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HomeMy WebLinkAbout038-1183-40-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Prope Address City /State Legal Description: Lot �_ Block Subdivision/CSM # C 'mac r . r, 1 1 � /a,� / a, Sec. a � , T,�N -RXW, Town of ���/ar 1'' rN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO Tank manufacturer Py A 2u7 Size ST/PCl Setback from: House Well 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: Width Length eP"6 Number of Trenches 2 Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark �?` �, � Elevation -� Description of alternate benchmark l /� /���7'".a ?'�o Elevation ' '1 Y Building Sewer X0,3 lr ST/HT Inlet /Dl- F ST Outlet /4l, Gx' PC Inlet PC Bottom Header/Manifold 1W- ° i' Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation 0kVY Permit number State plan number Plumber's signature '!, --- T s ense number a0? :e � Date Inspector ��G�r !� 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 Ga© ry v v a � Il w c `N G I INDICATE NORTH ARROW Q Wiscons'n Department of Commerce p ' 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)j. 344680 Permit Holder's Name: ❑ City ❑ Village 50 Town of: State Plan ID No.: HEINTZ, John STAR PRAIRIE CST BM Elev.; Insp. BM Elev.: Description: Parcel Tax No.: j O (�'D / BM 038-1183-40-000 TA 6 K INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� �,�(` �' dip Benchmar I ( yo f Im. 0 Dosing A l, of 3 'd ID 3. J � lei. f' Aeratio Bldg. Sewer 3 --Z2- a?.16 Holding St/ Ht Inlet GS-1 /0/8 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I ntake ROAD E) It Inte t ir Septic 75 p' / — NA Brtnn m Dosing NA Header /Man. A ,7 Aeration NA Dist. Pipe Ze Holding Bot. System oo . f6 PUMP/ SIPHON INFORMATION Final Grade 3 11;'- /OZ. C/ - Man emand 342 Model Number GPM TDH Lift Ion Sytem Ft COSS Force n Length Dia. Dist. To well SOIL AB PTION SYSTEM 8W$ THE Width _ / Len q h t No. 0 Ir nches PIT No. Of Pits Inside Dia. Liquid Depth DIME I N DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of i / CHAMBER Model Number: System: Cory1 i , 0 5 0 of S OR UNIT DISTRIBUTION SYSTEM Header / anifold tl u Distribution Pipes) p x Hole Size x Hole Spacing Vent To Air Intake �Z �a Length Dia 'l Length �Q Dia. Spacing .2 F �- 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 + Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) STAR PRAIRIE 21. 31 . 1 8. 921 2093 Cook Drive - Circle "C" Lot 4 O "Psw1_ S Plan r vision required? ❑ Yes P5( No .2 Use other side for additional information. (( zR dwL� SBD -6710 (R.3/97) Date Inspector's Signature Cert No. SANITARY PERMIT APPLICATION Safet and Buildings Division • Ai sconiin 201 W. Washin ton Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. r C -0�"t , Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, p? paper not less than 81/2 x 11 inches in size. • See reverse side for instructions for completing this applicati n state �� nary Pe rm 't Number 3 oSD Personal information you provide may Pe used for secondary purposes Ch' revision to previous application [Privacy aw, s. 15.04 (1) (m)]. � — j to tat Clio I.D. Number y 0109 3 C.ee'k I. APPLICATION INF RM ON - PLEASE PRINT ALL IWO I - R X Proper Owner Name Pro tion .J -14 W ar e : 1/4 A T , N, R E (or) Property Owner's Mai lin Address Block Number C Cit , State Zip Code Phone Number Subdivision Name or CSM Number t II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ I Nearest Road ❑ Village Public ja 1 or 2 Family Dwelling - No. of bedrooms_ Town OF d V : r.r III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo O �� ^ _ 7 41 19 get 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 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 M.Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 `l'�5_Q 1 -5'tf 3 $'7Q r ,vim �° Feet Ol. Feet acit VII. TANK in Cap llo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New — Existin g structed Tanks Tanks Septic Tank or Holding Tank lQ0l.) �/�G�Gr1 � `re- f- 94 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatu e: o Stamps) /MPRSW No.: Business Phone Number: aaw ��5 -3�c -311 Plumber's Address (Street, City, State, Zip Code): e se- ,W- IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) V- � AApproved E] Owner Given Initial 1 7 — q — i c t Adverse Determination �a.5 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: $BD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber s Ieb�fi U � h L, n 's Wiscon$In,�Department of Commerce SOIL AND SITE EVALUATION Division of ;Safety and Buildings - - -;�� Page of Bureau of Integrated Services in accor et 183.09, Wis. Adm. Code ty Attach complete site plan on paper not less than 8 1/2 A Coun 