HomeMy WebLinkAbout038-1055-60-100 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPOR
Owner
Property Address
City /State `
Leg. sc>t iption: ^�G 0
Lot Bloc Subdivision/CSM # zfl e
-SW t /a S �J 1 /a, Sec. /,LN -RW, Town of 5 r �- : PIY G O �Il�
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer l.) LaA Q^- Size ST/PC Setback from: House _,L!� Well
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road ent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPT ON SYSTEM
c
Type of system: �� o`Vidth 3 Length S14 Number of Trenches °V
Setback from: House -10 Well -7— P/L La , Vent to fresh air intake g `
ELEVATIONS
Description of benchmark I AA -- Elevation l4y
Description of alternate benchmark S c.J Od h Elevation
Building Sewer 1, �� ST/HT Inlet _ ! �� �� ST Outlet PC Inlet
PC Bottom Header/Manifold 9G' Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System (t) 9 S,, 1-5 (�) 95 • ice' ( )
Final Grade (�) q cti 7
Date of installation /"I Per number State plan number
Plumber's signature License numbe� 0 $ 3 7 Date 14 1 a � p p
Inspector
Complete plot plan �
a
NOTICE Please provide the following:
• 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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AL
INDICATE NORTH ARROW
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
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)]. 353182
Permit Holder's Name: ❑ City ❑ Village EjTown of: State Plan ID No.:
Town of Star Prairie
v. Insp. BM Elev.: BM Description: Parcel Tax No.:
038 - 1055 -60 -100
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic SP✓ jUv a Benchmark V y uG /OG
D Alt. BM Z, P3 2 3
Aeratio Bldg. Sewer c/
Holding St Ht Inlet Z
TANK SETBACK INFORMATION 4 D Ht Outlet Z
TANKTO P/L WELL BLDG. Ventto ROAD
Air Intake
Septic �' N� ► Z i NA
NA Header/ Man. `
' s qy. Y9
Aerati NA Dist. Pipe R7'L S
'f r. Z/
Holding Bot. System r� ,P P 6 Z
PUMP/ SIPHON INFORMATION Final Grade 9 ,
Ma rer Demand St cover
Model Number M
TDH Lift Friction Sys TDH F
L oss
Fo main Length Dia. ti Dist. To well
SOIL ABSORPTION SYSTEM 1, - ,,4
BED TRENC width / Lenath No. Qf Trenches PIT No. Of Pits Inside Dia. Liquid Depth
D
C� I DIMENSION
SYSTEM TO P / L I BLDG WELL LAKE/STREAM LE ACHWG Manu act rer:
SETBACK CHAMBE ,
INFORMATION Type Of Moe umber:
System: C 4 4 3 IlJ [iQ �– O
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length /l�• r Dia- / Length 2 - 1 Dia. _AL6 Spacing / AJ /�`✓ 4f
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 #1:1 Z/z / ff inspection #2: J /
\ Location: 1310 210th Avenue, New Richmond, WI (SW1 /4, SWIA, Section 13 T31N - R18W) - 13.31.18.238E
(} w � Q
Plan revision required? [:]Yes ❑ No
Use other side for additional information. f V 4 , V6
SBD -6710 (R.3/97) Dat6 pector's S ature Cert. No.
Safety and Buildings Division
Visconsin SANITARY PERMIT APPLICATION 201 B Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on pa _8 jlIRS! 4 t
than 8 112 x 11 inches in size. �� l
• See reverse side for instructions for completing this application 1\ StateSfni ry Permit Numb
Personal information you provide may be used for secondary purposes / / / fi t ❑ Check it rev 1 to previous application
(Privacy Law, s. 15.04 (1) (m)]. f •J? /D o Z� Q 7 -� ,f�/1 f ; 1 A&a1a Plan I.D- Number
/ ✓"
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF Abu
Propert y wner Name I Propert
. 117%man & LA III !9.,.0 . t /4. 3 N, R E-(er NM
Property Owner's Mailing Address L V ~ow ti Block Number
City, Stat Zip Code Phone Number Subdivi a e' r umber Moo� ! ( ) f? s C� IoO u c) I (o
II. TYP BUILDING: (check one) ❑ State Owned !t Ne res Road
rl Public 1 or 2 Family Dwelling - No. of bedrooms _ % Tow OFS ` �)b .1 A u IAL
III BUILDING SE: (If building type is public, check all that apply)Q��, f� arcel Tax Number(s) ' , `g r a 9805
1 F1 Apartment/ Condo CAW w 1 0.3&— 1
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. F New 2. ❑ Replacement 3. E] Replacement of 4 E] Reconnection of 5. E] Repair of an
______ System ------
System ______ ^ __,___Tank Only______________ Existing System ________ ^ ExistingSystem
B) C] 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 E] eepage Trench 22 In- Ground Pressure 42 ❑ Pit Privy
13 Seepage Pit C� �` �•2S 43 ❑ Vault Privy
14 ❑ System -In -Fill /8' X
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
Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Q I � e El�evatio
1 1 , 50 -3 57 ,3 Feet ! $ • Feet
Ca aclt
VII. TANK in gallo Total # of Prefab. Site Fiber- Ex p er.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic A p p
New Exi strutted
Tanksl Tanks
eptic Tan r Holding Tank El El 1:1 E] 1:1 t,
Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for inqaktion of the ons' a sewage system shown on the attached plans.
