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HomeMy WebLinkAbout020-1168-90-000 (2)St. Cro"County Plan ning and Zoning,v.e,re,eoy,October z<,znn-ata:o;:saA.M Page I raj.-1 Detail Sanitary Information Computer #: 020-1168-90-000 Sub/Plat: Ranchwood Section: 7 Parcel #: 07.29.19.1047 Lot: 17,18,19 TNfRNG: T29N R19W Municipality: P- Hudson, Town of CSM: ----------- 'l14 114: - - -. - SW 114 NW 1l4 Owner: - - -------- Miller, Sam 300 Windolf Lane Hudson, WI 54016 State Permit: 171456 Issued: 06/17/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 installed: 04/26/1993 POWTS Detail: Trench - Seepage Bedrooms. 3 WI Fund: POWTS Pretreatment: NA Notes Built Plumber Issuerllns ector As Bu ether Re uirements Additional Notes M©neXQwe._ $0.00 _ 1000 gal. septic tank to 2 trenches 5' x 83' Jim Thompson Yes Strohbeen, Douglas Jim Thompson '. ` Yes Maintenance Scheduled pub Date Pumped 7/30/2006 4/26/1996 7/30/2003 I S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �� W — ADDRESS M# LOT # SUBDIVISION CS I tLen '/ N-R 11? T o w n o f SECTION --T -LW, ST. CROIX COUNTY, WISCONSIN PLAN VIEW 'SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C 4.(j4LY INDICATE NORTH ARROW I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: X 3 SEPTIC TANK f PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: � � '° Liquid Capacity: Setback from: Well House Other Pump*' Manufacturer— Model# Size Float seperation','.,'."'.-..----- Gallons/Cycle:,�. Alarm Location .. �-SOIL ABSORPTION SYSTEM Width: Length Number o f t re n ch e s 2. Distance & Direction to nearest p--(.)p. line.- '7-d Setback from: well: House 2-6 Other ELEVATIONS Building Sewer ST Inlet, ST outlet PC inlet %---- PC bottom Pump Off Header/Man ifold !i n - /6-, '7 Bottom of system�-. 7 .�- Existing Grade -to-- iFinal grade DATE OF INSTALLATION: PLUMBER ON JOB: 0 mr �-' LICENSE NUMBER: INSPECTOR: 3 / 9 3 : j t I 07.9-19-1�4 SgrWJ?L?FFLAN E LO rtre 0�RustrrYTEMy gAA jabor and F,,Pjman Relations INSPECTION REPORT T S e i6gs Division a ' ty and Build (ATTACH TO PERMIT} GENERAL INFORMATION Permit Holder's Name: ')'AM -MILLER CST BM Elev.: Insp. BM Elev.:,., TANK INFORMATION TANK SETBACK INFORMATION El City 0 Village HUDSON BM Description: r ELEVATION DATA TANK TO P 1 L WELL BLDG. Ventto Air Intake ROAD Septic -1141 NA Dosin NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufa Demand I\Aodel Number GPM TDH Lift Friction K I Heastem D H Ft Lqss d Town ot: A9200221 Forcemain Length Dia. Dist. To vv�u, L SOIL ABSORPTION SYSTEM No. Of Pits Inside Dia. BED / TREN H Width Lenqt� No. Of Trenches PIT DTMrNS1 DIMENSIONS Manufacturer: SYSTEM TO P 1 L BLDG WELL LAKE/STREAM LEACHING SETBACK CHAMBER 'Model Number: INFORMATION TypeOf C`InV� 1 1. . 11 j d* .. 0 'A []RUN I L System: opk CVSYSTEM Liquid Depth DISTRIBUTION - / I x Hole Size x Hole Spacing Vent To Air Intake Distribution Pipe(s) FIX Header &T-Or AT 4 941-4@ '" �%j Dia. Length Dia Length eloo- Spacing it SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Depth Over (3>j IK - 0�'� � ` 'I El Yes El No El Yes 0 No &@i!�/ Trench Center Trench Edges Topsoil /'6 -.&- -- COMMENTS: (include code discrepancies, persons present, etc.) A /C777 1?77 7�e Afe' 09 Plan revision required? ❑ Yes o Use other side for additional information. 5-/- I , 1 SBD-6710(R 05/91) Date lnspeor's Signat6re Cert No. ■ - DILHR a cNi"PiR111=11 CW SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code -Attach complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION &,` /Allr_ S L^)/4 IYAO 1/4 PROPERTY OWNER'S MAILING ADDRESS LOT# CITY, STATE ZIP CODE PHONE NUMBER 10 OF I SUBDIVISION NAME OR GSM NUMBER M 11. TYPE OF BUILDING: (Check one) El El CITY State Owned 0 VILLAGE: , TO)UKI n�' r;uq 52 Jim 16.r I H_ E]Public 6Lw\J 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUP 111111. BUILDING USE: (If building type is public, check all that apply) 1 0 zo - / / �, — 7e:7 1 El Apt/Condo 2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home 3 F] campground 7 ❑ Merchandise: Sales/Repairs 4 Q Church/School 8 ❑ Mobile Home Park 5 EJ Hotel/Motel 9 El Office/Factory COUNTY/ df /'001 .4 STATE SANITARY PERMIT# J 2f / C ❑ / Check i revision : re vious application STATE PLAN I. D. NUMBER -do-ft. BLOCK NEAREST ROAD W ; eL 40 l f _*rA 10 ❑Outdoor Recreational Facility 11 EJ Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [A New 2. El Replacement 3. ❑F-1 Replacement of 4. ElReconnection of System System Tank Only Existing System 13) El A Sanitary Permit was previously issued. Permit# V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 ❑Seepage Bed 12 Seepage Trench 13 Seepage Pit 14 ❑System -In -Fill Pressurized Distribution 21 ❑Mound 22 El In -Ground Pressure Date Issued Experimental 30 1:1 Specify Type 5. El Repair of an Existing, System Other 41 ❑ Holding Tank 42 Pit Privy 43 E:1 Vault Privy V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE ft.) 5. PERC. RATE (Min./inch) 6. SYSTEM ELEV. 7. FINAL GRADE ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. 60 '300 4 0 Feet Feet I I mww� Vill. TANK CAPACITY in gallons Total# of Manufacturer's Name Prefab. Site Con- Steel Fiber- Plastic Exper. App. INFORMATION New xisting rTanks Gallons Tanks Concrete structed glass Tanks Septic Tank or Holding Tank Lift Pump ank/Siehon Chamber Vill. RESPONSIBILITY STATEMENT 1, 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: lAr 4e Oi�7 Itz g2 k Plumber Address (Street, City, State, Zip Code): IX. CO-YNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Am 6end Sign!at5MJNo, Sta ps) Surcharge Fee) 4'Approved F-1 Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber wr INSTRUCTIONS •. r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may .be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399 to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tanks; must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1--70 VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system., Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the fallowing: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tar:kts) or other treatment tanks; building sewers.; wells; ,:eater mainsi/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) S 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 second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------ Owner of property Location of property, 4 1/4,, Section T N-R W,/ Township Mailing address Address of site Subdivision name. Lot no . —I." Other homes on property? yesNo Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)?�, , Yes No Volume 7/3 - and Page Number r� 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 & 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 County Register of deeds as Document N o 10 Signature of applicant Co -applicant Date of Signature Date of Signature ' 1 ernes a singlee.rson �. rsi L. Fag ..APRO3 100 ..._.. .. .............-.. 4:55 m.. .. ..Miller ............ -_. ..... greys and warrants to .. ... _ .. ... . R�TU*M TO • Re"Cod & Cirf .. - P. o• Box 229 .. . - Hudson, WI 54016 described real estate in g. �• lol�inR l l No:..�.2o-�1b8- i� :teats of Vir'r,�constin Tax Parce Lots 17 18 and 199 Plat of Ran c}twood in the Town of Hudson. V,, is not xic.y (is not };xc•t•Pti�rl t+► warruntirs hnmeKte3d pr+gwrt �'- Existing, highwaYSq easements and rights of way of record. �+ y , �7a1�• l)� Dated L t' AUTRZNTICATION signature (s ) (SEAL) Is 1:.% 1 , j4 authenticated this day of DTI.}:: %IF�KER STATE BAR (IF N%-i:� �t«:;:I l V not. authorized t,.N ►. - lh Attorney David J. F-streen (121 2nd St. , liudsoat WI Apr i 1- , 102 At 0 • Craig L. Faget.nAI � •.:'r r ' v� d ti ' O ., tip; .....••;��,, ACKN0WLED414$NT STATE OF wj.s- 'UNtiIN t ,.tint\ ., 4 �t t� - �t,.�. :, � :tit:+• 14� �,►r+• 11 March 1:�� 2 thy ,tills tl,c,�•c itan 1 7 L • Fagerness = a sin�,le c,r�~t �. . person •�f Frt' tit+. �,�•*-r�tl •r r �� It ,j't. . ,, :,. dr t♦ t .tT S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER 1, iT 41 17 ADDRESS FIRE NUMBER or CITY/STATE ZIP 4 fe"U, 1/4, SECTION T.c N-R PROPERTY LOCATION -4 TOWN of St. Croix County, SUBDIVISION 2_a LOT NUMBER_//X_ 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 septic tank pumper. What A 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. Certif ication stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. 'A SIGNED - DATE : St. Croix co. Zoning office 911 4th Ste Hudson, WI 54016 DEPARTI\AENT OF I.N DWSTRY, UlkE (Q R A lti �f) HUMAN REL17TIONS LOCATION: SECTION: 41r 1/ '/ /T OIL BORINGS AND SAUILDINGS REPORT ON SFETY & BDIVISION 7969 PERCOLATION TESTS(115) MADIP.OBQX SON, WI 537073707 (H63.09(1) & Chapter 145.045) TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO,: SUBDIVISION NAME: H/ E t4/14,,�.�- �-vm COUNT ER__ UYER'S A E. MAILING ADDRESS: r DATES O SERVATIONS MADE USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: �esidence ❑�1(l�ew ❑ Replace r© fir— ,}� RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN -GROUND -PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) EjP If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the under s.H63.09(5)(b), indicate: �% Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS �RAf TFR nF gnll- WITH THICKNESS, COLOR, TEXTURE, AND DEPTH BORING NUMBER TOTAL DEPTH IN, ELEVATION DEPTH TO GROUNDWATER -INCHES CN OBSERVED EST. HIGHEST TI B- B- —3 p y ^, , e? B- / PERCOLATION TESTS �r HOLE TEST TIME DROP iN WATER LEVEL -INCH LLING INTERVAL -MIN. PERIOD 1 PERIOD 2 TEST DEPTH WATER IN NUMBER INCHES AFTERSWELLING P- - r %► P- E P- t'" •� P- P- ' P- .� RATE MINUTES PER INCH PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION- cr �t p n�? E s �_..w_. -( uJ717 V r :. .. .. A I ' r A i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) — OVER -- 4 k � INSTRUCTIONS m . orn� )lete legal description; 2 The use smticon roust clearly indicate t -�rjlj t.ljer thlis is a residence car cornet rcial pr ie t; , MAXIMUM rlUmber of be r orns or immmerci l € se Wanne€:IY 4� Is thk a new or replacement s stern; Um plete th!"Whialbility rating boxes. A SITEIS SUITABLEFOR A FiOLDING TANK ONLY IF AL OTHERSY1� a ARE RULED OUT ED ON SOIL CONDITIONS; Ek PLEASE use the abbreviathms shown Ferri fOr writing w€:ells descriptions ancl completing the plot Jan; , MAKE LEGIBLE cliagram accuratelylocating our test Wcations. Drawing to Scale is referrer_ . separate sheet may be r secl if desired; . Make sure youfbonch mr arui vertical elpstatlon referent (10lrit Ot-E= ClOaHY shown,and ate pen— ancrit; g�cjr r l Rr) y all � ap ypj.'.)$r opt late boxes as to dates, names, add assfs�sf flood plairr, Gala, Percolation test exemp- t i��'.. n, if appr.p t iet 10. If the W form tion (SUCKI aS Q10 lain, el r ahati (joes o-t apply, pla(mp N,A, in the appr -late box; .gy £,.,�7, y the form �+, g-} 9 } y� �*, �} i y� i yam- / �g- �{ {� and �§ E 3 y g �^ ya +� ¢ + j p q p�w-g b p & 3 , Si3 v�i t �e orm a Ed ���(�'w�+_k ', Ur �.wU rent address Your certi icE,7 ion nu lj)e ; z Make legiI_)1e copies and cliSttribUtO as r QUired. ALL, AIL, 7TESTS NIUST BE FILED ED WI' HE LOCAL AUTHOR ITY 'E,'VI IN 30 DAYS OF COMPLETION. -Sall Separates and TextUr s " !i r Gravel (undei r^ - ) x. _Sa I I cl si Sandy Loom s i l ...,,.,. Silt Uw,,,r Jr Si ,_ o j t ;° c f ......_ C.r �€ E i.. }� Clay }�' i -:y:�^Co Sc Sandy Clay sic silly clay c +: C 7 & u G.rk Six goneral soil textures Other Symbots HG Hig1� GrowduR ater 3 / i N p [ ,...._, i� �1 e 1 1 qq EM1 37 Miki Lis syso-"�� 3 a 3 '9 yy�} S F G4 p' i s Y 1 _F vd Red f f; few, I s e r t (4O %r6U:marse on (I 3r Many, ....._. F,s r) .:..,.. .,) f- t.:) f -n i 4 i k t H �,,"V fsurface watei M B cj: ncIi 1'V! a r k 2 F y l .je pre. [{ p d `uport isthe fjj sj S jEjj in `3ecuring a Sdr'6U �`.� r � 1" 0 unl r 3 a } 3 .3 t �` test 4� , ..g. [� E - q �: i. H :. ,.. st in tile �'��`�. (! !S 8 3� to ipe ni 4 ,i� Ai � ;�. ���plans ' � n i s i - a # r€ e + a `E � k r j s.s y e �': �v � L-a r't � = i �` E`' £ � h f'� $ r'� c WrMOPriate MCA p €. g y in l ..4 ii•: Y.E r,KS aa♦ d phor to &.. 1he Y yi� t ..pp i3 list ss4 wit ON t Lot s 17 18 and 19, Plat of Ranchwood in the Town of Hudson. A t'7r lei y9 ..... y N. SRleo+•. .. a ,.Y::.•: -';..� '. �:, e c r•�1��.'CO,idK �: � ���'ii.�r"hq,�M.`:i.•K.�i•'i''A. non. '.� f,s.'�y�'.yi,.... R'J.^N.' liaJte -/do 11&Yr peel� oe 4ig- '00 z �o �t z —7 D7 ALT Aic P3 L7bLLL lo -2 7` 1© , \,.7a lqe m 0 U q Tr s Ta -s Vt ttl T /Y f Aliotm rat \4 �-- 0 e qz T vi A SECTIO L A N- S,r Lo 4 )9 z qo. Raft / % .:.3 L '1 L1 i ) 1V ►7'S�" • LRV 11X L IJ U i�i ! 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