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HomeMy WebLinkAbout030-2115-70-000 O v C O v1 n 7 O f1 0 67 ( � I � I m 0 U) m Z O w (n In w° c 1 0 O O m O N CD CL a c A? p, m m i A 0 O N N C N N ? O T. CD O O N N N O- 0 c= N m � O O O CD tc VO O O 4 N C m O A° A� 3 CD O O 7 f%7 N 7 O d A OD O O D CD u y 'A W O N \ C C) CD N N ^ N O O 0 ° o y co 00 < N �. Q CL m O O O o �� o 3 N .. s cr v o N p 'fl o m d i ,i fQ v7 m w I 3 3 m C N A Z O Z co Z p D a _°? N o Cn lr o o D y CD I CD 67 N RYA C (D CD V y a A 2 m a ° z 3 .. W T m ° w rn m (D Z CL 3 A 3 .. Z 0 A N m I F w I 15 m ma � c d m a a j M I=D m T f0 N ? — 3 fD 0 c0 Z O G CD O 0 = O co ur CD N N :E - 0 O fi 0 d O y f7 N cp cD —. N a O (D N w P 3 ° Lo 0 CD p O Z ° 00 Ro ;o rn go Q �O N N 0 N n O 00 = a 00 00 W 0 CD dC 0 y b O C O ST. CROIX COUNTY ZONING DEPARTMENT r AS BUILT SANITARY REPORT P �. I]VE Owner F F P 6 Property Addres ^ T �' ST CRUX + C04JkTY City /State y "IWOr -FM if Legal Description: ' Lot — Block — Subdivision/CSM # - ,66f— %4 ' /4, Sec., TAN -13W, Town of S' PIN # �!e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / Setback from: House -ZL Well f P/L/ Pump manufacturer Model Alarm location i (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width ,��7 Length J �]Z Number of Trenches Setback from: House .-I-/ Well . le. P/L Vent to fresh air intake ELEVATIONS Description of benchmark A Elevation /zZ,? _ Description of alternate benchmark Elevation Building Sewer < 5- ST/HT Inlet 1 ST Outlet 9,Z-2 PC Inlet PC Bottom Header/Manifold 93/l Top of ST/PC Manhole Cover Distribution Lines ( ) Bottom of System Final Grade Date of installatio /_ / ' P rmit nuWber State plan number Plumber's signatur License number �Z24,Qk 3 Dates & / Inspector Complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y' Safetyand Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 3 ,P�rinyt[up.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 44 t 44 tC7 S ENRIoI Mr N GENE r� ! 'M Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: B Description: Parcel Tax No.: TANK INFORMATION ELEVA ION DATA A9800536 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic p �.. ?:..`r ; 'fir: Benc rk 1.7 101,7 bo 7 / Aera on Bldg. Sewer Holding St /.*Inlet -7 t._IC. TANK SETBACK INFORMATION ��T / St /Ht Outlet TANK TO P/ L WELL BLDG. Ai r��ke RgNA Dt Inlet Septic 456 81 �) ' Dt B ottom Dosing Header/ Man. e. 5 9 3 A, Aer ion N Dist. Pipe 2 95 O -1 Holding _ Bot. System R. qa / , y ., PUMP /SIPHON INFORMATION Final Grades 9 � 83 ;,, � Manufacturer emand Mode mber TDH Friction stem TDH Ft Forcemain Length Dia. Dist. To Well S BSORPTION SYSTEM BEQj4RENCH Width Length I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I N [ a DIMENSI SETBACK SYSTEM TO P/L BLDG WELL LAKE /STR M LEACHING Manufacture. --, HAMBER INFORMATION Type Of , er Syste : _ / OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) � x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. % Spacing � I /4STA4 - 2 7rj 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 36.30.20,NE,NE 1284 COUNTY ROAD V t r r l 1 ' .L" r( ✓+ 3 �^ I �. , e a '� ,�,...ff..� �IJ!../l. i �.1: j; 3 /c=-'� ..+ - s+s^ a �°, r / Mn revision required? ❑ Yes [f No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's 49nature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue 14 .4cons i n I n accord with ILHR 83 O5, Wis'Adm. Code P O Box 7302 • Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Perm Numb Personal information you provide may be used for secondary purposes p Check if revisi - on Wprevio s aappplication [Privacy Law, s. 15.04 (1) (m)]. t o State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location 1 6- 1/4 - 1 /4, S T , N, R Vtor) W Property Owner's Mailing ress Lot Number Block Num r i City ate Zip Code Phone Number Subdivision Name or CSIVIT Numbe I. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Ity Nearest Rp ad El Public Z 1 or 2 Family Dwelling ❑Village - No. of bedrooms 3 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 jZ 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 /�s 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: O 1. Gallons Per Day 2. Absorp. Area 3. Absorp. �rea 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Mit�f nch) Elevation t Fe et Feet Cap acit VII. TANK in llo s Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name concrete con- Steel glass Plastic App New Existin strutted Tanks Tanks epticTa M#eldiTiifT�lk ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i allation of he onsite sewage system shown on the attached plans. Plum er' Na : (Pr Plumb !7n No a ps) MP7IVIPRSW No.: Business Phone Number: Pl um her's Address (Stre t, City, t te, Zip Cod IX. COUNTY / DEPARTMENT USE ONLY y�, roved ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin Agen Signat re (No Stamps) A Surcharge Fee) Iii / pp ❑ . Owner Given Initial � Adverse Determination ou X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Jul= s 3 /30 . 05 I r � p JIA 1� C ic'q -sr �'iZ ,mss •i�S3 '.WisctfnsM Department of Commerce SOIL AND SITE EVALUATION Division,of Safety and Buildings Page of Bureau of Integrated Services in accordance with s._4� 1 :�13: Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches i ize�. Ian mu,� �'•,, unty include, but not limited to: vertical and horizontal reference point ( IJfp�i�ecti ( `< "� , S 1'b percent slope, scale or dimensions, north arrow, and location and ce to �'� I I.D. # f�E3 , l we APPLICANT INFORMATION - Please print all info rCnio n. - "'' `" i wed by Date l Y �rr`;vI.X Personal information you provide may be used for secondary purposes (Priv c s. 15.04do#KV le I Property Owner S Loca i Da n. S ka_ct _I_ }� k. 1 /4/(/E 1/4,S 3 (0 T 30 .N,R Z E (or� Property Owner's Mailing Address t _ k/ # Subd. Name or CSM# 3 (p / 4 Wt , ;� 6-1 Le City State Zi ode • Phone Number city El Village ® Town Nearest Road 1 01 Z 7$- Sf SUZz P h i f New Construction Use: Residential / Number of bedrooms 3 - 'q Addition to existing building Replacement - R Public or commercial - Describe: Code derived daily flow 0 - 7 gpd Recommended design loading rate bed, gpd/ft e- _ trench, gpd/ft Absorption area required l ?,CEO bed, ft DUO trench, ft Maximum design loading rate ' bed, gpd /ft _S_ trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations q Z r ZQ V Parent material - ba Gr`a. Q V-- -L j Q S ;1 Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I cgs ❑ U IF ❑ U [Z S U X S E:1 U ❑ S 91 U ❑ S M 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 Ground 3. ( r Y►'I S O S CA YY1. I C -7 elev. Depth to limiting factor Vin. Remarks: Boring # I o -10 r f! Lw o2MA-6 v LCe— C S Z 41 . z /0 3 o ,�iji 61C / -Yo8 a r 6 m U Vri l c s, - 7 — Ground elev. *00— ft. Depth to limiting factor 0—in. Remarks: CST Name (Please Print) Signature Telephone No. Ada w\. Sc k U WVa. -Qe - ZY Y Add ess Date CST Number I 747- Ile a .0 E 3U , zw� w . i rri l e It • /oo.o l "'.5 le N ku l3m2 eleu• /cb,o na,'l .� /y l s�sfeyn 2lev• q Z � �1,v d ry t-o J' a3 / � I ` 1 V � _ kZ r A f cl 1 1 GCT -09 -98 10:02 PM BELISLE EXCAVATING 713247303e+ P.01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �01- , �l'�rI,2 /�,r✓ Mailing Address X-2 9 C oea/• Property Address // (Verification required from Planning Department for new construction) City /State AA i Ck& • Parcel Identification Number LECAL DESCRIPTION Property Location 1((� 'h, ,A/� ' /., Sec. ,��, T& ,XL W, Town of Subdivision , Lot #. Certirled Survey Map # , Volume , Page # Warranty Deed # 3 �Zq 1 , Volume Page # Spa house 0 yes 9 no Lot lines identifiablexyes O no INTENANCE 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 std by a master plumber, journeymanplumbet, restrictedplumber or is licensed pumper verifying that (l) 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 Departmxnt of Commerce and the Department of Natural Resources, State of Wisconsin. Cartiflestion stating that your septic system has been maintained trust be completed and retumed to the St. Croix County Zoning Office within 70 of the three year piration date. SI 7VRE F APPLICAW 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 ownet(s) of e property described �bovc �byvir,;eof a wa ranty deed recorded in Register of Deeds Offict. � r r9 g � 4SIA : TURB OF APPLICANT DATE "••'• Any information that is mis- mpreaented may result in the sanitary permit being revoked by the Zoning Depattanent. •• include with this application. a stamped warranty deed from the Regis!er of Deeds office a copy of the certified survey map if reference is made in the warranty teed SCALE FOR QUARTER SECTION Each side large blue squares= 10 chains, 40 rods, 660 feet; area of square 10 acres. 400 Ft. 1 Inch Each side small red squares =2.5 chains, 10 rods, 165 feet; area o square .625 of 1 acre. Nw -NE< N Nt 'NE rl . Lg,ti6' WA if (>3 (a (S Ito j c I 34 6 a 6 Ile. .4 P ` -- i — i LlarlsoN o led 11l..wT42;fi :- -- -, — - - -- - — — -- 'i f !a •r i I � , � ! I �'t 1 72.7 N Z i b 114 I -_ 6 0- k �,Itz q �► int 1' ! f G b 1 OB \ I Of 4►D s I _ I tt�A/ S4 y A/i 13� ;I i ctl, I i --� - -- 3 1 y - -- r — —T -- -- woi/ 5 �I - =- a a 3Ceei VA IJ SCALE FOR QUARTER QUARTER Each side large blue Males= 5 chains, 20 rods, 330 feet; area of square 2.5 acres. SECTION, 200 Ft.•= 1 Inch I Each side small red squares =1.25 chains, 5 rods, 82.5 feet; area of square .15625 of I acre. • p PRONTO LAND MEASURE 20 -40 MAP SHEET PRONTO LAND MEASURE ;IY cODVright 1967, James Hamilton Adair, Flint, Michigan < n ✓ 4� t {• ^— G i 1� Nli - 1 a ,- r� nira . ti y LC g a,! >.: P -� V I't �'•` �t s tn �e pill 00- 9 s n r „ 7 4 � a xw' I •ylt W es . . QD Z I mow. a 1 r '.- . S�. .+• �"°°'e w�.mon�+'�w..s..m�i"' t' " .,.: Al y .. R .n'°` ,y �.,�..��, �a q a '+ki���. f s•°w'+N?!a�' a P �. xti: �"!`•tx �M �..0 � 4. � _y �� � Y .'-.,4 _ � M,v �Ha*" �'+a+�NW + w�4wA'°F. � 3 � � � . .yYrn[4'... ap.,. i ✓�',;,�"..- N!' f � � ,�` �,: t` "�.' hY,'kn g p yP.fW ,A ,1 "..# } t �F• `,,a..�.b- $,•. ' � ' 1 c �'� t':�y d "` ' �`� -'�' �, .� w . y `g � "',�'� ".Mx � ;�. .-.p � ..: � i t } r 1 � t *� d .l- > J �"..•. YP V. .,. - .�°°^ J-+ 4 - � i - Y p p 4 � b '�� o �, -, 1, y '`+' `. *e'iT ;�{S �' ._•.., ;.., *{+,+ ', 1.:8• "`r- .: �' f t { ! - <'f+A� f ,,y, !'�. , +,u. , - i,5 7i..M��� :winM :..r, � ti �k �� � , YF Div � ' �. ., ,�, :. � Its .ap, -"� `"�• ,,y,,i r- 1 ? �;T"'1 f "��.: F i 1 ' ' . M•. �.../ ++ ,�'`" -f "'� :�''(" , p X h ti. xy. 7p e +� ail 1 { , 1 � i� Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling Code, soil erosion control informa- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking (✓) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = feet EROSION CONTROL PLAN ell A LEGEND PROPERTY LINE G _ _ EXISTING ' DRAINAGE 1 -+ TD TEMPORARY DIVERSION FINISHED -' DRAINAGE LIMITS OF r 1 GRADING SILT Al FENCE STRAW BALES t - �• ' ` _ GRAVEL O VEGETATION SPECIFICATION 1 4 - ® TREE PRESERVATION ST OCKPILED a Please indicate north by completing the arrow below. r, —N— I PROJECT LOCATION BUILDER / `fir -6 ah N©wes OWNER ��✓I e �� WORKSHEET COMPLETED BY �I' `C(.lA �y�� DATE-