HomeMy WebLinkAbout012-1061-10-000
30.[-7.4z13
. Safety and Buildings Division county
201 W. Washington Ave., P.O. Box 7162 ' l ~J f
Sanitary Permit 5 Ito be filled in by Co.)
Iscoofnsoin ' Madison, WI 53707-7162
o 13
State Tranection/~~
Sanitary Permit) Application
in accordance with s. Conoco. 83.21(2), Wis. Adm. Code, subossion 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 different dun mailing address)
submitted to the Department of Commerce. Personal iz! ~rmadon you provide may be used for secondary
in accordance with the Privsc~ Law, & 15. 1 m „Stets.
L cation Infofmation -Please Print AU Informatio Parcel # ' •
Property Owner's Naas l Y 8 Zoos 012--
/Z?61 V
'f i Z ) 1 r~
Pr Owner-s Mailing Address f
rY CROIX L NG OFFICE GovL Lot /
l• Zip Code r ~'/wA~ `b, Section L 3
City, stag le o
RE rW
II, of Building (ehack all that supply) Lot #
Subdivision Name
{ 1 or 2 Family Dwelling - Number of B nts
Btock#
❑ Publie/Commereial - Describe Use ❑ City of
CSM Number ❑ Village of
State Owned - Describe Use Town of r~ .
III. Type of Permit: (Check one box on line A~. Complete But B if applicable)
4 A. ❑ New System t System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification. to Existing System (explain)
List Previous Permit Number and Date Issued
i B. ❑ Permit Renewal ❑ Permit Revision 1 ❑ Change of Phm►ber ❑ Permit Transfer to New
Before Expiration Owner
IV. of ]POW I5 S tem/Com nea~jee: Check all that a
on-Pressurized In-(}round ❑ Ptenurized In-Ground ❑ At-Grade ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ holding Tarok ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (extain~ el,
V. gn rsaUTreatm Area Information: Dispersal Arm Proposed (d) O E 6
Design Flow (gpd) Design Soil Application Ihspenal Area Requi (80 a
~ Z.~ J Manufacturer
Vi. Tank Info Capacity in Total # of
Gallons Gallons Units
New Tads Ex Wns T~n"
is, 10 A.
1 N/
Septic or Holding Tank L~~~
Dosing Chamber
VII, Res risibility Sta t- I, the undersigned. sibitity for Installation of the POWTS shown on the s>teachad plans.
P 'a Nam (Print) P1 lumllerIs MP/1v M Number Business Phone Numberr~
Plumber's Address (Street, City, State, Zip Code)
VII Coup /De artment U O
Permit Fee Date I d Issu' gent Sigmabme
Approved Disapproved $ . G oq
' m for ~ J
IX. Conditilnr i1(IpgYlV sons for Disapp val 3~ 61 _ 1 _ ~.,o
1. Septic tank, effluent filter and l 7~
dispersal cell must all be servkes I maintained
as per management plan provided !by plumber. If~[~`► ac 1+-- •
2. All setback requhe mutg be maintained
do I
Atteels m coca as a system and sabatit to the coaaty only oa papsr sot fen 81R x it fascia v slae
SBD-6398 (R. 01/07) Valid d1ru 01109
PROJECT Kristie Hince LOT PLAN
ADDRESS 1725 140th Ave New Richmond Wi 54017
NE 1/4 NW 1/4S 28 /T 3 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 5/7/09 3
DATE BEDROOM
CONVENTIONAL )00( IN-GRO" D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46
BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 88.6/88.2 5' below grade
WDNR
140th Ave
100Plans Designed U of Coeaching Chamber
Conventional PoExisting 3 ith 20.0 ft2 of Area
80 20' 25' fiGrade >6uick4 Standard-W
Manual Version 2. bedroom 8ft^2/pair of end caps
house 4' L3 4at System Elevation
20' Scale is 1" = 40'
Well unless otherwise
5~ noted 1\4 0 ~N 5 ~ w ww~e~ (~kyd'~%4-0 *4f
/ otr` ~~/1-0 0-~
Clean o t!
s'
2 of~ 10' 40'
ST B-3 2-3' X 94' Cells with >3' spacing
Old tank is o
pumped and buried 15 20
Old steel tank, collapsing T
B-1
Vents
3% Slope 3
93.5'
B-2 92.5'
Property Line
~ClcoPY
LOT PLAN
PROJECT Kristie Hince ADDRESS 1725 140th Ave New Richmond Wi 54017
NE 1/4 NW 1/4S 28 /T 3 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/7/09 BEDROOM 3
CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46
BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100, Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 88.6/88.2 5' below grade
WDNR
140th Ave
Vent
>6" Quick4 Standard-W
100Alans Designed U ' of Cover Leaching Chamber
Conventional Pow Existing 3 with 20.0 ft2 of Area
Manual Version 2. bedroom 12„ 5.8ft^2/pair of end caps
house 4' Long
3 4" Grade at System Elevation
80' 20' 25'
20' Scale is 1" = 40'
Well unless otherwise
noted
140'
100' Clean out! B.M.
30'
10' 40'
Old tank is to be ST B-3 2-3' X 94' Cells with >3' spacing
pumped and buried T 15' 20'
Old steel tank, collapsing B-1
Vents
3% Slope 3
93.5'
B-2 92.5'
Property Line
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P
include, but not limited to: vertical and horizontal reference point (BM), dire a Parcel I.D. 0 jig
percent slope, scale or dimensions, north arrow, and location and distance arest ro 10 Dro
Please print all information. Re ' ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). b
Property Owner r Property Locatr
1 ECEIVED Govt. Lot iv 1/4 114 S ZqT o N R I E (or W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
MAY 0 8 2009 -
City State ~Zip/Code Phone Number ❑ City ❑ Village [own Nearest Road
N ti L ST GkuiA . vuN i . Di -~j NING & ZONING OFFIC J
❑ New Construction Lse`p&esidential /Number of bedrooms Code derived design flow rate GPD
Oeplaoement ❑ Public r commercial - Describe:
Parent material l3C Flood Plain elevation if applicable _ ft.
General
and
recommendations:
System Type ~I~~1/t7w►~t`d System Elevation 96 - / S.
Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor ~ in.
-0 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2
YL110 Z' X,14
1
11 4
Boring # ❑ Boring )
pit Ground surface elev. C d. (0 ft. Depth to limiting factor in.
7T Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
" C t c~
s /a
Effluent #1 = BOD > 30 1220 mg1L and TSS >30 < 150 mgA- ' ffluent #2 = BOD < 30 mg/- and TSS < 30 nVL
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 7~J 715-246-4516
Property Owner _ I ID # Page of
❑ Boring
FIN Boring # ►~TT1l .
ICF Pit Ground surface elev. ft. t Depth to limiting factor - in. 7*Eff Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots DM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2
to
t
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 I
❑ a Boring # Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil lication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg& 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.
SBD-8330 (R.W00)
Property Owner _ Fa~el ID # Page of
F-31 Boring # t❑r Boring /
ICF Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicati Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
E Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil licatioo Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate.
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/t_ ' Effluent #2 = BOD. < 30 rng/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.
SOD-8330 UUM)
Soil Test Plot Plan
Project Name Kristie Hince Shau
Address 1725 140th Ave
New Richmond Wi 54017 C #226900
Lot Subdivision Date 5/7/09
NE 1/4 N W 1/4S 28 T 30 N/R17 W Township ErinPrairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Wood Corner Post
System Elevation 88.6/88.2 *HRpSameas Benchmark
140th Ave
100'
Existing 3
bedroom
house
80' 20' 25'
20' Scale is 1" = 40'
Well unless otherwise
noted
140'
No Clean out! B.M.
40'
B-1
15' 50, B-3 20'
T
Old steel tank, collapsing
3% Slope 35'
93.5'
B-2 92.5'
Property Line
' ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer A~; e.
Mailing Address 5- yp t (~.t.c,~'~.X ~IL/~ i7 )
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number alZ - /d to ! - /O - ~D~
LEGAL DESCRIPTION
Property Location A'E 1/4, ti+.J 1/4 , Sec. , T -30 N R W, Town of A, ~ A- f lcant.Itl-
r--
Subdivision Lot #
Certified Survey Map # , Volume , Page # ft~
Warranty Deed # Volume d- X , Page # 0
Spec house yes Lot lines identifiable ye 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.
Ilwe, 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.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we amlare the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
N ber of bedroo
uo
SIG TURF 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)
Parcel 012-1061-10-000 05/11/2009 04:56 PM
PAGE 1 OF 1
Alt. Parcel 28.30.17.421 B 012 - TOWN OF ERIN PRAIRIE
ST. CROIX COUNTY, WISCONSIN
Current ❑
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - HINCE, KRISTIE A
KRISTIE A HINCE
1725 140TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1725 140TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE
SEC 28 T30N R17W 10 AC NW NE NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1028/86 WD
2009 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/07/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 30,000 167,900 197,900 NO
AGRICULTURAL G4 8.000 400 0 400 NO
Totals for 2009:
General Property 10.000 30,400 167,900 198,300
Woodland 0.000 0 0
Totals for 2008:
General Property 10.000 30,400 167,900 198,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 110
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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 filteris being install0d in
orderto extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the Inspections pipes att to ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner d"lselmge 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
Option #1. If system_faiis, determine cause of failure, use alternate area and Install new
replacement area.
Oinstall system at a lower elevation, by removing chambers, removing blomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
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
11 I i y~
DQCUMENT NO. { +~~PpWARRANTY DEED I T 5 -ACC REFERYEp FOR REGORpING P~TA
II - - - _ _
.~~BAR OF 4. WISCONSIN FARM 2-1982
~ S P VOTE
0 11 86 riic4al E t$['y~i
Viola Harer a/k/a Viola M. Harer, a sin le S CROM co, vll
I - -
person-----)?Y.. t'6 f14ctK-. .!.~..-Fi_~-tQ[ 1ll~'y c_. Vs~_~.eZ7 E------ -
A
tt:,3o
conveys and warrants to ....-Kr,istie_._.. ._H,inee.,_.._a__s.ingl._-.._.._•, ~ 1R ~ i
'ts1~r tf DOadls 1
- - -
II
_
II
I~
.
' the following described real estate in St. CrD.i.x County,
II State of Wisconsin: I -
Tax Parcel No:
I
ii NW1/4 of NE1/4 of NW1/4 of Section 28, Township 30 North, Range
II 17 West, St. Croix County, Wisconsin.
ill II '
N a
I! II
I
I
i
i This ._.....-f s homestead property.
i (is) (is not)
Exception to warranties: easements, restrictions and rights-of-way ,
I of record, if 'any.
i
n ay of August 19.
Dated this r d
p ....................................................(SEAL)
.._._...(SEAL) I
Viola Harer a/k/a Viola---••- II
M. Harer ...........................................(SEAL) I.. ......(SEAL) l
' . . . II
f
AUTHENTICATION ACXNOWI.EDGMENT
Sigrtatyre s) Viola Harer a/k/a STATE OF WISCONSIN
{
II Viola M Harer ss.
jl
f ~ County. ,
authenticated ~~tthh~iiss oil ,'-Sad,,, of f..._A11gust-_•__._•, 10__93 Parsonslly came before me this ----------------day of
it I kf Cie - I 19°------ the above named II
I! Kristina gland
il TITLE: MEMBER STATE BAR OF WISCONSIN I'
(I£ not, ii
authorizecY i ii ?06.06, Wis. Stats.) to me known to be the person who executed the
I foregoing instrument and acknowledge the same. li
THIS INSTRVPhENT WAS OFiAFTED 9Y i{
Krisbina Og.land. I
jI Attorney at i.aw - .9--- Nota--ry Public County-,-i's .
(Signatures may be authenticated or acknowledged. Roth My Commission is permanent-(If not, state expiration
ry"
ante
-
I{
z:rc
II •N-" of persons gf"InS in any eapacity should be typed or printed below th:•ir signature..
run:rnFi ucci wiarnvc..v WiSCOn s.n IYQAI Blpni Cn Inr.
I, n_wn Op
.._TE FOAM No. 2 - I!A't M~I.va VkCt. W19L4nSl.n