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HomeMy WebLinkAbout026-1085-90-100 STC - 104 `i 1,91 AS BUILT SANITARY SYSTEM PORT OWNER• ~c. a ✓ w~ r /h D~ . / f . ADDRESS /018 srC, 199 ,a. . z SUBDIVISION / CSM# lO LOT SECTION22-T3-0 N-R I O W, Town of I_ni-D ST. CROIX COUNTY,, WISCONSIN PLAN. VIEW SHOW EVERYTHING WITHIN 100 FEET F SYSTEM i 1 20 31 2`1 l/b 9016 D / ~ 5 -ya - i 7 INDICATE NORTH A OW Provide setback and elevation information o reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. `13ENCHMARK : S ALTERNATE BM• :SEPTIC TAN UMP CHAMBER HOLDING TANK INFORMATION Manufacturer: Cwt/ Liquid Capacity: h U 'l Setback from: Well House o27 Other Pump: Manufacturer ~ee~ :Model#_ 0 Size r Float seperatidn Gallons/cycle: /0 Alarm Location /N-cL Q SOIL ABSORPTION SYSTEM 2 / Width: 3/ Length Number of trenches- Distance & Direction to nearest prop. line: Setback from: well: House_ Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet-, PC bottom-c?g~ pump of f Header/Manifold ✓ Bottom of system Existing Grade , 6 Final grade DATE OF INSTALLATION: - PLUMBER ON JOB: LICENSE NUMBER! R- INSPECTOR: 3/93:jt Wiscdnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar PermitNo.: 99033 Permit Holder's Name: ❑ C ty ❑ Village Town o State Plan ID No.: HERMANSEN, BRAD R CCjROND- ~ qq _ X0 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 026-1085-90-100 TANK INFORMATION ELEVATIO DATA A9700354 TYPE MANUFACTURER CAPACITY STATIO BS HI FS ELEV. Septic n C~ct Benchmar 1,97 ' D2), Dosing ~J Aeratio Bldg. Sewer Holding St/yK Inle ;J, 3d' 1 TANK SETBACK INFORMATION St/ Outlet O ~3' 9 y Vtto TANKTO P/L WELL BLDG. Aierintake ROAD Dt Inlet V / V-' Septic ~2 NA Dt Bottom /3 h oS Dosing NA Header /M n.~~ i Aeration NA Dist. Pipe S/ 97, Holding Bot. System 5-, 9 PUMP/ 1 INFORM, A,TIION Final Grad Manufacturer Demand Model Number g GPM -21 '78~ TDH Lift Friction System TDH Ft oss mead Forcemain Length 3S Dia. oZ Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LengtJ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 DI SYSTEM TO P / L BLDG WELL LAKE / STRE M Man r: SETBACK INFORMATION TypeO CHA wffr~ Moe Number: System: NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x H le 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 29.30.18.455A,SE,SE 1098 130T AVENUE LOT 1 Iq `l - Vila wz zl r Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. c ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t Visconsin SANITARY PERMITAPPLICA ION 201eE Wand ahnlgtonAve sion P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County I w than 8 112 x 11 inches in size. a 0/ • 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 E] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI cS cad Property Own a m e PropertLocation ~f nn~g ArIX-g- ja1/a R 1/4,S 9 T o,N,R / E(or Property Owner's Mailing Address Lot Number Block Number e r City, State Zip Cod Phone Number Subdivision Name or CS Number 96 .5 A16 X.5 7 ell, II. TYPE OF-BUILDING: (check one) ❑ State Owned it~ Nearest Road Public id-1 or 2 Family Dwelling - No. of bedrooms 3 w own OF > me 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax N tuber(s) 67 1 ❑ Apartment/Condo 0-2 b 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 online B, i applicable) A) 1. ❑ New 2.