HomeMy WebLinkAbout020-1333-40-000 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner
I�l, s
Address /,� 5j ,441 e;J`,4 � �'r ��� t , ; S7 CROIxl99$
City /State Z Cou
vN1NG pFFIC£
Legal Description:
Lot Block Subdivision/CSM #
' /4 64) I4 ,N Sec- 9 - 7 — , T -RAW, Town of PIN # 0,26- I ZZ.? 5`d
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer 117,'�lc,� �sT� ,rJ Size ST/PC Setback from: House ZC Well 6m a-✓
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: Gc,y Width Length ��,3 _ Number of Trenches 2
Setback from: House 30' Well �'�'� o Vent to fresh air intake 3rd
ELEVATIONS
Description of benchmark � 6 Elevation LOO 6
Description of alternate benchmark Elevation 4o
Building Sewer ST/HT Inlet l d,6, 7 Z ST Outlet- /d 6 , �/,2 PC Inlet
8'
PC Bottom Header/Manifold 971 9 T ?gT_ Top of ST/PC Manhole Cover Z01 F
Distribution Lines 7 2 () 97. 77 ( )
Bottom of System () 9�. F� () gG� 4Z ( )
Final Grade ( ) r0 /. D$' () ( )
Date of installation. b Ar Permit number 3�/��`� State plan number
Plumber's signature GJ���i -� License number �_ arm Date .57a
Inspector , cs
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.
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INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division count ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary T0rt 9W4
Personal information you provice may be used for secondary purposes [Privacy Lal s• 15.04 (1)(m)].
Permit H Ider' ❑ age [] Town of: State Plan ID No.:
STO& , �t ?8AARD {i D9c�tH
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta al® -13 3 3-40-000
J
r 00 ^ U c7V 1 %� 6'r i. j
TANK INFORMATION ELEVATION DATA A9800153
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Se j'►� y�/ (� C� Benchmark q , 2 I v O
Dosi ng
Aeration Bldg. Sewer
Holding Inlet
TANK SETBACK INFORMATION outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
eptic 7 5 �l � NA Dt Bottom
Dosing NA Header / Man.
G•z
a .T '7, - 7Z
Aeration NA Dist. Pipe s J G ,,� I,
Holding Bot. System t./
c 7• �.
PUMP/ SIPHON INFORMATION Final Grade �. IL 101 Oa'
Manufacturer Demand 5
Model Number -- GPM
TDH Lift Friction em TDH Ft
Forcemainj Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BEDdIXENCW Width / Length 1 N0.Of PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING ac ur _.
SETBACK CHAMBER
INFORMATION TypeO - OR UNIT o el
Syste
DISTRIBUTION SYSTEM
Header / Mani old r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length -1-5! Dia. Length ' t Dia. rf Spacing ej
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 11 Depth Over
Bed /Trench Center �V Bed /Tren Topsoil ❑ Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 27.29.19,SW,NW 752 WILFRED RD— BADLANDS PRAIRIE LOT 14
a d
S _z 01
wtuMl t GaVei/ 1o(-d
P �
Plan revision a uired? 0 Yes No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature
SANITARY PERMIT APPLICATION Safety W ashngonAve lion
Visconsin P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. St. Croix
• See reverse side for instructions for completing this application State Sanitary Permit Number
y ou p rovide may be used b other overnmenta agency p rograms G
The information
y p y y g 9 y p g E] Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)). 7 5 ,R W�" j rim d �� State Plan I.D. Numb r
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
Richard Stout SW 1 /4NW " 4,5 27 T29 , N R1 g )f (or) W
Property Owner's Mailing Address Lot Number Block Number
1353 Awatukee Trail 14
City, State Zip Code Phone Number Subdivision Name or CSM Number
Hudson WI 1 54016 I V15)549-6731 Badlands Prairie
II. TYPE BUILDING: (check one) El State Owned ❑ It Nearest Road
6 ❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms Q Town OF )n ate Hwy 12
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 [] Apartment / Condo �" �' / - / 7,54A J AI- f333 ._ ( �/ d
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 ________ Existing- -stem
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 [31 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
900 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
1125 1 1 30 .8 Na 96.92 Feet 100. 42 Feet
VII. TANK Capacit gallo Total # Of Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App
Tanks Tanks
e cTan n Ll 1650 1 Midwestern ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ 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: (No Stamps) MP /MPRSW No.: Business Phone Number:
William Schumaker �' - MP 227990 (715) 386 -3121
Plumber's Address (Street, City, State, Zip Code):
1070 Scott Rd Hudson, Wisconsin 54016
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued
roved Issul Agent Ski ent Signature (No Stamps)
A Surcharge Fee) /
pp ❑Owner Given Initial ��i orD� S s 9g �
Adverse Determination D Cc�)
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD -8398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety 6 Buildings Division, Owner, Plumber
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Wisqonsin Department of Industry SOIL AND SITE EVALUATION
Libo, -and 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 location and distance to nearest road. parcel I.D. #
vao - /o70 -0/0
APPLICANT INFORMATION - Please 1�t �N inmrmation `�, R v w by Date
Personal information you provide may be used for sec a urpo s (Pfldltcy law, s:55,04 1)
Property Owner /' ' 'M1 V L fXo erty Location CJ
Richard Stout _` ` �Q Lot sw 1/4 NW 1/4s 27 T 29 N,R 19 � (or)w An p Property Owner's Mailing Address Ln � `° ' Block# Subd. Name
or CSM#
1353 Awatukee Trail 5' CRt7 ±X
COUNTY � Badlands Prairie
City State Zip Code 1►pndtyf)FFI City ❑ Village ® Town Nearest Road
[X] New Construction Use: Residential / Number of bedrooms _6 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow _ 900 gpd Recommended design loading rate __7 bed, gpd/ft gpd/ft
Absorption area required 1286 bed ft 2 1 1 5 trench, ft 2 Maximum design loading rate - 7 bed, gpd/ft - 8 trench, gpd/ft
Recommended infiltration surface elevation(s) 96 .92 _ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material Glacial de 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 [9 S ❑ U ® s F u [Ys ❑ u ® S ❑ U El S ® u ❑ s E7 u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
1 1 0 -14 7.5 r2.5/1 none L 2mabk mfr cs 2m .5 '.6
2 14 -36 10yr3/4 none sil 2mabk mfi cs if .5 '.6
Ground 3 36 -94 10 r4/6 none ms osg ml cs -- .7 , . 8
elev.
100 -62 ft.
Depth to
limiting
factor
9 4 in.
Remarks:
Boring #
1 0 -15 7.5 r2.5 1 none L 2mabk mfr cs 2m
2 2 15-40 10yr3/4 none sil 2mabk Mfi cs if .5 ,.6
3 40-92 10yr4/6 none ms osg Ml cs -- .7 .8
Ground
elev.
10 0--2-2t-
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
'7 y 7 9 01/1
�ROPERTYOWNER Stout 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 -14 7.5 r2.5 1 none L 2mabk mfr Cs 2m .5 .6
2 14 -43 10yr3/4 none sil 2mabk mfi Cs if .5 '.6
around 3 43-91 10yr4/6 none ms osg ml Cs -- .7 .8
aev.
101_._Z2t.
)epth to
smiting
actor
Remarks:
3oring #
1 -12 7.5 r2.5/1 none L 2mabk - mfr Cs 2m .5 '.6
4 2 12-32 10yr3/4 none sil 2mabk Mfi Cs if .5 ;.6
3 2 -91 10yr4/6 none ms osg M1 Cs -- .7 ;.8
around
Aev.
101 .9 �t.
depth to
imiting
actor
9 1_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 14-36 10yr3/4 none sil 2mabk mfi Cs if .5 .6
3 36 -90 10yr4/6 none ms osg ml Cs -- .7 '.8
Ground
elev.
10
Depth to --
limiting
factor
90 in. Remarks:
3oring #
around
lev. --
tt.
Depth to
imiting
factor
in. Remarks:
SBDW -8330 (R. 08/95)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer C c h v 1z p S -- v u 4
Mailing Address 13 S 3 A w C e p 4
Property Address 1 r5_';Z 41.
(Verification required from Planning Department for new construction)
City/State dS 0 h r Parcel Identification Number
LEGAL DESCRIPTION
Property Location sGv %, /� Sec , T N -R 7 W, Town of S
Subdivisio P L 4-�,J3 Pj2c i rZ i t Lot #
Certifed Survey Map # Volume , Page #
Warranty Deed # _ 5' 3 S k y Volume . Page # Yy,;
Spec house 0 yes 0 no Lot lines identifiable 0 ❑. no
SYS'EM IVLAW
r9JNANCE
use andmamunaaoeofyousept .,ystemMIdresattia its
of pmaping out 'ale ta
e nk prcfas�ate to handle wastes. Properm�,aaax
can fists of be; fimexioa of le every throe Y� or sooh if needed by ar Incensed pamper, What you pat into the system
taak-as.a treatment sup in the waste sposalrystem.
The property owner agrees to aatb aif to St, Croix Zoning Dqwtatent a certification form, signed by the owner and by a
is M -mutcr Ph=bc4jO=eYmanPkm]bc4=trictodph=baortfio=scdpumperva&yiagdw(l)&eoa-cif,,6wadcwaterdiqKMISYStCM
FwPer operating condition and/or (x) after mspectioa and pig (f ,), the septic.tanlcis less than 1/3 fu11 of sludge.
Y,,,. he =dcWgned have read the above rogaironents and agree to maintain the private sewage disposal system with the standards
set forth, Vim. - as set by the Department of Commerce cad the Department of Natural Rexomvm. State of Wisconsin.. Cat ificaticn
stars$ drat Your Ye ar rystem has ba expiration date. n maintained mast be
days of the three year Completed and returned to the St. Croix _County Zoning Office within 30
,
SIGNATURE OF APPLICANT DATE
OWNER. CE1t MCATION
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 described above, by virtue of a warranty deed recorded in Register of Deeds Office.
_Rkj M, %Lcr '- y, !'
SIGNATURE OF APPLICANT pA
« « « « «« Any information that is mis-n presented 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 asap if refcrcnce is made in the wattanty deed
STATE BAR OF WISCONSIIS FORM 1 -1982
WARRANTY DEED
DOCUMENT NO. - -'-t --
. . - -- — MISTER3 OFFICE
ST. CR OIX CO., wl
This Deed, made betmun The NQ1 Corporation FWOIWiiNW
a Wisconsin corvoration, organized Aril 1 1996 and ;
fil With a Wi sconaln S etretary of state on D EC 2 0 1996
pr , , Grantor,
an d Richard 0 Stout 3:30 P.M
Hegistet of Dudc.t _ .�
Grantee,
Witne98eth, That the said Gtantor, fix a valuable oxiridrtad�
conveys to Grantee the following described real estate in St Croix ` _ THIS S RE FOR RECORD D ATA
County, State of Wisconsin: NAME AND RETURN ADDRESS
Richard 0. Stout
1351 Awatukee Tr it
$+mss
axta e'r ' -81*6 — Ja mb:: tgr $ tnt�Se any. r?eve- raiovtary rigs , t e3e and i t+arsEaz fa' the
st �+ed::in v li 58g, pa" 222, I3oc.:.Nzs. 35 4521, -And iix Viz -1. 5 , Pa B�`
eY . Sol 3343' 2`.
- ►rescead properey
57. ifs mt)
ifR vti arcl auiar chi h+dicMeats and:appunenartcea thettuntn beiottgiztg,.
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t t d *fe6d else saute,
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dity T*>s�aaaYa :aw . ;g :9b.
Barge
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w to me ktsown to tie tlys Pataou --- who vo omed the forwt*
innfuraent and a led�pe a seine.
7kItim
wm. HHN1::w - ]DRAFTED 9Y
:Y Tncbige Grdnl' 8 loo] stain
Y a "ca%d or 8oth:ate not . Ai
A4uOti l 4- 4110, a�f g tw' and ai ±dtcpttrt y ty�ird j tFtutc+} :ti err it slat
8 aRP Mb?ETitt
;Yi'litlC�i
vot M4 FAA 43
EXHMff A
Legal Description
The NG}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: Beginning at the Northwest corner of said Section 27; thence
along the North line of aid Section 27, South 88 degrees 23 minutes 58 seconds East
160 fist; thence, diagonally, South 29 degrees 07 minutes 38 seconds West 338.27
feet to a point on the West line of said Section 27; thence along said West line, North
0 degrees S4 minutes 02 seconds East 300 feet to the North-west corner of said
flectien
t .
"fit O: dw Of S t. CrOlt County for highway purpow. at estob
iaC1 the Ofte. tle Jq05ter of Deeds ftsr St. 0oft County, W110001b, in
Won 257, PIP 118 and Volume 302, pop 24;
Sawa was d' grant to the Wins in T fir, : in
dw e Of Mitt of Deeds, in Volume 472, pop 15, : down 3010;
10
read along the North lime of the »west Qualfter of the
NG of SWdW 27.
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Liens and Encumbrances
The NGL Corporation to Richard O. Stout
(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.
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