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HomeMy WebLinkAbout020-1189-30-000 -0 0 o ° O I M 0 ° ey ~ ° ~ I C~ o I ev" i :J Z w I e I I I h I o z c LL c 0 ~ I ~C 3 ~ I v ° Z • o ~zvl' ° I rn a m N F- U) o I O z 't c ~ N d Z d' ~ c O v7 H ~ ~ ~ Z c E o N 00_ N N • N O U) ~c O I 0 m O - O O Q 4 Z co Z o Z a N ca I! z o N N W N E - j lV N m _ y co - O. 'm co _N y d N O ° t C m O 0 a a N U co 0 0 0 a Z° • c o. CL a n N LO Un m V rn rn } 0 N co ,,M O O O _ Q ~ m it a ¢ } r;~ m G U) p O O O U) C U O p a) c c rn O p O~ O C C c N m c L N a0. N N e, t~ O c, c6 j . N C ° lOiJ W (0 g ) r 0 04 CC +O°k O d a CL w • a d .V d C r`~ Z E 2 C C STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ ADDRESS 2he/ ~~cr~so~v s Yol6 SUBDIVISION / CSM# LOT # ~o SECTION Z39 T ,79 N-R_,~f W, Town of~ZljO yy ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYT ING WITHIN 100 FEET OF YSTEM S~ ~rnP~N~i /~ti• ~ _ Aq Q = ~:~e , cr lohlncr' tarvey j ,NES : O Boa p~• 5-.,7- ® w 6CL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. { BENCHMARK: 'Z~?Cgvy ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: &&~s Liquid Capacity: Setback from: Well >J-0 House 3d i Other Pump: Manufacturer Mode Size Float seperati.on Gal le: Alarm Location SOIL ABSORPTION SYSTEM Width: / L Length 7 7 Number of trenches 2 Distance & Direction to nearest prop. line: o Setback from: well: >1m / House "Other ELEVATIONS Building Sewer ST Inlet. /Bp,_? ST outlet 100. / PC inlet PC bottom Pump Off Header/Manifold >^71 y Bottom of system Existing Grade Final grade Jay d DATE OF INSTALLATION: PLUMBER ON JOB: / LICENSE NUMBER: INSPECTOR: 3/93:jt I . M-sconsin Department of Industry, PRIVATE SEWAGE SYSTEM 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 DELTA CONSTRUCTION X CST BM Elev.: Insp. BM Elev.: B.M Description: HUDISON Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / o Benchmark /U3, 36 Dosing - - Aeration Bldg. Sewer 45 Holding St/ Ht inlet /0 6 ' TANK SETBACK INFORMATION St/ Ht Outlet 3, ioo. /6 ' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >aS~ 750 NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand /o 80 Model Number GPM TDH Lift Fric n System TDH Ft Head Forcemain ngth Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ~2 Al DIMENSIONS 1.2- " DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of /UcA-,1 >/O CHAMBER Mode Number: System: Lizzi /o' ~a v /f 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 ci Bed /Trench Center 3Ul Bed / Trench Edges c ~ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.28.29.19W, SE, NE, LOT 61, ALDRO ROAD Plan revision required? ❑ Yes 6~'No Use other side for additional information. /3 l7 2 G SBD-6710 (R 05/91) Date to ect 's signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I Safety and Buildings Division 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 8 112 x 11 inches in size. .S_ • See reverse side for instructions for completing this application State Sanitary /P`eermittNNumber The information you provide may be used by other government agency programs ❑ Check i" t revisiontpievious 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 - f, Rol 7- L S t/4 0,,6t14, S T , N, R E Property Owner's Mailing Address Lot Number Block Number ® Z Cit State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE BUILDING: (check one) ❑ State Owned PParcel C!yy Nearest Road Vllage Public 1 or 2 Famil Dwellin - No. of bedrooms- Ton OF k III. BUILDING USE: (If building type is public, check all that apply) Tax Number(s) 1 ❑ Apartment/ Condo 41P_Z0_ O 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. ;6 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 Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 m 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 409 ] Irs-7 7 7 9,.e;.2 Feet p Feet VII. TANK Ca in gallons_ Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass Plastic A New Existi strutted g PP" Tanks Tanks Septic Tank or Holding Tank 12-40 ~j oe 'D ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the o We sewage system shown on the attached plans. PI ber's Name: (Print) ' Plumb 's Signature: (No amps) PRSW No.: Business Phone Number: CIO% er's Address Street, City, te, ip de): O L3 IT COUNTY/ EPARTME T USE ONLY ❑ Disapproved Sanitar Permit Fee (Includes Groundwater Date Issue Issuing Agent Signa a (No Stamps) X Approved Surcharge fee) ❑ Owner Given Initial n Adverse Determination 56 ` 1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS T 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 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 pu-r4er 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, 608-26673815: To be'complete and accurate this sari'ifary 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 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 a.l septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VI11. Responsibility statement. Installing plumber is to fill in name, license number with appropriate -_,refix (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 10 x 11 inches rnust be submitted to 1.1).> cc :nty. The plans must nY,isde tho following: -A) plot pfam, drawn to scale or with complete dimensions, locati:)ri ~J ;c;dincq tanx. (s), septic t _k,s) or ; -her treatment tanks, building sewers; welk - water mainsiwater ser.i~_est'e,irr, . I ake,s; pump or siphon t,,r-ks; distribution boxes; soil absorption systems, replacement syst~~n~ areas; wi"i tie Io::r_t.) c the building served; ,oral ,nd vertical elevc.tion reference points; C) complete sf, _r iiicatiow. for purer s > ont cls; dose volume; Ele, uiiferencc,, fr ction loss, pump performance curve; purnp model and ,-,..jmpm. r ~r, 791, cross section or ; > sssor ption system i f required by the county; soil test data-ono 1 1 _r -TI ; a, C! , . .i sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin•Act 410 included the creation of surcharges (fees)'fof a number of regulated prac'_i'l es which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. d 0 \ a c~ 4 n v v 44 'Ilk goo Z ty ~ ac ~ ti ~ e'0 b ~3 u j p u 0 0 n i .Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ! of J Labor 4ad,Hur~an Relations Division iwwfafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but >T C~0 / k 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. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROP TY OWN R PROPERTY LOCATION LLB 1eW LrLCr GOVT. LOT 1/4 114,S T N,R E (or) W PROPERTY OWNERS MAILING ADDRESS T t BLOCK# SUED. NAME O~Fj CSM # 9 fl1d~ (-JrC.LS EST~dT S CI~,}', STATE ZIP CggDE PHONE NUMBER []CITY []VIL GE OWN NEAREST ROAD KU W) S~ I O ( ) ~soN p(J New Construction Use [4 Residential / Number of bedrooms [ j Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate - bed, gpd/ft2O trench, gpd/ft2 Absorption area required bed, ft2 trench, 1`12 Maximum design loading rate o •3 bed, gpd/ft20.~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ON t AbC 3 o R 3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft -ANK IS = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE YYSTEM IN FILL HOLDING T U= Unsuitable fors stem RIS ❑ U 0S ❑ U MS ❑ U .®S ❑ U S❑ U ❑ S U 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 Tench 4- S ,OZ to Y, I a, Z o, lo-:L S'3A 0~ 5 m ,'9r- ~'h I C I 10. Ground g 34 -161 /0 414- s m r 1 0 g elev. /6/•S3 fL Depth to limiting factor 7 Remarks: Boring # 5~ / SbK n~ 1 oY 10.4 O.S 4 Z B 11-43 IDY~2 3 4' - S r rn C l 7 `O`ff B 11 vie 114 -.Ground elev. 91A./_ IL Depth to limiting factor Remarks: CST Name:-Please Print Phone: .~ouNSo,v Address: 0 Ox C) L 01SO N W T 5'~ 0 6 Spnature: Date: CST Number* 3 3J g4 PROPERTY,OWNER SOIL DESCRIPTION REPORT Page-L of 3 PA,MEL I.Ci ZOT l Cede 14rccs Depth Dominant Color Mottles Texture Structure Consistence Borb3y Roots GPD/ft Boring # Horizon In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed nrch 3 0`7 6 k Z 5 I .~bK rn J A Z 0. ,S 1-7-21 /oYR 3 4 - S rh G 1 0-7 0 1 •7 a Ground 8 1Z/-119 y 414. 5 A, Tr elev. /01.4 t - Depth to limiting cr Z 7~• Remarks: Boring # d-s /Dy~~ Z 5 L sb 1 Q 2 10.4 0,5 15-I'M M 4 4 S © rn w, 1 10--7 O$ 131 Ground elev. /0? It. Depth to limiting factor Remarks: Boring # _6 /bye 3 Z S4 1 rh 5hK MI Z t.3. ?a•~ - S Q C 1 0.? oS 5 e► 6-43 /ov 314 -IZ /oy~ 4 S r C" O$ Ground , elev. /e7g~ it Depth to i limiting - ' factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SB D-8330(R.05/92) P44E 3 ov 3 cn a -d ft, r A N -Z7 ~y vl y L 9 44 Gvv a I S'r cry ~ a J 0.4 -77 i i L ~i a ! 4 ~ min 06 OC PA ld6 } i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/I3UYER "__P_V_tU MAILING ADDRESS 'Z.-e L (,cam-t om PROPERTY ADDRESS -7 -7 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION S~ 1/4, N 1/4, Section T ZI N-RNA' TOWN OF -m ST. CROIX COUNTY, WI SUBDIVISION LOT NUMI3ER CERTIFIED SURVEY MAP , VOLUME , PAGE _ LOT NUMBER (O j 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 property maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plu i mber, restricted plumber or a licensed pumper verifying that (l 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. UWe, 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 ye r xpiration d to SIGNED: L DA IT - - - St. Croix County Zoning Office Government Center 1101 Carmichael Road 11;9i Hudson, WI 54016 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 Location of propertyS 1/4 /V 1/4, Section TI-q N-R-/ `/-W Township Mailing address ~6 1-.6L lv,~ S v IL Address of site 27L S-Y--o It, Subdivision name Lot no. other homes on property? Yes No Previous owner of property e-'CA-) r- LL- Total size of property Total size of parcel Z - S -o Date parcel was created .7-d Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? ✓ Yes No Volume//3v- and Page Number .S 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. 2-,Y ® , 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. S-3 /s j, Signatur o Applicant Co-Applicant Date of Sianature ICI I ,I 1982 i :State Bar of Wisconsin Form 2 - - 5J2280 WARRANTY DEED6 voi.1134PAG~ DOCUMENT NO. I - li ` -add ive Farwell and Joyce Harwell - II AUG 9 1995 William C. - li -tius n and fe_' I,I 9 : 00 A. L.: ll~a Con~Ir]]s~i t s conveys and warrants to THIS SPACE RESERVED FOR RECORDING DATA j ` NAME AND RETURN ADDRESS I Delta Construction Company it 206 2nd I Hudso 54016 n WI the following described real estate in county. State of Wisconsin: 0y ~ (Parcel Identification Number) 'i Lot 61, Cedar Hills Estates III in the Town of Hudson. ILPA01 / 77 .i I i; homestead property. This (1s not) if any• of record, ,i and rights-Of-way Easements, restrictions an'I Exception to warranties: Au&P-St 19 4~._. day of Dated this JA (SEAL) V _ •~O y (SEAL) MceHarwell - William C. Harwell (SEAL) r (SEAL) I s I ACKNOWLEDGMENT AUTHENTICATION i STATE OF WISCONSIN ) ss. William C. Harwell Signature(s) County. day of ' 95 Personally came before me this , Jo ce Harwell August 19 l9 the above named day of - authenticated thi r Kristina 0 and TITLE: MEMBER STATE BAR OF WISCONSIN who executed the 'i to me known to be the persor (If not, authorized by §706.06, Wis. Stats•) foregoing instrument and acknowledge the same. - - RAFTED BY THIS INSTRUMENT WAS D land ' - County. Wis. 1(r1St111a_~g Notary Public - expiration date: e at Law My commission is permanent. (If not. state _ Attorn y l9 1 t are not (Signatures may be authenticated or acknowledged. Bo - - necessary-) _ - - _ - Inc 77 - or printed heloH then signatures. Wscons.n Legal Blank Co. NSIN Milwaukee. Wes Names 1 person signing m any capacity should he tvI'rd STATE BAR OF W ISCO. FORM No. 2 - 1982 WARRANTY DFED