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HomeMy WebLinkAbout026-1116-20-000 c 03 6n o n I 0 0.' o ti g ~ v in ~ I N c 0 3 y (D v c d m A 4) % r m > c 0 0 z y C I' C LL C 0 'i o Q y o I ~I M ~ a3i I z w co dE Z Y o z a m c,) cn o I O z c _ o I z U) ! c v (D E ° cn ai m o ~ y (DI • C C O O o z°F`-z z g I p ~ ~ ~ c*4 y > I i 1~ > C - V C v jo ' v G G a ~ I > N O U) U) Ur) 3 U 3 a aZ • a a a v, IL z ' ° z° N o v ! a) m rn 0 c (D 'p`1. t co co Q E o o m y (D D ce) ~ m ¢ ~ in m I O H H O O y c o 0 m C E O O n H U N V a. cc !g to w O co C 2 p E N O m N E' C y Cp 0 ooh in o z ~u) ~ - d V m a € I m st a ' a 1 L: 4-, I CL ~ m • ~ m c m r'w~ y o m 3'o t A vIL 0 U)c) , i` FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER fcL _~~Js.J~ TOWNSHIP , SECTION T~~N-R~_W ADDRESS /_<;1<7- /fit`` ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . s' ?83' Hof rah INDICATE NORTH ARROW BENCHMARK: Elevation and description: / Alternate benchmark SEPTIC TANK:Manufacturer:' ! Liquid Cap. Rings used: "'Manhole cover elev:~;&~Final grade elev: Tank inlet elev.: ~ Tank outlet elev.: 7 / z No. of feet from nearest road:Front , Side, Rear Ft.;1 From nearest prop. line:Front , Side, Rear Ft. ,G,2 No. of feet from: Well , Building: ? n (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE s 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: i Width: Length a~ Number of Lines: / Area Builtsi~ / Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of P pipe: No. feet from nearet p op. line:Front , Side , Rear~Ft.22 No. feet from well:: o. feet from building_ 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 9 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LlborantdNumanRelations INSPECTION REPORT St. Croix Safety and Buildings Division Sa No-: dtaryPer SE~',NW4'j4AeTT~CtIJO=KI';I Lb~ 21, Town R GENERAL INFORMATION 149078 Permit Holder's Name: ❑ City ❑ Village C Town of: State Plan ID No.: Michael R. Stevens Richmond CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA P9/06 6Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q d Benchmark ` /0 V, ~r 10 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ~ 7. TANK SETBACK INFORMATION St/Ht Outlet 41$3 97,47 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic !b ti y13 NA Dt Bottom q f. cJ . o Dosing NA Header / Man. gi Aeration NA Dist. Pipe Holding Bot. System 6 iy PUMP/ SIPHON INFORMATION Final Grade t4 gg'S-l Manufacturer Demand S 6 V Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. I f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a 0 A DIMENSIONS SYSTEM TO P/ L BLDG7 WELL LAKE / STREAM LEACHING Manufacturer: SETBACK _ INFORMATION Type O CHAMBER Mode Number: System: J /A OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing b 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.) NV f Plan revision required? ❑ Yes aAo Use Use other side for additional information. cS BD-6710 (R 05/91) Date inspector's Signature Cert. No. SANITARY PERMIT APPLICATION T01LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PER # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Z P8% x 11 inches in size. net i vision 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 S T,~ , N, R ~ (or~ P OPERTY OWNER'S ILING ADDRESS LOT # BLOCK # CV1, STATE ZIP CO E PHONE NUMBER SUBDIVIS N N ME OR CS UMBER ,4 1. J 1A) C-1 7 "uj 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE ❑ Public 1561 or 2 Fam. Dwelling-# of bedrooms PARCEL TN E III. BUILDING USE: (If building type is public, check all that apply) 491.4 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. D? New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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) ELEVATION S- Feet eet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete strutted Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank Mae I~J~fijiex Av~ PC Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation onsite sewage system shown on the attached plans. Plumber's ame (Prin Plu r'$ Signa re: (N S mps) MP/MPRSW No.: Business Phone Number: s 563 Plu rs Addr ss Stree city, State, Code): W. COUNTY/DEPARTMENT-USE ONLY i)r ❑ Disapproved Sanitary Permit Fee (Includes Groundwater e Issued Issuing gent Signature (No Stam un;harge Fee) Approved ❑ Owner Given Initial Adverse Determination' r1&`/// ONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: X. C SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber , e APPLICATION FOR SANITARY PERMIT . STC - 100 his application form is to be completed in full and signdd 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 yV1L-%.,vw V4ye-2 ~o - V4a± maC f'I1c.+4 A. ea_ R STEyEN5 Location of Property k ~4W k, Section W Township , EtC*k AA 0140 . Mailing Address Is05 4WV loS NZW P1.t.HMt7µOA W1 5401"1 . Address of Bite "1 to 3 144 New 121&"M0 t40 ~N1 5401-1 Subd.i iVion wane W1t,k<O W PA V E; 0, n116&,00 wS Lot Number 2 Previous Owner of Property &*9;EjiwL DE !SEc.4- M ~-r Total Sine of Parcel 'eZ,, Acme Date Parcel was Created i t=) - L9 - °la Are all corners and lot lines identifiable? x Yes No to this property being developed for resale (spec house) ? L_ Yes No volume 640V and Page Number +A4 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, and the Seal of the Register of Deeds. In addition, a certified survey, jf available, would be ` helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTV OWNER CERTIFICATION 1 W d 1 cv-t.tl.6 y that aCC A tatement s on t1dA ohm ane true to the begs t o l my (ouh ) hncwtedge; that f (wel am (ahe) the owneA(~~ 06 the phopehty derscAi.bed in this .L Wmati.on 604m, by v.thtue 06 a waAAanty deed kecoAded in the 06 ice o6 the Ceitnty RegksteA 06 Deedbah Document No. 4SS2A(* ; and that I fwe) phesentty sun We phopoaed site bon the ee~uage diApob system (o)t i (we) have obtained an rdAement, to stun with the above de,sc4tbed pupehty, bon the eonbtAucti.on o6 said system, and the same has been duty necohded Ln the 066tee o6 the County RegisteA o6 Oeedt, fib Doewnen t mo. ~b55 7.fl~o I . & NATURE WOWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED + ' .t^1 )f.l f-fil tl''. WARRANTY DEED THIS SPACE RESERVED FOR RCCORDING DATA STA7`13 BAR OF WISCONSIN FORM 2-1992 455206 . %1PAGE4S6 REGISTER`S OFFICE Michael. R.-. Stevens, William H.. Derrick, ST. CROIX CO., WI William.M.....D.erri.ck, Thomas. E.- Derrick. and........ Recd for Record Ronald. L.. Derrick. as. tenants-in common... of JAN 1q WO . 