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HomeMy WebLinkAbout026-1032-60-000 C„ o c ~ o O cq vc O 0. 0 1 O c0 N - ! a 0 N ! y t' ma) 0 0 av 0- C) C-4 y o X C N _N Q C Z O Cn m C LL 0 N C 7 O ! N 'a O O E Q 2 U CO CO a ~ N co W 0 Z O Z y y o co LU a co c C7 O z :!t o d c W Z o N H r c ~ N N Q ~ N Z z o Q ° m N ~ v c ° 10 £ E O c m Y o y E a 'R 06 Wv- O 13 a .0 o w H H H O U !hi 'I Z ~ ~ ~i a o ►i ~n O O O •"i io o a d a co O O N r N N N fn -j U 2) m rn ~U O CV } ~ O O o V 3 ~ 8, N C : w c o U o w c ® O M00 ~ m O N C M- o co O C O O U U ~ to E N L' O Q' Cn O N ~ E N m a j # G CL w • ro V Cl y C £ rr~ i C C N V "~1 A U a 0 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP ,c lZotA & OWNER SECTION e~rT N-R~ W ADDRESS ST. CROIX COUNTY, WISCONSIN L 24 SUBDIVISION- LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'Ell U ~ ~I r INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark SEPTIC TANK: Manuf acturer : A I - 'c~s Liquid Cap. Rings used:~/-Manhole cover elev:`'?0V Final grade elev: 9 Tank inlet elev.: < C Tank outlet elev.: S_.S 7 No. of feet from nearest road:Front X , Side , Rear Ft. From nearest prop. line:Front , Side, Rear Ft. No. of feet from: Well 5 Building:; (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE e PUMP CHAMBER Manufacturer: 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 ABSORPTION SYSTEM Bed:_ Trench: Seepage Pit: Width. Length 5- Number of Lines: _Area _l.. 1 Built Exist. Grade Elev. 9ft Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear( Ft.~ No. feet from we11:No. feet from building 1S 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 : ` LICENSE NUMBER: 6/90:cj L~CAT..ION: RICHMOND 10.30.18.138C SE NE,HWY. 65 isconsin Department o Industry, PRIVATE SEWAGE SYSTEM County: Labor acid Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 180288 Permit Holder's Name: ❑ City ❑ Village [XTown of: State Plan ID No.: SCHOLZ, DEAN E & CYNTHIA RICHMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 11 1 /04 O as CV i n 'al~h Nj 026-1032-60-000 TANK INFORMATION ELEVATION DATA A9200368 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic >'S / o D O Benchmark 11, ~ i ( o Dosing Aeration Bldg. Sewer Holding St/Ht Inlet p q5 q~ TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe ~,1 1 32 Holding Bot. System y PUMP/ SIPHON INFORMATION Final Grade ~ Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O I q / Sam/ `r / CHAMBER OR UNIT Model Number: System: U I ~o DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 4 Dia. ij Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 7Bd,/ h Over xx Depth Of xx Seeded/ Sodded Txx Mulched #2 Ij Bed /Trench Center Tren ch Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ Ni COMMENTS: (Include code discrepancies, persons present, etc.) ) j LOCATION: RICHMOND 10.30.18.138C,SE,NE,HWY. 65 it Plan revision required? ❑ Yes ❑ No , Use other side for additional information. rl ~3 -(z ~ , SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Ezz0ILHO SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Co MEN Q~~" STATE SANITARY E -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. C e?kl~frevlsion to previous 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 % t/4, S T , N, R JR, E (or) W PROPERTY OWNER'S AILING ADDRESS LOT # BLOCK # CI STATE ZIP COD PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER _0 CITY II. TYPE OF BUILDING: (Check One) El State Owned VILLAGE NEAREST ROAD 4Q : -A All~) IQ OF: e R ) ❑ Public 1Z 1 or 2 Fam. Dwelling-#of bedrooms 3 PARCEL TAX NU III. BUILDING USE: (If building type is public, check all that apply)C %O3~ -LUG 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El New 2. ~ Replacement 3. ❑ Replacement of 4.0 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 n. i REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Minch) / ELEVATION 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 structed Septic Tank or Holdin Tank - S Lift Pump Tank/Si hon Chamber D I F1 F1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instaliati n of the onsite sewage system shown on the attached plans. Plumber' Name ( rint): Plumber s S' natu : ( m ) MP/MPRSW No.: Business Phone Number: p Plumb 's A dress (Street, City, State, Zip Cod IX. CO NTY/DEPARTMENT USE ONLY suing A nna No Sts, e Is ❑ Disapproved Sa i ary Permit Fee (includes Groundwater Ea Approved ❑ Owner Given Initial ~ urcharge Fee) ~ Adverse Det rmin tin ~~TT 11u n X. ONDITIONS OF APPROVAL/RE ONS FOR DISAPPR VAL: G(J 0--tat SBD-63 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & 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 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. Ill. 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. Coun /Department Use Onl tY Y. X. County/Department Use Only. Complete plans and specifications not smaller than 8Y2 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 rnonies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) STC-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. Shoulthis 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 _ % - ^ - I "It e!J! al,Z Location of property S fl/4 AF 1/4, Section 0 L T3D N-R ~ W Township !Gi,,? X )t Mailing address /d 7 A/wk., ~ ~ ~ e~~ ~5yo17 Address of site 13AIV ~Q Subdivision name Lot no. Other homes on property? yes.No Previous owner of property Pig j f "d-'w' . b ) Total size of parcel Ltd 17S ~ S /00 "b' 176 ly /00 Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yes No Volume ls~sa,and Page Number Y7 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. certified survey, if available*, would be helpful I o asd 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. own the , and that I (we) presently 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. Signature of ap~lic t . &Co- pl cant Date of Signature / Date of Signature ' aSd~Jbl R VOG 552 wuE34 ~i STATE OF WISCONSIN St' Croix COUNTY COURT PROBATE BRAN4I4- IN THE MATTER OF THE ESTATE OF ) DOMICILIARY LETTERS Hazel Foreman REGISTERS OFfI~; r Deceased. ) ST. CROIX C0.1 WI& -Z-- Reed. . for Reoord this ~h„ t ;9: 0 IMI.: Atom of THE STATE OF WISCONSIN, to Pal O_ wenbV ' WHEREAS, Hazel Foreman died domiciled in St Croix County, Wisconsin, on aePtemh r 23, 1976 i and WHEREAS, you have been appointed personal representative and have fully qualified; , N i NOW THEREFORE, these letters are issued to you, and you are ordered to administer this estate !I l according to law. n ~ d IN TESTIMONY WHEREOF, I have signed these letters and affixed the seal of the Court on NOVemher 3- 1976 I .-r,1t: it (SEAL) Jo eph W. Hughes • y j ~ , State of Wiscomin County of St. Croix L► ? c' I hereby certify that this compared by me; t:1 : it is`~ • correct copy of 1{w. Original reco d in my once; and that It fo,ce and euect. -Attest 19V Reinstra & an Dyk egl:tar ~ Eiouata d . Attomey New Richmond, WI 54017 4 Address 01 i p i Recorded in Vol. Page c._ t1o 1._4 b_SR_ce__l2~o 9L_13_QMLSll.IDR1L1.ET7ERS r_ _~zi~- ~c-+•m¢s Z r 449" i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER sG401 z ADDRESS: PRA) Aci y FIRE NO: J6 a LOCATION: S 1/4 1/4, SEC. ) d T TOWN OF: Jyj6 nibs, ST. •CROIX COUNTY SUBDIVISION: LOT NO. 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 to help with the cost of the 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 the St. Zoning a certification form, signed by the owner and Croix Count by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix county Zoning officer within 30 days of the three year expiration date. SIGNED:_QQ DATE : Q _ a f St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 ST. CROIX CO., V Recd. for Record IWs_26t1 Orr. doyof oRL11-A.D• 1977 M. EXECUTOR'S DEED o.-d, 1977, tween THIS DEED, made this 1st day of February, Personal Representative of the Estate of ER PAUL O. SWENBY, as and DEAN E. X00 Hazel Foreman, Deceased, party of the first part, FEE 4 SCHOLZ AND CYNTHIA A. SCHOLZ, husband and wife as joint tenants, parties of the second part; WITNESSETH, that whereas, Hazel Foreman, late of the County of St. Croix, State of Wisconsin, now deceased, did in her life- time make her Last Will and Testament, which has been duly proved, and admitted to probate as such in and by the County Court of the County of St. Croix, State of Wisconsin, on November 23, 1976, and that pursuant to sec. 860.01 of the Wisconsin Statutes, the Personal Representative has complete power to sell, mortgage or lease any property in the estate without notice, hearing or court