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HomeMy WebLinkAbout026-1110-20-000 9 4� /1 p ST. CROIX COUNTY ZONING DEPARTMENT y A. AS BUILT SANITARY REPORT ny RECEIVE 0. Owner z� 1998 Address 1 ` sr CF40X City /State ` d. COU NTY S o ; 1 ;, TY YV� R. �mor� ,. �� 7 ZONING S Legal Description: Lot �� Block N o, Subdivision/CSM # L) cc V ` 01 � ` t t S _ /. /a Sec. , TAN RW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER HOLDING TANK INFORMATION Tank manufacturer i u Size ST/PC 1A, O/ Setback from: House 19 Well 85 P/L AL Pump manufacturer Model Alarm location NLY Setbacks: Service road Vent -to fresh air intake a' Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: 64 Width Length Number of Trenches Setback from: House Ate _ Well - &S P/L /2, Vent to fresh air intake 1 / ELEVATIONS Description of benchmark o p .gyp 4rx► o�,c 5.4on) RA �e. Elevation Description of alternate benchmark Elevation 1. Building Sewer ST/HT Inlet — 9 7, 7 ST Outlet PC Inlet �--- PC Bottom '-"'"' Header -- anifold Top of ST/PC Manhole Cove ` Distribution Lines (t) 6 b (x„ 6 Bottom of System O) 5.S (>) (3) Final Grade (i) 99� Z (i Date of installation 1 / 9 6 4 'Permit number � State plan number Plumber's signature License number 53 7 Date /l / / W Inspector Complete plot plan f 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. a r� s 1yQ�a� 5 ° 1 N S � �44 INDICATE NORTH ARROW Wiscofrsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety and Buildings Division INSPECTION REPORT ST - Cpa-bI� GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 Z4& C—P Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: — *C> � L ;—; rv,.o It C> --I%--- CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: I oU' CEr wi jT ?A-D Ar ?o - o o c� TANK INFORMATION ELEVATION DATA 4 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic �JLtac'Z ��� Benc ark 2. S IOZ /bC� Dosing Aeration Bldg. Sewer , t 98, Holding Stmr Inlet (�,��, C(7.14 TANK SETBACK INFORMATION St /btt Outlet S Z 97.3 TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet — Sep ) ` JV e3) 'jam,' 2� NA Dt Bottom Dosing — NA Header /Man. saps. R�•roz, Aeration - - _. NA Dist. Pipe (002 qG, tag Holding _ Bot. System ?. oq PUMP/ SIPHON INFORMATION Final Grade 3.3o 9`t• 2 Manufacturer Demand 04040 RoLF6 C ?i•�{( ° � ° l.p� j Model Number _-, GPM TDH Lift Friction` S stem _ TDH Ft — 1 oss mead Forcemain Length Dia. — Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width t Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM t N I (0 O DIMEN I N SETBACK —� SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ^ INFORMATION Type 0 r'Z 2 f �-- OR UNIT CHAMBER model Number: Syste�ut, atas DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air intake Length 1?- Dia. Length t(S Dia. '/ Spacing (n Sc.-4 4 c *5 1 1_5 - 1 3S 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 �� El Yes No ❑ Yes ❑ No COMMENTS 7 (include code discrepancies, persons present, etc.) Lod y�.Tt uN: ` Rt(, t t}. 2,0, le , G>Zo , C,0, 5G 172j C7 471L Fju . ?u ^^ N D - COLL#wPSt9jj S4k 'IT k tvc-? SIB? T'\ L, Pt3 Z cu.. Plan revision required? C] es )6"No ap, Use other side for additional information. SBD -6710 (R.3/97) Date Inspe is Signature Ce . ` `�► Safety and Buildings Division sconsin SANITARY PERMIT APPLICATION Zoo E. a Ave. Department of Commerce In accord with ILHR x3.