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Home My WebLink About038-1121-95-100 § j 2 2 0 f 2 D R 0 � { � ■ it ƒ � k in k a § \jc U. c � \/k � / \ K § z z 2 I R § k m E ) z t \ / k k 7 : D ) a 7 7 I � . � ) [ / ) / / \q � Q zmz \J 2 { % 2 ' ■ ` Lo ■ G CD \ & k 2 ) A £ 8 z k k k k EL i \ ) -� / m a a 7 % o B k c . f f ƒ r = c I \ \ _ 70 E § '» m 7 I= 82 a / � 0 % ( J » m 3 § \ § '§ ) k = E c L6 Cl) }f(2�EE� 42 e S ƒ # E E ` -0 § $ 7 w N r'- $ ) d ) / \ S k j\ co \ o z/ z) 2\ 2 .. k + E 2 2 k 0) ,_. IL E &' aka§ k J a o 2 & 0 Parcel #: 038 - 1121 -95 -000 01/12/2006 04:36 PM PAGE 1 OF 1 Alt. Parcel #: 30.31.18.503 038 - TOWN OF STAR PRAIRIE Current X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 7! RY'��*iv�, °MWl."f[P Pg4R �Tlf�ll - V ST. CROIX COUNTY TONING DEI'ARTME N'� AS BUILT SANITARY REPORT ��i C��1 Owner �' Address Tom® TOP i � X City /State --.g �� t s '' y c ® Z \ _r`' COUNTY f ZONINGOFFCE Legal Description: l f' Lot Block Subdivision/CSM # ' /.,7Sec., TN -R, Town of •r ray i G PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: �, - 31.) 8, �03� // l /l5 we l Tank manufacturer � <1e /� S Size ST/PC I�� Setback from: House Well P/L _�,5 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 stem: gh rr,� o yP system: F f � Width ,�_ Len Number of Trenches Setback from: House -. Z Well P/L }gw 'Vent to fresh air intake 5 ELEVATIONS ;�W Description of benchmark o ��r �, Elevation � l Description of alternate benchmark Elevation Building Sewer - Z` -2_ ST/HT Inlet 7 ST Outlet-- PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( 1) 9 ; Bottom of System (�) �!• ( ) Final Grade g 1.2 �s�.s�5 -�' y� Date of installation / / Permit number State plan number Plumber's signature �:'�r/ License number Date Inspector ve Cornplc(c plot plan Wiscobsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count 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)]. 315972 ]�'1'O R2DGE ❑City ❑Village Town of: State Plan ID No.: STAR PRAIRIE CST BM Elev. Insp. BM Elev.: BM Descri ti on: Parcel Tax No.: rs l p7� C C jtr 038- 1121 -95 -100 TANK INFORMATION ELEV TION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se tk p j Z v�j Benchm Z 3. (65 - 7 Dosing Aeration Bldg. Sewer y_G 3 e7g -7 Holding - -� St cat Inlet TANK SETBACK INFO ATION St Jix Outlet 6 `� T K TO P / L BLDG. -- Vent to Air Intake ROAD Dt Inlet / eptic .) ,{� �'� NA Dt Bottom Dosing NA Header / Man. 3c— Aerati NA Dist. Pipe L Holding- Bot. System T 1 ) z PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model er -- GPM TDH L Friction S TDH Ft L os s ad Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width w Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I�- 3.7' c DIMENSION SYSTEM TO P/ L BLDG L LAKE/STREAM LEAC G Manufacturer: SETBACK � CHAMBER INFORMATION Type �„ �A, �� OR UNIT Syst m dDU DISTRIBUTION SYSTEM Header/Manifold Distribution Pi e(s) 2 / x Ho e Size x le Spacing Vent To Air Intake Length It Dia ( ll h Lengt Brs J 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 30.31.18,NE,NW 1978 CTY RD C ob Plan revision required? ❑ Yes No Use other side for additional informs lion. ' `► �j ( 3 SBD -6710 (R.3/97) Date Inspecto s Si nature s SANITARY PERMIT APPLICATION 201 E W and Bldin shington�Ave sion N 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 r -. than 8 1/2 x 11 inches in size. le r • See reverse side for instructions for completing this application State sanitary Permit Number The information y ou p rovide may be used b other g overnment agency programs �� Y P Y Y 9 9 Y P 9 ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Nam Property Location vv ` �-'2. 2 /a N /a, S — ' T3 , N, R 0 E (or W Property Owner's Mailing Address Lot Number Block Number Sol Ist I _ City, State Zip Code Phont Number Subdivision Name or CSM Num -ier II. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms D ow OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �1 /' 1 C] Apartment/Condo 0 9 — I « ., 9! S— I v o 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 E] Hotel /Motel 9 Office/ Factory Zo - r,�, !c 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box oh line B, if applicable) A) 1:eW ___2_ - ❑ Replacement 3 em ❑Replacement of 4 E] Reconnection of 5 [:1 Repair of an ______System _ __ Syst____ ___ _____ _TankOnly______________ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit 37, S 43 ❑ Vault Privy 14 ❑ System -In -Fill slcJ O�,tdat^ VI. ABSORPTION SYSTEM INFORMATI 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.) (Galslday /sq. ft.) (Min. /inch) Elevation 0 G •— / Feet V Feet VII. TANK apacity in gallons Total # of Prefab. Site Fiber- Ex p er- INFORMATION New Existin Gallons Tanks Manufacturer s Name Concrete Con Steel glass Plastic A p p strutted Tanks Tanks eptic Tank r W001111lojiftirik ' ' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in tallation of the ons ite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' i ature.: (No amps) MP /MPRSW No.: Business Phone Number: `/ 006 6r- 6 i 1(.7 Plumbe 's Add s (Street, Cit , St e, r ip Code : d c � , e., ,�� IX. COUNTY/ DEPARTMENT USE ONL ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ss Issuing Agen natur (No Stamps) ® pp [] O wner Given Initial l A Oo Surcharge Fee) rQ Adverse Determination ft a� I lb X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S8D (8.11/96) DISTRIBUTION: Original to County. One copy To: Safety 3 Buildings Division, Owner, Plumber Safety and Buildings 15837 USH 63 N ��O��iI � HAYVVARD WI 54843 -8107 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary August 04, 1998 CUST ID No.220527 .4=A P19WFS BYRON BIRD JR 896 68TH AVE AMERY WI 54001 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/04/2000 Tdentifcation.Numbers Transaction ID No. 121271 Site ID No. 157558 SITE: Please refer to both identification ztumbers;. Site ID: 157558 above, in alI correspondence with the agency. ST CROIX County, Town of STAR PRAIRIE; CO RD C, SOMERSET 54025 CO �t "irli NEIA, NWI /4, S30, T*4, R18W Facility: BRISTOL RIDGE GOLF CLUB MAINTENANCE BLDG SEPTIC SYSTEM CO RD C, SOMERSET 54025 FOR: ; Description: NON - PRESSURIZED IN GROUND SYSTEM, 300 GPD Object Type: POWT System Regulated Object ID No.: 417120 C The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. (RE: private interceptor main sewer.) 3. The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and ch. COMM 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. 4. Each trench shall be long enough and wide enough to accommodate 6 High Capacity Sidewinder Infiltrators. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. • PLOT PLAN PRO ,IEC °r Bristol Ridae ADDRESS P.O. Box 280 Somerset Wi 54025 NE 1/4 NW 1/4s 30 /T 3 DATE 1 (/R W To S r Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 / 28 / 98 GPD 300 CONVENTIONAL X)0( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE 'TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 381 # of chambers 12 BENCHMARK V. R.P. Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96 . 1 'J.T.S. Alt. BM 'O1ZaIry Top of Fuel Tank Slab @ 98.2 County Higway C %ff V 16 11160 3F COM RCE r DIN Scale = 1/4" = 1 System to be SPONDEE/ - installed according to Commerce 83 � 7 500 ' , Driveway Tank to be properly Weeks o bedded 1200 Line to be Gallon Insulated under Septic Tank Driveway Shed with 15 CD employees all Well located on seperate parcel shifts and no floor B-1 T drains B -5 l5 x2ogGls = 3oc� Tested Area has KB.M. Been Cut 8% B -3 Vent Slope Rep A Alt. ent p M -2 B -4 i Sidewinder High Capacity Leaching Chamber with 31.8 f A2 per chamber 34 Grade at System Elevation Wisconsin Department Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau.of Integrated Services in accordance with s. R��316s�i. Wis. Adm. Code Page of Attach complete site plan on paper not less than 8 1/2 x 11 inches in zb,'Pfan muses unty _ include, but not limited to: vertical and horizontal reference point (B tVectior ,, , 1 C r percent slope, scale or dimensions, north arrow, and location and i ce to ne� Parcel I.D. # APPLICANT INFORMATION - Please print all info on: 1 r Cpax Revs. e y Date Personal information you provide may be used for secondary purposes (Priva s. 15.04 Property Owner Y ° c r - 1 �' �-4LL • 1/4 N01 14,S _30T31 N,R D E (o''lJ Property Owners ailing Address Subd. Name or CSM# City State Zip Code Phone Number ❑ city ( ty 1 �[ l Village ]X Town Nearest Road u ].New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building aw ❑ Replacement JKFublic or commercial - Describe: Code derived daily flow ' o gpd Recommended design loading rate L) bed, gpd/fe o trench, gpd/ft Absorption area required bed ft � 5 S trench, ft Maximum design loading rate, ? _bed, gpdHt gpd/ft Recommended infiltration surface elevation(s) ?r) l9 / r �� j� ft (as referred to site plan benchmark) Additional design/site considerations jr2.o -a,;6 4 ✓1 Parent material Du�� ,1, Flood plain elevation, if applicable /V )K ft S = Suitable for system Conventional ��M,,,,{{ound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system �S El .BLS ❑ U �S ❑ U KS ❑ U El WU ❑ S �I�U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu Sz. Cont. Color Texture Consistence Boundary Roots R G . PD /ft2 Gr. Sz. Sh. Bed ,Trench 7 L Ground elev. Depth to limiting factor =in. Remarks: Boring # _ 0 Ground I v. (0 Depth to limiting fa cto r _ 7 in. Remarks: CST Name (Please Print) Signature Telephone No. _ Sk It ru ri s J_ 6g Address Date CST Number E C.J - q 2- Soil Test Plot Plan Project Name Bristol Ridge Shaun B' Address P.O. Box 280 Somerset Wi 54025 M #3922 Lot ----- Subdivision - ---- -- Date 7/26/98 NE 1 /4 1/45 T 3 1 N /R W Township Star Prairie F1 Boring Q Well PL Property Line County S T. CROIX IL BM or VRP Assume Elevation 100 ft. Base of Siding System Elevation 96.1/95.1 * H R p Same as Benchmark Alt. BM Top of Fuel Tank Slab @ 98.2 County Higway C Scale = 1/4" = 10' 500' Driveway o b CD Shed with 15 r .. employees all shifts and no floor Well located on seperate parcel drams B -1 B -5 Tested Area has Pn A Been Cut B.M. B -3 8% Slope Rep A Alt. M. -2 F-4 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer 2 c I T2 w 7) n Mailing Address /. � c 20 ,,- 5� / � Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 03 LEGAL DESCRIPTION Property Location '' /4, ,, Sec. 3 0 , T Z N_R ? W, Town of Subdivision �-- _ , Lot # Certified Survey Map # , Volume a� ,Page # �- Warranty Deed # �t�° / S j , Volume 1 , Page # Spec house ❑ yes 12 no Lot lines identifiable Z yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of 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 masterplumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewater disposal 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 maint ined must be completed and returned to the St. Croix County Zoning Office within 30 edaythe ee y ar a ti n date. URE OF APPLICANT v —/ / 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 Zthe&ed by virtue f a warranty deed recorded in Register of Deeds Office. "SIGNATURE OF APPLICANT' 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