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HomeMy WebLinkAbout038-1055-80-500 V.*,"'i nsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: III 399602 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)i. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Star Prairie Township 038- 1055 -80 -500 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2/G o r / V Benchmark q / 1 / /0 i Dosin -- �— �\\ Alt. BM ! fD s _ Z -0 :1 Aeratio Bldg. Sewer/ ; 6, Z, otding Ht Inlet TANK SETBACK INFORMATION (OF Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inl Septic in \ Header /Man. 2 QQ, QQ — I 4 L �- Aeration Dist. Pipe L Cf , ( p 100 -0'/ olding Bot. System 4 h 2 9 '3 Final Grade -� ZS PUMP /SIPHON INFORMATION X /02.3 nufacturer �,_.__- - - - - -- Demand St over \ 5'7/ `17 GPM 7 / Model Number TDH Li Friction Loss stem Head TDH Ft F remain Length Dia. Dis . well SOIL ABSORPTION. SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ( �S i J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM , LEACHING Manufact Se INFORMATION CHAMBER Type Of System: / / IT moliel m er. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) , Cl '7 �j� — 7 l �� a ' La Le ngth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center Bedlfrench Edges Topsoil xx Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 Z Inspection #2: Location: 1344 210th Avenue New Richmond, WI 54017 (SE 114 SW 1/413 T31 R1 8W) NA Lot 22 � Parcel No-o- rG 13.31.18.239G 1.) Alt BM Description =Be 6N'%0�� 5�Sr VGW SYs� 1'46AZcv_ y tie �u Ly'S, s� 2.) Bldg sewer length = a / / /� /, S Q!� �a5 j� - amount of cover = 7 I �` ,�✓ IJ �p ���o► h�f S� 3. Dj setnr �l�s 1 n a1�d cwt • �' �{fe>ti d � %� Plan revision Required? SK Yes ❑ No Use other side for additional information. L i SBD -6710 (R.3/97) Date Insepct r Cert. No. >c over ., .� __ v � ZZ'-� 0 � - � f_ o ... 1 � l �� ®�- li Qo t _ • Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 G / >^ N v o iscons i n Madison, WI 53707 - 7162 Site Address De artment of Commerce qvP. Sanitary Permit Application Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1 60 ma be used for secondary purposes Privacy Law, sl5. 1 m Check if Re ion I. Application Information - Please Print All Information . . Number Property Owner's Name / Parcel Number Property Owner's Mailing Address Property Location cJ. �jdX A.5 K;S 3T' /N, Z 4 g City, State Zip Code Phone Number Lot Hurabor Block Number Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City or 2 F amily Dwell' - Number of Bedrooms � ❑Village ❑ Public/Commercial - Describe Use APR 10 2002 hip a / a ❑ State Owned Nearest Road ST. CR ING OFFIC C/ COUNTY �1O III. Type of Permit: (Check only one box on line A (numbering a for internal use). mplete line B if applicable) A. w 2 ❑Replacement System 3 11 Replacement of 6 ❑ Addition to For Courrty use stem Tank Only Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) - ressurized In- Ground 210 Mound 47 ❑ Sand Filter 5o ❑ 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. DispersaMeatment 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./Inch) 3 Elevation v' 3 -3 -? 7 / 2 -- �. �-) - �P7-1­ XV-0-1 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. Plumber's Name (Print) Plumber's MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, dkrlffode) V III. Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) D Owner en Initial Adverse Determination _$ t � � � �/, IX. Conditions of Approval/Reasons for Disapproval J CJ 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 Comity only) for the system on papa not less than 81a x 11 inches in size SBD -6398 (R. 05101) PLOT PLAN & Soil Test Plot Plan PROJECT P.C. Collova Builders Inc. A DRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 13 /T 31 N/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4 /8/02 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 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.3/97.9 B.M. Property Line 5 ' B -1 20' 8% Slope 2 -3' X 69' Cells with >3' Spacing 'Vents 10' B -2 B -3 Vents 2 ° 0 0' Plans Designed Using 55' Conventional Powts Pro 3 Manual Version 2.0 Bedroom House Well ll, nt > 12Sidewinder High of Cov Capacity Leaching Chamber 6' L Grade at System Elevation 210th Ave L Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of kafety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must c/ G 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. i ed by Date Personal information u provide may be used for seconds pur poses ( Priv a cy Law, s. 15.04 m Yo P Y secondary P R?o ( cY 1 () ( ))• Property Owner Property Location Govt. Lot S 1/45Z�1/4 S/3 Tj N R E ( ) W Property O er's Mailing Address t # Block # Subd. Name or CSM# a - Ci State Zip Code Phone Number ❑ Ci�ty -/. ❑ Village Mown Nearest Road New Construction UseResidential / Number of bedrooms Code derived design flow rate 4 O GPD E] Replacement �7 ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable 1 ft. General comme and recommendations: Boring # B �oring it Ground surface elev /&- a 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 I 'Eff#2 ® Boring # Boring �j it Ground surface elev ./��'' D 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 10 Y'- 3-1-1- -5 r e J— . 3 - LO / S's� cr, Nib r,� z� P' ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 g/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) nature CST Number Address to Evaluation Conducted Telephone Number r l SBD -8330 (R07 /00) t Property Owner Parcel ID # Page of {M Boring # [] Boring �f v /L,��) Pit Ground surface elev. /�" o ft. Depth to limiting factor / M 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- r sl ✓ F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. SAiI 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 F-1 Boring # ❑ Boring g surface elev. ft. Depth to limitin ❑ Pit Grounds P 9 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 ' 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) PLOT PLAN & Soil Test Plot Plan PROJECT P.C. Collova Builders Inc. A DRESS P.O. Box 489 Somerset Wi 54025 S SE 1/4 SW 1 /4S 13 /T 31 N/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/8/02 BEDROOM 3 CONVENTIONAL XX)C 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 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 98.3/97.9 B.M. Property Line 5 ' B -1 20' 8% Slope 2 -3' X 69' Cells with >3' Spacing 'Vents 0 10' B -2 B -3 Vents 0 20 0' 55' Plans Designed Using Conventional Powts Pro 3 Manual Version 2.0 Bedroom House Well Vent >12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 4 , Grade at System Elevation 210th Ave oadl Safety and Buildings Divistort County � "g �.— 201 W. Waton Ave., P.O. Box 7162 �54- er 17 i wnsin Madiaon, WI 13707 - 7162 Site Address De srtmbnt of Comm area � /3 Unittxy Permit Application 3 96 { In wwrd wW Comm 89.21. Me. Adm. Cads, perstod lofarfi W= you pmvide zhoc"k if Reviu Its PrIVW Law $13. 1 L APPU=dm latormadss -Pleas Prlet All. ><atw=&tiw Stave Plan I.D. Number Pt PRv Owner's Name i►arcel Number / 3 3 / • ' Os PmM Owmes Md W Address Prf,perty Location DS-- .5 3l • -- S ? N R E chy. llwe Zip Code -. Lot Nvreber Bl NumW bdivisio "M e CSM Number IL of 8adt c k an that AP* -4 � 2t1d1 Family Dwelli� umber of 8odroonis 1 Q PablialCommMw - Use ❑ atea� owned • , �'� Z(yNl�' \ =net R T►pr Q Ow o M. d Psnrltt (Cheek ataly baa an Hue A (num Bering ach C.omplate line D U Applicable) nati 2 E3 Replaoeme>:< 3 ©Rf�emeat of 6 ❑ Addldoa to Far Tank Exis ' g B. ❑ Cho* if Saa Lary Permit Previously Permit Number Date Issued I9. at Peaedtt (C9sedr W l6at reply)( ""0 a b for rnal use) -I¢t , � I&OwuW 21111 onad 47 Seed Filter so G Conttruaw Woitand / n Cl Pteaude.d In•Gtwuad 41 noidiog T single Pass 1 Cl Drip Line X03 i / 41 0 46 ❑ Aerobic Tres nit 49 0 Reciraula 30 U other i V. t Ana WWWM kws Dodp New WO Am Dbpexsol Ares, Pwrcoluloa Rare Syssem atioa F'iaal (bade l �� Q Requisbd Proposod Rate( s./DayslSq.Pt.) (Mla./ltmch) 131�ratfofl VL Tw* lob cvui,y is Total r Prefab site steel F,lrpr Plastic Qapaas � -- Concrete cord tilaa ew -Tab- Tugg sob or 116ft 7k* yL Sam TEL. ftdowmat- 1. tine saeema ier Wdecatim of the W N al+own on the atta&" Plumber's Nesoe s MP/MM Number 08 Pbotfe Number ,Sf 2 2 - -; , �0Z7 7soZy� Pi saW Addsw (sweet, Chy grata Code) V 33L CnWADewhowt v Ancivod © Saffitsry' P ermit Pee (iaelndee O wusdwafer Da / te Issued 1=u sig As,= S*nmm- (No &gaape) ❑ owm Iniaial Advafse • 2 Z5 `/( TK. - s# area of Vs, p rrvd P, �;co f t M / o sw Mepbm a. •W) the wvk m oe paw sot Lan t*se : fe els. SBD4639.8 (R'4 (SMI I PLOT PLAN PROJECT P.C. Collova Builders Inc. AfiDRESS 705 Countv Road E Hudson Wi 54016 SE 1/4 SW 1/4S 13 /T 31 N T- 18 W TOWN Star Prairie COUNTY ST. CROIX Yi MPRS Shaun Bird 226900 F DATE 11/12/01 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE 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. Top of NE Lot Stake ASSUME ELEVATION 100' Filte Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 103.0 B. j nt ewinder High Ca city Leaching Plans signed Using Ch r Con tional Powts M al Version 2.0 34" Grade at System Elevation / B- 45 ' �l , Vents 0' 2 -3' 9' Cells with >3' acing 28' B -3 35' 20' T 47' Pro 3 B -5 B -2 Bedroom Vents House 9 210th Ave wiscominbepartmentofIndustry SOIL AND SITE EVALUATION REPORT Page i of _.:k-_ labor and Human Relations 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 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. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RE IEWEDBY DATE � PROPERTY OWNER: PROPERTY LOCATION IP Nancy Bentley GOVT. LOT 1!4 1I4,S 13 T ,N,R 1 (or) W qw PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # g T - Ti cr h y i e-y 2 na CITY, STATE ZIP CODE PHONE NUMBER [ ❑VILLAGE MOWN NEAREST ROAD ( Star Prairie I 210th. Ave. j New Construction Use [x] 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 _ bed, gpolft $ " trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate ._ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 103.90 It (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem ® S ❑ U ® S ❑ U ® S ❑ U ER S ❑ 0 ® S ❑ U ❑ S CCU SOIL DESCRIPTION REPORT ( 2"D Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft _^ .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. jTrendh << 1 1 0 -10 10 r 3/3 none 2 10 -20 10 r 4/3 none sil lcsbk mfr Ground 3 20 -80 7.5 r 4/4 none tns 0sq m1 na na .7 .8 elev. 10 ft. Depth to limiting factor +80" Remarks: Boring # 1 - 1 ,S << .2....<> 2 11- Ground 3 30 -80 7.5 r 4/4 none ms 0SQ ml n } elev. l 10 ft. P4 Depth to n limiting U factor +80" Y 1 Remarks: = �, �O CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 - Address: 1554 200 e. New Richrppnd, WI 54017 Signature: Date: 9 -17 -97 CST Number: m02298 l PROPERTY OWNER Nancy RPn .1 y SOIL DESCRIPTION REPORT Page2�_of 3 PARCEL I.D. # 038 - 1055 -80 -100 Boring # Depth Dominant Color Mottles Texture Structure Consistence Bax>dery Roots GPD /ft Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3., 1 — f w 2f .5 .6 S 2 12 -23 10 r 4/4 none sic) 2msbk mf gw if .4 .5 Ground 3 23 -84 7.5 r 4/6 none ms osq ml na na .7 .8 elev. 10 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -10 10 r 3 2 none sl 2m r mvfr 2f .5 .6 S 2 10-18 2mar mvfr C1w if .5 .6 , S ................ Ground 3 18 -80 7.5 r 4/4 none ms os ml na na .7 ' .8 Ground 1 3o IvC,. Depth to limiting factor +80" Remarks: Boring # 1 0 -12 10 r 3/ none 1 2msbk mfr cs 2f .5 6 5 2 12 -26 10 r 4/3 none sicl 2msbk mfr 9w if .4 j.5 26-80 7.5yr /4 none Ms 0sa Ground _ M1 na na .7 8 elev. 10 ft. Depth to limiting factor +80 11 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Nancy Bentley New Richmond, WI 54017 MPRSW 3254 SE4SW4 S13- T31N -R18W (715) 246 -6200 town of Star Prarie lot #22 -csm N 1 =40' BM-= top of NE lot stake C el. 100' Alt. BM.= top of SE lot Stake C el. 106.10' 0M C� � vIQ` 37 � 1' Q w. Gary L. Steel 9 -17 -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. c Plumber: Shaun Bird 715 - 246 -4516 00 Shaun Bird #2269 FROM P C COLL.OVA BURS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07:333 P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGUMMENT AND OWNERSHIP CERTIFICATION FORIM Owner/Buyer Ve, G I� N_ ✓vr, -acs Mailing Address 7 cc) :� Property Address p A,44, (Verification required from Planning Department for new construction) City /State - W Rkln ltMii Parcc! Identification Number LEGAL DESCRIPTION Property Location S ;�,, S Scc. 7 I N- R Town Subdivlslori Lot A Cer#Iiicd 5cr�e :' :'Ian �� Jt" � I olumC [[ v � � � nags r � � .1 Warmnty Deets I �P �� - \1 voluble Page 4 �7 Spec Lous!x s ❑ no Lot du-- idovtiflablc; yzr 7 no SYSTEM :1-MAENTENANCR Im ". and maiatenaecc of your sc�tir, system could result is its Fr=riatare failure to I:yndic Basics, i roger aiaintcaat cc co asLlu of pumping out the st do tans; every thri c year of scener, if accdd by a licensed ptitzrrez. W not you put into the syst.^:n eau affect t$e ftmction of the septic bale as a bmItment stage in the waste disposal system. The prape ty owner stets to subtri t to St. Croix Zc-nins Department a c.- rtuicatioa form, sig3cd by tar own. and by a rPIU=br,1 =trietcd pluanber or it licensed purnper se.-ifyiag that (1) the on -site wastewater disposal system is in Fier cpemtin.3 condition sndtor (Z) after ins, ctaan and pmVing (if a= r=:: ), the septic tank is less than 113 fufi of sludge. Ilwe, the uadcrsiz=d have read the above requirements and :tree to maintain tlic private sewage dirposai system with the standards set fottb, he.e* as set by the Department of Commerce and the Department of Nattml Resotures, State of Wiscansin Certification stating that your septic ryatem has been maintained must be completed and returned to the St. C:oiY County Zoning Office within 30 drys a expiration ' te. S GNATURE O APPLICANT ^u ATE 0 M CERTIFICATION I (we) certify that all statcmeata on this form are tale to the best of my (cur) kaowiedge. I (we) ant (are) lire ownet(s) of the ri ab vt, b virtue of a warranti decd recorded in Rrgistcr of Deeds Office. Of 'M - NA TURE 0# APPL:ICAN'I' DATE Any information that is mss cgreseated uiay result in tie sanitary xrnit being revoked by tic Zoning Department. •; Include with this application: a stamped warranty decd from the Register of Deeds office I tnPY of the certified survey map if refereacc is made in the warranty decd I J 1pAQ� 660741 • STATE BAR OF WISCONSIN FORM 2.1999 KATLILEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number S CROIX CO., WI This Deed, made between — Na L. Eienje RECEIVED FOR RECORD — —_ — — —_ —.— — — 11-01 -2001 9:30 AN - — — — —'— — WARRANTY DEED — -- EXEMPT I Grantor, and P. C. Collova Builders, Inc.-- J - - - -__ CERT COPY FEE: — — -- — CEPY --- - - - - -- - -- TRANSFER FEE: 173.70 — .— - - -- — - -- — RECORDING FEE: 11.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in _S Croix _ _ _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area _ Part of SE 1/4 of S W 1/4 of Section 13, Township 31 North, Range West. Name and Return Addre s St. Croix County, Wisconsin, described as follows: Lots 21 an KRISTII�A OGLAND Certified Survey Map filed October 29, 1997, in Vol. 12 , pa a 337 , Doc. ATTORNEY AT LAW No. S_ 6 — HUDSON. W 359 WI 54018 038 -105 80400 & 038. 1055 -80 -50 — —,_ - -_ Parcel Identification Number (PIN) This is not homestead property. 01) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this �() day of October - - -._, _2001_ • _.. _ —..— —.. — — - - - -- • Nanc�L` Bentley — AUTHENTICATION ACKNOWLEDGMENT Signature(s) Nanc L. Bentley _ -- STATE OF WISCONSIN ) ) ss. — -- — —. —..— — County ) authenticated t is . ..day of Oct -- —, 2001 Personally came before me this — —,— day of - - - — �� -- - -- - -- - - - -_ _ = _ - - the above named • Kristin& Ogla nd — — -- TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons) who executed the foregoing (If not, _ _ — — —. -- instrument and acknowledged the same. authorized by A 706.06, Wis. Stars.) -- - - - - -- — — — —, —,— THIS INSTRUMENT WAS DRAFTED BY • -- - - - -- -- Attorne Kr istin& Ogland — - -- -- — Notary Public, State of Wisconsin Hudson, W 5�4 l6 — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- — - -' — • Nantes of persons signing in any capacity must be typed or printed below their signature. info maum v a au cob ca+ wro. Fo 8006Lac, r STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 -1999 y T 00 U� O, r� U" L �. N� �a {:F' OCT 29 1997 H. way 1 U Register of Deeds SL Croix Co., yyl ss7sss CERTIFIED SURVEY MAP Located in part of the Southealt Quarter of the Southwest Quarter of Section 1;; Township 31, Ran a 18_ �a 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. 4 Prepared for and at the request of: �$C ti NOTE: The parcels shown on this map - OWNER: subject to State, Count are sub' ,and Town Y Nancy Bentley y12 '77 ship laws, rules, and regulations (i.e. 831 Highview Drive Apt. "A" RONALD F. wetlands, minimum lot size, access to New Richmond, WI 54017 JOHNSON parcel, etc.). Before purchasing or Drafted by. Kristi A. Eyfandt 5 developing any parcel, contact the St. AMERY. Croix County Zoning Office and the Wis. appropriate Town Board for advice. C 1 � \ Ltlij SU Re� LOT 17 9 0A COUNTR__M_E_A_D_0_W_S FIR_S_T_AD_ I \ ----- NZ Y LINE 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 4 I _COUNTRY I ii ^ L O T 19 175,698 SQ. FT. 1 1 FIRST ADDITION I / I I - - -- -- - - -- 33'l 1 4.03 ACRES N i i 1 1 J 1 ELEVATION OF I W' WI li Q WETLAND =90.66 J ^ I �I 1 OM O �I ICI I 4 � W !EL MARK 0 �°� ,`� O 2 N PIPE W I I ,M o3 N; 95.48 M w i W O ir) iA I cn O; iA in o! Iof ZQ I�tsM�O i ).N, o ►�� rn� F 'I�I n I J ��: i n OJI ciI rnl I II I cn I r wl I I II QI jl I �w- - - -- S 88'34'13 495.95' - 1 3 3 �i �i o_I of r- — , — r- - -' -- 330.95 -- - - -- - -; / 1��' 165.00' - - i� °j cil I N:n O 1 !L / I // co 90 N w 1 I:° L:O T 2 0 i n r r Di N1 Io °o N o 58, 562 S4 F o N �+ , o 0 0l N I: . T. ° I '� I n W I N i cn I 1.34 ACRES 1 0 N .'' • I I N rn cn k = I �i I II II i i i rn .•'•• II O 00 I F i �i I a_ i S 8834'12" E 330.90'• ^N r7 ~ o i o I 0 1 i(ii I ' i �`. O 04 I I pW {HIV w IY'I 1� :LOT BM 2 /, �� M� 1 J I "i Ci I OI 11 OJ 1� iV 2 1 I in I u) 11� r) 4 ................ • Oli >� I0 I r0 COrn �•ON ••�........ i i �� o =� h `ri r i r) R.O. W. oo ui r I o I I I T V) K) CENTERLINE I QI I 1 N N II 210th St. � N I t j I 1 p W 210th I Ave. ICI V) I 1 ! / � 1 I I ! 1 1 1 V) V7 � - — — — - I — — _ �_ - - 3 -- -- �_ 1 1 _�_- 1 ------ 172 0.33' - - -- ` / �'` - - -M -N 88' '51 W / r --� / R - - - -- 330.84 = 403.22' —, 495.83- ` /� - — .._ .. . . - -M 403.28 --�;, "� - -- M - N 88'34'10" W — ''' -- R = N 88'34'10" W 496.13' '`-- -- --- - - - - -N 88100" W 2619.45' ---------- 210TH AVENUE R.O.W. 210th St. LEGEND SOUTH LINE OF THE SOU71.IWEST 114 S'L 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 AM QIt: 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' ,91L Denotes Wetland AREA EX W. R.a ELEV = 95.21 M- Measured As 58,458 SO. FT. R= Recorded As 1.34 ACRES N 1N -----Building Setback Line AREA LOT 22 : 64,675 SQ. FT. (100' from R.O.W.) 1.48 ACRES JOB #97086 AREA EXCLU. R.O.W. 150 o Iso Prepared by: 58,235 SQ. FT. A & E 1.34 ACRES GRAPHIC SCALE LAND SURVEYING & 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, WI 54017 WHICH IS ASSUMED TO BEAR N 88'34'10" 1'✓. Sheet 1 of 2 VOLUME 12 PAGE 3373 Tai �-- • Safety and Buildings Division County A ' 201 W. Washington Ave., P.O. Box 7162 �seonsi►n , Wt 53707 - 7162 Sine Address 1 Department of Commerce # I q Z vr. Sanitary Permit Application P ermit Number In accord with Comm 83.21, Wis. Adm. Code. personal information you provide may be used for secondary Purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information Number Property Owner's Name Parcel Number my v � .�,+,� - I �. 3!. Property Owner's Mailing 22 Address Property Location Sf -5 'A; S 3 T 1 /., City, State Zip Code Phone Number Lotr Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) REC ❑City or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Comm eroial- Describe Use APR 10 20 ❑ State Owned ST. CROIX COUNTY �J✓ !/lam E (/ jLel M. Type of Permit: (Check only one box on line A (numbering scneme Ifor Intemal use). Complete line B if applicable) A w 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank Only stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbermg scheme is for internal use) - ressurized In- Ground 210 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 ❑ P=irculating 30 ❑ Other V. D' rsal/1Yeatment 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./Inch) 3 Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New ExkfM Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the under, assjune responsibility for installation of the POVM shown on the attached plans. Plumber's Name (Print) Thimber s MPIMPRS Number Business Plane Number Plumber's Address (Street, City, State, e) VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ) i ❑ Owner Given Initial Adverse 1 Determination > >� IX. Conditions of Approval/Reasons for Disapproval raYr .Y i., T T�� 1. , - location. 2. ent filter to be maintained per manufacturer's reconttriendations. AttarL c-vkte &w (to the County adz) for the system on paper not Iles dean Sin z U iwha ha she SBD -6398 (R. 05101)