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HomeMy WebLinkAbout036-1050-70-100 Q o ° a O M ~y 'C U I a O Q C C G ~ I ty I C C '0 O 0) LO X ~ i H ~ O C ~ I _N U a O N C Z w 7 L LL C 03 O O O O Q O z ~j O Z Z i Z ~ y y N H Z d m o I O z ? c d Z C O N F L m y Z C 27 N m v o • a t p z co z N ~II~ C z _ M d O N 5 00 7 N N co LO N L U O > N y i ~ O O 0 a o a a o -,T 04 Q p CO N N w z > s 3'S R. U Z O a a Z, g (D O N z CD (D N ~ co o j N~ O O O Z: -0 C) o Q r- r- a _ N N r- 0) E ,Ai~..1., L O O 7 O W N m O W w a) Q G O O T N C r.+ Or N O C C E N co am O C co, ta) N N CL 30 ` a Q lo N 0 C5 CD N 0 i~ ~ E E O N N N N y~,l C - co O O O in N >O H O O c0 ~ _ a) 00 O y U • O N U) W N O Z N ~ O ~ ~ # w = 4 ~ E d d~ a t _a L a w • tq a G U m y E L O C 7 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT SECTIONA. ' T_ l T N-R_L7_W, Town o f1- d ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S e 9-1 f -o INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. . ~I BENCHMARK: C ,9 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER /,HOLDING TANK INFORMATION Manufacturer:Z')"'e<.e.r Liquid Capacity: ZQC Setback from: Well House Other t Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Wij*th: Length Number of trenches °5tanc Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer l 5`7 ST Inlet.jj,_L~ ST outlet PC inlet PC bottom Pump Off Header/Manifold_L Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: C.- LICENSE NUMBER: INSPECTOR: 3/93:jt a -Wisconsir.PepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ~ ° C'ft:3ZX Safety and Buildings Division INSPECTION REPORT S'~ (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 68513 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600223 4/ Zke- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SepticS n/ / Benchmark} Dosin C~ l . A , 31 -4,!2,7' Aeration Bldg. Sewer 97: 7/ Holding St/ Inlet TAIQIK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic NA Dt Bottom i Dosing NA Headers k-7 eration o A Dist. Pipe ~'lding Bot. System ~ PUMP/ SIPHON INFORMATION Final Grade Mar,w turer Demand r Model Numb GPM TDH L Friction Ft F rcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits on-side Dia. Liquid De h DIMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEA IN anufacturer: SETBACK C AMBER INFORMATION Type O Q, Mode Number: System: n~a. C R UNIT DISTRIBUTION SYSTEM Headers Distribution Pipe(s) d / x Hole Size x Hole Spacing Vent it Intake Length Dia. Length S~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Moun r At-Grade Syste my Depth Over Depth Over xx Depth Of xx Seeded/ Sodded Ich Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STIAivTO- NE, NW, 2.10JP AV 17 Plan revision required? ❑ Yes No Use other side for additional information. SID-1110(R 05191) Date Inspector' Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION Bureasafety u o oand ff BuiluildiinWater Systems g Water 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 1/2 x 11 inches in size. S' T. • 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 Owner Name Property Location GL ev ~►j~v4 y1jr,/1i4, S T 7/ , N, R,( E (or Property Owner's Mailiir g Address Lot Number Block Number 7.7 g f GrA 141;v. City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t Nearest Road E] Village 5*74.,T Public Ig-1 or 2 Family Dwelling - No. of bedrooms -LTown of o o21 /K III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 -E] Apartment/ Condo 6 ` / d 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. ppew 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 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./inch) Elevation Y, . 