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Home My WebLink About038-1054-70-100 (2)Q Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacv Law. s.15.04 It v,,,n Permit Holder's Name: ❑ City ❑ Village ❑ T6vvn of: Lewis, Steven Star Prairie Townshif CST BM Elev.; Insp. BM Elev.: BM Description: �D • o r b� ' (7 CST— ►^tip _ / oo . 0 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 1 2.(o O Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Airto Air Intake ROAD Septic >Sp' 3(, NA Dosi ng NA E101) NA PUMP / SIPHON INFORMATION Manu rer nd Model Number GPM TDH I Lift Fri stem TDH Ft Forc In Length Dia. Dist. To wel ELEVATION DATA County: St. Croix Sanitary Permit No.: 363960 State Plan ID No.: T� Parcel Tax No.: o;$ _ 10sq— 13.3(. 10. Z33g u -1+ STATION BS HI FS ELEV. Beni rl 0• 1 11 o f I LTO - 0� -3 I b�•B�r Bldg. Sewer 04 I vo o r 4t Ht Inlet I0 •,+L q 3' St/ Ht Outlet 0-scl �Ct.a Dt Inlet Dt Bottom Header/Man. 2 93r Dist. Pipe Bot. System a J SOIL ABSORPTION SYSTEM (ITN BED / TkNd Width Length f No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 2. • S`D 3 DIMENSIONS SETBACK SYSTEM TO —Type P/L BLDG WELL LAKE/STREAM�AM Manufa tur r: �,_S��c INFORMATION of System: � r >0 i M del Number: , _ acr DISTRIBUTION SYSTEM Header/Manifold tf : 2 Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake e 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 eeded/Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil T�lYes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: 1 k / e2/"e ns ection #2: �--r--T-� Location: , (NW 1/4 NW 1/4 13 31N R18W) - -Lot 2 i 1.) Alt BM Description = S 5 2.) Bldg sewer length = •''4 •o -amount of cover = } �-.o casvcr 3) o� ?rPAI " ,w Plan revision required? ❑ Yes t( No Use other side for additional information.112- IZOI ( S 2 SBD-6710 (R.3/97) Date Inspector's Signature Cert No -1) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e qp s e r e I a n_ s _.___ - 3 . � .� _ a f e s $ 2/ g i C-Tff" - C- Sanitary Permit Application Safety & Buildings Division In accord with Comm 43.21, Wis. Adm. Code 201 W. Washington Ave. 14sconsin See reverse side for instructions for completing this application PO Box 7302 [department of Commerce Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 [Privacy Law, s. 15 Submit completed form to county ( P ty if not state owned. Attach complete plans to the county copy onl t I ss than 8-1/2 x 11 inches in size. County State Sanitary Permit Number if revision previ us on State Plan I. D. Number 3`tgo I. Application Information - Please Print all Informatio - Location: Property Owner Name Jilt Property Location N i ft i 1/4 1/4, S ,N, PIXE or Property Owner's Mailing AddressNry t Number Block N ber ZON NGOF c City, tate Zip Code a Number , Subdivision Name or CSM Number 8 I II. Type of Building: (check one) ❑ City )�9 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village ❑ Public/Commercial (describe use):_ A T own of ❑ State -Owned j Nearest oad ' 3')( ! 3• S 30 C".J S Parcel Tax Number(s) III. Type of Permit: Check only one box on line A. Check box on line B if a licab A) 1. A New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A SanitaryPermit was previouslyissued IV. Type of POWT System: (Check all that apply) Non -pressurized In -ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland essurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line POA - de ❑ Aerobic Treatment Unit ❑ Recirculatin ❑ Other: is ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6, System Elevation 7. Final Grade Required Proposed Rate (GalsJday/sq. ft.) (Min./inc Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks f� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the updersigned, assume responsibility for installat' n of the POWTS shown on the attached plans. Plumber' am rint)l Plumber' ign (nos s): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State Zip Code) IX. County/Department Use Only ❑'Disapproved Sanitary Pe Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Su arge Fee) Determination X. Conditions of Approval /Reasons for Disapproval: � T�i�ovo�sro V.-consin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings . Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code 1 County Attach complete site plan on paper not less than 8 1/2 x 11 inches i �t / include, but not limited to: vertical and horizontal reference point M), dtrection anSL percent slope, scale or dimensions, north arrow, and location ar.,d dis)ance to nigwe road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. R 01vii wed by Date Personal information you provide may be used for secondary purposes Privacy Law, s. 15.04�1) (m)) (j ? 6 -n,' Property Ow er Property Location Gout: 1/4 1/4,S T N,R E (or&f Property Owner's Mailing Address Lot # Subd. Name or CSM# City State Zip Code Phone Number city ❑ vill e 0 Town Nearest Road Gi C I -.ZY417 I ( 5�.3�c' %'>t:'%ti /�= I L47,1 t 1 ()_� New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow Z6(9 gpd Recommended design loading rate .7 bed, gpd/ft2_trench, gpd/ft2 Absorption area required bed, ft2 ysG trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 9 trench, gpd/ft2 Recommended infiltration surface elevation(s)/G -%� / ft (as referred to site plan benchmark) Additional design/site cons)d�erations / - - Parent material�irC.�6,�/.r4 s./ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U � S ❑ U ®S ❑ U Z S ❑ U ❑ S 1I U ❑ S (1 U Boring # Ground elev. =ft. Depth to limiting factor in. Boring # Ground elev. gu ft. C Depth to limiting factor SOIL DESCRIPTION REPORT Dominant Color Mottles Structure Remarks: '/min. Remarks: 'ST Name (Plea nt) Signature j Telephone No. z ZZ 4ddress Date CST Number �� C s-� _ _ 1� PROPERTY OWNER PARCEL I.D.# SOIL DESCRIPTION REPORT , /D , t - -.,) a Page of Boring # Ground elev. /lkLft. Depth to limiting factor >ii d in. Boring # Eli Ground elev. /4L cc ft. Depth to limiting factor Boring # Ground elev. Y24ft. Depth to limiting f I F Dominant Color Munsell Mottles Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed Trench .c r actor ?jj,', in. Remarks: Boring # Ground elev. Depth to limiting factor 7 ,//D in. Remarks: SBD-8330 (R.9/98) • _, J w a87- e A19 Certified, Survey Map Steven Lewis Part of the Northwest 114 of the Northwest 114 of Section 13, Township 31 North, Range 16 West, Town of Star Prairie, St. Croix County, Wisconsin, being Lot 1 of that certified survey map recorded in Vol. 2, Page 465 of St. Croix County Certified Survey Maps' NW CORNER OF SEC. 13, T 31 N. R 18 W (BERNTSEN CAP FOUND) y { LOT 1 { 42' Owner's Address: 2189 C. T H. "C" New Richmond, WI 54017 PRAIRIE RICH LOT2 S 89" 07' 38" E 567 95' R0.701' 122.25162.95' i 405.00' D qr 6 M OUTLOT 1 S 00' 00' 23"E 65.6,V 127.25' T. r2599' 1 a N LOT a I ° Cli 9 14 ' s tij N 4 Y �• ; j� ��% M 39.94 g.00' I r •.. w Id $ �.0 o� 39.51' 32.59' 5pr pz ?, E N 90. 00' 00" E 72.10 ?85 26 2 U{� I LOT ;3 xj N 1 � y W W N N O 1 Y N � � ' UQ DWF.LLINC? W J � O GA+RAGF. ; o b DRIVEWAY 100, s 349.47530.25' — � ' 60, ^7. 7 ' ! 11.7 ' i 42' j N 69' 07' 51" W 567.95' UNPLATTED LANDS a � w �,w 114 CORNER SEC. 13, T 31 N, R 18 W, (BERNTSEN CAP FOUND) LOT3 LOT 210 48' N Certified Survey Map Steven Lewis Bart ofthe M'orfhwesf 1.14 of (lie Northwest 114 of Section 13; Township 31 Norfh, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, being Lot 1 of that certified survey map recorded in Vol. 2, Page 465 of St. Croix County CertMed Survey it? W Legend: • indicates 1 " x 24" iron pipe weighing 1.13 lbs.110. ft. set, 0 Indicates 1 " iron pipe found. ,S indicates snit boring for proposed septic site O Indicates exiting well. Qlndicates existing septic drainfield. Lot Areas: Outlot 1 - 0.177 acres or 7,695 sq. ft. - 0.146 acres exc: public road R. O. W. or 6,339 sq; ft. Lot 1 - 1.938 acres or 84,425 sq. ft. - 1.862 acres exc. public road R. O. W. or 81,117 sq. ft. Lot 2 - 1.844 acres or 80,337 sq. ft. - 1. 784 acres exc. public road R. O. W. or 77,716 sq. f6 Lot 3 - 2.040 acres or 88,658 sq, ft. - 1. 793 acres exc. public road R. O. W. or 78,108 sq. ft. Description: That certain parcel of land located in the Northwest 114 of the Northwest 114 of Section 13, Township 31 North, Range 18 West, Town of Star Prairie, St, Croix County, Wisconsin, being Lot 1 of that certified survey map recorded in Vol. 2, Page 465 of St. Croix County Certified Survey Maps, more fully described as follows: Commencing at the West fA- corner of said Section 13, thence N 00`00'00"E (assumed bearing on the West line of the Northwest 114 of said Section 13) a distance of 1627. 66' to the Southwest corner of tot 1 of that certified survey map recorded in Vot. 4 . Page 465 of St, Croix County Certified Survey Maps and the POINT OF BEGINNING, of the parcel to be herein described, thence continue N 00tl00'00"E460.16' on said line; thence S 89007"38"E 567.95" thence S 0*0'00"E 460.14'; thence N 89"07'51 "W 567. 