HomeMy WebLinkAbout030-2116-00-200 (2)
Stl" " ' ISm", , - PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT " °'ary Pe" "NO
GENERAL INFORMATION ;ATTACH TO P-RIOJTj P. I' No SAN-2017-404
P,- 'I :do:-n.ri Ein 11i ;,,id, n Sy ~
.s-'e ;econaar, F-'I (r ,:,:.y tI'`wl
an i'.'ASarr=`.amr i;dy aye lo'nnsr,ip P..., Tar Ve
White Eagle GC LLC TOWN OF SAINT JOSEPH 030-2116-00-200
r ,T Gr,' Llue Inse. 31.1 Etcv BN Uascnp;io,' be:xOm Im•: ~a'c Nl.lap No
7(0 Zn 31.30.19.9576
TANK INFORMATION ELEVATION DATA
TYPE 1,1,A N-rACTURER CAPACI fY SiATIO', BS HI FS Fl=':
Septc (Occ &ene'nnark
ell
5000
Dos r'_i v 1 I 5 /aor--~ All. Urvl
'F~ D I O C_ G~j I r~Ul O
•..ran:n .'CC --T-' - Bldg. Sewer
5
,rbf r; Sv+,l Inlet
TANK SETBACK INFORMATION Stau Oullcl
i%KID I L ;4__ ~~_ir; rI e'ca W'AD D1I4Ie1
Z t. J
, M1 rn aruc•,I
ik:'a11en Ulsl PIN: I I
I
r1,116l Hut Syslnal
PUMPISIPHON INFORMATION
dnu`,SC:dT4 ha'nt'<i St (:i:vci
cn as
bluafcl rdumbcr r~
eal,~ ~a A
-DIi LIf! r',Ntoj)LOSS sy'sterl ll ad 'IJif Ft
-crceman L." ; Da. Dist lc-.110
SOIL ABSORPTION SYSTEM
DEWTRENCN v."9t^ -nn'n `JC :il hrnchr:: PIT01MENSIONS Plc OI I'M1S nsid, ❑nvIn
DIMENSIONS
SL18ACK SYSTEM 10 BLDG I AKHti I HLAtv1 LEACHING 1A:r ul ~:9u of
INFORMATION Igpu fll $.y :I:r,r ✓l - CHAMBER OR
UNIT Liccei N.. r,F.cr
DISTRIBUTION SYSTEM
Hale ! panng 'Vent o l,- tar,;
Le ,t ~ia I i]In :La Sp.u:erv;
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
n':'G I Copy, P;~>, v cep:h ct _ d,..: t.,:Ill, .z slWaln__
R,: :T, h .:or Sol
c, t.e No
COMMENTS: ; hctude coec• c screpenGes. parson:; :,'rscra r:lc i rl,pcdlon al Irspectio•l a2
Location: '953 CTY RD V OR 129' C~ta. ti /a E
1.1 All BIA Description =
2.'I HIr4l sewn IOnglh = 5
artloUnl of cover -
L o n 2.!/CI IYI- I
Plan revision Heya:red7 Yes No Use UPIU' s de lo' addrtlUna: Infonnat:ml. 4 Z7 ' - - l ~ /
Date I^sc:°a Sionak{/e - ::en No.
SBC-6' IG (-r; Fry; i -
/
V'qvV -')V o - I/ C.
~Cy County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
In aooofd vAl, Chaperl 12 St ✓oix Cocny Gai:tary ' Ordnan e PLANNING & ZONING DEPARTMENT
Persona n-Ormabon VOL provide may be used for seooncary purposes ST. CROIX COUNTY 3OJERNM=N7 CENTER
[Pnvacy Law. S Wit m)J 1101 Carmichael Road
Hudson. %Vl 54016-T'1C
S,, i715386-463: Fax '715,386-4686
R - Attach comniete p.- gHGVT5CXYR- 6.7 2 x 11 inones in sze
CU 'County Sanda•y Permit W QF Q _--e aslon tc previous application I C 0), 16 - c1C - ')L U
1. Application Information ase Print all Inform on Location:
Property Dwner Name / -
1+4 , 1;4- Sec
N. R E (orf VV'
Property Dwner's Manmg Address Lot Numoer B.odx Numpo'
ii
:;ity, Stater iF C;ode Phone Nurser Subdivision Name o' CSM Numbe-
II Type of Building: check onei airy Vil:aoe i owr o:
❑ 1 n' =artily Dwelkrc - Nn nl HenmurTl .
