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HomeMy WebLinkAbout020-1138-40-000 Q c -0 ~ ~ °p a ao 0. o I I r. ~ I 0 N I ~ I a ~ I a ZY) x d c W N ~ O N c z ~ I 3 LL c C c O Ol 00 d N z L4 E p rn Z I,, j E rn w a m 0) 04 N I- z c I p o z it C O fn ~ r z E '0 -p M p N N p m N N m n • d s O o O N Q z co z zp N c N E E I is Y 10 Q C w C c d i N C 0 00 Ce) C G a o~ N N~II,1 m fA M W _.1 U ~i O O O a 0 z° •N a a a IL l In a' ° o In J U rn rn CD "V o o E :3 o I m a N .OC '6 d Q ~ N M Ill V1 ~ C 00 O N C O r-+ O c p co r ❑ V (M O p a) C U m 00 O a c N Q vMj Q7 ~ C y E N d. rZ I y.y c IU n N O Ca O O Y O) to z t n ` ^ O H & F4 a) E N 2 III N O N F- UJ O d V is d a a L - a E m c rr~~ L a g O in ~1 A U V ,61«.. ST. CROIX COUNTY WISCONSIN ZONING OFFICE t r r N ■ i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road AIN. ' Hudson, WI 54016-7710 _ (715) 386-4680 January 16, 1996 Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 ATTN: Becky RE: Septic Inspection for Glen Warnke Property Located at 793 Gherty Lane, Hudson, Wisconsin Dear Becky: An inspection of the septic system for the above address was conducted on December 7, 1995. This property is located in the NE; of the NWT, of Section 29, T29N-R19W, Lot 2, Gherty's Addition, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please do not hesitate in contacting our office. Since ely, s K. T omps Assistant Zoning Administrator St. Croix County, Wisconsin mz STC - 104 AS BUILT SANITARY SYSTEM REPORT 1fl OWNER- "1 41 ADDRESS , 1t tSL-' SUBDIVISION / CSM#' Y ~ 741 ~'ty ,.SECTION T,;,~N_R W, Town of ) ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /off G )3 4 V ,'law INDI E NORTH ARROW Provide setb elevation info a ion on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK' ,a'/i~°~_~ ALTERNATE BM: , SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: wellHouse Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width:- Length Number of trenches i Distance & Direction to nearest prop. line: Setback from: well: House 52 Other I ELEVATIONS Building Sewer ST Inlet. //27,2g ST outlet ,Z"9-Z 1,! PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - 7- PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:' 3/93:jt Wisconsin 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 Per iARNKEs N GLme: EN El City [I Village ❑_Town of: State Pla I o.: r X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA / d7 S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I~ S Benchmark CI, Dosin xm" s, C/o Aeration Bldg. Sewer /633 (,61 Holding St 1X( Inlet ~S 10.3. Off TA ETBACK INFORMATION St/44 Outlet /6 3, /f!' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header,!U a. 3 3s 9~/~ " Aeration Dist. Pipe 1,3'171 96-661 i Hol Bot. System s a.3 PUMP/ SIPHON INFORMATION Final Grade M nufacturer Demand Model Nu GPM TDH Lift Friction umeadt:l TDH Ft Loss Forc aIn Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length i No. Of Trenches PIT No. Of Pits a Dia. Liqui Depth DIMENSION DIME LEA Manu aSETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM AMBER INFORMATION TypeO pe,,.r Mo a System: L-o.J J-6t~q 59' ' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Ve take Length Dia. Length _IL Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / TnO4 Center Bed /#eT**-Edges Topsoil E] Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) -V-A5 4? _ Z /7,e LOCATION: Hudsen.29.29.19W, NE, NW, L t , Ghert Lane Plan revision required? ❑ Yes P-14-0 s~ Use other side for additional information. /a 167 SBD-6710(R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: I'I i ng Water ~ 'v~3i'~'r'■R SANITARY PERMIT APPLICATION BuSafetyreau o off Bui BuiildinWater 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 Count~~Zg~ than 8112 x 1111 nches in size. • See reverse side for instructions for completing this application State sapn~ita~ry Pber 7 Th e information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION- INFORMATION - PLEASE PRINT ALL INFORMATION Prop wrier N~a~mp Property Location VUa2+J ~ 1/4 1/4, S T , N, R /or)R Pro a Owner's ranuty ss Lot Number Block Number City, ate Zip Cod Tphome Number Subdivision a or CSM Number ) II. TYPE F ILDING: (check one) E] State Owned ❑ ~t~ Neares Road ❑ VII age Public [ff 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 ❑ 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. jZ 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 Qff 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 ell"Co Feet Feet a VII. TANK Ca n g it i allons Total # of Prefab. Site Fiber- Plastic Exper. INF RMATI N O O Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App: New Existing structed Tanks Tanks Septic Tank or Holding Tank - S' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the, undersigned, assume responsibility for instal t'on of on ite sewage system shown on the attached plans. Plumber' Nam (P Plumber' igna r N ps) MP/MP RSW No.: Business one Number: P umber's ddress Stre t, City a e, Code . IX. COUNTY/ DEPARTMENT US ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No S ps) Surcharge Fee) ? ~Approvecl ❑ Owner Given Initial 4 ~ _ f Adverse Determination `~`t W y . CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS I- 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. 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 all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIIL 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 dimensLons, 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. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of Labo7 and Human Relations 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 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 PROP OWNER: PROPERTY LOCATION 17 C_ GOVT. LOT 1/4 1/4,S T N,R (or,> PROPERTY OWNER':S M LING RESS LOT # BLOCK # SUBD. NAME OR CSM # CITI STATE ZIP CODE PHONE NUMBER ❑CITY VIL GE MOWN NEAREST ROAD 1 ti AZA1 New Construction Use [,4 Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ~ gpd Recommended design loading rate _lZ ed, gpd/ft2 , '~trench, gpd1ft2 / bed, gpd/ft2trench, gpd/ft2 Absorption area required bed, ft2 7:5~2 trench, ft2 Maximum design loading rate Recommended infiltration surface elevation(s) 9'S TS ft (as referred to site plan benchmark) Additional design / site considerations ° - 1 Parent material FI 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 JX~ S❑ U OS ❑ U OS ❑ U ®S ❑ U E] S Z U E] S I~ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BoundEry Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TwIch w Ground elev. -Z ft. s - Depth to limiting factor Remarks: Boring # Zi,g k: 21 -Z a '7 ,Y 1 'el /I Ground elev. - .7 g ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: ddress: v r Signature: Date: CST Number: PROPERTYOWNER SOIL DESCRIPTION REPORT Page zof PARCEL I.D. # Y Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. nt. Color Gr. Sz. Sh. Bed Trerxh e JZ Al Ground elev. 1f VT ft. / Depth to limiting factor /F? Remarks: Boring # Ground - elev. Z22 //T /1~1 Depth to limiting factor Remarks: Boring # / 1 Ground elev. LP-99 d 3 Ila Z ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) _ i oz is G` i 1Qj,~ ~ l 3 A/W J~~kz5- all ~-18 ~d 3 I 36 I 33 ` s~t~ S- ~ _I i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County gg~ owNER/BUYER _ -Glen and ,u ~ l.~ /l/ rn k MAILING ADDRESS '7-50v5 & , d - barPROPERTY ADDRESS `Mg Gher-I- U kane h lucl_~z, J l(location of septic system) Please obtain from the Planning Dept. CITY/STATE /i Ud coq PROPERTY LOCATION _ 1/4, 1/4, Section T G N-R TOWN OF 4U d5 cF , ST. CROIX COUNTY, WI SUBDIVISION 6 tie r4-q'5 Odd ,~i-tM LOT NUMBER CERTIFIED SURVEY MAP . VOLUME I W3 , PAGE 568 , LOT NUMBER B Ioc 3 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: r DATE: Z41 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. -------------------------------------------l-I-(---------------------- owner of property -)en and ~~t5a yi ~(Jai-nke Location of property A/Z -1/4 / 1/4, Section , N-R~ W Township 4'C(S Mailing address lu, © cr M§V St s le Address of site 9 6A Lej 5 0/(O Subdivision name he 'S cr i4 Lot no. o~ Other homes on property? Yes V, No Previous owner of propertym Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes , < No Volume and Page Number 5o;l 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. 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 /Iho/ Date of ig ature Date of Signature MTV State Bar of Wisconsin Form 2,= 1982 ,r.~VA~$AN Y.D Vol` 1.4' 3 PAGE REGISTER S OFFICE DOCUMENT No. ST. CROIX CO., WI Rao'd for Record Sam E'. 14i11er O CT 1 1 1995 &t 01:00 P M I I Rog l.-tor of Deods conpays and warrants to Glen A WarrikP and 511+3-+~--- li yky 'hU3band and yif2 O` Q 00 i THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS A, • 4 tl~y;iollowing described r ,f estate tp,,,~.~~ 5~ 75 I L, 5 5 / .a c County~State of Wiscoq q: u t'; ~y~ta a at-I,~ (Parce[ Identification Number) V-m Lo 2, Block '3, Ghery's Addition to the ToTm of Hudson. x.'17 1 f' ~»I` ' FEE r«1n.m'h. + 'wb wV • , ,K.,,y,,.r, nn boa .,,,w..., ' ~`,I,f~.r .s v, .,-Fy -`"Cta `-~•~1s~~d_i w~li~!~:~:~ll' 4 This JnfLt homestead,property. (is not) r ,;Exeeption;to Warranties Existingi/ryghWays, easements and rights of way of record. D~te th a 1 y 10th Y OL- -nhpr , I9~.5_• day of -)ey) JL SEAL ' (SEAL) w 3 c :a ► Sam 'S. Miller . (SEAL) (SEAL) ~ ~ iON ~ ACKNOWLEDGMENT A T • ENTIC T STATE OF WISCONSIN " Si~natUre;(s) ~a's,• . i ss. I St. Croix County. authenticated this -t _ day of , 19 Personally came before me this 10th day of October 19-95- the above named ~81YL~. Mi 11 Pr WISCONSIN TITLE.*-`MEMB$R STATE BAR Of (If not, authorized by §7 6;06, Wis. Stats,) to me known to be the person who executed the of wled the same. 'nstrument and ac o foe ga i THIS INSTRUMENT WAS DRAFTED BY Attorney David J Estreen w 621 Second St. Hudsm. WI 54016 Notary Public Rt Croix County, Wis. ($,lgnattiies maybe auAhenticated or acknowledged; Both are not My commission is permanent., If not lion date: nbcessary'.)-, 1 9L• UBL1 s 'Npmes of persons signing in any capacity should,be typed or printed Wow their signatures, STA E ` WISCONSIN WARRANTY DEED STATE BAR OF WISCONSIN W1 k Co., Inc, FORM No. 2 - 1982 MilWaukoe, Wis. • vol 1143 PAGE 52 7 REGISTER'S OFFICE ~ SL CROIXCO., Ul 534841 Recd for Record $ATIS'FACTI.ON OF MORTGAGE O CT 11 1996 ...-First Federal Savings a nk La Crosse - Madison, nt 01:00 p. M certifies that the following is fully paid and,4:`•.,. satisfied: Register of Deeds Mortga a executed by S E.'MILLER to First Feder a Savings Bank L Crosse - Madison and recor~"d in the Office,of the Register of _ Deeds ~ ~in St. Croix cou#ty, Wisconsin ' Volume 1124, ?age 451; as acct ent 5297.07, and 57 S descri)Ded as shown bet W: )o. ao C~aP e,K~ ~3 9 Return To: Parcel! Post losing lplfew Department First de Savings Bank P.O. Bo 868 La C se 154602-1868 LOT 2, LOCK 3, GHERTYI~ AUDITION,TO THE TOWN OF HUDSON,.ST. CROIX COUNTY, WISCONSIN. Dated: October. l0, 1995 F, t F deral Savin s Bank a C se - Madi o (Corporate Seal Not Rec~ufired- BY• Sec T 6.03 W s Stats ) AMARA K. HE ST Assistant Se retary STATE tl F WTSCQNS IN ST CRO ,-X COUI On the! above date, the foregoing instrument was acknowledged before above named officer. THIS INSTRUMENT DRAFTEI? BY-4... TAMARA; R. HERB'ST ! MARLENERfCHM. 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