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HomeMy WebLinkAbout038-1117-20-000 000)0 E-00 ~1 O d L1 C 2. 0" R CI CD n O 0 41 ~l Q N) o. S m 3 c j' N w 00 CL (D Z a Z N N M CD -4 n N a O O_ N G (p A IV O c 0 CD A 00 O r'-f c CD O rn Z o o oo C 5 y co :3 o < D ° n C/) C) to ? m (p m (o a (D CD O p c~ it n (D b C 0 fD Z i j 0 rt rS (D m 3 N o n r N rt !T C7 4- E (zn n m N N Cl) In o D T- 3 D 0 47 G1 'O t- N M r y r-*..N 3 A i o Z -I Z O p D 0 W ~ O-C, CD p p cn /yIIVV~ H H N CD 0 W j (a a J j'~ O 7y a (30 (p 1 V) rh i-' OZ D_ O p Z ~ 00 C/1 m C M s - 47 rt v a C) ~ O N = Z j rd rt W v rt (D n ~ ~ a 3 i~ z w 11 w o' SIL n w D o N Z CA) I a a ~ o - co c z a 0 CD m A. x m H O I ~ A I ~ I A I w N O O ~ V ! A (=D A W Cfl p v N 00 ~ b ti Parcel 038-1117-20-000 01/31/2007 01:34 PM PAGE 1 OF 1 Alt. Parcel 29.31.18.488N 038 - TOWN OF STAR PRAIRIE 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 O - SINGER, DANIEL R & BAMBI G DANIEL R & BAMBI G SINGER 1988 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1988 CTY RD C SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 1.761 Plat: N/A-NOT AVAILABLE SEC 29 T31 N R1 8W NW NW LOT 2 OF CSM Block/Condo Bldg: 2/424 EXC COM NW COR SEC 29, TH S 911.81' TO POB; TH N 87 DEG E 128.32; Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH S 17 DEG W 252.47' ON W ROW HWY C; TH 29-31N-18W W 51.62'; TH N 234.19' TO POB ALSO PT NE NE SEC 30 DESC AS COM NE COR SEC 30, TH more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 748/93 11/03/1995 535826 1147/410 WD 1147/409 QC 1147/407 QC 2006 SUMMARY Bill Fair Market Value: Assessed with: 175679 210,700 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.761 30,300 155,900 186,200 NO Totals for 2006: General Property 1.761 30,300 155,900 186,200 Woodland 0.000 0 0 Totals for 2005: General Property 1.761 30,300 155,900 186,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNLR TOWNSHIP jty^ SEC. I' 0 N-RAW ST. CROIX COUNTY, WISCONSIN ADDRESS. L Y~t SUBDIVISION LOT LOT SIZE cu ,r'(l~e~i PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 I I li I try Y3 INDICATE NORTH ARROW BENCHMAIM : Describe the vertical reference point used a7 if Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer; _ _ Liquid Capacity: 1(~ n Nrrmbcr oL r -rigs used: _ 2 Tank manhole cover elevation: /o w 'l'ank Inlet 1.1evation:Tank Outlet Elevation: Number of fret from nearest Road: Front,0 Side,o Rear, 0 feet From nearest property line Front,0 Side,0 Rear, _ j feet Number of fget front: well building: 7 (Include Lilis infortuation of the abuve plot JA WO ( Z reference dimensions to septic tank SE1; RBVI?RSI? S l 1)B PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: /Pump/Siphon Manufacturer: Pump Size Elevation of inlet-/ Bottom of tank elevation: Pump off swig elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, a Side, 0 0 Rear, Ft. Number of feet from well: X Number of feet from building: / (Include jistances on plot plan). SOIL ABSORBTION SYSTEM Bed: Width: Length: Number of Lines: : Area Built: Fill depth to top of pipe: ~ 'r-f- ' I Number of feet from nearest property line: Front, Side, Rear, Ft Number of feet from well: Number of feet from building: Z (Include distances on plot plan). SEEPAGE PIT Size: VNumber of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Bu' Has eith a drop box C) or distribution box been used on any of the above soil absor tion sytems? (Check one). HO .DING TANK Manufactu er: Capacity: Numb ~f of rings used: Elevation of bottom of tank: 1evation of inlet: Number of feet from nearest property line: Front, 0 Side, 0 Rear, Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: _ DaLed: Plumber on job: License Number: 3/84:mj 1 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 IP; CONVENTIONAL ❑ALTERNATIVE stare Plan l.D. Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER. INSPECTION DATE. Virgil Wilson N. #4, Box 67, Amery, WI ~6'_ ~~-yy BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.'. CST REF PT. ELEV. NW NW, Sec. 29, T31N-R18W, Lot#3, Town of Star Prairie Na- of Plumber. IMP,'MPRSVV No. County Sanitary Permit Number. Gary Steel 3254 St. Croix 49452 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIO ID C KCI TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKIN COVE q P OVI D. PROVID D. 7 11~ I O(Q .VC ES ONO O BEDDING. IVENTDIe VENT MA L. NIGH WATE NUMBER OF ROA PROPERTY WELL. 4UILDII~G IVENT T FRESH JALARM FEET FROM LINE AIR INLET L. G DYES ONO NEAREST tJ ZL DYES ONO DOSING CHAMBER: 7 MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL MPiSI7~u F TUREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: P AND CONTROLS OPE l0 AL UMBER OF PROPERTY JWELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM NE aIR INLET PUMP ON AND OFF) IM OYES N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moistureatthedepth ofplowin LFN(ITH JDIAMETER JMATFRIALANDMARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORC MAI the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH INOOF DISTR. PIPE SPACING COVER INSI DE DIA =PITS LIQUID BED/TRENCH TREN s MArE4~+At DEPTH DIMENSIONS b 13 1 / L, PIT GHAVFL DEPT FILL DEPTH DISTH. PIPE DISTR PIPE DISTR. PIPE MATERIAL NO. DIS NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH . BFLOWPIPES ABi)VE COVER ELEV INLET ELFV END. PIPES jLINE. AIR INLET ~0S Od I D 2-'l FEET FROM 2- [NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFS~YSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASG,ASED. DYES NO SOIL COVER TEXTURE PERM NT ARKERS j 0 ERVATION WELLS ❑ ES ONO DYES ONO DEPTH OVER TRENCH.' BED DEPTH OVER TRENCH;BED 11111TH OF TOPSOIL SOD16- SEEDED. MULCHED. CENTER EDGES. S O Y S ONO EYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACIN GAVEL DEP B OW PIPF FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD A RIAL. NO. DISTR. JDIS R. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV.. DIA.. ELEV.. PIPES DI / DISTRIBUTION INFORMATION ROLE SIZE HOLE SPACING DRILLED CORRECTLY / COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO OYES ONO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING: FEET FROM LINE DYES ONO DYES ONO NEAREST 67 r Sketch System on "7~ Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT IIDILHR ~Z. le (PLB 67) ~42j~ COUNTY 0 oEaaaTmEnTOC UNIFORM SANITARY PERMIT # ® In0USTRV,y,ae0a 6 HumannELaTIons -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 PROPER Y OWNER MAILING ADDRESS PROPERTY QCATION clTY~: v44 LR'QE: x11/4 rU /4, S ;7, t7 N, R J (or) W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER /1tj .0 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 Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed IX 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 ❑ 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 Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ~ . 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): -J~ ) K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name o lumber (Print): / Signature: MPRSW No.: one Number: Plumber's Address: e Name of Designer: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved I CkL ❑ Owner Given Initial r 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 6x98 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. y r S T C - 105 r • y H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County ~ I y H I OWNER/BUYER Vte-"i 1. Y► rG~ _ \"%1~ ROUTE/BOX NUMBER P--- ~)Vk (1 Fire Number CITY/STATE 1''ME~ l L.LP J'5,4o(z) PROPERTY LOCATI-ONQW'-z;, Section 4.~~' N, R /,!!3 W, Town of •iIM t- St. Croix County, Subdivision Lot number _ Improper use and maintenance of your septic System could result in its prematur-'fa ilure r„ handle wastes. Proper maintenance con- sists of pumping; out the septic i_.,,: ovorv Lhiae years or sooner, if needed, by a licensed se1,Lic Lank pumper. WhaL 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 stems 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 pinper 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. o I/WE, the undersigned, have read the above requirements and agree W to maintain the private sewage disposal- system is accordance with x r-~ the standards set forth, herein, as SeL by Lice Wisconsin Depart- hi 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. S 1GNEll a T 14A'1-111 DATE --ICS <i;-L) St. Croix County Zoning Office P.O. lux W llammo,d, W1 54015 715-7 i6-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT 5 i C - 100 II Chic application fern: th to be complel-nd in lull and signed by the owner(s) ol~ 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 he retained and completed when the property is sold and submitted to this office with the appropriate deed rHcordi.ng. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~II~CaII YV~LA;C3rJ l.ucation of Property 11)~ 14 N~J~ Section T N - R 161 W Township 2 (2 t aA E Mailing Address 4- Subdivision Name Lot Number 3 Previous Owner of Property Total Size of Parcel. Date Parcel was Created Are all corners and lot lines identifiable? ~ Yes Is this property being developed for resale. (spec house) ? Yes ~ No Volume and Page Number as recorded with the Register "I Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING; y i . Warranty Deed 2. Land Cuntric 3. Other recordings filed with the Register of Deudi Oi Dice 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 OWNY CATIFICATION 1 ge.) eenti f y that a," sta.tomenA on A& jonm ate true to the best ul my (cum) k.nowtedge; that I (we) am (ate) the ownen(s) of the pn_ope,ty deg ebbed in tAs 06o&mation Jonm, by vihtue of a wam4anty deed necoaded -in the 016ice o l the County Re j&n o A Deeds a6 Document No, ; and that I (we) pnesentky own the pvopobed 6-i.te bon, the ,owaga c'apuoat 3y6tem (on I (we) have obtained an ea,;, emery; , to auk ilk t-K ' n ot,ibe d pno; o ~ +V , of the con,6tauct(.on o6 sa-i-d system, and the scurne has been (ioty ne.conded A the 0h10c o6 the County Regiote-n of Deeds, as "Doewnevtt No. ) . Jj- ` ~g~ - VRSfG ATURE Oj' OWNER SICNATURE OWNER (IF APPLICABLE) DATE SIGNED DATE, SIGNED l DEPARTJMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN.RELATIONS N, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: fq , SECTION: TOWNSHIP/Mtt#FEFPA-HTY: LOT NO.: BLK. N5.T.-SUBDIVISION NAME: I V Y /a to /T31 N/R 19B (co W .r• X1)11_ fV1 4 E, z A) A- I rU COUNTY: &WNE~/BUYER'S NAME: MAILING ADDRESS: USE DATES O ERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: p1 PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence v ~1 WNew ❑Replace VIA '7/ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) M S ❑u ~ S ❑u EM S ❑u ❑ S ou a S ®u If Percolation Tests are NOT required DESIGN RATE: I If an IL y portion of the tested area is in the under s.H63.09(5)(b), indicate: A- Floodplain, indicate Floodplain elevation: %/+1 PROFILE DESCRIPTIONS s _ BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER p~#-M, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) to 7 07 rrJr t.5 ? C78 B /0~ 701 oto n 67 5a b7 f 75 zs B- 61 R.13 5.~. S3 2 v 07 - /0 a 10 e- 5 y so 50 .33 ~ 'p- 33 B 7- B U51 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER TM7RES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH P_ I 3$ nJo / © 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 lo 3 .4. Q - C1 G0~ -fop j I(^ 40 S ofp 48' I l N .z s # 7 t/ R t f4p~, 1, 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: CERTIFICATION NUMBER: PHONE NUMBER (optional): ~~F/0 ordJ Sir /9 rep r~ 'rso~ L r: ~ of 9~' ~/5'` L t~6 -Gzo~ CST SIGNATUFJ: 1.9 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82! - OVER ."LH a.=t}'d ti T ,cHon must INO, x a 7 k? n. i, ,c- of I„ +1`'J5 Cc7ETt ~r.a i ~i,r't' S Pj. f.~r 1", u7 wi A.€;., ~ L E~r.~ : 3 s;F? tftc,ni t ya ion .,.,P, fai C `t3kT,. ,.3 €>uii}. and are, ~3f: €~rr'-f;'?r; ~c7 ±C:k ~,~Oa111 ;]fa€.t=,3, pcft.E?laflCk=fi 1. i.,-A s , s< h c7m'€tovg; -acp ho VC', C S We 10' i'A ~r C "of F7L~ F, A i 'J E tY- B. a fir r€ T ~3 t_ { i'« a !t e~ ~ ' ~ T-➢y-✓' ~ tom" ~ ~ , ~ n ~5--~-.t-}"' 17 I' I I ~ 1 r J~ I coo,?, ,I. J