The URL can be used to link to this page

Home My WebLink About034-1043-30-000 ST. CROIX COUNTY ZONING DEPARTMENT _ ?; �1►` < "' AS BUILT SANITARY REPORT l _' RECE IVED Owner (. L� Fi`1�+� �i�aJ��z- [: T T; 98 / S CRax P Property Address 97 4o q0 Ml COUNTY %l ZONING OFFICE City /State L.t1 o o p J t l f s. l�� t:: 5 y Z. a' Legal Description: _.__! '- ✓ Lot — Block — Subdivision/CSM # Nw ' /al '/4, Sec. 19 , T ?,I N-R /5 W, Town of PIN # d� - /Dy3-3t -oco SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer /" /0Ww � `~ Size ST/PC 1,W / >< Setback from: House // Well P/L S ao Pump manufacturer f re f fig ! NA- Model All- Alarm location WA (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 - 2 S Well 7� PAL t zoo Vent to fresh air intake �ib ELEVATIONS Description of benchmark Elevation 0 0 Description of alternate benchmark ND N Elevation Building Sewer 9G ' 3 9 ST/HT Inlet gG Z S� ST Outlet 9 4 3 PC Inlet PC Bottom Header/Manifold S 4 11 Top of ST/PC Manhole Cover 7 7 Distribution Lines Bottom of System Final Grade Date of installation/ 9k Permit number Z`14 State plan number Plumber's signature r'� License number A 4 q ? z' Date/ / f Inspector /�� F (2G (, E ?- Complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM v' Safety and Buildings Division Count $T. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar5P�.rn.it-f�o.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. L ��FF ll�� 11 J SPOONER, N6LIFFORD Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 161%q- "1043 - 30 - 000 CC�C� t p p tZ- cq,,e, 4za . TANK INFORMATION ELEVATION DATA A9800504 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic 0,�,� ev i' r et. I �d � Benchmark 3,c56 103.06 t 0>b Dosing Aerati Bldg. Sewer Holding ON ijrjt Inlet TANK SETBACK INFORMATION ]�7 4� b n� St II'I[t Outlet - 7. 0 3 TANK TO P/ L WELL BLDG. 7hrtake ROAD Dt Inlet Septic A1,00 S Y 1 1► I NA Dt Bottom Dosing Header / Man. - 74 5 - A ation NA Dist. Pipe ,� 7. 7C , Holding Bot. System 1 3, / PUMP/ SIPHON INFORMATION Final Grade 32 G) 7.7 Manufacturer /Demand S� .� Model GPM TD Lift Friction Syste TDH Ft eaT� oss Forcem 'n Length Dia. hi Dist. To well SOIL ABSORPTI TEM BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ACHING Manua INFORMATION Type of CHA System { Zvb :Caw 2S '75 OR UNIT DISTRIBUTION SYSTEM 5e } O k 4 � Header / Manifold M Distribution Pipe(s) M. x Ho Size Hole Spacing Vent To Air Intake Length 1b� Dia. AL Length �� Di'a. L Spacing 8 Gr ( (1{,t G o n SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over rl Depth Over xx Depth Of xx Seeded /Sodded xx Mulched _j Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes E] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD 19.29.15.290B,NW,NE 2761 90TH AVENUE C7 pZpe, - �ra,�.- G1.1-1..-t --In ►i.�.o.Q�n.� Plan revision required? ❑ Yes VIN l it I n Use other side for additional information. SBD -6710 (R.3/97) Date Inspe is Signature Cert. o_ Safety and Buildings Division Vi scons i SANITARY PERMIT APPLICATION 201 W. Washington Avenue n 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 8 1/2 x 11 inches in size. % 4 ::n r t tc • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information rovide ou may re y p y be used for second purposes J ❑ Check rf revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �y ` w State Plan I.D. Plumber 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property er N m P ope o ation �va 1/4, T !!�g , N, R lj E (o Propert OvyrlerI Mailing �j Lot Number Block Number City, <(C/ � Zip o�� Pt�pn�,N bi� Subdivision Name orCSM Number ® l7� �ZS 11. TYPE OF BUILDING: (check one) ❑ State Owned !t Nearest Ro Public A 1 or 2 Family Dwelling - No_ of bedrooms Tow 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ( 7. 