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HomeMy WebLinkAbout182-1016-10-075 (2) 0 � � � � \ % 7! k ( ] , e — \i _ » / 7 0 / o m$ f 2 G w - c M ' �(c :30 ƒ ƒf % K\! § g � 2 @ 2 8 2; E } # e e ^ e ro = I 0 \!. @ / \ E M c w © / * \t t § CD / \ � E S / a � ® f R — Cl § m cn @ I , e Cl) E � � f / , cr 2/ CL 0 0 0\ rr 2= § R : ) 2 ■ 1 7 § e o — �§} $/ 7C °§ & \` ■� 2 3 \ \ r q I f � � > t 0 i. (D i \ ƒ \ / k \ k / / / ` k z ( Q \ ■ / \ 3 A / { % \ § � enn> ;r§i ® COD n z % �§0/ 22\ 2$[ � CD � �/ � � ƒ{ § 0— \ � CD , { . 5 * § { C> CD Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM Coun Safety and Buildings Division Wt. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) sanit3Y W AN Personat information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)). S�� it Ho de 's Natne: ❑ City ❑ la a oyvn State Plan ID No.: Ci` staf�, Samte Mai ralHe I ownsh p CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tMark � Aerati Bldg. Sewer / r /P olding St Ht inlet �' TANK SETBACK INF ATION t Ht Outlet TANKTO P/L WELL LDG. Air I to ROAD irntake Septic y 3 r NA om NA Header / Man. , d ;7, /S Aeratio NA Dist. Pipe Hol ing Bot. System 4 Sj� PUMP/ SIPHON INFORMATION e L Manu ftetute r e%GP Model Number TD�riction F S stem TDH Ft orcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM BED / TRENCH Width , Len th , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS Z I I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM L P Manu acturer: INFORMATION Type O r HAI o e Num er: *� System • DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Ah Spacing d� > SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Dep h Of xx Seeded/ Sodde� Bed /Trench Center Bed /Trench Edges Topsoil�nS eCtlOn 1' I �" / R Ye T5erSk' , e �f 1il&rsF Re319�!' 8i1' e Lbt 1.) Alt BM Description = 4ep a. {/A+— 5, 2. Bldg sewer length _s - amount of cover => ?z a �^ l e , el �o re tay. �li if o �t1 e l GQ i (n Gt tie o rc� rtu d 0-,S dw; lob ��•�D�s��ucC�raa., ply s ir~s��cllcc� y� Z� C�I�.,A6rr- �vvti Plan revision required? ❑ Yes No Use other side for additional informbtion. 2 G SBD -6710 (R.3/97) Dat Ins peRor's �tur, Cert No. �J i a _ e I l I s a Z1 733 Sa Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Peivacy Law, s. 15.04 l�(m ] (Submit completed form to county if not �A� I state owned.) Attach complete plans (to the county copy only r Wets • �iecb,ii pa .,o of less than 8 -1/2 x I 1 inches in size. County State Sanitary Permit Number k if revision to'pccvio application State Plan I. D. umber '2 L p lication Information - Please Print all Informati r1 Location: Property Omer N ame Prop" Location Q t � t IjJE 1/4 A)14, S T-3 ,N, li( YE or Property Owners Mailing Address v Lot Number Bl Num 30 City, S tate Zip Code one y one m er Subdivision Name or CS M Number ► ra _aor� LSIM /� P_ a II. Type of Building: (check one) �( i or 2 Family Dwelling - No. of Bedroom . ✓ r a V S S, b Wrn`�`ti 4 iRage Public/Commercial (describe use):_ of ❑ State-Owned S 42 r - Nearest Ro arse Tax um s III. Type of P rmit: (Check only one box on line A. Check box on line B if applicable) 1,0 — A) 1 eW 2. 13 Replacement 3. Replacement of 4. 5. 6 0 Addition to System System Tank Only Q Existing S B) PennitNum r Issued dG — DOO ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) zlH on- pressurized In -ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland El Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: Z Z 1r r 1. Design ow gpd ispersal Atea 3, Dispersal Area 4. Solt Application I ft.) 5. Percolation 6. System Elevation 7. Final Gra e l , Required Proposed Rate (Gals. /day /sq(Mi n. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ❑ ❑ ❑ ❑ o VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbers mbers ame pent u e ignature no ps): M o. Busi ness no um r S� 7 l r a ��- X131 Z Plumber's A dress (Street, tty, State, Zip ode) 10 °l Z IX. County/Department Use Only ❑ Disapproved 7 anitaryPermet Fee (Includes Groundwater Date Issued ssui Agent SIgnature (No stamps) Approved 13 Owner Given Initial Adverse Surcharge Fee Determination Z 2 S 0 0 < kti X. Con J ditions of Approval Reason ( proval s for Disapproval: n Ttl }fir �o be S�rJiGed (llr- v1�d- hlti- 'tac-urt,-5 Jt•CaM�MP..trQt uOr�S. A pc kCv e� puq� �v P✓P5�°rUP L! area +0r SBD -6398 (R. 07/00) ZY 4 tiv'A�r- \� C (` /'C� _ ;__ __ _ _ 8 - -_ v � • ,� _ _ -- � I __ _ _ . _ -- - _ 4,� U .__. V __�� _ � t -_ .� �.� s'� .. '' : 2 O d __ _ _ _ - __ __ __ _ __ � _ _._ a�� I f � i { 1 1 I _�.__- _.__.__...... __. -.. _._�.._- __._.____. _ ._- ._ - -. t j _�_.__ __ -_� __.- .____...__ -___ _ _.______. ___.__._.�_. _ -.. _. � . 3'- � _- .�___.___ _.___.� -- ____._- _._.._�_._.... _.._____.... ._... _.___. _..._.___.. - ._�__.. .._._.__ ___... _.___ .�__ }y-- .�___._._..— ___.. -__..i - _.._.__._ __._. _. _.... _.._ _.__�._-__._- __ -__._ ... �.:.._- ._______...._____ ...___._..- r — _.____._.�__.�.. ___ 1 _.____. _... - -_. _____ ..._... ... .__.._.__... _ _.____. _.._._..___�- __- �- 1s- e.�.____ __._ ' i �.. i I I � ��, � I ,I PLOT PLAN PROJECT Jaime Skifstad ADDRESS 702 Countv Line Ave Star Prairie Wi 54026 NE 1/4 NW 1 /4S 1 /T 31 R 18 W VillageStar Prairie COUNTY ST. CROIX _�— 3/11/01 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filte Za el A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 95.5/95.3 Plans Designed Using Alt. BM Top of Lath @ 101.5 Conventional Powts Manual Version 2.0 438' Property Line Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 34" Grade at System Elevation B -2 Alt. B.M. * B -3 Vents 10' 6% 50' a Slope 2 -3' X 69' Cells with >3' spacing a Vents 0 B -1 , 00 � T 10' 03 170' Bedroo H ouse 43 1' Property Line 200' 7 - ;_Vi t of WiecorAMDepa imeM of Cornaterce SOtI. �VALUATlON REPORT Pace Dwision of Sanely and Buidinae3 [[114,,_ In a�carde+P� Commti5, Wls. Adm. Code C , ST CR 1u J Attach complete site plan � psiper not ie 12 x 11 inch` rn size. Pien must include, but not limited W vt:rU0)WX II oe pej ",OM) arcel direction and P I.U. percent elope, scale or no '7 distance to nearest read. PWS p , TiQ>711 r R d Date Parronsr MNOnrretia+ You ProvM!• r^aY be iolsry purposae {PriwoY haw, s. 15.04 (1) {m)). PropertyOwrtfr PropertyLocation y� ` Govt. Lot _ 1 JN(/�/t �4 S T N R E property owner' Nerve lling Lot # Bieck # Subd. Nee or CSW o p City village E370YM Nearest R Nsw Con atructlon Use: Residential ! Number of bedrooms Cade derived design now rate r .. ---- t3PD © Replacement • � r] Public ar commercial • Describe: __.__ . _ -.._ _ _ . ----- -•• -__ _. _ _. _ .. __ _... M....�_ _. _._.._ ._ _ __ Parcm mstow 0z"" cz.'4L Flood Plain elevation if applicable E• General owtorm and recommendations: F ' r B S t� Pit Ground W01600 ale /� _ ft. Depth to limiting factor Sod H~ Depth Dominant Redox Description Texture Structwe Consistence Boundary Roots in. Mur"l Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •002 0 ? 1 r Z 3 -/ Q S Os X19 / 19 y� & Z Boring 1 c� 1 8odn s * t Ground surface e�� ft. Depth to limiting factor /�!� , in. Sol Appkaft POW Hart= Depth Dominant Color Redox Description Texture Slouches Con"Mnoe Boundary Roots WOO in. Munro Qu. Sz. cont. Color Gr. Sz. Sh. •ERlit1 •&fktGt o _ .� ass' yG .� z. * Eflluartt 01 Q f3GD > 30:5 220 mg/L and 1W: 30 <_ 150 mg1L ' Effluent #2 = ROD < 30 rngiL end TSS 130 MOL csT m. c a CSTNumber AddnWW u'``� Date Evaluseon Canduatad Telephone K+ "MW ProPwlN owrief Parcel ID # ^� Pape of Boting # [] Boring .a Pit ground surface elev/ v }_. v ft. Depth to Rft#ng factor ,� in, SoY lion Rate WZOn Depth DonW►ant Color Redox Deaoriptkwx Texture Structure Consistence Boundary Roots 0 P01R' In. Mcstseil Ou. Sz. Cont. CV -)r Gr. Sz. Sh. 'Eff#1 •EIO2 3 S .3 3 IE Boring # C] Boring ❑ Pit Ground surface elev. ft: Depth to Nrnitfng factor 1n. son Mo+t" Depth Dominant Rats �' Radox Description Texture Structure Consistence Boundary Roots GPD/f! In. fNurrseA Clu. Sz. Cont. Color Gr. Sz. Sh, •Eff# 'Eft#2 0 ❑ Pit Ground surface elev. tt. Depth to NmMng factor i Hodxon Depth DornInant S o l Rata Radon Desatption Texture Structure Consistence Boundary Root in. AllutnseN taut. St!. Cont. Color Gr. Sz. Sh. 'E1M11 •Bt1#2 ' Ef UWN #1 ■ Mk > 30 a 220 mWL and T58 >30 1150 mgl<. • Eftktent #2 = SOD, 130 malt,. and TSS c 30 mglL, . The Department of Commerce is an equal opportunity service provider and employer. lfyou need assistance to access services or need material in an tthernate format, please contact the department at 608.266.3151 or TTY 608 -264 -8777. saanso(RAW) Soil Test Plot Plan Project Name Jaime Skifstad Shaun Bird Address 702 County Line Ave Star Prairie Wi 54026 CSTM Lot Subdivision - - ----- Date 3/2/01 NE 1/4 NW 1/4S 1 T 31 N /R W Village Star Prairie n Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 95.5/95.3 *HRP Sa me as Benchmark Alt. BM Top of Lath @ 101.5 438' Property Line Alt. � .M. O T Alt. B.M. 6% B Slope 50 a 98' B 99' 100 170' 5th St. 43 1' Property Line 200' Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Shaun Bird #226 -2�A//�L — ST CRODC COUNTY SEPTIC TANK MAYNMANCE AMEEMENT AND OWNERSHIP CER.TERCATION FORM Ownar/Buya Mailing Address - 7 a 2 - C S � 1 c�J S LI a to I � Proparty Address G', zt 1� 4 � (Verification t4wed p'lathaing Department for now construction) ai atdte iSL A = :j= Parcel Identification Number 3 .A,.nRSOU TtON Ptoparty Location AF,,, A. N •.J h/ Sec. -L . T 3 1 N -R I q W, U ( �f ��) r 'Prc�i gu ' 'on — Lot # CerWW Survey Map # � �� 3 � � � Volume � � . Page # L U� Warcwty Deed # 4L Volume z z Page # Spec house ❑ yes ID no Lot lines identifiable.