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HomeMy WebLinkAbout040-1258-20-000 ST. CROIX COUNTY ZONING DEPARTMENT- 1 $_. AS BUILT SANITARY REPORT ' �� -�f `�. r Owner Property Address -,g" City /State _�. c�_ s� c1 , , r Legal Description: Lot , Block Subdivision/CSM # ZZ ' /4 '/4, Sec. 3, TAN -RAW, Town of SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / Setback from: Hous Well P/L1 — 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 r=4 c/L Width A` Length �7-!5 - Number of Trenches -� Setback from: House 7.5� Well zl,67_ P/L 70 , Vent to fresh air intake Z�2LJ `�— ELEVATIONS Description of benchmark i � c' Elevatio Description of alternate benchmark �� "�� Elevation /e-a. 3 Building Sewer l �`� ST/HT Inlet J y ST Outlet PC Inlet PC Bottom 3 /0 Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System( Final Grade () Date of installation ` WP'V Permit number � '1 � State plan number Plumber's signature License number Date Inspector Complete plot plan NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. points to center of se Two horizontal reference tic tank manhole cover. p • Show alternate benchmark, if applicable. PLAN VIEW `V v Q. o �1 o V � a o �1 a � /s 3 0 L IN DIC.— E 6�ARROW PAr.t GF � s Je PUMP CHAMBER CROSS SECTIOIJ AUD SPECIFICATIMS VEKJT CAP 4"C.I. VENT PIPE -7 fr WEATHERPROOF APPROVED LOCKIAIG � 25' FROM DOOR, JUNCTIOU BOX MANHOLE COVER WINDOW OR FRESH 12 "MID. AIR INTAKE I GRADE 4" MIM. I1 COUDUIT -- I B" /'11 u. - - - - -- -- 18 ° MIN. � ---- - - -_ -- IULET PROVIDE I - - - -- AIRTIGHT SEAL * A I III I I ALARM B I il. I *APPROVED I ow JOINTS WITH ELEV. FT. APPROVED PIPE I 3' ONTO PUMP -� , OFF D SOLID SOIL COIJCRETE BLOCK :g EXIT PERMITTED OIJL9 IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TANKS MAIJ UFACTUREK: O a%dzjts Se IJUMBER OF DOSES: PER DA-4 TAWK SIZE: d CALLOUS DOSE VOLUME ALARM MAIJUFACTURER: IRJCLUDIMG 6ACKFLOW: 1224 GALLONS MODEL DUMBER: CAPACITIES: A= Q UICHES OR r GALL0A15 SWITCH TYPE: &« c g c INCHES OR GALLOIJ5 I � 1 PUMP MAMUFACTURER: /d _l C = '7. S IMCHES OR GALLOWS I MODEL NUMBER: _4 �� �1Ly D= INCHES OR GALLONS j SWITCH TYPE: jhrsic. NOTE: PUMP AWD ALARM ARE TO DE MIIJIMUM DISCHARGE RAT ^ GPM J IN n STALLED OW SEPARATE CIRCUITS VERTICAL DIFFEKENCE BETWEEU PUMP OFF AND DISTRIBUTIOD PIPE. FEET + MIUIMUM DETWORK SUPPLY PRESSURE , , , , , . , , , 3ai FEET + d FEET OF FORCE MAIN X �a F /oo rtFRICTION FACTOR-2 FE TOTAL DtMAMIC. HEAD FEET ��// a F / Pc IWTERUAL DIMEIJSIOUS OF TAIJK: LEIJGTH ;WIDTH ;LIQUID DEPTH SIGUED: �" A LICEMSE DUMBER: 2 2 7 9 T o DATE:LC . Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count ^ INSPECTION REPORT V , GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No Personal information you provice may be used for secondary purposes [Privacy Law, s.i 5.04 (1)(m)]. 3 4 L 4 (o Permit Hold�� e++r's Name ❑ City ❑ Village own of: State Plan ID No.: CST BM Elev.. Insp. BM Elev.: BM Description: Parcel Tax No.: oD• 0 ' P te.. wl 0o 0q0— TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark' t�,�- ,00fl /� s-a / z( �o rod �o l UD . Dosing 1304 ! • v l oz. .