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HomeMy WebLinkAbout028-1022-80-200 Cb 75 ~T CRX: ~ R T h c 75 6 Q AS-Pui(t Cy Driverway 0 40 6' { 10 30 ~ U 'kale in Feet ¢t6~~° q ,6 tA tc V-4 Q- f-QG, 75 1200 gatlon 3 Bdr m septic 4-> Home C Existing Bottom 04~ ,M Skiing etevatio 100 f eet 75 Richard Walton Owner 0 1985 30th Avenue Baldwin Wisconsin 54008 ~ 684-2069 SE 1/4 SE 1/4 Sec 14 T29 N R 17 W 4-' Rush River, St, Croix County 0 U 30th Ave 30th Ave Wiscogsin Depaftment 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 268570 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: WALTON, RICHARD RUSH RIVER CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /01% , f TANK INFORMATION EVATION DATA A9600256 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark _ 00: Dosing oa Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > a(A NA Dt Bottom Dosing NA Header/Man. 95_~a Aeration NA Dist. Pipe aS 5, r Holding Bot. System , 1q 9 y, 6' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ?6' g3S~ Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well 71 r SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS ' 1,20 DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Model Number: System: s p ' 4 ' yS Q( OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole 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 s~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No -12 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION : Rush River. 14 n 2 R -17W , SE, SE, Gt=.y Fed Y Plan revision required? ❑ Yes ❑ No J Use other side for additional information. I/JLL SBD-6710 (R 05/91) Date 0Ins ecior's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 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 8 1/2 x 11 inches in size. C"a • See reverse side for instructions for completing this application state Sanitar Permit Number aLg5?D 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 O ner Name roperty Location n 1/4 1/4, S T (or W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 6fiN~pw w WZs - o - 6~ D II. TYPE F BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road ❑ Village 'A .e,/~ C~ Public 1 or 2 Famil Dwelling- No. of bedrooms own OF ✓ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 0 b QO2'2~ g Q 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 OnlyExisting 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 30E] Specify Type 41 ❑ Holding Tank 12Tp Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] 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 /y~ Required d (sq. ft.) Pro po ed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 47Y; Elevation V 1 (0 U Feet 717, Feet VII. TANK Capacity Total # of Prefab. Site Fiber- - App INFORMATION in gallons Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic Exper New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑l Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 1-1 u 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: ~ryxl $ GUS ~S- Plumber's A dress (Street, City, State, Zip Code : C V"im" IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial $ 130 a✓ I~~2-- Adverse Determination . 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. ll. 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. 