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HomeMy WebLinkAbout032-2122-20-000 \ ° CD 0 tj 0) \ � � ts LL c 0 � � (D z E IL ■ o z cri m CL m (D N 4) a Ln th .2 .2 C) C) IL to Q 04 0 < CD z z 0 z z (D LU 0 ' 0 CL 0 a a CL = -a E U) U) 0) U) CD YL iT3 0 0 0 0- IL CL a. ;j r- o cr 0 0) o o C) C, LO co C , C> 2D a 00 0 E 2 'o LO a) zz (D IL Lo < A (n I re a U) U) (D U) 0 c = E — 9 3: i CL 0 0 CO 0 C) M M 0 C/) � ID Lo § f) 04 to > 0) :3 Cl) > -� g§$ co 0 0 1 0 0 Cl) CD z U m CL E 2 L CL 0 CL r 0 0 m o ( . o n L) CL U) f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363926 Permit Holder's Name: []City ❑ Village ❑ T&vn of: State Plan ID No.: Germain, Steve Somerset Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: (3 we S. 032 - 2122 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2QiLS Benchmark 3.35 o3.36 op . a � L j � Dosing Alt. BM .2 1?v (70 ' Aeration Bldg. Sewer 6 06 $ , vT Holding St/ Ht Inlet 5- 9Lf TANK SETBACK INFORMATION St/ Ht outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > cfo NA Dt Bottom --_— Dosing NA eade / i Aeration NA Dist. Pipe •3S S,oO Holding Bot. System 0 2 S• 3 PUMP SIPHON INFORMATION Final Grade Manufact --Demand St cover (� ` Model Number GPM TDH Lift Fri stem TDH Ft Forcemain Length Dia. Dist. To ell ! SOIL A SORPTION SYSTEM `-`' I`F i h -a 4.1+t. &_ 8� S" Bfi&KTjW Width{ r Le th No. Of renches PIT No. Of Pits Inside Dia. 7Liqd e h DIMENSIONS 3 '� DI EN I N SETBACK SYSTEM TO r, P / L BLDG WELL LAKE /STREAM LEACHING Man fa t� — itX4JJ INFORMATION Type Of r CHAMBER Mo Number: System: OR UNIT At — DISTRIBUTION SYSTEM Header / Manifgld a 17 , r Distributio e(s) 1111 x Hole Size x Hole Spacing Vent To Air Intake Length, Dia. ing ^� .Z� 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 I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 : C.8 /o / /60Insnection #2: '7'T Location: 2119 76th Street, Somer et, WI 54025 (SW 1/4 SE 1/4 13 T31N R19W) - 1331191101 Rocky Knoll Estates -Lot 6 1.) Alt BM Description = _�;? U �� A6., 2.) Bldg sewer length= lS•� - amount of cover = 3 �Y s; �.�- o . /o • Js /4- ` �U ,� cep (g c'° �j¢r Plan revision required? ❑ Yes � Use other side for additional information. 0 13 0 t Z SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. r t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4-4-t- r s } i l E i g w. A- v I 7:7-6 Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue P 0 Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the sys paper no V ounty than 8 112 x 11 inches in size. j�rej c , • See reverse side for instructions for completing this appl'�„ ` n 4 a Sanitary Per Num Personal information you provide may be used for secondary purposes ^ �j 2 k if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. / / Q 7 /„ �( C ,, Plan Review Transaction Number I. APPLICATION JNFORMATION -PLEASE PRINT ALL FO Property Owner N / t ,C tW Loc �•CV L �9 —.e'/t ia�—e T3 / , N, R E Property Owner's Mailing Address Lot Number I Block Number o 7`. J �� City, State Zip Code ( hone Number Subdivision Name or CS urn e� II. TYPE OF BUILDING: (check one) ❑ State Owned C ity Nearest Road ID VII I age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF �' '� � r_ 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ®Z,.,..a�aa._� 0 1 ❑ Apartment/ Condo /3, S/• ) q. flo 1 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 12 ❑ 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 _'16 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _System Tank Only 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 1eee: page epage Be 21 [] Mound 30 ❑ Specify Type 41 []Holding Tank age Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy Pit Z 43 V It P ivy t 14 ❑System -In -Fill G / �-_ v = a VI. ABSORPTION SY TE 6M TION: Ct ZZ Z 1. Gallons Per Day 2. Absor . Area 3. Absorp. Area 4. Loading Rat . Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/ .S in. /inch) Q Elevation Feet 9'7_ Feet Ca acit VII TANK in gall Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Exist in structed Tank Tanks Septic Tank or Holding Tank ❑ ❑ 0 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum s Name: (Print)�� t Plu Signature: (No Starr)ps) MPlMPRSW No.: Business Phone Number: Plu er's Address (Street, City, State ip Code): IX. COUNTY / DEPARTMEN USE ONLY ❑ Disapproved Sa ' ary Permit Fee (Includes Groundwater ate ssue Issui g Agent Sign ture•(No Stamps) 4 Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determinations 6`3 X. ON ITIONS QF APPROVAL/ REASONS FOR DISAPPROVAL: S ,, V -- IL SBD -6398 (11.12/99) DISTRIBUTION: Original to C unty, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2),years. 2. Your sanitary permit maybe renewed before'the expiratibn dlite, and at a time of renewal any new criteria in the Wisconsin Administrative Code wilt Be applicable': 3. All revisions to this permit must b6 approv6d by the, ff rmit issuing authority. � 4. Changes in- ownership or plumber rewires a Sanitary Permit Transfer / Renewal Forrn (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tanks) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. if building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. V1. Absorption system information. Provide all information requested for numbers I through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number wi' li appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans specifications not smaller than 8 1/2 x 11 inches must be subr•;itted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions.., location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks, distribution boxes; soil absorption systems; replacement system areas; an the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and p Amp manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 `.)rm; and F) all sizing information. ----------------------------------------------------------------------..------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of reg.:!ated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. < PLOT PLAN PROJECT /L°l.�c E'�py� t ,J ADDRESS � 1/4� 1 /4 /S /T � N/R TOWN COUNTY PRS Byron Bird r. 18 D E ` BEDROOM CLASS PERC CONVE L,X NTIONA IN -GRO D PRESSURE CONVENTI�AL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TAB SIZE ABSORPTION AREA q9)9- -_PERC RATE 0• - 'SIZE 5 b Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. 0 Borehole Q Well Scale = Feet O Perc Hole System Elevation /l 9�, U f /J 1 2 " •v / Grndp �uJ 2� # TYPAR COVERING 2 " 1 i 12" 3' 4' 6' 0 3' 3' 0 3' 6" Sewer dock 18' .................... D �Al i .,.r . � 5 J/0 Liu � -- Wisconsin Department of Commerce SOIL AND SITE EVALUATION I Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches i n size. Plan must,, County /'�, ��0 1 � include, but not limited to: vertical and horizontal reference point (BM), direction and' J percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. `, Re'ieWe'd by Date Personal information ou provide may be used for secondary purposes (Privacy Law, s. 15.04 m Y P Y NP P Y 1 , (i�, )� Propert Owner PrpgtgtyClo'C" d'r� d i/?Co Govt. Lot s 1145, 1/4,S 3 T _7/ ,N,R /9 0(or)g) Property Owner's Mailing Address Lot # Block# iffid. Name or CSM# �s; City State Zip Code Phone Number Sys /� (� ) El City ❑Village ®Town Nearest Road u o� w� ! �S 5 X -s91i S'omersef 2 /o'`h aoe ® New Construction Use: CaResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow �GU gpd Recommended design loading rate ' bed, gpd /f12 • ` r � � trench, gpd /ft Absorption area required s00 bed, ft 4260 tr(ennch, ft Maximum design loading rate 7 bed, gpd /fF • J trench, gpd /ft Recommended infiltration surface elevation(s) / �� �te�¢dl ft (as referred to site plan benchmark) m 6! 83 Additional design /site consideration Parent material F�• Flood plain elevation, if applicable ft L: U ❑ � El Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system E S U S U ©S ❑ ul ®S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench kA-f ,s 2 Cw Ground '�`C �� 6 ,& elev. y y 39_9.? loin SL 4 Depth to limiting fa or .z- 9 6 Remarks: Boring # 0 -/� i M sz- )Mji& C - Z s- 14- 7Sy�' !Y fh C 2r►� Ground elev. 9`- a Depth to limiting 36(�Z 5��1• y fat � q r ,F in. Remarks: CST N me (Please Print) Signature Telephone No. Address 41 / �� ��� Date ST N ber / pPi elieo� / 6- / 9� 23 /r SOIL DESCRIPTION REPORT PROPERTY OWNER � '' Page 2— of � 3 PARCEL LD.