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HomeMy WebLinkAbout020-1287-10-000 ST. CROIX COUNTY WISCONSIN ZONING OFFICE r""~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ' Hudson, WI 54016_7710 (715) 386-4680 March 14, 1994 Ms. Jae Olson First Federal Savings 201 South Second Street Hudson, Wisconsin 54016 RE: Septic Inspection Dear Ms. Olson: An inspection of the septic system serving the Sam Miller/Eric Lundell property, known as Parcel No. 020-1287-10-000, was conducted on November 11, 1993. This property is located in the SE; of the NW; of Section 21, T29N-R19W, Lot 1, Wells Fargo Station, 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 bedroom home. Should you have any questions, please feel free to contact this office. ince ely, James K. Tho pson `-'Assistant Zoning Administrator mz (C(op'y STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 5 ADDRESS E,5s X PAS SUBDIVISION / CSM# Gc~LL 5f?~~oD LOT # SECTION, Z / T a 9 N-R_Z-_7 Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t. Pc.TE,~~+VffTE- o /SIX Yo , /IvUSE . ~ ~A2HG - {iz: 73 V If V/ u1 A JO7 /,•h ~ I INDICAT TH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 7.-P of 2' ?iP< /,17- ALTERNATE BM: To P of /{oetS~ /rcccn6'aTiptl 0?.70 /oz. 30 " EPTIC T~/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (da,' sc--r Liquid Capacity: /oo o 1c. Setback from: Well SS House z/ Other 9Z T~Sm~/ef/~ti~ Pump: Manufacturer - Model# Size - Float seperation Gallons/cycle: Alarm Location I :SOIL ABSORPTION SYSTEM Width: JO' Length yo ' Number of trenches Distance & Direction to nearest prop. line: 9O. 7%o Sou- t /of am Setback from: well: 7S House ss Other o' To ST i '+t ELEVATIONS /00.76) Building Sewer ST Inlet : 7< "8Z = 9719 ST outlet PC inlet PC bottom Pump Off Header/Manifold 7,39 47~,ABottom of system 9•Ga'= 95.3 Existing Grade 5~9D Final grade DATE OF INSTALLATION: PLUMBER ON JOB: 0 LICENSE NUMBER: INSPECTOR: 3/93:jt Z+ Ns1QWvrtWP1§Q&t;1. 29' 19 PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division Sill C (ATTACH TO PERMIT) Sanitary Permit N,6F:9TX GENERAL INFORMATION 1 9l Permit Holder's Name: ❑ City ❑ Village `X Town of: State Plan ID No.: yev.' nsp. BM Eev..: BM Description: / } t Parcel Tax No.: / all A-Ine a,5 020-_1287-10- TANK INFORMATION ELEVATION DATA A93 0297 11/11/9,3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark S 02 la, , Dosi .212S' 2, ,S 16-2-271 Aeration Bldg. Sewer Holding St/,l Inlet 7051 9717 TANK SETBACK INFORMATION St4W0utlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake c Septic >66-~ old NA Dt Bottom Dosing NA Headers. e ~ Aeration A Dist. Pipe 7$S 96, '17 Holding Bot. System -r 371 PUMP/ SIPHON INFORMATION F a Grade Manufa Demand ol~r r 37 !oS Model Number GPM TDH Lift Friction S Ste TDH Loss Forcemain Id. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width/ Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK > 7 77 ber: INFORMATION Type O fire CHAMBER System: ea a~ SS `/S DISTRIBUTION SYSTEM Header /Md" Distribution Pipe(s) x !He ize x Hole Spacing Vent To Air Intake Length _~DiaLength 2LZ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Orade Systems O Depth Over H " Depth Over / 'E e xx Depth Of xx See Sodded xx Mulched No Bed / enter j9 Bed/ ~rFr€dges `S Topsoil Yes ❑ No ❑ Yes E] COMMENTS: (Include code discrepancies, persons present, etc. LOCATION : ~F[LJ,DSON . 21„ 29.19lo, Plan revision required? ❑ Yes MA"ro, Use other side for additional information. r ( IAMIRd-- SBD-6710 (R 05/91) Date Inspector's Signatur Cert No. ~DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than `?q 8% x 11 inches in size. 1:1 check MAtprevious 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 L (1 V f 1E LL IS, 1212-2,D, 45 .115 '/4 4,) Y4, S 2 T d-N, R E (or) PROPERTY OWNER'S MAILING DRESS LOT # BLOCK # o ~Z8'Z CITY, ST E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER J1(3EI- r o S : 0 -7 C 57 1 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned O VILLA =N PF. GE J/1'4C.S cs ~ e0 ,v- Public oy ❑ 1 or 2 Fam. Dwelling-# of bedrooms A EL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) ©Z d 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 80 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an L+ 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 El Mound 300 Specify Type 41 El 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 s 5' 7Z O Q, Feet 9 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank D ©o Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: D o 4 ~o 6 o m-v~ 3 z- 3 Plumber's Address (Street, City, State, Zip Code): Coe r / t/ 9 O #/ZZ. G " S Tv IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved San'ry Permit a (includes Groundwater Date ssu Issuing nt lure (No S ps) 71~Ap El owner Given initial Surcharge Fee) Adverse Determination (~C•° 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 invalid 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'f 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 establishrnbnf of standards. SBD-6398 (R.11/88) ~~lc LONDELL/SPM /)'IiLL£,P WC-Zt 5 ::~XiZGV 77W-7 / Lo7 / Sys~~m 6 ,a 96-oo" 9p'7ta' Q I LoT ~ I I is.,t I A r~ 0 l r, I I ' t r4ous m- 7;7 16 Zd i t° r .W E ~ A - 71' , /A AT S. w, ~o✓.ta✓ E~: ~d0,ao z m ~ N - - - - - - - - - - - - - - - - I I I - Bi- Z I I I ~ I I C11 i < c7 I g~ ~ I I ~ I I h m i i I ~0 I r I O h I I I m ~bb m ; z j j 16 n rri r0 I I I ~ I n I I I ~"i . m I I I I ~ ~ I I .D I 95 m m I , I I ~ w I rn I rn I w I I ~ ~ j r I I I ®kj~ D I I I co -Jr- j I I I1 `v I I I j u m I n j -u -0 I I I ~ f m I I -o (/I I l~ m I I I I ~o I z p ~ I I Or I 1 I I I -om I _ o I I I W I '0 4 I I ~ 'p' I - I I ~ O m i z I cn C4 0 I O # I Z cw0 I ~ ~ z .rte, S~ x o -Ay 0 -A (D N Y -y1 o Z O r7n Vj x < 7C G7 V Y M O z m 'o :U- T m -n ~+~7 -p O N 4% Z m n 0 o I i i I i I I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 4 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COLIN Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but t ~1R0 t 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 `j AM M lwnt GOVT. LOT 5 C 1/4 N LJ 114,S-Z) T Z? ,N,R~ E (or) W PROPERTY OWNW':S MAILING DDRESS LOT # BLOCK # SUED. NAME OVCSM # -rkouT Qe a I LAki-CS OW, o CITY TATE ' l ZIP CODE PHONE NUMBER ❑CITY 171VALLAGE OWN NEAREST ROAD r vl&tn~ W) ' c ) c~&SO (rN uu New Construction Use [Q(] Residential / Number of bedrooms [ ] Addition to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow S~ gpd Recommended design loading rate Q.7 bed, gpd/ft20•16' trench, gpd/ft2 Absorption area required bed, ft2 S 6 trench, ft2 Maximum design loading rate Q .7 bed, gpd/ft2 C.? trench, gpd/ft2 Recommended infiltration surface elevation(s)&-.wgZA) 96.70 A.ja ?4, can ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE &T -GRADE SYSTEM IN FILL HOLDING T K U = Unsuitable fors stem Iff S ❑ U EFS ❑ U [!0 S ❑ U 3S ❑ U NS ❑ U ❑ SPU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxx3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ctt ()-lb 7, s f2 z Z. C S 6 A -Z6 5;L _Z obi M~( l 05 6,6 EGround- /2o i s ^ /'y► j r 0 elev. Depth to limiting factor ~n Remarks: Boring # - I-- 2 c m t" C 0 4% 7 ,s y~z 'Z 5P.0% Ilk" L) Z Ground elev. 99,5 ft. I Depth to limiting factor >9s~ Remarks: CST Name:-Please Print A ~ 61 ~0Q NSO ~ Phone: Address: P. Q tX l j ~S~~AI l/V r Signature: Date: CST Number: ~ 93 ~4g Z/ i~ ¢ PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # L671 Wk- LLSiW& 6 Depth Dominant Color Mottles Structure GPD/ft -Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3A S,L 2 abfz My O 6 Ground $ 3o-14 love, 4A Si-Gr, CO ~ r~ C_ I 0.~ $ elev. 1oo.iSft. g -I11 IDyk 4L4 S O rti r Depth to limiting f ctor ~ .2s Remarks: Boring # w Ground g %-1J4 d~ - S a m d•' elev. _4 ft. Depth to limiting ctor ? Remarks: Boring # 03 .sYZ~ O.S At Ground 36' S4 /6)\/ ~3~3 S { Cti $ M Ih I d .7 d n, -7 iat 7 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) f0O' N 72i SL 1) 4 ' E ~c A~~ 1 ~3 b' qo of n I ' RENC.I A Af-14.- L'/ Dori ITT 5 W LoTCa.2,v- ~l~f = ~OO.Od - Lbw ~ 3 - \ S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 2 L ADDRESSo Z FIRE NUMBER-~ CITY/STATE-A'r, ZIP-1,:;, PROPERTY /LOCATION: ~ 1/4, I'Vu)114, SECTION T--1 N-R TOWN OF_HU St. Croix County, SUBDIVISION 0- 6, 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/Ile, 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. Croi o. Zoning Officer within 30 days of the three year expiratio date. SIGNED: DATE: 3 lei 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 ~n 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 Location of property,5.!F- 1/4 /Yw1/4, Section a/ , T 9 N-R /9 Township Mailing address ~o aT, /4J nor Z f 4 / Address of site Subdivision name_Cj,- Lot no. _ _ Other homes on property? yes~_No Previous owner of property A?; fe, /ilo //s Total size of parcel Z Date parcel -was created _L 2 ',Are all corn.ers and lot lines identifiable? -.2-(,Yes No Is this property being developed for (spec house)? X Yes No Volume -2 4""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, '17 7 7-41 , 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. / Z signature of applicant applican Date of Signature Date of Signature• NNW • DOCUMENT NO.~ WARRANTY DEED II THIS SPACE RESERVED FOR RECORDING DATA 1I STATE BAR OF WISCONSIN FORM 2-1982" 47 291 vo( l i s A19 REGISTER'S OFFICE - ST. CROIX CO., WI Anita G. wellsr.. . .a......sin le woman Recd for Record . at DEC 3 01991 ~ 2:40 P. M _ conveys and warrants to John..A._.-Elbert,.and• Biic.-J. -Lundellx as...Tenants..in Cotnlnon,...an. undivided..one-half..J.ntert.45.t....... RQO ►ofDeeds ..each RETURN TO . . the following described real estate in .....Croix ......County, State of Wisconsin: Tax Parcel No All that part of the Northeast Quarter of the Northwest Quarter (NE}NW}) lying Southerly (Sly) of the Railroad Right-of-way; The Southeast Quarter of the Northwest Quarter (FE}NW}); The East Half of the Southwest Quarter (E}SW}), EXCEPT part to Alfred L. Ekblad , in Volume 498, page 484; part Y to Leslie L. Swenson in Volume 498, page 504; part to Donald F. Johnsin, in Volume 500, page 525; and part to Donald L. Jordan, in Volume 580, page 354, all in Section Twenty-Onz (21), Township Twenty-Nine (29) North, Range Nineteen (19) West. This Warranty Deed is given in full and final satisfaction of that original Land Contract between the parties, dated December 4, 1989, recorded December 13, 1989, at 11:30 A.M., in Vol. 858 of Records, on page 633-634 as Document No.454203, Office of Register of Deeds for St. Croix Co., WI. This is not homestead property. (is) (is not) Exception to warranties: Easements, restrictions and rights-of-way of record. Dated this .27.th............ day of December 19. 91 _ ...................................(SEAL) .Cv~~C.eX.~/........ ......(SEAL) _ • Anita. G....Wella...... (SEAL) _ . ......(SEAL) " AUTHENTICATION ACKNOWLEDGMENT Sigma e(s) OF Anita G. Wells, a STATE OF WISCONSIN si 81 woman ss. County. au a d t 27t}~a of.-----December 1991 Personally came before me this ....da of 19........ the above named Leo A. Beskar . TITLE: MEMBER STATE BAR OF WISCONSIN (If not. • authorized b ' y § 706.06, Wis. Stats.) to me known to be the person who executed the foregoiriv instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Leo A. Beskar, Attorney 'R6d11"" .Seska.r..6..8oles~..-5-.'C........................... I .gg21i.9..NOrt ..MainTT.St5),.nf .~..Z................................... Notary Public .........County. Wis. (9kVh%6,,Pk g y'be aZltfie3t'tl"Steil or acknowledged. Both MY Commission is permanent.(If not, state expiration are not necessary.) date: 19........) i 'Names of Demons signing in any capacity should be t)pOl or I•rinl,vl h.lnx th,rir riennturr+. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co . Inc. FORM No. 2- 17.42 Milwaukee. Wisconsin