HomeMy WebLinkAbout038-1189-10-000 ST. CROIX COUNTY ZONING DEPARTMENT
c— AS BUILT SANITARY REPORT
&,vner 7C t' U % d
Property Addres 0 I q(
City /State
Legal Description:
Lot L Block V A- Subdivision/CSM # Ah r�
All- ' /4 ' /4, Sec. 13 , T 31 N -R�W, Town of �rti. r�� P PIN # O � T -/O
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer W 4.t-S Size ST/PC Imo/ Setback from: House o1 Well K P/L
Pump manufacturer Model --
Alarm location
(HOLDING TANKS
Setbacks: Service road Ven�tofresh e Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: 6 �'�` Vidth 3 Length Number of Trenches a
Setback from: House ,S'0 Well _ P/L 3o - Vent to fresh air intake
ELEVATIONS
Description of benchmark To f a` 1 tt 4 ) vC alas. Elevation -
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet 9 9 ' y ST Outlet q$ `! �' PC Inlet
PC Bottom Header/Manifold 9133 Top of ST/PC Manhole Cover 9 9 7
Distribution Lines (1) R ' 2 , -?--T 2 33 ( )
Bottom of System (1) 9 (0 (
Final Grade /OZ (,Ij
Date of installation 9 / 5/ 9P it number 3 t *4 662 State plan number
Plumber's signature License number c' S 3 Date /1 4
Inspector t
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.
I
PLAN VIEW
44
J�
e
u �
�v
I
3
INDICATE NORTH ARROW
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
Safety and Buildings Division
INSPECTION REPORT X
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No_: 9" CRO
Personal infor mation you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)j. 344
Permit Holder's Name: ❑ Cit ❑❑ Village Town of: State Plan ID No.:
ERICKSON, ERVIN S�'.I PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
c7 0 O tis cr�J.. 038- 1189 -10 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic p Benchmark ASS 1 C30. p `
Dosi n l
Ae ation Bldg. Sewer
171
Hol St /Ht Inlet 7 '.If
TANK SETB RMATION St /Ht Outlet �•`� 8A�
TANK TO P/ L WELL BLDG. A l to ntake ROAD
Septic 5 r t — NA
Dosing NA Header/ Man.
.2
Aeration NA Dist. Pipe
Holding Bot. System `�• f�
PUMP/ SIPHON INFORMATION Inal Grade �t
Manufa rer Demand .(v 9
Model Number GPM
TDH Lift L oss riction stem TDH Ft
Forcema Length Dia. Dist.
SOIL RPTION SYSTEM �V
THE H width Len No. f T riches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 �6'z� -- �a DIMENSION
r'
LEACHING Manuf c tyryr:
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM (fva�a►- •��
INFORMATION Typeo � CHAMBER del tuber:
System: & 1 33 5- 5 - 1 -- OR UNIT
DISTRIBUTION SYSTEM
Header / nifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Lengt Dia - ngth Dia. Spacing I 7
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 ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PIRI X1,3.31.18.963 2146 134TH ST — NORTHGATE LOT 14
3 r
Plan revision required? ❑ Yes $3 No
Use other side for additional information. (Z Z AL6L
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ,
I
Safety and Buildings Division
`v= - SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue
�scons�n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less Count`
than 81/2 x 11 inches in size. -
• See reverse side for instructions for completing this application State Sanitar Permit Number
Personal information you provide may be used for secondary purposes ❑ Check it revision fo r i ous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI N
Pro erty Owner Name Property Location
rlj! �• � 1/4 "D 1/4, T 3 ,N,R I E(or
Pro eby Ow er's Mailin Address Lot Number Block Numb 14 1
Cot , State Z Code Phone Number S divisi a e.or CSM N tuber
11. P F BUILDING: (check one) ❑ State Owned ° It Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 3 ° v o w a n It -
III BUILDING USE (If building type is public, check all that apply) Parcel Tax N ' �. 31 , g,�
038— � mbe 1 B� l 94,3
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. Kul New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
______System System Tank ank 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 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
123M Seepage Trench 22 ❑ In- Ground Pressure Z57 42 ❑ Pit Privy
13 ❑ Seepage Pit r r 43 F1 Vault Privy
14 ❑ System -In -Fill rief
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/day /sq. ft.) (Min. /inch) pp Elevatiin
/ 50 / �- !�� Feet IC'D Feet
VIVII. Ca acit TANK in Cap acity Total # of r Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existing strutted
Tanks Tanks
e n+la;.rq�n1� d� 1d ? ` S is ❑ ❑ ❑ 1 ❑ ❑
Lift Pump Tank /Siphon Chamber J ❑ ❑ 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: (Pri Plumber's Sign tur . No St mps) MP /MPRSW No.: Business Phone Number:
t o I
Plum s ddress (Stree ty, ate, ZiAo, de):
V
f
I X. UN Y/ DEPARTMENT USE ONL
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing en ig atur (No Stamps)
Approved []Owner Fee)
Given Initial *��,rj vb I
Adverse Determination a (D
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber
aaa N
c c►.Q S A fr - , c Lo t-¢s a.
its a oa
AtQA - �P( "PSG El /aa
s��- a
- o s3
010
_ J �
I � c
tT
I
. .
{ %
-
|;
TO
|\ 11 ; | 3
i$ \
2
0 0
m 7 u / (D �w ƒ � ■ e � � � �
0
f�
,2 ( } $ � CD �
2\ \ ®
|@ G a
MOM
| 3 \
7)
■
1
||
�
i
f§
# m
«.
/ /
| ¥
ƒ C/) q
k 2 E§ a G O »
3' g o 3 (C) c «
q $ =r 0
t x 3 =r C J ƒ
§ @ 2 K
3 2 c
Cl) � w CD
C R 0
f 07 � k % °
J ' 0 0 7
B __ � q g 7 �
R — 2 R %
0'3 ,e
�
CO , � # \gym
e
Q m
wax 0 R_a_k2
-.L -4 B c
q 7 q o 3
0) x = < q
U \�i 5:CK q 2 2E'
. 0 _
C % k , . -
I m @ § q
Invert 1 V
I C
% 7 .
o
� § R
E
Wisconsin 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
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croi
noi 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
APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
k. GtN•
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 ,N,R 18 * (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
1416 Third St. 14 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD
4016 (71J 386-3674 Star Prairie 214th Ave.
PC] New Construction Use* ] Residential/ Number of bedrooms 4 [ ] Addition to existing building
I ] 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 858 bed, ft 750 trench, ft Maximum design loading rate ,_ bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) 96.00 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material cutwash 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 fors stem 1 11 S❑ U k] S❑ U CRS ❑ U CIS ❑ U OS ❑ U [IS W 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 <`? 1 0 -1 10 r 2/2 none 1 2msbk ml gw if .5I .6
2 12 -18 10 r 4/4 none sl 2mgr mvfr gw if .5 .6
Ground 3 18 -84 7.5 r 4/6 none ms osg ml na na .7 .8
elev.
9 9.8 ft.
Depth to
limiting
factor
+84 r
Remarks:
Boring #
1 0 -8 10 r 2/2 none 1 2msbk mfr gw if .5 .6
2 ... 2 8 -20 10 r 4 4 none sicl 2msbk mfr caw if .4 .5
Ground 3 20-88 7.5vr 4/6 none ms 0SQ ml na na .7 .8
elev.
10 ft.
Depth to
limiting Q:
factor
; y ,h
Remarks:
r cLOlX l
CST Name: -- Please Print G ZONING OFFICE L. Steel Phone: 715- 246 620�"� ,
Address: 1554 200th. Avo., New Rich and WI 54017 > -
Signature Date: b r 298
PROPERTY OWNER Greenwood Ehterpria DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 038 - 1055 -10
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft,
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
.................
3.....' 1 0 -9 10 r 4 none 1 2msbk mfr cs if .5 .6
2 9 -17 sl fr cfw if .5 .6
Ground 3 17 -88 7.5 r 4/6 non ms 0SCI ml na na .7 .8
elev.
9 9.4 ft.
Depth to
limiting
factor
+88
Remarks:
Boring #
1 0 -11 10 r 2/2 none 1 2msbk mfr gw if .5 .6
"s..4...;» 2 11 -16 10 r 4/4 none scl lcsbk mfr . w if .2 .3
Ground 3 16 -84 7.5 r 4/6 none ms osg ml na na .7 .8
elev.
9 8-4 ft. —
Depth to
limiting
factor
+84 11
Remarks:
Boring #
1 0 -9 10 r 4/3 none 1 2msbk mfr 9w if .6
S 2 9 -12 10 r 4/4 none sl 2m r mvfr C1w if .5 .6
Ground 3 12 -84 7.5 r 4/6 none ms osg ml na na .7 .8
elev.
9 3—L ft.
Depth to
limiting
factor
+84't
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave.
GSTM2298 NE4SW4 S13- t31N - R18w New Richmond, WI 54017
MPRSW -3254 town of Star Pragt (715) 246 -6200
lot #14 Nort,hGAte
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 mayor may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40'
BM. = top of 1 pvc pipe C el. 100 �
Alt. BM.= top of 1 pv,i pipe C el. 98.40
i
S� 3
p'
Gary L. Steel
10 -28 -98
I
ST CROIX COUNTY
' SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer rat `�- C� j L r ! G/ s e
Mailing Address & e p' ° v�
Aj
l3 �1,- c �► ' S�aJ
Property Address x
(Verification required from Planning Department for new construction)
�
City /State New 4 t M 1 _ arcel Identification Number
LEGAL DESCRIPTION
1 fit] '/4, Sec. T N -R
Property Location /V;" W, Town of S%� I �/`,yci,C` /�
/,,
Lot #•
Subdivision t�V� rT � �
b3 Volume Page #
Certified Survey Map #
635 , _ 7 ,
Warranty Deed # - , Volume I Page # l0
Spec house ®yes 0 no
Lot lines identifiable W yes O 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.
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
s of the e ye� exp' lion date. /
icy 1 1
DATE `
SIGNA OF APPLICANT
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 rty described e, by rtue of a warranty deed recorded in Register of Deeds Office.
ca el
SIGNA APPLICANT DATE
An information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
* * *s ** y
** 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
VOL 1431 619
0& a -&:a C-31 alp
` STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
Dmument Number WARRANTY DEED ST. CROIX CO., WI
This Deed, made between Greenwood Enterprises. Inc. a Wisconsin RECEIVED FOR RECORD
corporation Grantor, and Ervin T Ericksen and Vickie L. Ericksen, 06 -04 -1999 1:40 PM
husband 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 #
CERT COPY FEE:
COPY FEE: 2.00
TRANSFER FEE: 56.70
RECORDING FEE: 10.00
PAGES: 1
Recording Area
ame an et a
Edina Realty Title
400 South 2nd Street
Suite #115
Hudson, WI 54016
p 3� - /�S5- 1 a -•c>ad
Parcel Identification Number (PIN)
This is not homestead property.
(is not)
Lot 14 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 record.
Dated this,,jU day of 1999
GRE D ENTERPRI C 14 By:
* *� .Rusch, its presid -
Y
* *Mary R. sc secr
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) James E. Rusch, its president STATE OF WISCONSIN )
) ss.
Croix County ) 7
authentic led thisc��fday of May, 1999. Personally came before me this �_ day of
1999 the above named Mary R. Rusch, its
r s retary to me known to be the person(s) who executed the
regoing instrument and acknowledge the same.
CEO 1 S A Ir -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Slats.) * No b l�icl
Gc, State of Wisconsin
THIS INSTRUMENT WAS DRAFTED BY My Commissio is p g nent. (If not, state expiration date:
Lois A. Murraj, Zilz, Estreen & Ogland, LLP i g )
304 Locust Street, Hudson, WI 54016 B ,&da Poulin
(Signatures may be authenticated or acknowledged. Both are not Notary P Ub lic
necesury.) State Of/1SCOTISIrt
-• of persons signing in any capacity should be typed or printed below their signatures
,RRAN<V DEED STATE BAR OF WISCONSIN
FORM No. I •1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800 - 666-2021
A
D0.00' 200.00 66-00'
0 10' DRAINAGE EASEMENT I -1 - I
0
O O
co
CD 0
co 100 CO m
I co m
13
W l4
{ W W I
) sq. ft. 57.600 sq. ft.
355 ac. ) ,�-� I.. cam M I
1._��� ac. � -
° i cu cu I
°
° I z z I
0
I 33' 33' i
616'
63.00 — 200.00 — -- L
�� S89 263.00'
20 19 N89 °07'26'W 1199.00'
— 72.00' — — 192.00' r — -- — — 188.00'
CD
0 0 0
CD o
0 0
0 0