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HomeMy WebLinkAbout038-1084-80-100 a ~ 0 c- d Mo 4 0 �n 0 0 N O N j Q � `m ° y rn c z (n CD 9 z p j 7 N 2 LL c m � o c ' QI i 3 ° z H G E O z 0, d cC,4 a m 0 z c a�i 2 0 U) F- .= O N Z c E - o 'O �_ M N m m N C , N co •� d L O m 0 z m z N w N d c M E N y a Lo O co : c CN O A d d Q 0 C3 CL Z co Z •N aaa a E 0 co 0) 3 O N y rn rn y n .- 0 O O N E O m 4) 2 d N O N N / co �l � d Q >- (n m O O o 3 z y c cl 0 Lo V ° ° OD C > @ N N N 4 . ° ° r ° Y co °C7 w �N •- a 0) N c ° CO FBI M N - C N • M 0 - N t2 O C d m U O O N (n J c') O z_ Y � U) r 4i C� m a EL • a m m a r A vat jOU)0 ST. CROIX COUNTY ZONING I)EPARTMFNT, AS BUILT SANITARY R1 PORT ' Owner J Address Y s 7 City /State Z z y ' Legal Description: }� GF� - �<. Lot Block Subdivision -5 y1 S - 7 3Z- 1 ") '/, � '/4S A- / , Sec.a , T3LN -R W, Town of S 7u LX4 PIN e �a.31. t8. 3sa H SEPTIC TANK -- DOSE CHAMBER -- HOLDING! CANK INFOR No �c �'� o/v T 0, Tank manufacturer Size ST/PC / / Sett ack from: House 'AIr Well P /L >.s Pump manufacturer V1 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: — s Width �� Length 3G _ Number of Trenches Setback from: Houe Well N_ P/L >_ Vent to fre. !1 air intake A(4 ELEVATIONS Description of benchmark Elevation /a0 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet d /, '2 0 ST Outle ADO. B' Z- PC Inlet PC Bottom Header/Manifold A 6 Top of S7 /PC Manhole Cover /Oz, Z Distribution Lines ( ) 100. S 2 O ( ) Bottom of System ( ) T)-S7 ( ) ) Final Grade ( ) A 2 , j_ ( ) I ) Date of installation Permit number / S St; tte plan number Plumber's signatur License number ZZ /'/ ') J Date Inspector _ Complete plot plan r °t,. '0 Wiscohsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT k. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar ii `/ N161e_: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 66 Permit Holder's Name: ❑ City ❑ Villa e Town of: State Plan ID No.: ELLE, KEVIN STAR PRA E CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Iaxplo.: O TANK INFORMATION ELEVATION DATA A9800384 20. 31. /5,35 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Uk Benchmark Dosing Aeratio Bldg. Sewer ltin5 e.t T�6sn Holding St/ Ht Inlet 20 TANK SETBACK INFORMATION St/ Ht Outlet (6 too " ?z TANK TO P/ J�E LL BLDG. V,, i nt a ke ROAD D Airintake Septic > 5 r NA Dt Bottom Dosi n g NA Header/ Man. Aeration NA Dist. Pipe 1005 ` Holding Bot. System 5" S PUMP/ SIPHON INFORMATION Final Grade ' Manufacturer Demand 02.23 Model umber GPM PM Friction S em Ft L e Forcemain Lengt Dia. Dist. To well SOIL ABSORPTION SYSTEM D Width f Length o 'f PIT N f Pits Inside Dia iqu th EN I N DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEAC Manufacturer: INFORMATION Type O AMB System: ( , > 5a� OR UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold U Distribution Pipes) u r x Hole Size x Hole Spacing Vent To Air Intake Length�� Dia Length Dia. T Spacing (0.0 OIL 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 ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 20.31.18.352A,SE W 2006 94TH STR E 1 N 8- .27, T Plan revisio required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Water Systems Division �..■�i��3► SANITARY PERMIT APPLICATION Bureau of Building 2 01 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 1 than 8 1/2 x 11 inches in size. S L • See reverse side for instructions for completing this application state sanitary Permit Number , 159 01 The information you provide may be used by other government agency programs ❑ Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. ^' r^,b "__ I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop y Owner Name Property Location 1/4 Z4 S AG T 31 , N, R/ r E (or) wn Property Owners Mailing Address Lot Number Block Number .2o t w C y�y� State Zip Code Phone Number Subdivision Name or CS Number .5( 4 X°vo2 1 (7/j— - II. T YPE OFFU (check one) E] State Owned it( Near Road '1 ❑ vil age D Public 1 or 2 Family Dwelling- No. of bedrooms FA Town OF /4r ( f AA.,A c III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Q 38'_ f 6 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 R!.$eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage ' 1�K X K 43 ❑ Vault Privy 14 E] System -ln- 'll VI. ABSORPTIO 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 Y13 y I t � 99, Feet �O / �eet VII. TANK in allo Capacity Total # of Prefab. Site Fiber- Exper- INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks e tic Tan r Holding Tank /mil') ✓000 U }irCv ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ I ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PJber's Signa (No Stamps) M P /MPRSW No.: Business Phone Number: -=hn �' I ��-c r �� /.S Z Z i 4 26 66 3 Plumber's Address (Styet, Cityy State, ip Code): Z_ lelo lL S7 -e.- Wjr Leo( IX. COUNTY/ DEPARTMENT USIE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Iss g ent Signature (No Stamps) F Approved []Owner Given Initial t Surcharge ee) D n ao /� $ 2I c� Adverse Determination D v X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) - DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber f� 16 r _ I I _ r73 Op zz r sD $°► 3� /� I 6 ( I Wi sconsih Department of Commerce AND SITE EVALUATION Division-4Safety and Buildings Page _I of Y Bureau of Integrated Services h s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not le s ^ 81/ in size. I n must County T include, but not limited to: vertical and z tal refe 1 BM), direc'ti n and T. percent slope, scale or dimensions, no w, and location and distanc arest road. Parcel I.D. # !_ J 11 ! E, 7 1997 q �V 6,3 7 - APPLICANT INFORMATION - Sq e prim r• k rmati R 7 ed by Date Personal information you provide may be used f s da�Qbgllf p :04 (1) (m)). w g Z c� Property ner � Property Location L � Govt. Lot �� 1/4 S&/ 1/4,S, ,Z®T 3 / N,R f E (or) Property Owner's Mailing Address Lot # Block# I Subd. Name or CSM# qc00 Lv •- c1 'Z. t" 3o -z-- City State Zip Code Phone Number 5T f�, ❑City ❑ V' age Q Town Nearest Road 91 New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: p Code derived daily flow S�' gpd Recommended design loading rate 1 2 bed, gpd/ft � 0 . trench, gpd/ft Absorption area required ed, ft ft Maximum design loading rate •� bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) � C ft (as referred to site plan benchmark) Additional design/site considerations 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 '[5-S 1:1 U �-S ❑ U 1 ❑ S 0`U ❑ S [!�U ❑ S •© U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z y . s R s ic), ML. cts 1 04C Ground elev. Depth to limiting factor r70 in. Remarks: Boring # � Z y R d1 - e- /UF •;P Ground elev. 16 d,Y'3 ft. Depth to limiting factor �in. Remarks: CST Name (Please Print) Signature Telephone No. _/7 .S �.�,,H.r - 213--.24 f 6(.?7 Address w Date CST Number few tip �gy 1 Pik /6Z LT 12.1 32(, Z . All � 2 I W I _ ( Y7 J 7- - Arr 1- ST CROIX COUN11' SEPTIC TANK MAINTENANCE k 3REEMENT AND OWNERSHIP CERTIFICATIO I FORM Owner/Buyer kEU 1111 C • LC 1 Mailing ,Address - 34- Property Address (verification required from Planning Department for new sxmtruction) City /State ` r W t _S g Parcel Identification Nun ; fiber L EGAL D ESMM!QN Property Location 1 /4, Sw_ %,, Sec. -R O , T„ N-R /�.r - -W, Town of ST v Subdivision , Lot # Certified Survey Map # Volume � , � Z , Page # 332 , __ - - Warranty need # Volume 3 - z /_ _ . Page # S Spec house 0 yes 9 no Lot litres identil i able 0 yes © no SYSUM . MA VfMANCE Improper use and maintenance of your septic system could result in its pro mature failure to handle wastes. proper maintenance consists of pumping out the septic, tank. every three years or sooncr, if needed bj a hoonsod pumper_ What you put uuta the system can affect the finnetion of the septic tank as a treatment stage in the waste dispa al system. The property owner agrees to submit to St. Croix Zoning Dcpartmcut i certification form, signed by the owner and by a rusterplumber, journeymanplumber, restrictedplumber or a licensed pumper veri Eying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necea cary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requireutents and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Corumorce and the Department of ly stural Resources, State of Wisccrosin. Caitification stating that your septic system has been maintained most be completed and return rd to the St. Croix County Zoning Office within 30 days of the three year a te. SIGNATURI, OF APPLICANT DATE OV4M _ CERMIC nON I (we) certify that all statements on this form are true to the beat of my (our) knowledge. I (we) am (arc) the owner(s) of the pro rty described ve, a of a warranty deed recorded in Register Pf Deeds Office_ / 7 / SI NATURE OF APPLICANT 17ATE "s"•'"• Any information that is mis- represented may result in the sanitary permii being revoked by the Zoning Department. •"•' «` ,t * Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if refereno ! is made in the warranty deed v . l r... a.�, C CERTIFIED SURVEY MAP Located in part of'the SEJ of the SWJ of Section0, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. N Scale in Feet 1" = 100' r1a (A 03 ° ° c 0 0 50 100 200 rr - 1 BENCHMARKS / c m 100.00 CD CD o, b = 98.73 c ' Elevation of River 2/24/97 = 82.8 / m corn cn E n Ste ��+► 94t'�6lTA?=• ',p -j C a o tii In D O / / C 0 I Ci. v W c `r NYF•I o m� s m CD w r G• � �5 � ��j5 3 a� • 33 133' �j � � �Q Su 3 FILED o 6a 1N.R��� �FA . AUG 1 9 1997 ► 11 S z �TMLB H. WALSH / i0 Croix of Deeds o l�z SL SL Croix co, wl �? LOT 8 1.84 Acre§ - 1 �O 79952.75 Sq Ft �7> Wi °• overhead a ctric o W I nn i1 00 'SS 6 VIP �1 1N S ° 47 -o� --� 1 ' 33' 33' 12 E / .53 8 °59' 44 "W R16 I �� l0 6 4 .37 �8i 2 582 1 . � .� 15 OUTLOT 1 MI �I S24 °10'09 "E FLO ah 90� � `� 44ot \ ® N8 59 o S87 ° 45'36 "E 1718.15' t 1 4 2' S87 ° 45'36 "E SW Corner \ 587 °45 "E 236'f DRIVEWAY EASMENT 74- ' — L SOUTH LINE OF THE SW�I /4 L` � -� 24' Section 20 l,' � __ _ � �VOL 1054 PG 633 _ AF Pe4 &7 C� 4Ae4w ? 417 O i 1 j : I • . f �Z� TIC A gk ik - 4 s 7Is aye- 7U. 1 sue, W27 r �s- . sy�aS r I i. i B tQ flt r ,c ) a r�NS fZ�om B 14o PAVN.9., Of\ R