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HomeMy WebLinkAbout028-1000-10-000 n O F~ -v Cs p p `J r 3 ° cy) o oN ,ice 0 (1) co co c ? O0 ° Q m o o p N N .Q C D O O co ~T n U CD O O O W O -1 co N co (D Op SS +p 7 N (D 7 O N C n O v CD cl, a J L2 O C7 M td jd b O o!' (n w 2 O cn C) ° ° o cc' O Cp N N "WANK 51 ED r(D r"d 5J Z C) ID ~Q 67 O N ` O O O n r- r (t I.J O CO W W (n O c W Ut cn W r. a O F j- c, n N -0 -0 -0 0 W H LT1 0 0! z O O O 5. I-' dl 'z P ~ 'G. 2 T ~ ~ r2 (ylu~l ®uf o o c ca w w N CD H ~d ON 0 ED N N N 00 A 'ED v~ (D 00 O O 5) o: - m m o H O p 'L3 rn m m F- N m m ° N Z ED w a In (D (D c ~ z I ((D 1 p z co z N n, D n 1° rt O , l 9 m tv 1 1° N m h ° c I U ti -1 c N °o H H Z 0 r- ED cc m. Qr4 0 NJ m CL Cho w (C n- ( I rrJ z i; ° a Z m d O Pd o 5 n • h1~ I--' ED c A Z C) (D v G G C) Z N U` rt co v m k" co • f,, a m z O O 3 a 3 m F- v (D CD Ij w co p o o a O p U1 0 o ° fl - m -n Cl) D - CD O ~ O V C c X Q O Q N Q 0' ED 4 co (.n C 7 ti Q ~ ED 1 J v Q r t~ O a i o (D o (D C) ~ Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT r W OWNER / ii' 7 J)~r rt - TOWNSHIP / G SEC. / ADDRESS ST. CROIX COUNTY, WISCONSIN ` = * ~1 L CD SUBDIVISION'! LOT ~LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IM "`~r~tfi ua INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side, Rear, O feet V2i .From nearest property line Front, Side, 0Rear, 0 feet Number of feet from: well Z % building: / "f (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Man facture Pump Size Elevation of inlet: Bo' om f t'nk elevation: Pump off switch elevation: al ons per cycle: 11 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:- Lenth: Number of Lines: ' Area Built: Fill depth to top of pipe: Z i Number of feet from nearest property line: Front, O Side, O Rear,O Ft Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits:,~_ D7ameter: s / Liquid depth: Botto o sei*page p Plevation: Area Built: Has either a drop box O or distr butio?n,box been,~used on any of the above soil absorbtion sytems? (Check one). , HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevat~i.gn of bottom of-~tank: r' Elevation of inlet: Number of feet from nearest property/ 'line: f Front, O Side, O Rear, O Ft. Number of feet fr m we 1:° Number of feet from building: Number of feet from ne rest road: 1 Alarm Manufacturer: Inspector: t/ is Dated: Plumber on job: s License Number: i 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O' BOX !gdg BUREAU OF PLUMBING MADISON, WI 53707 'CONVENTIONAL ❑ALTERNATIVE St ate Plan ID.Number El Holding Tank ❑ In-Ground Pressure El Mound ( If a::Iynenl NAME OF PERMIT TO LDER ADDRESS ~FER~ HOLD ERINSPECTION DATE: ~I Gene Pribnow R. Baldwin, WI 54002 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.. ICST1111. PT. ELEV NE,;, Section 1 T28N-R17W, Town of Rush_River Name of Plumber MP/MPH SW N(, Cni, city Santa.y Permit Number Dale E. Hudson 6629 St. Croix 69668 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIGUID CAPACITY TANK INLL F, FV 1 ANK OUTLET E LEV. WARNING LABEL JLOCKING COVER PROVIDED. PROVIDED. ❑YES C7NO ❑YES LINO BEDDING. VENT DIA VENT K.TATI HIH WATER NUMBER OF ROAD FPROPERTV WELL BUILDING. VENT TO FRESH ALAR FEET FROM LINE AIR INLET /Z M _ I ❑YES LINO DYES _ NO _ NEAREST " DOSING CHAMBER: MANUFACTURER BEDDING LI GUIDAPA(. ITV PIIMPMrIDEI r.lh1P SIPHON h.^ANUI A,.TUIIE it WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES LINO ❑YES LINO EYES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT IONAL NUMBER OF PROPFHTV JWELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM I^,F AIR INLET PUMP ON AND OFF) ❑YES _ NO NEAREST, 30 I I=. I I I SOIL ABSORPTION SYSTEM. Check the soil moisture at,the depth of plowing Dl'_v F T-E7 ~AT1 HIAL ANL1 MAHKIN1, 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 LENGn DIMENSIONS + NOOF W,THPIPI ~(Ir.,~, VIH NRIr,FbIA ~PI~s LIQUID TPF NCHFS rA f} i:HI4I PIT DEPTH GRAVEL DEPTH FILL DEPTH DISiH PIPE DISTH PIPF DI$TR-PIPE MATERIAL NO DISTIL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH ~BF LOW PIPES ABOVECOVER EI EV LN(( r EI FV NND , PIPES FEET FROM LINE,/ AIR INLET. J I-Z 0.~ - / ~f! NEAREST ► 7 J SJ f MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill rmaterial for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- I❑YES LI NO meets the criteria for medium sand. TIONS MEASURED. SOILCOVER TEXTURE r'[ HM A NFN 141 A H I I IPS OBSERVATION WE LLS YES LINO _❑YES LINO DEPTH OVER TRFNCH BED DEPTH OVE H THENCH BFO __]T;TTTTT7T)F7-TOPS 1ILL S()I ):)I 0 REF iJE U I) M L CHFD CENTER EDC,ES I ❑YES LINO EYES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LFN(FTH NO.OF LATERALSPAC IN(, (,HAVEI DEPTHfiEIDIVPIPI FIE L DEPTH ABOVE COVER I BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL N() DISTH UISTH PIPE DISTHIBUI ION PIPE MATERIAL& MARKING ELEV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DR I LLF D CGRHE C I L Y COV ERMATEHIAL VEH TICAL LI F T CORR ESPONDS TO APPROVED PLANS ❑YES LINO _ ❑YES LINO COMMENTS: PERMANENT MARKERS QBSEHVATION WELLS TN UMBER OF PROPERTY WELL BUILDING IwFEET FROM LINE ❑YES LINO ❑YES LINO LJEAREST- 21 I~ dv e r~r Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE „ ---]TITLE" DILHR SBD 6710 (R. 01/82) wlf.consln APPLICATION FOR SANITARY PERMIT 2~k~COUNTY DILHR (PLB 67) UNIFORM SANITARY PERMIT # OEPriRTTE OF ~ InOUSTg4+t,LR ,LfiBOP 6 NUTRn gEC.ATIOnS. -Att&ch compete 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 `'?1 ,p J C. Rf, PROPERTY LOCATION Gl:P*: 1/4 1/4, S , TZ? N, R J~ (or ow TOWN OF: 5 1q/ L/If, y" LOT NUMBER BLOCK NUMBER SUBDIVIISfIIONN NAME NEAREST ROAD, `LAKE OR LANDMARK STATE PLAN I.D. NUMBER /Y / l/ /f~ /P~ Cam/ ✓ /Y i C~ G~ TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair t" Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vaurt 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 Gs470 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mo a E-A n-Ground Pressure Total #of Pr ab. t Steel Fiberglass Plastic Gallons Tanks ncrete Co str cted 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): 1•21 I'll',~~ Private L:1 Joint El Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. /MPRSW No.: Phone Number: Name of Plumber (Print): Signatur " M Plumber's Address: Name of Designer: _64"!96 7 SQL COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved )fC~ ❑ Owner Given Initial 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 A. cA ~ t vl j. h trz) y u c,}„ ~^t Off, ~ ye ....w.. r 4, ~ { L ~ t p~ ~ ' . " ~ a`^ tip G a ►t {1 l"1' ^ T (1j ' f S APPLICATION FOR SANITARY PERMIT ST 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 ~~/l~' f,~j/J~~UJ Location of Property IW- 14, Section , T N - R 17 W Township IoFels 7 Mailing Address If. Subdivision Name Lot Number J ` Previous Owner of Property L, Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? /I Yes No Is this property being developed for resale (spec house) ? Yes X No Volume _ and Page Number e 3'~ 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. PROPERTV OWNER CERTIFICATION 1 (We) eehti 6 y that att s ta.tementa on this johm ane tnu.e to the beat o j my (ouk ) III knowte.dge; that 1 (we) am ( ahe ) the owneh (a) o6 the ptopeAty du ch i.bed in th.is .inbonmatcon bon.m, by viAtue of a wa 4anty deed neconded in the 066ice o6 the .County Regi-6teA o6 Dee& as Document No. and that I (we) the a ew9 (oh 1 (we) have p4es a e poa a stem a►'~J own the K?'~opoa ed a.,te 6on y i obtained an easement, to u4n with the above ducAibed pupenty, Got the con.s#luAction o6 aa.id ayatem, and the same has been du.by neconded in the Oj6ice o6 the County Regia.ten o6 Deeds, as Document No. ) . - I SI N RE OF C ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE GNED DATE SIGNED H H a S T C 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER C~ Fire Number ROUTE/BOX NUMBER e- CITY/STATE 2117Ir e',e)e,~1 ll~' I.IP PROPERTY LOCATION:/V- 14, 4, Section / T ?S N, R W, I Town of /~r~ cs~r^ St. Croix County, Subdivision Al- 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 I the system can affect the function of tYie 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. yo I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H 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. SIGNED A-i Z ~oV 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. ° N 'r m x x ' O w CD c c N O • W p N w~ O CD O O y ' r. Ip (D c= 0 cD =r M r _ CS co cc O O , c N CD d N N 0 1 i ► A ° a p o w o D N ~ lul R (D CD m co w A r co cD 0 o fD CD W 3 a o ~(n~ w wo 0CDr. co> o > > E < w - =r > _ O O O c.. C c N 3 o c 3 o n0 w ' w N E. N - O d o ~ m o m w :1,m~c~ Q o < CCD N N (c Q A ^ CD oDc ip~ L' N O n n p cc co~~ ~0mao~ 7 w 0 p d Q 7 w O CL = CD 0NCD =mvw0 Z N New N~oZ w w CD Jr CD CD cD :3 U) CD CD CD CD cc w CA Er' o M w 0 a ~c w 0 a " N fD ( N - 0 > > N? Cl. to M L n: 0 CD C 171 CD 0 w 0) CD ccn m N CD n ..ate w mcm = -i ° n o 0 o No~= fm N0 c .~c~=oui w a cD00 E L7 not ccocc0.0 R1 w w CD cp N 7 a CD aa~ acv, o m c ~ 54m .<owmrn3 n n 0 cc :5 vi o CD O c CD O a C cc CIL w N N c 0 7 =r SD 0 C)- c CD 0 0 ;v c3 0-~3 b\~ cD 0 0 3 O < w m o ~oz € N m DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS R'vDUS')"r3Y, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATIOty- SECTION: Q e T / 1/4 OWNSHIP/~; OT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY:7-OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RI IONS: ER LATION TESTS: Residence 31 A1111 ❑ New y Replace L 0 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTI~VL:MffOU IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) ®S0S0uToS2u ❑S©u If Percolation Tests are NOT required DESIGN RATE: L y portion of the tested area is in the under s.H63.09(5)(b), indicate I If an Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION D PTH TO ROUNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH M, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 7, 0 7, f B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 'FPC~F{Eg AFTER SWELLING INTERVAL-MIN. PERIOD t PERT O 2 PERIOD PER INCH P-2 2.y2' P- 3-v' 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 I , , 4- ee 1 f r r i ~ i s F i P 7 t f- t ~ i I f f t I , 7 ~ i E i h 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: I z , ~ so 2 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): CST SIGN URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - r ' ~ I IL4 ~ ~ j\ 1, , it { 11 ,r 'yam 41 ~..r * I E 4? n gK, v b n 1? .31 Qr- s f. tit I o 0) O lD m "0 3 CD (D CD m <D m 3 - \ O Z m o oCD C o oN ~ d d N N S 0 00 p .Z1 N C fD O ~ m~ m o :-4 °o O CL m C CD -u o o N 0000 a CD p D o ~y 3 N N V ? °o C c rn O O m Cl) z D - CL _ m (a D N a ? C) OD ::z C: CD 3 a 0 cfl N No w l~ Zo co z m O pip a L. C !ir C cn cn ' Q N M M N . o -P, = -o * * * A -i -i Q cn to to 00 Dz (n "a N N v O Q O D N CD (D 0 0 0 7 f~D ! N crn Ln _ a A Z N z z z o D D O d O o ~ "WA, N C I CD p N W Q a 3 7 z CD fn O = O A Z n Z O CL A v C) O Z N W m ce NJ z 0 3 O Z 3 m N O n a m CL I v c z a a CD N a a I b Q 0 N O /III tOn I ~ I A O b ~v O Q O 69 O 0 ayo C) (D O L ti Parcel 028-1000-10-000 12/19/2005 02:32 PM PAGE 1 OF 1 Alt. Parcel 1.28.17.1A 028 - TOWN OF RUSH RIVER 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 ARTHUR R & LYNETTE A LUND O - LUND, ARTHUR R & LYNETTE A 576 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 576 HWY 63 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 12.780 Plat: N/A-NOT AVAILABLE SEC 1 T28N R17W 12.78AC NE NE EXC Block/Condo Bldg: PARCELS 028-1000- 20,028-1000-30, 028-1000-40, & 028-1000-60 AND INCLUDING Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) S25' OF E914' OF NW NE. 01-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 996/284 WD 07/23/1997 834/193 2005 SUMMARY Bill Fair Market Value: Assessed with: 82644 294,500 Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.780 69,200 221,000 290,200 NO 05 Totals for 2005: General Property 12.780 69,200 221,000 290,200 Woodland 0.000 0 0 Totals for 2004: General Property 12.780 22,700 136,200 158,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 108 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00