HomeMy WebLinkAbout026-1013-70-130 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner
Property Address --?
City /State
Legal D scription:
Lot Block #
,4L t /4 '/4, Sec. -4, T,�N -R,�W, Town of P # � �7/ - iii �- 4 - /3cs
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer Size ST/P / _ Setback from: Hous Well w� P/L ,:Zy
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: &D Width --Ie— Length `� Number of Trenches
Setback from: House 4ZI Well , A114 P/I, ,?S'_ Vent to fresh air intake Ir _
ELEVATIONS
Description of benchmark f Elevation
Description of alternate benchmark , Elevation 1d
Building Sewer qZeR ST/HT Inlet 7 ST Outlet 9l. 7C PC Inlet
PC Bottom Header/Manifold �./ Top of ST/PC Manhole Cover
Distribution Lines O _F O ( )
Bottom of System
Final Grade O y Sly— O O
Date of installation / Per it n ber State plan number
Plumber's signature License number �,?�/_ Date ?/
Inspector
Complete plot plan
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 VIEW
/e fi
o use
r u � i
/ R'
INDICATE NORTH ARROW
ft
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y'
• Safety and Buildings Division Count
T . CROIX
INSPECTION REPORT S
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarttrl .:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1) (m)].
bT86 1de T�IE JO [kCTt!,R6"e ❑ Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel �9�-1013 - 70 - 130
b�
16 0
TANK INFORMATION ELEVATION DATA A9800619
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ,�pv Bench r ,C43 I V C�
Dosing >< X ) 4 14.p - 3 3Z /Ol L/ ? 77 el. 5,t
Aeration Bldg. Sewer G -3 7- Oy
Holding St Inlet 7. Gi 7 /
TANK SETBACK INFORMATION
0* �_, St I;k outlet 7.6 4 , 7 (,c,
TANKTO P/L WELL BLDG. A ROAD Dt Inlet X
Septic •^' �� ; 1,(.. NA Dt Bottom
Dosing X x NA Header / Man. 1-02- NO .
Aeration NA Dist. Pipe ') 9 (p. ;t-5
Holding �_ -[._ Bot. System 9 Ob 1 �5 , 3
PUMP/ SIPHON INFORMATION Final Grade /) C) Cj -Sv
Manufacturer X Demand St ,(
Model Number X X GPM
LF:em Laift i Friction x System TDH X Ft
n Len gth_ Dia. I f r Dist. To Well
SO ABSORPTION SYSTEM
BED RENCH Width Length I i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
N 1 N 7 b DIMENSI
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION I Type O CHAMBER Moe Number:
:
Syste "44'P l Aa ! 35 O OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x 7To e ize —*-Wok-Spi" Vent To Air Intake
Length 12� Dia. Ll, Length �� Dia. _`' c Spacing �o .4�T�M
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 4.30.18,NW,SW 1738 112TH STREET - LOT 4
�j
A 11 A4 AA °r ) PtU � I
Plan revision required? ❑ Yes jig/No /
Use other side for additional information. & ctol r
SBD -6710 (R.3/97) Date I nspector4 Signature ert. o.
Safety and Buildings Division
` S ANITARY PERMIT APPLICATION 201 W. W Washin Avenue
Aiiconsin
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
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.
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary pur oses " ���
p ❑Check if revision to revlous ap /cation
(Privacy Law, s. 15.04 (1) (m)]. lg A a
!.� .c�ri State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI N
Prop y ner ame Property Location
/a t /4, S T , N, R (OrY&
Property Owner's Mailing Add �r Lot Number Block Nu er
Ci y ate / Zip Code Phone Number Subdivision Name or M Number
( ) .S
. TYPE OF BUILDING: (check one) ❑ State Owned It� Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ town o f " (�
III BUILDING USE (If building type is public, check all that a pp l y) Parcel Tax Number(s)
1 E] Apartment/ Condo 4v. `� ck O' 19.49P
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. Mr New 2 ❑ 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 N Seepage Bed 21 [] Mound 30 [] Specify Type 41 [] Holding Tank
12 Seepage Trench 22 ❑ In- Ground Pressure , r 42 E] Pit Privy
13 []Seepage Pit /g > - 70 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION: �(�,�
1. Gallons Per Day 2. Absorp. Area 3. Absot�p. Aroma 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. / ch) Elevation
Feet Feet
Capacit VII. TANK in gallo s Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
1 5 e ` ptic Tank r Holding Tank - ❑ ❑ ❑ ❑ ❑
Li ump Tank /Siphon Chamber I I ❑ ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for instofation of the onsite sewage system shown on the attached plans.
;PI ;me s A;m: rint) Plumber's ig u o ps) MP /MPRSW No.: Business Phone Number:
P umber's Address ( treet, ity, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing nt Signature (No Stamps)
® Approved E] Owner Given Initial / I Surcharge Fee) of -
Adverse Determinat UV 00
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
S / fir/
- SSG fiL
J
f
0
1
3
�Q — at
C') Y
n �
Wisconsin Department of Industry SOIL AND SITE EVALUATION
Labor and Human Relations Page - of
Dl*�ision of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
w
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
[!�'
IR -
APPLICANT INFORMATION Please print all information. Reviewed by
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ST C +.
Property Owner z Property Location
Govt. Lot �J 1/4 4,S ��:• O,NR� /PV
Property Owner's Mailing Address Lot # Block# Su . Name or CS V#
_....
Citi to Zip Code Phone Number EJ City Village Town earest Road
ew Construction Use: E"Public esidential / Number of bedrooms �{ Addition to existing building
Replacement or commercial - Describe:
Code derived daily flow 4l " gpd Recommended design loading rate -3 bed, gpd/ft - trench, gpd /ft
Absorption area required —,Z242 bed, ft � trench, ft2GG Maximum design loading rate _ bed, gpd /ft gpd /ft
Recommended infiltration surface elevations) ��� / ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material ���� L /—>�� zi 3 Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U El U S❑ U XS 0 U ❑ S ❑ S'N U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
I o- n � -
Ground
Depth to
limiting
factor
Remarks:
Boring #
�- -�
Ground
ev.
D pfi to
limiting y
factor
in. Remarks:
[Address T Name (P ase Print) ture Telephone No.
_ r
Date CST Number
I
PROPERTY OWNER m ��� SOIL DESCRIPTION REPORT
Page of
PARCEL LD.# ^
Boring Horizon Depth Dominant Color Mottles Structure 2
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
� c
i
Ground of 10 Of
Q� v.
Depth to
limiting
factor p
7 ,;�;Lin. 6
Remarks:
Boring #
r
.4
Ground
Depth to
limiting
factor
}in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # r
j
dr r
Ground
— Deptfi to ;
limiting
factgr
>n Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBDW -8330 (R. 08/95)
Soil Tost Plot Plan
Project Namet�. f '� Byron ird` Jr.
Address, f j
All
CS 479
Lot Subdivision. Date
r
/4 14 5 T /RI -W Township
❑ Boring O Well :: PL„ Property Line County Li
L BM ''or VRP:., ",Assume Elevation 100 ft.
System Elevation' *HRP
low
dO
{
-�
n,
1 7
. ,4' .:
Scale' 1/4" 10 Ft. When dimensions aren't stated
r7tr fy
LU
�J
ht 'h L
r' �'
�� .
d 1,
a
`b
JS
.J . T-
8 �
1
i
1
1
1
r�
,4
r
Q'
p
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION / F
Owner/Buyer I��t �I i o s i-nc �� (7 1 5) �
Mailing Address
Property Address Z 7 ,Z /�'` ,—
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location _&L0 '/4, 5 - h) '/4, Sec. T W N- R_,Zy W, Town of o
Subdivision Cy/ , Lot #.
Certified Survey Map # Volume , Page #
Warranty Deed # Volume , //� , Page #
Spec house Lid yes ❑ no Lot lines identifiable 9 yes ❑ 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 plumber, 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.
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
dad of th ee yea
i
SIGNATURE OF APC DATE
OWNER CERTIFICATION
I (W ill st ements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro scn d abo i ue of warranty deed recorded in Register of Deeds Office.
SIGNATURE OF AgVffCkNT 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
r C.,; V'
i
554 88 KATyLe 1997 A.
CERTIFIED SURVEY MAP
' S! rsler o/ Sfl
C•
2 rorx co., >0
,
Located in Part of Lot 1 of a Certified Survey Map recorded in Volume 2, Page 518 and Part t e —
Northwest Quarter of the Southwest Quarter all in Section 4, Township 30 North, Range 18 West, own
of Richmond, St. Croix County. Wisconsin.
Prepared for and of the request of:
OWNER:
William & Roxanne Stock NOTE: The parcel shown on this mad is subject to State, County and Township
1748 112th Street laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel,
New Richmond, WI 54017 etc.). Before purchasing or developing any parcel, contact the St. Croix County
Drafted by. Krlstl A. Eylandt Zoning Office and the appropriate Town Board for advice.
BEARINGS ARE REFERENCED TO THE WEST LINE OF THE
WNPLATU_ SW 1/4 OF SECTION 4 TOWNSHIP 30 N., RANGE 18 W. UNPIATCE!?_LAt4pS
WEST 1 4 CORNER WHICH IS ASSUMED TO BEAR N 01'04'09" W.
EAST 114 CORNER
SEC. 4 -30 -18 EAST -WEST 114 LINE SEC. 4 -30 -18
(FND 2" IRON PIPE) SEC. 4 -30 -18 (SEE RES SHEET)
-__ -- - - -- S 89'39'13" E 5289.82' - - - --
- - - -R = S 89'58'56" E 1320.38' - - - -- FND IRON PIPE_
_;- -- _ - - - -- - - - -M = S 89'39'13" E 1330.68' - - - -- _ - --- - -_
- - - -- 660.38' - - -- �l - -- 670.30' - - -- -- 1'-3959.141/
l � FOUND NW CORNER OF w j 1 S U E 12
FROM A4 F OUND ON
N .08'
D IR PIPE
I I I LOT 1= N 01'05'30" W I w LOT _ 1 DRIVE (TYP)
1 3.28' FROM SET IRON Op C.S 2. PG. 518 _
oI PIPE Into P EAST LINE OF LOT 1 & I I I
1 L O T 5 oM inrM THE NW 114 OF SW 114 3I
o; o TOTAL AREA LOT 5 . rn t - -S 89'56'22" E 450.00' —3' I I
gI v 828, 458 SO. FT ; i N01'0737 91 `� - SEPTIC s 33.08'N I I
1 19.02 ACRES f �� �- - - 416.92'
of AREA EXCLUDING R. O. W. : - - 49' I t
826,278 SO. FT 21 0.
�i 18.97 ACRES S 89'55'37" E o o HWY ROWS-
g R= S89'58'56" Fi ° LOT Q I °
�i \ TOTAL AREA LOT 2 . �;, � .w. to t t I.tI
3 89,979 SO. FT. f i�r- S 89'56'22" E 44,9.98'
is oo 2.07 ACRES __�-
tD rn 41 UDING R..W. ".-1 '``k'��V� N Q - 416.92' - / �i
AREA EXCL
Iri a' Z O co � �3.06�'�
to 83,366 SO. FT o 100' BLDG - - o I �o
N o 1.9> ACRES I �7 /1�r, r ° o, SETBACK F In
3 W TOTAL AR A LOT 3 .• JAN 2 7i' 7 N �M,, . I°
Z 104, 370 SO. FT. w o 1 LOT 3 f8I °
oa 2.40 ACRES +�,°� 1 X3.04'- \t HIV)
cn AREA EXCLUDING R. 0. W. : ; ;' • CROIX COU ►%� r -- 416.92'
0 3
96,704 SO. FT. r
2.22 ACRES Comprre/�h(en�sli�ve�Pl�annir o ` -- —S 89'56'22" E 449.96' -� �I� I
° FC3"2tfSe' o ` - - 89'56'22" 449.95' I N
Z TOTAL AREA LOT 4 �Qs
ptommittee N '- - -- 416.9
82,641 SO. FT. 1 1 Pi 33.03
1.90 ACRES
t
AREA EXCLUDING R.O.W.
