HomeMy WebLinkAbout038-1189-50-000 ST. CROIX COUNTY ZONING DEPART f I l k - o o .
AS BUILT SANITARY REPORT � ..�..
Owner Okr,e ry
Property Address q
City /State ham" , �, " - NT", l
Legal Dqscrip tion:
Lot Block Subdivision/CS #
lt/ t /4 . ' /a, Sea) , TN -R W, Town of ar . -r�,rs PIN # cJ �° �� S
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer Size ST/PC'" Setback from: House — Well 114 PAL 41 m
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 / K rj
Type of system: e Width ' _ Length' Number of Trenches
Setback from: House Well /2r1w, IL Vent to fresh air intake
ELEVATIONS
Description of benchmark /` Elevation
Description of alternate benchmark /�' C. -�—J Elevation
� S ,ws �� a v rf
Building Sewer ST/HT Inlet a" ST Outlet Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( 9)
Bottom of System (,) (�.) 1 ( )
Final Grade
/ e /� P ermit number '� ate plan number
Date of installation _� p
Plumber's signature License number zo�' Date�ll' /�
Inspector Complete plot plan �+
i
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
60
INDICATE NORTH ARROW
.Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT St. Croi
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)]. 1-511 9R
Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.:
CS BM ev.: p. BM Elev.: BM Description: Parcel Tax No.:
6V T ns 00 " 'a
TANK INFORMATION EL VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� S Z�. Benchmark 3 8 P /0e:
Aeration Bldg. Sewer ,? 'fe JZ
H g St Ht Inlet ( 0
TANK SETBACK INFORMATION A Ht Outlet G S
TANKTO P/L WELL BLDG. Ventto a ROAD '
Atgow
Septic 'ro0� i(ff �� I o NA EU
NA Header / Man.
Aeration NA Dist. Pipe --r
Ho g Bot. System r i `
PUMP/ SIPHON INFORMATION Final Grade , Z .�'' r 7
nufacturer : ::: � a ncl
I Qt
Model Num P
TDH Li Frictio S stem TDH
Loss
F cemain Length Dia. st. To well
SOIL ABSORPTION SYSTEM Z � Ca
BED RENCH Width - Leng 1h--�� / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM 7 S Z I i DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC NG Ma u acturer:
SETBACK -
INFORMATION TypeO f 3bi (,C IT N� er
System:
DISTRIBUTION SYSTEM
Air In
Header /Manifold T Distribution Pipe(s) x Hole Size x Hale Spacing Vent • A Intake
e
Length _J� Dia. 7 Length I,ff Dia. M Spacing ! /v, N 71 Q /
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: // /l0 / ffInspection #2•
Location: 2144 136th Street, New Richmond, WI (NW1 /4, SE1 /4, Section 13 T31N -R18W) - 13.31.18.967
1.) Alt BM Description = 7�
2.) Bldg sewer length= Z 6 �
- amount of cover = 7' /d► if
(jcll A*e j )oC,i_,ao1
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. a
SBD -6710 (R.3/97) Da a Inspector's Sig re Cert. No.
` Safety and Buildings Division
•
Asconsin SANITARY PERMIT APPLICATION 2 1 B W shington Avenue
Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State sanitary Per �umb�er
Personal information you provide may be used for secondary purposes [ if revision to pre viou's application
(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
is j tia, S/ T ffBlock , N, R E (or
Property Owner's Mailing Address Lot Number u mber
4 0ty,ate Zip Code Phone Number Subdivision Name or C� Number
1. YP BUILDING. (check one) ❑ State Owned ❑ C Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms A ro wan OF� /dY ^�/'�lJ�(�� `ZA ,# --
III BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) ��,? 18. (.n
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. E] Replacement 3. E] Replacementof 4. [3 Reconnection of 5. E] Repair of an
System -------- System_____________ Tank Only______________ ExistingSystem ________ Existing System
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 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In- Ground Pressure f I 42
13 ❑ Seepage Pit r r k 4 E] ault rivy 00
14 ❑ System -In -Fill / Gcc �f G� /
VI. ABSORPTION SYSTE110 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) _ Elevation
�� 33 Feet Feet
Capacit
VII. TANK in Ca allo
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App
New Existing strutted
Tank Tanks '
Septic Tank or Holding Tank 0 2 e S �' ❑ ❑ ❑ ❑ ❑ 01-
Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumb 's Name: (Print) Plumber's Signature: (NO Stamps) MP /MPRSW No.: Business Phone Number: / J
Plum s Address ( treet, Cit ��e, Zip Code):
l?'1 Ea c 4�0
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved S itary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) �
El Given Initial
- Approved Adverse Determina c Ob
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS •
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. 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 by 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, 608- 266 -3151.
Y
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
ll. 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. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale of with complete dimensions, location 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; frictionaoss; 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.
PLOT PLAN 1 7 3 1
. PROJECT rCel'e ADDRESS �Gcl
1/4 / ��G 1 14S �� /T s'� N/R ,(�' W TOWN j� COUNTY_r
1� �� !1� t`Z� CO J 1 -c
Zl
MPRS Byron Bird Jr . 220527 ter DATE /'p 22L�y BEDROOM
CONVENTIONAL X)OC IN -GROUN PRESSURE EN O V TIONAL LIFT HOLDING TANK
C N
MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers
BENCHMARK V.R.P. , p ���L� ASSUME ELEVATION 10U' /47 ❑ BOREHOLE O WELL *H.R.P. ��J �i i^r��ofLi_✓ li �.
SYSTEM ELEVATION 3 ✓
jL idewinder High
apacity Leaching
hamber with 31.8
t ^2 per chamber
34 Grade at System E levation
l
1f
� � H
1 A
- 7y
f �O
unp4��
V
v
!e
/ 41 7'0
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. C rQix
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 -95
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION VI W D BY DATE
.�
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT NW 1/4 SE 1 /4,S 13 T 31 N,R 18 k(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
1416 Third St. 18 1 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EFOWN NEAREST ROAD
14udson. WT_ 94016 ( )
[ New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building
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 • 7 bed, gpd /ft - 8 trench, gpd /ft
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 MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem El S 1:1 U �S ❑ U ®S O U ®S O U ®S O U O S CCU
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 Tre &
1 <> 1 0 -13 10 r 2/2 none 1 2msbk mf if .5 1 .6
2 13 -30 10 r 4 4 none sicl 2msbk mfr QW if .4 .5
Ground 3 30 -84 7.5 r 4/4 none cos 0SQ M1 na na .7! .8
elev.
9 9.1 ft.
Depth to
limiting
factor
+84 '
Remarks:
Boring #
1 —12 10 r 2
2 12 -32 10 r 4/4 none sici icsbk mfr QW if .2 .3
Ground 3 —
elev.
98
Depth to
limiting CE
factor
+84 �'' �-� . `= NOV 4.,;
Remarks: u' COUNTY
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. Richmond WY 54017 / T
Signature: Date: 10 -29 -98 CST Num er: m02298
PROPERTYOWNER Greenwood Enterpris DESCRIPTION REPORT Page 2 ' of 3
PARCEL LD. # 038 - 1055 -95 '
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 0 -12 10vr 2Z2 none 1 2msbk mfr gw if .5 .6
2 12 -32 10 4 4 none sicl lcsbk mfr 9w 1f .2 .3
Ground 3 32 -84 7.5 r 4/4 none cos 0sq m1 na na .7 .8
elev.
98.9 ft.
Depth to
limiting
factor
LJ
Remarks:
Boring #
1 0 -10 10 r 2/2 none 1 2msbk mfr
gw
if .5 .6
4 2 10 -30 1 0yr 4/4 none sicl lmsbk mfr gw if .2. .3
Ground 3 30-84 7.5yr 4/6 none cos osq ml na na .7: .8
elev.
gg ft.
Depth to --
limiting
factor
+ "
Remarks:
Boring #
1 0 -13 10 r 2/2 none 1 2msbk mfr gw if .5i .6
5 `' sicl lmsbk mfr Q w if .2 .3
Ground - none cos 0SQ m1 na na .7 .8
elev.
9 8.7 ft.
Depth to
limiting 'Z
factor
1 84"
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave.
CSTM Nw4sE4 S13- T31N -R18w New, Richmond, WI 54017
MPRSW -3254 town of Star Prarie (715) 246 -6200
lot #18- 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 =40'
BM.= top of 1 11 pvc pipe @ el. 100'
Alt.. Bin.= top of 1" pvc pipe el. 100.10' /
Oft AV 4-1
/peas
Gary L. Steel
10 -29 -98
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer FO C IW
Mailing Address /
Property Address f�
(Verification required from Planning Department for new construction)
City /State �t ¢ Parcel Identification Number !:� /mss i
LEGAL DESCRIPTION
c �
Property Location V"- '/4, Sec. , T N -R Town of
Subdivision �'``�j , Lot #.
Certified Survey Map # � e 3 ) 1" , Volume , Page #
Warranty Deed # �j� , Volume 6� , Page #
Spec house ❑ yes 9 no Lot lines identifiable o 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
da s o t three ye a 'piration date. PL/ jD /26 / qq
SIGNATURE 6P 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 propei descri ed bove, 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.******
** Include with this application: a stamped warranty deed from the Register of Deeds office
a co of the certified survey ma if reference is made in the warrant deed
copy Y P Y
• VOL 1466PAGE 144
Es 1275fs
STATE BAR OF WISCONSIN FORM 1 -1998 KATHLEEN H. WALSH
Do Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Greenwood Entcorises Inc. a Wisconsin RECEIVED FOR RECORD
corporation, Grantor, and Todd Marek. single person, Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following 10- 26-1999 2:30 PM
described real estate in St. Croix County, State of Wisconsin (The "Property"): WARRANTY DEED
EXEMPT D
CERT COPY FEE:
COPY FEE: 2.00
TRANSFER FEE: 56.70
RECORDING FEE: 10.00
PAGES: 1
Recording Area
N ame and et 0:
Edina Realty Title
400 South 2nd Street
Suite #115
Hudson, WI 54016
03 %- IIC9 q -`.5b
Parcel Identification Number (PIN)
This is not homestead property.
(s not)
Lot 18 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 of �C fin, ".
GRE D ENT S , INC.
By
* *J Rusch, its president
y•
* *Mary R. c s ry
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) James E. Rusch, its president STATE OF WISCONSIN )
) as.
/� St. Croix County )
authenticated this �r day of October, 199 Personally came before me this day of
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.
jT LE-: MEMBER STA BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
Notary Public, State of Wisconsin
THIS INSTRUMENT WAS DRAFTED BY My Commission is permanent. (If not, state expiration date:
Lois A. Murray, Zilz, Estreen & Ogland, LLP )
304 Locust Street, Hudson, WI 54016
(Signatures may be authenticated or acknowledged, Both are not
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM Na 1 -1"Is
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, W BOO -SES -2021
r
303
��•`��`�iJ%SG O NS ��••� Located in part of the N Vk' 1 '4
713 •
•; ; • SE 1/4, being also in part of l
iurveyor ' LAURENCE=
i • \�
, n Section 13, T31N, R18W,
:h, 1999 s W MURPHY i c: �► I
S »>a i � UNPLAT T r Il
CA •'. RIVER FALLS, . ; • ,
F •'• WISC. ♦
. J
LAND S�.•�'� S89 °07`26'E 3645.68'
209.00' 66 0' 300.00'
200.00' I 1
'26'E °0 804.00' o �-- 100' °
CD cD 100 1 Q
co I CC I 1 7
CO w CO
17 1 1 *' 63,190 sq. ft. +
u' 1 1.451 ac.
w
ft. M 57,600 sq. ft. 60,192 sq. ft. I _ ;� I
�u 1.322 ac. iu 1.382 ac: 1 (n�- ,oaf
In o I cu �,. L •2�
z — — Z - on In
1 ° O I 2
I Z z I
-- I 33' 33 , 1 �.;
616' L
200.0 I - 209.00'
� -____ - - -- 0' - - - - - -- - '
13 •�
S89 °0 7'26' E 8 04.00'
199.00' �
- - - 191.00' - - 188.00 - - - - - 179.00 - -
0 0
0 0
i o o W=
o M
88 L% 27 M 26 Q� `� ,00' I
56,400 ft. ' ft. e r
n 57,300 sq. ft. N sq ,n 57,877 sq. o� I ,1 14
1.315 ac. 0 1.295 ac. 0 1.329 ac. c CO o y
z 2 0
r�
Z 2rir
10. I m u i
N
• ." 0 ,
10 ' 55,756 sq. ft. I
188.00' 125.00' 1.280 ac.
191.00' I�
W 2139.00' 10' DRAINAGE EASEMENT
fop.
0
LANDS