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HomeMy WebLinkAbout020-1327-80-000 ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT 03 Owner i rte; `l REC IVED ti S Address 1999 City /State ��� %yS�.✓ ���' poi C °� ST CRUX COUNTY j 2QNINGO ICE Lega Description: Lot Block Subdivision/CSM # S T G 4o % 'Y4 4I C '/, S4 _ , Sec. 2JI I .Lq N -RAW, Town of /zL) VS 01V PIN # - &0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer �_)FIsArX- Size ST/PC / Setback from: House W Well P2 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: . 00 Width gth Len I � .,� 0 of TregcheS� < Setback front: House Wall P/L L Vent to fresh air intake ELEVATIONS Description of benchmark r�'��M -� � Elevation / aG ° Description of alternate benchmark _f G�dypAT r► �.; >� -�� oti 113,E A,o Elevation Building Sewer ST/HT Inlet 7 e ST Outlet PC Inlet PC Bottom ®O Header/Manifold - q& - 0 Top of ST/PC Manhole Cover Distribution Lines O m O ( ) Bottom of System Final Grade Date of installation Permit number 307& 7 3 State plan number Plumber's ngjiqature '.clw�_IL cease number 9 - D Date 11140 q e Inspector Complete plot plan R X, e 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 7 �O Ci Y� W 4 INDICATE NORTH ARROW I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ' Safety aid Buildings Division Count ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3Pdr;rlityg_: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). / bb /.S r er' lla a Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ulf'- 1327 - 80 - 000 t o I i we TANK INFORMATION ELEVATION DATA A9800062 MANUFACTURER CAPACITY STATION � HI FS ELEV. SQpt c Ile- Bench mar 1 0 d Dosing I }• 6M S S� /Da, Aeratio Bldg. Sewer 73" 99 Holding S 10 Inlet 7GI�r+ q7 $�j TANK SETBACK INFORMATION t 14 ® St 0 Outlet 7I%� 1 - 71 9 7 5 2 TANK T P / L WELL BLDG. Air Intake ROAD Dt Inlet Septi ro t W NA Dt Bottom Dosing A Header / Man. g- 33 rle - 6q r ration NA Dist. Pipe Ho d Bot. System PUMP/ SIPHON INFORMATION Final Grade ��'/ • 3�� °I Manufacturer Dema � eA Model er GPM TDH Friction S TDH Ft Loss ead Forcemain Length Dia. Dist. To Well SOIL SORPTION SYSTEM BED / ENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ION DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH IN INFORMATION Type // , c f i CHAME R Mo el N er: Syst to l vJ OR UNIT DISTRIBUTION SYSTEM Header / Man) fold Distribution Pi p e(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. I' Length Dia. _4� 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 29.29.19,NE,SE 721 CROSBY DRIVE ,Brut - T S Plan revision required? ❑ Yes NO Use other side for additional information. /� SBD- 6710(R.3/97) Date Inspector's Signature C SANITARY PERMIT APPLICATION Sa Washington nAve Divis N P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County p than 8 112 x 11 inches in size. 5 >4 , r • See reverse side for instructions for completing this application State Sanitary Permit Number The information ou p rovide may be used b other government ag ency p rograms y p y y 9 9 y p 9 C heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Prop y Owner Name Property Location 5 ,ftj 0 AAA) ,g pA F1/4 S 1/4, S 5 T o� , N, R q E (or) W Prope Owner's Mailing Address Lot Number Block Number I ?o / �'/r1�2�vA ID s-. 3(,- City, State Zip Code Phone Number Subdivision Name or CSM Number PU/0So0 3$e,--)0S3 Si CA0 F- srAres II. P F B ILDING: (check one) ❑ State Owned ❑ ic Nearest Road ❑ Village Public 1 or 2 Family Dwelling- No. of bedrooms S Town OF � 00s i2o 38 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © CP- © 13 c430 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 Q Service Station/ Car Wash 5 Q 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. 