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HomeMy WebLinkAbout030-1073-20-120 o �03o � § g ; � n T � 2 g $ 3 0 ° § �� $ k S k C \ � \ E § \ : & % \ < e a \ § { ( ~ E k $ j 0 0 0 0 _~ m } / § 3 § 2 o \ ® ro § o c \ a © 2 @ > E E > CD g m ® A " ■ m E k� § CL e S X' \ C § \ - co co c \ 0 § 2. \ J / § § § p = / G) CD 0) \ = g §D _ � \ / k 7 7 § / C / ` CD 2 z 0 CL ) � ƒ 2 k z o % E § . o � � C . 14 £ � ■ Cr (D B-c,n> k {»&m ° E =KmS2QB § 'R = O g CB §k� »E { (D oeR■ «z CL =I \ � k {[��a I E�27f� � ) ® q- ID k 8 m °� ! y � � -� . 0 J�kk \ to E$o50 j k � �aa�S . q k(D \k A 8� / � U { 0 � CD t \ f \ § 8& ®7 , � ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Addres _ / 3 tc6 w A-r1A K FF Th « City /State ll so y (,,), 5'y Legal Description: Lot A Block — Subdivision/CSM # %, '/, Sec. �, T � N -R /? W, Town of �r J osF�x PIN # 03 a - 60V&A - j 07- i0 3 - Rv - /.?0 �S SEPTIC TANK -- DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer Wlesz)? Size ST/PCI / — Setback from: House 16' Well moo' P/L 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: D4& � r Width — Length — Number of Trenches -- Setback from: House -FV Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark 1 "s ,ao,�1 �, of ,4 r i . �� S Elevation Description of alternate benchmark Elevation Building ewer *�Pr was g ST/HT Inlet f'S'. Y ' ST Outlet S'3, / `'Inlets 9g ° / - 3 OR w� ,"Bottoms $" 7 G a Header/Manifold 9,'�"-G3' Top of ST/PC Manhole Cover Distribution Lines ( ) O ( ) Bottom of System () Z G o () ( ) Final Grade () /00. 6 () Date of installation i0 /i9/ Permit number 3 -? -0:1 2 State plan number Plumber's signature License number �l f R '0 � 67 Date ro 119 / Ps Inspector Complctc plot plan Wise; sin Department Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT Count ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purp [Privacy Law ❑ Cit s.15.04 (1)(m)]. 320212 Permit Holder's Name: y ❑ Village Town of: State Plan ID No.: FROST, SUZANNE ST. JOSEPH CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 030 - 1073 -20 -120 TANK INFORMATION ELEVATION DATA A9800400 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se C117C'.Ile" (/u� ' .� Benchmark . Do g Aeration - Bldg. Sewer Holding St/ I Inlet TANK SETBACK INFORMATION St / Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake NA Dt Bottom Septic ,,,__ ,�._.........._.........,,,_>. P NA Headerfa Aerati - - Dist. Pipe wx Holding_ Bot. System PU / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number __1__._ --° ,GPM TDH Lift Ion tem_....__._._..TE}H .::: Ft t� .. oss Force nn,0 " Length Dia. H Dist. To Well I/ SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT No. Of Pits Ins Dra­ Liquid Depth DIMENSIONS DIMEN H DG WELL LAKE /STREAM STREAM LEACHI nufact SETBACK SYSTEM TO P / L BL �' - ---�- INFORMATION Type of y' p,,�h._a CHA ER Model Number: System: OR NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 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 El ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1 LOCATIO ST. JOSEPH 26.30 19.2 55H,GL6 l35"5 AWATUKEE TRAIL �✓ °'" �9y?_t� G dL J �l is _G lg -C..ew +',t , C �/, F 1,f R (� �,�„ -��J ° �s.� �'.� � 1 -�: � v� c�i.� a..� ...� .,� ,� �� ,.t .� 4;ti�.,, � �:.: llr �<`�•�,. rn�-,� ,; ,�',d U./o Plan revision required? ❑ Yes ❑ No Use other side for additional information. J FTI Ij SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Vi scons i n Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington 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 CI than 8 1/2 x 11 inches in size. � - Cro • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for second v ZoZI Z. ary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. NgAiber I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location vg 114, _' T 3o ,N,R /9 E(or)W Property Owner's Mailing Address / 3 5- / Lot Number Block Number Cit , State Zip Code i Phone Numb r Subdivision Name or CSM Number PE F B L IN (check one) ❑ State Owned ❑ it Nearest Road ❑ Village Public 1Z 1 or 2 Family Dwelling - No. of bedrooms �_ Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo - 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 ____________ Existing System ____ -___ Existin�5ystem 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 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 1 ' 42 [] Pit Privy 13 CK Seepage Pit 0 I an 1. W 43 ❑ Vault Privy 14 ❑ System -In -Fill 5 e- P7 l-ks t{ 0 A} 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) Elevation .SD 6 _ S Y . C Feet Ob, Feet Cap acit y VII. I NFORMATION In gallo Total # of Manufacturer's Name Prefab. Con- steel Fiber- plastic Exper. New Existin Gallons Tanks Concrete glass App. strutted Tanks Tanks epticTa ",.akl�k d0 ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si nature: (No Stamps) MP /MPRSW NO.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Dat I ssued Issuin gent Sig ature (No Stamps) ®Approved E] Owner Given Initial I � a, / Surcharge Fee) / Adverse Determination l 1 6 � I km X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber ' •PLB a PLOT a CROSS SECTION PLANS ZAPPA BROS. EXCAVATM INC 'R o.,j /t T �IpoOe ?�Y CoQiv � R PUKING UNIT .. r PROJECT PgoposEq Gclf�c 4ocA"An1 N OsT w EE Tsirt I 1 PC' �/ Ot✓N OF '� �Op}f 1 �1EJ /00.00' G,t�4�E t G,?' s Sf, vix ��vtNT1t' yMs�� o < 3 ►�► -►�1 iT �ohc , GJ, SEE? S4- p � 000 Aev ¢'t'f� <l ~ �c H �✓ t" FFut'vVT g 3 j /g sZ) 4 1' r 7 l x rl 4�v P ✓C t O rP0& 7/ o Q A VY ��P�i�S� oreE — E g3 w0? ♦CDC" o cl A 6tf SCALE Iko : Sysz� �QEIq o �.s wr - �&,L ? AO1t &o PA&LO Ire A44 S <o ov �Eau,.�eE.,glkf'�s' S VEAJTLAP— - WIGS�� X �� g J l�9q - M /{bod£ �n�,siIGPA46 1�� a 1 .�_ _ - _. - - -_ __ -- N,,1nI N�Lf � .l u57 ��.�I6S� Lc�v� Q '✓ " ?p !o" /�E Cou/ F. F,_ - rep - - -- - -- �• Qi15r '.r_.ISiAf. /.� of �RYc✓ N Ie e � �► p ® e pr ■ �► r SIGNED: ' LICENSE: * 7 ?'/ DATE: �' • -�� J 8 h b w A A pp • SOIL TEST", BY: Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page Of . Labor and Human Relations g Division of $afery fx 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 �► not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030 /0 20 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R BY D TE PROPERTY OWNER: PROPERTY LO ATION / 2 !� `� Was GOVT. LOT t> 1/4 1/4,8 T 36 N,R /� E (or) W PROPERTY OWNER':S MAILING RESS LOT # BLOC SUBD. NAME OR CSM TO S DD -- -- K # C 5 . 9 Pe 1s2_ CITY, STATE ZIP CODE PHONE ❑CITY ❑VI�LAGE OWN N� ROAD 5 , 144 S>53r (�f�) u .286 v7 3QSc. P4 Alt-J 4 ro i<r;E I lk nj New Construction Use (�'j Residential / Number of bedrooms [ ] Addition to existing building I ] Replacement ( ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 6 �_ bed, gpd/ft 0.7 trench, gpd/ft Absorption area required' - /.?sfbed, ft2 g. S trench, ft Maximum design loading rate t _7 bed, gpd /O Z trench, gpd/ft Recommended infiltration surface elevation(s) $'9. C�o ft (as referred to site plan benchmark) Additional design / site considerations Parent material e:�� „�..a_( Flood plain elevation, if applicable ft S - Suitable for system C VENTIONAL MOUND IN ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem S❑ U S❑ U �S ❑ U O S ❑ U ❑ S O U ❑ S U SOIL DESCRIPTION REPORT Texture Boring # Horizon Depth Dominant Color Mottles Structure Consistence B Roots GPD /ft in. Munsell flu. Sz. Cont Color Gr. Sz. Sh. Bed Trerr}1 LJ Ground eley, Depth to limiting factor Remarks: Boring # Xle 4/A Ground 1 r3 /O Zoe 4 .:? 5G /h 6 5 0.G rc _ ft Depth to limiting factor . /7•% Remarks: CST Name:—Please Print Phone: ,( Address: &)k Signature: hlt Date: CST Number: g� � I �e PROPERTY OWNER ?� �'•��€ � .i SOIL DESCRIPTION REPORT Page 3 of `- • P�IRCELI.Dw (a�lJ /67, � 2L? l20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bountlary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed rerKfi -il lba 4h CT 77 77 6 16 Ground $z `56 b K, ele to /0 S : CI — h . 3 : , ( Depth to {5'4 �'/ 070 limiting factor > Cam .. I Remarks: Boring # A Ground $Z 4 °`� j� S:C Zr�,�K- Y .r GS elev. 4 /�5 S� rr, ll � d •`6 >� eft Depth to - Gmiting i filctor 7 Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. - It Depth to limiting factor Remarks: SBD- 8330(8.0542) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Su za',111 1 -✓osf" Mailing Address 8 O kloe k P-1 �h ti ha �5s r c "! AI 515 Property Address 1-?,rl 4144460 -_ �✓� ✓ D l 6 (Verification required from Planning Department for new construction) City/State Parcel Identification Number 6, :23- 20 - 2-0 LEGAL DESCRIPTION Property Location '/4, '/4, Sec. , T 3 D N -RAW, Town of S f, J0 Subdivision , Lot # Z Certified Survey Map # , Volume (a , Page # 15 Warranty Deed # -�;_7 `/3 60 , Volume 130 Z , Page # qq Spec house ❑ yes 91 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 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 days of the three year expiration date. llluu 7 /d3/ 9 ff SIG ATURE 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1; 7 / 31 SIGN TURE 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 N APPROVED � BEARINGS REFERENCED TO THE WEST LINE MAY ;coo 11s OF THE NW 1/4 ASSUMED TO BEAR N00 i • �� e ALLEN C. !, ST. CROIX COU NYHAGEN &A w SCALE 1 200 �Ar+ tor�1► c 1• S-1407 zoo 10o so o zoo '��,'. t1uQ��N, N E S a ^ NW CORNER CSM vol. 2, page 553 V SECTION 26 -------- - - - -'- - - - -- �t CO. MON. Nonni LINE - GOVERNMENT LOT 6 m 189 E 3 89° 28'40" E 1 n 1600.76' 440.00' ° \�� BASS e r o "' $ 0 149,859 30 FT R � ?! LAKE H t ' W b. A. IN. R/W 3 E 6/2L `v7 ,i' . 0•. V = 147,362 SO FT. 6T b 0 % 9 3 �� ry $ 3.39A. EX. R/W N C 1V o X31 t 3 1 w114 CORNER -4 ro p v \\ SECTION 20 CO. MON. v I Z 4 +� 146,111 SO FT. 74 �+ b 3.32 A. IN. R/M /--'L•244.73' 9 �7 e 0^ 1�e 133,739 SOFT. b +� A' 6 3.07A. EX. R/W O f �p + 13T,017 SOFT. O •� ,F 3.15 A. IN. R/W �B• . P 4ti 0 � � v4,• e 0 131,013 SOFT. �• J 90.00 1 0.00. 10 eA 9ti' -e— a ti ti 3.00 A. EX. R/W F 63.80' 143.70' N99 28' 48 217.50 s 66 FOOT PRIVATE ROAD \ \ m �� EASEMENT DESCRIBED IN \ \0 '� 0 568 59 6os 69 s O JSE N,1n VOL. 679, page 524. \ ��$, 000 ZZ f. 138,05T SOFT. e2 Z 52g�1 a e3s 3.19A. IN.R /W o 0 0 33 p2 6 1►6 130,701 SO FT. 3.00 A. EX. R /W ° 6 9 ; ®. be e b a° �5 22 a O qZ 1 5s� et 1.97' '(D 0 I N13 0 48'34 "W / 1.67' N13 0 48'54 "E N76 °11'06" W 33.00 / 4711— Ip t J 7 h /'• \ 98• 66 FOOT PRIVATE ROAD ! 9E 70 Vol. 6 Page 1523 DESCRIBED ON C.S.M. r \ � C. VOL. 3, page 738.