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HomeMy WebLinkAbout042-1051-80-000 ~ ° 1 ci0il-o 0. 0 ~ o I c a? m t I to x ~c m -C ' o Hwy I N C E a 3 I N C C3: 1 C p O r C 75Y 'O S O C w Z' C V; '5 ~2o w a O Y tl) € C - N 1 6 w 0-0 O I V y y C O C 0 O Y O N N O E O N C -Fn C Z o;? o U I z Lo a m Li c °c I ti o rn T o app _Oa 0 M I 3 'O i' d= O N 'O O N I,' a aD:3 rn I E Q -.0 y I l0 M M I CL v ai h 3 Z E I _ o 00 Z o I " o € o I € V Z a m a m r' CN I o c t9 v I ~ ~ I o z N I o o 91 p c Z r (D (i FZ- c E 1 c aEi ~ M o I ~ I N 0) N I :3 N m I y aa, O N (A L a to z I a O C p O I o v a Q z co Z Z m z Z C14 N 1 re - to > d C W I N y N ° ` I a C is CL o U)i )F Vai o I U) Fmyt rtn a LL o Z CM >m y 0. I co co O O O Z O O O a a a wail °aaa IUl) O 1 ~t n M M w J V ui rn rn z I a CID 0 a) CY) CD 0 E ~l a N M 0 II o° 0 0 0 0 = N X m C d IN y 0 1 i,' N .a d aI Z (n I N d a} J5 11 A rn H y I to H E ° o= a o I= o m CD to a Q N F3p- c m y II c Ep N c~ C l _ N = M L V CD °r° c CO y~ pZ Imrn m Z~ pL A of d a~ p E w co E v F~ (V N N O OD p di N O I C O Z (n • p m Y °r° M Z_ I Y I ' € d I € a v Q0 a da 1 ~a • a d 2 (D a C c ~ Y w A E 0 3° c 10 ai ci 0 U) 01/25/2006 11:23 AM PAGE 1 OF 1 Parcel 042-1051-80-000 042 -TOWN OF WARREN Alt. Parcel 19.29.18.293A2 ST. CROIX COUNTY, WISCONSIN Current XApplication # Permit # Permit Type Creation Date Historical Date Ma0p0 # Sales OArea Owner(s): O =Current Owner, C =Current Co-Owner Tax Address: O - ROBERTS, DANIEL G & LORI J DANIEL G & LORI J ROBERTS 931 HWY 12 ROBERTS WI 54023 Property Address(es): Primary Districts: SC =School SP =Special .931 HWY 12 Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Acres: 1.930 Plat' N/A-NOT AVAILABLE Legal Description: Block/Condo Bldg: SEC 19 T29N R18W 1.93A IN NE NW LOT 3 40 1/4 160 1/4) CSM VOL 3/615 ORD ALSO 1/4 INT IN Tract(s): (Sec-Twn-Rng PRIVATE 66, RD AS SHOWN ON CSM 3/615 19-29N-1 8W (883/616) Parcel History: Notes: Date Doc # Vol/Page Type 1022/255 WD 07/23/1997 2005 SUMMARY Bill Fair Market Value: Assessed with: 79305 183,000 Last Changed: 10/22/2001 Valuations: Description Total State Reason RESIDENTIAL G1 1.930 36,300 111,500 Class Acres Land Improve 147,800 NO Totals for 2005: General Property 1.930 36,300 111,500 147,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.930 36,300 111,500 147,800 Woodland 0.000 0 0 Batch 131 Lottery Credit: Claim Count: 1 Certification Date: Specials: Category Amount User Special Code 15.00 SPECIAL ASSESSMENT 018-RECYCLING Special Charges Delinquent Chargges .00 Special Assessme 15.00 0.00 Total ST. CROIX COUNTY SURVEYOR'S RECORD 349572 CERTIFIED SURVEY MAP PART OF THE NE 1/4-NW I/4- SEC. 19, T-29-N, R-18-W. NORTH SEC. LINE Q 170'0'''' ' w , N 88°-57-28„ E to r w ~-1 0 w N 88°-S8'-37OE w NW COR. 1362.78' W m j 231.79 N SEC. 19 M ti cr QI ® _ _ - ® co CO. MON. N o~ „ O. - - P IVATE 66 ROAD (1.17A~ p J o~ / ~ p N ~ 241 p st N rn N-880-58'-37"E O,,o 0 93.36' - W Z %s~, C) C .M i S 17445 WE o'. 66.00 w 1.95 A. M w -4 o co z co (A a~ 3.67 A. N~ \ N y eb; 41 % . CD . w to 3 O ~ boo'°\, O co s 2 p ,y.0b p '3 7 W 3.98 A. ✓ -aND i) O ~ N ' ro /9 .,I 4 M e?o S 08, o/ co 0 N ASSUMED BEARING `s9`/pN 9 w 4.7 lt:-X fn REFERENCED N8$-57-28E Ir s ALONG THE NORTH, LINE 00, - OF SEC. 19 I O J 0 N Ct soo a C,`$ •gs, 3gS00 a . 