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HomeMy WebLinkAbout010-1038-95-050 0 3 00 O be a 0 I ~ I e o I 0 N ti N I ~ I ~ I kr I d N I O rn 16 C6 C Z Cl) Y. c O O 3 o w I I M ~ N ~ ~ Z H I y $ Z a co cc z o I ~ c z u W F- r rn N Z ~ E a I ~ ~ M I O N O c a) N a ~i .,y a ~ L o I 0 o d ¢ O Z m z z N 0 I c ~ N R E CL M o c Lo U M A N N p nIN ooca co `O E ce) ^ ~ a m 0 0 ~0 O O ~ z o I n. N J V !w a) b-) z° 'V O0) z7o O O E N O O = N I T m y c a N N N m r ~ I O ~Qf Q (n co O W C LO O C~ O (0 r U O O N O O O LO .4 O C N C Vl U IL N N O N H L E d C -0 M O c N EO C U co r+i O L N y N 'O H C N LO E m 00 o 5 E v • O W N O Z N Z=5 (A O I C sk E I C a E ` .E C r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ~~i-!e ~c~ lU Lyi ,moo%Z • r SUBDIVISION / CSM# LOOT # SECTION ~T.30 N-R_/j W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I r Cie y ' I V INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 5eP f T ' Wee (s loav K3 1917- 3; / GAG Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284296 Permit Holder's Name: ❑ City ❑ Village Town of: state Plan ID No.: DRATH, JOHN EMERALD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 010-1038-95-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark SS- Dosing J ~.z6 °2.3Q, Aeration Bldg. Sewer Holding St/Inlet, TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom HgWaw- Dosing NA Header r Aeration NA Dist. Pipe Bot. System 7. a~e~ Holdi PUMP/ SIPHON INFORMATION Final Grade . Manptare r Demand2,92 Modber GPM / TDH Friction Ft F Le ngth Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIM L Manua ' SYSTEM TO P / L BLDG WELL SETBACK LAKE /STREAM CHAMB Model Numer: INFORMATION T pe O 2 Y /l c a. C'd u~ v 2 7 I (J6 OR System: 4C o,/ DISTRIBUTION SYSTEM Header / rAi Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _Z,2! Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At- a Syste Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) EMERALD.16.30.16,NW,SW CTY RD O LOCATION: 61- C-02- Plan revision required? ❑ Yes ❑ No Use other side for additional information. I Date Inspector's Signature Cert No. SBD-6710 (R 05191) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' Safety and Buildings Division 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 n than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number A81V ,;1 9'1,0 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Narye Property Location 4 1/4,S T , N, 6 E(069 --Jo 6 Property Owner's Mailing Address - 141 Lot Number Block Number City tate Zip Code Phone Number Subdivision Name or CS~M Number c 1 IPW- II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road El Vilag, ❑ Public or 2 Family Dwelling - No. of bedrooms p Town OF rn ~tl D III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 line A. Check box on line B, if applicable) A) 1. !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. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/s . ft.) (Min./inch) Elevation Ll,~p d - !f Feet 11re Feet VII. TANK Ca in gallons Total # Of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank f El ❑ El ❑ ❑ Lift Pump Tank /Siphon Chamber 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' ature: (No stamps) MP/MPRSW No.: Business Phone Number: Plumbers dress (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) 6 Approved E] Owner Given Initial` Surcharge Fee) Adverse Determination 14N 1#~6040 'r I.C 0(]P X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 tank(s) 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 and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or vvith complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/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 contamination investigations and establishment of standards. 02 3 0 ~ /Z~ G- / J v rjo x j' 113 e4 ----7, 10 © y w ~F I 7 - J Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor arfd Human Relations Page of 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # /0 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location k7 V Govt. Lot 1/4_41)1/4,S T'10 N,R / E (or~ C2 __n~x ~Z A41 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Ci State Zip Code Phone Number ❑ City ❑ Village LX Town Nearest Road / New Construction Use: c2rFiesidential / Number of bedrooms - Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 - S trench, gpd/ft2 Absorption area required 7bed, ft2 , d® trench, ft2 n Maximum design loading rate _ bed, gpd/ftz_-° trench, gpd/ft2 Recommended infiltration surface elevation(s) (as referred to site plan benchmark) Additional design/site considerations Parent material (tom-/~~ t a C9 uJ G, 5/5 Flood plain elevation, if applicable f~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S ❑ U li~S ❑ U ~Zs ❑ u J~9 s ❑ u ❑ s U ❑ S Wu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Szz. Sh. Bed Trench W ~i Ground 1 . _ t b d- c r r~ Zf S~ elev. ` e- / Depth to limiting factor in. Remarks: Boring # _ 9 4" -1 /IVA Ground ~l elev. ~~ft. D pth'to limiting fac or in. Remarks: G,ST Name lease Print) ature Telephone No. ,Skf Address Date _ CST Number .-L n 7 SOIL DESCRIPTION REPORT PROPERTY OWNER Page . of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~DtV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground _ S~_ r!"~ elleev.~ Depth to limiting factor ~r Remarks: Bring # 010, 2- 7 Ground r elev. z4A Depth to limiting factor 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 # - 'q / G-,-L ! • {fir r+ G 07- 4, Ground ~eleevv/ Depth to limiting factor fV1 -in. Remarks: 5 G ti g # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Soil Test Plot Plan Project Name Byro ird Jr. Address G Xc/ CS #3479 Lot Subdivision Date - a 1 /41 /4S~T N/R~ W Township Boring ()Well PL Property Line County f ~,✓c BM or VRP Assume Elevation 100 ft.S System Elevation * H R P1 r/7 rid 0 Jzj4tAV7, 5-q 120 ito 16-1 1b U LIO //74 f yry e r G \ rr Scale 1/4" = 10 Ft. When Dimensions aren't stated 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 a 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 w : Location of property_&g/ 114,S-6t) 1/4, Section /(,eT3a N-R ~cy W t Township kry e,-,g ~-r Mailing address ado Co. RJ' G' Ci~►er '0 P Address of site IS-4 C d Lot no. ~ Subdivision name Other homes on property? Yes No Previous owner of property C'?u f s 5 Total size of property Total size of parcel rl` Date parcel was created ;7 Are'all corners and lot lines identifiable? --',~-Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number 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 DocQpient No.d 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 of fl'g .the County Register of Deeds as Document No. 2 f b Signa ure of Applicant Co -A pi~l Date of Signature Date of Signature r. ' .STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER, MAIING ADDRESS yo/ -Z PROPERTY ADDRESS S from the Planning Dept. (location o sep is Este/m.)~ Please obtain g CITY/STATE PROPERTY LOCATION ~W 114, .1/4, Sections T 3 N RLW TOWN OF ~7)?'1~`G/ ~f ST. CROIX COUN'T'Y, WI LOT NUMBER SUBDIVISION CERTI UD SURVEY MAP VOLUME- PAGE , LOT NLZEM Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of y:pP.utinto, ing out the septic tank every three years or sooner, if needed by licensed septic tankpumper. What the system can affect the function of the septic tank as a treatment stage ii.. 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 plufi?f~t-,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 statin ` that.your septic has been maintained Must be completed and returned to the St. Croix County . Zoning Ocer within 30 days of the three year'expiration date. F SIGNED' LL DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016. i! DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2 LDOh 496 PA CE 502 WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA 315645 i BY THIS DEED, Charles F. Ross and Bridget A. Ross, kliGiSTERS OFFICE l husband and wife ST. aROIX CO., WIS. ~I Recd for Record this_ 2,3rd_ day of -A.D. 1973 Grantor conveys and warrants to John J. Drath an Virginia J. Drath, husband and -,-o int tenants At-, at6:30 M. ~ -.-wife, as p i If Register of n,-Pd5 Grantee- for a valuable consideration RETURN TO i the following described real estate in St. Croix County, State of Wisconsin: Tax Key ~i This is homestead property. The West One Half of the Southwest Quarter (W1, SW34 ) I of Section Sixteen (16), Township Thirty (30) i North, Range Sixteen (16) West. i i TRANSFER FEE Exception to warranties: , Executed atG-1 enwood CitKt_ Wisconsin this ~ day of A rll-: 19_73 SIGNED AND SEALED IN PRESENCE OF (SEAL) _Charles R s- (SEAL) - - - ---Bridget- Ross - - (SEAL) (SEAL) (SEAL) Signatures.,(---Charles F. Ross and Bridget A. Ross aathnticatyd;his=•~1' T~ day of April -~~_(1g~73 "'~~'A William Forrest ;r}'~` ice' Ti~axMMO(DQX~f?QJrt)Q3~tx0(x1bC96JKDCD6)4?C~ak~tl?C?C>d'F.ACty ii B i Authorized under Sec. 706.06 viz.. Comm. expires: Feb. 23, 1975 STATE OIL' WISCONSIN S1. Croix } ss -county. j, Personally came before me, this 1 1 t Ali 1 19-Z3 - Parcel 010-1038-95-050 02/21/2006 04:42 PAGE 1 OF 1 F 1 Alt. Parcel 16.30.16.241A 010 - TOWN OF EMERALD Current ~ X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - DRATH, JOHN J & VIRGINIA JOHN J & VIRGINIA DRATH 1541 CTY RD O EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 39.680 Plat: N/A-NOT AVAILABLE SEC 16 T30N R1 6W 40A NW SW FKA Block/Condo Bldg: 010-1038-95(241) & EXC PT TO CSM 15/4113 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-30N-16W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 80220 Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 22,500 215,000 237,500 NO AGRICULTURAL G4 35.970 6,100 0 6,100 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 39.970 28,700 215,000 243,7000 Woodland 0.000 0 Totals for 2004: General Property 39.970 28,700 215,000 243,7000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 568 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 30.00 Special Assessments Special Charges Delinquent Charges 00 Total 30.00 0.00