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HomeMy WebLinkAbout020-1319-90-000 • ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT /��' .�► 4 Owner J l l'`1 N N A �4 �� LMAP Address . C Rci p S City /State N �. n s �► ti .J l 5 c Legal Description: �Lot a3 Block U1? Subdivision/CSM # S Cr T S 1�.1 Y' S W Sec. 1L, T d I -R f — Town of 1 u D S o u PIN # DdL(7 – 131 - 9a - Olo SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer V) LP S Size ST/PC LLU a / Setback from: use � 9 Well d P�, S o Pump manufacturer - °^ -Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Y�� Water Line Meter location Alarm I oc�,tien'' i SOIL ABSORPTION SYSIE Type of system: u Width 3 Length = Number of Trenches a Setback from: House Ce ( Well > S U P/L 7 S 6 Vent to fresh air intake ? S U' ELEVATIONS Description of benchmark C k,,) v e v- V Z U h Elevation Description of alternate benchmark Elevation Building Sewer ST/H'I' Inlet ST Outlet TT SS PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover _I Distribution Lines () 4 7.O V () `7 (lU ( ) Bottom of System Final Grade 19 Date of installation LL R g bpermit number 31 S 15 8 State plan number Plumber's signature (A-arn License number Date /0 / Inspector �j t.-P 4 complete plot plan R 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 3 llpD20o►h � a i s Over INDICATE NORTH ARROW y Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM y: . Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar 15958 : Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Cit Villa e'[] Town of: State Plan ID No.: ANNARELLY JIM & CAROL HUD g CST BM Elev.; Insp. BM Elev.: BM Description: Parcel TT N 1319- 90-000 o. D .1 4 O TANK INFORMATION ELEVATION DATA A9800347 TYP MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sepfic Benc r h , I. / /v Cl Dosing Al bA4 Aeratio Bldg. Sewer Holding Odr Inlet TANK SETBACK INFORMATION St/ Ht Outlet S. Q TANK TO P/ L WELL BLDG. Ve tto ROAD Dt Inlet Air lntake Septi .,' �f 3 d l NA Dt Bottom Dosing NA Header /Man. 5. / Aeration NA Dist. Pipe (�.� 5q rO —1 S.l Holding Bot. System 7 �/7 7. /03 6 S 10 3 77 PUMP/ SIPHON INFORMATION Final Grade p D .p Manufacturer ma A M Model Numbe TDH ift Friction System TDH Ft L oss e Forcemai n la. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT side Dia. Liquid Depth DIMENSION -� DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE / STREA ACHING Manufacturer: SETBACK CRAM INFORMATION TYp �b' ��� �/ OR UNIT Moe um er. Sys e DISTRIBUTION SYSTEM e "; S Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Len th © Di L D . Y in [ —7 9 a � en�t .� is Z� S'ac � � �() f aYCNc !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 727 CROSBY LN — ST. CROIX EST LOT 23 ? a n revision requiredr required. Yep No Use other side for additional information. tE I [l SBD -6710 (R.3/97) Date Inspector's Signature ert. No- Safety and Buildings Division SANITARY PERMIT APPLICATION 20 E. Washington Ave. . Visconsin In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County c r than 8 1/2 x 11 inches in size. J� Ieul)( • See reverse side for instructions for completing this application State Sanitary Permit Numb r The information you provide may be used by other government agency programs ❑ Check it rev Mon to previpplication [Privacy Law, s. 15.04 (1) (m)]. sa State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Propeywner Name II Property Location �1r+� l NfVARR�t (L�,yi S(,J 1/4,S a$ T� 9 .N,Rf E(or)W Propert Owner's M Ong Addr ss Lot Number Block Nup Z City, State Zip C Ph de one Number Subdivision Name or CSM Number NN �InD$all r II. TYPE F BUILDING: (check one) ❑ State Owned n !t Nearest Road ❑ village Public 1 or 2 Family Dwelling PS CRS 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a g- a'1- /9. / aao -13 1f _ Ao - O00 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. 6 New 2 E] Replacement 3, ❑ Replacement of 4_ E:] Reconnection of 5. E] Repair of an System _System Tank Only 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 i 21 E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench :37V !