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HomeMy WebLinkAbout038-1112-30-000 ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT RECEIVED Owner 0 N 4 1998 Address sr CROIX City /Stat 1 .' T� l -1 \. ZONINOGO FICE Legal Description: \ \' ,;,_.., -r Lot _ Block Subdivision/CSM # I a- ) '/+ dGeL '/+ ,, Sec., T N -RAW, Town of PIN # 0,?10 . X1.18- SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer s Size ST/PC / / 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: Width z,�2_ Length r Number of Trenches Setback from: House Well PAL ,- .4y Vent to fresh air intake r loo ELEVATIONS Description of benchmark Elevation Ise, a Description of alternate benchmark Elevation _ Building Sewer 9�7!2 ST/HT Inlet ST Outlet 9Z 7-? PC Inlet PC Bottom Header/Manifold lI Top of ST/PC Manhole Cover 2 Distribution Lines Bottom of System O ys O ( ) Final Grade () W 7 () ( ) Date of installation Per it numbe -_g0 7Z State plan number Plumber's signatur License number Date / , Inspector �S�/ w complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,P6u1,i194: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 33 // bb tics yy M er's aft'kE 'KIP \lillaae irrn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Y Parcel Tdlt?1 LL1112- 30-000 ts� L 1 0 R Q ���/ -/ e TANK INFORMATION EL VATION DATA A9800078 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / 6 D Benchm r ?j;95' / 1 , / D Dosing ALt- 9M — 2 ° O(o • $"l Aeratiorr Bldg. Sewer Holding ('43* Inlet TANK SETBACK INFORMATION a?iPrOutlet - 7. Z_2! '�_7( TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic +160 f / Z' 3 � NA Dt Bottom Dosing NA Header/ Man. ?,36' `76 -!l Aerati NA Dist. Pipe 1 7 q 4 1 6 j Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 7 Manufactur Mo Number T H i Lift Friction S st TDH Ft oss FOrcem Dia. Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width / I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D pth DIMENSIONS t DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA facturer: INFORMATION Sy 1� S�I / -_ C MIT Mo a Num OR IT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake p u �( Length � / Dia. q Length � Dia. Spacing A-S oA� a1 Z J O S_ 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 1k -40 e( Bed /Trench Edges Topsoil es Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 28.31.18.476A,NW,SW 1008 192ND AVENUE pqy� (-,I Plan revision re ulred.) ❑ Yes ] No Use other side for additional information. w a3 C, NIS SBD -6710 (R.3/97) Date Insp or's Signature C A sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. 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 8 vi x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Permit Number 30 � 8 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)I. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION I I ___-j Prop y Owner Name Property Location a1/4 1/4, S T , N, R (or) W Property Owner's Mailing Ad ress Lot Number Block N ber Cit tate Zip Code Phone Number Subdivi on Name Number I f ' a S ( ) Y II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road A Public 1 or 2 Family Dwelling - No. of bedrooms -� ❑ ga Town of 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) o38- - �0 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. V New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - ___System System_____________ Tank Only______________ Existing System - ------- __ExistingSystem 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 (A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , 1 42 E] Pit Privy 13 [] Seepage Pit ! Z. 