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HomeMy WebLinkAbout038-1189-60-000 n■ o o? r 0 o @ J % ; § § / { } § / f (D o % M [ fcn 0 A CD ? § ° c 0 c - CD � 5' C o / j am cO 6 \ \ i .� m g e / @ z ■ r e z E A a 3 > E CD J > A G _ e E _ 2 i \ 0) m i o E m 4 § 2 @ § q / § C 0 ( . n r CA co, o 0 0 0 3 o 0 0 )) 2 k _0 / � CO) ' G 0 §% a o v¥ m% o§ + m £ • § / 7 \ 2 2 « 4 � § � ) � > / 0 > ƒ 0 � @ \ § � \ k \ ƒ / \ A k CD ID ° N [ ( E [ 2 E J ( 3 N (6 ■ � a � ƒ § � § & \ CL r ■ � � .. ■ T ■ § k E ■ E ■ z § % § A \ 7 q z 7 m - CD % w 2 k . . � � ( � \ C3- § m E § Z 7 c z % ) z % cn 3 i , 2 � I m % N > � ® \ I 0 » C CD t § f o f o k EI 8� �2 Parcel #: 038 - 1189 -60 -000 03/15/2007 02:17 PM PAGE 1 OF 1 Alt. Parcel #: 13.31.18.968 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - GEURKINK, JOHN M & TERRY A JOHN M & TERRY A GEURKINK 418 CEDAR VIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 2143 136TH ST OR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.451 Plat: 2226 - NORTHGATE 1 99 SEC 13 T31 R1 8W NW SE LOT 19 NORTHGATE Block/Condo Bldg: LOT 19 1354 214TH AVE Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 01/26/2000 617482 1486/391 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.451 28,200 0 28,200 NO Totals for 2007: General Property 1.451 28,200 0 28,200 Woodland 0.000 0 0 Totals for 2006: General Property 1.451 28,200 0 28,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12104/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 408268 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secs — ary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Geurkink, John Star Prairie Township 038 - 1189 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 No ❑Yes !j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2143 136th Street New Richmond, WI 54017 (NW 1/4 SE 1/4 13 T31N R18W) Northgate Lot 19 Parcel No: 13.13.18.968 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [', Yes [] No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. �� .. .... vv.o% raA 1 anti 4060 ST CRX CO ZONING 0001 r � F Sa sad BalleAa6t Diri" Can" 241 W. WNMWm Ave, P.O. 8M 7032 ■ f 1r4dibe. WI S3707 - 7062 Sn h"wis rhiwMa (to 6s "w ipflr Ca) DePw tmont of Commerce (SM 261 -d5" 0 g !/ Sanitary Permit Application sw. rl.a i D Is .�.+ Cowan a� 2t. Wis. A� iafatnarrioo yon proms N a} msr bo wed far ase adwy p1,g. Mwecy Law, 43mwql - _- t l.d W i. Appe � . Adr'«' Cf di ir aK r.. w:tiet �dn� aWeee ur.aw" - Plsaec him Af1 Kaww dow r 3 ` . 'M""" s 0 3 2003 a a Q Ah �n.0 g a Owos's M� AMMU ? r / im 13 c i". seMC zip rwase W S saraaa S go f ly R Typo: atBvMft (deeds aN dot apply) T t my Dry - N wf 8edeaefeK _ 3 1 vldaa Name CSM Wuabar pw 0 J �i M'aae �' � OC�y (�awoslls of � n: 0 IQ. T r of ft s (Chock only ON be:-ow See A. S it appiiaabic) A. paw S)Itm ❑ Rephacea m syrwan 0 Moai6oaeioa ro �iainR syaeaa s• p�aaait Rmc ral �ye1a"'t Rav;ciow 0 Clams of 0 rerndt took w 14W " a Pnmw t „^aµ Noaeber sod DNe fusee sere,e P%WA er owaar I V. of rOWIS sysim c an too n4w) Im{isoaad 0 Mood? 24 ia. wfsduwk toil 0 Mawd < z4 ke. or=wbk "1 D Ai-t S& D 3w0t raa Swd EiAa 0 Coas"A d Weewutd 0 srauaiotd W4rawd D s Tank D sax FI*w D ANOW Ttranene Una 01tMre 4W% SW4 F11W D sroe& me" Raw 0 Leader Ck=* r OLMI Line ka w ©o*a ( ) Y. yaatMeat AO ! Dad�r I�owr (tnd) Danen Sai Ayp%cwdoa Rmc(W" Di: "rW Awn ftVA -d (wO Diapnsal Atw Psopot" Fkvaliaa lam{ oo � • .S V1. rink into Cegsciq is Toni Naaba 5tc sand lrar rGtuie of usin Cwneete CoaW%wwd a " TMkr rrkr �"5 07 X ar.;,aca..ea Vn. RU POMWO 5 tM&M t ewe sawts l.r twe rOwrS ab"M wa Owe AVA*b*d r .e None Hasaaa ft— Number s -S Pkmbw s city. swat Z P -SYk v_� © o vtn, c Uae 2! 