order; and whereas the party of the first part has been duly appointed such Personal Representative of said Will, and has duly qualified and is acting as such Personal Representative. NOW, THEREFORE, By virtue of the power and authority in him vested as such Personal Representative of said Last Will and Testament, and in consideration of the sum of One Dollar and other valuable consideration, to him paid, the receipt of which is hereby acknowledged, said party of the first part hereby grants, bargains, sells and conveys to said parties of the second part, their heirs and assigns, all the right, title, estate and interest which the decedent above named had in her lifetime and at the time of her death, in and to that certain tract of land lying and being in the county of St. Croix, State of Wisconsin, described as follows, to-wit: A parcel of land located in the Southeast Quarter of the Town- ship Northeast Quarter (SE; of NE3) of Eighteen (1 Ten 8) (10We)s, t, further ship Thirty (30) North, of Range Section at a point on the West described as follows: Beginning „65„~ a distance of right of way line of State Trunk Highway 1444.75 feet South of the North line of said Section 10; thence West parallel with the North line of tpara11e1Swithf NEn, a distance of 175.0 feet; a thence South, distance of 100.0 feet; the West line of said Highway, thence East parallel with the North line of said SE; of NEd a distance of 175.0 feet to the West line ofsaaidaHighta; dise thence North along the West line of said Highway above parcel of 100.0 feet to the place of beginning. The shall be subject to a public easement for service road over and across the East 25 feet of said par I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pagel of Y Labor and Human Relations Division otSafety & 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 S~ 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 GOVT. LOTS 114 1/4,S T N,R E (otW PROPERTY OWN R':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY.-STATE ZIP CODE PHONE NUM ER OCITY ILLAGE [MOWN NEAREST ROAD [ ] New Construction Use pq Residential / Number of bedrooms [ ] Addition to existing building ~j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ~7 ed, gpd/ft2_..,2trench, gpd/ft2 Absorption area required bed, ft2 = trench, 111:2 Maximum design loading rate _,_7 bed, gpd/ft2_-gtrench, gpd/ft2 Recommended infiltration surface elevation(s) QS~ 3 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 AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U OS ❑U OS ❑U 0S ❑U ❑S OU ❑S ~U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoUnclary Roots GPD/ft in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trench x; - Ground 4 elev. q~&L ft Depth to limiting factor :>12- Remarks: Boring # /Z2 YZ- Ground elev. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number J 7- 9 -2 PROPERTY OWNER~~ SOIL DESCRIPTION REPORT Page,-) Of PARCEL I.D. # 2- Z Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounclary Roots GPD/ft in. Munsell Qu. Sz. Color Gr. Sz. Sh. Bed Trench t 4 `4 S :y Y vv..:......... of Ground J42 X-~ ~7,' tie Y~ elev. 29Z ft. G Depth to limiting factor Remarks: Boring # 'Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) I i I I i _ I ( i ! 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OFFEE'Y' (•+O'Js-t•~s AGGRCGNTC ~p 01syFtiouTIUW PIPS TO OC AT I,Chs'i~ IMCHC3 BCLOW ORI&IMA1, •~-AAOE AIJU AT LEhST iO 1WCHLL OUT MO MOR.C THAW yZ 11JCNCS MLOW FIMAL. r rtAOC i , MAXUw~'1 ()SPT►1 OF F-Xc/lVATIOP FKOM OR16WA.L 69Pm WILL BE _62~- IUC.HCS tVHIMVM ©EFT 1 CF EXCAVATION r-P O ^ 04~14INAL GRAPE W►1.1. sc ~ 1NCHC s sl4uco: , S• LIGCUSC 11UMBCIi: • OAT C REPT131 RICHMOND ST. CROIX COUNTY ZONING PAGE 1 10/22/92 09:11 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/23/92 AREA: MJ Actiyity: A9200368 10/23/92 Type: CONVSEPT Status: PENDING Constr: Address: RICHMOND 10.30.18.138C,SE,NE,HWY. 65 Parcel: 026-1032-60-000 Occ: Use: Description: 180288 Applicant: SCHOLZ, DEAN E & CYNTHIA Phone: Owner: SCHOLZ, DEAN E & CYNTHIA Phone: Contractor: O'CONNELL, KIM A. Phone: Inspection Request Information..... Requestor: O'CONNELL, KIM Phone: Req Time: 09:10 Comments: c?"-n Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION