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HomeMy WebLinkAbout008-2000-90-055 (3) ST. CROIX COUNTY y WISCONSIN ZONING OFFICE h Y .a ST. CROIX COUNTY COURTHOUSE a4 19, F1, P9, 1-1 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Sept. 11, 1990 Jeffrey Murray 2626 Boston Rd. Woodville, WI 54028 Dear Mr. Murray: This is to inform you your case will be brought up under old Business at the Board of Adjustment hearing on Sept. 27, 1990, at 8:00 A.M. in the County Board Room, Courthouse, Hudson, WI. Either YOU or YOUR representative must attend the hearing to present your case. Should you have any questions, please contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj Attachment 0 D o (1) ° 0 ti O o a O N m c 'E e ° T v CL I I T C I' O v p ° p C z C U- c E ~ O ' O Q O M 00 d D e) Z o z v v q d z a ° co H ° m E c E m N - I o w E N O L N C O a 0 0 Q Q ~ z z I N M _ I E C v ' a a) I r w m N 00 a c O0 N o N O o> o a LO E Z N > a z ~w 333 ai O O O CL CL CL 4 0 o o ~ ° U C) c, cn _rn _rn LO co z° ~ o 0 I~ n C N ON O O O 7 ° 0 O C N Q CL O m Y M O m Q m ~i co d w O IA N O N L° (O 04 a _ p 3 T C C C E ,O 00 rn ~ tr: a a d 0 C> O (r N C O O N N e L Li N 00 U T O VJ L L CU ~O M N n O H W F O n CO i H N m O to E E v z In =3 =5 L: d w • CL N w C E i C C O `~1 A U a 2 0 N 00 "t or DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION State Plan I.D. Number: IS I I g717 1T"~,S~ec.36,T28-R16 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Eau Ga1le El Coulee Rd. Holding Tank ❑ In-Ground Pressure 0 Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jeff Murray 11037 Hwy-35, Hudson WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM LAN: REF. PT. ELEV.: CST P 1. ELE l G.r Name of Plumber. MP/MPRSW No.: County: Sanitary Permit Number: Bennie Hel eson 3215 St. Croix 128704 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE' AIR INLET ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ► DOSING CHAMBER: ' 1 LABEL LOCKING COVER MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING PROVIDED: PROVIDED: ❑ YES NO I . ? YES ❑ NO YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE' AIR INLET: PUMP ON AND OFF) 1 ❑ YES ❑ NO NEAREST --I► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHESNO.OF DISTR. PIPE SPACING: MCOVER ATERIAL PIT INSIDE DIA.: # PITS: DEPTID DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: a Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: moundsystems-to make certain that it ON REVERSE SIDE. SHOW i YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. 1 56 PERMANENT MARKERS: OBSERVATION WELLS: SOIL COVER TEXTURE: YES ❑ NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEMi t , i. BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &,.MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: 5 r i DISTRIBUTION VERTICAL LIFT CORRESPONDS TO HOLE SIZE: HOLE SPACING DRILLED CORRECTLY: COVER MATERIAL: INFORMATION APPROVED PLANS YES ❑ NO ❑ YES [__1 NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: YES E] NO IM YE ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) EI SANITARY PERMIT APPLICATION COUNTY ~HR In accord with ILHR 83.05, Wis. Adm. Code St. Croix STATE SANITARY PERMIT ~-Attach complete plans (to the county copy only) for the system, on paper not lees than ~ 7( 7 8% x 11 inches in size. ❑ Cheofc 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. S90-40301 PROPERTY OWNER PROPERTY LOCATION Jeff Murray NW '/4 NW Y4, S 36 T 28, N, R 16 P(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1037 Highway 35 N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISIONNAAME OR CSM NUMBER Hudson, WI 54016 1(715 386-6292 CITY NEAREST ROAD 1-1 II. TYPE OF BUILDING: (Check one ) ❑ State Owned 171 VILLAGE : • EA Gall Coulee Road ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 5 PARCEL X NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 36-28-16-541A & 36-28-16-542A 1 ❑ Apt/Condo 20 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 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. © New 2. ❑ Replacement 3.E1 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. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 750 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 625 625.6 1.2 34 99.10 Feet 101.40 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 1 Lift Pum Tank/Si hon Chamber Vill. 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) rP/MPRSWNo.: Business Phone Number: Bennie Helgeson 3215 715 778-4425 Plumber's Address (Street, City, State, Zip Code): Rt. 2, Spring Valley, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing gent Signature (No Stamps) f Surcharge Fee) Approved ❑ Owner Given initial Z C5_ Adverse Det rmination ` ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber M I M ; i i i 61 Ir a r I 4, I 1 a i fl i 0 1 co a I I 1 ~ I i i i r"Sk I I ~ I I I