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HomeMy WebLinkAbout042-1020-90-200 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 n G� j t 1 � 44 t. / Y 3, E e L 0 1 J i � � f f\ j +U tz INDICATE NORTH ARROW M. , W Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CXCIX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 324797 Permit Holder's Name: ❑ City ❑ Village IN Town of: State Plan ID No.: HANNAN, DAN WARREN CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: d W 042 - 1020 -90 -200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic zvo Awmark !! 2� ;�2 Dosing L b ki , B ti't I %4 z�.32s �• 3� L 3 . Aeration Bldg. Sewer ? , z /' 2 L.lL Holding 5p/ MK Inlet �� 31 12 TANK SETBACK INFORMATION & /4t Outlet 64 f TANKTO P/L WELL BLDG. Air to I ntake ROAD D ir Septic > 5-0 >1 ` 1 25 - 1 NA 1 Dosing NA Header /Man. A �i $ 0 -7 L Aeration NA Dist. Pipe 2•3? I 14", � JI S'- Holding Bot. System M ro. / /y. s 3 PUMP / SIPHON INFORMATION Final Grade H'� S'a Manufac mand 1 /. 3 ,3 13 1A el Model Number GPM S - Z TDH I Lift L riction m TDH Ft z /Ly, ea Forcemain Length Dia. Dist. TO - ,, SOIL ABSORPTION SYSTEM of $E$ TR Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa4tur� e INFORMATION Type O r CHAMBER mod Number: System: � +�() `} 0 `I3 OR UNIT DISTRIBUTION SYSTEM Header/Manifold K Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length" Dia. 1— Length � Dia. Spacing 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 P No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 8.29.19,NW,NW 1087 100TH STREET 13 1� gwt = �. p-�- 3 3l •o' .s ue-' - �s C, ex ek Plan revision required? F� �] Yes JNo Use other side for additional information. L �)6 SBD -6710 (R.3/97) Date I s cto 's Si ature Cert No. I —i3 -tab � - r _ - Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vis In 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 8 1/2 x 11 inches in size. 5�_ _ G re • See reverse side for instructions for completing this application State sanitary Permit Number y ou p rovide may be used for second re Z `� 19 �' Personal information y p y ry purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Nam Propert Location I P n N W 1/4 � f 1/4, S T a r , N, R / 8 E (orw Pro pgrt y Mailing Address Lot Number Block Number CC��/OO // ) I umm-&_r S-�- City �S #ate Zide (hone ;umber J Subdivision N m� o I�urp�er O Aos snz II. TYPE F MIL DING: (check one) ❑ State Owned 'I fl It v � •( � restRoa� Public 1 or 2 Family Dwelling - No. of bedrooms o row O rtyj L 5 T III BUILDING USE (If building type is public, check all thatapply) Parcel Tax Number(s) Q.I� 11 ' I g 1 ❑ Apartment/ Condo UL4 - � Dal) 9 — 0 00 0 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 Q 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, q New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Onl ________ y_____________y System __^ __ Existing y ______ ^_ Exlstln 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. SyYstem Elev. 7, Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) I -1� l S 3 - 1Iy Elevation (D �� 1 O ©G 1 1 bq 9' 'S11 a- 11 46 Feet I IF Feet Cap acit y VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank X � (�� d adwe_ - ,�'cxr\ ❑ ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I ❑ 1 ❑ 10 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu Tple r's Sign a No Stamps) MP /MPRSW No.: Business Phone Number: e � �� 6 (09 -oaf( Plumber's Address (StreetXity, State, Zip Code)• O , I I ut D Dr . woodv " I ) e w . S c4 ba IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Indude,Groundwater D ate I ssue Issuing A enZ ps) Approved ❑ Owner