7 9 Feet Pf'Feet VII. TANK Ca n g ant alloS Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION i Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) ` Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: Plumber's Address (Street, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved sa I ary Permit Fee (Includes Groundwater ate Issued Issuing Age Signature (N to ps) ,Z~Appro E] Owner Given Initial 7111,: R 10 Adverse Determination L Surcharge fee) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 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 maybe renewed before the expiration date, and at a time of renewal a=v n,e ~ cr~ a 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) tc De 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 13 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. ~ N 1"=40' BN--top of 3/4"pipe by power pole at el. 100' alt. BM= top of blacktop at road edge at el. 100.51 dm 210 24' 30' 1 g ►,o~ sup-n'42 ~o Pei. 30 a . Z v 46, 5x f l n rJ G~.4 1 I2`` s ~O J QGd, PrO~Gr~y ~Aa 36'z~ 10 10 1 )-vdl, /00 I\- L S-( . 19 PrOP af,e.4 t ~vc- 1000 &stPS 77S" ~ro Syf T b MGfc 6 y j sic S'S/ 7 -7 -7 £ _ _ /O - S'G LI 1~ T - k7 - 4 i--1 T C' -z, i 4-1 i'1 h_ Fi h-~ LI ~_I E `i' i h'4 _ F-. l_1 4_1 ' F• - 1 Q I ~ -OOfy i~ + ~o ~ ~ ~ ~ 9fi'•S~S ~ ih I M ~:1 1 I M 21 17 - _T ~ i i 3 Y C v J L,~ I Se'So~ p 'Z 21-oos ' I i a I ~ i i 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 µ COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. 036-1050-70 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Dale Swazsrn GOVT. LOT NE 1/4 NW 1/4,S21 T 31 N,R 17 A (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1641 210th. Ave. na na na CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD 210 th. Ave. New Richmond WI. 54017 (71$ 248-3787 Stanton New Construction Use [x* Residential / Number of bedrooms 3 [ J Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/112 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash 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 for system IBS El U M❑ U 91S O U ®S ❑ U S ®U S M 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 T 1 1 0-3 10yr4/4 none is Osg mvfr cs if .7 .8 ..02.0% 2 3-84 7.5yr5/4 none co s Osg ml na na .7 .8 Ground elev. h w 97.85 ft. Depth to limiting factor 17 2 119 y +84"r ru-f y' A7 I Remarks: Boring # to 1 0-3 10yr4/4 none` is Os mvfr cs if .7 ~.8 2 2 3-84 7.5yr5/4 none co s Osg ml na na .7 .8 n Ground 97..70 ft Depth to limiting factor +84" Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1554 200th. Ave., Ne Ric ond, WI. 54017 Signature: Date: CST Number: 6-16-94 I- 1 PROPERTY OWNER Dale Swenson SOIL DESCRIPTION REPORT Page ? of 3 PARCEL I.D. 4 036-1050-70 a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmnch >.,.,3.,..> 1 0-26 7.5yr4/6 none co s Osg ml cs if .7 .8 <:'< 2 26-27 5yr4/4 none sicl M na cs na np .2 Ground 3 27-84 7.5yr5/4 none co s Osg ml na na .7 !.8 elev. 97.05 ft. Depth to limiting f Remarks: Boring # 1 0-82 7.5yr4/6 none co s Osg ml na na .7 .8 kj 4 Ground elev. 97.05 ft. Depth to limiting factor +82" F Remarks: Boring # 1 0-12 10yr4/4 none S Osg ml gw if .7 .8 5<..: 2 12-8 7.5yr4/6 none co s Osg ml na na .7 '.8 :ii:;4H:i+;?:j;:y`: Ground elev. 96.75 ft. Depth iu limiting factor +82" Remarks: Boring # Ground elev. ft. ` Depth to limiting f factor i Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Dale Swenson New Richmond, WI 54017 MPRSW 3254 NE4Nw4 s21-T31N-R17w town of Stanton (715) 246-6200 t N 1"=40' BM=top of 3/4"pipe by power pole at el. 100' alt. BM= top of blacktop at road edge at el. 100.51 3z` 24' 30' t 1 0 ~D{~UYn`~2 ~o'UEi P"ih 13' 30 ° a-/d loo- t-1 Gary L. Steel 6-16-94 522832 CERTIFIED SURVEY MAP Located in part of the NEh of the NA of Section 21, T31N, R17W, Town of Stanton, St. Croix County, Wisconsin. N NC L 9 FILED ° + v- N O - 5 O CT 2 6 19940- 1 =o e z a+ JAMES O'CONNELL wt z Register of Deeds a St. Croix Co., WI e o w e+ UNFI_,-71-TCC LANDS 210TH_ AVENUE L ~ ~ b North line of the NW; CS e a N89059'28"W - N89°59' 28"W 316.79' N89a59' 28"W 9.0 1307.10' 8 M ZNW Corner of 990.31' U7 Section 21 N89 5912811W 316.79' N4 Corner of Section 21 LOT 1 z 3.99 Acres Inc. R/W 173,805 Sq. Ft. 01 C71 t ro ~I + M - M 0 x L 1 0 `n 3.75 Acres Exc. R/W RJ I1 '941 J~ - 163,351 Sq. Ft. M N O iv i°n ST. CROiXWE1f;. t U I - N Z 00 ►Nn N lJ I ~Ornprsha iae Via; :r I-I C o - - 00 <i Parks Ce~rnrrilft rn Jr QI - o CLI If not half -ji m LI CLI within30ifti q ~I 1 approval dfeiLe nun ,9 • Wnlr! 4' Scale in Feet 291-1211E 117 0 50 100 200 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County , ~j OWNER/BUYER f IV MAILING ADDRESS ~Qr/~ /iG✓ /~c~~••~~••l w' s`1a/7 PROPERTY ADDRESS / Z ~U ` ti c (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, ()~L_ 1/4, Section , T_3L_N-R__W TOWN OF C ~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 1 a~3~ CERTIFIED SURVEY MAP , VOLUMEPAGE, LOT NUMBER I C_ Improper use and maintenance of your eptic system uld re~su t 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 expiration d e. c° r' n SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i • 8TC- 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 eoun Location of property_N_E,.~1/4 NW 1/4, Section T_3j_N-R 1 -7 W Township ~tQr1~f Mailing address Address of site _ l6 J / Zi Subdivision name Lot no. Other homes on property? Yes No Previous owner of property te, F , gw&Wn 0(nd n o , & ~On Total size of property 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 110~1- and Page Number 67 , 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. 5693ysi , 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. 5n,3 (ArA Signature of Applicant Co-Applicant _ ok r %3 6 Date o 'Signature D t of Signature y DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR. OF WISCONSIN FORM 2-1982 523459 REGISTER'S OFFICE Dale E. Swenson and Neoma P. Swenson, husband and ST. CROIX CO., WI ; Recd fvr Record ia%fe NOV 14 .0.......5 ..A. 10.:0"0'-5..J.99 conveys and warrants to Z`-racey._L._-Ellevold• and-Michelle M. at M 4 -Elleyold_,._husband_ and wife, s f; Re$istorofDa.9d3 41-4 Vi Er~ To ~V1~11P 1~~.. - %~Glo~ o k r . the following described real estate in St.__CrQiX......--... m~rSa Z St(OZ~ ...........County, State of Wisconsin: Tax Parcel No Part of the NEA of the NWT of Section 21, T31N, R17W, Town of Stanton, St. Croix County, Wisconsin, more fully described as Lot 1 of Certified Survey Map October 26, 1994, in Vol. 10, page 2836, as Doc. No. 522832. try ~ This is not homestead property. - (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, ~M . if any. Dated this l ~w-------------•---------- day of ---------November ---------------------------------------1 19.. 94-. ---------•-----------(SEAL) .---.I , ------(SEAL) * Dale E. Swenson (SEAL) ---------(SEAL) * * Neoma P. Swenson AUTHENTICATION ACKNOWLEDGMENT Signature (s) Dale E. Swenson Neoma P. STATE OF WISCONSIN - Swenson as. County.