0 DW*P ved seaiory:unitFae(' 43Oroaada a ) F-) ,4 I// D Owu+ Caws Rwawa fee Daniel M C9441MO St etf Appravaif*eMM tar Disapproval An=* t wpb h plow h do Ceeaef 9WO tr do wo— r err ate tat art► Ila 7e 1 t to Ayr SBD -6398 (R. 08/02) j J st� J o � v�9A�Q- Lo�TI EZ1203H ' - •TPrr TrTTPT♦ o r P ,: fb r PTPP TPT I 4 'Yt T 7 - -- *•rr 1 21t 4 .625'' - ��`+�� T P rT TT - T T -> .,, j -•- r I/2 Circ. ► ;...,. , �.! � 18 'r -PTTT r7�� -r t T1 *RT ►T - -T T!!► TrTTrr! - *! -lr Prr 1 - 24 0 1 ' aDMDW 36 „ i 22_112„ Dbi . V' (, Void CocfTrcim" � A > 8="ta at 5 7.4%, O.D. or4^ §20 l ftm Lm A—"g IQ EL V oid volume W rer�„ R2,,, SdewaN t2 Sedew O, n. orC enter C)e iode, R.S mcrt� worn Ifl Void +folum ip =.m or f a ti ce Arty �� SWt hrterla tf j'- S7a4., 422 a. 5.1 $�, .4 d 0.t?. of oatg'We cyli l 1 2m r � t picas < D? Vold votes m oueside h t>nticrs , • 1. tst - ° - °i _ �raicct of 112mn ftj 901 IN 7'rtyep Area J j 4Did rolums W bottom SldewaH Haight 1 cvt #17t9crs ?4ie 12 Irl. •2 � Z.D)0 I ( Sq.Ft. Void Projected Tre ° °ltaAC at D2iar(i i2iarR { -t 3.t tlz } - U -'.3 ft' 36 in. = 3 -00 Sq.Ft. { bOttO°t CA ers {ir2 orvoid volo +ttDt Area a 0.422 0.90 D "olurac .. 0-117 � 0,215 .. sM Total void � R p8 ' 1.763 X 7.48 y a O. I Gallop # J Ifs 7 -A. ft fi « + : � x to � s C) E'S Aggregate Trench System EZi203H � 'n9`Industrial Gro Ow u 5 I Wand park Rd. TM .18()60 S►BEr t t TI -p1 7 1 State of Wisconsin County Department of Commerce SANITARY PERMIT S } . C,,o N Safety and Buildings Division Integrated Services Bureau Transfer newal Uniform Permit Number e Personal information you provide may be used for secondary purp [Privacy Law, s. 15.04 (1)(m)). Permit Re n wal Date Permit Transfer Date Original ermit Issu ce Date State Regulated Object �'J Property Location Town L1 Village U City of 1/4 1/4,S N.R E(or)W Lot Number Block Number Subdivision Name Nearest Road, Lake or Landmark PREVIOUS SANITARY PERMIT HO ER — IF C ED: SANITARY PERMIT TR NSFJQFNFWD Name (Please Print) S' natu Name (Please Print) Phone Number Address�, pp / Phon umber / Street Address, City, State, ip Co / 'I�g lctAc� ViccJ ( -7/5 )3FSL °l�0S� C O U NTY I, the undersigned, assume responsibility for installation of the private sewage system that has been previc usl i E Plumber Signature Previous Plumber Name (if changed) Plumber Address Previous Plumber address MP /MPRSW Number Phone Number MP /MPRSW Number Phone Number Issuing Agent Signature Date Approved SBD -6399 (R.4/99) wWn M&ARY amd 201 W. W� Air.. P.O. Hoar 7162 � c Of F • WI 33707 - 7162 Sbe Ad&M wM Conn 83M. wee. A&& , AL _ , _ 0 A IN 6 t All�otiNO - 4 s1S o.et i i<evi sNre si. LD- M • / Oaeta's NUN N PfiaPatq Owner's N�ii� Aibs,� ; . _ mfr coy. Sam ZIP Code Pbone Nazober Nssslar S T N. R Nam m IL �� S 4O 1(o O Nape CS11t Notds3r 11, 6ftwk an due 1 ar 2 y Dw o l - Nmober of ✓ o4' 0 Ppbi - D..&. V. OyMP 0 31 Otamd 3 x (p t c Newt Road �''r3le of G* are me s ire srienNS lrir iduead sses). R1on�ine in >3 1 New 2 0 >eaPaoenoot 3 0 c ofi 6 0 Addfeion so Cbr. aoe s - fxckuk it almoy Pdaeit Pmvi ate, kmed 3 o a.� �cp/ & -- L Due bma r►•' . aPa (ChI as u.� - o 44 KNaa — P--.i ied .a 210 1$ I nd ""� b 0 $1/ C 47 [] Sssd Mw 30 Coomoeted R►ed ad h p_ i4 •�� 13 22 13 0 lailtoned 41 HoW* T..k 18 0 Sbgk Pals 510 D* Li. AII A 1Anobsc llstpo M Unit 19 30 0 Odrcr Ana Asa` 301 APpnc sie. Pst°°w�e' Rene Sy tt.t Find Chi& C I pt 7 � >Reedoo Odkm Odloas � Pteriea Sift Sred FVw phod dI YII. �' Ar relsirtss► CN1w l�o�w'i� stews e. re srtellsd V-K >WMP�RS Nu.tLet llttliNee PIN.. i�l�mber Vk vulL u se 1 7 AMMve 0 Dbqpeved � Pbe (isciode�Qsoaedoosn ltmsa' cxo � 0 otneer 611 bow AdI ,z of A pp hr 1 �� r i it niImnt l "c'` 6�f G vYlt �(,U�3" ® J 46 add .6 r �� ' u1Sa� If 1V ��►�de�j� -i -,T si5 513 7 - 51 638 -If a'`i - 60 fl- 5 yy 11 d� � l IU Z 4f iA 70 ld ��sos 37 2 3 C� Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations I)ivision 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 int BM direction and % of slope scale or PARCEL I.D. # Po ( ), P e dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -95 APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION REVIEWED BY DATE 4!! .7 PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises GOVT. LOT NW 1/4 S 1/4,S 13 T 31 N,R 18 : �(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1416 Third St. 19 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE GOWN NEAREST ROAD Hudson WI. 54016 ) 386-3674 St-ar Prairie I 214th Ave, [ New Construction Use �c J Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft xlmum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.45 It (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 91 ❑ U &I S ❑ U �7 S ❑ U ®S ❑ U ® S 1:1 U ❑ S M U 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 jTw& ................. 1 ''< — .3 Ground 3 6 -84 7.5 r 4/6 no cos 0sa ml na na .7 .8 elev. 9 9.1 ft. * 8 "X l0yr 5/4 c2p7.5yr 5/6 sil nonconti ous len in H- Depth to limiting factor +84" Remarks: Boring # 1 —12 10 r 2/2 none 1 2msbk mfr 9W if .5 .6 2 2 12 -26 10 r 4 Ground 3 26 -36 1 elev. 4 1 36-84 7.5 r 4/4 none ( C - O os os 99.2 ft. 1 I. Depth to limiting factor IEWE + Remarks: ST CROIX CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 ZONING OFFICE Address: 1554 200th. Ave,, New RichmondIWI 54017 �: \ Signature: Date: 10 -29 -98 C 0 PROPERTYOWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page 2' of 3 PARCEL I.D. # 038 - 1055 -95 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncl3y Roots GPD /ft .................. in. Munsell Glu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. .................. ................. .................. ::...3.. - 12 10 r 3 1 2msbk mfr - w if .5 .6 2 12 -24 10 r 4/4 none sicl 2msbk mfr qw if .4 .5 Ground 3 24 -84 7.5 r 4/6 none cos 0SQ ml na na elev. 9 9-2_ ft. Depth to limiting factor + 8411 Remark Boring # 1 -12 if .5 .6 "4 2 12 -25 10yr 4/4 non sicl 2msbk mfr Q W if .4 .5 Ground 3 25 -84 7.5 r 4/4 none cos I OSQ ml na na .7 .8 elev. 99.1 ft. — Depth to - limiting o factor +84 tl3 71 Remarks: _ Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr qw if .5 .6 5 "' 2 12 -30 10 r 4/4 none sicl lcsbk mfr if .2 .3 Ground 3 30 -84 7.5 r 4/6 none cos 0SCI ml na na .7. .8 elev. 9 9.2 ft. Depth to limiting facto + 84 1, \ U Rema Boring # ................. Ground elev. 1 ft. Depth to limiting factor Remarks: I � 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 NW4SE4 S13- T31N -R18W (715) 246 -6200 town of Star Prarie lot #19- 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 2" pvc pipe C el. 100' Alt. BM.