HomeMy WebLinkAbout034-1042-40-000 e /
ST. CROIX COUNTY TONING DEPARTMI' ''"
AS BUILT SANI'T'ARY REPORT
Owner .� "V
Address 47
r
City /State [a D,,� �n,�.o��
Legal Description:
Lot Block Subdivision/CSM #;
Sec - T -RV, Town of IN # = 4 Q -cam
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer
�� r � �`' Size ST/PC / Setback. from: Hous ell > 3 'ZP/L ; �� 0 V�
Pump manufacturer Model / J� - j
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: i�e/IC; Width Len %J
Len Number of Trenches
Setback from: House .��ell /L Imo Vent to fresh air_ intake 6e Ca
ELEVATIONS
Description of benchmark _ l j�' c Elevation
Description of alternate benchmark Elevation
Building Sewer �'� ST/HT Inlet IEif rc� 6 . ST Outlet V PC Inlet —�
PC Bottom ,5� Header/Manifold / J Top of /PC Manhole Cover 4!�3 , 1
Distribution Lines( )
Bottom of System( ) _�'I / : /,�, ( ) � , r L17 ( )
Final Grade ( ) ( ) ( )
Date of installation 7/�/ Permit nu ber �cf � plan number
Plumber's signature r se number 9`/# Date /2
Inspector
Complcic plot plan
Wiscon$in Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 37.5876
Personal information you provice maybe used for secondary purposes [Privacy Law s.15.04 (1)(m)].
Permit Holder's Name: ❑City ❑❑ Villa e Town of: State Plan ID No.:
WEYER, JIM & MARY SPRINGF�I D
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Ta No.:
�- -T r�J34- 1042 -40 -000
TANK INFORMATION p ELEVATION DATA A9800264
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic D Bench k $
100• (p l 0 O
Dosing /
Aeration Bldg. Sewer
Holding -- -- /1A Inlet
TANK SET BA K NFORMATION /fit Outlet 773(
TANK TO L WELL BLDG. Air I to ROAD Dt Inlet 77 16 -� Cf 7
Air Intake I b
Septic U r It* Z0' /,�/k NA Dt Bottom 31 �0,�3 _�. o
Dosing ) ( / NA Header Ma . , ��
3
Aeration NA Dist. Pip how •7 .7.gs a
Holding Bot. System `pp Y' 5 / 4
9.13 V7
PUMP/ SIPHON INFORMATION qa V\ Final Grade `bW CQO 6 Sco G iSl�
Manufacturer oP II� Demand -7 (0 93
Model Number 3 0 GPM I 1 Z 77;31 23.5 '77
TDH LiftJ.S.q Lrictiorg2q System Qf i TDH 132 3
Forcemain Length Loo Dia. j �D ist. o Well
SOIL ABSORPTION SYSTEM 1.5
BED N Width Length --i No. Of Trenches PIT No. Of Pits e Dia. Liquid De
DIMENSIONS 7 DIMENSION
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM
LEA ING Manufacturer:
INFORMATION Type o f ,� CHA BER Model Number.
System O i l g 8 3 _� Slx� "'- OR UN
DISTRIBUTION SYSTEM
Header / Manifold f � Distribution Pip e(+) r x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length 7® Dia. Spacing --b— /� (�/� SL z 2)
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.)
LOCATION: SPRINGFIEL 18.29.15.282,NW,SW 929 CTY RD D
Plan revision requi ed? ❑ Yes No
Use other side for additional infor anon. ` �� ' -1
SBD -6710 (R.3/97) Date Inspector s Si ature Cert. No.
SANITARY PERMIT APPLICATION 20 Safety and 1E.Washington Ave
Vi sconsin P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
P Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 v2 x 11 inches in size. C/1'
• See reverse side for instructions for completing this application state Sanitar Permit Nu
The information you provide may be used by other government agency programs E] Check if revision o p revious 5pplication
[Privacy Law, s. 15.04 (1) (m)]. EOWVIL , State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N
Property Owner Name Propert Location
4 )
'e- �� IQ 114 ;,j 1/4, S I$ T 29 , N, R S SE (or)
Pro e w er's MailincfAddress Lot Number Block Number
L City r Statfe Zip Code Phone Number Subdivision Name or CSM Number
11. YPE F BUILDING: (check one) ❑ State Owned o vi a �L t Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF J
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo fig- a I ? - /S . a 8 a 3 `%
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..0�,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
12f!rSeepage Trench 22 ❑ In- Ground Pressure 1 42 ❑ Pit Privy
13 E] Seepage Pit — �1 - 7 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/5q. ft.) (Min_/inch) Elevati n
b *v ^, Feet Feet
VII. TANK in Ca gallo clt
allo s Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App
New Exist in structed
T nks Tanks
ptic Tank wi ❑ ❑ ❑ ❑ ❑
um Tan ber l r 5, ]` ❑' I ❑ 1 ❑ 1 ❑ I ❑ 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) , Plumber's Si ature: ( o Sta ps) MP /MPRSW No.: Business Phone Number:
LA, � n c ss ' - .� 7/ �� m ar _ 3 73 Zr
Plumber's Address (Street, City, State, Zip Code 1,9 Li
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitar Permit Fee (Includes Groundwater 57R l issuin/Al.ritsig ature (No Stamps)
Surcharge Fee)
Approved ❑ Owner Given Initial /� OZ'
Adverse Determination V
X. CONDITIONS OF APPROVAL/ REASONS FOK DISAPPROVAL:
Sl1Dfi396 (RA 1196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
SX b r
T
eTA D
i11 w ~��r s
I
PAGE OF
.ICC)IL)I
v
Meth Alr 11-1914 And Obto radon flips
"-- Approved Vent Cop
Mlnlm�m 11 Ahp.t
I lr �l l.r 1-A•
Irl - 41' Ab— Pipe _ _ •" Coal Iron
to Flnal Grad• Venl Pip*
Mar r1- /loy Or S nIh.11C Cort'I —
uln Z" Ao9rwor
Or#r Pipe
Dluribullon --
Plp� 0 0 0 0 0 — T�•
6 Apprspol: o P:rlorofod Pipe Below
f4n6olA Plp� _
u Coupling Tuminallnp At
Bottom Of S JIIem
SOIL FILL
QIS 1' I l l PIPE
APPROVED ,S4Mj'1IETIC COVER
r i' 11r• " — — MATF -RIAL Or q" or STRAW
2 "OFAGG9r6A7C - ) %� OR M ARS" NA`J
EL EV. O ` / �FE 1 4^r yiir� \�� .GL �1/,
A
Pill l F! n r) t 1' A I 1' I/ F , (? I! t /1 T I_ E n; 7 L^ 1 C O NA/ O R I G I*AA L G,R A,O.E
LC I. %UT ti /A Qrl I- 1;it IP,m q I.A1,CY ,fit LGW F,IJJ ^L r
MAXIfIV,M oEP r1{ r) r F XcAv/\rjoo rKom OKI &WAS 69ADF WILL e+L
MIcf1 Ulf?
Pff 1-i 01 EAILWAT ION FR Ge,I6I,HAL 6,49L WILL_ BE 3 INc uE s
LICI - USC - kIUMRF R' � 49-
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4 "C.I. VEtJT PIPE
WEATHER PROOF APPROVED LOCKING
2s' FRCM DOOR, JUNCTION BOX MANHOLE COVER
'-
WINDOW OR FRESH
AIR IAITAKE
GRADE
I `1 MIN
IB "mild.
CONDUIT -
1�11_.F_l PROVIDE I - - - --
T AIRTIGHT SEAL I III
II
APPR.OVEC JOINT A I I APPROVED JOIIJTS
W /C.Z. PIPE. I III W /Ca. PIPE
EXTENDIAIC. 3' I II ALARM EXTENDING 3'
OMTO SOLID SC:L. B I II ONTO SOLID SOIL
I i
I I o
C I I
I
OFF
D
L� CONCRETE BLOCK
RISER EXIT PERMITTED GKJLy IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFICATIOMS
SEPTIC AND
DOSE TAN Al MANUFACTURER: ," N UMBER OF DOSES: PER DAy
TANK SIZE: ����� GALLONS DOSE VOLUME �s � .0.0 x -.4
ALARM MANUFACTURER: ^,�"�4_ N�LUDING 6ACKFLOW: a310 GALLONS
MODEL (DUMBER: le / (. CAPACITIES: A =
INCHES OR GALLOWS
SWITCH TYPE: �? c -�!!�` '7 �Z
= INCHES OR � GA'_LOIJS
PUMP MANUFACTURER: De C . INLHES OR GA_t_OU5
MODEL NUMBER: l ` 3 D- INCHES OR GALLONS
SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHAR`E RATE GpM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE B 1�IEEAI PUMP OFF AND DfSTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE 2 . 5 FEET
-ti~ 2 FEET OF FORCE MAIN X v �L ' { F7
�o fTFRICTION FACTOR.. .?14 FEET
'�( = TOTAL DYNAMIC HEAO = FEET ,�hL�7
INTERNAL DIMEIJSIONf: OF TAAIK: LENGTH a° ;WIDTH -1CZ / - ;LIQUID OEPTH_�
51GQED:_ _� LICEWSE "UMBER. 6 DATE: 2
-117 -
; 2P.
I�L/AL/TY PUMPS SNCE Iff,79 �"" O Supers007p'r
Product information presented here
reflects conditions at time of 3280 Old Millers Lane
publication. Consult factory regarding 1939 0 t 1989
discrepancies or inconsistencies. P• 0. Box 16347 • Louisville, Kentucky 40216
(502) 778 -2731 • FAX (502) 774 -3624
COMPARE THESE FE TI(RFS ( `' 161 — `i63 - — "165 *" Series
is Non - clogging vortex impeller design.
Float operated, submersible (NEMA 6) HIGH HEAD
2 pole mechanical switch. " FLOW MATE"
• On point 14" Off point 5 ".
• Durable cast construction. Cast iron switch
case, base, motor and pump housing. FOR SEPTIC TANK SYSTEMS
• 20 foot UL listed 3 wire neoprene cord and EFFLUENT
plug. Longer cords available in lengths of
25 -35 -50 feet.
• Automatic reset thermal overload protection. OR DEWATERING PUMP
• Oil filled motor - hermetically sealed. SUBMERSIBLE
• Carbon and ceramic shaft seal. 1 NPT DISCHARGE STANDARD
• Maximum temperature for effluent or dewater- 2" AND 3 " NPT FLANGE AVAILABLE
ing, 130 °F. 54 °C.
• RPM 3450, 60 cycle.
• Major width 14" Height 19 ".
• No screens to clog.
'Stainless steel screws, bolts, float rod, handle
guard, arm and seal assembly.
• Passes 3 /4 inch spherical solids.
• 1 NPT discharge standard 2" or 3" flange
available.
• '163 and 165 UL and CSA listed. U L SSM
LISTEO
BRONZE VORTEX
Canadian r
M P E L L E R IP Standards Sump &Sewage
Assoc. Pump
Approval Mfg. Assoc.
available SSPMA Specification
BSC -1225
Z Alive ZZ L T
3280 Old Millers Lane MODELS AVAILABLE
P.O. Box 16347 • Automatic or Non - Automatic
Louisville, Kentucky 40216 161 -163 Series 165 Series
(502) 778 -2731
• 1 12 H.P., 1 Ph., 115V, • 1 H.P., 1 Ph., 200 -208V
200 -208V or 230V or 230V
( Manufacturers of... • 1 /2 H.P., 3 Ph., 200 -208V, • 1 H.P., 3 Ph., 200 -208V,
230V or 460V 230V or 460V
Q7"Zlrr PUMPS f1hVF If939
NOTE. No UL listing or CSA approval for 200- 208v /IPh (except model 165) or Extra Duty (ED) pumps.
