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HomeMy WebLinkAbout036-1054-60-000 0' o d ~1 1 Q c ~ > > n 3 r* q~M A m 3 Q! \ 1 M (A +y ~ 2 4f Z O oo -n N W W *0 O rtt I' d =r 0 3 v c o wW> ('70) M V o° (D I-d -4 (D FJ- z m ^ w N fl o m v~ z: w \O1 N td v rn n m n O C + 7 O C .y+ I- 00 p F+ H 0 - m al~ Z m u> (ID D a W (A N j 00 -j m a ° a co C CD (D C 3 co S H 0-c' tD \ ° ter In 7 Z ~ D! H C~ ~ o a°o co m N O c a) 0) v m d 00 I Z 0001 00 i t n m e N (A CO) 3 11 y o Q V G G 0 Z s m ON w --j 14 ° z N 0 0 r, V) yQ7 FJ O o i v CD yTWA m ~ O N v c O W CD N rh c N a w m _ rt a m -1 Uf az A Z ai a 0 0 C ' W < Z W o : -n I 3 w c z c o CD A y It, I!i I a c.a I °o ~ v o0 v Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,y1,,,/,ti TOWNSHIP ~TAti7.>H SEC. ;w_3 T 3 i N-R t? W ADDRESS ~P3 t?ny /67 i? ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT ~y/G¢ LOT SIZE PLAN' VIEW Distances and dimensions to meet requirements of I•IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /Du.G .%1 ECp. rj LG✓L i t ` p,Q Sic. VLP s • v INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used &,,I to E1.m0-ote p/.,`' 41yP / 1•I hW N~ Elevation of vertical reference point: -Jjffi Zoo" Proposed slope at site: 7E- SEPTIC TANK: Manufacturer: GJ~.ic~~s Liquid Capacity: j000 i Number of rings used: / Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, O /L 6 feet .From nearest property line Front 10Side ,0Rear, 0 feet Number of feet from: well >leo` building: i.S' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) nnn nrc.r•r nrl e.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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed:_ Trench: Width: /Length: Number of Lines:_ Area Built: X36 Fill depth to top of pipe: Y-~t~ Number of feet from nearest property line: Front, Q Side, O Rear, 0 Ft Number of feet from well: > 600 Number of feet from building: 6 °a (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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 'It-( S6 Plumber on job: License Number: E329 3/84:mj DEPART MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, 011 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Numner ❑ Holding Tank ❑ In-Ground Pressure El Mound of a:. xf AV-PA11,00 AU NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION A E Merlin Frank Rt. 3 Bx 167B New Richmond, Wi. 54017 8/12/86 2:30 BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEv.. CST NEF PT. ELEV NW-NW'-4 Sec. 23 T31N R17W Town of Stanton Namr nI Plumper. 1MP'MPRSW No.-. County Sanitary Permll Numlter. Mike Wilson 6388 St. Croix SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER 2,n PROVIDED PROVIDED 1W , 1J~1 YES ONO OYES NO BEDDING. - IVENTDIA. VENT MATL. HIGH WATER INVMB9R OF ROAD. PROPERTY WELL BUILDING (VENT TO FRFSH C I JALAR "t FEET FROM LIN / 5 AIFT wLEr DYES NO OYES NO NEAREST DOSING CHAMBER: MANUFACTURER 7INGS LTOUIDCAPACITV PUMP MUUEL PUMPSIPHON MANUF ACTUHEIT WARNING LABEL LOCK ING COVER PROVIDED POVIDED EONO OYES ONO OYES ONO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL. NUMBER OF PF7()PE It IV 11111 LL 1111111 DING VENT TO FIIISII (DIFFERENCE BETWEEN FEET FROM LINE I AIRINLET PUMP ON AND OFF) OYES ONO INEAREST-> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH IDI ANIF IF I+ IMATI IIIAt ANO MARKIN,,, 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 WIDT LENGTH INI OF UISTR PIPE 6SPACING C VEH JINSIDE DIA ~PIIS :AOL TRENCHFS TE H IAL: PIT OFPiFt DIMENSIONS OHAVEL DEPTH FILL DEPTH UISTH PIP! UISTH PIPE DISTR. PIPE ERIAL NO J 5TH NUMBER OF PROPERTY WELL HUILOING VENT TO f H! SII 1RE LOW PIPES ABOVE COVER FCIf V