-a) Aeration Bldg. Sewer Holding St / Ht Inlet �• `tT 4 - �9 TANK SETBACK INFORMATION ut et TANK TO P/ L WELL BLDG. Air i to ntake ROAD Air Septic >/ cy' ,lg 2 / NA Dt Bottom 1 Dosing ) ieD Z L (2- NA Header / Man. S. (fo Aeration Dist. Pipe e ''^�s S �f3 g• �j Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade I 2. rl oz, 27 Manufacturer AA 6 Demand / " 19, 3j Model Number Q ( GPM TDH Lift Friction Syetem TDH Ft Forcemain Length ijo t t Dia. N Dist. To Well SOIL ABSORPTION SYSTEM Bf1Y/1ZaENQ Width f Len TJ� / No. renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO ' CHAMBER Mode Number: System: �I T OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) u x Hole Size x Hole Spacing Vent To Air Intake K Length � Dia. Length � Dia. Spacing r q 3 t 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 ❑ o COMMENTS: (Include code discrepancies, persons present, etc.) o t -7 — Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. A Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst per 10 s County than 81/2 x 11 inches in size. ,p It 5' TGY'-a r !� • See reverse side for instructions for completing this appl' n 11F ` � e � Sanitary Permit Number Personal information you provide may be used for secondary purposes © - p - C eck if re SiD.0 tZs application [Privacy Law, s. 15.04 (1) (m)]. { Sta Plan I.D. Number I. APPLICATION INFORMATION- PLEASE PRINT A L IV Pro erty erty Loca Owner Name VS S' tr 1 / "�, T� , N, R E (or' roperty Owner's Mailing Address G� Block Number 3 C City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned it � Nearest Road Public 1 or 2 Family Dwelling 3 - No. of bedrooms , ❑ Town OF n q / e t" III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers 3_Z$_ 19, - L 4 8 1 ❑ Apartment/ Condo 64/6— l2 _T a O — a 0 0 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. kNew 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System____ _________ Tank Only______________ Existing System ________ ExlstingSystem 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 Ja Seepage Trench 22 ❑ In- Ground Pressure S 42 E] Pit Privy 13 [1 Seepage Pit ( OGlj�13 -❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation X15 - 7.5 0 r e� 9�° Feet 1 ( Feet Capacity VII. TANK in Ca allons g M anufacturer's Name Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks I pp�1 Septic Ta r G Ae {Lli El ❑ 1:1 E] 1:1 Lift Pump Tank /Siphon Chamber ❑ F ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber�si natu r (N Stamp 'MP PRSW No.: Business Phone Number: 1 Plumber's Address (Street, City, State, Zi Co e T. /d .7 o 2 Q t IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued suing ent Signature (No Stamps) /Ap proveci Surcharge Fee) []Owner Given Initial ^ ., j Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRI8UTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber n n 7 71 \ SI / r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisiomof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inclyd@ bµt °' Croix not limited to vertical and horizontal reference point . ??