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Home My WebLink About038-1235-02-000 Wisconsin Department of Commerce Count Safety and Building Division 'PRIVATE SEWAGE SYSTEM St. Croix r INSPECTION REPORT Sanitary Permit No: 463085 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purpos:s [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Green, David Star Prairie Townshi CST BM Elev: Insp. BM Elev: BM Descrip ion: Section/Town /Range /Map No: I� , 1, C M . `S ' ' ' � � 09.31.18. TANK INFORMATION ELEVATION DATA /b3, 4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ?D Z Benchmark T) Pooi g A J6t 4 Alt. BM ; ^ c Cc>? a Aeration Bldg. Sewer Holding St/Ht Inlet 7 TANK SETBACK INFORMATION St/Ht Outlet 0 k TANK TO P/L WELL BLDG. Vent o j Air Intake ROAD Dt Inlet \ Septic � c / Dt Bottom Dosing Header /Man. Cum �1 f Ty t Aeration Dist. Pipe (P . � 7 3 Holding Bot. System OLD PUMP /SIPHON INFORMATION Final Grade . Manufacturer mand St Cover GPM +:1 /' Model mber TDH ift Friction Loss S Head TDH Ft Forcemain Dia. Dist. to Well � — SOIL ABSORPTION SYSTEM BEDITRENCH Width Length a No. Of TOnches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '� ? SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR ��7 kt / UNIT Model Number. i AQ DISTRIBUTION SYSTEM m -_ /0 — G 36 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intak Pipes ( ) e Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth f xx Ye Seeded /Sodded xx Mulc ed Bed/Trench Center Bed/Trench Edges � Topsoil �� t � s �� No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1036 220th Avenue Star Prairie, WI 54026 (SE 1/4 SW 1/4 9 T31 R18W) Green's Rolling Acres Lot 2 P arcel No: 09.31.18. 1.) Alt BM Description = 5 `1 / �' Jam- Pe- C 2.) Bldg sewer length = ° 2- ( I 1 - amount of cover = , �! I t Plan revision Required? Yes No Is – l Use other side for additional information. Ic SBD -6710 (R.3/97) Date Insep toes nature Cert. No. Safety and Buildings Division County N) Pil 2 01 W. Washington Ave., P.O. Box 7162 15� � ��On�� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266-3151 • State Pla I.D. Number Sanitary Permit Applic*ition _ a In ac(brd with Comm 83.21, Wis. Aden Code, personal information you may be used for secondary purposes Privacy Law,s;15.04(1)(m) Project Address (f different than mailing address) I. Application Information -Please Print All Information / �1 e. � 2 2 Property Name :. Parcel # Lot # Block # Property 's Mailing Address Pro 'on 6�� 0� � y4, Section City, State Tip Code Phone Number � ci one) of B Id' check & N: or W � e ui trig ( all that apply) 22 //� r 2 Family Dwelling - Number of Bedrooms c L��+ ,y ,r/� Subdivision N t r, PublidCommercial- Describe Use State Owned - Describe Use City Villager ° r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A Aew system Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B. Permit Renewal Permit Revision Change of Permit Transfer to New Ust Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. a of POWTS System: (Check all that apply) on - Pressurized in -Ground Mound> 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single ter Constructed Wetland Pressurized Tn and Holding Tank Peat Filter Aerobic Treatment Unit b Sand Filter Recirculating Synthetic Media Filter g Chamber Drip Line Gravel less Pi Other (ez �e l> Q V. DispersaVfreatment Area ormation: ) Design Flow (gpd) Design Soil Application Rate(gpdsl) Dispersal Area Raluimd (sf) DisMsal Area Proposed (sf) I S 0 O B �� J� �� j VL Tank Info qty in Total Number Manufactum Prefab Site Steel F Plastic Gallons Gallons of Units Concrete Constructed New Existing Tanks Tanks SgAc or Holding Tank Aetobic Treatment Unit Dosing Clasuba VII. Resp onsibility Statement- I, the and a responsibility for installatfoa of the POWTS shown on the attached Flu Name (Print) Plumber' elute MP RS Number Business Phone Number + Plumber's Andress (Street, city, State. VIfL Co artment Use Only �ryy Disapproved Mary Permit Fee (includes Groundwater Date Issued Agent signatu (No Stamps) Surcharge Fee) OC� Owner Given Reason for Denial Zen IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: J � �C 1 Septic tank, effluent filter and 36 u l�y.Qkz Rc�R� �n... .Ax,, t� 4 dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained ►�` e`�`r� S /L �.. y as per applicable code /ordinances. nA an W 1 r Attach eompkte plans (to the County only) for the system od paper not less than 8W x 11 inches is size l ` OT PLAN PROJECT David Green ADDRESS 1047 220th Ave New Richmond Wi 54017 SE 1/4 SW 1/4S 9 /T N/R 18 W TOWN Star Prairie