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HomeMy WebLinkAbout020-1325-30-000 -o ° a) o c 0 6 m D M ~ 0. 5 I e I 0 o I s I ~ I Q ~ I ~ I h ~ I h I 0 Z N o z C 7 C LL O j > Q I LII I I Cl) Z N I E O L w III' a m N I- Z ; o o z c 9 o w o H m z .D a 2 M 1 m .5 N a a N N C N C a) N ' O N _ L 'O d U O Q p N Q U O Z FL Z o a c N Z cn (D CD E Y N l~0 E N - O O. w a+ C O }~1 T O N G1 FD O C O v c a O a QO o b /1 co (D Lr) F' F' U _ N F- Lo N oaaa o N 2 rn rn aa) U) J U -0 m an co 77 7- d ~l 0 M W O N r W O o ° ° ml m d cD N c 0 d Q m } (A o d is 2 N U) O O~ H O 'O E O Lo C O V C N a) 3 0 0 O M (00 O O E Y C N N E U) ~ N C C C a) 00 1 17 00 o co o Z c a~ 0) to ~ NO N= 0 O Z N Z ~L fn l e~ E d m d a • am ul, c ~j +r E L c r° A v(Lre O~c°v STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,5A W J'j'! l L Z r ADDRESS 10 y9 ~'1 O W N [ C) SUBDIVISION / CSM#T-_aLRI f t b (,C. LOT # S SECTION Z T N-R W Town of -/L) ST. CROIX COUNTY, WISCONSIN PLAN VIEW ~SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r/ z r t 5 r V fV l L%---- C b2tVEUAy w f(~ nF./Y, r~ f x~c INDICATE NORTH ARROW Provide setback and elevat on information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: j o P a F - 9 • = S!, s`S ALTERNATE BM: to h to e- AL Fe) 6.! A{~ AT /Q N Y z 7'Fj 3 3 SEPTICA`TANK /!PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity:( Setback from: Well _ House Z I / Other / TO Pump: Manufacturer - Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length . loo Number of trenches Distance & Direction to nearest prop. line: (PO N0109 Lot I ~ Setback from: well: House_ Other / Tn ',7, IRA P 4(01 2,VX =`/7,13 ELEVATIONS Building Sewer ST Inlet: C, 16 ` ST outlet: N= 412- to 1 k JA PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade ~a = / DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt ,Wiscons6ribepartmentofCommerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar~Pfnth-: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. t I pJ,der's9w: Ekbt6SP0kIlage ❑ Town of: State Plan ID No.: CST BM Elev.: AM Insp. BM Elev.: BM Description: Parcel 102V-6;1325-30-000 V_:1325-3U-D00 TANK INFORMATION EL`/EVATION DATA A9700284 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 1 U Aeration Bldg. Sewer Holding St/Hf Inlet 4~S 43 J; TANK SETBACK INFORMATION St/ FK Outlet 3 ~0' Vent irito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Ar Septic NA Dt Bottom 7 Dosin NA Header / Man. - ~ g Aeration NA Dist. Pipe 9 q~" 3 j -7, cl`r . 6 Holding Bot. System 47. ov c?'/' PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand ,Q$' Model Number GPM TDH Lift Fri 'on System TDH Ft Forcemain ~gth Dia. H Dist. To wen SOIL ABSORPTION SYSTEM BED /TRENCH Width r I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER model Number: System: L OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 40 Bed /Trench Edges (o - 6 v Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12.29.19,NE,SW 1049 MOON GLOW RD LOT 56 l " T J~ X4!1 / Plan revision required? ❑ Yes [y'No Use other side for additional information. WJ,11 SBD-6710 (R.3/97) Date I ' pedor s Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH r Y SANITARY PERMIT NUMBER: Safety and Buildings Division r~t■L~■r1• SANITARY PERMIT APPLICATION Bureau of Building Water System: 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. r'OI • See reverse side for instructions for completing this application State Sanitary Permit Number SIC? 1? The information you provide may be used by other government agency programs ~ [Privacy Law, s. 15.04 (1) (m)). y', 49 ^AOOn , d ❑ Check if revision to previous application (9/0;v K State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name opertLoc tion A+ PJA 4L - 41L ✓4 1/4, S T Z,. , N, R/ E ( Property Owner's Mailing Address Lot Number Block Number City, tate Zip Code P bone Number Subdivisio ame or C Numberl,) II. TYPE O BUILDING: (check one) ❑ State Owned ❑ Nearelt. est Road 1-1 Public 1 or 2 Family Dwelling - No. of bedrooms ' ° ~oW9 of JA4 LOA to.) If' OVA[ 61,0L III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ` ~t0, oQ 9' /7n• 1❑ Apartment/ Condo 0 f-S 2 S 3 i 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_____________TankOnly 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 1eepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 ❑ 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/sq. ft.) (Min./inch) 415eFeet + . ' er oo Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank d ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon ChamberL ET L_ ❑ ❑ ❑ ❑ ❑ 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 nature: (No mps) MP/M, RSW No.: Business Phone Number: Plumber's Address (Street, City, State Zip Code): /Z> -10 V 7 K- IL2 1-0 &2 40 -192 X/ IX. COUNTY / DEPARTMENT USE ONLY Sig ature (N amps) ❑ Disapproved San tary Permit Fee (Includes Groundwater ate Issued 1;~:/, A ~J Surcharge Fee) Approved ❑ Owner Given Initial A~v Adverse Det ermination v X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS a 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 with 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 carve; 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. 16, VIP p s ✓ / ~F t4: a 1.~t. 'tip l+el .t, Ole f? TA i t e NQ ell, - r leg' 0 a CZ t^ G/ A V o"i Wisconsin Dppartment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Di*ion of S~fery & Buildings in accord with ILHR 83.05 Wis Ad Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size: Plan ntJst rncludetib~ut9'° not limited to vertical and horizontal reference point (BM), direction an(;61o*of slope, "4!9 or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road.. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ` '?REVIEWED BY DATE ) PROPERTY OWNER: PROPERTY LOCATION Sam Miller GOVT. LOT 14E 1/4 1/4,S 12 T 29 N ,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD `NAME OR CSM 4 Trout Brook Rd. 'I 2aa Addn to Tanne Rid e CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD Hudson W i . 54016 ( ) H.iudeon T anne Lane 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 ©.7 bed, gpd/ft2 0.% trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0 bed, gpd/ft2 O trench, gpd/ft2 Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark) Additional design/ site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING K U= Unsuitable fors stem ®S ❑ U [XS ❑ U S❑ U 0S ❑ U ZS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bcurclary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 4 ..t .`•rYE A -iG 3 L 1 m -sk 64 1 s 82&S? P- 4A rh slot, 1-h+r- Es l~r •Z a. Ground -59 -79 7.SYR q 4 - s yh r- A ~ cs - a 7 elev Yh 6.3 161 Depth to limiting factor >1a9~ Remarks: Boring # 1 n.. A -Zt~ /oy,e3 L 1 rhsb~ n 4 e w -37 16 2 rh sbt n,~ Cw - 0.2 0.3 2 16N-/R 4L-3 1 S Yh 91- Ground ele~ ~e' r ft Depth to limiting factor Remarks: CST Name.=Plea Harve G . Johnson Phone: 386 -4080 Address: P. O. B 9 1 Signature: Date: Oct. 96 CST Number: 3484 PROPERTY OWNER SOIL DESCRIPTION REPORT 'Page ? of PARCEL I.D. # S~ s Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed mrch a ~3 /0 /23 / L ! nh sbK rh CS / 0 . ,S ~rmj ~3 43 /6`i,2 4 3 s,L 1 m -64 rnsr~ es 1 d,Z 0.3 Ground 3-I /o y~ 4 3 - s r n,1 J 0.7 O elev. 9~ ft. Depth to limiting factor il.va Remarks: Boring # Q O-l l L 1 /h gloK n, CS 47 /0`/24 3 - S I rh sb K rb-Fr es 0,1 6 .3 82 212 /O`/e4 S m ~,1 07 Ground elev 5.9 ft. Depth to limiting factor --T 7167 Remarks: Boring # A 6-14 "/P / CS /~7 J 0 5 S r L ,n sbK A -~r eS 6.2 0.3 Ground ele ft. Depth to limiting factor > 1D,so Remarks: Boring # Ground elev. Depth to limiting factor Remarks: cgn_ooIND Arlo,)) • c t V o ro dl n ( rpN I LA / (DVJ d° ~ cg o \ / w D O'er o. ~f► ~ \9 W ' c11 y/ ~ -tea . L ~l P - M o I A, ~ , sj~ °i I ~ ~ try 0 I v I ~ I ~ ~1 m I ' I O I ' m I ~ p i m I N -u i j O _ w z `g -0 I 1 m t~ 90 m •1' I~ N z 46 M rn LA • e e 1 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 Location of propertyf K 1/41/4 , Section I , T N-R / Township 4.4 0 M Mailing address tj C'~ V Cr ~ ~d b~ah- ( `t-o1 G Address of site (V ('t om Subdivision name rt n~ W j~ Lot no. „ro& Other homes on property? Yes S4 No Previous owner of property (R A M rS At 1,, ~N Total size of property 1 < Total size of parcel 2 Date parcel was created "7*" - / Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? W Yes No Volumed and Page Number V*L & 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 o the County Register of Deeds as Document No. e7 attuqAt4of Applican Co-Applicant ;7- °~F7 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 5 r~ I /21 , / l , f/" MAILING ADDRESS 0 0 S" PROPERTY ADDRESS le- V'1 ♦ + /c+ c5 ✓Y G ! 10 v- a I ~ L7 (location of septic system) Please obtain from the Planning Dept. CITY/STATE s lam.. t_~ M 1 J t G PROPERTY LOCATION 1/4,::70t,) 1/4, Section . T .:0r N-R TOWN OF f.1 s...' U ~,n r~I ST. CROIX COUNTY, WI SUBDIVISIONlj 'j ~j 1i~ 4 ~a LOT NUMBER ~!G CERTIFIED SURVEY MAP r f /4 3.~, VOLUME, PAGE , LOT NUMBER 4 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. 1 SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 J • DOCUMENT NO. STATE 13A F WISCO NSI ORM 1-1981 T"1e s+4C9 acst"vra ,on asco"O."o DATA _-ARR%TY 0 D ' 504.855 0"L 10 31ME 456 CISTER'S 0 `-I E r This Deed, made between 1 Randall W. S nan 00•• ................and. Patrici.a__E._.Sxnan,_._ ,ec'd tar Rowel 'c husban...._and ..vi fe._._....... SEP 1t 1993 and am (er.t...a...s.i.ngle person........ 1 ~S 10:45 - A: M 7 Grantor, R.~„a. o..a. Witt~ esSeth, That the said Grantor, f r valuable consideration...... Randall W. Synan and Patr~c~a E. Synan conveys to Grantee the following described real estate 'in St • Croy "arua" To County, State of Wisconsin: s !a Tai Pared .40:..........« i The SE1/4 of NE1/4 of Section 11; the SWi/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Y Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. FEZ - AND ~ 4" 'A A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point 'j of :.eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N8q 30100"E, along the North line of Certified Survey Map filed in Vol. "30, Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58'34"E, 351.07 feet to the point of beginning. This homestead property. (is) (is not) Together with all and singular the hereditament and appurtenances thereunto belonging; And..... Rs'iMAII...t1...... ynar}.. and,-Patricia.. E.-._Synan warrants that the title is • • en ~ ~ except good, indefeasible in fce simple sad free and cleat of en ......cumbrances ezcept easements, restrictions and rights-of-way of record, if any. a and will warrant and defend the same. i Dated this 3.............................. day of Aug.11S t......................................, 19-9.1. ...(SEAL) ~QYrl1k4~.4... ✓ ...........................(SEAL) Randall W. Synan Patricia Synan • - ................................................-•--•-...............(SEAL) ....................................................................(SEAL) • • A it A 1 t• AUTBSNTICATION ACKNOWLRDOWBUT STATE OF WISCONSIN zz St Croix » Caaety. n. authenticated this day of 19 i •j I Personally came before ma 1.. » ...day of August t1 the above named - ip........ il • Randall W. S nan,. Patricia.»~............ TITLE: MEMBER STATE BAR OF WISCONSIN S nan _ ~rr (If not. r-\i`3 II II authorized by 4 706.00. Wis. State.) . to me known to be the person 19 Ntlc4~I e 1