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HomeMy WebLinkAbout018-1082-10-080 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address 7,�? / / % -Y� � v� City /State �CUUN?1' r Legal Description: AG OPFICE Lot_ Block Subdivision/CSM # e /4 -N ' /4, Sec., T -RAW, Town of Pi SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: y flu from: House Well G P/L Tank manufacturer i cc� � Size STS /�L'b! Setback Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: t iEV1 Width / 5' - Length �_ Number of Trenches l Setback from: House :3 , � - Well 13S P/L Vent to fresh air intake - /3,P ELEVATIONS Description of benchmark - T-op -14� Elevation 1250- o d Description of alternate benchmark - �5 Building Sewer ST/HT Inlet 0 / C- / /U ST Outlet 5�'3, 9.) PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover S- Distribution Lines ( ) ,� 2- s_ () Z 3, Yom_ Bottom of System F - 5 - ' O 9 Final Grade Date of installation /010 //3/q9 Permit number 1 -/ Ve State plan number Plumber's signature /,4 L,-4�t6nse number Q;)o _ Date /J Inspector Complete plot plan � ✓, rovi e e o owing: C�2 �ca • A plane sketch sho eJrerythi ' 100 feet of the system. Ile • Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. �� ClSE /S'r 60 "eC4 PLAN VIEW • s 3 gQ�� 4& � vnc q7 F 1_�� CBS y I h b y J T P To 70 7h Ao S r ' i - e'ss Sec ii 97 o J - IMICA.TV NORTH RROW &L �� 1 i ,f1 � Wisdonsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count 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)]. 344635 Permit Holder's Name: ❑ City ❑ Village q Town of: State Plan ID No.: Hammon lev.: Insp. BM Elev.: BM D scription: Parcel Tax No.: e TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rl,t� J,u,&41&Z p , I CUD BenchmarkA p . 6 S co .6S lerD - v f Dosing Alt. BM 3. - +o c t(0 - 4'5 Aeration Bldg. Sewer 6 • zq Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 6, }3 R3.4 Z TANK TO P/ L WELL BLDG. Air i to ntake ROAD ir Septic 36 NA 9+ Bottem Dosing NA Header /Man. �' Q'3.ry Aeration NA Dist. Pipe �' } '13- Holding Bot. System &`� Is q2, �_ PUMP/ SIPHON INFORMATION Final Grade *,S turer mand t cover T'g �S -rry Model Number GPM TDH Lift Fri System TDH ss Forcema' Length Dia. H Dist. To well S L ABSORPTION SYSTEM r_BW Tt@pjKN Width I Len I No. Of PIT No. Of Pits Inside Dia. Liquid Depth IMEN I N 5 DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type � r CHAMBER Number: S stem: �� ;> 1r i D IM OR UNIT y lP► � DISTRIBUTION SYSTEM Header/Manifold a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia - Length 57 Dia. T Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over q Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center qz Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: 1 Inspection #2: Location: 721 159th Street, Hammond, WI (SEl /4, SE1 /4, Section 30 T29N -R17W) - 30.29.17.571 a '�a •sue I �" s� t�e� 44"6" �lan vlslon` qulred / � ♦ Ye_ z r - Use other side for additional information. 1 Zo ct + � SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �w... i E e 3 x 3 3 t r E e - , r r e e v em e m�r e 3 ... .0 t i 3 i s t t .vede.. 3 te e. ...., -.. .. m.n._ .. ,. .... ..o ..are, .. .. .p.�. .e ,..e.:.. _ n .., .... ._.�. .� .... .. m p ' e I x e i a e € P e r z i —s�..3 x e 1 9 € �.--„- ------ --- --- m m i { i 4 f a € � e® G a a c E ➢ e.. wep� e, �. . ®Rn ems... m ......,.. .� m.. .,.».�... 2 w.,. e e r € a. t � a i 9 .. ... �.., z,._ .._ .._ . _ .... �...::, .. .,.,..:....m .. :............... ...... _..... ... ..... .. , .. £ . ... . e,....,. ., .. , _ _.,..,.....l .,.,._...,.,.... .t..�.,......, w, .......t f Safety and Buildings Division 10 PERMIT APPLICATION 2 01 W. Washington Avenue n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number 3Z/�6.3.s Personal information you provide may be used for secondary T ses ❑ Check it revision to previous application �-,( [Privacy Law, s. 15.04 (1) (m)]. �^' 15 .4 7, State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location KEVIN & TERA HENNEN SE 1 / 4 SE 1/4, S 30 T 29 N, R 17 V f 99 W Property Owner's Mailing Address Lot Number 7� mber 269 11TH STREET 8 City, State Zip Code Phone Number Subdivision Name or CSM Number NEWPORT MN 1 55055 1 ( 651 ) 45 —2 21 Meadow Ridge II. TYPE F BUILDING: (check one) C] State Owned it� Nearest Road Vil age Public 1 or 2 Family Dwelling - No. of bedrooms _3_ Town OF HAMMOND 70TH AVENUE III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 018 - 1082 -10 -080 ��' ?