Loading...
HomeMy WebLinkAbout032-1071-30-000 t',,l f STC - 104 ~l r+ AS BUILT SANITARY SYSTEM REPT 1 cou, l ` NING OWNER 0 40"f ADDRESS l~/S AJA7,0 S.r o~3 g °l SUBDIVISION / CSM# LOT # SECTION -?S T 31N-R_ /W, Town of So~n~~p5 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A 411. &A 4oTE: AesaPro,j Atfq TA,-v CHr- AiV 0 ~o~,E /JEO o ~1EETK . 1J-- rl{ PfOA5a ai~,? yao' T /ail t~Ecc o40 o-rd.T 40,04 tY ~ L•iNc`s GY' 4y. ~&s y" S 3S ~ ~ewc~P ~~N6 oo, 1/0, A \ I QIQoP 60, T9 E~EN~Y O,sz?+13urL ,CF1--444e7Qr- ~oTk T/i1~.vc/¢cfs Soa~+ A?~pEY ~i.vE INDICATE NORTH ARROW 'Sr /~lo S <f /'?0-77y Provide setback and elevation information on reverse of this form+ Provide 2 dimensions to center of septic tank manhole cover. T~ ~PNo~►r / tV® of T L" or BENCHMARK : oO DF ~s,LFST ~l E ~i~1o.t1~ +O ~~,G /~O . bo' --T ALTERNATE BM:~~s~?r~t"dgr«~ ~vuioyl - 'Or'~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Gyi~s~R Liquid Capacity: /OOy 6 *4 Setback from: Well 6eV' House (el Other Pump: Manufacturer Model# Size - Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S_Length '716" Number of trenches Distance & Direction to nearest prop. line: /m$' ~vo4c rH Setback from: well: /00' House //0 Other ELEVATIONS Building Sewer ST Inlet, 9y- /a ST outlet PC inlet PC bottom Pump Off Am Header/Manifold ~7• 7 Bottom of system /S~ 86.00' Existing Grade ~3.6b• Final grade DATE OF INSTALLATION: 1,R- 331 5' PLUMBER ON JOB: _Z Y. - LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT 54. ifebr,X GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: t1 Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ?,qI I I t Permit Holder's Name: ❑ City ❑ Village H Town of: State Plan ID No.: ~_A.VY Wondo✓ .56o7ew-set - - - CST BM Elev.: Insp. BM Elev.: BM Description: pa"gg. n,S C-S75 Parcel Tax No.: loop !oo ,IBM o -f- 16 IlesT• talc opt ca/cstos 032- 1071- 30 - 000 TANK INFORMATION ELEVATION DATA wfoorlll TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W 1eS 1 0 p p Benchm ft• 7-107-4/ /DO Dosing ) m* Z•~ lo~f•$ ~ -46 Aeration Bldg. Sewer Holding &,6einlet iZ$fo~ 9Kf S"! TANK SETBACK INFORMATION a S©/ Jar Outlet 13.12 ~/•28~ TANK TO P/ L WELL BLDG. AAiirrlntake ROAD Dt Inlet Septic 150` VIZ 70 ` 72- ` NA Dt Bottom Dosing NA Header/Man. ,'h terJ ~f~ d,.eJ Aeration NA Dist. Pipe !w to 9767 gt.g Holding Bot. System 8 yZ n6•(o fe(4.1 PUMP/ SIPHON INFORMATION Final Grade lb•32. 9~•a~ Manufacturer Demand -113 9S'? a Model N ber GPM TDH Lift Friction em TDH Ft ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED EN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7-5/ 2- DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM L ACHING ctur SETBACK INFORMATION TypeO , HIA ER ode Number: Syste l {D$ 1tp V)2 - OR UNIT DISTRIBUTION SYSTEM Header / Manifold op Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length :7-r Dia. Spacing ~ I A S'rA^ 15'CW L7 Zc1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over t Over xSeeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 75-q ! 76Th ig'f, Q a f AM - lq 6or,~Sian - S ` Sl' .61rom oc) l k cfeop box . (jo t cnvtiGS o dcl, evtir i, ~ 'd, ~ Scwe - A-►'to_ -0 be- cvf 7~ waij 4ih '~72A o ✓~,i al stii'lo ~7~/0.1 ~~i~Gs Finn, ( ~•~0.~ a~~,~ Plan revision required . ❑ Yes [g No / / ll'~d Use other side for additional information. I ~~Cf A SBD-6710 (R.3/97) Date Inspector's Signature rt ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION E:71DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY, n, U e # STATE SANITARY PW -Attach complete plans (to the county copy only) for the system, on paper not less than a 1 8% x 11 inches in size. 75y /,?0 V-h Avr, v _ (`o??V.. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ,may ,Sw '/4 rs '/4, S a S- T 3f , N, R /9 E (or (WD PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ONt III. TYPE OF BUILDING: (Check one) ❑ State Owned El VILLLLAGE NEAREST ROAD TN III ❑ Public 9 1 or 2 Fam. Dwelling-~# of bedrooms ~ PARCEL TAX NUMBER() ~ III. BUILDING USE: (If building type is public, check all that apply) _ -70 1 ❑ Apt/Condo a 5. ~ / ' / 9. 37 9 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. T•Y~P7EI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. I 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 - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 El Mound 30 El Specify Type 41 El Holding Tank 12 X Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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) A- q, 4-0 ELEVATION 4-910 a SO D S O . gPg . oo Feet Q. ~o Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank o ra.~ZTA! F1 I F1 Lift Pump Tank/Si hon Chamber I Ej =n F1 1 0 Lj VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) #AP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Disapproved San' ryPermit Fee (Includes Groundwater Date Issued Issuing Age I A roved Surcharge Fee) pp ❑ Owner Given Initial /~,V~ A v rmin i n . / 7, 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 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time 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 (S31) 6399) td be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumpad by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete of.bedrobms if or 2 Family Dwelling. III. 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 .311 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 inrlude 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; weir; water maim;/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; re^llacement system areas; and the location of the building served; B) horizontal and vertica! elevation refererce points; C) complete specifications for pumps and controls; dose volume; elevatio.f differences; fri .ton loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil abfio,ption 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 o`, regulated practices which can effect groundwater. The monies collected through these surcharges are used for -nonitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 30. o~sg o 3 .PLB 87 ~PLOT & CROSS SECTION PLANS ZAPPA BROS. EXCAVATING INC ~S' PPoPos~~ PLUMBING UNIT PaoeoszA 061,1 \ ' aAbf PROJECT L.oGrtT,#0A /0 . R /n1" yN pJ~ Serf 4/0 4,.,j it AIO 15~r_ \ G c.~rBSE S L✓r v rP t.N'f'S /~00 A4, Roo &x - 3 3 s~ • Aic ~ sDP Ew ~ ~.vn~•-~I~ 1AZ.vc A'6 Al, Ae-,4 keso? wv" ~ ~ P?o~sL>7 ~E~°7'N lQ~ Q~t ~2~~1EN'rs FOR, ~ A g3 6•/0 ~~ap~ /.?fl ~~IcNm^nPK- l~T 7oP o~ ~',t~~sr ~~1 ~a~cOrFaif . EAe- v = Ioo'oo' tig SCALE FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 1Z' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: 6 MARSM MAY OR 8YNTMETIC COVERING LICENSE: MINIMUM Z' AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE I TEE SOIL TESTING BY: lv~~~r9,dn/s~,/ - ELEVATION BED 6' AGGREGATE BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST 18 COUPLING TERMINATING 're, - S -a FT. AT BOTTOM OF SYSTEM <6, oo' W isdonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor aW Human Relations Divisidt of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than,8 11 Q~1 in size. Plan must include, but ► ~~b IX PARCEL I.D. # not limited to vertical and horizontal referenc int (~fVI); drr o~,a /O of slope, scale or dimensioned, north arrow, and location an ,distance toarest roads' REVIEWED BY DATE APPLICANT INFORMATION-PLEA PRINI~Ai~E!' RMATIQ ~.F PROPERTY WNER: ' PROPERTY LOCATION & 7 GOVT. LOT SW 1/4 S E 1/4,S ZS T 3 N,R ! 9 E w PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUED. NAME OR CSM # couN FFIGE . CITY, STATE ZIP CO s E NUMBER []CITY []VILLAGE OWN NE EST ROAD ~,'►?l2Skr / i N AVM New Construction Use [fj Residential / Number of bedrooms [ ] Addition to existing building j j Replacement r l Public or commercial describe. Code derived daily flow. Cia) Recommended design loading'rate 0. bed, gpd/ft20. trench, gpd/ft2 Absorption P' 1-000-CARDIAC -trench, ft? Maximum design loading rate O.' bed, gpd/ft2 r~, ~ trench, gpd/ft2 Recommen .rt G&cw a ft (as referred to site plan benchmark) Additional t 1$ - A Ei - vh &QY Se- 6> - -SA Nr/AG0 Parent mat Flood plain elevation, if applicable ft ROUND PRESSURE AT•GRADE SYSTEM I FILL HOLDING T NrIK G $ = SUitab 0 ND 7111 S ❑U S 131.1 ~S ❑U ❑S U ❑S IZU S SOIL DESCRIPTION REPORT Boring # Moth Texture Structure Consistence Boundary Roots GPD/ft Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench > ^ C J C r N /F! C r I~'l r C. t-J L Al 1 V E"Y'A K' M OMPIACT. COM PI.ET 6. n?r w S, L / sbK ~ Ground 8 '5-13$ / YA 4 s ~C n S 0•6 lev. .1 ft. Depth to limiting factor Remarks: Boring# M Cr T L..) 2 04 115 •S 7.SY "f' Cc.1 6163 Ground qS.`i ft -I v 4 4 5 - S o. Afra TA Depth to A1.Kf L^'iYt4 EXCA .Ctrl Pr t.ra factorg C CCL1 Sd L 1\1 b v2 PRZIP < W: Q Y S i At OF g > 4&'t 7~- > J2 .`d Remarks: - CST Name-.-Please ppPrint - ~y \~~~3CaN Phone: O, Address: IpdX ff o ~&SOrij 1 rStst2 O~ Signal Date: CST Number: PROPERTY OWNER Al0IJtsO . SOIL DESCRIPTION REPORT Page z.,of PARCEL I.D. # ` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench 64% Yr2 3 3 L l rn c r r w 2 M O, d g~ it-S6 7.Sv►2 s r'hs6k n,~r Cw ,2 a Ground elev. 9t. i ft Depth to limiting factor Remarks: Boring # IQ C~~/(Z3 3 / rm cr- thfr Ow Zyl, 6,4 9, l2-4% 7•sY2 SC / rn S~ A4, Cw 1 6,2 D.3 Ground $2 -IL /bY 3 s SG Yy k Ill / 'elev. ILI ft Depth to limiting factor Remarks: Boring # A o- fs io~ire3 L /c r r Cw Z~y a,4 o. r S /bv 4 - SL S~ /hir cv) O.2 0,3 Ground 9-12 /avfe4 3 ~ s SG f d S O,G lev. 10'k ft. Depth to limiting factor 7 /d.47 Remarks: Boring # Ground kr 11 u SRO11°f - ! i I G ~C! t elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) M ire I a ~ l f I f cff 2 6 $ Q ~ h I v ~ 4 4 X19- m ~ I / VN y a ~ ~ 4 ~ D-- rA LI C'P, Q Q3 6 F 1V ~ ~ CT 4V o s 1 14 SN ~ 1 r~ r Z ~f ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER cdr YQrl~a~~` MAILING ADDRESS vL v/74~ n, PROPERTY ADDRE vipe_ Q~ 501 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Q Irr S I'/ `/a ~S PROPERTY LOCATION 1/4, 1/4, Section T_N-RW TOWN OF r►~onS2 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 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 system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: I©~7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC-100 This application form is to be completed in full and signed 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/contractor, (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. Owner of property 41r r yQn c~a Location of property5;i%4 l1/4, Section C ,T~N-R_ Lf Township „Soiner_sP_ Mailing attd/dress / Address of site 1~9D 7A J7 Subdivision name Lot no. _ Other homes on property? Yes No Previous owner of property f-rc t•a Total size of property _ Y/A ' "fc S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _-L/-1Yes No Is this property being developed for (spec house) ? Yes - ~/,_No Volume ~29d and Page Number 39as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE 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 description references to a Certified survey Map, the Certified Survey 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 warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signatu of Applicant Co-Applicant Date of Signature Date of Signature 566952 ~TATF BAR OF WISC~)~tii` lad? QUIT CLAIM DEED DOCUMENT NO _ t REGISTER'S OFFICE M ST. CROIX CO., WIr Rw'0 f9r 9qcpr4 Francis D. Mondor and Joyce _Aondor,husbard_a--id_wife _ - - OCT 15 1997 - - 9:30 ~ AM quit-claims it, _Lawrence A Mondor. a sin gman - Re sir of Dead. t q. Y St Croix County. T the following descnbed real estate to ; _ State of Wisconsin: T.+S SPAZE RESE?N--D rJF RECORDING DATA Southwest Quarter of the Southeast Quarter (SW 114 of NAME AND R.ET ;RN Accaess SF 1/4) of Section 25, Township 31 North, Range 19 REINSTRA S VAN DYK, S.C. West. post Office Box 127 t New Richmond, WI 54017 i 032-1071-30 = PARCEL ,0EN1 F'CV--Z% NUMSER 'y ~b l This is not homestead property uck us not' 13th day of October ►`t 97 + Dated this > aC (SEAL) y . (SEAL) } y= Francis D. Mondor Joyce Mondor _ (SEAL) (SEAL) yKb AUTHENTICATION ACKNOWLEDGMENT Francis D Mondor and Joyce State of Wisconsin, Signature(s~ it e Mondor - County 3th day of 0 o er 19 97 Personally came before me this - day of ' % authenti a d thi . 19_-, the above named Hendrik W_Van Dyk_ TITLE: MEMBER STATE BAR OF 15CONSIN - Of not. - - authorized by §70t. Ob, W,a Su,1 7-1c k tnown :o b,- the , s,n . _ __N f10 aSe al(i d the Io: C1!t,in g _.rament and 3:Kn1M kc ',he -'Jl -C THIS INSTR MEV NT W ')RAFTEC B _ Hendrik an~ v k AM N IC c C-