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HomeMy WebLinkAbout038-1021-30-200 o■ o I■' 0 c � @ E § § } ; $ � 7 k � / ƒ ƒ \ ƒ a � } \ R j 2 0 z§ \( \ k bD 6 i / \ ) _ _ ` 2 k ( » % 7 ® I « t O _ ( \ > 28 � ® $ � / § 2 OD } n r CO) 00 ■ o c I ic . % - � , i } 0 0 0 0 m E 2 = o < © z \ a 0 § co @ 0) % > §\ f 7 T 7 7 \\ I T C) ( -4 % CL 0 z d / k \ 2 C / 7 # ƒ / § 9 N. / CL \_ ` / k \ = i z E CL 0 8 S . w � 2 � a � � 7 2 § F m 7 2 � q � I � ak » \ 0 \ �\ c \z % CD ACA ƒ( rn 7 px ( ° f ) a) cr eE_ ƒ \_% u @ \ i = � \ _o \k §i �2 ST. CROIX COUNTY TONING DEPARTMENT AS BUILT SANI'T'ARY REPORT Owner /I Address City /State Legal Description: Lot_ Block Subdivision/CSM # Sec. , T, N -R z:z W, Town of � r r / �r�i�� "c_. PIN # C" -�3 4' — SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer e-- , c � _ Size ST/pc /- - - - C , / Setback from: House , �r' Well A P/L `� Pump manufacturer 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: 't Width Length �`- Number of Trenches Setback from: House L Well = �/L , 2-el ' Vent to fresh air intake _ -� X52 7-� ELEVATIONS Description of benchmark Elevation l / Description of alternate benchmark �? ' � r N Elevation � Building Sewer ' ` js S Inlet 7 s Z ST Outlet ? (' PC Inlet PC Bottom Header/Manifold G��' 1 � Top of ST/PC Manhole Cover Distribution Lines Bottom of System( ) () ( ) Final Grade Date of installation I/// ermit number State plan number Plumber's signature _ �- ! , License number / S7 Al ' Date Inspector complctc plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 315970 V e mi Ho Name: [I City El Village Town of: State Plan ID No.: tA C , ROGER JR. STAR PRAIRIE CST BM Nev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /. 038- 1021 -30 -000 TANK INFORMATION' ELEVATION DATA A98 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. a Septic , �- ` Benchmark L� Dosi ng :E Aeration Bldg. Sewer Holding St/ Ht Inlet 7 r TANK SETBACK INFORMATION St/ Ht Outlet �/ y TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet ir Septic 3 3 7� ( ' NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe (�,(, 0 Holding Bot. System t PUMP/ SIPHON INFORMATION Final Grade Manufacturer °' Demand �- tt Model Number GPM TDH Lift Lrict' Syestem TDH Ft Forcemain Len h Dia. FFii Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O /1 s .. Model Number. System: �:.., >2�J" �// OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Length Dia Length Dia. Spacing 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 �, tr Bed /Trench Center ' 7 1 Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 4.31.18.89,SW,SW 1008 CTY RD H — LOT 2 Y . z t- Plan revision required? ❑ Yes ❑ No , Use other side for additional information. SBD -6710 (R.3/97) Date In 131 cty. Signature Cert. No Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. Vscons In accord with ILHR 83.05, Wis. Adm. Code P.O. Box I 53707 -7969 Department of Commerce Madison, W • Attach complete plans (to the county copy only) for the system, on paper not less County / than 81/2 x 11 inches in size. _ • See reverse side for instructions for completing this application State Sanitary Permit Number 3 7 70 The information you provide may be used by other government agency programs p Check it revision to ous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name /--� P�rop Location do n T N f ( ,/ /f'1 t c / �,.1 /' , G�✓ 4 * E Q V Property Owner's Mai ring A ress Lot Number Bock Number 6 1 - or - Cit , tate . Zip Code Phone Numb e ivisioi`r CSM Number II. TYPE OF BUILDING: (check one) ❑ S ate Owned Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms Town of url/��^c�r.