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Home My WebLink About002-1020-10-001Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT ATTACH TO PERMIT County: St. Cr01X Sanitary Permit No: 430039 0 State Plan ID No: Parcel Tax No: 002-1020-10-001 Section/Town/Range/Map No: 10.29.16.137A GENERAL INFORMATION ~ ~ Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1){m)]. Permit Holder's Name: City Village X Township Me er, Steve Baldwin Townshi CST BM Elev: ~ Insp. BM Elev:~ BM Description: It , y~ ~. Z~ 80.0 ~ C~ 43 vu~ 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic w~~r` .7 ~ Z `D Dosing Aeration Holding TALK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ' ~ I ~ ^ ~~ ~_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numbe TDH Lift r 'on Loss System Head T H Ft Forcemai Length Dia. STATION BS lZ~~ts HI 3•~ FS ELEV. Benchmark ~ 5.4r S IlS.bs j •O Alt. BM • 3D ~ }• Bldg. Sewer ~• ZO ~ o ~'•~lS` SUHt Inlet ~-• ! 1Qrp ,Sb' SUHt Outlet 9.35 ~ p Dt Inlet Dt Bottom Header/Man. Dist. Pipe t ~C Bot. System 12 • • S •(~ o . zo' Fi I Grade ~~ - `~ c ob . ~S~ St over ~..0 J• 0 6 i r SSNL ABSORPTION SYSTEMr2~) [,y~aM,,,,.b,rs ~--~ i~wc1D~ BED/TRENCH Width Length ~ No. Of Trenches ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '? r ' ~S • C2~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING M ufacturg~• INFORMATION CHAMBER OR t O QL~ Type Of System: ~ J ~~ (~ ~ ~ ~~ UNIT u A n Model Nu r: ~ ~ , Q , N~+Ca~C DISTRIBUTION SYSTEM Qom, Q.p.W .(~~,~ Header/Manifolc]„ 'r/i c1 Length ~ Dia Distribution pipe{s) Length Dia pacing _ x ize x Hole Spacing Vent to Air Intake r 7 ~~ SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center BedlTrench Edges Topsoil Yes ~] No a Yes ~~, No C03M1~1 ~NTS: ,~I~ a de crepencies, persons present, etc.) Inspection #1~F~/~ Inspection #~: -~ / `~ Location: 1091 245th 5t Baldwin, WI 54002 (NW 1/4 NE 1/4 10 T29N R16W/)(~N,A Lot _ 1 ~tG~Q ~Pa~rce~,~Q~ .16.137A 1.) Alt BM Description = ~ ~ °~ ~ l~-~ C ~Z~4r ,,~~~~'~~+~~ "" "~- ""~ ~ 2.) Bldg sewer length = + ~~ amouAnt of cover = r~2 t" L L 3) ~' O t1..I .. u {A~,~, "~"b 'fwl~I\..GL.~... e r .... T „ . _ _ d - Plan revision Required? i ~ Yes ~ No /~_ r= -~-_~ Use other side for additional information. Parcel #: 002-1020-10-001 t 03/26/2007 10:57 AM PAGE 1 OF 1 Alt. Parcel #: 10.29.16.137A 002 -TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -MEYER, STEVEN D & ROBIN R STEVEN D & ROBIN R MEYER 1091 245TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 1091 245TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 33.000 lat: N/A-NOT AVAILABLE SEC 10 T29N R16W NW NE EX S 462' OF W lock/Condo Bldg: ' 660 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 09/22/2003 740782 2415/508 EZ-U 09/14/2000 629892 1542/545 WD 07/23/1997 1004/123 WD 07/23/1997 491 /591 LC 7nn7 CI IMMeI?v Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class RESIDENTIAL G1 AGRICULTURAL G4 UNDEVELOPED G5 Totals for 2007: General Property Woodland Totals for 2006: General Property Woodland Last Changed: 10/27!2006 Acres Land Improve Total State Reason 4.000 32,700 254,100 286,800 NO 27.000 4,500 0 4,500 NO 2.000 200 0 200 NO 33.000 37,400 254,100 291, 500 0.000 0 0 33.000 37,400 254,100 291,500 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/26/2005 Batch #: 05-17 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Safety and Buildings Division County ~ /~ ~ : ~ 201 W. Washington Ave., P.O. Box 7162 l /x ~scons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 3 eo 3 Sanitary Permit Application State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) / I. Application Information -Please Print All Informati n - T"~ Property Owner's Na me ~w~~Y 2 9 2003 Parcel # Lot # Block # ~ ~ Property Owner's M ailing Address ST. G~.OIX CG'UN i Y Property Location ZONING OFFICE _,n.._ ~J~~, ~~~k S i ~ City, State _ Zip Code Phone Number ,~' ~d~~, ect on ' j S ~° (circ one ~~ '~~ II. ype of Building (check all that apply) - ~~5 ~~ E r W N; Subdivision Name CSM Number / r 2 Family Dwelling -Number of Bedrooms S. ^ Public/Commercial -Describe Use t ~ ^ State Owned -Describe Use z 3 K ~?.~ S '~ ^Villa wnship of l III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Qp -2 .. o _ p - pcap oo2-I O t~ I o - A' ew System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modifica ton t~ xisting System • t 3 B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. Ty e of POWTS System: (Check all that a ly) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tauk ^ Peat Filter ^ Aerobic Treatment Unit ^~R,circulating Sand Filter ^ Recirculating Synthetic Media Filter eaching Chamber ^ Line ^ Gravel-less Pipe ^ O er exp in) , y- L3G,~exv V. Dis ersal/Treat nt Area Information: ~( ` Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersa rea Required (sf) Dispersal Area Proposed (sf) tem Elevation .~~U ~ S~ , t3D ~ . 3 i'D3- ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site •:eel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~~ /~ vl/ J /\ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned s e responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) ~ ~'~ ' Plumber's S' re MP/MPRS Number Business Phone Number a~.. ~ ~ Z 6 O~ ~l ~ L/~~ /-~ Plumber's Addre ss (Street, City, State, p e) VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuin Agent Signature ( Stamps) ^ Owner Given Reason for Denial Surcharge Fee) 22 S ~ 03 IX. C,'onditi ofnApproval/R+gasons for Isapprov G ~ /~_-- Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size tom( L~~ SBD-6398 (R. 01/03) PLOT PLAN .PROJECT Steve Mever ADDRESS 410 6th Ave Baldwin Wi 54002 IV1N i/4 NE i/4S 10 /T N/ 16 W TOWN Baldwin COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE5/28/03 BEDROOM 4 CONVENTIONAL XX)C IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE .~- HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40 BENCHMARK .R.P. TOp Of 1"pipe ASSUME ELEVATION 100' Filter Zabel A-100 BOREHOLE • WELL *H.R.P. Same as Benchmark Plans Designed ng Conventional Powts SYSTEM ELEVATION 104.3/103.8 2.5' below grade Manual Version 2.0 Alt. BM Top of 1" Pipe @ 98.5' nVent ~ Pro 4 > 6" of Cover 6' Lon~1,11 „ Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area Trade at System Elevation Vents B 1, _ 60 60' Bedroom House 0 ~ `~ 2-3' X 125' Cells with >3' Spacing B-3 60' 8% /~ , B-? Vents 100' 107' 106' 105' Alt. ~ B.M. ve 1 N 150' • PLOT PLAN .PROJECT Steve Mever ADDRESS 410 6th Ave Baldwin Wi 54002 NW 1 / 4 NE 1 J 4 S 10 /T NI 16 W TOWN Baldwin COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/28/03 BEDROOM 4 CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1244 # of chambers 40 BENCHMARK .R.P. Top of 1"pipe ASSUME ELEVATION 100' Fflter Zabel A-100 BOREHOLE WELL *H.R.P. Same as Benchmark Plans Designed ng Conventional Powts SYSTEM ELEVATION 104.3/103.8 2.5' below grade Manual Version 2.0 Alt. BM Top of 1" Pipe @ 98.5' nVent Fro 4 , >6" of Cover 111" 6' Lona Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area Trade at System Elevation Vents B L _ 60 60' Bedroom House b ~~ 2-3' X 125' Cells with >3' Spacing B-3 1 60' 8% /~ B-2 2 ~ .-^ Vents 107' 100' 105' 106' Alt B.M. ve 1 N 150' VlfisoonsinpepartrnentofCornmefce SOIL EVALUATION REPORT Page of Division of Safety and 8Lr1dmgs m accordance with Comm 85, Vlfis. Adm. Code JJ Courriy Plan must hes in size 11 in 8 712 ct l th 7 , `J I X . c ess an x Attach oompieDe site plan on paper rt inducts, but not Limited to: vertical and horizontal reference point (Blue. direction and Parcel I.D. . percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Please print air ~ form~ie E i V E D R by to ~ Persons iMOrmefion you pravi~ mey be used for purposes (PriveCy Law. s. 15. (1 j (m))• ~v (~ .Ta ~ A?r~ 2 1 20 location 4 l ~J T N E W ~ Qv ~ corr. 114 1/ S R ( j Property Owners Address S T. C R 01 X C O U ti"i ,Lot # Block # SutxJ. N!dme or CSMt1 ~ ZONING OFFIC .--. ~ City 2~ PFwne Nixnber ^ ~y ^ V~lage Town Nearest Road ` S 62 c 1~~68y .~ r; i /D~ ~ a1 s~(.s~ New Construction tJse: Residerrtial / Number of bedrooms Code derived design tbw rate GPO ^ Rnent ^ PubGc coirurierdal -Describe: ____ __ - _ Parent ritaterial ~~ ~ i-lood Plant elevation ff applicable ti I ~- R ~ mendations:s 5~- ~~2 /c.~%~'~/~'~ ~ 0 ~ • ~ ~ 1 ~ - J ~ elm ~-~ ~,v~ ~ '~ ~f'g # Pit Ground srxface elev.. O..~b - ~ . ft Depth to lirtritirtg factor ~ ~ nt. s~ Mormon Depot Dorrimautt Redox Desaiption Texture Struc4.ae Consistence Boundary Roots ®t. Mtn Qu. Sz Cont. Cobr Gr. Sz. Sh. •Eif#1 `EtTak2 0-1L 10 ~ 31z "~~ G~r~ , ~~ ~''~ Io~f. 3~ 3~ `G # CJ ~g /,, Pit Grotmd staface elev. b l~J ~ ~ ft. Ospth to limiting factor nr. ~p Rate Hormon Depth Dominant Redox Despiption Texttae Structure Cor>s Boundary Roots C3P D/ftr in. Muris~l (2u. Sz Cont. Color Cn Sz Sh. 'EfftE1 'EtfwR2 I 8 - ~ 3~Z ~_' ~ ~ ; J 'Z ,~ .~- rte/ / ~ ~ 30 • F_ffhrertt #1 = BOD > 30 _< 220 rtglL and TSS > 1 mgll ' Etfkrerit #2 = BOD < 30 mglL and TSS < 30 mglL ~-%r ~,,,~,e ~ CST Number a Address > Dale Evakra6ori Cofxiucted Teleptane Ntunber Oamer Paroei ID # C~rourrdsurfaoeelev ~ ~ l ~, ~~~ ~ ~~ ~ ~ ^ plc t~+airra sursace ~. ~. Depa, a t tacaor f-. s~ Rare Q ~~ ^ kbrizon Deptlt Domirrad Redorr Desaip6on Ts~dure 5trucare Cans~tence Boundary Roots t irr. Murrsei ter. Sz Cord. Color Gr. Sz Sh. 'E18F1 `Etflf2 ~ Soi Rate Horiaon Dorrinard Redox Desaipiion Textrs~e Structure Caroe 8oudery Roots CsPD/fF !n. Mtr~se>f ~ Sz Cont. Cobr GY. Sz Sh. 'Ett/~1 'E1~2 - ~- , S~ ^ Bairg # ^ pi hound surtaoe eiav. ~ Depf:r b ttrniting faGor ~. Sd Ra Harmon Oepttr Dotrdrrerd Redaor Desatplfon. Teosare 5oructure Gansrs4atrce Borrrdery Roots ~. I~kw>_se~ t]>i. SZ Gard. Color Cr. SZ Sh. ~'! . F_flkrerd #i ~ ~s > 3Q < ~ nmlL, and TSS >30 < 15p rrpil ~ = BpDs c 3p nrgR. ~ ~' ~ ~ ~' Ttm IkPactmenc of Cotnmetce is an equal opportunity sen-ice Provider ate employer. If you mod assistaa~x w access services ar need material in afl alternate format, pleasc contact the deparoment at 608"266-3151 or TTY 60&264-8777. DEplh m ~8 Esstor _~~~~ ~- Soil Test Plot Plan Project Name Steve Meyer Shaun B' Address 1410 6th Ave Baldwin Wi 54002 CST 226900 Lot ----- Subdivision ------- Date 4/17/03 NW 1/4 NE 1/4S 10 T 29 N/R16 W Township Baldwin Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. County ST. CROIX Top of 1" Pipe System Elevation 104.3/102.6 *HRpSame as Benchmark Alt. BM Top of 1" Pipe @ 98.5' Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT` . OWNE&SHIP CERTIFICATION FORM i OwnerBuyer S~'~!y Mailing Address ~~~ Property Address City/State LEGAL DESCRIPTION Parcel Identification Number property Location~`'~l/a,/~~ '/~, Sec ~0 . T~N-R~[~W, Town of Subdivision .Lot # Certified Sarvey Map # ~ .Volume ,Page # "2__ Warranty Deed # ~ ~ ~ S~ Z' .Volume ,S Page # S`f ~~ Spec house ^ y Lot lines identifiables ^ no SYSTEM MAINTENANCE improper use and maintenance of your septic system could result is 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 treatrnent stage in the waste disposal system. The properly owner agrees to submit to St. Croix Zoning Department a ccrtificatioa form, signed by the owner and by a masterplumber, jouraeymanplumber, restrictedplumberor a Iicensedpumperverifying that (1) the on site wastewaterdisposal system is in proper operating conditionand/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 tha your septic system has been maintained must be completed and returned to the St. G~oix County Zoning Office within 30 days of a year expiration date. ~ ~~~ ' S A AP ICANT DATE OWNER CERTIFICATION I (we) rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro 'bed ab e, by virtue of a warranty deed recorded in Register of Deeds Office. v s~~o S ATURE OF APP DATE **«***. Any information that is mis-represeatedmay result is the sanitary permit being revoked by the Zoning Department. ****** a~5 (Verification required from Planning Department for new ** Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~ ~ ~"U~~ ~ivw~ rn _ n'v~P Cv~-~ g~ ~SOG T •'-i ~.J4~Pac~ J~5 Document Number WARRANTY DEED Y629892 H kE6ISTEk OF DEEDS ST CkOIX CO WI This Deed, made between R & S FARMS ., . RECEIVED FOR RECORD a Minnesota partnership 09-14-2000 2:30 DM ,Grantor, AND STEVEN D MEYER and ROBIN R MEYER, husband and YARRANTY DEED EXEMPT N wife, as marital survivorship property, CERT COPY FEE: Grantee, ~ COPY FEE: TRANSFER FEE: 119.70 ~~ RECORDING FEE: 10.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordin Area This iS fit)}' homestead property. ~ame~nd~Retupt Addressr ~~D ~L i( ~ ( Together with all and singular the hereditaments and appurtenances ~ fi . c (_ __ - , pp S • thereunto belonging; And Grantor warrants that the title is good, th1 ere..Q ~~~ t wTS ~-[~ (~, indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. _ /J~ , lY `THE NORTH HALF ~ (Parcel Identlficatian Number) . OF THE NORTHEAST QUARTER 00,2- I pZo _ I p- 000 '-' ~~ t~•vt~ - ~ 1/2 OF NF; 1/4) OF SECTION 10, TOWNSHIP 29NORTH, 002-1020-10-001 - 3 3 ~~ i •~oV~S RANGE 16 WEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. EXCEPT THE SOUTH 462 ~ Qi . ~ . --- ~ r.e y.,Q,, FEET OF THE WEST 660 FEET THEREOF. U D d this 5thlay ofQ~sttber , 2000. Robert W. Rarer AUTHENTICATION Signature(s) authenticated this _ day of signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall "'-""~"` ` ; DIANE M. f:AF~i :<'~ ; Notary t'ul:k:: State of Wi}N+ Sandra J Hoog kker, f/k/a Sandra J. Rarer ACKNOWLEDGMENT STATE OP .WISCONSIN COUNTY OF ST. CROIX Personally came before me this 5 day of Sept. , 2000 the above named Robert w. Rarer and Sandra J. Hoogenakker, f/k/a Sandza J. Rarer to me known to be the person(s) who executed the foregoing instrument d acknowledtg~e~th~e same. signature type or print name i!/ y1,~~. ~j~,(~!'O /'~ Notary Public ST. CROIX County, My commission is permanent. (If not, state expiration date: /I- O i/- ~~*i 'Names of persons signing in any capacity should be typed or printed below their signatures.