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HomeMy WebLinkAbout002-1046-60-025 o m 3 m C d `i1 ~ co c3o m v ~ CD \ 1 ; " c o m o o W Ai CO (D - N 3 !D C2 o o `C • 3 C : n N ICI z d Cz N fT N ? C3 _ M rn o O o o co CD 0 N V+ CL N W -i N O O m O (D O ~O i C) C CD CD 0 O CD 7 W O l~ 3 l< O f/1 N pp O O CJ7 c w O m w D F a D CD W a o 3 n co\D rn s y O cn CD ~ ~ II ( c ~ R ~ c C o co o W z `D c N o c O p. c ~n z 000 . o n - . N . u' o D `may .Y ~ a r ~r O 0 0 N Z o ~ D N < o H C m 'a ~ O !~1 N cn 7z7'c- a N r ''r I z r ° z co z Q rn =4; y CD o d O ° y Z • a o' m CD ID t~l CD 0o N F o c i w m n 'p -1 y z m cn O 43 p z m Cy y N C ~a a n n p z O o :3 N rn W Nj ° CL z 8 C < t~ N CD ~ sv a n N w n (D O T 3 N C Z 0 CD CL o CD co~ 3 CD e U N o o pa A (D 6p O m A EA O O O (D p yb O ti Al Form - S T C - 104 s r AS BUILT SANITARY SYSTEM REPORT'y. c 1 , 1~r ,S r 'P~ T N-R W OWNER TOWNSHIP ~G~ Jr 11 jp ADDRESS ST, CROIX COUNTY, WI CD SIN r SUBDIVISION LOT LOT SIZE - PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM vh / / roPe- r c rte I ~ L /Va L~Jefl r X-1 y 20 /zo c~ o o ro INDICATE NORTH ARROW I BENCHMARK: Describe the ver-ical reference point used ;on ?,ec in .39{7 nm f of Y-Oad Elevation of verrlcal reference point: Prupused slope at site: SEPTIC TANK: Manufacturer: r Liquid Capacity: Number of rings used: Tank manhole cover elevation: 1 ~ Tank Ir,.let Elevation: /03..09 Tank Outlet Elevation: Number of feet from nearest Road: Front,@ Side,0 Rear, a 2~0 feet from nearest property line Front, 0Side, ~Rear, 0 feet Number of feet from: well 5Qr-# building: 30~ (Include this information of the above plot plan)( 2 reference dimensions to septic_ tank) SF:B I\111':vl':P2 J" ti 1 I)I: PUMP CHAMBER Manufacturer: Liquid Capacity: - I Pump Model; Pump/Siphon ufacturer: Pump Size Elevation of inlet: o tom of tank e e ation: Pump off switch elevation: I /Gallons cycle: 1 ~ ~ Alarm Manufacturer: Alarn /,Swit~h Type r Number of feet from nearest property line: ` Fronr, 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: i Width: %Z Length: 0U Number of Lines: 2 Area Built:- 07 Fill depth to top of piper Number of feet from nearest property line: Front, O Side, © Rear, O Ft.,ZO~ Number of feet from well: 7 :5 i Number of feet from building: 30 (Include distances on plot plan). SEEPAGE PIT Size; Number of pits: Diam Liquid depth: Bottom of so a64 n;* e va ion: Area Built: j f Has either a drop box or distributio box ) bee used ~n any of the above soil v 1 absorbtion sytems? (Check one), 1 HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of%00ttow'? f tank: i Elevation of inlet: Number of feet from nearest proper ine on , O Side, O Rear, 0 Ft. i Number of feet from w 11: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: !421 Plumber on job: or, License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7963 BUREAU OF PLUMBING MAD!•SO.N, WI 53707 CONVENTIONAL ❑ALTERNATIVE state Plan LD Number (lfassigned) ❑ Holding Tank El In-Ground Pressure ❑ Mound W II 179 NAME OF PERMIT HOLDER. JAOF PERMIT HOLDER: INSPECTION DATE. BENCH MARK (Perms l t reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. lit-whi A/ Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number: adf~.~9 ~y9 /S SEPTIC TANK/HOLDING TANK: % MANUFACTURER. LIQUID CAPACITY. TANK INLET ELL\F TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED '-'r 4? 