�I ' �� • S 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 Q Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 ® New 2 ❑ Replacement 3_ ❑ Replacement of 4 Q Reconnection of 5 ❑ Repair of an ______System ________ System _________TankOnly______________ Existing System ________ Existing 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 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill IS )C p� = c te VI. ABSORP SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft . Proposed (sq. ft. (Gals/day /sq. ft.) (Min. /inch) Elevation 450 .8-},5 goo 3• 01 a if +-2- 0.5 N/A 92.5 Feet 96.0-97 -Peet VII. TANK Capacity Site in gallons Total # Of Prefab. Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete strutted steel glass App. Tanks Tanks e ti Tan 000 1000 1 MIDWESTERN PRECAS ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb ' Signature: (No Stam ) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 0292 1 715/772-3278 Plumber's Address (Street, City, State, Zip Code . W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (includes Groundwater D ate Issued Issuing en Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial .-, ., C� ap Adverse Determination w X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 'i 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 properly maintained. The septic tank(s) 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 be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. 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.), 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 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; 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 115 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. 05 P3 f ,, �' 66.e o V h Uck � 4c�cv/t {.v P t o PBS A /" ec-, dGGv �cl �9 e Driv -E r __ a ` To 70 7h Au C- -� S O/ / N , -970 sit, l v�T 1� f� ctCQt Wisconsin Department of Commerce ,SQ AND - SITE EVALUATION Division of Safety and Buildings Page of j3ureau of Integrated Services in is g oo 96e with s. ILHR 83.09, Wis. Adm. Code ,�A E,., " I r.- f" County Attach complete site plan on paper not less than 1Tgi 11 incf- Olan must include, but not limited to: vertical and horizontal3'wfe'ience point (BM), direction and r� percent slope, scale or dimensions, north arrow, dlocatidn "aftd distancF to nearest road. parcel I.D. # APPLICANT INFORMATION - Please t>�ll @iVon. Reviewed by Date Personal information you provide may be used for seconds urp6!ye,,s (Privacy aw'YF1 t?4 (7) (Rh)). R • 1. (� .cla� Property O ner l r operty Location ct �C Lis ,QNF l �C — - Govt. Lot. S5 1/4 1/4,S_; T �q ,N,R �� E (or) W Property Owner's Mailing Address - Lot # Block# ubd. N r CSM# l p r City IF ❑ State Zip Code Phone Number city ] ty Village © Town Near at Road N tw Ro tjM1, JA s oc ( his' ).2q i fy 3 a V , ® New Construction Use: R] Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ��� gpd Recommended design loading rate i S bed, gpd /ft i trench, gpd /ft Absorption area required 966 bed, ft 7 SZ7 trench, ft 2 — design loading rate . S bed, gpd /ft gp trench, d /ft Recommended infiltration surface elevation(s) 77. © ft (as referred to site plan benchmark) Additional design /site conside, ations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system E'S ❑ U P!Fs ❑ U 4?SS ❑ U I ❑ S 4�T U ❑ S g'U ❑ S RT U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / 0. fi z. •g Iv ERs /r,� � s �l - /�iL -� -- . � , Ground elev C 11 � ft. Depth to limiting ctor 7 in. Remarks: Boring # s a z 27 S Q 3/3 Se S /n4F cr /Z Z7.514 Al Ground C1 ev. ft Depth to limiting factor 77jo _in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 5 31" 221171 SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z- of ' PARCEL I.D.# i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench _ 0A 2,y SL /i/F , 64 m i Ground c l 5�/5 ��► s /Ji d ✓ 5� . to elev. �Lft. Depth to limiting 5q /d p fact r Remarks: Boring # err �- s I��i4,�,C AfUFW a A-- is ci /774 Ground C, elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring# ©� SZ 1 A&A 3 9� �a� 7. a R s7+ti /Jt Zn S YRS'B' Ground elev, T� 7 Depth to limiting 1 f ctor a in. Remarks: Boring # .......................... Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) S�SF'S3o T)9 H/? T71v s-� /or 8 l f i73 i � I �p �- :2f 3y' 1 • JUfl -24 -99 01:33 PM P.01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwncrBuyer 4-f- y l n - ah Mailing Address f� / � � s Djew f r+ M aJ "SS SS Property Address cZ l 5 �i J �. Verification required from Planning De artit at for new construction 9 & P City /State �A� rno�J w / Parcel Identification Number LEGAL DESCRIPTION Property Location � ''h, _ '/..Sec. T,2j-N -R_j? ..W, Town of Subdivision /� P�. k a/a . Lot # Certified Survey Map # . Volume . Page # Warranty Deed # . 6 7094 / , Volume _ 7 -. page # Spec house 0 yes X no Lot lines identifiable # yes 0 no SYSIQ1 H&RE M ANCE 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 ayatem can affect the Ainction of the septic tank as a treatment stage in the waste disposal system. The property owner &&rase to submit to St. Croix Zoning Department a car0oation form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumbar or a licensed pumper verifying that (1) the on - site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic t&nk In less than 1/3 full of sludge. Uwe, the undersigned have road the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as act by the Departuuat of Commerce and the Department of Nattn d Rosoutcea, 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 three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICAI= I (we) certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of the pro erty described above, by virtue of a warranty dead recorded in Register of Deeds Office, 9� 341 7/59 SIGNATURE OF APPLICANT DATE tsa.tbrsnar— chat to tats- rapreaentap may result in the .unitary pamilit beins revolted by the Zoslinsl 17epartmont. vvavva `• Include with hits ■ppllcstleh; a atamned warranty deed rkom the Repi.ter of Elva," omaa e cop of the certified survey na.p it reverence in mncto Ira 0— warranty dead 3� Uft 503 KAT 1)()L- Smtc Bar ofWbconsin Form 2 -1982 REi3I 01-1h WA RRANTY DEED KMM FIR 07- 14-1"9 its All j r► ra�r ; HaIHalle guilders, Inc., a Wisconsin corporation, conveys and cEE CV1 FEES warrants to Kevin G. Hennen and Tera J. Henn, husband and tU69 FEE: 7LOt WMDIB Wife as survivorship marital property, the following described real r � ' estate in St. Croix County, Wisconsin: 11 Highway 64 Richmond, WI 54017 Parcel ID No. 018- 1082 -10-080 Lot S. Meadow Ridge, located in part of the Southeast Quarter of the Southeast Quarter (SE1 /4 of SE1 /4) of Section Thirty (30), Township Twenty -nine (29) North, Range Seventeen (17) West, in the Town of Hammond. This is not homestead property. Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. J'ellt8 Dated this %y ofd 1999. HALLE D INC B �' C W W. Halle, President By: *Linda R Halle, Secretary I ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) June Personally came before me this day of 34, 1999, the above -named Wesley W. Halle as President THIS DW JMENT DRAFTED BY: QN L, h and Linda R Halle as Secretary of said corporation to me (mown to be the persons who executed the Judith A. Remington NO foregoing instrument acknowledge the same. P. ox 1 7 7 r -kW OFFICES _ o — _ P.C. Box 177. New F. cl.rmond, WI 54017 �► �LIC � � • otary is State of (715) 246 -3422 ' a y 2 Mr Commis-;;.on Expires: Op W15GQ Easy access to I -94 (3.5 miles), Hammond (2.5 miles), and Roberts (4.5 miles). Open DERS rolling land with a good view and walkout basement possibilites. Lots perc for mound -a/ Estate, Inc. systems (except as noted). Your investment is protected by restrictive covenants. f apo S-e � Q I am of - L ?� L LOT S. 1 p� � \ 1..0 K•[f i • LO s I Z I ._ / � �` \ 2 64 M •M' f r. I S • i I(n Y 2M�•�•t IO 8 t / \ ` = LOT 4 LOT 9 M \ Y r.7r K•[1 y • •�, 88.64? 14. i Ml�1f *G.'? - LO r.[ K ` • I LbT 3 ,.w .mil[. 2.0 0f fart SSV58'06'W 330.00' T >; Lq 11 1.01; tale I ! LOT 2 YOLI • L. ►.«O I LOO AMU v,nf w.rt PG. 2684 L L X09 u A i.'W W LC i 1\ `SAT 1 LOT 12' r. W 20Kf 0'..z a W. R. fe Builders, Inc. I = AQ M, 330.00' !s $20,500 Lot 7 SOLD !s $23, 000 �.— {offer) Lot 8 2. conventional �s $24,000 Acres $26,000 (o er !s $22,000 Lot 10 SOLD �s $21,500 Lot 11 2.0 Acres $22,000 Lot 12 2.0 Acres $22,500 4/99 *r • W f • MTRS 11 JP,o -2o�� W !2o er E S -Tune L =e Mg t �uQ�e e S ¢o arc -� � u e . n. L /nd u,s/` D cp � � r 72./7 � � Lorna 170 .`� ot Ernrr, eCf � � r � `y Herber/ f iTa tee% /593 ° a h LewAc 7 Sa Turner o X17 � 155-43 / ¢B Fain y Test, 6 • 3 I Barbara ,� v z� emu/ W, ff', T� 0 0 ^ �°`' . vE. v c /42 U o COJ7 Do /owes i9nrna,be/% F Z7 / �u m Fin r l r � u Ford fh17so17 T, I7o /o�cs C�J p h /¢/ Ford San y • T T rcK.c �5 L. �r • Fia 17CI s o l C.8 7u�ne oi y y . o cGor Ru s sr // C p '9 -D D //4•Q5 cTohn,son . • 210 •�, 1,52 .3 .2z �M R. R tQ ,r s3 a S fern ... i 3 R. 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