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HomeMy WebLinkAbout020-1061-30-000 r.; 4q N r. O N O Cr` h N I p C p LL C 1+ O ~ =a E I Q o I v ~ z N W Z O 2 O L Z ~ I rn a m N F- Z I o z v ° U d Z `1' w ~ H r ~ N E 14 c p N M~ N O C (0 O • m N O u O O O N Q O N Z co Z Z O O N M y m N E =O N iy Q L CL a) O N d i N N Z (N > d ) 3 O O ~ I •w.l (D a a a FL o v ~~yy a LO 04 N •i NO U) am a) i Vi U § rn rn o Cp N 0 0 O O N O O p p0, (O ) O O N C O O C co 00 E U') 0) O p p O O r\ , OM CO O O Q a w O (D ~ p O O O N n y..i O C N W N N r t p N O N I- F O • > . C, - E E U L. 0 ~ ma I a CL 4) r- r.~ E i c c u a o N U I r AS BUILT SANITARY SYSTEM REPORT OWNER w 1h,'11 TOWNSHIP 44JS o SECTION a-~ T_2_2_N-R ADDRESS Box z Z ST. CROIX COUNTY, WISCONSIN t4 L SE, .-k-/o 1 f SUBDIVISION I,-k, T-u ~L,16,%- LOT z LOT SIZE /~e. PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 5<G(~ =1b Lo'~ 3 tea. Jy~, ~g yS ~ 31 ` l~ oy 3 A'-ro , R z zz' d 90" R 5iw IoF'coKN.r 70" ~ wd ~ INDICATE NORTH ARROW BENCHMARK: Elevation and description: i AT SL-: Alternate benchmark Te E I z c . Z SEPTIC TANK: Manufacturer: G %s r- Liquid Cap. lee d Rings used: - Manhole cover elev: 4*-f z3 Final grade elev: 5. 5 Tank inlet elev.:~_~/ Tank outlet elev.: No. of feet from nearest:road:Front , Side Cam, Rear Ft. `?S From nearest prop. line:Front , Side , Rear Ft. ~S" No. of feet from: Well G'!/ , Building: "-1 2-' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE z PUMP CHAMBER Manufacturer: !T Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPMION SYSTEM Bed:eox ~eM Trench:= Seepage 'Pit: .01 Width: /9 -Length L4- , Number of Lines:--R-Area Built ,;;~ZV ST 7 T Exist. Grade Elev. 7113 Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side, Rear Ft.7D No. feet from well:_J!~I_No. feet from building Y-S- HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE : PLUMBER ON JOB : ~.oicw,~s•e . LICENSE NUMBER: 6/90:cj 1Q1gAWiWLSP"pirtri .P1P P"Ast23 . 29.19. 2 PRIVATe SEWAGE ~YSTEML TWELVE CoRD, unty: ry, 'Labor and Human Relations INSPECTION REPORT Safety and Buildings Division $T. CR IX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 175678 Permit Holder's Name: ❑ City ❑ Village [Town o : State Plan ID No.: MILLER', SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1061-30-000 TANK INFORMATION ELEVATION DATA A9200337 O /Z X, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic/ Benchmark D ~ ~ ~ 1 yJ , 32 /O ~ Aeration Bldg. Sewer Holding St/ Inlet 5/ a~ TANK SETBACK INFORMATION St/ l~ eoutlet TANK TO P/ L WELL BLDG. Ventto ROAD Air Intake Septic >s(~ ~b ' ~a NA Dosi NA Header /A4&n. ' Aeration NA Dist. Pipe 0.59 Holding Bot. System PUMP/ SIPHON INFORMATION inTI i ra e ~s-6 Manufact Demand°/' r'i` Z,3 Z Model Number GPM c✓ ry TDH Lift Friction Syste TDH Ft oss Fi Forcemain Length Dia. Dist SOIL ABSORPTION SYSTEM BED/TRENCH Width d r Length_ / s No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a DIME SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC G Manufacturer: SETBACK INFORMATION Type O `i~ CHAMBER System: 6 ~3 Y OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake Length _4~ Dia- Length _az 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 /T Center Bed /Tieeth Edges (3 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) C' tzo 1 11 el-6 CID Plan revision required? ❑ Yes D_w Use other side for additional information. w <7 RP/1,91 SBD-(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~.we ' STATE SANITARY MIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. I.Z~evi,57topr sous 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 SI,r" /h• //Is r- td,14 xE '/a, S Z3 T-29 , N, R / E (orQ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ~mX ~ ~ 8Z_ Z CITY, STAY ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0 / 3 Y,•o z 7s: el mat; Ttv~ v~- 11. TYPE OF BUILDING: (Check one) El State Owned VILLAGE : /So NEAREST ROAD n ❑ Public 1 or 2 Fam. Dwelling of bedrooms PARCEL TA MB III. BUILDING USE: (If building type is public, check all that apply) 20 - /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 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. IS New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 472"70 ELEVATION C) 2 O 2 © (0 Z S qs-, 2-0 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 P4- 01Da U) 4-1 S'm Lift Pump Tank/Si hon Chamber VIII. 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: 0-A ? f 7 Plumber's AddressXStreet, City, State, ip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date ssue Issuing gent Si nature (N tam A roved Surcharge Fee) pp E] Owner Given initial , 1 ( Z Adverse Determination Z9 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. " f 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 (SEM 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be purnpec 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 it 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; close 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) S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), 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 Location of propertyA/V #F-_1/4, Section 2-3 , TN-R l9 Township' So Mailing address R4A 2 P' 2-- W L't 9 o 0- WZ sYvl4, Address of site _ L/w U I Z 44 s c~ w2 Subdivision name Tro,( 1 w0-(U 4L- Lot no. Z Other homes on property? yes X No i Previous owner of property S`Iawav'~- Total size of parcel 3,3 Date parcel was created Are all corners and lot lines identifiable? k Yes No Is this property being developed for (spec house)? k Yes No Volume and Page Number 3/8 f 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. S1F-1794 , 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.7f Z Signature of applicant Co-applicant Date of Signature Date of Signature i • f DOCUMENT NO. STATE BAR OF WISCONSIN FORK 1-1fl~ asrrateso saseoao+~ lam -W WED 481'794 W E p a7~ lfIERA GE RGV~OS OFFI~ This Deed, made between ..6uad..... s ~cldiotR~ootd ;;a. j susi,e..JQ..Sr.aKarx,-.hu~ba~d..and-.ki.~~..._....._... APR101992 a ~i - . ' t--o- 8-30 A. I and .-Sam.E.,..Miller..... I R1 dD1Mdt . , Granomr Witnesseth, That the said Grantor, for a valuable consideration...... 11[TU11N TO conveys to Grantee the following described real estate in ..-.SZ, -.CrQiiX......._... County, State of Wisconsin: A parcel of land located in the Nh of the NEk of Section 23, Township 29 North, Range 19 West, Town Tax Parcel No: of Hudson, as described in the Certified Survey Map filed and recorded in the office of the Register of Deeds for St. Croix County, Wisconsin, on July 6, 1976, in Volume 1 of C.S.M., Page 271, Document #334002, which parcel contains 20.48 acres. w6, This is not homestead property. 4iu+ (is not) Together with all and singular the hereditamr tits and upp.lrtenance.; thereunto belonging; Arul Kenton P. Stewart and Susie Jo Stewart \c:urants that the title is good, indefeasible in fee slmplr• am! free and clt-w of cneumbrame,, cscopt easements and protective covenants or restrictions of record and-existing highways, if any, and will warrant and defend the some. Dated this 7th do:. April 1992 t t:A I.t f > /lI! .c ' (SEAL) Kenton P. Stewart (SEAL) Susie Jo Stewart AUTHENTICATION ACKNOWLEDGMENT ~irna+nr••I:I K~tn ton I'. Stcwnrt and "i'lTl' ill' •,t•1?l'flV^1\ Susic .lo :-tctanrl day of 70, Apr i i nm this lU tiw al,o~e n:rml I .John 1). Heywood >II{'rtltl•;R >T \-1'I•: It 11: ril' \ I. ' n I I i mgt. •~i4 :i '•1 1, -w' lu! to hr Iry• •:~rtr \%!I., c-m".11ted 'Ile ~~n. ~~~<huui~r nni ;.r6m'•cl•~i~e ti.. .,rnlo Ilcvwr~rxl 5 Cat i by .John D. Ileywood p, u. 1{ox 229, lludson, hiscon;in 5401(- Cwlptv, Wis. not. . ,:ttr expiration i!1 .I lnn ..I ti nni n ^ I r n tll n r ,I •..I♦ l\', m u, I,..,.,.1 Yllnnk Inc. Inlt?i I . ~Irh•nn l- w:,. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 50-W ADDRESS _ 13 7_t 8 FIRE NUMBER CITY/STATE ZS a ti L4-,) ZIP Syy~~ PROPERTY LOCATION: ~1/4,fF- 1/4, SECTION Z3 , T off N-R 9 TOWN OF#"4' e' , St. Croix County, SUBDIVISION 7i7 rin~4~ I ~a- , LOT NUMBER Z 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 officer within 30 days of the three year expiration date. SIGNED: DATE: cJ ` 1 f - f Z- - St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor awl Human Relations - Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 'Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST lx 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 S M/' l f L[ GOVT. LOT f 4W 1/4 N~ 1/4,SZ3 T Z.9 ,N,R / g E (or) W PROE P~,p TY OWNERS MAILING ADDRESS LOT~# LOCK # SUBD. NAME OR CSM # y d / CITY TATE ZIP CODE PHONE NUMBER ❑CITY ❑VI LAGE MOWN NEAREST ROAD ~f New Construction Use n' Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow A-95 gpd Recommended design loading rate bed, gpd/ft2_Ztrench, gpd/112 Absorption area required bed, ft2 ench, 112 Maximum design loading rate (3,-7 bed, gpd/ft20.t~ trench, gpd/ft2 Recommended infiltration surface elevations 5 . Z6 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL UND GROUND PRESSURE I~T-GRADE SYSTEM IN FILL HOLDING TK U= Unsuitable fors stem I$1 S❑ U S❑ U Il-KI S❑ U At S❑ U 0 S ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bajxlary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench }w timg 3" z o-4 s 14' 4~la I o:7 OX Ground ~Z o" /b R 4-A 1 ) .7 % elev. Depth to limiting factor , > 8 97 Remarks: Boring # a :.:...A # $ /3 16YR 3 3 - SQL / qb no r 1 s 10.6 $a; .iv::ncaw $,p Ground 2 ° /OYIQ 414 SL vh O O.s Iev g 6- 6YR S /I'l s 1 1 ft. 90 10.7 102 Depth to limiting factor 7 / 7 Remarks: CST Name:-Please Print ~y JOA►nlSOr~f hone: Jou saw ~~,~>l l ~N~ 6- 46b Address: Sd N w Signatu Date -2, CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # l,2 23-2~-1 Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Tn~ ~f: v 3 1 m r . 4 $ q'' 16YR 4 3 L alo r,Fv- 0.4 a.y Ground p r2 h 5 I ,4 elev. 16~ t. g3 70 a 4 ,MS I o.7 b.% Depth to limiting factor > Remarks: Boring # -Z CA 10-< 16Y ct~ G b k h,,~r / O s 0. ? Ground /bye 4 MS 0 0. og elev A MS `6 -dolt. Depth to limiting > fctQ3 Remarks: Boring > Q 14 /60P V -Z L, alO rr,~rr 4. IO +e4 3 Sjl.- rn QJok rn~r 1 b.G 416 Ground elev. $3 6 D S M) 0:7 O.$ Depth to limiting factor 7 /A 06 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ~r r ~ r- ~ I Q M C a D O Z • rb e!C r ~ Wl nb ~ / r W W ra Z e t~ No Sa V,, X1;11 ~-r C . S, M. Vo Lo Ij 20 ~G L 7 13.00 ;SD1(No /I ~rr 7,f I . y0 ~ ~ , A ,'1 ems„ A D LOA s' qo L J 1gasoi ~e~ IV ti ,1 Zy~.3 j, ~o a 0 Z v ~P ~ f f i a LA 3 S~v \a~ \ 0 M-1 if i 1 I o TTI r ill ! i ! I I If; ~ I ~ l ii f ~ 1 ~ + IIi~ < ~ji l( l ii X11 i ~i ~ ~ ? I i I I: ► I ~rn I m CA 1~ ` I ! o ! =7 it ~ I 1 rn i - T jII W ill -A_ 'ii L I n ( I _f I ~ II M .Aa R° x O -Ax o c o -i -10 co x + ;K z m b i 7 m L Ll i REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 1 10/28/92 09:45 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/28/92 AREA: JT Activity: A9200337 10/28/92 Type: CONVSEPT Status: PENDING Constr: Address: HUDSON 23.29.19.231D,NW,NE,LOT2, TRAIL TWELVE RD. Parcel: 020-1061-30-000 Occ: Use: Description: 175678 Applicant: MILLER, SAM Phone: Owner: MILLER, SAM Phone: Contractor: STROHBEEN, DOUG Phone: Inspection Request Information..... Requestor: STROHBEEN, DOUG Phone: Req Time: 13:10 Comments: /N5- Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION