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HomeMy WebLinkAbout161-1024-20-000 o N O n CO) p ',I o n d f 3 m o d cn z z F z O 7 cn g z u—, z < w rn < �'•+ • !, S G O O W 0 N J 23 0 M C 0 CJl N x+ A N O O. d (CD 6D 7r O (D d !D 7c �p CD 0 N N (D C N O O A O to Q a 3 3 n N N ° 3 j 10 M z N N 0 3 O. O. O N a N 7 N O 7 tll O I' 2 O O to co CL o • N _ V N r« O O O !D Z � ,fD. z i13 O J v 2 1 O .Z1 O °O C U O C o J -4 0 3 cr 9 a O z O O O z O O O 0. p y m 0 cn z `ice n x c D fA co fA N A n N fn fA N A° o v O O °= m a T =. 'm z z 0 0 .. . co z _ Z M z Z ni O D a 0 w 0 D 0 0 a ZY m m m m m m �yZ� • C c m p c N m CL CL a 3 a 3 z m (6 Z m (6 -1 N O y O O O y O A Z O C � � 3 C �, .a � .• O O. N c 4 A C O 3 D 3 fli U) t a t I a z a Q 1 1 `G 3 I� A 3 � 0 r: 0 r: C) N O 3 c 3 m C) N Z 3 m (p o A � 'I 7 3 o X � Q S cn an d a � 7 7 O .+ O N O C'WO M V O T •-�•, 01 7f0 7 T CD M y O' N C n O N C m °_. 3 'C o a �'. v m o n O n CD 7 N 0) O N N = O - 0 O_ CD 7r N CD C a'O 0x01 rd CD OC N CD 6 5:3 N 7 7 C <M c 2C M Om aNm 0 m 2� m 3 Er o S C 0.0 a -a m o S O O N V j 7 O 5D N A 3 O 69 690 ° a o m o m ` a 0 C O a } I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 115 115 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City X Village Township Parcel Tax No: Kask, Helen I. 1 Village of North Hudson 161- 1024 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No . ST BM Elev: Insp. BM Elev: 7 . 13.29.20.429 e TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION i TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. I Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length F 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 JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution THole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes r No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 201 Helen Street N Hudson, WI 54016 (SW 1/4 SE 1/4 13 T29N R20W) NA Lot 10 Parcel No: 13.29.20.429 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) 06/11/07 MON 10:15 FAX 715 386 4686 ST CRX CO ZONING 14001 � County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386-4680 Fax 715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit ❑ Check if revision to previous application Appllcatio ation - Please Print all Information Location: Prop caner Na 1/4 1/4, Sec F C 7 2 N, R E or Prope ailing Address Lot Number Block Number 0 // City, State Zip Code Phone Numer bdivision Name or CSM Number II Type of Building: (check one) I! s �� � Ixity �i'C/illage ❑Town of R' 1 or 2 Family Dwelling - No. of Bedrooms: ❑ PubliclCommerclal (describe use): n O lyQ I / ; ❑ State -owned Ne Road H. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) A) 1.jj�Repair 2. 11 Reconnection 3_ ❑Non - plumbing 4. ❑ Rejuvenation Sanitation f� jD -Z V Zi✓ c e p Perm B) it u b r p G (Date Issued M, -bate Sanitary Permit was previously issued 1/� � I Sa'� /IQ(�1 d IV. Type of POWT System: (Check all that apply) ig Non - pressurized In- ground �� ❑ Mound :; 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A +0 ❑ Sand Fitter ❑ Constructed Wetland ❑ Peat Filter ❑Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other 0 At - grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area information: I,— 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.tt.) (Min. /inch) Elevation (Jnl KAIi� VI. Tank Information Capaicty in Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks N ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement ❑ E3 11 ❑ ❑ I, the undersigned, assume responsibility for repair/ reconnenctton /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A icense is not required for terrallfi rep air r o the installation of no plumbing sanitation system. PluU� ,Nal (p I) C Plumb e Sig stamps); Mp /MPRS Iy4. B ss Phone Number Plumber's Address (Street, City, State, Zip Code) 4 VIll. Count ss Onl Disapproved Sanitary Permit Fee Date Issued 1 uing A t Slgn ur stamps) Approved Owner Given Initial Adverse ,7�j u�u � � S O Determination IX. Conditions of Approval /Reasons for Disapprov 1: �f rn,Ge�t. ^Xt4,� &VA ke.-& � �'!4 � u. ,de �a� ¢�.. �L Cc��un �� 0 ' . � �►��� ire 7- � d y I X11 �d P A y 5� i (apoD antTP.zlsiuituPbV utsuoosirn £ I I WN) .zasodsip pasuaotj io (sajnjL uisuoosirn `90' St, I 's) .zagtunjd pasuaotp q palajdtuoo oq of ttuo3 : Ira) S a,IW/dW (.zagwnN osuaorl) (atli L) � S G1 (a j (aznluaiS .zagwnjd pasuaorl) 7 9z < :(umou3I jl) �imu jo 35V � Iryn :(umou}j jj) i �'a� �' zaglp jaal aiazouoD ggpid :uoilon tlsuoD =r �q _ os G :XjiovdL,� saanuitu suollL'i :aultI Jo gl�uaj Jo atunjon al '6ultxozdd� ( jxgu dqs `oup) -- N<oN sak zwoisXs uoi cUosq, wog zn000 jouq molj pia aoinJas Jo allep juaoaa IsoW ro ° r*" s�,.o u' o ( m •iflndozd 5uiuoilounj aq oI (s)juoddu Vow Ii PuU `gz g 'urtuoD jo sluatug.zlnba.z aqI oI uuojuoo Ilim `asp lmoual Xtu jo Isoq aql of `(s)3juuj aqI punoi anIUIq I I 'Oql Spno I ` opoadsul uodn • uisuoosi m SIunoa xio�D 'IS ` o o umo.I, `Ak P'z a�u `N - umo T ` I u bp :w powooj oouapisa.z /�/ •.ls /�L �jy /0z agI ruin ias Xjluasazd 31uvI otld�s auI paloa sud i DALIq I IBuI �Jil13o oI si sitj j MNV L 31MIS f)NI,LSIXa ATV AO NOII.VZI II.Lfl 2103 IM51IN HMS NOLLVDI3IZ2IaD 3XJA0 OAIINOZ A, NfIOa XIO2I�) 'ZS Z m y D co Lo� 0 O� m m O - n m x � rr+ m L 0 0 0 U) m � C .� �- � � O yam, -- � $k 00 w O r G) h r m 0 D C A - r m O o Om 0 m I m 0 O C m C/) Z N Z W o m ° (� O X -n C/) C: o C/) cn c < N n Az m O � ZZ m � O �Q - m o m s S m 5 a 3 3 a (� s m y (D�v� o �, a I — aj D oo `° o n�i omo 0(D 0 r q � C (D 7 C- Ul N =' 7 I- ID O (�D N N. Oo (D fl- a1 5D N O O CD �o �»m m (D �� o 3.m m o o�, I� a� o =r :3 E X to ^ (A N O (D C7 m o C) CL ? o m y �� Boa rvm - n o ,2 - O 0 O 6 Q- 3 O N N -O D 7 0 = m 3 m c (D o .. t0 "O (D 3 n) m m o N o N Ct). ;� 3 2 3 0 a m o o o o z CD ° �C Z O 3 0 3 (fl � D 0 z (D n� v w m m Z r z o o > > o o z -1 C m �l (D w (D m I m o D D (7 m o CD o (D m q m O O z O D CD (n w o m m v c o o z z G7 z x 3 w 3 m a Cr m m 0 m m (D P 7 N N ° ' ❑ ❑ ❑ a (D o le 0-1 kls A- fly s.,Aj 'tic) / roe f� ✓2 ..q /yS ,v j 94 C A-3 f .Le..J :53 I WO t/zu i� ✓,wl�, J P ro w 0��z�, O O �Jc s� De �4 �� r 0P/11/.07 MON 10:16 FAX 715 386 4686 ST CRX CO ZONING IM 002 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /7 e %�`'r n / Mailing Address 4,o/ iklc-n It t' Property Address (Verification required from Planning & Zoning Department for new construction.) City /State l/V° :r� _ Parcel Identification Number 141- - 10 ' zZ - Zz _6©c) LEGAL DESCRIPTION ' / Property Location ` /4 , ' /4 , Sec. 3 , T 9N R CT W, Town of V / ' " ' 964 /k Subdivision k is A DD Lot Certified Survey Map # , Volume 645: , Page # Warranty Deed # , Volume 477 S , Page # Spec house yes Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The P roperty 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. Uwe, 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 statin g your septic tic 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. 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. Number f bedrooms 95 TWITUkE O PLICANT(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 the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed_ (REV. 08/05) Parcel #: 161- 1024 -20 -000 06/15/2007 09:51 AM PAGE 1 OF 1 Alt. Parcel #: 13.29.20.429 161 - VILLAGE OF NORTH HUDSON 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 - KASK, HELEN I HELEN I KASK 201 HELEN ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 201 HELEN ST N SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 03 /36- KASK'S ADDN 1955 LOT 10 KASK ADD VIL NH INCLUDES Block/Condo Bldg: 161- 1024 -30 (P430A) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13- 29N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 695/174 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 05/19/2005 Description Class Acres Land Total State Reason RESIDENTIAL G1 0.000 104,900 (miprove ,100 256,000 NO Totals for 2007: General Property 0.000 104,900 151,100 256,000 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 104,900 151,100 256,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount es Special Assessments Special Charges Delinquent Char N N � � g Total 0.00 0.00 0.00 { Parcel #: 161- 1024 -30 -000 06/15/2007 09:59 AM PAGE 1 OF 1 Alt. Parcel #: 13.29.20.430A 161 - VILLAGE OF NORTH HUDSON 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 - KASK, HELEN I HELEN I KASK 201 HELEN ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 03 /36- KASK'S ADDN 1955 LOT 11 EXC N 30' KASK ADD VIL NH Block/Condo Bldg: ASSESSED WITH (P429) 161 - 1024 -20 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13- 29N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 695/174 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 161- 1024 -20 -000 Valuations: Last Changed: 05/04/1994 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00