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HomeMy WebLinkAbout022-1041-10-200 r � Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363959 Permit Holder's Name: ❑ City ❑ Village ❑ TKvvn of: State Plan ID No.: Bauer, Eric Kinnickinnic Townshi CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 1c;.18 03.89 C�T'8� -* 2 022- 1041 -10 -200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY S ATI N BS HI FS ELEV. Septic Benchmark 10, I>� (p3.88 Dosi ng Alt. BM Z $ Aeration Bldg. Sewer Holdin St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet zt 10q ,sa TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet �— ir I Septic S5p ?,� r NA Dt Bottom Dosing NA Header/ Man. nJ /0,3 le3•�3 Aeration NA Dist. Pipe S 1(. Holding Bot. System o [072. S 3 0 PU / SIPHON INFORMATION Final Grade - Manufa r emand St cover Model Number GPM TDH Lift L rlction Y TDH Ft F emain I Length Dia. Dist.Towell SOIL ABSORPTION SYSTEM BM E Width r Len th N O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 I DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Mau ctuer: SETBACK CHAMBER v — INFORMATION Type O r M e Number:. System: C^%) • T" �" ~' io �—' OR UNIT _ DISTRIBUTION SYSTEM H 1 Mani Distribution Pipes) x Hole x Hole Spacing Vent To Air Intake > `, Dia. e' �ngth — � Tia. Spacing T SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over v a Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center zo _ f D Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 40 7/6 2 $ / °21 Inspection #2: --f — t — ' Location: 396 Cemetary Road, River Fa ls, WI 54022 (NE 1/4 NE 1/4 15 T28N R18W) - 1528182 5A20 -Loo . 1.) Alt BM Description = -EeP �ec►. �� l.n S' 2.) Bldg sewer length= 30 - cps ,,,,� � p s , �- o � �ha��,Ql�J �w - amount of cover = > 1Z k *Cb PI r evis io n re uired? Yes No a q t o o( ab J , t (o U s e oth r side for additional informati o 13 &° 0 D � 0 C"'k �^ Date Inspe r'sSignature Cert SI' SBD -6710 3/97 � l pei�'"P ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i P 5 g 3 ] e 1 g_ -- -- i s � E i � € s a $� a, i 4 fl ? y ............. i t _ _.,...._......_._ .,._.. �.�. m.�'�...�ml _ ...�..�aJ..a .w.a..n.ww...�..�....� � ,..._- .......,._ _ .......�.....�._ ..�...._......,...�,..�_ ._. _...r.,_a„..,,.�,.„...1,._..w _.... � __.,..M.S�........._�,..��..a ...........�..,....�..... a._.�....,.. r -3 p2V Sanitary Permit Applic tion Safety &Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. sc See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Deportment of Commerce [Privacy Law, s. Is (Submit completed form to county if not state owned. Attach complete plans to the county copy only) m on t ss than 8 -1/2 x 1 I inches in size. Count / State Sanitary Permit Number / cKr if revis o previo tion State Plan I. D. Number T. (fro r I. Application Information - Please Print all Informatio - Location: Property wner Name t— Property Location /� _! L! !_ 1 4 , 2000 t✓. N E , �1/4, S -78 ,N, FI'0 E or iP Property Owner's Mailing Address .- .t Lot Number Block Number /,3 � ci ZO couNn � � ��^. i�� NINGOFFiCE h City, Zip Code P Number Subdivision Name or CSM Number y - S o / CSC 3Y5 II. Type of Building: (check one) / ❑ City ✓ ❑Village ❑ 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Town of ❑ Public /Commercial (describe use):_ �nh / , ' ❑ State -Owned C / M, 17 c eares oad Parcel Tax mber(s) Z _ 1 III. T ype of Permit: Check only one box on line A. Check box on line B if applic able - 28 / ?. 2 A) 1. "ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 46 Non - pressurized In- ground ❑ Mound ❑Sand Filter ❑Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/Treatment Area Information: Z 2 fi c�S . e r a c✓z� 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application D. Percolation Rate 6. ystem Elevation 7. Final Grade Required Proposed Rate (GalsJda /sq. ft.) (MinJinch) /0 310 t! n . Elevation y s� ✓ 3�s' 37 , y 2 ✓ 77 I Z /o 7-1 o �° �,�� iota, o VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks S I i C_ / iY t�aG� 7 ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Business Phone Number Plum bees Name (print) PI is Signature no stamps): MP/MPRS No. 2 /y 5 = G 6.� 7 Plumbees Address (Street, City, State, Zip Code) /Yo ix ST IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ' Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee Determination ZZ . O U ! 7 - /Z 0 00 X. Conditions of Approval /Reasons for Disapproval: / P� 5 ( �� 6P �«- �.�Q�n ea✓ ! /tier / 'I't a�., / G�fcr� S � Qr / �T PC Gib 1r S�GL �� be h SI2 ���I / ln S� c��t Tin ?.A �/ X, Q� % O r, - f'rp #K= PiQT AwA - Tj NFCos-,.., 14:9 L � J, 7W Vz I� r b 0 $V A � o�se• J a�i o'er �' � �° � 5 �a. ,r c l ode- o .� Wisconsin Department of Industry SOIL AND SITE EVALUATION 3 Labor and Human Relations Page of Division of Safety and Buildings r In �racordanM ^ with S. ILHR 83.09 Wis. Attach complete site plan on paper not less t ar 81/2 xI size Plar� must Coun Sr. C eo r X. Include, but not limited to: vertical and hors referer>I� r l), dire rdn $nd percent slope, scale or dimensions, north ro�v; and location and distance toEr)ea�est road. parcel I.D. # AP 1 1998 = 02-2- o 1 t (• c 0 APPLICANT INFORMATION - Pie ~ se p rint atl 9tlon. Reviewed by ° Dat Personal information you provide may be used fors cortdary pMjMw, y 0 (1) (m))_ l g Property Owner , -Q Property Location p 40,4'LD /"� i /c1-; �, t �� Govt. Lot NC 1/4 Me 1 /4,S S T Z N,R E (or) W Property Owner's Mailing Address t , of Lot # Block# // Subd. Name or CSM# / Z5 o caU�Ty S' Z CSM 7 City State Zip Code Phone Number Ems Nearest Road 12 i U E R �h l(S 4J (, S y01�— 1 015 ) y - 3 El city ❑ Villa Town ('EvET19/E' Y RP El New Construction Use: esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: /S'O - Q Code derived daily flow &4V gpd Recommended design loading rate bed, gpd /ft2 ° �j trench, trench, gpd /f1 Absorption area required �� bed, It 2. 7 5 0 trench, It 2 Maximum design loading rate • � bed, gpd /fl O gpd /it Recommended Infiltration surface elevation(s) S��' Pa - 3 It (as referred to site plan benchmark) Additional design /site considerations d Parent material S CS d �D�i�t ff��'`� -¢K7�S 01 4L Flood plain elevation, if applicable N �/ It S = Suitable for system Conventional Mound In G ^ roun / d Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system (❑ U -❑ U L❑ U [s ❑ U Q S El U El S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l 1 a•Cv ie >VR3 13 2- 6- ioYR 3! S L. / s"fie 'q -5 / . � ;. Ground .3 �' '7• S y/?; J S O, S • d elev. /o 5 - aft. Depth to — limiting + factor y In '3 Remarks: Boring # d. I o 10Yr1- 313 L f she /wr fie q 2 z o- ioy e 3/ / SL /7`'slfe tis-s-7ie cs . q :.5 3 a - 3 / y14k cs Ground 7. S m S .s �C. • 7 elev. Depth to limiting factor T in. Remarks: CST Name (Please Print) Signature Telephone No. l ��S•3S4• 185 Address Date CST Number rfPR; e- - f cs T11 :X y z- Private Sewage Consultants 666 O'Neil Rd. Hudson, Wis. 54018 Q �I L-0 T Z G PROPERTY OWNER Page EMffo�TZ SOIL DESCRIPTION REPORT 2 of 3 PARCELI.D.0 d2Z /O V I ' !Q (PEA- )p l A.3& Y `� C SI ;) Horizon Depth Dominant Color Boring # a t Co o Mottles 9 P Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color G►. Sz. Sh. Bed , Trench 3 i o •� /Cy YR 313 1<' S Z 2 • ZS /a vie / 2 f S ht /w-F/? r i - • s ' Ground 57-3 /b yIQ S L / f S O� ^,70r j e 4 1 S elev. Depth to limiting factor in. Remarks: Boring # /0 yR 3/3 ----_ . c /fs,6 .w� � s Z f . �{ ' . s /o Ye a/ I - G z - f S!