HomeMy WebLinkAbout020-1306-60-000 8
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ST, CIZOIX COUN'T'Y ZONING DI;I'ARTMI;
AS BUILT SANITARY IIEUIOR'I'
Owner f �. 92 aleet L.0, �9��
Address _ ? o� k
City /State ol � 'Q
Legal Description: Z
Lot Block Subdivision/CSM # ALL- " 97 /s �1tca,9�
'/< '/. , ,Sea ��, TnN- RL9�_W, Town of Ak,,,(s v , PIN # U � G" L go Cd
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer _ Gv l e -ter- Size ST/PC " Setback from: House /C ' 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
; At - <<
Type of system: 1&0184 Width - � � Length _�_ Number of Trenches —
Setback from: House _ _4 I Well f tf , P/L -eO Vent to fresh air intake * r'
ELEVATIONS
Description of benchmark Elevation
Description of alternate benchmark �,.,�� Elevation
Building Sewer _ �3,l! .6 ST/HT Inlet - 77 ST Outlet - �.2 PC Inlet
PC Bottom
Header/Manifold l . l Top of ST/PC Manhole Cover z
Distribution Lines
Bottom of System
Final Grade
Date of installation Y—/T/—?0 number 3 I l elate plan number
Plumber's signature ���
icense number s_ _1_ Date 1 I-P
Inspector �¢ �j l_ `�
t'om{+Ictc pint plan �'
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W iscensin Department of Commerce PRIVATE SEWAGE SYSTEM County: 1
• Safety asd Buildings Division INSPECTION REPORT �!- Cre
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)]. 315'
Permit Holder's Name: ❑ City q Village Town of: State Plan ID No.:
�vvi
CST BM Elev.: Insp. BM Elev.: De scription: Parcel Tax No.:
f bo` 1 loo 1 ( surUe- 0 & 0 -It -36 (.- -
TANK INFORMATION ELEVATION DATA A'76003
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
S ptic le ev- 1 d CD BenchqjW — , j( 4� 3
Dosing -�. gfvf 4
Aer Ion Bldg. Sewer
Holding
i t Inlet q 9
TANK SETBACK INFORM ATION N - �� St/ Outlet 9. w �f' •S
TANKTO P/L WELL BLDG. Air lntake ROAD Dt Inlet
Septic 7 P-1 /4. (7 r O�S NA Dt Bottom
Dosing _ N A_ Header / Man.
Aeration NA Dist. Pipe 1(• 3 /(�•
Holding ___._ Bot. System
PUMP/ SIPHON INFORMATION Final Grade q7 3.S
Manufacturer Demand 6 -F G h w% r�, �l
Model N L �• _
H Lift Friction ystem TDH Ft
oss ead Forcem Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED RE C idth a Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
I N DIME
SETBACK
SYSTEM TO P / L BLDG WELL LAK STREAM LEACHING Manu
INFORMATION Ty p 7S' OR UNIT R Moe Num er:
Sy a ' yK
DISTRIBUTION SYSTEM
Header / Mani Qld rr Distribution � ( r n zr x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length JCO' Dia. 34 Spacing _
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 ❑ Y E] ` e ss '
COMMENTS: (Include code discrepancies, persons present, etc.) - 71? 6 4o(e (wc — 4vw►bI#; (IS Lt `mil
� L T-4:�w
Hof
Plan revision required. I� Yes No N _
Use other side for additional information. b
SBD -6710 (R.3/97) Date In ector's Si ature oertNo.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue
Aiicons In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitar Permit Nymber
/S5'g
Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. ' -7 / 8 OfN/We 4Q'/?e State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Property Owner Name. )) Property Location
it a2�v � t _L. t /a, 5 27 T , N, R / E (or)(0
Property Owner's Mailing Address Lot Number Block Number
City, State J Zip o e Phone Number Subdivision Name or CSM Number
II. T I IN : (check one) ❑ State Owned !ti '/ Nearest Road / /
Public 1 or 2 Family Dwelling - No. of bedrooms — Town of H✓ �/' e [.
