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HomeMy WebLinkAbout038-1184-00-000 1 ST. CROIX COUNTY ZONING DEPART. AS BUILT SANITARY REPORT Owner ; 0i:5' �clle vex Address - City /State 1-1 yd", ,/ Legal Description: F.CC Lot _J2 Block Subdivision/CSM # Sec. ;?I , T N -R W, Town of _5 .� v ra : ' ►�� '� PIN # SEPTIC TAN 7--U OSF, CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer &, °d w e 7` Y Size ST/PC /e Setback from: House Well P/L 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: _Timms �/, Width s— Length _4 l.' Number of Trenches Setback from: House ,SQ • Well — Vent to fresh air intake ELEVATIONS Description of benchmark ,al ,oz Elevation �dD Description of alternate benchmark Elevation , Da, x Building Sewer yS ST/HT Inlet Md. 4e,57 ST Outlet zzy. PC Inlet PC Bottom Header/Manifold f G Top of ST/PC Manhole Cover i, 57' Distribution Lines Bottom of System Final Grade Date of installation i.,,�7-- p ermit number 3o7l J State plan number - -- Plumber's signature License number ,��' r(fD Date / / ! T - Inspector AIJ Complete plot plan or Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y- •. Safety'and Buildings Division Count INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary30768$.: Personal information you provice may be used for secondary purposes (Privacy L s.15.04 (1)(m)). Perr� ` it H0 eKT6% BUILDERS (HEINTZ) E �hRP P 1 en of: State Plan ID No.: CST BM Elev.: L Insp. BM Elev.: B Parcel Tax No.: o po -6oc) TANK INFORMATION ELEVATION DATA A9800071 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ep c 'M; �rcA s I oa Benchma k 7 (0 1 D1F L �OC� Dosing { (} g f 1 . 5 0 1 Aeration Bldg. Sewer 3.f poi -yam Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet' TANK TO P/ L WELL BLDG. Ai -1ie to a ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe (og 4r j� Holding Bot. System (,.°) q 72 PUMP / SIPHON INFORMATION Final Grade 3 - 7� /oo . Manufacturer Demand Model Numb r GPM TDH Lift QFriction stem TDH Ft Los ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSION BED / TRENCH Width s SYSTEM TO P/ L BLDG WELL LAKE/ STREAM LEACHING actu,er: SETBACK AMBER INFORMATION T�pe O - , L of OR Mode er: U S stem a. `( DISTRIBUTION SYSTEM Header /Manifold a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _n� Dia. Length 600 Dia. 7 Spacing AS7 / Z_ 72 °� 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 ❑ No ❑ Yes ❑ No 4 COMMENTS: (Include code discrepancies, persons present, etc.) G9 x 5'6 97 � LOCATION: STAR PRAIRIE 21.31.18,SW,NW 2048 COUNTY ROAD C 3 6q I , p ✓+ I c ttiu.'G{ Grp L--0 Plan revision required? ❑ Yes (� No F7 � U se other side for additional information. c 9 �L� I 1 SBD -6710 (R.3/97) Date Inspector's lignature ert. Safety and Buildings Division `CO/fS/11 SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83 -05, Wis. Ad m. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. c yp • See reverse side for instructions for completing this application State Sanitary Permit NN(u�mb CDL The information ou provide may be used b other government agency programs O Y P Y Y 9 9 Y P 9 [ 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 Property Location •` rz- c c l sL/va L &d 1 /4, S t T 3l , N, R E (or)�V .Property Owner's Mailing A dr ss Lot Number Block Number Go City, State Zip Code Phone Number Subdivision Name or CSM Number 4 '64M r II. TYPE OF BUILDING: (check one) ❑ State Owned !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms .� k V ow a n of ciY �` �' �O 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 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. Ig New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an -___ System -------- System ___ _______ ___ Tank Only_ Existing System Existing System B) El 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 j 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) © Elevation S 10 hX_ l 7 Feetj I dl, 2 Feet VII. TANK Capacity in gallons Total # of , Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel Plastic P New Existing structed glass App. T nks Tanks Septic Tan s f� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ I ❑ I ❑ I ❑ I ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 0'7 s 01 AV'e, s' IX. COUNTY / DEPARTMENT USE ONLY ent Si ❑ Disapproved Sanitary Permit Fee t (Includes Groundwater a e ssu Issuin nature (No St Approved ❑ Owner Given Initial oo surcharge Fee) I � 70 Adverse Determination t 1 / r 4 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: G SB083913 (11.11196) OISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Fn � (o(.2 a P QD' O j G Wlgconsip Department of Commerce SOI#_-=ANQ SITE EVALUATION 'D}visiodof Safety and Buildings Page of Bureau of`Integrated Services t'aCCQfJance with s;'t1.HR 83.09, Wis. Adm. Code County Attach complete site plan on paper not less tha x 11 i Plan.mu include, but not limited