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HomeMy WebLinkAbout032-2038-20-100 ST. CROIX COUNTY ZONING DEPARTME ' AS BUILT SANITARY REPORT �o Owner f �- Address a IV) City /State Y '�T �'- ' Ic Legal Description- Lot c _,2 Block Y ,/ I l Subdivisio CSM # y 5/ _ - a %, '/, ,N «% . Sec. �, T.ILN_R,& W, Town of _ ��s�� PIN # SEPTIC TANK -- D OSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer / ` - Size ST/PC / Setback fro Pump manufacturer m• House 7. Well l�7 P/L Model j,) , ,o V/ 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: rEa _ & Width �_ Length Number of Trenches Setback from: House Igs Well 2�14 p/, Vent to fresh air intake t /eg ELEVATIONS Description of benchmark Description of alternate benchmark Srp� Elevation_ ��° / °� l'�� ® - `� // Elevation ir9 � g Building Sewer y ST/HT Inlet ST Outlet /ice yJ PC Inlet PC Bottom Header/Manifold _ 1 1 Y8 Top of ST/PC Manhole Cover 4,11-, Distribution Lines Bottom of System( Final Grade Date of installation 2 2-/ I-22 P rmit number `�7 d& State plan number S 97 - 7erl� Plumber's signature ! License number 1 � � � Date Inspector 1 / - 1 1 , o „ Complete plot plan * -7(f ' Wisconsin Department of Commerce PRIVATE EWAG �5Y5 y= Safety and Buildings Division $ County: . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3U Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)). r�iq;der�le: 1 Lfity_Aue Town of: State Plan ID No.: CST BMElev.: Insp.BMElev.: BMDescripti 1 ParcelT�XND_2038-20 -100 t oo 10 uV o��tU -� I 3L TANK INFORMATION .e Qr`r -e, ELEVATION DATA A9800056 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic h f 1 2 ob Benchmark a • •� 3 /0 v Dosin g �QUU 0 A , ! 1 i >� Aeration Bldg. Sewer S ° 11 � S7— Holding St /Ht Inlet 74 12__�j TANK SETBACK INFORMATION St/ Ht Outlet 77 f /'J-- TANKTO P/L WELL BLDG. vent to ROAD D let Air intake �0 ' T Septic 1 2� it✓ NA Dosing i 1 ' ` NA Header / Man. 104, 80 Aeration Dist. Pipe ,�j� / 3�_ Holding Bot. System I p Z' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 54 rA ^-WL ,4 y , I 1/ (0 33 Model Number GPM �If3 2,g� 102 4 ` Friction System . q t'QH Lift Loss Fi ,1. TDH Ft D� . v� �G� `12- (�l DAP Forcemain Length 100I Dia. S" Dist. To Well p� , �p owl to SOIL ABSORPTION SYSTEM R -e yic /) 3 dMVTRENCH Width Length p�/ No. Of Trenches PIT No Inside Dia. Liquid pth DIMENSIONS 0 7 DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM L CHING Manua r: SETBACK CH ER IAI _� INFORMATION Type O t j. rt Mo el er: System: 1"�WNG L� 2 — OR UNIT DISTRIBUTION SYSTEM Header/Manifold t Distribution Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Z Length T-Dia. Spacing r r 11 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 E] No C] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) 4 •3 y•3 l L LOCATION: '6� � SOMERSET 1 Si �I• �SetVi LIp�2 COUNT 4r - R I 3) Plan revision require? ❑ Yes @ No Q � 7 Use other side for additional information. S 8 SBD -6710 (R.3/97) Date Inspe is Signature ert. No. . r SANITARY PERMIT APPLICATION 2 01 e E. W and ashington Av vision NM Lcons/n I n r _ P.O. Box 7969 Department of Commerce acco d with ILHR 83.05, W IS. Adm Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar Per It Number '307( 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'vtq 7 & State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 7— Z4 Prope ner Names P opert Location c to 1/4,S T , N, E (or Pr perty wner's Mailing Address of Number v Block Numb_ e_ City, S e Zip Cod Pho Numb r Subdivision Name or CSM u ber z S >� ,y II. TYPE OF B ILDIN6: (check one) ❑ State Owned �/ It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms - 7 ro ors ,r{ III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 10-30. /<I. 