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HomeMy WebLinkAbout038-1061-40-100 ` v ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owners Address Ci City /State Legal D scription: Lot Block = Subdivision/CSM # �'S� X73 3 a '/. '/ G•� Sec,/, L , T, N -IiI W, Town of a� ®u�l' # �A SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:, 8 Tank manufacturer Size ST/PC D /' Setback from: Houso Well Pump manufacture_ r, Model Alarm location (HOLDING TANKS y) Setbacks: Service roa o es air intake Water Line Meter location ``�- -_____ Alarm location SOIL ABSORPTION SYSTEM: Type of system./,4/ Width .3 Len Number of Trenc es Setback from: House �� Well,vo P/ Vent to fresh air intake 12: ELEVATIONS Description of benchmark J Elevatio> 0 Description of alternate ben cfimK Elevatio> o Building Sewer. e ST/HT Inlet I Y ST Outlet C Inlet PC Bottom Header/Manifold 9 � y Top of ST/PC Manhole Cover eo, o Distribution Lines O Bottom of System Final Grade ( )� () ( ) Date of installatiolt s� / r ' number 7 tate plan number Plumber's signature License number Date Z& Inspector Complete plot plan Wiscdnsin I Department of Commerce PRIVATE SEWAGE SYSTEM Count S�afetyand Buildings Division INSPECTION REPORT y ST. CROiX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarflniLyy l�j.: Personal information you provice may be used for secondary purposes [Privacy s.15.04 (1)(m)]. 3 VV / , // HENDRICKS ,mPAUL w y Oliikwn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel o.: ��- 1061- 40 — bO0 >OD /,00, ' r .✓ r TANK INFORMATION ELEVATION DATA A9800185 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / 3 e.93 Dosing U. J Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet S�.6a TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic / ' 3 a 7 5 ' NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System ).o3 /o v a 100. PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand , .06 Model Number GPM TDH Lift L rictio System TDH Ft Forcemain Le Dia. Fi Dist. To well _7 F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length+ P No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � `' s_ I DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREA LEACHING Manu ctur R,: INFORMATION T eO CHAMBER ���` YP Mo Number: System: - 4 , i gyp' '� 3 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing 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 Bed /Trench Center rr Bed /Trench Edges' - ` ' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 15.31.18.266,SW,NW 2155 GOOSE LAKE ROAD Plan revision required? ❑ Yes [3'No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Vi sConsft SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • 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 Sanitq � 0 7 4- y Permit Number Personal information you provide may be used for secondary purposes p Check it revision to previous appliEacjo [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Pro rtyOwner. a Pr perty o tion Q r.C�/ ,�..�- �•-,� /a ,�1 /4, S T , N, R E (o W Property Owner's Mailing Address Lot Number Block Number 6 GG Cltvospte y� Zip Code Phone Number Subdivision Name or CSM Number GJ /C l S7l G �7 H . TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� e s ) Nearest Road V II i Public 1 or 2 Family Dwelling - No. of bedrooms Town OF - '"`'``�� D +C— III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) / �T 1 ❑ Apartment/ Condo wV � � � ^! � � 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 1[st New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ____ystem ________System _____________ Tank Onlv______________ 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 PSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure t i 42 E] Pit Privy 13 ❑ Seepage Pit /a X �O� 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.) Pro ose (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevations V / 0— 101 � Feet : 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 Tank Tanksl Tanks Septic Tank ❑ ❑ Lift ump El ❑ ❑ ❑ P 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)- - Plum is Signature: (No Stamps) rP/MPRSWNo.: Business Phone Number: Plumb s Ads (Street, City State, Zip de): fj'Z Gh r IX. COUNTY./ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater I ssu g ent Signature (No Stamps) kAp Surcharge Fee) ❑ Owner Given Initial {/ - 5/2 - & 9 S CA Adverse Determination 0 0� /ob X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber PLOT PLAN PROJECT Paul Hendricks ADDRESS 2153 Countv Hiohwav CC New Richmond Wi 54017 SW 1/4 NW 1/4S 15 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MFRS BYRON BIRD JR. 3318 DATE 7/20/98 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 763 # of chambers 24 BENCHMARK V.R.P. Top of PVC Pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P. NE Corner of Property Vent SYSTEM ELEVATION 101.8 A6'lLong Sidewinder High Capacity Leaching Chamber with 31.8 ft " ^2 per chamber Grade at Sy stem Elevation 34" Goose Lake Road AL 500' T 0 Garage r Pro 4 Bedroom House 20' T B -5 104' 15' 154' 8 ' B -2 2- 34" X 75' Trenches ' L 6' Spacing Between Trenches 8% B -3 140' h2 r lo p B.M. 0' r B -4 ' 20 106 B -1 166' 5' Vents 03' Property Line PLUT PLAN PROJECT (Jcc�� �� -,C4, C ADDRESSO� JLJ 1 /4kJ 1/4/S/ ?� N /FY W TOWN r " COUNTY - lii� ;C ge r- MPRS Byron Bird Jr. 3318 DATE _ BEDROOM .2 CLASS PERC - CONVENTIONAL�N - GROU PRESSURE CONVENTIO AL LIFT_ MOUND HOLDING'TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE - , BED SIZE Benchmark V.R.P. Ass me Elevation 100' Location of Benchmark AA GO/�rNi C Borehole Q Well Scale = Feet 0 Perc Hole System Elevation Vent 12" TYPAR COVERING 2 " 12" 3� O s , 4O 3' I 6 " Sewer Rock i 12' AC v q ��� s' 7 � � S ---- -� �/ A/o --- Wisconsn Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor a,,,d Human Relations Divisjon of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038-1061- APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Lois Satterlund GOVT. LOT SW 1/4 NW 1 /4,S 15 T 31 ,N,R 18 R(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2153 C. T. H. " na Csm CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD (7151 248 -7223 1 Star Prarie � Goose Lk. Rd. 6 New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 45 0 gpd Recommended design loading rate —_ bed, gpd /ft _ trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 102.3-100.7-100.2-99,00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem IRS ❑ U [i s ❑ U [kS ❑ U [as ❑ U ❑ S 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench .................. ................. .................. ................. .................. ................. .................. 1 1 0 -80 7.5 r4 6 none m BREA Ground elev. 105 ft. Depth to limiting factor +80 Remarks: Boring # 1 —30 10 r4 4 none 2c r mvfr if 2 0 -84 7. r4 4 nonp MS oSg ml na na .7:: .8 Ground elev. 105 ft. Depth to limiting r factor +84 i:,,..,, r p01X J Remarks: ZONING OFF CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. Richmo W4017 Signature: Date: 5 -6 -97 CST Number: m02298 t� STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Lois Satterlund New Richmond, WI 54017 MPRSW 3254 SW4NW4 S15- T31N -R18w (715) 246 -6200 town of Star Prarie lot #2 -csm N 1 " =40' BM.= top of 2 pvc pipe C el. 100' Alt. BM.= nail in Pine tree C el. 106.50' ©c�SL �K• Z� ode Co R 11 �'►2 P 3� Gary L. Steel 5 -6 -97 Mai 15 98 05:54a Renee M. Bird 7152687616 p.l ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CE FORM Owner/Buyer Mailing Address Property Address o �� (Verification required from Planning Department for new construction) - & I , t z�r C?-S City /State e�.t)�i AM,9,,k t/ Parcel Identification Number f738- /awl - ya- /06 LEGAL DESCRIPTION Property Location S u ' ) 1 /.; '/,, Sec. �, TN -R / g W, Town of r Pin i r- < . � %/ '94 ,tJ � �y q Sec" 1,4 Subdivision , Lot # 2. - Certified Survey Map # `� '� L , Volume / , Page # 3s3v Warranty Deed # 's Volume /2 . Page # y Spec house ❑ yes El 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), thi septic tank is lees dhP—m 1!3 ftl 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 the three year expiration date. _ -5 GN � O DATE S ATURE 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 Mperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. s, 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 covv of the certified survey map if reference is made in the warranty deed CERTIFIED SURVEY MAP Located in the Southwest Quarter of the Northwest Quarter of Section 15, and part of the Southeast Quarter of the Northeast Quarter of Section 16, all in Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Prepared for and at the request of: Donna Preece NOTE: The parcel shown on this nrap is subject to State, County and Township Century 21 Premier Group laws, rules and regulations ( i.e. wetlands, minimum lot size, a New Ri chmond, WI 54017 ccess to parcel, Knowles etc,). Before purchasing or developing any parcel, contact the St. Croix County New OWNER Zoning Office and the appropriate Town Board for advice. Lois A. Satterlund BEARINGS ARE REFERENCLI) TO IIIE WEST LINE OF THE 2153 C.T.H. "CC" NW 1/4 OF SECTION 15, TOW14SIIIP 31 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR N 00'57'46" W. Drafted by. Kristi A. Eylondt A County Section Corner Monument NOTE: SEE SHEET 2 OF 3 FOR F of Record LINE AND CURVE DATA TABLES • Set 1" x 24" Iron Pipe weighing n minimurn of 1.13 pounds per linear foot. 0 Found Iron Pipe i�G�y7 Y ci M= Measured As T� RONALD F. > c v R= Recorded As ,� JOHNSON j O W O 1 ar An4r.1,v. 1 /l1�EST LINE OF M NW 114 , ," "•• -may ' -k % V UN1 LATTED LANDi,NL� S11Ft'r tP 0 ; GOOSE L RD NORTH LINE OF THE SW 1/4 06' THE NW - R. 0. W GOOSE rF, I I I GO _O_ S__ E L___ A KE R_ O_A__ D LAKE ROAD -- -- J� _ _ -- --- - - - - -N 89'24'27` E 1321.10'-- - - - - -- 441.10' _� F .\\N89-29-23-E _ _440.00 440.00 I z C r� r r� 1 440.00' // 1 1 N89'29'23 "E 440.00' ' r t 1 Z I, I 29 23 E 375.7 r i r I 1 rl 1 1v 1 I'� r l 1 Z 65 ' r I I I I, I rn � r - > II ) I 1 00 ..............i.i..�.a. .....................�.4 1 1 1 1 bo !10 VN I '" 1 I jo I I i is �� to ! 1 j -100' BUILDING I l 5f TLIACK IINC FROM R. O. It/ 13> ■ I j i I I I v' j r x , �� I I 11 0 lr) I I I n o I o I I I i �~ -- I M 0: 19 i �a N89'24 27 E rb n o? 1 o 1 I I " v �1 0 N 48.64' P ) �; LOT 2 n; LOT 1 r%1 I I p I x O r j m I ` ' r I Imo :LOT 3 I ' n1 TOTAL AREA: TOTAL AREA: u' I Tr yZ i0 I co : TOTAL AREA: j i 432,892 SQ. FT. rn m 431,974 SQ. FT. o w °O ly o ��'�" I : 344,926 SO. FT. 9 .9 4 ACRES 9.92 ACRES N � x ��n, j� 7.92 ACRES AREA EXCLUDING I 1O 1 OD oo AREA EXCLUDING w D j i I o 'AREA EXCLUDING r °D RIGHT -OF -WAY: RIGHT -OF -WAY: x ir- 1 l l i : RIGHT -OF -WAY: 1j 1 412,677 SQ. FT. o_ 411,482 SQ. FT. I l m Iz x299,773 SQ. FT. 1 i 9.47 ACRES i 9.45 ACRES I �° i' ,6.88 ACRES t l I l x \ i S 89'08'11" W 434.44' FENCE LINE -- — o i o' (1 / r 1 N LOT (n � I ,, 1 ,I x I ~ 1 1 1 1 I r �i i J1 0 : TOTAL AREA: o o l i i �I i U) - -� 0 545,573 SQ. FT. '� r 440.01' --- �,tr -- 440.01' 12.57 ACRES - - - - -S 89'08'11" W 880.02' - - - -- --- � C n, 1 S DR I VE - � AREA EXCLUDING I x 2 I cb � -� O 4' o� 1 � ' SIZED RIGHT -OF -WAY: SEE SURI/EYORS REPORT r � I n�,K 2 I ►�' 02 5HED 539,029 SO. FT, (A o rl I o C7 ON Pt A T LINE o l a T 12.37 ACRES 1 q � I S %1E D t o NORTH LINE OF THE PLA T r, I BARN _ —mr-z r r /e i1nRA11- x I � �h CERTIFIED SURVEY MAP Located in the Southwest Quarter of the Northwest Quarter of Section 15, and part of the Southeast Quarter of the Northeast Quarter of Section 16, all in Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, SURVEYOR'S CERTIFICATE I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, hereby certify t by the direction of Lois A. Satterlund, I have surveyed, divided and mapped the Southwest QuarLer of the Northwest Quartet' of Section 1.5 and part. of the Southeast Quarter of the Northeast of Section 16, all in Township 31. North, Range 10 West, Town of Star Prairie St. Croix Country, Wisconsin, described as follows: Beginning at the West Quarter Corner of said. Section 15; thence, on an assumed bearing along the south line of Lhe Southeast Quarter of the Northeast Quarter of said Section 16, South 89 degrees 57 minutes 50 seconds West. a distance of 90.75 feet; thence North 00 degrees 57 minutes 46 seconds West a distance of 297.00 feet; thence North 09 degrees 57 minutes 50 seconds East a distance of 90.75 feet to the went line of the Southwest Quarter of the Northwest Quarter of said Section 15; thence, along last - said west line, North 00 degrees 57 minutes 46 seconds West a distance of 1019.96 feet to the northwest corner of said Southwest Quarter of the Northwest Quarter; thence, along the north line of the said Southwest QuarLer of the Northwest Quarter, North 09 degrees 24 minutes 27 seconds East a distance of 1321 - °10 feet to the northeast corner of the said Southwest Quarter of the NorthwesL Quarter; thence, along the east line of the said Southwest QuarLer of the Northwest Quarter, South 00 degrees 20 minutes 44 seconds East a distance of 1310.73 feet to the north line of the Plat of Apple River Bend First Addition; thence, along last said north line, South 89 degrees 08 minutes 11 seconds West a distance of 1310.00 feet to the point of beginning. Containing 1,755,365 square feet (40.30 acres). Subject to Goose Lake Road (a Town Road) along the most northerly line and County Trunk [Highway "CC" along the westerly line of the above described parcel and subject to all easements, restrictions and covenants of record. 1 also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the 'Wisconsin Statutes and the Subdivision Ordinance of the County of St. Croix and the 'Town of Star Prairie in surveying �bw� =t�aLye'rY :tya and mapping the same. a ��� e4c ; j A r RONALD � - Y �a Ron ld F. Johnson Reg. No. 1186 Da a )r! A & E Land Surveying Telephone 1 (715) 246 - 4319 a pit P. 0. Box 325 Ar-0 i� Y, 9 New Richmond, WI 54017 W t SURVEYOR'S REPORT: The area between the fence line (just- west of the easterly line) and the easterly line of the above described � ` �,��`' property may be an area possessed by others, the adjoining land '' "• '� owner (or an attorney) should be contacted before removing said fence. The north line of Lhe Plat of Apple River Bend First Addition was held as the south line of the property surveyed i Hereon. In discussion with the St. Croix County Surveyor, the south line of the Southwest Quarter of Lhe Northwest Quarter of said Section 15, may be south of the north line of said Plat. It appears that the surveyor platting Apple River Bend First Arldil-inn hPld an iron nine at L•hP Baal: Ouarl -Pr Corner of said