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Home My WebLink About032-2045-80-100 Wisconsin Department ofCofnm4ce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506281 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: City Village X Township Parcel Tax No: Benish, Dennis & Chris to her Creighton I Somerset, Town of 032 - 2045 -80 -100 CST BM Elev: Insp. BM Elev: BM Descriptio Section/Town /Range /Map No: b Ic7 1 6 12.30.19.659B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark Alt. BM Aeration ��.. � Bldg. Sewer \ Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing `u Header /Man. 4 __ 9 7.5 Aeration Dist. Pipe (i, y7 5� Bot. System Q c , c/ / PUMP /SIPHON INFORMATION Final Grade �• Manufacturer Demand St Cov�i r GPM 3 reX a CO 4. Z • I U Z . 3 Model PWITIer TDH ift Friction Loss System TDH � Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LengtOf Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / Pew \ \1 \1 \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �. INFORMATION Type Of System: CHAMBER OR- +�.i'. �4J� �.+: d (,o 52 A l UNIT Model Number: Lj DISTRIBUTION SYSTEM 66„1� yL/ +• 1 4 - 13 = 70 Header /Manifold 1 A Distribution x Hole Size x Hole Spacing Vent to Air nta Pipe(s) \ \ \ 3l ra Length Dia Length Dia Spacing 1 Q �C>f.5 C) 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 3 Bed/Trench Edges Topsoil ' es ❑ No Yes ❑ No COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1: / / Inspection #2: / / Location: 1645 85th St New R' hmond, WI 54017 (NW 1/4 SE 1/4 12 T30N R19W) NA Lot 1 / Parcel No: 12.30.19.659B 1.) Alt BM Description= 3rck CG - ,C. :,"5 �b�(� -s a✓� 2.) Bldg sewer length = e % - amount of cover = Plan �b Use others de for additional Information. revision q � U No SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No. *10cmerd Co mmeree.wi.gov Safety and Buildings Division County /�� 201 W. Washington Ave., P.O. Box 7162 (, Madison, WI 53707-7162 Sanita�ry iP-e�rr/m__it Number (to be d in b isc ) a Departmt>nR of Cammeroe�J vc I actn umber Sanitary Permit Application State Trans io I ^"I In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ' (0 f 5 C_ I s 1. Application Information — Please Print All Informatio Property Owner's Name Parcel # u Property Owner's Mailing Address Property Location / /_ 8 923 � r ,,� ST. CROIX COU Govt. Lot ) � City, State pp l Zip Code Phone Number Nc. y, �� /., Section / J� T - N; R ircl� on %�.n H. T pe of Building (check all at apply) Lot # ubdivision or S� 2 Family Dwelling - Number of Bedroorrks T - &� ��_�� N �, .+++• S n,, ^^ - . (�,v/•' 1 n �+ ' Block # l/U Y 1 L ❑ Public/Commercial - Describe Use El City of �ovm` 0 3 - Lv' rte— CSM Number ❑ Village of ❑ State Owned - Describe Use L '� f Town ot / C e 7 - 111. Type of Permit: (Check only one box on line A. Complete line B if appltca e) A • ❑ New System lacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New C Before Expiration Owner IV. Tirfe of POWTS System/Component/Device: Check all that appl Non - Pressurized in Ground ❑ Pressurized In Ground At - Grade f Mou�� 24 in. o m ile spil r ❑Mid < i o f suts soi ' L /-+�• li > 24 i in. .'J J ; I e :Yh; i i / Tf i to ✓ � Y ❑ Holding Tank ❑ Other Dispersal Component (explain) re ea ment Device (explain) V. Dis ersal/rreatment Area Information: ► % ee -� G Desi n Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (st) y Ellevation / V L Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U h = New Tanks Existing Tanks d o ? -° a.. U rn h rn ti C7 0. Septic o Holding Tank 3 Sleva, FS, Z012 osing Chamber `O VII. Responsibility Statement- 1, the undersigned, assume ponsibility for installation of the POWTS shown on the attached plans. Plumber Name (Print) Plumber's ure MP /MPRS Number Business Phone Number Plumber's Address City, State, Zip Code) VIII. unt /De artment Use Onl Permit Fee Date ISSsued I ing Agent Si ature pproved ❑ Disapproved $ D'� -7 /3 ❑ Owner Given Reason for Denial / V IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: /� '� - hU a' t_a 4 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained t p as; ppr management plan prpyided by plumb 2. All setback requirement'g b> lf4JLw 1Mt ML�e system and submit to th ounty only o • er not less than / 812 11 inches in size as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thtu 01/09 r PLOT PLAN PROJECT Chris Creiahton I A ADDRESS 873 174th Ave New Richmond Wi 54017 NW 1 /4-SE ` 1 /4S 12 /T 3 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/20/07 BEDROOM 6 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 3 -1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1303 # of chambers 64 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE WELL *H.R.P. Same as Benchmark Well is to meet allp setbacks required by SYSTEM ELEVATION 95.8/95.7/95.6 4' below qrade WDNR Property Line Vent > 6„ Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts 5.8ft^2 /pair of end caps Manual Version 2.0 4' Long 12„ 40' 34" Grade at System Elevation Well 1 , B -2 5' Scale is F = 40' 5V unless otherwise noted Old system is off the 42' Cell 5 property --10- 30' ST 's 30' B -1 6 Bedroom Dwelling rd Tank is to house the filter 0% Slope 3- 3' X 72' Cells with >3' spacing 0' B -4 if space permits, the short 42' cell 85th St. would not be used, and the 25' remaining cells would lenghthened B -3 30' 5 ' B.M. Prop P y A BrL Line Q 1 11 f r✓' T PLOT PLAN PROJECT Chris Cre iahton ADDRESS 873 174th Ave New Richmond Wi 54017 NW i/4 SE 1/4S 12 /f/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/20/07 BEDROOM 6 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 3 -1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1303 # of chambers 64 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter BEST Filter ❑ BOREHOLE ( • WELL *H.R.P Same as Benchmark Well is to meet all` setbacks required by SYSTEM ELEVATION 95.8/95.7/95.6 4' below qrade WDNR Property Line Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts „ 5.8ft ^2 /pair of end caps Manual Version 2.0 12 4 Lon g 0 3 4 Grade at System Elevation Well , B -2 5' IF Scale is 1" = 40' s5 unless otherwise noted Old system is off the 42' Cell 5 , property —10- 30' ST's 30' B -1 6 Bedroom Dwelling =ef 0% Slope 3- 3' X 72' Cells with >3' spacing 90' B -4 if space permits, the short 42' cell would not be used, and the 25' 85th St. remaining cells would lenghthened B -3 30' 5 ' �' 1 B.M. Property Q � Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must c� include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — o — Please print all information R 'ewed b Date /� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �/� V Property Owner Property Location �/- Govt. Lot /VL J 1/4 1/4 S �� T� N R r E (oe Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 73 / 1 1/0 / 2 4g /8 City State Zip Code Phone Number ❑ City ❑village o NearedtR ad ❑ New Construction Use Residential / Number of bedrooms 40 Code derived design flow rate GPD Replacement ❑ Public o mmer fyft� Parent material k! elevation if applicable /v ft. General 11 JUL 3 1 and recorrxrlendations: 2001 41/'&- OLC � �s - $ 95 System Type Al G X COUNlS'Stem Elevation Boring # El Boring C I 5g pit Ground surface elev. � ft. Depth to limiting factor 1 �U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/rf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ® Boring # a Boring K Pit Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 D Effluent #1 s'BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Pyles Signal CST Number < a Bird Plumbing; c. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 — Z? 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring Pit Ground surface elev. v r ft. Depth to limiting factor r J b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 a Boring # Boring ❑ f Pit Ground surface elev. b 1 r ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Ong # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg1L and TSS >30 1150 mgA_ ' Effluent #2 = BOD, < 30 mg/_ and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) Soil Test Plot Pla Project Name Chris Creighton Sha it Address 873 174th Ave New Richmond Wi 54017 e&YM #226900 Lot 1 Subdivision -------- Date 7/10/07 NW 1/4 SE 1/4S 12 T 30 N /14 W Township Somerset Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.8/95.7/95.6 *HRPSame as Benchmark Property Line Scale is 1" = 40' unless otherwise noted 40' Well 55' B -2 5' Old system is off the 5 property 30' ST 's 30, B -1 6 Bedroom Dwelling 0% Slope 90' B -4 25' 85th St. B -3 30' 5' M. Property Line ST_ CROIX COUNTY ZONING OFFICE CERTIFICATION STATSMBNT FOR UT.:LIZA2ION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ( residence located at: 'A t 5E %, Sec. �Z T3_. , R, 2_W, Town of �� ..�._ at. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last tixm serviced %" / `' U 7 Did flow back occur from absorption system? Yes No,� (if no, skip next line. Approximate volume or length of time: ,_______ gaA. min%'Ites Capacity: 3 /ter 4 Construction: Pref Conc � � Steel Other Maauf acturer (if knawa) : /"o c — Age of Tank {' known) al { g ;Name, Pleas _ int Title (License NLjmberl (Date) Form to be completed by iieensed plumber (a. 145.06, wiaconsin Sta:tute&) or licensed disposer (NA 113 Wisconsin Administrative Code) plumber (applying for sanitary permit) Corti fication: in accepting the above statement regarding exiet n eapt.ia tasak c0r1d'ti.on, I certify that the tank, to the beet of my kn dge, will conform the m. requirements of IUM 83, 'riis- Adm. Code (exae or inspection opening over cutlet ba e). Name S igilAture 6' .