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HomeMy WebLinkAbout020-1284-50-000 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE IYgpNgqll■ Noun ST. CROIX COUNTY GOVERNMENT CENTER rA.1101 Carmichael Road Hudson, WI 54016=7710 (715) 386-4680 May 30, 1995 Knutson Mortgage 3001 Metro Drive Suite 515 Bloomington, Minnesota 55425 RE: Septic Inspection for Property Located at 899 Wert Road, Hudson, Wisconsin Dear Sirs: An inspection of the septic system for the above address was conducted on December 9, 1993. This property is located in the SW; of the SE, of Section 17, T29N-R19W, Lot 124, Willow Ridge East II, Town of Hudson, 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. Since ely, ames K. Thomp on Assistant Zoning Administrator St. Croix County, Wisconsin mz STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S ADDRESS i SUBDIVISION CSM# Lam/ !`~Dcv c _L- LOT 7 SECTION__~ 7 T 72 N-R_Zf W, Town of_~~Xf/~ - ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7. 3S~ INDICATE NORTH ARROW $M1 Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: 6; ALTERNATE BM: /B®, 721 S PTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: ~6z9d Setback from: Well e House- other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 6Z Number of trenches .Z~ Distance & Direction to nearest prop. line: /G Setback from: well: House_~ Other ELEVATIONS A' Building Sewer_,/,,f72_ FY- ST Inlet, ST outlet. -1 PC inlet PC bottom Pump Off Header/Manifold_ Y7, 7' Bottom of system ~7 T Existing Grade lo 1. 2 Final grade ,Cps" --fz '.7Y. ~iGra~y~~ R . DATE OF INSTALLATION: ~-L PLUMBER ON JOB: LICENSE NUMBER: ZZLI19 INSPECTOR: /r°wt e~~ 3/93:jt r- ~`s r+ itrr> ~F°Pt~ tr~ 7.29.19, I~'Edi TE ffiV C'SYSTEM RD. County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERALµINFORMATION 1934117 Permit Holder's Name: ❑ City ❑ Village Nown of: State Plan ID No.: rQN1;TR1J._TTQN HUDSON BM E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: rte. 160. a,-Yl 61 020-12R4-50-000 TANK INFORMATION ELEVATION DATA A9300079 / 6 ~3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / Do ' , 8 166, 60 Aeration Bldg. Sewer 13,711 1p~, Holding St 11FX Inlet 13,87 9Y TANK SETBACK INFORMATION St/ Outlet d 101.7a /Fie TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic I~A NA Dt Bottom Dosing NA Header*b&L1. ' l c"7,96 Aeration N Dist. Pipe 97 ,?V Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Ma r Demand 70N 77 Model Number GPM TDH Lift Friction =TDHFt oss Force rn engt Did. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING anufactu SETBACK rer INFORMATION Type O/7,,-- CHAMBER / _McriTel Number: System: 43ea/ DISTRIBUTION SYSTEM Header /lMwAekl ri Distribution Pipe(s) tr / x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length y 7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over 3 fl „ Depth Ov r it „ xx Depth Of xx Sodded xx Mulched Bed /._r~~.t-Eenter 14S S~ Bed / Edges Topsoil w ❑ Yes ❑ No E3 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 17.29.19 SW, SE, LOT 124, WERT RD-a V Plan revision required? ❑ Yes [0' Io r / 4 Use other side for additional information. !9 SBD-6710 (R 05/91)} / ~T I~ ele~//~L Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code cSTATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 1 ~f~qpvlous 8% x 11 inches in size. Check f r PvJion application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P PER OWNER OPERTY LOCATION .r P ) Y. S T , N, R E (or PROP RTY OWNER'S M ILIN DR LOT # BLOCK # CITY S ATE ZIP CODE PHONE NUMBER SUBDIVIISIQ.N N ME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned CITY NEARE YR 9 • LA dt"OCOM j ❑ PUbIIC Z 1 or 2 Fam. Dwelling- of bedrooms " AA R ELTAX. U B R() 111. BUILDING USE: (If building type is public, check all that app~Z © Sa 1 ❑ Apt/Condo 20 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. Z 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 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) ELEVATIO;4 S~ O • .S~ Feet 00•A 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 Se tic Tank or Holdin Tank ~!p I I F1 El Lift Pump Tank/Si hon Chamber 11 =0EH 0 El 1 0 Ll VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached,plans. Plu is Name (Print): Plu Signatures) MFEMPRSW No.: Business Phone Number: 17 Arde ~ 1 9 Z::~ 71Z 7ft) J- Plu is Address (Street, Ci te, ' Code): IX. OUNTY/D P RTMENT USE ONLY rmit Fee (isurcharg roue Water Date Issue Issuing ent Si ature (No tamp ❑ Disapproved KE§~:~ pproved ❑ Owner Given Initial CG_ se Determination J ~C dver Z 2_14= A 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. . t A san t, Ky,permit is valid for two (2) years. 2. ,Your sanitarj 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, -,Submitteto the coya_t prior to, installation. 5 °-0nsite sew age system" Pmust be propeiry maintained. The septic tank(s) must be pumped by a licensed pumper-whenever necessary, usually every 2 to 3 years. 71 6. If you have questions concerning your on§ite sewage system, contact your local code 4&ninibtrat6r or the -We of- isconak4-Safety-$ I~uildings )ivision, 608-266-3815. To be complete and46curate 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` 6 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. Vlll. 