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HomeMy WebLinkAbout042-1076-90-500 . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you rovice may be used for secondary purp [ Privacy Law, s.15.04 (1)( 70240 Permit Holder's Name: ❑ City ❑ Village ❑ Trwn of: State Plan ID No.: Flettre, Marvin & Deborah Warren Township CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: IoD. i 1 01D .Z) i "S4 — CSr 6w 042- 1076 -90 -500 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark -C 105 Dosing Alt. BM Aeration Bldg. ewer g� RO q'S.3o Holding St /Ht Inlet Z 11 03' TANK SET INFORMATION St/ Ht Outlet -% r TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Oe Dosing NA Header / Man. 9'? . y `f Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufac errand St cover 5-, gq Model Number GPM TDH Lift Fric stem TDH Ft Forcemai ength Dia. D. . well S ABSORPTION SYSTEM BE Width t Len th / f T s PIT No. Of Pits Inside Dia. Liquid Depth MEN I N Z- 2 �S DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of t CHAMBER Mod Number: System: �j OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s)( M i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. ___C_— Spacing 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, p er Q ns r s I� � � ns j e. ns'Oect>on Location: 759 112th Street, Roberts, WI 5403 ( fP4 N W ll4 28 T29N R1 8W) - 28. 9.18.437& -Lod, 5 1.) Alt BM Description = $,� s -4w4491V e "' 2.) Bldg sewer length= -4 ( }.p Sy SGT '`"" ` - amount of cover = �U loe..'" l �� S �+�C+�'«✓' , � �°�' ` 3) P.,k C . #; te -e_. Ct Plan revision required? ❑ Yes No Use other side for additional information. ©te 1 1 9 l ap y� SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ..., .m { fl F �' f ' Safety and Buildings Division Itisconsin SANITARY PERMIT APPLICATION 201 B Washin in Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst p o s County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this app 6 n D� j tate Sa " Permit I umber Personal information you provide may be used for secondary purposes , iV ' Check revision to previous application [Privacy Law, s. 15.04 (1) (m)]. fr, , St to Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT 1 Property Owner Name rty Location r rig, V_ 7 , e T , N, R E (oRt%> Property Owner's Mailing Address % Lot Number Block Number W� AS City, Stiite Zip Code Phone Number me or CSM Number �f+0 II. TYPE OF BUILDING: (check one) ❑ State Owned p V il a Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 2 t jT 111. BUILDIN USE: (if building type is public, check all that apply) Parcel Tax Number(s) p"r -0 2 ' a-8, 2 1.18, 413 1 ❑ Apartment/ Condo c4Z -$4d 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. XNew 2_ ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an ------ System ________System __ ___________ Tank Only______________ Existing 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 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure i f 42 ❑ Pit Privy 13 ❑ Seepage Pit 12ML 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTI SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) . f � Elevation Feet Feet Tanks Tan VII. TANK in Capacity s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist'n structed ks Septic Tank or+Feld+Ag.�aak Q Ld El 11 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 113 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation ofA onsite sewage system shown on the attached plans. Plu ber's Name: (Print) Plumber's Signature: (No St i) kUWPRSW No.: Business Phone Number: r/ �p - 363 Plum s Address Street, City, State, p Code): , 9 ' A- d A010 0C174T a►T IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) AA roved rch.rge Fee) pp []Owner Given Initial �oZ S . 0� Adverse Determination X. CONDITIONS �F / S NSF R DIS PPI�OV c t_ J o� tf W� L� C sf - / IBUTI i , An ivi wn , SBD- 98 (R. 4/99)L� t INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems "must be p(operly maintained:' The septic tank(s) pumped by 'a li'cehsdd'pumper'wher4v 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, 608-266-31-5l.'- 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 be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 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 with appropriate prefix (e.g. MP, etc.r, address and phone number Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans "st i6clucre 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; and 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 pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data'on - a' 1 15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. �-.. 7( �J I P &kg I 286 McKenzie Rd. I $pwner, Wi 54801 L X715) 635 -9609 'PA- 7 yQ—y�i38 y aDr�m � � 2 0 ► � �r �.r i •/ sL , /"�� ' s yo 4 vr h fdt.n Fjc �D� .fsA'iwr� /ego ' .vG p D- o e T. ,f ' k LL > Axe � ' C- 3 r. /qty x e ' A t o � D r 4, 0 i i i � � i i i � _ I t _ _� 1_ _._. __.�� r � � �-- � - -- _ . _, __ _ - '. i i _ I + � _ _.. � j ' � g+�dnrofq i - � �; 1 `�. � � � _ _ _ __ _ 1 _�... t ..S _ _ _ _... _ y _ 1 I _ t � - - -- - ; -- . - _ i, a, ' ?d 7 � I .__ —_— __ ___ __. _ __.__. ___.__ _ — _._____ ... � ... __ — � . --f- - , I � � �, I .� � t fi � �, i � I i j — -_ __ } _ __ I I - _ _ - � � -- - _ - �- _ � _ `- _ y _ -T- + , __.__..._- � 1. a ..._ I * � _.._ T �._ _. ._. __. .. _ 1 _ I � � - �_ I i I � L I �� L_ t � __ - -- _ - -- - - � .- i i � i I i + _ ! ; I _ _ � I � � I i -- I I - - -- �_- .. 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I i i . � � - -. �� � � � -r _ � _e,_.. _ . -- - ____..t _ - - - -- --- - - -_._ � -- � � _- ,. i I -- i - - ._ - - , - — - -- - _ __ _ _ I �_ T - ,_ f ST, CROIX COUNTY WISCONSIN ZONING OFFICE I I m o i l u r s■ - ST. CROIX COUNTY GOVERNMENT CENTER "d 1101 Carmichael Road Hudson, WI 54016 -7710 �— — (715) 386 -4680 February 3, 2000 Mr. David Coyer 1122 76" Avenue Roberts, WI 54023 Dear Mr. Coyer: S & N Land Surveying has submitted a concept to this office proposing the creation of one lot on a parcel of land you own in Section 28, Town of Warren. The sketch shows one lot of 2.14 acres with frontage on 112'" Street. Please note that a 200 ft. separation distance is required between driveways as well as between driveways and an intersecting road. Should Outlot 1 of Certified Survey Map 11/3206 be used for access, it must be upgraded to county standards to the point where it splits off for the proposed lot. A certified survey map must be drawn to create the lot. The map must be approved by the township prior to being submitted to the Zoning Office. It appears that the parcel lies within the boundaries of the Extraterritorial District for the Village of Roberts. Please Contact them to determine if they will review the map. This also must be done prior to submitting the map to the county. (. , Escrow and application fees for the map totals $500 and should be forwarded to the Zoning Office at the time of map submittal. A soil evaluation must be done for the proposed lot and the report submitted with the application. The map will be presented to the Planning, Zoning & Parks Committee for approval. The committee may approve, approve with conditions, or reject the map. You will be notified of their actions. The committee meets the fourth Tuesday of each month. The submittal deadline for certified survey maps if the fourth Tuesday of the month two months prior to the meeting at which the map is presented. This allows for the map to also be revile-wed by the Land & kN,ater Conservation Department as well as the Department of Natural Resources. Because the project submittal is conceptual, nothing communicated during review shall be binding on staff or the committee. Should you have questions or concerns, please feel free to contact this office at the above number. Sincerely, 7. J j J / / Mary J. Jenkins 7 1,/ Assistant Zoning Administrator C: Clerk, Town of Warren S & N Land Surveying 1 W' _." Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites 00.0 'tttg to iapters $t. 20 & 1 f the 11 �scon5in iitf tm Y velltng Code, a aatl ecasi0n rontr9l plan . needs to be submitted and hppraved prior to theissuance of bwiting lsermits #or Y ,& 2 family darlltng uttts in khoset:nS?klCitot�8 whet'e the mil ecastatt' eotttr+l provsxons 1nifQrm are t~pforeed. 'tis .::.....:.;..;:...: <Standar� t'ontrul Planris r�ayYded to �issist':inm #Trig th>s r �ureiment ::: Buildua n : . ; .._ : ors have uthon ::to: erostan . Outxol 1uCaSl3 esxilQt sj�eafically required by C de�vhen :;;:.:<:.::;...;::,:.:: •ice: ?• >:<• >;:. k :;:.X;:.;;;;;;:::.i.::::::.::.. ;;::.;:, >;;;;;;::; } .. .:::. ::::: :: ,.: .: _ ::.: ..:..y . :.:;.,..:. '.::.:, ...... k ..... ........ ::;::: ueltktrietres :ire::deetned. to tier ttie. Cofle'ivtiailt; rftirmance standard of keep�ng oil site tt '' "more'ttia dis bs ........ :: 5 «'< oii t uctlon "ri ecis ghat disturb: mart; tIt' 5 acres .or aro... rt of a 8evelo meat that :...... n ::.:::::.::::.:.::...... ......:.:::.:..1.:............. .. .....:..................:.... ,..... ::. App licant: C AM-G'QcM 4 d - 6t & 7 S1 -i-O C, �'l 1 K C. _ Name yti a telephone number o A 16 1 - 446 - 77s Street address, city, zip code Landowner. / U trr� ��_'dD eA 4- CO 7 Name Daytime telephone number 1/ 9 k Street address, city, zip code Location of the building site (complete as appropriate): _ quarter of Section g , Town 9 N., Range I E Lot �S_� Block Street address Instructions: I. Complete this plan by filling in requested information, marking (.n appropriate boxes, and completing the site diagram. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608266 - 3358. Erosion Control for Home Builders (GWO001) can be ordered through Cooperative Extension Publications, 608/262 -3346. 4. Submit this plan at the time of building permit application. J. `Chock (.) appropriate boxes below, and complete the site diagram with necessary information: s CP � Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. / ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ Location of storm sewer inlets. The gradient and direction of slopes before grading operations. �( The gradient and direction of slopes after final grading operations. Location of existing and proposed buildings and paved areas. ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence or more than 25 feet from any downslope road or drainageway. X Location of gravet access drive(s). Note: Recommended gravel drive design is 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick Drives should extend from the roadway 50 feet or to the house foundation (which ever is less). ❑ Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded soil from leaving the site. ❑ Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by Code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff' (sheet flow) from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and hock rip - rap. When used, a given in channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area In- channel practices should not be installed in perennial streams �1 13 Location of other planned practices not already noted. t_ -Site Diagram - Note: Any base map of useable scale can be substituted for this sheet. AL 1 I r� N n i 1 Site Diagram Legend Please indicate north direction PROPERTY _ _ SILT LINE completing the arrow. LINE FENCE EXISTING ST RAW DRAINAGE BALES -� TD TEMPORARY I'tri GRAVEL DIVERSION ''' _ FINISHED TREE -� DRAINAGE PRESERVATION I LIMITS OF STOCKPILED GRADING TOPSOIL VEGETATION SPECIFICATION Scale: O AREA 1 inch = 1(� a feet "Indicate management strategy by checking (.0 the appropriate bac Q / Management Strategies ❑ ` Temporary stabilization of disturbed areas. l Note: Although not specifically required by Code, it is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible. ❑ R" Use of downspout and/or sump pump outlet extensions. "' »> Note: Although not specifically required by Code, it is recommended that f low from downspouts and sump um outlets be routed to stable areas such as established p avement. sod or p ump P ❑ Trapping sediment during dewatenng operations. Note. Although not specifically required by Code, it is recommended that sediment -laden discharge water from pumping operations be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. :. I hexeby certify that I understand the construction site erosion control p*rovtstQ�s of the W�scotisin Uniform Dwelling Code, and that I accept responsibility: for caciying out the above erosioncontroi plan hispproved<by the for en h � f Signature of applicant Date A publication of the University of Wisconsin - Extension, Ron Sauss, UWEX Water Quality Education Specialist (12192). This publication may be freely copies duplicated Additional are available through the UWEX Environmental Resources Center, P 216 Ag Hall, 1450 Linden Drive, Madison, WI, 53706 6081262 -3652 ` Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wi Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in si . 41TI 8 / ,9 . County include, but not limited to: vertical and horizontal reference point (B , it on and �� p p nt slope, scale op4mensions, norto4Mow /Jan�d loc n nd d' to n` r Aad. Pa el I.D. # � APPLICANT INFORMATION - Please print all in ir>! '"" ;- ie ed by , t _o�, Date ^7 Ln Personal information you provide may be used for secondary purposes (Ph w, . 15.1M 1)` (m)). ° a,� `,� V Property Owner P6W* cation ' '1/ 1/4,S 1 T N,R E (or) W Property Owner's Wiling Address j ubd. Name or CSM# /22 ' /0& City State Zip Code Phone Number ❑ City ❑ Village Narest Road evD n Z (7 ) 0 1Z New Construction Use: � Residential / Number of bedrooms 7 - Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � W gpd Recommended design loading rate 7 bed, gpd/ft - J trench, gpd/ft Absorption area required SS7 bed, ft 7S_4 trench, ft Maximum design loading rate I bed, gpd/f1 • .Z trench, gpdNt Recommended infiltration surface elevation(s) Aj "� 9y ft (as referred to site plan benchmark),IreT rR,�gvt/S/E t Additional design/site considerations r '— Parent material BLIP iJ�LA.�.ti1 � Flood plain elevation, if applicable ft Jr S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ZS [:]U ,® S❑ U s ❑ u m s O u ❑ s u EIS ,F u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench n: 10—J 7. L a Z/ S h9 S pss' z 1 Ground �s Z9 0 L elev. ® Depth to limiting factor , >f�in. Remarks: Boring # - i 7 f; Ground to - S� WL ; • elev. -� Depth to limiting �'' `�Z'� Z' factor 7ZLf(__in. Remarks: CST Name (Please Print) Signature Telephone No. 0 ) �r Z 71;--7V 4'-m Address Date CST Number k4 ZAV A44413209 o � z 0 �° ,r SOIL DESCRIPTION REPORT 2 of PROPERTY OWNER ..U� <ol��Z Page PARPEL 1.D.# Boring # F n zon Depth Dominant Color Mottles Structure 2 P Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 - a . 5 Ground �elev. Depth to , i limiting q�/. fo aL • `� factor T in. To, O Remarks: Boring # T• S — t � - 7 S , _ L Ground -elev. , Depth to �� • t,� limiting (o�• Z -Z 3 �' factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PDl Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Boring # _ _ 2 1 S — r cs m or cs • f, - ,YL� / _ � --- psi < '-- ; • Ground ne -7 S 3 elev. ' Depth to limiting flaf 1 or in Remarks: Boring # _ . s A- Ground S elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) FOGERTY PLUMBING / & PERK TESTING, INC. P.O. Box 130 ROBERTS, WI 34023 ?y o' — 0 1 2 --k- '6 I ✓s cA4E' / " a 4 , o i 4gga e) j lAk a 1 � , sz l . _ FOG.r//� LiT Coy&tX'R • � � I icoDS, f�rsrE'� �YN: .s 'O'CD I Y9 x a� a� 0 �a Ns T,ivs, Aw • 76' cc Nr� rCOT, To o F P057.- • s ST, CROIX COUNTY WISCONSIN r„ `�` -�"" �`""' ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER r r r r ■ w ■ ■ . 