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HomeMy WebLinkAbout038-1181-00-000 a 0 °� z 0 o - N N c .> c oa m o � (D m � I y d m O U E aa a' ? m es 00 y v o . r — rn v I ncv Qv �a a) m c > O O O O z m MU LD m o c Z Z o uf m U) m Lo 3 °_ Scyo U 6 F y U O O O > N Q Z N to � M v' Z a>o E (D a� m = o v z d ;, o M W d m 7 Z o 0 O o Z c T O o m Z m N H r °' a d c m E o U c }� N O Y c_ 7= O O N O N — N C C co q N m O 0 0 0 • l0 y O = c N IL N Y m N N O o c w O C _ N O Z C z O Z O O N Z ( t w 1 � E z a r m d (i O a m a 0) Q FN- al m r 0 0 0 CL M N IV m ', N a a a o M o N j o aO ( D to J U I 2 0) rn Awl m M y C) o rn o w E > o 0 0 m y c D N o ° w d rn w a °' ¢ o } i� m C y .'3 v O C O Y� C 1�l O O 0 N O O O J LO e' C� E1 O O O �i a o m CD m a� a o o it i 07 N C y m w c N y c O Lg L N � r N C d O N d N w w C O 1, ~ M . m N O w O O m U 0 M O Z y d' 2 2 (Q V � � a ` a • a m :2 i' m r A 0a ,0 Ui0 ' ST. CROIX COUNTY ZONING DEPARTME�� AS BUILT SANITAR Y REPORT _ S i GftQIX Owner Property Address 16 st l zoNlNC City /State l r . Legal Description: Lot Block Subdivision/CSM # /4 � Sec. Z�L, T,�/ N -R W, Town of �y /�GrL *� PIN # , S/ ev-aao SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: O S �Well / Tank manufacturer , e /" Size ST/PC 1,0W Setback Setback from: House, _ 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: � � W dth , 6 Length s e Number of Trenches Setback from: House ` . Well ¢ /L 4 Vent to fresh air intake ELEVATIONS 9qi Description of benchmark �� ° G' r Elevatio Description of alternate benchmar T d w rO C'O' — Elevation /60 Building Sewer 9� - 7; ST/HT Inlet O ST Outlet �ny'°1 4' PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover C/ .Y ,. f G Distribution Lines ()) / � E - r ( 3 ( ) Bottom of System Final Grade ( ) ( ) Date of installation 1 /�/ ermit number State plan number Plumber's signature License number Date�e /Y5T Inspector f r v Complete plot plan Wisc."in Department of Commerce PRIVATE SEWAGE SYSTEM v Saisty -and Buildings Division Count ST. CROIX INSPECTION REPORT } GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar e Personal information you provice may be used for secondary purposes (Privacy s.15.04 (1)(m)]. Permit Holder's Name: ❑ City 11 V ill wn of: State Plan ID No.: URCH, DAVID /DABON ENTERPRISES STAR PRA k CST BM Elev. Insp. BM Elev.: BM Description: Parcel - ::1181- 00-000 0 7 6 P d7 hb� � .� TANK INFORMATION \ ELEVATION DATA A9800465 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ep=ic ' I Benc bna ,1 /per /P Z> Dosing J . L Z 4 Ae ation Bldg. Sewer �. b ';'7 Holding S 4 Inlet TANK SETBACK INFORMATION t Outlet Sze cj , a TANK TO P/ L WELL BLDG. vent to A ROAD Dt Inlet ir Intake Septk ►�� 7 r ta NA Dt Bottom Dosing - - -- NY Header / Man. Aerat'on NA Dist. Pipe Holding Bot. System `' 5�- s8 /•2 PUMP/ SIPHON INFORMATION Final Grade Manufacturer De m nd A 0b S Model umber TDH Li Friction System DH Ft oss H ead Forcemain Le la. Dist. To Well SOIL ABSORPTION SYSTEM BED Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D�p#h DIMENSIONS 3 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LE CHING Manu acture . SETBACK CHA BER Mod INFORMATION Type mber: Sys a c!•c fib : 5z! ~ /G( ° OR UNIT DISTRIBUTION SYSTEM Header / Manif / old Distribution Pipes) x le 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 Bed /Trench Edges Topsoil El Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 15.31.18,NE,SW 1110 212 STREET 76p� zz 0 sew az l 3z' �5ys� O ! Snu ! 