HomeMy WebLinkAbout030-2098-60-000 ST. CROIX COUNTY ZONING DEPARTMENT` RECEIV
AS BUILT SANITARY REPORT
n n ii.
- 1998
1,,,E L Yr � '
S7 CRUX
rner - � 4 couNT`�
)perty Address $ /
ty /State r< 4r'Y
;gal Description:
,t _ Block -&A- Subdivision/C5M # n Y ^7 ��
PIN #
/4, Sec. 2,$, T.IN R.JyW, Town of
TANK DOSE CHAMBER -- HOLDING TANK INFORMATION:
EPTIC P/L
ank manufacturer �'��� ' Size ST/PC /%
Setback from: House Well
ump manufacturer nrd Model
alarm location
OLDING TANKS ONLY) , Water Line
>e OLDI : a Vent to fresh air intake
deter location
Alarm location
SOIL ABSORPTION SYSTEM:
TRPn� ,.� _ Width -3— Length ��
Number of Trenches :?- Type of system: Well P/L Vent to fresh air intake : Oat
Setback from: House
ELEVATIONS:
Elevation
Description of benchmark o Elevation
Description of alternate benchmark
Building Sewer 8. ST/HT Inlet
5T Outlet PC Inlet
—
Header/Manifold Top of ST/PC Manhole Cover
PC Bottom
Distribution Lines
Bottom of System Q)
Final Grade ( ► )
Date of installation / / / Permit number�2c,2,&'� State plan number
Plumber's signature
'- License number _ Date / / /
1 �1 ` Complete Plot plan
Inspector G1 \
g in Department of Commerce PRIVATE SEWAGE SYSTEM County:
and Buildings Division INSPECTION REPORT ST. CROIX
Sanitary Permit No
IERAL INFORMATION (ATTACH TO PERMIT) 320269
nal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No.:
❑ City ❑ Village Twn o
of:
�Vbvf N �'�,�TID ST. JOSE
Parcel Tax No.:
M Elev - - - Insp. BM Elev.: �M Description: 030- 2098 -60 -000
W 1 CO)o ICTD Li—ra-r— d
IK INFORMATION ELEVATION DATA
(PE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
is Benc •�� /0 .q /f��
ng At �• Oa
)tion
Bldg. Sewer
ding
St /Ht Inlet �'6.7 97 1,
VK SETBACK INFORMATION St/ Ht Outlet
fit to
AK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet
?i2 f Z
0 dt/ NA Dt Bottom
ping
NA Header / Man.
�
- ati on $ `
NA Dist. Pipe q / p
c •
ding
Bot. System
MP / SIPHON INFORMATION Final Grade l0• �'I 8. 2- °
inufacturer
Demand ,�cr�e 6.33 9e'
Ael Number GPM
H L' riction Ft
e
rcemain Le Weu
)ILA N SYSTEM /n F'i`r
Width Length6g No. Of Tren es PIT No- Of Pits Inside Dia. Liquid Depth
:D 3 DIMEN I N
IMEN I N LEACHING Manufacturer:
'tTBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER Model Number:
(FORMATION TYP
s � .��' S
ISTRIBUTION SYSTEM f ,-C;'l �� �� ,' ���� 9 -;
r
Bader / — Manifold fold Distribution Pipes x oJe Size x Hole Spacing Vent Air Intake
►
,ngth Dia. y Length f°87�Dia. 3 Spacing r3 S
r
OIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
xx De th hed
epth Over Depth Over N
A /Trench Center
e rent Edges Topsoil ❑ Yes ❑ No E] Yes ❑ o
.OMMENTS: (Include code discrepancies, persons present, etc.)
