HomeMy WebLinkAbout018-1057-80-000
STC - 104
AS BUILT SANITARY SYSTEM REPORTS
OWNER
1y~~''`krjlsr r t
~2 :2
ADDRESS
SUBDIVISION / CSM# LOT
SECTION LC T N-R / I W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic t.-Ink nuinttole cover.
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T,to9tf? frC§a6P:artfii~ntlSrfcfilda3trYa 5.29.1 7W =PFOVATV'SEVM(3gWS4EM J County:
Labor and Human Relations INSPECTION REPORT
Safety rid Buildings Division
(ATTACH TO PERMIT) Sanitar rrnit
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
X
"pL tR7 pki ammond
9cri Parcel Tax No.:
13?AMMWMX,: f-14 _j _ETIAT X AM AW X Vf
TANK INFORMATION ELEVATION DATA A9400120
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Airinta to ke ROAD Dt Inlet
Ar I
Septic NA Dt Bottom
Dosing NA Header/ Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction S stem TDH Ft
Loss Head
Forcemain Length Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _ Dia Length Dia. Spacing
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 ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Hammond.,25,29.17W, SW, SW, County Road ,7
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. Li I IT I Ll
SBD-6710 (R 05/91) Date Inspector's Signature Cert No
®ILHR SANITARY PERMIT APPLICATION .
In accord with ILHR 83.05, Wis. Adm. Code cou
.
` STATE _2ERMIT #
-Attach complete plans (tot 9:111 ocopy onl ) for the sy em, on paper not~ess than p/~~,O RY
8'/i x 11 inches in size. ) t, d P, - FQ rA , , Q ! "I ❑ Check if revision to previous application
-See reverse side for instructions for completirib this application~"`^'~ STATE PLAN I.D.~NUMBER
Sq ~t 0 a0 13
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. t
PMzz_~_ PROPERTY LOCATION
Z :1-1~ / //f '7 Zl <,~4d '/4,j4CY4, S~ T~ , N, R a~'(o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
Z 23-5- ® re e A d
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
CITY NEAREST ROAD
13
II. TYPE OF BUILDING: (Check one
State
Owned 4OWN VILLAGE : C T/'S`~
N Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms _ PAR ELTAX NUMBER( )
III. BUILDING USE: (If building type is public, check all that apply) ,.+o -/C) ~r- p
1 El Apt/Condo ~ C.~
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/C r Wash,
5 ❑ Hotel/Motel 90 Office/Factory 13 Other: Specify R~Ch~1`e O C.
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E1 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. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
/ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
1 r c~ ar 3, 3 Feet ;7.:5--Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank A~ /W j'
Lift Pump Tank/Si hon Chamber
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) MP/MPRSW No.: Business Phone Number:
umber's Address (Street, City, State, -Zip Code
IX. COUNTY/DEPARTMENT USE ONLY
F-1 Disapproved S$j~itary 4~0 rmit Fee (Includes Groundwater Date Issue Issuing Agent Si =at ps)
~Lf/,
charge Fee)
pproved El Owner Given initial Sur
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
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
fi F b3 RECE31 f:-n
AT'R
" T CROiX
is ^T'~F .1 TT Tr,_;7 T'~;, ~ i;0UNT`! O,
pC :l 61 Z'C7NIPIGQFFij
1?TVFR FALT:S WT 5402`? 8 f, ,
on, nn
b11I,LS, DAVID
DALDWIN SPORT PARt
SW,SW,25,29,17W
TOWN OF HAMMOND
'V'ON-PRESSIJRIZED IN-GROUND SYSTEM
111r f)f'; ti.rtment. has reviewed the above- serf-t-6tlicPd -1uo1i; I.'.:1'
if0ii! tional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
c1n chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
"p,is plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
iiitial sanitary permit expires. The licensed plumber responsible for this
i-,.z;tallation shall keep one set of plans with the Department's stamp of
proval at the construction site. The installer shall notify the appropriate
rispector when inspections can be made.
Ail permits required by the city, village, township or county shall be
c,ltained prior to installation.
`iiquiries should be directed
the plan number shown abo'
i
'sincerely,
~ I
r,C Swim
Plan Reviewer
-(-tion of Private Sewage
R) 785-9348
-9
S H U-0423 (R. 01/91)
S9
t CONVENTIONAL SCIL ABSORPTION SYSTEM
FOR
Page 1 of
at~~~wt1v S p~ZT P~2H c~wr~ Cl.l.,~, 11vc.
LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION S T Z9 N, R V7 W,
TOWN OF 1A Nv~m OKiO ST. C1?a lX COUNTY, WISCONSIN.
INDEX
PAGE 1 OF 4 TITLE SHEET
PAGE 2 OF 4 PROJECT DATA
PAGE 3 OF 4 PLOT PLAN
PAGE 4 OF 4 PLAN VIEW-CROSS SECTION
PREPARED FOR
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PREPARED BY 4
10
WEGEE;t E[=Z SO I l_ TEST S NG 0#0841621
AND
DES = Gtv s1=FZV I CE 3`1 y-~y
P.O. BOX 74 421 K. KAIK ST.
