Loading...
HomeMy WebLinkAbout012-1020-70-000 R.i ~ 'O O I N O Q c 3 0 o p vy o c E I `o o N I 'D a E y c U c r :a c E -2 n 8IF m:6 0 o y c m~ 0 1 Ev o o GCo F. N N y a c z 3 N 3 d O .C LL C (n Y N B co o c Q co I- o N m z N r w o z y y r~ H z a m o I c z oz:~' c y a c o V1 F- O (ll z c ~ v O N j) (D ro Z m Z O o N z -N0 c m E £ N a I ~ i Y d a V N C N C O N 3 N i~ ° ~r N 'o o d c0 N •v~J z F- F- F- c U N E (D 3: 3: 3: O o 0 a a a z ry • m d 0 c N ~ Lo U') N U rn a) 0) rn z° a o 10 U N p ..0 O M C) E I m a,C> f0 I ~ -a ~ N N \j 0 3 N c til o Q o ° 00 00 Z) (n 0) 0 0 Lo N p v C C LL O Q Y O L 0 Q N c N a) (D ° a o s z 00 o G o _ M N n.l Nr C= N C r~ W U • yam,(' O O W N O N N Cn N ' \ w i' E V~ m ca a v m xt a L a w CL m .9 0) y c lw~,i E o c c o rr t O y u `01 A v a NZ O t N ~ N I w C t" M ; O 3 y > N _ O a ~ 'D N ~ L L 'O a u cn-rnca 3 ~ m N Y Lo M 7 O Co ~9 C O Z J c to CO I'T '0 .2 -0 E • o b a V U 7 III 4 E o ' LOL i o v co Y o o °'O •a c U o N y o o a~mo a in h o NN Q1 w'° 3a - C Z C O m x O - C •O 7 (6 a,6; 2 N ap LL O N C N U x 3 U > N 'C C a E Q CL r 7 U (0 O U O M V N r` U) E Q_ v p O Z m M a co F U) C O O Z C U w n (n U (U Z d• O O !A H m O Z C E -2 N O O co N N ~ N d CO O N Z M Z O i O N r z N d "Its M c E C N > % 2 O > t0 d tv V C4 U C O O a L N N o O O U) U) E 0 N~ O U 1- H E 2 O U N • 3 0 0 0 a Z° N u,CL aIL CL z (D LO LO U) U) J V rn 0 a r- :7 } LO Lf) 0 64 LO as ° ° T if> iA E 04 N C O O ~ rn rn =3 m a o N F _ U o d Q Y ca m m ~i C o o w ~j C) 3 w c ~l ° o U o c E CZ) o W co 00 _V PE ° co h~ W y c_ d rn o ° °o c (V\ p ~ ao c o c E„ ° m w o aci °r n.l N M C E M ..0. 3~ •c • 7a O N M O y E m €"S U O O O W I'I Y N O Z N U) CC ~ •E m V ~ ~ ..I ~ E I r/~v m ' a a • cl CL a; U N y E c S A U am M 0 0 V V STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ ADDRESS SUBDIVISION / CSM# LOT # SECTION- ~7 W, Town of y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHQW EVERYTHING WITHIN 100 FEET OF SYSTEM yr. ~a 4-7 INDICATE NORT ROId j Provide setback and elevation information o erse of this form. Provide 2 dimensions to center of septic tank manhole coves. f / BENCHMARK: • ,(,p,~ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House ~2 -2 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: 1W House ' Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold_ 9y Z9 Bottom of system 2271 Existing Grade Final grade ge-9 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE S~IIIISTEV County: Labor and Human Relations INSPECTION REPORT ST, CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI MILLIRON, CHRIS X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A 500041 TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. Septic Benchmark ~Tlq(o ! Dosing g Aeration Bldg. Sewer 2.71 Holding St/Ht Inlet 3-K al TANK SETBACK INFORMATION St/ Ht Outlet Verit TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe d Zd ~0 Holding Bot. System -7. f PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand -ld Model Number GPM TDH Lift 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 DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Moe Number: System: OR UNIT 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.) ~r^ ~Q LOCATION: Erin Prairie.7.30.17W, NE, SE, GG ky~ 6 Zeta( Plan revision required? ❑ Yes ❑ No Use other side for additional information. I~- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL CQMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITAELY PEOMI # -Attach complete plans (to the county copy only) for the system, on paper not less than //~`''r'_ 8% x 11 inches in size. ❑ Check if revision to 4vious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 4~~161 A i&, 6 Z & % S T , N, R (or) PROPERTY OWNER'S MAILIN ADDRESS LOT # BLOCK # STAT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 1 II. TYPE OF BUILDING: (Check One) ❑ State Owned VILLAGE NEAREST R?