HomeMy WebLinkAbout010-1080-70-110
0 N 0 3~ 0 d col
r
3 ! f m 3 D,
7 0 Cp ~j N y •
~n
3
3 C~CD 0 C0N N r7~
CD 7
00_ Z N
N a 3 0 fD I O Oy
W° >v p
offCD
O w
p N 5'i c C3
m U) D Cp fl p
(D 0 CD CL -4
rt O
N. R G w
n Z O s',
N. L
CD
J rt
O 000 OOD y r co)
Cn U1 3 Q
fD
ra E H 000
~En3 o 0 a CO) CO) to 0 41 0
r~ o cr D O 7
U, OD
,a -0
r w O m co
m
cJ~ d ° m d = 0 t~
r N CD o
ao CL :3 3 00
w
c p
i Ul z ca z
O O D CL
o w
IS)
\ Os^ o o fn
~ y !NI
I
tJ ! m
x tai m w m a
:Ej
C G
rt m c6 :t
U) FJ 0 ri 0 O ~ O A Z f~
O W O =h c
(?Q(
W
w
CD o
q) W
I a ~ z
- r 00 3 Z C~
z G
I w CD j .P
I I
CL >
Er CL
I ~ o~i c
0 oz a
I ~ m
o s;
I ~ y
I
1246
I `
it
I 14
I ti
N
I o
i o
v
A
ti
I o p
CD b
O
O ~ ~v
I ~ O 'I
Parcel 010-1080-70-110 01/25/2007 09:14 AM
- PAGE 1 OF 1
Alt. Parcel 33.30.16.487B-10 010 - TOWN OF EMERALD
Current X I 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 - SMITH, DAVID M & CHERYL I RUCK
DAVID M & CHERYL I RUCK SMITH
1247 230TH ST
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1247 230TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 33 T30N R16W PT SW NW LOT 1 CSM Block/Condo Bldg:
8/2198 5 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-30N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1166/170 WD
07/23/1997 1005/391 TI
07/23/1997 933/73
07/23/1997 876/198
2006 SUMMARY Bill Fair Market Value: Assessed with:
168375 232,500
Valuations: Last Changed: 10/19/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 25,000 179,900 204,900 NO
Totals for 2006:
General Property 5.000 25,000 179,900 204,900
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 25,000 179,900 204,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 113
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 30.00
Special Assessments Special Charges Delinquent Charges
Total 30.00 0.00 0.00
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. T N-R W
ADDRESS f." ST. CROIX COUNTY, WISCONSIN
SUBDIVISION j~ LOT /W LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of II-HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/
z~-- o /Doa a/
K 1
I~
S7e ✓e 26~
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: '
G7 Proposed osed slope at site: S'
SEPTIC TANK: Manufacturer: l e ~°7~ s Liquid Capacity:
Number of rings used: zrto Tank manhole cover elevation:
Tank Inlet Elevation: 7 ®9 "Tank Outlet Elevation: O p
to 'D t-UN Number of feet from nearest Road: Front 10 Side, Rear, O feet
From nearest-property line Front 10 Side 0Rear, 0 feet
/ r
Number of feet from: well 4/5 , building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: PuWSiphn tur Pump Size
Elevation of inlet: f k elevation:
Pump off switch elevation: l ons per cycle:
Alarm Manufacturer: itch Type:
Number of feet from nearesFront, O Side, O Rear, Q 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: AZ& Z)q
Fill depth to top of pipe:
Number of feet from nearest property line: Front,' O Side , Rear,O itt 3~f
- fC~
Number of feet from well: ,
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Botto of seepa a pit e v tion:
Area Built:
either a drop box or distri t'on bo bee u es on any of the above soil
O O
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of a":
Elevation of inlet:
Number of feet from nearest prop ty ine: Fro Jide, O Rear, 0Ft.
Number of fee from el .