�RCEL I:f3,# ( BM ), direction and % of slope, scat Ff,, dimensioned, north arrow, and location and distance to nearest road. -' pend ` 9 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION / REV B y ^ D, E PROPERTY OWNER: PROPERTYtO ATION v Richard Stout GOVT.LOl, 1/4 i,;ril4,S 3 T � / _ N,R 19 5d or) W 'ift PROPERTY OWNER':S MAILING ADDRESS LOT # BLQ f`fAfa1L DR 1353 Awatukee Trl. 71 na, nt CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLA t r NEAREST ROAD Hudson WI. 54016 (7 15) 549 -6731 Troy - '' Tower Rd. [ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 98.21 ft (as referred to site plan benchmark) Additional design / site considerations alt. site system el. = 97.27' Parent material pitted outwash plain Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I fxl S ❑ U RI S ❑ U 611S ❑ U u ❑ U fa S ❑ U ❑ S fl U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boiurtday Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -16 10 r2 2 none - 2msbk mfr cs if .5 .6 '} 1 2 16 -29 10 r4 4 none sicl lfsbk mfr CrW if .2 .3 Ground 3 29 -84 10 r4 6 none lfs osa mvfr na na .5. .6 elev. 101 ft. Depth to limiting factor +84" Remarks: Boring # <•:;•::< >..._:::; 1 0 -22 10 r2/2 none 1 2msbk mfr cs if .5 .6 ` 2 `' 2 22 -42 10yr4/4 none sicl lfsbk mfr gw if .2 .3 4?::::::.•.•: 3 2 -84 10yr4 /6 none Ifs osg mvfr na na .5 .6 Ground elev. 10 Depth to DO L T limiting factor +84" Remarks: CST Name:—Please Print Gary L. Steel Phone: 715- 246 -6200 A ddress: 155 200th Ave., New Richmond, WI. 54017 MO2298 Signature: Date: CST Number: - 4 -19 -96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # pending Lot #71 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench \. 3 1 0 -13 10 r2 2 none 1 {: s <.< 2 13 -29 10 r4 4 none sicl lfsbk mfr aw if Ground 3 29 -84 10 r4/6 none lfs 0scr mvfr na na .5 .6 elev. 101 ft Depth to limiting factor ?5 +84" Remarks: Boring # 1 -16 10 r2 2 none 1 2msbk mfr if .6 w 4 :«<. •'•....., 2 6 -30 10 r4 4 none sicl lfsbk mfr Cw if .2 .3 Ground 3 0 -84 10 r4 6 none lfs 0SQ mvfr I na na .5 ::.6 elev. 101. ft. Depth to limiting 2 A A P factor +84" Remarks: Boring # 1 -13 10 r2/2 none 1 2msbk mfr cs if .5s .6 2 3 -30 10 r4/4 none sicl lfsbk mfr crw if .2 i.3 Ground 3 0 -80 10 r4 6 none Ifs osa m elev. 100 ft, Depth to limiting factor +80 Remarks: Boring # Ground d elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r f STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Richard Stout CSTM2298 1 1 New Richmond, WI 54017 MPRSW town of Troy S3-R19W 3254 �4n4 S (715) 246 -6200 lot #71- Country Wood N 1 =40' BM.= top of 1 steel pipe C el. 100' alt. bm.= top of marker stake C el. 102.8' �7 � 2 , 11� � Gary L. Steel 4 -19 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C al/o'14 ,Qur 7clee-f - r4,j,- :o y,j 4 N oatz So�v Mailing Address 7 05 7 ('e /Fd �9 Property Address - 5SD a i /6,04 ` /C'� /��fo.✓ GcJ.t s4o/ �o (Verification required from Planning Department for new construction) City/State " cS 10-L Parcel Identification Number o4o - ( Z 3 , f- 2_0-000 LEGAL DESCRIPTION Property Location &j� %,, eeV y., Sec, . T -RZZ W, Town of TK Subdivision Co f2.V W o a 0 rt r ft ' Ac &t 1/v� Lot # ? / Certified Survey Map # _ /� Volume . Page # Warranty Deed # 0 '1 0 96P Volume /X/S/ Page # 3 Spec house O yes )�,no Lot lines identifiable .yes O no SYSTEM hL4E TENANCE Improper use and maintenanceof 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, journeymanplumber, restrictedplumber or a licensedpumper 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 a year expiration date. NATURE Or APP ANT 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 scribed above, b virtue of a warranty deed