150' 100' 50' 0 150' Ao Zl* " = 15 0' APPROVED SCALE I ~ • Ne `34p. . JUN 08 1978 eo- 404 ~9y ST. C2OIX COU. • T Y COMPREHENSIVE PARKS PLAN."iNI E G E N D AND ZONING COMMITTEE SEE REVERSE SIDE FOR o - I" x 24" IRON PIPE SET CURVE DATA AND WT. 1.68 LBS-/LIN. FT. CERTIFICATION X4,9572 APPROVAL OF THIS MINORSUBDNISION THIS INSTRUMENT DRAFTED BY G.C•Shaffeer DOES NOT MEAN APPROVAL FOR I/f>1 7 7 8 BUILDING SiT OR SEPTIC c Y T -M. REF-'A ir, 0. ~I r OENE Q F! RED N SHAFFER m JON 211978 s. t3zs 00 j HUDSON L *06 %-1 VOL. CIO CERTIF- IED SURVE7C MA I1R ST. CROIX COUNTY, WI.I~t/tBSa~ Volume 3 Page REPORT OF ITISPECTIO.;I--I:dDIJIDIIAL SETHAGE DISPOSAL SYSTEM Snnitary Permit318 • r State Septic 7A! 1E TOt•JIJSHIP ~ I _ t. C.. Size gallons. umber of Compartments Distance Front; Dell °ft. 12% or greater slope ft Building` ft. - Wetlands f: Ilighwater ft. DISPOSAL SYSTF,.1 Tile Field or • Seepage Pit(s) Distance From: t1eli. _ ft. 12%.or greater slope* ft Building Wetlands _ fz FIELD Hiphwater ft. Total length of lines --7-Lft. Humber of lines---~'; Length of each line f Z--t. Distance between lines ft. Width of the trench ft. Total absorption area - sq. ft. Depth of rock below rile ,•,~~in. Depth of rock over file in.. Cover -aver. rock., Depth of tide below grade in. Slope of trench in per 101 ft. Depth to Bedrock . ft. Depth to ground water £t. PITS (lumber of pits Outside diameter ft. Depth below inlet ___f t . Gravel around pit: __yes no. .Total absorption area sq. ft. , Square feet of seepage trench bottom area required v uare q. feet of seepage nit area required Inspected by: Title's . Approved :Date 197 . Rejected Date 197`. • ~EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS - LOCATION: Section A-?, TZ9N, R L (or) W Township r Municipality eel--fde. G' c.-Ti M tX Voj-3~61 Lot No. Bf 1= County St, e r" c Px ubdivisio Name Owner's Name: f"* h Q Mailing Address: I 7 12~- ~ S.{., 1 . jgP56~2+JA&4f_ 1~yj e.,C)✓1 W : ~J~~LO)Cp TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ✓ ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 8S/28~'7 8 PERCOLATION TESTS J Z 9~7 F~ SOIL MAP SHEET 13SA -ZFr - 43 SOIL TYPE 13~ r 1S hatiedt - pC', V~- 0*ck PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 / ; NA P- -re Y- 3 ~ T.5 28 s) . P-3 uzk TS., 3o,,S1 c 7. 71J Z SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) _ I 004 ' > 8 11-1- s, 4 -S c r 8if T5. Z8N 5l t1 8a CS g N -r, 5 0" S1 " C'S. Gr. Z 6 " S . -46, 5 C .S • I Z " `t: 2 " I 38 G, S• B G '7Z a 7-T. S. I A— s I SLID` PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. G 15 sg 1=T". Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ~ G / 0. 1 uS 1 J- C ~ O 00 t N 20 O i 447 13 y ~ ~ Q s ~ I, the undersigned, 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 Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Certification No. Address SO-) ©°rk s `J W t C. IS LI p t L_ Name of installer if known CST Signature _ e COPY A -LOCAL AUTHORITY B67 State and County State Permit # PL Permit Application County Per it for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: A~ ~,r - J7,7- 7- - / 3 "X, &r B. LOCATION: 44e '/4 '/4, Section Ir, T RE (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family le!0~7 Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2)__/_3) Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length ~_Width Depth 6( 1- Tile Depth _j(_ No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slo e I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifie Boil Tester, NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone #s ~ -Z-4 Plumber's Address T PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 41)/ Do Not Write in Space w FOR DEPARTMENT USE ONLY Date of Application -Fees Paid: State /19,6C County ~d Date Permit Issued/Rejected date) Issuing Agent Name Inspection Yes No Valid* Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4, plumber (canary copy) Revised Date 6/1/76 I ws I?~partment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 uman Relatiorxs 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. Croix 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 Burt & Kathleen King GOVT. LOT K3•; 1/4 Ned 1/4,S19 T29 N,R 18 )¢or) W 1 # SUn/a AME OR CSM # (O f S 031 EHy OW 12 ':S MAILING ADDRESS 3 nLOT # /a BLOCK CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Roberts, WI. 54023 (715 749-3441 Idarren Hy. #12 =Replacementf-' Use ] Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Public or commercial describe 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.50 for bed ft (as referred to site plan benchmark) Additional design/ site considerationsfor trenches 98.78 then 3.51 below surface level on step down Parent material outwash Flood plain elevation, if applicable n/a It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ~S ❑ U iaS ❑ U faS ❑ U EkS ❑ U ❑ S ®41 ❑ S Ell) 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 1 0-8 1 r3/2 none L. 2/m/gr mvfr c/w 2/f .5 .6 2 8-17 10yr4/4 none sicl 1/f/gr mfr_ g/w 1/f .2 .3 Ground 3 17-28 7.5yr4/4 none Is. 0/sg ml g/w 1/f- .7 .8 elev. 99.5 ft. 4 28-84 10yr4/4 none o.s. 0/sg ml n/a n/a .7 .8 Depth to limiting factor >841, Remarks: Boring # 1 0-8 10yr3/2 none L. 2/m/gr mfr c/w 2/f- .5 .6 2 2 8-47 10yr4/4 none sil. 2/m/sbk mfr g/w 1/f. .5 1.6 3 47-58 10yr4/4 none scl 1/f/sbk mfr g/w 1/f_ .2 .3 Ground elev. 4 58-10 10yr4/4 no 0/sg ml na/ na/ .7 1.8 99.7 ft. Depth to limiting factor >100" U C< backfill to be cu Ilk c ~:~f ar a Remarks: CST Name:-Please Print Gar L. Steel Phone: 715-246-6200 Address: 5Zffl 200th. A3je. Flew Richmond +017 Signature: Date: CST Number: 5-27-93 2298 PROPERTY OWNER BLtrt King SOIL DESCRIPTION REPORT Page 3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bounncl Bed Trench 3 1 0-13 1, r3/2 none L. 2 m r mfr c/w 2/f .5 .6 g/w 1/f .2 .3 2 13-36 10yr4/4 none scl 1/f./gr raft Ground 3 36-58 10yr4/4 none s1. 2/m/shk mfr g/w 1/f .5 .6 elev. 07.60 ft. 4 58-10 10yr4/4 none co.s. 0/sg ml. /a n/a .7 .8 Depth to limiting factor >100" Remarks: Boring # 1 0-10 10yr3/2 none L. 2/m/gr nf_r g/w 2/f .5 .6 `'`4 2 10-21. 10yr4/4 none sic_ 1/f/shk mfr g/w 1/f .5 .6 4:$5 21-43 10yr4/4 none ls. 0/sg m]. P/w 1/f_ .7 i.8 Ground elev. G +3-98 10yr5/4 none co.s. 0/sp m]_ n/a na/ .7 .8 101.7 qt. Depth to limiting factor >9811 Remarks: Boring # 1 0-9 10yr3/2 none L. 2/m/shk mfr g/w 2/f . 