~Replacement 3. ❑ Replacement of _ ❑ Reconnection of 5. E] Repair of an _ System ____System Tank Only _____________Existing System ________Existmgsystem 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 20Mound 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) le!) Elev~tion ~J Feet , 6 Feet VII. TANK Capactt in gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con- steel lass Plastic App New Existing strutted g Tanks Tanks Septic Tank or Holding Tank / ❑ El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber >I- ~roc / ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews a system shown on the attached plans. Plumber's Name: (Print) Plumbe ' gnature: (No Sta ) MP/M RSW No.: 7 Business Phone Number: Plumber's ~Addre~ Street, ity, State, Zip Codeli ~ VV c. /~1L IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sari-tary Permit Fee (Includes Groundwater ate ssue Issuing A ent Signature (No S m Approved ❑ Owner Given Initial Surcharge Fee)/ 10 1 Adverse Determination C 5---' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: BBD-6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Build nrgs Division, Owner, Plumber r INSTRUCTIONS i 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: I_ Property owner's nameand 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 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 establ ishment of standards. t 1 SAFETY & BUILDINGS DIVISION i State of Wisconsin Department of Commerce August 29, 1997 158-37 USH 63 Route 8, Box 8072 Hayward WI 54843 BIRD, BYRON JR 896 68 AVE AMERY WI 54001 RE: PLAN S97-21009 FEE RECEIVED: 180.00 HERMANSEN, BRAD SE,SE,29,30,18W TOWN OF RICHMOND COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed pl er responsible for this installation shall keep one set of plans with the D partment's stamp of approval at the construction site. The installer s all notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number li ted below. Please refer to the plan number shown above. Sincerely, Leroy G Jansky Wastewa r Specialist for Section of Private Sewage (715) 726-2544 SOD-7997 (R.11/96) AUG-28-1997 69 05 FROM CONNECTING POINT AMERY T13 17262549 P.01 PLOT PLAN Pxi,OJECT Bradlev Hemnansen ADDRESS 1373 Hphwav 65 New Richmond V4i '54017 SE 1/:4 SE i-44 S 29 IT 30 N/ 18 W TOWN RIrhmo COuNtYST. CROIX MPRS Shaun Bird-3532 DATE 8/17197 BEDROOM 3 CONVENTIONAL, IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK . MOUND XkXX SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK' SIZE800 Gallon HOLDING TAN$ SIZE LOAD RATE 1.2 ABSORPTION AREA 375' ! !BED sx ! W X 95' BENCHMA" V.R.P. Base of Siding ASSUME ELEVATION i00• ' ❑ BOREHOLE! V WELL +H.R.P. Same as Benchmark i SYSTEM ELEVATION 96.8 Scale - 1/4" - 10' Pro Line Tanks alie to be Properly Bed ands, B-2 Area 25l Below to be Provided with a System to Rcmain Lock Down Cover and DT LTndist4bed LAapioved'UVsrning S DWO ; Existing 3 Well Bedroom Old Well to be Properly B'3 ' House Sealed and Buried i • Old Drywell to be Filled in and Buried S9'7-21000 I Well C 0 P.O W.T.S. Conditionally , APPROVED DEPARTMENT OF COMMERCE OF SAFETY AND BU NGS DIZN' e, c F_ C E P0. Nth i ; TOTAL P.01 Page Of Cross Section Of A Mound Using A Trench For he Absorption Area G _ H -Jl ° ~-FF Topsoil 3 E D Trench Of '2" - 2~" Aggregate, Plowed