HomeMy WebLinkAbout038-1193-80-000 Wisconsic,Department of Commerce County:
Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No:
399545 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. I Star Prairie Township 038 - 1193 -80 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION EL VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 4� f
DU
Alt. BM
Aeration Bldg. Sewer
Holdin ! pt Inlet
t Outlet
TANK SETBACK INFORMATION , S3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic QJ; Bottom
Dosing Header /Man.
c
Aeration Dist. Pipe
Q 4
Hol ' g Bot. System L P, ,q 0
L 3 p /o'
PUMP /SIPHON INFORMATION Final Grade
M cturer Demand St Cover
Model Number = -
TDH Lift Friction Loss m Head TDH t
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM 1 r 6lh BEDITR ENCH Width Length No. Of Trenc es ENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 / / p, —7s/ Z AV
SETBACK SYSTEM TO l04 T P/L BLDG WELL LAKE /STREAM L G Manufact r.
INFORMATION
Type Of System: } � o , 2 � 7 d Model umber
DISTRIBUTION SYSTEM 7
Header /Manifold IlDistribution ole Size x Hole Spacing Vent to Air Intake
/ N Pipe(s) / 1 /
1 Length _ jL2 _ Dia Lengt 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 xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
0 Yes R9 No 0 Yes � No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #l: Z 1 Inspection #2:
Location: 1345 218th Avenue New Richmond, WI 54017 (NW 1/4 NW 1 13 T31 RI 8W) Pine Acres /' Parcel No: 13.31.18.1003
1.) Alt BM Description = y J GvG� �t�/ , c1 ks 4- s- / 7 5
2.) Bldg sewer length 7`• :rl l % i
- amount of cover so � f
7 � ebser ✓rod %a. - P;pes �h.s�l�0 �i.� /� �o `�.S —d
Flu«
Plan revision Required? [ Yes fffl No /
Use other side for additional information. ti. (�
SBD -6710 (R.3/97) Date Insepctors Sign ture Cert. No.
to " / Qh� balrlr�q ale JQ.��b.� 5 4fc��v�a� 50t`I
did ,�, / Co� r c l�• S s FG,, (Mas /w s�•�,� /� P ✓e' _
Gtr �0('/ p r e- 5-7f �� b lew O�•�,�,.,� g�c.
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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 15 Box 7302
®�J��i ®n�,� Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
(Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) fbL& system, on paper not less than 8 -1 /2 x 11 inches in size.
County , State Sanitary Permit Number UKheck if revision to previous application I State Plan I. D. Number
rb X SAS'
I. Application Information - Please Print all Information Location:
Property Owner Name Property Leo /coati /on
T� ,N, (or W
Property Owner's Mailing Address Lot Number Block umbe
City, State Wp Code Phone N"F Sub ision Name or CSM Number
I Type of Building: (check one) ❑ City
or 2 Family Dwelling - No. of Bedro °Z /r ❑ Village
❑ Public /Commercial (describe use):_ , >94ovi of
w �7
❑State -Owned :'� ' �tO �� �� � � - �r ��G'A__�
z
7 C`q{,; x Near f oa
Co
z, y
ts<T Parcel Tax Number(s)3� /S
III. Type of P rmit: (Check only one box on line A. Check box o :find. , >i£ a plic ble1 y * (/
A) Iw 2. ❑ Replacement 3. ❑ Replacement of I i 5. 6. ❑ Addition to
/System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Non- 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: L Z - , Z
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. S stem Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min ./inch) � � Elevation / 6
^� r
Q 3 �� 7 / /t Z
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
❑ 0 ❑ ❑
VIII. Responsibility Statement
I, the undersigned assume responsibility for installation of the POW shown on the attached plans.
Plumber's Name (print) Plumber's i ur (no stamps): MP/MPRS No. Business Phone Number
J 2 2 .6 i Z
Plumber's Address (Street, City, State, Zip Co
l� J'
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination �Q_ Q�j
X. Conditions of Approval /Reasons for Disapproval:
< re e (�U s
SBD -6398 (R. 07/00)
P C18 N
PROJECT P.C. Collova Builders Inc. s 705 Ctv Rd E Hudson Wi 54016
NW 1 NW 1/4S 13 /T 31 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/2/01 BEDROOM 3
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE L RAT 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V .P ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE c mark
�
� �,
SYSTEM ELEVATION 9 8 /03, IL 1dj.
Q 0� ft
G4�� r� opt 218th Ave
Vent
>12" Sidewinder High
of Cover Capacity Leaching Plans Designed Using
Chamber Conventional Powts
6' Long
16" Manual Version 2.0
34" Grade at System Elevation
a1
g�
Pro 3
2 -3' X 69' Cells with Bedroom �G
>3' Spacing House
0 '
20'
2%
0 ' Slope
B.M. T 5'
35_� 20' -3
2
134th St. Vents Vents
Ljq B -6 7 B -2
80'
177' Prop Line 80'
P y
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division o 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 ----- - • t
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. 3 �' -- �/9 3 " �' Q — Da D
Please print all information. Re ' ad by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � v
Property Owner Property Location /
Govt. Lot 114 "/4 S / 3 T 5 l N Fa E (or to
Property Owner's Mailing Address Lot # Block # Sub . Name or CSM#
City State. Zip Code Phone Number ❑ City ❑ village -Q Town Nearest Road
New Construction Use: Residential / Number of bedrooms �` Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material � r� Flood Plain elevation f applicable ft.
General comments
and recommendations C% 10 3 . (S� kXs,,,� s
1 S�JJ Boring # ❑ Boring /0 -7•
1 b f C pit Ground surface elev. ft. Depth to limiting factor/ 2,_ in,
Soil Ap lication 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
-1 L)
-
C
v
Z
3 s
/22 A1121
/rill I. L IEE I
n Boring # ❑ Boring
L / J -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/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2
Z 4
Effluent #1 = B OD, > 30 < 220 mg /L and TSS >39 m L
9/ " Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L
CST ame (Please Print) S nature C T
Address Date Evalua ion Conducted Telephone Number
F r; T'1 -k 7 Zl1 I S7 r17.' /1!i l
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
® Isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce bit ltd f t
(Sum completed o county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) for t system, on paper not less than 8 -1/2 x inches in size.
County State Sanitary Permit mb eck if revision to p revious application ;fan I. D. Number
� . 3
I. Application Information - P lease Print all Information Location:
Property Owner Name Property Location l �j
✓ T � N, ld(cCW
Property Owner's Mailing Ad Lot Number Block Number
"wr i:!�
City, State ' ip Code Pho et Subdivision Name or CSM Number
II. ype of Building: (check one) �:% ) ❑ city
\,' t`
-- 1 or 2 Family Dwelling - No. of Bedroo s C � _ ��,� ❑ Village wn of
❑ Public /Commercial (describe use):_ p
1 r
❑ State -Owned
Nearr tRoadW
.
I W1 2✓ ({rOfo ` ✓ �. ;' ,;0, J�N� Parcel Tax Number(s) 0 S - -,'v -
111. Type of rmit: (Check on y one ox on the A. Veck bo o rhi� )B if applicable) 13 - 3 4 le. ov >
A) 1. 2. ❑ Replacement 3. ❑ Rep cem t of 4. -- - 5. 6. ❑ Addition to
Syste System Tank On Existing System
B) Pe Number Date ssued
❑ A Sanitary Permit was previously issued 3 3O yp
I Type of POWT System: (Check all that apply /Aerobic oEJ - N on-pressurized In- ground und ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade Treatmen nit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: Z L - arlor S�
1. Design Flow (gpd) 2. Dispersal Area 3. Dirsal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required P Rate (Gals. /day /sq. (Min. /inch) Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
'
New E ting rete structed
Tanks J17anks
❑ ❑ ❑ ❑ ❑
VIII. Responsibility StatjFment
I, the undersigned, assurjfe responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Si nature (no s ps): MP/MPRS No. Business Phone Number
Plumber's Address (Stre , City Zip Co e)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing ent Signature (No stamps)
I Approved ❑ Owner Given Initial Adverse Surcharge Fee) _
Determination S Q . " 2- &
X. Conditions of Approval /Reasons for Disapproval:
1. Effluent filter to be installed and maintained per manufacturer's recommendations.
2. This revision/transfer was submitted to reflect a change in plumber.
3. Any filling and grading that will affect the capacity of the HWL retention area is prohibited.
SBD -6398 (R. 07/00)
PLOT PLAN
PROJ19CT P.C. Collova Builders Inc. ADDRESS 7 5 Ctv Rd E Hudson Wi 54016
NW 1/4 NW 1 /4S 13 /T 31 N/R 18 TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/24/01 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PR 416 CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SE LOAD RATE 1.2 ABSORPTION AREA 377 # of cha ISers 22
IL BENCHMARK V. . Top of 2" PVC Pipe ASSUME ELEVATION 100' ilter Zabel A -100
❑ BOREHOLE O W H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.0
218th Ave
k16"
>12 Sidewinder ' h
oover Capacity Leach PI Designed Using
f C
Chamber C ventional Powts
6' Long
anual Version 2.0
34" Grade at System Elev 'on
o3
droom
Ho e
10
10'
B -1 B -5
Vents
35 0 , 2%
Slope
2 -3' X 69' Cells with
>3' Spacing B -3
35
134th St.
AL 3 B -4
B -2 Vents
80'
B.M. i 177' Property Line 80'
Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
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 County
include, but not limited to: vertical and horizontal referenc direction and 5't
percent slope, scale or dimemsions, north arrow, a octiori�apd df to nearest road. parcel LD.#
APPLICANT INFORMATION - Please.print all j' Pendin
Personal information you provide may be used for secondary purposes �Proae ! law s. 15.04 (1) (m)). Rev ie d y Date
Property Owner Property Location
Lakes & Hills Development " °` Gm. ILot 1/4 NW im,s 13 T 31 N,R 18 W
Propertv Owner's Mailing Address # Blo( # Subd. Name or CSM#
o x // v ; ,, r r - 8 - Pine Acres
City State Zip Code PhoJt9fftWQ� F '_'� City llage (Town Nearest Road
218TH. Ave.
New Construction Use: Z Residentii ms --- L _ ❑Addition to existing building
❑ Replacement [] Public or commercial describe
Code Derived daily flow 450 gptl Recommended design loading rate .7 bed, gpd/T 8 trench, gpd/fts
Absorption area required 643 bed, f1 562 trench, fl? Maximum design loading rate .7 bed, gpdM .8 tr ench, gpd/R
Recommended infiltration surface elevation(s) 95.0 It (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 ❑ U ® S ❑ U ® S ❑ U Z S ❑ U ❑ S ®U ❑ S ® U .7
SOIL DESCRIPTION REPORT
Borin # Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/ft2
g in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. Bed Trench
1 1 0 -10 10YR3 /3 ------------ - - - - -- I lmsbk mvfr as if 4 .5
2 10 -24 10YR4/4 -------- - - - - -- - - -- 1 lmsbk mvfr gw lvf .4 .5
Ground 3 4 -52 7. 5YR4/4 ------- - - - - -- cs osg ml as - - -- 7 8
elev- — - - - - - - -- — - - - - - --
98 ----------------
4 ft. 4 52 -80 10YR4/6 s osg ml - - -- .7 .8
Depth to - fb — iti►c bye, rt
limiting 1 Z
factor
>80
Remarks:
2 1 0 -11 10YR /3 ------------ - - - - -- I 1 msbk mvfr as if .4 .5
2 11 -24 10YR414 ------------ - - - - -- 1 lmsbk mvfr gw 1vf .4 .5
Ground 3 24 - 51 7.5YR4/4 -- - - - - -- - cs osg ml gw - - -- .7 .8
elev — -- - -____
98 4 ft. 4 51 - 82 10YR4 /6 ------------ - - - - -- s osg ml - - -- .7 .8
Depth to l o' 2 ' 3 Cis
limiting
factor S
Remarks:
CST Name (Please Print) Signature: Telephone No.
