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HomeMy WebLinkAbout182-1025-95-050 0 ���� J Lo� U) ■ � � U z ° § E § $ ° E E 2° w E e . m e A( 2 R §} g• o k ; % $ o k� \k \ / 0 m \ i CD 00 a 0) k CD ' m @ c , ■ ®( f / ��� E 3 m ] 3 E S t § m § §$C /) / (D § / § E 00 Oo ■ ; M M 'o k �. o o o 2 j j j £ z art cn o v \ ; 0 0) J �§ 2[7 z =z Q 2 5 § g E § § % \ E ƒ "M• ) g m k aft � } — � C / z 0 � 2 ¥ w CD ( } 0 z \ k k > C, k § % \ n 7 z ( ® E � £ ■ � 0 � q t / ; m ) I � : 14 � 2 § ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT l EL b` Owner (.✓GZ. -� O l �s a `fir RUIN IN � w 1909 Address ,1T cHo�x, City /State Ol 7 `,. >, ; N IN G F r Legal Description: Lot Block Subdivision/CSM # %,S '/, OcJ Sec. Z, T 1 N -R_L2W, +an of _ PIN # V8 ll�-g c.. SEPTIC TANK -- DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/ Setback from: House c2l Well Pump manufacturer -- Model Alarm location T (HOLDING TANKS ONLY) Setbacks: Service ro Vet esh ater Line Meter location Alarm 1 SOIL ABSORPTION SYSTEM: Type of system: j Li Width Lepgth Number of Trenches Setback from: House �O Well �0 /L Vent to fresh air intake ma ELEVATIONS Description of benchmark R.. ° _c �y- cve.,J Q�l� J Elevation J � Description of alternate benchmark T /ter Elevation / Building Sewer ST/HT Inlet Jr ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () 24, () ( ) Bottom of System () t. , J () ( ) Final Grade Date of installation Aperptitnumber State plan number Plumber's signature License number 53 Date 0- Inspector /2v Complete plot plan + 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 ,V{�I l� 411 3 bra tt QCI til 7� 0 rj� 1 Z *16. s� 90 R� INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y Safety and Buildings Division C ounty- . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaruP .tA.: Personal information you provice maybe used for secondary purposes [Privacy La s.15.04 (1)(m)). WAYNE ft Qjjj1& n of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: \ BM Description: Parcel Tax No.: jr a� TANK INFORMATION EL VATION DATA A9800067 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e „e � j6Up Benchm '? . �OZ> 3 /o o ^ Dosing , Art,-t 6 s 47- Aeration Bldg. Sewer 7.1 14 . / 9' Holding St/ Ht Inlet 7 78 5 TANK SETBACK INFORMATION St/ Ht Outlet 03 25 a TANKTO P/L WELL BLDG. Akto ROAD Dt Inlet A NA Dt Bottom Dosing NA Header /Man. Aeratio NA Dist. Pipe �,�•? Holding Bot. S PUMP/ SIPHON INFORMATION _ Final Grade 511 `17 Manufacturer De and �. qo.. ar.. Model N er GPM TDH ft Friction S s TDH Ft orle. ad Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BE RENCH Width ( Length ( No. Of Trenches PIT No. Of P n ia. Liquid pth - D IMENSIONS IL — DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LE CH Manufacturer: SETBACK INFORMATION TypeO �� CH MBER Mo a Numbe . Syste OR IT DISTRIBUTION SYSTEM Header / Manifold Distribution Pi (s), r . x Hole Size x Hole Spacing Vent To Air Intake - ` �� Length V r Dia. Lengt / Dia. Spacing `.' Ac'; V44 C_4+ ).7°( SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Seeded A& WdW— ulched Bed /Trench Center Bed/ Trench Edges Topsoil E] Yes 1:] No ❑Yes o COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: VILLAGE OF STAR PRAIRIE 7.31.17,SW,NW a Vy (00 � n Fk Vna j �� Plan revision requlr d? ❑Yes No Use other side for additional inforrratl n. SBD -6710 (R.3197) Date Inspector's S nature Cert. No. Vi SANITARY PERMIT APPLICATION 20 1 fety and E. Washngton A sion scons�n 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 l than 8 1/2 x 11 inches in size. 5 +. C r 1));/ • 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 E] Check it revision to previous acation [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 i c/ 5 Wva /4, S T31 , N, R t E (or) Property Owner's M iling Address GF Lot Number — Blfk Number City, State Zi Code Phone Number Subdivision Name or CSM Number AJe.LJ )U ^ �� �y Q — 11. TYPE OF BUILDING: (check one) ❑ State Owned it _ Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 Village ' 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 Q Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recre onal 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 _�f New 2 Q Replacement 3. Q Replacement of 4 Q Reconnection of 5_ E] Repair of an "System _ System Tank Only Existing System - -------- - Existing System B) Q 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 C,Seepage Bed 21 Q Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22 ❑ In- Ground Pressure 1 , 42 ❑ Pit Privy 13 ❑ Seepage Pit 6 2- X 5 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 /sq. ft.) (Min. /inch) Elev tion Feet AI 'L Feet Capacit VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanksl Tanks e tic Tank ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El El El El 1:1 Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb Ignature: (No S mps) MP /MPRSW No.: Business Phone Number: Plumber' Address (Street, ty, State, Zip Code): 0 j ,l IX. COUNTY / DEPARTMENT USE ONLY C1 V ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing A ent Signature (No Stamps) EKApproved QOwner Given Initial /� O Surcharge Fee) Adverse Determination c 70 , X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety 8 buildings Division, Owner, ttkwrber PLOT PLAN PROJECT Wavne Bottolfson ADDRESS 110 Jewell St. New Richmond Wi 54017 SW 1/4 NW 1/4s 7 /T 31 N/R 17 W Village Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 3532 DATE 3/24/98 BEDROOM 3 CONVENTIONAL X)OC IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X 54' BENCHMARK V.R.P. Base of Power Pole ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark VENT SYSTEM ELEVATION 93 12" GRADE Alt. BM Base of Power Pole @ 99.2 TYPAR COVERING 12" 3' 6' (a) 3' " SEWER R K 12' 150' Property Line him Pro Driveway 120' II `. Prd 3 2% Slope Bedroom House B -4 60' 35' �. Rep A Vent 20' 30' B -3 T ' B -2� .- - 60' B -1 12' X 54' Bed 5 ' Alt. 45' Pro Property Line 10' 'wsc onsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance s Wis. Adm. Code N ` unty Attach complete site plan on paper not less than 81/2 x 11 inche ,f�lan, � include, but not limited to: vertical and horizontal reference point ir e' s .. percent slope, scale or dimensions, north arrow, and location and ce to Bars D. # APPLICANT INFORMATION - Please print all info ' fon Re ' e ed b Date Personal information provide may be used for seconds ` S j 1 bkj*Ty You P Y N Purposes (P ' kekv, s. 15.04 v Property Oyin MOft bo6a i lion - 4S ` Govt. Lot S 1/4/4,S T ,N,R / E (or Property Owner's Mail' g Address � ot'# toerc# Subd. Name or CSM# City State Tip Code Phone Number ❑ Ci Village ❑ Town Nearest Road 106'.) Z7CAx&J1 1 21(7/sv� I agg��5- I O New Construction Use: XResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd LL Recommended design loading rate bed, gpd* trench, gpd/ft Absorption area required Y3 bed, ft2 ,5 3 trench, ft Maximum design loading rate _bed, gp&V _ trench, gpd4j Recommended infiltration surface elevations rI ,� . ft (as referred to site plan benchmark) Additional design/site considerations AA Parent material Flood plain elevation, if applicable __ /_ ft S = Suitable for system Conventional Mound in -Ground Pressure I AT -Grade I System in Fill Holding Tank U = Unsuitable for system s❑ U ,f S❑ u Z S ❑ u S U Ws ❑ u ❑ S R SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench c Ground ,S S Al 1A Depth to limiting factor Remarks: Boring # Vzea 15,1- S G Ground © elegy Depth to limiting factor in. Remarks: CS(Please Print) ature Telephone No. i7Q Address Date CST Number PROPERTY OWNER W 0" '0/4 SSO fl DESCRIPTION REPORT Page of • PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench ...,.. I/-JO /?- (i/ /rni/itt / 4 e_s • a ',), Ground //t0 �/‘ �in?yz.. / S a �� ItJ)/ ifs ,7 elev. Depth to limiting factor ein. Remarks: Boring# I 60j )D• 2/ f- e C gym- , 5 1. . £st_yy �� �i� �- -z- I i>", s K e c / .a 3 fy2/ 7, SyryJb s lea /1/ .400)9 7 -g Ground elev. "1f:. ft. Depth to limiting f t j7 u in. Remarks: Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/ft2 Texture ii in. J Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench Boring # J�k t ye Ala- ��S o� w, c2 ib-34 10,,,-5J5' , j fir►.si k .f, 3 j6-A" Jrrzi/C SL s 0/111 MI /V yv;if Ground • ll1, ft. Depth to - limiting factor Remarks: Boring # 19E40- Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330(R.07/96) Soil Test Plot Plan Project Name W ayne Bottolfson ShatpXrd Address 110 Jewell St. N Richm Wi 54017 STM #3922 Lot ----- Subdivision -- --- -- Date 3/9/98 SW 1 /4 1/4S T 31 N/R 17 W Village of Star Prairie ❑ Boring ()Well PL Property Line County S T. C ROIX lk BM or VRP Assume Elevation 100 ft. Base of Power Pole System Elevation 93.8/91.8 *HRP as Benchmark Alt. BM Base of Power Pole @ 99.2 150' Property Line Pro Driveway 120' x Pro 3 - 2% Slope Bedroom House B -4 60' B -5 35' Rep A 15' 30' B -3 30' Pri A 15' B -2 60' B -1 5' Alt. 45' * Pro Property Line 10' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWN ERSHIP CERTIFICATION FORM Owner/Buyer W Arar,� e_ iz ' &)if 6 Mailing Address //o nil Property Addres (Verification required from Planning Department for new construction) City/State arcel Identification Number 4 ` LEGAL DESCRIPTION Property Location Wx-) ' /4, ' /4, Sec. 7 TZI N -R�W, wn f Subdivision , Lot # Certified Survey Map # ��'�►�/ , Volume , Page # Warranty Deed # 361, � %2 , Volume 6' // , Page # Spec house ❑ yes'>'�no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE 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 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 wastewater disposal 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. I/we, 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 the St. Croix County Zoning Office within 30 days of the three year expiration date. -3 i zYOV SIGNA OF APPLICANT DATE OWNER CERTIFICATION 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. K / SIGNA URE OF APPLICANT 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 ��390� WARRAN'try DEED �ev r Document Number ;V ZEGISTER'S OFFICE ST. CROIX CO.. WI R"'d fw Reed Return Address AW 1 4 1997 F^' 10:30 A M . ,4..., °k R� tw d t)tids Parcel I.D. Number. 182 - 1025 -95 f� Linda Bottolfson, a/Wa Linda K. Bottolfson, f/k/a Lida Eckdahl, and Wayne E. Bottolfson, wife and husband, conveys and warrants to Marls D. Abramson and Debbie M. Abramson, husband and wife, as survivorship marital property, the following described aml estate in St. Croix County, State of Wisconsin: South 660 feet of W1 /2 of SWIM of NW114 of Section 7_ Township 31 North, Range 17 West, Village of Star Prairie, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights�-of- -way of record, if any. Dated this * day of August, 1997. TRANWEr (SEAL) (SEAL) L' d�K. ott olfson Wa a E. Bottolfson AUTHENTICATION Signature(s) Linda Bottolfson, a/Wa Linda K- Bottolfson, f/k/a Linda Eckdahl, and Wayne 1l Bottolfson, wife and husband, authenticated this ° N"' day of August, 1997. 4 Kristina Oglan R. TITLE: MEMBER STATE BAR OF WISCONSIN ; THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 ci n t: N,ii�r C,vnp, DOCUMENT NO, STATE RA-i OF WISCONSIN - FORM 2 �q WARRANTY DEED I rH!s SPACE RE SERVED FOR RECOROrNG DA rA REGIS RS prF►Cr G t r :1 LIS J1:1:.? :lil � wljL 3S ]41I1t f' `�• ,.x:1 -- _ �ilac'd, fcr Rr:�d Nils 30 _ �' cf - APO I __Q evs i.,� Na!•: n !� Linda Ec�ilahl - � - - -_ A. D. ;q �0 a 51r_,�1_ of ._ - - - -- — &Ld1ae5-A' Conne l 1 _deputy RETURN TO !be following descr;J" real estate in S t C r , _ - - - -- - State of f✓isconsin: - -- - Coun!y, L Tax Key No. The .V:!St Half (wz) of the Southwest Quarter SW14 of the Northwest q �,1 arter ( 4) of Section Seven M� ,-) (7), Township Thirty -one (31) .forth, Range Seveiteen (17) West, containinq 20 acres, more or less. l F,r r p �y FCC i 3 ,..-,;,s:Aad property .s i (SEAL_) -- - ISEALi Lam_ ISEAL) L. er T - - � � ....QYC.i._.E_ - ZYruc.. AUTH CAtlON ACKNOWLEDGEMENT ia r -! STATE OF WISCONSIN i s r . c> i x --- t`.�_. n I� .ame OPfore mP. thls 25th L . April 80 day of _ ;9 JOYce E. J1eC