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Home My WebLink About038-1198-20-000 , isin Departme4to(.Commerce PRIVATE SEWAGE SYSTEM County: St. Croix .y and Building Division r • INSPECTION REPORT Sanitary Permit No: 430207 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: New Horizon Homes Inc. I Star Prairie Township 038 - 1198 -20 -000 CST BM Elev: Insp. BM Elev: T Descrip n: Section/Town/Range/Map No: v a (�' D 13.31.18.1046 E LEVATION TANK INFORMATION cLEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w G"6"� � Benchmark 2ar3�� Z (� pv tT 57 Z Dosing Alt. BM o Aeration Bldg. Sewer Holding St/Ht Inlet f. d TANK SETBACK INFORMATION St/Ht Outlet +1s6 `1 `f- 20 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1� ' Dt Bottom Dosing Header /Man. Aeration Dist. P' . 30 Z - 1D • V 9Z•fo0� Holding Bot. System , 3 p /• SW o q. Final Gra e � PU MP /SIPHON INFORMATI (� Manufacturer GP and St Cover kbu N 2 `� �i, 30 k Model Nu er TDH Lift Loss ISyste m Hea TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM 81 - / I BED/TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS L. SETBACK SYSTEM TO P/L B G 7 WELL LAKE /STREA LEACHING Manufacturer: INFORMATION CHAMBER Manufacturer Ty Of System: If 3� ` 5>� � Model umber: � �� A DISTRIBUTION SYSTEM � HeadertManifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Len is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of x Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No r j Yes «I No C ` MENTS: (Include e i e ncies, persons present, etc.) inspection #1: / 3 Inspection #2: T — T — " "At A- -1 (� f-i Location: 1335 216th Ave Star Prairie, WI � / 5�4026 (Unknown 13 T31N R18W) Pine Acres Lot 51 r Pgcel N : 13.31.18 1.) Alt BM Description = �' M�W w 2.) Bldg sewer length .0 % I - amount of cover = 3) 6`65w• 2 Il stew. A � Plan revision Required? Yes No Use other side for additional information. c7 SBD -6710 (R.3/97) Date In wctor's Sig �t. Cert. No. � I Division County � 201 W. Washington r Safety and Buildings /I ' Ave., ., P.O. Bo —) (i' > \ Sanitary Permit Number (to be filled in by Co.) Madison, WI 53 iscons�n 7 - 716 PA 2020 (608)266 -3151 J Department of Commerce State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information y9tl,provide project Address (if different than [nailing address) may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information J& Property Owner's Na me Parcel # Lot # Block # l/ - A� Property Location Property Owner's M I,ez ailing Address � 3�_ �� tiA_� .. , Sectio ;L City, State � Zip Code Phone Number ctrcl �n) `1' � N; �E r W II. Type of Building (check all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use — �(,g, - -� ZZ� ❑City_ ❑Villag pwnship of - f L7 State Owned - Describe Use CZ� X cu M. Type of Permit: (Check only one box on line A. Complete line B if applicable) p 38 — (9g 2D — CPT . 10 7�0 A ew System ❑ Replacement System ❑ Treatment/ Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision [J_ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) A n - Pressurized In- Ground i] Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-G d ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recir ulatingg Sand Filter 0 ' ❑Recirculating Synthetic Media Filter Lea g Chamber ❑Drip Line El Gravel -less Pipe El (explain �y (3 r/ V. Dispersal/Treatment ersal /Treatment Area Information: 10 ! S Dispersal Area P s Dispersal Area Re uired (sf) r posed (sf) yst� E �� Design Flow (gpd) Design Soil Application Rate(gpd f) p 4 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing 'ranks Tanks S Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I , the undersign stone responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber' gnarure MP /MPRS Number ; Business Phone Number Plumber's Addre ss (Street, City, State, ip Code) n