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HomeMy WebLinkAbout030-2120-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and guildintd Division INSPECTION REPORT sanitary Permit No: 405047 0 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: Village X Township Parcel Tax No: Matz, Jeffrey City St. Joseph Township 030 - 2120 - 50-000 CST BM Elev: Insp.. BM Ele�v:: SM Description: d0 3 I U J fry. Z er - e C� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / S / Z � Benghmark =� 6 �� 3 w I b b I , Dosing _ _ -___ ___ Alt. BM S y0 Aeration Bldg. Sewer Ho ldi t Inlet t Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ( / 7 Dt Botto Dosing v Header /Man. Aeration Dist. Pipe M S r I� din Bot. System 9. q3 g - �2 �► 4: 3 . h Final Grade f + o PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 2 100 Model Numbe TDH Lift Fr' Los System Head TDH t Forcemaih Length Dia. Dist. to well SOIL ABSORPTION SYSTEM /Q BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS Na Of Pits Inside Dia. Liquid Depth DIMENSIONS 3" r 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L� Mapufact r INFORMATION 7 HAM R R Type Of System: (,8 Model um r: / s- I ny DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Al i Pipe(s) f -�' ,, / } / Length p _� Dia _� Length Gz•. f Dia Spacing =� Al w SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes Not Yes I] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_/� S Inspection #2: Location: 809 134th Ave New Richmond, WI 54017 (NW 1/4 SW 114 25 T30N R19W) Bass Ridge Pines Lot 5 Parcel No: 25.30.19.978 1.) Alt BM Description = 4 6r 0 ( 2.) Bldg sewer length = /j �:, JaS C{�b�/' f K f.✓x amount of cover II I �, g DS2 ✓J AP k w- r e 5 f� ${«l��/,x L . s s S i a . - - -- !C r, � cil I Ye c o ) {� l k5� l/ d ole .bt✓1 Sot1 Plan rev ion equ s � j No Use other side for additional information. Da( Insepct re Cert. No. SBD -6710 (R.3/97) I `i (: 3p o GG� io+"' � a a55 �ST�P`r e e OY��Q` 0,I p�ePICif fraPe✓I!� Irwe. 91 LOT PLAN PROJECT Jeff rev Matz ADDRESS 1871 Goodview Ave Oakdale Mn 55128 NW 1/4 SW 1 /4S 25 /T N/R W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/25/02 BEDROOM 4 CONVENTIONAL XXX IN- G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (D WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 95.5/95.0 Alt. BM Top of Nail in Tree with Orange Ribbon @ 5' Pro TowiLRoad Vent REC` 1 �°E® >6„ Standard Infiltrator jlj;L 4 20 Leaching Chamber of Cover with 31.1 ft2 of Area sr. C) ° �� 6' Long 12" Grade at System Elevation 34 99 50' Property Line 220 Pro 4 Bedroom 30' House Plans Designed Using -6 Conventional Powts T Manual Version 2.0 15' 30' B -2 Vents 60' 15' _ B -1 2 -3' X 94' Cells 15 Rep Vents with >3' Spacing 4% B -4 Slope B -5 15' * Alt 108' B. .M. 544' operty 15' Line Property Line 237' Property Line lVi sconsin 201 W. Washington Ave., P.O. Box 7162 � . l t. Madison, WI 53707 - 7162 m Address Department of Commerce s - 7 .-4 Z V7 f �S C) Sanitary Permit Application SWUU' Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal kdbtmation you provide /- �L' - way be used for secondary purposes Privacy Law, sl5. 1 _ m 11 Check if Revision I. Applkabon Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number C'00 Property Owner's Mailing Address a r Property Location G (,J !f • S t� J T 3 b N, R) w City, State Zip Code Phone Number Lot Number Block Number X 97 25, Subdivision Name CSM Number no II. Type of Bw'lding (check all that apply) RECEIVED min' r 2 Family Dwelling - Number of � ❑ Public/Commercial - Describe Use8e APR 2 5 2002 ❑ State Owned o • Db Nearest Road ST. CROIX COU � 3 12D S T. 1- 3 fz III. Type of Permit: (Check only one box on line A (n h it hweeww use). Complete line B if ap ble) A. 1 0-New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem I I Tank Ont Existing System B. ❑ Check if Sanitary Permit Previously Issued Pernut Number Dam Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) - re ov'Ci-ICs � c/' iW1_ -4-c c ha m r s 4 oa - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand � a v Zit hrw�Y 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line vz�txal 31- 45 ❑ At- Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation teal Grade tired Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacnuer Prefab Site Steel I Fiber Plastic Gallons Gallons of Tanks Concrete Constricted Glass New P.xisft Tanks Tanta /)'43EZ - 14 - /C(1 f"/ / I' Septic or Holding Tank _ Dosing Chamber W !" VII. Responsibility Statement- I, the underh4ped, assure responsibility for indaHation of the POW1s shown on the attached phus. Plumber's Name (Print) PlambA s Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State. r Code) g' p vIII. corn me artment Use O Approved ❑ Disapproved Sanitary Permit Fee (mledes Groundwater Date Issued lssving Signature (No Stamps) Surcharge Fee) 0 Owner Determinationen Initial Adverse -0 C _ 1 !J� 1/l 3 /1) G�oC IX. C of A roval/Reasons for Di �,L _ sap p ro �( �(n � / ' lG' y f?�- �i41�Ca- 'u��' 11,4 Althch cempkie plani (to the County only) for the system an paper not leis than SV2 x 11 inches In size SBD -6398 (R. 05101) PLOT PLAN PROJECT Jeffrev Matz S 1871 Goodview Ave Oakdale Mn 55128 NW 114 SW 1 /4s 25 /T 30 / i9 w TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4 /25/02 BEDROOM 4 CONVENTIONAL XXX IN -GROUN RESSURE / CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons ✓ LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambe s 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A�100� ❑ BOREHOLE (DWELL •H.R.P. Same as Benchmark _ SYSTEM ELEVATION Alt. BM Top of Nail in Tree with Orange Ribbon @ 5' Pro Town Road Vent �6„ =Chamber of Cover 6' Long 12" — Grade at System Elevation 34 19 50' Property rti fen' Line 20 Pro 4 Bedroom 30' House f/ Plans Designed Using -6 Conventional Powts 30' T Manual Version 2.0 15' -2 Ven B -1� ---- 15' Rep A 2 -3' X 94'C 11 4% 0 , Ven �3'Pacmg B -4 Slope B -5 1�k�, Alt. 108' M. 544' Property 5' Line Property Line 237' Property Line Wisnonsin Department of Commerce SOIL AND SITE EVALUATION DivisVn of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Ad . Code % = � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Couhty include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location CLa ( 6 Govt. Lot b.) 1/4 < 1/4,S �S 30 ,N,R q E (or� Property Own e s Mailing Address Lot # Block# Subd. Name or CSM# �� �s / -? .5 Ci State Zip Code Phone Number ❑ City ❑ Village .®, Town Nearest Road 3 rc� 5�/_/ 3.24/j .mil New Construction Use: Residential / Number of bedrooms — Addition to existing building ❑ Replacement (��r1 ❑ Public or commercial - Describe: Code derived daily flow 1! /� gpd Recommended design loading rate 7 bed, gpd/ft gpd/ftz Absorption area required e ` 3 _bed, ft `S .. trench, ft 2 Maximum d sign loading rate - bed, gpd/ft Z— trench, gpd/ft A Recommended infiltration surface elevations) ft (as referred to site plan benchmark) Additional design /site considerations B "(, Parent material Flood plain elevation, if applicable // ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system X S E3 U S❑ U ,®S ❑ U S❑ U ❑ S ,,� U ❑ S � v SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ; -Grounds x�rV Depth to i y Q limiting CY in. S C �Ofk Remarks: Boring # r ® -/� - .3 S�j7� •: Ground c•/ GfI Dep61 limiting far or Remarks: CST Name (Please Print) i e , Telephone No. ��iL c<,1.c it i / •' 71d U pC l Address Date CST Number i Dominant Color Mottles ME OVA, W.Mm W- - IV/F MR = 0 Dominant Color Mottles Gr. Sz. Sh. MO ,owfdr =� u I W-1 WYOM !W� �-, M WA , In , ` M Mr s NMI L rId MITtn • Soil Test Plot Plan - Project Name Dave and Arla Railsback Shaun r Address 845 133rd Ave New Richmond Wi 54017 CSA4 #226900 Lot 5 Subdivision Date 6/ 4 / 99 NW 1 /4 1/4S25 T 30 N/R 1 9 W Township St. Joseph Boring Q Well PL Property Line County S T. C R O IX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 95. 5/94.3 * H R p Same as B Alt. BM Top of Nail in Tree with Orange Ribbon @ jp0, O 5' Pro Town Road Soil Test done to satisfy zoning requirements, may not be suitable for buyers desired building site. 50' Property Line 20' \ B-2 �p0 Pri A r 15 J ��. 30' 30 B- 15' Rep A 4% 30' B -4 Slope B -5 108 15' B. Alt. Pr operty .M. _ 544' L ine Property Line 237' Property Line ST CROIX COMM SEPTIC TANK MAROHNANCB AGRBBMBNT / AND OWNERSHIP CERTIFICATION FORM Owaer/Buyer ��' � � Mailing Address Property Address g A- P40 (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Properly Location 1 /4, �'/4, Sec. 2 S . T 3 o N -R —W, Town o Subdivision le.A 944 �j Lot # Certified Survey Map # , Volume Page # 17,; , Warranty Deed # �` � g� 7 , Volume Page # Spec house 0 Lot lines identifiab Yes 0 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 113 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. z a S OF CANT 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 owne of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / BSI NA OF APP CANT 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 L4 I Maintenance and Contingency Plan for a Septic System D"It- Maintenance Plan _-,-- Se is T umped once every 3 years ���' /� 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected Via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. if system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 spy$ ���. - 7/j -- 3 Y� gO Shaun Bird #226900 r � ' 1 I j 28PASE Co STATE BAR OF WISCONSIN FORM 2 - 1999 Is 57AB 43 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David H. Railsback, 11, and Aria J. RECEIVED FOR RECORD R ailsback, husband and wife, 10-01 -2001 9:45 AM — —. WARRANTY DEED Grantor, an effrey R. Mat an4 Peggy L. Jo -Matz, husband and EXEMPT N wife, CERT COPY FEE: COPY FEE: _..._ - -... TRANSFER FEE: 174.60 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 5, Bass Ridge Pines, Town* St. Joseph, St. Croix County, Wisconsin. Name and Return Address KRIS7, 41 OGLAND ATT02 NEY AT LAW P.O. COX 359 HUDSON, WI 54016 030-1066 -20 -000. Parcel Identification Number (PIN) This is not homestead property. a() (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this _ ' &O A day of September 2001 + David % H � Rallsba � ck,11 + + Aria J. Railsback AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Rai 11, and Aria J. Ra STATE OF WISCONSIN ) hus an d wife, ) ss. —,. _ 4t hi ' �day County authenticat d of September , 2001 - Personally came before me this day of the above named Kristi Ogl — TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If' not, instrument and acknowledged the same. authorized by Q 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 - _._ .— My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ , __ ') + Names of persons signing in any capacity must be typed or printed below their signature. Inronnedon Profes+fonab company, Fond du Lm. Wt WARRANTY DEED STATE BAR OFWISCONSIN eoo655 -2021 FORM No. 2 - 1999 i I f- p��� -7-7-7 EV. q _ .r 928.9 - - - - - - - .K'= '_ - -- _ -,� �j� I •932 • ....... ..... ..� --_ -_- \_�` j f B�4 .I. f i ^� B-2 Mh 13 =3 B -1 / El x',923.1 / - -6 GB 4244L p T x .130 984, / / El B -3 j .01 ES �. x 1 fl x �8- 4!B - 31 ;n$ 3 ` ACR t 9'21.2 < 2G. a . 'L O T -- ' 919.6 , �. r • P >. .0 y� $ A / 3 3.01 ACRES x 9.19.2 - ✓' % // j - /� <.�!, /.y �j ,• /,�./9 x 924.0 P. co _ - - ,,�� L.O.• "1 �' - -'Q 131,369 $0: FT. W _ 37. ti 3.02 ACRES � B =4 p '._. � �-- - _ X65• `: - � • � t : 4 _ 1 q x ` 0E d LOT 9 , 130,86 so. 1�7: L Q T 8 3:00 ACRES 131,187 SQ. FT. ' 3.01 ACRE_ 66' .JOINT•flRIVEWAI'' ...... ;' . UT1VTY EASEMENT - _ A$9_5 at SOUTH LINE, OF THE NW 114 OF THE SW 114 ELEVATI • /' U � `'E�_ -- - 1;[1.55 -- -- / r-t_ ` I I O -EAST 142.89' O ,,\ 99' 513. ^W � �� i © WEST 142.89 O M 583 �. I �� -_ -- 133.4l •'.�' \ OI 0 S� � W. L. i \ CO w I I .. R.O..W. .....>>.9j .•�, f ?54E 4 DRAINAGE � 184,790 SO. FT. EASEMENT 4.24 ACRES .�� 5 0 84 SO. FT. 3 � 3.01 ACRES o MIN. F.F.E. =931.5 0 131,045 SO. Co 3.01 ACRES v/ MIN. F.F.E. =9 N89'56'25 "W 427.63' / 1 - -NORTH LINE OF WARRANTY DEED VOLUME 991 PAGE 139 I UNPLATTED LANDS � 23 6.96' WARRANTY DEED_ ; ; 1 26 5.4s'.�� OLUME 991 PAGE 139 ; _ 70 1.84' 9 - S7 '0 ,, n W i �o �'4O 0 E 877 130,826 SO. FT. / V i 3.00 ACRES O O " o I °' ,,, "E DRAINAGE �'�''� W I �8130� EASEMENT �+ _ 4 ° o 1�co�^� y j Z in i 20' DRAINAGE EASEMENT �i' FOR 5 Ci W Q I I go ....... ....... �• I �'- 100' Building Setback Line NOW- 1' • • • • • • • • • . • ........... 12" UT /CITY EASEMENT •� IRON PIPE IS I o NWVC47'W 1.72' I i o p FROM 0101 1 1 N R.O.W. 132nd Avenue 33' 1 1 �— — 446.39' - - - - -- - -- ; — R. Q. W. 1 .n4 A -"nm - - - - - -- ------ N89'58'05 "W 669.89'--- - ___CfKTERUjE_1 2t+_ ► M - - - - - - - - - verue n N89'56'25 "W 743. 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