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HomeMy WebLinkAbout038-1180-50-000 Q o ~ ° 3 0 v y O k a) o h m O N ' N O C O ;v j a t 2 d - m ~ o a Z c o z ~o Sc c6 N 1 LL O _N O O v v c3i Z y U) O Z d d Z am 0 c (7 O Z C6 O z a o p fn FF-- r N Z c -o p M N C C U) a) 0 a ' 0 0 ¢ Z m Z Z w N N d _ N m R N n ~ d Y c a - LO a G G a o ca U) U) :3 0 r r U) N a 0 0 0 • °aaa Z r N IL L U . n 0) Z } J U rn 0) C14 0) gz~ N N N w O _0 E Q O co y~ Cl. co (D 2) N ~1 'L m a u) Q O N C" C fV H a ~l O N C O O d 0' O O Fw O O C C C R 'D N wC-0 r y 0 3 N f- y U w +O+ 'O 0-4 ap cM d a2S COD) .2 r f0 • O y~' O r U) N O Z c a' (n xt a € a CL L: a r'~V E c c Q 0 a j N V f ST. CROIX COUNTY WISCONSIN ZONING OFFICE Nally a a p a s ST. CROIX COUNTY GOVERNMENT CENTER "d 1101 Carmichael Road rte;;,, Hudson, WI 54016-7710 (715) 386-4680 March 6, 1998 Remax Team 1 Realty Attn: Mike Germain 103 Main Street Somerset, WI 54025 RE: Septic Inspection for M & G Inc. located at 1120 212th Avenue, Lot 34 of Apple River Bend First Addition, Town of Star Prairie, St. Croix County, Wisconsin Dear Mr. Germain: A septic inspection of the above referenced property was conducted on December 23, 1997. This property is located in the NE'/4 of the SW'/4 of Section 15, T31 N-R18W, Lot 34 of Apple River Bend First Addition, Town of Star Prairie, 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. Sincerely, Rod Eslinger Assistant Zoning Administrator /sm r - STC - 10 4 ' `Ec` AS BUILT SANITARY SYSTEM REPORT ~J sT CROIX I ` UNTY OWNER_ Z2 Z'~~ `w ZONCINGOFFICE ADDRESS SUBDIVISION / CSMJ LOT SECTION-_.Z,.2- Z L_Z L6 W Town of ,,tom ST. CROIX C WISCONSIN So-Doc, ' 15.31 . I g. X00 PLAN VIEW S R NG WITHIN 100 FEET OF SYSTEM Hmrs,~ r ys ( A ~~ypsd INDICATE NORT ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK: ALTERNATE BM: / 7 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: h L4 Liquid Capacity Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 715'~ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: - House ,Zf Other ELEVATIONS Building Sewer ST Inlet: Z42Y ST outlet: M, ?,_ZS_ PC inlet PC bottom Pump Off Header/Manifold Bottom of system q Existing Grade 44,2,1,-;? Final grade Z4= 42_ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wis;ongin-Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County: INSPECTION REPORT '4, o 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)]. q 7 Permit Holder's Name: ❑ City ❑ Village Iq Town of: State Plan ID No.: r 01 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: o • g, ur Dom'- -SD' TANK INFORMATION ELEV ION DATA A q7 pwj TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic pp Bench M, 47 10/. 7 Dosing All, M*k c~ 06-17 Aeration Bldg. Sewer 3,3 Holding ~b Nt- Inlet ,0 l00/2; TANK SETBACK INFORMATION 6~ I3t Outlet •3 X037 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic pp+ ' ( NA Dt Bottom Dosing NA Header / Man. g~ f( ' Aeration NA Dist. Pipe •77, Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Wom kale, tag-3,r Model Number GPM TDH Li r System TDH Ft oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM B RENCH Width Length No. Of PIT No. Of Pits Inside Dia. Liquid Depth IMEN SIGNS s 73 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufactur SETBACK INFORMATION TypeO 2 CH R delNumber: System 0~ OR DISTRIBUTION SYSTEM Header / Manifold rr Distribution Pipe(s)r it , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length ~ Dia. 4 Spacing 6 Ay Isce =7 1 1 Z,04- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over H Depth Over xx Depth O ed xx Mulched Bed /Trench Center 32-NP Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 041i"I b f.c k mA K Wks fLevwd e,5- c_ 41 I ; 6 ed pile t l SM of ' ✓ad~ ~ VI,Gk ~ ajar l ,w ~ 1 ~tbYlP.i ~~~J ~Fth~ 12'13.011 Plan revision required? ❑ Yes ® No ,(1 Use other side for additional information. 