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HomeMy WebLinkAbout020-1331-50-000 \ o D 0 \ @ 0 $ � � m o � � § � � \ � o � ƒ � t } o z G % k . LL ƒ . � { \ { § g § \ \ a m g . ( 2_ 2 ) § 2 ® U) R = CD 2 / } ) ) 2 ) § f 4) § p \ k 7 , \ m g 6 \ / / e � © Q$< E� 0 8 0, \\ z e z 7 z%\\ � / � k � d \ j) _ (D k \ « T) cc § o CL E f E ® w \__ $ § § CL § 0. 2 j\ k k k 2 \ \ r 2 / / ° § / o \ n a / f a § \ \ 0 :3 1 / # x m 2 2 % \\ // Q / \ » 2 § n I- § / / \ } 7 \ ` § 8 S � , 2 (2 Q e e _ / § _ / c ± = c - o k\ )§ / k *\ k§ S 5 S - \§ I j R o 2$) \ 7 m (C "tea E) ' k a § Con / A a 2 3& 3 Ccurt�Tn�Dapartment of Commerce 'Safety and Buildings Division PRIVATE SEWAGE SYSTEM county: �. 1 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 307 (00 - 4 Permit Holder's Name: ❑ City ❑ Village IS Town of: State Plan ID No.: cv3Se J,4,dSey-t � — CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: loo` l ` 000 TANK INFORMATION EL ATION DATA 3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. - Sr e - Ic I Benchmar SKI 1O0 Dosing A,-+, 0.0 l C!f 45 — Aeratio Bldg. Sewer too -55' Holding It Inlet S.�f X19.55 TANK SETBACK INFORMATION Pit Outlet ( 99. is 1 h� ec�ie TANK TO P / L WELL BLDG. A Intake ROAD Dt Inlet Septic E$— 8 © &ep 18 -7 NA Dt Bottom Dosing NA Header / Man. a -I T 97. Aeration NA Dist. Pipe 9.47 C A. 97. i Holding Bot. System 9 45, 9a PUMP/ SIPHON INFORMATION Final Grade �•to2 IOD.$� Manufactur Demand S MCLIn hole- co xk- 3 • II 1t�2,3' Model Icumber GPM rForcemain DH Li Friction em TDH Ft Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED NC Width a Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth I N I N -� 2— DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREA --LEACHING Manu rer: INFORMATION Type O s CHA Mode Number: System v o , !e{Q — OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) r � x Hole Size x Hole Spacing Vent To Air Intake Length I Dia. i Length &0 1 Dia. T Spacing L STi� S4 272cj 90 / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over �� Yes ❑ No Depth Over dded xx Mulched Bed /Trench Center q Bed /Trench Edges Topsoil ❑ ❑Yes [] No 7 2 COMMENTS (Include code discrepancies, persons present, etc.) -7// 1,c'u �a�✓d Y�'J (� ALk• 13AA - Ii oAo l o•� 4iGli i74 Oa +t� ( -a N"ey - 7 6 Plan revision required? ❑ Yes ® No Use other side for additional information. 2'l �(� o� �1 � - 7 y SBD -6710 (R.3/97) Date Inspector's Signature ert. ( ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1 M N b M ■ NNU11 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 - (715) 386 -4680 FAX (715) 386 -4686 Friday, March 14, 2003 Richard LaCasse 711 Waldroff Farm Road Hudson, WI 54016 Regarding septic inspection for Richard LaCasse. Location of Property in St. Croix County: Municipality: Hudson Township Subdivision or Plat: Evergreen Estates I Certified Survey Map: Lot: 15 Address: 711 Waldroff Farm Road Dear Applicant: A septic inspection of the above reference property was conducted on April 27,1998. This property is located in the SW 1/4 NW 1/4 of Section 23, T29N R19W, Evergreen Estates I (Lot 15), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 3 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. S' ly, .� Rod Eslinger Zoning Staff cc: file ST. CROIX COUNTY ZONING DEPARTMENT y AS BUILT SANITARY REPORT .�► `< RECEIVED Owner Address _ a ?, A Z, 4oe, - City /State �z ST CROP, COUN ti Legal Description: Lot Block Subdivision/CSM # `�+ %+ AJ Sec., TAN -R Town of PIN # e V Q SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer a,`,1w,6kz - .. v 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: Width Length Number of Trenches Setback from: House Well ` � So = - P/L, 3p , Vent to fresh air intake ELEVATIONS Description of benchmark /a O. 7 ;r,- e Elevation /D4. Description of alternate benchmark Elevation 1D�� Y S - Building Sewer /d"e .Ss� ST/HT Inlet . 5_S� ST Outlet 99 /S� PC Inlet T a e 7 e li PC Bottom Header/Manifold Top of ST/PC Manhole Cover , Distribution Lines () /O Bottom of System Final Grade Date of installation b / Permit number O 7 a State plan number Plumber's signature g License number Date y �./ 1 7 r Inspector 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 t a h Q � o Q 1 0 h 0 INDICATE NORTH ARROW A s s - SANITARY PERMIT APPLICATION 201 E w hingto e. cvns►n m P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, WIS. Ad Code Madison, WI 53707 -7%9 • Attach complete plans (to the county copy only) for the system, on paper not less County �. than 8112 x 11 inches in size. S / ,c- n/ o c X • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other g overnment agency programs � The information a placation [Privacy Law, s. 15.04 (1) (m)] 7 y p y y 9 g y p 9 �� E l if revision to previous t' W /„/,iO f I VV (/� (,/ / (/ r/ State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N ' Property Owner Name Proper L cation eycr 5-S 16? � 1 /4 ' y 1/a,S2, T29 NR/? E(or)v Property Owner's Mailing Address Lot Number Block Number f t,Jr, 4 a,& r tT r City, Stat Zip Code ,r Phone Number Subdivision N ame or CSM Number T YPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road Village Public A 1 or 2 Family Dwelling - No. of bedrooms 3 town OF zI.o/.vo,✓ Ic je.e .0 Al d6 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Dad 13,E /. 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. Eg New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an Sy tem ________ 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 2TRf 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. /inch) ?( '20 Elevation 10 5 _613 i l� � 5.3 d Feetj 4, Feet Capacit VII. TANK in allon Total # of r Prefab. Site Fiber- Exper- INFORMATION g Gallons Tanks Manufacturer s Name Concrete con- steel glass Plastic App New Existin structed Tanksl Tanks Septic Tank or Holding Tank J( fQQa r 7` r,V a ❑ ❑ 1 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP PRSW No.: Business Phone Number: r rn e>r Plumber's Address (Street, City, State, y ode): /,0 76 o r1 a IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) Ig Approved E] Owner Fee) Owner Given Initial /Q� !21� �. ?� ©. c•ea Adverse Determination 1 V X. CONDITIONS OF APPROVAL 1 REASONS FOR DISAPPROVAL: SBD4IM (R.11/96) DISTRIBUTION: OrigWW to County. One co" To: Safety B: SuAdings Division, Choner, Mnum6er ,I lJ �, CCi s'S G I� d �7 �' ,� ' T r > > rod S/ d X Et Q 0 5 T 19G.�d • l(f r • U fa ;�g G Wisconsin Department of Industry SOIL AND SITE EVALUATION Page / of 3 Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 112 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. # P END / N t's—°- APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes.(Pdvacy Law, s. 15.04 (1) (m)). Property Owner Property Location q f f (lir'l13 L-4A P 4 PX Govt. Lot SW 1 /4 NW 1/4,S 23 T 2 ,N,R / / E (or )(0 Property Owner's Mailing Address E S J Lot # Block# Subd. Name or CSM# 332 NiNNjZs0T`A_ :5-r. h G-- • /� vER(r�PEE•v EST -TES City State Zip Code Phone Number Nearest Road 1140.. /2 ST u L 1`f dN� s 10 i (� l z- ) 2.7 - 5S,5_5 0 ty 0 village Tod air iC A'�/4Y D . New Construction Use: ErResidential / Number of bedrooms - Addition to existing building ❑ Replacement NSo [J Public or commercial - Describe: - p Code derived daily flow 69 gpd Z sO Recommended design loading rate bed, gpd/ft a trench, gpd/t> Absorption area required gy bed, ft trench, ft 2 Maximum design loading rate •? bed, gpd/f trench, gpd/fi / s 6 Recommended infiltration surface elevation(s), 5EE . 