HomeMy WebLinkAbout032-1078-90-000 ST. CROIX COUNTY ZONING DEPAR
B ARY REPO ._ _ ��
AS UILT SANff ' V
Owner
Property Address d
City /State
Legal Description: I. 7
Lot Block Subdivision/CSM #
t /4 y '/4, Sect, Tf/ N -R jW, Town of _ ;w .! L PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
o? a6
Tank manufacturer k Size ST/PC / ,IW / Setback from: House _-?7 Well jd_ P/L
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
Type of system: r Width Length Number of Trenches _
Setback from: House x5 Well /moo _ P/L S_ Vent to fresh air intake
ELEVATIONS
Description of benchmark �, �- �, , /�rr s,�x Elevation ��/-I
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet ST Outlet p 7 PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover f
d.,a
Distribution Lines y9 ( )
Bottom of System
Final Grade () () ( )
Date of installation / / P rmit nu ber 71, State plan number
Plumber's signatur License n umber 7/3 Date
Inspector
Complete plot plan Or
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
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INDICAITE NORT ARROW
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Wisconsirt Department of Commerce PRIVATE SEWAGE SYSTEM Count y=
Safety and Buildings Division
' INSPECTION REPORT
G ENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 34467 Permit 6 X
6
Personal information you provice may be used for secondary purposes [Privacy L M, s.15.04 (1)(m)).
Perm' 1�oldeiN�me: KARL ❑ Cit6 17_�LiII Town of: State Plan ID No.:
CST BM Elev. Insp. BM Elev.: BM Description: (J � j � Parcel Tax No.:
(�.pr �r �S� 032 - 1078 -90 -000
e
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic a k 's-, "D Benchmark , b$ Jim •O r
Aeration Bldg. Sewer g T3. Y8 '
Holding St / Ht Inlet • `�v QZ. }S
TANK SETBACK INFORMATION St/ Ht Outlet cf„�3 92.42-
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet mil 31 9,
Air Intake 2-,Z
Septic 3 �-S .26 r NA Dt 8attam &4 e C'. (..S Q2.o
Dosing 30 r �$S� (o NA Header / Man.
Aeration NA Dist. Pipe
i`F• Z 8 L
Holding Bot. System tS•�S
g y rwJ .O
PUMP/ SIPHON INFORMATION Final Grade 9 . q
Manufacturer emand - S. S'/ ,
Model Num GPM
TDH Lift L oss lotion stem TDH Ft
main I Length Dia. Dist. To
SOIL ABSORPTION SYSTEM (2) a 43• -�-'
RE Width f Lengt r N Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN N3•� 5 DIMENSION
SYSTEM TO P/ L BLD G WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of e t CHAMBER Mod Number:
System: , 'j0 S (� OR UNIT
DISTRIBUTION SYSTEM
Header �/ M_Aanifold u Distribution Pipe(s) x Hoe Size x Hoie Spacing Vent To Air Intake
Length � y Dia- Length ia. Spacing >S
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
COMMENTS: (include code discrepancies, persons present, etc.) st
2�-
OCATION: I
O E SET 2 31.19.38 B 1952 COUNTY RO D tr
U ,2& , D r 2-2: o ►�., PJ� • q 'CA ., f,�., > C4%�--
Plan revision required? ❑ Yes No
Use other side for additional information. o( 1 0 - 4 1 0 O S z t(P
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No
Safety and Buildings Division
Al soonsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue
In accord with ILHR 83.05, Wi P O Box 7302
Department of Commerce JJ Madison, WI 53707 -7302
• . Attach complete plans (to the county copy only) for the sy e par not ounty
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this appl tfon a eSanitary Permit Number
Personal information you provide may be used for seconds s 1999 3y � ��
Y P Y secondary purposes .._ C, r• t3 t eck if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
CP
ST ST C ]� a Plan I.D. Number
I. APPLI ATION INFORMATION -PLEASE PRINT AL � R S
Propert O r Nam 1 /4erty Lo T , N, R /C E (Ot10 I'll
Property O v er's Mailin ddres; Edr4u ffell Block Number
City, to Zip Code Phone Number Subdivision Name or CSM Number
( )
II. TYPE
Zly BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms '� Town OF
III BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 20. ep
1 ❑ Apartment/ Condo 032 -7/ 2 - OD
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. W 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 61 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill �tD
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. nch) Elevation
3Q t Feet gy 9 Feet
VII Capacit
TANK in gallo s Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank " ^ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i talla ion of tDj onsite sewage system shown on the attached plans.
Plum r' Name: ( Int J Plumb is � natur o p MP /MPRSW No.: Business Phone Number:
Plumber's Ad ress (Street ity, S te, ip ):
zzzi
IX. COUNTY/ DEPARTMENT USE ONLY
E] Disapproved anitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature o Stamps)
JoApproved E] Owner Given Initial ;L2—C O Surcharge Fee)
Adverse Determination
C ND TIONS OF PPROVA / REASONS FOR QISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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4 je5/Woe - S / /Al �✓ l'S�S.cf d� /Y� lb(/ Q
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
F .. Divisiuh otSafety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel #
V^
APPLICANT INFORMATION - Please print all information. Rev' by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Propert y 0 Property Location l
Govt. Lot 1( 1l4,S T N,R
Prop rty Owner's Mailing Address Lot # Block Subd. Name or CSM#
Stat Zip Code Phone Number ❑ City ❑ Village ®- Town Nearest Road
I
❑ New Construction Use: Residential / Number of bedrooms -:5 Addition to existing building
[�f Replacement ❑ Public or commercial - Describe:
Code derived daily flow 7�1 gpd Recommended design loading rate _ y � bed, gpd /ft — trench, gpd /ft
Absorption area required _ bed, ft trench, ft2 Maximum design loading rate _7 bed, gpd /ft —,. trench, gpd /ft
Recommended infiltration surface elevation(s) f1S" ft (as referred to site plan benchmark)
i i
Additional design /site considerations
Parent material Flood plain elevation, if applicable ft
r S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ®S ❑ U 91S ❑ U I Ws ❑ U 1 .Zs ❑ U I ❑ S a u I ❑ S'2 U
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
8-
r
Ground
elev. "
Depth to
limiting �c'
factor
Remarks:
Boring #
a
Ground _
elev.
Depth to
limiting
`/2W factor S
in. Remarks:
CST Name ;(PI 7a int) Signature Telephone No.
Address ) Date CST Number
2 -�
I
1
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
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.
qft.
Depth to — "
limiting
fact r
Zin.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
� in.
Remarks:
I
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
I ,
Ground
elev. t
ft
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
�� � •-- �1fpC�laap ��y il�,t �y- s� - T..� /.t� �t' /gGJ
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SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Chamber Soil Absorption Systems
Permit Number 9/7/99 Date
x "x" Gravity Distribution
only 1 Pressure Distribution
3 ft Suitable Soil , Note 1: Bury depth as per manufacturer
16 in Chamber Height 2
8 ft Maximum Bury Depth 3
750 gpd Estimated Daily Peak Flow
0.80 gpd /ft Wastewater Infiltration Rate 937.5 ft' Code SAS Size
40 % Down Sizing Credit 375.0 ft Reduction ( -)
562.5 ft Min. SAS Size
86.05 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? 88.88 95.38
1 89.45 96 84.45 87.45 Yes
2 91.10 124 83.77 89.10 1 Yes
3 93.90 140 85.23 91.90 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
Owner/Buyer
Mailing Address,
Property Address
(Verification required from Planning Department for new construction)
City /State ��,�„�cs 6 / t_� Parcel Identification Number ,
LE GAL DESCRIPTION
Property Location �_ ' /4, ' /o, Sec. T j .ZL N - R1f W, Town of
Subdivision , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # q' - Pr , Volume T3 �' , Page # I
Spec house 1Z yes ❑ no Lot lines identifiable R 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 wastewaterdisposal 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, her in, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o t three year expiration date.
GNATURE OF A LICANT DATE
OWNER CERTIFICATION
I (WA 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 pro %scribed bove, by virtue of a warranty deed recorded in Register of Deeds Office.
GNATICANT 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 Y ma of the certified survey if reference is made in the warranty deed
P
• pnc'U . tt1T r. t.0 1I.�TE +' k OF WISCONSIN FORS{ 1 —198$ r„ s 11 - RE19"I en Von Rccow� 04rA
•
4 � WARRANTY DEED
VOL 937 md, 1.47
v. 'is`st:� ' at kla 'I.EGISTFR`S OFF
Tnis Deed made h,�tween cE R. LD * ' GT CRoyk+ CO w)
Gera;U V.- Plartin:•on and JOANN : , .MTI. 5EN d /k�a aAst!i Recd far Record
F_.Martinson, husband and wife as survivorship
marital property , Grantor, FEB 2 71992
and KARL. A. SKOCLUND and LIND;+ M, SKOCLUND, husband of 830 A. /}M�
and wife as survivorshir marital property, C,l'`�1C
Grantee, l R. of Deeds
Witnesseth, rhat thr ,aid Grmitor, for a valuah!e consideration
St. Croix RE—RN J
cony;', to Grantee the ,,,IlowinK described real estate in
('punt}, :•t.ate of
Tax Parcel No: . .. ...... ..... ........
.........
f ` Part of Southeast Quarter of Northeast Qua. (SE'4 of Nc'4) of S, =i -on Twenty-Eight
(28), Township Thirty -One (31) North, Range Nineteen (19) Wes[, deseiihed as follows
Commel•.ing at the poi. where the North line of the highway bounding said 40 acre
tract on the South intersects the West line of the highway bounding said 40 acre trai-t
on the East, thence North on said West line of said last named highway 13 rods, thence
West on a line parallel with the said North line of said first named highway 12'i. rods,
thence South on the line parallel with the said West line of said last named highway
to the point of intersection with the said North line of said highway first above
mentioned, thence East to the place of beginning.
TOGETHER WITH and SCB:ECT TO reservations, restrictions, easements and rightq -of -way
of record, if any.
Phis Warranty Deed is given in full sati :jfaction of that certain Land Co"_'ract between
the above parties dated May 23, 1991 and recorded may 28, 1991 in Volume 903, Page 478,
as Document No. 469164 in the office of the Register of Deeds for St. Croix County,
"sl Wi Sconsin.
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r'P011 '.gin_ r u c R'41 S'!STEi 1 PHONE r - J- May. 19 1999 09: 02AM P2
ST. CROIX COUNTY
.- WISCO
ZONING OFFICE
— ST. CROIX COUNTY GOVERNMENT CENTER
e n " Is m r+ �, ■ N —� _. .. AR.. 1101 Carmichael Road
Hudson, WI 54016-7710
- (715) 886 -4680
NOTICE OF viOLATION
,Wy 17, !999 NUMBER 99 -V -07
KARL SKOGLUND
1911 104 STREET
P:j;'; W T 5 017
LOC,ATTON: SL'ra OF TI-1.1^ ' E Y., Sec. T31N - R19W, •
TOWN of 5omarset
SAINT CROLX COUNTY, A
Cx,}tnputer 4 032 -1G', 3- 90 - -(M, PI 28.31.19.38713, 1 _Cs :acre
1PX; FAUJN13 SUP'TIC SYSTEM .+ T 1952 COUNTY RO.4ID I
Uwar v1.-. Skoglund:
As required by the ST. CR41X COUNTY ZON.INO ORDINANCE, notice is hereby given that you are in violation of
254.59(2) Wisconsin Statutes, CUNLN2 83,01(2)(r) Wisconsin Administrative Code, and Article 15,43 of the St. Croix
Co Zoning Ordinance. This sys=n has fa ted under t1m dGfinidon in § 145.245(4)(d) Wisconsin Statutes (Category
rf). This violation was first noted on M2y 14, 1999.
Pre violation noted is discharging swage to the surface of the ground. An con -site inspection oa May 14, 1999 did
revet l t'ne Septic effluent dischargng, w the sulace. If fmos and or fo>fcRures become neccsmvy to bring about the
abaternent of this violationi, they will be assessed as of May 14, 1999, in accordance with Chapter 145.12(4) Wisconsin
Statutes.
THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES AN IMNIEDIATE HEALTH
CONCERNS, AND 1tiTEEDS PROMPT ATTENTION.
REQULRED ACTION: By July 1, 1999, contract with a certitled soil tester to have a soil evaluation conducted. Thee
gait evaluation will deirrinine the typo of septic system nocded and it's location. Than contract with a licensed plumber,
who - A , ill design the septic system and obtain a sanitary permst through this office. The septic system must be installed
no later than August 31, 1999.
If 1;ou have any questions or concerns that 1 can address for you ut this matter, please feel free to contact nme. 1 bolo
forward to working tugethor k-N resolve this matter..
sizcerel }•,
Rod Eslinger
Zan.,4 Specialist
C17: F_oger Erickson, Deputy Zoning Admaiistmwr
file