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HomeMy WebLinkAbout020-1123-60-000 0. c a) o I o O kl, a ao a ev y ~i I `c 0 a I ti4 ~ I 0 ~ I m N ~ I o z a E LL CO = CD a E E Q (ao I 3 ~ I z U) rn ! w 0 z y y CD LU r IN- z d m o I c i~ m O z a c w = a - o o N H O O z c 'o -0 0) N CL 3 y N O N O •}V d L .C U Q N C U C N 4- Q O O Z h Z 0 N Z N N N 4) CD m y 0 0) .0 a O C co V O Q7 O H d L O G G IL N w m d LO F- F- 1- 7 E_ w N I W,,J W N 3 LL~ z p . a a a 0 N 7 O N 0 6~ O) to J V = W O) } O C 0 0 co M r J 00 C4 E O ml LL O 5 'O N N 4) .r A V! ce) U) U) C O O O C Z' p:a 0 0 0 'v o M 3 aUi c N Cf rn o l U? E a) w Z F O N O O N O N rti O N 7 rp U • y O O= (n to r w a at a_ I a w u a 2 0 to 0 A V o FORM - STC - x6 K AS BUILT SANITARY SYSTEM REPORT OWNER g j y SO it 11'-Ct kA TOWNSHIP SECTION T-2v' N-RW ~j ADDRESS ;~r6-44 )Py ~z-ro..j_ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ; LOTLOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /v 5M a, 4 F 25 INDICATE NORTH ARROW ti 11~i 416 BENC' K:Elevation and description: C CcS~,►~~r /e~-o Alternate benchmark SEPTIC TANK:Manufacturer: Nee~f Liquid Cap. ~,:'oc~ ~La rr cRings used:Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft.1,:;~V'` From nearest prop. line:Front , Side, Rear Ft.•-- No. of feet from: Well Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER i, 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:_ Length 2.-- Number of Lines:-_a Area Built 7J Exist. Grade Elev. p✓ Proposed Final Grade Elev. y>} Fill depth to top of pipe: No. feet from nearest prop. line:Front ?C , Side , Rear Ft. No. feet from well: _NO- feet from buildin .1 9-- HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation4of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well, building , nearest road Alarm Manufacturer: INSPECTOR: DATE. PLUMBER ON JOB LICENSE NUMBER: 6/90:cj A(q 100 County: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM • Labor and Human Relations ~Szrfetyand'BuildingsDivision INSPECTION REPORT Eagle Ride St. Croix (ATTACH TO PERMIT) Lot 24 Sanitary Permit No-: GENERAL INFORMATION NE4 , SE4 , sec. 7, T29-R1 9 , Krattley 1 491 60 Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: Garry Souman Hudson CST BM Elev.: / Insp. BM Elev.: BM Descriptio Parcel Tax No.: /0 a ,0,50 r 32-29-19-376H3 TANK INFORMATION ELEVATION DATA If TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 42 Septic Benchmark A.101 Gt~I -13 - sing , 7 ~*n J,120. 490 Aeration Bldg. Sewer J ' Holding St 4WInlet r TANK SETBACK INFORMATION St/)K Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ? ~r r NA Dt Bottom NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Ad nufacturer Demand Model Number GPM TDH Lift Friction System DH Ft H Length Dia. If ead Dist. Toweu SOIL ABSORPTION SYSTEM BED /TRENCH width y2Length No. Of Pits Inside Dia. epth DIMEN I N Manufacturer: SETBACK SYSTEM KE / STREAM LEACHING INFORMATION Type of Can OR UNIT CHAMBER Model Num er: System: A DISTRIBUTION SYSTEM rLength er Distribution Pipe(s) , c( x Hole Size x Hole Spacing Vent To Air Intake 7EDia. Length / Dia./ Spacings SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulche=No, Bed /Trench Center © Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ~'~K ~n 8 o~ COMMENTS: (Includeco discrepancies, persons present,etcJ'r•7,,. b .