recorded in Register of Deeds Office. GNA AP CANT 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 it STATE BAR OF WISCONSIN FORM 1 - 1982 Es49Q#36 WARRANTY DEED 1; KATHLEEN H . WALSH RESISTER OF DEEDS DOCUMENT NO. ST. CROIX CO., W1 1-45 AGE .Ja TECEM FM RMW This Deed made between ' RTCHARr] n sypouT I 08- 231999 1000 qM n I' 'I E �® Grantor, i UM COPY FED and _ 7, _ 0 - nvn BUT - .DRRS , T1Ur - a� ij CW FEET TRA[!UM FEE. 96.74 _..,..,...:w..,._.. .,.,..,_, _.., .....,.n ROM INE FEES 10.64 PAKS1 PASES� 1 Grantee if {� Witnesseth, That the said Grantor, fat' a valuable consideiz I 1, i conveys to Grantet the f described real estate in g.'t C li THIB 6PAGF. REBERYEO FO RPCORDINp DATA 5 ,.....,........_. ,..�.____.. County, State of Wisconsin: ii NAME AND RETURN ADDRESS Lot 71, Plat of Country Wood First Addition, Town of Troy, St. Croix County, Wisconsin. � if 41 � I� i 040- 1 238-- 20-b00 PARCEL IDENTIFICATIQN NUMBER f, jj II I II i '1 i n (t i ,I ii This i la nn+- homestead property. I (L� (ts not) t �i Toge with alL and singular the hereditaments and appurtenances thereunto belonging; And 1; warrants that the title i3 good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights -of -way and covenants of record ! and will warrant and defend the same. Dated this 20th day of A ugue 1 I Ii �s a _ d (SEAL) (SEAL) Ri h r II • i` (SEAL) _.. _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT ,1 ' State of Wisconsin, " Sigttttturr. {a) St. Cro ix Gouaty ! authenticated this day of , 19 Personally carne before me this Z 0th day of j' Illtr4uet , 19 the above named - • :l phard O Stout TTTLL: MEMBER STATE BAR OF V14SCONSLN authorized by 9106.06, Wis. Stars.) - to an }rilbw�t o be the person — who executed the feresaing ! Cruttitlt r d aclazowledge it THIS INS °(RUMENT WAS DRAFTED BY i) Llanat P. Stott .. _ ............._. li Awa Tz. ° �' Hudson Wi _ 5401 6 e - "t& _ r 1Votary E'Ciblic, County, Wis. ii (SignatuTm may br authenticated or acknowledged. Both are Hoyt' My commission is permanent. (If not, state expiration date: i; necessary.) 19_1.1 u 1 ' Nrttn¢s of penma slErlinB In any apu<ity.huuld by typed of printed below then s.Enantres. I ' STATE DAR OF WISCONSIN waeconsin Lou Blame Co., Inc. WARRANTY DEED porn No, I - 1962 Miweukee, W6. � 7 N2 OWNERS RICHARD O. STOUT 8 JANET P. STOI )N 1353 AWATUKEE TRAIL HUDSON, W1 54016 :I/4 OF THE SWI/4, PART OF 616' ALL IN SECTION 3, T28N, cill xi 33' 33' L% 7j BENCHMARK = SE CORNER UU I� CONCRETE PAD OF ELEC. n � L BOX EL = 978.55 Cj�1a USGS DATUM i 7 „ 333.63 12- '--------- - - -_ -_ �sTS 5 79053 PUBL 680 M _ r 153 9 530 ?.,E N7 �71 •o PO ®;� 0 0 _ 2.00 AC. y +. 87, 199 SO. FT. �N� 70 \ \2.00 AC. 87,203 SO. FT. 1.55 AC. EXC. ESM N � \67,374 SO.. T, (P • A\ AZ � 26� 62 / � i 3 AOi AZ 6 ST. CROIX COUNTY WISCONSIN ZONING OFFICE A R A Rif i e■ 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 P.C. Collova Builders located at 550 Gilbert Road, Lot 71 of Countrywood Add't, Town of Troy, St. Croix County, Wisconsin Dear Laurie: A septic inspection of the above referenced property was conducted on September 28, 1999. This property is located in the NE% of the SW' /4 of Section 3, T28N -R19W, Lot 71 of Countrywood Addition, Town of Troy, 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