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HomeMy WebLinkAbout032-1031-50-200 ST. CROIX COUNTY ZONING DEPARTMENT �J AS BUILT SANITARY REPORT Owner S u� ee Address O. p Y. # City /State a , a w Legal escription: , ! / � `� Lot Block — Subdivision/CSM # U � '' /.-! 2� '/< LL, Sec. // , T3-)—N- °) W, Town of s .�z.P�.d � PIN # Q _ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION i �D Tank manufacturer A, Size ST/PC/ Setback from: House Well L/L Pump manufacturer Model Alarm location (— (HOLDING TANKS ONLY) Setbacks: Se Vent to fresh air intake me Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width 4 length S7 Number of Trenches Setback from: House Well 1-fO PAL �� Vent to fresh air intake 9/t� ELEVATIONS Description of benchmark a Elevation Za2 Description of altemate benchmar Elevation Building Sewer ST/HT Inlet 0- ST Outlet- 9r PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover y Distribution Lines O O ( ) Bottom of System ( Final Grade ( ) �• ( ) ( ) Date of installation /11 -1091 it number 1 State plan number 9B Plumber's signature License number � J Date / Gz Inspector a,� Complete plot plan or I r_ Wiscons Department of Commerce PRIVATE SEWAGE SYSTEM County - Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3d"41O.: Personal information you provice may be used for secondary purposes [Privacy L 21 s.15.04 (1)(m)]. Permit Holder's Name: Town of: State Plan ID No.: SHADOW CREEK BUILDERS %���� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T8-� 90-000 TANK INFORMATION LEVATION DATA A9800139 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic. Benchmark Q Q� .6v 40 p p Dosing Z. 7 ' Aeration Bldg. Sewer 06 9;. -5 Holding St/ Ht Inlet $, �/ q /, 93 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header/ Man. 4'Si' ?1 .13 ' Aeration NA Dist. Pipe q5? 1, (- , Holding Bot. System 0�6 /' 0,03' PUMP/ SIPHON INFORMATION Final Grade Q, 6 %' e .2, 1 1 ' Manufacturer Demand Model Number GPM TDH Lift Lrictio System TDH Ft Forcemain L gth Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' i5 ' DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO � 3 CHAMBER mod Number: System: Q OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 / c Bed /Trench Center Bed /Trench Edges 0 i Topsoil E] Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 11.31.19.151D,SW,NW 617 LAKESIDE LANE / Q) - Plan revision required? ❑ Yes No Use other side for additional information. Cp ! %5 �g n� a�► j U SBD -6710 (R.3/97) Date Ins a or'c- signature Cert. No. } I Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. �sconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box Madison, Wl WI 53707 -7969 Department of Commerce • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ` State Sanitary Permit Number • See reverse side for instructions for completing this application 107 , The information you provide may be used by other government agency programs El Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. /„ f n f! n s/1 ate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Ow r Nam ^' Property Lo lion Z ( �' /a � f /a, S T N, R E J PrOpert wner's M ling Address, Lot Number Block Number Ci y, State Zi Cod Phone Number Subdivision Name 7r CSM ber l P F B ILDING: (check one) C] State Owned !t N res oad ❑ village Public Agi 1 or 2 Family Dwelling - No. of bedrooms nijp, FJCMI/) 111. BUILDING USE (If building type is pu check all that apply) Parcel Tax Number(s) 1 [] Apartment / Condo //. 