HomeMy WebLinkAbout038-1148-50-050 ST. CROIX COUNTY ZONING DJEPAkTMENT
AS BUILT SAmrrARY Pg1�T
Owner A
Property Address
City /State Sc,. �` ����.: S`y a� l�y�tGl~
LINTY
d
Legal Description:
Lot 10 Block 4? Subdivision/CSM #
L V 1 /4 t /4, Sec. L2 TAN -R /F I&I Town f n7'-, " # X13 `�- //5/r� -
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer - ;W Size 63_7PC e("c / Setback from: House 2 Z Well > - — P/L �S
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: Width �2 y Length 3 3 — Number of Trenches
Setback from: House 7a2s' Well . DSO P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark 7 - Elevation 00'
Description of alternate benchmar '7 o Elevation - 0 - P s
i��H
Building Sewer ��,9 3 T Inlet • / ST Outlet (� S� PC Inlet
PC Bottom � Header/Manifold 7 S Top of ST/PC Manhole Cover
Distribution Lines () 3 () ( )
Bottom of System
Final Grade 6 S ( ) ( )
Date of installation / /e /5 Permit number 7/'Z. State plan number
Plumber's signatur U :�� 1, C License number Zi`,/ 7 / Date 4 4W /
Inspector e
Complete plot plan e
�
Wisconsin Department
Commerce
Safety and Buildings Division 12- Z3 � 1?;•
PRIVATE SEWAGE SYSTEM Count y:
INSPECTION REPORT ST. CROIX
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)]. 324712
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.:
WILLIAMS, ALLEN STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
f 0� 1 0(7 10 038-1148-50-050
TANK INFORMATION ELEVATION DATA #9000 /
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic, Bench ik y .yr 1 044 lc5c--�
Dosing A t �zt3
Aeration Bldg. Sewer ' ,c� 2
Holding St /Ht Inlet 7 "TW (
TANK SETBACK INFORMATION S / Ht Outlet 97 9�
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic -i.1 f, '1 NA Dt Bottom
Dosing NA Header/ Man. 7q q7 o S
Aeration NA Dist. Pipe 0 7
Holding Bot. System 73 q5 ,qci
y
PUMP / SIPHON INFORMATION Final Grade �.3
Manufacturer and &
Model Numb GPM A14. /ly�
TDH Lift Friction S ste TDH Ft
Forcemal Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
TRENCH Width a � r Length � Trenches PIT Of Tre PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING er: —
SETBACK CHAMBER Z ZZ er :
INFORMATION Type O /
Systerr�W o - i'll . OR UNIT
DISTRIBUTION SYSTEM
Header / Man Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length ) / Dia. Length �1ro Dia. Spacing A STS^^ 27 z
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 E3 No ❑ Yes E] No
COMMENTS (Include code discrepancies, persons present, etc.)
CA�T�IO�N: STAR PRAIRIE 1 7.31.1 8, NW, SE 68 BRAVE& RIVE — OT �1
P ce V
s
Plan revision required? ❑ Yes CeNo P4,1
Use other side for additional information. Z>
SBD 6710 (R.3/97) Date Inspector's Signature E No.
��i�i..■'•ir"i S afety and
ofBuil Bui Wa Div
SANITARY PERMIT APPLICATION
Bureau of Buildin Water S st
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. C,277, C .c,
• See reverse side for instructions for completing this application State Sanitary Permit Number
37,012-
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 INFORMATION
Pro pe er Name ,_ l ` Property Location
JA 1i4St! 1/4,5 /'7 T 3 j , N, R E (or)(iff
Property Owner's ailing Add re) Lot Nymbber Block Number
�cr ��- / 6 iJ
Ci p, Pte Zip Code Phone Number Subdivision Name or CSM Number
J; o n.@ r S' f� �>/J 1,40r k114 S c r
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it age Nea rest �
Public 1 or 2 Family Dwelling ❑ VIl - No. of bedrooms Town I` � a a ir
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) f
1 E] Apartment/ Condo 1 ?' 3I' /19. � ' / �� �/ So S�
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 _ ,S New 2. I] Replacement 3_ ❑ Replacement of _ 4. ❑ Reconnection of 5. ❑ Repair of an
------ -------- ________ System_____ _ _______Tank Only___ __________ Existing System ________ Existing5ystel
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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit r��7 X� 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 Grad
ff// Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevation
75b Wo Feet c7R:S Fee
VII. TANK Capacit g all o ns Total # of Prefab. Site Fiber- Ex
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A p
New Existing n strutted
Tanks Tanks O f (�(
Se tic Tan or Holding Tank . moo I CJ ❑ ❑ ❑ ❑ C
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sews e s stem shown on the attached plans.
Plumber's Name: (Print) Pat� Stamps) M RZILt W Business Phone Number:
WhA -
Plumber's Address (Strest, City, Stateyip Code):
IX. COUNTY / DEPARTMENT LAE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps)
A roved Surcharge Fee)
pp ❑Owner Given Initial / n
Adverse Determination � Z"'f
l U t /
X. XONDITIONS OF APPROVAL / REA ONS FOR DISAPPROVAL: rte. d /
amt- 4AoL& 6e, ,zs o'�- b "4 `1 bt
SBD -6398 (R. 0 5/94 )V DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber
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s
49P 11-on
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' Yr i lai lert "LL YIS: 4J FAA '715 366 4E.86
ST CRX CO ZONING
ar
F) fl, S y >�C
1
Yf6sh Alr IAtelf Ali# OCeerroclas Pipe
(=�P---Apprrvod VNir Cs,
WY I Y A""
/ d0
!�)• Above Pipe e Ceer Iron
To Fpe .... Venr Pipe
wree fifty Of II melllt
WIN . iere
va
O
Olerrlsat4w
ripe �" . — ree A• A}. �e. Mtlereled pipe sole.
�..`��e l win lrtm rtnO eI
Ao)tor* Of 3per.w
►on
$oli. FILL
DISTRIGUTIOI.I PIPE
• A►PRavfo sy1J'j1tEtIG GOVER
A4C/REGAt ...�' ' oa a" OF STRAW
OR KARsw fAk4
-EY. O 7 e L air
%Z•�lic AG6RCGAT� �.�
DLST'ftlR'JTI0W PIPS TO bC AT LEAs? rrJ N
AAlls AT LEA$'tL0 I►�ICNtS e►IT AfO MORL THAN 42CIkIEk1iS 6ElOW FlA1Atr GitADE
!'WtrW 06prij O F EXCAvATieo FRort oAitswgL 6t(AorL Wlt->_ air y- ►UC14ES
MIKIi'III/7 PTM OF "CAVA -r(OM FR OM OlklefWAL GRADE WILL ec cWEs
SiGTwICD. ��
DUMBER;
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Wisconsin Department Commerce SOIL AND SITE EVALUATION
division of Safety and Buildings
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Page of
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Coun
tY
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.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Re iewed by Date
[Prop roperty Owner �. �� p
Property Location O
(� ` Govt. Lot �1/4��1/4,S
erty Owner's Mailing Address T N,R 1 8 E (or Lot # Block# Subd. Name or CSM# ity State Zip Code Phone Number a '�
a / 5 1L ^ ❑ City ❑ Village _ Town Nearest Road
FCodederiveddaily ruction Use: 'Residential / Number of bedrooms
Addition to existing building
❑Public or commercial - Describe:
flow y�-) V ' qod
po� 2 Recommended design loading rate bed, d/ft .�
Absorption area required 9P trench, gpd /ft
_bed, ft _ 1_ — trench, ft2 Maximum design loading rate -%5 bed, d /ft
Recommended infiltration surface elevation(s) ® 9P trench, gpd /ft
Additional design /site considerations ft (as referred to site plan benchmark)
Parent material ' y�
Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade
U = Unsuitable for system S El S ❑ U System in Fill Holding Tank
_WS ❑ U �S ❑ U El U El S,�U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture Structure
pu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots GPD /ft
Bed Trench
e round ��Ai
Depth to
limiting
fact f
Remarks:
Boring #
Ground
2.3
Depth to
limitin
297 facto
in. Remarks:
COUNTY v
CST Namg (Please Print)
ignature
ep He No.
Address
Date - °~ r T Number
r
Soil Test Plot Plan
Project Name Al and Diane Beeler
Address 97 Byron Bird Jr.
0 Brave Drive �'
Somerset Wi 54025
Lot 10 4CM #220527
Subdivision Wigwam Date 10/15/98
NW 1/4 SE 1/4S 17 T 31 N/R 1 8 W
Township Star Prairie
[] Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Property Line Stake
System Elevation 96.0
H R P Same as Benchmark
Alternate Benchmark Top of Property Line Post Qa 99.0
quaw Lake
N
O
� N
U
r
c�
r
Pro 3 Bedroom Hous ro
Note to home
builder /designer:
259 building site is not to be
<25' from B -1 and B -5.
0 B -1 5 5
-5
Pri A Rep A
0 '
-3
5%
Slope
5' 35'
0 , -4
15' B-2
B.M.
5 85 , Alt.
B.M.
Brave Drive/ I epee Trail Right of Way
si 4i
ST CROW c�otjNTy
SEPTIC �"'NK ,T,rr
NANCE AGRP- ZMIiNT
Oft ERSHIP CERAN �CATICN FO RM
C�wtter /i:3uyer '�
Mailing Address 47'/0
OA-9 All
Properly Address
(Ve}riticattoa required fron i f'lanM D9 Do;ammrrit for new coral a )� --- --- - -- -
city/state — ..,_ ..._._.
Parcel Identification Number
LEGa �= v - o s - v
bESCRT� pTJON -
PrOPMIY LocadDll NV %.
R ,.... W, wn of
Subdivision
Certified Survey Map # _ -
Volume �..: Page #
Warranty .Deed # a !
- ---- -. Volume # Pag Spec houso U yes Q no g
Lot lines identifiable d yes ❑ no
SY- a� -UAW
proper 'Ile and mattceof your se; pc system enuld recruit in its prcmatuze fai]urG to baadlp wastes. Co13S15tS of puxuping ont the septic tank thri a y ea" or sooner if tttedod
b y a licensed a
can affect t he fimCtion of the septic tank. as a tre.? s. Pro pe to t ea system
pment stage in tlir. waste disposal s ystem. pu mpe r. What you put into the systean
The property owner agrm to sub tit to 5L Qix Zoning Ltic
is in pluznbar, jotrzusymatiplttmber, resiri to lrttberor a lioned ` "tm=t a cortii3catic k form, signed by the owner and by a
is in prapir operating condition and/or (2) after pj : trnbe a li trna p�perverifying that (1) the alt -site wastewaterdisposal system
P tsitlg (if Necessary) the SejSriC tatk 18 0668 titatt 1I3 tub 4i"' sluAge.
Uwe the uttdersign,ed have read the above rc Q
set forth. he -rein, as set by the ll ti1 Monts and agreo tea t�taintaira the private sewage tllsposal s yst crra with the standards
stating that yours tic apartment of Can acne and the Depart nont of Natural Resouroes, gt o f septic systtetti ties been maintainer f tttttst be completed and raturned to
the St. 06j Ceunty Zo Of�tce t 30
days of the three year expiration date.
S ATU1tix OF A.PPL AY
— W N - E:Et ATE
(� E.R�'IF1 TI ON
I (wd) certify that all statoments ou thi : i rm ar tms to tho hest of my (cur) k Qowjed
the PtI�e�y described above, b vin►,e of a w aIm lty deed recorded ilk Re 3istrr of Deeds (5ltice.
ge. I (we) ant (are) the owner(t) of
Va p
ANT
IJA.
A-uY iAformation that i ll mil represented rY sy result in the sanitary permit betng revoP�ad by the Zoning De artme
Include with th rt is aPPlieation- a stamped wan I tty deed from too Register of .Deeds r�{� ;
p tlt.
a copy of the a rtified surv Jn,ap if refareace is made in the warranty deed
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