^� 111. BUILDIN USE: (if building type is public, check all that at apply) rcel Tax Number(s) 1 [] Apartment / Condo (' 3/ • l t. 9 1 o 3Z — ioal 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. E] Replacement 3_ [] Replacement of 4. E] 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 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure r�t x q / 47❑ 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 �. S Feet Feet VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New ExiStin d Gallons Tanks concrete glass App. strued Tanks Tanks eptic Tan LI Pump Tank /Siphon Chamber ❑ I El [] E] Q El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans_ Plumb Name: (Print) Plumber's ature: (No Stamps) MP /�PRSW No.: Business Phone Number: l /^D ! rC' !/ C7 / Plu is Address (Street, City, State, Zip Code 'c' iy c�OF3 IX. COUNTY / DEPARTMENT USE ONLY Disapprove Sanitary Permit Fee (Includes Groundwater at I ssued I suing Age t Si ture (No Stamps) E] PP Surcharge Fee) - _ j , �/ [� Approved E] Owner Given Initial I Q� D oo �� 8 1 G j 8 �^ Y i/ Adverse Determination { l� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD 8396 (R.11/96) DISTRIBUTION: Original to County, one copy To: Safety 6 Buildings Division, Owner, Plumber i PLOT PLAN PROJECT Roaer Rineck Jr. ADDRESS 547 E. 6th St. New Richmond Wi 54017 SW 1/4 SW 1/4s 4 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX 8/4/98 3 MPRS BYRON BIRD JR. 220527 '�� /y DATE BEDROOM CONVENTIONAL XXX IN- GROUNI RESSURE CO / NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 134 BED SIZE 12' X 94' BENCHMARK V.R.P. Top of Surrey Pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL +H. R. P. Same as Benchmark SYSTEM ELEVATION 9 2.5 Alt. BM Top of Steel Fence Post With Orange Ribbon @ 101.6 Alt. AL M. 5' Property Line 35' ' B.M. 5 ' VENT 10' 12% 12" GRADE B -2 Slope B -4 TYPAR COVERING 12' X 94' Bed / Vent 12" 3' 6' (D 3' / i " SEWER R K / B -3 12' / o cD / 5' 0 ' 3 bd�r 10 , Pro 3 T Bedroom B _ 1 25 ' B -5 House (Driveway County Road H N isconsiri Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with S. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size(Io P J, mupt - my include, but not limited to: vertical and horizontal reference point (BMQr%and ,,rrte� f percent slope, scale or dimensions, north arrow, and location and disP�eare�parcAll. . # 1p APPLICANT INFORMATION - Please print all inform ,�, eviewed Personal information you provide may be used for secondary purposes (Privacy 5.Ost (11 (ink: l Property Owner ProperogooMn o •-� O 2ry y UOF_ �` 1/4 t d1 /4,S T ' ,N R E (or) vV Property Owner's Mailin Address of ;- Block# . 5ubd: Name or CS # = - - -- - Csart city state / Zip Code ( Phone Number City ❑ Village Town Neares t Road New Construction Use: tPublic esidential / Number of bedrooms _ Addition to existing building El Replacement or commercial - Describe: Code derived daily flow 0 gpd Recommended design loading rate __ —bed, gpd/ft -,5—trench, gpd/ft Absorption area required bed, ft ®U trench, ft Maximum design loading rate . 7 bed, g pd/ft 2 _ s trench, gpd/ft Recommended infiltration surface elevation(s) �� �� ✓�✓�, Del ft (as referred to site plan benchmark) Additional design /site on iderations Parent material Flood plain elevation, if applicable ^i 40 ft [ S U = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank = unsuitable for system ids r u )1 S❑ u s❑ u s❑ U ❑ S 4;X u ❑ s 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 I �Ground Depth to limiting factor ' n. Remarks: Boring # >; , 1 , Ground Depth to limiting Remarks: CST Nam (Please Print) ature Telephone No. � c�c.c �✓ Date CST Number Addiess .. �� r J Soil Test Plot Plan Project Name Roger Renick Shaun Oird Address 547 E. 6th St. L� Z kAJZ/" New Richmond Wi 54017 CSTM #3922 Lot 2 Subdivision Date 8 SW 1 /4SW 1/4S T 31 N /R W Township Star Prairie n Boring ()Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft. Top of Survey Pipe System Elevation 92.5/9 * H R P Sa me as Benchmark Alt. BM Top of Steel Fence Post With Orange Ribbon @ 101.6 Alt. . .M. 5' Property Line 35' B.M. 5' 10' B -2 B -4 12% Slope B -3 90' o 5' r Pro 3 25' 25' 10' Bedroom B-1 B -5 House (Driveway County Road H Y Wisconsin Department of Industry SOIL AND SITE EVALUATION Page of Labor and Human Relations - _ Division of Safety and Buildings in accordance withs. (LHR. P3,09, W Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in s@ Ian "Y include, but not limited to: vertical and horizontal reference point (B d'�ection I E0 Co s� C rO t y percent slope, scale or dimensions, north arrow, and location and s �e to nearest road. p�rce I.D. # p� APPLICANT INFORMATION - Please print all infor ati n. 3T CNCk eaaif� d by Date WUNTY Personal information you provide may be used for secondary purposes (Privacy r , 15 1l )6FRCE ' 2-2. l e ) Property Owner ' "��/ N o oc 1/4 $ W 1/4,S 4 T 31 ,N,R I g E (ore All en+ i to vo. Property Owner's Mailing Address Lo ock# I Subd. Name or CSM# 01311 1 ao S +. CN State Zip Code Phone Number El City ❑ Village ® Town Nearest Road %c-vw\ov\ kxt 1 S yo►7 ( 71S )a 8 -31D3 6+o v- P ry, r`r c- I C-0 r k&_ . New Construction Use: ® Residential / Number of bedrooms �_ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Lt Code derived daily flow T C) gpd Recommended design loading rate • t y 1 bed, gpd/fF trench, gpd/ft Absorption area required 1 21, 5 bed, ft2 _ 0C) trench, ft 2 Maximum design loading rate T bed, gpd/ft -- 5 Z trench, gpd /ft Recommended infiltration surface elevation(s) LQ3 q (0.7. i 3 7 ft (as referred to site plan benchmark) Additional design /site considerations Parent material A (k G 'N a \ R• 4 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S U 9S ❑ U IS S ❑ U I MS ❑ U ❑ S ®U ❑ S W U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -16 lbY0 a .a3 7.Sy,Ry1 - — $L rn c k I ZFr Gw I r 5 , Ground 3 3 -3? 7 .5 `l R - L It' elev. / OOL�7 ft. 31 -SD SI 'l� L 2 rn 5 Depth to SC - YQ 4 _'__ 1 M �r �I limiting factor _jS_in. Remarks: Boring # I -10 DIP Y/A L o?I,nG� R rntr,r zis F , S S yf L C) VV\ G� 3 7• 7 5 y "JI L 5 Est L 1 vF , ,'F Ground 7 - s y 2 yl 5 �— r^ S�i h �'r ' y ' ` elev. 1 p,b ft. Depth to limiting factor % _a-in. Remarks: y Telephone No. CST Name (Please Print) Sig ature ` P br r 1Q. Address CST Number .