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HomeMy WebLinkAbout038-1194-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395141 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: De oun , Bill I Star Prairie Township 038 - 1194 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: C7U. -D cJU.rs� Z •` I'tA- (c vram 1� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing V Alt. BM ' ' 9 qS r O Aeration Bldg. Sewer 1 40.0 t • t3C • 3O Holding St/Ht Inlet ( _ �/ r TANK SETBACK INFORMATION St/Ht Outlet G ' RR• ST , TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > �S 4 Dt Bottom Dosing (v Header /Man. Aeration I N, Dist. Pipe c.0. �. 98 • s Holding Bot. System*-' r PUMP /SIPHON INFORMATION Final Grade •Sd Manufacturer Demand St Cover GPM 6 94 , %A 1 Model Num TDH Lift Fricti oss System Head TDH Ft Force in Length Dia. Dist. to well SOIL ABSORPTION SYSTEM RENC Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME IONS / �,. SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTIQ# SYSTEM Header/ ani u Distribution ��i x Hole Spacing Vent to Air Intake • Pipe(s) ry � � ' Dia S acin Len th Dia Length p g 9 9 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulche T d Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No �a] Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 018 / �S / L Inspection #2: Location: 2183 134th Street New Richmond, WI 54017 (NE 1/4 NW 1/4 1; T31N R18W) Pine Acr arceI No: 13.31.18.1008 1.) Alt BM Description = TQQ d &K • P 1 v 2.) Bldg sewer length = 70. blf - amount of cover = Z� {+ / �� `v- 0. Plan revision Required? [a] Yes No 11 II Use other side for additional information. I ba �S+ 01 r — -- - - - Date In ctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division Cry 201 W. Washington Ave„ P.Q. Box 7162 , Madison, WI 53707 - 7162 Site con in De artmont of Commerce - - :Z Sanitary Permit Applic Sanitar Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal o n youf�,vido El Check if Revision be used for seco Priv I. Application Information - Please Print All Information/ State Plan I.D. Ntmtber Property Owner's Name ` X�. Parcel Number s� 90 Property Owner's Mailing Address �! 2 � / S T 2 r Pro p f � ul.acatlon J) N City, State Zip ode I,o t Number Block Number Subdivision Name CSM Number H. Type of Building (check all that apply) . ❑City 4 of 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use ownshi eve P oc /LLQi ❑ State Owned Nearest Road III. Type of Permit: (Check only one bos on line A (numbering scheme for internal use). Complete line B if applicable) A. phew 2 ❑ Replacement System 1 3 ❑ Replacement of 1 6 ❑ Addition to For County use /� Sy stem Tank Only Existing System -• t �7 �O — O 0 B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued 3 .3/, f 100 rV. Type of Permit: (Check all that apply)(nmmbering scheme is for internal use) A--t00 1 ; t ; ) - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand 22 ❑ Pressurized Ia�Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -arse 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispenaMeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gsls./ Days /Sq.Ft.) (Min./Inch) Elevation '/ -" * -�, --� S -?, -- 2 -� _ ) 1 2- 9 7 K VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plague Gallons Gallons of Tanks Concrete Constructed Glass New Existins Taeks Tanks Sepik or Bolting Tank _ Doeing Chamber VII. R onsibiil Statement I, the uadersiped sun= responsibiilty for iaetalla the POW" shown on the aft &" Plumber' Name (Print) Plumber's Signature MF bar Business Phone Number � � 7� OW Plumber's Address (Street, Cit