Loading...
HomeMy WebLinkAbout032-1082-70-120 a ° 3 0 a 0 y~ M ~ I 0 0 M 0 y ~ •o y O x N y r 0~ O S I Y N U O a Z h LL C co O O) p Q O 3 M a ~ Z y ° i o 1 Z y m N FM- (n I'I a m o I c C7 -o m o 2 d C C •d Z ~ O C O fn F- r- ~ N Z Q1 N O O co N N • A1,~ ~ N CO O Q w O O 0) Z m z Z I ~ to N M N E N Z4 ! a n Y v `y - d h CL M C M e- > N d i O C O 0 d N Z v > N Z ~ N ly- IN- Fy- 2 U = o E O O O 2 0 Z° •~ra 0 a m 0 a Q g ° r y O O N fA J j } V - Q N '0 O Cf) Lo O N N ' 6) O O 7 W O> I m ~ m rn N O I` 7 w O O OC 0 N C N 3 C Y C C hh~~ N c0 00 ee rn H C) y o Q 0 0 0 [v1 M CO O N V) y V° _O r..i O NO S N O . Z o '00 CD F- (D -r N M E n 00 E E t 0 CD F- r \ 2k w I~' v ~ E N :3 y 'v y a w E 'c c 10 CL 0 (5 0 i' STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, a ADDRESS' SUBDIVISION / CSMJ LOT SECTIONT N-R~ W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~y~ 1~oust G~K Ida to t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center -f- BENCHMARK' ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well- House I - _ / 7 Other Pump: Manufacturer Modell Size Float seperation Gallons/cycle Alarm Location :SOIL ABSORPTION SYSTEM Width: ~ Lengthy Number of trenches Distance & Direction to nearest prop. line: Setback from: well: 7,3 House,-2/ _ Other ELEVATIONS Building Sewer /42, D.2 ST Inlet ST outlet qq, PC inlet PC bottom Pump Off Header/Manifold yp Bottom of system Existing Grade IM Final grade / DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt wiscbnsin Department of industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX • Safety and Buildings Division (ATTACH TO PERMIT) Sanitar PermitNo.: GENERAL INFORMATION y268582 Permit Holder's Name: Vill a a Town o : State Plan ID No.: ERSE'1~ FOSTER, STEVE TSOC01 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600288 7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0- 660 Benchmark s/ Gl~ Dosing- (3 A Aeration Bldg. Sewer G1) ,1Ja ' H Ing St/ Inlet 97,212 TANK SETBACK INFORMATION Stl)A Outlet ~7/ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >576 r jj/ /7 / 11,4 NA Dt Bottom yl Do NA Headers Aeration NA Dist. Pipe ing Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~J T Gn ~ C'nu~ / r n CR-t ~ YO 16~), 65- Model Number GPM I Loss Friction System TDH L' rce mead lain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 7 Leng% r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /1--P / DIMEN G Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA Moe r: INFORMATION Type O a-s- C~e 6 ~.J OR UNIT CHAMBER System: DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x H x Hole Spacing Vent To Air Intake Length Dia. Length ~ Dia. Spacing , SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mu d Bed /Trench Center Bed/ Trench Edges Topsoil E] Yes E] No E] Yes COMMENTS: (Include code discrepancies, persons present, etc.) 4- ~s LOCATION: SOMERSET.28.31.19W, SE, SE, 192ND AVE a...-1,e aA.-~ Plan revision required? ❑ Yes 9-N-0- Use other side for additional information. ~l SBD-6710(R 05/91) Date Linspector'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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number a&gsgz., 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 INFORMATI N Propert wrier Nam Property Location T , N, R Flor - 1/4 1/4,S Property Owners Mailin d ss Lot Number Block Num r Ci , tate Zip Code F(PIne Number Subdivision Name or CSM umber rest Road 11. TYPE F BUILDING: (check one) ❑ State Owned E] it Nea 11 Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town Village OF U III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) _J~~ - 70-h2d 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 if 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. 