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HomeMy WebLinkAbout026-1122-11-000 Q o . O °e» c c •• 0. 0 I C � j 0 3 •c I N 7 ° — 3 M C N ry c N E. U L N N N C O cz O TEY C N c O cl O N 1 O) Z N o Y ` N c Z ` a .0 . m N— E LL c O O W o E c c -I- 0 0 U O N C > O 0 47t Q+ Cl) 3 Z E � c Z m m Cl) o a m v F- Z c C7 Zo o Z v c T O N H �' n a c m E C) (3) -C E V_.t�1 N W N m ' m N � O O cu F- U') z z cs z o N U Q A (n N 7 . C C o o a �� Z F�' -�� - 0 0)333 O •N @ I, =3 a a a CT M 7 0 W L O 0 0 � N NJ .J C) 0 0 _ } N N O ro W Z .;- N O O O - 3 O X O C O C� N N N O cl © F m a m m u a ° o o l L N ap C > C N @ C N N G o E Y CO c ,c c co co M U - > > t • L' o o U) M o 10 Y Y *� \ 2:1 E _ a m y a ° n, w • • C� CL E o `�1 A 0a�'',',Ov>ci Parcel #: 026- 1122 -11 -000 01/20/2009 05:06 PM PA 1 O F 1 Alt. Parcel #: 04.30.18.747 026 - TOWN OF RICHMOND 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 - EGGEN, GARY R & KATHLEEN T GARY R & KATHLEEN T EGGEN 1107 174TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1107 174TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.410 Plat: 07- 079 -WEST SIDE WINDING TRAIL ESTATES SEC 4 T30N R18W PT NW SW WEST SIDE Block/Condo Bldg: LOT 11 WINDING TRAIL ESTATES 1.15AC LOT 11 & PT LOT 12; COM SWLY COR SD LOT 12; TH S 55' Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) E 250.31 FT TO POB; TH S 87' E 180.00FT 04- 30N -18W TO WLY ROW CUL -DE -SAC; TH S 55'W 214.54FT; TH N 01'W 128.16FT TO POB Notes: Parcel History: Date Doc # Vol /Page Type 05/18/2006 825568 WD 01/09/2003 705229 2105/514 WD 01/09/2003 705228 2105/511 WD 06/07/2000 624413 1517/203 WD more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 283967 223,400 Valuations: Last Changed: 09/09/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.410 41,200 175,700 216,900 NO 05 Totals for 2008: General Property 1.410 41,200 175,700 216,900 Woodland 0.000 0 0 Totals for 2007: General Property 1.410 25,200 167,500 192,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/09/2007 Batch #: 07 -13 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Coun Safety and Buildings Division �t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitnr yvµtNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Villa ❑ o n of: State Plan ID No.: tock, William Rich mond Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Ta o.' oU • O� I . t�� o = CS( e 02 122 -11 -000 7 v TANK INFORMATION ELEVATION DATA / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C Benchmark 0 2.30 /02.30 10D. O r Dosing Alt. BM 3.0 C Aeration Bldg. Sewer .-3 .eiS� Holding St/ Ht Inlet 6;32 %, 79 TANK SEMM& INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 3c f ' 9 NA Dt Bottom ---- Dosing NA Header / Man. Aeration NA Dist. Pipe 3 o qS2�� Holding Bot. Syste PUMP/ SIPHON INFORMATION Final Grade,9�+0� Manufactur errand St cover 3.9 I •3g Model Number GPM TDH Lift L � Ion stem TDH Ft Force ain Length I Dia. Dist. SOILOSQRPTION SYSTEM ,s a IKQ TRENCH Width I Length No Q f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMERSIDW 3 l DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufla�c- tryure: INFORMATION Type O r ® �� CHAMBER Model Ni System: CON 023 1 O OR UNIT -_C DISTRIBUTION SYSTEM LAW, (.w Header / Manifold M Distribution-Pipe(s) x Hole S I x Hole Spacing Vent To Air Intake Length ��t� Dia. Len ia. acin 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 ❑ No El Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 6512- 0T Inspection #2: / Location: 1107 174th Avenue, New Richmond, WI 54017 (NW 1/4 SW 1/4 4 T30N R18W) - 04.30.18.721 West Side Winding Trail Estates -Lot 11� a s� u et P Q 1.) Alt BM Description = I �� C ��C 2.) Bldg sewer length = 3 - amount of cover= 41 Plan revision required E] Yes No Use other side for addi tional information. Ofe Z„� vo SBD -6710 (R.3/97) Date Inspector's Signature Cert No t. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a_ °e M s m — �e. „ < s � � ea # < ... ... I w , t ° z € E f x t i 1 e # f � F $ e t 8 S 3` t t # < R 2 g S 3 eee fl t 1 # � a e" F t E i f F < q a J / p e ti x i t v 3 c Safety and Buildings Division SANITARY PERMIT APPj CATIQW, . 2 01 W. Washington Avenue Vsconsin h P O Box 7302 Department of Commerce In accord with Comm 83.05, W ,Ad Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste ' p ss C than 8 1/2 x 11 inches in size. n `- • See reverse side for instructions for completing this applica to Stat a itary Permit Number 3 5 3 S� Personal information you provide may be used forsecondary purposes Lo y , rs�Z 'it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. S an I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL IN Propert y w Name P rq T , N, R (or ` Pro pert Owner's Mai linoddr ss Lot Number Block Number Cit , State Zip Code Phone Number Subd ision Name or CS Number ' ( ) - I , II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road ❑ village Public Rf 1 or 2 Family Dwelling - No. of bedrooms Town OF 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) Q.0 11 —11 1 ❑ Apartment/ Condo ��6 — /l - / - e66 `{ 3 D . 1 8' . 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 14 New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ------ System -------- System ------------- Tank Only -------------- Existing System - ________ExlstingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 54 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. , lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. ch) -v Elevation d /i Feet Feet VII. TANK Capacity in gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Con- Steel glass Plastic App New Existing concrete structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1131 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans. Plumber' ame: Pi t) Plum *"s S' : ( m M No.: Business Phone Number: Plu ber's A dress (Street, City, St e, Zip e): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved iiii nitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial 0 Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems - must be properly maintained- The septic tank(s) must be pumped by a - ticensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and .BuildingS.Div.ision,- -6138- 266 -3151. To be complete and accurate this sanitary permit application must include: i L Propertyewner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on fine A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the follbwing: A) plot plan, drawn to scale o'r with complete dimensions, location "of holding tank(st, septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the - county; E) soil test data on 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i oe- Red /�-C 7 i 7y,9 -/zAZIL 1 � 3 3 I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divisiori of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ^ include, but not limited to: vertical and horizontal reference point (BM), direction and e- y/ X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please ;r J 2 ,, inJW76# lon -- • Re iewed by Date Personal information you provide may be used for second ` A pses (Pri vacy Law, s. 15.04 (,1) (m)). Property Owner Prof* rty Location �f /11 GQJ�1 v� _/) Qovt. of 1/4 1/4,S T © NR '' E (o& Property Owner's Mailing Address ) z Lot # Bloc Subd. Name or C # 1 City tate Zip Code ,.rPflo earest Road `��ity Village �] T n New Construction Use: � Residential/ Numb V , u ms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4P gpd Recommended design loading rate _bed, gpd /fl .j trench, gpd/ft Absorption area required bed, ft2 ft aximum design loading rate bed, gpd(ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material � / 0- o - % Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system I NrS ❑ U ❑ U 11 S ❑ U YS ❑ U ❑ S M [Is �B U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench rr d 3� i r Ground lev - w �. ; ft. Depth to 9 `� 0 / limiting factor ;r Remarks: Boring # 3 Ground elev. Depth to limiting fact r Aa in. Remarks: CST Name lease Print) Signature Telephone No. Address;,—/, Date CST Number / SOIL DESCRIPTION REPORT PROPERTY OWNER `� �' " Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 0 - - Ground elev s Depth to limiting factor in. 310 ��Z� Remarks: � o f ring # _ Ground elev. Depth to limiting factor �in. Remarks: • Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ' ::6' / Ground elev. De tito limiting fact r — Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) Soil Test Plot Plan Project Name' /�k? �f� Byron Bird Jr. Address Lot Subdivision Date 1/4 � 1 /4 Se 4T N /R,&(W -'— Township Boring Q Well PL Property Line County BM or VRP Assume Elevation 100 ft. '�� � ��� 1 911 ;X-07 System Elevation �� *HRP o /° s � - �- AA Scale 1/4" = 10 Ft. When Dimensions aren't stated ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer cx'_X� Mailing Address f ^7 V �/ (� �� S T ✓�'�� Property Address 11 7 A (Verification required from Planning Department for new construction) Cit /State Parcel Identification Number 0 - 3 � • �a + LE GAL DESCRIPTION Property p Pro e Location /" O '/4, S &1 '/4, Sec. T -RW, Town of a. y Subdivision + �vl�yU�� vu� �S , Lot #. Certified Survey Map # , Volume , Page # Warranty Deed Volume 7 249 , Page # �S Spec house des ❑ no Lot lines identifiable 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. 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 stating 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. AMA- 03 SIGNATURE OF 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. 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 7 .' occun,c_r,r No WARRANTY DEED ....... .......... STATE BAR OR WISCONSIN FORM 2 -I9li �a5611 .ct � 1 POLE fi5 Croft Dennis W. Schultz and Rachel Schultz, ~Ix `Vii. husband :. , 30th and wife as joint tenants ' _... __.. _.. . ........ ..... -x� Sept. .. and Roxanne D: .... .ron,rya and warrants to William Stock ... ._ Stock, husband and wife a 3oint tenants ............... w _. _ __......_.._ Northwest Federal S &L _. ........ t .. ... _ �yt 160, New Richmond WI , the !allowing describe real estate in .. St..._CcC.i:c ... P.O. Br ....._.._..........County, •,4 017 State of R'ucor:sin: Tax Parcel No: .............................. Part of the "k Quarter of the SOUthWst Quart (M I, of %-%) , Section Four 4) TCwnship Thirty (30) North, Range Eighteen (18) Nest, described as follows () , ; f our ( 4 , at the west quarter corner of said Section Four (4) ; thence South 89° 58' 56" East along the East -west quarter Section line of said Section, 660.38 feet; thence South 01 07' 40" Fast, 330 feet; thence South 89° 53' 56" East 660 feet; thence South 01 07' 40" Fast, 634.57 feet; thence North 89 58' 56" West, 330 feet; thence South 01 07' 40" East, 33 feet; thence North 89° 58' 56" West to the West line of said Section Fc&lr (4); thence North along said West line to the West quarter Corner of said Section Four (4) are the Point of Beg 4 34 t is not _._...___.. homestead property. till (is not) X-ption to warranties: 20th day of September 19 85. V 1 r W C t (,L It L (SEAL) h _: C L )�i � (SEAL) Dennis w. Schultz Rachel Schultz {SEAL) _ (SEAI.t AUTHENTICATION ACKNOWLEDGMENT i i Sigrnture {s) .. . .... _ _ - STATE OF WISCONSIN Count ...... ........_...................... ............ - . - - -- _ St. CrOlX s authenticated this ...... da; oL.__..... ... 19...... Personally came before me this. 20th _daY of September_ _ _ 1985... the above named Dennis W. Schultz and Rachel Schultz _........ . . .. ................................ ............................... T ITLE: y(F.l[BF.R STATE BAR OF WISCONSIN - I If not. .__ _.. ..._._... _. _..__ _. ... authorized b ... .. _.. _. _..._ ..... .. . Y 3 70fi.U& Wis. Stata.) to me kno.vn to be the person S _ _ . wFo executed the rotexmr,u instrument and acknowledge the 04me. . INi'FtL, FIT HAS DRAFTED 9Y Reicstra, Van Dyk & Needham, S.C. - / :~ /��` •'r} .. lttorr.e s at Law Linda J. 'Codfr Rich .cnd, Agisconsin . 51917- N 7 0 12 7 r = otary puhlic St. C! X'- I.r tn4. S. �Sianat,r.s may be authenticated or acknnwledw,,I. P - %Iv Comink.iinn is perman4t. Lf;F r d R at exoiL. .re not nec —ary.l date: 1L -15 - v t •s.,n....r ,. r.,:,,..1 - t i i n r "--Y .t,. , i .. .o.t ...,.ni..t i:..i::w n �. ...,..,.: • ........ , ' 'ry .............