State, ,Z' Code) f 17 VIII. covet me artment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' g Agent Si nature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse dD Determination �. IX. Conditions of Approval/Reasons for Disapproval t Attach eoatplete phas (to the County only) for the system o a paper not less than 81/2 x 11 inches in she SBD -6398 (R. 05101) PLOT PLAN PROJECT Bill Devouna ADDRESS 1822 Oak Ridae Drive New Richmond Wi 54017 1/4 NW 1/4S 13 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/20/01 BEDROOM 3 CONVENTIONAL M IN -GRO RESSURE 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 IL BENCHMARK V.R.P. Top of 2" Pipe P VL .-,ao.D ' ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 97.1 0 Plans Designed Using Conventional Powts 2 Manual Version 2.0 Property Line Aed Property Line B 3s � B- 2-3' X 69' Cells with >3' Spacing a B -3 80' B -2 Pro 3 0 ' Bedroom 0 House 4 6 B 2% 20 Slope T 40 Vents 40' B -1 60' Property Line Not Enough Slope to establish contours 134th St. Vent 1 >12" Sidewinder High 240' of Cover Capacity Leaching Chamber 'Long 16„ Grade at System Elevation 34" PLOT PLAN PROJECT Bill Devouna ADDRESS 1822 Oak Ridae Drive New Richmond Wi 54017 1/ 4 NW 1/4S 13 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/20/01 BEDROOM 3 CONVENTIONAL XXX IN -GRO RESSURE 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 PVL --- 1ap.D ' ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 97.1 Plans Designed Using Conventional Powts Manual Version 2.0 Property Line 4t 4l 2 l Property Line B B- 2 -3' X 69' Cells Vents with >3' Spacing B -3 80' B -2 Pro 3 0' 0' Bedroom House B- 2% 20' 40' Slope T 40' Vents 40' B -1 60' Property Line Not Enough Slope to establish contours Or 134th St. l Vent >12" Sidewinder High 240' of Cover Capacity Leaching Chamber 6' Long 16" 34 „ Y Grade at System Elevation Wisconsin Npartment of Commerce SOIL AND SITE EVALUATION Page I 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'h x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Coun ty j e,e®> X percent slope, scale or dimensions, north arrow, and locatjQn :uad.di5tance to nearest road. Parcel I.Q.# �i APPLICANT INFORMATION - Please ri�+tl �nformatiohk viewed B Pending Personal information you provide may be used for a ar poses (P,pr�vecy Law, s. 15.94 (1) (m)). J ?.00t Property Owner _%/ E -' ;. L Property Location Lakes & Hills Development _ t Govt. tot 1/4 NW 1/4,S 13 T 31 N,R 18 [W� Property 0 er's Mailing Address 1 j �' ' 1 ;0, Lot# Block # Subd. Name or CSM# L_L 1 -- _ Pine Acres City State Zip ( ode PhoneWWW ty illage XTown Nearest Road Le .v ,,.. ��� ,C. 134 TH. ST. A. Z New Construction Z Reside P r Or 6 bled "s 3 []Addition to existing building - Use: E Replacement [] Public or con cribs Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/fF 8 trench, gpd/ft Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpolft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 97.1 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 pj S❑ u M S❑ u ❑ S u El S❑ U ❑ S ®u ❑ S H U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots GPD Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 10yr3 /3 ------------ - - - - -- 1 lmsbk mvfr as if .4 5 2 10 -18 l 0YR4 /4 ------------ - - - - -- I 1 ms mvfr gw 1 of .4 .5 - - - - -- — - -- - - - -- -- Ground 3 1 8 - 41 7.5 -- ---------- - - - - -- cs osg ml gw - - -- . 