8:30 M conveys gild ,,:;r,antr: to Willow. Ri.ver..Joi.nt _ . ' Reptster of Deeds I~ - !I II RETURN TO . . . I~ the follmvinv degeribf,d rent estate in St. .-Croix-............... ...Count State of Wisconsin: ~I Tax Parcel No: Southeast Quarter of Northwest Quarter and Noutheast Quarter of Southwest Quarter of Section 1, Township 30 North, Range 18 West. •I rR~NSF~ FEE I~ 1 is not.. ),nmcstcad property. !I (is) (is not.) i Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. Dnted this . ! day of _ ......--_.Janu ry._ 1 .._9.0. • _ _--~srAl,) rvl.,.... (SEAL) Michael R. Stevens . William M. Derrick _ . EA L) ~Ail ,;l~l: . I. (SEALi t.~ William. H. Derrick Thomas E. De ick AUTURNTICATION C ~1 FS M E N T ^.,it;»attae(,) -.-.Mi--------------- haelR. Stevens, STATE OF WISCONSIN . . William H. Derrick, William M. SA. Derrick- ---Thomas.-E.-..Der.rick-,and Ronald L1. De'ek ...........................County. authenticated this .ay of....... .Jan.uary_-., ]9_.94 -I_emnally came-before me this of - DD • 19 the above named Judith A. Rem ngton TITLE: MEMBER STATE PAR OF WISCONSIN (If not............................................ authorized by § 706.00, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY REMINGTON- LAW OFFICES 99941 4. RedmiRYton54017 --•_c.. mon.--= Nota-y Public ............County, Wis. (Signatures may be authenticated or acknoirledr:ed. Both My Commission is permanent.(If not, state expiration are not necessary.) date: 9 I9--•-•-•-•) •Nnmes of persons signing in nny espneily sh.mid ho typ•••1 .u I.rint.•d h,•Ina• (heir sifinnhlres• AVAnnANTT PFF.D STA'ri SAR OF wISCONs1N tWisennsin Te7al nlnnk Cm It I. 603.51 so 40.100u*fOM 1 I. , 3 17 1.07 A" C4 "Wil 10, W, 9BS 2.03Acrsc 3~ 18 N C 2.02 ACree River ^~J 16 7-01 Acres 19 ? .00 2.02 Acre Meadows 20 2.03 Acres 15 2.u Acres 14 ~,a~ ,des ,~ys• 396 2.02 Acres h -s 9 296 99 13, 21• s' ~s eja 2.16 Acne 103 Acres ?2? 7y `74 361.13 to A N ' O 181.13 200 (D 283.18 2.01A"" vi 2.00 Acres 0' °a fa 11 ~ p 200 Act" 1.2 22 2.01 Acres 2.00 Acres N 206 214 135.29 Public 298 489.74 2e9 23 A $ W N 7 2.00 Acne 2.00 Acres N 2.22 Acres 2eyy9 a~ -``1 ~6 N M N 269 206.30 a~ 24 504.30 200 Acres 6 28 2.27 Acres c A 2.02 Acne 425.25 w o 318.33 0 25 N C 2.01 ACM ✓ N A 2.94 Acres C4 0 440.49 m N 27 m N &q 29 2.33 Acres 4 2.32 Acres 77.60 Willow 2.0 Acme a River 476.33 260.57 10. f~.80 77.60 City of New Richmond p 26 3 " ~ s@ z•i1 Acres H hway 64 2.30 Acres 428 507.06 Z 3 0 226 200 Acres 211.03 c m County Rd. GG 323.20 U N 32 33 r CD (L lmV N r 2.20 Acres 01.94 Acres C4 = 01 3 W N N 31 N O Ir 1.61. Acres a 2.03 Acres N f f PO 200.50 326.37 226 Highway GG (715) 246-2320 RRICK Route 1 New Richmond CONSTRUCTION'"" Wisconsin SEPTIC "'ANK `4ALVTEMANCE AGREEMENT Sr.. Croix County W XW4gu, WLCJ Alva& Soj N LAF4 jug/ OWNER/BUYER le. S v' ,41 ROUTE/BOY NUMBER /SOS JYWV I&r Fire Number CITY / STATE Aic...! jet u4 mapD14 W/ zip 54-00 P^OPERTY LOCATION: `c; tVVJ`~, Section 6 T 30 1, R ~O W, Town of )e1CW", 0140 St. Croix County, SubdivisionwIwOQ✓ 4VQw Lot number EA•DOwS Improper use 9nd 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 licensed septic tank pumper. What you put into the system can affect the Eunccion of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 607. of the cost of replacement