0 15188 Plan revision required? ❑ Yes B'No Use other side for additional information. I h SBD -6710 (R.3/97) Date Inspecto ' Signature Cert. No. Safet and Buildings Division *Lionsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. d n accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce I Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. _ • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs E] Check'ii <evis ion to previou application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbe 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Na c P pert Location _ G "4 4't /4 S!>` T r N R.­'Ot (or� Property Owner's Mailin Address Lot Number Block Number �` >< City, St e _ Zip Code Phone Number Subdivision Na a or CSM N II. TYPE IL IN . (check one) ❑ State Owned 0 Cit I Neares Road Public or 2 Family Dwelling - No. of bedrooms Town of 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. j'New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an -- System - - - - -- System Tank Only Existing Syste Existing stem S ------------ ---------------- y------------- - - - - -- g-y-------------------y---- 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,ZSeepage Trench 22 ❑ In Ground Pressure r �, 42 E] Pit Privy 13 E] Seepage Pit �� ✓ V• ZS 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/da q. ft.) (Min. /inch) �^ Elevation 0 a F ,C Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Plastic Exper. New Existin Gallons Tanks Concrete Con- steel glass App. Tanks Tanks structed Septic Tank or Holding Tank x © GCJ le „e I El ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility fojilrgallation o onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI tuber' tur : (No amps) MP /MPRSW No.: Business Phone Number: ��`/! 4 �-C l�1 e; Plum r s Tess (Street, City, State, Zi Co e): 'F3 A-Z X 4 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater i Issu Issui Signature (No Stamps) 'RA pp roved E] Owner Given Initial Surcharge feel Ind Adverse Dete rmination f V / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Noct f&4ei, $BD -6398 (R 1/98) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber PLOT PLAN PROJECT David Burch ADDRESS 1641 31st. St. Amery Wi 54001 NE 1/4 SW 1/4S 15 /T 3 N/R 1$ TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/28/98 BEDROOM 3 CONVENTIONAL XXX IN- 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 Culvert ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P Same as Benchmark Vent SYSTEM ELEVATION 89. >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ft ^2 per chamber Vents B -5 6' Long 16" 0 -2 34" Grade at System Elevation 2- 34" X 56' Infiltrator Leaching Chambers ep A 60' B -3 60' o 6' Spacing So Between t" Trenches 30 Alt �' B -4 09 M. 50' 0' B -1 130 10' T Pr edroom House 180' W a Garage 1 Easement Road riveway an/ iscons]A 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i Property Owner Property Location I Govt. Lot 1/4 f /4,S ` T N,R�� E Property Owner's Mailing Address Lot # Block# Sub Na / me or CSM# 6 — 3 C v�r 1 City State Zip Code Phone Number ❑ City ❑ Vill e ` 'Town Nearest Road C Mew Construction Use: 00�esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow qJZ) gpd Recommended design loading rate 0_ bed, gpd/ft trench, gpd/ft Absorption area required �� bed, ft trench, ft Maximum design loading