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HomeMy WebLinkAbout038-1180-90-000 FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -680 DATE: `T— q TO: Fax Number. �� ��'� ` L to Name: FROM: Fax Number. (�1 386 -4686 Name: Number of Pages Including Cover Sheet 9 9 IF COMPLETE AND LEGIBLE INFORMATION IF NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: ' �D� f � ��' ST. CROIX COUNTY �� WISCONSIN Mmn } ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 - -_ _ - - -- (715) 386 -4680 April 30, 1998 Northern Mortgage Attn: Bob 1525 Coulee Road Hudson, WI 54016 RE: Septic Inspection for P.C. Collova Builders located at 1112 212th Avenue, Town of Star Prairie, St. Croix County, Wisconsin Dear Bob: A septic inspection of the above referenced property was conducted on March 20, 1998. This property is located in the NE 'A of the SW Y4 of Section 15, T31 N -R1 8W, Lot 38 of Apple River Bend, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 - 4680. Sincerely, r Rodney Esli ger Assistant Zoning Administrator cc: Pat Collova /sm ST. CROIX COUNTY ZONING DEPARTMENT AS QUILT SANITARY REPORT Owner (f C ry , Address c ��!x `N7. City/State ar�rUO�t�� Legal Description: t �% Lot „ Block Subdivision/CSM # 1ZCZ-Z •e '/. 44� %4- 5 —"L , Sec. 45 T -R,zr—W, Town of _ Sta �� . �'► - -� PIN # J2F 15.31. 1 g•�1 SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer u,Q_s 72t ST/PC Zi)d Setback from: House i6 Well P/L _G ' 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: re .o Width J Length C' d' Number of Trenches 2 Setback from: House Well PAL Vent to fresh air intake 4 ELEVATIONS Description of benchmark Elevation iDO- Description of alternate benchmark 2, t-r Elevation Building Sewer .7 ST/HT Inlet 2 -;� 2 ST Outlet 9X 1'F PC Inlet �h a- PC Bottom Header/Manifold 7T of Top of ST/PC Manhole Cover Distribution ) qG1 Bottom. kryskem (a �j'S`.� () ( ) Final Grade Date of installation 2? / /9y - Permit number 0 State plan number Plumber's signature License number v.�:?�S�d Date3 /.76/ `i`2" Inspector L= Complete plot plan Or Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT Sh C� x 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)). 209P'7 3d Per it Holder's Na []City ❑ Village Qj Town of: State Plan ID No.: . L • 60 E �©JPn. PV 44 - 6 1011/ c — CST BM Elev.: r Insp. BM Elev.: BM Description: C A414M, 4 Parcel Tax No.: too 1470 T v taf ZAKG - �T � 0 3e ` ! 1 So — 'I TANK INFORMATION ELEVATION DATA 00 / ,f TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e I Benchmal qli8 Dosing g Z.�t 103- 0 3 , Aeration Bldg. Sewer 7 72• 99: Holding 45>4 Inlet X3o 'gir Ze TANK SETBACK INFORMATION Outlet ir-s f GI Me � TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake eptic 1S 2,� NA Dt Bottom w L Dosing NA Header/ Man. gt� '770Y� Aeration NA Dist. Pipe 749 1li Holding Bot. System /p,W C.`W PUMP/ SIPHON INFORMATION Final Grade G.o lw.w Manufactur Demand M eNumber GPM TISH Lift Friction ystem TDH Ft oss ead Forcemain Length Dia. Dist. To wen SOIL ABSORPTION SYSTEM BED Width r e Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N I N J 4 Z- DIMENSION SYSTEM TO P/ L BLDG WELL LAKE / STREAM CHIN s: r: SETBACK AMBER INFORMATION TypeO f ModelNum e System* IL3 NO ) V/0L_ ✓' OR U T DISTRIBUTION SYSTEM Header/ Manifold Distribution it x Hole Size x Hole Spacing Vent To Air Intakg Length. Dia. � Length OO Dia. Spacing �7 *5Th . G11 SOIL COVER x P ress re S stems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of ded / xx Mulched Bed /Trench Center Bed /Trench Edges I UP5.01 I ❑Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) `�/ 2. Z/ Z l N AV H UC. A4 �D 60 ' 1i V 1 1 � '4y 1�0 V & P1460 M �-th -lr "tea - wcv Plan revision required? ❑Yes E@ No 2 � 8 � t Z Use other side for additional information. 