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) te -7. oZ 9. / 90 . 1Sa $
1. [] Apartment / Condo �� — t/ � _ O �
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
Syrstem System_____ ________TankOnl�r______ _______ Existing System ___ _____Existln9syrstem
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)R Seepage Trench 22 ❑ In- Ground Pressure _�2 i r _ 42 [] Pit Privy
13 E] Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill 14 Vt i xJ ev I n "
VI. ABSORPTION SYSTEM INF RMA ON:
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)+JAi Elevation
5r Feet �' Feet
VII. TANK Capacit gal Total # of Prefab. Site Ga
Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tank Tanks
Lift Pump Tank /Siphon Chamber I I ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name: (Print) Plumber's Si nature: (No St mps) MP /MPRSW No.: Business Phone Number:
Plumber's Address (Stletet, City, State, Zi C de .
S�
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Is g ge Si ncnaature (No Stamps)
t :� A pp roved E] Owner Given Initial Surcharge Fee)
�
/ Q Adverse Determination �O
X. CO NDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
A vc f l '"" � c,4 v q_1 Mj G P,,5 e `f' av , be f'C_, S ✓-� I I7`ai Co `�Y'u� 1 d rl ,
.SBD- 6398 (8.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety 6 Buildings in accord with II-HR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must include, but PARCEL I.O. #�
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: 111IR6 1 /fil;S L4wp PROPERTY LOCATION
1 41IL- ;B % o .t/ GLiA /�.N y GOVT. LOT 3E 1/4 SC_ 1/4,S 2 7 T Z ,N,R /, E (or) W
PROPERTY OWNER':S MAILING ADDRESS / � /yip, �/` LOT / BLOCK # SUBD. NAME OR CSM t
334 *o•,eoB�TS ST C S� S/ }{UMRii?D H il ls t%PtinS� 3
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [�- "N NEAREST ROAD
�', /�/tu G /�! ,s'S /D/ IGr� -1 222 5SS5 }} u flSo,J D�PiE /E L.,J
New Construction Use 1 ,4- Residential / Number of bedrooms Addition to e xis ti ng building
[ J Replacement [ ] Public or commercial describe - y -l35
yso - •� trench, gpolft
Code derived daily flow 0°a gpd Recommended design loading rate bed, gp(W
Absorption area required �bed, ft2 7�0 trench, P Maximum design loading rate � bed, gpdAt ' trench, gpd10
Recommended infiltration surface elevation(s) S-� � 51te 3 _ft (as referred to site plan benchmark)
Additional design / site considerations S-e �'� 1 S
Parent material 5C5 (oG UlP�f' Flood plain elevation, if appli6able tip It
S a Suitable for system �❑ U L ❑ U e 0 PRESSURE AT G ❑ U [ SYSTEM IN I [I S'C� TAW
U - Unsuitable for stem LL77 �� LTA
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fi
Boring # Horizon in Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed tends
fK s 17C ,s
3 Z � - � f �o lie / � --- s/ Z-fs6'C ��fe c s —'� . s • G
Ground
2. y —
Depth to
limiting
f fa � act to� or ��
Remarks:
Boring # S
z v o /e'// ��, stir �, s ��� , s
e e and ei p 6
5 1, 3D ft. %��
Depth to
limiting
factor
for C
Remarks:
T Name: - Please Print Q E T- - 4 L (af2 i' C k 7— Phone: 713 A;
� 0' lie f L. �k d u DSo 40/S • Sl/4ii(o //- 7- i� l CST ! gnature:
Date: CST Number:
AlAF4 y " /3 ' / - ,5 - 01 1 5
,P�g vi ,t'F O�s••�,✓ /a,�o..c7 �� 7 - z� - o� , JI-' Gil ��i�•
ORIGINAL
7
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3
PARCEL I.D. # /6 # S� /fv- y/.� i.�l� 11111 -S
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence eajxj y Roots GPD /ft
In. Munsell Glu. Sz. Cont Color Gr. Sz. Sh. Bed Tiendi
Io iP,512- 2 's 7
Ground FO SD 75yt' 311&
elev. I
Depth to
tlmifing
laCIbr
N k
7 F4 j
_
Remarks:
Boring# a �a /L) Y/e 3/2- S.' /, 1 fs6.r �,-{,e s ��` •S
v-�� e Ile W s/ /f fe
Ground
elev. / . C 7
5,� ft.
5 �
Depth to
fimigng .
factor
Remarks:
Boring #
Ground
7
elev. — , S yid . S/ �S 0 1,1 1 �•� C S '7 -
7 Y76 it.
Depth to =
limiting
factor
Remarks:
Boring #
1111
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
con eoon,o nc=nrn
�o T 51
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F/EVf7700 = /00•
� 79
cL oel - elE L,v
N '30'10 "W 664.12 S
• � V
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S 45' 50' 00" W
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86.82'
S44° 10'00 "E
66.00'
sl
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S89 ° 30'15 ° W 942.42 _,i
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address / S
(Verification required from Planning Department for new construction)
City/State
4 6 --
4i / CAw c,��,Z' Parcel Identification Number
LEGAL DESCRIPTION
S S�
PAY 6 %., '�,
Pro Location �',�' /,, Sec, 17 , T�N R j W own of ttv�scr.•.
Subdivision AAr Lot #
Certified Survey Map # Volume . Page #
Warranty Deed # _ y ((� Volume 1-3 q q . Page # : 30
Spec house ❑ yes no Lot lines identifiable QI yes ❑ no
SYSTEM MAINTENANCE
kpq pauseand=hkm=of yousepticqst=couldrmhmuPm=tmfailumtobanatwasteLftopermmmmanm
consists of pumping out the septic tunic every three years or sooner, if needed by a licensed pamper. What you put into tie system
can affect the Simction of the septic tank as a treatment stage in the waste disposal systems,
The property owner agrees to submit to St. Crone Zoning Department a certification fomr, signed by the owner. and by a
awtaPlumbujowmpyinanPlumbe4reshictedplumbaora licensed pumper verifyingdw (1) the on-site vwastewaterdisposalsystem
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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set fords, herein, as set by the Department of Commence and the Department of Natural Resources.
tating that year septic State of Wisconsin.. Certification
s
system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the year exp' do te.
GNATURE OF APPLICANT /
DATE
OWNER = CATION
I (we) certify that all sta eats on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
descri a e, a of a warranty deed recorded in Register of Deeds Office.
Z V
ATURE OF LICANT 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
2 T 1 19
LOT 48
1
2.84 ACRES 33 33' EL = 1005
123,747 S0. FT
5 W ..�'
N, x,42 w
97' LOT 6
SSA 5 ��. i � I N
+ 1 0 A7 2.62 ACRES
LOT 49 _
f m 113,914 S0. FT.
143 3 9 , 0
3.11 ACRES r I
135,291 SQ. FT. w T w i
t0 I . 1 O
1 1 v
0 1
O 1
S83 °28 '58 "E 6�6'
6 54.00'
520.40' i 337 E
1 33.60' I ° 8'
W
LOT 50 $81044
W
: O
O
3.00 ACRES
130,489 SQ. FT.
I 111 11
LOT 6(
� 2.Oi
ACRES
N88 0 I5' 13 " W 650.76' t �` 1 \ 87,557 SO. FT.
375.00'
275.76'
Z 1 1
O
o 1 1 17
_OT 52 N ' .
LOT 51 �.� 1r°
2.68 ACRES m ® S� ( j �� �' 16
!6,630 SO. FT. 2.28 ACRES
99,459 SO. FT.
cyl �, o o,, yyy V� 13
Lit
' EL = 994
6\Q /
S89 " W
I ,
i 145.87'
6
E 257.71' — ORIOLE ---LANE 12
LOT 5E
N89 2047 "E 145.87'
1 10 86.79' _ _ 59.08' I I
9 ` 2.23 ACRES
96,965 SO. T
-- `� ............... • 301 � i0
LOT 53 _ o LOT 55 A 0
2.24 ACRES � I 2.20 ACRES
97,740 SQ. FT. LOT 54 ( I 95,719 S0. FT.
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ST. CROIX COUNTY
' WISCONSIN
� ` ti
ZONING OFFICE
r r n r r r e u■ ST. CROIX COUNTY GOVERNMENT CENTER
" " ■+ 1101 Carmichael Road
.N p • _ _
Hudson, WI 54016 -7710
_ (715) 386 -4680
December 16, 1998
Century 21 Premier Group
Attn: Dyan Aminson
Hudson, WI 54016
RE: Septic Inspection for Jim Rouleau located at 718 Oriole Lane, Lot 51 of Humbird
Hills, Town of Hudson, St. Croix County, Wisconsin
Dear Ms. Aminson:
A septic inspection of the above referenced property was conducted on September 9, 1998.
This property is located in the SE %4 of the SE' /4 of Section 27, T29N -R19W, Lot 51 of
Humbird Hills, Town of Hudson, 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.
Sin ely,
Rod Eslinger
Assistant Zoning Administrator
AM