Given Initial ��� Surcharge Fee) 316 S 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 Dan Hannan • 918 %Z, Summer Street Hudson, Wl. 54016 NW 1 /4. NW 1 /4. S8 T29 NR 18 West Lot 2 Township of Warren 33 Envirochamber = 1049sg.feet System el. 1 — 115' 2 — 114.5' 3 -114' Joe Stang 223475 Lot Line Garage 4 bedroom house septic tank 1200 Driveway �— 70' i B1 118.8 B2 118.8 {_ 36' � ■ i 3' 6' 1 % 2 3' 6' 37' 3 3' B3 118.0 �— 68.7' —� B5 116.0 B4 115.4 92' B.M. Top of West Connor of survey stake 100' 4 N 110 Ave. 100 Street ,r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division df 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 s Plan must include, but ` not limited to vertical and horizontal reference point (BM), dire 1 0 / scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne s r D 42- -- 0 Z Q ­ T6 O APPLICANT INFORMATION- PLEASE PRINT AL f1! RMAT N REVIEWED BY DATE Dr 'INI PROPER;y NER: c-� � ; r PER - ATION b l r c1 d ':'" GOVT. LO? () 1/4 (� 1/4,S T N,R / (or) W PROPE TY OWNER':S MA!I_ING ADDRESS ,LQT # BLO K # SUBD. NAME OR E - 1 0 CI�T TE ZIP CODE PHONE U R > ITY LLAGE OWN NEAREST ROAD -T, 6_&r 0 I 4 New Construction Use Residential / Number Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow °4 -0 gpd Recommended design loading rate L � bed, gpd/ft , j(-- trench, gpd/11 Absorption area required 7 00 bed, ft 7�O trench, ft Maximum design loading rate . bed, gpd /ft ,/- trench, gpd /ft Recommended infiltration surface elevation(s) //S 1-0 ft (as referred to site plan benchmark) Additional design / site considerati Parent material ���+s h Flood plain elevation, if applicable _r✓)l'a ft r7 u n l table for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK suitabl e for system Z S ❑ U � ❑ U �S El U S ❑ U ❑ S � ❑ S -� SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trendt /Q g - 4,/ /vd A) C_ sl z rhS r Ground 3 ,�i2 / & 1U i� S elev. go )fir so - 1 06 Zvz2 s s / 1 7 1, 9 Depth to limiting factor •�/ I " Remarks: Boring # -/5 O fll z z e S v 6 / , 5 ' • to /o ya �/ s lSQ z 3 Ground V4— 6 /VX el / ® _6b - 88 91 Depth to limiting factor Remarks: CST Name:- Please Print Phone _ Address: d �� r //j2QYl LE'J� J� Signature: Date: CST Number: PROPERTY OWNE v� � B� SOIL DESCRIPTION REPORT Page Z of i�3 ' PARCEL I.D.# Depth Dominant Color j Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. I Consistence iBotuxi<iry I Roots Bed iTrendi �/� S l • 5 Z 2Z m v a 4 4 NO /() — 9, / � 6 I , io i Ground D i2 4 1 b G s 's 60 �4 (o %/ 6 ° I --, y , s i3 rvt ✓i AIA IVA 5 , ±n Depth to limiting fac r p" Remarks: Boring # .................. . 37 �/ / � O /� 6-7 V,4 Ground Ground eIev.�p 6c> s2 '/ d / �5 So S 0 e ft. Depth to limiting factor Remarks: Boring # z a � Ground "7 , 8 Depth to limiting factor Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor f Remarks: SBD- 8330(R.05/92) ..f STEEL'S SOIL SERVICE Gary L. Steel ��� , e C.S.T. 2298 /� �r�r New Richmond, WI 54017 MPRSW -3254 �,� �� NI,) (715) 246 -6200 -/V1) /-7 tiv 7 � P P61 .� N 0 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer N A.v Mailing Address u i J SG Property Address - - 10$ 7 lga Z t (Verification required from Planning Department for new construction) City /Stag; �/� Parcel Identification Number LEGAL DESCRIPTION Property Location N V _ '/4, NVJ '/4, Sec. , T 9 N -R W, Town of Subdivision , Lot # Certified Survey Map # Volume , Page # q Warranty Deed # I DV y S , Volume , Page # Spec house ❑ yes 0 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewat, rdisposal 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 widersigned 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 