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HomeMy WebLinkAbout032-2114-40-000 Parcel #: 032 - 2114 -40 -000 08/01/2007 04:16 PM PAGE 1 OF 1 Alt. Parcel #: 3.31.19.1052 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BENOIT MOORE, CHRISTIN M ` CHRISTINE M BENOIT MOORE \� 2334 53RD ST SOMERSET WI 54025 (` Districts: SC = School SP = Special Property ddress es) ' = Primary Type Dist # Description 2340 D ST SC 5432 SOMERSET SP 1700 WITC Y Legal Description: Acres: 3.280 Plat: 2 - MEADOWOODS LOTS 1/1 98 SEC 3 T31 N RI 9W NE SW LOT 4 MEADOWOODS Block/Condo LOT 04 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 03-31N-19W Notes: Parcel History: Date Doc # Vol /Page Type 01/18/2007 842798 PR 01/18/2007 842797 DMLT 10/25/2000 632375 1553/331 WD 09/21/2000 630330 1544/472 WD 2007 SUMMARY Bill #: Fair Market Valu Assessed with: 0 Valuations: r,' b #st Changed: 0712412003 Description Class Acres Land t ; Improve Total State Reason RESIDENTIAL G1 3.280 52,400 0 52,400 NO Totals for 2007: General Property 3.280 52,400 0 52,400 Woodland 0.000 0 0 Totals for 2006: General Property 3.280 52,400 0 52,400 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce y' Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count St. Croix ` INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3BQ / �Wo.: Personal information you provice may be used for secondary purposes [Privacy Law, s 5.04 (1)(m)]. Permit M & G Inc.s Name: ❑city El vige Pse$"�"o ° State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel TOAI0,;114 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BTF Aeration Bldg. Sew Holding St/ Ht Inl t TANK SETBACK INFORMATION t/ t Ou t TANK TO P/ L WELL BLDG. it Intak AD t I et Septic A t B to Dosing A ead / Man. Aeration Dist. Pipe Holding Bot. S em PUMP/ SIPHON INFORMATION Fi Grade Manufacturer De n t cover Model Number GP TDH Lift Lriction System TDH t ead - 7 Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM _ BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manuf acturer: INFORMATION Type Of CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over [ Bed h Over xx Depth Of Tx Seeded/ Sodded xx Mulched Bed /Trench Center Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: / / Insyection #2: Location: 2340 53rd Street, Somerset, W1 54025 (NE 1/4 SW 1/4 3 T31N R19W) - 0331191052 Meadowoods -Lot 4 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = i Plan revision required? []Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspectors Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' v...E,-.—,.� a 3 A I _ a� x u Sanitary Permit Application 1'3:3L4 fa Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. '`� seonsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison. WI 53707 -730^ Department of Commerce [Privacy Law. s. 15.04(1)(m)] (Submit completed form to county if r state owner Attach complete plans (to the count) copy only) for the s,' a er not less than 8 - 1/2 x 1 I inches in size. County State Sanitary ermit Number ❑ Chcck, irr ishon t6 preztugi application State Plan 1. D. Number I. Application Information - Please Print all Information Location: Property Owner Name r Property Location / 6 U ._;. Ale 1/4 5 W 1A. S 3 T I N. R or Property Owner's Mailing Address 4 -- _ 1 I Lot Number Block Number ._. - :;T CRO!X �F fl L1 Av.o City, State Zip Code Ph GF;CE- Subdivision Name or CSM Number AMA II Type of Building: (check one) :'. D City Wt 1 or 2 Family Dwelling – No. of Bedrooms: ❑ Village L3 Public /Commercial (describe use): Y WTown of ❑ State -owned III Type of Permit: (Check only one box on line A. Check boat on line B if applicable) Nearest Road S'3 RO - A) 1. It? New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) -System Tank Only Existin S stem o2. B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) (NNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland 0 Pressurized In- ground ❑ Holding Tank D Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit D Recirculating ❑ Other: V Dispersal/Treatment Area Informat 1 0 0 — 1. Design Flow (gpd) 2. DispersaWea 3. Dispersal Area 4.Soil Application 5. Percolation Rate 6. ,System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) r Elevation r0 O ' + y / VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber - Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ D ❑ D S E P rl C /0400 000 / ' ❑ ❑ O D ❑ VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plum is ignature (no stam s): M PRS No. Business Phone Number ,S' S —,tl. w Plumber's Address (Street, City, State, Zip Code) u_ \ E S VIII County/Departmefit Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) `® Approved ❑ Owner Given Initial Adverse Surcharge Fee) _ „j Determination a 5 /d v g 6b gL� 9, IX. Conditions of Approval /Reasons for Disapproval: �olrtiut,sr� �j . ( h � pw, J_ l�c� 1�6W4w►+N- I 1< tSo = 4So 4 sr 0) SBD- 6398�R�07/0 I I s , f�j { t ` � i { . t f t ' I A 4 14 e�:laL— ' --�__— _ l -- �- �— � -- s - - - --- I , t - i f f I 3 r +f I � 1 f i t 1 II • A i. 9 1 1 Wisconsin Department of commerce SOIL AND SITE EVALUATION ALUATION Di�sion r M Safety and Buildings Page �_ of 3_ Bureau of ,`egrated Services in accordance *Ws. ILHR 83.09,104s. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches to size PlaArnust C unty include, but not limited to: vertical and horizontal reference point . (8m) direcboh�i4 1l St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcipl I.D. # E, r r T +l,' APPLICANT INFORMATION - Please print all infakmalrion a '� Re � ed by Date COUNTY Personal information you provide may be used for secondary purposes (PnvaRy l,aw, s 1frA91WJ6�iCE Property Owner Property Location Richard Stout :+Govt. Lot 1/4 SW 1 /4,S 3 T 33 N ,R 19 E (or)t Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1353 Awatukee Trail 4 Meadowoods City State Zip Code Phone Number ❑ City ❑ Village [2 Town Nearest Road Hudson W' S 016 7(15 5)49 -6731 Somerset 232nd Ave F] New Construction Use: ❑ Residential / Number of bedrooms a Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate ___ bed, gpd/f1 trench, gpd1ft Absorption area required — /+o`Z� Q bed, ft trench, ft Maximum design loading rate • bed, gpd/0 � trench, gpd/ft Recommended infiltration surface elevation(s) R n 1 c) t n 1 n ft (as referred to site plan benchmark) Additional design /site c erations Parent materi Flood plain elevation, if appli ble ft S = Suitab s stem Conventional Mou In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S U g S ❑ U ® S ❑ U ®S ❑ U EIS ®U ❑ S i] U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -4 1 0 r4/3 -- sil 1 16K mfr cs 1 f .5 . 6 2 4-5E 10yr4/6 -- si 2. 6 - , 6h, mfi cs -- .4 .5 Ground 3 55 -106 10yr4/4 sl $'b mfr cs -- .51 .6 elev. 96 ft. 6g , Depth to limiting tb factor 106 in. Remarks: Boring # 0 -6 10 r4 3 -- sil iJW j!5'bAL mfr cs i 2 2 6-56 10yr4/6 -- 53e'= 2 M mf i cs if .4 :. 5 3 56 -104 10yr4/4 -- sl )n mfr cs -- .5 '.6 Ground elev. 9 7-0-ft- Depth to limiting 1 fac tor 4 in. Remarks: CST Name (Please Print) Zatu Telephone No. Address ( // L +J (< / Date r> CST Number PROPERTY OWNER R i ,. a r - d St oi , t ^ SOIL DESCRIPTION REPORT Page 2'' o`I 3j" PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -4 1 0yr4 /3 -- sil 1 nl5bl� mfr cs if .5 .6 2 4-6C 10yr4/6 -- sicl 2 br5bIC mfi cs -- .4 .5 Ground 3 60 -113 10yr4/4 -- sl I hi.!rb K mfr cs elev. 9 6 .e ft. Depth to limiting factor 1 13 in. Remarks: Boring # 1 -5 10 r4 3 -- 0 5�& 4 2 -45 10yr4/6 -- icl 29�/%'�( mfi cs -- ".,.......," 3 15-1)0 10yr4 /4 -- 1 yhs�, !; mfr cs -- .5 .6 Ground elev. 96. ft. Depth to limiting factor 1 in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft i Texture Consistence Boundary Roots in. M unsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed , Trench Boring # ; LU 2 6 -55 10yr4/6 -- icl 2u�s1��S' mfi CS 3 55 -104 10yr4/4 S hilglh mfr cs -- .5 .6 Ground ^� elev. 95. LAyW ovLA t Depth to limiting 1 tc�or ' Remarks: Boring # [3 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) e0.( qd dP nr � r v- 16c) to r 5 y st� ►-ri �� e � I N ff 6 r.- Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or overnmental unit. The approved plans and permits for system are on file at the county 9 PP P P zoning or health department. This management plan complies with Comm 83.54, Wis, Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Des Specifications Y 9 p Sanita ry Permit Number 3 cl 9 (o Number of Bedrooms 3 : Design Flow - Peak (gpd) �/Sa Estimated Flow - Average (gpd) Septic Tank Capacity (gal) l �� v Soil Absorption Component Size (W) .2_ 4;' ,k 4t WiKd�( Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) AOD / Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The Y 9 P 9 septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and Access openings used for service and assessment shall be sealed on watertight u soundness. 9 p the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A' Mailing Address Property Address (9 3 O - (Verification required from Planning Department for new construction) City /State Parcel Identification Number ©3a - 011 - 'ado LEGAL DESCRIPTION Property Location Kl$ ' /,, 5 ' /., Sec. , T 11 N -R I Town of rn RV s ZT Subdivision V�\'eAaa W 00X)5 , Lot # _. Certified Survey Map # , Volume , Page # Warranty Deed # 6 , Volume 1,71/ V , Page # V 7.2 Spec house ;k yes ❑ no. Lot lines identifiable lK 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 in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwc, thr undersigned have read the above requirements and agree to maintain the private sewage disposal system with th e s tandards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a thre year xpiration date. _ - � o SI . ATURE O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) an► (are) the owners) of the pro rty described a ove, by virtue of a warranty deed recorded in Register of Deeds Office. . 9 �a1� SIG14ATURE IF AP LICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • STATE BAR OF WISCONSIN FORM 2 - 1998 63Q33G1 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS rryyt� S T. CkOIX CO. WI YO Document Number � � A /� /, � ;/ ;. , t PAGE j�, RECEIVED FOR RECORD This Deed, made between RICHARD 0. STOUT and 09 -21 -2000 12:30 PM JANET P. STOUT, husband and wife, WARRANTY DEED Grantor, EXEMPT R CERT COPY FEE: and M u G ► I COPY FEE: TRANSFER FEE: 124.20 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In St. Croix County, State of Wisconsin: Lot 4, Plat of Meadowoods, Town of Somerset, Recording Area St. Croix County, Wisconsin. Name and Return Address M I k-*., G-9- -r � 13s°� AW PCT -'- N,�c�se U► 032- 2114 -40 -000 Parcel Identification Number (PIN) This i S nn homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 20th day of September 2000 (SEAL) (SEAL) * Richard O. Stout * Janet p. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this 2 0 ill day of September 2 1 000 the above named Richard O* Stout and Janet P Stott TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person S who executed the foregoing authorized by §706.06, Wis. Stats.) ,,� instrument and acknowledge the same. CHERYL JACOBSEN Notary Public THIS INSTRUMENT WAS DRAFTED BY State of Wisconsin Janet P. Stout 1353 Auxatilkae Tr, Hudson, WI 54016 Notary Public, Sta of Wisconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not �'D. ; •) necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis. I •,. •.. '.. •. 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