HomeMy WebLinkAbout020-1341-15-000 - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
,Safety and Buildings Division Count
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary315917
Personal information you provice may be used for secondary purposes [Privacy Lay, s.15.04 (1)(m)).
j�ffji drA NaVI .E7�
U �Viage E] Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: o� BM . Description: Parcel
T
TANK INFORMATION ELEVATION DATA A9800306
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septi �L� Benchm k q 7. 3 3 167.0
Dosing
Aeration Bldg. Sewer
Holding St /Ht Inlet q_S� jaa.
TANK SETBACK INFORMATION a ` St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic �✓ l ' 7 NA Dt Bottom
Dosing NA Header/ Man.
IT Aeration NA Dist. Pipe T Z 9 - 7/ Z5 3--
9.2 c l7 - 7 f0t�
Holding Bot. System T
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer D�
Model Numb GPM
TDH Friction tem TDH Ft
Forcemain Length Dia. Dist. To well
SOIL ABS TI ON SYSTEM
BED TRENC H__ - Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM N N DIMEN I N
SETBACK
SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LE Manufacturer-
CH
INFORMATION Type / BER - ode Number:
cyst OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold r/ Distribution Pipe(s)� x Hole Size x Hole Spacing Vent To Air Intake
Length 1Q! Dia. Length _7s -&m 3 Spacing 17 5 1
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 E] No
COMMENTS: (Include code discrepancies, persons present, etc.) r
LOCATION: HUDSON 24.29.19,SE,NE 887 YOUNG ROAD - WYLDWOOD II LOT 15
Pit wry w "�eC AIrri woks
Plan revision required? Yes 14 No
Use other side for additional information. g � j ( L 5
SBD -6710 (R.3/97) Date Inspect s slignature Cert. No.
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT / Yn
Owner
Y ST CROIX
Address oco , ^� WUN
CityJState
ZONING CFFICE
,�
Legal Description:
Lot h Block Subdivision/CSM # 4 -� lez
�E Sec. �T lj/�W, Town of PIN #
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
_l - I 0 �
Tank manufacturer Size ST/P(l �/ Setback from: House _f� Well 1 96 L
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road ent to fresh air intake Wa ne
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
C�l
l
Type of system: //l �= Width Le �� Number of Trenches
Setback from: Hous We
_ ll P/L to fresh air intake /2 d'
ELEVATIONS
Description of benchmark A Elevation �ad
Description of alternate benchmark Elevation -a (5
Building Sewer . Cuff ST/HT Inlet ST Outlet •% , PC Inlet
PC Bottom r— Header/Manifold -Job Top of ST/PC Manhole Cover/
Distribution Lines( ) Sot () � Z
Bottom of System (
Final Grade
Date of installatioq� / / e m' number � / `� // / State plan number
Plumber's signature License number 6:1 496 Date 9P
Inspector
(bmplete plot plan r+
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
i
i�r n
i
.
t
� - 3 7 5� Tr
Q `
INDICATE NORTH ARROW
�r� h-
Vi s � 6n� i n SANITARY PERMIT APPLICATION 20 Safety and 1 E. WashngtonAD'vision
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on'paper not less County
than 8 112 x 11 inches in size. , C y'O 1 ?4-
• See reverse side for instructions for completing this application State Sanitary Permit Number
369ti
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)). State Plan Y.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N - ---- --
Property Owner Name Property Location
�� "�S��t/ Ev4 _1/4, Sp? T ,N,R E(o)W
Propertv Owner's Ma ng Address Lot Number r Block Number
l /
City, 5ylte Zip Code Phone Number SubdiviponNprie or CSM mber
II. TYPE OF BUILDING: (check one) ❑ State Owned ci Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Tow OF /*
III. 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 'New 2. ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
_"System ________ System____ _________TankOnly______________ Existing System _________Ex - 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
12E464epage Trench 22 ❑ In- Ground Pressure t 1 42 [] Pit Privy
3 ❑ Seepage Pit 3 X 7� 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 . ft.) Pro o cl q ft.) (Galslda /sq. ft.) (Min. /inch) t> - 17a Elevation
eet Feet
Ca ac)t
VII. TANK in allon Total # of Prefab. Site Fiber- Exper
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Co" steel glass Plastic App
New Existing strutted
Tanks Tank
Set! Ltic Tan ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name: (Print) ✓C � Plumber's S a e: (No t s) MP /MPRSW No.: Business Phone Number:
Plumber's Add re s (Street, City, State, ip Code): � �bl
IX. COUNTY / DEPARTRAr-MY USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issu g e t Signature (No Stamps)
I S O Approved ❑Owner Given Initial era Surcharge Fee)
Adverse Determination t� , ��
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBE14MI (8.11/86) OISTRiBuTicillil: Originel to County, one copy To. Safety 6 Buildings Division, Owner, Plumber
I
PLOT PLAN �y
PROJECT �. �� ADDRESS zo� _ 2 t _
1/4 1 / /4S,-; /T N /R W TOWN OUNTY
MPR DATE / `� 7- � BEDROOM
CONVENTIONAL X IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE o LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE , ABSORPTION AREA / 7 # of chambers a y
CHMARK V.R.P. / �✓
/-I- /-I- U- 1 c . ASSUME ELEVATION 100 ,
❑ BOREHOLE O WELL *H.R.P.
Vent
SYSTEM ELEVATION 9 ;7
>12" Sidewinder High
of Cover Capacity Leaching
Chamber with 31.8
ftA2 per chamber
'Long 16"
34 „ Grade at System Elevation
chi
at Wed I
I
l
S
1
- 3Y , S
,3 02 7
7 010
1 �
1
- - - -- � /, ��.� l� � .?c'Y •' y'J� -aim. 7/ �''%. -(i
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and.Hurnan 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 roix
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. 020- 1329 -90
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IE ED BY D T
PROPERTY OWNER: PROPERTY LOCATION
Greenwood En terprises, Inc. GOVT. LOT SE 1/4 NE 1/4,S24 T 29 N,R 19 Fir) W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM #
1416 Third St. 15 na I W ldwood Phase 2
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE EjfOWN NEAREST ROAD
Hudson, WI. 54016 (715)386 -3674 Hudson I Youn Rd.
:k ] 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 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) 96.70 ft (as referred to site plan benchmark)
Additional design /site considerations alt. area= trenches @ 95.90 93.60'
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 1 N S ❑ U NS ❑ U N S ❑ U IRS ❑ U ® S ❑ U ❑ S 0 U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
..................
.................
..................
.................
1
1 0 -9 10yr3 /2 none 1 2msbk mfr gw 2f .5 .6
2 9 -21 7.5yr4/4 none sl 2mgr mvfr gw if .5 .6
Ground 3 21 -82 7.5yr4/4 none co s Osg ml na na .7 .8
elev.
9 42.. ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
1 0 -11 10yr3 /2 none sl 2msbk mfr cs 2f 1 .5 .6
2 2 11 - 5yr4/4 none is Osg mvfr 9w if .7 .8
3 24-1013 7.5yr4/4 none co s Osg ml na - .,7 .8
Ground
elev. ,
10 ft.
Depth to
limiting cr,
factor
+1081, �, . sT C x
ZONINGOFF!CE ,.,
Remarks: if area of B-2 used, area to be backfilled to code X
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200tVVAve., New Ric mond WI 54017
Signature: Date: 4 -6 -98 CST Number: m02298
r
I
PROPERTyOWNER Greenwood Enter. SOIL DESCRIPTION REPORT Page 2 of 3
I
PARCEL I.D. # 020- 1329 -90
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Barbary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -18 10 r3 2 none sl 2m r mvfr qw if .5 .6
2 18 -84 7.5yr4/4 none co s Osg ml na na .7 .8
Ground
elev.
9 9.4 ft.
Depth to
limiting
factor
a 4
Remarks:
Boring # 1 0 -12 10yr3/2 none sl 2mgr mvfr gw if
. 5 .6
2 12 -80 7.5yr4/4 none cos Osg ml na na .7 .8
>>
Ground
elev.
9 6.4 ft.
Depth to
limiting
factor
+80
I
Remarks:
Boring #
1 0 -21 10yr3 /2 none sl 2mgr mvfr gw if .5 ` .6
�> 5 2 21 -90 7.5yr4/4 none co s Osg ml na na .7 .8
Ground
elev.
9 8.0 ft.
Depth to
limiting
factor
+90 11
Remarks:
Boring #
Ground
elev.
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 SEgNE4 S24- T29N -x19W (715) 246 -6200
t - lot #15- Wyldwood phase 2- town of Hudson
N
1" =40
BM.= top of SE lot corner stake C el. 100'
Alt. BM.= nail in wood post C el. 99.90
Soil test was done to satisy a zoning requirement, it may or may not be
satisfactoru for your use.
p� P �
- l0
Ob p� b
32 �
` p l o )V g
Gary L. Steel
4 -6 -98
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer i ick �,6155 te -
Mailing Address S`I &A_. s .94vee � &t'UUj( , 6 j z
Property Address / gojoat 0 1,0twoox l 'i 4/ -^
(Verification required from Planning Department for new construction)
City /State 96", (�J �' Parcel Identification Number OZ-0 -/
LE GAL DESCRIPTION
Property Location %4, `/4, Sec,,-N -R, W, Town of
Subdivision �y�or�/ ��— G�-4�� , Lot # Z�-
Certified Survey Map # jl� , Volume , Page #
Warranty Deed # D 3,9 / , Volume /�� �, Page #
Spec house ❑ yesf?�rno Lot lines identifiablXeyes ❑ 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
daWftlhr year ex iration date.
SIGNATURE OF 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 peecribed t 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 copy of the certified survey map if reference is made in the warranty deed
.� , may.- aa. t — .—
x8 8'78 10L 1�;��PAGES
t ,.n : Nun WARRANTY DEE1D
R ECfft4' S�O f ff
This Deed, made bett•nen Greenwood Enterprises„ htc., a 1 5T. CROIX CO., WI
Wisconsin corporation, Grantor, and Rick L. Geissler and Kelly M. P•c'd +rr ae.or'd
Geissler, husband and wife as survivorship marital properrv Grantee. JUL 141998
Witnessath, That the said Grantor, for a valuable consideration
of one dollar and other good and valuable consideration convoys to 8:40 A
Grantee the following described real estate in St. Croix Coumv, State , . t)�
Of Wisconsin: Re star of Coda
Recording Area
Name and Ratum Address
�/1T �lyot o6
(Parcel Identification Numbed
Lot 15 of the Plat of .,iyldwood 11, filed in the Office of the Register of Deeds for St. Croix County, Wisconsin
on May 27, 1998 in Volume 7 of Plats, at Page 20, as Docunwnt Number 5791316.
T ER o SF
$ —
This is not homestead property.
Together with all and singular hereditaments and appurtenances thereunto belonging;
And Greenwood Enterprises, Inc., warrants that the tide is good, indefeasible in fee simple and free
and clear of encumbrances except easements, reservations and restricticns, if any, of record and will warrant
and defend the same.
Dated this d r+� day of Ju14/1998.
Gi� OD ENTERPRI S, INC.
BY.
•,lssRusch, its president
ENTER E
-mxv R Rus s se e ry
AUTHENTICATION ACKNOWLEDGMENT
Signature James E. Rusch, its president STATE OF ST. CROIX
ST_ CAOIX COUNTY nn
Personally came before me this a A day of Juh/1998
the abave named Mary R. Rusch, its secretary to me
authe ated this ` day of June, 1998. Iuwwn: to he the person(s) who executed the foregoing
t and acknowledge the same.
i
signatu
Lois .Murray �fe
of print nee" tW* or print name
TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County,
(If not, My commission is permanent. Atatp tion
authorized by 1 706.06, Wis. S14,s.) d la�t '1.0
THIS INSTRUMENT WAS DRAFTED BY PAM J.
i
Lois A. Murray, Zi1z, Estreen & 091and, LLP 1 1kroes of persons signing in a c a � rev or
304 Locust Street Hudson, WI 54016 t Wow their signatures. Nj
' (Signatures maybe authenticated or acknowledged. Both are not YipuWG\
�# nQ cs sary1 —
bwk. � P".1— ionels Ce F_y Foxed du Lac. W..sc ;n 900- e66-2021
P
UUIL
- RES z z z 4.881
A o
�. FT. w(is 14 w w w 212,59E
J w o m C.
� � o
1 ;51' £ 3.327 ACRES £ °
.42' 144,930 SO. FT. £
02.57'
55.5' E A =44 °09'06'
R= 233.00'
_w ARC = 179.55'
_ o CHORD= 175.14
— _ _ ° S 68 °29'36' E
N 89 °25'51' E 385.14'
36 44.4 — 340.65' _ — 133.92'
80.99' m N 89 °25'51' E 474.57' 58,377 SO. FT.
[IUTLUT- 3 -
° N o N 89 °25'51' E 474.64' 1.34 ACRES
s S
— 169.64'
In OT �. `p
�
o _ — .
A =44 °09'06' 60
14.91' �
N89 °25`51'E R= 167.00'
39 °25' E ARC = 128.69' �0- F
I 105.00'
1 CHORD = 125.53'
z m Z S 68 °29'36' E
o °d z
° 3 Z
o m � I N A =4'
I r> .� w w
I � R =2�
w D m 0 1 5 w N ARC=
o 3 �,w
51 E £ CHOF
z z z 2.539 ACRES 0 • S 6F
o <
i
I ON cn �, 110,607 SQ. FT. DUTLDT 4
4. - N v)
c (AREA EXCLUDING POND
I a t o EASEMENT = 82 ,782 SQ.FT. 3.731 ACRES
I o OR 1.90 AC.)
I
.J 162,538 SQ. FT.
c
�
Roy S89 I 105.00'
ti 2 0 S89 °25'51'W 305.00' 534.1 z `� o � N 89 °42'32" E 839.12' (N 89 °50' E 836.9')
o ,DC� I °
NOD ° ° Z UNPLATTED LANDS Vol. 512, Page
ru V) I ry T ry --- - - - - --
-- - - - - --
�D M 3 V o
V7� • Q • e
�� £�-£ L E G S N D
i s9 6 y6•�
N . F
4 S 6F z SECTION CORNER MONUMENT FOUND -- ALUMINUM CAP
Lp
cn
co c • 2' IRON PIPE FOUND
f_
I w �'� • 1 IRON PIPE FOUND
CD CA m � v
z – EXISTING FENCE
o W - - -- UTILITY EASEMENT - - WIDTH SHOWN IF OTHER THAN 12'
I d
BUILDING SETBACK LINE - 50' OR 100' AS SHOWN
` O 2'X30' ROUND IRON PIPE WEIGHING 3.65 LBS PER FOO
i
���_
i
��