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HomeMy WebLinkAbout032-2112-10-000 "r o C o N o ~n p W o C; L n I 00 .3 I N M M ~ N ry. , E v 00 U C (4 E c S f9 N .S. a 0 f9 N U t N L _ O Z > m C O 75- 3 c. LL O j 3 :0 r (D ) B N 3 E LL N M N Z rn U) E O r L Z y m M a H Z c 0 o z d' 2 o d z a ° E d N N c0 0 Z m z N _ z 'DI E E ° ,0 N o L m Y m CL (0 o w m c o aa) 3: G G aL c o c N N fn <j o twt d c F- d O - N E a 0 a0. z o ttl U a r C N a) N N to J U Z 0) rn } pp N O Cn 0 _ ,.O E i IL C, m N as Q D GO 7 O C L N C E U) ❑ O FO- ca p c 4. © RR ~ 04 c Y ) c ce) O N N N c ZCD .O CN 04 co ~V O ~ M O O (4 0 O Z O _ U \ w E v r~^ E d ~dt a `a w jr~~ E i C I C 3 _1 A U a 2 0 N U Parcel 032-2112-10-000 08/23/2007 04:22 PM PAGE 1 OF 1 Alt. Parcel 11.30.19.1040 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - FAGERLAND, MARK A MARK A FAGERLAND 1626 70TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1626 70TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 13.832 Plat: 2322-PINE MEADOWS '97 SEC 11 T30N R1 9W NW SW LOT 1 PINE Block/Condo Bldg: LOT 1 MEADOWS Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 11-30N-19W NE NW Notes: Parcel History: Date Doc # Vol/Page Type 06/03/1999 604255 1431/160 WD 06/03/1999 604254 1431/159 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 13.832 102,100 263,800 365,900 NO Totals for 2007: General Property 13.832 102,100 263,800 365,900 Woodland 0.000 0 0 Totals for 2006: General Property 13.832 102,100 263,800 365,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 515 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER - TOWNSHIP SECTION _T_2~ LN-R_LW ADDRESS ~b ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING W THIN 1 0 FEET OF SYSTEM 9a~~ G~ . a~ INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK: Manufacturer: - f d,,c S Liquid Cap. Rings used:,,;2-Manhole cover elev:- Final grade elev: Tank inlet elev.:_1~Tank outlet elev.. No. of feet from nearest road:Front , Side , Rear Ft._J.20o From nearest prop. line:Fron , Side— C , Rear Ft. No. of feet from: Well Building:; (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.: 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: )C -Trench: Seepage Pit: Width: -Length ,q,Z ,L Number of Lines: Area Built'Za j Exist. Grade Elev. ~ i~ Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest p op. line:Front , Side, Rear Ft f No. feet from well: No. feet from building HOLDING TANK I 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: ~'G} 6/90:cj it Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Felations Safety and uildings Division INSPECTION ( Q~-H REPORT T St. Croix Sec, ~9 P1Z1 V,'T 0th Ave. SanitarPermit y GENERAL INFORMATION SW4 , Sw4 , ec.f+, Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: Mark Fa erland Somerset CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 639 h&q Il 032-2042-50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet a3~ $z.g 3 TANK SETBACK INFORMATION St/ Ht Outlet 8~ 6 tTANK TO P/ L WELL BLDG. Ai Inake ROAD Dt Inlet Septic >A,vo NA Dt Bottom Dosing NA Header / Man. Y,,7 e 3,32 Aeration NA Dist. Pipe 1~11/.%- g3~a~ a. aY Holding Bot. System 7,0 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand yyr r ly ~10~43 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length EDia. Ff Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a. ~tf DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO 41-4 CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold 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 Over Depth Over xx De tt Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter Bed /Trench Edges Tops ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons presero -71 1 0 i C1 Plan revision required? ❑ Yes ❑ No Ilk 6 a Use other side for additional information. a~ 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 911~-rHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COON STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / ~a~2 8% X 11 inches in size. Check i# 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. PROPE OWNER PROPERTY LOCATION '/a, S T,3O, N, R / (or MY) P OPERTY OWNER'S MAILING DDRESS LOT # BLOCK # df9f 7L V ze I CCITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION AME R CSM NUMBER ' CITY NEAREST Ra4D 11. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLAGE : th =N QF v ❑ Public X1 or2Fam.Dwelling-#~ofbedrooms ~ PAR EL TAX NUMB R() ,a~~ III. BUILDING USE: (if building type is public, check all that apply) p v ~C~~-~S~ 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 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. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 El Mound 30 El Specify Type 41 El 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gal /day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 1115~ E3_ . 0 1 F 0 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installat" n of the onsite sewage system hown on the attached plans. Plu be s Name (Pri tj) Plumb 's natur (No MP/MPRSW No.: Business Phone Number: 1 r P umb 's A dress Street, CD, State, Zip de* IX. COUNTY/DE ARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g gent Signature (No Stamps) i Approved F-1 Owner Given initial ) / Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 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 /#&Z/ A A ( it)ld Location of propertyAL14_1/4 SO 1/4, Section T -3Q N-R/V W Township Mailing address 1Z/ Z^/,e9 7:7 - t5D/o Address of site Subdivision name Lot no. Other homes on property? yes No r Previous owner of property /C /J ecl /-J Total size of parcel Date parcel was created Are all co i rners and to ~ t lines identifiable. Yes No Is this property being developed for (spec house)? Yes .2No Volumes5-9and Page Number q,3LI as recorded. with the Register o f Deeds. cfi~ 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 n the ffice of the County Register of Deeds as Document No.S 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. Signature of applicant Co-applicant Date of Signature Date of 4gnature SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Awa Z~4 ADDRESS: FIRE NO: LOCATION:A11xJ 1/4, ,~GtJ 1/4, SEC. ~T_~50 N-R1W, TOWN OF: oMAo-e5f--7 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. Croix County Zoning a certification form, signed by the owner and 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: I. DATE : St. Croix County Zoning office 911 4th St. Hudson, WI 54016 DEPARTMENT qF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDOSTRY,' DIVISION LA$OR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT N .:BLK. ]!SUBDIVISION NAME: /T3 N/R/ E (or) ~~y _S kj COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ' / ot1 p / .c USE T DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMME IAL DESCRIPTION: PROFILE ESCR PTIONS: ER OLATION TESTS: Residence ~ ©New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(opti nal) ©s ❑u ®s ou ©s ❑u DS au OS ©u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. I LHR 83.09(5)(b), indicate:/ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, A DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 44 _ - B- 9' AIN& y 9,19 B- 'S_ - - 92 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE RIO 2 PERIOD PER INCH P- 34 r s r P_ JVdAAE 7 43 P- /r 1 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 t p an Show the surface elevation at all borings and the direction and percent 0K0 of land slope. SYSTEM ELEVATION ~ ' t/ ~6 _ _ , I , E _ yJ Ord .P 3 € v 'T' E 7~ ~ICt nZ~~ ~ , b o 'lei W N rt , , 1, 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. NAME( p TESTS WERE COMPLETED ON: / Ll 'Au'c Z/ ADDRESS, CE TIFICI N NUMBER: PHONE NUMBER (optional): -lay CST SIG AT R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - t 'W~~.~~~~ StJ sW% s~/~ 0AI~9hJ i`Yi~.osaaJ ~ S Tif'.cV/oQ -31 Gi m 1 i L //L.7 ' g7s qm 0 a • PA.. E' or r o S ~t 1 U11 p /~l Ur17 1Tr`n'1 Ao/~ fieth All Iolel► And Obistwollon Plpa ADDrorjd Van/ map ' Mlnlmun 12-AD°ra final C/ado 1 1 20. 42' Above Plpp Coal Iron To final Grae* Vonl Plpa - Mw $1, flat Or S/niM/1a Co.o/Iny Wa 2• Ayp/ap°la 0.or Pipe OIap1b.119n Pipe o 0 0 Tao i 6 ~ A~p/epale I 8anaa1% Pipe ° Pulorola~ Plyo Bal°r1 o -Co W410% Tamle°IlnIAt l Boloom 01 Spalam f i • Pru(~o~rp 5r ~1«~•.~ ion ~ ~ ~ • SOIL FILL OISTRIBLITIO).I PIPE APPROVED S`IN'(HETIc com • r•~ r - "e' lUTERIM- OR 9" OF STRAW, 2'Acf hGGREGAIF. , OR t1ARSN HA`.f f FLor.%-z'/i AGGREGATE "~P ELEV. oF El;T---a- I'I OISTRIP,/JTIOW PIPE TO BE AT LEAST _ IUCHES BELOW ORIGIMAL C.RAOE AQU AT LEASTLO 110CHE5 BUT 1.10 MORE, THAM tit IUCI{ES BELOW FMLIAL GR:\CE MAXIMUM MN of EXCAVAT100 ROM OWWA,L 6i~hD ~ WILL. 5Z: j2/1- IMCHES tNHIMVM 0CFnA of CACA\/AT10" r-f\OM 0161NAL GRADE W1IL 6E 1NcHES i . SIGIJEO: I I LICCUSC WUMBER: ~ y • • ~p~ / I + :1ATE: I