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HomeMy WebLinkAbout020-1150-40-000 O m C 3 3 n 3 P N N r.r 1 0 CA -I Z Z ° CD C w N W • J n O y O O N 0 > n O R rl n- Z CD 3 O ►'h A o W Fes- ~ N a 0 0 :3 CD ~J CD (D b f, N CL O ; N O CD G co o w c 3 ~ ~r rt ' rt d m o r• o sU v> D m a w m N W a n G r VI x" CID rz CL CD 0 3 rn Cn C _ H b 7(~\ O F- CD N CL ro F- Ln z E o o°D oCOO m Q. 0 r- N o c + o 0 0 N 0 c` H ^ c cn to vi ° v :T Ol N 77 < d 0 0 N v\ rt z 3 m 0 z ° z Co O D o N N vi 7y O n ~i "vA o : CD 0 • G :Ei (D r CD ~y cn G H rt @ CQ N. l7 rt r.. c o ° w m n ~C ~J o n CD a N K G 0 a A FJ- W i~ w CDW CL z 'o H Z CID w I N o a CD ~ :3 n CID n N C 0aa c ? w CD CD x 3 a m ~ c y m CD 0 0 ~o t ~m N o 0 = a N a CD DA O OCD ts~ O w o o b o CL ti 4 Parcel 020-1150-40-000 03/22/2006 04:03 PM • PAGE 1 OF 1 Alt. Parcel M 33.29.19.812 020 - TOWN OF HUDSON Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BEVERS, KEITH O & ELIZABETH A KEITH O & ELIZABETH A BEVERS 635 COUNTRYSIDE LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 635 COUNTRYSIDE LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.010 Plat: 0215-COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGE LOT Block/Condo Bldg: LOT 26 26 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 904/318 07/23/1997 738/112 07/23/1997 694/442 2005 SUMMARY Bill M Fair Market Value: Assessed with: 92680 348,800 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 75,000 280,700 355,700 NO 05 Totals for 2005: General Property 2.010 75,000 280,700 355,700 Woodland 0.000 0 0 Totals for 2004: General Property 2.010 30,100 217,800 247,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 103 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 SG Croix County Planning and Zoning • t - I Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W ADDRESS l T. CROIX COUNTY, WISCONSIN SUBDIVISION 2LOT LOT SIZE. PLAN VIEW Distances and dimensions to meet requirements of I1HR,83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i ILE l~ `V I ,INDICATE NORTH ARROW I BENCHMARK: Describe the vertical reference point used;,, Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: /,1 Liquid Capacity: C- _ Number of rings used: U Tank manhole cover elevation: - Tank Inlet_Elevation: Tank Outlet Elevation: Number of feet from :nearest-. Road.: Front>O Side Rear , 0- tea feet From nearest--property -line Front,OSide,ORear, O feet 11 Number of feet from: well ~ }Z building: 10? (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RFR. RR.UR.RCR CTnV r 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lendt.h: Number of Lines: Area Built: Fill depth to top of pipe: " Number of feet from nearest property line: Front, O Side, Rear,0 Pt. l Number of feet from well: Number of feet from building: l' (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 line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of.feet from nearest road: Alarm Manufacturer: Inspector Dated: Plumber on job: h---- _ License Number: 3/84:mj i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 796`9 BUREAU OF PLUMBING MADISON, WI 53707 1?9'CON~11/ENTil ❑ALTERNATIVE State Plan LD.Number: El Holding Tank El In-Ground Pressure ❑ Mound assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER- INSPECTION DATE: William Schumaker Rt. 2, Ellsworth, WI 54011 16 ~w3D BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW-14 of the NE14 of Section 34, T29N-R19W, Town of Hudson,Lot#26,Countryside Village Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William Schumaker 6382 St. Croix 79131 SEPTIC TANK/HOLDING TANK: MANUFACTURER: I • LIQUID` CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER (44144 1 115o Q j ~ PRO IDED: PROVIDED: 1 `!ytl~+ 'L" nT YES ❑ NO DYES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE f AIR INLET. DYES NO DYES NO NEAREST 4 DOSING CHAMBER: MANUFACTURER'. 7BjED I NG: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES ❑NO DYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT IONAL NUMBER OF PROPERTY WELL- BUILDING. VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing ILF N1,T If DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO OF DISTR PIPE SPACING COVER INSIDE DIA #PITS LIQUID TRENCHES. MAyCfI IA L: PIT DEPTH: DIMENSIONS ! ~^•j GRAVEL DEPTH FILL DEP DIS P ABOVE COVER'. ELEV IN 7. EI DISTR. PIPE DISTR. PIPE MA ERIAL: NO. DIS NUMBER OF PROPERTY WELL BELOW PIPES : BUILDING: [VIENT TO FRESH . f LEV END PIPES. FEET LINEIR INLET: ~1 f~j NEAREST 1177// 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- DYES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: JOBSERVATION WELLS DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED D L. SODDED'. SEEDED: MULCHED. CENTER. EDGES . DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NI DTH LENGTH NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: JNO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING'. ELEV.. ELEV.: DIA.: ELEV.: PIPES: DI A.: ELEVATION AND DISTRIBUTION I RMATION TOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED I PLANS. JI DYES ❑NO DYES ❑ND COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES O ❑ YES El NO NEAREST U~v a o~ 10 16.95 t 1. Z~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE: DILHR SBD 6710 (R. 01/82) WISCOnsln APPLICATION FOR SANITARY PERMIT ~DILHR C ~ (PLB 67) inisuS COUNTY - T OF # In111U5TRY,4, LR LriBOGi 6 MUTRn RELRTIOnS UNIFORM SANITARY PERMIT /79i3 / -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPER NJLOCATION , 6✓ 1/ 1/4, S N. R E (0r)&9 TOWN OF: a eE. 44/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER o2~t ~N calms • l~ TYPE OF BUILDING OR USE SERVED A,,1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. K Seepage Bed ❑ Seepage Trench 0 Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Al, r ,t IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square): la 41, 0- /2'IC-011111" Private ❑ Joint ❑ Public 5Z_ 1~w 4pe e I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: M MPRSW No.: Phone Number: c Plumber's Address: Name of Designer: ' r F1 1_01/ COUNTY/DEPARTMENT USE ONLY f Signature of Issuing Agent: Fee: Date: ❑ Disapproved f ~ ~6V 0 0 L;V El Owner Given Initial Approved Adverse Determination Reason or ap al 61 Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber L INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 4 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -ti Owner of Property Location of Property IIAJ Section Zq , T a dJ' N-R / fF Township tq_&d s vAl Mailing Address R/? aZ ~6t v 6&y -h Address of Site fi T / i-lw~ So .c! G,/S Subdivision Name L°Q.c~.ryT Lot Number Previous Owner of Property -K~= ~~pti.✓ J!~ Total Size of Parcel Date Parcel was Created 01- 4 y jo Cc' Are all corners and lot lines identifiable? P~ Yes No Is this property being developed for resale (spec house) ? Yes X No Volume '72F and Page Number J/ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a .Document number, volume and pagze 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION I (We) ceAti6y that att .6tatement6 on thi.6 bojcm cute tAue to the beat ob my (outs) knowledge; that I (we) am (cute) the ownet(.a) ob the pnopenty debc4 bed in thins i,nbonmati.on boAm, by viAtue ob a wa Aanty deed neconded in the Obbi,ce ob the County Reg"ten ob Deedd as Document No. 4111 p q,.5- ; and that I (We) pne~sentey own the pnopoded .6tite ban the sewage diZpo.b byes tem (ok I (we) have obtained an eabement, to nun with the above d"cA bed ptcopehty, bon the conbthucti.on ob aai,d bystem, and the dame h" been du.e teco&ded in the Obbtice ob the County Regizten ob Deed6, ab Document No. qP ) . a w~is s-.+l~f~ SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DA SIGNED DATE SIGNED H H a STC - 105 C" r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z t~ a OWNER/BUYER ROUTE/BOX NUMBER Fire Number .CITY/STATE w~ ZIP PROPERTY LOCATION :&&) , Section 3 T 2 N, R r~W, Town of /.y~ St. Croix County, Subdivision;10 u.urr 3e'dG t1~'i`~.~ Lot number I 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 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. y 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro 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. J / ~lD_ ~/f SIGNED DATE St. Croix County Zoning Office P. 0. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. - o Z \ > O c ch 4) a~ W W CL 0 G C N V i (/f O (M 0 c 0 H O 0 O w c U' O go (qt w 3 c.a m a3 ' .O. O ca -0 C- N cc c O 3: 0-0 O L 7 C /R O 3 O V M_ y C~~ O C ~O' V Q cm 7~ U to O ~w 4) 0 c c0 c ( cm "a co d C V o W N' O d N C 41 Ix cc W = 1~.E~0 to Lo 0 4) C0a ='E M U) cvs N v c w3c~t~ ~ O Q y r 4) 4) E ~ v Z 3 C, I-'.~-..m4Nic ii Q Z v~3:4i0 > Q 3 p y~ w ° c v..oa t rn p V V t0 C V 0' Itt OM 4) ' Q O 0 4) t7 C :3 4) Ili .0 0 a: > Q a a CO O E- air o~ o (D c c O co ~ N cd «f 0 ° 0 o 3E>.0 C)Z. o~ m o ~ m » E 0.- r ~Oco0°' ~cc M E v 'IT M '0 4 N o v 0 (D O Y Q M U co 4) U co C 4) ` O~ V 'p ° 3 a 0 0 C 0 a ~0 o(D a)~a a)~0a c ° >.~c > E c- RS i (C ~0 :3 O a a 0 c0 L L i s E i 0 C O U U OEcm U) W-- FL-4) `v► s N _J O INDUS TMENI'OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR AND • PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 76 HUMAN RELATIONS (1-163.090) & Chapter 145.045) 9 ATIO : SECTION : TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: '4 / 3Y /TQ N/R/A(or)(~ ~c►~/~o'. COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL ES R PTIO : PROFILE DESCRIPTIONS: 1PERCOLATION T STS: Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system (J pc ONVENTI NAL: MOUND: IN-GROUND PRESS E: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) OS ❑U ❑S ❑U ❑S ❑II ❑S ❑u ❑S ❑u CON v 7( tIOLI t~ F ercolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the er s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PDESCRIPTIONS BORING TOTAL rGROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION VED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / yy. ° OW 9~ ° /o ,C B- IR v lie e- 2 / ° ,c -At - /d -7 f' "lyre 74; lzqej_g- B ~G a r 9 r..z r~ Ap, z B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERT D 1 PERIOD 2 PERIOD PER INCH P_ s . P G P_ ' P- P- y r dzezk 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 .~o j ' ~i'clt a,v , , 1 I `~~ir3 ! : s! I - t ( 3 l__ l i 1 j f to , i 1 , , i ( h 4 IN i : 43 \ I. ~tl±~ I i 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 (print : TEST ERE COMPLETED ON: C /P J L_ ~~Lsfc ADDRESS: C TIFICATIO, NUMBEfl: P ON`EINUMBER(optional): CST SIGN URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - <t 4 N s YY+ c} e' ft y., jj ~j See `l 4. ~ S fopoFr~si F~-~J l6©r'`' 3 L° d~ a5~ Or ,r 7,,~