1 ❑ Apartment/ Condo / a 9 S ' �Q 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 S []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. [:3 Replacementof 4_ ❑ Reconnection of 5. E] 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) lot t � by at, k Pnr�� "S, -,l� " ��, $ �� Non - Pressurized Distribution Pressurized Distribution ` � " ""�I Expe mental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank LVIr 12 Seepage Trench 22 ❑ In- Ground Pressure f 42 [] Pit Privy 13 Seepage Pit 3 x �•Z� 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 �1 Required (sq. ft.) Proposed (sq. ft.) (Gals/d /sq. ft.) (Min. /inch) Q' E ion 7� % � 5 &Z ✓ Feet Feet Capacit VII. TANK in Ca allon Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank"_"6W"gTM ND /� /� ❑ ❑ ❑ ❑ ❑ Lift P - ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility r install of the onsite sewage system shown on the attached plans. PI is Name: (P ) Plum a 'SS re: o Stamps) I MP /MPRSW No.: I Business Phone Number: lii✓Z- PI3��z�zS"- Plumber' d (Street, City, State, Zi ): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Is ent Signature (No Stamps) A roved /►� S� pp ❑Owner Given Initial Surcharge Fee) f �( /� � /� �D�� p,� • s /`" Adverse Determination [ Q V X. ONDITIONSOF APPROVAL / REASONS FOR DISAPPROVAL: PkW '" AA S q4il ail/ 4*1� ji IIIWI q*b SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Z�(91 Qo Nw.\VE- \mac- 2q.�rw 1V ` I titK •czt'�'�i „ 3� o t s t o 3 p � .� � Z's'' �N Cq � •b� o k m e 4L k Wisconsin Departmant of Commerce SAIL AND SITE EVALUATION Page. _1 _ of 3 ` Division of Safety and Buildings in accord With Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. C roix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - - -- - - -- - Parcel I84- 1043 -30 -000 (19.29.15.290B) APPLICANT INFORMATION - Please print all information. - -- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i e By Date Property Owner Property Location Spooner, Clifford Govt. Lot NW 1/4 NE 1/4 S 19 T 29 N 15 W Property Owner's Mailing Address Lot # tBlocl # I Sut�d. Name or CSM# 2761 90th Ave Clt State Zi Code PhoneNumber El City Village XTown Nearest Road W WI 5028 715-698-2871 Springfield 90Th Av New Construction ® Residential / Number of bedrooms 3 - ]Addition to existing building Use: X Replacement ❑ Public or commercial describe Code Derived daily flow 450 g pd Recommended design loading rate - bed, gpd /ft2 8 trench, gpolft Absorption area required 643 bed, fN 562 trench, ft' Maximum design loading rate - bed, gpo1ft - tr ench, gpolft Recommended infiltration surface elevation(s) 94.0 ft (as referred to site plan benchmar Additional design / site consideration install 2 - 3' x 54' Sidewinder, Hi- capacity "turtle- shell" trenches Parent material sandy /loamy outwash Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ® ❑ U X S❑ U N S[ 1 U N S❑ U FI S XU L _l S x U Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. C Boundary i Roots Bed Trench 1 0 -6 7.5YR 3/2 sl 1 f cr ds cs 1 Una 4 2 6 -10 lOYR 3/3 sl 2 m sbk dsh cs 6 Ground 3 10 -28 5YR 3/3 - cos 1 m sbk __ __� - ___1_f 8 elev- -- -- - - -- - - -- - -- - - -- - - -- - I - 9 7. 6 ft 4 28 -32 l OYR 3/3 - s 2 f sbk dh cs .7 .8 Depth to 5 32 -100 10YR 4/6 - s/mcos 0 sg dl .7 .8 limiting factor _> 100, - -- I T Remarks: _ - -- ----------- ._------ _____.__ _ 2 1 � 0 -7 7.5YR 3/2 - sl 1 f cr ds cs I Urn 4 5 2, = 742 0 10YR 3/3 A 2 m sbk dsh cs if .5 .6 Ground 3 12 -78 7.5YR 4/4 - s 0 sg dl cs - .7 .8 elev - -- - - - -- - -. -- - - -- - - - 96.8 ft 4 " "78 -100 1OYR 4/6 - s 0 sg ml _ -.- t 7, 1 .8 Depth to y A- limiting Y C factor - -- ' A r _ > 100' Remarks: c �C:; 7 1 0E CST Name (Please Print) Signature: r o• Henry F Grote:. - - - - - cif of Testing — - -- - ---- - - - - -- - _ _ � -� - - - - -- - - -- Address g Date CST of # P.O. Box 57, Knapp, Wlr 54749 7/27/1998 222774 1019 e - } d�� nor, ems„ . S�� o., c� 34 • to43 ow% t tr . 