rate _gy bed, gpd /ft gpd/ft Recommended infiltration surface elevation s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material S. �� E / f� sQ �� Flood plain elevation, if applicable `i�S�� ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system I as ❑ U ®'S ❑ U 1 2 S ❑ U ,as ❑ U ❑ s U ❑ S 4U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ; Trench G .s Ground 6 � elev. th Depth to limiting factor Remarks: Boring # J /h r� r Ground Depth to limiting �� facto .S in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Soil Test Plot Plan Project Name David Burch Shau ird Address 1641 31 st St. Amery Wi 54001 - CSTM #226900 Lot 39 Subdivision Apple River Date 9/28/98 NE 1 /4 SW 1 /4S 15 T 31 N /R W Township Star Prairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Culvert System Elevation 89.6 * H R P Same as Benchmark Alt. BM Top of White Stake @ 98.0 B -5 30' B -2 AL R ep A Pri A 60' B -3 0 , o 3% � Slope 30' Alt. B.M. B -4 0' 501 15 15' B -1 0' Pro 3 Bedroom House 180' G arage Easement Road veway M. -Wisconsin Department of Industry, SOIL AND SITE EVALUATION T �2 P age / .3 l:ebctfind Human Relations Division of Saiety R 9uildings ;% in accord with ILHR 83.05, Wis. A de Pt" NTY Orx Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must nclude, but', i not limited to vertical and horizontal reference point (RM), direction and % of slope, sla -;or " ` PARCEL I.D. IF dimensioned, north arrow, and location and distance to nearest road APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION 6 N OATE PROPERTY OWNER: PROPERTY LOC • N ? Xi'G A A 11 ? S TO V � p� �� �� ,N,R /S E T GOVT. LOT //V,65 1 %d X � °�if4;$ T PROPERTY OWNER':S MAILING ADDRESS LOT R BLOCK ti SUB A OR CSM i 3 3 14 w.4 T k�, -rR P /C` i U� X -tr CI STATE 5 �� D� PHONE NUMBER /c9 �s (7 'I R o7 31 ]111LLAGE T RO D S r sr PRh1RiF ,ya,y. CC 1pri4ew Construction Use [ q- 'Oesidential I Number of bAdrooms 3 +0 4 [ � [)Addition to existing buikNng Replacement [ [ Public or commercial describe Code derived daily Now y ov gpd Recommended design loath rate ~ �/P 2 1 9 n9 �. 9P� trench, 9Pdtlt Absorption area required A/ /X bed, R 1z trench, 111 Maximum design loading rate 41 11e bed, gpol4 • tret>dt, gpd#t Recommended Infiltration surface elevations) SA • 3 R (as referred to site plan benchmark) Additional design / site oons tations - f5Ec LoN N ow ZrE' 5 . Parent material SCS 11 ON ,, j Flood plain elevation, N applicable R S = Suitable for System COyWIONAL O U IN-( WMD,p U ES AT SYSTEM IN O DM T U r- Unsuitable for stem S ❑ U [• '� C�5 j] U 0S SOIL DESCRIPTION REPORT N�/c woT iPEcoHp�,v�J Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell tau. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botrxlary Roots Bed 10 R 3 /L- s� /. Zfsb� /« vie es If- . S . 6. .:.::........ Zf N Ground 3 8 -32- /D ye 3/3 of Depth to D - `'0 7•s0 a-t , ? , g limiting factor f l /D J/ S/ , Remarks: Boring # / 0 - f io y,P 3/3 2- .. L 9 -/y /0y� ............,.: . Ground 3 f - 33 /o 1K he elev. yG. art. 3 3 jo loyle -- Z Ze .s. � Depth to limiting iactor� Remarks: ST Name: — Please Print R n 8 E R r 7A L Q R i'C 1,% T Phone: 7is 3 CJ � Address: 2y- f& esrA sociates )7" Signature: t C w 101 _ oAvole Qawanw Cansultants Date: CST Number: PROPEhTYQWNEh Ri;�:- ,eD VOL9 SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.