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HomeMy WebLinkAbout040-1214-60-100 h y °o I o: I h O c M 0. 0 ~ L I o N ~o I LO N x -0 in ~ U Ct y ~ ~ I Z N c m ~ c ~ U. 0 0~ I Q ~ I I v m M I w z rn Z i' . p z 0 co co a m 0 O Z c w ;p m 'z d c o cn r z c E z K •N co t o c ►i L c c U Q z r z 0 -o `n o Q k-_ z N ~ I N O y c N C O . O H m 4) CL -ii y m 0 c ct a 0 a o) > E~ FD M = H H H b OM Rr 3: OM O O O U) •uy m i a a a LO to O O N = N rn U <n rn } . Cl) M O N C O M CO o 'j p N 06 ^J O E t~yll C O (D ;V O O - O O O 0) O co o o CL a o ~2 o o o o N N N tp w" G c~ c m N IL FL- o cz E E CO • p 1-',, fn N o C'01 ~t a d a a w • ~ a d I' m E ` C I. c c 3 A U a 2 o m 00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER o IQ IYI .sIJCj S 6,/2 ADDRESS)00.~Z e A esl ox z _NlK C4s6t'l L-J X46/ 4, SUBDIVISION / CSM# Z46V e f _C> te, LOT SECTION G T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .AA ' ~b5 3 g. INDICATE NORTH ARROtti' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f BENCHMARK: e G~.•~ ~ ~~,~t:► ALTERNATE BM: SEPTIC TANK / /PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: cJ W e S~/ ~1 Liquid Capacity: U U Setback from: Well N114- House 2 6 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width:' Length S✓ 9 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: ~J House Other I I ELEVATIONS Building Sewer ST Inlet. / ST outlet PC inlet PC bottom Pump Off c j Header/Manifold Will Bottom of system Existing Grade Final grade 0~ DATE OF INSTALLATIO PLUMBER ON JOB: ft t ; LICENSE NUMBER: AM lr' INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI SWANSON, WILLIAM & LARRAINE X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA Q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - u yps v Benchmark' Dosing W Z2 01;~p /17 Aeration Bldg. Sewer 3 ~3, Holding St/ Inlet wIr/ TA-N--K SETBACK INFORMATION St/ Outlet 9 75` TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic (35 NA Dt Bottom Dosing Header / Man. 9~, 17i Aeration N Dist. Pipe 97* Bot. System 9~d PUMP/ SIPHON INFORMATION Final Grade Man cturer Demand Model Number GPM TDH Lift Lriction System TDH Ft For n Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length / No. Of Trenches PIT No. Of Pits Inside Dia. th DIMENSIONS S S DIMEN I SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING acturer: SETBACK INFORMATION TypeO 112w CHA Moe Number: System: WdSL 05 GfCt DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length f Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S I Depth Over Depth Over xx Depth Of x Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: Troy.16.28 19W, SW, NE, Lot 37, Meado ve ~i~i. p Plan revision required? ❑ Yes to Use other side for additional information. (p I cv-__i SBD-6710 (R 05/91) Date Inspector's Signature Cert No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: µ SANITARY PERMIT APPLICATION r~'~~Ir7■7 In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ a a 935 ?i 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 William & Larraine Swanson SW % NE S 16 T 28 , N, R 19 E (Orm PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 2002 Chestnut Drive 37 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson WI 540 715 )386-7107 Glover Station ~ 16 1111. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned 0 VILLAGE : Tr0 Meadow Drive x 3 ❑ Public ❑ 1 or 2 Fam. Dwelling-## of bedrooms- PARCELTAx NUMBER(s) III. BUILDING USE: (If building type is public, check all that apply) T 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12E] 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. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑x 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 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 450 5,65 570 .78 97.5 Feet 99.5 Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank 1 1000 1 Midwestern R] Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins allation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): PlZV4_6, s Signature: o tamps) MP/MPRSW No.: Business Phone Number: Joe Stang MP 66 46 715 698-2266 Plumber's Address (Street, City, State, Zip Code 506 Willow Drive Wood lle, WI 4028 IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag m Signature (No S ps Surcharge Fee) / Approved ❑ Owner Given Initial ytT /,Q'/ ~f Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, 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 the 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 & 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 bp 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 in 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. Complete for all septic, pump/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (8.11/88) 2~v CkestnwZ Hudso~ s"~l~I L t~ w h of T&a y S/a.'/K N/~' rr S l !o t 2 i g c.J S440ISrGry rjlG✓e- ? Jtct ki Lo 3 1 Q, p'1. )!9p I Ranh njAG 4t S, 1.✓, 1vt L,h G Sys t mow, L- /v 9 7 , s~a 0aawh i3y fvt StGn~ i 66 9 9 s'~ 8,1 J3.3 1 v v , s`b ,e cr t i:. Bey a•~ L; e s , yy , i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: NICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: S 0/a N E1/a /0 W R/? E (or e .3 /ae el, COUNTY. 'OWNER' MA INGADDRESS: ,p 0; S 07 iC f S~yo•7 DATES OBSERVATIONS MADE USE NO. B RMS.: COMMERCIAL DESCRIPTION: PRO ILE DE CRIPTIONS: ER O A ION TESTS: (Residence 9New ❑Replace e RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) C24S ❑U S ❑U S ❑U ❑ S ©U ❑ S DU 0 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVAJON OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 16 I!~ Ca rs 5F6r S B- I It 6 ~0 p `logo is / S' B- a ,SD 140.SQ >lo,SO ~x/'3 /F~BnSI y? "AA er2 e44dSeS B- 3 g. i5 ?la,S'O V"Bh; all nbnAed A,402C S B- 11 d .01 1*4 1,00 se S; B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER PER INCH P- 3 61' /D AV6 P- 3 t., © 49 PI P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Co v er~ E S` Z`~ ke 3 a=6oTe~~s 3 71 F, tN I to-'~ 'f,&io a~ k N E E y 1 Jtl ro n S.~• k. Co i"11 ~ r Mr WAS ~testse , e undersigned, hereby ce rtify that the soil tests reported on this ord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the of my knowledge and belief. NAME ( ri TESTS WERE COMPLET D O ,I A0 fi-t 0, '4 vlN.9 ADDR_ S. CERTIFICA I N PHONE NUMBER(optional): 220 d hi CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - Now 'NST ' C-r'DNS FOB COMPILETING ErNM 115- S BD - 6595 Tot p t~ e , J report 1)1a ii 1. C' 2. tlr Gorr o0rns £ use plarrne ring box( ,UITABLE FOR x. Hf TANK ONLY IF ALL. CI JLED O T AIL CON- 6. PL _ ns shown hr i'ng prof: c i t1;e.> plot plan, 7. MA' ackr -,tl n your test ie is preferred. A n reference ,mown, and are permanent; 9. a; names, address percolation test exemp- 117 . I ation) does riot the auprooi'iate box; 11. I, is and your cert.ifi:nu 12. required. ALL _ TESTS -'SST BE FILED WITH THE L,,, 'I XYS OF GOV, _MIA'. OR CERTIFIED SOIL. 1 E' r»ar rrnbols s BR rock cob - CS ryes gr. ...._r 3zrt LS - L HGW Perc bps idg Y ia)aCYi R Lc in mot - .p sic- fffi' fairr€ P r11 rY1 P 1''or ,I:. HVVL - Hii., eel, .i rE-Mures ~ ~r ~'ispc3sal E3 IM VRP -C TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ` e OWNER/BUYER i~:; MAILING ADDRESS d o C~ /y"61y -r--V6, 7- , /DS PROPERTY ADDRESS ES-9 JO'k t~.+' n W (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 4 1/4, Section 1 T N-RW TOWN OF t 1? v ST. CROIX COUNTY, WI SUBDIVISION e_ J C Q t LOT NUMBER 32 CERTIFIED SURVEY MAP , VOLUME 5, PAGE U G LOT NUMBER 3 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: CLI~t~1a/7~t1~11~ DATE: St. Croix County Zoning Office N Government Center 1 101 Carmichael Road Hudson, WI 54016 11/93 APPLICATION FOR SANITARY PERMIT STC - 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 k, L ' - , JW A-A 2 S n k/ Location of Property 7/1 Nt Section 1 , T~N-R W Township a ~y f (o Mailing Address 1> G C s a~ , r? ! c', S cp t 5 4-1 c q Address of Site .S 4 c i {-r C ~~cC Subdivision Name 0 V G fe S t 4 t Lot Number 32 Previous Owner of Property Dt5 c Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes !.~No Volume R ~ and Page Number 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ceAti6y that a.Pt statementd on this bonm ane thue to the best o6 my (ours) knowtedge; that I (we) am (she) the ownen(s) ob the ptopehty desnibed in tW inboAmati,on 6oAm, by vi tue o5 a waAAanty deed uco&ded in the 066ice o6 the County Reg.i 6ten o 6 Deeds " Do cument No. 2 L 22; and that I (We) puz entey own the pupo.bed .6 to bon the sewage diz pas system (o,% I (we) have obtained an easement, to nun with the above deschibed phoperrty, bon the constnucti.on o6 .said system, and the same has been duty %eco&ded in the 046ice o6 the County Reg-i.ateA ob Deeds, as Document No. 3-2 G 4 S° 7 ) . SIGNATURE OV OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 5269 5"7 State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED DOCUMENT NO. REGISTER'S OFFICE ST CROIX C9" W1 Dorothea Mitchell, f/k/a Dorothea Case Rec'cl for Record , 4 MAR 3 1995 I at M conveys and war ants to Wllllam E. Swanson~Jr_, and odd, - Laraine Swanson, husband and wife r' , r D~cds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St_ CrOlX County, State of Wisconsin: i (Parcel Identification Number) Lot 37, Glover Station Second Addition to the Town of Troy, St. Croix County, Wisconsin. 1"l~ti~3St'~:~I 0 FIT:, This is not homestead property. XXK (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this V day of March 19 95, (SEAL) (SEAL) w Dorothea Mitchell, f/k/a Dorothea Case (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Sign ~thea Mitchell, f/k/a STATE OF WISCONSIN ss. -O County. 11' lf*at tlu~ G =day of March 95 Personally came before me this day of N . r 4 ` a GG~ 19 the above named °P r• zsnd _ T Nf B E RATE BAR OF WISCONSIN (I nbin~a~~~~ authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Attorney at Law Notary Public - County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 'Names of persons signing in any capacity should he tvped or printed below (heir signatures. WARRANTY DEED STATE: BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. ~ FORM No. 2 - 1982 Milwaukee, Wis.