5 .6 `'.5 2 9-25 10yr4/4 none sicl 1/f/gr mfr g/w 1/f .2 .3 3 .5-58 10yr4/4 none sl. ]_/f/skh mfr g/w 7_/f_ .4 ` .5 Ground elev. 4 58-104 1 r5 4 none co.s. 0/s ml_ n a n a .7 .8 102.4 ft. Depth to limiting factor 2124' Remarks: hackfil-1 ow area to be cut to code if area used Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1554 200t)i Ave Gary L. Steel 999WOSR693Mive C.S.T. 2298 Burt King New Richmond, WI 54017 MPRSW-3254 iTE%NGd' S19-T29N-R18T--T (715) 246-6200 town of Warren 1-7 M: a " ry) -6p m .mr `mac- P, Rr I 2 Ola-v s 5a 5 h ' z o ~1~5~n~k 110 r2 R l oo 4- 50 3 Zo /13 s y STC - 104 AS BUILT SANITARY SYSTEM REPORT n OWNER ADDR S 9 3~ Z `t r W= d'q, SUBDIVISION / CSM# LOT # SECTION . l q T.Zl? N-R/PW, Town of ST. CROIX COUNTY' Vi SC ONSINa 3 ~2 PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l old syr ~ -foes s~ C ~/f CONO'R°C ;k j~L tOH~~,sr..cio~ t~SuyC INDICATE NORTH ARROW 74 Provide setback and elevation,in/of on on reverse of this -form. Provide 2 dimensions to cent ptic tank manhole cover. BENCHMARK : 41 { ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING_TANK INFORMATION Manufacturer: C~r/.IG~S Liquid Capacity: / 2 ~ Setback from: Well House Other Pump: Manufacturer odel# Size Float seperation Ga s/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: 2 Length GD Number of trenches Distance & Direction to nearest prop. line: /.2 i Setback from: well:7,/5V House Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom - Pump Off 97S ~ ~ > Header/Manifold Bottom of system 773 Existing Grade Final grade DATE OF INSTALLATION: 3 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L ' ' part , ustlr~ • 29.18.29 A V+44E SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar rmi Permit Holder's Name: ❑ City ❑ Village X Town of: State P YNKII E nsp. ev.: BM escription: Parcel Tax No.: Gv ,J / Gv rYr~ tr 042 51:0- TANK INFORMATION ELEVATION DATA A9300156 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark x~o 60 Dosing Aeration Bldg. Sewer Holding St/I;~f inlet TANK SETBACK INFORMATION St/ 'Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet 9 Air Intake Septic -~Sd 77 f{ NA Dt Bottom Dos NA Header h1ban_-- D, f ~7 Aeration NA Dist. Pipe ~D ,7 7 Holding Bot. System 9( Sly PUMP / SIPHON INFORMATION Final Grad Z zO,'' Z_/ Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain I Length Dia. Head Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length i No. Of Trenches Inside Dia. Liquid Depth DIMENSIONS ~ (60 DIMENSIONS LEACHING nufacturer: SYSTEM TO P / L BLDG WELL LAKE/STREAM SETBACK INFORMATION Type O Pe CHAMBER Model Num er. System: a~f C' S OR UNIT DISTRIBUTION SYSTEM Header 14Aaw 4*W 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 Ove ,r Depth Ov xx Depth Of xx Seeded/ Sodded xx Mulched (5v O)l Bed/ T.certmh Center,. Bed / Tre"h Edges Topsoil E] Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 19.29.18.293A2 (HGV} u Plan revision required? ❑ Yes lp_to Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION 713ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY , STATE PA(~ITARYP # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check 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. PRO ERTY OWNER PROPERTY LOCATION t/4 '/a,S TN,R E(o PROPERTY OWNER'S MAIL NG ADDRESS LOT # BLOCK # 2?/ Mv Z 3 C STATE ZIP CODE PHONE NUMBER OR CSM NUMBER .311t - NEAREST ROAD 11. TYPE OF BUILDING: (Check one CITY ❑ State Owned VILLA =NQ GE r 2 ❑ Public [Z 1 or 2 Fam. Dwelling-# of bedrooms PARCEL T Nu B ( 111. BUILDING USE: (If building type is public, check all that apply) 2-~ 80 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. Q 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-ln-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 Feet 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 strutted Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI er's Name (Print): Plumber's Signature: (N tamp h"MPRSW No.: Business Phone Number: ~r 7 '2 CGS I ~12- #.f., I ~ X. lu er's Address (Street, City tale, Zip e): IX. C LINTY/DE ARTMENT USE ONLY ❑ Disapproved Sanjtary Permit Fee (Includes Groundwater a 773 Issuing gent Signature (No Stamps) -cP! Surcharge Fee) Approved Owner Given Initial 14d Adverse Determination IJA 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 yopr on.site..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. s II. Type of building being served. Check only ~Ie 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. 1 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. SBD-6398 (R.11/88) STC - loo . This application form is to be completed in full and signed by the oc;mer(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 1iouse), then a 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 _r i Location of propert?y_,Ay 1/4 wl.J114, section 19 , T o?9 N-R 9 W Township ~•~~~~J Mailing address Address of site 44e_2_45 subdivision name Lot no. other homes on property? ryes` No Previous owner of property Total size of parcel / 2 Date parcel was created _ 'i 9;?e Are all corners and lot lines identifiable? __2~ _Yes No Is this property being developed for (spec house)? Yes 0~_No volume'12/_and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS RDnr.Tr+a•*•~ R WAnr,:...-- - OA,?IA41 r GEU0. !r c-,:a 1. STA'T'E OF WISCONSIN-FORM 2 ` ~ r VO`' auf THIS SPACE RESIRVLD FOR W04DOIC DATA 35174,55 tht,.-----__.....__aayot._._.._._..-August REGISTERS OFFICE THIS WDMTURI,Made 7 6 between. R. C Constr. Inc. ST. CROIX ZO., WIS. _ Recd. for Record this 14th ____-_-•--._.-•..-.-.----_..a Corporation dp of Sept- A.D. 19 78 duly anized and exis in9 under and by virtue of the laws of the State of Wisconsin, located Y _ at,,, ~FfDrest Lae, Minnesota - - X1K.WG)fAC party of the first part and at 2:30 P. M. ~ ~r _-R R ng._* and_.Kathlee.. A. Kings husband and Wife as point tenants Jar,es O'Cp_rnelL R 7 ter of Dse + part_..._---of the second part, OETOOM TO W l t a • s • e t h, That the said party of the fast part, for and in consideration of the sum of_... _ ae - to it paid by the said partleS..of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give. grant, bargain, sell, remise, release, alien, convey and confirm unto the said part -eSof the second parttlle.l reirs and assigns forever, the following described real estate situated in the County of.......... _.S t . C.roAX and State of Wisconsin, to-wit: A parcel of land in the Northeast. Quarter of the Northwest Quarter of Section 19, Township 29 North, Range 18 West, described as Lot 3 on the Certified Survey Map recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, in Volume 3, page 615, document 349572. TRANSFER :3--f. qt_ Fn (U NECEssARY. CONTINUE DESCRIPTION ON REVERSE SIDE) ToOether with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said partl.! .A..of the second part, and to....thel rheirs and assigns FOREVER. And the said __..........R. _C .