1101 Carmichael Road ►`� Hudson, WI 54016 -7710 (715) 386 - 4680 ebruary 3, 2000 Mr. David Coyer 112276 1h Avenue Roberts, WI 54023 Dear Mr. Coyer: S & N Land Surveying has submitted a concert to this office proposing the creation of one lot on a parcel of land you own in Section 28, Town of Warren. The sketch shows one lot of 2.14 acres with frontage on 112 Street. Please note that a 200 ft. separation distance is required between driveways as well as between driveways and an intersecting road. Should Outlot 1 of Certified Survey Map 11/3206 be used for access, it must be upgraded to county standards to the point where it splits off for the proposed lot. A certified survey map must be drawn to create the lot. The map must be approved by the township prior to being submitted to the Zoning Office. It appears that the parcel lies within the boundaries of the Extraterritorial District for the Village of Roberts. Please icontact them to determine if they will review the map. This also must be done prior to submitting the map to the county. , Escrow and application fees for the map totals $500 and should be forwarded to the Zoning Office at the time of map submittal. A soil evaluation must be done for the proposed lot and the report submitted with the application. The map will be presented to the Planning, Zoning & Parks Committee for approval. The committee may approve, approve with conditions, or reject the map. You will be notified of their actions. The committee meets the fourth Tuesday of each month. The submittal deadline for certified survey maps if the fourth Tuesday of the month two months prior to the meeting at which the map is presented. This allows for the rap to also be reviewed by the Land & Water Conservation Department as well as the Department of Natural Resources. Because the project submittal is conceptual, nothing communicated during review shall be binding on staff or the committee. Should you have questions or concerns, please feel free to contact this office at the above number. Sincerely, Mary J. Jenkins Assistant Zoning Administrator C: Clerk, Town of Warren ^� f S & N Land Surveying ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owl °,./Buy "I .. ni ?vim �, L ?zy9- e-/i 3 e Mai ng Ac,i •;, ;s ­�9 r�X S� K & Prcl -wrty A ; :;s za, 43c TS,, �1 (Veriftc rtion required from Planning Department for new construction) Cit3 State , 2 -S . Parcel Identification Number LEO AL D If � �]; q ,' RIPTIO; V Prot -rty Lt x ;:r:. on / ' / <, ' /,, Sec. a , T a - % cp W, Town of Sub ivislor 1. _ .... _ , Lot # �-��-- Cer ifled , is t -i cr Map # t r S , Volume , Page # W€t ranty .1114! d # __4_ I ZP . Volume /S /O , Page # I Spe house 1;::' ;yes X nc Lot lines identifiable lZ yes ❑ no SYIt ITEM :1!l I .INTENAl10E Impi i »: i 'use and ma: atenanceof your septic system could result in its premature failure to handle wastes. Proper V. t onancc cons ;t of pt r:.r.li: i r.g out the s ;ptic tank every three years or sooner, if needed by a licensed pumper. What you p -at into . ; , ; system can . Tact the f su , :lion of the septic tank as a treatment stage in the waste disposal system. The iu al: a rty owner tgrees to submit to St. Croix Zoning Department a certification form, signed by the owns: ; ad by a mast. rplumb+„t . ; , inneymanp [umber, restrictedplumber or a licensed pumper verifying that (l) the on -site wastewaterdisp.: [ system is in troper oix ia,; ing condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1./3 full ;['sludge. Uwe tine and r ; i±: ned have re:.d the above requirements and agree to maintain the private sewage disposal system - with th andards set f ;tit, here at s set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin,. t:;, t ification state ; - that y:tu ° „!ptic systen: has been maintained must be completed and returned to the St. Croix County Zoning; Offict ithiA 30 n 4thetl, . . „,_ ,ear expirat on date. SIG, A.TURI l APPLICAI rr DATE OV NER (;`I i; l ', FTI ICA” TON I (w ;) r,;; rtify that al statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the 2; ier(s) of to op le ibed above, by virtue of a warranty deed recorded in Register of Deeds Office. S t. ATURl 1)I' APP ALIT DATE Any r.i: rmation tha is mis- representedmay result in the sanitary permit being revoked by the Zoning Departmf ** l elude v A It :his applics tion: 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 vn� , V ictlnllitvr a uMt3r:x WARRANTY ]JEW �y wy �^.fi•AY >F_.u... c 