Loading...
HomeMy WebLinkAbout020-1316-20-000 ST. CROIX COUNTY WISCONSIN " ZONING OFFICE r r p N _ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 r (715) 386-4680 February 26, 1998 RE: Septic Inspection for Gary Nelson located at 860 Benoy Drive, Sunridge III, Lot 47, Town of Hudson, St. Croix County, Wisconsin To Whom It May Concern: A septic inspection of the above referenced property was conducted on February 20, 1998. This property is located in the SE% of the NE'/ of Section 24, T29N-R1 9W, Sunridge III, Lot 47, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Cti2~ Rod Es linger Assistant Zoning Administrator /sm ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORTVE 0 Owner 'J''~ E Address A~Flb~y - City/State la r SSG coax f ZONINGa 'rt Legal Description: Lot _ 2 Block Subdivision/CSM # ' ` y l '/4 ,L, Sec. ,7 , T2,c~ N-RAW, Town of PIN # SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer l Size ST/PC/ Setback from: House,-- Well , P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: &,a Width Length :L4- Number of Trenches Setback from: House 9s`' Well fL' PAL _(0 Vent to fresh air intake ELEVATIONS: Description of benchmark Elevation &t2/~,_ Description of alternate benchmark i Elevation,,,' Building Sewer & o ST/HT Inlet ST Outlet my, 7%- PC Inlet PC Bottom Header/Manifold Top of T/PC Manhole Cover / Distribution Lines O i~~ _s` O ( ) Bottom of System( ) ( ) ( ) Final Grade ( ) ( ) ( ) Date of installations r it number ,-2 , c State plan number Plumber's signature License number Date>~ 6-1 Inspector 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 VIEW X77 h5V L f I rr{ V kf( INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Countv ~Sf• INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ~lPermit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Zg1709'5" Permit Holder's Name: ❑ City E] Village ff] Town of: State Plan ID No.: & 01 CST BM Ele Insp. BM Elev.: BM Description: Parcel Tax No.: /00' lops To k "1✓-on r -Sxwe OZ0-13/4- -10 -GAO TANK INFORMATION ELEVATION DATA 41700411.5- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e tic y~/tG/~S 1000 Benchmark /00 Dosing A. If. 61M SO.Z 3.4 !/2.Slo Aeration Bldg. Sewer/b,2, 5-2 x/0.6$ Holding V ftt inlet 7 Q,1 //&.1- 3.6-6 ~ 00 TANK SETBACK INFORMATION t tit Outlet I& to 3,g'r ~o7 75-, TANK TO P / L WELL BLDG. oAir Ina a ROAD Dt Inlet Septic Gf p t S y~ f 2 f NA Dt Bottom Dosing NA Header/ Man. ~!Q$' 103. SZ` Aeration NA Dist. Pipe T. 103.41 ' Holding Bot. System 0(o 10 2-5q. $1/ ~ /oz •6 PUMP/ SIPHON INFORMATION Final Grade q7b 1 O(o C ' Manufacturer Demand Sf :Yvlahtv~6Cov Z•Z Model Num GPM TDH Li Friction yst H Ft ead Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Length 't / es PIT No. Of Pits Inside Dia. id Depth DIMENSIONS l2 c~T DIMENSIONS G Manufac SYSTEM TO P/L BLDG WELL LAKE/STREAM LrAMBER SETBACK C INFORMATION Type O o el Number: Systern(m m -7 ODISTRIBUTION SYSTEM 24 L4 Header / Manifold / v Distribution Pi e(~ x Hole Size x Hole Spacing Vent To Air InYta-k W1 Z•?Z~ -0 Length ---(e: Dia. Length Dia. Spacing (O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over De t xdded xx Mulched Bed /Trench Center ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) $(0(Q ISM0~1 p~ Svvt t 1I! 4f 7 © crl, - a~ r gill rn (>&K46W J Alm Plo -qg ~lof ~~tin Plan revision required? ❑ Yes (!g No Use other side for additional information. Y 1,40 CO Z SBD-6710 (R.3/97) Date Inspecto 's Signature iT ADDITIONAL COMMENTS AND SKETCH _ SANITARY PERMIT NUMBER: Z~Igo~ls' 8M r, ~i we v L7 ~ v J. T ~a 3 ~ V^Cl Ae~ o ~ Acl All,~ W c[I 5~.a~G I 40 Safety and Buildings Division A~ - SANITARY PERMIT APPLICATION 201 E. Washington Ave. Visconsin 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 than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary9 ls-ermit umb 0? evision to p}evious application y y y programs Check if r The information you provide may be used by other government agency E] !Q [Privacy Law, s. 15.04 (1) (m)]. -SCV?Vc` State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION ,,.~pp~~ Prope Owner N e Property Location T i1/4 1/4,5 9 N, R /(Or)p►!v Propert ner.S Ma'' g Address Lot Number Block Numb r City, State Zip C de Phone Number Subdivision ame or CSM Number ( ) II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village 1 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ulc 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) We 1 E] 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. Z New 2. I] Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only ExistingSystem 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 BJ 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/sq. ft.) (Min Inch) Elevation 1_: 3 - -/A - Feet _A2!:5 I Capacity VI • NTANK FORMATION in gallonTotal # of Manufacturer's Name Prefab. Site Steel Fiber- Plastic Exper. New Existin Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans. Plum r' am (Pr Plum be S a d a ps) MP/MPRSW No.: Business Phone Number: Plumber's Ac dress (Stre t, Ci , Sta e, Zi ode): IX. COUNTY/DEPARTMENT USE ONLY E] Disapproved itary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stampsr pp E] Owner Given Initial Sa Surcharge Fee) /L/)-o.7_ 7 A -roved Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6M (R 11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS I - 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, 608-266-3151. 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. 11. 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 mainstwater 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. oj`~~ 0 ~ r 43 ~i _ Q h Z 1~ Wisconsin Department of Industry, SOIL AND SITE-EVALUATION REPORT Page ~ of 3 Labor and Human Relations Division of Safety & Buildings in a~ d %01:441LHf; 83'.05,, Wis. Adm. Code COUNTY_ T C,P O / J( Attach complete site plan on paper not less tha e1119 x I I inchn1i'n sizo. Plan, st include, but not limited to vertical and horizontal reference 'I (BM), dtrdP,tiort and 0/o of scale or PARCEL I.D. # dimensioned, north arrow, and location and di tan a to nearest road APPLICANT INFORMATION-PLEASE P 1F0-rNAT103N r` REVIEWED BY DATE .x. a P PROPERTY OWNER: RTY LOCATION c7i H 3 M,f/P Y 4,OUSG A LOT $E 114 NE 1/4,S Z T 2-9 N,R E (o Wi~ PROPERTY OWNER':S MAILING ADDRESS ti OT # BLOCK # SUED. NAME OR CSM # Yl( 3RD S r- Z y7 sox-5 R I O&E CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [BrOWN NEAREST ROAD f-f u P.S o A-) W1- 510 1 Co (715) 3,'( -36 7 UPS a A../ 13E.vo y v.P,vE [t-f'New Construction Use [v]-'Residential I Number of b6drooms 3 -to [ ] Addition to existing building [ [ Replacement ySG - [ ] Public or commercial describe Code derived daily flow (o o O gpd Recommended design loading rate ~ bed, gpolft2 , trench, gpolft2 Absorption area required - g 5 9 bed, ft2 150 trench, ft2 Maximum design loading rate ? bed, gpolft2 ' Y trench, gpolft2 Recommended infiltration surface elevation(s) P • 3 It (as referred to site plan benchmark) Additional design / site considerations it " Parent material 5-"5 5f S~ rTk- H- - X0,4) SGT Flood plain elevation, if applicable A- ft A-Z -D S = Suitable for system CONVENTIONAL MOUNQ U IN-GRSIUNDD U ESSURE AT-G31 RADE ❑ U SSYYSTE FILL HOLDING TANK U = Unsuitable fors stem 931 ❑ U L ag L3'_ U O S CW SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou day Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed reilch !f Y S /o i/4- 3/3 .S~& iw+fk 0.5 .20 75 yg fl~,, .00 Ground 3 ;0 - SS 7.5 Y9 `1/lp S d S l.Q.Q C3 - • ~ S elev. ,s S Q ion Depth to limiting ~iac~~ ~ Remarks: Boring # / o- c,, io yR 3/3 -F s h& MA _F ~2 a S S . 