Loading...
HomeMy WebLinkAbout020-1115-30-000 e ' O °va I M V tic O N O r' O N y C r.i U ~c a I O (n I U ~ o s, O 0) LL X x Q ~ I I 3 m Z w E Z o rn N a m z O z a ° (D z d c E N O ~ ° I (n CL r- Q0 (D N o o d _ 0 N N © O a) a o V C,4 CN V N N z m z z o o. d m (n E 0 Q) h a 'y w o ° o G a nl r o N N N E o O O O d~ I • ~w,y~ a a a ►~111 n N (mil 0 m m In a) i F~ fA U =3 rn rn ~+V (D J ° o - E rn M _ o m 0 a ° In N `Irrr ~ ~ d Q ~ I C _ O N N _N C O C C E o a C (O N Q) o r~©l o N 3 m a~i ° C 0) ° ) w a- CL 0- c6o 1-4-: Fo- -0 In E E cc) 0) a c -C G = of 3 v w F- I- co 0 ..1 CA E E U L.' ° 2 U o 1 0 v ~ Ed at a a w • CL iu .gy m rr,ly E A U a 2 0 in U d' N O~ D4 t} p; N ti C r, 0 N t_ i v v h rn ~ Z O N LlJ N P Z C t9 O Z ? ~ H N Op W ~ a o as > Z a t! J U IV O O 0 O "c o 3 i T FO v v T c G 6 N r1 O N -o N • 04 O O M O rte. • O. y v i E i C O u a STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS eg JCQ o A W419W LaA-a - *W 2TV-) SUBDIVISION / CSM# ~i1,~/OW ~Jydy ~zfQ 7/~ 5 LOT # ~I SECTION T z9 wR /f 6J Town of //&e `,S n 412- p" ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Wl LLBc d(F_ D R Z J~ sl. t de. wA (Ka•s ~ uQx D Y L Goo- z v'Y s a WF 11 I So .Xy r2l, S a' its nr 4; it' K•Kt Deep [AITE-k/YATE 24' ARE/I /t rao' A ~ ct NF [e+Co Mar EI=/00.06' INDICATE NORTH ARROW Scala. ~v ~ ~ /V S Sf a' Kn E 9 S'O ~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: !e~rierE1=/4a, eel ~ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /pOa q4 J. Setback from: Well S7 House 8 Other /3 brow. lacLif- 1,D4 Pump: Manufacturer Model# Size Float seperation Gallons/cycle: - I Alarm Location - SOIL ABSORPTION SYSTEM Width: 12' Length (6 O' Number of trenches Distance & Direction to nearest prop. line: S 'fo w.&.a'f Setback from: well: S House 24~ Other 1S to E-,-t- /ol ELEVATIONS 11411rPlir.. S,Do Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold -).c.7_ Bottom of system ~N. 7.17 Existing Grade Final grade DATE OF INSTALLATION: n PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: i 3/93:jt rs`rartm~fiSirtr9.~9.~9.4~~1TE~At~t SYSM.OW LA County: Lat or and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX .GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 19346 Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: URKE HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: P /dd. W'-~,,e QS 020-1115-30-00 TANK INFORMATION ELEVATION DATA A9300120 (r'~4 f'3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 77* 1604' Dosin a,7?' b/ 9P Aeration Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/)o Outl Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt 11,444- Septic NA Dt Botto Do ' NA Header.. 9 (oz 9P. A Aeration NA Dist. Pipe ,9e 196,f? Holding Bot. System ~61 PUMP/ SIPHON INFORMATION Final Grade Man cturer Demand ri Model Number GPM I Loss Friction Syste TDH Ft TDH Lift Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIMENSIONS o~ DIME 1 N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN Manufacturer: SETBACK CHAMBER INFORMATION Type O f e-4 System: a-r~ii OR UNIT el Number: DISTRIBUTION SYSTEM a!O~• Header / M!nditslfl Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake ~ i Length --(R- Dia. Length ~Z Dia. Al- Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over it Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/T~w4rCenter 39 Bed/TarsibhFdges 34 ` CAI I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LCiCATION: HU SON 19.29.19.472A,NW,NE,LOT #4,WILLOW LANE 7~~,"Coe- / e-&// Plan revision required? ❑ Yes ❑g-Igo Use other side for additional information. CU y~ SBD-6710 (R 05/91) Date Inspector's Signaturfe Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i 17D~LHR SANITARY PERMIT APPLICATION ~D ~ In accord with ILHR 83.05, Wis. Adm. Code co~W_ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ .f J. Yin re !