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HomeMy WebLinkAbout038-1196-10-000 n ■ o ■ 2 � \ § / k d a . « (D £ i k i ZF § $ ƒ 7 / 0 ° / ƒ \ § S , / \ o R i & I 2 ■ \ § § \ N � k' \ §/ ■ � 3 E E 0 \ 2 §^ 2 § 2 § \ f / > ± ¢ / 3 \ / �. § 2 2 § $ : (D 0 \ \ \ § 0 a ca @ § z 0 0 0 c Oro 1 3 F CD E -u a 0 d � E k k [ (D _ Ln Z { mo § { { � E f { / ƒ �• 0 CD /k $ & \ k \ z /k / \ -.4 CA m @ \ q \ � { E \ ¥ § $ ; _ � � ■ � ! 2 ? � 8 \ 1 $ 7 o z 7 2 k > . 0 § 0 \ g � § i CL 2 � � k . , \ o _o �§ ! \ � \ 2 0 0 » CD n £ 2 � - � � 0k k � / §§ ID / , § ƒ § I f , CL U ( -4 N 5: ®� cr o § 0) }io�� ■ � ® § r £SID a E m v > E % « e , ® A p . 3 \ � oƒ 7 7§ n r■ / (D m , r k § k / � � R 7 § ■ ■ ■ �� � ¢ E > @ f n � � ( r § ¥ § � N) — & & 0) z ( z ¥ ® / )\ § 0\ - a m . m \7ƒ ƒ ID i ƒe �, w 2�{ §E z 7� 0 \ ■ . ! - \ �;kL� CL , C� . S tE o f ■ M \ e ® \ / k i z k CL a I » % . � g$ y{ � . � ° I � Eƒ± C D i00 . \ MX ("o i . e (D > CD 0 i \ . 0 q � CD � t \ . � $\ � � 0 CD � a,2 wboonsirO i°`dd commer PRIVATE SEWAGE SYSTEM spow aw MAslon C ounty: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pamud kdom *m you provtce may be used for seoondwy purposes (privacy Law. s.15.04 ( 38 415 7 mit H r s Name: 0 City 0 Village 9 Town o : State P n 10 N O.: 149m I— I Star Pramr N em We o -' E ev.: B Description: r Parcel Tax NO.: 038-1196- Q- 1 , TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q 6?�'O Benchmark 7 %.,O (l? 10010 DOSIng toz Alt RM Aeration Bldg. Sewer Holding St /Ht inlet .95 q ,7� TANK SETBACK INFORMATION St/ Ht Outlet 8, 2- _ S' TANK TO P / L ELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic q ' --- , NA Dt Bottom Dosing NA Header /Man. Aeration NA OistA;We Holding Bot. System "9 - 7 7 PUMP / SIPHON INFORMATION Final Grade (0 - q Manufacturer Demand "9. Model NO ber GPM 2 / Q rS TOH I Lift action S tem TDH ft Forcemain I Length Oia. rst.TOwell SOILABS RPTION SYSTE l) cogs eack4ra ENCH Width 3 r Le ngt �� No f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO ((�n P / L BLDG ELL LAKE / STREA LEACHING M i�� – S 1eQl, DIMENSI NS INFORMATION ype CHAMBER a Number: System: CO'ItJj . 361 OR UNIT AR — DISTRIBUTION SYSTEM Hea r/ ni o , , Distribution Pipe(s x Hole Size x Hole Spacing Vent To Air Intake Length Dia. _ ng Spaci r 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 P P P Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes Q No ❑ Yes Q No COMMENTS: (Include code discrepancies, persons present, etc.) inspection #1: Oq/03lo1 Inspection #2:' -- f f -- �' p p Location: 2158 134th Street, Star Prairie, WI 54026 (SW 1/4 NW 1/413 T31N R18W) - 1331181025 Pine Acres -Lot 30 1. Alt BM Description = 5� r 2.) Bldg sewer length = 1,p.b r � - amount of cover = � 4- a l- L Plan revision required? Y ❑ No Use other side for additi Inf •{ q� r - mation. SBD -6710 "7) %� t to s Signature Cent. No. 4- 2 158 �3 Sanitary Permit Application Safety & Building r tA In accord with Comm 83.21, Wis. Adm. Code 201 W. Washer • SCQhs�n - See reverse side for instructions for completing this application PO Personal information you provide may y p be used for secondary purposes Madison. WI 5' Department of Commerce (Privacy Law. s. 15,04(I)(m)) (Submit completed form to co scat Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x t I inches in size. Count) State San Pin jlumber ❑ Check if revision to previous application State Plan 1. D. Nu . x 3g U6 S r L Application Information - Please Print all Information Location: Property Owner Name Property Location �k Lo hor; n HCirYtt° W 1/4 NW 1/4 S t T ,3) ,N, R Property Owner's Mailing Address L t Number Block W7 Rw 3 Cary, State V Zip