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HomeMy WebLinkAbout026-1061-20-130 C) O i Gcy Y 00 Q a ti O N b O ~ II i I oyi I y I I" N O C z 7 N i LL p 3 I' I ~ ~ M I e 0 a m N H I O z c O z c = a O N O 0 0 C (D 0 •IV N fn OC O d _ 1a f0 N V U O ' w N z I 0 ! n Z M Z o Z O a.. N N 3: 10 E Iwo o ~y a c a O iE a d ~ Co I N a O U F- FN- I- m_ z N> 3 3 3 3 a m 4)000 •N ~ ;zaaa CL a ° 'n fn U rn rn N a r o j i N O O N N N j Lo to E ao m d 1- 04 U.) w ¢ az(n is O > 3 v O O O C 1-"/! C O 1V M M < 30 O_ N_ V 7 O -C4 G H a) a) C C_ U d O) O O O r ~ fV M 'O 7 M tl01 y ~ a e- N N N V w (O p L p O d 7 N .n- N 00 b O N CO " N Z' C d co I- ~ ~ O M U C_ O p t=il p a3 t6 H ~2 IUn 04 • lo N (4 O z L) r I v cam • ed ° 5 `IV E 'c m c A 0 a 0 N U FORM - STC - 10 AS BUILT SANITARY SYSTEM REPORT VG s r 4 TOWNSHIP OWNER n 9sc D s SECTION _TaA-d~;> N-R_ W ADDRESS 22 Gc>G/ee ST. CROIX COUNTY, WISCONSIN (?S~1 ~2 z/ y SUBDIVISION LOT LOT SIZ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f 1 N y 3~~ fit INDICATE NORTH ARROW CHMARK: Elevation and description: Alternate benchmarks OAT SEPTIC TANK:Manufacturer: Liquid Cap. /d-a-/o4 Rings used: Manhole cover elev;9Einal grade elev: /O®. %2 Tank inlet elev.: J5~-,o2 Tank outlet elev.: No. of feet from nearest road:Front, Side Rear Ft 70?00 From nearest prop. line:Front Side, Rear Ft. No. of feet from: Well -04&// , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE J • .ems ~ 1a y r P 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: 1,2-' Length Number of Lines:o2- Area Built-er.,X,.'.* Exist.•Grade Elev. Proposed Final Grades Elev. 9$= Fill depth to top of pipe: No. feet from nearest prop. li e:Front , Side, tear Ft. n~o ildin No. feet from well: A No. feet from 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 • 4 ` PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj Q j 00~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HQMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SE4,NW4j,Sec.20,T30-R18 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (11 assigned) Town of Richmond ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Co. Rd. A NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT N Steve Singerhouse 77 Coulee Rd., Hudson, WI GATE: FDA / BENCH pMARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. T. ELEV.: CST REF. PT. ELEV. 1 vc/.. . _ ~I " Name of Plumber: MP/MPRSW No. Cnumy. Sanitary Permit Number: Byron Bird Jr. I3318 St. Croix 149060 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER pp PROVIDED: PROVIDED eer 3 ;M . 4ES ❑NO ❑YES ❑NO BEDDING: ' VENT DIA.. VENT MAT I HIGH WATER NUMBER OF ROAD: PROPERTY WELL. - BUILDING. VENT TO FRESH ALARM FEET FROM LINE 7- 1 AIR INLET ❑ / r 7 a J ~a YES LAID r ❑YES L1 N0 NEAREST DOSING CHAMBER: % MANUFACTURER BEDDING. JLIQUID CAPACI Iv Pl1MV MOUk l POMP.SIVIiON MANE/I ACTUNEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CO THO S ERA IO L NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 E A ❑NO NEAREST30 SOI L ABSORPTION SYSTEM. Check the Soil moisture at the de th of plo ing 7f-N(. 1 rl JDIAMI TE 11 110AIIIIIA1 AND MARKING or excavation. (If soil can be rolled into a wire, construction s all cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH IN--0-0-T------jDISTH PIPE SPAIN NI, COVEN JINSIDE DIA -PITS LIQUID BED/TRENCH } THEN CII s MATEHIAL: PIT DEPTH DIMENSIONS J -J C , 1 GRAVEL DEPTH FILL DEPTH LEI~ TH PIP DISTH PIPE DISTRPIPE NO DIET 7 NUMBER OF ROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER FV INE( ELEV ENU PIPEFEET FROM LINE ` r INLET4 J~ NEAREST u~~ %.C MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE [11111,1ANINIMARKEHS 11111SIFIVATIONWFLIS ❑YES ❑NO OYES FINO DEPTH OVER TRENCH BED DEPTH DVFN TRENCH HEU UE PT11 OF TOPSOIL SOI1UI 11 SFF UII7 MULCHED CENT EH EDGES ❑YES. FIND DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING [HAVE L UEPTH HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO UIS7N UISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV. DIA ELEV. PIPES DIA DISTRIBUTION ' INFORMATION HOLE SIZE HOLE SPACING U"ILLEU CONNECT L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO WE BUILDING: COMMENTS: ( (7 PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY LL: t FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST t ~ J I x r ~ Sketch System on Retain in county file for audit. Reverse Side. SIGNA RE: I TITLE ^ ~ ~ f DILHR SBD6710 (R.01/82) 1(-! L, SANITARY PERMIT APPLICATION _ ,&HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY , -a,.