PUbIi:JCUmme'Ci31 ineSnnDe USeI L
❑ Stauz-cvwd Nearest Road
L. Type of Permit: iCneck only one bo) . on hire A. Cie:i, be): or pine 6 i- aopiicabiei - 11
oarr,el Tax Numper.:,
A) - .❑Repair Re;;nnnent:oc :.❑Nnr-pl,vrbmg 4❑Retvroenat or
Sanilalinn
B) Permit Number Date Issued
15f State San3ary -,-rmd'nas previausly .slued
IV. Type of POKT System: (Check all that apply)
' ;E Non-Dressurizeo In-groun- ❑ Mound t 24 In. suitable so' ❑ Mounds 2e Ir. sui;az e soil ❑ P.7oanl A
❑ Sand Filter ❑ ConstruC:ed Vvctlanc ❑ ?ea-. Filer L Drip : ine
❑ Pressurized Ir-grDUno ❑ Holdrig 7a-e: ❑ Sing* Pass ❑ Other
❑ A--grade ❑ Aerobic l ca:~lun: Writ ❑ Roc:rc jotorr
V. Dispersallfreatment Ara Information:
I. Desi_on Fio'w i;gpol -)&.-.rsa A'ea Dlspersa Area Sn:l Ap[:iicatrun Rain Pe:-oolatrDn Rate SysteT Elevation T. Fina G'aoe
Reowred IPrannsed (Gals :dayvsa.Y..j Wsn.;incni . Eievation
I. Tank Information Capaintx it GaYons- Total # of Manufacturer Prefat Sle Cor- Steel Fiber- P;asb:
New Existing Gallons Tanks ; ; Conc ete str.rctee. glass
Tanks Tanks
rTM ! `.7 ❑ ❑ C -
VII. Responsibility Statement r /lam C <
the undersignec assume respDnsibi6h. for reoaidreconnenctionlreivvenation'instal.ation of non-plumbing for :rte POVv7S shown or. the attachec {)tans. A
license is no-. required for terraiitt repair n• the instaltaron of non ptumbmo sandaron system.
Plumbses Name.; 11 y Piumber5 Stgcatutd:; r>t5tampst I PAP:M>RS Nn. Business Pnnne Nua:ber
Piumt Aotl ss Street :;iy, Star~..Zlp Coder ,
VIII. County Use Only
C:n:t"'~ verse sanltay Pefmlt Fee e ed SSUin; '-r.t J'gCa re ( sta
pproved . ad /L SssJ 7
IX. Conditions of Approval/Reasons for Disapproval: / J r'-/ t G a
SYSTEM OWIM11: { J ✓ f oN~.
1. Soplw: tMk, tAkx't: lilfrrrrkl 2, !j'1 f yi~
uix~en Ceti suet all tx a4 is -n! er f 1 4a~
as per rear ayemen' plan p o nag-: W ylu,noe .
