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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
r INSPECTION REPORT
•. Sanitary Permit No:
430636 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:
Oevering Homes Star Prairie Township 038 - 1211 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/00.0 'T of Sc u - k-- 13.31.18.1155
TANK INFORMATION I ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
22(L ID +b c. �tG 3:G6 103,E to o
Dosing Alt. B / y / ll 2
beH � ;
.d
Aeration Bldg. Sewer Soit-N- q7.18
Holding St/Ht Inlet
TANK SETBACK INFORMATION A l4U I11 SvHt outlet
7 o p qte . 5
TANK TO P/L WELL 4BLbG.Vent to Air Intake ROAD Dt Inlet
I "
Septic I Dt Bottom
Dosing 1 Header /Man. we 4
Aeration Dist. Pipe
5a wu Ct.a a
Holding Bot. System V-45 �- / u �� 4 , /9 - y S-
e "� - t
Final Grade
PUMP /SIPHON INFORMATION leu y4 r O Ce q, IL
Manufacturer Demand St Cover
GPM aZ� a„1 f0 b
Model Number r6 {
111 b , T
TD H Lift Friction Loss System He d TDH Ft We4 1,Y0 gG 6
Forcemain Length Dia. �� Dist. to Well tit 3
D ° 5b/ V"t 56L }h d Qo s6
SOIL ABSORPTION SYSTEM k Sl eIty
BEDITRENCH Width Length / No. Of Trenches w e y .I PIT D ENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS J { 4, 5' � Z Ct Uj ea0 I 4�y�
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR J
Type Of System:
UNIT Model Number:
DISTRIBUTION SYSTEM > 5 a'
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Q // Pipe(s).,.
Length " Dia `f Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center ,3 ` Bed/Trench Edges / Topsoil Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:Q /2.1 tnle 2 /
Location: 1343 212th Avenue Star Prairie, WI 54026 (NE 1/4 SW 1/4 13 T31N R18W) North Gate II Lot 65 Parcel No: 13.31.18.1155
,, M�� 3 I�Js, vJ z LI ' n Z:� Z k { iv .c�p� c it. "0�7'rt ax_45
1.) Alt BM Description = & 4p ^ dJ t Gt � �- ) 6
2.) Bldg sewer length = a'1 q i e (� A &A d-
- amouunt of cover = '7 rV �IKv- h•fn n � I� ) / ,_ /:h� 4- �_ _
Plan revision Required? No �- —
L 0 i Use other side for additio al inf ation. I�� _! _
--
Date Insepctors Signature Cart. No,
SBD -6710 (R.3/97)
zoi w. p_� sr:
M fr�oo, wI Pty Nedrer (lo be tr'itd is by Co.)
Department of Commerce �� >SI �30 to (o
Sanitary PINM Applicautio 20
t
To a cwd with Cam 83.21, NIL A&& tbft permd iefalmedoa ' ROIX COc�rd R
�7W'�F 9PmP��a7Lw•� -oKi ZONINGOFFIC ��� �°� )
I. Appfication Ida — Please Prat AN lld'i nmadm
3 2f '
PtoptnyOwmirs Na mt ' rsoa lAt s 1" Pock f
I& 1 Prtrperry owner's m � Address Ptq=W lmcaoon
MP
CSty. Stye zip Code Pboae xamber
N kit Q 715— 749- T -el N; R _ E at
II. Type of B (ebea an that apply}
0 or 2 F=* Dwdrag- NrmberofBe&ooms -T boa Mae -eI Nor
O PowdConmuacia! - Desctbe the
O Soft oweed - Describe ire 2 1)15 C L'LLS (,<J / 0 t // AI J Ocity OVilw Etramsho of
g
HL Type of PaMilt: "AWk M* me box m sw A. C afe B B appacew A. whew Sysnm O lhphoemeet Sysfee► O TrealeleadHold'mg Talc Orly O O&w Mod'dinfim a E>bft Syslem
B. O Pan* Rmewat O Pamk Rtmim O Cbaegc of O Ples Ttaas6a 0 New Ua r eriota Park Member ad Dast aoed
Before Fapatim Phmrticr owner -
IV. iww of POWTS System: (Cheek an that }
Non �iesswixed ro�mo.pa O Mo=d > 24 a of sofa W soli O Mormd < 24 m of seifabia sal O Ac -Grade O Moot Pas sad Framer
O Commusd Wedmd O P,essuraed Task O Pen Filer O Aaabw T eaumm deli O R
O Rom Symbdc Meru Filer Ll'I.ead L Chamber O Drip 1S O taad-Ica Pipe O odter (eri)
V. DilipersaMerimad Area t 3 X 17 S
DcfW Flow WQ
4 Design SoN App�e. let Aim Rt Ana P (� s>� 3 9� -7 r -
vsa < f�Z • �G s
VI. Tank Info Capaaly in Taw P1 MW I Ptefatr sift sled r
Ga N Plastic
Gel= llons of Uaa / Caecteet Caesawmd Gia$s
Alew Fjdwm
Teak Tale I - /Or/ f
VII. Re*o"ft t L We nadasig w4 aammtt far bUNWian of the POWIS vil i m tLe attarhed pleas. - --
Pbm*Wz Na me OW* prfeee base= Niesbv eesieess Pbooc Nedw
Pl Addre ss (sneer, �i. � _ ewzLL Lr/_
A S-1 37
V1Q
! 8teiary Premtf Fee ( G Dale sigmmre }
❑ owner Green Reas for Dead, sd d 1 1 / 7
`
JIL �'A$°'�
ep c an c, e luent filter and
dispersal cell must all be serviced /maintained
as per management plan provided by plumber
2. Alr requirements must a main sire
as per applicable code /ordinances. �� G Zd - O le4&.J
Og - �- Y -�
Aft&°O#kfttnwB°dwCWwd► Or fte4amm Pwwmthw Max
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Fogerty Plumbing
�-� #221180
`pr `s 28288 McKenzie Rd.
Spooner, WI 54801
(715) 135 -9609
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Fogerty Plumbing
- #221180
r 28288 McKenzie Rd.
Spocner, WI 54801
(715 C-35- 9609 _
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P;&,VJtTYOMER Greenwood ]Rnternr. ja eSOVIL ve *Un r iun Nc rvn r O
PAitCEItD.# 038- 1055 -10
Depth Dominant Color Modes Texture Structure Gonsisieoe n 8ov� wy Roots GPD /ft
Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed T xh
3 4
,bkomS
2 11 -30 1 r sicl 1 mfr .2 .3
f
Ground 3 3 84 7.5 r ml na na .7 .8
elev.
98.5 ft.
Depth to
knifing
fa"
—t84
Remarks:
Boring #
v s 1 0 - 11 10 r 2/2 none 1 2msbk mfr if .5 .6
4 ;bk r w if .2 .3
�.. —
Ground
3 20- 4 7.5 r 4/6 none cos os m1 na na .7 .8
elev.
99. A
Depth to
limiting
factor
+84
Remarks: _— —
Boring #
rk. - if .5 4
2 1 12-27 10 r 4 4 none sici lcsb mfr if .2 .3
Ground 3 7.5 r 4/6 none cas O@q mi na na .7 .8
9 8.4 ft.
Depth lo
Remarks: 7 e?
Boring #
Ground }
Depth elev.
I
limiting
factor
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor 'Human Relations
Division of Safety & Buildings
i 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 St. 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 -1
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWED BY DATE io, l 7iw.. r 1
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S 13T 31 N,R 18 Eor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM
1416 Third 65 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ EFOWN NEAREST ROAD
Hudson, WI. 54016 h15) 386 -3674 Star Prairie
[ New Construction Use [ ] Residential / Number of bedrooms 4 [ ] Addition to existing building
[ ] 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 — gy bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) 95.30 ft (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 I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem I (OS ❑ U ® S ❑ U I E) S ❑ U 12 S ❑ U @S ❑ U ❑ S (JU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -2 10 r 2/2 none 1 2msbk mfr qW if .5 .6
2 2 -26 10 r 4/4 none sicl lcsbk mfr qw if .2 .3
Ground 3 26 - 84 7.5 r 4/6 none cos ) 0SCI ml na na .7 .8
elev.
98 ft. 2 �"
Depth to
limiting
factor
84 1 1
Lb
Remarks:
Boring #
1 0 -12 10 r 2/2 none 1 2msbk mfr qw if .5 .6
2 12 - 10 r 4/4 n one Sici Icsbk Mfr aw if .2 .3
Ground 3 32 -84 7.5 r 4/6 none Cos osa m .7 .8
98 ft ;
Depth to
limiting
factor �` sr
+84 ,q� r
rr �,,.�' a �
G
Remarks: \ oa c
P, E /
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. ew Richmond WI 54017
Signature: Date: 11 -8 -98 CST Number: m02298
1
PROPERTYOWNER Greenwood Enter=ris DESCRIPTION REPORT Page
PARCEL I.D. # 038- 1055 -10
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.................
..................
.................
..................
3
- 2msbk mfr qw if .6
2 11 -30 10 r 4/4 none sici lcsbk mfr 9w if .2 .3
Ground 3 30 -84 7.5 r 4/6 none cos Oscf ml na na .7 .8
elev.
98.5 ft.
Depth to
limiting
factor
3 0 0 ,4 1
Remarks
Boring #
1 0 -11 10 r 2 2 none 1 2msbk mfr if .5 .6
4 2 11 -20 10 r 4/4 none sici lcsbk mfr qw if .2 .3
Ground 3 20 -84 7.5 r 4/6 none cos osg ml na na .7 .8
elev.
99.3t. —
Depth to -
limiting
factor
+84
Remarks:
Boring #
- 2msbk mfr C1w if .5 .6
5 2 12 -27 10 r 4 4 none sici lcsbk mfr w if .2 .3
Ground 3 27 -84 7.5 r 4/6 none cos osg ml na na .7 .8
elev.
9 8.4 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
13
Ground
elev. i
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW -3254 NE4SW4 s13- T31N - x18w (715) 246 -6200
town of Star Prarie
lot #65- NorthGAte
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1" =40' J
BM.= top of 1 pvc p ipe C el. 100' '
Alt. BM.= top of 1 pvc pipe C el. 98.70
M
r 5�
J
Gary L. Steel
11 -8 -98
1
FROM :pEUERING HOMES LLC
FAX N0. :7155311282 Oct. 30 2003 10:24AM P1
Oet 20 Oa 09:29a FOCCATY PLUMDING 171GOOGGPAO P•e
ST CROIX COUNTY
SEPnC TANK MAINTENANCE AGPMMENT '
AND
OWNERSHIP CERTIFICATION FORM
OwnedBuyer '£ 4VL
.Mailing Addrew Z fl
Pmvparly Mina . /3 v
(Vedfcem regad ed fmm Phoning Dgwtt mt for now ;;mw
ctioa)
City /State &6ZXjr&&dL Pwal Identification Number D3f /AI j Z Q -
LEGAL DBSCRiE=
P roperty Location %,. ScrJ /., Sea !,� • TA � N -> w, Town of Esc .fir
Subdivision t '4i-7�0 -'—
Certwed Surrey Map # Volume - -Y . _ ., Page #
Warranty Deed # :ZC- S t Volume Page #
Spw house D yes tB'no Lot lines ideifi&ble Q'yes O no
$'!is"!'SM_1NAlANCR
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ea a �Vw is" dw
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eao sQeet tlm fsrlstioo d daz aepde tdpAc a . 4eiMamt stars i t�s warts � sys0ead.
The psparty mw apses b tam to at. Oak Tung Dap. tOmaat a aeW W& W. h=6 signed by to owner and by a
mada Pmber.l iegt >tet(1)fbeants0ewwte 04, disposala
i# a pope erisd�fioi; sudAotr(Yj aAec' nd d Mee m* h hpi than 1/d fun: oEstsdgs.
a�spsehss psattrng f �y�
Uwe tk�anieeoigaeitonaraiiie�a. tee. 1. a. a. �eaw.. wsierorwMeaewade +(�arlspMe�.n�lblasaadesds -
aatrft therms,mmetytieD�ttao<a/ ai�eDepr tall wlltwwoea�9misat da.
statiegtlitysstr, tap; ctgrea4lwfteesaasiteiiaedtlasstieas�ieleisssdssassrisiltbsSt Cfaar4h► ?waitg oiicews�dda30
A?!I]C mr DATE"
OWNER CERTIELC ON
I (w� ce�fl►+6rt si stslasteafs as this i'etat sea ttow m tbs bat a[ w4 � toso•rte�p. I ('weI wt (tom tbt: osr�eeX : d'
s+1lo try vhm ifi wm=mV $esd.esaids ling a *w erDante 0ffsw- -
f)P PLiCtINf
DATE-
AV inf m s iaq Ord is mh4q eseaW mry wank in ttts ariftry pen* Lei% itvowd by the Ze ft D"wm aaaaai
•• Indade w10 d& P"NcmdW.. ; sgMed wanwq deed fw fba RsgWw or Deeds office
a copy of the onlif a siaww map if re&vmm is nia& in aye wftnau r deed
U. 2482P 084
• STATE BAR OF WISCONSIN FORM 3 —1998 KATHLEEN H. WALSH
QUIT CLAIM DEED REGISTER OF DEEDS
ST. CROIX CO.. NI
RECEIVED FOR RECORD
Document Number
This Deed, made between Earl Mielke, a married person , Grantor, 12/29/2003 01:00PM
and Oevgrina Homes LLC , Grantee. QUIT CLAIM DEED
Grantor, quit claims to Grantee the following described real estate in St. EXEMPT ti
Croix County State of Wisconsin: REC FEE: 11.00
TRANS FEE: 90.00
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address
OQ , 4N Lo OEoefzw Nc,
83$ Sumrr,E rt t�iJE$ Ci.eCCf
�- {,�c�soN C.vi Sy0i6
038- 1211 -70 -000
Parcel Identification Number (PIN)
This Is not homestead property.
(is) (IS not)
D665 rthgate II, St. Croix County, Wisconsin
er with all appurtenant rights, title and interests
Dated this W day of December, 2003.
(SEAL) (SEAL)
Earl Mielke
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
} ss.
S t. Crol x County
authenticated this day of _
Personally came before me this day of
December 2003 the above named
Earl Mielke. a married person to me known to be
the person who executed the foregoing instrument
TITLE: MEMBER STATE BAR OF WISCONSIN and acknowledge the same.
(If not,
authorized by §706.06, Wis. Slats) /
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State f Wisconsin
Coldwell Banker Burnet
1301 Coulee Road My commission is permanent. (If not, state expiration date:
Hudson, WI 54016 q -1d
3 -66429 a.5 )
(Signatures may be authenticated or acknowledged.
Both are not necessary.) PAM A. SPENCER
NOTARY PUBLIC
Names of persons signing in any capacity must be typed or printed below their signature. STATE OF WISCONSIN
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 3 —1998 Milwaukee, Wis.
32 31
33 I
' I N ORTH AT
Vot 7, Pt t Page 46
_17.00' 24.00'. — N89 °07'26' 2139.00'
11.00' 28.00'
209.00' 190.00' 181.00• i,
209.00' 225.00' 209.00' o,
DRAINAGE EASEMENT �0
o
ON
47 N
46 N
54,562 sq. ft. 3
45 r 60 3 W 1.253 ac.
CU 58 328 . ft. a sq ft'
sq ..
1.384 ac. cu � CD
1.339 ac. % a / v
v v / Co
M — —
tn � ., z Z
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Cq
�LOOA •� 8 7 207.4 7 �
- - - - - - - 2t39 0 @ - _. - - - - - - - - - - - ' • A�
'0
930.96' S ,00•E n 1e "' S
10 0 . q0 _ - - 63.95'
930.96
-- 2 1 2 t " --- AVE. —Z8 0 N
15 16 N , o oo , ,
- 205.98' - - - - -- 211.99' -- 127.01' - - - - -
15' CV)
v o CO —
v o '0I ( /
ao Z / w
CU C1\ — (h ,
(U
68 - 67 �W 66 W 65
61,139 sq. ft. -, - 63,183 . ft. . � 62,441 . ft. r. . ft. o
n cu sq. ^ a sq � 75,
08 sq
1.404 ac. �n 1.451 ac. vi 1.433 ac.. 1.723 ac. Z
68 E �' S 88 50'52' E c l ") 35-00 8'S'S2' E oN
- -- 0 z
205.99 z 207.00' z I W S 88'50'52' E 1927.33'
NG AND DRAINAGE .E SEMENT MAX. ELEV. 1004.0 v '
10 STRUCTURES ALLO ED IN EASEMENT I ti 207.39•
205.99' - - - - - 212.00' -- - - - 150.00'1 z 157.39' - - - -- - - 216.65' - -
=II AS N88 2575.53'
1 SOUTH LINE OF THE NE 1/4 OF THE SW 1/4 6
-- 1
,DRI T_IQN. _ _ 14 _ - 1 S -- / - - - - --
- -- -- ; GENERAL NOTICE STATEMENT: The parcels shown
and Township laws, rules and regulations (i.e. wetlands. r