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HomeMy WebLinkAbout042-1094-70-000 C( 2 3 °-0 0 ' C M c "a 7! 0 m o o=i o vvi v w• =r 3 V CD Z a f' N CO 7 f~D CO O `A\ C W 7 `p 1 .7 rt N d 3 p N f0 A t"'1 O N v O (D I-d N NIA $ c I n mW 0 (D O CD '2. 3 H =r ct td U) (A 0) i O. A,';~ 0 c N tJ VK D. W 00 c `G c F-4 C=i a o mmo c~rtn ~ CO rn ((p 1 3 S. H z 80 0 0 CD N) > 00 "a O\ O N Z O N fD 3 01 Z trJ D m o O N O Pd CL 00 F- 0 d 00 En , CD C (D U) o c N O E a w _ r w a m w p C (6 Ch p A R I W -I W ~ W I71 C.) z 06 c to 3 m_ y z <D W ~ d d C N a G 3 m c a o a I CD m m I a I y I O I I a A O V N I ~ I v C o b ~ 00 I o ~ ~ C) i v' t y" Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER ./(r f',kq TOWNSHIP ~arru~ SEC. 33 T ,?9_N-R /Y W ADDRESS 5yr,,,j ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT - LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM X 41 S.% ~'i X00 yon. yr, b)2 b ~YXS9 I 1.s. _ iz d'INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /md,o Proposed slope at site: r? SEPTIC TANK: Manufacturer: '(ye' s Liquid Capacity: /,too Number of rings used: / Tank manhole cover elevation: 76 Tank Inlet Elevation: Tank Outlet Elevation: If Number of feet from nearest Road: Front 10 SideG Rear, O > goo ~ feet From nearest property line Front, 0Side 10Rear, O feet Number of feet from: well ~7 S©f , building: ,7y (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE STnR w ~ PUMP CHAMBER Manufacturer: ~/"5cz Liquid Capacity: 75-d Pump Model: ,r z Pump/S:iphon Manufacturer: Z Pump Size Elevation of inlet:: Qd',(m Bottom of tank levation: X"X le Pump off-switch elevation: Gallons )er cycle: Alarm Manufacturer: Alarm Switch Type: 1>1.ed4"jy _ Number of feet from nearest property line: Front, O Side, O Rear, Ft.~ Number of feet from well: T S0 Number of'feet from building:, (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed Trench: Width: ?y Length: 5'9 Number of Lines:- Y Area Built: Zy/ 4 ' Fill depth to top of pipe: L " Number of feet from nearest property line: Front,` O Side, O Rear,0 Ft. Number of feet from well: > 75- Number of',feet from building: 37 (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. P.umber'of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3~zr 7 3/84:mj DEPARTMENT OF4NDUSTRY, INSPECTION REPORT FOR SAFETY & BUILD, LABOR & *HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISI, P.O. BOX 7969 BUREAU OF PLUMBIN,. MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE Staasste PlanignedL) D. Number (If ❑ Holding Tank D In-Ground Pressure ❑ Moun 12, x ~r • NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: Mike Kaltenberg Rt. 2, Box 18, River Falls, WI b .3 o BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. NE SE, Section 33, T29N-R18W, Town of Warren Name of Plumber: MP/MPR SW No. County: Sanitary Permit Number: Dave Fogerty 3289 St. Croix 75049 SEPTIC TANK/HOLDING TANK: it ` MANUFACTURER: LIQUID CAPAC V: TANK LET ELEV. : TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER PR VIDE D: PROVIDED'. , j Q YES ONO DYES ONO BEDDIN VENT DIA.:,, VENT MATL: F~HGHWATER NUMBE O ROAD: PROPERT WELLBUILDING: VRESH 'Q 7 FEET FROM LNE ONO YES ONO NEAREST 114 DO ING CHAMBER: - 1 J MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTRO LS OPERATIONA L NUMBER OF PROPERTY WELL. BUILDING. IV ENT TO FRESH FEET FROM LINE. AIR INLET: (DIFFERENCE BETWEEN PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LLNhTH DIAMETER MATERIAL AND MARKING =FORCE or excavation. (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WID LTREONC DISTR. PIP~PACING COVER JINDIA. #PITS JLIQUID IENGTH RIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEP DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: TR. - NUMBER OF PROPERTY / WELL: BUILDING. VENT TO FRESH BELOW PIP S. ABOVE,COVER. EL V. LE EN IP FEET FROM LINE. / AIR INLET NEAREST rJ+ MOUND SYSTEM: i 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. DYES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OFTOPSOIL: SODDED SEEDED. MULCHED: CENTER. EDGES. DYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: PLANS. DYES ONO _ DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: OYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATU E: ~ TITLE: DILHR SBD 6710 (R. 01/82) wlsconsln APPLICATION FOR SANITARY PERMIT //~1 D I L H R ea1x BOUNTY (PLB 67) UNIFORM SANITARY PERMIT # OEPRRTTT1Er1T OF TOUSTRV, LRBOR 6 HUMRn RELRTIOnS -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 OWNE MAILING ADDRESS L-,4- PROPERTY LOCATION -etfY: FiE: f" 1 /4Sc 1/4, S T N, R XY E (or) d6 TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST R0AD;tAa4€OR fc STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED [!J`~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 El Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. RI/Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank El 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 77 e 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 Feet): U;KPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. 7e of Plumber (Print): re: MP SW o.: Phone Number: \Jvid e ~S (7 ~f1 34~~ Plumber's Address: Name o ner: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ,~y ❑ Disapproved Vi17^a Owner Given Initial 7 i Q Approved Adverse Determination _~~Vzh 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. 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 S T C - 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/contractglt,("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 Location of Property _14, Section T N - R W Township Mailing Address S Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? ZYes No Is this pro er y being developed for re ale7(-<spec house) ? Yes L,-- No 35 Volume and Page Number-~T as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eenti.6y that att btatementd on this 4o)cm ante thu.e to the but of my (oulc) k.now.eedge; that I (we) am (ane) the owneA.(b) ob the ptopenty dac&i,bed in th" in6onmati,on 6o4m, by vi tue of a wahAanty deed 1104211- eede .(.n the 066ice of the Ap- 'County Regi4ten o4 Deeds ad Document No. that I (we) pnesentey own the ptopobed site Jot the bewage pob ' by6tem (on 1 (we) have obtained an easement, to hu.n with the above dedcA bed pujoeAty, Got the condtn.ucti.on of bai.d 4yetem, and the .dame has been duty n.ecoaded in the 066ice f-•e6 the County RegfateA o6 Deeds, ad Document No. ~6,~A7 -7 1'4, /fit, 3-jxy SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (I APPLICABLE) / i q1 DATE SIG ED DATE SIGNED • H ° z H a ST C- 105 r" r a SEPTIC TANK MAINTENANCE AGREEMENT ryi 0 St. Croix County z d OWNER/BUYER 6 ROUTE/BOX NUMBER Fire Number CITY/STATE. _S -2- ZIP PROPERTY LOCATION:"_'~, - Section.?-? T~N, R W, Town of -Al G~~arrSt. 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 II 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 z 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 -DATE St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCWTION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: t/4~t~ 33 ITz N/R E ( air - - COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: t ,Z 1S- USE DATES OBSERVATIONS MADE NO. BEDRP : COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: li? esidence IIJNew ❑Replace. RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDEDSYS/TEM:(optional) EU C Colruck ox./J it 3'yX S41 f` ❑U CAS ❑U z S ❑U ❑S ~ ❑S If Percolation Tests are NOT required DESIGN RAT : If any portion of the tested area is in the under s.H63.09(5)(b), indicate: x/Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS L,Z BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WI THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B v we 7 3 n .3 3 s w B- L > S 1.2 ` "e, Ae. w/tee , I~il2 - 'V'dN B- S 73 X13 ,3' .9 S~w t w ,P' s .r,~~ sew o~ PERCOLATION TESTS - a nr TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INC ES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIO PER INCH P- c 3 3 P- 2 G A9 2 .t 20 P- !J / P- P- L HSY L N: Show loca tions of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- an vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent sl pe. M ELEVATION f _~~ta/ F- 7-11-1 E . f f t i , E f n !V 2 , 7 _.t. N /L' 'y2 "r/.S / f a nfj' /Sfr ~-~I 9SSCI/f+ ~r /1 # -47 qin 1, the undersigne d, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods onsin 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: v`d e~~ 4,- L q-! _j ADDRESS:.._. CERTIFICATION NUMBER: PHONE NUMBER (optional): - r( ca 1 %-!L s 7HR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - ' ! b B e° x aw. x e ew r- 4"?, R iri,„ M L - 7 YOUr red , i Fl t• f 3 I ` I r ~ t • 1C ~T t 41~1 ark S ' `S~ d 1, ~wN lit re are n~ar~~ ha f"irs 7` e~ -Z ~¢l I"`^^~ ~'~SPa ara ov~~52Y fQt'kq roGCY~t 1~+ / 2 3 7"1 71 7° ~s {ZO y~ rrQ ~ ~rt rr..uf in Y~iY ~ c eFs. -~f- is O/,A,R X /Y .1OGf T~7 K ~G,[Y~AL r~ `fi 7e. ell Gt04 jr Z r I M Y ' + + k f, r r + j 0 e4 {f a S i W 0 A j ( yg s8 N i l !K i I f j t + 9 I j i htC/ ~ 1 j i ! ~ - r T ~ 3 I i i . 4 OYL i t\ \ 1 L / M 101 ~,-l i i i f i 3 6' i G( ' f 3 ~ J Parcel 042-1094-70-000 02/07/2007 01:03 PM PAGE 10F1 Alt. Parcel M 33.29.18.5238 042 - TOWN OF WARREN 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 - KALTENBERG, MICHAEL & SHARON MICHAEL & SHARON KALTENBERG 621 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 621 HWY 65 SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.400 Plat: N/A-NOT AVAILABLE SEC 33 T29N R18W PT SE SE LOT 1 CSM VOL Block/Condo Bldg: 4/921 & N 33'E OF LOT 1 CSM4/921 ALSO COM SE COR SEC 33 N17 DEG W 1367.25'S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 350.50'S 89 DEG W 616.96'-POB N 83 DEG 33-29N-18W W 67.95'S 17 DEG W 259.15'S 76 DEG E 66'N 17 DEG E 267.58' Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 783/226 07/23/1997 735/299 07/23/1997 686/432 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.400 51,100 180,500 231,600 NO Totals for 2007: General Property 5.400 51,100 180,500 231,600 Woodland 0.000 0 0 Totals for 2006: General Property 5.400 51,100 180,500 231,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 206 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00