Jac Hawkins / \ µ „r-�C . Y `7 Z - Y-y y (e
CQ �.- lo.Gcll�w._ �G
Address — il l Date CST Number Ref#
lie 1 U au z f U 8S 4/8/00 0? Z_' 380
PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of J
PARCEL l.D.# - Pending
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPDI12
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ;Trench
1 0 -11 10YR3/3 - - - -- 1 1 msb mvfr as if .4 .5
2 11 -21 10YR4/3
I 1 msbk mvfr gw 1 of .4 .5
Ground
3 1 -52 7.5YR4/4 ---- - - - - -- - -- cs osg ml gw .7 .8
elev °`- -`-
98.7 ft. 4 52 -84 10YR4/6 -------- --------- s osg ml - - -- - - -- 7 ! $
Depth to 1'
limiting ,
factor 0 A
>84 11 — -
Remarks:
4 1 0 -11 10YR3/3 ----------- - - - - -- 1 lms mvfr as if 4 5
2 11 -24 10YR4 /3 ------------ - - - - -- 1 lmsbk mvfr gw 1vf .4 .5
Ground
elev 3 24 -49 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8
98,7 ft. 4 49 -84 10YR4 /6 -- ---------- - - - - -- s osg n - - -- - - -- .7 .8
Depth to
limiting - -- — - —
factor
>84"
Remarks:
5 1 0 -12 10YR3/3 ------------ - - - - -- 1 1 msbk mvfr as if .4 .5
2 12 -28 10 /3 1 l mvfr gw lvf .4 .5
Ground - - -- —
3 - 8 -50 7.5YR - - - - - - - - cs osg ml g .7 .8
elev " - " " " '"
9 5 ft. 4 50 -94 10YR4/6 ------------ - - - - -- s osg ml - - -- 7 8
Depth to
limiting -- — — -- -
factor
>94"
Remarks:
Ground -- - - - -- - - - - -- - - - - - -- - --
elev _
ft.
Depth to
limiting - - - - -- -
factor
Remarks:
�.���1;�. •� � �� / /S �cv�'��,.,,.,E -,v f " S�'c•. �3 �T,�l N //"� l�c.c.r
P
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fir
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ST CRO1X COUNTY
SBPTIC TANK MAINTENANCE AGRLEMENT
AND
nn n OWNERSHIP CERTIFICATION FORM
Owner /Buyer IJ. 1 110VA W tt S --�- ,J <—
Mailing Address - 70 , 00. s u•v U
Property Address 1 S
(Verification required from Planning Department for new construction)
City /State A Ack, M&Ar Parcel Identification Nuniber o 3 - ! 19 3 ' g 0 - Q�C�
LEGAL DESCRIPTION
Properly Location � /,, Sec. 0 . 'f 3 -R--(LW, Town of � 1 12- iOC4 /mo f
Subdivision L 1' VE AcAies Lot 11 8
Certified Survey Map Volu(nc , Page 1E
Warranty Decd # ( VZ Volume c l _`J ' . Page It
Spec houses ❑ no Lot lines identifiablexyes El no
SYSTEM MAINTENANCE / \\
Improper use and maintenance of your septic systcm could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic lank every three years or sooner, if needed by a licensed pumper. What you put into die 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. Qoix Zoning Dcpaitrncut a certification fonu, signed by (lie owner and by a
master plumber, journeyman plumber, restrictedpluniber or a licensed pumper verifying that (1) the ou -site wastewalerdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), die 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 (lie 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 yc expiration date. l
e-
S NATUkB Or APPLICANT DATE
OWNER CERTIFICATION
I we) certify that all statements on this form arc true to lire best of my (our) knowlcdgd. I (we) am (are) the ownci(s) of
the perly dcs ibc above, by virtue of a warranty deed recorded in Register of Deeds Office.
NATURE Or APPLICANT nn
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by (lie Zoning Department. * * « * *•
�* Include ivltli lhls application; a stamped warranty deed fioni the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty decd
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
�- °7f
Shaun Bird #226900
RIVER VALLEY ABSTRACT Fax :715- 381 -5053 Apr 2 2001 10:28 P.03
1595puE283
' R O MMN OF 9PH
ST. CROXX CO., NI
AdEM FAR Kl:OR9
DQCUMMSNTnix Q!J!7 CLd1iM @9 @ 03-0'3 - 80ol ho0 AN
r FOE.
K um] ,matme,., ing
P
.
'AA . 9 f�c 1�b :o o
l
said dwm IQ P.C- roman Rufkt�5—m:
the Bo1lowius dmrlbed teal mss in
state of Wismasid
C. . C ollets
Lot a, Pins Aare, Se Croix County, WiraaaaU , P.C. s
P.C. C 8utldars,lae,
705 County head B.
HtWsom, Wl 54016
TimpamaiNa. Q3a 1199.90.000
Tay u 11or horamma property.
Dated f 1r t 1,
=u Canat<ttEft Ltc.
AathMedt!atie6
Staoms($ STATEOFMDaeSOTA )
cowry oB ' 1
anthanticattq &A _day Of 20,x„ �,�,y(
Pe -mUy alga befaee no thir Aday of
40,►, do abow named p3L+iaM. schceitk tk r c s {�t�r
7Ytk;Matabeg9:ur8arofwiroonein - — .... -..� —.
THIS JN34Ril31ffiVT WAS D1lAF YP.D Bli: m 1>1e Imo/Vti to for paaea(s) who the Pereioiog
wlrttSe the ame,
StiII>Idfsr. Mlv Sso9z ' �
(6511439.2931 Nomry P tt a - COWM. Mica
MY Won is PwmmedL (If not. slate expirstioa data:
StOaatans tnsy be twdtendcata4 or aekxoaleUed t + 20
x
xrcv �on"�evt
IN THE RIG Located in the SE 114 of the NW 114, Ic
onumentation fees.
1 14 and mart of the NE 1 of the NW
R18W, Town of Star Prairie, St. Croix C
80' RADIUS RIGHT -OF -WAY -�
TEMPORARY CUL-DE TO BED UNPLATTED
AUTOMATICALLY VACATED WITH LAND S
ROAD EXTENSION TO THE EAST.
--------------------
326.24' 33' 3 ' `;' _ _ _ _ 119.14'
3 - 356.01'- �� 0,
r
10 M .�,
6 ft Iv I o I o I v) 68,123 sq. ft.
5, 791 s
q• •r 1.56 acres hM• hw
1.51 acres
"1 7
328.36 ;L W .W o , 65,531 sq.ft.
° '2� "E ' / 1.504 acres
S00°16 57 W -�° ;.� I o Sri ✓
L� R�
65,776 sq.ft. 'I 8 0
1.51 acres —1 33' �, � 66 517 q. ft. �� � `��' �o i � �
C
1.5 acres
To \ \
C
SO6 -23 45 E \ 10'0.
335.6 1 \
�%
12 � \ \� �� k'L � ��� mo o\
70,634 sq.ft.
1.62 acres
so '
27 s
/0 82,146 sq. ft. o
1.89 acres
G ip / / �i i•• � / // ' W N � `� ��p
83,.
