HomeMy WebLinkAbout040-1105-40-125 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitar Permit No:
157
GENERAL INFORMATION (ATTACH TO PERMIT) 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 X Township Parcel Tax No:
Carstedt, Evan & Brenda Troy, Town of 040 - 1105 -40 -125
CST BM Elev: Insp. BM Elev: BM Descripti n: Section/Town /Range /Map No:
160 dg i S " 27.28.19.4191310
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
1.75 ioi. 7, 0 5 /ab
Dosing Alt. BM
Aeration Bldg. §ewer
3.73 1 99 • aZ
Holding St/Ht Inlet
C.. I. Z..73.55
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
? So 54 — 13.0
Dosing 5�l C� / Header /Man.
Aeration J Dist. Pipe
Holding Bot. S stem �. ac-
PUMP /SIPHON INFORMATION
Final Grade
Manufacturer GPMand over ,, 7
a� J
Model Number �.
TDH Lift Friction Loss Sysf6m Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of T nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
s
SETBACK SYSTEM TO P/L BLDG [WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type yttem: UNIT Model Number:
50
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
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 xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil E Yes E] No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 163 S. Glover Rd. River Falls, WI 54022 (SE 1/4 NE 1/4 27 T28N R1 9W) NA Lot 1 Parcel No: 27.28.19.419610
1.) Alt BM Description = �� /
2.) Bldg sewer length = J� � _ 1� A C ON ��
- amount of cover = �'� r 7 / /� �
3.) Contour = �- �� C�OJU.- Plan revision Required? � Yes �No
E Use other side for additional information.
SBD -6710 (R.3/97) Date Insepcto Signature Cert . No.
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 157
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal inforrAtion you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Carstedt, Evan & Brenda I Troy, Town of 040- 1105 -40 -125
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
27.28.19.419B10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Tength Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
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 xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil 1:1 Yes [] No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / _
Location: 163 S. Glover Rd. River Falls, WI 54022 (SE 1/4 NE 1/4 27 T28N R1 9W) NA Lot 1 Parcel No: 27.28.19.419810
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
3.) Contour
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No
r yr�
t
AY 4 � County Smfflaiy rft Application ST. CROIX COUNTY WISCONSIN
n accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT
VUV
Ty r nal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER
OAF [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road
Hudson, WI 54016-7710
(715)386 -4680 Fax 715)386 -4686
Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size.
County Sanitary Permit # ❑ Check if revision to previous application
0/57
I. Application Information - Please Print all Information Loc t'
Property Owner Name r-5 AV 1/4 1/4, Sec 2 7
e ALA 28 N, R E (or
Property Owner's Mailing Address Lot Number Block Number
1, 3 S ay,( lo -vex— 44
City, State Zip Code Phone Numer Subdivision Name or CSM Number
9►de14 - L� // Q J/27- o -5'10C 6 0 - 200 7
11 Type of Building: (check one) Mity ❑ Village Town of Tk
$ 1 or 2 Family Dwelling - No. of Bedrooms:
❑ Public /Commercial (describe use): , Or+
❑ State -owned K est Road
II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) vC� J G
ax Number(s)
) 1.❑ Repair 2. W Reconnection []Non- plumbing 4. ❑Rejuvenation I
A DD�1 * L Sanitation � -����
fficu wt P ermit Number D Date Issued _
B)
State Sanitary Permit was previously issued `/
IV. Type of POWT System: (Check all that apply)
El Non-pressurized In- ground ❑ Mound z 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A +0
❑ Sand Filter 13 Constructed Wetland ❑ Peat Filter ❑ Drip Line
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other
El At-grade El Aerobic Treatment Unit ❑ Recirculating
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation
VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic
New Existing Gallons Tanks Concrete structed glass
Tanks Tanks
❑ ❑ ❑ ❑ El
❑ ❑ ❑ ❑ E3
VII. Responsibility Statement
I, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A
license is not required for terralift repair or the installation of non - plumbing sanitation system.
Plumber's Name (print) Plum ign 21X tamps): MP /MPRS No. Business Phone Number
«'t0U
G
rCon 'Adss (Street, City, State, p Code)
Only Alf
ell
Sanitary Permit Fee D e Issued Issuing ent Sign ure
d Owner a Mal Adverse it Zz S IS�zS �l
ination
f Approval /Reasons for Disapproval:
STEM OWNER :
Sepfjo tank, effluent lift and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2.1 All setback t'egtgrements must be maintained
as per applicable code / ordinances.
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S �6G &ti ADDITIONAL SEWER LINE CONNECTION
FOR A EXISTING THREE BEDROOM RESIDENCE
REMODEL WITH NO ADDITIONAL BEDROOMS
Owner's Name Evan & Brenda Carlstadt
163 South Glover Road
River Falls, WI 54022
Located in the NE '/4 of the SE ' /4 of Section 27, T 28 N, R 19 W.
TOWNSHIP OF TROY
ST CROIX COUNTY WI
Lot 1 CSM 22 -5406 040 -2007
Parcel # 040 - 1105 -40 -125
Previous Permit # Permit not on file at County
INDEX
Page 1 Index & Title
Page 2 Plot Plan
Page 3 Management and Contingency Plan
Prepared By Michael Rodewald
285 County Road SS
River Falls WI, 54022
715 - 821 -6229
MPRS 931384
5/23/2011
Septic System Management Plan
System Owner Brenda Carlstadt 715- 441 -2660
System Installer Michael Rodewald 715 - 821 -6229
Septic pumping Al Septic 715- 425 -9188
Regulating agency Saint Croix County Zoning 715- 386 -4680
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and
shall be maintained in accordance with it's component manuals and local or state rules
pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or Pump tank since dangerous gases may be present
that could cause death.
Septic and pump tank manhole risers and covers should be inspected for water tightness
and soundness.
Exposed access openings greater than 8- inches in diameter shall be secured by a locking
device to prevent unauthorized entry into a tank.
Septic Tank
The Septic tank shall be maintained by a certified individual under s.281.48, Stats.
The contents of the tank shall be disposed of in accordance with NR 113, Wis. Adm.
Code.
The operating condition of the septic tank shall be assessed at least once every 3 years by
inspection.
The Septic tank shall have it's contents removed when the volume of the scum and
sludge exceeds 1/3 the liquid volume of the tank.
The addition of biological or chemical additives to enhance septic tank performance is
generally no required. However, if such products are used they must be approved for
septic tank use by the Department of Commerce.
Pump Tank
The pump tank shall be inspected at least once every 3 years. All switches, alarms, and
pumps shall be tested to verify proper operation. The effluent filter installed within the
tank shall be inspected and serviced as necessary.
Contingency Plan
If the septic tank or any of its components become defective they must be repaired or
replaced to keep the system in proper operating condition.
If the dosing tank, pump, pump controls, filter, alarm or related wiring becomes defective
they must be immediately repaired or replaced with a component of the same or equal
performance.
If the septic system fails to accept wastewater or begins to discharge wastewater to the
ground surface it must be repaired as necessary to bring the system into proper operating
condition.
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i 111111 IIIII IIIII 11111 IIIII IIIII IIII 111111 IIII Ilil
*
State Bar of Wisconsin Form 1 -2003 8 8 5 2 8 8 1 ��
WARRANTY DEED U L 2UV
KATHLEEN H. WALSH
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Larry J. Bauer and Mares Bauer, husband and 12/10/2008 03:00PH
wife as survivorship marital property
WARRANTY DEED
EXEMPT I
REC FEE: 11.00
( "Grantor," whether one or more), and Evan W. Carstedt and Brenda L. Carstedt, TRANS FEE: 975.00
husband and wife as survivorship marital property PAGES: 1
( "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 Edl Realty Title
St. Croix County, State of Wisconsin ( "Property") (if more space is 400 S th Second Street, #115
needed, please attach addendum): Hudson, V 54016 -1974
Lot 1 of Certified Survey Map filed June 8, 2007 in Volume 22 of Certified Survey (; t ,, r
Maps, Page 5406, as Document No. 852380, located in the SE 114 of the NE 1/4 of File # jbq q
Section 27, T28N, R19W, Town of Troy, St. Croix County, Wisconsin.
Part of 040 - 1105 -40 -100
'Metro Legal Services Parcel Identification Number (PIN)
EDIRET 869441 A
is homestead property.
972888 «'D 491 X39 This p perty.
(is) (U;A15f)
Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except:
easements, restrictions, and rights of way of record, if any. +ET wo TO:
,IETRO LE%k SEiNM- NC.
00 SOUTH SECOIOMIBNJE 8= WE 150
+ J d1 wAPOW, TIN 5W.2217
Dated 6£XL
(SEAL) �� .� - (SEAL)
* a ry J. er
(SEAL) (SEAL.)
* * Mary A. Bauer
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
authenticated on nn�� ) ss.
�. C� Q �_ COUNTY }
41 1 Personally came before me on N 6J trrl y3
the above -named Larry J. Bauer and Mary A. Bauer
TITLE: MEMBER STATE BAR OF WISCO ?4 V6 /�
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) i ment and acirl ed d the same.
THIS INSTRUMENT DRAFTED BY: \� ..• ' '•.
Joseph D. Boles - Attorney at Law o T^ Public, State of
River Falls, WI 54022 -0138 ft
y commission (i pires: 2_ )
(Signatures may a autheniVe� o��{{�sly' mra�iedged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANS�MODIEIAT10$`'IO'THIS FORM SHOULD BE CLEARLti' IDEN'TTFIE:D.
