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HomeMy WebLinkAbout040-1237-40-000 S I'• (;ROIX COUN'T'Y ZONING UI:I'ARTME r' , AS IIUI1;1' SANI'T'ARY RI;1'0Ij'I' n n � L n r Owner f l�l� 1— Address 1 City /State c� Legal Description: % Lot 413 Block VA Subdivision/CSM it A1d2' Sec. -3—, T ? N -RLq_W, Town of PIN tt �U SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC t� /lp etback from: House //// Well � Pump manufacturer _/yl�lL�1L S P Model /L 7 Z- � _ /�J�� �(� Alarm location (HOLDING TANKS ONLY) Setbacks: Service road -1- Vent to fresh air intake Wate f Meter location A) r Line _ Alarm location r 1-j SOIL ABSORPTION SYSTEM: Type of system: e- / _. Width __L_. Lengthy Number of Trenches J Setback from: House ±�� Well PIL Z G Vent to fresh air intake > 5 o ELEVATIONS: Description of benchmark Description of alternate benchmark .5'Q C o 2 Aye-; 0,- d F Elevation O , h� Building Sewer —9 22 L ST/HT Inlet ,;2 ST Outlet•' �' - -- PC Inlet PC Bottom � . � Header/Manifold ��. Q Top of ST/PC Manhole Cover q 0 Distribution Lines ( ) ( ) Ewo ( ) Bottom of System ( ) _qq _0_ ( ) ( ) Final Grade Date of installation crmit tuber State plan [lumber Plumber's signature License number r Date /4 l e � t' Inspector y (lm,�lcc pin( plan K Wisconsin!pepartmentofCommerce PRIVATE SEWAGE SYSTEM Y Safety are Buildings Division Count ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary5e,Cr�'M Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)). PORTS e , s ?8 TT & CHRISTINE E]+ o4 village Town of: State Plan ID No.: CST BM Elev.: , nsp. BM Elev.: BM Description: Parcel Tax No.: too to& acs a 4iAzv. wo.l ce - � TANK INFORMATION ELEVAT ON DATA A9800035 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptl Utz Benchmark 7, a_qA I o3 - � ItaFL - ! oZ Aeration Bldg. Sewer /b.`i// e7_3 4 Holding Inlet 1r.3 la TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet Air Septic 5']! (� NA Dt Bottom r6.3 S S - Dosing N I t a NA Header/ Man. 1o�• k, _? . S5 /oe) a Aerati n NA Dist. Pipe i -7 7.7 .� Holding Bot. System (� L PUMP/ SIPHON INFORMATION ( Final Grade (n- S D lOb2 Manufacturer r Demand (o. '7 7.0 Model Number _50 GPM TDH Lift 12 S Friction L9 System TDH I,W_Ft Forcemain Length So I Dia. 2'# Dist. To Well SOIL ABSORPTION SYSTEM RENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid epth MEN I N 1 SV DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE HING Manufacturer: INFORMATION Type O + 1� UNTE a :� l Number: S DISTRIBUTION SYSTEM � Header/Manifold Distribution Pipe s) t 1 �� x Hole Size x Hole Spacing Vent To Air Intake Length �Z Dia. Length � Dia. ! Spacing e p,gT �/� �j 11 Z ? L� , SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Seeded /So e Bed /Trench Center Bed /Trench ges Topsoil ❑ Yes ❑ No ❑Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: TROY 3.28.19,NW,SW 612 OAKLEY CIRCLE ()4�CA.60— Lj Plan revision required? NJI YesNo Use other side for additiorP information. Qy g SBD -6710 (R.3/97) Date Inspect 's ignature ert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue �sconsin P O Box 7302 I n accord with ILHR 83.05, Wis. Adm. Code ' Department of Commerce Madison, WI 53707 -7302 •' Attach complete plans to the county copy only) for the system, on paper not less Coun t than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Permit Number - 0�1?6 _�/ Personal information you provide may be used for secondary purposes btcheck it revision to previous pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name �� P 1 ropert Location p e. W 1/4 . 1/4, S 3 T� O r Nr R I E ( Property Owner's Mailing dress Lot Number Block Number g// 54 . 675 Cit , tate Zip Cod Pho2q Number Subdivision Name or CSM Number 1i ) M. Y E OF BUILDING: (check. one) ❑ State Owned !t� Eearest Road ❑VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF w III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 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 [ E:] Replacement 3, [] Y Replacement of 4. E] Reconnection of 5_ E] Repair of an -- - - Y -`' _'System -------- ------------ __- _________ Tank Only __ ExlstinQSystem ...... Exlstl nqSystem -------------------- 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 I I k eepage Bed 21 E] Mound 30 E] Specify Type 41 ❑ Holding Tank 12"❑ Seepage Trench 22 ❑ In- Ground Pressure f / 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 Req ' d sq. ft.) Pro osed (sq. ft.) (Gals/day_ /sq. ft.) (Min. /inch) Elevation p , 5 feet D3 Feet t6 1 VII. TANK Capacity Site INFORMATION in gallons Total # of Prefab. Fiber Plastic App - Gallons Tanks Manufacturer's Name Concrete con- steel glass APP- New Exist in strutted Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank /Siphon Chamber o0 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility f9f install4 of the onsite sewage system shown on the attached plans. Plt,mber's Name: (Print) Plumb Signat ( Stamps) MP/ RSW No.: Business Phone Number M s &3`79 C�3 -VqA Ander A e Address (Street, City, StatQ, Zip Code): 0 / i IX. COUNTY / DEPARTMENT USE ONLY [] Disa roved Sanitary Permit Fee (includes Groundwater ate sue Iss In t Signa ure (No Stamps) pp Surcharge Fee) Approved El Owner Given Initial �. g f Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber N* 6consin 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 �� 0 than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Number The information Y P Y ou provide may be used by other government agency programs El Check if revision - cati previous 6pplion [Privacy Law, s. 15.04 (1) (m)1- State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Pr perty Location r9 GtT /c.�f�f, /NCB /L4�� Pr JQ 1/4, S T � , N, R E (or Property Owner's Mailing Address Lot Number Block Nu mber City, St to Zip Code Phone Number Subdivisio ame or SM N m er A.1 LA1 II. TYPE F BUILDING: (check one) ❑ State Owned !ty Nearest Road E] Vil age 11> O LL ChZCC.E Public 5q 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 0 4 - (0o 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 EgiNew 2 ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ystem ________ System____ _________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 V§ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ 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 �. ft.) Prop s�sq. ft.) (Gals/day/sq. ft.) (Min. /inch) Elevation �I Feet Feet VII. TANK Capacity Site in gallons Total # of Prefab. Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete con- Steel glass App - New Existin structed Tanks Tanks Septic Tank eAdh El ❑ Lift Pump Tank /Siphon Chamber E VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's ame: (Print) / Plumber's SignatureZ(NoS s) MP /PAW" 1%No. Business Phone Number: 9;�� , �/� �( / J / r� Plumber's Address Stt�reeet, City, State, Zip Code): t/v 7i11 mac,/ IX. COUNTY/ DEP ARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Surchargeree) XApproved []Owner Given Initial /Q0h Adverse Determination I OU X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) Rl DISTaUT10M: Origins 10 County, one copy To: Sa" i aui ding Owner. s Division. Oer. Plumber µ g0 u L PTO r �5� sAof GS /ID,O B� BS 63 �t n �F 1` g2 �L U - - -5co+� -),- hk4-M Owner's name San. Permit No. H63.05 PLOT PLAN Show: Location of building served 0 Dosing chamber Septic tank Vertical/horizontal reference point Building sewer System elevation is L Effluent system Q _WgTf Replacement system area Property lines w /in 50' df system e/ Distribution boxes F—I Scale = % 0 , or dimensioned a Pump and controls: u Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal—per Min._ Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: 7-7/ ♦ 4M ` LL �, (q C(Z E � 0 LvG LL o et Z N By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, Pierce County and the Pierce County Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after i tallat' 4 - 2 1, 4 8 P um s si n ure se 15Z� 9 Rev. 3/83 C n tj ) r , c o 4+ 4ffff (5 24C-2 U 4-r 49 1, rz 0 7 7 ' PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATICIMS PAGE OF VE IJT CAP 4 'C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE -7 or 2: 10' FROM DOOR, JUNCTIOIJ BOX COVER WITH WARNING LABEL WINDOW OR FRESH IZ'MW. AIR INTAKE GRADE - COUnIAT PROVIDE I — INLET 7 AIRTIGHT SEAL. I v APPROVED JOIAIT A Tank construction shall comply I li) APPROVED JOINTS with approved with ILHR 83.15 and ILHR 83.20 I pipe extending ALARM 3 feet onto 31 1 solid soil. ON Both sides of C tank. LLEV. FT __� PUMP —� OFF O CONCRETE 9LOCK RISER EXIT PERMITTED OIJLy DD IF TANK MANUFACTURER HAS SUCH APPROVAL 3gEPOING SPECIFICATIOMS DOSE TAWKS MAIJUFACTURTrR :� � �� NUM9ER OF DOSES PER DAy TA NK LIZE: Cx� GALLOWS DOSE VOLUME t ` AL ARM MANUFACTURER: IWCLUDINC, OACKFLCW: i4�I� �C��'- GALLONS MODEL NUMBER: CAPACITIES: A= WCHESOR 30 ___ LLONS SWITCH TSPC: 5= Z:-- INCHES OR ` Z 3,� G�L.LOL 5 PUMP MAMUFACTUItGR: C OR /3a CA MODEL IJUMbER: - On IMCHESO GALLONS SWITCH TYPE: MOTE: PUMP AND ALARM AR C 60Z, 7 MINIMUM DISCHARGE RATE S GPM INSTALLEO ON SEPARATC CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AI,JO..DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PKE56URC .. . . / FEET + FEET OF FORCE MAIN X F oorr.FKICTION FACTOR .