0 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 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. nch) Elevation Feet Feet VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION g 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, t e undersigned, assume responsibility for )nstallation o on ite sewage system shown on the attached plans. Plumb s N e' r JPIumer's Ig u to s) MPlMPRSW No.: Business Phone Number: 257 Plumb is Ad ress eet, City, to , Zip Cod D COUNTY / D PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A gn r tamps) pproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination /`C X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety a 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 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. Vl. 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. /,S~s ,yob lw "sue. ,0. W&bnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 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 / "n 2 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or It D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RQVIEW DATE PROPER,TY OWNER: PROPER AT I0 f 1 ; GOVT. LO Y/4 44,S T N,R E (o1 PROPERTY OWN ':S MAILING ADDREySS LOT # SoNcNAM j,SM o~ CI Z, STATE . ZIP CODE PHONE NUMBER T ~Cc ST ROAD y yCJ New Construction Use Residential / Number of bedrooms isting building j ] Replacement [ ] Public or commercial describe Code derived daily flows gpd Recommended design loading rate ed, gpd/ft2 , S trench, gpd/ft2 Absorption area required bed, ft2 3- trench, 11:2 Maximum design loading rate bed, gpd/ft21S trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem WS ❑U ®S ❑U ®S ❑U PS ❑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. Bed Tre d ...r.... / 7 77 L -~1 Ground & f:~I_ Z' elev. /022 ft. _ r - Depth to limiting fact Remarks: Boring # t `r •4 4`` 7 C V Ground elev. AZ fLLL ft. Depth to limiting fact Remarks: CST Name:-Please Print ✓ Phone: Address. Signature: ` Date: CST Number: Z I- I ~L-- 1 PROPERTYOWNER =52SOIL DESCRIPTION REPORT Page .0i PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench Ground elev. Mft- Depth to limiting factor Remarks: Boring # -1,5- IN :vv.. f se aS -2 1 Ground elev. IS' ft. Depth to limiting factor > Remarks: Boring # 15 4Z w S Ground l s elev. ft. Depth to limiting factor >9~ Remarks: Boring # IN' Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) All 30~ y ~ \3s' 33~ Q ©f°~ 4 78- ~~t STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER _,s+_ y,e °I d h~ T~ FoS+er MAILING ADDRESS tk .35 SV')sr PROPERTY ADDRESS /M 112 kehuQi (location of septic system) Please obtain from the Planning Dept. CITY/STATE , PROPERTY LOCATION 1/4, 1/4, Section e~ T-3-4 N-RW TOWN OF ~Z f T ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP~'~~' ZOLUMEJ,PAGE,LOTNUMBER 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 I, 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, joumeyman plumber, restricted plumber or a licensed pumper verifying that (I) 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. UWe, 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 t e St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: O St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. ownerof propertyS+f'UV_.,,! Q S+e-r Location of propertyg1/4-e1/4, Section T_aLN-R_JI_W Township SI)M.V Mailing address Address of site A Subdivision name Lot no. other homes on property? Yes No Previous owner of property n m 'e- Total size of property Total siie 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 and Page Number 31-;)-l 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 a:, Document No. signature of Appl.i 11t Co-Applicant. f mite of 'Signature Date 0 Sinature I' I C~ vG~ tir 'STATE BAR OF WISCONSIN FORM 1 - 1982 54'7513 WARRANTY DEED DOCUMENT NO. VOL It 92 PACE383 AEGIUERS OFFICE 7 CR01X CTY., W1 s Fse'd for Ae.cd i , This Deed, made between Thomas F. Belisle, a JUL 3 0 1996 single man _ $ty 1.00 P JA Grantor, and Steven D. Foster, Janet M. Foster, and F, _•l Cy Steven D. Foster, Jr., as joint tenants Grantee, Wltnesseth, That the said Grantor, for a valuable consideration THIS SPACE RESERVED FOR RECORDING DATA ! NAME AND RETURN ADDRESS OS7'er conveys to Grantee the following described real estate in St . Croix -;;Zrl 4W 3 S ~F 6Y County, State of Wisconsin: PQ Bem-iv-7 -No 41 e r t✓S 5NO t- Lot 4 of that certain Certified Survey Map filed June 26, 1996 in Volume 11, page 3121, (Parcel Identification Number) as Document No. 545967 in the office of the Register of Deeds for St. Croix County, Wisconsin. II'I $14jFER This is not homestead property. (is) (is not) j Together with all and singular the hereditaments and appurtenances thereunto belonging; ~j And Thomas F. Belisle warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except II easements and restrictions of record i and will warrant and defend the same. Dated this day of 19-9b_. i ' (SEAL) (SEAL) Thomas F. Belisle (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN j ss. St. Croix Countv. c~ 0i FILED 3, JUN ' 6 1996 d KATHLEEN H. WALSH .1 Reofster of Deeds SL Croix Co., WI S~a96`7 r s CERTIFIED SURVEY - MAP Located in part of the SEJ of the SEJ of se, ction 28, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. OWNER E1/4 Corner Section 28 Tom.. Belisle.... . 489 192nd Ave. 1-=ROVEa Somerset, WI _ 54025 3 - $ JUN 2 616.1 Q) fn UNFLA,_ I cD LANDS $ O d O -P V) 0 a oo North line of the S89°59' 24'!W 132 PJ i~`✓t. CROIX COUNTY r-D Z s of the SE>r, 3 5 3.9 2 ' - - - Comprehensive Raw* L ~ Zoning and Parks Committee "'-P N89°39 '03"W 356.80' iv 0,0 riot recorded N c 7 (VI - - . tD WK'hin 30 di} t of c uJI ?OpfOY~I oats N 00 v4rov;O ifiii b# CO w N I N •n R void rrz G 0, w (41 ? [jl Ln LEGEND co cnl ~I. S. ul - 1° CSI Aluminum County Section _j1 LOT 4 ~ ~ _y I Corner Monument Found UI -~I 9 99 Ac. Inc. R/W 2" Iron Pipe Found 1. $ 435,101 Sq. Ft. O 1" x 24" Iron Pipe Set, - weighing 1.13 lbs. per of l~il ' 9.50 Ac. Exc. R/W- linear foot N fall 413,926 Sq. Ft. M 3 Y, x Existing Fenceline v (-1 C Q:I 'co = - - - - Centerline of Existing o Ln Drive 0-1 j - o o - - -100' Roadway Setback line -1 . 11 I-I ~I co I-I I / ~I E LL1 p Z _ll 'c -C01 _ LLI 0 (D ;Zi v w • p v • ~ O r • ~l ,r c W y e c _ N oo N89°59' 45"E ` "`a'~' 1110 170 1 A07 • ( v1 VOL. 11 PAGE 3121 r SURVEYOR'S CERTIFICATE I - Allen- C. Nyhagen, registered Wiscons-i-n---Land Surveyor, -hereby- certify that by-.-,the ...direction ...of ..Steve and Janet ..-Foster, .__.I have ..surveyed, mapped and described the land parcel which is represented by this Cert•if ied Survey Map.;_ ; that the exterior ..'boundary... of the land. -parcel --surveyed and mapped i&-described as follows-,_... A parcel of -w land located n--pant. of. the--..SHI/4 _of.-...the..._SEI/. 4 of..: Section 28, T31N,--R19W, Town --of' Somerset, St-.- -Croix----County, -Wiscons1n; further described as-follows: -Commencing.. at the SZ..Corner of Section 2.8.; thence. .N04°00115"W,....-along the- east line of the -S$1/4, 175.25 feet ...to the._. point of beginning; thence continuing N00000115"W,-along said east line, 1156.58 feet to the north line of the S1/2 of the SE1/4; thence S89059124"W, along said north line, 353.92 feet; thence S0204815511W, along the easterly line of a 66 foot wide private road easement of-Certified Survey Map recorded in Volume 5, Page 1482 at the St. Croix County Register of Deeds office, 958.95 feet; thence S17024125"8, along said easterly line, 208.28 feet; thence N89059' 45"E, 338.79 feet to -the- noIn•t of beyinnina. Above described parcel is subject,..to right-of-way for.town road_ (192nd Avenue),and iii easements of record. I, also certify that this Certified Survey Map is a- correct repre'sentation' • to scale ....of the exterior boundary survyed and described; that._ I- have fully., complied with the current ...provisions of be Land- ubdivision 1 .9 .-Chapter 236.34*• of-. the.--_wisconsiii 'Statute. - Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on..th s .trap (p1atJ...`.is,,. subjijct to-..Stat-,...._Cou4nty. and Township laws,.rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel _Contact the St. Croix County Zoning, Office and appropriate Town Boar for advice. Y