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Home My WebLink About026-1030-90-000St. Croix County Planning and Zoning Detail Sanitary Information Wednesday, January 24, 2007 ar 8:37.36 AM 'Page I of I Computer 0: 028.103D-90-000 Sub/Plat: 40 acres Section: 9 Parcel 8: 09.30.18.131 Lot: TNIRNG: T30N R18W Municipality: Richmond, Town of CSM: 1/4114: NE 1/4 SE 114 Owner. Jerome Fairbo Fars, Inc. 1633 County Road A New Richmond, WI 54017 — Stab Permit: 249791 Issued: 11/13/1995 POWTS Dispersal: Non -plumbing Sanitation County Perk: 0 Installed: 11/13/1995 POWTS Detail: Privy - Vault POWTS Pretreatment: NA Nobs Issuedinspect As Built Mary Jenkins NA Not determined Signed Of: No Maintenance Scheduled Pump Date Pumped 11/13/1998 Plumber Other Reauirements Unknown 1 st Notification 2nd Notification 3rd Notification 04/20/2006 Permit: New Bedrooms: 0 YYI Fund: Additional Money Owed dit is likely an owner4nataMad privy $0.00 Wisconsin Department of Industry, Labor andjluman Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: JEROME FOODS, INC. 0 city 0 Village Q Town of: CST BM Elev.: Insp BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. ventto Au Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction 5ystem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No.: State P an o.: Parcel Tax No.: STATION 85 HI FS ELEV. Benchmark Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header / Man. Dist. Pipe Bot. System Final Grade BED I TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes x Hoe Sae x Hoe Spacing Vent To Air Intake Length Dia Length Dia. Spacing I 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.) LOCATION: Richmond.9.3O.18W, NE, SE, County Trunk A Plan revision required ❑ Yes ❑ No Use other side for additional information. SOD-6710(R 05191) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: -==== Safety and Buildings Division vi�rirri 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. • See reverse side for instructions for completing this application State Sanit �er Number The information you provide may be used by other government agency programs ❑ Cfwt:k it revisxal to prevxxis aPO Callon (Privacy Law, s. 15.04 (1) (m)l State Plan I Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI N Property Owner Name PropeFty, Location N(o 1/4 1/4, S T 26 N, R� E (orxli1 c , Property Owner's Mailing Address Lot Number Block Number tb - City, tate Zip Code Phone Number Subdivision Name or CSM Number >C, I 05LI 8 (,7/ 5') II. TYPE OF BUILDING: (check one) ❑ State Owned ❑C ity Nearest Road Public 1 or 2 FamilyDwelling- No. of bedrooms TI`own of C III. BUILDING USE: (if building type is public. check all that apply) Parcel TaxNumber(s) o a�-Ib3o'go �C) 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 S ❑ Hotel / Motel 9 ❑ Office/Factory 13 ,® Other: specify 6u±d"r Pr IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1-9 New 2, ❑ Replacement 3. ❑ Replacement of 4. (7]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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43KVauIt Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per D �y 2 Absorp_ Area 3 Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. N ORMATION Ca c1t in gallons Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Con- Steel Fiber- glass Plastic Exper App New Existin strutted Tank T nks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑ I. ift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. (Print) 's Signatures. No Stamps) fC1 k" . Business Phone Number: Yeah G. le r Address(Strget, City, State ip Code . De IX. COUNTY / DEPARTMENT USE UNLY ❑ Disapproved Sanitary Permit Fee (iroude, Groundwater Issuing A ent Signature ( t ps) Approved ❑Owner Given I Fatessued Adverse Determination 11� �OdSurt�ergefee) 3 Z� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD.6398 (x OS94) DISTRIBUTION. Original to eounly. One Copy To. Salety a Ruil, ingt 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: 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. 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. Vill. 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. V� mernber dadenel Pnoul Concrnlra A V11stonaln Precast As.00latbn �+ ,I'lly Huffcutt Concrete Manufacturers of Precast Concrete Products 737 Herben Street Chippewa Falls, Wisconsin 54729 qC -4 �� CQ,,�, Co. Zor,,,gr - ew L Q.a To:le46 i�i,`M V,.jS 11 cwt M �I NOV-09-1995 09:34 J0aJW FOODS FARIBALLT u.i a• r.r ...ram- .... �. 1 JJ/r/ x J a } �I Y 5U? 332 53633 P.01 w r v — — — TOTAL P.01 G 11/09/95 10:21 TX/RX N0.1213 P.001 • NOV-10-1995 12:22 DRREN J. POWERS CPR 715 246 7762 P.02 PRIVY VAULT PUMPING AGREEMENT ST CROIX COUNTY, WISCONSIN Property Ovner(s): Jerome Foods 34 N 7th St Barron, WI 54812 Location: NW quarter of the SW quarter of Section 9 Township: Richmond Township Pumper Name i Address: Powers Liquid Waste Management, Inc. 550 Riley Ave New Richmond, WI 54017 License #107 We the above named Pumper agree to service the privy vault for the above named owner. Printed owner(s) Name(s): subscribed and sworn 2 ))II before me oasis date: Orian Owner(s) Si ature: ! nary •pu.blic My om;n;-91 a e -p rea on: 4 (Z /9 -•• -- - Printed Pumper Name: Pumper Signat e: TOTAL P.02 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT �St. Croix County OWNERIBUYER �emayv'jz t `Joos , T14 c MAILING ADDRESS 34 r • 7I'' Sl>., & V, PROPERTY ADDRESS I V5$ & k :, (locatio of septic system) Ply obtain from the Planning Dept. CITY/STATE ,y�yyI l q oil PROPERTY LOCATION NC- 1/4, S� 1/4, Section 1 T � N-R /0 W TOWN OF RCk-VV-0^o ST. CROIX COUNTY, WI SUBDIVISION —' LOT NUMBER CERTIFIEDSURVEY 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 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:%l�Q.�� DATE: ///0/9o5— 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. ------------------------------------------------------------------- Owner of property �6 rrt e � Ojs , --D C Location of roperty Nv 1/4 JF 1/4, Section q ,T 30 N-R % O W Town iC� &Lo rj d Mailing address 34 t1'& , rzA� W ► 5�-$ I AAy Address of site 3 3 tr Subdivision name - Lot no. Other homes on property? Yes No Previous owner of property Total size of property `W A-CvtS 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 X No Volume (06 LF and Page Number Z 1i 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 owners) of the property described in this information form, by virtue of a warranty deed recorded 1XI 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. ,&'GC`� ignature of Applicant Date% f Signature Co -Applicant Date of Signature St. Croix County Planning and Zoning Tuesday, September 19, 2006 at 10:54:48 AM Detail Sanitary Information Page I of I Computer 0: 026.1030-90-000 Sub/Plat: 40 acres Sec0ort: 9 Parcel 0: 09.30.18.131 Lot: TWRNt3: T30N R18W Municlpallty: Richmond. Town of CSM: 114114: NE 114 SE 114 Owner: Jerome Falrbo Fars, Inc. ISM County Road A New Richmond, State Permit: 249791 Issued: 1111311995 POWTS Dispersal: County Permit: 0 Installed: 11/13/1995 POWTS Detail: POWTS Pretreatmen Notes Issuer/Inspector As Built Plumber Not determined NA Unknown Not determined Signed Off: No Maintenance Scheduled Pump Date Pumped 1st Notification 11/13/1998 04/20/2006 Privy - V�^ NA Other Requirements 2nd Notification 3rd Notification Permit: New Bedrooms: 0 WI Fund: Additional Notes Money Owed $0.00