HomeMy WebLinkAbout032-1006-60-200 r -
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 453379 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:
DeRosier, Travis I Somerset Township 032 - 1006 -10200
CST BM Eiev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
9 . CI _4 c , -�- 03.31.19.38C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic "1 Benchmark
U C I G, 16 2 ,- 7 c is _ - i
Alt. BM
�
]o'� C� C �
r- -Y� I ,
Aeration Bldg. ewer �� y
Holding St/Ht Inlet ) 0 .
TANK SETBACK INFORMATION St/Ht outlet --� , . Z
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f r Dt Bottom
Dosing Header /Man. 3
t
Aeration Dist. Pipe `iS �
ct (1P
Holding Bot. System `►
93 1
Final Grade
PUMP /SIPHON INFORMATION 44 c , I
Manufacturer Demand St Cover
GP, J•� I
Model Number
TDH Lift Friction Loss System Head H Ft
Forcemain Leng Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS q (, -3 1 +`` \
c
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: J UNIT Model Number:
C0N%.;e I -.0,a 3o `ta c
DISTRIBUTION SYSTEM 3 j o h
Header /Manifold J� Distribution x Hole ize x Hole Spacing Vent to Air Intake
r Pipe(s) \ ` F
Lengt Dia Length Dia � Spacing
SOIL COVER
x Pressure Systems Only xz Mound Or At -Grade Systems Only
Depth Over ! Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bedlrrench Center Bed/Trench Edges Topsoil -
! Yes i ` ] No "Yes I -! No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 2395 50th St Unknown (NW 1//4 NW 1/ 3 T31 N R19W) NA Lot 3 Parcel No: 03.31.19.380
1.) Alt BM Description = ( �z wau'h c�tr �.e �4� ; �� �— Le �6-'� �d
2.) Bldg sewer length = I
- amount of cover = Z
Plan revision Required? Yes ` No (1 G -- - - - - -- -- — -- - _ / 1
Use other side for additional information. 7 �
SBD -6710 (R.3197) Date Insep tors Si ture Cart. No.
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
consin Madison, WI 53707 - 7162 ' Sanitary Permit Number (to be filled in by Co.)
De artment of Commerce (608) 266 -3151 453 ?-9
Sanitary Permit ApTk m _ State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, persotl inform a r
may be used for secondary p cy 4w, s 15.04(1 )(m) E Project Address (f dif kmt than mailing address)
F
I. Application Information - Please Print All
6 S 50 -S +
Property Owner's Name �Parcel # LAN Block #
Property owner's Mailing Address perry Location
Salon
City, State . Zip Code Q Phone Number f c q
a T N: o / ` r W
A Type of Building (check all that apply) S w< < �`
X Z Family Dwelling - Number of Bedrooms S • �
Public/Commercial - Describe Use 0 `
State Owned - Describe Use 2 ZS S City_ Villa 9. wnship of
III, Type of Permit: (Check only one box on line A- Complete line B if applicable) 03 2 - (lr G - 60 - . �
A ' >I em System Replacement System Treatment/Holding Tmtk Replacement Only Other Modification to Existing System
B. Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
/ ` n - Pressurized In- Ground Mound 2:24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Sin In Pass Filter
Constructed Weiland Pressurized In- Ground Holding Tank Peat Filter Aerobic Treatment Unit ecu+wlating Sand Filter
Recirculating Synthetic Media Filter g Chamber Dri Line Gravel -less Pipe Other (explain) �6el i'
V. Di rsaVrreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s� Dispersal sed (st) System He 'on
6cJ - / -2 &0 /_ 7 1,11 91,5 7 -
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units , w � p _ n A— 1 0b niece Constructed Glass
Now EXisting "'/ �a�� �C ! , 1
Tanks Tanks • t i �{�
Septic or Holding Tank
Aerob Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the and a bility for installation of the PQWTS shown on the attached plan&
Plumber's 14ante (Print) Plumber' MP/MPRS N tuber Business Pbone Number
zz IS
Plumber's Address (Street, City, State, Zip )
VIII. Conn /De artment Use Only
Sanitary Permit Fee (includes Groundwater Date Issued Signature o Statrtps)
ro Surcharge Fee)
v 25�'— 2 ZQD
UL Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced I maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in size
L
PLO AN
PROJECT Travis Derosier ESS 1472 23rd St. Houlton Wi 54082
NW 1/4 NW 1 /4S 3 /T 31 N/ TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/30/04 BEDROOM 4
CONVENTIONAL X)CX IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40
, BENCHMARK V.R.P. Top of white stake ASSUME ELEVATION 100' Filter Zabel A -100
❑BOREHOLE O WELL *H.R.P. Sameasl3enchmark
SYSTEM ELEVATION 91.9/91.5 5' below qrade
I
Alt. BM Top of Survey Pipe @ 97.3
431' Property Line
Well is to meet all Plans Designed Using t J�
setbacks required by Conventional P
WDNR Manual Version 2.0
20' 30 30' B -5 i5'
T B.M.
� 5
P 4 50'
Be o 2 -3' X 125'
ouse c lls with >3'
Propert Line pacing S
-3
6%
Slope
150'
B -2 ' . 15 B.
Ve
>6 „ Standard Biodiffuser
0 0 9 of Cover Leaching Chamber
'0 with 31.1 ft2 of Area
11"
Alt. Long Grade at System Elevation
Polk/St. Croix Road
' PLO AN
PROJECT Travis Derosier ESS 1472 23rd St. Houlton Wi 54082
NW 1/4 NW 1 /4S 3 /T 31 N/ TOWN Sbmerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/30/04 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PAXSSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
I
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40
BENCHMARK V.R.P. Top of white stake ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 91.9/91.5 5' below qrade
I
Alt. BM Top of Survey Pipe @ 97.3
431' Property Line
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
B -1 30 , B -5 15'
20' 30
50 tf
Pro 4
50
Bedroom
2 -3' X 125'
House cells with >3'
Propert i Line Spacing
5' B -3
6%
Slope
150'
B -2 15 B -4
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
0' with 31.1 ft2 of Area
A t 6' Long 11
3499 Grade at System Elevation
Polk/St. Croix Road
�lin Department of Commerce
of Safety and Buildings SOIL A11D ALUATION Page of
aunt Integrated Services in accordan is. Adm. Code
Attach complete site plan on paper not less than 81/2 x 111 I size. P' County
include, but not limited to: vertical and horizontal reference nt ), directioni<�
percent slope, scale or dimensions, north arrow, and location sta o rest road.
i Parcel I.D. #
co
I A_ 3
APPLICANT INFORMATION - Please print all' ati �9
Qn'X O eAewed tv Date
Personal infonnatanV
1 provide may be used for secondary purposes (P 'v�jc r S. �' AA
1/4 N�1 /4, e
Property Owner
a„/� �^ s 3 T3
/ F ,N,R E { W
Property Owner's Mailing ARldress Lot # Block# Subd. Name or CSM#
V. Box 3
City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest Road
t �3�6 0� o /� • � i�C
New Construction Use Residential / Number of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe: /
Code derived daily flow gpd Recommended design loading rate bed, gpdfiF trench, gpcL*
Absorption area required Z.2 od_ bed, ff U trench, ft Maximum esign loading rate _- 5— bed, gpd* , trench, gpd*
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site consideration ,
Parent 1 Flood plain elevation, if applicable Al J ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system JK[ S El U] s El U ,R S El U S F1 U ❑ S ,K U ❑ S �U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
Ground - Z � /•�? �" x1l"'of x'o
Depth to
limiting 6g'
factor
- Remarks:
Boring #
a -,TY . 2
Ground
ev ft '
Depth to �6
limiting
factor
�Z/- Remarks:
CST Name (Please Print) turej Telephone No.
6 a�
Address 1, ,r _ J 2h Date r d � CST Numbe
.7C K/ v / b //J
'N -1
IC- SOIL DESCRIPTION IMPORT -
PROPERTY OWNER Page of
PARCEL I.D.# n8
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench,
ij .(to
f�lJ 2
Ground � ,� � -(e
e ev.
Depth to
limiting
factor
? D
Remarks:
Boring #
Z
Ground
Depth to
limiting
facto
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # C' S --
A
Ground
Depth to
limiting
f�cso
/G " Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
. M
X Soil Test Plot Plan
Project Name Hobby Farms Inc. Shaun Bir
Address P.O. Box 716
Hudson Wi 54016 CS #226900
Lot 3 Subdivision ---- -- Date 5/2 4/99
NW 1 /4 1/4S T 31 N /R W Township Somerset
M Boring ()Well PL Property Line County S T. CROIX
BM or VRP Assume Elevation 100 ft. Top of White Stake with Orange Ribbon g �
System Elevation 91 .9/91.4 * H R P Sa as B
Alt. B Top of Survey Pipe @ 97.3
431' Prop Line
B - 30' B -5 15' B.M.
0
w Pri A Rep A
° 50'
0
15 B-3
6%
Slope
50
150'
B -2 15' 15' B -4
0 '
Alt.
