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HomeMy WebLinkAbout038-1172-70-000 ST. CROIX COUNTY WISCONSIN - - ZONING OFFICE N r "Jim" r no NM,"b. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 16, 1995 Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 ATTN: Becky RE: Septic Inspection for Property Located at 1983 Nighthawk Drive, Somerset, Wisconsin Dear Becky: An inspection of the septic system for the above address was conducted on December 15, 1994. This property is located in the NW; of the NE, of Section 29, T31N-R19W, Lot 11, Country Living, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please do not hesitate in contacting our office. nc ely, mes K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin mz s s STC - 104 AS BUILT SANITARY SYSTEM REPORT tQ OWNER _1~i~~ J ~o ~s P , L ADDRESS JI ? .K ~r ~ ~^'r~~ 4t Vag 14 )-r SUBDIVISION / CSM# SECTION.',,,?~_T.,3Z N-R. W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s3 1 bZ' INDICATE YNOOTH A ROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. e BENCHMARK: .~A.'/SJ Dov)tc° 9P.~- / JII ALTERNATE BM:~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:. Liquid Capacity: Setback from: Well r~ House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: IZ2 Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well House ?R, Other ELEVATIONS Building Sewer ST Inlet. - ST outlet , 2 d()r,e - 9s8 PC inlet PC bottom Pump Off Header/Manifold. Bottom of system Existing Grade Final grade S DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin DC-partment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑iTown of: State PIA APg HARTMAN HOMES X CST B Elev.: Insp. BM Elev.: ~11 B~VI Descriptio 2~y w, n, Parcel Tax No.: TANK INFORMATION ELEV TIO DATA Z S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark O' 11),(~) ' Dosing-- a 31 rvl_ 97, , F? , Aeration Bldg. Sewer 06P' S, 1 Ing St/ hW Inlet S~' TANK SETBACK INFORMATION St/ W Outlet Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet I~ Septic NA Dt Bottom a - Dosing - NA HeaderTZ49n. & .3 ' Aeration NA Dist. Pipe 3 3~~ .gll Hold' Bot. System F PUMP/ SIPHON INFORMATION Final Grade 5, Manufacturer Demand Model Num M TDH Lift L ctl S stem TDH t ain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT ' No. Of Pits Inside Dia. Liquid Depth ~i DIMENSION S~ DIMEN -SIONS It --W - ti SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING acturer: OiK, o -Ihjum er: INFORMATION Type O fiZ,_ a CHAM System: 6P., yQ O IT DISTRIBUTION SYSTEM I-A Header /a101*m otcr Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~P7 Dia- Length _f Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste ZaOver Prufthed-_ Bed /Depth Over " Bed /Depth vrtyEdges , TopsaPth Of ❑ Ye ed / So Ndoed xx❑ Yes E] No #>Eenter COMMENTS: (Include code discrepancies, persons present, etc.) .k'/ , / LOCATION: Star Pia/rie/.29.31 19W NW, NE, LQt 11, Nighthawk Drive„ /~L-~'~/,?/~"ri tn`..✓ C ~.'`"l~r~ ~t t., yG'~ ~C: ~~;-.i".'` `s, i~r' . ~G+..-GSt. J, oG,i-~+' ~~G3 r sL Plan revision required? ❑ Yes ;~)o o Use other side for additional information. Z~ A~ 7 SBD-6710 (R 05/91) Date I pector s Siratur Cert. No f ADDITIONAL COMMENTS AND SKETCH n SANITARY PERMIT NUMBER: I I i SANITARY PERMIT APPLICATION COUNTY v'~~I•'■~ In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PE IT # -Attach complete plans (to the county copy only) for the system, on paper not less than C9 19 oq~ 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. APPLI ANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OW ER PROPERTY LOCATION '/a '/a,S ,N,R E(or PROPERT~Y~jOWNER'S M7NG ADD LOT # BLOCK # cY CIT STATE ZIP CODE PHONE NUMBER SUBDIVISI NAM OR !SM UMBER NEARE ROAD I ,5T 11. TYPE OF BUILDING: (Check one) CITY ❑ State Owned O VILLAGE ❑ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(5) 111. BUILDING USE: (If building type is public, check all that apply) 70, 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ 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. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 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 :&_6 , 1 /4,/? '17 - - Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holding Tank 4Z I S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio f the onsite sewage system shown on the attached plans. Plumber Na a (Print): Plumber' Si t e o ps) MP/MPRSW No.: Business Phone Number: PI mbe s Ad as ( treat, i State, ip Code) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (includes Groundwater roeej water ate Issued suing Agen Signatur No Sta ps) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a 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. 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 (R.11/88) ~`i~-rte Ao es VA) ~y ~l~ ~/J s,~c~~, y'~~/✓,~i9~ ,~~~-S~~ G~J15~4~?5" -S,E~~•~ %s~ ~✓tt~e~' /E.Y~D~i~~ jam,. sLli tc 's /,Pav c~E~l 94 14 I , o wl i ~ I Wiscbnsin Otpartment of Industry, SOIL AND SITE EVALUATION REPORT Page Of Lab:r and Human Relations DiGision of Safety & Buildings in accord with ILHR 83.0 dm. Code 10 - COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inche an mus ut not limited to vertical and horizontal reference point (BM), directi mg % o slo ,scale PARCEL I.D. # dimensioned, north arrow, and location and distance to neares ro i~G~fg~f~4~ ir- APPLICANT INFORMATION-PLEASE PRINT ALL IN ATION, REVIEWED BY DATE PROPERTY OWNER: PROPEM Y'1 CAT 1/4,S T N,R E(o 9egd.~,.y 6C)Vf.'EOT~Ik PROPERTY OWNER':S MAILING AD RESS it BLO 'k SUB NAME 0 CSM # ~i t°,, L Z~cc/~ 't CITY, STATE ZIP CODE PHONE NUMBER CITY. GE OWN, NEAREST ROAD Residential l Number of bedrooms Addition to existing building Use New Construction )d' ~ [ ] 9 9 j ] Replacement [ ] Public or commercial describe Code derived daily flow AQ gpd Recommended design loading rate gibed, gpd/ft2__,,._~trench, gpd/ft2 Absorption area required ~ bed, ft2 c~_5 rench, f 2 Maximum esign loading rate - bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 7 V ft (as referred to site plan benchmark) Additional design / site considerations td Parent material s Flood plain elevation, if applicable ,/f; ft 5 = Suitable for system CO VENTIONAL M UND IN-GROUND PRESSURE AT RADE SYSTEM I FILL HOLDING TANK U= Unsuitable forsystem s ❑ U n S ❑ U ®S ❑ U WS El U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounci-ary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& Ground S r 7 AZ51 _t. Depth to limiting f ctor, d arc Remarks: Boring # a c ,,l a - c . Ground 001- ale . Depth to limiting f or l 37 Remarks: CST Name: Please Print Pho~s.. 76' Address: 9 l/✓~!~ Ma"1 Signature: Date- LT N m y er: PROPERTY OWNER XW SOIL DESCRIPTION REPORT Page_of PARCEL I.D. # ' . Depth Dominant Color Mottles Texture Structure Consistence Bourifty Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 44 IA~wg 000, Ground elev. ft. Depth to limiting factor -7F e/ -l a?, 3.3 Remarks: Boring # Ground elev. ft. Depth to limiting fact 3 Remarks: Boring # y A r2 Ground lev ft. Depth to limiting factor 3,1 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Charles Borgstrom Byron B' rd Jr. Address 2033 Co. Rd. C Somerset Wi 54025 C #3479 Lot 11 Subdivision Country Livin Date 8/31/94 NW 1 /4 NE 1/4S29 T 31 N/R19 W Township Star Prairie Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of Wood Stake Red Ribbon System Elevation 92.6 *H R P Same as Benchmark 13=4 15' 15' B-1 40' .M. 0' w Rep A Pri A 0 b3 z 5% Slope -3 60' 40' 14 x 60' c~ -2 B-5 30 c~ Easement Area 161 110' Night Hawk Drive 1_. 41 s BEARIIp3 ARf Rl PERCHED TO TM Nd1TN LINE a ~_I f Sff T10N 2!. ASSVMED TD BEAR S!° SI E. 7 THE NEN O M L O JI } 0) fll ✓J X c1 0l c,l C~ : go 0 3` MATCH LINE ~~m N Wg Wg Ull SEE SNEET t I r'M w t)I ~J IT O = } S01 3153 W 628.33' [AST LINE OF THE NwlA OF THE NEIM, SECTION 29 r- U i a 1 v SO1`5'132"W 630.66' Z ~ 562.69' I 6T9T / 4 S ' O laz N INI "rl c I W / QI QQ IN W ~9Uf •WT. I ° Ic O ~1 I to v_~ N M a N v 1A I 33,133, r m n wj call Y a w 0- N a NI rl 11 fj 0 0 b N i vJ y 1 V r I t" d FO > N N -J I = to o J I C]I yNj j t,Ji O~ V vi V.1 Q V 0: CI WI1 S01'39'53'W 1246.49 VI 631.10' 615.39' - 317.00 314.10 ti I- ~ W Q I N I W - v = (,11 100, i zo- I fn AI r' QI W o I w N _ll ~ N a 6I6' I c.i l_ n O a ti 0 a W a o ° N 10 N I NI I WI L]I In I I li E'" in I M I nl = CID r1 _ ZI N Z I N 0 O+•1 ~ N Y\ 1 a w 0 W S0I'39'53"W 632.95 tr ut N n m •I 0.1 I= M N =1 - lei 1.71 F N z z 1- I I I C 1 i I I z w N V, O N e M ~ „ N 1~ .IZ I I~ IJ ~ _ o l- i I -319.00'---. .-512.80'- R~ N01 39'53E II48.81 y _ _IGHTHA`tlK-~-- - - - - - - '~2N I I E LOT 3 LOT LOT I I =OT 5 I LOT 6 I w CERTIFIED SURVEY AAA' LL 1 CERTIFIED I SJ<VEY AA? VOLUM - I - - I z Y -)/OI_U A_ 3 , I PAGE 2248 I 9, PAGE 2584 a R i i - - - - N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYERa MAILING ADDRESS z 5~, -41 e.5 e-/ G~ S-- PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE S " e / f5-.1Q _~5' PROPERTY LOCATION AJeO 1/4, 1/4, Section T---31/ N-R l f W TOWN OF _ ST~ic ST. CROIX COUNTY, WI SUBDIVISION _ COc%f 411 f t~, rJ~ LOT NUMBER CERTER IED SURVEY MAP . VOLUME I/©l- , PAGE e M 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 f SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ~ Iii 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~¢,2T.-~~~}.~ Location of property /N1,J1/4 471/4 , Section W Township s7'~rC t ~,C-rr¢ireiF_ Mailing address Address of site f c<- Subdivision name Lot no. Other homes on property? YesNo Previous owner of property Total size of property Total size of parcel Date parcel was created Cc t - 1-71, ) '?C/ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? X_Yes No Volume 1107- and Page Number /70 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. j Z,3 Z778 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. Signature of Applicant Co-Applicant Z Date of Signature Date of Signature i DOCUMENT NO. i! WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 5232'78 AAL Charles H. Borgstrom and Dolores Borgstromt a/k/af rd -w -r% aw Dolores S. Borgstro Im husban. -d_ and wife - NOV 8 1994 Hartman Homes Inc-. A 10` 00 A. M1 conveys and warrants to J J . ~__4 L ✓.~m~ i~ RETURN TO the following described real estate in _--St,...CrQiX ....................County, State of Wisconsin: Tax Parcel No Lot 11, Plat of Country Living in the Town of Star Prairie, St. Croix County, Wisconsin. i 1S not This homestead property. is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. stir November - 19. 94 Dated this - day of --------------------(SEAL) ---G''/.....L'...J. ---------(SEAL) ` - Charles-. H,_. Borgstrom. - - (SEAL) (SEAL) u%u Dolores Borgstrom, a /a - Dolores 'S: BorgStrom AUTHENTICATION ACKNOWLEDGMENT Signature (s) ..._Charles H. Borgstrom, STATE OF WISCONSIN ss. County.