1l Inches i�z I must' include, but not limited to: vertical and horizontal refer ;nee point and percent slope, scale or dimensions, north arrow, and * tc , n and distance to nearest r ad. Parcel I.D. # i APPLICANT INFORMATION - Please pri r all infornWtW101x / Rev' wed by Date Personal information you provide may be used for secondary p(Priv Property er ! �, roge ovation of 5 1/4 114,S T ,N,R (or� Property Owner's Mailing Address Lot # Bloc Subd ' amer or CSM# /9 Cl Sta Zip Code Phone Number ❑City Villa] Town Neare t Road t New Construction use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 2 bed, gpd/ft -,-g_ trench, gpd/ft Absorption area required - �/3 bed, ft S� S' trench, ft 2 Maximum design loading rate � 7-bed, gpdfft trench, gpd/ft //�� Recommended infiltration surface elevation(s) 7 ,9, 9 It (as referred to site plan benchmark) Additional design /site considerations Parent material r ✓ 1Z r,R �� t � �f �4h,� 5&�a 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 ® S ❑ u 0S ❑ u M S ❑ u M S ❑ u ❑ S M u ❑ S ® u SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 19 ej cJ /� Ground elleev Al J1_ Depth to limiting factor Remarks: Boring # X y Ground s. Ca elev. Depth to limiting factor din. R arks: CST Name (P ase P ' t) Signa re Telephone No. - Address Date CST Number J �� . 2 r 5 • sell Moolb-Y'l _awem Gr. Sz. Sh. =MO "I'M Dominant Color Structure Mun Dominant Color Motdes � M � WM I MWWA I ./ M- , e oo;ae A�a X�I�hew.A k�L s5 �/7 Ile- e SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems Permit Number 9/9/99 Date X X. Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil 1 6 in Aggregate Depth 2 4 in Nominal Pipe Diameter 450 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 562.5 ft Minimum SAS Size 98.90 Ift Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 101.40 103.23 1 101.90 92 97.23 100.40 Yes 2 101.40 92 96.73 99.90 Yes 3 102.00 92 97.33 100.50 Yes 4 102.80 92 98.13 101.30 Yes 5 101.90 92 97.23 100.40 Yes i 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) • • f ` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer John N. Heintz / P. C. Collova Builders, Inc. Mailing Address 9 05 County Road H, N ew Ri WI 54017 Property Address 2093 Oook Drive, Somerset, WI 54025 (Verification required from Planning Department for new construction) City/State Star Prairie, W1 Parcel Identification Number LEGAL DESCRIPTION ©3F - «� Property Location SE 1 / 4 , NW y., See. 21 , T 31 N -R 1 a W, Town of Star Prairie Subdivision circle C Lot # 4 Certified Survey Map # Volume , Page # Warranty Deed # 5 5 0 5 21 Volume 1202 . Page # 234 Spec house 13 yes ❑ no Lot lines identifiable ® 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 masterplumber, journeyman plumber, restrictedplumber 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, 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. GNATURE OF APPLIC 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 abor, by virtue of a warranty deed recorded in Register of Deeds Office. GNATIJRE OF APPLIC 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 � t i k �, �_ {! State Bar of Wisconsin Form 2 — 1982 55U521 WARRANTY DEED ii - r�,�,_ . REGISTERS01=riCE DOCUMENT NO I VO �o� e�pt?T�'�' ST. rROiX CO., WI James Barnett, a married man i 'OCT T 1996 - -- ji At 10:00 A. M - 4UL conveys and warrants to John N. Heintz and Patricia J. - H -7star of Deeds Heintz, husband and wife as survivorship marital property II THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS REINSTRA & VAN DYK, S.C. described real estate in St. Croix 201 South Knowles Avenue the following I, New Richmond, Wisconsin 54017 County, State of Wisconsin: 038- 108 -30, 038 1084- (Parcel Identification Number) 038 - 1089 -30 and 038 - 1089 -30 -110 SEE ATTACHED SHEET {� I TRANSFER d E I' i t This is not homestead property. (is) (is not) Exception to warranties: Subject to all easements, restrictions and covenants of record. 2nd October 96 Dated this - day of - -____ ___. , 19 _. - (SEAL) -- — - (SEAL) James Barnett (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT II Signature(s) James Barnett — STATE OF WISCONSIN Ii -- _ County. I 'i authen is ted this day of October 19 96 - Personally came before me this _ day of II 19 -_— the above named a Hendrik W. Van ' TITLE: MEMBER STATE BAR OF WISCONSIN - - - - -- (If not, .�-- ---` --- - ._. .-- --- --- -- - -- authorized by §706.06, Wis. Slats.) to me known to be the person . -_ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Ij REINSTRA & VAN DYK, S.C. - 201 - South - Knowles Avenue New Richmond, Wisconsin 54017 Notary Public _. __._ _County, Wis - - _ - -_ - - (Signatures may he authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date. necessary.) 19 - - -1 •Name%of persons signing in any capacity should he typed or printed below their signatures I WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. ji FORM No. 2 — 1982 Milwaukee. Wis. �j VOL 12O�PACE?J Part of the SE 1/4 of the NW 1/4 of Section 21 -31 -18 described as follows: Lot 1 of Certified Survey Map filed December 12, 1990 in Vol. "8 ", page 2301, Doc. No. 464863. Part of the SW 1/4 of NW 1/4 and part of the SE 1/4 of NW 1/4 of Section 21 -31 -18 described as follows: Commencing at the West quarter corner of said Section 21; thence S89 ° 05'40 "E along the South line of the NW 1/4 of said Section, 564.19 feet to the point of beginning of this description; thence continuing S89 ° 05'40 "E, along said South line, 549.89 feet; thence N05 °48'11 "E, along the West line of Certified Survey Map recorded in Vol. "8 page 2218 at the St. Croix County Register of Deeds office, 416.36 feet; thence S89 ° 10'57 "E, along the North line of said Certified Survey Map and the North line of Certified Survey Map recorded in Vol. "8 ", page 2301 at said Office, 834.79 feet; thence S01 °24'58 "W along the East line of said Certifed Survey Map recorded in Vol. "8 ", page 2301, 416.14 feet to the South line of the NW 1/4; thence S89 °05'40 "E, along said South line, 66.0 feet; thence N01 °24'58 "E, along the West line of Certified Survey Map recorded in Vol. "4 ", page 934 at said Office, 442.68 feet; thence S88 ° 35'02 "E, along the North line of said Certifed Survey Map recorded in Vol. "4 ", page 934, 384.00 feet; thence N01 °24'58 "E, along the West line of a parcel of land recorded in Vol. "654 ", page 498 at said Office, 206.00 feet; thence N89 ° 59'48 "E, along the North line of said parcel, 208.64 feet to the East line of the NW 1/4 of said Section; thence N01 ° 24'58 "E, along said East line, 259.89 feet; thence N89 ° 17'52 "W, along the South line of a parcel of land recorded in Vol. "538 ", page 506 at said Office, 208.50 feet; thence N01 °24'58 "E, along the West line of said parcel, 208.50 feet; thence N89 ° 17'52 "W, along the South line of said parcel, 233.85 feet; thence S35 0 50'14 "W, 457.42 feet to a point on a 378.00 foot radius curve concave Southerly, whose central angle measures 46 °13'51 ", whose chord bears N66 °10'57 "W and measures 296.79 feet; thence Northwesterly, along the arc of said curve and the South line of Certified Survey Map recorded in Vol. "8 page 2356 at said Office, 305.00 feet to the point of tangency; thence N89 ° 17'52 "W, along the South line of said Certified Survey Map recorded in Vol. "8 ", page 2356,-945.54 feet to the point of curvature of a 233.00 foot radius curve concave Southerly, whose central angle measures 40 ° 00'00 ", whose chord bears S70 °42'08 "W and measures 159.38 feet; thence Westerly, along the arc of said curve, 162.66 feet to the point of tangency; thence S50 0 42'08 "W, 6.87 feet; thence S01 °24'58 "W, 793.08 feet to the point of beginning. rn N to c 1 v' W � II D> \ N I co m to S 01'24'58" W 705.04' W s N 45.52 348.06' I 310.46' J/ • —, —._ 658.53' / .N 1 J / I V v .' D . 0000 D on n (p v > t�0 , m -J+ A rn I N N I 7 N N 01'24'58" E 000 46.48' I In 348.06' N 01'24'58" E 390.83 co to N m - — (A O I� rnJ � r W cn j II ai I� ....._ rnD O v ' mw 00 vD N '� m cc m 0 `i to w. 0 9 En M U7 I O N m ca N C0 3E Ul cn r 0 IN O (A 46 I °'. N 01'24'58" E w N 01'24'58" E 391.17' r 46.45' 348.06' N C I 0) OI �� _.__. —._ J N 0 I v� ccoo �D W v D 0 OQf I (n n W M N ;u N O A rn w En Cn - ------ N 46.60' N 01'24'58" E 391.51 ,�, 3 49.36' 367 .85' o 45' 45, N 0 5'48'11 " 414.45' 18.49' J OD n �► I� I 0 M Of OD Iy I N 01'24 58 E 373. I I I lei co . � ,y �Ln I p Oi L� I� (n co N 01'24 58 E 37,3.78' L 20 J J N 14 4 Q io A M r N , e ` m 00 N 01'24'58" E 374.14' i L 22 t W 130.00' 244.14' r r V � �p r m D l a, cn (AI l i h -4 N W �S V co D J j v z vD v CO �� Ih �,� (n M En ) � 00 N orn, V 2 F z rn • - O to ST. CROIX COUNTY WISCONSIN 1� ZONING OFFICE p p p p p �� p p■ ST. CROIX COUNTY GOVERNMENT CENTER _ " " ■� 1101 Carmichael Road " Hudson, WI 54016 -7710 (715) 386 -4680 November 29, 1999 P.C. Collova Builders Attn: Laurie 705 County Trunk E Hudson, WI 54016 RE: Septic Inspection for John Heintz located at 2093 Cook Drive, Lot 4 of Circle "C" Addition, Town of Star Prairie, St. Croix County, Wisconsin Dear Laurie: A septic inspection of the above referenced property was conducted on September 24, 1999. This property is located in the SE'/ of the NW' /4 of Section 21, T31 N -R18W, Lot 4 of Circle "C" Addition, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Kevin Grabau Zoning Technician /sm