HomeMy WebLinkAbout030-2108-30-000 (2) ST. CROIX COUNTY ZONING DEPARTME •,';. `
AS BUILT SANITARY REPORT � � Rt -�
Owner �±, , 1
Property Address // 1 / �0 5' ---- r5'T_ t,, ST c o x s99
City /State
� . �OFFOCe
Legal escription:
Lot Block Subdivision/CSM it
t /4 ju,�A( t /4, Sec. _a_, T21N -Ry2W, Town of _sr. PIN # Q3 a/0 O
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer ;'• • �` Size ST/PC A&Y _ Setback from: House Well P/L+
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM: �>
Type of system: Width 3 1 Length Number of Trenches
Setback from: House 3 ,5 - Well -' P/L t2o !vent to fresh air intake ;
ELEVATIONS
Description of benchmark o? �- Elevation
Description of alternate benchmark Elevation /aS"
Building Sewer / d `� S Y ST/HT Inlet . l ST Outlet 04 `/ PC Inlet
PC Bottom Header/Manifold . g a Top of ST/PC Manhole Cover 16D, 2
Distribution Lines () �/r 2
Bottom of System () 1 g < 3y
Final Grade () / D �/ () l0 -�,, y ( )
Date of installation L/—//—/fJPermit number 3 Sg 77State plan number
Plumber's signature License number X1 ?Date S"l�Il
Inspector `
Complete plot plan �
r
NOTICE Please provide the following:
i
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATE NORTH ARROW
Wiscongin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: X
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338877
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
BEARL,- RON ST. JOSEPH
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
i; ' ;, , t - 030 - 2108 -30 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
§7p C h/t'A..�tp 1'f Qc�. t I Z of Ben�hfn�
Dosing
Aeration Bldg. Sewer
Holding - --' " St /Ht Inlet
TANK SETBACK INFORMATION e t , �.�, , r St/ Ht Outlet �5 CC, c, .
TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet
NA Dt Bottom 1
Dosing __NA Header/ Man.
Aeratio NA Dist. Pipe
Holding - -- Bot. System p >J0
PUMP/ SIPHON INFORMATION Final Grade .0 o,) p�./
Manufacturer emand t �,, I, ,� 1� 775 / Oa d �
Model Number GPM
TDH Lift Friction S TDH Ft
Forcemain Length Dia. I Dist. To well
SOIL ABSQRPTION SYSTEM
BED / tl[REN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN I N 7 S Z. DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
SETBACK lvr
INFORMATION Type Of CHAMBER Model Number:
Systemcc>ko, y ki OR UNIT (�, �� ,
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. `) Length -' � s+a. Spacing �" 7 1 2 C�Inu �. -F(po
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Ov r -- -" xx epf 0 �' —
7 --- xx ee e / o ed xx Mu c e
Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes E] No ❑Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH 3.29.19.897,NE,NW 1191 64TH ST - BUCK HILL LOT 7
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Plan revision required? E] Yes o
Use other side for additional information. `� 7
SBD -6710 (R.3/97) Date Inspector's ignature C Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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SANITARY PERMIT APPLICATION Safety and Buildings Division
. 201 W. Washington Avenue
N - Mi s i cons i n I P O Box 7302
Department of Commerce I n accord with ILHR 83.05, Wis. Adm. Code
p Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
5 C
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal Personal information you provide may be used for secondary purposes ❑Check if revision to 8--77 previou application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORM TION - PLEASE PRINT ALL INFORMATION
Prop" Owner Name Property Location
;�_ �/ 1/4 �t/e c (1i4, S T , N, R )((or
Propert Owner's Mailing Address Lot Number Block Number
7 72 T',;,�� CA-17 7
City, Stat Zip Code Phone Number Subdiu4sion Najne or CSM m r
(7i > I
II. YPE OF 6 ILDING: (check one) ❑ State Owned o it Nearest Road Co Y
P .
Ula
Lj
Public 1 or 2 Family Dwelling - No. of bedrooms ow
of 5 r
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 19 , !9q-7
1 ❑ Apartment/ Condo 0 3& —
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 &' 2_ ❑ Replacement 3 [:] Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an
ystem 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 ja Seepage Trench 22 ❑ In- Ground Pressure 1 r ► 42 ❑ Pit Privy
i 3 E] Seepage Pit 43 ❑ Vault Privy
4 ❑ System-In-Fill ,;,,, ` 7 3l a 76
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Re9u d sq. ft.) Proposed (sq. ft) (Gals/day/ . ft.) (Min. /inch) o // Elevation
00 / f 01 � �8,60eet Feet
Capacit
VII. TANK in Ca gallo Total # of Site
INFORMATION Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App -
New Existing strutted
Tanks Tanks
an Sd O /d s0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber I 1 ❑ ❑ ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum Sig urea ( o M MPRSW No.: Business Phone Number:
s
Plum Wddress (Sir ity, State Zip
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwate4
te ssue Issuing Writ Signature (No Stamps)
Approved ❑ Owner Given Initial C old Surcharge Fee) Adve rse Determination � v //D
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL.
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS -
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to 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.
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) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
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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.
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Wisoons;n Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Jl,.aboeamrHuman Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
St. Croix
o EL I.D. #
not limited to vertical and horizontal reference point (BM), direction and /o of slope, scale or PARCEL
dimensioned, north arrow, and location and distance to nearest road. 030 - 1008 -95 -000
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION Z %DBY DATE
'? `
PROPERTY OWNER: PROPERTY LOCATION
S teve Hennin GOVT. LOT NE 114 NW 1/4,S 3 T 29 N,R 19 bdor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
1182 61st. St. 7 na Buck Hill
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OTOWN NEAREST ROAD
Hudson, WI. 54016 ( 715 549 -6094
i ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft
Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate ____L bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) 98.60 ft (as referred to site plan benchmark)
Additional design / site considerations trenches spaced to code 3.50 below surface
Parent material outwash Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U G 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
.................
..................
.................
..................
1 0 -8 10yr3/3 none sil 2c l' mfr cs 2f n .2
2 8 -26 10yr4 /4 none sil lcsbk mfi gw if .2 .3
Ground 3 26 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8
elev.
10 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -9 10yr4 /3 none sil 2cp1 mfr cs 2f np .2
2 ' €. 2 9 -32 10yr4/4 none sil lcsbk mfi gw if .2 .3
3 32 -84 7.5yr4/6 none ms Osg mvfr na .7 .8
Ground
elev.
f
10 ft. AF
Depth to
limiting
factor I�/
+8 A .,1 j %-
Remarks: _
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 / C r
Address: 1554 200t e. New Rich and WI 54017
Signature: Date: 7 - - CST Number: m02298
i PROPERTY OWNER Steve Henning SOIL DESCRIPTION REPORT Page? :of 3
PARCEL I.D. # _30- 1008 -95 -000
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -10 10 r4 3 none sil 2c P1 mfr qw 2f n .2
:4:.......:. 2 10 -23 10yr4 /4 none sl 2mgr mfr gw if .5 .6
Ground 3 23 -84 7.5yr4/4 none co s Osg mvfr na na .7 .8
elev.
Depth to
limiting
factor
+84"
2V • .`
Remarks:
Boring #
1 0 -8 10yr4 /3 none sil 2msbk mfr gw 2f .5 .6
2 8 -24 10yr4 /4 none sil lmsbk mfi gw if .2 .3
3 24 -36 7.5yr4/6 none is Osg mfr gw if .7: .8
Ground
elev. 4 36 -80 7.5yr4/4 none ms Osg mvfr na na .7 .8
Depth to
limiting
factor
+ "
Remarks:
Boring #
1 0 -12 10yr4 /3 none sl 2mgr mfr cs 2f .5 .6
2 12 -24 10yr4 /4 none is Osg mfr gw if .V .8
.................
3 24 -80 7.5yr4/4 none ms Osg mvfr na na .7 .8
Ground
elev.
1 00-1 ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Steve Henning New Richmond, WI 54017
W- 2 4 _ _ 715 246 -6200
MPRS 3 5 NE NW S3 T29N R19W
4 4
town of St. Joseph
lot #7 -Buck Hill
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location or the test may or may not be as shown
as permanent lot lines has not bee established at the time of testing.
I
N
1 =40'
Bm.= top of 2 pvc pipe C el. 100
Alt. BM.= top of 2 pvc pipe el. 100.30'
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GAry L. Steel
7 -14 -98
li
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ L
Mailing Address
Property Address
(Verification requited from Planning Department for new construction) /Z,c
City/State �� r Parcel Identification Number
LEGAL DESCRIPTION 030 - R 1 0 - 3 0 '
•
Property Location Nto '/4, A& /,, Sec, 3 , T2d - M - � — W, Town of _S f
Subdivision ./� ;/, (, Lot # _-__�_.
Certified Survey Map # Volume . Page #
Warranty.Deed # Volume Page #.
Spec house ❑ yes no Lot lines identiflabley, yes ❑ no
SYSTEM M_AiN'rFNANCE
Improper use and maintenauceof your septic system could result in its prematurehilure 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 agiees 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 thgt your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a three a expiration date.
SIGNATURE PLICANT L —f=L_/ 9
DATE
OHNER CERTFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the grope desc ' ve, by virtue of a warranty deed recorded in Register of Deeds Office.
GNA F PPLICANT
DATE
* * * * ** Any information that is mis- represented may suit in the sanitary permit being revoked b the Zoni D
y g *• *s *•
-*.* Include with this application a stamped ped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
qq _ � v
�i:,_ VJ� �1PAGE `x:85
601976
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
ocument Number WARRANTY DFFD ST. CROIX CO., WI
5 &1 This Deed, made between Steven W. Henning and Norma J. RECEIVED FOR RECORD
Hennina, husband and wife, 04 -26 -1999 10:00 AM
Grantor, and Ronald R. Bearl and Kathy J.
Bearl, husband and wife, WARRANTY DEED
EXEMPT #
Grantee. CERT COPY FEE:
Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE:
the following described real estate in St. Croix County, State of Wisconsin (The TRANSFER FEE: 131.70
RECORDING FEE: 10.00
"Property "): PAGES: 1
Recording Area
LA I.a J. ES T, - Ar't.: N
304 LOCUST I ,
r 0 U. WI 15 r11 S
030 - 2108 -30
Parcel Identification Number (PIN)
This is not homestead property.
Lot 7, Plat of Buck Hill in the Town of St. Joseph, St. Croix County, Wisconsin.
1
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
Dated this � - l day of April, 1999.
* * teven W. Henning
* * Norma J. He g
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
authenticated this _ day of U h County )
Personally came before me this 8 ' day of
* April, 1999,_ the above named Steven W. Henning and Norma
J. Henning husband and wife,
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who
(If not, executed the foregoing_ instrument and acknowledge the same.
authorized by § 706.06, Wis. Stats.) 1 nj
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland V Notary Public, State of Wisconsin
Hudson WI 54016 My Commi sion is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not W I , *4ARL)ENE K. LINN c '
necessary.) Notary Public -SM13 of WiSCOnSh
sons signing in any capacity should be typed or printed below their signatures
t6ANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 -1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800. 655.2021
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