HomeMy WebLinkAbout026-1116-50-000 ST. CROIX COUNTY ZONING DEPARTMENT"
AS BUILT SANITARY REPORT � J / REGEIti'
_ Ill
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Owner R +� �� -- " � 0 15 i q
Property Address o S 4 S T CACA !. r
COUNTY
City/State j 5 5` i � z0NreVt30FFlc
Legal Description:
Lot J'Y_ Block Subdivision/CSM # 0
%. t/. Sec. T N -R W To
lU..� .�, � 1f� ... 0 PIN # aao
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
� r �
Tank manufacturer (k kooafi-1 Size ST/PC /�51� Setback from: House Well 60 P/L S
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: &Ieo Width 1°2 Length 7g9 Number of Trenches
Setback from: House �Z Well S P/L , Vent to fresh air intake
ELEVATIONS
r
Description of benchmark n ;. -c �,,,� Elevation
Description of alternate benchmark Elevation
Building Sewer '7 ST/HT Inlet `� 9 • �� ST Outlet q % 2S PC Inlet
PC Bottom '— Header/Manifold S t Top of ST/PC Manhole Cover /O Q,39
Distribution Lines () ,� � 4 ( ) ( )
Bottom of System ( ) 9 7 -P, ( ) ( )
Final Grade () /Da , 10 () ( )
Date of installation /'// I `Per mber & State plan number
q
Plumber's signature License number 22 O 53 Date 5
In sp ec tor 6A-
Complete plot plan
I
1
I
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 VIE
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54 v*
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\ 'hC ATE NORTH ARROW
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM County CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarti!W41`1.:
Personal information you provice may be used for secondary purposes [Privacy Uj s.15.04 (1)(m)).
WILLO nf e 2 g2 JOINT VENTURE PATTY -�I�S`"e E] Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel biAL;1116-50-000
I6 u6Z I &
TANK INFORMATION % _ � ELEVATION DATA A9800532
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
tI vV (ZS� Benc ,, S 7D joS. )oC
Dosing
Aeration Bldg. Sewer (3
Holding St /Ht Inlet as ]b (.• &D
TANK SETBACK INFORMATION )� St/ Ht Outlet 6 93 99.77
TANK TO P/ L WELL BLDG. Aiake ROAD Dt Inlet
Septic 24 NA Dt Bottom
Dosing NA Header /Man.
Aeration NA Dist. Pipe �7 •c{7 ° f $- . �.
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade C�•S lo/
Manufacturer d s `� ` 6 3.1� /D a • S
Model N er GPM A 14 • R, ry �
T Lift Friction System TDH Ft oss
Force g Dia. Fi Dist. To well
S SORPTION SYSTEM
BED / RENCH Width Length - No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
N I N l� � DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa
SETBACK
INFORMATION Type Of a ')I s� —� OR UNIT CHAMBER Moe Number:
Syste
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _ Dia. J Length -76 Dia. 7 Spacing �2 51'(� Z Z 5
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: RICHMOND 01.30.18.676,NE,SW 1444 176TH AVENUE
TTP 1% N,�66te C
6��Cf1 _
Plan revision required? []Yes U � / No
Use other side for additional information. b I(OlCi� L Cat
SBD -6710 (R.3/97) Date Inspector's SigWature Cert- Nc.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
N06consin 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
than 8112 x 11 inches in size. _
• See reverse side for instructions for completing this application State Sanitary Permit Nu r e
The information you provide may be used by other government agency programs ' � p � ❑ Check if revisio evious application
[Privacy Law, s. 15.04 (1) (m)]. /�/q� /7 & *', ,4 State Plan I,D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Propifty Owner me Property Location
Ujr A /a 1 /4, S T , N, R l 1K W
uJ t V �C(' . w v rte. S W
Property Owner's Mailing Address nn Lot Number Block Number
SOS (0.S f O B o N
City, State Zip Code Phone Number Subdl � ion Name or SM Number
O ( IS) ls� : O uJ
II. TYPE OF BUILDING: (check one) ❑ State Owned o It Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Tow of �� It
111. BUILDING SE: (If building type is public, check all that apply) arcel Tax Number(s)
1 E] Apartment/ Condo • '� 0' 9• (� 7cY Q 1D — t 1 5 - oo ,
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 E] Replacement 3, [] Replacement of 4. ❑ Reconnection of 5_ [] Repair of an
,____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 E] Specify Type 41 ❑ Holding Tank
1 ❑ Seepage Trench 22 ❑ In- Ground Pressure I 42 ❑ Pit Privy
13 ❑ Seepage Pit X - 7 ; L , 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) p _ Elevation
80 8 o$ � � -7 17 3 Feet 99', Feet
VII. TANK Capa It in gallons Total # Of Prefab. Site Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App
Tanks Tanks I 1 _
Septic Tan r Holding Tank 25 6 I W I r::S El El Fl El 1:1 I Pump Tank /Siphon Chamber 11 ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i allatl of the nsite sewage system shown on the attached plans.
Plumber's Name: t) PI er's Sig ature: (N tam I MP/MPRSWNo.: Business Phone Number:
Plumber's Address (Street, City, tate, Zip ode):
I K15 N 1 o
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Age Ig ature (No Sta -
M/Approved ❑ Owner Given Initial � Surcharge Fee)
Adverse Determination 0 0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6M (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber '
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13c�� S ystems -�
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01
F(1►A All 111111.1 And ODtatro{fon P1pa
�. L. Lr s (
ns Y s T30 )Q 1
Approrl0 Vonl CaP(,"
MIFJM" 12' Aaovo
flnol Cl.d.
20. 42' Above PIP' _ 1' Call Iron
10 61111 Orldo Vonl Pipe
►lain 11 It Or S nIM1k C0.11
Len 2' A99110011
Ovot PIP 1 ..
DI11110v11on •
PIP1 0 0 0 Too 1
2 b� A99lopoiii o
011111th Plpo P41101olod PIP$ dolor
r o C1 plin0 TuminUlna At
Galloon 01 S1111m
SOIL FILL
DI.STRIBUTIO }.I PIPE :
APPROVED $yurH COVEIt
2 Of: I\GGREGAlF —/� `� — AkTI:RIA1- OR v" OF sTn�w
OR 1AARSN HAi
FJ-7� EE" (____• t "Y L,OF•�2-21 /2 AGGREGATE
1:LEV, o F _
OISTRIBUTIOQ PIPE TO BC AT LEA5T
ILICHES BELOW ORIGIMAL GRADE
AUU AT LCASTLO ILlCH[S BUT LIO MORC THAN 42 IIJCHES BELOW FIUAL GRADE
M IMM DaprH OF EXCAVATIOP F OM ORI&WA 6RADF- WILL BE. � -5 �j 4 _ ILICHCS
7'Ur1 0 5 F r11 OF E ACA \IA TImN r'P\ ►(,It1q( C R49 WILL EC, =��_ INCHC S
SIGIJED: (_�
LIGCIJ$E ►!1lMBE {t: ac)
DATE:
110
Wisconsin, Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of
.L$bor and Human Relations
Division of Safety & 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 inghas in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (Bf�r�ection and "/o caf slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance- to `nearest road. ; 026- 1116 -50 -000
%� RW D BY DATE
APPLICANT INFORMATION- PLEASE PRI . ii I PA ON`s `
PROPERTY OWNER: PROiPERTY LOCATION
Derrick Construction Inc. 'i > .� 1 �' GapV, . I OT NE 1/4 SW 1/4,S 1 T 30 AR 18 (or) W
PROPERTY OWNER':S MAILING ADDRESS ST CPCgX L `?' BLOCK # SUBD. NAME OR CSM #
1505 HY. #65 COUNTY 241, na Willow RiV_er_Meadcws
CITY, STATE ZIP CODE P IPNE N998M OFF+CZ C; QVILLAGE MOWN NEAREST ROAD
New Richmond WI. 54017 Richmond
( 176t Avp-
New Construction Use k ] Residential / Number offdFeeiz "`` [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 g pd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 75_ trench, ft Maximum design loading rate _ -7 bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) A =97.30 B= 95.30 -93.80 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 ®S ❑ U I CA ❑ U I CA ❑ U ❑ f ® U E7 S ❑ U EIS ® U
SOIL DESCRIPTION REPORT
� G P D /ft
Depth Dominant Color Mottles Texture Structure Consistence Roots
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trey&
1 0 -18 10yr3 /3 none 1 2cP1 mfr C1W 2f np -
2 18 -38 10yr4 /4 none sil 2msbk mfr gw if .2 .3
Ground 3 38 -88 7.5yr4/6 none ms Osg ml na na .7 .8
elev.
9 6.5 ft.
Depth to
limiting
factor
+88"
Remarks:
Boring #
1 0 -11 10yr4 /3 none sil 2msbk mfr gw 2f .5 .6
2' 2 11 -30 10yr4 /4 none sil 2msbk mfr gw if .5 .6
3 30 -90 7.5yr4/6 none ms Osg ml na na .7 .8
Ground
elev.
9 9.8 ft.
Depth to
limiting
f +90 actor
F /
" ?;`I
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. A ew RichmoA WI 54017
Signature: Date: 10 - - CST Number: m02298
PROPERTYOWNER Derrick Const. SOIL DESCRIPTION REPORT Page? of 4
PARCEL I.D. # 026 - 1116 -50 -000
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 0 -16 10yr3 /3 none 1 2cpl mfr gw 2f n .2
p
2 16 -44 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
Ground 3 44 -84 7.5yr4/4 none ms Osg ml na na .7 .8
elev.
9 7.8 ft.
Depth to
limiting
factor
+84"
30 '
Remarks:
Boring #
1 0 -13 10yr3 /3 none 1 2cpl mfr gw 2f np .2
4 2 13 -43 10yr4 /4 none sil lcsbk mfr gw if .2 '.3
3 43 -88 7.5yr4/6 none ms Osg ml na na .7 .8
Ground
elev.
9 9.1 ft.
Depth to
limiting
factor
+88" 5 �,
Remarks:
Boring # 1 0 -20 10yr2 /2 none 1 2cp1 mfr gw 2f Inp ' .2
5 2 20 -30 10yr5 /4 none sil 2fpl mfr gw if np .3
3 30 -48 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
Ground
elev. 4 48 -90 7.5yr4/4 none is sOg mvfr na na .7 .8
9 7.2 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
°' 6 2 9 -28 10yr4/4 none sil lcsbk mfr gw if .2. .3
3 28 -48 7.5yr4/6 none is Osg mvfr gw na .7 1.8
Ground
elev. 4 48 -98 7.5yr4/4 none co s Osg ml na na .7 : .8
1 01.9 ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PROPEFITY,OWNER Derrick constructi SOIL OhtSUMIN I IUM ht!'UM I
RaACn I c. # 026 - 1116 -50 -000
Depth Dominant Color Mottles Texture Structure Consists emsi �y Roots GPD /ft
Boring # H in. Munsell Ou. Sz. Cont.:Coior Gr. Sz. Sh. Bed Trw&
0 - 11 10yr3/3 none 1 2msbk mfr caw 2f •6 7 11 - 20 10yr4/4 none sil lcsbk mfr 9w if • 2 •3
Ground
3 120-54 7.5yr4/6 none is Osy mvfr yw na .7 .8
elev. 4 54 -84 7.5 yr4 /6 none co s 0sg ml na na .7 .8
10 ft.
Depth to
6migng
faddy
+84 t ,
Remarks:
Boring #
E.3
Ground
Deepth elev.
to
liming
#ac�x
Remarks:
Boring #
7
Ground
elev.
Depth ID
ft.
wing
�clor
Remarks:
Boring #
13 i
Ground
ft.
Depth
faekx
Remarks:
www wwAAe,'Y A!/AHl
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Derrick Construction, Inc. New Richmond, WI 54017
MPRSW -3254 NE4SW4 S1- T30N - R18W (715) 246 -6200
town of Richmond
lot #24- Willow River Meadows
I N . (t
1 " =40' p
BM.= top of base of elec. transformer @ el. 100'
Alt. BM.= base of elec. transformer C el. 101.3
IL
� 4 .3
3
8`
1 �` r
Gary L. Steel
10 -14 -98
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer l L� o w �► v� a ► �c N-Cu rt.� M ► ca-E-aEL.. Q.- . ST ;E - vf- V4 -%
Mailing Address �� o K ��1 c Vv �t �1 �o �-►o,S S413 t
Property Address 4 4 4 if 1 b -v
(Verification required from Planning Department for new construction)
City /State "%E [1A 4+wta wLD Parcel Identification Number . Q - Lto - t t io _ 5
LEGAL DESCRIPTION
Property Location NC %a, �w %., Sec. , T IO N -R Eq� W, Town of P U-Ma L4 .
Subdivision \P4 i t-2-i yo f \A "o w S Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # 4 S Z to , Volume �' 4 , Page # 4 S g
Spec house �< yes ❑ no Lot lines identifiable Kyes ❑ 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 pltimber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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.
Itwe, 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days the three ear�,xp' te.
j 10 /Z3�
S GNATURE OF APPLICA T DATE
OWNER CERTIFICATION
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 p erty �described abgye, b e of a warranty deed recorded in Register of Deeds Office.
✓G / � Lo / L3 / pg
IG ATURE 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
I �
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95,031 SO. FT.
2.18 ACRES � 88,471 SO. FT. N
II 18
2.03 ACRES
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S89 0 25' 52" W 361.13' p m p M.
161.13' 200.00' N
a ---� a N89 °25'52 "E
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2. 01 ACRES 87, 284 SO'. FT. c�0
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9� 00 i DRAINAGE ° \O EASEMENT Z
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23 8
87, 217 SO. FT, 0
`,f_ \ 2.00 ACRES 1 5 i 1 S NI
7' o =
SOUTH LINE OF THE SE 1/4 OF O 0 X
THE NWI /4 OF SECTION 1 5 \Q \6 0 Z z
p p, , a
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s 24
87,291 SO. FT.
2.00 ACRES
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