HomeMy WebLinkAbout040-1188-90-013
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER, C f P 5 / r u
P LyL ,P-
ADDRESS
SUBDIVISION CSM LOT
SECTION 5(0-T,41 N-R_~? W, Town of , /^p V
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
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BENCHMARK:
ALTERNATE BM:
SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: f l~VQ1 5 e l_ Liquid Capacity: l-Z ~n
Setback from: Well House Other
Pump: Manu acturer Modelt Size
Float sepera ion Gallons/c cle:
Alarm Location
q SOIL ABSORPTION SYSTEM
Width: / Length J~b Number of trenches
Distance & Direction to nearest prop. line: Cv
Setback from: well: House 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:
PLUMBER ON JOB: Aj C ~J
LICENSE NUMBER: ( D 7 80
INSPECTOR:
3/93:jt
Wisconsin Department 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 ❑ Town of: State PI
STRUEMKE, CHARLES X
CST BM Elev.: Insp. BBMll Elev.: BM Description: Parcel Tax No.:
/0,, 1 A9486247
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing 1ae1L(0_fi1(,
Aeration Bldg. Sewer
9
Holding St/Inlet 99 7
TANK SETBACK INFORMATION St/ Outlet e~
7, 99
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet
!
Septic `3 NA Dt Bottom
7 8 3'
Dosin9- NA Header
5P 727
C
Aeration Dist. Pipe B
Holdin Bot. System q 7 73
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
5, 3G O ,
07
Model Number GPM
TDH Lift Friction Ft < /
L
ead
Forcem ength Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches pl No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN 1 N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH acturer:
SETBACK C "AMBER
i4
INFORMATION TypeO /%1_0 (J. Mo a Num er.
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Mani Id , Distribution Pipe(s)j ip. x Hole Size x Hole Spacing Vent To Air Intake
Spacing
Length Dia. Length 3 Dia. J1
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems
Depth Over Depth Over xx Depth Of ed / Sodded xx Mulched
Bed / Tr €#i Center Bed /Trench Edges _~k9 70 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)S
LOCATION: Troy.36.28.19W, NE, NW, Lot 73, Woodridge Drive
~ C\j~7,//'~%y IG.%e8i ~ ~ ~ ~i~._ 9 ~ , 'r'`. E rf ? ~C~ cTG j'~~ / , 4 ! !_Q-~!.{%
Plan revision required? ❑ Yes [r No Ile 5:'~ /
Use other side for additional information.
~ BD-6 10(R 05191) 1 Date Ins ctor's ignature Cert. o.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
F
SANITARY PERMIT APPLICATION
COUNTY
r~'~L■7■'~ In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITA Y PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than a a 6,0 V
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
Charles Struemke NE % NW N4, S 36 T 28, N, R 19 )BqMW
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
402 Foster Street 73
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
River Falls. WI 1 54022 1(715 25-9438 Oak Ride Acres
Ii. TYPE OF BUILDING: (Check one) State Owned NEAREST ROAD
T ROAD Woodridge Drive
❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms A_ PAR EL TAX NUMBERO
111. BUILDING USE: (If building type is public, check all that apply) 040-1188-90-013
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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.[2 New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 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
600 1,200 1,200 .5 98.9 Feet ) •.Z Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- ~ Steel glass Plastic App
Tanks Tanks structed
Septic Tank w*1*hnffZRpIpc _12~ 1250 .1 Wei ser F1 1-1 R T_[T_
Lift Pump Tank/Si hon Chamber El El El El I El FJ
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PmpnT=)=~m~_ MP/IV No.: Business Phone Number:
Paul Steiner 71-5 ) -
Plumber's Address (Street, City, State, Zip Code):
N8230 945th Street; River Falls WI 54022
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved ry Permit Fee (Includes Groundwater Date Issued uing Ag S ig (N tamp
Approved ❑ Owner Given Initial /j G~ Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS t
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.
r---------------------------
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)
p
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (Blv), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. O q d ` d I eg-qD ~0 l 3
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION Z$ ,N,R 1`l E(
GOW. L$T N F 1/4 N W 114,S 3 bT oteW
C t'~'P~\ZL..~S S YlZ ~C ~ lz-~
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
14 b -L I=os ST. `13 - 0 A~ V. R.kbGE fmj.izeS
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD
'2,lu~H\z_ I~LIS kiI SyuZZ. U)IS) 14ZE- cly3f3 ~Z0`i ~DRlD61; D2.
K New Construction Use [,q Residential / Number of bedrooms 3 [ ] Additkn to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow Ll SO gpd Recommended design loading rate 6 - S bed, gpolit? o , 4 _trench, gpd/ft2
Absorption area tequired 01 0 O bed, ft2 1 :%13 trench, 112 Maximum design loading rate o • S bed, gpdfil~ trench, gWt2
Recommended infiltration surface elevation(s) s Te '~'q 3 o r- 3 ft (as referred to site plan benchmark)
Additional design/ sloe considerations "Zsv"-\ - V'~DS , rcte14SO t'r Z fl , - UOse- a~►~IP 1Ze.dM h esvD! .
Parent material Lo `s S - Flood plain elevation, if applicable tv t~ - It
S. = Suitable for system WWENTMAL MOUND F W GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLM TANK
U =unsuitable for syslem ICJ S❑ U W S0 U ID'S ❑ U WS Ou ®S ❑ u ❑ S Q.13'u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Cola' Gr. Sz. Sh. Bed ranch
0_1 ~b-Ac~ z[Z - si I Z`f sbk YAn` - cam, - ~,.s o•
Z 7-3b 1~`t Q 31L _ S t 2 ~s \~Vt ho ~1- c s o S o. 6
\ Ground 3 36-$6 1 0 `1 v- yly - S O %5 w" l - o . S o. 6
elev.
\%k.\4 ft
CS) cow rvS k 3 / lLs IS f S
Depth to
limiting
factor
? 86 V
Remarks:
Boring #
o-zo ~b-I.R- z.la - S I 1 Z~sb~ 'fr ~w o-S o•b
Z. Z Zo-S6 ~~`1R 31% '1 Stl Z~-Jbk 1~'Fh cS °-S 0.6
3 S6- 83 ~w2 y/ 'Fs D s 1 - o• S s o
Ground .
elev.
°l9•nft
Depth to
limiting
7_1
Remarks:
CST Name:-Please Print Pine
Arthur L. We erer 715-425-0165
gerer Soil Testing & Design Service-P.O. Box.74 River Fa11s,WI 54022
Signature: Date: CST Number:
7-z6-9y M00576
1
PROPERTY OWNER 5-~►~~, SOIL DESCRIPTION REPORT Page _Z gf 3
`
PARCEL I.D. # DLL 010 -011
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundbty Roots Bed ranch
0 lu `11 3 ! % - s l 2 `Q 3 bk WLT- C -v 0-S b • 6
3 Z 1 _ZZ l u'-l tii 3 11. - S t,l Z - sblz kh'fi, S _ o• s o. 6
Ground 3 22-qIr-) t 0 ~t R Slly - `f 19 P~-, 1 0 • S
elev.
Depth to
limiting
factor
Remarks:
Boring,#
1 0 -~Z 1~ `l Q Z-c Z S i( 2 S bk w, it- C$ - o. g a
El Z ~ 1--L5 1~ `-l t- 31 I. s j I Z E` s bh wr C 1,~, - 0,S o. 6
3 ZS-y'1 10 ti 2 3 1 L - S ~ \ C-A k vh V C - o Y 3 0.5
Ground
..;elev, 4 47-$9 t r-,3,1 R vi - `~'S O S I - 0-S o. L
CpN Tyruj S Se - t0° o L U" stwoe 2RG
Depth to
acting
''factor
7 `d of
Remarks:
Boring #
0-11 1oK1Z z-fZ s~~ Z~S1~k `M`fg, ~S - o.S o•
S Z ll-Zy tort Iz 3!~ - Sil z'Fsb~ `M`ph C_S - o•S u.6
3 2y-38 Vbktz ~1~ - S lJ ~~sb1Q wtU~~. CS - o•yo•S
Ground
aelev. 38-99 l1Z 4! - `TS O S9 yvN - 4• S o. L
ft.