7 .8 elev - -- - — - - -- - - -- 100.4 ft. 4 41 - 80 1 0YR5/6 ------------ - - - - -- s osg , ml - - -- - - -- .7 .8 Depth to - -- - -- - - — -- -- - — - - -- — limiting factor >80" Remarks: - -- - -- -- — - - — — — 2 —_ 1 0_9 10YR3/3 - -- -- -- - - 1 - -- lmsb _ — mvfr as if 4 _5 2 9 -18 10YR4/4 ------------ - - - - -- 1 Imsbk mvfr as lvf .4 .5 Ground 3 18 -40 7.5YR4/4 ------------ - - - - -- cs osg ml g w - - -- .7 . elev - - -- - -- -- - -- - - - - -- 100.2 ft. 4 40 - 79 10YR5 /6 - - - - - -- s osg ml - - -- 7 ! 8 Depth to limiting factor >79 11 Remarks: -- -- - - - - -- -- - - -- -- - - - -- CST Name (Please Print) Signature: Telephone No. Jacque Hawkins - ?I Z - 9- Y V (" Add ess Date CST Number Ref # t J a h v Au C' �f', 4/8/00 g 7 Z_ 385 i — PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots — Bed Trench 3 1 0 -10 10YR3/3 ------------ - - - - -- I 1 msbk mvfr as i f .4 .5 2 10 -19 10YR4 /4 ----------- - - - - -- I l msbk mvfr as l of .4 .5 Ground elev 3 19 -49 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 -- - 99.5 ft. 4 49 -75 10YR5 -- -------- - - - - - -- s osg ml - - -- - - -- .7 .8 Depth to limiting - -- — -- — -- - — - -- - factor >75 -- — — Remarks: 4 1 0 -9 10YR3 /3 --- --------- - - - - -- 1 lmsbk mvfr as if 4 .5 2 9 -18 10YR4 /4 ------------ - - - - -- I lmsbk mvfr gw 1vf .4 .5 Ground elev 3 18 -48 7.5YR4I4 ------------ - - - - -- cs o sg ml gw - - -- .7 .8 100.4 4 48 -80 10YR5 /6 ------------ - - - - -- s osg ml - - -- - - -- 7 8 Depth to limiting -- -- factor >80„ - - -- Remarks: r, 1 0 -10 l OY /3 ------------ - - - - -- 1 I msbk mvfr as i f 4 .5 2 10 -19 10YR4 /4 ------------ - - - - -- I lmsbk mvfr gw lvf 4 ! .5 Ground -- - - -- — 3 19 -49 7.5YR4/4 -- cs os g ml gw - -- . .8 elev _ - - - - - _ 101.6 4 49 -95 10YR5/6 ------------ - - - - -- cs osg ml - - -- - - -- 7 .8 Depth to -- - - -- C,./ /a - -- — -- - - - - - -- - -- limiting — factor >95 -- -- - - Remarks: -- - -- — — — - - - – Ground---- - - - - -- -------- - - - - -- - -- - - -- — — - elev _— ft. Depth to limiting — -- - - - factor Remarks: ��✓ D,/4. - 7 5 d� 1 6 / i e, d3a .16 622, rd,e- Al e � 4 I Z Z 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 1� /� Shaun Bird #22690 ST CR OIX COUNTY SEPTIC TANK MAWMANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address �-q 0j 7 Property Address (Verification t3nara Planning Department for new consftction)_., Citymb" - A)U'o Parcel Identification Number ;. FAQ.j Property Location ,_,_„_„ 1 /s, 1 / 4 , SeC/ T Z W, Town of 44 , Subdivision / Lot # CertlW Survey Map # Volume . Page # Warranty Deed # (oS) 6 O Volume 13n Page # &° Z Spec house 0 ye!�" Lot lines identifiableZ yes © no MMM Improper one gad miitenaa000f Pont septic aygtem could result in its premMure fad= to h=fle wu0at. Props =dWeii m consists of pumping out the eapde taaic every three y sass or sooner, if herded by a licensed puvVer. What you put into dw system can affect the function of the sepde tame as a treatment stage in the waste disposal system. 110 property owner agrees to submit to St. Cram Zoning Department a cardfication am. aped by dart owner gad by a rptumber, jom'Aeytaamp1muber, restricted, plumber or a licensed pumper verifying that (1) the on-Me wostewstardlspood system is in lPEoM opentiag condition and/or (2) afar inspection aid pumping (if necessary), the septic I&A is less than 1/3 #sill of sludge. Uwe, the undersigned have read the above m*wwneaw and agree to maintain the private sawage disposal system with fire stoiduds set forth, heraia, as set by the Department of Commerce and the Departma t of Natural Resauces, We of Wisconsin. Cer#fleatim swAng that your septic system bas been maintained must be completed and ret=Led to the St. Croix County Zoning Office within 30 days of the three ym date. SK,}NATURE O CANT DATE OWPM