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HomeMy WebLinkAbout038-1132-10-600 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT ST. C ee 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)], 338982 Per `NL�V1§t7A ❑ City p Village Town of: State Plan ID No.: ', VIKI STAR PRAIRIE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: f � 0/ 038 - 1132 -10 -600 TANK INFORMATION EL NATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i Benchmark Ir 103,1'r Dosing i/Z -► p, =` ^ ! 0 1.1 1r (0 •?Sa Aeration Bldg. Sew -4 (O 3 � `I��• $'(� Holding St/ Ht Inlet �tl f( 3 , �' D TANK SETBACK INFORMATION St /Ht Outle A �I.S - 9 �j3,6(m TANK TO P/ L WELL BLDG. AirI to ntake ROAD Air I Septic > 50 ++ NA Dosing NA Header / Man. Aeration NA Dist. Pipe = jD ' — tn•gL 42• g'f 12. St tt• 6 . [ Holdin g Bot. S stem e t? y 3. now 9 el;* • o • 2S PUMP/ SIPHON INFORMATION Final Grade 'yo 9a s5� Manufacturer Demand I'$,8` Model N er GPM �j. / b �{•Z.� TDH Lift Friction Syste TDH Ft Forcemain Length Dia. m ead Dist. To well SOIL ABSORPTION SYSTEM Width Lengt f No. Of Trenches PIT No. Of Pits Inside Dia. Depth DIMENSIONS s DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN Manuf urer: SETBACK CHAMBER INFORMATION Typeof ► , (Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold u Distribution Pipe(s), x Hole Size x Hole Spacing I Vent To Air Inta ke Length l�P_ Dia. Length Dia. Spacing _ S 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 El Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE 32.31.18,NW,SW 1819 WINDING TRAIL ROAD O IN D wjk y o — c* 5, - > s pp J �n� - � F.OtL `� " I�ws(k reGe N ® Flan revlsion required? ❑ Yes X No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. NVSafety &� and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue 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 County than 8 1/2 x 11 inches in size. % c—: • See reverse side for instructions for completing this application State Sanitary Permit Number 3 3Trq ?a- Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)l. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location / iG & a r� cJ 1 /a � 1/4, S e a2 T t V , N, R /F- E (or)�o Property Owner's Mailing Address Lot Number k4od A ' 7�� mber ,IB.r ; gr [P City, State Zip Code Phone Number Subdivision Name or CSM Number r N� 11 . T E B ILDING: (check one) E] State Owned It rest Road Public 1 or 2 Family Dwelling - No. of bedrooms valage TownO �y + .' III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)� 1 ❑ Apartment/ Condo D 32 •il ,t8, f4v F 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 l i IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. g_New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. Q Repair of an ______ System________ System_____ ________TankOnl�r______________ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 []Seepage Pit C .1� S x 57 r0= 43 Vault Privy 14 ❑ System -In -Fill 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) SQ, S Elevation 0 l<3 7 d I G Feet 15 e "(eet VII. TANK Capacity gal Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank an r G5'lCrru' iL ❑ I ❑ ❑ ❑ ❑ Llft Pump Tank /Siphon Chamber I I I ❑ ❑ I ❑ I ❑ I ❑ I ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's N me: (Print) Plumber's Signature: Stamps) P/ PRSW No.: Business Phone Number: umber's Address (Street, City, S e, Zip Code : I IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Age ign ure (No Stamps) Approved ❑ Surcharge Fee) �a s Owner Given Initial oe� Adverse Determination i00 17 e X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber i rj I &V X- �y °�Oasc rl , tiy -c �v 92 p C 3 Wisconsin Department of Commerce $ A � VALUATION Vivisio7o6 Safety' and Buildings Page of Bureau of Integrated Services in ac nbe wit F s. ILHR $,3,09, Wis. Adm. Code � r County Attach complete site plan on paper not less than 8 1/ x t1 inches in sizd Platt must f include, but not limited to: vertical and horizontal refe e(tce poi? ; direction and pergent slope, scale dimensions, north arrow, and location destake to st road­' parcel I.D. # CO f ! ��-�, �..� 5 ' APPLICANT INFORMATION - Please rin ' {f - � f;;vrr /7 !N R viewed by Date Personal information ou p rovide maybe used for seconds r Y P Y secondar P rp s {P� �M�acy Law, s. 15.04. '1(rri�� 7 Property Owner i tell ' erty Location V er Govt. Lot L �j 1/4��/4,S JZ T 31 ,N,R E (or) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# T.d• B O-A City State Zip Code Phone Number El city village Town Nearest Road , �/ LS o � �.C.� 4 5'g T yo�o S cc , P r j j. ,ti ew Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement !� Public or commercial - Describe: c� Code derived daily flow ` �� gpd � Recommended design loading rate 7 bed, gpd /fi - D trench, gpd/ft Absorption area required 63 bed, ft ft Maximum design loading rate 7 bed, gpd /ft o J trench, gpd /ft Recommended infiltration surface elevation(s) ��, .S 89 -d cQ� ft (as referred to site plan benchmark) Additional design /site considerations Parent material ��� Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ U S❑ U S❑ U S❑ U ❑ s_�E L ❑ S U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .46, Ground gglev .6 ; Depth to limiting f ctor 8 ., Remarks: Boring # ,3 � 7 Ground 4 epth to limiting �$ factor - 21Z Ain. Remarks: CST Name (Please Print) Si re Telephone No. Address Date C T Number SOIL DESCRIPTION REPORT PROPERTY OWNER 61 Page ef PARCEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench i? Z r ►�- 5 ,� o - .� ten✓ c I S �,6 D� Ground yle / 7 Depth to limiting in. Remarks: Boring # Ground elev. Depth to limiting in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # a� Ground Depth to limiting �tor ' "' Remarks: Boring # Ground elev. ft. , Depth to limiting factor '"' Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name Vicki Nueberger Shaun Address P.O. Box 478 Somerset Wi 54025 M 226900 Lot Subdivision Date 1 0 / 25/98 NW 1 /4SW 1/4S32 T 3 1 N /R1 W TownshipStar Prairie M Boring ()Well PL Property Line County ST. CROIX k BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 9 2.1/89.5/89.0/88.2 * H R p Same as Al Benchmark Alt. BM Top of Insulator in Power Pole @ 91.0 Property Line Pro Driveway -4 5% 80' ope Rep A 89.0/88.2 0 0' B -3 20' B -5 40' 40' -1 0' Pri A 92.1/89.5 * 0' B.M. x-20' B -2 o Pro3-Bedroom � House 110' Alt. Property Line No P W C COLLOVA HLDP.S, INC PHONE NO. : 715 549 5911 May. 31 1999 08:05AM P2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address / 1 PwPertY Add . 17 (Vaifiaatioo mpiTed from place * D"nam t for near ooashvadon) — Pared idenwiicatioa Number _• „51�� -1 f3a -,�� p3� -J ►3d� — is lam D OZY property Location , /,, S W i /a, Soc. ,.� T. R .W, Town of sTaR Snbdivis = Lot # Certified sunray Map # vcluaae 3 PaEa # Warranq Deed # 9 1,202 . volume Pw # . Spec houao © yea QO t=o Lot tines idanfifiable 0. yes 0 no sn MAMMA= Ia rolxradosand ucoeofyoursepticsrystomoottkTiosuliinits tohndlewastes.Propermsioteaaaoe cow of proaw$W out the septic twk every throe years or am m, if neodedby a limned pamper. What you p A into the syv= em text Ire ftsnedon of da &antic tank as a truftaft OF in do wfsto dkm d iyo= mw piopesty awm agaes to sAuut to St C ma Zaning DeputmGat a cord. afift ftm, tined by the ow= and by a . �, joumsymmplrunbar, tesn�tedplumberocali�edpamperves+ ty► iarttbst( �) t} aeoneite.vast�aterdispoWl:yaoem is is proper open4* condition aadlar (2) gftr inspection fad pumping (sf eaoeasary), &e deistic tack is lose dun 113 fall of dodge. VV% clue =deniped have read the about mquhaneub cad agm to tmietain titre private sewsp dbpoW ry Mm aitb the stacdu& cat facllt, bwoh u set by die Depuw&eat of Com=um sad the Doputad of NoiW Resoumm, State of WboomhL Ctraftatioa SWIS& tbayom' uptie syst= bas boas maims nod mid be coaapietod and teumW to the St. Croix Co mw Zoning Office witluu 30 days of three year *Vitstion date. SkONATME O APPPLIC.ANT r DATE 7 a orgy I (We) dwA all atatemez” on this faun are lose to the best of my (our) ire. I (we) am (am) the ownags) of to 4.Y desma" above, by virwo of s wumaty deed morded is RegisW of tkc& Of m. � q SIONATURS P App DATE AZY iafow ' tai:- rePMMUeed =Y rsyslt is tht: •••••• Y pmt b=8 revokod by dse zoning Deparacoat •' Iaetade with this application; a tb=ped warranty rood !!roan the Regittor of Deeds ochre 4 copy of the ceatffied tuvey map if aw&mnee is made in tho warranty deed 40L 1404PACE624 • STATE BAR OF WISCONSIN FORM 2 — 1982 598120 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ST CROIX CO., WI RECEIVED FOR RECORD 02 -19 -1999 12 :00 PM WARRANTY DEED EXEMPT # 8 Russell Louis Flandrick, widowed and unremarried CERT COPY FEE: convcvs and warrants to ski Kay. Neuberge an d Joseph J ohn COPY FEE: Neuberg husband and wife,as joint tenants, with TRANSFER FEE: — right of survivorship. ' RECORDING FEE: 10.00 PAGES: 1 THIS SPACE RESERVED FOR RECORDING NAME AND RETURN ADDRESS i the follov.Ing described real estate in St . Croix County, State of Wisconsin: 038 - 1132 -20 038 - 1132 -1 PARCEL IDENTIFICATION NUMBER Part of the Southwest Quarter (SW}) of the Southwest Quarter (SWJ) and in part of the Northwest Quarter (NW}) of the Southwest Quarter (SW}), Section 32, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin described as follows: Lot 6 of Certified Survey Map recorded in Vol. 13 of Certified Survey Maps, page 3591 as Doc. No. 595665. This _ homestead property. (is) )U Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this - 16th day of FPhrnars , A.D., 19,9.8._. t (SEAL) 1. ` (SEAL) • /f U_ __ 2 asell Louis F1 andrj k <r (SEAL) (SEAL) JO's e_ j . AUTHEN ATION ACKNOWLEDGMENT -51*4i Y ' D State of Wisconsin, �. t s� '.k • ,: S.S. St. Croix County. au en?Avitetixs day of , 19 P tsonally came before me this !(•, day of s 19 � � _, the above named Russel L is_ Flandrick, wiowed and ' d ' 1 1 1 1 unremarM.ied - Tl'gt STATE BAR O � WISCONSIN (If not, authorized by' §706.06, Wis. Stats.) to me known to be the person who\Wt:We t (�te,going instrument and acknowledge the same. ' 1` \ � . ��i� / �i THIS INSTRUMENT ED WAS DRAFT BY ' Ru Flandrick ° Brenda W irt.i r iger = 7k Notary Public, St. Croix = Cott'' ' (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If : ttaQpUt�i' necessary .) 8 -12 -01 �i 11 Names of persons signiq in any capacity should by typed or printed below their signatures, %VARRANTY DEED STATE BAR OF WISCONSIN WiscrosinLe Form No. 2 — 1982 FP4 P C COLLOVP BURS, INC PHONE NO. : 715 549 5911 Mar. 16 1999 03:17PM P8 ,v. 03,'1611999 13:55 ��89 @0 ®0H 6LIENl iw: 1%,) ._ CERTIFIED SUR MAP I I-OcArEa IN PART OF THE sWt /a aF THE 5wt/4 aNlr, IN Pair aE THE NWi /4 3F THE SW1E4, SECTION 32, T31N, R1SW, 1'DWN OF S TAR PRAIRIE, S T, CRO IX COUNTY, VISCONSIN V R RAL164 CC4704 ANGLE CWMD 3t:4RING ENGRO I.CNGTM ARC LENGTH 'TAt0fNT 7Ary0ENT I 167AQ' "�Q'dd'OQ" SG5�3�'42 "P 141.V t�5.73' S19•EA 18'V 53t'37'4d"Y OWNER RP 4 Bhp% 42 I w- /4 COW 3� raw RiCMU D w 44y 1 ► b sit7nm 32 UNPLATTED LANr �wo 1 3 ib t$� ( I ^ ^ erxES W is ^� er.rra as rT. U 1 *� Ac I I $ n i 7 QS '1WC Nw1 14 Or TWj '$,4'1/4 4 N f wht v w *mA Y fMt 5ws /4 f G, h $9'3'14" E S2,3a' `! I VOL, a, PG. 216 M: `tip UNwL4TTED LANDS f 3w cormv LEGE \ / ALUA11 E COUNTY ET14N CCszNER >rlONU6�FJV7 FOUiW] 1 i • 1' IRON PIPE FCVND �. 1" x 24' "m PIWE 367 6N1U3 1.66 05. PER UNCAP FART H IOW ROADWAY 9ET3A.:R LACE 1 1/4' REOAR FOUND t;I erttcTM+c partl>:caa SSA iN FC&T t 0 10c 200 Val. t 3 wage 3391 f