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HomeMy WebLinkAbout036-1031-30-000 y ° 0 o 0 e» of c O a 0. 0 tt m I O N ~ I N D O R c Q Q © O LL) N i LO 0) C x m N ~ r N Ci N 4 N Y ~ 'ti C~ ~0 Y C ~`r C N O. ~ N N N O p >N O C z N > OS 7 75 LL C L ryj m 0 O N N O O N 2) O C U'-0O-0 E Q Q co cm V O M <r ° (3) W E z O O z Ol y o I 0 z g ° v c w a w z in IZ- IT N 0) O N N 7 N ~ • p~ ) Q z m z w z N ° I (n CL r, N O CD O a O O O 1_ ICI d Q m @ N N L7 /1 N y F- U N N F- F- CL 0 0 0 z 0 (L CL CL a~ 7 p U1 CO cp N m j U > rn T N c0 AV w O r O O O N N 0 0) (m C' 04 N O O j M N d O U> N look, ~r ~ 7 w O c N C O 01 O O C Q _ N LO W OM 30 O Q C CL C 0 C y 'y •0 N N N o a, y v n+ M C E (0 M N E N U) I- N O N CIO- r (D ~Y a.. ~ E a w d • m a d d y c rr`Iwwv i c c `'1 A U a li 0 N U Parcel 036-1031-30-000 10/04/2007 09:50 AM PAGE 1 OF 1 Alt. Parcel 14.31.17.198 036 - TOWN OF STANTON 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 - TAMOSHAITIS, AGNES AGNES TAMOSHAITIS 1965 110TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1871 220TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 14 T31N R1 7W 40A NW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-31N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 989/628 TI 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/16/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 92,500 107,500 NO AGRICULTURAL G4 34.000 6,100 0 6,100 NO UNDEVELOPED G5 4.000 2,800 0 2,800 NO Totals for 2007: General Property 40.000 23,900 92,500 116,400 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 19,300 92,500 111,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 STC 104 AS BUILT SANITARY SYSTEM REPORT OWNER L~ . 5z~ ADDRESS ~/C. ~ ~ SUBDIVISION / CSM# LOT # SECTION / T31 N-R_//_W, Town of ST. CROIX COUNTY, WISCONSIN 1;2e P VIEW SHOW EVERYTHING WIT INr100 FEET OF SYSTEM j ve . i Z 7t ~rA 36, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. k S 01 may, S~ C i^s7 y. BENCHMARK ALTERNATE BM: EPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacture . e -e' Liquid Capacity: Setback from: Well ,>~r 11 House / If r~,s Other ' Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 1,2 Length 5 ,5 Number of trenches Distance & Direction to ne~rest prop. line: Setback from: well: L House 67 Other ELEVATIONS Building Sewer f.2, 44 ST Inlet: c>-.3 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system .-7 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3 .3 /3 3 . INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary26Permit No-: 8636 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: TAMOSHAITIS, AGNES STANTON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /Z. 1 11116. 1 Q.tf TANK INFORMATION EL VATION DATA g6nn'l 97 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark oo. Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic Y , NA Dt Bottom 1/61 Zoo 101T Dosing NA Header/ Man. K.51' q?, 411 / Aeration NA Dist. Pipe 93, 9 Holding Bot. System rl ~~3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syesatem TDH Ft oss Forcemain Length Dia. Fi 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: p ,q OR UNIT System: =L 120, 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 : STANTON.14.31.17.NW, NE, 2r20TH/SAVE 6~2 at Plan revision required? ❑ Yes [B"No -I Use other side for additional information. SBD-6710 (R 05/91) Date I pe is nature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' 6 SANITARY PERMIT NUMBER: ^ww~ Safety and Buildings Division rr.••~■~'iR SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 t than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 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 Ow Name Propert Location An 1/4, 5 T 3 , N, IV ;7 E (ore7 Property w r' Mailing Address Lot Number Block Number 6 Cit State Zip Code Phone Number Subdivision Name or CSM Number ~~7 Q L~ 11. TYPE OF BUILDING: (check one) ❑ State Owned Vil l L] cityage Ta;; est Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF" Q h / e"7 p;p III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) O~6 io3/~- 3a 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. Q New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ~SystemTankOnlyExisting System Existing System B) E] 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 Requi,red (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 141~5_ 6 Cf Feet Feet VII. TANK Cap city Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank Y / ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ Cl VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb "Name: (Pri Plumbe " ature: (No Sta s) MP/MPRSRjSWNo~.:l Business Phone Number: u er's Address (Street, it Sate i Code): ~.L_ ~1~ Gam' IX. COUNTY / DEPARTMENT USTE ONLY Disapproved Sanitary Permit Fee (Induces Groundwater DasIssuing A ent S nature (No amps) A/Aroved surcharge Fee) ❑ 75,_- Adverse Determination pp E] Owner Given Initial 014j~~j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: original to County, one copy To: Safety & Ruildings Divr ion, Owner, Plumber INSTRUCTIONS Y 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. 