VIII. County/Department Use Onl Disapproved Sanitary Permit Fee (i cludes Groundwater Date Issued Is uin gent Signature o Stamps) Approved Surcharge Fee) n S � • p} ❑ Owner Given Reason for Denial G .Conditions of Approval /Reasons for Disapproval_ Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size POT PLAN PROJECT New Horizon Homes ADDRESS 1475 Hwv 65 New Richmond Wi 54017 1/4 NW 1/4S 13 /T 31 /R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/24/03 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE 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 chambe 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 97.5/97.3 4' below grade Vent >6„ tandard Biodiffuser Plans Designed Using of Cover Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 �� 6' Long 11 " �r � 1 `� �� 34" Grade a evation Q 2 Property Line Pro 3 Bedroom House L 10- z� 45' B_3 2% , Slope B -2 -6 0 15' 30' Vents 2 -3' X 69' Cells Vents with >3' spacing 1 60 ! 140' B.M. B -4 Property Line � I r PLOT PLAN PROJECT New Horizon Homes 131/R ADDRESS 1475 Hwv 65 New Richmond Wi 54017 1/4 NW 1 /4S 13 / 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/24/03 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE 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 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL .H,R,P, Same as Benchmark SYSTEM ELEVATION 97.5/97.3 4' below qrade Vent ji Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 3 1. 1 ft2 of Area Manual Version 2.0 1" 34" Grade at Sy stem Elevation `Z Property Line Q N Pro 3 Bedroom House 15' T a� B -1 45' B-3 2% 30' 0 Slope -2 B -6 15' 30' Vents 2 -3' X 69' Cells Vents 1 5 B.M. with >3' spacing 60' 20' 140' B -4 Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of 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 Ist include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north amowt, and.Jocation and distance to wearest road. Pleas I in a ewed by Date e se pant a ll 0 Personal information you provide may be used foraecondary purposes (Privacy Law, s. 1 5.04 (t) (m)). . 0� 3 Property Owner Property Location ew 'l La, Govt. Lot 1/4 A S /3T3 N E (o Property Owners ili Address Lot Block # Name or CSM# i s ,i City State, p Cod Phone Number ❑ city ❑ Village own Neare t R d IV2,� Jrl ( ) "1 h New Construction Use. Residential I Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public commercial - Describe: __— Parent material L9 L � C{ �J Flood Plain elevation if applicable and da comments li recommenons: �✓'� l aA Boring # Boring /� L `V i Ground surface elev. V l t ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. fEff#1 •Eff#2 T EE 1 F-1 Boring # C] Boring El 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. fEff#1 fEff#2 f - f - Effl #1 - BOD > 30 < 220 and TSS >30 < 150 Effluent #2 - BOD < 30 and TSS < 30 mglL _ m9n- � CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date valu tion Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 °� �.3 715 - 246 -4516 Property Owner _ Parcel ID # Page of F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soll lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F Boring # ❑ Boring ❑ 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/ff; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 F-1 Boring # E] Boring 11 pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDIff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:5 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (RAM) Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 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% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal referQ ce ), direction and �jCa percent slope, scale or dimemsions, north arrovr, =id location apd,d ce to nearest road. parcel LD.# APPLICANT INFORMATION - P { 3e print informati6n. Pendin te Personal information you provide may be used f rdecondary i1ft eser> (K4acy Law, s. 'I( -04 (1) (m)). e By ❑ G � Property Owner ? Property Location Lakes & Hi Devel opment - ❑ e'❑ �` : i� Govt. Lot t/4 N t/4 ,s 1 3 T 31 N,R 18 (W) Property Owners Mailing Address Lot # Block # Maili Subd. Name or CSM# Pin Acres City State Cot1e �lxhCAb'Nurtr`be'r City, [7r own Nearest Road c a.� ,✓ l 7 � cy 216 TH. Ave. ❑ New Construction ❑ Residen ' gAlufnb-4 'bedrooms 3 ❑Addition to existing building ---- Use: ❑ Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate - bed, gpolf lz 8 trench, gpdt t Absorption area required 643 bed, ft' 562 trench, ft' Maximum design loading rate •7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 97.0 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 17 S n U 0 S U N S I F - ] U N S n U ❑ S N U ❑ S N II SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ftz Boring# Horizon in ' Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -10 10YR3 /3 ------------ - - - - -- 1 Imsbk mvfr as If .4 .5 1 2 10 -29 1 0YR4 /4 - ----------- - - - - -- 1 I Im mv gw Ivf 4 5 ❑� Ground 3 29 -36 10YR4 /6 ------------ - - - - -- cl Imsbk mvfr as - - -- 2 3 elev 100.5 tt 4 36 -60 7. SYR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 5 60 -83 10YR4/6 ------------ - - - - -- cs osg ml - - -- - - -- .7 .8 Depth to — — — -- - - -- -- - - - -- - - -- -- - 1- - - - - -- ❑- - - -- — - -- - limiting _ factor >83" Remarks: s �►,� ).�2 2 �_°-- 2 1 0 -11 10YR3 /3 ------------------ 1 imsbk mvfr as if .4 5 1 I msbk mvfr 1vf 4 .5 2 11-19 I l OY / 4 - - - - -- -- $�' • Ground 3 19 -33 1 ------ ------ - - - - -- cl_ I msbk mfr as - - -- 2 3 elev -- ❑- �— —�— 101.5 ft. 4 33 -57 7.5YR4/4 ---- -------- - - - - -- cs ❑ osg I ml cw - - -- 7 .8 5 57 - 94 10YR4 /6 ------------ - - - - -- cs osg ml - - - -- 7 .8 Depth to - -- - -- - - -- - - - - - - -- -� — -❑ - limiting �------ - - - - -- factor >94" 57 1 O4 Remarks: - - - - -- — - - -- - -- - - -- - - - - -- - - -- CST Name (Please Print) nature: Telephone No. Jacque Hawk - -- _ - __ - y 7 2 _ 4 9 y b Address - f LI 1 L Date CST Number Ref# u kQe_ k ) r u i ,�3 4/12/00 7 424 PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPD/fl? Horizon in Munsell Qu. Sz. Cont Color I Texture Gr. Sz. Sh. onsistence Boundary Roots — Bed !Trench 1 1 0 -10 10YR3/3 I -------- ---- - - - - -- 1 lmsbk I mvfr as if I 4 .5 3 -17- -� - -� -�-- 2 10 -20 10YR4 /4 --- -------- - - - - - -- 1 1 msbk mvfr gw 1 of .4 .5 Ground - -__ 2 3 100.5 elev 3 1 20 -33 I 10YR4/5 I ------------ - - - - -- cl lmsbk mfr as ft. - - -- 4 133 -59 7.SYR4/6 ----------- - - - - -- cs osg .7 .8 I ml gw I Depth to 5 =59-86 10YR4 /6 ----- ------------- cs osg ml - --- .7 .8 limiting I I I facto „ -- — - -- - —}— — - Remarks: 1 0 -10 1 OYR3 /3 - - -- -- -- - - - - -- 1 1 msbk mvfr as 1 f 4 .5 2 10 -19 10YR4 /4 ------------ - - - - -- I 1 lmsbk I mvfr gw I 1vf I 4 .5 Ground I - - -- Y 3 1 - -- - __ -- 2 3 - elev 9 - 32 10R / 4 - - I - -- - � - ----- -- - - = cl lmsbk mvfr - ------ - - - - -- -� - - - 101.5 4 32 -59 7.5 I ----- - ---- - - - --- I cs I osg ml I cw 7 .8 -I -- - - -� -- - - -- - — -- - -- Depth to 5 59 -94 I 10YR4/6 I ------ - - - - -- I s I osg I m1 - - -- I - - -- I .7 .8 limiting - - - -- factor Remarks: — - - - -- - - - -- - - - - -- - — - 1 0 -1 1 1 0YR3 /3 ------ 1 Imsbk mvfr as if .4 .5 2 111 -19 I l 0YR4 /4 ------------ - - - - -- I 1 1 msbk I mvfr gw 1 of .4 .5 Ground ____ elev 3 19 -31 10YR4 /6 - -------- --- - - - - -- c1 l msbk L mfr as I 2 .3 101.5 4 - - - 3 7.SYR4/4 - - - - -- _ - cs } -- o — - - -I c w - -- 7 8 Depth to 5 53 -96 1 0YR4 /6 - ------- ---- - - - - -- cs I o I m l - - -- - - -- I .7 .8 limiting -- -- I —�— -- — -- -� - - - - -t- factor —� >96" WA O Remarks: - -- -- -- -- -- — — I � Ground elev — --- - - - - -- - -1 - -- — — ft. Depth to limiting -- — — - -- factor Remarks: r � 1 X-1 U 6v i N N Z) N `� a C � c \ u O ` o T . N 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 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 I � Shaun Bird #226900 I I ST C;Ir.tMN C".. ")r.tNTY SEPTIC TANK AND MVNFI+, :SHIP ('.'ERTI,ialC'ATION FGFIVI ',)Yvt; ,'I�ta.