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HomeMy WebLinkAbout038-1091-70-002 I ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y 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. 353171 Permit Holder's Name: ❑ City ❑ Village ❑ x Town of: State Plan ID No.: Town of Star Prairie M ev.; Insp. BM Elev.: BM Descri tion: Parcel Tax No.: C� • is ` CS tac TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1.;TD cra Dosing 0 Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK5fiT6ACK INFORMATION St /Ht Outlet TANK TO L WELL BLDG. Aierrintake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe �"• 13 •moo Holding Bot. System E6 ,loo Lt z • / 0' PUMP/ SIPHON INFORMATION Final Graded 67 110 S.to Ma u ac Demand S t cover S �8 • ZZr Model Number GPM TDH Lift L Ion 5 stem TDH Ft ad For _ ain I Length Dia. Toweu SOIL ABSORPTION SYSTEM a ) 0 ,,6 RENC Width t Len th No Qf renches PIT No. Of Pits Inside Dia. Liquid Depth IMEN �J �� _ DIMENSION SYSTEM TO / L BLDG I WELL LAKE / STREAM LEACHING Ma u ctu er: n ` SETBACK -- < 3 - .4,4 t INFORMATION TypeO `���� ) r r ! CHAMBER M el Number: System: Crew OR UNIT etu DISTRIBUTION SYSTEM Header /Mani U Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ia. 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 ITrench Center BedITrench edges Topsoil E] Yes ❑ No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 6 '� 125TODInspection #2: �t` Location: 1140 County Road C, New Richmond, W� � Q n(N�EE 4, NW 1/4, Section 22 T31N -R18W) - 22.31.18.377B Plan revision required? []Yes No Use other side for additional information. © 7- (3 1 0 I j C - _XJ4 I SBD -6710 (R.3197) Date Inspector's Signature Cert No. 1 ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: �.» j s � € s a 3 _2 g ..... fi } t j r E a t aa 3 , z [ jji c I � i � 11 a .,....,,..— ...,.�.� ...... ..... 1 , a....a....__�, ...%.— ...e.,..., w,_� «» .....,...J_... :.�..L. ...._ .... , e.„L...,,. 2., ........ " L . .... ...........L..,3.....,......,,, A......._...........«---. y �9 y �.....,......,........... ..L.».._m,«...8— . ««....:..»... 1 Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 2 1 Box Washington 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 8112 x 11 inches in size. - • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes C] Check if r evision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Nam t P open Location �•Q et Ae,1 /4;V 1 /4, 5 TT , N, R E (o67 Property Owner's ailing Acidress Lot Number Block Number /J7 f" 73 1 CI y S Zip Code Phone Number Subdivision Name or CSM Number `,�6 J S� II. TYPE OF BUILDING: (check one) ❑ State Owned V ° It� ,C t Nearest R ad Public 1 or 2 Family Dwelling - No. of bedrooms ° Town of� / ` t `�`� i 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 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. geNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System ________System _____________ Tank Only______________ Existing System _________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 E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 1 ❑ Seepage Pit f 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFOR ATIO 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 . Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s ft.) (Min. /inch) Elevation - 7 Feet 4W l Feet Capacit VII. TANK in Ca g allo ns Total # of r Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum ame: (Print) Plumbe ' i ature: ar`ps) MP /MPRSW No.: Business Phone Number: P u is Address (Street, C� St to Zip C ): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater ate slue Issuin gent Signatu (No Stamps) 'MApproved El Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Chamber Soil Absorption Systems Permit Number 10/18/99 Date x . X . Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil , Note 1: Bury depth as per manufacturer 18 in Chamber Height 2 8 ft Maximum Bury Depth 3 450 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 562.5 ft Code SAS Size 40 % Down Sizing Credit 225.0 ft Reduction (-) 337.5 W Min. SAS Size 92.20 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 95.20 101.70 1 96.20 96 91.20 94.03 Yes 2 96.20 96 91.20 94.03 1 Yes 3 95.70 108 89.70 93.53 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is equivalent to top of aggregate. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. SBD- 10553 -E (R.05198) PLOT PLAN � PROJECT' �JC� L - (/tGc��� ADDRESS /.� x 111 1 /4V iT N/R W TOWN �f COUNTY S� MPRS Byron Bird Jr 220527 L ( DATE Z e BEDROOM CONVENTIONAL >00( IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AKEA ✓ � # of chambers g BENCHMARK V.R.P. ���� G � � / 1f 1 ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P._�� Vent SYSTEM ELEVATION >12" Sidewinder High ' of Cover Capacity Leaching Chamber with 31.8 6' Long 16" ftA2 per chamber 34" Grade at System Elevation fro i f .� r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # C :� '5 �� � / APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location �C o f Govt. Lot G� 1/4 �� /4,S a T N,R E W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Ci Slate „Zip Code Phone Number ❑ City El Villa a Town Nearest Road New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement M Public or commercial - Describe: Code derived daily flow _� gpd Recommended design loading rate bed, gpd/ft _L gpd/ft Absorption area required bed, ft `trench, ft Maximum design loading rate bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design /site considerations Parent material _ i G' C -' Flood plain elevation, if applicable �� �" ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system S El KS El El S ❑ U [- ILU ❑ S 156 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground Depth to limiting factor W __ / Remarks: Boring # Ground /�e v,, Depth to limiting W in. Remarks: CST Nam (Please Print) Signature Telephone No. Addy s Date CSJ Number PROPERTY OWNER �� d� //� SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure z 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground ear Depth to limiting T factgr �in. ' � Remarks: Boring # Ground elev. Depth to limiting fac or in. Remarks: 3 ' Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 13 Ground elev. Depth to limiting faA �S17in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) � oil Test Plot Plan Project Name' -00 Byron Bird Jr, Address Lot Subdivision d� Date A,10 l Township 0 I3orinb O Well PL' Property Line County BNI or VRP Assume Elevation 100 ft System Elevation �� *HRP / ���� L J� 1 -3 j y V �- 4 l Scale 1/4" = 10 1~t. When Dimensions aren't stated ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND � �OWNERSHIP CERTIFICATION FORM �hvner — J a� Mailing Address Property Address ©z��!/� O " (Verification required from Planning Department for new construction) - &M C. State Parcel Identification Number LE GAL DESCRIPTION 1/ ' ' f /l T ,;2N-R�W, Town of � I roperty Location , ilr� /4, Sec. , Subdivision , Lot #_. Certified Survey Map # �� �y , Volume , Page # �7 Warranty Deed # Volume �y Page # Spec house ❑ yes X no Lot lines identifiable 2 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. 1'he 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. Pwe, 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 6a lie three year expirati GNAT 1ZE OF APPLICANT DATE OWNER CERTIFICATION 1 (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 perty describe abov , vi e of a warranty deed recorded in Register of Deeds Office. /� /� i GNA RE OF APPLICANT DATE * * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ri* 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 j'407 pta X91 `98728 STATE BAR Oe WISCONSIN FORM 2 - 19" R H. E5N REGISTER R OF D DEEED unt ent Numbe p ST. CROIX CO,, WI This Deed, made between Miehpel J. Uteca+ and Jeanne A. Utech� RECE'.VED FOR RECOJ husband and wife 03-03 -1999 9:30 AM Grantor :.nd J oseph A R>aho and Dana L Raboin husband And wife. Grantee. YARRANT DEED I XEMPi Grantor, for a valuable consideration, conveys and warrants to Grantee CERT COPY FEE: the following described real esta' • in St. Cruix County, State of Wisconsin (The TON FE : FEE: 103.20 . Property*): RECORDING FEE: 10.00 PAGES: 1 Recordi Area Name ani Return Address NOfMN W SAVM BAN( = KWMM DUK FICHMM, VA 60 038 - 1091 - 70-002 Parcel Identification Number (PIN) This 1s no t homestead property. Part of the NE1 14 of NW1 /4 of Section 22, Townstip 31 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 3 of Certified Survey Map filed September 7, 1984, in Vol. 5, Page 1459. Doc. No. 396143. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of March, 1999. • Michael J. ht 5 �zz a,--e— * Jeanne A. Utecht ' AUTHENTICATION ACILNOWLEDGMENT Signature(s) Michael J. Utecht and Jeanne A. Utecht. husband STATE OF WISCONSIN ) and wife ) SS. authenticat°d this day of March, 1999. county ) PersarWly came before me this day of the above named ' Kristin Og _to me lutcwn to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrumetu and ackrwwlodo_ the same. (If not, authorized by 1706.06, Wis. Stats.) THIS 1IN STRUMENT WAS DRAFTED BY Attorney Kristin Oglend Notary Publim. State of Wisconsin Hudson, W1 54016 My Commission is pemlanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) 'Narms of persons signing in any capacity should be typed or printed below their signatures WARRANTY VEM STATE RAR Of WISCONSIN FORM Na 2.19" IMFOMAAT':04 FROFESSK'N S COMPANY FOND DU LAC. WI 800-%•2021 A€'�,• E4 t R v Ar 4 I T 2T» 232.86 Ar 1 _I O 0" ,• ,So sr' (j ; .,: � �, a. t t ... e i J e'�' t• �ir r 4 . •�R K r3 i or, $I rear. (cott r �•"' Nbnr*f LIOrE or ##rg rrr�r �itQittilFrr�K# tRr 8 9046'34" ."'",.._.$�9,Q 4 a aec.�cs . TAT its LOT 2 3t LOT 4 5 NG v . 3, 5 £} bCRIP3 0 ♦ 4C R' � 3.0"36 ACRES *� r C?fit E ink r y � SQ �y 2 5 ` J� �.�r 220, 2'5,8 S8 FT _ saely.r iyy ® 1� #� ( �7 -11.. R`.i +�i.r J.f�K. +�.�t: {0� p J 3 ,1 69AC.roI�.�O_�` y Q (201,6 Q?•�T�€4.��r� c� 4..4804C.r+0.o_aw� ALL. €223,t!f354Je 3. 11tQ tr'Za 1R '0 WAT �, � "" "� 192- -0' 2 , t 1 94, 6€14 3a�RT i€ 31�. X34' °b "p,, .,. e'- =,� = '",I�'r'2 w -- • "" �' t 4.!`o` 4 6 4 . 44 3 -49' 509 • ZT- cc rl S CAL.E... _t" 3 1 50' 3Qt? 600 O SEr r "x 2#" tROM PIPE wrIGHING F I.t3 LIPS, PER LfNEAL F00r. _ f"1401t PIPE 'cau a. ►,. _9 ANO Asscc. r r, FILED M � a .1984 co b@W* Of �61�3 SEE SHEET 2 OF 2 FOR DESCRIPTION p Cmk CERTIFIED SURVEY MAP e LOCATED IN THE NW I/4 OF THE NW 1/4 AND THE NE I/4 OF THE NW 1/4, SECTION 22,T31N, R18W, TOWN OF STAR PRAIR- IE, ST.CROIX COUNTY, WISCONSIN OWNED B Y. IRENEBALZART 18980 FENWAY AVE. NORTH ,p tsesselfifi U,NPLATTED LANDS FOREST LAKE, MN 55025. WEST OF - _ — - _ _ p w o G �� V1 % THE NWI /4. - ' x �, �1 i 1' I N 0 "E 790.47' s5.25 :,� a o A M • w a �C W m� o�_ _.. 416.79' 274.49' I �WZ '� w Oa p wp cnD gmt m n D 33.94' ` :� ZZ0 :� .:t• o o� .'l. w I � m rn A • `� i o N n fq 4. CO N 6 , 1� ^' 1' o z ro V i N 01 ..y •(�i • c N Nn boa ' N N x M a M w e xrN - 3 O rnrn V " n cn w w. ri M , li 1 �L o y n , ,,. . -� V V D F,tm z e ` V Vz a Q1 C I - �N to v ° �1 0' \ y 0 c O 3 DD pl O O \ N N 0 W�p : \ W N a n ,y CX q .4n N C:; 1 my wn, ni.'', \ nay w Z : M ot .. -1 y a ` � w -2 sl °o2'IO "w 511.77' .� •;;� -� "n 467.78' +� � 2 A O G) O ga � M N of , Na O C N k vN wf� w 00m v mA -I O w M x: �' -0.4 r m O C i o A CL Z m2 _ `� r SI 0 02'10 "W 477.12' O 10 33 444.11' o: N - 4 APPROVED 0M (A 2 w; o i, :U -� O y _ N � x S , '� oN 0 to Z $ P 0 51984 Z B RANDENTT � f e `D o G) _AVg,NIZ ^_' 0o V y c ^ ' (A i0 -1 ti5�r <OIX COU•'T _ M. I x'I a x 0"1'.FItiENSIVE PARKS f:A;• :G "�- to V X Z rA?4 ONING COmmll1Ec �-� 1 S I -62'10"W 473.73' IE .. I 55.01' 418.72 # �, I _ANA OW2.�� •�� I I to�,00 r Z -�•y .Ui 1001 0, aw M DN0) 0 3zn v C m Im0n (Aa ,-� 0 z�xo :f11 NOTE: Ol4 1AOpo� • BEARINGS REFERENCED TO THE NORTH 1. _ ;0 PM m � 0 LINE OF THE NW1 OF SECTION 22. - 1 10„' ) co�:CL' (RECORDED BEARING 49 1 1 "� Z cN = 55.01' 415.88' 1 S 1 0210 "W N - S QUARTER LINE ✓ I 551 470.89' UNPLATTED LANDS SHEET I OF 2 Volume 5 Page 1459 I - •�,.' ��;! - 11111111111► ,� , / ►� �Ii11I li,� ��. iiii • ■■rear eee■ ►.e ■rll■e■ j ■r:ee■ i ,rear• ii. I ` • koddemommuss e Naomi IN f ■anal • ,■■ ■r■rl • �r ■ur■r l Imes ■�■ ■err.■■ r • ST. CROIX COUNTY WISCONSIN ZONING OFFICE m a i l A M N N N■ NOUN ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 - - (715) 386 -4680 Fax (715) 386 -4686 September 11, 2000 P.C. Collova Builders Attn: Laurie Collova 705 County Trunk E Hudson, WI 54016 RE: Septic Inspection for Joe Raboin located at 1140 County Road C, C.S.M. Vol. 3 Pg. 1459 (Lot 3), Star Prairie Township, St. Croix County, Wisconsin Dear Ms. Collova: A septic inspection of the above referenced property was conducted on 07/25/00 . This property is located in the NE 1/4 NW 1/4 of Section 22, T31N R18W, CSM Vol. 3 Pg. 1459 (Lot 3), Star Prairie Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Kevin Grabau Zoning staff /sm cc: file