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HomeMy WebLinkAbout026-1014-50-000 n to O 9 v n v ~1 o d F c d o CD m (D A 0 A (D 3 .r sv v 0 7 z ° A v `C • _ v o 7 (D C S W a z m -4 3° C N O O .•y N a W N o Q, O n CD 0 CD O O O O O W O 9 cn c N o O° lr .h 3 N N W 7 O O t~ CD o (D (D ~ x p N C cn r (D M cn v C/) C D rt O N CD CO a W r• rt c :3 N co a O r• H o rt o 3 o< V w v i CD _ O j z < O 0 O r- Cn Z V lh In CD cc) co en !V C (D CTI -44` ti0 ;U a y z O O O o ~y"WA I - 1 n~i ° CD N r- I N a ( O 00 (M O0 U, z Co z C - y CD o H H v~ D~ O ° O O W CrJ p' (n !mil Z -0 ~ t`~l n C N h h F (D 00 cn CL O r• ° (D _ n n rt z Z~ ° Z C (D 0 H O n O_ H o C W m W 0 z CL , ' 3 0 o w U) N < Z O A A W m a x 4 -n Q m z n CL o F N Ut <O (D N ft n N 7 N N O O A O b O o O r v O Parcel 026-1014-50-000 05/24/2005 04:53 PM PAGE 1 OF 1 Alt. Parcel 4.30.18.50D 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner JAMES E JR & VERONICA LAUCK LAUCK, JAMES E JR & VERONICA 1135 173RD AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1135 173RD AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.320 Plat: N/A-NOT AVAILABLE SEC 4 T30N R18W SE SW 2.32A LOT 1 OF CSM Block/Condo Bldg: 5/1306 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 12/02/1983 389713 678/312 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.320 41,900 141,600 183,500 NO Totals for 2005: General Property 2.320 41,900 141,600 183,500 Woodland 0.000 0 0 Totals for 2004: General Property 2.320 41,900 141,600 183,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 „ Form- S T C - 104 Y AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP C► SEC. ~ T N-R_Z~LW ADDRESS T~~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION It LOT ff' LOT SIZE / f k << `3 PLAN VIEW Distances and dimensions to meet requirements of I•ZHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IJ A "J i f f i AN, SYSf INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ~~"NrS Liquid Capacity: / S Number of rings used: Tank manhole cover elevation: j~ ?Tank Inlet Elevation: Tank Outlet Elevation: ~f ~rf Number of feet from nearest Road: Front,OSide ,,RRear, O feet From nearestproperty line Front,OSide,0Rear, ® lte{ / feet Number of feet from: well building: / (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f 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 ~ r Bed : X 7 Trench: ' Width: 3 Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, © Rear, Olt. Number of feet from well: Number of feet from building: r'te' (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ~ ~ - ~,7~--- License Number : 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 MADISON, WI 53707 RRCONVENTIONAL ❑ALTERNATIVE Stale PI., I D. Numbe, Holding Tank ❑ In-Ground Pressure El Mound (If assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECT ION DATE. Jim Lauck R. R. 1, Box 159-F, Somerset, WI 11-14 5 .30,?o BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. CST REF. PT. ELEV SE SW, Section 4, T30N-R18W, Town of Richmond Namt~ of PI-Ph r MP/MPHSW N,~ C.,)liit v Sanitary Permit Numbe*. Gaylord Worrell 5285 St. Croix 74976 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELL V ITANK OUTLET ELEV WARNING LABEL LOCKING COVER P VIDED. 