1Z 2~ 9 l ^ 7 SBD-6710 (R.3/97) Date Inspector Signature . N ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: Misconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. 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 than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar Permit Number The information you provide may be used b other government agency q I Y Y Y programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property.Owner Name Property Location 114 t/a, S T&/ , N, R Y(or)(9) Prope y Owner's Mailing Address of Number Block Numb dk_ -E-l-, City State Zip Code Phone Number Subdivisi n N e or SM Number . II. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms V Towan OF-5)z III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 01.38 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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 ,1 1,® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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. nch) Elevation Feet Feet VIV 9R, c-- VII. TANK Capacity in gallons Total # of Site Fiber- p plastic pp. Gallons Tanks Manufacturer's Name Concrete Prefab. Con- Steel glass App. p. New Existin strutted Tanks Tanks Septic Tank or Holding Tank ^ l ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans. Plu e s Name: (Print) Plumb is gn r N to ps MP/MPRSW No.: Business Phone Number: t Plumbers Ac dress (S~ reet, ity, State ip Code): IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) (Approved ❑ Owner Given Initial ~T,. Surcharge Fee) Adverse Determination M X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) 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 a 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 (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. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. 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. II. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 1/2 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 contamination investigations and establishment of standards. S.Z•~ - X7y~ /lc~js,Zo ~Q/~41N1 ~mttF'.~ ~ oSJ IO/ y/ 1 leg ~a 33 ~ Wisconsin Industry, Laborr and Human Relations LA SOIL AND SITE EVALUATION REPORT page / of 3 DMalon of Safety A Puddings in accord with ILHR 83.05, WrAdm Attach complete site plan on paper not less than 8 1/2 x 11 inches in site. Plan Mr c R O 1' K not limited to vertical and horizontal reference point (84, direction and % of slo dimensioned, north arrow, and location and distance to nearest road. 00 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION IE DATE PROPERTY OWNER: >V PR LOCH Vi'chARD 5-7-oV T G _ i ~i0y,Cf/ N,R E(oio PRO 3 E owN~R':S MAILING ADDRESS T 4 ON ~f Gv.4 -rU kEZ= TSP. CITY, STATE ZIP CODE PHONE NUMBER ITY ❑VIL NEAREST ROAD II~U So.J ~i5, 5yo1~ (;7/5)sqq-(v731 /coy. CC FCode few Construction Use (r-} AesidenCal / Number of b6drooms 3 +0 4 Replacement Addition to existing building ( J Public or comme►dal describe derived daily flow To& 9Pd Recommended design loading rate - ~ bed, gpdAl2 .8 trench, gpd/ft2 Absorption area required ?S8 bed, g2 trench, fl2 Maximum design loading rate • 7 bed, gpd/ft2~ trench, gp"2 Recommended infiltration surface elevation(s).SEj }1q . 3 11 (as referred to site plan benchmark) Additional design / site cons rations Parent material $CS 11 c) R 1- 1, y oT ? Pllfv yRood plain elevation, ti applicable R UMP S = Suitable lor System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL. HMDING TANK U- Unsuitable for stem L IS L1 U ❑ S IOU O S 11 U O S 13 U E JS O U ❑ S ❑ U SOIL DESCRIPTION REPORT N/2 = N~ iPE~oHCf`r,vfJLeD Boring # Horizon Depth Dominant Color Mottles Structure GPD/It In. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh.iste ROOD 'ed-ff ~oF'2 31d- 5. / ~s s f _ 8 Y- . 7 8 Ground fie) / 0 y2 elev. - iDO, 0Co it. Depth to limiting factor Remarks: Boring # o-f ,oy,e 3/~ ~S ms`s s Z..... Z /C~ /ore 314{ Cs f , S 16- Ground S Q 7 •8 elev. j o l -20 ft. Depth to limiting factor fo Remarks: T Name:-Please Print R n 8 t R r V L Q R 1'C T Phone: 71a , 3Ut~ _ S5 Address: Signature: Ulbric ~ _ f (o CST 1 ~~P~t Private Seweas Consultants Date: CST Number: PROPERTY OWNER Rr?44)eP 540 0 T z 1 3 301E DESCRIPTION REPORT Page _ot PARCEL I.D.I 1-o T 3 R/f1Er- BG.V,D Boring II Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounmy Roots GPD/ft In. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. 13W Mench 3: o io 0 3/ s s w z . 7. Z /o /o k S 41, ~S S of , Ground 3 -9 /D Poc S ©S' elev. I aY, 3o it. Depth to tlmitlng factor Remarks: Boring ~ o_/o ioy,P 313 G S 4 S' zf , 7 o - /o lle 3/ S /4m :es cs l . Ground' x9 le elev. on, (gyp It. Depth to ImiNng factor Remarks: Boring # 0-9 10YA %3 Lf -3 ~11 Ground i °G . S Lieu t 19 it Depth to limiting factor Remarks: Boring If Ground elev. It. i Depth to lmiting factor R LA La Ica p O 4 ~ o 0 Ih m ~ Z. Z. N w w rn z °V c3 • In r c ti o 'CIO ~ w w rn ~ ~ o ~o 07~ A . 1• +a...c a 1 - 1 ' 16 LOT 36 . , ' 9,5 . 1113. A50. FT. m LOT 31 , 0114 N ~ 1.73 AC. ~ I 75.367 50. FT. ~ M Q. o n 1 N , 589'5J'06"E 346.56' \ N- \ I ~ Ds SI I _ NNq'43'44"E 333.06' CO 245.06' LOT J 9U. S I 71 N a LOT 35 N 3 - z F i . AC. LOT , 83,046 50. FT. N 1 T 32,,- 10. 6 6 1 Qns 2.04 AC. C.l 569'56'04"E 351.59' 99, 727 SO. FT- AC. lull LOT 34 50. FT. u 1- it 1 2.27 AC. ZI 1 ,1 98,972 Sy. FT. - L07 % rv to 2q6 40 - g0 ~ - rzzpO '?6'S ~W LOT LOT 8 3a _ 'i~ _t7T 14 VF A H File. pIjclp a►SflNBlTS _ to pole or buried cables are to be placed met that the installation vonld disturb any survey state, or obstruct vision along saseuacs as ar~rre any lot line or street line. The disturbance of a surrey state by anyone is a violation of Section i of sisright a Stato serve Ot the are area. herein set forth are for the use of public bodies and private public utilities s having the rig SHEET I 'f i S T C - 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. _______T_____________ Owner of property Location of propert _1/4 1/4, Section T i N-R_LJ_W g ailing address ~tA"-nom mailing Township it Address of site ` Lot no. Subdivision name Other homes on property? Yes_ No Previous owner of property Total size of property 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 :!2;' No Volume and Page Number zn~- 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 of the best of my (our) knowledge that I (we) am (are) the owner(s) o property described in this information form, by virtue of a warranty deed recorded in the office o the that County Register presently Deeds as Document No. and own the proposed site for the sewage disposal system or for(th) obtained an easement, to run the above described property, construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Si nature, f pplicant Co-Applicant 4- r C` r. 4 r r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER , MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1 _S / PROPERTY LOCATION --L 1/4, 1/4, Section. , T~N-R-W TOWN OF e-le-114 .C ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER 3y 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. t ~ SIGNED: DATE: St. Croix County Zoning Office Govemment Center 1101 Carmichael Road Hudson, WI 54016 11/93 s VVAFlHANV( Dr_ i out ` RaaCROIX CC `d ter 1taoeW pya y,-t .'7.'a fa SEP 17 1997 1 00 - , 1 : Srrfb3G RV vt~r of Nods ~:c)cLtI - - - 4 r' ~ - Plat of Apple River Bead First Tyl --.an of Star Prairiei St.. Ii f * Ci~,x. ~ 1~~•~, b. Fl~nrr7=1 i w Wicavor) Numbe iN+r ) i ;I i i! - v tit Iii 'x. or,hp' + 3rC3Ci[i!3' easements, rest, i4 1'~I1S L ' atud I~ !n s day of W4 jtTPiTl i t - - - i9 i - i f. E AL) ! ' AUTHENTICATION AVKNOWLEDGMENT n ii tature(s STATE OF Wi&CGN3iN 0 t- - l r l 5 Y