Loading...
HomeMy WebLinkAbout038-1167-90-000 N O d 4 0 p ~ ~ I o I H I a I ~ I I ti v z C c LL O I I N z ~ ao Z O ~ g € o Z a m co H V) O O z c = rn U) N o Z c E v Cl) N = C :3 N C N L O O N C w Z m D Z ayi 0 c w0 {0 E E N w _ Y C CL 0. ° C C a` a c U) V) ~co 0 0 o h~ z 0 y IL v) J U cr rn rn } :z ZZ CD cn (D co 0 O a N z°° w m C: a u) CD .n a O 1 0, N C E co O 0 0 N 0 a m co z m m a c rn rn V 42 O O y M O 10 O r L = t=yam') - te a C O N N H C N M O •O O N U) Y N O Z C g V ~ V~ N A € a I a ` CL 2 y • a d E ;c ~1 A ciao ~Uu ST. CROIX COUNTY WISCONSIN ZONING OFFICE r N a n ■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 30, 1995 First Edina Mortgage Fax: 386-1502 Attn: Beth Stenzel RE: Septic Inspection for Sid Kaminski Address: 1991 - 104th Street, New Richmond, WI 54025 Dear Ms. Stenzel: An inspection of the septic system for the above referenced address was conducted on October 3, 1995. This property is located in the SW 1/4 of the NW 1/4 of Section 28, T31N-R18W, Lot 18, Red Pines Estate, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a two (2) bedroom home. Should you have any questions, please give our office a call. Sin rely, es K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin db L A, F y1 d .r , STC - 104f~ a ILT SANITARY SYSTEM REPORT--' S AS BUILT SANITARY SYSTEM REPORT--' l OWNER 3~~ •,~{~r < ~'f ADDRESS /1/ x;l SUBDIVISION / CSM# - LOT # SECTION _T_ sI_N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM pel 1 ~ 4% r r/ M`Aie 10 INDICATE NORTH ARROW r vide setb and elevation information on reverse of this form. X~ rovide 2 dimensions to center of septic tank manhole cover. BENCHMARK: " r - ALTERNATE BM: ',4 SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer Liquid Capacity: Setback from: Well House An Other - Pump: Manufacturer Model#Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: ~ 2 Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well:_ House- Other ELEVATIONS Building Sewer-/_,n. ST Inlet ST outlet PC inlet PC bottom Pump Off Header/Manifold ZZ _ Bottom of system , Existing Grade Final grade DATE OF INSTALLATION: 49- i PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: yr-, 3/93:jt Wisco.1sin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village p Town of: State PI o.. KAMINSKI, SID X BM Description: Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: I A9509247 TANK INFORMATION ELEVATION DATA /0 0,Bys TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S ~Ne JoC~ Benchmark Q Dosi Aeration Bldg. Sewer Holdi St / Fe inlet TANK SETBACK INFORMATION St/ F;If Outlet /Dl~ $(o1 TANKTO P/L WELL BLDG. Venttc ROAD Dt Inlet / Air Intake Septic NA Dt Bottom Dosing NA Headers 160, 761 Aeration a Dist. Pipe 16b-66' olding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 3, a' 16)6 odel Number M TDH Lift F ion Sys oss Forcemain ength Dia. H Dist. To Well SO BSORPTION SYSTEM BED/TRENCH Width/ Length No. Of Trenches No. Of Pits Inside Dia. id Depth DIMENSIONS 1 ~o / IMEN I t+UNS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LE anu acturer: SETBACK INFORMATION Type O , , CHA R Mo ter: NIT System: DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) e'~ x Hole Size x Hole Spacing ntake Length Dia. Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grad st s Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodd xx Mulched Bed / Center Bed /,T_4qozh_Edges r- Topsod-` ❑ Yes ❑ No ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.28 31.18W, SW, NW, Lot 18, 04th Street ~C. /rT1 Gt..tt" Cr "K Plan revision required? ❑ Yes Fi lAb Use other side for additional information. SBD-6710 (R 05/91) Date Inspector'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. • See reverse side for instructions for completing this application State Sa ittar Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION FORMATION - PLEASE PRINT ALL INFORMATION Prope caner Na a Property Location 1/4 1/4, 5 T , N, R Vo Property Owner' Mailin Acid re Lot Number Block Number 91 Ct , Stat Zip Code Phone Number Sub I ion Na r CSM Number f /J Ir I ; 7 1 ( ( S . TYPE OF BUILDING: (check one) ❑ State Owned City Nearest Road F1 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF / , 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) - 1 ❑ Apartment}/ Condo ©Z9^ 11d7 _ 9O 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. pj 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 JA 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. ate 6_ System Elev. 7. Final Grade Require (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min ./ich) Elevation Feet 4to 7 Feet VII. TANK Caa in gltoaclts Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins llati n mf onsite sewage system shown on the attached plans. Plu b 's Na Zn Plumb 's Si ature: mp MP/MPRSW No.: Business Phone Number: nl lumbe sA dre Stree Cit te, ode): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Ag nt ture ( Stam :,~A/pprovecl ❑ Owner Given Initial 00,~ Surcharge Fee) Adverse Determination - X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION:. Original to County, One copy To: Safety & Buildings Divm:ion, 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. 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 receive( 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 subs itted to the county. The plans must include the following. A) plot lp;an, drawn to scale or with complete dimensioi-,, loca'Ji.jr) of hc•icling tank(s), septic '.Imk(s)orothertreatrnenttank building sewers, wells; water mains,Y,atc s.f :'e lakes; pump or siphon t,:inks, distriCrution boxes, sod absorption systems; replacement system area,.I tPie loo 3t~o c.f the building served; !,orizo t,nd vertical el<1vator, reference pcir,ts, CI complete spec~'it.,~•7n`or orr~r7s zr ti `ontrols; dose volume; elevation differences; friction loss; pump performance -urve; pump modf~: ard :ramp rn, nu4:ciurer, D) cross section of t},e soil absorption system if required by the county, E) soil test data on a 1 15 dorm; and F) al sizing information. - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practice.. which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. LAW ~„SK i i 7f Fjo~' =iy'~ 0 i WisdAsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page-/ of t 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 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 GOVT. LOT 1/4 ! 1/4,S T N,R /(or)g PROPER OWNER':S M LING ADDRESS LOT # BLO # SUBD. AME 0 CSM # CITY STATE ZIP CODE PHONE NUMBER CITY VILLA 0 WN NEAREST ROAD ] New Construction Use [~J Residential / Number of bedrooms [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ,bed, gpd/ft2_.,,/ trench, gpd/ft2 Absorption area required 99o bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2_1t1/_trench, gpd/ft2 Recommended infiltration surface elevation(s) g ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood 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 ❑ S ❑ U El S 11 U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure t Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots G P D/f Bed Tra-ch Ground _ elev. ft.?- Depth to t ; limiting (i a F 4 T u factor w---1 -lot r a. r Remarks: t Boring # 'AIZ /I Ground elev. AZZ /.42" ft. 's "j Depth to limiting factor Remarks: CST Name: Please Print Phone: :41 ZZ Address: Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page,2!bf-L2., 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 Tw 1 /4 a - O Ground elev. id~,PG/.z ft _ Depth to limiting factor Remarks: Boring # J J Ground... elev. Depth to limiting factor Remarks: Boring # n S b AJ Ground elev. / ft. _ Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) so fs ~~Om~ Cs,~~ /itJ Z' S^`7Q~S~ jZ l ~~c~/ 1j,A', o-f yf 41 X ~Gocn-~~m.J m ~s,~E 1 . /r,f/E ye,12., o /Sy 10~~.