3 / - /? ! 5O (f 2 3 — /� /�� ol OV 2 E] Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 El Outdoor Recreational Facility 3 ❑ Campground 7 ❑ p 11 Restaurant /Bar /Dining Merchandise: Sales / Repairs ❑ 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 E] Replacement 3, E] Replacement of 4_ E] Reconnection of 5. E] Repair of an stem System _____________ Tank Only___________ - __ Existing System ________ Existing System - y--------- - - - - -- - 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 E] Mound 30 []Specify Type 41 ❑ Holding Tank 12 []Seepage Trench 22 E] In-Ground Pressure 42 ❑Pit Privy 13 [] Seepage Pit 412! X S`� 43 Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallon Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requi ed (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation f �— Feet Feet VII. TANK Capacity Total # of Site Fiber- Exper- in gallons Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New Existin Gallons Tanks strutted Tanks Tanks ❑ ❑ El Li ❑ Septic Tan 9 an Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' i ature: (N O�Sta MP /MPRSW No.: Business Phone Number Plumber's Name: (Print) � �' I Q Plumber's ddress (Street, Cit tate, ip Code): IX. COUNTY / DEPARTMENT USE ONLY Disa Sanitary Permi ee ( includes Groundwater l atelssued u i g gent Signature (No Stamps) pp Surcharge Fee) Approved ❑ Owner Given Initial / �(� �I172 Ilss Adverse Determination I O X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: DISTRIBUTION: original to County. One copy To: Safety & Buildings Division, owner, Plumber SBD -6398 (R.11/96) r PLOT PLAN PROJECT Shadow Creek Builders ADDRESS P.O. Box #2 Hammond Wi 54015 SW 1/4 NW 1/4S 1 1 /T 31 lyMi 19 w owN Somerset coUNTY ST. CROIX 4/30/98 BEDROOM 3 MPRS Shaun Bird 3532 DATE CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE '�— HOLDING TANK SIZE LOAD RATE •7 ABSORPTION AREA 648 BED SIZE 12'X 54' IL BENCHMARK V.R.P. Top of Fence Post with Ribbon ASSUME ELEVATION 100' ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 89 Lakeside Lane VENT 12" GRADE 'veway TYPAR COVERING 12" 3' 6' Q 3' i SEWER ROCK 130' 12 B -1 15' 30 . Garage 30' 10' 10' Pro 3 Bedroom House -2 12' X 54' Bed r CD B.M. 45' l - 1 See the Soil Test Done by Alt. B -3 25' Kim Oconnell on 4 -14 -97 10 M • Vent for Replacement Area • N t!i b Q r CD - Wisconsih Department of Commerce SOIL AND SITE EVALUATION Division'of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. IL _ Wis. Adm. Code X/ ('F Attach complete site plan on paper not less than 8 1/2 x 11 inches in All P1; i1'mu ,� �, MY � include, but not limited to: vertical and horizontal reference point (BM ion r x percent slope, scale or dimensions, north arrow, and location and di r ' / W c to net Pe I .D. # APPLICANT INFORMATION - Please print all infor1/ n., i + '_' S R 2d by - Date Personal information you provide may be used for secondary purposes (Privac L9w�s. 15.04( R:_ I t Property Owner GQVt. Lot Y/4 W /4,S �l T N,R 1 E (o W Property Owner's Mailing Address t # low Subd. Name or CSM# 1A19 /-17 City, State Zip Code Phone Number ❑ City ❑ Village Town Neares Road ,; Xj ILA' 0 