Polk/St. Croix Road
i
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 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.
required 8. Discharge into system is not exceed those r eq as p er Comm. 83
Cont' ncy Plan
Option #1. system fails, determine cause of failure, use alternate area and install new
. -s in tested replacement area.
Option #2. Install 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
ST CROIX COUNTY ENT.
SEPTIC TANK MAINTENANCE AGREEM
AND
OWNERS
HIP CERTIFICATION FORM
owner/Buyer r �p
Mailing Address
z
Property Address —
(Verification required from Planning Department for new construct►
�
City /State Parcel Identification Num ber ��Cl
LEGAL DESCRIPTION /
-
• i—
/., )1 Sec. '2> 'r �/ N -R W, Town of JI?
_
property Location 1� y> i v�-
Lot #
Subdivisio 7
Ma # 6" � 7 �-� G Volume � , Page
2211
Certified Survey P
Volume Page #
Warranty Deed #
Lot lines identifiable5yeS 0 no
Spec house 0 yesAno
YSTEM �NANCE remature failure to handle wastes. Proper maintenance
S
Improper use and maintenance of your septic system could result in its p r what you put into the system
is out the septic tank every three Years or sooner, if needed system,
cspumper
consists of pumping
can affect the function. of the septic tank as a treatment stage in the waste D a certification form, sign ed by the owner and by a
es to submit to St. C Zoning Departme
,-he property owner agre
lumber Ora licensed. umper verifying that (1) the on - wastewater disposal system
masterplumber, journeYmanplumber, restrictedp ri necessary), the septic tank is less than 113 full of sludge.
is in proper operating
condition and/or (2) after inspection and pump g C
agree to maintain the Private sewage disposal system with the standards
Uwe, the undersigned have read the above requirements and
the Department of Commerce and the Depa=ent of Natural Resources, State o f Wi Certi 30
set forth, herein, as set by ed must be completed and returned to the St. Croix County
stating that your septic system has been maintain
ys of the thm ear expiration date. � A/ Q
da
•!/� DATE
SIG Af[ OF APPLICANT
OWNER CERTIFICATION knowled I (we) am (are) the owners) of true to the best of my
I (we) certify that all statements on this form deC corded to Register of Deeds Office.
r erty 'bed above, by virtue of a warranty
DATE
SIGNATURE OF APPLICANT « « « « ««
An - represented may result is the sanitary Permit being revoked by the Zoning Department.
y information that is mis
d warranty deed from the Register of Deeds office
«« Include with this application: a statnlx a copy of the certified survey map if reference is made in the warranty deed
VOL 1711PAC 400 mss -0a 4EiN.o
STATE BAR OF WISCONSIN FORM 2- 1999 KATHLEEN H. WAL
sH
Document Number WARRANTY DEEP1 : : cR OF D-'EDS
ST. i;i�olx CO.. wI
This Deed, made between Hobby Farms, Inc., a Wisconsin !:ECEIVED FOR RECORD
Corporation 08 -31 -2001 10:50 AM
I
WAkRANTY DEED
EXEMPT 8
Grantor, Travis J. DeRosier, CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 119.70
RECORDING FEE: 10.00
P
Grantee. AGES: 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
Part of NW '/. of NW '/. of Section 3, Township 31 North, Range 19 West, Name and Return Address
St. Croix County, Wisconsin described as follows: of of Certified Survey First National Bank of New Richmond
Map filed July 28, 1999 i Vol. 1 3, Page 3 697, Doc. No. 607536. PO Box 89
New Richmond, WI 54017
032 - 1006 -60 -200
Parcel Identification Number (PIN)
This is not homestead property.
(1¢) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this d 7 day of August 2001
Hobby Farms, Inc.
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) Ss.
St. Croix County )
authenticated this day of
Personally came before me this 2 7th day of
August 2001 the above named
Hobby Farms, Inc., a Wisconsin Corporation by
it's
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed1fif6,foregoing
authorized by § 706.06, Wis. Stats.)
in Mt and ackno g d the same �� ..««.....
n'V
w V
THIS INSTRUMENT WAS DRAFTED BY ► b4a ilynl K V l ^' Cr c, '• ' �•
Attorney Kristine Ogland Notary Public, State of Wisconsin to t
Hudson, WI 54016 My Commission is permanent. (If n xpiraGAn c(att~:
(Signatures may be authenticated or acknowledged. Both are not necessary.) 12/08/02 q . ; *;,•)
" Names of persons signing in any capacity must be typed or printed below their signature. iwormauon Pro • 11 o na o.. Lac, wi
WARRANTY DEED STATE BAR OF WISCONSIN e00-655-2021
t I+ "'
FORM No. 2 - 1,999
l
s �
a to fO X536
CERTIFI i VEY MAP
The Fractional Northwest Quarter of the North w r of Section 3, Township 31 North, Range 19 West,
Town of Somerset, St. Croix County, Wisconsin.
Prepared for and at the request of: LE_ .FND:
OWNER: Count Section Corner Monument
P.O. tax ox 716 Forma, lnc. of Record
Hudson, WI 54016 a aeminimum4of Iron 1 13 g per g
Drafted by. Kristl A. Eyiandt linear foot.
NO wminSr colwdER • • • • • • • • • •Building Setback Line (100' from R.O. W.)
SEQ 3 -31-19 (75' from Wetlands)
(ALUA/. CQ. MON..) VNP LkN12S
133' I NORTH L/NE a- THE FRACTIONAL NW 71 OF' 7HE NW 7/4 NORTH 1/4 CORNER
P' POLK / ST, CROIX ROAD SEC. J PK -JI-1
— - L= — — — — CENTERLINE ------ N89 _ 2841.84 - -- --
N89' 2 42'E 1320.9
—
S89'S2 42' Wi
428.74' — 71.- 42 — .�.
429.67' ,n 429.67'
i 1 I - - - -- - -N89'52'42'E 1288.(M' -„�� -- -- -- ! i ♦ ♦�
of W M+ 3.1 LOT 1 r7 3
46252
-i- 430.75' • r ` . 429.87' - - -- 29.87 - - � -
i �� ♦ �4_ - -_ a - -- 1290.09'-
I ---- --- N89'52'42 "E 1321.86'- ---- _. .....
I l 31.77'/ WETILCAN S,'`
TYP
M LOT 4
TOTAL AREA: ry
Q� 1.025,796 SO. FT.
Wi rM ' L e 23.55 ACRES $ ��
.a
Io I++ 2 AREA EXCLUDING R,Q.W.: +� 1 j
.� W 1,002.538 SO. FT. 0rwrr.►w�
fAl $`� 1 n'O d 23.01 ACRES
in
r z w l r . o �i RONALD
IWO) JOHNSON
a g = o
W) . C3 i i A Nf G. 4ri
< `9ND
1294.34'
N8"W01'W 1323.18' •• �.,- - :.w
I SOUTH UNE OF 7HE FRAC7700NA4 NW 1/4 G6- THE NW f/4 �•..�, �try
Q4 1 fi iif�PLAO LANDS I +r,:.. , •.. :r. «IIL.r
. ^` and vbR!
o 1 DENOTES CONTIGUOUS BUILDABLE AREA PER
f �" TOWN OF SOMERSET ORDINANCE CHAPTER 98 -4
C.B.A. LOT 1- 29,521 SO. FT. /0.68 AC.
vii o r 4 C.B.A. LOT 235,269 SQ. FT. /0.81 AC. r,c
C.B.A. LOT 3-34,151 SQ. FL /0.78 AC.
C.B.A. LOT 4- 32,988 SQ. FT. /0.76 AC.
•--ri i ' TOTAL AREA LOT 1: TOTAL AREA LOT 2: TOTAL AREA LOT 3:
----- 145,658 SO. FT. 145,658 SO. FT. 156.635 SO. FT.
3.34 ACRES 3.34 ACRES 3.60 ACRES
AREA EXCLUDING R,IZW.: AREA EXCLUDING R.D.W.: AREA EXCLUDING R.Q.W.:
131.480 SQ. FT. 131.480 SO. FT. 131.503 SO. FT.
3.02 ACRES 3.02 ACRES 3.02 ACRES
NOTE: The parcels shown on this map are subject to State, County and
Township laws, rules and regulations (i.e. wetlands, minimum lot size, access
to parcel, etc.). Before purchasing or developing any parcel, contact the St.
Croix County Zoning Office and the appropriate Town Board for advice.
JOB #'98261 (Sta1) 250 ° 250 NO). TI-I
Prepared by.
A & E GRAPHIC SCALE
LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 Inch - 250 feet
Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE
109 East Third Street, P.O. Box 325 FRACTIONAL NW 1/4 OF SECTION 3, TOWNSHIP 31 N.,
New Richmond, WI 54017 RANGE 19 W. WHICH IS ASSUMED TO BEAR N89'52'42 "E.
Sheet 1 of 2 Vo1.13 Page 3697