COUNTY ST.CROIX 9/28/04 3/4 BEDROOM MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 IL BENCHMARK V.R.P. Topof 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 96.5/96.1/95.7 5' below qrade Conventional Powts Vent Manual Version 2.0 ALo Standard Biodiffuser Alternate Benchmark Top of 1/2" pipe @ 100.0 Leaching Chamber with 31.1 ft2 of Area Well is to meet all 3 4 „ Grade at System Elevation setbacks required by WDNR Pro 3 bedroom Scale is 1" = 40' house, being sized unless otherwise for a future 4th edroom noted 30' 721' Property ST Line 30' B -3 Vents -- B-2 3-3' X 63' Cells with >3' spacing 10' 9% Slope 35' 30' 10 , * 1 To 220th Ave B.M. 10' Alt. B.M. 330' 10' 535' Property Line OT PLAN PROJECT David Green ADDRESS 1047 220th Ave New Richmond Wi 54017 SE 1/4 SW 1/4S 9 /T N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 3/4 CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Topof 1/2" Pipe ASSUME ELEVATION 100' Filter ZabelA -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 96.5/96.1/95.7 5' below qrade Conventional Powts j6'Long Manual Version 2.0 Standard Biodiffuser Alternate Benchmark Top of 1/2" pipe @ 100.O Leaching Chamber with 3 1. 1 ft2 of Area Well is to meet all 34 „ Grade at System Elevation setbacks required by WDNR Pro 3 bedroom Scale is 1" = 40' house, being sized unless otherwise for a future 4th bedroom noted 30' 721' Property ST Line 30' B -3 Vents B- F 3 -3' X 63' Cells with >3' spacing 10' 9% Slo1? e 35 ' 30' -1 To 220th Ave 10 , B.M. 10' Alt. B.M. 330' 10' 535' Property Line ..Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R 'ewes by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). A Q Property er i " ° ' m Property Location �—(� ICE e g�� Govt. Lotto 1/45L J/4 S T3j N R E ( W Property Owner' Mailing Address Lot # Block # Subd. Name or CSM# o2a 2.004 -n" ,.... City late 4Ce Phone Number ❑ C3 village Town Neat Road �h 7 New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or_com eraaI - Describe: Parent material Flood Plain elevation if appli ble General comments e_ and recommendations: d /``f' C_ C/ i Boring # Boring // Pit Ground surface elev i � ft. Depth to limiting factor� ,, � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 r771 Boring # Boring i k Pit Ground s urface ele i ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 oylW i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conduct, Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ > _ 715 -246 -4516 Property Owner _ Parcel ID # Page of Bori # ❑ Boring ,\ Fil n g (,� Pit Ground surface ele /� ft. Depth to limiting fador�� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# 'Eff#2 —/ L - a 2 V2 0 I A1 ! -% 9 o g F-1 Boring # E) Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I a Boring Boring # Cl Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef#12 1 = BOD_ > 30 < 220 and TSS >30 150 m ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L Effluent # mg/L < _ 9IL s _ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SB0.8330 (8.6/00) u Soil Test Plot Plan Projet:t' Name David Green Sha d Address 1047 220th Ave New Richmond Wi 54017 e�Y #226900 Lot 42 Subdivision ---- --- Date 6/30/04 SE 1/4 S W 1/4S 9 T N/11 W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pie guc System Elevation 96.5/96.1/95.7 *HRpSame as Benchmark ate Benchmar Top of 1/2" pipe @ 100.0' Scale is 1" = 40' unless otherwise noted 721' Property Line 102' B -3 100' B -2 10' 9% Slope 35' 30' 1 To 220th Ave B. 10' B.M. 330' 1 535' Property Line �I 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. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new s!Fal sted replacement area. nstall system at a lower elevation, by removing chambers, removing biomat, ew system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 COUNT' ST C NTENANCE AGREEM SEPTIC AND yEg,SHIP CERT�ICATION FORM O , w► 's of owner/Buyer Address b Mailing _ _ � Q �. i Property Address fired from Planumg Department for new construction) (Verification requ parcel Identification Number city /State Town of L EGAL DFSCR -T W, l T 231 N -R 5� ,.. proPerty Location Lot # Subdivision Page # Volume Certified Survey Map # volume 26 5-4 Page Warranty Deed # es p no Lot lines idenrifiab S pec house O y e <no p remature failure to handle wastes. Proper maintenance Sr w�j j -ENANCE tic stem could result is its p ed umper• What you put into the systcm SYST e and M 1 � •..