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HomeMy WebLinkAbout036-1057-60-100 } ST. CROIX COUNTY ZONING DEPARTMEi 7, AS BUILT SANITARY REPORT Owner Address 90 City /State 11J, TZ, s fqq Legal Description:' < , Lot Block Subdivision/CSM # /. ' /, Sec. .2- T -31 N -RAW, Town of S r�4yJTo � PIN #� 03 (,� , i oS - 1 - 1110 - (a 0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION ?4- - C). � � 1 6 Tank manufacturer 1400 ® Size ST/PC / Setback from: House — 7 n; — Well �� P/L ,2 ' Pump manufacture_ r. --- Model 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 Z Setback from: Mouse I Well I z- PAL Vent to fresh air intake f / ELEVATIONS Description of benchmark Id 8 Elevation Description of alternate be nchmark --r -o -F fAw ,� Elevation T? o ri Building Sewer ST/HT Inlet S -0/0' :ST Outlet S PC Inlet PC Bottom Header/Manifold / 5 p 13 Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade O 76,7 O O Date of installation ? / / Permit number -3d -77 ? / State plan number �— Plumber's signature nse number 44 y Date / / Inspector 10040 \Ij 4 d" Completc plot plan or E Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: ST. CRt3IX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Vr&I Personal information you provice may be used for secondary purposes [Privacy Laws.15.04 (1)(m)). TRM 5 P am aTEVE ❑ SOVARryone ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T — 1 O ( aC3 l o t :98oulyu TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic �'1 ?a�Wtb{�rn ��QG4st" 1MZ7 Benchmark J�E r, 2. e> 1o2. Idc> Dosing 'p u. a M � co ! `� Aerati Bldg. Sewer Holding St Inlet -7,12 9 5.68 TANK SETBACK INFORMATION in fide �; St Outlet -3 qS �% TANK TO P/ L WELL BLDG. A e ROAD Dt Inlet eptic Z6O' 3(; 2 NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe 71 $ Holding Bot. System T fs rbj �'' PUMP/ SIPHON INFORMATION Final Grade 4.7Z Manufacturer De and Mod umber GPM T Lift Friction S ste TDH Ft L Forcemain Dia. Dist. To Well SOIL ABSORPTION SYSTEM GB 2t BED / E H Width a ' Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth IMEN I .� � DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA HING Manufacturer: SETBACK CHA ER INFORMATION Ty O Moe Nu I s t S, 2 v 0 7.� 75' OR UNIT DISTRIBUTION SYSTEM �Ic�rrw 7 nc(ra, ►+ (� l N l�r��ar cam ��•-- Header / Many old Distribution Pipe(s) f x . Hole Size x Hole Spacing Vent To Air 'ntake Length i t Dia. �' Length r .Bier� Spacing __K 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: STANTON 24.31.17.371,SW,SE tq62 200TH AVENUE g L ,, .P4 I_� e of Lc7f G� k e(r/ -- 4 L f. 6M - cov n4s,+ C Pcvii,b-A- SHE Lo­se_ r. cl e k-=e ( l Plan revision required? ❑ Yes V No �,/ Z ( h� Use other side for additional information. t5 SBD -6710 (R.3/97) Date Inspector's S nature e No. ate;:^ o Safety and Buildings Division � •p`i ; SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County c� ,�/ than 8 112 x 11 inches in size. j , /� • See reverse side for instructions for completing this application State Sanitary Permit Number � Q - 7 - 7 8/ The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Qwner Name Property Location ti > 1 /4 J <� S i f T �< , N, R E (oo�v /: ' 57 ' �c r J _ Property Owner's Mailing Address, Lot Num r Block Nu ber C , State zip Co Phone Numb r Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ CItY Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms tow OF i�r( " �f i - �f III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 3 e, 149 5 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.)S New 2. ❑ Replacement 3. E] 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 12RSeepage 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/ ft.) (Min. /inch) Elevation f , Feet ��, eet ci VII. TANK Capa t in g allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank T4 f: — 0 r1 : Gail: t r. 7 0 "'< /L oV Lift Pump Tank /Siphon Chamber ❑ 1:1 E VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum4er's Na e: (Print) Plumber's Si ature: (No Stamps) APRSW No.: Business Phone Number. l�. " -�_ y-3 Plumber` Address (Street, City, St t , Zip Code . ++�� ^rl - � = ! • - � .� ` 'er � r -��1 <' , o ' � 0`" � - � .� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Slitary Permit Fee (Includes Groundwater Date Issued ng Agent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial � C J , � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S8D -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: safety & Buildings Divr ion, Owner, Plumber �D cz� j �� l6 y /llePt d �' , 2 Qc > > 410 0 . �LJ� S'� se,�j C7,� / 4 `e `l � N j j ) ac) "t 4b `! s a ny � u ry /� I f G — r— Z;o ' T7C17•s� �! Gl� /y/� , Wisconsin Department of Indus "'� �'' SOIL AND SITE EVALUATION REPORT c,� �'ag�°`l of 3 Labor and Human Relations 4 ' r—? Division of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code �' C SI; "G°ro ° � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but � •' not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or Mki L I.D dimensioned, north arrow, and location and distance to nearest road. P ehcTi6q f APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION E D BY c. =s:.n. DAT PROPERTY OWNER: PROPERTY LOCATION r Steve Halleen GOVT. LOT SW v4 SE v4,S2 3t ' �Z r) W PROPERTY OWNERS MA!I.ING ADDRESS LOT # BLOCK # SUBD. NAME OR - 2162 170th. Ave. na na na CITY, STATE ZIP COD PHONE NUMBER ❑CITY [:]VILLAGE ®TOWN NEAREST ROAD New Richmond, WI. 54017 (715) 248 -3746 Stanton 200th. Ave. [x] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 god Recommended design loading rate • 5 bed, gpd/ft - 6 trench, gpd/ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate • 5 bed, gpd/ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 93.87 ft (as referred to site plan benchmark) Additional design / site considerations alt site system el. =93.12' Parent material pitted outwash plain Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ® S El ®S ❑ U O S O U (3S U I ❑ S id [Is ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure I GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trerctt 1 0 -9 10yr4 /3 none 1 2msbk mfr gw if .5 .6 ^k5` 2 9 -18 10yr4 /6 none s icl i f sbk mfr gw if .2 .3 Ground 3 18 -30 7.5yr4/6 none sl 2mgr mfr gw na .5 .6 97.07 ft. 4 30 -84 7.5yr4/6 none is Osg mvfr na na .7 .8 Depth to limiting factor +84 Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr cs if .5 .6 'v 2 2 9 -25 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 3 25 -60 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground av 4 160-84 7.5ry4/4 none f s Osg mvfr na na .5 .6 97. * ft. Depth to limiting factor +84 Remarks: CST Name : — Please Print Gary L. Steel Phone: 715 246 - 6200 Add ress: 1554 0th. Ave.,Ne Richmond, WI. 54017 Sgnaw c Date: CST Number: 11 -13 -95 cstm02298 STEEL'S SOIL SERVICE Gary L. Steel Steve Halleen 1554 200th Ave. CSTM2298 SW4SE4 S24- T31N -R17W New Richmond, WI 54017 MPRSW 3254 town of Stanton (715) 246 -6200 35 acres N 1 =40' Bm.= top of 1" steel pipe C el. 100' Alt. Bm.= nail in Oak tree @ el. 104.00' Yo J L off'' Gary L. Steel 11 -13 -95 WaconsinDepartmentofIndus", SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations fi of Safet & Buildings in accord with ILHR 83.05, Wis. Adm. rode (: UN Y Attach complete alt* plan on paper not less than A f/2 x I I Innhee in size. Plan must include, but St:. Cruix not limited to vertical and horizontal reference point ( ©M), direction aril % of slope, scale or PARCEL I U M dimansloned, north arrnw, and location and distance to nearest road pcind I ng APPLICANT INrORMATION PLEASE PRINT ALL INrOnMATION nFVl Wbny DAIF PnOPFRT Y OWNER 111101 E111YIU(;AIION St V -en GOVT. LOT SW 1/1 M 1/4,S24 T 31.._... :NJI I'/ *.Aa) W PROPERTY OWNERS MAIUNG ADDRESS - LOT N BLOCK N SUBD. NAME OR (:SM N 2162 170th. Ave. na I na na CITY, ST/)T F ZIP CO PHONE NUMBER 0CITY OVILLAGE EYOWN NEAREST ROAD New Ric nd, WI. 54(517 p15) 248 - 3746 Stanton 200th. Ave. 1acl New Construction Use 1 Residential / Number of bedrooms 3 ( I Addition to existing building ( I Replacement 1 Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate - 5 bed, gpdAt - trench, gpdrtt Absorption area required 900 bed, fl 750 trench, tt Matamum design loading rate • 5 - bed, gpdAt .6 trench. gpolft Recommended infiltration surface elevations) 93.87 ft (as referred to site pan benchmark) Additional design / site considerations alt site system el. = 93.12' Parent material pitted_outwash plain Flood plain elevation, if applicable na ft S • Suitable for System CONVEMTIONLL MOUND IN- GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U - Unsuitable for sys tem ®S ❑ U ®S ❑ U ® S ❑ U S ❑ U ❑ S I3dJ [IS M U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consstenoe J "y Bed tTtendrI n :. 1 0 -9 10yr4/3 none i 2msbk mfr gw -1f 5 1 .6 1 2 9 -18 10yr4 /6 none sicl lfsbk mfr gW if .2 .3 Ground 3 18 -30 7.5yr4/6 none sl 2mgr mfr gw na .5 .6 97.07' n 4 30 -84 7.5yr4/6 none is Osg mvfr na na .7 .8 Depth to Imiting factor +84 Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr cs if .5 ' .6 2 2 9 - 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 4 1 3 25 -60 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground 4 60 -84 7.5ry4/4 none f s Osg mvfr na na .5 .6 97. ft. Depth to limiting fam + 8411 Remarks: - Name: —Please Print Gary L. Steel Phone 715 -246 -6200 rer 1554 POth. Ave.,Ne Richmond, WI. 54017 C� ^F:;.Ta T - r�7 ►1. rte. PROPERTYOWNER S teve Halleen 8011 DESCRIPTION REPORT PARCELIA.,it P ending Depth Dominant Color Mottles Texture Structure Consistence ��, Roots GPD /ft Boring # Hortzon in. Munseli Qu. Sz Cont Color Gr. Sz. Sh. Bed 1Trench 1 -9 10yr4 /3 none 1 2msbk mfr gw if .5 1.6 3 2 -16 10yr4 /4 none sicl 2msbk mfr gw if .2 .3 3 16 -36 7.5yr4/4 none s1 2mgr mvfr gw na .5 .6 Ground 97 .122 ft 4 36 - 7.5yr4/6 none is Osg ml na na .7 1•8 �� i b 1 factor +84" ' Remarks: Boring # 1 0 - 9 10yr4 /3 none 1 2cpl mfr gw if np .2 4 2 9 - 18 10yr4 /4 none sicl 2cpl mfr gw if np .2 3 18 -51 7.5yr4/6 none sl 2mgr mvfr gw na .5 .6 around g .8 4 51 -84 7.5 r3/4 none cos Os mvfr na na .7 ; 9 5.77 �, ` Depth 19 UM 4M f Remarks: Boring # 1 0 -8 10yr4 /3 none 1 2msbk mfr gw if .5 .6 5 2 8 -20 10yr4 /4 none sicl M na gw if np .2 3 20-42 7.5ry4/4 none sl 2mgr mfr gw na .5 .6 Grotxw 4 42 -80 7.5yr4/6 none is Osg mvfr na na .7 s .8 i Depth b firni6ag taC 8 0 11 Remarks: Bortng # Ofound elev. tL Depth to 6M Remarks: STEEL'S SOIL SERVICE if, efi Gary L. Steel Steve Halleen 1554 200th Ave. CSTM2298 SW4SEk S24- T31N -R17W New Richmond, WI 54017 MPRSW 3254 town of Stanton (715) 246 -6200 j 35 acres N 1 "=40' Bn.= top of 1" steel pipe @ el. 100' Alt. Bm.= nail in Oak tree @ el. 104.00' Q r0 � 5 � LA Gary L. Steel 11 -13 -95 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �— ��. ��` � ` 1� � �� ✓ 1�r� Mailing Address �� 4 1 b 42 / 2. Property Address (Verification required from Planning Department for new construction) City/State Ltei��_1 ,' /[ r �'/i ���;_� a �r Parcel Identification Number LEGAL DESCRIPTION Property Location- '/., % <, Sec._: I T`' N -RW, Town of ->7 r� Subdivision XVt4 Lot # Certified Survey Map # , Volume , Page # Warranty Deed # z Z/5 �W , Volume Page # Spec house ❑ yes fiT no Lot lines identifiable 19 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 y of a three year xpiration date. /j -/ V IGNATURE OF PLICANT 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 ,property described bove, by virtu of a warranty deed recorded in Register of Deeds Office. [- C J 6 c a 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