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HomeMy WebLinkAbout038-1185-70-000 ST. CROIX COUNTY ZONING DEPARTMENT. AS BUILT SANITARY REPORT ; : A. 'u } Owner � Property Address 3 25' :2 1141 '�?o City /State /� �.� , ���.��� �, ST CTIOx COUNTY ZONINGOFFiCE Legal Description: „�- Lot - � . 'Block -- Subdivision/CSM - '/4, Sec. TAN -R W, Town of , �� ,piL (��-, PIN # 6) 3,4 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer L C zZ-42 Size STIPC, •'/ Setback from: House Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) \� Setbacks: Service road Vent to fresh airin*ce T —� Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of sys�in � ^�' Width -� � L n � T gt , -5,!� Number of renc ,es O� Setback from: House 4 C e Q" Well /--0 P/L Vent to fresh air intake /? 0 r� ELEVATIONS 7 Description of benchmark Elevation Description of alternate benchma& Elevation y Building Sewer`s ST/HT Inlet ST Outlet `�� PC Inlet' PC Bottom Header/Manifold� - 2- Top of ST/PC Manhole Cover n � Distribution Lines Bottom of System Final Grade Date of installationj 4ermit nu ber .3;'/7c; y State plan number v Plumber's si ture License number �-O/ Date / / / /`� w Inspector Complete plot plan Wisconsin. Department of Commerce Safety and PRIVATE SEWAGE SYSTEM 'Buildings Division County: / INSPECTION REPORT 576 60. "A rn GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar P i t NP.� Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: lam(/ v ❑ City ❑ Village � of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: /1� Parcel Tax No.: 1 T W &V OK dGi / �J TANK INFORMATION , ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S - Be nrc ar b 1. ?j 9�•7 OT> Dosing Aeration Bldg. Sewer 4 . ­f 7 c l ZS Holding - inlet _11.07 Gj /. ( TANK SETBACK INFORMATION Outlet o TANK TO P/ L WELL BLDG. A iulntake ROAD Dt Inlet Septic C�C) C`S / NA Dt Bottom Dosing Header / Man. Aeration NA Dist. Pipe 142 q f .2.$ .D Holding Bot. System W- (07 PUMP/ SIPHON INFORMATION Final Grade ll6 9 Q Manufacturer Demand f ( • 27 Model Number GPM T Lift Fricti n System TDH Ft Forcemain Length ma Dist. To Well SOIL AUORPTJON SYSTEM BED THE Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. DIM E143MNS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING 3/ / INFORMATION Type �_ CHAMBER M " gdel Nu Mb Syste DISTRIBUTION SYSTEM Header / Ma fold (ir Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length LLf _'Dw. 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 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) t�vww w►�t 5{v>fv r ud� 8kV�ee( q, Ov ttAJ6(,j a&jPZd -_�R It Af Plan revision required. Yes JE No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Co Safety and Buildings Division VisConsin SANITARY PERMIT APPLICATION 21 oW3hingtonAvenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI O 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 1 than 8112 x 11 inches in size. aT- C rD► • See reverse side for instructions for completing this application state sanitary Permit urr er Personal information you provide may be used for secondary purposes ❑ Check if revision to prdvious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Ow r Name ) Propert Location l .S DN i4 j y 1 i4, S T , N, R E (or W Property gwn�s Mailing Address Lot Number Block Number City, State ` Zi Co a `hone ;umber Subdivision �me or CSM Number TYPE F BUILDING: (check one) E] State Owned o Its n Nearest Road Public l or 2 Family Dwelling - No. of bedrooms ❑ Tow OF ''- 111 BUILDING USE: (If building type is public, check all that apply) Parcel Tax N umber(s) lll 1 E] Apartment/Condo �/ /) 70 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 -- -_ Replacement 3 ❑ Replacement of 4 E] Reconnection of 5. � Repair of an _stem -_ System -- Tank Only -------- - - - - -- E xisting 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 12,15eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit d _ 43 E] Vault Privy 14 E] System-in-Fill r r 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 q. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevation t o'` Feet , v Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Fiber- plastic Exper. New Existin Gallons Tanks concrete structed steel glass App. Tanks Tanks S ptic T olding Tank -� �Q ��J ❑ ❑ 1:1 El El Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's S ure: (Np Stam M - um PRSSW Business Phone Number: Plum ber' Address Street, ity, State, Zip Code / IX. COUNTY / DEPARTMENT USE ON ❑ Disapproved Sanitary Permit Fee (Includes Ground ate ssue Issu g Age Si nature (No tamps) P A roved Surcharge Fee) pp ❑Owner Given Initial /�� GD Adverse Determination ( / G , X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT Chuck Olson ADDRESS SW 1/4 S E 1/4S 13 /T 31 18 W N Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 Lz' DATE 12/13/98 BEDROOM 3 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18 IL BENCHMARK V.R.P. Top of Wood Post ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H. R. P. Same as Benchmark Alt. BM SYSTEM ELEVATION 90.5 Top of Steel Fence Post @ 101.6 Alt. 352' Property Line * 110' 12' 5' N Vents New Testing was done B -4 30 , o 9% -2 on this sight for no Slope evidence of the first test o could be found. Dimensions and c B- setbacks of boring did r 55' S not fit this sight. 30' -1 ' ' 5 5 B -5 10' 2 -3' X 56 Trenches with 6' Spacing T 10' Bedroom 303' House Property Line Garage C. 247' Property Line New Road To Highway 65 Wisconsin 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. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and T percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. R ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner � J Property Location Govt. Lot t.J 1/4S — 1/4,S T N,R �J E (o& Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# / 6 7 City State Zip de Phone Number Nearest Road `Ol ( ) ❑ City ❑ villa e Town isor t � New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: loading �> Code derived daily flow gpd Recommended /ft _ d g g rate bed, gp trench, gpd /ft Absorption area required bed, ft rench, ft2 Maximum design loading rate . 2 bed, gpd /ft ' 9 trench, gpd/ft Recommended infiltration surface elevation(s) ?;19 =5 ' � 5(. Z ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable i ✓ ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system k9-S El KS ❑ U Ks El krS El ❑ S � U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench LS Zf Ground elev Depth to limiting factor nn �in. O� Remarks: Boring # -i z �. r .6 Ground le Dept A L limiting factor �j1,o�_in. Remarks: CST Klame (Please Print) f Signature Telephone No. // Address Date CST Number Soil Test Plot Plan Project Name Chuck Olson Sha ird Address 1408 Hwy 64 New Richmond Wi 54017 CSTM #226900 Lot 7 Subdivision Prairie Flats Date 12/13/98 SW 1 /4 SE 1/4S13 T 31 N /R18 W TownshipStar Prairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Wood Post System Elevation 9 0.5/88.2 * H R p Same as Benchmark Alt. BM Top of Steel Fence Post @ 101.6 352' Property Line Alt. 110' 12' 5' N i B_4 30 , New Testing was done o 9% -2 on this sight for no Slope evidence of the first test could be found. c� Dimensions and B setbacks of boring did r" 55' 5 5 7 not fit this sight. 30' -1 B -5 5' S' 5 ' P-W . Bedroom 303' House Property Line Garage c� 247' Property Line New Road To Highway 65 Wiscpnsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of " t - Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must l ounty Gille Trucking & Excavating, Inc. include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north ar n and distance to nearest road. arcel I.D.# j I 0 APPLICANT INFORMATION pnntall in ation. — - - - - -- - -- Personal information you provide may ary poses (Privac Law s. 15. 04 (1) (m)). eviewed By Date Property Owner - Property Location Cas e ,Dan G ovt. Lot SW 1/4 SE 1/4,S 13 T 31 N,R 18 CW \ _ Property Owner's Mailing Addre' -t � Lot # i Block # Subd. Name or CSM# 323 Sawm Lane u GR 7 Prairie Flats City St to Z 'AfotNumb �� [ ]City [] Village ElTown Nearest Road New Richmond W1 0) * , Star Prairie Hwy 65 New Construction Use: ir�etalU I u ' r of bedrooms 3 _]Addition to existing building ❑Replacement ❑ Pub I ,ommercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 643 bed, ft 562 trench. ft Maximum design loading rate .7 bed, gpdPftz .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) �_ 90.6 ft (as referred to site plan benchmark) Additional design I site considerations Parent material -wash 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 NS D U N S U N S U ❑ S I❑ U ❑ S® U ❑ S❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistenc GPD/ft2 Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Boundary Roots Bed Trench 1 1 0 -9 7.5YR2.5/1 -- - - - - -- S1L 1FABK MVFR AW 1VF .2 .3 2 9 -13 7.5YR4/6 --- - - - - -- CL 1FAB MVFR AS 1 VF .2 .3 Ground 3 13 -96 7.5YR5/3 ---- - - - - -- S O -GR ML - - -- - -- .7 .8 ele — - - -- — - -- - - 7- _ V Depth to limiting factor 96 in. Remarks: 2 1 0 -6 T5Y R2.5/1 -- - - - - -- SIL 1FABK MVFR AW 1 VF .2 .3 _2 7.5YR4/6 --- - - - - -- CL 1FAB MVFR AS 1VF .2 .3 Ground /d - IIO .S�t� /3 ,� ©. . od e � ele — V , Z s Depth to _ limiting - — — — — -- factor i Remarks: - - -_ CST Name (Please Print) nature: f �I Telephone No. DENNIS GILLE Address ' CST Number Ref# 3 7 2 e/o s T Am4, 1!�l' .s`� t� t f 9� 6/97 y 9 106 PROPERTY OWNER: Casey Dan SOIL DESCRIPTION REPORT Page 2 of Gille Trucking & Excavating, Inc Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots PD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. $ed I Trench 3 1 0 -13 7.5YR2.5/1 -- - - - - -- SIL 1FA MVFR AW 1VF .2 3 2 13 -29 7.5YR4/6 --- - - - - -- C L 1FABK MVFR AS 1 VF .2 .3 - - - - -�- elev 3 29 -96 7.5 ---- - - - - -- S O -GR ML - - -- - -- .7 .8 911 — Depth to - limiting - - -- — factor 96 in. - -- -- — - Remarks: 4 1 0 -14 7. -- - - - - -- SIL lFABK MVFR AW 1VF .2 3 2 14 -44 7.5YR4/6 --- - - - - -- CL 1FABK MVFR AS 1 VF .2 .3 Ground - -- elev 3 44 -96 7.5YR5 - -- ----- - S O -GR ML - - -- - -- .7 .8 ` �S� - ----- - - - - -- - - - - -- - Depth to limiting — r - -- - -- factor 96 in. - - -- - - - -- Remarks: 5 1 0 -16 7.SYR2.5 / 1 -- - - - - -- SIL IF MVFR AW 1VF .2 .3 2 16 -44 7 .5YR4/ 6 --- - - - - -- i CL 1FA MVFR A S 1VF .2 .3 Ground - — -- - -- -- r - - - - -- - elev 3 44 -96 7.5YR5/3 ---- - - - - -- S ( 0 -GR ML - - -- - -- 7 8 9v. `7r - Depth to - - -- - limiting factor - -- - - factor 96 in — -� -� - -- -- - -� - -- — - - - - -- -- - Remarks: — —_ Ground - elev Depth to limiting - -- -- - - -- factor Remarks: - -- -- -- -_ —_ -- - Sw sFyS/ T3�JVir /�'c� �ST� -, 33 Tw/ xor 7 141 - Fy Ac fr� /00 3 .22 01 1 2 1 I 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) City /State �1/ ��C_� _ Parcel Identification Number LE GAL DESCRIPTION Property Location'_�Z- '/." ,C y,, Sec/ , T_,�/ N -R / ZW, Town of Subdivision ` ��� e ,�( , ,Lot # �_. Certified Survey Map # ,Volume Page # Warranty Deed # g I tJ ,Volume Page # Spec house ❑ yes);Lno Lot lines identifiableXyes ❑ 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 th ?three year xpiration date. I 1Z/ / 1 SIGNATURE 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 e ribed abov by virtue of a warranty deed recorded in Register of Deeds Office. / / i5 SIGNATURE OF APP ICANT 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 � r THIS INSTRUMENT DRAFTED BY ED FLANUM OWNERS DANIEL AND BETTY CASEY 323 SAWMILL LANE NEW RICHMOND, WI 54017 UNPLATTED LANDS 89'43'27" W 2582.09' 4.69' 352.64' 37.50' / • .lrs/ 7 8 /z o ho/ 1.92 ACRES o /Zb�' / `� O 83,584 SQ. FT. o 1.92 ACRES o 83,587 SQ. FT. CP S90 "E 13 .• / 3 AD / / 9 N90 "W N IA lb •% %may / �� / �• . � // w 15 9 / / . •) / 1.80 ACRES o 78,212 SQ. FT. o I ' ° o LLJ z z J • �\ - - r 90'00'00" E IL