Loading...
HomeMy WebLinkAbout020-1319-30-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner - Property Addre City /State 1"1 <-A,) /JY Legal Description: Lot �i 7 Block — Subdivision/CSM # - rs A�j /4 "-,a '/4, Sec ;2L, �N -RAW, Town of PIN # - �a9 -,�� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer _ Size ST/PC , :! �jr / Setback from: House /5 Well t22 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 lS',� o Width Length 7,-,' Number of Trenches Setback from: House -?S _ Well er P/L ,/Q_ Vent to fresh air intake _Y ELEVATIONS Description of benchmark enchmark Elevation Description of alternate benchmark / Elevation 17,E J Building Sewer 11G,d7 7 ST/HT Inlet /yob ST Outlet „ PC Inlet PC Bottom Header/Manifold , /i�,a _� Top of ST/PC Manhole Cover Distribution Lines( O O ?` a Bottom of System ( ) () ( ) Final Grade Date of installation , Per, it num er State plan number Plumber's signature License number ,� 3 Date Inspector Complete plot plan Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarj2gr6".: Personal information you provice may be used for secondary purposes [Privacy Lxw, s.15.04 (1)(m)]. T1tEWN ambAVID (A tsb9illage []Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel D80o-:1319 - 30 - 00 TANK INFORMATION 'ELEVATION DATA A9800515 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept lot) Ben Dosing X ^, i,, > -:� - � ► t z� Aeration Bldg. Sewer 1ZU t % 1 / /O, � Holding S ! Inlet TANK SETBACK INFORMATION S *Outlet TANKTO P/L WELL BLDG. A i r I to ntake ROAD Dt Inlet Air NA Dt Bottom >` Dosing f f y NA Header /Man. b�`� ?2fl,�i G a-1 Aeration NA Dist. Pipe I (o, °1 Holding' - Bot. System 1 1C, .1 7.1ia PUMP/ SIPHON INFORMATION Final Grade 1 4 14 1 S Manufacturer V Demand ?�7 c ! _Gj 7 1 5 }� Model Number V `.'GPM TDH Lift Friction ' System TDH Ft ead Forcemain Length i Dia. Dist. To Well SOIL ABSORPTION SYSTEM RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N ° - 7 i DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typeo CHAMBER 5 r -- Model Number: System e60 Vf111_ft (�' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air In ;ake Length L Dia ` `' Length Dia. ` ; Spacing r .. _. - .. -- . X q 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 521 PAMELA LN — ST. CROIX EST LOT 17 "v(y4 l2 ( Plan revision required? ❑ Yes f No Use other side for additional information. SBD -6710 (R.3/97) Date InspectorY Signature J L 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. l PLAN VIEW 9 3� INDIC T NORTH ARROW ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue 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 81/2 x 11 inches in size. 1_� �_� • See reverse side for instructions for completing this application State sanit imb ary Permit N Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT A L INF RMATI N Prope Owner Name Property Location �^ 1 /a ;� 1 /a, S T , N, R (or) W Property Owner's M ' ng Add ess t Number Block Number 7 City, ate Zip Code Phone Number Subdivision Name or SM Number ( ) , TYPE F BUILDING: (check one) ❑ State Owned o Cit y Neare oad ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (If building type is public ,ca check all that apply) Parcel Tax Number(s) a 1 [] Apartment / Condo ag- a7. 1 & a 9 ©" j� — 1 "5 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 _ New 2. r] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ 9 y C] Repair of an S st S stem Tank Onl Existing 5 stem ____ Existin System ------ - Y --- --------- -- - - - - -- Y Tank--- ------------- - - - - -- -- - - - - -- q- ----- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) - Dis tribution Distr ibution i n Pressurized Dist �but/o Ex perimental Other Non Pressurized Dist but o p 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 42 C] Pit Privy 13 []Seepage Pit I t� )( 24Q , 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 q (q ) P (q ) ( Y 4 Required s . ft. Proposed s . ft. Gals/da /s . ft.) (Min. nch) Elevation f Feet 142, 7 Feet VII. TANK Capacit gal Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing Tanks T nks Pmp c Tan Ing ank o ❑ ❑ ❑ ❑ ❑ u Tank /Siphon Chamberl I ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, thq undersigned, assume responsibility for i tallation of the onsite sewage system shown on the attached plans. Plum s Na :(P' ) Plumb is S nat o S s) MP /MPRSW No.: Business Phone Number: / , Plu ber' Address trees City, State, Z e IO Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuin ent Signature (No Stamps) A roved Surcharge Fee) pp []Owner Given Initial Q,l OD Adverse Determination U Ull1l Ito X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6396 (RA 1I97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 3Sa yZt(M °itch u wli�I v /5;�,�1��� ins' — � ____ __ ©.� Co�Pt Owe✓ � �C� 3 1 Ad' ll ss' ,t3/yl Wisc-onsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor LjO Human Relations Division of Safety 8 Buildings in accord with ILHR 83. �, d �i 05 COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in elan muclude, b `t St. C roix not limited to vertical and horizontal reference point (BM), direction d 1 of sl}��,r PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest roa pending APPLICANT INFORMATION — PLEASE PRINT ALL INFOR I ION REVIEWED BY DATE PROPERTY OWNER: f '' j PROPS ATION ti 1/4 ,S T N,R or W Bridgeland Dev. Com an , T 28 29 19 ) PROPERTY OWNERS MAILING ADDRESS :LOT # BLOCS D. NAME OR CSM # 11736 117th St. i .y St. Croi - s$tat e&,firsst add CITY, STATE ZIP CODE PHONE NUMBER ine4TY IR:96E IggR WN NEAREST ROAD Lakeville. MNJ. 55044 115512) 985 -5000 Hud I Pamela Ln. 3 [x] New Construction Use jr, ] Residential / Number of bedrooms [ ]Addition to existing building I I 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, ft2 750 trench, 111: Maximum design loading rate • 5 bed, gpd /ft - 6 trench, gpd/ft Recommended infiltration surface elevation(s) 109.45 trench ft (as referred to site plan benchmark) Additional design/ site considerations trenches to code 3.25' below surface, area of B -5 103.87' or less 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 E]S ❑U ❑S ®U :91S 0 U ®S ❑U EIS ❑U ❑S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot.Ktdary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerich 1 0 -15 10 r3 2 15 -54 7.5yr4/6 none s 0Sg ml 9W if .7 .8 Ground 3 54 -80 7.5 r4 6 none fs 0sa my r na elev. 11 ft. Depth to limiting factor +80" Remarks: Boring # 1 —14 10 r3 3 none sl 2m r mvfr CrW 2f .5 .6 2€ 2 14 -26 10 r4 4 none sl lcsbk mvfr aw if .4 .5 Ground 3 26 -80 7.5 r4 6 non Depth to limiting factor +80" Remarks: CST Name:— Please Print Phone: Gary T., Sf-,epl 719-946-6900 Address: 1554 200th Ave New Richmo WI. 54017 m02298 Signature: Date: CST Number: 6 -24 -96 PROPERTY OWNER Bridgeland Dev, Co . SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # P ending ot #17 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Board y Roots -GPD /ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Tranch 0 -10 10 r3 3 s 2 10 -20 10 r4 4 none sl 2m m 5 r vfr w if . .6 Ground 3 20 -84 7.5 r4 6 none elev. 11 ft. Depth to limiting factor Remarks: Boring # 1 0 -10 10 r3 3 none sl 2m 4 2 10 -18 10 r3/4 none S1 2mcfr mvfr Qw 1f .5 .6 Ground 3 1 18 -78 7.5 r4 6 elev. 106 ft. Depth to limiting factor + 78„ Remarks: Boring # 1 0 -16 10 r3 3 none '......5.....'' 2 16 -29 10 r4 4 n Ground 3 129-70 7.5 r4 6 elev. 4 1 70-80 10 r4 4 2 7.5 r5 6 1 06.7 ft. Depth to limiting factor 70" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Bridgeland Co. New Richmond, WI 54017 MPRSW 3254 �4�4 S28- T29 -R19W (715) 246 -6200 town of Hudson lot #17 -St. Croix Estates First Addn. N 1 " =40' BM.= top of mid lot survey stake C el. 100' 3 o� I � -3 � Uo So L3 kj "K, ire 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 wham 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 Owner/Buyer GL(� E (� h 16a 1 i e, 6 m a 6 r Mailing Address j q1U Nu V1 fp I % , Jj gd Property Address 4� (Verification required from Planning Department for new construction) City/State , k(AdSOR Parcel Identification Number (9��l LE GAL DESCRIPTION (� Property Location iy w '/4, Sec. 2L , T aq N -R_jj_W, Town of Subdivision �� • Cro Fe es - , Lot # _. Certified Survey Map # Volume , Page # Warranty Deed # 541 7 9 Volume 0 , Page # S�,p -t• a 3, i4aG Spe house ❑ yes no I-ot lines identifiable byes ❑ no SYS " EM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenane consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systen 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 master plumber, journeyman plumber, restricted plumber or a 1 - ensed pumper verifying that (1) the on -site wastewater di ;posal systen is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fell of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standard set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatioi stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 31 d , v s of t three year expi ation 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) o the pr rty described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. 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 - - DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 -19V THIS SPACE RESERVED FOR RECORDING DATA .�"�979 WARRANTY DEED _ -- WIM 9L 6 VU JL REGISTER'S OFFICE lit' _ lkvek�ricni Com ._a inter tim ST =am SEP231996. conveys and wa rrant s at .' A. M 8-00 _1�iILM- ThldmaDr: and Dm011 ilmun wl+ard Fe;is�rott?gdt { RETURN To the following deaaibed real estate is SL Croix County, State of Wiscoosus (j _ ('Z-) i q OCR TAX PARACEL NO. a Lot 17- SL Croix F.gates First Addition in the Town of I'itds0o, SL Croix County, Wia000sin. T A� FM s This is not hoandeed property. a Exceptions to WO im. Dated this _ day of 1 9 ---%— (SEAL) (SEAL) • (SEAL) (SEAL) . • • AUTHENTICATION ACKNOWLEDGMENT `s Sim meted this dry of STATE OF MINNESOTA 19 Dakota County Personally came before me, this _ day of "`' • AuzusL 1996 the above named TTTLE: MEMBER STATE BAR OF WISCONSIN Neal Kuv7�n�ak x ,:. (if not,._— authorized by 706.06, Wis. Stets.) This instrument was I oiled by to me known to be the person who owc used the H t r forgoing instrument and the same._ 20141 10mic Tr Cute D a CY to 1,AAt 5 5044 CCU �i i. (Signaum may be authenticated or aduwwledgcd. + Warta T BaL1e'I Both are not n=ssary.) Notary Public Dakota County, MN } m ` My commission expires hoary 1, 2000.` EvonJanm h. a D�AIAl.lM� ��Y; 'Names of persons signing in any capacity should be typed or hinted below their signatures. 982 NTF 0021 '; WARRANTY DEED STATE BAR OF WISCONSIN, FOR M NO. 2 -1932 FROM :EDINR REP-'Y HUDSON 1 1999,10 -06 11330 #Lee P.01:01 4C*ES 33 4 Be. Pry d pft Il .. — otolc•rce •p,4 ' � , • ,• 1 I s r„_ _ •tiL A • 26 `. .. ;oa �. x LOT 19 txc &Sur, = oo Acts SQ er ! Q s 47.1w SO F L — _ • ,• � •`� 3 l 1.13 K ErC a / 1 ii I 1 C E w LOT /8 j � •S.tsO SG rT. i ! . 04.4%4 SQ. FT 1 t OS AL I 11 tSrr WIS► So xT i 00 2 =9.921 Su FT t � , \ •�� • ay AC txC tS&Ars. • \ r v in. 'Ll S it lip / ` ` • i lb { s'rrs.'� off` \`` ; 7 3 � S 00 &Cfts s LOT Z! 1 44 ac f ac Is"? � • • 2 07 A:Irt! s0,1S0 SQ ►r q ' lr � 1� •� ^ e +' •` 44496 So. Fr. 1 I t 00 K. Cxc Lsr , I S 7 07.31 so, OFT •11 't \ i to � bbl n1 LOT 22 + 1 r 'at 1 It so Accts t 1 117.464 SQ rr F . (n 148 K IK. ICs"I's Q ZZ 00' i 44• 4o 14 89'49'00'E 1293,20 SOWTN ♦oat O rot wo,,4 W iwt S. W SCC,00% PAS t.-- -. Well 0 NORSE a n e 0 0 816.96 I