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 A4 J C,eAWLEy '5AP1 :~Ivr VU) % F'/a,S /f T2-7 ,N,R E(o PROPERTY OWNER'S MAILING A RESS LOT # BLOCK # p0X --4z Fr 2-- y CITY, STATE T ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER f_n 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) state owned . ❑ VILLA GE : =N OF: ❑ Public ©1 or 2 Fam. Dwelling- # of bedrooms 3 PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) D ZD -//s _ 3 O 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 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. SYSTEM ELEV. 7. FINAL GRADE yS0 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7 LD 7 Za 0. 7 Tr. Sv Feet 9T, c Feet CAPACITY VII. TANK in allons Total of Prefab. oSite n Fiber- Exper. INFORMATION . New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank k looep a I1 S@~✓° 77 Ll Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PRSW fro.: Business Phone Number: Plumber's Name (Print): Plumber's Signature: (No Stamps) M0-6f32- ow 0 Z~l7 3233 Plumber's Address (Street, City, State, Zip Code): PO 4--A /;L,4-. mew Al 64M>44( w,s y G# IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved )a 'tary Permit Fee (Includes Groundwater ate ssu Issuing A m Sign lure NO Sta ps pproved El Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: II SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber s INSTRUCTIONS % 1. ? ,,Asiani~any-permit is valid for two (2) years. 2. -Your sanitarytipermit 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. y N't SBD-6398 (R.11/88) S T C - 100 This application form is to be completed in full and signed by fthe 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), thenta 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 -J. Location of, property NW 1/4 #6 1/4, Section Iq N-R /y Township Svti Mailing address _RoX Aso 1-a w s- ya/~ Address of site 5(t) I4 W,, 110 rya1~6 Subdivision name__ Lot no, T Other homes on property? yes--j' No Previous owner of property _Ch d_s'J9 r Total size of parcel /3 /'bra r_ Date parcel -was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? r Yes No Volume.$5_1 and, Page Number Ya 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.'fs 27y/ , 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. S2 7 signs ur of applicant Co-applicant Date of Signature Date of Signature --W, D STATE B_\R OF ~YISCONSIN FOP'S{ 5-1982 TN15 iPA .E RESERVE FOR RECORD'" OOi:UM~ OATH • ` NT NO PERSONAL REPRESENTATIVE'S DEED REGISTER'S OrriCt, Mary J. Crawly - ST. CROIX CO., 'M Recd for Record - ata e as personal Representative oft the E_ U'v i 0 It 1989 _Burke-------- _ - at 8:30 A. M - ("Decedent "1. Marv J. Craw ey, r Re9isterofDeeds without warranty, to for a valuable conside.ation conveys, dri uT1Cl~c~ed 1/4 an undivided. l/2 interest,.Davic~_Burke,-ded 4 interest ke . un- - iv_-- -~i . . . . 1/ _J..__..-.-.-.. r_ an (i l'Zn tee, RETURN TO interest.and-Lu~'erne Bur - - County, St. Croix the following described real estate in - Mate of Wisconsin (hereinafter called the "Property") East 80 feet of Lot 4, 1Jillow River Estates Tax Parcel No: in Town of Hudson- FEE Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which , prior to Decedent's death, and all of th. a estate and interest in the Property which the the Decedent had immediately Personal Representative has slur Ce.acqwired. 19-- Dated this - day of . - - r ^ r ` - (SEAL) __....