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HomeMy WebLinkAbout030-1099-80-000 '0 O Q C '3 O M ~ c M CO a C C a) _0 N I N NL O(O~ i O F a) Mp I ' C X C I 2 E C 0 -Z6 2 O C T m p o C = N co . N N C d > c o Q N O y d N .C N N c C p C 0 ' z o O c O O L 0) n3 "O C N aNi CO p O°?9E C) N w M d M C Z O T D N 7 N- co N N -0 C LL C M U C tM N N o 3cwN I E a~ y ~O <i EL mw-0~ c a> O w E z = 00 a z a m 0 m IM- c O c C7 f° o z d c w a~i Z c Z N O M a y ►~1r 0- r o N o_ _ ►i m O U © p N a Z I- Z p E N L O, w - m c O O W d i N C 0 O o O 0 a 0 p> v N N N N Z 3: .p z o o o z C a a a a 0 N W J U = m a) O }y~ ~ Z \i w r- ~ O O Iry ` a) O O o o ~ a M ao I c m o N a z U) 0 7 o U c y 00 0 30 p C N CO O © p o 'a0 F- ~ a) a N N N r N O rn O N O 'a 1- 00 (n -o G ° o o ~Lr) Q) , ~j try~,j O M y 00 N E Co U :51 E \ CC " E d v d ` a a d j 0 L 3 0 wr Parcel 030-1099-80-000 10/03/2007 09:32 AM PAGE 1 OF 1 Alt. Parcel 33.30.19.358D 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ITEN, DIANE M DIANE M ITEN 554 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 554 CTY RD E SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W PT SW NE W 379 FT OF Block/Condo Bldg: THAT PT OF SW NE LYING N OF HWY E EXC PARCEL DESC IN 408/220 EXC TO HWY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 33-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 886/630 07/23/1997 680/323 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 161,600 156,700 318,300 NO Totals for 2007: General Property 5.000 161,600 156,700 318,300 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 161,600 156,700 318,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 WisconV.n Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) sanitar~P6ef3r 525 GENERAL INFORMATION jtHoldefs 10pe: f7 Sity SEacle Town o : State Plan ID No.: CST B!`~IM Elev.: AAllVV Insp. BM Elev.: BM Description:: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600235 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent iritontake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Ar Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBER Model Number: System: 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST JOSEPHa33t30.I9W, SW, NE, CTY RD E Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i ~ 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. GCb~~ • See reverse side for instructions for completing this application State Sanitary Permit Num er cp(oBS0S 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 P rt y Owner Name Property Location E (or W u1/a al/4, S T 3v, N, R lcf Property Owner's Mailing Address Lot Number Block Number C, y, St a Zip Code Phone Number Subdivision Name or CSM Number l~1I. 5- 401 6 (-7/5- 11. TYPE F BUILDING: (check one) E] State Owned E] ill Nearest Road C] VII age r 2 Family Dwelling -No. of bedrooms _ wn OF 5+- So III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment / Condo O- O cl - d 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 21 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5.epair of an System System Tank OnlyExisting System ______Exlsting 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 Lepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 {'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/day/sq. ft.) (Min./inch) Elevation S-(::) eetl Cf Cf. meet 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 t r-J ~ Septic Tank or Holding Tank ~(7C7C [ t ❑ L 1:1 ❑ Lift Pump Tank /Siphon Chamber 1:1 1 El 1 1:1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. s Phone Number: 911 im rer's Name: (Print) .9honeWpol=s Signature: (No Stamps) MP/MPRSW NO.: 7T37T/5;--,3 d c - L~ ress (Street, y, St te, Zip Code): s Add p -1 tw dt 5004 % (54o16 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signature (N t ps) AApp roved jSurcharge Fee)❑ Owner Given Initial ~ Adverse Determination CONDITIONS QAPPROVAL/ RE ONS O DISAPPROVAL,;. ,-f,J. Q-{~~S SOD-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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be instal fed. 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.T,-, 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 8 112 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 , . _T - 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. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS '5S CIV-1 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE e, t , "h . PROPERTY LOCATION _ 1/4, R E__ 1/4, Section 3 T 30 N-R__LCI_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , 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 ex iration 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 property77D`'4 aMt - ~4 Location of property_W 1/4__tjE1/4, Section 3 T 3L.N-R )q -W Township Mailing address 6-64 G4. , . -Z j-, E Address of site Subdivision name Lot no. Other homes on property? Yes- No Previous owner of property r Total size of property S 0~-c Total size of parcel Date parcel was created 1164- Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number 6-30 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. 6$G V.,d-c 63y , 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 Signature of Applicant Co-Applicant 12 Date of Signature Date of Signature ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: ~1..~ 1/4, tit E- 1/4, Sec. TAN, R_2_W, Town of J dT, Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced r\^C"\ l ~9(3 Did flow back occur from absorption system? Yes"*r No (if no, skip , next line) Approximate volume or length of time: (coo gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : Age of Tank (if known) : < .A~f~., tR ~•l 1 ti %3 (G CA-4 ignature) (Name) Please Prin t~ - ~c.'~ - C.ci~.~'~•~ .~`rlc.~'~ a.1 611-1 0 (Title) (License Number) -111 -4, 1 C (Date Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/MPRS 5/88 y Vii ~ GA~T~o•J o ~ ~o~ ~s ,fit' T~4~•v~~' 7~ ~ X i 5 Ti,~ G- S !/S ' doe 5 y/5T~,~-t /~E • ~'vv~,v~4-~ <o..v /J/~oG~'sS //i;~~}--- ~ER/~~4 G ~'FT Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of 2 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~T C/PO~ K percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. If 0 30- /of F- 57000 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location V1 41u E Z~EAJ Govt. Lot 5&,l 1 /4 M5' 1/4,S 33 T 30 N,R 19 E (orxD Property Owner's Mailing Address Lot # Biock# Subd. Name or CSM# 5.5"y cry RIQ . E City State Zip Code Phone Number Nearest Road *04-TOA) W/. TYO $z (syq) 636 ❑ City ❑ Village IJ Town hr/ E 3 ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement / ❑ Public or commercial - Describe: Code derived daily flow Y70 gpd Recommended design loading rate 7 bed, gpd/ftz • 0 trench, gpd/1`12 Absorption area required bed, ft2 7~0 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 ' 9 trench, gpd/ft2 _0"enimended nfiltraflon surface elevation(s) 77 ft (as referred to site plan benchmark) Additional design/site considerations / Fr& ~ Parent material :5e--5 y ~ SA"p UC-.,,Pge;e Flood plain elevation, if applicable ft O S = Suitable for system Conventional ~oun~d In Ground Pressure ,AT,-GGrrade System in Fill Holding Tank U = Unsuitable for system 2 S ❑ U L`~ ❑ U ❑ U S L`~ 5 El U S 11 U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench f / D-$ 10fil2 313 S/ zfSbt .ttit f~ eS 2- • /L 10V 3/3 S /-IZ,e /•-6e e- /f Alp - 3 s ; . Ground 3 a.- /o 511. 2-jC 4e 4~A elev. 99. 20 ft. y /O S C •S. 5- Ge~ e a 10!112 5X *7 8 Depth to limiting factor Cin. 7 /o-a- r 7 ~d'? Remarks: Boring # Ground elev. ft T is test ite AP I . or a o v all 31PUC; 5 (*Will. Depth to limiting factor in. Remarks: CST Name (Please Print) O 61✓R 6 i2 Signature telephone No. T- ~ 1 I COLT- ~ r'~ 7~S 0 Co - /8_67- • a N e4 Q N ~ o ~ Q , Vv ~ j 40 Q o M ~ V Ob ~ a N 0 rl) C n DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 9-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 46,1341 , ~~I~~jr - REGISTER'S OFFICE ST. CROIX CO., WI 7era Ld .R. n Lsen, sln,~ Le Reed for Record quit-claims to. 1 J`~ 2 11990 at 4:00 P. M "Lane " Tten v Register of D the following described real estate in `:t - t7ro 1 v County, The ,des} 379 feet of that part of the Southwest 1/4 of the Northeast 1/4 of Section 33, Township 30 North, Range 19 West, which lies North of the Northerly right-of-way line of County Trunk Hwy. "E", except that part thereof deeded to Richard Ostendorf and Rosalie Ostendorf by deed recorded November 2, 196,4.in Volume 408, page 220, Document No. 278060. Examiner's Note: The description used in Document No. 278060 is as follows: Commencing at the intersection of the West line of the Southwest 1/4 of the Northeast 1/4 of said Section 33, Township 30, ^ange 19, and the Northerly ry e right-of-way line of County Trunk Highway "E" as presently used and laid out, thence North on the West line of the Southwest 1/4 of the Northeast 1/4 444 feet, thence East 160 feet, thence Suuth to said Northerly right- of-way line of said County Trunk Highway "E" as presently used and laid out thence Westerly on the Northerly line of said Highway "E" to the place of beginning. t.s deg' is 7Lven to rPleTSe.any and all interest ;grantor has to su5Pct oremisPs,incLudtnR without Ltmttation any and aLL interest reserved unto 7rantor under the terms of the judgement and decree of r'issoL;ltton of narria?e dated recember L5th. 'L9 6,fLLed in St. Croix county dLstrict court,-Lie k d6--A-L69 This is homestead property. (is) (is not) Dated this day of ovember 90 19 (SEAL) (SEAL) -eraid 3. jLsen, sinSLe (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Ar.neaota Signature(s) STATE OF iP KPI010"StPf* ss. __BgneL _n - County. authenticated this day of .19 Personally carne before me this N day of overiber .19- )O theabovenamed ,PraLrl a. seg., sIFT P TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person- who executed the authorized by § 706.06, Wis. Slats.) foregoing instrument and acknowledge the same. MIS INSTRUMENT WAS DRAFTED BY