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HomeMy WebLinkAbout038-1168-60-000 a o ° o ao MM 4 a N o ~ I I y ~ -0 N O O y U-) C C X O A ~ 0 p "C O a) =p a) C d o "6 E -o I N U O N Y _ 0 a) c 3 '2-0 1 C Z > "O 0 ca P LL C 0)O O O C) ~ 3 0 o Cl~ Q _ I M z E 0° z o 0~ v T o z a m N F- Z I o z :!t 4) o N Z ~ c cn H r N N N t4 m (V N a) C N O O O a) C) a U o 0 (3) Q Z m z O° N N zzo ° C ut, I E (n 0 -0 C T o E D d ~~vN N U I- cn CO CO =3 1- ~ 0 0 0 m •N a a a N a z M M ~i = O fn a) N O J U rn Z 7 d 00 m N N Q C p ~ O ~ 'p Q CO a) O 7 w Op U) C o E CD -r- o ~a0)o, c 0) O 00 a ` N W U7 W •i (C6 r- C O a) C a) N N f". d E~ ~ Z ~ o C) cu 0 U) 0 0 06 • O N (n = O N M F- fn r- ~ I EL y a L: CL • CL t A 0 a. 0 inci V ~ n STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS l °1 S o 10 Li SUBDIVISION / CSMI_X' l/' t r sf LOT SECTION_,,~?C T N-R /~W, Town of ST. CROIX COUNTY, ICOS N PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3 10 1r J-• 10 1fi D INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s BENCHMARK' n //0~1 nsdc~ •~y ALTERNATE BM' SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: h,e e Liquid Capacity: 0_Z>_ Setback from: Well e House Other le,- 7L. Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ;SOIL ABSORPTION SYSTEM Width: fob ( Length _f Number of trenches Distance & Direction to nearest prop. line: /o Setback from: well: O //ouse G/~ Other ELEVATIONS Building Sewer j • ST Inlet. ST outlet - v v PC inlet PC bottom Pump Off Header/Manifold Ile yv~ Bottom of system Existing Grade Final grade 0 or DATE OF INSTALLATION: / Qq PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L9AaMWl;art T" IR tIE 28.31.A&V j SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and R;iildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar rTnit Permit Holder's Name: ❑ City ❑ Village R Town of: State PI o.. ev.: Insp. BM Elev.: Description: X Parcel Tax No.: BM 0-28-3369-60-000 TANK INFORMATION ELEVATION DATA A9300253 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (n f Benchmark Dosing Aeration Bldg. Sewer 7 y Holding St/Ht Inlet !/Z, TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/1 WELL BLDG. AirI to ntake ROAD Dt Inlet irl Septic NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System 7 7 PUMP/ SIPHON INFORMATION Final Grade Ael Manufacturer Demand 2 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Moe Number: System: 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 28.31.18.816 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ m m SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY &)-o STESJIT CeRPEIT# tjM-Attach complete plans (to the county copy only) for the system, on paper not less than fi/J /fYj_fP 8'fi x 11 inches in size. ef en to revious 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 /a 'a, S T , N, R E (or PROPERTY OWNER'S (LING ADDA 4S LOT # BLOCK # on 1252 V, CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION "E OR M NUMBER . TYPE OF BUILDING: Check one CITY , NEAREST ROAD 11 ( ) ❑ State Owned VILLAGE f ❑ Public1 or 2 Fam. Dwelling-# of bedrooms A RGEL TAX u 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 1120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPF OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. El Replacement 3. El Replacement of 4.0 Reconnection of 5.0 Repair of an S em System Tank Only Exist'n ystem sting System 03 Iq a (Z a, 4 - y (,oToZ~ B) A Sanitary Permit was previously issued. Permit # 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. (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet D Feet VII. TANK CAP CITY Prefab. Site in allons Total # of Manufacturer's Name Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank l Q Lift Pump Tank/Si hon Chamber I F] El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plumber' pS)pnature: (No Stamps) MP/MPRSW No.: Business Phone Number: w Plum is Address (Street, City, State, Zip Code): d cV IX. COUNTY/DEPARTMENT USE ONLY Disapproved S Itary Permit Fee (include g roue Wet Date ssue Issuing A ent big No S mps Approved E] Owner Given Initial Adverse Determination 60 I X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: i SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i l 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 renew-di 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 (SF) 6399) to be submitted to "he r.ounty prior to installation. 5. Gnsite sewage .ysferns-must be properly maintained. The - .:c tank(s) must be-purnped 1 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 appligation must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax nomber(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms i` 1 or 2 ~:amiiy 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 tark replacE:rrrent, reconnection, or repair. V. Type of system. Chec~: appropriate box depending on system type. VI. Absorption syrs?o!?~ ;rformation. Provide T11 information reques-t-4 f11-7 VII. Tank InfUr~ ,wl, ri- n the capacity o+ , .-ry r,ew and/or exit k st ii-_- t,)'.A ' ~ .!l ber of tanks and d =c" t'S name. Indlcwi-, pt ,'ab or site uonsje;,tit.kii eanr tank ma!erial, i for all seP pl _ane holding tanks c. .;,is system. Checrc r ~irr er;t.3l :ipprovai c-. ks -eceived exper , 'Ja; product apprhval;from DILL q. VIII. Responsibility statement. installing plurr~-° is to fill in nave wer,se number with a^nrop,i ae ;prefix (e.g. MP, etc.). address and phone number. Plu;nber must sign app (.i,p.;on form. IX. County/Department Use Only. County/Department Use Only - X. Complete 7°ans and specifications not s_^.,Nenr than 8% 11 incl ~ lust be subn, t}r,_: It, The plans moss the food whng: A) ric. n drawn to sc=ale; co"i ^ca";Cn of holding septir. tank(s) or other trF -trnent tarks; buiidi+ ; •-s: yve 5; w «<<°er service; r.Yrs ..-.~.es rrr. .distribution n t iX ..rr l.~i~ ~ -,,,.n t r'r~. stream_ ; pup or siphon tar-k-, ~ es; r ~a, ~ nt ~ system .areas, cl Focatlon of the bur (`r,.,(j ;:1erved; B) r?c, izonta! c' ~ ICo ek" oi' C) complete specifications for pumps sand controls; ;lose volume, c levat:on driference$; '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 pct 413 included the Creatiom °J .surcharges (fees` 4),, i number of regulated practices h;ch can effect groundwater. she nionies c: te:i through these'sorcharges mon;torijr cr;;.< ~dl..;ate gr::ur - water eontaminatiw, irives`igc!i, rns and estabiishr . ci' w,Tandards. - SBD-6398 (R.11/88) Plot Plan Project Name Byron Bird Jr. System Elevation CST# 3479 L Benchmark H.R.P. C7 Boring Q Well 1 ,t v 1 . V i ~fl Y 1 PROJECT ADDRESS 1 /4~/'1 /4/S i`r~7/ NIR/l V TOWN C0 NjY X MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC1:7--CONVENTIONAL IN-GRO RESSURE CONVENTIONAL LIFT_ Mom HOLDI G TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK S~E ABSORPTION AREA PERC RATE,/ BED SIZE - ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark /e",40 - * H. R. P. --,err z - G o e77.e ^ ± ~e e~`~_ 1:1 Borehole Q Well Scale Feet O Perc Hole System Elevation Uent 12" Grndp TYPAR COVERING 2" 12" 3' 4 g' O 3' I' Sewer Rock 6' 1.2' l ~ 414 1-7 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and 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 - G v`D not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL .D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION CtI„~ - GOVT. LOT 1I4V4J 1/4,Sa2fT N,R lt- E (o® PROPERT to"+l_ING ADDRESS ]]L;OT# BLOCK# SUBB MORCSM# CITY STATE ZIP CODE PHONE NUMBEn Ty ❑VILLAGE OOWN NEAREST ROAD a i ri "4 A T- [ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ~{5 0 gpd Recommended design loading rate F 7 bed, gpd/ft2, 5, trench, gpd/ft 2 Absorption area required _ 63 bed, ft2 trench, ft2 Maximum design loading rate __j Z bed, gpd/ft2- 2(,trench, gpd/ft2 Recommended infiltration surface elevation(s) 1c - ft (as referred to site plan benchmark) Additional design / site considerations c~ yS - Parent material Flood plain elevation, if applicable e&z ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S ❑ U 5k S ❑ U ❑ U 'Ea!S ❑ U ❑ S U ❑ S RU 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 t f : t G GJ " yy4 ,xe<,{{{}}}{{{...ytyyy,.~`<.. a o - , a ~ f~ d~'~-c_ ~ m r t✓ . Ground 3 X"t~ e7 0,77 _5 elev. Depth to limiting factor l~ Remarks: Boring # Qr 5,0 4_t fi ' 'v2 C G y o5lw-lb' or A9 Ground elev. AD-Z--et. Depth to limiting factor 5- . ;:z Remarks: CST Name:-Please Phone: Address: ' Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page _of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend 4/0 1111, rm,,311-11111- gf- Ground d- f elev. Depth to limiting CC}t~ . f Remarks: Boring # t Ooo /0 JI;-V Axe o Y y i Ground Depth to limiting actor 3- / Remarks: Boring # t- : {ryi\+iv Ground elev. Depth to limiting factor L Remarks: Boring # Ground elev. ft. i Depth to limiting factor Remarks: SEPTIC TANK MAINTENANCE AGREEMENT w St. Croix County OWNER/BUYER 0 ROUTE/t'OX NUMBER Fire tiumber a d CITY/STATE ZIP S" a L -sue R 58~-JST- o PROPERTY LOCATION:', Section Z TN, R4W1 Town of s>~ znf f/P_!GSt. Croix County, ~ Subdivision ?'P/ Lot number; 54i. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.' Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a l'ic'en's'ed' ''ept'ir.-tank pumper.. What you put into the system can affect the, unction of the's-ep.tic tank as a treat- ment stage in the waste disposal system. St. Croix Count 71 residents'•m be eligible to recieve 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 'sys't'ems agree to keep their system properly maintained. The property owner agrees to. submit to St..tCroix County Zoning a certification form, signed by the owner an by a mater plumber, journeyman plumber, restricted plumber or. a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2)-after inspection and pumping (if nec- essary), the septic,-tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned have read the above requirements and agree o . to maintain the private sewage disposal system in accordance with the standards set forth, herein, as..set by the Wisconsin Depart- : ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration.date. SIGNED DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. APPLICATION FOR SANITARY PERMIT 8TC-100 This application form Is to be complatod in full and signed by the owner(s) of the property being developed. Any lnadoquacles will only result In delays of the parmlt Issuance. -Should this development be intended for resale by owner/contractor,(spec house)$ thou a second form should be retalned and completed when the property Is sold and submitted to this office with the appropriate deed recording. Owner of property A1/G 4-4- S 14-~- Location of property _fLIM /`Z/C() 1/4, Section T ..~•R..V Township Malllnq address e Address of alto subdivision name Lot number - Z Previous owner of property Total also of parcel Data Parcal was created Ate all corners and lot ilnss dentlflablet ~_Ye■ No Is this property being developed for resale (spec house)?