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HomeMy WebLinkAbout042-1056-95-400 tz 0 e M o � @ � . \ �$ ;'$i7 7 � e A z o� z� § 2 ' m \ \ \ \ k \ k cn CO $ \\ \) /` / / \k 2 O ` E E- a o 8 f fn fA MFR \ / \0 \ ° CO _ R \ \ / § $ ( § � ® ( § -4 ;0 « § § E n r CO) �.0 ���� k CD / i v w w 2{ ° ° © OIQ § ® 4 : CO) ■ CA U / § ` § \ G ƒ ® 7 ^ e £22 J ,..; ) 3 k N) � go 0 : \ { g \ / E; �- � )' o / Li z J § / j -1 ■ o , R a CL / z $ \ P• z w t T m § o 2 CL § § F \ & . 2 » � f c 0 % CD 0 � I § � � a � ¥ \ � I 14 2 0 { . o / § § \ o = \ƒ �4 1 W isconsin Department of commerce PRIVATE SEWAGE SYSTEM Count safety arts Buildings Division N INSPECTION REPORT • Sanita o.: GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provice may be used for secondary purposes (Privacy Law. s.15.04 0)(m))• Permit Holder's Name: ❑ City 0 Village D Towrxof State -- X I Insp. BM Elev.: BM Description: Parce Tax Nn TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic epa_s q, Benchmark 9.0 S av .D' Dosing A 4.10 o .9.S Aeration Bldg. Sewer 5.5T lo Holding St/ Ht Inlet loz , o TANK SETBACK INFORMATION St/ Ht Outlet ,�(3 02 - tz TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet -- Air Intake Septic >7j 35 t ' NA Dt Bottom — Dosing NA Header / Man. Aeration NA Dist. Pipe $ -3 Im . !+S7 r Holding Bot. System 1.6 99 • 1 r PUMP/ SIPHON INFORMATION Final Grade 10 3 -S Ma ufacturer De d Model ber GP TOH I Lift Friction System TOH Ft Forc ain Length H eii L F OIL ABSORPTION SYSTEM BENCH Width r Len r No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth IME 1 3 °r3 • S DIMEN 1 N Manufacturer: SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING _ �r SETBACK CHAMBER M e Num r: INFORMATION Type O sys tem: �V > 5ar N 9 s r y I r OR UNIT system: DISTRIBUTION SYSTEM DISTRIBUTION /Mani of Distribution Pipe(s) x Ho le Size x Hole Spacing Vent =Inta I Length 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 C] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 12.. / cA•/ yo Inspection #2: / / Location: 830 110th Street, Roberts, WI 5402 (NE 1/4 l/ T29N R1 8W) - 202918317A40 -Lot 9 1.) Alt BM Description = T•P �a,a� Ie+� �`'� 2.) Bldg sewer length = 2 Z . o'1 1 ` - amount of cover = X &s "' I P `"�` `ms`s J -� k n A - (00 E4 41 L� revision required? ❑ Yes JR No ( q � SZ Use other side for additional information. F F SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. # ?30 / O Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ""ISCOnSf Personal information you provide may be used for secondary purposes Madison, WI 53707 - 7302 Department of Commerce [Privacy T3�:0 (Submit completed form to county if not '; i i�. state owned.) Attach com fete plans (to the county co R1 ) i'nr t e sysic , er not less than 8 -1/2 x I I inches in size. County , State Sanitary Permit Nun cr.._ O C�hcc rvi r s l ion nis application Stale Plan I. D. Number . r • i , I. Application Information - Please Print all Infor atVnn ! Location: Property Owner Name _jI C r- r; Property Location i ST C F3QtX i t . I/ 1/4 N, E (or Property O 's Mailing Address ti - ",� GOUN / Lot Number Block Number f S/ �,•� ZONINGJ:r-tCE City, S e Zip Code �� // eR Subdivision Name or CSM Number II Type of Building: (check one) ❑ City rj ❑ I or2 Family Dwelling No. of Bedrooms: �✓ as Per A ( 5�(tM.