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HomeMy WebLinkAbout020-1319-40-000 ST. CROIX COUNTY ZONING DEPARTMEN for�;�r AS BUILT SANITARY REPORT C] Owner � // 'y` .//,(.[.�/ f ' M Address C 2 / �Dc��� -2i�G St �¢P f 7 �, sT c�?ai t � City /State 4-tA 10 5h AJ L4,) S�{v/ �, I ONING orF�C E. f ; Legal Description: Lot /�_ Block --- Subdivision/CSM # 'A &L 1 A :�6Z, Sec. Z , T,[2-N -R W, Town of date ^J PIN # — SEPTIC TANK - DOSE CHAMBER - BOLDING TANK INFORMATION: Tank manufacturer tJJ fr5 - 6z - Size ST/PC Setback from: House ?2 Well -> �P/L > Pump manufacturer Model _ Alarm location — (HOLD G T ONLY) Setbac : ervice road Vent to fresh air intake Water Line Meter ation Al loca i n SOIL ABSORPTION SYSTEM: Type of system: �'�C Width 3D 5/D8 +JIB e7 S gth _ umber of Trenches �— Setback from; House ' Well > M P/L _ Vent to fresh air intake > Sa ELEVATIONS Description of benchmark Elevation /0 O Description of alternate benchmark 7-1dA oic Z x6 6As'�� ,Oaro2 �au6K ooE.v % de Elevation IP Z. Building Sewer ST/HT Uet ST Outlet - . Z K PC Inlet 3,d PC Bottom Header/Manifo� Z� Z, Top of ST Manhole Cover 2-, 9 6 9 Distribution Lines ( ) O ( ) Bottom of System ( () Final Grade (f) 9 5i (�) 11 4Z ( ) Date of installation `S1111 9 Permit number 30 blI State plan number Plumber's signature License num& Date 8/1<5/ Inspector Complete plot plan •+ h 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. i • Show alternate benchmark, if applicable. / Z�o/ PLAN VIEW J� z� .41-+ a y l e 15, 1P P W�r✓at� t,tJlc�Lt�'R�"�s D Z� LL- LL INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety tind Buildings Division ST CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 307i611 Personal information you provice may be used for secondary purposes [Privacy La k s.15.04 (1)(m)). HOLT oldRiffi @: f LCii� L�_�Cillage Town of: State Plan ID No.: CST BM Elev.: Y Insp. BM Elev.: BM Description: Parcel TB._1319- 40-000 t o . o � V c7 ) �� i .. +s c.¢_. TANK INFORMATION ELEVATION DATA A9800000 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �S�o 7 Benchmar Dosin Aeration Bldg. Sewe Z 100 7$ Holding - ,33?I`$ Inlet G , C?1 • S / TANK SETBACK INFORMATION (ghtp Outlet 7.2 TANK TO P/ L WELL BLDG. Air i ntake ROAD Dt Inlet Air Septic ►� �� Z 2,-51 NA Dt Bottom i Dosing NA Header / Man. IZ • sue ` Aeration NA Dist. Pipe T7_ 1.4 2 2 Holding Bot. System T '�5., 0rZ z S n PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand St Z ' `IL oz 9g r� IZ.14-7 93 q3 Model tuber GPM � ,,.� ('�,uw� T - 0 11 TD Lift Friction S s L TDH Ft Forc ain Length Dia. Dist To well SOIL ABSORPTION SYSTEM BED/ Width , I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid epth DIMENSIONS 3 0— DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM L ACHING anu INFORMATION Type O I C T o M mber: Sy stem Y S t!8,,.,ou3 I Z S �j OR UNIT rn 1 `�_ DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _� Dia. W v Length _a, / Dia. Spacing �ca C lnuw. v �5 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over �I Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trenc Topsoil ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) r�� �QCATION: HUDSON 28.19.19 NW SW 517 PAMELA LANE (� w t, ' I 'N -i�LC� to ('I C�.`�" ���7 JC { b1 n Plan revlslo ` quI ed. ❑Yes 09 No p Use other side for additional information. 0 IG SBD -6710 (R.3/97) Date Inspecto Signature Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. 'isconsin I n accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 ,apartment of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. 5� • See reverse side for instructions for completing this application State Sanitary Permit Number 3 0'7 61 The information you provide may be used by other government agency programs [I Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION --- Property Owner N me Propert Location rJ 1Z O L �/4 $- L f /a, S Z g T , N, R f E (or� Property OwnerslMailing Address Lot Number Block Nu mber 1%'f S - City, St to Zip Code Phone Number Subdivision Nam or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ityy . Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Tow OF 4 y dsd A & 41 E<A IJ 6 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. GI New 2 E] Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. ❑ Repair of an Y_�_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 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. 1 7. Final Grade 49 :P� L,� Required (sq_ ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation 7 ✓ �/ 99 Feet Feet Capacit VII TANK in Ca allo s Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallon Tanks Manufacturers Name Concrete Con Steel glass Plastic . App New Existin strutted Tanks Tanks Septic c r ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Cha ❑ 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the, undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb Name: (Print) Plumber's Si nature: (N St s) MP /*PR"V No.: Business Phone Number: � Plumber's Ac dress City, State, Zip Code): Swami -f=- I IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) u ) CH Approved E] Owner Given Initial 1 � /W/ ; Surcharge Fee) g �•2.G� v 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 PAGE or Fresh Air Inlelc And Observation Pipe . Approved Vent Cap Mlnlmwn 12' Above Final Grade 20- 42' Above Pipe _ 4' Cost iron To Final Grade Vaal Pipe Mash Itay Or SrnlMlk Covering tlln. 2' AggraqaN - Over Plpe Oletrlbulion —Tae Pipe 0 0 0 0 6' Aggragale o perforated pipe Below Bones Ih Pipe Coagllno Taminalloo Al Bottom Of System P,�� PoSeU �lnk gr�,rlc � � . V c lj, T Ion C ` ' SOIL. FILL ST !J PIPE - APPROVED SIMPETIC COVER 2 "oFA6GREGATE MATRIA�- OR 9 " OF STRAW �• OR JJARSN HAy la ;'OF e OF1 -2 AGG EGATE MEV.. OF ` +Z �EET__ DIS'T•RIg�JT1ON PIPE TU BE AT LEAST WCHES BELOW ORIGIOAL GRADE AQU AT LEAST20 INCHES 15UT 1.10 MORE THAN H2 IAICNES BELOW FINAL GRADE MAXIMUM DEPT!{ OF F-XCAVATIOIJ FRQM ORI WAL rJKAOR WILL BE Ikic-HES PO MMU w " of EXCAVATIOM FK 01�1 (61MAL GR49E W ILL BE _ INCHES SIG"ED: LICEWSE DUMBER: a z DATE: P LO+ pzmJ w,2 y �� l Fo' Pf' M - Ce - LA G� k y 8 3 sx9s r4L ,42 L- d 2r� LL eot Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisio9:.t.:',lafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI 'Snehide but St. Croix not limited to vertical and horizontal reference point (BM), direction and % s1pp+3, scale or ''' P ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. \r , ending PIEV APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATf ` y IEWEDBY DATE _ 1 PROPERTY OWNER: ! ­1 PROPLIAV LOCATION Brid eland Dev. Company 1� I GOVT.LW - ; 1/4 /._1 /,,S T ,N,R I(or)W MW PROPERTY OWNER':S MAILING ADDRESS c �b9T # i��9 0,K. #� ,SUB, E OR CSM # 11736 117th St. % J Qioix Esbahes f ir, s h a. d n. CITY, STATE ZIP CODE PHONE NUMBER GfTY :JL ,GE N NEAREST ROAD Lakeville MN. ( ) i Pamela Ln. [ 1: New Construction Use [Xj Residential/ Number of bedrooms 3 [ j Addition to existing building j I Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd/ft Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) trenches C 92.23 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code and 3.5' below surface level. Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND 71dNG PRESSURE 7e SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem [3 S ❑ U ❑ S 97 U ❑ U S ❑ S E] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtc Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0-16 10 r3 3 none sl 2mQr mfr gX .5 .6 2 16 -80 10 r5 4 none S os Ground elev. 95. ft. Depth to limiting facto +r80" 1 _T Remarks: Boring # 1 -13 none sl 2 U 2 13 -25 10 r5 4 2m r if Ground 3 25 -82 10 r4 4 none CW rT ml I na ..7 .8 elev. 95 ft. Depth to limiting fact� Remarks: CST Name:—Please Print Gar L. Steel Phone: 715- 246 -62 Address: m02298 1554 20 h Ave. New Richm Signature: Date: CST Number: 6 -24 -96 PROPERTYOWNER Bridgeland Dev. Co. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Mending Lot #18 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 10 9w ... ....... 