_.d_KY4x No Volume /035 and Page Number /-Zg as recorded with the Register of Deeds. rr----------r-r--rrr--------- -r-------w---w---------------------------------w-- INCLUDE WITH THIS APPLICATION THZ FOLLOVINCI A VARRANTY DEED which Includes a DOCUMENT HUMSZR, VOLUM2 AND PAGZ HUMsZR, 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 Hap, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION T(Va) certify that all statements on this form are true to the best of my (our) knowledge] that I (we) am (ate) the owner(s) of the property described In this information form, by virtue of a vatranty deed recorded in the office of the County Register of Deeds as Document No. _Sn -5-71-4 I and that I (Ve) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded In the office of the County a star of De ds, as Document No. S d S 74 Signature of Own c signature of co-owner (If Applicable) Date of signature Date of Signature Loo _ 440 15 14 A II y^ 10 807 806 I $ 803 802 13 16 ° S MD 805 1 I vs ' - S(MD 4NW 4 \ I . 114 - NW !14 9 / 23 C 815 8 4 / 801 $ rr=a, ~ 'G. ~ e t+, 4 I 25 0 8 6 soo Y:. SOLD eo I 817 \ t N' 22 / 450' lab. is. 814 SOLD 19 20 811 21 ~ I 813 I $ e SOLD OLD I / 474 B ~ i l \ , 35 65 •I ri 355b2 3T225 ' SOLD Huai t 6 799 3 12 nP' Sta Prair;. 798 a 795 .S ME ET 1 , - . ' 4 /V114-$ 56604 r-1, L ST A Wt.. 24 ` 4 PRAIRIE 794 2 4. ~z>= - New 797 so6.74 1 11{: Somerset y Rjchrnond ea 4 I 1 1 796 I 793 x )5 '.rf i L A L 50494 624.?4 IS6 34582 345.4 3232 C. S. M. VOL. I PAGE 1 15 a 1oR SOLD I-c SOLD m S6LbE LO I LOT 2 1 I LOT 3 LOT .4 /91 ND RF/MW teaml realty 1-..~.-. 103 Main St., Box 68 Somerset, Wisconsin 54025 Mks 708 Somerset Rd. ® New Richmond, Wisconsin 54017 each office Independently owned and operated • o•E F= 1 b-9 THI_I 1 1 : 09 F _ a3 I 1- 1982 I TMIe SPAGN KlrOCRVG4 vaR RCCORDINO DATA OOCuMEN7 NO. STATE EAR OF WISCONSIN FORM WARRANTY DEED 505744 0L 10'35PAGE.128 l FL' S C; FICE This Deed, made between Co., M Rec Q for Record Dan McCulloch a/k%a Danfel McCulloch a/ka Daniel,,,,, C. McCulloch Grantor, S E P 2 0 1993 and Michael Hclxtman,.d~b/a .Haxtman ,Concatxvc4n ai 10 15 - A" . Regsta►aFt x Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... RCTYRN TO I:onvoys to Grantee the following described real ostate in CC017C............ County, State of Wisconsin: Tax Parcel Nos e.3`~ /f... .0..... Lot 24, Red Pine Estates in the Town of Star Prairie, St. Croix County, wisconsin. o This is nOt... homestead property. (is) (is not) Together with all and sinMa-Dan-el the her ditatrlonts a d ppurtenancea thoreunto belonging; And Dan McCulloch -McCul.,ocah . , warrunts that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. I) .g3.... i ate<1 thin day September of ........,.p...... (SEAS) .""'baniel"C~ 1LIcCtiTTtitn. a/Tt/a'" (SEAS.) Dan MCCulloch a/kL/ Da 'el M 110ch .`'mac (SEAL) .(SEAL) * AUTHSNTICATION ACENO'WLEDtGMENT Signature (s) S'T'ATE OF WISCONSIN ea. I' .............................County. authenticated this day of 19...... F rsonall ame before me this /......day of ; " 19. the above named .r r. . ' Eill.Il:. TITLE: MEMBER STATE BAR OF WISCONSIN ~'.•~MYrt,n"~~ (If not x~ ~seK~v x a~:a.. authorized by 4 706,, Wis. State.) to me know It 01 ha ea uted tho foreSving instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY j Kristine Ogiand .'--r Attorney a t aw*...... AT y Public ..........................................County, Wis, . e xpiration (Signatures may be authenticated or acknowledged, Both My Commission is pormano t. (it ...no..t.,_9.t&..to are not nuce:ssary.) dates ~1~. 19..1.. . I . a ST. CROIX COUNTY 00 WISCONSIN ---=ZONING OFFICE 1 r r r r r r■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road _ Hudson, WI 54016-7710 (715) 386-4680 Q November 5 1993 To Whom it May Concern: An inspection of the septic system for the Mike Hartman property, known as Lot 24, Red Pine Estates, and located in the SE; of the NW; of Section 28, T31N-R18W, Town of Star Prairie, was conducted in October, 1993. 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. Sincerely, Thomas Nelson Zoning Administrator mij