Loading...
HomeMy WebLinkAbout020-1321-90-000 c oc N a" O C d ) C c 0 cX Z in N _O Y c N m C Z M m O LL C O O O Q N M rn Z O 0) a co 12 Z O I o z v ~ 7 u7 a o m Fz- 0) a) o _ y E ch _0 0) a) m N CD ~ 2 CD C d = ~ O C c O U N Z F- Z o N Z ~ I a) C\l rn m c O G O a O N E o c~ O) EL O O O O •N CL IL CL 0 0) a) W } ~v 2 CD O 7 N p 7 CL n 9 a> c :3 04 ~ ~ Q Yv2 ~ C C OL" OU') 3 O QUj N N CL p o N O~ c o O O V 6) ~r O O C co O O O L -r- N N H H n..a p N V) L6 t N 7 00 E E U L~ O Z N O N ~I © ~ I C4 L ~ d EL 0 a = CL rr.~ L C 0 CL 0 U) o I o ~ I d I a e J I g I H V~ I y c~ I ry mE o o a v z w o I LL o -OD 3 00) I ~ ~ tO I rn z = o 04 1 z ~ a m I ~n z o c o z Z v v I ~ c w V ce O w m Z c z I m F- d E a M c ~ ~ I 3 Q) o O z F- z N *6 I z I y E Y N j - CL cv U) c c a o c~ w CO N N U) 0 U o WSJ C~ rn o~ 3 3 0' ~ o d' I z ~i000 CL a. (L CL I o vii c co N J U N OOi OOi I _ D ~ M { O N p O~ ml c - n CD V a) Q (n m N y y O O I` N C O C E N I` 0 c 0 c:> CD 4) ~Ol G O E C a C- N N V ~ m c a~ E c o a rn l N C En N o r 'p n W N N d N F- C d C4 'T • 0 2 N D Z N z con 0 r \ ~ ~ ~ - E I v C~ E I d 16 O. ` a • (m a m d y c rw r i E c c A c0a~ l0 inci STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER re ADDRESS 7 ~P 2fJt' /2c->,,q ' SUBDIVISION / CSM# LOT # SECTION 5 T1247 N-R ~q W, Town of Ny ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~e- AU4--E 2o.q o jv-7? ' Y- T_ e° V 1 3 v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 1 o P c r / /PE 47 i,,a) e-o Q x, f"~. f / : 9 7.9 ALTERNATE BM: Tof ®t g/o~(- ~~~uPi4T !oN E 3. 4os = ~/9 S SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: lboO s~54,1 Setback from: Well SS House /9 Other o-/ Ti SF ~,ree,t' Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: i " Length (,,.O Number of trenches Distance & Direction to nearest prop. line: 7s'' f~ JVac714 Lc)7 Z/NE Setback from: well:/0/ House Sow Other ELEVATIONS Building Sewer ST Inlet: 7-5g=ST outlet: PC inlet PC bottom - Pump Off FN ~.9y- 93.2/ Header/Manifold Bottom of system 1 Zz = 9 (.93 P-N lo.z z _9Z,~~ Existing Grade Final grade G.(,S~ DATE OF INSTALLATION: PLUMBER ON JOB:/'1= LICENSE NUMBER: 41)DeS- 03s~'" n o2 o1S~? INSPECTOR: 3/93:jt ,Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 'Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284202 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MILLER, SAM HUDSON CST BM Elev Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tt~, eSe,~ C'. +te • / '0,,v, Benchmark Dosi f~. . r 3,~ r Aeration Bldg. Sewer HoId.i St/,~W Inlet 967,31 TANK SETBACK INFORMATION StlJK Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe /e)Zz' O~ Hold Bot. System 2111 ZZ ' PUMP/ SIPHON INFORMATION Final Grade Manufa Demand` `raps/r S7 C''~`~ Model Number PM -,41'r-iction Sys Ft TDH Lift Loss Head Length Dia. Dist. To Well Force mA-in- SOIL ABSORPTION SYSTEM BED/TRENCH Width Length, No. Of Trenches PIT - No. Of Pits a Dia. Liquid Depth DIMENSIONS DIMEN I SYSTEM TO P / L BLDG WELL LAKE/STREAM L manufacturer: SETBACK HAMBER INFORMATION Type O I)gx,,- Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Man Vold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length _/62 Dia Length J! 7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or ade Systems Only Depth Over Depth Over xx D f xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges op soil ❑ Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons'present, etc.) LOCATION: HUDSON.15 29.~9W, NW, NW, GRANGE O D C r "w Plan revision required? ❑ Yes ❑'Iglo - p Use other side for additional information. / _ W 6/ r SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: Safety and Buildings Division r^~~i~'r'■ i 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.. C-~DI • See reverse side for instructions for completing this application State Sanitary Permit Number a d qaf a2 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 Owner Name Property Location S / ~GLEie *61/4 14, S .S T Z~P , N, R /j, E Property Owner's Mailing Address Lot Number Block Number Q Z~ Z- City, State Zip Code Phone Number Subdivision Name or CSM Number ~o~ o /u w l /a/ (38(.) z7 61W Z ~ II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ,t~ Nearest Road Public 1 or 2 Family Dwelling- No. of bedrooms3 Town OF t} III. BUILDIN USE: (If building type is public, check all that apply) Parcel. Tax Number(s) 1❑ Apartment/ Condo O ZD 13 2-, f v 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. Cg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an SystemSystemTankOnlyExisting 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:ffSeepage 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 sO :S_~, 3 (::n 0C7 S , 00 Feet 91. S' Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks Septic Tank or Holding Tank ~Oc~O r Li It 2 ❑ 1:1 El 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. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: QtF ' 74,47 z Plumber's Address (Street, City, State, Zip Code): 0 Al 0- / D6,4 v o > ~v r _'/0 i IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A ent Si ature (N am )V/Approved ❑ Owner Given Initial &0 Surcharge Fee) 91k 111113 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety s Buildings Division, Owner, Plumber INSTRUCTIONS ' ' r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. ti I G\ o ~bl 2 00 1141 1T ' E } s ~ FF 4 W N t 0 . t ~ I I I 01 -D j v j ~ ~ I I p I ~ ~ m ' °z I I ~ ~ r I N `D I I r I m ' w I ' rn ' w O CTl ' ± -U ~ t t G~ n I -v ! t 1 ~ ~ m t t -u cn 0 i j Z I I I `C I I m ~ ~ n C o t -1. Fn -0 CA W t I A, Ct) CA Ul C4 I m ` h, z ~i LV N 0 00 -1 0 O O O x -Ni r NO v = m o 1 z b m p =6 S c rn 46, rn z trrient of Wisc°asr r Hem n Relations Industry, SOIL AND SITE EVALUATION REPORT Page _L_ of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but -s-rceb t x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -SA'h, M 1 L.LEQ GOVT. LOT IqW 1/4 p, )I.J 1/4,S IS T 19 N,R j q E (or) W PROPERTY OWNER':S MAILING ADDRESS Lj# BLOCK # SUBD. NAME OR CSM # -l r31QAK3C(E Y 04 U& Li CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑~I~LAGE 161 OWN NEAREST ROAD C-r 14 P( New Construction Use [,X] Residential / Number of bedrooms OtQ [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate .S bed, gpd/ft2 6.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O.7 bed, gpd/ft2 ,0.$ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations'Sn,c. E Ydc,cj.aT 164 ,DO Qk YC,- PLat- ,d to Pl ~0'%/ i i. Parent material Flood plain elevation, if applicable ft S = Suitable for system O.NVENTIONAL JOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T/4NK U= Unsuitable fors stem ® S ❑ U S❑ U 0 S ❑ U S❑ U S (:I U ❑ S T.4 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxfary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends ors h / A n, zz 16'14 3 / L ! I,, s i, ✓h r' w 1 0 lo-- Ground -66 7 SY 4 S r r. l C w o-7 g elev. ,-7 ft. $3 - 129 /Ay ~e 4-4 t 1 ~ n.8 Depth to limiting factor Remarks: Boring # _23 ICY 31 / L ! m cr n i~, r 5 Z~ O.q O.S 3' /DYr2q 4 Sze. M. '~br= rh~r C- g 2-~' .2 :0 Ground (,6-13 16 Y k4 S m r !t-t j 0.7 0, Qe~ev~. / ft. Depth to limiting i uvcc~~ factor /~y1,S ,N [ u~ rte 5~~ 1 m s b>~ y!~ r t C S ? ~f l~ Remarks: CST Name: Please Print >~PV y Phone: 614N~I) Address: N ca M1M1--~~ Signatur Date: Number~~~ PROPERTY OWNER S4fh M'LCLP, SOIL DESCRIPTION REPORT Page of ~ PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell tau. Sz. Cont Color Gr. Sz. Sh. Bed rencn M Q 7I /b73 r L I M <r (h C Z 0A S r-'~;7 ,6Y 414 A-P- Cs, 4- O.z 6:3 Ground '37-A 7-SYPZ4 4 S r n+ 0-7 0•` ele. l6oyl ft g tS-13g /oy►24 r j 4 7 t~ Depth to limiting factor > l f'S~ Remarks: Boring # A 10-17 Dye 1/7-42 5L r r'^ r5 o ttJ ~.S 02 iZ -24 Ground elev. 93 161YIP-4 4 S ri+ M 9~.s ft. Depth to limiting ~ factorZ Remarks: Boring # 3 sL Ground ' r M V ~.7 d g elev. j-12.7 & Taft Depth to limiting factor > Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Q ~ xa~tk- OF i i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S i'L l I~ lL L 15 MAILING ADDRESS &OX 2 'R 2. PROPERTY ADDRESS G I ~22 e_ #9 iV (n E D D (location of septic system) Please obtain from the Planning Dept. CITY/STATE E k j b S O k LAJ ( S" SAD 116 PROPERTY LOCATION 1Y)0 1/4, / /y-1/4, Section T Z q N-R /F TOWN OF f l L) 0 S 614 ST. CROIX COUNTY, WI SUBDIVISION aA 4N ,6 ,F_ LL 0 y LOT NUMBER / CERTIFIED SURVEY MAP -IT o i y 3 , VOLUME , PAGE S , LOT NUMBER `7 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. ...i b SIGNED: DATE: j / Z 9 So St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ` sTC - loo 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 / 11 / LL pg7,.L Location of property , ~ 1/4tik--' 1/4, Section / S ,T N-R lS W Township c~D SAN Mailing addresso,~ S 14 0DZD T/ Utz r -/0 Address of site ~ Ap.40 Subdivision name ~2f4 M t,)Az L.-r-y Lot no. Other homes on property? Yes No Previous owner of property Da„ s L a s kt ✓a r Total size of property -Z-, S L Total size of parcel Z , 7 S y¢ c Date parcel was created 9- Z 9- i S Are all corners and lot lines identifiable? aC Yes No Is this property being developed for (spec house) ? ~C' Yes No Volume /142 and Page Number/0-2A 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. 5" 3 yy o o t4 , 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. s3 yyoa g In' ature o pplicant Co-Applicant U- tZ- q~ Date of Signature Date of Siqnature Slaic liar Wiviu:,~i~~ Tuna Z 1942 + /V~ J 6~GJ ( WARRAI'AY DEED { ie . J Jil ~i r nL DOCUMENT NO Rt ; Lt t ivL s f CO IX CO., W! R;-'d NfP.t _A Douglas C. Katner, Bernard J. --N uii,,I,' SEP 2 9 19"0' --and Chris -P. Neunian 12:30 P.M Sam E. Miller 1 conveys and warrants to Regl; _+r ul 7 1,11, Hk C()lit,if- DA'A HAVE AND NE rUAN ADDRESS II the following described real estate in St • Croi X County, State of Wucoasiii (Panel Identification Number) 3 NW1/4Nr111/4, Sec. 15-T29N-R19W, except Certified Survey Map recorded i in Vol. 5, P-ge 1418 as Doc. No. 393288, and except Certified Survey Map recorded in Vol. 6, Page 1761 as Doc. No. 420627. III i i) is not ~I This Homestead property. It (is) (is not) i Excepti.>ntowarra,tics: easements, restrictions and rights-of-way of It record, if any. ^ September 95 ~ Dated this ---._lcQ1 - day 19 - - - - ff' 7 (SEAL) Douglas C. Katner Bernard J. Neuman (SEAL) { _ F w►~ - - _ (SEAL) • Chris P. Neuman i AUTHENTICATION ACKNOWLEDGMENT Signature(s) B~rDard J_. Neuman, STATE of ~`:Sr'353? Chris P. Neuman ss. County. authenticated this day of _Sgp_Qmber , 19.9.5_. vulg ca _ before me this day of 19411k ,•se names 1 as C Katnee Kristina land g TITLE: MEhfHER STATE BAR OF WISCONSIN - - - ~ r fret - - - -~N $ ~d S (If not, authorized by §706.06, W,s. Stag.) tome known to be the person w',.u eaccu rLtl foregtNng in-Aranrnt and ackno,%Ic fse~ G y sZ - I' TMIS INSrRUN1ENT WAS DRAFTED BY i Kristina Ogland