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HomeMy WebLinkAbout042-1046-50-150 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: y 0 GENERAL INFORMATION ATTACH TO PERMIT)State Plan ID No: ra~& Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name:City Village X Township Parcel Tax No: 042-1046-50-150 TPRIFFRIFIrm lel E. & M Warren, Town of CST BM Elev:Insp. BM Elev: BM Description:Sectionlrown/Range/Map No: jr__17.29.18.2686151119-41- Z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1V r 0/ Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 5 q 7 6 St/Ht Outlet T TANK SETBACK INFORMATION q TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing v esHeader/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover q~ G J GPM f .V• 09 Z 72 Model Number n TDH Lift Friction Loss System Head TDH Ft L C,1 O Forcemain Length Dia.Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System:l r UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s)i Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 77eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.)Inspection #1: Inspection #2: Location: 1005 100th Ave. Roberts, WI 54023 (NW 1/4 NW 1/4 17 T29N R18 ) NA Lot 1 J~ Z l Parce No: 17.29.18.2681315 1.) Alt BM Description = 0 2.) Bldg sewer length = amount of cover =J. a f3,), 'IL j Q 5e- Uj-e~ Plan revision Required?Yes No Use other side for additional information. l v Date Insepcto Signatur Cert. No. SBD-6710 (R.3/97) May-04-2012 09:31 AM St. Croix County Plan/Zoning 715-386-4686 1/6 s t°Hite Perm t Applioat on sr. CR61X COUNTY WISCONSIN A ICI Chart 12 S Croix County Sanltary Ordinance PLANNING & ZONING DI~PAFITMENT rignal IntP ay be used for secondary purposes 3T. CROIX COUNTY GOVERNMENT CENTER S`0\ yQ w. 3. t8.04(i)(m)J 1iai Carmichsel Road Hudson, WI MIS-7710PP 71mse-46a0 Fax 15)388.4866 4 ech complete plans for the a tern on paper not less than 8.1/2 x 11 inches In size. linty SanIN Permit 0 Check If revision to previous application 1. Application Information • Please Print ell Information Location: t Property Owner Name AlLd im 4Ax seo f Oev p r/ n N.R E o Property Owner's Malang Add a Lot Number Block Num sr 3 ce,4"e-' s 1 City, state Ep code Phone Numer ubdivision Name W CBM Number tCl ~ 14 c~4r~ter ~Y3 -z / GO l 2 o So 3 of Bu ng:(check one why Vlllage of or 2 Family Dwelling • No, of Bedrooms: ~ubifo/Commerclal (describe use): tate-owned Neergat Rcad 11. Type of Permit: (Check only one box on line A. Cheek box on line B If appacabl6)Number(9) A) 11.0 Repair 2: Reconnecilon [I.ClNon-plumbing Ij4 Raluvenadon Farce ax s Sanitation 2,7DateIssue 2, C,e) Permit Number 2- ' / te19 Sanitary Penoit was Previously Issued 7 IV. Type of POWT System: (Chock all that apply) Non-pressurized In-ground A Mound P 24 In. suitable so und 5 341.. auitobie soli ound A+0 Sand Filter Constructed Wetland Drip Lana Pressurized I"round Molding Tank 3 single Pass 0 Other 12 rade Aerobic Treatment Unit 0 Recirculating V. Die rsairrmtment Arm Information: 1, Design Flow (gpd) 2. Dispersal Area S. Dispersal Area 4. Soil Application Rate t3. Percolation Rate B. System 6lavatlon 7. Final Oracle Required Proposed Gars./daylsq.R.)Min.lnch)Elevation 60 0 0 7- Vt. Tank Information Ca oty in Gallons Tota ff of Manufacturer Prefab Site Can-, teat Fiber- Plastic Now Existing Gallons Tanks Concrete strutted glass Tanks Tanks Ills f~ r A fia 13 VII. Responsibility Statement 1, the undersigned, assume responsiblaty for re pair onnenoltan/re)uvenallonnnstaliatlon of non-plumbing for the POWTS shown on the attached Plana. A license Is not reculred for terrallft r it or the In ion of non-plumbing sanitation system, Oar's Name (print)Plum pna t stamps):MPi•MPRS No. Business Phone Number; Plumber' dress (Street, City, Sta Cod L~/) S I VIII. Cou Use Only Disapproved t3anit Permit rue Date issued IpU)ng Age Bnal e ( pa) Approved Owner Given Initial Adverse Determination X. Conditions of ApprovalfReasans for Disapproval: saoueuiplo/apoo algeai(dde gad se G(f f 1 t: paule;ulew aq )snw sluewaalnbai peq)as led 'Z 4 z' ua wn d A 2ti~=liYv+ z q 1 q papinoad veld )uawa6euew lied se 4 peuie;ulew / peoinias eq lie )snw 119o lesiadsip n r~Q:G n,~~ fc rvC pue aa)1!{ )uanlj}a glue; oi)dag i, i e PLOT PLAN PROJECT Oeverina Homes ADD SS 1433 Cernohous Ave suite A New Richmond Wi 54016 W TOWN Warren COUNTY ST. CROIXNW1/4 NW 1/4S 17 T 29 N/R 18 SYSTEM ELEVATION N/A 6w L BEDROOM 4A . 4. Z CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1200 gallons LIFT TANK SIZE DOSE TANK SIZE 1000 gall MOUND XXX SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA of chambers BENCHMARK V.R.P. Top of septic tank cover ASSUME ELEVATION 100' Filter BEST G1710-8 BOREHOLE O WELL *H.R.P. Same as Benchmark 100th Ave 393' Property Line Pro 4 Bedroom house Building sewer is to follow all comm 82 codes 20'ST 40'100'10' Cleanout DT 100' mound 34' X 160' 75'AL-30' 01 AL 0' 300' property line ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/.Buyer _ oeu o Mailing Address Z9 Z,e r n:- Property Address l00 D- -004t Verification required from Planning & Zoning Department for new construction.) tso City/State CJ y~-Parcel. Identification Number C) LEGAL DESCRIPTION Property Location AA_J_ Y. ,a , Sec, 7 T Z? N R - W, Town of e% f{/ P.v Subdivision Lot # Certified Survey Map #Volume Page # 5j2~-~ Warranty Deed #Volume Page # T Spec hous ye Ito Lot lines identifiably SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Propermaintenanceconsistsofpumpingouttheseptictankeverythreeyearsorsooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in -the waste disposal system. Owner maintenance responsibilities are specified in §Comrn. 8352(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & "Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date, Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroom 1311 Z IGNAT OFAPPLICANT(S)DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from die Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. REV. 08/05) i I{ ~111111~N~1~111 IIlI~I II ~ 805'5.833 STATE BAR OF WISCONSIN FORM 2 - 2000 Tx:4041573 Document Number WARRANTY DEED 955613 BETH PABST THIS DEED, made between Daniel E. Hamann and Margaret REGISTER OF DEEDS A. Hamann, husband and wife, Grantor, and Oevering ST. CROIX CO., WI Homes, LLC, a Wisconsin limited liability company, Grantee.05/03/2012 11:30 AM Grantor for a valuable consideration, conveys and warrants to EXEMPT#: NA Grantee the following described real estate in St. Croix County,REC FEE: 30.00 TRANS FEE: 123.00Wisconsin: PAGES: 2 Lot 1 of Certified Survey Map filed July 6, 2005, in Vol. 20 of C.S.M., pg. 5013, as Doc No. 799573 located in part of the NW 1/4 of the NW 1/4 of Section 17, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin; including Lot 1 of Certified Survey Map filed in Vol. 12 of C.S.M., pg. 3348. Recording Area Name and Return Address:a Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 1026951 Exceptions to warranties:042-1046-50-150 Easements, restrictions and rights-of-way of record, if any.Parcel Identification Number (PIN) This is not homestead property. Dated this April 27, 2012 Daniel E. Hamann M rga et A. Hamann WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 2 Parcel 042-1046-50-150 07/27/2007 04:08 PM PAGE 1 OF 1 Alt. Parcel M 17.29.18.2628-15 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/06/2005 00 0 Tax Address:Owner(s):O = Current Owner, C = Current Co-Owner DANIEL & MARGARET HAMANN O - HAMANN, DANIEL & MARGARET 1440 HAZEL CT UNIT #4 HUDSON WI 54016 Districts:SC = School SP = Special Property Address(es):Primary Type Dist # Description 1005 100TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description:Acres:3.350 Plat: 5013-CSM 20-5013 042/05 SEC 17 T29N R18W PT NW NW BEING LOT 1 Block/Condo Bldg: LOT 01 CSM 12/3348 (2.730AC) NKA CSM 20-5013 LOT 1 (3.350AC)Tract(s): Sec-Twn-Rng 40 1/4 160 1/4) 17-29N-18W NW NW Notes:Parcel History: Date Doc #Vol/Page Type 07/06/2005 799573 20/5013 CSM 10/31/1997 567809 1274/071 QC 2007 SUMMARY Bill M Fair Market Value:Assessed with: 0 Valuations:Last Changed:05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.350 42,600 7,000 49,600 NO Totals for 2007: General Property 3.350 42,600 7,000 49,600 Woodland 0.000 0 0 Totals for 2006: General Property 3.350 42,600 7,000 49,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date:Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent ChargesTotal0.00 0.00 0.00 t3 3 799573 VOL 20 PAGE 5013 KATKIL'EE H. REGISTER R OF DEEDS ST.WXCERTIFIEnSURVEYMAPRECEIVEDxFCOR* hRCORD LOCATED IN THE NW1/4 OF THE NW1/4 OF 07/06/2005 01:26PM SECTION 17, T29N, R18W, TOWN OF CERTIFIED SURVEY MAP WARREN, ST. CROIX COUNTY, WISCONSIN; REP FEES 13° 0A COPY FEE: 3.00 INCLUDING LOT 1 OF CERTIFIED SURVEY MAP PAGES: 2 RECORDED IN VOLUME 12, PAGE 3348. NW CORNER SECTION 17 OWNERS SURVEYOR DANIEL & MARGARET HAMANN EDWIN C FLANUM 1440 HAZEL COURT NORTHLAND SURVEYING, INC. uc~~S g HUDSON, WI 54016 P.O. BOX 14y \u ROBERTS, WI 54023 v MG~JC~f~LQ`~4GDD L~,LQMD~ EXISTING CENTERLINE ---)I R - S89-43-20-W C1S89°26'06"W 158.68' I OOTH AVEN U E c2_ _93 S89°26'06-W 159.06' LEGEND 1.9-:t 143.47'15,59'I H I H WLZALUMINUMCOUNTYSECTIONI 4 CORNER MONUMENT FOUND 1^~ i15/16" O.D. IRON PIPE FOUND V~ O 3/4'X 18" IRON REBAR SET LOT 7 WEIGHING 1.50 LBS. PER I 3.35 ACRES INC. R/W 2 a ILINEARFOOT145,753 SO. FT. x -X EXISTING FENCELINE c UJ 1CDp3.07 ACRES EXC. RM/ 133. SO. FT.100' ROADWAY SETBACK LINE 9 I r I L.B.O.O. = 1086.14 w R - XXXXX) PREVIOUSLY RECORDED DATA I d~Q a~oilVUo FM-I 66'i H.W.L. a PONDING AREA TO HIGH v I MOO do co 2, P®a 0134£g3 I z 1064.14 WATER LINE ELEVATION EXISTING C71 C:D I L.B.O. LOWEST BUILDING I I MOUND SYSTEM a OPENING ELEVATION Q NOTE:4i w 3.5'. 300.00'88.00' NO OWNER OR RESIDENT I S89°54'46"E 366.00'T WSHALLDOANYTHINGTHATLnfpjR = S89°37'32'E)O ~n WOULD INTERFERE WITH OR I w n CHANGE OPERATION OF THE J pPONDINGAREAASSHOWNONI THIS CERTIFIED SURVEY MAP.1 W WTHISINCLUDESBUTISNOT2.1 w LIMITED TO BUILDING UPON,I v OBSTRUCTING, ALTERING,w FILLING, EXCAVATING OR PLANTING IN THE PONDING W1/4 CORNER O AREA.SECTION 17 gz %CURVE DATA TABLE m 1 THIS MAP SHOWS AN EXCHANGE OF LAND BETWEEN ADJOINING LAND NUMBER C1 E27 RADIUS 1302.00'OWNERS. NO NEW LOTS ARE CREATED BY THIS INSTRUMENT.CENTRAL ANGLE 9°10'19" CHORD BEARING sea°so'ss.s'W 9'W Property Owner squired the original property with document CHORD LENGTH 2os.20'567809 and is adding adjoining property from documentARCLENGTH208.42 750607. This map shows the exchange of land betweenTANGENTINS80°15'47"W aW adjoining parcels and has been completed with documen tTANGENTOUTsag°2s'o 799453(QCD). No new lots are created by this instrument. Approved on s"w 8W " - © S by~~{~~lGcN ~p~:f r n Zoning Department SCALE IN FEET 1" = 100' THIS INSTRUMENT DRAFTED BY SAM ADAMS SHEET 1 OF 2 SHEETS 100 40LJOBNO. 05-14 DATE 3-10-05 0 100 Vol 20 Page 5013 go A 8 FILED SEP 1 1 1997 00 1 71997 Z KATHLEEN H. WALSH Re4isterof Deeds 2 ST. CROIX COUNTYSLCroixCo., WI URVEYOR'S RECOR05~52SS 0) CERTIFIED SURVEY MAP Located in part of the NWJ of the NWJ of Section 17, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. Owner Legend Eldo Hamann Aluminum County Section Monument Found O 1" X 24" Iron Pipe set, weighing 1.68lbs per linear foot Prepared Fo 100 Foot Roadway Setback Line Dan Hamann A OF Existing Fencel i ne J N 1607 Aspen Dr, o m N Apt. 1 W a N Hudson, WI. 54016 m C C y3 L L z ~0 d d dL~NW Corner c. o 3 Section 17 WI 0m N N N DOUGLAS I cp 0 en ZAHL R y N Co 21 m i UNPLATTED LANDS 100TH AVENUE S89°43'20"W 143.10' S89°43'20"W 143.47' 4 LI N r L N 0^q V1 J J CAe- L N N d-1 M Cl LOT 1 0 o c r, r-ll I VJ ZI M QI 2.73 Acres Inc. R/W I 3Ji 118,908 Sq. ft.QI u; 4.0 w W I o I M Wi M 2.50 Acres Exc. R/W N I---i v NI~--~108,993 Sq. ft.o 1: °o io C 0000 N N Z~VO V) Nm C4 0 O ZIdlaPO zl Z 0 Z oom 33 I H L 4 N 0 0 4j nI 4J y N N me ° ° c m mm N 00 00 C NLI O F-m CD N N