IIN~I PI' l ELEV END PIP LINE A I I IINLE T G Zip - 7 Z INEARESTFROM FEET 7/ ~ovD f lra~t t~J 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- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TF-xTURE TUITNI-ANE NI MAHKF RS I I I4Sf Ii VA II(I N WI l l S DYES ONO _ _DYES _ LINO DE PTH OVER THE N(:F1 HED ]DIPTIIIIVIII THENCH BEII DEPTH OF TOPSOIL ISOLILIF 1) SEE OFD Ml1L(:I+fD CENTER EDGES OYES ONO OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACIN GHAVEL DEPTH HF LOW VIP! FILL OFPTIf AHOVf COV! H BED/TRENCH TRENCHES DIMENSIONS MANIF UIU PUMP MA N1 Ff1111 UISTR PIPE MANIFOLDMATEHIAL NO DISIII I:ISIH I'IPF I W; IIIl11111 PINPIPI MATTHIAI 7(I ~1AllK INIELEVATION AND ELEV ELEV. DIA ELEV. PIPES DIA. DISTRIBUTION INFORMATION HOLE SLIF HOLE SPACING DRILLLOCOFIHf CTI.Y _ COVFH MATERIAL VEI+TICAI I IF T CDHRESPnNDS IO APPHUVI 11 PL AnIS DYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROEPS HiY WELL BUILDING FEET FROM LIN OYES ONO DYES ONO NEAREST_- V N 0) 0 Sketch System on _71 in county file f r audit. Reverse Side. G SIGN TITL DI LHR SBD 6710 (R. 01/82) I ® wisconsin APPLICATION FOR SANITARY PERMIT - (PLB 67) & COUNTY DILHR - OEPRRTTEnT OF # InOU5TRY, LRBOR 6 HUmgn RELgTlons UNIFORM SANITARY PERMIT ff3 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS /ye r -r r+ k 6 ry PROPERTY LOCATION CITY: ,,v&.)1 14ww 1/4, S N, R / E (or VILLAGE: S Tl~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME rNEAREST42ZM? LAKE OR LANDMARK STATE PLAN I.D. NUMBER . s 7: 14 1 ILt ' TYPE OF BUILDING OR USE SERVED ~ 03 ~QS 1 or 2 Family Number of Bedrooms: Public (Specify): /V THIS PERMIT IS FOR A: X 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. 5~. Seepage Bed ❑ Seepage Trench ❑ 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 Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity GOO Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 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 .10 Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /p 63P g~ ? ❑ Private X Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.: Phone Number: /"I i~i 6 61. L.~, 4 xe r~ 6-7 V? Plumber's Address: Name of Desig ner: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved W,ij,ae 61, (~a_Q,S(,~.e,[./ `2 lr~~ Q~~/ O/ ❑ Owner Given Initial Al o-t/ Q 0 (O ~ Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 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. 70 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 roust 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. Form - S T C 100 Owner of Property -e Y' ! r\ rUY~~ Location of Property ~ N U,, Z, Section Township ~l A- 1n~ p Mailing Address 5 X0)7 T3 ox rb~l ~ ~ _ Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the followin : .Certified Survey Map .Deed .Land Contract, or KOther I+egal Document which describes the property PROPERTY OWNER CERTIFICATION I I (We) certify that all statements on this form are true to the best of my knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty des r cordgd in the Office of the County Register of Deeds as Document No. r~o ;and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an casement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED it ' H z cn H . a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County x d a OWNER/BUYER ~Y t~11'1 F QAA "i ROUTE/BOX NUMBER 0Y , I Lj 13 Fire Number .CITY/STATE Jy ~U-~ L (i)VY1 C V1 CI ZIP b ~ PROPERTY LOCATION:_W 1%, 1%, section oJ3, T N, RW, Town of S-'a 0 , 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 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. 