HomeMy WebLinkAbout040-1157-50-600 ' Wiscdnsin 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)). 344647
Permit Holder's Name: ❑ City ❑ village Q Town of: State Plan ID No.:
Town of Tro
CST BM lev.: Insp. BM Elev.: BM Description: N Parcel Tax No.:
G Dd v 040
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic s r / - V v Benchmark
D Alt. BM A 6 Z.
Aer Bldg. Sewer
Holding (9/ Ht Inlet J' fd ,
TANK SETBACK INFORMATION �/ Ht Outlet P /� y
TANK TO P / L WELL BLDG. Air I to ROAD
Po / /✓r] �,� �� NA
[A 9049FA
D -------- Header! Man.
Aeratio NA Dist. Pipe yz :Yti� d
Holding Bot. System - r
PUMP/ SIPHON INFORMATION Final Grade
ufacturer and St cover , (, /d.�j'
Model Number GP
TDH Lift L oss riction em TDH F
Fo cemain Length Did. Dist. To Well
SOIL A RPTION SYSTEM 3 r 5 e
BED / RENC Width leng o. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIME . 3 1 l C'/. DIMENSION
anufac re
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM M
INFORMATION Type O d CHAMB Model umber: r
System: /� NIT
DISTRIBUTION SYSTEM o
Header/Manifold LJ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia_ 7 r, Length jfl,_3 Dia. A& Spacing A/ I N t
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 E] Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: )1 I)ql fl Inspection #2:
Location: 2 /J Woodview Trail, Hudson, WI (NW1 /4, SW1 /4, Section 24 T28N -R20W) - 24.28.20.614M
n
5�� 0 Lev <✓ `
Plan revision required? ❑ Yes kD No
Use other side for additional information. L Z
SBD - 6710 (R.3/97) Dat Inspec is Signature Cert. No.
Safety and Buildings Division
lriiconsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue
In accord with ILHR 83.05, Wiy
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less, (�U
County
than 8112 x 11 inches in size. ',% � T r
• See reverse side for instructions for completing this applications,, t� /!i.. State Sanitary Permit Number
y ou ma
Personal information p rovide be used for secondary u
Y P Y ry p rP oses
�r � ❑ check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. - r State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRfNT�" �IR
Propert Owner Name erty Locution ' _
T 07 N, R ROX(or) W
Property Owner's Mail. g Address trrllb r ` Block Number
City, S ate Z.p Code Phone' Subdiv. io Name or CS]VI_Num eer ,
I I. 'TYPE GF BU (check one) ❑ State Owned it Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Tow OF `
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) /,�. , Lv1 J T M
1 E] Apartment/ Condo Q � _ S — 7 Q "
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 10 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
__System System Tank System
______________ Existing Syse ________ ExlstinaSystem
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 W5eepage Trench 22 ❑ In- Ground P essure / 42 C] Pit Privy
13 []Seepage Pit ( e �,f &d. F 43 [] Vault Privy
14 ❑ System -In -Fill 3 3
VI. A BSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Requ ired ( ft .) o posed (sq. ft.) ( Is/da /sq. ft.) Min. /inch) 9 , o �j7 levation
7, bS Feet Feet
acct
VII. TANK in Cap li Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
epticTank ❑ ❑ ❑ ❑ ❑
L -Etramber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum 's Sig ure: kMIMPRSW No.: Business Phone Number:
Plumber's Addr ss (Street, City, State, Zip de):
icy /f 00
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes G undwater ate Issued Issuing Agent Signature (No Stamps)
Approved ❑ Surcharge Fee)
Owner Given Initial .-
Adverse Determination "f" 2 Z ' 161 -OIL 1 0 �
'X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: v
C 7" s
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
u _ ij�j . T w o S
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wisconsin Department of Industry SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance .with s. ILHR 83.09, Wis.
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 ST. C A X
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Ro7 by Date
Personal irtforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r <
Property Owner Property Location '
•s�/ Z /� Govt. Lot, N � 1/4 0) / 1/4 'S .37 / T Z 1 ,N,R 2.6 E (orX0
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number Nearest Road
UfJS!>,✓ WA Sy0 /w ( 715 s73 El Cit El vil e Gown cvoo0ll�ircJ T,E'
[R ew Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑Public or commercial Describe: jv //? Ja /�/d T /�
Code derived daily flow gpd Recommended design loading rate N/e bed, gpd/ft • trench, gpd*
Absorption area required bed, ft trench, ft Maximum design loading rate " / bed, gpd /ft? gpd/ft
Recommended infiltration surface elevation(s) � tb 3 ft (as referred to site plan benchmark)
Additional design /site considerations -«- s ,(Ae /ok.' •
Parent. material /�.y G Dl1�Cri �[Jij S .vim Flood plain elevation, if applicable' V It
S = Suitable for system , Conv ntional Mound In- Ground Pressure AT-Gi a System in Fill Holding Tank
U = Unsuitable for system L7 S❑ U 2 El RS 1:1 U 2 ❑ U I ❑ S B ❑ S
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
ifshe BPS cs 3 t . '-( s
Ground S 2-
J�L 'M ,Sie �m 6's A • $� , • �o
ele . •� /o y/•-
/ 0 YA
Depth to 7/& 10 � s D s /.'N
limiting 5 � J Q.