*r.,g�ce of your septic �' d b a liceas . P ro per use . aiS tic tank every three yew or soo ner, if neede osal system. consists of pumping out the sep task as a treatment stage in she was, disp s ed by tie owner an d by a can affect the function. of the sep �mcnt a cc form. iga disp osal system owner grees to submit to St. Croix Zoning DeP rverifyiag th less t at (1) the on -site wastewaterdisp a Ora licensed pUMPe tic tank is than 1/3 full of sludge. The pro . ymanplumbels meted nspectr if necessary), the sep masterplumber, j 2 after inspection and pumping ( the standards sa l system with is in proper operating condition andlor () rain the private sewage dispo cation cats and agree to main Resources, State of Wisconsin- Certification d have read the above req� the Department of Natural Zoning office within 30 11we, the undersigne t of COMM ere and returned to the St. Croix County set forth, herd as set by the 'Dtpart ed must be cornpletod r =A: your tic steal has been � main ft� / y piration date. �_ DATE RE pg ~ LICANT ER T CA'I'I are true to the best of my (our) knowledge ON . I (we) am (are) the Ow"*) of V`y?Q — __.. --- I (we) certify that deed recorded in Register of Deeds all state mems oa this f o 0 Offi erty describ bove, by virtue of a warranty' DATI t being revoked by the Zoning Department. 74X NATURE OF ppPLTCANT *sssss Any in that is mis- representedmay result in the sanitary Perna ** Include with this application: a starrlpe d warranty deed from the Rf gef rene D eeds made in the warranty deed a copy a the certified survey n�P 774 1 £3 is 1 ' r U 2 6 S 4 P 6 2? KATHLEEN H. W ALSH REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 3 - 1999 ST. CROIX CO., VI Document Number QUIT CLAIM DEED RECEIVED FOR RECORD This Deed, made between Jesse Joseph Green, a single person 99/13/2M 11:15AN Grantor, QUIT CLAIM DEED and David L. Green and Christine J. Green, husband and wife EXERT It 8 Grantee. REC FEE • 11.80 Grantor quit claims to Grantee the following described real estate in TRANS FEE: St. Gro ix County, State of Wisconsin (if more space is needed, please attach COPY FEE: addendum): CC FEE: W'/2ofNE1 /4ofSW1 /4 PAGES: I W 1 h of SE 114 of SW 1/4 Section 9, Township 31N, Range 18W, Town of Star Prairie, St. Croix County, Wisconsin. Recording Area Name and Return Address David L. & Christine J. Green 1047 220th Ave New Richmond, WI 54017 ox 038- 103940-000: 038 -1040- 20-000 Together with all appurtenant rights, title and interests. Parcel identification Number (PIN) This is not homestead property. Dated this day of Sentember — 2004 (is) (is not) -- ---------- - - - - -- — * Jesse Joseph Gre — - - AUTHENTICATION ACKNOWLEDGMENT Signature(s) - -- _ -- —� STATE OF ' yUi 1�1r1 ) ss. County ) authenticated this _ _day of _ _ _ _ Personally came before me this —�3� day of -- Y� Se member — 2004 the above named sse Joseph Green, a single person - - -_ TITLE: MEMBER STATE BAR OF WISCON BE (If not, —_ — me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) d'T� nstrument and acknowledged the same. OF THIS INSTRUMENT WAS DRAFTED BY --- — - - -- ----------------- - - - - -- Attorney Kristin Ogland " �A Hudso WI 5401 Notary ublic, State of /iul __ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ — 'EA * Names of persons signing in any capacity must be typed or printed below their signature. Intonuation Professionals Co., Fond du lac, W t STATE BAR OF WISCONSIN 800-655 -2021 QUIT CLAIM DEED FORM No. 3 -1999 1�� eiYl S � � � i ✓`�i V--- 1CX�� J4 4 C� o�oU1No S89 W 666.60 NORTH — 333.30 m r m O n � m \ On T X m z I I o I p MM 4 I @A.wo m o X39 o r -, m N A cs LOT 2 5.93 ACRES LOT 1 vj 258,331 SO. FT. 5.02 ACRES 10 218,749 SO. FT. m � — N V N i+ y m N —1 r Z m 0 A m m ll LS l�o�otNUo ^� --- r, - 7 -- - 0 yy 2 A • SOUTH LINE OF THE N1/2 OF THE SEt /4 OF THE SW1 /4 _ N89 ° 50' i 267.93 0) SOUTH LINE OF THE NORTH 66 FEET OF THE Si /2 OF THE SE 1/4 OF THE SW 114 N89 WE 601.99' MGr1PdG144C�D [�GJ[n1 DDS �Q l`?o�alluU EASEMENT CURVE DATA TABLE 0 o 0 0 NUMBER RADIUS CENTRAL ANGLE CHORD BEARING CHORD LENGTH ARC LENGTH TANGENT IN TANGENT OUT 1 80.00 155 °3231 S12°2334.5'E 156.37 217.18 N89°50'10 E S65 °2241 W 2 80.00 65°38'17 S3233 32.5'W 86.72 91.65 $65°2241 W IS0015WE 3 167.00 89°4946 S45 °1029 E 235.82 26183 S00°15 WE I NW5438 E SURVEYOR'S CERTIFICATE — — I, EDWIN C. FLANUM, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT IN FULL COMPLIANCE WITH THE PROVISIONS OF CHARTER 23( ,f4 Q @o g I OF THE WISCONSIN STATUTES, AND UNDER THE DIRECTION OF DAVID L. - -- - -' "'� GREEN AND CHRISTINE J. GREEN, OWNERS OF THE LAND DESCRIBED ON TH PLAT I HAVE SURVEYED, DIVIDED AND MAPPED GREEN'S ROLLING ACRES; TH SUCH PLAT CORRECTLY REPRESENTS THE EXTERIOR BOUNDARIES AND THE