~G i 2 INYp 4otrene-1. ( r G / o, D NSA- /3 Plan revision required? ❑ Yes No / LV / Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: + e. .2 Z' 92 7' 97 140 a 4'oq i~Q •T 3 z4 ad~, '2- t 3 c~ef a • - SANITARY PERMIT APPLICATION couNTY w n~~V"~,r-' Rai L ,vHR In accord with ILHR 83.05, Wis. Adm. Code ~ O , s.un~.,~wn STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /Lj 9 f to C) 8% X 11 inches in size. Check 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. PROPERTY OWNER PROPERTY LOCATION _ t/a ~L Y4, S _ T ~7 , N, R (o060 PROPERTY OWNER'S MAILING ADDR SS LOT # BLOCK J P j, u 70 I"? ~ CITY, TAT ZIP CODE,,, PHONE NUMBED SUBDIVISION NAME OR C $M NUMBER CITY NEAR ST ROAD II. TYPE OF BUILDING: (Check one) ❑ State owned L1 VILLAGE : ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms L PARCEL A NUMBER(S) aaQ _ 111. BUILDING USE: (If building type is public, check all that apply) - 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 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 in line A. Check line B if applicable) A) 1. M New 2.E] Replacement 3. ❑ Replacement of 4.0 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 1, 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) Lf & ;~/o~ ELEVATION -l 8 U -7 T 7. /v Feet f • lJ Feet VII. TANK CAPACITY Prefab. Site Fiber- Exper. in gallons Total of Manufacturer's Name Con- Steel glass Plastic App INFORMATION New xistin Gallons Tanks Concrete structed Tanks Tanks Septic Tank or Holdin Tank 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): Plumbe ;s Signature: (No S ps) MP/M~No.: Business Phone Number: 7/ h/'7 2 12,/ ~J ~6( dwvcQf: Y~ s ~J T / 7 Plumb s ress (Street, City, State, Zip Code): f IX. COUNTY/DEPARTMENT USE ONLY Iss ;g~Age ti nature o Staps) ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ne e 9 p Surcharge Fee) p Approved ❑ Owner Given Initial 7°1 J yS L0 -7 j Ad verse 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 JOB t- fl ✓ f w U(. Yl^ i TIMM EXCAVATING SHEET NO. / OF 7 Route 1 Box 192 _ WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE SCALE I . . i... `.T. Y r Q k . . i s . . . {1 I . L..... t . . O T o \ 6z -r vy 2b r, l %r . G y ii . as ~Q :z . f~ . . r u` ,cam%y1 Esc s 7, 10 - ~o r, I L. PRODUCT205-1 ~s Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800,225.00 JOB . TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BYDATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE i 4 ' t . _ r . ...........1 r r 1~ ~ iL SI.1p , 1 "r rz I ~ 8 vl~ T o 8s, w a _ e a i F I f . PRODUCT 205-1 Inc., Groton, Mass, 01411. To Order PHONE TOLL FREE 1800-225-0380 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN.DDIVISION +LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (I LHR 83.09(1) &'Chapter'145) LOCATION: SECTION: TOWNSHIP 1~Y~tYfiY: LOTNO.:BLK NO.: SUBDIVISIO NAME: tNLe 1/ SLC 1/ /T7_9 N/R) 9 E I. W a nj 24 FA4Lrf1'" COUNTY: 0 Nt;.WS IMP LIN ADDRESS: CA, r4C LrN o. &R 764 do Saw Q 'S 616 USE DATES OBSERVATIONS MADE N0. BEDRMS.: COMMERCIAL DESCRIPTION: P )9?/ STSResidence ~NJ gw ❑Replace LULy ULY RATING: S= Site suitable for system U= Site unsuitable for system 0 MM CCLN~ENTIO~NAL: MOUND: I `7S IN-GROUND-PRESSURE: ISMS EM-IN❑-FILLHO❑LDING TA K: RE'OMMENDED SYSTEM: (o~o~nal; [ S Per DE IGN RATE: i~ ~~~~C If f Percolation Tests are NOT required I If any portion of the tested area is in the under s. ILHR 83.0915)(b), indicate: LIQ$S ' Il Floodplain, indicate Floodplain elevation: AIa PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 43. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 7 ILL-r-S 9 "zv 9wS tL V4v t4 R-6 ,St B- 9• Z ► 4.4Z ,7"Q.a$eNSL 7Z"R>D$>zNMS ~G~ - Z .So 7 ~0 Ida K > 8 ,Sb ~s g~t~rs ~C GveuScL 2~';~>sBRu 55"8c$tyMS~l~~ iZ"et~crs ,6''Q~ ew's)L 9 k+~eftSL B- 3 8.b1 8~. .67 17>'~2~1"-lhs s1S"8-LMS+4t B- 3 optE 8.83 4`64v s'ZI"ka$esS z'' geajSL B- %A f~ 0 ? S ~ 830&_-. r5 Ze 9RMSL 66, 69am m~ 6- - G rRCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER R40"89 AFTERSWELLING INTERVAL-MIN. PERT 1 P 5192 D PER INCH P_ .bo a 1Q1-16 / P_ 2 D n10V46 o J z 111Z P / z t4ONE /6 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. upa*, a TT>~-EaGN 87. )Q 8COZ.qM0,ltX,- lOP CR GRAN1T6 SYSTEM ELEVATION Uk 110i I FR zS wi C ' b~~01 I ~ I 1 i g► 1 I I F-FT i Tl~ N I BSI k-4- 1 6 E A, Ate{ A9 ► OP,? u os ~ , B _~~ts 940- R ~Spj 7:s 's, -rep? I -I - - A 1.8,4E Q EA V-tt SYSTF M IS Tl4 HT au T1 I, the undersigndd, hereby certify that the soil tests reported on this form were made by me in accord with the prgc dunes and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print) TESTS WERE COMPLETED ON: Af, ~~F~~ISoN .~pNNSaN SoRYEv~N JC3L l1 /4ql ADDR SS: CERTIFI TION NUMBER: PHONE NU BER(optional): pa~sd~ W s4 0~~ 4~ 6w CST SI TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD•6395 (R. 10/83) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR A'ND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: ' SECTION: P.JTOWNSH LOT NO.: BLK. NO.: SUB DIVISIO NAME: S6 /a /TZ4 N/R? 9 E (o U. n! 24 EdGI{ ~ N L~ COUNTY: O NER'S/~`ER`9 11AME: M LING ADDRESS: ' C>2alx CAN E6aaw IP0. &V 764 tit) &avj Q1 -91 16 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: W New OFILE SCR NS: R LATI N TESTS: ,Residence L4 ~►-7- I^~New ❑Replace I suLy I_ ~I tILY )971 So►LS rz. 4 49 Sobs o $ 3_2,ft ,D r' RATING: S= Site suitable for system U= Site unsuitable for system -rfornelICT NTIO1NAL: MOUND: ❑A IN-GROUR P❑U RE: SYSTEM-IN❑FI LL HOLDING TA K: RECOMMENDED SYSTE ;(oo~nalL rpos E If Percolation Tests are NOT required D~IGN RATE: I If any portion of the tested area is in the I, Id Floodplain, indicate Floodplain elevation: AIA under s. ILHR 83.09(5)(b), indicate: sS PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH $t, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Z 91 14 IE > 9.4Z 17"d$en>tSL ZZ"R>D$>>:NMS•r~G-- B- Z 8.190 '7'90 NO 7 j a,-56 Er BL.LTS /4 6y9euS(L Zi `kASe J FS S-S"$L19tV MSi4f- ►2"8 vrS )4"T& e S, L 9 k*9m S L B-3 8.61 g~ . .67 ~7'' >D -M s sa" Bc Ms +G g.3 6Ng~LTS 21;;ga>~Ss Lw Z~~ M &G~ L B- $ 4 3 oNE 7 8.08 ~"8tst-rs Z3''$1¢IO5[ 66" 6~t1~ ~'1~ B- 5 .08 %A•b WONE: B- G PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATPER INCH ES NUMBER FI49"l16 AFTER SWELLING INTERVAL-MIN. PERT 1 PERIOD 2 PE P_ 14.6D a q 1. 6 174 /A P_ Z 11-16 nla 2146 0 1 z P/7- P-3 3.3a N It Ab 6 >2 >Z ~Z <3 P- P_ E -dllzl kA Al RC. P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. oPPLR T'>1:E~•1CN " Q-7. Ib scNM1~~1c,- 10P x oR dkAwITL' zS' _ _ +,1c►1 ' $ S.1 b 8ocj # _ ~N FROOT . QR _ La SYSTEM ELEVATION T 3 j W CbfL. LeT 7-4 _ ai,!1 1L, f E L" 24.46,66 l►J'S r E c r e~!~ y 4 _ 49 1. 40 tN _ _ - E E N /-c><eul~~ ZZ C AtZA -2A I" t I 3 I ~EA Vbt-SYSTEM iS T►G N _ m F__ 20 I, the undersigned, hereby certify that the soil tests reported on this form w d b ccord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the to r e e my knowledge and belief. NAME (print): 9 TS WERE COMPLETED ON: 0, A ~t 'h1 NSo N 3614 Sa R y Jc,< /1 1941 ADDR SS: ¢ IFI TION NUMBER: PHONE NU BER(optional): f-~v~sdw l^/ 54 bjl s S r- 4g¢ 3ss6- 1>1 , 0, ~(0. , T SI TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owr~sr•'a\rtd f4q.i] ~T 'tjr~\ DI LHR-SBD-6395 (R. 10/83) - OVER- APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the .property bung 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 &-*061 t1• De'4W* ° LA, rl A J Location of Property ± 14, Section 07 T Z", N - R 41 W Township Q Mailing Address Subdivision Name f~J*Cj L4: Lot Number Previous Owner of Property Vekej t&LV #-J 26A DeA*J 6(jC~ HDnPS Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume, and Page Number as:recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION.ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register-of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTS/ OWNER CERTIFICATION 1 (We) eentiSy that aee 6tatement6 on thio 6o4m ane t.u.e to the but of my (out) k.nowkedge; that 1 (we) am (ane) the owneA (.a) o j the pnopen ty de,6 cAibed in .th i b in4o4mati.on Jonm, by vixtue o6 a wanAanty deed neeo&ded in the 066ice of the County Reg"Iteh o6 Deede as Document No. and that 1 (we) pneaentty own -the pnopr.tie.r s~ to doh. the aewage poa 3y-`_^n Ion 1 (we) have obtained an ea6ement, to xun w:i:th the above de,6c& bed pieopelcty, $on the con,st&ucti.on A aai,d byatem, a,ad the name has been duty necotded in the 066iee o6 the County Reg.,6ten of Deeds, a6 Document No. _ I SIGNATURE OF CO-OWNER (IF APPLICABLE) SIGNATUR OF OWNER r $ 11 411 1 DATE SIGNED DATE SIGNED a y ST C- 105 r Y • H O SEPTIC TANK MAINTLNANCL' ACRLLMLN'' St. Croix County o I ~ ~ l - 0WNf?it /BUYI:It PD. 5av 70'1 -Fire Number ItOU'1'L/BOX NUMBL'R o~ f~l 'L I1 _ - Suction T Z + N> Nft0Plilt`'Y L0CAT1.ON~~~! 'u, ! r., 4CJ St. Croix County, '1 o wn of _ mb Subdivision Lot nuer tkej 9'% el I [mptoper use and maintenance of your septic system could result in its premature"failure to handle wastes [roger ma`atenati`e con-, silts of pumping out the septic tank every if needed, by a licensed Le tic tank um~er. What you p it into the system can affect the function of the septic Lank as a treat- ment stage in the waste disposal system. St.-Croix County residents max be eligible to receive a Kraut for a maximum of 60% of the cost of replacement of a failing syst,e,m, which was ln.operation prior to July 1, 1978. St. Croix County accepted this program iii August of 1980, with the requlrement,that owners of all new sYsteu►s agree to keep their systems properly maintained. The The property owner agrees to submit to St. Croix mCounty Zoning aster plumber, certification form, signed by the owner and by journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-;ite wastewater disposal system is in proper operating condition and .(2) after inspection and pumping (if. nec- es sary), the septic 'tank is less than 1/3 full of sludgendtscum. Certification form will be sent approximately 30 days prior 0 three year expiration. f-/WE, the undersigned, have read the above requirements and agree U) to maintain the private sewage disposal system in acc rdanc with the standards vet forth, herain, as Set went of Natural Kesources. Certification fors mustwith1omple.red and returned to the St. Croix County Zoning 1.. of the three year expiration date. SICNG - U ATE r St. C.•oix County Zoning 'Office P.O. Uox 9b. Hammo,od; WI 51,015 715-716-2239 or 715-425-8363 Sign, date and return to above address.