PION: ST. JOSEPH 28.30.19,SE,SE 581 132ND AVE — BIRCH POINT LOT 6
Nan revision required? ❑Yes 0 No � Jse other side for additional information. E 2� Ce�,
Date Inspector' ignature
SBD -6710 (R.3/97)
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
P.O. Box 7969
w nsin In accord with ILHR 83.0 5, Wis. Adm. Code Madison, WI 53707-7969
rnt of Commerce
) complete plans (to the county copy only) for the system, on paper not less County �(
cwt (.✓o i 1�
11/2 x 11 inches in size. State Sanitary Permit Number
verse side for instructions for completing this application Z"o
Check it re islon to previous a placation
tion you provide may be used by other gover / nmen a pro am /�° S e ' ` . State Plan I.D. Number
, ,s. 15.04(1) 5 3 + +.J0 - " , _ � –�—
ATI N INFORMATI N -PLEA E PRINT ALL INF RMPr peONocation N R E (or)o
vner Name C .3� 1/4 St 1/4,S 8 1
,, ,III 111,11111 J Lot Number Block Number
nrner's Mailing Address
Zip Code Phone Number Subdivision Name or CSM Number
❑ It Nearest Road
B I DIN (check one) ❑ State Owned village v��
Town O S d
�blic 1 or 2 Famil Dwellin - No. of bedrooms F parcel TaxNumber(s) a g . 3+D. /C/. g/0 LDING USE (If building type is public, check all that apply)
030 - 909a -6 o
,partment /Condo 10 ❑ Outdoor Recreational Facility
assembly Hall 6 ❑ Medical Facility/ Nursing Home 11 ❑ Restaurant/ Bar/ Dining
:ampground 7 ❑ Merchandise: Sales/ Repairs
g ❑Mobile Home Park 12 C] Service Station/ Car Wash
:hurch / School 13 ❑ Other: specify
iotel / Motel 9 ❑ office/ Factory
PE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) Repair of an
New 2- ❑ Replacement 3. Replacement of 4. ❑ Reconnection of 5� C] Extstlnc�System
❑ Tank only _ - _ - -- E --- S stem
- [g S stem System -------------- - - - - -- y- - - - - -- - -
Date Issued
C] A Sanitary Permit was previously issued. Permit Number
PE OF SYSTEM: (Check only one) Experimental Other
'ressurized Distribution Pressurized Distribution P 41 Holding Tank
Seepage Bed
21 ❑ Mound 30 ❑Specify Type 42 Pit Privy
Seepage Trench 22 ❑ In- Ground Pressure a — 7 j' X 7 S 43 ❑ Vault Privy
Seepage Pit
System -In -Fill CGL au c)� I1CLC l�
BSORPTION SYSTEM I FOR MATI N:
ons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Raft 5. Pell 6. System Elev. Elevation
rade
^ Required (sq. ft.) Proposed (sq. ft. (Gals/day /sq. ) ( 9 7J Feet Feet
`w D • Prefab. Capaci Pr . Site Fiber Plastic Exper.
ty
ANK in gallons Total # of Manufacturers Name Con- Steel glass App
NFORMATION New Existin Gallons Tanks concrete structed
Tanks Tanks _ , ❑ [] ❑ ❑ ❑
Holding Tank � – C ❑ ❑ ❑ ❑ ❑ ❑ Il
np Tank /Siphon Chamber
RESPONSIBILITY STATEMENT
the undersigned, assume responsibility for installation of the onsite stowage system shown on u N m
er's Name: (Print) Plu is Signature: (No Stamps —
iJ I
per's Address (Street, City, State, Zip Code): ,�r�� `J
COUNTY/
DE P RTMENT USE ONLY (i ncludes Groundwater
ate ssue (No Stamps)
❑Disapproved Sanitary Permit Fee Surcharge Fee)
tpproved ❑Owner Given Initial l �� W��
Adverse Determination
CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
DISTRIBUTION: Original to County, One copy To: Safety d Buildings Division, owner, Plumber
;
it
5
r ,
— —•
1 ♦.
!
- t-- --- + ----�- - +--- t--- *- -_ -.- -}-- � �f /100/'7
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II
8� C1f3u -� ul�u�
1 /� S
os
Igm AL
Department ofIndustry SOIL AND SITE EVALUATION REPORT Page 1 of 3
a`nd Human Relations
n of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY
St .Croix
i complete site plan on paper n `� t jri. eshes in size. Plan must include, but PARCEL I.D. #
Wiled to vertical and horizonta f ce point (BM);`diifi nand % of slope, scale or ending
isioned, north arrow, and to and dia
e. ,� nce near 9efq d. VI W Y AT
,
ACANT INFORMATION t _ ASE T 14 L`'INF ~ TION
r,
PERTY OWNER: 71 PROPERTY LOCATION
-- ~; GOVT. LOT SE 1/4 SE 1/4,S28 T 30 N,R19 x9(or) W
ennis Erickson ', :�
IPERTY OWNERS MA!I_ING ADD ES5 r� . f '!►� LOT # FnVIILILAGE SUBD. NAME OR CSM #
43 St . Croix Tr1 . r' - "`` 6 Birch Point
f, STATE ZI QCITY MOWN NEA A 60th D St . akeland, Mn. 55043 36 -5211 S. se h
New Construction Use (x J
Residential / Number of bedrooms 3 [ j Addition to existing building
Replacement [ ] Public or commercial describe
450 Recommended design loading rate • 7 bed, gpd/ft2 8 trench, gpolft
ie derived dairy flow 9Pd
sorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd4t
)ommended infiltration surface elevation(s) 95.75 ft (as referred to site plan benchmark)
iitional design / site considerations
na
, ent material outwash Flood plain elevation, if applicable na ft
Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
: Unsuitable for system ®S Q U ® S ❑ U S O U �r S ❑ U Q S CC ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mollies Structure Texture Consistence IBartdarY Roots G P D /ft
Bed ITrertch
g# Horizon in Munsell Du. Sz. Cont Color Gr. Sz. Sh.
1 —11 10 r3 3 none 1 2m
> 2 11 -30 10yr4 /4 none sil 2msbk mfr gw if .5 .6
id 3 0 -34 7.5yr4/4 none 1S osg
na .7 .8
mfr w
ft. 4 4 -84 7.5yr4/4 none cos osg ml na na '7`'8
I to
tg
r
4 ..
Remarks:
ng #
1 —8 10 r3 3 none 1 2msbk
2l' 2 —26 10 r5/4 none sil lfsbk mfr w if
:« .8
3 6 -30 7.5yr4/4 none is os
ind m l na na .7 mfr w na .7
.8
4 0 -84 10yr4 /4 none Cos osg
ft.
ith to
ing
or
34"
Remarks:
Phone:
3T Name:— Please Print G ary L. Steel 715- 246 -6200
ddress: 1554 200th St. Richmond, � wi. � 540 � 17 9_ _
Date: CST Nur^t>er:m
STEEL'S SOIL SERVICE
1554 200th Ave.
L. Steel Dennis Erickson New Richmond, Wi 54017
A2298 SE 4SE 4 S28- T30N -R (715) 246 -6200
SW-3254 town of St. Joseph
lot #6 -Birch Point
:401
= top of NW lot stake C el. 100'
2�
0
6�' �� Q0
t� 3
Gary L. Steel
9 -4 -95
+ ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
DwnerBuyer 29 A LI !D �T � ` "
Mailing Address J
L-O T G� 6 l occ y L r
Property Address
(Verification required from Planning Department for new construction)
City /State L 7 r= = uLcel - identification Number _ 030 098
O O C
LEGAL DESCRIPTION
Property Location &F 1 �4, '/4, Sec. _,g_g _, T N -R
Town of S� LTOSC�N
Subdivision
/j��c� �o�N7- , Lot# _
Certified Survey Map # A
Volume � � � S _, Page
Warranty Deed # ,7 5 a
Volume 1 3 7 , Page # �
Spec house ❑ yes no
Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE ma
Improper use and maintenance of your septic system could result in its premature failure t handle wastes. P u p i e n r to the system
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you p
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 the on-site master plumber, journeyman plumber, restrictedplumber
or a licensed pum necessary), the t se ) tic tank is less than 1/3 fu sludge
f
is in proper operating condition and/or (2) after inspection and pumping ( p
Uwe, the undersigned have read the above requirements and agree to main the Private sewage n dispo e of Wis onsin. Certification
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Zoning Office within 30
stating that your septic system has been maintained must be completed and returned to the St. Croix County
4dayse three year ex iration date. DATE
OF APPLICANT
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) know I (we) am (are) the owner(s) of
4 theperty described above, by virtue of a warranty deed recorded in Register of Deeds tri ' /a) ATE TURE OF APPLICANT
sented may result in the sanitary permit being revoked by the Zoning Department.
* * * * ** Any information that is mis- repre
** 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
�PA 79
Sag 20 WARRANTY DEED
Document Number
S Vol f
Return Address ►- , ...,,r Q
MAY 8 t39i'
, �
1 1:45 A M
N ��Ia4 -1 .�7 :1beJy
Parcel LD• Numb
oer. 030- 2098 -60
Ercksmith,
Hanscom Inc., a Wi and sconsin Cor
husband pUr h co —� —�
Croix County, State of Wi
w survivor i shp mari nv e ta ; p l op warrants David J. Hansco and
Lot 6, Birch lowin de- Mary F.
ch Town of S
Point in the To real estate in St.
S t- Joseph, St. Croix County, Wisco
This is not homestead prope
ruin.
warranties: E xception to warranties: Easements,
restrictions and rights -of- -way of record. if
Dated this �eI 4,1, day of April, 1997. may
Eri
m� h, Inc. `�-
B Dennis W Eric, : TRq���„�.
tckson, President (SEAL
A UTUENTICATION
,ignature(s) Ericksmith
'y Dennis �y, , Inc., a W isconsin Co
Erickson, Presi�cpa Pd lion
"--at, authenti ,
day of April, 1997. this
istina Og and
FLE: MEMBER STATE BAR OF
W ISCONSIN
S INSTRUMENT WAS
Attorney Kristin, O l and
DRAFTED BY:
g
Hudson. WI 54016