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HomeMy WebLinkAbout020-1267-50-000 y w °o p ~ v a 0. 0 0 o I N O i t y 0 V 0 C O I ~ Z U. C O Q v 3 ~ 0) E Z °o z a 4) 04 m 0) N F- Z 0 O Z a III', v d 2 (A P ' O N z N d ~ N IL L L C c U_ O Z F- Z 0 z N ° 10 E N N - W a w co co -p O N d C D O O c o G G a n c N N LO N fA fq E ~j 0 0 ~v (n _ F- F- F- N N 0 0 0 0 a z o 0 •N m c a m m CL N g o y 2 rn rn ~ N J U II rn rn co ao o rn o 0 C> (O _ E N O N Z O O j 3 7 O 3 a . O c CO O (n a) Cs) O H O Q 's N 2 d O ~ O ~ p N C O 0 C E C4 to LO 00 O O~ M a N x 0 0 0 0 1 ` O O O O V 0 ~ y Y L7 N N N N O 0) E C O O N j 0 0 v 0 0) cl) U) 0 m E co • O N 2 N N O w E a CL y y y ~ c A 0 a O 0 0 AS BUILT SANSTC - ITARY 104 SYSTEM REPORT OWNER_ _F _ ADDRESS SUBDIVISION / CSM#_ LOT # t-.)Q°i~ln.Y SECTION T -,?q N-R W, Town of T. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OFD SYS EM `r s X73' I ' INDICATE ')R H A4ROW Provide setback and elevation information on reverse of this fo M. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Ile ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: l Liquid Capacity: _,Lv~ Setback from: Well fS-o House r Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: S Length Z,_ Number of trenches Distance & Direction to nearest prop. liner Setback from.: well: 7 House_ Other ELEVATIONS Building Sewer ST Inlet: ST outlet L~,2 PC inlet PC bottom Pump Off Header/Manifold Ldp. Bottom of system /02 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt \A isconsin J)epartmentof industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT OT. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.: ZEILINCER, TIM CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: HUDSON r i ~e Do - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tz Benchmark 10,E Dosing /2 C/ Aeration Bldg. Sewer ~dy fig' Holding St/Ht Inlet _ o~.~ TANK SETBACK INFORMATION St/ Ht Outlet G 7 ~ la3.93 Vent irito ,take ROAD Dt Inlet TANK TO P / L WELL BLDG. A Septic >aSr 'Sor NA Dt Bottom Dosing NA Header / Man. 7. 9 le 3. yy ' 03 rq / Aeration NA Dist. Pipe 1 Holding Bot. System S'~~/ lea - PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S g DIMENSIONS LEACHING Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O h CHAMBER Moe Number: System: 12o, /1)M OR UNIT DISTRIBUTION SYSTEM [Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ength 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: HUDSON.24.29.19W, NW, SW, HUTTON HILL ROAD d, VZ" 167 Plan revision required? ❑ Yes No / Use other side for additional information. ' SBD-6710 (R 05/91) Date Insp cior's Signature Cert. No r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: mow, Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 Permit Number as9*/ 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 Propert Owner Name Property Location f 114 1/4, S T , N, R (or)~ *Prodpe~ty wner's M lin res s Lot Number Block Num er Zip Code Phone Number Subdivision e or CSM Number j 1,4 E F RUT' DING: (check one) ❑ State Owned ❑ it~r Neares Roa VII age Public 1 or 2 Family Dwelling - No- of bedrooms Town OF //1,4 S~qj,) 0, _.;~Ld' 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. S 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)R 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/da /sq. ft.) (Min./'nch) Elevation Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for i tallation of the onsite sewage system shown on the attached plans. Plum er' Na : (P ) ` / Plumb sSi at 6,86 p M/MPRSW No.: Business