= top of 2" pvc pipe C el. 100.30' 8 to jb.k 60 0 10 Gary L. Steel 10 -29 -98 Wisconsin Department of Commerce EM PRIVATE SEWAGE SYSTE Safety and Buildings Division Count9t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar `� Personal information you provice maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ la T.o of: State I o.: eurkink, John�ai CST BM Elev.: Insp. BM Elev.: BM Description: ParceLTmn, -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing t ' Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME ION DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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 ❑ No ❑ Yes ❑ No C 1 11 od I cre a ties, r s n 1 ns p ec ion Inspec Locat><on: 143 1 �th ree ew �>c �p ��(�1 1 1/4 SE 1/4 13 T31N R18W) - 13.13.18.968 Northgate - Lot 19 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �, .. _ . .. a , a � g i , o , = a e_ s t P .,. e ,..ems E s � e t E r s a , ; q e ` € M , e � , g _ 1 , a s i y a , F @ �s V c t .,.� _ .<. , ..,. ... .. ... s^ i a s d i 's g �..o ...m_ .ate.. a 6 S I i € 3 1 ¢ $ 1 R Witter wa r /� A r\ l�eixr I rt + E3iop, 34 " z 76» , Jr , open both)m g aes ♦ Leuven = *; auk" C"Act ♦ S >x + s°'0d e + ImPEO*+od z j � al u k� it sur fa ce 'b ject eve lea the nmaUed i to Provide �o space. its � t h ela a ction de all to l to allow efflun bottom and ,tto ed by cornbinin lrecti ons. This has w via SPFC /FICA with Win! insld a series of louvers traditiona/ ben Ube e the rs a l o op n 'm9th.._...... Prprda Unn 76' E a long the cha mbeF flo ng t he sides. w blft .............34" ,' 9th . 76" designed erlgth of each s. uncompacted Height ... ... 4- W ... " l � to 34 °mPacted bac I, while en t Vie. l he lo uvers ifinert.... .. Height ..... .... t 1 " to allOW 1cfxll while Pass into the Bf°pi�� lR�ert ...._......6.5 into # Ch ambbe preY Preventin i from grade '" of a she, " and re f �"� withstand ►�_ t M d h -20 factors �Y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM eU Y"ki I 7� ess f Qd ua address �.� 3 n / (Verification required from Planning Department for new construction) State Parcel Identification Number ZGAL DESCRIPTION Property Location — '' /4, 5� '/4, Sec. � , T��N -Rj KW, Town of � i�rQ, � � +� Subdivision No a a� Lot # 1 Certified Survey Map # , Volume , Page # Warranty Deed # Lei 7�i FS a , Volume 1 , Page # c ? Spec house ❑ yes 'A no Lot lines identifiable K 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 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. 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 f e thrc year expiration date. j - t' ©o SIP ATURE 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. '4L )41 jai, (0 / &0 S NATURE 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 MANAGEMENT PLAN P POWTS OWNER'S MANUAL & " I f .� 1 1X NIIFOAMATlON S YSTM BPECIRGATIONB Owner Septic Tank Capacity pp ❑ NA permit Septic Tank Manufacturer c DNA F1 0 PAf1AMETERS Effluent Fitter Manufacturer D NA Number of Bedrooms 3 D NA Effluent Fatter Model D NA Number of Pubes Facility Units Cl NA Ptmnp Tank Capacity as , D NA Estimated flow leverage) 36 O Pump Tank Mannufactuner D NA Design flow (peak). IEstimatsd x 1.5) Pump Manufacturer ❑ NA Soil Application Rats 1 7 gaWgt!!L Pump Model D NA Standard influent/Effluent Quality Monthly average Aretrestment Unit D NA Fats. Oil & Grease fFOGI S30 mg/L 0 Sand/Grnvel Filter 0 Peat Fitter 8iodhernical Oxygen Demand 1800 5220 mg/L ❑ NA D Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 51 SO mg/L D Disinfection D Other: Pretreated Effluent Ou+sky Monthly average Dispersel CON ❑ NA 8WdMM icat Oxygen Demand (BODj 530 mg/L In- Ground l gravity) D In - Cuou nd Ipressurizedl Total Suspended Solids ITSS) S30 mgft. D NA D At -Grade 0 Mound Face! Coliform (geometric mean) 510' cfu/1OOmf 0 Drip -Line 0 Other: Maximum Effluent PwtkM Size yi in dia. 0 NA oaror: 0 NA Other. 