Groundwater ate ssue Issuing gent Signatur (No Stamps) � Approved Owner Given Initial Adverse Determination �cS.� Surcharge Fee) X. CI� F APPR�� � REASONS DISAPPROVAL: SBD-63 (R. 4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I 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. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained "The septic tank(s) mustbe 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 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. III. 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 Use Only. - X. County/ Department Use Only. ~' Complete plans and specifications not smaller than 8 1/2x 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 SURCHARGE' 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. Soil Test Plot Plan Project Name ��,rz>� , � Byron 'rd Jr. ` Address • ,/����������� �.,ll/ � �i GS . 002. a S � � Lot Subdivision Date 1 /4A21 / N /�� W -1- Township Bering O Well PL Property Line County BM or VRP Assume Elevation 100 ft. " G> —, .� �, <� �/�.�c •> System Elevation ��� *HRP � \ x � T �r . � s 4� 0 ly 5 I z Scale 1/4" = 10 Ft. When Dimensions aren't stated W isconsin Department of Commerce SOIL AND SITE EVALUATION P.vision of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and J t Ere f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 APPLICANT INFORMATION - Please print all information J Reewe ' d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Q Property Owner ( Property Location 5 1 1 f 11014 ��(�/ p�'� Govt. Lot 1/4 � 4,S T��? ,N,R E ( W Property Owne6 Walling Address Lot # Block# Subd. Name or CSM# 155 V f City P S Zip tod e Phone Number ❑city ❑ Villag Town Nearest Road New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement / ❑ Public or commercial - Describe: Code derived daily flow -! gpd Recommended design loading rate 7 bed, gpd/ft trench, gpd /ft? Absorption area required bed, ft , trench, ft 2 Maximum design loading rate bed, gpd/ft a trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material ` %-c- • f < i�< < Flood plain elevation, if applicable — ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for syste i ❑ U S ❑ U [S ❑ U ❑ U ❑ S [R-U ❑ SU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground d { elev , Depth to limiting factor 5' S Remarks: Boring # Ground elev. �ft. , Depth to limiting factor / Remarks: CST N Na a �i' e (Please Print)) Signature Telephone No. Addrigis Date CST Number PROPERTY OWNER �i� /^ �C��D ! r t y1 OIL DESCRIPTION REPORT Page of ` PARCEL I.D.# . Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 2 l elev. Depth to limiting \ factor in. Remarks: Boring # [3 Ground elev. ft , Depth to limiting factor 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 # E3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PLOT PLAN PROJECT ADDRESS 1 /4 fZ 1 /4S /T N/R /� W TOWN COUNTY i MPRS Byron Bird Jr. 220527 DATE 42: BEDROOM CONVENTIONAL )00( IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE /, LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE , ABSORPTION AREAZz, # of chambers_ ,BENCHMARK V.R.P. ASSUME ELEVATION 100' ❑ BOREHOLE O WELL "H. R.P. /��� Vent SYSTEM EEL NATION / >12 Sidewinder High Capacity Leaching of Cover Chamber with 31.8 ft ^2 per chamber 6' Long 16" 34" Grade at System Elevation two 1 b. e� 1� N 1 SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Chamber Soil Absorption Systems Permit Number 10/18/99 Date x "x" Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil 1 Note 1: Bury depth as per manufacturer 18 in Chamber Height 2 8 ft Maximum Bury Depth 3 600 gpd Estimated Daily Peak Flow 0.80 gpd /ft' Wastewater Infiltration Rate 750.0 ft Code SAS Size 40 % Down Sizing Credit 300.0 ft Reduction ( -) 450.0 ft Min. SAS Size 93.30 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 96.30 102.80 1 98.70 108 92.70 96.53 Yes 2 1 97.80 105 92.05 95.63 1 Yes 3 98.70 108 92.70 96.53 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is equivalent to top of aggregate. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. SBD- 10553 -E (R.05/98) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM �hvuer /Buyer / �jz i"�� �Cc4� Mailing Address Property Address �' `�< y S�r/ (Verification required from Planning Department for new construction) Parcel Identification Number 7D— �o LF GAL. DESCRIPTION Property Location �'— `/4, d�' /4, Sec.Z T ; N -V e ,;f' W, Town of Subdivision , Lot # . Certified Survey Map # ©�{°2 , Volume Page # / �O Warranty Deed # J / U , Volume l0 Page # Spec 11011SC ❑ yes r o Lot lines identifiable CX yes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 1'hr property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a n nester 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 hill of sludge. Uwe, 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 le three y e i tion date. IGNA1'URE O 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 p perty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATU � F 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 co of the certified surve ma if reference is made in the warranty PY Y P Y deed DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5 -1962 THIS SPACE 49S[nv[D roes R[C01OIN0 DATA PERSONAL REPRESENTATIVE'S DEED 505486 03 - - - i . ...... ...............ftr.14a....Ga.... Hawk iri B---.