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HomeMy WebLinkAbout022-1083-10-000St. Croix County Planning and Zoning Wednesday, February 08, 2006 at 12:28:55 PM Detail Sanitary Information Page I of Computer #: 022-1083-10-000 Sub/Plat: NA Section: 29 Parcel #: 29.28.18.449 Lot: 1 TN/RNG: T28N R18W Municipality: Kinnickinnic, Town of CSM: Vol. 09 Pg. 2644 114 114: NE 1/4 NE 114 Owner: Radke, Ray 1080 Prairie Moon Drive River Falls, WI 54022 State Permit: 218897 Issued: 06/15/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 06/15/1994 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuerllnsoector As Built Mary Jenkins Yes Jim Thompson Signed Off: No Maintenance Scheduled Pump Date Pumped 6/15/2006 Plumber Steiner, Paul 1st Notification Other Requirements 2nd Notification 3rd Notification Additional Notes Money Owed check data - from notecard only $0.00 r RADKF.,•RAY $ LISA NE4,NF.4, Sec. 29 1431 Wild Cat Court Apt. 201 Kinnickinnicown River Falls, WI S4022 Lot 1 Address of Site: 1080 Prairie Moon Dr. Permit N(-.: 218897 6 1S-94 Paul Steiner New - Bed I Parcel #: 022-1083-10-000 02/08/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.449 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner. C = Current Co-owner O - KOLASHINSKI, ROBERT J ROBERT J KOLASHINSKI 1080 PRAIRIE MOON DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1080 PRAIRIE MOON DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.620 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W PT NE NE BEING LOT 1 OF Block/Condo Bldg: CSM 9/2644 ALSO A PARC COM N1/4 CDR SEC 29; TH N 87 DEG E 1305.92'; TH S 00 DEG Tract(s): (Sec-Twn-Rng 40 114 160 1/4) E 484.99' POB; TH N 87 DEG E 653.05'; TH 29-28N-18W S 00 DEG E 200.15'; TH S 87 DEG W 653.08" TH N 00 DEG W 200.25' TO POB Notes: Parcel History: Date Doc # Vol/Page Type 06/09/1998 580679 1330/338 WD 05/20/1998 579469 1325/15 WD 07/23/1997 1187/453 WD 07/23/1997 1187/451 IAD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 143860 398,900 Valuations: Last Changed: 08111/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.620 100,000 303,300 403,300 NO Totals for 2005: General Property 10.620 100,000 303,300 403.300 Woodland 0.000 0 0 Totals for 2004: General Property 10.620 50,000 223,400 273,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Chargges Total 0.00 900 0.00 St. Croix County Planning and Zoning Detail Sanitary Information Computer #: 022-1083.10-000 Sub/Plat: NA Section: 29 Parcel #: 29.28.18.449 Lot: 1 TN/RNG: T28N R18W Municipality: Kinnickinnic, Town of CSM: Vol. 09 Pg. 2644 114 114: NE 1/4 NE 1/4 Owner: Kolashinski, Robert 1080 Praine Moon Drive River Falls, WI 54022 State Permit: 218897 Issued: 06/15/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 06/15/1994 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Mary Jenkins Yes Jim Thompson Signed Off No Maintenance Scheduled Pump Date Pumped 6/15/2006 Plumber Other Reauirements Steiner, Paul 1st Notification 2nd Notification 3rd Notification Thursday, September 07, 2006 at 4:42:47 P41 Page I of I Additional Notes Money Owed check data - from notecard only $0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT • •II . " I t•j I, 1 ADDRESS SUBDIVISION / CSM I�n ✓ 4da.c,4 /2/2 LOT %�P L SECTION-T�N-R�W, Town of // /n h /c NMN /C ST. CROIX COUNTY, WISCONSIN VIEW SHO VERYTHI WITHIN 100 F ET OF SYSTEM y'bro�� r0lM.t .y Ii o � II Q I� �bk r I I �j 63 „ Q, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE B', SEPTIC TANK'/ PUMP CHAMBER / HOLDING TANK INFORMATION K(/ Manufacturer: �.e l 5 t �, Liquid Capacity: < d oo Setback from: Well House Other Pump: ""nu Float sepe tion_ Alarm Location Model# Size Gal,kons/cycle: I SOIL ABSORPTION SYSTEM Width: 12 Length �� Number of trenches/� 1/ Distance & Direction to nearest prop. line: 3 ' S Setback from: well: Building Sewer House Other ELEVATIONS ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: C, P S 