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Home My WebLink About040-1226-10-000 r! ST. CROIX COUNTY 7 NT ZONING UE['AR'I'MC AS QUILT SANI'T'ARY REPORT Owner Address / IM P City /State s �✓ y orl/ -�.ta 3: Legal Description: Lot Block Subdivision/CSM # 1/4 AT- '' /+.1�, Sec. , T -'I r N -R /'? Town of P IN fl TYG SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Ag. ! ! /off Tank manufacturer ,;J,` es Size ST/PC of &- Setback from: House 16 Well J�' P/L S� 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: Z a.,J Width _ .� Length 7S Number of Trenches ;2- Setback from: House Co ` Well leo P/L - ' Vent to fresh air intake �;a -f- ELEVATIONS Description of benchmark � f . '�7 Elevation MO. " d Description of alternate benchmark Elevation P7 Building Sewer ST/HT Inlet 11.3 ST Outlet • 4L PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) 14"41. Bottom of Syste Final Grade ( ) {�5 r ( ) 1�G_ 1 ( ) Date of installation ' I / Permit number 3.24'�4� State plan number Plumber's signature License License number Date Inspector a Complctc plot plan wr Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division bT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarJYM6.: Personal information you provice may be used for secondary purposes [Privacy Ljw, s.15.04 (1)(m)). FLEM Holder s GUN A . & PATRICIA D . "I 8yli village []Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Nbc`- :1226-10-000 ( , Fug ; TANK INFORMATION ELEVATION DATA A9800550 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t�.� arc �rP� Benc pT I I �1 1, q) Dosing rv � 16 E Bldg. Sewer 1 t7q_ � St /Ht Inlet q� / aZa TANK SETBACK INFORMATION �s St /Ht Outlet TANK TO P/ L WELL BLDG. V' i Intake ROAD Dt Inlet Septic 4 '� �U 1 ` / NA Dt Bottom Dosing NA Header /Man. I i, f l7�� to /D Aeration NA Dist. Pipe a rte/ S k, Holding / 9 Bot. System i�t �.r7 g �'� PUMP/ SIPHON INFORMATION Final Grade 1 Manufacturer De d f Wan, 44r {% ''n? Model Numbe TDH I Lid Friction S s_t�errr TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r No. Of Trenches PIT No. Of Pits ._ Inside Dia:_ Liquid Depth J DIMENSIONS ! DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufactur INFORMATION Type O� / CHAMBER Moe Number: SysteW -±,, 3a (O�j -- OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length > ; Dia. Length � , � Dia. y Spacing A :T w+ ? — 7 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 E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION. TROY 9.28.19,NE,SW 537 BRIANA LANE — GLOVER HILLS LOT 11 Vb `� r f c a, , r ► a �c� ° C 's Plan revision required? ❑ Yes ❑ No Use other side for additional information. / SBD -6710 (R.3/97) Date Inspector's Sign ture ert. No t IvC consin Safety and Buildings Division S ANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. �� , • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes �� ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop y wner Name Property Location �(e ,' v 1/4 -a 114, 5 T , N, R E (or) Property Owner's Mailing Address Lot Number Block Number 2 -�% /��1 L � �t �� City, State Zip Code Phone Number Subdivisi ame or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned E] E] Nearest Road Vile Public 1 or 2 Family Dwelling - No. of bedrooms _ E] Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment/ Condo O Z/6),_ 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ 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. jZ 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 121ZSeepage Trench 22 ❑ In- Ground Pressure r / 42 ❑ Pit Privy 13 ❑ Seepage Pit �.�_�5 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. ystem Elev. 7. Final Grade Required (s. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min.linch) '- 10T -9' Elevation - 7 sV d— :Z y-3'Teet Q , ; ,e Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- plastic Exper. New Existin Gallons Tanks Concrete Con Steel glass App. strutted T nks Tanks e tic Tank . '► ✓ G� l �17 � S 7`FV.x ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: o 5 amps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): S G -d 6 .e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issu e Issuing A4 ent ig nature (No Stamps) Approved [:]Owner Given Initial /�j ac Surcharge Fee) Adverse Determination I /J� W640t_ X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber / . / - ' ov � Wiso -sin De= 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 COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in si an must include, but sue- c.