- yes ❑ no 1gp"W ass and maiateaanaeof year septic system could remelt in ids preanswe fafl= to Mn&ww tea. Proper once consists of p=Vb$ cot dw septic tame every t'htee years or sooner, if needed by a lieu pwmper. What you pat into the system can ago the fttactioa of the septic tame as a tmatment stage in the waste disposal syat = 13re property owner Wv a to submit to St. Croix Zoning Dgwmamt a certification form, signed by the owner tad by a nisster phunbw, joamaymatiplumber, testricted pltimnber or a kcoased pamoper verifying that (l) the on-aft wastews►terdispt d aystetm is m proper opamtiag condition, and/or (2) after mspection and poampimg (if necessary), the septic tank is 1010 than 1/3 !aril of du*- Uwe, the wed have read die above regairemears and agree to maintain the private sewage, disposal syat= wish the sundurds set forth, herein, as act by the Departianent of Camsmem and the Department of Natmral Resources, State of Wis00naia Ce dittiOli stating that your septic system has been tmaintained must be completed and retmnred to the St, Cmix Comity Zoning OfECe'within 30 days f tine three year expiration data // ����� 11 to . t3NA'l[JRB OF APPLI DATE QV„y= ,MMMATION I (we) certify that ail statements on tins faun are true to the best of my (our) knowledge. I (we) On (are) the owners) of the described above, by virtue of a wattttuty deed recorded in Register of Deeds Office. GNATtJRB OF APPU DATE « « « « «« Any information that is mis- represemtad may r esti t in the sanitary permit being revoked by the Zoning DepattrnW. «+ 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 • V01. 1F)24 4,99 STATE BAR OF WISCONSIN FORM 3 - 1999 KATH LEEN H. WALSH -- QUIT CLAIM DEED REGISTER OF DEEDS Document Number ST. CROIX Co. WI This Deed, made between Linda S. Skifstad and Dennis J. RECEIVED FOR RECORD Skifstad, husband and wife, 04-225-2001 9:30 All OZZAIH DEED EXEMPT # g Grantor, and Jamie L. Skifstad and Terry E. Lodahl, as joint tenants, CfiPJ'ZOPY FEE: COPY FEE: T&MM FEE: 15.90 RECORDING FEE: 10.00 Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the franctionsl Northeast Quarter of the Northwest Quarter (NE1 /4 of NWi /4) Recording Area of Section One (1), Township Thirty-one (3 1) North, Range Eighteen (18) West in Name and Return Address the Village of Star Prairie described as follows: Lot 1 of the Certified Survey Map filed April 20, 2001, in Volume 15 of Certified Survey Maps on Page 4067 as Judith A. Remington Document No. 643302. REMINGTON LAW OFFICES P.O. Box 177 Retaining unto Grantor a non - exclusive permanent easement for drainage and private New Richmond, WI 54017 utilities including electrical, storm, water and sanitary sewer as shown on said Certified Survey Map. Part of 182-1016-10-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this 24th day of April 2001 * * LINDA S. SK * * DENNIS J. S FSTAD AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. ST. CROIX County ) authenticated this day of ' Personally came before me this 24th day of April , 2001 tile. ve named * Linda S. Skifstad and Dennis J. Skifstad, h►fsbaii h wife, TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) wh t th io going (If not, instru ent and acknowledged the s e. to authorized by § 706.06, Wis. Stats.) t J ' THIS INSTRUMENT WAS DRAFTED BY * J ith A. Remington •��••••' Judith A. Remington - Remington Law Offices Notary Public, State of Wisconsin ' P.O. Box 177, New Richmond, WI 54017 My Commission is permanent. (I not, state eXpiratgion ate: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company, Fond du Lac. wi QUIT CLAIM DEED STATE BAR OF WISCONSIN 800- 655 -2021 FORM No. 3 - 1999 � V • ••ter/ $ FILLT � APR 2 0 2001 ► 643302 ��LEEN N W Rek;lsterof 1p St Cfobc Co •Z CERTIFIED SURVEY MAP .� Located in part of the Fractional Northeast Quarter of the Northwest Quarter of Section 1, Township 31 or N , Range 18 West, Village of Star Prairie, St. Croix County, Wisconsin. NORTH 114 CORNER SECTON 1 -31 -18 Prepared for and at the request of: (FOUND ALUMINUM COUNTY MONUMENT) OWNER: Dennis Skifstad 5 6 8'3i 'E S8 702 County Line Avenue — • — .. 8 .. 2626 Star Prairie, WI 54026 NORTH LUNE Ole 1HE Nyy 1j4 — • .34 — — — �..— Drafted by. Ty R. Dodge N RIHWEST CORNER SEC77ON 1 -31 -18 0 (FOUND SPIKE BY BENT 1 " IRON PIPE) W \� jG' J`l,��►f� NOTES: PARCEL IS ZONED R -4 j RONALD F. # i SETBACKS VARY BASED ON BUILDING HEIGHT- J ?`i'i5ON CONSULT STAR PRAIRIE ZONING CODE 1 SECTION 13 -1 -45 FOR SETBACKS. ' b Y NO DRAINAGEWAYS OR BUILDINGS ARE PRESENT I m VVIS. .; ON THIS PARCEL AS TO THE DATE OF SURVEY. v,l I �4 W �! I . SU R.IE� UNPLATTED LANDS OF OWNER -- �w��s.•cg�c�` S "E 437,95- 20.29' -.,J, I 404.93' 33.03'1= I� I I � I I o X.Jwl I D I I 1 C D S LOT 1 I v j i ir- N TOTAL AREA: ° to I I D + �o ^� 167,592 SO. FT. Iw Z I P I No io Ir 3.85 ACRES IN m v r I i ° ,�, Ir I0 4 I� C ° ! Iv, N 10 I� V Ij C I � I V jN n � 0 I j I Z I� I A 15' DRAINAGE AND PRIVATE UTILITY EASEMENT I I I V AND PUBLIC EASEMENT FOR WA7ER, STORM Ic AND SANITARY SEWER I 1 I I Iz RIB �LOEF rN AY I I I> I I I 1 398.87' 33.03'1z 33' I Jr- N86 "W 431.90 I 1 �0 UNPLATTED LANDS OF OWNER ICA. ' I N j I I r LEGEND y r Section Corner Monument 03 of Record SOUTH 114 CORNER • Set 1 SEC77OV 1 -31 -18 v " x 24" Iron Pipe we (IN RIWER- ESTABLISHED a' i 1.13 pounds per linear foot FROM 77£S) DWG # 1192 goo o too NO TH Prepared by. JEO Consultin Grou Inc GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET. 1 inch = 100 feet Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH -SOUTH 1/4 109 East Third Street, P.O. Box 325 LINE OF SECTION 1, TOWNSHIP 31 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S00'37'27 "W. Sheet 1 of 2 Vol 15 Page 4067 PLOT PLAN PROJECT Jaime Skifstad #DRESS 702 Countv Line Ave Star Prairie Wi 54026 NE 1/4 NW 1/4S 1 /T 31 8 W Villa geStarPrairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3 /11/01 BEDROOM 3 CONVENTIONAL XXX IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 2 " Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.5/95.3 Plans Designed Using Alt. BM Top of Lath @ 101.5 Conventional Powts 12 Manual Version 2.0 y 438' Prope L' od AL e Vent R J(i j? .. > 12" Sidewinder High - ST 20 ; � y Capacity Leaching' of Cover Chamber » cj it 6' Long 16 / !! 34" Grade at System Elevation 5% Alt. B.M. Slope * B -3 5,10 50, B -4 10' Vents 50' a Vents B -2 > 20' �, 6% 2 -3' X 69' Cells with >3' spacing B -1 Slope T 00 �► 45' Pro 3 170' Bedroom House 43 1' Property Line 200'