HomeMy WebLinkAbout030-1073-20-100
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Parcel 030-1073-20-100 02/18/2005 04:03 PM
PAGE 1 OF 1
Alt. Parcel 26.30.19.255F' 030 - TOWN OF SAINT JOSEPH
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
* RORABECK, DANNY B & KATHLEEN M
DANNY B & KATHLEEN M RORABECK
1355 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 1355 AWATUKEE TR
SC 5432 SCH D OF SOMERSET
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.070 Plat: N/A-NOT AVAILABLE
SEC 26 T30N R19W PT GOV LOT 6&7, LOT 3 Block/Condo Bldg:
OF CSM 6/1523 EXC PT TO AWATUKEE TR
EZ-UT-1282/570 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1097/465 WD
07/23/1997 1078/180 RD
07/23/1997 713/238
2004 SUMMARY Bill Fair Market Value: Assessed with:
5347 498,900
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.070 272,500 218,300 490,800 NO
Totals for 2004:
General Property 3.070 272,500 218,300 490,800
Woodland 0.000 0 0
Totals for 2003:
General Property 3.070 173,900 165,900 339,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 120
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 695.84
Special Assessments Special Charges Delinquent Charges
Total 695.84 0.00 0.00
L ri
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER j!2E L-, TOWNSHIP S / SEC. T N-R W
ADDRESS T ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r)
MCI
C A-
3`>
!
/8 x
_ SE L-' L ,~'L f~
Z I
\ \ i /
ys ,
v
INDICATE NORTH ARR
BENCHMARK: Describe the vertical reference point used
Z IV-
Elevation of vertical reference point: r)~~ Proposed slope at site:
SEPTIC TANK: Manufacturer: [ Liquid Capacity: Number of rings used: C Tank manhole cover elevation: r,
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, 0Side ,ORear, O feet
From nearest property line Front,OSide,~Rear,O feet
Number of feet from: well building: ( 7t
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump, Model: Pump/Siphon Manufacturer: Pump Size
Elevation"'of inlet: Bottom of tank elevation:
Pump off switch e-IAvation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest prop-exty line: Front, C~Side, 0 Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: -j Length: Number of Lines: Area Built: Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, Rear, 0 Ft
Number of feet from well,:
Number of feet from building: 3J
(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 0 been used on any of the above- soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capaci,ty:'"y
Number of rings used: Elevations of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, 0 Side, 0 Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:.
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, "11 53707
CONVENTIONAL ❑ALTERNATIVE Holding Tank ❑ In-Ground Pressure ❑ Mound
INSPECTION DATES
NAME OF PERMIT HOLDER. ADDR SS OF : EHMIT HO Hudson WT 54016 tBa
LDER William DeRose R R 2, it , 1 -
REF. P7. ELEV. . CST HEE. PT. ELEV
BENCH MARK (Permanent refere nre point) DESCRIBE IF DIFFERENT FROM PLAN
SE NW, Section 26, T30N-R19W, Town of St. Joseph,Lot#3, Stout Sub
Namv o! Plumber.. MP/MPRSW N, Cyr ~~ry Saniley Pe-1 Number.
