HomeMy WebLinkAbout030-2108-60-000 f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
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)]. 353246
Permit Holder's Name: ❑ City ❑ Village ❑7jown of: State Plan ID No.:
Erickson Brian I Town of St. Joseph
CST BM Elev -:- Insp- BM Elev.: SM Description: rcel Tax No -:
v / 00 Z r
,, 030- 2108 -60 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark P p lG 0
Dosing Alt. BM L l 5 % f Z
Bldg. Sewer
Holding S Ht Inlet
TANK SETBACK INFORMATION St Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic / A _ 5__' NA Dt Bottom
Dosing y G, U' NA Header/ Man. �U
Ae
A Dist. Pipe y Z d
Hold' 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 / 79EN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEkstous> 3 3 � Z- DIMENSION
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufactur r:
INFORMATION Type O F fi _ , l C BER Mddel Number:
System: ,] - z Z _ dy lV a , �4, j
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- Length Dia. Spacing Nr�
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/Tr nch Center Bed / Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: /Z / / Mnspection #2:
Location: 1186 64th Street, New Richmond, WI (NE1/4, NW1 /4, Section 3 T29N -R19W) - 3.29.19.900
1.) Alt BM Description= �, �a`; S �� no we(( a1r 4
2.) Bldg sewer length=
- amount of cover = >0
�� ai✓( � a � ""'!° C�1�.6� ,- �, t u� 1� - (nor w�� %a
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
XI
I�
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
N*s SANITARY PERMIT f 1 '#.kATTIOI ` 201 W. Washington Avenue
�� P O Box 7302
Department of Commerce In accord with Comm 8 . \ Adn od, Madison, WI 53707 -7302
Vi
• Attach complete plans (to the county copy only) for the stun, orr not less ':Ci5u ty f
than 8 112 x 11 inches in size. ' < n 5 � -
• See reverse side for instructions for completing this appli,t:ation V.," . X $ Sanitary Permit Nu �� m �P / er
AM
Personal information you provide may be used for secondary purposes ; ^ ca�,G� , ' heck it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. r •�11
<„ _ ,"\ ate Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL IN A 1 )
Prop Owner Name a Cation
OE 1/4 (,l,(1/4, S T N, R
Property Owner's Mailing Address Lot Number ^ Block Number
U
City, ate r Zip Code Phone Number Subdivision Nam or CSM N m4er
R.t.e/' (� )
II. T YPE OF BUILDING: (c eck one) ❑ State Owned ❑ It Nearest Road (A
Y (
Village
Public 1 or 2 Family Dwelling - No_ of bedrooms own OF 6 _ �p L=- -57 - . .
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Num bq s) 3. 24.111,`1
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor ecr ational 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 _t 2. ❑ Replacement 3. E] Replacement of 4_ E) Reconnection of 5 E] Repair of an
______ Sem ________ System _____________ Tank Only______________ Existing System ---------
Existing
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 c > 2 1 E] Mound 30 ❑ Specify Type 41 E] Holding Tank
12XSeepage Trench s 2 ❑ In- Ground Pressure 2 ❑ Pit Privy
13 ❑ Seepage Pit "�� 43 V ult Privy
14 ❑ System -In -Fill �1( /p� = a yX 31, a = 7(�
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
�� Req (sq. ft.) Proposed (sq. ft.) (Galsfda lsq. ft.) (Min. /inch) Elevation
o o J 3 Feet Feet
Capacity VII TANK in g Total # of Prefab. site Fiber- Exper.
INFORMATION Manufacturer's Name Con Steel Plastic
New Existing Tanks concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank Q(, ❑ I ❑ ❑ 1 ❑ ❑
Lift Pump Tank /Siphon Chamberl I I ❑ 1 ❑ 1 ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum en's ame: (Print) 2 7/f / � / f.4 Plumb Signatur : (No t P MPRSW No.: Business Phone Number:
J
Plumb Address (Street, City, St at Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY 7
❑ Disapproved S nary Permit Fee OnclucFe Groundwater Date Issued Issuing Agent Signa ure (No Stamps)
to Approved []Owner Given Initial Surcharge Fee)
Adverse Determination I It 9 1 4A�,
X�CONDITIONS OF. APR AL / RE S011LS FOR�IS PR VAIL: - C.d J
t
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
7.
INSTRUCTIONS
1. A sanitary p ermit is valid for two 2
YP (2 y ears.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
1 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 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, W8. 266-3151.
To be complete and accurate this sanitary permit application must include:
C- j
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
systefiis 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 Coun3..y/ Department Use Only.
X. County / 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 folrowing' 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.
----------------------------------------------------------------------------------------------------
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.
Steve Henning
NSkNVA S3- T29N -R19W
town of et. Joseph
4 lot #10 -Buck HIll
Ni l
1 "=40'
BM.= top of 2" pvc pipe @ el. 100'
Alt. E1I.= top of 2 pvc pipe 0 el. 99.90'
This soil evaluation was conducted to satisy a zoning
requirement, it may may not be suitable for your use.
The location of this test may or may not be as shown as
permanent lot lines had not been established at the
time of this test.
X10 �' +
J �f
F7
I
s
Wisconsia„Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
0 COUNTY
Attach complete site plan on paper not less than 8 112 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. 030 - 1008 -95 -000
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION WE BY ATE
PROPERTY OWNER: PROPERTY LOCATION
Steve Henninq GOVT. LOT NE 1i4 NW 1/4,S 3 T 29 N,R 19 fc(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # TBLOCK # SUBD. NAME OR CSM #
1182 61st. sT. 10 na Buck Hill
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ MOWN NEAREST ROAD
Hudson, WI. 54016 ( 715 549 -6094
[x] New Construction Use tK ] Residential i 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 /ft - 8 trench, gpd /ft
Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft •8 trench, gpd 1ft
Recommended infiltration surface elevation(s) 95.35 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 I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem [OS El U WS ❑ U [OS ❑ U us ❑ U Q S ❑ U ❑ S U U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -10 10 r3/3 none sil 2c 1 mfr cs 2f n .2
L 1`:::`: 2 10 -38 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
Ground 3 38 -43 10yr4 /4 none sl lcsbk mfr gW na .4 .5
elev.
9 4 43 -84 7.5yr4/6 none co s Osg mvfr na na .7 .8
Depth to
limiting
factor
=84"
Remarks:
Boring #
1 0 -14 10yr3 /3 none sil 2cpl mfr cs 2f np .2
2 ^,€ 2 14 -36 l 0yr4 /4 none sit lcsbk mf i gw 1f .2 .3
-. 3 36 -45 10yr4 /4 none sl lcsbk mfr r, .4 .5
Ground
elev. 4 45 -90 7.5yr4/6 none co s Osg na 4. na -8
9 , t
d
4,
Depth to f,
limiting
( I I! P P 1 1- j
9
factor W ,
+90
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. New Richmond WI 54017
Signature: Date: 7 -14 -98 CST Number: m02298
I
PROPERTY OWNER Steve Henning SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 030 - 1008 -95 -000
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -17 10yr3 /3 none sil 2cpl mfr gw 2f np .2
2 17 -40 10yr4 /4 none sil l csbk mfr gw if .2 .3
Ground 3 140-84 7.5yr4/4 none co s Osg mvfr na na .7 .8
elev.
9
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -9 10yr3 /3 none sil 2cpl mfr gw 2f np 1 .2
t 4 2 9 -31 10yr4 /4 none sicl lcsbk mfr gw if .2 .3
3 31 -37 10yr4 /4 none sl lcsbk mfr gw if .4 .5
Ground
elev. 4 37 -84 7.5yr4/6 none co s Osg ml na na .7 .8
9
Depth to
limiting
factor
+84
Remarks:
Boring #
1 0 -12 10yr3 /3 none sil 2msbk mfr gw lvf .5 .6
5 2 12 -24 10yr4 /4 none sit lcsbk mfr gw lvf .2 .3
3 24 -33 10yr4 /4 none sl lcsbk mfr gw lvf .4 .5
..................
Ground
elev. 4 33 -84 7.5yr4/4 none ms Osg mvfr na na .7 .8
99 ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
i
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Steve Henning New Richmond, WI 54017
MPRSW - 3254 NE4NW4 S3- T29N -R19w (715) 246 -6200
town of st. Joseph
�} lot #10 -Buck HIll
N
1 =40'
BM.= top of 2 pvc pipe C el. 100'
Alt. BM.= top of 2 pvc pipe @ el. 99.90'
This soil evaluation was conducted to satisy a zoning
requirement, it may may not be suitable for your use.
The location of this test may or may not be as shown as
permanent lot lines had not been established at the
time of this test.
6,4
y 3�
1 07 0
10' afro P,
3 3 7
A G L. Ste 1
7 -14 -98
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer '& t VAyu
Mailing Address Raq /—
Property Address
(Verification required from Planning Department for new construction) /K C—
City/State Parcel Identification Number '0 — 6
LEGAL DESCRIPTION
Property Location .� %a, _" 1 /4, Sec. 3 T__Z Rf�E_W, Town of
Subdivision !R i E L . Lot # 1l�
Certified Survey Map # —14 , Volume . , Page #
Warranty Deed # 17 055 . Volume 17 7l , Page # e � 3
Spec house ❑ yes K no Lot lines identiflable tXyes ❑ 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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
/ / Q
GNATURE 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 p 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. * * * * **
** i of Deeds office
Include with this application: a stamped warranty deed from the Register
a copy of the certified survey map if reference is made in the warranty deed
I
ti,..1471PAGE603 ID
STATE BAR OF WISCONSIN FORM 2 - 1998 Cs 14th 55
WARRANTY DEED KATHLEEN H. WALSH
D Number F;EGISTER OF DEEDS
ST. CROIX CC -, WI
RECEIVED FOR RECORD
This Deed, made between Steven W. ennin and Norma J Henning. 11 - 18 - 1999 10:00 AN
husbpad and wife YARRANTY DEED
Grantor, conveys and warrants to EXEMPT M
CERT COPY FEE:
Brian D Erickson and Vir inia A Erickson husband and wife COPY FEE:
TRANSFER FEE: 146.70
RECORDIN6 FEE: 19.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and w to Grantee the
following described real estate in _ St County, State of Wisconsin (The Recordin Area
"Property"): Name and Return Address
EAGLE VALLEY BANK, N.A.
1301 Coulee Rd., Unit 2
Hudson, Wl 54016
030 - 2108 -60
Parcel Identiftcation Number (PIN)
This is not homestead property.
Lot 10, Plat of Buck Hill in the Town of St. Joseph, St. Croix County, Wisconsin.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
Dated This /Co day of November, 1999.
i
Steven W Henni g
w
+ Norma J. He i g
AUTHENTICATION ACKNOW L
S STATE OF WISCONSIN )
) SS.
County )
authenticated this _ day of
Personally came before me this � �° Y
• of November, 1999, the above named Steven W. Henning
and Irma J. Henning husband and wife
TITLE: MEMBER STATE BAR OF WISCONSIN — to me known to
(If not, be the person(s) who executed the foregoing instrument and
authorized by § 706.06, Wis. Stats.) acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY f):
Attorney Kristina Ogland • r r e n E i /1 h
Hudson, WI 54016 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
tttcessaryJ 3 ! � a(.XJ I . J J
'Names of persons signing in any capacity should be typed or printed below their signatures
W DAD STATE BAR OF
WISCONMN
FUIU4 No. f • 19fa
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 8DD- 555.2021
O
O� 3.021 ACRES ,
LO
131 SQ. FT. i
Sp.
i
0, 0i
O S86'19'26 "E 498.51'
Z Z
O W w
s = ,
0 co 0 LL.
R= 80'
cG
W �\
Z /�.
Co = 3.012 ACRES
o ,� 131,188 SQ. FT. 6��
o
Z Z �� 10 o.
J J �IK
~ ~
N N
Q
W
S89 "E 212.42' 3.200 A
-� t.P.. 139
9
t AGE DE7ENSION
H.W.L.= 922.0
ft
/ o.
o
` 0 3.454 ACRES o
^
4.200 ACRES 150,437 SQ. FT.
�'
182,973 SQ. FT.
0
0
0
L
• 14.5' +/— '
346.05 447.11
SOUTH LINE OF THE NE1 /4 OF THE NW1 /4
-D LANDS