__Constr.r..._Inc. party of the first part, for it,elf and its succe,sors, does covenant, grant, bargain and agree to and with the said part.le.s.of the saond part-- A.h1.: K..........._..__.heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever Y_ and that the above bargained premises in the quiet and peaceable possession of the said part...iE.Sof the second part,theihlEirs and assigns, against all and every person or persons lawfully claim'ng th whole or anyppaart thereof, it will forever WARRANT AND DEFEND. In Witness Whereof, the said.. R. riStr. Inc. . party of the fir,t part, has caused these presents to be signed by its President, and eountersigi-d by its Secretary, at................ Wisconsin, this.__..J.._...._ day of.........Al1cJuSt A. D., 19.. fits C or" t1, aT SI~~tD TA16 SCI BINi AE~~tJCE OF R. C. CONSTR. INC. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County NE /BUYER_ Qlel / ADDRESS / FIRE NUMBER_ 2.f/ r / ~ CITY/STATE dr ^G . ZIP__ ~S S~Q o PROPERTY LOCATION: : NE 1/4 , L U)1/4 , SECTION--IL, T_aZ._N-RAW TOWN oF_ ~t~'.D-~r2Fr_~ , St. Croix County, SUBDIVISION__ LOT NUMBER I. . 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/Sae, 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: DATE• St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 LLaaboora__ Hum nR lationsuse' SOIL AND SITE EVALUATION REPORT Page 1 of 3 ` Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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 Burt & Kathleen King GOVT. LOT NTE, 1/4 MJ 1/4,S19 T29 N,R 18 )Nor) W PROPERTY OWNER':S MAILING ADDRESS - LOT # BLOCK # SUBD. NAME OR GSM # 931 Hy. #12 n/a nn/a CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [-]VILLAGE )GOWN NEAREST ROAD Roberts,.WI. 54023 (715 749-3441 Warren Hy. 412 New Construction Use ] Residential / Number of bedrooms 3 [ ] Addition to existing building jx] Replacement Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.50 for bed ft (as referred to site plan benchmark) Additional design /site considerationsfor trenches 98.78 then 3.5' below surface level on step clown Parent material outwash Flood plain elevation, if applicable n/a ft L=S Suitable fO, system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TA Unsuitable fors stem RkS ❑ U iaS El U fraS El U ~S ❑ U ❑ El S FKJ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.rtdary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 1 3 2 none L. 2/m/gr mvfr Ow 2/f .5 .6 2 8-17 10yr4/4 none sicJ_ 1/f/gr mfr g/w 1/f .2 .3 Ground 3 17-28 7.5yr4/4 none ls. 0/sg ml g/w 1/f- .7 .8 elev. 99.5 ft. 4 28-84 10yr4/4 none O.S. 0/sg ml n/a n/a .7 .8 Depth to limiting factor >84" Remarks: Boring # 1 0-8 10yr3/2 none L. 2/m/gr mfr Ow 2/f- .5 :.6 2 2 8-47 10yr4/4 none sil. 2/m/shk mfr g/w 1/f- .5 :1.6 3 47-58 10yr4/4 none scl 1/f/sh1c mfr g/w 1/f .2 .3 Ground elev. 4 58-10 10yr4/4 no 10 0/sg ml na/ na/ .7 1.8 99.7 ft. Depth to limiting ctor 17 s> >1001, backfill to be cu c jf ar a Remarks: CST Name:-Please Print Phone: Garv L. Steel X~~7 Y - 715-246-6200 Address: 155 200th. e. New Richmond-, F017 Signature: Date: CST Number: 5-27-Q3 2298 PROPERTY OWNER Burt King SOIL DESCRIPTION REPORT Page,2 :of, # PARCEL IA Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3~ 1 0-13 1 r3/2 none L. 2/m/.r mfr c/w 2/f .5 .6 2 13-36 10yr4/4 none scl 1/f./gr mfr g/w 1/f .2 .3 Ground 3 36-58 10yr4/4 none sl. 2/m/sbk mfr g/w 1/f .5 .6 elev. 07.60 ft. 4 58-10 10yr4/4 none co.s. 0/sg m7. /a n/a .7 .8 Depth to limiting factor >100" Remarks: Boring # 1 0-10 10yr3/2 none L. 2/m/pr nfr g/w 2/f .5 .6 2 110-21. 