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HomeMy WebLinkAbout036-1065-10-100 Q 3 0 p t* 4 c a; o O m ~ N V 7 p ~ II C I O ~ N 0 W U X N co O T Y ~ C C N N 0-0 O Q. C z a) v 3 f6 2 LL C (o O_ 0I ~ " O y a C:) Co Q ° 3 3 Cl) z a w o z = O L z cao c Z a m c 0 o Z c Q~ 0 a> Z o c N F- p N z c E '2 N Oa N p 3 N a p ° o Q w © N o N z m z z (D It O E N (D N L N CL CL (0 C O O O -p y d i O C O O O O C O D A C N N .J Z 0 I E F• FU) U) • F• = U N N ~+v ~aaa _ I a ~ z ~ O N N N cn U a~~i rn rn } 1~ N 'D O O L A N _ A N N O CD U) rl- N O Q 0 7 w ~ O N C p O O R~G+j CO C '.6 y N a 0 0 0 C-4 0 Y+ F- III C, E C 41 N N N (O n C C O O d• co Cr' o N N ti l0 ~ M 00 O(0 N E (0 -Co O N (n N O N Cn v C4 V~ m a L: 0) 3 a a r w a` c E t c A 0(L 0U) r ti- STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS--Ila r SUBDIVISION / CSMW LOT SECTION _T N_R W Town of ST. CROIX COUNTY, WISCONSIN ITS . PL IEW SHOW EVERYTHING WIT I 100 FEET 0 SYST yD sc~~ s G?` INDICATE NORTH ARROW Provide setback and elevation inf mation on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f l BENCHMARK: O- ALTERNATE BM: y/~f~Zj SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 4) s Liquid Capacity: J e,6V- 4, Setback from: Well House Other t Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop, line: n: Setback from: well: _ House >7Z_ Other ELEVATIONS Building Sewer ST Inlet. _Za,0 /g' ST outlet PC inlet PC bottom Pump Off Header/Manifold 9yG~ Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - PLUMBER ON JOB: tr l LICENSE NUMBER: ZZ5- INSPECTOR: 3/93:jt ~I r W De~artmentofIndustry, Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Vint Holder's N~rr~G,.- ❑ City ❑ Village Town of: State Plan I o.: 4ESS K, fUDALL R 1 1014 R CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark % - /D f, Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet /da. q y TANK SETBACK INFORMATION St/ Ht Outlet .7- /"0( o Aintto ROAD Dt Inlet TANK TO P/ L WELL BLDG. Ver Intake Septic T 3 r NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System ' ia~ 9 9!~. S PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand T, I yt~ rf /o 0, 7 6 Model Number GPM TDH Lift Fricti Syesatem TDH Ft Forcemain Length Dia. HH Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 98 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: roc . J, '/OD /70 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) ix Hole Size x Hole Spacing Vent To Air Intake Length Dia I 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 T xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No E) Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STANTON.28.31.17W, NE, NE, 170TH STREET 7 ,`pp ~ 1 ~ i.J Plan revision required? ❑ Yes (3"'No Use other side for additional information. ;z. 1?6 SBD-6710 (R 05/91) Date n ector's Signature Cert No. " Safety and Buildings Division v~■~~i■R 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 1/2 x 11 inches in size. lij~ • See reverse side for instructions for completing this application State sanitary Permit Number 02~~ The information you provide may be used by other government agency programs ❑ Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope wner Name Property Location 114 - 1/4,.S T , N, R 7 _E-(or)0 Propert Owner's Mailing Address Lot Number Block Number J Ci State Zip Code Phone Number Su ivisio nName r MJalumber f!2 / i ( ) y + II. TY BUILDING- (check one) ❑ State Owned ❑ It Near st Road ❑ Vil rage Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) _ 1 E] 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. g 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.) (MinA ch) Elevation Feet Feet VII. TANK -Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank 21 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i stallation ofthp onsite sewage system shown on the attached plans. Plumber' Nam (Pr Plum is ign r m MP/MPRSW No.: Business Phone Number: P umber's dress (erg ity, State, Code): IX. COUNTY / EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag nt Sign ure (No mp XA/pproved E] Owner Given Initial c Surcharge Fee) pd Adverse Determination / O 7./~GB X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, Orte 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 ne,.v 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) tc, 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 iicew,,ed 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. I 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. 111. 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, recininection, or repair. V. Type of system. Check appropriate box depending on system type. V1. 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, numbei of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all se:atic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental ,)roduct 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/AljX ~ /~mltS~ JkdO+~k fi~lzlf aye S \ I i' 33 ` 3,57 f,Pa ,tlu / 9r8 CF3 q ~ 7-D o~~u.~,a9-~/eu C~x'sJ~v~f~•J -~•C/moo / ~J,~~~~~7` ~yo sfi• 7r;" S ~ -74 3sY Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of I ahm6and Human Relations Gosion 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 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 PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT Z 114 114 T S N,R /t"(or& PROPERTY OWNER':S MAILING ADDRESS LO BLO # SUB. NAME OR CSM # Cl STAT ZIP CODE PHONE NUMBER CITY VIL GE ZTOWN NEAREST R9AD b(] New Construction Use K] Residential/ Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gybed, gpd/ft2__,, ~trench, gpd/ft2 Absorption area required bed, ft2 96Q_ trench, ft2 Maximum design loading rate -bed, gpd/ft2-,trench, gpd/112 Recommended infiltration surface elevation(s) 9/, 5 ft (as referred to site plan benchmark) Additional design / site considera'ons 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 ®S ❑U ®S ❑U ®S ❑U 2S ❑U ❑S JAU ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed Trench ........iiti4:•i IV14 as Ground _ elev. Depth to v - - limiting factor y 91~ Remarks: Boring # t4r Sin.,.:.::. Ground - r elev. ft. a~hC; Depth to limiting factor > 3 Remarks: CST Name:-Please Print v / Phone: Address: S 4 ' rx Signature: Date: T Numb f , - 3 PROPERTY OWNER SOIL DESCRIPTION REPORT Page,--- - Of PARCEL I.D. # t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench Ground elev. 2F-j ft. _ Depth to limiting factor > ?-2 Remarks: Boring # AZ 0 -<Z _ic__ Ground S elev. /Q2." ft. r ' . - S Depth to 9V Az limiting factor Remarks: Boring # -16 1,4 9,k-s- ~2 Ground elev. ft. Depth to limiting factor Remarks: Boring # ky Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER R S e rl MAILING ADDRESS 301 ci ( o vt J a V~ 0S M l~v gee PROPERTY ADDRESS htf2t (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section T 3 N-R 1 7 W TOWN OF 5'&P\ ~0 k ST. CROIX COUNTY, WI SUBDIVISION ~~ft LOT NUMBER 1 CERTIFIED SURVEY MAP /0 - 06 J 3, VOLUME PAGE 2 65 7, 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 expiration date. SIGNED: DATE: 0q- ®c~ -0~6 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 sTC - loo 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 1147 eS f-e- Location of property 1/4_1/4 , Section T N-R__LZ_W Township s~a~T dt~ Mailing address Address of site F' 1y7~' 1701 STS{ St~17 ~C71 T Subdivision name Lot no. Other homes on property? YesNo Previous owner of property 6,, y Vv) /~g (eCi i r )eh2 ~~~~leeh ~~e~ev~ Total size of property l0 f~C-,' 'H411ee Total size of parcel fjc,reJ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this prope tbeing developed ~f(spec house) ? Yes No Volume nd Page Number _ has 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. _!j~Q72 67 , 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. Signature of Applicant Co-Applicant Date of Signature Date of Signature . I FILED 0 O CT 0 61993► 4 JAMES 0.coNNELL s Q 6 8 Register of Deeds St Crux CO., WI 6P CERTIFIED SURVEY MAP Located in part of the NEP4 of the NEk and in part of the SEh of the NE4, all in Section 28, T31N, R17W, Town of Stanton, St. Croix County, Wisconsin. N OWNER Steve Halleen AdN m NE CORNER H w 2162 170th StNew Richmond Wi E OF SECTION 28 o, ' 5-1407 5417 s ~o \ ^ h5ar N C CT CD M 10 Q ".9 -tea m 01 0 o ao C3 -fi a O N rt o m o co' 'Pre(7Qnsl . M- rt. = Zoning UNPLATTED LANDS ~ P,,;,M ccrn......