7`~ Gr', DYES LIq..11LDIN. DYES LINO BEDDING JV . =NT J HIGH WATER NUMBER OF ROAD: I J PROPERTY WELL. VEN T TO FRESH rt ALARM uNE AIR INLET ~ YES ❑ NO l ~ ❑ YES ❑ NO NEAREST G os DOSING CHAMBER: MANUFACTURER. 71 NG. LIQUID CAPACITY PUMP MODEL 1PUMP'SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ES LINO DYES LINO DYES LINO GALLONS PER CYCLE: PUMP AND coNrROLS OPERATIONAL NUMBER OF FR OPERTV JWELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES LINO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing N(,TH 1111AMIT111 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: WIDTH. LENGTH JNOOF DISTR. PIPE SPACING. COVER JINSIDE DIA -PITS. LIQUID BED/TRENCH TRE%[eHES MA AL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIP' DISTR. PIPE DISTR. PIPE MATERIAL. NO. DI NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BF LOW PIPES ABOVE COVER I 'LE INLET ELE V, END PIPE LINES AIR INLET: i t FEET FROM ,q 7q ~S NEAREST► VV 0 MOUND SYSTEM: Mound site plowed perpendicular 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- D meets the criteria for medium sand. TIONS MEASURED. YES LINO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES LINO DYES NO DEPTH OVER TRENCH BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES DYES NO DYES LINO EYES LINO 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 JMANIFOLD MATERIAL. JNO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING FLEV.. ELEV.. DIA. ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES NO DYES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE DYES LINO DYES LINO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE'. DI LHR SBD 6710 (R. 01 /82)~-''. 7 Wisconsin APPLICATION FOR SANITARY PERMIT s D 1 L H R /)(-COUNTY (PLB 67) UNIFORM SANITARY PERMIT # F== oecRRTmenT of In...TRI 1R90R 6...r1 RELRT.w S/ ' j / I_Y -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 PROPE OWNER MAILI DDRESS RAd ~e y l.Jerele s ALd w~ LJiS S'~o o Z PROPERTY LO ATION CITY: IIr ~W 1/45 1/4, S TA2' N, R E (or TOWN OF Z'9 z LOT NUMBER BLOCK NUMBER SUBDIVISION NAME REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED , 004 - /OCAO/ - 5_6 I 1 or 2 Family Number of Bedrooms. 3 Public (Specify): THIS PERMIT IS FOR A: LXJ 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. X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit C! Holding Tank E] System-In-Fill ❑ In-Ground Pressure U Vault Privy L] Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued LLI 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 /0& 0 OJd e_ X Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ~~t Ks IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound EJ 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): pl0 9Al 5 9~4 Private L1 Joint ❑ Public I, the undersigned, hereby assume responsibility for inst tion of the private sewage system shown on the attached plans. Name of PI ber (Print) Si na MP/MPRSW No.: Phone Number: e0eeff ;F.Lq/~ /hr° ~~~9 (qir 16~~-33~P Plumber's ress: Name of Designer: A (.,c{ w w Li SA M t COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Owner Given Initial Approved Adverse Determination (lam 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 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 l "o Location of Propertyf 34, Section- T N- R W Township Mailing Address / ~x Subdivision Name Lot Number 3 Previous Owner of Property h 'e 0 J Total Size of Parcel 0 Date Parcel was Created 9 Are all corners and lot lines identifiable?_ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number /0 YAO 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) een ti6 y that aU statements on this 6onm aAe tAue to the beast o j my ( ouA ) hnowtedge; that I (we) am (aAe) the owner (s) og the pnopeAty de~scAibed in this tn6oAmation Aoim, by vi tue of a wajuranty deed neeonded in the 06bice o~ the County Regis,teA os Deeds as Document No. .3 90Z and that I (we) pAment y own the pnoposed site ion the sewage Viz- posa.e system (oA 1 (we) have obtained an easement, to nun with the above descA ibed pnopeAty, bon the con,stAuc tcion o6 said system, and the same has been duty neconded to the 066,tce o6 the County Regiu ter o6 Deeds, " Document No. ) I - / / - ~ 0 A lam l ,.z~ SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H '-3 y r ST C- 105 y H SEPTIC 'T'ANK MAINTENANCE AGREEMENT o St. Croix County c7 y OWNER/BUYER G / Z ° s F i r e Number GIP ROUTE/BOX NUMBER 7 e CITY/ STATE ('r / t~7 ►g ' PROPERTY LOCATION: Sect ion r N , R~&W :~J © St. Croix County, Town of L o t number Subdivision I Improper use and maintenance of your septic system could result in I its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, I a licensed septic tank pumper. What you put into if needed, by 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 tor 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 mCounty Zoning a aster plumber, certification form, signed by the owner and by journeyman plumber, restricted plumber or a licensed pusper proper fying that (1) the on-site wastewater disposal system i in operating condition and (2) after inspection and pumping (if nec- essary), the septictank is less than 1/3 full of dsludge andtscum. Certification form will be sent app H 0 three year expiration. I/WE, the undersigned, have read the above requirements and agree W to maintain the private sewage disposal system in accordance with r, the standards set forth, herein, as set by the Wisconsin Depart- 'v 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 J DATE 4~ - St. Croix County Zoning Office P.O. Box 98 f Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. W r_ RPM DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,,. DIVISION . AND PERCOLATION TESTS P.O. BOX 7969 HUMAN RELATIONS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: (or I-rW _7~~ TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: NIR16 (or( COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE i NO. BEDRMS.: COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE (PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence { ~ New ❑Replace e-e ?w RATING: S= Site suitable for system U= Site unsuitable for system CCZ71 TI ONAL: MOUND: IN-ROUNDPRE: SY ~T ~L HpLpINC~N ; RECOMMEND? D SYSTEM:(oonal) ❑U (51S [lu I Q''JjS UU S [under,cs,H63.09(5)(b), otion Tests are NOT required DESIGN RATE: If any portion of the tested area is in the indicate: //j/~ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPT ITO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH M. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i 12 o el !