HomeMy WebLinkAbout038-1208-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
Y (ATTACH TO PERMIT) 479207 0
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:
New Horizon Homes Inc. Star Prairie, Town of 038 - 1208 -00 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
GS \ 14.31.18.1125
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z / Benchmark 6 -1 3; Z 5 103
assin Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 9 7
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
ccds 4
Septic 5 t r ! Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe 7• Z
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION 3
Manufacturer Dema St Cover 277
Model t /�
Model Number
TDH Li Friction Loss System d 1 TDH Ft
Forcemain Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenched_ PIT DIMENSIONS No. Of Pits Inside ++ ( Dia. Liquid Depth
DIMENSIONS '3 D9 {
Z l /-
SETBACK SYSTEM TO ` P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer, t
INFORMATION Type Of System: s CHAMBER OR ! "
O i 2- .33 /l �/,- UNIT Model Number:
DISTRIBUTION SYSTEM /v ��/rT�T
Header /Manifold � istribution x Hole Size x Hole Spacing Vent to Inttr
Pi s)
Lengt 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 /S dded xx Mulched
Bed/Trench Center �j , Bed/Trench Edges \ Topsoil Yes No Yes F No
.//
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1266 217TH Avenue Star Prairie, WI 54026 (SW 1/4 NE 1/4 14 T31 NN RI W) Pr irie View Estates Lot 30 Parcel No: 14.31.18.1125
1.) Alt BM Description = 6OJ4�---
2.) Bldg sewer length = Z4 ` ^ 1 at^
- amount of cover = d�`•+e' 1' N+- a i
(U�� 4, �Qr
due. �a i w�; P - - -- 4n ature Plan revision Required? Yes
2 o - 7I 11
Use other side for additional information. L Date Insepcto s Cart: No.
SBD -6710 (R.3/97)
Safe uildings Division County
= 201 W. i n e., P.O. Box 7162 5 0, l
���,�, M — 7162 Sanitary Permit Number to be led in by Co.)
(60 6 r�
Department of Commerce '' min
Sanitary Permit Applicati n Stal Plan I.D. NumbeP lA
In accord with Comm 83.21, Wis. Adm. Code, personal informati you ptoyide , .1 N
may be used for secondary purposes Privacy Law, s15.04 1)(m) 0 Proj ct Address (if dirferent than maili g ad�
I. Application Information — Please Print All Information /
zoivirvc oFFic� 8 — Z p r (,IV — vvb
Property Owner's Name Parcel # Lot # Block #
30 s
Property Owner's Mailing Address Property Location
I �7,5 - _ & 9'/,, Section /
City, State Zip Code Phone Number
lrcl one)
II k a
. pe of Building (checll that apply) / / \J
3 v —�� Subdivision Name me CSM Number
r Z Family Dwelling — Number of Bedrooms l
❑ Public /Commercial — Describe Use r / `�—
❑ State Owned — Describe Use VI IT ❑City U71age Townsbf
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' ew System ❑ Replacement System g p Y g Y
❑ Treatment/Holding Tank Replacement Only El Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. T e of POWTS System: (Check all that apply) /ST G �D/ // - -- - k --- C )
on — Pressurized In Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of 06table soil ❑ At - Grade ❑ Single Pass Sand Filter
Constructed Wetlan�essurized In- and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
t
Recirculating Synthetic Media Fitt thing Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (ex in)
V. Dispersal/Treatment Area uformatlon: d /
Design Flow Design Soil Application Rate(gpdsfJ Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevati �1
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site 906 fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit /\
Dosing Chamber ! I
VII. Responsibility Statement- 1, the undersigned, 9 responsibility for installation of the POWTS shown on the attached plans.
PI c Name (Print) Plumber's S" ure MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip e)
7 _,eg
VIII. un /De artment Use Onl
pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ng Age t Sit
Surcharge Fee) ��
✓ '�ie
El Owner Given Reason for Denial
IX. Conditions of Appr4yaweasolIs for Disapproval
SYSTEM OWNER:
OSeptic tank, effluent filter and
dispersal cell must all be serviced maintained
as per management plan provided by plumber
2. All setback requirements must be maintained
as per applicable code /ordinances
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in sire
SBD -6398 (R. 01/03)
PLOT PL N
PROJECT New Horizon Homes ADD S 1475 Hwv 65 New Richmond Wi 54017
SW 1/4 NE 1 /4S 14 /T 31 N/R 18 W WN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/25/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRESS CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 000 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 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. 1 Same as Benchmark
SYSTEM ELEVATION 94.4/94.2 5.2' below qrad
210' Pro2erty Line
Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
setbacks required by 90'
WDNR
Vent M.*
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area B -1
l e' 6' Long
11"
34" Grade at System Elevation
Vents
2 -3' X 69' Cells with >3' Spacing 5
B -3 45'
Pro 3 Bedroom
House
5 '
30' ST
30'
B -2
55'
Property
Line
217th Ave
PLOT PL N
PROJECT New Horizon Homes ADD S 1475 Hwv 65 New Richmond Wi 54017
SW 1/4 NE 1 /4S 14 /T 31 N/R 18 W WN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/25/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRESS 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
IL BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.4/94.2 .2' below qrad
210' Property Line
Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
90'
setbacks required by
WDNR
Vent M.*
>699 Standard Biodiffuser AL
of Cover Leaching Chamber PEB '
with 31.1 ft2 of Area -1
6' Long 11 "
3 4" Grade at System Elevation Vents
2 -3' X 69' Cells with >3' Spacing
5'
B -3 45'
Pro 3 Bedroom
House
5 '
30' ST
30'
B -2
55'
Property
Line
217th Ave
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8. tq 1 I s in size. Plan must
include, but not limited to: vertical and horizontaf reference point (BM, direction and Parcel I.D. 1 0 3 �pZO� �d -�lI
percent slope, scale or dimensions, north ah'pw, and location and dls ' ce to nearest road.
Please prfpt a►f- informilfo R Date
r i `. �1/ I
Personal information you provide may be Lsed for secor� Opbliieis (Privacy flaw x\15.04
Property Owner h r, r, P perty Location
j r �r�:' �' '•5 i U t_ vt. Lot SW 1/4 NE 1/4 S 14 T 31 N R 18 EX(or) W
Property Owner's Mailing Address - ,• tit # Block # Subd. Name or CSM#
J �yti.
1430 220th, Ave. ��� /30 na Prairie View Estates
City State Zip Code. Pho a Number ❑ City ❑ Village $] Town Nearest Road
New Richmon , W .5401 , (.715'24$ - `7j,1' Star Prairie CTH . " "
New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material out u m — Sh Flood Plain elevation if applicable na ft•
General comments
and recommendations:
trenches @ el. 94.65'
E Boring # Boring
® pit Ground surface elev. 99.85 ft. Depth to limiting factor +1 10 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
none L 2msbk mfr cs 2f .5 .8
2 13-33 . 7. 5vr4/4 none scl 2msbk mfr gw if .4 .6
3 3 -50 10 r5/4 c2p7.5yr 5/8 sil M na gw if .0 .2
4 50-110 7.5 r4 6 none ms osg ml gw if .7 1.2
❑
Boring # Boring
2 ® Pit Ground surface elev. 99' 65 ft. Depth to limiting factor + 11 0 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 - Eff#2
1 0-13 10 2/2 none L 2msbk mfr cs 2f .5 .8
2 13 -35 7.5 4/4 none scl 2msbk mfr 9W if .4 .6
3 35 -50 M na 9W if .0 .2
�l
'Effluent #1 = BOD > 30 220 • g!L and TSS >30 < 150 mglL -,E uent #2 _ BOD < 30 mglL and TSS < _ 30 mg/ L
CST Name (Please Print) Signature CST Number
Gary L. Steel - 02298
Address Date Eval f tion Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 12 -4 -2000 715- 246 -6200
Property owner Ewlen Properties Ltd. Parcel ID # pendincf Page 2 of 3
Boring # ❑ Boring
pit Ground surface elev. 99.70 ft. F - 31 Depth to limiting factor + 110 fn
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 'Eff#2
1 0 -15 1 Oyr 2/2 Cs 2f .5 .8
2 15 -30 7.5 4/4 none sl 2ms k mfr gw if 5 .9
3 30 -50 7.5 4/4 f2d7.5 5/6 j COS/SA na gw na .0 •2
4 50 -11 7.5yr4/6 none ms Osg ml na na .7 1.2
f
Cp
F-1 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 'Eff#2
F-1 Boring # 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg1L and TSS < 30 mg/L
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.
SBD -8330 (R.6=)
•
STEEL'S SOIL SERVICE
Gary L. Steel Ewlen Properties, Ltd. 1554 200th Ave.
CSTM2298 SW4NE S14- T31N -R18w New Richmond, WI 54017
M.PRSW -3254 town of Star Prairie (715) 246 -6200
lot #30 Prarie View Estates
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" =40'
BM.= top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 99.90'
A
r�
5
� 5
Gary L. Steel
12 -4 -2000
i
.., .........................................................................................__........._._-....._..... ............................... .......... .................
............
,;HP I'iC' T.a.iv'l� MAINTENANCE ll,A,�iCtil�- ACsk..F: ;L;'v[•�:f�i1
AND
;FR.`31•11P (;ERTI,i"ICATION F'Oi M
Own: ;/F. ; W....
swZ..,-. «... VV w..��il�Il�'1..A/���.,l���t,
(Ventica Atnx required lion Planning Department for new curastruc.twni , , , ... _ . . ...... ..... .........,...
t.;ttyl''tato ,. w E l..�/ .uni✓�!. Parcel Identification Numb...
iv Lt;, Sw ", jy- %,. Sec. 1 `.3 _....i ,.•,___..,,..�` 'Tu��ri ui sT/1,�...�'✓ ,rye/
C'or1: i. 'ied 131 ;K,� Y M.U.P ;N ... _.1-- :.._._.._....._> 'v'trlurrc;s __...� _ __.._._.• }'ale _ .... _.
V olume
....• ... _ ..
Snco .louseA ! • i .'s I_.J no Lot lines identittaN YOS U no
uvpm D , rite and tnaistcn;anceof your septic system could result in its premature failure to handle wastes. Proper nxainiea nce
eonsis of puxapi;l: out the sej.Aic tank every three ye-m or sooner, it needed by a licensed nuraper. What you pill. into tite, system
can at..ct the rtier:,rian of the sraptic tank as a treatt.nent stage in the waste disposal syst
The pm: a ^ty owner afgees to subrait to St. Croix Zoning Dep,aitmw a certifitatwn.form, signed by tbe." by a
mastr, s plumbs,•:, i oi.aneYu=plwnbar, it stril abcr or a Li,ctsnsed,pt>mpvr Ycrifyiug tixat (1') the uu -5itr %yastewatexdigw ski• system
is in :! per op- -nt'v: ig condition and/or (2) after inspection and pumping (if necessary)., the septic tank is less than 1'1.31W of: tAudge.
11wc, c it uadwsi ?i,:s :d have real;• the above requirements and agree to maintain the private sewage disposal system with.thr•;;,tandards
set for; hez'eia.i, .i::. set by the Department of Commerce end the Uepartruent of Natwitl Resom-ces; State of 'Wisconsin. C:ef:.dlication
stab p lhat yot {r ;; , rtic system teas been maintained. must be completed and returned to the St. C„roix Zoning. OfT1ce'i-'v1+ 30
clays c. he t�sr. ':r 'v• rr C` V;.VUi!1 date -
3ICi.lt � D A , IT .._.�:,
I. (we)Yo',c'I.ify that all i.tatements on ibis form are true to the best of my (our) latowled.2e. 2 (we) am (arc) die, ov,4acts) of
the n:r•: ,;5erty dvw !!,v izd above, b y virtue o a warranty deed recorded ui Register of Uceds Office
/U y
TEA ➢ J:
Any ilnfo ngation that i , ntis- represented may result in the saWtary permit being revoked by `he Zoning Y)elf'aftKrieu "" *"
"• 11n,s:.ude with 4HO applicati.an: a•starnped warranty deed from the Register of Leeds ottice
a copy of the certified swvey snap if reference is made in the we.rmnry deed
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years. r filter is being installed in
2. Effluent filter is to be cleaned once a year. Please note: a large
order to extend the maintenance interval of the filter. at the ends of
3. Once every 3 years, cells are to be inspected via the inspection s pipes
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. p Comm. 83
8. Discha_r�e into system is not exceed those required as P
Plan .
n fails determine cause of failure, use emate ae - and install new
ptio7htested yste ,
replacement area.
option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
I
Plumber: Shaun Bird 715- 246 -45
St. Croix County Zoning 715-386 -4680
Pumper Tom Mondor 715- 246 -51
Shaun Bird #226900
J 2 5 5 0 P 3? 5 75856 '(
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Co., WI
This Deed made between EWLEN Properties. LTD., a Texas
RECEIVED FOR RECORD
Limited Partnership Grantor, 04/16/2004 10 :90AM
and New Horizon Homes, Inc. WARRANTY DEED
Grantee. EXOPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
TRANS FEE: 90.00
(if more space is needed, please attach addendum): COPY FEE:
Lot 30, Prairie View Estates, Township of Star Prairie, St. Croix County, CC FEE:
Wisconsin.
PAGES: 1
Recording Area
Name and Return Address
53 a S (<, -to „Jlos A J
ct) �
038 -1208- 00-000
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and right - of - way of record, if any.
Dated this day of April 2004
�WLEN LTD.
B Y: Paul Anderson / j r., y' A 'ef
- - - G h ♦ 121. .�n..-
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF -7& )
QQ KCLC __ County )
authenticated this _ day of _
Personally came before me this G day of
April , 2004 the above named
EWLEN Propert L a Texas Limited Partne rship,
* BY; - Paul Anderson
-�- -- --
- - -- - - -- -- — - -- -- --
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ — to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland * —
Hudson, WI 54016 Notary Public, State of CIS
My Commissio 's permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) — .)
*Names of persons signing in any capacity must be typed or printed below their signature. du Lac, wi
STATE BAR OF WISCONSIN Mlrf ATHENA M. KOENEN 655 -2021
WARRANTY DEED FORM No. 2 - 1999 Notary Public, State Of TOM
My Commission Expit
ii Augmt 23, 2006
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