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HomeMy WebLinkAbout022-1083-30-000 0 cn0 ~v0 C7 r~ :3 0" 3 (D v >v T n a c a) CD 3 3 3 U1 .~T, --I 2 N z O al N O 0 W O W W O co O O' c0 N • o CD 3 0 m m, ~ a z a N CO a co O N C m co O M 1 m Q N co Co ~ W N 0 O W N W 0 A G') ~'~~~•••S O n 7 CD `z n O L3 O O c CD C) v, 3 0 o a D CD vi tN/l o :E o O W Cn ( D (D C o ~J m fl ai N C W C m 3 O o 0 C~ cn 7~ E lot CD 0) ° !fir L O A~ N D C z l ;D C (D G) o Co 00 CD ~ r- cn !D b rl .A A K Q (D -n rt a) N• ylj 9 rn N• 0 rt r H~ oz O O O r3 1 P3 vl 0 v y cn o D Or~ 00 (a v v O . 00 11 ~ Oll o 1 N -0 CY) 3 fD. cQ W N C - V _ a CD Lri N z z co z O H v O D a o 20 y O ° m m (n • I -a 9 N y ( co t' I 0 c CD N V r OD W p d r=' a 3 s H cn C7 O N :E~ z (D cn I cn Fh 00 Z 7"v I C7 n A Z p p' 1 00 cn ZE~ tv n n ca -u rn rt CL CD co z W I . N.° 3 a 00 0 OTC ~j ~j o z w F''' u z N ~p O A / W 3 _S Q ° O T C: :3 (n a) C (D W CD z o ° * cn m (n y Q c ID o a 3. co ° fi U) C O N L ~ N W O a Gp (D 0 o ~ ti o0 0 C ' Parcel 022-1083-30-000 02/02/2006 08:10 AM PAGE 1 OF 2 Alt. Parcel 29.28.18.451A 022 - TOWN OF KINNICKINNIC 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 RICHARD T, & JILL PRINCE BLUHM O - BLUHM, RICHARD T, & JILL PRINCE 1060 E RIVER DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1060 E RIVER DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 29.571 Plat: N/A-NOT AVAILABLE SEC 29 T28N R18W SW NE 11.003AC NOW Block/Condo Bldg: KNOWN AS LOT 4 CSM 6/1754 ALSO PRIVATE ROAD EASEMENT ALSO A PAR IN THE NW NE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DESC 1113/564 AS PT LOT 4 CSM 9/2543 COM 29-28N-18W N1/4 COR SEC 29; TH N 87 DEG E 1305.92'; TH S 0 DEG E 697.71'POB; TH S 0 DEG E more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1112/553 LC 07/23/1997 790/190 07/23/1997 726/24 I'J I J 07/23/1997 725/436 W l 2005 SUMMARY Bill Fair Market Value: Assessed with: 143869 494,600 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 358,100 438,100 NO UNDEVELOPED G5 24.571 62,000 0 62,000 NO Totals for 2005: General Property 29.571 142,000 358,100 500,100 Woodland 0.000 0 0 Totals for 2004: General Property 29.571 64,500 268,000 332,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1083-30-000 02/02/2006 08:10 AM PAGE 2 OF 2 Legal Description: cont. 621.22'; TH S 88 DEG W 1306.29'; TH N 0 DEG W 617.58'; TH N 87 DEG E 1306.16' TO POB q~ Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~;4`? C L 4'~ TOWNSHIP le 41 t'1 ~1 !C SEC. L~ T N-R / W : I ADDRESS qT 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 1 ij ~Ca t 1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: le'~ Proposed slope at site: 1 SEPTIC TANK: Manufacturer: 5 Liquid Capacity: Number of riigs used: Tank manhole cover elevation: Tank inlet E evation: Tank Outlet Elevation: Number of feet from nearest Kuad: Front ,0 Side, Rear, feet 0 L From nearest property line Front,0Side,~Rear,0 feet i Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE, REVEI:S1? 511)1` r. 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, 0 Ft. Number of feet from well: Number of feet from building: (include yistances on plot plan). SOIL ABSORBTION SYSTEM Bed: ~fTrench:- -Width: Number of I --s - Area Built :-L- Fill t° Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side Rear, O Ft C Number of feet from well _ 0 s Number of feet from building: cl/ (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, 0 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: v!l-t744,0 ~ S~ I License Number: i 1/84:mj ~M wlsmnsm APPLICATION FOR SANITARY PERMIT ~~~~COUNTY (r D!ILHR (PLB 67) 0& ' - JEPRRrrnEnTOF UNIFORM SANITARY PERMIT # In OUSTRY, LABOR 6 HUTRn RELRTIOnS V V W -Attach complete 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 O NER MAILING ADD ESS ^t J f r lit 0 PROPERTY LOCATION: 6J 1/4 tv 1 /4, S , T~~'N, R 1t- E (or ' T I AGF: d~ ji 1 LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMA K STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED d 1 or 2 Family Number of Bedroo ❑ 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. k Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank Ell 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Al '1 4 $ 7 y ~~4 4' 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(~ 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): Signatur MP/MPRSW No.: Phone Number: Plumber'sA`ddress• N fDesigner~:jA' J~J 1y, COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved `y ❑ Owner Given Initial Approved Adverse Determination Reason for Disapproval: Alternate coursels) 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. i 1145 f K do t° I' f' Rk. i ID, X15 b E~i rrS' to Alt 1 ti q 1~ lox 36` t: gs r~ ~~lll/i UCt l' 3i is 2 9-, Its, ~i I ~ I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,' DIVISION LABOR AN P.O. BOX 76 HUMAN REDLAT1ONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWN~HIP/MUNI IPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: AI N/116 E (or W e rt~~ f COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: _ USE DATES OBSERVATIONS MADE NO. BEDR COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New [:]Replace 4 RATING: S= Site suitable for system U= Site unsuitable for system rfN IN-G ROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED YSTEM:(optional) DU INS DU ❑ S ©U ❑ S ©U frh ~t ~a'r3s If Percolation Tests are NOT required DESIGN RATE: LF' an y porvon of the tested area is in the under s.H63.09(5)(b), indicatoodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- o 66) 6/k -5" 60 S B V to NO . 00 5 3 , 5; s B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P 3.ab in a P- 1.33 i O P- P- P- 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 /7~• orrh F.L. )k 1( hh (Q2 1w elf ~?~"C fal~ b ire` fv' - ,y4 . a r stP1 Old • a IV- N , 3 , E ~ 1 t R_ T q Cee-JA Lee I, the undersigned, hereby certify that the soil tests reported on this form were made by mein 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 intl: a TESTS WERE COMPLETED ON: ~ d~~✓LV' a h ADDRESS: CERTIFIC N .NUMBER: PHONE NUM ER(optional): 1007 eA-) CST SI 1 TUBE: r yF uE qtr r ~ D' 'ti's log; d x. c i' k , MAX f AUVI is zPM, r r t~i to tt, ,}`3!:: 1sun ktoxx._ A Q SWARD U 041? SYSTEMS ARE RULED OLK BASLD CPj SOIL COW AW,:' PLEASE Earn W Wn w; E7. _t;o nun n tot :.'many ;t. de C(e'o t iptA', wnwen OWN e c , w .=t D ,i. r .a , am, E a c o „ . , _ t w, cl 1, ,f> Er , and air pci of ivy, p -u' aii €imn amvwvu, P W do c pr, °t'l~-m Cl Q. p t.E=t! t,n~f. ?tt, ,wkn& d os rt * n_, A. 1 % 'w o Wt, b i r , . c' ,l E l E n y ur t.€u ! atoms no 'b r w , ...,E 't bpi 114-f SS sn' F is3 M 1t:.a x Ply BYWt F4W F-," vrawl t tc. e t Want Snow (01 Lomn P i' a 1 10V ux" , I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON; WI Gt3707 KACONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Ilt assigned) Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gary Wang River Falls, WI BENCH MARK (Permanent reference Poem) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.'.r CST REF. PT ELEV SW NE, Section 29, T28N-R18W, Town of Kinnickinnic Name of Plumber: MP/MPRSW N... County. Sanitary Permit Number. Tom Wang 3237 St. Croix 58864 SEPTIC TANK/HOLDING TANK: MANUFACir LIQUID CAPACITY: TANK INLET ELL V.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED V C/~f 5V{ YES ONO ❑YE$ IIaNO BEDDING. DIA.. VENT VATIC HIGH WATER NUMBER OF ROAD~~~(([ PROPERTY WELL BUILDING: VENT TO FRESH ALARM FEET FROM jJo u~D AIR INLET OYES OYES ONO NEAREST QY" U DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MA UFACTUR WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: OYES ONO -YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N ER F PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN F T FIR M LINE I AIR INLET PUMP ON AND OFF) EYES ONO EARES SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN(; TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until F CE the soil is dry enough to continue.) AIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF DISTR PIPE SPACIN( COVER JINSIDE DIA =PITS LIQUID L/ TRENCHES . IM BBL PIT DEPTH. DIMENSIONS (1(' J a GRAVEL DEPTH FILL D TH DISTR. PIPE HDISTF P DISTR. PIPE MAOF PROPERTY WELL BUILDINGENT TO FRESH BF LOW PI FS ABjdi(E C V EI EVINLE r / D PIPES. FEET FROM L y/ AIR INLET. L/- ~ OG v~ ~ Z~ NEAREST ,I 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 ONO SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS _ OYES L NO OYES ONO DEPTH OVER TRENCH;BED DEPTH OVER TRENCHBED DEPTH OF TOPSOIL CENTER EDGES SJS ' MULCHED YES O OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: r._ BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING TEL D PTH BELO PIP FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE 17/FOLD MA ERIA NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. DIA. ELEV.. PIPES. CIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY CO R MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ❑ O OYES ONO COMMENTS: PERMANENT MARKERS: SERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE OYES ONO ❑Y ONO NEAREST i Sketch System on Re n_ . unty file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) Form - S T C 100 Owner of Property 0 Location of Property !!y 1 N R 4, Section ,T~"` W Township ~h~/ laay1~ Mailing Address Subdivision Name Lot Number Previous Owner of Property Os- Total Size of Parcel Date Parcel Was Created Are all corners identifiable? _ Yes No Include with this application one of the following: .Ce-y~fied Survey Map _ .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed~re %clod.-in the Office of the County Register of Deeds as Document No. ` and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGN OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIG NED DATE SIGNED ti y S T C - 105 r y ti SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z 0 OWNER/BUYER Co'11.Cr' - rn ROUTE/BOX NUMBER lcl/2 ___Fire Number CITY/STATE ~(11 --L LP_yD~~" PROPERTY LOCATION: lJ N ~4, Section T N, R~d W, Town of St. Croix County, Subdivision Lot number`-- I improper use and maintenance of your septic System could result in its premature'f:ailure to handle wastes. Proper maintenance cun- sists of pumping out the septic tank every three years or sooner, if needed, by a 11censed 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. 0 I/WE, the undersigned, have read the above requirements and agree U, to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b meet 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 1) ATE C L~ 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. v_ N ~ n s m ~ ~ ~ (D ~ W ? cA cA N ~ O v N (D cIDD ~ o n n CD 7 all (MD a3 '!a ?7'W~ N N N c =r t° :3 t c co co , I O z o ..15. 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