Depth to S 8
limiting i
factor
7 . Clot"
Remarks:
Boring # 1 0-13 1 ~ `t ~ z l 2 ~ S 1 ~ Z `F S b>z Yv1.'F H C S o •S • b- 6
~3-33 IV34R 316 - S1l 7-isbVC CS o•S u-
Ili. 'Ground 3 33-u~ 1oy2 3lL - s l 1 csdk VA UT-1, cS a•4 € 0.5
elev. y6-lb !0`t ¢ ~/y - `tS s3 wt J u, S' o. C
~i~•9 ft`
Depth to
limiting
factor .
Remarks:
SBD-8330(8.05/92)
PLOT PLM Page 3 of 3
Pt0 Kv OUo-~i~8- 90-013
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(71 ) 425_0169 FI00576
CST Signature _ Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Charles Struemke
MAKING ADDRESS 402 Foster Street; River Falls, WI 54022
PROPERTY ADDRESS 35-Woodridge Drive V✓e5f'
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE River Falls, WI 54022
PROPERTY LOCATION NE 1/4, NW 1/4, Section 36 T 28 N-R 19 W
TOWN OF Troy ST. CROIX COUNTY, WI
SUBDIVISION Oak Ridge Acres LOT NUMBER 73
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 exp' tion te.
SIGNED:
DATE: ✓
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 54016 11/93
S T C - 100
t
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 Charles Struemke
Location of property NE 1/4 NW 1/4, Section 36 T 28 N-R 19 W
Township Troy Mailing address 402 Foster Street
River Falls, WI 54022
Addressof site q5' woodridge Drive VJPsf
Subdivision name Oak Ridcre Acres Lot no. 73
Other homes on property? Yes X No
Previous owner of property Richard & Fran Fox
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 X No
Volume 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.
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. 5')y.SS.3 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
/1""
ure Date of Signature
Da e of Sign
pet
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
519553 -
VOL 88Par,E
1d 632
Rolling Hills Development, Inc., REGISTER'S OFFICE
a Wisconsin corporation ST. CROIXCo., WI
Rec'd for Record
J U L' 2 7 ^1994
conveys and warrants to Charles W S truemke and
Ricarda V Struemke, husband and wife as at 2:40 P• IM
survivorship marital property I~RegisOer of Deeds
RETURN TO
the following described real estate in St Croix Counly, t - -
State of Wisconsin:
Tax Parcel No:
Lot Seventy Three (73), Oak Ridge Acres
to the Town of Troy.
?J#
This is not homestead property.
(is) (is not)
Exception to Warranties:
easements, restrictions, and rights-of-way of record.
a,
Dated this day of IS 1_11
(SEAL) L)
• Richard N. Fox, President
r
(SEAL) ` (SEAL)
Frances J. Fox, Secretary
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
l Lf L-C County. 4-74) authenticated this day of 19 Per na ly came before me this! -day of
199 the above named
Ric r N. Fox and
Frances J. Fox
TITLE: MEMBER STATE BAR OF WISCONSIN _
(It not, reg0 rr~kn n to be the person S who executed the
authorized by § 706.06, Wis. Slats.) i VI~trument and a knowledge the same.
THIS INSTRUMENT WAS DRAFTED BY I
C. L. Gaylord, Attorney : 1~ t
River Falls, WI 54022 :N
s A A~ r• County, WIS.
(Signatures may be authenticated or acknowledged. Both:'~f► mmivsion is permanent. (If not, state expiration
are not necessary.) ''••r••••'•'~~ [ --Z9 19~-.)
Names of persons signing in an t aCil Should be I S82 NTF 0021
y ?G y y'petl or printed below their aignawrea.
a
WARRANTY DEED STATE BAR OF WISCONSIN N
Form No 2 - 1982 elCO orms, P.O. Box 10208, Green Bay, WI 54307-0208