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HomeMy WebLinkAbout040-1188-90-003 C a) p v ao y o ~ I r~ °o I N li I v h I ti I Q C I N z C L iS O i Q I Cl) ~ ~ z E rn z , = c I ~ v z a 4) co (N m f- z O o z V c v o I d Z c z H c 72 o M m a~ (D N Q ~1Y N N N C • V) .c O O ® o 4) Q z co z o N z I N W N V U Q O M N N tn N O d O G t0 w ~ O CO .0 c ° °o D D CL Y N E y O N N O (DD Co f- O w O N d z O O O Z O •MV R > a a a a O N c V1 J V rn rn } 7- 7 LO uuV a : ?2 c °o 45 E O co d LC) a ~i 6 N y frv • d Q co w 1°. O M I~ N C C C C© rn c v a s V O 0000 O m = o o co Li.w w O C L L q} 3 N 1n y' O co I- CJ o = U) cry ~ E d a a u CL « • ca a m .2 m iv E L c c A u * oin0 I FORM - STC - 04 AS BUILT SANITARY SYSTEM REPORT OWNER AYLE:L d1&~,TOWNSHIP` 2 SECTION_3(a T_LLN-RN W ADDRESS _-5,11V(fr'Cu,) dA, ST. CROIX COUNTY, WISCONSIN F SUBDIVISION_ OA7 (t I ~l 6r- 6 s LOT-L~-LOT SIZE PLAN VIEW SHOW VW6THING WITHIN 100 FEET OF SYSTEM B~ I6p,0 N t ~ 6h INDICATE NORTH ARROW /V LC Elevation and description. - OP A44-1w,A0k .BENCHMARK: O F l o-r- d Alternate benchmark TAF- goc- I Alzrw~ 1` au~~ + ~ ~✓A-~~ 3 SEPTIC TANK :Manufacturer : Liquid cap. d-(Cro Rings used:o~ Manhole cover elev: j/rYJFinal grade elev: ! Tank inlet elev.: 7~6 1 Tank outlet elev.: 9 7.39 r No. of feet from nearest road: Front 7-/)--,Sid, ear . From nearest {rop. line : Front 7z~SidGe~_R,aa-F- r No. of feet from: Well , Building:. (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manuf turer: Liquid Capacity: Pump M el: Pump/Siphon Manufact.: Pump Size Elevation o inlet: Bottom of tank elevation Pump on el v.: Pump off elev.: Gallons/cycle: f Alarm: Man.: Switch Type: Location Distan a from nearest prop. line: Front, Side, Rear-Ft. Dist ce from: ell Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: /_Length_L3 _Number of Lines:-3-Area Built Exist. Grade Elev. fd Proposed inal Grade Elev. C/Ol 5S r Fill depth to top of pipe: S r. Y60110 -^Vv t ?/O No. feet from nearest prop. line:Front , Side , Rear No. feet from well: No. feet from building HOLDING TANK Manufact rer: Capacity: No. of r ngs sed: ' Elevation of bottom tank: Elevation 9f inlet: No. feet f om nearest prop. line:Front , Side , Rear Ft. No. f t fr : Well , building , nearest road Al m Manufac urer: p INSPECTOR: DATE : PLUMBER ON JOB : d~ tp 4k/,<b q,/ LICENSE NUMBER: 6/90:cj QI Wiscorf in Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT SafekyandBuildingsDivision St. Croix (ATTACH TO PERMIT) Lot Sanitary Permit No.: GENERAL INFORMATION NW, NW, Sec. 36,T28-R19 Hillside Dr. 14924-0' 25q Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: Quality Built Homes/Kruger Troy CST BM Elev.: Insp BM Elev.: BM Description. Parcel Tax No.: 81 $ r 040-1 1 8-90-00-3' TANK INFORMATION ELEVATION DATA 12,11}'I~l TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark w d' D / LZ 537' 26,33 Aeration Bldg. Sewer 7-2- Holding St/~K Inlet 9 TANK SETBACK INFORMATION St outlet Z' 973Y Verit irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic 3 p'~ / d NA Dt Bottom Dosing NA Headertidfan. Aeration NA Dist. Pipe Holding Bot. System a' 10 85- O~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand / L y S Model Number GPM f TDH Lift Loss SY TDH Ft Forcemain Length Dia. H Dist. To Wel SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches P No. Of Pits Inside Dia. Liquid Depth DIMENSION / g 3 DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING nufaaurer: SETBACK INFORMATION Type o CHAMBER Model Numb",. System: 31-(J~ OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) I r x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. Length __L90 Dia. Spacing _L 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 qc -(PQ Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies persons present, etc.) , Gr/✓v ct~/1~~Fe'"_'"_„" .t t~ ~`f~~~" ~,`'1 .A` ,F1 Ord fd....'A .t{~ ..r t 4'.-a:¢.-/' • CJ~,~ f J T Plan revision required?' es e'-N0 Use other side for additional information. /Z_ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION .U DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY _ St CPO Ix STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. c k i ffrvlsion pr sous application --See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PRO.P~jRTY LOCATION U - Oa W'/4 k1'/4, S 3 T 27-914, R E or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ((ti v« 63 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I U&Z Gtr (,J( OZ Z ~ S_:53_9 6,41C o 6E II. TYPE OF BUILDING: Check one CITY o NEAREST ROAD ( ) State Owned O VILLAGE t E D ❑ Public 191 or 2 Fam. Dwell in" of bedrooms t' PARCEL TAX NUMBER(b) jqRltc~ 41 916 III. BUILDING USE: (if building type is public, check all that apply) Z / / O Q _ -00 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.E] Replacement 3. ❑ Replacement of 4.0 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 I VI. ABSORPTION SYSTEM INFOgJ11,~1N: 1. GALLONS PER DAY 2. ABSOR A 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE q9_0_ REQUIRED (sq. ft.) PROPOSED ( q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION (o Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ~U ~;rV !r (K Lift Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbs 's Name (Print): Plumber's Signet ure: Stamps) MPRAPRMNo.: Business Phone Number: 6 L LSo~ 3? 1(275) 9 Plumber's Address (Street, City, State, Zip Code): LL w OZ2 ~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved ry Permit Fee (includes Groundwater a e Issued Issuing gent signal A/ \1 J~ Surcharge Fee) Approved ❑ Owner Given Initial OD dverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 1 I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber I STC-100 i 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 A (&T 10 011 "Mn Location of propertyl/4 AULI 1/4, Section T~N-R±W Township d Mailing address S/,{A) V/e f0i~ /Pfun2 Address of site subdivision name---DA, 121 D ue Lot no. 4r~ Other homes on property? yes No Previous owner of property Poct w6 tc ® 6 (Uetao ~c , r (A/C Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No DOCUMENT NO. STATE BAR OF WjSCON8Wf-,,QRM 2-18$2 THIS SPACE RESERVED FOR RECORDING DATA WAROWNTY DE.FD 4175189 VOL 920 GE 5 REGISTER'S OFFICE I, Railing Hills Development, Inc. $,,a Wisconsin ST. CROIXCO.,,WI cor!,poration Recd for Re _ cord 0 0""1" 2 91991 5 P. conveys and -warrantsto Eugene 0. Larson, ))on D. Kruger, i~Reglatei•ow and''Lawrence M. Johnson, Jr., doing business as Qua,lit Built Homes `.T BANK 1124 S. SECOND ST. ER FALLS, WI 540ZZ the fodowing described real estate in St. Croix County, State of Wisconsin:' I Lot Sixty-Three (63), Oak Ridge Acres, to the Tax Parcel No: Town of Troy. T' I r i I I i This is not homestead property. (is) (Is not) Exception to Warranties. pAaements. restrictions. and rights-of-way of record, if any. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 0 ITy //L ( e&x%6~rS /J 1(50- a . ADDRESS: 1(Jo yl ft J J k, ~IU6W r-Af t S FIRE NO: LOCATION:_ AlUl _1/4, 1/4, SEC. 34 T z5N-R_49 TOWN OF: 12fl y ST. CROIX COUNTY SUBDIVISION: CA* hut LOT NO. h 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 a 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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