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HomeMy WebLinkAbout020-1173-60-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 1✓,,,j5s -_y W 452, ©y AZ-K- s SUBDIVISION / CSMj_-/y ,"//.,a LOT ~ G~, G e SECTION. Iq T qg! N-R t 1 W, Town of cv88 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I e~ INDICATE NORTH ARRO Provide setback and elevation information on reverse of this 'form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK ALTERNATE BM' SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: /~~;®lw~s7 Liquid Capacity: food Setback from: Well _55--de- House /3 ` Other Pump: Manufacturer Model # Size Float seperation Gallons/cycle: Alarm Location ';SOIL ABSORPTION SYSTEM Width: Length S7 Number of trenches c;Z Distance & Direction to nearest prop. line: Setback from: well: SDf House__,ILE' 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: 4 I~._ LICENSE NUMBER: M042 _ INSPECTOR: 3/93:jt L ` ~pertk1a1WQ&sJy7. 29.19. I%VVATE SEWAGE SYSTEM County: tabor and Human Relations INSPECTION REPORT Safety'and Buildings Division (ATTACH TO PERMIT) Sanitar unit GENERAL INFORMATION ` Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI ev.. nsp. M Elev.: BM Descriptio : nmsol; Parcel Tax No.: 175._11e 020-1:91:73 60-MO TANK INFORMATION ELEVATION DATA A9300228 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -lryF'CS/f Benchmark Dosing 601, Aeration Bldg. Sewer S Holding St/ Inlet TANK SET FORMATION St/ Ht Outlet 95' 9S. Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic 3 z~ NA Dt Bottom Dosing NA Headers .~z Aeration A Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa turer Demand Model Number GPM TDH Lift Friction ystem= Ft ead Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S ~ _1Z, DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ufact SETBACK INFORMATION Type Of CHAMBER M6del Number: System: ecs lGD GJ OR UNIT DISTRIBUTION SYSTEM Header /Manifold y Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length ~S Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / a Depth Over 'i xx Depth Of xx Seeded / So xx Mulched Bed /i~►Center J~ ,~a Bed /7 Edges , q2, Topsoil ❑ No ❑ Yes ❑ No - _3G COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19.1084 / Plan revision required? ❑ Yes 21C Use other side for additional information.' e~ PW I / SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: =-:7EQ3LH1R SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE S q'g C. -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. neck 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 12"ll /4Lycue/7 S`4)%4 SL=%4,S sJ Td29,N,R /Q' E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # u rQ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER l soV 1,6-yo /o' 7 3FG 3 f W !5~ y II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned O VILLAGE r,ri A ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms -I- AR EL TAX ( ) III. BUILDING USE: (If building type is public, check all that apply) D oZ ©'-?3 6Q 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 5.0 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 300 Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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. SYST3M ELEV. 7. FINAL GRADE y~ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) .12.4/ ELEVATION 1:5-a S J~TO r i(//C_ fFeet W1 10 Feet CAPACITY VII. TANK in aRasnt ns Total # of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New iin Gallons Tanks Concrete structed glass App. Septic Tank or Holdin Tank Tanks ks `S" 7` Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: e- T, Plumber's Address (Street, City, State, Zip Code): A0 7e IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued ing Ag nt S' nature IN tamps) Approved ❑ Owner Given initial j ~jlS Surcharge Fee) 0e Adverse Determination d vv X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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; bui'idin g 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 e'evation 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 `98' W sconsir, Act 410 included the creation of surcharges (Sees) for a nurnber of regulated practices which can effect groundwater. The ninnies ; ol;ected through these surcharges art) used or rFtit ifa~i r~, grOUnuwater, ground.. water contamination investigations and establishment of stan&rds. SBD-6398 (R.11/88) r w2 „S'GJ S' L~ 2 f/p/~!!~! y `~lAf!/ C /C.e T/w.d S C Ceti G `J ~ /,lea 3a 3 y "Yog s P Q IP I00' C3ve.^ f~ea ot.-95 1 00 911 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor ana 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 8 1/2 x 11 inches in size. Plan must include, but ST f'X 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 p p, w ,e GOVT. LOT :S i j 1/4 S(` 1/4,S J7 T Z T N,R f 7 E (or) W PROPERTY 0 ~~:S L MAILING ADDRESS LOT T# # BLOCK # SUED. NAME OR CSM # tLLzt-/ CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL GE OWN NEAREST ROAD We-d w ♦ WSJ3PJ, 8Y 3S idSarJ CTK [tyNew Construction Use K Residential / Number of bedrooms [ [ Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow Sb gpd Recommended design loading rate ~ -bed, gpd/ft2 ~ trench, gpd/112 Absorption area required KAS bed, ft2 'S6 trench, ft2 Maximum design loading rate O 2 bed, gpd/ft2 Z trench, gpd/ft2 Recommended infiltration surface elevation(s) B-T+ & E ft as referred to site plan benchmark) Additional design / site considerations 2 ,q 6 4 N A 4~. &A, Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL gUND IN-GROUND PRESSURE 7 AT-GRADE Y TEM IN FILL HOLDING TANK U = Unsuitable fors stem ENS ❑ U L'S) S ❑ U gas ❑ U I$S ❑ US ❑ U C] S j~'U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench :~,w $ t~ 33 ,a 4/ 1 rat l 4 s Ground ~Z 3 /2 /C iy + S /117 1 I d ,7 d .p elev. 9L ft. Depth to limiting factor > /D,CkS Remarks: Boring # 4) A 10 04 :Z ww. 17.4 b >o ye, 3 I- 1 5 b M-F C a+ ki o- !o 4 S n 10 rfq-7 Ground elev. Ch'/0 ft. Los Depth to limiting factor >9.7< Remarks: CACAX CST Name: Please Print U 7qS0-'1 `NapNt%iCE e: ~ 616 Address: Signature: Date: > CST Number: ¢ 462 PRQPERTY OWNER SOIL DESCRIPTION REPORT Page 7. of 3 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 Trends oT. o7, r.........,.. / Z-16 16 4 3 I s1oK rr G 14.~ b.~ Ground -J /O elev. C)j i% ft. Depth to limiting t4to3 Remarks: Boring # S 0,7 Ground elev. ft. Depth to limiting ctor3 . 7 Remarks: Boring Z Ground elev. nj ~ ft. Depth to limiting factor -S"S Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) -O M ' ILL,,,,LL~~~~ g I Q~ I <ej ~4 a , i I V 11) N ~ ~ ,C ~avJ r RUSCH SURVEY3 ILA& vain . ~ A rc 4 yy ~ S .f ~ ' ~ is i 1 "$8 4 r a A~,F 4~ { r loft -77 IoM - F ' `mss s + r ~.s ~ ,s ~,y 'mac ,r •'"'~y1..~. ~'~1~". `_"'~"'l'*~ Ok, . ,v t 90 e4p~ My .h . S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER__~~~ ~I GQ t~GUe,17 ADDRESS G ~dt• FIRE NUMBER CITY/STATE _~atinJ IAJ ZIP_ s36ol4;~1 PROPERTY LOCATION: S~ 114,5f 1/4, SECTION _17, T !ELN-R / W TOWN OF ~31W5'a.J , St. Croix *County, SUBDIVISION_ Z,.;, `/GS4J ~Vlda- 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 a 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 Co. Zoning officer within 30 days of the three year expiration date. + SIGNED: ~,~,~~.,,.L DATE:- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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/cofit.ra.ctor,(spec house), thenta second form should be retained and.comple.ted when the property is sold and submitted to this office with the appropriate deed recording. Owner of propertyz4e~.y we_G1 Location of property,Y4)_1/4 57jef 1/4, Section 17 , T Zt N-R_,~? W Township _4q 66~ Mailing address _ d;e Ze w e Address of site • I Subdivision name- _ Lr/d`C7aw fy~,~ _,.,rz j Q T Lot no. Other homes on property.? yes No Previous owner of property _ Qd0i✓v/-d ~e~7~/iSt~„cJ Total size of parcel /e 7S Date parcel -was created Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)?-YYes No Volume4 u 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 & 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. , 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 County Register of deeds as Document Cf~ No. Signature of applicant Co-applicant Date of Signatu a Date of Signature f RDGISTERS OFFICE ST. CROIX CO., W14. 339`5' MI V0~ 0U.31"AGE 46 Recd, fa• Record this 23rd • day of J sul -_A. D. 1 S' a4 A _;~md 55 at 11: V LAND CONTRACT . Contract, by and between Arnold R. Bertelsen a/k/a A1.4. R. sen and- r " Virginia A. Bertelsen, husband and wi,fe,•Vendor, and.B. & Hpment, I nc:, a Wisconsin corporation, Purchaser! J Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this Contract by Purchaser, the following property, together with the rents, profits and other appurtenant interest (all called the "Progerty"), in St. Croix County, State of Wisconsin: South 53 1/3 rods of South Half of Southwest Quarter (SJSWk) and South 53 1/3 rods of Southwest Quarter of Southeast Quarter (SW'kSEk) of Section 17, T29N, R19W. i That part of Northwest Quarter of Northeast Quarter (NWk, NEB) and of Northeast Quarter of Northwest Quarter (NE1, " NW's) of Section 20, T29N, R19W, lying Northerly of the centerline of St. Croix County Trunk Highway "A'F.(formerly , known as Hudson-New Richmond Highway), EXCEPT the following ' e llowing parts of the above described tracts:. $-IA. 0 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, I , page 114, Document Number 324430. TOGETHER with an easement for street purposes over the Easterly 33 feet of said parcel deeded to Roger E. Hetchler 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 $100,000.00, 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 $85,000.00 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, i Purchaser shall pay to Vendor a $2,000.00 principal payment,- to be applied to the $85,000.00 base ccniract:balance outstanding. - (b) A minimum annual°payment:of $15,000.00 principal shall be paid each year, excluding the-year of sale. -Each per'lo.t principal payment required above, shall be credited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December lat.of each year thereafter Purchaser shall pay 11 P Y to Vendor the differential between the required minimum principal payment of $15,000.00,. and the total $2,000.00 per lot payments made during the preceding twelve (12) months, until the Base Purchase Price has been paid in full. (d) Interest on the principal balance of $85,000.00 shall accrue from the date of closing, with annual payments of interest due on the 1st day of December, each year, commencing December 1, 1984. Wm. J. Redosevich 2 Additional Per Lot Payments. In addition to ::he foregoing Base Purchase AtrORNF• .r uw Price Purchaser shall pay to Vendor addit>l ' payments, onal .Per lot payments totaling not less than $130,000.00, as follows: Tulgren Square 502 Second St. (a) No interest shall accrue on the principal sums paid to Vendor Hudson. Ws. under the terms of this Paragraph. 54016 715.386 8234