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HomeMy WebLinkAbout038-1212-30-000 Wisconsin Departmei of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building bivision " INSPECTION REPORT Sanitary Permit No: 463203 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: Halle Builders Inc. Star Prairie Township 038 - 1212 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: 22 / Section/Town /Range /Map No: q - 1 1 'J ( Gs-r 13.31.18.1161 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J Benchmark u too �� , alt. BM W 3 , $ Aeration Bldg. Sewer 3. 1 's Holding St/Ht Inlet / J 5 .z— 9 TANK SETBACK INFORMATION St/Ht Outlet rJ, .7, 6 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 4 7 1 4Z Z4 I Zy v Dt Bottom \ Dosing `I Header /Man. Aeration Dist. Pipe 71 Z 95 Holding Bot. System (b w PUMP /SIPHON INFORMATION Final Grade - 3, Manufacturer Demand St Cover GPM - Z Model Number TDH Lift Fric n Loss stem He T Ft Q'Z - 9-r Forcemain Length T fa- Dist. to Well SOIL ABSORPTION SYSTEM 1 1 Z BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System r. / �� ^'� UNIT Model Number. O 16pa 4 1146 'C ( ' DISTRIBUTION SYSTEM Header /Manifold 1 � Distribution x Hole Size x Hole Spacing Vent to Air Intake P ' / Length » Dia Lengt Dia ` Spacing \ 2 `7�' SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth e� 1 xx Seeded /Sodded xx Mulch / / Bed/Trench Bed /Trench Center Edges Topsoil es No Yes No Y COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / 05 19 Inspection #2: Location: 1315 212th Avenue Star Prairie, WI 54026 (NW 1/4 SW 1/4 13 T31 N ,ill Northgate II Lot 71 rr / r Parcel No: 13.31.18.1161 1.) Alt BM Description = �t /� /Z 6O v l g�d�ct ,J�,Li A!E> L11216 lk" ILArdet 2.) Bldg sewer length - amount of cover = 7_54 . t 1 Lam �' b� �Gt>ZyLJ 1Z Plan revision Required? ,Yes 6 o Use other side for additional information. _ jj; �(4! SBD -6710 (R.3/97) Date Insepc is Sig ure Cert. No. Safety p ^. County ` _ Was ingto ox 1082 IS T isevnsin i n, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce I��Sa46, 326) 3 Sanitary Permit Appl>< State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal info ationy _u OFF maybe used for secondary purposes Privacy Law, sl .04(1)( lvi' Project Address (if different than mailing address) I. Ap Information — pp Please Print All Information 6P 3►5 I 2 AAj� . 1Z Property O er' ame Parcel # Lot # *lock#�- Property Owner's Mailing Address Property Location 1 3 ilw Ci State Ir W '�. /., Section _ 1 Zip Code Phone Nu / tuber ` y 441-4 (c ir Eor ® T N; R cle one) II. Type of Building (check all that apply) ' S t ` ( Subdivision ame t„CM N umber ❑ I or 2 Family Dwelling — Number of Bedrooms y ❑ Public /Commercial — Describe Use Z ❑ State Owned — Describe Use ❑City _ flVillage 02pwnship of $T4 r / r eti rte, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' XNew System ys El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal El Permit Revision Change of Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System Check all that appl ;6 Non — Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil A c 'on Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity ' Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks ptic r Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installs 'on of the POWTS shown on the attached plans. Plumber's Name (Print) Pl s Sign 2 14CFAUER.S.Number Business Phone Number !'1 r Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use Onl �J Approved El Disapproved Sanitary Permit Fee includes Groundwater Date Issued I um gent Signature (N Stamps), Surcharge Fee) _ El Owner Given Reason for Denial Zs� l2 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintalwel as per management plan provided by plumbft 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 111 inches in size SBD -6398 (R. 08/02) I I n' t _ _ Z /C oo dot ift I r T _ f Y . I} � eo - -- - - - I I - II i i i• I era. A6 - � d QM ti ti 1v NkOSk/s 13 Nee f 7 2li�7/ 2a0 A If #2 146 1. An I i 7 � r / �{ M isconsfn Depar% of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 bor aFid 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 St. C roix 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 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE I 1 j q j . PROPERTY OWNER: PROPERTY LOCATION Greenwood Ent Inc. GOVT. LOT NW 1/4 SW 1/4,S 13T 31 ,N,R 18 ifQor) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1416 Third St. 71 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hudson, WI. 54016 b15) 386 -3674 Star Prairie 212th Ave. ' [ New Construction Use [ ] Residential / Number of bedrooms 4 [ ] Addition to existing building I J Replacement [ J 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 . - a trench, gpd /ft Recommended infiltration surface elevation(s) 94.75 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 AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem EIS ❑ U FI S ❑ U I KI S ❑ U ©S ❑ U ®S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITirench ................. ti...,.1.....' 1 0 -12 10 r 3/3 none 1 2msbk mfr QW if .5 .6 2 12 -2 Ground 3 27 -32 10 r 5/4 none sil lcsbk mfr QW na .2 .3 elev. 99 ft. 4 32 -84 7.5 r 4 6 none Cos osq M1 na na .7 .8 Depth to limiting factor 9`f -sue iA _01 op +84 Remarks: Boring # 1 - 2 Lj 8 -20 10 r 4/4 none sicl 2msbk mfr w if .4 ':.5 Ground - sil lcsbk mfr CIW .2 .3 elev. 9 .L ft. 4 30-84 Depth to 14 limiting q�t,S� qtr factor +84 BONING Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. Richiuon4 WI 54017 --` Signature: Date: 11 -9 -98 CST Number: m02298 PROPERTYOWNER Greenwood Enterpris SOIL DESCRIPTION REPORT F l age 2 if PARCEL I.D. # 038 - 1055 -20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax'clary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench - sicl 2msbk mfr qw if .4 .5 Ground 3 1 24-36 10 r 5/4 none sil lcsbk mfr gw na .2 .3 elev. 98 ft. 4 136-84 7.5 r 4/4 none cos osg ml na na .7 .8 Depth to limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none sl 2m r mvfr if .5 .6 4 2 12 -22 10 r 4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 22-84 7.5 r 4/4 none cos osg ml na na .7 .8 lev 99.7 ft. 18" 10 r 5/4 c2d7 5/8 sil Lens nor. contiguous in -3 — Depth to - limiting factor +84 Remarks: Boring # 1 0 -9 10yr 3/3 none 1 2msbk mfr Crw if .5 .6 5 2 9 -29 10 r 4/4 none sic-1 2mqbk mfr "Tw if Ground . 29 -37 10 r 5/4 8 .3 ft. 9 4 37 -84 7.5 r Depth to limiting factor +84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 501L ANU 511 t bVALUATIUN HF.FORT Page 1 at s • L,ebor and Nur»ae Rel�tiona OMsk n of Safety & Bulidl -ow in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S Croix not limited to verticjd and horizontal r"ance point (BAS, direction and % of slope, scale or PARCEL I.D. 8 dimensioned, north wrow, and location and da sane to nearest road. 038- 1055 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT ITT v4 SW it4,S 13T 31 ,N.R 18 ]G(oi) W PROPERTY OWNERS MAILING ADDRESS LOT 8 1 BLO 8 SUED. NAME OR CSM 8 1416 Third St. 71 na CK Nort to CITY, STATE ZIP CODE PHONE NUMBER []CITY [VILLAGE SOWN NEAREST ROAD Hudson, WI. 54016 V15) 386 - 3674 Star Prairie 212th Ave. Lld New Construction Use [ j Residential / Number d bedrooms 4 j ) Addition to existing building I ) Ravlaomwt (] Public or aommerc ial describe Code d&*W dally flow 600 gpd Recommended design loading rate ---7-_ gPW Q_ trench, gp0 Abswption area required 858 bed, R , 750 trench, ft Maximum design IDading rate —.7-- bed, gpd* . 8 trench, gpd/ t Recommended infiltration suface elevation(s) 94.75 ft (as referred to site plan bendowk) Additional design / site considerations na Parent material outwash Flood plain elevation, I applicable na ft S - Suitable for system CONVL34TIONAL MOUND IN•GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK u - Unsuigible iiar stem ®S O U M S O U M S ❑ U Cos ❑ U ®S D u ❑ S (MU SOIL DESCRIPTION REPORT Boring #► Horizon Depth Dominant Color MOWN Texture Structure Corsislence Boutdt8y Roots GPD /ft '^C tt��,, a.KSt� in. Munsell- Ou. Sz. Cont Color Gr. Sz. Sh. g� ItBtd� �k 1 1 0-12 10 r 3 e I 2msbk marr aw if b:R:3f:#:i5 Ground 3 27 -32 10 r 5/4 nave s'1 2csbk mf 99 ft. Depth 10 L -11 I"ng 18Ctor + n Remarks: Boring #1 r - i 2 8 -20 10 r 4 4 none s c1 Ztnsbk mfr Qw if .4 .5 Gmund sil icsbk mfr aw na .2 .3 elev. It: 4 30 to limiting !attar +84 0f Remarks: CST Name. -- Please Print G L. Steel . Phone: 715- 246 -6200 Address: 1554 200th. Ave. Richmond W154017 Signature: tie: 11 -9 -98 CST Number: mO2248 i STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 WIWI S13- T31N -R18w New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #71- 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 r 1 =40' BM.= top of 1 pvc pipe C el. 100' Alt. BM.= top of 1 pvd pipe @ el. 99.20 ti S 31 P At' D't �J fig° Gary L. Steel 11 -9 -98 i Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity !n- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) sha -11 include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. .The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Deli n S ecifications Sanitary Permit Number Z� Number of Bedrooms Design Flow - Peak d Estimated Flow - Average d Sad Septic Tank Capacity al /Ovo Soil A bsorption Co mponent Size ft 13 Domestic Tvpe of Wastewater. Table 2: Soil Absor tion Com onent - Limits of Reliable O erp ation Septic Tank Com onon Soil Absor tion Component Design Flow - Peak- . d NA M 1 /8 aximum Influent Particle Size in 2 2 0 - -- Maximum BOD5 Maximum TSS m /L NA 0 3 Maxi FOG 30 Table 3: Maintenance Schedule Septic Tank inspect and /or service o nce every 3 years Outlet Filter Should ins ect o nce a year and clean once ever 3 ears Soil Absor tion. Cam anent Ins ect once every 3 ears 5epti� , The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adrri a C e o geds�S e Pits, Seepage Trenches UPrpv Privies, Grease or Portable Interceptors, Seepage p Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection,. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, tl filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volumeof scum and "sludge in the tan exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an Ptur new ta uatt,of lamas uncia oi tsa ttithig predur4m or allict A71gLnmiXettit That rraY V I f1lra 090rrialrit: illrthahmtss orrad 6111`ril aw *sa• dimaparai do twilCer}, If Mall aararsr datragvlaz m ruts atratmae'1<dd.- hU'Voa fte askitrirtrrr, af th a 't triad mel rnrn6vaad by rc asfapxtegb saaandrsing apa3arastok rm►it5r Sa ra Mao,, systa M mU t a.ras shatl rite anaur°wtailiaen Ball cas dhicilw we ftt= *it the H•tl'lirrsriv* suriimm. Dur'Irig pattwtr filth@ `{� mm pump tacankar m ay till zhum a jev�l3a. +l hiaii jprawaer Yo rest4ti "ed tits Owego Wootalm+ tsar will Ei, dlacahurgsad bw thw diasperaar►1 04111VJ 1h viy'a l aud °ge do aa, civ'rorlmadlig i:Y•ies o aafa and shnamt,►• reawat In This ha ckap a) 4il=tlujint. Tmay at old this rrt'cattlon hafts thm daNrimi to trf 11TS panitipVItzte. rartinua d by g &Olntgov $151- VItthg ap►apatwi' plar to restar ➢spat va wgir to 'fills afflumit pumps or tom em as Jalumbaasr yr '; Mfli1irl'mibaar to a sslat'r NA l xiairau;a y Ope rating t ho 1 2di Tip 00!'3'C `1:a raatstarea flu ra's'laal laaviolaz'aaitt'tIllm the la ni p 'TeikY DO 4aat ddVa •car psat AE01110128 over Mike will 41ir•Iamraaal aawl1g. 00 timat drlvs or park avmY', ur o litarvarlsd d1lit ueb of adinpu at, •cirri mrmat w11 11i U 'fast down alrips all drhy mound or at ih H Obsorpatlalf areal. 1R'eadutrtfora or aalirriirtsticrtf of the fnllai'wlrag frram t11% wastmataLaar alra urn riaaty Impirla'vse thlo patarfoarrrmoandis and p polo ng the 111 elf thl; f'OW TSs erribla ltitax h9by wlizes. a lftares<'dat butte; ca ndt3MS; aaaal;Eon *waalairS dagrs liaisra, dsrrtaul 'floss; .idfaaparat CTlBYail'aac9laaiaztaa; *v1; Ttfa,ittefsTIEM A'Iralti fsatarripa pstrsiPl Wdtaar; •frult totd vtagetsiblaa Paulk'o.- pasrillnel grasa'aa r harlilalclan" rsisat a;jaeraL091 nziad,011tio"al (At; ppUa9at Ing: praaduata; i 39trilcilide s; ma nitary impakIne; temp onov orld wsUr bditlal to brinra. .KeAribuNmear Wlwan thm POW TS ilalla umildr lea paarinaahentiv irrakeri rtu of #4ihruiCNa tli�s .1bHntnrIVIV tt'4 apes shall l a t:aa<kan to ireerartb abet tires ibyaataarrt pi it *iir and taui'uly aplara scrum d li'm tat2inpli aa'lsas +m ITh 01"m tiV COMM 83.23. W'1000isialrm Adt'rt1mtt0tvat1VV odd + All piipirig to tgmk o alid pU mshoU late disat' mnatrmad and •Mae dhandeft- Y pmlpe raparilrilgo asaled. a :r'ho czard.'Ormts of toll taanka a;arid lutnoe'shall b e re il - 40 wid ia r op mrly d1lavitiawd W bV a J�abp'pmtgm i ec alsig C?pesarst7rat °� +► krio pwripsne, Sall UnkU tkrlcl Pit% ntlIMI 110 ataaom1'V%iwd arld rasn0Vwad ar •111es1r Istyvasrs rmrriuvad and tha'a ranter asls800 f7lim3a:l w1th dv% gruvaai or aartathar Inert sa llad rssasrtorls).. 00WlllfGEtaYiaAY PLAN It thm TsOW7 Mlas nad ca$tawt be raapakm d 'aho ftalTctwfixg mmaamsurms flave 'bselz, or musk bib 'h akimj, 'to pmvldaa >sa 0060 iranipallusit l:::J :A sulteblo eaaapJrtrx6maivt arasa Baas 3adon Ssirpala.tr tmd gna trtuay he rifAlmad for tho funaVara of at ral'ulaxceutment Salt ataSataearP13.0n myaalrcu". "lli ma i%plaosrrseri'catr'ama shotald ba paro can tt 1'rmarrb 181iii�IaACISSB geld cSampsalkin and S11{1uld lt�t�l'y1 Qd'�l�dr►'�+y raa,'pt!'lred ataftkaaraoh's fram eiml ettrig a2rkd ppraaipaa s ed satrualtUilla, )at 111160 81-W wsilit- OAlurSs TO parr tabaat 118 regletaratriayr't AM= WM ae a vu 1 11 tuva3lumlaan ate t� 'dillk%h ra, sattielalaa rsaplraaazat�iant aaroa. i�inlz ?abteerrra rat islreats'i�r�t rritr..e4'. rtaitt t�C In aln a�iSatmtl pi7r as rtes anal sExsl is to rararrtpaly W11 ft the ararlaes fit 0 aatit ot, t hat Thtim. t:[ A atttttb replatuaarriem eras Is but available adtts it asolaT'mak andfor $all IltrrlWIltatza. iysitrlsim sadvemum fn 1 tsetahrsa5Ja3py s ltrstdJrtg tuttlt rrispp (7aaa 1'itz;'tt;;lti2d cats ,s teat rasipsurl, '4a raspalriQa+ t�tat fimltrrrJi 1�i6N'T'�, Thaa SITU tits not baron aavaulualerl is ttlaara0v to msubablaar ropJaaastsitisrec rua'oat, Up oh failure of thps POWs as &all; and r51rc t asvSallretlaara must. he psarfmriartsaa xay 7caayabi a 6WItIlblaa #ayp3aiefaimibrrL` a9rao. 1j' rip rmplauairi nsan't oe ratat 7mc duayltrabitg u huldIng trAnk May tiro 1tieslteel mi as lamtf lion to aespaliaaDth a fallaea3 POW'1:& 1 1fEfutauid tst:aad mat« raadra. affil a b9(JYPt(an BYatt;Firaiat rtasay' bd rmuricrazstr�ttaGNacl Yr, p1mog 'PajllctwSrip rsrrtc Val d ' Hct Vlairtttt at 'thcj 1111llit=Tvs str;arfaLasx& of such aaytm4+UtK >a rrrua�t ourraplij tk tfi ilia rulas9 In d'llact at thUt tiimM. we <WARNIN1S SAPTID, X MP AND 0THERT19RMIZINKIr TANKS M1Ay tio1' TAiW LITIaliAL 43 ON aANVI R;NSUFFl0lMT OXVGPIN« *0'0 NQ*r b".lilaTAR A SUTIC, PUMP OR ts'' HgR'! RgAlAfiM11i111T `f ANX 1J1"WRR >iAD' V OIN13CtiGfS"1"ipaiVO96. 01llttk'TM11i'!AV U':r- 1RJ360UE Z' " PERSON IM-40M THE IN T't$MOR OF 1A,. TAUK 'MAV Bit 0111ttJtbULT C7a13 IlVllaUi9atilIL21. .+ "�.iL.f..�w4 �S � �Y 1{!1 Y� . _ .,...........w.......urw,.n✓. . uwi-«.•... s... ..i.....a....u_i,,.,..�.....,. a•A {Rd J74 'lr 1.�AIff1 *A a �1i -- - - .wu.r -.- ..._..._..•........,. ........- r.u�.r. �.... ..---... .n......._.....,....n..W.....a . mrt...,,....r«.iwH...., •..,..,,...... uu... ..+. a. ew„•.,... __.... « .......e. i�Fis�ri j,t e2(o G3 psi9asriaa � c a� V F-'�JA NY. ICi lw Q r I � ' hF' + lrlair19t3 H�. , - - w_ 1•1adIl'1N1 ,�T �� C....dh /h �_.._... 2- hurita . Thraa a.{ctwutnom Wna 4frrafma In casampli aanne witJh ahsapaxar Cionlirt #SI.�� "'atln)i' }ltall��l,uau3 �ad.i��tt1+ fy3 am, Wilmdaas'i" 1Ai'ltlftlltrs'dar+a loads. ST CROIX COUN'T'Y SEPTIC TANKMARMNANCE AGREEMENT AND 1 OWNERSHIP CERTIFICATION FORM Owner/Buyer 1�zt \�e Mailing Address m3 \' (� El,•� C <- Fm�+�O W\ Property Address /3' S -;2/ (Verification required from Planning Department for new construction) BB City /State Parcel Identification Number 0 O- I a (0 11 - 3 0- O o O 13. 31. t LEGAL DESCRIPTION Property Location Sec. JZ , T N -R ' W, Town of XPe o'r-e Subdivision )���°C` Q t� P�S�— , Lot # Certified Survey Map # , Volume . Page # Warranty Deed # ?69 75 , Volume ;,722 . Page # Spec house ❑ yes V� no Lot lines identifiable � yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank than 1/3 full of sludge. em with th standards and agree to maintain the private sewage disposal cyst Uwe, the undersigned have read the above requirements gr set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. zsui. Certifi cation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expira . n date. j ATURE OF PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowle I (we) am (are) the owner(s) of the property descri a ve, by virtue of a warranty deed recorded in Register of Deeds Office. ,' S ATURE APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' llllllllillilillllll l IIIIIIIIililillllllll I II' I II' I ' I ' II I�q, rrrr r Illlllllllllliflflllllllll �, rF MEMO �Il�il i i � I I Id MEEK ■�� �'� MEMO mmms rF ✓; � � � � �';�' I � � �� iii � �� z II IIIIIIIIIII II \, ° °''� ��� ■��■ ���� � ' IIIII1111111111 �� a -- _ II x II z 11 II - 4 it II III II II -II II II II II II 11 I I II o O 11 g 11 z 11 11 W � 11 II II � I 1 Farm ° ♦10W I rL x N � f • f l�� � Q �a =z w i� — — — — — — — — — — — - II II II II it II I II It{ II ( � S IN I I I I - L -- ------ - - - - -J s �VI I II II ` -t J = I I I I I I 4 I I � fl II I �� P I I X11 Il II ;o I I I I f I I Flo M I I tI N J 2228 P 981 719'-=33S � STATE BAR OF WISCONSIN FOKM I - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between GREENWOOD ENTERPRISES, INC., 05/02/2003 02: 40P1i Wisconsin Corporation WARRANTY DEED - EXEMPT Ii l Grantor, 1i REC FEE: 21.00 and HALLE BUILDERS, INC. TRANS FEE: 65.70 COPY FEE: 2.00 CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in Si ( - rrniX County, State of Wisconsin (the "Property "): �; Pu r >r iu,c� F,tea ;. �; Name and Return Address dt!71 f the Plat of NorthGate II, recorded in the Edina Realty Title ice of the Register of Deeds for St. Croix County, 400 S. 2nd St., #115 Wisconsin, on June 20, 2001, in Volume 8 of Plats, at Hudson, W154016 Page 55, as Document Number 648882. i l ii 0 Parcel Identification Number (PIN) i i , This 15 not homestead property. (is) (is not) i I jf I I Together with all appurtenant rights, title and interests. 1' Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, and reservations, if any, of record. t. i, Dated this �,�� day of April 2003 G)NWOOD IS , NC. (SEAL) ( (SEAL) * * , James E. Rusch, President (SEAL) (SEAL) * * Mary Rusch, Secretary /Treasurer AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, ii ss. St. Croix County authenticated this day of Personally came before me this day of _ ADr 1 2003 ,the!abo e named james 'P Rusch, its Presi d'04 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, me known to be the person S ho:execk%d tote 7¢regoi�4 authorized by §706.06, Wis. Stats.) instru ent and acknowledge the sa O / �[b THIS INSTRUMENT WAS DRAFTED BY 5 t Al Mary R- Rncrh ra l' , Sand___ 7 anh Notary Public, State of Wisconsin New Richmond, WI 54017 My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not 1 4 , 2004 ) necessary) " Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. T(NG By OTHER INSTRUMENT 38 EXIS 185.00' 58.O 133.00` / 243.00 0 200 N� � 9990 _ NO STRUCTURES ALLOWED IN EASEMErr �1 � � '• 2.8a' 230.20' r� r. v 60,256 sq. ft. o` L :-. 55,9 o , o 'o a; 1 .383 ac. ti 41 Z cu , 6,W 4 77,012 sq. ft. 1.768 ac- / ,tea LA .49 — -- — — 200 J ti sq. A.C. ��6 �' J ' / 1 t r J 1 35-30' y � 'c'� -� / Z -7 178.98 -- .... — — � C4 o 00 �r0 !� / ru Li r r c� Al o 70 ;r f / 1 (n 55,060 sq. ft. o 65,559 sq. ft. 1.264 ac. f z 1.505 ac. Z y ea sement i 1 / 05.0 -` — 22 00 1 13 — — — 80. -- - -- — — - --195.00` — — -- - _ __ . AT Pf %j S fHV' ThtT[Coccr -Trrau Asconsin Npart ment of Industry SOIL AND SITE EVALUATION REPORT Page __ of 3 W Labor atiid Human Relations ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 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- 1055 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NW 1/4 SW 1/4,S 13T 31 ,N,R 18 for W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # / / / _ / 1416 Third St. 71 na NorthGate ` !l � CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAP E ROAD Hudson, WI. 54016 'G15) 386 -3674 1 Star Prairie I 212th Ave. [� New Construction Use [ ] Residential / Number of bedrooms 4 [ ] Addition to existing building j J Replacement [ J Public or commercial describe Code derived dairy 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 _ bed, gpd /ft .. 8 trench, gpd /ft Recommended infiltration surface elevation(s) 94.75 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft $ = Suitable fOt System CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ❑ U FI S ❑ U � S El U ®S ❑ U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrch 4 f 1 0 -12 10 r 3/3 none 1 2msbk mfr QW if .6 1 Ground 3 27 -32 10 r 5/4 none sil lcsbk mfr QW na .2 .3 elev. 99 ft. 4 32 - 7.5 r 4/6 none MR 0SQ Mi na Depth to limiting factor +84 11 - y Remarks: Boring # 0-8 10yr 3/3 none 2mqbk mfr 2 2 8 -20 10yr 4/4 none sicl 2msbk mfr qW if .4 .5 Ground - sil lcsbk mfr -- a- - .2 i .3 elev. 4 9 9.1 ft• }, r Irn Depth to limit .r T ' 7 9 8 + 84" `; cR 3 1- `f f J �►v1IyG � t� J Remarks • F 7 CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 ' Address: 1554 200th. Ave. Richruoncif WI 54017 Signature: Date: 11_9 -98 CST Number: mO2298 PROPERTYOWNER Greenwood Enterpris SOIL DESCRIPTION REPORT - Page 2 at - 3 PARCEL I.D. # 038-1055-20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Comistence Boundary Roots GPD/ft - in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITmr& A L 3 il;; ---1— 0-10 10yr 3/- none I 9 m-qbk --mfr-- cm I f c; .6 ii,,- 9 1 Q-94 1 Qyr 4 - JA sici 2msbk mfr gy if .4 .5 Ground 3 24-36 10vr 5/4 none sil lcsbk mfr gw na .2 .3 elev. 1 98.7 ft. 4 36-84 7.5yr 4/4 none cos osg ml na na .7 .8 Depth to limiting factor +84 Remarks: Boring # 1 0-12 10yr 3/3 none sl 2mqr mvfr 9w If .5 .6 -14 111 2 12-22 10 4 none sl 2mgr mvfr gw If .5 .6 "Z "mn Ground 3 22-84 7.5vr 4/4 none cos I OS9 MIL na, na, .7 .8 qgej 18 10 5/4 c2d7.5yr 5/8 sil Lens no contigucius in H-3 Depth to limiting factor +84 11 Remarks: Boring # 1 0-9 10yr 3/3 none 1 2msbk mfr qw If .5 .6 5 2 9 -2 9 10 4/4 none girl 2mqbk mfr 9w -4 i C; if Ground 3 29-37 10 5/4 none sil I (-sbk i mfr CYW na -3 elev. 98.3ft. 4 37-84 7.5yr 4/4 none MR M I na nA -7 -R Depth to limiting factor +84 11 Remarks: Boring # MIM -1 Ground elev. — ft. Depth to limiting factor Remarks: SBD-630(R.05/92) 'jam °�'• WIL ANU ,1 I t tVALUATIUN HEPURT Pape 1 a j 01iiw01 of say a Swi ri p In accord with ILHR 83.08. Wis. Adm. Code Attach OW1100W sits plan on Pspw not less than 8112 x 11 inches in size. Plan must include, but S Cralx rwt Nn*W to vwbcW and horizontal reNtence point (BA4, erection and % of slope. sctde or PARCEL I.D. 8 dimmmioned, north arrow, and.focation and defence to nearest road. 038- 1055 -20 APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION anVtx)d Unterpri sea. Tito, cam. LOT ' NW 114 SW 114,8 13T 31 ,N.R 18 dal W tatOPERI Y OWNER'S MAIIWG ADDRESS LOT s I BLOCK I SUED. NAM£ OR CSM s 1426 Third St. 71 na rthGate CITY, STATE ZIP CODE PHONE rftJfIIBER OCRY OVILLAGE SOWN NEAREST ROAD HWISori WI. 54016 V15) 386 -3674 1 Star Prairie 212th Ave. New Conetw iar tlae ResfdW" Number of bedrooms 4 j ) Addict to existing building t 1 PAP6090"ni O Public a ocmmerciE describe Cade derived defy flow 600 gpd Reeomarended design folding ►are bed, spent* $ _ trench. gpdMt AbsaPfion area regWred 858 bed, tt �7 Q_ french, 9 Ma mum design faadng rate . _ bed, WW 9PdM Reoomntended melon surface elevmbxs) 94.75 ft (as referred b sole plan bendwk - #V Addl(Ionsd design ails na Parent materiel outwash Flood plain elevation, # applca* r1a ft U • S ( I br ®S O u M s ❑ i J �N PRESSURE c GAADC7 (1 ® ❑ UU 13 S ® SOIL DESCRIPTION REPORT Boring #f Horizon Depth Dominant Color Mddes Texture Sere ConsLsimoe GPD in. Munsell Ou. Sz. Cont. Color Gr. Si. Sh. Roots Bed remelt 1 1 0-12 10 r e Ground 3 27 -32 10vr 5 4 none Sil lcsbk mf elev. , 99 ft. 32-84 Svr 416 n9w -- Cor a lirtdtlng ✓ �- �cbr Rerna : Boring 2 2 8 - 20 10yr 4 none s cl 2msbk mfr aw If .4 i .5 oil lcsbk Mfr aw na .2 .3 elev. 9,,1 ft. 13Q b Inviting t�or + 84 �� Remarks: CST Name: - -f%m Print GaryL.Steel. Phone: 715 246 - 6200 Addrea: 1554 200th. Ave.AW Richmond W154017 Ste' Date- 11 -9 -98 CST Number. m02299 STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NW4Sw4 S13- T31N -xi8w New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #71 NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may 9 r � not be suitable for Y our 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. 111=4 $ , BM.= top of 1" pvc pipe @ el. 100 Alt. BM.= top of 1" pvd pipe C el. 99.20' (10 Ad 39' ay p A 1 Oro Gary L. Steel 11 -9 -98