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HomeMy WebLinkAbout020-1335-20-000 ST. CROIX COUNTY ZONING DEPARTMENT/ ,� AS BUILT SANITARY REPORT RCr VE� = s Owner SM FYI Address 5' W R6 rf- A) ST CRUX COUNTY'. City /State 14 y D .50 N t.✓ I :5 -t-/0 � ZONINGOFFICE Legal Description: Lot -3 Z,. Block "' Subdivision/CSM # RA ( )LA N D S '' /.$ '/< / tom, Sec. 1�2_, T Z9 N -R *' W, Town of H %J Ib SO R PIN # O ZO " 1131'- Z o SEPTIC TANI DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / °O Setback from: House Z Well PAL 4 9 7 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: ' R E N G 1 Width S Length 7�� Number of Trenches �— Setback from: House D Z' Well 16 o' PAL, ]S , Vent to fresh air intake 1 19 ELEVATIONS Description of benchmark - rof a F Ftr N e j E Fo 37 c[V YO/Z719 GoT Z/ N.F Elevation G Description of alternate benchmark S 1 LL o d VAI k -O r!T L jfZ. F (; 2.9 Z Elevation IC-6 A Building Sewer y ,5 Z ST/HT Inlet •�� • it �� ST Outlet. � g"s K, PC Inlet z PC Bottom Header/Manifold 7 '� S Top of ST/PC Manhole Cover J .OZ = /o� ?S Distribution Lines( $ • 3 =Oj 5 (t) 8 . z y = �,:; , ( ) Bottom of System q. 3 -2 : 14, 9, Z �� % q, Final Grade (r) L ,2�/ =' ?,► (.�) a ( ) Date of installation 3 1 1 Z 116 Permit number ? (t> 3 State plan number Plumber's signature / '' -� License number t' Pl S - c: St Date 3 //2/78 Inspector Complete plot plan I t� I 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 o2 - ru "T £- g, F � 5CA 1 - / /0 ,po i R r ✓� 5 y 5 7' e M l : ��f , I J t Hoo E X117 4A a 1,J ' INDICATE NORTH ARROW `r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety.and Buildings Division INSPECTION REPORT ,Sf •C>rb l 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)]. D 7 Permit Holder's Name: ❑ City ❑ Village 0 Town of: State Plan ID No.: KII -eY' I Nerds o CST BM Elev.: ' Insp. BM Elev.: _ .BM Description: Parcel Tax No.: 90•321 3 kit Z Su o 6 6 r 020 - 5 -20 --dock TANK INFORMATION ELEVATION DATA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic I �,�' �� Benchmark 75$ �03.9p 9'o• 3Z_ Dosing Ali, aM + 100•9S Aeration Bldg. Sewer fl, 6� 99; Z Holding St /Ht Inlet 1 ?1 9 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet eptic Z ' t&o 28` ? NA Dt Bottom wf, Dosing NA Header/ Man. 79' W 9 Aeration NA Dist. Pipe – 6� Holding Bot. System g.3v' q , a we PUMP / SIPHON INFORMATION Final Grade q7- e13 Manufacturer emand �', W"Welcoveve ( -(oZ- !OZ•Z�j Model NuPrCer GPM TDH L ft Friction stem TD Ft Forcemain Did. Dist. To Well SOIL ABSORPTION SYSTEM BED Width Length i No. Of Trenches PIT No. is Inside Dia. quid Depth DIMENSIONS �s DIMENSIONS Manufadu r: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM CHING INFORMATION Typeo CHA Model Number: System (OZ - f - /3Q OR UNIT DISTRIBUTION SYSTEM Header/Manifold _ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length /5 Dia. Length 7s Dia. Spacing! fa 7457 - .-K 6,* wv (z ` SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over De f � xx Mulched Bed / Trench Center Bed / Trenc ❑Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) 1;57 Wjj l �i�• t {. M - 'To Plan revision required? ❑ Yes a No Use other side for additional information. 7 SBD - 6710 (R.3/97) Date Inspector's Si nature inLIA Safety and Buildings Division Wi sconsin SANITARY PERMIT APPLICATION 201 E. x7969 gtoAve. 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 8 1/2 x 11 inches in size. • tom o • See reverse side for instructions for completing this application State Sa Permit Number The information you provide may be used by other government ag ncy program E] Check if revision i� n to pivious application [Privacy Law, s. 15.04 (1) (m)]. - 7,1 6 Vr Rd r w�, /A419 State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION �" r Property Owner Name Property Loc tion I C L I�L.d, t /a /4, S Z T 7.f , N, R/ E( W Property O ner's Mailing Address Lot Number Block Number Q ) 3 2- City, State Zip Code Phone Number Subdivision Name or CSM Number o llrw v7 toi BAbL /' A2 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms : ° own of b II L ICQ 5. III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) /� �� 9. / /77 !� 1 ❑ Apartment /Condo © ZC7 GC - 'X- Ot\ 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, agNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System __ _ __________Tank Only______________ Existing System _________Existtn - S -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 Seepage Trench 22 In- Ground Pressure 42 Pit Privy 13'] [] E] Seepage Pit 43 ❑ Vault Privy 14 ❑ System -ln -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation S o 1 7ke Q g Feet 9 Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks e ti mg ank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ j ❑ I ❑ ❑ 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) Plum is Signature: (No St s) MP /MPRSW No.: Business Phone Number: AW DeQ r LL- _114011? P lumber's Address (Street, City, State, Zip Code): H0 V4-4e AE" W. COUN / DEPARTMENT USE ON LY ❑ Disapproved Sanitary Permit F (Includes Groundwater ate I ssued ISSUIn en Signature (No Stamps) Jff pp []Owner Given Initial A roved ,- a Surcharge Fee) Qj� M ..� Adverse Determination ((JJ( io X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to county, One copy To: Safety 8 Buildings Division, Owner, plumber SAM MILLEt 8Abl -ANDS 4AIP-IF- DoT 73 1LLF2Fp �D TAX VIA r21 e n "r t iN _... PA .� ° `�aYy �gc7rllalAtE c, I VA o i 1 � 70 tD10" b w 4' O X a Lai .00 ssa wEtL c qy �J I � p 4 '\ E id IL f�Sb � fix v �a7VIw ( _ 9 o 1 1 O tt tl- o o i Oy o } o {� o f- I I � I Co I I = I W M I i I LL li n IL L I I �P I .li I C9 I V) IIJ m kit 4 ( I iC 1n V1 k Kt � � t Wisconsin Department of Industry SOIL AND SITE EVALUATION l aborand Human Relations Page _4- of 'I 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. # o 0 -16� 5 -oo APPLICANT INFORMATION - Please print all " Batton. Revie d b . Date Personal information you provide may be used for secondary � (,rivacy Law, s. , 04 (1) (m)). Property Owner` perty Location Richard Stout - „t> Lot SE 1/4 NW 1/4,S 27 T 29 ,N ,R 19 fr�(or)W Property Owner's Mailing Address NOT #1 Block# Subd. Name or CSM# n y- 1353 Awatykee Trail Badlands Prairie City State Zip Code y ... horAM, m C ? .C, Nearest Road (r ity ❑ Village ( Town Hudson WI 5401 6 � ,071 5 )5 ''.��F :.41 dso I Badlands ® New Construction Use: ( Residential / rukmei of pedrmom' 3 _ 4 Addition to existing building ❑ Replacement ❑ Public or commercial - DesarF6 Code derived daily flow 600 gpd Recommended design loading rate 9 !S bed, gpd1ft 4 t:� trench, gpd /ft Absorption area required 8 5 8 bed, ft 7 trench, ft 2 Maximum design loading rate 401 • S led, gpd/fF t 4 trench, gpd/11 Recommended infiltration surface elevation(s) 8 ft (as referred to site plan benchmark) Additional design /site considerations .Z /l Parent material -lam a l d e jails i tr. _ Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ER S❑ U [ S❑ U S❑ U S❑ U ❑ S (� U ❑ S L2U 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 0 -1 7.5y r2.5 1 none L 2mabk mfr cs 2f .5 1 - 2 12 -36 7.5yr4/4 none fs ogr ml cg if .5 ;.6 Ground 3 36-92 10yr4/6 none ITIS osg ml cg -- .7 .8 elev. 9 6 -9-- ft- Depth to limiting factor 9 2 in. Remarks: Boring # 1 0 -13 7.5 r2. L none L :2mabk mfr rR 2 f 5 _ 2 2 13 -34 7.5yr4/ _ _ none _ s ogr Ml cg if .5 .6 3 34-90 10yr4/6 none Ms osg 1 c - .7 Ground elev. 99.3 ft. Depth to —� — -- — — -- -- limiting factor 9 0 __in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Id � >�s' � g7 97 79fa . Richard Stout R9WERT�! OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 -12 7.5 r2.5/ none L mabk fr s f .5 .6 2 12 -96 7.5yr4/4 none fs o M1 cg if 15' .6, around flev. )epth to imiting ; actor _ Remarks: 3oring # 1 -14 7.5 r2.5 none L 4 2 14-915 7.5 r4/ none fs r ml cg 1f .5 .around alev. 97 ft. )epth to imiting actor 9-6— 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 -6 7.5yr2.5/1 no L 2mabk fr s 2f .5 .6 2 -96 7.5yr4/4 none fs ogr U1 g if .5 .6 5 Ground elev. 96 ft. Depth to limiting factor 96 in. Remarks: 3oring # vround Dlev. tt. ' Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) JCJ C3 lL ha//� %f✓J� L1t.�Vr Z 7 L2 . l v I 1 1 Qht.Q rd�/ FF�.✓� B�Yl6$7" 7�0 t 307 {� s� 1 C 3 0 1 a e 0 g Ot po `h oT3 �- rt 3 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer m M 1 L L E ►`? Mailing Address -�oX /S Property Address '� - UJ I LL - &F Q (Verification required from Planning Department for new construction) City /State _H y4j�o U N L j( Parcel Identification Number 0 116 3 4= - Z-G 7 LEGAL DESCRIPTION Property Location S F 1 /4, N w 1 /4, Sec. Z 7 , T Z 7 N- R2,' dZ)Town of HL-06 .Subdivision 2A D L AAA D 'S 1 9 LF , Lot # � CertiFed Survey Map # Z'40 �'� � ' , Volume , Page # Warranty Deed # C 7 Z. 7 , Volume Page # 4 Spec house 1, yes ❑ no Lot lines identifiable X yes ❑ no SYSTEM MAINTENANCE Impi+aper 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 wastewaterdisposal 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 undersigned 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 St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNA OF XPPLIC.,kNT DATE W NER CERTIFICATION certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of .rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE & ) "ICANT DATE * * * * ** 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 �i • 51"1TE 01 WISCONSIN CJl — 1982 J 1�i61� VVARIIANTY DEED DOCUMENT NO. ! Richard O. Stout T� I 0Q 1 W 4101 Mr Arlen conveys and warrants to Sam E. Miller _ FEB 0 8 1998 8:00 A M R .ti r,�� THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in S t . C r i x County, Sam E. Miller State of Wisconsin: P.O. Box 283 Hudson, Wi 54016 Lot #32 Plat of Badlands Prairie in the Town of Hudsonand Part of Lot 33 of Badlands Prairie in the Town of Hudson described as Parcel D on Exhibit "A" EXCEPT Parcels E and 5 as described nn EXHIBIT "B ". PARCEL IDENTIFICATION NUMBER TRA FER 41VZ E This _ homestead property. (is) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 20th day of January A.D., 19 98 - (SEAL) (SEAL) (SEAL) (SEAL) 4 AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, t ss. County. _ authenticated this day of 19 P rs nally came before me this day of 1 , the above named 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 ROM I n. UC'ir " i and45kxpwledge the same. THIS INSTRUMENT WAS DRAFTED BY NO(ARY PUBLIC Richard O. Stout w w Q► Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both are not My c mmission is rntanent. (If not, state expiration date: necessary) • Names of persons signing in any capacity should by typed or printed below their signatures. RRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co..Inc. Form No. 2 - 1982 Mil —i kee. Wis F� VOL 129 cE`� � EXHIBIT "A" PARCEL D FROM LOT 33 TO LOT 32 OF THE PLAT OF BADLANDS PRAIRIE SAM MILLER TO RICHARD STOUT A parcel of land located in part of SE1 /4 of the NW1 /4 of Section 27, T29N., R19W, Town of Hudson, St. Croix County, Wisconsin; being part of Lot 33 of the Plat of Badlands Prairie recorded at the St. Croix County Register of Deeds Office; further described as follows: Commencing at the NW corner of Section 27; thence S89 11 E, along the north line of the NW1 /4, 1298.49 feet to the east line of the Plat of Badlands Prairie; thence S00 11 W, along said east line, 1311.61 feet; thence S89 11 E, along the north line of said plat, 713.90 feet to the northeast corner of said Lot 33; thence S22 11 E, along the east line of said Lot 33, 29.49 feet to the point of beginning; thence continuing S22 along said east line of lot 33, 165.18 feet; thence S89 11 W, 105.68 feet; thence N30o17'll "W, 176.86 feet; thence N89 11 E, 131.94 feet to the point of beginning. I Above described parcel contains 18,144 sq. ft. (0.416 acres) and is to be deeded to an adjoining landowner. t 3 86 PARCEL B EXHIBIT "B" A parcel -of land located in part of the SWl /4 of the NW1 /4, and in part of the S81 /4 of the NW1 /4 all in Section 27, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being part of lots 39, 35, 34, 33, 32, 31, and 30 of the Plat of Badlands Prairie recorded at the St. Croix County Register of Deeds Office; further described as follows: Commencing at the NW corner of Section 27;, thence 589 11 E, along the north line of the NW1 /4; 1298.49 feet to the east line of the Plat of Badlands Prairie; thence S00 "W, along said east line, 1311.61 feet to the south line of lot 40 of said plat, also being the point of beginning; thence N89 0 59 1 06 "W, along said south line, 4.35 feet; thence S00 "E, 27.50 feet; thence N89 "E, 1224.89 feet; thence N78 "E, 72.99 feet; thence N89 11 E, 10.98-feet to the west line of the SW1 /4 of the NE1 /4 of said section; thence N00 "E, along said west line,13.01 feet to the north line of said plat; thence N89 0 59 1 06 "W, along said north line, 1303.28 feet to the ! point of beginning. Above described parcel contains 35,016 sq. ft. (0.804 acres) and is to i be deeded to an adjoining landowner. PARCEL E FROM LOT 32 TO LOT 31 OF THE,PLAT OF BADLANDS PRAIRIE A parcel of land located in part of SE1 /4 of the NW1 /4 of Section 27, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; being part of Lot 32 of the Plat of Badlands Prairie recorded at the St. Croix County Register of Deeds Office; further described as follows: Commencing at the NW corner of Section 27; thence S89 11 E, along the north line of the NW1 /4; 1298.49 feet to the east line of the Plat of Badlands Prairie; thence S00 11 W, along said east line, 1311.61 feet; thence 989 "E, along the north line of said plat, 1032.90 feet to the northeast corner of said Lot 32; thence S00 "W, along the east line of said Lot 32, 27.16 feet to the point of beginning; thence continuing S00 11 W, along said east line of lot 32, 331.82 feet to the northerly right -of -way of Oakley Road; thence N90 11 W, 35.60 feet; thence N00 "E., 331.83 feet; thence N89 11 E, 33.08 feet to the point of beginning. Above described parcel contains 11,395 sq. ft. (0.262 acres) and is to be deeded to an adjoining landowner. ti .. Q� Z O p 00 00 ° 0 N 16.39' �^ PARC EL "F" N00'06'24 "E 339.80' N W • w w � Q1 eM-- CT1 C4 O to r O 0 W (A O °0 r'7 o d o N � rK Q D 27.16' z PARCEL "E" j 337 83 O R w N z w w N tp w w • tt � �, G.2 F : S2 o) LO 2 a- X 00 0 G7 Z ✓' ° z Q 4 �V 0) o �c Q Q 4� h� p o, • � o W z ' C co 0 N W I— Q CD CL V) ��-�� 805 9 > c - ' ��6 `1 w rt tY `� ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r NOR - -- i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Y Hudson, WI 54016 -7710 n == r (715) 386 -4680 April 7, 1998 RE: Septic Inspection for Sam Miller located at 735 Wilfred Road, Lot 32 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin To Whom It May Concern: A septic inspection of the above referenced property was conducted on March 12, 1998. This property is located in the SE% of the NWY4 of Section 27, T29N -R19W, Lot 32 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (71 S) 386 -4680. Sincerely, Rodney Eslinger Assistant Zoning Administrator /sm