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HomeMy WebLinkAbout026-1016-10-000 v CD o ~ I Q tl c ,0 4 o o o. r d c E (D 0m03 C4 (D M CD c ~O) CD a o C CL _ p C m c a °O- v o r a. •3 I ao da~pp= O Y U Z N O CL o Z'=c~3E Z c N m m v LL CO Of tl1 v c > g 3 Qw E Q H U f6 M CL d N co w Z O M W a (0 LO F- Z I E O 2 c ao Z ~ c N H S ~ ~ I i N N O) c0 I y re 0 0 0 •1V d L '•6 .U N c -0 V O O Z m z O Z Z N I Lo a o CL 9 b u e d co m e o a M U) U) U) A o H H F- E a 'm u 0 0 0 •N a a a ~i a 3 I U °z r n ~ oU) IZ a) 0) v)JU drnrn Z > _ p E L o o v m a' co W 0) v m ¢ in to o o \j O O C N C IV O 3 i' O E O O Q o LO I-O o N c c a °o o f y N l3 N O r v C~ o IM Of O O y 7 M b ° o E F- y Z Z v ,n t=y~'1 10 co M CL1 aCD w 7 E E • 4 t 0 0 0 N O Z N H H fn O ~ I `m ~a € a ~dt a `ate • a m (D c E` c l c °3 o rw 0 A l 3 0 r A Ua~ ',0 v)U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Aso ADDRESS M~vz &e-., SUBDIVISION / CSM# LOT # SECTION _T N-R_Z W, Town of7 , 'I" ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C c1 ao ~ CAO INDICATE NORTH ARROW Provide setback and elevatio i formation on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Y 4 1 BENCHMARK: ALTERNATE BM: EPTIC T PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /~o~ ~6 1J~+4 Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length O Number of trenches / Distance & Direction to neapest prop. line: l e7 Setback from: well: House Other ELEVATIONS al or Building Sewer f ST Inlet: l 9 ST outlet: £1 PC inlet r PC bottom -r-- Pump Off Header/Manifold, 3 Bottom of system Existing Grade Final grade . O~ DATE OF INSTALLATION: 7 r PLUMBER ON JOB: Y LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) SanitaryPermit No.: GENERAL INFORMATION 289319 Permit Holder's Name: ❑ City ❑ Village $I Town of: State Plan ID No.: ASP, ROBERT RICHMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 026-1016-10-000 TANK INFORMATION ELEVATION DATA AQ7nQ1 '11 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark yrt~~ C ~5 Dosing Aeration Bldg. Sewe x 7 Holding St/Ht Inlet D ,6-b -7 (.e TANK SETBACK INFORMATION St/ Ht Outlet 2-o V TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. 7 q3 7, -3. Aeration NA Dist. Pipe 7(y3?• I Holding Bot. System O PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (03 DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P /L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Mode Number: System: 11(0 l~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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 5.30.18.55A,NE,NE 1095 180TH STREET / p YoG+ Ve GGt , G f 1 _T1 Plan revision required? ❑ Yes ❑ No Use other side for additional information. _ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau Building Water Systems V~=L■7~'1 201 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. "o • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs Check t re ision to 3eviq o s application [Privacy Law, s. 15.04 (1) (m)]. $)Ou'Nje_1 State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner a Property. cation 1/4 1/4,S T p , N, Rx (ORO Property Owner's Mailing Addres`s Lot Number Block Number fAI city' S to Zip Code Phone Number Subdivision Name or CSM Number ,cl , 417 1 11. TYPE OF BUILDING: (check one) E] State Owned ❑ c~t~age r Nearest Road L L ellin - No. of bedrooms Town OF r y10 O E] Public 1 or 2 Family Dw ❑ VII Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ©4P ~d 1 ❑ Apartment/ Condo 5.30. 19.65A 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. Q Repair of an System System Tank OnlyExisting 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 E] Mound 30 E] Specify Type 41 E] Holding Tank Yil 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 S. Perc. Rate 6. System Elev. 7_ Final Grade !.kRequired (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation /✓7 z) 0 Feet J;;. Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper INFORMATION Gallons Tanks Concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank 62J27 f El 1:1 ❑ ❑ ❑ 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. Plumb ' Name: (Print) ] Plumb ignature: ( Stam s) MP/MPRSW No.: Business Phone Number: Plu 's Address (Street, City, State ip Code lop, , , zgn f ,o5 IX. COUNTY / DEPARTMENT USE ONLY Ej Disapproved Sanitary Permit Fee (IndudesGroundwater ate ssue Issuing Agen amps) r ved E] Owner Given Initial Surcharge Fee) Adverse Determination . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber i 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 r equires 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 incensed 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 add c-ss. 