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HomeMy WebLinkAbout030-1099-60-000 ST. CROIX COUNTY ZONING DEPARTMENT ^\ AS BUILT SANITARY REPORT REC�lVED '. Owner f AI�,��i �L L i Q T - JUN '^ g Address ST CROIX City /State -- 1 &0 S ©,v P _ Yoi6 s COUNTY ZONING OFFICE Legal Description: Lot Block Subdivision/CSM # ` '/. — V' /, Atii', Sec. IL , T.ON -Rj1W, Town of S7, r7Df gD.# PIN # 030 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer LV G e A,',s Size ST/PC Isool goo Setback from: House A q Well /Oo PAL Pump manufacturer. 2.,a gFt.L Ei2 Model &y /3 '7 Alarm location 1A_ /feu s,5 ONLY) Setbacks: Service road esh air intake Wat Meter location Ala SOIL ABSORPTION SYSTEM Type of system: TiP Width _— Length 5 L Number of Trenches Setback from: House VP Well loo I P/L yo _ Vent to fresh air intake ELEVATIONS Description of benchmark ro p o F nu •r S / n f,--r ,LCA ae- `r Elevation Description of alternate benchmark & ai C/°rr ,Dooi2 Elevation 96.7 Building Sewer _ ST/HT Inlet �0 . ST Outlet 90 , .5 3 PC Inlet 9 0 , 3 ? PC Bottom Header/Manifold Top of ST/PC Manhole Cover 700 1/0F/ Cr1?Aj01L Distribution Lines ( ►) 9, r ,Z 7 (2) �,� „z 7 ( ) Bottom of System (r) C13 y (2) f-1 5 ( ) Final Grade (() _ 22 (2) 2 ( ) Date of installation 41 /D Permit number 30 3 State plan number /14 Plumber's sig a re License number ,2 Z/7 c// Date 61/Y19�' Inspector ' A 04 J C ('otmlete plot plan r ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division y ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita`18"bNy.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)]. Permit Holder's Name: t Town of: State Plan ID No.: ILLIQUETT, PAUL n S''�. 969typ CST BM Elev.: Insp. BM Elev.: B Description: Parcel &Jb0.'1099 -60 -000 i� too Sy TANK INFORMATION ELEVATION DATA A9800183 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e .W e, L 0� Benchma j.0 /p /.D 1070 osi n Aeration Bldg. Sewer Holding no, Inlet 0.55' !1.'73 TANK SETBACK INFORMATION S&*Outlet �p ��' 2 9- 5 3, TANK TO P/ L WELL I BLDG. Air I ntake ROAD Dt Inlet i Air NA Dt Bottom osin NA Header /Man. 5 67 Aeration NA Dist. Pipe 5-77 GJS Holding Bot. System 7 23 3. s PUMP/ SIPHON INFORMATION Final Grade $ q Manufacturer �� f �� -Demand eis '5 ZS 47 7 Model Number 37-1,pM PC L ?- Yy 7 TDH Lift �, Lriction ) System ® TD ,�� Ft Forcemain Length 1 Dia. H a Dist. To Well s• SOIL ABSORPTION SYSTEM BED / R NCH Width Length o No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 3 -� �- DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typeof CHAMBER t Mo Number: SystemeAl OR UNIT DISTRIBUTION SYSTEM Header/Manifold t' Distribution p x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length b� •9rar Spacing � h Y Je !M G I 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 Q`Ifr Bed/ Trench Edges To s Yes ❑No E] Yes o COMMENTS: (Include code discrepancies, persons present, etc.) t Z.4 " -5.-74- LOCATION: ST. JOSEPH 33.30.19.358B,SW,NE 552 CTY RD E j0 133 r (Z4�� Plan revision require? equire ?' ❑ es No Use other side for additional information. o 1 ' 7 9D 6710 (R.3/97) Date Inspect- Signature ert. No. V i sconsin P.O. Box 79 SANITARY PERMIT APPLICATION 201 E w sn ve Si °° 69 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 ' 54. 6vo x than 8 1/2 x 11 inches in size. ! • See reverse side for instructions for completing this application State Sanitary Permit b The information you provide may be used by other government agency programs ❑ Check if revisiont previous applica� [Privacy Law, s. 15.04 (1) (m)]. s o, rnC State Plan I .D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property O ner Name Property Location elL G 5W/4 ` c 1/4, S T , N, R E (or Property Owner's Mailing Address Lot Number Block Number A• City State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned It( Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _ 3 Town OF t A III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) M - 3 0, /'7- 1 E] 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 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit �Z) W 1 S7 r 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) Elevation 3, 7 Feet Feet Ca at VII. TANK in g allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete C ° " steel glass Plastic App New Exist in structed T nk Tanks ❑ ❑ ❑ ❑ ❑ L -- -- o o ❑ 1 ❑ � E] I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewa e s stem shown on the attached plans. Plumber's Name: (Print) L Plu er s Signature: (No S a s) APRS N Business Phone Number: P umb J e M rs d Address (Street, City, State, Zip Code): IX. COUNTY/ DEPA TMENT USE ONLY ❑ Disapproved Sanitar Permit Fee (Includes Groundwater D ate Issued Issui ent Signature (No Stamps) Approved ❑Owner Given Initial Q� /` �b Surcharge Fee) a 7/ � � ` Adverse Determination UU �-t0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 8 (PLtt196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber a - 97 z 36 ` S /D iv ymo S / N Ff L 711A Tog 5 J`NF/i -MA 70/15 6y Z - 3X.7 7 ` /NF /cTR R 70,E TfFLNclle.S D Soo a - n e a �xrs��rw nay Cu��� F^l�E� �.3 r0O0 GL. Sr. �cc.kg �JEt -L Exrsl iN� '3IDA �puS (3rj l Top oAr oa7SAOE FA4'c &T Q EL = /DD• D AGT� ff�l. e p-- CA47 s4A13 C 1- Rb )5AAwllver fd2 ' s -z 2- q8 DRAW 13y Pigul- 569 Gi y 10 9 � 8� 61vG e-ex drew 7 �lW asoN, cUr`• �yo /� �'orr�� GUS'• syazs - 217 y/ Wiscongin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisiortnf Safety & 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 St. Croix not limited to vertical and horizontal reference po (BM), dire ' and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and ace to near 030 1099 - 60 APPLICANT INFORMATION -PLEA NT�pL4�NFOR , N REVIEWED BY DATE N h� PROPERTY OWNER: PROPERTY LOCATION Paill W 1 Q3 t - T i GOVT. LOT SW 1/4 NE 1/4 33 T 30 ,N,R 19 9(or) W PROPERTY OWNER'-.5-MAILING ADDRES t LOT # BLOCK # SUBD. NAME OR CSM # ST CROIX na na na CITY, STATE ZIP C P [ ❑VILLAGE [MOWN NEAREST ROAD Hudson WI. 54016 015 549 -6 Co. Rd. " E " [ New Construction Use [x] Residential / of s 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 93.90 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem [N S ❑ U PC ❑ U ®S ❑ U ®S El U ® S ❑ U ❑ S ® 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 Tmnch 1 0 -8 10 r 3/3 none 1 2msbk mfr cs 2f 1 2 8 -35 10 r 4/4 none sici lcsbk mfr Ground 3 35 -45 7.5 r 4/6 none ms OS mvfr elev. 9 7.1 ft. 4 45 -84 7.5 r 4/6 none cos OSQ ml na n �.8 Depth to limiting factor +84" Remarks: Boring # 1 0 -12 10 r 3 3 none :5 .6 <' 2 2 12 -28 10 r 4/6 none sici m na aw Ground 3 28 -35 7.5 r 4/6 none fs Oscf mvfr CrW na .5 .6 e 4 35 -84 7.5 r 4/6 none ms os ml na n 9 9 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200t e. New Ric and I 4017 Signature: Date: 9 -24 -97 CST Number: m02298 STEEL'S SOIL SERVICE Gary L. Steel S33- T30 1554 200th Ave. CSTM2298 Paul w33 N -R19W New Richmond, WI 54017 MPRSW 3254 SW4NE'a town of St. Joseph (715) 246 -6200 f N 1 =40' BM.= top of outside faucet C el. 100' Alt. bm= top of cement slab by garage door C el. 98.70' ti t `1r v 0 70 ^ F` C J 4V 4 TO �ri Gary L. Steel 9 -24 -97 Z °ip , �� • PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS V T CAP - T 1'C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIMG JuWCTI0IJ e0X MAIJHOLE COVER �: 25' FROM DOOR, 12•MIU. .IIWDOW OR FRESH AIR I u TAKE I GRADC 1 y' MIAJ. I �. Ie• MIIJ. COWDUIT -- ---- - - - - -- PROVIDE -- IWLET � AIRTIGHT SEAL APPROVED JOINT A I III APPROVED JOINT w /c.z. rlPC I III W /C.=. PIPE I I I ALARM EXTELIDING 3' EXTENDILI& IrE 3' O I II ONTO SOLID 1014 NTO SOLID %OIL e I I I I o c I I I LLCV. FT. PUMP --_ _ -� OFF r D COWCKETE BLOCK 3" APPR&- RISER EXIT PCRMITtEO OWLy IF TAWK MAWUFACTURE.R HAS SUCH APPROVAL scoop SEPTIC E SPEC.IFICATIOKIS TA MAMUFACTURER: 1..+.�,�1'S 'A1 12er WUMBER OF DOSES: PER DA4 TAWK 51ZE : ©� GALLOWS DOSE VOLUME --7 ALARM MANUFACTUKLR: /VX / &A? IWCLUDING OACK►LOW: � 0, ,C GALLONS MODEL WUMBER: ,NA CAPACITIES: A= 17 OK 3AL Y GALLOU5 SWITCH TYPE: 1`;I�/? C � g = _ Al IWCNES OK � f 4LLON5 PUMP MANUFACTURER: -L C- _{p� ILJCHE5 OR 151 fO CA LLO US MODEL IJUMDER: 132 D - /2 INCHES OR .1d,11 GALLOWS SWITCH TYPE: 176'/fCuAy MOTE: PUMP AUD ALARM ARE TO BE MIWIMUM DISCHARGE RATE 32, VV GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEICEM DETWEEW PUMP OFF AU0.0I5TRIDUTIOU PIPE.. - 1 - FEET t MINIMUM NETWORK SUPPLY P�KESSURE . . , , . . . . . . . _ FCCT + SO FEET OF FORCE MAIM X � j6,2- F YottFRICTIOU FACTOR. 31 FEET TOTAL DyWAMIC. HEAD = FEET 1 W) i IWTERWAL D ►JSIOW� OF TAWK: jA/5/n46i 02A ,_90 ;LIQUID DEPTH 3-7_ SIGNED: f LICENSE WUMBER: 217 Y� DATE: -_ - N TOrAI DYNAMIC HEAD /CAPACITY _..1 A MINUTE to HEAD CAPACITY CURVE EFfWENT DEWATLRINC If MDDEL 13P39440-4114 Mooccs MODELS 137/139 140 /6140 rt - M0ta7% COI. Llr6. COI. Mrs. D 12 as 110 i0% 76 7f4 40 NI _ 1 40,414 0 1! 4!r 64 142 63 314 3a- 70 6.10 76 136 73 276 t 7% u7 6 30 53 236 1 1/2* - 11 1/2 NPr 30 - - b 6 14 - - W 20 f 7 _ __ f e t Q/'11 its N 41 47 1q __ tj IN No 114 t� 6 7a• u' 1 i I 10 E Q 10 1 I FF 2 BK37S a A B C D WS 1371139 4 314 7378 8118 4 4 M u's. CAL. DNs 10 z° 3o ao ao eo 7o Bo N 1160 110 140 4314 S 5118 813!32 4 LITERS Bo 160 240 320 400 FLOW PER MINUTE 4140 4 4 8 5501 81313 4 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 2001208V or 230V - 1371139 Models. ' Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. ' Double piggyback variable level float switches are available for variable level • Mechanical alternators, for duplex systems, are available with or without long cycle controls. alarm switches. • Long cords are available in lengths of 15- 25.35 -50 feet. (Maximum 25' length • Combination starters are available for 3 phase pumps, for 14014140 models @ 1 f 5V) • Control alarm systems are available for 1 phase pumps, • Over 130'F. (54 special quotation required. 137 Series - 47 lbs. 139 Series - 51 lbs. 140 Series • 53 lbs. 4140 Series - 73 lbs. • Refer to FM0806 for 200' F. applications. si ftakeseal I Control Selection I Listings Model Yolks -Ph Mode Am Si mp hx Du = CSA UL M1371139 1 15 1 Auto 11117 1 1 or 16 8 Y Y SELECTION GUIDE N1371t39 Its 1 10.7 2 or 2 6 7 3 or $ 6 6 Y Y I . Integral float Operated 2 pole mechanical switch, no external control required. 113 115 1 1117 2 - Y Y 2. Single piggyback variable level float switch or double piggyback variable level • 01371139 230 1 Auki 5.8 1 or 1 &8 Y Y float switch. Refer to FMO447, Et 7 t i Non 2or2&7 3or5&6 Y Y 3. Mechanical aflemator'M-Pak' 10.0072 or 10-0075. • k48.O t 5 1 6 e - N 4. COmbinelitin Starter. Refer to FM0514. • n371t39 t "' 11; 5 2 a 7 3 or 5 6 B Y N 5. See FMO712 for correct model of Electrical Alternator 'E -Pak . J1371139 3 Non 2.6 2&4 361 or 586 Y Y g Variable level control switch 10.0225 used as a control activator, specify duplex F1371139 3 Non 2.8 2 6 4 364 or566 Y Y G137 3 Non 1.4 2 64 364 or 568 N N (3) or (4) float system. G139 3 Non 11.4 264 361 orS68 N N 7. Four (4) hole `J - Pak', Junction box. for watertight connection or wire" simplex or 2 pump operation, 10-0002. 14014140"' MODELS Control selection L 8. Two (2) hole'J - Pak', for watertight connection or spill 10.0003. Model Model Voft *h I Made Arim Sirnplex DuPWx CSA UL N140 N4140 Its 1 Non 15.0 2or267 3or566 4NN E100 E4140 230 1 Non 7.5 2or267 3or566 jffjfi 1 1 N 7. 67 6 BN140 BN4110 115 1 Non 15.0 2or267 3or 68 CAUTION NP mokMd Pw9 " SVIO Pgarm41 raft Indlic" - AN installation of controls, protection devices and wiring should be done by polals,selo.iotamavall e1. W1B, o, aileolilmoawnsainscimS ealF e+;wicamr1o11s11eftrinNEMAIorNEW4x a qualified licensed electrIcian. All electrical and sataty coda should be meted Pill". PurtlpsmustbeoperatadinuprigMpositbn. followed including the most recent National Electric; Code (NEC) and ti Occupational Safety and Health Act (OSHAI Three phase units require a caebol swilch to operate an external magnetic or Combination saver. For Wonnation on additional Zoeller products refer to catalog on Combination starter, FM0514; Piggyback varisble I "FloorSwitetMs. FMO471: Electrical Aftemalor.FM0486; MechanicalANema- tor, FMO495: Alim Packape..FM05 /3; and SuMOSewage Basins. FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAN. T0: P.C. BOX 16347 Louisville. KY 40256.0347 �ZI � SHIP TO: 3649 Carle Run Road Louisville Queen . KY 402r1 -1961 Pu F� was SMS PUMP �D (502) 7782731 • r (800) 928 -PUMP fAX(502)774.3624 M RM F i i W V ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the l b i aaL 7 r residence located at: l/ 4, sec. 33 T_3&_N , R __L�_ , Town o f Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes -'No (if no, skip next line) Approximate volume or length of time: ? gallons minutes Capacity: Construction: Prefab Concrete X_ Steel Other Manufacurer (if known): Age Tank (if known) : /4pP1?0,K /7y,45 (Signature) (Name) Please Print tmk (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06 Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tangy condition, I certify that the tank to the best of my knowledge wil. conform to the requirements of ILHR -83, Wis. Adm. Code (except fo: inspection opening over outlet baffle) Name , Qj`/,e},i,ti )2CAK `��TT Signature - — MP MP 5/88 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM w PaAA --t p Lb V ( [ ' O nerBuyer V V I I (� Mailing Address 55 0� \ y` E Property Address 5 0 -fL Q 0- d U (Verification required from Planning Department for new construction) City /State 4 t,) Parcel Identification Number 0 — O LEGAL DESCRIPTION Pro Location �� %. IV , P�tY , � /,, Sec. T ;y N -R I � W, Town of & Subdivision i2Z , Lot # Certified Survey Map # Volume . Page # Warranty Deed # Y 5 VX Volume 3 Page # Spec house ❑ yes *no Lot lines identifiable ❑ yes no SYSTEM MAINTENANCE Improper use and mamtenanceof 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 owns agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, Journeyman Plumber, restrictedplumber or a licensedpumper 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. 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three year expiration date. —V0j �'Im� SIGNA OF APP 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 thellropertyde dbed above, by virtue of a warranty deed recorded in Register of Deeds Office. 5 / StGNAMM OF 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