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HomeMy WebLinkAbout020-1327-60-000 8 9~ STC - 104 RECEIVED AS BUILT SANITARY SYSTEM REPORT JUN 1997 N ST GPOX OWNER `S 0OLxTy 20NINGOFRCE ADDRESS p sRg d - ~~~1C1 Sc2a1~1-,L S-~~_ r ~ l SUBDIVISION / CSM# 7 LOT # SECTIONT_N-R_,Z.~Z_W, Town of ST. CROIX COUNTY, WISCONSIN f A- PLAN VTRW SHOW EVERYTHING WITHIN 100 EE 0 SYSTEM D~ l~ vrll HJF INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~e~ ALTERNATE BM:.~~~,f~, SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: I~1/z Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: _Ir 2 Length Number of trenches i Distance & Direction to nearest prop. line: Setback from: well:- House Other ELEVATIONS Building Sewer- ST Inlet: 9 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9 Existing Grade /S Final grade DATE OF INSTALLATION: 1 PLUMBER ON JOB: 2_4~~ LICENSE NUMBER: S~ INSPECTOR: 3/93:jt w scon* Department of Industry, PRIVATE SEWAGE SYSTEM County: ay ad Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284266 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SCHUKNECHT SHOEN HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 0-, /o 0' 020-1327-60-000 TANK INFORMATION EL ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark J / Dosing Aeration Bldg. Sewer cl-~ ' Q g Holding St/ Ht Inlet cl `p TANK SETBACK INFORMATION St/ Ht Outlet / Vent irIto ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic ~l0 > oZ r NA Dt Bottom Dosing NA Header/Man. b, t`, , keevl Aeration NA Dist. Pipe Ly2' 9h -71 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade -2-&q 'Iel '~YF Manufacturer Demand Iu M lj~7rlff :5 /Jab Model Number GPM TDH Lift Friction System TDH Ft Forcemain Lengt Dia. Dist. To Well Ii SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f S/ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type 0 CHAMBER Model Number: OR UNIT System: Q 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 a Bed / Trench Edges a U Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.29.29.19, NE, SE 725 CROSBY DRIVE LOT 34 13 Plan revision required? ❑ Yes ❑ No ry6 Use other side for additional information. a ~_f'_1aa~ I JAJA~6 SBD-6710 (R 05/91) Date Inspe is Signature Cert. No ADDITIONAL COMMENTS AND SKETCH` a SANITARY PERMIT NUMBER: t 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 than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Nu ber 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 wrier Nam Property Location Ot .4 S 1/4 1/4, S T , N, R Elor Property Owner's Maili Address Lot Number Block Numb City, to Zip Code Phone Number Subdivi n ame Cc ;M Number ( ) . TYPE F BUILDING: (check one) ❑ State Owned o !t( Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~-7 1 ❑ Apartment / Condo A9199• a l,c • 19. /7c)5 ©~Q - ) 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. R 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 21 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 17 - Required (sq- ft.) Proposed ~q. ft.) (Gals/day/sq. ft.) (Min./* ch) Elevation (F Feet Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ n ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, th49 undersigned, assume responsibility for iqs4llationpfff~ onsite sewage system shown on the attached plans- Plu ts Na Plum r' Ign n:( tam s) MP/MPRSW No.: Business Phone Number: 1 Plumbe s d resptre , City, Stat ip Code): IX. COUNTY! DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (Includes Groundwater Lassued suing Age Spproved ❑ Owner Given Initial Surchargeree) Adverse Determination ~ 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 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 criter;a 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 13 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 8 112 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; sort 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. r i I I } r 1- 113, i F i r I i n / , _CoAiC 6 K j , j ~ i I i t I I f • f 1 t I ; i ' i } i ~ 1 t 1 ~ I i t 1} f t I 1 I I I' I , ~ I 1 ' ! ~ I li r 4 f} 1~~~ 1 f f I I E I { t l I I ~ f 4 4 ~ } i } } i i 7A DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 t~,uman Relations Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY mplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but d(5E d to vertical and horizontal reference point (BM), direction and % of slope, scale or PAd 4.0. # ned, north arrow, and location and distance to nearest road. n ANT INFORMATION-PLEASE PRINT ALL INFORMATION IEWEDBV-' RTY OWNER: PROPERTY LOCATION Bridgeland Dev. Company GOVT. LOT NE 1/4 1Y,,4,S 297gt:xa ,N,R 1. or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD.~A ,O, 11736 117th. St. 34 na St ' r ,ixt`a= Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE RTOWN Lakeland, MN. 55044 1612) 985-5000 Hudson r• [ xJ New Construction Use J Residential / Number of bedrooms 3 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.04 ft (as referred to site plan benchmark) Additional design / site considerations alt. site system el.