HomeMy WebLinkAbout038-1242-16-000Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
(ATTACH TO PERMIT)
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m))
Permit Holder's Name:
City Village Township
Franklins Carpentry, LLC
I TOWN OF STAR PRAIRIE
CST BM Elev.
linsm BM Elev:
IBM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aerafion
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Head
t. to W
SOIL ABSORPTION SYSTEM
ELEVATION DATA
Inlet
BED/TRENCH
Width
Length
No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
SETBACK
INFORMATION
SYSTEM TO
JPIL
IFLDG
WELL
LAKEISTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer:
Type Of System:
Model Number:
�Il�Tlf1�11T1A\1 w�ro\e
Header/Manifold
IDistribution
x Hob Size
x Hole Spacing
Vent to Air Intake
Pipe(s)
Length Dia
Length Dia Spacing
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
lBedrrrench Edges
Topsoil
Ik Yes Q No
Q Yes 0 No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1
Location:1831 90TH ST
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? no Yes A No
Use other side for additional Information.
Date InaeppoYs Signature
SBD-6710 (R.3I97)
Inspection #2:
Can. No.
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Application 1
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SYST M OYYNER: �-
1.Septictank, effluent fitter and dispersal cell` �,
must beserviced /maintained as per J f�, f�,,,,,, � _ �Y A,^.4or non , , j, A. A
rnanagement plan pro " aRabrawraaaw SDSRCMNWtF aw. r. . rra
2• All setback requirements must be maintained
as per applicable code / ordinances.
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name
Owners Name:
Owners Address: 9 1 a 17a Nd
N.xAw W T—
s yo i
Legal Description: _ /) //a - j,E VL/ - -r 3 lu
� 1
Township: � /l.p.J�/t.t.2�
County: SJ' CA-,O-�
Subdivision Name:
Lot Number
Parcel ID Number. 03 8 -- / a q 2 - 16 - o�
Page t Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross -Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St Croix Cty S nce orm f
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber.. B/Vf p / u! MPjI License Number. 220 3S7
Date: Li Phone Number %%S- 760- D`fy�
Signature
Designed pursuant to the 1 nd Soil Abso neat Manual for POWTS Version 2.0 SBD 10705 P (N.01J01 ).
Page 1
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o >33
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o
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Cross Section of a. _—_ Cell EZ Flow In-Grouno Dispersal Component
Final Grade
Observation Pipe
Geotexlile Fabric
— System Elevatici
Design Flow _ 600 Loading Rate 0 . = Required dispersal area SS 7 Sq Ft
Required dispersal area • �S 7 _ + 50 (F_ISA) _ 17, L%_ (number of units)
Geolextile fabric to meet Comm 84.30(6)(g) Wis. Adm. Code
Minimum of 12" of cover over top of cell
Two observattontvent pipes to be provided per cell
Not to scale
Cell #1 Cell #2 TII
Systern Elevation:, Fq's t System Elevation:,_ ��Ft
System Eleva Ft
Final Grade ,89,, 5 Ft Final Grade: =t
-K3 Final Gra t. Ft
e rvi ouA. CiHECIi
E XCEPTS T SHD 40
FOR INLET EXTENTION
H
PL-525 FILTER HOUSING
PART NO, - 30142-525
MATERIAL:
HOUSING - POLYPROPYLENE
-a OUTLET BUSHING - PVC
`14, 6.5 BALL - HDPE
L�
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A35
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ST. I RO PNTY SANITARY SYSTEM File
(/ic
Oe Use Only
''- ' OWNERSHIP/ADDRESS FORM croated2l=I
�,-
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the Property Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer f
Mailing Address 91 oZ 1 V Ap AIJLA-
City/State/Zip /U2AV "
Phone Number (required) 7iS- yy/ - 80913
Email Address (required) a1 W 070
Parcel Identification Number O-1 a L/a ^ 1 6- 000
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location P 4 L, SE'/, , Sec. -3 1 , T _ILN R ,Town of .ID
Subdivision Plat: • Lot # /�O.
Certified Survey Map # Volume , Page 4-
-Warranty Deed # I / & 3g $ (before 2006)Volume Page #
Number of bedrooms -3-Ly— Spec house Otyes 0 no Lot lines identifiablelp yes O no
New Property Address
(Staii Initials)
(� O F E USE ONLY /
b'3 / ,lu 5 l (aA
(Ve riricati of n address required from Community DevelopmAt Department fdr new construction.)
71� 2Bz3
(Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is mode in the warranty deed.
Community Development Department - Land Use Division
715-386-4680 St. Croix Countv Government Center 71 S-7dS-d7Sn Fav
P�4-
State Bar of Wisconsin Fonn 1-2003
WARRANTY DEED
Document Number 8 Document Name
BY THIS DEED, Oevering Homes Investments, LLC, a Wisconsin limited
liability company, (hereinafter "Grantor," whether one or more), convey and warrant
to Franklins Carpentry LLC, a Wisconsin limited liability company,
(hereinafter "Grantee," whether one or more), the following described real estate in
St. Croix County, State of Wisconsin:
Lot 16, County Plat of Bella Vista in the Town of Star Prairie, St. Croix County, Wisconsin
1163886
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
02/ 13/ 2023 10:20 AM
EXEMPT#:
REC FEE 30.00
TRANS FEE 195.00
PAGES: 1
"The above recording Information
verifies that this document has
been electronically recorded
& returned to the submitter
Recording Area
Name and Retum Address
Exception to warranties: easements, restrictions and covenants of record; highway and St. Cmix County Abstract & Title Co., Inc.
street rights of way; and Municipal and zoning ordinances and agreements entered 575 N. Knowles Ave., Suite a6
under them; and further except real estate taxes accruing in the year of this conveyance. New Richmond. WI 54017
Dalcd r0f3kuApg 'c)� Zc�23
Oevering homes Inver t consin limited liability company
(SEAL)
• By: Oranzo J. Oevering, member
AUTHENTICATION
Signature(s)
authenticated on
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:nf
St. Croix County Abstract & Title Co., Inc. y Andrea S.
Carpenter at the direction of the Grantor. 23-S35540
038-1242.16-"
Parcel Identification Number (PIN)
This IS NOT homestead property.
"\ O O S l t
..•......M .YO
?.•
�• 0,
y.�ybl0 'a=
���rinnnttutor�
ACKNOWLEDGMENT
STATE OF WISCONSIN
St. Croix COUNTY
ss.
Personally came before me on the
the above -named O_ranzo J. Oeverine member of Oeverin2
Homes Investments, LLC a Wisconsin limited liability
company,
to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
Notary Public, State of Wisconsin
My Commission (is permanent) (expires: �✓ /L2/ Zt/ )
(Signatures maybe authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED A 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
• Type name below signatures.
St Croix County 1163886 Page 1 of 1 1 3
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Soil Test Plot Plan
Project Name Oevedng Homes inveswo is Shau
Address 1433 CGIM0h0 $ Ave Suite A
New Richmond Wi 64017Cbk #22690()
Got 16 _ Subdhrisbh BsMa YMta Date 12/22/21
N 112 SE 1/4$ 31 T 31 N/R1S W Township Stari'tairie
[] Boring O Well PL Property Line County ST. CROIX
SM or V1tP ASSultle Elevation 100 % Top of survey iron
System Elevation TSD *NRIazialme as Benchmark - -
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Attachn
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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.
aauwo (RAW)
Soil Test Plot Plan
Project Name Oevering Homes Investments Shau d
Address 1433 Cernohous Ave Suite A
New Richmond Wi 54017
C #226900
Lot 16 Subdivision Bella Vista Date 12/22/21
N 1/2 SE 1/4S 31 T 31 N/R18 W
Township Star Prairie
Boring Q Well PL Property Line County ST CCROIX
' , BM or VRP Assume Elevation 100 ft. Tap of survey iron
System Elevation TBD *HRpSame as Benchmark
COUNTY PLAT OF: SOIL TEST MAP
BELLA VISTA CBA EXHIBIT W/ CONTOURS
/
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i rDe 116i7
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tDter t
STA
OWNER
4 —8eeAroN**&
fK couNrY
T��S
NO. 648411
TRY PERMIT
SrjREviousyo.
PLUMBER
TOWN OF M4ftQ"00&&
SEC ,T_X_N, R
AND/OR LOT BLOCK MINNOW
SUBDIVISION
145.135 (2) W1SCOfISIN STATUTES
(a) The purpose of the sanitary permit is to allow Installation
Of the private sewage system described in the permit.
(b) The approval of the sanitary permit 4 based on
regulations in force on the date of approvaL
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of ■
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
�✓ IL AUWORI D ISSUING OFFICER - DATE
-tf I!mt
PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI 1/20)