HomeMy WebLinkAbout032-2093-80-300 r
ST. CROIX COUNTY ZONING DEPARTI 1 , < , \�
AS BUILT SANITARY REPORT
f "A
Owner
Property Address`
City /State 1
Legal Description:
Lot Block — Subdivi ' CSM #
,A�L '/4 , 1 / a, Sec, TAN-R,/2W, Town of
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer L _ Size ST/PC,/ �/ Setback from: House Well P/L
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: A4�6 Width 4,� Length _-<Z Number of Trenches
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark Elevation , /r,6', D
Description of alternate benchmark Elevation
Building Sewer - /S/ , s ST/HT Inlet _ 99 /S" ST Outlet PC Inlet
PC Bottom Header/Manifold 9S, _ Top of ST/PC Manhole Cover led,
Distribution Lines
Bottom of System
Final Grade !2 O ( )
Date of installation MM ? Pe it number State plan number
Plumber's signature / License numbe Date / /
Inspector <JQ.,y
Complete plot plan Or
1�
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 cover.
• Show alternate benchmark, if applicable.
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P AN VIEW
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INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST IX
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)). 338983
Permit RER, LUKE ❑ CitySOMERSET Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM D (,scription: Parcel Tax No.:
UU Dv rd �C 032 - 2093 -80 -300
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic MOO Benchmark � � Dd
Dosl e>#1 /d 3 . 6_T
Aeration Bldg. Sewer Y, g •
Hol ' g QL >t Inlet f r
TANK SETBACK INFORMATION t/ t Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD
Air Intake
Septic �'� � 7Qp - e - } Z 2 NA
Do ' Header / Man. L j Q-311,
Aeration NA Dist. Pipe 3
Hol ing Bot. System
PUMP/ SIPHON INFORMATION Final Grade
nufacturer )nd
Model Number TDH Friction S stem TDH
L
Fd - rc Length Dia. Dis . II
SOIL ABSORPTION SYSTEM
BEb TRENCH Width Length No. Of Tre ches PIT No. Of Pits Inside Di Liquid De
N I N ( j DIME
Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION Typeo C B odelNumber:
System:
y d >l�pi � RUNIT
C /
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- 7 Length S_z Dia. Spacing �j Z Z �7 9 > 7 ,-
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.)
LOCATION: SOMERSET 24.31.19.917D,NE,SE 2027 77TH STREET — LOT 4
'V(V be-
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. Z Z
�C SBD -6710 (R.3/97) Da Inspector's 67hture Cert. No.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Visconsin
to 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 8112 x 11 inches in size. : E Z 4 �- e
• See reverse side for instructions for completing this application State sanitary Permit N
Personal information you provide may be used for secondary purposes ❑ Check i7'rrevlsi to previou's application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Prope y Owner Name Property Location
1/4 1/4, S T , N, R (or�
Property Owner's Mailing Address Lot Number Block Num r
Citye Zip Code Phone Number Subdivision Name or CSM Number
( )
11. TYPE OF BUILDING: (check one) ❑ State Owned V a Cit Nearest Road
p Village
Public a 1 or 2 Family Dwelling - No. of bedrooms M Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
.,Y` M
1 ❑ Apartment/ Condo
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..® New 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 (d 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
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. /' ch) Elevation
Feet Iel Feet
Cap acit y
VII TANK in Ca g Total # Of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete con- Steel glass App.
New Existin structed
Tank Tank-
Tank or Holding Tank 160 xeyo I, - ❑ E] E] ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1:1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for inst
allation of the onsite sewage system shown on the attached plans.
Plumber' Nam (Pr Plumbe s S at e: m s) MP /MPRSW No.: Business Phone Number:
Plumber's Address Strut City State,Zi de):
IX. COUNTY / DE ARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issui (No Stamps)
A roved Surcharge Fee) ��
pp ❑Owner Given Initial �� S- ate ,� 8
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber
99 S �F1S�t
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Wisconsin'Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations. Page of
Division of Safety and Building "� in ceo ance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan r not &&"1/2 x 11 in size. Plan must County
include, but not limited to: all and horizontal reference BM), direction and C r D
percent slope, scale or di ns, rN 14ntv4arjS®6ation ... istance to nearest road. Parcel I.D. #
ST CROX
APPLICANT INFORM - P wit a rmation Reviewed by Date
Personal information you provide or secondary s rivacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
�Qr r Govt. Lot E 1/4 S�1 /4,S a T 3 1 N,R 1 E (or
Property Owner's Mailing Address Lot # I Block# I Subd. Name or CSM#
" S n Q v 1 (r s+ IgOA.
City State Zip Code Phone Number
❑ City F Village Town Nearest Road
Gk . Paul.. r1l S S N 0 " + S .`l b S fi ` A %j ,
® New Construction Use: R Residential / Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 9 S o gpd Recommended design loading rate bed, gpd/ft r C 3 trench, gpd /11
Af3sorption 2 2 area required (o y 3 bed, ft S�e�,� trench, ft Maximum design loading rate
''�� g g bed, gpd /ft . � trench, gpd/ft
Recommended infiltration surface elevation(s) (9%211 1 j . S (IS � ft (as referred to site plan benchmark)
Additiongdesign /site considerations
Parent material Flood plain elevation, if applicable It
r u = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank = Unsuitable for system S ❑ U ®S ❑ U ®S
❑ U 0 S ❑ U ❑ S ®U ❑ S ® 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
�. b- ►hW 3 6 - s L l Ff,r• CI o�F
a -IB o — �s d- �w i .$
Ground 3 jjj -A 7 31 s J ca
elev. Y b - L �" w F
/00 - a- , L ft. Y -40
Depth to 5 9 -10 5 (t VI
limiting
factor a
Remarks:
Boring #
0 -1 1 IL) 313 — L F r trti F r Q S a ir .
c� oZ 11 -1 I p'1 Y/3 - 1. S V - 5 IM L- w
3 18-A 7, S YR y/3 L 6-64 L- I F
Ground y $ -3 -7. ---- O- r
elev. �
I) +S ft. 5 -SO ML G 1a9
- S 3 13
Depth to v
limiting
factor
$Qin. Remarks: e. t \ k
CST Name (Please Print) Signature Telephone No.
Q , S +d tY - 715 -a g - �S'$ K
Address Date CST Number
A 6 d 0 d h -, f'cs r f " ter t? t 11- 13 - 9 14 0\ 1
PROPERTY OWNER Dare r cJwgVIs611'kSOIL DESCRIPTION REPORT
Page of
PARCEL I.D.# p GY\rSi r
- T
Bonn # Horizon Depth Dominant Color Mottles Structure •. 2
9 Texture Consistence •Boundary 'Roots
in. Munsell Qu. Sz. Cont. Color dr.. Sz. Sh. Bed Trench
- 20 q N L. r T" Fir w I S
Ground 3 ( bc a y L. m b M F r i u
elev. ` 7
/ b3.1 O ft, 4 .- ---- -- D - M w Ivv Sj
Depth to p_ iM M v Fr . 7
limiting ;
factor
IGV in. �.
Remarks:
Boring #
y a •d 1 Y 4 l3 1•. 5 1~ G w
3
; q _ 3D I lk4 1 . Cw IlF
e e and c- `1 ' Y �'_""" S "� L, C 4" v .'7.:,
ft. 5
41 5 414 L ._..
Depth to
limiting
factRr
V in.
Remarks: �p o 1+ 3'' � }� i` ► .7-
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring# 1 b -11 uKR� SL \F MFv-
-16 ft( w
3 -ay 10V I O I, S T
Ground 7 4 31 1 b- Y�� l_
elev.
9 1., 5 q ft. S A -S q1tJ C, M L w . . g
Depth to
limiting
factor
8Q in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW -8330 (R. 08/95)
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OCT -09 -98 10:02 PM BELISL.E EXCAVATING 7152473038+ P.01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer u ke Se- i /e,
Mailing Address 0. 0 x a��` ✓t'J/ylL�i�S�
Property Address
(Verification required from Planning Department for new construction)
� � '
Citylstate ,�t�n- Leya -/ , /mil Parcel Identification Number
i
LECAL DESCRIPTION
Property Location 1' ' S� ' /., Scc. C4 1 T 31 h'- R,,- ILA Town of
Subdivision Lot # �.
Certired Survey Map 5���39' , Volume Page # �
Warranty Deed # , Volume Page #
Spec house O yes �no Lot lines identifiable �+es ❑ 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 ftutetion 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, jouraoysnan plumber, restrictedplumber or a licensed pumper verifying that (i) the on -site wastewaterdisposal system
is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge.
t/wc, 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 be compacted and returned to the St. Croix County Zoning Office within 30
days the three year expiration date.
SIGNATIAM 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 ownet(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
• 00 . 00 Any information that is rnis- represented may result in the sanitary permit being revoked by the Zoning Department. 0000
" Include with this application: a stamped warranty deed from the Register of Deeds OMcc
a copy of the certified survey map if nfarewA is mate in the warranty deed
STATE BAR'U1� VPISC�INSINAFOla4f'� -1998 KA THLEEN 6043 9 Fi
REGISTER OF DEEDS
r—nment Number WARRANTY DEED ST. CROIX CO., WI
This Deed, made between Darrin Swanson and JoAnn Hardeat?er, RECEIVED FOR RECORD
husband and wife, 06-04 -1999 9:30 AN
Grantor, conveys and warrants to Lucas J. Seiler and Jennifer R. Seiler, WARRANTY DEED
husband and wife, as survivorship marital property, EXEMPT #
CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 78.00
Grantee. RECORDING FEE: 10.00
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(The "Property "):
Recording Area
Name and Return Address
10- sawL"a,,
00 wry! 7-•�O
032 - 2093 -80 -300
Parcel Identification Number (PIN)
This is not homestead property.
Part of Outlot 1, Block 2, Hansen's Turtle Lake Hills First Addition in the Town of Somerset, St. Croix County, Wisconsin,
described as follows: Lot 4 of Certified Survey Map filed December 23, 1996, in Vol. 11, Page 3196, Doc. No. 553639.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this Zj day of June, 1999.
1 V . —
* arrin Swanson
dicer �QiC
* * Ann Hardegger Uv
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Darrin Swanson and JoAnn HardeQeer, husband STATE OF WISCONSIN )
and wife ) ss.
authenticated this day of June, 1999. County )
Personally came before me this day of May,
* Kristina Oglan 1999, the above named
to me known to be the
TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and
(If not, acknowledge the same.
authorized by § 706.06, Wis. Stats.)
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.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2. 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 600 -6;
DEC 2 3' 1996
0� KA71'LE[51 fl. VVALSN
553639 s tU1x °f ,-vw �s
This instrument drafted by Fran Bleskacek Proj. No. 96 -60
O
Cn o C1 Bearings are referenced to the east 1 i ne of 'U Or
te Ln o u , � the SE1 /4 of Section 24, assumed to bear fv 0 0
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East line of the SE1 /4 of Section 24
VOLUME 11 PAGE 3196