HomeMy WebLinkAbout034-1048-80-000 ` ST. CROIX COUNTY ZONING DEPAI NT- � -
AS BUILT SANITARY REPORT '
Owner
Address ob
City /State ING
Legal Description:
Lot Block Subdivision/CSM #
'/, %. s ,, Sec. z . T z -R, W, Town of , tr'<= 4 ` /'�' PIN # �,�y - �"�' -�;
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer �,11 SLP,- Size ST/PC 1, Setback from: House ?3 Well �5 P/L
Pump manufacturer Model E,
Alarm location sw�
(HOLDING TANKS ONLY)
Setbacks: Service road _ Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: /�Vb z<„, a/ Width Length �v ' Number of Trenches /
Setback from: House 27 Well Lo P/L Vent to fresh air intake I"
ELEVATIONS
Description of benchmark 1 �� 4o E r < Elevation /n 0
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( ) () ( )
Bottom of System( () ( )
Final Grade () () ( )
Date of installation / /Z /7r Permit number JO 7 65.3 State plan number
Plumber's signature ,� v .__. License number
. Date
Inspector
Complete plot plan
f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division ST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar
y 3:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)].
PQdi�]jtNA]c��me: TE Y Ljtv,[�,�(M ) Town of: State Plan ID No.:
S CST BB Insp. BM Elev.: BM Description: Yt211v1�r t Parcel TaXNo4048-80-000
TANK INFORMATION ELEVATION DATA A9800042 �_ 8,
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. J
Septic / Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ff Inlet ^1 47R
TANK SETBACK INFORMATION St/ @t Outlet
TANKTO P/L WELL BLDG. Ae lntake ROAD Dt Inlet 5l'�
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer r Demand
Model Number 27 GPM
TDH Lift Lriction System TDH Ft
Head
Forcemain Length/ Dia. �•� Dist. To Well,
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
D IMENSIONS DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Mod Number:
System:~ OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) III x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length — Dia. Spacing `7 V41 J `
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over x Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges ' 1 `r Topsoil E] Yes ❑ No C] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD 21.29.15.335,SW,SE 2970 80TH AVENUE
t �
/[1 f) Su�
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
V i sconsin SANITARY PERMIT APPLICATION 201 Safety and
shin
P.O. Box 7969
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 v2 x 11 inches in size. - (�Vol A.
• 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 if revision to re ous ap cation
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION " g��
Propert Owner Name Propert cation {
1 1 i4, S Z T r Nr R W
Property O ner's Mailing Address Lot Number Block Nyrpbler
Cit , S a Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It� Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms E] Town of
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers)
1 ❑ Apartment/ Condo
Day - Boyd' - �
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. , M New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
System System
- _____ ________ ____ _________TankOnly Existing System ______________ _________Existingsystem
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 21S 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. /inch) Elevation
4�a I 8.- Y.-5 . 53 �T'6' Feet 3 Feet
Capacity
VII. TANK in Ca allons 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 or"ekhm7+"i 1 IaZ40 , ;. ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ( pa / 1164 (, do C_,6A1h6 ❑ I ❑ 1 ❑ 1 ❑ I ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum is Name: (Prin) Plu er's Signature: o Stamps) MP /MP_, RSVI[�lo Business Phone Number:
r Jl - �� 'zi - - 7 7z -3z
Plumb 's Ac dress (Street, City, State, Zip Code):
7
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Approved ❑Owner Given Initial �' / Surcharge Fee)
� /�•
Adverse Determination �!
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R t tom) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
_ 1
i
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
Pisconsin La Crosse, WI 54603
Department of Commerce CUN
Tommy G. Thompson, Governor
27- Feb -98 William J. McCoshen, Secretary
TIMM EXCAVATING TERRY SCHUMACHER
ROGER TIMM
3128 20TH AVE
WILSON WI 54027
SCHUMACHER, TERRY Plan ID 9820251
SW,SE,21,29,15W
Municipality of SPRINGFIELD Inspector: Leroy G. Jansky
County of St Croix (715) 726 -2544
Private Sewage plans including the following element(s):
MOUND 450 GPD
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for
compliance with all code requirements.
This plan action is subject to the conditions listed on the following page(s).
A copy of the approved plans, specifications and this letter shall be on -site during construction and
open to inspection by authorized representatives of the Department. All permits required by the state or
local municipality shall be obtained prior to commencement of construction /installation /operation.
This project is under the supervision of a state inspector. As inspection concerns arise feel free to
contact the state inspector at the number listed. The inspector for this project is listed above.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when
making an inquiry or submitting additional information.
Sincerely,
`Vletr-�
Oerard M. Swim
POWTS Plan Reviewer
(608) 785 -9348
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
M . j� LaCrosse, Wisconsin 54603
isconsin G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
Page 2
98 20251
A Sanitary Permit must be obtained from the County where this project is located in accordance with
the requirements of Sec. 145.135 and 145.19, Wis. Stats, prior to installation.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be
made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
SBD- 5524 -E (R. 2/98) File Ref: H: \STANDARD PARAGRAPHS APPROVAL LETTER.DOC
03 Y - i0YB - 9
Terry Schumacher - Mound 2 5 1
98 -20251
Location: SW 1/4, SE 1/4, Sec. 21, T 29 N, R 15 W
Town: Springfield
County: St Croix
F
Date: February 27, 1998 S � C,
L�
Owner: Terry Schumacher
1
Address: 1080 Wildhurst Trail
Orono, MN 55364 cS'
O�
Plumber: Roger Timm
Signature: ?1066 ��-
License # MPRS 226524
Attachments: 6748 -Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan
4: system cross section_
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
page 1 of 7
p W •fin lly
C
� p�ED
�► I P COMMERc 1N
of? ARTMS SA FEr
V1S�pS
E NCE
SEE coRaESP
• System Calculations
One family residence 3 bedrooms
Loading rate �`S gallons /sq ft per day
Depth to groupd water ° in
Depth to bedrock '' in
Cross slope %
Force main length L0 Ig ft of 2 in
Manifold /header length 4- ft of Z in
Drainback . $ • 4 gallons
i
Lateral length Z @ ft of �L in
Lateral elevation �' ft (bottom of pipe)
Lateral hole size �l�i- in @ �'`�' in ( �' ° ft) spacing
k° holes /lateral, ° holes total
Lateral volume �•Z g gallons
Total lateral discharge rate � gpm @ Z ft head
i
Elevation difference �'' ft
i
Friction loss q ft @ Z-, gpm
Total dynamic head � C( 4 ft
Pump /si�on gpm @ ft of head
Manufacturer* ° ~1 i e, , Model # n
3 S
Dose volume \ � gallons
Lift /si(on tank' W-.,444." w � - 60c:> C�rQ', "-° gallons
Septic tank � , �q-0-0 gallons
Measurement pump on & off �•g in
Height alarm from tank bottom S $ in
Reserve capacity 3 3 �•� gallons
calcs page Z of
TEN mommmo OEM IMMUNE
IN4 ME IN
MUNI ENO
No No MEMO M
MEMO No
M ON ME mmim M
ME IN M ENE
�!��n I MMINI
�i�l�'i� I
OL
1,
3 d 6 ve a.�t
_' \ a.�s opt T..�...•� e..�..,, .� `rI
to s�bc
�01...,. o,�w ad•a ..�
•�... � ._41.8 g r.} � �
I
S. z`
Hco
Lr O
zs.z'
s
q.0 `
(Q.1' S70.0 ' I I ID. I'
�o. 2
X : 1
L �l � ta.f.1 � t 1� t• ► \O I ul . � � �� � A•\ 0+.� .r. rr lL � bS � p: v M+ � 0 i • ` �� �.
o'. 1 4' ? vC. �� ol.• }a.NV.••. ...a11♦ �• `e. 'o•.. t...1� ba7
flvc. 4o
t t Q �t c
S. o ' s . p' I s o' I 5, o '
I
p
1 4r* �o a r►tl.iM
�! 0 4A It s
+ 1n o` t� o ... 1 �.� Ate► � �.,.� 4+• �D o� o ... 1:.. ti � o. o �� e. e+►'t S, o' J
(2.05 1.�4 w, = :Z x' ' •� }ok 4L1 Q 2.S ha�
Z)
WEI►TMERP�F
LOCKINe cvrLR JLwdloN
AAWAC
Iort
Gin 4 C.T. IMK�ifMN�M+IMb
PIPi. 3�
I ND+bTuA81:R
VOL. Z4" =.D.
YfiwR
mold " � S
ti1w.
ppPAOMLQ A L • Y. rw
T aboaJ BAFFLES 3' awo
LTIaM` ow
Os
D g ..
Ca�tTE
EPTIC _ S PE G I F I'GATI OAJ S � .
CSC• ! •
AWK MASIUFACTUKCR: _ ~ 6umbER or DOSES: PER D"
T A/JK SIZC: I to '"-• 604LLOWS DOSE VOLUME
A LAR Pk"FAMILILK: `� ILICLUOIN(i OACKPLOW: 1 ` &ALLOWS
MOOCL IJUMOCR: vo t %w CAPACITIES: A 2O Z IIJCIIES Olt � GALLONS
SWITCH TUPL: %Oft s"4'' LI s �' INCHES OA� GALLOWS
( AMP MAIJUFACTURCRS Go 11JCHES OR 1 GALLOWS
MODEL IJUMOCR: 3 ��1 °0 0• �o INCHES OR GALLOWL
SWITCH TUPC: ��_';'�' ` �"� ATV PUMP ^1J0 ALARM ARE TO OL
MINIMUM OISCKAR"'ItATK 2 ' 6PM INSTALLED OIJ SEPARATE CIRCUITS
VfKTICAL OIFFLRCMCL; "TW69W PUMP OFF AMC DISTRIWTIOSI PIPC.. FEET
MISIIMUM )JfTWORK' SO ► ►Ly totCiSUltf , 0 0 - 2-s FLCT
� O g FEET O F FORCE MAIN Y, � RF ItICT1o1,1 McToa.. _ FECT(_:� �
TOTAL. oVWAMIC ,MEAD
• M ,' N
TERNAL. OIMLIJ6I0 AIS Of TAWK: LEAI6TH i 4.��;WIDTH LIQUIC OCPTH ��
I
I
M ODEL DVP03 M OD EL II
Vertical • Pump EPO4 P0
Submor§i4jQ Mont Pump
,a: t
, 1
GOULDS
I
I
i
Pump Spw4ficatim
tb HP METERS FEET
Up to 40 GPM '° MODEL: 3871
Dischar size 1 NPT °
Solids: 'Ya maximum
Motor 25
Single phase: 115V • ao
Materials of Construction S
Brass/thermoplastic +6 E p a r
Features and Benefits 3
0
*Top suction eliminates ' 10
impeller clogging. a • fP0•
• Corrosion resistant +
construction. • 10 �o 30 .o so u:aM
• Float actuated swltich. • a . 6 • i• is .ar
CAPACITY
METERS FEET
Pump Specifications Features and Benefits
MODEL DVP03 y, and' /: HP a EPO4 impeller- semi -open design
• Up to 60 GPM with pump out vanes to protect
6 +° Maximum head to 32' mechanical seal.
Discharge size 1'/:" NPT • EP05 impeller - enclosed design
S 10 Solids:' /." maximum for improved performance.
0 a • Motor * Rugged glass - filled thermoplastic
1 All motors feature ball casing and base design provides
• o bearing construction. superior strength and corrosion
o s +o +s as as 3• x p u.S.6m resistance.
o s ; e s WW* Single phase: 115V . Cast iron motor housing for
CAPACITY Materials of Construction efficient heat transfer, strength,
Cast iron and durability.
Thermoplastic • Corrosion resistant threaded
Stainless steel stainless steel shaft.
• Available for automatic and
manual operation.
9 CSA listed models available.
I
All Models are designed for continuous Lrathion feature stainless steel hardware. o
I
` Wisconsin Department of Industry SOIL AND SITE EVALUATION
Labor and 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 Gf
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel-I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed b Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9. ( ZZ U
Property Owner Property Location
Govt. Lot _57jV 1/4_t' 1/4,S o 2 1 T y ,N,R /3-- .*r W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
--
City 1 6tate Zip Code Phone Number Nearest Road
��.� ❑ Ciry ❑.Village . Town r7 al-4 /l v 2 -
New Construction Use: ® Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe: {/
Code derived daily flow — gpd Recommended design loading rate bed, gpd/ft --v — trench, gpd/ft
Absorption area required 3� bed, ft trench, ft Maximum design loading rate bed, gpd/ft gpd /ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material 6:.4,4 C J ,4 1- t / Flood plain elevation, if applicable A(A ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S [9 U ® S ❑ U [_ S R1 U [__1 S ®U ❑ S 20 U ❑ S IR U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
r x / 1 .5 G if /M l-4 V1=_1f C Pr 2 -Z?
W S M L. G- S I 1=
Ground S p a - /ryE S M
elev.
9ft.
Depth to
limiting
factor
,Lin. '
Remarks: WY h ip a. 5 4 g.4 t'L v C e m e N rie d b A (y o�
Boring #
5 d % •
0 t' '� � J-- I-
C- dS C 0-s
,
Ground'
e�ll
Q 1
ILI
Depth to
limiting Sj GP
factor G
in. Remarks: $ Cry' e'N d lS ` zONt�
CST Name (Please Print) Signature�ti
Address Date CST Number
cp 000
e ll
all
R
-----------
AIT
IE
Foe--'*ov
J
L
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address �i % 7
Property Address
(Verification � required from Planning Department for new construction)
City/State fit/ r " &kl. Parcel Identification Number ee4
LEGAL DESCRIPTION
Property Location �� '/4, S!✓ ' /4, Sec. d` , T -IF N -RAW, Town of
Subdivision /1/W , Lot # _/ .
Certified Survey Map # , Volume , Page #
Warranty Deed # S / -IPW Z Volume _6� 3 , Page # e7
Spec house ❑ yes ;K no Lot lines identifiable V 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, restrictedplumber 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.
SIGNAT 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.
'.4", -.�e "Z _-� / 4
SIGNAfthRE 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