01-Kew 2. Q Replacement 3_ E] Replacement of 4. E] Reconnection of 5. E] Repair of an ystem -------- System _____________ Tank Only -------------- Existing System --------- Existing System B) Q 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 Erfe Bed 21 Q Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 Q In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 1 0 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/ds�( /sq. ft.) (Min. /inch) /� Elevation 7 5 C /'d 7/ / O S� / 5. Feet 7 g Feet VII. TANK Capacit gall Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks ft- p — t, 6 I l (�� ❑ ❑ ❑ ❑ ❑ 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) m er's ignatur a ) MP /MPRSW No.: Business Phone Number: ac 14,5ru-9 3 P r 8 .533 Plum er's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issui gen Signature (No Stamps) %Approved []Owner Given Initial 01 Surcharge fee) r Adverse Determination V 3 ME Air) � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Origirwl to County. One copy To: Safety 8 Bu&fings Division, Owner, Pkanber I 0 D o " Ir. rn 46 y / IBS C, fi :- t Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division,9f Safety & Buildings in accord with ILHR 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 - 9C PARCEL }:ffi: # k w i 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. ending APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION EVIEWEDBY f' .� A TE PROPERTY OWNER: PROPERTY LOCATION - t GOVT. LOT 1/4 w 1/4,S T ,N,R `" 9(or) W Brid eland Dev. Compan NE SE 29 19 PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SU$D ;( ME OR'CSM # r . 11736 117th St. 36 na `' "' CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [:]VILLAGE MOWN'.. , _._ NEARES [ New Construction Use [x j Residential I Number of bedrooms 3 [ ] Addition to existing building [ j Replacement (] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 7 bed, gpd/f: - 8 trench, gpd/ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 95.1 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 for system ®S ❑ U R1 S ❑ U ® S C1 ® S ❑ U ® S [3 U ❑ S [RU 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 Trt nch 1..- 1 0 -11 10 r2 2 none 1 2m 2 11-29 10 r4/4 none s i l 2msbk mfr qw if .5 .6 Ground 3 29 -84 7.5 r4 6 none ms osa mvfr .8 elev. 99. ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -9 10 r2/2 none 1 2c P1 mfr cs lf np i.2 '`~ 2 2 9 - 26 10 r4/4 none sil lfsbk mfr 3 26 -84 7.5 r4 6 none ms os Ground elev. 98.4 ft. Depth to limiting factor +8411 Remarks: CST Name: Please Print Phone: Gary L. Steel 715 -246 -6 Address: 1554 200th. Ave., New Ri hmond, WI. 54017 m02298 Signature: Date: CST Number: 8 -20 -96 i PROPERTYOWNER Bridgeland Dev. Co. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending lot #36 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots. GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 1 0 -12 10 r2 2 3 2 112-281 10yr4 /4 none sil m na CFw if n .2 Ground 3 128-841 7.5 r4 6 none ms elev. 98 ft. Depth to limiting factor +84 Remarks: Boring # cs if <4 2 18-26 10 r4 4 none sil ......... 3 1 26-84, 7.5 r4 6 non Ground elev. 9 8.7 ft. Depth to limiting factor +84" Remarks: Boring # 1 10-12 1 '' S 2 112-30 10yr4 /4 none sil m na if n `.2 U 3 1 30-86 7.5 r4 6 none ms Ground elev. 9 8.7 ft. Depth to limiting fact Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. CSTM2298 1 1 New Richmond, WI 54017 MPRSW 3254 NEgSE4 S29- T29N -R19W (715) 246 -6200 town of Hudson lot #36 -St. Croix Estates Second Addn. N 1 BM.= top of 12' pvc pipe C el. 100' � 2g r1 0 t Gary L. Steel 8 -20 -96 STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 554 200th Ave. MPRSW -3254 Now Richmond, W 64017 (715) 246$200 To WIM 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 010 N �K� Iy S C)tj Mailing Address _ O ! r— O / p-ca c4 y P iz 14 U n 15� o ,0 cd i S*J o i c. Property Address 0 C- R O S Q k 0g- 14 v P!& w G' a- S L1 D 6 PI=; (Verification required from Planning department for new construction) City/State 11Q o n: LJ Parcel Identification Number C 9 0 - 1 2 O LEGAL DESCRIPTION /4 V Property Locations ' /,, ' ,Sec. _�, T �N -R �' W, Town of T� �� S clro Subdivision > i C ( O! Y 1~ 5; 11;► Lot # 3(- Certified Survey Map # , Volume , Page # Warranty Deed # S 7 o Volume/ Page # 02 7 Spec house ❑ yes f0 no Lot lines identifiable JSI yes ❑ no SYSTEM NLA NTENANCE 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 masterplumber, journeyman plumber, restrictedplumberor a licensed pumper 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. 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 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 day of the three ar expiration date. -� 9 / '?y 7 SIGNATURE OP 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 perry desc ' ed above, by virtue of a warranty deed recorded in Register of Deeds Office. - -. (l.4. ✓ /; 9 0 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 574089 DOCUbIENt' NQ STATE BAR OF WISCONSIN FORM 2-1!02 WARRANTY DEM RE � ( � Bddaetud DeMeiciomeat a aoro+ratlod ' MY hr az MAR 0 $1998 conveys and warrants fb 4:00 A M the hawaing dwaI , f real estate in St. clobr county, sws ar Wisoom" � ,��ti>�w Lot 36 . Si. Crok Eatalcs Se000d Addition in dw Towa d ehon, SL Croix cam(y, wbomsia rcr- T1ria_ Tab• 00 0104 EWoepim m Warranias Datod *4 Aft- delr of l9 4L� XSEM4 SEAL) _ cSEAi.I (SEAL) + s AUTHTTdMCATM11 AC1TaiOWLEDG1YRl T autbeatiated this day or STATE OF bIINNESOTA . 19 Ddmta , County Peraooally came be6ore me, this 25th ._day of + Febnwy 1998 the above named 17IT3 : hG MBER STATE BAR OF WISCONSIN Died Krivnniak (If Nat, srrtb0:lxed by 706.06, Wis. Stats.) This insbument was dratted by tr ace lrnown to be the peaon who aao ted the tene80ing iaatFUM9ot and admowled Lama 20141 Iconic Tr. Suite H. Laloeville_ MN 35044 aL�it� (Sigosbau may be authenticated or adrnowiWpi + Bath are not necessary.) Notary Public DdwM , Canty, MN 11[yr counn ission expires J=vxy 1, 2000. t�TAA�Y A PI �itt1M� i tapiq . 31.200@ 'Names of persons signing in any apaoity sbwM be "W or primed below their signisum. am V" 0021 WARRANTY DEED STATE &MAR OF WISCONSIN, FGR M NO. 2 -1982 • _ / U 1 1, ! Q O s �'i LOT 31 A- ' 2I E 464.02' EL = 903.5 ! 2.57 ACRES I / 111 , 8 18 SQ. FT. 459,73' 33' 33' 1 1 / / 1.73 AC. EXC. ESMT. 75, 458 SQ. FT. T 39 �''� ' ,� S790 36, 0t W ACRES 441 SO. FT. X 10 ®S 4p3.y3, O .y LOT 32 ;5 y6 us, O� \\ 2.33 ACRES LOT 38 ®/ / ` O S \ 101,677 SQ. FT. 3.03 ACRES 132,073 SO. FT. 2.70 AC. EXC. ESMT. ®/ / / \ 0 117, 566 SQ. FT. / / O ss 0 �\ / /* O O LOT 37 y 4.26 ACRES �o / 185, 564 SO. FT. LO T 3�V \� `- 9 4.12 AC. EXC. ESMT. 19 ACRES _ 179,252 SQ. FT. 9 373 SQ. &T. 1ti X O d` LOT 35 -�v 2.31 ACRES a� 100,822 SQ. FT. 0 M� a 0 443.91' )0. 00' 250.00' iE NEI /4 OF THE SEI /4, SEC. 29 $89 15� 34" W 1321.91' -� l ,' ,aNCS U LAT►E� „ L -. - -- - ;plat) is subject to State, County and CURVE DATA ions (i.e., vetlands, minimum lot size, irchasing or developing any parcel contact CURVE LOT RADIUS C ENTRAL CHORD CHORD ARC Um and appropriate Torn Board for advice. 1 No Um SIB AR 1 -2 32 317.00' 54 N63 289.49' 300.63' 3 -4 31 167.00' 101 N14 257.901 402.23' i o 11.5E 383.99 60 10 19 N34 44 5 -6 RD 383.00 31 383.00' 16 N56 107.67 108.03 1 1 30 383.00' 21 N38 140.38' 141.18' 1 RNER MONUMENT FOUND - -- 29 383.00' 22 N16 152.00' 153.02 1 7 -8 42 317.00' 59 S35 312.6 326.91' -11NG 3.65 L BS. PER 9 -10 RD 233 .00' 101 S14 359.82' 411.11' 41 233.00' 38 S45 154.23' 157.20' :RS TD BE MONUMENTED - -- 40 233.00' 23 S14 94.65' 95.32' 3 E WEIGHING 1.13 LBS. - -- 39 233.00' 26 S10 107.95' 108.94' 38 233.00' 12 S30 49.56' 49.65' 11 -12 RD 383.00' 54 S63 349.76' 3E3.22' 36 383.00' 19010'52' S45 127.62' 128.22' , Iaz nn 32 S11 215.48' 218.42'