Loading...
HomeMy WebLinkAbout040-1237-00-000 ST. CROIX COUNTY ZONING DEPARTMFA AS BUILT SANITARY REPORT � L•�L L'`PVEO Owner Property Address G '/ s agt /11 c, Y cz e " - ` 1 ST cRax City /State t�it�sa.J G+J COUNTY ZOO ING OFFICE Legal Description: Lot .-9 Block Subdivision/CSM # as Gs J t/a 51�d t /a, Sec. 3 , T F N -R_W, Town of Tro PIN # 0 /G - /;z 3 7- a a' �.�B.I 119 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC /ayo /c6a Setback from: House /-,5 Well -eld P/L //o Pump manufacturer s Model Alarm location 7 u s --e— (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: C cAJ Width s Length L Number of Trenches %z Setback from: House �� , Well P/L �" ' Vent to fresh air intake ?6 ELEVATIONS Description of benchmark Elevation 7 Description of alternate benchmark &A.' / r"'(1 %t' e-e- Elevation Building Sewer :?r c -I ST/HT Inlet ST Outlet PC Inlet PC Bottom rd'' 93 Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System () 3 () ( ) Final Grade Date of installation /,7 f / g� Permit number State plan number Plumber's signature �z axe License number ;Z Date Z /t / 9:r Inspector -1? Complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y' Safety and Buildings Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitars Ep" 11t: Personal information you provice may be used for secondary purposes [Privacy s.15.04 (1)(m)]. 111 �/ �� L 1 Permit Holder's Name: i Village Town of: State Plan ID No.: KELLY, STEPHEN & PATTI g1�28� CST BM Elev.: Insp. BM Elev.: BM Descr )tion: Parcel b4b'_:1237 -00 -000 10 S t ll U TANK INFORMATION ELEVATION DATA A9800110 TYPE //nn ^, MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic uv l ( CGtS� Benc r - 2S -j f Gy , 460 Dosing 1nN lY ,�, Z/ I !v Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet Airintake /V NA Dt Bottom ��.� 0 $, Dosing I I ' f NA Header /Man. 5 Aeration NA Dist. Pipe 5.-�6 9.3 , Holdin Bot. System G•�j (g 3.5 PUMP/ SIPHON INFORMATION :1 O Final Grade �_o`� - Manufacturer e o 1 ) 14 5 J Demand t '75_0 $I PfA Model Number GPM TDH i Lift671 Friction $ Systems TD L t Fff Forcemain Length l2 Dia. ra Dist. To Well SOIL ABSORPTION SYSTEM BED - Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N - 7 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man urer: SETBACK INFORMATION Type CHAMBER � � o ber: Syste Lx Z� OR UNIT -- DISTRIBUTION SYSTEM Header / Manifold ,� ,� Distribution Pipe(s) x Hole Size h Spacing x Hole Spacing Vent To Air Inta� Length Dia. / I Length Dia. r, jT(/� 21 2C-7 O T 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 E] Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 3.28.19,NW,SW 615 OAKLEY CIRCLE — COUNTRY WOOD LOT 59 v LA �5'm - _t�v �Av Vl^ o ka /, Plan revision required Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's gnature Vi 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 1/2 x 11 inches in size. 7' C • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide maybe used by other government agency programs 3 © 1 ❑ 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 Name Property Location 1i4 / ,J 1i4, S T , N, R/Q E (or W Property Owner's Mailing Address Lot Number Block Number r 7' ALI r' a DS Cit , State Zip Code Phone Number Subdivision Name or CSM Number a ( 7 / 0 4f OliAlf ne W Ol aL II. TYPE OF BUILDING: (check one) ❑ State Owned o it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �� j Tow OF � >r III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 V f -12 37 - aro 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. Ua 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type_ 41 []Holding Tank 12 Ig Seepage Trench 22 ❑ In- Ground Pressure r ,--r 42 [] Pit Privy 13 E] Seepage Pit � S X - 75 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 7 Feet G. Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- er. INFORMATION Gallons Tanks M anufacturer's Name Concrete Con Steel Plastic E x p er. New Existing structed 91ass App" Tanks Tanks eptic Ta (D 1 4 © ` ❑ El 11 E] 1:1 Lift Pump Tank 4 o: e /71 V ® 1 ❑ I ❑ I ❑ I ❑ I ❑ ONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite eyXage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No tamps) M MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): G a ®� W` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F e (includes Groundwater ate Issued Iss " Agent Signature (No Stamps) rI pp Owner Given Initial- A roved Q � Surcharge fee) �O � OD � Adverse Determination U 16b X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, plumber Sri tia.� �l �' / w/ s�J �S3 T 2� �.ol - S9 Goy v- i✓ ®oc� l .✓ o f T a- 0 I��D a •�� r ,8l Al ,2 S X7S' Tve� �S A 7 f � B d v PAG; Gr PUMP CHAMBER CROSS SECTIOIJ AMD SPECIFICA VENT CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKINIG Z5' FROM DOOR, JUUCTION BOX MAIJHOLE COVER WIIJDOW OR FRESH I2 "MIU. AIR IAITAKE GRADE _T _T Y" MIN. I L COUDUIT WAIN. v \`� ---- - - - - -- 11� IAILET PROVIDE I _ AIRTIGHT SEAL * A I I I I I I I ALARM B I If I I c *APPROVED I I ON JOINTS WITH I f ELEV. FT. APPROVED PIPE I 3' ONTO PUMP __J OFF o SOLID SOIL COUCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS DOSE TAKIKS MANUFACTURER: &, dl&) 2 ;" fi.d IJUMBER OF DOSES: PER DAy TANK SIZE: _ ��/J GALLOUS DOSE VOLUME ALARM MAUU FACT URER: /, +-U e a IUCLUDIMG BACKFLOW: GALLONS MODEL IJUMBER: — D/v CAPACITIES: A- LIF IAICHESOR ,l GALLOUS SWITCH TYPE: / 7 .e tr G B= 2 IIJCHES OR 3 GALLOWS PUMP MANUFACTURER: /mod wZ-✓ C = 7 WCHE5 OR f l � GALLOWS MODEL UUMBER: // D = --C! INCHES OR GALLOWS i SWITCH TYPE: " MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE GpM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. / FEET j + MINIMUM NETWORK SUPPLY PRESSURE . , , A IL FEET OF FORCE MAIN X I' . loo FLFRICTIOIJ FACTOR. _ `` FEET _ TOTAL D'J JAMIC HEAD = L- Lf FEET Gal-nbo INTERNAL DIMEIJSIOAIC 1 K of TAA LEIJGTH /6061GS^O — ;WIDTH ;LIQUID DEPTH I SIG�IED:.._ l , , EPO4 3871 EP 05 APPLICATIONS • Fasteners: 300 series • Fully submerged ' high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oik for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Available for automatic and • Farms Motor: and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. •Heavy duty sump 115 or 230 V, 60 Hz, 1550 models include Mechanical • Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering automatic reset. preset at the factory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4 °.maximum. • Power cord: 10 foot with pump out vanes for •.Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CO. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in " or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. " BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET 10 o Capable of running —I -- stainless steel. dry without damage to s 30 777777777- - - -_ 5 _ components. Pump: EP05 a �22r • Solids handling capability: o 3/4 maximum. w • Capacities: up to 60 GPM. 0 s 20 • Total heads: up to 31 feet. • Discharge size: 1 NPT. Z 5 • Mechanical seal: carbon- 0 15 - - -- rotary/ceramic- stationary, BUNA -N elastomers. 0 4 ?41.; • Temperature: 3 10 - -- 104 °F (40 °C) continuous EPO 140 °F (60 °C) intermittent. 2 I a 5 1 I I --- -1._ _ l- 7777 - - - -- -- - 0 00 10 20 30 40 50 GPM L 0 2 4 6 8 10 12 m3 /h CAPACITY ©1995 Goulds Pumps, inc. Effective May, 1995 83871 Wisconsin Department of Commerce SOIL AND SITE EVALUATION 1 3 Division of Safety and Buildings Page of Bureau•of Integrated Services in accordan s "4P.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 i ctt County include, but not limited to: vertical and horizontal referen rit (BM,t��nd St. C r o i x percent slope, scale or dimensions, north arrow, and loca ' n bfiid distancyrtaneacest road-', parcel I.D. # p : J APPLICANT INFORMATION - Please print a rmation. �' R awed by Date Personal infonnatan you provide may be used for secondary Purpos s�4Prikacy L 4 1 J 1j (m)). Property Owner I 7Propertw_ on - Govt ,Lbt 1/4 1/4,S T ,N,R E (or Stephan & Patti 3 28 19 Property Owner's Mailing Address _`::. L W Block# Subd. Name or CSM# 1457 Wildcat Ct Apt. 208 59 1 l Countrywood City State Zip Code Phone Number ❑ City ❑ Village] Town Nearest Road River Falls i 5 O22 (715 h26 -4907 Tro D 0" New Construction Use: Residential / Number of bedrooms_ Addition to existing building Replacement Public or commercial - Describe: Code derived daily flow 4 5 0 gpd Recommended design loading rate gi bed, gpdA? -6— trerich. gpolft Absorption area required 9 bed, ft n� trench, ft Maximum design loading rate � - bed, gpd/fl? trench, gpd* Recommended infiltration surface elevations) ft (as referred to site plan benchmark) Additional design/site considerations A 1 t P r n a t P q 1_ 7 Parent material Glacial O u twa s h Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Hokfing Tank U = Unsuitable for system ® S El U 10 S El U [3 S❑ U 0 S ❑ U ❑ S [R] U El S ]] U SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ' Trench 1 1 0-1 10yr3/3 -;il 2sabk mfr cs if 2 1 1- 5 1 0yr3 /6 -- sl 2sabk mfr cs -- .5 ' .6 Ground elev. 9 7 ..