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./' ch) Elevatio Feet Feet 17 Z, 91­6 Capacity VII. TANK in Ca a Total #'of Prefab. Site Fiber- plastic Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin structed T nks Tanks tit T ❑ I ❑ El ❑ Lift Pump Tank /Siphon Chamber ❑ 1 1:1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inslallation of the onsite sewage system shown on the attached plans. Plum er' am (Print) Plum rs Si ur� tamps MP /MPRSW No.: Business Phone Number: Plumber's A( dress (Stre t, City, S ate, Zip ode): IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitar Permit Fee (includes Groundwater ate Issue ISSUIn AgentSignature(NoStamps) o Approved []Owner Given Initial t j/� Surcharge Fee) 7 � , / ^ A� rt Adverse Determination ! (/' V / // 4 � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6M (R.11/96) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber i o � F a � l6� � n h� 1 6 Wisconsin Department of Commerce SOIL AND SITE EVALUATION 3 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 - ------ nearest road. Parcel # b3SS - I l 12�3d APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal irdomation You provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /� � i /•LZ•q g Ply Owner Property Location Govt. Lot I 1/4 1 /4,S T ,N,R E (oQ9 Prbperty Owners Mailing Address Lot # Bloc 1 Subd. Name or CS M# City State, Zip Code Phone Number ❑ cit ❑ Vill a ,® Town Nearest Road New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow —� gpd Recommended design loading rate bed, gpdfft , , trench, gpdtW Absorption area required ` ' _ bed, ft trerch, ft2 Maximum design loading rate _.� bed, gpd/fl „I trench, gpd4t Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site ponsiderations z Parent material ' ! Flood plain elevation, if applicable IC ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Folding Tank U = Unsuitable for system El s ❑ u l� S ❑ U S ❑ U 1 0" ❑ U ❑ S ®U El [ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground _ % ` _ _ le ea& elev. Depth to limiting factor Remarks: Boring # 13 i4 Ground � ' <^ elev. �-~ ST CROIX Depth to limiting ZONI GOFFI factor ,}�)n. Rem, arks: CST Name �Ple P ' t) Z Sign Address Date CST Number 1'�IAIV y8' g j ,� 30 a� )416 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Crois County OWNEWBUYER �yA N r� F/4 6P)` N N MA MG ADDRESS 1 O� I r/ 2 A v , _ � PROPERTY ADDRESS Ino 1 q a h c� (location of septic system) Please obtain from the Planning Dcpt. CITY /STATE PROPERTY LOCATION N "/ 1/4� w 1/4 Sectiuu 2-f , T 3 f N_R 1 5 ' W TOWN OF 5�� /��i/�1�11= ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY ADAP 5 , VOLUME 1- 2 , PAGE 3 , U?y, LOT NUMBER 6 Improper use and maintenance of your septic system could result in its premature fuilurc 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 Cho 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 I, 1978. St. Cruix 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 c urtitication form, signed by the owner nand 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 ;end pumping (if necessary), [lie 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 ilia 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 expiration date, SIGNED: DATE; 7 ` 7 St. Croix County Zoning Office Government Center 1 101 Carmichael Road Hudson, WI $4016 11/93 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property 17 q R/y 1 = I= H Co lV A/y Location of property 1V w 1/4 S k/ 1/4, Section , T 3 1 N -R 1$ W Township SrP(? p1?.R'R11_ Mailingaddress 100 �( 19' A N i; W 81614 MON✓g X4.1 'C h Od 1 - 7 Address of site 10 o g l g ;L A _ I 15 w 1 16 H &oH h w£ 574 Subdivision name / Lot no. 6 Other homes on property? Yes V No Previous owner of property /?P,/ l= G N /A I Total size of property �t ;?. - / .2 /}c2I= s Total size of parcel '3 7. 