7n Q NOR TH U z d O DrivewaY' -F' E: 52 v 0 to eo 30 40 r 30 gybed O APB W I U Scale in Feet ~r ev'P 1200 gallo >1 septic Bdr~, -P None ~ Existing Bottom of r- Siding elevatio 100 feet 75 Richard Walton Owncr d 1985 30th Avenue O Baldwin Wisconsin 54002 684-2069 >1 SE 1/4 SE 1/4 Sec 14 T28 N R 17 W Rush River St, Croix County C O 30th Ave 30th Ave 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 Attach complete site plan on paper not less than 8 1/2 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: PROPERTY LOCATION R Aatr`6' t:i(1'd+1 GOVT. LOT SF, 1/4 -Sf, 1/4,S I T A% N,R 17 X(or o PROPERTY 0 NER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WOWN NEAREST ROAD P)A 1~ Aji 114)6CC,5M 5 J © (115')631 a66'-7 544 :rV F CAITY D [ ] New Construction Use (j~] Residential / Number of bedrooms 3 [ ] Addition to existing building N Replacement [ ] Public or commercial describe Code derived daily flow S gpd Recommended design loading rate (1•36 bed, gpd/ft2 trench, gpd/ft2 Absorption area required 100 bed, ft2 9,5-0 trench, ft2 Maximum design loading rate Q,i bed, gpd/ft2 b trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 70 ~ btc o1wHnrc) e care ~ (1Wa~c^ w4e3 5i'te Wvm V Parent material e'SS p5 Bpi, Mack 8~r c(-S/af: = to Flood plain elevation, if applicable ft -T S = Suitable for system CONVENTIONAL MOUND 1-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem RES ❑U iS ❑U ES ❑U WS ❑U ❑S ®U ❑S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. RBe Trench 2 3 -3`~ f o l 3 S; l CA c 0 6 Ground 3 2 to K 416 01 elev. q7,3 ft. 0 40 4-70 6-16 Depth to "/c b y vt' IA limiting factor `7 Remarks: Very Wr 'I ~6iv Y~YPvi0114 via) 1o~y ~i ~1,evW` t~. Borin # i S311 ANC ? ~~.~~s i~~~ ~l~ s' ~ FCC c~ 1 0-> 4 Ground n elev. 4f _q ~E? ft. Depth to limiting factor 70 Remarks ylyl'o 1 CST Name:-Please Print A A 1L 6 4 rn / ,157 Phone- go Address: 365_ Ca)nJI J' C 3~Yol Signature: Date: CST Number: C_(11_11 5TO - 02 PROPERTY OWNER ~~'chcrv►;) ydto, SOIL DESCRIPTION REPORT Page -of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench P6 WYE 36 C 2 i~ 3 oY 1 s; I I k C Ground 3 PAS 104 q ~ - - Syrid .L U S CS 0-~ elev. ~10 ft. 6$° ~D I oya 'Z Depth to limiting factor ;7 To Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) 75 i it U ! i I-! U B2 97,8 • z; 0 n/ B1 97,8 Driveway 1 i 0 40 to 30 0 Scale ►n Feet B3 M97,0 existing drywell 3 Bdrm existing se~+ttc -P P Home Existing Bottom of U Siding elevatio 1010 -Peet Richard Walton Owner 1985 30th Avenue 0 Baldwin Wisconsin 54008 684-2069 SE 1/4 SE 1/4 Sec 14 T28 N R 17 Id 4--1 Rush River St, Croix County C 0 U 30th Ave 30th Ave I F 75 ry NORTH >1 U Z d 0 ry Driveway 0 40 :5 o 30 is eI 1 AP4 b 1 bid U I -1 Scale in Feet ~ 1200 gallo Bdrm septic 3 Hom m -N e ~ Existing Bottom of U Siding etevatio 100 feet Richard Walton Owner 1985 30th Avenue O Baldwin Wisconsin 54002 (E 684-2069 >1 SE 1/4 SE 1/4 Sec 14 T28 N R 17 W Rush River St, Croix County C O U 30th Ave 30th Ave K. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER i?J C 94 p Ll-)A I -roAl MAILING ADDRESS `rl' O I h4- R U & : PROPERTY ADDRESS 3 CAI do k Q 1 (location of septic system) Please obtain from the Planning Dept. CITY/STATE " `3 & I,y / w PROPERTY LOCATION 1/4, 1/4, Section T N-R W TOWN OFv ST. CROIX COUNTY, WI SUBDIVISION , LOT NUMBER CERTIFIED SURVEY MAP , VOLUME417, 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 year expiration date. SIGNED: t GAG%2/ DATE: 8 -40/ - ~O 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 '21le-#ox D W,+ 1 T W Location of property 1/4 1/4, Section , T N-R W U~ Township QL S Jj A Mailing address -~1o 714 1-4/ p W~~ W Address of site Subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel p o Date parcel was created Are all corners and lot lines identifiable? Yes _NO Is this property being developed for (spec house)? Yes No Volume y i4r( 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 & 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 off ice of Cniinf- Paorli c+-nr r,f A-Ae r~ ..............a. DOCUMEWT NO. Sr ATE 1"R OF WISCONSIN-Irmid S POSO~aAL RQpESENTATIVE'S DEED ° Itl . M ^'LXJ~ ~ ~ ~ 577 ..cE Ti1r3 S+•wCE A~`trVEO f0n NEC0110111G OAT> V( s ~ SRS OFFICE j 11inr1r~saF Bank Minrtedt~l.iS, N. A., formerly 1Q'~C'1h1Y1 as It. `„-"l~n CO., w/5. j j bitth_.ater• .ts«iQ l Bank of Minnea:..lis, a national :edL ur ra-c-, t9 this 30th hanktng association , as Personal Representative of the estate of )gov. A.D. 19-83 day NN=J X200 P~tlA. fnc a valuable consideration conveys without warranty to_r of~ D. Walton and Joan M. Walton hi.sban9 and wife as tenants in coltuct, Id D. Walton an undivided two- EUrds iRF Joan M. Walton an undivided one-third NETUM TO interest, Grantee, the following described real estate in St. Croix Cc_nty, HAROLD D. C LSON State of Wisconsin: (hereinafter called the "Property") AT'GRNEY AT t I'W flstON'IN, WI Ta Key No. a The Southeast Quarter of the Northeast Quarter (SE 1/4 of NE 1/4) and the East Half of the Southeast Quarter (E 1/2 of SE 1/4) of Section Fourteen (14), Township Twenty-eight (28) North, of Range Seventeen (17) West, St. Croix County, Wisconsin. West Half of Southeast Quarter (W 1/2 of SE 1/4) of Section Fourteen (14), Township Twenty-eight (28) North: of Range Seventeen (17) West, St. Croix County, Wisconsin. S $i~• ~t$Li iven in fulfillment of a certain Land Contract betsween Marcel K. Lynun and 0:40 i ',tuband and wife, and said Edith H. Lynun in her own right, to Richard 'X.-Wit. anfl,,~paf1 M. Walton, husband and wife, as joint tenants, dated February 18, =e ` ~'"9 &k. r~coj!449 9}arch 13, 1969 in Volume 449, page 615, Document No. 295565, in the >~i of of the Aegi ter of Deeds for St. Croix Qounty, Wisconsin- Personal Representative by this deed doe: convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. NOFWEST BANK 1.MM*a AP0LJS, NA OVAL ASSOCZATICN, Pe to m crf the Estate of 9ar~i t Dated September 2, 1983. t Yn • (SEAL) By / / (SEAL) Its Vice fesi en[ Wflliam J. en By . Z-4,Aosa- A_ Hellickson Personal Representative Its Assistant Vice President AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this . day of STATE OF 19 ss. Hennepin County. Personally caste before ®e, this inn day of September s]9S_~ Ike above named William J. Cullen, a Vice President and E. A. H- eTTic1son TITLE: MEMBER STATE BAR OF WISCONSIN Assistant Vice President of Norwest Bank (If not, Minneapolis, National association also known as Nor, p~nlr Minn.-~nca2ic N A_ , fnrmp 4 authorized by 4706.06, Wis. Stats.) known as Northwestern National Bank of M iAnne.aP as.soci.a"t:-i.an This instrument was drafted by Nancy S. Bender-Kelner Fae re Benson to me }mown to be the person s who executed the fore- 2300 Multifoods Tower goingibstrument and acknoariedged the same. .Z Cnnrh Firh Rrrppr ~ . - - - - 306 JUN 2 3 F 7s 6 1 GD ST. CROIX COUNTY QN 2 SURVEYOR'S RECORD 8,1'91999 ~ • ~ Z ~,WA L a0O* d CERTIFIED SURVEY MAP Richard D. And Joan M. Walton Part of the Southeast 1/4 of the Southeast 1/4 of Section 14, T 28 N, R 17 W, Town of Rush River, St, Croix County, Wisconsin EAST QUARTER CORNER SECTION 14, T 28 N, R 17W (FOUND PK NAIL) 8 l&ej. ;TED LANDS I S 88014'54°E 211.01' 1/ 78. 0' 33.01 I I 100 33' 33, I AREA N 41 rDRIVIEWAY cn EPTIC ^ N I b) u N 00 V ELLING N N I N 0 ~I N O WELOL 0 W I Q! Z LOT 1 Z~ QI 0 58,617 SQ. FT. OR 1. 346 ACRES a J~ SCAL f fN FEET I_ 60' (INCLUDING R/W) I L 0 15 30 so 120" J) 43,618 SQ. FT OR 1.001 ACRES (EXCLUDING R/W ,BEARINGS ARE gEFERENCED TO THE SOUTH ) _ LINE oF.THE SEI OFSECTION 14, ASSUMED 33' 33' J BEARING N 890 05 57 ° W. . N 89°0557°W 177.97' N L_ O W 24 4.02 M 30th CENTERLINE n 1 AI/f - ~ ~ H AV E 1~ 210.97' - - SOUTHbUARTER CORNER - - - N 89° 05'57° W 2634.99'--- SECTION 14, T 28 N, R17 W M (SET "RR" SPIKE) M SOUTH LINE SE I14 SEC. 14, SOUTHEAST CORNER VNPLAT TED LANDS SECTION I,4, TgBN R/7W I - - (FOUND RR SPIKE) LEGEND' i;,,. Indkotes /"x 24 Iron Pipe Set 0 (Min. Wt.-I./3/bs./Iin.ft.) ~5 C0 /VS. /A ,