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required .3 bed, ft 5 3 t ft Maximum design loading rate bed, gpd/ft2 MCI trench, gpd /ft Recommended infiltration surface elevation(s) O �• ft (as referred to site plan benchmark) Additional design /site considerations D/'/ D/✓ CO d i� Parent material ��� Flood plai elevation, if applicable 1 "4 ft S = Suitable for system Conventional r Moound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S El u „>zSLS ❑ U '�S El S ❑ U ❑ SU El U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots l Bed 1 Trench ��Y1 -�' v� gel a Ground 3 _ WZ Depth to limiting U fa / ct to or,{ Remarks: _ ,/ Boring # [ 3T Ground elev ft. Depth to limiting factor 1,/ in. Remarks: See- .6—/ WAddress me (Please Print g ' ure Telephone No. J r d - r5 -b „ Date CST Number Soil Test Plot Plan Project Name Shadow Creek Builders S un Bird Address P.O. Box #2.�, �,�� Hammond Wi 54015 CSTM #3922 Lot #2 CSM # Vol 11 pg 3242 Date 4/30/98 SW 1/4 NW 1/4S T 31 N/R 19 W Township Somerset Boring Q Well PL Property Line County St. Croix IL BM or VRP Assume Elevation 100 ft. Top of Steel Post with Orange Ribbon System Elevation 89.7 * H R P Sa a B Alt, BM Top of Steel Fence Post @ 99.4 Lakeside Lane riveway 130' r30' B1 30' Garage FP � Pro 3 Bedroom House CD * 45' B.M. 10 ' See the Soil Test Done by l0 Alt. B -3 25 Kim Oconnell on 4 -14 -97 M. for Replacement Area Wisconsin Department of Industry, Q y�. -- - S OIL ARD SITE EVALUATION Labor and Human Relations �� Division of Safety and Buildings O� i a Page of rL ce►rdance vG�l�s. ILHR 83.09, Wis. Adm. Code } r Attach complete site plan on paper not a an 8 1/2 x 11 inches in s4 - Plan must County include, but not limited to: vertical and onta T "epoi (W), *ection and S percent slope, scale or dimensions, no ow, and I a ' n8tstan o nearest road. ` ? Parcel I. D. # V_ 03UNTY APPLICANT INFORMATION - P a 1 11. Reviewed by Date Personal information you provide may be used for s � L , S. 15.04 (1) (m)). EPrope rty Owner Property Location Govt. Lot 1/4 1 /4,S T N,R 5'(or& Owners Mailing Add ess Lot # Block# Sub Name or CSM# C, Stat Zip Code Phone Number ( _) ❑ City ❑ village Town Nearest Road ® New Construction Use: Residential/ Number of bedrooms y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow �_ gpd loading design Recommended ��.-,� 9 9 rate bed, gpd/ft gpd /ft Absorption area required gi bed, ft2 `? trench, ft �9 Maximum design loading rate �Z bed, gpd/ft , e l e_ trench, gpd /ft Recommended infiltration surface elevation(s) n� ft (as referred to site plan benchmark) Additional design /site considerations 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 S❑ U JZ S El 0S ❑ U IM S 1 : 1 U EIS EN u F_] S [:a U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD /ft2 / Gr. Sz. Sh. Bed , Trench f / ' Ground / elev. ©_ ? /y Depth to limiting factor in. Remarks: Boring # Ground — elev. — — Depth to limiting __M in. Rem ks: CST Name Ple a Print) Signature Telephone No. Address ^- / ��i� Date > CST Number 7 ��k a �Ofz ScJ l - �l/W �`/ -s� =e // - 73 /,A/- A / j elom . . . iy 97 ys ,e ! 70 s/07 4 O '3u00iS£o00N ivaq o4 pownsse ILL u0143eS ;o IMN 9 44 40 au}} 0 4SOm 844 0 peouoio ;oi Gie SGU JR09 N O = IA 3 _ Ob 12 4 1 , g z O gN E-4 NI �3��Jb'd a� z � ILO'SLS MuZlISZo00S o � .� ,io'ss 1 90' Zfi5 � 4-J g' c W WI O z ,.O- q W ,pp W V m re) c t LL. o. .o O °D 2 o c W o p 0 U)I C N g o O w c. Wi w 14 % x V Q.. nHf Y I O� n In 14 8 JI C4 z v C I i LU W ISS'9LS 3u00iS£o00N w Cn O Cn 185'£h5 ►L- A 4J — .00 cs ; J - N W �1 .. I." it _ILL a Ln rn UN .� t0 to '- _ O O N ZI Ui C X LL� <1 U b U W 00 W 6 atT y� O JI M Lij LO C +! O O L N L e g +f if N N y�j IA N IAN I I � 109 • aas l J 3 109 *LLS 311OOIS£oOON t 41 0 4-) C N Q1 V N O x L O M 0► J <Oo <O M + 0.O Ip�� ..^ u N 1AN 1AN y $4 U 014-► 1 Z9' ShS 3 11001 S£ o 00N Lzn _ 3u001 S£oOpN L 1 lL 8 3 S£ o 00N b N _ v.. a r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND O� CERTIFICATION FORM Owner/Buyer <>�(140 C�� . % yDc -- (� jQ,ft Mailing Address Pa, 3v Property Address �� Lfx oe (Verification required from Planning Department for new construction) 7 c City /State �(,�y� >/-T, r Parcel Identification Number LEGAL DESCRIPTION Property Location Si.J %,, _ p4u) y Sec. JL, T_jLN -R Iq W Town of Subdivision Lot # — Certified Survey Map # Volume , Page # Warranty Deed # _ '7 �/ , Volume ,Page # Spec house ❑ yes Pj�to Lot lines identifiable kyes ❑ 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, restricted plumber 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. 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. SIGNATURE OF ANT / 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, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF ICANT 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 A n7, FILED F I I L LED b _b PR 2 3 1 9 4) T 11 w U., IPP 2 3 1997 0- KATHLEEN H. WAL%f ea 0 % " Re D Co , S Cro ix c o.. W L CMU C M 558.373 0 tlq 0 0 U_ 0 -1 UEL IT ED LAND �l 0 (D 0) 0 11 11 7 U) WEST LINE OF THE NW 1/4 rt (D h H. (D ¢l N00 I 0011E rt. NOO 578.71 .25 cn R06o35_ 'lE _5_45_.621 rt- tw �n Q :e cn z rt O c Ln l F V 0 0 '1 0 0 ct n pi 4- 0c) w P. -.0 Fl- Fil C, r— w M M w 0 " 0 0 -, 0 w (D cn 0 -1 t7 r 7 0 0 (D rn m _h X _n :7 ct ct N !, rt :4 &< P*- ft F M M 3S 3S J m z ,Ln IC o 0 IF N00 577.601 33.00 (n (t II I> 0 544.601 0 (D U) CD 00 00 U) IFT1 z co OD C) OD a 0 0 JCD 00 0:) (:, P13 0 0 > > 0 C) CO sv 1, 2 r-2 T Fil (n m b CD rii m . — ___q 0 0 IF 0 a C _n x _n =1 m L4J W N � IC7 U) uj �n C) I(J) W E f —n Ln f1 m `2 F �l C 33.00'— rt t= 54J.58 0 C/) N00 o35'00 "E 576.58 rt m (D 0 > t rt li Ln -4 W OD Im 0 o r) > > 0 -P c 0 kD 0 ct ct CD MIM co 0 0 Cr W 0 c 3 m l < Q. :3 _n X _n m 00 00 ct 0 ct 0 _0 (n 117 a) a 0 0 CD ct (A rt 0) It 0 m 0 . :3 1 77 * m 0 2. 0 N X , (D U:) 0 CD f-4 C3 coo rt —4.3't H 542.061 33.01'— 0 0 c 0 S00 575.07 z oc, 07 C7 r ST. WISCONSIN COUNTY ° a bay ►►, „� _ ZONING OFFICE ' ST' CROIX COUNTY GOVERNMENT CENTER _ Nor +6 - •-- , , 1101 Carmichael Road - Hudson, WI 54016 -7710 (715) 386 -4680 August 24, 1998 Shadow Creek Builders P.O. Box #2 Hammond, WI 54015 RE: Septic Inspection for Shadow Creek Builders /Bill ense 617 Lakeside Lane, Town of Somerset, St. Croix County located Y, Wisconsin To Whom It May C oncern: ern: A septic inspection of the above referenced property was condu cted on June 15 1998. This Property is located in the SW/ of the NW/ of Section 11, this septic systtee m was found T31 N -RI9 , St. Croix County, Wisconsin. At the time of the inspection W' T ° of Somerset, to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, � Mary J. Jenkins Assistant Zoning Administrator AM