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HomeMy WebLinkAbout038-1150-30-100 O i O C; c et 4 n d; ~ I co n 0 rn o - O 0 0 H ~ 0 O of Z c .p t N _ N I co 4 N 0 u In - x 3 N O) N c O C Z O m c (0 7 N 0-0 C LL 0 C Y 0 C Q a N 3 ~ v ~ Z y 00 Cl) = 0 ~ ~ £ L Z d d w a m M F- Z I''', o I c z v v o Z v I c w o a) z c E co N 0) N • I ~ N ~ CU *i O m O Q z m z o Z > N w~ d E £ CL H Y L m OI - N N Q 0 0 p O ~ 0 i 47 c t? p D d C M N U In 2 N LL 0 ~w >333 0 O O O •"Oi m N Q d a rl Z a 0 Lo N 7 O y rn 0 V1 J U rn rn } 0 -j Z Z: N O "a- E 0 'L} O N m co 0) U) 9 N 0 iJ3 0 _ o Q ~n N N N 0 3 y c 0 p a~~ co Q(n CLa)o r C? (0 0- 12 - 7 N O ao co c o uci N H ~ M d N~ 0 E m 0 I` 00 ~0 N co N E (6 M 1 r U • O M Cn O. N O y Cn r/~ y a v ~ • c~ a m .2 m y c r.~ E i j 3 Y 7 A 0 a O V) U f t 9 ~0 STC - 104 e~ ~1 AS BUILT SANITARY SYSTEM REPORT ~ N OWNER J U L 2 4 1995 ST C4CiX ADDRESS 00` (Ty .S' ~NtN~0A'10E ~ SUBDIVISION / CSM_ LOT_ SECTION / - - t -T-?Z N-R ,L W, Town of ST. CROIX COUNTY, WISCONSIN. PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYS h'QUrn;, \ s I INDICATE NORTH hI2POl' Provide setback and elevation information on revel-se of this for m Provide 2 dimensions to center of septic tank manhole covec_ BENCHMARK: ,o ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- ~ L Liquid Capacity: w / Setback from: Well- 9"~7 House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM i Width:- Length Number of trenches Distance & Direction to nearest prop. liner Setback from: well:/c? House Other ELEVATIONS Building Sewer q7 ST Inlet. / ST outlet 7 PC inlet PC bottom Pump Off Header/Manifold Bottom of system_. 9S7 Existing Grade Final grade DATE OF INSTALLATION: - - S°~ PLUMIBER ON JOB: LICENSE NUMBER: INSPECTOR: 3 /93: ] L Labor . r) Department of Industry, PRIVATE SEWAGE SYSTEM County: aborjand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: P PRP 8HAK ~ eDAVID El City El Village [1 Town of: State PI CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /00, I (fJ~ . J y Cc~ l.A~r A9500366 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~o Dosing Aeration Bldg. Sewer 5 7B 9 y~ ' Holding St/ Ht Inlet 5192' 22, " TANK SETBACK INFORMATION St / Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic yak' ~S NA Dt Bottom Dosing NA Header/Man. G.9 a ' 9G"d. St r Aeration NA Dist. Pipe k-031 .0 3 " 01 l7' Holding Bot. System 7-89 ' 1,53 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 75 Model Number GPM TDH Lift Friction Syesatem TDH Ft Forcemain Length Dia. H Dist. To Well /Z I SOIL ABSORPTION SYSTEM BED/TRENCH Width , Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS A I / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK 41 , Model Number: INFORMATION Type o X CHAMBER 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 y, Bed/ Trench Edges c`✓t o~ u Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.30.31.18W, NE, SE, Sicard Lane v r Plan revision required? ❑ Yes No _ Use other side for additional information. /7 '15 PF [l SBD-6710 (R 05/91) Date I peg's Signature Cert. No SANITARY PERMIT APPLICATION BuSafetyreau o oand ff BuilBuildinWater System: ing Water 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. ~l • See reverse side for instructions for completing this application State Sanitary rmit Number c;?3 V7 The information you provide may be used by other government agency programs ❑ Check it revision to revious application (Privacy Law, s. 15.04 (t) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop y Owner a Property Location k-" t 0 / 1/4, S T , N, R (or & 1A Propert Owner's Mailing A res of Number / Block Numl:ief r City, St to Zip Code Phone Number Subdivisio ame or CSM Nu er II. TYPE O BUILDING: (check one) ❑ State Owned ❑ !tr Nearest Road ❑ VII age Public 21 1 or 2 Family Dwelling - No. of bedrooms Town OF !~~L III. BUILDING SE: (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. W New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank 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 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 tT^ Feet Feet VII. TANK Ca in 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 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for nstallation of the onsite sewage system shown on the attached plans. Plum er' N7m. Plum er' igna e: o t8 s) MP/MPRSW No.: Business Phone Number: Plu tier's Addr Street, City, St e, Zip e): l i IX. COUNTY/ DEPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag t re N am XApproved E] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber a INSTRUCTIONS 1. A 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- 11 . 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, rEconnecticn, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 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. Con- plete fur all septic, purip/siphon and holding tanks for this system. Check experimental approval only if tanks rec re::i experi 7-ient:!I -_roduct approval from DILHR_ VIII. Responsibility statement. Installing plumber is to fill in name, license number approxia'= r(~'ix (E.g MP, etc.), address and ;phone number. Plumber ,r.ust sign application form. IX. County / Depa;-, i,ent Use Only. X. County / Depar'.ment Use Only vv 3ept i _ldti ng>E 4 , - .I Ile'. s? J~,l i•. . z: ~ il!fJrr7latlon. CROUNDWAFER SI E_-H, . (_,E 19&3 4' r, l;1 l!ae^Ci th <rea;; it Gr SUrc_hargE ('~eeS} fOi .i nUi' f,!C!l Can effec? 10d y in u; ~eS CJ __tC..: eClr rlonltc ring arc. _ / t -:3tlOrG and e abh. 'nt of Span`d,,rd,. GLIP ~a/bsw ~r l~ /~atWSG .y . A 30 ' lk~ leP nD t~ PAGE OF CrUSS Jec~Ion or SyS Fresh Air Inlelc And Obcervallon Pipe t Approved Vent Cap Minimum I2" Abov Final Grade 20- 42' Above Pipe _ 4' Cad Iron To Final Grad Vent Pipe Murk Hay Or Synt Mtk Covering yin. 2' Aggropal• Over Pipe Oldrlbutlon - Too Pipe !Agg,ogat4 o 0 0 0 6' a Perforated Pip• Bdor Bh Pipe -Coupling Twminotlna At a t7A Bolcom Of System Prp~oSe~ T Inkl grc.cl< ton SOIL FILL DISTRIBUTIOU PIPE APPROVED ~4WTMETIC COVER O ° `MATERIM- OR 9"0':7 STRAW OF A6GR EGATE OR MARSU NAy (o OF J2-ZI/2 AGGREGATE ELEV. O~ FEAT DISTRIgUTirJAI PIPE TO BE AT LEAS-1 WCHES BELOW ORIGIIJAL GRADE AQU AT LEASTZO IIJCHES BUT 1.10 MORE THA1J `I2 FICHES 6ELOW FINAL GRADE MAXIMUM © rvi OF F-Y,(aVAT100 FROM ORI&WAL 6KADF- WILL BF- IuCNEs MINIMUM ®qrn of EACAN/ATIOW FROM. CW\161WAL (jRAQf WILL BE ~f~-- INCHES m e. SIGIJEO: LICENSE I,IUMBER~ DAT E Z-2 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page __L of - 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 0/4 not limited to vertical and horizontal reference po.OgEk d'rrelc Qn,and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and di nQtb:rrearet/oad APPLICANT INFORMATION-PLEAS T eLL XFORMATI'0 REVIEWED BY DATE PROPER OWNER: ROPERTY LOCATION OVT. LOT 1/4 ~ 1/4,S T_]5' N,R or n PROPERTY OWNE ':S MAILING ADDR S OT # BLOC # SUBD. NAME OR CS 4# Cl STATE ZIP CO Pv ❑CI ILLAG mfOWN NEAR T ROAD jX] New Construction Usej-,j Residential / N ,of bedrooms [ ]Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate ~7 ed, gpd/ft2-,,!C trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2_._,y_trench, gpd/ft2 Recommended infiltration surface elevation(s); X17 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable :t ~S ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem WS ❑ U 21S ❑ U LIDS ❑ U 01S ❑ U ❑ S .®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Both' ty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground L~ IV /14 7 ! - 3 elev. W,7- ft. 7 Depth to limiting factor Remarks: Boring # /7 1 's Ground elev. _ c = J JT ya& ft. ys' y Depth to A~o 100 limiting f factor Remarks: CST Name:-Please Print Phone: r q Address: Signature: Date: CST Number: I- Z A,- PROPERTY OWNER I~,~~/r~ ,atJ SOIL DESCRIPTION REPORT Page-22. of PARCEL I.D. # v Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench ti:'• - - Ground elev. V--Z ft. Depth to limiting c~ Remarks: Boring # 7 9 Ground elev. _ ~s 7a / n 7 ft• Depth to limiting factor Remarks: Boring # Ground.... elev.. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Y7 ~ A -cIl I I zz/ j 4 DEC-29-1994 14:07 P.01 ' ~ ~ X96 (i0 • / O' r / 900 s s / O'er 90 o 29 8 O• rJ ,y O ro Va. 4.> a o' 4CV 62045 / 6®Q a ~ P3 ?3 . O' g0 Oiy i . S da m , / X00 0 r ~3 ~y n +''d 2, / 106°56' O / /90 a +a ?/3, O 11.51 y , / J ss~o8~ 001, l5 . 7 T' y~~ 1 , 5' / O~ 1T'3 0~ J~ I .3 / 00- ~s~ gi r I / 4,1P 1! 83 110503' -0 f` / / V ) P4 c "l A0 ~ 8 as O O ~ ~ M ~ ° r .4i O O 00, n~ ti 00 Zed O BO~~ ? bo 99, rip ~4b I' r ti O•.•~ r ? ~e ~O tiCb S 'ti ` 1v 83°0 `\\1 l 00 11+s 8 to's 04 C • ` Q .00. ~0' 0ro aer. , 00\ 89 °50 f~ O~ 2.t _ n. ary ~ h TOTAL P.01 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County r OWNER/BUYER % MAILING ADDRESS ~C5 C no k abbe-- So PROPERTY ADDRESS IR4 1 'L,(C_G 1> (gym (location of septic system) Please obtain from the Planning Dept. , CITY/STATE <r t rl'~ Lk ) Q--(,o PROPERTY LOCATION /VE 1/4, -E 1/4, Section 3 T 3 / _,N-R_I__y _W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~A,/~~r; k)t~yv. ri"dGtS, LOT NUMBER d" Y2 CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER `f- 2-of 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 SIGNED: Q DATE: 199 S St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - loo • 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 Location of property_&a- _1/4 5F 1/4, Section aQ IT 1 N-R W Township Mailing address Q (OL cy~k S- oe c v~2 C S-- Address of site VIC-1 * [y ( ~j2(p Subdivision name c-ny-y-iiS A Pao 1r Lot no. Other homes on property? -Yes_)~'_No Previous owner of property _7k L. Ce-J 1,0-Ae n Total size of property (gyp S/T YZ o-t Total size of parcel 7H S Date parcel was created C'Pc.~n(oD,/- Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? __Yes >_-No volume l/yoo and Page Number 555_? 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 TIIE 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. S_S/7~ 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 Deed; as Document No. - h-4 Signature of Applicant pplicant Date of Signature Date of Signature it DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA ~+~51.~! 1 WARRANTY DEED VOL 1i F r F'REG ER'S OFFICE This Deed, made between John..L..-:Sgpanar--and OIX CO., WI for Record Collette-R.--5poox~er..--husband--and-wife---------------------------- 16 1995 Grantor, nd..--. DaVid._D_Praschak - .and._Sarah.R._.Pra.srhak,-_b sbanrl----_- 11:00 A. a -y,~fe-,_-Survivoshi -Marital -Property---------------------------- - Grantee, 16 Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration...... conveys to Grantee the following described real estate in St_--CrolX_.-------•-- RETURN TO County, State of Wisconsin: part of Tax Parcel No:.U.b:1-15_Q-X1--_____---._ All of Lot 5 and S~ of Lot 4, Carries' Apple River Addition in the Town of Star Prairie. I'RMSFEA EUE This iS--not.......... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.--- ----Grant warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject v) easements, restrictions and covenants of record, if any, and will warrant and defend the same. t~ Dated this day of Tarnipry-------------------------------------------- , 19-- 1\ 1 (SEAL) (SEAL) J rlm-L~_ s.. ner (SEAL) 4= . (SEAL) * * Collette. -R•--.Spooner-------------- AUTHENTICATION ACKNOWLEDGMENT STATE OF ~~f I"iSSO i ature(s) ss. Z0.(--------------- County. fk authenticated this da , 19 Personally came before me this _JA. --.day of j?------------------- 19.95--- the above named ...JA ..L.--Spoaner..and-.Collette.-R-.,Spooner W TITLE: MEMBER STATE BAR OF ISCO ( f~ O (If not- - authorized by § 706.06, Wis. Stats.) to me known to be the person .S......... .whve c. i O o foregoing instrument and acknowledge the sIg LYNDA K. • 4r~•r. ~•'1~ THIS INSTRUMENT WAS DRAFTED BY Realty World- Pauley & Johnson Co nm ssyo SMITH ---res Notary 5ssou~ „ y xpfiA!I$:- - Stillwater Mn------------------------------------------------ Notary Public ounty, (Signatures may {~e authenticated or acknowledged. Both My Commission Is manent. (If not, state expiration are not necessary.) date: - ~-s-t--------------------------- 19.9.-..) - -Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR ,OF WISCONSIN Wisconsin Legal Blank Co. Inc.