Number of feet om buil g:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated : Plumber on job: License Number: Zq
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
f MADISON, WI-53707
p MCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned)
j
t NAME OF ?LRMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
John Walz R. R. 1, Glenwood City, WI 54013 ?5 2 { !3 6)
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
SW NW, Section 33, T30N-R16W, Town of Emerald
Name of Plumber: imp /MPRSW No. County: Sanitary Permit Number:
Dale E. Hudson 6629 St. Croix 74959
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: _ LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
- l PROVIDED: PROVIDED:
/ fi DYES ONO DYES ONO
BEDDING: IVE1T CIA.: VENT MAIL: HIGH WATER - NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM FEET FROM 9 , LINE: AIR INLET:
DYES ''0 DYES O NEARESTJ0 /~J
DOSING CHAMBER:
71-NG
MANUFACTURERCITYPUMP MODELPUMP/SIPHON MANUFACTURERWARNING LABEL LOCKING COVER
PROVIDEDPROVIDED:
YES DNO DYES ONO DYES ONO
,r. GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMB ' F PROPERTY WELL: BUILDING. JVENTTOFRESH
(DIFFERENCE BETWEEN FEET RC ~INE AIR INLET:
PUMP ON AND OFF) DYES NO NEA EST 1111ij
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 ~NCTH 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 INO OF DISTR. PIPE SPACING. COVER NSIDE DIA #PITS LIQUID
/ 7 TRENCHES MATERIAL' PIT DEPTH"
DIMENSIONS F /(J
GRAVEL DEPTH FILL DEPTH DISTR. PIPE-. DISTR. PIPE DISTR. PIP MATERIAL: NO. DISTR. R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE~~OVEFI ELEV INLET. ELEV. END J PIPES'- FEET FROM LINE: n/ i AIR INLET:
/J NEAREST > ✓C'
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
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WFLLS
DYES ONO DYES ONO
DEPTH OVER TRENCH/BED 7PIH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED:
CENTER- GES:
DYES ONO DYES ONO DYES 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 IM ANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.. ELEV.: PIPES: DIA.:
ELEVATION AND
t RIBUTION
RMATION HOLE SIZE- HOLE SPACING. DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FR E
LINE:
M
d. DYES ONO DYES ONO ]NE ARESO
lv
y, 7-/
,
D.'
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710 (R. 01/82)
- r
`"15`°"!W" APPLICATION FOR SANITARY PERMIT
COUNTY
DILHR (PLB 67)
orPRRTrrwnT op UNIFORM SANITARY PERMIT
mousxRY,LR90R 6 MUmgn PElPTldns - -
_ / / /
Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in.size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNEF► MAILING ADDRESS
• < c
PROPERTY LOCATION ~T,T=
W 1 /4 /IJIc)1 /4, S , T N, R,14 It (or T 0 W N 0F: ,E /yC.r'l1f
LOT NUMBER BLOC NUMBER SUBDIVISION NAME NEAREST ROADE LAKE OR LANDMARK STATE PLAN I.D. NUMBER
fY /`n~/♦~ ,2 3d S .
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms: 3 ❑ 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.
Seepaye 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
Gallons Tanks Concrete Constructed: Steel Fiberglass Plastic
Septic Tank Capacity Q.
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: S
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #99 efab. Site Steel Fiberglass Plastic
Gallons T s ncrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE AB SORPTION' AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
53 /.ZS
®Private ❑ Joint ❑ Public Ili
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number:
•Ca c SEE (715 ) -3
9 6P 3 7F
z ~
Plumber's Address: Name of Designer:
O /'?v, n Y7', w / _51'00 Z.
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
ink r 4 ❑ Owner Given Initial
U~ iJ, J C~ Approved Adverse Determination
Reason for Disapproval
Alternate course(s) of Action Available:
DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
1 P6
Gcl1'1 ~ r" S
30
n ~o ~z Pao ,
1
~ 30
/ SeP f"rr
70/
"Ve n
Pie r e, ea-"e. 53 in, de/'7th ~
J* 11 N, 3col A? )e 70 d
rep e
49 Pe~~'flr ofed Pvc, P,~e.
8
4
Sec. 33 SS
y:
T
s"ay N ,yy
7
4 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 inadequaoies 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.
c% A1 Al IJ g L Z
Owner of Property
Location of Property SG✓ 3~ Section 33 , T N - R /46 W
Township 6-M e-
Mailing Address 0 I
Subdivision Name A1,4
Lot Number A '
Previous Owner of Property e;g e 5~~i,•,~/l
Total Size of Parcel
Date Parcel was Created OctO ~e r' q
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume ,2 3 and Page Number AoI as recorded with the Register of Deeds
CLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
Cl.Waarrannty Deed
d 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) cvtti.6 y that att d tatementa on this 6onm ane tnu.e to the but o6 my (oun )
knowledge; that I (we) am (cute) the ownex(e) 06 the pnopenty desehdbed in this
.in6oamation 6onm, by vchtue o6 a waAAanty deed neconded in the 066.ice o6 the
County RegiAten o6 Deeds a.s Document No. o5q Z ? and that I (we)
pnesentty own the pnopoaed .6 to bon the sewage pod bybtem (on I (we) have
obtained an easement, to nun with the above de cA bed pnopen ty, bon the
constnucti.on o6 eaid system, and the came has been duty neconded in the 066.ice
06 the Co
AA or_-- unty Register o6 Deeds, as Document No. 4CATU
E OF OWNER IF CO-OWNER (IF AP LICABLE)
SI ATUR
DATE SIGNED DATE SIGNED
H
H
y
ST C- 105 r
H
SEPTIC TANK MAINTENANCE AGREEMENT' C 12,
St. Croix County
d
9
H
OWNER/BUYER__
ROUTE/BOX NUMBER Fire Number
-
rL I P ~~13-----
CITY/STATE _c°/744,20
NcJ 14, section .3~ `r 30 N, R
PROPERTY LOCATION: SW
Town of 41?9e;ra St. Croix County,
Subdivision_ Lot aumber Aa._•
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 puii)er. 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 iu.iy 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 1.980, with the requirement that
owners of a_i_1__ new stems- agree to keep their systems properly
maintained.
'Elie 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 N
three year expiration. °
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- b
meat 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. Fox 98
Hammord, WI 54015
715-756-2230 or 715-425-8363
Sign,, date and return to above address.
MEMO
,;rte:.,.::. ::Y:
x"~~,,:%,i
C ' m N~ Cf O > V m
E d m 3 co o N
N t" O C G p
3 4)
W 3 ~ oo~ ~ ~ E a
c~ ~
~~c_(m== =oU)
Q m ? _ ~ y L- o do
v
~ _ CO Cd m aims a q
W m m3mmV ""'t`d
d U) ld C C U y m m m D
w
CC W c~o,3 0 ~o(D
Q ~Q ~r m ami E U) r m
1- 3 Cd C m .
~ V N O N .m..
Q Z N~"~mN 4) 3
cNd O d 0 w CO V C
O 3 v o a = M 'o°s
p~v~ a yCrc
a 7 m et cd m
_ _ N
Q ~ '
O
C m O 4 7 0
C a. - N w i:+
(A td ~ m ~ L O ~
c 3 c a rnZ c
0 :3 o0C
~o`.-°cco, tcc
0 M 0
ri tmv>",'o v E 0
rn me
V N d >r N a ld U C
~ Cd W (D Ae ~ o m 3 N m a1
O
r' 3 N m3 3 m N m~ n of °
C O m m d N p c 2
Y cm cm j E C 0) t M Os
T O cd O D i 0 N
C y U U 0)Y 3 O pr
coA~Lm0 L'-3N m c
0 E N fA U) rL.. ~ = vmi
W
p S
N .J
D
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AN-D PERCOLATION TESTS (115) MADISON, WI 53707
HU110AN RELATIONS (H63.090) & Chapter 145.045)
s
LOCATION: SECTION: TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME:
s -
S'lJ/alCla 33 /T3o N/R/j' L (or► W e.n 0,It,
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
DATES OBSERVATIONS MADE
USE
ii I PROFILE DES RIPTIONS: PERC LA ION TESTS:
NO.BEDRMS.: COMMERiii i DESCRIPTION:
Residence _ VNew ❑Replace 'r 16
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(opti71)
S au Ys ❑u s ❑u EIS u s au
DESIGN RATE: If an
If Percolation Tests are NOT required Y Portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain indicate Floodplain elevation:
PROFILE DESCRIPTIONS
OBSERVEDOUND EST.EHIG H EST S TCHARACTER OF O BEDROCK IF OBSERVED (SE THICKNESS, ABBRV. ON BACKjEXTURE, AND DEPTH
BORING TOTAL IN. ELEVATION DEPTH TO
NUMBER DEPTH IN
B- f / 7. 3.1 W
B- .3
B- 7,` o4 3S > 7, a G "er 1 .2. O
/0 1. ag A& 16 L2
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
rP--
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 /d/, 07
CJ b ~eS ..I36~.......~ m. e~~R
l B~_ _1..... __~I 'S?
I
,
IN
L P113 " F 71,
i
,
.
i i
I
. - -
s I, l E 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 (print): TESTS WERE COV- GTED O :
6 C4, I I,-.).
ADDRESS: CERTIFI J? MBE PHONE NUMBER (optional):
u, O! 7,e~ - 8
.2- 1 CST SI N TUBE:
r
ZL/
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
°JSTRU T1 S FOR COMPEL. < _:33 FORM 115 - S CE -
TO ' and accurate soil test, your r M n
1. I description; _
2, or) must clearly i :ate whether thk is or commercial project;
3, 1 ;dr or commercial use I
4, is
SITE I qLa' IF ALL,
T _ ASE"
6. re to e
Lion . to l
per ;
r t testa
iate box;
E FILED WITH THE
F !T` 1 'A . S ",F C
ALTE T
cc
~r - u }
`s -
i" Y _
S(,
s
p _ r ni
n
l{~.' y E. _
_ v point
T THE OWNER: This sail test report is the first step in securing a sanitary permit. The county or the Del ment may request
anon of this soil test in the field prior to permit is ~ replete )r the private
i system and a permit application must be submitted w a1 lc I r _ y in order to
a I errnit~ I ary permit must be obtained and post r