_ 3 133' Vnot rcrr N90°0d00°E 673.03' I 4.i°iin 30 636.24 36.79 'JI provzd S,' ...ai! & IC (f) iz p 0 rn q IC Ir w° ~ z ID ° m 10 IF_ LOT 1 0 N O° ~O 1= ID 117 10.00 ACRES INC.R/W f o = I~ 1(::) rr435,644 SO. FT. INC. R/W k m 1-~ M m 1~ ID NEI/4 - NEI/4 M I-~ Ir SEI/4 - NE 1/4 0) I~ ID O 0) OD 0 9.43 ACRES EXC._R/W Ln -n IRl Ir IZ fV 410,589 SO. FT. EXC. R/W <n (nl I> n I~ IZ ~U) (~1 BARN FOUNDATION : .4 W N Ip O IN O) Icn OD GRAIN HOUSE BIN FOUNDATION 648.54' WELL N83°0459"W .36.09 . 684.63' 6 UNPLATT 16 --L E2 LANDS T.F.C7F.TiT) J. o`er L69Z 39dd 6 3Wnl0R •eOTnpV .70J 90T_;Jp buTUOZ A4unoZ) xTOJD •lS 944 4opluoo Tao.aed Aup buTdoTanap 30 buTspgoand aaojag ( • ola ' Taoapd of 99900e '9ZTS 4oT wnwTUTw IspUPT49M '•a•T) suOTlejnba.a pup saTn3 'sMeT A4unoz) pup a4e4S o4 loaCgns sT dpw sT144 uO uMOys Taoapd uopS •awps 6utddpw put 6UTAanans uT XToaD •4S 3O A4unoo alql ;O 90UPUTPIO UOTSTnTpgns pUSj agl pup saln424S UTSUOOSTM aT44 ;o :,£•9£Z aaldpt4D 3o SUOTsTnOid luaiano 974l u4TM paTIdwoo AIIn3 9npt4 I 4pu4 lpagTiosap pup padanJnS Aappunog DoT-794x9 a1T4 ;o 91VOS 04 uOTlpluasa.zdaa 409za0O p ST dpw d9nanS,paTTT4a9O sTt4l 4pu4 ATTla9o OSTp 'I •paoaaa To sluawaspa TIE pup (4aaalS u4OLT) ppoi uMol jo; ApM-3o-lt4bT-l.o4 loaCgns ST Iaoard pagTaosap aAOgV uruur aq jo 4UTO 9144 04 499; £0 • £L9 ' 2„00 , 00 oO6N a0u9144 : 4aa; £L • Z09 ' S„Si, , L£ o00N aOuat44 : 4aa3 £9 • t,89 ' M„6S , iv0 o£8N aOUa144 :laaT gl'g89 'auTI lspa pTps buOlp 'M„00,00o00S 6UTnuT4u0O aOUat44 uruur aq jo 4uro ago 04 4aaT 9£•826 'uoTloas pTps To 6/Tam 9u4 ;o auTI lspa atll 6uolp 'M„00,00o00S 9OUat4l :8Z uOTlaaS pTps To aau100 ZN 9t4l 4p buTauawwoD --l- - f. DOCUMENT NO. + I THIS SFACE RESERVED FOR RECORDING DATA WARRANTY DEED fl STATE BAR OF WISCONSEN FORM 2-1982 V 5()77(;7 - II v~ ~ 1Q , r i REGISTER'S OWCE IT. QQIX Co., W1 I, Gary_;i.. Halleenx Arlene_ L._-Halleen_-and Steve S._ Halleen= Rb!'~d for Record as-.jQint_.tenants..-••••-...----• OCT 2 5 M3 9.45 A, M k conveys and warrants to _.Randall-.R...-Mease _ 4011W of - ~M~ _ i. II ETUP TO II Ifortiwest Savings Bank 532 S. Rnowlea Ave. . - the.following described real estate m.....--S.t.._-.:Gr.9.x--_--- --.._...County, New Richmond, WI. 54017 State of Wisconsin: Tax Parcel No_ A parcel of land located in part of the Northeast Quarter of the Northeast Quarter (NE} of NE}) and in part of the Sowtheast Quarter of the Northeast Quarter (SE; of NE}), all in Section Twenty-eight (28), Township Thirty- one (31) North, Range Seventeen (17) West, described as follows: Lot I of Certified Survey Map filed October 6, 1993 in Volume "9", page 2697, as i Document No. 506822. j I This ia.not----------- homestead property. (is) (is not) Excepting to warranties: Dated this 1.2 day of Dr-tob_eL....................................... 1x.93... i (SEAL) ......(SEAL) . Gary_ M.__Halleen, Steve SG Halleen . h-:... ------------------•--.-(SEAL) (SEAL) AxXene..b...-Ha een------------------------------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day ot---- 19 Personally came before me this . ......day of IICtobel____._......_.___..•._._. 1943.---. .abq•ve nwned r~r5~_M.._Halleen.-A=lene..L~:~ _I lee>}~ and:.. r - - - StPv_e__S_. alleen............ TITLE: MEMBER STATE BAR OF WISCONSIN ' 4_1 - (If not, ; authorized by § 706.06, Wis. Stats.) is be he rsoa q exituted 6 nt and adcnowle ft sarr . THIS INSTRUMENT WAS DRAFTED BY