2 1 16-30 10 r4/3 none sl 2m r mvfr aw 11f -9 Ground 3 1 30-80 7.5 r4 6 none s elev. 9 4.13 ft. Depth to limiting factor +80" Remarks: Boring # 1 0 -20 10 r3 3 none sl 2 2 20 -80 10 r4 4 none Ground 89 e le v. 7 ft. Depth to limiting factor +80 Remarks: Boring # 1 k -9 10 r3 3 n U S 2 —80 7.5 r4 6 none s os mi n ................. Ground elev. 89. ft. ")%th to � ting factor +80 Remarks: Boring # ................. I Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) 'W,. STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. CSTM2298 NW4SW4 S28 T29N - R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #18 -St. Croix Estates First Addn. -t. R �i 1 =40' BM.= nail in pin Cherry tree C el. 100' Alt. BM.= nail in Pin Cherry tree C el. 105.00' l� 7 " z S V Gary L. Steel 6 -24 -96 STEELS SOIL SERVICE Gar L. Steel 1554 0 Gary 2 0th 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 e system may or may not be as shown, as permanent lot lines had been established at the time of the test. Gary L. Steel STC -1OS SEP'T'IC TANK MAnWrENANCE ACREE1v zNr St. Croix C ounty OWNERlBUYER L7 � y [ _ � - r��.0 G - R/� /CL ... ! '•�•vp 9� l�y� WWO ADDRESS I, ?�i _l -� ST - /04 eu�-,— ivy ilcr/1 PROP`ERTi Y ADDRF,SS j �i9nl�L/ „ G'¢�!�, Lc�/✓SUv� r aV';� l� (loction of septio system) Please obtain from the Planning Dept. cm/STATE PROPERTY LOC ATI ON /� ( /J _ 114, 114, Section , T Z,9 N R_,�w TOWN OF ST- C_ ROrK COX NTY, WI SUBDIVISION LOTNUPUMER /V CIKRTUr1ED8vRVEYMAP VOLUME PAGE LOTN[lMBER Improper use and maintenance of your septic system could result in it$ premature failure to handle waxtn$. Proper maintenance c onsists Qf pumping out the septic tank every three years or sooner, if needed by lioetlsed septic tank pumper, What you put Into the system can affect Zits lunctiou uC file septic tank as a treatment stage in tho waste disposal system. St. CtOix County residents may be eligible to receive a gent for a maximum of 60 of the cost of replacement of a failing system, which was in nremflan prig io July 1, 1978. St. Croix county accepted this progmm in August of 19$o, with the requirement that owners of all new systems agree to keen, their system, properly maintained. The property owner agrees to submit to St. Croix. 7A a certifreation form, signed by tho uwnCr and by a Matcr plumber, journeyman p l a rnber, restricted plumber or a licensed pumper verifying that (l ) the ran - site wastewator disposal gy3tzljl is iu proper operating condition and (2) after inspection and Pumping (if necessary), the septic tank is less than 113 full of sludge and scum. UWe, the undersiped have read the above requirements and agree to maintain the private sewage disp4cal system in acCBrdancG with the standards set forth, herein, Certification ! tion stet[ that as set b the Wisconsin DNR yUttT s eptic has been maintained must be earaplctcd e,sJ jujumeti to the St, Croix COWAy Zoning Otficor within 34 days of tho three year et,piration date, t I SIGNED: •��� DATE: St. Croix County Zoning Of"Ce Goverrltaeat Center 1 101 c4 michael Road K��dson, Wj $4016 Y I(93 ze-� a N37i"N-L a A3 n mi s,Ao wa ez:er ,L66- 4z -3aa This appliCation form is to be compl.ete4 in full and signed by the owner(a) of the property being developed. Any lnadequac:Ics will only vaoult in d4lays of the permit issuance Should this development bra intended for resale by own*tr /c;unt r a cILur, (apec housa), then a second form should be retained ano compli.I.ed when the property is sold and submitted to this office with the appropriate deed recording. ---- ar---- wrt- rr�- r--- rr.- ....----- r.. -_... owner of property t /En% Ate _ -1 �- ZJ-ok r %4 !s tc�iFi= Location of property_1 /4_1/4, section ,T N -H W Township, Mailing addres>g �. �rv/J sm�c /�/✓� Address of site��'1'7 ion O 4ivc ,_ .aVO t�. _.... Subdivision name � r: 401 x ES i s — - Lot no. _ dthor homes on property? you 2 _ NO Vrevioua owner of property R P � Total size of property _„_ Total size of parcel � � �6:5 Date parcel was created Ara all aerhora and lot linots idcnti£iablc? 7C�7(ac 110 is this property being developed for Cmpee houE:e) 2 _Yes A No volume AeL. and Page Numbnr . L �2­ as re.nnxded with the Registar- of beads, _...