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HomeMy WebLinkAbout020-1110-90-000 I o ° I M C Y I N w I N C? ~ N I I ~ I •y ~ I GL ° Q m ;nl c I C ~ O c ° 7 N : LL O 'O Lo a Z` x I 3 Cl) vi ° I Z y N Z C O Z y (V ~ UJ a m o I o z d c N Z E I''. N CA N c N ~ N 0 L O O N Q 0 z m Z w m E ° m o w IL c CL m cn _ d i CU N O °O C D a 1' E N Q H H = o o N Z cv > M O O O a m Z° • wJ 3 a a a g cD 0) m ° o N o I (n N -j U U rn M z Cl) a _1 0 0 0 c ° o o E o I w w° O ~j A ~ 'a a I ►~i ° ' O R O m c U) N 0 O h rn LO o co ° ° ° C'4 C'4 C o o~ E c "2 v W N C N(D L -O] - N O C14 E °cv cV ° o c000 E • y` O 2 co CV O J) o R I ti 3 *k a w m a CL • cis Q -y d . d w ~1 A 0 a O in 0 M - r 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT _ ^U \C1 frt.,; OWNER Su-~- ADDRESS O (C4 ` SUBDIVISION / CSM# ff\\ LOT SECTIO. 1 ;i T j.~,4_N-RJR/! W, Town of ~f UAS oN ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 00 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~RQUN0 I`,)t6 H') ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WRe Liquid Capacity: Setback from: Well C50 R S0' House 0' other 3 Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: M~ Length S y Number of trenches Distance & Direction to nearest prop. line: q 3~ Setback from: well: were so House_ ~ 8 Other r~ l IOU, 39 ELEVATIONS Building Sewer ST Inlet. Q ST outlet Id~. I PC inlet PC bottom Pump Off Header/Manifold Bottom of system I?.Sr~ Existing Grade SAr-`-, Final grade WD A_1 DATE OF INSTALLATION: PLUMBER ON JOB: lJGILa LICENSE NUMBER: INSPECTOR: 3/93:jt ' Wiscgrisin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268666 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BOUMEESTER, SUZANNE HUDSON CST BM Elev.: Insp. BM Elev.: , BM Description: Parcel Tax No.: 'Co leo,(6 - _J TANK INFORMATION ELEVATION DATA A9600372 X30197 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosin 1 .3 -o.a3 Aeration Bldg. Sewer Hold' St/$f Inlet TANK SETBACK INFORMATION St/* Outlet dA TANK TO P / L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic > y f 4 NA Dt Bottom Dosin NA Header MWarx__ Aeration NA Dist. Pipe i H ng Bot. System 38 , Sal PUMP/ SIPHON INFORMATION Final Grade Manufacturer errand~d /o 3s~ ` Mo I Number PM TDH Li Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits inside Liquid Depth DIMENSIONS 5 DIMENSIONS LEACH nu acturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION Type O BIER Mode Number: System: ? Sp OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. Length S~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s \ Depth Over Depth Over xx Depth Of Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.12.29.20W/ASE, NE, LOT 2, OLD H GHWAY 35 4 r? j/ A QV {'Y~ ~(~rs t G(s Yf !L ~~z P/~/ PAS ^ Q~. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 1 y ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I Safety and Buildings Division e.•■~r■rs 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. 15t- C KO't K • See reverse side for instructions for completing this application State Sanitary Permit Number a6S 666 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 Na Pro4e-rt Y Loc 1t4 S d '1 T , N, Ra b E (or~ Property Q~wqer's Mailing Addre£ Lot Numbe h Block N er Ci Statrew 5A , ✓.9 S Zip Phone Number Subdivision Nam or COS[M Number ~l Ito s 6~4 ( > 3 S + r 11. TYPE F BUILDING: (check one) ❑ State Owned it( Neaarrestdl 'i°a~W Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ~D5611r n J III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 vS 1) J O 