to: vertical and horizo ( erence point i Id p ercent slope, scale or dimensions, north arro ,..aqd to a distance to near road. Parcel I.D. # ST Cploj: APPLICANT INFORMATION - Pleas ' i nt all iDrbtlg Ion. ewed by Date Personal information you provide may be used for se 11 �""!016� s. 15.04 (m)). P Pro a Owner f� ° roperty Location v Govt. Lot 1/4 1 /4, ! S 7 2/ U N,R , y E (o W Property Owners ailing Address Lot # Block Subd. N ame CSM# i b State Zip Code Phone Number ❑ City villag Town Nearest Road l! 1 1A sC / N New Construction Use: 0 Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, bed, gpd/ft gpd/ft Absorption area required _�1_ bed. ft _ trench, ft Maximum design loading rate � 7 bed, gpd/ft _ trench, gpd/ft Recommended infiltration surface elevation(s) _ �� 7 ft (as referred to site plan benchmark) Additional design /site c nsiderations Parent material .4 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 aS El S ❑ U [K S ❑ U I S ❑ U ❑ S U ❑ s ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 v , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench _ 3 u " J " , 5 aJ Ground S g r �,s I.J 1Z elev. S� r _ J42,7-ft. - J Depth to 7- — limiting factor Remarks: Boring # Al El r 5� Ground / , elev. Depth to limiting factor Zin. Remarks: CST Nam (PI ase Pri � Si�ture Telephone No. —�� Address Date CST Number �' - 7 I ��,/ 2 t z) ' T Xglj �` - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNER�SHHIP CERTIFICATION FORM Owner/Buyer Z / / . �— ✓ a /1o v.4 644v j - g c_ Mailin Address U S 0o i 2O A4 q Property Address �-/ �' x Co (Verification required from Planning Department for new construction) City/State :s4A w PzA 1 ( ' 6 _ Parcel Identification Number LEGAL DESCRIPTION Property Location 5Gt1 % N�1 /., Sec, _a , T f N -R /9 W, Town of SV4tz l E Subdivision rz- C € Q I T ( 0 A-) Lot # Certified Survey Map # Volume , Page # Warranty Deed # 5 Z 1 Volume Page # a 3 Spec house Ryes ❑ no Lot lines identifiable Dyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.f lure 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 masterplumber, journeymanplumber, restrictedplumber 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 days of the three year expiration date. GNATURE OF AP LIC DATE 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 property described !Pove, by virtue of a warranty deed recorded in Register of Deeds Office. J GNATURE OF APPLIC DATE * * * * ** Any informatio 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 . a o • z I� Ih I I I I� aj I� I N II DD 'A O (rl 00 I v l I ci o m N� W I CJ N I (O S 01'24'58" W 705.04' No 46.52 348.06' I — — _ 658.53' I I m I .. CD ° I J is co 0 O 1 00 D > co 0 p Am l V1 ly I b N N 01'24'58" E 00 46.48' I 348.06' co t o cn m � Ln co W J o I v cn to rn p W cn is -1 il~ I m J o X 0 0 00 r ►� m o m � °V ' n O m GN' 00 LO LO A m m co °° o� I �`� 00 Icn !A W N 01'24'58" E 46.45' 348.06' -o I c a, r.imrm o0 ozc ° co N 0 m D gg D c m N O C j to N o Z o( M, C`� Ur--{ N (7 14> tG Ln �m� 0 D LnN� 0-C N cn O -V CA m 0 � mm V) X I Ln N W I�rjC7 Gy%nZ0N DN u, M:r> L/) K - K • — • — m m =D N �NZ(ACm �ZVO QDm�muz -ai 46.60' D ° m om ° 3 49.36' 3 67.85' to 45 4 s' N 05 .4 8' 11 " L 414.45 1 s. 'a M - z <� - o ° D cc�m �A o- r���mcn Z V) flr� D rr* -- u ._. y a, m I (7 I rn z m�o� rn O�m� n ND m o I• 00 - Z > g =1 m m o Ot �;z U O > >v '^ "' �' °n V1 V1 =N S -<<nm . c D oo° - I I I o . <MZZ � I I� I IO ozm ,� rTl zm c ICZ I° � "M_D" I � l y D � V) r = � no�o mms0D Icy I I� rn z �0 = (n J I� �N.r�* m m o n 0 o� v rrn� 5 „ - mC- � m - ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 July 13, 1998 Re/Max Team 1 Realty Attn: Mike Germain 103 Main Somerset, WI 54025 RE: Septic Inspection for P.C. Collova Builders located at 2048 County Road C, Lot 10 of Circle "C" Addition, Town of Star Prairie, St. Croix County, Wisconsin Dear Mike: A septic inspection of the above referenced property was conducted on April 27, 1998. This property is located in the SW %4 of the NW %4 of Section 21, T31 N -R18W, Lot 10 of Circle "C" Addition, 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. Si rely, Rod Eslinger Assistant Zoning Administrator /sm �� ST. CROIX COUNTY f WISCONSIN I - t ���� ZONING OFFICE Islip "Ra -- L ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 July 28, 1998 P.C. Collova Builders 705 County Road E Hudson, WI 54016 RE: Septic Inspection for P.C. Collova /john Heintz located at 2048 County Road C, Lot 10 of Circle "C" Addition, Town of Star Prairie, St. Croix County, Wisconsin To Whom It May Concern: A septic inspection of the above referenced property was conducted on April 27, 1998. This property is located in the SW Y4 of the NW of Section 21, T31 N -R1 8W, Lot 10 of Circle "C" Addition, 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. Fod rely, Es in er g Assistant Zoning Administrator Am