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Home My WebLink About040-1236-80-000 r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 2 ADDRESS ~aa 1 ~ SUBDIVISION / CSM# L1 n S LOT # SECTION T_N-R9j W, Town of b v -1 ~3(~ - ~a -ovo ST. CROIX COUNTY, WISCONSIN I/9, / PLAN VIEW T SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Cc9~G~ suse 7 . Qr 6~ sus INDICATE N RTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM:- SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: i Setback from: Well _ House 121- Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well:^ HouseC-2~ Other ELEVATIONS Building Sewer ST Inlet: ST outlet: 91-171 PC inlet PC bottom Pump Off Header/Manifold Y1 Bottom of system Existing Grade Final grade &5/- DATE OF INSTALLATION: 7-9-- PLUMBER ON JOB: LICENSE NUMBER: S~ INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Caboor and'Human Relations INSPECTION REPORT Safety and Buildings Division d Sanitary Permit No.: (ATTACH TO PERMIT) GENERAL INFORMATION 289307 Permit Holder's Name: ❑ City ❑ Village g Town of: State Plan ID No.: BARRINGTON HOMES MARK SOVA TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~y~l 040-1236-80-000 1-7,5 5 TANK INFORMATION ELEVATION DATA 7 09 7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SepticC a aQ Benchmark YS~/ Cc,~V S i Dosing , wl 516 Aeration Bldg. Sewer Holdin§ St/ I~Q Inlet ,ds ' TANK SETBACK INFORMATION St/, Outlet 4/3 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic Sll' NA Dt Bottom Dosing NA Header. K.~ Aeration NA Dist. Pipe Holding Bot. System ,S PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 5 GPM Model Number -qL TDH Lift L Ion Syste Ft Force-w In Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 67 DIMEN LEAC Manufactur SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION Type O n, ~ C tJ CHAMBER el Number: System: L,,-_W 7(]C OR UNIT------., DISTRIBUTION SYSTEM Header /-P Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake n Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ems Depth Over 0 Depth Over xx Depth Ot xx Seeded / Sodded xx No C] Yes ❑ No Bed /Trench Center Bed /Trench Edges/ Topsoil ❑ Yes E] COMMENTS: (Include code discrepancies, persons present, etc.) aF ~1s PJ f( ~d' r LOCATION: TROY.3.28.19,NW,SW 619 OAKLEY CIRCLE LOT 57 crx 0,0 ,GG ot~rv.4 may"" V~/u 'it..,~~T{i' /~.P-'?. ('.J:-I..C. ~r+r.L~.y ,t: .-'tom t"' /~.Q O~~`_" - Plan revision required? ❑ Yes U o 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 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary PermiittjNumber 8'7 7 The information you provide may be used by other government agency 3 " Y Y Y . programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope Owner Na a Property Location ~1/4 1/4, S :tB , N , R Cor~ Owner's ailing AddLot Number ock Nu mbe~ L / City ate Zip Code Phone Number Subdivi n N e or CS Number ( ) Ado II. TYPE F UILDING' (check one) ❑ State Owned 0 City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms C Towwn OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s 1 ❑ 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. M 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 ,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 ./'nch) Elevation Feet Feet VII. TANK Capac ty in gallons Total # of Prefab. Site Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks 1:1 1:1 Septic Tank or Holding Tank E] ❑ ❑ _ 6221+ Lift Pump Tank /Siphon Chamber ❑ E ❑ ❑ 1:1 El VIII. RESPONSIBILITY STATEMENT I, the ndersigned, assume responsibility for inst ation of the nsite sewage system shown on the attached plans. Plum er' a Plumb is Si t ps MP/MPRSW No.: Business Phone Number: Plumber's ddiess ( reet, y, State p Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing A e mps) 1 Surcharge Fee) G 7 Approved ❑ Owner Given initial U 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 t 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 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. ,L1~o S~ /fi'YG7- ~ 1:511-7- 7 J 9~ 6wM ~I ~ J ~ ~ J ~ i f ~ { ~ ~ i Wiseohsin Department of Industry, SOIL AND SITE EVALUATION REP Page 1 of 3 Labor-?end Human Relations I Division of Safety & Buildings a in accord with ILHR 83.05, Wis. Adm. . CO S roix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must's e, bul' not limited to vertical and horizontal reference point (BM), direction and % of slope, ,dc`dFs or CEL I.D. dimensioned, north arrow, and location and distance to nearest road.:, en g EVA ED DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPER TIOIy r. ` Richard Stout GOVT. LO 1/~ SST 1/4; `T 8 N,R19 3fXor) W PROPERTY OWNER':S MAILING ADDRESS LOT # BL d ~'UBR: X~W M # 1353 Awatukee Trl. 57 na ' I-ry Wood CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [OWN NEAREST ROAD Hudson, WI. 54016 (715) 549-6731 Troy Tower Rd. [i] New Construction Use [ 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 • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 92.59 ft (as referred to site plan benchmark) Additional design/ site considerations alt system el. = 91.97' Parent material pitted outwash plain Flood plain elevation, if applicable na It S =Suitable for system CONVENTIONAL MOUND 71NGROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ®S ❑ U S U ci S ❑ U ~ S ❑ U ❑ S [3q1 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench l -12 10 r2 2 none 1 22msbk mfr CS if .5 .6 2 2-30 7.5 r4 4 If .2 -3 Ground 3 0-80 7.5 r4 4 none lfs lcsbk mvfr na na .5 .6 elev. 95.15 ft. Depth to limiting factor +80" Remarks: Boring # 1 k-12 10 r2/2 none 1 2msbk mfr cs if .5 .6 2 112-21 10yr4/4 none sil lfsbk mfr 9W if .2 .3 3 1-31 7.5 r4/6 none sl lcsbk mvfr 9w na .4 .5 Ground elev. 4 31-80 7.5 r4 6 none lfs lcsbk mvfr na na .5 1 .6 94.97 ft. Depth to limiting factor Remarks: CST Name. Please Print Gary L. Steel Phone: 715-246-6200 Address: 155 00th. Ave., N Richmond, WI. 54017 m02298 Signature: Date: CST Number: 4-22-96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending Lot #57 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BowdEry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-12 10 r2 2 none 2 12-3 7.5yr4/4 none sicl lfsbk mfr w if .2 .3 Ground 3 34-84 7.5 r4/6 none lfs lcsbk mvfr na na .5 .6 96.49'. ft. Depth to limiting factor +84" Remarks: Boring # :M:E< 1 0-14 10 r2/2 none 1 2msbk rnfr if -9 !-6 2 14-34 7.5 r4 4 none sici lf-qbk mfr if .2 .3 Ground 3 34-84 7.5 r4 6 none elev. 96.26 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-12 10 r2/2 none 1 2msbk mfr crs .5 .6 tiro 2 12-24 10 r4 4 none sil Ground 3 24-30 7.5 r4 4 none elev. 4 30-84 7.5 r4 95.59ft. Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard Stout New Richmond, WI 54017 MPRSW 3254 Nw4Sw4 S3-T28N-R19W (715) 246-6200 town of Troy lot #57-Country Wood N 1"=40' BI.= top of 11, steel pipe C el. 100' -top of marker stake =el. 103.2' ~~45' ~,~E ~p k adz l ' ib h l .Z, 10`2Z1 Zp' 0~ as dS I~ 07 . Gary L. Steel 4-22-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County c OWNER/BUYER MAILING ADDRESS `q C yc W !G PROPERTY ADDRESS C 1 6(401 (location of septic system) Please obtain from the Planning Dept.- CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section T N-R W TOWN OF IL -C d ST. CROIX COUNTY, WI SUBDIVISION f~ ya'Ll~ ~C~ 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 expiration date. SIGNED: 1 d~- DATE: II 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 f(Ih. HDws. Tqc Location of property_l~ /4 S(.() 1/4, Section T28 Township I ro Mailing address L~o~C 2s~(o~ MN tZ Address of site Cola Qakle~(( G/Cle- Subdivision name.C-cxjo~l WOOds Lot no. ~ Other homes on property? y Yes No Previous owner of property ;c~drd stotA Total size of property Z.0 AcyeS Total size of parcel Date parcel was created lqq( Are all corners and lot lines identifiable? Yes X No Is this property being developed for (spec house) ? Yes No Volume VS(o and Page Number y2T 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. 15S5 ~ 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. Sig ature of Applicant Co-Applicant pate of Si nature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County nn OWNEWBUYER f t Ih ~Or Vt and z ac qu it- R(YC I~ MAILING ADDRESS ~O 'K))C Z~' , (,t~c~dd ur`r~ I►'1N S&Z5 PROPERTY ADDRESS 61de- Ow, A (loc ion of septic system) Please obtain from the Plannin Dept. CITY/STATE S sG~/ PROPERTY LOCATION -~-1/4, ` 1/4, Section, T_Z&___N-R- W TOWN OF r ST. CROIX COUNTY, WI SUBDIVISION ~Qi lH \1 WbO &S 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 (lie requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning n 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 ex 'rat' elate. SIGNED: r'vV" DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 558799 STATE BAR OF WISCONSIN FORM 1 — 1982441/v,Lild WARRANTY DEED_ DOCUMENT NO. VOL 1236 PACE 424 REGISTER'S OFFICE 1 ST,CROIX CTY.,WI This Deed, made between Richard O. Stcmt Hoed fur Firmed MAY, 2, 199T, , Grantor, and Barrington Homes , Inc. 11`:30 A. M fleplster of Deeds , Grantee, Witnesseth, That the said Grantor,for a valuable consideration conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA County,State of Wisconsin: NAME AND RETURN ADDRESS Lot 57 , Plat of Country Wood First Addition, 41/1"r/� Town of Troy, St. Croix County, Wisconsin. /9/ Or1yy PARCEL IDENTIFICATION NUMBER TRAWER This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Richard O. StOtlt warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements , restrictions , rights-of-way and covenants of record, if any, and will warrant and defend the same. Dated this 3 0 th day of Apri 1 ,19 97 . (SEAL) (SEAL) * Richard n_ Strnit (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of , 19 Personally came before me this R 0 t h day of April , 19 97 , the above named Richard O. Stntlt * TITLE: MEMBER STATE BAR OF WISCONSIN Brenda Poulin (If not, Notary Public authorized by§706.06,Wis. Stats.) State of Wises= • to be the persd who executed the foregoing instrum t and acknowle ' the sxirie, THIS INSTRUMENT WAS DRAFTED BY 41/ I"!/" Janet P. Stout 1353 Awatukee Tr. Hudson, W i . 54016 Not ry Public, County,Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, tate expiration date: necessary.) t/// *Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.,Inc. WARRANTY DEED Form No. 1—1982 Milwaukee,Wis. ".�". 'a i ; ..." ....'"; Williiiiii r I F F.. I . 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