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HomeMy WebLinkAbout020-1090-70-000> 4) c 0 Q C 4 4) cc '0 0) U 4) .00 CO m &X c Lu 4) 0 a 0 00 CD 4) ca Z CL M 4�) U. § 10 0 a 0 < m L E 4; 0 m Lij CM CN Cl) z 0 k k 2 !E z E UO 4�) Cl) 0 ƒ im M c- 01 .9 1 rL 4) < 0 4) z (1) z 0 z 04 Lo m 0 L C (A j S 0 U) U) U) E 0 0 0 CL CL CL IL 0 o U 0 U i m Cl) z 4) 0 E 4) z V ca r a. b C14 CC §§ C4 0 (D (0 u) c 4) 2 4 8 F. 4 4) ■ a. Ci a C A U) w C') 4) 4) C', C, c -,i c) m 4) Z 0 0 z z cc CL CL 0 L: CL 0 U)2 CL STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � LG' POW ADDRESS -� 2 - d /U.Q� /e CO '94 SUBDIVISION / CSM# SECTION N -R,�f W, Town of t y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V� ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK • IDa D ALTERNATE BM: =b D c1ts T •�, / '� /Lfjty �ZO'►�C - 4 ".1 , 3' 4�rxlA) SEPTIC TANK BER Z • Pos el;� ? �p Manufacturer. S ` 'fie �,• ? Liquid Capacity: /617T0 Setback from: Well -> 7.5 r 2. S . H ouse Other Pump: Manufacturer / Model# Size Float seperation Gallons /cycle: Alarm Location * / /e_4A~.✓ ':SOIL ABSORPTION SYSTEM Width: 10 Length 3 Number of trenches �— Distance &Direction to nearest prop. line: ? 2,S •S Setback from: well: House y0 O ther ELEVATIONS Building Sewer ST Inlet; ?• ST outlet. PC inlet / PC bottom _ __ ,_,_­ Pump Off S. ' f�/'�Zfl Heac>,�r /Manifold 6 Z Bottom of system Exist ng Grade Final grade 7 •'S y DATE OF N PLUMBER ON JOB: R O� LICENSE NUMBER: 2 " 2 ' 4t f' INSPECTOR• No J 3/93:jt Z.; �- a i d O it Ii U S Cz - IN z � � b © � O W w' G 1 b m 0 01 C��Q C = N ?Z . o A n m co M V r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you p rovice may be used for secondary purposes (Privacy L aw,7G.1 5.04 (1)( m)]. ��I �flld�h ❑ cit ❑ vNW46 wwovsnship CST BM Elev. - . Insp- BM Elev.: 7scription: TANK INFORMATION P/ L TYPE MANUFACTURER CAPACITY Septic Septic Inside Dia. Dosing D IMENSIONS Aeration Dosing Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Air Air I to ntake ROAD Septic Inside Dia. Liquid Depth D IMENSIONS NA Dosing DIMEN I N NA Aeration SYSTEM TO P / L BLDG WELL NA Holding Manufacturer: SETBACK INFORMATION PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft H ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA M n -70 -000 STATION BS HI FS ELEV. Benchmark A BM Bldg. Sewer St / Ht Inlet St /Ht Outlet Dt Inlet Dt Bottom Header / Man. Dist. Pipe Bot. System BED/TRENCH Width Length No. Of Trenches I Vent To Air Intake PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER Type Of Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I I Vent To Air Intake Length Dia. I Length Dia. Spaci I #'Q Yes/ []/No I n e�dtl'o�t # 2t No / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges T opso il InS ectio #'Q Yes/ []/No I n e�dtl'o�t # 2t No / LMMMENTS: (Include code discrepancies, persons present, etc.) Location: 682 O'Neil Road, Hudson, WI 54016 (NE 1/4 NW 1/4 32 T29N R19W) - 322919374G 1.) Alt BM Description = r 2.) Bldg sewer length = h - amount of cover = A I a �� 'e Plan revision required? [:)Yes ❑ No T1 Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. County Sanitary Permit Application ST. CROIX COUNTY WISC ZONING �p4 In accord with 15.04 St. Croix County Sanitary Ordinance OFFICE' ( Personal Information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER �i [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road W 7 (715)386-4680 Fax (7 5386-4686 Attach complete plans for the syste o ..not less`Ua 1/2 x 11 inches in size. County Sanitary Permit # ❑ C vision to revious j tion 1. Application Information - Please Print all Information �� ;-' Location: Property Owner Name. y , T ' — / I , / 1/4 A 6v 1/4, Sec 3 2- fl T N. R 9 (or) W c Property Owner's Mailing Address CU v ',t>,e 1'G Rip Lot Number Block Number City, State �A Zip Code S' Phone f4um Subdivision Name or CSM Number f f (> vS4 /6P 7/1-M� ' �y3 Co N� . �` esov,�pS 11 Type of Building: (check one) (amity ❑ Village QPown of K 1 or 2 Family Dwelling - No. of Bedrooms: #11 O� ❑ Public/Commercial (describe use): 'pS Nearest Road O /N1 1 L /?, ❑ State -owned 11. Type of Permit: (Check only one box on line A. Check box on line B If applicable) Parcel Tax Number(s) A) 1 1 2.0 Reconnection 3. ❑Non- plumbing 4. ❑Rejuvenation p °L C1 - r b 7`6 7 o ,cjve Sanitation B) Permit Number 7Date I ssued a 3 ❑ State Sanita Permit was reviousl issued • IV. Type of POWT System: (Check all that apply) A oT ` ,� ✓Lt vc tOS l �(� du -au �oc v� /a ZE], K pressurized In-ground A#Aov • Mound ❑ Sand Filter Co nstructed Welland ❑ Pressurized In ground lq?o S Q Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersai/Treatment Area Information: 9 1"T N 6 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation to 6. System Elevation Proposed /day /sq.ft.) (Min.Dnch) A? 44 7. Final Grade Elevation Required (Gals. �,�, ..2 y /ff N//� o �o - - 7 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic Gallons Tanks `Z Concrete structed glass New Existing Tanks Tanks Q�� 160 l ❑ ❑ ❑ ❑ crow! /S z. ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/ reconnencUon /rejuvenaBonMstallaUon of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. P be Name ( tint) Be2i �Z hxicLcI Plumber's Sig ture (no stamps): 791P /MPRS No. zz�37S Business Phone Number 7/1"•38 ' J 0 1<5'S Plumber's Address (Street, City, State, Zip Code) SS- D 7 �� �C,IUD�• �,J �/ S" Ill. County Use Only Disapproved Sanitary Permit Fee Date Issued su ng nt nature (No stamps) ed Owner Given Initial Adverse / � S � �� Determination IX. Conditions of Approval /Reasons for Disapproval: G2 p� 6.CG ri - ��n , lr'tt-{ -p{fe. J / f f dw. '4 ok d - r•P ice— Yk*q HIV U tr ter o4 c otr / t ✓ _ 1 �/�. v�' "f y'taL( (.S Ye tr lJL.2 Prob( ew&�{ -o �n�.i"`C 1t� s�s�ci.. rna ar�s "� �e S�Fklle h l o CO z � N O� U� v m c a O Z_ O O U m Q Q _ W M_ Z y W O U Z U w Oz LLJ cy- C t m U o CO z � N O� U� TA 0� LJJ LJJ m Z J O a. 4%?— kb U O LL O Z 0 0` z NI U 0 m rr VJ O J 0 Z Q a N O CL L y d 0 w y c N `o N O. 4) w N c N O 3 0 T O m 0 m U) O P W Q D w U LL U- 0 Z D U) D W N i— D Q 1 6 Q w O LL m W w W U) J Z) W X I-- LJJ a. 3: w Z Q J Z W a 0 2 0 W- LL R W } C/) r� O J 2 Z Z O Z U O L� 0 � O 00 LJJ ( :c Z Op w J m v m c a N c ° m — m 3 a y o a o° 0 ` N ID C t m U O C N 2 ' a) `ZK C N y ° ° N .� ID C d y N 0 C C M R N •p _ ' U) = V c y co 0 0 `° 7 m E E a d c C N n N . 0 3 ° a c a) w 6 o m r 0 - Co C `" y m 0 L j 0 a C O. N 0 N C� a y y 3 N >, a) .-. m M y Q m 5 Cl 'c E E E >, E ((a, 3 d 02 a5 o_ 8 E y �N ° a 0 N L C m O N C 7 o a Na= �U y y f6 m L O L m N w _ +T+ E E c C c - C Co E U _ �• y N y E O @ a 0 N N N 0_ 0) N C 0 a O _O ;a � L ° . N ° @ m r- N v 3 m o Q. c c m 0 c m 6 C N y .�" m a p L CO = F-m N O L y �m y t ~ m L y U N y �E L F- .0 c T N v E E - -- LO . "�..0 m � �.' m TA 0� LJJ LJJ m Z J O a. 4%?— kb U O LL O Z 0 0` z NI U 0 m rr VJ O J 0 Z Q a N O CL L y d 0 w y c N `o N O. 4) w N c N O 3 0 T O m 0 m U) O P W Q D w U LL U- 0 Z D U) D W N i— D Q 1 6 Q w O LL m W w W U) J Z) W X I-- LJJ a. 3: w Z Q J Z W a 0 2 0 W- LL R W } C/) r� O J 2 Z Z O Z U O L� 0 � O 00 LJJ ( :c Z Op w J m Owner /Heger Mailing Address �Z ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND y3 ( t - - 7 OWNERSHIP CERTIFICATION FORM ;,e �• ? l�DiPt a',V��� Property Address s f jM 'Q__ 'L'. (Verification required from Planning Department for new construction) 0 2o lD 0�70� City /State lf10'-'-) 4. Parcel Identification Number o� LEGAL DESCRIPTION -2- t ORIUjINAL A/ Property Location J 1 14, '/4, Sec. , T 2Q N -R W, Town of }�v PS��7 r Subdivision --/ _ /t'l ���r%`^^�` s , Lot # Certified Survey Map # A_)111__ , Volume , Page # Warranty Deed # 3 ( 1 -? �s / Spec house ❑ yes OGo Volume S�Z' , Page # �tY Lot lines identifiable C( yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, 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. The property owner agrees to submit to St. Croix 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 slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE F APPLICANT DATE OWNER CERTIFICATION I (we) 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. 7 / SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed .. , 1, Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis, Adm. Code J County :5 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q ZC Please print all information. Re ' e by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 7 Page l of �/ X— r v . `J r Date IfIx 1 5-0/v Govt. Lot IV 1/4 ft) 1 /4 S fy T 2� N R / � E ( ) Prop Owner's Mailing Address / Lot # Block # Subd. Name or CSM# 8Z 4 ItXi& IQD - A/4 - M 6-7S � j30 0N DS City State Zip Code Phone Number ❑ City ❑ Village .] Town Nearest Road ff wo-fo.,-) G� /. SYo�� t ��S>3 �6 o'.v e: =ev ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Z QESS oU -S V Flood Plain elevation if applicable General comments 0 (t e&1,� , 5 f j`s and recommendations. O �' rim F/ I ❑ Boring D �, 41 Boring # 7 1 gy �!Q Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots I •rr•• GPD /ftz •Eff#1 •Eff#2 o -(, 1,0M 313 s — If 5 ie nw -k w a f— 2 6' D /D l S& 24m SIB />r �' s • 5 o �o y� .�-- G S /f X eS • 7 1. Z i GS I ex 9y- 71( r 4(i.Z0/ 7,4 Z f 6 z� ❑ Boring [' r 4 Eti,LLp� Boring # F ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun oots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 a..nwc . fY , - avv - ov _ ZZU myrL drw 1 00 - oU � - IOU mg /L - tmuent 8Z = tsVU, < 3U mg /L anti T55 < 30 mg/L CST Name (Please Print) �G� �/ vt I Signatur 1� C S T Number � 43 r S Ulbricht & Assoc►ates on—.— rnneii*snte 655 O'Neil Rd. Hudson, Wis. 54016 Goa O a..nwc . fY , - avv - ov _ ZZU myrL drw 1 00 - oU � - IOU mg /L - tmuent 8Z = tsVU, < 3U mg /L anti T55 < 30 mg/L CST Name (Please Print) �G� �/ vt I Signatur 1� C S T Number � 43 r S Ulbricht & Assoc►ates on—.— rnneii*snte 655 O'Neil Rd. Hudson, Wis. 54016 Goa O b f) C. a w+ � o� 0O ms m � O O W ? N W N _ 1 "1 O � " V 0 Ci o � � 1 0 ~ h V LA I � I f 0 N / 1 1 �a y n 7� ; Its © I 1 7011 %0 0 ooCtA,�r, 341 BY THIS GEED Theodore E. Barron and Barbara 8. , Barron, Wife 1 toe Ge r e E. Nelson and Dorothy y Grantor conveys and warrants to Q E ,_Nelson. husband and wire as joint _ As + tenants — - Rgbfar a• Qeifs a s ` Grantee, `i for a valuable consideration aETU11N TO 3 Gwin, Gilbert & Gwin the following described real estate in St. C ro ix County, Stateofwisconsin: A parcel of 0.88 acres located in the Northeast Tax Key 0 Quarter of the Northwest Quarter of Section 32, This is homestead property. Township 29 North, Range 19 West, described as follows: Beginning on the East line of said Northeast Quarter of the Northwest Quarter 350.2 feet North of the Southeast corner of said, Northeast Quarter of the Northwest Quarter;. thence North on said East line 175.0 feet; thence West at right angles 220.0 feet; thence South parallel witt the said East line 175.0 feet; thence East 220.0 feet to the POINT OF BEGINNING. Together with an easement for an access road 15 feet in width from the above described parcel, Easterly over the Northwest Quarter of the Northeast Quarter of said Section 32 to the town road as now opened and travelled and an easement for the installa- tion any maintenance of telephone and power utility lines as now located over the Northwest Quarter of the Northeast Quarter of said Section 32. TRANSFER Exception tv warranties: �� • `I EE Hudson, W ; 2'.(/ ( , Executed at _ tbi _ day of SIGNED AND SEALED IN PRESENCE OF ` (SEAL) . Theodore E. Ba rron i Barbara S. Barron (SEAL) (SEAL) P Signatures of_ Theodore E. Barron and Barbar S . Barron, his wife authenticated this z f-14 day o! 19, 77 " Title; Member State Bar of Wisconsin gam( Authorized under Sec. 706.06 viz. STATE OF WISCONSIN ss. County. j Personally came before me, this day of 19�, the above named to me known to be the person.._._ who executed the foregoing instrument and acknowledged the some. T �# �St t3gS` AV14" t1q , Attorneys Hudson Wisco Notary Public County, Wis. The use of witnesses is optional. My Commic.sion (Expires) (Is) Names of p —sons signing in any .apecity should be typed or printed below their signatures. WARRANTY L RD — STA14 BAR OR WISCONSIN, FORM NO. 2 — 1971 L� ��• 'OOCUMENT NO. .347954 VOL 572 -Q� 16 9 BY THIS DEED Drexel H. Henderson and Marilyn K. Henderson, his wife, Grantor con ve a and warrants to George E. Nelson and Dorothy E. N2slon, husband and wife as joint tenants, antes S for a valuable consideration the following described real estate in St. Croix County, State of Wisconsin: STATE BAR OF WISCONSIN-FORM 2 WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA RETURN TO o 20 �l ��0, pe2 The North 90.1 feet of the South 350.2 feet of Tax Key 0 the East 220 feet of the Northeast Quarter of the This is homestead property. Northwest Quarter and the North 50.1 feet of the South 310.2 feet of that apart of the Northwest Quarter of the Northeast Quarter lying West of the Town Road, ALL in Section 32, Township 29 North, Range 19 West. This deed does not create a new parcel or lot, but merely conveys additional land to the -- grantees who own the land adjoining the above parcel on the North. TRANSFER $ -3. FEE Exception to warranties: Executed at —_ Hudson Wisconsin thi �^ day of_— April 19_78 S IGNED AND SEALED IN PRESENCE OF ! ° / r .mss-' (SEAL) D rexel H He nderson (SEAL) M arilyn K. Henderson_ t (SEAL) (SEAL) Signatures of Drexel H. Henderson and M arilyn-K. Henderson, his wife authenticated this -a day of Ap ril 19 78 . Y'o'hn D. Heywood Title: Member State Bar of Wisconsin Dt2QMXLR(1X Authorised under Sec. 706.06 viz. STATE OF WISCONSIN s s. _ County. Personally come before me, this the above named day of to me known to be the person_ who executed the foregoing instrument and acknowledged the some. This instrurnenl was drafted by John D. Heywood, Attorney at Law Hudson, Wisconsin The use of witnesses is aptioLal. Notary Public , 19,, County, Wis. YY Commission (Expires) (Is) I REGfSTERS OFFICE ST. CROIX 00., Wis. Recd. for Reword tbft__19U day of . 1978 Names of persons signing in any capacity should be typed or printed below their signatures. aG r WARRANTY 09=0- BAR OF V CONStN. FORK NO. 2 - 3971