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HomeMy WebLinkAbout038-1195-80-000 . >.. . . . . . . & o / 2 ! E � / � i Ra m«27 \ i \ \7kk\kk a 2 � , =k ® =o�a k `K2�f�°Ee R K » %e@2§a� § mlat a� = E \ \ / /(k ƒ ! > '(D —0= »C ] /f (] \ 2$S =� ) }��§ — \E%§§ LL c kz §�/2 0 k \\m :)E /\ J£G /$ § § {k%/ n / 2 E & � n / ƒ a m . 0 k z 2 ) _ � _ , � 2 @ m i � \ u § co k f q L 0 2 § \ z \ £ z t ) \LO m 0 — e }� 3 a a § £ \ E q f k k k 0 � k \ 2 2 2 M ' k \ 0 k o § ƒ _ \\ ® / E � / @ 2 V .<2 R ■ � �\ z 2 8 k \ ©) / [ \ ° r ° �� » C, / %2 k r Q. ° / co a) o �\ Ck§� , © '�i/ \ 2c c2=� \ \ \ .ƒ \ z / } / � ■ : � (C CL E } ) \ k a f / ja & \o)j Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: /1 y 3 g GENERAL INFORMATION (ATTACH TO PERMIT) 2 4 1 " State Plan ID No: i Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) �'---- --...� Permit Holder's e s Name: City Village X Township Parcel Tax No: Marek, Darin I Star Prairie Township 038 - 1195 -80 -000 CST BM Elev: Insp. BM Elev: I BM Description: �•6 `im-0 T Qac = CS; s Ak i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic we t Benchmark 3 } o �O• ! L. 3 Ui9 , b Dosing Alt. BM wti� S:T. l\AQ Aeration Bldg. Sewer c) S < O i Z 2• Holding St/Ht Inlet b• O I o i . 3l' TANK SETBACK INFORMATION St/Ht Outlet 15.3b o l• 0 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 �00� z 3 f �- Dt Bottom C� Dosing Header /Man. 5 11ao, o Aeration Dist. Pipe 6. Z c Holding Bot. System 7. 1 .18 ', • i c� PUMP /SIPHON INFORMATION Final Grade p2. 2-3 t Manufacturer — - -_ , Demand St Cover GPM Model Numbe TDH Lift F5Rl6nj System Head IT D Ft Forcemain J ! Dia. Dist. to e SOIL ABSORPTION SYSTEM dN 0AAt y BED/TRENCH Width Length lNo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 6$ QwCJti Z SETBACK SYSTEM TO RL. BLDG IWELL LAKE /STREAM LEACHING ,M = anUfactyrer: s` � i Y\� INFORMATION CHAMBER OR i s f Type Of System: + t ✓- J" � (,� �/ UNIT Mo I Number: ,Vt DISTRI!3 SYSTEM Header/ o Td IlDistribution x Hole Size x Hole Spacing Vent to Air Intake L� Pipe(s) 1 L Dia Len � - Dia Spacing 57c) SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil xx Seeded /S Yes 0 No El Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I ( ! 20 / O l Inspection #2: Location: 2168 134TH Street New Richmond, WI 54017 (SE 1/4 NW 1/4 � 13 a � T31N RI 8W) Pine cr L L� P r el No: 13.31.18.1023 1.) Alt BM Description= `7T.nw trL�� ts�.c/ L*) S) 2.) Bldg sewer length = Z amount of cover = �� �4 u.t ((__ // tan revision Regwred . ❑ Ye �� Nc r Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. i `A 2 ► ( $ (3 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 compl�tipg this application PO Box 7302 'Wisconsin Personal information you provide ma be used for sec purposes t completed WI 53707 -7302 Department of Commerce Submi leted form to county if not [Privacy Law,S;�(5.04(1)(m)] ` % ''Y ( p state owned.) Attach complete plans (to the county copy onl f the syst apex kt, th an 8 -1/2 x 1 I inches in size. Cou State Sani Pe it Number wl check i revious "app i ation State Plan I. D. Number I. Application Information - Please Print all Informatio i " Location: Property Owner Name S CpOIX PPrroperty Location —y^ ✓11 &� S 1.3 T ,N, W% Property Owner's Mailing Address r f ^ k Lot Number Block Number City State Zip Code Phone Subdivision Name or CSM Number ,S > � � ..W 1' //C nib IL Type of Building: (check one r . _ a , ❑ City I or 2 Family Dwelling - No. of Bedrooms ❑Village ❑ Public /Commercial (describe use):_ ( � " a (( ' � ' � w n S ['Town of �u � r b ❑ State -Owned �R � 661 '-A �yt�t�+.i O+^� Nearest Road I V. Ste' Parcel Tax Number(s) 7$ lf5' III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 1 . 1 g , 4 ;k3 A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued t 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: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. X stem Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. R.) (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 strutted Tanks Tanks ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (print) Plumb ignature (no stamps): MP/MPRS No. Business Phone Number i Plu er's Address (Street, City, STate, Zip Code IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 22- , 21) M U4 ZM X. Conditions o pprova /Reasons for Disapproval: 5le. S > c. 3 — Lek,&& - reS � rt ►`�l � �1�� .,w� %5 ✓�- °- �.e'^S `� � .��..�►. '�_. Via. �,�tc. �'d..�c -.. s� � �� c S r c t t ct N PQ^` SBD -6398 (R. 071 0) Plot Plan PROJECT ` W P112 i & hE II ADDRESS 123 �1/4 n���/1 /4S T . � r N/R 1 W TOWN COUNTY Byron Bird Jr. 220527 DATE � Z, ` I BEDROOM CONVENTIONAL X IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE / :2 ABSORPTION AREA 3 ] of chambers r IL BENCHMARK V.R.P. �• �o� a �- �� // C�J�ASSUME ELEVATION 100 ❑ BOREHOLE SWELL *H.R.P, SYSTEM ELEVATION Vent ilo >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ft ^ 6 „ p 2 per chamber 6' Long 34" Grade at System Elevation 1 4 7. lay 5 3� r QQ - Plot Plan /J PROJECT G f l� o �/ < C� L2 JI ADDRESS 12 I/4 / 7,/L C / I J4S r ?j JT j NJR W TOWN S� y ,� Byron ron Bird Jr. 220527 ,, r _— �-� BEDROOM 3' ! DATE "Z / ,3 CONVENTIONAL X IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE/ 2 ABSORPTION AREA —# ) -# of chambers BENCHMARK V.R.P. �~ r , �• r �O� cp ,f?tlj C ASSUME ELEVATION 100 ❑ BOREHOLE O WELL *H.R.P. SYSTEM ELEVATION Vent >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 fM2� �� 6 „ per chamber 6' Long 34" Grade at System Elevation �., C �3y Ti A r a 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'h x 11 inches in size. Plan must County L include, but not limited to: vertical and horizontal reference point (SM), direction and 5T, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D,# APPLICANT INFORMATION �# nt�iaitcQn. ORMATION - P /ease ewewed � Pentlin e � ____ Personal information you provide may be used for p4upOses (Privacy Law, s.46 (1) (m)). Property Owner ! ' t P rty Location Lakes & Hills Devel meat GoA'Lot _ 114 NW 1t4 S 13 T 31 N.R 18 ❑W❑ Property Ow Mailing Address ^ r t Wt # I Block # Subd, Name or CSM# ne 2 d ,k - w Pine Acres ity State Zip Code PhoneNur)tber ,; illage [$Town Nearest Road 134 TH. ST. ❑ New Construction Use: Z Residential / Number of bedro s 3 ❑Addition to existing building -- ❑ Replacement ❑ Public or Commercial dwdbe Code Derived daily flaw 450 gpd Recommended design loading rate .7 bed, gpdr .8 trench, gpd /ft' Absorption area required 643 bed, ft-' 562 trench, W Maximum design loading rate .7 bed, gpd/fts .8 tr ench, gpdr Recommended infiltration surface elevation(s) 97.7 _ ______ ft (as referred to site plan benchmark) A ditional design / site considerations P rent 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 1 ®S ❑ U ® S ❑ U ❑ S ❑ U I ®S ❑ U ❑ S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftz -- Boring# in, Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 10YR3 /3 ----------- - - - - -- 1 lmsbk mvfr as if 4 .5 �( 2 10 -20 10'Y /4 -- ---------- - - - - -- I lmsbk mvfr gw lvf A 5 Ground 3 20 -50 7.5YR4/4 - - - - - -- - - - - - -- -- -- cs o sg ml cw - - -- 7 8 -� elev -- 102.2 ft. 4 5 -93 14YR4 /6 --------------- osg ml - - -- 7 .8 Depth to limiting , 3 factor --~- — >93 Remarks: 2 1 0 -12 10Y R3/3 ---------- 1 1 msbk mvfr as if .4 .5 `{ 2 12 -23 10YR4/3 ------------ - - - - -- 1 1 msbk mvfr gw 1 of .4 .5 Ground 3 23 -51 7.5YR4/4 - - cs osg m1 cw 7 8 elev- - - - -- -- -- - - - - -- - -•- 102.2 ft. 4 51 -94 10YR4/6 ------------ - - - - -- s osg ml - - -- - - -- 7 8 Depth to limiting factor >94" Remarks: CST Name (Please Print) Signature: Telephone No. Jac Hawkins Y 7Z- Address Date CST Number Ref # l o�b 0 rGV /t KCB e 4/9/00 Z.Z.Z_ €17 Z�, 400 II` _ PROPERTY OWNER: Lakes &Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPDiftz Horizon in Munseil Qu. Sz_ Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed r Trench 3 1 0 -i 1 10YR3/3 ------------ - - - - -- I lmsbk mvfr as if 4 .5 . `{ 2 11 -21 10YR4/4 ------------ - - - --- 1 1 msbk mvfr gw 1 of .4 5 . �{ Ground 3 21 -49 7.5YR416 ------------ - - - - -- Cs osg ml cw - - -- 7 8 elev - 101.8 f, 4 49 -90 10YR4/6 ------------ - - - - -- s osg ml - - -- - -- 7 8 Depth to limiting -- factor c1q . a� >90" Remarks: 4 1 0 -11 01 YR3 /3 ------------ - - - - -- 1 1 msbk mvfr as 1 f .4 5 �( 2 11 -19 10YR4/3 ------------ - - - - -- I l msbk mvfr gw 1 of .4 .5 , t{ Ground ~ 3 19 -52 7.5YR4/4 --------- _------- Cs osg m $ 1 gw ____ .7 elev -- - - -- - - -- - -- i 00.9 ft. 4 52 -80 10YR4/6 - - - - -- s osg ml - - -- 7 .8 Depth to limiting factor >8U - Remarks: — -- r 1 0 -9 10YR3 /3 ------------ - - - - -- 1 lmsbvk mvfr as If .4 .5 2 9 -19 10 YR413 -- ---------------- I 1 msbk ' mvfr gw 1 of 4 5 �{ Ground elev 3 19.49 7. ----- ------- - - - --- Cs osg ml cw - - -- .7 .8 - �- 100.9 4 49 -82 10YR4 /6 - ---------------- - s osg mi - - -- ? 8 ` Depth to limiting ~- factor >8211 Remarks: Ground elev _ - -_ -- ft. Depth to limiting — —« -- -- - - -- - - -- factor Remarks: tAi q Pi r G IL To w � t' � � e Ab _ Maintenance and Contingency Plan for a Septic SWOM ' Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. f 2. Effluent filter is to be cleaned once a year. Please note: k Wge rfi lte bfrkn', n 4 L $R: order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected Aa the Inns pipes of the co1ls 1 4. fawner agrees to emit greases, garbage, and water coriftner cfiecharve' �s " m• 5• The ter agrees to save this plan. 6. Do not plant trees nor park nor drive over system. ` Contingency 1 h r 1. If system falls, determine cause of failure, use alternate and Indd n ow Install system at a lower elevation. 2. Replace any other failing components as needed. f G. nr . s ' s - F y ; Y' ago 3 �} is y. . ]`r 24.:.. WV L J } 4 f'. .. - {. >k y Y 4 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ERTIFICATION FORM OWNERSHIP C Owner/Buyer Mailing Address Property Address �� 4 7 S� e (Verification required from Planning Department for new construction) Parcel Identification Numbe LEGAL DESCRIPTION r Property Location J'�� r /4, / 0 / 7 -%, Sec. / . T_gLN -R W, Town of c Subdivision �hj < -y" . Lot # Certified Survey Map # , Volume . Page # Warranty Deed # C O Volume Page # Y 3 Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE use an m your system could result in its premature failure to handle wastes. Proper maintenance improper and septic stem r. What you put into th consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumpe y p system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the-three year expiration date. SIG AT URE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** * * * * ** Any information that is mis- represented may result in the sanitary pe rmit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I Vol,1643na 338 STATE BAR OF WISCONSIN FORM 2 - 1999 646.094 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, 45 -21 -2441 4.00 PM WARRANTY DEED Grantor, and Darin H. Marek EXEMPT D CERT COPY FEE: COPY FEE: TRANSFER FEE: 80.70 RECORDING FEE: 10.00 PAGES: 1 Grantee. 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 20, Pine Acres, Town of Star Prairie, St. Croix County, Wisconsin. Name and Return Address Da Marrs K 1-7,3. - 4Z, P5, wood' Aye cull; }e gear Two/ MIN Parcel Identification Number (PIN) This is not homestead property. p4) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this "211 4A- day of May 2001 Lakes and Hill_, Inc. * * By: Richard S. Nels n, residen * AUTHENTICATION ACKNOWLEDGMENT Signatures) _Lakes and Hills, Inc., by Richard S. Nelson, its STATE OF WISCONSIN ) President, ) ss. ` County ) authenticated t of May 2001 Personally came before me this day of the above named * Kris:ina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 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. information Professionals company, Fond du Lao, wl STATE BAR OF WISCONSIN 8OD-655-2021 WARRANTY DEED FO R M No. 2 - 1999 f , � J' (NBA) Xi 1 12 cores \\ 68,123 Sq. f t. � �� � F J acres 1.56 I X p 1 i ,fir° ('L�• ° \� �O iT\ \ ro 44,917 s .ft. I � X03 acres'MA)'o 1000.4 �^ F � 1003.2 X \ .N r i �\ SS �� i 1 r � { / o� � � O ' i \`.. �..^•. ! �' '' \ ;" � 630 � ' 1 V s.r p i X f 999. 1\ / / \ °' 1004.8 % �� g 4 '� X / r 6 i'�� 6 L � 5 .1 Z � / v f.�` �' P 97.3 s 0 111 .� �� ° B3 PT F� � %� ZQ1 006 ` 2146 � 996.40 i 8,q. ft , 4 a \ 9 B10 r �� i \ v v, \ / 9� 6 � � \ ' - - ��oi 05 1o9 acres 10 n9 a ¢ y' 65, 1.504 acres 996.9^ X ykt S 1 05.5 - ( 1.50, tree BA e / ,g9 I � - A l o\ 6 �° ~' N. 3 �• -� 1 ��s S6 ?° ' � ` \ a 44.096 .an. \ r+ 1 ° %/ 1.01 oavo(NBA) y �6 N „ 8 � T s ° 'tV, l 1. ' res B �// �� \� , \ \ -.,. 1002.8 X /J / / / 994.2 Pr 1007.6 1002. � \ 'S ,� X L ;- 2 0(5.94 � l / X � - uY 65,459 sq.ft. � � X �'�� \ l 1 .502 acr B16) I C' 10 .1 I t �/ ,•i o / cn j ,/� 59,789 sq.ft. _ ? / r ,,.. / -11.12 acres ` \il 1 1 37 acres(NB�I PO i ) t X 3, 55f sql ft. F.�+ :'.t : /) ; .;� ' '65, 9 sq. fl,. li {' , 1008.6 ' COX 1007.E 76 acres �:. ; ' X / ' 1 acre I 10 4.5 I 1005 cres( ',9 X 1 1006.7 I i 993.4 / �-I° �o 7 X0 51,160 sq.ict.:' oNBA 36.51 <' / PT S89 *2 E 0 } I X 3' %�? , 0 ( N 9 °4801 1 "W r... X99: 9 - 7 50 ,,I� 100 ? '•� �.^°� /. .� / • - =02 °3T 06 "_ 008.3 � `I,` 4 X ? Z v- f .:::. X44.19 . _ - 4= 01 ° �'c"''r :. T, f::.x ._ 1 . j + 33 33! L =34.48 Z -rG .oDcO( '! 6 'i• i • 0 I "'+ 4s?Dx � Pry ' 1 .. rs t ` 991.2 1006.8 N :. a :::. rn X N 12L7 rnl w 6 2 s rn 65, 340 sq. ft. , o .� 8 I 1.500 acres 59 582 sgAt. X ' . ,,, x57,510 sq "ft. I 3 . I�' 1 39 ocres(NBA).. .. I .�I °_.. K1006.9 ±,37 acreq(NAA) 1007.3 '10 ; \ 5.2 I . I� _ - - -�C- �'S� C14 S87 °53'16" SR \ " i ? j \ = - - - - - -i N I 276.20 X 1007.4 + i ° O ..0 � � I I °9 . 67, sq.f �$ w 6 922 s O ft. I - � Cr�� i :: w" 1. acres �_ _ 100' I 65.381 sq. ft. X 44,70 sQ.,ft. y 58.511 q.ft: rD - -- - - -- 03 acr BA1 :1.34 acress(NBA) , N 59 034 s .ft. _1 ( 1 cM acres e8 :a ° ' 1.3 6 acres BA) 1 50 i In o r `- ! 1 06.6 F`n 59,808 sq.ft. 1002.8 X 1 �� 1.37 acres(NBA) PT X 990 9 X .�f _ BS 38 1 . I0LL 10 5.B5Q { 1 5.5 X N^ a I X 1006.7 1006.5 (� t 1004.4 ...- •••.,. I 1► � I t r �'- 3 J jj I /I~,,, \ N78°i2'20 „W X 1 p 296.94 .1 618 v/ N O /� N N ;1 CC) n X . x - o- -rte^ /: O h , r•i', _ _ _ h c o q o ° U / 008.9 ` \ _ 9 t r� 1 - �' 0, '- / p � '_� 1005.5 " Rt2000.0 L 24.9 - X 1007.0 - ; f 1007.4 X 1004.8 �. �\ X • t 85 t . s q. ' ft. - { el � t l