Loading...
HomeMy WebLinkAbout020-1313-30-000 i' C o a) ° 3: C; 0 U9. c N Q O n r~ ~ I a ~ I I ~ I ~ I a ~ I f L i z c _ U. O Q M z z o 0 . LL ~ •C L Z d d IL m 04 04 I N F- U) O O z d c U O d 2 C U) F- m a I I ~ - ` N N O z m z I' o N z y N 7i E c c > w m m - w L Q I C W Q cc m ~ (O N a7 _O N ~ - a) L a) I .O m o G C a a~ a E m m L F' O O a M O O O d LL z •N C aaa 0 CL g N .O .o 7 p N3 7 LO In N N U v rn rn m to FIAV O N 00 d (n a) 6 (n a) o~ d m N - O m co ~y 7 • ) O O N c O - O O U p C C E C = U O O 0 O O00 00 ) O 0 00 3 O O N U) O p M LO c a a a 'o O M 6i ~ o N c E E_ 0 ~ 0 L d l t2 M c ! U L t;7 -0 m (0 ~a d q Q) F- F- m N • N N a) °,n) O N E E m U O N 2 N O L9 =5 to 3 a a a 0 CL 4) ~`Mwv E c `~1 A 0 a 0 N U i I ~I i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER EL tzE ADDRESS .Zi9~ ~ SUBDIVISION CSM# LOT # -3 wig SECTION T N-R W, Town of T ST. CROIX COUNTY, WI ` ONSIN PLAN VIEW, SHOW EVERY HING WITHIN 100 EET OF SYSTEM rr i .i I'll A, IN ORTH A OW Provide et~i t ott'i 5 t 0--bn'---reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: / /V-0 Setback from: Well House /0 Other Pump: Manufacturer Model# Size Float seperation Gallons Alarm Location :SOIL ABSORPTION SYSTEM / Width: Length ZQ Number of trvn-cTi-LTs Distance & Direction to nearest prop. line: > yp Setback from: well: 02rc House IVO Other _ /od -~/p ~a~ ELEVATIONS Itl H. CuPr Building Sewer ST Inlet; ST outlet. 6K, 7 PC inlet PC bottom - Pump Off Header/Manifold Bottom of system la 2/ Existing Grade ev Final grade Q9 d DATE OF INSTALLATION: PLUMBER ON JOB: / I / '-'y / LICENSE NUMBER: INSPECTOR: J/ ~r ~sdLi 3/93:jt Wiscorisin!.epartmentof Industry, PRIVATE SEWAGE SYSTEM County: Laborand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION ❑ City ❑ Village ❑ Town of: State Plan o.: P brkL A'erd8V UCTION 1 Hudson CST BM Elev.: Insp. BM Elev., 7 TM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 1211 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 42 Dosing Aeration Bldg. Sewer ; Holding St/ Inlet (P TANK SETBACK INFORMATION St/Outlet &71 L,75' Vent irito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Ar YLA- Septic NA Dt Bottom Dosing _ A Headers , Aeration NA Dist. Pipe? 30 /a ' Hol Bot. System j' q,'r PUMP/ SIPHON INFORMATION Final Grade Manufacturer Dema r dal ' 7 Model Number GPM TDH Lift Friction System TDH Ft oss Forc aln Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length/ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 6a CP, D SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA Manufacturer: SETBACK CH BER INFORMATION Type O pe,,, 06j / Model Number: System: d 76 ~TJ ~j UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole g Air Intake i Length Dia Length 52 Dia. Spacing W SOIL COVER x Pressure Systems Only xx Mound Or At-G a System Depth Over Depth Over „ xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 36 Bed /Trench Edges -21/1 Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Huds~oon.2/2.29.19W, SW, N , Lot 3, Ross Road Plan revision required? ❑ Yes p'Vl'o Use other side for additional information. SBD-6710(R 05/91) Date Inspe6r'sSignature Cert. No. Safety and Buildings Division ~~'■~riR 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 than 8 1/2 x 11 inches in size. C • See reverse side for instructions for completing this application State S7tvsion nitary Permit Number The information you provide may be used by other government agency programs ❑ Check~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 G 1i4 lM, S 2 TZ , N, R4 E (or Property Owner's Mailing Address Lot Number Block Number 1W .3 .2ga '7 Cit , State Zip Code Phone Number Subdivision Name or CSM Number w m ( > l E .A II. TYPE BUILDIN : (check one) ❑ State Owned ❑ itNearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms Town OF gpf . S 111. BUILDING USE: (If building type is public, check all that apply) rcel Tax Number(s) 1 ❑ Apartment / Condo - 3d 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 S ❑ 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. [21 New 2. ❑ Replacement 3. ❑ Replacement of 4. E] 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 [a 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 1/5-10 1 t11 Vs 4.1 O F ; 3 Feet !Ff. AT Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank a ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation the onsite sewage system shown on the attached plans- Plu ber's Name: (Print) Plumber's Sign e: (N tamps) AAWMPRSW No.: Business Phone Number: 4E 1-06EIZ ! !T1 ' Plumber's Address (Street, City, State, Zi C de) O v s•r O Z IX. OUNTY / D PAR MENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Ag nt Signature ( t s) Approved E] Owner Given Initial 60 Surcharge Fee) Adverse Determination l 4 /~°2$ - 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 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. _ Il. 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 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. ~jff' ~L.DAD DAVE FOGERYY PLUMBING Licensed perk Tester Plumber #3233 #3 F.g~erty HeC4rs Noad ROB S, VAS > go Phone 749.3656 4 TOE StFEL /~-T PL 6~5~ I Sf,~,r~ r¢ vD Lr~,C-QED, ~isy~.r= DoT #3 ~ e ~ LvT cv/Z iv F jt s / O 000 dZ41 S.T. p O = cv ea r Fv= yr, 3 O 3, L.t AilAM? 721 7- a ffL /fov x C !2 A/ ,L'S O IU wfs f LoT ~r H e i i - I n 1T~ • i , s • ~p 0 tooR~ " ii 4LA d I 1 w LaboonsinDep Re~tofIndustry, SOIL AND SITE EVALUATION REPORT Page / of 3 Division 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 S7, czaK 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 / rO, V_- GOVT. LOT w 1/4,fJE_ 1/4,S_;,2 T ~ 9 AR E (orjO P OPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUED. NAME OR CSM # 3 'f Al r A"Ji CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GOWN NEAREST ROAD /fuD aiv ~vr O / ( ) 391 //4G 6 / uD o/t/ e 3s V] New Construction Use [/1 Residential/ Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ySO gpd Recommended design loading rate ed, gpd/ft2 trench, gpd1ft2 Absorption area required G Y3 bed, ft2 Z6 3 trench, ft2 Maximum design loading rate bed, gpd/ft2_ 7 trench, gpd/ft2 Recommended infiltration surface elevation(s) FS - 3' (3,Y,f~ ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It Fu = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK =Unsuitable for system 0S ❑ U ❑ S ❑ U 0 S ❑ U ❑ U ❑ S o u ❑ S o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bajxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3K:: '1/1 rg gs .3 Ground 2/-f/1 c /M 3'40,k- 1A FA 0 s , z elev. _ I ft. Depth to limiting factor Remarks: Cox-6 CoLo/z 1/,z,4h1<f/ VA99,rFL.>= Boring # - 3 O > L S L .'t S /e MPJL S F Ground 3 2 6 sd t9 . 3 elev. 3/j_rfD _ y S o SG L q~ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: T- y Address: / u ~,cRr3 ws fyo~ 3 -z3 X33 Signature: 1 Date: CST Number: PROPERYYOWNER /)-67-s4- el7t - SOIL DESCRIPTION REPORT Page Z of 3 J" W 3 PARCEL I.D. # Z? Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ( a 2 L a - - e s F 2 3 Ground 3 _ yo _ ( e G c si3 f2 c s , elev. ~7 ft. Depth to Z- 6 - ©SG L 117 .-57 ~ limiting factor Remarks: Boring # <4 .7 All 5;17X FP- R;' Ground -z- ,q- C Ae- SXY- T S O .O elev. ft. Depth to limiting factor Remarks: #3 Boring # `'l 5 2 c_ a 75 - 3 S G /1l1 5,13 K S Ground -t S O , CJ elev. _ LS o TU ft. .57 11A L S ,9 . Depth to i limiting factor Remarks: 0 -7 ` r~1,e , Boring # Ground elev. ft. Depth to limiting factor Remarks: DAVE MORTY PLUMBING ucensed Perk Tester & Plumber #3233 #3289 ad Fo arty Hei~!►ts ROSEonel749N31N 54023 3 Zl 3 s. i-7 fuels' Sc/j Gam. - ~ ~ = 30 11 dM 70 01~ /STEEL ~~PE S7"fiAF D ,v = L©T co/t n/ S -/moo u~v AYE V = 9-:l 3 < 77, /OT /11A~K 360 ~N ~a' ~i --mod SEA ~'A~ 11C a~ 2 x ~S 15 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I OWNER/BUYER _~r~y~ ~O,yST• MAILING ADDRESS ,ZmG "~ST PROPERTY ADDRESS (location of septic system) ,Please obtain from the Planning Dept. CITY/STATE C,~1Z' c, yp/d PROPERTY LOCATION ~ 1/4, A~e 1/4, Section T .7 9 N-R /!F W TOWN OF 17111"l~o t/ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME ,3 , PAGE 6-2/ , 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 st be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year xpiration te. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 6 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, ~2,6TZ. Location of property SS/ 1/4 yE 1/4, Section .2 -z T2_.4' N-R__ZF_W Township Z14,f, Soif/ Mailing address ,7,0e, _64y-'c s-Z/y/A Address of sitejp Subdivision name Lot no. 3 Other homes on property? Yes No Previous owner of property Total size of property yd Total size of parcel .2 3 Date parcel was created Are all corners and lot lines identifiable? ri Yes No Is this property being developed for (spec house) ? Yes No Volume / and Page Number ?K, 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. S3'I Oi , 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 o fice of the County Register of Deeds as Document No. N Signature of plicant Co-Applicant Date of ignature Date of Signature v 5309 (STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. VOL I'MPAGE 74 REGISTER'S OFFICE ST. CROIX CO., WI Redd for Record i This Deed, made between Ruth L. Rock a widow S EP 2 0 1996 and not remarried, .t gat a:oo P.M Grantor, 4. and Delta Construction Company ° Reg' tar 6f Deed3 Grantee, 1 Witnesseth, That the said Grantor, for a valuable consideration Of I THIS SPACE RESERVED FOR RECORDING DATA - Ten Dollars and other good and valuable consideration h - - j~- - ~ NAME AND RETURN ADDRESS i conveys to Grantee the following described real estate in St. Croix , County, State of Wisconsin: F'E D~ a v ro o~.-r d S FEE Part of the Southwest Quarter of the Northeast Quarter (SW* NE*), of SectioniTwentytit ou(22), Township i. Twenty-nine (29) North, Range Nineteen (19) West, described as follows; Lot One (1) of Certified Survey Map filed May 15, 1987 in Volume "7", Page 1817 EXCEPT commencing at the East Quarter corner of said Sec ion 22; thence NOOoO2'57" E, along the east line of the NE* of said section 1327:95 feet; thence S89 42'26" W, along the North line of the S1 of the NEI of said Section, 1958.94 feet; thence SOOo1141" E, along the West line of said Lot 1, 679.77 feet to the point of beginning, thence continuing S00 11'41" E, along said 6% st line 427.23 feet; thence N89o50'17" E, along the South line of said Lot 1, 215.93 feet; thence N34 37'45" E, along the Southeasterly line of said Lot 1, 172.35 feet; thence NOOoII'41" W, along the East line of said Lot 1, 321.20 feet; thence N88 09'52" W, 266.01 feet to the point of curvature of a 233.00 foot radius curve concave Northwesterly whose central angle measures 16"17'04" whose chord bears S47006'45" W and measures 66.00 feet; thence Southwesterly along the arch of said curve 66.22 feet to the point of beginning. Grantor releases any easement rights in the drivemy crossing the real estate conveyed herein as shown on Certi fit Survey a tVol ume 7 %t Pale ~ 817 as recorded in the office k,4 (is not) of the St. Croix 'County Register of is ome ea property. Deeds. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Rllth I- Rnrk, a widow and not remarried, warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to existing highways and subject to easements and restrictions of record and will warrant and defend the same. Dated this day of September , 19--95- (SEAL)(SEAL) Ruth L Rack (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. Barnett County. authenticated this day of 19 Personally came before me this day of September , 19_95- the above named Ruth L. Rock . a. widow and not " remarried, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me know o be the ers who executed the foregoing ' strumen c now e e same. THIS INSTRUMENT WAS DRAFTED BY GEORGE W. BENSON, Attorney at Law 6t04-6 W. I Box 370, Siren, WI 54872 Notary Public Burnett County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) tames of persons signing in any capacity should he typed or printed below their signatures. L ARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 1 - 1982 Milwaukee, Wis.