factor
T O Remarks:
Boring # .� /0 3/ L-• /7 sk 6? S d q _5
Z Z • / /o ole /fS nom, 4 G S / 7` . 2- • 3
3 .35 /p Yje S/ — S/G Z,N, Il/e /W C
Ground 77. 11 C L S /*1 117 'C"e
/0 elev. O SL �r T ,2 atZ '
5=
Depth to
limiting
f ctor
fin. Remarks:
n
CST Name (Please Print) � n ; G/ t Signature ^T� Telephone No. a!
r r 71S•38�•lJ
Address Date CST Number
Ass ociates 5- y api
Private Sewage Consultants
655 O'Neil Rd.
Hudson, Wis. 6401 s •� Ti(�E.v �lS � 'fl S /.l1s �1 d.�,r �O�j��.oG -...
iv fj� T3, ' /-3y /g f � D-�Gl� • �
r INAL
, J , X 477E °F
00er ea
rX0 W44o( S
,r tip`''
I ,
• SL�"T it SOIL DESCRIPTION REPORT S. "
PROPERTY OWNER !, Page of
PARCEL I.D.# G 60 o
Boring Horizon Depth' Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
. 3 3 / o•� is ye L/ — L 2�• sti,� �,,, fie s 3 � . s .. �
2 - /D YX 3 2 - � S�G �f S`! / k �r�+-�i ' 'e /07`' Z- • 3 /
Ground 3 /d -f s �- S , • �v
elev
/oy tt d /o .SL h ,e x .,4
Depth to
limiting
S factor
/ Gin.
7 Remarks:
Boring #
5 17 SlJe 111-'4f
Ground ,S SL �� / U� � f
elev
3 � ft is s/ ._-�- -5 ' D S �l
Depth to
,
limiting
factor
` in.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD /ft
Texture Consistence Bounddry Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
I3orrng # z Z ----• /L
3
'35 A0 3/y S /L` 2 stiff f', • cs . s ; G
Ground 3 - /o S/G 1 k I IJ4 f ' a Z • 2 ' • 3
jO y e v ft. 7 S .Nl,IE• D SG C •• iyr> 7 �j�
Depth to L J ! T � /117 � i •s ;. •�o
limiting
fac or
T fain. Remarks:
Boring # °
K <:
Ground y
elev.
tt.
Depth to
limiting
factor
in.
Remarks:
SBDW -8330 (R. 08/95) -
IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer textured
soils (loams,sifts, etc.) can & will be easily smeared Or
compacted even by a backhoe bucket during trench construction.
When this occurs, premature failure will result. As per ILHR 83.13
(4), the installer MUST be very careful to properly hand rake
the sidewalls.& bottoms to re- expose all of t 1% l a j tural
structure. Minn. even recommends that scarify
in this ' iT! e
mounted on the sides of the bucket. tti
treatment & absorption be most st enhanced f.or normal longer
system life.
J
I-W # Z 7o/) of /lhene
13 �►
2
s t ( I
i
v I ► I`oI Iii
QA r IC �I.� 1 19y
5V7 717 -
Lo T
100' 0
- -- zo
3
en��,v
C5
"t, or L
wbilch, & Associates
ultants
ptwa18 Sewage Cons
355 p.Nell Ad 54016
Hudson, VVis.
U / 7
v
• CERTIFIED SURVEY MAP
Located in part of the NW4 of the SW4 of Section 24, T28N, R20W,
Town of Troy, St. Croix County, Wisconsin; being Lot 8 of Certified
Survey Map in Volume 7, Page 2015.
Wj Corner of u °
N � = �
SiCtlon 24 fu H,-0
W OWNER U 4, w
N s 7
" ' Robert Setzer t` George Setzer L
t!) h O y y .
t°
4 W b W
x� Route 3 w
Hudson, WI 54016 d)
.
0.1 ( Lot 7 -
66' - (rec 2015
C-S 'M- Vo 7
L N L
orded - - _' Pg_ m, o
° 66.64 83o 2 8,03 es N84041,28,,
64 I Lot 1
N - -- -- - - -- C.S.N ' i n i .
N ( _ 20.001 731A 661 Vol_ 2, Pg. 325.
345.021 PA V V E il..!
T
N w -
•C N O Io 1 0
t. W �- t✓ Ih
ti M l0
av 9
° y o d acv LOT O ya 1157 -- o i- ,n
V C3 W 0 O 1
N
36 c.¢pr1 ji9nsdve Plamiii
= a c S88 0 07 1 00 11 W 435.82' ' ` Zening a nd
to
to
0 2u
•�-1 �-� S6�269
If not r d� ;-'
N 1
o '
°i c - 0 ° 'pprovat shat�1 ft
o N ntA & void
CD
LOT 9 w
=°{ to
I N E .-
L O
�C) 0 M tr N°:
c° mo L to
dpi t eu `- ; N87 ° 46 1 30 "E 424.24 a - � 1 W ;1.
�/ K 144.54' 279.70' v' �_ N 1-
' ` N J 1t0
m ` r t
W
1 3
_ ` J
� V �, N l>o
•; W
L) 1 M LOT to 1,
0
260.00 •y'1.
596.47
S 29 "E g
56.47' �
(recorded as 1 489 0 40 1 15 "E ' 857.06 `•^ '
41i'
N South line of the NWj of the SW} of Section 2p; � Y " -1 e
~ --- -- -- - - -- - Pg. - - - - --
C.S.N. in Vol. 5, 1323 "` 6
N VOLUME 10 PAGE 2720
SCALE IN FEET
SW Corner of
Section 24 0 100 200 `'``''
K . 300 .. :.:
h
AND
OIAINERS141P t``ew aFTCATION FORM
Mai n.g A l
( v'erific ..tion regutired from Ftar,ning Depa rtmen t for spew - -
� - 1
Cit} tats 1 Parcel identificat Nam. ber
LEiLr
Frog :rty Li :: 3n N W 'la, _ t i4, Sec. _, T N--IZ_ W. Tawri of f —
Sub ivisiot
Cc, Aed w .m ,�y Map t �t . Volume °- , Page
spe Bemuse f ! -es 0 nc Lot lanes identifiable z 1 yes 0 no
Imp] �j peat and ms .#arced your septic 5stcm Gould result tR its premature failure to handle wastes. P.:oper r:: .:tenar►cr
cow; ts; of pt :t:.: <g out the s ptic tauk every three years or soonet, if needed by a licensed pumper, Wbat you put into system
can ; frsot the f i pion of the septic tttz* as a treat meat stage its &c waste dimposal system.
The !a .ay ouumer grees to submit to St, C4oix ,GZonitig Dtpartize tit a certification fatxu, seed b th, uA'R , 3d h; a
M., - 1.:]iumb ,i jue man f 'tuiat,er,.rest'acted plumber or a hi4twea pumper - verifying that (1) ttmc co-site wastewat r (isr" s ys:e a
is in n3per o. ag candid( i and/or (2) after inspeotion and pumputg (if r_e cessary), the septic tangy: is ;ess than 1 1 ]ill -Judg:
Vwc: Le undo r red have re d the above requirements and agree to maintain the. pt sewage disposal system i vit.i tl ?:: andards
set i t)r, hero,ti : set by the )c of Commerce and the Depa rtmeo: of Natural Resource -, State of 'JJiscor;:siz. C #ication
stati. that y.: a . ptic system has been maintained must be completed and returmd to the St. Croix County Zoniui< r, ri
Offici: ttni S
da : time V r xpirat rn date_
_ *,PLTC�
SLG; '!"E st ' T t�A'fE
0V 4 t t _l IFICA` TON
I (w ! rify that aT statemmitss on this fowl are true to the best of my lour) knowledge. (we) am (art•.) tote nc(s) of
rhe) �perty I d above, )y vim.t of a warranty (iced mc orcted in re g ister of Deeds Office.
SIG
I;) :�Tl
kny ((ration tha is rnis- represented tray r esu lt it] th sanitary permit being re voked by the Zoning D;:paitw-
s# I :rude v !$s applica f ion; a itampt;d warranty deed from the Register of Dccds office
a copy of The certified survey map if rcferrnce is mgdc in the warranty dct-
•
�ryQ VOL V4 7PA 1 0 6
5613 I SLATE BAR OF WISCONSIN FORM 2 - 1982
WARRANTY DEED
DOCUItAENT NO, iI r - - 7 - -- -
(1
Gena Set z_er as A_ncillar Personal Re rPSenta- S ?.CRO!XC7Y,.W1
five o the Est ate f Ge F . Sette F
deceas and Rob J . Se tter, JUN Z 3 1991
_ 4
_ _ -- — 1:40 P M + �+
conveys and warrants to Tt' tomaS Klost and Moni ue f
Ha hu an d wife, as sur�i�'o �{, it 4)616k marital proper t - - - -- Hu91UK a1 Deeds
I! PI+s SPACE RESERVED FOR RECORDING DATA
I
NA -AE AND RETURN ADDRESS
the following described real estate in S t___Cr.Ol.x .— - County
1 State of Wisconsin: L�
6u_17 r
f
_ 040- 1157 -50- 6 0_0_
PARCEL IDENTIFICATION NUMBF,"
� s
Ii
Lot 11, Certified Survey Map recorded January 3, 1994, in Volume 10,
Page 2720, Document No. 336861 being a part of the North West Quarter
of the Southwest Quarter (NW1 /4 of SW1 /4), Section Twenty -four (24),
Township Twenty-eight i ht (28) North, Range 'FwFnty (20) West, Township '
g .
