HomeMy WebLinkAbout020-1333-20-000 I ' 1 1-
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner ��i? °cl��- T� , ►l't ,
Address ,d 1 4
�r -
City /Stat
ZONING OFFICE `y
Legal Description:
Lot /a Block Subdivision/CSM # -
'/, ;;;�i %. �r,J Sec. ? TAN -RL1W,Town of Ar, sv / _ PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer f'crwcs - Tr°o Size ST/PC /� Setback from: House V�5 "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: T g d Width -5 Length 1 /3 Number of Trenches -Z
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark Q7 r � pr'UL Elevation
Description of alternate benchmark Elevation
Building Sewer 1, I ST/HT Inlet 9?f F3 ST Outlet V/ PC Inlet
PC Bottom Header/Manifold g ?. a d Top of ST/PC Manhole Cover
7_ d !o
Distribution Lines () g () IF 7- V C ( )
Bottom of System( ( ) ( )
Final Grade
Date of installation Permit number State plan number
Plumber's signature r,�- -- —� License number Date 5 /tea/ 9 r
Inspector h �l / -j
Complete plot plan
1
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
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INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division
INSPECTION REPORT sT. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarlk `M:
Personal information you provice may be used for secondary purposes [Privacy LaW, s.15.04 (1)(m)].
"t]l4pIde'1:2YMfARD p b kWI age E] Town of: State Plan ID No.:
CST BMElev.: Insp.BMElev.: BM Description: Parcel
too Tax Nv ._1333-20-000
( Z' � , � - c�T s
TANK INFORMATION ELEVATION DATA A9800151
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
M W (o Sz 8enchmar S• b to-5 160
a
Dosing
Aeration Bldg. Sewer r ��D• S/
Holding (91-4* Inlet S .g
TANK SETBACK INFORMATION *y outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
r
D � � NA Dt Bottom
3 �I
Dosing A Header /Man. 7 -a7 I
Aeration NA Dist. Pipe e SS 47 °L
Holding Bot. System 2D
PUMP/ SIPHON INFORMATION Final Grade J` f� ADO
Manufacturer Demand +; N a,sl� ( �•� �"p,
Model Number GPM
TDH Lift L ctlon 5 TDH Ft
Forcemal Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED MMNC.W Width r Length r No.Of Trenches PIT No. Of Pits Inside Dia. Liqui epth
DIMEN N v ! 1 DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE CHING Manufacturer:
INFORMATION Type of ,1 ., r OR UNIT R umber:
System orl�'�x 7
DISTRIBUTION SYSTEM
Header / Manifold r Distribution Pipe(s) j x Hole Size x Hole Spacing Vent To Air Intake
Length 13 Dia. � ' Length Dia. `I Spacing � 1C �r ! "^ 77IL � U /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over �� Depth Over xx Seeded/ Sodded xx
Bed /Trench Center �j'�!) Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 27.29.19,SW,NW 758 WILFRED RD— BADLANDS PRAIRIE LOT 12
v t r I , 4 ;; i
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3) F "It'ft� �T youree(® l h,S pe f - M
1:1 not 1 51zz{41b
Plan revision required. ❑ Yes Z No 3
Use other side for additional information. FT/ 0
SBD -6710 (R.3/97) Date Inspector's Si ature Cert. No.
SANITARY PERMIT APPLICATION Safe and Buildings A ve .
Vis con s in In accor d 8 with ILHR . . Adm. Code P.O. Box 7969
Department of Commerce 3 O5, Wi s Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. St. Croix
• See reverse side for instructions for completing this application State Sanitary Permit Number
30 774 c�_
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. 759 9 w, / & ! CI
V / c..v , Cw . State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION �—
Property Owner Name Property Location
Richard Stout SW 1/4 NW 114, S2 7 T 29 , N, R 1 X (or) W
Property Owner's Mailing Address Lot Number Block Number
1353 Awatukee Trail 12
City, State Zip Code Phone Number Subdivision Name or CSM Number
Hudson, WI 54016 1 (715)549-6731 Badlands Prairie
II. TYPE Or (check one) ❑ State Owned 0 Cit Jearest Road
0 Village
Public 1 or 2 Family Dwelling - No. of bedrooms 6 Town OF
III. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s)
1 ❑ Apartment/ Condo A all?. J 9• / 75Q Q a 0 1333 - .20
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 -------- ------------- __ ______ __ ___ Tank Only_ ____________ Existing System ________ Existinq 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 / „\ , I X I )3 1 42 ❑ Pit Privy
13 E] Seepage Pit tp�) 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 1130 .8 Na 96'20 Feet 99.70 Feet
VII. TANK i Ca n gaall Capacit Total # of r Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks
tic Tan ank X 1650 1 Midwestern ® ❑ I ❑ ❑ 1 ❑
Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 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's Signature: ( tamps) MP /MPRSW No.: Business Phone Number:
William Schumaker- �/ _ P 227990 1 (715) 386 -3121
Plumber's Address (Street, City, States Zip Code):
1070 Scott Rd Hudson, Wisconsin 54016
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issu gent Signature (No Stamps)
Approved I ❑ Owner Given Initial 9�0 Surcharge Fee) �� Adverse Determination 1 0 /I M I Y M L
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -BM (R 11196) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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Wisconsin Department of Industry SOIL AND SITE EVALUATION
�
La•'�r and Human Relations Page 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 S Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
0-?v " - 90
APPLICANT INFORMATION - Please pri al>lilgfb�r�i Revi wed by Date
Personal information you provide may be used for second Pu*' s (Pri cy Law, sC;t 1) (m)).
Property Owner rty Location
� 1
�c a CE I
Richard Stout - t 00!t. Lot SW 1/4 NW 1/4,5 27 129 N,R 19 K(or) w
Property Owner's Mailing Address r , _ 1-04 Block# Subd. Name or CSM#
1353 Awatukee Trail S' C t.��
^�T CFi01X 1 Badlands Prairie
City State Zip Code one Nurr6QWN
FFICE City ❑Village ® Town Nearest Road
Hudson WI 54016 (=�, 5ZP'' '' 67.,2 Hudso State Hwy 12
® New Construction Use: ® Residential / Number o e rooms 6 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 9 00 gpd Recommended design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft
Absorption area required 32 bed, ft 1_ 2 5 _ trench, ft2 Maximum design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft
Recommended infiltration surface elevation(s) 96. 2 ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Glacial de posit 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 1 S El S❑ U [N S ❑ U ❑ S [q U ❑ S MU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Te Structure GPD /ft
in. Munsell ou. Sz. Cont. Color xture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
1 1 0 -1 7.5yr2.5 1 none L 2mabk mfr cs 2m .5 ,.6
2 13-- 10yr3/4 none sil 2mabk mfi cs if .5 '.6
Ground 3 36-E 5 10yr4/6 non ms osg ml cs -- .7 .8
elev. -- -- - -- _
10 0 —2--ft-
Depth Depth to
limiting
factor - - -- 8-5
Remarks:
Boring #
1 0 -1 7.5 r2.5 1 none L 2mabk mfr cs 2m .5 .6
2 2 15-40 10yr3/4 none sil 2mabk mfi cs if .5 '.6
3 40-E5 10yr4/E none ms osg ml cs -- .7 .8
Ground
elev.
99.8ft.
Depth to —
limiting
factor
85 in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
?ROPE&TY OWNER Richard Stout SOIL DESCRIPTION REPORT
Page 2 of 3
PARCEL I.D.#f
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 -16 7.5yr2.5/1 none L 2mabk mfr cs 2m .5 ..6
2 16-23 10yr3/4 none sil 2mabk mfi CS if .5 -.6
around 3 33-E4 10yr4/6 none ms osg ml CS -- .7 .8
alev.
9 9 ft.
Depth to
uniting
actor
8.4 in.
Remarks:
3oring #
1 0 -14 7.5yr2.5/1 none L 2mabk mfr CS 2m .5 .6
4 ' 2 14 -41 10yr3/4 none sil 2mabk mfi cs if .5 ;.6
3 41 -89 10yr4/6 none ms osg ml cS -- .7 '.8
around
)lev.
100.5 ft.
Depth to
inviting
actor
8g_in.
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 0-14 7.5 r2.5 1 _ none L 2mabk mfr CS 2m .5 '.6
5 2 14-42 10yr3 /4 none sil 2mabk mfi CS if .5 .6
3 42-83 10yr4/6 none ms osg ml cs -- .7 ;.8
Ground
golev•9
I
Depth to
limiting
fiactor
8 -in Remarks:
Boring #
Ground
elev.
.Depth to
limiting
factor
in.
Remarks:
SBDW -8330 (R. 08/55)
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ern! 7'4i 144,
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
I
Owner/Buyer G q 12 O 1 0 U
Mailing Address 13 ,53 /9 t u 4y r- -,- 7 ;
Property Address 4e I
(Verification required from Planning Department for new constiuctioa)
City/State U i Parcel Identification Number
LEGAL DESCRIPTION
Property Location S 6 J y., i w/� /, Sec. a W, Town of S
Subdivision A 06 iq h o s (�- �2 a i i Lot # J a
Certified Survey M # Volume . Page #
Warranty Deed # 3 5' 8 y Volume _ /,�L / </ Page #
Spec house ❑ yes ❑ no Lot lines identifiable OF yes ❑. no
LatNTENANCE
Years or
Imgmperteeandmaiateaanoeofyms is couldresultinits
consists of pumping out the septic task every throe prematic lure to ��adle wastes. Pcnpermaiatcnanoe
can affect.fin fmrctioa of tie if needed by a licensed pumps What y ou , put into the >�e tuk a stage in the Wadedigmdsystem.
The pmperty owner agrees to submit to St. Croix Zoning Departaeat a certification form, signed by the ownee sad by a
� � . restrictodphrmberor a Iia.ased &at ( �e oa�ite arastewaterdisposal systeac
proper operating condition and/or (2) after iaspedioa and pumping (if neo�saty), � septic.taak is less .$ran lf3 full of shrdge.
Uwe. the mdersigaed have read the above requirements and agree to maiataia &c private sewage disposal system with die standards
set forth, herein, as set by the Dqmtmcnt of Commerce and the Department of Natural
stating that your septic system has been maintained must be eompided and retumed to the SL Croi ate of Wisconsin.. Certification
days of &e three year expiration date. Count Zoning Office within 30
—Pk qTut 2
SIGNATURE OF APPLICANT DATE
OWNER. CERTIFICATTON
the
I (we) Certify that all s on this form are true to the best of my (our) Imowledge. I (we) am (are) the owners) of
property descdbod above by virtue of a warranty deed recorded in
n. ^ �` Register. of Deeds Office.
SIGNAIURE OF APPLICANT DATE
« « « « «« Any mformatioa that is mis- represented may result m the =unitary permit being revoked by the Zoning Department. « « « « ««
«• Include with this application: a stamped warranty decd from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
I
STATE BAR OF WISCONS19 FORM 1 -1982
WARRANTY PEfp
DOCUMENT N0.�� '
- - -- REQISTER'3 GFFiCE
St. CR OIX CO., WI
This Deed, made between The NQ ColRorat Lon .__ tkddbfR"W
a Wisconsin corgoration, or anized Aril 1 1996 and
fil ed with e Wisconsin setretary of State on D EC 2 0 1 996
A 3p 199b ,Grantor,
and Richard 0. Stout at 3.30 P • M
-'Ko4.,.— * ld,,,4,k
Register of Du tlG i
Grantee,
Wit nesseth, That the said Grantor, for a valuable mttsideiati�
conveys to Grantee the following described real estate in St Croix —_ THt8 SPACE RE FOR RECORDING DATA
County, State of Wisco NAME AND RETURN ADDRESS
Richard 0. Stout
1351 AWatukee Tr
r
r.e.
c r ii - clai�as ;ter grantas any reve- rsionary rtgt , ti -la, and tutatift-to. -he r a e!auuki - � &' in V�ot 5 page 212, Doc.: No.
35 4521, :mod in Vtil. 58.,; a`'�21.4,
fits nct)
ga,+t l a�t tie riotr the hi d neaata and:gppunenances thereunto belonging'
1Rtre Ealt ibl— r B hie to
% d
"**a sad4oftrid the same,
R•ffiA3`tt AW WJK.,ON$tN -
to me known to cite peter who #s eomed in
ittstt!ument and 0 04welfte to Sri ne.
tmitive"WWOW. W��% DRAFT-ED BY
Gr 17 & +3nlstain
,
N �r
:s tied cu att�uledd. :atst not ld3►.. i
Rtita�itgtr£ r' tY+'Y 9 io �tlf stew raCni
vot TM PAcA 43
SIT A
Legal Description
The NQ.L 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: Binning 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 f0d; thence, diagonally, South 29 de ees 07 minutes 38 seconds West 338.27
feet to a point on the West line of said Section 27; thence along aid West line, North
0 degrees 54 minutes 02 seconds Past 300 feet to the Northwest corner of said
.. _.. �reelxea�2-
,.
fi-
n gi
to d, Oft. CMk Coannty for highway pMs as a Wam"d .'
M=dd la the 0000 Of i ftgistw of Deeds fang St. Ch* Csuaty, Wit can , in
Vokme 2;37, l i1-84nd Vtwe 302, pop 24;
Sam to the rW- of way g to the Wisconsin Tai« , : in
the 40oo of mW 'cif heeds, in Volume 472, page , dement 3 l $;
ftW? ect to road along the North line of the Norte Quartm of *e
MO of Sin 27.
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Exhibit B
Liens and Encumbrances
The NOL Corporation to Richard O. Stout
(i) Municipal and zoning ordinances and agreements entered under them, (ii) recorded
easements far distribution of utility and municipal services, ('iii) recorded building and use
restrictions and covenants, and (iv) general taxes levied in the year of closing.
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