# iE /11 Erf? BL�uJ� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmsiby Roots GPD /it In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed 3 i o io io 3/3 7 .8 Ground 30 /O — y'P U elev. ff . 70 It. 30 12-1 o �e '- Depth to 6miling tact 'r Remarks: Boring # ................ /O X 313 — y 5 y 17 1. yi CS Ile- . y 9 7 ,41101 - 1 , V Ground 3 ` /e y — (�� S iyyr,� 4;5 • 7 �' elev. 3 /0 Z 7 2 5 1 If S Y 5 .2— 3 Depth to �� v / IAG 41 Orniting factor 7 —� Remarks: Boring # /0 3/3 51 /fS�� ��iC' G's /JG • � 3 , yG /0 Yle 6 r 4 2— Ground /o yX z," he , s,, > • cs ..s . � elev. y(,'7 75 /,e M6 s/ /-fsl�,� .wti�, C _ y S yl /. ft. Depth to -9 /o /� _— s . D s �►�� . 7 g limiting factor _ v � y Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: AL V _ v' U ^� W r c 0 O `�A G Z L IN N z -v A-1 W i ` w o O R� 1` O ' cN o� a cr LL LAI q � r m M l� ko 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 'Z6 _S y�7 OWNERSHIP CERTIFICATION FORM Owner/Buyer �j � ff � G Mailing Address -_ 6 �{� 3/ J�� �✓ Property Address _ Q 'P / a Ve ification re from a tin ing. Department for new construction) ;e � /'Z_ .- rte 4 i ) City /State Parcel Identification Number /� 3 f ---o a - 01 LEGAL DESCRIPTION Prop Location /, 5 P �' ' '/ Sec. 5 , TA N -RW, Town of J�U, �r�, h � Subdivision �' �e vex - -� ,Lot # � . Certified Survey Map # — , Volume , Page # Warranty Deed # , Volume 13 �a , Page # C? Spec house )4 yes ❑ no Lot lines identifiable 1)3 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 wastewaterdisposal 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 C daf the thLeca expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements rni this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of to rt Aderibe�ue of a warranty deed recorded in Register of Deeds Office. NATURE OF APPLICANT DA / 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 i r uw N N O U O z3z w to w w w W � F=- m to 0 f(_�) w ti 0 < O 282.00' - -- a w w �-i 2081.32' _ .t �z� 0_jD z F- cn ° W w 4 / N M LO m 2. LO 39 - 91,18 1.81 � 2.55 AC. (� 110 99 SO. FT. N88°47'3F- t� .41 1.47 AC. EXC. ESMT • �� t�� "V 64,065 SO. FT. L07 \o ' o0 2.07 O N 90,042 O \ 2.06 Ac LOT M 89.76. F f>6 38 N88 32 "E _ 2.02 AC. 88,006 SO. FT. � LOT \ ! o 0 0 1.90 AC. \ 33 \ 25 N 82,974 SC \ 33 322 . S ?2 3A p\ „W `7 / 4 I 19 27 — I S88 0 15'38 "W z_ LOT 37 00 M 1.87 AC. p 81, 509 SO. FT. o ICI r— I M o n I _ LOT % I Z w p 1.76 AC. f � ti OD 76,781 SO. FT. in 1 I I ® aD N C ,, ( C-) N88 0 43'43 "E 310.62' ��I l I I �— r �I / 17 �Q 1 J Zt W I 1 Coi I O O I S88 0 48'45 "W 2E o 16 LOT 36 W 1. 5, A 0 84 S O. FT � to LOT 3 5, 0 S � M m FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 DATE: a 9 TO: Fax Number. -7 / Name: E FROM: Fax Number. 3864=6 Name: v Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: ��� ST. CROIX COUNTY WISCONSIN ZONING OFFICE d r M r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 = s ( 715) 386 -4680 February 4, 1999 ReMax Team 1 Realty Attn: David Burch 708 Somerset Road New Richmond, WI 54017 RE: Septic Inspection for David Burch /DaBon Enterprises located at 1110 212th Street, Apple River Bend Lot 39, Town of Star Prairie, St. Croix County, Wisconsin Dear Mr. Burch: A septic inspection of the above referenced property was conducted on October 15, 1998. This property is located in the NEA of the SWA of Section 15, T31 N -R1 8W, Lot 39 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. Since ely, d Esl ger Assistant Zoning Administrator Am