0 NA Other. 0 NA "vakm typical toe domestic weatewater and septic tank eMivaat. Clare►: D NA Service Service Regw wy hnspsct condition of tank(s) At least once every: ts? (Maidranwa 3 vowel D NA Ahimp out contents of tannkfs) When combined sludge and scorn equals one-third (Y of tank volume 0 NA km**" diaper" ces) At best once every: 2�-?j �r lls! (yam 3 y.ars! DNA ll D rrnanthls) DNA At bast once ?',lean effluent fitter �D every: ( s! Mks N� D month(s) D NA Inspect pump. Pump controls 6 alarm At bast once every: O s) 0 months) 0 NA Rusin laterals and pressure test At least once evwy: O year1 Other: 0 martth(sl D NA At least once every: D s) Othw: 0 NA Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following ficenSna or certifications: Master Plurrnber; Master Plumber Restricted Sewer. POWTS inspector: POWTS Maintdner: Septage S fhueaator. Tank inspections must include a visual inspection of the tankfs) to identify any miSsing or Woken hardware. identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal sal(s) shall be visually Inspected to check the effluent levels in the observation Pipes and to check for any ponding of effluent on the ground surface. The ponds ng of etfknent on the ground surface may Indicate a faiting condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scuts in any tank equals one- third ()q or more of the tank volume. the entire consents of the tank shall be removed by a Septage Servicing Operator and disposed of in sxordsncs with chapter NR 113. Wisconsin Admhnbtrativs Code. All other Services. in cAiding but not limited to the servicing of effluent fitters. mechanical or pressurized components, pretreatment units. and any servicing at Intervals of 512 months, shalt be performed by a certified POWTS Maintainer. A service report shell be provided to the local regulatory authority within 10 days of completion of any service event. BMW 14101 i p Ze —tART UP AND OPERATION that For now �� to of the PC)WTS c ° of y impede the dnek treatment tarrklsl for the Of the tank(S) removed by a Proce" WWI damage the dispersel ceflsl. if high oorpcentrationa are Presence of Peintapg ducts or Other ��, System start up shall not '"Stage �wcing operator Prior to .. detected have the conter System Power out occur when Soil condoms are frozen at the infiltrative surface. Pump tanks may fill above discharged to the d' tnormal hi9hwster Twirls. When effluent. To avoid this cis! le one large dose. overloading the Celts! and mower is rsatored the ocaccees wastewater win t Power to the eNN►ettt oror tact the a c ontents of the pump tank rived by p the backup or surface dame c restore normal lave" within Plumber ox �WTS Maauairw to asist in Servicing Operand it to ntrols � Pump tank. anuafy Operating the pump controls t Do not drive or park veh icles over tanks an within 15 feet roar, slop* of d dispersal cent. Do not drive or park over. a y mould or an -9rede so Reductuon or elimination il absorption area. Otherwise disturb or compact, the are: POWTS: antibiotics.- � from the wastewater stream may approve the : bale 11 *2ndation drain ! G � � � % condoms• cotton swabs � d* the We of the Pump} watr�• • degreasers; dental Painting Products: Pesticides; sanitary napkins, t V"Stable pee : gam; grease; herbicides flow diapers' d ei lion fat; ABANDONMENT ampons; and water softener brine, ABANDONMENT snrrapt; medications; oil When the POWTS fails and/or is permanently, takers out of Service he Property and safely abandoned in compliance with chapter CO"Wn 88 33, yN follo wing be Moen Ad min istrative Code: Kr sure that the system is e All Piping to tanks and : Pits shall be disconnected and the abandoned • The contents of a" tanks Pope openings sealed. and pits shah be removed and Property disposed of by a Se • After Pumping, an tanks and Servicing OPwator. Soil. graved or Snooper in t material. excavated and removed or their covers removed aped the vol space fiNed with CO NTINGENCY PLAN if the POWTS fads and cannot b replacement system rep the foibwing rrwaeures have been, must be taken, to provide a code compliant A suitable replao;ement area has been evaluated system. The replacem area slrated and may be utilized for the location of a rrent sow ragU� setbacks cam Should be protected from disturbance and compaction and ahOuld not be in abs orpti on result in the need for a new soil and Proposed structure. lot lines and weft. Fafure to Protect the aged aeon by comply with the file evaluation to establish a suitable refit area. Replacement area will rules ar effect at that tans, systems must 13 A suitable replacement area is not available due to setback and /or W " technology a holding tank may be installed a Est stations.e advances in POWTS ❑ The site has not been evaluated esort to replace the faded POWTS. evaluation must be aluated to identify a suitable rePlacement area. Upon failure of the POWTS a soli and site may be to locate a suitable �t any. if no replacement area is available a holding tank resort to reps the famed POWTS. D Moiurd and of -grade sail absorption systems hfiftmWe surface. Reconsnr s of such Y be stccompl with in place followi removal of the biomat at the < <WARRWAG> > systems must co with the rules in effect at that time. SEPT IC - Pt1W AND OTHER TREATKUNT TANKS MAY CONTAIN EVER A SAC. P OR TK*WT TANK UpIM ANY C N. DO NOT PERSO THE WTERIOR OF A TANK MAY 1SE IMPOSSIBLE � fY �R TREA SuFHCN�IT OXYQE CULT OR . DEATH AdAY RESULT. RESCUE OF A ADWWNAL COMMENTS POW1S WSTALLER Nam POWTS MAMITAII� Phone `T I Name 49PTAGE SERViCING OPERATOR WUMpERj Name LOCALtLATORY AUTHORITY Phone Name c c ro< < Phone 7[S document was drafted in comPkence with chsPter Cwnm 83.22(2llbj(1 j(d)dilfj and 83 .5411), 12! tt f31, Wisconsi Adn*fttrstive Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jr)L �U_ r Mailing Address b C / Property Address l Q-1 1 3 S_T (Verification required from Planning Department for new construction) p� � ll City /State N ' , ' va -, �w.o ►ti kj,�:t- Parcel Identification Number LEGAL DESCRIPTION Property Location _.� I_Lo ' /a, 5< ' /a, Sec. 1 T_3LN -R_1_KW, Town of Subdivision No _, Lot # 19 Certified Survey Map # , Volume , Page # Warranty Deed # 61 71-4 K A , Volume K , Page # S Spec house ❑ yes IA no Lot lines identifiable K 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. I /wc, 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 f e thre year expiration date. SI ATURE 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. .'4L tz' S NATURE 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 No. 82581 r• 10-1 - Form � o..Aw 61748`2 STATE BAR OF WISCONSIN FORM 1 -1998 KATHLEEN H. WALSH Document Number WARRANTS DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Greenwood Enterpricpc_ Tne_ * Wisoo — RECEIVED FOR RECORD corporation. Grantor, and T husband and.2 'f 'v h>I 01 -26 -2000 3:10 PM Grantor, for a valuable consideration, conveys to Grantee the following WRRIINTY DEED described real estate in St. Croix County, State of Wisconsin ('The "Property"): EXEMPT 1 CERT COPY FEE: COPY FEE: TRANSFER FEE: 56.70 RECORDING FEE: 10.00 PAGES: 1 Recording Area ame q oc) S+ Ao&; a ' a saq 1 o3� -t►$q --moo Parcel Idea ification Number (IQ Tb;s b ugg homestead property. (is not) Lot 19 of th Plat of NorthGate, recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on May 1999 in V lame 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 21 day of 2000, h ,. G 0OD C, By * *J E. Ruach, its presid By. * *Mary R. sec AUTHENTICATION ACKNOWLEDGMENT +�F Signature(a) James E. Rusch, its president STATE OF WISCONSIN ) St. Croat County ) su rated — day of January, 2000. Personally came before me this 2 day of , 2000 the above named Mary R. Ruscb. its - secret& t6 me known to be the Person(s) who executed the L 6 � R �'IC foregoing instrument and acknowledge the same. I � �- lt, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) Notary Public, State of Wisco THIS INSTRUMENT WAS DRAFTED BY My Comm sion is permanen . f not, state expiration date: Lois A. Murray, Zilz, Estreen & Ogland, LLP ■ ) 304 Locust Street, Hudson, WI 54016 R B CA J. pH ANEUF ■ ( Signatures may be authenticated or acknowledged. Both are not NOTARY PUBLIC necessary STATE OF WISCONSIN ■ *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DSFD STATE EAR OF W1800N8IY INFORMATION PROFESSIONALS COMPANY FOND DU LAC. W 90"W2021 •• -. _ �. - - �_____ —•,—cam r - -- — '— ^....�_,__. .._..tti e j� � I � =� • �_ u ra 1. �. t} 1 4 ' ! a u (t 1 4 { 1 _ 1 ni. MA o fa.i Si-'! 43L� 'nF ^ u' 1 t-thl: YXI4 oft', 389.07'26'E 3545.68' EAST - \ 1 /4 23900• 66 e• I SECTION LINE 1 IQO' - , °° o 100' –,• I20 00' 1 CO c6 I 1 9 S99'07'26'E 875 86' 45586' 1 1 1 I fU N ru 0 L 21 60.192 sq ft. r I.45 ac. `� L' V CU -- 1.382 act 1 M `D I s 55.440 sq ft. 3 1 OSA56 sq. fl. o N [') iu 1 I o 1.27j Ac- m a, 2.412 ac. en 1 N I , ti0 - rU L ° °o I Z ° 1 \ c O I 1 33'33 S8 rn S89'07 457 v t J bl5' � _ �� 9 G 7 c6 E 20I 62 � � 1 0 15 41' I 66 0' 1 190.00' to - 17900 , �• 24 r) 23 t ° r 0 - - r I ° to ° I cu � 61.155' !3. R. 1 c � 50' 50'-� � 2 ° i °c o . ` i 1.404 ac. v .? 62.870 sq. ft. ' ►_- I y C C. { = �i \ 3 ca 443 °–' 1. ac. I ;� 0 en ^ f 58.898 sq. ft. c c trn V) 1.352 ac. cn ru cu ° Z 1.329 h� t� 0c °_ i c Z I 3 6 685' - 23e J 31 �:, _ _ 70. cn ti _ S 391.20' 14575 tv 213 . A V E — _ S 7 '26'E 19000 o cn o 55.756 sq ft.l I N89.07'26 -V 647.73• 125 00' i Z 00 3 1.286 ac N 89 - 0 7 - 2 6 - W •� _ 494.59 145.75 DRA:NA;,E EASEMENT 41 � -✓ THIS 80' RADIUS TEMPORARY CUL -DE -SAC UT LOT 1 ti WILL BE AUTOMATICALLY VACATED VITH � p • ��'o / ROAD EXTENSION TO THE EAST. ! c o TTie Cbr+sLrvction of 7 9 .39' 9 j and of sc'vcq_ s ild buildin for hur�n habitatio N 89*07'26'W N on wtlo► I is N 8 S'07'cW' 6' 6600' Prohibited. v T • � i , '!r , F • Taw.. +4 ' ta• ^: t � Sr 1 F t ♦ - A +. tee y 11,+x'"' 5. v R • Y. 7 3 II Safety and Buildings Division SANITARY PERMIT APP 201 W. Washington Avenue Wisconsin I P O Box 7302 Department of Commerce In accord with Comm 83.05, 4►Att►. ?� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) forth sys 4n pa t� s c y than 8 vi x 11 inches in size. • See reverse side for instructions for completing this appli c ti State S nitary Permit Number o`.n 9 f ZOO _}_ '37 4 Personal information you provide may be used for secondary purposes T -ROIX Ch It revision to previous application [Privacy Law, s. 15.04 (1) (m)]. .OUN r� / aOtQ Ian I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL I R� Property Ow er Name Rr pert 1 i0j T 3 , N, R ) W f Property Owner' Mai ing Address Lot Num Block Nu er Cl i ty, A te ZiCod I' w ` hone ;umber Subdivision Name o CSM Number 3a 1 I. TYPE OF BUILDING: (check one) W ❑ State Owned ! Nearest Road o Public 1 or 2 Family Dwelling - No. of bedrooms 3 F &.,I ,l,*4\ III BUILDING USE (If building type is public, check all that apply) AJ2Z,, Parcel Tax Number(s) 1 ❑ Apartment/Condo 110. i3' 1 - X08 3 8 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational 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. I New 2 ❑ Replacement 3, ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ______Syrstem ________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- Ground Pressure 42 [] Pit Privy 13 Seepage Pit �2� 3� � 6� 2S 43 C] Vault Privy 14 ❑ System -In -Fill 72• VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. SjCSte lev. 7. Final Gracle S � Required (sq. ft.) Proposed (sq. ft. (Gals/day /� ft.) (Min. /inch) QS Elevation Feet Feet acct VII. TAN in Ca gallo Total # Of , Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed T nks Tanks Septic Ta o� C ❑ ❑ Li Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI ber's Name: (P t) PI tier's Sig tur {No Stam MP /MPRSW No.: Business Phone Number: Plum� Address (Street, City, t S�t \ ate, Zip Code): E� 's � � ! l� T u IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Issuing Signature (N tamps) J Approved []Owner Given Initial Surcharge Fee) Adverse Determination (� Ax y , X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Rave f l -- L �n' - A •mss. �� SBD -6398 (R. 4/99) 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 pufriped'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, 4608 -266 -3151. - To be complete and accurate this sanitary permit application must include: I. Property owner's nameand,mailing address. Provide the legal dewripti6n and parcel tax number(s) of where the system is to be 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 online 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_,mugt ig application form. IX. Count9/:Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions,76cation 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 bphe•county; Q - soil test data on a 115 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. I Lo -- C� IVwY LO ,c dsw 1.e 2` x(01 �o r P ra `' fo . a��SL�1 d 3g I A► fvc_et Pte; �1 ion' 70 N ®r A/7 - r , — �3 r t j Is µ r I _ ( w�l g3 If 0 ,ee e0 i t 7'' e _1 O v 0 MIR ' r '•; L i C1• T O � i cn I n Orr OV 3 ' 1 n f i I • '� Q • • • - V (D CZD O N ? Q f O 1 cD i (D (Q p O (Q C 1 CD S = ` (D (O d _ (� n X =r ? fD (D 'D n d' f tin N i n C E N O = :3 = O 0. N -+, j � 1 (7 �G 3 o= so O — ? N =3 p O N `G (D pa :'� CW cQ x Z) — = 3 d -i ti V 3 (D p o - T' Q �• U; Q n 0 3 CD 0 o . w 3 >v (C) C W C C j 3 •— Invert 11' —� 5 (�' U