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HomeMy WebLinkAbout042-1051-20-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER lour 640DZ /E .T ADDRESS Z !Y,3 / al r- 9 SUBDIVISION G^/ CSM# LOT # SECTION---/ / T~y N-RW, Town of ST. CROIX-COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITH N 1 FEET OF SYSTEM 575 )61 11 LgC,4 f- at. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- `Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: / ".7rz-EL PiIP 40 r r 1l ZrAWX_e2 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: jZ) ,9 „S' Liquid Capacity: ./ZOO Setback from: Well House Other :Float ump: Manu Model# Si ja.vm seperatio Gallons/cyc e. Location SOIL ABSORPTION SYSTEM Width:_ Length Number of trenches Distance & Direction to nearest prop. line: ~',0 f,~lES j- Setback from: well: House Other ELEVATIONS Building Sewerf/'S T ST Inlet. ST outlet Header/Manifold4Q Bottom of system S 6 Existing Grade Final grade DATE OF INSTALLATION PLUMBER ON JOB: lot LICENSE NUMBER: /7//?5&; INSPECTOR:_ 3/93:jt • s Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and 'Hjpman Relations INSPECTION REPORT ST. CROI?X Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 21 AR4;R Pelp]i~H41d~jplam; : TOR ❑ City ❑ Village Town of: State Plan ID No.: Warren CST BM Elev.: Insp. BM Elev.: BM Description: r ~i Parcel Tax No.: i /c~ b rT J d SAC Gt- A94001 51 TANK INFORMATION / ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~kj 1 k Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 6,73 qg, o TANK SETBACK INFORMATION St/ Ht Outlet Ct C/ 9~ a TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > 1<, 6 NA Dt Bottom Dosi ng NA Header / Man. , 7 Aeration NA Dist. Pipe 1).73 g6.gI Holding Bot. System ~o yS,7 PUMP/ SIPHON INFORMATION Final Grade J Z- ~xk Manufacturer Demand 1 y ~`1 9!,5 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Oenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of V)id a V/6 7 ti Model Number: System-j /i2.,,,J 40 N OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x 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 Systems Only Depth Over Depth Over ~1 ! I I xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center r' f Bed /Trench Edges 0 Topsoil ❑ Yes ❑ No Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) r /0 LOCATION: Warren-19.29.18W, Nt'i NE, U.S. Highway 12 a ~-7 1 ~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. !r SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r x x r a r a■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 16, 1994 Mr. John Bradley 309 North River Road River Falls, WI 54022 RE: Peabody/Kolodziej Property Line Dispute Dear John: Enclosed for your review is a copy of a report from the St. Croix County Sheriff's Office dated June 13, 1994 with regard to the above matter. If you have any questions or comments, please let me know. Very sincerel , Thomas C. Nelson Zoning Administrator mz Enclosure I (n), FRD I M~ SANITARY PERMIT APPLICATION OILHR In accord with ILHR 83.05, Wis. Adm. Code - . a.... STATE SAKI L 43 -Attach complete plans (to the county copy only) for the system, on paper not less than KLA! 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 ? S 12 T ,N,R E(o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 4 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER f II. TYPE OF BUILDING: (Check one) 1-1 State Owned VILTMLAGE NEAREST ROAD / I Public N-1 -or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) Ill. BUILDING USE: (if building type is public, check all that apply) _ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/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. 