HomeMy WebLinkAbout036-1087-20-000 CROIX COUNTY ZONING DEPARTMENT `� 3�
AS QUILT SANITARY REPORT
RE-EX!VE0
Owner ,
Address
City /State sr CR0X
- 'N. CCi,NTv
,
.cONiNC =p; - FIt.E
Legal Description:
Lot
Block Subdivision/CSM #
�� Sec. TN -RZ2W Town of
' PIN #
SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION �� S Z 9 L
Tank manufacturer d L.cp $ice ST/P
Pump manufacturer � d/ ,� °C' Setback from: House /.� Wel1 S3 P/L,
Alarm location /�t�s- Model
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh
Meter location a Water Line
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: '
Well / Number of Trerhes
Setback from: House P2
Vent to fresh air intake /30
ELEVATIONS:
Description of benchmark
Description of alternate benchmark Elevation �
Elevation °' , .
Building Sewer 19- STYHT 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 6� b
rmit nu �� State plan number
Plumber's s' nature
License number � �/ Dat�
Inspector j
Compictc plot pls-
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM County:
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law 5.15.04 (1)(m)]. 315872
Permit Holder's Name: ❑ Cit pp�� Villa e own of: State Plan ID No.:
MYERS, MATT & PAM S'ANTO>(�
CST BM Elev.: Insp. BM Elev.: BM Description:
/ Parcel lax No.:
----LFu-p l� �,-�, 036 1087 -20 -000
TANK INFORMATION ELEVATION DATA A9800260
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Benchm k .�� 102,11
os' ng 0D /
Aeration Bldg. Sewer
Holding St /Ht Inlet II
TANK SETBACK INFORMATION f Iq St/ Ht Outlet
TANK TO P/ L WELL BLDG. 9 ROAD Dt Inlet
Air Intake 75 6
Agwir
b� S3f 1 S I NA Dt Bottom 1Z.(� c�0
Dosing NA Header/ Man. w S(
& '7 .�
Aeration NA Dist. Pipe
Holding
Bot. System W PUMP / SIPHON INFORMATION S . v l\ Final Grade Manufacturer Demand �
Model Number J 1,(,1 GPM
TDH Lift,. Frictiorr� System TDF Ft
L e
Forcemain Length ' 0 Dia �f Dist. To Well
SOIL ABSORPTION SYSTEM as
TRENCH Width Length �� t No. Of Trenches PIT No. Of Pits In Manufacturer: side Dia. Liquid Depth
DIMEN 1 N DIMENSION
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA HING
INFORMATION Type O CHA BER Model
Nu
System j® +5G t OR Ukff _
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s)
t x Hole Size x Spacing
L
—]
ength Vent To Air I take
Dia Length Dia. Spacing 7GS'� S 1I Z�Z ���� �.
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sod
ded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil P ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STANTON 3 3.31.17.528C,SE,SE 1806 170TH STREET
k1
Plan revision required? ❑ Yes XNo
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's S ature ert. No.
SANITARY PERMIT APPLICATION Safet and nngtonnA D ivis ion
A scons in 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 1/2 x 11 inches in size.
• 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 El Chec 1.S, o"pr�vious application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INF RMATI N - PLEASE PRINT ALL INF RMATION
Property Owner N4rne Property Location
551/4 5," 114, S3 T 3f , N, R 17 E (or &
Property O 4r 's Mailing Address Lot Number Block Number
City, State Zip Cod , -, Phone Number ,� Subdivision Name or CSM Nu be y
II. T B ILDIN : (check one) ❑ State Owned ❑ VI ! I a t� Nea a ad
Public 1 or 2 Family Dwelling ❑ - No. of bedrooms Town e OF - - A - + -) ( O v_-
III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 E] Apartment/ Condo 0 61Y / /C) Y / 7
/
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 NReplacement 3_ ❑ Replacement of 4. E] 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)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11�Seepage Bed 21 E] Mound 30 Specify Type 41 E] Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy
13 ❑ Seepage Pit X 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 /s ft.) (Min. /inch) Q Elevation
G/ U O /a J G Y" -YO Feet 9 'f. S'o Feet
VII. TANK Capacit gallo Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic T ��O W PJ'S El El El 1:1 1:1
Lift Pump Tank /Siphon Chamber (/ ❑ I ❑ I ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for'nstallation t 9 onsite sewage system shown on the attached plans.
