HomeMy WebLinkAbout030-1014-10-000 (2)St. Croix CTd2ty Planning aIZa zoning .11ontlay, October 29, 200 - (it 11:41:14.AM
Pa ce I q 'I
Detail Sanitary Information oil ...
Computer #: 030-1014-10-000 Sub/Plat: metes & bounds Section: 4
Parcel #: 04.29-19.58A Lot: TN/RNG., T29N R19W
Municipality: St. Joseph, Town of CSIVI: 114 114: NE 1/4 NE 1/4
Owner: Hawkinson, Arthur F. 603 County Road E Hudson, VVI 54016
State Permit: 180259 Issued: 09/15/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement
County Permit: 0 Installed: 10/14/1992 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
ji, �
- , ot N". _.f ,.
Issuer/l. n5L)eql: mr.
As Built Plumber
Jim Thompson
Yes Bourneester, Jim
Jim Thompson
Yes
_-.-
Scheduled P-, irn_p
Date PL-imped
7/4/1995
7/29/2003
7/29/2006
8/26/2005
8/26/2008
8/8/2007
8/8/2010
Other Reaqkq�ts. Additional Notes _Mone_y Owed
used existing septic tank (1000 gal. ) to valve $0.00
alternating between existing bed and new 18' x. 40'
bed. Hawkinson purchased in 1973, we don't have
original permit on file
04/01/2UUb
AS BUILT SANITARY SYSTEM REPORT
OWNER )AN 6 0 -"� op
TOWNSHIP
SECTION —T 1 N-R)9 W
ADDRESS YA --ST. ,CROIX COUNTY, WISCONSIN
SUBDIVISION
LOT LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5"
INDICATE NORTH ARROW
BENCHMARK: Elevation and description:
Alternate benchmark
Cl )
SEPTIC TANK:Manufacturer: —Liqui a � � �
Rings used: I ' Manhole cover elev: ZFinal grade elev: I (jQ-9
� -
r7
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road :Front Side_, Rear Ft..
"� 6 0
From nearest' prop. line: Front Side_, Rear Ft.(JLl
-
No. of feet from: Well (s>( Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.:Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front Side_, Rear Ft.
Distance from: Well Building
r .
SOIL ABSORPTION SYSTEM
Bed:-- �Trench : Seepage Pit:
Width: - Length NumberBuilt
°f Lines: Buz
Exist. Grade Elev. � 1'� Proposed Final '
Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line: Front-- Side , Rear 3(k)T
E
No. feet from well: % No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank;
Elevation of inlet:
No. feet from nearest prop. line:Front Side
Rear Ft.
No. feet from: Well building nearest road
Alarm Manufacturer:
DATE
r
6/90:cj
INSPECTOR:
PLUMBER ON JOB:
LICENSE NUMBER: 3 ro,
JOSEPH 4,29,19,58A NE NE, CO, RD, E
IQCAT-ION: ST'ol tnaustry, isconsin Department PRIVAYE SWAGE SYSTEM
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT)
GENERAL INFORMATION
Permit Holdeil's Name: 0 City El Village [Town of:
I
1AWKINSON01 ARTHUR F & NANCY ST, JOSEPH
CST BM Elev.: Insp. BM Elev.: BM Description:
ce,
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
DoAi n
Aeration
Holding
TANK SETBACK INFORMATION
TAN KTO
P L
WELL
BLDG-
Vent to
Air Intake
ROAD
Septic
>
2-
NA
Dosng___��
NA
Aeration
NA
Holding
PUMP / SIPHON INFORMATION
[County -
Sanitary Permit No.:
180259
State Plan ID No.:
Parcel Tax No.:
030-1014-10-000
ELEVATION DATA
A920034 0
STATION BS
HI FS
ELEV_
Benchmark
OOX
f
Bldg. Sewer
K 4.
Inlet � _f,
, i
St /++t- Outlet
, i
Dt-1 hT&t
---------------------
-Dt
Header /-A4aa_
A-2,
Pipe
/f 5.5
-:2 TDist.
7
Bot. System
.04
Final Grade
77 7
71
Manufactur*r- Demand
Mqdejl Number GPM
TDH Lift Friction �Ystem-,TDH Ft
Loss_ Head
Forcemain Length Dia. Dist. To Well -A
SOIL ABSORPTION SYSTEM
BED/TRENCH
Width Length
No.Of Trenches
PIT, _- ....1-Tq0.-Of
Pits
inside Dia.
