Loading...
HomeMy WebLinkAbout038-1209-30-000 Wisconsin Department of Commgrce PRIVATE SEWAGE SYSTEM Coun y: St. Croix Safety and Building Diiis n ' INSPECTION REPORT Sanitary Permit No: 430070 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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: Oeverin , Ken __ Star Prairie Township 038 - 1209 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: ti�D �av I TO b•F I, TVVv l� is (ems 13.31.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3.L/ ' y lo?-t/sr Dosing Alt. BM Aeration Bldg. Sewer S p-:� rHolding I SVHt Inlet S- 3 fig• St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic + 1 h 4 ( Dt Bottom IV '� Dosing Header /Man. Aeration Dist. Pipe -7.0 3 Holding Bot. System 7• r6 p�� / PUMP /SIPHON INFORMATION Final Grade 3 • �l'7� Manufacturer Demand St Cover GPM Model Number lit �Jwr (c,'I �•S� TDH Lift Friction Loss System He TDH Ft D Y U +''" jyt Forcemain ngth Dia. ist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS INF S ETB ACK AT SYSTEM TO P/L BLDG WELL LAKE /STREAM CHAMBER OR Mar�uµc#gr� J� Type Of System: ^ G9 UNIT Model Number: IbV1 v2 t � c3� ar DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake j l L a Pipe(s) r -- f Length �� / Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil I - Yes [] No ["I Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 4 0 / 6 / 03_ Inspection #2: / ! Location: 1316212th Ave Somerset, WI 54025 (NW 1/4 SW 1/4 13 T31N R18W) Northgate II Lot 41 Parcel No: 13.31.18. 1.) Alt BM Description = �� D .1�t tw �b��l �oUt{� ) r Y rO V"1 5 �00 - Fv�'el 4' /AZ- 2.) Bldg sewer length = y t' S�k ' f amount of cover = ®boar- �61A'�rP�S aKre. , in.is � n l(u+2 •QLt/� C�1�,.�J(il �n `CV Uw- `('�2 utvif �lue.�i�i � _- — — - - -- -- - - -- — - -- - - -- - / 7, -- r � Use revis for information. l, Yes �;'NO U I Re - — i � . -- - - -- - -- - - - - -J � L SBD - 6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division Comity 201 W. Washington Ave., P.O. Box 7162 S C N *Iswiisin , WI 53 70 7 - 7162 Sanitary Patnit Number (to be filled in by Co.) Department of Commerce ( 2663151 a 0 A p plicati on State Plan LD. Numbe In accord S � Vru- A din. Code, lnit A pps you proms 15. Pro" Address (if i than t ailing address) may be used for secondary purposes Privacy Law, s 04(1 m X) l� I. Application Information - Please Print AO Information 7 `4 to .z ,x - Property Owner's Na me Parcel 0 Lot P Block P 2003 1 o- o Property Owner's M ailing Address I Property Location z- e- G oFF ' Q � 3A.Section /3 City, state Zip Code //Moso&� Ey-ya t 4 H. Type of B ding (check aD that apply) 3 T N; R��E or �.�?/ Subdi � ion Name CSM Number W1 or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use Z .. City ❑Village QTowrtship of 4 _ III. Type of Permit: (Check only one box on line A. Complete ifspokab A. "ew System ❑ Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System I B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that ) M'Non - 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 -Gmnnd ❑ Holding Tank ❑ Prat Filter ❑ Aerobic Tr eatntax Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber . Line ❑ Gravel Pipe ❑ Other (explain) V. DispersaUTreatment Area Information: Design Flow (gpd) Design soil lion Ratdapdsf) Dispersal Area Required (st) Dispersal Area sf) system Elevat / (QS3 C -z fns VI. Tank Info Capacity itil Total Number Manufacturer P Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constricted Glass New F.z Tanks Tanks Septic oridoldiag..Tatk Aerobic Ttrruuent Unit Dosing Chamber VII. Responsibility St atement - I, toe - undersigned , asswme for instaDation or the POWTS shown on the attached plats. Plursbees Na me (Print) --ot Phm*cr's Si gnamm 'N@fMPRS Number Business Phone Number Fogerty 1180 Pfum bi>1lg 1 _� �• 7/ f - s:fo o PlumbeQsresgq�RC�(State, zip -1 EA801 6 - 0 VIII. our /De _ J J ent Use Ud — Approved ❑Disapproved Sanitary Permit Fee (includes G water Date Lssued Issuing Ag nt Signature tamps) Surcharge Fee) ❑Owner Given Reason for Denial *.,) v �—'— w ig 3 IX. Conditions of ApprovaUReasot� for Disapproval ou -> W� vim �rnNtz. 3. s� M4"il" - �K� - e aol�9"411v . Ayvz4alz Y 3 Attach complete phtes Ito the County only) for the system on paper not teas than sin x n inches is sore i t� ti J � � x : W L � m o o lA t0 o oh`•l v 00 g o Z LO I C14 m #� o� o N a r l� b y q U Y. NN Q 4 � S \ "5 n � � � i .�,. 41 by I ew d � Xk ` \ r W e �1 b � n � � n O © • N m O r.'O � � �N CD C N Q� h A pr N � b h c, o '. A co 4 Cl c� H 1 n O t9 \ C _ (D rjQ _ - Vi � r m r J • < "d ;M r7 .. N t 10 3 m :l1 - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner*uyer Mailing Address Sw-osfA571t mmj; Gr'e�. 1�a��Soit/ cyr� /G Property Address /.?/o Vyu (Verification required from Planning Department for new construction) City /State tex— Parcel Identification Number — /.ice p ar LEGAL DESCRIPTION Property Location '' /., �$ef) i / Sec. 13 , T_ZL - R_/j_W, Town of 52/tA- ­A2/%t.9.T= Subdivision Lot # y/ . Certified Survey Map # , Volume . Page # Warranty Deed # ?•Z e/ 10! , Volume - 2 . 2 4-f . Page # 3�s Spec house O yes B no Lot lines identifiable &'Yes O no SYSTEM MAI 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 wastewater disposal 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 Resourcet, State of Wisconsin. Certification stating 0 jaLypur septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 day r. v� ;.er;...• a_._ SIGNATURE 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 pro escrib d above, by virtue of a warranty deed recorded in Register of Deeds Office. / � ...L r— 6 SIGNATUPA OF APPLI DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa a - " 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 PO OWNER'S MANUAL & NAGEMENT PLAN Page of Z — 'FILE OMPMATION SYSr M SPEC11FICAiIONS - Owner _V 'd eX _ Septic Tank Cwacky 0 NA Permit if -2 Septic Tank Manufacturer Y ��"' r O NA DESIGN PARl4 Effluent Filter Mmmlect rer ,� ,�� ❑ NA Number of Bedrooms „ 3 0 NA Eftitient Filter Model Y l ®O O NA Number of Public Facility Units Pump Tank Capacity g al i3 NA Estimated flow (average) * Pum Tank Mariufactrer NA al/d Design flow (peak). Grated x 1.5) PuPW Manufacturer Lt NA Soil Application Rate _ _ . 7 gaVdaVfle Ptimp Model 13 JNA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, ON & Grease (FOG) 530 mg/L 0 Sand /Gravel Filter 0 Peat Fkw Biochemical Oxygen Demand (BODJ 5220 mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other. Pretreated Effluent Quality Monthly average Dispersal Cells) 0 NA Biochemical Oxygen Demand (BOD 530 mg/L )q In-Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids (TSS) Q mgt- 0 At -Grade 0 Mound Fecal Coliform (geometric mean) 510 ckdl 0 Drip -Line E3 Other: Maximum Effluent Particle Size N in die. 0 NA Other: 0 NA Other: 0 NA Other: 0 NA `'Values typical for dornestic wastewater and sepw tank of luerit. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Fregnem:y Inspect condition of tank(s) At least once every: Zi NEmaKrtlt( S ) NA Pump out contents of tank(s) When combined sludge and scum equals one -third t NA Inspect dispersal cell(s) At least once every--2" 0 y� (s) (Me>ekreari 3 years) NA 0 months) 0 NA Clears effluent filter At least once every: 1 Yvads) Inspect pump. pump controls & alarm At least once every: 0 month( s) u A 0 month(sI ush laterals and pressure test At least once every: 0 year(s) Q NA Fl Other: At least once every: 0 V ows) a NA Other. CLNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks• measure the volume of combined sledge and scum and to dock for any back up or pending of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fang condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page L of �— sattT UP AND OPERATION For new constntction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cells). if high conimmatons are detected have the contents of the tank(s) removed by a septa" servicing operator Prior to rise. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fN above normal highwater levels. When power is restored the excess wastewater WIN be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to asset in manuallY 0Pw8ting the pump cbMrols to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,-Atha area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or efirnination of the following frorn the wastewater strearn may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; drapers; disinfectants; fat, foundation drain (sump pump) water, fruit and vegetable peelings; gasoline. grease; herbicides; meat scraps. medications; ON; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replac t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed s t ru cture, lot Cues and wells. Failure to protect the replacement area wall result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply ith the rules in effect at that time. 13 A sulfa le r lac eat a a i not available due to setbac d /or soil limitatio Barring ad noes in POWTS Paybe hol g tank a in stalled as resort to lac the failed PO S. h s n en a ated o identi a s able placement area. U n failure o e POWT a soil and site mus b pert ed to I ca #e suitable acement area. - If eplacement area is available oiding tank stalled as a last resort to pi a the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT =ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE W7ERIOR OF A TANK MAY BE DIFFICULT OR 1111111 POSSIBLE- � #221180 (715) 6 J POWTS INSTALLER POWTS MAINT ER Name I v Nam Maae tone S _, Phone _..._ SEPTAGE SERVICING OPERATOR ( PUMPER) LOCAL REGULATORY MJTHORITY -�j Name Name 1 �.� C6tW`�t Phone Phones — � " h" This document was drafted in comaiance with chapter Comm 83.22(2 lbH1lll&M and 83.54111. (21 & (3), Wisconsin Admibrdsuativ• fie. r - - Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division 6f Safety.& Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to rerp . 