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HomeMy WebLinkAbout030-1085-60-100 t, o I ~ 0. p I ~ I n ° I 0 N y I I I I ~ I a ~ I I ~ I c ~ LL c o q ~ y M I z w E z o ~ v E Z a CO C) Cl) 0 Cl) F- U) o I E z c (D z d c N H r- a) Z c E a .O O I f0 Q1 ~V 7 d N CO a C © O a) Q p 4= Z m z o N N z N _0 V > N `o y E co I O O P C C GOO. s' E ~N Z > O H F H ' V w N Z 12 a a a • a 3 I (A U > rn rn } ro o > 00 O E M co a ~j 'O N Q } tl? m O a. O F1~ U) C O C ob N 3 c 0 0 p o r o ~r 0) p 0 f O 6) O Lo CL Q) E N p rn ,c c " a) M CO U - 0 0 3 N C U) y, O M Z p r E a> 0 E CO co ~ I r~ it w `m m I' a g~* o ~n.w • c~ a m m y c E L c c rrww o o _1 A U a 0 U) U FORM - STC - 10 AS BUILT SANITARY SYSTEM REPORT -XI OWNER Rf_~LCG/r TOWNSHIP S; r, r'7,5~F-^ SECTION3_T_,W N-R 9 W 7 ADDRESS (j6FLy zz- ST. CROIX COUNTY, WISCONSIN 7-d Ae SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J600 SoT1 a r.r I~ I ®usE S &x- / a ulE~ Q oc 41 UAucr U/EU~ 7/Q, INDICATE NORTH ARROW 00 rro" O,;-r 3/Di ve- ,N•E COPA(e2 BENCHMARK:Elevation and description:_ n~ /J~DLt.4L3 S'!D<rrG Alternate benchmark 4^L a ~~EC/1 i~3~a ,4 Pid<rC SEPTIC TANK: Manuf acturer: Liquid Cap. Rings used:-I-Manhole cover elev: ,10;!~tonal grade elev:_, ( a j Tank islet elev.:-/O /P-T6-Tank outlet elev. ~ ~r40 3 No. of feet from nearest road:Front-A-, Side , Rear Ft. 70 From nearest prop. line:Front_X, Side , Rear Ft. Z74 No. of feet from: Well 8®Building: -517r (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pu ize Elevation of inlet: Bottom of tank ation Pump on elev.: Pump off el Gallons/cycle: Alarm: Man.: Switch Type: Location Distance fr earest prop. line: Front-, Side_, Rear_Ft. Di ce from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width:JQ- Length Number of Lines:_A Area Built Exist. Grade Elev. /6a2 Proposed Final Grade Elev. Fill depth to top of pipe: 1199 It No. feet from nearest prop. line:Front_X_, Side Rear Ft.,2L2 No. feet from well: 93, No. feet from building t HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank, Elevation of inlet: No. feet from neare rop. line:Front Side , Rear Ft. No. feet Well , building , nearest road m Manufacturer : INSPECTOR: DATE: 7 PLUMBER ON JOB, LICENSE NUMBER: x.265 6/90:cj Aql Wisconsin ~ Department of Industry PRIVATE SEWAGE SYSTEM countyst. Croix Labor and 1Lur~an Relations INSPECTION REPORT Safety and Buildings Division qq~ ,q~~ pp EERRMM ) Sanitary Permit No-: GENERAL INFORMATIONSE,NE,Sec~.30;T30TR1P9,Va~lley View R 149131 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: John Emmeck St. Josep CST BM Ele Insp. BM Elev.: BM Description: Parcel Tax No.: 030-1085-60 100 TANK INFORMATION ELEVATION DATA /p TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmarks G Dosing Aeration Bldg. Sewer Holding St/0( Inlet ape 9Q TANK SETBACK INFORMATION St/ Outlet p TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header4l4an Aeration NA Dist. Pipe 12,2l _2, 71 Holding Bot. System 3,30 86 PUMP/ SIPHON INFORMATION Final Grade Manuf rer Demand Model Number GPM TDH Lift Friction m TDH Ft oss ea Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER OR UNIT Model Number: System: , DISTRIBUTION SYSTEM Header/M. Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _Cl Dia. Length _~_L Dia. `f Spacing _40-_ 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) r~et•...L.' , ~ a4, ~ W~='5:.~~ {;:ax~~x ~ Cy{.U z,~- ~ ..rf 4.. ...,~-~c`r'r. "~,<..t'7 ♦ ~I~„~C~t.~ Plan revision required? ❑ Yes Q'ITo Use other side for additional information. 1/0 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION DI.. HR cm. In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El cf1 / 8% x 11 inches in size. 1442, f eck f s on to /revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 545% t'/4,S O T 0,N,R / W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 7 ALL ` Fw 2 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER % r S O x OD II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned R VILLAGE r 45-VA I - 0. ❑ Public ~ 1 or 2 Fam. Dwelling4 of bedrooms PARCEL AX NUMBER(S) r III. BUILDING USE: (If building type is public, check all that apply) 030 - 10 .s -6o 00 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. M 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION T ✓ 0 j , Feet D Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed F1 1 11 -7 1 Se tic Tank or Holdin Tank Ct ~E~S 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): Plum is Signature: (No Stamps) M PRSW N Business Phone Number: DdMAVI,ly c#n17-7_ 1 - S Plumber's Address (Street, City, State, Zip Code): 5,86 AG_EX 7 -AZ 0 IX. COUNTY/DEPART ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuin gent Signature (No Stamps) XApproved El Surcharge Fee) Owner Given Initial _7 ~ / Adverse Determination l X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber + APPLICATION FOR SANITARY PERMIT 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. 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 John P. and Susan K. Eanneck Q_N-R_2W Location of property 1/9 ,x/9, Section 30 , T- Township Si- - Jcn,sepb Mailing address 200 Sarah Lane - Apt:. 5 Somerset:, WI 54025 Address of site 374 vale= view Trail - Hoult-on. WI 54082 Subdivision name Lot number Previous owner of property Carroll Gene Enmeck Total size of parcel 5_nR99 anreG Date parcel was created Certified Survey Map Recorded on March 15, 1985 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes XX No Volume 910 _and Page Number 564 as recorded with the Register of Deeds. Document: Number 472061 all this information pertains to_ the rmit Claim- Deed. 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, 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. 472061 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction said system, and the same has been duly recorded in the Office of the Coun Register of Deeds, as ocument o. gnature of Owner Signature of Co-Owner (If Applicable) j Date of Signatni Date of Signa re DOCUMCNT NO, 1~[STAT1 BAR OF WISCONSIN FORM 8 1982' THIS OF-AGE RESERVED FOR ACCORDING DATA Olt CLAIM bttb 2 G : acE 1 REGISTER S OFFICE 564 i Carroll Gene Emmeck and Carol Ann Emmeck ST. CROIX CO., WI .1 Rec'd for Record Husba-nd---and••-Wi•te...as-Z-0int...Te-nants• ; J U L no 1 1991 at 3:30 P M quit-claims to John .--P•:-..Emmeck- and--.Susan-•K-...... V . Emmdoki. Husband ---and- -Wife••as- Joint-T_enants•-- Register of Deeds S-t eroix............. the following described real estate in County, II State of Wisconsin : RETURN TO \a 1 /•1 • /K -1b, I Tax Parcel No: Located in the NW 1/4 of the NE 1/4, the SW 1/4 of the NE 1/4 and the SE 1/4 of the NE 1/4 of Section 30, T30N, R19W, 'Tdwn of St. Joseph, St. Croix County, Wisconsin. A parcel of land located in the NW 1/4 of the NE 1/4, the 5G~ 1/4 of the NE 1/4 and the SE 1/4 of the NE 1/4 of Section 30, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the N 1/4 corner of said Section 30; thence SO°27'5311W (assumed bearing referenced to the monumented North-South 1/4 Section line) 1374.67' along said North-South line; thence S89°32'0711E 817.54' to the point of beginning; thence N6705914311E 466.701; thence S2200011711E 4616.70,1 to the centerline of an existing Town Road; Thence S67059114311W 249.47' along said centerline; thence Southwesterly 226.5711 along the arc of a 450' radius curve con- Cave Southeasterly whose chord bears S53°34'1711W 224.191; thence N2200011711W 522.54' to the point of beginning; containing 221,717 square feet (5.0899 acres); and being subject to an undelineated easement to St. Croix County Electric Cooperative to place, operate, repair and maintain an electric transmission system as recorded in Volume 256, page 538, in 1938'; and also being subject to existing roadway easement across tAe Southeasterly 33' as shown on the attached map; and also being subject to all other easements, restrictions, covenants and ordinances of record. thisi homestead property. ~u J is not) (IS) thi ................Dated n day of Cc~.r ro.~.11 l. ..:.....Em.YhCd~. (SEAL) _ (SEAL) " t..... " C t: .......i=:.mC.n.~S,-1.\._. (SEAL) (SEAL) s• AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. Cl(.•~--~J. County. authenticated this day of 19...... Personally came before me this ......j1.... of 19.11. the abovenamed j-'~t bra j~ r . al.k _._-.~'Q10./. Anr).. !11 TITLE:4l9I,EMBER STATE BAR OF WISCONSIN (IIN, t1Tj I.....- 1 ' . ........:i.. thorized by § 706.06, Wis. Stats.) au to me known to be the person ._5....v:. imbo,executed the foregoing jnstrument and acknowledge~,the sam¢:; THIJ INSTRUMENT W 'AS DRAFTED BY - m K v _o-J e...... .....S.~-~.!.`Q!.-~LJCr. Notary Public ~_Gb X y ! ....Coun~y, Wig. (Sg res, may be, authenticated or acknowledged. Both My Corhmission is permanent. (If ri t, state•.expirla~ign are not necessary.) 1* } j• date QUIT CLAl'M DEED STATE. 11AR OF WISCONSIN R'iscrm,in T.rcnl Rlnnk Co. Inc. rnn\r . rn. n SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County a OWNER/BUYER John P'. And Susan K. Enuneck V% ROUTE /BOX NUMBER ' 374 Val' ley View Trail Fire Number 374 CITY/STATE Hoiultori ' 'WI ZIP 54082 c~ PROPERTY LOCATION: Section 30 T 30_N, R19 W. Town of St. Joseph St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed''sept'ic tank pumper. What you put into the system can a' ect a function or the•septic tank as a treat- ment-stage in the waste disposal system. St. Croix Countyy residents-may _ be eligible to recieve a grant for a maximum of 60% of the cost-of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. i The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2)•after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year-expiration. H I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- w ment of Natural Resources, Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATFs~~'~~ ~ f~/~ St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. Y r T' - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ti INDUSTRY, DIVISION LABOR-AN P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: . J SECTION: TOWNSHIP/MIHN GJPA4_ IT`r LISION NAME: 1 V c /13c~ N/R 1q 1(or, W w ~i COUNTY: OWN R'S BUYER'S NAME: MA I ADDRESS: ~C)l p___ ( \ USE TES OBSERVATIONS MADE x~yy~I NO. BEDRMS.: COMMER I L DESCRIPTION: PROFILE DESCRIPTION ER ATION ESTS: MI'lesidence XNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system q cwt` Sac-a- S q CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYS M:(optional) &S ❑U CAS ❑U S ❑U ❑S U ❑S U Grj If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the All j4 under s,H63.09(5)(b), indicate: a~ -1_a_,o 3 I Floodplain, indicate Floodplain elevation: I c PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-f CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER Dom, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 31 1- R'Ansl B-Z 102UN a - q 13/_5j s ` Z. - ens B-3 16-2,i-71- A/ 0 Ne ZS O is - 2.q~ d s -.57 "6n--T a, I .-Y o „C B- 21 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER D2 P PER INCH P , / N d /1/ 0 ~1/91 If 4/ 6> P- 3 O d O P- . e- v / 7 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 9- _ 17 '~)0/l3cr^n" _ i T1 I r r ,may I r 1 I t t3 € I 3 I jj 0/6-1 70 E I -~zz I t 3 ; I I 3 ? q.5 V CL !I i 7 f 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 the location of the tests are correct to the best of my knowledge and belief. NAM (print : 4 TESTS WERE COMPLETED ON: DRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 5-1-1 a 'S - 5- 2 6 " S` I 5` CST NA URE / 1 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - L - oL ' 6` / - - D - - - - - - - - - - i I /Au ~-74, 1 1 1. i ~ i VC. I i9/2- S ! G - S E ¢3 i ~lG - O Mows e i j }