~ts STC-105 SEPTIC TANK MAINTENANCE AGREEME NT St. Croix County OWNER/BUYER MAILING ADDRESS d PROPERTY ADDRESS le0ZA C9. (location of septic system) Please obtain from the Planning Dept. CITY/STATE V PROPERTY LOCATION 1/4, _ 1/4, Section,,,)jT N-R. W TOWN OF ` - ST. CROIX COUNTY, WI SUBDIVISION ~~~s G ~~Z( LOT NUMBER CERTIFIED SURVEY 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. 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 must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: J~~ A~*~ 4~~ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 L 'L L - 1U0 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 hermit issuance. hou:LCi this-, development I)(- intended for resale ley owner/contractor, (spec 1rouse), then a second form should he retained and completed when the property i_ sold and submitted to this office with the appropriate deed recording. Owner of property - ------C~( l1~~- - _ _ Location of property_.~ _1/4 1/4, SccLion 1!-R Tow strip --Ma i. l.iIiy I.icl(Ires,, lfw - - '11 - - - - - - - - - Address of site q subdivision name Gt Lot nO other homes on property? Yc ~ - 1Io Previous owner of property~~;,~~~ '1'o t a 1 size o f p T o p c r t. y - - _ - - - - `IPot..t]. size of parcel. Date parce]. was created Are all corners and lot lines i.dent.if ahle? Y(?,; _ 1Io 1.s t.his pro 4crt:y being cicve-loped for- house.),-, lNo , rPr_orded with tlhc peg i ster V( 'I.ume i and P_tge Number J:31 of Deeds. IM,' , IDE WITH T HR, AP11TJ('AT 1.011 THE F01,1,0WI NG : A UTARIZAI TY DFFD which includes a 1)OCtimE1'I' 11Ummi p, VOI,U1 F AIM PAGE 1`11U10ll31:I\' ANU THE :;11:1%T1 OF THE RVG I 1T ;I, OF Ul?EI)'.; . I n Ltdd i.t~. Ion, a ,el-t:i fi-ed survey, i.f available, worth:l he helpful. so avoid del,iys of the reviewing proces.,:;. 1:f tt)c dc~d dc_;cri.ption references to ,a Certified Survey M(Ip, the Cert.lied Survey Map ;hall al-lo be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statement! on thi..s form ill-c' true to the of my (oull ).nowledge that 1. (we) ~Im (are) the owner. (s) of,- the property described in this inform<iti-on form by virtue of a w,rrt ~inLy decd rccorcled i 1 of I i_cr,I: t.hc County R< (j_ister of Deeds as Documc'.nt Nc.). and that f (tic) presently own the proposed site for the scw- ige disposal sy::;teln or 1 (wc) obtained an easement, to run the above described property, for the construction of --'ai.d system, and the >amc~ has been (-Wly recorded in t110 office of the County Register of Deeds ~ls I)ocument 1`I0. naLute 0C ~1I?t>.I_ icant Co- App1.I-c,rnt_ o .~i.gI t111:e U~it~~ of: .>>_gnattlr W . 07/24/95 MON 15:55 FAX 1 715 386 6560 ZILZ & ESTREEN IM 002 532232 State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED REGISTER'S OFFICE bpcUnnE► NO. VoI_ .1134PAGE231 ST CROIXCO.,W1 _ - - - Heed for Record AUG 11995 ~ Dan McCulloch a k D ' ej,- lloch. aka Daniel C. coc:3t) P.~, F conveys and wA k RegIsterof Desds do e y A. Kam i n g~-and - wants to ,~j Tekria A... ,Kamin:s "j b,11g•banc3 anti THIS SPACE RESERVED FOR RECORDING DATA NAME ANO RGTjJ3N ADDRESS /'may the following described real estate in St. Croix County, State of Wisconsin: (Parcel Identification Number) Lot 18, Red Pine Estates in the Town of Star Prairie. This deed is given in fulfillment of that certain land contract between the parties hereto dated June 1, 1995, recorded June 7, 1995, in Vol. 1125, page 272, as Doc. No. 529888, in the office of the Register of Deeds for St. Croix County, Wisconsin. . EXEi pT This is not homestead property. UX (is not) ~i Exception to warranties: Dated this z 4/ day of Jul l9_15 Signature of Daniel C. McCulloch, a/k/a Dan McCull , a/k/a Daniel McCulloch authenticated this 24th da of J_ (SEAL) ~ (SEAL) LUCILLEJ..HERMES Dan McCulloch, A/k/ • Daniel PAM COUNTY lit MCUU oc a c a aaniel"Z , McCulloch 6 (SEAL) (SEAL) NN Lucil e J. He es, Notary Public, Ramsey County, Minnesota i My commission expires 01/31/2000 THIS INSTRUMENT DRAFTED,: KRISTINA OGLAND ATTORNEY AT LAW r to we knnwn In hr. thn near;