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HomeMy WebLinkAbout020-1119-10-000ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner nl~ S Gi~~Qo~ suo~E/„7~ Address 3 h~ a*Cc.~r~v/? 4r ~E City/State ~/Js~ w~ syo~6 Legal Description: Lot S Block -- Subdivision/CSM # ~~~ /gpoo,t C,Je+s ''/,~I~- %,S£, Sec. ~8 , TAN-RR W, Town of Dso,v PIN # 17.29• ~• Sow SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer G/~~5~/t Size ST/PC/nor/ - Setback from: House i.2 ~ Well ~~~ P2 ~/ Pump manufacturer - Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: ~.rJ?~iL~~t rot Type of system~~~ c ~ Width 3 ~ Length 93. ~S" Number of Trenches -2 Setback from: House ~~ . Well i~' P/L a~ , Vent to fresh air intake .2~' ELEVATIONS: Description of benchmark ~ ~~ ~ in1 ~~ ~~£ Elevation Boa • oc~ " Description of alternate benchmark Elevation Building Sewer 92 ~S" ST/HT Inlet !'l •G a ~ ST Outlet C9l • 3 3 PC Inlet PC Bottom ~ Header/Manifold `~~•`9'~~ Top of ST/PC Manhole Cover ~ G D Bottom of System (~-) ~g• mo" (h) ~~. ov' ( ) Final Grade (,4) 9'-/- 3~ ' (g) 9h . 3~' ( ) Date of installationl~ L~/Permit umber ~fo3°ly`~ State plan number Plumber's si ature ~ License number ~.? S/'7 S~ Datell /2/ / od Inspector Distribution Lines (A-) ~g • S,s~ (~S) Sg. ss' ( ) Complde piot,p~n ~ NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. ~, i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and t3uildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Sudheimer, Hayne & Carol Hudson Township CST BM Elev.: insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~. p ' ~- Z ` ~ I ~--~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lrlction S stem TDH Ft For ain Length Dia. Dis . I ELEVATION DATA County: St. Croix Sanitary Permit No.: 363949 State Plan ID No.: Parcel Tax No.: 020-1119-10-000 STATION BS HI FS ELEV. Benchmark /O~~ r v Alt. BM ~, 08 /03. Bldg. Sewer Cs~~.rQ St/ Ht Inlet (2.52 9/. 9L St/Ht Outlet IZ•82 4/.~6~ Dt Inlet Dt Bottom --~ Header /Man. '~` Z $q, 2,~ r Dist. Pip ~ ~ ~~,; Bot. System (`'`S B~• q 8 Final Grade 'n"'`"~ St cover ---~ ~~ ~~ SOIL ABSORPTION SYSTEM (I S~ ~,~„ _.,,,~,~ ,,,,,/ .~,,,~,. e,~, gip Width r ~ Lenggth r N . Of Trenches ' `S v PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N / 73•~ IMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: S~P.w/ ~~/~ SETBACK ' INFORMATION Type O l r ~2 "'~- CHAMBER Mo a Number: ( System: ~t~(,t/t, a O ~.%p J . OR UNIT - ~ -~ DISTRIBUTION SYSTEM ~ ~~.D.,,~ ~6vn,rr v Header / Mani old ~ ~l Q e Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length ~ ' Dia. ' ia. 