` MP jMPRS � ,� i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OW�NER.SHIP CERTIFICATION FORM OwnerBuyer C6"'r s r �^ S Mailing Address Property Address '� � � -CIN Lb L ' .5 y (Verification req ' e om Planning & Zoning Department for new construction.) City /State ( — Parcel Identification Number /1 �d� o�o�s� go — /00 LEGAL DESCRIPTION Property Location 1 /4 , 1 /4 , Sec. T ,3 R�_6W, Town of I. Subdivision �` I Lot # . .�� , D �- Certified Survey Map # Volume P age � 7 g Warrant Deed # d� 2 - , Volume Z �� Page # Spec house yes . ® Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of youzj I 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 as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52() and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit t? 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. I/we, the undersigned have read the ab Dve requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Departz aent 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this corm 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 of bedrooms I SIGNA OF APPLICA�T(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) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped 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 $ 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 Option #1. if system fails, determine cause of failure, use alternate area and install new systegwn tested replacement area. Option #2. stall system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 �I 2829P 125 61c 11 KATHLEEK H. WALSH State Bar of Wisconsin Form 3 -2003 REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX CO,, kI RECEIVED FOR RECORD Document Number Document Name 11/16/2005 10: 20AK QUIT CLAIM DEED EXEMPT II 10 THIS DEED, made between Ben -Ton Properties, LLC REC FEE: 11.00 ( "Grantor," whether one or more), TRAKS FEE and Dennis R. Benish and Joan G. Benish, husband and wife and Christopher J. COPY FEE: Creighton and Brenda L. Creighton husband and wife CC FEE: ( "Grantee," whether one or more). PAGES • 1 Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Part of the NW ' /4 of SE' /4 of Section 12 Township 0 North, Range 19 West, St. P g First Nation o al Bank of Hudson Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map riled PO Box 187 August 24, 1987 in Vol. 7, Page 1873, Doc. No. 455. udson, WI 54016 032 - 2045 - 80 - 100 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Dated Ben- Properties, LLC (SEAL) SL 1 ?2 /� (SEAL) * * y : Dennis R. Benish, Member (SEAL) /fA1 1 (SEAL) * *By: Christopher J. Creighton, lRember AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on NoJ • (� Z-OO S , (If not, the above -named Ben -Ton Properties, LLC authorized by Wis. Stat. § 706.06) By: Dennis R. Benish, Member and Christoa her J. Crej' Member ,, .••"•",..• THIS INSTRUMENT DRAFTED BY: to me known to be the person(s) who executed the Ar g inst nt and acknowledged the same. Attorney Kristina O land Hudson WI 54016 No 1' , tate of '? My Commission (is permanent) (expires: l� D (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. INFO -PROT" Legal Forms 800- 655 -2021 www.infoprofortns.com i 429455 ST. CROIX COUNTY CERTIFIED SURVEY MAP N0.1873 RECORDED IN VOLUME 7 OF CERTIFIED SURVEY MAPS MAP BEARINGS ARE ON PAGE LOCATEU IN THE NORTHWEST QUARTER REFERENCED TO TH OF THE SOUTHEAST QUARTER OR SECTION TWELVE, NORTH - SOUTH 4 TOWNSHIP THIRTY NORTH, RANGE NINETEEN WEST, LINE OF SECTION 12, TOWN OF SOMERSET (SOUTH PART), ST. CROIX T - -N, R-10-W. COUNTY, WISCONSIN. ASSUgED TO BEAR PREPARED FOR: Richard Flandrick N -00 00 " -E R.R. 4 New Richmond, Wt. 54017 (NORTH) PREPARED BYs Lee Villeneuve, R.L.S. R.R. 6, Box 150 Menomonie, Wt 54751 SCALE IN FEET` I " =60' L E G E N D P.O.B. = POINT OF BEGINNING ST. CROIX COUNTY MONUMENT (ALUMINUM CAP IN 2" X 30" PIPE) SET. �O = 1 24" IRON PIPE WEIGHING 1.13 POUNDS PER LINEAL FOOT SET. NORTH = CORNER OF SECTION 12 T -30 -N s R - -W -�' NORTH - SOUTH 4 LINE OF SECTION 12 U N P VE T T E D L A N D x 33 33' i EAST 242.OD I MOO' 209.00 U N P L A T T E D � LOT / --- - - - - -- � APT. L A N D 43,560 SQUARE FEET (1.00 ACRE) I INCLUDING ROAD RIGHT OF WAY z Y 37 SQUARE FEET (0.86 ACRE) EXCLtMING ROAD RIGHT OF WAY PROD ! 00' z09 00' AU6 241987 wEs r 242 00 90NOa ! o mss U N P L A T T E D L A N D �� i IF1 do m r SOUTH 4 CORNER OF SECTION 12, T -30 -N, R -19 -W r s s F r I E APPROVED -s s ir AUG 1 7 1981 �VIR�`�� goof • s;. CRIu;x VOLUME 7 PAGE 1$73 COMP.ZEHENSIVE PARX5 PIANMk40 MAD ZONING CQMMU7fi