~~w s f !3r 2,4 a _S C? R c. B-3 Rir >r B Z-A fl`/ice ,r- c.! 5 `2 B- At __'5 2 Aj -5 Z~5 5C ~ n PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -}}Ecf AFTER SWELLING INTERVAL-MIN. TOD PERIQD2 7ERIO P PER INCH P- G s' P- -3 - 7 12 770 / / a2 S 0 P_ oZ O 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 TN 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: ADDRESS: / _ ( ^ CERTIFICATI~ONNUMBER: PHONE NUMBER optional): c Y-~ J r J 7' ' to' 3 d S TU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tes:ter- DILHR-SBD-6'95 W. 02/82) - OVER - - -6 fi 3 C 71 ` i yC ~ 1(* eye '(Z) ~ r s I - o LA n'I Lu X4-4-1 00 wljv ^a q * PA`E OF ~.rv~S ~c'Iu of A Zep S, s ~RAgIley egL s ('iefb Alf Walk And ODiervatipn Pipe ~~~~w,~w GJt's ^ J~. Approved V6n7 Cop Mlmmwn 12" ,Apwe fin 1 Grade ZU - 12" Above Pipe Coq iron Ta final Grads _ Vent Pipe ^ M$reh Huy Or SYntMlk Cove~lt~_ Min 2° AQ,ggol$ Over Pipe - PlNrlbvllan Pip$ " a o Too br Appr$yate Bonnie Pipe a Perlorpl$b Pipe below o 'CovOIAp Terminating Al ~ flpttam 01 Syvlem I ~r~iJvSp Drin<~~ L.~iJn~ tvn ' ' SOIL FILL DISTKIBL1710A1 plPr: APPROVED S4071HETIC COVER r. rc.. ' -IMATERIAI OR 9" OF STRAW 2u11FhG6REWE -----"v" OR IJAF;SN Hk`J o i „ r/ p (o C]F!z -c `gyp AGGREGATE ELEV OF/ 00. FEET.---•.. 3 3' DIS-r'RIf)JTjtDM PIPE TO BF AT LEAST 9~0 IUCHES BELOW ORIGINAL GRADE AIJLi AT LEAS72fl IUCHkS BUT AIO MORE THA1.1 tit IKIC.HFS @VLOW FIIUAL GRADE P"Lmur1 W N OF EXCAVATIOP FROM 0KI&VAL 6KAD9 WILL BE WCHES MIMM1UM OffT'H of FXCAVATiaDAt filknM a,141144L 6R49f- WILt_ BE -3-Zrr M.ICHES SIGIJED: LICENSE IJUMBE R: /'17P T ~O 9 DATE A LAJ Z~ °O kill N Z L kA f 31 ~t ro 1\ tn ash-all do (LA l w m ~ ~ a rv 0 n o ~ ti ~ In P T Parcel 002-1046-60-025 09/08/2006 04:54 PM PAGE 1 OF 1 Alt. Parcel 20.29.16.297B-10 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/11/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner BRADLEY D & KAREN I WEVERS O - WEVERS, BRADLEY D & KAREN 1 833 220TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 833 220TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 5.084 Plat: 5087-CSM 20-5087 002-05 SEC 20 T29N R16W PT NW SW FKA LOT 3 & PT Block/Condo Bldg: LOT 05 LOT 4 CSM VOL 4/1040 & PT LOT 1 CSM 2/497 BEING CSM 20-5087 LOT 5 (5.084 AC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 20-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 11/28/2005 812930 2934/301 QC 10/11/2005 809088 20/5087 CSM 09/08/2005 805812 2884/72 AFF 09/08/2005 805811 2884/71 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/03/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r N `'C O I 00 N I Y h a ~ 0 0 N ~ I O Y d d Q II ~ I LLJ O Z Z r w i O 00 N Z C C7 O Z FZ- r Cl) ~J •W"A N M C N O IL I O O Z M EL in 0 U aV O p p r .~r 1 O Ai N O d . 3 S. Cl) 0) O 1~1 N 7 mil/ ~ aT• ~ r it O. :r C E c _1 Q 0 a 34411 3 ST. C,ROIX COUNTY SURVEYOR'S RECORD CERTIFIED SURVEY MAP FILED OCT 261977 tx SCALE IN FEET "Es 01 CONNRL o Regmw of crc c~ j, St. Croix Comity, 0 100 200 300 wboonsin 8 v I1IIRON PIPE FOUND O 1"X 2411 IRON PIPE WEIGHING 1.13 LBS./LIN. FT. SET Q 10 O I ~ c 1 1 S 8703006"E 656.201 I 3.031 e 262.47' ~o I 30~ 360.701 0 I ' , 1 1 02 APPROVED C91- 7 I I o 35- -0 0 '0 p o -0 x I 6 LOT I OCT 19 15r l Nom/ 2.003 ACRES LO 0 ST. CROIX COU.,TY 10) U? i i N O COMPREHENSIVE PARKS PUNNING I AND ZONING COMMITTEE I ~ 0 I I L I (D APPROVAL OF THIS MINOR SUBDIVISION DOES NOT MEAN APPROVAL FOR O I I N BllKI NNG SITE OR SEPTIC SY-TEM. 06 33 03" 262.47 R TO H62.20. ~ I '1 0 I ; N 87°301061tiW I I I I I ~ I 3 I LOT 2 I O R/W LINE OF LO I z ~-66NTOW N ROAD 7.901 ACRES N I I O It :-CV o 1 0 10 0 r4i M IM 1 I I I I I I i I I I--1 APPROXIMATE 1 I HOUSE LOCATION I I I I L_~ I I I ' 'L2 1 1 0\~ 1 - I 33.0 CPA 1 622.601 0 N 87° 31144'1 W o i 655.631 o i:7) z - SW CORNER f SECTION 20, Volume 2 Pale 497 T29N,R16W