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HomeMy WebLinkAbout038-1196-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430130 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: Kopp, Steven I Star Prairie Township 038 - 1196 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: .L Section/Town /Range/Map Na t e I Im.0 I 1 izv�^�`' 13.31.18.1033 TANK INFORMATION ELEVATION DATA TYPE ANUFACTURE LO CAPACITY STATION BS HI FS ELEV. L 49 q Zj Septic Benchmark ,aS Dosing Alt. BM Aeration Bldg. Sewer 5 I to - 2} Holding St/Ht Inlet ♦ ?C TANK SETBACK INFORMATION St/Ht Outlet �� �o (, • 39 TANK TO P/L WELL BLDG. VLto Intake ROAD Dt Inlet Septic , ♦ / � Dt Bottom Dosing Header /Man. Aeration Dist. Pipe v C �• S Holding Bot. System PUMP /SIPHON INFORMATION Final Grade ,6pS� 6(•�p� Manufacturer GP and St Cover Model Nu er TDH Lift action Loss System Head TD Ft Forcemai Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM RE CH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMNWSLDW 31 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf uper: INFORMATION CHAMBER OR ( D Type Of System: , � � UNIT �_ Model Number: e "j DISTRIBUTION SYSTEM L1p6 6ag� P Header /Manifold Distribution Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Lengt ing 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 Yes No Yes ] No COMN TT (In ud code discrepencies, persons present, etc.) Inspection #1: Inspection #2: P-4 — — Lo tioY 320 216th Ave Star Prairie WI 54026 SW 1/4 W 1/4 13 T3 1N R18W Pine Acres Lot 38 Parcel No: 13.31.18.1033 1.) Alt BM Description G o t Of 2.) Bldg sewer length - amount of cov r = � g f � '� .� �.�W Z� � /` _ _ �''t'�� �S �♦ - � { I' �� 13 ___ I* t�I��errfC�4 re uired? Y - No 1 - � Use other side for addition rmation. A - -i - SBD - 6710 (R.3/97) � n � � ( Dom_ at � .� (^ � l I epctor's Signature , Y` �( Cert. No. �Q,Q,,�( CSi�j�, O J `j Oi V V ♦ Safety and Buildings Division County �J C 201 W. Washington Ave., P.O. o L �� visconsin Madison, WI 53707 - 7 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (fig) 266 -3151 Y 3 30 Sanitary Permit Application State Plan I.D. / Nu ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �" A may be used for secondary purposes Privacy Law, s15 l 4J1)(m) Project Address (if different than mailing address) r x ., y 1320 I. Application Information - Please Print All Informati n "" w i 0 u - 1 Property Owner's We a ;, i Parcel # Lot # Block # o z, Property Owner's M iljl7pnA -- Property Location /a/W'/'SS ection /3 City, State Zip C de Phone Number r O' 7 �j trcl one) /V lJ(/ 1 / T / N; R W II. pe of Building (check all that apply) 1 1 10 1, h /Sh �iZ�� e'f 1 or amily Dwelling - Number of Bedrooms L- a ? a pe,,,`���,e`J Subd Name CSM Number ❑ Public /Commercial - Describe Use 7 t _V, 4�� 4�� A9 7 F] State Owned - Describe Use T /�' 'k OCity El V illage ) Kvwnship of fit! III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision El Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV Type of POWTS System (Check all that apply) on - Pressurized In Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter IZX ❑ Recirculating Synthetic Media Filter Leaching C mber ❑ Drip Line JG- Pipe 01 Ot her (explain) q, V. Dis ersal /Treatment Area m ration: /0 p rsalAr 1 Des low (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Require Pro p sed (sf) S stem levati �Gt C� of o �, `� 9 Manufacturer Prefab Site eel Fib r Plastic C in Total Number VI. Tank Info p Y Gallons Gallons of Units A Concrete Constructed Glass New Existing Tanks Tanks Tf j Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, jAsume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si re MP /MPRS Number Business Phone Number ��� i Plumber's Addre ss (Street, City, State, Zip ode VIII. ount /De artment Use Onl Sanitary Permit Fee (includes Groun water Date Issue ssuin A ent Signature o ps) Approved El Disapproved Surcharge Fee} � 2- -0 r 'P �R ❑Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disa a; ^- ' G `�� � Y3, Attach complete plans (f6 the County only) for the system on paper not less than 81/2 x 11 inches in size ] PLAN PROJECT Steve Kot)o �.� DDRESS 1 /4 475 Hwv 65 New Richmond Wi 54017 17 4 NW 1 4 S 13 /T 31 18 TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/25/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUZ PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 2 IL BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL sH Same as Benchmark SYSTEM ELEVATION 98.8/94.4' 4.2 below g rade jL, Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 34 Grade at Syste m Elevation a� a 0 B -5 B -4 3 oom %*1 30' 15' N ouse --- ~I' B-2 30' Vents 5' 10' 70' B -1 6 B -3 Vents 2 -3' X 69' Cells with >3' Spacing 120' 216th Ave B.M. * PLAN PROJECT Steve Koo[ /<. ��,� � DDRESS 1475 Hwv 65 New Richmond Wi 54017 1f4 NW 1 4 S 13 /T 31 18 TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/25/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUrg PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 2 ,BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.8/94.4' 4.2' below grade jL Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 Grade at System Elevation 34" a a� B -5 B -4 Pro 3 ° Bedroom 30' 15' Vents N House B 30' 5' LV 10' 70' B -1 B -3 Vents 2 -3' X 69' Cells with >3' Spacing 120' 216th Ave B.M. 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. i o be diverted away from s i 7. Watershed s t y stem. y 8. Discharge into system is not exceed those required as pe r 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 St. Croix County Zoning 715 -386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 Wisconsin Department of Commerce ✓ SOIL AND SITE EVALUATION Pag 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8'h x size. Plan must County 4nclude, but not limited to: vertical and horizontal r nge,g in, ' ft"direction and �� �� a percent slope, scale or dimensions, north arr � I- cbtion end dlstai'1ce to nearest road. parcel LD.# APPLICANT INFORMATION - prf{tf _ l prmalfior� P Personal information you provide may be used ndary ��jPtwacy Law, s 104 (1) (m)). ev Date 4 f 4C Property Owner i F P perry Location Lakes & H ills D C "'' G Lot 1/4 N 1 /4,S 13 T 31 AR 18 Property Owner's Mailing Address t # Block # Subd. Name or CSM# o x 6 z. ? ; ;_,r ✓i:_ 3 -- Pi ne Acres City State ZipNQ6cle' PhoneNumber �` U City Vi e Town Nearest Road h,fX 3rv, LL"�c - 'e ' 216 Th. Ave. Z New Construction Use: Residential %Nun er of bedrooms 3 ❑Addition to existing building ❑ Replacement Public or commercial describe Code Derived daily flow 450 gpd ommended design loading rate 7 bed, gpd/W 8 trench, gpd/ftz Absorption area required 643 bed, W 562 mw Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 1 ft (as referred to site plan benchmark) Additional design / site considerations t Paren t material - - - - -- Flood plain elevation, if applicable --- - - -- ft ble for System Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank uitable for system NS L U ❑ S U 7 S❑ U ❑ S❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound Roots GPD/ftz Boring# in. Munsell Qu. Sz. Cont Color Gr, Sz. Sh. Bed Trench 1 1 0 - 10 10YR3/3 ------------------ 1 Imsbk mvfr as if .4 .5 2 10 - 18 10YR4 / ------- - - - - -- I Im mvfr gw 1vf .4 .5 Ground 3 18 - 38 10YR4 / 6 ------------ - - - - -- lmsbk mfr as - - -- 2 3 elev - -.. _ 1 _ 10 3.5 ft. 4 38 -59 7.5YR4/6 ------- - - - - - - cs osg ml gw - - -- .7 8 5 59 -94 10YR5/6 ------------ ---- -- s osg ml - - -- - - -- .7 .8 Depth to — - - -- limiting a- �� = h /�, y, `/ �,s'(, o yv• factor 2 // 94 2 Ca • ( t � Remarks:._ 1 0 -11 10YR3/3 -- - - - - - - 1 Imsbk mvfr as if .4 5 2 11 -26 10YR4/4 ------------ - - - - -- 1 Ims mvfr gw lvf .4 .5 Ground 3 26 -38 10YR4 /6 -- - c Imsbk mfr as - - -- 2 3 elev - - - - - -- _ 103.0 ft 4 38 -59 7.5YR4/6 ------------ - - - - -- cs osg ml gw - - -- 7 .8 5 59 -89 10YR5/6 ------------ - - - - -- s osg m - l - - -- 7 .8 Depth to [ limiting factor >89 11 Remarks: CST Name (Please Print) Signature: Telephone No. Jacque Hawkins .o Y ] L - ;' - YY (P Address Date CST Number Ref # /,f QV4 Y853 4/10/00 2-- 411 PROPERTY OWNER: Lakes &Hills Development SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPD/ftz Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed !Trench 3 1 0 -11 10YR3/3 ------------ - - - - -- I lmsbk mvfi as if 4 5 2 11 -22 10YR4 /4 - - -- 1 1 msbk mvfr gw 1 of .4 .5 Ground 3 22- 10YR4/6 w y- ita - -- lmsbk mvfi as - - -- 2 .3 elev 7 102.8 4 38 -52 7.5YR4 ----------- - - - - -- osg ml gw - - -- 7 8 Depth to 5 5 -86 10YR4/6 ------------ - - - - -- s osg ml - - -- - --- .7 .8 limiting — — - /i factor >86" y - -- Remarks: 1 0 -9 10YR3 /3 ---- - - - - -- 1 I msbk mvfr as if .4 .5 2 9 -16 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground - elev 3 16 -29 10YR4/6 ------------ - - - - -- cl lms mfr as - - -- . 2 .3 -- ----- - - - - -- - -- - — 101.6 4 29 -56 7.5YR4/6 --------- - - - - -- cs osg ml gw - - -- .7 .8 Depth to 5 56 -76 10YR4 /6 ------------ - - - - -- cs osg m - - -- - - -- 7 8 limiting - -- — - - -- - -- factor Remarks: 5 1 0 -11 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as if 4 .5 2 11 -25 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 Ground —_� - - - - -- - -- -- - - - -- - -- — 3 25 -37 10YR4/6 - -- cl lmsbk mfr as - - -- .2 .3 elev --------- - - - - -- 103.5 4 37-59 7.5YR4/6 ------------ - - - - -- cs osg ml gw - - -- 7 8 Depth to 5 59 -94 10YR4 /6 ----------- - - - - -- s osg ml - - -- - - -- 7 8 limiting — - — - - — - - -- factor >9 4 " — Remarks: Ground — - -- - - - -- -- -- - - -- — -- elev — - - -- - — ft. Depth to limiting - -- -- -- - -- -- factor Remarks: II r , -41 t7,) ? �. Q O o � � c 4 6 tJ 'd M y N � 2 V A- o .3 � ST CROLX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O u A Mailing Address ) Property Address � 3 °�" d � l b �' (Verification required from Planning Department for new cons truction City /State Parcel Identification Number 0 3 D — 1 1 C & l0 w o LEGAL DESCRIPTIO l . 103?, Property Location �V ' /,, ' /a, Sec! , T N -R4W, Town of P rty Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # � ���3�0 Volume � S� � � , Page # Spec hoes�(�' yes El no Lot lines identifiable es El 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper 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. I/we, 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e year expi lion da NA "� ss 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 owner(s) of the p "dsernib above, by virtue of a ty deed recorded in Register of Deeds Office. e( f�rlzx3 SIGNA LICANT DATE Any information that is mis represented may result in the sanitary permit 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 4�V 1517P 272 KATHLEEN LE � H. SH REGISTER OF DEEDS Document Number Document'Rtle ST. CROIX CO., WI �!' [� RECEIVED FOR RECORD 06-07 -2000 4:00 PN WRRRANTY DEED EXEMPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: 980.70 RECORDING FEE: 14.00 PAGES: 3 Recording Area Name and Return 1 NOr'F� (,j 7e ri ( T t'I� r b �9croc�Coff. 35--5 n,IS r N n�(' - '• f " e Udi8Na1S C S Q - lost' r-- (30 Parcel Identification Number (PIN) Q'S ^lc)5 - Q — 70 0 0 This information must be completed by submitter: document title name Rt return address. and EIN (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 lL t� Use of this cover page adds one page to your document and $2.00 to the recordine fee Wisconsin Statutes, 59.43(2m) 215-32 (2/99) r i form No. 1 -M— WARRANTY DEED Minnesota Uniform Conve akin g Blanks 1978 Hofstad & Larson, P.L.C. . Individual (s) to Individual (s) YOi. IX 7PAG[ i 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: May 25 20 00 FOR VALUABLE CONSIDERATION, George Marvin Birkholz and Marion Violet Birkholz husband and wife ,Grantor (s), (marital status) hereby convey (s) and warrant (s) to Lakes and Hills, Inc. ,Grantees, real property in St Croix County, Wisconsin, described as follows: See attahced legal description together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: . :� �' 7'xa-�� , Affix Deed Tax Stamp Here George Marvin Birkholz Mark,n Violet Birkholz STATE OF Minnesota COUNTY OF Ramsey SS. The foregoing instrument was acknowledged before me this 25th day of May 20 00 b George Marvin Birkholz and Marion Violet Birkholz, husband and wife Grantor (s). NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) ,�- SIGNATURE OF PERSON TAKING ACKNOWLEDGMENT DEBORAH L. TEICH Tax Statements for the real property described in thisinsuunmU NOTARY PUBLIC . MINNESOTA should be sent to (Include nark and address of Grantee): MY COMMISSION 0 EXIIRESJAN.31,2005 'THIS DOCUMENT WAS DRAFTED BY (NAME AND ADDRESS) Lakes and Hills, Inc. PO Boa 10622 Northwest Title & Escrow Corp. White Bear 1.Ake, MN 55110 3535 Vadnais Center Drive, Ste. #120 Vadnais Heights, MN 55110 56030 vot.1517PAGf 274 EXHIBIT "A" Lots 1,2,3,4,5,6,7, 8, 9, 10, 11, 12,13,14, 15, 16, 17,18 ,19,20,21,22,23,24,25,26,27,28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, Pine Acres, St. Croix County, Wisconsin 51 3' -0" 25' - 5' -0" a �,,,t',� y ..� DHI 3046 5D2 6068 ��`tt++77�1 " "iT�` "' (2) 2z10 HDR. a 1 q' -0" _ N D60 O Tv 12' -oY" lo' -v" 0 2 T O 2 2/3 -� m MASTER I/6 _ wW BEDROOM BREAKFAST NOOK m 51- lo 2 2 � PB OLU �N LL o r I ° I SNACK BAR 6" ® 14'-5° 3 524 BlS CN W = m KITCHEN W EE - - - NO BULKHEADS -' C`+ 5/0 BF n 410 BIPA$6 ' - -� 5 5 _`�s' 2/e 3' 5 J2 " 5 1141 81 BEP3 o B15 BD4 -24 O 2/13 WI53 W2430 I W3013 134@14" v BEDROOM #2 „ BA L,0 O -1 _ _ m `V2" _ 32 x60 10' -8" ir- 0 i r --- GREAT ROOM - - - OPEN RAILING BY BUILDER N o r n GARAGE -2'� _ 9' -0 %" WALL HEIGHT o N = o {! m (2) 2x10 HDR. !- Q 2' i" DH2 3446 F - - -, ENTRY a 6" 7 - - - - -i t_ - - -- - - mo `r' 1 Tn I \ 1 3/0 " I BP \- _GI RDER TRUS I \ / 10051. TT 223 DB 4 PORCH i 0 T SB 2'-10" 5' -10" 5' -6" 5' -6" \\ // BP (2) 2x10 HM 4Gi 44 BUILT UP W/ �(1) 11 %q' LVL 4 (1) 2,12 32 4 BTR F / CEDAR WRAP BY AMWOOD -� I6 /0x7 /0 OVERHEAD DOOR v •8" 16'-4' I' -8 "• II' -010 40 \ X26 ,`'• \�`� \ ti� `�i CAA TO 1 ► 804 aq.ft. o `.\ ,�y1 �.Z \ `�� ��s• o 3:35 acres o el C61 C 60A 50 4 0 39 50' 72,878 sq. ft. �\ \� • � yo o �\ NI 1.67 acres \ \\ �� °'• 34.75 V -02'00 "W 31 3 \ ° S S76 -! f 65,402 sq. ft. ' c 66 1.501 acres m 1 38 N! N , 4" 68,310 sq.ft. \ $ s' \ \ 1.57 acres Ot °� I . f t ea i C's\ C72 \ 1 v` — jcn css -- X69 c7 � 51 _ 67,097 sq. a N N°o 1.52 acre, 47 w .�� A ft $ 5 43 sq. . ^ ' s )9 acres �'` �� •r � 4 r- 49 50 "011 65,742 sq. ft. 66,326 26 sq. ft. 65,451 sq. ft. 1.51 acres 1.52 acres 1.503 acres 4 - 2090.08'- 7.9x' 260.22' 234.33' c° ty 2641.67' AMO */1 -o&-• N4- ►, _