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Home My WebLink About038-1148-50-200 0 to O y n d �1 0 w f G d 0 eF fD (D ID d C c N y C3 O V < p V W ��•' s v a c m w w ° r. CD CD N) o a D' p v� w ? !j 0 j � , 1 wM c N - . Q n 0 A N O 3 A N T o p ch O d CD Q v D a ( n d m c e o= o m 3 10 r o 0) 0 CD z �°� °w !� CL N OD (D O O n O G � y � cn cn c• p v a O O O o = !1 0 m � * * * m �E co 0 =r (~p N c m a N 3 C 2\ N N — CD CL N Nm 0 v O zooz Ds N N CD fD CD C r N CD z CD cn (R o D o p Z G n a a z w � m Z 0 ' z co H z m CD ? W � i m Q a C j T y a a U) N y S N ^ N y N V� 3 CD o. o i CL 'I o N Li N N 7 O O ZJ V r m a ° q �.q O 0 CD a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479237 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: Wilson, Burt Star Prairie, Town of 038- 1148 -50 -200 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No: M 1 17.31.18.647 7 CST BM Elev: Insp. BM Elev: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z / Q� y Benchmark /e Alt. BM / li:�A <� o Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 4 .9 17 -cl TANK TO P /L — WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2- 4 1 7 'e_ / 7 / Dt Bottom Dosing Header /Man. 73t TI.-I Aeration Dist. Pipe J Holding Bot. System 2W 0 t� Final Grade PUMP /SIPHON INFORMATION a,'ir— T ( 3• �Q �• Manufacturer GPM Demand St Cover \ ` f Z6 3- Model Num r C7, O I I 1 TDH Lift Friction Loss Syste ead TD Ft ; /l 3 1 Forcemain Length Dia. Dist. to Well 7 9 � SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. U ic}g_d Depth DIMENSIONS 0 Q � I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION I CHAMBER OR I.Jr .- J Type Of ti t Z -� 12. 1 UNIT Model NumberS DISTRIBUTION SYSTEM 16 d- /Q Header/Manifold #/ Distribution x Hole Size x Hole Spacing Vent to A' Intakr Pipe(s)� \ \ Zw C Length Dia 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 Mulc ed Bed /Trench Center 1 Bedrrrench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 966 Brave Drive Star Prairie, 1 54026 (SE 1/4 NE 1/4 17 T31 R1 8W) Wigwam Shores Blk D Lot 12 Parcel No: 17.31.18.647 1.) Alt BM Description 2.) Bldg sewer length = �(�'�� S1 d Z - amount of cover = r4 N �' Plan revision Required? Yes �o Use other side for additional information. Date Insepctors Signatu Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 51, 201 W. Washington Ave., P.O. Box 7162 ( � �� Madison, WI 53707 - 7 Sanitary Permit Number (to be filled in by Co.) (608) 266 -315 Q / 2 • Department of Commerce State Plan I.D. Number Sanitary Permit Application �v In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different than trailing address) may be used for secondary purposes Privacy La I. Application Information - Please Print All Information 96� ?LA-VE DR, arl el # Lot # Block # Property Owner' ame � / °� A Prope cats ` G, Property Owner's Mailing Address ZONING OFFICE / Section / Zip Code Phone Number N, /� o w E City, State • It (circle ne} II. Type of Building (check all that apply) ft Subdivision Name CSM Number or2FamilyDwelling- NumberofBedrooms 5 V��Villa I �(/rt4", JXD ❑ Public/Commercial - Describe Use ship of i ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) t) - -Z�b • A _ ew System ❑ Replacement System [I Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. El permit Renewal ❑ Permit Revision L1 change of El Permit Transfer to New Before Expiration Plumber Owner I of POWTS S stem: (Check all that a 1) C ❑Sin le Pass Sand Filter ❑ > �4 in. of suitable soil ❑ Mound 24 in. of suitable soil [I At -Grade g El ressurized ln- Grourtd ❑Mound - Cons Wetland [I Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter El Aerobic Treatment Unit [I Recircula ilter chin C ber ❑ Drip Line ❑ Gravel -less Pipe 0 Other (explain) &U �S� Recirculating Synthetic Media Filter g app I t=(- u$ V. Dis ersallrreatment Area I formation: Dis ersal Area proposed (sf) System Elevation Design Flow (gpd) Design Soil Application Rate( d Dispersal Area Required (sf J p Manufacturer Prefab Site Steel Fib r Plastic VI. Tank Info Capacity in Total Number oncrete Constructed Glass Gallons Gallons of Units New Fidsting ' Tanks Tanks Septic or Holding Tank asJtj Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached pla Number MP/MPRS Number Plumber's Name (Print) Plumber's Si at e 269 L 1 7 Plumber's Add ( City, S � zip Code O /' 1 VIII. Coun /Department Use Onl Sanitary per Fee (i udes Groundwater Date Issued wing t Signature o Stamps Approved ❑ Disa oved Surcharge Fee) 2 0 r S 11 ❑ O 'ven Reason for nial 7 ' A. Conditio ofAp rov ?j> a - 4 - �-& . SYSTEM OWNER: 1 Septic tank, effluent filter and tained 20 r�) a dispersal cell must all be serviced /main as per management plan provided by plumber. 2. All setback requirements must be maintained �ICC as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 iru es in sim SBD -6398 (R. 01/03) r PLOT PLAN PROJECT Bert Wilson Shore Drive Somerset Wi 54025 SE. 1/4 NE 1 /4S 17 /T 31 IDDRESs 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/4/05 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PIASURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Wood Corner Post ASSUME ELEVATIO 10 ° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Alternate Benchmark SYSTEM ELEVATION 95.5/95.0/94.5 5.5' below qrade Top of Wood Corner Post @ 103.0 Well is to meet all Pal ns Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 313' Property Line 1t.B.M. 3 -3' X 63' cells with >3' spacing Vents B -1 15' 15 42' ST Pro 3 Scale is 1" = 40' / 30 , Bedroom unless otherwise 7% House noted Slope j 0-2 / 70' 10' B -3 94' 105' 103' Brave Drive Property Line Vent > 6" Standard Biodiffuser of Cover Leaching Chamber with 3 1.1 ft2 of Area 6' Long 3411 Grade at System Elevation C;Ofo f PLOT PLAN PROJECT Bert Wilson DDRESS 2168 Shore Drive Somerset Wi 54025 SE 1/4 NE 1/4S 17 /T 31 1 8j W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/4/05 BEDROOM 3 CONVENTIONAL )XCX IN- GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Wood Corner Post ASSUME ELEVATIO 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 95.5/95.0/94.5 5.5' below qrade Alternate Benchmark Top of Wood Corner Post @ 103.0 Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 _ 313' Property Line 30' It.B.M. 3 -3' X 63' cells with >3' spacing � Vents 42 B -1 ST 5 Pro 3 Scale is 1" = 40' ` 30 , Bedroom unless otherwise House noted Slope B -2 70' 10' B -3 94' 105' 103' Brave Drive Property Line Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11" Grade at System Elevation 34' Property Owner _ Parcel ID # Page of r + Ong # Boring a it Ground surface eledo,� ) ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 I L„ -� - L A1 a 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF 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. SBM330 (R.6=) Soil Test Plot Plan Project Name Bert Wilson Sh i If Address 2168 Shore Drive Somerset Wi 54025 TM #226900 Lot 11 Subdivision wigwam shores Date 4/11/05 SE 1/4 NE 1/4S 17 T 31 N /R W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.5/95.0/94.5 *HRpSame as Benchmark Alternate Benchmark Top of Wood Corner Post @ 103. 313' Property Line Squaw Lake * 30' B 1t.B.M. 25' B -1 40' 42' 30' Scale is 1" = 40' 7% unless otherwise Slope B -2 noted 70' 10 IF B -3 94 105' 103' Brave Drive Property Line Ma intenance and Contingency Plan for a Septic System .. Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. la r g er er filter is being installed in 2. Eff luent filter is to be cleaned once a year. Please note: a g order to extend the maintenance interval of the filter. i ections pipes at the ends of 3. Once every 3 years, cells are to be inspected via the p the cells. to limit greases, garbage, and water conditioner discharge into the system. 4.Owner agrees 9 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• d as p Comm. 83 8. Discharge into system is not exceed those required p Co _ y Plan = , srnate armed and ins �v O Lion #1. ystem fails, determine cause of failure, use`> p k �a system in tested replacement area. r tall s stem at a lower elevation, by removing chambers, removing biomat, Option #2. Ins Y and install new system. • lacement area, and system elevation Option #3. No adequate area is suitable for rep cannont be lowered. Install holding tank as last resort. 3. Replace any other falling components as needed. Plumber: Shaun Bird 715- 246 - 4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 - Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ;1 Owner/Buyer f Mailing Address c� C . pq Property Address (Verification required from Planning Department for new construction) I CitylState Parcel Id Number LEGAL DESCRIPTION �- /' r 1-7 T 3 N _g�W, Town of CL - Proper Ioca r / tion --_- -- /4, Sec. P o Lot # r� Subdivision Page # Certified Survey Map # Volume , Volume Page # Warranty Deed # 2� Lot lines identifiab yes ❑ no Spec house ❑ no SYSTEM MA_UMNANCE P remature failure to handle wastes. Proper maintenance improper use and maintenance a your septic system could result in its P a licensed Pumper- What you put into the system consists of pumping out the septic tank every three years or sooner, if needed by waste disposal system- can affect the function of the septic tank as a treatment stage in the sig b the owner and by a t a certification form, Y The property owner agrees to submit to St Croix Zoning l P ring at (1) the on -site wastewaterdisposal system masterplumber, journeymanplumber, restnctedplumber or a licensedpumpOr the tic tank is less than 1/3 full of sludge. (if necessary), seP is in proper operating condition and/or (2) after inspec tion and pumping with the standards ft ed have read the above requirements and agree to maintain the private sewage disposal system Certification Uwe' undersign of Commerce and the Department of Natural Resources, State of Wisconsin set forth., herein, as set by the Departm eat leted and returned to the St. Croix County Zoning Offi within 30 stating that your septic system has been maintained must be comp dyear exp:1 date. DATE CANT OWNER CERTIFICATION our knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are true to the best of my ( ) the rty descnbed ve, y virtue of a warranty deed recorded in Register of Deeds Office- l P , DATE SIGMA OF APPLICANT « « « « «« may result in the sanitary Petit being revoked by the Zoning Department. Any information that is mis- represented d warranty deed from the Register of Deeds office «« Include with this application: a stamped if reference is made in the warranty deed a copy of the certified survey map U 2553P 4`78 '7 s10 iR,4 -7 • STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., WI RECEIVED FOR RECORD This Deed, made between Burgee O. Amdahl and Joyce E. 04/21/2004 09 :30At1 Amdahl, husband and wife Grantor, and Burton K. Wilson and TJ Jane R. Wilson, husband and wife WARRANTY DEED Grantee. EXEIPT 11 Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 300.00 (if more spa COPY FEE: needed, please attach addendum): CC FEE: Lots 11 anf 12, lock "D ", Wigwam Shores in the Town of Star Prairie, PAGES: 1 St. Croix Coufity, Wisconsin. Recording Area Name and Return Address KP117`:'I'A OGLAND AT INEY AT LAW P.O. BOX 359 HUDSON, WI 54016 0354148- 50-100 & 038 - 1148 -50 -200 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this - ` day of April 2004 * * 1 ee mdahl -- - -- - - - - -- -* * 'Joyce E. Amdahl -- — AUTHENTICATION ACKNOWLEDGMENT Signature(s) B urge e O. Amdahl and Joyce E. Amdahl, STATE OF ) husb and wife ) ss. /a `w County ) authenticat this L l 4ay of April 2004 Personally came before me this _ day of the above named * Krist Ogland — - — - -- -, - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY — Attomey Kristin Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du L WI STATE BAR OF WISCONSIN 800-655'2021 WARRANTY DEED FORM No. 2 -1999 I� _ = do Aug 16 A: ! 4b �% �1 62 °4t' 4fyb 15 0' 0eti b j /go � 7 O 30a ei Town Mary %1 N 2 1 48 0 19' t pp 1 9 00 4 1 23 ° 35 • U z v aZs 28 ' , ° 1 ' + N. O °0 t O � ' 4 fig 89° 34' 930 68 DD/ f W 1 4 J147 004 tr o • `at 0. �-1? I10 °16 town ° 00 q O %P B5 , •��, i, Co ZO• �2` \ 2 90° a ll 10 7 T 014 O �J 1r 0� 6 9 9 ° B 2 . 0 °" 6 a SAO O ♦ 116°Z5 { p1.46 o � r L 0 2 op is j 4 I I m, y 0 ti 7 tie 6• I O N y1n1n0 o►fA a ti c feet of the of � o nor See. 17, ^ r° , 0 m ' R.1 117.0 0 hV, o �1g p,0,ratl M / aatl' • This instrument drafted by Howard R. Kruse i., R. 18 W.