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. ❑ 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 Meepage Bed 210 Mound 30E] Specify Type 410 Holding Tank 12 ❑ Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy 13E] Seepage Pit 43E] Vault Privy 14E] 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 Req it sq. ft.) Pr posed (sq. ft.) (Gals/day/sq. ft.) (Min nch) Q / Elevation ti 1~-G7Feet IN-9 Feet 950 VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic, App New Existing strutted Tanks Tanks Septic Tank or Holding Tank V_ cZQ ❑ ❑ ❑ ❑ ❑ 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) Plu raber's Sign ore: (No Sta s) MP/MPRSW No.: Business Phone Number: .JIM oarneeS -PR PI mber's reisj (Street, City,,State, Zip ode): 1616 t-k kk)[) s 0-14 Vi _ir c- S i b IX. COUNTY/ PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Si nature( St ps) j Surcharge Fee) proved ❑ Owner Given Initial Adverse Determination OV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a Ruildings 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. 1 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 narne, 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. PLOTA 1-11 \'u ")b ' N A M E ~5ks2Gi~ll^^ee S e NN`'`. !a_ I,t r~ov.mePl L 0 A I NI 61 d qw 3 S I C E-N S E r 3~v~_w.. PLO T NJ A • gY~ gs 9-o A rV) s~~t tN~ (~,za Ne-Xt b lye w;>4 Pdlp . I t I I /Do. C) 0= ?PJ6q P;If- r r NOfie , d ACQN 1q Sp~'>~A J N o'~e e w o '('~pN 5~r,.~•~r~aw~ nfi~~ `f'~~N ,QD' ~a~or,~ F-RES11 AI1; INLETS AND ODSERVATiONTIRE CI;OSS SECTION • r Approved Vent Cap Minimum 12" Abovc I l 6 °~`~~iN PI yep( Final `T a`~ gip- 1 4" Cast Iron Above Pip Vend Pipe To Final Grade- 1 • • • Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of labor and Human Relations Dtpo o of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNPP 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 k- L I.D # dimensioned, north arrow, and location and distance to nearest road. " ' B APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED PROP NER: PROPERTY LOCATION GOVT. LOT 1/4 4's 'N ,R (or~ PROP RTY NER: MAILING ADDRESS LOT # BLOCK # SUED: NA E:.OR CCsfrC#k'f y F 7-1 CI STAT T ZIP CODE PHONE NUMBER QCITY VI S E41OWN N Ds .~L New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe G,~o Recommended design loading rate , Z _bed, gpd/ft2 , 4 trench, gpd/ft2 Code derived dairy flow gpd Absorption area required bed, ft2 lZ trech,3 2 Maximum design loading rate ' 7 bed, gpd/ft2 .g trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site consid rations Parent material '°i "/'IF ood plain elevation, if applicable ft $ _ Suitable for System ONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem jaS [I U as ❑ U 9S ❑ U QS ❑ U O S ~ U 0S U U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Cont. Color. Gr. Sz. Sh. Bed Trertdi Ground 3 zc - 9 3~1401- ALA Sl lr» s ~ d S Depth to limiting factor 0 ~v Remarks: U Boring # U''✓ r l Ground F,-- 0~~/ Y J b 7 S 13- Depth to limiting Remarks: ETNaome-Please PPhone: ress: DT Number: e: % Z PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # a, Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. BRIE! Trench 77 Iv 3 L" 2 Sj k ?,C.