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HomeMy WebLinkAbout020-1319-20-000 ST. CROIX COUNTY ZONING DEPARTNI��' /;1' AS BUILT SANITARY REPORT Owner T' � O � Address S/��' �� c/Q .< a ,r> . 1998 ST CR ax -1 COU City /State Legal Description: Lot /,/,, Block Subdivision/CSM # 5 '/, J' /. C A2, Sec. - 7,L, T_j/j N-R LW, Town of /,(�,� sa.�� PIN # �C�U - 2-0 -bc� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC /,�& / hod Setback from: House 7 o Well � P/L Pump manufacturer G ou /oCS Model - -r Alarm location 4 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh i Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: o e&l Width .s Length filly Number of Trenches �- Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark Se i , e. s l S — Elevation ZBQ' ° Description of alternate benchmark Elevation Building Sewer ST/HT Inlet -31 ST Outlet PC Inlet PC Bottom 3 S% Header/Manifold 1�G Sz Top of ST/PC Manhole Cover Distribution Lines( = �t„ _f,5 - () ( ) Bottom of System Final Grade ( ) () ( ) Date of installation T / 9 /A Permit number .2G 7&' 7d State plan number g2 ?99e Plumber's signature � =� � � Li cense number Date /7 Inspector C( Complete plot plan Or 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 g n ,f r (` S ` z` e 3 INDICATE NORTH ARROW `Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety` and Buildings Division I NSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarl"" Personal information you provice may be used for secondary purposes [Privacy Livy, s.15.04 (1)( R PgrWplder'me: RLity T1 �4illage El Town o : State Plan ID No.: CST BM Elev.; Insp. BM Elev.: B Description: Parcel �bq,,:1319 -20 -000 6 ac, T o I "VI e— TANK INFORMATION ELEVATION DATA A9800059 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1�1�� WC�"F�.,►r ✓tCa vzap Bench 3. �O�_ OD 7 Q2 osin9 �CX� t - TaN A Aeration Bldg. Sewer Re r} .C, Holding 't Jet Inlet TANK SETBACK INFORMATION (3DWO Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic d ✓ /�, NA Dt Bottom Dosing r' t' 7 S NA Header / Man. Aeration NA Dist. Pipe l -L -7. 1 16-55 — Holding Bot. System D le �S�Z PUMP/ SIPHON INFORMATION Final Grade AAanufacturer Demand Model Number GPM TDH I Lift(3. I Lriction System ` TDH Ft Forcemain Length !�'L Dia. L Dist. To Well SOIL ABSORPTION SYSTEM BED Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Li uid Depth D IM EN I 5 10 D DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBE INFORMATION Type I Moe Num e . Syste ut>v OR UN DISTRIBUTION SYSTEM Header / Manifo)d �� Distribution Pipe() x Hole Size x Hole Spacing Vent To Air Intake Length 4" Dia- Length tq:2 Dia. _�C Spacing A 5C 1-12-1 � O 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.) LOCATION: HUDSON 28.29.19,NW,SW 518 PAMELA LANE —ST. CROIX EST LOT 16 L+ . &NN - S o A CvU �2 fre (� a,�• C l�¢ae(o� �4 i us I �Q p l y�� 6c +V1 L °o v��•e s o4 v"e,_ �� ,c 7N — 7 1 1 (k a Ise �S �sasn I S�Ubvv> IcJI ti"V'I/XA �L01 �11 $ eVer�l ` Plan revision required? Vf Yes ❑ No Use other side for additional Information. 4 � 7- SBD -6710 (R.3/97) Date Inspector's 5 nature ert. No. *6 con s i n SANITARY PERMIT APPLICATION 0 E. WashngtonA P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madi WI 53707 -7969 • 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. V - 0 -, .,- • See reverse side for instructions for completing this application State Sanitary Permit Number 3o - 7b7o The information you provide may be used by other government agency Check it revision to previous application 9 Y pro 9 rams ❑ [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION - Property Owner Name Property L cation t/4o 1/4, S T , N, R E Property Owner's Mailing Address ,4p a Lot Number Block Number S� S e eol.. deft S 7'" a / ,1.0/ S City, State Zip Code Phone Number Subdivision Name or CSM Number ssG. / S /Q9, ( - ) '— s< k' .X II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it� Nearest Road ❑ VII age Public 10 1 or 2 Family Dwelling - No. of bedrooms A l 19 Town OF .. 