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HomeMy WebLinkAbout040-1064-60-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner © a elR L 2 2 I L— Address 328 GLo u g—n R0 City /State H6 SO/y 60 f , S Logal VaWeriptiunt Lot 0 Blook .A(A Subdivision/CSM # 521C2 CS '/a A(W 1 /4 A(z Sec. J( T,9$N -R-ZLW, Town of , �T PIN # r7 yc7 =JD6 Y— 14 (,,2S- )'l .7-' - /A SEPTIC TANK DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer ! &E&z�.r r 5 Size ST/PC /Off/ A-A Setback from: House Well 22! P/L Pump manufacturer /1//I Model Alarm' location /V A (HOLDING TANKS ONLY) Setbacks: Service road Vent t f sh r intake Water Line Meter location Alarmi location SOIL ABSORPTION SYSTEM Type of system: 7� ,e - WC W Width �_ Length 3B r Number of Trenches 3 Setback from: House Well G 3 1 P/L S' Vent to fresh air intake ELEVATIONS Description of benchmark /3T/f/ n E of /n iivG �C l' a/1 i✓�/? Elevation O� 0 = 0 Description of alternate benchmark Leo DA/C2 .s OD LUAcK. Elevation o. Building Sewer y. ST/HT Inlet _ 3.9" ST Outlet 9 PC Inlet AIA PC Bottom Header/Manifold _� 7 Top of ST/PC Manhole Cover - Distribution Lines (/) (3) l/• ` 2 .— Bottom of System ( 1) /��� S (Z) �4 • J (� 9D - Final Grade (!) 9 7 Date of installation 7 113 Permit number State plan number t Plumber's signature - License number -2;1/ 7 Date 7 +113 / Inspector U jd,�64— Complete plot plan � Wiscon in,Depaftment of Commerce PRIVATE SEWAGE SYSTEM Count Safetynd Buildings Division INSPECTION REPORT County: 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)j. 315885 Permit Holder's Name: ❑ City ❑Village Town of: State Plan ID No.: MERRILL, ROGER TROY CST BM Elev.: Insp. BM Elev : T I,,J) Description: Parcel Tax No.: wi /O O ea a, 040- 1064 -60 -000 TANK INFORMATION ELEVATION DATA A9800272 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2 1. ' /&,( -^; / Benchmark ) 169, Dosing $. Aeration Bldg. Sewer Holding St /Ht Inlet J!2, ' TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet irl Septic '/e • r s d • _ >as NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System ia. �a•, Qo S' PUMP/ SIPHON INFORMATION Final Grade L ; ; 47-o 1 . Manufacturer Demand 9g, va Model Number GPM TDH Lift L ricti System TDH Ft Forcemain gth Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Mo Number: System:: , d) - -5 1 �3 ' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over i 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: TROY 16.28.19.241A,NW,NE 398 N GLOVER ROAD Q 1 r /vj' l C�— d�C�C�G"T�� �- <ae..r � c�- c.t�,i.o � �v �-c a,�.c..: �+"Il� -J J raj Plan revision required? ❑ Yes [VNo Use other side for additional information. 1 1,411 6 SBD -6710 (R.3/97) Date In a �'s Signature Cert- No. 4 Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. l 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 Ol than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permits Number �88 The information you provide may be used by other government agency programs ❑ Check if t6vi §ion to previous ap ication [Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number I. APPLICATION INFOR -PLEASE PRINT ALL INF RMATION Propert Owner Name Property Location L L &V /4 l y t F 1/4, S 16 T 8 , N, R 1,9 E (ore Property Owner's Mailing Address Lot Number Block Number Co A A City, State ".51"o e Phone Number Subdivision Name or CSM Number / 4 Q / (751 - s ,S,9c>2cs II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ Vll age Public 1 or 2 Family Dwelling - No. of bedrooms .�_ Town OF O Lo 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. ❑ New 2. ;g Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System -- ____________ System__ ___________ TankO nly_ - ____________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 [Z Seepage Trench* 22 ❑ In- Ground Pressure t X 3 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 3 8 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFOR ATI 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_hrich) 1__� Elevation !Y 5_0 _(3 5 1 0 1 , ) Feet 6 Feet Ca ctt VII. TANK I al lOnS Total # Of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks manufacturer's Name Concrete Co" steel glass Plastic App New Existin structed Tanks Tanks Septic Tank an �^ r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews em shown on the attached plans. Plumber's Name: (Print) Plu a 's Signature: (No St a s) M /MPRSW No.: Business Phone Number: o / / Plumber's Address (Street, City, State, Zip Code): 566 — F— O IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Is uingAg ntsi to (No Stamps) Surcharge Fee) ApprOVed ❑ Owner Given Initial !,� Adverse Determination I X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SM -6306 (FL111ANQ DKTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber � ian Olk !e P , r . I , I I , 5�iG6cSrC�) s YS7Iff `90� 1 T • 1 r 1 _ '3 .,3x'3$ /lllr %LTRfJ %�L�/�C�f�s- - - - - -- __ r - r � - -- I I �4i � � � __�- - _ -- - -- - �B1.7_ �.oI L0���1�'__9JL� /�!G. �Y�s'a2K��Z ._� L �CR ? E t � ♦♦ __ t 1 , , I . I , , t -- - + &SOS - I Wisconsin Department of Industry, $ ITE EVALUATION Page ./ of 3 Labor ^ndiumLn Relations j ; f Division of Safety and Buildings I A'nEg<Wfttl 11 Wis. Attach complete site plan on paper not less than jt'11 inch #lrrA b l� gTrlan �' gt_ County ST GWOi include, but not limited to: vertical and horizonta reference point (Brut), dlMction acid r' percent slope, scale or dimensions, north arrow, nliJocatiadIistance to nearest d. Parcel I.D. # APPLICANT INFORMATION - Please r°i}.><t all ,ln1'e tm t n. -.' ' Reyie e ¢ y D to Personal information you provide may be used for seconda 06r066es (PnvacK4i,4 Property Owner y ��j ,Q t operty Location �) p I�D /y�/i'S ��' / 1 Y►� Govt. Lot /vU 1/4 /v F1/4,S T 1 d ,N,R E (o W Property Owner's Mailing Address Lot # I Block# 1 Subd.NameorCSM# 3 ff G1oeli � 51 e X29 . City State Zip Code Phone Nu�m/ber // Nearest Road yzs ' /i El ❑ V'llage Town rr�flll�� XW • ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building (� Replacement ❑ Public or commercial - Describe: N14 7 C O- RN 3p - Y �;iq ,y / p Code derived daily flow gpd Recommended design loading rate 1bed, gpd /ft o trench, gpd /fiz Absorption area required NW.....--bed, ft2trench, ft 2 Ma design loading rate bed, gpd 1ft gpd/ft Recommended infiltration surface elevation(s) .S.Q- e47`es �� S��yG- i ft (as referred to site plan benchmark) Additional design /site considerations .sue- �of�S S J 3: 1 'Y Parent material /OFSS OUg ' wpy U ` a �"� Flood plain elevation, if applicable x tt S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System A! l Holding Tank U = Unsuitable for system 2 El ❑� U u �❑ u ❑ S C ❑ s ❑ S 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. r Bed , Trench SI • Z • 3 Z . ( /D YR y C4.q /f e7`�v S/G /7 /M - 7 — / ' CGJ P -:-N Ground S� /7�S / . S elev. tt f I 14 Y,e 4l2- IDmitingo s ,� S factor Remarks: dU,911 13Z - �E�/ CD�Ip�LT`EJ> o/� % 2 o.yS Boring # I d• 2 /©Yr2 s%L ' 2`FShe lm CS y• G - sL Z fs 6 cs if •s , 3S- fe Ground J — ` elev. Depth to limiting factor C in. Remarks: CST Name (Please Print) Signature Telephone No. j'oQE�r 2 t /,6/�i�T- 7/s • 34`6 • Fle-5 Address Date CST Number 2•S • 5T Private Sewage Consultants . ti R M ST. CROIX COUNTY WISCONSIN f ZONING OFFICE a r x x r x x ST. CROIX COUNTY GOVERNMENT CENTER N ~ 1101 Carmichael Road ,.. ,.. F Hudson, WI 54016 -7710 (715) 386 -4680 NOTICE OF VIOLATION June 12, 1998 NUMBER 98 -V -14 LOCATION: NW '/a, NE '/a, Sec. 16, T28N -R19W, Tn. of Troy, St. Croix Co., WI PIN # 040 - 1064 -60 Roger & Margaret Merrill 398 Glover Road Hudson, WI 54016 RE: Failing septic system Dear Mr. Merrill: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 145.20(2)(0 Wisconsin Statutes, COMM 83.01(2)(c)(e) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes. This violation was first noted on June 10, 1998. The violation noted is discharging sewage to seasonally saturated soils. Please refer to the soil report submitted by Robert Ulbricht (CSTM 2482) on June 8, 1998. If fines and /or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 30 days of this notice, contract with a certified soil tester to have a soil evaluation conducted which will determine the type of septic system needed and its location. Give the results of the soil evaluation to a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must then be installed and placed in service within 180 days of this notice. Please contact me if you require clarification of this matter. Sin ely, od E nger Assistant Zoning Administrator • y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer < 4 — ' Mailing Address Property Address (Verification required from Planning Department for new construction) 11 City/State � _ �I Parcel Identification Number 0 LV - 0 6 e_ / 0 000 LEGAL DESCRIPTION Property Location N U/ %, ' /., Sec. F . T N -R W, Town of Y i-v Subdivision Lot # IDd� . Certified Survey Map # N L pr Volume Page # N/ ++ /I� Warranty Deed # (� r 7 7/ Volume o? Page # Spec house ❑yes no Lot lines identifiable ❑ yes no SnYSTEMM �PrnPu we and maintenance of Your tic sysDeni could temp is its consists of pumping out the septic tank every d= P farTure to handle wastes. Propermaiateaaaee can aff:ct_the function f fire Y or if needed by a licensed pumper What you Pat into the system o sep& ft* - as a t a is the waste disposd System, The Pr'oP= owner agrees to submit to St: Cwk Zoning Department t �cati 'P ]°°meymanPlumber, restrictedplumhcror a licensed on form signed to the owner and a u m Proper operating condition and/or (2) after inspcctioa and S @rat (1) the onaite Rrasteavaterdisposal system .(if necessary), the septictank is less .than 1/3 hill of sludge. Lam. the und=4acd h Department of Com read the above req Com set forth, herein, 'as set by c ' and agree to maintain the private sewage disposal system with the standards by the and the Ikpartarent of Natural C sta ays tmg of that the your thrx scptic system has b= maintained must be and retuned to the St � qt Zoning pia within 30 d year expiration da SI . TURF � OF APPLICANT DATE O'VWNER. CERTOCATTON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above. by virtue o a warranty deed recorded in R egister of Deeds Office. SIGMA �0FAPPL1CAANVr DATE « « « « «« Any information that is mis- represented may result in the saai t uy 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