Loading...
HomeMy WebLinkAbout032-2044-30-400 ST. CROIX COUNTY ZONING DEPARTMEN.N ; AS BUILT SANITARY REPORT - Owner Prop ddress 9 � t t c 1999 r- City / State e uNTV Legal Description: - (Vi, Lot 'Y Block -- Subdivision/CSM # ' ;7 t /< t /4, Sec. 2 , T,,f,N -R 4EW, Town of PIN # V4 j 2- X ° 5Co SEPTIC TANK — DOSE CHAMBER — BOLDING TANK INFORMATION: Tank manufacturer Size ST/PC Setback from: House Well PAL — Pump manufact Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fi mt a Water Line Meter location Alarm location ' SOIL ABSORPTION SYSTEM Type of system: I&P Width Length A Number of Trenches Setback from: House ? S ell > /9s P/L Vent to fresh air intake ? ELEVATIONS Description of benchmark air Elevation Description of alternate bencffWark Elevation Building Sewer , 7 -.2& / . ST/HT Inlet /4 2 2 ST Outlet !OC / 2 PC Inlet PC Bottom Header/Manifold _ -� Top of ST/PC Manhole Cover M 7. ,CL Distribution Lines Bottom of System () 9 7. 3 () ( ) Final Grade O f�•� O ( ) i Date of installation L/ Permit nu er T.X P85 ^6 State plan number Plumber's signature License number -Z -J- / to Date -f M- ff Inspector /� ►t'1 Complete plot plan } 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 w 41 t Aq i � �Sr L / rte' x �a r �4D ICATE NORTH ARROW GG►v r •, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No - : ST CRO Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338856 Permit Holder's Name: ❑ City ❑ Village gg Town of: State Plan ID No.: GORMAN, JOE SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 2044 -30 -400 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZUp Benchmark /D.3 • �o Dosing 6�, 91K / 0 q• 2 'f Aeration Bldg. Sewer 3. 1 t 20 Holding 1-W Inlet ,1( /a& 23 TANK SETBACK INFORMATION 4t Outlet f,.5 TANK TO P/ L WELL BLDG. Ventto ROAD BA .!P4et Air Intake Septic ) r ��S r NA ot eaaa— Dosing NA Header /Man. M s �?' 99- 31 Aeration NA Dist. Pipe tL•32 . 0 - 48. /o Holding Bot. System (a•7� g�„ 4G� PUMP/ SIPHON INFORMATION Final Grade t0 ,o ;• 49 Manufact Demand Model Number GPM TDH I Lift Friction Ft Forcemain Dia. Dist. To well SOIL ABSORPTION SYSTEM BE +REkWM Width r Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth MEN I N 12 7 DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER model Number: System: C � ' �J • OT > dl l� OR UNIT DISTRIBUTION SYSTEM Header / Manifold 4 Distribution Pipe(s) c� / r x Hole Size x Hole Spacing Vent To Air Intake Lengtlfid— Dia. Length � Dia. � Spacing �O 7 /cU 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 E] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 12.3,0.19,SW,NE 1659 85TH STREET — LOT 4 g - ►3�k Tom- �� ����; � Plan revision required? ❑ Yes fZNo ( 6 Use other side for additional information. F FT , 3 ` 1 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E �m. ... .. „ dam . �......... . _ _ A E £ , v a r, s t 3 e j � - W t £ { i Y S .... — ., . .b m . . ,., ..«... s. .....:«d I £ c , fi E . e ; s a { E mm a.mm _ . - -s, _ --- g ......... eee . am „ � ....., r a< ,. F Y r r r i F 7 1 f a i [ gg ..e.im .. .... . ......:. ... %. . ,. . .. [... ._ _ Y E .n. _... - 3 E d Y i S t 3 I .; _ e r � 3 t ,...,� ° =a i 1 ' SANITARY PERMIT APPLICATION 20 Safety and 1 E. WsBn n Ave r sion V isconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County . than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Peermit Number y ou p rovide may be used b other g overnment agency programs �ev �� The information y p y y g g y p g ❑Check if to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location W 1/4 XIJ 1/4, S 2 T a o , N, R E (or P perty Owner's Mailing Address Lot Number Block Number Z > o .- City, State Zip Code Phon ber SubdmAge NomeorCSMNumber 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it ea rest Road Public 1 or 2 Family Dwelling - No_ of bedrooms Z Town OF we III. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) 12 . 1 7 D O . 