HomeMy WebLinkAbout038-1188-70-000 ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT : f
Owner
Property Addres
City /State
'o z C N ' t Y
04
C
fi
Legal Description: ..-
Lot Block - Subdivision/CSM # � Z , ,
'/4 ' /4, Sec. 2,-;f -9 , T,�N -R W, Town of PIN # _ ° & c
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer l�iy' - ' Size ST/PC / Setback from: House Well P/I.
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: 0 Width 1— Length -?,E Number of Trenches
Setback from: House Well 1/ L P/L .,71 Vent to fresh air intake >
ELEVATIONS
Description of benchmark' Elevation
Description of alternate benchmark - - Elevation ,1zo.er
Building Sewer ST/HT Inlet 9 ST Outlet S'7 PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover S
Distribution Lines O ,9, 7-/ O ( )
Bottom of System
Final Grade
Date of installation/ / / Pe it number ._ State plan number
Plumber's signat re License number /VZS' Date
A
Inspector =
Complete plot plan �
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
F /
ns
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ay'
INDICATE NORTH
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• Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
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)l. 353186
Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.:
Toym of Star —
Insp. BM Elev.: BM Description: • Parcel Tax No.:
03 9- 11 RR-70-000
ago
TANK INFORMATION Y � ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark q p
Dosing
Alt. BM��
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic Q/ f NA Dt Bottom
Dosing NA Header /Man. g Qb•33
Aeration NA Dist. Pipe g• 21 c1`•2�
Holding Bot. System q. I D W 3�
PUMP /SIPHON INFORMATION Final Grade �• to 98,35
Manufacturer mand
Model Num GP
4
TDH Lift L ction System TDH F
Forc ain Length H Dist. To
SOIL ABSORPTION SYSTEM
BED / wwvem Width c Len ( o. Q f c s PIT No. Of Inside Dia. Li epth
EN I N 2 0 1 DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN Manufa r: INFORMATION Type Of f r CHAMBER el Number: LLO System: CGO.-I. 1O� 1I00
— — OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold 4 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Leng2j�L Dia. Length 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 I ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: Ally /99 Inspection #2: '7 t
Location: 1322 214th Avenue, New Richmond, W1 (NE 1A, SW 1/4, Section 13 T3 IN 8W) - 13.31.18.960
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}Al, ga 4v f lam .
Plan revision required? ❑ Yes No
Use other side for additional infor ation. O•'S o Z B I Z.
k SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
i
. Safety and Buildings Division
•
SA PERMIT APPLICATION 201 W. Washington Avenue
SA
`AIsconsi In accord with ILHR 83.05, Wis. Adm. Code <�, i P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper4uM.,40s' County
than 81/2 x 11 inches in size. Gt
• See reverse side for instructions for completing this application e1S n ry Permit Number
Personal information you provide may be used for secondary purpos E] Check if rewsron5o az1 -!ion
(Privacy Law, s. 15.04 (1) (m)l 1 -Z Z ! f State Plan I.D. Number
I. APPLICATION I O RMATI SI - PLEASE PRINT ALL INF RMATi N
Prope Owne ame Pro perty p Loc ti $ T , N, R 60
Property wner's Mailing A dress Lot Number Block Number
CIt , tate Zip Code Phone Number Subdivision Name or SM Number
E BUILDING: (check one) E] State Owned /l il Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Q Town o fy
111. BUILDING USE (If building type is public, check all that apply) —. Parcel Tax Number(s) )�j 3 I g (� O
1 ❑Apartment/ Condo
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 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. [ Repair of an
System ________System ________ Tank Only______________ Existing System Existinq S� stem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Nqn- Pressurized Distribution Pressurized Distribution Experimental Other
11 jaSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 42 ❑ Pit Privy
13 []Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill3
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Propos d (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation
®® +Feet Feet
VII. TANK Capacit gallo Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con - Steel glass Plastic App
New Existin structed
Tank Tanks
eptic Tank _ ❑ ❑
Lift Pump Tank /Siphon Chamber r ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
1, the uodersigned , assume responsibility for instajYalion of th nsite sewage system shown on the attached plans.
Plumb ame: r' Plumber s Si ur t ps MP /MPRSW No.: Business Phone Number:
I
Plum er's Ad (Street, City. Zip C ):
IX. COUNTY / DEPARTMENT USE ONLY
❑Dsaproved Sanitary Permit Fee (Includes Groundwater ate ssue Issui gentSignature(NoStamps)
Surcharge Fee) W
VApproved dner Ow Given Initial
l� S od I y
i p
Adver O'
se Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
C_
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
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Ap
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of _
Labor and Human 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
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. 038 - 1055 -10
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R VIr -�41 1W ED BY DATE
;1 . 1
PROPERTY OWNER: PROPERTY LOCATION
Greenwac)d Enterprises, Inc. GOVT. LOT je 1/4 �� 1/4,S 7j T 1 ,N,R E (or) W
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # � r � �
1416 Third St. 11 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE MOWN NEAREST ROAD
Hudson WI. 54016 (7A 386 -3674 Star Prairie
[ New Construction Use [x] Residential / Number of bedrooms 4 [ J Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft
Recommended infiltration surface elevation(s) 95.85 It (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 AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for stem ® S [I U ®S ❑ U ®S ❑ U :7 S ❑ U [3 S ❑ U ❑ S 91 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 Trerich
.................
..................
.................
..................
1 0 -13 10 r 2/2 none 1 lcsbk mfr if .41 .5
2 13 -25 10 r 4/4 none sicl lcsbk mfr gw if .2 .3
Ground 3 _ 7 4 nane CICIIq Oscr ml na na .7 .8
elev.
99 ft.
Depth to
limiting
factor
+84 „
Remarks:
Boring #
none mfr aw if
.4 .5
2
Ground 3 39 Cos o scr ml n a na .7 .8
99.6 ft. \
Depth to
limiting
Ainti
factor
F9 98
11 C •
UNTY i
Remarks:
Z ONINGOFFICE
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. Richmond WhI 54017
Signature: Date: 10 -28 -98 CST Number: m02298
li
PROPERTY OWNER Greewood Enterprises SOIL DESCRIPTION REPORT Page-2—of 3
PARCEL I.D. # __ M8-1055-10
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barclay Roots GPD /ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.,...3.... >' 1 0 -13 10 r 2/2 none 1 Icsbk mfr gw if .4 95
2 13 -27 sicl mfr if .2 .3
Ground 27 na na .7 .8
elev.
9 9.0 ft.
Depth to
limiting
factor
+84" „
3'.b
Remarks:
Boring #
1 0 -11 10 r 2/2 none 1 Icsbk mfr if .4 .5
4 2 11- 4/4 none sicl lcsbk mfr if .2 .3
Ground 3 25 -84 7.5 r 4/4 none cos osg ml na na .7 .8
elev.
98 .& ft. —
Depth to
limiting
factor
+84 1,
Remarks:
Boring #
1 10 r 2/ none 1 2msbk mfr w if .5 .6
LU 2 9 - 22 10 r 4/4 none sicl lcsbk mfr
yw if .2 .3
Ground 3 22-84 7.5 r 4/4 none cos osg ml na na .7 .8
elev.
99.6 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
' CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW - 3254 NE4Sw4 s13- T31N -Ri8w (715) 246 -6200
town of Star Prarie
lot #11- NorthGate
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1
BM.= top of 1" pvc pipe C el. 100' j
Alt. BM;= top fo 1" pvc pipe @ el. 100.40' V
N I �\ <
D Vv
Q
Gary L. Steel
10 -28 -98
i
,
ST CROIX COUNTY
SEPTIC 'TANK MAINTENANCE At;Ri�i.,Nfl1 NT
AND
OWNERSHIP CERTIFICATION FORM
�1 Owner/Buyer
Mailing Address ��!'I'►G' / �co tT- Sd/a 'Cr r_12.�
Property Address
(Verification required fiom Planning Departrncnt for new ii)
City /State Identification Nunibct
LEGAL DESCRIPTION
Property Location � ' /4, � ' Sec. _�_� > T_ N -IZ �� i ,,��, t� of
Subdivision L�,,l��Zr` ___ -__. __, Lot it
Certified Survey Map # I'fJ 5 ? , Volume `_ - -- ►'arc tf _
Warranty Deed # / 1,-2r<30.2 Volume � Page it
i
Spec house ❑ yes C,3 no Lot lines identittabte ycs ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prelnawrc [allure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by i Gccnscd pumper. WI1at you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal systeur.
The property owner agrees to submit to St. Croix 'Zoning Department a tone, Signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed puniprr v� nlynil ilia[ (1 ) the on site wastewater disposal system
is in proper operating condition an(For (2) after inspection and pumping (it necessary), the �,cptic tailk is less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to mijimain the pn,atc sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Depaitnient of Natun.l resources, Mate of Wisconsin. Certification
suiting that your septic system has been maintained must be completed and rt�turnc�i t�� ili. '�i i'i�u�oinity 'Zoning Uffi, e within A
day, of re three year expiration dat4,,.
SIGNATURE OF APPLICANT DAIP,
OWNER CERTIFICATION
I (we) certify that all statements on till' toil" are true to the best of illy (ow i,'AI , y. I (we) am (arc) tiie owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds "111:c.
�l
IGNATURE OF APPLICANT LEA fi
«t•" Any information that is mis- represented may result in the sanitary peimut
t(ic f.onutg Department.' " « ° ' •
*• Include with this application: a stamped warranty deed from the Register of Oecds otticc
a copy of the certified survey map if icierence is ima,ic mi Il;: % %,iijanty deed
A - 'L
VOL 1463P 14 is 120173 40
STATE BAR OF WISCONSIN FORM 1 -1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Greenwood Enterprises. Inc. a Wisconsin RECEIVED FOR RECORD
corporation Grantor, and Burton K Wilson and T.I.R. Wilson husband 10 -13 -1999 9:05 AM
and wife as survivorship marital property Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following WARRANTY DEED
described real estate in St. Croix County, State of Wisconsin (The "Property"): EXEMPT N
CERT COPY FEE:
COPY FEE: 2.00
TRANSFER FEE: 56.70
RECORDING FEE: 10.00
PAGES: i
Recording Area
ame and Return Address
Parcel Identification Number (PIN)
This is not homestead property.
(s not)
Lot 11 of the Plat of NorthGate, recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on May
20, 1999 in Volume 7 of Plats, at Page 46 as Document No. 603503.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances
except easements, restrictions and reservations, if any, of reword.
Dated this day of O
G D ENTERP
By: I 'Q—�
s *J es E. Rusch, its president
By:
* *Mary i sec ry
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) James E. Rusch, its president STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this day of October, 1999. �,�.��� Personally came before me this '� day of
C &;k 1999 the above named Mary R. Rusch. its
�- secretary to me known to be the person(s) who executed the
foregoing instrument and acknowledge the same.
p t'S
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, r &AA4Y�k�
authorized by § 706.06, Wis. Stats.) * !
Note blic, State of Wisconsin
THIS INSTRUMENT WAS DRAFTED BY My Commission is permanent. (If not, state expiration date:
Lois A. Murray, Zilz, Estreen & Ogland, LLP , 3:0
304 Locust Street, Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both are not DIANE M. BARRON
necessary.) Notary Public
State of Wisconsin
•Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM Na i -1998
INFnRMATION PROFESSIONALS COMPANY FOND DU LAC, WI 6GC -666 -2021
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UNPLATTEn LA%IDS
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26'E 227 41'
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7 sq, fu 56.325 P EL Ai
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8 0 7" ;2 r6, -;
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N 106 65
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36 ;r 35
55,500 sq A
37 56.300 sq. ft
1 2 74 ac.
1. 304 ac. 34
1 4,459 sq 33 �r
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63.317 sq. ft. ac. z �� 1.454 3c. 61.759 sq. in iv
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LOCATION ;; KETCH
x Vhem th e s 501 0*n On Lot 6 is rem or If sicrim l
the entrance is ChQv-ged to the Post Side. then r3lpi, R
shall the oa^er of Lot 6 ha the rIght to channel 4b
s he natural svroace watrr past the west end OF IL 220m
ad shop a aC land to the north O F SQ?d
S:•OP. an Lot 6. tile dra-mage Co tjrSe Con joe re
po.:ptlomeg� at Own r' O wlth,f% tile III OF PC4
b-i• Platt d easement, and sad easement 0.01th can
CC
r j�C Wit
ecl to lot less t?* 15 130"Ov-ded
LEGEND +he O ' ac " - Ql F low 'S altodecl to rerma,m on Lot 6
)ON CORONER MO.NU%IEN r F,
'ALUMINUM CAP
6 ROUND IRON PIPF WFIGIIING
tmAI.L rAacts
3.65 LBSTT. SET SCALE IN FEE T
ON PIPE FOUND AWS. F
1w
too M jcc
IN PIPE FOU •
JLI TV E.A.SFAII:Yt MRALLH.