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HomeMy WebLinkAbout040-1160-05-000 ST. CROIX COUNTY ZONING DEPARTMENT //" AS BUILT SANITARY REPORT Owner rt.r. -K �e6rfCr �> Address !d De-li der D. -,j, °Q 8 City /State R: ve• t a //r i s cROlx ZONINGOFFICE , Legal Description: Lot Block Sub4*i4wVCSM # It '/. S E '/, Aid , Sec. 2S T 8 N -R .2O W, Town of trey PIN # 16 ;L 6k -1 - OS -DDDI 5 a,8. (o3 +A SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION Iff Tank manufacturer 6yelfee Caftc ST/f�& ° / ' Setback from: House 411� Well V t. P/L / Pump manufacturer Model -- Alarm location (HOLDING TANKS ONLY) AV1t Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: R e- */ Width Length Number of Trenches Ali Setback from: House t r ? Well vr. P/L & Vent to fresh air intake 9� ELEVATIONS Description of benchmark nd,/ �e �`�� Elevation A - • C7G Description of alternate benchmark ro */' ,o o ••-pe- d 1 wz ddt /a h Elevation /fi Building Sewer 3 -SA I ST1W Inlet 9s'• 91 ST Outlet- �s- 3 ' �' PC Inlet PC Bottom Header/Manifold 93• Top of ST/PC Manhole Cover Distribution Lines( Bottom of System ( coos !op e- 9 X Final Grade 95.73 ( ) ( ) Date of installation /q ,# Permit number State plan number Plumber's signature C- 4��`'_ License number 9-7 Date d Inspector eo 1 er— c'omplctc plot plan K We h.�'yc� i i+r t�Me al! % )\ 0 0 k 1. v , M 0 U CLs) /1 \ C1` i. u 3 ._c z • -., z 3 Q O U J r '\I `0 o 1. r r Al 0 ; 1 b 11....1 0 4, , ..;, ,..1 k f\( i v: o o(q .„.., 4 ,..„ /0: v U c:4: <t• \, b c.i 4 r A ti- .. \ i t c'- . 4=I.. \ v --4 q a IC Z // �\ u ra � .1.\_._ v .;,... LLj 4-1 t Y w t a pl K y u ti I . ` 'Wiscorif}sIn Department of Commerce PRIVATE SEWAGE SYSTEM County: *Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: WEBSTER, MARK TROY CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel T� x ko_ -05 -000 ' It c) I 0o S e i+1-{,, TANK INFORMATION ELEVATION DATA A9800389 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi i e Z� Benc �O� LY�•<i rOL7 Dosing r'�. g W1 1-G5 /� L� Aeration Bldg. Sewer 2 q0 Holding St /Hf Inlet • 72 • , TANK SETBACK INFORMATION St /itt Outlet S 2 ,5 - TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet --"— Septic I Z til A- NA Dt Bottom Dosing NA Header / Man. 6 •� .�� Aeration NA Dist. Pipe 7• C� 3, (P 3 Holding Bot. System Lj,;!• - 7 1 PUMP/ SIPHON INFORMATION Final Grade�. o 3 ��•"� Manufacturer Demand 5�. �►a�hale 2. 3� ���3 Model Number /GPM TDH L oss e Ft Forcemain Len th Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width f Lengt / No. Of Trenches PIT No. Of Pits h 'DT II�EN I N I Z I DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O f Model Number: 6 System u , 5 p / ))- OR UNIT DISTRIBUTION SYSTEM Header/Manifold � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length "� Dia. Length Dia- � Spacing AC7 Tl✓[ Z 21 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded TXE] x Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes E] No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 25.28.20,SE,NE 164 DELANDER DRIVE — LOT 2 C r, A - 1 4 -. 6 -An - -Tv P aZ � �v re� OW Ct b Id,� S ewe b w we0 e "P^ 41Au �ivkes 3.r G I I a of ri I '4 C,4 '- s('e tt Plan revision require? Q]es ` No Use other side for additional information. �L Lti ° tj SBD -6710 (R.3/97) Date Inspector's Signature Ce SANITARY PERMIT APPLICATION Saf E Washington Ave. ivision A sil&onsin 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 1/2 x 11 inches in size. J� C`d i • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N --�� Property Owner Name Property Location a.-,K ule i rtes- ;-`- 1 /4wz 1/4, S 2 j' T fj , N, RHO *J r) W Property Owner's Mailin g Address Lot Number Block Number /ep/ -E A Y> as Jr. City, State Zip Code Phone Number Subdivision Name Number 1f, v Gr �� �!�' �.'. S 6 1 (7 /,S`) 4,?,S.,f c r� a II. T E F B ILDIN : (check one) ❑ State Owned o it Nearest Road g jo age Public 1 or 2 Family Dwelling - No. of bedrooms Town of T III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) /!/7� D �fD - lll� —D 1 ❑ Apartment/ Condo 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 fine A. Check box on line B, if applicable) A) 1. g 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 J! Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [ Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 [] Pit Privy 13 E] Seepage Pit 12 r ? Z , 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s ft.) (Min. /inch) Elevation �0 1 I R -ra d. 6 /y,# 7 Feet 77. O Feet VII. TANK in Capacit Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name Concrete con steel glass Plastic App New Existing structed Tanks Tanks ecTank „2,S'O /�,S - O L ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 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 Si ture: No Stam s) ri P /MPRSVVido.: Business Phone Number: c�Gi� -lcr 66- 71d _.2_73- 3430 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (in cludesGroundwater ate ssue Issm gent Signature (No Stamps) KApproved [I Owner Given Initial Surcharge Fee) w12, c/D at> / Adverse Determination D � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SB116M (R t tom) - DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Pkmk r �. Pp t�'on �ar alt /' /dti N T s, a y To - I c , D D` r ...app• -max /�.h a L•Ye �lDl.�n� :^� _ ti �/= toa -opt Wiscdnsin Department of Industry, . (� Labor 2nd Human Relations SOIL AND SITE E Ati A R T Page l of Division of Safety &Buildings in accord with I FirM.05, Wis.1fm. ' ti y 4 'J COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inc , • size. PlaKm St .I Je, not limited to vertical and horizontal reference point (BM), dir °/ slo � (e = PARCEL I.D. # dimensioned, north arrow, and location and distance to neare r'y'a Y t'' '} -' APPLICANT INFORMATION- PLEASE PRINT ALL INF I� , �5' �� REVIEWED BY DATE PROPERTY OWNER: y OPER I 21Frt j G6t_L,�ZjGE 1/4 NF 1 /4,SZST 28 NR ZO E(� PROPERTY OWNER':S MAILING ADDRESS L LOCK # SUBD. NAME OR GSM # '� 16$ b�t_AwD UZIUE Z — C�2s��os� cSwt CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD 1Z. WeZ ? -� wl StI117- z.( -1 15) k1ZS -ozZ7 I `r ELhMttM btz. New Construction Use [,((J Residential / Number of bedrooms [) Addition_ to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 6 00 gpd Recommended design loading rate o • -) bed, gp&ft 0.8 trench, gpd/ft Absorption area required S SS bed, ft - 1 S 0 trench, ft2 , Maximum design loading rate 1 r)- - 1 bed, gpdf2 0 - 8 trench, gpd /ft2 Recommended infiltration surface elevation(s) Z - - 7 ft (as referred to site plan benchmark) Additional design / site considerations \Z' Y- 7 2 " Q et Parent material Stt Smi" %5jT ouOx Slo-ii> 14 Gmfru ex- Flood plain elevation, if applicable !y . Pt . ft S = Suitable for system CONVENTIONAL I MOUND I IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable fors stem W S ❑ U ®S ❑ U ® S [I U ® E ❑ U ®S ❑ U ❑ S R1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 0 -t0 11� y. %Z z L2 - Sit Z w, sbk , +,f{� cS zu o.S 0, 1. z )b-'ZS l0` 31ra - S1 )I Z �- sbh YA i�, CS 1\ (5-S o. Ground 3 25-3s - ).S'd1L Sly lS O Sg tNt cg o•'t o.$ elev. `'1 ft. y 3 5 -93 )O`diL y S Depth to limiting factor > R3 Remarks: Boring# j 0 -9 Z zu o-S 0, Z l 3 _ Cl -S - 7 �itZ 31y � O S w1` cS 0.7`0. 3 33 C tZ, `1Q VA - S p s9 vvn 1 - 0- 0 a Ground elev. 9 0 ft. Depth to limiting facto Remarks: CST Name: - Please Print Arthur L. We erer Phone: 715- 425 -0165 e Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: l $ 31 S Date: CST Number: �Z - I - M00576 •- PROPERTY OWNER 0 LA.. SOIL DESCRIPTION REPORT Page 2 of 3* PARCEL I.D.# Depth Dominant Color Mottles - Structure G P Dift2 Boring# Horizon TextureConsistence Bcurriary Roots in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench g4I 0.—ci \o-m_ si I N,sbt-t C. 2u4 o. s 6. ci-3 1.s Lica Ground 3 6:1b 10`1R. Lift4 S rv) elev. Z.•-1 ft. Depth to limiting factor -)E3" Remarks: Boring # • IbLixt Pm:Ma% Zwts\* lvIcV cs 21,%c L .10. -3Z —1. Vz-- 3iy 1 s csg I e..s - -3 3z_ios:si.. vf( 2 s% \set 1 - O.7, Ground elev. on•Z ft. Depth to limiting factor -7 Me: Remarks: Boring # \ 0-9 \W-i2 7- / S wt `iv‘i-1- LSzc I • a 9-1.0 Rs MR 3 7.+ S‘41 Mih CS ci-S 0-10 EMI 3 "?..Ci S 3 y s 3 — • 0• B. aS Ground ft viz. ill — o. 41B•0 . — Depth to limiting factor I t.2.4 Remarks: Boring # gima: Ground — elev. ft. Depth to • limiting factor Remarks:_ _ ncicr:n . y. PL AN PLC",L PLA Page 3 of 3 SCALE 1 "= ' 1 `Rut" Sz ll ' o� I aa� i CEL. °l Z. ? I � evo ? P e -y "V 1 {ta 6 1 N l� Rl, t3 � -j-- -� , 't' 1 ►3.2 fit. g 4 °- 1 %K1 - L . loo.o o�► SPtkE �Z.`� RHO V� GRUU►�U 1N ^� � J rj silo Ln jty t wLI;'Lc 4 - - - -- ( I .J rf 1 9S —311 �l 1Z -1 -q s ( 715 ) 425 -0165 M 00576 CST Signature Date Signed Telephone No. CST # P L OT P LAN Page 3 of 3 SCALE 1"= Lj Q ' 1 �� �R.v►v S�tPE h 1 11 IUI o� vV o o 1 I {p 6 p, -L et. 9.x•1 °- I M. 100.0 OlU Spike I R80 Vt G%QvNb IN ttgg °- � s% a� . 1 Qom{ 1 4i.gS s O :21 C vjT iv-*Z ri t: ks� ' £�?6tt._B 13 ' tm 9 .o' to At �1 ( 1 A J l ^^� ll qS -311 ( 715 ) 425-0169 M 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owncr 5 dvK ".,e k_ *,_ Mailing Address _ /0/ d St ��'Vi 1'i ok A� /iii 1/ r ,mod llr, �.' s` 4 o a .� Pro Address �P PAY � b. IQlC�1n�P (Wrific rcquimd from P[aming Department for new construction) citylstate Lie Parccl Identification Number .z A( 0 14 - e 700 LEGAL DESCtIPITON Property Location t.a' %, NE y<, Sec. .2,3� , T !44 -R .)- 0 W. Town of Subdivision Alp? Lot # - -- •tified Satvep Map # Ss3 �{ l Volume !l _. . page 9 2/ z _r A d >. o 1 o- kcd os Aw z q 7R Warmty Deed # ovc. H o. j 7.i' 6• Volume 1 q 7 Page # / 74 Speq.boase 13 yes)lrno Lot lines identifiable, Pt ❑. no S YS T f� R�! L A R 1 NAB IC` E �' OP���ofy�rKPtlesy�Cmooalda�ftmi�Es .. � • • • • �•• tohandiewastc s.Proi�ere consists of pampiag out the septi�ataaic evMy three y � art==; if aeodc.d by at liecasedpampm - ww you put ido Se system cad sti oct$rc $radian of the septic tML -= -a ti & tacce is 60 waste disp 0 1 1 4cystcm. PAY ooera;r agroes to sabmrt to St: C rok Zoning Department x =ffimfim form. sigaod by &c ow= dad by a P 7 y�aP plambcrorariocasodO- L-L— Ve fYing61, ( i) theoaaiteiaastearaLcrdssposalsys is in pc+opcx opctatiag eoadilm andlor(2) after=pcctiaa and p=Wg (rf Y). the scpti,atank is ins $rar< W •tall of shrd,�c. . hahe t+cad the sbov�c togair sad agree ry maiatzna the pz<vatc sewage d;sl osai system vi & She standards Get foctti, bemin.1ts sd by ifs cf C =m xec sari Me Dcpuftmcd of IZatmcd Rcsoa ccs; State of Wisoonsin.. C aOcahau stLtiDS that Y= uPtic has been maiataimd neat be completed and mwmcd to the St: e ix.Couaty Zoning Office within 30 days- of tha 9= year expintioa date, =NATURE OF APPLICANT DATE OWNER CE�T�CATXON 1(we) oetirfy that all stag on thrs fomr are tine to the bat of my (oar)1�aowledge. I (we) am (am) the own « (s) of the FWcrty described above. by victac of a wuranty flood wcotdod in Register of Deeds Office. =NATURE OF APPLICANT DATE too*.** Any information that is mis ma � y tacit in the sanitary pumit being revoked by the Zoning Department. 4040•0 04 Iadade With IhLs appticattoa: a cumpod warranty dood fxom the Register of Deeds otlicc a copy of the c«ti ied c=cy map if mibmaee is made in the wamaty dcod _/ y 4/ ol VOL 1147P`0174 L,� 'j ( 1/0-7141f w 584736 STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED _T� DOCUMENT NO. ---------- . ........ = .. .... . ... . . *_- REG STE OFFICE Adrian D. Golledge and Elizabeth B. Golledge, ST. CROIX CO,, W1 it husband and wife Rivc'd for irt AUG 10 1998 jj M conveys and warrants to Mark n Weh.-,ter and Debra J Webcd-tzr, 9:45 A husband and wife, Register of Dood• THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, WESTCONSIN CREDIT UNION State of Wisconsin: PO BOX 308 RIVER FALLS WI 54022 ...... . .... ....... ...... -276 tt94-T17M PARCEL IDENTIFICATION NUMBER Lot Two (2) of Certified Survey Map in Volume Eleven (11) of Certified Survey Maps, Page 3212, as Document Number 555419, filed in St. Croix County Register of Deeds Office on February 7, 1997, Being located in the Southeast Quarter of the Northeast Quarter (SE of NE of Section Twenty-five (W, Township Twenty Eight (28) North, Range Twenty (20) ii West, Town of Troy, being Lot 1' of Certified Survey Map recorded in Volume 7, page 1992, St. Croix County, Wisconsin. TRANSFER $ /0 y FEff� This is not homestead property. dxb( (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of August A.D., 19 98 (SEAL) (SEAL) Adrian D, Goi led ge (SEAL) (SEAL) ii Golledge 4 1 B. Go AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) Atirian n rZnlledcje and ss. ji Elizabeth B. Golledcre. husband and wife County authenticated this ay of - AUCIUSt ­ 19 98 Personally came before me this day of 19-, the above named 2 FEB 0 7 1997 Pr 3 37 iv I' 6 �(pTHiEEN H.WALSH 555419 Regrsler of Dew � � sl. CrolxCo , IV s CEP T .I F ED SUP VE Y MA P Located in the SE 1 /4 of the NE 1 /4 of Section 25, T28N, R20W , Town of Troy, being Lot 1 of t1kat Certified Survey Map recorded in Vol. 7, pg 1992, St. Croix County, Wisconsin. El/4 Cor. . Section 25 LEGEND I s I s' Berntsen j� N Section corner monument. I I C? cap. N 1 "X24" Iron pipe weighing 1.68 lbs per lin. foot set. I j 1" Iron pipe foundl - I N CERTIFIED SURVEY o O 2" Iron pipe found. - - - - - -- - MAP I ~ Vol. N 9, page 2404 ° ............•••• Building srtba�c 4ines -, DE l ` S 0 1'42'21 "W 662.96' -1 217.71 DRIVEWAY 4 25 zoo - Lot 5 ACCESS • 92013 Sq. Ft. 100�'b •lciin 2.11 acres). g setback • •� " " "" ti �' line v PLAINVIEW :r 9 p � /L® ]j' 2 ` yO �O N � • O, ACRES drive l�y CID , W N 23 ° A � '36 ; 0 UNPLATTED 1 3 N O O �D ' - LANDS house co N co I � � n Ul$PLATTEI — - - - -- iL.® 7T (DZ o LANDS , Ss C! -51X : Square feet ; o M - - - - — G.;:':: • •. >�,es Plaruiirr (11:6 ? acres) ' 10' Utility easement a twterded Vol. 718, pg 10 --�-3� w W `W days of ' 2'0 iLe ;el d 43t9 > O Description. A parcel of land located in the Southeast quarter of the Northeast quarter of Section 25, Township 28 North, Range 20 West, Town of Troy, being lot 1 of that Certified Survey Map recorded in Volume 7, page 1992, St.Croix County, Wisconsin, described as follows: Commencing at the East quarter corner of Section 25; thence North 87 degrees 27 rAinutes 02 seconds West 421.92 feet along the East -West quarter section line to the Point of Beginning; thence continuing North 87 degrees 27 minutes 02 seconds West 902.41 feet along said East -West quarter section line; thence North 01 degree 37 minutes 11 seconds East 667.47 feet; thence -South 87 degrees 09 minutes 57 seconds East 903.48 feet; thence South 01 degree 42 minutes 21 seconds West 662.96 feet to the Point of Beginning, containing 600,556 square feet (13.787 acres) more or.less, and being subject to all easements, restrictions and covenants of record. I,. Harvey G. Johnson, registered Wisconsin Laud Surveyor, hereby certify that under direction of Adrian Golledge, owner, I have surveyed and mapped the above desci -.bed property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Troy Subdivision Ordinance to the best of my professional knowledge understanding and belief. `, <tt������n� Harvey ohnson S -1899 * (NA V Johnson Surveying, Inc. 216 Meadow Drive North L 899N Hudson, Wisconsin 54016 Z ` S r r A. Revised October 5, 1995. �o y.......••'' O� This map is hereby approved by the Town Board of the Town of Troy. h d'L,� ley z r - G y - y- Margaret Ann DesLaUriers, Clerk Date General Notice Statement: The parcel shown on this map is subject to state, county and township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate town board for advice.