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Home My WebLink About038-1086-70-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 648454 GENERAL INFORMATION 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 Township Parcel Tax No: DANIEL & MOLLY KRETOVICS I TOWN OF STAR PRAIRIE 038-1086-70-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown/Range/Map No: IOO 0+ W4A* 21.31.18.357G TANK INFORMATION jELEVATION DATA TYPE MANUFACTURER Y CAPACITY Septic WAOSIX Dosing Aeration 41G� a TANK SETBACK INFORMATION 1 erlr i If YEA;.Lrz TANK TO P/L WELL BLDG. Vent t6ATTMake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION 10% anufacturer De nd GP del Number /J TD Lift I FrictiA Loss System Hea TDH Ft Forc mai Length D Dist. to We SOIL ABSORPTION SYSTEM Mzff1 1ow 1 1 St/Ht Outlet BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO W LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of Syste Model Number: DISTRIBUTION SYSTEM I Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil 0 Yes 0 No 0 Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1093 210TH AVE 1.) Alt BM Description +%" GOvlell, . )w ete} ok risevls o& teoL immWe s 2.) Bldg sewer length = ��. w - amount of cover =0('U Al i x\s}+*j dal a0*4 ?V � y� Plan revision Required? * Yes W No(� Use other side for additional information. b SBD-6710 (R.3/97) ct Date Ins gnature Cert. No. r;:= n c\ n I—_FF�\ s,"-2o23-a73 s='' Department of Safety County /X & Professional Services, ST CROIX Number be filled in by Co.) " MAY 15 2023 Industry Services Division Sanitary Permit (to Communi� e mit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if ditlerent than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. I. Application Information - Please Print All Information Property Owner's Name 1n # AParcel Dan Kretovics hlolL,�l' o�tc.5 ID 038-1086-70-000 Property Owners Maili g Address Property Location 1093 210th ave Govt. Lot City, State Zip Code Phone Number NEW RICHMOND WI 54017 N E '/. NE '/+, Section 2 1 T 31 N N R 18 E or W X II. Type of Building (check all that apply) Lot # Subdivision Name 0 1 or 2 Family Dwelling- Number ofBedrooms � �.c.�. vo. 4- Block # ❑ Public/Commercial - Describe Use �— ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number ,?�e 4 JV � � s ��. �- 0 Town of STAR PRAIRE III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i applicable.) A ❑ New System Rep e t System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound El Site Desi ®Other T e (ex lain g Type (explain) (conventional) tank replacment List Previous Permit Number and Date Issued C. El Renewal Before El Revision ❑Change of Plumber ❑ Transfer to New Owner Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Y , c Tank Information Gallons Gallons Units 52 �,p� F P c u y 0 _5 R New Tanks Existing Tanks 0. U i; H t:. 0 G... Septic or Holding Tank X 1000 1 WI ES ER X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signa MP/MPRS Number Business Phone Number PAUL R KOEHLER/"_'`�---- ��' 225410 715 246 2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DR NEW RICHMOND V1. County/Department t?se Only Approved ❑ Di Permit Fee $ 2 � Date Issued Sl�b�z� 2- Issuing Agent Signature - Own n for Den Conditions of pprov al ` Ge�44� ,G 1 SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell S �' S - 99, r-[� ,,,n-w� aAkft"'Q gawmust be serviced 1 maintained as per ' `T'� � S � S management plan provided by plumber. �� per il& tJ;�_ 2. All setback requirements must be maintained / _aA— as per applicable code / ordinances. Attach to complete plans for the system 197-subm)'i to thCounty only on paper not less than 8 F2 x I 1 inches in size r _ o l SBD-6398 (R. 03/22) ul 5) .4s- B,,�l-� s AS BUILT SANITARY SYSTEM REPORT iFXiER i E_S U� __ t�EbE�E. , TOWNSHIP ,"EC.o?/ TS' N, R_(g,A 0, ADVRES5 yy , ST. CROIX COUNTY, WISCONSIN. .Ali. . ".'BDIVISION LOT LOT SIZE - PLAN VIEW Distances S dimensions to meet requirements of H62.20 114=3230 F I F w ■■■■■■■!■l�1PlIII■■ ■ONOEM �11� PIPE ■■■■■■■■■!■■ V■■■■■■■■■■■■■■■■ ■■■■■■■■:ii�v ,SEE ME ■■■■■■Nell ""MIN, M--' `-- MENN■■■i-■■ON7■EE.■tTnnar�Er� ■■■■■91 ■EN MEN ■■E■■■■lf1 no ■■ ■E■■�■■■■■■■■lii IN ME OMEN No ME ■■■■■■■■■■■ mom O■O■■O■■O■■■■ONO■■■■■■■■■ mom ■■E■■■■E■ OMEN ■■■■■■■■■■■■■ mom ■■■■E■■EMESON ■■■■■■■■E■■■■� MEN ■■■■■■■■■■■■■■■MMM ■■■■■■■■■ No ■■■E■■O■■■■■■■■■■■F ■ON■E ENE O■■M■■■■M EPTIC TALK(S)I MFGR. i ,M. - - CONCRETE_ TEFL NO. of rings on cover I Depth / Z'' DRY WELL ANCEES NO. of width length area _ .i no. of lines -a- width= length 3K� area (cdOd" ' epth to top of ipe ,;24-i aSREGATE V '� W1 RATE AREA REQUIRED Cnl.4 p' AREA AS BUILT l dah' 4sclaimer: The inspection of this system by St. Croix County does not imply complete .wpliance with State Administrative Codes. There are other areas that it is not possible la inspect at this point of construction. St. Croix County assumes no liability for jStem operation. However, if failure is noted the County will make every effort to tter®d-ne cause of failure. l$1SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. - INSPECTOR ' DATED PLUMBER ON JOB Cx LICENSE NU11BFR 147e oe As-o _ r 5/15/23, 8:55 AM St. Croix CO.M.P.A.S. 4 looft https:Hscccdd.maps.arcgis.com/apps/Webappviewerlindex.html?id=893ffed22946484fb78237a6d2c721 de Map Unit Description: Hubbard loamy sand, 0 to 6 percent slopes --St. Croix County, Wisconsin St. Croix County, Wisconsin HrB—Hubbard loamy sand, 0 to 6 percent slopes Map Unit Setting National map unit symbol. g58r Elevation: 700 to 1,500 feet Mean annual precipitation: 28 to 36 inches Mean annual air temperature: 39 to 48 degrees F Frost -free period: 120 to 170 days Farmland classification: Not prime farmland Map Unit Composition Hubbard and similar soils: 100 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Hubbard Setting Landform: Stream terraces, outwash plains Landform position (two-dimensional): Summit Landform position (three-dimensional): Tread Down -slope shape: Convex Across -slope shape: Convex Parent material. Sandy outwash Typical profile A - 0 to 18 inches: loamy sand AC, C 1, C2 - 18 to 60 inches: sand Properties and qualities Slope: 0 to 6 percent Depth to restrictive feature: More than 80 inches Drainage class: Excessively drained Runoff class: Very low Capacity of the most limiting layer to transmit water (Ksat): High to very high (5.95 to 19.98 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None Calcium carbonate, maximum content. 15 percent Available water supply, 0 to 60 inches: Low (about 3.9 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4s Hydrologic Soil Group: A Ecological site: F090AY019WI - Dry Sandy Uplands Forage suitability group: Low AWC, adequately drained (G 1 05XY002WI) USDA Natural Resources Web Soil Survey 5/15/2023 21111111111111 Conservation Service National Cooperative Soil Survey Page 1 of 2 Map Unit Description: Hubbard loamy sand, 0 to 6 percent slopes --St. Croix County, Wisconsin Other vegetative classification: Low AWC, adequately drained (G105XY002W1) Hydric soil rating: No Data Source Information Soil Survey Area: St. Croix County, Wisconsin Survey Area Data: Version 18, Sep 6, 2022 USDA Natural Resources Web Soil Survey 5/15/2023 it Conservation Service National Cooperative Soil Survey Page 2 of 2 3 En on ry 450 1a 1- N 0 u� O 450 9 45" N Soil Map —St. Croix County, Wisconsin , 3 En oM N <T 531800 531880 5319M 532040 532120 532200 3 Map Scale: 1:3,620 f printed on A landscape (11" x 8.5') sheet Meters N 0 50 100 200 300 A 0 150 300 600 900 PP proles: Web Merotor Comer coordinates: WGS84 Edge tics: UTM Zone 15N WGS84 USDA Natural Resources Web Soil Survey 21111111111 Conservation Service National Cooperative Soil Survey 450 10' 1' N 0 Ln i _O 450 Y 45" N 532520 3 to M 5/15/2023 Page 1 of 3 MAP LEGEND Area of Interest (AOI) Area of Interest (AOI) Soils Soil Map Unit Polygons Soil Map Unit Lines Soil Map Unit Points Special Point Features v Blowout I Borrow Pit Clay Spot ,r> Closed Depression Gravel Pit Gravelly Spot Landfill Lava Flow 4k+ Marsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock Outcrop + Saline Spot ` Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot Soil Map —St. Croix County; Wisconsin MAP INFORMATION Spoil Area The soil surveys that comprise your AOI were mapped at 1:15,800. Stony Spot Very Stony Spot Warning: Soil Map may not be valid at this scale. zcrf Wet Spot Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil Other line placemertt. The maps do not show the small areas of Special Line Features contrasting soils that could have been shown at a more detailed scale. Water Features Streams and Canals Please rely on the bar scale on each map sheet for map measurements. Transportation +44 Rails Source of Map: Natural Resources Conservation Service Web Soil Survey URL: ,ter Interstate Highways Coordinate System: Web Mercator (EPSG:3857) US Routes Maps from the Web Soil Survey are based on the Web Mercator Major Roads projection, which preserves direction and shape but distorts distance and area. A projection that preserves area, such as the Local Roads Albers equal-area conic projection, should be used if more accurate calculations of distance or area are required. Background r Aerial Photography This product is generated from the USDA-NRCS certified data as of the version date(s) listed below. Soil Survey Area: St. Croix County, Wisconsin Survey Area Data: Version 18, Sep 6, 2022 Soil map units are labeled (as space allows) for map scales 1:50,000 or larger. Date(s) aerial images were photographed: Jul 30, 2022—Sep 1, 2022 The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. USDA Natural Resources Web Soil Survey 5/15/2023 .mConservation Service National Cooperative Soil Survey Page 2 of 3 Soil Map —St. Croix County, Wisconsin Map Unit Legend Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI BrB Burkhardt sandy loam, 1 to 6 4.9 8.5% ' percent slopes BrC2 Burkhardt sandy loam, 6 to 12 14.5 25.4% percent slopes, eroded - - -I BxD2 I- I Burkhardt-Sattrattre complex, 12 0.3 , 0.5% t30 percent es, eroded EmE Emmert loamy sand 12 to 35 1.3 2.4% percent slopes Fe Fluva uents 1.7 2.9% HrB Hubbard loamy sand, 0 to 6 12.6 22.0% percent slopes �-PmB - -- -- _ - - - - - Plainfield loamy sand, 2 to 6 --t-- --- -- - - 1.21 - --- 2.2% percent slopes PmD Plainfield loamy sand, 12 to 20 0.2 0.3% percent slopes Se - _-- - - - . _ --- -- Saprists and aquents - - - - --- - - 2.2 — . - - - --- 3.9% Sm 1 Seelyeville muck 11.9 20.8% W Water 6.3 Totals for Area of Interest 57.1 100.0% usDA Natural Resources Web Soil Survey 5/15/2023 Conservation Service National Cooperative Soil Survey Page 3 of 3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN . Page I of I. - FILE INFORMATION Owner Dan and Molly Kretovics Permit # DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) 300 gal/day Design flow (peak), (Estimated x 1.5) 450 gal/day Soil Application Rate n/a al/da /ft2 Standard influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) 510'a cfu/100ml Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTMANrF RP-14 I11 F Septic Tank Capacity 1 000 gal ❑ NA Septic Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer poly lock ❑ NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity gal 12 NA Pump Tank Manufacturer IR NA Pump Manufacturer 1I NA Pump Model 5? NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: Ek NA Dispersal Cell(s) ❑ In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) p eve At least once every: 3 ❑ month(s) hs) (Maximum 3 ears) [Iear(s) y ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ® year(s) ❑ NA Clean effluent filter At least once every: ❑ month(s) 0 year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ ❑ month(s) h(s) } Ij? NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) M NA Other: At least once every: 0 month(s) IR NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 7i of 7/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or=must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ffi T . �/ aluat a o mg�ank be ' e ai a ��Di-il'� T1i✓L� �D�2- J�l� �tilS77ZfI�'l D ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name COUNTRYSIDE PLUMBING Phone 715 246 2660 POWTS MAINTAINER Name PAUL R KOEHLER Phone 715 246 2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS SEPTIC Phone 715 246 5600 Name 15t. G ( 2W 1l j I Phone —% 1 S— 3 El — (p (� This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 4" CAST -A -SEAL w Qo w ry INLET - V) Ln 2 j' WLP1000— M R TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1 /2" 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1 /4" LENGTH: 8'-8" WIDTH: 7'-2" ii� _ `� ��yQ BELOW INLET: 42" '� LIQUID LEVEL: 36" I t WEIGHT: 6,790 LBS. �`--'� 7/ INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET FILTER OR ii� BAFFLE INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 -- (OTHER STATES SEE CHART) TOP VIEW LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) Lo ------ -- TANK: MIX DESIGN #10 (STRUCTURAL FIBER) _ _ _ _ - OUTLET I I r - cn I - n cD l � � ---J----------E-= J n PUMP PAD (TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE w cn Of o w a a w w 0 0 i� 3 0 0 0 0 } _o � m o o a z 3 a a U J � a W W L' U Ln p Coo vZ w oU) a N Lai I 0 = Coo WD 0 0 REVIEWED BY 0 r- REVIEW DATE J Q z Q U H d w V) SHEET NC. 1 � OF 1 ST. C RO �NTY SANITARY SYSTEM File #: l r�°°{zr.,r�� Office Use Only OWNERSHIP/ADDRESS FORM crevted2/2o21 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 Dan j And Molly M Kretovics Mailincl Address 1093 210th ave City/State/zip New Richmond Phone Number (required) n/a Email Address (required) N/A Parcel Identification Number 038-1086-70/000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location ne ,�4 ne 1/4 , Sec. 21 , T 31 N R 18 W, Town of star praire Subdivision Plat: , Lot # Certified Survey Map #_ Warranty Deed # Number of bedrooms 3 New Property Address (Staff Initials) Volum Page # (before 2006)Volume , Page # Spec house O yes ■ no Lot lines identifiable 0 yes ■ no OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) (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 made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number II Document Name THIS DEED, made between Scott R Coty, single ("Grantor," whether one or more), and Daniel J. Kretovics and Molly M. Kretovics, married to each other ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached Exhibit "A" a3s„3, r,43z,,,o 1034483 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 08/ 24/ 2016 9: 28 AM EXEMPT#: REC FEE: 30.00 TRANS FEE: 702.00 PAGES: 2 Recording Area Name and Return Address WOTconsin Title Services, LLC 533 S. Broadway Menomonie. WI 54751' 03 8-1086-70-000 Parcel Identification Number (PIN) This (S homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: None Dated N&G oS�_ 1 le T—' Ili (SEAL) (SEAL) Scott R Coty (SEAL AUTHENTICATION Signature(s) authenticated on NOTARY PUBLIC STTATE OF WISCONSIN TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. COUNTY ) Personally came before me on I fj IA:1y the above -named Scott R Coty, singre— to me known to be the erson(s) who executed the foregoing instrument a d 'cknowle ged the e--- Ul Burnet Title -Scott Tranby, 5151 Edina Industrial Blvd, Notary Public, State of Wisconsin 4500, Edina, MN 55439/ 16-12041 My Commission (is permanent) (expires: l 0 1 ) (Signatures maybe authenticated or acknowledged. Both are not necessary-.) NOTE: THIS IS A STANDARD FORMM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. St. Croix County 1034483 Page 1 of 2 LEGAL Part of the Northeast Quarter (NE '/4) of the Northeast Quarter (NE '/4) of Section Twenty-one (21) Township Thirty-one (31) North, Range Eighteen (18) West, Town of Star Prairie, St. Croix County, Wisconsin described as follows: Commencing at the Southeast corner of lands owned by John G. Nelson and Yvette M. Nelson, husband and wife, acquired by deed dated April 8, 1953 and recorded on April 16, 1953 in Volume 307, Page 376, which is point of beginning; thence directly North to a point 33 feet South of the North line of said Northeast Quarter (NE '/4) of the Northeast Quarter (NE '/4); thence directly East to the line of said Northeast Quarter (NE '/4) of the Northeast Quarter (NE '/4); thence South along the East line of said Northeast Quarter (NE '/4) of the Northeast Quarter (NE '/4) to the Northerly bank of Apple River; thence Westerly and Southerly along said bank of Apple River to a point directly East of the point of beginning; thence West to the point of beginning. St. Croix County 1034483 Page 2 of 2 Parcel 4r: USk$-1Ut$b-/U-UUU Alt. Parcel #: 21.31.18.357G vaiia as or u�/i�/zuzj ut5:4/ AM TOWN OF STAR PRAIRIE ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: DANIEL J & MOLLY M KRETOVICS 1093 210TH AVE NEW RICHMOND WI 54017 Districts: _Dist# Description__ _ 3962 SCH DIST�NEW RICHMOND T 1700_NORTHWOOD TECH Abbreviated Acres: 2.080 Description: SEC 21 T31N R18W PT NE NE COM INT N LN SEC 21 & E LN HWY CC, TH S 33 FT, E 550 FT TO POB: E 125 FT, S 155 FT MOL TO R... more... Co-Owner(s): Physical Property Address(es): * 1093 210TH AVE Parcel History: Date Doc # Vol/Page . Type 05/24/2016 1034483 .............................................................. / WD 05/03/1999 602391 1423/319 WD 07/23/1997 770/340 .........................._........................................... .......-..-..-......,................................... 07/23/1997 � 4............. ..................................... .............-.....................,..... ' 1177/244 r WD more... Plat Tract (s-T-R 401/4 1601/. GL) Block/Condo Bldg N/A -NOT AVAILABLE 21-31N-18W NE NE 2023 Valuations: Values Last Changed on 10/21/2019 Class and Description Acres _ Land Improvement _ Total G1-RESIDENTIAL 22.924 58,600.00 _ m mm 137,000.00 195,600 00 Totals for 2023 General Property Woodland Totals for 2022 General Prop e t Woodland 2.924,58,600.00 0.000 �0.00 2.9241 58,600.00 2023 Taxes Taxes have not yet been calculated. 137,000.001 195,600.00 137, 000.001 195, 600.00 Key * - Primary 1� r, Fepwy_c- Arr- CRo i x COUNTY No.�� STATE SANII.A.RY PERMIT ) 073 A) b — tlt vc- ,,D -'xP itAlvS Ei:./P.ENE`vVA;. PREVIOUS NO. 29 :�0 E/7-71) &ie; y- --> 4C i&&L N a Lt Y vl CS PLUMBER?A-q�-46RLPP, ® TOWN OF i AND/OR LOT CHAPTER 145.135 (2) WISCONSIN 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 is 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 a 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. AUTHORIZED ISSUING OFFICER -DATE THIS PERMIT EXPIRES 5A&12.p2. UNLESS RENEWED BEFORE THAT. SBD-06499 (R11/20) St. Croix County Planning and Zoning Detail Sanitary Information T ursday. Der Mhe 07, 2006 at 12:00. H PM Computer#: 038-10800 Sub/Plat:Page metes&bounds I ojI Parcel #: 21.31.18.357G.35TG L°1' Section: 21 Municipality: San PrairieTN/RNG: , Town of CSM: T31N R18W _ 1//1/4: NE1/4 NE 1/4 Owner: Bebee, James 10932100h Ave. New Richmond,W15401T -- '- ---- -_ Smte Permit: 12970 Isauad: 10/22/1979 POWTS Dispersal: Non-Pressunzed In -ground Permit: _ County Permit: 282 Installed: 11/08I19I9 POWrS Detail: Bed - Seepage New POWTS Pretreatment: NA Bedrooms: 3 WI Fund: Notes Imue'Ans.e.do As Bull Rumbar 9ther Reou'rem is Harold Barber Yes Sleel, Gary L. Add't'on I Note, Manev Owed Tam Nelson Signed Off. No Could not 9ntl "ownei nameanany deeds for this $0.00 other propetios in N, of Sec. 21. ubba soil re repotde,ddrphsohowointhi o1 map#11, with #1 Hubbard Wits shown in this viunity. Babes may have been e, Maintenance the builder for AspluM7 Scheduled Pu pate pumped in Notividan 2nd Notification 3rd Wifillh.n 10/22/2005 AS BUILT SANITARY SYSTEM REPORT i�XiER i E_S U� __ t�EbE�E. , TOWNSHIP ,"EC.o?/ TS' N, R_(g,A 0, ADVRES5 yy , ST. CROIX COUNTY, WISCONSIN. .Ali. . ".'BDIVISION LOT LOT SIZE - PLAN VIEW Distances S dimensions to meet requirements of H62.20 EPTIC TALK(S)_I MFGR. i ,M. C - CONCRETE_ TEEL NO. of rings on cover I Depth / Z" DRY WELL ANCEES NO. of width length area _ .) no. of lines -a- width= length 3K/ area (cdOd" aCa'-iEGATE ' epth to top of ipe ,��}.� W1 RATE AREA REQUIRED Cnl.4 p' AREA AS BUILT l ,jah' 4sclaimer: The inspection of this system by St. Croix County does not imply complete .wpliance with State Administrative Codes. There are other areas that it is not possible la inspect at this point of construction. St. Croix County assumes no liability for jStem operation. However, if failure is noted the County will make every effort to tter®dne cause of failure. l$1SES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. - INSPECTOR ' DATED PLUMBER ON JOB Cx LICENSE NU11BER Parcel #: 038-1086-70-000 12ion20W 1145 AM PAGE 1 OF 1 Alt. Parcel #: 21.31.18.357G 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co -Owner O - COTY, SCOTT R SCOTT R COTY 1093 210TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 1093 210TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2080, Plat: NA -NOT AVAILABLE SEC 21 T31 N R1 SW PT NE NE COM INT N LN Block/Condo Bldg: SEC 21 8 E LN HWY CC, TH S 33 FT, F,5.90- FT TO POE: FE_�S 155 FT MOL TO _ Tract(s): (Sac-Twn-Rng 40 114 160 1/4) RIVER, WLY ALG RIVER -TO -PT -OFF. 21-31N-18W N-POB 4361594 ALSO COM SE CDR LAND DESCRIBED IN VOL 307 P 376 TH N TO PT 33 nwr. Notes: Parcel History: Date Doc# Vol/Page Type / 5L l 05103/1999 602391 1423/319 WD 07/2311997 1177/244 WD 4M'Ir7✓aLt4-vi 0723/1997 7TU34a 07/23/1997 2006 SUMMARY Valuations: Description Class RESIDENTIAL G1 Bill #: Fair Market Value: 175374 229,0D0 Acres Land 2.080 88.100 fi2/232 ., 70 Assessed with: / - Ir gk7 Last Changed: (Last Changed: 10/14/2004&plr Improve Total State Reason JJ 114,300 202,400 NO Totals for 2006: General Property 2.080 88,100 114,300 202,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.080 88,100 114,300 202,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: o Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 000 0.00 0.00 REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM Sanitary Permit • ^ State Septic/ NAME �ru'-� cQ� Townahip�Ca-,, St. CAoix County Location /J -._ « /-�- Section_ ,2 SEPTIC TANK -- Size Ste, gattonz. Number o6CompaAtments � Distance From: Wett .Qt. 12% oA greater stop¢ 6t Building nrit. Wettands ( - _6t• Nighwater t} 15t. DISPOSAL SYSTEM Distance From: I E L9AIAf Width o6 tAench^ t% 6 6t. Length o6 each fine ,3o it. Numbero6 fines Totat length o6 finesTO 6t. Distance between fine".