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Home My WebLink About038-1186-20-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner EIZ T 1A • L.S a� Property Address. Z A91 L3 5- 711 57 City /State k, "4h - 1,0Mz3 z//1, - Legal Description: Lot /&2 Block WA Subdivision/CSM # RRAI t kz F-L d T I SLW 1 /4 S E '/4, Sec. L-3, TILN -RJW, Town of .S 7A/7 j2&All'r f` PIN # 03 8 - V SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 6149 6FAC s Size ST/PC ,/, W! Setback from: House /3 Well �,, P/L r Pump manufacturer NA Model AVA Alarm location &A (HOLDING TANKS ONLY) Setbacks: Service road A Vent to fresh air intake Water Line iVA Meter location NA Alarm location AIA SOIL ABSORPTION SYSTEM Type of system: TA?6A 1,C !' Width 3 Length 2,5 Number of Trenches �! Setback from: House -1 Well 9A P/L 7 6 Vent to fresh air intake . 40-0 ELEVATIONS Description of benchmark 7o &C- Pi/dL✓ Q. fLYG Elevation 40.00 Description of alternate benchmark Elevation i, Building Sewer ST/HT Inlet ST Outlet q 7. 98 PC Inlet /1T� i PC Bottom NA - Header/Manifold 9. 0 4 Top of ST/PC Manhole Cover y G 3 Distribution Lines Bottom of System Final Grade Date of installation ! G! Permit number State plan number Plumber's si nature - �,icense number Date 2142 Inspector. Complete plot plan or 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. i i • Show alternate benchmark, if applicable. PLAN VIEW � ALL 0 a /OOO GL S�f? w .I 7f Tl?aNc 13JI T i - vc- P //jc EL /do,v INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338866 Per Na rgB _ ❑ City ❑ Village Town of: State Plan ID No.: q�iLFlo�l�ri$ W�i11,,JJ 11VV tSU STAR PRAIRIE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: t oo- 0 V = C ' 7 boo 1 1 038 - 1186 -20 -000 TANK INFORMATION ELEVATION DATA A9900130 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark Dosing g04 3. O1. +-0' Aeration Bldg. Sewer 6Z 9115 [ Holding -bl# Inlet 6-64 9 16,5 - TANK SETBACK INFORMATION &/+ t^Outlet TANKTO P/L WELL BLDG. Ventto ROAD 9-Itet Air Intake Septic NA of -Be4em Dosing NA Header / Man. Aeration NA Dist. Pipe �. qT, 3Y Holding Bot. System /! qb. 0`f" PUMP/ SIPHON INFORMATION Final Grade (, /9 qg, 6 Manufac r —Demand Model Number GPM TDH I Lift riction Syste TDH Ft ii Forcemai n Length Dia. H e ad Dist. To Well SOIL ABSORPTION SYSTEM BE&/TZINC Width t I Length r No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 3 �s DIMENSION Manufacturer- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING s', INFORMATION Type O i , CHAMBER Model Number: System: J . �� 7 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake _ o Length Dia "' Length Dia. Spacing 7 p S I 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 l Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) CATION: TAR PRAIRIE 13 .31.18.943,SW,SE 2102 135TH STREET y" m z - Cl 9 I Plan revision required? ❑ Yes No �( Use other side for additional informat!on. / SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Vi scons i n SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. m P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, WIS. Ad Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 4t547- C✓p • See reverse side for instructions for completing this application State Sanitary j Permit tN Number The information you provide may be used by other government agency programs E] Check if reGsio to prcevious a" pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location ' 14 Eva, S T ,? i , N, R ` E (or� Property wner's Mailing Address Lot Number Block Number '+D City, State Zip Code 7Fhone Number Subdivision Name oPC4M -Wmaihw II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms Town OF /� l� [�aS� III. - BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /Condo 038 — 1184 ° Cy — 00 2 ❑ Assembly Hall 6, ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ 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 O New 2_ ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an - _____System ________ System____ _________TankOnly______________ 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 1 1 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 C'Seepage Trench 22 ❑ In- Ground Pressure / — f 42 ❑ Pit Privy 13 [] Seepage Pit ( 43 ❑ Vault Pri y 14 ❑ System -In -Fill 4L �idtNl� C j 3 1-19 VI. ABSORPTION SYSTEM INFORMATI 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) Elevation ® 76 Feet 1406 Feet Cap acit y VII. TANK in Ca g allo ns Total # of Prefab. Site Fiber- Exper. n INFORMATION New Existing st Gallons Tanks Manufacturers Name Concrete u- Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank X ❑ ❑ ❑ I ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 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 r Signature: (No S s) PRSW No.: Business Phone Number: - ] v umber's Ac dress (Street, City, State, Zip Code): '. 5 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing t Signature (No Stamps) A roved rcharge Fee) '� pp ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR ISAPPROVAL: SOD -6398 (R. f t/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber . a - � --�- -- , 1. � - - -�T- - -�� ►�LrJ�t� pt �� ;�1�jCD`'�- /�lr` -- - - - - -_ - - - - � - - -- - , , V S E , , 1 i , i -T i -� -r -- - - -- -- - X, I T r . i { 1 - T_ . 1 . , ( t ' t ; ' i - - , , 1 ' La y l -Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Gille Truckin g & Excavating, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (13M), direction and _ St. Croix _ percent slope, scale or dimensions, north arrow, and to n e to nearest road. Parcel l.D.# r , APPLICANT INFORMATION - Pleas ! stI( inforr - - - -- - -- Personal information you provide may be used for rposes riva*Law, s. (1) (m)). RevleW y Date Property Owner f -17 Prope Location Casey, D an Govt L t S W 114 SE im,s 13 T 31 N,R 18 Property Owners Mailing Address Btodc # � Subd. Name or CSM# 323 Sawmill Lane — `, C C1 �� Prairie Flats City State Zip C '/ E] Villaqe MTown Nearest Road New Richmond Wl 5401 _ -24 Star Prairie j Hwy 65 New Construction Use: N Residenti r nQ&_ of ms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpolfts 8 trench, gpd/ftz Absorption area required 643 bed, ftz 562 trench, ft Maximum design loading rate .7 bed, gpd/W .8 tr ench, gpd/fF Recommended infiltration surface elevation(s) 9S, 7S_� ft (as referred to site plan benchmark) Additional design / site considerations Parent material Out -wash Flood plain elevation, if applicable ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ES E U ❑ S❑ U Z S U ❑ S U ❑ S N U ❑ S® U SOIL DESCRIPTION REPORT Horizon Depth 1 Dominant Color Mottles Texture Structure Consistent Boundary Roots GPDAF Boring# in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -15 7.5YR2.5/1 ---- - - - - -- S 1FABK MVFR AW 1VF .2 3 2 15 -36 7.5YR4/6 -- - - - - -- CL 1FAB MVFR AS 1VF .2 3 Ground 3 36 -99 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- 7 8 ele-- — — - -- - -— vllu Depth to limiting - factor 99 in. Remarks: _ 2 1 0 -13 7.5YR2 ---- - - - - -- SIL 1FABK MVFR AW 1VF .2 .3 -- -- 2 13 -29 7.5YR4/6 ---- - - - - -- CL 1FAB M VFR AS 1VF .2 .3 Ground 3 29 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ! ML - - -- - - -- 7 8 ele - Depth to limiting — — -- - -- - - - -- factor 96 in — Remarks: - -- -- - -- ,� - - -- -- - -- -- CST Name (Please Print) Sign Telephone No. Dennis Gille ..Q�.,4; 715 268 - 6637 Address pp t CST Number Ref # 372 140th Street Amery, Wl 54001 VN/97 3409 107 f - PROPEr OWNER: Casey Dan _ SOIL DESCRIPTION REPORT Page 2 of PARCEL LD. #_ Gille Truckin & Excavatin ,Inc. Horizon Depth Dominant Color Mottles Texture Structure o Boundary Roots GPDtft2 in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 7.5YR2.5f1 ---- - - - - -- SIL 1FABK MVFR AW 1VF .2 .3 2 10 -30 7.SYR4/6 --- - - - - -- CL IFAB MVFR AS , 1VF .2 .3 Ground elev 3 30 -96 7.SYR513 ---- - - - - -- S 0 -GR —� M - - -- - - -- .7 .8 Depth to limiting - -- - —� - factor 96 in , —. -- - -- - - - -- - -� -- -- — — -- — Remarks: — — - -- ------- - - - - -- — -- 4 1 0 -11 7.5YR2.5/1 ---- - - - - -- SIL 1FABK MVFR AW 1VF .2 3 -- — - — - 2 11 -30 7.5YR4/6 ---- - - - - -- CL 1FABK MVFR AS 1 VF .2 .3 Ground — 3 30 -98 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8 elev - - -- - -- - - - -- -- — , Depth to -- limiting -- - - -- -- -- - - - -- — , factor 98 in. ,h -- I � Remarks _ - -_ -- —__ -- 1 0 -9 7.SYR2 --_ I SIL 1FA BK MVFR AW 1VF 2 3 2 9 -22 7.5YR4/6 - --- - - - - -- CL 1 FABK MVFR AS 1 VF .2 .3 Ground elev 3 22 -96 7.SYR5/3 ---- - - - - -- S 0 - ML - - -- - - -- .7 8 Depth to limiting — - factor 96 IN — - - -- — Remarks: - -- - -- --_ __— — , , Ground - -- -- - �---- - - - - -- -- —_ —_ -- - - - - - -- , elev Depth to limiting — -- - factor , Remarks: — — - - - - -- -- -- - - - -- — -- P /� pion m a u,--l A ub Swy SES /� �!R t$li/ CSTin 3Yo g gar tZ L./� -► To pl'c �r� ot, 1&/ sab I 1 33Y7 � Q s�� I i f ro 1 �io.l7 u I 2 5 1 I 86� I r � 1 �I f 3q r r-- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer f 3L� /2 r Al Mailing Address ,Sl/ 3 O res 5 A? 2z = -& f � Property Address ' 6�� J , (Verification required from Planning Department for new construction) City /State 1yL•'LO &Cffl`jolva Parcel Identification Number 038 — 1186 '.?0 DOo LEGAL DESCRIPTION Property Location 5 I /4, ,5,�F ' / a, Sec. / 3 . T _-3j _ N -R_/A_W, Town of SlA 1? PA M, Subdivision P f�,� /)? E �L ,4 TS Lot # _ . Certified Survey Map # , Volume . Page # Warranty Deed # _6;6G yo ti , Volume /y� 5' . Page # /3Q Spec house ❑ yes ICI no Lot lines identifiable X 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 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 dayyss'of the three year expiration date. Z SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /23/ IGNATURE 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 . � • � � 1415I�Q STATE BAR OF WISCONSIN FORM 1 – 1962 E►0 WARRANTY DEED KATHLEEN A. WAESH REuISTER OF DEEDS DOCUMENT NO. ST CROIX CO., WI RECEIVE? FOR XM This Deed, madebetweel_ Daniel J. Casey and 03-31-1999 3 :15 PM Betty D. Casey, husband E im and wife and Grantor, COPY fEEt FEEt T. 1. Jane R. W TRRIMSFER FEE: 56.70 �1�orq._t14i>z and wife as °ECODS FEE: 10.00 survivorship marital ro erty MESt I . Grantee, Witi- esseth, Thu the said Gtanta, fate, valuable cerive to Grantee the following describ d real tstue in St. Cr o i X THIS SPACE RESERVED F CR RECORDING LATA County. State of Wisconsin: NAME AND RETURN ADDRESS So H N.' w P 14 Lot 12 of Prairie Flats Addition in the T39 s K LC Town of Star Prairie, St. Croix County Wisconsin. W 1 f' ►'� PARCEI. IDENTIFICATION NUMBER This ie n ot homestead property (is) (is not) Together with all and singular the hereduaments and appurtenances thereunto belonging; And ty V ' warrants that the title is good, indefeasible in fet simple and free and clear of encumbrances except recorded easements, rights of way and covenants. and will warrant and defend the same. Dated this 29th day of Marc l9 99 t (SEAL) - [�Qdna/ (SEAL) • Daniel J Case get y D. Casey (SEAL) (SEAL) • AUTHENTICATION ACKNOWLEDGRIENT Signatures) State of Wisconsin, ss. St. Croix County authenticated this _day of 19 came before me this 29th d r of March , 19 99 , tl,e above named • Da niel T Cas y and Betty D Ca TITLE: MEMBER STATE BAR OF WISCONSIN (If nor. - -- -- authorized by 9706.06, Wis. Stats.) to me known to be the person r _ who execute the foregoing irtstrument a4 acknowledge the s,rme� THIS INSTRUMENT WAS DRAFTED BY John D. Walsh John D. Walsh _ — Nrx:ry Public, County; Wis. (Signatures may be authenticated or acknowl,dged Both are not fit} commi> ion is permanent. (!f r.ut, state ex� ration date necessary.) --- -N4u�- tuber- -�3.,_ 2f19- 1- - - -• Ia____ _ ) Names of persons signing in an) ,apac. ..e should hp q ped or pnntcd !ti'ow !be!, s:gnai.vrs. JOHN D. WALSH Wisconsin Notary Public WARRAN 1Y DFFu STATF BAR OF WISCONSIN MY COITM11LSion Exoires Nc4 aa,k cc 'nc Form \,.. 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