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Home My WebLink About038-1193-10-000 ' Wisconsin Department of Commerce ounty: merce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405106 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: P.C. Collova Builders, Inc. Star Prairie Township 038 - 1193 - 10-000 CST BM Elev: l 00 , Insp le BM Des7tio� r C E I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark �M 2 •U � 149 0 I CJV ld „ ` , o Dosing Alt. BM Y' o GvQL -7 Aeration Bld .Sewer 9 Gs y Y. 3s Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 3 f TANK TO P/_ L W E�L BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7e�/ Dt Bottom Dosing -- Header /Man. - D• lv �l '3.3a' Aeration Dis Pipe a, -13, 2 Holding Bot. System 2 PUMP /SIPHON INFORMATION Final Grade f .28 X 17. 7 Manufacturer and St Pover GPI� Model Nu r TDH Lift Loss System Head TDH Ft For a' ength Dia. ist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length W f- No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EACHING I Manu ture ,- INFORMATION HAMBER OR h , Type System: f ) Ye UNIT Model Numby� DISTRIBUTION SYSTEM Header /Manifold IDistribution rle Size I x Hole Spacing Vent to Air Intake s-� f 6/ Pipe(s) r / 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 Mulched 1 Bed/Trench Center ”- Bed/Trench Edges Topsoil Yes 70No7 - Yes Yes No COMMENTS (Include cods discrepencies, persons present, etc.) Inspection #1: /�/ Inspection #2: Location: 2147 134the F�lch ond 1 54,017 (SE 1/4 SE 1/4 13 T31 N R18W) Pine Acres Lot 1 Parcel No: 13.31.18.996 1.) Alt BM Description = � 2.) Bldg sewer length = Z' / - amount of cover = > I � Plan revision Required? I ; ,•' Yes [ No Use other side for additionall nformation. f SBD -6710 (R.3/97) Date Insepctor's Signa5ure Cert. No. 1 x . Q e X' J Safety and Buildings Division C ounty - 0 c i 201 W. Wasngton Ave., P.O. Box 7162 J D hi Ivisconsin Madison, WI 53707 - 7162 Site Address Department of Commerce L vz S3/ 2 /`{ Sanitary Permit Number Sanitary Permit App 'cati n `foss 0 in accord with Comm 83.21, Wis. Adm. Code, personal inf do ME E p ❑ Check if Revision ma be used for ses Privac Law, 5. m State Plan I.D. Number I. Application Information - Please Print All Information Property Owner's Name Parcel Number 1 3.31. (� • 9 r 1� /r �1 ST. CROIX COUNTY O 31 - 119 ID OM Property Owner's Mailing Address ` `' ` � Luca s�'A Si; S T N, E City, State / Zip Code Phone Number Lot Num r ` Block Number Subdiv Name CSM Number II. Type of wilding (check all that apply) of P' "°' ❑City or 2 Family Dwelling - Number of Bedrooms ❑Village //❑ Public/Commercial - Describe Use ownsMp ✓ ❑ State Owned (Z Nearest Road 2 3 M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) AL 1 ew 2 ❑Replacement System 3 ❑Replacement of 6 ❑Addition to For County use stem Tank Onl Eris ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44` 4,n - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 D `` Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other _2ea. 15__:� V. Dispe rsal/'lYeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Perc Elevation On Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) lot Y VI. Tank Info Capacity in T Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the and assume responst'6ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Phrml» cure MP/MPRS Number Business Phone Number P1 is Address (Street, City, Sta , e) VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Is Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) �_ ❑ Owner Given Initial Adverse ZL Determination IX. Conditions of Approval/Reasons for Disapproval `C �l spa- X� . U •�f� l�-, S Attach complete plans (to the County only) for the system on paper not Iesa than 8112 x 11 inches in size eRn _A14R (R 05 /01) PLOT P AN PROJECT P.C. Collova Builders Inc. ADD Ss P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1/4S 13 /T 31 N/R W TO Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 BEDROOM 3 CONVENTIONAL )00C IN-GROUN CONVENTIONAL LIFT HOLDING TANK SIZE MOUND SEPTIC TANK SI 1000 gallons LIFT TANK SIZE DOSE TANK SIZE _ HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # 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 92.5 134th St. Pro 3 Bedroom House JB- 220' -1� / 60' Vents vents B- B -3 30' 2 -3' X 69' Cells with >3' Spacing 0' Vent >6 » Standard Infiltrator of Cover Leaching Chamber property with 31.1 ft2 of Area Line 12" 6 Long Grade at System Elevation Plans Designed Using 34 p Conventional owts 200 Manual Version 2.0 . B.M. Property Line l r PLOT P PROJECT P.C. Collova Builders Inc. ADD ss AN P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1 /4S 13 /T 31 N /R,1� W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /19/02 BEDROOM 3 CONVENTIONAL XXX IN- GROU-W6 ESSURE CONVENTIONAL LIFT HOLDING TANK i MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL 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 92.5 134th St. Pro 3 Bedroom House 10' T 220' 20' B- 60' B -1 40' Vents vents ?B-6 B -3 0 2 -3' X 69' Cells with >3' Spacing 0' Vent "�– D–A— >6 „ Standard Infiltrator Leaching Chamber of Cover with 31.1 ft2 of Area Property Line 6' Long 12 91 Plans Designed Using Grade at System Elevation 34" Conventional Powts 200' Manual Version 2.0 . $ M– B.M. Property Line r 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 8112 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. a 'ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). P0 ZI Property Ovine Property Location . Govt. Lot S ff 1/4/4 S J 3T 3 I N R E (or) Prope Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ C ❑ Village Town Nearest Road ity New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate A l 5 GPD ❑ Replacement J _ ❑ Pub 'c or commercial - Describe: Parent material 0 Flood Plain elevation if applicable t-" ff. General comments ,� n and recommendations:-: - © Boring # p 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 Boring # O Boring pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •042 Eftl OD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name ( t) Signature Z CST Number Date Evaluation Conducted Telephone Number -� /U Property Owner _ Parcel ID # Page of 1-1 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 i; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # C] C] ❑ 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. '01#1 `Eff#2 Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 = SOD. > 30 1220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg/L and TSS 130 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 (8.6/00) r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of ,Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code %Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must J� K ' include, but not limited to: vertical and horizontal r e M), direction and County percent slope, scale or dimensions, north arr � r,� c6 o¢ , td n � -� C, ce to nearest road. Parcel LQ.# APPLICANT INFORMATION. `' Tint Pendin p .*i inform�trbn. Personal informa Reviewed B information y ou p rovide ma be u Y P Y ^° n�' IILLCI'r!�Law;s.'�15.04(1)(m)). Y Date Property Owner roperty Location Lakes &Hills Develoment `' 1 ") A l qQ Lot 1l4 NW 1l4,S 13 T 13 N,R 31 W Property Owners Mailing Address 5T C#a&A � ot # Block # Subd. Name or CSM# U Q X /p COUNTY ! 1 - -- Pine Acres U State r ' "Code rh r ; ` [] Ci lase Town Nearest Road / j 4/ fih J� Lc Ed4 1% , �� 7 c l� �'�C al �C C- New Construction Use: Resid n ' e , r of bedrooms 3 ❑Addition to existing building - - -- [] Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpc Recommended design loading rate .7 bed, gpdfftz 8 trench, gpd/ftz Absorption area required 643 bed, f? 562 trench, ftz Maximum design loading rate .7 bed, gpd/ft .8 t rench, gpd/ft? Recommended infiltration surface elevation(s) 93.5 ft (as referred to site plan benchmark) Additional design / site considerations Parent material ---------- - - - - -- Flood plain elevation, if applicable -- - ------ ft S-- Suitable for System Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ®S El U ®S ❑ U ®S ❑ u ®S ❑ U El ®U El ® U SOIL DESCRIPTION REPORT P i bkk- AJQ, t, Depth Dominant Color Mottles Structure I C GPD/ftz go ring# Horizon T in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh onsistenc Boundary Roots Bed I Trench 1 0 -11 10YR3 /3 -- 1 + lms mvfir as lvf .4 5 1 2 11 -18 l 0YR4 /4 ------------ - - - - -- 1 1 msbk �mvfr gw 1 of .4 .5 Ground 3 18 -49 10YR 4/6 -- cl I fsbk mfr as .2 3 - Z elev ------- --- - - - - -- - - -- -27.8 ft. 4 49 -66 7.5YR4/4 ------------ - - - - -- s o ml gw - - -- .7 .8 De th to 5 66 -92 10YR4 /6 -------------- ____ cs osg ml - - -- - - -- .7 8 p limiting factor >92" �or tsSe1 Ss Remarks: 1 0-11 i OYR3 /3 - -- 1 1 msbk mvfr as 1 f 4 5 ' 2 ___ - - - -__ _ -_ __ 2 11 -20 10YR4/4 - - - -- I l mI msbk mvfr gw l of .4 l .5 `f Ground 3 20 -49 10YR4 /6 ...... cl lfsbk mfr as 2 3 elev — 97.4 ft. 4 49 -70 7,5YR4/4 ------------------ s osg � $u' .7 8 I E � - - -- Depth t0 5 70 -88 10YR4 /6 ------- ----- ---- -- cs osg ml - - -- - - -- .7 .8 limiting factor >88" Remarks: CST Name (Please Print) Signature: Telephone No. Jacque Hawkins 1 �� Y 7 L - e Y Y(,, Address Date CST Number Ref# / S �� U u C d� • TV 4/8/00 4 Z 7- 9 7 L 373 Jr ' AROPERTY OWNER: Lakes & Hills Develoment SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pig Depth Dominant Color Mottles Structure GPM? Horizon in. Munsell Qu. Sz. Coat Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed Trench .L 1 10 -12 I 10YR I----------- - - - - -- I 1 I lmsbk mvfr I as I if .4 .5 • `f 2 I2 -19 10YR4l4 ----- - - - - -- 1 I msbk mvfr 9w l of .4 .5 Ground 3 1 19 -43 10YR4l6 c1 lfsbk mfr I as .2 .3 Z e l ev ------------ - - - - -- - - -- 97.5 ft. 4 43 -67 7.5YR4/6 I ------------ - - - - -- I s I osg I mi gw I --~ I .7 8 Depth to 5 67 -89 10YR5/6 F - Cs I osg mi - -- - -- .7 .8 li miti ng I I I -- I I factor >89° I Remarks: 1 1 0 -10 I 10YR313 I------------ - - - - -- I I lmsb mvfr I as if 4 5 2 10 -19 I 10YR4/4 I------------ - - - - -- I 1 I 1 msbk I mvfr I gw 1 of ( .4 .5 `I Ground elev 3 1943 10YR4/6 ------------ - - - - -- Cl lfsbk mfr as - - -- .2 .3 .L 97.8 ft. 4 43 =69 7.5YR4l4 =__ _____ __ ___ 1 s i osg gw ____ 7 .8 •� Depth to 5 __ TT' 69 -93 I 10YR4/6 ------------ - - - - -- I cs I osg ml -- I - - -- I .7 .8 •� limiting factor '93 ,. Remarks: 1 0 -12 10YR313 ------------ - - - - -- ] 1 msbk mvfr as 1 f 4 5 , 2 12 -23 10YR4/3 - - - -- I 1 I I msb I .4 5 ------ - - - - -- mvfr gw I 1 of � Ground elev 3 23 -46 10YR4/6 ------------ - - - - -- cl Ifsbk mfr as -- -- .2 .3 7- 98.O ft. 4 1 45 -67I 7.SYP.4l4 ------------ - - - - -- s asg I mi gw I - - -- ', 8 4 Depth to 5 67 -94 10YR4 /6 ----------- - - - - -- I cs I osg I m1 - - -- -- .7 .8 limiting --�– –�--— factor —_I- -- Remarks: Ground elev _ ft, I I I I Depth to I_ limiting factor Remarks: ±�A mo w_ o l k El l � q N 3 � � N N r � � � G � � a o z � U . 1 fir,' til;, \� Qi NIP � c � c n X � � 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 Ding 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 falls, determine cause of fdkire, 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 Sly 1 - 6z t�- / - 71j---3,P.6 8 n ✓ Shaun Bird 00 ,f J 1 l.lwln L.L/U11 A SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSIiIP CERTIFICATION FORM Owncr /Buyer cVA g t1 S =w < — hfailing Address Property Address `� (Verification rcquircd Crom Planning Dcpartmc.it [or new constructi l City /State i j&A) 1 N\ % L Parcel Identification Nurnbc1 (p LEGAL DESCRIPTION Property Location 5 c - - - ;,, S� " +, Sec f W, Town of Subdivision I -ot it . Certified Survey Map 4" VolllIlle Page Fr' ��` trrauty Decd # O -'�'! / �/ Voluly3� Pag � Sl;ec hour es Cl no Lot littcs i� :Itiii i c yc �Cg<o SYSTEM t�1AINTENANCE Improper use and maiatc aance of your scptic systcm could result in its premature failure to handle wastes. Proncr maintenance consists of pumping out the septic tame cvc.y three yearn or sooner, if needed by a licensed pumper. What you put into the systcm can affect the function of the scptic tans as a treatment stage in the waste disposal systcm. The property owner agrccs to submit to St. Croix Zoning Dcpartiiicnt a certification form, signed by the owner and by a mastcrplumber, joumcynranplumbcr, rtstrictcd plumber or a liccased pumper verifying that (1) the ou -site :vastewaterdisposal systcm is in proper operating condition and/or (2) alter inspection and pumping (if accessary), the scptic (auk is lcss than 113 full of sludge. Uwc, the undersigned have read the above requirements and agrcc to maintain the private sewage disposal system with the standards sc. forth, herein, as set by the Departmcat of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic systcm has bcca maintained must be completed and returned to the St. Croix County Zoning Office ,vithin 30 days of ee year expiration date. SiGI DATE OWNrR CERTIrICATION I (we) certify that all statements on this form are true to the best of my (our) hmowledge. I (we) ant (arc) the ovmcz(s) of the propc :t cscribed above, by virtue of a warranty deed recorded in Register of Deeds Office. A y Z SIG , A - OF APPLICANT DATE "•• *'• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning D " 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 decd U 1871P 407 6 7 6 1 1 8 STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., YI This Deed, made between Lakes and Hills, Inc., a Minnesota RECEIVED FOR RECORD Corporation, 04 -11 -2002 11:00 AK - EXEMPT It NEED Grantor, and P. C. Collova Builde Inc. REC FEE: 11.00 TRANS FEE: 77.70 COPY FEE: C ERT COPY F Grantee. --- -- --.- -- PAGES i Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area L 1, Pine Acres, Town of Star Prairie, St. Croix County, Wisconsin. Name and Return Address David J. Estreen 304 Locust Street Hudson, Wl 54016 038 - 1193.10.000 _ Parcel Identification Number (PIN) This is not homestead property. Ot) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ; , 0-- day of April 2002 Lakes and Hills, Inc. • By: Rich ard S. N son, Presi ent AUTHENTICATION ACKNOWLEDGMENT Signature(s) Lakes and Hills, Inc., by Rich S. Nelson, its STATE OF WISCONSIN ) President, ) ss. County ) aut rk4S day of April 2002 Personally came before me this day of the above named n d r. -- -.- --- -- ;7q MEIviBER.-STATE BAR OF WISCONSIN ing ; c a� Y to me known to be the person(s) who executed the foregoing L, - x § 706.06, Wis. Stats.) instrument and acknowledged the same. otli¢tvc� by THIS INSTRUMENT WAS DRAFTED BY r _ Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, Wl 54016 _ My Commission is permanent, (If not, 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. Intormarlon vrmosronai. company. Fond au Lot yh STATE BAR OF WISCONSIN 8001.55 -Ml WARRANTY DEED FORM No. 2.1999 011 f : Ig ° O O Q O .0 CD rt v i I ! CD J y 0 �Z - -� S8753'16T Z 2 76.20'— w 00� ZE 100• w a Z �o O, l l l ?9 ?0 W 3 'a ; c x a� / 8.94 • O / o z 0 / /•► N N 7 a U1 U1 p Z n 00 O a UI •fir (0 V �A CA) o *J �y (D - / Nsvr / o {' --% (n v p (n C (D rt °rte p? rt n CND �. ?. _ w '01#46-C N w� �CD _wo s 3' /I —r —�� ? m / �0 C Lf) � A.7C 00 ' ;0 n 100' O PMA 00 co r -( z $ I to V � . rt c -2" iron pipe found a 425.58' �� S 89 '07 (�� _ i 2640.20' •\ i! - - -- 15 NORTHGATE 16 _i1'� ��500 - W • • S 1/4 Comer. Sec. 13. T31N. R18W.