y r expiration date. SIGNATU i P CANT DATE OWNEI CERTIFICATION I ' ,:ve ) certify hat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of Y the proper,, desc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. !O� LX SOR O PPLICANT DATE * * * * ** Any infnrmetion that is mia- represented may result in the sanitary permit being revoked by the Zoning Department. ** ittclttth ��itlt lhiti ��►ltlicutiau .t "t;ttttIWA ��Am%wN} klcr(i fnom the prl- h let of needs; offirr a copy of the certified survey map if reference is made in the warranty deed ID nocuME:rvT No. R WARRANTY DEED 570845 SPATE DA C01W ' FORM 2-1082 rc.' RECIST�R'S OFFICE . Humbird Land Corporation; - a 15T CR IX CO Minnesota Corporation � � - r WI ............................................................ ............................... �} cif�9A►d q g j ........ ............ ................ .... _ ., ........ ..... I nd .. ............................... JAN cativcyx .. ....... ............. -• 11' o� alts to .....................y... �..9.....P .... ....... t�.� . , u , ; ,,• ; • ; Dan Hannan a sin le erson _ \� ....... .... ... ""� {dt J Re star .. ............... ................ ...... ..................... .. — - -- _. ........ ...... ....... - - .............. J tlic roliuwing described re; +l estate in . ...S ....... .. ............County, "' 4 State of Wisconsin: Part of the NW 1/4 of the NW 1/4, Section 8, T29N, Tax.Parcel No :. ............................. I R18W, Town %f Warren, St. Croix County, Wisconsin described as follows:" l/`f Lot 2 of Certified Survey Map filed August 16, 1994 in Vol 10 page 2802 $ T 4FE SFER This ....... is not .... -•-- homestead property'. _ ip4) not) Exception to warranties: 1 Easements, restrictions and rights -of -way of record, if any 1 I { lhIted this ... ............................... day or ... Dec. ember. ................ ......... .................... 19N..... (SEAL) .. 1 HUMBIRD LAND CORPORATION • •, (SEAL) 4 i •.........• ..................... .......................... (�y. ... ...i...... Austin .i. Baillon Its President ...... ............... ............................... (SEAL) _ . ....... ... .......................... I ..... .... I .......... (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) ..................... ............................... STATE OP' X%FZCJC SX)W MINNESOT ss. ................................................. ............................... Rams, e Y .... .......................County. ....f l..,...:,:.. +.,:. d-.l..- ,i— -4 O :l u e �13 �.- ,, .. . ��r�f n,- '�-- r..m-- i- !,4ic..... loth ' I _...... • p This instrutient drafted by Ed Flanun Job No. 93 -59 -1 Bearings are referenced to the ] of the NNE of Section Hest line 8 assuoed to bear Ufa?! AT i ED -AND 33' 33' N00 46 "E 461.80' 0 435.82' p a r5.98' o . I t " O. r , L ..4 N pC 7i d O 1 N ' � u aC • v o7 �+ U u W O • �-•. 1!. O J I 1 J p O N /., CIA M 'i oiD `r 1 L • C O L'J I O r"� O / • N N N <L 1 CO I f I > I = 01 Co ; CD 00 _JI 435.82' 27.52' • ��I 21 TI " N00 °48146 "E 463.34' C]1 - - 1 O N J I ++ a-• M N CO •a- SDI c w x4 c '3 1J I ( 1 " O o o N Q ur o • al ; c U O L V 04 V u 0 I 2i u N O -t W 0 iii 1_'�I 6 �j �i cis a a. C)I 465.19' 3 435_82 - I- 29.37 r. 225.001 316.291 J� 254.37 2 J I N00 048146 11E 570.661 E-+ - m co •.� N LA O O '" l V Ln •rl U '•- o u N L 1 ! I - W 1 _ J I S _ _ ,°� W O U• Q l i N 3 !I � I 0 °o ^ u `� m v' Go u All V � I i' M ao o —I L!�i�1j1 = 1 °' o o M W ,;• Oro I o y " N; a s w 41 V 1 I I " ^ �" N u. , '+- a �- H Q u •n N . N -� rr .- p l 3 r = O u 1n u �n W I W a J c _ W O C 1 I (!)1 ��11 J e 6 N 11- r '� ., r. N W Q C4 CO 0 ;�"N .1 04 Ejul J Lr i x '��. - • ...N UI IA O N ( - ) I S00 0 48 1 46 "W ': 541.29 M 41 3 6 6� 225.001 " 3 16.29' 1.4 0 - - N 44 ri 316.29 U) 040 1.1 258.00 0 3 ;r, S00 0 45' 54 "W 574.29' - O 1'1 4J E aJ West lisle of t {le I1W4 of Section 8. S T F E ET la c IO0 H O'-1 o a x 0 ~ a. Number -" 7 l9 / / MINOR SUBDIVISION APPLICATION 96 1. SURVEYOR: Please complete upper portion of app , ion a ci mit to. Zoning Office accompanied by aopy...of . avert' d mad?. nd applicable fees. Application and map will fo to, e appropriate board for their review. r FrP 2 � 39 Only after written notice of town actin s reed by the Zoning Office will the map be p nt N h < Planning and Development Committee for a val'. �� See" fee 's'ched'ul'e on reverse side t "" OWNER hICWIt ► ADDRESS/ /Ia lJ ST -R SURVEYOR h(. ���Sau ADDRESS P6&X9/ C)"O - K) _... _ .. `TOWNSHIP °' (JMAN - LOCATION /Jt h A , Sec. T N -R W Number of Lots Total acreage of lots AW 4C. Size of original rYarcel.. 16 °A, Parcel Number Make a sketch in the box showing how the new lots) fit within the original parcel. Page No. of the St. Croix County Soil Survey. 51 Soil Types 51 * )rwen Limitations D'R Does the new lot (s) have any exi ting buildings suitable for habitation? YES No s ----------------- ------------------=------=-- _--------------- - - - - -- ZONING OFFICE Review fee of $ paid on (date) Escrow fee required? yes , . no Amt paid $ Public hearing fee required? yes no Amt paid $ (Make check payable to St. Croix County Zoning) TOWN BOARD (Period of review -30 days) SIGNATURES OF THE BOARD"' DATE Approves . . .. Rejects Cond. Approv. Conditions.of approval or reasons for rejection: - - - - - - - - - - - - - - - - -- -- -- - - - -- - - -- - - - - -- - -- - - - - - - - - - -- - - - - -- -- - - - - - - - r PLANNING AND DEVELOPMENT COMMITTEE Date - Approves., Rejects Conditionally approves Signature of Chairman Conditions of -approval or reasons for rej ect•ion.: 2 2 199 - ho a cre s F a ca „' cQ S1 N1 /-" 'L CEP T11 S Lip .VE Y MA P Located in the Northeast quarter of the Northeast quarter of Section 9, Town- ship 29 North, Range 18 West, Town of Warren, St. Croix Gounty, Wisconsin. Owners: Ken & Pamela Herink 1057 110th Curve Information Roberts, Wisconsin Northeast Cor. Sec. 9 -29 -18 _ _ St. Croix Co. Central angle - 00 °05'36" � cap found) . Arc length - 3.63' o Chord - S00 0 38 1 08 11 E Tangents - S00 035120 "E b SO 0 "E UNPLATTED LANDS N 89'19'57 "E 473.21' 438.59' 3462' , IL~ ®7T 2 I o W �I ^ °• ail 94,560 Square feet (2. 171 acres) p1 0 Including right -of -way �I a II cn� Z� a° 87,688 Square feet (2.. 013 acres) 0'I;, o I C) I o o Excluding right -of -way: Im o • I Q 0 o v o Imo 3 N 89'19'57 "E 472.39' IW w l W 43.8.89' - 2 i in Wi IO OI 2 Uj Iti ° tL0T .3 l o 0 0 1 ° J i Z o 94,397 Square feet (2.167 acres) alc' o N I _j 2 I 0- ZI o .' Including right -of -way. 0 N �I 00 :! 87 Square feet (2.012 acres) ° al jl Q N i Excluding rightbof - way. I =�� W . • N�I 438.00' 1 33s� I S 89' 19'57. "W 471,58'.. I 66' SOUTH LINE OF THE ME1 14 - NEI /4 I I UNPLATTEp LANDS =^ Legend Z ,� AL Section- corner monument (as noted). 1 "x24!' Iron i e wei hin 1. 16 lbs East quarter cor. . P .. g g... i! of - Section 9- 29 -18. ` per'lin. foot set. -=�-- Fenceline (3/4" bar found). Bearings referenced'to the East line of the Northeast quarter of Section 9, assumepglNH to bear S00 031'57 "E. ``���� SCO/V 0 i SCALE lNI°EET /'= l00' HARVEY Q. .ita�a.VSON x' ' 0. /00.. ..200 300 - ~`•._ c 99 This instrument drafted bye "' 10 < �Q� 92609A - °o -9N "."'" 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