Loading...
HomeMy WebLinkAbout038-1161-20-000 Q c a~ I M p 0 cOO 1 G C r. I 0 ~ I CN ~ I s ~ I ~ I I ~ I I N N O C z I O m LL c j Q j M Z N I ~ o I - o C L •G L z I r d d N M W a CD O O Z d °c O ~ p d' 0) z N m m m I ~ d N c w y 0 y N ~ C •FV r a L m O C O O Q ° O a~ Q w. O Z (Yl z o N Z I N d N N Q c y f6 > 06 E d O L - -~D U Ln 41 Eli c O O d (D M N -a L) 3 rn m m E 3 o tv O 0 2 a a a a s Z CL ~ L I w -1 0 U) 0) 0) CD Mme, _ M N ~ N O N r0 E o 3 M • d Q } O U) 7 C> O C N C ~i 3 N 0 E 00 O fR"y o H U w c c U IL :3 0) o (m p C, Lo a)- nr _ N_ Cr M cL y 't S N N N O [ c' d l C N US N M M 'O c6 m 'E 7 M • 7~ M N N y m m 4 o to 'j', o N <n I I N Y a ti a w I • m a c, m y c E i C C 7 rr~~ CJ O iy 3 O `~1 A u(L 0 t)U FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIPS-41`!z , C, ; SECTION-jL~_T _,j N-R~ W j ADDRESS{; ST. CROIX COUNTY, WISCONSIN SUBDIVISION ALA LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e ~oic,~z:l y INDICATE NORTH ARROW r BENCHMARK: Elevation and description: tJr), 5!-4-- fj Alternate benchmark y SEPTI1',; TANK:Manufacturer: p6lw- Liquid Cap. Rings used.,-i9- Manhole cover elev:,-7' Final grade elev: 4 Tank inlet elev.: 17t~d- Tank outlet elev.: No. cf feet from nearest road : Front, SidelD, Rear j o Ft. I From nearest prop. line:Front , Side , Rear-KFt. ~'L> ~No. cf feet from: Well Building: f '(Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE t f 'I 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:&' A Trench: Seepage Pit: Width:- Length Number of Lines: Area Built 4-Q s Exist. Grade Elev. .6 Proposed Final Grade Elev. /f Fill depth to top of pipe: r f, No. feet from nearest prop. line:Front"~-,,Side ld, Rear2S~Ft. No. feet from well: 2~1`` No. 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 Wisconsin Deparyment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations St. Croix Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Lot 2 Sanitary Permit No-: GENERAL INFORMATIONSE, SW, Sec. 12,T31-R18 135th St. 149124 Permit Holder's Name: ❑ City ❑ Village Ej Town of: State Plan ID No.: Chris Martinson Star Prairie CST BM Elev.: Insp. BM Elev.: BM Description:' Parcel Tax No.: 1001 03,3 T - 756 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet . TANK SETBACK INFORMATION St/ Ht Outlet 5 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic a(~ ) ' NA Dt Bottom Dosing NA Header / Man. q b Aeration NA Dist. Pipe IS ,C Holding Bot. System qy, 2 PUMP/ SIPHON INFORMATION Final Grade_ J Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss - _71 _-A Forcemain Length Dia. mead Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1a" 51"" DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O -1l0 Moe Number: System: l 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 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.) r Plan revision required? ❑ Yes Q/No r Use other side for additional information. I},{,v SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s ' ~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTI/ STATE SANITARPERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 22218' 8% X 11 Inches in Size. C on 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/ 1/4,S/ T NR E (or PR RTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, TATE ZIP CODE PHONE NUMBER SUBDIVI ON NA E OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE ❑ Public R 1 or 2 Fam. Dwelling-# of bedrooms ~ PAR TAx N ER ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo V 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 12 ❑ Service Station/Car Wash 4 ❑ Church/School 8 ❑ Mobile Home Park 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.W 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 Holdin9Tank 12 ~ SeepageTrench 22 ❑ In-Ground 42 El 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 Feet Feet Vll. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concret structed Con- Steel glass Plastic App Septic Tank or Holdin Tank Tanks Tanks . 4-~ zeAa., j - .±L F11 _F14 El 1 0 LJ 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. Plum er's ame (Prin PI is ignatu : (No to s) MP/MPRSW No.: Business Phone Number: S Plum is Address (Street ity, State, Z' ode): IX. COUNTY/DE ARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No6amps), V7 Approved F-1 Owner Given Initial Surcharge Fee) Advers D t rmination 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 INSTRUCTIONS 1. A san,itary.,permit is valid for two (2) years. 2. Ybur 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 maintanied. 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. Il. 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 if tanks received experimental product approval from DILHR. Vill. 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; (lose 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) APPLICATIOH FOR SANITARY PERMIT STC-100 This application form Is to be complatod in full and signed by the owner(s) of the property being developed. Any Inad©quacles will only result In delays of the parm)t Issuance. -Should this development be intended for resale by ownst/contractoc,(spoc 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 property -17~b"_1/4 ~/4, Section T- w Township hailing address ' IrALC' Address of alto lvbdtvlslon name Lot number Previous owner of property'/ j Total size of parcel Oats Parcel was created Ate all cotnars and lot lines ldentiflablet X' as 0 to this property being developed for resale (spec house)? so 1\ NO Volume a3 and Page Number erg- i2 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TITS FOLLOWINGt A WARRANTY DIED which includes a DOCUMENT NUMBER, VOLUNZ AND PAGt NUMetR, and the SEAL OF THE REGISTER OP DEEDS. In addition, a cettlfled survey, 11 available, would be helpful so as to avoid delays of the tavlewing process. it the dead description references to a Ceitified Survey Nap, the Cartitled Survey Map shall also be required. 7 PROPERTY OWNER CERTIFICATION I(Ye) certify that all statements on this form are true to the best of my (out) Rnovledgel that I (we) am (ate) the owner(s) of the property described In this Information form, by virtue of a warranty sod recorded in the office of the County Register of Deeds as Document No.G and that i (We) pcasently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, lot khe construction of sold ayatem, and the same has been duly recorded In the office of the County Register oL Deeds, as Document No. s gnatute of owner Signature of Co-owner (If Applicable) Data of signature Date of Signature O ` DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 463078 VC! 883PAGE REGISTERS OFFICE Timothy J. Ra.ehsler, ST. CROIX CO., WI Rec'd for Record - at ~ i 4 9190 11:35 M conveys and warrants to -.Christopher-J, Martinson and ally.,Jo_-Marti.n.son,-.husband and - a$ .__sur<tluorship-.property-.. - Regiahbrofa,. - RETURN TO the following described real estate in .3t,._.Cmlx---------------------County, I_ State of Wisconsin: Tax Parcel No: Lot 2, Johnson & Associates First Addition to the Town of Star Prairie. TOGETHER WITH an easement for ingress and egress over a private street, designated as Outlot 1, private street, in said Addition and TOGETHER WITH a cul-de-sac Easement located at the North end of Outlot 1, private street, as shown on map of said Johnson & Associate's Addition. This is not homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated this -------------------5 day of October --------------------------------------------199A (SEAL) (SEAL) " * --Timothy - ----F;aehsler.----------- ---------------------------(SEAL) --------(SEAL) ~I * * I AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN III ss. l St. Cr'01X---------- ---County. authenticated this day of--------------------------- 19----.. Personally came before me this day of I I 199Q.... the above named of _ _ _h J. Raehsler * J__ TITLE: MEMBER STATE BAR OF WISCONSIN - - (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the f oing instr nt and w he same. I THIS INSTRUMENT WAS DRAFTED BY J - - 0- - Kristina._0gland_.Lundeerh---------------------------- Alice Joy_.. __[q QTA Y__/~. Attorney at Law Notary Public - - Cr0 ounty, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is anent. f not, eta expiration are not necessary.) f PU i date: _J_uly-1a-- 199a ) *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 2- 1982 Milwaukec. Wis. v~ p ~ s~ C/ ~Al .J.J • SEPTIC TANK MAINTENANCE AGREEMENT a St. Croix County M w 0 OWNER/BUYER o Fire number _ ROUTE/BOX NUMBER M CITY/ STATE ZIP ~,D~it~iiti tD PROPERTY LOCATION: 'sS Section_ T,.• N, R_a W. Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes.. Proner maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed' 's'e' t'ic tank pumper. What you put into the system can affect the .uncC on o, t e•septic tank as a treat- ment-stage in the waste disposal system. St. Croix Count residents-maZ be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, wh E 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 'sys't'ems agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, veri- journeyman plumber, restricted plumber or..a licensed pump fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- 30fdayssludge apthan 1/3 proximatelyfull priordtoc~• essary), the sepc~illkbe ssentless Certification form 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 Depart- Y ment of Natural Cer,ification ,cao0ffice must withinm30edays ~ and returned to the St. Croix County Zoning of the three year expiration date. SIGNED--( DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: SE 1/4 SW 1/4 12 /T31 N/R183j (or)W Star Prarie 2 n/a n/a COUNTY: BUYER'S NAME: MAILING ADDRESS: St. Croix Chris & Sally Martinson Box 303A, Star Prarie, Wi. 54026 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: I Residence 3 n/a Clev ❑Replace 19-27-90 9-27-90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL MOUND: IN-GROUND-PRESSURESYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ®S ❑U E S ❑U ❑ S MU ❑ S ®U conventional 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 decimal' PROFILE DESCRIPTIONS page 4 BxD2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTF(ld4Q. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 17.01 97.60 none >7.01 .92bl.1. 1.00bn.sil. .42bn.l.s. 4.67bn.c.s. B 2 7.50 97.81 none >7.50 1.08bl.1. 1.25bn.sil. .67bn.l.s. 4.50bn.c.s. B 3 7.41 97.90 none >7.41 1.08bl.1. 1.50bn.sil. .50bn.1s.. 4.33bn.c.s. 4 7.67 98.11 none >7.67 .08bl.1. 1.17bn.sil. .42bn.l.s. 5.00bn.c.s. B- B-5 17.75 98.65 none >7.75 .67bl.1. 1.08bn.sil. .67bn.l.s. 5.33bn.c.s. B- decimal' PERCOLATION TESTS TEST EPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER D AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERT D PER INCH P-1 3.50 none 3 6 6 6 <3 P-2 3.71 none 3 6 6 6 <3 P-3 3.80 none 3 6 6 6 <3 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 94.10 _ 3 o0 -,.v t~' 10 3 ~df /•5/.~s_ ' o i TN E 3 E e y E 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. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 9-27-90 HE NUMBER (optional): ADDRESS: CERTIFICATION NUMBER: r7j~246-6200 1554 200th. Ave., New Richmond, Wi. 54017 2298 CST SIGNA E: C~p DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 1 PE I TO THE J Th tc r C guest 0 I L ~~i~'/S ~~~P?/,ilSo~ S~ ~ S~~~s~c/~~T~s/,~;h/~~ foot ~ ~ - l°' ~ I ~ ~ .I e I ~ ~ ~ Q ~~~s~~ l,/ ~s,~ i~ ~ ~ - CroSS fS~c~101, o~ 1~c17 Sy ~l~✓//~.Sp.~ fresh Air IAI And Optervallon Plp• ,&x, 303,E l ADProvid V.nt Cop Fltnlmum 12' ALOr. Fl not Grade 20 - t2' AEo.$ PIPP _ 1' Coil Iron To Flnol Grade V.nl PIP$ 1Aain Hoy Or Synln.tk Covirlny min 2' AgQr.aol$ - Ovu PIP$ Olitrlovtlon ' Plp$ - 0 T$. 6!Aggt!#qaI* B0 Pulordl.d PIP. 6.lor o -Co,01ng T.,rnlnollnp AI Bottom 01 Syit.m pro p~~eD SOIL FILL DI5TRIBUT101.1 PIPE ;t APPROVED SjWTI-IETIC COVCR ` o tUTER1AI OR 9 OF STRAW 2" OF I~GGREGAIE Ott MARSH HAy i9 F 0 r- - 2 t/2 AGGREGATE ELEV. o f EE T DISTRIIjUTIOU PIPE TO BE AT LEAST I►JCHES BELOW ORIGIUAL GRADE A1.IU AT LCASTLO INCHE' BUT KIO MORC THAI] 42 IAICHES BELOW FINAL GRADE MAXIMUM DaPtH OF F-)(CAVATI,00 FXOM ORIGWAL 6~1\1[)F- WILL BE INCHES MIN MUM ©CPrli of EXCAVATION F'KOM. CA,161t4AE ()RAVE WILL »E. INCHES SIGUCO: LICEUSC DUMBER: _ Zs DATE