� ❑Village C3 Public /Commercial (describe use): UTo n of ❑ State -owned 1 III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ,yy A) 1. 0 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) V4e System Tank Only Existing System /V 9LE-zftei B) Permit Number Ld- Z '? �S! 3/74 - y� Date Issued ❑ A Sanitary Permit was previously issued 1V. Type of POWT System: (Check all that apply) ` 19 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: Z I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5 P ercolation Rate 6. System Elevati 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /ine ) Elevation VI Tank Capacity in Total 4 of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ vJ 4/00 VII Responsibility Statement I, the u dersi ned, assume responsibility for install "ion of the POWTS shown on the attached plans. Plumb is ame prinj) Plumb is Si fff o sta MP /MPRS No. Business Phone Number r / i l� S c3 Plumber's Address (Street, City, State, Zip Cod., VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 71ssuinAgent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge F e) Determination Z Z r. O Z O IX. Conditions of Approval / /Reasons for Dis l� [ /a 4, VC S44L/ �e r�n� e" / lrh /_ 0 ✓vicez / 0er W �fr.uta< / �arcrS YPranvvne,, / SBD -6398 (R. 07/00) D Q u c � L M 41 L � n v 13v Meg G ,41q y NEL. Sb.v Wisconsin ` rtment of Industry SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of Division of Safety and Buildings in accordance I�MFR 83.09, Wis. 4l �: Attach complete site plan on paper not less than 8 1/2 x 11 inches i A), .. an mush. County ST'• GRo i X Include, but not limited to: vertical and horizontal reference point (B irect[onpd �t r : D percent slope, scale or dimensions, north arrow, and location and dls'tar a to ne ) Who Parce : I.D. If rpr �� �. � e Z — ld s& . 4j S OOb APPLICANT INFORMATION - Please print all lnforMation. sT CAROX liby7a ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (ty(id)rn Z y Property Owner rcp Location., - D ARYL -- 70 0 E s Egt y `' � 1!4 SE 1/4,S 20 T f ,N,R E (or) Property Owner's Mailing Address Cot-# -: # I Subd. Name or CSM# ovj O�g 17113 STOA C Ti se BA 7 CSM VttS city 1 State Zip Code Phone Number Gd D �-,/ Nearest Road r'T l) (7S M ��• s 7 �p (! 5) 3 3 1 ' 7 ! o U ❑ City ❑ villa Town IVA I? New Construction Use: Wliesidential / Number of bedrooms - t o Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: 7 � bed, trench, gpd/11 Code derived daily flow _�,� gpd Recommended design loading rate gpd /ft Absorption area required _Q_t 2,__bed, ft2 ISO trench, 0 Maximum design loading rate _ bed, gpd /ft - S trench, gpd /ft Recommended Infiltration surface elevation(s) `S'� M a ' it (as referred to site plan benchmark) Additional design /site considerations Parent material 5,+VP y d V / W f Flood plain elevation, if applicable It S = Suitable for system Conve tonal M � ou � In Groun ressure AT G e Vsyste in F itl Holding Tank U = Unsuitable for system p u [�'s ❑ u❑ u CCS ❑ U ❑ u ❑ S u SOIL DESCRIPTION REPORT Boring # FHorizo Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. wed ; Tr p l3 �DYA 3/3 — SL �-FShk A*I vAR S rf •Sri. i y2 Ground dl, y J7 G _ . 7 ✓./s� elev. r ' A PROPERTY OWNER �D N ES SOIL DESCRIPTION REPORT O f Page of PARCELLID1 o q Z - 1 d S b c I 50 114 -ts� 40 9 Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots QPQJft Tr 3 •�� io y,� 2-/2- — s� ifs / � f ... F... ✓� • ✓' Ground i E— elev. f� ft. o /0 S S, © • - 71,,� Depth to limiting factor 16 0 � Remarks: Boring # T ,, o• /D yR Y3 Y 26 S � G f QS Ground elev. / Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure GPD it In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Boring # � Bed ,Trench o -1y • 1 D Ground �0 S S. e9 7� elev. Depth to limiting factor 4 ?U ln ' Remarks: Boring # it - Ground elev. ft. ' Depth to limiting factor in ' Remarks: � p 1 1 K d � N 4 � O 1` w r -� � a r ti c c rn ST CROIX COUN SI PTIC TANK MAINTENANCE AGREEMENT AND OW'NERSI-IIP CERTIFICATION FORM Owner/Buyer S 0/V Mailing Address -2 3 Property Address _ ��U T� 5 '7-, _TG 3 fle TS GeJ �- S YO- 3 (Verification requirc(I front Planning Department for new construction) City /State R0 13 4gTS' Lc1 I Parcel Identification Number V"? C / LFGA DESC Property Location IV '/ _ ' /,, Scc, _ O, T a c t N -R W, Town of Subdivision _ , Lot j "D Certified Surve Map # a 3 ? Z Volume `� , Page # adz Warranty Deed # �� Volume 5 V3 Pa � cl � e # J g Spec house 5' yes ❑ no Lot lines identifiable A yes ❑ no SYSTE MAI Improper use and mamtenanceof your septic system could result in its premature failure to handle wastes. Proper marntenan.c consists of pumping out the septic tank c�cry three years or sooner, if needed by a licensed pumper. What you put into the can affect the function of the septic tank is 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 b. a III asterplumber, journeyman plumber, resu ictcc! plumber or a licensed pumper verifying that (1) the on -site wastewaterdrsposa! $ s. is In proper operatnnt condition and,or f?I alici in;pcction and pumping (if necessary), the septic tank is less than 1/3 full c I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standaras set forth, herein, as set by the Department of' Commerce and the Department of Natural Resources, State of Wisconsin. Certtfica-W; stating that your septic systern has been marn[Xiw i must he completed and returned to the SI Croix County Zoning Office ^:.n :• days of the three year expiration date. / / �—/ 0 SIGNA 0 APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on ibis form are true to the best of my (our) knowled r ge• I (we) am (are) the o the propert y described above, by virtue of a arranty deed recorded in Register of' Deeds Office. L ey CD SIGN PURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department •• "'• ** Include Nvith this application: a stamped warranty deed from the Register of Deeds office 3 copy of ihr certified survey map if reference is made in the warranty deed 01. 1543PAGE 95 • 629965 STATE BAR OF WISCONSIN FORM 2 - 1998 K ATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Daryl L. Jones, a married 09- 15-2000 12:50 PM person WARRANTY DEED EXEMPT it Grantor, CERT COPY FEE: COPY FEE: and Gary D. Nelson and Jillenne J. Nelson, husband TRANSFER FEE: 210.00 and wife as survivorship marital property 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: Part of the Northeast 1/4 of the Southeast 1/4, Section 20, Township 29 North, Range 18 West, now Re- :ordingArea known as Lots 8 and 9 of Certified Survey Map Na ne and Return Address recorded in Volume 14 of Certified Survey Maps on — T, . U_ 0 y � Vim; 2✓ &✓o v r page 3862 I_ '�o Vx I C( ev- S T s o -f-h �A') c`sor'� (--j I b i 42- 1056 -95 -000 (part of) Patecl Identification Number (PIN) THs is homestead property. (is) (is not) Exceptions to warranties: easements, roadways and restrictions of record Dated this day of \ V� L * * Daryl L . ones ' * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County. P n.