7 It Le'V SBD -6710 (R.3/97) Date Inspector's Signature Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. Vi sconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7%9 • 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. I • See reverse side for instructions for completing this application State Sanitary Permit Number 3 ay (r3v The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name / Y Pro45� Lo 1/4, S �` T , I d CL N, R f E (or Property Owner's Mailing Address Lot Number Block Number X 2 5 7 ,5 / -ec //,e k- 4il e .4 City, State Zip Code Phone Number Subdivision Name or CSM Number &h'rA r S O3 �- (CSC) y.�9- y1 �e e r e Y l�'J� 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Lit Nearest Road Public R 1 or 2 Family Dwelling ❑ Village - No. of bedrooms — Town OF V, In ,.I -••'C :1 / z 9" - 4 a III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �� �j I , 1 .91 0 1 ❑ Apartment/ Condo O g a c ~ 11 ea ?&4 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 Q Hotel/ Motel 9 ❑ Office/Factory 13 Q Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. c New 2. Q Replacement 3_ ❑ Replacement of 4. Q 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 Q Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ 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 1 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 9 o Elevation y.5'6 Feet ' .f>Gc- q6'• B Feet 19 S Feet VII. TANK Capacity site INFORMATION in gallons Total s anks Manufacturer's Name Conc rete Con- Steel Fi ber- ass Plastic Apppr. New Existin strutted T nks Tanks e tic Tank an l 8 El Lift Pump Tank /Siphon Chamber El 1:1 Q 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) Plumber's Signature: No Stamps) IMDfMPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): /41 70 S a e d S' e.C/ ZV r` .S4 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater L�ate sue Issuin g Agent Si nature (No Stamps) ® Approved E] Owner Given Initial Q ,��/ Surcharge fee) 1+ `8 Adverse Deermination l So l/� G`7 • X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD4M (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I 5 7-,d • � C • � e a /�yUa. /��.,° /de ,yG y�' si;�i sss r l� �' , u k • e.v ��yP Labor nd Human Relations Department Industry SOIL AND SITE EVALUATION REPORT Page / of 3 Labor Division of safety 9 euIldings in accord with ILHFR 83.05, WIS. Adm. 0 Attach complete site plan on paper not less than 8 1/2 x 11 inches in site. Plan mus e, t �'" R o I• K not limited to vertical and horizontal reference point (84, direction and % of slope, or CEL T. A!� dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION ° R ' D DATE )Ix N PROPERTY OWNER: PROPE ATION C-, NTY Xi'G lI.9 t7 S"TO V 7 GOVT. LO f 17' ,N,R /P E t PROPERTY OWN R':S MAILING ADDRESS LOT OY WNIEAREST W,4 7-v A- CITY, STATE ZIP CODE PHONE NUMBER Q i,f: ..` u So �S 5 yo f (v QVILLAGE ROAD (�i5) 541 (o7,31 PRht I fi'cvy. CC (�ew Construction Use ) 4"Aesidential I Number of b6drooms 3 +o 4 )) Addition lo existing buikflng ) ) Replacement () Public or commercial describe Code derived daily flow ' t ov 9Pd Recommended design loading rate 7 bed, 9 ' g trench, gpd/ft Absorption area required ?SO bed, 11 750 trench, 11 Maximum design loading rate .7 bed, gpd/ft ` 8 tr eftrflt, gW Recommended Infiltration surface elevafion(s) _SEA ft (as referred to site plan benchmark) Additional design / site cons rations Parent material $CS 11 p , 1 + _ �yiP /CGw� �7` Flood plain elevation, if applicable ft S = Suitable (or CONy�4TO UL MOlIy�. U N.Gp U ESSURE AT_GRA�E� u SYS N FILL system NOl gNO TAW = Unsuitable lo r stem L?'$ [ M L� $" C O U D S &U- SOIL DESCRIPTION REPORT N1le : N 071 �PE�of►/��,vflLe f) Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Baixry Roots Bed o t 0 - /0 10 s/3 /S . 14, / VV es z 7 ' , 7 . Ground 3 �� �v lo ye etev. 9'9, /Co ft. Depth to limiting factor > ­ f4O— Remarks: Boring # 13 . 1 y,I 31 /S //I► fie tvi 0f P- 3 _9 , ye Ground elev. 99 SO ft. Depth to limiting factor� Remarks: ST Name: — Please Print Q d 8 t R T- ZA L Q R I'C (,, T- Phone: Address: CSTA Signature: r c Date: CST Number: J.— % Private Sswaos Consultants r <o T � FS e I " cr y 0 o • N ae fap O o m —••11 IT- e �/ n � V W O n O Q p t fi s Ul tee, ON w 0 0 W � _ � o u, S T C — 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor., (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. --------------------------------------------------- Ownerofproperty P. Q- 00 L.l_ovq bidns Location of property / E 1/4 Sh/ 1/4, Section 15 ,T_LN -R IL W Township :SCAR. RA 1r j E Mailing address Address of site 111 o 7 Ave Subdivision name /1,2,2 If- R IMF R- &N p Lot no. _ Other homes on property? Yes No Previous owner of property l C 1401 Q S40 0 - 1 Total size of property a , pa A Total size of parcel Z, d Z Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes � No �o Volume � and Page Number (; /� as recorded with the Register of Deeds. ------------------------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. . _ rj de lVl14 r te✓ L S' ture of Applicant Co- Applicant - '- �dl Date of Signature Date of Signature STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County P.C. COLLOVA BUILDERS, INC. OWNER/BUYER 12575 Keller Ave. M 55038 PH. 439 -9547 ID. #1073 MAILING ADDRESS PROPERTY ADDRESS // of jug t/E (location of septic system) P ease obtain from the Planning Dept. VI CITY/STATE E uj z d l S C 0,0 S ') PROPERTY LOCATION N ` C 1/4, S W 1/4, Section T 3 N - /0 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION K I y6t LOT NUMBER 8 0 CPRTH WZSUMTX-MAP g7 Z -0 , VOLUME � Z y4 PAGE �'� , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex i. . SIGNED._ i DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 � I O/� �`\ ,0/ 001 w z@ a m w �►. "� i / f H wox 00 .90 w I Z r: n► Mr 1 V' 1 W U. 11 n u o uN #> N ~ w �` wcD �`` N m ` m x a 1 a 00 w u cn w cn M O � Q W {� M 1 O N Co ED~ M ~ Q� W Q N J ti O O O t0 N v o ao M ti 3 Z J N N o O I C O D �.! C � m OD N N M O) O N 1 01 ,9£' 181 ,00'0OZ 00'OZZ I ,00'021 00'01£ ,00 -c M N. F LL I l0 0) Q N Q On il� N ® M ��� O O O O O) LO N 3 N Q 0 s O) 1 1 N N 0 S . 9 w L ` � s wo _ r- O �� t = M ° Orr - c b � n --- — 2 y es °��ti i 3 „Z1,1Z ° OON at138 Ol 03Wf1SSt/ `51 iJ3S JO WIMS 3Hl d0 3N1'1 1S3M 3Hl Ol 030N383338 Sat/ SDNIHV38 ' 1j FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -4680 DATE: 41- _�3 0 - q g TO: Fax Number. '\'3ff / - L F Name: 90 FROM: Fax Number. 386 -4686 Name: °-J'/ l a G<l /ZGc� Number of Pages Including Cover Sheet- IF COMPLETE AND LEGIBLE INFORMATION IF NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: