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HomeMy WebLinkAbout042-1026-20-000 0 CO) 0 i 3 v 0 C7 `r1 A CD m m y o m 0 o cAO o o° • m j d, 3 Z N N V N (0 .7 c o :z ° 0- CO O W O C N n o W N° `Y 1 a cn ° n° N Q f cAi, No Q (D 0 !D rt t7' 3 m O 00 O. U) to (A K) it a 00 0 H. (D (0 H an C j N N a a 0 V H O W S t 3 CL C) CA rnn D N ` j C:O:z 0;0 o r- U) CD CO Co y N A A N fn c lV Z n ~ N ~ "fti A m z 000- r rt v, Q N y N Ao D v1 d rr r-3 o m~ v art :3 0o n. ~ N n D(D (D 0 0 0 z m `0 O 7 ~ I ~ ~ m m h I--h 00 N N I b w n C CD O ca m a C1 n rt rt I-'• n 3 ~ G (D 0 Z = -I Cl) (y O O I, A Z ~O a A Z . . o W 'D M N O CD (D O Z C 3 A Z O 00 N _ D A W ~ N Q (D r' O - N C o c N I fi Z y I A fi A F I ~ N O O V O O Ry A p W I N dQ N O 0 ~ w yb O O V y i O L ~ Parcel 042-1026-20-000 01/18/2007 04:28 PM PAGE 1 OF 1 Alt. Parcel 10.29.18.145B 042 - TOWN OF WARREN 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 - KLINGSPORN, FAITH A FAITH A KLINGSPORN C - GOELZ, KARISE R KARISE R GOELZ 1289 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1289 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 10 T29N R18W 5 A N 726 FT OF W 300 Block/Condo Bldg: FT OF E 718 FT OF NE NE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 06/16/2004 766106 2597/401 WD 06/16/2004 766105 2597/400 QC 11/06/2001 661254 1755/600 WD 07/23/1997 829/271 more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 149157 227,000 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 48,500 117,100 165,600 NO Totals for 2006: General Property 5.000 48,500 117,100 165,600 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 48,500 117,100 165,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 207 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 314 Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C o 5 t,' L L cL TOWNSHIP LA/a H1- e n SEC. I O T O N-R I S W NF 1 CIE _ ADDRESS Rv ttS lv' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 10U FEET 3F SYSTEM '7 i 75 INI)I CATS NORTH ARROW tveLlL BENCHMARK: Describe the vertical reference point used E c(-er elevation of vertical reference point: 10011 Proposed slope at :site. ~ycL T ~iEPTIC TANK: Manufacturer: :we~'$~ r Liquid Capacity: l 6) Number of rings used: 1 Tank manhole cover elevation: ! ya 'l'ank Inlet Elevation: ~G.06 Tank Outlet Elevation: G i Number of feet from nearest Road: Front ,Side 10 Rear, O - _ ,_(U 1~oc t dFrow nearest property line Front, (aside0Rear,Q I q0" Number of feet from: well, building: I ~S (Include this information of the above plot plan)( 2 reference dimensions to septic-- gunk) SEE HF.VERSk i J)I r, _ • ~,~be~fi c ~Sfi,c,t~. PUMP CHAMBER Manufacturer: 111A 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 feat from nearest property line: Front, O SW We, O Rear, 0 Ft.` Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ✓ Trench: Width: ay Length: 71 Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, /(D" ide,0Rear, 0Ft Number of feet. lr.om w4.:! Number of feet from building: _ 0 (Include distances on plot plan). SEEPAGE PIT tiq 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, ( Rear, n Ft:. ~a / Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: 674/ Dated. 0 7 Plumber on job: c- License Number: U1 l~ 73 4 j 3/84:mj a DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O.O. . BOX 79b9 PRIVATE SEWAGE SYSTEMS DIVISION BQ~~bISON, WI 53707 BUREAU OF PLUMBING j CONVENTIONAL ❑ALTERNATIVE S❑ Holding Tank ❑ In-Ground Pressure D Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: Gilbert Costilla NSPECTION DATE 7 Roberts, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: JCST REF. PT. ELEV.: NE NE, Section 10, T29N-R18W, Town of Warren Name of Plumber. MP/MPRSW No.. County Sanitary Permit Number: Paul Cudd 2739 St. Croix 49477-71 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED: OYES ONO DYES ONO BEDDING: JVENTDIA.. VENT MATL. HIGH WATER NUMBER OF ROAD- PROPERTY WELL. BUILDING. VENT TO FRESH( ALARM FEET FROM G% L' w~ (AIR IN,)~T: O / YES ONO OYES ONO NEAREST-----) DOSING CHAMBER: MANUFACTURER BEDD I NG. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ONO EYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE C1 I AIR INLET PUMP ON AND OFF) DYES ONO NEAREST C1 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATFRIAL 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: BED/TRENCH WIDTH PV~NLEI H NO OF DISTR PSPACING COVER INSIDE DIA -PITS,,„ LIQUID TRENCHES T RIA PIT DEPTH Z -7 DIMENSIONS M A ,t] ERLAOVVEL DEPTH FILL PTH D4VF3 F DISTR. PIPE DISTR. PIPE TERIA L. NO' DI PROPERTY WELL BUILDING . VENT TO FRESH B ABO c XR E E v E NUMBER OF ~j PIPE$ NEAREST FEE T MOUND SYSTEM: f 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- O YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED C ENTER EDGES SEEDED MULCHED. OYES NO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR DISTR. PIPE DIS TRIBUtION PIPE MATFHIAL & MARKING. ELEVATION AND ELEV.. ELEV.. DIA.. ELEV.. PIPES. DIA.'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO EYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING: ' L FEET FROM LINE u i DYES NO OYES ONO NEAREST Sketch System on -5e n in coun y I e for audit. Reverse Side. SIGNATURE TITLE. DILHRSBD6710(R.01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Gilbert Costilla Roberts, WI 54023 Property Location: 'TXiY_Y3UY4KiW Township: County: NE '/4 NE '/4S 10/T 29 N/R 18 Ig)kWKW Warren St. Croix Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: lst Street (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: Q 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif,, SEPTIC TANK CAPACITY 1000 1 X HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Weiser oncre e Products EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New © Replacement ❑ Experimental ® Seepage Bed ❑ Seepage Pit Class 2 948 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sign MFKMPRSW No.: Phone Number: Paul R. Cudd - 2739 1(715)425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, WI 54022 Arthur L. Wegerer (576) COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: J eji Date: APPROVED Sanitary Permit Number: 'v -1 A Y ❑ DISAPPROVED 9 4'7 7 '21 Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plurnber DI1..FR-SBD-6398 (N.03181) APPL,iCATCON FOR SANITARY PERMIT S T C - 1(70 This app 1ica tiou Form is t~,> bcco nap'.cr~,~! fn 11_11! zind 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 g,lh P✓'~ c Sti r 5/ ~oS ~i~~ Location of Property A) Section %b T N - R _ W Township Mailing Address, c~- ~6 Subdivision Name. Lot Number Previous Owner of Property %A-e L ~16 if Total Size of Parcel Igey e S Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes t,-' No Volume and Page Number as recorded with the Register of Deeds INCLUDE WIT TT `i'HI S APPIA CATION ONE OF THE FO!,LOWI NC : 1 Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if avail-able, would be helpful so as to avoid de ays 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.) emf .()y that a X A atements on ,thus^Konm ahe -tAue to the. beat oK my (ouA) knowledge; that- T (we) am (alLe) the owneA(6) o4 -the. pnopeaty denscAi,bed in this -i_n{onrnati.on Konm, by viAtue of a wam-arty deed Accorded in the OK(llace OK the County RegiAte'^- 04 Deed5 aA Document No. ' and ,that. I (we.) pn.mentAly own the pnopoAed /site- {ion, the 6e-wage_ i6po,Sa - /system (on I (we) have- obtained an e.a6eme.n-t, to 'r.un with the above dm n i,be.d pnopetuty, 4on the eok?AtAucti.on o{ Raid hyh,tem, and the- tame, haA been duly Aeeonded in the 0~{Ji.ce of the County Reg,i6,tC- rl o~ V(ed,~, a,5 DoC-I!POn.t NO. ) . /116 All -z:e SIGNATURT; OF OWNER SIGNATURE OF 09-10 ER (IF APPLICABf,F) DATP SICNI:D DATE SIGNED H r-1 y S T C - 105 r r • y H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County d ~7.. y a OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/ STATE L I P s r PROPERTY L OCATION :l//'-4 Section 1 1--- N, R _W, Town of St. Croi:c County, Subdivision Lot number I Improper use dnd 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 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 'rhe 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 to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- o 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- D ATE- 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN LABOR P.O. BOX DUSTRY, DIVISION HUMA HJUMAN RANED LATIONS PERCOLATION TESTS (115) MADISON, W1 3707 (H63.09(1) & Chapter 145.045) CO LOCATION: SECTION: TOWNSHIP/AflttiWE+PAtfYY: LOTNO.:BLK.NO.:SUBDIVISIONNAME: E- '/a ~/a o /T- ~)H/R ! ~E (ors COUNTY: OWNER'S/Bb'Y-EftS NAME: MAILING ADDRESS: . - USE _ DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: 7OFILNS: PERCOLATION TESTS: ® Residence ❑ New V ❑Replace iV1 .G1 RATING: S= Site suitable for system U= Site unsuitable for system CONVE~+NTIONAL: MOUND: IN-GROUNDPRESSURE:SYSl-EM-IN-FILLHOL DING TANK:(optional) ❑S E JS ❑U ❑S ❑U EIS ❑U ❑S ❑U If Percol ation Tests are NOT required r~~)I:SIGN RATE: If an L y portion of the tested area is in the under s.H63.09(5)(b), indicate: LP Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-"fliO E CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH tip OBSERVED EST. HIGI-I EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) J ~{r t B- v. ~ > l ~ " ~ i; y ' " L Jam'-`,e -~i`~ ( B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD2 PERIOD3 PERINCH P- P- r., 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 • ~ > SL~y"3 AT 1'to~,st✓ a - r - t. [ x,19' _ S LOe R-I S © 1-1 g ~ ~ - _ Su,Tfc$~c ~~•CA a3 ~ Z-OO' S , or "I}} ~ 1J~E. I LI, J 1 S L~c~l~u~ S -5 T- 5.T i I ; EX1S?T- , e _ _ _ ~ S~~+TC E E w~LL ~ h9 sr, i _ i Vz) t4b 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: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI LH R-SBD-6395 (R. 02/82) - OVER - i a . ite. LS,, S2a.l i€,t7 MU .a €;i€.'o? Ail, r~..iis.'~t..,t~'t 3,nt?1? rE tE'tticttkr,=,, ;i;talP~+t.(t:i~at U~ A e,tT F (S WF TA E',', t S" D ON S' IL C~' `lift tt, ni, i7C ct PS-II .3„€~ J- ,n . ;x),s t itrg for itst;r z ;,6tt t ,ly .;~~=4r v,. F- '3N E IT, ~.F .t Sta~c'. , ;"-E. _ =t= V~ ._'~d v , c°l rflov.~fso I s i -v si: IG «tf g7 ,3 ~br fi~~; tEt t:i¢P, L'd z, i7 S, 11811"a# .>~i aS9::, T}cf.tI.Ctt, Pei .E 2lat f,, ,b 5t f, ~E i='fii i-I ral r: - -pj-~ r_A. y jh"~a-1 rx)tiz ,t ~t_ft~ lt~zz~l s,. your u n F r'i 2 r 4 ~i' cwt' - f_ - TII! t t~ - Sa G 3-) rc P3~ c, Ii, U eti y. to I c,iiI? ' Oai t t'y -v t L1?;aI R 1 ifv/ .r . 9 a t> tttsl?i rat rtba , or{it?, PA-'E (DF i CROSS SECTIDU OF A BED SYSTEM f 4-- SOIL FILL 2-"o AGGRLGATE ~r PV O DISTRIBUTIOU PIPE APPROVED Sy1.1THETIC COVER T~ MATERIAL OR 9" OF STRAW OR MARSH HAS ` (o OF' AGGREGATE ELEV. OF FEET DISTRIBUTIOM PIPE TO BE AT LEAST 2 INCHES BELOW ORIGIIJAL GRADE AIJD AT LEAST?O INCHES BUT IJO MORE THAM 1-12 IMCHES BELOW FIAlAL GRADE MA) MUM DE.P-: H OF E-XCAVATIOU FROM ORIGIQA.L GRADE -JILL BE I"C-HES MINIMUM DEPTH OF EXCAVATIOIJ FROM ORIGIUAL GRADE WILL BE ~Z INCHES LIG E►JSC UUMBE R:Z<< 73 7 UAT C : - w- - C%r7ner's name man. Permit o. 11,63.05 PLOT F~=u~ Show: F1 N Location of building served posing chamber Septic tank Vertical reference point t_~ Building sewer Horizontal reference point Effluent system well Property- lines w/in 50' of system t"4 Peplacement system area P A Scale = 1 =30~ , or dimensioned L Distribution boxes I A and controls: Nfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal, per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: 4~ /C l►~i N 2 N T F+n-) ~ ~ ?NSThI.I X00 GPrt_, 0 p ' \~RPI L . ~I ~ I oT v~i4 vSo~ SC 1-3-n~S E W\ZUc~ by the granting or approving of the above plan, or upon the event of a subsequent omit being issued, ~T-cr_oix County and the nT-cp tX County Zoning Administrator, does not assume or hold itself liable for any detects in.plans or specifications, plan omission, examination oversight, construction, or any damace that may result in or after installation. J y~ - Plumber's signature