95' to the POINT OF BEGINNING, containing 5.999 acres or 261,316 sq. ft. being subject to easement over Westerly portions of said parcel for C. T. H. "C" R. O. W. purposes as shown on this map and also being subject to easements of record. Note: Each parcel shown on this map is subject to State County and Township laws, rules and regulations (i. el., wetlands, minimum lot sue, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice. This instrument drafted by Laurence W. Murphy Dated: April 13, 2000 State of Wisconsin) County of Pierre) 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Steven Lewis, have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are- a true and -correct representation thereof. zo.-IS."90 7�01AVA%404' 46, ST CROIX COUNTY SEPTIC'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I Owner/Buyer f Mailing Address Property Address (Verification required from Planning Department for new construction) City/State met, '1/GL!->rseV) („�Z' Parcel Identification Number LFGAI, DESCRIPTION Property Location _ '/4, _ '/4, Sec. T.Z/ N-R,j.S� W, Town of /x Subdivision Lot # -,-;'— Certified Survey Map # Volume , Page # Warranty Deed # Spec house C7 yes K no Volume , Page # Lot lines identifiable -2 yes ❑ no , -1-/-ell 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition an&or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 b maim rood must be completed and returned to the St. Croix County Zoning Office within 30 dayj of the three r expiration te. T� � /3 , SIGNATURE OF APPLICANT F DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are tnte to the best of my (our) knowledge. I (we) am (are) the owner(s) of th perty des t ed above, by virtu aLairt deed recorded Register of Deeds Office. oSIGNATURE OF 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 DOCUMENT NO, WARRANTY DEED THIS S R6!(RVr.O ►olt RCCoSD,NO 0.14 STATE BAR OF WlscONSIY FORM 2-1961 482800 ---==-YO'- = y$P��E� REGISTER'S OFFICE Charles L... Zahnow and Corinne F. Zahnow, STCMCo.,VA husband--And.._wi.fe ♦ toed kwRomd MAY 011992 . _. ....... __.. conveys and warrants to . ....Stevens C ., _L.e10:20 A. MM.i e .. . _....................................... . . . .......... Rpisar of Dn& AMNJI44 To the following; described real estate in . - ....5�. • Croix State of Wisconsin: ��U°ty' Tax Parcel No: . Part of the NW4 of NWa of Section 13, Township 31 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed September 26, 1977 in Voi. 11211, Page 465, Doc. No. 343407. fRANS EI S--M- d EA T! is is not homc:tead pro pert.— pert:. 0_;1 0,; not) Exception a- warrantieseasements, restrictions and rights -of -way of record, if any. day listed thi- ! April 92 Charles L. Zahnow 1`A1.. . Corinne F. Zahnow AUTHENTICATION Signature(s) Charles L. Zahnow, Corinne F. Zahnow ---------- _.. t authenticated this day Aprl1 92 Kristina Ogland TITLE: mEJIBER STATE BAR OF WISCONSIN (If not, . authorized by 706,0F1, Wis. Kristina Ogland AtLornev at r.Aw ACKNOWLEDGMENT STATE OF R'ISVONSIN ' Per=,mal!y c:ur.e beC• n• me tf:l: day w la the ahuce nar,+i to nee n to he t%a• P.,-.,❑ i,,;, � eSPe.ltt'd tl;e .�m,e,.in� ;n;tr•ni•.r�t .� ,.3 .�•�m «�L.•Ice t'e .:u,,,, �00 �� 00 • 14 %O Certified Survey Map Steven Lewis Part of the Northwest 114 of the Northwest 114 of Section 13, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, being Lot 1 of that certified survey map recorded in Vol. 2, Page 465 of St. Croix County Certified Survey Maps` Owner's Address: Dated: April 13, 2000 NW CORNER OF SEC. 13, T 31 N, R 18 W -^ 2189 C.T.H. "C" "Revised this 29th day tsERNTSEN 4LUN. C4PFD./ o New Richmond, WI 54017 of June, 2000 . " o � cma Z CL W � a �., ;AT wa0.�70' o N 41.6 M in h v N 60') M y I in 39.94 O 4C �I N co O l O 0 S PRAIRIE RICH LOT LOT2 S 89' 07' 38" E 567, 95' 122' 25162.95 1 .ram 405.00' OUTL OT 1 S 00' 00' 23" E 65.6Y 527.25' 12599' I 1 N26"� 3�1W LOT1 00, 16j60, l wQ g$ I Op � N 1 Z IC Cti I'd I J N 2 N N g 1 DWELLING W _ 1 ti I GARAGE o 2 1 > U DRIVEWAY �y� 100' �' 349.47' S30.25' 60' I �... r 17.1/ 42. N69'07'51"W 567.95' UNPLATTED LANDS N ►4 W 114 CORNER SEC. 13, T 31 N, R 18 W, ?� fBERNrSEN 4LUN. CAP FDJ L O T 3 tQ7�. � Q / E i Q ° zs- LOT 2 218.48' S N AVOSCMOI"ft�aw ail LI L