HomeMy WebLinkAbout038-1097-90-100 (2)
Form - S T C - 10C~
• AS BUILT SANITARY SYSTEM REPORT
OWNER ~Qr} Q l Q/ ~(/~/f r^j TOWNSHIPS ~ZI-q 1p,j G SEC. T N-R~ e W
ADDRESS zft, - ge x 3pZ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT '-LOT SIZF,
PLAN VIEW
Distances and dimensions to meet rejuirements of I•I.HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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BrD~' INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used T,°O 4,51 rill er' Ira 14
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, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: x Trench:
Width:__ Lenith:Number of Lines: _y _ Area Built:.5-~,
Fill depth to top of pipe: c
Number of feet from nearest property line: Front, (SrSide, O Rear,0 Ft.
Number of feet from well: &4 tJ
i
Number of feet from building: Ile
(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 0 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, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
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
SWk, SEh, S23,T31N-R18W CONVENTIONAL ❑ALTERNATIVE s'«: ft.. I.D. Number:
Town of Star Prairie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
200th Avenue
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION OATS:
Ronald Wohler Route 2, Box 32 Wall Street Village,
BENCH MARK (P.-m relerence m..Il DESCRIBE IF DIFFERENT FROM PLAN: New Richmond, WI 506 REF. FT. ELEV.: ST REF. PT. ELEV.
Nerve of Plumber MP/MPRSIN No.: C-Iy: OIIMY mq Nwnber:
Byron Bird Jr. 3318 St. Croix 102820
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV_ AFINING LA LOCKING COVER
/ Q ^~I P OVYES PROVIDED.
(//w!//L•C-/L~~r 7 • YES ❑NO -]YES NO
BEDDING. IVENTDIA. VENT MATL,. HI H WA NUMBER OF ROAD: ROPERTY ELL UIIDING V NT iqE H
JALARM FEET FROM INC LAIR INLET
❑YES O ❑YES NO NEAREST ID N
DOSING CHAMBER:
MANUFACTURER BEDDING ILIOUID CAPACITY PUMP MODEL JPUMP/SIPHON MANUFACTURER WARN ING LABEL LOCKING COVER
PROVIDED. PROVIDED.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: _7P AND CONTROLS OPERATIONAL : NUMBER OF PROPERTY WELL ISUILDING V N TOFRE H
LINE AIR INLET
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JOMATERIAL 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: LEN N N0.PIPE SPACING V J INSIDE DIA SPITS LIUIBED/TRENCH TRENCHES MAjER1AU PIT DEPTH
DIMENSIONS b Ge(+ Is_ I
(CIIAVIL L DEPT" FILL D P H UI TN PI DISTR PIPE I$ R. PIPE MATERIAL. NO. DIS NUMBER OF Y WELL BUILDING V NT TO FHES/1
BELOWPIPES t 1 ABOVE C ER ELE V. :IT ELEV.END: PIPES FEET FROM LINE A I L
NEAREST 2
1
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.
❑YES ❑NO
OIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCHIBED DEPTH OVER REN H/ O DEPTH OF TOPSOIL [01IDID SEEDED MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO.OF LATERAL SPACING 1GRAVILDIPTHSELOWPIP1 ILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUM MANIFOLD DISTR. PIPE MANI OLD MATERIAL NO DI$Tq DIS q. PIPE DISTRIBUTION PIPE MATERIAL &KiAHKIN(.
ELEV ELEV.. DIA.. ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE 512E HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIF CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY JWELL: JBUILDING
[T~ FEET FROLINE
❑YES ❑NO ❑YES ❑NO N~
, ly S~s
0
Sketch System on q
Reverse Side. 1 itlcounty file for audit.
S rIL Zoning Administrator
DILHR SBD 67101R.01/82)
7 DILHR SANITARY PERMIT APPLICATION COUN
In accord with ILHR 83.05, Wis. Adm. Code r. ep oft
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than //j a
8% X 11 inches in SIZe. STATE PLAN I.P. NUMBER
-See reverse side for instructions for completing this application.
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION
FOR VARIANCE ❑ YES L151 NO
PROPERTY 01 71 PROPERTY LOCATION
S T , N. R E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOC UMBER SUBDIVISION NAME
CI STA 6 21P CODE T ONE NU ER CITY REST RO LAKE OR LANDMARK
G r G//IrG~U O VILLAGE
ui L ao d 7`~/~J.
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family- - OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. Xi New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously. issued:, Permit# Date Issued.
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in #2)
1. a. Conventional b. ❑ Alternative ..c. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. El Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. C91see a e Bed b. ❑ Seepage Trench C. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
f hr 67Feetrivate ❑ Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New 1EXisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank 11
Litt Pump Tank/Si hon Chamber
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's
Name (Print): Plumber' Signature: (No Stamps) f. MP/MPRSW No.: Business Phone Number:
wjalx
Plum s Address (Street, City, Sta e, Zip Code): Name o signer:
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VIII. SOIL TEST INFORMATION
Certifie Soil Tester (CST) Name 1,00, 110,
CST #
CST' DDRESS (Street, City, State, Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee Groundwater ate b Issu g Agent Signature (No Stamps)
Approved ❑ Owner Given Initial S charge Fee
Adverse Determination V, /
X. C MMENTS/REASONS FOR DISAPPROVAL: L
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'BD
-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbinq, Owner. Plumber
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS P.O. BOX 7969
H~Jb1AN aE-LATIONS (115) MADISON, WI 53707
3707
(ILHR 83.09(1) & Chapter 145)
OWNSHI MUNICIPALITY: OT NO.:BLK. NO,: SUQIDIVISION NAME: ATI F 4 S %T ~N/R/ E (o yTY: OW ER' UY R'S NAME: A AD
USE r' .rce ~ c C~~• C/fi~o
DATES OBSERVATI MADE
NO. O T -
1XResidence
New ❑Replace r
1 .2 1 %!!f PI-16
RATING: S- Site suitable for system U- Site unsuitable for system
ONVEN I NAL: MOUND: IEM-IN-FILL OLDING TANK: RECOMMENDED SY:(optional)
S DU S Du s u a s ®U cam.:.,
If Percolation Tests are NOT required DESIGN RATE: [Floodplain, f an
under s. ILHR 63.09(5)(b), indicate: Y Portion of the tested area is in t e
indicate Floodplain elevati n: o
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T R UNDWATER-INCH S 'CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERV D TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- r p6. °--.6' ~i ~5 0?6 C v76 3g~rs
B- A~ i 7 /fps. 9 -7 40-V ~.xIla, is
~nL
B- 1 ,
PERCOLATION TESTS
PTH WATER IN HOLE TEST TIME DROP IN WATEA LEVEL-INCHES RAT MINUTES
NUMBER I AFTERSWELLIN INTERVAL-MIN. PER INCH
P- /1 30
P-
P. /1 d . I
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. cJ pt r~~Y / 6
SYSTEM ELEVATION
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SEPTIC TANK MAINTENANCE AGREEMENT Ho
St. Croix County z
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OWNER/BUYER hl~ -3
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ROUTE/BOX NUMBER Fire Number
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CITY/STATE- AIF- L(/ 4'L' H ' 7o y ?.LP 49
PROPERTY LOCATION: S ✓ Section, TN, Rw,
Town of,Sf~~ St. Croix County,
Subdivision Lot number
Improper use and 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 pit 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
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three year expiration.
I/WE, the undersigned, have read the above requirements and agree EA
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- 'b
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Offk~--e within 30 days
of the three year expiration date.
SIGNED
DATE St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sion_ liarP anal return to above address.
APPLICATION FOR SANITARY PERMIT
STC - 100
his application form is to be completed in full and signdd by the owner(s) of the
roperty being developed., Any inadequacies will only result in delays of the permit
ssuence. Should this development be intended for resale by owner/contractor, ("spec
ouse"), then a second form should be retained and completed when the property is
old and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
caner of Property ~J 4my4 2 eq ZA/
,ocation of Property Section -12 , T~N-R+Z,:~ W
owns hip
tailing Address C //A
Address of Site
p~/v1-2
Subdivision Naas
Lot Number
Previous Omer of Property )tom / / j L fC' 4A T ~S
Total Size of Parcel 6
Date Parcel vas Created 6 6 -7
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number
iTEPT' as recorded with the Register of Deeds.
3
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Scal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
DOCUMENT NO. STATE BAR OF ISCONSIN FORM 11-IM T"le Arµ'A PEELRV90 FOR 49CORDING DATA
LAND CONTRACT I% ti:p uiniou rAY"'~""•
,11181 ImLividual and Corporate l~ljo 0
r TO BE USED FOR ALL LL TRANSACTIONS WHERE OVER ~ ~~I•
$26,000 IS FINANCED AND IN OTHER NON-CONSUMER 1$0(81.)1 bnolla
ACT TRANSAOTIONS
Li l: HVcsAlEnx
Contract b and between ku GIS I`ERS OFFICE
by MX ..and.........
ST. CROIx CO., wa
Einar 0. ~ to husb nd n w
s -.s .._5 e............. W CL for Record "S
("Vendor". 1._7 t h
_
whether one or more) and............. RQRA1d..WQb,1er.a y Of Jun _A.D. 19.A7
8:30 A L
("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, together with the er e
rents, profits, fixtures and other aRpurtenant interests (all called the "Property"),
St . CY;O1X.................... County, State of Wisconsin: RETURN T L.r
gaxxxpsf x$i~xafcxgRx88>~ataxxRBx~~axabsicg~ RIO .17( 410
1 txXaxak*xRxxgaxiixWaxj*
Sk of SEk of Section 23, Township 31, Range Tax Parcel No
18, EXCEPT part to Joseph L. and Karen A. Langer
in v ol. "496", Page 467 (No. 31) and EXCEPT Certified
Survey Map in Vol. "2", Page 333 (No. 32) and EXCEPT
part to Franklin DeJerome and Leona B.B erget in
Vol. "464", Page 376 (No. 33) and EXCEPT part to
Virgil D. and Sylvia A. Estes in Vol. "464", Page
592 (No. 34) and EXCEPT part to Glenn Goldsmith
in Fol. "477", Page 129 (No. 35) and EXCEPT part to
Robert E. Casey in No. "625", Page 223 (No. 47) and
EXCEPT Certified Survey Map in Vol. "5", Page 1331
(N(?. 49).
This 4f..N?.~......... homestead property.
(is) (is not) their
Purchaser agrees to purchase the Property and to pay to Vendor at a..P.lace-_ of ts_• re.que.st
the sum of ;....25.0.0 0.4.Q0...... in the following manner: (a) ;..14.,.OD_Q~.QO
at the execution of this Contract; and (b) the balance of .,•QQ•Q•••Q0......••......•. together with interest from date
hereof on the balance outstanding from time to time at the rate of....... nine.-.1r9.) per cent per annum
until paid in full, as follows: Four Hundred Seventy-seven and no/100ths ($477.00)
Dollars on the 15th day of July, 1987, and a like amount on the 15th
day of each and every month thereafter until the 15th day of June,
1990, at which time the remaining balance, if any, shall be due
and 'payable to the principal thereon. The Purchaser herein shall
have the right to prepay in any amount at any time, without penalty.
Further, Purchaser agrees to allow the Vendor to keep all rents paid
for the year 1987, as well as allow the party rentin said operty*
Proytded, however, the entire outstanding balance shall be paid in full oft or before thF.........-a,5~E..--. day of
...............une................. , 19...V.0_ (the maturity date).
Following any default in payment, interest shall accrue at the rate of .-..9L % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor.
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes. assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after June ...13......... 19.8.7.. (OR)
ti ffY> i~ 3ii1 C R~}~ fKx axit Q
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of nrincinal. and interest (and in such case accruing interest from month to month shall be treated
. . .
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