HomeMy WebLinkAbout038-1035-90-050
I
•.:hs°°nsir Depamnc-I OI ConnncPRIVATE SEWAGE SYSTEM St. Croix
Salety ane liu U~`~~ Di'asion
INSPECTION REPORT SardayPermit NO SAN-2018-069
GENERAL INFORMATION (ATTACH TO PERAIT) Stare Par ID Nu
versonal ~n'crma7i::n you prc<,ce may to user: IV >ecc'Naiy Pm POSNS IPir:acy 0, , s 1- C4 tt',imil
Peurn t llomeis Name Ciry Village Tcunshio Parcel Tax Nc
I TOWN OF STAR PRAIRIE 038-1035-90-050
CS- 3l l LJer. I-sa RM Flev Bld Dena Pticr. A SectionrTrma Pangerhaa. NO
`i'~ ~/r A'~ Cl. ~ 08.31.18.158A-05
TANK INFORMATION ELEVATION DATA
TYPE MANIJFACTl1RCR CAPACITY STATION D BS1 HI FS [LEV.
SeP:c l.~_x- 1GY-CG Bell
^nmar /C73 ltd 9-
Dosirg Alt Blot
C~.w~=TC7 lU it% s
AaraMn Bldg. Sewer f~7S
Lti
Holding SUHI Inlet j
TANK SETBACK INFORMATION SUHt Outlet
Cr;
TANK TO P+L V:'FI L BLDG `een! Io Ar Infa<c ROAD D1 Inlet
Septic 3 3 Dt Bottom
Dosirg Heade0i
Aeration Dist Pipe
FIOICing Bot System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Mode, Nurrrer t 3 r' C
TDH Lot Fridpon Lcss System Head - TDH I
Forcemam Length Dia Dist :u will
SOIL ABSORPTION SYSTEM
BEDiTRENCH lVddlll ierath No Of I'en e'E-s PIT DIMENSIONS No .CI Pits 1,S.deD-. Lq.dDCDPDIMENSIONS
SETBACK SYSTEM TO P:L BLDG WFI I LAKESTRFAM LEACHING Marulacturer
INFORMATION CHAMBER OR
T'iFe O'5ystu"' UNIT Medel W-be'
.
DISTRIBUTION SYSTEM ~+C1 n
Ilcaoe•'.Ir,n talc, O,t,h_bar x An Sze xHole Spatmg Vent Is, Arlntake
Pire',s
I e~gih Gia II engm _ D,aSaamrg _
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
D,A-' Over Deat, Over xx Depth of xx Seeded+Sudded .x Mj[r.red
BedrLcnoF Cente• DedrTrench Fdges fOp5r,' Yes No Yes No
COMMENTS: (Include cede discrepancies. persons present. etc.) Inspection #T: Inspection #2:
Location: 2224 CABIN LN
1 l All BM C_scription = 1
2 y Bldg sewer length = _7L vt
- arrounl of cover = !j /O
C ♦ CI- G
PI2n revision Required? I Yes No '34 /
I.'se other side for edoitional information
Ua:c Irser,"t s 5iynaA Cert. No
SliD 571r!R.-?q.-
1% - :)c 1'S - `
County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
In 3=rd with Chapen t St Croix Coun7y Sanrt r, )rdinar- PLANNING 8 ZONING DEPARTMENT
Pc sofra infomahor ,you provide may be use *or secon ay ocnoses CROIX COJNTY GOV-RNMENT -EN-ER
(Privacy Law. S '.L 04.1 jimj) 10' Carmichael Rat;
Hudson,! l 54016-71C,
!7151386-459- =az ;715;386.4685
ALtaEn comotete pars for me system or oaper no' less than 6-t:2 x t t mcnes ii size
C,gµfi(y' . - Permh # :1 Cher) if tewsion lc p- roe iicaUon
S74i)-2018-Dto9
I. Aoplication Information " Please Print all Information \ Location:
Property--nnner Name / 14 '
1i4. Se: Z~
N. f R E to-~ Vv
°ropeny Owners Maiiinq Address < Lot Numbe' BUa: Nurnoe-
Gtv, State Zip Canoe Phone Numer Subdivision Name or CSfd Numbe"
iv 62 '-L~z lsyc) l7 ~~s - s~i~i v l' P v~y
II Type of Building: (check one) / malty ❑Viltage (g 7 'owr of
' or 2 Farrm Dwelling - No of Bedrooms.
- oubiicrCommeraal ld!•sc:ive urea. ,fit Ind. _ C~e,~~- S ~ ~i ~Cl~-vuJC t~
State-avnec Nvaret Rc;tc
It. Type of Permit: .'Check nn,}' and box an 6ne A,. Check 00x: On Ime E i' appliap-ei I I'
❑ ~c•~ rn
Par:f•Tax Numberls''
' UV~/ III
plumbing 4. (]Rejcvanc~r C~ 3 _ IO 357- Ye'
2. IF Reconneclion 3 ❑Nnn- _
Ai Repait y
Sam:ahoi
H) F--rind Numbe- Date Issue -y
Q~ Stale Sanitary Permit was oreviwsly issued yt~ 6 3 y' rJl~ O
IV. Type of POWs System: (Check all that apply)
❑ Non-pressurize- in-around i; Mound = 24 in stinaore soil ❑ Moan? s 24 ,n. s-rQable soi'. ❑ Mound A-0
❑ Sand Filler ❑ Constructed Wetland C Peat Filter ❑ Drip Line
❑ Pressunzac In-ground ❑ Holding Tank [ S:ny~e Pdss ❑ O:nci
❑ .At-araoe ❑ Aerobic Treatment Unit G RecrpSah•la
V. Dispersat•Treatment ea Information:
1 Design Flow igpdj 2 Dispersal Area 3. Dispersal Area 4. Soi Appl,atdr Rate 5. Percotauor Rate 6 System Fie:auor - Final Grade
Requires Proposed ksa!s.rdaVsc R'. !h4~r. ~nchl Elevation
300
3v~ 3CY~ i,a/. (x,37 99,E i
VI. Tank Information Capatcty in Salbrs Total : o' fAllufacturer Prefao Sne --on- Stee. Fide% Plastic
New Exstmq 'alioes Tanks Concrete sr-urred glass
-anks -anks
JAPW /e.C 600 ❑ ❑ 7 ❑
ess~ !>DO f 4 ❑ ❑ ❑
11. Responsibility Statement
1 me undersigned, assume •esDcisipiuy for repair'resmnenc~iosrrejuvenaGOn/ins:alfaiioa of non-plumbing for the P0017S sho•.vr on the attached pians. A
license is not reouired to- te:ralit repair or tie ins;allauor of non-plumbing sanitation systerr• _
°I .fir AS ame (p{inij-, O Plombt_ Sre i}s•,: rr dPRS No. Business Phone Number
rl !V ~1(1/' YrA~ CC Get/ ~~G~.$ 7' 75..
Plum rs Addi •ss iStrcut City, Stale, Zip Cc9ei -
p oz
_ .4 G4~1 y0o
411
VII:. County Use Only
isa proved rSanitay Permit Fee -a:e Isued sswnq. _en; Signature c sta. si
~Approvec Owner nAia .40vu:se i~ ✓..7 t[ ~L /fi.
tnabon - /J O
IX.,onditions of Approval/Reasons for isapproval:
~ Ca„~1; • ti L - 26t S'- o to t /eUl t~C~.d
2 Qom. 1~~l4,j, F ovr :a1 --5 Se ;c L~ /IIlea- t; t sS~L !j
4.) Te•t eL 4~ op~ to rL-X..x_ il`-,lam s±ea e L. i SS.IL_
Qe, eoroQ 6c.m...•.c # /n Cron^. d-+w rto //vum 1.
O V L c..s.IL tiw dJ 1-U r Ga- rv`.."t ti ta...v1L Y
Rev W05 6r.4_ aQ 7aA~ 01004-- ly- C l C 0 rr NL-- Gp✓ n Si 9 wr~vl r A.Al _
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ST. CROIX COUNTY
SEPTIC. l:/=~' T~?\=~\C Ur^~.ETr d 1
A- ND
-3 A
97
T✓iLia_ ^.aesc 5 75 ~1 NOz--~-ra~, /i-'~<u` L,e-e.~ S SSG /
CV o a oc.esu y i oc iarn c_ 3 ] D pa-~ cn: io: n::u u uc ua.`
038-~o:3c USo
Ciy'Sra~ SpY~ .v _ P r. i; ~ ca~o~?vmbor U._3~ _ /0:5`/- 95 GoU
LEGAL DESCROPO,N
/V t. i . 5. S~C. CJ U 11'. _ OC~'1 OI ~ A~ (-Certified Survey Map 7~
R'arrai Deed
j.,9 hOL•'iC J VCb~h L.CA 11DeF 11'V ii:i.L~1e~( Y---S nc,
SYSTEM ATALNTl N,t\CE ONR T.R CERTIFICATION
nproner and mitt-r;ance : yos : ?tic sys =r„ cc'U'. resit n D-etnanr 'al}ure T.- i:ardie wffit--.
tna31 `:2nce :DeS'S'3 of "urnain_ -a'il: et'^-c t:ut::e t'cara :c sooner, if nc:as'1 CN a ii CI:e d nunpcr. R-h= VDL ; tr. int,
t_he _-VS~:.>r can i cci tue ~unct3oi oft:te septic tZal: ac a in ae way;, cisrost:] s}'son. :,-wDt.
res an b'1JC5 as spe ,,`,ed i] and m Chap---r 1=. S_'Cr -v-, C<rnrt Sar_ = Crdmarce.
":~he?rontr:} rN]esa=_ acs t slbnit tc S:. C::•a Cnty ?:,~niL $ .onmg caa~cnt a ,off roc o}'t6:
owner and n% a =L7= ptunbe iou ne_mar p:unb es is c 7+i= h:7 Ur a Lce ed :,umnar Vc-, ,a bW i orsite
L J.] p-ope7 0-:1-7ilt1111_' ,a.,lti:n and 17 i c.l uc eV nn and n:i" •:1M_ f ] .eSSa]":...LC ct!:6C ur}.:s
le~z 7nan l: , fu1 of slud_c.
L t, _ae . ,d °yiyed h2VC- tcad'LC ab:rve :fl:!-&emenz a_nd =tt to naintam the nrv:=c sex2Ce di mx-,' s stn with tat
s:-ndars se' ic; ei:_ sat ^t ;h: = e_~i~teat i, S cr And ?rote»ic-yl jer,iccs and the. 7:~a-non: of:':atr. ai keso:>r:.es,
;,ad-.q :.`,at zr septic :~,sur a be= m&L= Ded n~-r. be c:,n-,ic±cd and r-- Lmed -,c. :be k Crea
Gnhn`.\' Y:ar_7-n; ZJU'y£ -)e-)2--Lm 1i uT~tn = nr'S of tnc• u:: :t Vni e)';,ira:~;,n cat::.
. PC ".°7. ' that cl. C axm TI'S m i5 1' zct tni_. to to b- om) r sx 1sr,wit6et. Lice am'ar--- the N ] S I ^f the
.Y(=n , d-3-.jt, cn t'C. bt Nj--= .If a'A'X i d-"4 in :):Da*:ds 'D5=.
,Number of bedrooms
n
1CN ~ E Cr =YPi._C'~~ D.'TE.
y :07G27that is IL`:; r.nrna re;Llt ii :I`_ 53^.]'•371' nerS.it hei:lY rev.~i51 ^S Je YiaLllirs 7:11I'J9pat?17 C]L >x:
Inauda w7 n IDS 37JIcatjx a I -c. 7J9 wa:,-aa-, J d 5-3m me F:es:ar o: D,='s G-ce anc a coo ];:Jt L.: 17B_ 4 ty ma:- if
:Cf=-X!t made S 211 wa.-.nn de":
RFC'. 04'1.1
l
ST. CROLX COUNI1' ZONLNG OPIYCE
CERTIFICATION STATEALENT
FOR UT'ILIGA 1 ION 01: FN IS I I\'(-; SEP FIC I ANX(S)
is L_i u`" " 4 . _1c 1I >l?, JLC~ _ SJr71: and x- &-s-
1 06*111-
J'r~111
SO-'LoUal caI d
T- \ R anLe /S
TpF t 5 ` ~/~C~L 2 ` rt l OLL7L V1 C01~
Don insp.ai~,=. I X11_• r i~c Ii,l.:c~ to - .<~~i, to the best ofi,
2>_ Ln6
= i to be L- DCil D:
~\SOGt r.°Cc'rl`.. d3i.~ :ij Ill ~7~....fl ~~-•1.. ~ y
r1:d y)Q it' ]•%8C): ill. J'_r t?;111'1 11.;C'11t1 C'n >>"'~'at:I!.~ i
i. no.
]ate i-c)Iume or Icu_ of ti lle: lcn n ::I_;es
Twnk Canacin: UdC> -
ConstrlcaOIl: fret-in C.O_iC:rctc \teel _ C)tle-
arutacr.:rer 's :i lov."n (emu ~z ~
c I Tani l ; i: _070 0 -
er/_ tr~rr~er{if) ii l U,9G _1
L'_icer.~ c ,'Ic:r_:her ~ __1a^lre~ ~ ='ri;•.t \am
Il?~ _a~~~3~F7
Da,
Fo= to be compi~n--1 n_,
1 if 't or l can cd di_pc
s. s :o-lsln :es) , s c s:r i _~R - - ; r, isconsir
ydr_unis ati; e Cori i /
~ye e~^ 6(Jc1a+;.~q ,Orcp * ef a° fjc~ 7 51/8
Wisconsin Department of Cen'n1B1tie , PRIVATE SEWAGE SYSTEM County: St. Croix
Seloy and Building Division
• INSPECTION REPORT Sanitary PernW No
GENERAL .INFORMATION (ATTACH TO PERMIT) smte Plan ID No: 395231
PeroaW Mametion you provide may be used for secondary purposes (Privacy law, s. 15.09 (1XMIJ ~
PemY Hofdefs Name: city Vilega Township Parcel Tax No
Hielkema, Harvey Baldwin Township aj - 2Ld
CST BM F.1ev. Insp SM I SM Description
/aa3!,-~ Z 35' j
TANK INFORMATION ELEV ION DATA
TYPE MANUFACTURER CAPA ITV STATION BS HI FS ELEV.
s{ If cs~[-!N NaT 0n
Septic Benchmark OL
fl
Z~e of ~rfn•LU U -7-9 Dosing $OD AIL
ton Y Bldg. Sewer a
Holding SUHt Inlet
/59 3
TANK SETBACK INFORMATION S(Mt Outlet
TANK TO PIL WELL BLDG" Vent to Air Intake ROAD Inlet
JD-7- I
Septic / I Dt Bottom i?o
Doug / der/Man.
~ _ CT _Z
w/.yL~/) 4tVZ4
ell 3
Aeration at pipe
--Fop Holding Vf- BoLSy"I t-0) y d'3 !O /
Final Grade ly.ln.
PUMP/SIPHON INFORMATION -{TM sG^'`'6 Sfi /O!o •SL
Manufacturer Derna d SIC
Y/ 0 9
GPM V A+
Model Number
/3 G•~s /pZ.ly
DH Friction I.
17
Sys Head DH Ft
(o Z3 .
Forcernaln Length / Dia. A nisi. N wolf
Z Ai /n/ y&:7-
SOIL ABSORPTION SYSTEM 3 J / S on
BED/TRENCH Width ( Length v Nn OI TrggG~es PIT DIMENSIONS No. OI Pits Inside Dia 'quid Depth
DIMENSIONS 1 ~.fld
SETBACK SYSTEM TO II& BLDG WELL LAKELSIEZ LEACHING Meaifadurx
INFORMATION CHAMBER OR
ype0)Systarn: - ~~r t (A' UNR Model Number
DISTRIBUTION SYSTEM ck
FleaderRASnaoW DislnWtion X Hole size X Yule Spacing Vent b Air Intake
I ! L a rims al / r / / f r 3!v
Lergn _y_ Die_ Lenglh_ l! Do Spacing `!~7`O
SOIL COVER x Pressure Systems Only xx Mound lbr At-Grade Systems Only !
Depth Over Dept, Over XX Depth of r Suoded'.XURJ Mukiwd
BedTrm,pt Cartier SaNImXr Edges roo" ',M1 Yos No a (I! Yet; Ljf No
COMMENTS: (include code discrepenries, persons present, etc.) Inspection pt: 11 1111 to-1- I p2: L
Lo tlon: 2122 90th Avenue Baldwin, M 540D2 (SE 1/4 SE 1/418 T29N R181M) NA Lot NA ~K IF Parcel No: 182111
1.) Alt BM DeSCdplion = 15 f- Ce\J64 4 yep ~n . bl o ck of 0 rqe4 r 1-
2.) Bldg sewer length =29-
-
arrant of cover = / ltrlaf.dtOls I~ ~►[s~nC~.cfse~. 7[~+-ct ~InQ-94~G3.) Contour = / D 2 •V I h/~ cunt fvt~ a..~.a ? s ed (l
Plan revision Required? IN
Yes - - r,
Use odw side for additional Information. _ (,f,L~~ • I
SOD-6710(A3197) Dale weepcines SgNrbxe
De ent of Commerce
Sanitary Permt Number
Sanitary Permit Applicati ,,1,)w . r 3c 3 I
in .coned wi& Comm 93.21. WU. Adm. Code. per= info Provide ❑ Cbeck R Revuim
AL-
nay be used for Law m
L Appticatim Information - Plea me Print All Information ' ) r
Prop" ownee, Name / 3 ~pp1 eel Number
prop-,M- T •a fAuft Adders ~_,~yg~ 1.oauen all *30 0
J U S k $ L Cif l p ac!~"^"~ S6' u 5f : S /d/ T/7.C q N. R - ;Al City. state zip Cade / . Los Number Block Number
SadaBvuioo Name CSM
~41G°w 'h w,' S~/~Z S~Uo2 ?ly ~i~~( IFSv
H. Type of BWMhns (dw* all dust M*) / Dilly
c 1 or 2 Family Dwearg - Number of Bedraam Dvoiw!
( ) PubWCommescial - r-rribe Use ,0 ~ w ,
0 Sraw Owned Nearest good ✓
"p Ch lj!/G
IQ. TypCr ofpermit: (Cher'k mlf ease beer on line A (msmbe ing acbeme f" latesnW use). Compote Bm B if appBcabie)
A' I Il'N/~ ew 2 ❑ Replacement System 3 ❑ Replaxmemof 6 0 Additionm For Cermry new
SvsllM Tank O ' stem L..
Uase Issued
B. ❑ Ciuck if Sanitary Pemrit Pmimsll Issued I Permi Number
IV. Type of Permh: (Cbeck a0 that apply)( baft atime is for internal use)
44 n Nm-Pressurized InGrmrd 21,W~, &cd Q D Seed Filer JO n Coaled WeWod
22 n Pmmtnzcd In-Greed ♦1 ❑ NoWmg Tank 49 ❑ Single Pass 510 Drip lice
45 ❑ A")Mk 46 ❑ Aembic T ra mna Uric 49 0 RecirevIUM 31D 0 Other
V. Area Information_ - _7CkA . C,
Design Plow (pd) Dispersal Area Dispersal Am Sod Appfiorim Porto loo Ram Synder Mevanon Fund oradc
Regw3w proposed Raw(Gds.lDryalSq.FL) (Min.nacb) Elevation
600 603 VL Tank info Capecay in Taal Number Mmfacauv Pnfib slat sled Mer PlasUe
Gdlam Gagers of Tanks cowax Cassnacwd Glass
Nw Prises
Tads Tads
Tank L/ - J 2~ (.r/i e P r,
Sht~eot- 4 the sass aft fur Wits" M of Ile PDWIB lbws on the attached pRrs.
P4rmber's Nave (Prior) m"mre JfPIICIPRS Number Bnsnea Phom N
oe (if -f - ~23~(7)r ors C S/LG
Pk mber'a Adder (Suva. . Slaw. Z.
y
rU 41, l(0 4, /~i2 ~Go d _
VIII. Cmmt Ile oast
ICAppmved 0 Disapproved S>n Pesmi Fke cmciadea Gromdwaser Deer ls+oinR fpent Sipmsre (No Suosps)
D Owner Oi.ea Initial Adverse ~ ~ Pee) c fac7 Z ° / ,
Demo:xmieerion
IX. rat of App wWIReasom for Difnpprmal
wclbr~ Fin. A, rL S .
~Yl~( (~rw> ('s rx S(+-% ~CA h'l l juw N0,4 A
~Q ~ ~ CS
r. dAIV, pirbtke -wo rthe mom m wa el/r all Ydac`Joe
SBD-6398 (R. 05/01)