Layer 6" Below Pipe, Covered With D Ft. Straw, Marsh Hay Or Synthetic Fabric E Ft. 0 Ft. F c~J Ft. H Ft. 597-21009 Plan View Of "Mound Using A Trench For The Absorption Area Force Main FT _ J Distribution Pipe Permanent Markers Observation Pipe A - - - W B K `Trench Of Z" - 21i" Aggregate I L -4 A ' t. I Ft. K Ft. W 13,_t" Ft. B Ft. J Ft. L ~ 16 Ft. License QQ Signed: Number: ~5,3 ~L Date: U' /7 ' 9 Page Of Distribution Pipe Detail For Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Maim t f Y 1 t`X X P C Distribution Pipe P P * Last Hole Should Be Next To End Cap P~ Ft.Hole Diameter Inch X Inches q Lateral Diameter Inch(es) Y~ Inches ;r Force Main Diameter cl~- Inches # Of Holes/Pipe Invert Elevation Of La eral. 9 Ft. Ht` S9"7-21009 Signed: License Number: Date: 9- /7 - 22 - ;y` PAG. (;F PUMP CHAMBER CROSS SECT 101 A~JG SPE IFICATIMS VEIJT CAP `iC.I. VENT PIPE WEATHERPROOF" APPROVED LOCKINJG i IQ, DOOR, JUIJCTIC)J BOX MAIJHOLE COVER a~ =ROM WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I y.. MIIJ. I ~ ~ Ia°MIU. COUDUIT 18"MIN. IAILET PROVIDE I AIRTIGHT SEAL * A I ICI I I I I ALARM d I II I C *APPROVED I I Orj ~ JOINTS WITH I I ELEV.6~~L FT. APPROVED PIPE PUMP I 3' ONTO --j r-y D SOLID SOIL 9` - 2 1 0 0 9 COWCKETE BLOCK RISER EXIT PERMITTED OIJLy IF TAWK MANUFACTURE HAS SUCH APPROVAL SEPTIC E SPEC, IF IGATIOhJS a DOSE TAIJKS MAQUFACTURER: JtL IJUMBER F DOSES: PER DAy TAWK SIZE: l~``t/~ jGALLOQS DOSE VOLUME I 7 ALARM MAAIUFACTURER: _1lLlL~7D2 St/S7PrytQ IKICLUDI G 6ACKFLOW: "!iC"( ZALLONS MODEL QLIMBEK: 1/L CAPACITIES: A= WCHES OR GALCOAIS SWITCH TYPE: /.n~s/(f WCHES OR fO G//ALLOUS PUMP MAIJUFACTURER: C= / ~WCHES OR GA OUS MODEL MUM5ER: S D. INCHES OR 12 0 CALLOUS SWITCH TYPE: IJOTE: PUMP AMD ALARM ARE TO DE MIAIIMUM DISCHARGE/ R_ATE_.:Z,'h G m I STALLED OM SEPARATE CIRCUITS VERTICAL DIFFEKEWCE 15ETWEEM PUMP OFF AA1D DISTRIBUTI" PIPE.. FEET + M~IIAJIIMUM NETWORK SUPPLY PRESSURE . 2.5 LET + 1SL FEET OF FORCE MAIM X I /pp FEFRICTI0A1 FACTOR.. FEET TOTAL Dy1JAMIC. HEAD = FEET 13.1 y f / ~O / I IMTERIJAL DIMEWSIOMrs OF TAIUK: GTH ;WIDTH ;LIQUID DEPTH SIGIJED: ~ LICENSE ►JUMBER' S3~ DATE: '-9~ HEADICAPACITY CURV EFFLUENT and DEWATE RING WARNING: Model 18514185 should not be subjected t less than 30 feet TDH. TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE N M V- S}SS tj A# ~W{~S, ER 4 S7-S/ 1 137-119 I40 16104161 16314167. 16YI16„ 1131411! MAIM 6 1 111 1 Iwtl3 111 lc. 1T. ^ M Gat tbv Gel. LIrL Cal, Lea G41. LYs I Gal. -L n Gal: Las: Gal. Ltra Gel. Lim Gal Lft Gal. ~ Lft Gat. Lt L Gat I Ltn. Gat LOs. Gal Lb. 14 1 4d2 161 u SI 109 : U 1e7 tt 317 17 -::332 H S356106 401 61 x71'. 61 171$1 2201S3 317 I$$ SI7 f 41 171` 42 10 i:3A6' 171 $O 27 Ih H 121 61 371 71 >300 Po 341 100 776 61 231 61 271 SI 120 141 044 111 172 4S 170 ' 135- 16 437 1.1 1S 07 U 43 w t 17 1( 11 60 277 60 27 SO Ll* 143 7 14S 45 17171 20 {dE 2.6 1 7 11 25 U, 76 1136 77 701 12 710 $1 227.( 10 227 !1 220 134 111 140 $30 43 40 1 3 21 7AI' 1 i 70 67 :234 74 280 57 1111 SS 221( II 121 121 444 137 SOS 45 170 w 1.14 17 ,201 65 246 SS 301 SI 220, to :.741; 61 I21S 121 49 127 An 45 1701 w :112.11 30 <114 46 >174 46 172 SS .206: if :211• 41 1201'. 106 3/7 114 411 > 4S 171'. 36 1 2 w >t514 21 :P 10 77 125` 51 111: SI $1 M $0 344 100 3710 4S 170 w 1113 1! tir 47 111; 36 :13(: St 2111 71 2SI 83 32 43 171 12 1e : 21:34 70 iIA 10 $2 117.: $1 11370 363 4$ . 171= 36 191 Ie 14 : p ! 45 "17121 101 54 IM ? 4S 170 1 1 w . S1A1 32 `1211' 2 1 37 ton 45 111 too 70,41 I I u 11 71 to III 34 110 ?71.00 7 26 I X 70 1141' 1 10 120 NA 20 n 105 130 . 3>u 10 34 32 Led Valve: vx 21' ills 2r 2r 4r 56•.. w' or 7r 110 It' 110 1,r 100 30-- 95-- 28-- 90-1, 186, - 4- 26 4186 85 165, 24 80 4165 75-- 22-- 70- S2 x 20--- 65 6 N3 18 60 14 6 3 189, 4189 0 55 0 16-- 50- 14 45 2 40 140, 188, 210 V 9 35 4140 4188 10__ ON 30- 13 185, 8 7,139 4185 25 6 20 - - 15- 4-- J 10 i 2 5 43 4 98 161, 5 ,59 4161 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 0 140 150 160 ?53 Q LITERS 80 160 240 320 400 480 560 640✓/ ` s 0 FLOW PER MINUTE 009922 7 Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219. Wiscorl In 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 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Gr'o ix percent slope, scale or dimensions=Please cation and distance to nearest road. Parcel I.D. # APPLICANT INFORMATIO 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 9M Govt. Lot 5~ 1/4~ 1/4,S©2 T ,N,RE Property Owner's Mailing dress Lot # Block# Subd. Name or CSM# b Ci State 'Zip Code Phone Number ❑ City El village iZrown Nearest Road 4 ~/1 ~...-c_ d,~ - ' d/ ('7l /D L 4 ❑ New Construction Use: MResidential / Number of bedrooms Addition to existing building Replacement Public or commercial - Describe: Code derived daily flow T50gpd Recommended design loading rate / bed, gpde L 2 trench, gpd/ft2 Absorption area required - 75 bed, ft2~trench, ft2 Maximum design loading rate a bed, gpd/fi2~trench, gpd/ft2 9 It (as referred to site plan benchmark) Recommended infiltration surface elevation(s) `Additional design/site considerations _ Parent material Flo plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Trunk U = Unsuitable for system ❑ S u $S ❑ U ❑ S U ❑ S U ❑ S ❑ S 1K U SOIL DESCRIPTION REPOR Boring # Horizon Depth Dominant Color Mottles Texture Str cture Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. z. Sh. Bed , Trench o-~ a : `3 9 -c29 40 9: .3 Ground _4~ Rosa.. r 44 Depth to limiting fac or oin. Remarks: Boring # a-/ - , 3 7Z A2 l,} 'IV I~ Ground elev. 3 ~ft. Depth to limiting e. m fact min. Remarks: QT rariX CST Nawe (Please Print) Signature ~ONt tGrr T e No. J V, , I I j i I,- - , ~ \ / / 1 Address ~ 14' ffg Da - Z` T Number Iv" 6 a PROPERTY OWNER Fr-r, . ~Q OLD SCRIPTION REPORT _ Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 Conence in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. sist Boundary Roots 13 Bed Trench 0-/Y 14 alb , - r _s ' Ground y Q r5 Wev GI l C //Q f ✓//V J~ l'4 Depth to limm~it~~ing in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Trench Boring # Bed ; 13 Ground elev. ft. Depth to limiting factor 'n' Remarks: Boring # E3 Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) Soil Test Plot Man Project Name Bradley Hermansen B ro ird Jr. Address 1373 Highway 65 New Richmond Wi 54017 C M #3479 Lot 1 Subdivision Date 815/97 SE 1 /4SE 1 /4S29 T 30 N/R 18 W Township Richmond ❑ Boring C )Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of Siding System Elevation 96.8 *HRPSame as Benchmark Property O ❑ Old Well to be Properly DW B-2 Sealed and Abandoned 4% B-1 ❑ *B M Slop Mound Area Well O Existing 3 ❑ Bedroom B-3 House 0 c~ w a Well O • RIVER VALLEY ABSTRACT Fax:715-386-7664 Sep 5 '97 10:18 P.01 s'APPROV 39 459670 JUN 1!1 n9o < < :.E, C.,.!?CAL l'nVfdTl' ~'~a~r.4 s•ik; :~~vz ;.'I~;;,;s ,1~,4tdl;vl; p n It Bearings are referenced to the C") I r. o south line of the SQ of Section Z4, o m M N X. assumed to be Ne§'t. I"•1 °D rt r x r. U1 Z +n 7' k` a W Z p 4v - a b • 'y1 7 H O ti trJ 0 0 y jO f x ~ ee o or R 7 t c rt U7 t'1 eo ep rt rt 0 10 o 41 W, tu N I~1 rr• 6ib to 0 ' .ir "ii ~~T`,1:. Zw• \ [7f~ Y,~ 7 n U n PIy 41 In M ! o Unplatted L nds 0 M `0 J 1 0 T En M rt to N00034'02"E 269 63' 33.00' 236.631 rt H ft f"1 a :r T v rt M ° ro EM ate-. -1 tri -n 1 b m rnN 331 331 M 'C= w It In e s C ra to I N a r i i= R M i n 1 ti•, 1 r. O la IN ~ D in Ic : e. W ~c In I O es, o cr In el w a m En i e m IrT x o, cn fl/ 1 a iw i m 1+7- rt s 'n u M 'n Ln f fi i H I'» a H n 7 N n O 1 N W N 1 r, W A ro ~ N m a r 1 .1. r w c a e -I W I rt O CL Q. p N 1 Ci In rt rt 7 N ~p U5 to a I r _ O 17 n) la CO ' " Ca FILED a 0 0 RIVER VALLEY RBSTRRCT Fax:715-386-7664 SO 5 '97 10:19 P.02 39 Continu 'd. SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Lan Surveyor, do hereby certify that by the direction of Patrick Ball;, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SEk Of the S Ea of Section 29, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin; further described as follows: Commencing at the SE corner of said Section 29 and-being the point of beginning of this description; thence West, along the south line of the SEk of said section, being the centerline of.the town road (130th Avenue), 342.32 feet; thence N00034'02"E, 269.63 feet; thence East, 339.03 feet to the east line of the SEk of said section; thence S00007'57"E, along said east line, 269.62 fee to the point of beginning. Above described parcel is subject to night-of-way for the town road (130th Avenue) as shown on this map and subje t to all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Revised Statutes and the Land Subdivion Ordinance of the County of St. Croix in surveying and mapping same. ~4gptRb~r'~ f Av. dye ~~l:.I. aT~• VOLUME 8 PAGE 2222 STC-105 SEPTIC TANK MAINTENANCE A REEMENT St. Croix County le 24~e~'.,Va OWNER/BUYER s e C d~~sr~ MAILING ADDRESS . ` o SYO~, PROPERTY ADDRESS D9 3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Cwt o L;!/ 1 PROPERTY LOCATION 1/4, J~ 1/4, Section T N-R_zL_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAW~r 94-lQ, VOLUME $F PAG o?o,Z, 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 at 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 ' r SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 L 'L 1vu 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 ssuance. 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 propertyJi_ 1/4 i-1/4 , Section T N-Rle.5' W Township Mailing address 4 Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created If Z 37 Are all corners and lot lines identifiabl ?_Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number c2,2 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION HE 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 n the office of the County Register of Deeds as Document No. 2 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 as been duly recorded in the offS i e of the County Register of Deeds as Document No. Sig e f Applicant Co-Applicant G1,3/a~ Date of Signature Date o Signature SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce August 29, 1097 19537 USH 0 Route K, Box 8072 Hayward W1 54843 BIRD, BYRON jR a96 68 AVE AMERY WI 94001 RE: PLAN S97-21009 FEE RECEIVED: 190.00 HERP'ANSEN, BRAD .E, 5E, 29, _30, 18W TOWN OF RICHMOND ~OUNTY OF ST CROIX MOUND SYSTEM The Department: has revie"ad the above--referenced submittal. Conditional approval i:; hereby granted for the systea plat, :submittal. All noted items must be corrected. The review and approval o the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Cede, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the cede requirements set forth in chapter Comm 62 or in chapters 11HR 50-64, Wisconsin Anministrative Code. This plan submittal approval will expire twr, years fEce the approval date, or if a sanitary permit is obtaine:f., plan approval will :Hpire on the day the initial sanitaty permit expires. The lio Lynd plumb c responsible for this installation shall keep one set of plan, with the P nartment's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspect ion... can be made. All permits required by the city, viliage, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number liar,! below. Please refer to the plan nured-,er shown is Ve. sincerely, CJ Le y G T; Y"] ky Wastewa ..r Specialist .or Section of Private Sewacr,a (115) 726..-2544 SOD4997 (MUMS) 564892 VOMU PACE M. STATE BAR OF WISCONSIN FORM 2 - 1996 DOCUMENT NO. WARRANTY DEED FREGTRec~'d~ R'S OFFICE ST. OIX CO., WI for Rec ord conveys and warrants to S E P 0 4 1997 9:50 A.M -4k tj." Register of Deeds the following described real estate in County, State of Wisconsin: RET p p Dl1 n/ l 1 O s,~c a 9 7'.~ ~ S ~~y S E% Cs M s~d2aa~, ►~a~ 3o-v~ newruchir~cr~f w% S~~ui~ Lot I of C51K 19, Mo !h 001 S on Pg 2 z2'2.. ag OV_t~~oc~gS~ ~0 1C~C~ Parcel Identification Number (PIN): ~a C. U% w..t,,, Na. 4S 9 (c 70 0 90 /OD 4.. S-A FEE g TRANS ER EXEMPT $ two This ZOJ homestead ProPerH . (is) is not E)sception to Warranties: 7?. Dated this day of 19 (SEAL) ! ` (SEAL) (SEAL) 1~k /zl~ (SEAL) • N C 2 a AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. . C rte, # County. authenticated this day of ,19 Personally came before me this a-9 t day of At 19 7 the above named n STC - 104 AS BUILT SANITARY SYSTEM REPORT . OWNER / ! [a 41 ADDRESS !6-2 y<<vr D~ G~ ~~s° SUBDIVISION / CSM# LOT SECTION 21 T_20 N-R_,Z,6 W, Town of ~h? E'~'ct lc~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM fA i ~ fro 4 Gu ~r JV 7 .5 i INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: ki ALTERNATE BM: SEPTIC T Imo/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- e c k~ _ Liquid Capacity: Setback from: Well / House- Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~ ~ Length ?6: Number of trenches- Distance & Direction to nearest prop. line: / w{sue Setback from: well:_j?.~ House--,ZZ Other _ s 1 r L ' / ~+f -i. ELEVATIONS Building Sewer ~~3ST Inlet:--.f _761f ST outlet: r~ ;7 PC inlet- PC bottom Pump Off Header/Manifold Bottom of system- J.,'~dZ Existing Grade Final grade 01 DATE OF INSTALLATION: j~ PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt