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HomeMy WebLinkAbout032-2051-90-000 -0 CD 0 3 o h O GF> ~ o I Oq Ii ~ I b N 0) N I m y I O O Y I E I T I Y I (D z I ° f6 y o co I ~.CD co E a ~ M H I ~ w E rn ~ = O I o I Z r a m I H z o I o z a c to F- ~ ~ ~ I N ° c co y I U) I y 0 (_D c O Z m Z 6 16 Z w N y0 d N - C ~ f~ H R ? I ` • • d f0 CL co N III N d N 0 0 N 'i ~ N N N j O w N N I E o n a 3 Z v v o 0 0 0 0 0 •N Eaaa a *a L I crn I.3rnrn a i fA J U ° rn rn } ti z a - N In o Q N N N I ` O O E 7 a c, o ~ I a r v m 44) a~ Q > in m Cl y c I O I o v c E co LO co O o m ° c a°i y u d o o ~ m a C-0 N N O oi N 1 7 c EO r M 0 1 y.y r e w 00 t d 00 C~ . rr o O L d 4) 'D° H C N In ]r^~)1 1 4 co) E r O O co O tn O t6 U I • ~E N O Z Z fn O e~ I v Cl I E j Cdr 'IV +Cd-+ E •E ' t~ R t A vat 'IONV STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS /-S7 5f 7 7 S SUBDIVISION / CSM# IV~I LOT # N /S SECTION l T 30 N-R//9 W, Town of .SoY~'721^SQ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q ~ ~rcye,h ao' y. 0 PJ` QI-f ~,,ic wnC•e ~y i INDICATE ORTH ARROW Provide setback and elevation information on reverse ofthis form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK 1 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:` Liquid Capacity: Setback from: Well House Other Pump: Manufacturer ModelSize Float seperation Gallons/cycle: - Alarm Location SOIL ABSORPTION SYSTEM Width: /oR -Length- 4 _ Number of__ _ Distance & Direction to nearest prop, line: v• -3S Se Setback from: well: /d-a _-k House 26_ Other .00 ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold 5 Bottom of system Existing Grade 7 ..5 Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wiscdnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laborand Homan 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 Plan o.: `R I WIRTH, EUGENE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA W 01 ~5~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. d~ 6hi Septic = ~ C Y Benchmark oly Dosi n Aeration Bldg. Sewer Ing St/I'Inlet TANK SETBACK INFORMATION St/ Outlet S 7~1 J00, 3~j r 4Lf TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom 1-7 Dosing NA HeaderfAfta: Aeratio NA Dist. Pipe 9 Z?a ( 0/ olding Bot. System PUMP/ SIPHON INFORMATION Final Grade Ma facturer Dema Model Number GPM TDH Friction Sys Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT o. Of Pits Inside Dia.. th DIMENSIONS ~O ("J DI EN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING cturer: SETBACK INFORMATION Type Of CHAMBER J stir if i ~ 7 ode Number: System: ~d ~l/0 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) , x le Size ZHolies Vent To take Length ~D Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gr Systems On y 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: Somerset.~1i4..30.19W, NW, SE, 75th Avenue - Ln i Plan revision required? ❑ Yes 940 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. I i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION 7UILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY _.e.,,~,,,.o,....,... 57 G tr-a 1X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than A V0 746 8% x 11 inches. in size. ❑ Check if revision to previous 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 Geri L) 1 1r"~n &LI % 5 Y4, S T 3a, N, R ; (or) W PROPERTY OWNER'S MAILING /~[tDRESS LOT # BLOCK # A 151:2 -7 S - a DRESS A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER W t O! 71 I !ti 79 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD d ❑ State Owned D VILLAGE.: 7$ ~ [:]Public 19 1 or 2 Fam. Dwelling-# of bedroom PARCEL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) o, 3a - 0~0 y 7 0 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.E1 New 2A Replacement 3.E1 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 ~jSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 LJ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12.ABSORP.AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. f.) PROPOSED (sq. f.) (Gals/day/sq. f.) (Min./inch) pELEVATION #-5v 4f3 . 70213 1'g fb+ 750 a Feet l s Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App. Tanks TI a S- Al F-1 eptic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber El 0 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pripqj Plumber's Signat e. o S ps) AAP/MPRSW No.: Business Phone Number: sr,/a rs 15 6.3 51US' CA 10/ n Plumber's Address (Street, City,mte, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY tPn1 ps) ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing ent Sig ature k9" / Approved E] Owner Given Initial Surcharge Fee D® Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. 4 sartitary.permit is valid for bvo (2) years... 2 Your sanitary permit may be r~3newed 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 mu:;t be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submiped;to the county prior jo installation r 5. Onsite sewage systems must IA properly maintained. The septic tank(s) must be pumped by a licensed pumper-whenever necessary, jsually every 2 to 3 years. ya, 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 tb.s.sal~ttW.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 instalt3d. . 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 Fublic, check all appropriate boxes that apply. IV. Type of permit. Check only one i i 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. Qomplete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if1anks 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'f 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 ether 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 s6i(tec4 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 collepted through these surcharges are used for'monitoring groundwater, ground- water contamrrlabon investigations and establishment of standards. ~r `.w. SBD-6398 (R.11/88) , i , ! . i 1 ; , k a , Q. oqiuj 1 . f i r , T : i J_ - 1 v 'A . r r r : i ! e . e- i 1 ~s a 1 T 1 I 1 . i i 1 , f I i _ ' . 1 PAGE OF C`dSS Sec~Ion o~ S s~e~+-~ JS Y7 7.f-tt y r Qn f 1~~cJ A t' ~ rat yy-p~ W Fresh Air Iniala And Obaervallon Pipe (2~--- Approved Vent Cap Minimum 12' Above Final Grade 20- 42' Above Pipe _4' Caen Iron To Final Grade Vent Pipe Moreh Hay Or Synthetic Covering Min. 2' AIgregale I Over Pipe Oletrlbutlon -T . as PIP. 4 9 0 0 0 0 j 6" Aggregate a Perforated Plpe Solar Beneath Pipe 0 -Coupling Terminating At 8oltom Of Syllem 4D s 1 ~~cJ•:~ ton SOIL FILL DISTRIBUTIOfJ PIPE APPROVED SyMrIETIC COVER MATERI^~ OR 9" OF STRAW 2" of A6GREGA'T~ ` ; ; _ ~ e pR (~ARSN NA`.i ~.OF 12-21/Z AGGREGATE tLEV.. of FEET_-.. DI•STRIBt]TIOIJ PIPE TO BE AT LEAST 010 WtHES BELOW ORIGIUAL GRADE AMU AT LEAST20 IIJCHES BUT K10 MORE THAI) 42 IUCNES BELOW F11JAL GRADE MIMUM OWN OF EXCAVAT100 FROM OPI&1NAL 69AoF WILL BE Ja INCHES J 11(lin m gefT1i of EXCAVATION .ROM. 01KI(AWAL GRAPE WILL BE INCHES SIGHED: UG EU SE 1JUMBE R: I~6 3 DATE: Wisconsin Department of lndustV, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor 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 a 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 P OPERTY OWNE , PROPERTY LOCATION GOVT. LOT W 1/4 1/4,S / T~ N,R joor) W PROP WNER':S MAI NG ADW LOT LOCK # SUBD. NAME OR CSM # A/ A- V *t CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑V LAGE OWN NEAREST ROAD IG G Uj.'510/ O I T -5.1 [ ] New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow .5~ gpd Recommended design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate gybed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 25,73 ft (as referred to site plan benchmark) Additional design / site considerations A4 A 14 Parent material Lj aLS Flood plain elevation, if applicable Allh It S = Suitable for system CONVENTIONAL UND IN-GROUND PRESSURE AT-GRAD SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S❑ U PS ❑ U S❑ U El S U ❑ S JSI U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 133 o S im - 7 elev. S Depth to limiting factor Remarks: Boring # w:> a I--11 s a rnsbK, f-'\ I .5 6 a) .7 Ground ~r S - M~ - 7 g elev. S /OVA Vq 5. 9,2ft. Depth to limiting factor { ~F Remarks: CST Name:-Please Print Phone: rs 7/S" Address: 9 l 2 2! Signature: Date? _ a5 9jr CST Number: 31 PROPERTYOWNER G e.n QL L',) I r 1 r~ SOIL DESCRIPTION REPORT _ Page oZ Of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench b-i6 16 R 3'6k m0 Ground 0~3 Jb R S D _ f elev. ft. Depth to limiting ~tn Remarks: Boring # i4 Ground elev. ft. Depth to limiting factor Remarks: Boring # F.: w:. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) : a L , I , i - I t ~ lick- 1 ' 7 i 1 0-1 3. - h t J I -s_ --a : s y\ ooll , , i , • 4-4 t r l ~ (y7 1 _ M ? I : Y i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT n FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 0 •a-Y%R- W % r\, residence located at: O 1/4,~1/4, Sec. IF T 36 N, RICW, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes)ENo (if no, skip next line) Approximate volume or length of time: ---gallons _--I_minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : PCP I dwa'`+ ca+, ' fe- Age of Tank if known) : o?O~rl-• (2al.' V jr ?C)We_r,5 ~Y- (Signature) (Name) Please Print ~t.,Gs, Yr1PRS~ / ~ 3 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wi Adm. Code (except for inspection ope . ver outlet baffle). Name ()l;j Pj~; rI S ignature /MPRS 3 5/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix -County OWNERBUYER MAILING ADDRESS 5 u -7 S ~ PROPERTY ADDRESS a v~~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1 ..e c~1r~ o L ©i 7 PROPERTY LOCATION 1/4, 1/4, Section T_..3 15 N-R_L!~ W TOWN OF S o -WI -2 rs~~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER T J CERTIFIED SURVEY MAP n)/ , VOLUME__tjPAGE 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.. r SIGNED: UV~✓ DATE: 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 G `eq\4 Location of property ;W 1/4 1/4, Section N-R W Township s•2. Mailing address S c P `I~ Address of site ct rye. Subdivision name Lot no. ry~ A Other homes on property? Yes_k_No Previous owner of property mats y Total size of property Total size of parcel 3.03 42 e- Y, Q 3 Date parcel was created .Sr =2 T- I ci Are all corners and lot lines ide ifiable? /r Yes No Is this property being developed for ('spec house) ? Yes _,~_-No Volume S,y and Page Number 66 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. 3 and that I (we) presently own the proposed site for the ewage 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. Signa ure of Applicant Co-Applicant - 4, Date Vd-signature Date of Signature I DOCUMENT NO STATE BAR OF WISCONSIN-FORM 2 WARRANTY DEED r 801( 5~4 PAtit~ THIS SPACE RESERVED FOR RECORDING DATA 323144 ! Marvin Wirth & Beatrice R. Wirth, REGISTERS OFFICE BY THIS DEED, husband and wife, ST. CROIX CO.. W1s• Recd for Record thls_.?i~th Eugene M. Wirth & Cheryl' day Of__;-Q1y______AA19_74 Grantor conveys and warrants to gene P Wirth, husband and wife, at__ 4_141 M gleter of Deeds Grantee- for a valuable consideration one Dollar and other valuable RETU N TO consideration the following described real estate in ST. CROIX County, State of Wisconsin: Tax Key k This is homestead property. The North 378.00 feet of the West 350.00 feet of the Northwest 1/4 of the Southeast 1/4 of Section 14, Township 30 North, Range 19 West, Town of Somerset, St. Croix. County, Wisconsin. The above described parcel TRANSFER contains 132,297 square feet or 3.037 acres of land subject to the Westerly 33 feet being reserved for Town $ .S Road purposes. FE]a Exception to warranties: Execut6d-at New--Richmond,--Wisconsin this--25th day of July 19 74. SIGNED AND SEALED IN PRESENCE OF " I V V (SEAL) Marvin Wirth q ,~Q re~llr.~c~ Cam. Gf/,e~-(SEAL) Beatrice R. Wirth (SEAL) (SEAL) Marvin Wirth and Beatrice R. Wirth Signatures of Zbth 74 authenticated this day of Ju y 19 W Ward Title: Member State Bar of Wisconsin ER-MM9 Ac"ti-evrne3-unite a Bfr K . STATE OF WISCONSIN s s. County. Personally came before me, this day of 19_, the above named to me known to be the person- who executed the foregoing instrument and acknowledged the same. This instrument was drafted by L.R. REINSTRA, Attorney Notary Public County, Wis. New Richmond, WI 54017 The use of witnesses is optional. My Commission (Expires) (Is) If Names of persons signing in any capacity should be typed or printed below their signatures. M.CMfIlerCanparry[fY11 WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 2 - 1971 t.II~ l J