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HomeMy WebLinkAbout038-1081-20-200 N O O b4 N M O C h O O N b ti d C i h y O O Z c L m LL C O E 3 Q U M M D. � N a w G O Z d y Q ,a,w am F_ I o O Z c d' O p U) H c � � � N M N O • CL y O O (0 O Z m Z w N w Z _ c N N Ln t0 �+ O) p d _ d C C. 10 +�.. O C In t LO H_ d > o O co O O O a m N T a) Z O O O •w 0 mmm CL O g cn 7 0 N O N U) -j U c rn } N a 70 L N O O N O O _ N E N m N c d N 'd 41 Q } U) c6 O O m 10 Li C 7 �+ 0 c 3 o y c O N D = N +r O E >> C. N N J .n C a 0 C N M '6 N v ap O v 00 C� 00 r L1 N y H b M a • O Y�i O U) S O Z c `1 r L U) v� m R € a L IL r� ee CL 0 y c r A Dam join L) I Parcel #: 038 - 1081 -20 -200 06/16/2005 03:11 PM PAGE 1 OF 1 Alt. Parcel #: 19.31.18.34013 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner " HALVORSON, RICHARD D RICHARD D HALVORSON 2022 90TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description 2022 90TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.000 Plat: 1422 -CSM 15/4241 SEC 19 T31 N R1 8W SE SE LOT 1 CSM 15/4241 Block/Condo Bldg: LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19-31N-18W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 04/05/2002 675450 1867/271 WD 07/23/1997 948/82 2004 SUMMARY Bill M Fair Market Value: Assessed with: 30227 132,700 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 47,000 91,600 138,600 NO Totals for 2004: General Property 5.000 47,000 91,600 138,600 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 23,500 65,900 89,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMIE AS BUILT SANITARY REPORT RE Owner u Property Address Jf 1 City /State JUNTY Legal Description: Lot Block Subdivision/CSM # '/a ' /a, Sec. , TJZN -AZ;��W, Town of PIN SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer X40 -e6 Size ST/PC` / Setback from: House 13' Well >SO p/L '>tab 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 r Type of system: A Z Width loZ Lengt Number of Trenches _ Setback from: House � IW Well $4 PAL ) Vent to fresh air intake so ELEVATIONS Description of benchmark Elevation Description of alternate benchmark Elevatio Building Sewer ST/HT Inlet ST Outlet � PC Inlet —' PC Bottom �^ Header/Manifold ° Top of ST/PC Manhole Cover Distribution Lines Bottom of System () () ( ) Final Grade () • ` ! ( ) ( ) Date of installation / / Permit number �`'� L W State plan number Plumber's signature License numbe Date Inspector �Vl, C4eJ Complete plot plan � I 4 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 G c INDICATE NORTH ARROW �n� , a Wisconsin Department of Commerce y: PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit N IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)j. 344522 Permit LVO S RSON e , LAMOYNE ❑ CitySTARa pa Town of: state Plan ID N o.: CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: labi �Or 038 - 1081 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic p Benchmark I p �2.e.YC., cs�-p d . � 3 /ark . � rr0. Dosi ng 4#-2 641 I . Aeration Bldg. Sewer d 1 4 qg, 03 Holding St /Ht Inlet 1 O V %6 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake '- Septic > taut )$0 NA Dt Bottom Dosing NA Header /Man. s G ;j C , DS Aeration NA Dist. Pipe 5 c •� 3• [ Holding Bot. System sz 2.91 PUMP/ SIPHON INFORMATION Final Grade 5 6. Manufacturer Demand j .2 p Model Number GPM TDH Lift Fric ' n System TDH Ft m ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM D T4W-F*H Width , Length PIT No. Of Pits Inside Dia. Liquid Depth EN I N DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type > 2vp `j - -' OR UNIT CHAMBER Model Number: syste U . ` DISTRIBUTION SYSTEM Header / Man p iif ; o J l� . � Distribution Pipe(s) � , x Hole Size x Hole Spacing Vent To Air Intake Length t.ta/Dia. Length Dia. Spacing _ 7 D SO 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 El E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 19.31.18 SE �- SE,SE2 22 90TH REET p ,� �•T^^- C Qv Le 4k %4 frtf" M,�A o I L� J., c..t( .,%-A 4 G u� w r{k 54-t 0,4 �,� t L,,lL A tilc , eQcQ Plan revision required? ❑ Yes No 11+1 Z. 6 Use other side for additional information. q SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division *6consin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code 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. 6*-a� ` • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ [Privacy heck if revision to previous application Law, s. 15.04 1 m )1 y O ( State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Own Name Propert Location Gt / ©r a /4 1/4, Sl T3 , N, V2T ( W Property Owner's Mail in Address Lot Num er I Block Number City, a Zip Code Phone Number Subdivision Name or CSM Number II. B ILDING: (check one) ❑ State Owned ~ E] it ,/� EE Nearest Road ❑ village �/- r/ e Public 1 or 2 Famil Dweltin - No. of bedrooms own OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment /Condo ©���y�l -�_o ®o 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 X 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 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 f k Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Q� t Elevation `f S � - �^^--- ' Feet Feet VII TANK Capacit in g all o ns Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank 0--e- r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum Name: (Print) f Plu5kv>r Signature: (No Stamps MP /MPRSW No.: Business Phone Number: Plum s Address (Street, City, State,, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial � Surcharge fee) p Adverse Determination � L - 14 - 71 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: U VV qa&4 4rli� hh ' ID- 6398 (R.11/97) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Division, Owner, Plumber PLV I PLAN PROJECT o� ADDRESS COUNTY -a�`- G•-� X MPRS Byron Bird J r. 3318 DATE � �D �� ��i,�� ������� BEDROOM CLASS PERC �� `CONVENTIONAL�iN- GROUND PRESSURE CONVENTI NAL LIFT_ MOUND_ HOLDING TANK SEPTIC TANK SIZE IFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE AL Benchmark V.R.P. Assume Elevation 100' � �.�� Location of Benchmark CI Borehole Q Well Scale = Feet 0 Perc Hole System Elevation Uent 12" Grnfip TYPAR COVERING 2" 12" 3 4 ` 6' 0 3' 3' 0 3' I s " Sewer Rock 12' 18' >d s do a O a Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 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)). Property Owner Property Location & Govt. Lot � 1 /4� /4,S/ T N,R ,/. (� Property Owner's Mailing A dress Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City Villages f Town Nearest Road wt C f s2� S Gr <- / /�GCtt -+/ �i ❑ New Construction Use: residential / Number of bedrooms _ L Addition to existing building Replacement LJ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd /ft _ , S tench, gpd /ft Absorption area required bed, ft trench, It Maximum design loading rate bed, gpd /f1 rench, gpd /ft Recommended infiltration surface elevation (s) u ace ele O ft (as referred to site plan benchmark) Additional design /site considerations Parent material 7 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 S❑ U 9S ❑ U A S ❑ U )�q__❑ U EIS jo U ❑ S .TU SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground y- elev. 7- Depth to limiting facto Remarks: Boring # vr 7_ . . ; Ground glev i Depth to limiting factor in. Remarks: CS Name (Please Print) ignature Telephone No. Address*" / Date CST Number PROPERTY OWNER i;"; e &'-1Z1w h SOIL DESCRIPTION REPORT Page Qf 1 PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground C � / a Depth to limiting factor Remarks: Boring # Ground �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 # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) I • Soil TestPlot Plan Project Name � °'� Byron ird Jr. r Address Lot Subdivision Date -/� J �C 1 /4 T N/R W -,— ' le Township / w Boring O Well PL Property Line County BM or VRP Assume Elevation 100 ft System Elevation , , *HRP a-00 tv fo P _. 30 \ s ye Y ` � T c �� l to A Ffo . J pti ,� r Scale 1/4" = 10 Ft. When Dimensions aren't stated ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C C ERTIFICATION FORM Owner/Buyer kw C 1 Mailing Address 7V Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number g:? LEGAL DESCRIPTION Property Location ' 15 , Sec. , T N -R Town of i4, ! V4 S Subdivision , Lot # Certified Survey Map # — _ , Volume , Page # Warranty Deed # 4gj?�02 7 D , Volume 7<1:2�L_. Page # Spec house ❑ yes ,Z no Lot lines identifiable yes ❑ 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURLYOF 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE F APPLICANT 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 i 1 DC- UMENT NO hTY W.fl�C4�'3 DEEO THIS IPA:Z *t SEPVQ!' ,MI nac000fma oAr♦ 'E r `L8 �� 1 STATE r +,iR.1J��i ° � "7 0 i N i SI:V FORM 2—IM �����'�c �3 REGISTERS OFFICE Sr Ckox co., M d Reed la lewd ... - -.... APR 3 01992 lio Opelt, Richarl D. Halvorsoni Fart r�. llalvorsoh " and Jon W. Halvorson Gt 10:50 A. M conveys and warrants to "ie and 1vai Halvorsori Vdlitily' �p _ Trust- Richard D Hal�A)rson and Lori ._.. . _ Opelt, co- Trustees _.. ....... Rem: c( Net& Oltmart & Webster, Ltd. Ellsworth, WI 54011 the following described real estate in ._- St.. C"O1X .... ... Cuunty, State of Wisconsin: Tax Parcel No: ........ .................... The South P,alf (S 112) of the Southeast garter (SE 1/4) of Section 19, Tbwnship 31 North, Range 18 West. L7J� L �'A1 ti This lS homestead property. (is) (is not) Exception b, warranties: Dated this 20th day „< April 14 92 . (SEAL Robert A. Halvorson chard u. Halvorson lJ •'Iv -�4._ (SEAL) W' AI.i .' E Lori A. Opelt Jon W. Halverson AUTHENTICATION ACKNOWLEDGMENT Si ahre(s) Robert A. Halvorson, Richard D. STATE OF WL�( NSIN Ha�vcrson, Lori A. OpeH rind irm W. s. Count;_ authOntiea —A this 20 " day of -- Apr tl 19 ` Prrson.eil% carne be'..r. me th' 3av of 19 the afxn'e named . L�. . 6* TITLEv MEMBER STATE BAR OF W ISCONSI\ (If not, authorized by 706.063,, Wis. Stats.) to me knuu n to be the person w!'u execut. °d tee for ow instrunwnt Ind the same. S IN:;TRLMENr WAS CPA -ED 9M L.J. Wei st: r P.O. Box 490 1:11 r r + t. r w1 >4ijl.l (Sgrnnt,.. s rtty Fe d't .enti�ated ar - vkr ;wi v. !,:.J. K. yt re not re ces, arv.) - • Stock hio 13002