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HomeMy WebLinkAbout038-1188-40-000 I f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363967 Permit Holder's Name: ❑ City ❑ Village ❑ TBwn of: State Plan ID No.: Wallander, Phil Star Prairie Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: C70. 0 czD.o' G5 9 -V­ *j_ 038- 1188 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (J Benchmark '3, to�•� Cp Dosing Alt. BM x go 1 (4-16 6 Aeration Bldg. Sewer 57.2 W . 24 ' Holding St/ Ht Inlet 5 -7.611 TANK SETBACK INFORMATION St /Ht Outlet TANK TO P / L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic 60 1 � I NA Dt Bottom Dosing NA Header / Man. , C6.3lo Aeration NA Dist. Pipe `—,& o I o .l(e� Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade f p(�' Manufactur Demand St cover Model Number GPM TDH Li Friction System Ft l oss H eac Force ain Length Dia. Dist. To Well SOIL AB RPTION SYSTENI(jj) BED / RENCH Width Length No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI N I N 3 (.8•$S a DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE anu ur r: / STREAM LEACHING M t INFORMATION Type Of r .__ CHAMBER Y odel Number: System: tom � s 1 1 -11_51° f OR UNIT IL ` DISTRIBUTION SYSTEM S• t%' "^L Header / Mani Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length4r!r Dia. N ia. cing 7 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/Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection # 1: C9 / 07/ Inspection #2: - t -- 7 ' Location: 1310 214th Street New � Richm c� W 54017 / W 1/4 13 T3 IN RI 8W) - 133118957 Northgate -Lot 8 l.) Alt BM Description = ae'�''`^" �ev�. #� 2.) Bldg sewer length = I �, 0 1 Y i $ a . - amount of cover = > ($ z�� 5 � ` Plan revision required? ❑ Yes No (� 27711 her side for additional informatj 09 03 0:V �-laek 4 — t&0 � �D Inspector's Signature Cert. No. (R.3/97) v1n6 e N ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: E —. _mem _ F4 4-7-- 9 � 3 g k t ( k 'c B ? I g 4 I { I ° x i 1 3 a 7 � r Ir 4 ; 3 �.°. ...«..... ..A. ..a.. .mow 8 333 x gg jj 6 g a .._.. w.. �m. w, w..°.,....., .- ..«...«...„..ia .............. � .- ...., ......�»t....,..,.. �, i ... . Aw,..,..... �° a..e..........— L...«........ d...«.«»..,. ...im»......«.1... ...- ....��... ....- .«.-- .,.... '� L A) o 21 t { - Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. lVisconsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. County /m `` State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number �/� I. Application Information - Please Print all Information Location: Property Owner Name Property Location / (/ ! Gc f •� A 4, S T� ,N, WX Property Owner's Mailing Address a �S— �op�"�c C Lot Number Block Nu ccJ t S O City, State ip Code Phone Number Subdivision Name or CSM Number I1. Type of Building: (check one) V ❑ City 1 or 2 Family g Dwellin No. of Bedrooms : ❑Village t ❑Public /Commercial (describe use):_ I own of ❑ State -Owned Nearest RoadQ t dam/ 3 r l y / � 1-S__ Parcel Tax Number(s) _ III. T e of Permit: Check only one box on line A. ' Checl box on line B if applicable) r 6— �l�S� D — 0 13• ail• 18 _q j A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ,Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculatin ❑ Other: V. Dispersal/Treatment Area Information: r - '� G << c r 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Re aired Proposed Rate (GalsJday /sq. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks t v 1 VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumb e ' Signature (no sta ps): MP/MPRS No. Business Phone Number Plu er's Address (Street, City, Stiic, Zip Code IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Si ature (No stamps) N,Approved ❑ Owner Given Initial Adverse S harge Fe) Determination r 6� X. Conditions of Approval /Reasons for Disapproval: S �` 4 cerVWT164, t9-t� ane.Q. oP� v ALNnco pow �S xI 0H0 1S r Om►Z E, t ; i�,� 03AIJJ3J �(/ � �� Plot Plan / 3 i o �i yam_` ADDRESS PROJECT / / % / 1/4`�� j 1 /4S IT N /R/ W TOWN ._ COUNTY Byron Bird J Jr. 220527 DATE �d -'05' BEDROOM CONVENTIONAL IN -GRO D PRESSUR CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE �, 7 ABSORPTION AREA3l, # of chambers IL BENCHMARK V.R.P. © 6� �fi!L � it ASSUME ELEVATION loo' ❑ BOREHOLE O WELL *H.R.P. ,-n e` ^c GL SYSTEM ELEVATION Vent >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ft ^2 6' Long 6 " per chamber 34" Grade at System Elevation if a rao! �r S f L. e c�"�k1Q Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings In accord with ILHR 83.05, Wis. Adm. Code COUNTY ..� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION vtv IEWED BY DATE Ji-_ • 7 PROPERTY OWNER: PROPERTY LOCATION U (' Greenwood Enterprises, Inc. GOVT. LOT NUJ 1/4 SI,L) 1I4,S !I,? T �j) N,R �a E (or) W c Hwy PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 1416 Third St. 8 1 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ KTOWN NEAREST ROAD Hudson, WI. 54016 (715 386 -3674 Star Prairie I 214th Ave. [ New Construction Use [ c ] Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 95.40 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem © S El ® S ❑ U ®S ❑ U ® S ❑ U ®S ❑ U ❑ S ICU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITirench >.<`. 1 0 -8 1 1 2msbk mfr aw 1 2 8 -24 10 r 5 4 none sil lcsbk mfr QW if .2 .3 Ground 3 24 -84 7.5 r 4/6 none Cos os ml na na .7 .8 elev. 9 Depth to limiting factor *841, Remarks: Boring # 1 0 -12 10 r 2/2 none 1 2msbk mfr CIW if .5 .6 U 2 12 - 10 r 4/4 none sicl lcsbk mfr qw if .2 .3 Ground 20-84 elev. 9 f Depth to F� - limiting 3 factor Net a Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. N w Richmond ,,WI 54017 Signature: Date: 10 -27 -98 CST Number: m02298 L r PROPERTYOWNER Greewood Enterprises SOIL DESCRIPTION REPORT Page � of 3 PARCEL I.D. # 038 - 1055 -20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxlary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. .................. ................. .................. .................. 3 1 0 -12 1 1 lcsbk mfr gy 2 12 -24 10 r 4 Ground 3 124-84 7.5 r 4/4 none cos oscr M1 na elev. 99.1 Depth to limiting factor +84 1, N l Remarks: Boring # 1 0 -12 10 r 2/2 4 Ground 3 25 -84 7.5 r 4/4 none elev. 99 — Depth to - limiting factor Remarks: Boring # 1 0 -9 10 r 2 2 none 1 lcsbk mfr if A: .5 5 2 9 -25 10 r 4/4 none sicl lcsbk mfr CAW if .2 .3 Ground 3 25 -84 7.5vr 4/4 none Cos 0sa M1 na n elev. 9B_.95ft• Depth to limiting factor +84" Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) l STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Greenwood Enterprises, Inc. New Richmond, WI 54017 MPRSW -3254 N�^�4SW4 S13 T31N -R18W (715) 246 -6200 town of Star Prarie lot #8- NorthGAte This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 1" pvc pipe C el. 100' Alt. BM.= top of 1 pvc pipe C el. 100.25' 6kk L6 A 3T � 9 �l Gary L. Steel 10 -27 -98 ST CROIX COUNTY Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S� �� �� ` Mailing Address / Property Address 3 1< (Verification required from Planning Department for new construction) City/State �'l/Cr- c��!�j� Parcel Identification Number LE GAL DESCRIPTION Property Location �/4, �Jw ' /o, Sec. , T 5 / N-R �W, Town of �_2 �-�4 "ry C Subdivision �� e5 An , Lot # _ . Certified Survey Map # , Volume , Page # Warranty Deed # 7 , Volume _J�O 7 , Page # Spec house ❑ yes 0 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, restrictedplumber or a licensed um er veri in that 1 the on -site w P P fY g () astewaterdisposal system ism 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 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 th / 7;ar a it ion date. SIGN xin E 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 b virtue o y f a warrant deed recorded i Y in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary ermit being revoked b the Zoning Department.****** P g Y g P ** 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 Y91. , 1501hGE STATE BAR OF WISCONSIN FORM 1 - 1998 K ATHLEEN 6223 ALSH Docam"Nam6w WARRANW DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Greenwood Enternrises. Inc. WisconSin RECEIVED FOR RECORD commtion. Grantor, and Philip R Wallander and Shelley R Walkander husband and wife as Qurviyorshin marital property Grantee. 05 -03 -2000 2:00 PM Grantor, for a valuable consideration, conveys to Grantee the following IIARRt*TY DEED described real estate in St. Croix County, Slate of Wisconsin (The "Property "): EXEMPT II CERT COPY FEE: COPY FEE: TWISFER FEE: 63.30 RECORDING FEE: 10.00 MS.- 1 Recording Area N ame and RCUM Addren f,Cc art s u0 a99 7L 03&1188 -40 Parcel Idamificatiou Number (PIN) Male lM homestead property. (ia mot) Lot 8 of the Plat of NorthGate, reoorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on May 20, 1999 in Volume 7 of Plats, at Page 46 as Document No. 603503. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record. Dated this 2Z4_- day of GRE ODE C. /J B y: �v¢ • sJamce E. Rusch, its president _ *M' secrairy AUTIiEDMCATION ACKNOWLEDGMENT Signaturc(s) James E. Rusch, its president STATE OF WISCONSIN ) ) as. St. Croix County ) authenticated this ZQ�&y. of � , 2000. Pe onal1y came before me this day of the above named Mary R. Rusch, its seciAn to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. * Lois A. Murray / TITLE: MEMBER STATE B F WISCONSIN (If not, authorized by; 706.06, Wis. Stets.) ■ ) iscons THIS INSTRUMENT WAS DRAFTED BY REBE00,ACY" F anent. (If not, state expiration date: Lois A. Murray, Zilz, Estreen & Ogland, LLP N _ ) 304 Locust Street, Hudson, WI 54016 STATE OF WISCONSIN (Signatures may be authenticated or acknowledged. Both an u necessary.) Names of persons signing in any capacity should be typed or primed below their signatures WARRA?nT DGED FrATR DAR Or w19COMIN IORM FN. r - lna INFORMATION PROFESSIONALS COMPANY FOND OU LAC. WI 800. 6664021 Located in part of the NW 1 /4 of the S W 1/4 SE1 /4, being also in part of Lot 2 and Outlot in Section 13, T3 IN, R18W, Town of Star P POINT BEGINNING 0 F EAST -WEST 1/4 SECTION LINE S89 °07'26 "E 36 0 68.00' 78.82' 250.00' Is TO 14 .82' ,` 230.00 205.00' D > I p Z I o < 0 K L j_ 8 co t� o0 3 o vi 2 cU � L_ � a 56 325 . ft. 9 ( CD �. � I I N 7 �, sq 5 , 04 CV) Q �' N• 1.293 ac. 1.355 CD °, - a I �I I N o 72,330 sq. ft. w . o N v �- — fin I 1.660 ac. w 3 'S HOP J z i o i j� 53.00' 90,680 sq. ft. �� / ; z M u S89.07'26'E 2.082 ac. 0 � o, , - oo _ — — — 90.93' — — — 205.0( Ln o ° �' — —fi--- / � 4 S89 °07'26'E (U C CD th 6 6 3 Z 2 N C ��2 , ,�1�b 907'26'W 1 z I ' �� '2 u� 165.02 agA �3Q � 40.93' — — — 185.00' — 18.20 - 0 2 - - - Y 2 r i - 4 6.8 1 2 � 6 6'E 421.28' t 66 '22 ,,AA�6 0 0 T _ I 2 s --- o' —.. 3.08 16.92 0 ,� M A 2 0 / 6' 420.00 N 3 6 o CD o / 3 7 0 55.500 sq. ft. 1.274 ac. o ° . z W 74 ao o � 459 sq. ft. M 1.709 ac. p W J 99.0 - NO STRUCTURES J J � — — 3 8 �' �`-�' 185.00' 66,555 sq. ft. x ��` M 1.528 ac. rl.. _f L