- 5-0-ft• Depth to limiting factor 8 5 n. Remarks: Boring # 2 12- 0 6 -- sl 1 sabk mfr cs -- . 5 ;. 6 2 0 1 Y r4 / 3 30- 4 10yr3/6 -- sl 2sabk mfr cs -- .5 -.6 Ground elev. 9 5 _7 Depth to limiting factor 8 4 in. Remarks: CST Name (Please Print) Signatur Telephone No. Address Date CST Number C� �Lf sue- ,� "�� � � G? �< :.S E � '�.2 � � 1 =e-lo i ,r {,, en o� et- 100 bi, Sys4er— e,(cu, q B 1/' � x'11.0 ✓� 6� � 0 4w r o�� i Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT 1 of 3 Labor and Human Relations in accord with ILHR 83.05, Wis. Adm. Code Division of Safety & Buildings ®' WI RE Attach complete site plan o n paper not less than 8 1/2 x 11 inches in size. Plan must include, but r not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. n APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION E - PROPERTY OWNER: PROPERTY LOCATION Richard Stout GOVT. LOT NW 1/4 SW 1 /4,S 3 < PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CS 1353 Awatukee Trl. 59 na Countr CITY, STATE ZIP CODE PHONE NUMBER [ ❑VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 (715) 549 -6731 Troy Tower Rd. [x] New Construction Use [ Residential / Number of bedrooms R [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loadinq rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench. ft - ate • 5 bed, gpd /ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) erred to site plan benchmark) Additional design/ site considerations alt. sit Pwl `� Parent material pitted outwash P. Ar`Jv elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOU ���� AT -GRADE 7 YSTEM IN FILL HOLDING TANK U = Unsuitable fors stem Y1 S ❑ U C3S ® S ❑ U S El U [I s 1 1:1 U sc tc�k� AAZA 4. - Depth Dominant Color ,•gyp Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrich l l € 1 -11 10 r2 2 none 1 2msbk mfr cs if .5 1.6 2 11 -20 10 r4 4 none sil lfsbk mfr if .2 .3 Ground 3 20 -28 10 r4 6 none sl lcsbk mvfr crw na .5 .6 elev. `794 ft. 4 8 -82 7.5 r4 6 none lfs osa mfr Depth to limiting factor Remarks: Boring # 1 -12 10 2/2 none 1 2msbk mfr I 2 '' 2 2 -24 10 r4 4 none sil lfsbk mfr aw 1 3 4 -30 10 r4/4 none sl lcsbk mvfr Q1W na .5 .6 Ground elev. 4 0 -84 7.5yr4/6 none lfs oscf mvfr na na .5 1.6 .•I3' ft. Depth to limiting factor +84" Remarks: CST Name: Print Phone: Gary L. Steel 715 - 246 -6200 Address: 554 200 e. , New Richmond, WI. 54017 m02298 Signature: 4 -24 -96 Date: CST Number: I zf&*e� STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NW4SW4 S3- T28N - R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #59- Country Wood l N 1 =40' BM.= top of 1 steel pipe C el. 100' ►Qi' ,5�I0 it I ►o I Gary L. Steel 4 -24 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address -� `` �U �I d (C' Property Address � �(I o (, I ' � �S ti� I G j (Verification required f m Planning Department for new construction) tY Parcel Identification Number o d City/State /State �E -d��� s.,r.> cF `��-�� 3 7 -_ LEGAL DESCRIPTION Property Location 4W ' /,, S� ' /., Sec. 3 , T N -R lr W, Town of r� r Subdivision _ e; oe-,✓ try W 60-d Lot # � Certified Survey Map # , Volume , Page # Warranty Deed # mss` > �% / Volume /A 3 cr , Page # 6 ' 15F Spec house ❑ yes El no Lot lines identifiable 0 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 master plumber, journeyman plumber, restricted plumber 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. Uwe, 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. 3 SIGNATURE OF APPLICANT 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF A PLICANT 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 / 1 n - S90 ° 00'00 "W 664. 27'- 30_0U 1 - - 195.00' - - 259. 27' I I M M f UBLIC -ro — — 3 REE i CD 1 M I 219.49' - 220.72' - /�Y ® __ 0 - - - - - - N90 ° 00' 00 "E 654.73'- - o 58 ' IT M 57 M (30 5 9 w 2. 87, 555 SO. FT. 87, 557 SO. FT. 9 AC. I to 2.01 AC. w w 2 S0. FT. 0^� 87,555 S0, FT. $ g e co 8 _ 0 0 0 t z o 0 1.3 Z z 56 326.57' 219.56 220.73' N8-9 "E 1324.14' SOUTH LINE OF THE NWI /4 0 m ro ', - J IN PLATT LANDS Y SHEET 3