HomeMy WebLinkAbout036-1047-30-100 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner L •2 2 r' 4 pc CI
Property Address / 7 o
City /State A) g a j 5
Legal Description:
Lot �_ Block Subdivision/CSM #
X1 k1 '/ N F ' /a, Sec. .1,b , T.S�N -R12W, Town of PIN # (7)3 f-' - l tti y --z -3 C�
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer W Lett Size ST/PC 16 7 Setback from: House /6 Well P/L
Pump manufacturer Model — R
Alarm location
(HOLDING T O ONL
Setbacks: Servic o d Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSO TION SYSTEM
Type of system: rOfd Width Length -� Number of Trenches
Setback from: House _--?3 Well a' P/11, Vent to fresh air intake 7D
ELEVATIONS
Description of benchmark �s. �: o r ext S- Elevation /Od
Description of alternate benchmark 8 a o- ja s t c(l a4 e-�, 4 - er , � Elevation 2: 1 9
Building Sewer / ST/HT Inlet g7� �S ST Outlet 8 ? 1 PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( i ) 3 �- r q s ( ") A- -1 ( )
Bottom of System
Final Grade
Date of installation // 1 z / 9 9 Per i umber -34 State plan number
Plumber's , siignature License number .1 �a53r7 Date / / /Z./ j' 9
Inspector K� c �
Complete plot plan �
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.
PLAN VIEW
S�
to o 35
Ib
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INDICATE NORTH ARROW
so. d
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
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)]. 344619
Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.:
Br n'o d Lee I Town of Stanton
CST BM Elev.; Insp. BM Elev.: BM Description: _ t- p `Pe — Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark I1.6 Z o06
Dosing Alt. BM •s3 fl , D
Aeration Bldg. Sewer
[ Holding St/ Ht Inlet a•�} $� ��
TANK SETBACK INFORMATION St /Ht Outlet /X2 $ , 3*-
TANK TO P/ L WELL BLDG. A ir ir I to ntake ROAD
A
Septic >6 p r 7 46 f NA
Dosing A Header / Man.
Aeration NA Dist. Pipe "� �P/S ; v2 •S'9
Holding system
PUMP
PUMP / SIPHON INFORMATION Inal Grade
Ma . facturer Demand St cover /4•5_0 q6. ( Z
Model Number GPM
TDH Lift L oss action System H Ft
For ain Length Dia. H Dist.Towell
SOIL PTION SYSTEM
Width ( length No. O Tr ches PIT No. Of Pits Inside Dia. liquid Depth
— DIMENSIONS DIMENSION
. S
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING 71 rer
INFORMATION TypeO r CHAMBER 'Mooel Number:
System: > (00 OR UNIT - �i
DISTRIBUTION SYSTEM
Header / an'fold a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. �' Length Dia. Spacng V___ -_ — ____ 1.0 ,
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: tf /!t /gq Inspection #2:
L 1573 210th Avenue, New Richmond, WI (NW1 /4, NEIA, Section 20 T31N -R17W) - 20.31.17.294A -10
14-G`� gtM
6 4%" , ? �.�E •r E�s sib
I
Plan revision required? ❑ Yes g No (2 4 t - 5 a 6
Use other side for additional information. I l
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
I
Safety and Buildings Division
Vi s ' cons i n SANITARY PERMIT 41T 201 W. Washington Avenue
> P O Box 7302
Departme4t of Commerce In accord with ILHR 83.0 , \ m. Code \ Madison, WI 53707 - 7302
l;ry
• Attach complete plans (to the county copy only) for the sy on pv ss ty
than 8 112 x 11 inches in size. - - - -- - - -
� /�,(l1; s anitaryPermit Num Number
• See reverse side for instructions for completing this appy atrOn 1999 5
- ST CR iX 3 �
Personal information you provide may be used for secondary purposes - CQUNTy k if revlslon to prev application
(Privacy Law s. 15.04 (1) (m)], iON4NGC)FFICE a Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL I AVII,
Propert Owner Name P L ao T 31 , N, R E (or)o
Property Owners Mailing Address Lot Num�er Block Num e
5 5 3 I O� � e_ Tr
