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HomeMy WebLinkAbout032-2046-20-000 / ° 2 � $%k 0 ) M CD ID ` ; 2 i / § � ■ m - z o _� ° e a ° B ° q �@ / [(� /3 2§ k # o K i ; ] $ \ 2 2 ƒ % ¢ \ E E (a 00 / E E _2 2 > i E 2 � * © $ E " i co 3 E 2 � R \ j « _ _ @ E 5 g 0 c T, � 7 f o 0 0 � o § / o § cn (a 7 z k f f k/ j\ ~ Q co ° ƒ \E0 @ ƒ Q 7 a \ 4 / % § ƒ ( g E / �_ 2 CO) � R � § 9 ; ƒ \ - ■ M \ m d » f 3 \ / / o ; z 7 z / 0 CD k /]km \k\ , to = °§e § Eaa\ %7728 EEe \D =E c /o& > #2kz % < ,.o ) � k8tu{m\ E f\(n —o \[ \7 7I(D 0 7 $Etg ` �F ! k /J§[ §�/ da)C) (n ƒ \ \§k_� / §= n - u # \ ° m7- 7 u �0 $ Cb 0 \ $ § -0 § /� \ �\ LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REALESTATE ERSET COMPUTER NUMB 032 - 2046 -30 -000 Parcel Num 13.30.19.663 OWNER NAME: First ast BOARDM PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 13 TOWN 30N RANGE 19W ' /4160 '/440 Line Description Line escription TOTAL ACREAGE 42.492 PLAT LK 01 SEC 13 T30N R19W NW NE 15 NKA NATHAN HILLS 02 ALSO A PARCEL IN THE NE NE 1 03 DESC AS COM NE COR SEC 13; 17 04 TH S 89 DEG W 1323.75'; TH 18 05 S 00 DEG W 737.12' -POB; TH N 19 06 89 DEG E 694.70'; TH S 00 20 07 DEG W 584.95'; TH S 89 DEG W 21 08 694.63'; TH N 00 DEG E 22 09 580.51' TO POB(9.292 AC) 23 10 EXC AS DESC 1224/340 24 11 EXC AS DESC 1224/341 WHICH 25 12 IS THE 584 + -X 694 + - PARCEL 26 13 DESC ABOVE THAT IS QC BACK 27 14 TO BARRY 1346/196 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2046 -20 -000 Parcel Number 13.30.19.662B OWNER NAME: First MATTHEW J & BRENDA L Last BRIGGS PROPERTY A se -- treet Name -- Type S pa 889 160TH AVE SECTION 13 TO 4 '/440 Line Description Line Description TOTAL ACREAGE 3.893 PLAT CSM 12/3295 LOT1 BLK 01 SEC 13 T30N R19W PT NE NE 15 02 BEING LOT 1 CSM 12/3295 16 0 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit • STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /�� ADDRESS C' C,, �,� , U " - ZONifdu UP FiCE SUBDIVISION / SM # 11.A LOT # SECTION / _ N -R /,� W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �I I i� G .Sol INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Ile )c32 1 7a j6 13 OAl Wiscbnsn Department ofCommerce PRIVATE SEWAGE SYSTEM - : Safety and Buildings Division Count y ST . CROIX INSPECTION REPORT s GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryP Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)j. 1802412 1 , Na RRy C�bAa ilty E] Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel ZMY_:2046 -20 -000 TANK INFORMATION ELEVATION DATA A9700310 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. o• vn n ,,"\ Dc>c> a 1 4 g'�'�/ X03 9� 2 2•�y Dosing .� N.,,j fZ,� W\ 1 .2 6b1 100 Aeration `•_ Bldg. ewer g (03 0 I 9 3,x8 92.1) Holding St �t Inlet 9i.c,) TANK SETBACK INFORMATION 0,14t Outlet g.6 °I3 y/ 15� TANK TO P/ L WELL BLDG. Airintake ROAD Dt Inlet Septic o •' ��© wG f 5 r 1 �` NA Dt Bottom Dosing NA Header /Man. 02.71 Aeration NA Dist. Pipe I D .4l q2_ &,2' 0.7� Holding Bot. System � of /. - 7 PUMP / SIPHON INFORMATION Final Grade 1 '?.1y F-q ,Xj' 7 -q1) Manufacturer Demand . �,,,. (Q e.✓ � cif -8S �.q� Model NyCber GPM TDH L Friction System Ft oss Forcemain Ia. H Dist. To Well SOIL ABSORPTION SYSTEM B EPRTRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Li id Depth - D - rMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LE HING facturer: SETBACK C 1 MBER INFORMATION Type O ^ 0 ^ ( �� ? 7 �/ r� • �G• OR U Syste Mo a Nu er. m �h DISTRIBUTION SYSTEM -, Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length �Z Dia. L 4 Length Y—b Dia. 4 +� Spacing ( A 4 -N 272 Q SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over it Depth Over I xx De d / Sodd xx Mulched Bed /Trench Center Bed /Trench E Topsoil ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons pres LOCATIO ; SOMER, T 13.30.19.662B,NE E 893 160TH AVE ISM 112 vJ b�wc� �►�' IBC 1 �U ` a� (� r i ol; b l Inc vv rna. VL UtPLA? 1 0 •,4- dU'/t w# t } f, 9're et w" + �a� ��Z3I�� �tv� n) , Plan revision r quir d? ] Ye k Q E] No Use other side for additional information. (p SBD -6710 (R.3/97) Date Inspector' ignature e .:; ^�•,,; �^ Safety and Buildings Division r .• ■� SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 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. C ' • See reverse side for instructions for completing this application State Sanitary Permit Number a8 y90 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)]. Sa-rvia- State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert wner Name Property Location 1/4 1/4 S I T , N, R E (or) W Propert 0 n s MailingAd re s Lot Number Block Numbe Cit , tate Zip Code Phone Number Subdivision Name or tuber ( ) C _ C . TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity arest Road El Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms EW Town of —� III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo /3 ' 30 &3 o3L — ,7 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. X New 2_ ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System 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 21 ❑ Mound 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. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. inch) Elevation Feet Feet VII TANK Capacit in allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank — ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst lation of the onsite sewage system shown on the attached plans. Plum r' Nam : (PriRt� Plumb s =ro ps) MP /MPRSW No.: Business Phone Number: l ! t ��- Plu dress (Street City,Stat ipCode). IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Sig a No S A roved Surcharge Fee) pp ❑Owner Given Initial /60 Adverse Determination / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 0"4) DISTRIBUTION: Original to county, one copy To: Safety 8 Buildings Divi. ion, Owner, Plumber /UFO ,te a w L� 5*1 Sys 7 � - �'4 d Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of S Labor. nd Human Relations : Division-of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA), ') # dimensioned, north arrow, and location and distance to nearest road.y�— �} APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP EqTY OWNER: PROPERTY LOCATION GOVT. LOT = 1/4 1 /4,ST` N,R ( N� PROFIERTY NER':S MLIN ADDRESS LOT BL C Sy 9D. NAME OR CSM # G a� �, f CV Y, STATE ^ 1 ZIP CODE PHONE NUMBER ❑CITY [:]VILLAGE WN A NEAREST ROA New Construction Use Residential ! Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate � bed, gpd /ft trench, gpd/ft Absorption area required bed, ft .� r^ trench, ft Maximum design loading rate , 5 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / sit considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem El S ❑ U ❑ S ❑ U U S ❑ U ®S El El ®.0 ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Co 9t Color Texture Gr. Sz. Sh. Consistence Boundar Roots Bed Trench 6 t Grounds L C ft. 5'� 4 v — Depth to S limiting factor Remarks: Boring # /V Z SIC .::.; :: .. 3 x' Ground elev. - Depth to limiting A. factor Remarks: CST Name: — Please P ' t Phone: — ST i Address: � 1, ZONI Signature: Date:: I ±� /,� s - T2 t � / sT 7T- Ole A , i VON .R• CEP • T .I F -TED SUP V E Y MA P Located in the Northeast quarter of the Northeast quarter and the Northwest quarter of the Northeast quarter of Section 13, Township 30 North, NE Corner Range 19 West, Town of Somerset, St. Croix Coun ty. Section 13 Barry Boardman 3 869 160th Ave. o New Richmond, Wi. 54017 h e IQ) �0 i UN_ PLATTED _LANDS I S 00'09' iGIN 731.41' I 694.00' I 13741' II ® T 1 � I 1 . 169,561 S.F. (3.893 Ac.) I V IN including right -of -way LO .; I" 160 S.F. (3.689 Ac.) N IN _ excluding right -of -way. N . � I ; r 39.3/' S. 00'09' 19 "W 733.31' I- LL1 i 6 6' :Y 694.00' Q I I m LL ® 7T 2 CD 170,002 S.F. (3.903 Ac.) 3 m? to `` including right -of -way Q I m (n 160,680 S.F. (3.. 689° Ac.) 0) Q� J; `4 1cQ excluding .igh: - vf - way. N 2 1 co Q LO :3 0 J� • /.22' '� S 00'09'19 0 W 735.22' G7 N 694.00' a) 1L ®7T 3 .-� �I to W • WI^ :0 170,443 S.F. (3.913 Ac.) L to including right -of -way LO COI-; a 160,680 S.F. (3 .689 Ac.) ti LO I 0110DI u : ? excluding right - of - way. N M. 61. - .. - 737/2' - • C . 43. /2' 94.00' CO 356 .00'• • N 00 381.12' Z I Bearings referenced to the 0) North line of the Northeast quarter of Section 13, I assumed to be N89 0 35'05 "E o to ' 3 Q � v IM 0 Uj 7T " t!7 L_ LL OT co FILED g JUL 0 7 1997 ► 9LL CQ j *Go,1VMA 561969 �' J C ER T .I F I ED S UR V E Y MA P Located in the Northeast quarter of the Northeast quarter and the Northwest quarter of the Northeast quarter of Section 13, Township 30 North, NE Corner Range 19 West, Town of Somerset, St. Croix Coun ty. Section 13 Barry Boardman (St. Croix 869 160th Ave. County mon- ument.) ° New Richmond, Wi. 54017 to M 0 1 UN_ PLATTED _LANDS S 00 "W 731.41' I tfT 694.00' 1 13741' ILO 7T 1 I. 169 ,561 S.F. (3.893 Ac.) V I„ including right -of -way 1 1�+ 160,680 S.F. (3.689 Ac.) CU IN : excluding right -of -way. N Lid S 00'09' 19 "W 733.31' 6 6 : �c 694.00' QI I m LL ®7T 2 CD to Q): I I� ;W 170,002 S.F. (3.903 Ac.) L I� `� including right -of -way 3 I m I 160,680 S.F. (3 .689 Ac.) m V p� excluding right -of -way. cu . Z 1 to q LO :3 O J, S 00'09' 19 "W 735.22' <.° N 694.00' m LL ®1T 3 ti N WI .0 W v w 170,443 S.F. (3.913 Ac.) io co _ 0 l0 a including right -of -way LO �+I�+ 160,680 S.F. (3.689 Ac.) ' r " �ugC CUMIN ,tom excluding right -of- way. "' c:;iri., un In O C am/ , N corm nittee 0 - - - 737./2' - - - • m ' 43. l2' cat reoarti d 0I I 3/2.88' 94.00' 3uuys of m ...... 356 .00'..... N 00' 09' 19 "E 381 .12' , orova! date Z t °.,. i shall be Holt ull a nd void I a Bearings referenced to the a t I I 0) North line of the Northeast I m quarter of Section 13, M ° 35'05 "E assumed to be N89 Mac- m Iv o p� m m Q ; I I LL ® 7T 4 In �'' 8 T C - 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 in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recprding. -------------- &4 Owner of property a r r X Location of property F 1/ �e1 /4 , Section, Township {' Mailing address Nio iG A Address of site Subdivision name Lot no. J !! Other homes on property? Yes No Previous owner of property 2 Total size of property 1 1 , Total size of parcel 3. Date parcel was created Tie, Are all corners and lot lines identifiable? !es No Is this property being developed for (spec house)? Yes No Volume L and Page Number 2:0 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 AND 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. 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 the County Register of Deeds as Document No. Signature f Applicant Co- Applicant Date of Signature Date of Signature STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ` w OWNER/BUYER 6, %r r L IS u r � M(k MAILING ADDRESS Q — 7 D I �P 1 V �f C �t dWc1l l�fd'� PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. T Q CITY /STATE LJ R L j r 1 0 L �)_ PROPERTY LOCATION 1/4, _ 1/4, Section , T -R l L W , r� TOWN OF S b yrie 'r SE 4 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER ' CERTIFIED SURVEY MAP s / ,9 , VOLUME 12, PAGE Z-2 _S' , 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 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 set 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 County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93