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Home My WebLink About038-1186-10-000 c 4 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT e Owner X � .* Property Address City /State rite ,w Legal Description: Lot I ! Block Subdivision/CSM # r- r-. S� '/a ,' /a, Sec. 13 , T2 Town of STS N ,per c- PIN # 13.31 .(8. r 1 d� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer & �6, eln -1 Size ST/PC/ / Setback from: House �" Well 6 P/L F 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: _'- o,/ Width Length 5 `l Number of Trenches _ Setback from: House - s - d Well " P2 ';° ` " Vent to fresh air intake .A ELEVATIONS Description of benchmark a 7 „A, �r-e- Elevation } •':s Description of alternate benchmark d�+ s $ v" _ Elevation .� ,�... Building Sewer 9 .7, 7 ST/HT Inlet ST Outlet 9'C. Per PC Inlet PC Bottom Header/Manifoldf T p Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation /2/ / rpermit number State plan number Plumber's signature License number Date Inspector f�® Complete plot plan ' Wisaunsin Department of Commerce • Safety and Buildings Division PRIVATE SEWAGE SYSTEM CounT. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaiyydirftitylo.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. LLL ie Permit Holder's Name: ❑ Cit a Villa own of: State Plan ID No.: OODPASTER, JAMES STAR PRAj&yj CST BM Elev.:. Insp. BM Elev.: 7 M Description: ParcebTY&Vo1186 -10 -000 TANK INFORMATION ELEVATION DATA A9800413 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a4v4 Ben i � ar e Dosing 4, ?'40 C1q,2 Aeration Bldg. Sewer PIG �? Holding St/ Inlet S; 5o 97/ 2 TANK SETBACK INFORMATION St/ M Outlet 5 S , 4 g10 TANK TO P/ L WELL BLDG. nttO Air Intake ROAD Dt Inlet i? Septic �(� w' NA Dt Bottom Dosing NA Header / Man. "7 o j Aeration NA Dist. Pipe 7,3 Holding Bot. System �, �� Cl y, ell PUMP / SIPHON INFORMATION Final Grade ��' 7• y Manufacturer Demand P. YLI�,.� Model Number GPM �fu/C,N 5-- 017 / j TDH Lift Lriction System TDH Ft 1 - pa,� �� , Forcemain Le la. H Dist. To well lag S Sss 97 SOIL ABSO PTION SYSTEM E /\A #E BED / REN Width Length No. Of Trenches PIT No. Of Pits h DIMEN I N C DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypA f CHAMBER Mo Number: Sys rWQ 7 ? J OR UNIT DISTRIBUTION SYSTEM Header / Mayfold �, Distribution Pipe(s) it z x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length �QQ Dia. Spacing c, 7'w Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of 7-xleeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No El ;No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 13.31.18,SW,SE 2106 135TH ST — PRAIRIE FLATS �, 5 Gevision � ., w� .,� required? ❑ Yes Rf No Use other side for additional information. SBD -6710 (8.3/97) Date Inspector's Signatures Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Viscons In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. sr evo s • See reverse side for instructions for completing this application State sanitary Permit Number 3Z02Z5'� Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location %r4 ,cY u)1A 5 1/4, S 3 T 3` , N, R /PE (orjo Property Owner's Mailing Address Lot Number Block Number r: City, State Zip Code, Phone Number Subdivision Name or CSM Number of ( r v II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road ❑ Viliage Public 1 or 2 Family Dwelling - No. of bedrooms � Town OF t iJ III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ® �F- fl '� y 1 E] Apartment/ 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. ❑ Replacement 3_ ❑ 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 12 RSeepage Trench 22 ❑ In- Ground Pressure ' 42 E] Pit Privy 13 [] Seepage Pit d f X �7 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 �Sd S4 3 6 ?C' d Feet .0�; Feet VII TANK Ca aclt in gallons Total # Of Prefab Fiber- . App Site INFORMATION g Gallons Tanks Manufacturer's Name concrete CO" Steel glass Plastic Exper_ New Existin structed Tanks Tanks eptic Tan t ft 1:1 11 Lift Pump Tank /Siphon Chamber ❑ ❑ El 1:1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) I Plumber's Si nature: o amps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, p C de): G G. SO i IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuln Age t Signature (No Stamps) ® Approved [:]Owner Given Initial # / 6'n surcharge Fee) Adverse Determination / CJV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber `/'n 'CSOe d,0o S 7`e� S4l yY 5��s 1' 3 T3/ /�/ ,4 ll �Ya ,',�. ' r F�a.'�s 5T4d pr° ,✓ d b� 0v � 5 l it IV �� z G B ''BMA poDl 310�1►�ov, -� c� will t &o / fRa6 - ✓ef Usa� — 4ou Se 4 t6e%6A iS Wisconsin Department u Commerce SOIL AND SITE EVALUATION � Page I_ of _ Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code + Gille Trucking & Excavating, Inc. Attach complete site plan on paper not less than 8M2 x 11 in es in size. Plan must County include, but not limited to: vertical and horizontal ref ce n direction and St. Cr percent slope, scale or dimensions, north arro a�ldc� to nearest road. . parcel I. D.# \ l APPLICANT INFORMATION - P/ ��'P ilnt ll rmn Wo Personal information you provide may be used dary pure Law, ; 16- (1) (m)). Reviewed By Date � Property Owner ` ; �^ .; Ro erty Location _ - -- - - -- Casey, Dan r. r Go t. Lot S W 114 S 1/4, 1 3 T 31 ,N,R 18 W Property Owner's Mailing A�:res �. Grv01 # Block # Subd. Name or CSM# 323 Sawmill Lane Prairie Flats City State Zip We ,.,Phone City ❑ Villa( e NTown Nearest Road New Richmond WI 540 x`11 Star Prairie Hwy 65 New Construction Use: J Residentia of bedrooms 3 ❑Addition to existing building Replacement F Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/ft Absorption area required 643 bed, It' 562 trench fF Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) �3 7. 3 j ft (as referred to site plan benchmark) Additional design / site considerations t Pa, u enl material -wash Flood plain elevation, if applicable ft ble for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank uitable for system ❑ S❑ U ❑ S❑ U 71 S U ❑ S U ❑ S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Motfles Structure GPD/ftz Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistenc Boundary Roots Bed Trench 1 1 0 -15 7.5YR2.5/1 ---- - - - - -- SIL 1FABK MVFR AW 1VF .2 .3 2 15 -40 7.5YR4/6 ---- - - - - -- CL 1FABK MVFR AS 1VF .2 .3 Ground 3 40 -100 7.5 ---- - - - - -- S 0 -GR ML - - -- - - -- J .8 ele- -- -- - - - -- -- -- -- - - -- - - -- v JOL t Depth to limiting - - — factor 100 in Remarks: 2 _1 0 -16 7.5 YR2.5/1 _ ---- - - - - -- SIL 1FAB MVFR AW 1VF .2 3 2 16 -43 7. 5YR4/6 -- - - - - -- CL IFA MVFR AS 1VF .2 3 Ground 3 43 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - — - - -- ele 7 8 — - — — v .g3 Depth to -- - -- - - -- -- - -- - - -- - limiting — - -- - -- — - -- -- - -- - - -- factor 96 in. Remarks:._ .— CST Name (Please Print) / nature: Telephone No. Dennis G ille 715 268 - 6637 Address pp t CST Number Ref # 372 140th Street Amery, W1 54001 VP6/97 3409 107 'PROPSRtY OWNER: Casey, Dan SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.#'---- Gille Trucking & Excavating, Inc. Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/ft2 Munsell Qu. Sz. Cont Color Gr. Sz. Sh. � Bed Trench 3 — 1 0-15 TSYR2.5/1 ---------- SIL 1FABK MVFR AW IVF .2 3 2 15-41 7.5YR4/6 ---------- CL 1FABK �MVFR AS I VF .2 .3 Ground 3 41-96 7.5YR5 /3 ---------- S O-GR ML ---- ---- .7 .8 elev Depth to limiting factor 96in 4 Remarks: 4 1 0-8 7.5YR2.5/1 ---------- SIL IFABK MVFR AW IVF .2 .3 2 8-96 7.5YR4/6 ---------- CL IFABK MVFR AS 1VF .2 .3 GroundF - -- elev Depth to limiting factor 96 in -- Remarks: -- L 1 0-8 7.5YP,2.5/1 ---------- SIL 1FABK MVFR AW IVF .2 .3 5 - -- I 2 8-18 7.5YR4/6 ---------- CL IFABK MVFR AS IVF .2 .3 Ground elev 3 18-96 7.5YR5/3 ---------- S O-GR ML .7 . -- - - -_ � Depth to limiting factor 96 IM Remarks: Ground elev Depth to limiting factor � -- ---- - - - - -- Remarks: ®ion S kr Shy S 3IN espy, 3Yo q S. Tw p 1.07 // - 75 - 17 � f1c goo El id gig — - - Lo T L01a U i 23 2B3•S'" � l�'` 3 � I Iti S 2y' ZZ� U7 s o !-1 I � I I I tqg. ° V Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of safety and Buildings Page of Bureaa of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code �� County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plon fnust S include, but not limited to: vertical and horizontal reference point (BM), irctron an4h percent slope, scale or dimensions, north arrow, and location and dist 1;6 nearegttoad Parcel I.D. # APPLICANT INFORMATION - Please print all inform*io h. Reviewed,by Date Personal information you provide may be used for secondary purposes (Privacy Lbw s: 15.04 (1) (m)). ProWN Owner Pr rtf ueatidrf ,Govt. Lot 1 /4S�� 1/4,S �3 T 3 / ,N,R E (or Property Owner's Mailing A dFess Lot # Block #. Subd. Name or CSM# S' City State Zip Code Phone Number ❑ C ❑ illage Town Nearest Road '!'New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: i Code derived daily flow S gpd Recommended design loading rate _ bed, gpd /fi trench, gpd /ft Absorption area required 3 bed, ft a b _2- trench, ft Maximum design loading rate 7 bed, gpd /ft _ trench, gpd /ft Recommended infiltration surface elevation(s) Q / ft (as referred to site plan benchmark) Additional design /site consi erations Parent material 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 1 -6 S ❑ U ti S❑ U I ❑ S 4�5 U ❑ S >F4 U ❑ S P1 e SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence FB Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench S Ground 47 3't• 7y .. ley_ le o ' Depth to Yfitiliting facJA r in. Remarks: Boring # S Alle , 3 Grounds elev Depth to limiting 73 f r in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number z. :,r , k zzi DL To 1a 7 W hl,1*7 0 121 i t I 21� ;27 7e fq�'.DY Y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ' �'4w' - Mailing Address ' Cv/v % < 4 ,Sr /drZ Y Property Address S fi9 �i�s %� z c,�fs / /D 1 z5 - 7 ' - h 5 (Verification required from Planning Department for new construction) ZA C_ City/State Parcel Identification Number &JT /!�'�' �O" D0�1 LEGAL DESCRIPTION Property Location 4" ' /a, S �L '/4, Sec. 13 , T ,3/ N -R /'�p W. Town of Subdivision . ?/' ,0, '/y- -' Z A4 S . Lot # -Z Z Certified Survey Map # , Volume , Page # Warranty Deed # S peo ? 7 , Volume 13-5 40 , Page # 7 y Spec house ❑ yes 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da the a year expiration date. #° /9 IGN WNER F APPLICANT DATE O 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 T th operty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 00 mo IGNA 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 ,00'00L 3 sj 00 s 00.00 N — Z . 3 „00,00.00 N ,00'L6 L ,00'Z99 ,00'99* , • 00'8 00'0£6 L N w C • v� i (if cn XN =a `� QLn � . . . . . . . . . . . . . . . �. co . Co T CIO 00 ui • I \ 0 r� — — -- — -- -- — \ M A .��o. � ~+ -!�� 00. DO s th • N a o0 00 c 00 0 6 o o 03 ,LL'06Z ,06'6£ • • . \. \ \ • • ,LO 022 3 .92 LO S O Q 41 O Q Q v° ¢ O M � r N N �� \- Z v cn n O w Q 0 \Z\ o N ,Z6'£8Z _ 3 „S£,90.10 S 3 st w e g0. LO S t , /LM 3Hl 30 * /LMS 3H1 30 3NIl 1S3M