--------- .- .- .- .- .------ •-•--- -• "lac'd !or Recvu .....................................•............................_........... ...........- •-- •-- ------- -• -••. •• S Ep 14 1993 i .................. .. ............................. . as Personal Representative Uf the estate of 11:00 A. ........ ........ ........... ••- •- •........._.... ._...... 4bgr . ........ a•- alagla ..Mam ............. _ ............... Or ("Decedent "), --•-----------------.----•-- --- --------- -•---------- . - -- --- PMs'ar 7f t j� for •valuable consideration conveys, without warranty, to .............................. -- 1 I .................................•-•.. ........................- - -• - -• - - -- ..... - -••- Kenrod C. Sorum and 4!4§4A...Tr....5g.rupi..1. � anc7'vie --------- - - - - -- Grantee, R[TURN TO t i the following described real estate in ... ..._....ytt...CrDlx ---- _.- - - ---- ---County, � M t State of Wisconsin (hereinafter called the "Property") : lVi� li 012- 1 01 6 -7e -100 i Tai Parcel No: .............................. � I j Lot (1) of Certified Survey Map recorded in St Croix County 1 Register of Deeds office in Volume 6 of Certified Survey Maps on Page 1560 as Document No. 404218, being part of the Northwest Quarter (NW%) of Section Six (6), Township I Thirty (30) North, Range Seventeen (17) West. TRA IS FEE 1 I � Personal Representative by this deed does convey t.. Grantee all of the estate and interest in the Property which �i the Decedent had Immediately prior to Decedent's death, and all of the estate and interest in the Property which the i Personal Representative has since acquired. M I, Dated this ...--...... 3r4 ............................... day of --------- Ser `eirbe.. 'I �I � f !� C_ j� �...... ---(SEAL) •--- - - - - -- . ....._ ...... (SEAL) 1 I' - ,I Njarian �r-- f ? - - - - -- — - () Personal Representative Personal Representative i o ,I �i AUTHENTICATION ACHNOWLEDOMBNT Signature( s) ............................................................ STATE OF WISCONSIN i I ......--• .........................•-•--- •- ••----- ..................... 1 County. �Yd i authenticated this day of. , 19 - Persoamm fore me this ................ day of - --_- -_.__ - . --- __••- _--•-- .--.., 19.-•3'.. the above named •-- -••......• •-•••---••----••-•---••.._.....--•------• ......................••-- -- � • ,,..`` n -- ----- - -- TITLE: MEMBER STATE BAR OF WISCONSIN --- --- .......................................... ° --- - --- ---- -- (If not,.... ....................................................... - -- – ° — authorized by 1 706.06. Wis. State.) _- - - -.i. ; .......- ....�_. to k, son to be th pers ._:. who ezec�uted the } I fill nstr=n an a nowl6d the e. i THIS INSTRUMENT WAi RAFTED e : -. .... , i -- -- . eXi e, e m Grr.;�, Notary Public __...._... _ County, Wis (Signatures may be authenticated or acknowledged. Both My Commission is permanent. { o state expiration i are not necessary.) date: 19. ir =1y1) date: ------------------------------------ --- w ,! •Names of persona alsaine in any capacity should be typed or printed baow their aic"tures. S r• 7D 'O ?. �+ C - O O N W W Z V z ,.. m N v cn H O A 0 0 n' m n Z N -4 Z -I r m rr a a m I— s r x r c o = " m ►' M ® z ;o rn z n o N —1 m H .) a O rM = z o o z Bearings referenced to the north -i m —I 2 m = m -!A a line of Section 6 assumed to bear -h en z i a m ° rfM S89 0 55 r --1 r a z m n. � I N o -� m c f"7 Cr m I" Il Cil C) Ul en W ,* T Cl) CIO N N •* N O W m W C DM C O < O 0 .'O z C'), = 3 r O O V W W C z Ac N z c m � 8 3 M m FILED n AUG 12 ° m � W C W C7 co wa a aoNNeu z = o °M Zz 1 3 W m M It Ook QmMy, o .- 0, ;;D �y Z N W 'C C o x v m W N z 1y ? W .F u N = I= \ � r r H H W o 0 W o z ° r*I z z a a � _ o m T - n 0 o m m H O z H Z H unplatted lands owned by platter Z a m z H O o z -n S00 496.50' m = M 441.50 55' - Z Cn co .°D CA3 o w I off Ln ~ x �_ c W .• o rn C n APPROVED - Iv O O n v a o ° c N m I � N a 0 - F , co AUG 0 7 1985 z H 0 fi fi. N N � i_ z N O) St. CROIX COUNTY ; (D ` v z -a COMPREHENSIVE PARKS PLANNING i� r- r- o m AND ZONING COMMITTIM i w z ° ° I ;� o z z 1= co r z z - 4 r TI I a 10 1 N O 1 fn W Cn m V 1 0 W \ \ ° n H 17 O I� � O 7C H I Co O I = o Id '16r ND m O I CL C) ♦w �� + 4 ' I rr O W1 I rr o ca M (� esa. 42 9 1 c O S rt W I A M r r C) y Co -3 o f C7 +� `' •Ae ' v m d H Cn �, • 'y {Ti A .._+. as z V dti t [D S .qe� t .-- C W N z ° c o C �- z 451.50' ° 45' z N00 21 496.50' to Z °' a v c m 3 = unplatted lands owned by platter w Vol. 6 Page 1560