- C~ IV( S Ground ✓N C - S I 29 o, S S s yi S ' - 7 Sl Depth to smiting faclor Remarks: Boring # o u g n 3 nom- s~~ S lv z~H 74 I Z ll~ 11 ' GC.) v~ S E3 -11 7~ 73~~4/v y Ground _ g y alms w.r 3 y_~o, S r 0~ s if V L Depth to limiting >faclor Remarks: Boring # 4YV- 13 ~ ~~s~~C w✓ ~s z V,21 7-,,, Sbt d ~ S 3 GJrroound u / G~ S ft. I 1 -~y SY c5J G ✓ S f'y1 7 Depth to limiting Remarks: Boring # '3 Ground elev. ft. Depth lo limiting factor Remarks: SBD4M(R.05/92) 1 3r- s' to 6q es. 3° o \ ~ n ~ 8y I- i I Aopft. '3 e FILED AUG 2 2 8 KATHLEEN H, W Regiswol SL Clotx CO L 548558 0 SEC. 12 CEP T Z E Z ED SUP V E Y MAP NE COR. Located in the SE 1 /4 of the NE 1 /4 of Section 12, T29N, R20W, Town of r. I Hudson, St. Croix Coixnty, Wisconsin. 01= I NPLATTED LANDS S89°03'55"W 91999 tl I I N 89.03'557E 400.74' 1I~) v .05' 77.30' I o ' 7.59' 275 ; 9o' 65' I M o I l0 4t It w /00A_,►. o l 2 I CD Z. / Ia► LO T 2 a / I I E 114,COR. tQ*1 I W ti I SEC. 12'- • I CID CO m / I a l I N ~ ~ Iv m~ a N ' I Im o ti / I i= ao I to ui; W Q: / I j... 10 co ~ I r 3 43 224 q , ~ I' - - N .3 82'45'43"W 14 s 6' I 287.77' I 3 .ti _ r a co M o ~w w Q I - 10 /I 0 N 3 Ich F+ v = to / ~ : r m SHOP - /l C31 CU 2I m I I Z Q / EDGE WOOD ~j .lL ® 7r"' 1 / ~ -•-i ~ / DRIVE o ~3 / Z 411 p co sg •0 •99. .00 21 ` 90, AUG 2 2 '9b J W $ ® / 5 / w -4 CROIX COUNTY 1 S"1'(-'- 105 S1,A)TIC'T'ANK ~[AIN"I'ENANCI. AGRI;F.N(I;N'I St. Croix County OWNER/130YER u zah he, E tter~e e5-~--e MAHANG ADDRESS / 9 M Oh rode Aj' ud -soh u l sym PROPERTY ADDRESS 3 d 44WU 35 N • ~L d~D_Vl (location of septic system) Pl e obtain from~te Planning Dept. CITY/S'T'A'I'R; Lk.d5Q , i-------- - - PROPERTY LOCA'T'ION 5F 1/4, ~ 1/4, Section TOWN OF ~ A SO Y1 ST. CROIX COUNTY, W1 SUBDIVISION LO'T' NUMBF,R CERTIFIED SURVEY MAP j--,e, VOLUMES, I'AGE 3iySLO1'NUM]3EIt ,W 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 sct by the Wisconsin DNR Certification Mating that your septic has been maintained must be completed and returned to the St Croix County l.oning Officer within 30 days of the three Year expiration date SMJNI;I) ~~o un rl : ~~/a 9lv tit Croix County Zoning; ( )flir~. (im,crnrrrcnt Centel 1101 ('.itIII rchael koad f godson. I `~~1(I I I Il'1.( " u A. 1. 1 Vv 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 Lt Z0. h ne- N ar l e- _ED LA_M _eS4er _ Location of property,5E 1/4__,4j 1/4, Section /,2 T_21-2-N-R W Township tA-J,0 Mailing address r ~ 9 YYt ©n rD e ~ d sr~n , w 1 Sal O1 l.P Address of site W 3 Jr ►V , Lt son w 1 5y 0/ ~O Subdivision name f/ dq Lot no. a Other homes on property? Yes XNo Previous owner of property l 1rU :'ea„ne_ ) .[JK ) ry. ),-e Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume r;RpDD and Page Number _nt) 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 7 (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. S tore of Applicant Co-Applicant --q /_i a Date of Signature Date of Signature A VOL 2000 PAc[ 51 WARRANTY DEED 549616 F19EG00 TER'S OFFICE Document Number OIX CO., WI cd for Record 17 1996 Return Address P. M ~U j~UY , ~ Rer"rt 4 of Deeds r~lu d 56A), E folk Parcel I.D. Number: William F. Boumeester, Jr., and Mary Jeanne Boumeester, husband and wife, conveys and warrants to Suzanne Marie Boumeester, a single person, the following described real estate in St. Croix County, State of Wisconsin: A parcel of land located in the SETA of NEIA of Sec. 12-T29N-R20W, Town of Hudson, St. Croix County, Wisconsin, described as follows: Lot 2 of Certified Survey Map filed in Vol. 11, Page 3145, as Doc. No. 548558. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 1 tVY" day of September, 1996. (SEAL) All C>4"O AL) William F. Boumeester, Jr. M y J nn oumeester AUTHENTICATION $ TaSFER Si It F. Boumeester, Jr., and Mary J usband and wife, authenticated .p September, 1996. "till P^ TPi' ER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016