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Home My WebLink About030-2101-10-000 ST. CROIX COUNTY ZONING DEPARTMENT '�' AS BUILT SANITARY Rl✓PORT RECEIVED 1 �n Owner S E P 1 4 195'8 Address S�� City /State ZONINGOFRC.£ Legal Description Lot ;; : ,Z Block � Subdivision/CSM # %, %, 44, Sec T-;F -R W Town of -� , PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/P / Setback from: House _Z,_l_ Well �7[_ 7 � – 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: Width 11— Length _ Number of Trenches Setback from: House z.Z Well / _ P/L 7s Vent to fresh air intake �— ELEVATIONS Description of benchmark Elevation Description of alternate benchmark - Elevation Building Sewer ST/HT Inlet ST Outlet g PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover 9r5 Distribution Lines Bottom of System Final Grade Date of installation 11ZLOL Per it number b �l9g State plan number Plumber's signature License number ;; ; Date / L EY Inspector complete plot plan or E WitcoAsin Department of Commerce Count PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar er�mitN Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). P rm IK Ede ��Naame: �jty 0 iIlaQe Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: B escripti n: Parcel Td�U f�Lo 2101-10-000 66 b TANK INFORMATION ELEVATION DATA A9800087 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. W Z6a Bench s(o �dS [ cyb Dosi ng � . 13 S-W c r j -6 Aeration Bldg. Sewer Holding St 4'Inlet '/. 7y TANK SETBACK INFORM ATION eke-_ f St Outlet I ntake TANKTO P/L WELL BLDG. Air to ROAD Dt Inlet ir Septic 40 17 ' NA Dt Bottom Dosing ^A Header / Man. 9/• Aeration NA Dist. Pipe 1 g /4 Holding Bot. System ��5� 10 l— PUMP/ SIPHON INFORMATION 33 Final Grade Manufacturer De and 54 Model Numb e GPM TDH Lift Friction System TD Ft Forcemain Le H Dist. To Well — 1 F_ SOIL ABSORPTION SYSTEM E RENCH Width �_ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liqui epth MEN I N . 1Z I DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STR EAM LE HING Manu acture . SETBACK CHA ER INFORMATION Type �j Mo el Nu Syst m UC4 I O y '— OR UNI DISTRIBUTION SYSTEM Header / Mani old Distribution Pi e(s) / r • x Hole Size x Hole Spacing Vent To Air Intake Length _� Dia. Length Dia. Spacing - A-5TM v ZZ Z 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: ST. JOSEPH 29.30.19,NW,SE 448 HIGHLAND VIEW C� Af-i • grin - To P'0% wike(W 5 i I l N E C o r h e4-, Plan revision required? ❑ Yes 4No Use other side for additional information. 1c l �8 j7 SBD -6710 (R.3/97) Date Inspect 's Signature Cert. No. V i sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION Po Bo Washin Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 09 A The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. S/y& State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Propert y Owner N e Property Location 114 < Z 1/4, S T , N, R (or Prope y Owner's ili Addresy Lot Number Block Number ' City, to Zip Code Phone Number Subdivisi ame CSM Numb _J ( ) GI II. TYPE U BUILDING: (check one) ❑ State Owned o it Nearest Road ❑ Village Public Eg 1 or 2 Family Dwelling - No. of bedrooms Town of 111. 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.-E] 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 1 1 0Seepage 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: 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) Vea i on Feet Feet acct VII. TANK in Cap llon Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks _Z_+ Septic Tank or Holding Tank 41= El El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the ndersigned, assume responsibility for inst9lgation of the onsite sewage system shown on the attached plans. Plume am . (P t) ) Plumber' Si t o a MP /MPRSW No.: Business Phone Number: 1 - - Plumber's Ac dress (Street, Cl Sat Code): IX. COUNTY / / DEPARTMENT USE ONLY ❑ Disapproved Sa i ary Permit Fee (Includes Groundwater ate ssue Issuing Ag t SI Sta s) A / A roved Surcharge Fee) pp ❑Owner Given Initial, j//� Adverse Determination O �J ' 5 l f X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber I f x s 8 Wei Il k Y 1 A Y i i I w i i I - I Wisconsin Mpartment of Commerce SOIL AND SITE EVALUATION bivision of Safety and Buildings Page of Bureau of Integrated Services 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 