0 • E I/WE, the undersigned, have read the above requirements and agree EA to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b 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.'~-~2/T~. r DATE (p 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. O N Fm x --1 S N N '03 O (D ID (~D 0 10 0_ '(D ? w ' 3 c CE co _ z 0 E; C FD' -a N m O:3 wa-yO0 yi 0 co N t 0 13 a 0 0 pj 00 = N O CO n m 0 N O N a A) A. _ wwm «m~~~~ Q~ 0 'lb ?c0io~cDOID " 0 o a o- 'Comw o w o w0Cc ~c-ccu► jZS c~3'a ? ~ ~ v, ~m w w cn N m 0. 0 O• D m _ c0 CD w ~vv C y Q ~ 0 r. 0Dc C~ G) C tp ? O t~D a p O n w sago vwi C m 0Nm WD o;wm N o N -~(A w m g~ Z a w ~w ^ca►w'~ 0 Z o a(ft m m m m M= (D. 1 a a CD ch c w' a ar w a c " CL (D Cla viw; ac0*m~ ,y O m c ? a m v, mm pj aNy = O a~ m r. m "N - 60 N 0 --.C+UG a co n N fA G) ao* Ncca0 o m w w o.am m n. v N o m m C -=r 0 n o 5'c < Co M .m " 3 m 0 C ~fQ 7 'N 0 m O C O CL r a O c1D C -4 m ~ A CL 3 o~m0o,o m 1. dM w cx Q CD O O - - 3 m to ~a o< - Z 1 ~ O 0 i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, ~ DIVISION LABOR P.O. BOX 76 HUM-AN REILATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: /MUNICIPALITY: LOTNO.:BILK. NO.:SUBDIVISIONNAME: '/4 /T N/RoEA I COUNTY: BUYER'S NAME: MAILING ADDRESS: .S 'Y r L ~'ti -r , / It?-? Rok 147n Al w USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~ ~PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: .Residence Ql NeW ❑Replace g l ~6 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) [.0-1 S ❑U ® S ❑U IS ❑U ❑ S ZU ❑ S ZU If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: 1D L Floodplain, indicate Floodplain elevation: /yIyl _~¢T PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-I€S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I.W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Si 7$" fll0 h Et [ T r 0, L .2 L r B- 3 b~ r B- L c?S. S i I v S C T S L 3,47 0" S w- r B- B- 5 die a 7- "/_7 L? c-- 7! PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- 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 _ i ~d E, II I ~ ~L Q re- 4'~Ss(of}e)~~~r LI`f f 1 1 _ 5 .JGSN ~L f. [ (31 3 I (3.2` I ~~d ~f r G: ` Q~+ F1 ioa - V'L S c} 3 j 4 core t iGt mm z e{ ' 111; s Sit I _ J11- 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: . ^GliG, t LSO SS -'B'-74(1 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): h *V .C o 1 is ? I- s r t--" S'/00/ 7 7/s--.2 6 k- a s ? 7 CST SIGNATURE: IMSTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - --77U--`--3 R OM L ETI C ~ a 11 - D - 6395 r To a t(st, your report n)rls 1. 2. =tiler this is car r , _ en 14 10, 11, THE ITv a~ _ E 1-1 i « t7 s 1 ~ O A n a~ ~ ~ A i G 0 ~ ~ C ; p y~ ~ 6 ;j ~l f0 C ~ O ~ O ~ ~J a r e.. K IF- T 'f C3 V1 D 1 p 1 ® r- vs o * y _ r N Z i p ~ 0~ S V _ L i t a o l n fh r~ Q ~Y J Parcel 036-1054-60-000 02/06/2007 04:55 PM PAGE 1 OF 1 Alt. Parcel 23.31.17.346 036 - TOWN OF STANTON 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 - FRANK, MERLIN A & JOAN H TRUST MERLIN A & JOAN H TRUST FRANK 181121 OTH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 181121 OTH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 23 T31 N R1 7W 40A NW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-31 N-1 7W Notes: Parcel History: Date Doc # Vol/Page Type 07/10/2003 729662 2309/500 QC 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 2,800 0 2,800 NO OTHER G7 3.000 20,000 180,400 200,400 NO Totals for 2007: General Property 40.000 22,800 180,400 203,200 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 22,800 180,400 203,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 143 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I