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 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 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. Z",--FLU 1 FLAN PROJECT r <G// - ADDRESS ~1 /4 1 /4/S ~/T /N/R TOWN ~ COUNTY RS `Byron Bird Jr. 3 18 ~;_,DA E BEDROOM CLASS PEROZ CO ENTIONAIIC IN-GR ND PRESSURE-- CONVENTI NAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE /Qzrz~ AFT TANK SIZE DOSE TANK SIZE -HOLDING TANK SIZE - ABSORPTION AREA i PERC RATE BED SIZE h6 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. 0 Borehole Q Well Scale - Feet 0 Perc Hole System Elevation Uent 12" Grnde TYPAR COVERING 2" 12" 3' 4 6' 0 3' 6" Sewer Rock 120 ~C-1 o -~i ` - h w~ o r. cd I Soil Test Plot Plan Project Name yh~s Byron Bi d Jr. Address CST 9 Lot subdivision... Date A 1A&IA S/,4/ T-N/R2,2W Township 0 Boring o Well PL Property Line County L BM or VRPAssume Elevation 100 ft. System Elevation *HRP dl~~ 1'P fir f V b~ 4{ O O Scale 1/4" 10 Ft. When dimensions aren't stated Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of safety and Buildings in accordance with s.1LHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County / r include, but not limited to: vertical and horizontal reference point (BM); direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # r3/-.3 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 Govt. Lot t 1/4 jU 1/4,S T~Z N,R E (o w r 62 Property Owner's Mailing A ress Lot # Block# Subd. Name or CSM# 61 L~~ S f City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ems 5O/ 7 ❑ New Construction Use: residential / Number of bedrooms Z-) Addition to existing building tKLRepiacement u Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate _-2 bed, gpd/fl2 trench, gpd/ft2 Absorption area required 1~5_bed, ft2 trench, ft2 Maximum design loading rate =Lbed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevations It (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 for system YS ❑ U F-11 S ❑ U JX s ❑ u ;KS ❑ U ❑ S XU ❑ S or U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I O /t ~qS'~ e J/ Ground ~lev. Depth to limiting ; fa t ~in. Remarks: Boring # Z., 3 'Z Ground ft. 747'- 1 Depth to limiting factor 7 ,(,~_in. Remarks: CST Name (Please.Pri t) Signature Telephone No. r ~ ~~~~-14 42 o!!~2 Address Date C CST Number SOJL DESCRIPTION REPORT PROPERTY OWNER, "I Page of ~f PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench lox Ground elev. Depth to limiting ; facto ~1O in. /-/-0 Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) .STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 9eVA e OWNERIBUYER MAIL NG ADDRESS PROPERTY ADDRESS 46e;~ Odle If ovation o septic s s m) Please obtain from the Planning Dept. U , 1. CMISTATE PROPERTY LOCATION 1/4, 1/4, Section s N R_Z W TOWN OF h fo PST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER r-~ CERTIFIED SURVEY MAP ,VOLUME 9 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 thesystem 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 plun*W, 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. Me, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance withthe standards set forth, herein, as set by the Wisconsin DNR. Certification statin that, your septic has beg maintained trust be completed and returned to the St. Croix County Zoning Ocer within 30.days of the three year•expiration date. F SIGNED; DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, Wl 54016 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 Location of property. f~1/4,ei` 1/4, Section TN-R, f? W Township ,F7L ~ ailing.address Address of siteIX71 Subdivision name mil- Lot no. Other homes on property? Yes No Previous owner of property f c.~ s Total size of property Sri ez Total size 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 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, I'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 DocQoent 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 as Document No. ignature of Applicant Co-Applicant i Date of Signature Date of Signature { DOCUMENT NA STATE BAR OF WISCONSIN-pORM 2 WARRANTY DEED i! r THIS SPACE RESERVED FOR RECORDING DATA .:3,39662 ~ VOL 3Jr3 ~ X204 Albert Ailts and Alict~ Ailt us w ~ , as s RFGISTFRS Offia , BY THISa n ngan_.d _ p_oint tenants; .iY. CR01X Co., Wl$. ii h b Rsc'd. far R*wd Ns 9 day 0f Apr i 1 A.C. 19 77!1 Grantor conveys and warrarta to _ Agnes LL_ 1'Sha1t1S at 8:30 A. m. a! • Grantee- for a valuable consideration RETURN TO i the following descnued real estate n Croix County, State fWisconsin: 'Tax Key r This is homestead property. The West Half of the Northeast Quarter (W~ of NE4) of Section Fourteen (14), Township Thirty-one (31) North, Range Seventeen (17) West, subject to easements of record. Grantors hereby re%erve a life estate in the above described premises to each of them and to the survivor of them. FEE Ex WT Exception to warrant.es: d It Executed at New Richmond, Wisconsin day of I SIGNED AND SEALED IN PRESENCE OF ` sue-/• ///f~ (gE,A,~ if N/A Albert Ailts_.- - (SEAL) Alice Ailts N/A a (SEAL) (SEAL) signatures of__ Albert Ailts and Alice Ailts authenticated this day 1977 G. E. Norman Title: Member State Bar of Wisconsin ar'Ottter-larcy A thericed•ander-Leer-TCi.Gir►aw STATE OF WISCONSIN l Personally came before me, this. -_-_-_____.N/A day of 19- the above named - to me known to be the personwho executed the foregoing instrument and acknowledged the some. N/A