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HomeMy WebLinkAbout030-1085-50-000 0 .. O m m n d Ot O C w 7 n 3 O 'O N � n 0 O N n C/) ' ' , O W ( 7 O y O u O c • a o s Q M* C O a m m � m o w c N o a R AAA =0 �� �� n Q� a � , 0)I o a p -� V � .Ni C O O O1 n cn D A a 0 a m Iz II � 3 E. ° m OD 0 V O ° m o m a ' m y ao co O c N 3 Q o I :2 I ao oo� < w z a v� o D N 00 O CO N .► ! (D fG L d N W N 3 m 0 Q _ o N o z ?° zcoz p n n' D a � O to a m y �• C CD C (OD N W C. z (D N C. A C O. W V C,) O d z o' 3 O z 0 y m m A I a � 3 CD I� o' v c o a m z O I I I � i a: I I � I � N I b ii I tea, O b O � b 6O 0 ti CD O o CL ti y � 9 s 10 JUN 17 (^ 2819 � f E� P��ec °i SURVEYOR'S RECORD � �1,CcolxC S983i7 CERTIFIED SURVEY MAP Paul R. Schauer Part of the Southwest 1/4 of the Northeast 1/4 of Section 30, Township 30 North, Range 19 West, Town. of St. Joseph, St. Croix Count Wisconsin. OWNER'S ADDRESS — NORTH 114 CORNER 24468 DANIEL JOHNSON RD. / ' SEC. 30, T. 30 N. R. /9 W. SIREN, WISCONSIN 54872 / ' (FND. 8£RNTSE/v CAPPED MON.I I BEARINGS ARE REFERENCED TO / THE SOUTH LINE OF THE NE 114 I OF SECTION 30, T. 30 IV, R. 19 W, ASSUMED AS S B9 °53'36 "E. \. SCALE IN . FEET 1"--200 J L m � N O SO /00 200 400 �1 o, Dated: January 11, 1999 N c' h ?`./mil tul r Ntu NI ,// __ Ai jai Ni I �. i 1008.17 / 5701 / i , c �� ?��, g. M• ELE� 9j.74 689.78 v ;/� N 75 �~ 318.39 / iE LE✓ LOT 4 m (ELE✓ 76.0 70.9 B/ 8/98) C4 � POND 8/28/98) 4� 7 5 ' 1 (M y CONTAINS 278, 392'SO. Fr.. �.; LOT . 1 W to / OR 6.391 AC. CONTAINS1-96,963 S0. FT. p OR . 4.522 AC. w o ,� (V Jr t. �j mJ h WELL (ELEV. 82.8 y o = $ ,y jl E l O 3 p HOUSE 8 /2B SEPT /C m S/ �� 4 6� , /0p W114 SEC. 30 N M 3s� DRWY. _ � ; ENTS T. 30N., R. /9W. • ❑' (FND.BERNTSEN O �. `9" C S'HEO (8. M. 8 POND + ' CAP /N CONC.I C e N i 0 4. Po NO V. EL 12118/ 0 1 p Q 3 �,�'I £LEY 79.0 `l 9 I EAST 114 CORNEA N'LYR /W C.TH. "E" POND �p (5 � A SEC. 30, r. 30 N., R. /9 W. NOO'20'3B "E _ 1S 3 5 .8 N "E (FND. BERNTSEN CAP /N CONC.) 64.13...'.` ��, , _ 7 Lt. S89• 53'36 "E � 8/7.86 - �y R SB9.33'36 "E /9'- SOUTH - L /N NNE 114 2'332.44' C - S 89'53'36 "E P629.051- _` (R- SB9'/ ?'26"E,SB9'36'30 "EI � � •„ /5/ �j � r, (R= 589.46'/2 "E a L` /r � S ' � LY R /W C. T, H, "E ' °, �' e& ID C114 i r r SEC. 30 T. 30 N., R. /9 W. =`_�_ ✓ (FND. A ERNTSEN CAP /H CONC.I i� 7 yn ST. CROIX COUNTY ZQP, 13 �r f' ' ? AS BUILT Owner Address x`)98 �— City /State ` ' 1q sr cROI ST C ROIX r CrJUw — Legal Description: ,;�; zcINlraoa <lu: Lot Block Subdivision/CSM # - �.� Y 'y ' /S(.-,) '/, LI Sec,3 d , T3Cl_RLW� Town of PIN # (:Q ,?, SEPTIC AN -- DOSE CHAMBER -- HOLDING TANK INFORMAT N: Tank manufacturer —�� Size ST/PC Setback from: House � Well _� Pasob 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: � l 1 Type of system: Width 9 12 / Length � � Number of Trenches Setback from: House Well Z -J Z P/I,, Vent to fresh air intake ELEVATIONS: Description of benchmark Elevation Zaa Description of alternate benchmark i Z, Elevation / Building Sewer "o2 - Inlet ' XQ ST Outlet 42. � � PC Inlet PC Bottom Header/Manifold / Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Da to of installation/ / Y ermit number - S State plan number Plumber's • nature License number e2S a' Date Inspector Complete plot plan a . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal info rmation you provice maybe used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 320205 M A K N PAUL ❑ C t JOS�PH Town of: State Plan ID No.: CST BM Elev.