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. 4 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 1516jbq'> ounty; E) soil;est data on a -b§ form; and F) all sizipg information " GROUWiDWA ER`SURCHARdE ' • - 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices` which can effect groundwater. : The monies pilected througtvthese- surcharges are used for monitoring g>;oungwater,.gro, nd water bdhtamirration investigali86s ahd establishment of standards. ' k SBD-6398 (R.11/88) N N~ lP *gill - i W _ o o. :zt V~ r s 14 5, u ` \ 0 a\ p ~ \ Ts- x 111 x \ n o pie 44 w x sr,. c, Ski sr". a g ' r • Cy , „ , r_ DEPANTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 3707 HUMAN RELATIONS (ILHR 83.090) & Chapter 145) LOCATION: SECTION: OWNS HIP/N+1_4~thTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 11 ce' / /T N/R E (o T r~ z y 4111 CO NTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE , AT OBSERVA IONS MADE 1NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: I Residence kNew ❑Replace y .a 3 TO RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(opt'onal) OS [_]U ❑S©U [aS❑U ❑S2U ❑SEa pax o' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBS4E4RVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) > B- Elf Loa, 7 1~n rrr 5, cs B- F~ b 2 P P~ ' ' u L W .L e ^g S B- P3 /,1/,2 m S. B- S OD. 3 "6s/ 'gp, cs 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER PERINCH P- / L 3 P- P- 3 2 3 7 '0z Lek P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 97 7 i c/ 5ca~ rr_L/ig/ z F 44 A 45>rx 3 E ~t ~~Gr~oY s 'w c " e ~ l~ l 12'X ~a : . ly z E I iY NC I, the un ersi nad, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administ ativ Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME ( rint): TESTS WERE COMPLETED ON: DAVE FOGERTY PLUMBING to r3 ADDRESS: #3233 #3289 CERTI ICA ION NUMBER: r07 UMBER (optional): ROBER S, WISCONSIN 54023 CST Sl ATE: Phone 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - J !w ° TO T# Y ~ it 5 o I A N 02*03'36'W ! m 351 73' N 02'03'36'W 351.73' m WERT ROAD _ - - - - - - W - S 02' 03' 36 E 345.15' I W - - - - - - 75.00 270.15 t A N OD p~ - 4 - m Of v 2 p t~ N \ ~ v CM v w p~ Nom. v N IN Nc NO n-n U RI • N O ! u o N 02'03'36 W 168.91' u SZ \9 ! 7 0) CD LN -4 0! W W _ N bl O W _ q~ 2 I N 4D _ as ' . O A Irn Lv, ! o t0 0 0 ar F - r - - 9 q 2 1 \ ~•p~'~9 ~9 - ~ 4'm~~ 6602 6 \ 'li • m 0,0 _ A \o• cNn ' L co 47 N cn ao a D ,p I G Ul \ o' \ \ 00\ \ O !q v j 01 (A T -C~ Ln N ',A Iro 4) S- ~ m ~ ~2' • 49 ~ ~ ~ T A \ 9! - D U) C) \ O \ T I 74 (Yl s, W -4 Iw ! \ _ l n o ti co LT. ~ Z . I ~c C I'~ I'~ III I I v S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 'S-~ OWNER/BUYER ADDRESS FIRE NUMBER CITY/STATE ,C. -ZIP V49 PROPERTY LOCATION: 1/4,1/4, SECTION, T--( N-R14W TOWN OF , St. Croix County, SUBDIVISION 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 600 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 da e. SIGNED: _ C1 DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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), thenia second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. j- I Owner of property Location of property$k)_1/4 Fe4 1/4, Section T,2ZN-R W Township Mailing address <2-5: ~ Address of site ~Q' tr~~ G~►L _rg"014 Subdivision name ao%~ Lot no.. Other homes on property? yes No Previous owner of property Total size of parcel Date parcel-was created q/ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes 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 & 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 n 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 No. r V Signatu f applicant Co-applicant Date of Signature Date of Signature . DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA II STATE BAR OF WISCONSIN FORM 2 1982 498882 i~ ~aGE - REGISTER'S OFFICE i~ i B.. ...Deyelopment., Inc SL CROIX CO., WI Recd for Record : MAY 111993 conveys and warrants to ...Delta---Construr-tion at 1: 50 P. M tie s~ofD"dss RETURN TO I the following described real estate in S.t.....Cr.o. iX ...................County, State of Wisconsin: t. Tax Parcel No: I Lot 124, Willow Ridge East II in the Town of Hudson, St. Croix I~ County, Wisconsin. i (I I~ !BANS ~ FES 'I ~i This .,is...n.Q.t......... homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated this day of MaY..........._.........................._............., 19...93.. i B &,41 Dev 7myt, Inc . ..............(SEAL) bY.=. . /..(SEAL) I •Donald...Es::'$j.ornst.ad...................... i (SEAL) by ' . &2AAV (SEAL) *William C. Harwell + '10 AUTHENTICATION ACKNOWLEDGMENT Donald E . B j ornstad , STATE OF WISCONSIN r~ ,lzf4 .d. Harwell so. .r 4- + . '•I1 ......................Cou nty .euLhhen icsQd h;`i`+ day of......May 19.9.. Personally came before me this ................day of ~ • t.. AM--................................. 19........ the above named ~risi,tia land 'i'ITL: Mfik STATE BAR OF WISCONSIN (14sngk authorized by $ 706.06, Wis. State.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kr st na Ogla nd Attorney at Law Notary Public ..........................................County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19........) #Names of persons signing in any capacity should be typed or printed below their signatures.