HomeMy WebLinkAbout038-1242-16-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide maybe used for secondary purposes [Privacy Low. s.15.04 (1)(m))
Permit Holder's Name: City Village Township
Franklins Carpentry, LLC I TOWN OF STAR PRAIRIE
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
<,5�,�-
�2.5•(7
S
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
i
install�l
Z}
2� i
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Ft I
CountySt. Croix
Sanitary Permit No:
648411
State Plan ID No:
Parcel Tax No:
038-1242-1$-000
Section/Town/Range/Map No.
31.31.18.1331
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg. Sewer
•U5
C1 $
St/Ht Inlet
JC
q2 I
St/Ht Outlet
DtInlet
Dl Bottom
HeaderlMan.
c,
Dist Pipe
Bot. System I TZ
).
7 5"1 SS
Final Grade
2•b
9 4I .7J
St Coverq51
Alp C.V./
�•D�
51gS
p• $
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIIi1E NS No. Of Pits side Dia. Li uid Depth
DIMENSIONS V Z
SETBACK SYSTEM TO PA_ BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR
Type Of System: �oF �S�q I� h UNIT Model Number: �
� F�oJ
Co'iILni wla
DISTRIBUTION SYSTEM
Header/Manifold Dislribu x Hole Size x Hole Spacing Vent to Air Intake
II Pipe(
Length Dia Lang Spacing
L+nu f+nvco __ ^-I., -w RM—na fir At-fZ- . Svatams Oniv
Depth Over - —
Depth Over -+- - - -
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed[Trench Center I ull�
Bedfrrench Edges
Topsoil
L� Yes L] No
Yes Q No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: I I2o2� Inspection #2:
Location: 1$31 90T1i ST
U- 4, -, f�/ � oY
1.) Alt BM Description = S� ,� IS" �h. 5wl ril1>< d xr;J� 13D'
2.) Bldg sewer length = 33 5 Fir
-amount of cover = � 21 4-
Plan revision Required? *Yes *No / I ��/Z Z34
Use other side for additional information. l�/l S(B Iq
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
tr>dListry Services Division
# r=
F ., 1 7 . 43
1400 E WaW*Sbon Ave
P.O. Box 71e2
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isPrim 10 abta.i■a a aaaaao-
ay Pcrant Nalm AppkW= IC[Ns for suosaed POiW7S am airdued b
Depat�rat of F and Peafes�aarl Settrioes Pa9oo.11•io�artim 3'att P� my be awed far acmda=
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Address (tf dffW= d= aaait@ aNMB)
a7 aOLonhum t;ifllt tire Pma
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WI 1 a 2 Faaa7y DwtftE - Nu■bcrof Be&ooaas
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❑ Pubis- Destsbe Use Brock r
t/,C Qt�
❑ State Owned - Desaibe Use
❑ City of
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❑ Yti W of
[a Tomm of
)II. T of Pera ft C'kaek box as Nue A. use B id
A.
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❑ R*W—M t S)sk=
❑ TteaaareaalHoid'-- Tank Replaaeaeat Ody
❑ Other Nb&fkM= to Exi Ws S)U= (c*mn)
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❑ Pgait Rerisim
of
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test Pmioas Paoit Ntrabtr ad Date h d
IV.
Type of POWYS
vice: check all that )
❑ Ptessatmed ht-C ,v ❑ At-C,ta ❑ mwod> 24 it. or=kdAe soiI ❑ Mound < 24 in. ofstun k =1
® NQD4%eIsariaeN&Odwrl (expo) ❑ PretrrmmtDeriQtaWfe
a)
r
V.
Arm Isrr.adose orb 0
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Desist Froar (
boo
.�
� Sod 0 Appbcobm Dkpetsal Area "gored (in Dbpmd Mew Papposed M e /
� 7
VL Tank ILfe
Capacity 6n
Gallows
_
Tte�K TMIa Taal # of Maaufadaer u U
Ems-f=Im Galia�s `+
Sep&orfidft
Dosft Cimbw C
-
YII. Staaaaaeat- I. tape wed, assaae rspaaa Ar ba" odee afar POW" sMtra as I& attached phumIn
,s
Qt-
Nervier
) Pane Kaober
=
7
7/s 76"
Phanber's Addeeas (Shirt, City. star. Tip Code)
vlll. C
Vp
APpnWW
❑ Di, prv.ed Plesmit Fee Date Issued
53
for Deaiai $ J z
tx. Conditions
SYSTEM OWNER:
1. Septic tank, effluent filter and dispersal cell
must be
Serviced/ maintained as per�-
management plan prow-1— aaiswi.aft—cambr tes ; v= t.
zbIe
2. All setback requirements must be maintained
as per applicable code / ordinances.
