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HomeMy WebLinkAbout016-1046-20-025 cC c ° a~ 00 0. N t L c C F- CY) ry .V CU 0 3 U aim °s 0 m c o "Q Y NO U N C N C N U ~ ,r S •o m N ~ q n O N t~: H S O p o O Z c c o n - LL C E y L m O O ) W O N Z f6 O c W ¢ 7 r m Z 3 M v o W Z " 'n z p rY v o z ~ ~ a ° (L m N F- Z 0 c O z Z m d' c C) , m N U d• O O in I- r O N z il C E -O - N "O Of N Cl) i N m - O N v _~V N CL N U) N M C L O ® 0`¢ z f- z :o N N c 'a C M N LO (~i ° y m N Mid O d - O d Lo CL M co co N V O(D cO p N N 0 d w Co Z> F- F- F- O E w N 0 0 0 0 z 0 0 CL (L (L a _ N c ►~i• o c N l C7 rn rn o N J U rn rn Z to Q c2 CD N O O O ? T LO m 0- 'p N N 7) N N 0 O C 1 C N C O Q y ~j c E co 0 LO V O M f W X37 C N o- p p 04 n CL M C N E ~ N N U L O G) 00 00 N 'O F- O C U = O r..l O M O C M N O E U • O N U¢ N O N z (n a; o y a w r`~1v Q y d a c `~1 A 0 cva~ 0U)L) 3 839724 VOL 22 PAGE 5322 KATHGEM H. REGISTER OF DEEDS ST. CROIX CO_ , MI FOR 10:00AM CERTIFIED SURVEY MAP 11/31b%2 D006 VOLUME 22 PAGE 5322 CERTIFIED SURVEY HAP REC FEE: 13.00 COPY FEE: 3.00 PART OF THE NORTHEAST QUARTER OF THE NORTHEAST PAGES. 2 QUARTER. AND PART OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER OF SECTION 21, TOWNSHIP 30 NORTH, RANGE 15 WEST. TOWN OF GLENWOOD. ST- CROIX COUNTY, WISCONSIN RECEIVED oIa _Z JAN 1 2 2001 d E T 3 -1 C-D j ? vOi or. CRW COUNTII nx v = ~ r'1 N 1 ~ < w 7,o T zE c/) m y, E3 C) NOO.39.46"W 328.91' 1 I 0i0 .rD-, G ^ 292-31 i•~oI Q a j j T T " O T r s !r`.~ -S,otl"2• I ? :o co S 0 ''s fi 9 1.._ N 4 (n-1 _a-- i° NI oI w r") r ~ _ o. j 1\ t r?C r0 r-rl N. 4 kn d N ' N a y O a o ir_ ? L1 c m a f ~_o~ ni ~I ~I c m N ID N X a W q 1 I 1 - O Z r--1 r-. N 1 KI N I N 1 p N O N 1C,~,nn• ' p b 1 rp N O 7 1A Q iZ O °m V' vl NI E j• T i Z i ° n 283.23• 150 ' 't a IV O _ rD C> v' j o i So0.39'48"E 320.00• I C N.- ma .31} e a C:>ra Njo N O - „ 210.00• 1 r, =•-o. N0039'48"W N o co o 173.13 1 c 40 line 1 m Cal T - - - - - - - - - - " ~r-) m ru~a Q (o „1°sIo_ o - c E Is CI I vv,, y rn N O •I N °-IN O 41 I~ N i j' N CD QV i , P W Q O n "Z7 N C O 6 co C> CL C? a A_ ~O I E N I N G' N (/1 n T O rn ' VVY' i'~ nl~ rnl E N 'P _ ? rco a g o I rn ° CD L~ J~ I8 I co { I- ro a N rn c nc-, C. 174.31'! so u ( N I I` w `a N i ^3 SOO'39'48"E 210.00'-~ O O O c1 O p N0009'43"E 29460 ' 77• ~o 1. -A 3i 00 f u z '•le N IQ Z'I 1 ^ ro N ' N W 0c;-, cn I I o nv~ =r C= 0 C) -1 6 = o 260.61 so' ffi 1 ° o cr a • - I'N •v r~o r H SOO'11.22-W 294.60' (D I IO u ~ n s 1 rn o <NOO.27-44.0 ~ItS1 I ' N N° Nr° n CLIP 'y C, =2 ~c °O ? ~6 p c c~ n rn 1 9- 1 r// 2 21 i Y, I ccD N O Z5- r1 p C W 01 O C n O ~ro ~ ~ rv ~ a f, rn ~ O , 3 g: o ZQ r moo, Oo a aN - CLZa G ° ;n :3 1°n ..C N 7• ~ d Gl V ~ ~ r'U ~ N ~ `o ~ ~ Wr +cO O W nl 4rD ~ n 7 00 fu MEND 1012 lb Po Page 1 of 2 Vol 22 Page 5322 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ 57 N N~/r° S O /y ADDRESS O 4 V P~ -e /V SUBDIVISION / CSM# ~d ~fJ LJ6 .2- C~ LOT # SECTION-2L_T2N-R~W, Town of LPN 4-t-'O ©p/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /5-0 h v - Hem e a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. rn' BENCHMARK : !/e/oe N N J 1 /)y A /I- rR c:~ e- ALTERNATE BM:~ 1; / SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: llJk',~ Liquid Capacity: Setback from: Well House Other Pump: Manufasp~ Model -Size Float seperation s/cycle:. Alarm Locati SOIL ABSORPTION SYSTEM Width: Length / Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer , ST Inlet; 9~?,2~2 ST outlet 9,2.,-o' PC inlet PC bottom Pump AOff Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB:/'Y LICENSE NUMBER: r INSPECTOR: 3/93:jt s Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and HLSman Relations INSPECTION REPORT ST. CROIX Saf6ty and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PeANDL ( , ' LLISON E] City E] Village a Town of: State Plan D o.: e"Wood CST BM Elev.: Insp. BM Elev.: BM Description: ^ Parcel Tax No.: '40 1 ~ la, 42) '5a'~Ie 7 /-6 -6 1 A911001 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C Benchmark 919 Dosing l j~. /yf '3.3s D 7 Aeration Bldg. Sewer 0r '7 Ho St/,fit Inlet TANK SETBACK INFORMATION St/,*ft Outlet (o 0 a•Oa TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet it Intake NA Dt Bottom Septic '>'/0 A4 Dosing---__ NA Headers Z Q' ss' d,7 Aeration Dist. Pipe Hol Bot. System PUMP/ SIPHON INFORMATION Final Grade anu er Demand -7e -,p "t T /71", Model Number GPM TDH Lift Friction a TDH t Forcemain Length Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ! Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS 07 DI SYSTEM TO P/ L BLDG WELL LAKE/ STREAM G Manufacturer: SETBACK INFORMATION Type O Ile-- anu , CHAMB o u er: System: e, OR UNIT DISTRIBUTION SYSTEM Header"AAam is el-- Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length , Dia. Length -Zl Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over Depth Over 3 „ xx Depth Of xx S /Sodded xx Mulched ftdl Trench Center0 0 ~d7Trench EdgesTopsoil ❑ Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) *f{5.6' t CATION: Glenwood.21.3 .15W, NW, NE, 150tj3 venue LOCATION: Plan revision required? ❑ Yes No / Use other side for additional information. ~l SBD-6710 (R 05/91) Date Inspectors Signature Cert. No. = SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code RT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SAC1NITARY PE 809 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 / d Nall i-e li/ &J I S l T Z d , N, R 94or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # //47 ,Zylye vt1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned VLLAGE ~~~Nw~~d ❑ Public 1 or 2 Fam. Dwelling-#~ of bedrooms!- AR EL TAX NUM ER(S) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo b v 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. IN New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 300 Specify Type 41 ❑ Holding Tank 12 ® 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) t70 , ::Z,r 0- ELEVATION 11-6-0 1 910 e 1 as a _-I-- Feet 9 ;Ze Feet CAPACITY VII. TANK # of Prefab. Site Fiber- Exper. in allons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xistin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holdin Tank p j 0 Ej 0 0 1 0 1 F-1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam S) MP/MPj"1111WNo.: Business Phone Number: e ~1 m 7`` / • - ~~9'O 71,6 ?4! Plumber's Address (Street, City, State, Zip Code): ;2 6r! 17d 6"l IX. COUNTYIDEPARTME T USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate issued Issuing Agent Signature (No Stamps) Approved El Owner Given initial ~ Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber I O I I I j I i I . ;Wood - - - - 1 1 - ,7 - - - „ = &A-1 ; a l r - r!` - - - El I e~+ r ~-1 11,q I Co C, ~ I -I_ - - - - - - _/O_ - - - - - -a - - - - ---a-- ~1 SOIL AND SITE EVALUATION REPORT Page~of DI~HR 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 .sf C 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. o a - O - e APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION / A A cle /I/ GOVT. LOT G j 1/4 ,;r 1/4,S,7/ T Yd N,R 1,5" I111111pr) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # /0/ e ve CITY, STATE ^ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD GL C ,s' o/ (71x ) .2 - 11-fiK7 G~ e ry 44.11 a 47 d 4510 v PQ New Construction Use [X ] Residential / Number of bedrooms [ J Addition to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow o0 gpd Recommended design loading rate / _bed, gpd.'ft2 --j- trench, gpd/ft2 Absorption area required 7&0 bed, ft? Z100 trench, ft2 Maximum design loading rate lambed, gpolft2 , trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material Gx A 0 L 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 cgs ❑ U ® S ❑ U ❑ S NU OS ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boudary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o- e Ground 3 -70 ,.5 r S C elev. L , 7 : S It. Depth to limiting factor Remarks: Boring # C C_ 2 _ 6 jyh• •.~.y 2 -/8 0 3 Sr s NI e S. 6 S.4 r t Mr= - e S Ground elev. ~ 71 --7 Depth to limiting factor __T - - Remarks: CST Name:-Please Print L r5' Phone: Address: Signature: ~ Date: CST Number: PROPERTY OWNER 4 Nc1B,V SO/V SOIL DESCRIPTION REPORT Page .Z of PARCEL I.D.'# O /D Depth Dominant Color Mottles Texture Structure Consistence Bour><1ary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend vR 2Z 3 - to Ground / - 4116 J'C .2 hdll-A / C 5 - .5' elev. ' Depth to i limiting factor i i Remarks: Boring # v a Sid. s M IR C• S, G . 6 Ground elev. ~ it. 2, 04 Depth to limiting factor Remarks: Boring # A4 ~Z;2. Ground elev. ft. Depth to limiting factor Remarks: Boring # h\•:t~v~xi~{fi~ Ground elev. ft. Depth to limiting factor Remarks: - 1-- - - I- - - - - - 41 - - - I - - - - - h-, - - _ - i i 1 Q - - F-- -4! - - e__ V16 I ! I - -Will sly - W _ _ I I I I I I I I I I _ t - I I I r- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMNER & a1V /~~YdBR SDN MAILING ADDRESS /0/f PROPERTY ADDRESS :2 ~.S0 7`h' i4 Ile oe, (location of septic system) Please obtain from the Planning Dept. CITY/STATE 45"'-X 'eNGV O OOH /~S! Z'e-' PROPERTY LOCATION IV4--' 1/4, Illog 1/4, Section T .~?D N-R 46' W TOWN OF 19,/, /Y Gv g o d ST. CROIX COUNTY, WI SUBDIVISION 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. 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: 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 propertyL o y ~//►/0%/;7 Sa ti Location of property_ !k 1/4A[,=- 1/4, Section Z/ , T ,?o N-R /S W Township GL-eNtvo o d Mailing address 1,019 SYn~e f}y~ G,Ceiywood Ci7`T, ~ri/'~o/s Address of site ,2 !i 5,1 env zvo o c/ ~V. / 5yg j Subdivision name Lot no. Other homes on property? Yes____K_No Previous owner of property Eo(w i ni /rif ILL s® N ~i v~P f ~L, cif R.CSoiY Total size of property 7a X aRe- Total size of parcel 7d If a e el Date parcel was created / Z Z!f Are all corners and lot lines identifiable? Yes X No Is this property being developed for (spec house)? Yes ___X No Volume 24W and Page Number j y 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. fl,~~`~? ? , 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 Deeds as Document No. uo.~dy8' Signature o Applicant Co-Applicant 17 (7, D e of Signature Date o Signature