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HomeMy WebLinkAbout038-1055-80-400 r Wisconsin department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division . o INSPECTION REPORT Sanitary Permit No: 399601 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: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Star Prairie Township 038 - 1055 - 80-400 CST BM Elev: Insp. BM Ele v: BM Descri lop: lV0 / (00 t'or (1lLIS$ TANK INFORMATION v ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer �3 / Holding S t Inlet TANK SETBACK INFORMATION t Outlet �� 0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt i n l et Septic /� ) s _ Dosing Header /Man. L ? q S Aeration Dist. Pipe qs 0 Holding Bot. System QJ- too Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand t over GPM Model Number f ✓" TDH Lift Frict ss System Head TDH Ft For Length Dia. Dist. to I SOIL ABSORPTION SYSTEM Ch &t*-:5 e4 C' ( BED/TRENCH Width Len,9th / No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM G Man rer INFORMATION Type Of System: I AMBE OR h 74 y T� iGGc /� �/ J Model Num er. DISTRIBUTION SYSTEM d ? Header /Manifold IDIstribution / x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length_ Dia Length y/ Dia Spacing �P SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eded /Sodded xx Mulched xx Se Bed/Trench Center Bed/Trench Edges Topsoil 10-1 Yes [] No [E Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /$i inspection #2: 1 1 Location: 1338 210th A e Unknown (SE 1/4 SW 1/413 T31 R1 8W) NA Lot 21 / / S / P Parcel No: 13.31.18.239F 1.) Alt BM Description = U Sir CDVC'e Grc/ sY5 /dam ACA' 'a' e eG V'P vC SC a I , — 2.) Bldg sewer length= ��, SOr l �Ct f Sr - amount of cover = / ,' /r 3 )abseyv4 - is ,tis � /�o� ,,. � ktVj Plan revision Req ire � Yes No / Use other side for additional information. (7 W An ( � SBD -6710 (R.3/97) Date ( Insepctor's Signat Cert. No. o —7 I� � e= :... Y }(., r ._, �4 � s b _� - _ ... ti ' � L �� r. � '�'1 ////���I /! 0 �r o �� -1 o �,� " - �� -° �� ._ Flo r . �'s�l� N CJ L Safety and Buildings Division County C �' 201 W. Washington Ave., P.O. Box 7162 J C XVr� Sconsin Madison, WI 53707 - 7162 Site Address Dep artment of Commerce -4- 1 - S3<P 2 Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Revision may be used for Purposes Privacy Law, s15. 1 m Check ' Revis I. Application Information - Please Print All Information I.D. Number Property Owner's Name Parcel Number Cv // k1 - bjP- /oSS - P6 'fGb Property Owner's / Mailing Address Property Location 6 dJ1J 4,0�� '� 5 9'J T- N. E City, State Zip Code Phone Number Lot Number Block Number 0 7 Subdivision Name CSM Number z P . 33 II. Type of Building (check all that apply) R E C E I V miry 2 Family Dwelling - Number of Bedrooms ❑Vtilag ❑ Public/Commercial - Describe Use P ❑ State Owned Nearest load ST. CROIX CO T } / M. Type of Permit: (Check only one box on line A (numbering scheme r intWOEW e B if applicable) A. ew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank On' stem B. El check if sanitary Permit Previously usued Permit Number Date Issued X of Permit: (Check all that apply)(numbering scheme is for internal use) - Pressurized In -Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Disqpme rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq (Min./Inch) Elevation 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. Plumbe 's Name (Print) Plumber's S' MP/MPRS Number Business Phone Number Plumber's Address (Street, Ci Y, State, e) VIII. Cote /De artment Use Onl i Sanitary Permit Fee (includes Groundwater Date Lcsued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination �� Z, �t� IX. Conditions of Approval/Reasons for Disapproval 1. This revision was submitted to reflect a change in system location. 2. Effluent filter to be maintained per manufacturer's recommendations. Attach complete plans (to the County only) for the system on paper not less than 81a z U inches is size SBD -6398 (R. 05101) j31R T PLAN & Soil Test Plot Plan PRO%CT P.C. Collova Builders InADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 13 / 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 22690 DATE 4/8/02 BEDROOM 3 CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 96.5/96.3 Property Line 35' 150' 15' 12' S 10 ' S B -1 Vents Pro 3 2 -3' X 69' Cells with >3' Spacing Bedroom House 25' B.M. 35' B -3 5 ' B -2 Vents Plans Designed Using Conventional Powts Manual Version 2.0 jL Sidewinder High Capacity Leaching Chamber 3 �Grade at System Elevation 210th Ave Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County s �. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location v Govt. Lot Z� 1/4 5 S T R E( ) W Property Qwners Mailing Address Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road ew Construction Use• esidential / Number of bedrooms Code derived design flow rate J GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: C'c�"" �j'�i(lc•(��� �6 • � 9�r� M 16 Boring # ❑ Boring J �) / Pit Ground surface elev, , `' ft. Depth to limiting factor �C in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 1:3v s � F -J ✓ [::� �10 -I 87 �zs' © Boring # ❑ Boring L Pit Ground surface elev. / ' A ft. Depth to limiting fact in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munse Qu. Sz. Cont. Color Gr. Sz. Sh. A *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TS >3 _ 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg1L CST a e (Please Print) Signature CST Number Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page of © Boring # ❑ Boring JJ t Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 �s �, �v J ✓ . rY ✓ F-1 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 GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '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 GPDff1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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. SBD -8330 (R.07 100) PL T PLAN & Soil Test Plot Plan PRO'f,CT P.C. Collova Builders Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 13 /T 31 R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/8/02 BEDROOM 3 CONVENTIONAL XXX IN- GROU11 RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 96.5/96.3 Pr operty Lin 35' 150' S f 15' 12' S 10' B -1 Vents Pro 3 2 -3' X 69' Cells with >3' Spacing Bedroom House 25' B.M. 35' B -3 5 ' B -2 Vents Plans Designed Using Conventional Powts Manual Version 2.0 Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 34" Grade at System Elevation 210th Ave I _ V;I Safety and Buildings Division county a�� 201 W. Wtwitiugton Ave., P.O. Box 7162 �`� 1 r D ) >. Madi3on, WI 53707 - 7162 Site Address a mbnt of Commerce ,4. /339 2(0 ' A . Sanitary Permit Application s ankary Pen Number ID Mold WO Comm 83.21. Wis. Adm. Code. person! iofbrmadoo you provide 3 q a Pd Law 615. 1 tm [ I if Revision WMMItIft - PkM PkW Alt Wormatiao s Pfau LD. Number POPS Owmes Name ®vim s-- mi l a�, j Propuny 0~8 MWft Address Froporw 1oe.d C) .� �b, e- s / 3 T 3 N fi Cby, no Zip Code Phone N 3 �1 k Number �AJ s (� vision Noma M Number - A 1 , //2 35 II. 4r8>1 (aluolt apply), ; k1' ct 1Pun* DweW - Number ttedsoorus 0 Pnbiii A/Commmial - Describe Use i S -. _ NOV 11 20 / �✓ 13 Stitse Owned Road `�' (� �"ts ST CfiOIX ait/L.t_.e. 2 3 K 68 ' ' c.2Q.Qs oou�t / 1H. Ty" of Peanut (Check only tuts box line A (nun for 1 ompletss line B If appticabk) A 2 0 Replgoentant Sy"m 3 oplaeament of 6 its _ C 7 utie Tun R • ©Check it 8aaltary Permit Pravfatt�y Tmued Nnmber Date Issued W. • of Premise (C.bock alt that apply)(n=nbnIn= is iateraa! use) eQ f -- I CD '6 7 tewziwd TwOrattnd 210 Mound 47 0 Sand PUter 50 11 Ccnsaucted Wetland 22 Q Prantelasd Lo -Ground 410 Holdin3 Tadic A p 0 single Pass 510 Drip Line as 0 4d o Asroltie 4 30 0 Other v. Are. W t Vodp Now Wo DiVald Ana aieparW Area so P�arcajetlod Rate system Sisvadoa T'imat Ciade 1 POSed Rawoabuuys .Ft.) (MIGIA W Sbvaticn M. Testis Ist6o CQU is I Tom Number Ulamo>bcturer Pratab site stow Piber Plastic Nam ate Ccutrackd elan ae . -�.a a -4 ' �" I for ioet o"M of the POW93 I'M on eta+ shed Pbmtbar'e Name iritnnber' MP/MPies Number Phone Number 2 Plnimbar's Addrasa ( saaert, Clgr, Zip > � / vm. �a8 f X Appeovad 0 � Flee) Fm Cmeiudee Oroumdaaser n.t. Iaauad t&su =S**X*WI- 0 2- tatWU Adverse , r {{ ZZ S 13L C40dkkm of Ow Din prowl AA � d- env) kr .r,w. an pyw ,wt Go& His s u WAMW (f sae SBE66398 (R. 03100 PLOT PLAN PROJECT P.C. Collova Builders Inc..j ! ADDRESS 705 Co. Rd E Hudson Wi 54016 SE 1/4 SW 1/4S 13 /T t` N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 / DATE11/12 /01 BEDROOM 3 ` CONVENTIONAL )00( IN � UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallon LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of SW Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P Same as Benchmark SYSTEM ELEVATION 97.4 t AL > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using hamber Conventional Powts 'Long 16" Manual Version 2.0 t 34" Gra at System Elev on 69' Pro 3 Bedroom 69' R House 30' 14' Vents S 125' 16' 4 95' B -3 2 -3' X 69' Cells with 19' Spacing 21' Vents 8% 36 Slope 95' B -5 23' X .M. 210th Ave Le(» °andFDfumanRelatiol�^dustry, SOIL AND SITE EVALUATION REPORT Pagel of 'I Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S t. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -80 -100 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Nancy Bentley GOVT. LOT SE 1/4 SW 1/4 13 T 31 N,R 18 %(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 831 Hi hview Dr. "A" 21 n CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD New Richmond WI. 54017 (715 246— 1 qtar Prairi e 210th. aVe. [� New Construction Use [K ] Residential / Number of bedrooms 4 ( ] Addition to existing building j Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Recommended infiltration surface elevation(s) 97.40 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3.50' below surface grade Parent material Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem I ® S ❑ U I X7 S ❑ U I K S ❑ U ® S ❑ U ®S [:][I ❑ S ® U SOIL DESCRIPTION REPORT � I v=v ; Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxtdary Roots Bed JTrench 1 I _ 1 2msbk mfr cs 2f .5 .6 S 2 13 -28 2 Ground 3 28 -84 7.5yr 4/6 non elev. 10 ft. Depth to limiting / factor O , / 4z- Remarks: Boring # 1 —10 Or32 n 1 2 ' 2 <' .5 r 4/4 none scl lcsbk mfr if .2 .3 2 2 10 -20 Ground 10. 9 ft. 0 4 L 8-82 7.5yr 4Z6 none ms osa m Depth to 1; , limiting Z � fact r + $2.. Remarks: c` CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 -6200 Address: 1554 200th. AW, New Richmon4, WI 54017 Signature: Date: 9_22 - C unilr] 239 - L. A�t� PROPERTY OWNER Nanry Pnnt,lelr SOIL DESCRIPTION REPORT Page 2' —of 3 PARCEL I.D. # 038- 1055 -80 -100 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 10 -15 7.5 r 4/4 none scl 2msbk mfr C1w if .4 .5 Ground 3 15 -82 7.5 r 4/6 none ms 0SQ ml na na .7 .8 elev. 9 8.5 ft. Depth to limiting factor +8+ 21 Remarks: Boring # 1 0 -13 10 r 3/2 none 1 2msbk mfr cs 2f .5 .6 4 2 13 -26 7.5 r 4/4 none scl lcsbk mfr 9w if .2 .3 ,Z Ground 3 26 -80 7.5 r 4/6 none ms osg ml na na .7 .8 elev. 9f . 5 ft. Depth to limiting factor Remarks: Boring # 1 0 -8 10 r 3 2 none 1 2msbk mfr cs 2f .5 .6 .5 5 2 7. 4/4 none scl lcsbk mfr qw if .2 .3 ,2 Ground 3 22 -30 7.5 r 4/4 none sl 2mgr mvfr gw if .5 .6 elev. 9 6.9 ft. 30 -80 4/6 none ms 0SCI ml na na .7 .8 Depth to limiting factor +80 11 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) I STEEL'S SOIL SERVICE Gary L. Steel Nancy Bentley 1554 200th Ave. CSTM2298 SEg.SWg S13- T31N - R18W New Richmond, WI 54017 MPRSW 3254 town of Star Prarie (715) 246 -6200 lot #21 -csm t �N ,- 1" =40' BM.= top of SW lot stake C el. 100' jAlt. BM.= top of NW lot stake C el. 102.70' B� G c oq � 3� 'b" Z 0 , ( 2V 216 -0 `gvt Gary L. Steel 9 -22 -97 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 7u rKPe - r _ -� / / / J f i r Shaun Bird #226900 r r KLn : r u: L UA 13LLRS, INC FHLH? NU • � -5 Feb. 01 2001 07: 33AM pl. f ST CRQIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND n OWNERSHIP CERTIFICATION FOILM OwncrfBuyer �• �• ll� ��cV�• (31 n � vim., �F— VA/uJG /L-- Mailing Address S - 4 , ; Property Address Verification required frorr, Planning Dc ^artineat for new concoction) City /St.ato K m(" LA J Parcel ide:zLfcn : :cn ;lumber LEGAL DESCRIPTION Prcperty Locaticn ; :,� , SCC � �� I -Z ) T V, .cwr, Subdivision Lor ;t L �S ! \ 3" • Warr= Deed It �O �� 1 VCiU Cc= �Lcus°. V YF:..�. ^.Q fir.:; SYSTEM MAEN ENANC i�^rspe: r:c and m;iztcaa.:cc of your mac : }� :�... _auid re;.tit W iL: _ r� - r� afatits_ to ;:.sonic - ��stc :. P;oocr. :a �_ ;a asi= of pumping out the septic =k every +.r-- ^ y ear iecner, ii c=d=d'. a ic_ased - zu=er. What you put kto can a ffzct dac fimc:i= of the :epric =ak u a Yea --ent ;age in L.e w=e d#osal ryst The r owner a s to =b=it to SL Caoa Zzaia Decarr = a a '�:ca " - p epe:tY etc- . g -rein Lion form, _tgacd by t :. and cy i tr:a .izrptutubez, jvti�ew~..:aplumixr, t:ieicd plumber or z 1kcnsednurr.—,er7erfyi :3 tL:t (1) the on -site mstcxatcrdiSpc -.al .yst= s in proper cpem drg c =dition a d al'Ler inx. and 7=p ing t'i acs: a ) 4`e s =tic tack is 1_s the: 113 full cf sludge. 1we, the =dcssip=d have rmd the above requirenazz= and az =e to auintzin ;i:c private $c x-4c di =osai system with the saadar- - set forth, ht.: -..n, ss set �y the of C.ommerca and the De^ of'Natiz-al Resources, State of Wiscrrsia Certifiicatioa ::sting that your septic ayatern bas bcca maintaincd.^ust be ccmplc:cd rod rersred to r!.e S L Croix Cour ty Zoning Office withi : 30 days hrt year ri 2tion . St-NA CF APPLIC.-kivi CATE OWN TER CERTIFICAMON I (we) oerdfy that all stat cmezu an this form ue truc to the pact of my !cur kmowtedge. 1 (wc) ant (ors) die ownetfs) cf the scri above ' y virtue of wuranry dead recorded in Rngis:cr of Deeds Office. ( At NATURE 6F APPL'IG1N7 DATE "'e Any information that s mis- represented may result is die sanitary per..rit being revoked by rt+c Zoning Dcpartrricnt. " Include with this appi[e2dan: a stamped waaraiity decd from the Register of Deeds ofltce a =43y of the certified survey map if refuence is made in the warranty dead Vill. 91.41'Arul-3 �3 STATE BAR OF WISCONSIN FORM 2 - 1999 660 KPIT-itLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number I ST. CROIX Co., WI This Deed, made between Nancy L. Bentley RECEIVED FOR RECORD 11-01-2001 9:30 AN WARRANTY DEED Grantor, and P. C. Collova Inc. EXEMPT N , CERT COPY FEE: COPY FE. TRANSFER FEE: 173.70 RECORDING FEE: 11.00 PAGES. I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. C roix - County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of SE 114 of SW 1/4 of Section 13, Township 31 Nortlb.�ange 18 West. Name and Return Add R OGLAND St. Croix County, Wisconsin, described as follows: Lot QI,1md22of KRISTI A Certified Survey Map filed October 29, 1997, in Vol. 12, page 3373, Doc. ATTORNEY AT LAW No. 567615. p BOX 359 HUDSON, 038 -1055- 80-400 54016 039-1055-80400 & 038-1055-80-500 Parcel Identification Number (PIN) This i no t homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of October 2001 • , 4 CL.. !Bi!e n I I e AUTHENTICATION ACKNOWLEDGMENT Signature(s) Nancy L. Bentley STATE OF WISCONSIN ) ss. County authenticated Personally came before me this day of the above named Kristins Ocland TITLE: MEMBER STATE BAR OF WISCONSIN ic_me_known to be the persons) who 'exec'uted the foregoing (if not, i and acknowledged the same. authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Attorney KrIstina Ogland Notary Public, State of Wisconsin Hudson, WT 340-16— M Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary,) InfofmMion Professi—Is cmPany. Fond du Lee. W Names orpersons signing in any capacity mus be typed or printed below their signature. 8001-M-2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1999 DO 4 .ro FILED:, c� U %� 0 W w OCT 2 9 1997 j N o ; KATHLEEN H. WALM 1 Repisterof DWS U SL Croix Co, M 567115 CERTIFIED SURVEY M APO Located in part of the Southeast Quarter of the Southwest Quarter of Section 1#, Township 31, Ran West, Town of Star Prairie, St. Croix County, Wisconsin. Also being Lot 1 of a Certified Survey Map as recorded in Volume 7, Page 2029, Document Number 441791 recorded in St. Croix County Register of Deeds Office. s+►W� { � Prepared for and at the request of: ��G�NS� S► NOTE: The parcels shown on this map OWN Bentl y/2�97 ww-- are subject to State, County, and Town - Nanc Y "� ship laws, rules, and regulations (i.e. 831 Highview Drive Apt. "A" RONALD F. • wetlands, minimum lot size, access to New Richmond, WI 54017 x JOHNSON parcel, etc.). Before purchasing or Drafted by. Kristi A. Eylandt - 1186 developing any parcel, contact the St. W �� - Croix County Zoning Office and the ` ���� O � ,� appropriate Town Board for advice. •• � ♦ '� N v -1 • SU R ••� LOT 17 • *n�N \ COUNTRY MEADOWS FIRSTAD I NLYLINE CSM - R = N 88'34'10"� _ _ _ _ _ _ _ W 496.13' I VOL. 7 PG. 2029 33 M - S 88'34'13" E 496.06' LOT 4 1 1 N 1\ COUNTRY MEADOWS I r/� L O T 19 1 1 1 ij 175, 698 SO. FT. FIRST - ADDITION 1 1 � � ----- ADDITION 4.03 ACRES Vi ELEVATION OF 1 — — — — — — — — �LUi I i 1 Q WETLAND =90.6 r`1 o I�1 1 4 1,- W BENCH MARK �1 Z I01 -I M TOP IRON PIPE W 1 NI J I 1 o N; ELEV = 95.48 \5_ i l �nl l ZQ IMO �1�.,N; o of) in �1 F -I�IaI v i I� r, i Q. v,• o � dl cil rn1 I Cn w �! - - -- S 88'34'13" E ,1L ,d1� 40 3 3 �i Ni aI 330.95' >1 f `- — — — ^NOD � -"',� r )%, 165.00' - - i� �- i� -sI cil N FO 1 �1llc I / co N W co n i C iA to j oon °o L:O T •'. 2 0 0 N 4' o I o 0 � r< 58,562 SO. FT. 1. N • . •� i f` 8 °o > Q I w j vl z i 1.34 ACRES I •, i 2 I _ I QI II II I • •• 1 I a) .•'•. I II II v I t-1 � o I I I/ S 88'34'12" E 330.90' • •11 '�, �"' o I a '\ 1 i I °IvI°0I i I � :LOT �� O �� i i oho I v w l I Ile 1 BM 2 �� u� � III J J v J I o I f I �l 1i oo i� �, ' 21 i -� i 'n l i Lr) O ILL v > I I t,l 1 p ao a) ... i ................. CON •1• jn , , • r • 7 • Q I I 1 In OL r ui R. O. W. ap ° co 1 1 I 1 i M to CENTERLINE I <i 1 I N N II 210th St. °d 1 0 1 j l n 11 Ci 210th 1 j1 1 1 << X N► Inn -„� — _ --I — — — - 330 --1 - 4 17 - 2 0.33' - - �� �.' _ -- M =N 88 4 51 W �� /495. 83 — ^ i .�� -M 403.22' ' —�, -- 330.84= _ . � i -15.0 4_ — --- "'- - — — — — — - M = N 8834'10" W 495.84' - - -- - R = N 8834'10" W 496.13' — — - --- --- - - - - -N 8834'10" W 2619.45'------- -- 210TH AVENUE R0.W 210th St, I FG Nn: SOUTH LINE OF THE SOUTHWEST 114 S Y LINE CSM County Section Corner Monument VOL. 7 PG 2029 -- --- TED LANDS of Record -- - - - - -- -- • Set 1" x 24" Iron Pipe weighing a minimum of 1.13 pounds per AREA LOT 21 : BM #2 RECORD INFORMATION linear foot. 71,139 SO. FT. BENCH MARK FOR R.O.W. 210TH AVE: O Found Iron Pipe 1.63 ACRES TOP IRON PIPE R= N88'44'00 "W 496.10' X L Denotes Wetland AREA EXLUD. R.O.W. ELEV = 95.21 M- Measured As 58,458 SO. FT. R= Recorded As 1.34 ACRES NO TH • • • • -Building Setback Line AREA LOT 22 : 64,675 SO. FT. (100' from R.O.W.) 1.48 ACRES JOB #97086 AREA EXCUl R.O. W. : iso o iso Prepared by: 58,235 SO. Fir. �- A & E 1.34 ACRES GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 inch = 150.feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE 109 East Third Street, P.O. Box 325 SW 1/4 OF SECTION 13 TOWNSHIP 31 N., RANGE 18 W. New Richmond, N 54017 WHICH IS ASSUMED TO BEAR N 88 W. Sheet 1 of 2 VOLUME 12 PAGE 3373 Safety and Buildings DivisiontY /! 201 W. Washington Ave., P.O. Box 7162 G l 1'\ Viscons i n Madison, WI 53707 — 7162 Site Address Dep artment of Commerce 4c; , U -(6 33<P z /Q Sanitary Permit Application S'°'ffi' Per°°" g Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / ?�O/ may be used for secondary purposes A dmacy Law, s15. 1 m ton I. Application Information - Please Print All Information I.D. Number Property Owner's Name Parcel Number 0 3 - R 6 ygv Property Owner's / M v ailing Address Property Location 7 -/ 7 q � Z4 Cfi�f : Y J T./ N. E City, State Zip Code Phone Number Lot Number Block Number 0 7 Subdivision Name CSM Number .�- II. Type of Building (check all that apply) R E C E I V DCity 2 Family Dwelling - Number of Bedrooms []Villa 8 ❑ Public/Commercial - Describe Use ❑ State Owned Nearest oad ST. CROIX CO III T M. Type of Permit: (Check only one box on line A (numbering scheme e B if applicable) A. evv 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to Tor County use stem Tank Only stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IVZ of Permit: (Check all that apply)(numbering scheme is for internal use) 4 - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min.Anch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ Dosing (umber VII. Responsibility Statement - I, the undersigned, apfige responsrbility for installation of the POWTS shown on the attached plans. Plumbe 's Name (Print) Plumber's S' MP/MPRS Number Business Phone Number , t Plumber's Address (Street, city, State, ' e) VIII. un /De artment Use Onl ' 6�n ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) -� ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for Disapproval % L .. Irrt�txat�nge in-zt�teai toCataon... 2. l�i(h£ained per manufacturer's recommendations. Attach eomplete plans (to the County nay) for the system on papa not less than Sla z 11 Inch= in she SBD -6398 (R. 05101)