Liquid Depth
DIMENSIONS
DfIVIENSIONS
Manufacturer:
SYSTEM TO
P L
BLDG
WELL
LAKE STREAM
LEACHING
SETBACK
INFORMATION
Type Of
CHAMBER
Mode ber'.
System:
I j
> 5n
4
OR UN IT
DISTRIBUTION SYSTEM
Header f-l&mtf-aid
Distribution Pipe(s) r
x Hole Size
x Hole Spacing
Vent To Air Intake
Length c D I a
Length
Dia. Spacing
f:,
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 0 No
COMMENTS: (include code discrepancies, persons present, etc.) or
10 6'
cc
f 60,
74
_71 40"6 l -)/Zrae"n- oc
f,T)
Y-N6,V4,
47,-T� CCV
F #
Plan revision required? El
0-1 S E11TO Ie / 9 �C.
Use other side for additional information. "Z' le X�7
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
. —.uAmccriml SANITARY PERMIT APPLICATION
n,,,ILHR In accord with ILHR 83.05, Wis. Adm. Code
-Attach complete plans (to the county copy only) for the system, on paper not less than
81/2* 11 inches in size.
-See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
PROPERTY OWNER'S M41LING ADDRESS LOT #
COUNTY
STATE SANITARY PERMIT
❑ t f 0
Ch ec revisio toprevid s application
STATE PLAN I.D. NUMBER
T c/, N, R I E (or
BLOCK #
&//,t
11T 4111t
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVIS10h NAME OR CS UMBER
11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 0 CITY NE REST Ro
VILLAGE: 0 T
%5 o- o Im wil
[R IOXJN OF: 1
Public L'41 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S)
111111. BUILDING USE: (it building type is public, check all that apply)1611y-
1 El Apt/Condo
2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home
3 [] campground 7 El merchandise: Sales/Repairs
4 El Church/School 8 1:1 Mobile Home Park
5 El Hotel/Motel 9 El Office/Factory
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
replacement
A) 1. ElNew 2. 3.E1 Replacement of
System System Tank Only
B) EJ A Sanitary Permit was previously issued. Permit #
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution
11 r rl.� Seepage Bed 21 ❑Mound
12 n Seepage Trench 22 D In -Ground
13 ❑Seepage Pit Pressure
14 ❑System -In -Fill
NOW
10 ❑+Outdoor Recreational Facility
11 El Restaurant/Bar/Dining
12 El Service Station/Car Wash
13 0 Other: Specify
4. ❑Reconnection of
Existing System
, Date Issued
Experimental
30 ❑Specify Type
5. 1-1 Repair of an
Existing System
Other
41 ❑Holding Tank
42 ❑Pit Privy
43 ❑Vault Privy
V1. 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
So
REQUIRED'sq. ft.)
PROPOSED (sq. ft.)
14=) b
(Gals/day/sq. ft.)
1 0'
(Min./inch)
07
J4*
9 t).,s OFeet
ION
ON
1co.
Vill. TANK
INFORMATION
CAPACITY
in q. Ilons
New xisting
Total
Gallons
# of
Tanks
2
Manufacturer's Name
Prefab.
Concrete
Site
Con-
Steel
Fiber-
glass
Plastic
Exper.
App.
Tanks
Tanks
r
strutted
Septic Tank or Holding Tank
-".NOW
7
10
Lift Pump Tank]Siehon Chamber
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print):
rN-." &, S'
-Vt JL
P�
er s Sinnature: (No Sta s)
Crk,
MP/MPRSW No.:
Business Phone Number:
j 8 L
Plumber's Address (Street, City, State, Zip Code).
N fl
,log
N
Ix. CWNTY/DEPARTMENT USE ONLY
Disapproved
Saiy*tary Permit Fee (includes Groundwater
Surcharge Fee)
Date Issued
wing AjdentSig S r_.,P!9_111
rApproved
ED owner Given initial
Lture(No
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
f
1',4 ... A. sanitary permit is valid for two (2) years. .
