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HomeMy WebLinkAbout038-1120-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Personal information you provice may be used for secondary purposes [Privacy Law, )9.15.04 (1)(m)]. ftilitt dolegryarrie: City ❑ V81or mFffldiFDT oWnS Ip State Plan ID No.: CST BM Elev.; Insp. BM Elev.: BM Description: Parcel TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B nc I My k Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding j Bot. Syst PUMP/ SIPHON INFO ATION Manufacturer man Model Number GP TDH Lift Friction Syst H Ft Forcemain Length Dia. Fi Dist. To We11 SOIL ABSORPTION SYSTE BED/TRENCH Width Len th No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDA WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER model Number: System: OR UNIT DISTRIBUTION SYSTEM Had eer / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Z 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 ins ectl0 # Yes / No In Wl - E� MMENTS' LLu��i1e�o disge�ar�ues 4 n ,I C__ SW 1/4 SE 1/4 29 T31 R1 8W) - 293118497 -Lot 3 ocatlon: $6((fi�n 3 �92n ve., a Ic on , 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision required? ❑ Yes ❑ No T] Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. 93 ,Py3 96 3 9 2 Xie, Sstnitt ur Pe P11 of `� Saf Build Division In accord with 1 1, W e ! 201 W. Washington Ave. See reverse side for instru o or co pplic n PO Box 7302 Deoertment of Cam tree Personal information tfv pro a ay be used for secondary Madison. W1$3707.7302 V acy ; s. ; rt11 n s ; (Submit completed form to county if not w� i state owned, Attach - Complete plans to county co on _ e steg, per not I 8-172 x 11 es in size. emu* C� , t an Pm+nit Number oa rw iota on um v 'Ot Jt 3 `' ".� ?Dt�Mi(30FF+C� , ---- -- I. licatioa nforma"OD - lease Print all Information � � , .^,� Locstio>•; W04"y erne n s ® s74S 7 T ,N, lY [!6 (0 of um 1 � b city, swe Ne.e� Y Phone um r ' or tan o Typ e Of tt (C eek One) ks p" 4 "' a City l or 2 Fdy Dwelling - No. of Ballrooms h. : .*u K— . to Village 3 un biiciCom mr W (describe use) :_ Tawn or D Scat -Owned P( CtA Nearest Rood /- A 3 ' k so C,a IIi of erm t: (Check onl one box on line A. Check box on line B If livable 3 t , A) 1, ew eplacetnent eplacement o 4. _ dition to 3 S Tank only � S ,r um ssue O A 3aai Ferrait wan 'oual issued IV, ype o ck tem: (Che all that apply) — [on � ht-ground D Mound Cl Sand Filter l7 Constructed Wetland 0 At -grade - grOUnd O Holding Tank [� Singte Pass D Drip Line 13 Aerobic Treatment Unit O Recirculating D other: V. Db rsa reatment Area information: 6 1' 0W 4 ' ppl catio erco on j / Required Proposed Rate (Gals lds /sq. ft. (&On. /inch) yam ev�Tn n / T Elevation . Tank spacity in Total # of Manufacturer Prefa Site tee FIber- lastic Information Gallons Gallons Tanks Con- Con- g ;mg Tanks Tanks crate swcted D a U ❑ D D VIII. Respo Ility Statement the undersi ell, assume o - 'bill for installation W O rS shown on the attached inns. f M ure no stamp a 1 9 n o ttass ne o um � / A a ty� p ) D V / 00� , N Ix Couaty/Departm ae Only , t ee tnctudes Group r Approved Pprov Ovvnq Cilven Initial Adverse s arBe 1 'a) no sue su Sent o atompa Deynaination 225, r 200 ( X. Conditions o Approval /lesions for Dbap roval: A(s���.t,�,s �''uk-S+ a S Fv ►Me.H..t Y� s roc SBD -6398 (R. 07 /00) f OT PLAN PROJECT Gary Motto ADDRESS 1860 100th St. New Richmond Wi 54017 SW 1/4 SE 1 /4 S 29 /T 3' R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5 / 10/01 BEDROOM 3 CONVENTIONAL )00( IN -G PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 24 hL BENCHMARK V.R.P. Base of Property Line Marker ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL 'H. R. P Same as Benchmark Vent SYSTEM ELEVATION 98.2 Plans Designed Using > 12„ Sidewinder High Conventional Powts of Cover Capacity Leaching Manual Version 2.0 Chamber 6' Long 16" 3 4" Grade at System Elevation Property Line 03 N B edroom 3 -3' X 50' Cells House 40' B- 25' 10' ` MP 101ST Vents - 40' Vents Rep A 0 , 20' 20' -4 B -5 � Property Line 10 20' * M. 1 0 ' OT PLAN PROJECT Gary Motto ADDRESS 1860 100th St. New Richmond Wi 54017 SW 1/4 SE 1/45 29 IT 3 R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 2269 DATES /10!01 BEDROOM 3 0 CONVENTIONAL XXX IN -G PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 24 IL BENCHMARK V.R.P. Base of Property Line Marker ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 98.2 Plans Designed Using > 12" Sidewinder High Conventional Powts of Cover Capacity Leaching Manual Version 2.0 Chamber 6' Long 16" 3419 Grade at System Elevation Property Line No No o3 N Bedroom 3 -3' X 50' Cells House --B 40' B- 25' 10' MP C9 10' ST Vents 40' Vents Rep A 0' 20' 20' T -4 B -5 Property Line 10, 20' * .M. 1 0' Wis(;onsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.,1K., APPLICANT INFORMATION - Please print all information. R view�edby Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location O Govt, lot 1 /4 /4,S T N,R E (or y Property Owner's Mailing Ad ss Lot # Bock# Subd. Name or Cl tale r Zip Code � Phone 3 ❑City ❑ Villag �� � Town • . _ Nearest.Road New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: �( Code derived daily flow eo pd Recommended design loading rate 7bed, gpd /ft " trench, gpd /f1 loading Absorption area required bed, ft2trench, ft Maximum dlft �•77 g g rate bed, gp trench, gpd /ft Recommended infiltration surface elevation(s) �t � Q 74 9 /• 3 ft (as referred to site plan benchmark) Additional design /site considerations Parent material oAtr_ ,5: Flood plain elevation, if applicable ft S = Suitable for system Conventional Mo nd In -Gro nd Pressure AT -Grade System in Fil Holding T k U = Unsuitable for system S❑ U S❑ U S❑ U S❑ U El ❑ S SOIL DESCRIPTION REPORT_ S �,Znoo Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l 1 4 o l z s WZ Ground O `I2 ) , , k e /I Depth to limiting fa for in. Remarks: Boring # Ground A , v yft. De th to limiting fac Remarks: CST Name (Please Print) Signature Telephone No. Addre Date CST Number 3 ILI 7 1� �S IL DESCRIPTION REPORT PROPERTY OWNER f Page of PARCEL I.D.# Borin g # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground d` ✓ 1�d elev Depth to limiting ' facto �in. n L ' - Remarks: Boring # Ground � ele v v. � Depth to limiting factor An. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 5 :. Lo M 47" Ground 9 e v. Depth to limiting fa or n ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) / I Soil Test Plot Plan Project Name G Motto Byron Bird U/, Address 1860 100th St. New Richmond Wi 54017 STM #3479 Lot ----- -- Subdivision ---------- Date 9 /25/96 SW 1 /4 1/4S T 31 N/R 18 W Township Star Prairie Boring ()Well PL Property Line County ST. C R O IX BM or VRP Assume Elevation 100 ft. B ase of Property Line Marker System Elevation 98. 2/97.3 * H R P Same as B Property Line Pro 3 N Bedroom a, House y c B -2 40' B -1 25 ' Pri A B -3 40' 0' Rep A 0' 20' 20' -4 B -5 Property Line 1 2 0 1 * .M 100' Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes -at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 Shaun Bir #226900 ;' f ST CROIX COUNTY SEPTIC TANK MAI'T9NANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t Y Mailing Address Property Address �3 90Q- (Verifieation required from Planning Department for now construction) City /State Parcel Identification Number LEGAL DESCRIPTION 2° t � � • /�• � � �' Property Location �l� ' /, l Sec. � / - C/ � /Ct �r its p�'h' , �.,._ _,�,, T�N R�1� W, Town of � G Subdivision Lot it —� Certified Survey Map # �__ -�- ///� , Volume �, Page # Warranty Deed # ��r; Volume / Page # . Spec house ❑ yes&no Lot lines identifiab yes ❑ no SYSTEM D 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 ou -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 throe year expirat date. ^ S / I U/ C-1 SI F APPLICANT DATE OWNER CERTIFICATION I we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the perty b above, y e ! ter to of a warranty deed recorded in Register of Deeds Office. � GNA 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 STATE BAR OF WISCONSIN FORM 3 - 1999 6196.96 QUIT CLAIM DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Jennifer D. Motto RECEIVED FOR RECORD 03 -16-2000 8:00 AM QUIT CLAIM DEED Grantor, and Garry D. Motto, Jr. EXEMPT 1 811 CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 Grantee. PAGES; I Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 3 f Certified Survey Map recorded in Volume I I o f Certified Survey Maps on Recording Area e 3203 as Document No. 554710 being a part of the Southwest Quarter of the Name and Return Address �F/ - S outheast Quarter (S - 4 o S -1! ) of Section 29, Township 31 North, Range 18 Timothy J. Scott West, Town of Star Prairie, St. Croix County, Wisconsin. Bakke Norman, S.C. This deed is given pursuant to a divorce decree entered in Circuit Court, St. Croix P.O. Box 50 County, Wisconsin, on January 22, 1998. New Richmond, WI 54017 038- 1120 -20 Parcel Identification Number (PIN) This Is not homestead property. 41) (is not) Together with all appurtenant rights, title and interests. Dated this _ day of March 2000 Jennifer D. Moto `� + i AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jennifer D. Motto STATE OF WISCONSIN ) ) ss. County ) authenCcated this / >L� day of M tie e 2000 Personally came before me this day of the above named + Timothy J. Scott TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to e the person (s) who execute a foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY + Timothy J. Scott Notary Public, State of Wisconsin Bakke Norman, S.C. My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) + Names of persons signing in any capacity must be typed or printed below their signature. information Prof"wooa13 company. Fond ou tac, wi STATE BAR OF WISCONSIN 800 - 2021 QUIT CLAIM DEED FORM No. 3- 1999 i C 1 > 1 554'' 1 O # A 9 � Ica w� � CERTIFIED SURVEY MAP , Located in part of the Southwest Quarter of the Southeast Quarter of Section 29, Township 31 a W o ° P n Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin Prepared for: NOTE: The parcel shown on this map is subject to State, County and Township ?� Gary Motto laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, 1860 100th Street etc.). Before purchasing or developing any parcel, contact the St. Croix County New Richmond, WI 54017 Zoning Office and the appropriate Town Board for advice. OWNER: Ralph Mondor LINE I DIRECTION IDWANCEI DESCRIPTION 1854 100th Street L1 S 8750'0 E 139.73' R.O.W. LOT 3 New Richmond, N 54017"" L2 S BT47'Or E 307.12' R.O.W. LOT 4 Drafted by. Kristi A. Eyiandt L3 S OCrOO'4,T W 438.36' EAST BOUNDARY LINE LOT 3 L4 M= S00'00'43"W M= 19.86' R= NU17'41 "E R= 20.24' NORTH 1/4 CORNER 1 TOP OF IRON PIPE i 2) TOP OF IRON PIPE SECTION 29 -31 -18 SOUTHEAST CORNER LOT 3 SOUTHEAST CORNER LOT 2 (COUNTY MONUMENT- ASSUMED ELEVATION = 100.00' 1 ELEVATION = 120.40' ALUMINUM CAPPED I I BERNTSEN) UNPLATTED LANDS ' I NOR [ IF TH L /NE OF THE SW 1/4 OF THE SE 1/4 192NDAVENUE R =N 89'42'19" W R =N 89'42'19" W 192nd Ave M =S 89'59'3°1" E M -S 89'59'33" E 307 _— I ! d I R. 0. W. :19 48' i i/ L1 �i o� `t/ C �� Ir 3 ...,. ui.� ¢- ! N N C ". A I Zi �i I toi I ^� 0) �� II N 1 . (OM I 3 � cp N N (Y II I I I gj ( � 'd'In � 1 � .. i�ao 3 N� 3r r_ II II ' 00 O I I QI I i 1 I W v I I - M M Co WI pp1 �i�I�I M o M d- �I rO II II I apl � i i Oi ia� �d JII II o0 a - x 1 a N - p , of � imi bb :2' 0 I N 1 g1 J1 U1 r' '1 d ' bb Ni I oo I Q O �, C9 I Ll 1 I � � ' 1 .. ZN Fi 01 II IJI � { °� � Uj n I Z J N I -II t i 0- , II O h I L I �� of o1 00 `� 1 u J >1 fry , 0:2 c51 o f U) f W i >I >I (qZ �` �/ �` �� 00 Z i I I it X M =N8755'23" E_ Z g I- f .. V1 �� j 209.95' o - Ir' °i 0 Ui 51 R= N89'42'19 > in I iv I, R= 400.00' �� i R= N89'42'19 "W 20 `n o` 0 �, -- 257.35' - - - -- M=399.93' - - �.� • 210.00' m - in g; E ° , `-- M -S 89'57'38' E 657.28' -�- ° S 9.79 0 0'2" to o o i Z R= N 89'42' 19' W IL o 3 3 N M � 1 ( ELEV. =91.1 APPROX. EDGE N N to 1� ' ' A�MEAS. 12 -03 -96 : OF WETLAND ' \ A AL w (0 Lu LOT 3 �� b b y y 70TAL AREA: . ..... ... o W W 61,305 SO. FT. W I I 1.41 ACRES WETLAND SETBACK v 0 II W 00 2 p W AREA EXCLUD. R.O.W.: a 14 0 58,556 SQ. FT. LOT 4 o ; Z) , W 1.34 ACRES W O U 0 v 70TAL AREA: AREA £XCLUD. R.O.W.: N Lzi 1,219,418 SO. FT. 1,212,732 SO. FT. Z J c0 W 27.99 ACRES 27.84 ACRES j 4--- > Z SOUTH 114 CORNER FND IRON PIPE LIES I O h Q m X i SECTION 29 -31 -18 S 18'42'46 "E 0.55' ` (COUNTY MONUMENT- FROM COMPUTED POSITION I ' � 1 i 1 , ALUMINUM CAPPED i i 6' SOUTH LINE OF THE x x BERNTSEN) SW 1/4 SE 1/4 i - 1314.32' --x � -- N 89'47 01 W 1314.32 -- -`` - - - - -- M = . N 89'4701" W 2628.64' - - - - -- R S 89'29'27' E r; FENCE LINE County Section Corner Monument UNPLATTED LANDS (TYPICAL) of Record -------- - - - - -- • Set 1" x 24" Iron Pipe weighing BEARINGS Aft�' 0 THE WEST LINE OF THE a minimum of 1.13 pounds per SE 1/4 OF" �l C'f1 �9 1 SHIP 31 N., RANGE 18 W. linear foot. WHICH IS ASSUMED TO BEAR N 00'02'55" E. O Found 1" Iron Pipe AL Denotes Wetland �� ' M = MEASURED AS � C NO TH R = RECORDED AS D ©uGLAS �, �N y ZAHLE JOB #96127 S J1 >T. CR04X COUNTY Prepared by. f't 250 0 250 ' A do E LAND SURVEYING . W1 (� T Phone No. (715) 246 -4319 0 Parks Comm P.O. Box 325 109 East 3rd Street aSURv GRAPHIC SCALE New Richmond WI 54017 Mat C ecOrdett SCALE IN FEET: 1 Inch - 250 feet Sheet 1 of 2 If v;•iihin 30 days,sr' approval data VOL. 11 PAGE 3203 nprvat shall tat'