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HomeMy WebLinkAbout020-1173-90-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER p(/Y ADDRESS SUBDIVISION / CSMj_,4). ffsa fr LOT SECTION T N-R W, Town of ~~~(9e ,,J ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o f 6m~1' G s z .v X N INDICATE t40RTH APPOk~ Provide setback and elevation information on reverse of this fo►m. Provide 2 dimensions to center of septic Lank manhole COvel BENCHMARK: SCl G /L S ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: j~,`,fWcs7`r~.y Liquid Capacity: IDQB Setback from: Well House /7 Other Pump: Manufacturer Modelg Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width:-,5- Length .-7 Number o f trenches Z Distance & Direction to nearest prop. line: Setback from: well: House J" r other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: CS__ PLUMBER ON JOB: LICENSE NUMBER: fy~~~3rj~ INSPECTOR: 5/93: )t L( ert~~ st~y7 29.19.1 MVRfg ^gifdAVCi'•E $ EM S County: -'t'gbor arad Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary PermitlVO.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: HUDSON CS BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: L TANK INFORMATION ELEVATION DATA A9400055 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic u1+`~S r e ~ G/ Benchmark a. ~y W 11 Dosing it 1 a S~ /do, r Aeration Bldg. Sewer 732 9~ Sa Holding- St / I~ Inlet 7 031 TANK SETBACK INFORMATION St/Outlet SSA/ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA ' Headert~. g3 9 o , Aeration Dist. Pipe B S~ o~ Holding Bot. System 9 !S PUMP/ SIPHON INFORMATION Final Grade Manufacturer and T Model Number GP TDH Lift Friction System t Loss e Forc ain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits I e Dia. Liquid D th DIMENSION S 57 s DIMENSI SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI facturer: SETBACK CHA ER , Model Number: INFORMATION Type O 0Qxr System: ("c/; { OR NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s)/ Nx 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 S ms Ontya. Depth Over Depth Over xx Depth Of x Seeded / Sodded xx Mulche p Bed /Trench Center- Bed /Trench Edges Top soil ❑ Yes ❑ E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17. 29 , ] 9.1091 SE, SW,/O,VER LOOK ASS~G rd Z = ~a UGC, 5. , _ C c F (\r"J) (~N ~~ai..4X~d./ ~ L-~`-s~., ~ l Q~'<2'.Gfyi'7.~GC~L.~- ~ L`'~ ~~L~,. ~ 1 Plan revision required? ❑ Yes Oo Use other side for additional information. (p o~ 7` 7 SBD-6710 (R 05/91) Date Inspe or's Signa ure Cert. No SANITARY PERMIT APPLICATION CO In accord with ILHR 83.05, Wis. Adm. Code C STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a0 T 9 3 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 ti•,-5-4J %4, S/ T a N, R / E (or ont A/ 6' PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE ~tt6- R TOWN OF: ❑ Public L3.J 1 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) ;2 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 12 ❑ Service. Station/Car Wash 5 ❑ 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. K New 2. ❑ Replacement 3.E1 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 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 L,~~ REQUIRED (sq. ft.) PROPOSED (sq. tt.) (Gals/day/sq. ft.) (Min./inch) 1 ELEVPTION I ~eJ Q , ~ O Feet 7 © Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New fisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ® W e 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 Stamps) MPRSW No.: Business Phone Number: ,p " l (.~Gt 14 A 715 l 1.2 r Plumber's Address (Street, City, State, Zip Code): ZZ a," ~ T IX. C NTY/DEPAR MENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater ate Is ue Issuing Ag nt Si No mps) .,(~Surcharge Fee) ~i pproved F-1 Owner Given initial c Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08193) 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 maintaired. 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 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 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. I 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 (R.11/88) 8 e tiO L ~ G ~ , rG lv ~ 8 GrS ~Gfv.l~ G t~ 7-c s a°~rc i .4 ~J ~X~ r~ -rep yf a - Wiscoasin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor, and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNT'Y' 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:t~pQ.YL j~oeaSTMD PROPERTY LOCATION q Q I.ONSi (KT'1~1J GOVT. LOT Sk 1/41w 1/41Si7 T 2-9 ,N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS I,QT~# BLOCK # SU~ N~ OR C~~# `I 'C_-AS-7 206 5Ee-oNa S ; CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVI LAGE OWN NEAREST ROAD New Construction Use [.y Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate (3•-7 bed, gpd/ft2 0.16 trench, gpd/ft2 Absorption area required 4qs bed, ft2 ;6< trench, ft2 Maximum design loading rate 10-7 bed, gpd/ft2 _trench, gpd1ft2 Recommended infiltration surface elevation(s) aN PA4,r 3 AF 3 It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MO ND U ROUND ,ROUND PRESSURE AT-GRADE Y TENI IN FILL HOLDING T NK U = Unsuitable fors stem IBS [I U [S ❑ U EIS ❑ U rvf S ❑ U S ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed TrPa& 17-38 L ! abk r►,r Z O.4 b.S Ground ICg~ -S-6 lbyk4 3 S i L l rh -.,.,bK ryiTr C I O.~ 0,3 elev. S o-ft. 83 -ll~ DYk4 S rn n'► 0.7 61 Depth to limiting factor .9Z Remarks: Boring # q b mT r 7. 8 ~-z~ ~oy~3 0 sc-4-7 /6- 4 3 oL I Sb~ Yr "r C I d,Z 0.3 Ground elev. 47- Z 16VP 4/4 S 04. /h r /h 0.3 01 Depth to limiting factor 7/0.00 FT Remarks: CST Name:-Please Print oY , Q u q SaN Phone: Inc6- 461W Address: U ~ ~ t1 s I ~4g Signature: Date: Z Z n CST Number: PROPEMYOWNER LEZT4 CdxtSiltUc,Tl4 SOIL DESCRIPTION REPORT Page? of 3 •PARCEL.I.D.# ~&r 9Z W-t,Lowgi&AIrPis7 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench a fi•« >M < O -17 /6~ 2 I 7Z /h r r►)r C Z O .S 0.6 r.:<::h g 17- 3s / 3 f / a by, m Z 0.4 Ground / bV P-413 S. L rk SIo K /+1 ~tr C 1 O.2 0.3 elev. 9S'n ft. 83 s~- ri? l oy~ 414 A r r1 I ~ Depth to limiting factoL Remarks: Boring # .6 >:w<.> ©-Z I o, e, - I Z c r rh~i- C 2, O .S O Y $ tl- 41 0 3 1 4 b!~r z o. ,S 1- Z y2 413 ,L 1 s bK n,°~r I O.Z O 3 Ground el v. ft. 83 Z-174 /D` 4 S r /r► / 91-6-1 Depth to limiting factor Remarks: Boring # -P 3 ` o. L, ~~r $ 4 ~ 1 abK .4 Ground '6Z O 3 Sit' S~k MTr C L-0 "Z 0.3 elev O e~. S Urn r 1 a tg Depth to limiting _ factor Remarks: Boring # gi~ sa:: Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) . S . . ~ PAC, 3 ~F 3 QJ~~ uSo=L p~SS Ztie t ' I Q vvi El 60, i I ~ h~o ti ~ 1 1 0\3, "i ~ ~ ~rtoMMe.JDSA 6N~1L7~.+'1'f 10~J ~~JAT+~S 1~1~~-r A2~ a , °1 l ,so 1 At&A - 93.00 'xraLt~ ) 30" g E~u~ M~~k - ?dP of PNou ~ ~ DES ~ 4 L l[v ELENA7'iom /UO.OV + x ,v f3 - n,`~ a4. ~px} .9 a~;. ~5£'k 'c STt •v.. - 77 14 C' ^ 44 • Y ` _ idol CR~ .t.. 'w 1 ~ 4 n F w 't n` r ~ i , vu 4 y I FLn Z a A Vwv i'a°F . . . a . r r € i~ s Af t'Y J 04, . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS c20,, SE'Gy d TCrc~- ~S'c~.11 / J PROPERTY ADDRESS r-i e B (location of septic system) Please obtain from the Planning Dept. CITY/STATE d ,,-o jp~ ZJ PROPERTY LOCATION ~ 1144<4;J 1/4, Section f T_2~?_? N-R l W TOWN OF ,~5' ..rJ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER J Z CERTIFIED SURVEY MAP , VOLUMEGy3, PAGE Y~ , 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 property t~Je~vp~yie ~t Location of property,.~7~1/4 1/4, Section /~2 ,T~N-R-(E Township ~c•ds o,r/ Mailing address Al ZJ t' Address of site Z14**, 5- /r eda, s'S Subdivision name Lot no. 1.z Other homes on property? Yes No Previous owner of property Aer 7- e v Total size of property Total size of parcel j~ Date parcel was created Are all corners and lot lines identifiable? KYes No Is this property being developed for (spec house)? Yes , Volume z<;~2 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. I 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. , 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. 3 Signature of Applicant Co-Applicant Date of Signature Date of Signature . ~ 395020 ~~ps 693PAu 46 This 23rd % -A.D. 1784 It 11:5~ A Ad LAND CONTRACT CJ• I low 00 D"dip and Contract, by and between Arnold R. Bertelsen a/k/a A. R. 7elsen Virginia A. Bertelsen, husband and wife, Vendor, and B. & H. nt, Inc.,a Wisconsin corporation, Purchaser. Vendor sells and agrees to convey to Purchaser, upon the prompt and full perfcrmance of this Contract by Purchaser, the following property, together with the rents, profits and other appurtenant interest (all called the "Property"), in St. Croix County, State of Wisconsin: South 53 1/3 rods cf South Half of Southwest Quarter (SSA) and South 53 1/3 rods of Southwest Quarter of Southeast Quarter (SASEk) of Section 17, T29N, R19W. That part of Northwest Quarter of Northeast Quarter (NW's NEB) and of Northeast Quarter of Northwest Quarter GIE'4 NW's) of Section 20, T29N, R19W, lying Northerly of the centerline of St. Croix County Trunk Highway "A" (formerly known as Hudson-New Richmond Highway), EXCEPT the following parts of the above described tracts: 0 All land included within the Plat of Willow Ridge Second Addition to the Town of Hudson as described in Vol. 4 of Plats,' page 25; Parcel deeded to Marlin 0. Amdahl and Rnth L. Amdahl as described in Vol. 517, page 26, Document No. 324368; Parcel deeded to Roger E. Hetchler as described in Vol. 517, page 114, Document NumJer 324430. TOGETHER with an easement for street purpo3es over the Easterly 33 feet of said parcel deeded to Roger E. Hstchler as described in Vol. 517, Page 114, Document Number 324430. SUBJECT TO the right-of-way of said St. Croix County Trunk Highway "A" and to telephone easement adjacent to said highway as recorded in the office of said Register of Deeds. Purchaser agrees to purchase the Property and to pay to Vendor at: __St. Croix Heights,: Hudson, Wisconsin, the Base Purchase Price of $100,000.CO, together with additional payments per lot, as follows: 1. Base Purchase Price. The base purchase pr'ce of $100,000.00 shall be paid in the following manner: $15,000.00 at the execution of this Contract, and the balance of $8`-,000.00 together with interest on such portions thereof as shall remain from time to time unpaid, at the rate of 10% per annum, until paid in full, as follows: (a)' For each individual lot developed and sold by the Purchaser, Purchaser shad pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 base contract balance outstanding. (b) A minimum annual payment of $15,000.00 principal shall be paid each year, excluding the year of sale. Each per lot principal payment required above, shall be credited toward I~ this $15,000.00 annual payment. iI (c) On December 1, 1985, and on December lat of each year thereafter, Purchaser shall pay to Vendor the differential between the requited' minimum principal payment of $15,000.00 and the total S2;000.00 per loc payments made during the preceding twelve (12) months, until the Base Purchase Price has I been paid in full. ~i (d) Interest on the rincipal balance of $8,000.00 shall accrue from the date of cL:)sing, with annual payments Or interest due on ` the 1st day of December, each ,oar, coaamencing December 1, 1984. 2. Additional Per Lot Payments. In addition to the foreooin;; Base Purchase Wm. J. Radosev ch Price Payments, Purchaser shall pay to Vendor ,additional per lot payments ~f totaiin, not Less than $,50,000.00, ,is tollows: i (d) tdo inter( st shn1 L ;accrue on the principal suns acrid to Vendor under the tcrms of this P:ara;r;aph. A