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HomeMy WebLinkAbout038-1119-60-000 ti ~ it a o ~ O ° c 0 M ~ v C O 6 X '0 Ln Q O N 6 N ~ n 3 `p ~O C 2 i c Q a C N n O a c 76 obi a°i ° p E 150 o N o o ° S (n h I N tU6 w N 7 ~ 4) w _U O Z 0 Vi o ° N C 7 <6 rn N p N 1L C co O ~ C Q. Y O (p0 '0 :e , O O N N Q I- ° fn . M Z 1/) co E U) p Z a m 0) LU N (n C O I c t9 is ° Z d c p U O 4= N y0 0 dt Z N N O 0) 0 O CL y O O C I,' ~ O a o y Q w q zco z o N Z 00 co N E N l6 Y o> m - al a 2 a R w c m co T d v N C O° o a o a IL n c° ° m to u) p"p~' ° Z> E F- F- FL O _ N • m m 0. N a g Z 0) 0) to J V 7 rn rn O Z LO > Q) Q 2 E N ° o o CL co °N' p m QI m a~ U a ~ O O N Ill O ° o 3 a c Q p ° c 1° ao ° q co o I- ° N c CL O V N a O N c o (D c o V CL co d Z C (p N ~co N E p v Cl) • y~'i O N U) C7 N O z N F- U) V t~ 4) M IL dt a L a w STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS l!&2 14 SUBDIVISION / CSM# LOT # SECTION 2 T. Z/ N-R ,L,? W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM hQ [ U $K 7 .s~' w,~ll INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. i Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: - Liquid Capacity: Setback from: Well 11 _,&~?o House--_-_E2 _ Other Pump: Manufacturer Model#__ Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width:-_ Len th ~ g Number of trenches Distance & Direction to nearest prop, line: Setback from: well: ' Housed/ Other ELEVATIONS Building Sewer ST Inlet, -25 , 7--~2 ST outlet PC inlet PC bottom Pump Off Header/Manifold ~ S~ Bottom of system Existing Grade , Final grade y DATE OF INSTALLATION: c~~-- PLUMBER ON JOB: ' I LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor bnd Humin Relations ST. CBOT Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit NC Permit Holder's Name: ❑ City ❑ Village p Town of: State PI n o.: GROEPPER, ROBERT X -4-ar- Prairie CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit TANK TO P/ L WELL BLDG. A irItc ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. f Dist. Towel SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: 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 Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.32.31.18W, NE, NW, 192nd Avenue Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buili SANITARY PERMIT APPLICATION Bureau of Buildl 201 E. Washing In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 5' • -Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. t • See reverse side for instructions for completing this application State Sanitary Per Number The information you provide maybe used by other government agency programs ❑ Check it revision to pre7vioZs appllcauon [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop Owner Na Property Location 1/4 1/4, S T , N, R E'(or Pro r Owner' ilin A d ess of Num er / Block NumJ~er C , ate Zip Cod Phone Number Subdivision Name or CSM Numb r / S ( ) Ole II. TYPE C B IL DING: (check one) E] State Owned ❑ Ct Nearest Roa ❑ Vil age , ❑ Public 1 or 2 Family Dwelling - No- of bedrooms Town OF r 111. 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 12E] 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. IA New 2. ❑ Replacement 3- ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank OnlyExisting 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 ~J Seepage Bed 21 ❑ Mound 30E] 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./i ch) Elevation Feet Feet VII. TANK Capacity gallons 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 p , El 11 1:1 1:1 1:1 4 VeO_ - Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for in allatio oft ` e onsite sewage system shown on the attached plans. Plum er' Nam (Pr Plum r"s S na o Sta ps) MP/MPRSW No.: Business Phone Number: Plu tier's ddress Stree ity, te, Zip e): IX. COUNTY / DEPARTM N USE ONLY E] Disapproved Sartary Permit Fee (Includes Groundwater Date Issue suin A ntSi9n re No m 9 9 ,IkA/pproved ❑ Owner Given Initial 47 Surcharge fee) (~jJGy~ Adverse Determination I/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Sufety & Buildings Division, Owner, Plumber i i - _L INSTRUCTIONS r1A 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 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- V1. 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, purnp/siphon and holding tanks for this system. Check experimental approval only if tanks 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 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 dirnensioi-,, location of he !ding tank(s), septic t;:..k(s) or othe tr_ar_r t~,rrtt<,nk_,, building sewers, wells; water i~iJr,, v-);s-r r ice, s~.rE',1MS,::.r, lakes, pump orsiphon distribution so ; a`_;>orption systems; replacement system 3-c.,J,,- 11F.,' the location c I the building served,- -P, Horizontal and ,~er_icsl el--v,ir on reference points, C1 eomp'eri> sr;~i `ica for pur-,ps a-id -ontr0s,- dose volume; eie-ation differences, 'r!r_tiart loss; pump performance :urve, pump r ude' )nc -.!_irnp m,~nuf:.c1urer, D crosssection o` the soil absorption system if !cquired by the county, soil test data or, ii 1 ' f !orm, a, iJ : a: 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. ~~C"~ iii /~r/~ ~ ~ "~t ,4 i jj/~fGaJ 3~,S~j dr$~S~'a 1J~~I ~~t +J A J r Wisconsin gepartment of Industry, SOIL AND SITE EVALUATION REPORT Page o Labor and Human Relations Dibision of Safety r3< 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 7W.Clpal 2-eua-'ge GOVT. LOT 1/4 1/4,S ) T N,R E (or jVI-e PROPERTY OWNER':S ILIN ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY STATE d ZIP CODE PHONE NUMBER ❑CITY VILLA MOWN NEAREST ROAD (~J New Construction Usel~l Residential/ Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required..Z bed, ft2 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2;,_trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site consider tions 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 ❑S ❑U ❑S ❑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 Trench Ground 3 elev. Depth to limiting factor , Remarks: Boring # f -21 1,2 Ground r elev. 2 LL ft. _ 7 9 Depth to limiting fact } Remarks: CST Name: Please Print Phone: Address: Sianature t Date: CST Number: -  I LL 2 L 4:: E; ~ -1/1 14-IL 1 OPERTYOWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bax~dary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cot Color Gr. Sz. Sh. Bed Trench :y Ground elev. rl 7 ft. Depth to limiting fact` limiting L1 Remarks: Boring # 14 lei Ground s elev. ft. Depth to limiting fact Remarks: Boring # Ground elev. S - - ,27 7 ft. Depth to limiting fact Remarks: Boring # Ground elev. ft. Depth to limiting factor  ' MI Ical RA. SBD-8330(8.05/92) -sera t y o? l d6 ~o ash STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix county OWNS UYER 1?6~6 e r i 6ro e-,9,e MAILING ADDRESS /25- 7 53rCr 57~, ~G evS~l~ CcJ1,5. 5162'5' PROPERTY ADDRESS 9*1 9:3 r'rZitcl 4 ue e~o5 5 Rre6 Pwf addr PS (location of septic system) Please obtain from the Planning Dept. CITY/STATE A~e5c,-) Cl~l rr~ ~I GcJtS , / PROPERTY LOCATION N Lc 1/4, 4k/ 1/4, Section a T f N-R W 'SOWN OF ~^T'f} f? i2(~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ,VOLUMEQ~{ D v 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 (I) 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: o~ DATE:", 9 Q S St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 S T L 100 This application form is to be completed in full. and signed by the ou.,ner(s) of the property being developed. Any inadequacies wi.ll- only result in delays of the permit issuance. Should this development be intended for resale ley owner/contractor, (Spec }louse), then a second form should be retained and completed when the property i sold and submitted to this office with the appropriate deed recording. e p .3- 7~,j 6.,er 7"-- fi. ©N Owner of Pr. opert:y - - - - - / - - - Location of property NE 1/4-AW 1/4, Section -~~,`l' 3fIJ-R - ~~W Townshipsr1912 Rhoel E_ Mailing 196-7 Address of site 33 /9Znc/ 170 p5&6-- l~_kow,u ada4ve6_5,. Subdivision name Lot-, no. c>thcr homes on pl:opcrty'? Yc N 1'r e v i_ o u s owner of proper. t. y `T'otal size of property 7 Q Ore 5 'Total size of parcel fl` p QC'l^F$ I)at0 1)<rrce1. was created Arc ala corner:, and lot: lines id(_ut i.f iabLc Ye No - - - 1s this property being developed for (:,pee house) ? lr~ ; No Volume and Page Number~+~ r_ecor.dc:d with the Register of Deeds. INC'T,CIDI; WITII T111;I APT'T,ICA'l1l0N TIII•: I'OI,I,0W1_NC: A WARRANTY DEFD which includes a DOCUMI:NT NUMTIEP, VOLUME AND PAGE NUM111-;1\' AND 1'lil? :.;EAI., OF '1.HE PFG 1S'.I'I,J11 OF U1,1'1 D,,; . .111 ~rdd i_t i on, ~1 ccrti_fi-ed survey, 1-f available, wou](I he hclpLul_ ;o t- r~vo~id del.,lys of the reviewing process_;. I' f the de("d de.-;cr. i.pt:ion re c('rence!-, to -I certi. r..i.ed Survey Miip, t.lw Cer-t-i I i (`:d ;urvoy Mz,f) shill 1 i fso be i-equ,ir.ed. PROPERTY OWNER CERTIFICATION I (we) certify that all statement_; on this form r)re true to the of my (ot11.) l:nowlc(Igc ghat I: (Y~c) jm (~-1rc) t.Irc, ownor-(s) or the property descr. i-bed in this infor:mat.i on form, by virtue of a wat 1. nt.y decd i.c corded >i.n the off i - c(~ ref: t_hc County ltc_g i. ;ter of Dee ds r Document: No. ill.'' - and that I (we) presently own the propo:_;ed site for the set~ac)e 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 Dced~-, <i,; Document No. 5.1 ynature of App.ll.cant Co--App1I_c,1nt S.i.gnatu r c' of `~ignaturc, 4 • DOCUMENT NO. I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA ~ STATE BAR OF WISCONSIN FORM 2 - 1982 464960 ` ~r 1 II - - S PAGEW REGISTER'S OFFICE Davi.d W... . .Wi.n..el. a. .d Andrea L. Winkel husband ST CROIX CO.' WI ......k. ......n.. ..i.... he.i....... Re and wife,• _ individually. and each n their own C1CI for Record right.,- a, k a..Dayid_Winkel and Andrea Winkle DEC1 199 - - Y Ct 11:30 A.M conveys and warrants to ?'O P]" I,• ('xpepper'r, ..a...... _ _ Register of Deeds - - - - _ . RcrunN To OW1n Law Firm 430 Second St. - - . Hudson, WI 54016 St. _ _ the following described real estate in Croix - - - - - - State of Wisconsin: 038-1131-50 & 1i Tax Parcel No: -•038-1119-60 I' 1. NEn of NW44 of Section 32-31-18; 2. The SE 3-A of SWk of Section 29-31-18 except the following VA described parcels : 1) Lot 1 of Certified Survey D'lap filed October 31, 1979 in Volume "3", page 888 as ?-ocument No. 360837. 2) Commencing at the S4 corner of said. Section 29; thence N00°40'12"W 632.70 feet alone the east line of said SWa to the point of beginning of this description; thence continuing N00°40'12"W 468.24 feet along said line; thence S89°08'37"W 212.00 feet along the south line of Certified Survey Map volume 3, pace 888; thence S00°40'12"E 467.76 feet; thence N89D16'27"E 212.00 feet to the poina of beginning. Subject to all easements of record. 3) Lot 1 of Certified Survev Map filed August 17, 1988 in Volume "7", page 2011, Doc. No. 440599. This 1S not homestead property. (X) (is not) l Exception to warranties: TOCTTEER WITH AND SU&TEC'-T TO anv other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. Dated this ..............12th.-- day of ....December I9_90. - - .........(SEAL) i. (SEAL) David W. Winkel . . _._...(SI.AL) i.s LJ-&P. (SEAL) !I A.ndreaL . .Winkel AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN N/A ss. •S••t-- . --•-C-•_r_oi--x County. authenticated this day of___________________________ 19.._._. Personally came before me this ...12th .day of ii -------December , 19.90 a ove named David TI. Winkel and,.'°~ It i~d8 • Winkel, husband a_ Y€l.tivif_e 1/ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to mVikno)to he ers S ="i7v the for egnd Iwledge the`same~ - THIS INSTRUMENT WAS DRAFTED BY Hugh H. (-.win (win Law Firm - - - 430 Second St. , Hudson, WI 54016 ...Hin______________'_:__:"""-----------.-- Notary Public _ St. Croix ------..County Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: I *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONFUN u•:,.- r ..l itl , r.. I... 4 G