Plumber's Name: (Pr Plumber' re: Sta s) MP /MPRSW No.: Business Phone Number:
iS '71.1' ?lPl
Plumber's Address (S City, ate, Zi Code).
(� '1 -yr1
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issui g nt ture (No Stamps)
Approved ❑Owner Given Initial Surcharge Fee) l
Adverse Determination 6 °uO
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -8398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety B Buildings Division, Owner, Plumber
NLU r' PLAN
PROJECT A05�t )'y�_� ADDRESS
MP 1/4:5E 1/4/S,33/T - 3) N/R 17 VM6 COUNTY
RS DATE
BEDROOM CLASS PERC . _ a
_ CONVENTIONAL GROUND PRESSURE
CONVENTIONAL LIF'I><MOUND_ HOLDING TANK
SEPTIC TANK SIZE /.42D LIFT TANK SIZE _ O
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
16 Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark �' �
* H. R.P. sSct.m.r --
[O Borehole Q Well = t
O Perc Hole System Elevation 9
Uent
12"
rrndp
21 TYPAR COVERING
_.
12" 39 4 6' ( D 3' 3' 0 3'
I
6' Sewer Rock
12' 18
X
-3
q10 1
5 e
AD
b —_
WisconsR Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less tha 12N0 ine0h jtysize. Plan must include, but St. Croix
not limited to vertical and horizontal referenc nt PARCEL I.D. #
�a1 difectio�i % of slope, scale or
dimensioned, north arrow, and location an di�fice to east road; j 026
APPLICANT INFORMATION -PLEA INT AL�C �MAT BY DATE
10 e
R
PROPERTY OWNER:
IV f PROPERTY LOCATION
Matt &Pam Myers S� � ��998 +GOVT. LOT SE 1/4 SE 1 /4,S 33 T 31 N,R 17 R (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1806 170th. St. / \, na na na
CITY, STATE ZIP COD NE NUMBS ❑CITY ❑VILLAGE VrOWN NEAREST ROAD
New Richmond, WI. 54017 1 0 Stanton 170th. St.
[ J New Construction Use k ] Residential / Number of bedrooms 4 [ ] Addition to existing building
jx] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft
Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate • 5 bed, gpd /ft • trench, gpd /ft
Recommended infiltration surface elevation(s) 94.80 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material glacial drift 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 fors stem ® S El ®S ❑ U EIS ❑ U ®S ❑ U ® S L:] U ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon
Depth Dominant Color Mottles Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
..................
.................
..................
.................
..................
.................
..................
1
1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
2 9 -18 10yr4 /4 none sicl 2csbk mfr gw if .4 .5
Ground 3 18 -39 7.5yr4/4 none is Osg mvfr gw na .7 .8
elev. 4 39 -65 7.5yr4/4 none sl 2csbk mfr gw na .5 .6
97. Bt.
Depth to 5 65 -84 7.5yr4/6 none is Osg mvfr na na .7 .8
limiting
factor
+ 84..
Remarks:
Boring #
1 0 -10 10yr3/3 none 1 2msbk mfr cs 2f .5 .6
2 >< 2 10 -32 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
3 32 -90 7.5yr4/4 none sl 2mgr mvfr na na .5 .6
Ground
elev.
9 8.2 ft.
Depth to
limiting
factor
+90"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200 Ave. NeNy Ric nd I 54017
Signature: Date: 6 -17 -98 CST Number: m02298
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Matt Myers New Richmond, WI 54017
MPRSW -3254 SE4SE4 S33- T31N -R17W (715) 246 -6200
town of Stanton
N
1 =40'
Bm.= top of SE corner of cement slab C el. 100'
Alt. BM.= bottom of siding of house ? el. 101.15'
N,lof��NE
X0
ti 50'+ 3�
5v �0
o �
f7 ,
s
Gary L. Steel
6 -17 -98
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the /LO residence located at:
1 1
Section T N, R Town of
S Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced: e5 -Z— 1s
Did flow back occur f om absorption system?
Yes No (If no, skip next line)
Approximate volume or length of time: gallons minutes
Capacity: ?'2vo
Construction: Prefab Concrete Steel Other
Manufacturer: (If known) : Tzs c•P�
Age of Ta ( known).