2. AL rrefwk reeUreln11116 malt eu 17.'..nt: ire ` r v ^ O
a per xKkvbA cod'=. ; :Kn r 'to 3 J\ ~7M1 G V%V- r A + "Cyr
S 4b ca
Rey sr05;1,% s loestAe'Ir. pfe~;o.7b • /a S a GeJS
q 1.~ 6
-fc z ov~..1, o!'i,v .R LaeleS ~e~~:r e✓~
45+-7
r
- 7fl~Tv~~)f - ✓o:~J 7t%zJrv - ✓a..l rkz.se~S* - !S8't`'~,r~/ /'Xs; x~ ✓u X34
7s = ~ ~~i- 7917
I_
/G - i-',.~e .S~c,Jcx'.s /GJV~•%~~ si,,nJru'- ~ ~~~;r~y - LSD
$D.- lsF' G~si/.vtifHrC- roJN nlla/re~,~:✓t7.e'! _ ~1i0._~~+----- -
3~.3oyr,✓ .e' %8'/S~.a/~,.a - /'/.w Us.~ U/- .~Scoy.r/ f✓;;s~.~,~ ,5d(~ i~rrrs
4 y,az s Z,4,60-,, //a! -/-/GO
SG ze DTs .x /o yCS/a y x /o7s = /GOO q,~ - fi x k ru /OLbyA/ 4) ~ ~s~t TNrI
/4.~ /e 4~E --•cJj1 BLL f._%/.i.C- ,~1.1t~ ~X-J" c..'/?/~..,
3~G -yT//,oy -s~ = 8G7S,.,,a ~,~.r ✓~osE _ - - .
>4, Ur: /Gs~S j,/ f 'i~ss Ft r1~J
3 13
15 a~l 7/L-
s's .ter oa':: w
sy,s~;., ~ - y T`ew'~ w, /8 (¢fx:. /Y s.oc''aA%~otl ~//~.rs - 7-,a7 76. <8
11_:x3 12nt hLE EXCAVATING I
i
/ocny./ 1
9~ru;.k
i
9 At
41
~,ra o x .
A
CV
rz sin DepartmentofCommerce PRIVATE SEWAGE SYSTEM °On1. Croix
l~+o'l31%ngs Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) saona3SNO:
Persona! Information you provice may be used for secondary purposes IPrvacy LaNs.15.04 (1)(rnh.
II r, 1' Namr•. Clty Lj~ State glen to NO.:
1Y11'HfY~ 1~, `$'~`iJo'~eT~Pf"fbwnshi
C.St Wiley- - Intp HM Elev W Detcopt,on* I'afCebtliO'll16-00-200
TANK INFORMATION ELEVATION DATA _
TYPE` MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 'Z _I )r9D _O r
- --*IY~Tfi- -
Dosing
Aeration v~ Bldg. Sewer ~Y^
Holding l.~ St/Ht Inlei ~6
TANK SETBACKINFORMATION ,✓<Itt'r, -;~+h ; St/Ht Outlet Ev
TANK TO I !L WELL BLDG. AirIntake RbAD, Dt Inlet g
Septic I NH NA Dt Bottom
Dosing NA Header/Man. L,7q % I0-13 .°Z_c(I
iefa Gilt' ;1 NA Dist Pipe ( z tG I o ~w.r =lot 39
++oldIng ' Bot. System 12. `f3 100.04'
PUMP/ SIPHON INFORMATION rn I Grade
Manufacturer Demand - tom 1~•} 6-z +u•f`{ ~f`l'_g5 f
Model Number GPM--+r;,I k3o =qo qS
TDH Lilt friction Mead TDH Ft - f~q 30• IB~ I • I~st
Loss Forcemain Length Dia. H Dist Towel[.
SOIL ABSORPTION SYSTEM _
BED 7 TRENCH Wnlrh Length Nn f Trencher PIT No 01 Pelt Inside UiaU uld Depth
DIME"4St4 - DIMENSIONS. Man 17 to -r'
SYS FEM TO PIL BLDG I WELL, tAKE/STREAM LEACHING
SETBACK CHAMBER 'M. e. NUmbc'r:.-
INFORMATION y emT'.
System J fV ✓ ~5, 1 !360 OR UNIT
_ t"
DISTRIBUTION SYSTE y,4'J/'1A cJ, > b'D
II`4d..0Manduld tfRrr6'19 pe(s; ole Slie x lln'e spa<Ing Vent TO AK tniak~~
len U Uw len th O.a Spaung ✓ /I P
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 7
Depth Ove, Depth Oxer xx flepth Of xx Seeded/Sodded xx 10o111t,
{I(H'ediT,cncl•CCnter Hed: bench Edges Tcpw,l 1L1 1='
l_OMMENTS: (Include code discrepancies, persons present, etc.) b pr-:t 2-1 zml ~
Location: 1297 County Highway V, Hudson, WI 54016 (NW 1/4 NW 114 31 T30N R19W) - 3130199576 _
Lot 1 (f ) {f~ C11~/lkotif~l
1.) Alt BM Description
1
= ~C ~s Lit s - 5 t (L 101-3T
2.) Bldg sewer length l
-amount of cover
C'. to .0
~f ( =
VSpr t~ S`llS le e~4vu~{w : "
3~ c ~ e( c'J.
11Ian revs n required? es) No
Use other side for addition gtinlormation
lL-) Cert No
SBD ,710 (R.3l97) ~ Uate Inzvecto(s Signature
Wisconsin 'Department of Commerce PRIVATE SEWAGE SYSTEM ourtly:
t Sanity apo Buildings Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No
Personal information you provice may ue used for secondary purposes (privacy Law, s.15.04 11)(m)). 383935
Permit Holder•s_Name: LI City I 1 Vdlaye ❑ own Of: Stale Plan ID No
While Eagle. GC LLG St. Joseph "Cuwnship
CST aM rlev Insp BM Elco BM UescnpUcn Parcel Tax No.:
LP :2
TANK INFORMATION ELEVATION DATA _
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1,AJ 60 Benchmark
Septic #2 / r 5 coo Alt. BM 3• SD lOS G
- 103.
Grsc Intro /DOD Bldg. Sewer Z
Dosing St I Ht inlet L /0/. A
TANK SETBACK INFORMATION St IHt Outlet 0 -
1ANKT0 P/L WELL BLDG. Veo1 tO ROAD p o
An Inlave St i;2 Inlct Q . 0 'p
5 1 ' NA St a2 Outlet
Septic
Septic £72 NA Chaise Inlet _ 3 (Q2. Q 7 _
Grsc Inircpt NA Grease Outlet 162
Dosing Dt Inlet
PUMP/ SIPHON INFORMATION DI Outlet
Manufacturer Demand Dist. Box
Model Number GPM Chambers
TDH Li (t Friction System TDH Ft But System
Forcemaln Length Oia- H Diu Toweu Final C'r;lt(o
SOIL ABSORPTION SYSTEM
BED/ REC w.dln length No Ot 7renr heS PIT N0.Ot Pits Inside Uio Lwu'd Depth
DIME I INS DI IQN
LEACHING
_ BLDG WELL LAKE/STREAM
(5f o a<turer. Mo a rvum cr.
SETBACK CHAMBER
INFORMATION lype SYSTEM TO P/L
OR UNIT
syuem _
DISTRIBUTION SYSTEM
HeaCCr %ManiTnlA D411100Cn P~pe(s x 1101P Site x Hole Spauny Venl ru An Intake
f I enylh _ Da Le0rglh _ Did. Spacing l__-_ -
SOIL COVER x Pressure Systems Only ■x mound or At-Grade Systems Only
Depth Over C1c•Uth Over xx Oepth O+ xx SeOdetl: Sodded xx Mulched
Bed: Lenrh (enter eed!T ranch Edge$ 7eptal Ej Yes NO El Yes O No
COMMENTS: (Include code discrepancies, persons present, etc) Ins action"I: /?7 Inspection ;;2:
Local(un: 1297 County Highway V, Hudson, W[ 54016 (NW 114 NW 1:4 31 '1`30N R(9W) - -Lot
AI: BM Description-'is11 dr v~eC~r.(. (xAd
2.) BIdg ;ewer length =
-amount of COVCT =
Plan revision required C] Yes No F ~I 1 I
Use other side for addi tional information ~J
Date Inspector's Signature Celt No
SOD 6710:F1.1-97)
I
r--z
I
r✓
~sb ~l
I
i
I
Sanitary Permit Application Safe & Build;l. 7,2 7 ings Division
' I In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
Sec reverse side for instructions for completing this application PO Box 7302
isconsin 1'crnnal infirunation you provide mny be !!snE for .ceumdarc purpuacs Madison, W1 53707.7302
o a•n'<rtmenc M Commerce lPriv acy Law. s. 15.(91 I1(tn)1 (Submit completed form to county if not
state owned.)
Attach eump'.cle l:larr. (to the county copy on ) or the system, on paper r.oi Icss than 8-1.2 x I I inches in size.
- -
Coun:V.~ - State Sa:~iwv I'cnnit Numbcr U Check ifsvwon to previncs application Stale Plan 1 D. Numbcr
ir' 383 3(0
1. Application Information - Please Print all Information Location:
Property c cner Name ProNity Locati:,n
-_.~C~L,~~ 1:4 j:; ]!4. Sam'/ TJ'il N. Y c (n
Property Owner's Mailing, Address Lot Number Block .'umber
Can, 8 2Ip CCude Phone Numbcr Subdivision Name or CSM Numbc,r
1 S
' ; cs^~ b~ZlZb R yobl
It. Type of Building: (check one) n cl
Ig I or 2 Family Dwelling - No. of Bedrooms' - ~ ❑ Village
~PubliciCommcmial(describe use):_ ! ~iLgtes't ID tbwnof
❑ Statc-Owncal c
( Nearest Rua!
C~ k, ~.,,5P~ CCX~~ L~ eu< /Id Cln Pnral Tax NumbcKs)lJ -~O'Oll16 -J'
111. Type or Permit: (Check only one box on hne A. Check box on line 13 if applicable) • j ~ `i ~ 7
A) ( I. J~! Ncw - Rcplaccrnrnl 37-0 Rep:acrmcr.t ni .1. 5, 6. ❑ 1ddilinn lu
System Svslc;o Tank (h::v Pxisling System
I'crnm Nurnha Dale lssoed
❑ A Sanitary Permit was prcvionsty issued
IV. Type of POWT System: (Check all that appiy') it-D C . r,J4er
2-
)4 Non-pressurized In-ground ❑ Mocnd ❑ Sand Filter O Constructed Wetland
U Prcssurimil hr-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At-grade ❑ Acrobic Treatment Unit ❑ Recirculating ❑ Other:
V. Di.spersal/Ireatmenl Area Information:
I. Dcsign Flaw (gpd) - -1_21. Dispersal Arca i. cpersal A rca -0. Soil Application 5. Par-,A usion Rate 6. .S)'stem Llm'alion final Gradc
Rttp:ucJ frtg Uin•scJ Rrt (G:ds:day'sy. R) (Min.' n'bY /~0. d GlcvG
L V L Tank Capacity ill Total H of Mam!fact ver Prefab Site Steel Fiber- Plastic
Information Gallmli Gallons Tanks I Con- Con- glass
(I)(`New - Fxistmy crele strutted
I-anks 'l arks
L/
fi4 ❑ ❑ ❑ ❑
J,j
Vlll. Responsibility Statement ^
1, the a dersigncd avumic responsibility for m+ la ru on of the -0N'TS shown on the attached plans.
C I'Vumhce . "ame ,m Plum r s Si w s NPiMPKS Na/ 1 ~tsus~incsi Phone Aumbcr
j hbet'sA dress (Street, Jn)•, Stale lip ode)
d
~ IX. County/Ocpartmcnt Lac Only "
d ❑ Disapproved Sanitary Permit I'ec (12!dudcs Groundwater Dale Issued I<sJ~mg Agar Sigru;urc(No swops)
J• •Appwvad ❑ Owner Given Initial Advers7c s ge fcc) Of)
Determination 225 - l `ZG "jcD !