*._L -- _ FEET y = TOTAL DtIWAMIC HEAD = FEET DIAMETER IUTERNAL DJM IJSION� OF TANK: LEW6TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA - 231' GAL /INCH AS PER MANUFACTURER = A Z. GAL /INCH _ r ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 N 30 10 Z 25 8 E O H l 20 6 15 SIB? pµ 4 0 10 5 2 0 0 10 20 30 40 50 6C 70 80 90 100 0 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company -1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 •Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code LQll,NTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inctude "but Croix not limited to vertical and horizontal reference point (BM), direction and % of slope dimensioned, north arrow, and location and distance to nearest road. p ing APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION EVIEW DATE PROPERTY OWNER: PRO ERTY LOCATION . Richard Stout GOV`t,`LOT• 114 S 1/4,S 28 N,R 19 �or)W PROPERTY OWNERS MAILING ADDRESS LOT # \ , %0,CK# StT D,-MM # 1353 Awatukee Trl. 63 f `.� ; na­.. Wood CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE O NEAREST ROAD Hudson, WI. 54016 (713 549 -6731 Troy`- "� Tower Rd. [� New Construction Use 6 ] Residential/ Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate . 5 bed, gpd /ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 99.55 ft (as referred to site plan benchmark) Additional design / site considerations alt. area system el . = 98.82' Parent material _pitted outwash plain Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ®S ❑ U ® S ❑ U 13 S ❑ U ® S ❑ U ❑ S CCU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -13 10 r3/3 none 1 2msbk mfr cs if .5 .6 2 13 -19 10 r4/4 none sil lfsbk mfr gw if .2 .3 Ground 3 19 -28 10 r4 6 none sl lcsbk mvfr qw na .4 .5 elev. 103 ft. 4 1 28-84 7.5yr4/6 none fs osg mvfr na na .5 .6 Depth to limiting factor +84" Remarks: Boring # 1 0 -12 10 r2 2 none 1 2msbk mfr Cs if .5 .6 ' 2 <i 2 12 -21 10yr4 /4 none sil lfsbk mfr gw if .2 .3 Ground *3 21 -31 10 r5/4 c2 7.5 r5/6 sil m na gw na np .2 elev. 4 31 -84 7.5 r4/6 none Ifs osg mvfr na na .5 .6 103 ft. Depth to *Less than 1.00' limiting factor +84" Remarks: CST Name:—Please Print Gary L. Steel Phone: 715- 246 -6200 Address: / 11554 200th Ave., New Richmond, WI. 54017 MO2298 Signature: X 11 Date: CST Number: oC 4 -19 -96 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard Stout New Richmond WI 54017 MPRSW 3254 NW4SW4 S3- T28N -R19W town of Troy 715 246 -6200 ) lot #63- Country Wood N 1 =40' BM.= top of 1 steel pipe @ el. 100' Alt. Bm.= top of marker stake @ 103.3' ti 5 � v /V [fib 1 Gary `L. Steel 4 -19 -96 V1/ Vl/ 177;J VO. 41 f 1:J4 11 f r JJ IVCLSVIV Y'LUI*Il�11Vla f'falat bl ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / C Q , � H1 d Mailing Address Property Address oL Q C i y' C, I.Q 'p (Verification required from Planning Department for new construction) City /State Parcel Identification Number © YD - /Z 3 T — �D LEGAL RESCREPTION Property Location V., S %., Sec.T�N -Rl W, Town of G�� Subdivision : O Ut AJ 00 , Lot # 6 3 . Certified Survey Map # , Volume , Page # Warranty Deed # - 7...�, volume ,Page # 2 Spec house O yes CR no Lot lines identifiable ® yes O no SYSTEM KAiN'ITi_NATq improper use and maitatenanceof your septic Sys m could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three ye or sooner, if needed by a licensed pumper. What you put into the system can affect the lttnction of the septic tank as a treatment tags in the waste disposal system. The Property owner agrees to submit to St. Croix Zoning Departs ut a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber 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 113 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. --�` SIGNATURE OF APPLICANT /Z / — 2 ,0 0 RATE 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 p described abov by virtue of a warranty deed recorded in Register of Deeds Office. j SIGNATURE OF APPLI ANT Z DATE 0 Any information that is mis ropreseated may result in the sanitary permit being revoked by the Zoning Department. 00 . 0 •• •• Include with this application: or stamped warranty deed from the Register of Deeds office 2 copy of the certified survey trap if reference is made in the warranty deed