HomeMy WebLinkAbout032-1093-20-000
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STC - 10 4 AS BUILT SANITARY SYSTEM REPORT ~cwvt'
<(,1N ~'iU dry
1 t OFFICE
W IeG~W y /'r'
OWNER KIPN
ADDRESS
SUBDIVISION / CSM# - LOT # 13
SECTION 33 T3) N-R~_W, Town of S01'''~-RfZ~`
.ST.'CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
5A1
54~1~c
`i (3eD2c11
i
Non..e o~ le
31 8,
Yo,
SS, ~ , a
Nv~e : n'IAr~l.o~e i S dVe K
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: IOfl7 A C0k3C [(JP AP FO (Z PI 00() `i-
ALTERNATE BM*
SEPTIC TANK 11PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: JI P ~S Liquid Capacity: Gn)
J-
Setback from: WellN 6 N House S Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
~-1
Alarm Location
SOIL ABSORPTION SYSTEM
Width: (8 Length ( Number of trenches
Distance & Direction to nearest prop. line: OU EF- S;()'
Setback from: well: NOf House U Other S'
HQZ~, C~? rZ 9a - 4a. 39
C r v ELEVATIONS CUVE2 r~'3~
Building Sewer ST Inlet: ST outlet:
~
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system S
Existing Grade 3 pr,p Final grade 1 .5
DATE OF INSTALLATION:
PLUMBER ON JOB:
'T~ 1JP1C t/Yr ~4
LICENSE NUMBER: 3 TU L'
INSPECTOR:
3/93:jt
Wisconsin Department of Industry,
Labor and Human Relations PRIVATE SEWAGE SYSTEM County:ST. CROIX
• Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
26247-1
Pgrtpittipl W', NWT LORI ❑ City ❑ Village R Town of: State Plan ID No.:
SOMERSET AN & CST BM Elev.:
Insp. BM Elev.: BM Description: Parcel Tax No.:
I A9600131
TANK INFORMATION ELEVATION DATA s 5 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic oc. I Benchmark
Dosi n
Aeration Bldg. Sewer
Holding,,- St/Y( Inlet
TANK SETBACK INFORMATION St/,jlii+f Outlet
TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake'
Septic. NA Dt Bottom js
Dosing NA Header
Aeratio NA Dist. Pipe
olding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Mani old 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: SOMERSET.33.31.19W, NW, SE, 45TH ST
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
IIII7~•M1~ Safety o and Building Water Systems
l
_ ~•i~~,ir. SANITARY PERMIT APPLICATION Bureau
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 Count
than 81/2 x l l inches insize. y
• See reverse side for instructions for completing this application State Sanitary Permit Number
ap li ion 7j
The information you provide maybe used by other government agency programs ❑ Check it r Sion 4toevfo_us~
{Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Mrty Owner Nam ~ P o erty Location
-t/4, S 3 T , N, R E (or)
13 Qt- Je -A Prop rt Owner's fling ddress Lot Number 13 Block Number
0 C 44 /
City, State Zip Code Flihone Number Subdivision Name or CSM Number
( //S
II. TYPE F BUILDING: (check one) ❑ State Owned y ay age Nearest~c
+1(
Public 1 or 2 Family Dwelling - No. of be Village oII wn OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
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/ 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.vNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System________System_____________TankOnly 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)VSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 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
Re uired (sq. ft.) Proposed (sq. ft.) (Gals/d /sq. ft.) (Min./' ch) E tion
d 6 J . os.7 Feet Feet
VII. TANK Capacity lloacitn Site
s Total # of Prefab. Fiber- Exper.
INFORMATION New gallons
Existing Gallons Tanks Manufacturers Name Concrete strutted Con- Steel glass Plastic App
Tanks Tanks 11
Septic Tank or Holding Tank Q00 ' W e2 19 ❑ ❑ ❑ ❑ ❑
LiftPump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber:
Name: (Print) Plumber's Signat re: (No Stamps MPlMPRSW No.: Business Phone Number:
fPlumber's Address (S eet, Cit , State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Saryl ary Permit Fee (Includes Groundwater ate Issue Issuing A nt Signature (No St
Approved E] Owner Given Initial f 1275 _A Surcharge Fee)
I /
Adverse Determination / (,~'J
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 n6ov criteria in the
Wisconsin Administrative Code wil! be applicable.
3. All revisionsto 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.
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.
. ._ . . . .
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FRESH AIII INLETS AND OBSERVATION 'PI.PE
CROSS SECTION
. ...._.. _ ...._
(-----) Approved Vent Cap
'•• Minimum 12" Above P;k1P) GicAta
,.. Fined Gr_acle .......‘ - 9g,SS.