,_Wisconsifi Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in acc rice - ith-s_.ILHR 83.09, Wis. Adm. Code
°
Attach complete site plan on paper not less than 8 � inches if�ize. Plain County
�ntu �
include, but not limited to: vertical and horizontal r ce poi ction'and 1 K
percent slope, scale or dimensions, north arrow, cation an �to nearQ ad. Parcel I.D. #
APPLICANT INFORMATION - Please riall infpi��c►n. ' J Reve by Date
Personal information you provide may be used for second -pTi�oses (P
` rip�nK s. 15.04 �t(M .
Property Owner Location
Lot 1/4 S�1 /4,S Ta ,N,R /5- (o
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
c
City State Zip Code Phone Number ❑ City ❑ Village wn Nearest Road
❑ New Construction use: (Residential / Number of bedrooms Addition to existing building
K Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate O S bed, gpd/fF " trench, gpd/ft
Absorption area required -16 bed, ft ft Maximum design loading rate 0 7 bed, gpd/ft ' S trench, gpd/ft
Recommended infiltration surface elevat�n(s) . V/ _ ft (as referred togite plan benchmark)
ide If.
Additional design /site considerations � r`�' • •�lQi /01_� j" ?
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional nd Mou In- Ground Pressure AT -Grade System in Fill Holding TY k
U = unsuitable for system S ❑ u F� , ❑ u 9s ❑ u Xs ❑ u ❑ S u ❑ s
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure GPD /fl
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
Depth to
limiting
� '
Remarks: w
Boring # 0 4"-
10
Ground
ft ' '
Depth to
limiting
f in. Remarks: - Ste✓" -� "`
CS Name (Please Print) Signature Telephone No.
A , D to CST Number
dd
'4 riv
5 `/Od/ � - ` 7 3 2
i V
Soil Test Plot Plan
Project Name Jim Weyer Byro rd Jr.
Address 533 Rail Drive
Sommerset Wi 54025 CST #3479
Lot - ----- Subdivision ------- ---- Date 8/1
NW 1 /4 SW 1/4S 1 8 T 29 N/R 1 5 W Township Springfield
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Property Line Stake
System Elevation 92.5 *HRP as Benchmark
660'B.M• 1320' Pro erty Line
0 '
7% Slope
12% Slope 6% Sloe -3
Swamps
30' 12% Slope
133-2 20' ���►
0 '
Swamps
-1
12%
Slope 450'
650'
Swamp /Area of Barn
Standing Water
Well Located
in
Existing
E xisting Milk House
B uilding To County
Failed System F oundation Road D
Running into
Gull y
STC -105
SEPTIC TANK ?MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS °� / -- /
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE Z--
PROPERTY LOCATION ��� 1/4, 1/4, Section
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
r'
SIGNED:
DATE: 7 //%;�
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
- 8 T C - 100
This application farm is to be completed in full:'and "signed by the
owner. (s) ui Uie pr (-Terty being developed. Any inadequacir s will
only res1 in delays of the permit issuance. Should this
develnnmpnt be ivt. ended for resale by owner /contractor, (spec
house), nen a-second form should be retained and completed when
the prop�F-ty is sold and submitted 'to this office with the
appropriate deed recording. "
--------------------------------------- ��- - - - - -- � - - - --
Owner of property i71 n' t
Location of property u� 1/4 7 1/4, Section f _ ,,�T - �c/ W
Township ,_.z, - Mailin%�addrests
Address of site
Subdivision name Lot no
Other homes on property? Yes
_ No
Previous owner of property 7 4.17 &iP 4 -' s
Total size of property P 6 Q-,.
Total size of parcel
Date parcel was created -
.
Are all corners and lot lines identifiable?..-� Yes No'
Is this property being developed for (spec house) ? Yes __ ;?c _ No
Volume ?;Z i and Page Number L as recorded with the Register
of Deeds.
------------------------- - - - - -- ------- - - - - -- ------ - - - - --
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
. *references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in th office of the County Register of
Deeds as Document No. -, 7 _ _, and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for t'-
construction of said system, and the same has been duly recorded .i
the offi f the County Register of Deeds as Document Nr.
Signatu of Ap cant Co- Applicant
Date of Si nature Date of Signature