19 614g 1 ❑ Apartment / Condo 67 32 — 20 — o — V O,10 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System 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 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12 b Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 1,24 7Z /S6b 43 ❑ Vault Privy 14 ❑ 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) Elevation 6 ' Feet 141,a Feet VII Cap acit y TANK in gallo S Total # of r Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass App. New Existing structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation Othe onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No ps) I*PfMPRSW No.: Business Phone Number: PI mber's Ad-dress (Street, City, State, Op Code): ZV v c IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes G f : 4e Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial a�s 0►/ 113 Surcharg 19 Iqqq Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) 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 maybe 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) 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. 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 1/2 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. i 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. 1 t a M %rz ° tv J I N Q o .s i k n cu v � N Lit � I R \� n � r Wisconsin Department of Commerce SQIL.AND SITE EVALUATION Divisiorrof Safety and Buildings Page of Bureau of Integrated Services iR4Ckdrdance w1th''s,,ILHR 83.09, Wis. Adm. Code t County Attach complete site plan on paper not less than &j. x 11 ��`}�4� Plan must include, but not limited to: vertical and horizon 4r e"ference , As T. and ' C O' percent slope, scale or dimensions, north arroG+, and location and distance to nearest road. Parcel I.D. # ipgR APPLICANT INFORMATION - Pleasre p int all Reviewed by Date Personal information you provide may be used for secokd2ry:purpgM(rm : s. 1,5.04 ( (m)). ��� jD Property Owner ri, `r `. roperty Location Vic F LL Govt. Lot S-W 1/4 � 1 /4,S � T �O N,R E (o� Properig Owner's Mailing Address L 1V ; T_c1 # Subd. Name or CSM# n City Stat e Zip Code Phone Number ❑ City [:1 Village V1 Town Nearest Road U�= w 0/ %� ) 7 , s �-� New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow 4 gpd Recommended design loading rate 7 bed, gpd /ft gpd /ft Absorption area required gi bed, ft trench, ft Maximum design loading rate _ bed, gpd /ft X trench, gpd /ft Recommended infiltration surface elevation(s) � ft (as referred to site plan benchmark) Additional design /site considerations t1 /t/OrVF Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system V1 S ❑ U 0 S ❑ u 0S ❑ U �A S ❑ U ❑ S 0 U ❑ S 0 u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench — 0-- 3 c/ .S Ground 3 D_ Sc /1'1 sB Lc M -� elev. /eft' y s" s o — _ 7 Depth to limiting factor q Remarks: &1 o% � aNTZiv -roue — l�i�o /r Boring # 0 -3 3 .sL si3 v - . S' z z. /YI L c s �s� v 3 NO - lv SL 2 CS F/2 Ground 1 13 — ,$ '/ S ©S L elev. /1 K f Wal ,r 74-v Depth to limiting factor ? in. Remarks: 493 /e' L,E gr 4jp21 47_Clrl CV WC /%, 6701rz CST Name (Please Print) Signature Telephone No. Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER e C — .r C /< Page 2 of 3 _ PARCEL I.D.# - , ax - �U � -- -170 + Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench S s ZE .S` S- 01K G Wl- C Ground j — *Z elev. /91—aft. Depth to limiting factor I Remarks: Boring # ( v 119-313 r SL Y Z - L - e 5 3 7, s S VfA — Ground elev. Depth to limiting k factor P/ 0-f 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 # S L 'F&J In FR- '09LS S z -,z3 ?.,5 - r L S 3 F CS Ground _ - L V =r elev. 10- �- Depth to limiting factor 7 //o in. Remarks: 6 Y iI/ � fSL /111/ T,LO�fI� — /�/l0/fE/►/. Boring # - �` s o B _ 03 2 /0s Z` o e Ground (.✓ 1/v C tl� /t/r= titl - /1J elev. Depth to limiting jE LQC -,�,v So .Z __ factor in. Remarks: SBD -8330 (R. 07/96) - - E3 w 4L N Ri � w o �, Ir h b � � h n In �� a O ro • h � o i r b �- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT l' AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - k - 4r 6�ge�, tli -- Mailing Address 22 // 7 syrf Property Address (Verification required from Planning Department for new construction) lymm City/State C-Cx ' Parcel Identification Number /r 3- : 2vYV -- le -Yyd LEGAL DESCRIPTION Property Location S 4; i /4, L (i i /4, Sec. / Z , T -R_f W, Town of Sow-AX-LET . Subdivision , Lot # � . Certified Survey Map # S 9y3�� , Volume Page # -?--,; Warranty Deed # �® / .Z. P 1 d , Volume /LIZ Page # y9 Spec house ❑ yes 0 no Lot lines identifiable,I 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. NATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. I-- IGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I vci. PacG Es01260 STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH Document Numbe WARRAN DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Cyrella M. Flandrick A /K/A Cyrella RECEIVED FOR RECORD Flandrick, a single person, Grantor, and Gorman Construction, Inc., a Minnesota Corporation, Grantee. 04 -14 -1999 10:00 AM Grantor, for a valuable consideration, conveys and warrants to Grantee 11TY DEED the following described real estate in St. Croix County, State of Wisconsin (The EXEMPT B " Property"): CERT COPY FEE: COPY FEE: 2.00 Part of the SW 1/4 of the NE 1/4 of Section 12 Townshi a TRANSFER 75.00 P 30 North, Ran g 19 y •' RECORBING FEE: 10.00 West, St. Croix County, Wisconsin described as follows: Lot 4 of Certified 'R ES: 1 Survey Map filed December 23, 1998 in Vol. "13 ", page 3577, Doc. No. 594356. Recording Area Name and Return Address 032 - 2044 -30 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this day of 999. *Cyrq M. Flandrick * (� AUTHENTICATION II // ACKNOWLEDGMENT Signature(s) ` —`/ P 1 I r.I r /�\ STATE OF WISCONSIN ) ) ss. j County ) authentic4ted this Q day of Personally came before me this day of 19_ the above named C to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN Of not, authorized by § 706.06, Wis. Stats.) * THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Ronald L. Siler My Commission is permanent. (If not, state expiration date: VAN DYK, O'BOYLE & SELER, S.C. ) Post Office Box 127 New Richmond. W1 54 17 (Signatures may be authenticated or acknowledged. Both are not necessary.) FILED DEC 2 3 1998 ► KATHLEEN H. WALSH Register of Deeds � SL Croix Co., WI CERTIFIED SURVEY MAP ti Located in part of the Southwest Quarter of the Northeast Quarter of Section 12, Township 30 North, Range 19 West, Town of Somerset, St, Croix County, Wisconsin. Prepared for and at the request of: OWNER: 1914 Raleigh Road a Fla NORTH 1/4 CORNER New SEC. 12 -30 -19 Road — New Richmond, WI 54017 i . �� Drafted by. Krfsti A. Eylandt I � (ALUM. CO. MON.) ' UNPLATTED LANDS 1 D LANDS r CD NORTH LINE OF THE SW i _ ��► a " `_C�� + - -- 114 OF THE NE 114 RONALD F. JOHNSON Owl 10 S -ttrtr �� N I AMFRY, °o N LOT 1 Wis. n 4 I 0 CERTIFIED_ SURVEY MAP g� r� •1F ���� I 33I VOLUME - 12 PAGE 3388 ��'• r.AL0T. IJ3 .00' I I C.S_M_ zl VOL. 11 PAGE 3_205 ki I . a 01 1 r i 0 TOTAL AN'�N 01 Wi I I I i o cV 202,623 SO. FT. Qi ' y w; - I ?i i 4.65 ACRES ° �� o c QI � I s o O AREA ._ R.O.W. o Ci F N I J 192,492 SQ. FT. QI o N fly; to i x 1,33.00': 4.42 ACRES �j 0 vt o t� _ � j N89'37'57 "E 660.07 0 c o O 3 W i o o ' 627.07' 'v) 7i> j �.' I N o E U I U ea �N I Co TOTAL AREA N " ;c o ° o �I - a0t 0 I rn � I N Q: 202,623 SO. FT. °f E a0° 0 1 c° I � o �: I-- 4.65 ACRES '� c p L aic 3 ^ o W Ly: O AREA LESS R.O.W. of O I I cV M I N J 192,492 SQ. FT. '`� N 0 -� I of vii a � i I N I 00 p 4.42 ACRES 3 0 °- I p I o m : 0 a ai a��i o Iz z N89'37'57 "E 660.07' 0 ova a Ji Z i i I E ' a � 1 627.07' rn c o , C c r TOTAL AREA I v 202,710 SO. FT. o o+ o of o 1 4.65 ACRES c ; , M 0 CL U 0 0 AREA LESS R.O.W. 0 t c 1F M f i n , 192,578 SQ. FT. o 0 4.42 NCRCS v 7 m .0 L / N C PLAT OF NORTH I I i o �N _ J I 627.07' e G >, BASS LAKE ESTATES j I ;�, sag '39'19 "W 660.07' UNPLATTED LANDS OF OWNER t C 33.00' — ~ ay o _..— ..— ..— .. —.. —. �.. 0 —.. —.. .... —.. �I °SIN Lij C X '� ' N N ~ O o JOB #97108 (R14) a.` N o SOUTH LINE OF THE SW 1/4 OF THE NE 1/4 Z �- o u / z LEGEND � SOUTH 114 CORNER UNPLATTED LANDS Count Section Corner Monu - - Y en t SEC. 1 2 30 19 of Record (ALUM. CO. MON.) • Set 1" x 24" Iron Pipe weighing a minimum of 1.13 pounds per linear foot. O Found 1" Iron Pipe 200 0 200 NO TH Prepared by. A & E GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 inch = 200 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH -SOUTH 1/4 109 East Third Street, P.O. Box 325 LINE OF SECTION 12, TOWNSHIP 30 N., RANGE 19 W. New Richmond, M 54017 WHICH IS ASSUMED TO BEAR S00'28'20 "W. Sheet 1 of 2 Vol.13 Page 3577