�- -.. - ----------------------- r- �.-- r- .. - -w-r- INOLVDg WrTX THIS APPLTCATIdlt THE 1E`OLLOWXN[Cs A WAPIUMTY DEED which .includes * DOCUMENT NUMBER, VOLUME AND PAGE WVMnrIR AND THE SEAM, OF .L= RE013wrFt of DrEbS. Xii Adaltia", a certified survey, if availablo, would be helpful so as to avoid ftl*Y6 of tiles reviuwing pr ouebu. Xr the duud deucriyLiun references to a Certlri cad Survey Map, the c' Survey Map shall. also be requiretd. 1PROPEWev OAR CLRTIPICATION i (we) certify that all state on this form are true to the bast of my (our) knowledge that I (we) am (arc:) the owner (a) of `he property described in this information form, by virtue of a warkant►y decd reca:de -d ill t sto a Criuo of the courlt;y Register of Deeds as Document No. and that I (we) presently nm„ tho rropoced cit4 i'c-r the ,swage disyvsaz :dy:=�Leut vt Z (wu) obtained an easement, to run they above described property, for the Onnstruction of amid aystom, and the saute hQs been duly reco rded in the Qff ico of the County Register of Deeds as Document No. n4 ur f pp l vent pp cont Da o S g t r a ur e ba - t..��._� - dtE: Q� � t7tlAttilrQ Te a 213"II � 31� s.�tobr wd 0�:i9i ts- 3Z -o3a NO. STATE BAR, ' FORM 2 -1982 THIS SPA a RESERVED FOR RECORDING DATA fiU1.� WARRh 'Y DEED �✓ REGISTER'S OFI '( ,: Bridgeland Development Company. a Minnesota co=ration ST. CROIX CTY., V1 Reed (or Record JUN 2 7 1996 conveys and warrants to __ "__ Henry H. Holt and Bonnie L. Bakke a � w �10: 0 M Re�eterat?r.a•, + RETURN TO the following described real estate in St. Croix County, State of Wisconsin ` TAX PARACEL NO. Lot 18 , St. Croix Estates 1st Addition in the Town of Hudson, St. Croix County, Wisconsin. TRAN S FER -0 ER FEE This is not homestead property. (is) (is not) Exceptions to Warranties: Dated this 13day of Tune. 19 96 01/10/1995 00:27 7152737753 NELSON PLUMBING PAGE 02 sT. CRO IX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Mn f taL� Address /: 2 1ALDtt1f116 157' - City /state ,LL 1 10,�n Lj -j 1 S4t�f Legal Description: Lot 6j Block .::= SubdivisionKSM # C!e Ae- I`E+4 E'S' '� +Qtly �r•1eE', scc. �8. T,N- R w, Town of a> P IN tl SEP17C TANK DOSE f'HAMBFR HOLM!Q XANK 1 QK Tank manuhwtmrr r AF01" Stae STMC Setback from: House ! �Z Well }, P/L > g? 37 Pump manufoaivc+ec -- -- Model Aiarm location gg- Wa tor Li ne Vent to freab air intake 6011. ABS M Type of system. t*JC ff / umber of Trenches Fattmck fivm- Ilou= ' Wd1 P/L ? -!4 Vent to f vsh air inuft XLE3L& Z S Dmaipdun of bendmark Elevation Descr43idon of alt rave be nolmoa* =6p ar~ 2 rG ArAg7 .wart• teen a l lcvatkm Building sewer - STAIT Iai ST Outlet P7 Z PC Inlet PC Bottom - HeaderAotanifin _ r Toil of STS Manhole Cover Distribution Lines () () ( ) Rattmin of System W ( ) Final Grade T (1) ( ( ) Date of itnsttnfttion S /! [/ Permit number v/ _/Sttatte plan number Plumber's slaunture I..ieense nntn�bTEfr .•? Date Impactor (2 (bmvlele viol vtaa 4' i 01/10/1995 00:27 7152737753 NELSON PLUMBING PAGE 05 NOTICE: Please provide the following: i • A plan view skewh showing everything within 100 feet of the eyetem. Two horizontal reference points to center of septic tank manhoic cover. Show alternate banchmark, if appliesble. i rx." Vmw L l r L- L- IN )ICATE NORTH AMUM I ST. CROIX COUNTY WISCONSIN l � k ZONING OFFICE N p p p p p M - ST. CROIX COUNTY GOVERNMENT CENTER ' "'• 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 August 19 1998 g , Centennial Mortgage Attn: Kim Houvert RE: Septic Inspection for Henry Holt located at 517 Pamela Lane, Lot 18 of St. Croix Estates, Town of Hudson, St. Croix County, Wisconsin Dear Ms. Houvert: I A septic inspection of the above referenced property was conducted on May 11, 1998. This property is located in the NWY4 of the SWY4 of Section 28, T19N -R19W, Lot 18 of St. Croix Estates, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a five (5) bedroom home. If you have any questions regarding this, please contact our office at (715) 3864680. Sin rely, od Es g Assistant Zoning Administrator /sm I