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HomeMy WebLinkAbout038-1215-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430510 0 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: Given, Mark I Star Prairie TownShi 038 - 1215 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range /Map No: � C7p •a I liiv f V L �3uw 11.31.18.1181 TANK INFORMATION 1 4 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , � Benchmar / •, ZSD .SID S•zo C5.ZD OwD Dosing Alt. BM 0 O -sb Aeration Bldg. Sewer to .:To . f Holding St/Ht Inlet • 3S r St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , �r � � �_ Dt Bottom 'S , • � • � � Dosing << < f N l.� Header /Man. Aeration Di2f ipe D r tzq 4.18 Holding Bo . ystem .y t 9(a . r Final Grade PUMP /SIPHON INFORMATION l Manufacturer Demand St Cover GPM Model Number *1N TDH Lift Friction Loss System Head TDH Ft Forcemain Len t f Dia. K Dist. to Well SOIL ABSORPTION SYSTEM allillDg Width Length No. O Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3t Tren e�f\ QR. L 2 SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufa turer. INFORMATION CHAMBER OR 00, F'Ftit S Type Of yst: wO 3(,' , / ) UNIT Model Number: I t O r DISTRIBUTIO TEM (z .o, c,.>' Header /ManifQd Distribution x Size x Hole Spacing Vent to Air Intake ilk ~` P ( s) 1 t7 Length Dia Len Spacin 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 Yes H No 0 Yes � No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1: Cf1Ce /?1S J�� Inspection #2: / Location: 1253 224th Avenue $ ( Star Prairie, WI 5402 NW 1/4 SE 1/4 11 T31 N R18W River Place Lot 2,0 Parcel No: 11.31.18.1181 „,,� 1.) Alt BM Description = i '"'a"�� ”) 5) S� tW& ` 2.) Bldg sewer length •r - amount of cover = � 1�F 'I" • _[ _ n � � -�{t� • 6j-"l T Plan revision Required? Yes X No� Use other side for additional information. —L -- - -� SBD -6711 l Date /� Insepctoes ignatur_ e ^ °rt. N� ` i , \ V (R.3/g� - ". t �i L6'µ • i F /{f�f - Jt7� I � l ��� � 'Sf� - © A5 - PLOT PLAN © ss�..� , PROJECT Carrie Malonev/Mark Given DDRESS 2294 Commonwealth Ave St. Paul n 55125 NW 1/4 SE 1/4S 1 1 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/21/03 BEDROOM 4 CONVENTIONAL IN- GROUND ESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallon DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 97.5/97.0 5' below qrade Merril Way 150' 45' 340' Property Line 43' 100' 2 -3' X 88' Cells with >3' Spacing 50' This distance was B -1 change due to a 7% error in lope the original soil B M * test. The setback , was verified at the time of inspection B -2 B -3 25' 35' B -4 Alt. B.M. Top of 1" Pipe 50' @ 91.60' Pro 4 Bedroom 30' House 322' Combo Tank RECEIVED Propert Line JAN 0 2 2004 Vent ST. CROIX COUNTY >6" Standard Biodiffuser ZONING OFFICE of Cover Leaching Chamber Plans Designed Using with 3 1. 1 ft2 of Area Conventional Powts 6' Long 11 " Manual Version 2.0 " Grade at System Elevation IT .54 RE LR Wisconsin Department of Commerce j � .ATI N REPORT Page of Division of Safety and Buildings in actor an wit to te h Adm. ode ST. Y County Attach complete site plan on paper not less than 1/2 x 1 an mus include, but not limited to: vertical and horizontal n an Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. e ' wed by Date Personal information you provide may be used for secondary purposes (Privacy law. s. 15.04 (1) (m)). Property Owner Property Location 2 t Govt. Lot 1/4s 1/4 S T �J N R E nr)W P�pe is Mailing Address Lot # Nock # Subd. Name or M# 0 1 I f City `/� State Zip Code Phone Number ❑ City ❑ Village own„ Nearest Road 6 -k P, Construction s i Number of bedrooms Code derived design flow rate GPD U dent al / oo s g ❑ Replacement Public or commer al - Describe: Parent material d ��C J� z-C /�(. Flood Plain elevation if applicable General comments and recommendations: rWI F1 Boring _ `• S ft. Depth to limiting Boring # Pit Ground surface elev p factor 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#1 'Eff#2 0-10 0 Sl z o � . so a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor 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#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 / � 715 - 246 -4516 Property Owner _ Parcel ID # Page of a Ong # 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 F-1 Boring # El Boring ❑ pit Ground surface elev. ft. Depth to limiting factor 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#1 - Eff#2 F-1 Boring # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil ApplicationRate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eft#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/_ ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L 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. SBD -8330 (RVOO) Safety and Buildings Division coun 4� / r NVIsconsin 201 W. Washington Ave., P.O. Box 7082 7 Y I ) Q Madiso WI 53707 - 7082 Sanitary P � O ber billed in by Co.) Department of Commerce U Sanitary Permit AP 'cation State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, info o yogpftvit�e003 /� /' 1 may be used for secondary purposes Privacy w, s 1 1 ( Project Address (if different than m I' g ress) I. Application Information - Please Print All Information ��s3 y� ZONING OFFICE _ - O Propert� Owner's Name Parcel # Lot # Block # Property Owner's Mailing Address Property Location p JIT ' /., %., Section — City, State Zip Code Phone Numbe r / (cucleve) I I. o Building check all that apply) T / N; ! o g ( PP Y) !�/� 1 or 2 Family Dwelling - Number of Bedrooms --rte/ Subdivision Name CQS�M Number ❑ Public/Commercial - Descr Use z W d . ❑Ci ❑Villa a wnsb' o State owned - Describe Use 3 A �'f � �� � -S � 0 (�'(! -�`-�� -P/�_ tY g rP l l IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. N ystem ❑ Replacement System ❑ Treatment(Hokiing Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T= of POWTS System: Check all that appl C tee; ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized in- Ground ❑ Holding Tank ❑ Peat Filter [I Aerobic Treatment Unit ❑ Reci Ia[ing Sand Filter Pipe ❑ Other lain -� l i Recirculating Synthetic Media Filter - a - thing Chamber ❑Drip Line ❑Gravel -less Pi (explain) \, . d VT V. Dis ersarestment Area nforms on: j G �/ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis Area Required (sf) Dispersal Area Proposed (sf) rein El ti C in Total Number M ufacturer VL Tank Info p� tY Prefab � /1 sicel Gallons Gallons of Units (d/ -!'V� Concrete Constructed Glass New Existing �p T Tanks Vc Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber r7 VII. Responsibility Statement- I, the undersigned L me responsibility for installation of the POWTS sbown on the attached plans. Plumber's Name (Print) Plumber's re MP/MPRS Nu-bq Business Phone Number Plumber's Address (Street, City, State, Zi e) VIII. Coun /De artment Use Onl Date Issued ssuin A t Signature S ps) Sanitary Permit Fee (includes Groun water Da 8 Approved ❑ Disapproved Surcharge Fee) �1 � �� C � l / � � -k ❑ Owner Given Reason for Denial "` 6 -- IX. Conditions of Approval/Reasons for Disapproval Y� f ,� Q G l�G( � � a 1 W S STEMO R. ��f e i✓L a r�� r n (- Septic tank, effluent filter and •SZ ��' Yll �h y W 1 dispersal cell must all be serviced I maintained 0 ry Vg4e-d 6 i - Is r"AlY( s er management plan provided by plumber. All setback req ulre us a main acne S S^ 2. !� asp r applicable code /ordinances. �(a�� 3. -/ ' t oua onl or the system an paper not than 1/2 s 11 Itches is sine Attach Complete plans (to he C Y) f SBD -6398 (R. 08/02) P OT PLAN PROJECT Carrie Malonev/Mari( Given ADDRESS 2294 Commonwealth Ave St. Paul Mn 55125 IWV 1/4 SE 1 /4S 11 /T 3 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/21 BEDROOM 4 CONVENTIONAL IN-GROV16V PRESSURE CONVENTIONAL LIFT )XX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallon DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chamber 30 IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 99.5/99.0/98.5 3.5' ow qrade Merril Way �i 88' 45' � 340' Property Line UD i o� S 43' b 3 -3' X 63' Cell s th >3' Spacing 50' 100' \ B -11, B.M. * 7' a B -2 B- I 0 Please note: I believe the a s on the s o 5' "St are _ UU O iled in e levations, base on a visit to the sight. This will be checked at the time of p of 1" Pipe installation 50' 91.60' Pro 4 Bedroom 30' House 322' ombo Tank Prope Line Ven >6 „ Standard Biodiffuser of Cover Leaching Chamber Plans De Usint` y • with 31.1 ft2 of Area Conventi al Powts 6' Long 1111 Manual V sion 2.0 34" Grade at System Elevation P OT PLAN PROJECT Carrie Malonev/Mark Given ADDRESS 2294 Commonwealth Ave St. Paul Mn 55125 NW 1/4 SE 1/4S 1 1 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/21/03 BEDROOM 4 CONVENTIONAL IN-GROYIG PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 gallon DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chamber 30 BENCHMARK V.R.P. Top of 1 " PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 99.5/99.0/98.5 3.5' below tirade Merril Way 88' 45' 340' Property Line 43' 3 -3' X 63' Cells with >3' Spacing 50' 100' B -110, B.M. * 7' B -2 B -3 Ip3.a l ot 0 P lease note: I believe the bnchrruff s on the soi 5' . tests are_l4F -- o� ed in elev ations�ased on a visit to the sight. This will Alt. B.M. be checked at the time of Top of 1" Pipe installation 50' @ 91.60' Pro 4 Bedroom 30' House 322' Combo Tank Propert Line Vent >65' Standard Biodiffuser Leaching Chamber of Cover with 3 1. 1 ft2 of Area Plans Designed Using Conventional Powts 6' Long 11 Manual Version 2.0 3 4" Grade at System Elevation SEPTIC TANK !U1"!P CliAMBER, CROSS SECTION AND SPECIFICATIONS irt£ATNERPRWF 4» CI VENT PIPE I2" MIN. ABOVE GRADE JUNCTTON BOX APPROVED >25t FROM DOOR, wxNDow OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE Wf PADLOCK 5 WARNING LABEL FINISHED GRADE � �... -- 4 tt MIN. n a (r re,%." i. D. o �8 ' �N• fl�G t a i a INLET � GAS- , WATER TIGHT SEALS - T - TIGHT t ED A SEAL JOINTS VITH �iLTE.R ALM APPROVED PIPE B + ON 3 3' OD SOII APPROVED --F_ PIPE 3` C P ' 0m SOLID �) OFF PUMP OFF ELEV - �v_____ FT" D 3" APPROVED BEDDING UNDER TANK / C NCRETE PAD SPECIFICATIONS r� SEPTIC f DOSE NUMBER DOSES PER DAY= TANK MANUFACTURER: 5� GAL. DOSE V i3T�7 ME IIdC LtTDING �.� GAL - F LO SEPTIC Ld K � TANK SIZES: DOSE GAL. J/ _J �° ✓ GAL. �� CAFACITiIES= A ' , ;ACHES __ n ___ ALARM MANUFACWRER,: Uc�- 5 a = ` INCHES = J GAL. MODEL NUMBER"- .S GAL. SWITCH TYPE: C = 7' � INCHES = pUMp HAREiFACSURER: INCITES MODEL NUMBER D --�fF-'--- SWITCH TYPE : 15.23 yaAt: L? GPM PUMP £ ALARM WIRING AS PER / I REQUIRED DISCHARGE RATE / !J FEET _ --'- FEET 'i'ICAI. DIFFERENCE T FORCE BETtr1EEN PU �£ .ANB.DISTRTBU'IION FACTOR FEET + INIHUI'I NETWORK SUPPLY PR �'I/ 1ti 0 . FT. - F RZCTIdi3 Ftt► FEET + FEEMAIN X A TOTAL DYNMIC BEAD/ I DIAM£T �- LENGTH `� J INTERNAL D114ENSIONS IlF PUMP TANK= LIQUID � ---- -- �-� 060 �AT£:la / LICENSE NUMBr S IGNED: !t88 • �■ now om 11 MMOMMEM `'� \�� iii■ ■ ■ ■ ■ ■■■O ■■ • IN ON w M NO Ell . . • ••. . 6�4 7 - o Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 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. in Please print all information. Re ewes b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �/tL 3 Property Owner Property Location LaCasse Development, Inc. Govt. Lot NW 1/4 SE 1/4 S 11 T 3 1 N R 18 R (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 573 Cty Rd. "A City State Zip Code Phone Number ❑ City ❑ Village K] Town Nearest Road Hudson WI 54016 1( 715)381-5405 r ® New Construction Use: (2 Residential / Number of bedrooms 4 Code derived design fio ,,fl GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if ap I a ft. General comments and recommendations: trenches @ el Z 0 spaced to code 3.50' belies grade , S� � 1G � t_ Boring a Boring # ® Pit Ground surface elev. 1 01 . 60 ft. Depth to limiting factor 120 do 9 oil lication 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 'Eff#2 3 7.5 4 4 none i Boring # Boring 2 pit Ground surface elev. 101 ft. Depth to limiting factor 1 9() in. Soil A lication 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 'Eff#2 1 -10 L 2c .5 8 2 0 -25 0yr4 /4 none si 2msbk mfr qW 1m 3 -120 .5 4/4 none cos o 9� z 1. ' Efflue #1 = BOD > 30 < 220 g/L and TSS >30 < 150 mg /L ` , Etpuent #2 = BO J 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel z 1W. 02298 Address Date Evalu lion Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -27 -2001 715 - 246 -6200 Property Owner T.aCa ssg DgV I-t? . Parcel ID # pending _ Page 2 of �— ■ 3] Boring # ❑ Boring 1 03.00 Lj Pit Ground surface elev. — ft. Depth to limiting factor 120 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#1 I 'Eff#2 1 2msbk mfr qw 2c 5 2 9 -34 10yr4/4 none sil 2msbk mfr 9w 1m .5 .8 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I F-1 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit I Soil A lication 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 *Eff#2 — ---- ---- -- - --- ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L 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. S ©D -6330 (R.6 100) STEEL'S SOIL SERVICE Gary L. Steel LaCasse Dev. , Inc. 1554 200th Ave. CSTM2298 Nw4SE' S11- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prairie (715) 246 -6200 lot #20 -River Place This soil evaluation was conducted to satisfy a zoning requirewent, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 11 =40' BM.= top of 1" pvc pipe @ el. 100.00' alt. BM.= top of 1" pvc pipe @ el. 91.60'-�tl((� ik 1 to .b d" O, Gary L. Steel 6 -27 -2001 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �u -- L eAc=:� Mailing Address 022 Gv.M � v CAJ� CS/ Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number Q.3 - 06 -00L) L GAL DESCRIPTION Property Locati0MLMVV4, V4, Sec. ' 'Y - 3 T 4LWI Town of � w� Subdivision gl . Lot # Certified Survey Map # , Volume . . Page # �qq3� Pa e# 3�� Warranty Deed # - 7 y , Volume g Spec house ❑ yerKno Lot lines identifiable;gCyes ❑ no 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 masw plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days oj; a three year expiration date. _ IGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the p p7 above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT ADXTE « « « « «« « « « « «« . Any information that is mis- represented may result in the sanitary p 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 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 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. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 U. 2443P 385 �! • 7'44671 STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between LaCasse Development, Inc., a Wisconsin RECEIVED FOR RECORD Corporation. __ Grantor, and 10/27/2003 11:30AN Carrie J. Maloney and Mark T. Given, H usband and-w sur martial property. Grantee. WARRANTY DEED EXEMPT Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 roperty ") (if more space is needed, please attach addendum): COPYSFEE: 464.70 Lot 20 Plat of River Place in the Town of Star Prairie, St. Croix County, CC FEE: Wisc sin. PAGES: 1 Recording Area Name and Return Address The RiverBank PO Box 747 St Croix Falls WI 54024 038 -1215- 00 -000 r J b Parcel Identification 14umbcr (PIN) This is homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this day of 2003 LaC Dev elopment, I - - * B AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Wisconsin ) ss. St. Croix _ County ) authenticated this day of _ Personally came before me this ` day of 4 ;� , 2003 the above named LaCasse Development, Inc., By: TITLE: MEMBER STATE BAR OF WISCONSIN �� * (If not, _ _ to me kn� be tsoft(s executed the foregoing authorized by § 706.06, Wis. Stats.) instrumeg*d'ac�knowleWW the se. THIS INSTRUMENT WAS DRAFTED BY _ Kristin Ogland, Attorney at Law 304 Locust Street, Hudson, WI 54016 Notary Pub N e��N ` ��•`� My Commissio If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons sighing in any capacity must be typed or printed below their signature. Information Professionals Co.. Fond du Lac. wl STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 1 -1999 oo IQ /�� �; � I - - - - - -- - • • • tea ,o ` N- rI a m 0 N 151 ' SS I {a i $ & joh %. a awpt 1 , I a co;c 07� �. e el-a s . o 30 2.O& I / I \ `\ lo A� N Q m� rn= Qmmm 560 al \ O 3 r I 4b On 10 4 ! �Qw. • �.:r S .��.•� • .a .. gy p. �� ?` '� r.r S� " [' ♦ ^ ; .� �1: Y .• Y r .+i !tom Y �+ �'� m v � 'Sj +fi .c p, 5� %�d � `+ � S - '. f f ; r"+ : '� ?� r� f 'F• -- ' -t • ,;.. -. c. ,••,- s x•' .fir: �_w�ay' 'S.y .'- �"'; - .'+.3 - '1 Ow Z�'. rS s .t.�' - -"� "_i.rw*'t',4'�fiy. _ • :.. f 17 #e:s?, v sR'k' ? t • � '. s . +• r j �i • jY' r - i�'f? �. ...t ,.a• �, §y. e `'`. ,\; t � t �°` .a ) t _ �' r'R �Z�� '. 1 "¢'Y �'�, ;,� t ,, � iyu °e y+J, .t Yt,` ,�4t r.�r � '' �`'i�.. .. r" r + ty , ggs � �' it .�, . ♦� `� v s +�`�� Y' �' �.'. " Jc: <. (}' � Z , . 'Sy �� 1 ;r t • ° ,s zas ; a' -Y`1• � t. rRF"T 5 } _. 1 4 l r � .�'. 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Indicate and name adjacent streets or roadways. ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. >L Location of storm sewer inlets. -� Location of existing and proposed buildings and paved areas. . The disturbed area on the lot. lid Approximate gradient and direction of slopes before grading operations. l Approximate gradient and direction of slopes after grading operations. ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. "i Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from �r any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide Y and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). .a ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide `f' f vegetative strip) that will prevent eroded soil from leaving the site. Location of sediment barriers around on -site storm sewer inlets. . ,.; ❑ Location of diversions. ;= Note: Although not specifically required by code, it is recommended that concen- trated flow (drainageways) be diverted (re- directed) around disturbed areas. •:,; Overland runoff (sheet flow)from adjacent areas g q greater than 10 000 s ft. should also be diverted around disturbed areas. D Location of practices that will be applied to control erosion on steep slopes (greater than K,• 12% grade). `a Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or seeding with use u,+ of erosion control mats. D D Location of practices that will control erosion on areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year round flow). `g Cf Location of other planned practices not already noted.