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HomeMy WebLinkAbout020-1315-30-000 a o ~ ° M O oo N ~ a~ I c p O N N .O N c io o ° J c O ~ O O X a0 O N V N 0 CL C Z N 7 ~p LL C m q O °O d N Z w O Z « O d Q z a m co N rn N H !n G O j C C7 O Z a (D Z C E '2 _0 h y _ O N O) N O Vl 1 O ~ o Q) z m z N z a E E N N w m 25 CL M r_ (D (0 U G C a 0 m N N H F- F- U w N N U) •~V 'n O O O Z o 0 CL a a a 7 O W O 0) 00) w U) J C.) n D) O) O 7 } N co D N Op O p p 1 N N 0 0 E N 0) m d d ao w o d is d ~j o ~ y c Al w o CQ C? ° C r~,o N N LO rn °M LO p N C N Q- =000 E C~ 12 O N N N p n m~ H 0 c E ? v N rn -0 I O W 0 N 5~'3 O N O ~ _ O • N o0 7 O O C2 [p m E U Y O N m U) N O iA CC V ~ w E v~ d £ a a L • cl CL m 'u d E L U a 0 c nu STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS o, SUBDIVISION / CSM'c C LOT # SECTION_c22_T_,,Q? N-R~e?W, Town of ~m o ST. CROIX COUNTY, WISCONSIN L / PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM >8/~/~ use 19A, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 'y~ ALTERNATE BM: 6 ~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 4, 'Cl S Liquid Capacity: Setback from: Well /p00' r House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: r Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold--- Bottom of system l.S Existing Grade Final grade DATE OF INSTALLATION: - PLUMBER ON JOB: LICENSE NUMBER: _S__9 INSPECTOR: 3 / 9 3 : j t Wivcpnsin De~partmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST' CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Peflwo~~e: ❑ City ❑ Village © Town of: State Plan No.: CST BM Elev.: Insp. BM Elev.: BM Description: 1~ Parcel Tax No.: TANK INFORMATION ELEVATION DATA 09~(, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi d /0,k c~• n2 Aeration Bldg. Sewer a 73 Holdin St/ J K Inlet _a/ TANK SETBACK INFORMATION St /X Outlet 53~ Q/.S~ t TANKTO P/L WELL tLD Ventto ROAD Dt Inlet Air Intake Septic gyp' .St NA Dt Bottom Dosing NA Header s _ 7/~V/ Aeration A Dist. Pipe Holding Bot. System i 8.9s s, 3 PUMP/ SIPHON INFORMATION Final Grade M facturer Demand S~~.? Model Number GPM TDH Lift L Iction e em TDH Ft oss Force In Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length , No. Of Tyenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 / DIME LEACHING >aiiufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O n QV1.A- CHAM deINumber: System: qUKQ, la) >50 OR,U-NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) r x H Size x Hole > T~irlntake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or rade System 1 Depth Over Depth Over xx Depth xx Seeded/ Sodded xx Bed /Trench Center Bed /Trench Edges " Topsoil El Yes El No ❑ [Y,,[_] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.28.29.19W, SW, NW, CROSBY D8I Plan revision required? ❑ Yes a<0 ~Al Use other side for additional information. 7 SBD-6710 (R 05/91) Date Inspector's Signature Cert No. Safety and Buildings Division ~~■~r■r. SANITARY PERMIT APPLICATION Bureau of Building water system: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar PPeer~mit N mbee The information you provide may be used by other government agency programs E] Chec if r is to Y-P. tion [Privacy Law, s. 15.04 (1) (m)], State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert wnerName Property Location 12/4 ! v4, S T , N, R Oor& Property Owner's ailing Address Lot Number Block Number , r ne Number Subdivisio N e or CSM Numb City, ate Zip Code T(P o ) Z ) 6.I`TYPE F BUILDING: (check one) ❑ State Owned E] City Neare t Road Public 1 or 2 Family Dwelling - No. of bedrooms Towan of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo / " ` v /3~ ✓ v 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. 2 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 Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 O-Seepage Bed 21 0 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.7/ich) Elevation Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of manufacturer's Name Prefab. Site Fiber- Ex er_ New Exist- Gallons Tanks Concrete ~O"- steel glass Plastic App strutted Tanks Tanks 1:1 El Septic Tank or Holding Tank - El Lift Pump Tank /Siphon Chamber ❑ . Z2222.1 1:1 1 E ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in IIat/oil of a nsite sewage system shown on the attached plans. Plum e ' Name: ri Plumb r' natur n(mps) MP/MPRSW No.: Business Phone Number: Plumber's A ress (Stpet, Cit ,State, Zip C e): K I~r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nary Permit Fee (includes Groundwater Date Issue Iss ing Agent Si ture (No Stdomps) X A roved ¢ Surcharge Fee) pp ❑ Owner Given Initial /J or / Adverse Determination C1 (i J1 I ~U~ X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD-6396 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Div, ion, Owner, Plumber } INSTRUCTIONS z 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, 608-266-3815. 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. 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. zo/ 14SiU~ //L) t9 'g 1 C q e~ 1 S X T~'Lr~ l✓ A~X- rr~ 5Q r Ld /3 ST. GaiX S''T~ G~a~c.Y vJ v ~ ~ W 6OA.S t FAT ,4 Tc~ i 4~0 30 ~ °4T C1 < ,E 7% S Lp NO ll O ~ Fv..l7nr 0(&-rgu,i~~~ wiser,-gsin r)epartment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 wi Labor and rluman Relations I On. r Cnvision of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COU ~.l Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but t& Croi I.D. ~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P # ~ 'VED dimensioned, north arrow, and location and distance to nearest road. ?t . endin I WED v 199rPAT APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION K "wTy PROPERTY OWNER: PROPERTY LOCATION (A John Rauchnot GOVT. LOT SW 1/ate T ' %.&-1 PROPERTY OWNERS MA!I.ING ADDRESS ;13 # BLOCK# SUB D. NAME 527 Co. Rd. #W na St. Crix~Estates CIH dsAon, WI. 54016 ZIP CODE l~i?~E NtI~1052 HusonGE prOWN N CtAREST ROAD rosby Dr. [x] New Construction Use [x ] Residential /Number of bedrooms 4 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _-5 bed, gpdM2 -6 trench, gpdtft2 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.15 ft (as referred to site plan benchmark) Additional design / site considerations alt. site =94.4' system el. Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ®S ❑ U CBS ❑ U [3:S ❑ u ❑ S ®U ❑ S (RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botndary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed Trerlcft r1 1 0-10 10 r3 3 none 1 2msbk mfr aw 2f .5 •6 R~~ 2 10-31 10yr4/4 none sicl lfsbk mfr 9w if .2 .3 Ground 3 31-84 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 elev. 98.75 ft. Depth to limiting factor +84" Remarks: Boring # 2f .5 .6 1 0-12 10yr3/3 none 1 2msbbk mfr gw 9 2 Y 2 12-22 10yr4/4 none sicl lfsbk mfr 9w if .2 .3 >.K BA 3 122-32 7.5yr4/4 none is Osg mvfr gw na .7 ;.8 Ground elev. 4 32-84 7.5yr4/6 none co s Osg ml na na .7 .8 98.75 ft. Depth to limiting factor +84" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 00th. Ave., New Richmond, WI. 540 17 Date: CST Number: Sgnature: 11-4-95 cstm 02298 PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 0i-3 PARCEL I.D. u pending Depth Dominant Color Mottles I Structure I GPD/ft Boring # Horizon in Texture Gr. Sz. Sh. Consistence IBouncl ry I Roots Bed iTrer in. Munsell Ou. Sz. Cont Color 3 1 -10 10 r3 3 none 1 2msbk mfr 2f .5 2 0-31 10yr4/4 none sicl lfsbk mfr gw if .2 .3 Ground 3 1-84 7.5yr4/6 none S Osg mvfr na na .7 .8 elev. 98.4 ft. Depth to limiting factor +84" Remarks: Boring # 1 -10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 4 2 0-31 10yr4/4 none scil lfsbk mfr gw if .2 .3 3 1-80 7.5yr4/6 none is Osg mvfr na na .7 .8 Ground elev. 97.35 ft. Depth to limiting factor +80" Remarks: Boring # -8 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 5 2 -25 10yr4/4 none sicl lfsbk mfr gw If .2 .3 3 5-80 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 Ground elev. 96.9 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor F-11 -1 Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot 1554 200th Ave. CSTM2298 SW4NW4 S28-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #13-St. Croix Estates t N 1"=40' BM.= top of P Steel pipe C el. 100, Alt. BM.=nail in tree C el. 103.6' Qr A 0 ti Nt ~w 47 Gary L. Steel 11-4-95 . r LOT SETBACK ST. CROIX ESTATES FROM THE FRONT: 50' FROM PROPERTY LINE 83'1 ROM CENTER /ROAD FROM THE BACK: 25' FROM BACK LINE FROM THE SIDES: 25' FROM SIDE -10' IF THERE'S 25' BETWEEN BUILDINGS. HOWEVER, ONLY ONE DRIVEWAY OFF THE ROAD. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYERi S' STEP MAIIING ADDRESS /Sl /y • /~i,~'150~ S S ~Sly l PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. C -1 a CITY/STATE PROPERTY LOCATION 1/4, N 1/4, Section oZ TN-R~W TOWN OF bf LL090A) ST. CROIX COUNTY, WI SUBDIVISION A CULL E-S'77~1"E~ LOT NUMBER A CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER S' 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: 1,44 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • S T C _ 100 This application form is to be completed in,'full'and signed by the f 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 -1 I 01 Location of property ;Std) 1/4 1/4, Section ,To;?q N-R jq W Township A DSOM Mailing address I S P~ P A ~c-~.~~ S 1~ • 7 1 Address of site 74~ q C-05 b V be Subdivision name Lot no. Other hgmes on property? Yes yC 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 No Volume..J/~,~ and Page Number L as recorded with the Register of Deeds. 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.-C~Tand 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. nature of A plicant Co-Applicant i Date of Signature Date of Signature 2 2 REMA;%; TEAM 1 REALTY PAGE 01 ',~;ULEY PESTF =T T)"A wN r NO STATI E BAlk 4F WlSCONBIN FORM 2-1992 THIS SPACE RESERVED FOR RECURDlNG DATA ' WAKRAt* Y t' c A TMQF G11 mood fu Ftemd APR 25 1996 ~t~tvcyd Qli`u~ water $ - t RFTTJRti TQ Ong cnW real estate in St, C'Yrsix Lpunly,tatc of WiSCOtwin ~14 P 1RACEL NO I lot St Croix Estates in the Towr: of Hudson, St. Croix County, Wisonsin. ,9 T k Awl _r - homestead property j, t h- _t. fl~J ffr'~ - : A SEAL,) . .emu . (SP.AL - .~tt'~'H~'V'T!C'A'T'FO?~ ACKNOW:I.EI~;NIth Si at4tes a t hay neved this day of SPATE (7t= NUNNESUrA PeteoAAliy came !)dots $pt7l ~'~t.~ the aiwye ' T.U MFnkBE?L S T A'-t'E BAR OF WISCONSIN ff n' to minent wjU draw ri5 [c me known to be the vemn who cx*x-"W - foregoing insuumm and ackmwi the w (Sipan= rrA be anthemkated or acknow!edged, Bub a re nut ueeaasrr< ) ,.ime.rt. 6iii.?ice i1AYfJY~ `..+y tl+'Yt~', M.-• ST. CROIX COUNTY WISCONSIN """"i°`, _ ZONING OFFICE rrrri ST. CROIX COUNTY GOVERNMENT CENTER ~MM/IIpI1N■ L -hael Road `l~ c 54016-7710 16-4680 j) 96 eX- July 19, 1996 Hartman Homes P.O. Box 326 Somerset, WI 54025 Attn: Becky RE: SEPTIC INSPECTION FOR TIM STUMP ADDRESS: 796 CROSBY DRIVE, HUDSON, WISCONSIN Dear Becky: An inspection of the septic system serving the Tim Stump residence located at 796 Crosby Drive, Hudson, Wisconsin, was conducted on July 9, 1996. This property is located in the SW; of the NW; of Section 28, T29N-R19W, Lot 13, St. Croix Estates, Town of Hudson, 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 or if we can be of further assistance, please give our office a call. Sincerely, James K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin db