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HomeMy WebLinkAbout040-1056-90-000 y 0 C a O- N 0 o a a_ C O C o o m tl c O E C c >•°'E l a� CO CD v, m Q) > y E N C Z y � w, v Q) LL cc 00O N a . "a o a Q f r U 00 3 `n I it E 00 .- °0w am I o I O Z • a aai z a c a cq F r O N Z c E a a N M N 0) y � C L O = 0 c C Y O O 2 c w Z {- D o Z I U) C c d1 N C t6 E 7 V! ++ a m r a0i E N d A r O C ca 04 O y d 81 ~ 0 N G G a E D Cc 0 ce 000 z cc CL •�r�i y �N 7 LL'� 0) 0) o N ' >a 0 � m rn) r Z w O C) N � 0) N E 0 a o m m 0 d °—' Q >- to m I li M 7 O I�Np C O O m E ! c Q) X 0 0 LO 1 co V O N C to u EL O y N N W lO O :2 N O N y 7 N N e!y', FBI O E U r Z C FO- fn d•+ E V ` U L a Parcel #: 040-1056-90-000 09/28/2004 09:41 AM PAGE 1 OF 1 Alt. Parcel#: 040-TOWN OF TROY Current -7 ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): *=Current Owner " DUANE M&CATHY A VORWALD VORWALD, DUANE M&CATHY A 793 GLOVER RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): * Primary Type Dist# Description *793 GLOVER RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 8.000 Plat: N/A-NOT AVAILABLE SEC 14 T28N R19W 8A IN NE SE N 400 FT OF Block/Condo Bldg: E 660 FT&66 FT STRIP ALG W LN OF E1/2 OF NE SE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 14-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 848/293 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 233,100 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.000 88,000 181,300 269,300 NO Totals for 2004: General Property 8.000 88,000 181,300 269,300 Woodland 0.000 0 0 All 8.000 88,000 181,300 269,300 Totals for 2003: General Property 8.000 55,000 169,300 224,300 Woodland 0.000 0 0 Total 8.000 55,000 169,300 224,300 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 205 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER .�PJi4 k Uj)j 1k TOWNSHIP SEC. T 00 p N-RYW ADDRESS ST. CROIX COUN Y, WISCONSIN C SUBDIVISION __._ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 100 � 4 IN tleAdeS ►g' 13 b t/ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used S{' Le(► role Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer:J�CYPS (`'`�1 ''e���i id Capacity: (! Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ' Number of feet from nearest Road: Front,O Side,O Rear, O �11� feet t From nearest property Une Front,0 Side,0 Rear,(D feet Number of feet from: well , building: _ (Include this Information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER ., Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: P ^ Width: Len$th: a- L5 .� Number of Lines: 09 Area Built: 5y Fill depth to top of pipe: 42 Number of feet from nearest property line: Front, (D Side, O Rear,O It .SQ Number of feet from well: J161 fP i 17C Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property liner Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: nn Dated: �d OV Plumber on job: 1/f O L' 5 License Number: 3031 3/84:mj 1 �SD k r r V-w4j �L S L 7-d9 Pile 31 WtOt r w I b�miv► �a h�� (e0y �G►�v 'Elev• ��.60 I ao � ru as Alter. ao' I , C 1] b� I w DePARTM�ENT OF INDUSTRY, ' INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE4S4fSec. 14,T28-R19W ❑CONVENTIONAL 1:1 ALTERNATIVE state Plan l.DNumber Ilf assigned) Town of Troy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Glover NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D TE: Duane Vorwald — r j3 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. R .PT.E EV.: CST REF.PT.ELEV. Name of Plumber: MP/MPRSW No Coumy. Sanitary Permit Number:C_r Thomas A. Wan SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. ROVIDED`ABEL P OV IDED KINGCOVER ❑YES ❑NO ❑YES —]NO BEDDING: VENT DIA.. VENT MATL_ HIGH'WATEfs INUMBER OF ROAD: PROPERTY WELL: BUILDING. JVENTTOFRESH ALARM. LINE AIR INLET: FEET FROM OYES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: UOUID CAPACITY PUMP MODEL PUMPlSIPHON MANUFACTURER WARM PROVIDED LABEL V OVIDEO OVER ❑YES ❑NO ❑YES 1:1 NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1EJYES ONO NEAREST— 41110 SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH UTAMETEN MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until LRCE the soil is dry enough to continue.) IN C NVE�yN-TIONAL SYSTEM: "'.BED/.�RENCH ": WIDTH. LENGTH TRENCHES DISTR.PIPE SPACING. MATERIAL: INSIOE DIA sPITS DEPTH: PIT DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH.PIP, DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER ELEV INLET ELEV.ENO PIPES FEET FROM LINE AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO PERMANENT MARKERS OBSEH NATION WELLS OIL COVER TEXTURE ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH'eED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER EDGES. ❑YES ONO -]YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: ('I�`y.�yy 3' WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BE IOW PIPE FILL DEPTH ABOVE COVER :��SED/TIWW', TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFIMATERIAL NO.DISTR. ID ISTH.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. DIA. ELEV.. PIPES DIA.: ELEVATION AMC DISTRIBUTION{ INFOWAATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY R MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. I YE ­__E_ NO DYES ❑NO COMMENTS: ERMANENT MARK RS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE DYES ❑NO OYES ❑NO NEAREST I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710(R.61/82) SANITARY PERMIT APPLICATION CSI=HR In accord with ILHR 83.05,Wis.Adm.Code couN .e...,�...