PI tier's Name: (Print) P er's Sign ure: ( Sta ps MP /MPRSW No.: Business Phone Number:
l ` P-& 7 S
Plum is Address (Street, City, State, p C ):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issu ng en Sire (No Stamps)
� ! Surcharge Pee)
S
[Approved ❑Owner Given Initial
Adverse Determination /
X. CON ITI NS OF APPPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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Wisconsin Department of Industry SOIL AND SITE E V A L U AT I O� AI— RE T Page 1 of 3
Labor and Human Relations
Division of'Safety � Buildings in accord with ILHR 83.05 V>ft" Adm. Code
MUNTY
� �� �� `�.,St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size 1 must inolud , bi t!q,
not limited to vertical and horizontal reference point (BM), direction and %t.of slope r � scale or PARCEL I.D. #
" ° b38- 1055 -60 -100
dimensioned, north arrow, and location and distance to nearest road.
REV I B DATE
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PRQP �4(zATiO� I
Sherman Boucher GOVT. LOT SW 1/4 SW 14,s13 T 31 N,R 18 Nor) W
PROPERTY OWNERS MAILING ADDRESS LOT BLOCK #, SUBD. NAME OR CSM #
1895 100 St. 4 ` "'nom -- =. csm
CITY, STATE Z I p C DE PHONE NUMBER ❑CITY [ MOWN NEAREST ROAD
New Richmond, WI. 54017 (71� 247-5251
Star Prarie 210 th. Ave.
[:j New Construction Use jx] Residential I Number of bedrooms 'I [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft . 8 trench, gpd /ft
Recommended infiltration surface elevation(s) 95.15 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 I AT -GRADE SYSTEM IN FILL I HOLDING TANK
U= Unsuitable fors stem ®S ❑U ®S ❑U I ®S ❑U ®S ED U1 ®S ❑U El C$U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color G Sz. Sh. Bed Trertdi
.................
1 -8 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6
1
2 -19 10yr4 /6 none sicl 2msbk dsh gw if .4 .5
Ground 3 9 -90 7.5yr4/6 none co s Osg ml na na .7 .8
elev.
9 8.8 ft.
Depth to
limiting
factor
+90
Remarks:
Boring # 1 -7 10yr3 /3 none 1 2msbk dsh cs 2f
2 2 -18 10yr4 /4 none sicl 2msbk dsh 9W if .4 .5
3 8 -90 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev. i
9 8.4 ft.
Depth to 3�
limiting S
factor
+90
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. New Richtnon WI 54017
Signature: Date: 10 -12 -99 CST Number: m02298
I &P-L - I
PROPERTYOWNER Sherman Boucher SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 038 - 1055 -60 -100
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 -10 10yr3 /3 none 1 2msbk dsh gw 2f .5 .6
2 10 -29 10yr4 /4 none sicl 2msbk dsh gw if .4 .5
Ground 3 29 -90 7.5yr4/6 none co s Osg mi na na .7 .8
elev.
9 8.6 ft.
Depth to
limiting
fac,%
Remarks:
Boring #
1 -11 10yr3 /3 none 1 2msbk dsh gw 2f .5 .6
4 > 2 11 -30 10yr4/4 none sicl 2msbk dsh caw if .4 .5
3 30 -90 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
99.4 ft. —
Depth to -
limiting
factor
+90
Remarks:
Boring #
1 -10 10yr3 /3 — 7 none 1 2msbk dsh gw 2f .5 .6
<< 5 2 10 -21 10yr4 /4 none sici 2msbk dsh gw if .4 .5
3 1 -35 10yr5 /4 c2d 7.5yr5/6 scil 2msbk dsh gw na .4 .5
Ground
elev. 4 5 -90 7.5yr4/6 none co s Osg ml na na .7 .8
98 ft.
Depth to
limiting q3
factor
+90
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Sherman Boucher 1554 200th Ave.
CSTM2298 SW4SW4 S13- T31N - R18W New Richmond, WI 54017
MPRSW -3254 town of Star Prarie (715) 246 -6200
lot #4 -csm
N
1 =40'
BM.= top of 1 pvc p ipe @ el. 100.00'
Alt. BM.= top of SE lot stake @ el. 97.50'
�•
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a ,v A-YL a y '
Gary L. Steel
10 -12 -99
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer � r Yrjc r, Q eo k._ e � Q V�
Mailing Address t c � 9S 1 0 6 t ' v \ S IU,e
Property Address _ a l Q c� uQ ,
(Verification required from Planning Department for new construction)
City /State to �L Parcel Identification Number Q 39 —) bS S — (00 — / 0 0
LEGAL DESCRIPTION
Property Location SW '/4, S U3 '/4, Sec. y, T- .LN -R —L��W, Town of 7 O -ra r;
Subdivision C,S VA I t E!� I QCOC U y '� �� ��l (�� Lot #
Certified Survey a # y 0 (Co Volume Pa e #
Y P g z—•
Warranty Deed # c� ns ,Volume , Page #
Spec house ❑ yes N no Lot lines identifiable 0 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
masterplumber, journeyman plumber, restrietedplumberor a licensedpumperverifying 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 th ur septic system has c maintained must be completed and returned to the St. Croix County Zoning Off icc within 30
days of ie t ' ion at .
SIGNATURE OF A PLICANT DATE
OWNER CERTIFICATION
I certify that all statem s on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the prop de c ' vi a of a warranty deed recorded in Register of Deeds Office.
/U/ I g/R
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
I
e .
STATE BAR OF WISCONSIN FORM 2 — 1982 121 U5
WA TY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
DOCUMENT NO. VOL 2 i3 P AGE 315
ST. CROIX CO., WI
- - -_ - - - - =---- -- - -- ... _ - - -- - -- - -- -- - - - - - -- - - - RECEIVED FOR RECORD
Dennis A. Tornio and Nancy C. Tornio, 10 -15 -1999 9:10 AN
husband ,
each in thei WARRANTY DEED
EXEMPT R
CERT COPY FEE:
s and warrants to COPY FEE:
conveys TRANSFER FEE: 74.70
Sherman R- Boucher and Jean M. Boucher, RECORDING FEE: 10.00
hushand and wife as survivorship marital PAGES: 1
prop erty
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
the following described real estate in St. Croix County,
State of Wisconsin: GWIN LAW FIRM S.C.
Part of the S' of SA of Section l:i, Township 430 SECOND STREET
31 North, Range 18 West, described as follows: HUDSON, W154016 - 1510
Lot 4 of a Certified Survey Map dated
March 25, 1992,-filed March 26, 1992 in
rf,7o1. "9 ", of Certified-Survey Maps, at 038- 1055 -60 -100
Page 2467, as Doc. No. 481060, In PARCEL IDENTIFICATION NUMBER l
the office of the Register of Deeds for
St. Croix County, Wisconsin
II
I
I
,f
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This i G nn - homestead property.
(is) (is not)
Exception to warranties: TOGETHER WITH AND SUBJECT TO any other easements, i
covenants, reservations or restrictions of record, if anv, but this shall{,
not be deemed to extend any such other recorded encumbrances beyond the
term established by law therefor.
Dated this day of October , A.D., 19 9 9 II
Ij
.
(SEAL) (SEAL)
R Dennis A. Tornio
' II
(SEAL) L( /Q�LG�1 GTy�Lvrtit'� ,
(SEAL)
Nancy C% Tornio
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dennis A. Tornio and State of Wisconsin,
Nancy Tornio; his wife ss.
A County.
authenti th' of October 19 Personally came before me this day of
TOM&.
r
19 , the above named
Hugh/H. Gwin N/A
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing
instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY i
At - Hugh H . -Gwin
430 St., Hu dson, WI 54016
Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.)
Names of persons signing in any capacity should by typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blends Co.. InC. II
Form No. 2 — 1982 Milwakee Ws
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MAR 261992,,,, Z Bearings are referenced to the south line
JAMES O'CONNELL of the SN} of Section 13, assumed to bear
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*A h void VOLUME 9
*t7-T�- Continued on following page - - - --