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HomeMy WebLinkAbout040-1191-40-000 C ~ o I Q i O I ~c be I c „n L c O V X y ~ TS N Y y C N U N 0 a) LL a LL C <D O O) 3 o a ° I I Z N O > ~ I N cn w o 0 z It d ~ w a m N f c U' O z zt c° U tY e O n N ~ N a ly N • ~ ~w_ 000 I MV U (0 N c O U O o F z O N Z Z o c d C'4 L; E N O N c6 > i Q i 0 x o o (L E (D ~J Fy- H H o *i U (i O O FL LL O •ti m > a a a !Vt a ~ I ~(~►i~ O O V' > N N O N J U 0 OOi 00i Wft%Q N N O T O c O O E ~ O LL V co 0 d Q c6 N d O 'O N H O (D M C r.+ E a c c E ,n r tQ LO 0 a) a QQ ~°OI L o 3 a E E y V _ ONO. F- " L L ti CO Co t' N i L N (ll H 4- N E E O U yr,~' O N F- Q ~1 r V CS n d a • a. d 'y a w E i c C .O. 3 ? w A U a O N U -AV t 00'0 00'0 00'0 WWI s9BJe43;uenbullaa seBJe40 leioedS s;uewssessd leioedS ;unowV tio6a;ea apoa leioedS Jas :sleioadS 9£1. V 433e8 :a;ea uOReDIIIIJ83 1, :;unoa wlel0 :4Ipaao AJa;;o'l 0 0 000'0 PuelpooM 000`Z9Z 000`966 000`99 009'1. f4jadad IeJauao :£ooZ Jol WWI 0 0 000'0 PUe1PooM 008`t,8Z OOZ`ZLZ 009`ZL 009'1. 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H31f 3Hn9v f N3MJ'8 f 4`dWHd Jaumo juennO :(s).ieumo :sseippv xej, 0 00 adA13!wJad #;Iwaad # uol;eallddd eaJV sales # deW a;ea IealJO;sIH a;ea uol;eaJa NISNOOSIM `,11Nnoo xioHo '1S X', ;uaJJna , OHi =10 NMOl - Ob0 058'0Z'8Z'bZ IeDJed 311 wd 90:90 90OZi90i170 000-0 - ~6 b V00 laDaed X"*" Y AW AS BUILT SANITARY SYSTEM REPORT OWNER 24~~ f "P/ rl k TOWNSHIP _ SECTION-2T/ T N-R -°O ADDRESS c ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT, _ LOT SIZE -Z C PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Bar 7~ S. T. IJP~a 89 9,_~ " i OKZ 3q 6 l re's ~ yr «f S9 INDICATE NORTH ARROW BENCHMARK:Elevation and description: / 1 ti Lte Da F Al" Alternate benchmark Pik L / 3 • s SEPTIC TANK: Manuf acturer : Liquid Cap. ~T4ne- Rings used:-~LManhole cover elev: ol. Final grade elev: Tank inlet elev.: '77-Y ' Tank outlet elev.: 97. No. of feet from nearest road:Front , Side , Rear ✓ Ft. >/,w From nearest prop. line:Front , Side Rear Ft. > S-o No. of feet from: Well -6/, eve", Building: 36 (Include this informationin the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: L Length f- _Number of Lines: Z Area Built /d/' rf'e I Exist. Grade Elev. ff.>r' Proposed Final Grade Elev. 97.5 Fill depth to top of pipe: No. feet from nearest prop. line:Front , Sider, Rear Ft. No. feet from well: wYNo. feet from building 7(I> W1 7e HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well , building , nearest road _ Alarm Manufacturer: INSPECTOR: DATE: Ap L PLUMBER ON JOB: LICENSE NUMBER: 3 ~g 6/90:cj LOCATION: TROY 24.28.20.850,SE,SW,24,PLAINVIEW DRIVE Aisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 1- or and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX r (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 149271 Permit Holder's Name: ❑ City ❑ Village )U Town of: State Plan ID No.: ABUHEJLEH, AHMAD J & GWEN J TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040119140000 TANK INFORMATION ELEVATION DATA A9200117 (-A/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic CJ~5 C, E d~~C7 7 Benchmark /CrSo 3~6 /l~l). Dosing Aeration Bldg. Sewer Holding St/ Inlet / ,2- / TANK SETBACK INFORMATION St/ Outlet 37 65 ' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ) 60 / NA Dt Bottom f 16 D NA Header / Man. Q Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufact Demand l`" . Z~ dam, 7~ Model Number GPM TDH Lift I Friction S m TDH Ft Forcemain Length Dia. Dist.To SOIL ABSORPTION SYSTEM BED/TRENCH Width / 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q1 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: G `ra0 n 114 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 ~:X - q n Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include