HomeMy WebLinkAbout038-1221-08-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 561035 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:
Oeverin Homes LLC, aka Oeverin Pro ertie Star Prairie, Town of 038-1221-08-000
CST BM Elev: Insp. BM Elev: Description: Section/rown/Range/Map No:
/GD•Z. BM 1'3 PA r Gg-r 31.31.18.1208
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER • CAPACITY STATION BS HI FS ELEV.
E
Septic Benchmark
/dG • AN) .
Dosing Alt. IBk/I J ~ ~ z 16q. 7
/ l o.I
Aeration Bldg. Sewer 21*0 16Z - 00
Holding St/Ht Inlet '5.5 A • -7
St/Ht Outlet 5"s O `
TANK SETBACK I ION v (J
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic --l 47 Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
e,rJ
Holding Bot. System
/ -Cl 43
PUMP/SIPHON INFORMATION Final Grade 1016 19.1
Manufacturer Demand St Cover
GPM 6 162-1
Mode umber
TDH Li Friction Loss ad Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM • Co boo At Z -3
0
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z " 7~
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactu r.
INFORMATION SIC
Type Of System: CHAMBER OR n / T^ F, / r
Gerbr✓ ' O+~aX- 3q 7Z AJ~- /A- UNIT Model Numbe
DISTRIBUTION SYSTEM J 7 /66 14 + f 3 Z 4 4 .9-
Header/Manifo`d Distribution x Hole Siz x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia T Length- Dia~~ Spacing_`
~zb
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ar 91 5
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M ched
Bed/Trench Center 5.. Al Bed/Trench Edges \ Topsoil ` Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1872 90th Streeet New Rich ond, WI 54017 (NW 1/4 NW 1/4 31 T31 N R1 8W) Prairie Pond Breaks Lot 8 //Parcel No: 31.31.18.1208
1.) Alt BM Description
= ' ' OJ~-. CL.a -tom Lo~C~s Q
2.) Bldg sewer length = Z 7 / ~Z ! ~
- amount of cover = f/ /.S
> YL t 0.1
G
Plan revision Required? ❑ Yes tjjj: No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insep is Sign a Cert. No.
w;
, IV
N
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NW 1/4 NW 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
3/18/13 3
DATE BEDROOM
MPRS Shaun Bird 226900
CONVENTIONAL XX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
1000 gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 92.5/91.5 5.5' below q (de
of tank, piping shall be Schedule 40. Well is to meet all
Alt. BM To „ Pipe @ 100.2 al( setbacks requir d by
Top of 2
198 150 ~ej WDNR B.M.*
C
Q
Vent
7>6" Quick4 Standard
Leaching Chamber
of Cover
.0 ft2 of Area
with 20
150 5.6ft 2/pair of end caps
Long 12" i~
Grade at System Elevation
3 4"
Vents B-1 2-3' X 6' cells with 3' spacing
Scale is 1" = 40'
unless otherwise •
noted 0% Slope 3
B-3 C~-
25' A 1=' 3
B-2
1
e
Z7
10'
ati
Pro ~3 57'
Be oom
H se
0
Pro Town Road
aartt+tseras"wl`BrYw Safety and }3uildings sion Coun i
r ?-U1 W. Washington Ave.,1'.U. y t _
1
rsconsrr r Madison, Wl 53 7. ~ _
ry~,,,,,,,ir~,~
Ueputntwrtt of CQlrltrl®IM1C® 6. S'uuitx.ry u..uit Nun.~u p~br flLud iu ey t - _
- - State 7}'ausuctio 1 Ntsribef - -
aJan)I`~t! Permit Application
In accordestoe with s. Cornrn. 83.21(2), 'Wis Adm. Code, submission of this forum to t
unit is required prior to obUdnin u sanit ~ t
ary permit. Note: tation youti s for state-owned POWTS are Project Addre (if diiitttent than moiling attrlres:;j`-
submitted to the Dcparttnent of Comrnerre. Personal information you provide may be used for r sew st:txrndary
purposes in accordance with the Priv~_Luw, s. 15.04(l)(rn), Stats. - - r{~ y .