1,9 3 _ 7, 5 y0 l . S. 0 S 6RZ C 7_-00 Ground elev. / 00 ~ it. Depth to limiting factor Remarks: T Name:-Please Print 12 o f3 ER T U 113 R I-C 1,t T- Phone: 71.,5-' 3 S16 . P 8S Address: 2Z-frj L Sianature: t , e .,_~....e ceWSnw consultants Date: CST Number: PROPERTY OWNER 3 M RU SC"~- SOIL DESCRIPTION REPORT Page Z of 3 PARCELI.D.# GOT SU,vR/DG-E Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourdarY Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch o- f /o YR 31.)- Sam/. /f skt 4,-rR- C9 z f , S z 9- ~-7 /6 YX 31s/ f Yl4 ~►-f2 s c f Ground elev. cos, z~ rt. 3~-S /0. be y l ` Ids Depth to S O -9 D M 51S' © ' fimiting S factor ~t Remarks: Boring # 7 2- 7- 20 /o o~,~-t ~s6~fe cs ►f , s Ground /S ~s CS ' 7 I' Depth to limiting factor Remarks: Boring # l 10-s 16 ye 3y.2- s~/ lfs6,~ -Ft cS /Uf , y s id 1-f sd~ 441 f e a s i~ s! . . . Ground 7S /2 Y GS 0 S GP~ C S , _ . /nelev. ft. /O vR si s . a f Depth to limiting factor f T Remarks: Boring # Ground elev. ft. Depth to limiting factor 6 z - a o - z (A c ~ o ~ (^N v ~ _I W " O C ~ e % 00 \ /0~ Z rn ~ w i 1 \ LP Q °'0 ~ O r o p o ~pp n 6 SOLD. a 0 Z ~ .4.• ' CO) O { N ! Cti ••~I b ss t. O N F`14 pwp o D N j A T (7 C) GJ CA) .A C3 6 ,f; ; d , All. N~ W to 5 N D r o J61 . m 10 yo~ / 00 A S~ 1 r \ n Y f. D I n ~ N C-D G) to 14, ~'tf y~~f, ~,(,~~Rx`:~:~': L ~S: rut i•a C) o D 8 43, I • 4t t.~~~y~,~:,~. ~ ry ~Yt.►~~,J+` ~G~F}~.~tx~l ~{F~`" +`4 M~t1.~'~[^~• fir, "t. ,r~ + , fk1;J1~..t~►i' ..r'';Jqp`~'~ P'~i~; '7•LZ' r~A'.{,~'P°t~+ ~ • • f i 8 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 GAA / T w ( „i L= / S d iv Location of property 5 L 1/41/4 , Section TAN-RW Township /-/c,tDSaic/ Mailing address Address of site Subdivision name ~U ~~T2, Dom, L 17~ Lot no. 471 Other homes on property? Yes , No Previous owner of property ~fj'G ~ W p p 4/ ~ -j L T IZc f1~. s ck Total size of property Total size of parcel _ a ( I~Cres Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? D< Yes No Volume!- and Page Number as recorded with the Register of Deeds. Ss: s 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 of the County Register of Deeds as Document No. Signat re of Applicant Co-Applic n Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location f septic system) Please fain from the Planning Dept. CITY/STATE A/ 41 PROPERTY LOCATION -1/4, 1/4, Section , '~~N-R_Zq_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 dateSIGNED: "4"~ '0. DATE: ^ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 VOL 1966 PO 5 33 566035 WARRANTY DEED Document Number: REGISTER'S OFFICE ST. CROIX CO„ WI Rac'd for Rocord f Return Address: SEP 2 9 1997 10 :00 AA a Ro {ster of Oesda Parcel I.D. Number: THIS DEED, made between Greenwood Enterprises, Inc, a Wisconsin corporation, Grantor and Gary D. Nelson and Jillienne J. Nelson, husband and wife as survivorship marital property, Grantee. WITNESSETH, that the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 47, of the Plat of SunRidge III, filed in the Office of the Register of Deeds for St. Croix County, Wisconsin, on January 2, 1996 in Volume 6 of Plats, at Page 46, as Document Number 538046. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Greenwood Enterprises, Inc. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record and will warrant and defend the same. Dated this 2-I7' day of September, 1997. GREENWOOD ENTERPRISES, INC. GREENWOOD ENTERP SES FEE By:- By: *E . Rusch, its president Mary , ibq,retNT AUTHENTICATION Signature James E. Rusch, its president o` authen ' ted this a1'{ ►day of September, 19! D a~ Lo. K Murray E: MEM CRSTA~ BAR OF WISCON; <kl Mary R. Rusch, its secretary '.ed the foregoing instrument (J' r THIS INSTRUMENT WAS DRAFTED BY: Lois A. Murray Zilz, Estreen & Ogland 304 Locust Street P.O. Box 359 Hudson, WI 54016 ~a~c of Wisconsin