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Home My WebLink About038-1190-50-000 e s Wisconsin Department of Commerce E SYSTEM Count y PRIVATE SEWAGE 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)]. 353310 Permit Holder's Name: ❑City ❑Village E] T n of: State Plan ID No.: Marek, Todd Star Prairie Townshi CST BM Elev. Insp. BM Elev.: BM D scription: Parcel Tax No.: 1 W f On. I vc- 038- 1190 -50 -000 TANK INFORMATION 0 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Zp0 Benchmark 1 I ,� Alt. BM Dosing Aeration Bldg. Sewer 3.21 2ri Cfl .98 Holdin St/ Ht Inlet S O d 4 $.I ° f TANK SETBACK INFORMATION St/ Ht Outlet 31 5 ' 3'XY t TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet — Air Intake Septic .I o r ` NA Dt Bottom Dosing NA Header / Man. , Aeration NA [fit. pipe. Holding Bot. System �: 3 2 ' to PUMP/ SIPHON INFORMATION Final Grade Manufacturex emand St cover 3 3 S? 2 " cf, `/8 Model Number GPM TDH Lift Fri S stem TDH Ft ss Forcemain ength Dia. D. 7o well , SOILA &&QkPTION SYSTEM EN H Width a Lengt No. f� enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 35 0� DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man a re SETBACK CHAMBER INFORMATION TypeO ► (1 r Model Number: �� System: CrftA) TZ OR UMT DISTRIBUTION SYSTEM r Header�anifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Spacing �Z ! 'f - SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center 2— Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No CAM NTS' c c de disc a le , ers t t . I nspection ns ion - Location: T34�2�'4t�i t�venue, r N�w iciionc�, e ��1"�W 1/4 SE 1/4 13 T31N R18W) - 13.31.18.976 Northgate -Lot 27 1.) Alt BM Description 2.) Bldg sewer length = 3o J - amount of cover= 1$ k f Sa C - Plan revision required? ❑ Yes 4 4 No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No e � ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: S i w.� # ,..gym? 3 .ma...,.,�a. "m, X ,. .. �.,.... .� �. ... »��....<. .,, �}..........., ",....g t # # # a E 3 5 v 3 v ] D -._.4 .. ;. ",..:...». ,d. _ - ..._ e r a �m ®.. .m t € # r # e 6 # { } { I b F 2 2 � j € e. ; . S..m am, j t € " re— A 1 s gy m.,.M. x t g y ,. d ----------- __ _ _.s.. ......... —.. ..._.....,...._..- a t € i r € € # € Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Wisconsin 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. G ro C • See reverse side for instructions for completing this application Stat Sanitary Permit Number 3.6 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 RMATI N Property Owner m pert ert Loc a4 t /4, S f T / , N, R E (o Property wne 's Mai g Address Lot Number Block Number C St at r t Zip Code Phone Numb pr Subdivision Name r CSM i y ber II. TYPE O F BUILDING: (check one) ❑ State Owned Ij C it Nearest Road Village /YI Public 1 or 2 Family Dwelling - No. of bedrooms own OF ee. 4r!^A ` l 111. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1, 31. /r, 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 online B, if applicable) A) 1. (New 2 E] Replacement 3. E] Replacement of 4_ E] 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 Weepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 E] Vault Privy 14 E] System -ln -Fill 1 ' , o 7 G � �G VI. ABSORPTIONSYSTEM INFORM TION• 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s . ft.) (Min. /inch) et _ Elevation 6 ,$—� �Z� <'j d -*eet Feet VII. TANK Capacit gall Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank p?G`lZ� El 1:1 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ • ; ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb ' Name: (Print) ` Plumb Si ature: (No Sta ) MP /MPRSW No.: Business Phone Number: Plu er' Address (Street, City, Stag, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) (� Approved [I Owner Given Initial Adverse Determination Surcharge Fee) a-Zl �caD X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6396 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y 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 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 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. n 1 2 x 11 inch must be submitted to the county. The plans must Complete plans and specifications not smaller tha 8 / es P Pa P Y P 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 orsiphon 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 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 _ LOT PLAN PROJECT G ` `e ADDRESS I /4 J ! 1 /4S j� /T N /R W TOWN s r COUNTY MPRS Byron Bird Jr. 220527 DAT /Sl d am' BEDROOM CONVENTIONAL >00( IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE , LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers ,BENCHMARK V.R.P. �ey 4 ASSUME ELEVATION 1Q0' �— ❑ BOREHOLE O WELL - H.R.P. Vent SYSTEM ELEVATION �� S >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 6' Long 16" ft ^2 per chamber 34" Grade at System Elevation wx �� rary J r �ocr se )24 1 r � \� � 0 � �� Wisconsin, Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety s 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 -95 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R DATE uK- PROPERTY OWNER: PROPERTY LOCATION Greenwood Enter rises, Inc. GOVT. LOT NW 1/4 SE 1/4,S 13 T 31 N,R 18 k(or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1416 Third St. 27 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER [ []VILLAGE []TOWN NEAREST ROAD Hudson WI. 54016 (715)386 -3674 Star Prairie I 214th Ave. ( New Construction Use [ : Residential / Number of bedrooms 4 [ j Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow 600 g pd 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 .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.65 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 91 S ❑ U CIS ❑ U I CAS ❑ U ®S ❑ U ® S ❑ U ❑ S ® 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 Trench 2 12 -28 10 r 4/4 none sicl lcsbk mfr qw if .2 .3 Ground 3 28 -84 7.5 r 4/6 none cos 0SQ ml na na .7 .8 elev. 99.4 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -15 10 r 3/3 none 1 2msbk mfr 9W if .5 .6 2 15 -33 10 r 4/4 none sicl lcsbk mfr 9W if .2 .3 Ground 3 33 -84 7.5 r 4/6 none cos 0sq ml na na .7 •: .8 elev. 1• 9 9.2 ft. Depth to limiting facto + ! NOV V 1 1 1998 I. Remarks: 'i awNTY CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6 %` Address: 1554 200th. A y. New Richm9nd WI 54017 i I Signature: e Date: 11 -2 -98 CST umber: m02298 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 Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .:::.3:..,::::::: 1 - n 1 ............ 2 12 -23 1 Ground 3 23 -30 10 r 5/4 none sil lcsbk mfr QW na 1 .2 .3 elev. 4. 4 30 -84 7.5 r 4/6 none cos OSQ ml na na .7 .8 Depth to limiting facto *84 S BPS g Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6 2 12 -30 10 r 4/4 none sicl lcsbk mfr C4w if .2 Ground 3 30_84 7.5 r 4/6 none cos OSQ ml na na .7 .8 elev. 92g ft. — Depth to -- limiting factor Remarks: Boring # 1 0 -12 l r 3 none 1 2msbk mfr if .5 5 2 12 -29 10 r 4 4 none sicl lcsbk mfr if .2 .3 Ground 3 29-84 7.5 r 4/6 none cos OSQ ml na Ina .7 .8 elev. 99.3 ft. Depth to limiting q3.13/- 0 factor +84 I Remarks: Boring # ................. Ground elev. j 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 NW4SE4 S13- T31N -R18W (715) 246 -6200 town of Star Prarie lot #27- 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 @ el. 100' A1t.BM.= top of 1 pvc p ipe C el. 99.30' 4W Al Ak e Y. Gary L. Steel 11 -2 -98 ST CROIX COUNTY d SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ,• k Owner /Buyer T. Mailing Address 0 C� S 75 l Lam% 1�C,� C��(:,� �" yo' Property Address (Verification required from Planning Department for new construction) z9a City /State Parcel Identification Number LE GAL DESCRIPTION Property Locations 1 /4' �� '/4, Sec. �, TJ,/ N -R W, Town of Subdivision , Lot #_. Certified Survey Map # , Volume , Page # Warranty Deed # 1O - ,Volume / , Page # Spec house7yes ❑ no Lot lines identifiable 5(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/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 the three year expiration date. y r a PLK / /o 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 describ d above, by virtue of a warranty deed recorded in Register of Deeds Office. ), / / 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 >t .1491PME247 STATE BAR OF WISCONSIN FORM 1- 1998 KATHLEEN H. WAL.SH Document Number WARRAN DE ED REGISTER OF DEEDS ST- CROIX CO., WI This Deed, made between modEnter Inc. a MI conSln RECEIVED FOR RECORD corporation. Grantor, and Todd Marek - a ma�B3 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following 02 -22 -2000 8:45 AM described real estate in St. Croix County, State of Wisconsin (rhe "Property "): WARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 59.70 RECORDING FEE: 10.00 PARS: 1 Recording Area N ame end Retur TO: Edina Realty Title 400 South 2nd Street Suite #115 son, WI 54016 038- 1190 -50 Panel Identification Number (PIN) This it ml homeatesd property. (s not) Lot 27 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 L,� day of GREE y�� C/!Jl_� r � B a *Sa Gehr A for y " James � E. Ruseh, its president BY ?�''Z/l�/iDW X�CfLLJeX a *Sandy Gchrk A for Mary R. Rusch, its secretary AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) 33. St. Croix County ) authenticated this _ day of • e Personally came before me this & day of REBECCA 3. PHANEUF jo, X044 the above named Sandy Gehrke POA NOTARY PURL I C p resident n Mary R STATE OF WISCONSIN to me known to be the person(s) who executed the * ■ regoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by ¢ 706.06, Wis. Spats.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wi onain Lois A. Murray, Zilz, Entreat & Ogland, LLP My Comm' sion is Pennancnt. (If not, state expiration date: 304 Locust Street, Hudson, Wf 54016 C3 5' ' (Signatures may be authenticated or acknowledged. Both arc not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRAMT DKKD SfATK BAR 11r WISCOMIN k"N"'I Na. n - ra■1 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI $00466.2021 t �•i4 r>x _J {i 7', ft , - t Al tt f 1 r t PJfyJ t } • f i�t�S { t ) td� }I.. f ff:ff - tU +t�� y 4,k r � L +� n �f , :`d ��4n J, �•� �.' �j - G f t N 0'S3 ':74'1'. 30000' ��- - - - - •- — - - �� N 0'52'34' %?88.U0' tr .w 134 TH wN 0'5 2'34' 288.00' U I C " f; W o 33' 33' - tv I o I _ c� a+ O t c o Ln -- -MATCH LINE - SEE 1 01' 3 � SHEET N � %D T N O'52'34'E 1 30000' I D I..._ S Z - I 000 N 0 •E 280 00' = r t I 110 F . I - { f V C7� 1 - r-1 I 'E o f—, OD ru d �D Cl.) CD 300 , ' -_, m C? O Iz N I I p 0 n r - ni N 0'52'34'E 23800 00 LA o C, o p i c?_.34_F 1 t el f� o I � •' - „ a� o O r 4 R cu ' N 0 28800 �•� • v� 1 s y :31 I I 1 1 D_ N () 300.00' 1 ru 00 ;° • - ti 10 L S?Z N co D ! 50 ni I t I r 110 i L N "^ 1 0 x O l] v p O Fu IO t —100' WN 0 °52'34'E 288.00' m ON � chfHr 1 Z; W. �?N 0'52'34'E 288.00' ' .-. W, - X Z ` U c- is � _ ,9 L L