WARRANTY DEED MAS q TE BAR OF WISCONSIN FORM NO. 1 -2001
* Type name below signatures. INFO-PRO- Legal Forms • (800)655 -202, • in,opro,orms cam
1 of 1
11111111111''''' "'ll Illll IIIII Iill 111111 IIII illl
852380
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
06/08/2007 11 :20AM
CERTIFIED SURVEY MAP C ERTIFIED SURVEY MAP
LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION 27, T28N, R 19 ' - REC FEE: 15 .00
TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. PAGES: 3 / s
SCALE IN FEET NE CORNER
UNPLA TT LAND Y WAY A. AUER SECTION 27
_ - 163 SOUTH GLOVER ROAD T28N, R19W
0 100 200 400 RIVER FALLS, WISCONSIN 54022
a
NOTE: A 3/4" REBAR NORTH LNVE OF THE NOTE: A 3/4" REBAR °O
WAS FOUND S 21° W 0.4' SE 1/4 OF THE NE 1/4 WAS FOUND S 04° E 0.2'
FROM THE FOUND PIPE. FROM THE FOUND PIPE.
N 89.1 1317.28'
I 272.76'
t - - - - - N 0003.37 �„ E
o LOT 2 ,) c
W I 3 14.480 ACRES /
1 SOL BORINGS p�°! C 630,729 S.F
QI PERFORMED 2>0:g INCLUDING
--r BY OGDEN o TOWN ROAD
zW �3 ENGINEERING = RIGHT -OF -WAY
a I ON MARCH 27.
_ 14.364 ACRES
\ 2007. j-Nm 625,704 S.F.
SOIL BORING, P p EXCLUDING
ao _ TYPICAL. TOWN ROAD
W ° I � V p RIGHT -OF -WA� U ® to
N
Lf) 63 BZ mW Q OUTLOT 1 W �I
g I N 8 4_ �„ W , / / \ u ' 8.061 ACRES
22.0 , �I
351,141 S.F. t ° QI
Z � 4op05p0�/ 3 N N �I
5
` PROPOSED /
C DRIVEWAY /' r
n LOCATION, / r �c�, .,� SEPTIC MANHOLE, \ b
,�c3J ` / �O+r � TYPICAL Co
\�/ DECK, MOGWD SYSTEM / N
TYPICAL SYVENT
PICAL ,
'1
LOT
1 AC RES $
Nb U` 664,144 S.F. g
` INCLUDING
TOWN ROAD
, RIGHT -OF -WAY H ti
15.247 ACRES
�T �
EXCLUDING 65' WADE TRAAM#SS/ON cn _
\RIGHT -OF- WAY
EASEMENT REGARDED + N p
�, g0 AV V01AAC 663, PAGES a vi ti
W 1/4 CORNER `S , 285 -286, Doct4wNT POINTOF Q
SECTION 27 \'A�\ ?� MAIASER 384147
T28N, R19W \ N $BEGINNING
-. W
(2 3/8" IRON PIPE) - . -. -. . -•- - • -• -• -• . -. -. + - - - - -
979.80 m
' -
4291.96' \�\ �n 754.04' c^ ire
°p 13.04' rO 5.76'
LEGEND I \ 41.00' S 89 °21' 25" W 5271.76' EAST -WEST 11,4 E 1/4 CORNER
SECTION LAWS SECTION 27
COUNTY SECTION CORN . ..1, T28N, R19W
MONUMENT, FOUND (ALUMINUM ��``; JG NS�N" ' UNPL A T TED LAND
CAP UNLESS OTHERWISE SHOWN).�.� -
• 1 1/4" IRON PIPE, FOUND. JAMES D.
X 3/4" REBAR, FOUND. r FILUMQ S -_ � F K �INS 1 1 /4" x 18" IRON PIPE � 2 2 � 46 ' FOOT, SET .68 LBS. /LINEAR < F21VEFtwFALLS, J O
JO B *06 -2877
Q REGISTERED LAND SURVEYOR
OGMPANY
— - - EXISTING FENCE. ��� r ,v� � °`��\ 34 L
ll
_ _ BUILDING SETBACK LINE 30' rrrrrurrrrruiluw�+ + RIVER FALLS, WISCONSIN 54022
UNLESS OTHERWISE SHUN. NOTE: ALL IRON PIPE (FOUND DATE: MARCH 22. 2007
OR SET ) ARE DIMENSIONED AS REVISED: MARCH 27, 2007
- 12' WIDE UTILITY EASEMENT. OUTSIDE DIAMETER.
1 of 3 THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 3
NT-1 99 n — c%nc