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1- qD
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Y
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name
Owner's Address: 91 ), 17a /4
Legal Description: _ N'b f / — 5 3 1 — T 31 -- %Z / g WE
Township:
l
S County:
Subdivision Name: f
Lot Number �(O
Parcel ID Number: 0�3 gj --1 a y -1 b - o�
Page 1 Index and title
Page 2 Plot Plan
Page 3
Page 4
Page 5
Page 6
Page 7
Page 8
Page 9
System Sizing & Cross -Section
Filter Specs
Maintenance lniormation
Management Plan �n
St Croix Cty S nce orm S
Warranty Deed
CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber 6&E 7 K �� License Number. ,��0 3S7
Date: ,R - f y- a(>,t3 Phone Number 715- 7 & 0 - `1
Signature
Designed pursuant to the In 4und Soil Absorpti Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page 1
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Ri.IE: iNfDEMATWM
P)WPS OWM3rS MANUAL & MANAGEMENT PLAN . POSI• 1 .1 -Z
inspects m of tanks end dispersai Mk shall be made by an uxgvidetai
Master Munbw � � Ph mdw Reeuieted 5ewar- P�1IV P5 �r�= ore of the foiorMitQ icsraoea a oer m
it OW*Drrs treat indrrde a vfaeai hrmp�: POWTS Me'e�irm' Sapdpe Serviairp Operafar. rank
measure the votenrre of of the taNW to jderrtify any rniasirrg a brdoen hardsraie, kwrwy any Cracks or heats,
The mad ca�il(s! s rah be arrd sotwn e& to d1w* for any bad* up or P,rB p f meant on the Pnu:d eta face
of af`t7uertt on the hart rd anrt j�}gym PDndhg in at @MM, an 00d �e aflkterri IeweFs In the observation P ee clot m dwak for eery po�9
Unmadiars nodf� of the kCd ♦ CUr d waca rn" lea g a tamp caralirfan end requires the
When the combined ;ecm of and scum in any tank egetais a&-thiref (Y,! or mots of the tank vaktrns, the end
coat M of the tank shell wr be Sept"* by a Septe Serviobg opers2pr end Wisconsin Admintsbz&q Cods disposed of in accnr> ww& with QhIVbw MR 113,
Au oiler aervb W kKkKft bee not 6rrdted to the
usi'cr. and ally aervi3bg ec *asrvois of st 2 mottle, � of effkmM meohd pO or ptaarttiaed oamporterrts,
a a ortf8ed POWi51Ai+bYtar.
A servim report shall be provided to the kxud regulatory authority within 10 days of con plemcn Of wTy service event.
wou" =Nkb0 "araartr pdsr ae ra.
`�frabar dart o ahW not saw v^m Mg aawdkfiwa arw fraaa - at Isebdubsenawlaoe.
DurjM poaar 411"Ou PLWP>Dt MW w aiaw wwwrid Olskuprr1r IrsdL WbM PVww b raarirad Ire arrows rwaaearwW wi be
a 1101M . Ta 1*n 11108" w w Ira �~ �ri� I'a 9Md wd aW rawk Iw dw rNorp Q a ffbag ardwW of
Poway m Ise .a.ra oaadwr w of P wua tart rawrstrad ti . BaP�lapa Swtriaiq aawator psrior 16 wsforiq
MMM =w d iw ab w" In p� ! Pb'"�'r ar s waainr a awl t b OMOdly amp on ronP mamas m
Tad oat ddm w Pant volddu owr tarsiw ad dbparaal calk. Oo WAR drive or park owr. at odtarwbe disturb or corapiat, tlsa area
wild I S feat dawn dqw of my wnoiad aratIpada sdi . , girl MOIL
Aeduotidrs sr a- , -M u I# tits idowirq *a= Mee the parfan■rwca and psr♦� She fiFa of the
ft=kPOWd aadbid/eq p PO w"4 w bwfdq 41! `mow swOi dopaaows: dead Seek dWWM &*An w ft fat;
fotardallaw drda 1■■■4 Phi sr,stat: tank• awd w�; wwdhRC W aum hwbiddW Mart MGM �R on;
Pa p"W iewdtr� Paadcidar: aw *mr wgdAw m ` s I a - 6rfrrs.
Whm the PPOWTS taft =dkr b 9MMOMMIF ig.4` tiro
PmPulY arsd aafdtr ab@UAbXUd In a w�oarr.Iw .h.Il h. m. m irwiaa rat the n is
• � Pf�O � tanks wed pits afia/ M :'": � • "' `
qMlhM abawdoad P%W aPWAW sealed.
The -I of of teens db .
* atsd Mp a1i d aad MWwl r &woad of bE a So~ S� A*W op..,.
• After PMOPM& al riffs awd PIs ebW Ma%ii4nd and remover! of ON* cwss removed and the void space fife& with
sok firwr or anodsar bMlt sold ns■1aeltL
CONTOdQEII V PLAIT
ffcuwwt be raPahad tfse fdbw%@ aaww■ws have beentaken. , or-num be ken. to provMG a Coda oompfrarrt
IA A su taW rePlaceraera as�a has bean 4VdM ed and MW be ut&W for the bcatiort of a rapinsOerttarrt san ebeorpfion Wst=L TbO am aho M h• olwabd hoot dbwdm oa and cornpaa#ion and abould an be b*kt ed upon by
rquired awdmdn fium a.datlrq wnd pppwad sutstihze. bt fines atd ors. FaM&" to prvlact the rapids a N P area w8t MR* in Ise and for a MW 80 sd aloe wVMk Lion to esbkfsh a adteble. Mftwm@ft area. RapISM.swa syaaents moist
�M w & the nan it of hM at Irat rive.
O A wrkabis nowt area it nxR avaftb due to - whark ardim son &nftadwss, BwFbtp UNIM M b POWTS
I*Chnokav a ltoldh tank wwar be irtaI - ae a lrt nedrt M wptwce the failed POWT&
Wl*
e4wt Iowa
E3 11
b � abwrpdarr VV*W ss Heal► pa in P� �avWig mrowal of the Monet at me
Of uxh systarns MM comply vfih Its ndw it a#feot at that tine.
c c WARNTI�IIi> >
SEPTIC. PtMW AND OTHM TIM9ATMOff TAM MAY COYTAw LETHAL GASSES A MDMR NISlfFFK�T OXYGuL Do NOT
DAM A SEl M. PUNT OR OTM TIEA,TNMT TANK I MY C TANCFA. DEATH MAY R86llf_T_ T OF A
PIM6M Pilx W TIE WTMR OF A TANK MAY a DNfICMT Og fI E,
A" IIiiONAL OOMMf e
POWTS MOTAUER W� --
475�/1 n p
71,5- 74&o - n 9,1(
S-r C RO NTY SANITARY SYSTEM File #:
Office Use Only
-=- OWNERSHIP/ADDRESS FORM cr awv2o2i
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
Mailing Address 91 vZ 17afIUL-Z-
City/State/Zip RAV-
Phone Number (required)
Email Address (required) c)/d k "0t1 w 070
Parcel Identification Number 0003
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location N 4 L, SE'/. , Sec. 3) , T _:�JN R)I�W, Town of
Subdivision Plat: , Lot # w.
Certified Surrey Map # ~` , Volume , Page #
Warranty Deed # 1 / & (before 2006)Volume , Page #
Number of bedrooms 3LY-_ Spec house 0tyes 0 no Lot lines identifiable yes 0 no
New Property Address
(StaA Initials)
O F E USE ONLY
90 5 T
(Verificati ofTnaddress required from Community Devetopn,At Department fdr new construction.)
