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HomeMy WebLinkAbout038-1034-10-000 Q c ~ ° r;: oc I, ~ I O a o a N Q) C.. N CO N U N C O 3 E O o o M y aQ.~ o c -0 Q N f6 E N L N O Q ` N C H O E x c O N O Fr N N Y O ~ N m m O O (D N 7 (O O CL N LL c dY N O = O c N N C) O O .X U Q N E 16 O m 7 N N z ao C v o Z r v m m M a co co U) 0 O Z dt v _N m 2 (A P r m O Z C E U (D Q) may] 'O cn -~V N O 3 O N N ~ CL ~ co co O Z OOO z 0 Z N N n y C N O N 10 ~~1 L y _ d c 06 (D a m ` O O a o G a` a m° .2 0 ryU E O F- F- F- 2 E N L333 ° co o Z •►~v w "aaa U)i g a~ ~ o vs ~ I fA ~ U ~ rn rn N } Lo L 6 c) N O N N N O p E N O N O N B 0 Q_ N O O O O . O C) 3 U N C 0 O p c O W N U O O W W r N 47 C Q Q. 0) N N 5.. U ~ Y a C M02 c c E cu v n ° t i p `0 Z ~ Cl) oo~aEi m (n m E L O O U) 2 N O U) w w V1 a; #t .a a • % a d V N a j o L C y 7 D U a 2 0 N V STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT SECTION T N-P,/- W, Town o 01 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S~ I ~ I t INDICATE NORTH ARROW: Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: S ALTERNATE BM: TIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other r i Pump: Manufacturer Model# - Size Float se eration r- r P Gallons/cycle' Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of trenche~ _,ee Distance & Direction to nearest prop. /line: Setback from: well:- House Other ' ELEVATIONS Building Sewer ST Inlet: b ST outlet PC inlet PC bottom `s Pump Off Header/Manifold 2. Bottom of system &e 15r Existing Grade Final grade, DATE OF INSTALLATION: \ PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. 4 OIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 2 6 B? 10' Permit ~ Holder's Name: y~epp77 '~f ❑ City ❑ Village Town of: State Plan ID No.: I TAAl 11ILMMi 4,8JA f; AY4J ~`"S?ZM' rRf1T . D CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /ark, &1) ' I/°~-- TANK INFORMATION ELEVATION DATA /,1 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0-C,4; ~a Benchmark -p Dos- 79 Aeration Bldg. Sewer H`6 ding St/ J"`K Inlet TANK SETBACK INFORMATION St/ Kt Outlet 3. S~ 9G, 6 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake d2t -77 Septic > ~ >61 NA Dt Bottom Dosing NA Header 4tft /Q Aeration NA Dist. Pipe' 9 G~ Holdin Bot. System PUMP /SIPHON INFORMAT Final Grade Manufacturer De and Model Num . ` GPM TDH Li Friction System TDH Ft 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 `'e, DIMENSIONS a SYSTEM TO P / L BLDG WELL LAKE / STREAM _t C HING'J nufacturer: SETBACK INFORMATION Type O 7 1 i CHA Num er: System: ,hcca >S~, " /Ua OR UNIT DISTRIBUTION SYSTEM Header t :L_-- Distribution Pipe(s) / 1i i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Sz Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems Depth Over n r~ Depth Over xx Depth Of r ~r xx Seeded/ Sodded xx Mulched Bed /Trench Center - 79 Bed /Trench Edges t0 - 70~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) T 0 a^A r" ON 0 M A TS I-In A-r T3 T'L 0 "31 1 C1 TO L1 T.7 0T7 00TE ST i_i;V l.1~L']J VJI~1~r .J f F~;( 1-n ff L" - SJSJ sO 2AA,." A 09Y a.79V; VV Jv S~(1✓fr47 1.l J~iA yy1/ / Y ©KJrc-fl•'~ rcl! ~ ~i~/~.1 r.~ r""_ ~-C ~ ~'~G .GL<-~'v`.'/ ~ . /v (GY-YLy1"1 (y' • ! !✓~~'1~L~/!y_/1//J/Vl /Vl'~w~(!1 Plan revision required? ❑ Yes 0-Ne-- fo Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I vi~'r'■■'~ SANITARY PERMIT APPLICATION Bureasafetyu o oand ff BuilBuildinWater System! ng 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 8 112 x 11 inches in size. 154. Cro 1 A • See reverse side for instructions for completing this application State Sanita Pe it~knber The information you provide may be used by other government agency programs ❑ Check i rev ton to previous a Ilcatlon [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property OwnehhN me Propert Location 1, Q./ a -ct,f W/4 A, S T , N, R (or Property Owner's Mailing Address Lot Number Block Number JZPj1p e ber Subdivision Name or CSM Number City, J W e.2' r f j 11. TYPE OF -BUILDING: (check one) ❑ State Owned City a Nearest Road Public 1 or2 Family Dwelling - No. of bedrooms Dogown OFFC7~~~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~j 1 ❑ Apartment/ Condo 03 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. ❑ New 2. M~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 E] Mound 30 E] Specify Type 41 E] Holding Tank 1 ❑ 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 5 Required ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation eet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete CO" Steel lass Plastic Ap New Existing structed g pp Tans 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' Signature: (No Stamps) MP/ RSW No.: Business Phone Number: Plumber' Addre (Street, City, State, ip Co e): IX. COUNTY / DEPARTMENT USE ONLY Issue Issuing Agent Si t (No Stamps) ❑ Disapproved SapItpry Permit Fee (Includes Groundwater i;;_: Approved ❑ Owner Given Initial f-I& Surcharge Fee) /W I Adverse Determination X CONDITIONS OF APPROVAL REASONS FOR DISAPPROVAL: r Yoe d,4tjt"(Jc, ~.L 7& f.3, SBD-6398 (R. 05/94) 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 lice ised pumper whenever necessary, usually every 2 to 3 years- 6. If you have questions concerning your onsite sewage system, contact your local code administral-cr or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family D" eyling. lil. 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, re annection, 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, numb~-r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all s,:,ptic, 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. -----------------------------------------------------------------------7----------------------------- 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. Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 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 4o: 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. # 03 o ~ h 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 C!4 r ':7 e/ Govt. LotXkf 1/45"4)/4,S T ,N,R !$'E (ofVP- Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /a- 9075' City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ❑ New Construction Use: (,Residential / Number of bedrooms_ Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow Recommended design loading rate bed. gpd/ft2 0 trench. gpd/ft2 Absorption area required &J _bed, ft2 © trench, ft2 Maximum design loading rate + bed, gpd/ft2 • -5 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 IT-T-Sunsuitable uitable for system Conventional Mound In-Gr and Pressure AT-Grade System in Fill Holding Tank for system S❑ U S ❑ U S❑ U A S ❑ U ❑ SU ❑ S XU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench e-Z 42DNa--- W- s d -Y" , A ; 4 01 p ~ Ground /rn r g ~ft. f _ 1 Depth to limiting ~fin. t Remarks: Boring # 77 Ground v 9 ft. Depth to limiting f ct ,1 n. Remarks: [Address ST Name (Please Print) Signature Telephone No. .1001, Date CST Number 6 G S yr s ~d -I~~' 3N-? 9 $ I DESCRIPTION REPORT PROPERTY OWNER (A Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground - /1 r I f 4/ , Depth to limiting in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 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 08/951 PLOT PLAN PROJECT Clarence Heiman ADDRESS 912 90th St. New Richmond Wi 54017 SW 1/4 SW 1/4S 8 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 DATE 7/10/96 BEDROOM 3 CONVENTIONAL XXX IN-GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 125 BED SIZE 12'X94' BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VFNr SYSTEM ELEVATION 88.7 12" GRADE TYPAR COVERING 12;' 16' Q3' SEWER R K 12' Shed B-3 Old Drainfield 65' T 20' T 0' 0' 0 N 3 2' 88' y tB.M. f D 0' % 8, Existing 3 B-2 15' Slope Bedroom Well House El No 12' 30' 6' 6' B-1 Pool Vent 0' Property Line 10 Soil Test Plot Plan Project Name Clarence Helman Byron Bird Jr. Address 912 90th St. New Richmond Wi 54017 M #3479 Lot Subdivision Date 7/10/96 SW 1 /4 SW 1/4S8 T 31 N/1318 W Township Star Prairie Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Base of Siding System Elevation 88.7 * H R P Same as Benchmark Shed B-3 Old Drainfield T 20' 740' 0' 30' 12' 88' M Y 30' 8' Existing 3 B-2 15' Bedroom Well House T ' 30' 12' 0' 61 'I -1 Pool 30' Property Line STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMI YER a rr- MARMG ADDRESS'1 d 44- 5+. N t~ R' r-~ m ' 3 q0) 7 PROPERTY ADDRESS 7•ck,'a_ ate Pr hove-- (location of septic system) Please obtain from the Planning Dept. CITY/STATE ,,~~~J kre-,-,~ IV' 5M)7 • PROPERTY LOCATIONS:A,) 1/4, l~ 1/4, Section 15 , T 3 / N-RW TOWN OF ST. CROIX COUN'T'Y, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME_-yYAGF --,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 tan~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 pro gram` in August of 1980, with the requirement that owners of all new systems agree to keep their system pro perly maintained. The property-'owner agrees to submit to St.. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plunift-restricted,plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system ism 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 with'the standards set forth, herein, as set by the Wisconsin DNR. Certification statiu that. your septic has been maintained fnust be completed and returned to the St. Croix County Zoning Olficer within 30.days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center'`':' ' 1101 Carmichael Road Hudson, WI 54016 11/93 z S 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 OcLg.L--Irl~`P yr-U. Location of iproperty&&2_1/4~ 1/4, Section ,T31-N-R W Township 1' Mailing address ~YV Address of site S~ Subdivision name Lot no. Other homes on property? Yes_'Z _No Previous owner of property ,-//w Z , l~-, s to Total size of property 4~e / 366 Total size of parcel qf~o I x ~b6 I Date parcel was created i' Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Numbers 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. 3 `-4 F>ZO_5- , 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. ,,4 I dos Signatur f Applicant Co-Applicant Date of Signature Date of Signature • DOCUMENT NO. STATE BAR OF WISCONSIN-FORM I _ WARRANTY DEED • VOL 53r-,8 THIS SPACE RESERVED FOR RECCROINO DATA 34840 - This Deed made between - lirtle M. Kehl n-:3 - 0Fi='C•E James R.-0 song as tenants i n cor" mon-- ST. C;?.;ii C40" ~V1S. Zyc'd. for 1Z::=rd rNs - - - -----7---------------Grantors do-, of lav and Clarence j. Hellman and Sandra K. Heira_L_ _s_.and A•~. 1978 - _--------and_ Wi 'e es point tenants at_ R_ _ ~0 _A , M. _ - - - -----Grantees Reghl•r of Deed Witnesseth, That the said Grantor for a valuable consideration---..- of One Dollar and Other 1r-J ;able Nrsideratlo. conveys to Grantee the following described real estate in St___2 -.=x_-----._. RETURN To County, State of Wisconsin: Tax Key No- A parcel located in the SWy of ST^'w of Section 8-31-1'', - escribed as follows: Fromthe SW corner of said Section 8 go tue North alo t t'- section line a distance of 400 feet; t,enze go due East a :iistance of 400 feet to the point of teginn;na o_-he parcel to 1-e descrited; thence continue Fast a distance of 3r f^et; thence d-ie 'forth a distance of 250 feet; thence due West a distance 300 feet; thence due South a distance of 250 feet to the point of beEinning. Also an ease.ment for ingress and egress to the above escr:red property alon_ the roadway now laid out and establish-a- ex-endini in an F-W direction from the N-S town road located on the ,e=t side of said Section 9 to the atone described parcel sail rca .may tieing; locates a_proxi^.ately 400 feet North of the South line of call Section Lti-St ER This is------------------- homestead property.of Myrtle Kerl (is) (kruvo Together with all and singular the hereditaments and appurtenances thereunto belonging; And...MY?'tle M._ Kerl and James R. Olson, as terants in co,=on warrants that the title is good, indefeasible in fee simple and free and c!ear of encumbrances except municipal and zoning ordinances and rec-_rde'_ easements for public uttllties and recorded building and .se restricti__s Q^d covenants. and will warrant and defend the same. Dated this R 4th----------------------- - day of -Q" 19.7------ (SEAL) - (SEAL) } V_;-^ le M. Kerl - ------------•----------•---------°------------------•-------•----._(SEAL) - •--..(SEAL) .'a...-yes R. Olson ` AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 19------- St. Croix ss. - County. - - - - Perso ally came bafore me, this -..4th- day of 7~ M' rtle M. Kerl = - the above named a li _a:yes R. Olson TITLE: MEMBER STATE BAR OF WISCOvSIN (If not- - authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY to s who executed the ave~ known to bet epper n- T_R_ F?aaGrh_ Rrnkar l'~ n_ a__ a_