COMMAMM I (we) certify that all statements on this form arc true to the best of my (our) imowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. io� �'< i° SIGNATEJRB 4F A ,A DATE •1n�f*• it be Cn� Aa erne � drat is a1iS rutty result is the sanitary perm being revoked by the ZoVk9 DgM ** 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 r � !..tJ83PAGE 602 STATE BAR OF WISCONSIN FORM I - 1999 6S 16410 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Lakes and Hills, Inc., a Minnesota RECEIVED FOR RECORD Corporation 07 -19 -2001 12:15 PM WARRANTY DEED Grantor, and William J. DeYoung EXEMPT R LERT COPY FEE: COPY FEE: TRANSFER FEE: 80.70 RECORDING FEE: 10.00 Grantee. PAGES: 1 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 Lot 1 Pine Acres, St. Croix County, Wisconsin. Name and Return Address Cu /r vu /i 161- . k /So 038- 1054 -90 -000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (W (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and right -of -way of record, if any. Dated this 7 day of July 2001 Lakes and //H�iRs� Inc. ✓� by shaved its Ow. k + AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ) ) ss. County ) authenticated th�i �7 day of - 1v0 Personally came before me this day of July , 2001 the above named S - T ( 0 � � � L Lakes and Hills, Inc., a Minnesota Corporation TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland, Notary Public, State of Hudson, Wl My Commission is permanent. not, state expiration ate: (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. mrorm lJw Prdesionats Company. Fond du Lac, wt STATE BAR OF WISCONSIN 600-65&2021 WARRANTY DEED FORM No. 1 - 1999 col nj I I I ol NI N I ^I I I N • MI to ' cod ZI w 328.36' 3 .� C o ° ~ ' zi Z l Q S00'16'57'W -� O I o 51 W w C; a i W I I IV I I O !1 Co H I 65, 776 sq. ft.I � 100 a� 1.51 acres Z I �I E al al N 33' 33' I Cr. I Cr.1 01 3i zi c^o i \ I N; \ \ ?494. $06623 "O \ 00 0 17" W I 335.69' I \\ 470.24 1 . 00 ' 109.24 1 2 — 437.24 - �W 70,634 sq.ft. \ j '�� \ ��2 14 .+� $ 1.62 acres \� 600 sq. ft. g s0. 51 acres a 1 3 Ir 67,544 sq. ft. 1.55 acres 009 /G,v / /� \ s � `C 3'17 S / 15 F 424 sq. ft. a H 75 acres 21 W / � • I M I 68,652 sq.ft. 1 d n 8 $ w �ry 1.58 acres wo I 70,766 sq. ft. 3'17 1.62 acres �'� ? l c ?4 C� 16 22 8 .4► 70,332 sq. 28 sq. ft. N .1 . 1.61 acre acres 0 08 20 #1 s 1 $ 93,346 sq. ft. 7 „ E g 2.14 acres 2 0• 19 1 93,110 sq. ft. 2 0, Wlnsin Lepartment of Commerce SOIL EVALUATION REPORT Page of ' of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code r Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must County 5 . 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, sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location j ) e - t Govt. Lot 1/4 LJ4 S „J T3/ N R E (or) Property Owner's Mailing Address Lot # Block # SubcAName or CSM# City State Zip Code Whone NO r ❑ City [] Village Town Nearest Road New Construction Use' Residential / Number of bedrooms Code derived des!gn flow rate hF•;` Cl GPD ❑ Replacement ❑ Public or cogpmercial - Describe: Parent material _ ®, 1;t2-r j 71 -- Flood Plain elevation If applicable Al at!j ft. General comments ��/ and recommendations�q T [] � _ Boring Boring # z� ® Pit Ground surface elev. A CM 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 L(4 31 ❑ Boring # ❑ Boring ❑ pit Ground surface eiev. 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 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 rng/L ` Effluent #2 = BOD 6 < 30 mg/L and TSS < 30 mglL CST Name (Please Print) _ Signature CST Number Address Date Evaluation Conducted Telephone Number onn 07]n /nl% /Am