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. # APPLICANT INFORMATION - Pl - Print all information. Reviewed by Date Personal information you provide may be use rye `dary purposes (Privag� aw, s. 15.04 (1) (m)). Property ner ) �, ,, �� Property Location Govt. Lot p 1/4 11,S T N,R (orCW,) Property Owner's M ing Address +� Lot # Block Subd ame or CSM# ® ST s City , State i de CPkip�p :: ❑ City P V'llage Town Nearest Road L ` , 1 : v New Construction Use: Reside7rh�l -! l r of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow : :�Z gpd Recommended design loading rate bed, gpd /ft -2— trench, gpd /ft Absorption area required bed, ft ,75 "C trench, ft Maximum design loading rate / bed, gpd4 trench, gpd /ft Recommended infiltration surface elevation(s) 9n ft (as referred to site plan benchmark) Additional design /site considerations n Parent material qL,' 2 'r 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 ® S ❑ U ,® S❑ U 1 JO S E U I ❑ S M U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / y ,2 ,- Ground S' s �elev. Depth to limiting , factor in. Remarks: Boring # 7 0- Z. /f n °G 1 h / 111 / Ground „5 — elev. �s Q�ft. Depth to limiting factor Re rks: CST Name Ple e P ' t_ Signature Telephone No. SS =�L Address Date CST Number G — r 7, 5 rr � I I I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Nvision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 9 ' roix 0 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but F not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or *ED # dimensioned, north arrow, and location and distance to nearest road. en APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION P, 9 DAT PROPERTY OWNER: PROPERTY LOCATION r C Joanne Persico GOVT. LOT NW 1/4 SE +V ,R 19 .(or)W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NA #g 400 S. Second St. 20 na High lan CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN E 0 Hudson, WI. 54016 (715) 386 -9060 1 St. Joseph Co. Rd. #E" [xI New Construction Use bc I Residential / Number of bedrooms 3 [ ] Addition to existing building I ] Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate _,gy bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 100.0 alt. are= 99.06 It (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted Glacial drift Flood plain elevation, if applicabl It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL 1 HOLDING TANK U= Unsuitable fors stem RI S ❑ U ® S El ® S 11 U ® S ❑ U ❑ S ® U ❑ S F U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. ................. .................. ................. .................. 1 1 0 -12 10 r3 3 none s i l 2msbk mfr 9W 2f .5 .6 2 12 -26 7.5 r4/4 none sic( 2msbk mfr 9W if .4 .5 Ground 3 26 -80 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 elev. 1 o ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -12 10 r3/3 none sil 2msbk mfr cs 2f .5 .6 2 `' 2 12 -33 10 r4/4 none sicl 2msbk mfr 9W if .4 .5 U Ground 3 33 -80 7.5 r4 4 none sl 2msbk mvfr na na .5 i .6 elev. 1 Depth to limiting factor +80 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. 4,v4., New Rich nd WI 54017 Signature: Date: 11 -14 -96 CST Number: m02298 r STEEL'S SOIL SERVICE Gary L. Steel Joanne Persico 1554 200th Ave. CSTM2298 NW4SE4 s29- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #20- Highland HIlls second Addn. N 1 " =40' BM.= top of SW lot stake C el. 100' N X 5` 1° 3zi 2 ` i°' �5 t - 7 r Gary L. Steel 1 -14 -96 R ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Z ?1 (� A) Property Address ;� , �' , 4 Z crification required from Plannin« Department for new construction) City /State Parcel Identification Number �2 � -_Lelz /,!:2 LEGAL DESCRIPTION Property Location _,& ' /4, 4 '4, Sec., 2 , T N -R Iq W, Town of < Subdivision zL b // �� _ , Lot #; Certified Survey Map # , Volume , Page # Warranty Deed # _5 l ,7z,ih , Volume / ,2 76 1 Page # 9 Spec house ❑ yes no Lot lines identifiable ( 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 completcd and returned to the St. Croix County Zoning Office within 30 days of the three year expi uo date. ATURE OF APPLI ANT DATE OWNER CERTIFICATION 1 (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 abo , >y v�rtuc of a «•arranty deed recorded in Register of Deeds Office. A PPL ANT 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