2gz 1
(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
71 S-386-4680 St. Croix Countv Government Center 715-7a5-a?5n Fav
P,�-
State Bar of Wisconsin Fonn 1-2003
WARRANTY DEED
Document Number D4wument 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 "Gran(ee," 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 Ana
dame and Return Address
Exception to warranties: easements, restrictions and covenants of record: highway and S[. C'r, " County Abstract & Title Co., Inc.
street rights of way: and Municipal and zoning ordinances and agreements entered 575 N. Knowles Ave.. Suite ssB
under them, and further except real estate taxes accruing in the year of this conveyance. New Richmond. WI 54017
Dated a r4kr j ()j ^ 3
Oevering Homes Inve t " consin limited liahilitA compatn
(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 DRAI"I'ED BY:nf
St. Croix County Abstract & Title Co., Inc. y Andrea S.
Carpenter at the direction of the Grantor. 23-S35540
038-1242.16-000
Parcel Identification `umber tPIN)
This IS NOT homestead property.
y' ot4
ACK'VOW1,EDGMENT
SI ATE OF WISCONSIN )
ss.
St. Croix COUNTY )
Personally came before me on the = l Q 2 Q
the above -named Oranzo J. Oevering, member of Oeverin
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: � 2
(Signatures may be authenticated or acknowledged. Both are not accessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
Type name below signatures.
St. Croix County 1163886 Page 1 of 1 4 3
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vfwat coyvrw=$OIL EVALUATION REPORT
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sanroAm
Sail Test Plat Plan
Protect Name 0avering Homes lnvos*m to Shao
Address 1433 Cenlohm Ave Suite A
Now Richmond Wi 54017
CEW #226900
Lot 1 �. _ Subdhrlsion Be" Vd to Date 12/22/21
N 1/3 SE 1/42 31 T 31 N/R18 VV township Bear ftift
-
0 ]Boriat 0 Well PL Property Line
County ST. CROIX
JIM or Vltp AeSuM Elevation 100 fL Top of survey iron
System Elevation TBD *HRP a as Smnchmark - - -
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PISIS$# prit7f all Information. Reviewed by
P�rsonsl �nfam»uon You provior m�5. b� u�ap Ia Ma+nds7 P�+n>! (Privsry tsr<, e. 1:.W {17 {m77. J Date
ProPe�ty Ow'1er J
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14", Constructlai Use. esidentiai 1 Number of be,11
❑
❑ Repdoopment Cade derived desiflr, licw rate -) U Grob Public commercial - Describe:
Pal matarw
Gertaral .tts F'OW Piai, elevation If applicable h/ J :y
Aid recv+xrMrtdatiort:
System Type A If
Svstarr. Flw ft i— 1 I 1
aamno
Pit Ground surface alay. 7 R
N ❑ aftv ----
Pit Ground surface eiev. F?i D fi
Ellkunt gm ■ stars , '%R _ .
Depth to Brrdti factor / / ) In
Depth to III web c factor
- wv, _ w rr WL and f SS c 30 ri
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ProPWtY Owner _ Parcel ID b
Page
song ,V 0 ern y
{�h Pit Ground surface elev.. ' ft, Depth to limiting factor _ 1y in.
Horizon Depth Dominant Color Redox Description Texture Structure MConsistericeBoundaryRoots
in. Munsep Ou_ Sz. Cont. CoW Gr. Sz, Sh.
G - zw
r�10
❑ Boring #
❑ Boring
❑ Pit
Horizon Depth
Dominant i
in.
Munsell
Of
boa Application {late
GPDMf
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i
Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
:olor Redox Description Texture SLSz.
re Consistence Boundary Roots GPD/ff
Qu. Sz, Cont. Color GSh. •Eff#1 1 Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev, ft. Depth to limiting factor in.
Horizon '1e tfi p Soil lication Rate
P Dominant Color Redox Desch bon. Texture Structure Consistence BoundaryRoots GPD/ff
n. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 r BODE > 30 < 220 mg& and TSS >30 1150 mpt • Effluent #2 = BODs E 30 ngll_ and TSS < 30 moll.
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Soil Test Plot Plan
Project Name Oevering Homes Investments
Shau
Address 1433 C
ernohous Ave Suite A
New Richmond Wi 54017
Lot
16
Subdivision
Bella Vista
N
1/2 SE
1/4S 31 T 31
N/R18
W
Boring 0 Well PL Property Line
BM or VRP Assume Elevation 100 ft
System Elevation TBD
CM #226900
Date 12/22/21
Township Star Prairie
County ST. CROIX
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