Phone Number: r Plu ber's Address (Streetity, e, Zip Cod : -T;?, St2: IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Si nature (N tamp A roved ❑Owner Given Initial ,~~)GQ/ Surcharge fee) / pp Adverse Determination 211k 66 ph 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 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: I_ 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: el~31 A/I Co , 4 ( ~ ~ y5 I c 4 lapdPcsr%IVA; ~ fJp;,~,5~ (jA~°IJGR p+{~ivkcJA~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY -577 C of X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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: 1-30Y4-9 PROPERTY LOCATION GOVT. LOT &W 1/4 1/4,S L7 T -Zy N,R If E( 7. PROPERTY OWNER'. ILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # &Ya 8 + sT ig suvR~DG~ CITY, STATE ZIP CODE' PHONE NUMBER []CITY []VILLAGE [SOWN NEAREST ROAD Rio pT/f f UG~o.v GUjs . -90'16 l ?!S) 3 -~a'so QSo„i I-luTTvw /y%/ j [,i([ New Construction Use [X[ Residential / Number of bedrooms [ [ Addition to existing building _ _ I l Replacement [ ] Public or commercial deqq~~e o m4 Nor P *7 Code derived daily flow C000 gpd A11if " - aming rate Plot bed, gpd/ft2 trench, gp~ R410-A►ME"Ot'ecommended design loading Absorption area required ~ bed, ft2 trench, ft2 Maximum design loading rate/ 111 k bed, gpd/ft2~trench gpd " Recommended infiltration surface elevation(s) SEA t~ 3 ft (as referred to site plan benchmark) ~T,e'E,w~ES i Additional design/ site co ations -SE~D~vD / 5/7-Z' ~¢v~PES /D4D'v (r 74- o~ 414~P Parent material _ c5 15aAe11,tRP7- - otl Flood plain elevation, if applicable ti~ it S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem S[] U MS O U as U S[] U S o u [Is o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed u ch , ~ 4 /0 Ye 312- S~ 2 , W, s4e M,fl~e Z,w . S- G -~s io yR y Z 40, -5 Ground 13, IS. y 7syR y .5 , S -0 CS ~ : 7 , 00 Depth to r1f-4 cT W EO Z1-Y S ro ao~ ~0 lim iting I •4I' ~{s/ factor S~T~ 5vi ~1~8/E .9T l z oa Ly fOR N u uD 5 TE-4 S . Remarks: Boring # _ &p- 1,,L /0,Yle 2/2-- '51 /,f, 5,i- /7m f2 s l,r~ .L•' - 3 2, 5h& C5 13,, 33 IL Ground elev. r32 33- y~ 7 sye y STR•tr~F•~v ~s U, C, q,~ 4-n,~ 76- Y~ v~ Depth to limiting _ factor a Remarks: CST Name. Please Print T ZlG,aA .c h . I i Phone: Address: 5s ' N61'L g- F 3 e5" 7 Aj Z 1/ .2 Signature: Date: CST Number: • w PROPERTY OWNER SOIL DESC -)TION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Gp t2 in. Munsell Qu. Sz. Cont Color Gr. Sz. $h. Y ROOts Bed rerxh El 9 9- 32. io y4 3/4 S,/ Z,,w,, hl- fi' c s f . G Ground G 1-10 7KS 4", ~~E' ~ ~ ~ s r" • 7 ele.~. /off, 3~' ft i Depth to limiting factor 1D Remarks: ~ip4~TV2& D G~:ti~ STo~~ D~ T~~rv 9O vo ~vv ~v Boring # ©-/o y e 3/2- f s6~ f e s z t . z .3 .3/Ile, S/ Z. dk ~n-~i' ~S if -S , (f-8a Ground 6,10% tL Depth to limiting _ factor i Remarks: /X-"4C7IJW~D Li~I~SJ7~-vim /a G ~g ~Q Boring # yx 31z L'3o /0 y 511 ,-0c 13 Ground L o - y6 ?,S Ye 5~~ elev. C G - Z 75 y{i? S4 ~ M► f i 2 ti" s /05,03 ft. Depth to Gmiling factor > Remarks: .¢T ~iP~C/•t~,e1~ L.~iES7i7~F OrSSf~Pvzza Boring # /o~l~ y 511 3. A.,), bK n~fi' S l~f ,S .G 51 d5 Ground e 5' 16AMS, ft. C U- goy Depth to limiting factor Remarks: 5 ( r C-0 \N ••~i ,v M l o a v1 ('i ~ oo po j V' OM ~ V ~ ~ v1 00 ( I~ ~ ' I H Q C9 ~ lJ o -:i,- cal M I I N ~ 0 5 r4 h'~1S oS AS C -J ,o0)x,s ~ _-----off x=s___.~ c»X,S-----~ • co F_ ~o CM, O STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER 11 M AID WTTY MAILING ADDRESS D C.~ 11% A160Ti'-1 UT 54616 PROPERTY ADDRESS Sal) , (locat on of septic sy tem) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION ' 1/4, a) _ 1/4, Section TOWN OF_..., ST. CROIX COUNTY, WI SUBDIVISION JaAl /Rj~a LOT NUMBER CERTIFIED SURVEY MAP~y , VOLUME,:j:~, PAGE ~L, 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: 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 Jas r'a Location of property 1/4 -7 Township Mailing address Address of site 1 Subdivision name Lot no. Other homes on property? -Yes 74, No Previous owner of property )Jwwn 2 144 66 6S Total size of property "2 Total size of parcel Date parcel was created T Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 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 the office of the County Register of Deeds as Document No. 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. :~.6L 2 Signa u e of App icant Co-Applic t Die of"nature Date/of/Signature i DOCUMENT NO. WARRANTY DEED THIS SPACE RE3ERVEO FOR RECORDING DATA 'I i `STATE BAR OF WISCONSIN FORM 2 -1982; ~ 505065 - 103~p - - 0 =-_~I r:~G1STy!2'S 0; i=iC~ I~ Greenwood Enterprises. Inc. a Wisconsin Corporation, l $1; 11Ri11;~ Co. 11.1 ~I Rea*dTorReoot i . . . . . • 1~4 i Timoth J Zeilin er Patti J iI of )•2'3 - P conveys and warrants to and ......_.....X.... ~ ..............K.....:---- i~ tY ~I'►~e„~, ii ..Ze.:Lj ~nge.r.,-.~oint tenants as survivorshi..p... darita2 property i, i RETURN To Heywood be Cari, S.C. P.O. Box 229, Hudson, WI I~ F the following described real estate in ...St..--Crai.x County, R State of Wisconsin: Tax Parc-J No: 0' C ~I F ! Lot 18, of the Plat of SunRidge filed in the Office t i of the aegister of Deeds for St. Croix County, Wisconsin on Septemter 22, 1989 in Volume 5 of Plats ' ii at Page 71, as Document No. 451750. i~ i i i 4 e II F '~.A I~ E I This -__-.143..Tl~r homestead property. (is): (is not). Exception to warranties: r ! Dated this day of ..__t_ 93 F (SEAL) (SEAL) i James E. Rusch, President Ma Rusch, Secretary/Treasurer ~~~at~'~~• S ' (SEAL) ' : zill- ' AUTHENTICATION ACKNOWLBDG& T' aI,'!1 -C3 i UI J • ; r.• LI. ! Signatare(a) ..James_-E..-_Rusch.,-_President_._...-- STATE OF WISCONSIN Sr. CROIX y' ; f ~I /Z unty. authen ' ted this Zt_.day of_.August 93 ___-___--_119 Personally came before me 1413 day of II iG~ L~ 19.9 the above named IS Walter Hod sk Y. !lorry R. Ruscli Se c y7Treasu 2t= retarrer TITLE: MEMBER STATE BAR OF WISCONSIN ST. CROIX COUNTY WISCONSIN ZONING OFFICE ■ ■ ■ .~..6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 July 2, 1996 Mike Hartman Hartman Homes P. O. Box 326 Somerset, Wisconsin 54025 RE: TIM ZEILINGER SEPTIC SYSTEM Dear Mike: The septic system for Tim Zeilinger located in the NW, SW, Section 24, T29N, R19W, Lot 18, Sunridge, Hudson Township, was installed and inspected on June 28, 1996. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please do not hesitate in contacting our office. Sincerely, 4 c~ Mary J n i s Assistant Zoning Administrator St. Croix County, Wisconsin bjp 07/03/96 10:26 $ COUNTY CLERK Cih 001 ACTIVITY REPORT TRANSMISSION OK TX/RX NO. 2077 CONNECTION TEL 92473622 CONNECTION ID START TIME 07/03 10:25 USAGE TIME 01'12 PAGES 2 RESULT OK . .C~Q'o~ c~~ cvao~~ cO~~ co•oo~9 c~~ c~~ c~aao~ CO~~ Cpao~~ CO•op~~ M zS r S ra A G = E GOVERNMENT CENTER 1101 CARMICHAEL ROAD HUDSON WI 54016 DATE: TO: FAX NU103R: ha r NAME: . EMM: FAX NUMBER: (715) 381-4400 v NUMBER OF PAGES IIZQMM OVER SHEET= - IF OOMPLEaE ARID LEGIBLE MCt4 IS -t= RDC'E NMI PLEASE CONTACT: NAME: - zap - TELEPBOM NUMBER: