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HomeMy WebLinkAbout032-2052-80-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner asp Address o C City /State _Sa,►,� �s� T w� Legal Description: Q Lot f Block Subdivision/CSM # G/ f 1 Z %, %, /y, Sec. /s , T N -R W, Town of ^ers—T PIN # 01Z 2 0s - $ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 4- /re.. 71" Size ST/PC /z- / Setback from: House 12 Well P/L S'z 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: & 0 Width f�_ Length ? Number of Trenches Setback from: House 3 sS " Well - 7SO PAL 7 z Vent to flesh air intake 7 $o ELEVATIONS Description of benchmark /UC Elevation ICAO. 0 Description of alternate benchmark e 1 Elevation Building Sewer Z ST/HT Inlet 47 ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System 01' () ( ) Final Grade () _17_ () ( ) Date of installation /17 Permit number 3077 `� State plan number Plumber's signature y g License number - 222 - - L 57— Date Inspector Complete plot plan �+ Wisconsin,DepartmentofCommerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division y: ST. CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary5e"YV9 Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. P MA'1'M. s '1'514 & LORI ❑ # , ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta6A o2:- 2052-80 -000 TANK INFORMATION ELEVATION DATA A9800159 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic ^ Benchmark Dosing ��,�, Aeration Bldg. Sewer Holding St!X Inlet 7/� 5 TANK SETBACK INFORMATION St/ Outlet Z 96 i TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet irl Septic 7�(j� n NA Dt Bottom Dosing NA Headers 9� Aeration NA Dist. Pipe 7, Holdin Bot. System PUMP/ SIPHON INFORMATIO a Final Grade Manufacturer * nd92� Model Number PM TDH Lift L r�ction V�ystem Ft os For cemairi Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /6 7' DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACH nutacturer: INFORMATION Type O 91L— CH ER Model Number: System: C,,rt? L-(Cl —,V ci• yl t� OR UNIT DISTRIBUTION SYSTEM Header /. . it Distribution Pipe(s) / x Hole Size x Hole Spacing V nt To Air Intake Length / Dia. Lengt Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade S ms Only Depth Over // Depth Over , ! � xx Depth Of Seeded / Sodded xx Mulched Bed /Trench Center a2 ' �� Bed /Trench Edges d' _�(- Topsoil ❑Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 15.30.19.698B,SW,NW 604 155TH AVENUE /� ^� / / i_ ��✓ CY G•f./x t ��� •.y,� F � -,�, ,Car. �,�- P, _ f Plan revision required? ❑ Yes -M Use other side for additional information. I F1 I I I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Safety and Buildings Division Vis-consin SANITARY PERMIT APPLICATION 20 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI W707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ST 01Or • See reverse side for instructions for completing this application State Sanitary Permit Number J4 T7 ZP 9 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)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pr y Owne Name Property Location OA1 t o�� a V 1/4 N k1 1/4, S / S T . Nr R /9 E (or)0 Property Owner's Madi9kAddrest Lot Number Block Number Go 8' Sy ctc4r, City, State ® Zip Code Phone Number Subdivisio Name or CS Number G'.'r o2� (7 /r )W51y'57� � /70 11. TYPE OF BUILDING (check one) ❑ State Owned ❑ It Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms m Town OFSp er /cam 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 03 Z —.?oS Po 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 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) p, Elevation Oa ZOO -2oG If S Feet ° 1`! 1 Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Fiber- Plastic Exper. New Existin Gallons Tanks Concrete strutted steel glass App. T nks Tanks Septic Tank or Holding Tank pp d vx' El El El El El Lift Pump Tank /Siphon Chamber 7 C) Z (` r 7r El 1:1 E] 11 El 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu ber's Sign ure: (No Stamps) MP /MPRSW No.: Business Phone Number: �jc J' :2 � 4S5� "/d' 6 f. e i:�9 7 Plumber's Address (Street ty, State, Z' Code): Z / yG S7_ 4Z V _-T IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanita Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) A pp roved ❑Owner Given Initial y� Surcharge Fee) _q j y Adverse Determination o(/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SIBIDMOD - DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber om W /0 1 6 . . . . . . . . . . . 7y Page Of COMBINATION- TANK /PUMP CHAMBER (No Scale) 4 ci Vent Pipe with ,Approved Locking Manhole Cover Approved Cap, +251 With Warning Label Attached From Buildings Warning Label Weatherproof Approved _ Junction Box . 'Vent Cap - ---- -� . , 12" Minimum Final Grade 6N Minimum — Minimum N 6" Maximum 18" Minimum 4N C•I• ' Quick Insp. Pipe ;_ Disconnect 1/4" Weep Baffles Hole J_ � A 4 Alarm B `* On 61 C * APPROVED JOINTS WITH Off 6' APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Beddinq Under Tank --/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ o Doses: A50 Gallons i Volume of Backflow:.......+ Tank Manufacturer: Gallons Tank Size - Septic /Pump: Aar Total Dose Volume: ........ =Gallons Alarm Manufacturer: o a ons Model Number: Capacities: A ;21d inches or �8'9 4 Gallons Switch Type: + B niches or 2 Pump Manufacturer: + nC s'7 inches or---- Gallons Gallons Model Number: 9 + D 0 inches or /2o Gallons Minimum Discharge ate: 2 6 Total ..... _ ncties or = Gallons Vertical Difference Between Pump Off and Distribution Pipe:a Feet � Minimum Required Supply Pres ure :.........................+ m0 Feet of Force Main x Feet . Friction Factor /100 Feet: + eet Inch Diameter Force Main Total Dynamic. Head: ... M Internal Tank Dimensions: Length /3 Width, ; Liquid Depth Signature L License Number 2Z7- 5-S °Date 6-,3-9V HEAD CAPACITY CURvi �— �� ,/. .•. MODEL "98" ts.._ +. 4 S/16 1/7 11 1/2 will Yp s o .. _ !rr1.t.C1NS 7t1 70 JO 40 4 i 7V IV kS- . (k1 t: ,s )40 0 FLOW P011 MINIM 1 r t 6 IF I r/�:rrt \1�•ai''3t�lAtt:'/.q l I r J It I i I t.N•Ae !IT + MCAr) 11«1ryAlul I �� Il.f;1 04mns oAtS t,t14 t � Pit 1D 4 11 At 1 P 11 �1. �•. 1rn iV A rp 111 1� _L►� 3 S /16 l CONSULT f' ^.!; "nR'. FOR SPE( AL A, IJPLI MONS Icmcal anowat tnr m om svmQn1S, ;vv nvoilibfo tars •Mot ary f wit sww ato available; for eorftifl singM and prAWj with irn alarm. 111 u phaso t'aYslmr ictlaniul aftefrnawirn, fur dw)irx syvi:t, •, we availame if ith r • l)UUI ;N j*jjQyt18Ck t wCufy tkOal •witches 8'9 %valailatoe for P t t,l 81111m nwflahet, v ." , .1' ' ^vES; !exty ( 1: 11 wriffols f LC iraN OVID[ I iiii"i 1 now wo i woo , +, n.c,wK.i w.N A, . ,,, .:�. OoMrW x1101 /kale S13ne9arrf all 111edell, : HJol�t�l 3j It) /, H.P. :.r,+q1, PlMbW •d X11, ..... _ _ .. Of%m tl tMINCTbr� awtte!' rrtrra b + mwor! cat �YOk� aMh M.tC� {St 1un�ltl 6iA1pr� a _t :..._ Ovk"� _ i AMtPn u/lall aftew'msox it a r,,; f _ (t3 �•• ,• A,.•fu `_ 9 A _ f r I _ -• .... 1 ciao i IU/t; , hn a1Arlefe <I i,d d t.+l:(r+Cfl AMlttr.�td. �t' �',t • ' _i . a A •.. _ lr ;lac V sonew <9uw r I. , :4 .72 2 1 :; uiwi iir a QCIV: iCINOWI, iPWth 011111'• (3) Of (4; IWW N m it 230 t ArAu 1_i r a+ i i (. _. _ ` rt •ur ) tf&*v ' .it :f :Mt ton& too womwwV4! ronnprwn wan d- to tins • 1>.;kl • 1 KH� i 1. • ?r�?tA ! .. •' •t1 , I r;�.i, d:J; «t+l:v, �t: /r »t .. _ ..., l Tom to •, te"hi C0rwtwAkt%•a orm TNd 01 &OWWW ZMM pWk*.t7 IWO -GAW V aA ht +At1 "A *AM, d w 514. An •e I*, Iu,A r ok, 11rO1U, a +1• law M.tw ..4 wrins o0w.10 N Ob» N s ouAw e• MatW► OMlin o, FAM1ll; (JaCbkof A/N►r1411110. fMM1111 AAldllP" Aaor Itll►, two r„w!. N dvkj #r' % 4 n. tlrw+t •.