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 Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ((lZl /DU Inspection #2: / / Location: 375 Brookwood Drive, Hudson, WI 54016 (NW 1/4 SE 1/4 18 T29N R19W) - 172919508 Trout Brook Woods - 1.) Alt BM Description =-~"'es~ 2.) Bldg sewer length = Z.D. o ~ C 5 ~Qu~`f 0 amount of over = ,~ ` ~ ~ ~ µ/ _ ~ ,q0 PIarS revis on requi ed? Ye~ ~ No Use other side for additional information. I ~ .2.1 ~ ~ ( Z SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ~7 ~~ tJ ~,~ _. ~C t, i .9,-, n[ ~~ Sanitary Permit Application safety & Buitdings Division [n accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 See reverse side for instructions for completing this application ~~ ~ ~ Madison, W [ 53707-7302 ~ Personal information you provide may be used for secondary purposes .~r+a~~ , t]epprtment of t2ammerce [Privacy Law s. 15.04(1)( (Submit completed form to county if not , state owned. Attach com lete lans to the coon co onl for the 8-I/2 x 11 inches in size. State Sanitary Permit Number ^ Ch r ~ ton to proyous o ' '~~ ~` ~ty ~ State Plan [. D. Number . 3 3 9 ~. .S~. ~ o ~ t' A lication Information -Please Print all Information `- I ocation: . Prop/erty Owner Name ~ t q f'~/`t•~.clE ~' ~~ (~D L ~Gt Q ~~/ i~J ~ ~ Y~ J f 11 ~ 7 20~Q ' petty Location CJ1/4SE l/4, S/~ ,N, I~E or Proputy Owner's Mailing Address ,.• T Cf901X COUNTY ~ 111°ber Block Number ~ _ OQl v~ ~~ z 3~~ ~P~arwood - City, State Zip Code P ne fiber ~ / ~~` Subdivision Name or CSM Number 'oc l ~ J ~~d5~ GJr SYQ/fo k rr Qo~r OOtlS . II. Type of Building: (check one) ~ / V ^ city ^ Viltage 1 or 2 Family Dwelling - No. of Bedrooms : ,Town of ~ ~ 5 ot/ ^ pubtic/Commercial (describe use):_ ^ State-0wned Nearest R ad D ~ rJE KWOo~ Parcel TaxNumber(s)O~O -/r/4 - /O - 0 T e of Permit: Check onl one box online A. Check box on line B if a licable III ~-- Z 9. / 9. S o ~ ^ Addition to 6 . 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. A . Existin S stem S stem S stem Tank Onl Permit Number Date Issued B) ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check ali that ap ly) ^ Sand Filter " ~ ' ^ Constructed Wetland ~ S K 't 3 • Non-pressurized In-ground 2 C'3 ^ Mound ^ Sin le Pass ^ Holding Tank g ^ Drip Line ^ Pressurized In-ground ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: ^ At- de . ~ - ,~ ~ V. Dis ersal/Treatment Area Information: 3~ Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 1 ~ 6. System Elevation Elevation rade . Required roposed to (GalsJday/sq. ft.) (MinJinch) 9 '_'- ~ / ~ ~ fig. vo ~ ~ • ,~ ~St~ S -0o,r rz S/y .rV ,/mar , VII. Tank Capacity in Total # of Manufacturer Prefab Con- Site Steel Fiber- Plastic Con- glass Information Gallons Gallons Tanks Crete sttucted New Existing Tanks Tanks ~ ^ ^ ^ ^ E~<< K /OaJ / /~J/E~j£lj ^ ^ ^ ^ ^ 1,i2T/f ZAQEL /~/~OD WA.rTE (.io7ER fscTF.t S VIII. Responsibility Statement the undersi ed, assume res nsibili for installation of the POWTS shown on the attached Tans. I Business Phone Number , Plumber's Name (pri ) Plum Si azure ps): Mp/MPRS No. <s ~ 3~~~ ~ ~~o «~ .