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 1V. 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 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/da /sq. ft.) (Min. Inch) Elevation _5' 9 Feet y .3 Feet VII. TANK in gallon s Total # of Prefab. Site Fiber Exper- INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank cfriieldnrgfiank — ' ❑ ❑ ❑ ❑ ❑ Lift Pump Tankq&**arrEhen►I@r ❑ ❑ 1 ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, th , 0 undersigned, assume responsibility fof ins . Vallation of onsite sewage system shown on the attached plans. Plu is Na e: ri� Plumbe ' atu to s MP /MPRSW No.: Business Phone Number: lumb Ac ress (StreeZCP, State, Zde): J e1` R IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) � [WApproved E] Owner Given Initial 2,�o h f Adverse Determination V I� Surcharge Fee) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD (R t 1/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber r SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce July 31, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 K 0 CONSTRUCTION KIM 0 CONNELL 504 THIRD AVE OSCEOLA WI 54020 RE: PLAN 597 -20710 FEE RECEIVED: 180.00 FAUST, MIKE NW,NW,10,30,19W TOWN OF SOMERSET COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, `l $_eroy G ansky astewater Specialist Sen or Section of Private Sewage (715) 726 -2544 Friday's 4975R/ 1 SBD -7997 (R.11/96) Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID 8 LOS 1 I Ulaee/r9wa , Y Contents Comments/Special Instructions Pane N included 7*o copies needed for all laps 1 Plot Plan 2 Plan View /i d 57 Q Return by Mail n 3 s . S Tank A Pump/ Q Fax Letter to (County) (Submitter) Siphon Information Circle One and Provide Fax #: ( ) 3 S S' ' Public) 6. 0 CW for Pick -Up: ( ) Other I, the undersigned, hereby certify that the Seal (if applicable) plans and gwdd catim nbnitted hemewith were prepared .nder ny R FC r: t direction and eontrol. r�UL 3 0 19 - T,• R. RLOGS, Vil liz S97 -20710 For office Use Only ,► b..ats: Applicadoe RO.V91.T.S. Sa a*Bovdanio. Conditionally Y Needed for Mill" To ;! r ROVE D Oes DEPARTMENT OF COMMERCE sVe nunt. (orweW soCeaegr) U1 ON OF SAFETY AND BUILDINGS Needed for At -Grade Subiefth odginW sipsd ad woriaed *W*Wso(wAa ScE C RESPOND E Grew Gaaty ea.aNe .amoa.l,a otpaw see -1o26s (N-011%) on _. �� � � -• �� _., � �. m � � _ .. �"�' � ,� �' `�c ___ . � _; _._+ M � � , �, C� � r _� \� � ._ � _ _ Q M \a '`l � - _.�. ,,; � � �� � � �-� � � �, ,� _J ;� � � � `� �� __� � � � ,� �� � � � _ _, .. pw-�a or str Marsh Nay Or Byothetio Covering Distribution pipe Topsoil H � 3 E D 5-% ik0� god Of 2 Fore Main Plowed Aggregate From Pump Layer 0� Cross section Of A Mound System Using E JS A Bad For The Absorption Area F .. i Signed. A �_ Ft. N Ft. License Nm*or: 1 / 6 29 , Ft. Dates J 7� Ft. K " Ft. Alternate Position L Ft. of Force Pala M ; 2L, j/ Ft. d Observation Pipe K A t , Distribution Bed Of 2 Pipe Aggregate 1 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ' 1 P49e Ct,, Perforated Pipe Detail 0 E nd View Perforated 1• Zed Co P PVC Pipe tO�aE N . e holes Located On Bottom. d Are Etivally Spaced R j )7,jW,-Lk1 PVC Farce Moir ,7 Alt at• Position Of pi�trip•Nion Forc Main Pipe Ft- P PEIL,), Lost Mole Should Be 5 &H.