X.`Conditions o Approval /R~ea~snsI'for Disapproval: }J f
T l~~'Y, CV`w~~~CV\.f~lV•.S•ISM G V~ay _'rl i ItAl s- .<wftnd-/` )~hMQ4 h C(:
e/~tas u(nc a~(.nCc Cpc ~I c~ 4 k l lid rd t (c>e~ c aLLxclc~ vv~y lea 11c,i>rV C.
~ t7~~~ (t nr C~4. C~ V^L-W.1Sa1-/ak AM/(b-_ !N^ dQ~l f» IO~ -R 1(G L/; / ,yy I
G - !k~ OY.@l~ ):Sa-~ <e-l. <'~\CY-/e.`~.~9I ~waA, , x 7-F. CT 1 .Ci,+rt Y- t tP(y i i~0_ ~+i. I #F
6v- Oawi OF TYS k/RZ '1 ter 'i. =ei ~".Sf or ~c -R' w',II lire 1.>~' a;.. L
SBD-6398 R. 07;W C!-Ae an.ct, ' ^1 ` v? r(v 't d( Ib .•,,.,i#,,n eye a _t~aQ ~<•Si
~s~ (H zdtecwxt- a1k:~-'E<>6~. .,£.rCfr<- 1 it L-t r
Yrc Ji n,S -f i,o 1`"w is r q -.•..r•vtl (..fin'. ri CaeCr fn:•_p .a.1 iy ~{e... 1>i2et(' trr•r Este `~u,4tf_LC Servieg-
SITE PLAN
-for- WHITE EAGLE GOLF CLUB - y- l -
-of- 316 WHITE EAGLE TRAIL,
SAINT JOSEPH TOWNSHIP, WI SM16
Sex
NORTH
LNU'YK a.~LL -
• . . ~ ~i 1M~'-ham ~
%
f)wvt.
TOHum I tom.
OPNCNI
C' ck,
\ p
\ v
\
SH BOOM= AND TOPODAM IBM
SOafIH1MO0HIW1MH10Pffip1t00 lf0 fYr
. e...._.._ gSM M
Pmfe ioml Land Survoya
6677o6 LaLake Mtve kev6 Is SWfe 116
14MI) nme ruM0..
SITE PLAN VICINITY MAP
-for- WHITE EAGLE GOLF CLUB
_uJS32'Sn `F 1
-of-• 316 WHITE EAGLE TRAIL, +v.vo
SAINT JOSEPH TOWNSHIP, WI 55016 L'
' JoaJ, L r?.
t" .
. r :i r. (z`Cn CQ.1-Y. J.ISCO~CrIs _ '
I a
a~1 r - NORTH W ~Y
lf'r♦fr' \I rl YC _ - rte, '
• 6
rtiVC
- ei LEGEND
U'11V
" La IEOaS NF1r0.( / - •
"4N jAEP aPa01 '
fu f. fgSLIG :/11h_gt - ♦
i 3 far n
1 :1 1 E vp 1 H-F - v.
a- ( ♦ d1 L" ♦ v1- N' t r
` r...
TREE 0t1i ME
BENCHMARK \ \
iv
T.
1C`
N Jj
> Ny,
V
as
SEE BOUNDARY AND TOPOGRAPHY NOTES
SURVEY FOR ADDITIONAL INFORMATION f~
'T' t
PROPERTY DESCRIPTION
Professional Land Surveyors
,m 6776 Lake Drive NE Suite 110
Lino Lakes, MN 55614
Tel.1651i361-6200 Fax 1651i361-8701
17831CS
f`c. I g~ • II ~ .
_ a
M
cp,
n
G.
,N
- Q 1 r e e i ' ~ 4 t
4 S
-o
m A
:T
1 p Z
o D
H T T T