Code Phone Number hbdivision Name or CSM Number 1� -eu,� R;ulmun rt/i 5yv (7,15 �160q Pcn� char& II Type of Building: (check one) 22 ❑ City I i or 2 Family Dwelling — No. of Bedrooms: 1J ❑ Village • Public /Commercial (describe use): gTown of • State -owned tRw Aaw III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road / h %�L A} 1. f New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number 0 System Tank Only Existing System © $ — �b B) Permit Number Dace Issued 1 0 A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) X Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At•grade 3 , x68 - I � Aerobic Treatment Unit O Recirculating D Other: ✓ -1 a V Dis ersaUTreatment Area Information: // S I Design Flow (gpd) 2. DispersalArea 3. Dispersal Arta 4. Soil Application 5. Percolation Rate 6. System Elevation 1. Final Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevanor 450 3 7 3'7 7 /e A R3, 9 VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- PI Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks VII Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plum s Signat a (n s MP /MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) 4t I r c W VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued k ng Agent S' nature (No star fX Approved ❑ Owner Given Initial Adverse Surc a CO F t Determination 2Z�j,to ktankT 24V IX. Conditions of A proval /Re s for D' pp roval: � 1 aES � b� `r VEO ,, . s a4 p� t&mut,IM�•(9vtS + — 3T CfaOtK COUNTY n N� CO . Q � SBD -6398 (R. 07/00) t rtic►tQ f~201,i J - �St/ 11��.�cc.t� uc,�,tsir m I 1 1 M 0 1 _ o v a d O w � Ilw I +� 0 0 W � I c I i ^ 13 y X _, r Wisponsin Department of commerce SOIL AND SITE EVALUATION Page 1 of -i Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 0 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and loc r�na' a to nearest road. , Parcell.D.# Pendin APPLICANT INFORMATION - Please "in'al/`informatron. Personal information you provide may be used for seco 0 (PO wy Law, s. 15.04 (1) (m)). VIevVBd By Date f Property Owner T ropert Location Lakes & Hill s Development ovt tl _ 1 NW 1/ 4,8 _13 T _31 , N,R 1 8 Property Ow s Mailing Address_ ot # Block # Subd. Name or C" - - o k //� � � ' � Pine Acres fift J State Zip C6�ie PhoneNUrrat4br C' [�►aqe ;'Town Nearest Road 1.��7 134 TH. ST. New Construction Use: Residential 1 Number of txeds 3 ❑Addition to existing building• - ❑ Replacement Public or commer6 describe Code Derived daily flour 450 gpd Recommended design loading rate bed, gpd(ftz .8 trench, gpdm Absorption area required 643 bed, T 562 trench, fF Maximum design loading rate .7 bed, gpd/fF .8 t rench, gpd/ft' Recommended infiltration surface elevation(s) 93.8 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 ❑ u ®s ❑ U S ❑ u ®S ❑ u ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT I ZtM - A1ew ILI Bi Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDIf� g# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10Y R3 /3 - - I lmsbk mvfr as if .4 .5 2 10 -23 I OYR4 /3 -------- - - - - -- I I m sbk mvfr SW 1 of .4 .5 Ground 3 23 -40 10YR4 /6 ------------------ cl lmsbk mfr as - - -- 2 3 2 elev - - - -.