1 ° a ko e III. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) ag i} p !7+ 162-9 1 ❑ Apartment/ Condo cs2o !3/ 9 , — 2 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. (l New 2 ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an Sysstem ______ 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 JR Seepage Trench 22 ❑ In- Ground Pressure , , 42 ❑ Pit Privy 13 ❑ Seepage Pit `-� ..S�'! ©O 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 4i& O D 04 4� , 7 S� g Feet Feet Capacct VII. I NFORMATION in allons Total # of Manufacturer's Name Prefab. Fiber- Plastic Exper. Con- steel 9 Gallons Tanks Concrete lass App. New Existin strutted Tanks Tanks e tic Tank k DU r y ✓ (� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I Q ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stamps) PRSW No.: Business Phone Number: z 1 : ,;;v lumber's Address (Street, City, State, Zi Code): S` D r� IX. COUNTY / DEPARTMENT USE ONLY [I Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin gent re.(NoStamps) ® pP ❑Owner Given Initial A roved Surcharge Fee) D / �� %60 I I 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 h Q m 6 16 f�a s c aw � Wisconsin Department of Industry SOIL AND SITE E V A L U A T Page _ of Labor arvi Human Relations Division of Safety & Buildings in accord with ILHR 83.0 dm. Code • U NTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz n mus St. Croix 9� / ' 6 �Y. .Y.It not limited to vertical and horizontal reference point (BM), direction and slope, ,spare or EL I.D. # dimensioned, north arrow, and location and distance to nearest road. i ] I ti0 pending Eza{VED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATI 1T S7 OP',0x pp CGUNT I I L PROPERTY OWNER: - a Brid eland Dev. Company 0 114,S 28 T 29 ,N,R 19 for) W PROPERTY OWNER':S MAILING ADDRESS LO B 0 D NAME, OR CSM #. 11736 117th St. 16 r na I St., _ f - Pf'st a 'ifn CITY, STATE ZIP CODE PHONE NUMBER [3CITY [I VILLAGE EYOWN NEAREST ROAD Lakevill )9 8 _ 5-5000 on Pamela T-n. 1c] New Construction Use [x] Residential / Number of bedrooms 3 ( ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Absorption area required 900 bed, ft2 750 trench, ft Maximum design loading rate • 5 bed, gpd /ft • trench, gpd/ft Recommended infiltration surface elevation(s) 95.50 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [3S ❑U ®S ❑U LA S ❑U CA S ❑U �] S ❑U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trernch _.....1...__> 1 0 -22 lQvr2Z2 none 1 2msb1c mfr cs if .5 .6 2 22 - 34 10 r4/4 none sil lfsbk mfr gw if .2 .3 Ground 3 34 -46 7.5 r4 6 none sl 2msbk mvfr CrW na .5 .6 elev. 99 ft. 4 46 -84 7.5 r4/6 none s os mvfr na na Depth to limiting factor 11 Remarks: Boring # 1 0 -15 10 r2 2 none 1 mfr 2msbk cs if .5 .6 2 <> 2 15 -32 10yr4 /4 none sil mfr lfsbk 9w if .2 .3 Ground 3 32 -84 7.5 r4 6 none lfs mfr lcsbk na na .5 .6 elev. 98 ft. Depth to limiting fact % 4 1, Remarks: CST Name: Please Print Phone: Gary L. Steel 715 - 246 -6200 Address: 1554 200thpAVe., New Richmond, WI. 54017 m02298 Signature: Date: CST Number: 6 -24 -96 PROPERTYOWNER Bridueland Dev. Co. SOIL DESCRIPTION REPORT Page 2 of 3 PARCELIM4 pending Lot #16 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tivnch 3 1 0 -19 10 r2 2 none 1 2msbk mfr CFw 1 2 19 -36 10 