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HomeMy WebLinkAbout032-2099-30-000 ST. CROIX COUNTY ZONING DEI'ARTMEN AS QUILT SANITARY REPORT R `l . Owner Address; 7 `T CRi3tX City /State E cauNry ZONING OFFICE Legal Description: Lot �_ Block -&,& Subdivision/CSM # '�� 1 '�• -, Sec. - , T2LN -RJ_2_W, Town of S PIN # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/ Ig Setback from: House /I Well, P/L Pump manufacturer Model ij 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 Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS: Description of benchmark e �' / T Elevation Description of alternate benchmark Elevation Building Sewer S c ST/HT Inlet A� , / ST Outlet - /,� ; PC Inlet Y PC Bottom /, O ; Header/Manifold 9�. 9y Top of ST/PC Manhole Cover Distribution Lines ( ) �S; 97 O ( ) Bottom of Sy Final Grade ( ) 9 ( ) ( ) Date of installation / I�Z / P mit number _]L2 D�'l State plan number Plumber's signature �� License uumber 5' Date // / Inspector _ Complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division k . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitasy�e�rribV-: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. 33 U LL UU yy Permit Holder's Name: p Cit ❑ Villa e Town of: State Plan ID No.: ALE, DAVE SORERSE'I� CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel &JPq -- '2099 -000 ti TANK INFORMATION ELEVATION DATA A9800397 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 5 Bench a k9 1 Op 1! o n (Aj - e-2_-S Aeration Bldg. Sewer Holding t Inlet TANK SETBACK INFORMATION S _0 Outlet l 67 Tq 83 TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet C Air Intake tic -4 1�t l3( A T0_ NA Dt Bottom Dosing l� /L/ NA Header/ Man. Aeration A Dist. Pipe �6 53 Holding Bot. System c�s PUMP/ SIPHON INFORMATION Final Grade C� Manufacturer ��� Demand Model Number W WII I (I 3 GPM TDH Lift(�,y Fri Ctiona System TDH/ % a) Ft Forcemain Length (/ Dia. Fi a Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS laDIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STR LEACHING Manufacturer: INFORMATION Type Y eO 7�/ ,� ��� OR UNIT Model Number: 3S' ,;cC 7 DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size Hole Spacing Vent To Air Intake Length ( Dia- 4 Length �0 Dia. `f Spacing 1 56 µ A_57`" x Z7 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded x Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) III el - LOCATION: SOMERSET 26.31.19,SW,NW 1974 62ND ST — PINECLIFF LOT 3 a• ��I C Cca�t �` b uUIt e quired. v Plan revi in r g E] Yes D-No 1 / / Use other side for additional information. 1 1 - 7 / 7 SBD -6710 (R.3/97) Date InspectoiQ Signature Cert. No. Safety and Buildings Division N* iconsin SANITARY PERMIT APPLICATION Po s W ashington �n n Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/z x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs E] Check Check it revi§ previous application S /7 [Privacy Law, s. 15.04 (1) (m)]. vin _ State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Na Property Location t/a 1/4, S T , N, R (or Property Owner's Mailing Addres Lot Number _ Block Number' _ 3 City tate Zip Code Phone Number Subdiv n Name orfAM Number i II. TYPE BUILDING' (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 0 1 or 2 Family Dwelling - No_ of bedrooms d Town OF III. BUILDING USE (If building type is public, check all that ap Parcel Tax Number(s) 1 ❑ Apartment/ Condo I� (f. 3/- / / • % 0 70 9`? 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 S ❑ 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. M New 2_ []Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an _____System ________System _____________Tank Only__ ________ ExistinQSystem - - _ - - _ - __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 JS 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. / , Rate Elevation 3 }' 7 Feet Feet Capacity VII. TANK Ca i allons n Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin structed Tanks Tanks Septic Tank r Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank iphon Chamber -- Ea ❑ ❑ I ❑ I ❑ I ❑ P NSIBILITY STATEMENT I, the undersigned, assume responsibility for in Ilation of the onsite sewage system shown on the attached plans. Plumb is Na e: (Print Plumb is ' n VPJNo S s) MP /MPRSW No.: Business one Number: J - - -i Plumbers Address ( eet, ity, State, ip Code): Ir I COU NTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issu a Ignature (No Stamps) Approved ❑ in Surcharge Fee) 3 7AK' Owner Given Initial 1 ? 6 csU Adverse Determination X. CONDITIONS OF APPROVAL / REASONS F R DISAPPROVAL: S80.6398 lP 1U98) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, f kuvd r o 'Too 2 ,jl Sys c, G?,�GE PAb E of PUMP CHAMBER CROSS SECTIO AND SPECIFICATIONS VENT CAP VENT PIPE WEATHERPROOF APPROVED LOCKING JUIJCTIOM box MAWHOLE COVER W ITM Z5' FROM DOOR, VJAKNING LABEL W14DOW OR FRESH IIU. AIR INTAKE GRADE y.. MIAJ. COUDUIT la•MI►J. �\ ---- - - - - -- PROVIDE ( -- -- IAJLET -T AIRTIGHT SEAL i APPROVED JOINT A i III APPROVED W/ PIPE I I � I EXTE►JDIWG 3' EXTENDIWb 3' ALARM OWTO SOLID SOIL B II ONTO SOLID SOIL I I I ow C i (, CL.EV. FT. PUMP -� - -i b OFF 0 COWCKETE DLOCK RISER EXIT PERMITTED OWLH IF TAIJK MAIJUFACTURCK HAS SUCH APPROVAL B" t NfPRoVEN $ECCIn+G "ndcr T►'t►.IK SEPTIC E SPECIFICATIOKJS DOSE /, TAWS MAWUFACTURER: ALe IJUMBER OF DOSES: PER DA.4 TAW SIZE: GALLOUSS DOSE VOLUME ALARM MAIJUFACTUKER: �� U INCLUDING 6AGKFL / W: �5� -� GALLONS MODEL MUMCEK: /1�� ,', I � CAPACITIES: A= c,Z OR S /9l GALLOUS SWITCH TIM: B= IWCHESOR GALLOWS PUMP MAUUFACTURER: C.- 9 INCHES OR 1Td GALLOWS MODEL AIUMBER. D. INCHES OR GALLOWS SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO DC MWIMUM DISCHARGE RAT GPM INSTALLED O)J 5EPNRATE CIRCUITS VERTICAL DIFFEREN OETWEEW PUMP OFF AWD OISTRIBUTIOM PIPE.. _ 2 FEET 4 MI►,IIMLIM METWORK SUPPLY PRESSUR ✓ . . . . . . . . FEET + / FEET OF FORCC MAIN X�F,GOrr.FRICTIOU FACTOR.. FEET TOTAL D HEAD FEET IIJTERUAL DIMEWSI M OF TA LC14GTH ,w IDT'H jLIQUID DEPTH SIGIJED: _ LICENSE NUMBER: ,=22:g2L-z OAT EN.' =`1_� Pedormance m u e n Z Ji Curves Pumps e Mmits FEET — - — — MODEL 3885 25 60 SIZE 3 /4" Solids WE15H — - 10 20 WE10H -- C - - 14 60 - WE07H — — - f. -- — 15 50 WEOSH 40 - -- — 10 30 WE03M - - - -- -- - - — { -- - 20 WE03L - S 10 0 0 +7t 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m'/h CAPACITY °'.,I GOULDS PUMP u S, INC. METERS FEET 120 MODEL 3885 35 — SIZE 3 /4 " Solids 110 WEISMM 100 30 90 25 80 70 60 = — ~ 50 WE05HH 15 40 IN 10 30 - Ix 20 0 0 1._ - F - -- - 0 10 20 30 40 50 60 70 Wj 90 1w 110 120 GPM L 10 20 30 m'AI CAPACITY •1"6 Gould& Pumps, Inc. E4o" July, I C3611° Wisconsin Department of Industry SOIL AND SITE EVALUATION 'Labor and Human Relations 3 4 e of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. `ti s 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D Pi -- jU�� APPLICANT INFORMATION - Please print all information. Reviewed � C*' tNT{ D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). zpNtNG pFFICE Prope Owner ) Property Location * ;,► Govt. Lot 1/4 1/4,S !�' T - -� (orl�p Property Owner's Mailing ddress Lot # Block# Sume or C 1 � 7 City State Zip Code Phone Number Nearest Road New Construction Use: 1 Residential /Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow -4:;CM Z gpd Recommended design loading rate _ bed, gpd/ft gpd /ft Absorption area required _ bed, ft . sD trench, ft Maximum design loading rate bed, gpd/ft � trench, gpd/ft Recommended infiltration surface elevation(s) 25 7 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Zg l'(�C Flood plain elevation, if applicable At ' ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S U © S ❑ U ® S ❑ U [Z S ❑ U ❑ S ® U ❑ S 0 U SOIL DESCRIPTION REPORT Borin g # Horizon Depth Dominant Color Mott Texture Consistence Boundary Roots Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench C / " UZ j Al Ground elev. Depth to limiting factor ,22in. FT Remarks: Boring # I 3 Ground 1 elev. Depth to limiting factor 4�in. Remarks: CST Name (Please Prin# Signature j Telephone No. Address Date L CST Number rs , Y'e sc : 36 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ''//OWNERS HIP CERTIFICATION FORM Owner/Buyer �� JC ACA H ft-f- Mailing Address 1,/4at0/, -A�, colr- S��l Property Address Z- ,2` ' (Verification required from Planning Department for new construction) 5 L— City/State Jpn 2�T , G' Parcel Identification Number 9�- LE GAL DESCR b�y Property Location e '/4, SE /4 ', Sec. , "1 N -R�W, Town of N J'07l1�.�ET Subdivision _ 1 e (''/ )g�r , Lot # Certified Survey Map Volume ,Page # Warranty Deed # Volume , Page # Spe house ❑ yes Kno Lot lines identifiable O�yes ❑ no SYS " EM 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 aff_et 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 master plumber, journeyman plumber, restricted plumber or a 1 i - pumper verifying that (1) the on - site wastewater di >posal 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 d of the three year expiration date. /'A SIG ATURE 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, by virtue of a warranty deed recorded in Register of Deeds Office. /�-67 SIGNATURE 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 T -'a VOL M'AR -R;k' Y V DEED _ D ocument Nufnbc. - - REGISrLR'S flr'nCE ST. CROIX CTY." t w9v ,wro -A r Return Address JU 2 3 199 10 :45 A M 411 Parcel I.D. Number: ~' a: Pinecli.ff Partnership, consisting of Michael J. Hartman and Wendell V. Viebrock, conveys and warrants y to David J. )Elate and Kara E. Hale, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wits .vnsin: ; Lot 3, Pine Cliff in Town of Somerset, St. Croix Cx:nty, Wisconsin. 0 !_ This is not homestead property.'' ' W (Z'. Exception to warranties: Easements, restrictions and rights -of -way of record, if any.« Dated this day of June 1997• , T Ali ER j so Pinecliff Partnership (SEAL) y, Michael J. H an -' AUTHENTICATION ' Signature(s) )Michael J. Hartman for Pig tiff r� Partnership authenticated this _+ V� day of June,:` 1997.' Xf Kristina Ogland TITLE: MEMBER STATE BAR OF WISCU":SIN j THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54015`° OD dsT, Cw L —bf IL r. • f' a � � . >, .. � � 23.x•33 ® 1C1��G L%F'r ROUTS L - '� t � SLO Rs r s _I PINE CLIFF LOCATED IN PART OF THE NWI 14 OF THE NWI /4, PART OF - -f SWI 14 OF THE NWI /4, PART OF THE SEI 14 OF THE NWI 14, PART OF THE NEI 14 OF THE SWI 14 AND PART 7F THE NWI 14 OF THE SWI 14 ALL IN SEMON 26; AND IN PART OF THE NEI /4 OF THE SEI 14 OF SECTION 27 ALL IN T31N, R19W, TOWN OF SOMERSET, ST. „ROJX COUNTY, WISCONSIN. �., 1\ 4gr 3 !4' i�. r ,. rc '. •wo w .to r w..a: ' arsc �7.::L: ^ •.5 :. .._w ot'. 1 :.�•'r> r, t� ... .... T OtOK ° F r0 rK N.\K Tw•e• °rrK. f.f'o ♦t.'[ ].,rl 1, � « u I I rJ ry! • 11: P. Y It t • Fl if i% !t Y • r! , LOCATION SKETCH ti ; ' (,y .. `p SECiION . iSIN 11r9w P .a OUTLOT I / \ ' �A F' 11» fl 1O 1•..,. wl �' W •°N �. w, •N.. u. r , � p.r t Ix. 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