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 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- - rLU I PLAN ~o- /gar PROJECT_,~e ADDRESS < > 1/4 C~7.d E 1/4/S /T N/F W N , and ' COUNTY S Byrop Bird fr. 3 el DATE CLASS PERC BEDROOM :3 CONV IONAL~IN-GROUND PRESSURE ~ CONVENTIONAL LIFT M _ OUND_ HOL G TANK • . SEPTIC TANK SIZE LIFT TANK SIZE F DOSE TANK SIZE HOLDING TANK.SIZE>~ABSORPTION AREA, ZZ PERC RATE' BED SIZE w 5 { ► Benchmark V.R.P. Assume Elevation 100.1. ~Location of Benchmark * H.R.P. 0 Borehole Q Well Scale = Feet 0 Perc Hole a System Elevation yL_ Uent; 12' . Grndp TYPAR COVERING , 12M 3' 4 61 O 33 3' k +x.3'.;4" .r l 8 Sewer Rock`.. 12' 18' ;r • -r.YC,a L w ,t 1 1 1~° F Wisconsiv Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Count' 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. # Oaf -l o~~ - l ~ 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 7, Property Location .t Oha Govt. Lot /rG 1/4 1/4,S S T,70,N,R ` E Property (Uner's Mailing Address Q Lot # Block# Subd. Name or CSM# O / w 1~ /7 tu._ City State Zip Code Phone Number 094 ❑ City Village ,~To Nearest Road ! j ` j E:1 New Construction Use: Residential / Number of bedrooms Addition to existing building 9 9 KReplacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate gybed, gpd/ft2 • S trench. gpd4t2 Absorption area required bed, ft2 'O® trench, /ft2 Maximum design loading rate 4 bed, gpd/*-.-- r wich, gpd P Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material C r e, .5 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in FlII Holding Tank U = Unsuitable for system ( s ❑ U as ❑ U S ❑ U ~RS ❑ U ❑ S 12ru ❑ S au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ole Ground 416 G s Jff~ ` GJ' 2, ~75` elev. ft. Depth to limiting fact Remarks: Boring # Ak !s r - . Ground 3 Depth to limiting factor in. Remarks: CS Na (Please Print) Signature Telephone No. 21 Addre Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l0 ~t.Z fv-~ A/T Ground G~ ,lzt 7: elev. ~tdLft. dam` f nti r- f Depth to limiting factor ~ IL- in. 3- Remarks: Boring # • 'oot ooo~ Ground 40r elev.. Depth to limiting factor in. Remarks: yG /s ~ /~%X o ~ J~hlr ?c a-'a Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) Soil Test Plot Plan Project Name Byron Bird Jr. Address ~oyS l~-p f~ ,fir<c~o 5<~~7 C g& #3479 Lot Subdivision Date y~ 1/4~ 1/4S T N/R W, 3a Township E]Boring G Well PL Property Line County 5 BM or VRP Assume Elevation 100 ft. S-GJ • Goric cam, System Elevation *HRP: , 4 y ~ Scale 1/4" = 10 Ft. When Dimensions aren't stated STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ ~c~~eh 9►- reOfz ~s,/~ MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Sections T to N-R/1~~ 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 date. SIGNED: DATE: 5~ y 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson. W1 54016 11/93 i v '1 C: ~ 1 u U 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 A Location of property ~l/4 1/4, Section T N-R1 W Township. Ma' ling address 16,,g5' /I'A7~ , ~ G..t terra S ;moo/ 7 Address of site Subdivision name Lot no. other homes on property? YesNo Previous owner of property lo, Total size of property Z24p Total size of parcel Date parcel was created D-C Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _/,No Volume and Page Number g~,C~7 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. f 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. 33 Signature o 'Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. j WARRANTY DEED 'R"a e►ACS R[e[RYaD IOR RCCORDINO DATA ~I STATIC BAR OF WISCONSIN FORM !-»e 430& 53 1DX iaJ PA;E 60 REGISTERS OFFICE ST. CROD( CO., W46 Aced. for Ruud Rhiil 6th Maz4are~..6.....banson I' Oct. 19.j7 8:30 ` coaveys and warrants to ...AOttert..E.. A3R................ ..and..I.eQrl a._ASp, C2 I~ as-..terrants..in..commoa.............................. wwwwom To . l I~ the followinE described real estate in St.._..CrOjX ..................County, Stab of Wisconsin: 'T'am Parcel No : All of my interest in the following des-cribed property: i The East Half of the Northeast Quarter (E-Aj of NEh) of Section Five (5), Township Thirty (30) North, of Range Eighteen (18) West, St. Croix County, Wisconsin; also s a• An undivided one-half (1/2) interest in the following decribed F'-0 property: The West Half of the Northwest Quarter of the Northeast Quarter (Wh of NW's of NE'k) of Section Four (4), Township Thirty (30) North, of Range Eighteen (18) Kest, St. Croix County, Wisconsin. This conveyance is given in satisfaction of that certain land contract between the parties, dated July 28, 1972, recorded August 3, 1972 in Volume ''487" of Records, page 316, Document No. 311621. This is--nmt...... homestead property. (is) (is not) Exception to warranties: a~n<. Dated this day of Sep.tejnbe-r_ w_./../......., 19...62. ---....(SEAL) X... `~+~*-,~..(SEAL) Y Marge et E_ Hanson (SEAL) • ......(SEAL) AUTHSNTICATION ACKNOWLSDOUNNT Sisnatare(a) TEXAS STATE OF ~ ss. ----County. authenticated this day of 19 --ersonally c ie before we this . yler 19 8.7 .1'lr~ t _E_ Hang I,Ic ~i Tea: MEMBER STATE BAN OF WISCONSIN l i. authorised by 1 706.0 Wis. Stab.) - - fo - III-XI to me be an O I lepted rww the sam(Z. THIS INSTRUMENT WAS ORAFT[D sv - 17, 77, ~ ~ IL