cod Iscrepancies, persons present, etc.) 07 C c, Q 21 r 9,?S~ -,6716.2 Plan revision required? ❑ Yes P4T0_ Use other side for additional information. SBD-6710 (R 05/91) J1 412 Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w T I,LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~j . ~4~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑Q ~1 / 8% x 11 inches in size. if evislon to /previous application ec -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 1444,1XI011101 .4 r~ %4 Srti %4, S ~2 g/ T z , N, R W E (orJ10 PR PERTY OW R'S MAILING/A/DDR SS LOT # BLOCK # G GvOOGY 74N C - CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME CSM NUMBER w J-YO/P/ 6 III. TYPE OF BUILDING: (Check one) -1 State Owned ❑ VILLLLAGE ~ NEAREST ROAD ~rJ v ❑ Public [D 1 or 2 Fam. Dwelling- # of bedrooms L AX . UMBER()® ^ 111. BUILDING USE: (If building type is public, check all that apply) oYo- !l4/- Yo 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPPE/OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Lg New 2. El Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 430 Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: ,o-2- F7• sr 0' 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) !+E ( Ft:,& ' ELEVATION L/S-D P S 9 S^" 77 . ;Sr- 4t2- Qy. S^ Feet Feet VII. TANK CAPACITY Site in allons 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 Holdin Tank Lift Pump Tank/Si hon Chamber . RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Piu 's Signature: Sta ) MP0MPRSW No.: Business Phone Number: vfta,4 , o er f 3 2 P 7 s Plumber's Add ss (Stre , ity, Stat , Zip Code : c~ GtJ 6j ~L X. COON /D RTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uing Age !gnat f+fp[ ~kzharge Fee) Approved ❑ Owner Given Initial a etermination 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 INSTRUCTIONS w 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 owner-hip or plumber requires a Sanitary Permit `'ransfer/Renewal Form (SBO 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 years. 6. If you have questions ooncerningyour 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. 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 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, 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 81/2 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; watts inr,. ns/water service; streams and lakes; pump or siphon tanks; distribution boxes; scil 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 purnp manufacturer; D) cross sect; ;n of the scil absorption system if ,jaquired by the county; E) soit test data on a 115 form; and F) all sizing information. - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fo a riumi,,,r of regulated practices which can effect groundwater. The mote °s col':-cted through4hese suicharg(;s are ucf.-;rz f(yi rreF :Fit.:arinp tirct.iadwater, grv, water 'rontamination investigations and establishment of standardl:J. SBD-6398 (R.11/88) APPLICATION FOR SAIIITART PIRHIT g T C - 100 This application form Is to be conplntad In lull and signed by the ovntr(s) of the property being developed, Any Inadoquacles will only result in delays of tilt pit rrlt Issuance. - Should thin development be Intended for 'Shale by owner/contractot,(spoc houa%), then a second Iarm should be retained and c a x p I a t a d vhan the propatty is sold and submitted to this o f f I c a with the ■ppropriate deed rtcotdlnq. Ovn:t of ptopetty Le , Location a[ property 114 k3 1/4s Bactlon 11-R Township Hailing a d d r e s s_-_ll~ 2 a r. t9 O 1 >s moo=- ` ' L it ` - Address of site svbdivInlon nawe_ C~,en► 4 Al .;W, 11 Lot number PttvlauI ovner oI propatty Total mile of parcel Date parcel was created All all eotnors and lot lints Identifiable? ,_`Yes Ho Is this pro patty being developed for resale (spec house)?, yes ~C No Yolvr.r _and page (lumbar as racotded vlth the Reglrter of Deeds. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - w - w - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUD9 WITH THIS APPLICATION TIM FOLLOWING( A YAARXXTT D¢rD vhlch Includes a DocuHzNT NllHBQR, VOLLN2 AND PAOt lltl)IeIR, and tilt BIKL or Tlls RBOIBTHR OF DRRDB. In eddltlon, a eectl[led survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed dtsctlptlon teterencam to a Cettltled Survey Hap, the Cattifled Survey Hap shall also be required. PROPB RTY OVIIER CERTIFICATION : - - Ilve) certify that all statements on this [arm are true to the best of ■y (our) knovltdgcl that 1 (we) em (ate) the owner(s) of the property deacclbtd In this IntoematIon term, by virtue of a warranty deed recorded In the Office the County Rtglsttc at. Dees as Document 110. of Presently own the proposed mite for the sewage disposal ayatenl(ocdIt(ve)I have obtained an eeaement, to tun wlth the above daacelbad property, the at conottuctlom yon of raid nyrtem, for and the same has been duly recorded In the olllca o f the y Re l a t r f Deeds, as Document No. slgnatvice of owns 8lgn tuta of Co-ovner ( t J1pp llCA bIaI l 17~~~ . Date of elgnaluca Da to 8lgn4ture i d, r ~ r! .1 Cowl,"" LqjSGs2vTM rasa nseraum atsa ow "on" . the ~ aPPra~OCa bebati~t 4g is am 09, !rbaboe, of the sail pad of the !ka eitbat Is M° i sod tbek bee~iitaoeots and trt~P t#ilr 1 *r ieee p above dcuribed oi* ebt? i~etaditaaenp aad ! ► b" "d loaavM 4 ' i-Ton anc . Wo a:d •a« a aft wide `ttilN►a> . «cotMOrt, `aaq carepgR. ~ , , heirs, s- Oat Gt ow tim of the COMM4.esd P04 ,ate; Aohae 04 iada4aidMR at ia6pnNMt .440 - - - -r_.._.........___. _w._. - -=y---~- im dw"gniet and pennabk Posxaioo of the said Pat- - pet Dsrsaa larfaUr cMiaii4K "-bah ar my Pao thereof, it tom' 4" " at a Fi" mic lamas. Ina. ..a c ration, its *wpsreMF .}a ba DYM NIC W W1pID lK. , COUMAttil~a thwArd z H 9 ST C- 105 r - a - H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z OWNER/BUYER n ROUTE/BOX NUMBER J"34 Fire Number r e4 • d1Di( ZIP ~j Gf~G CITY/STATE PROPERTY LOCATION: 5 w Section, T <94~ N, R 00 W, Town of 1.V1 St. Croix County, Subdivision dMUO 1t 1LeA to Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- It ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Of is w't in 30 days of the three year expiration date. SIGNED DATE Z/h 1/9-21 St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. O 1 D y ~J C a N^ hd r o c A 7 r a W N - ° 4~N o ~o r~t a 0 e, 3 Z no Pit ' T hn A 1 D 7 n 0 Q7 61 OL v f a a s ~x m I' 00 (D N N lam A3 J p r t1i s q p O o~ (D ~ o G S~ L 0 C ~j rf N 5 W W m r. ti ^ O 1/J ~ ~ r X ' X L C1 C> - N s ~ to ~ ~ ~ to 01+ z e% C N On N L s1 Or 0 In % r~ C x 7] v m fD 0 c 00 O %A (D m c T -D . r+ 0 ID) LA s in 'a n N m ~ - c- l -a ~ o O 3 03 no &A 0 0) 4.A e p C ,b z (D 3 C: D to _0 O M LL u`'. 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CROIX COUNTY ZONING PAGE 2 06%01/9,2 10:09 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 1/92 AREA: JT "ActiVity: A9200117 6/ 1/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 24.28.20.850,SE,SW,24,PLAINVIEW DRIVE Parcel: 040-1191-40-000 Occ: Use: Description: 149271 Applicant: ABUHEJLEH, AHMAD J & GWEN J Phone: Owner: ABUHEJLEH, AHMAD J & GWEN J Phone: Contractor: FOGERTY, DAVID B. Phone: 749-3656 Inspection Request Information..... Requestor: DAVID FOGERTY Phone: Req Time: 15:06 Comments: Items requested to be Inspected... Action Comments Time, Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 06/Q1/9~ 10:09 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 1/92 AREA: JT SELECTION CRITERIA INSPECTION DATE - 6/ 1/92 INSPECTOR AREA - JT REQUESTS SELECTED - 2