6:Y f)aVia AD. Cq3fX It, CEU'ul . t (.c*tes ItIISbft fr,�st ¢t 11•;_t,} f gc,ks t A MLEE N: W01.1 in their owst ti ht Rf (i )S'I`E OF DEEDS RECEIVEA.FOR RUIRD coriveyn find warrants to jy! twin R. F lr ttre and DebW q i C) .Flint .1 tsUucad -- and wif'�, am *41r(`ia�,- sutyvsttiF_I3oei4Y_. C5 1� -2dCO 9.25 AN WRMt1NTf DEEP EXEMM M rpl?y FEE the following dese6bedseal rntate. ill u i St., Croix ..._ Conty; Stet++ or IRPIiiSFER FFt Waseonssn. �. _ T- ttfCDhDIHG f FEa h,tt9 ': 6't1Cif 5: i ( cif a ol` a corul,dil �1 Ivey Map tlate*d Aptil'25, ;2000 aftd filed Aprit 28, 2000 in volutnc 14 ofCts'tifierl 8wuey Nlaps at Page 38 an IJncuuicnt No. 622069 loerx(e l ui part of dovei ineut u t 1 of Section ?.8, 'rownmhit, 29 North, Range — __Tres srnce t: ?srt F o t t r itt . ?euttirl Wlhh ,;. . ..._ 1S Vrist;tsi ron "of WX rren, St. (. voix Cuunty, Wisconss t, rll as tecorded in the NAME ANDRETURNAD ur. s ±: Uflice of fire 12epister `of Deeds for St. Croix County, WiGealssin, i 6W1 LAW l•IRM, 9.c). 430 ,}rood f1treet Ihidnoi), W1; 54016- -1510 rLis' ttosha.xitraat#. pr,,,Ixrty, ' (is) (is turf(, lIRC7ftG I,is. NIJMtipp or, Ol 8. Exception to yrrv'rantics. VOC. PTHER WITH AND :3Uf3,IhC T 'C) sury otlier eacenteutrs, cov.'furnta, I myadvlu s oi restrirdon ol'tecord, if Twyv, 1 this oliall not be dcemc l to eixirnid any ouch otllat fecortt"d rucirznliso-accs beyolld I t1;r. tetTtt esiablis };eti ky la"s iher;cl'oz•. r i x J r / ( Y I)at'd J Is �$ L gr Ma A 1l 2000 r _._ r i t , r A(i'l'NPP TICATIC)id AGKN( ?wr.iT1 ?(1M1iE;YC t $TATE01PCNIIt4c:t)M91%. } 9i nafwc(a UKVttI U C gyvu'_anc 1. Coyer ) Ruthesfti erl is (i of M; 2000 couI)ITY _ Personally eater hrfore. sire this _ is f 1 C;w x ,- lay of T7 '_ !3 k named T 1 l:F R_�& `'i2 iTA11 11A1 O Wlar ONSIIV (if not — 'Alitjloslz d by §706,06 , Wiq. Start&.) to fur. knoivrl�to be tbn p r twu Who exaeuted- Cf ll (t7S�Rill+4?N l' 1NA.3 nI?,Ai PO 17 Y: the fotagosnq instj 013leni_ and arltnawltrl9c the saute: �i ♦ t t9[n i t t;� 1.Ar1.4! 3� »ur $,C.' - — � - - -- - ' (sigsiattirevihuybesttiE ;tektiowlec[1i tl. 136t.lt. ^sP Ftot rutresvaty.) Notary Viiblic, __. _ - -- - C:olinty, t ✓1. _ / r � ! G lY'asztWg,of persona siWibTg in any My cotnmiasicAs in P s zixk t)� nt (if ndt, state; rajraC;fy hisr,nlil be t;yp.xl or prrrntod below tlseit•.. exf,ii'KtSala date,' _ _ _ _ , 70 . _ - lit -i r � t j %,,;ERT1,F1 "P LOCATED IN PART OF GOVERNMENT LOT 1 � I'. CR OIX COUNTY. WISCONSIN L.EGFND �- ALUMINUM COUNTY SE G 1 1 IOf 1 CORNER MONUMENT FOUND � OWNER DAVID A C3AHOL COYER - 1" IRON r'IPE FOUND ` F ILE- E ) 1122 6 - FI -I AVENUE ROBEM - S, wl 5402 I.. x 4 IRON rIl�E IY,, r 4�/EIC.;t1INC3 APR 2 8 cM 1. 1;3 1.::BS. PER 1_,INPAR F"06'r ��. Yw %(tiIEEN t" tit�isiers><QS - 100' i-iC)r�DWAY SET' BACK U_ ,I �l.�t�t�i.�t� / r (XXXXXX) I`RE:VIOLJSI.Y Rf_C.:r'7F•1t)EC (JAIA j�3 ,) r loll- BORI G, -. _- 'u 3 OOOU' ) . .I O A OE1 "tv 194.0 I _ 3.0Ci LOT 5 2..414 ACRES INC. IFIAN �c � 11-`01 105, 1'i2 SCE. E I', 1-4163 o c) 2.'144 ACRES F_XC, RPN i � �" U i r I i a �w (f). 93 360 SQ. 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Parcel #: 28.29.18.437E 042 - TOWN OF WARREN 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 - FLETTRE, MARVIN R & DEBORAH D MARVIN R & DEBORAH D FLETTRE 759 112TH ST ROBERTS WI 54023 -8329 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 759 112TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.414 Plat: 3840 -CSM 14/3840 SEC 28 T29N R18W PT GOV LT 1 BEING CSM Block/Condo Bldg: LOT 5 14/3840 LOT 5 2.414AC EZ -U- 1527/86 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 05/12/2000 622878 1510/122 WD 07/23/1997 1077/415 WD 07/23/1997 686/171 LC 07/23/1997 416/181 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/08/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.414 39,500 183,200 222,700 NO 2 Totals for 2007: General Property 2.414 39,500 183,200 222,700 Woodland 0.000 0 0 Totals for 2006: General Property 2.414 39,500 179,800 219,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00