�IUA42 ❑ In- Ground Pressure i 42 ❑Pit Privy 13 []Seepage Pit � '"' � X 6 2 ' � 43 ❑Vault Privy 14 E] System -In -Fill Gay 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 S Re uired (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Mi /inch) _ Elevation S(, 3 `7 ( of , 9 S Feet 1 Z . ) SFeet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st tided Steel glass Plastic App Tanks Tanks eptic Tank v UU El El ❑ E] 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St mps) MP/MPRSWNo.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 1 b b w �� >ai� IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved San Per" Fee (Includes Groundwater at I ssued I' o (No Stamps) Approved []Owner Given Initial / G Surcharge Fee) „ � _ Adverse Determination ( F 1 X. CONDITIO NS OF APPROVAL / REASONS FOR DISAPPROVAL: S13D -6396 (R.11196) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber A 1-11 \ U — I� } �'M t CP0 1 `J,pNWAr.Q l N 11 M Im D 4 e �" X12 IC N #N k G hrt nwX TO F 100.0 /�• • N �< � We ll ..s. �,��'��. �wN ^ SU S Fr .0 W � �q 1600 CIA) 00 Ba �• pi 45 i . , .•.;. . , FRESH AI11 INDETS AND OBSERVAPION YIDS C11OSS SECTION Approved Vent Cap „ : k • Minimum 12" Above . iNAI G�b�r •• t — E i nal Gra de_____ \ �01 dS 4" Cast Iron Above Pipe Vent Pipe To final Grader M arsh Itay O Synthetic Coveri Min. 2" Aggrey';il _ Over Pipe '�� Tee ' . Disl-ribuli_o�n,� �— • Pipe .1 _ T Aggregate +__ Per Pipe Below • ,,� ���� Beiicath Pipe Coupling Terminating A � not tom of System Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ? of 3 ' Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05 WI ode f t. COUNTY A,tach complete site plan on paper not less than 8 1/2 x 11 inches in si must incIude' 6� St. Croix not limited to vertical and horizontal reference c ), p point BM direction a sl v, or ``.. PARCEL I.D. # � dimensioned, north arrow, and location and distance to nearest road ", ,' >',',.` -� endin APPLICANT INFORMATION- PLEASE PRINT ALL INFOR Ao�l N ` .� - ;' j EVIEWEDBY DATE PROPERTY OWNER: Pfd PERTY,LOCATION Brill eland Dev. Comp GOVT`tgT,, i .., 1/ 1/4,S T AR rK(or) W PROPERTY OWNERS MAILING ADDRESS OT St #„ NAME OR CSM # 11736 117th St. Cro>lx "Estat4 t6 firs ' 'addn. CITY, STATE ZIP CODE PHONE NUMBER I q IL OWN NEAREST ROAD Lakeville MN. 55044 6112) 985-5000 Crosby Dr. [x] New Construction Use [K j Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] 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, 11: 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 102.95 It (as referred to site plan benchmark) Additional design / site considerations — alt. site system el.= 102.12 Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ® S ❑ U ❑kS El U Cis [1 U ®S ❑ U ❑ S CU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boultary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '..,..1....< 1 0 -6 7.5 r4/4 none sl 2m r mvfr qW if .5 .6 2 6 -84 7.5 r4/6 none s os ml na na 1 .7 .8 Ground elev. 10 Depth to limiting factor +84 Remarks: Boring # 1 0 -8 10 r3/3 none sl 2msbk mvfr i.6 2 8 -84 7 none s osq ml na na .7 .8 Ground elev. 10 Depth to limiting factor +84 Remarks: CST Name Print Gary L. Steel Phone: 715 A ddress: 554 200th Ave., New RicbmQnd, W1. 54017 m02298 Signature: 6 - - Date: CST Number: _.- PROPERTYOWNER Bridaeland Dev. Co. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Pending Lot #23 Depth Dominant Color Mottles Texture Structure Consistence Roots _ GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Treh 1 0 -4 7.5 r4 4 none is os mvf r 1 f .7 .8 2 14-80 7.5 r4/6 none s 0SQ m Ground elev. 105 ft. Depth to limiting Remarks: Boring # 1 10-6 7.5 r4/4 none sl 2mcir mvf k 4 2 6 -80 7.5 r4 6 none s Ground elev. 104 ft. Depth to limiting factor +8 0" Remarks: Boring # 1 10-14 10 r2/2 none 1 2ms .a> 5 j 2 114-28 10 r4 4 n if .4 1.5 Ground 3 1 28-80 7.5 r4 6 na •7 '.8 elev. 104 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) t STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Bridgeland Dev. Co. CSTM2298 Nw4Sw4 S28 T29N -R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #23 -St. croix Estates First Addn. N 1 =40 BM.= top of NE lot stake C el. 100 I q S`,�& �90 4 �� aryv Steel 6 -25 -96 STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 9554 200th Ave. MPRSW-3254 Now Richmond, N 54017 (795) 246-8200 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 Owner/Buyer J_ I 1 `and CIq P-O L YAN tAr —f-L-LY Mailing Address q L E I'Zy t/la '1�i t1E, Fit t.5 W t 5 4 22 - Property Address - 72? L.2os L �E u Aso i.! '' ff (Verification required from Planning Department for new coastructioa) City/State t1uy6or l Parcel Identification Number O 2 - 0 ' 13 t 9 —' o — 00 o LEGAL DESCRIPTION Property Location N w y,, S In/ y,, See. I T 29 N -R 1 9 W, Town of Subdivision ST CRo IX, ES"N ST F=- t n D rJ Lot # Z 3 Certified Survey Map # Volume /, I A - , Page # Warranty Deed # �� °� 8 �-- Volume l 3 O Q . Page # CP 18 Spec house ❑ yes $,no Lot lines identifiable 4t1 yes ❑ no SYSTEM MAINTENANCE Impmper use and maintenance of Your septic system could resalt in its premat = failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed b a licensed pamper. What you put into the system can affect the fimction of the septic tank as a but meat stage in the waste disposal, system. Tle property owner agrees to submit to St. Croix Zoning Department a certification form, sigped -by the owner and by a Wa ? ter Plumbe 4 7ouracYnianPIumber, rest <ictedplumberoralicensedpumperve wastewater system n in Proper operating condition and/or (2) after inspection and pumping (if necessary), the septic-tank is less than 1/3 fiLll 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 ent of Natural Reno Departtn urces, State of Wisconsin.. Certification stating that Your septic system has been maintained must be completed and retumed to the St. Croix County Zoning Office within 30 der of the three year expiration date. 'l lf� BSI TURF O APPU DATE OWNER CERTIFTCATTON 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. - �P� UA Jn 7 / IS-1 SICUUTURE OF PLICANT DATE « « « « «« Any information that is mis y terry permit being revoked by the Zoning Department. - c+eprrseated ma result in the saai «« Include with this application: a stamped warranty deed from the Register of Deeds office a co of the certified COPY survey map if reference is made in the warranty deed 575984 R.. r DOCUMENT NO, STATE BAR OF WISCONSIN FORM 2 -1982 WARRANTY DEED BridgGland Development Company- a Minnesota coWgr.AIjnn T R� t f�Y�}z'�•4 F'fICE — — T. CR IX Co.. WI Fsc'd 4^ rNn conveys and warrants to MAR V 1998 James Yanttarally and Carol S. Yannagelly 8 . 1 00: Rotator .r U"do the following described real estate in St. Croix County, State of Wisconsin Lot 23 St. Croix Estates First Addition in the Town of Hudson, St. Croft County, Wisconsin. i t JA0 JSFER FEE This is not homestead property. Exceptions to Warranties; Dated this 17th day or March- 19 98 '. (SFAL) Sly) * * hi (SEAT.) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 19 Dakota County Personally cane before rne, this ,1It11_ of Maieh TITLE: MEMBER STATE BAR OF WISCONSIN —hUl 1998 the above named anlak (if not, authorized by 706.06, Wis. Slats) This insirumcnt was drafted by to ma known to be the person who exmied the 11dilgeland_ Dcvccl pment Company foregoing Instrument and adtn wlodged the same. 20141 Icenic It s s1fl ic B Lakeville. s5�044 (Signatures nmy be authenticated or acknowledged. * Darla J_ 8aau f Both are not necessary_) Notary Public Dakoln Co". MN My 001maluion expires Jet Mfy 1, 2000. M DARLA �. BJIIIER Iloravtti wg(t�tkllal[!t)sn ' pNlptlt CtltNitY 11yConsnlstiOaEsMnsiN 116 •Names of persons signing in any rapacity should be �ypcd or printed below their signatures, am m 0921 WARRANTY DEED STATE BAR OF WISCONSIN, FOR M NO. 2 -1982 I THIS INf TRUMENT DRAFTED BY ED FLANUM .Z OD OD O N 4 UNPLATTED en v, O yt O M) o^ z� m ct N m S ° 36' 4 I A j 'Nw ' 00' 440.06' O w I m 500.59'44 "W OD I N 259e.30' S00 ° �: X 34 "F 269 m -- SECTION Zg ° C) w J OI u n 7 r I m U I 1 m O m N N w 1 1 1 L4- 1 m ♦� O m N N U A 0 1 I m ri ^ m y ; A ton y 1 1 ( rl by. _ m ONn, ti t� .. ^ a y m -1 ♦ ♦4 v m N Ul .4 444100% -4n m 2 0 / ♦ N r M u1 ✓ y 00 m 2 p x/44 0 \ x \ ♦� ; 1 1 c cl i n ♦09 VOA_ .♦' i ° 3..OG.OtieLOS O � u`� O� ` o , (A 3 3 } r.- 6s N � aJ �{ CA Z 19 121 £ e� Q ♦ ,� w ' yJ � � \ O. 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