RIVfE FALLS. YI 54022
715-425-0155 tl ti ~a
~Se
i Y
c l oos. Di 4l JOB NO-
qy
- Oy
PROJECT DATA Page Z of
The owners of this Sport Parachute Club wish to install urinals,
toilets and coin operated showers at this facility. It is now
served by a vault privy which will be abandoned as per code.
The site also contains 17 campers which are used by some of the
members for weekend stays. These members are included in the 100
people anticipated and will also use the proposed facilities.
ANTICIPATED WASTEWATER
Showers - 15 gal X 25 375 GPD
Employees - 20 gal X 2 = 40 GPD
Floor drains - 50 gal X 1 = 50 GPD
People (Outdoor Sports Facility)- 5 gal X 100=- 500 GPD
TOTAL 965 GPD
SEPTIC TANK
965 + 750 = 1715 gal minimum capacity required.
A 2000 gallon precast concrete tank by Midwestern Precast,Inc.
will be installed.
ABSORPTION FIELD
965 GPD - 0.7 ( loading rate ) = 1379 SO FT minimum required.
The proposed 2000 gallon septic tank will allow for up to 1250
GPD of effluent. 1250 0.7 = 1786 SO FT of absorption area
required.
A 24' X 75' conventional bed will be installed to provide
1800 SQ FT of absorption area.
')CIA /1000r~
PLOT PLAN Page 3 of
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
!N;2ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
s~-. G Z~ t x
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. O I B - 1 V_') S 7 - ~O
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: G/o RUi D m l L_Us PROPERTY LOCATION
pi'ti~pW11J SF~tzI- 1~t>~ZZ ►~C~}t,y~ L C._u ~ t~ C GOVT. LOT yvJ 1/4 SW 1/4,SZS T Z9 N,R I7 E(or)o
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
7.3 S O A tt6~~L~~1.~ Fv jk , hV URt-n-4
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE DOWN NEAREST ROAD<
S- t- SSoBZ (61 Z) k/36- S Z Z S l4N !~"1C~iJD 0_-,T• S
New Construction Use [ ] Residential / Number of bedrooms ( ] AdditiQn to existing building
Replacement [)(J Public or commercial describe SPORT ~?4c1~ A HST C ~.u~3
t Srruv ~~ztuY
Code derived daily flow 96S gpd Recommended design loading rate bed, gpd/ft2 o• B trench, gpd/ft2
Absorption area required X31 bed, ft2 1113-7 trench, ft2 Maximum design loading rate bed, gpd/ft2 o g trench, gpd/ft2
Recommended infiltration surface elevation(s) q 3.3 ft (as referred to site plan benchmark)
Additional design / site considerations vn L . 1ti1~ x 100 C-OXJy LJTy~~ f:~ ii\~ -
Parent material s f < o u t_'~ S NQ. b d ~c~ hv~t Flood plain elevation, if applicable N ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S El U ® S El U ® S El U ®S ❑ U IBS 11 U ❑ S 0 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boaxx* Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
r_:-<. o \Z ~oLAz Z1 L ~ 5 ~ 1 Z m S ~k M ti- Cw 2 ~ ¢ o, S u.
:`4}~'= Z 12-Z[ ~OLi[z 4/C - Sh Z ~S~h ~t~ r,~~v 1vf u S u,b
Ground 3 2) - 30 -)-s LIP- W/ - U>.- S U o - . S o. ~
l Zcsbk m r e.S
elev.
Ct 3D_96 /o 'BIZ y/( - S tf 6I o s5 ~ - 0.1 o.a
Depth to
limiting
factor
Remarks:
Boring #
~oLl~ z/Z s~\ Zvnstih ew z~~ u.5 u.b
Z ` Z. 11-1-1 1l~ `7tz L/A. Sbk w, f ~w 1 v u.5 o.
-).S yQ YX Ghs Z e sbn wtv cs _ 0.5 o,
Ground
elev. y 3$-q y 1 Lr R 4 /6 - S 4 Gv s g r~ ( - 0,5
CC). 3 ft.
Depth to
limiting
factor
> qy`'
Remarks:
CST Name: Please Print Arthur L. We erer Phone: 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fal1s,WI 54022
Signature: ' Date: CST Number:
a~'c~.~r~,vc lv<<.z 14- Dill M00576
PROPERTY OWNER ~fiJ v~~ L S SOIL DESCRIPTION REPORT Page L of 3
PARCEL I.D.# S-)- Cdr
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
o-Y3. tio~~~ z lZ - Si 1 Z rn Sb~ Gw z~~ u.S v.
Sal Z~sbk m~~ r2w ,.s 6-h
Ground X0.40 S `JR S~/6 - 6 S Z G S'b k v f4 0-5 v• 5 u
elev.
-A711o ft. 14D-88 Io `BIZ y/6 - s ~Gt- o s~ w, 1 - o, o E~
Depth to
limiting
factor
Remarks: _
Boring #
l o-~z to~tt~ z/z s; Z sbk mF~ cw zu~ 0.5 o. b
y.:.. Z ti-31 to e y !6 - si , sbk % Aw 1 k
3 3t-vto S LIli V/b - G~ s 1 Z ~s bk h) v 0-S
F~ S
Ground
elev. Lj E3 S 1 o L' g C►- O S 5 w, J - o u, ~3
a~ Z ft.