= 97.37' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U [1S ❑ U RIS ❑ U ®S ❑ U to S ❑ U ❑ S CCU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BouryJay Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich '.........1.., 1 0-8 10 r3/3 none 1 2cp1 mfr cs if np .2 2 8-18 10 r4/4 none sil 1f r mfr crww na .2 .3 Ground 3 18-48 7.5yr4/4 none cos osg ml gw na .7 .8 elev. 101.54ft. 4 8-88 7.5yr5/4 none ms osg ml na na .7 .8 Depth to limiting factor +88" Remarks: Boring # 1 -13 10 r3/3 none 1 2c pi mfr cs if np j: .2 2€ 2 13-38 10yr4/4 none sil lcsbk mfr 9w if .2 .3 Ground 3 138-80 7.5 r4/4 none cos os ml na na .7 .8 elev. 100.7{x. Depth to limiting factor +80" Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1554 200th.ve., New R'chm d, WI. 54017 m02298. Signature: Date: CST Number: 8-16-96 PROPERTY OWNER Bridgeland Dev. Co. SOIL DESCRIPTION REPORT Page 2 _3 PARCEL I.D. # pending , • Lot #34 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh 1 0-10 10 r2 2 none 1 2c pi mfr cs if .5 .6 2 10-24 10yr4/4 none sil lcsbk mfr 9w if .2 .3 Ground 3 24-54 7.5 r4/4 none cos os ml na .7 .8 elev. 101.04 ft, 4 54-80 7.5 r5/4 none ms os ml na na .7 .8 Depth to limiting factor +80" Remarks: Boring # ``:.°a':.•''<.< 1 0-7 10 r2 2 none 1 2c Di mfi cs if n .2 a 2 7-12 10 r4/4 y: none sil lcsbk mfr k if .2 .3 •..~4\ii:•i:6•x 4 Ground 3 12-36 7.5 r4/4 none ms os ml na .7 .8 elev. 4 36-88 7.5 r5/4 none ms os ml na na .7 .8 101.54 ft. Depth to limiting factor +8811 vt~ Remarks: Boring # 01 :•`.titi;:$;:$;}: 1 0-19 10 r2 2 none 1 2c pi mfr cs if n .2 M,.. 5 k 2 19-30 10 r4/4 none sil lcsbk mfr if .2 .3 Ground 3 30-80 7.5 r4/6 none ms os ml na na .7 .8 elev. 100. 34t. Depth to limiting factor +80" Remarks: Boring # lII •y vi: ,i'•: Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Bridgeland Dev. Co. 1554 200th Ave. CSTM2298 NE4SE4 S29-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 i lot #34-St. Croix Estates Second Addn. N 1"=40' BM.= top of elec. transformer base C el. 100' zI1 c3o ` 1 t~~ 32- ' -z o'~ f N ~~QD Gary L. Steel' 8-16-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER yGhD en \9catz" E c w7 r MAILING ADDRESS &EAX 4X 9b, PSI '/E 4 C • 53 7../ PROPERTY ADDRESS /ICE 114. 14. sac 9-9 . T~2_ 1 , Al. ~Q /rqG~ L 3¢ ~S.C rm (location of septic system) Please ob in from the Planning De tr^ . CITY/STATE Crosb s PROPERTY LOCATION- 1/4, S~ 1/4, Section `j T 2' N-R__W TOWN OF )JUISOVN ST. CROIX COUNTY, WI SUBDIVISION 64. U'~i ~C ~ GS 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 t the St. roix County Zoning Officer within 30 days of the three year expiration date. SIGNED: c DATE: Z ZG St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 •J/%ow eGtx'~ Location ofpropertyAo(C1/4 86 1/4, Section At?,T__N-RW Township XY-w✓7 Mailingaddress Address of site pp 7 CronLq 1,)r. Subdivision name A 6y;.l' t~.3•Aler ~ Lot no. Other homes on property? -Yes >e No Previous owner of property Total size of property 9.1(0 ArcrtS Total size of parcel Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house)? Yes No Volume L22c/~ 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 th office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site or 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. Signature of Applicant Co-Applicant 2 12- 9 Dat of Signature Date of Signature ~D as d.. ~2~PACEQ 556431 VOL V DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 WARRANTY DEED ]REGISTER'S OFF, CE Bridp-eland Development o paU. a Minnesota corporation ST, CROIX CTY., WI MAR 61997 conveys and warrants to 2 :30 P. Schoen A Schuknecht~ck~a~~#tt~~, oAk Register of Deeds (Std o Zia 57 the following described real estate in St. Croix County, State of Wisconsin Lot 34 St. Croix Estates Second Addition in the Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. (is) (is not) Exceptions to Warranties: Dated this -5th day of March, 19 97 (SEAL) (SEAL) * * Ne K niak sidcnt (SEAL) -(SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 19 Dakota . County Personally came before me, this 5tb_day of * March. 1997 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Neal Krzyzaniak (If not, authorized by 706.06, Wis. Stats.) This instrument was drafted by to me known to be the person who executed the Bridgeland Development Company foregoing instrument and acknowledged the same. 20141 Icenic Tr. Suite B. Lakeville. MN 55044 (Signatures may be authenticated or acknowledged. ;Darla J. Bauer ST. CROIX COUNTY WISCONSIN 1 ZONING OFFICE n o n u M n r n■ rrrrb ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 25, 1997 Hartmann Homes Inc. 103 Main Somerset, WI 54025 RE: Septic Inspection for Schoen Schuknecht To Whom It May Concern: An inspection of the septic system for Schoen Schuknecht's property was conducted on June 16, 1997. This property is located in the NE1/ of the SEY4 of Section 29, T29N-R19W, Lot 34 of St. Croix Estates 2nd Addition, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, a Mary Jenkins Assistant Zoning Administrator sm