�.,�.e. STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ � /e 8%x 11 inches in size. Ch vis 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. PROP TY OWNER /( P OPERTY LOCATION ��C 00 W , %T4' % S T-2k, N, R I E(or PROP TY OWNER'S TILING AD E LOT# BLOCK�! 1t?U" IjY,STA ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) ❑State Owned ❑ CITY !d NEAR ST�OAD ,OP k ❑ Public ❑1 or 2 Fam.Dwelling#of bedrooms Ax NUMBER(P ) Q /O_! O III. BUILDING USE: (If building type is public,check all that apply) 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. N New 2. ❑ Replacement 3. ❑Replacement of 4. ❑ Reconnection of 5.❑ Repair of an 9 stem 9 System stem Existing S Y System System Tank Only Y F 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 El In-Ground 42 1:1 Pit Privy 13 Seepage Pit n t f Pressure 43 El Vault Privy 14 El System-in-Fill o�" X 5� VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQ RS (sq.ft.) PRPO ED(sq.f.) (Gals/day/sq.f.) (Min./inch) ' $01i ION l SD 6 1 6 bOFeet I .ob Feet VII. TANK CAPACITY Site In allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank P P �CI' d Lift Pump Tank/Siphon 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): Plu r Signature:(No St mps) Business Phone Number: g a 3 7 ��s yas- s Plumber's Add r (Street,City,State,ZIP C de): IX. COUNTY/DEPARTMENT USE ONLY Ej Disapproved Sanitary Permit Fee(Isuronag Groundwater a e s us Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial 06 Adverse Determination VV 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 sc 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: I. 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. 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; 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 monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD4M8(R.11/88) r I APPLICATION FOR SANITARY PERMIT STC. - 100 I 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 La'o' e Z)04a2a / Location of property Iff 1/4 5� 1/4, Section _, T A N-R 1114W Township f A Mailing address h �l A4 A7 Address of site a Subdivision name x Lot number Previous owner of property i Total size of parcel Date parcel was created Are all corners and lot lines, identifiable? _Yes No x Is this property being developed for resale (spec house)? Yes No t Volume lJ l l and Page Number D l� 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, 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. ---------------------------------------------------------7--------------------- 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. �-2 ; 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 of said system, and the same has beeMd rec orded in the Office of the County Register f Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) Date 0! Si nature Date of Signature +a i ry 1 ;� H Ln , H a T ST C '- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYER dn(° /,./0 t lio ROUTE/BOX NUMBER �(j 0 V- �C3 Fire Number CITY/STATE ��() .e� � �S �� �� ZIP PROPERTY LOCATION : _14, � Section � '! T &9u N , R W, Town of St . Croix County , Subdivision , Lot number 1 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 septic tank pumper . What you put into I` the system can affect the function 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 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 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) 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. yo E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein , as set by the Wisconsin Depart- v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'Zoning Office within 30 days of the three year expiration date . SIGNED DATE St . Croix County Zoning Office P . O. Box 98. Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . r • 3,c DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TO N /MUNICIPALITY: LOT NO.: LK.NO.: SUBDIVISION NAME: A V%eI /T "/R E(o M COUNTY: ' 0 N R'S BUYER'S AME: A ADDRESS: "�.Prb ►X vl e � if �d e: USE DATES OBSERVATIONS MADE NO.BDRMS.: C DESCRIPTION: PROF D NS: AT O TESTS: Residence New ❑Replace �' Q' g uu RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUNDPRESSURE:r YSTEM-1 N-FILLHOLDING TANK:RECOMMENDE SYSTEM:(optional► ®S ❑U SS ❑U ©S ❑U ❑SS]U ©SL V'e� e If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: (Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.Hl H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) .-X s'6 0 106,6 Is; I 000 e h S- -3- 015 Xn Aed B- a ,�h 6o hl T•1 -2 60A14 s .c9 5'/fin ed S B_ 3 /,,5'o4ijs ( V�A4 .*ied4l B- y 9F•d 10 4 .1 ,reed S B- ,o 2 6o A t-9 i I A 1 0611 S -9,64 444F?W 5 el war' S B- PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —PERIOD t PERI PERIOD 3 PER INCH P- 36►' o 015 a a /a P- 3o a 1 I P. ,. 30 a a a is 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. --fAG010-0 1 1 40-50 SYSTEM ELEVATION a 95.66 l,ue d, i JI 0< ___i __ ____ _ err- f I tN I j i t f t_ i j 1 _ D :C r�� tS . - t I 'bv i I I i i 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(pr t :- TESTS WER MP TF ON: D,ft4 c 5 Pot i 71d 9 PH NE sNU—MBER( tonal): ADDRESS: CERT _CA ON UMBER: s CS ATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. QILHR-SBD-6395 (R.02/82) - —OVER=