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HomeMy WebLinkAbout020-1332-90-000 ' / ST. CROIX COUNTY ZONING ING DCPARTMCN'�? �..� . ` AS BUILT SANITARY REPORT'r; !� - Owner Address g�?& AFB _ ` S7 CROIX �aUNTY City /State _�`''L�� 6 4 ��';;. =ONIJ OFFICE Legal Description: Lot_ Block Subdivision/CSM # '/+ '/+ W, Sec. a7 , T a l N -R q W, Town of /k ./.T .�/ PIN # O? 6 - I3,3:z - 9e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer e 2n w s s.v Stu STRC i ,j 54- Setback from: House a © Well r2 Pump manufacture_ r. 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 S Length Number of Trenches a Setback from: House Well PAL Vent to fresh air intake ELEVATIONS Description of benchmark a Elevation A la a. a Description of alternate benchmark - To o Elevation t b 1 - 7:) Building Sewer f D6. o '7 ST/HT Inlet F' 9 - 9 ,7 STOutl& - ,* ,r,- JFf PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () ? 7 - 9 2 () 1�7� -7 Bottom of System( 4 Final Grade () I. 7 () ( ) Date of installation Permit number State plan number Plumber's signature li cense number - >--2 -2 -Fy°a Date ,S7aa/9� 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. i • Show alternate benchmark, if applicable. PLAN VIEW �V I J M v Q I I INDICATE NORTH ARROW I Wisconsin Department of Commerce p PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary r ?l!�1r7: Personal information you provice may be used for secondary purposes [Privacy La X, s.15.04 (1)(m)]. Permit STOUT der1�2ICAARD E1 la E] Town of: State Plan ID No.: j ftpdW CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T02IG 32-90 -000 1 1.5 1 1 p 11 - 0 - - Z �7T TANK INFORMATION ELEVATION DATA A9800146 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. km WP Benchmar 3. /0 ,i /01."5 Dosing /,L4.v3vA - �i V / 1po.o7 Aeration Bldg. Sewer $ 9 4 0 - 0 Holding St Inlet 2-e 113 TANK SETBACK INFORMATION � , .< 1 �9** Outlet q ezcr TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet go 'f" NA Dt Bottom Dosing NA Header/ Man. 7,V7 Aeration NA Dist. Pipe - 7 .7;,q 9� -83 D✓o - 7. Holding Bot. System q7 a �6 PUMP/ SIPHON INFORMATION Final Grade Manufacturer De and (;}, I 1 ra �� •ate Model Number GPM TDH Li Friction S st TDH Ft Forcemain Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length f I No. Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S 114 DIMENSION SETBACK ZMBER SYSTEM TO P / L BLDG WELL LAKE / STREAM CHING Manufacturer: INFORMATION Type O�L(�1(.f.H�fia L,) �SI �I � OR Mode m er. System DISTRIBUTION SYSTEM Header / Manif Id , c , i Distribution Pipes) I p x Hole Siz x Hole Spacing Vent To Air Intake Length `� Dia. "f Length `I t ( Dia. y Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a Depth Over xx Depth Of I x Setdad rdd.d I mljlrbid Bed /Trench Center Bed/Trench Edges opsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19,SW,NW 766 WILFRED RD- BADLANDS PRAIRIE LOT 9 ` F,nA I 51174 ol v Plan revision required? ❑ Yes No Use other side for additional information. AA SBD -6710 (R.3/97) Date Inspector's SignatureQ Safety and Buildings Division Vii PERMIT APPLICATION 201 E. Washington Ave. n In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 30 - 7 5 - 7 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. -7 ? /„ J/ l / mc l d ((j/CX y1/ / i 4-(J � l State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION ---- Property Owner Name S Prope rty Location ;S 2 7 T 1 2 9 , N, R E (or) Property Owner's Mailing Address Lot Number Block Number 1353 Awatukee Tr City, State Zip Code Phone Number Subdivision Name or CSM Number Hudson, WI 54016 1 (715)549-673 Badlands Prairie II. TYPE F B ILDING: (check one) ❑ State Owned i ty Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o Tow of Hudson State Hwy 12 III. BUILDING USE (If building t ype is public, check all that apply) PArcel Tax Number(s) 1 ❑ Apartment/ Condo a 7 OZ J g • 7 �� • /3'3 —9' 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 ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System ,_______ Exis _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 ❑ Seep`age Pit C� 5 X �) 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 900 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min-/inch) - Elevation 1125 1 1 3 0 Feet eet VII. TANK i Capacity Total # of Prefab. Site Fiber Exper. INFORMATION gall Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tan �a,rllt X 1650 1 Midwestern ® El 1:1 1:1 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ 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) Plumber'sSignatur : (No Stamps) FmP227990 MPRSW No.: Business Phone Number: William Schumaker 1 715 386 -3121 Plumber's Address (Street, City, State, Zip Code): 1070 Scott Rd Hudson, Wisconsin 54016 j IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuin Agent Signature (No Stamps) I8 Approved ❑ Owner Given Initial Surcharge Fee) � Q� oo I is s s q Adverse Determination Ito o a/riD ' I a D X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (8.11/96) MSTNiBI/fTiOM:: Original is Cawty. One coq To: Satety i Noid4up Division, Owner, Pkwrber ,t t d v d . a Y•' s_ %.V uJ,r/ O f � b4�f O�r»5 A� t O �z �J ✓C.�I E 11 _ � /1 !:.s �C t( D U e �/ 511' � fie rn $'yiSrP A ,� /rI Z- / � �'' S � �. �. .� C ^//° a2 Wisronsin Department of Industry SOIL AND SITE EVALUATION I Latwr Human Relations Page 1 of 3 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 St. Croix percent slope, scale or dimensions, north arrow, and I distance to nearest road. Parcel I. D. # - 8( -�,.�j APPLICANT INFORMATION - Pie nt all form oft, Ravi' wed by Date Personal information u provide may be used f 6& a ; .; ` _ Yo P Y N P Y Laws; t5?�4 (1) (m)). d Property Owner roperty Location C Richard Stout ? ovt. Lot SW 1/4 1/4,S 27 T 29 N,R 19 �(or) w Pro Owner Maili Property s al Ing Address • ... - a. ST G90IX of # Block# Subd. Name or CSM# 1353 Awatukee Trai COUNTY 9 Badlands Prairie ZO City State Zip Cod /'Pkgne Number ❑ Cf Nearest Road Hudson WI 54016 1 cit ❑ Village ® Town SjT Hudson State Hwy 12 EkNew Construction Use: ERResidential / Number of bedrooms 6 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 9 0 0 gpd Recommended design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft Absorption area required 1286 bed, ft 2 1 12 5 trench, ft 2 Maximum design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft Recommended infiltration surface elevation(s) 96.60 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Glacial d e o s i t Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In r Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ] S El 91 S El I1 S❑ U I 1 S U ❑ S t U ❑ S )n U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 1 -16 7.5yr2.5-/j none L 2mabk mfr cs 2m .5 ;.6 2 6 -4 10yr3/4 none sil 2mabk mfi cw if .5 ,.6 Ground 3 41-95 1 0yr4 /6 none ms o , cw -- . 7 8 elev. - — 100 ft. Depth to -- -- -- -- -- - — -- - - -- — limiting factor 9 6 in. I Remarks: Boring # 1 0 -14 .5yr none L 2mabk Tif r Cs 2m .5 .6 2 - sil 2mabk fi CW if 3 36-83 10yr4/6 none ms DSg Til w - .7 .8 Ground elev. 10 0_.2 -ft. _ Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. _ 7/� 3 /2 Address Date CST Number,' 078 S 7 rl j g t G .z? 41 7 i �'ROPERTY OWNER Richard S tout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 3oring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 - 7.5 r2.5 1 none r2.5/1 2mabk mfr cs 2m .5 '.6 2 14- 1 10yr3/4 none sil 2mabk mfi cw if .5 -.6 round 3 41-92 10yr4/6 none ms os ml cw -- .7 . 8 alev. 10 0_..2ft. *3epth to imiting act 9 or 2 in. , Remarks: 3oring # - 1 5yr2 . 1 now-- L 2mabk mfr 2m 4` 2 16-33 10yr3 /4 none sil 2mabk mf cw if .5 ,.6 3 38-8 10yr4/6 none ms osg M1 cw -- .7 :.8 around Aev. 100 ft. -depth to imiting actor 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# 1 0 -18 7-5yr2.5,/J none L 2mabk mfr cs 2m .5 .6 2 18 -42 10yr3/4 none sil 2mabk mfi cw if .5 -.6 5 3 42 -86 10yr4/6 none ms osg ml cw -- .7 .8 Ground elev 100 ft. i Depth to limiting factor 86 in. Remarks: 3oring # around ,lev. ft. ]epth to imiting :actor in. Remarks: 3BDW -8330 (R. 08/95) I P 3 ar 3 ,tQ7` 9 L 1 h orq y •� V6- �a / yea, v 2 '�ri� A i i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r To Mailing Address 1.315 Qfja -71, .kwe T , ; /-{t, J so h S 4`0 /4 Property Address ,' t (Verification required from Planning Department for new construction) City/State , ' Parcel Identification Number LEGAL DESCRIPTION Property Location S cJ y,,, ,rL4 /, Sec. 7 , T ate! N -R / I W, Town of A(, , Subdivision ,L�Q d� „As ,�,,,� ; . Lot # Certified Survey Map # Volume . Page # Warranty Deed # .S s3 S Volume /a Y Page # y Y 2 Spec house ❑ yes ® no Lot lines identifiable 12 yes ❑ no SYSTEM ;MAEMNANCE Improper use and maintenanceof your septic system could result is its prc=t=fai1ure to handle wastes. Proper maiaOcaance consists of pumping out the septic tank every three years or sooner, if needed by a licensed puffer What you put into the system can affect ire function of @ic septic tank as a treatment stage in du waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a niasterphunbcrJourneynianplumber, resttictedplumberor a ticensedpumperverifying that (1) dre on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septictaak is less than 1/3 full of sludge. Uwe, dre wed have read the above requirements and agree to maintain du 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 ng stati that your septic system has been maintained must be completed and retuned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 12� - C,�k" n, Rlix SIGNATURE OF 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 descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. C). SIGNATURE OF APPLICANT DATE ss « «ss 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 STATE BAR OF WISCONS114 FORM 1 -1982 WARRANTY DEED DOCUMENT NO. -� -- REGISTER'S Orr iCE ST. CROIX CO., wl ThiS Deed, madebemun The NOL Cor2oraatjoa O1 PA0Awo a Wisconsin corgorat on organized Aril 1 1996 and fli ed Ulth th e Wisconsin Secretary of State on D E C 2 0 1996 k pril J. 199b ,Grantor, 3:30 P. M and Richard 0. Stout Register of Dour -A Grantee, WituesBeth, That the said Grant, for a valuable co nveys to Grantee the following described real estate in St Cr o i x ,_ THIS SPACE RE FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS Richard 0. Stout 1351 Awatukee Tr it 000a INNTMATION f���:. yr ►+f i NU MBER FE �iator :44iio "t-ec ai�as 1� gra'ntee any rove-rs'icuary rig . t 3s- and 3:rzt+eZriEsx - Q tse a $ t , d in V�►U 3S0, page 232, I3noc.: No. 35 4521, i d i�Y Vxs =i �3 "S46-2 14; » b 3 4 12'. 'iii► �..,. + a _-.. 3itttttcsctrrd proptm, ;is tttst _ - ti3 v a ttll ato>1�4gula{rtm 171*retl t teatta and:appurtenattm thertrunto belonging•,; tae fthib t B hovmto rldltt,aA#rdlpfiail the same. #1 :#fit d �exeae �,._ ,i9 -• 1 3 4:0? v aStN + +1 irfilif to the known to !E tlgs petson whov=uted the for*it tn,trument and 14 D aled�e asine. 7} its { k)tdlf l f wR4�FTED sY Grin4a1 lolsi"ain y. Y f�•1� 11r6 attlfite d or attm WVla Od. iieth:ate not Irljr Y i�� .� t n rT#rts trs:.n t +do�gt ar twaCaetauietr" snit • '010 114" 1�14o:#iPib�#flfiiIIF vot M4PAu -443 EXHIBIT A Legal Description The NGL Corporation to Richard O. Stout The South Half of the Northwest Quarter, the Northwest Quarter of the Northwest Quarter, and the West Half of the Southwest Quarter of the Northeast Quarter of Section 27, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. Except that portion of the Northwest quarter of the Northwest quarter of said Section 27 described as follows: Beginning at the Northwest corner of said Section 27; thence along the North line of said Section 27, South 88 degrees 23 minutes 58 seconds East 160 feast; thence, diagonally, South 29 degrees 07 minutes 38 seconds West 338.27 feet to a point on the West lice; of said Section 27; thence along said West line, North 0 degrees 54 minutes 02 seconds East 300 feet to the Northwest corner of said Seeden-29Land-ibe-paint of bo wing: .. n Subject eo the right of St. Crok County for highway purposes as utabl d Mcooded in the ofl )dater of Deeds for St. Croix Counter, ii , in Vey 257, page .118 and Volume 302, page 24; 5sdO to- the right Of way grand to the Wisoonsin Tdephcft Cowpwy, : Ift the OMM of saw RM&W of Deeds, in Volume 472, page 05, document 305105; &*J90t to to existing town road along the North line of the Northwest Qww of thz 1' w vast QuIarw Of won 27. i t rasa I I 41 it �4Pacf' 44 Exhibit B Liens and Encumbrances The NGL Corporation to Richard O. Shut (i) Municipal and zoning ordinances and agreements entered under them, (ii) recorded easements for distribution of utility and municipal services, ('iii) recorded building and use restrictions and covenants, and (iv) general taxes levied in the year of closing. I r,. i i t I i i i x '1 i 1 } . �,aWaaae+aw n..rnS.vx �,.•..v,; .:. sr -+k `.vu"��!�v .... _. t ; T- OF- Y • S 00 28' 54" E . 08 379 ' X Sao ~ x rn _ W V � O 00 L1'1O— It 6 O X nn DD �I x N N y N ;� N `/ N I X W x i h r o �Q w %