2. You-r sanitary permit may be renewed before the expiration date, and at the ti rye of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
5. If you have questions concerning your onsite sewage system, contact your local code administrator'or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary, permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in #1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from. DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use only.
X. County/Department Use only.
Complete plans and specifications not smaller than 8'/ x 11 inches must be submitted to the county. The
plans must include the following. A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; -wells: water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal anal vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss, pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11 /88)
S T c - too
.his application form is to be completed in full and sl
*gned by
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the permit issuance, Should this
development be intended for resale by owner/contractorl(spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
---------- ------------- ~ ----------- ~ ---------------------- 0--fir ------------
Owner of property
Location of property
L-C '1 4 1/4, Section 41 T 0(/ N-R W
Township Z57 70L:6'g�
Mailing address
/*
Address Of site
Subdivision name Lot no.
Other hornes on property? yes No
Previous owner of property 7,4�1
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
volune_and Page Number as recorded.with the Reqiste
of Deeds. f__ r
- - - -- - - - - - - - - - - — — — — — — — — — — — — -- — — — — — — — — — — — — — — -- — ---- -- — — — --- — — — — — — --ems
-- — — — — — —
A WM INCLUDE WITH THIS APPLICATION THE FOLLOWING:
-PANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE SEAL OF T11E REGISTER OF DEEDS. In addition, a certified survey, if available-, would be helpful so as to avoid
delays of the reviewing process. If the deed descrition
-references to a Certified Survey map, the Certified Sp
urvey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I(we) certify that all statements on this form are true to the
best of my (our) knowledge that i we am (are) the owner(s) of
the. property described in this information form, by virtue of a
war'l-anty deed recordedinthe office of the County Register of
Deeds as Document No. -�' and that I
_j1the�_ (we) presently
own the proposed site fosewage" disposal system or I (we)
obtained an easement, to run the above described property,,
the cons for
construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
3
No. 1
4",
Signature of applicant
Date of Signature
Co -applicant
Date of Sig -nature
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS: Cc c,57-,,,j-TV XD --FIRE NO: 6;
T N-R C1 W,
1/4, 1/4, SEC.
LOCATTON: &_
TOWN OF: :!2' T _aL^:5 CTIA —ST. CRCX COUNTY
SUBDIVISION: L01P NO,
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, J ' f needed, by a licensed septic tank pumper* What you
put into the system can affect the function of the septic tank as
a treatment stage in the waste disposal systems -
St. Croix count- 7 -r-es.`Ldents may be eligible to receive a grant to
which
1-elp with the cost of the replacement of a failing system, w I
1978. St Croix County accepted
was in operation prior to Sul 1, owners
this program in August of 1980 own
with the requirement that properly
of all new systems agree to keep their system
mainta.ined.
The property r.-)wner agrees to submit to the St. Croix County
Zoning a certifica-LLion forn, signed by the owner and by a master
plunber, Journeyman plumber, restricted plumber or a licensed
-site 'wastewater disposal system
p-11,J-.np121-r -ve.rA,fy.--1'.Lng that (1) the on
# (2) after inspection and
is in prcQer opjc_�rating condition and
Of
PurL-IP-Lng necessary)p the septic tank is less than 1/3 full
Cl Certification from will be sent approximately
Sludge a-1-i" SCUM.
30 days prior to three year expiration.
t--.1iAn. unC".(?rsigny%,-_d "nave rec-Ld the above requirements, and agree
to i-,.rie private sewage dd. spro�sal system,in accordance with
q
as set by the wissconsis') .), NL P.
h c, st.z,�Sdatds to t" le S4_
a -andd.
0 1% h r m tn il z
e f i rz z-i- AZ-, comp ete returned
-flfic,.�r T�.rithin 30 days of the three y o ':L:'
c ,,- o x o u nt
X
ci:o' -,,_,00.nty rZol-iine:, o0f 1% ce
St*
9 11 1i S) t
Hudson r Wl.*, i54016
DEPARTMENT OF REPORT ON SOIL BORINGS AND
INDUSTRY; _
'LABOR AID PERCOLATION TESTS (115)
HUMAN.RELATIONS
0 LHR 83.090) & Chapter 145)
LOCATION: SECT N: TOWNSHIP/MUNICIPALITY: LOT : BLK.
R1 for Z-se
/ �/ /T,�)j / sk
OW ER'SIBUYER'S N NAF-6 MAILING ADDRESS:
SAFETY & BU I LDINGS
DIVISION
P.O. BOX 7969
MADISON, WI 53707
SUBEW41,S�N NAME:
COUNTY.
�44'01.4�kn S'04- A 4u LL Z_ �t'�4
USE DATES O SE VATIONS MADE
3 �
NO. BEDRMS.: COMMERCI L DESCRIPTION: PROIFIFFI D CRIPTIONS: PERC AT N TESTS:
esidence A -_I
❑ New M Replace � � ..
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-G OUND-PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECO MENDED %�YSTEM OPI ona_l))
S El U �S ElUXS EA El S NA El SXU
..
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: /f' Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEPTH W.
ELEVATION
DEPTH TO GROUNDWATER -INCHES
OBSERVED EST. HIGHEST
CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
DROCK IF OBSERVED (SEE ABBRV. ON BACK.)
TO BE?J,
. /7
411�� /
If 3
L.
B-
l�3✓.3
B.
B
B-
B
PERCOLATION TESTS J
rc-
TEST DEPTH WATER IN HOLE TEST TIME
NUMBER tip AFTER SOF,.LLING I INTERVAL -MIN.
P_ ` + 3
P-
P-
P-
P-
P-
RATE MINUTES
PER INCH
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
i
SY
M ELEVATION
C i 0
,sr
11-i e > i 0 frcy
fA,)ed
0' �t�
fj-rI�`'`� - _ _ _ . ,',•c. cif''
tN
6� 0
"0
ROW,
DROP IN WATER LEVEL -INCHES
PERIOD 1
PERIOD 2
PERIOD 3
A
...� -
Ak
I, the undersigned, hereby certify that the soi es s repoite�an tisorm were"made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83)
— OVER —
I \ C - T..I. (*� 1\1
) 0 SS T A C)
NAM
C NJ L I C E N S E
ID
rar
I qr..�
10 lot
Ut Cj
FRES If XI-11, 10LETS AHQ_
013.SERVAT I 0t] i�f�PE.
CROSS SECTION
'_ 1
Approved Vent Car
Minimum 12" Above
Einal fir-aOIQ
w
40' Cast Iron
7\bove Pipe
Vent Pipe
'o Final Grada-
Marsh Hay Or Synthetic Cover i i (i
Min. .2" Aygrc(j'jj
Over Pipe
s, L r j. bu L ion",
T e e
Pipe ---�Aggregate
Ver For Led Pip--
13cnea h Pipe
ccuplAng Termi.F�,-ii--
Sys tel-.
b
Bottom of
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
4
serving the pk'j L)j 6 residence located at:
1/4, 1/4 Sec. Y-01 TQ N1 R 12 W1 Town of
S - -� Upon inspection, I certify that I have f ound the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced D
Did flow back occur from absorption system? Yes No (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete X Steel Other
Manufacurer (if known): N-�i
Age of Tank (if known)
L) I Y-n
rne()
(S(Urnature) (Name) Please Print
42s -S MVKJ
(Title) (License Number)
(Date)
Forin to be
completed
by
1icenE-Jed plumber (s.145.06,
Wisconsin Statutes)
or Licensed
Disposer
(NR
113 Wisconsin Administrative
Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection openin over outlet baffle).
/1171
Name]I r--\ , , W"' 3
� VbMtv-�ts�j 4K Signature4C- MP/MPRS
5/88
REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE
10/1-3/92 15:17 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/14/92 AREA: JT
16 Activity: A9200340 10/14/92 Type: CONVSEPT Status: PENDING Constr:
Address: ST. JOSEPH 4.29,19.58A,NEINEf Co. RD. E
Parcel: 030-1014-10-000 Occ: Use:
Description: 180259
Applicant: HAWKINSONF ARTHUR F & NANCY Phone:
Owner: HAWKINSON, ARTHUR F & NANCY Phone:
Contractor: BOUMEESTER, JIM Phone: 386-9020
Inspection Request Information.....
Requestor: BOUMEESTER, JIM Phone:
Req Time: 09:10 Comments: !06 Time Epp
Items requested to be Inspected... Action Comments
00012 FINAL INSPECTION
Inspection History ooess
Item: 00012 FINAL INSPECTION