Donavin Schmitt 3205 _ St. Croix 69628
SEPTIC TANK/HOLDING TANK: -
MANUFACTURER ^ LI OUII CAPACITY FT K IN LET ELE`✓. TANK OUT LET ELEV ROVIIEN OLABEL PROVIDED COVER
YES ❑NO ❑YES ONO
IN D~~~r"r~ PROPS RTV WELL BUILDING NT TO FRBE DDINGVENT DIAVENT Mnal HIGH WATE R OF ROAD LINE IAVIER INLET
nLnH 1 OM
❑YES NO YES ~NO _
DOSING CHAMBER: KING
IMANI)FACTUREH aEDUING. LIOUID (:nPAClly PUMP M[1DL1 1MV /1'110N T1.1Nli1 nL 71 i12 N p OVIICE LABEL PROCKING OVIDED OVER
ES ❑NO
❑YES ❑NO / CJ YES ❑NO L__IYE
FRESH
IR T ET
GALLONS PER CYCLE: PUMP AND CONTROLS oPERATIO nL NUM"R OF ''I'NI' TV WeLL BuIEING I VENT
I.INk AIR INLE
(DIFFERENCE BETWEEN L] YES PUMP ON AND OFF) L_JYES i_'f'N0 LFORCE NEASOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plovv iny nlnV1[ I E It
~~rATE RInL nNI, MAHKw(,
or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: -vl1s uouto
F of nlLIH PI(t'WA'1% PIT DEPTH
BED/TRENCH WIDTH LENa7H ~ NO
HNC;r'IS r
~ DIMENSIONS ~
NUMBER OF PROPERTY WELL TitNT TO FRESH
(RAVEL DFP7I1 FILL DEPTH UISTH PIPE DISTR PIPE DISTRPIPE MATERIAL ( 5('t LINE R INLET
B ELrLwPIP avE ovER EIEV INI1 ELEV IND IPE FEETFROM 33 1
NEAREST 1
MOUND SYSTEM: t~
Mound site plowed perpendicu r to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO - ')"L'Hva lI'N 1, 1 us
SOIL COVER TEXTURE HMnNINI ~tnwKrHs
-]YES ❑NO ❑YES ❑NO
TI)Df I) JEk DF 11 ~.'IVLCHLU
UEPTH OV EH TRENCH BE DEPTH OVF H THEN(: H BED Ill PI H()1111PSI11L
CENIFR EDGES
OYES -]NO ❑YES L] NO ❑YES NO
PRESSURIZED DISTRIBUTION SYSTEM: - FILL DEPTH ABOVE covEH
WIDTH LENGTH NO. OF LAi6HAL SPACING GRAVEL DFP T4 BE LOW PIPE
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MAN( F OLD DMnTEHIAL PNIPESISTH DISATH PIPE DISC HIBUTION PIPE MATERIAL&MARKING
ELEV. ELEV DIA ELEV
ELEVATION AND
DISTRIBUTION CoVLR MArF HIAI VERTICAL LIE T CORRESPONDS 7U APPROVE
INFORMATION Hole SIZE HOLE SPACING DE.ILLeo COHHECI I v PLANS
DYES ❑NO _ uYES ❑NO
PROPERTY WELL. BUILDING.
COMMENTS: PERMANENT MARKERS'. ~013bt:HVIIION WELLS NUMBER OF LINE
FEET FROM
❑YES ❑NO UYES LINO _1NEAREST
2 S a' 2~-ca 37
T z
/L• ~ I S
04
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNATURE TITLE
1!_HR SfSD 671Q (R. 01/82) `J
sln APPLICATION FOR SANITARY PERMIT COUNTY
TR1EnT DILHR OF 6 (PLB 67) UNIFO//RM SANITARY PERMIT #
~ .Z 81
V, LRBOR 6 HumRn FIELRTIOns V
R
F:;i
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
CITY:
PROP Y LOCATION
r VIL z-
> 1 /4 /V u'1 /4, S TIV, R I "E (or 1N l wN oF: - ~f
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ARE ST ROAD, LAKE OR LAN MARK STATE PLAN I.D. NUMBER
• ~ is ~ ~ ~
TYPE OF BUILDING OR USE SERVED
❑ Public (Specify):
1 or 2 Family Number of Bedrooms:
THIS PERMIT IS FOR A: ❑ Repair
New System ❑ Tank Replacement
❑ ❑ Privy
❑ Replacement Soil Absorption System Revision Petition for Modification
❑ Reconnection
❑ Alternate System
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Holding Tank
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit
❑ Vault Privy ❑ Pit Privy
System-In-Fill ❑ In-Ground Pressure
issued
❑ Existing, For Which A Previous Permit Is On File, Permit #
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
r ; y +
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total # of Pref b. Site Steel Fiberglass Plastic
Gallons Tanks on ete 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):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Mp RSW Phone Number:
Name of Plumber (Print): Signat (7
Sic, ytl~~ n , j
Name of Designer:
Plumber's Address:
COUNTY/ DEPARTMENT USE ONLY Disapproved
Fee: 7Date:j 5Re u of Issuing Agent: El pwner Given Initial
- Approved Adverse Determination
n for Di sapproval: r
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
Location of Property.
Section T N - R !`T W
4 4t_
Township
Mailing Address
Subdivision Name
Lot Number _j
Previous Owner of Property IL G/f/fh'/~ C'i j
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number s% as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed.
2. Land Contrac+_
3. Other recor& i,~ !)t k j: tai ; 1, ,
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.
PROPbRTY OWNER CERTIFICATION
I Md eeti.{y that aYt 6 tatement~s on the 6oh.m ane tAue to the best o4 my (outs)
hnowtedge; that 1 (we.) am (one) the ownelc (s) o6 the pnopeAty d"cA bed in this
tin6onmat on 6orum, by virtue o6 a wawcan.ty deed neconded in the OA4ice o6 the
County RegisteA oA Deeds as Document No. , - ;c r ; and that I (we)
pniaenVy own the proposed site bon the sewage posa. system (oA I (we) have
obtained an easement, to nun with the above desn bed pnopehty, bon the
constAuction o~ said system, and the same has been duty neconded in the O~6ice
o6 the County Regii ten o6 Deeds, as Document No. ~~7 / ) .
(~9 F
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
H
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ST C- 105 r"
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SEPTIC TANK MAINTENANCE AGREEMENT H
0
St. Croix County z
ry
a
OWNER/BUYER
ROUTE/BOX NUMBER i',,ri'► Fire Number
CITY/STATE ZIP
PROPERTY LOCATION:, %4i Section, T N, R W,
Town of ;~Z,~,eX 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 I(
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
I/WE, the undersigned, have read the above requirements and agree W
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.
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IN
DU DIEPARTMENT
, - REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DU.S,TRY DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7909
HUMAN RELATIONS 1 / MADISON, WI 53707
r (H63.09(1) & Chapter 145.045)
LOCATION:,` SECTION: q OWNSHIP LOTNO.:BLK.NO.: SU DIVISIO ME:
t>/ 1/ 02 6 Mo N/R/ 1 11(or A' fA S J T~
COUNTY: OWNER'S /BUYE 'S NAME: MAILING ADDRESS:
~
c CAE ar i r- K; / P X a
USE C-L• es: . ~4~i.t'~
DATES OBSERVATIO S MADE
NO. BEDRMS.: COMMERCIA DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence ,p XNew ❑Replace
/J .5--, -3 It
S.': A,41119 5-A e4- (1n C,L
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-I -F1ILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
®S❑U [&S []U PIS❑U OS ®U ❑SKU
L.'frI Percolation Tests are NOT required DESIGN RATE•
der s. H63.09(5) (b), indicate: If an
y portion of the tested area is in the Floodplain, indicate Floodplain elevation:
PR FIE DESCRIPTIONS
BORING TOTALS '
`
ELEVATION DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPT OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B A, -S
1F~rrJ
97.0 Ail 5 *;7r.
B-
41, y~. O.fte_
ell p
S
i ,
esil
61V
B-
PERCOLATION TESTS
TEST DEPTH' WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER .1W6++e3 AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH
P-
P- 2- A10 -3
P- 3
P-
P I
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 ?S j
ZG~I
e,c
%
s
It &JZOP OF
AQ-
Pee *-A
pl- F1
.7,611 16 -e4
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
.cs.f C ris a ~iP.1t~.c~ COMPLETED ON:
7-~?/
ADDRESS:
CERTIFICATION NUMBER: PHONE NUPJIBER(optional):
/a ot*als U A4 0/1
CST S TUBE: i
Lnri ~ C- `..G'
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER
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