�
If not recorded tt ��i O ,- 4 � I�
76,872 SO. FT within 30 days of t o - 33.01'�t4 f VX
I 1.76 ACRES F n I z
I approval date �� `�,' 7' ,
r , - - -- 871.56' : approval shall be - -- _ � i1 19.92' ' - -MaN$ 5'14 "W 33 3
.� 9. 8 , I
89'56'22" W 9 .48' _____- r R= N89'58'56 "W �I
tl -- R 8,9'58'56" W ,.,�,� Iwo- 330.00' ��
-�
W Z UN?�TTED_LAND5 1�M° zl
ZA
I
iv V Z LINE DATA TABLE �-, a I 1
"' I o LINE DIRECTION DISTANCE Io z I o �
L1 S 01'07'38 E 38.00' IN II ~0I �I I
L2 S 01'07'38" E 162.00'
I I J L3 S 01'07'38" E 232.00' I c ii I
I p W V L4 S 01'07'38" E 66.00' _____— J I
L5 S 01'07'38" E 174.77'
! No TH L6 S 01'07'17" E 66.00' EAST LINE OF THE
NW 114 OF SW 114 ---I
200 0 200 I
GRAPHIC SCALE
SCALE IN FEET: 1 Inch - 200 feet DOU @LAS ,j. fh L
Z AHL :l
JOB #96156 Count Section Corner Monument c
Y
�
Prepared by:
of Record
A & E LAND SURVEYING • Set 1" x 24" Iron Pipe weighing rl
Phone No. (715) 246 -4319 a minimum of 1.13 pounds per
P.O. Box 325 linear foot. Sddt�
109 East 3rd Street O Found Iron Pipe
New Richmond, WI 54017 M = Measured As
R = Recorded As
Sheet 1 of 2
Vol. 11 Page 3204
-�I
' r
V
CERTIFIED SURVEY MAP
Located in Part of Lot 1 of a Certified Survey Map recorded in Volume 2, Page 518 and Part of the
Northwest Quarter of the Southwest Quarter all in Section 4. Township 30 North, Range 18 West, Town
of Richmond, St. Croix County, Wisconsin.
SURVEYOR'S CER'I.'11 i cn'I'R
1, Douglas J. 7,ahler, a Registered Wi.sconr,.in f,and Surveyor,
hereby certify that by the direction of William and Roxanne 1).
Stock, I have surveyed, divided and mapped a part of Lot 1 of a
Certified Survey Map recorded in Volume 2 page 518 of said Maps
and part of the Northwest Quarter of the Soil tl; west Quart rr of
Section 4, Township 30 North, Range 18 West, Town of Richmond,
St. Croix County, Wisconsin described as fo.l.lows:
Beginning at the West Quarter Corner of said SecL 4; the-ric -e,
on an assumed bearing along the east /west. Quarter line of said
Section 4, South 89 degrees 39 minutes 13 seconds East a distance.
of 660.38 feet to the west line of said Lot 1. of a Certified
Survey Map recorded in Volume 2 page 518; thence, along said west
line, South ' 01 degrees 05 minutes 06 seconds East. a dist of
326.70 feet to the south line of said Lot. 1; Hienre, along lash.
said south line, South 09 degrees 55 minutes 37 seconds East. a
distance of 210.49 feet; thence N(:)rth 01 degrees 07 minutes 38
seconds Went a distance of 37.91 feet; thence Soi.rth 89 degreeR fib
minutes 22 seconds East a distance of 450.00 feel: to the east
line of said Lot 1; thence, along last said the east line and the
east line of that property described in Deed Volume 722 page 251,
South 01 degrees 07 minutes 1.7 seconds East a distance of 672.74
feet to the'nor.theast corner of Lot 1 of a Certi Survey Map
recorded in Volume 5 page 1498; thence, along the north .li.ne. of
said Lot 1, North 89 degrees 59 minutes 14 seconds West a
distance of 329.98 feet to the west line of said Lot 1; thence,
along part of last said west line, South 01 degrees 04 mi miens 515
seconds East a distance of 33.00 feet to the south .line of said
Deed; thence, along last said south .line, North 89 degrees 56
minutes 22 seconds West a distance of 991.48 feet to the west
line of said Northwest Quarter of the Southwest; Quarter of
Section 4; thence, along last said west line, North 01 degrees 04
minutes 09 seconds West a distance of 990.14 feet to the point of
beginning. Containing 1,105,447 square feet (25.30 acres).
Subject to right -of -way for existing 112th Street (a Town Road)
along the most easterly line of said property and also subject I:o
all easements, restrictions and covenants of record.
I also certify that this Certified Survey Map i.s a correct
representation to scale of the exterior boundaries surveyed and
described; that I have complied with the provisions of chapter
236.34 of the Wisconsin Statutes and the Subdivision Ordinance of
the County of St. Croix and the Town of Richmond in surveying and
mapping the same.
Dougl J Z:16 ►ler Reg. No. 2145 Date
A & E .,and Surveying Telephone # ( 715) 246- 4319
P. o. Box 325 Of N
New Richmond, W1 54017 A < �0
A�' DOV31 AS J.
ZAHIT .-
S 145
H ?5)fJ,
Vol. 11 Page 3204 S�Rv .(
S heet 2 of 2
L I
i
i