�,'.,• ........._[U'�'�+k/ . ��'7s�2.a. . .....�l��.t'.r-S .... .... .... .....,............ iL 1 3 3 (Ven ica ion rcquircai tiom PlAnning Department for new consitnrc;tiun�, ,,•,,,, ' ....� ..:.....,. c.:tiy`�;AMC .,�� /G11r✓lct,M�_. ��tirC.ol Identification Nunih .r ._.,._.._..._...._.._._,_.... �.,._.._.._.�° � `� � 3$- I 19? 7� � o ! Prop v. Lo , a n V4, Sec. l3._._. T 31_....i� ~�,,,•l_ $...,.. \h' '1'uti�a _....... era . +C'ert:i.led l5t�tc.! Y Map, .._____. ____._.__._...,..._._.._....._, �1'GlllCrr;'. __..�_.. payze 2 ' - ' -3SD .._ _. I'�iv t ..,.,,,5. ...... _..... Snec; .louse X +r5 I.:J no iXt lint;S sdPntifiable VCS U DO �� ummpra rK r.' rate and tnaiMemanceof your septic system could result in its prematureiailure to handle wastes. Praper nnyitlt>unaur consis? of pur,apiar out the saytic tank every three yeses or sooner, if needed by a licensed purnper. .VVItlrtt you per, into tfsr system can. of r ect the rill , ; :Trion of the loptic tank as a treatment stage in the waste disposal .system. The p :co: „ °ty owner agrees to subrait to St. Croix toning Deportment a certifica on form, signed by the.mvner..avd by a mute r olumbe,-, i oi .aneyuraupltxnnbor. r or a liceused.puntper verifying that (I) the uu•sito wastewafardiepo4ji. iystom is in p )per oplre.ate tg; condition and /or (2) after inspection and pumping (if necessary)., the septic tank is less than 1/3 fW 0 3 Ilwe, c ;e undes:si N),i : d have reac the above, requirements and agree to maintain the private sewage disposal system with t6r „tyndards set fora >a. heikiu .i . set by the Deparanent of Commerce nad the'Depi.rtmcat of Natuml Resources, State of 'Wisconsin. C:et <iafiration statirpdut yoiii ;, ! rde system Las been maintained. must be completed and returned to the St. Croix ;Zoning. OffiYce l .bn 30 days o rhe; t' 17t txpiratiQ•ti date. lCi.l �[t3I:It, .,r ��Y ...,. �''....__....... DA E I (we)`,&!".I.ify that all uatements on This form are true to the best of my (our) knowled;te. I (we) am (are) the, ov,•nrr(s) of the n:t•.` :;5er y drse xi�;ed above, l: y virtue: of a warranty deed recorded in register of Ueeds Office Any ir&irctation that i:: nos- .rcprescntedmay result in the sanitary permit being revoked by he Zoning °• Xac o de wit.tt ', h Ix applicati. ;in: a'stamped warranty deed from t he Register of Deeds oiEcc a copy of the certified swvey map if refbrence is made in the we,rmnry deed J 2263P 054 - 7 24350 STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER I. DRESS - REGISTER OF DEEDS DocumentNumber WARRANTY DEED ST. CROIX CO, r MI RECEIVED FOR RECORD This Deed, made betweeri - Lake and Hills, Inc., a Minnesota t 06/04/003 08:30AM Corporation WARRANTY DEED EXERT # Grantor, and New Horizon Homes, Inc., REC FEE: 11.00 TRANS FEE: 258:60 COPY FEE: CC FEE: 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 Name and Return Address Lot 3 Dmd 55, Plat of Pine Acres i n the Town of Star Prairie, St. Croix County, Wisconsin. 1� Cr — C75 ( A 038 - 1196 -30- 000,038 - 1198 -20- 000,038 - 1198-60 -000 Parcel Identification Number (PIN) This is not homestead property. (K) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this d ay of May 2003 Lakes and Hills Inc., a Minnesota Corporation * + Richard Nelson * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) T'raC, ��vr— ) ss. �i-► County) authenticated this day of Notary PublIc Personally came before me this _ day of % of Wisconsin May , 2003 the above named Lakes and Hills, Inc., a Minnesota Corporation by Richard ' Nelson, President TITLE: MEMBER STATE 13AR OF WISCONSIN (If not, a known to th person(s) who ted the foregoing V a owl d d t ame. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Pub W, Slate of Wisconsin Hudson, WI 54016 My Commission fs ermanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) a -, , ) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company, Fond du Lac, wi STATE BAR OF WISCONSIN a -2021 WARRANTY DEED FORM No. 2 - 1999 I odd M. Hendershott, RLS 2362 c'v�\ Registered Wisco sin Land Surve or \ , 0� �\ \\ Dated this day of / 2000 z ' CS o� J 3'7 1 ! Os \ 65,402 sq.ft. 0%; ---- - - - - -- MATCH LINE 1.501 acres � ;_ ,,- ' "" - " - -- / d / 33 y_ — 0 . TIM 42- � C4i � � � C s -C70- C48 � .� 30 3 i 1 C73. _ — - - r C74 — �C7 w / C72 / — -- - - - - -- --- w L o p - — — �a w — ao 50'' � 150' 54 - X69 / 51 �� 8 67,766 _ 67,097 sq.ft. 1.56 ac N NCD 1.52 acres c\ C7 9A/ G� NS I R 50 1s W 66,326 sq.ft. 2 N 53 1.52 acres M N 65,892 sq.ft. $ 68,507 sq.ft. 1.51 acres 1.57 acres N om. - 2090.08'- 234.33' 245.77' 227.27' 2641.67' soutt ' " N8s o7 zs W of Sec 9 10 12 NOTICE TO ALL UTILITY COMPANIES: Z T H G A TE To preserve all Lot Corner Monumentation (ALL UTILITY COMPANIES SHALL MAINTAIN — — — — — — A 5 FOOT DISTANCE FROM ALL LOT CORNERS AND BENDS IN THE RIGHT —OF —WAY) Any monumentation being disturbed will be subject to remonumentation fees. a e / \s. SUFI ✓ V 6 — s U - (A ,�• \ ` ti �(� 4� �,�/17 �� I ;� 210TH nvENUE add M. Hendershott, RLS 2362 Qn� Registered Wisco sin Land Surwey�r SECT 13. 7.31 N., R 18 W. Doted this ry day of M 1 2000 SCALE: 1" - 2000' 1t. � 6\ a�j � 1 � :a \ z 37 0. I i 65,402 sq.ft. ° --- ---- - -- - -- MATCH LINE - SEE SHEET 2 OF 4 1.501 acres w� 38 n 1 __ ♦ � , 68,310 sq.ft. 1.57 acres -C42- J S3 Ci b _— _ -C70- \ \ CyO �� _ 33 3 rte- — - - C74 - - : -•� — - _ - • �O�' R Cf 2h O 50 n I - '1 1 54 51 ` eO• / 67,766 sq.ft. 1 55 I I _ 67,097 sq.ft. 1.56 acres 65,437 sq.ft. I I 1.52 acres �,F, C7aA� 1.502 acres h 2sQ�Qey, SVW'22 Iryv�' I , . t� - E I c m 50 ,� 27�2a• , ^f 49 I I 65,742 sq.ft. m 66,326 sq.ft. 52 = 53 $ 56 1.51 acres 1.52 acres -1 v �r ^ ti I 1 . 65,530 68,507 sq.ft Ye 65.892 sq.ft. _ � a�Ar 1.504 acres 1.51 acres 1.57 acres 0 . y a° x8 Ne ?ry - 2090.08'_ 2* iron pipe found 8I �2" iron pipe found 260.22 234,33 243.77' 227.27 36161' - 2641.67' I _ south tine of NW 1/4 as N89'0�''26 "W of Sec. 13, T31 N, R78W x PREPARED BY. F E= e� NOTICE TO ALL UTILITY COMPANIES: SURVEYOR t amn N OR TH G A TE Todd M. Hendershott To eserve all Lot Cornsr Monumentatlon (ALL UTILITY COMPANIES SHALL MAINTAIN Metro Land Surveying k Engineering Gr 332 County Road D' — — — — — — — — — — A 5 FOOT DISTANCE FROM ALL LOT CORNERS AND BENDS IN THE RIGHT —OF —WAY Any monumentollon being disturbed will be subject to remonumentotion fees. Little Canada. MN 55117 Sheet 1 of This instrument drafted by Todd M. Hendershott 0 r Al ° J J%7!k k T ) _ � ƒ ƒ 7 = z ° S ƒ ®& S , i f m / 2 ° c \ \ 0 / � \ } \ « I o c 6 E E ° ! 8 E o k ) � / / § £ ¢ . \ E E d 4 2 8 CL 2 § i:3 C ( 0 0 0 5§ Eƒ . >� ■ Z . k T /� J z o 0 o 5; Oro 0 \ (A §) @ ƒ ( =r �� > { g E \ § a � § & �I \ E > \ §\ - \ / (n �/\ C ) ) w cn \ § & / E ¥ z o R R :3 / ) » ) 2 (D N z ! \ § % \ f 2 f z » w � 0 2 CD[ § n $ / % � f / E x / $ i \ a � $ 0 � @ (D \ ,? § sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430207 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: New Horizon Homes Inc. Star Prairie Township 038- 1198 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 13.31.18.1046 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w Q� Benchmark j ZA) 2 � Dosing Alt. BM Aeration Bldg. Sewer G Holding V- St/HtInlet S• • o TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I r- \ ` ' 2 _ Dt Bottom Dosing T ) Header /Man. Aeration Dist. P' , 1 � • ty 9Z• fo0' Holding Bot. System L L . 