# L 0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench M5 01 yle P /f Ground lev. � Depth to limiting fa for � in. Remarks: Boring # C 21)7 2 2 7 SY� NA 2ms /I/A IBS d' Ground 7 7y /a � iC �A SL Depth to limiting factor Oin. Remarks: Frizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # a -fib /oYP %2 il/ fff /r�ss�r Cw 10-21 7 5') 4 , y ;�j,� ��� Zr�� Iti c� �I� 's 3 eel- V /o �% Y IP S Ground 4� 1 61/ OR' 6 lyk elev. �ft. Depth to limiting far,tor ' Remarks: Boring # i Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) � r OWNER Page 3 of 3 Name ')�7 d'- G 1n - Brian Parnell Address CST 231314 Date / 0 // 9 A Benchmark 1 lon D �p �, e 13y 122Dh SoaA Gotl; A Benchmark 2 8 ���e 121 ❑_ Soil Boring 1 Suitable Area 1" = 40' Scale t � ' I a , i ct r cc — C( Y J i ' v \ 0 _ n e i TV t O 0 � ♦ z \ J . C' `�° I �• �• 1N3w NI'11i31N30 f f m / r� Q r N I o / O I y / XCS Q.. N No /� y Cn O� �R N o (-n _ g Z. w I I / '' czi � Q f� Z —I z CO DD w-' b C�' Ol )m r� A�1 f� =J 0 r r f �D I i - ni c `� CI z f c. '>• N \ .� ' C7 a co z 1 I O `Q CG 9 11� m O u, *1 D o .� Q v f �...... o� � m� Co z j0 0� 1 X I (� Q D D ` 00 m N W > \ . -" O p m .- �_r�•__ I Q R =733 TOW OAD '� I° ._. —_ R— Eifi7•' m N121.0p f 370.33 Im' . _.. _ 00 50 "W A / _, IM N7231'00 "E 370.33• 93.24• ' 8 O o - 0 - . _.. 12 . R =267 S 1'1442 s� . 16 17), Eskfr m W p t A - ._........... Z a s m p R— Q m p < C C 513.21' a528`" \ j f • . _ Q r M ON I> rn c,•, —r D - m I r i lo Z) ' I'D �? � n . O m cD v a D -c Q O O / m D D A n -1 z U7 l{� (n I G� Z r N rnrn CA Q O M / ^ l� A p �7 rn; cn °z n �l m (n �' O (%J m O CD ,' I m ; ` �m o � o 0 � � 030 111 i i Ld p ^`D ob . \ 240.01' 231.00 f f j I 216.00' 33.08' — $01 "E.689.01' - — z E SE 1/4, SEC. _. 70 o p Ln UNP L ANDS MELVIN AND FRANCES BR' = AULT - ° ZONED AG -RES s ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Q-3 0 4 D S c e_o Ict Sys ZO Property Address g l 1 q - 7 6 Cj S 0 e Y 5 e I LA,) i- S g Q Z (Verification required from Planning Department for new construction) City /State S 6 rney i , - Parcel Identification Number 3 2 - 2 a a� (- C LEGAL DESCRIPTION Property Location S W _ n / I /,, Sec., T 3 I N -R�W, Town of 0 Yn 2 y S e� . Subdivision E'_S Lot # Certified Survey Map # , Volume — - -, . Page # Warranty Deed # l0 C� a� , Volume 1 . Page # 3 Spec house M yes ❑ no Lot lines identifiable V 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 mas pl journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - s it e wastewaterdisposal system is in proper operating condition and/or (2) after 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 Natural Resources, State of Wisconsin. Ce rtification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. & o0 R OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. �_• l� l O.Q SIGN TURF dF APPLICANT 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 1521PAGE332 �a STATE BAR OF WISCONSIN FORM 2 - 1999 62595 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Michael J. Germain and Michelle M. RECEIVED FOR RECORD Germain, husband and wife, 06 -23 -2000 11:30 AM WARRANTY DEED Grantor, and Stephen J Germain and Melanie EXEMPT Y A Germain husband and wife COPY FEE: FEE: TRANSFER FEE: 111.00 RECORDING FEE: 10.00 Grantee. RAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): p ocky Knoll Estates in the Town of Recording Area Somerset, St. Croix County, Wisconsin. Name and Return Address J OLT A) . 5 yo17 Pt of 032 -1 037 -90 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this fit/ day of June 2000 Li * * 1141 as J. t n Michelle M. Ge ain AUTHENTICATION ACKNOWLEDGMENT Signature(s) Michael J. Germain and Michelle M. Germain, STATE OF WISCONSIN ) husband and wife, ) ss. County ) authenticated this day of June 2000 Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) f ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fond du Lac, WI STATE BAR OF WISCONSIN 800.655 -2021 WARRANTY DEED FORM No. 2 - 1999 253' 230' 211' i w -- C s w w a s co -6 y N `` MI A v � r � Q m A � i m "J> 46' 191. ° -+ IN R OAD 20' \` G, 23g 45' 174 146 87 80' — 47' cn m iO w w. n �. M A W n y 0 V fn to M . " 1 f*1 • y y� N 0A V rn �CA) W y co - — — — 240 226 213' T LINE OF THE SW 114 OF THE SE 1/4