r4 4 none I s Ground 3 36 -84 7.5y 6 none lfs 1 elev. 9 Depth to limiting factor +84 Remarks: Boring # 1 -20 10 r2 2 none 2msbk mfr 1 if .5 .6 U ­ 2 LO-28 10 r4 4 none Ground 3 8 -50 10 r4 4 non elev. 4 0 -84 7.5 r4 6 none f 99 ft. Depth to limiting factor +84 Remarks: Boring # 1 L21_ 5 2 61-33 10 r4 4 none sil lfsbk mfr qw if .2i .3 Ground 3 k 3-54 7.5 r4 4 none sl 1 2rnsbk mvfr Cfw na .5 .6 98ef. ft 4 k4-84 7.5 r4/6 no ne fs 0sa mvfr na na .5:: .6 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) I'' STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. CSTM2298 WIWI S28 T29N - New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #16 -St. Croix Estates First Addn. N 1 " =40' BM.= top of NW lot stake @ el. 100' 5 c . .0 �r3 Z G� Gary L. Steel 6 -24 -96 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW 3254 (715) 246 -6200 To whom it may concern; This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be satisfactory for your use. The location of the system may or may not be as shown, as permanent lot lines had not been established at the time of the test. Gary L. Steel ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuya ! , ,,.. t4 - Mailing Address t5& tog ©S[_e.Q 4-,c R JIQ-- SF e wa W� s S I o S_ Property Address / g Pd to E X a. d a ,y ,�/� �s� .✓ a✓ , r S y�� (Verification required from Planning Department for new construction) City /State tq e.N Parcel Identification Number 0;2 - 4 -- 1-3 t 9 - 1; LEGAL DESCRIPTION Property Location NCO '/4, 1 / 4, Sec. TN -R f W, Town of Subdivision 44- t` '_,=� , �5� , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # S7 / S' Ilya , Volume la t9 , Page # Spec house ❑ yes 2 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 master plumber, journeyman plumber, restricted plumber 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. Uwe the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards gn q gr P g P Y 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. SIGNATURE 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. 0� l 1021 9� SIGNATURE 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 a ;A ZAP 571546 JCIJMENT NO. STATE BAR OF WISCONSIN FORM 2 -1982 WARRANTY DEED �REGIS7ltE2'S OFFICE Bridtte Develop,;,sdiLCt+lrit?any.a Minnesota CO[nQ�dtion ST. C R O i( .' 0, W JAN ___ z 1 1998 conveys and warrants to 8.00 A M Timothy J Rutter and Cheryl E. A. Rutter Q , of oe.,ds the following described real estate in St. Croix County, State of Wisconsin it Lot 16 . St. Croix Estates First Addition in the Town of H=2wn. St. Croix County, Wisconsin. j s T p�0 FER F 4 This n ot -- homestead property. (y/ (is n.d) Exception-, to Warranties: Dated tt,. __11th day of ._January 19 98 (SEAL) ) �� s • i n (SEAL) (SEAL) 'z t s s K AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA -• 19 DoltXa County Personally came before me, this 13th _day of +' 1998 the above named TITLE: MEMBER STATE BAR OF WISCONSIN `'cW Krzvzaniak (If not, aut orized by 70&06, Wis. Stars.) This instrument was drafted by to tee known to be the person who executed the Sri eland Development Company t%-rcgDinp instrument and acknowledged the same. 20141 Ic nic Tr. Suite R Lakeville MN 55044 (Signatures may be authenticated or. acknowledged. ' Dales t Bauer .' Both are not necessary.) �iutary Public Dakota County, VIN R commission expires January 1, 201x1. 1 �. k. DRRIA J: hcS0TA ER voTARY K9L DAKOUV -� ' th Commissia� E�i+es Nn. 31.1000 *Names of persons signing in any capacity should be typed or printed beiovk tLm signatures. sB2 NTF 0M, f' WARRANTY DEED STATE BAR OF HISCONSIN. 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