3 i ` Date parcel was created 3 - � 3 -- `fir Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes &---" No Volume 1Z and Page Number 3 e-1 2 y 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. S 7 56 - x6 , 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. Signature of Applicant Co- Applicant 7 1 - � Date of Signature Date of Signature 1� co J S FILED 10 � MAR 2 3 1998 KATHLEEN H.WALSH �1 Register of Deeds St. Croix Co., WI i CERTIFIED Y MAP LOCATED IN THE NW 1/4 OF THE SW 1/4 OF SECTION 28, AND THE NE 1/4 OF THE SE 1/4 OF SECTION 29, ALL IN T31 N, R 18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. NOTES FOUND 2" IRON PIPE IS S 85 E 0.34 FROM COMPUTED POSITION. FOUND 1 " IRON PIPE IS N 77 0 04' 51 " E 0.66 FROM COMPUTED POSITION. W 1/4 CORNER © FOUND 1" IRON PIPE IS N 56 °16' 42" E 0.54 FROM COMPUTED POSITION. SECTION 28 T31 N , R 18W © FOUND 1" IRON PIPE IS N 48 °20' 25" W 0.48 FROM COMPUTED POSITION. UNPLATTED LANDS 1 / RED ESTATES I of - - - - - - - -/ 20 - -I I ZI - - - - - - 21 (REC. AS N 89 29" E) I POINT OF BEGINNING I I JI S 89 0 55' 11 " E / NORTH LINE OF NORTH LINE OF 321.24' S 89° 12' 1 10" E 1315.94' THE NW -SW I �• 0 THE NE -SE 243.33' 1065.31' A �I (REC. AS S 88 0 24' 14" E AND 17._ ~ NE -SE c 77.91' N 89 0 45' 20" E 1316.69') LJ SHED CO JI SECTION 29 a? o I FOUNDATION n tll 0 ^ N ° LOT 7 ( w ?1- LOT 6 7L, N I V) - 22.125 ACRES ± ° r` ° I 0 963,786 S.F..t �/ 12' `t > r o 13 INCLUDING TOWN ROAD 3 M 0 3 3 in- Iz ° 'd. rn 3 RIGHT -OF -WAY �� - 3zo 1 1 _ (DI= ,� 22.096 ACRES ± XSECTION � t° N a I o +I o • 0 I - I ``' 962,484 S.F. ± Q 04 F ! �! �; w ^ EXCLUDING TOWN ROAD ? NW -SW .-� Q Nm NmN� 1 N RIGHT - OF - WAY 11.1 28 o w" NI o ° . � 0 ' Z ° (REC. AS �� REC. AS N `� w Z' rn co o U) 0 3 ° o I V) ° S N 00 20" 00° 9' 6" W) c� N 89 E ? 1 o cr to - w z 331.77') \ d I o ao N z 13 117.65' C N 89 °05' 44" W LOT 3 a- o n3: +Iz B of o N 3 0 3 - ' Q 1 (REC. AS N °07' E) 330.98 3 , w C.S.M, w o � w ° S 00° 19' 1 W48.50' REC. A 88° 16' 50" E) fn1 I V) to rrl VOL. 10 wuz 0 o � N89 °04' 34" 89 °04' 34" 9 °04' 34 "W417.00' p 3 PAGE 2757 z a z 8 250.64' o ZI I z DOC. # 51655 to o o N" LO 3 a Li c7 o _ _ � oI C.S.M. 1 JI I = `.�-' z Sri x t ] �- o �I VOL. 7 I of - ~ - - w � Q, ^ Cli c rl cal � I P AGE_ 1966 �I I v p oM �I d `� �) oINI�If - 0 - - QI 11 w co N ��vl cO u� F- � is dl II 1921 3 ` lcjo °rn o vi O o1ao VOL. _6 I Z 1-I�j I 8844845" Jk�I >I W 01� v°i �k.ii >Ia101 PAGE 1581 5I Ip N cn �QC4050521 - �Ic O ° 4 w _ — — — - ° (R�C. AS 321.83' � — — —_ — -- -- — — — N 89 6 12" E 321.65' )io 1 N 89 °04' 34" W SOUTH LINE OF LOT 1 LOT 2 THE NW - SW C- s_1�. I�,M� N I (� 66.0��_ CENTER LINE 192ND AVF,.. Lj VOL. 6 153 YOJ,. J_ �I M I N 88 0 49' 19" W 0 3 E_41PA�E_ 1$5� W w l I PAG 66.00' w N WI N — — rl•4a' —e — — ZwV �I N (� UNPLATTED L YI&DY w _ o w 3W U. =I o f 1 10 AF1i? e9$ c w" n O z 0Z N ~ I -, Z J Z � O Z' w �..w1Y Qf"�e r 111��� r•. i..•,...... u N U O FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -4680 DATE: I' ,D' / TO: Fax Number. a 4-7 — 3 o W Name: FROM: Fax Number. 386 -46 Name: Number of Pages Including Cover Sheet: IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: ST. CROIX COUNTY f�, =� WISCONSIN 20 ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 January 20, 1999 i Duane Fagnan 1008 192nd Avenue New Richmond, WI 54017 RE: Septic Inspection for Duane Fagnan located at 1008 192nd Avenue, Lot 6 Town of Star Prairie, St. Croix County, Wisconsin Dear Mr. Fagnan: A septic inspection of the above referenced property was conducted on June 19,1998. This property is located in the NWA of the SWA of Section 28, T31 N -R1 8W 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) 3864680. Sinc rely, f-641 Rod Eslinger Assistant Zoning Administrator /sm J