�ll ame before me this day of authenticated this day of he above named Daryl LY Jones * TITLE: M EMBER STATE BAR nF WISCONSIN to nn.- known try he 0w ncr�4on whn cxcc.itcf St. Croix County. ) authenticated this day of' -)H I' " all m m ae before e this / day of' �lie above named Daryl L r Jones r TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed 4 flore ;; wl edged the same. instrument and authorized by § 706.06, Wis. Stats.) , /` THIS INSTRUMENT WAS DRAFTED BY v / Michael H. Forecki At Tracy L • Turner Eau Claire Wiaeonain Notary Publ c, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are My Com , sion is ermanent. (If not, state expiration date: not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. racy . urner WARRANTY DEED STATE, BAR OF WISCONSIN Notary Public FORM No. 2.1998 V Produced with ZipForm TM b State of Wisconsin y ertisofl Inc. 16025 Fift mile An F aen omty Micha H Forecki 1830 le Road, Clinton Townshi Michi 8nckdl Ave, fau Claire WI 54701 -4627 P� gan 49035, (800) 383 -9905 ^� Phon, : (715) 835-3029 Fax (715)835.4112 i s FILED ' 8 �1A1 2 6 2000 ► `� SL Crott Cg� W1 K14THLEED! H.15aL;>♦t 3 623'762 L 3/ Certified Survey Map Daryl Jones, eta]. Part of the Northeast 1/4 of the Southeast 1/4 of Section 20, Township 29 North, Rang o 18 West, Town of Warren, St. Croix County, Wisconsin. c f N 89 ° 10'OB'E 5220.38' 2 UNPLATTED LANDS ` r OWNER'S ADDRESS: IY89 . 10'06'E 430.01' d� 17113 Stone Pine Bay ° ° 397 1 d F Hudson, W1 54016 ; 4790.95' ENV i/4 AE 33.01' r ti Q �CL ° W HW This instrument dra8ed by x Laurence W. Murphy Z, LOT 6 ' I 2 I m + W` ti m Dated: February 17, 2000 c ��+ 3.240ACRES, 141,121 SQ. FT. W f + r) I w "Revised this 22nd day NQ 2997 ACRES, 13'M$0,FT. U) Y t U 2 EXC. ROAD R O. W. Q �{ of May, 2000." y C 97 I J N C� Q y ►�. N 89° 14'46'E 430.00 `� w Q m z w 395.88 ° LOT J J3 W E •I APPROVED 3 S W 34.12' 6 . ST. CROV COUNTY IAM I 3 � I PCnq Zoning and Parka ComlroMee Q $ 6 � q f� W 2J10ACRES, 101;04! S0. FT. ~ ;r; ,� • i Zi1 MAY 2 6 200 2. N 2133 ACRES, 91,929 SQ. Fr. - '4 h l ,� ai b 2 EgC. ROAD $ R .O. W. $ $ o Go 1371 I b M not recorded within 30 days Of to � ; x app dud � � ahml he ,I N 8 9 . 14' 46' E 436.0 -- 4t I f O W 395.08' 34 $ o $ 0 LOT 8 �- g $� $ LEGEND: g ° g o z .d 2.320ACRES, 101,0!1 ° $ "I H W • f' X 11 •IRON PIPE LYCiGHING � ' 2129 ACRES, -92, 742SQ: F+ h O EXC. ROAD R.O. W. W 1.13 LBSAIN. FT. SET , I I s ? •� >r 1' IRON P/PEFOUND 1 T 394.28' ' 35.7' �y 0 SOIL BORING i S 89" 14' 48 W 430.00' u 4 D[S1GNA 7ED ORIVE_ W WAY LOCA /O UNPLATTED LANDS N 69° 14'46 "E 430.00' I$ ti y $ n 4\'Z394.06 r .r 100' o • O :4 1 :a ROAD SETBACK UNE 35. W {III 1111!! " vi 1, 0 U. Q I 2.320 ACRES, 10041 Sc. FT. g, ^� g Z 100• 2114 ACRES, 92,602 SQ. FT. b N� FXC ROAD R 0. W. , O r �` • 993.26' 1 t y .' RE CF. g 41.00' 352.28' m W M Y 36.74' i v pp a :t y F S 1713 > j S 89° 14' 48' W 430.00' E ti i FAL /& .. - wtsc. ,� LPT 2 C• s.M. F ''.•gJ VOL 10, P AGE 2872 � h�' 2 •., 1, LANG � J � U O� W ¢� o 30 . SCALE 1' s 160' 100' 1 20 3001 400• SHEET 1 OF 2 Vol.14 Page 3862