~ _ Gr 0 TNIO~ ` -Attach complete plans (to the county copy only) for the system, on paper not less than S'z >%r 11 inches in size. ❑ c k if Xeasion to prevUious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OW FOR , PROPERTY LOCATION fr U~ -lr f?d4 C' , S T fPN, R j E (or) W PROPERTY OWNER'S MAILING ADDRE LOT # BLOCK # CITY STATE _ ZIP CORE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5 v 1' 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE : m O ❑ Public LAI 1 or 2 Fam. Dwelling--#~ of bedrooms AR EL AX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) -,.2,::51-1 3© 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. ~ New 2. El Replacement 3. ❑ Replacement of 4.E] 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 A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 El Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 5~0 46 r L - ~ Iaet 0- 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 Holden Tank QaTa 4 Lift Pump Tank/Si hon Chamber El El -IM14 Ej 171 1 El VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's lure: (N=Sta) MP/MPRSW No.: Business Phone Number: ~5 6-2'?4 Plumber' Address (St et, City, State, Zip Code): CP IX. COUNTY/DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuin ent Signature (No Stamps Approved ❑ Owner Given Initial Surcharge Fee) _ /1 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 s Buildings Division, Owner, Plumber • APPLICATION FOR BANITAAT P&RHIT • 9TC-100 This application form Is to be conplnted In full and signed by the ownet(s) of the property being developed, Any lnadoquacles will only result In delays of tilt pit ralt Issuanco, -Should thiss development be Intended tot teaals by owner/contrsctot,(spoc houaa)t thou a second form should be retained and co.p19ted when the property is sold and submitted to thla office with the apptoptlate deed reeotding. Otmtr •of, pproperty ~"``L Location of pcopetty !J15- 114 Nw 1/Is Section 173k 6 T ~ZS N-It ~'1~5 Y Tovnshlp _ ► L1 >Y\ UY-A _Q= QA 2_7 1'N Malling address Address at A l t o 1Z~ a C-t\f P `etj c rr~or~ lubdlvlslon nowe ' Lot number Previous owner of property _ ~s4rJV_y\ U1C(~- \_XIr►~1~ Total Ilse of parcel _ O~ ~J A.eS s Date patcel was created AtI all cotnsts and lot Ilnes ldentltlable? _z~_Yas No Is this property being developed tot resale (spec house)?_ as Yolnr.e 62D And Page I(umber 73L)- as recorded with the Reglstat of Deeds. INCLUDE V1711 THIS APPLICATION Till POLLOVINCI A YAARANTI DQID which Includes a DOCUHKHT HUHDRRI VOLVMI AND PAOR NUM aJ;tI and the SILL or THIC RIIOISTBR OF DERDO. In addition, a cartlfiad survey, It available, would be helpful so an to avoid delays of the reviewing process. it the deed desctlptlon teferences to a Cettltled Survey Mspf the Cattltlad Survey Hip shall also be required. PROPERTY OWNER CZRTIPICATIOH ilve) eirtlty that all statemento on this form ate true to the best of my (.out) xnovledgej that t (we) am (ace) the owner(s) of the property desctibed In this Intotmatlon form, by virtue of a warranty dead recorded In the ottlcs of the County Reglatec of Deeds as DoCUmeht Ito. qS9 a 0%. 