3 it (as referred to site plan benchmark) Additional design /site con ations S� L ow 6-- ti�'ii'� 4J 7 44X S , Parent material 5C-5 0 6 0 P /' //0 T ' S4 rrP j5 1"- fs • Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system O U L9-6 0 U IR'S El U [] S ❑ U ❑ S ❑ S SOiL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Boundary ry GPD /ft In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed , Trench 0- 13 /O YR 2- Z Z 23 - 39 /o Y 3 S /L z cr., 6,e mow, die S Ground 3 . V /O Yj2 y '� ; l G / fS� d4 2 5 elev. Depth to ` o / limiting factor > � in. ; Remarks: Boring # 1 0- 13 o ya, 3/3 — — GD�}.r./ fs�.r �►•, l2 C 5 io yi2 �/ — D/li� -i / 7`S�i� f� G • �-(; . s 3 1 - 35 3/ t( , 24- 54e .PK 1�,2 CG 5 Ground 3 5,qg l0 V A yl L S ,, fx d5 elev. ft f, yk /O w 6 S D S Depth to limiting factor f In. Remarks: CST Name (Please Print) Signature Telephone No. RaQER'( -- _2AQ3Ri 61- 7�, 396 �Yfs'S Address Date CST Number Asso cia tes /011 ' �3' �1 CSTM Z S/e2_ Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL PROPERTY OWNER c SOIL DESCRIPTION REPORT Page �Z' of PARCEL 1.131 G o f` 6 S 7 Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 0 /o y e 313 Gosh /fs� �, fie C S 3 ! F N ; •s 2- 11 /o YA 31 11 f S 44, fA 4 S S'• G Ground 3 - y /Q elev ,OL 2ti ff. 4 S / 4 ? S �, s Depth to limiting factor I In. ; Remarks: Boring # 1- I /oY 3/ S i L 1 >cs hi- nrfi2 c S Z ; 3 3 -2 1-0 !1,R 311 S /L Lf Ground I 3 2 /0 yt 31,& S /L f s h� ,rte L+ G —� 2- ; 3 elev. 3 7 YA l0 Y A, Depth to `� /O / v e limiting factor 7 In. Remarks: FHodzon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # o 2 /L C / L / f S 44, l 'L C 5 Z /- /7 o yIe L/3 fTA& &M 7 CS Ground y - - 4 /oY/2 3/y S/ - f SAe elev. Depth to T 0 limiting factor Remarks: Boring It Ground elev. ft. ' Depth to limiting Li factor in. Remarks: SBDW -8330 (R. 08/95) � 5 v �s 3 l R� N -� d � � •� G 4 N W� w • N N w 0 0 • 'i r c O'zi f tj J � I . STC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result �n delays of the permit issuance. ,should this development be intended for resale by owner /contractor,(spec house), thenta second form should'be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. owner of property �ac A , ,4...a Location of proper ty5 6 X114 114 Section 2 T-9LN -R Township Mailing address J - z- /!5 / yr &1 li J 5131 4-Xr Address of site _ 7L/ lJu /d rs Subdivision name /. .,r. Qro..c_1� Lot no. Other homes on property? yes 11 No Previous owner of property ��� r W UdU LA,A Gor Total size of parcel _ / [� ,,,�, Date parcel•was created Are all corners and lot lines identifiable? - Yes No Is this property being developed for (spec house)? Yes No l t/ AG, Volume 2 - - and.Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County, Register�of Deeds as Document No. S , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document N o. . signat re of applicant Co- applicant 1 Date of Signature Date of Signature. f S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER 1A 7// hlc/ �l°e,` - a Y ylt jolt l�� Q se ADDRESS / 2 LCD zPA kwab ei ( _ FIRE NUMBER / Z ' Y CITY /STAT la _ ZIP � elC6/ f PROPERTY LOCATION : fi� l/4 , _4(d) 1/4 , SECTION Z J_ T2L_N -R TOWN OF p/i, , St. Croix County, SUBDIVISION Q �v_ �$f- LOT NUMBER ! . 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 septic tank.pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1). the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and Scum. I /We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards sett forth, herein, as set by the Wisconsin DNR. certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Z ning Officer within 30 days of the three year expiration date. SIGNED: DATE • I St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 L . VOL ` I, �.�..91PAGE167 ' DOCUMENT NO. WARRANTY DEED ! i STATE BAR OF WISCONSIN FORM 2 -1982 571935 1 REGISTU 'S OFFICE. Humbird Land Corporation, a Minnesota Corporation ST. CR CO.. WI ....... ......................... ............................... Roe'd for Rseord • ..........._ .................................................................... ............................... JAN 2 9 1998 ......................................................... ............................... M conveys and warrants to Ri .chard.B...LaBasse..and..Crace. J...LaCasse.,........ � 8 -00 �� husband_ and ,wife. &) .................. Rs lster of Deeds . ... .... ............... ..... ........... .......... .......... ........................ ......... .............. . ......... ..._.....,..... _ _ ... - -- ............ ........ ............................... .......... .._ .. ..... _.............. ........ nETunn To _ ....................................... .... - - -... _... ...........- .U— er �Tai�tey Albstract & 'title, In . . ...... ... ................................. ........... ......... ........................ r:0. Box 149 . 206 2nd St. the following described reA estate in ......St,•,Croix ... ..............County, ueTSOn, WX 54 State of Wiscunsin: Tax Parcel No: .02.0- 1.33].._-5.0....... Lot 15, Evergreen Estates, Town of Hudson, St. Croix County, Wisconsin TRSFER FEE This is not....... .. homestead property. xX9(D( (is not) Exception to warranties: Easements restrictions and rights-ot - way of record, if any Dated this ..,. .._22nd Jahuary, 98 ... ......... ...................... day of _........ ......_........ .............................., 19......... ............................................................... .....(SEAL) HUMBIRD LAND CORPORATION (SEAL) �.......• . ...... .............. ................................... ........... .................... Bx' ............. Austin J. Baillo , Its President .............. .........................(SEAL) ....... ............................... .........................(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................. ......................... ...... STATE OF 7JXZXXXX1 MINNESOT ss. amsey •......... ._......County. authenticated this ........day of ........................... 19...... Personally came before me this ...22Bd. day oi' .... JAaunry ...........................I 19.9$_.. the above named - Austin J. Baillon, President of ... ............................................................................ * Hu - .. P Land Corporation ... .... ..--•-"-----•-- ...••......-•-.... .__..- •- •• . .................... TITLE: MEMBER STATE BAR OF WISCONSIN ..............•--•-•-•"••-•""-•-"-"•--"•--•--.... ................._............. (If not, ............................................................ .......................... authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the foregoing instrument THIS INSTRUMENT WAS DRAFTED BY ,- U1 BAILL®N rLt.. c �JGwW'+ y Stii2l Ha�Y- 1?UBLiC i61A1NES0 ?A - ... .,Humbird Land CBrporati on ................. .............. 7,' c,t " " " " "" ""' Paul A. Bai 11 on � COUNTY --.-.• . ............... •--- •-- " $ • - - - - -- +�y ao►mn- £mpiree +an s'1;2�Oi�y� --•--•--""-••-•"---•---"--" .. ......................... .••••. Notary Public .... ...... MN (Signatures may be authenticated or acknowledged. Both Diy Commission is Permanent. (If not, state expiration are not necessary.) January 31 X19 2000,) date: .......... •-•----.....-• - ............................... . *Names of persona signing in nny cnpneity should be typed or printed below their siruntares, � -- -- - -_ W ♦v a M w w t (� P tl N rn M Ux N W Qw N Z N .wa 0 N 0 1 ' U > >- w d w�I w 3 M� / < U �t 0 Q M N ,00'0£Z 0 aw Q O O 3„ r,,£Io00N (D 7m O _ - 'T w04. 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