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Home My WebLink About038-1190-90-000 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)]. 353325 Permit Holder's Name: ❑ City ❑ Village ❑ Tov#n of: State Plan ID No.: Smith, Michael & Donna Star Prairie Townsh CST BM Elev.:- Insp. BM Elev.: BM Description: _ Parcel Tax No.: ( `` � P 038-1190-90-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 2 S n'� Benchmark oq.(O I M.0 f Dosing Alt. BM �O r 2 u 2 I c>Z.2Q f Aeration Bldg. Sewer o$ oo •SI f Holding St /Ht Inlet (Q .5-f C1 i TANK SETBACK INFORMATION St/ Ht Outlet �• c��, �9' Vent to TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet — Septic > Sp r 3U NA Dt Bottom - — ---- Dosing NA Header/ Man. t , - ke S y Aeration NA Dist. Pipe 7. 38 :t.?q Holding Bot. System - PUMP/ SIPHON INFORMATION Final Grade Sx'�c A & Manufacturer Demand St cover 5 .22 c {9•Y � Model Number GPM TDH Lift F n e em TDH Ft .oss Forcemain Length Dia. Dist. Towel SOIL AB TION SYSTEM TRENCH Width Length f No Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 $� oL DIMEN I N SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type OB r V r CHAM go Number: System: OR UNIT DISTRIBUTION SYSTEM r _-�.- Header / Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air I� take Length �Q� Dia- Length Dia. Spacing — O 1 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 COMMENTS: (Include code discre p�ancie�, ersons s c_�T ns ec ion : nspec ion Location: 1333 214th Avenue, New Ric9mond, � 4 � (N� 1/4 SW 1/4 13 T3 IN R1 8W) - 13.31.18.980 Northgate -Lo 31 -sit 1.) Alt BM Description = VW°°'"` 2.) Bldg sewer length= '3 -o , , r - amount of cover = y i8 �•r. 3 ✓ 1 / 1�1 o wit ��4 h a''� AAE - Plan revision required? ❑ Yes A No Use other side for additional information. �o SBD 6710 (R.3/97) Date Inspector's Signature Cert. No. a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € f i F F £ F f k ° F . f m _ 6 , £ � f € $. .a.e ----- _.......a...... ...,..�.» .3 ...... ....... <..,...P, s,_. ... ----d. ___4. »,.m�.. �.e.a ,.- ,..... -s,.. _...�... _.. .._ i._.._.'r,. ._- .LW_____s. ..... ». i 3 i t g k s s a 6 s f t 5 1 ! } j F J S i c f i i a ¥ .. <.E m, . .. € ..< . < <w � I s t € ..., w. m...m.<,. , E I III ., 4 ... - s .�..., y .F .....1.a.. 3 ,,,,k ............... ., i [ i .. i .: ._. P �.r ..e.. �,. .. � ...tea ...m,_.,. .,. _., �. f .... _..., ., _,�,. e ..... —;� , ....... <�.. `• ,w.�� I ' } t q £ g j . ry < E ff -2 Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue 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 k than 81/2 x 11 inches in size. � • See reverse side for instructions for completing this application State sanitary Permit Number 35 3PS Personal information you provide may be used for secondary purposes p Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan Review Transaction Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMA �"'/✓�- Pro ert wrier me Pro ert Lo ation p , G �� t/4 o 1/4, S/ j T , N, R �(o Property Owner's Mailing Address Lot Num er Block Number -- 7 /rte Ci ate / Zip Code Phone Nu er Subdivision Name or CS mbe I. F BUILDING' (check one) El State Owned ❑ !% ge —/ 1. rk f/% � t Nearest Road ❑ ` o a Public 1 or 2 Family Dwelling- No. of bedrooms own of 54 III BUILDING USE (If building type is public, check all that apply) P rcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recrea ional 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 USeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 1 ❑ Seepage Pit e } 43 [] Vault Privy 14 ❑ System -In -Fill ac etc f h � r "'r 7 / VI. ABSORPTION SYSTEM INF RMAT N: -� 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/d /s . ft ) (Min. /in h) �01 Elevation Feet �,sS Feet C a acit VII. INFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. New Existing Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank 1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum s Name: (Pri Plum ignature: (No s) MP /MPRSW No.: Business Number: Plu er's Address (Street, City, State, Zip Code): _ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date I ssued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 3'3"2 ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: . SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary p ermit is valid for two 2 YP (2 y ears. 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. IL 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 must include the following: A) plotpta:n, 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 115 form; andfl all sizing information. -- - - - - - - - - -- - - --- - - - -- - --- -- -- - -- --- -- - --- -- - - --- - - --- - - -- - - - --- - - - --- - - - - - - - -- --- ----- - -- - - - ---- - --- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharge's (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. PLOT PLAN PROJECT 4 >,weJ ADDRESS 1/ 4 S /� N/R W TOWN � COUNTYp/ MPRS Byron Bird Jr. 220527 DATE BEDROOM_ CONVENTIONAL >00( IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE �� LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD R AREA # of chambers IL BENCHMARK V.R.P. p�n -ncl�( ASSUME ELEVATION 1Q0', /M * ❑ BOREHOLE O WELL *H. R. P. Vent ✓ %mac° SYSTEM ELEVATION ATION >12" Sidewinder High of Cover Capacity Leaching C hamber with 31.8 ft ^2 per chamber 6' Long 16" 34" Grade at System Elevation OWL ~� 9�- R j 'l �i Ir r�s b VN 9 a r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Diyirion 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. Crnix 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 RPIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 N,R 18 $(or)W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 1416 Third St. 31 na I NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MEOWN AREST ROAD Hudson. WI. 54016 ( ) r 214th Ave. [ 31 New Construction Use .1c J Residential / Number of bedrooms 4 [ J Addition to existing building [ J Replacement [ I Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 gpd /ft _ trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft •8 trench, gpd/ft Recommended infiltration surface elevation(s) 95.55 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem g7 S ❑ U [3s ❑ U C$S ❑ U ®S ❑ U MS OU ❑ S nu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed JTW& 1 >>' 1 0 -8 10 r 3/3 none 1 2msbk mfr 4W if .51 .6 2 8 -24 10 r 4/4 none sici 2msbk mfr Qv if .4 .5 Ground 3 24 -84 7.5 r 4/6 none ms 0SQ ml na na .7 .8 98 1e55 ft. Depth to limiting factor +84 Remarks: Boring # 1 0-11 10yr 3/3 none I 2msbk mfr QW if .5i .6 .........:::: 2 11 -28 10 r 4 4 none sici 2msbk mfr QW if .4 .5 .................. Ground 3 28 -84 7.5 r 4/6 none ms os L mi na , .7 .8 99 ft. Depth to limiting factor +84 T . RU u Remarks: 'A, ZONINGOFFICE CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 v Address: 1554 200th. New Richmond ,X1 54017 Signature: Date: 11 -2 -98 CST Number: m02298 l , PROPERTYOWNER Greenwood Enter r; g S SOIL DESCRIPTION REPORT Page 2 ofd PARCEL I.D. # 038 1055 - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 8our>dary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. ...3. 1 0 -10 10 r 3 3 none 1 2msbk mfr w if .5 .6 2 10 -28 10 r 4 4 none sicl 2msbk mfr gw if .4 .5 Ground 3 28 -84 7.5 r 4/6 none ms os mi na na .7 .8 elev. i 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -11 10 r 3/3 none 1 2msbk mfr gw if .5 .6 11 -29 10 r 4/4 none sici 2msbk mfr gw if .4' .5 Ground 3 29 7.5 r 4/6 none ms osg ml na na .7 .8 elev. Depth to - limiting �� 6 factor +84 Remarks: Boring # 1 0 -14 10 r 3/3 none 1 2msbk mfr gw if .5 .6 5 >< 2 14 -30 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 30_84 7.5 r 4/6 none ms osg ml na na .7' .8 elev. 9 8.95 ft. Depth to limiting B� factor +84" Remarks: Boring # MEMO Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) M STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NE4SW4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #31- 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 p ipe @ el. 100 Alt. BM.= top of 1 pvc pipe @ el. 99.15 d 1 t° Gl Gary L. Steel 11 -2 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r OwnerBuyer Z/�/I/ Mailing Address Property Address 4� z'". 14 (Verification required from Planning Department for new construction) City /State 0.r�✓ Identification Number LEGAL DESCRIPTION Property Location '/4, �J ' /., Sec. TN -R_W, Town of ir/ Subdivision , Lot #�. Certified Survey Map # , Volume — . Page # Warranty Deed # Volume Page # 3 Spec house ❑ yes'0190 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has en maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of th year expiratio e. SI A M OF APP ANT DATE OWNER CERTIFICATION I (we) certify that all ements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of thA descri d abo y virtu arranty deed recorded in Register of Deeds Office. OF PLIC 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 on 61 9 1 90 STATE BAR OF WISCONSIN FORM 1- 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DFFT)�) Document Number ( co", WT This Deed, made between Greenwood Enterprises , Inc. a Wisconsin RFEP!VFD FOR RECORD corporation, Grantor, and Michael A. Smith and Donna I Smith. husban A i A:00 AM and wife as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following WARRANTY DF7P described real estate in St. Croix County, State of Wisconsin (The "Property"): F Y F r P T 0 EFRT COP'T F- r TRAN'IFFF FEE: 19.70 RECORDING FEE: 10.00 PP'C'Es: I Recording Area -- Name and RetliftIPAMM" 0... Edina Realty Title r\ 400 South 2nd Street Suite #115 Wdson, WI 54016 038-1190-90 Parcel Identification Number (PIN) This is not homestead property. (is not) - Lot 31 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 yj2day of 2000. GRE OOD ENT ERP ES C. By: 7- *James E. Rusch, its president *i4 fry — R secre AUTHENTICATION ACKNOWLEDGMENT Signature(s) James E. Rusch, its president STATE OF WISCONSIN ) ) ss. St. Croix County came before me this Pe;sonafl day of ;nti authe this ;t5' of kj 2000 y re 2000 the above named Mary R. Rusch, its n�ti lhis,��' day secretary to me known to be the person (s) who executed the a going instrument and acknowledge the same. Lois A. Murray REBECCA J. PHANEUF TITLE: MEMBER STATE BAR OF SCONMTARY PUBLIC (If not, STATE OF WISCONSIN authorized by § 706.06, Wi?�§ Notary Public, State of Wisconsi 'sco THIS INSTRUMENT WAS DRAFTED BY My Comml*ss*on is permanent. t. state expiration date: f not, a, Lois A. Murray, Zilz, Estreen & Ogland, LLP 304 Locust Street, Hudson, W154016 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I - 1996 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-656-2021 _ •.e t i , -' �e i �!+'Y � 4�'�.'?"�y'�,t t'}i �9:. P ��' „ ^' �`�, .' IS �� `' ' °� �}° i - ti :r; y .I F* I I qr 4 � 1 � ; Ur � � •1. {� I� 'i`'' z k. '� - "t'• �1 w � 'x I t,'• � � � r � � .3 p 'd � � I N r �! v i�.. 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