- 1- 3' Most To End Cap 1,,, o End Cap Distribution Pipe Layout. P - Ft .E'er R_ S --� X Inches `f Y Inches 6, q Signed: Hole Diameter Inch Lateral a Inch(es) License Number: Manifold " ,_•Inches Date: Force Main " _ Inches # of holes /pipe ,L Invert Elevation of Laterals r• r• A tY � m � a •• o N r A rt A s O O O M b n — e � ro m rt � � a . to � �o s rr rrrr '' rrrr r r r r -rrrr r r r r r r r r r r r r r r rr '''rrrr N r• r rrr' 1p hA rrrrrrrrrr C M _ r rrr f r M L � A A rt� �• o tr a o z R r • n a a a ' PAGE PUMP CHAMBER C9055 SECTION AND SPECIFICATIONS V E WT CAP H VEIJT PIPE WEATHERPROO APPROVED LOCKING JUWCTIO BOX MANHOLE CoVGR W ITN ? 25' FROM DO OR, WINDOW OA FRESH II'MIU. WAIWING LABEL I AIR INTAKE � GRADE COIJDUIT 11� INLET PROVIDE AIRTIGHT SEAL I I APPROVED JOIIJT A I I APPROVED JOIUT W/ PIPE I I W/ ' PIPE EXTENDIM6 3' I I ALARM EY.TEIJD111G 3' OWTO SOLID SOIL I I I ONTO SOLID SOIL I I I O N C O ets_i I CLEV. FT. PUMP —�_ b OFF 0 COUCKETE DLOCK RISER EXIT PERMITTED OWLy IF TAWK MAWUFACTURCR HAS SUCH APPROVAL 3" APPAoVEa B ECDING undcr rl'•�K SEPTIC f SPEGIFICATIOUS DOSE TAWKS MANUFACTURER: ' WMBER OF DOSES: PER DAB TAWK SIZE: -SP" / GALLO►JS 005E VOLUME ALARM MAIJUFACTURER: �� �. /���+ � �' INCLUDING BACKFLOW: GALLONS MODEL W UMISER:. CAPACITIES: A = > IAICHESOlt .r/ GALLOw5 SWITCH TyPC: I g IMCHESOR GALLOWS PUMP MANUFACTURER: , C WCHES OR /� / _ CALLOUS e MODEL WUMDER: D INCHES OR yl GALLOWS SWITCH TYPE: / AJOTE' PUMP AMD ALARM ARE TO DE MINIMUM DISCHARGE RATE �$�L ,Larm INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEIJCE OETWCEN PUMP OFF AUO DISTRIBUTION PIPE.. _ _ FEET + MIMIMUM METWORK SUPPLY PRESSURE / . . . . , . . , . . . 2 . 5 � FLET Ion rr.FRiCT10U FACTOR.. + .laQ FEET OF FORCE MAIN iO F/ � / FEET TOTAL DyIJAMIC. 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Wiscgnsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page _ L of Division of 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 ' rte, j N not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR . . # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION RE D BY ; DAT PROPERTY OWNE PROPERTY LOCATION 4 y C _ GOVT. LOT `L) 1/4 R 1/4, PROPERTY OWNER':S MAILING ADDRESS LOT # BLOC # I SUBD. NAME 0 C17L STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE MOWN ` NEA ,, /, (is) 1 1 ,2 7 - 341 New Construction Use M Residential / Number of bedrooms [ ] Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flow Z� gpd Recommended design loading rate bed, gpd /f: gpd /ft Absorption area required 3� bed, ft _ trench, ft Maximum design loading rate gi bed, gpd /ft 5: trench, gpd/ft Recommended infiltration surface elevations) ft (as referred to site plan benchmark) Additional design / site considerations Parent material - Flood plain elevation, if applicable 411 ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S O U ®S El ❑ S ®U El M U ❑ S M U ❑ S R� U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwidary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tr & , Ground _ } elev. ` � •e ft. e � Depth to limiting factor „ Remarks: Boring # a Ground ' elev. - Depth to limiting factor P Remarks: CST Name:— Please Print �' Phone: A ddress: Signature: j, Date: CST Number: L_ L-- 2_"�L — / (.& , �L� 1©o tea© j , � fj r Mar -16 -98 03:26P P_01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND y� OWNERSHIP CI'RTIFICATION FORM Owner/Buyer _ / ► l i kt rtu Mailing Address q DB SCE r f I < ' �P— i V e, Property Address �V (Verification required from Planning D,-partmcnt for new construction) City /State J1?24 eSG7 .c T. Parcel Identification Number t LE DESCR IPTION Property Location :, Scc. T SQN - R_W, Town of Subdivision , Lot # Certified Survey Map €# jf ,� , Volume f , Page # Warranty ed # / /65! h' Volume ,Page # Spe• house ❑ yes 9 no Lot dines identifiable /yes ❑ no i SY� " EM MAINTENANCF Improperusc and maintenance oi' your septic system c result in its premature failure to handy_ wastes. Proper maintenance consists of pumping out the septic tank c%. thn:e years or Bonner, if needed by a licensed pumper. What you out into the system can of -ct the function of the septic tank as a treatment stage ir, the waste disposal system. The property owner agrees to ,submit to St. Croix Inning Department a certification form, signed by the owner and by a master riumber, journeymac p;umbcr, restricted plumber or a 1 "mser.t pumper verifying that (1) the or. -site wastewaterdi,posai system is in proper operating condition and, (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 tell 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 leas hccn rnaintaircd must be complctec and returned to the St. Croix County Zoning Office within: 3^•• (' of the three year expiration dale. GNATURE OF APPLICANT DATE OWNER CERTIFICATION 1 (we) certify that all statcnien ?s nn this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property desc6bcdphove, by warranty deed recorded in Register of Deeds OfTice. GNATURE OF APPLICANT DATE Anv information that is mis- represented may result in the sanitary permit berg 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 3 0 ti - 6 �R�9��1eo�'►x��„W! .'�' 544452 CERTIFIED SURVEY_ MAP- Located in part of the NWJ of the NW* of Section 10, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. SMALL TRACT SMALL TRACT I 'MALI_ T RACT I ?°— — — -- — - -- -- I — — - -- - - -- — — — OZ ° 171 XvLEI o '2 nW W NW CORNER I 1305 I Z ' ° SECTION Io North l i n e of the N Wk� I M S88 ° 39'28 "W 1305.43' M — - FENCELINE Ii 1.7' 589 ° 07'39 "W 1252.89' �— o WEST OF 1/4" REBAR FOUNDATION If)] m GARAGE _ HOUSE ILO...... -❑WELL 6�� X11 i 3 Z NI S HED is 'eROVED i s JI BARN a El 0 010 o >l+� W- 4- SHED e :I C - WUl) 1 M r N J W 4' ' - LOT I os{�ix couNTV M ^ _ o N N ° m .....5.'. �.i3CSnS1Ve i�tann'w rr�l3 `^ W? �1 a ° 29.12 Acres Inc. R/W honing and ^ �jl rl _ 1,268,575 Sq. Ft. P'l rks canrrrtittee 4 , �I - BM I ASSUMED EL ° 100.00 N Ql 27.21 Acres Exc. R/W ` I I LU _JI N ` — � 1,185,270 Sq. Ft. `rat recorded „r:- : tin 30 days of N w 26.,87 Acres t Exc. 7t�roYa1`datii \ R/W & Water N M \ .''; ►liar shall be I O N 0 3 �� 9 trt�id Z c 1111 �• I o I —I N —� EL : 83.23 N88 0 41 1 4 7 11 E 738.34' Z qI E� R I I 5/ 24/96 700.00' 38.34' WAT �I U) zI <I 0 <I LOT 2 C � i� 7.41 Acres Inc. R/W i 11 322,949 Sq. Ft. OD o =I qi i S I M M I — UJI ` N 7.10 Acres Exc. R/W 33 33' UI 1 - ` EL c 93.08 - 309,470 Sq. Ft. E <I 5/24/96 c 31.12' — JI wATERr ° 0 68.94' — 11 1 zi I 1 ,8M 2= I00.02 Z N00 °42'31 "E N88 41 47 E o n 3.0' j 568.34' 629.94' 6 .041 100.06' o N88 0 41 1 47 11 E 1198.28' VOL. II��O, PG. ICI SMALL TRACT - -- - - - -- - - - -- �, 0 z a OWNER 0 _ LEGEND °