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Home My WebLink About032-2063-80-000 ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT Owne /d Address 1 :5 - 13 d City /State Sff - er::& -1 Legal Description: Lot 41 -4 Block Subdivision/CSM '/. '/. St<I Sec. ,TAN -R_Ly W, Town of PIN # 632 - - - SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer _ / 1j-z k r Size ST/PC OUq' Setback from: House a Well 40 P/L !cn ; - Pump manufacture_ r 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: Width - -�5 Length 63 Number of Trenches j Setback from: House / " Well /cot P/L Vent to fresh air intake /0 �f ELEVATIONS Description of benchmark ec Elevation Description of alternate benchmark go ifg... 6 -et o 92afiop Elevation 9y. / Building Sewer l ST/HT Inlet ST Outlet - q!q. y4 PC Inlet PC Bottom Header/Manifold �/�/• �� Top of ST/PC Manhole Cover �� Z Distribution Lines (/) . °, r,- () g �/, 0 5 Bottom of System Final Grade Date of installation Permit number 3 1 flfo State plan number Plumber's si nature 6,aY / License number �//� - 2- Date /f%& Inspector Complete plot plan a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: Safety and Buildings Division INSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar y315916: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. RADKE lde ' N E�B &gy ff Town of: State Plan ID No.: CST BM Elev.: Insp. BM E v.: BM Description: Parcel T�tc,fy 2063 - - 000 -. � 3G TANK INFORMATION ELEVATION DATA A9800305 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0 0 B e qL 1 OD- L Dosing �) I/ CD7 o Aeration Bldg. Sewer 5-42 5 Holding St Aff Inlet (o (o` 3 tj' (� ( TANK SETBACK INFORMATION St /Outlet L •�(®� 5'1 9�.� TANK TO P/ L WELL BLDG. ven to Air Intake ROAD Dt Inlet eptic i-( tci ' � NA Dt Bottom osing X NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ?4 ;- Manufacturer 7Da n d St. �� .v (� • af Model Number GPM TDH Lift L rict System TDH Ft ead Forcemain Length Fi Dist. To well SOIL ABS O TION SYSTEM BE T C Width �' Lengt f No. O renches PIT No. Of Pits Insi 4)- DIMENSION SETBACK SYSTEM TO P / L i BLDG WELL LAKE/STREAM LEACHING ranyj�cxyrer: INFORMATION T pe O CHAMBER _ e . y ( M e Num er: Syste 15D �( 2 '� OR UNIT w DISTRIBUTION SYSTEM Header / Man f 1 � Distribution Pipe(s) ( x Hole Size x Hole Spacing Vent To Air In?ke Length _ ` Dia. `"1 Length 0_3�_ Wa. Spacing (a /t/ 4 �dS 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.) OCATION: SOMERSET 18.30.19.751,SE,S 1513 CTY RD V n �l a� �(/! G�t �'-�/� ;Gr al old F /` tt Plan revision required? []Yes ® No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature ert N . Safety and Buildings Division Visc SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue In accord with ILHR 83.05, 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 /� C , than 8 1/2 x 11 inches in size. - kb 1 • See reverse side for instructions for completing this application State Sanitary Permit Number .315gI Personal information you provide may be used for secondary purposes ❑ Check if revision to pr evious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location v�� CAC1C e �1i4S�,; Zia, 5 / T 30 , N, R./ (or Property Owner's Mailing Address Lot Number Block Number 1 513 h City, State Zip Code Phone Number Subdivision Name or CSM Number ,se Gc�� ✓fXv�s 1 (7/5 )5 -� y3' Zo lk,-es II. TYPE F BUILDING: (check one) ❑ State Owned 0 L ity Nearest Road ❑ Village C Public 1 or 2 Family Dwelling - No. of bedrooms 3 own OF —5d ewsef /C ylv Ll III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 3�. 9. 7��/ o �a -and 3 --80 2 ❑ Assembly Hall I[] 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 _____________ _Tan - - - ly______________ Exist. --- ExistinqSystem 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 [gSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit � i�n aJiw�e� � 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 30 5�� 95 0 5 -- P , 7,5 Feet 96. Feet Capacity VII. T ANK NFORMATION in allo S Total # of P Name refab. Site Fiber- Exper. g Gallons Tanks Manufacturers a concrete Con- Steel glass Plastic App New Existin structed Ta ks Tanks I ' / �+ Septic Tank or Holding Tank =/6250 /lh�a � !�/ C ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name: (Print) Plumb 's Signature:( tamps) MP /MPR N o.: Business Phone Number: M ` 715 - 7 7 Z 3aZ Plum is A dress (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) � �4pproved ❑ Surcharge Fee) Owner Given Initial n Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber JOB TIMM EXCAVATING SHEET NO. OF -Z— Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE-2 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCAL ........... ... .. .......... ..... ............... .......... .......... .......... i ............ ........... .......... ........... ........... ........... .......... ........... ........... ........... ........... ........... ............. ....... .......... ........... ........... .......... . .......... ....................... ........... ........... ........... ........... .. ........ ........... ........... .... .. .... ........... ........... ........... ..... ............ .... . -4 4 .......... I ........... .......... .......... .......... 4' 01 .......... 4- ............ .......... ......... ...... .... ........... ........... ........... .......... ........... ................... ........... .... .............. ........... .......... ....... ... ...................... . .......... ... .......... ........... ........... . . ..... .......... .......... ....................... .......... ........... ........... ...................... ........... ........... ........... ........... .. ...... ........... ............... . ......... . ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ............................... . . . . . . . . . . . . . . . . . . . . . .................................. - - - - .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. .... 4 yr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . ..... . . . . . ..... . . . . . . ..... . . . . . . ..... . . . . . . ..... . . . . . . .... . . . . . . . .... . . . . . . .... . . . . . . . . .... . . . . . . ..... . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . .... . . . . . . . .... . . . . . . . .... . . . .. . . . . ..... . . . . . . .... . . . 9. ..... ............................... . . . . . .. . . . . ..... . . . . . . ..... . . . . . . ..... . . . . . . . .... . . . . . . . .... . . . . . . . .... . . . . . . . .... . . . . . . ..... . . . . . . ..... . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . . . . ........... .......... .... ........ . ..... ..... .... ..... .... ........... .......... ....... ........... ........... ... . . . . . . . . . . . . . . . . . . . . . .. . . . . . . ....................... ...... ............... ............... ...... . . ...... ...... ...... ...... ....... ......... — ........... ................. .......... .......... .......... .......... ....................... .......... .......... .... ............... ... ........... 7— ..................... . ............ .......... .............. .......... . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . ........... ........... .... ........... ...... ...................... ---------- .......... .......... ........... ........... .......... .......... .................. — ........... ........... ........... ......................... ....................... ........... .. .. ............................................ .......... ...................... ....................... ........... ........... .......... . ....... ........... ..................................... ............................... ........... .............. ................ ........... ........... .......... ........... . ....... .......... ...... .......... ........... ........... ........... .......... ...... ......... ........... ........... .......... ................ ........... .......... ............. ----------- .......... ....... . ........... ........... ................ ........... .......... ............ ........... ........... .. .. .......... ........... .......... ........ .............. ... ....... ..... -Z zil ........... ........ ...... ............... ........... .................... ........... ........... ........... ........ . . .. . . . ................ ........... ......................... ............ .......... ........... ...................... ........... .......... .......... ...................... ................................ . . . . . . .. . . . . . . . . . . ... . . . . . ............. ........... ---------- ........... ---------- ...... ........ ........... ........... .......... ............... ............... .......... .. ........... .......... .......... ............................... ........... - ............. .......... ----------- ---------- e ............ ---------- ........... .......... ......... .......... 40 A� f�'; JL ........... ---------- ---------- ------------- ............... .......... .......... ................ .............. ........... 25 77, 6' 4, n 1-1-111-1- -- � I ................ ............ - ............ .......... ZZoiw ....... ........ ........... .............. ................. ...................... .......... ----------- ----------------- - to p .......... . .......... .. .............. ......... ............. ............... .......... ........... -------------------- .................... ................... ........... ----------- ----------- .......... ........... ..................... .............. ----------- ........ ................................. .................... ... ........... ........... ..................... ....... ... ................................ PRODUCT 2D5-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-M JOB - TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCAL .......... ................. ........... ........... ........... .......... ........... . ....... ... .......... ....................... .......... .......... ............ ----------- ........... ........... ........... ........... ........... ........... .......... ........... ............. ---- ----------- ........... .......... .. .................... ........... ........... ....... ......... ........... ................ 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PRODUCT Groton, Mass, 01471. To Order PHONE TOLL FREE 1-0-2256380 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Plfvision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper e 11A -x11)l ,Cnc in size. Plan must include, but St. Cr oix not limited to vertical and horizontal P n restdir��tlo nd % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and loca032 - 2063 -80 APPLICANT INFORMATION -P Z'� A ON REVIEWED BY DATE PROPERTY OWNER: �;�g t PROPERTY LOCATION I GOVT. LOT SE 1/4 SW 1/4,S 18 T 30 N,R 19 (or) W Marvin RadkL- PROPERTY OWNERS MAILING ADDRE t t LOT # # SUBD. NAME OR CSM # 1513 Ct Rd. "V" ! :,c+ 3twg3cl� '� , na N a n na CITY, STATE ZIP C 9 ON1 ❑CITY [:]VILLAGE jjrOWN NEAREST ROAD Somerset WI. 54 2 `�(� 454 Somerset " [;j New Construction Use k ] Residential ! Number of bedrooms R [ ] Addition to existing building [Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 4 bed, gpd /ft • trench, gpd /ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate • 4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 92.75 ft (as referred to site plan benchmark) Additional design / site considerations 3 5 trenches Parent material pitted glacisl drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem I ®S ❑ U KI S ❑ U I El S ❑ U NS ❑ U [IS ®U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10 r4 3 none 1 2f . 5 .6 2 11 -26 7.5yr4/4 none sl 2mgr mfr gw if .5 .6 Ground 3 26 -36 5yr4/4 none scl lcsbk mfr gw na .2 .3 elev. 4 1 36-80 5yr4/4 none sl lcsbk mfr na na .4 .5 96.2 ft. Depth to limiting factor +80 Remarks: Boring # 1 —11 10yr4 /3 none 1 2msbk mfr gw 2f .5 .6 2 11 -43 5yr4/4 none sici lcsbk mfi gw if .2 .3 2 j 3 3 3 -84 5yr4/4 none sl lcsbk mvfr na na .4 .5 Ground elev. 96 ft. Depth to limiting factor +84 Ld Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. 42w Richmon VW 54017 Signature: Date: 8 -29 -97 CST Number: m02298 STEEL'S SOIL SERVICE Gary L. Steel Marvin Radke 1554 200th Ave. CSTM2298 SE4SW4 S18- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 t N " =40' � 51 BM.= nail in Elm tree C el. 100' Alt. BM.= top of stump C el. 100.40' k y �J� a 150 ` 5 3 4 '7' v ��D k3 Gary L. Steel 8 -29 -97 f f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 6'd At Mailing Address /.f - 13 JZ Property Address 5 irk s 4, k.--o £,, (Verification required from Planning Department for new construction) City /State ZA-4 Parcel Identification Number 30� - - L6 4 - 3-6 1 6 LEGAL DESCRIPTION Property Location S ' /<, 5 ( ' /4, Sec. I . T__j0 N -R / l ! W, Town of r . Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume . Page # Spec house ❑ yes ® no Lot lines identifiable IN 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 masterplumber, journeyman plumber, restrictedplumber 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. 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 has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SfG14XTURE 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 the property described above, b virtue of a warranty deed recorded in Register of Deeds Office. f F - 1 1 SIG ATURE OF APPLICANT 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