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HomeMy WebLinkAbout032-2100-30-000 !' N ar ° o I N i r O Z (D 0 Z C _ U. m LL c O Q I O a) Z E O) O Z .. - O (L m N H Cn C O '° U O Z d C d Z C ° Z c � � N � O m 0) 6 O N ''. a) C a1 O O a) Q O w--- Z m Z 0 N E N �1 _ �i Y ~ 4) N C 0 N d ►�- N C O 0 U O G G a Q C N j LO F FN- 3 V r- d w o 00 0 a 0 Z° a N m au o N E } (A U U 0) "mil o �r ro CO O E U) O O O O 5 � m � a a w a) S ; v CD m LO Ai O O Vl Vl �'i O C H C O o m ° 0 o 0) C a N !-1 CV co a) V1 y R L a d • CC Q. a) .V d w C O I A U d j'I O N U ST. CROIX COUNTY ZONING DEPARTMJF�N AS BUILT SANITARY REPORT Owner 114 Address City /Stat Legal Description: Lot Block Subdivision/CSM # '�' Sec.d /, TAN -R.&W, Town of _ s�.�K�s�� PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer - Size ST/PC Setback from: House Well — P/L Pump manufacturer Model _ i �� // 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 _ O ng , 5 _ Number of Trenches Setback from: House Well P/L Vent to fresh air intake love ELEVATIONS: Description of benchmark nchmazk > � Elevation Description of alternate benchmark ,1 f t9 , �� , Elevation Building Sewe ST/HT Inlet 95,x- ST Outlet �-/_ PC Inlet PC Bottom Header/Manifold L2ff Top of ST/PC Manhole Cover 42,, 7 Distribution Lines ( ) 9�S'y� ( ) ( ) Bottom of System( Final Grade Date of installation / /� / P rmit number 3i S � — State plan number Plumber's signature License number - U Date Inspector c•o,,,pi«c plot plan .r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety,and Buildings Divi sion y: INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315962 Permit Holder's Name: El City ❑ Village Town of: State Plan ID No.: ANDERSON, NEIL /PYLE, MARCIA t SOMERSET CST BM Elev.: ^ Insp. BM Elev.: BM Description: Parcel Tax No.: f 032 - 2100 -30 -000 yy TANK INFORMATION V ELEVATION DATA A9800351 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Se ti W D1)`0 Bench �. (� 021 I D O Dos' t +. (zvrvt 4y 7o3 '7917. Aeration Bldg. Sewer A w W I 9a / Holding St /Ht Inlet c r, <v,',� 9d S TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet Gf 9 y'o1 ya— ep is tJ (A 3 ICJ' A, NA Dt Bottom 5 1 a. ba t(i -37 Dosin NIA 4(; NA Header /Man. (U.z•f9 q Aeration A Dist. Pipe r �i r ra 6 -70 Hold Bot. System r 10a•8 ? 5 5 c j�•(o� PUMP/ SIPHON INFORMATION J j y Final Grade )00.(16 4.OS Manufacturer Demand S4, PActo ht, 60 _� °��,� 6.1 a 0 Model Number -7 7 L qS GPM TDH Lift /() Lriction�� System TDH /35 Ft rl e Forcemai n Length Z ZI Dia. Pit Dist. To Well SOIL ABSORPTION SYSTEM BED ENCH Width Length NO.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N i 2 DIMENSION SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREA JEACHING JaR raref INFORMATION Type r CHA Sys e 2 pr OR UNIT DISTRIBUTION SYSTEM Header / Manifold �� Distribution Pipe() � x Hole Size x Hole Spacing Vent To Air Intake Length V Dia- Length ! Dia- 'r Spacing _ r jI (.} S Z 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.) 2_�?_ /a 3 LOCATION: SOMERSET 26.31.19,SW,NW 1954 62ND STREET — PINECLIFF LOT 13 At 4 - 6 — Tap b 4c* Zv. r — U 6l iIircw,eA . Plan revision required? ❑ Yes No Use other side for additional information. Q 1 14 R d SBD -6710 (R.3/97) Date Inspector's S gnature rt. Safety and Buildings Division ,• SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue 106onsin 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 than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information ou provide may be used for seconds purposes � g a y p y secondary p rp ❑Check if revlslon to revlous application [Privacy Law, s. 15.04 (1) (m)]. s� State Plan I.D. Numb 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 2Propertyc r Name Property Location 1/4 1/4, S T , N, R f/(or& - ' Mailing ddre�s Lot Num ber Block Nu er Zip Code Phone Number Subdivisio Na o M Number OF BUILDING: (check one) ❑ State Owned 0 c ity Nearest Road Public P4 1 or 2 Family Dwelling - No. of bedrooms ❑ village �pa "! S�• Town OF III: BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment/ Condo a(J�9 , 3 i . i q . 75 e-L� - c;2 / 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 online A. Check box on line B, if applicable) A) 1 aNew 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 (A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit �a X SS 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 (s .) (Gals/day /sq. ft.) (Min inch) Elevation Feet Feet Ca ut VII. TANK in g allons Total # of r Prefab. . Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name concrete con- steel glass Plastic App New Existin strutted T nk Tanks Septic Tank r Holding Tank ❑ ❑ ❑ ❑ El Lift Pump Tank iphon Chamber -- r ❑ ❑ I ❑ I ❑ ❑ VIII. R STATEMENT I, the undersigned, assume responsibility for i tallation of the onsite sewage system shown on the attached plans. Plumb 's Na e: (Pi s Si nt) Plumb i ure`. (No mp MP /MPRSW No.: Business Phone Number. Plumber's Address (Street, City, State, Zip de): 1t',0 "Idw 14 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue ssuing Age t Si re (No Stamps) A roved G Surcharge Fee) pp El Given Initial ©t� Adverse Determination ! 2�� X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: tifSy '�E i � t 1g�4fe— r �- -4&t, S ,�, (Oc w�, (�r ca� S ,�...e so, /S �l SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber /-99 � 3 �I i J a • I ✓r '� �,t�pk PSAnI PAGE OF PUMP CHAMBER CA055 SECTIO►J AND SPECIFICATIONS VENT CAP VENT PIPE WEATHERPROO /►PPROVCD LOCKING JUMCTIOM BOX K w WHOLE COVER YVITIt ZS' FROM DOOK. ARNING LABEL WINDOW Olt FRESH It�MIU. AIR INTAKE GRADE I y" MIIJ. I COWDUIT - - - - -- _ -- - - - - - - -- ::9 PROVIDE 1 - - - -- LET AIRTIGHT SEAL I i I v APPROVED JOINT A I I APPROVED JOIN? W/ PIPE I I W/ ' PIPE EXTENDIU(m 3' I I ALARM EXTE►JOING 3' ONTO SOLID SDIL B I 1 j ONTO SOLID SOIL i I OIJ ELEV. FT. PUMP � b OFF 0 COUCKETE BLOCK - - KISER EXIT PERMITTED OQLy IF TAIJK MAUUFACTURCR HAS SUCH APPROVAL 3" APPAoVE4 6£CDIn+G under T r4NK SEPTIC E SPECIFICATIOUS DOSE TAIJKS MAIJUFACTURER: (DUMBER OF DOSES: _PER DA-4 TAW SIZE: GALLOIJS DOSE VOLUME ALARM MAUUFAGTURCit: -T �- /� � ��G�� ,T�t/�' IMLLUDIMG DACKFLOW: Z_X - � G ALL0NS MODEL IJUMBEK: LL2,1 � CAPACITIES: A= 24 OR GALLONS SWITCH TYPE: L-_ B= -2- IIJCHES OR L GALLOWS PUMP MAWUFACTURCK: G =__INCHES OR GALLONS MODEL WUMBER: D. _f INCHES OR GALLOIJS SWITCH TYPE: i 1 MOTE: PUMP AMD ALARM ARE TO BE MIWIMUM DISCHARGE RATE _�Y INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFE BETWEEIJ PUMP OFF AMD DISTRIBUTIOM PIPE - FEET + MIIJIMLIM METWORK SUPPLY PRESSURE . . . . . . . . . . . FEET + k2Q FE ET OF FORCE MAIN Y >On ri FACTOR.. FEET TOTAL 0 HEAD = -Z: FEET IIJTERIJAL OIME S►OIJC /OF ►JK LEIJGTM i\41DTIN ;LIQUID DEPTH SIGIJEO: LICENSE NUM8CR; � � j OATE: Gn Perfurniance ' Curves P u mp s METERS FEET 00 - — MODEL 3885 SIZE 3 /4" Solids WE15N — — 70 20 WEIGH — -- 60 O WE07H f. — -- — t5 WE05H - 40 10 30 WE03M 20 WE — — S 10 0 0 =F + 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L p 10 20 ml/h ry CAPACITY 4 �M1i•� ''�'�`Rlri. + 4E� "".,., 'Q� ;ii�� ��' ,. ..s '� ;' s.� 1 �'l � I, r GOULDS PUMPS, INC. J`J V;�E Faus ntw rliw METERS FEET 120 MODEL 3885 35 — SIZE 1 /4" Solids 110 WE15HH 100 30 — 4� -} 80 70 — 20 - -- - - - -- - -�. 7 60 o _ ~ WEOSHH 15 SO 40 10 30 I 20 10 0 L 0 -- — 0 10 20 90 40 50 60 70 Gi 90 1(4 110 120 GPM L L p 10 20 90 m'/h CAPACITY • 1 Gou10• Pumps, Inc. 980C4v0 duly, 1 Wlb C)11' -Wisconsin Department of Industry SOIL AND SITE EVALUATION Laborarid human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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. # '� rua 4'� r� APPLICANT INFORMATION - Please print all information Reviewed by e.;' , . ; . ate Personal information u provide may be used for secondary ' "' yo p y ry purposes (Privacy Law, s. 15.04 (1) (m)). � � � Prope Owner Property Location Govt. Lot 1/4 1/4, ,� "Y'';Nf3 CEv ��, Property Owners Mailing Address Lot # Bloc # Subd. me o a Stalls Zip Code Phone Number Near es J ( ) El pillage [Z Town ® New Construction Use: ® Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � .'16 gpd Recommended design loading rate bed, gpd/ft -,2— trench, gpd/ft Absorption area required _ bed, ft trench, ft Maximum design loading rate _ bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) %s 77 ft (as referred to site plan benchmark) Additional design /site �/J considerations Parent material ZiS zz'l".rs" _"- le 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 Q S ❑ U Z S ❑ U [2 S ❑ U ® S ❑ U 1:1 S ID U ❑ s ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench , -" AlY 7; Ground elev. 8 _ _ Alf Depth to limiting factor 8_ 1n. Remarks: Boring # -/ 7 Ground elev. Depth to limiting factor Zain. Remar s: CST Name (Pie s rint) Signature Telephone No. Address Date CST Number �d l k S &Ps j -s�/ L .3-7 i�r I. 60 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ,,11 / OWNERSHIP Ct� RTIFICATIIO FORM Owner/Buyer N uyer Ei Mailing Address 0 (�ec� �7 �dmP� (.JT • 5�� Property Address 2'/ n (Verification required from Planning Department for new construction) City/State 1 l"f6P �, G)1 . Parcel Identification Number LE GAL DESCRIPTION Property Location A '/4, /164) '/4, Sec. ;2�, T 3 N -R ! y W, Town of Subdivision Tl�_)G G //T , Lot # I3 Certified Survey Map # 5� Volume , Page # Warranty Deed # Volume , Page # Spe• house ❑ yes,9no I-ot 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 affr_ct 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 11 -ensed 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 fitll of sludge. Uwe, 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 Of'tice within 30 d�Vs o the three year expiration date. /'?9 SI NATURE bffAPPLIC 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. _ 7 / V/ 99 STQbATURE Ot APPLIGOT 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 G " 1 � r' r UTILITY EME= 12 No pole or buried cables are to be placed such that the 66 N< installation would disturb any survey stake, or obstruct vision along any lot line or street line. 9A The disturbance of a survey stake by anyone is a violation `\ 9 of Section 236.32 of Wisconsin % 0 Statutes. Utility Basements as herein set forth are for the use of ublic bodies and private public utilities %o ��� having the right to serve the 00 \ to ` area. F 41 \\ \ \ BI F BA '� N87 ° 2026 ° W �M 66.00 &0 15' ! /5' \\ PV8`1C 9 8 BH BB BG O 30' \ 4 2 � p , o, wlo �v EgSF1yENNTfNq\ �' 1 \ / 3.13 ACRES 1 36,282 SO. FT 1.30 AC. EXC!/ o ESMT. BD / 56,769 SO! FT. d 13 4 S3•� DIKE � 6 HWL 840 t 6' 1106: 3.80 ACRES 6 165,410 ST / � 0" 0. F 1.71 AC. EXC. ESMT/ F2' 7 4,669 S0. FT. J yg3 / M 9 3' 60, (n 0 rV �(V N / / N / °° M Co� o0