74eih e v LICENSE NUMBER: 3/93:jt Wisconsin Department of Industry, Labor and Human Relations Safety and Buildings Division -GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Nam ❑ City [I Village Town of: RADKE, & LISA R WTMMTCKTMMTC CST BM Elev.: Insp BM Elev.: BM Description: /D . C1J 60 . Gd a ! a., TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration I ng TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic NA Dosing NA Aeration Holding 1 PUMP/SIPHON INFORMATION Ma u a Demand cb Model Number ti Q�9 TDH Li riction System TDH t Loss Head Forcemain Length Dia. Dist. To Well fSOIL ABSORPTION SYSTEM ELEVATION DATA ounty:ST. CROIX Sanitary Permit No.: State P an ID No.: Parcel Tax No. STATION BS HI FS ELEV. Benchmark d l Bldg. Sewer St/ Inlet 736r / St/Outlet Dt Inlet Dt Bottom Headers O,57 r Dist. Pipe 'e. t� ' Aq,3 r Bot. System 9/ r9 _i Final Grade a, 07 BED/TRENCH Width ' Length No Of yenches PIT I No Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM Manuactur . INFORMATION CHAMBER a Num er: Type /Puj _rip i System: `7S. DISTRIBUTION SYSTEM Header / MudbW r Distribution Pies , �� � x Hoe Spacing Vent To Air Intake Length �z Dia Y Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx odded xx Mulched Bed/Tt�Center Bed/ dges Topsoil ❑Yes ❑ t ❑Yes ❑ No COMMENTS: (In(lude code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 29.28.18.449,NE,NE,LOT 1, LIBERTY ROAD Plan revision required? ❑ Yes Erlto Use other side for additional information. ,:I/p �— SBD-6710 (R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e±+AuarAnv ntt-nuer Anne I^Arl^u DILHR%'Wr%o.s I reaa I tr S...,.I. I �r- r- 5.1%or. I e„e. COUNTY In accord with ILHR 83.05, Wis. Adm. Code e..... St Croix STATE SANITARY PERMIT —Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. o2/ J90 ❑ Check H revision to pravlaua application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Ray Lisa Radke NF, 'Y4 iQE '�4. S 29 T 28 , IN, R 18 W PROPERTY OWNER'S MAILING ADDRESS LOT N 1 BLOCK 0 1431 wild Cat Court Apt 201 1 ------- -- CITY, STATE ZIP CODE PHONE NUMBER — SUBDIVISION NAME OR CSM NUMBER ---------------- 11. TYPE OF BUILDING: Check one NEAREST ROAD ( ) State Owned AR.4=9 44PW c-kinnir- Liberty Road ❑ Public ®1 or 2 Fam. Dwelling—# of bedrooms -3--GEL TAX NUMBEFI(S) III. BUILDING USE: (If building type is public, check all that apply) 0.22 _ / o U ,-.. /Q —d Q 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. © New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. $YSTEM ELEV. 7. FINAL GRADE 12,ABSORP.AREA REQUIRED (sq. ft.) PROPOSED (sq. fl.) (Gala/day/sq. tt.) (Min./inch) ELEVATION 450 1,125 1 125 .4 89.50 Feet 9z, SO Feet VII. TANK INFORMATION In alTotal CAPAijisk Gallons #01 Tanks Manufacturer's Name Prefab. oncret Site Con- Steel Fiber- glat3s Plastic Aper. AppTanks New T atructed Septic Tank 1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu s Signatur : (No Stamps) MPS: ess Phone Number: C 6780 r(715425-5544 Plumber's Ad ( Veel, City rasa , State, Zip N8230 945t--h Street; River Falls. WI 54022 IX. C UNTY/DEPARTMENT USE ONLY Approved Disapproved ❑ nitaCCJrmit the (Includes Groundwater 6Iseuing Surcharge Fee) a s Issue-A t Slg Owner Given Initlel / Adverse Determination Co X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 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 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'f2 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 it 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 (R.11188) W6consinDopumwntoflndustry, SOIL AND SITE EVALUATION REPORT Page —ol_._ D �iskfi of Saafety Buldngs in accord with II.HR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 81r2 x 11 inches in size. Plan must include, but OL. LXULA not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. s dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION REVIEWED BY DATE Steven C1.tdd GOVT. LOT NE 114 NE tr4,S 29 T 28 .N.R 18 VWI of PROPERTY OWNER':S MAILING ADDRESS LOT f BLOCK r I SUBD. NAME OR CSM r 1 CITY, STATE ZIP CODE PHONE NUMBER � NW tkW WOWN NEAREST ROAD River Falls. WT 54022 (71§425-2757 Kinnickinnic Liberty Road [)d New Construction use IK 1 Residential / Number of bedrooms 3 ([ Addition loexisting builoing _ I I Replacement ( I Pudic or commercial describe Code derived daily flow �450 gpd Recommended design loading rare_, 9 bed, gpddt2 .5 trench, gpdh= Absorption area required 1,125 bad, h2 90W wench, 0 Maximum design batting rate .5 bt.4. gpdM2_�._trench, gpdrh' Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site oonsiderations System Elevation 89.50 Parent material Flood plain elevation, if applicable h I S■ Suitable for system I CONVENTIONAL MOUND MOUND I IN -GROUND PRESSURE I AT-GMDE U I ❑ SYSTEM N FLL I mOLDO $`` I U I U= Unsuitable tar system [as O U CBS O U IRS O U Boring 0 Ground ekw. qZ'" IL Daplh to limiting 1XILV Boring A Ground elev. 92.961L Depth to limning factor SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Ou. Sz. Coral Color Texture Structure Gr. Sz. Sh. Consisionce Boa -my Roots GPUiIt 1 Bca ilitra, 1 0-301 10YR 211 None sl 2 m sbk mfr as if 5 �,. t6.. 2 30-49 10YR 4/6 None is 1 m sbk mfi gs 1f .5 .6 3 49-11 10YR 6/2 None is 1 f sbk mfr -- -- 11 .5 I�.6 T..'. _ Remarks: System has to be below 49". on - Remarks: Syet-«n hae t-n be furl ow 39" _ rnel June 1, 1993 CST n rrw�t:3074 PROPERTYOWNER S ov M Qtdd SOIL DtSCRIPTifal, I,crutiT page —ot. - -- . f PARCEL I.D. 8 GPUrlt3_ Boring N Horizon Depth Dominant Color Moores Texture Ou. Sz. Cons Color Structurefer= Gr. Sz. Sh. Bafy Roots Bea Iti4ar - in. Munseu 1 0-32 10 2 1 None6_ ,3,' M- 2 32-49 10YR 4/6 Alone is 1 m sbk mfi s 1f .5 I_,6_ Ground 3 49-11 10YR 6 6 None is 1 f sbk mfr -- -- 5 II_,6_ elev. 93..SS11L Ocpth to __... IimiUng lactor I. Remarks: Boring # _ 0_27 10YR 2 1 None sl 2 m sbk mfr s 1f .5 1 _ 6. - :4 2 7-48 10YR 4/6 None is 1 m sbk mfi gs 1f .5 --..6-.- 3 8-113 10YR 6 6 None is 1 f sbk mfr -- -- 5 -.6 Ground elev. - _- 94AkIL Depth to lintiling - factor Boring M 5. Ground elev. 93.77 It. Depth to limung factor KemarKs: 1 0-33 10YR 2 1 10YR 4/6 10YR 6/6 - None None None sl is is 2 m sbk 1 m sbk 1 f sbk mfr mfi mfr gs s __ 1f 1f __ .5 _.6 _ .5 _6 .5 .6 _ 2 33-44 4-116 3 has 1 n UP below 44". -- Boring N Ground dlev. IL Npth to linuling factor Remarks: rnn M9H10 I\r, il1 •�\ 611/93 AOH4 PXT PLAN Scale 1 =GO1 "I. Wesl t, L ocFu.3 0 C� 0.0 Pralre Ac4N, Pr 6�/�93 PJDT PLAN S ,Lot Conesr �H scale I =G0' a C SM Uo! S"e e lqo r Sy 5> em To L � bh�t G•si House Task -110 horiJ �W( %.cf • Ji i r v 'STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAM ING ADDRESS PROPERTY ADDRESS n (location of septic system)) Please obtain from the Planning Dept. CITY/STATE ` iy ' (` 0115 1�L PROPERTY LOCATION i 1/49 1/4, Section TII_N-R__I%__W TOWN OF V I ON k\ i � I G t ST. CROIX COUNTY, WI SUBDIVISION I;rPPA AC MPS LOT NUMBER CERTIFIEDSURVEYMAP ,VOLUME&jgPAGE j,,23,LOTNUMBER�_ 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 y ;expMiote. Z SIGNED: DATE: 1. - I S -`1N St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 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 cL Location of property � 1/4�&� 1/4, Section _°__,T7,5N-R_g_W Township Mailing address , r g Pra.l(`Ip KnLy\ hr V0 -- W? i vi)� Ic9,cc) u GDP zO l Address of site 10,90 Bra,; r, P Mnn^ DPJA7%P Subdivision name C epr� Ac"5 Lot no. Other homes on property? Yes X No ,,((�� Previous owner of property _S+ekJ P— 4- (x 1 (,O. A Total size of property _ Total size of parcel _ Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house) ? Yes __No Volume b 2 and Page Number L-?3 _ 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 owners) 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. 5-/79SY , 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. AZ K e of Applicant Co -Applicant Date df Signature Date of Signature