(Signature) (Name) Please print
- -��� 3, 3
(Title) (License Number)
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR 83, Wis. Ad Cody xcept for
inspection opening over o let baffle). /
Name v� �-�
� J�� Signature /MPR�j
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer A
Mailing Address i fO (� / 2a 9��, JK
Property Address fe 17
(Verification required from Planning Department for new construction)
City /State /�I_; "_; cL6 ,,o, Parcel Identification Identification Number
LE GAL DESCRIPTION
Property Location 6 ' /,, SZE Sec. .3 3 , T N -R Town of S4-�4je
Subdivision , Lot # 'Z� .
Certified Survey a #
Y P Page #
Warranty Deed # , Volume , Page #
Spec house ❑ ye S11 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
that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o the a ar expiration date.
�. n r _
SIGNATURE F APP ANT
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
C - the prope // described above, by virtue of a warranty deed recorded in Register of Deeds Office.
r /,�j '7
SIGNATURE OF APPLIC NT 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
a c
STATE BAR OF WISCONSIN FORM 2 — 1982
51112 WARRANTY DEED
DOCUMENT NO. VOL 1'33 PAGE
Terry M. Milton and Janell L. M ilton,
us a an w e, REGISTER'S (!FF1
ST. CRCfd Co., W1
rr.
conveys and warrants to Matt Myers
J 17 1998
and Pamela J. M husband and
wife, as survivorship marital propet 8 : 00 A M
of o..d.
.— THIS SPACE RESERVED FOR RECORDING DATA
the following described real estate in St.. C ro i x Coun y , NAME AND RETURN ADDRESS
t
State of Wisconsin_ First National Bank of New Richmond
FO BOX C
New Richmond, WI 5401%
TRANSFER
$ 036 - 1087 -20
FEE PAF :E IIDENTi F1CATION NUMBER
Part of SE1 /4 of SE1 /4 of Section 33 -31 -17 described as follows:
Commencing at the SE corner of said Section 33; thence
N88 1 58'05 "W along the Section line 251.7 feet; thence N12 0 18 1 09 11 W
231.5 feet; thence N0 0 34 1 01 11 E 228.07 feet; thence N35 0 05 1 11 11 E
135.8 feet; thence N19 215.08 feet; thence N38 0 26'23 "E
238.0 feet to the E line of Section 33; thence S 958.76 feet to
Place of Beginning.
SUBJECT to right of way over Sly 60 feet and Ely 33 feet thereof.
is
This homestead property.
(is) XX"'X
Exceptiontowarranties: Easements restrictions and rights -of -way of record,
if any.
Dated this
� da of June , A.D.. 19 98
J — � (SEAL)
(SEAL)
r ry M. Milton Janell L. Mil n
(SEAL)
. -- (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Terry M. Milton, State of Wisconsin,
Janell L. Milton ss .
authenticated this Jun __, Iq 9$ — County.
Ptrrxxxally came before rite this __ day of
19_ — , the above named
Kristina Igland
TI FLE: MEMBER STATE BAR OF WISCONSIN — " --
(If not, -- — — _ - --
authorized by §706 06,
to :xae : -rnAn to be the person —_ who executed the foregoing
tnstr,: rent ar:d acknowledge the same
THIS INSTRUMENT WAS DRAFTED BY
HEAD /CAPACITY CURVE
EFFLUENT and DEWATERING
WARNING: Model 185/4185 should not be subjected to less than 30 feet TDH.
TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE
sJ ss � r i
SERIE /7 4 1/59 �9! _1)7179 1 4014 140 16114161 11614 165 16 3 16L'4111 16N41 p6 1 Sb .