� L x not limited to vertical and horizontal reference point (BM), dir ' o e or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne r APPLICANT INFORMATION- PLEASE PRINT AL RMATIPN REVIEWED BY DATE PROPERTY OWNER: $Q,B A'tz -Pi R , G �, P ER TION Ci$1fF tl4 $ 1 /4,S 9 T Z 8 ,N,R 19 E W PROPERTY OWNER':S MAILING ADDRESS # B SUBD. NAME OR CSM # 5p t -3 , C�l-p l�pi' . i ��W Gt_0U 1 l,l-5 CITY, STATE ZIP CODE PHON w ER GE ®TOWN NEAREST ROAD 1DS Otu� kJ [ S V O1 nt 5)l3 t'7 p �tz;tpTyvp L{4N� t [kj New Construction Use N Residential / Number of bedr 1 5 ► 1 [) Addition to existing building [ j Replacement [ j Public or commercial describe Code derived dairy flow '-So gpd/Bt=Drcu%l" Recommended design loading rate bed, gpd/ft 0 . 0 0 trench, gpd/ft Absorption area required — bed, 11 — trench, ft Mabmum design loading rate 0 . bed, gpd/ft o. 8 trench, gpd/ft Recommended infiltration surface elevation(s) 5EE f-joT>r aU Prr6L� :3. ft (as referred to site plan benchmark) Additional design / site considerations �z ttH Ste► - thy Parent material o v Flood plain elevation, if applicable N- A • ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem E4 S El MS ❑ U CC'S El ®S ❑ U f$ S❑ U ❑ S o U 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 Tmr& \ tL 31 L lKs. h x c--S a uk Z 11 Zo 10 `t R 3 l 6 — L Z wI S bh vn T �- Ground ) v16 — S v 39 m - 0.1 n•8 elev. Depth to limiting fac tor $„ - Remarks: Boring # �p `te - 31Z lu o.S D 6 ft Z : <T Z. �1 -31� 1 o `l rZ 3 t yr —' s1,1 �- `�' S �k w► `�h C-S 1 u � o . S v. 6 Ground 3 3L -8Z ��'1P- vl S O S9 - 01:0.8 elev. _ l OZ.8 ft. Depth to limiting factor 2 $Z Remarks: T Name: — Please Print Phone: Arthur L. We erer 715- 425 -01.65 Ad dress: r er ,S:Q]1 TeS ting & Design Service - 0.`Box 74'River Falls,WI 54022 -- - - - - - - -6 --- 5 7 _ - PLOT PLAN Pa a of 3 r r SCALE 1 "= S O' -- - - -- r -- Lod tit �W�sE - m BE WT UMA'r ZS' FRum - rR_ENjc%t - .T, �)Lst.L 4 k k k Soy t t � .0 r ai a� Il e 7 � S \ X3, 3 EZ LO O I I 100.p uN 10 ttt6Li \iELtoZ. 8 'y Cttoy`r 3 [c� "Dtq, PUC l�tp@ W/ LR'Tli /64.89 1r3S'tl. ��Gl}�S 36 DF Afi Dt��121�'11►JF l�►� CN �-� 1'�T 1 l�s _ �T � �"'1� of �r?51�� - 1�.0_�. gS�IS -11 95 ( 715 ) 425 -f1Rte— MO.0576 EST_Sigriaft�re - -- -E�ate S Fec# TeFephone t v: CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4k Al l& W / ✓) Mailing Address Ah ft v SOn/ Wl' Property Address 53 y'!aN 1.d Wf v Sa t/ LV / j / (Verification required from Planning Department for new construction) City /State SyyAAl GUi Parcel Identification Number Q e/o — 1 AA6 — �o LEGAL DESCRIPTION Property Location N t '/,, S VJ ' /a, Sec. � T Z$f N- R -`-W, Town of Ir ✓6 Subdivision (Daer ' �/ua l' Lot # r� Certified Survey Map # , Volume , Page # Warranty Deed # SSA$ N� , Volume IRAJ , Page # Spec house ❑ yes B Lot lines identifiable 1 '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 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 maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. v 1,45 S' SIGNATURE OF APPLICAN 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 above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURTE OF APPLIC 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 SITEPLAN MURPHYLAND SUR VEYING RIVER FALLS, WISCONSIN Laurence W Murpl y 715 - 425 -9032 PROPERTY DESCRIPTION Lot 11, Glover Hills, located in Section 9, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin. Prepared for - Glen Flemming 612 4th Stneet. No, #10 N Hudson, Wl. _ Scale In =100' a�.01 46�i i I Q A�s1 oe LOT 11 ; m e- % XW '$ �\ i 9$ ' � II un nwmr I � Ew Ty.) • �: p I 1 _� -- '-- N SS• Or'!e' E fait' GRAINFIELD AREA AS PER PLOT PLAN NY A. WEBERER ` NOTES 1. Building footprint as provided by client. 2. Dimensions shown from proposed house to M� ..s,