038- 1055 -20 V %La r APPLICANT INFORMATION- PLEASE PRIN NFORM rREWEDCY D 43 PROPERTY OWNER: i ��:, Pa RTY LOCATION Greenwood Enterprises, Inc. � � GOVT: OT NW 1/4 SW 1/4,S 13T 31 NR 18 6gor) W PROPERTY OWNERS MAILING ADDRESS t L0T � BLOCK # SUBD. NAME OR CSM # 2141 Ct Rd. "C" !11 na NorthGate CITY, STATE ZIP CODE ONE k [�CI []VILLAGE ]TOWN NEAREST ROAD New Richmond, WI. 54017 �5)� 1 "., Star Prarie 214th. Ave. 1c] New Construction Use [x] Residential/ Numbef of b� �rt [ ] Addition to existing building ] Replacement [ ] Public or commercial de Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 8 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.5 alt area= 94.2 ft (as referred to site plaan benchmark , Additional design / site considerations na 'r # Sdoes MN'w-✓k- m. ctccp.rz Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I ®S ❑U ®S ❑U ®S ❑U [2 ❑u ®S ❑U ❑S ZU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. <' 1 1 0 -10 10yr3 /3 none 1 lcsbk mfr qw if .4 1.5 ................. 2 10 -23 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 3 -8 7.5yr4/6 none co s Osg ml na na .7 .8 9 8.8 ft. Depth to limiting factor +84 1, Remarks: Boring # 1 0 -12 10yr3 /3 none 1 lcsbk mfr gw if 1 .4 .5 2 2 12 -24 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 24 -84 .5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 9 9.5 ft. �J Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v ) .,,New Richmond W 54017 Signature: Date: 4 -25 -99 CST Number: m02298 PROPERTYOWNER Greenwood Enterpris DESCRIPTION REPORT Page 2 of 3 ° PARCEL I.D. # 038- 1055 -20 a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ds in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tren 1 0 -12 10yr3 /3 none 1 lcsbk mfr cs if .4 .5 ``''`::`` 2 12 -26 10yr4 /4 none sici lcsbk mfr gw if .2 .3 Ground 3 26 -84 7.5ry4/6 none co s Osg ml na na .7 .8 elev. 9 8.2 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -18 10yr2 /2 none 1 lcsbk mfr cs if .4 .5 >:' 4 2 18 -36 10yr4 /4 none sjjj lcsbk mfr gw if .2 .3 3 36 -84 7.5yr4/6 none co s Osg mi na na .7 .8 Ground elev. 98.Oft. — Depth to - limiting factor Remarks: Boring # 1 0 -16 10yr3 /3 none 1 lcsbk mfr cs if 1.4 .5 2 16 -28 10yr4 /4 none sicl lcsbk mfr 9w if 1.2 .3 3 28 -84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 9 8.7 ft. Depth to limiting pf t7 G factor O +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: ` SBD- 8330(8.05/92) I STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Greenwood Enterprises, Inc. NW4WI S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #41- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=401 BM.= top of 1 steel pipe by sw lot corner @ el. 100.00' Alt. BM.= top of 1 steel pipe C el. 99.30 ID p0 Gary L. Steel 4 -25 -99 Aggregate SAS / VIA SYSTEM ELEVATION AND SIZING CALCULATIONS �2 r Below Grade Aggregate Soil Absorption Systems Permit Number 7/18/99 Date X •X• Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil 1 6 in Aggregate Depth 2 4 in Nominal Pipe Diameter 600 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 750.0 ft Minimum SAS Size 95.50 Ift Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 98.00 99.83 1 98.80 84 94.80 97.30 Yes 2 99.50 84 95.50 98.00 Yes 3 98.20 84 94.20 96.70 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) Aggregate SAS II A, s SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems Permit Number 7/18/99 Date X "x' Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil , 6 in Aggregate Depth 2 4 in Nominal Pipe Diameter 600 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 750.0 ft Minimum SAS Size 94.20 Ift Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 96.70 98.53 1 98.20 84 94.20 96.70 Yes 2 98.00 84 94.00 96.50 Yes 3 98.70 84 94.70 97.20 No Cut required 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) W,jcawimMpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety an division INSPECTION REPORT Sanitary Permit No: 420509 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Mau han, Rex I Star Prairie Township 038 - 1191 -70 -000 CST BM Elev I lnsp. BM Elev: I BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic < �sv Benchmark P0 I ff� Dosing Alt. BM Y O Aeration Bldg. Sewer c a t577 olding Ht Inlet TANK SETBACK INFORMATION S t Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ±ZS I / Dt Bottom Dosing Header /Man. �O . 3 . D/ s Aeration_ Dist. Pipe D 9ff O olding Bot. System , � IL Final Grade PUMP /SIPHON INFORMATION y o M nufacturer Demand St Cover GPM Model Number T Friction Loss stem Head 75 Ft Forcemain Length Dia. Dist. to SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 r SETBACK SYSTEM TO S P/L BLDG WELL LAKE/STREAM LE Manufac er: INFORMATION P#I%M_Bt&bR Type Of System: .S y DISTRIBUTION SYSTEM Header /Manifold Distribution x �- �[ N -q r V Hole Size I x Hole SSpacing Vent to Air Intake ipes) p 1 1-ength � Dia P _Z_ Len g th V � Dia Spacin gam_ SOIL COVER x Pre ssure 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 0 No FRI Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: It / Z� / 07- Inspection #2: Location: 1322 212th Ave. Star Prairie, WI 54026 (NW 1/4 SW 114 13 T31N R18W) Northgate Lot 42 �s Parcel No: 13.31.18.987 1.) Alt BM Description = 2.) Bldg sewer length = '+ I y')i SP S G'eire depc i ioyA ,4( W e - lased 4 awovx. -amount of cover= Will dt S Cow C 0� i 1, re.- plu.,Ae✓ UA atubj fo 4�t 169 t he 4 4kt Plan revision Required? 0 Yes No Use other side for 2 - Date Insepctor Sign re Cart. No. SBD -6710 ( 97) __r4 Sy S VOL, r•�'St�lt /per � v ` n \ ! , w � 1t 5.,.../.. 1 2260 P *3 7241t I STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN H. WAL3H WARRANTY DEED i REGISTER OF DEEDS ST. CROIX CO., W1 Document Number I RECEIVED FOR RECORD i i 06/02/2003 10:15AN i This Deed, made between Greenwood Enterprises, Inc., a ` I Wisconsin Corp=ai-iCIn i WARRANTY DEED _ I EXEMPT # _ __ Grantor, I� REC FEE: 11.00 and Kenng-th j- QeUering TRANS FEES 76.50 COPY FEE: 2.00 CC FEE: - ---- PAGES: 1 Grantee. it Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Cori x County, State of Wisconsin t ( the ro err Recording Area p ) P I Name and Return Address t 41 f the Plat of NorthGate II, recorded in the f' of the Register of Deeds for St. Croix County, Edina Realty Title Wisconsin, on June 20, 2001 , in Volume 9 of plats, !I 400 S. 2nd St., #115 't at Page 55, as Document Nwtiber 648882. Hudson, WI 54016 34r((a 038 - 1209 -30 -000 Parcel Identification Number (PIN) !! This is not homestead property. �I (is) (is not) if i i I' it I ! it i f i II Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except I easements, restrictions, and reservations, if any, of record. 'i Dated this day of May 900' GR OD INC. (SEAL) (SEAL) i * awes E Rusch, President (SEAL) (SEAL) hb sue, Se /m�a AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, 1 1 l ss. ii i. St: ('miv County. i''. authenticated this day of Personally came before me this day of May , 2003 , the above named Ja .c R, Ric .h, it Praci dan a d Mary R _ Bch, its Sp_c /T ac * TITLE: MEMBER STATE BAR OF WISCONSIN t to '! (If not, me known to be the person - tit foregoI4 authorized by §706.06, Wis. Stars.) instrume and acknowledge the sa i t. I THIS INSTRUMENT WAS DRAFTED BY r !I M ary R. Rusch Randra (',ahrlca Notary Public. State of Wisconsin New Richmond, WI 54017' 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 capac ily mnet be typed or primed below their signature STATE BAR OF WISCONSIN Wisconsin Legal Slang Co.. inc. WARRANTY DEED FORM No. I - 1998 Milwaukee, Wis. nU I t: ALL V l PICK LV I UV"EK _ ---- /� WITH 1" X 24" ROUT A — WEIGHING 1.68 LBS I F LOT IRON = 1004.89 I 6 I PLAT 5/20/99 I 3 7 I 1 �' PQ 38 t'y`N EXISTING BY OTHER INSTRUhIEI 3 _ 185.00' 51 JQ�,� 1 '- ` t 243.00' Q / P SC�� 999.0 — NO STRUCTURES AL 2.80' 3 0' o lP OF LOT IRON 1004.82 go orb P 1NP 5 ro - s ,2 PER PLAT 5/20/99 / 2 pa > \ K7 6. 41 1.383 ac. r N89007'26W 77,012 sq. ft. 1.768 ac. S 66.64 _ t CD .I.� \/ Ri p �'o. o o_ - - - -- 114.49 �QS 12 2� a� 0��0 59,945 sq. ft. lo •�� 2 1.376 ac. �6-� loo / „' oe 14 N89'07'26W 335.30' 67.48' 267.82' i / — — — — —178 loe 115.30' 220.00' � N M N 123,394 sq. ft. 0 2.833 ac. • cu / 65 �r 55,060 ,559 sq. ft. �,.� 1.264 1.505 ac. PIPE FOUND AT R/V LINE INTERSECTIDN / Z 0' 5 2 - ! 8 iZ Q � A 15' utility easement 20' 255.0E 12 13 — — - 80.00' — - — — — — - - 195 Ir NOTE:`25' IRON BAR FOUND AT R/W LINE IN _ 11 VE_ in VARIABLE WIDTH - - - - -- _, — �c •� S6 0 _ INE OF THE NW 1/4 OF THE SW 1/4 / S F SOIL AND SITE EVALUATION REPORT Page 1 of 3 in accord with ILHR 83.05, Wis. Adm. Code COUNTY ion paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # ow, and location and distance to nearest road. 038 - 1055 - ORMATION PLEASE PRINT ALL INFORMATION RIE D BY ` DA 0 NER: PROPERTY LOCATION ;wood Enterprises, Inc. GOVT. LOT NW 1/4 SW1 /4,S 13 T 31 N,R 18 EAW) W OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # ,(16 Third ST. 36 na NorthGate STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Hi3dgon, WI. 4016 (715) 386 -3674 1 Star Prairie I 214th Ave. ] New Construction Use [ y j Residential /Number of bedrooms 4 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft 8 trench, gpd /ft 2 2 Maximum design loading rate . 7 bed, /ft .8 trench, Absorption area required 858 bed, ft 750 trench, ft /Ma g g gpd gp d /ft Recommended infiltration surface elevation(s) 95.70 ✓ ft (as referred to site plan benchmark) Additional design / site considerations na PaMnt material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem i7 S O U (RS O U IR S o U CA O U CJ 11 U E S f7 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Bot,rldaly Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ' 1 _ 1 0 -12 10 r 2/2 none 1 lcsbk mfr gw if .4 .5 2 12 -25 10 r 4/4 none sicl lcsbk mfr yw if .2 .3 Ground 3 25 -31 10 r 5/4 none sil lcsbk mfi gw na .2 .3 elev. 99 ft. 4 31 -84 7.5 r 4/6 none ms osg ml na na .71 .8 Depth to limiting factor +84 Remarks: Boring # 1 1 0-12 10 r 2/2 none 1 lcsbk mfr 9W if .4 .5 2 12 -22 10yr 4/4 none sicl lcsbk mfr yw if .2 .3 ' 3 22 -28 10 r 5/4 none sil lcsbk mfi gw na _ .2 .3 Ground elev. .8 �fi ft. 4 128-84 7.5 r 4/6 none ms os ml Depth to I limiting 1 factor f � , +84" fV1L{ _ l.__. \� ` 11T (I WO , Remarks: ZONING F: - CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. ,New RichmojAVjN 54017 Signature: Date: 11 -3 -98 CST Number: m02298 ■ / STEEL'S SOIL SERVICE 1554 200th Ave. Greenwood Enterprises, Inc. New Richmond, WI 54017 NW4SWa S13- T31N -R18W (715) 246 -6200 , f 4 town of Star Prarie lot #36- NorthGate. ,s soil evaluation was conducted to satisfy a zoning requirement, it may or may ,at be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top ofl" pvc pipe C el. 100' Alt. Bm.= top of 1" pvc pipe @ el. 100.00' AO Joe a- 1 5� Gary L. Steel 11 -3 -98