10yr4/4 none sic! 1/f./sbk mfr g/w 1/f .5 .6 3 21-43 10yr4/4 none ls. 0/sg ril_ g/w 1/11 .7 .8 Ground elev. 4 43-98 10yr5/4 none co.s. 0/s p M1 n/a na/ .7 .8 101. Th. Depth to limiting factor >98'1 Remarks: Boring # 1 0-9 10yr3/2 none L. 2/m/sbk mfr g/w /f .5 .6 ` 2 9-25 1 4/4 none sicl 1/f/gr mfr g/w 1/f .2 .3 3 25-58 10yr4/4 none s]_. 1/f/skb mfr g/w 1/f_ .4 .5 Ground elev. 102.4 ft. 4 58-104 1 r5 4 none co.s. O s ml n /a n .7 .8 Depth to limiting factor >104' Remarks: backfil 1 ow area to be cut to code if area used Boring # Ground elev. ft. Depth to limiting factor Remarks: ecn o~~n~o n~iorn s STEEL'S SOIL SERVICE 1554 200tb -Ave Gary L. Steel ggrive C.S.T. 2298 Burt Kind; T1F%NGd% si9-~r2~r?-R18~a New Richmond, WI 54017 MPRSW-3254 (715) 246-6200 town of Warren m_ I c~ ( rn i~ P, \ 2 Od-►i S 5a 7- Ur` Su y- ,mob 1. f oo '4- t Z0 .d.` ~g ` ~ ~GK / 1"14 y 17 If 'e- > sfl - S7 n r- ~Y 7~`2 0 q~ 43 X = 6a ri H~ ST. _ ; nea fss~ i. _ . _ - . , . . _ , - . _ . _ _ , . _ _ _ r - . . _ _ _ . . _ r CERTIFIED SURVEY MAP • • PART OF THE NE 1/4-NW 1/4 - SEC. 19, T-29-N, R- 1.8-W N OIo-OI'- 23° W N 880-57=28"E NORTH SEC. LINEo co 1700' w Lt w NW COR. 1362.78' w o_ - - o w N 88°-58'-37"E w SEC. 19 I ti L. 231.79 N CO. MON. _ _ M 3Z" O - ~P IVATE 66' ROAD ®17A) / o N~o~32 60 p _ O~p~J rn \ P 04 10 st rn 03 "o O N 880-58'-37" E 3 p + 93 6' by W 'sue, o o M - S 17 =45-35"E 3 O w 66.00' - N Z A. M W 3 I - n o Z - co aV 3.67 A. ci^ W 'fob W M N th (A ' M o' co O O M N 3 3 J7 o o° ° z SRO 2 o 3.98 A. W i~ m N M O CD " '9S P ✓ Gi 1 M s2 o, Oro, a (1 N 4 Sg ~ti ~ 0 ASSUMED BEARING t/ o REFERENCED NSB-57-28E Olf 41 `9S W 4.71 A. 0 - W ALONG THE NORTH Ll~ ~ 004 OF SEC. 19 0 o 4f 0 sOo .45388 S, 01 11 150' IOG' 50' 0 150' 0. R /4 3 so SCALE 1" = 150' APPROVED JUN 08 1878 "ISO 4? Op" X19. s2„~ ST. C.iOIX CJU. (11 COMPREHENSIVE PARKS PLAM...:':oL- E G E N D AND ZONING COMMITTEE SEE REVERSE SIDE FOR o - I" x 24" IRON PIPE SET I CURVE DATA AND WT. 1.68 LBS./LIN. FT. CERTIFICATION - - - 349572 APPROVAL OF THIS MINOR SUBDIVISION THIS INSTRUMENT DRAFTED BY G.C.Shaffer DOES NOT MEAN APPROVAL FOR Niltt~?~ 7 7- 8 FU_LD::~v C" SEPTIC N. L c'o 9 IO • i FlLED fr 5 sl~ C. ~ JUN m 2.11978 S-1325 MAN 0, HUDSON G v amur co Xis. • DAVE FOGEM PLUNNNG Licensed Perk Tester & Plumber "3233 "289 Fogerty Heights Road ROBERTS, WISCONSIN 54023 Phone 749-3656 Cc AND V Srvw 3, I 6, 3~---- /z - ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: A5 1/4, lVzt) 1/4, Sec. /f T L9 N, R_ZJ' W, Town of G~/¢~,,{J Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 7 Did flow back occur from absorption system? Yes VNo (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X_Steel Other Manufacurer (if known): 4~ /C.& Age of Tank (if known S'.44,110 Signatu e) (Name) Please Print 4 r (Title) (License umber) P -7 " (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baf Named cotkv goNQkk~ignature ~c-- MP/MPRS oc -1-70 5/88