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. II- • See reverse side for instructions for completing this application State Sanitary �Permm'it Numbef The information you provide may be used by other government agency programs E] Check it r�sion to prev i�us" application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Projuu,%y,Ow er Nam P opert Loc tion t.� � +(' S E-1 /4 E 9t /4, 5 L4 T :30, N, R EW* W Property Ow is Mailing Adc]rgss nn Lot Number Block Number City, Stat ip Code Phone Number Subdivision Name or CS Num ( ) i u 2 111. TYPE OF BUILDING: (check o e) ❑ State Owned it Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms own of 111. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo �" ��• /81 n au �� 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_ Replacement 3_ Replacement Of 4. ❑ Reconnection cif ❑ f 5 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 NSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 79 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) q Elevation 600 S-Sg soy , � `S`s Feet 99• Z- Feet Capacit VII. TANK in g allo n s Total # Of Prefab. Site Fiber Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glaze Plastic App New Existin structed Tanksl Tanks eptic T or++�� K ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ 1 ❑ 1 ❑ VHI. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instg4tion of the onsite sewage system shown on the attached plans. Plumber's Name: (P . ) PI tier's Signa ure: ( o S amps) MPRSW No.: Business Phone Number: P um er's A dress (Street, City, State, Zip Code): V\ f� i, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanita Permit Fee (Includes Groundwater ate ssue Issuin ent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial X/� I) , Adverse Determination U V X. C IONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Number i Ro s V- Y Yt S y s ©N Tap 64Cwco°:�t sly 7 AV IA ,O ID .rs dpi 1 . S 5S d fl-j E 11N fifth Alr I1%1616 And ODiurotlon Pt � W P too 0 �i 5 q t 7 �—�^ APPror1A Yon% Cop ' Mlnlmum 12•Aboro y , S, flnol Cradr / YL -S cf—r ^^ A f> t ` ^f ^^ l�� 20. 42" Above Plpr _ 1' Caol I(an o � � �� ko vcw-t 0 To flnol Orado . Vonl Pipe Kor o^ Ito% Or SyntMlk Co oriny - LI ^ 2 A4ol ' 0141 Pipe 4ro'I .. Dlallib.110n Pipa o Toa a e' A40ro4alo Donool► Plpa Paloroh^ Pipe ONor �Co.glln4 Tam111611n4 AI Dollow 01 Sislom ton SOIL FILL 0 ISTRIBUTI01.1 PIPE ' • �� ROVED S r `I)•IprTIC COVCR 2uO�AGGREGATE APP —�' /IA7ERIgt- OR 9" OF STitAW OR MARSH HAy LEV O F /JJ 1; /Z AGGREGATE. � �ji �•,. � —�„ �E o ./ � DISTRIBUTIOIJ PIPE TO BE AT LEgS -f INCHES BELOW ORIGIIJAL GRADE AUU AT LCAST LO IIJCFI[s BUT 1.10 MORC THAI) 1 -12 II.ICHES 9ELOW FINAL GRADE MAXIMUM Dap.r i OF FXCAVATI IfK O►tl t,Wgl, 6RAVR WILL BE �Q 711KIr1V _ M O CP n+ Of EA CAVA TIm N fZol� tGlttgt- �Rnv . WILL 8 — INCHES SIGIJC.O: LIGEIJSC DUMBER: a DATE: Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of S,ai4ty & 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. Plan must include, but St. Croix not limited to vertical and horizontal reference on and % of slo e, scale or PARCEL I.D. # point,(I3f�f), P dimensioned, north arrow, and location ar4,distadceto`neares, ro . 026- 1110 -20 11 R VIEWED BY DATE APPLICANT INFO RMATION- PLE/RS :PRINj AINFORMA ION PROPERTY OWNER: lI t PROPERTY LOCATION Ted Bauer GOVT. LOT SE 1/4 S 1/4,S4 T 30 N,R 18 kkr) W PROPERTY OWNER':S MAILING ADDRE$� s s ,, LOT # BLOCK # SUBD. NAME OR CSM # 1728 174th. Ave. - r't�' 21 CITY, STATE ZI 0 ER ❑CITY [ MOWN NEAREST ROAD New Richmond, WI. 5401 _V 715)24 - Richmond 174th. Ave. [ ] New Construction Use [ Residential rooms 4 [ ] Addition to existing building jx] Replacement ( ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 95.50 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem I ® S ❑ U fK1 S ❑ U EkS ❑ U ®S ❑ U FE] S ❑ U ❑ S l&1 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10yr3 /3 none 1 2msbk mfr qW 2f .5 .6 2 9 -17 10yr5 /4 none sil 2cpl mfi gw if np .2 Ground 3 17 -25 10yr5 /4 none sil lcsbk mfi gw if .2 .3 el 4 25 -fJ6 7.5yr4/4 none '91 2>�r myfr gy na .5 .i 9 2 ft. Depth to 5 36 -84 7.5yr4/4 none ms Osg ml na na .7 .8 limiting factor +84" Remarks: Boring # 1 0 -14 10yr3 /3 none 1 2msbk mfr lm .5 .6 2 14 -22 10yr5 /4 none sil 2fpl mfr gw if np 3 22 -37 10yr5 /4 none sil lcsbk mfi gw if .2 .3 Ground elev. 4 37 -43 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 99.5 ft. 5 43 -84 7.5yr4/4 none ms Osg ml na na .7 .8 Depth to limiting factor +84 4% 1 L Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. &v New Richm2Ed, WI 54017 Signature: Date: 10 -12 -98 CST Number: m02298 PROPERTY OWNER Ted Bauer SOIL DESCRIPTION REPORT Page? Of PARCEL I.D. # 026- 1110 -20 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bandary Roots Bed Trench 1 0 -12 10yr3/3 none 1 2msbk mfr gw 2m .5 .6 3 2 12 -31 10yr5 /4 none sit lcsbk mfi gw 1f .2 .3 Ground 3 31 -42 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 elev. 99.2 ft. 4 42 -84 7.5yr4/4 none ms Osg ml na na .7 .8 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Ted BAuer New Richmond, WI 54017 MPRSW -3254 SE4SE4 S4- T30N -R18W (715) 246 -6200 town of Richmond lot #21- Viebrock River Valley View N 1 =40' BM.= top of concrete slab C el. 100' Slt. BM.= top of tel. ped C el. 101.70' jB D� 30 �y as , � a ' 07 , Gary L. Steel 10 -12 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ff i Owner/Buyer Mailing Address 1 7 c� R 7•c.1 Nv Property Address (Verification required from Planning Department for new construction) City /State kU . , k;c nn o jA uJ Parcel Identification Number 0 cat (o l (f p -,�n_ LEGAL DESCRIPTION Property Location ' /a, s ' / <, Sec. T 3D N -R Town of Rk Subdivision V % 6 - 0 c v ', 0'Q Lr- C-CA .2 v , V :.J- Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # -3 - 1 !� / Volume Page # y rVi Spec house ❑ yes r no Lot lines identifiable f SJ 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, 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. Uwe, 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 days of the three year expiration date. IGNATURE OF 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. , / / 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 ?,, °i�` .L� a ,�, ��� •a, ,�S 9.91 0 .00 G41 o �- c , Om vi O t O -0 L0 006 O - 3 t co pOZ oe w . N O ° -b� m N o c ' o � `v ��q ��� N ° e � Cfi(O � t c O / N N - - O a) a ��' a ����N� m� bl o c.\ o ,00'.QL1 cI ° ���;��c v+ IN O o li S rn _� c Z ° h � 1 �.�� 3 'O c �\ 2 n^ 0 MM 8 a p p a) d a� i O iq tO m Y� .o, m' ,°� W '�' of ~ o N3 a Z,£9 s o06. 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