HomeMy WebLinkAbout030-2141-00-012 it
Wisconsin Department of Comm4ce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
552344 0 ,
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s:15.04 (1)(m)].
Permit Holder's Name: Village X Township Parcel Tax No:
McCabe Homes Inc., c/o Tom McCabe City St. Joseph, Town of 030-2141-00-012
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/S 6-1 C, -5 1 36.30.19.2062
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
~ z~ Z•S 1a1. 9'S.iB
Alt.
Aeration Bldg. Sewer 5• 9G, ~O$
7 O
Holding St/Ht Inlet .
TANK SETBACK INFORMATION St/Ht Outlet ~ 13
G. .
TANK TO P/L WELL BLDG. Vent to r Intake ROAD Dt Inlet
Ad 16
Septic y ~~oL Dt Bottom `
75~s /l)A- 7Z
Dosing Header/Man.
B ~3 g8
Aeration Dist. Pipe 7. 3.
Holding Bot. System . g
7
PUMP/SIPHON INFORMATION Final Grade ,4 8'ZT
Manufacturer Demand St Cover~
GPM 6'd
Model Number
TDH Friction Loss System He TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO 10 P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR F'(
Type Of System-
A- UNIT Model Number:
DISTRIBUTION SYSTEM 6(A'_ 21 i-Z!•= ¢Z, S
Header/Manifold Distribution x Hole Size x Hole Spacing Vent t irInak
Pipe(s)
Length 7 Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Dept of 7 Seeded/ odded xx Mulched
Bed/Trench Center Bed/Trench Edge Topsoil Yes ~ No es Q No
1-0 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1265 84th Street Hudson, WWII 54016 (SE 1/4 NW 114 36 T30N R19W) Natalie'ss Ridge Lot 1 Parcel No: 36.30 19.2062
1.) Alt BM Description= F- At 66Jt.A- /4
2.) Bldg sewer length = 7Z. 1 _
- amount of cover =
Plan revision Required? 0 Yes 60 5
U17,
se other side for additional information.
SBD-6710 (R.3/97) Date Insepc s Sig re Cert. No.
Safe' i ision CO1lg,
commefcB.wl.9ov 2 1 W. Washington Box 62 K,
• ( Sanitary Permit Num~er~jto be filled in by Co.)
isconsin &Z
Np11t1G --Transaction G-
State Transaction Number
Sanitary Permit Application A
In accordance with s. Conan. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if %fifterent than mailing address
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 l (m), Stats.
opv sr. 1. Application Information - Please Print All Information Parcel # '
Property Owner's Name &,513o -,_9%11 00 ,Z(/{ 12_
7
r ~ LcZ.~ Property Location Z
Property Owner's Mailing Address C r Z d
,e/ / Z g, /,u~l Govt. Lot
Zip Code Phone Number_ Section
City, State 7 cle o
1-v - - -
y) Lot#
II. ype of Building (check all that apP 1 Subd' talon Name
l or 2 Family Dwelling -Number of Bedrooms
~ruJ~ Block # ✓~t
_ - - - -
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
7_ J~
❑ State Owned Describe Use - - - , own of.
`T~
III. Type of Permit: Check only one box on line A. Complete line B if applicable) - - -
A ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
_ List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to Now
Owner _
Before Expiration
IV.. - 66f- TS to /Com onent/Device: (Check all that apply)
El Mound'>_ 24 in. of suitaie soil El Mound < 24 in. of suitable soil
-
tin Pressunzed In-Ground ❑Pressurized In-Ground El At- de
0 - r a[tft/enYl7evice (exp in)
❑ Holding Tank U Other Dispersal Component (explain) - ~j 2
V. Dis ersal/Treatment Area Information: System Elevati
Design Flow (gpd) Design Soil Applicatro Rate(gpdsf) Dispersal Area Required (st Dispersal Area Proposed (st) s, Z
I Vs -6 41-1,
0v
VI. Tank Info Capacity in Total # of Manufacturer
s p U
Gallons Gallons Units 0
P,
New Tanks Existing Tanks j y can 1113
Septic or Holding Tank S S
nf-S
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ass, a esponsibility for installation of the POWTS shown o the attached Bplans usiness Phone Number
Plumber's Name (Print) Plumber nature
Plumber's Address (Street, City, State, Zip Code)
r~t /
Onl - rissuin Agent 5 tat
ViIl ount /De artment Use
Permit Fee Date Issuer g
Approved ❑ Disapproved g 61
❑ Owner Given Reason for Denial /
rovallReasons for Disapproval ~~YL~`! /
au-
I Septic tank, effluent filter and
dispersal cell must all be serviced / maintain
must be maintained
as per back requirements
2. All setback
ac t to complete plane for the system and submit to the County only on paper nut less than a tfz x It inches in size
SBD-6398 (R. 01/07) Valid thru 01/09
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 5/2/12
Owner: McCabe Homes Inc.
Location: SE1/4 NW1/4 S36 T20 N,R19W Lot 12 Natalies Ridge St. Joseph
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-5. Maintanance and Contingency Plan
6. Filter Specifications Sheet
Signature , a
License number #5p,900
PLOT PLAN
PROJECT McCabe Homes ADDRESS 948 LaBarae Road Hudson Wi 54016
SE 1/4 NW 1/4S 36 /T 20 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/2/12 BEDROOM 4
CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons' LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
462' Property Line SYSTEM ELEVATION 95.2/94.7 4' below qrade
126th Ave 13' 42' 8' 33
213'
Well is to meet all
setbacks required by 33'
WDNR M.AIt.
B-1
Vents
143' 6% Slope
100'
Pro 4 2-3' X 80' Cells
Bedroom 112 with >3' Spacing
House
30' -3
ST 50'
B-2
84th St IL
B.M.*
Plans Designed Using Vent
Conventional Powts >6„ Quick4 Standard
Manual Version 2.0 of Cover Leaching Chamber
with 20.0 ft2 of Area
12 10.2ft^2/pair of end caps
4' Long
245' Property Line 34„ Grade at System Elevation
All piping shall be SDR 30/34, within 10'
G
of tank, piping shall be Schedule 40. Awi" 2
-Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
n To be >1, above grade
1 0.2ft 2 parr of end plates
Finish grade elevation
Typical Installation 99.2'
Vent 01 Grade Vent
3' 411 3'
X30/34 Septic Tank
5' Long 1 19 5' S' Long 1 19 Grade at System Elevation
3611 Grade at System Elevation
Spacing 5'
2-3' X 86' Cells
Same on other end Observation tubeNent
At end of cell
A
B
21 chambers per cell
System elevations:
A_95.2
B 94.7
_TP
I- D-1
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t ~ r{i
~Ca ~
LLL
.r.
I: V
pn
im.
r
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
installed in
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being i
order to extend the maintenance interval of the filvia the inspections pipes at the ends of
3. 'Once every 3 years, cells are to be inspected
the cells.
't greases, garbage, and water conditioner discharge into the system.
4. Owner agrees to lime g
5. The owner agrees to save this plan.
Do not plant trees nor park nor drive over system.
6.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
C a cy Plan
If system fails, determine cause of failure, use alternate area and install new
Option -to
stem in sted replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
area is suitable for replacement area, and system elevation II
Option#3. No adequate
cannont be lowered. Install holding tank as last resort.
3. 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
I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
/ OWNERSHIP CERTIFICATION FORM
Owner/Buyer me ~C-L GJS2 ,~0
Mailing Address y CL 9a rcl,ze~
Property Address F. _
(Verification required from Planning & Zoning Department for new construction.)
City/State Lj ens'-- Parcel. Identification Number 0~~7
i
LEGAL DESCRIPTION
Property Location S~ '/4 M~ Sec. 3 , T ZO N R W, Town of
Subdivision Lot # 2,
Certified Survey Map # , Volume , Page #
Warranty Deed # Volume , Page #
Spec house ye no lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & "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.
I/we, 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 Planning &
Zoning Department within 30 days of the three year expiration date.
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.
Number of,, droo
SIGN URE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department-
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
i
(I 1I~!(I !IlII!(It
IAN II~II
8055749
Tx:4041520
STATE BAR OF WISCONSIN FORM 3 -2000 955551
Document Number QUIT CLAIM DEED BETH ,PABST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, Grantor, ST. CROIX CO., WI
05/fl2/2012 3:54 PM
and McCabe Homes, Inc., Grantee. EXEMPT#: NA
Grantor quit claims to Grantee the following described real estate in St. REC FEE: 30.00
Croix County, State of Wisconsin (the "Property"): TRANS FEE: 105.00
PAGES: 1
Lot 12, Natalie's Ridge, St. Croix County, Wisconsin.
II
i
Property Sold As Is With All Faults
Recording Area
Name and Return Address:
Title One Premier Group
File # 17916
Together with all appurtenant rights, title and interests. - < < 0,30 -914(-Qa
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 2nd day of May, 2012.
Citiz s tate Bank
* ere Haberman, Vice Chairman
* *
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ST. CROIX COUNTY ) ss.
authenticated this Personally came before me this 2nd day of May, 2012 the
above named Citizens State Bank by Gene Haberman, its Vice
WPu n to be th erson(s) who executed the
TITLE: MEMBER ST~r4E B ROB NSIN n ckn ged the same.
(If not, authorized by § 'D6.06 ' , Wis.Sta THIS INSIP.%lMEA Z SRAFTW A f Wisconsin
My commission is permanent. (If not, state expiration date:
MichasS `o` 10/27/2013 )
(Signatures may be authenticated or dudW~ed. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
1 of 1 QUIT CLAIM DEED STATE DAR OF WISCONSIN FORM No. 3-2000
. 25ta
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'TED LANDS ORTH-SOUTH 1/4 UNE H00'19'19'W 5287.71' UNPLATTED LANDS
NO0°19'19'W 1527.26'
48 1
:0010 01ST - 564.98 `~~282.44, 88 Y K? M x32212 gLOqK d5T &32. 366.
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S0099119'E 584.98' n S00119119'E 309.70'
84TH STREET - n - M 84TH STREET--
M O .s N
N00'f9'19'W 584.98' HJ N0019119"W 310.24'
I r 5
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Parcel 030-2141-00-012 05/04/2012 08:43 AM
PAGE 1 OF 1
Alt. Parcel 36.30.19.2062 030 - TOWN OF SAINT JOSEPH
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
07/08/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - CITIZENS STATE BANK
CITIZENS STATE BANK
375 STAGELINE RD PO BOX 247
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # 1265 84TH ST
SC 2611 SCH DIST OF HUDSON
SP 1700
Legal Description: Acres: 3.013 Plat: 10-065-NATALIES RIDGE LOTS 1/32 030-05
SEC 36 T30N R1 9W PT SE NW NATALIE'S Block/Condo Bldg: LOT 012
RIDGE LOT 12
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-30N-19W SE NW
• II
Notes: Parcel History:
Date Doc # Vol/Page Type
08/24/2011 940558 WD
02/12/2010 911845 QC
02/12/2010 911844 QC
07/08/2005 799811 10/065 PLAT
more...
2012 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/11/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.013 33,700 0 33,700 NO
Totals for 2012:
General Property 3.013 33,700 0 33,700
Woodland 0.000 0 0
Totals for 2011:
General Property 3.013 33,700 0 33,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1329
Wisconsin Department of Commerce so e T Page I of 3
Division of Safety and Buildings in accordance with omm 85, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper not less than 8% x 11 inches i size. P st`2, ounty
9 2005
St. Croix
include, but not limited to: vertical and horizontal reference point ( M), dired
percent slope, scale or dimensions, north arrow, and location and istance to nearest road. P reel I. D.
Please print all information. ST. C, 1O. COUNTY Q 3~- (xJ-
ZONING OFFICE vi By ;71
Personal information you provide may be used for secondary purposes (P ' m). ~
Property Owner Property Location
Grand Properties, LP Govt. Lot SE 19 N 1/4 S 36 T N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 12 Natalie's Ridge
City State Zip Code Phone Number city Village ✓ Town Nearest Road
Somerset i WI 54025 715-247-5900 St.Joseph Cty. Rd. A
✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (stream terrace) Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0.7gpd/sgft rating. Possible system elevation for Area 1 is
95.50'. Slope is 6%. n
Boring # Boring
✓ Pit Ground Surface elev. 99.18 ft. Depth to limiting factor 96+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
*Eff#1 *Eff#2
1 0-11 1Oyr3/3 none I 2fsbk mfr as 1vf .6 .8
2 11-23 1Oyr4/4 none sl 2msbk mfr cw 2vf .6 1.0
3 23-57 10yr6/4 none grs Osg ml cs - 7 1.6
4 57-75 1Oyr5/4 none vgrcos Osg ml cs .7 1.6
5 75-96 1Oyr5/6 none grs Osg ml .7 1.6
rr
Boring # Boring
u ✓ Pit Ground Surface elev. 99.18 ft. Depth to limiting factor 97+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftl
'Eff#1 *Eff#2
1 0-11 1Oyr3/4 none I 2fsbk mfr as lvf .6 .8
2 00-23 1Oyr4/4 none sl 2msbk mfr cs 2vf .6 1.0
3 23-28 7.5yr4/6 none s Osg ml cs .7 1.6
4 28-45 1Oyr5/6 none grs Osg ml cs .7 1.6
5 45-85 1Oyr6/4 none grcos Osg ml es 7 1.6
6 85-97 1 Oyr5/6 5 „ none grs Osg ml .7 1.6
* Effluent #1 = BOD ? 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mgtL and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 4/14/05 715-247-2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
3 ] F Boring # Boring
u f/ Pit Ground Surface elev. 95.96 ft. Depth to limiting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-10 10yrM none sl 2fsbk mfr as 2vf,1f, .6 1.0
2 10-24 10yr4/4 none scl 2fsbk mfr 9W 1vf .4 .6
3 24-49 10yr5/4 none grcos Osg ml cs .7 1.6
4 49-98 10yr5/6 none ms Osg ml .7 1.6
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
* Effluent #1 = BOD y> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
3 @
'Conducted by: Conducted For:
Schmitt Soil Testing, Inc. Name: Grand Properties, LP
Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street
1595 72nd St. City, State, Zip: Somerset, WI. 54025
New Richmond, Wl. 54017
Phone: 715-247-2941 Subd.Name: Natalies Ridge
--~11~ Lot No.. I _
Legal Description: l/4 A14A14 S36 T30N RI 9W
Township of St. Joseph, St Coix County
® Soil Boring
A Bench Mark El. 100.00' Top of 2" pvc pipe
® Alternate Bench Mark El. /Or) QQ ® Top of 2" pvc pipe
Slope= le~,9 Contour Line El. /Yf
r
a31 13 33' 1~3
Scale 1" = 40'
l
This sat report was done to fulfill a zoning requirement, it may or may not be in a location suitable for your use.
33' 33' - - - - -463' - - -
I 6V I le x 923.4 x Z
917.2 O
' I 9226 .
i x I I r. _ j
• t~ x 923.2
.L.=
T 12
3.013 AC.
(2.34 AC.) °
I 75' L.B.O.= 918.0 6
I I
920.8 I 470• J
I I ,
I I x
921.21
921.4 •
x 0 > x
921.1 / LOT 13 I'~917
3.007 AC.
(2.63 AC.)
L.B.O.- 918.0 x
919,6
1~ x 918.7
1 x 918.8
32.200 AC. x
(0 AC.)
L.B.O.= 910.
LOT 1 B[m ~ a
3.00 AC. -
(2.7 AC. d 910.8 i.
L.B.O. 910.0
H.W.L.=908.0
• 913.2 90£,
x
x