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HomeMy WebLinkAbout026-1101-80-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ��. �.Y E9vED - 1. Owner „L �� ., s n Property Address /ya S 7 y ; , l S1 CROIX r0UNTY City /State Z S Vol �� ZONING OFFICE Legal Description: Lot Block Subdivision/CSM # %a i/ ' / a, Sec.6 , T,N -RAW, Town of PIN # C� Z - //o /- - ° o SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer A4u# Size ft/PC A / Setback from: House Well -` P/L . -,-> D Pump manufacturer V 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: & Width 2 Length S`a Number of Trenches Setback from: House Z Well P/L v�_ Vent to fresh air intake ELEVATIONS Description of benchmark T/' oil x Elevation ra Description of alternate benchmark 1 Elevation Building Sewer I D /- 3 i &T Inlet /O®. 4 / cI 49 Outlet /Oa- Z (- PC Inlet PC Bottom Header/Manifold -? Top of9DPC Manhole Cover AD/. Y 2 Distribution Lines Bottom of System () �/S' L 2 () ( ) Final Grade () 7 7 () ( ) Date of installation //? /SF Permit number 4 170 S State plan number Plumber's signa r o_51•� -• License number Z Z I41-7 Date / /:r/ Fe Inspector Complete plot plan - 4 ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX 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)]. 324705 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: DILLEY, AARON RICHMOND CST BM Elev.: Insp. BM Elev.: , BM Description: Parcel Tax No.: r�t7 026-1101-80-000 TANK INFORMATION ELEVATION DATA A9800595 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi ��w �- lZ oZ� Be be 10 5 V 0 Dosing ��f, /� /b.?. Aeration Bldg. Sewer Holding St /W Inlet S'r MoD• GI TANK SETBACK INFORMATION f St/lift Outlet TANK TO P/ L WELL BLDG. A ir ROAD Dt Inlet Septic YJ14. l of ' tz) NA Dt Bottom p �� Dosing NA Header / Man. � !' .2 Aeration NA Dist. Pipe 6,,(7.57 Holding Bot. System A9,41 S Z PUMP/ SIPHON INFORMATION Final Grade 7.9 3 177 Manufacturer Demand %, k&to" �.Z & y , el Model Number GPM TDH Lift Friction S stem TDH Ft Forcemain Length Dia. Dist. To well F SOIL BSORPTION SYSTEM B D BENCH Width Length f No. Of Trenches PIT No. Of Pits _ i Dia. Li uid Depth EN I N DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Ma� acturer: SETBACK INFORMATION Typegql CHAMBER Mo del Number: Syste :Q 7Q Ep /I> OR UNIT DISTRIBUTION SYSTEM Header / Man`fold �r Distribution Pip s) „ x Hole Size x Hole Spacing Vent To Air Intake Len�th / Dia. Length Dia. Spacing A-, -7-7,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 E] Yes [] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) ,,QCATION: RICHMON 3 1 30.18.557A,NW,NW 1279 140TH� Plan revision required? [:]Yes 0 No Use other side for additional information. / �a– I q 9 SBD -6710 (R.3/97) Date Inspector's Si nature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave - In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 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. -I • • See reverse side for instructions for completing this application State Sanitary Permit Nu be ber The information ou provide may be used b other government agency programs E] Check it revision to preJlous appl�. Y P Y Y 9 9 YP 9 [Privacy Law, s. 15.04 (1) (m)]. / 410 Q / 3 O Y4_ ^ YC it ( State Plan I.D. Num I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pro rty Owner Na a Property Location 1/4 �� 1/4, S 36 T .? r N, R I8' E (or)a Property Owner's Mailing Address Lot Numb ef Block Number h z ty, State Zip Code Phone Numb r Subdivision Name or CSM dumber �w u..i o (�is� ) a ye- 7 -?( y - �, � i 1 3 II. TYPE F BUILDING: (check one) ❑ State Owned ❑ Its Neare d Roa E] V I age I Public 1 or 2 Family Dwelling - No. of bedrooms Town OF I S/o S7 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ��• 30. /o 55 7A 1 ❑ Apartment/ Condo 02 G "- — 7 "— 6 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 of 5. ❑ Repair of an _____System ________ System _____________Tank Only______________ Exesting ---- -- 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 Ij Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: W I 664d* 1- Gallons Per Day 2. Absorp. Area 3. Absorp. Area A. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L., Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (MinAnch) Elevate}n v 1� Sip 9� Feet � � Feet Capacit VII. TANK in g allons Total # Of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks manufacturer Name Concrete co" steel glass Plastic App New Existing Tanks Tanks eptic Tan or Holding Tank 14 L p� 7- ❑ ❑ 1 ❑ 1 ❑ 1 ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewagq shown on the attached plans. Plumber's Name: (Print) er's Signature: tamps) MP PRSW .. Business Phone Number: Plumber's Address (Strxt, City, State, Z Code): _ 14,(o % /1^140 L yd IX. COUNTY/ DEPARTMENT US ONLY E] Disapproved Sanitary Permit Fee YApproved (i "dudesGroundw ate ss a/f, ing gent ig ature (No Stamps) 2 ❑ Surcharge Fee) Owner Given Initial f Q%� 0O Advers e Determination t Vv X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD -6398 (R. 05/94) DISTRIBUTION: Original to county, One ropy To: Safety & Buildings Division, Owner, Plumber rloT 22AV1711 ,m w /8 w 330 46% is 10-00 io' !g - � - - - •s aµ a ISO 3W It /lo /'yet 'ALI 115 4 VAA 715 388 4680 ST CRX CO ZONING (I p�; T ' !' G t 1^( TStf5 is Cr—j from Alr foists And Oessrratloo pipe (�- Atpr.v.d V.ne Co.- Minimum N:' *"Y. ZO. 42' Above Pipe 4' Cart iten To Final Ctsda VMr Pips &We$ feer W d Ifflastic CwsrMs Yln Z Apr.seslr O.a Pbe Otrttlovfwo ` 7o* a CIS• �� i`AdQrs wato Pipe e Perforated Pl * 4e44r '. �a cowlaq Terminating Al flomm Of lfefook ���,Vr T 1911 SOIL RILL DISTRr6U'r101.I Plat A►►Rovto SNOTWETIG covot Oa W'00 STRAW OR MARSU NAy DlSTR tku - riow PIP% TO DE Al ' L . EAS- 1 IWCNfS 6CLOW ORIGIIIAL GIRAC% A&RJ AT LEAS - rZO IQCNCS 9 U Af0 MORE 7MAN 42 INCHES DILLOW FWlIkIL 01KAUC PW"M 0rFr4 OF EXcAVATlem FRoM OK16WAL 6K AVE WILL 6E. C3 _ $w 4E MIKIi'Wlq W T H OF RACAVATIOM PROM 0161wAL GR ADE WILL at �_ IKJC14E S DATE. JI-Z �1r,cusc u�MgER,��?r Soil Test Plot Plan Project Name Stacey Dilley Byron ird Jr. Address 331 N. 2nd St. New Richmond Wi 54017 C M #3479 Lot ------ Subdivision --- --- - - - -- Date 8/5/98 NW 1/4 NW 1/4S36 T 30 N/R 1 8 W Township Richmond [:]Boring Q Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft.Top of White Stake with Orange Ribbon System Elevation 95.2/93.7 * H R P Sa as Benchmark Alternate Benchmark Base of Power Pole @ 91.2 330' Property Line Pro 3 Bedroom Driveway House w w 0 0 40 , o 90' *B.M B -1 50 , B -2 �. 1 Pri A 20' B -3 0' 25' 20, Rep A 150' B -4 5 B -5 6% Slope Alt. IS,B.M. 330' Property Line py ST CROIx COUNTY SEPTfC' MAjMr,?NANCE AGREEmi-m AND Wt ERSHIP CERTIFICATION FORM O%vt1or/Btiyer � ,'� Mailing Address __`33�� � 2 h S � —��!� �,.�,�. - Propetly Address (Verification required fron i Planning Department for new co City/State, Parcel Identificati Niunber QZX — LEGAL I&SCRIpTIOL Propaty Location T3 kel_W, Town of Subdivision Lot # Certified Survey Map # Volume page # Warranty Deed # Volume T Page # Spec house 0 yes 0 no Lot lines identifiable U yes ❑ no SYSTEM N—AINTENANCE Improper ule andmaintena=eof your sN'0Csystem could result in its premature failure to handle wastes. Proper xxabaten=ce consists of pumping out the septic tank ev tor' 6 YeAn Or sooner, if netaod by a licensed pumpe Wh you pu t into th sys can affect the function of the vaptic tank. as a tmq stage it thewast di gystem. The property owtkff agrm to Submit to % C] Zoning DOVArtment a cOffiftatiou fom3, signed by the awacr and by a master plumber, j ourneyman p1timber, restrictedpl.; amber or a 1icetmt4umper verifying that (1) the on-site waatewater disposal system is in proper operadi)g conditicm and/or (2) after in, � ection&od pumping (if setoasary), the selptic ttx* i la se 1/3 f 6 a than full o u ga. .Uwe, the uadersigned have read the above requires bents and attec to maintain the private sewage disposal systern with the standards set fortb. herein, as set by the Depa=etit of Cote "me and the Departmoot of Natural Resouttea, StAt o f Wisoonsftj. Cfqt;fie&Iion stating that your Septic system has been maintainer 1 mutt be completed and etturned to the St. Qr6j County Zon Office with 30 days of the three year exmiralion date. 4 ATURP OF APPLIC 1. DATE q—"E A M"CLA1ION (W) cextifY that all statements on this irm are true to the best of my (o I mow l e d g6. I ( am ( t h e owt%er o f the P describedb a Qyc bY virtue nf a warra ity deed recorded iu Rtgivter of Deeds Office. TNTU F a APPLICANT I 0' A Oi A CA14 f 21— DATE Any information that is mis-represented u RY result in the sanitary permit tieing revoked by the Zoniug Department. Include with this appflc2fion- a Stamped wan Inty deed from vie Register of Deeds off. Ice a copy of the c4 rtified swvay inAp if reference is itiade in the warranty deed Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code it Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and `j� o percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ( n APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location 7 Govt. Lot V&11141W 1/4,S T ,F© ,N,R l, E (o67 Property Owner's MailingXddress Lot # Block# Subd. Name or CSM# Ci fate Zip Code Phone Number ❑ City ❑ Village wn Nearest Road ®.New Construction Use: EaResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: // Code derived daily flow gpd Cam, Recommended design loading rate c L- bed, gpd " - trench, gpd /ft Absorption area required = bed, le 7.7f/ trench, ft2 Maximum design loading rate L bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation s O �� 2 - f2•��J�7 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ��fT ft S = Suitable for system Conventional Mound In- Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system B S El 0 S El ] S El Z S ❑ U El g U ❑ S ] 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 , S Ground SS ft Depth to limiting Remarks: Boring # .5' /, or ✓— , 14 p Ground /� ev2 ft• ' 1 /0 Depth to limiting facto Remarks: CS ame (Please Print) Signature Telephone No. Add(ess f ` 4� � ' Date ,$ CST? mbar i' STATE BAR WISCONSIN FORM 3 — 1982 QUI LAIM DEED DOCUMENT NO. 1 roV ST. CROIX CO., WI Raa41 for ftaoord quit- claims to OCT 2 v 1998 q 0 0 A. M oir � � ' 4 Re= of beds the following described real estate in County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS T VCL L. D1 y L o caked o� ' one or-}h v�f e s N- Pic_km " , o 1 "*� 0 14hWrst Oua( +cr o-�_ oac, -Iloi -So -000 I; S e C. T to � � PARCEL IDENTIFICATION NUMBER � �ownsh�p 30 tJor� -h,Zl an9e.1 g -To wn Croix COkn4y , LAJ ►S(Ons,r) , �a1�11 ClS SLkrQt Ma y P k4d GZIl?�2 4 5 y h�� r I s �a��%�y 3 3 Fie, a; e. � i This homestead property. (is) (is not) Dated this jo f day of , A.D., 19 Ii (SEAL) (SEAL) (SEAL) 1 (SEAL) ; Sv,.So`r1 M . C3C AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ij ss. - ( ro i X County. . E 89045 CERTIFIED SURVEY MAP Located in part of the Northwest Quarter of the Northwest Quarter of Section 36, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. Prepared for and at the request of: Stacy Dilley � -- - NORTHWEST CORNER !! 2 331 North 2nd Street i SEC77ON 36 -30 -18 New Richmond, WI 54017 (FND 314" BAR) OWNER: � Ig 4l FILED -3 Paul and Susan Brown a OCT 1 4 1998 �' 1409 130th Avenue Iw New Richmond, WI 54017 ;� .N KATHLEEN ItWALSH � Drafted by. Kristi A. Eylandt i 14 o 33' 0 UNPLATTED LANDS OF OWNER 3s' I N89'52'21 "E 330.00' r I I 297.00' C i I 1 33.00' 1 100 I ti i0 I I r� �� Ic -I I Z 1 Z i-0 1 i-a Z i2 C I d 18 :C LOT 1 i� D � "•- I G1 1 w :o w �m ;Z TOTAL AREA P 1 10 rn I 108,900 SO. FT. l � 1 * :rn 2.50 ACRES iZ r-i l I :W j o iZ i� 0 I w 1 :> AREA EXCLUD. R.O.W.: 1 'N 1� it 0 100 1 :71 98,010 SO. FT. 0 1-n O P b, I g 1 1 g :� 2.25 ACRES 8 10 m O I 1 •rn Im Z II 1 33.00' 297.00' S89 'S2'21 "W 330.00' — — - 4 ' 98 SOUTH L /NE OF THE NW 114 OF THE NW 114 UNPLATTED LANDS OF OWNER I '9, WEST 114 CORNER * RD►�►ALD F, o SEC77ON 36— ,TO -18 n JOHNSON a (SET 1 " IRON PIPE) S— t 1 e i A -AERY, WIS. NOTE: The parcel shown on th �' .map is subject to State. County and X1 0��i Township laws, rules and regulations (i.e. wetlands, minimum lot size, %'-1 - j access to parcel, etc.). Before purchasing or developing any parcel, i�a SUR`fE contact the St. Croix County Zoning Office and the appropriate Town ff et4rfe004oi��