17)YES ED h" c" //a /a7 YES LINO NO BEDDING: VENT DIA. VENT MAT I 11,11,H WA EH NUMBER OF ROAD. PROPERTY JVVELL. BUILDING ALARM FEET FROM LINE AIR INLET ❑YES LINO C_JYES LINO NEAREST--~1 ~J~ ~S 1v~ /L IVINTTOFRESH DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPA(;I I V FUMP MfTUE PU".9P 74-1 1rr^.tANU! :TITHER WARNING LABEL LOCKING COVER ~~a. PRGVIDED. PROVIDE D ❑YES LINO /Z ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP A O ROL OPERATIONAL NUMBER OF PHUPEHTY WELL BIJ LDIN(, VENT TO FRESH (DIFFERENCE BETWEEN f FEET FROM " I AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST-- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - "T 7TI RIAL AND MAHKI or excavation. (If soil can be rolled into a wire, construction shall cease until LFORCE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTH PIP vET - NsII L nIA =PITS uoulD _ <11 ` THE N( :III pTf Ri PIT DEPTH DIMENSIONS ~ !V GRALlVELPIDPEPTH FILL DEPTH I)IS1H PIPE DISTH PIPE DISTR. PIPE MATERIAL NO ]I~ H NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH 6F )W ES ABOVE OVER EI Ell INIII ELEV END PIPES LINE AIR INLET. FEET FROM 7_ L 1 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- YES LI NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE [ HMANf NT 91AHKF HS OBSERVATION WELLS _ I_IYES LINO ❑YES LINO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH BED IJf PTH OF TOPS(IIL F Il ~f f Df IJ MULCHED CENTER EDGES rL_1YES. LINO ❑YES LINO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRNO -OF ENCHES LATERAL SPACING GRAVEL DEPTH HE OW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATEHIAI NO DISTH DISTH PIPE DISTHIBUIION PIPE MATERIAL & MARKING ELEV. ELEV DIA ELEV. PIPES CIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECI IY COVER MATERIAL VERTICAL L IF T CORRESPONDS TO APPROVED PLANS ❑YES LINO _ ❑YES LINO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS LhNUMBER OF IPROPERTY WELL: BUILDING. FEET FROM L INE ❑YES LINO ❑YES LINO NEAREST / a1L % Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Cam- ...T.. r DILHRSBD6710(R.01/82) ~t *I~" wlsconsln APPLICATION FOR SANITARY PERMIT DILHR COUNTY OEPggTR1EnT OF (PLB 67) UNIFORM SANITARY PERMIT # - InOUSTPV, LABOR 6 HUmgn RELRTIOns A41917 6 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER r MAILING) ADDRESS y- '1%I~-, r/ G( ~t c U1 ~lo A / 5 ! F -So 'rl c- 1 PROPERTY LOCATION Q~Y: 2~ VILLAGE: 1/4501/4, S T&O N, R E (or TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 3-~'' C TYPE OF BUILDING OR USE SERVED ITa 00 71 1 or 2 Family Number of Bedroums. 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. X1 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 - E-1 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 5- G Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: tL C, /51 c 7, I , C, c r l C -'i 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): `l 3, 6 / 6 / G i Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): [Si gnature: MP/MP~SV~'No.er: 4 Plumber's Address: S y Name of Designer: % 1 ti r / / r / COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: I❑ Disapproved ('BUD ❑ Owner Given Initial AA ~J G7 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. 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/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 JK rnES E L_?9L,_,-lc Location of Property '-)E: 14 S W 14, Section , T 3c~ N-R F? W Township E cj, w, , nl Mailing Address a c, 1 S ,:j _ F c- Address of Site R T 5 Bob -]y Subdivision Name Lot Number 1- Previous Owner of Property, F- H #9 r o ; u x Total Size of Parcel ~2. 32 eaPEs yozp,76' Date Parcel was Created cc - -a -7 - S2 3 Are all corners and lot lines identifiable? 'x Yes No Is this property being developed for resale (spec house) ? Yes X No Volume IV and Page Number tftx6 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) eekti6y that a.U statements on this 6oltm ahe thue to the best o6 my (ouT) knowledge; that 1 (we) am (ahe) the owneA (.6) o4 the pnopenty dens ear ibed in this .insohmati.on Sovn, by vi tue o6 a wa,tAanty deed neconded in the 044.i,ce o6 the County Regis -ten o4 Deeds as Document No. 3 ) -3 ; and that I (We) pnesentty own the proposed site {otc the sewage d vs pos system (ot I (we) have obtained an easement, to nun with the above dei n bed phopehty, 4ok the eovvstcucti.on o6 said system, and the same hays been duty hecotded in the 046,ice o4 the County Reg-i~steA o6 Deeds, az Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H z . cn H a ST C- 105 t" r a SEPTIC TANK MAINTENANCE AGREEMENT H o St. Croix County z d a OWNER/BUYER c s E L p i,-Ck r nn ROUTE/BOX NUMBER Fire Number CITY/STATE fir? f~.lc11 /i J)__) 1 ZIP 5901 7 PROPERTY LOCATION: SE k, SL,-' Section T 30 N, R _W, Town of F Ict,rnon1 St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in f 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. H 0 E I/WE, the undersigned, have read the above requirements and agree M 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 Sign, date and return to above address. • o w r ~ m N 'e ~ ~ N W~~ w~ c c N~ 0 COD. CD m n n cwD O 'o~ww v O C O o m ~c~m ~aCDm°p~? „ N D 0' m N m N N S m~o W3 co m N', CCD $ cn ..m ?m = CD' co w n a O n. ° m m oo o CD w c co ca > > O w oco 3 2 l< C- c - ~Z= c°~oca 0) o 0 S c~D w w ai c m N o ~o 0. > >D m w co CCD C n N Q . CD m c N (Ca Q N D _ A C: o _w ~ ~ o pp s v o a -m~ ° -*aQOw O N 7 N CD -0 A) o a w co w co = -i 7 Z aCND n 3 w m m a - D i CD, c a o S:(o CO) ~w sO =r o IT1 a m v, CC) m a = w c f CO) \0 3 m° Eo m w w C ITi CD N m - 0 CA. CD ~ =r iT w CD N m .w N CL 0 15 cr 0) op ° N O n. _ .c. D v pN"j 3 (MD ~ n f~ y CL o f ai c c c f A' 0 a o m Q N 1 Q O a CL N c `G c0 ? cD cc ~ (a m o ui CD CD a 0 7 o co a C 1 N n j c w ~C =r a ° m w o o A„ 03 o, o00 V a a m 0 3 cD o N z ~0 ZTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ;TRY, DIVISION Nn P.O. BOX 7969 PERCOLATION TESTS (115) AN RELATIONS MADISON, WI 53707 (H63.09(1 & Chapter 1145P45) l" TIO'/ SECTjO~T- (or)W TO TOIBLK.NO.: SUBDIVISION NAME: 2~1 "a &A IVI,4 TY: O ER'S BUYER' NAME: MAI ING ADDRESS: DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCI L DESCRIPTION: I Ne 1PROFILE DE R PTIONS: PERCOLATION TESTS: sidence w ❑Replace / _ S 1:2 JS r\JG: S= Site suitable for system U= Site unsuitable for system 6Q ENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM- N-FILLHOLDING TANK: REC MMENDED SYSTEM: (optional) sou IS ou ®s au os 21 u os ©u o - :olation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS NG TOTAL D PTH TO GROUNDWATER INCHES CHARACTER OF SOIL WITH THIC!:NESS, COLOR, TEXTURE, AND DEPTH DER DEPTH IN, ELEVATION OBSERVED EST. IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) f ' 3S-6 'R0 z Q- 7- 3 Z9 - PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES i3ER INCHES AFTERSWELLING INTERVAL-MIN. PERT 1 PERT P R PER INCH PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori nd vertical elevation reference points and show their location on the plot plan. Sow the surface elevation at all borings and the direction and percent 1 ;lope. ,'STEM ELEVATION I 4 I , In,) aLy FYI _ s . -23 i , N i i r _ ; t- - - -r A ~I• J.l .i indersigned, h reby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin ,istrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. (p,+4 0: TESTS WERE COMPLETED ON: - CERTIFICAT ON NUMBER: PHONE NUMBER (optional): CST AT RE: IRUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. SBD-6395 (R.02/82) -OVER - Be x / 5 F S c-. t z z t l' 5 r 7 y S. cam- L<~ S y T C S, E 3 t i 10 N vim' A~a f p tlt^cr S ~ S 4'0r/gof''X i Drawn by MP5285 TURTLE LAKE Gaylord C. Worrell PLUMBING & HEATING P.O. Box 93 Turtle Lake 54889 Turtle Lake, Wl 54889 715-986.4138