(SEAL) mar craw. ey........ , J• Personal Rcor-rntative ACdNOWLEDGMENT AUTHENTICATION Signature STATE OF WISCONSiti (s) ~1- - _ - s County. 2 th d CROLX.... authytt 19 Personally came before me this .the above named of , 19 f d is~~ day C"ca "Ie". TITLE: MEMBER STATE BAR OF WISCONSIN n i , er ;trd "the (I i not, 70R'AF,.Wis. S.tat3.) to n., ~.n to ! r• authorized by 3 t, .,r ,t .1 :,knwxl,-I,e tt, :.y TH-3 ;TR-.J a T -,'AS CRAFT10 Robert F 4a11 RICHA-RDS, Tlr'~LL & f~11 "'IS r~ ? SeCO~~ s~,,l~ udson i Simo n; i ti u.,. 'n,ty hr• ;t-., nti';.tC,l ~.,r `mi,. •?i nr^ + r c tl 1, Nit „F 111-, PERSONAL REPRESENTATIVE 9 DEED S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_AtV ADDRESS ~pY 47 Z ~ FIRE NUMBER CITY/STATE ~uZ_ PROPERTY I/LOC/ATION : NW 1/4, 1/4, SECTION- / , T Z ? N- / 9 TOWN OF hu~cr S e h. , 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 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 icer within 30 days of the three year expiration date. SIGNED: DATE: - St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 Wisconsin Qepartment of Industry, SOIL AND SITE EVALUATION REPORT Page _L of 3 Labor and Human Relations Division df 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 ' Ck0 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. Y DATE r EVIEWED B APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION xe-J.- GOVT. LOT 14L.) 114 N e 1/4,S R T29 N,R /9 E (or) W .at- OWNERS MAILING ADORESS L0# BLOCK # SU D. NAME OPCSM # PROPERTY ,&0), okz_ aLcpW Iv S, d- F_ -s CITY, S;ATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST R~AD so to-' S' d /G (3810 2-7 / I'S O'Nd f t~`t QAA V_ 16 Rf New Construction Use (q('J Residential / Number of bedrooms ( ]Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate a.7 bed, gpd/ft2 3 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2Q 0 trench, gpd/ft2 Recommended infiltration surface elevation(s)gn Airzm - is - ac) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CO VENTIONAL M UND IN- ROUND PRESSURE AT-GRADE YSTEM IN FILL HOLDING T K U= Unsuitable fors stem L S❑ U S❑ U as ❑ U S❑ U k(S ❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rrerO Q I.sY 5 L 1-7-34 lb-lk 3/4 :7 Ground $ Z 36 S 7.S YR +/6 n,, 6.7 OK. e~j r'7 ` ft.-} 7.5 IIZ 4 4 n,, s m Depth to limiting factor Remarks: Boring # s~ 0-6, 7.S y>~ o S L O r I Z 34 10 c- 3r ioyA 3 4 - S 01 M, rv~ 4•ii:: nv: 14-7 ,tir 1 0,7 0- Ground 3/-41 7 SYt~ 6 - O / elev. ft.-ID .SY 4 5 / 101-3 P161 Depth to limiting factor Remarks: CST Name:-Please Print Phone: o Address: Z 1 O MEN ~U ~IQlV~ L) f~5~~, Signatur : Date:6 S ^ CST Number: 30-4 PROPERtY OWNER SOIL DESCRIPTION REPORT Page? of 3 ' PARCEL I.D.#Lc-, 4 ~~LLOw '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 G ~.5 vF, z c 0 4 o.s .....vv..x,.. pp L) 0.1 Ground elev. Depth to limiting factor Remarks: Boring # { 7.519 3/1 D 0-T (51,~ Ground _ elev. 8~ 7.SY~ 4 S rti• / 0.7 'O-g /00 Q~ft. Depth to limiting factor ? -orb Remarks: Boring # 0-7 SIC .f 4 y.e 4 L,3 S c 1 0.? 0. Z B- Z(- 7, S-Y~ 4 A Ground qeley~,- -!ll IC y~ A 4- S ' 7.°15ft. Depth to limiting factor FT Remarks: Boring # Xv} ti <}ii 't\ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) • LA L 3 A Cpp Z N p r1l ~ I ` N 7 I i -oft- ~l r n Z L r O~P/7'W /et 11AiE ~a.ao' o o ~ t*i ►1 -c o P - ~ i o rt e 1 - - -d 44 r., \ ,,l s o "tl r #p C - . J L'1 7 7-) 7s 2 b ~ P w v1 0 0 m -v 7Z o T = rn M ~l y - N - i 3 TIN aC~ ~ h, SE i r Ll 70 ` v rr N` ..1 r oz tN So .T! Cif L/ Y o-eC le o - wlGCOU/ LANE cl 2 a- Y 'at la: G' d ~ ` ~ i r 14) 'o o } o O T N a t t h 1 -4 y NO ~~tt i 44 Le I., lov -~I