►. IV a11111bt M 4 TA IrMw" iwtlW.. A1ll1Ar ♦',llllf>gM, ►tMtN1 ?;'.ute�f$Aer�1 iWi*q. �I�gMI, rrf !iw'ra� ' N Item tpq IM n a1 IMMS tw1 vw C de*61101r.1 sM.1T ow/ HL ti l' #/z l ) C- i ERF;,G > rE ii& For unusual cor..a.tiarv* rusk ;; ;: d,tty 0, ?: IS !C! :h the c c )n of b`. Zo!fmr a1 !ono. �/ 1 �.. _ w s. �' let►f'�t,l: i�fi;ofi llliuea:i !"Ol,. Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of 3� Bureau of lgtegrated 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 -!� f ,, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # d3Z - .2os � go APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 601 &M S Govt. Lot SL/ 1/4 NG/ /4,S /-r T3C ,N,R E (or) 10 Property Owner's Mailing AkIdress Lot # Bloc k# Subd. Name or CSM# t,07' 15 - T ,29( 11e- _7 City State Zip Code Phone Number City E] Village ,® Town Nearest Road � _ va (7,J )av - 5- , ❑ Ci e/.3 e ors M New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement / El Public or commercial - Describe: c Code derived daily flow 6,60 gpd Recommended design loading rate 1 sJ bed, gpd /fF _J�_ trench, gpd/ft Absorption area required j26 bed, ft ©a trench, ft Maximum design loading rate s bed, gpd /ft2 gpd/ft Recommended infiltration surface elevation(s) C 2 4 �g ft (as referred to site plan benchmark) Additional design /site cons' erans tio Parent material 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 9 S E:1 U ❑ S a U 9 S ®U ❑ S ® U ❑ s ®u ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 / in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench . 54 1l/Fs�X u'F a rm IPIK , 5V at O.1 ' . a R , S_/Y SL ItvfSd.0 14 MW Ground , S 0 FS elev Depth to limiting '7� fac or in. ' Remarks: Boring # E4 7 1 5 . y ew a ` /rJ(0 066 's ;2, j?X 2 A m ) s Ground elev. Depth to limiting fact 9 1 0 1 in. Remarks: �• 6 CST Name (Please Print) (7, Sign ture Telephone No. E ( ? /SS ?CB =CC37 Address Date CST Number /1(6 � ST �fi�� �� 5 3 y S C/q 5y 9 I 79 q I k-- - 4 1 JAL : I ' I � II S° ;- -- - - -- -- - - - -- - - - - -t -- - �- � I I I I I I, I 1 I I i _ � I I ST CROIx C'OUNTX SEPTIC ;'AN;K MAIN "NANCE AGREEMENT AM) OWP, ERSHIP CERTIFICATfON FORM Mailing Address ,(.�Q�.� > n �tV `L • 4r� 5 Al0-6' -+ Pro,petly Address­ 4–q.y— / S' � 5 n. -e S A 7 L✓1 (Verification required frorl i Planning Dep arttnent for new construcrior,)� City /State Jom�5�— Gy f .: Parcel Identification Ntunber LE G AL DESCRIPTIO Propex Location x/" Y6v_ V., Sz c. I �, T ,�v ,�l -� 1 cl W, Town of Soo e -i's Subdivision _T Lot # Certified Survey a # '����° 3 Y P Volume �.� Page # Warranty Deed # Volume �, Page # Spec house El es ano M yes O uo g ' P Y Lot lines identifiable SYSMM MAII�ITENAtyCE Improper use and maintenanceof your sel Xic system could result in its premature failure to handle wastes. Proper z aintenance ;1 Consists of Pumping out the septic tank every thrt a years or semoner, if tttadod by a licensed pumper, What you put into the system Un affect the function of the saptie tank. as a tre a went stage in the wa ste disposal system. The property owner agrm to submit to Ste Croix Zoning Devputacut a cortificatiom form, signed by the awuer and by a tuasterplurnber, join neymanplumber, resttictedpl; amber or a liceamdnumper verifying that (1) the on -site wastewaterdisposal system is in proper operating cond.i.tum and/or (2) after in: section A-0d patting (if necessary), the selstic table is leas than 1/3 full of altrd.ge. Uwe, the undersigned have read the above rcquiut, hints and arec to maintain the private sewage disposal systern with the standards set forth. hezei,rt, as get by the Departmeta of Com scree and the Departm ofNaitum! ltesettxe ?s, Stato of Wisoonsin. C.ert;.ffoetiem stuing that your septic system kiss been maintainer I must be completed and rehwmd to the St. Croix County Zoning Office witihin 30 days of the tltrree year expiration date. S NATURE O PI.ICA 1' DATE OW NER C.E.RT,Ik — TQ►. I.ON I (use) certify that all statements on this : irm