% Insp. BM Elev.: BIV�cription: Parcel Tax No.: � I pp lo �� , 030 - 1085 -50 -000 TANK INFORMATION 0 ELEVATION DATA A9800393 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e �Q� /ODC7 Bench ZD /D / zp boo Dosing Aeration Bldg. Sewer Holding St' /. nlet TANK SETBACK INFORMATION /,% e0l. a St W_autlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic �pQ �p / NA Dt Bottom Dosing A Header / Man. P //, 7� Aerati n Dist. Pipe fl. 9`7 37 Holding Bot. System IZ.7a a 6 ' Z ) PUMP/ SIPHON INFORMATION Final Grade Manufacturer Dem d� (?b Model N er GPM TDH Li Friction System TDH Ft J. C> Z_ m Forcemain I Length la. Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 DIMENSION CHA SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI anu ac �l INFORMATION Type rD� I / � OR U ER Mode mber. Sy st m Ue h DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) „ x Hole Size xHole Spacing Vent To Air Intake Length —(a— Dia `f Length —I—/— Dia. Spacing 14 ,j /- l 0,77-9 / C/O 7�_ 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 30.30.19.310B,SW,NE 350 COUNTY ROAD E e ' Plan revision req �i red ❑ Yes, IV No Use other side for additional information. I C SBD -6710 (R.3/97) Date Inspector' ignature Cert. N Vi scons i SANITARY PERMIT APPLICATION 20 Safety and 1 E. W shnlgtonA erosion n In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County /J , than 81/2 x 11 inches in size. 1 (. Ir& k • See reverse side for instructions for completing this application State sanitary Permit Number 3 LO 7, 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 n �'Y1 /? W i �-i State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION �– Property Owner Name Property Location is 1i4, S T a, N, R� E (o W Property Owner's Mailing Address A � Lot Number Block Number `, City, Sta Zip Code Phone N tuber bdivision Name or CSM Number owi �. s (1st /3 30 o II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Near t Road C] Vil age Public r 2 Family Dwelling - No_ of bedrooms Town of 111. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) 3©• 30. ! 3/0 0 3 0 1 E] Apartment/ Condo 9. ('� 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 online B, if applicable) A) 1. ❑ New 2. pIacement 3. E] Replacement of 4_ E] Reconnection of 5. ❑ Repair of an ------ System ________System _____________ Tank Only______________ Exist IgSystem ________ 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 11fij6eeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 1 Z, X qq 42 E] Pit Privy 13 E] 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 Req it d (sq. ft Pro oseed (s . ft.) (Gals/d sq. ft.) (Min. /inch) EI atiory .�� - oFeet 1 0 Feet Ca acct II. I NFORMATION in gallon Total # of Manufacturer' Prefab. Fiber- Exper. Gall Tanks glass Plastic App New Exi s Name Con- steel Gallons Concrete stin structed Tanks Tanks Septic Tank Mk�k El _, 2_e , 0, 11 ❑ 1:1 Lift Pump Tank /Siphon Chamber I ❑ 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) Plumb gnature: (No tamps) MP /MPRSW No.: Business o Number: I ber's Address Street, y, at , ip C de): IX. COUNTY / DEPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date I ssued Issue Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination © 1 to �.� X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 1✓k� 4t sls-k h pe'. CGk- r• 1 P V /r� SBD W (FIL 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber li PLOT PLAN PROJECT Paul Schauer ADDRESS 350 Co Rd E Houlton Wi 54082 SW 1/4 NE 1 /4S 30 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MFRS BYRON BIRD JR. 220527 DATE 8/26/98 3 BEDROOM CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 128 BED SIZE 12'X94' BENCHMARK V.R.P. Top of Window ASSUME ELEVATION 100° ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89. Alternate Benchmark Base of Siding @ 100' VENT Well 12" GRADE Alt. TYPAR COVERING t �* B.M. 8' 30' 4 12" 3' 6' 0 3' E xisting 3 SEWER ROCK 42' B edroom H ouse 30' *B. 0 30' 5' c JB- a. T Old System to be Buried � T Overflow 70' 300' 1 I I 5' 18% 12' X 94' Bed I B-2 Slope I 18% I Slope I 5' I I -1 Vent 500' Property Line 1/uisconsm 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 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plaq, nust County include, but not limited to: vertical and horizontal reference point (BM), Ke Wjdn anc+ _.