— - -- - -- - - -- - - -- - 98.1 ft 4 40 -59 7.5Y ------------ - - - - -- s osg ml Sw - - -- .7 .8 5 49 -93 10YR5 /6 _ ------------ - s os ml - - -- -- -- .7 .8 Depth to , - - -- - — limiting factor >93" S(•� $�•fO Remarks: Z 1 0 -12 I OYR3 /3 ------------ - - - - -- I lmsbk mvfr as if .4 .5 2 12 -23 IOYR4 /3 -- ---- 1 lmsbk mvfr Sw lvf .4 .5 • `{ Ground 3 23 -41 10YR4 /6 -- --- --------- - --- Y cl lmsbk mfr as ---- 2 3 elev • 2 — 98.1 ft 4 41 -56 7.5YR4/6 - -- - - - - -- s osg ml gw - - -- 7 8 . } 5 56 -94 IOYR / --------------- - -- s osg ml - - -- - - -- 7 8 Depth to limiting • 4 g•� factor - >94" Remarks: _ -_ �__ - -- -- -- CST Name (Please Print) Telephone No. Ja cque Hawkins Signature: Y7 7- - Address {� / Date CST Number Ref # 4 /10 /00 2— 403 - PROPERTY OWNER: Lakes & M11s Development SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPD11 Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed :Trench 3 1 0 -11 10YR3/3 ----------- - - - - -- 1 Imsb mvfr as if .4 .5 2 11 -21 10YR4/4 -------- - - --- I Imsbk m vfr gw 1 of 4 .5 Ground elev 3 21 -39 10YR4 /6 ------------ - - - - -- el Imsbk mfr as - - -- .2 .3 .2 - 27 - .7 ft- 4 39 -50 7 .5YR4 /4 ------------ - - - - -- s osg ml gw - - -- .7 .8 Depth to 5 50 -88 10YR4/6 ---- ------------ s osg ml - - -- - -- .7 .8 limiting factor >881 — -- — - -- - — - - - -. �. -- -- - Remarks: — - -� —� - - -- -- 4 1 0 -10 10YR3 /3 ------------ - - - - -- 1 Imsbk mvfr as If .4 .5 2 10 -23 10YR4 /3 ------------ - - - - -- 1 Imsbk mvfr gw lvf .4 . Ground elev 3 23 -40 10YR4 /6 ------------ - - - - -- cl I msbk mfr as - - -- .2 .3 •2 -- — -- — T 97.5 ft. 4 40 -59 7.5Y R4/4 ------------ - - - - -- s osg ml gw - - -- .7 .8 Depth to 5 59 -87 10YR4 -------- - - - - -- s osg ml - - -- - --- 7 8 - limiting - -- — - - -- factor >87" — Remarks: - -- I Imsbk mvfr as i f 4 .5 y 5 1 0 -12 10YR3 /3 -------- - - - - -- , 2 12 -24 I0YR4/4 - -- 1 I m gw lvf 4 .5 Ground - - elev 3 24 -41 10Y / 6 ------------ - - - - - - Cl Im mfr as - - -- .2 .3 . Z 97.5 ft. 4 41 -58 7.5YR4/6 ------ - - - - -- -- cs osg ml cw - - -- .7 .8 - Depth to 5 58 -90 10YR4/6 - s osg ml - - -- 7 8 ----------- - - - - -- - - -- limiting -- -- — — factor >90" Remarks: ,- —_ —_ -- - -- —_ - -- Ground - — - � -- - - elev —. - -- -- - - - - -- -- ft - - Depth to limiting - factor Remarks: D ZK- CA z Qo CA �. z 4' qj G �t C (Y` �- ea 4 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 Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number g 1S Number of Bedrooms Design Flow - Peak (gpd) S� Estimated Flow - Average (gpd) vp Septic Tank Capacity (gal) Soil Absorption Component Size (ft — Type of Wastewater Dome is �S Table 2: Soil Absorption Compone - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) — as Maximum Influent Particle Size (in) U 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /o r service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the s"tan d outlet filter shall be assessed at least once every 3 years by inspection. Th hall be clea proper operatioperatio The filter cartridge shremoved unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the 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 when the volume of scum and 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 next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or . to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwneCBuyeC ___�v!�,tit/ �-� - v � 1 ZV Iry 7 r✓YI� ,�, J Mailing Address _ ti 7 �,, , e / t 0- rk-0 Property Address 4-- -T - 2 _ 5 - . —r (Verification required from Planning Department for new construction) City/State &_ �� : a Parcel Identification Number 3 g - f/ 9 -,In -r J �� LEGAL DESCRIPTION 3 , / 9 - %o a15_ Property Location sr '/,, .vim y,, Sec. l 3 , T 3_,_ -RAW Town of _ Subdivision !�� s Lot X39 °icy Z 15 � Certified Survey Map # , Volume Page # Warranty Deed # o Volume _, Page # Spec house O_yes Q no Lot lines identifiableO_yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the 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,journeymanpl umber, restricted plumber or a licensed veri fying is in proper operating condition and/or (2) after inspection and pumping ( necessary), the t septic tank less th n /3 fun of slud sys t em e. 