Depth to
limiting
factor v
?
Remarks:
Boring #
2,
S l` Z S 1~k { r~1 v ) u u, 5 u, b
XX. 5... > Z 1 •_Z. - 3 1 '~l Y y VA
Ground
elev. 38-5 9 t y v V16 - S G p S, - o • 6
q~-3 ft.
Depth to
limiting
factor
> 89"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
i
Remarks:
SBD-8330(R.05/92)
i
PLOT PLAN Page _ of _
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CST Signature Date Signed P
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix Country
-c a_jz, o RAT
OWNER/BUYER /l4c~c~ w v► ~ -4 'L
r 517-tnl~4'1., h~1M j SOS Z--
MAILING ADDRESS 24/
X
PROPERTY ADDRESS :Y-
(locati n of septic system) Please obtain from the Planning Dept.
CITY/STATE /
PROPERTY LOCATION SW 1/4, SL✓ 1/4, Section s T~N-R (7 W
TOWN OF wt 0!!D ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUMF~-O PAGE „5 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, set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be com et d returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration t
SIGNED.-
DA'T'E:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
lludson, WI 54016 11/93
S T C - moo
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 Gy
Location of propertyS Lc/ 1/4S'L1/ 1/4, Section S- ,T~N
Township m Octii~ Mailing address 22-- ` dfjc-s,azo
Address of site,,
Subdivision name Lot no.
Other homes on property? _Yes No
Previous owner of property cj
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 30/ 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 the office of the County Register of
Deeds as Document No. L1 ?s c (c~ and that I (we) presently
own the proposed site for he 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.
c'
7L M-
Signature of Applicant Co-Applicant
Date of Si nature Date! of Signature
DOCUMENT No STATE BAR OF WISCONSIN FORM 3--1982 THIS SPACE RESERYED FOR RECORDING DA-A
QUIT CLAIM DEED F(EG,SYERS OMCE
P GK 8 n' ST. CROIX CO., W1
a3 Recd for Record
January 26. 1988
--David Ellsw,rth Mills and Michael Franklin
HaYden, as joint tenants at 8:30 A M
.
-------------R
Baldwin International Airport, Inc.,
a Wisconsin corporation _gista: of Deeds
,
-
County, -
St....Croix
. .
the following described real estate in . . .
RETURN TO
State of Wisconsin:
Tax Parcel No-
The West One-Half (WZ) of the Southwest Quarter (SW4) of Section Twenty-five (25),
Township Twenty-nine (29) North, Range Seventeen (17) West, EXCEPT the West EXCEPT One-Half
(W12) of the Northwest Quarter (NW4) of the Southwest Quarter (SW4 and ) of the
Commencing 432 feet North of the Southwest: Corner of tt)e o We s t One-Half (Twenty five
Southwest Quarter of the Southwest Quarter (SW-4 of SW4 1 Section
the Southwest
(25), thence North to Northwest corner of said West One-Half (Wz)
Quarter of the Southwest Quarter (SW'-4 of 13WO ; thence 'East to Northeast corner of/said
West One-Half (W-,) of the Southwest Quarter of the Southwest Quarter (SW4 SW the
thence Southwesterly to place of beginning and EXCEPT all lands being a part
Chicago and Northwestern right-of-way, containing 51.207 acres, being subject to
easement over Westerly and Southerly portions of said parcel for Town Road anIf C.T.H.
"J" right- of-way.
Subject to mortgages to the First National Bank of Baldwin, Wisconsin, dated March 15,
Page 69, as Document No.
1985, and recorded March 21, 1985 in Volume 708 of Records,
400523, and to Everett C. Iverson dated March 15, 1985, and recorded March 21, 1985,
in Volume 708 of Records, at Page 71, as Document No. 400524, which Grantee assumes
and agrees to pay.
EXE
WT
This iS not homestead property.
(is not)
day of May. - 19-.87
Dated this
(SEAL)
- - (SEAL)
David Ellsworth Mills _ -
.
G L~:~ t/'(SEAL)
(SEAL)
l
Michael Franklln Hayden
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) _of- David--Ellsworth.Mills and STATE OF WISCONSIN
ss.
Michael Franklin Hayden St. Croix
.-------I--------------- County.
°
•
authenticated this ..:.....day of _ y----------. 19-87- Personally came before me this day of
19-------- the above named
Thomas A. McCormack -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, .
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS GRAFTED BY
Thomas A. McCormack
.Wis.
Baldwin, WI 54002 _ Notary Public . County,
- ermanent.lIf not, state expiration
Commission is p
(Signatures may be authenticated or acknowledged. Both My Comm 19--
are not necessary.) date: _
•N6unea of persons Signing in any capacity should be typed or printed bet, w their sift-I-es.
i STATF. DAR OF WISCOti61ti Stock No. 13003
I NCW i'r1 FORM No. 1 1982
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