City, State I Zip Code Phone Number Subdivision Name or CSM Number /1
of ('7 1S) y 3 40 t
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road
illage
Public 1 or 2 Family Dwelling V
- No. of bedrooms 3 own OF S%X.A
I ll. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) so -3 t1 +
1 ❑ Apartment/ Condo 0 36— 10 —:30
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 8, if applicable)
A) 1. New 2 E] Replacement 3 C] Replacement of 4_ [] Reconnection of 5_ [3 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 ZSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit nn r 43 E] Vault Privy
14 ❑System -In -Fill C�� �C 3 X5T
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
r+ Required (sq. ) Proposed (s ) (Gals/da /sq. ft.) (Min. /inch) Q C� Elev on
-5 D &a P 5(0 ` • � t9.51 aFeefi X / Feet
Cap acit y
VII. TANK in Ca allo
g Total # of Prefab. Site Fiber- Exper-
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Exist in structed
Tanks Tanks
Septic Tank or Holding Tank I �fl LV e-S r. ❑ ❑ ❑ ❑ El Pump Tank /Siphon Chamber ❑ El ❑ ❑ 1 ❑ 1 ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: m (Print) Plumber's Sig atur : ( Stamps) MP /MPRSW No.: Business Phone Number:
.1A rs S3 `7lS
Plu errs A dress (Street, City, State, Z Code):
LO V Q. 1
IX. COUN_ TY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (InduciesGroundwater D ate I ssued Issuing AQWt Signature (No Stamps)
K Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination Z 2 r J /Z
X. CONDITIONS OF APPROVAL/ REASO S FOR DISSA�P Rp OVA
I.) Mte_�_ 18" so;�2., C oultr N�a�at� &-- lew tir6?e Ir
SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
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Wisconsin Department of Industry SOIL AND SITE EVALUATION ??
Labor and Human Relations Page 1 of J
Division of Safety and Buildings in accordance with S. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and S+ C ro
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # '
036 -la q9 3D d OJ4 - 10 Y? -Y 0
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /.-j'f
Property Owner I(l U i ^�(. (' ie�v V Property Loci tio y �, [Y
Lee.. 6 rLLn d �CX L c t Govt. Lot Y) w 1/4 1/4,S 1 0 T 3 I , N , R ;� (or) W
Property Owner's Mailing7ddress Lot # Block# Subd. Name or CSM#
i -5 5 -3 110 4 I
City n State Zip Code Phone Number ❑ Nearest Road
t Or1 �! 101 S 0 l (� � City ❑ Village � Town
T '�.� + p n ,Z. 1 b
X New Construction Use: Residential / Number of bedrooms Addition to existing building
El Replacement ❑ Public or commercial - Describe:
Code derived daily flow god
Recommended design loading rate 7 bed, gpd/ft i L5 trench, gpd/ft
Absorption area required 6q L bed, ft S f;o trench, ft Maximum design loading rate / 7 bed, d /ft * c2
g g gp y trench, gpd /ft
Recommended infiltration surface elevation(s) 8 d It ( as referred to site plan benchmark)
Additional design /site considerations ` n "� 3
Parent material Q �af� f�,��/ Flood plain elevation, if applicable /v ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U 5s ❑ U Xs ❑ U 1 0s E U ❑ S U ❑ S X U
SOIL DESCRIPTION REPORT
Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft
Boring Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground 3S3 7 , ,S R /i J OS l`� 1 !cJ °— ; 7 i 8
elev.
Depth to
limiting
factor
Remarks:
Boring #
Q.-
Ground
elev.
or Oft.
Depth to
limiting COUNTY
factor
in. Remarks:
CST Name Please Print) Signature
Address ) Date CST Numb r
I
PROPERTY OWNER rG� (� ar SOIL DESCRIPTION REPORT
Page Z of - ,-3
PARCEL I.D.#
Bonn # Horizon Depth Dominant Color Mottles Structure 2'
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
l p.. �, -n /�' — S / .,Z } r •j'/' .2
0
Ground s /�
elev a 4. Depth to
limiting
factor
$ in.
7
Remarks:
Boring #
I o - o R S% 1 f r uJ -Z
Ground
elev. 87 )/
LAO ft ,
Depth to
limiting
factor
7�''(�in.
��` 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 # fl /' 3 — .S .� 19
(4 jVq i l�
21 LAS
3 _
Ground
elev.
Depth to
limiting
factor
w� in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBDW -8330 (R. 08/95)
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JUN -24 -99 01:33 PM P.01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwncrBuyer
Mailing Address
Property Address �" �� t
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number n 3 U -1_a '4 7
LEGAL DESCRIPTION
Property Location , t1,,�-? 1 /., IL- X14, See. Q, T_2L4_N -R__L?_ W, Town of -St v%*tD
Subdivision , Lot #
Certified Survey Map # . Volume . Page #
Warranty Deed # S 7 too i0 :z m
Volue 1 31 0 Page # 0 9
Spec house 0 yes ;C no Lot lines identifiable P f yes 0 no
SYSIF K&R=ANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastea. Proper tlialatenanee
consists of pumping out the septic tank every three years or sooner, if needed by a lieensad pumper. What you put into the system
call affect the fitaetiou 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, joumeyman plumber, restricted plumber or a licensed purnper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (Z) after inspection and pumping (if necessary), the septic tank Is leas than 1/3 full of sludge.
I/we, 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,Resoumes, State of Wisconsin. Cortitiwtion
stating that your septic system has been maintained must be completed and retumed to the St. Croix bounty Zoning Office within 30
days of the three year expiration date
OF APPLIC DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowlodge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
1
—J&wa—. Ad
INWIUM Of APPLICA DATE
- " "' .�.uy is�tbrsna[lou last is into- rayraaentad may result In the aanitory pamlit beta& revoked by the ZoistnS Y7epartartant. •••• +•
•• Include with this application; a stamped wnrr. my dead from the Ra,d.t•r ar paeda ofrloe
a espy er Me certified aarvy —im Jr rarbrenoe is made in t,ae werranty dean
VOL 131 p [I
576067 QUIT CLAI DEED
Document Number RA
T. CRC;.
Lewerenz Farm, Mary « E. Barney, et. al MAR V1998
1413 .... 2 . 00th . Ave ► «..«.«.......«......« ..................... ............................... G :: 5 D V
... .. t
..................... New.. «Richmond.f....Wi......« 540 17 .................. ...............................
.. .. ..... «....... «.. Rg�l3i of DeAd3
quit claims to Lee « B .. Bran,j,o �, « a„ « single„ « man,,,,,,,,,,,,,,,,,,,,,,,,,,
1 5 5 .210th ,. A ..................................................
.........................
New Richmond.Wi. 54017
.......................................................................................................«........................ ............................... Recording Area
....................................................................................................................... ............................... Name and Return Address
the following described real estate Irit.. «. &.. .... «. ,V.4 .;.K . .........................County, Mary E. Barney
1413 200th Ave.
State of Wisconsin: Part of NWh of ;NE4 20.31N.17W New Richmond, WI 54017
Commencing at the North Quarter Corner of said
Section 20; thence, on an assumed bearing along 036 - 1047 -30
the north line of-the Northeast Quarter of said
Section 20, - South !89 degrees 58 minutes 18 036- 1047 -40
seconds East a distance of 1107.81 feet to the (Parcel Identification Number)
point of beginning; of the parcel to be described;
thence, continuing, along last said north line, South 89 degrees 58
minutes 18 seconds' East a distance of 208.72 feet to the east line of the
Northwest Quarter of the Northeast Quarter of said Section 20; thence,
along last said east line, South 00 degrees 33 minutes 01 seconds East
a distance of 450.42 feet; thence North 89 degrees 58 minutes 18 seconds
West a distance of 208.72 feet; thence North 00 degrees 33 minutes 01
seconds West a distance of 450.42 feet to the point of beginning. Contain -
ing 94,007 square feet (2.16 acres). Subject to right -of -way for 210th
Avenue (a Town Road) along the north line of the above described parcel
and also subject to all easements, restrictions and covenants of record.
(Part of parcels 294A & 294B) CSM 572186 Vol. 12/3407
nis..... s....11.O.t....homestead Property. Dated this ....... ............................day of....................... ............................. 19
(is) or (is not)
........................................................................................... ............................... « »» ..................... ...................
FEE ...............................
•.....Mary ... E. BarneX ............................... ............................... •««»» � ,y I............................ ............ ...............................
A11 ....Q.a.....L.expa X.:o.1. z ....................« ............................... —� G,G» ».. ................ ...............................
• ........................... ............................... .. ....... .::... «... «......... «...... • ....««..............«...................«............
...............................
.
AUTHENTICATION ACKNOWLEDGMENT
Signature( s) ........................................................................ ............................... STATB OF WISCONSIN
S '(- 01 14 :............ .........................County. Personally came
.......................... .__....... ..... .... ..... .....».......«............................................ .................................
Q
authenticated this .............day of. .............................................. 19............... before me this.�.A...dayof..... FE�R �"
...... 19....... theabovenamed
.......................................................................... ............................... .f i� .. .._..........._ ...........................................
...............................
aignuturc
u
°y.... « .............»»..........»...... i�............................................ ...............................
........................................................................................... ............................... r.
type or print name k . • `
a `;;; � ........................................... ...............................
TITLE.: MEMBER STATE BAR' OF WISCONSIN
(if not . ............................................................................. ............................... ............ LM1...................................................
...............................
authorized by SS 706.06, Wis. Statutes) to me known to be the person............ who executed the foregoing
*M — runlTnt and acknowle e e same.
i.
signature
yE...� Sr�.A�v�s
I. type or print name..........« .... ........... «................... ..........................
• Names of persons sl&nin ln:�ti�tdapaaly should be typed
or printed below their sign Notary Public........ ...........County, Wis.
My Commission Is permanent. (If not, state expiration
- is instrunty; was drafted by (tYPe o print name) date: ........................... ............... ...............SA.............. .....)
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CERTIFIED SURVEY MAP
Located in port of the Northwest Quarter of the Northeast Quarter of Section 20, Township 31 North,
Range 17 West, Town of Stanton, St. Croix County, Wisconsin.
Prepared for and at the request of:
Lee Branprd
1553 210th Avenue
New Richmond, WI 54017
OWNER:
Mary Bamey, et. al.
1413 200th Avenue
New Richmond, WI 54017
NOR AI£AST CORNER
UIJPLATTED LANDS SEC. 20 -31 -17
210 T_ H A _V E_ N_ U E (ALUM CO. MON.)
NORTH LINE OF Al,- NORTHEAST 114 _ R O . W.
—
_ - -r -- — '58
— — — - S 89'18' E 2633.08'- - -- - — — _
_ -S 8958'18 E 208.72 =_- CENTERLINE —
-KS8950'1WE 1107.81 'w- N8958'18'W 1318.53' --'
�S 8958't E 208.72' �% ('
t``% R.O.W. / r - - - - --
NORM 114 CORNER i w
SEC. 20 -31 -17 t SA f
(ALUM. CO. MON.) 1 o p CL
I B( /lLDING SETBACK 1
I � 9.Bf —t ti
z rtn C
-U o I Z
I D (,1 I I I Z
LOT 1 A �° 'D
t
lZ
N TO AREA N td
1 0 Z o 94,007 SO. FT.
p ID
I I 2.16 ACRES I I �' I
1 0 I I M • t
AREA EXCLU R.O. : j N 't IN
87. SO. FT.
M
M 2.00 ACRES
I i
�tNIN4aI
t I t I f r 2 5/ 91
RONALD F.
.f t
JOHNSON
s —t tor; s
NB9'58'18'W 208.72' ■,� 'S AMERY. � �F
n1 tr W15.
UNPLATTED LANDS OF OWNER t� \�'l N R { O
NOTE: The porcel(s) shown on this map is /are subject to Slate. County and
Township laws, rules and regulations ( i.e. wetlands, minimum lot size, access
to parcel, etc.). Before purchnsinq or developing any parcel, contact the St.