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. Certificatio stating that your septic system h been maintained must n be completed and returned to the St. Croix County Zoning Office within 34 days of the three year expiration n date. SI NA , OF AP l.� f c•� 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 Owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 5KMATLY& OF APP CANT DATE Any mfomtatioa that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «�•••• °! Lrelude with this application: a stamped warranty deed froth the R a copy of the certified survey Register °{ Deeds office ey map if reference is made in the warranty deed VOL 15 97PAGI �U7 1 ' � - 6.39►962 KATHLEEN H. WALSH Docu ment Number Document Title REGISTER OF DEEDS ST. CROIX CO., WI U a r Y`q •,�,� e C� RECEIVED FOR RECORD 03-07 -2001 11:30 AN Y UMU DEED EXEMPT # CEST_EOPY FEE: COPY FEE: TRANSFER FEE: 74.70 RECORDING FEE: 12.00 PAGED:,, 2 Recording Area Name and Return Address Northwest Title fie Escrow Corp. 4255 White Bear Parkway Suite 113O0A Vadnais Heights, MN 55110 (}3�-II R1 -tC) Parcel Identification Number (PIN) This information must be completed by submitter: document title. name & return address, and PM (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Nq. tc - Use of this cover page adds one page to your document and $2.00 to the recordingfcc Wisconsin Statutes, 59.43(2m) WRDA 2199 215.32 12199) W.lou I PAGE 065 Form No.9- M— WARRANTY DEED Minnesota Uniform Cone ancin Blanks 1978 Holstad & Larson, P.L.C. Corporation or Partnership to Corporation or Partnership No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed( ) not required Certificate of Real Estate Value No. , 19 County Auditor by Deputy STATE DEED TAX DUE HEREON: $ (reserved for recording data) Date: 20 ` 01 FOR VALUABLE CONSIDERATION, Lakes & Hills, Inc. a Corporation under the laws of Minnesota , Grantor, hereby conveys and warrants to ew Horizon Homes Grantee, a under the laws of real property in St Croix County, Wisconsin, described as follows: D LotPine Acres, St. Croix County, Wisconsin "The seller certifies that the seller does not know of any wells on the described real property: together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: Easements, covenants and restrictions of record. Lakes & Hills, I _ C. By: 1kichard S. Nelson Affix Deed Tax Stamp Here Its: President STATE OF WISCONSIN SS. COUNTY OF The foregoing instrument was acknowledged before me this 2p � y day of February , 20 01 by Richard S. Nelson and the President _ and of Lakes and Hills, Inc. a Corporation under the laws of Minnesota on behalf of the Corporation NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) SIGNATURE O ERSON TAKING ACKNOWLEDGMENT r MARLENE J. NELSON NOTARY PUSUC- MINNESOTA Tax Statements for the real property described in this instrument MY COMMISSION EXPIRES 1.31.2005 should be sent to (Include name and address of Grantee): I THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS): New Horizon Homes Northwest Title &Escrow Coip:_ 1475 Highway 65 Suite #1300A New Richmond, Wisconsin 54017 4255 White Bear Parkway ' Vadnais Heights, MN 55110 63822 dt `f .5 Z j ARIS WWI '£l asS'�auJo0 *It S • wMi>>l l oos so's \ 31 b'�H 3 oz'o�sz , ' L 9 �ON Sl I - -vI - -E-4 I- -- V �� 3„ sz,�oeses %; ,gS sz>b �1,9s�'I . z 9'�69?' . u 0j , Li c r j 13 00 cr era ^ I$ $ v Z ^' 3 O p r - pool $� g co 2 n 00 Y�ci ^� NZ ,�? N a W cn W , �2 O t_ Z _Z ° � a. 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