of a failing system, which was in operaci.on prior to July 1, L978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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) af't'er 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. I/WE, the undersigned, have read the above requirements and agree to maintain.the private sewage disposal system in accordance with the standards sec forth; herein, as sec by the Wisconsin Depart- ment of Natural Resources. Certification form muse be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED G DATE St. Croix County Zoning Office P.U. Box ?'_7 Hammond, WT 54015 7 L ~-796-'~_3? Sian, (lar.• ;ind reritrn rc) above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDI. INDUSTRY„ DIVISIOI. HUMAN LA@OF AND RELATIONS PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS HIPY: LOT NO.: BLK. NO.: SUBDIVISION NAME: /4 A/►)'4 1 /T30 N/R 18Lor) W Richmond 21 n/a Willow River Meadows COUNTY: OWNER'S E: MAILING ADDRESS: St. Croix Derrick Const. 505 Hy. #65, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a 2tKb61ew ❑Replace 5-8-91 5-8-91 RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑ U ®S ❑ U [jJS ❑ U ❑ S U ❑ S ®U 5x100' conventional trench If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 28 BxD2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.08 98.55 none >7.08 .83bl.1. .75bn.sil. 1.00bn.s.l. 4.50bn.c.s.&gr.:.. B-2 7.00 98.55 none >7.00 .67bl.1. 1.50bn.l.s. 4.83bn.c.s.&gr. B3 7.00 97.95 none >7.00 .58bl.1. .67bn.sil. 1.25bn.s.l. 4.50bn.c.s.&gr. B 4 6.83 97.60 none >6.83 .83bl.1. 1.00bn.l.s. 5.00bn.c.s. B-5 6.67 97.45 none >6.67 .83bl.1. 1.67bn.sil. .42bn.s.1. 3.75bn.c.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -PERIOD 1 PERIOD 2 PERIOD PER INCH p-1 3.50 none 3 6 6 6 <3 p-2 3.50 none 3 6 6 6 <3 P_ 3.50 none 3 6 6 6 < P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION X5.05 I 3 3 E E r OE, i1- rte. 0 3o1 E t Pt e (z u~ 3 F 5( r_ E E E N I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord ith7the b yre Vd Pods s d in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of wlbe Cn C3 NAME (print): TE S FIT COMPL ED O Gary L. Steel ADDRESS: CERTIFI CA 1) B HONE NUMBER (optional): 1554 200th. Ave. New Richmond Wi. 54017 2298 15-246-6200 CST SIGN E:'"'~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - sac f r3Ci✓, ;0/94/ %sos' ,s/wy 6s' 7~c~,/asaab Saw." zzve. i s'e tsAWC j Bs / 10 -r- 70 Q i yy, • PAGE OF CroSS 10n o~el~ Sys~~~ 4 Froth Ali Inlot• And Obtsivollon Pipe /SQJ S- APprorld Venl Cop Minimum 12* Above final Grede 20- 42' Above Plpie _ 4* Coal Iron To final Grade Vent Pipe MW lA liar Or Srnlholk Covulny urn 2' Ayyeeyale Over Pipe DIUf1b.11on -Tee - Plpe o 0 0 Gons UalR Pipe Perloroled PIPa below eQ01e ° o -Co,01019 Terminallnp AI Sollom 01 Slalom III SOIL FILL DISTRIBUTIOM PIPE l4uTM APPROVED ~7 ETIC COVER 7~ OR 9„ O - > OR RfSN NAyF STRAW 2"OFhGGREGAIE OF l2 -~'/z AGGREGATE ELEV. OF-AILK-FEET, D15TR15UTI01J PIPE To BE AT LEAST _ IIJCHES BELOW ORIGIIJAL GRADE A►JU AT LEAST LO IIJCHE!; BUT 1.10 MORE THA►J 42 INCHES BELOW FINAL GRADE MAXIMUM DEPrH OF EXCAVATIop r om mi&w 1. 6~w- WILL BE IMCHES rimmuM 9EPTM OF EXCAVATION FP ,01A. e4~16QJAL GRADE WILL BE INCHES SIGI.IEO: LICEUSE IJUMBEli: SAT E