3 e PUMP /SIPHON INFORMATION Final Grade Manufacturer b St Cover GP 2-t(9 cm:0 Model Nu er TDH Lift Loss System Hea TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION c Type Of System: CHAMBER OR .. Z / 1 � s4 r UNIT Model Number: DISTRIBUTION SYSTEM 7`0 1•n " w,oar+►l' n Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Len is 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 Yes No r' Yes C U M J- A (include clud? fV-- 4isgep�ncies, persons present, etc.) Inspection #1: ` /,7 Inspection #2: —7---7— Location: 1335 216th Av WI 5��4026 (Unknown 13 T31 N R18W) Pine Acres Lot 515 Parcel No: 13.31.18.1046 1.) Alt BM Description = !' "0.k //" "U —� 1 2.) Bldg sewer length = '► �� V�� amount of cover = �� • ;f 3) bb grv, Q> 2 ' Ian revision Required? Yes No I i �- ! Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division Count :5-1 � ' 201 W. Washington Ave., P.O. Bo T / sconsirn Madison, WI 53707 — 716 w w IU Sanitary Permit Dlumber (to be filled in by Co.) (608) 266 - 3151 f �• f - 3o w - - Department of Commerce State Plan I.D. Number Sanitary Permit Applica ' In accord with Comm 83.21, Wis. Adm. Code, personal info ationii ¢. tr may be used for secondary purposes Privacy Law, s - 04(1)(m) t "' Project Address (if different than ailing address) I. Application I - Please Print All Information ' - 2 3 2 003 � � 3 S 2 1(0 A v& ' Property Owner's Na me C;; ; `.{ ;l '_ I Parcel # Lot # Block # Property Owner's M ailing Address Property Location ,4 Secdo - City, State Zip Code Phone Number arc C/V / 2 !F2 T N;E II. Type of Building (check all that apply) - l wb AI Subdivision Name CSM Number 1 or 2 Family Dwelling -Number of Bedrooms ❑ Public /Commercial -Describe Use ❑ State Owned - Describe Use (-Z) 3 X Z ZGK ❑City_❑Villagownship of� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p 38- ((9? - ?_o - ODD . /o A cv A. ew System ❑ Replacement System ❑ Treatment/ Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision [J_ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner N. Type of POWTS System: (Check all that apply) CD -Aton - 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 [I Holding Tank 11 Peat Filter ❑ Aerobic Treatment Unit ✓ecir ulatin / g Sand Filter 0 ' ❑ Recirculating Synthetic Media Filter El Leaching Chamber El Drip Line ❑ Gravel -less Pipe ❑ Other (explain) '4 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area (sf) Dispersal Area Pr posed (sf) ystem Eleva 6 91 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site eel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank v Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersign stune responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber' gnature MP /MPRS Number ;Business Phone Number Plumber's Addre ss (Street, City, State, ip Code) r VIII. Count ylDe artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (i cludes Groundwater Date Issued Is uin gent Signature o Stamps) 2m_�� Surcharge Fee) 2-M O} ❑Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size J31 OT PLAN PROJECT New Horizon Homes ADDRESS 1475 Hwv 65 New Richmond Wi 54017 1/4 NW 1/4S 13 18 W TOWN Star Prairie COUNTY ST. CROIX 7/24/03 3 MPRS Shaun Bird 226900 BEDROOM DATE _ CONVENTIONAL XXX IN -GROUN RESSURE 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 22 BENCHMARK V.R.P. Top of 2 Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P Same as Benchmark Vent SYSTEM ELEVATION 97.5/97.3 4 below grade ji Standard Biodiffuser Plans Designed Using Leaching hamber Conventional Powts with 311 ft2 of Area Manual Version 2.0 3 4 „ Grade at System Elevation '� 21 � 2 Property Line M 8NA Pro 3 v Bedroom House .� B -1 2% Slope 0' B -2 -6 15' 30' Vents 2 -3' X 69' Cells Vents with >3' spacing 1 .. g' 140' B.M. 60' 36 B -4 Property Line all 1 i r i E E� r