� a to �• �. Spa P f ^ �', c : e �. 5 Yn P 6 .Q - :t 1- 9 9 11 ■■�■ ■�■■■MEM ■■ M I Olwo rm_ a ■E■ R!� ■■ "■■ ■E ■■■ ■■t r ■m- ummm■ , I ■ti ■ ■�� ■ ■i�t I . lei■ I ■wi■■■■■■■■ ■■ ■ii■■ ii■■ i mmomm ■ I ■■I■■■■■■■■■ ■■■■■■■■■ ■■■■■ ■ I ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ 1 ■■■■■■■■■■■ ■!l■■■■■■■■■ ■■■ ■r■■��li ! ■■■■ ■■■■■■■■ ■■■■■■■■■■■■mum■ow ■ ■ ■ op 1 ■ ■■■ ■■■■■■ ■il■■■■�.._�■■S■I■■m!wp ■�u� ■!i■■■■■■■ ■ail■■■■■■■■ ■■■■ ■t ■E3 I■■ ■■■■■■■■■■■ ■fl■■■■■■■■ ■■■mmom■ ■■ I ■ ■■■■■■■■■■ ■1:!■■■■■ ■ ■ ■ ■ ■ ■Irrri�■ li■ ■MEMEM■■■■■■■ ■■■■■■■■■�1�Irmmom No I ■ ■ ■■■■■■■■■■■■■� ■■ ■■■■■I r ■FT "E ■M I ■! ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■! \ ■ ■!I l" WR. ! ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■`■R ■- JI ■ ■'■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■!� ■ ■ ■ ■ ■L ■■ !'■■■■■■ ■ INVEMEMENEW ■■■■■■■■A! " ■mm■■ ■■■■ ■■■ ■■■■■■■ ■ ■!!� ■,1�� ■l�"3S�l4� ■! M■NN■■ ■■■■■■■ 0 ■■ammum■■■■ ■■ ■wiii■ ■ri■■ ■■■■■■■ ON ■!: llmmm 7i■■ ■■ ■■: ■ ■1! ■■■■■■■ ■■ on No ■■aI+1■!! ■D!!m■■ ■■ ■■■■■■■ ■ I ■ ■iil ■■■i■ ■■■■ ■ ■!!I■ ■ ■ ■■■ ■■■!■ ■ I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer v Mailing Address �`� � 14:7 Property Address M t �y ---_- F� (Verification required from Planning Department for new construction) City /State (.(;,Parcel Identification Number LE GAL DESCRIPTION Property Location � Sec. T�N -RZff W, Town of_ a, Subdivision Lot # �_ . Certified Survey Map # Jam` ���� , Volume page # Warranty Deed # Volume pag # Spec house ❑ yes_,E;�fio 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 slat' you epti ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys of e thr e ye expiration date. J SIG A OF APPLICA DATE OWNER CERTIFIC TIO (we) i that a statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e perry esc ' ed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG ATURE OF APPL N1 / y/ `�7 DATE * * * * ** Any inform ion th is mis- represented may result in the sanitary permit being revoked b the Zoning De artment. Y g p * * * * ** ** 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 co 0� ED 6 FIL 578047 1:1 CX0 APR 2 8 1998 b. I%THM 11. W&M Ret QQAWWK 0 1 C E R T J F I E D SURVEY MAP %.Qwkck Located in part of the Southwest Quarter of the Southwest Quarter of Section 4, Township 3 No ' r1a Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Prepared for and at the request of: Drafted by. Kristi A. E&ndt OWNER: JOB #97118 (R14) i LQI.J I Allen and Cynthia Campeau (n co z Q $A 1311 100th Street 80 1 55' 1 VOLUME 8 1 New Richmond, N 54017 Z 4 0 (n PACE 2132 ! > L 'QDJL'l -6-IR-E-ET > — — — — — — — C: 0 M a (n 0 o - -- Co 1 * 46'42"E 2821.91 t---- L i . w 0 0 ;a ----NO1'46*42"E 390.50 — * — * W�2j --I Z M --� " — --/ N 'r,. S01 *46'42 24,31.41' 0 r M -4 - 0 X Lq Ll I I ., \ ZM> 0 LI CF rH,- 03 -,, C WST LINE CF H rn -V 3 0 , - :LN R1 1 76 . 34 ' 1 SW 1 1 4 OF SM 4 > r7i ;a I 4� - r- C -, 0 0 z 1 Z-8 C) ED' I M: --h . GO P OI :� R. 0. W 00 0 1 00D E= C, rr, :-- N ::r > (A G L4 z a oi M -It� (A M 01 n Fn - U :3 N L4 (A M C :rj 1Z) (Z 41 z - 0-5. (D 1 A 0 1 JIL 0 z C-z �-ST Ln Cb C) I la. 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