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HomeMy WebLinkAbout030-2094-60-000 -0 0 Q o CD o CIA C) h o a ~ w d o c '0~ N 'p 7 a O N O C C Q QQ 4 E N O a~ O V> O O r C Q X ~ v O Qp y' o C C S U 7 CO O CO m N N 0 N co Q C O m ~ I Z O) Z = O O N d rn co W a m N H Z ~I O C U' '0 v o Z d c - d Z c N F- r y Z c ~ -a N N ~ 7 CL N N O C • C a L .2 0 cu C O U O N Q t-- I co Z O -0 Q Q z N rr ~ N d C • • C NI V (Q G _ O 4) (D - a C Cl) O 7 N i N J O O LO .0 ui L D d 76 N ,Y~ w y~ (n fA N O JU e~ _ o ° o 0 0 0 0 z •"OVA N a a a 7 7 O N 3 OOi N J 0 a~ rn rn j } CO co o o ~i m o o 0 0 m C, C^1 +i E O O E N 00 07 = d r- N V N O co N N _ V y Q } Q O O C J N C b O O C O C E N p N t0 O O~ Q O C N - N N N 00 a C CD C r c E N _ N lrx'j N M E CL (0 O.7 Z. r W O to N E C~.7 I O 0 C,4 O O ik L7. a CL 4) 'Irul ~ i c c ~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 2~" / ~~jL~f,Fr,~P~-lc.T ~ 5 1991 ADDRESS 9<' 'Af (/j~-T1) gEcEtl,11 MPR I~u ~T7JnJ. e.~J I ~ SUBDIVISION / CSM# y/il/442D ZT - LOT # SECTION ,~22 T ~N-R__Z2~_W, Town of S j - On& / ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTH .Ni-JiITHI.N._10_0.._FEEZ_..9F-..S_YS .EM_-Lr~ rt ~r ~ 7aXC7 r, 3, r z. ~o ("Az- _l, 74 J~ INDICATE NORTH ARROW r Provide setback and elevation information on reverse of this form. x Provide 2 dimensions to center of septic tank manhole coll- . BENCHMARK: -7-19p c L ,iZyy S~¢TL 10"t 6441j~~2. ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATION b / Manufacturer: i.~a.2g STL~ f / r4Liquid Capacity: Setback from: Well, douse Other Z e- Pump: Manufacturer Model# Size - Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Ig_ Length 6". Number of trenches sc L> Distance & Direction to nearest prop. line: Setback from: well: House (j2 Other %2,%4-D Ifl ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 5 Z) IF INSPECTOR: p-~-•, l ~t co") 3/93:jt i ! Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division s ' (ATTACH TO PERMIT) sanitary m o.. GENERAL INFORMATION 2686*8 Permit Holder's Name: ❑ City ❑ Village 41 Town of: State Plan ID No.: KRAMPERT, ALLEN L11 rr. j1WEPv CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: / / . Ce Sanc a S TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 _ r /05,03 Dosing COL 5-& 4- Aeration Bldg. Sewer r St/ Ht inlet 7,16 v , 55 Q3 TANK SETBACK INFORMATION St/ Ht Outlet -7, Yf' TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet 4 Septic SO r l ` NA Dt Bottom v~ . Dosin Header/Man. Aeration Dist. Pipe 33' 101. Hold' Bot. System ; i7 )6e?. S ,;L PUMP/ SIPHON INFORMATION Final Grade Ma ufacture Demand S` ~ ; ~3 Model Number M TDH L' Lriction System TDH Ft Forcemain Length Dia: Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a 11111 7 DIMENSIONS LEACHING SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK urer: INFORMATION Type O new CHAMBE model Number: System:e,-,jj- Li'd ~7~Ifa. OR VWT DISTRIBUTION SYSTEM Header / Distribution Pipe(s x x Hole Spacin it Intake Length Dia. L Length o _ Dia. Spacing lt3 SOIL COVER x Pressure Systems Only xx Mound Or At- a Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil El Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSE1*,.19. 30.19, i SW, Lifer. i H10 iLA VIEW 30 t~ I1a 'revision required? E] Yes to Use other side for additional information. - ~91 SBD-6710 (R 05/91) Date Inspector's ignature Cert. No. T ADDITIONAL COMMENTS AND SKETCH . SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION bureau of Building Water System! V.~`AA 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 9f, cro than 8 112 x 11 inches in size. n • See reverse side for instructions for completing this application State Sanitary Permit Numb/e_ra ~ ? 6 6`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 Propert wrier Nam ert~Lq`ation o 1 (.