of Troy, St. Croix County, Wisconsin. ?t
9 ,z `ij
T Ai%;,
FEE
r I1
9 \ is not 1
_ II This homestead property. `f' '
X}'(Z (is not) '
Exception to warranties: Easements, restrictions and rights -oE -way of record,
1 i f any.
i 4
!' -T
97 V
2s. J(f' A 19 --
Dated this �D day of
< 1 Estate of George F. Setzer, D
r
' I Rober J. etzer _ - �'k
I` Gena Setter rr 7 %e --
i4 (SEAL) —._ —_ — (SEAL)
14 1 li Y
AUTHENTICATION It 1, _,�'
State of wiseonsin,
i Signaturc(s) _ 5 ry
St. Croix �� `•
County � y�
i I authenticated this _day o[ — 19_ Personally��� ne before mI this ___�i`! —� d'Y of
Y - - -� 190_, the above named !.
-- GenaSe as Ancillary P ers4faa -1 i
_Re s _ 0 - f_y_Sta_keQFGsorge 1!
�as� and 2aher L- -J-
c_ .
TITLE' ME "•113i R STATE BAR OF WISCONSIN F -. S e t Z e�s_�e- � -� -- ,
r' t
authorized by §706.06, Wis. Stars.) Notary Public to me kno \ \Tt u, be rite perwn �_� \ \'hIt executed the foregoing I
: State of Wi8COnsIII instrument n d acknoa!edge the same. r .
f • i THIS INSTRUMENT WAS DRArrED 8y Diane M. $arrOfi _ --
A t t n r n e- y._ _F-ri s t i n a _0 g Lan t�— -
, _ _ - -. County. Wis
H Ld s,an_ _W I i -4D D6L- -- __ PJotar uhh - - -
(Signatures may be authenticated or acknowledged Guth are rot tit} commis'!-I' IS pclm neat. (1( t�. p
l ST exi•at1:99,, date ky
T- la f
necessarf )
• Nanus of re .egnmg m anp -r-t) chonld by Iyn'd ur luintcd Ixlnu rh< r sgmnucs r�...r.v s + I M R v+l• Co ``
STATE BAR U�
N'A RPAN TV D: -rn form n, 2
c
s FILED
JAN 11 " 0- 0
�,�.� Off+ - JAMES O'CONNELL
5111305 J ftiswr of Deeds
SL Croix Co., WI l/
A.
CERTIFIED SURVEY MAP
Located in part of the NW; of the S61h of Section 24, T28N, R20W,
Town of Troy, St. Croix County, Wisconsin; being Lot 8 of Certified
Survey Map in Volume 7, Page 2015. 0 °
W} Corner of -o z "
Section 24 N
OWNER s
W L ++ N
;-Ti Robert Setzer R George Setzer
=` i � Route 3 ` o, n
o � I W i Hudson, WI 54016 � "
W I 'c .-y O O
1
71 W I C a, v N
to Lot 7, C,S_N_ in Vo 1, P9 __ _
20 ° L °
N 66' I ( recorded as o
N84
N 2 81,W) Lot 1, C.S.M. in
830 28' 11 41 2811 - -- -- - - - - -- --
66,64r
_20.00' 03 7 , 66 1 Vol. 2, Pg. 329.
- - -- - --- ---
D
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c S88 °07' 00 1 'W 435.82' zcKmg mid
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LOT 9
yl � • � IN
of tv� F
al v N
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it N °r
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un
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O LOT 10
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LOT 11 °' M '
o �
z -
260.00' 596.47' �� ?•" -� w .'
.. ,:.�
S89 "E 856.47' ���,� -•
(recorded as N89 0 40 1 15 11 E, 857.06
South line o f the NW} of the SW} of Section 2
N ..._._ ._ ..IV�
o C.S.M. in Vol. 5, Pg. 1323
h VOLUME -10 PAGE 2720 M
SCALE IN FEET
SW Corner of
Section 24 0 100 200 300
.�._.. _
This instrument drafted by Fran 8leskacek Proj. No. 83 -56 -189
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•6utuu 30 juiod a44 o4 SIOZ abed 'L awnloA deW baAjnS pat313ia0 pees 30 L 303 3o auil Alua4 :nos ay4 6uole
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