~ ~ ~ ~7 plumber's Address (Street, City, State, Zi e) IX. County/Department Use Only Signature (No stamps) A e suin I ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued g ~ g s Approved ^ Owner Given Initial Adverse Surcharge Fee) ~, ~ ~ ~ Q ~ / ,~ ~ Dv ~-- Determination L rre~wt'ly 6+. rt~o~ X. Conditions of A proval /Reaso s for Disapproval: ""' ~/"~"•r~/~au~M ok ~ ,/ ~/~~r [[ ~ ~ ~ ~/Jt/ {'N-n.IL U Y"+GI~U /2r5 rCCO~vJ of i'vT'-' ~Ti~T~r ~ ~t yry ash Inc r 5 CoY~~i ~iOVS ~ sy5~y.,.~ .{o ~ ~e~t a5 S/.ar/lam a5 /pr,5si~,~ 7la 4vo<d C~ .... '. 3~. /~ ,~o ~ ~ oW N ~~ g~~µ~.~r - , kf iN . ~~, ...p 4 . ~~ ~r~w..fY PLOT M CROOS 8EC'TION PLMN L1PPA 9ROt. EXCAYATNib MIC srs' ~.uM61Nri- uNT ... ~~'- ~-?o ' _~ f 3<~ !I ~r- , ~~ ~~ ~ / .. P~iO~IEC`T . /'T /~l~ ~~- 7N !'fie.` IM EiQ JJ~cJ IoR~J ~'~`f '~ENGN r7!"S'fFec uT (-.>vv4S 1-~rnd So.J ~,.~, ST~,~~. ~ L~,~ ofi~ ', ~ ,~~ ~s' ~ v 4 J a ~ ~~ ~~~ ~ ~ B3 ~ 5er`~~~ a~ rs` ,' ~~P~ o bow ~ DNS b,n, P`P ~s , ~ e ~ ,5~ / N TfVc NE? .~FicTP•f fD,~ G ifNA?l,~f.~5 . ~. ' /Gb0 ~t.. /~aJiESLI?7~fK'T~fNK ti.zna ZAQ~'L A/Poo w~.rr6 w.a~F/1 F.LL~E/L ' ' /~(n ~p' nt ~ 'S~ Nola NL Stl., f_rl ~ii~-~ ~ CI1LH Yj m~ ~ifi~ ~4 '- V ~ T f' f~8~~ hT/cKl PIo~ ~P/~oVf4 VENT L,~o Mkici atrtn'1 ~.?" r~$~lF ~N,sH 6Qko~ F~rsH ~~P~~E - ~/ ~~ ~YG Sc N yo JE.ti/~( P~ PE /rt~rc, MuM 40~ Aeov~ L~.I.v1Rc~P To fi nl ~ S N {~QhQE 8101~D: uceNSe: a25/~ ? DATE: 7 , ~ ©c7 i ~' ' .BgLTE6~1t~0Y: ~ I a~~~ Side View ~ F,~EdA'fio.J T snlc H ~c t~"o-+~ i'EQ soy c "rLST End View m 7S„ ( '~ I~--- S~ o£ c.., ~ ~l o~R N ~GN CAPAc~r~r /1/~vOE ~ 15° 34' `~ ` ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of~ Division of Safety and Buildings m accoraance wim Comm ua, vv~s. ram. ~,oae County ~ Plan must lan on er not less than 8 1/2 x 11 inches in size h l te site a Att S o ~ x p . p p ac comp e include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. p~ ~} ~~ ~ ~ / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ . 7, 7 . Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~ Property Owner Property Location p ~x(y ~ ~ Q~~L S ~ N i~~,e Govt. Lot n1w 1/4s~ 1/4 S / ~ T i9 N R ~ 7 E (or) W Property Owner's Mailing Address ~ B Lot # ~ Block # Subd.' N~a ~ ~TCS~~~ K ~tl~~ oo kw~ d l~t~ ~s City State Zip Code Phone Number ~ ^ City ~ ,^ Yllage ~ Town Nearest Road l v~so>v W ~ S ~) (~ ) S49'-bo r9 IJ o~- i R , 8~r Q~ New Construction Use: ~ Residential / Number of bedrooms Code derived design flow rate GPD ^ Replacement / ^ Public or commeraal -Describe: - ____ Parent material (-~t~~f ~" ~~U ~'~ 5 ~~ Flood Plain elevation if applicable `V e'i ft. General comments and recommendations: GCQC;At ®UTC-Jf45~J Boring 9 Borin # t~l Pit Ground surface elev. 70 ~Z, ft. Depth to limiting factor ~ ~ ~ ~ r in. tw Soil liration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D-~~~ ~o - `~~ vr+~C~ m r S l 0,4 -~ - 33 ,MS 5 Ml s - o. B ~ i i - v 3 ~ r~s S I - .~ a Boring # ~ Boring pit Ground surface elev.~~.~ ft. Depth to limiting facto~'~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Q ~-g- io -~ ~L U~cr r S l 8 ~ - r~ s M I s -- ,~ 7 0 ~' `_ S ~~ M r -' z ~ ~~ ~ ~ ~,~ ' Effluent #1 = BOD > 30 < 220 ntglL and TSS >30 < 150 mglL ' Ettiuent #fz = ti~u < 3U mg1L ano r ~ < 3u mgrL CST} (Jame (Please ) Si a re CST Number /v ~ ~ .SQ~J ~ Z ~ ~ S~ p,,~~ Oate val~tion Conducted Telephone Number ~0 fox ~~ ~v~v~ 7~z QC~ 3Fs6--400_ Property Owner SvD N ~ ~ ~ ~~ Parcel ID # / 7.2 ~, / 3 . S08' page _Z of 3 Boring # ^ Boring Pit Ground surface elev. ~~ ~ ft. Depth to IimiGng factor 5' i Z 1 in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fft in. Munsell t2u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q O-~ ' ~ 3 2 -- S U lhcr r CS / 0.4 0. - 3 I 4 3 -- m5 C~ 5 m $ ~3 ~ ~ d -- ~S n, I .-- 7 -!~.) goy 4 ~ ,MS n~ `~' , ~ z of o4 , U (,3-~ Boring # ^ Boring - - c pit Ground surface elev. ~~ ft. Depth to limiting factor } O~ in. mil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 0-7 • I07R3 S~ U Mc~ ,M c GS ~ .4 -~~i- ,23 -~ ms 5 ~ s / o, 6' o S ~ r-~ ~ Cs _ ,5 0, ~ - ~ S M ,- - ~ ~~ 3Z • ~, ,, Boring Ej Bonng # Ground surface elev. ~. U ft. Depth to limiting factor ~ ~S in. Pit Soil ication Rate Horizon Depth Dominant Caor Redox Desaiption. Texture Structure Consistence Boundary Roots GP D/ft'- in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh, 'Eff#1 'Eff#2 ~ 0-? ~ ~Oy 3 -- SZ U Mc~ rn r CS / ,Q 7-6~- -- ~ S l c.s 1 >is5 .... ~ M S6 k r .-- .S , C 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mgll • Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sso-also pe.sroo) ,~ _ ._...._.. .~_.._~r`.~P'~ ~r M....,~-...... ..... ..... .. _'...., rte.. .. ...~..~._~. .. '.. .. _ ~2 ~ ~ ~ 1 ~ ~ ~ .I~ 93,b ~ ( I 1 ~ a ~ ~ -~ ~ i ~ ~~ ~ ~- ~ ' I~ a.T~~~9- a ~ ~A~ ~ m p c- g ~~ ,~ -' ~ J ~ ~ I ~' ~ ~ ~ ~ I ~~~ ~ ~ ~ Bt.-x~-~ha~fti-5~iyit ~N \~ E~~g3A .~ ~- I zz."Oar', ~ ti 9~ ~ ~ `~ ~~~~3 ~9s,36 r ~ ,.~ ti~ .~ ._. ~T ~~ ~~ ~ y A A d m PAa ~ r3 as 3 FROM Zappa Brothers Inc. FAX N0. 715-3B6-0323 Jun. 29 2000 02:25PM P1 OwnerBuyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address .~~.~ ~s~®t,-_..~,~,~ ~is=/t Property Address (Verification required from Planning Department for new City/State I~(~CLSO 1'l, ~,(~~ S IIUI(o Parcel Identification Number ~02~ ~~ ~ , ~ -~ ~ LEGAL DESC)<tIPTION Property Locaxion~t.J %4, ~~ ~/., Sec. >~ , T ~" N-R,_~W, Town of t,~CI SU ~ . Subdivision ~~r0~1<-I ~1rU0 (~ (~ 0 UC~S _, Lot # _-~,_. Certified Survey Mapc# ,Volume ,Page # Warranty Deed # "J ~ 7 ~ 6 I , Voltune 1 z 3 Z ,Page # z ~ _ Spec house ^ yes ~ no Lot lines identifiable` yes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification fornr, signed by the owner and by a master plumber, journeymanplumber, restrictedplumberora licensedpumperverifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge, I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Naturai Resources, State of Wisconsin. Certification stating chat your septic system has been maintained must be completed and returned to the St. Cmix County Zoning Office within 30 da s of the three year expiration date. ~, ~~ ~ / ~7C SIGNATU1tE r APPL1CArrT DATE OWNER CERTIFICATION I (we) certify that all statemarts on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of perry desert ed a ve, icy, irtue of a warranty deed recorded in Register of Deeds Office. ~~ ?/ /UG SI N TIIRB OP' Al' I.ICANT DATE iKyFw* Any information that is Cnls-represented may result in the sanitary permit being revoked by the Zotting Department, #•*~*'` "* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if referarce is made in the warranty deed ~ /t.~- V~~..~ '~: S ~ PA~'Erl~~~) 55'7869 srarr_ ana or• wlscorlsiN roam 2 - 19x2 ~VARRAN1l' Df ED DOCUMENT NO. Garv (3reaul t- , a/k/a Gar. y Il . l3reat.tl. t conveys and ~earrants to _ a y n e i~-emu ~TI-t e ]. m e`- ~-t a 1~ ~l - Carol Sud ~e].mer,~1u pan-~--and W?-Fe, as_ surV]VOrs[iiP arm i al_proper-Ly,--- __. - the following described real estate in S t •_ C L" O i X Count; State of Wisconsin: REGISTCfI'S OFFI~~^~ ST. CROIX CTY.~ Wl ~toCt1 kr ~~ APR 1~, ~:99~, ~j 9:00 A.'~ fie~lslor ut Deoc:y TIIIS SPACE RESERVED rOR RECORDING DATA NAME AND RETURN~AyDDRE~S~S/ r5~ ~`ta ~5" r. ~ ~`~ ~z,~ 5 Spy/ v ~I ~y~ _~U-1 1 1 9-1 ~ PARCEL IDENTIrICATION tJUMBER Lot 5, Trout gook Woods i_n the Town of Lludson, SL. Croix County, Wisconsin. .rt„~ i s n o t - _ Y.~i~X (1s not) rxceplion to warranties: _ homestead property. l;asements, restrictions and rights-oL--way of record, if any. -~ Dated this ~ ~ clay of -_._ AU"I IiL•N'i1CA1'ION Signature(s) authe;,,.....,~-1 {I,ic -.. I Apr ~-1 - -~-- , n.D., I9 ~--• (sr_nl.) (sen~) --ate-- , Gary I3 eau -t, a~l~ Gar`y -[I. reatil~ clay of 19 ACKNOWLLDGMI?NT State o[ Wisconsin, 55. S t. C r 0 ]- X County. O r~J Personally came before me this _~L daY "[ --'A]_~~-1~- _ I9-c~.~_-, the above named -G.ai)!-iir~.uii ~ ;:_,--'-~ k ~ a_S1.a r~r_~-1. ----- ,. • 7 .A9~ / ~~ °p • s • ~ Y O I • p• • I I O' m . OC• ~ I • ~. ~, rn I • 9 Q Q • K r .• 0.33 3: Z•• Q• .• J .• = O O :Z • i NOTE ~ PLAT BEARINGS ~ i I ' REFERENCED TO • II o °` TRUE NORTH BY • o `L SOLAR OBSERVATION, . / • • / ~ ~ • / / ~ • • / / ~ •. / Q ~ / v•~~~ / / ~ / .~ ,t / .•33~~ / / 33r ~ ~~ yti/ p' 12 N a~~ °~ . • tt' _ ~ / / • t0 ~ ~ • .` ~~~/ 13 4~0~350„ W ~ p; ' O ~' , ~ O ti w • Q ' ~\O • p ~ N J: Z; °•. c h 0a 32 ~~ ~~Ao% ~ o j 0 v~ / I r oooFC]~1~1° W