~J 114, 5.2. Q T ~Q N, R l! E (o W Property Owner's Mailin Address Lot Number S Block Number qqy, State Zip Code Phone Number Subdivisipin Name or CSM ;umber II. TYPE F BUILDING: (check one) ❑ State Owned _ ItY Nea est Road / Public 1 or 2 Family Dwelling - No. of bedrooms own of P 6// III. BUILDING USE: (If building type is public, check all that apply) r Tax Number(s) 1 ❑ Apartment/ Condo 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 XNew 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 1 loseepage 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 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/dip/sq. ft_) (Min./inch) Elevati n 4 ©d 11..'200 le l, <7 Feet 0 Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Concrete strutted glass APP. Tanks Tanks Septic Tank or Holding Tank .2 dry 1,106 6.J-6 f Tr -V? En ❑ ❑ Lift Pump Tank /Siphon Chamber, 'E ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu tier's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: Plumb is Address (Street, City, ate, Zip Code ,r~/35z Sn¢I-s- / it,( 4o lLzc- ails SY ZS IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issui g Agent Signature (NO Stamps) ) Surcharge Fee) Approved ❑ Owner Given Initial 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 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 nevv 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 smallerthan 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. S-`?~ j ff-n.1 c=~2 v At1~ S7 ~C(~ ~y ~ u~ ~Y Ste? 4 'T3~K.~ ~"c l / t.~s p n S s c'~~ rA- v h17 9 z e a~ ~ g Z ~l v P f ~Z rs ~.z ©a G P qo P ~ SSG ~ - ~'h Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division-of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY • St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Jo Ann Persico Bruce Peterson GOVT. LOT NE 1/4 SW 1/4,529 T 30 N,R 19 k(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # #328 Co. Rd. #F MM 15 na Highland Hills phase II CITY STATE 54016 ZIP CODE PHONE 3868ER OCITY OVILLAGE OTOWN NEAREST ROAD WI. (7 , -8236 St. Joseh CO. Rd. E [x] New Construction Use [ jj Residential / Number of bedrooms 3 (J Addition to existing building j ) Replacement [ I 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, gpdfit . 6 trench, gpd/112 Recommended infiltration surface elevation(s) 101.59 ft (as referred to site plan benchmark) Additional design / site considerations none Parent material alacial till Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem EFS O U 19S ❑ U 0S O U 0S O U 0S IOU O S MU 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 Tre & 1 0-10 10yr4/3 none 1 2msbk mfr 9w 2f .5 .6 ti§17.1 0"1 2 10-15 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 3 15-56 7.5yr4/4 none sl lmsbk mfr 9W na .4 .5 Ground elev. 104.814 4 156-82 5yr4/4 no 1 lmsbk mfr na na .4 .5 Depth to Limiting factor r r +821, Remarks: Boring # 0-9 10yr4/3 n / G L. 1 r' 2msbk mfr gw 2f .5 .6 2 2 9-22 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 22-48 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 Ground elev. 4 48-86 10yr4/4 none co.s. Osg ml na na .7 .8 104.019 Depth to limiting factor +86" Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1554 2 th. Ave., )Jew Richmond, WI. 54017 N y~ Signature: ejtll~ 6-24-94 Date: cs STZ~8 lu r PROPERTY OWNER Persico/Peterson SOIL DESCRIPTION REPORT Page _2 "of 3 ` PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ~Trerxh 1 0-9 10 r4/3 none 1 2msbk mfr 2f .5 . .6 2 9-22 10yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 22-4 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 elev. 105.84x. 4 48-96 10yr5/4 none co s Osg ml na na .7 .8 Depth to limiting factor +96" Remarks: Boring # ~:„4... 1 0-10 10yr4/3 none 1 2msbk mfr gw 2f .5 .6 4 2 10-17 10yr4/6 none sil lfsbk mfr gw if .2 .3 3 17-78 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 104.04t. Depth to limiting factor +78" Remarks: Boring # 1 0-10 10yr3/3 none 1 12rnsbk mfr gw 2f 1.5 .6 <5 2 10-27 10yr4/4 none sil lfgr mfr gw if .2 .3 3 27-80 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 104.59t. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. I Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Highland Hills phase TI 1554 200th Ave. CSTM2298 lot #15 New Richmond, WI 54017 MPRSW 3254 NE4SW4 S29-T30N-R19W (715) 246-6200 town of St. Joseph N 1"=40' BM.=top of NE lot stake at el. 100' 3 7' Alt m c~' ,t- z Z zz IoQ~ z 070 -2~ 070 -2 Gary L. Steel 6-24-94 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix /County OWNERBUYER ~f L L I'C 2 ~h Q~'~T MAILING ADDRESS L4zJ t S rr+6 V , PROPERTY ADDRESS 1C ~Z~fp C ' t--tj (location of septic system) P ease obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 4/4~ 1/4, 1/4, Section ~2 7 T N-R / Q W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION f> LOT NUMBER CERTIFIED SURVEY MAP _1 VOLUME PAGE , LOT NUMBER I 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: T 3 I to St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 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/-// L AlkIi,~, r°tE-7f c 114 SU ) 1/4, Section r,- I , T36 N-R W Location of property 6 To hip s7 Mailing address~/S fr6NLrI~ 11 / c-z~S ~ i s ~ D Address of site So ,,S , -s-Y& A~ Subdivision name D 1 11rtsz-r Lot no. Other homes on property? Yes X No Previous owner of property Total size of property Total size of parcel D S 14- 1IC= 9 Date parcel was created Are all corners and lot lines identifiable? V Yes No Is this property being developed for (spec house)? Yes )e No Volume 1197 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. -:5-419 72 / , 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. 7 Z Signature of Applic nt Co-Applicant 1 b-:5h./ Date of Signature Date of Siqnature IL y' aL 1197 PAul 5.9 548721 WAPJRANW DEED F~ECi En oFM Document Number 8'E CM M V4 MINA a AUG 2 7 M 30. Retum Address [`41tur.. 11: A.M it "O.L M gi 1- dDn& 1 I.D. Number: 030-2094-60 - Farce I (p_ M Highland Hills, a Partnership, conveys and warrants to Alks I- described real estate in St. Croix busband and wife, as survivorship marital proeprty, the Mowing County, State of Wisconsin: St. Croix County, Wisconsin. Lot 15, Highland Hills First Addition in the Town of St. Joseph, This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this. I'S day of 1996. Highland Hills, a Partnership s _ (SEAL) (SEAL) JoAnn Persico, individually and as Power of Attorney for Bruce Peterson and Roger Ruelin ACIMOWLEDGMF1" STATE OF WISCONSIN ) C COUNTY )33 Personally came before me this 1 S _ day of 1996, the above named JoAnn Pereico, individually and as Power of Attorney for Bruee and Roger Ruehn, to me known to sad ackomledge the same. be the person(s) who executed the foregoing instrument - Notary Public County, WI Alm Joy Camms My commission expires Stitt of( WLVM361 A~ THIS INSTRUTAE WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 0 F Q co to zl w mJ O 0 Z ;O w DRAINAGE 'n EASEMENT 00 o 477.26 0? 1 0) S00° 34' 57" E 504.99' ° 267.55' 1 237.44' ° I 1 50' 0 : lD 00 I : H W N O ~ N M DRAINAGE 0 EASEMENT ar` I 33' 33' o N W W ~ 3 d' 0 , .J M M : W ,Ofl NI j. N ~ t~ I O , O 0 > 0 ~ OD OD N • Z Z I F- N IL N W. W w 0: N I • ~ ~ Q Q N 18,0 8" E 487.89 I p 0 NO 3 J M I I Ii - I O M M v M - WI I v' N 0 cV 0 3l , S- OD ~ 0 i~ W N° W d n O U N 0 O LO (D 0 ON © 2 J M M ~ / ~R I I I - N01 ° 34' 23" E 630. 29' - I I 302.57' 327.72' I 350.58' 279, I ~ I • I I ' 3' 04%@E 440.43 I © 1 . I I I , v 0 cl N : N W z Iq cli : 0 M o f W 0 Z ~ W} W 0 W N 3 O Q N N Q 0 N N I N N 0 w _j K; (A (r d w - d OD u o N 66 ' 0 Z a 0 N co W O 0 1: In I _ J m OD I f 0 m \ J 1 1 N N J p o ,ZL'LS~ W W N L ,19'IIZ • , ,b8'016 N N I N N l0 in