1 . .
1 el FA e---,/ • i 1
• 4 " Cast Iron
._
Above Pipe .. Vent Pipe
To Final Grade- • •• • ••
•
. -
_____ . . — • • ,
Marsh Ilay Or Synthetic Covering . .
• \ •, . .
Min . 2" Aggreg',II •.:
Over Pipe ,
. .
Dis tribu Lion I\J Lj 1 --'•• .,,______. _ Tee
. . .
Pipe
In /, ? . . . •
10r. i3r4 Aggregate
2____
e. Perforated Pipe Belo ,
861 - Beneath Pipe
--Coupling Terminating P
,
-- • •-• • Hot. tom. of. System.. . .
•
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•--'•• • • - • . .
. .
isconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page/ 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 8 112 x 11 inches in size. Plan must include, but 6- `k
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
P ERTY OWNER. PROPERTY LOCATION
t' 1,-j A P. do U) GOVT. LOT 114 5-C 114,S 33T N,R `f' E (or
PROPERTY OWNE ':S ILING ADDRESS LOT # BLOCK # SUBD. NAME 20 M #
,3
CITY STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE OWN NEA
e
New Construction Use Residential / Number of bedrooms [)Addition tq existing bulld116g,
Replacement [ ] Public or commercial describe
Code derived daily flow gPd Recommended design loading rate bed; gpd~ft2 trench, f
9P
Absorption area required 620 bed, ft2 0 trench, ft2 Maximum design loading rate s bed~gpdgt2 . 6 tren*"gpd/ft2
Recommended infiltration surface elevation(s) 71,25 ft (as referred to site plan benchmark)
Additional design / site considerations sk- A?a)e 6, -,0',-
WIA
Parent material Flood plain elevation, if applicable
S = Suitable for system CONVENTIONAL MOUND ICI-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem S❑ U NS ❑ U S❑ U 51l:6 ❑ U ❑ S I U ❑ S
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 Trench
Ground 5 -wl/ /0y, e /0 y Q C sc ie C L3 - • 7 Sl
elev. i
9V 17 ft. s-YA s/~
Depth to 161 SY y'S J'~9/ G-IJ - 7
limiting
L
Remarks:
Boring # 'i /Dy
0-/0 YKI Cr
Z lo
Ground
ft. 32's A, /9 9
S 0 3' d~
Depth to
limiting
factor
7s
Remarks:
CST Name: P Pri i J~ Phone: G~ ~0
Address: D
10 70 ~ --?S AJ . sue &J _ 0 6
Signature: Dates / Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page?-of
PARCEL I.D. #
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
q14( kfofu m7 c7a 7-T
2- 1A a" /)Oyr
Ground l -41 ~ 4 vot VP, 6- kJ
/0 w
Depth to
limiting
factor ,
.17
Remarks:
/ - n
Boring # 0 /f1 /CZ Z rte` / h'►U r fib ,S
Ground l0 !ef N'r tj
7/-//I/o ~Av 54" 4,-4 S~q rn
oe.v,,.
Depth to
limiting
,
factor
Remarks:
Boring #
f ti
o- 0/100 5 s S N>~r C~J - ~y .S
3- y3 S C S C: l~ - , ~
Ground
oi"15'!~ 141
y
✓
Depth to
limiting
factor ,
> 7, 33
Remarks:
Boring #
C~.C
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
S9 / 6 5'
4
4o A
203 Ll s° O 13 S
t Z1/' 3
S'o
So`
~ ~gy ~ d d
B
6( 6
I
k
~I
Fle ii. 4(n- o
gqci tae ~s
,(9 3
Cti ~ 7b /r~~ y I ,vih,aw, Cav« k/fr.n.. 7S
STC 105
SI?I'TIC TANK MAIN"TB,NANCF, AGREENI ENT
St. Croix County
OWNEIZ/131WElt -[~_C! _ __fyQ~ f-_C~'►_e Q:
MAILING ADDRESS _4)C)q ('&d0jr S+
D7c #L---------_.
PROPERTY ADDRESS ~~rll S-,r,
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE, rs-J - lz) L ~ Q,~ - - -
PROPERTY LOCATION 1/4, SC- 1/4, Section
TOWN OF ST. CROIX COUNTY, \VI
SUBDIVISION LOT NUMBER
,VOLUMr_~,I'AGE,LUTNUMBER
CERTIFIED SURVEY MAI)-Igffj
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 properly 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
pumpinl, (it necessary), the septic tank is less than 1/3 full of sludge and scum
I/Wc, 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
Cell Ificatloll stating that your septic has been maintained most he completed and returned to the St Croix
County Zoning Officer within 30 days of the three year expiration date
1)A I1F
SI CI+nx Connly Zoning ()11icc
( i++vel mnclll Cetllel
1 101 1 ';+I lnlcl+acl I:oad
Ilnds+m. \V1 ,11010 t I/9,t
8 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 Brj'aA d- D!' t W i e C~n uO
L_N-R_ _
Local ion of property~JW 1/4 rj"e 1/4, Section-3 ,T-
Township =~ome,r se4- Mailing address U09 Ceder- S4 Son+er 4- 41of* f
tool
Address of site Lj<~-4-k -C-4,
Subdivision name Lot no./ 3
Other homes on property? Yes__Z_No
Previous owner of property Z22„r,oA- Ljogu A
Total size of property
Total size of parcel
Date parcel was created 7e,19 , 1975
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume - and Page Number as recorded with the Register
of Deeds. I174. ypq
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
refoi,onces 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. -jyl and-that I (we) presently
own the proposed site for the sewage disposal system or f-1 (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.
Signature of Applicant Co-Applicant
01~ ~ Ce
1'lt i, of i (inat-_ure Date of Signature
i
v
32586
CENTERLINE
I TOWN ROAD
SOUTHERLY RIGHT-
1 1 1 2 OF- WA L
- - - 3=-
EXISTING TOWN ROAD to -J
S88°14'2dE 895.09'
6 6' 518.18' 376.91'
*0 F0 SECTE 1/4 ION 33R T31N R19W
00O
NW 1/4-SE 1/4 Co
I ~
a
I 0 13 W 12 11
cc b
I Z 3 6.78 ACRES 0 5.03ACRES - o o
co 0
3 0 et
N N
0 4t
p1 o CO
I IAA _ 10 o 0 M
Z Z N o
I N STER RIGHT- U)
OF-WAY LINE
X
W POINT OF
9
a00 BEGINNING
920 g0' N 89 ° 30' W
16 6' 482.61' 377.00'
I N 8903d w 859.61' 1745.02'
C~J 'SCALE EAST LINE OF
WEST INE SE 1/4, SECTION 33
SE 1 /4 , SECTION 33 200 0 IOo 200
URVEYED FOR: GEORGE HOLCOMB
R.R.#1, STILLWATER, MINN. 55082..-=
ESCIRPTION:
a parcel of land located in the NW1/4 of the SE1/4 of TRUE
ection 33, T3114, R19W, Town of Somerset, St. Croix County, BEARING
yisconsin described as follows: Commencing at the E1/4
orner of said Section 33; thence S1°07'20"E (true bearing)
1320.00' along the East line of said SE1/4; thence 1489°30'W
1745.02' to the point of beginning; thence N89o301W 859.61';
hence N1o40'W S96.79' along the Easterly right-of-way line of an existing
town road; thence S88°14'20"E 895.09' along the Southerly right-of-way line
f another existing town road; thence S1o45140"W 576.81' to the point of
eginning.
I certify that the above description and map are correct and that I have fully
omplied with the provisions of Sec. 36.34 of the W'sconsin Statutes.
FRANCIS H. OGDEN S-882 MAP NO. 73-142
)ATE: February 17, 1975
WARRANTY DEED
Document Number - REGISTER'S OFFICE
VOL 1179PA,'E489
ST. CROIX CO., WI ,
Recd for Record
54412.8
Return Address J~~Y - 2 s 3 1996
at at 11:00,1 A M
Register Qf 0eeda
Parcel I.D. Number: 032-1093-20
Marion Bernice Hopp -conveys and warrants to Brian G. Wiedow and Lori L. Wiedow, husband and wife,
the following described real estate in St. Croix County, State of Wisconsin:
Part of NWIA of SE1/4 of Section 33, Township 31 North, Range 19 West, St. Croix County, Wisconsin,
described as follows: Lot 13 of Certified Survey Map filed March 4, 1975, in Vol. "I", Page 83, Doc. No.
325865.
This is not homestead property.
Exception to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this day of May, 1996.
T o%FER
(SEAL)
Marion Bernice Hopp
AUTHENTICATION
Signature(s) Marion Bernice Hopp authenticated this
► - day of May, 1996.
,I
Kristina O and
TITLE: MEMBER STATE BAR OF WISCONSIN
THIS INSTRUMENT WAS DRAFTED BY:
Attorney Kristina Ogland
Hudson, WI 54016