> 7.� CS Ground O 7. S S� —� d .j �i� _ • 7 •� el ev. /o L. 3Sft. Depth to - -- — limiting Z '' factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /fe Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # _ / 0 • Q /b�j� 3�3 ---� L. /�.I ,C' �.+� -r S' Z-� .Y . , S 31 L 7 • s Y R yle GS / S Ground ?..S 51 S a � � -- • � . elev. Depth to -- -- a� /0 Z limiting , factor 7 0.1 Remarks: Boring # a Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) _• A �oIs-,? ,O 'ma am y u C o o p p vj M o kA CIO d�► - jz 'p W � � d � � o W w °d (1 Q1 G ` o - o �^ ST CROIX C'OUNTV SEPTIC ':'RINK MAWTENANCE AGREEMENT AND OWr CE,RTIFICATI FORM Owticr/Buyer Mailing Address Property Address. (P (Verification required fro» i Planning epartrnent for new construction) City/State � Parcel Identification Ntunber 0Z- L EGAX,, bESCR1PT�O Sic. `� . T 5 E' N -k-_ W Towrt of - /nn �C LC Subdivision Lot 0 � Certified Survey Map # Volume �, Page # Warranty ]Deed # Z Voltame Page # Spec houso 0 yes no Lot lines identifiable 91 yes ❑ no SYSTEM WARMFNANCE Improper use and maintenanceof your sel pe system could result in its premature failure to bindle wastes. Propermauntensnce consists of pumping out the septic tank every thr( a yearn or sooner, if atadod by a licensed pumper. What you rut into the system can affect the function of the septic tank as a cant �ment stage in the waste disposal system. The property owner arm to submit to St. C'mia Zoning Department a cortifloation form, signed by the comer and by a masterplumber, joumeymanplumber, restrictedpls trnber or a lice m6dpumper verifying that (1) the on -site wastawaterdisposal system is in proper operating conditicw and/or (2) after in: �eedon "d pumping (if neeeasary) the septic colt is lase than 1/2 full of sludge. Uwe, the undersigned have read the above requirt) bents slid agreo to maintain the private sewage disposal system with the standards set forth, herein, as set by the Departtnettt of Cam- "me and the Dapartinont of Natural Reaoumea, Sts of W isoonsla. C,,t ion stating that your septic system has been maintainer i must be completed and catarned to the St. Croix County Zoning Office tt AJt 30 days o the titres ye expiration date. SIGNA OF APPLICANT YATE O W NER LERMI T A ION I (a"e) cettitfy that all statements oil this : irm are true to the best of my (our) Im I (we) am (are) the owner(s) of the property :7ri by virtue of a wa tra ity deed recorded its Register of Deeds Office. 'r ONAT JRE OF APPLICANT' DATE �•�4�. «..* Auy information that is mis- representedre ey result in the sanitary permit being revoked by the Zonixig Department. •• * *"• Include with this application- a stamped wart tnty doed from the Register of Deeds office a copy of the a rtified survey rnxp if refereace is nude to the warreaty deed 6225x47 DOCUMENT N o. KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Gerald A. Emholtz and Jean E. Emholtz, husband and wife, Grantor, 05`05-2000 2:00 PM conveys and warrants to Eric Bauer and Susan Bauer, husband and wife as survivorship marital property, Grantee, the following described real WARRANTY DEED estate in St. Croix county, State of Wisconsin: EXEMPT D 17 CERT COPY FEE: COPY FEE: LOT TWO (2) OF CERTIFIED SURVEY MAP IN VOLUME TWELVE (12) OF CERTIFIED TRANSFER FEE: SURVEY MAPS, PAGE 3459, AS DOCUMENT NUMBER 579996, FILED IN ST. CROIX RECORDING FEE: 10.00 COUNTY REGISTER OF DEEDS OFFICE ON JUNE 1, 1998, BEING LOCATED IN THE PAGES 1 NORTHEAST QUARTER OF THE NORTHEAST QUARTER (NE 1/4 OF NE 1/4) OF SECTION FIFTEEN (15), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Subject to easement over the Easterly 33.00' thereof for town road purposes. Together with and subject to those joint driveway easements as shown on Volume 12 of Certified Survey Maps, page 3459. This deed is given in full satisfaction of the Land Contract between the parties recorded July 24, 1998 in Volume 1342, Page 608 as Document Number 583625. NAME AND RETURN ADDRESS I34o 3 DOmann Dr rA eLV jZ i C4%A -YI- KA la-T 022 - 1041 -10 -000 Parcel Identification Number (PIN) This is not homestead property. Exception to warranties: r All easements, restrictions and rights-of-way of record, if any. Dated t is / day of January, 2000. Z .,/" (SEAL) (SEAL) Gerald A. o tz Je E. Emholtz (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMElff Signature(s) STATE OF WISCONSIN ) ) ss. G C COUNTY ) authenticated this day of 19_ Personally came befor % ae«ChL4 day of January, 2000 the above named GeraiCl'' 44 •4nd Jean E. Emholtz to me known to be t b. executed the foregoing instrumeS � � 'the same. TITLE: MEMBER STATE BAR OF WISCONSIN w �• �G ©� � (If not, authorized by 9706.06, Wis. Stats.) N • t h THIS INSTRUMENT WAS DRAFTED BY: Notary Public County, Wis. Joseph D. Boles My commission is pel n !•mot t, expiration date: Rodli, Beskar, Boles & Krueger, S.C. �q P.O. Box 138 , River Falls, WI 54022 � - r , I ti yl. s FILED z ' JUN 1 1998 [� [� r KATHLEEN H. WALSH 3 57 99 - 9( ; 9v Register of Deals \ L � CERTIFIED SUR VEY MAP GERALD EA11HOLTZ Part of the Noriheasl 1.4 (?I'the Northeast 114 of'Seclion 15, 7c)wwship 28 Norlh, RatWe 18 West, Town of Klnnickinn/c, .S Croix COunly, Wisconsin. NE COR. SEC. 15, r28N,R 18W, N 114 CDR. SEC. /3, T 28 N UNP LA T T EO LA /2 "IRON PIPE FOUND/ s /078.03' - R /8 W. / / "IRON PIPE FOUND) N LINE NE //4 4. 2 FfNCE B • 07'07 "E 2676. 94 ' i 5 3 8.0 3 ' 340.00' 33.02' 57 /. 05' I 33 33' I 1565. / / / /.o _ , .. I 6 ~ Q v L OT / LO � _-r/ 0o' M p I 5.590 ACRES 4.105 ACRES 7 _Z(� I •� a I V_I ° j 243, 506 SO.Fr. N / %B, 820 S0. FT. I t O) M to N l am' N 5, 464 ACRES EXC, ROAD EASEMENTS J. 869 ACRES EXC. ROAD EASEMENTfS y � M 238, 028 SO. FT. � /6B, 526 SO. FT. I � 3 O v o 1 33.0 ' M ? 539.23' Q ^ N 87. 53.0,- 572.26' I, I N �� v ? I I - t&6 Itt&6 N J I tnb 3 Q I W N 87. 53'37 " 1111.5 : I Q J Q , ` 539.4 7' ' Y I 33.0 o N r, N 540.09' 0 572.50' �V I O 2 � /079.56' � o eto O QI o M LoT ' A h1� 2laa�'I J LO 3 N 3.713 ACRES 1 I B7.5 '.3 Z N -- N /6/, 728 $0. FT. ; E N /03.518 I J 5.3 ACRES o 3,531 ACRES EXC. ROAD °0 70.56'33.02' 241,025 50. Fr. EASEMENTS 6 1 .a °0 r 0 I `150' O S. 40 7 ACRES EXC. ROAD EASEMENTS O /53,806 SOT � 5 F 0i" 235, 339 SO. Fr. ? 57 "E 214..0 N87 � - � 69.003 .02 1 ° ' (� © '' S 87 57 "W 4 , d ° /0 /.02' o0 H 89 "W 296.18' 5 87.53'57 "VV 460.50' UNPL TIED L W v 2 Dated: December 10, 1997 "Revised this 22nd day of May, 1998." ? J 'Owner's Address: W 1250 C.T.H. "J" E /J4 COR. sec. /5, T2.9m,R18W River Falls, WI 54022 /c•ouNrY SURVEYOR'S AIONJ LEGEND: R() Previously recorded data. ``-* �sty'O�S� iii O '1" x 24" iron pipe weighing e ms ••••..•• �� s 1.13 lbs. /lin. ft. set. ° O 1" iron pipe found. F rn W Y • ' C ��' •� cz: ALL BEARINGS REF. TO THE EAST LINE OF THE r � � G N£ //4 OF SEC. 15, T28N, R/8 W, ASSUMED + S 13 y • N Do 07' 00•'E 1. j �`•.RIVERFALLS,,.',�e This instrument drafted by Laurence W. Murphy ����� ft I SCALE / 200' aurence W. Murphy 0 50' /Do 200• 300'• 4 00' 500• 600' Registered Land Surveyor CU RVE DA TA CURVE CHORD Be ARIN6 CHORD DI ST. ARC D/Sr. RADIUS CENTRAL ANGLE /S r rAN. BEARING 2NO TAN. BEAR /NG 1 -2 S74 "W 90.77' 91.57' 200.00' 26'13'57" S87 '57 "W 561 "W 3 -4 S74 128 . 8 8' 130.01' 283.97' 26•13'57" 561 • 4 0'00 " W S07 "W S -6 H74 "E 98.93' 99.80' 217.9% 26•/3'5 N87'53'57 "E N61 "E 7 -8 N74 "E 120.73' 121.79' 266.00' 26•/3'SJ" N6 /•40'00 "E N87 "E SHEEr i OF 2 VOL 12 PAGE 3459 i