�t. Total absoAbtion area. 6t2 t. Buitding 6t. ffighwateA c 46t. .Required area PIT DIMENSIONS: Number 06 Outside d. Total abs Area AeofY G YYY INSPECTED BV APPROVED REJECTED 121 oA greater stops-- 6t. Wetlands Sd _f Ft. Depth o6 tack below titeLz,—in. Depth o6 rock over tile—L—�in. Depth o6 Life below grade Z Utin. Stope o6 trench in pert 100 6t. Depth to bedrock 6t. Depth to groundwater - 6t• J Type o6 CoveA: (!apex ox StAaw pits--yes—no below inlet 6t. TITLE DATE 797. DATE 197 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 MCA , ��Lc REPORT ON SOI L BORINGS AND PERCOLATION TESTS LOCATION: MCA, W'b. Section 31, T-Z/N, RL P(or) W, Township or1"Drths1h a*tY a Lot No. _. Bloch No. -- County ��• Owner's Name: _ Mailing Address: i TYPE OF OCCUPANCY: Residence 6/ No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW .ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOILBORINGS. 10—%—]!PERCOLATION TESTS Z10 SOIL MAP SHEET /( SOILTYPE A/A 14� A" PERCOLATION TESTS TEST DE➢R1 HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES CHARACTER OF SOIL THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN(IN 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 3 PERIOD 3 BUR P-f 3„ 5,cz— / /U 3 6 5 SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, I NCHES CHARACTER OF SOILWITH THICKNESS, INCHES IDEPTH TO BEDROCK IF OSSERVEDI OBSERVED JESTIMATED HIGHEST B 1 7—Z u 7 ZH s. B 77— h NL ' 7Z �• aI / 1 S . •I PLANVIEW (Locate permlationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. (c f5 a• Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 'N I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are Correct to the best of my knowledge and belief. , Name (prim) Name of installer if known CST Signature COPY A —LOCAL AUTHORITY State and County P L B V Permit Application for Private Domestic Sewage Systems 'DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan ID. # A. OWNER OF PROPERTY State Permit #t� County Permi County` e M>4m�s �h�bse, /Lr'2 �)02.� I�fn.y.rJc1 B. L ATION: JL[-_'G u E '/., Section / T N, fl EI (orl W Lot# _City Subdivision Name, nearest mad, lake or landmark Blk# Village Township i'iPy/4E_ C. TYPE OF OCCUPANCY: Commercial 'Industrial 'Other (specify) Variance Single family Duplex -----__No. of Bedrooms .3 No. of Persons_ D. SEPTIC TANK CAPACITY /)_Total gallons No. of tanks _L HOLDING TANK CAPACITY Total gallons No. of tanks Prefabconcrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement r� Lift Pump Tank or Siphon Chamber_Total gallons Prefab concrete_Poured-in-PIam Other Specify)— E. EFFLUENT DISPOSAL SYSTEM: Percolation Race t` t- Total Absorb Area b /d sq. ft. Nervy —Replacement L/ Alternate ISpecifyl Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenche Seepage Bed: L Length .f7 ' Width /a a Depth a I. ' —Tile depth Bopl m" No. of Lin Seepage Pit: Inside diameter. Liquid Depth No. of Seepage Pits Percent slope of land 0-? Distance from critical slope �- WATER SUPPLY: Private Joint ❑ Community Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, ' Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the CenAd Sail Tester, NAME lU Am ✓ I. S "- , l C.S.T. # ZZ S A and other information obtained from tit 6r br r- (owner/builderl. Plumber's Signatsure� MP/MPRSW# OJ Phone 4,2 Plumber's Address P_LL L^ �P /. / / Y .S PLAN VIEWProvide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors Property. If well has not been drilled please indicate. Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE NLY Date of Application Fees pPaid: State /J. o O ou y a . Q Da �O -.2 ` -71 Permit Issued/1 1 (date) /0-zi,2-Z% Issuing Agent Nam f s Inspection Yes�No _ State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 711178