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HomeMy WebLinkAbout020-1356-23-000 ST. CROIX COUNTY WISCONSIN ZONING OFFICE t :.�: 1�rMllgrrr -- +rrrri" ST. CROIX COUNTY GOVERNMENT CENTER _ -- 1101 Carmichael Road •.;. Hudson, WI 54016 -7710 (715) 386 -4680 Fax (715) 386 -4686 May 24, 2000 Affinity Mortgage RE: Septic Inspection for Kernon Bast located at 987 Paul Burch Circle, Grass Range II addition, Lot 23, Town of Hudson, St. Croix County, Wisconsin To whom it may concern: A septic inspection of the above referenced property was conducted on December 21, 1999. This property is located in the NW' /4 of the NW' /4 of Section 14, T29N -R19W, Grass Range II, Lot 23, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Rod Eslin 9 er Zoning Specialist ST. CROIX COUNTY ZONING DEPART N ' AS BUILT SANITARY REPORT► Owner Property Address .. , 3T Ckax City /State l �� ;AUNT'y ZONING OFFICE Legal Description: Lot --,-,7 Block Subdivision/CSM #��� c. �/gL ' /a/ Se, T� -RAW, Town of / >So PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer / J.S' Size ST/PC / / Setback from: House �� Well �v,� P/L Pump manufacturer d Alarm location (HOLDING TANKS ONLY) Setbacks: Service road o fresh ai ' Rice Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM J L Type of system: �.= / Width �_ Length _ Number of Tftneh s Setback from: House /20 Well � P/L Vent to fresh air intake , > t� ELEVATIONS Description of benchmark G >1" Elevation IeW- 0 Description of alternate benchfn4i Elevation o% O Building Sewer ST/HT Inlet Z ST Outlet f&' d 3 PC Inlet PC Bottom Header/Manifold ! Top of ST/PC Manhole Cover 6*y• VY Distribution Lines Bottom of System O - .1 6 O ( ) Final Grade Date of installatio>p�� /��/ / Permit numb r3 Z.3� 7 State plan number - -- Plumber's signature License number //'fd Date✓'1-L25) Inspector Complete plot plan �+ iX NOTICE Please provide the following: A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole covgr. • Show alternate benchmark, if applicable. LAN VIE puT 2g , l r4f / C �A.- © 4 L s7 . PLC V INDICATE NORTH ARROW JZ • Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County 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)]. 353257 Permit Holder's Name: y C] Village ❑XTown of: State Plan ID No.: l ast, ❑Cit Kernon Town of Hudson CST BM Elev.: Insp. BM Elev.: I BM Description: a Parcel Tax No.: 100 .0 ( 1 . D r C SC _ (- 17, PV C, 020 - 1356 -23 -000 TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark gQ v0, p Dosing Alt. BM to I. O Aeration Bldg. Sewer Holding St /Ht Inlet (Q, q TANK SETBACK INFORMATION St/ Ht Outlet ( q�- (V- ?3 TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet --+^ Air Septic ­7 NA Dt Bottom Dosing NA Header / Man. q ` t I qt f Aeration NA Dist. Pipe �` �` If Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade .. qq. 0' Manufacturer Demand St cover 3 OO.4 Model Number GPM TDH Lift Friction S ystem TDH Ft oss mead Forcemain Length Dia. Dist. To well S L ABSORPTION SYSTEM T_ BEW T1 Width 1 Len th ► N f PIT No. O i s Inside Dia. Liquid Depth EN 1 N 2 Z- ` 1 DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION TypeO Moe Number: System: 8 8 CHAMBER OR UNIT DISTRIBUTION SYSTEM Header / anifold Distribution Pipe(s) a x Hole Size x Hole Spacing Vent To Air Intake Lengt � Dia. Length ao Dia. q Spacing fo-L I 1 1 " m 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, persons present, etc.) Inspection #1: P121111 Inspection #2: Location: 987 Paul Burch Cir��cle, Hu on, WI X4016 (NW 1/4 NW 1/4 14 T29N R1 9W) - 14.29.19.2085 1.) Alt BM Description= o ajet �'' 2.) Bldg sewer length= ISM - amount of cover = f 4 I Plan revision required? ❑Yes No Use other side for additional inform tion. I o1. (3U (�[, SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �_ mm « -_ i j [ « 3 tt I a » E e � — I — I ' 9 ( d r 1 r pa CA�� SANIT PERMITAPPUCATION w g ingtonA e�4 NVIsconsin <II6accord with 83.05, Wis. >4 dm. Code Box AD Department of Commerce �� , - 4addi -7302 • Attach complete plans (to the co A co o r the ,� �by) y , on paper not less County � than 8 1/2 x 11 inches in size. - • See reverse side for instruction for'completing State San this �p�pIicatro y it N er Personal information you provide may be u ed} r se�ondary purpos s [] Chech, is ✓ ion pr us a lion [Privacy Law, s. 15.04 (1) (m)]. State PI I.D. Num I. APPLICATION INFORMATI - EA564PRNT ALL I FORMATION ` £ Property Owner Name r, f' - Property LocatiO'n S �; �: °` 1/a 1;� T , N, R E (o Property Owner's Mailing Address Lot Number Block Number 42 Aaw City, State If Zip Code Phone Number Subdivision Name or G&M Plumber t.!/ ) 7.77-5 6:4-tIF 44466 II. TYPE OF BUILDING: (check one) ❑ State Owned 0 It 12 arest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ 0 To w OF bace III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) I L4 I9 • �7 _ 1 [] Apartment / Condo 4.2� — — l � 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchanc[i�e: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Horne 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. m New 2 ❑ Replacement 3. (D Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an ------ System ________ System L 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 , , 42 ❑ Pit Privy 13 [] Seepage Pit 1.2 X 7. 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION 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 8s" 0 0 1 7 5 1'.S. Feet Feet Capacity VII. TANK in gall site Total # of Prefab. Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tanko� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of t,09 onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Sta ps) fm /MPRSW No.: Business Phone Number: 7 um ber's Address (Street, City, State, Zip C de): 1&2 /* 4 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved j a n itary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signatur (No Stamps) RApproved [] Owner Given Initial Surcharge Fee) Adverse Determination 2-_�S M 11 2-4 - �j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit tmay be renewed before the expiration date, and at a tine 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 81/2 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. \ c � it 1r n it a �� M c � Q ir - s m 0 X73 t Pw v � zc n Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor`and Human Relations Division of-Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distancQ rW r" r`o'ad 020 ` i ��! - -- �'' RE IEWED BY DATE APPLICANT INFORMATION - PLEASE P T4i INFORMATION � � f � y PROPERTY OWNER: ROPERTY LOCATION Kernon BAst + VT. LOT NW 1/4 NW 1/4,S 14 T 29 N,R 19 { (or) W PROPERTY OWNERS MAILING ADDRESS �!!� '� , �r?�a� .tL T # BLOCK # SUBD. NAME OR CSM # 948 LaBarge Rd. �_ - 3 na Grass Range Second Addn. CITY, STATE ZIP CODN. ' PHONE ;' „ CITY ❑VILLAGE [grOWN NEAREST ROAD Hudson, W 54016 '.`Y.71 6f'l6 /' Hudson LaBAr 'e Rd. (x] New Construction Use (x ] Residential / �Uobi 61 ms ; 4 (] Addition to existing building [ ] Replacement [ ] Public or commercia Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.40 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem XIS ❑ U CAS ❑ U ❑ S ® U EIS ®U ® S ❑ U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Bed Trer& 1 0 -11 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 2 11 -35 10yr4 /4 none sil lcsbk mfr yw if .2 .3 Ground 3 35 -42 5yr4/4 none co s Osg ml gw na .7 .8 elev. 9 9.3 ft. 4 42 -84 7.5yr4/4 none co s Osg ml na na .7 .8 Depth to limiting factor +84" Remarks: Boring # 1 0 -15 10yr2 /2 none 1 2msbk mfr 9W 2f .5 .6 2 2 15 -37 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 37 -43 5yr4/4 none ms Osg ml gw na .7 .8 Ground elev. 4 43 -84 7.5yt4/4 none ms Osg ml na na .7 .8 99.3 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AvA., New RichmandWl 54017 Signature: Date: 8 -24 -98 CST Number: m02298 sei Kernon BAst PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 020 - 1021 -00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10 r2 2 none 1 2 msbk mfr gw 2, f 2 10 -27 10yr5 /4 none sil lcsbk mfr gw if 12 .3 Ground 3 27 -41 5yr4/6 none co s Osg ml gw na .7 .8 elev. 4 41 -84 7.5yr4/6 none ms Osg ml na na .7 .8 9 9.3 ft. Depth to limiting factor + 84 11 Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 12 -34 10yr5 /4 none sil lcsbk mfr gw if .2 .3 3 34 -84 7.5ry4/6 none ms Osg ml na na .7 .8 Ground elev. 99 ft. Depth to limiting factor +Fi4 1 Remarks: Boring # 1 0 -9 10yr2 /2 none 1 2msbk mfr gw 2f .5 .6 5 2 9 -28 10yr4 /3 none sil lcsbk mfr gw if .2 .3 3 28 -38 10yr5 /4 c2d 7.5yr5/6 sil lcsbk mfr gw if .2 : .3 Ground elev. 4 38 -84 7.5yr46/ none ms Osg ml na na .7 .8 99.4 ft. Depth to limiting factor d +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Kennon Bast WI 54017 CSTM2298 New Richmond, MPRSW -3254 N4N4 S14- T29N - R 19w (715) 246 -6200 town of Hudson lot #23 -Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM.= top of 12 pvc pipe C el. 100' Alt. BM. -= top of 12' pvc pipe @ el. 100.60' , 7 y' p b In Gary L. Steel 8 -24 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerA3t:yer Lt2W,&1 N AA - S'7' Mailing Address 7FZ 4z_C r Property Address 8 7 (Verification required from Planning Department for new construction) City /State AACa , 44- I 16 Parcel Identification Number a_©_ ).rS6_ - - O(n LEGAL DESCRIPTION Property Location /4, Vim/ '/4, Sec. /y , TAN -R Town of Ze f o Al Subdivision A , , Lot # Certified Survey Map # �— , Volume , Page # Warranty Deed # 'Z t15 Volume / /-I f , Page # Spec house O yes P no Lot lines identifiable ,0 yes O 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 wastewater disposal 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. Uwe, 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. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30 day / of,�the three vear a iration date. SIGNA URE 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) am (are) the owner(s) of the �property descri d above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF XPPLIdANT 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 oocuMENT NO WARRANTY DEED THIS %PA::[ RESEOV[O Fr.M aEC000 OAT♦ STATE BAR OF NISCON RY : — 1lb2 529'745 i VOL11.2 - RAY..G.,- .BR.QWN. and- ELEANORE.BROWN a / - J. Brown, husband- - and-. wi fe..... ....... ............ .. ......... 1 . - -•- JUN 9 ............................ ........ .... .............................. 8 A. ^t . conveys and warrants to ...QQ�A.I�A..J.• . $PEER - BAST .._ .....................� ,,, � I ........................ ............................................... .............. ... ....... ....... .................. ............... .......... .... ........_... .......................... I ...... . ._ ............................................................. ... ..... .............. ......... .. [[TVI�M T% ..... -._ .for_ 1,* and other valuable consideration ... , I I /� .._ l 20 = = ao t County, I ; the following described teat estate in ............................. .......... - -- - - , - 1019 – I State of Wisconsin: Tax Parcel No: 020- 1020 -90 i !� -19 EXCEPT part to Hudworth, Inc. in NW's of NE's of Section 14 -29 !i Vol. 604, Page 226. ! NE"f of NW'k of Section 14 - 29 - 19 EXCEPT part to Thomas Wiley in Vol. 958, i Page 577. Subject to torn road right -of -way along the southerly line of said lands 11 Ii i Grantee is responsible forpdysubsequent real Yearsestate taxes for the it year 1994, payable in 1995, a NS I This ....... ft- I10.1~_.__• .... homestead property. ji ()s) (is not) Exception to warranties: 'I �I I� 1 Dated this da 3uf).@ .. 19. 95 8. t ................... y of ......... _ I _....__ . ...................... ... ...... .......(SEAL) /v �` .. _(SEAL) I Rav G. Brown • .(SEAL) (SEAL) ... . • • Eleanore Brown ' { _... __ i t AUTHENTICATION ACKNOWLEDGMENT } r Signature(s) .. RaJ(•- G� _. QI"lZWp- .and_.Ele a STATE OF WISCONSIN ss ..... Brow .................._...... ... ........... .County. it •. . ._._., 189 -- Peraomlly came before me this ................day of j suthe 'ca ._. ...d y ... .... I� _ - ........ ......... .. 18...- __..:he above named j E I' •...Wil iam J. ilbert .... ..................... - - .... i4 TITLE: MEMBER STATE BAR OF WISCONSIN........................................... ................. .. ; 1 ! I (If not . .............. ...... ........ _.__........_.........._ ..................... •• .......... I _.................... ......... authorized by 4 706.06, Wis. Stab) to we kno" to be the person ............ who executed the a i foregoing instrument and acknowledge the same. I } I I, THIS INSTRUMENT WAS DRAFTED SY E __ .------- ........ ............. ..,................ -. i, Sd� . . • X516 �� � -� .,. - � . a } .,4 L b � `�Y s'�' , } s� � ' ' �.Ca, vw:c,T� q � 3 . e�` E �:'''.. .. _ (11 ro N ( V W Gj �' x