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HomeMy WebLinkAbout038-1188-90-000 I ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner" Property Address .r City /State Legal Description: Lot Block Subdivision/CSM # �--- /I 4 J4, Sec. �, T N -Ij� ' , Town of i� IN # � — SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer L:C/ e'J / Size ST/PG Setback from: House AV Well / P/I1>4 o � Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTE Type of system: /�"e'� Width Length Number of Trenches Setback from: House /gn � Well 11 P/L © Vent to fresh air intake ELEVATIONS Description of benchmark y� Elevation l� Description of alternate be nchmark fides' 0 Elevation _ p Building Sewer ST/HT Inlet /� ST Outlet /f� PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines l Bottom of System () ��� �� ) R ✓? ( ) I Final Grade ) ( ) y Date of installation //0/ — ermit number � State plan number V Plumber's signature d License number � � �.5�° Date 16"V9 6*!P Inspector Complete plot plan � Y" NOTICE: Please rovide the following: I P g • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW s� a INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353314 Permit Holder's Name: ❑ City ❑ Village ❑ TowrXof: State Plan ID No.: Wollenberg, Bernie I Star Prairie Townst ip CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: D v 10d' y 038- 1188 -90 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic UU Benchmark 3 Do � Alt. BM D Aera ' Bldg. Sewer Z Z r Holding t Ht Inlet TANK SETBACK INFORMATION dl Ht Outlet ,r L 1 O f , Y TANK TO P / L WELL BLDG. A ir ir I to ntake ROAD A Septic ��i i NA D A Header/ Man. 7 11 !�' Aerati NA Dist. Pipe 4) T z o� H olding Bot. System PUMP/ SIPHON INFORMATION Final Grade Demand St cover Model Number GP TDH Friction m TDH Ft L Forcemain I Length Dia. Dist. To SOIL ABSORPTION SYSTEM BED / E C Width Le th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI MEN Z� Z DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LE Manufacturer: INFORMATION Type Of AMBE / o e Number: System: Lo,,, J Z �� �S� ZO ,/� OR 1�111FT ' DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length r d ' -- P g N4 L �- g Dia. Length 2 Dia. S acin 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 [] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. //a /DO Inspection #2: Location: 1330 214th Avenue, New Richmond, WI 54017 (NE 1/4 SW 1/4 13 T3 1N k1 8W) - 13.31.18.962 Northgate -Lo 13 1.) Alt BM Description = bvj.. ply 2.) Bldg sewer length= ZV - amount of cover = > 1p fr Plan revision required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Da a Inspector' nature Cert. No. r. 3 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .._ a,..� ., .._----- . p ee a t i a � { F ...m. ., �., .. °. e S s t n g e W � am �. a { e 9 — 4— ,. e .L e i e a ry a i e y c 9 e a t e:. � F e [[ i g l g 4 I ri 3 � � x [ m i F 4 � /3 30 �/ f �' j� Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue N VIsconsin P o Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 353 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan Review Transaction Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Al* Property Owner Nam/ N Property Location n / L Gi^ 1/4 ,�tri4, 5 /.3 T , N, 13/ E (o� Property Owner's ailing Address � p ' Lot Number Block Number Cit , S t i Code r Phone Nu S b ivisio Name o M Nu r Y, ���r p � c �rsF " r �- 7- G � t' 11. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road 3 vi 4� ll age �'>�r� r Public 1 or 2 Family Dwelling - No. of bedrooms Town o v 11I. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment [Condo l 3 1. is . �1 Co a- O T - I W-1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Red eational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ------ System ________System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12'� Seepage Trench 22 ❑ In Pressure V 42 ❑ Pit Privy 13 ❑ Seepage Pit i , 3 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTE INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s ft.) (Min. /inch) Elevation ✓Z� G 2 = O, :$ Feet Feet Capacit VII TANK in Ca allons Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tank nk Septic Tank or Holding Tank d'ZO .�+ ❑ ❑ ❑ ❑ 1 ❑ - TH Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb ame: (Print) Plu er' Signature: (N to MP /MPRSW No.: Business Phone Number: Plumbe ' Address (Street, City, State, Zip Cod •e Az/ S �� IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved tl tary Pe rmit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) roved ; r7>� A Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination "TAU X. CONDITIONS OF APPROVAL/ REAS NS FOR DISAPP OV L: , (,o SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems ,must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151: To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans' include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 11 S form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. + 4 _ /� //� LOT PLAN PROJF,CI' i1 �i`C -^ ADDRESS 1/4 jj / 1/4S /Tj/ N /R /," W T0WN � Gi ���C0UNTY s _ Groi MPRS Byron Bird Jr. 2 DATE — 1'K BEDROOM _ CONVENTIONAL >00( IN -GROUN RESS R U I; CONVENTIONAL LII'T HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE �' ABSORPTION AREA�� # of chambers �g NCHMARK V.R.P. ASSUME ELEVATION 1Q0' ❑ BOREHOLE O WELL 'H.R.P. /' l p� & Vent SYSTEM ELEVATION >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 6' Long 16" ft ^2 per chamber 34" Grade /f at ill Elevation 1 i 0 5�1 7 i � I Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Hum #n 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 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 Si 1/4,S 13 T 31 AR 18 6 W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1416 Third St. 13 1 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hudson WI. 54016 (71q 386 -3674 Star Prair' 21 4th Ave, [ New Construction Use [ Residential / Number of bedrooms 4 [ j Addition to existing building (] Replacement ( ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate ._ bed, gpd /ft .8 i trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.05 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 fors stem I ®S ❑ U ®S ❑ U ® S ❑ U U s ❑ U U S ❑ U ❑ S CCU 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 Trench .................. ................. .................. 1 '? 1 0 -11 10 r 2/2 none 1 lcsbk mfr gw if .41 .5 ................. 2 11 -34 10 r 4/4 none sici lcsbk mfr gw if .2 .3 Ground 3 34 -40 7.5 r 4/4 none is 0Sg mvfr gw na .7 .8 elev. 99 ft. 4 140-84 7.5 r 4/4 none ms osg ml na na .7 .8 Depth to limiting factor +84 1, Remarks: Boring # 1 0 -8 10 r 2/2 none 1 2msbk mfr gw if .5 .6 2 8 -28 10 r 4/4 none sicl 2msbk mfr w if .4 .5 Ground 3 28 -38 10 r 5/4 none sil lcsbk mfr yw I na 1 .2 .3 elev. 4 38 -88 7.5 r 4/4 none cos 0sq ml na ,<- , 9 9.4 ft. Depth to - limiting factor � � +88 11 r N OV T 199 7 Remarks: ~ ; COUNT CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. A4/New Richm d WI 54017 / ~ Signature: Date: 10 -28 -98 CST Number: m02298 r PROPERTY OWNER Greenw En SOIL DESCRIPTION REPORT Pag; 2 of 3 PARCEL I.D. # 018- 1055 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 `? 1 0 -12 10 r 2/2 none 1 lcsbk mfr gw if .4 .5 2 12-22 10yr 4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 22 -84 7.5 r 4/4 none ms osg ml na na .7 .8 elev. 98.7 ft. Depth to limiting ., factor �y V +84 M Remarks: Boring # 1 0 -12 10 r 2/2 none 1 2msbk mfr gw if .5: .6 2 12 -31 10 r 4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 31-x1 1 10 r 5/4 20.5yr 5/6 sil lcsbk mfr gw na .2 .3 elev. 4 39 -84 7.5 r 4/4 none cos osg ml na na .7: .8 9 9-4 ft. — Depth to limiting a z z factor +84 Remarks: Boring # 1 0 -10 10 r 2 2 none 1 2msbk mfr gw if .5 .6 S 2 10 -23 10 r 4/4 none sici 2csbk mfr gw if .4 .5 Ground 3 23 7.5 r 4/6 none ms osg ml na na .'T .8 9 9.8 ft. Depth to limiting factor +90 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017 MPRSW - 3254 NE4Sw4 S13- T31N -R18w (715) 246 -6200 town of Star Prarie lot #13- 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 mayor may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM-= top fol" pvc pipe C el. 100 Alt. BM-= top of 1 pvc pipe @ 41. 98.60 �' br Al Gary L. Steer. 10 -28 -98 l r, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �� 5 �'„ �% I � V►'I r �� L L14y? Property Address 3,3 el (Verification required from Planning Department for new construction) r City/State / a;Aarcel Identification Number LEGAL DESCRIPTION �, " r � Property LocationzZ/, %,, ��" � ' /., Sec. / T l�l N- RW, Town of /a • - �� ^ `r • , c. Subdivision N 0 f t k G W4 L , Lot # Certified Survey Map # - , Volume . Page # Warranty Deed # , Volume Page # Spec house ❑ yes - f,4- 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, 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. 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 a year a lion cjate� SIG&Akfth OF P ICA&r �� 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 the pro describe bov / ,by virtue of a warranty deed recorded in Register of Deeds Office. O0 0 �4 C" SIGNATURE O V 1 1 1 1 1 1 1 PLIC DATE Any informatio 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 t � Vo 1490PAGE 501 16m, X467 STATE BAR OF WISCONSIN FORM 1- 1998 KATHLEEN H. WALSH DecutastN.ber WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between G ad Enterprises Inc a Wisconsin RECEIVED FOR RECORD n. mr 101LU Grantor, and t r Wollenberg an Kathryn L.- W_ollenbera, hus d nd wife ae c.e.o;.�.�ti:D marital property Grantee, 02 - 17 -2000 9:45 AM Grantor, for a valuable consideration, conveys to Grantee the following YARRANTY DEED described real estate in St. Croix County, State of Wisconsin Me "Property "), EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 60.60 RECORDING FEE: 10.00 PAGES: 1 Recording Area N am and Return Address WESTCONSIN CREDIT UNION P.O. BOX 269 NEW RICHMOND, WI. 54017 038 I0ss- -vim Parcel Identification Number (PDT This �o bomeAead property. (s not) Lot 13 of the Plat of NorthGate, recorded 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 t� day of 2000. BRE By ' * *JarpA E. Rusch, its president Bye / ' *Mary R. RO sec ry AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) STATE OF WISCONSIN ) ) 89. St. Croix County ) authertticatcd this _day of 2000. Personally came before me this" day of 1�5.l1Q the above na h its resi ntnt andlMary R. Rusch. its s - r be the " penwn(s) who executed the * • TITLE: MEMBER STATE BAR OF WISCONSIN acknowledge the same. •344 (If not, ,: 4 authorized by g 706.06, Wis. State e ' 1 THIS INSTRUMENT WAS DRAFTED BY Notary IPublic, State of Wisconsin Lois A. Murray, Zilx, Estreen & Ogland, LLP My Commission is permanent. (If not, state expiration date: 304 Locust Street, Hudson, WI 54016 j — lg (Signatures may be authenticated or acknowledged. 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