/ 13 CITY ?D TOWN OF: j Public M 1 or 2 Fam. Dwelling-# of bedrooms =Z PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) ~D 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. M New 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 # 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-ln-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 ./'nch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 171 F-I F-1 Ll El I L1 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name (Print): Plumber's ign re: ) MP/MPRSW No.: Business Phone Number: lumber' Address (Street, City, State, Zip Cod i IX. COUNTY/DEPARTMENT USE ONLY (No S tamps) ❑ Disapproved S itary Permit Fee (Includes Groundwater Date Issued uing AgenMJJ ❑ Owner Given Initial Surcharge Fee) XApproved Adverse Determination J, A X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 the 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 & 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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 i 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ~ ~(l,F'/~, S~ sic 7, T.3a~✓ x~i7W ,kiJ , c,~/h~-d,~ ~S' ~D~~ vS~~~,~ ~~~~s /oa~~,~/ /7,~stil ~S`~' 1 ~ A ia' 5'~ , G~ I ~yx' a. ~~®~~p PAGE OF CrC) Sec~lun O~ A e0 S stems Y ~ Frech Air Inlets And Obcervatlon Pipe Approved Vent Cap Mlnimum 12" Above Final Grade 20- 42' Above pipe _ 4' Coral Iron To Final Grade Vent Pipe Mash Hoy Or Synlhefk Covering wtn 2" Aggregate II Over Pipe Olstrlbullon Pipe 0 0 0 0 0 - Tee i 6' Aggregate Beneatn Plp• o Perforated Pipe solo. Coupling Terminating At Bollom Of System Prupo c ti Pmcd grcac'< - ~~cJr.~ iorl \ \ / SOIL FILL DISTRIBUTIOF.1 PIPE APPROVED $4NTUETIC COVER 2"oFAGGREGATE ~MATERIAt- oR 9" OF STRAW OR /'JARSN HAy !v' of "'2 AGGREGATE"8 ELEV. of FEET, ps, K-- DIS7-RIgJTIOU PIPE TO BE. AT L S AIJU AT LEASTZO WCHES BUTI.IOMORE THAM 42EAICHES BE OW FIIUAL GRADE MAXIMUM ®EQrli OF EXCRVAT100 FXom OKI&WAL 69A0F. WILL BE 1UCHES MINIMUM OEf OF EAC4VATION MOM 01K141"AL GRAVE WILL BE INCHES SIGAIED : LICENSE IJUMBER: A DATE:5~ VViscons"eFrartrhent of Industry, SOIL AND S I T E E V N REPORT Labor and Human Relations Page Division of Safety & Buildings Of in accord with I COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 i in size- P-fF~n-must inclUde,'-but not limited to vertical and horizontal reference point (BM), ion and °Io of sfope, scale or - PARCEL I.D. # dimensioned, north arrow, and location and distance to nei~estf road. - APPLICANT INFORMATION-PLEASE PRINT ALLRMIITION REVIEWED BY DATE F PROPERTY OWNER: ""MOPERTY LOCATION J., GOVT LOT - 1/4 - 1/4,S T N,R (Oro PROPERTY OWNER':S MAILING ADDRESS ~K # SUBD.,NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY IL GE MOWN NEAREST ROAD NJ New Construction Use [XJ Residential / Number of bedrooms ~ L ] Replacement [ ] Public or commercial describe [ ]Addition to existing building Code derived daily flow _ gpd Recommended design loading rate _bed, gpd/ft2 2 _`~trench, gpd/ft Absorption area required f~ bed, ft2 - S- trench, ft2 Maximum design loading rate bed, /ftl 2 Recommended infiltration surface elevation(s) q~ g~ ark) trench, gpd/ft ft (as referred to site plan benchmark) Additional design / site considerations Parent material J,R 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 [3U 2S ❑U ®S ❑U ~S ❑U [Is ~U ❑S 0 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft `.in in. Munsell Qu. Sz. Cont. Color Texture Consistence Bound3y Roots Gr. Sz. Sh. Bed Tre & Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground _ S elev. 15 Depth to limiting factor ,xr Remarks: CST Name: Please Print Phone: 14 ~V Address: Signature: Date: CST Number: 3 PROPERTY OWNER SOIL DESCRIPTION REPORT Pagof 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Gr. Sz. Sh. Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Bed Trends 01.......,r.., 1': / Ground elev. ft• Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor R 7 L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) L! ~ ;C7oc°,i,~ s / -y0 sc,,.t~ y C.ST~o d~yy G'G \ NNN to 6 Y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT ,St. Croix County OVVNER/BUYER z C dal MAILING ADDRESS PROPERTY ADDRESS (location septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, ` 1/4, Section T_N_R! 7 W TOWN OF ST. CROIX COUNTY WI SUBDIVISION ~UU /V ' LOT NUMBER /li~A'4~57 CERTIFIED SURVEY MAP-., VOLUME -____,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 the system can affect the function of the se tic as a treatment stage in the waste disposal system. P tank 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 verifyin that 1 the on-site wastewater disposal system is in proper operating condition and (2 ) g ( ) pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. after inspection and 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,4nust be County Zoning Officer within 30 days of the three year, eexpiration date. eted and returned to the St. Croix n SIGNED: DATE: 3 - Z 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 y S T C - loo This application form is to be completed in full and signed owner(s) of the property being developed. An inade uaci b only result Y Y the development ben delays of the permit issuance. Shout s will intended for resale b Should this house), then a second form should be r tainedr and completed when the property is sold and submitted to this office with appropriate- deed recording the of propertyC~/1r,.5 ~ owner Location of propertyfi-F--l/4_5E 1/4 Township Q; Section N_RW Mailing address Address of site Subdivision name O/UJ Other homes on Lot no. ~V~ property? Yes No Previous owner of property Total size of property /1r~E~7z~ Si S -0 Total size of parcel, Date parcel was created Are all corners and lot lines identifiable? Is this property being developed f (s Volume (spec house) ? Yes __No and Page Number as recorded with --2~7 of Deeds. h the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER AND THE SEAL OF THE REGISTER OF DEEDS R, VOLUME AND PAGE certified survey, if available, would be helpful so asdtolavo'd delays of the reviewin references to g process. If the deed description a Certified Survey Maps the Certified Survey Map shall also t required. PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge that I property described in this (We) am (are) the owner(s) of the warrant information form, by virtue of a Deeds as D ed e No.ed in p Office of the Count own the proposed Y Register of site for the sewa e' pand that I (wm presently obtained an easement, to run the above described p ropert , I for e construction of said system (we) t and the same has been duly recordedpin of the Count (.B y Register of Deeds as Document No. Signature of Applicant Co- pplica. t Date of Sicrnaturp TlatP cif Rirrnati~rP ' 526891 v L ~ j f 5 78 DOCUMENT NO. WARRANTY DEED This Space Reserved For Recording Data REGISTER'S OFFICE ST. CROIX Co., WI THIS DEED made between RAYMOND G. SISLO and Reed for Record ANNETTE M. SISLO, husband and wife, Grantors and CHRIS R. MAR 2 1 1996 MILLIRON and LINDA G. MILLIRON, husband and wife as survivorship marital property and Grantees, at 11:00 A. M K• ,.-A. I. JJ.- Witnesseth, That the said Grantors, conveys to Grantees the Re9later of Deeds following described real estate in St. Croix County, State of Wisconsin: The Northeast 1/4 of the Southeast 1/4 of Section 7, Township 30 North, Range 17 West; EXCEPT the North 4 rods thereof, and EXCEPT all that portion lying within Lot 1 of the Certified Survey Map recorded in Volume 71of Certified Survey Maps on Page 1965 as Document Number 437245. The East 4 rods of the Northwest 1/4 of the Southeast 1/4 of Section 7, Township 30 North, Range 17 West; EXCEPT all that portion lying within Lot 1 of the Certified Survey Map recorded in Volume "7" of Certified Survey Maps on Page 1965 as Document Number 437245. S EBB This is not homestead property. TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-wa of record, if any. y Together with all and singular the hereditaments and appurtenances thereunto belonging; And Raymond G. Sislo and Annette M. Sislo warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this 20th day of March, 1995. R G. SISLO (SEAL) i ANNETTE M. SISLO (SEAL) STATE OF WISCONSIN ) ss. ST. CROIX COUNTY ) Personally came before me this 20th day of March, 1995, the above-named RQnyo ed G-,,,Sislo and Annette M. Sislo, to me known to be the persons who executed the fore acknowledged the same. gtrurtl~d `co Notary Public, State of Wisconiif,/;'~ ..Q•T~ My Commission FApk:69: l THIS INSTRUMENT DRAFTED BY: RETURN TO: Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street Post Office Box 802 Hudson, Wisconsin 54016 _ . 3.~~ ~ ~ 3 ~ ~ 1-~ ~ z o ~ E 1 /4 COR. SEC. 7 - - r 1056 426/543 14 SE 114 ► NE 114 SE 114 I I 1066 105A 106A 807/390 _ 807/390 426/543 807/390 564.45 105C 9 06 16 2ND ST. I LOT 1 'n r _ vol. _7,_ pg._ 1965 C.S.M_ r 07B 1086 310/264 807/390 & 470 810/264 I 811/309 564.27' 114 -SE 114 i SE1/4-SE 114 I I 107A 108 807/390 807/390 0 U J A VE. SE COR. SEC. 7