R. M.I'
Gat LIn.:'; WI LIM. GA L" G.I. Us Gm. '.Los W1. <L0S' G11. L11 GLL'Un. Gd. <LtL U. -Ltn.I GII. Lim GU Ltn. 1G,� L:n. � Lln
130 nlLl
-- 3 1'.52 21 1015 4) .117 77 27).. 13 1312 54 :3 $6 1061407 61 271: N .171 31 220 1f3 597 i33 S47
- -. 10 7A6 172 w _ 34 _ 119 61 211 71 :700 '. 90 6341 P. 100 371: 61 111 11 "771' 16 120. 141 510
;, 11 19 IS 67 11 77 4S 70 64 / I7 3/ 11 744 60 777 60 77 51 210 147 5:' �14� YS 170
-- _1
70 6,11 1.5 1 7 11 73 IS. 16 136 17 X116: 92 310 51 223 10 171 31 770 111 S1S
70 U 1:176 74 ,260 57 21{: $1 :227 SI .220 171 N
.4 137 SO) •.s 170'
i 3 G— 10 1.11
!7 i<201' 6S 241 33 706? SI IIO: w }IO.' SI 1?OS 121 ?rU 177 4d1 45 11p`
b �i12N 70 if14 46 174 46 112 SS 761 7S 7U. 1/ T70 10! !J91' 114 t 41 .171,:
1121 21 '.60 77 12S': 51 111'. $1 711 $I 2701' w 341 400 37$ 1 - `.-
,., 60 1719 17 Sl 47 111: 71 176 $1 220 71 241 1 IS 7 .5 171
J46 — ?d 10 11.74 70 114': 10 76 `. 52 191.' $t -I I1 70 766 •! 1712
191 10 24.33
w 21A7 < 71 111'; 2 1 7t 1 ^ •. 110
- -- 100 70:11 6 16 61 r . 11 1__ -. 111 -
-- -- 110 MOO
120 31.51 --- - n
.. : L4K1 VSM: 21.! 11• 191s• 77 M' 49' 56 bd' 1]' 72 IIr �-- --- .___... _ -. __ --
I
186,
4186
165,
— 4 165 — - -- r --
�1
c — 163, — — — _
�—
41 63 1 89, 1
— —�—
�— -- — 4189
12— 140, 188,
4140 4188
�:; -- 137, 185, —T— —
>5— 139 4185
2— , - --
5 — 43 4
161,
57,59 98 4161
u 10 201 30 401 50 601 70 80� 9 0 __ l 00 1 110 120 1 0 140 1150 1 60
80 160 240 320 400 480 560 gr,C,
FLOW PER MINUTE
ote: For Head Capacity on Model 112, industrial column - explosion pr000f pump, see Fh1021
rnr,t C
PLJN",P CHAMBER CROS5 SECT 101J AUD SPECIFICA'F10Q5 F
VEIJT CAP
`I C.Z. VE "JT PIPE
WEATHERPROOF APPROVED LOCKINJG
POOR, Tj JUIJCTION BOX MAIJHOLE COVER WINDOW OR FRE5H U.
AIR IIJTAKE
GRADE
I
`1" M �
CONDUIT ` -- 18 "PMIId.
18 "Mfm, ---- - - - - --
INLET PROVIDE �11 - --
AIRTIGHT SEAL
- -- —
*� A I I II
I I I
I I
a
ALARM
I II
I
c *APPROVED I I oIJ
JOINTS WITH
— f ELEV. FT. APPROVED PIPE
3' ONTO PUMP---_ - -j
D SOLID SOIL OFF
CONCRETE DLOCK
RISER EXIT PERMITTED OIQLy IF TANK MANUFACTURER HAS SUGH APPROVAL
SEPTIC f SPECIFICATIOUS
DOSE '
TANKS MANUFACTURER: �•
N UMBER OF DOSES: / PER DAy
TANK SIZE: �� d G ONS
�° DOSE VOLUME
ALARM MAWUFACTURER: - �r J INCLUDING DACKFLOW:
, GALLONS
MODEL NUMBER // n
c CAPACITIES: A=
SWITCH � INCAES OR GALLOAIS
TyPC: cS /�,
PUMP MANUFACTURER: B' 11JCHES OR GALLONS
MODEL NUMBER: 3 C ° INCHES OR GALLONS
SWITCH TYPE: D= INCHES OR � GALLONS
MIN IMUM DISCHARGE RATE M IJOTE: IN ONR5EPARATE CIRCUIT
VERTICAL DIFFERENCE DETWCCAJ PUMP OFF AND DISTRIBUTIOAI PIPE..
+ M NETWORK SUPPLY PRESSURE , . FEET
�' =.sL_ FEET OF FORCE MAIN X � � � � � � �- FEET
= _-5� /
loo F�FRICTION FACTpR.. / 3 FEET
TOTAL DYNAMIC, HEAD = FEET
ILITERNAL DIMENS O OF TAN ' LENGTH � � ; �
;WIDTH LIQUID DEPTH
SIG►JED: �j
LICENSE NUMBER: `35 3a
DATE: