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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y:
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353122
Permit Holder's Name: ❑ City ❑ Village [� Town of: State Plan ID No.:
•D
Town of Star Prairie - --'
Elev.:- Insp. BM Elev.: 8M Description: Parcel Tax No.: �/ I
lw oo.a - T PuL O `��
TANK INFORMATION ELEVATION DATA l 3 g 1, ($ q SP
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , p Benchmark 60 / S5 1 06A ,_
nb M .a /
Dosing
- Alt. BM 3• 8 `f
Aeration Bldg. Sewer • 48,
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P / L WELL BLDG. A ir ir I ntake ROAD
A
Septic �' - r NA
Dosing NA Header /Man.
Aeration NA Dist. Pipe
Holding Bot. System �•� `� S
. S
PUMP/ SIPHON INFORMATION Final Grade
Ma facturer mand St cover to •
Model Numbe GPM
TDH . Lift Fricti S stem TDH Ft
Forcemaj ength Dia. Dist. To we
So k, B RPTION SYSTEM �Q, e j j T �' •• ,cuf- BMV RENCH Width Length No.O Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIME I N 3 -2s DIMEN I N
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu ct,u��
SETBACK �it�uJ
INFORMATION Type Of CHAMBER — Model Num r:
System: 0,vw, OR UNIT u
DISTRIBUTIO SYSTE 3
Header/Manifold Distribution Pipe(s) x Hole Size x Hoe Spacing Vent To Air Intake
Length Dia Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over / v Depth Over xx Depth Of xx Seeded/ Sodded xx yVlulched
Bed /Trench Center 3V Bed /Trench Edges Topsoil E] Yes El No Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: /o /a*/ 9y Inspection #2: --��
ocation: 1314 214th Avenue, New Richmond, WI (NW1 /4, SW1 /4, Section 13 T31N -R18W) - 1�i31.18.958
Plan revision required? ❑ Yes tNo �Q �� 1 M
Use other side for additional inform tion. /° 2� g9 r}`'
V SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. o
r -
_ - -� Safety and Buildings Division
Vi sconsin SANITARY PERMIT APPLKATION. �,,. 201 W. Washington Avenue
P O Box 7302
Department of Commerce In accord with Comm 83.o Wis. -Adm
,T�, Madison, WI 53707 -7302
• Attach comp lete plans (to the count co only) for the s em, on � not less Cqt r t 0
P p Y copy s Y Y# F�! P'�
than 8 1/2 x 11 inches in size.
t
• See reverse side for instructions for completing this applica St S nitary Permi Number
tion �'" ' p; F �
tJ i'
Personal information you provide may be used for secondary purposes C�V O � ` ' it & iJt5�or . previous application
[Privacy Law s. 15.04 (1) (m)]. T0,���yta S e Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE III T AL NF '�►Tt "L �' `
Prop y Owner Name '�Rco eit Ion
1/4 1/4, 5 I!3 T3 , N, R f j4or) W
Prop Owngj's Mailin Address Lot Number Block Number
t ert ^
City, State Zip Code Phone Number Subdivision Nam o CSM Num er
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
❑Village G�� V
Public 1 or 2 Family Dwelling - No. of bedrooms Town o 1 21
III BUILDING USE (If building type is public, check all that apply5AW^ Parcel Tax Numbers) ,�. • / T - 1156
1 [] Apartment / Condo l
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 ( New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
System ____ -___ System ___________ __ Tank Only Existing System Existing System
-------------- xistiny ___ -____
I
B) ❑ A Sanitary Permit was previously issued_ Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 E] Holding Tank
12 Seepage Trench; 9 R2 ❑ In- Ground Pressure 3 �� , 42 ❑ Pit Privy
13] Seepage Pit / ) �+• 43 ❑ Vault Privy
14 ❑ System -In -Fill - •_ , /
V ABSORPTI SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft) (Gals/day /sq. ft.) (Min. /inch) Elevation
0 - S ?S, Weet Feet
Capacit
VII. TANK i Ca allo
n Total # of Prefab. Site Fiber- Exper.
INFORMATION g Manufacturers Name Concrete Con- Steel Plastic
New Existin Gallons Tanks structed glass App
Tanks I Tanks
ptic Tank ❑ ❑ 11 El 11 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum r s e: Pri t) Plumb Sign re: (No S m ) WWBVMPRSW No.: Business Phone Number:
Aid [ P) Address (Street, City, State, 4 p ode):
Al
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin gent Signature (No Stamps)
Approved []Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
L 6'398 l =r�f- C tf (R. 4199) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
r
Greenwood Enterprises, Inc.
NW4SW4 S13- T3IN -T1811
town of Star Prarie
lot *9- NorthGate
this moil= evaluation was conducted to satisfy a zoning requirement, it may or way
not be suitable for your use. The location of the test may or ray not be as show
as permanent lot linen were not established at the time the test was conducted.
f '
N
1 " =40' '
BM.= top of 1" pvc pipe 2 el_ 100'
Alt.., at, = top of I pvc,: pipe. r el. 99.9o*
- A 4 1
I
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
iOtvision ot`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. 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. 03801055 -20
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
w... - 7
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT 1/4 1/4,S 13 T 31 ,N,R 18 Wor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM #
1416 Third St. 9 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER []CITY VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 (715 386 -3674 Star Prairie I 214th Ave.
[x] New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building
I ] 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, 11 Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) 95.95 ft (as referred to site plan benchmark)
Additional design / site considerations nas
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 ®S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U [R S ❑ U ❑ S [1U
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 jTmnch
>. 1 0 10yr 2/2 none I i
i
2 13 -33 IO r 4 4 none sici lcsbk mfr QW if .2 .3
Ground 3 33 -84 7.5 r 4/4 none Cos osa M1 n na .7 .8
elev.
9 9.5 ft.
Depth to
limiting
factor
�2L-
Remarks:
Boring #
1 0 -17 10 r 3/3 none 1 lcsbk mfr Qw if .4 .5
2 17 -36 10 r 4/4 none sicl lcsbk mfr CIW if .2' .3
Ground 3 36- 7.5yr AM none ms ns(l ml na na 7
eiev.
9 9.7 ft.
Depth to
limiting
factor
Remarks: zp+vr
CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200
Address: 1554 200th. Av . New Richmond, WI 54017
Signature: Date: 10 -27 -98 CST Number: mO2298
I
o —
PROPERTYOWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 038- 1055 -20
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bamdary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch
.................
..................
..................
3
0 -11 1 1 lcsbk mfr if .4 .5
11-28 sicl lcsbk mfr aw if .2 .3
Ground na na .7 .8
elev.
92 ft.
Depth to
limiting
factor
+84"
a
Rema s:
Boring #
1 0 -12 10 r 2Z2 none 1 lcsbk mfr gw if .4 .5
4 `'' 2 12 -30 10 r 4/4 none sicl lcsbk mfr yw if .2 .3
Ground 3 30 -84 7.5 r 4/4 none ms osg ml na na .7 .8
elev.
9S-5- ft. —
Depth to -
limiting
factor
Remarks:
Boring #
1 0 -16 10 r 2/2 none 1 lcsbk mfr gw if .5
5 '.. 2 16 -36 10 r 5/4 none sil lcsbk mfr gw if .2 .3
Ground 3 36 -84 7.5 r 4/4 none ms osg ml na na .7 .8
elev.
99.4 ft.
Depth to
limiting
factor
84
Remarks:
Boring #
.................
.................
Ground
elev. j
ft.
r
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 �4�4 S13- T31N -T18W (715) 246 -6200
town of Star Prarie
lot #9- 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'
BM.= top of 1 pvc pipe C el. 100'
Alt.., BM.= top of 1" pvc pipe C el. 99.90'
t t"� W jW
Av J e l
"Y
Gary L. Steel
10 -27 -98
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer i3r 2 rl jo
Mailing Address r►.,�. -�� ,¢i���, o ,�� w/
Property Address 13�y 17,
(Verification required from Planning Department for new construction)
City /State /UAAAt Parcel Identification Number
0 00
LEGAL DESCRIPTION
Property Location )UOA %, 3G4 y., Sec. T 3 � N_R W, Town of
Subdivision Lot #
Certified Survey Map # , Volume Page #
Warranty Deed # _aaa Volume Page #
Spec house 0 yes 1 no Lot lines identifiable 0 yes X 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.
Tie Property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
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 expiration date.
t.
SIGNAM 1 ijF APPLIC /. /
DATE
OWNER CER FICATION `
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the Property gibed above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGN OF p NT 5 031
DATE
" "" Any information that is rnis_
represented may result is the sanitary permit being revoked by the Zottia .•....
g Department.
'• Iachade with thris, appugtioa: a stamped warranty deed from the Register of Deeds office
2 copy of the certified survey nap if reference is made in the warranty deed
ro
Vnl.1450pAr,t375
STATE BAR OF WISCONSIN FORM I -1996 KATHLEEN H. WALSH
DoctmmtNumber WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., W1
i
This Deed, made between Greenwood Enterprises Inc a Wisconsin RECEIVED FOR RECORD
-» coMllration Grantor, and Bernardi Koon and Shirley F Kona. husband 06_ 20-1999 10300 AN
and wife as surylyQrhio marital nroDerty Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following 6 DEED
described real estate in St. Croix County, State of Wisconsin (The "Property "): EXERT i
CERT COPY FEE:
COPT FEE:
TRANSFER FEE: 59.70
RECORDING FEE: 10.00
PAGES: 1
Raeord'mg Area
CC — Name and Return rmu
yon S
4 irifet f ific,�dtn (Sufdber (PIN)
This ig, illgi homeatud property.
(is not)
Lot 9 of the Plat of NorthGate, recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin on May
20, 1999 in Volume 7 of Plats, at Page 46 as Document No. 603503.
Together with all appurtenant rights, title and interests.
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.
Dated this �- day of �� �, 1999.
GR �,Ml) ENTERPI
B:
*J ca E. Rusch, its presi an
By;
* *M ry R. sec
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Junes E. Rusch, its president STATE OF WISCONSIN )
) as.
Croix County
authenticated this day of July, 1999. Personally came before me this a day of
Tforegoil'n.,luumont Z 1� the above named Mary R Rus ch, its e known o be the penon(s) who executed the
d acknowledge rho same.
ois A. Murr
TITLE: MEMBER STA SIN
(If not. $Y0t1�y u hSj�
authorized by $ 706.06, Wis. State.) Notary Public, State of Wisconsin ,t �6 �[ �'tSc tt il[t
THIS INSTRUMENT WAS DRAFTED BY My Commis on is permanent. (If not r
,�tatt expiration date:
Lois A. Murray, Zilz, Estreen & Ogland, LLP
304 Locust Street, Hudson, WI $4016
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Names of persona signing in any capacity should be typed or printed below their signatures
WARRANry D99D eTATE NAR Or WISCONSIN
FORM Na 1 • rass
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI a00•05a•2021
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