�; ` r ✓ Li/U /� percent slope, scale or dimensions, north arrow, and location and dist�nce'to nearefttdstd _ ; Parcel 1. . # APPLICANT INFORMATION - Please print all inform r ' evieWl�>I'by Date � _,x Personal information you provide may be used for secondary purposes w .15.04 (1) (1 f "UJhJ (Privacy L Property Owner PraNt�!Ciie�ftbbn 1/4 1/4,S_ T Q ,N,R E (Or W Property Owne s Mailing Address tei #' Block #,,- Subd. Name or CSM# G City State Zip Code Phone Number Nearest Road 11 ❑ City ❑ Village 2TT wn o "'2 �0 (,7/3 ' 6VX a �i Go - ❑ New Construction Use: NResidential / Number of bedrooms Addition to existing building W eplacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/f !i� trench, gpd/ft Absorption area required bed, ft 2 —,tt:g�' trench, ft Maximum design loading rate bed, gpd /ft r trench, gpd/ft Recommended infiltration surface elevation(s) �• ft (as referred to site plan benchmark) Additional design /site considerations Parent material a ` Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank = L Unsuitable for system ZS ❑ U .Q S ❑ U A S El � S ❑ U ❑ S U ❑ S U U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots .......................... in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ........................... ........................... .......................... es" Ground �/ /Y» 1' �l� elev. Depth to limiting fa oy ,7 win. 3 Remarks: Boring # / ,_3 2- 5 C Ground Depth to limiting f �in. Remarks: C ame (Please Print) ignature Telephone No. Address Date CST Number -.25 15,2 Soil Test Plot Plan Project Name P aul Schauer Byron rd Jr. Address 350 Co Rd E Houlton Wi 54082 CST #220527 Lot ------ Subdivision -- ---- --- -- Date 8/ 2 6 /98 SW 1 /4NE 1/4S30 T 30 N/H 19 W Township St. Joseph Boring ()Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft.Top of Window System Elevation 89.0 * H R P S am e as Benchmark Alternate Benchmark Base of Siding @ 100 Well Alt. B.M. 8' 30' E xisting 3 42' Bedroom ouse 30'B. 0 35' 0 90' a � T Overflow 300' B- 12' 5 ' 18% Slope B -2 18% Slope 5, -1 00' Property Line ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNE CERTIFICATION FORM Owner/Buyer / d [.� J� J G ti, u -t V Mailing Address I � ' gK Property Address 3 S' C %t kl �/ (Verification required from Planning Department for new construction) City /Stat du JZ h W T- SyDQ Parcel Identification Number _ j 1© LEGAL DESCRIPTION Property Location ' / <, Sec. T N -R W, Town of ���_ �,Td S f�° Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed ## Lt 3, � 'T`6 , Volume , Page # 3 `l fL Spec house ❑ yes W no Lot lines identifiable t` 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. 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 statin t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 W of a three yea ex iration date. 0 SIGNATURE 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 pr erty descri d ove, by virtue of a warranty deed recorded in Register of Deeds Office. &jg , ' rzi-/ SIGNATURE OF APPLICA 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 G I �. 230.51 > 7D - W I w I I r �n �1 W t `N O �i D co ►N ,3 Old � I o _ ° O -_� N m I Ln ao C _ oL 9 j Y� I. w W - � � I �N r I W C — co — Im I I