Loading...
HomeMy WebLinkAbout032-1095-60-100 St. Croix LESLEEJ OJALA Municipality: TOWN OF SOMERSET 1859 58TH ST Permit Number: 259415 SOMERSET WI 54025 Parcel Number: 032109560100 Alt Parcel Number: 34.31.19.443B Site Address: 1859 58TH ST Components Component Manufacturer Description Last Next Status Schedule Service Service Conventional Bed- Seepage Bed- Seepage 05/15/2015 05/15/2018 Current 36 Drainfield Septic Tank Septic Tank 05/15/2015 05/15/2018 Current 36 Maintenance History Service Date Maintenance Name Gallons Pumped 05/25/2007 Not Available 0 11/02/2012 Not Available 0 05/14/2015 Not Available 0 05/15/2015 Not Available 0 Notes Date Text 7/4/1776 12:00:00 AM ADDITIONAL NOTES: 1000 gal. septic tank to 12'x 75' bed - should have been 0.5 rating for 2msbk sandy loam MIGRATED ON: 09/04/2015 *No data found for Notices, Violations t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERS ADDRESS SUBDIVISION / CSM# LOT SECTION ~t1 T J/ N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s I14DICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: D a G ALTERNATE BM•.. S/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: l.G>(' . e Liquid Capacity: ~ Setback from: Well &-:71'-4/House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: j~ Length Number of trenches Distance & Direction to nearest prop. line:__ Setback from: well: A/a/ House Other ELEVATIONS 1.9k~~ Building Sewer 0 ST Inlet, /_3? ST outlet PC inlet PC bottom Pump Off Header/Manifold j~-5 Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: p•--.x-~/ LICENSE NUMBER: INSPECTOR: 3/93:jt / CC ~ BENCHMARK: /D ALTERNATE BM: Z-f SEPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Z~C le Liquid Capacity: / Setback from: Well }House i Other Pump: Manufacturer ModelW Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Z,;7- / Length 7~ / Number of trenches r Distance & Direction to nearest prop. line: Setback from: well: 10~ House 4, / Other ELEVATIONS i%`L✓G' - Building Sewer ell- ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifoldf3'-.5 Bottom of system _:~~/,74-- Existing Grade Final grade _ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County ST. CROIX Labor and Human Relations INSPECTION REPORT Safety arvd'fruildings Division (ATTACH TO PERMIT) Sanitary Permit No GENERAL INFORMATION P~m;t Fior; NaIAe..L ❑ City ❑ Village ® Town of: State Plan ID No.: CST BM Elev t'AV Insp. BM Elev.: BM Description: Parcel Tax No.: A950041 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing j; / I/' Aeration Bldg. Sewer b3' q Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet(! q 7,1 Vent TANK TO P/L WELL BLDG. Air Intato ke ROAD Dt Inlet Septic >/U,') NA Dt Bottom ~,r~'-. ay' >;,1 t Dosing NA Header / Man. 7,0' 26, Aeration NA Dist_ Pipe 7 ~Holclirg Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand r f : 1 i 9 Model Number GPM TDH Lift Friction f S stem TDH Ft L Dead Forcemain Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No Of Pits Inside Dia. Liquid Depth ' DIMENSION DIMENSIONS Manufacturer: LEACHING SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O+c./ CHAMBER Model Number: System: . v n) , y'1 OR UNIT DISTRIBUTION SYSTEM [Heagder / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake th _ 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 Be. /Trench Edges ' Topsoil ❑ Yes E] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.34.31.19W, SE, NE, Lot 1, County Road I i ~ Plan revision required? ❑ Yes No Use other side for additional information. ,t SBD-6710(R 05/91) Date Inspector's Signature Cert No Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System V~~~~7R 201 E- Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O- Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size., • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. r te Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Ow r ame/ Property ocation c i'r•~~ 1 /4 1/4,S T N, R Property wner's Mailing Address Lot Number Block Number aj Cl, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Barest Road ,3 El ❑ Public 1 or 2 Famil Dwelling - No. of bedrooms olwg of 911. B U I L D I N USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/Condo O 3a-j6q 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 12E] Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. [New 2. ❑ Replacement 1 ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ---System System Tank Only - Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 i 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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) G Elevation Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site - Fiber- Plastic Exper New Existin Gallons Tanks Concrete Con- Steel glass App. strutted Tanks Tanks Septic Tank or Holding Tank/ {i F L ift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum Name: (Pnn Plumb ignature: (No mgs) / MP/MPRSW No : Business Phone Number: m Br's Address ( treet, City, State, Zip Code): _ IX. COUNTY / DEPARTMENT U 5`E ONLY XApproved ❑ Disapproved S nitary Permit Fee (includes Groundwater Date Issue Issuing Agent Signature (No Stamps) lee) ❑ Owner Given Initial Surcharge Adverse Determination ~J / G► Xz Arl~ i, AX40 . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Seo-6398 (It OY94) DID iRIBU7ION Original !o County, One copy To: Sefety & 8uildinps Dive.r n, Owner, Piwnbar CTS... _ ary permit is valid for two (1) y,. ;r sanitary permit may be renewed before the expiration date, aI consin Administrative Code will be applicable. evisions to this permit must be approved by the permit issuing aL, angesin ownership o mty prior to installat ite sewage systems i essary, usually every ;u have questions concerning your on' Safety and Buildings Division, ,te and accurate this sanitary pc--:, roperty owner's name and mailing address. Provide the legal de ystem is to be installed. ype of building being served. Check only one and complete # of bedrooms wilding use. If building type is public, check all appropriate boxes that app! me of permit. Check only one on line A. Complete line B if permit is for to of system. Check appropriate box depending on system type. )rption system information. Provide all information requested for numbers 1 through 7. information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and ufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and ing tanks for this system. Check experimental approval only if tanks received experimental product approval from R. onsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g_ MP, etc.), ess and phone number ity/ Department Use C )ther treatment tanks; building sewers; wells; water mains/water service; streams and lake,; pump or siphon s; distribution boxes; soil absorption systems; replacement system areas; and the locatic Iding served; orizontal and vertical elevation reference points; C) complete specifications for pumps e dose volume; rrncccPrtinn }UV SURCHAR1- ,rci. s) for a nun eci yruuI iowa«r. rT Onin4 rnilPrtnrl thm!joh. thp,e ,urcharaes are used for monitorinq groundwater contamination, investigations PLOT PLAN PROJECT _ ADDRESS ~`f I 6 l is / W 1 / 41 r • 7~L 2 SE 1/4 NE 1/4S 34 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX 11/17/95 3 MFRS BYRON BIRD JR. 3318 DATE BEDROOM CONVENTIONAL IN-G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 BED SIZE 12'X 75' BENCHMARK V.R.P. Top of Steel Stake ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 95.1 12" GRADE_ TYPAR COVERING 12" 6' ®3' SEWER ROCK 12' County Rd. I M. 720' 0' B-3 d Note: May need to be cut to 42" ppk f' \601.9 slope o 18 33' 13-5 27' 15' 60' 12 B-2 r- 35' rD Iz'' B-4 R Vent 48 T 25' \ 20' Pro 3 B-1 Bedroom House Garage Wisconsin DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page _Of _ ?,at> r- n~, Human Relations Division of3afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION r GOVT. LOT 1/4 1/4,S_~, T N,R V(or ' PROPER OWNER':S MAILING ADDRESS LOT # BLOC ,I( # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ITY ❑VILLAGE [v' TOWN NEAREST ROAD j q New Construction Use KI Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate_, _bed, gpd/ft2___~/_trench, gpd/ft2 Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate bed, gpd/ft2__L_trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) 1 r Additional design i site considerations 1_).L? Parent material l= ~ c~~Fr Flood plain elevation, if applicable^ A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend Grounder elev. /tL ft. Depth to limiting factor 1 Remarks: Boring # .5" 441-4 Ground t _ elev. >f ft. A-r% Depth to limiting factor >~f s` 4......_ V Remarks: CST Name-Please Print Phone: 3 f' - -1-221 Address: Date: CST Number: Signature: r, cJ PROPERTYOWNERSOIL DESCRIPTION REPORT Page ~!of_ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench q 7 Ground a. _ elev. Depth to limiting factor Remarks: Boring # / 4111 t;,k) Ld r 6/1 1 _Al/ Ground elev. Depth to limiting factor Remarks: Boring # LQ Ground -Z ZZ2 elev. T- Depth to limiting factor yz Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PROPEMOWNER ~ / ~rts~ ✓ SOIL DESCRIPTION REPORT Page J?of_ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground a. elev. Depth to E limiting factor :i ~ Remarks: Boring # Ground elev. 1 - - _ - S 91, 4&2 ft. Depth to limiting factor Remarks: Boring # - Y Ground _ elev. _ /l I T_ I ~ 1 /C./4 y .eft. Depth to limiting factor yz Remarks: Boring # I I I Ground elev. ft. I Depth to limiting factor Remarks: SB D-8330(8.05(92) I ~vre f r I /sip r -44 ~f / d LJ.r tom: ct / c41, it J tit C:n N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS f ' jai"' 1 ~5q 5g-~ PROPERTY ADDRESS co pr,~_Cr~T (location of septic system) e obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section ' T_3 N-R~W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER _Z_ CERTIFIED SURVEY MAP 7,6, OLUME r b, PAGE,, O LOT NUMBER 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 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 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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) pumping (if necessary), the septic tank is less than 1/3 full of sludge and scun I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: /U ✓Er?fe2 _p St. Croix County Zoning Office Government Center 1101 Carmichael Road 1 Judson, WI 54016 11/93 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_ Location of property.! 1/4_1/4 , Section TN-R W Township Al ts.-, fr - .A Mailing address 7CD Address of site ~y-- Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ X Yes No Is this property being developed for (spec house)? Yes ~C No Volume l/,i'~Jand Page Number l as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the o fi~e of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for he sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the fof- the County Register of Deeds as Document No. Signature of Applicant Co-Applicant IP4vi'6'e /'5- Date of Signature Date of Signature • •c~oav.~ coao~~ c-o~ooo~ co°ao~~ cvao~ cvo~~~ cvaoo~ c~ao~ cvao-o.~ cvodc~ c~.~y~ E - s Y ris A G ' E GOVERNMENT CENTER 1101 CARMICHAEL ROAD HUDSON WI 54016 DAM: TO: FAX NUMBER: 7 CL NAME: FROM: FAX NUMBER: (715) 381-4400 NAME: v NUMBER OF PAGES RiaMMG COVER SHEET: IF CaAE .ETE AND LEGIBLE INEU MATION IS .NOT RECEIVED, $ PLEASE COtMM NAME: irk TEEJ25ONE NUMBER: -6 4 ST. CROIX COUNTY WISCONSIN •I4I,~ if 4,_ ~ - ZONING OFFICE 11N01111119 IIM - ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ~ - - Hudson, WI 54016-7710 (715) 386-4680 TO: David Bracht FROM: Barb Prinsen~ St. Croix County Zoning Office DATE: April 22, 1996 SUBJECT: Copy of Private Sewage System Inspection Report Paul Durand, Part of SE 1/4 of NE 1/4 of Section 34, Township 31 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed April 12, 1995, Vol. 111011, page 2903. Attached is a copy of the Sewage Inspection Report requested by you this morning. If you have any questions regarding this matter, please contact our office at 715/386/4680.