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HomeMy WebLinkAbout032-2099-70-000 C9 AS BUILT SANISTTC - ARY 104 SYSTEM i REPORT t} E IVEQ OWNER AUK p cn ST CROiX ADDRESS n COUNTY ZOPJINQOFFiCE 1 Z~l SUBDIVISION / CSM# SECTION LOT # T - W, Town of ST. CROIX COUN WISCONSIN P SHOW EVERYTHING ITHIN 1 0 FEET OF STEM ~uf r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK I/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well ~S House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /2 Length 2 Number of trenches Distance & Direction to nearest prop. line: / Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: , ST outlet: C--:;2 PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: /re- w- PLUMBER ON JOB: l LICENSE NUMBER: INSPECTOR: 3/93:jt W, isconsin,Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division CountvST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanital"I ft: Personal information you provice may be used for secondary purposes (Privacy L &w, s.15.04 (1)(m)]. H ' .S E 814 j jg"e ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description. Parcel T351'1-;2099-70-000 TANK INFORMATION ELEVATION DATA A9700197/gyp TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark d CQ' c_ ~7/ ` G~ ~ Dosin v Aeration Bldg. Sewer Holding St/,Pt Inlet TANK SETBACK INFORMATION St/ IWOutlet 7/9 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 14 NA Dt Bottom Dosing NA Heacler-ZIVINU7 g~ Aeration NA Dist. Pipe 3 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand odel Number M TDH Lift Loss ction System TDH Ft Force I n Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length, No. Of renches PIT No. Of Pits I ia. Liqui Depth DIMENSIONS ~ DIMEN I SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEAC Manufacturer: SETBACK INFORMATION Type O C BER Model Number: np System: OR UNIT J~j DISTRIBUTION SYSTEM Header / Mawi# - „ Distribution Pipe(s) - / x Hole Size x Hole S Vent o Intake Length _L/ Dia. Length __7/ Dia. Spacing ~o SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 26.31.19,SW,NW 11966 62ND STREET LOT 7 ~F'~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DIL R SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than seal s A 8% x 11 inches in size. ❑ Check if revn to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS OWNS PROPERTY LOCATION '/4 '/4,S T ,N,R E(or)W ROPER OWNER'S MAILING AgPRE7 LOT # BLO # Z M NUMBER CITY STATE ZIP CODE PHONE NUMBER SUBDI ON NZer _0 f II. TYPE OF BUILDING: Check one CITY : NEAREST ROAD ( ) ❑ State Owned ❑ VILLAGE : +t~s l Fla 190 n5 zc;;2 ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEL A NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) -moo 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable) A) 1. 0 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ 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. PEiR ATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./ch) ELEVATION 9 T-1 / Feet Feet VII. TANK CAPACITY Sonite in gallons Total # of Manufacturer' efab. Fiber- Plastic Exper. INFORMATION Manufacturer's Name Co C- Steel New istin Gallons Tanks Prncrete strutted glass App. Tanks Tanks rT- F-1 Se tic Tank or Holdin Tank - Lift Pump Tank/Siphon Chamber ~ai I LJ I F1 I Lj I I I VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installati n of the onsite sewage system shown on the attached plans. Plumber' am (Prigt): Plum is na e: ps) MP/MPRSW No.: Business Phone Number: S~ Plu ber's A dress Stre t, City, State, Zip Cod q IX. CO NTY/D ARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a to Issued Issuing Agent Si n mps) Surcharge Fee) /go pproved ❑ Owner Given Initial ap ~-ao Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6388 (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 m -,,y be renewed before the expiration date, and at the time of rer:ewal 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 cr plumber requires a Sanitary Permit Transfer/Renewal Form (SED 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. 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. 11. Type of building being served. Check only one and complete of bedrooms if 1 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. rumber of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a!/ septic, pump/siphon and holding tanks for this system. Check experimental approval only !f 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 and 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) 1 I N i i I II } i , . i :;2 i { I I 1. 1 I t i i. ~I j i i { i ~ I ~ ~ t } ~ I--.. .I - 1 f ~ t I i ~ i I j I ~ j t t I a ; I ' . I ~ j t t a ~ ~ I 1 I ~ I t I i ! i I ~ ! I i i i I I i i ~ ~ ~ ~ ~ ~ I I I ~ j i I r ~ j i ~ j j f fif II I_ II ~ tII I 3 ~ ( h + t 1 r i , ~ I ! ~ I • ~ i ~ I + I 1 I I ~ j i i ~ I { I ~ l i 1 I ~ t~ ► ~ ~ i , I . ~ ~ i ~ I i i t f~~ j t j I i ~ i? i i I t~ i i' j I I ~ l 1 i I j t ! { j ~ i i ~ I ~ I I ~ l ~ ~ f ~ f f 4 ~ ~ _ i r~ I t j 1±; f f I; j ~ 4- ~ -4 i L { r i ~ , 1 ~ ~ ~ ~ ~ i I ~ i ~ ~ - - ~ - - - + t j I ! I j I j { ~ : - j f 1 ~ ~ ~ 1 ~ 1 ~ I { -l I ,III I I i ! I I I I j i ~ 1 i i 1 I ~ ~ r • ! ~ ; j ~ I ~ i I j ~ { ~ ~ ` } r ' { i ' ~ I - f i _ ' ~ i I ! i { 1 f f ~ I I I f ~ , { ' f ~ f~ t ~ f I~ ~ f j I ~ ~ r j _ --a 1 t ~ j~ i t! t i,; ~ ~ f ~ j r -_1 I { ~ ~ ~ i ~ ~ ~ I i ( ~ ~ 1 f ~ j ~ { ' ~ - } - ~ ~ ~ I I tlE j ~ ~j { ~ r ~ , { 1 1 ~ f i i ~ j i ~ _I__~ - i I j ; } ( ; I j~. { } 1 j c ~ ~ i i i i ~ , j { ~ ~ ~ _ I ijt~~fi ~ I I j ff { i i I I I f ~ ± I J ( j t I r t 1 ~ ~ { t i i _ _ I I) f ~ ~ i 1~ j f 1 1~{ I i~ f i i I ~ ~ i ~ ~ f ~ f t j I Ij I ! ; I i I t - ; I i ~ , , ~ ; - ~ ~ -i I I 1 i ~ t I I ' I ( I i i, i I # ! j ~ i i ~ ~ ~ I I I _1 ~ ~ - a 1 , ~ ~ ~ _ f _t j - j -j _ I i - i i ' I i I I I ~ I Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of S*hfety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # r ppg APPLICANT INFORMATION - Please print all information. Reviewed Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). _ i s e f - Prope er Property Location i 40T Govt. Lot 1/4 A , Al~ t&, X/ '.~^R V (or) W Property Owners Mailing Addres Lot # Block# Subd. Name E #70N;~ NG OFFI Ci Staff Zip Code Phone Number ~Aldar El ' L~ ( ) City-- VUaye Town b"odd- New Construction Use: Residential / Number of bedrooms y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6& gpd Recommended design loading rate ~2 bed, gpd/ft2_~9--trench, gpd/ft2 Absorption area required gibed, ft2_Z5-_0trench, ft2 Maximum design loading rate 2 bed, gpd/ft2_. trench, gpd/ft2 Recommended infiltration surface elevation(s) SS ft (as referred to site plan benchmark) Additional design/site considerations Parent material 07'a>, ~ ~~c.✓ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = unsuitable for system 3 S ❑ U ® S ❑ u ©s ❑ u ©s ❑ U ❑ s C3 U ❑ s u 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. Bed , Trench / S - C t Ground _ At' x elev. 9?,.-ft• S _ Depth to limiting factor Remarks: Boring # 7; -0,-2L as 13, __j z Ground s y s elev. Depth to limiting fack~o,r _Min. Remarks: CST Name (Please Print) Signature Telephone No. Address 1 Date f CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER 7 Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 7 A9 7: zz J'7 -je,111V Ground 8 / elev. G/!,/L ft. Depth to limiting factor min. Remarks: Boring # 44 1 ~ 7n Ground nnelee~v.,, Depth to limiting f or in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 c Al ZI /s Ground - S elev. att. Depth to limiting f for Remarks: Boring # Ground elev. tt. , Depth to limiting factor in. Remarks: SBDW 8330 (R. 08/95) I l ~A /w- -ice, o ~o STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /,'~~~.r ~iy, MAILING ADDRESS Py "k 3~ Grp r E L Vii,s ~S/ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE rri~•C5G% , W -.Z-- 5 Y0 .1v- PROPERTY LOCATION , 1/4, .e7_6-_ 1/4, Section---' T S 1 N-R_W TOWN OF SG/ ST. CROIX COUNTY, WI SUBDIVISION /ANC G/F~ LOT NUMBER CERTIFIED SURVEY MAP , VOLUME -L PAGE lDr , 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: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r S T C - loo 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 Location OffropertyAIC- 1/4 1/4, Section ,T LN-R_W Township cJ L~Sb~ Mailing address ~U~ ~~'k 3~-Cr Address of site Subdivision name /'iN~ C'L/FG Lot no. Other homes on property? `Yes No ` oT Previous owner of property A~ Total size of property v7 46~5_ Total size of parcel ~r 0 Ac,eer;* Date parcel was created zj~l-~ ?s I I Igq("V Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? _ CC,Yes No Volume - and Page Number as 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 e office of the County Register of Deeds as Document No. S'SU , 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. Signature of Applicant Co-Applicant Date of Signature Date of Signature 528739 soft uo whAc TYFDO Z =2 IIeu [SE CROIX C9y WI DOCUMENT NO.'d)tif R~COttI MAY 8 1986 Qmma T. NEW" 9!" PUMMA, at ll:C* AM 8-clamp ce ~6 pllif~pertiTTwrp mom 2! ara = AaM"W0 FCO MCORDM10 DATA • HAM AM OITLOM Al"08 Ve it ial~M11tb.; 3[. Croix d *IKM ds r S 4 a "A; 01/4 of SWft Au that part of WA of WA ftW4t =4 tint pert o! MIA& of SW/4 lying Ely of Apple River R a tom, pwt of M/4 of SnA lying Ely of the Apple p 31 liwtk BmW 19 Neat, St. Qvi x County, Yi > J New- wl, t pmts! reatrictims amd zl&ta-of-my of records Msv , t~~. ar 9 _p d; (SEAL) - (S)- ,3 t: MAL) ACKNOWLIDGMZW aI I SLATE OF WDCOPAW s • ; N6 ' . i hmortlt c s bdors ~e t~ir der ON . If dices urn& mm or mscolmn iM 4fwi t f ~K01~ ads Sir.) m ft&" to be Me pmm a►IM.xeco w tim ftnesoiaa immmm mw ackww;o* ft sea - R TIMr lltti OMW WAS CRP# fd Or . W ST. CROIX COUNTY WISCONSIN ZONING OFFICE p p b e x r n: ST. CROIX COUNTY GOVERNMENT CENTER rrr~( 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 11, 1997 Hartman Homes Attn: Becky P.O. Box 326 Somerset, WI 54025 RE: Septic Inspection Pinecliff, Lot 7 - Tn of Somerset Dear Becky: An septic inspection of the above referrenced property was conducted on August 18, 1997. This property is located in the SWV4 of the NW1/ of Section 21, T31N-R19W, Lot 7 of Pinecliff, Town of Somerset, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. riC rely, 7 amen K. Thompson Assistant Zoning Administrator sm