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 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 > 195, Feet Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 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): Plumb Signature: (No Stamps +l MP/ P,ftSiW N Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sa ry Permit Fee (Includes Groundwater Date Issued Issuing Ag t Si No m s Approved ❑ Owner Given Initial Surcharge Fee) O Adverse D t rminat!on ~v / CO X. CONDITIONS OF APPROVAL/R SONS FOR ISAPPR01/,(4L: SBD-6398 (formerly Plb-67) (R. 11/88) 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 rene,,Nal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the pei snit issuing authority. 4. Changes in ownership or plumber requires a Sanitary hermit Transfer!Rerewal Fort' S 13i1) 6399) to be submitted io the county prior to installation. 5. Onsite sewage systems-must be properly maintained 4rie septic tanks) rnrst be pun+i ! <a licensed Prr Pr whenever necessarY, usually everY,2 to 3 Years. u e 6. If you have questions concerning your onsitesewage system, contact your local code a&;-nist4tor or the- - State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sa`t'tary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax n tuber(s) of where the system is to be installed. II. Type of building being served. Cheok only one and complete of bedrooms if 1 or 2 Family Owelling. 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. Absorntion system information. Provide all information requestrd in ##1-.7, VII. Tanr f;r;formation. Fill in the cap3+.ity c; every new and/or ex s task, ist t'je tital gal'; of tanks and manufacturer's name. irtdic,ite prefab or site construa°R>« and tank material. tot, all sept°(-, pLwnp/siphon and holding tanks for this system. Check experimental approval o anA received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, li-_ense number with apprupri )iii prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. Counfy/Department Use Only. Corr p'e'e -:k;ns an+! sherification~ not s -alter than 8~/s " inches mi 1 + sa imllt'n,' t,-, lt., -,-11 The Walls rz"'u"I irlc'k,~de folio-wing- A) plot t:L n, drawn to s^4 ...-r with co; 1. Oimer!9 ns, _ . ton of hoi,iir,g septt,: tank(s) or other °.6---atrnent tanks; bL.Ilcj r water n voter service; streams aid lakes; pump or siphon arikc• jtstributi3n boxes e+tr-. 0: systems, , - + nion system areas, and the location of the bU ',Nine . >"l'ed; B) horizont.- G'rtlcai elewation refo oc1 1)`int3; C) complete specifications for pumps and controls; Jose volume; elevat;or.:ffefencesi; trict'.nn !oss; pump performance curve; pump model and pump manufacturer; D) cross section cf the soil a.tisorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. Y - - - - - - - - - - - - - - - - - - GROUNDWATE R--SIMCHARGE 1983 Wisconsin Act 410 inciuded the creation Of SLWr harge S (tees, ic. a run,,-;;! > r c,` regulal:ed practices which rant effect groundwater. The MOD WS cU' ected through tuf;&e si,irchar gQs afr. used fcr rnorftw im gro ! dvrat` r. qi c. ,,,n - i water cootarn4iaiion invesligatiurs and establishn-ieri of starriards. SBD-6398 (R.11/88) $C/'1' y0 pdC /INSPECT/oN o~ ~~7' L, vcJa cove ay0 ~ ©PArrv our 6" ole s ysT&--7'% c.: L . 94 6 y Nw c OT 5'TAX-6F 57-A Nu> Ate ~nr 5 r,4 y96, ► J \sir a Aso` ,aw ~RO~os~ h 16-0' Ho us&5- PR opos~o 5 CA 887 EL loo,0 1~.b9 AG2ES /Ol") /SOLOD7- 45 J 4C JM t-- p~ ~ qy,3 T1f i E ft wy ~a2- 58G U/~c c y /EGG F4 ~OQE/zTS, Gtl , S°/7E/1 S ~T Cl1i' SYo.z s' /7PR S' 320,5- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 ,Labor and Human Relations Division ofSafety & Buildings 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 St. Croix 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: PROPERTY LOCATION Tort & Tina Ko-lodzie j GOVT. LOT T]Td 1/4 T•Tf, 1/4,S 19 T 2Q N,RIS X9 (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # 8330 Arbor n/a n/a n/a CITY STATEE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE SOWN NEAREST ROAD la ttomec!i, 55115 (613 429-8148 T•{arren St. Hy. #12 New Construction Use [Y4 Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) Q5.64 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material 0 „twash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem 1S ❑U xBS ❑U 06 ❑U 016 ❑U ❑S 30U ❑S 4NU 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. tBe Trench 10yr3/2. none 2 n shl; rafr c/s 2/f ? Q-16 10vr4/4 none sil.. 2/m/sbk mfr g/w 1/f .6 Ground 3 16-36 7.5yr4/4 none Is. 0/sp r1J_ g/w n/a .7 .8 elev. 98.64 ft. 4 36-84 10yr5/1r none cO.s. O.sg ml n/a n/a .7 .8 Depth to limiting factor >84 Remarks: Boring # 1 0-10 1 3/2 none L. /rrn/sb?; 0Yr raft c/s 2/f .5 .6 2 10-28 10yr404 none co.s. O/sg r'll g/w 1/f .7 .8 U 3 28-44 10yr5/4 none S. 0/sa M-1 g/w na/ .7 .8 Ground elev. 4 44-80 10yr5/4 none cO.S. O/sg- ml n/a n/a .7 `.8 98.44 ft. Depth to limiting factor >80 Remarks: CST Name: Please Print Gar L. Steel Phon X115-246-6200 Address: 1554 20 th. Ave., PT r Richmond, VTT. 54017 Signature: 5-15-93 Date: 2 ',RST Number: 1 PROPERTYOWNER Torn Kolodziej SOIL DESCRIPTION REPORT Page ? ofT PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ><....3. 1 0-7 1 r3/2, none L. 2/m/sbk mfr c/s 2/f .5 .6 2 7-16 10yr4/4 none sil 1/f/sbk mfr g/w 1/f. .2 .3 Ground 3 16-50 10yr5/4 none co.s. 0/sg ml g/w n/a .7 .8 elev. 99.64 ft. 4 50-84 10yr5/4 none S. 0/sg Ell n/a n/a .7 .8 Depth to limiting factor >84 Remarks: Boring # 1 0-10 10yr3/2 none L. 2/ms/bk mfr c/s 2/f 1.5 .6 4 2 10-22 10yr4/4 none sil. 1/f/skb mfr g/w 1/f .2 .3 3 22-35 7.5 4/4 none S. 0/sg rnl g/w n/a .7 .8 Ground elev. 4 35-34 10yr5/4 none co.s. 0/sg ml n/a n/a .7 .8 99.94 ft. Depth to limiting factor ->84 Remarks: Boring # 1 0-10 10yr3/2 none L. 2/ms/bk raft g/w 2/f .5 1.6 5 2 10-17 10yr4/4 none sil. 1/.f/sbk nfr g/w 11f .2 3 17-60 10yr4/4 none o.s. 0/sg Ell g/w na/ .7 .8 Ground elev. 4 60-64 10yr4/4 none sl. 1/f/gr nvfr g/w n/a .4 .5 99.24 ft. 5 64-84 10yr5/4 none co.s. 0/sg ril n/a n /a .7 .8 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1 554 2001-h- Q[TP _ Gary L. Steel C.S.T. 2298 Tom & Tina Ko)_odzie j New Richmond, WI 54017 MPRSW-3254 ~`~'.•r?F'` S19-T_29PI-RIM (715) 246-6200 tom of Warren 0 f 27 ~ +f4,«o' 117+ 6"-v, vS ton t ~ 35~ +a7Z) a` i7~ 00 -M! pomp, w 4 it N tlf~ r - cat T T S M 1 11 Oki N 880 3.8 E~ 55 i 9 4 1 rx,~ ' i j .ass j t 0TAL'AR A - 1;5.69 ACRE'S ' AREA EX LUDING ROAD R/W = 15.2`6.ACRES TM : 1, 4 g YSTiNG ARCEL; PARCEL NO. 290A h .cm ~ r ago Q V v u~ o c1T ° w ` ' - Q X PAS < 4 1 tai RIGHT-"w. RALROA / T ~,J f 50' NORTHERLY"AND 'RADIAL TO THE CENTERLINI 'OF tXISTIN!G 44404 JV ac iIu I i n7 ,e STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Royal Crest Properties, Inc. MAILING ADDRESS 2956 Frank Street, Maplewood, Minnesota 55109-5500 PROPERTY ADDRESS 943 Hwy. 12, Roberts,Wisconsin (location of septic system) Please obtain from the Planning Dept. CITY/STATE Roberts, Wisconsin PROPERTY LOCATION AIW 1/4, " 1/4, Section TA 2 . _N-R / $ W TOWN OF L AAR &EM 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. rOM 1(0&0Dz_ i45-d. Owner of property Royal'Crest Properties, Inc. Location of property_ NW 1/4~[z7 1/4, Section /T_y_N-R__LS_W Township l1JA4RREN Mailing address 2956 Frank Street Maplewood, Minnesota 55109-5500 Address of site.- 943 Hwy. 12 , Roberts, Wisconsin subdivision name Lot no. Other homes on property? Yes X No Previous owner of property At-j- Ic MIg JK Total size of property /Ls", 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 /OZ,? and Page Number (oy 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. S~ y/547 , 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. ~~DY/S9 Signature of i nt Co-Applicant Date of Signature Date of Signature