HomeMy WebLinkAbout038-1189-70-000 f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
-� 399447
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:
Fox, Travis Star Prairie Township 038 - 1189 -70 -000
CST BM Elev: Insp. BM Elev: BM C o
lei d ��'
TANK INFORMATION V ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV,
Septic Benchmark
l Je v 0
sing Alt. BM g. Sewer
ation B
Holding S Ht Inlet S Q ,/' 9
O S 3,Z�
Ht Outlet
TANK SETBACK INFORMATION �- Zb I Z • O
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 S -�- , Z P' Dt Bo
Dosin Header /Man.
G. ,
Aeration Dist. Pipe (p< t v� L G S0
Holding Bot. System rr yS�
f/ L
PUMP /SIPHON INFORMATION Final Grade 3 -2- QS 90
Maa ufacturer Demand St Cover
GPM
Model Number
TDH Friction Loss tem Head TDH F
orcemain Length Dia. Dist. to
SOIL ABSORPTION SYSTEM ( 5 t
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 /
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM �� —i1NG Manufacydror.
INFORMATION Type Of System: HAMB T OR —Fz
Model Number.
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
ji 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 eded /Sodded xx Mulched
xx Se
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ON No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /1 / ?/� Inspection #2:
Location: 1360 214th Avenue New Richmond, WI 54017 (NW 1/4 SE 1/4 13 T31N R18W) Northgate Parcel No: 13.31.18.969
1.) Alt BM Description = � &* we l
2.) Bldg sewer length =2? f
-amount of cover= mi s-�
j n- �—
Plan revision e d? * Yes ] No
Use other side for additional information.
Date ! 1n,,pctr, Cart. No.
SBD -6710 (R.3197)
(,� o
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
lVisco Personal information ma provide rov
ou u Madison, WI 53707 -7302
Department of Commerce y p y be used for second purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)) state owned.)
Attach complete plans (to the county copy y) forAhr s tem, paper not less than 8 -1/2 x 11 inches in size.
County State Sani Permit Numb heck if revisio to previous application State Plan I. D. Number
I. Application Informati - Please Print all Information Locatio
Property Owner Name Property Location
, )�Io,x jVk - 1/4, S/
3T ? /,N,1R 9(or
Property Owner's Mailing Address Lot Number Block Number
P 7 3 20
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. Type of Building: (check one) ❑ City
1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village
❑ Public/Commercial (describe use):_ own of c �p
❑ State -Owned -
Nearest Road
Parcel T rrnbe
III. Type of Permit (Check only one box on line A. Check box on line B if applicable) �
A) 1 w 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B} Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
PCCNon-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1, Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /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 !
';1- ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumbe 's Si tura (nos p ): MP/MPRS No. Business Phone Number
cr ux i �r� 1� ° 0
Plumber's Address (Street, City, State Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issyffi gent Signature (No stamps)
IN Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination /� 1 0 0 1 2 0
X. Conditions of Approval /Reasons for Disapproval:
�l' S e,? ,j r si
SBD -6398 (R. 07/00)
PL &18 W
PROJECT Travis Fox 73
NW 1/4 SE 1/4S 13 /T 31 NNorth Gate COUNTY ST.CROIX
MPRS Shaun Bird 226900 ATE 10115!01 BEDROOM 3
CONVENTIONAL XXX IN- GROUND P CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 10 0 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 Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
Vent
SYSTEM ELEVATION 91.5
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber
Alt. BM Top of Survey Iron @ 96.4'
6' Long 1 M.
Grade at System Elevation
3 'B.M. 120' Prop Line
20'
Plans Designed Using
30 Conventional Powts
Vents Manual Version 2.0
B -2
Property
Line 35'
Site has
2 0%
B -3 Slope
35'
B- Vents
10'
25'
10'
Pro 3
Bedroom
House
ss,
0
in
v�
N
214th Ave
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
f�
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County S X L Q
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.
P lease print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 4
Property Owner Property Location
�T Govt. Lot rJ1/4 1/4 S T f N R � E (or W
Property Owner's Mailing Address Lot # Block # Sub . Name or CSM#
City _State . Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
- )
ew Construction us esidential / Number of bedrooms Code derived design flow rate � k>" 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 4 Flood Plain elevation if applicable �'�� ft.
General comments
and recommendations: Sys e °`^� 1 �v -
F-/1 Boring # ❑ Boring q
t Ground surface elev. / .S ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
S S ✓ ,�
L J
.�-� -r rL -S v1 /l? w !Ill -
f I
❑ Z Boring # ❑ Boring
pit Ground surface elev. 4 0 ft. Depth to limiting factor ! &/Id
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
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
CST Name (Please Print) S' at CAT Number
Address Date Evaluation Conducted Telephone Number /
SBD -8330 (R07 /00)
Property Owner Parcel ID # Page of
Boring #
Boring
F -3 - 1 g pit Ground surface elev. / ft. Depth to limiting facto� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
S
-3 1212k Al)
❑
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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
F
❑ Pit Boring # ❑ Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
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.
SBD -8330 (R.07 /00)
` V
Soil Test Plot Plan
Project Name Travis Fox Sha
Address P.O. Box 73
New Richmond Wi 54017 M #226900
Lot 20 Subdivision North Gate Date 10/15/01
NW 1/4 SE 1/4S 13 T 31 N /R18 W Township Star Prairie
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 91.5 *HRpSame as Benchmark
Alt. BM Top of Survey Iron @ 96.4'
L,B
B.M. 120' Property Line
20'
30'
B -2
Property
Line 35'
Site has
25' 0%
B -3 Slope
35
B-
25'
Pro 3
Bedroom a
House
a
0
zn
N
214th Ave
I
j3&0 Z 9 a
Sanitary 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
1*sbons Personal information you provide may be used for second purposes p Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1 /2 x 11 inches in size.
County fj r O State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
( 3g9Y
I. Applicatio Information - Please Print all Information Location:
Property Owner N Property Location
� Co V 1 � ) . `� : ?: ' ' 1 - Wt /4 1/4, S N, o W
Property Owner's Mailing A ess Lot Number Block Number
o, 13 3 X �_- ,, Z0
City, State Zip Code Num ubdivision Name or CSM Number
II. Type of Building: (check one) J City ,1 or 2 Family Dwelling - No. of Bedro s : �'� �c✓ { �b Village
11 6'� O
❑ Public/Commercial (describe use): own of
�as Saf
State- Owned >' j '/ " "Sva T P
Near
[ Parcel Tax Number(s)
III. Type of Permit: (Check only one box on line A. Ch k box line B if applicable) p 5 , 2 - ( - -7p - (5 !
A) 1. w 2. ❑ Replacement 3. ❑ Replac a of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Pe tuber Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
on- pressurized In- ground ❑ and ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground olding Tank \Un ❑ Single Pass ❑ Drip Line
❑ At -grade Aerobic Treat ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: I Z 7— o
1. Design Flow (gpd) 2. Dispersal Area 3. Disp al Area 4. Soil Application Percolation Rate 6. System Elevation 7. Final Grade
Required Prop d Rate (Gals. /day /s , ft.) ( . /inch) Elevation
VII. Tank Capacity in Total # of Manufacturer P ab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Co Con- glass
'
New Exis g creteN structed
Tanks Tqfks
S Dot) V11 l t o_f O
- roe ❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statem t
I, the undersig assume y4ponsibility for insta ation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber' i �(�o s): MP/MPRS No. Niness Pho ne Number
.2 2 -6 � oo
Plumber's Address (Street, City, State, Zip C
IiX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signa (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination 2-2 . 5 — , on O Zp / Z,
X. Conditions of Approval /Reasons for Disapproval:
1. Well setbacks to be maintained per NR 811 & 812.
2. Chamber louver shall be installed in soils with a soil application rate of .7.
3. Additional boring work was completed to confirm that sufficient depth of unsaturated soil exists below system elevation — (cos).
4. Effluent filter to be installed and maintained per manufacturer's recommendations.
SBD -6398 (R. 07/00)
PLO PLAN
PROJECT Travis Fox DDRESS P.O. Box 73 New Richmond Wi 54017
NW SE 13 31 18 Star Prairie ST. CROIX
1/ 4 1! 4 S /T W TOWN COUNTY
MPRS Shaun Bird 226900 DATE 9!26!01 BEDROOM 3
CONVENTIONAL XXX IN- GROUND RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND S
1000 g allons LIFT TANK SIZE DOSE TANK SIZE
TIC TANK SIZE 9
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
IL BENCHMARK V.R.P. p of 2" Pipe
ASSUME ELEVATION 100 I+" e r Zabel A -100
❑ BOREHOLE O WEL "H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.85
Vent
> 12" Sidewinder gh
of Cover Capacity Lea mg PI Using
Chamber wts
16 " 2.0
6' Long Grade at System El ation Alt
3 ' 25' 115' P
10' 10'
B -1 Vents B -4
45'
B -3 80'
2 -3' X 69' Cells 0' -6
with >3' Spacing
Property Line
B -2 B -5
60'
T
30'
a
t~
Pro 3 °
Bedroom �� 2
House
214th Ave
i
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labo. and Human Relations
Diviiion o , 'W ery a Buildings in accord with ILHR 83.05, Wis. Adm, Code
COUNTY
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but S Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 038-1055-
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY r DATE
PROPERTY OWNER: PROPERTY LOCATION
G ree nwoo d Ent Inc. GOVT. LOT NW 1/4 SE 1/4,S 13 T 31 ,N,R 18 �c(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
1416 Third ST. 20 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE :KJOWN NEAREST ROAD
Hudson, WI. 54016 715) 386 -3674 Star Prairie I 214th Ave.
[xj New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft — ,8- trench, gpd /ft
Recommended infiltration surface elevation(s) 94.85 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE T SYSTEM IN FILL HOLDING TANK
U = Unsuitable for s stem ®S ❑ U ®S [] U ®S E3 as ❑ U ®S ❑ U ❑ S] U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft h� k)
Boring # Horizon Texture Consistence Bour>dary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trendl LocGe-
1 1 0 -15 10 r 3/3 none 1 2msbk mfr C1W if .5. .6 x'
2 15 -30 10 r 4 4 none sici lcsbk mfr QW if .2 .3 'Z
Ground 3 30 -84 7.5 r 4 none Ins osa M1 n .7 .8
elev.
9L ft.
Depth to
limiting
factor q �s
+84 S
Remarks:
Boring #
1 -
2. 2 1 4 Z
..............
Ground
3 20-30 1 2-
elev, 4 0 -84 7. 4 M1 na na .7 .8
9 - ft.
Depth to
limiting
factor
VLIJ
+ 84 1
3
Remarks: ST r";Zru
CST Name: -- Please Print Gary `
L. Steel Phone: 715- 246 -62 '. COUNTY
Address: 1554 200th. AA, New Rich and WI 54017
Signature: Date: `T mQ2
10 -29 -98
PROPERTYOWNER Enterpris DESCRIPTION REPORT Page,2 of 3.
PARCEL I.D # 038 - 1055 -95
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3
1 0 -11 10yr 212 none 1 2msbk mfr gw if .5 .6
Ewa 2 11 -24 10yr n sici lcsbk mfr gw if .2 .3 �Z
Ground 3 4 -84 7.5 r 4/4 none cos osg mi na na .7 .8
elev.
98 ft.
Depth to
limiting
factor
ys „
5`
Remarks:
Boring #
1 0 -10 10 r 3/3 none 1 2msbk mfr gw if .5 .6 .5
2 10 -26 10 r 4/4 none sicl lcsbk mfr gw if .2 .3 Z
Ground
3 6 -84 7.5 r 4/6 none cos os ml na na .7i .8
elev.
gg-5 ft.
Depth to -
limiting
factor
Remarks:
Boring #
- 2msbk mfr if .5 .6 S
5 2 12 - 10 r 4 4 none sici lcsbk mfr yw if .2 .3 •�
Ground
3 6 -84 7.5 r 4/6 none cos osg ml na na .7' .8 .�
elev.
9 8.6 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW -3254 NW S13- T31N -r18W (715) 246 -6200
town of Star Prarie
lot #20- NorthGate
This soil evaluation was conducted to satisfy a zoning requirement, 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 =40'
BM.= top oft" pvc pipe C el. 100'
Alt. BM.= top fo 2 pvc pipe C el. 99.90'
tA
f l
IG O r
�/9 h
nZ
Gary L. Steel
10 -29 -98
I
3 -06 -1995 7:59PM FROM P.1
OWEftowlia Greenorood Rater ri ."a — ftOM DESCRIPTION REPORT Pape 2 "of 3
pAitlCEl. Cp. =. 038 -- 2055 -95 t912��0i��. 1'�
Boring # Horizon Depth Dominant Color Motfies T #x Structure � R GPD/ft
in. M Ou, SZ. ConL Color Gr, Sz, S.. Bed Taxh
NOW05UPPOW9MMOWN MddWA .. M-0
g - f .5 .6
2 11 lQyjc MA s' if .2 .3
Ground 3 24 - 8 7. 4 nCne cos ml na ba
elegy+.
r"D
Facror "
Remarks:
Boring #
Z - 1 Zrr gy if .5 .6
2 10--26 10 r 4/4 none sicl 'IcsUk afr if " :2' .3
GtRUnd 3 7.5 r 4 0ag m1 na na .7' .8
Dep to
tacior .
Remarks' --
Boring #
wa Qv if .5' .6
L 2 1 - 26 10 x 4 asicl lci*k mfr if .2 .3 __
Ground 3 26 7.5 r 4/6 none cos 009 t4a - na na
91% fL
Depthro
Igcbr
+;84"
Remarks
Ground
IN T
e�ev,
ST G pIX
ZoNtNG FFFC
Dq* lo
linlaing
f
Wisconsin'Department of Commerce SOI EVALUATION REPORT
Division of Safety and Buildings Page of
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must County
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. c-- p
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
C Govt, Lot �� 1/4 .51/4 S / T 3 J/ N Rl r� E (o W
Property Owner's Mailing Address Lot # Block # Subd, Name or CSM#
City State Zip Code Phone Number city ❑ Viliage 1�Town Nearest Road 'p
w Construction Use// esldential !Number of bedrooms _ _ Code derived design flow rate �— GPD
D Replacement ❑ Public or commercial - Describe:
.,� �r
Parent material - 0 4& JM.4 �/� Flood Plain elevation if applicable !(/J ft.
General comments
and recommendations:
•�
Z2 "Lo
g- S s
Boring # ❑�° Boring o j
tC� TT:•..y Pit Ground surface etev. 7 ft. Depth to limiting factor / ZS� in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. M ��u{{nsell Qu. Sz. Cont, Color Gr. Sz. Sh. *Eff#1 *Eff#2
J /.
Boring # ❑ Boring
❑ Pit Ground surface elev, ft, Depth to Ilmiting factor in,
Soli Appllcation 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
* Effluent #1 = t30 S > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 =SOD < 30 mg /L and TSS < 30 rng/L
CST Name (Please r' t� Signature CST Number
, dam
Address Date E luation Conducted Telephone Number
dt.�i
SBD -8330 W07 /0-q
; PLOT PLAN
PROJECT Travis Fox ADDRESS P.O. Box 73 New Richmond Wi 54017
NW 1/4 SE 1/4S' 13 /T N/ 8 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE9X26 /01 BEDROOM 3
CONVENTIONAL XXX IN- OUND 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 WELL - H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.85
Vent
> 12" Sidewinder High
of Cover Capacity Leaching Plans Designed Using
Chamber Conventional Powts
16" Manual Version 2.0
6' Long Alt
34" Grade at System Elevation 53' B.M. 30' 25' 115' PL
10' 10'
B -1 Vents B -4
45'
B -3 80>
2 -3' X 69' Cells g0' -6
with >3' Spacing
Property Line
B -2 B -5
60'
T
30'
Pro 3 °
Bedroom
House
214th Ave
- PTIC'. TANK /1
AND
OWNERSHIP CERTIFIC.'ATION FGDP.Nl
Mai..,
Prop ty
(Veritica -ion required tiotn Planning Department for new construction)
c;ytyr:'tatw ri k'r�rcel Identification Number
Pro . � ..- u
1... y L.o. ;,,.�,n ,vw ! 4, -- /,. Sec l T' iw •R 4ti' Town f
S b � 1 ir. { L G'. '� ,
sew Yls t 7Jr �t2 .. 'vv ... .... ....._.� _. .. �. .,�,�..�.,,....... ..�...,........ ,.... �............,........_......._ ..�.__..._____._..- .....__....J
iC'er't't tech yt ir,a' !t Map - H ..,._ _.. _. _ �.� .._.....,, .. , ,.., > Volumu .� _.r ....... r ... Ya�,e #
�" aX1 �J RJ Vol ume ..._ v , L
1 t'4' F , � ?, I �z� : ft
Spec; .louse 'es tkno Lot lines idPntifiablervas G no
Ltrpro per i and maimenanceof your septic system could result in its premature failure to handle wastes. Praper ma�DICnanW
consir!.; of purirpi;r out the saTatic tank every three years or sooner, if needed a iiecused pumper. What you put. into tti system
can. af:: set the r.irrr::t ion of the septic tank as a treatment stage in the waste disposal systems,
The pxar -N ^ty owner ai;;rees to subimt to St. Croix toning Department a certification form„ sipxd by the,owner.:itn'd by a
rnastr.,, plumbs:, i i:iu.:tneymanplvtdbo4 rtrsuictodpluxubcr or a li(.cusedpumper vcrifyiug tW (1) the uu - Site �vastewatetd sptrs )l . system
is in c., )per ope. -n is ig condition and/or (2) after inspection and purnising (if necessary)., the septic tank is less than 1/3 fii11 oy 3lus�ge,
1/we, :. is under.si ii;,; :d have reacv, the above, requirements and agree to maintain the private sewage disposal.system with the-t,'19ndasrds
set for: >a, herebL' fi: ;. set by the Department of Commerce and the Department of Natural Resow:ces; State of Wisconsin. Cat,
statirrp. that yotw in i'do. systems I�.as been maintained. must be completed and reWrrxed to the St. Croix County Zoning, Office 30
(lays o the t!i7 -,c '4'..ir cxVi,ratii :late-
a . _........�`� .�;t✓ /�Gr,Or'Z,_ „�l/ ��r✓Nr� � /,�l/c: ._.,1� �r� _.� 1 %.
DAM
7.1'1'q A'MR +I ION
I (we) o'.''i ify that all altements on this form arc true to the best of my (our) knowied;ge. I (we) am (are) the ovi n'or( of
the p,r::)erry dvsurii' zd above, b y viriva of a warranty deed recorded m Register of Deeds Office
Any inforf:i.ation that i:; nus- represented may result in the sanitary permit being revoked by he Zoning DepaMUaU'... ” * **`*
** fw"''::ude with ','Hi Is applieati.�in: a stamped warranty deed fron5 the Register of Deeds office
a copy of the certified survey map if reference is made Irl 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
Shaun Bird #226900
1
J,:
STATE BAR OF WISCONSIN FORM I - 1998 CE31 t:310 - Z 116=1 cm. CE3.
WARRAITY DEED H
f
5-)ER OF DEEDf..i
PAC7 65
.;;:.. Cli'".'t-JIA CO., W!
Document Number
RELLEIVED FOR RECORD
This Deed, made between CrP-P-rWCCd Eni-PrprjSe---, Tric., a 09-27-21001 1:25 I'M
Wisconsin Corporation WA,�iRANTY DEED
-? #
Grantor, ,9T COPY FEE:
and Travi G- anj Xi mberly 7 \- Fox, hushand and wife
"WNSFEk FEE: 73.50
FEE: 11.00
4fiES: i
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in qj - ('rni X County, State of Wisconsin
(the 'Property"): Recording Area
Nam p and Return Address
Ibt 20 of the Plat of NorthGate, recorded in the Off ice — T - te4A - (� � ',A-07(
of the Register of Deeds for St. Croix County, 1 0 0VX
Wisconsin, on May 20, 1999, in Volume 7 of Plats, at � ,
Page 46, as Document Number 603503.
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
ii
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements restrictions, and reservations, if any, of record.
Dated this day of Jill V 2001
(SEAL) (SEAL)
(SEAL)
—(� � (SEAL)
OF
Ril--,cb, retarV
U
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
S.
9t. Croix County Z �— day of
1S
authenticated this — day of Personally came before me this .4
July 2- the above named
James E. 'Rusch, its President and Mary R.
Rusch, its Secretary
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Stats.) instru nt and a he same. ��,�
THIS INSTRUMENT WAS DRAFTED BY
Mary R. Rusch Sandra r—hrk-
Notary Public, State of Wisconsin
New Richmond, WI 54017 My co is ' n is p:Went. (If t, state expiration date:
(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.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY DEED FORM No. 1 1998 Milwaukee. Wis.
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