1 and that I (ve) ptt aentIY own the proposed alto tar tha savage disposal systesl (at I Iwe) have obtained an eeaement, to run with the above described property, tar 1.he conattuctlon of sold nyatem, and the same has been duly taccrded In the Ottlca at the coynty Register of Deadsj as Documeht No. v ~ lignstute of wnsc Egnatute oL Co-Owner (I! Applicable) Date of Signature Date of Signature rr SEPTIC TANK MAINTENANCE AGREEMENT • St. Croix County p O1dNER/nUYER"'~`1ES~~ c~r'I~LU,C'~ o ROUTE/BOX NUMBER Fire dumber__. ZIP 5u 4 i ~ CITY/ STATE °y^ UQ PROPERTY LOCATION:'f3F ' k, NcJ k, Section -:~kG T .51 N, R_VF5 W. Town of IZ cc~,►v~a a__ St. Croix County, Subdivision Lot number_ Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prooer maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a 's'eipt'ic onno. tmaeaepCicttayou nk astaitreat- the system can a ment'stage in the waste disposal system. St. Croix County residents'-may be eligible to recieve a grant for a maximum of 604 of the cost.of replacement of a failing system, whic 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 *~st'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper nec- operating condition and •(2)•after inspection and pumping 30fdayssludge essary), ',-he septic~~iikb~s sentless apthan 1/3 proximatelyfull priordtoc~. Certification form three year expiration. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- Office t within completed ment of Natural he o St. Croix Certification days s County a Zoning for-m and returned Co the of the three year expiration.date. SIGNED DATE / / - St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAI E I Y & IIUILOIW N INDUSTRY, DIVISION P.O. BOX 7969 LABOR AND N PiEL'ATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCA 10 EC ION: ~C_ TOWNS HIP/M)9)Q XP(=TY: LOT NO, BLK. NO.: SUBDIVISION NAME: /:l a n a n a SE - I/4NWI/4 010/ U0 N/R18JQClor) W Richmond n ADD T SS' COUNTY: OWNER'S BUYER'S AME: MAILINU Steve S'n „rl ouse 177 Coulee Rd , Hudson, Wi. 54016 USrr DATES OBSERVATIONS NO. BEDRMS MADE TE9 : CO M R€ CIAL DESCRIPTION: PROFICE 1W8 1 ~6CfilSI7 S: C~Ixe:idence 3 n/a New OReplace I 4-11-90 4-11-90 RATING: S- Site suitable for system U= Site unsuitable for system O ~M~ s. ❑u IfV-G® ❑u Sa ~ULHOaLDING®U : REC conyertlonalM:loptional) It Percolation Tests are NOT required DESIGN RATE: I It any portion of the tested area is in the under s.H63.09(5)I1rl, indicate: n/a Floodplain, indicate Floodplain elevation. n/a decimal' PROFILE DESCRIPTIONS page 35 ShjA, BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH TtlICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH7IK ELEVATION OBSERVED E51. GHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 61 7.33 99.08 *none >7.33 1.00bl.1. 1.58bn.s.s.J_. .50y.mot.sil. 4.25bn.c.s. B2 6.50 98,78 *none >6,50 .75bl.1. .83bn.sil. 4.9211tin.c.s. mot.sil. lens 1x1 @ 4.33' * g3 7.66 99.06 none >7.66 1.08bl.1. 1.00bn.s.l. .83y.mot.sil. 4.75bn.c.s. B4 7.42 99.50 none >7.42 1.00bl.l. 1.08bn.s.1. .67y.mot.sil. 4.671)n.c.s. 5 7.08 98.96 none >7.08 1.17bl.1. 1.08bn.s.1. 4.83bn.c.s, mot.y sil. lens g 1x1.25 @ 3.50 -le s and layers df y. mot. si t less than 1.00 in layers and lens are non contiguous in borng. g.*- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WA1 ER LEVEL-INCHES RA1 E MINU I ES NUMBER UffiVik, AFTER SWELLING INTERVAL-MIN. PeRI D PERINCH P 1 none Z' p. 2 3.50 none 3 0-2 4 4 1 P. 3 3.78 none 3_ 6 6 6 <3 P• _ 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. ~ I SYSTEM ELEVATION 95.28 I 1~ +is I I , Io ®,21. I d ( I I I i... l 1 i ~ y j _ 11 I j (p ;►'J1 p4-r~w2 R`~' E!~~t ~ QO'~ . I . I Q' i w X06 i. i = I ) r I ! I tN I _I i. I I 0 l i ~1 k`rr „ I I l i i ~ ~ ~ f3M 8 I I I ~o t ' . rl l 1091i Std. I ~ I ~ ~ . cx-90} I r i i i 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods sl+ncilied 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: Gary L. Steel 4-11-90 ADDRESS: CERTIFICATION NUMBER: PHONE NUMB En(opt ional): 988 N. Shore dr., New Richmond, Wi. 54017 2298 15-?,96-6200 CST SIGN f RE: DISTRIBUTION: Original and one copy to Local Owner and Soil Tester. DILIIR•SOD-6395 (R. 02/82) - OVER - 1 i PLOT PLAN PROJECT ~v ,~~lou DDRESS Go ?;~j14/1/w 1141W/T N/R 14W TOWN c ~G.. COUNT MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERCCONVENTIONALX IN-GRO RESSURE CONVENTIONAL LIFT MOUND_ HOLDI G TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE k Benchmark V.R.P. Assume Elevation 100' Location of Benchmark 4" H.R.P. _ ~ GOrn P~~o 0 Borehole Q Well Scale Feet 0 Perc Hole System Elevation Uent 12" Grade TYPAR COVERING 212" 3' O 6' 3' 1 Sewer Rock 6 12' r ld~ ~ h"a ~P 3 n~. I ! u~je hte4 ~ ~°S'sc spa Ve X96 G' o-