4. 1, k°t - Zg c t- tit-♦c zzt'i'�i a O is ZO t+s i•+.a. � ��o) 4 �t}� r 74 C �� CQ� •�S 46) sa'-} bay X11 oV�. _ o•. � �. `"�+� �i yo y "�Q•� S�V�e..a Or � S ^�m•.�� w ( k ' K I 1 C9 Wismnsin Department of Commerce SOIL AND SITE EVALUATION Page I of _ 3 -_ • Division of Safety and Buildings i omm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not a incha size. Plan must County include, but not limited to: vertical and horizontal reference poi BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I n.## APPLICANT INFORMATION - Please print all infonnation. [J34 1043 - 30 - 000 (19.29.15.290B) Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). R wed By Date Property Owner Property Location Spoone Cli Govt, Lot NW 1/4 NE I/4 S 19 T 29 N,R 15 W Propert Owner's Mailing Address Lot # Block # Subd. Name or 2761 9 0th Ave. Cit State Zi Code 87 PhoneNumber ❑ City Village MTown Nearest Road W WI 5028 715- 698 -21 Springfield 1 90Th Ave. [ ] New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building Z Replacement ❑ Public or commercial describe Code Derived daily flow 450 g pd Recommended design loading rate -7 bed, gpd/ft' 8 trench, gpd /ft' Absorption area required 643 bed, ft' 562 trench, fN Maximum design loading rate - bed, gpd/ft' - tr ench, gpd /ft' Recommended infiltration surface elevation(s) 94.0 ft (as referred to site plan benchmar Additional design / site considerations install 2 - 3' x 54' Sidewinder, Hi- capacity "turtle- shell" trenches Parent material sandy /loamy outwash Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ®❑ U ® S❑ U ® S❑ Ll I ® S U EIS z U ❑ S X U Depth Dominant Color Mottles Structure GPD/ft' Boring# Horizon in Munsell Qu. S7_ Cont. Color Texture Gr. Sz. Sh. Consistence Roots B Trench ., 1 0 -6 7.5YR 3/2 - sl 1 f cr ds cs If/m .4 .5 ,. 2 6 -10 l0YR 3/3 - sl 2 m sbk dsh cs if 5 tt .6 Ground 3 10 -28 5YR 3/3 - cos 1 m sbk dh cs if .7 .8 elev - -- - -- -- -- - - - -- - - - - - -- - - -- -- 97.6 ft 4 28 -32 I OYR 3/3 - s 2 f sbk dh cs - .7 .8 Depth to 5 32 -100 l OYR 4/6 - s/mcos 0 sg dl - - .7 .8 limiting factor - > 100' - - - - -- - - Remarks: — - - - - -- - - -- - - -- - -- - - -- - - -- - Z 1 1 0 -7 7.5YR 3/2 - A 1 f cr ds cs I f/m .4 .5 2 7-A2 10YR 3/3 - sl 2 m sbk dsh cs 1f ' " "5. 6 Ground 3 12 -78 7.5YR 4/4 - s 0 sg di c� ` 7 8 elev - -- -- - _ 96.8 ft 4 78 -100 IOYR 4/6 - s 0 sg ml �^ �- ;_fv� 7 8 De limiting fact 00 �� -- _,gc! Fi�� l _ �� UM1I , Remarks: - - -- - - - - -- - �' -� - - CST Name (Please Print) Signature: Telephone No. Henry F. Grote ! 715- 665 -2681 Address Ce rt if ied of estm Date - - - - 8 CST Number Ref # P.O. Box 57, Knapp, WP 54749 27/1998 222774 1019 c9 34 ► X43 -I u«. ��. ta, kt 2q 1t cTh►." t yt-♦t zst'�t IA c t— vc + S •.•. � a..s v�� r C4b% IT6) :� - f1 3' x s"� ` ^ N o S3 S.► o za � \o�. �c ,�y�.� -akn+y S:JCAr.:� to S � \-►t\ �1" 7 �, v c �.vja..� b Q-1v ftQ qaJ 303 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C L i ro F j r) S 0,o k! C k o S LL a J'Poo N c, Mailing Address 7 / i'E �cx� ✓. tJ Property Address (Verification required from Planning Department for new construction) City /State G�-� � < <-- LLJ Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /4, %4, Sec. , T_�IJN -R Town of ,5,0X 1W6 f�9 . 14 Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed 4 079033 a , Volume �s � Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ 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 master plumber, journeyman plumber, restricted plumber 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. 6%04ftlm� 4 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. 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