N
'�
na \ \
21 IN
A) 2
I
68,652 sq.ft. \ ?9q *0-"W C35
w 80 ' Jry 1.58 acres ��9\ `� S1
?0J0 07 "W
Cl* s.
`?,q / y �� 9 ,�� 316 "�O
_ 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
NVisconsin
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] — (Submit completed form to county if not
j 1 state owned.)
Attach complete plans (to the county copy only) for the syst , o r not le ,, /2 x 11 inches in size.
County State Sanitary Permit N ber ❑ Check if to pre "ous,*plicafi Plan I. D. Number
I. Application Information - Please Print all Information ;Go ation:
Property Owner Name i� 0) RAY rty Location / 7
J T C ?��� N�+ +! 1 A' /4, S ! 3 TJ 1,N, R / or�
Property Owner's Mailing Ad s "tNumber Block" Number
City, State Zip Code Phone Nu -, - 1 S division Name or CSM Number
(-
r Type of Building: (check one) ❑ City
1 or 2 Family Dwelling -No. of Bed ms
❑ Village
❑ Public/Commercial (describe use):_ �( Town of
❑ State -Owned S�O A ✓� o- �-�,�R
Nearest Road
Parcel Tax Number(s)
III. Type of Permit: (Check only one box on line A Check box on line B ' applicable) 1 3 1 00 3
A) I. WrNew 2. ❑ Replacement 3. ❑ placement of 4. 5. 6. ❑Addition to
System System Tan my Existing System
B) Date Issued
❑ A Sanitary Permit was previously issued ertnit Numhe
IV. Type of POWT System: (Check all that apply)
WNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holdi ❑ Single Pass ❑ Drip Line
• At -grade ❑ Aer c Tre ent Unit ❑ Recirculating ❑ Other:
f7/
V. Dispersal/Treatment Area Information: f it t r feV - T
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal 4. Soil Appli ion 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /da.� in. /inch) Elevation r
? 95 9g
VII. Tank Capacity in T09tal # of Manufactur Prefab Site Steel Fiber- Plastic
Information Gallons alions Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume resp sibility for installation of the POWTS show n the a ttached plans.
Plumber's Name (print) Plumb 's Sig ture P PRS No. Business Phone Number
Plumber's Address (Street, City tate, Zip Code)
11D
IX. County/Departm nt Use Only
Disapproved Sanitary Permit Fee (Includes G water
11 round Date Issued Issu' g S' n re (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) Z , L av v
/ Determination (btu S 3
X. Cond'tions of Approval /Reasons for Disapproval:
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Privat /atmentSystems astewater Tr tment
System (POWTS) shall include information and procedures fong the sys m within
the parameters of Comm 83 and 84, and the conditions of appe depa ent, agent,
or governmental unit. The approved plans and permits for sysn file the county
zoning or health department.
Th management plan complies with Comm 83.54, Wde, and the In- Ground
Soil Absorp ' n Component Manual for Private Onsite Wastewment Systems SBD- 10567 -P (R.6 9). Table 1: System Design Specific
Sanita ermit Number X 1 9
Number Bedrooms
Design Flow - eak (gpd) ySC�
Estimated Flow - ft rage (gpd) DSO
Septic Tank Capa (gal)
Soil Absorption Compone Size (ft) 7
Type of WastewateN Domestic
Table 2: Soil Absorption C ponent - Limits of Reliable Operation
S "c Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size (in) OF 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
/Table 3: Maintenance hedule
Septic Tank Z Inspect and /or servicftnce every 3 years
Outlet Filter Inspect once a year an clean at least once every 3 years
Soil Absorption Co onent Inspect once every 3 yea
Septic Tank
The sep c tank shall be maintained by an individual certi\torvice septic tanks
under s. 281.4 , Stats. The contents of the septic tank shall be accordance with
NR 113, Wis. dm. Code (Servicing Septic or Holding Tanks, Pubers, Grease
Interceptors eepage Beds, Seepage Pits, Seepage Trenches, rtable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
fr m its enclosure. If the
retain solids in the tank that may slough off the filter when removed o
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed volume an
P emo ed when the vo u e of scum d sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the ext service
needs to be performed to maintain less than maximum scum and sludge accum tion in the
tank.
Manhole risers, access risers and covers should be inspected for ater tightness and
soundnes Access openings used for service and assessment shall sealed watertight upon
the completi of service. Any opening deemed unsound, defective r subject to failure must
be replaced. osed access openings greater than 8- inches in meter shall be secured by
an effective lockin evice to revent accidental or unauthorize ent into the tank.
P rY
No one sho enter a septic or other treat nt or holding tank for
any reason wit ut being in full complianc ith OSHA standards for
entering a confin space. The atmosph a within the septic or other
treatment of ho/din ank may contain that gases, and rescue of a
person from the inted of the tank m be difficult or impossible.
Tank abandonment shall be in corda with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS com n t.
Soil sort Component
The soil absorption compon t serving th\oration re is designed to accept domestic
wastewater from a residential faci ' The limits of this component are shown in
Table 2.
The longevity of a soi bs n e e s greatly on proper and time)
g ty orptio component d p g y p p y
maintenance, and system a within or below the limits of r 'able operation. Good water
conservation practices by II occupants and the installation o ater conserving plumbing
fixtures are key factors i extending the useful life of this comp ent.
The soil abso tion component's operation must be assess by inspection at least
once every three y rs. The inspection shall include recording the I els of ponding, if any, in
the observation pi s, and a visual inspection for any evidence of su ce seepage or discharge
from the compon nt. On steeply sloping sites, areas of erosion should a identified and
reported to the ner for repair. The surface discharge of domestic was water or sewage
from the syste is prohibited and considered a human health hazard.
Traffi around or over the soil absorption component should be avoide particularly
during winte months. The compaction or removal of snow cover over the com onent may lead
to hydraulic ailure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep - rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
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PINE ACRE
Located in the SE 114 of the NW 114, part of the S
114 and part of the NE 114 of the NW 114, all in
R18W, Town of Star Prairie, St. Croix County, Wiscc
UNPLATTED LANDS
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A 1.56 acres ` ^ o �°'s z 65,
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3.36 1.5 acres
C% C39
Computer #: 038 - 1193 -80 -000
Parcel #: 13.31.18.1003
Municipality: Star Prairie Township
Address: 1345 218th Avenue
New Richmond, WI 54017
0411212004 Jackson, Aaron D. Jon Sonnentag
I explained that I looked back through the file to see if there was any history of problems during
construction for this area. I did not find anything, so either it was installed properly and for some
unknown reason began to fail or it was possibly just over looked or did not appear to be a source
of problems. Unfortunately, we do not have any financial guarantees anymore and really do not
have any authority to require activity from the developer. I suggested that he try to work with the
developer and builder as best as possible to see if there is anything they can do for him. I also
suggested that he could contact Pete Kling to get suggestions on the type of seeding rates and
erosion control devices that would be helpful.
ST. CROIX COUNTY
�,�� - WISCONSIN
r'' "*o z ZONING DEPARTMENT
f O M 1 N u now ST. CROIX COUNTY GOVERNMENT CENTER
- 1101 Carmichael Road
—� Hudson, WI 54016 -7710
Phone: (715)386 -4680 Fax (715)386 -4686
rax
To: Pete Kling From: Jon Sonnentag
Fax: 715 -684 -2666 Pages: 6 + cover
Phone: 715 -684 -2874 Date: 4/8/2004
Re: Pine Acres erosion problem CC:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
9 Comments:
Pete
I received a call from the property owner of lot 8 over problems that he is currently having with
washouts. He has contacted both the developer (Nelson) and the builder (Collova) and neither will take
any responsibility to help him correct the problem. Could you take a look through your file to see if we
can confirm if we ever had issues with this area during construction. I'm not sure that there is a whole
lot that we can do since no one really gets identified to complete the long -term maintenance. Any
thoughts? Talk to you later.
Jon
St. Croix County Map Output Page Page 1 of 1
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St. Croix County Planning Department '—' State Roads
1101 Carmichael Road Township Roads
Hudson, WI 54016 County Roads
Phone: (715) 386-4674 Rivers and Streams
Lakes
DISCLAIMER : The information contained on this map is advisory. Map Villages
O Townships
accuracy is limited by the quality of the public records from which it was
prepared. It is not intended as a substitute for an accurate field survey. Federal Land
m State Land
AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist County Land
presently in the County may not be present in the photos.
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• 1960 8th Ave
St. Croix County Land and Water p a Boar 9s
Conservation Department
Baldwin W154002
r
Phone: 715- 684 -2874 Fax: 715 -684 -2666
August 30, 1999
Mary Jenkins
Zoning Department
1101 Carmichael Rd.
Hudson, WI 54016
Re. Escrow money and erosion control for subdivisions
I would recommend the releasing of the escrow money for erosion control practices for
Pine Acres Subdivision. I visited this site earlier today and everything looks to be in
order. I will' continue to observe this site and make sure everything continues to go as
planned.
Respectfully,
Chad M. DeWyre
Z00 e WA I /Ma XIO2I0 is 999Z X89 STL XVd TIC : £T ([HM 00/0£/80
P.O. Box 108
1150 Davis Street (715) 796 -2227
Hammond, Wisconsin 54015 Fax (715) 796 -2339
ST. CROIX COUNTY WISCONSIN -'
HIGHWAY DEPARTMENT ,4-
1
August 21, 2000
Steven Fisher
r
Zoning Director = ✓
110 1 Carmichael Road
Hudson, WI 54016
RE: Pine Acres Subdivision
Dear Steve:
The Highway Department has completed the final inspection for Pine Acres, located in
the Town of Star Prairie.
The road constructed by Selzler Excavating for this subdivision was built accordingly to
the design plans as regulated by town road specifications.
Note that during final inspection an area in the southwest cul -de -sac was found not to
meet the required depth of base course. The contractor was notified and this matter
has been corrected.
If you have any questions or concerns on the above, please feel free to contact me.
Sincerely,
L
J s W. Krizan
Construction Engineer Technician
C: Dan Fedderly, PE, RLS, St. Croix County Highway Commissioner /County Surveyor
Jeff Durkee PE St. Croix County Highway Engineer
• ty 9 Y 9
Douglas Rivard, Chairman, Town of Star Prairie
JWK/jn
QUALITY • EFFICIENCY • PRIDE
ST. CROIX COUNTY
WISCONSIN
+ ZONING OFFICE
°— ST. CROIX COUNTY GOVERNMENT CENTER
• ___ 1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680 • Fax (715) 386 -4686
December 20, 2001
Builders Mortgage Company LLC
Attn: Patricia Filip, Chief Financial Officer
646 East River Road
Anoka, MN 55303
RE: Irrevocable Letter of Credit No. 6966- 500 -DI
Dear Ms. Filip:
Enclosed please find the above referenced letter of credit issued by your institution to
Lakes and Hills, Inc. This financial guarantee was required by St. Croix County to
guarantee proper road construction and the installation of erosion control practices
within the major subdivision of Pine Acres, Star Prairie Township.
We have been informed by the St. Croix County Highway Department and the Land and
Water Conservation Department that all road construction and the installation of the
erosion control measures have been completed according to plans, therefore we are
releasing the guarantee.
Should you have questions or concerns, please feel free to contact this office.
Sincerely,
Mary J. Jenkins
Assistant Zoning Administrator
Enclosure
C: Clerk, Town of Star Prairie
Lakes & Hills Development
File