are true to die best of my (our) Imowiedge. I (we) am (are) the owner(s) of the prop y described above, by virtue of a warra q deed recorded iu Register of Deeds Of-Tice, SIG: O �PLICAUNNr DATh Ajay information that is mis- represented u ay result in the s,snitary permit being revoked by the zoning Department. * +'� * *• Include with this application: a stamped wan i ty deed hom the Register of Deeds office. a copy of the o rtified survey inap if reference is rtiade in the warrulty deed n Pjo 411,903 s0 U N PL A T T E D L A ND S h CERTIFIED SURVEY MAP WILLARD JOHNSON 3 N 88.35' 46 "E 263. 07' N h Part of the Southwest 1/4 of the North - 2 Mlwest 1/4 and the Northwest 1/4 of the ? #• Southwest 1/4 of Section 15, Town - M y V ship 30 North, Range 19 West, Town of OlSomerset, St. Croix County, Wisconsin. h> O � ` ��tNrrrrrgti� y y I �'4k % SG O NS r9r��ii �N LAURENCE 0 3.032 ACRES T •' W 01 MUR' - 132, 940 SO. FT. S _� • NET r 2. e4 / ACRES * ; 123,769 so. Fr. . � , ALLS. a ; M 3 '� � •. ISC. , � Q • m a • Indicates 1" iron pipe h J I ' LAND s% m found. O �rrrrrllt��� �� o h M 0 Indicates 1 "x 24" iron ° n pipe weighing 1.13 ° Laurence W. Murphy CO lbs. /lin. ft. set. Registered Land Surveyor O � ? W SCALE / "; /00' O „ O 50' /00' 150' 200' 250' O 7 � O N n a 66' TOWN ROAD 2 2 N87_44 45 "E_ 155.02' 0 _ hi N87 44' 45 "E 409. 14' 7,3 . 68 ' 255. 46 ' N i E 3I ' 9• 0 -- . J M y o 3 N --0-- .4' M 255.46 O g' N 87 4 . 4'4 5 "E 407.80 /00 501 63 L o r 3 PROVE .2 h M `N q6 3. 194 ACRES l c 139, 112 S0. Fr. S !" Q R H O NEr = 3. OOO ACRES J r\ 130, 682 SO. FT. O COMPR;:i = N51Vc PARKS PLA7vNiNG J 3 LOT 2 Ah1D OP11NG COMMITTEE b 3.242 ACRES O v O 141,243 SO.FT. NET = 3.027 ACRES h h V 131, 665 SO. FT. a - O h 4j QI -Il � O a Dated: June 4 ' W 1986 � ° W • r v 0 3 0 o h W o 0 2 2 0 CERTIFIED SURVEY MAP WIL.LARD JOHNSON Part of the Southwest 1/4 of the Northwest 1/4 and the Northwest 1/4 of the Southwest 1/4 of Section 15, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. CURVE DATA CURVE CHORD BEAR. CHORD ARC RADIUS CEN7RAL ANGLE /S7. 7AN.BEAR. 2ND TAN BEAR / -2 N67.07'/75 "E IIS.84' 119.40' 165.85' 41•14'53" N46.29'50 "E N87.44'45 "E 3-4 V67.07'17.5 "E 93.59 95.64 132.85' 4 /. 14'55" N 46. 29' 50 "E N87. 44' 45 "E 5-6 N67 3 E 70.34' 71.68' 99.85' 41 • 14' 55" N 46. 29 50' E N87.44 45' E Description: That certain parcel of land located in the Southwest 1/4 of the Northwest 1/4 and the Northwest 1/4 of the Southwest 1/4 of Section 15, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southwest corner of said Section 15, thence N 00 "E (recorded as N 00 28'52 "E) a distance of 2168.83' on the West line of said Section 15 to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 00 02'16 "E (recorded as N 00 "E) a distance of 1045.48 thence N 88 "E 263.07'; thence S 00 "W 496.60'; thence N 87 11 E on the centerline of a town road, a distance of 255.46 thence S 00 "W 545.00'; thence S 87 "W 518.16' to the POINT OF BEGINNING, containing 9.488 acres, being subject to easement over portions of said parcel for town road purposes as shown on this map and also being subject to easements of record. (For purposes of this description all bearings are referenced to the West line of Section 15, Township 30 North, Range 19 West, assumed N 00 "E) CERTIFICATE OF THE TOWN OF SOMERSET I, do hereby certify that this Certified Survey Map has been approved by the Town of Somerset. AP day of 1986 p R j ;f! " SAP G S . L f. (J li\ Town erk of S erset CohtPiEHI �;si'; Pa,eM1a AND ZON"4G State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Willard Johnson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236 of the Wisconsin Statutes and the Ordinances of St. Croix County and that the map and description shown hereon are a true and correct representation thereof. ,`, , ` �s�t t4 /y Dated: June 4, 1986 ��� \90 O NS /� �io,