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Home My WebLink About030-2095-10-000 ST. CROIX COUNTY ZONING DEPARTMENTr. f �► AS BUILT SANITARY REPORT RECEIVED j Owner o M c m r 1 ST CROIX Address C 5 9 q. Q ` ; \ COUNTY City /State unsoN Ui r S YOI (, zav l#VCC?FFK:E Legal Description: 11 Lot � Block Subdivision/CSM # Gov, �A x 5 C Lq �3 A e S `/4 5 f�- '/4 N W , Sec.a , T N -R V W, Town of St • � s PIN # 0 30 - PO4s' 10 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer w S Size ST/PC IaW / etback from: House Q2� Well0 S 0P/L, 61er° 5 0' Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service ro ine Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system Width 3 Length Number of Trenches -3 Setback from: House 70 Wella Wo P/L a8' Vent to fresh air intake 0Z K SO' ELEVATIONS Description of benchmark N A 11 1 N I R - tk Elevation 00 , C ) Description of alternate benchmark Elevation Building Sewer (:� loriT Inlet U a ST Outlet �r Pe'IT PC Bottom Header/Manifold . - Top of ST/PC Manhole Cover - 1 0 3-1 3 Distribution Lines U • 0 a` 0U 0 0 Bottom of System (L) 1 Final Grade (L) ! W9, L S Date of installation 8 /I hig Permit number 3 7 7 0 3 State plan number Plumber's signature License number g Q y Date Inspector R O S I N q} IC Complete plot plan r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count . Safety and Buildings Division INSPECTION REPORT County: . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,P�rp�lDlo,: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. .SS / V 3 Permit Holder's Name: ❑ I Town of: State Plan ID No.: ❑ J SCHMIDT, TOM S CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T ._ 2095- 10-000 [ ` T TANK INFORMATION ELEVATION DATA A9800094 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Bench ik � �T•7 oa 7� Dosing Aeratio Bldg. Sewer Holding Inlet TANK SETBACK INFORMATION 6�10_Outlet TANK TO P/ L WELL BLDG. AirIntake ROAD Dt Inlet ti 0 ( Z / NA Dt Bottom Dosing A Header/ Man. u'.' Q/• Aeratio NA Dist. Pipe �z 4 .7'7 2 Holding Bot. System 1Z PUMP/ SIPHON INFORMATION Final Grad _T' _T Manufacturer pemand Model N er ,GPM TDH LW_� Friction em TDH Ft Loss Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BE RENCH Width 7 LengtF No. Of Trenches PIT No. Of Pits Inside Dia. Liquid epth DIME (y DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING nufactwer INFORMATION Type :( C CHAMBER um er: Syst 6; 12(j I OR UNIT DISTRIBUTION SYSTEM Header / M� j nifold Distribution Pipe(s) n x Hole Size x Hole Spacing Vent To Air Intake Length l ! Dia. Length ` Spacing--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 E] Yes E] No ❑Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 24.30.20,SE,NW 1467 24TH STREET C�: i bck C Plan revision re uired? ❑ Yes �No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's ignature Safety and Buildings Division Vi sco n s i n SANITARY PERMIT APPLICATION 201 E. Washington Ave. I n Box 7969 Department of Commerce n accord with ILHR 63.05, W IS. Adm. Code Madison, WI 53707 -7969 • 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 Permit Number 30770 � The information you provide may be used by other government gover agency programs /� E] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). 1 L l & T' L Q Iq 44* S t . 7q t) State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Pro Owner N me Property Location. QM Tr Srl Nul1 ay 30,N, AOE(or)W Property Owner's Mailing Address Lot Number Block Number �a .5 yJ g,at Zip d Phone Number Subdi ision Name or CSM Number zl p . � II. TYPE OF BUILDING: (check one) Q State Owned o it 7^ Nearest R c Public 1 or 2 Family Dwelling- No. of bedrooms town of 111. BUILDING USE (If building type is public c heck all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Ol q• 3 O ' 61 0' ?941 0 30 c�0 F,:j /o 2 ❑ Assembly Hall 6 Q Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Q Campground 7 Q Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 Q 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. Q Replacement of 4. E] Reconnection of 5_ [] Repair of an - ------ System-------- System Tank Only Existing System Existing System B) Q 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 Q Seepage Bed 21 Q Mound 30 ❑ Specify Type 41 Q Holding Tank 12 RSeepage Trench Ws i Ne 22 In- Ground Pressure 42 Q Pit Privy 13 Q Seepage Pit '::t4 i �, STt 43 Q Vault Privy 14 ❑ System -In -Fill 51 Dow) N Dr r 1 VI. ABSORPTION SYSTEM INFORMATION: (; 03.6 0 1. Gallons Per Day P p 2. Absor . Area 3. Absor . Area 4. Loading *Sys Rate 5. Perc. Rate 6. lev. 7. Final Grade Goo Requ re 8sq ft .) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation' (� S Feet OV I Feet VII. TANK C T si te In g allo ns Total # of Prefab. Si Fiber- Ex INFORMATION g Manufacturer's Name Con- Plastic er. p Steel Gallons Tanks Concrete lass A i New Existing g PP strutted Tank Tanks Septic Tank oF1 Tani` ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI er's Si ture: ( Stamps) MP /MPRSW No.: Business Phone Number: M OL rr.-e f � a '71 ff - 38(0 - 96610 Plumber's Address ( t eet, City, State Code): Ow IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (Includes Groundwater . ate ssu Issuin g99 ent Signature (No Stamps) �( A roved Surcharge Fee) �� 9 pp []Owner Given � I��_ Adverse Determination _00 X. CONDITIONS OF APPROVAL / REASONS F R DISAPPROVAL: S804M (Ft. 11196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber I .I � O. L .- U I L U I A 11 (.: I U ;� `� I� C . 7 JAI- I '. L 0 I M A_ _ ' • Q�� OUo�1 ;� �� Clev -�� g Y�' a . I TR eQ BBL. .14 4 sLj Ivf s fia 3�_ 8� .� 3 to � I U V t � rP ff old/ 1 •:� ^.• U� - W211 IS �p�� VL- ��•PN � bl µdome 1 i FRESH AI1: INLETS AND OBSERVXTION PIVE CROSS SE CTION Approved Vent Cap Minimum 12" Abovei F.i.nal a de___w A" Cast Iron Above Pipe Vent Pipe To final Grade! 3 -26 -1996 5 :59PM FROM GARY L STEEL 715 +246 +6200 P -1 Yb& o60hr4ne latio ndustry, SOIL AND SITE EVALUATION REPORT I,�p� Nurnan Rslatiorm `Division of *dory A 6WIclings in ac-card with ILHR 83.06, Wis. Adm. Cade COUNTY Attach ca ate site Ian on St. Croix nil P paper not IeSS than 812 r 1 ! ir�ee in size, Plan trust include, but not limned to varocai and harizontal reterenee point (SM). direction and % of abpe, scale or. PARCEL I.D. R =, dimen nod, north arrow, and location and distance to nearest road. 030- 2095 -10 APPLICANT INFO RUATION- PLEASE PRINT ALL INFQRMATION REWEVED BY DATE PROPERTY OWNER: PROPERLY LOCATION vernell A. & Stephen L. Skogriund GOVT. LOT SE 114NW 114,324 T 30 ,N,A 20 3fta►w i P� F Y OW R;S MAN.ING ADDRESS LOT # BLO >mlr"y �iC�2 states CITY, STATE ZiP CODE PHONE NI�MBEp LLAGE�OWN NEAP — EST ROAD New RichMond, WI. 54017 (115) 246 -4767 St. Joseph St. Hy. 435 -64 [fit New Careftc bm Use J* ResidenlW ! Number of bedrooms _- 3 ( Addition to erisdng building I i Repl Wnent [ ] Public or nom riercal desoiDe Code derived dally Now 450 g pd RraoomnenM design loading rasa 5 bo, gp W - 6 bef,ch, g p*lt2 Absorption area required 900 bed. 42 750 trench, ft Mq*n= desicpr loadinq isle - 5 bed. gpdM1; -6 hin c h. OW Rommtnended Infiltration sWbm elevation(a) 100.65 ft (as referred 0 silo plan beru7tr .Vk) Additional design j site oorsideratrions alt. area system el.= trenches @ 104.20' - 102.75' - 101, 25' Parent material pitted glacial drift i=looe plain eievapon, d a pplicable na ft S = 5tirable br system Cowen low A40" W-CIP IND PREWLft AT�AADE syrreN IN FILL mom TANK U a Unsuitable bt stem (1 6❑ U. Os ® U as ❑ U as ❑ U I CS Lau )3 SOIL VESCRIPTION REPORT Boring # Horizon Doom Dominant Color m mo Texture Structure Conishmm W idity Roots GPo in. Munsell 00 Sz Cam Color Gr. Si. Sh. ow nrrdt 1 1 0 -12 10yr3 /3 none 1 2tmsbk mfr gv 2f .5 .6 2 12 -27 10yr4/4 none sicl lfsb* mfr gv If .2 .3 Ground 3 27 -63 7.5yr4/4 none el 2mgr mvfr gv na .5 .6 10 ft. 4 63 -80 7.5yr4/6 none I. fe Osg mvfr g na .5 .6 Depth to 5 80 -96 7.5yr4/6 none 1 fs Os / 1cs mvfr na .6 limiting factor + Remarks. H -5 done on 4 -10 -98 by Steel Boring # §., 1 0 -12 10yr3/3 Wane 1 2msbk mfr gw 2f .5 _6 2 2 12 -34 10yr4/4 none sicl lfsbk mfr gv if .2 .3 3 34 -80 10yr4/4 none sl 2mgr tan .5 .6 Ground 102 r- e V�G ,4 ft cab x+80 1 Remarks: Z7 N:-- .PlessePik //}} Gary L. / Steel Phm: 715- 246 -6200 as: "A 7AK7. t w Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of 3 Labo! and Human Relations g — Divisiob of Safety 8 Buildings in accord with ILHR 83 05, WiS. Admr�` t COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inche , ,,_s4e. Wan fhust include, not limited to vertical and horizontal reference point (BM), directi and % d .slope, scafe or , PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest r ' �� ? ` t 030- 2095 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFO TION ` ) REVIEWED BY DATE ,~ PROPERTY OWNER: PROP 10CATI . Vernell A. E & Stephen L. Skoglund �� ` GOVT. Uyt' SE' -, " 4 NW t /4,S 02A4�ST 30 N,R 20 qor) W X49 1 ghWSt R :S MAILING ADDRESS ;, t8 Ot; S C�ountry Side states _Aa is CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 (715) 246 -4767 St. Joseph St. Hy. #35 -64 4 New Construction Use (4 Residential / Number of bedrooms 3 (J Addition to existing building I Replacement [ ] Public or commercial describe Code derived daily flow 450 gPd Recommended design loading rate • 5 bed, gpd/ft trench, gpd/ft Absorption area required 900 bed, 112 750 trench, ft Maximum design loading rate • 5 bed, gpd/ft - 6 trench, gpd/ft Recommended infiltration surface elevation(s) 100.65 ft (as referred to site plan benchmark) Additional design/ site considerations alt. area system el.= trenches C 104.20 Parent material pitted glacial drift Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system MS El El ®U ❑ U S ❑ U El [BU ❑ S U SOIL DESCRIPTION REPORT Texture Boring # Horizon Depth Dominant Color Mottles Structure I Consistence Botndary Roots GPD /ft OEMN, in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& l 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 12 -27 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 Ground 3 27 -63 7.5yr4/4 none sl 2mgr mvfr gw na .5 1.6 103 4 63 -80 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 Depth to limiting factor +80 Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 '<: 2 12 -34 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 3 34 -80 10yr4 /4 none sl 2mgr mvfr na na .5 .6 Ground elev. 102 ft. Depth to limiting factor +80 Remarks: CST Name:— Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 20 A and WI. 54017 Signature: Date: 9-1- CST Number: r r STEEL'S SOIL SERVICE Gary L. Steel vernell & Stephen Skoglund 1554 200th Ave. CSTM2298 SE 4NWQ S24- T30N -R20W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 f lot #1-- Country Side Estates f N 1 11 =40 1 BM.= nail in tree C el. 100' Alt. BM. = top of SW lot stake C el. 89.75' 1 3 1 Gary L. Steel 9 -1 -95 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer --� Ma s c Mailing Address �� '-� C� /- AL BXJ ItIT �D j/ Property Address 1 f �1 St 0 (Verification required from Planning Department for new construction) City /State 9U' /V6w1 UJ 7 Parcel Identification Number 0_ :n Jn9S %CD LEGAL DESC Property Location ,T f ' /a, AJUJ ' /a, Sec. - .2�t, T N -R,,2QW, Town of v Subdivision LQ"A &j c7�5;d e, , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 5 . Volume Page # . c Ir Spec house ❑ yes ,P no Lot lines identifiable ❑ 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. 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 days of the three year expiration date. 43 19 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 property described above, 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 ' 1 VOL 1?3:vA�E�35 s WARRANTY DEED 558045 Document Number - 1 S' G - I C X C TY., WI 1 :u': n ti.art Return Address 1 APR 16 J y 3 t Parcel I.D. Number: 030- 2095 -10 %'ernell A. Skoglund and Stephen L. Skoglund coneys and war:ants to Thomas M. Schmidt, .Ir.,, a single person, the following described real estate in St. Croix County, State of Wisconsin: i Lot 1, Country Side Estates in the Town of St. Joseph- St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights- of -\\ay of record, if any. Dated this _ ��;��Jt:.. • S day of April, 1997. f- Ver_ nell A. Sko rlund �� _(SE: \[.) t 6 v Stephen" L. Skoglund ' AUTHENTICATION Signature(s) Vernell A. Skoglund and Stephen L. 'r Skoglund authenticated this _ day of April. 1997. / Kristina (?gland TITLE: MEMBER STATE BAR OF WISCONSIN "FI INSTRLIMENT WAS DRAVFED BY: Attorney Kristina Ogland Iludson. WI 54016 w 41 0 c o (4 N i N m i I m °� �a m 0 i \ = m � M A \ m w pa tx F 0 0 p o \ D 1 Z 0m C N \ \ \n I L N 1- '1 p�p �i�. � \G� V Z 4 00 Ul S00 ° 16'03 "W 368.58' I v w c w i ,, r .L L' 0 ` •� ID N OD � f I(1) w 8 w c CA o i S00 0 16'03 "W 636.00' ' I i m � I ° w r i 1 FA v 01 � O �o N m 0 SOO ° 16'03 "W 636.00' I 2' � i