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HomeMy WebLinkAbout038-1046-90-000 I Wisconsin Departmehtof Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary i JJ o.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. S Permit Holder's Name: ❑City ❑Villa a T.6Wn f: State Plan ID No.: Nelson, Karl Star raine �ownshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: p'( t - Q3w• e 038 - 1046 -90 -000 TANK INFORMATION ELEVATION DATA l I , j tt ug (qga TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0 Benchmark obb Dosing Alt. BM Aeration Bldg. Sewer Holding St / Ht Inlet, /4( TANK SETBACK INFORMATF014 St /Ht Outlet " _gyp 7 3,2�' TANK TO P/ L WELL BLDG. V et ROAD Dt Inlet Septic > ZS� - �3 3 / NA Dt Bottom �-- -- Dosing A Header/ Man. cit.IT Aeration N Dist. Pipe 9 , 't .09 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufactu Demand St cover , Model Number GPM TDH Lift L 'ton H TDH Ft Forc In Length Did. Dist. To Well SOIL AB PTION SYSTEM Off) e,,,,� A_ RENO Width , Length N . Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a DIMENSION SYSTEM TO PDG W LAKE / STREAM LEACHING Manua ure YSM / L BL WELL : •� S - — IN RMATION Type Of � � / _ CHAMBER Mode umb er: System: C&vj) � f 2S ^'�Z OR UNIT !� - e, DISTRIBUT SYSTEM Header/Ma Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Di a. 30 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 E] Yes [] No ❑ Yes [] No COMMENTS (Include code discrepancies, persons present, etc.) Insuection #1. Ik /a Inspection #2• - t- - Location: 1240 Old Mill Road, New Richmond, Al 540 17 (NE 1/4 NW W4 11 T3 1N R1 8W) - 113118198 1.) Alt BM Description = �e,;i¢�i (� � ` 16 2.) Bldg sewer length = 2 2' - amount of cover = > I$" Se+ 3) 4--101D 07> 4.11 Plan revision required? ❑ Yes [R No � Use other side for additional information. �I F ] (R.3/97 ) ate (t� Inspector's Signature Cert. No. SBD 6710 ei— S ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .m� -a _ ____ �. e _ a t { i € g # 7 d b } # a w f � � : Sanitary Pertnit Applicatloln Sk yy BuildlnVDlviCon in accord with Comm 83,21. v i3. Adm. Code 201 W, Washin>Rtott Ave. See reverso ride for irtstr cc..ns ror crif"pl ttng this application PO Bo 7302 • Persona{ information, you provi,.c may br, used rot• r+oondaq purposes r Madison, Wi 33707. Depe•trr,.m of Cansmtroe {Privacy Uw. % IS JAM{ rn)] (Subma completed form to eourny ifr• state owner Aftaeit com late isms (to the count Y co ` as a er nut less than R -1 iz x I inches in size. Calm * ate Sanitary P t Nut , „ ate i! ei�l9t 0 previous application State Plxn I. D. Number L Ag li m foratio - Pleaa4 P tt 1n n Lac�a Aro"nY QM NOW ��� ,,�� a ?F Propert; Locruon ) '� a Mw CS C r Lot Nu r loci. a 1 zY v O1 i. City, Z pCode CO Subd ivision Nam or CW414aWber lONiN QFFICE r S , .. ll Type of Buildingi (check one) f ° ":. ' , > C':y Af 1 2 Faretiy Dwalling - No. of aadnoorns; qS ! (� 1 �� %` O village p (o Q PublidContnter M (dewriba sae)• < . t - _� 1'ov, of CC` f V ff D SteN � J Ill Type of Pet'Itt t: (Cheek oni>> ot1C box on litre A. Chaok box on line S ;° applicable) Nea rap Road 101 {YL ` ,1 /J p A) 1, C New Syatem epiecernen 1 3, Q Raplu.crn t of t. C Addhign to Partal Tax Numbor(s) S stem T Only Existin 5 stem 1 038'-w( - o - 000 4 )l;] Permit Tdumber 1. 3i, /� (9� ' l/. 31. ( I F,? 3 ❑ A 9anl was nvlo issued N.'I'ype sf 1'""OWT Syntem: (Check all that apply) tn�rotutd D hloutid 0 Sand Filter G Conatrueted Wetland D Pttaat daw O Holding TAnk 0 Single Pass 0 Drip Line 13 A•p& ❑ Aerobic Treatment L nit D R mulatln 8 a 01her: V Die ruVrraatnfs>st Area Infbrmatia : Z a L, Del ) 3 ais"C hftx 4. Solt Ape- aaden Yracolak4od Rate if lystam E levoil on 7. Final Orado Required Proposed 3 ✓ Rtae (10411s. , days• ft.? (Mill. /iMlht iilavation S ✓ S 3 ✓ ✓ ✓ VI Tank y in Tem! a of Manufacturer retbb t-c Stsel Fiber- Plastic Itaformatbp allons Gallons Tanks Cat- Coa- SUN New Lxiscna crate &ttvolod Thift Teaka 0 • i a ❑ fl VII Itespoawibility 8tateeeat eflo il: ity for ;0VAILation of *t POWTS shown o f the agm 21a ns, lietws a (prlttt) r Plamiter stamps t MPR5 No. a tiatien Number � Y� C*, 77 l V II[ County/Department use Only DiftWoved San twy it Fes ( ue rat n to issued I7 Mt a Amoved ID Owner Given Initial Adverse Suva" Fee) Z S 0 O /D j Z ol�v Conditions of Approval /Raason for Ditta ee alp ai m 2 he. (,/e < -.> ex5 {in SyS {e— 4 6e a�o Rh ao '1 hre( ,er Ca., F3.33. llJe�� w.ks¢ a�so bt sew ojej esker. 4v -, 6der h,ow, t5 reMo a.�( f�p 7It , tiS� ( Bt °� 2- KCw Se�)`iC Sys t GtC4J o f rep a Seer it~ / p CSr� l fo N� 3) / 4P 19� CrxN -0 3:y3 tG�S CGtx NBC r 0wy WeL L7r'S�;w, �Oro�OC/'�f5 d eSGri�eeAl in 1 r�T . oeL r(-A. Sl3D- M OL 0700) PLOT PLAN PROJECT Karl Nelson ADDRESS 1240 Old Mill Rd. New Richmond Wi 54017 NE 1/4 NW 1/4S 11 /T 3 /R 18 W TOWN Star Prarie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 3 CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Fi �-100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 89.7 Alt. BM Top of Nail in Jack Pine @ 101.9' Old Mill Rd Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 125' 34" Grade at System Elevation 6 S F /, :o►- 14% fie► S�.ew 13�rds Cornh.e, -, -(S z000 Slope dr y Please note: well is to be rem v when trailer is removed 35' 35' B - 10 e Existing Single 15' 20' B -2 Writs Trailer to be • removed Sandpoint well B.M. 5' B -3 ' T 15 30 Alt. .M. 10' Pro 3 N Bedroom House &, " OP O4 - 41!j � ,,,, s' O Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings In accordance with Comm 85, Ws. Adm, Code County C ss 1 5 ' 1 Y D I Attach complete site plan on paper not to than 81/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. l'� 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. jj Please print all informs \ 1 ! i tt Re '"� Date Personal information you provide may be used for secondary p a vary Lew. e.1�3..&-� V (rhl). �' 0 PropertyOwner f pedy 9 a n ` C t� (V R��CI . Lot t 1/4IVk)14 S/� T .3/ N R /1J B ( W Property owner's Mailing Address Le O BI . Subd. Name or CSM# z sE� , -�. City State p Code Phon er City t� Village own Nearest Road New W 5 s' • - 3 � FF'c 9 O/ i aw Construction Use521 ! Number of be s erived design flow rate GPD ❑ Replacement ❑ Publ commercial - Describe. L Parent material f. - Flood Plain elevation if applicable R. General comments and recommendations: s /sue � C3 Boring © Boring # �! pit Ground surface slev. L ` Z ft. Depth to limiting factor _ In, L� Soil A �ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJfg In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#t `Eff#2 - s ® Boring # 80l "g Pit Ground surface elev. ft. Depth to limitlrtp facto in. won Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#i "Eff#2 q y Effluent 01 = BOD > 30 1 220 mg/L and TSS >30 < 5o mgA. " Effluent #2 = BOD < 30 mg/L and TSS <_ 30 mg/L CST " (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number ��� �� Property Owner Parcel ID # _ Page _ of 21 Boring # ❑ Boring �/ pit Ground surface elev. ! 1 J' 3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#i `Eff#2 Z- J3 ( S� a� ❑ Boring # ❑ Boring ❑ pit Ground surface elev- _____� ft. Depth to limiting factor in. Soil licatlon 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 "Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. _,_. ft, Depth to limiting factor in. El Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. "Eff#1 - Eff#2 " Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD S 30 mg/L and TSS 130 mg/L 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 648 -266 -3151 or TTY 608- 264 -8777. SOD -8730 (RWOO) Soil Test Plot Plan Project Name Karl Nelson Shaun B* Address 1240 Old Mill Rd. f New Richmond Wi 54017 CST #226900 Lot ----- Subdivision ------- Date 9/4/00 NE 1/4 NW 1/4S 11 T 31 N/R 1 8 W Township Star Prairie ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Topef hail in Jack Pine System Elevation 89.7 *HRP Same as Benchmark Alt. BM Top of Nail in Jack Pine @ 101.9' Old Mill Rd 125' 14% Slope Please note: well is to be removed when trailer is removed 35' 35 B -1 10 Existing Single 15' 20' -2 Trailer to be —► removed Sandpoint well 3 ' 94' B -3 15' 30' 95' Pro 3 Bedroom House a� 0 t~ 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer r � - w' A J 5 o r� Mailing Address `E D D l d ✓' / Neu) R1 &h1xe n 5 5(0 - 7 Property Address d M ; l l f1� D� cl /l� � �' � ti o u % 1 61 (Verification required from Planning Department for new construction) City /State Ney- R�� M /I iO t Parcel Identification Number LEGAL DESCRIPTION Property Location L= -' /., ,NVJ ' / <, Sec. , T -R_L_ W, Town of 5 rd r 'P 1241 r r e Subdivision Lot # Certified Survey Map # �- , Volume _ Page # Warranty Deed # 32, 9099 LI S' 0 3 8 Volume .5a fv _ y 01 . Page # o — X 70 . Spec house ❑ yes ❑ no . Lot lines identifiable 19 yes ❑ no SYSTEM MAIIV'TENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper main:erance 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 oume lumber restrictedplumber or a licensed Pumper verifying that (1) the on-site wastewaterdisposal system mast�rplumber, j ymanP � 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 Wisconsit Certificatio stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning o ffi c e within 30 days of the thr year expiration date. 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 owners) of th / property described above, by virtue of a warranty deed recorded in Register of Deeds Office. �7 Q A ` 1 / l owl DATE SIGNATURE OF APPLICANT * * * * ** 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 ST CROW COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O wner /B uyer �K _► W, Aj ej ;s T n Mailing Address `� 0 D l d ✓Y1 r l fQ ��� Ne Property Address / ( 1 l Ref f d Ale-'J M O / u 1%. 5� �f 01'2 (Verification required from Planning Department for new construction) City/State Nil A M e Parcel Identification Number LEGAL DESCRIPTION Property Location ' /., N r /., Sec. I , T_.jL_N -R I W, Town of S rd r 12 1 1 r r e Subdivision . Lot # Certified Survey Map # Volume . Page # Warranty Deed # 32 EDER LI S' Q 3 ? , Volume 5,a fv -~ `f C i , Page # Spec house ❑ yes ❑ no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainte: ance consists of pumping out tie 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 mastprplumber. journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. 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. cQ� ,ka4 / 1,51V/ e� 2 1 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 � �F sK ,tin ' � K $.b � '}!"' f+° 3':L•F3' a � "°'T ^" C _ DOCUMENT NO STATE E=AR OF WISCONSIN -FORM I ' oj WANANTY DEED THIS SPACE RESERVED FOR RECORO'NG DATA G C� rtEGISTERS OFFICE THIS hFF.h, made between ._ Norman Laral sad Etzhll _j�aon, gY, CROIX CO.. Wis. husbaAd_ and wife of the Town .-Star-- ofPz St &__Croi County,. Wisconsin. - -- _ - - -._ �1tils Recd for Reid this-AWL _ _ _ -- .- - - - - -- Grantor day of u_1.Y- ___- _A.D.19_75 and Karl Nelson and Judith Nola on, husband and. _ 8: A. wife as Joint tenants, _�_ -- - - - -__ Grantee, Witne..eth, That the said rlrantnr t,r a valuable consrderation___ot . - Regisfarof Deeds Hundred Fifty _ ($250.00) Dolan _- conveys to C,ranlee the Folluwtng descntx•d n ,,t r - .t�h• ,r, S t".. Croce _.,_.. __ County RETURN TO State A Wiscun%in: Part of the Northeast Quarter (NEB) of the North west Quarter (NW) of Section $].even (11) , Town- Tax Key u ship Thirty -one ( 3 1) North, Range Eighteen (18) This is _ humestead property. west, described as follows: Commencing at the Southeast corner or the Northeast Quarter (NE0 of th Northwest Quarter (NW}) of Section Eleven (11), Township Thirty -one (31) North Range Eighteen (18) West; thence on an assumed bearing of South 89 °29 west, along the South line of said Northeast Quarter (NEk) of Northwest Quarter (NW,), 135.42 feet to the point of beginning; thence continuing South 89 West along said South line, 100.24 feet to an iron pipe; thence North 03 East, 211.54 feet to an iron pipe; thence North 89 029 1 16" East, 100.24 feet to the Northwest corner of that certain tract of land previously conveyed from Herman Larson to Karl Nelso ; thence South 03 west, along the west line of the above mentioned tract 211.54 feet to point of beginning. Containing 0.486 acres Together with all and Ringular the herediramenta and aon+i•+A thereunto belonginp — :- —, ..• sear"" Dag! tae assaspt1M that tae %fth -Umtb 1/4 lint of said ssetioit I1e�sl2 1 , bears due North and. _mouth Star h'sirie lrwaskip,,ft, Croix, County, Wiide"Wis. No. 269 Warranty DNd—To Husband and Wife u Jo1nt TanatU L Published by Eau CLLn soot ! Bt►tboerr Co, VMS This Indenture, Made this 16th day of August , z9 63, between Herman Larson and Ethel Larson, husband and wife, of the Town of Star Prairie, St. Croix County, Wisconsin , part i e s of the first part, and Karl Nelson and Judith Nelson husband and wife, as joint tenants, parties of the second part. Witntooetb, That the said part ies of the first part, for and in consideration of the sum of Two Hundred Fifty ($ 2 5 0 . 00 )-------------------------- - - - - -- -Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha ve given, granted, bargained, sold remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate situated in the County of St. Croix , Wisconsin, to -wit: A parcel of land located in the Northeast Quarter of the Northwest Quarter (NEB of NWT.) of Sectian Eleven (11), Township Thirty -one (31) North, of Range Eighteen (18) West, more fully described as follows: Commencing at the Southeast corner of said Northeast Quarter �f the Northwest Quarter (NE4'Of NW4) as the point of beginning; thence North along the East line of said Northeast Quarter of the Northwest Quarter fNE-' of NW4) a distance of 133.80 feet; thence North 68 West a distance of 133.80 feet; thence South 1 West a distance of 193 .53 feet; thence North $5 Fast a distance of 130.80 feet to. the point of beginning. Above bearings based on East line of said Northeast Quarter of the Northwest Quarter (NEI of NW4) being due North and South. 198 A- L� LOT 2 198 ` NW 4 N 114 NE��l 4 - NW 114 3 04 � ` ,i96 H r I98 IF � - 19510 19 ' ` .i �• s r 198 r G 3 � — (� � UUO R f s R _ ' Z�L� +_ }' r ' I 3 +�` ^ «� "b B• Z ( � Q � 4 .. ��� yp •` � _ r. . , Y" i' N '. f "� ''�� 653.34 ��- (v ylo - 9v o "�� �'r r. l p 3 «o l ' t. / r 1 7 r �' � 3 t .i. r `4 �"'ax dr _ I � � z � �w��'i �` ar �,• � 1 ,�� JAI \` N LOT 3 201C t 2018 i K � f ✓ +" Y. 643.40 t ' SE l/ NW 114 �q4 o LOT LOS' 2 201 A G 201A 10`` ts , s P� tE'• u