Y. Application Information - Please Print All Information
PJ- 0
roperly Owner's Name
~
-20 4t--S-
Pruce, #
-Eroperty Owner's Malting Addres • - Property Location
l
Govt. Lot
City, State Lip Code - - Phone Number
3 Section I
A40 A, 4A, I
cJ c~/~
_ _ 'rote un
!I. Type of Budding (check all that appl - - Lot IE _ y(W
r2 Family Dwelling- Number of Bedro ~ Subdivision Name - " -
1_1 Public/connuo..,..., - Describe Use _ - - _ _ ~i> 1 / - - City
~..1' State Owned Describe Use GSM Number - U Village of
- Gown of --_~6'
III. Type of Permit: (Check only one box on line A. Complete lime 8 if applicable) -
w, System U Replaceinuat System ❑ Treatment/Holding 'tank Replacement Only [.j Other M I (cation to Existing Syslem (explain)
A
U. 0 Permit Renewal U Permit R-isiolr El Change of plumber 1-1 Permit Trarrslir to New mist Previous Pc relit Nimrber and Date Issued - -
Before Expiration Owner
Y' .Type of PO'W'YS SystemlCornpooxrit/Dervice: (Check all that apply)
'ressurized In-Ground ❑ Pressui ized In-Ground 0 Al-Guide F I Mound > 24 in. ' Suhabl soi U Mound 24 in. of suitable soil
_ X
CI Holding "tnrrk' ❑ ()Hier Dispersal Component (explain ZQ~rilw~.%CC_------- - U Itneni Device (ex{1aiuJ- (O r
- -
V. llispersal/"treatment Area YnfortrttutiunY` - - -
Desl t Flow ( d) Design Soil A iicwiori Rat
8P pP e{gpdst} Dispersal Area Required (sf) Dispersal Area ropused (s elevation
J-12 6 6--5-1 q
/ --X-1-7- ,i V!. '!'anlc Info Caaaaity in Manufacturer
Gallons Gallons
New Tanks Existiug'Pm>ks DyvS
a. rg ui u, ~ w i~h w
septic or Holding 1'a1Jc - - - - - - -
pcrsing Cliwuolbm - - - - -
V.lY. Responsibility Statement- the undersigned, assn espansibitity for installation Of the Pt)W'I 6 shown on t11' attached plans--
Pbumbe '8 time (Print) Plumber' ignature MP/MPRS Number Business Plurne Number
r
Zze -cam ---L~l roz 6~ /,f/~
- - ---n---_ r - -
Plumber's Address ( eet, city, state, Zip (ode)
V11 . Coun !l)e artment Use Only
Approved CI Disapproval Petndt Fee i) Date- Issued suing Agent 'ign re -
~7 Gay `
U Owner Given Reason for Denial $ ~ / 5 • 3 ~ ~ 3
I . Con~itlet~pt®pqq tl/Reasons for Disapproval SYs VI-L ';;Ad ( -C~
1. Septic tank, effluent filter and r
dispersal cell must be serviced /maintained r `
as per management plan provided
by lu ~
mbe (o
p r.
2. All setback requirements must be maintained
as era livable curia/nrvV'
Attach to coropdete p nht s foe the system u ubmtt to the Co y only un paper not less ftwu 8 2 x 1 t iuc6~w in ails
Z
S10-6398 (R. U2/i)9) 0{7W%~ Na rru c ooD
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 3/18/13
Owner: Oevering Homes
Location: NW1/4 NW1/4 S31 T31 N,R18W Lot 8 Prairie Pond Breaks Star Prairie
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License numb #226900
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NW 1/4 NW 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/18/13 BEDROOM 3
CONVENTIONAL XX IN-GROUND 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 651 # of chambers 32
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 92.5/91.5 5.5' below qrade
of tank, piping shall be Schedule 40.
Well is to meet all
Alt. BM Top of 2" Pipe C 100.2' setbacks required by
198' 150' WDNR B.M.*
Vent
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
150 5.6ft^2/pair of end caps
Long 12"
Grade at System Elevation
34
Vents B-1 2-3' X 66' cells with >3' spacing
Scale is 1" = 40'
unless otherwise
noted 10% Slope
B-3
25'
B-2
10'
S
10'
Pro 3 57
Bedroom
House
Pro Town Road
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
5.6ft 2 pair of end plates
Finish grade elevation
Typical Installation 95.5'
Vent Grade Vent
3' 4„ 131
,&;-'~30/34 Septic Tank
5' Long 1 19 5' S' Long 1 Grade at System Elevation
36" Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A_92.5
B 91.5'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FIL
E INFORMATION SYST9M SPECIFICATIONS
Owner
Permit # P -o e Septic ank Capacity 7ZXQ I ❑ IJA
010
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer p t4A
I Number of Bedrooms ❑ NA Effluent Filte-
r Model ❑ NA
Number of Public Facility Units >qMA Pump Tank Capacity
gal NA
Estimated flow (average) Pump Tank
al/day p ank Manufacturer NA
Design flow (peak), (Estimated x 1.5)
e13 _2__2 gal/day Pump Manufacturer NIA
Soil Application Rate al/da lftz Pump Model
NA
Standard Influent/Effluent Quality Monthly averag Pretreatment Unit
Fats,' Oll & Grease (FOG) 530 m /L NA
g ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODE) x220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) m /L ❑ Disinfection ❑ Other.
!Pretreated Effluent Quality Monthly average Dispersal Cell(s)
13 NA
Biochemical Oxygen Demand (BODs) 530 mg/L in-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L - , NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 1W c fU4100ml ❑ Drip-Line ❑ Other:
iMaximum Effluent Particle Size in dia, p NA Other.
!Other: NA
❑ NA Other.
NA
"Values typical for domestic wastewater and septic tank effluent. Other:
NA
MAINTENANCE SCHEDULE
" Service Event
t Service Frequency
!inspect condition of tank(s) At least once eve 2 month(s)
- L4
ry' J +~ear(s) (Maximum 3 years) ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third {l~) of tank vdlume ❑ NA
linspect dispersal cell(s) At least once every: months)
ar s (Maximum 3 years) ❑ NA
Clean effluent filter At Jleast once every: ea fths)s) 13 NA
Inspect pump, pump controls 8. alarm At least once every. 1 13 y n h(s) NA
1=lush laterals and pressure test At least once every: ❑ month(s)
ether, El ear(s) NA.
At least once every: ear(sjs) NA
ether,
NA
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
linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of
icombined sludge and scum and to check for any back up or ponding 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 failing 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
I:he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin
Administrative Code.
fall other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
land 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.
START UP AND OPERATION Page of _
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thilt
may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thja
tank(s) removed by a sptage servicing operator prior to use.
System start up shall not occur when sog conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bla
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt.
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 Malntalner to assist In manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area,
Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWT,:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drsa(in
(sump pump) water; fruit and vegetable peelings; gasoline; greasa; herbicides; meat scraps; medications; oll; painting producljs;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS falls 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 shalt 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 sofl,
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 complhont
reply ent system:
J A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil ap
//l The replacement area should be protected from disturbance and compaction and should not be Infringed upon b re utl ed
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the rnfed
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulem in
effect at that time,
13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a
holding tank may be installed as a last resort to replace the failed POWi'S.
0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalu"oi
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be Installed) as
a last resort to replace the failed POWTS.
Q Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biornat at the lntiitra ive
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 NIOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. [DEATH MAY RESULT. RESCUE Off' A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone
Phone
SI:PTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name
Name
Phone
Phone -
This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(R and 383.54(1), (2) & (3), Wisconsin Administrative Code.
JIM
1ILTER CARTRIDGE INSTRUCTIONS
s,r w x ury fd fire rillrel' crier lamer the and of 1:10 uutl"I pMre to ensure it is
Centered undi tie zuneavs zeroing. If rvo% their eithesr Ihrert move pied itetu ttea
tank khrough the outlet or salbeent weld (after) additional pipe britu the uutlet
pipe.
rFiy a While the Casa Is still dry i1fted Uri the outlet pipes, rnuasaurv tiee length
of +w-hreh pipe towelled to bram the niter to time tank ltnd wall if utileelrig the
epttoaa,{ xuppkeMM1311 Wile sulmort. If side suplaurt tviethud. IS Itut utilized,
laureled to ska►1 foul.
4-vvi'" ~ Put instsllat•Ieri1s utfllzing the uptiurni atlpipluhrairtel side suµl,urt:
solueht weld tiee % -iych pipe old u the tiltt:r came. If spda suppnrt Mekhod is bad'
utilized, prataad'te step four.
5ulveht wylld the filter ease ahto the outlet
Cartridge into the case, pressing rTipe• T the Inter
Nee case. dOWh until than filter {nmks into t to the bott,rne of
if a VIts svAhir is utili:&d_ insert into tires ::•{~'p
dwkwis a goo lilteer arid {vck by turning
1~1e11t~p1f~1>It~I
1. The affluent niter should be cleaned every time live septic tank is
serviced, f
2. Ob an the outlet access opening to Inspect the tools( dild k1tel;
s. Pump the, septic tank aompieituiy, making sure to tanitrve the s'fudge e
lbyer on the bottom, of the blink and net just the sp"m uhd efllumnt. V
rs
4. once time emuent level has t, van towered below the invert w#
outlet pipe, firmly pulp up an the fitter bundle to dieledgte the the :t
cartridge from tine cages.
5. slides the rarh'idge up and of w: of the teem for cieaning. pt
6. it a VRs swnicb coot stod to an alartre is prolierit, the switch '
should be removed by turninlp t 011interduckwlsia gtr• and d amAd '
with water only, ; c
7. While holding the cftrtyMga em Iii; sides (large fiat surface fwcir,ae
down) over the aea'+ass ulaarokiiii 41114ee r111'V1e1 Cddrldge %Wtit Wilde ,l sir'
only, rnakirig sure all suptaye, rnaturlai is rinsed back lntu tire, tank. dl.
' a. if Vfts switch Is utilized re lai* t► r f4r•. t
r h V Hrseltiny into filter and
turning dddewisee 90°. m'
9, Irrsart the fl{tar cartridge back in
to the tlrreo Itrassln dtwlnr untlf M4' ti
the tinter lacks Into the Lnttorn of the aaa;u.
IO.Replace and suture the 8cceiis tmeiiviniji off the tank.
r.: Ir' •rfN:.r ~ ••,c .•yK ~ 9r1: $aT(rd ' 4.';t' ''1 Il,f i SI'ee • i.r~ ;a:li!M1!p
wwjcbox lmW te.{cam. 877-MMLT19M (653-4583'
p
r } !
AftoowDsp~~~ n toffQm~.merse SOIL, EVALUATION REPORT Page~of3-
W. - -1. 048 Courdys+
ANach complete sloe Plan on paper not leas than S 112 x 11 inches in size. Plan must
Include, tilt not knftd to vertical and horizontal reference point (BM). direction and Paoet F.D.
percent slope scale ords ons. north arrow. and lodatlon and distance to nearest mad. c
R"Wmad Pease print an kdbmlapwp- am by pwsow kdmwAbou you prv msy be used for secalfry try Law- s.15.04 (1) (m)). RDate
s . 20
PMPWVOwnar Pix4mty Locallon - 3 /
Govt. Lot & J 114/y 114 3 N R E ( W
p~pa(y Ow am 9 A Mock # Name or CSMl1
Icky Stale Zlp Coda Phone Mxrtrer ❑ City El vftP Tam NWWRoad
New ConsUuction Us~;"Resident / Number of bedrocrns -3 Code derived design low rate 'V J-g!1 GPD
0 Repleoanent ~ Pubic or coinmercid- Describe
Parent nrntedal /'7i~ c ! Flood" rI .9 appicabie ,fit///5z
and '
5- ~l
F-I I Bnrktg 0 Borkv
pit Gmundsurfaceelev. R Depth toIlid rrgfavor~v~• Sol Application
Rats
Horiaon Depth Donuirwit Color Redorc Descdptkm Texture Sbu ckm Coneislence Boundary Roots GPOW
in. Mmes! Qo. Sz. Cart. Color Gr. Sz. Sh. II •EW 61211112
Ir, I/ IIcr S
O L
s t f A L
oz
pyt Ground stake elev. / J ' ~ ,L Depth to irni&V taclor ` in. Sol Amkmdon Rate
Hadmin Depth Dan6rant Color RedoneDesaipion Texture shuck" Consistence Swridery Roots GPiff
iu Munsell Qu. Sz. Cat. Color Gr. Sz. Sh •EW •EN/12
1 0 0 3~Z s~ S Z a
o.~
o Z
• tBlkrent #1 BW > 30 < 710 nV& and TSS >30 11 /5'. • E11Mient 22 m AM < 30 mg♦l and TSS ~ 30 VIOL
Nuvftw
CST
CST (Phase P"
Address _ Date Evaknion Carduclad Telephone Number
Property OWW Parcel ID # Page of
2 ❑ soft
J J Pit &0und surface elev. Depth to *Tding fackx n
Horizon Depth Don*m*Cdoi Redwc Sol Rale
Descigaon Texture Struck" Consistence Boundary Roots GPO
irr, iMunsell tlu Sr_ Cont. Cater Gr. Sz. Sh. mm
0-11 10 w 3/2 J L 2 r 2t r'1 tS a
Z
5~ LQ 4
S7 ,~r
3 a
jg# -
92-~
la Z, ~Z
U Boxing # ❑ e
❑ Pit Ground surame elev. R Depth m Irvi ft facbr in.
Application
Horizon Depth Dom' mt Color Redox sol Ram
DesaipGon Texture Structure Come Boundary Roots GPUAF
In. Mrxrsel Qu. Sz. Conc. Color or. Sz. Sh. *W1 TIM
~ # a Boring
❑ Ph "srs(aoe el . R Depth b bn*V facbor
Sal Awlicallon Rabe
Horizon Depth DoeninantColot Redox Description- Texture SIMMA xe C roe Boundary Roots
in. Munsel am Sz cat Color Gr. Sz Sh. 'EW 'EIM
' Etlluent #1= BOD, > 30 220 nVt and rM >30 < 150 rrQ L ' EtBuerd #2 = BOD, 130 ffoL and TW 130 nV&
The Depaimmt of Commerce is an equal opporhudty service provider sad 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 609-264-8777.
rf
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Shaun B' /
Address P.O. Box 489
Somerset Wi 54025 CST #226900
Lot 8 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N/1318 N►
N W 1 /4N W 32 Township Star Prairie
❑ Boring Q Well PL Property Line County ST. CROIX
k *or VRP Assume Elevation 100 ft. =Top of Survey Iron
System Elevation 92.5/90.1 *HRPSame as Benchmark
Alt. B Top of 2" Pipe @a 100.2'
198 150'
Alt
S `7 M.
150 -Q a~Z~ti~
97' 95'
B-1
' 10% Slope
B-3
61 1 25'
30
13-
557'
Pro Town Road
I
AgtMl1NBdFnWMAAVf OF ~ I w f p1 I
TED LANDS ~sraA~rka~s 3r
- z SEE SHEET f ° I W
9°34W E 385.19' N 89'54'40" E I
M. i _ 336.61' S 89'474
~ OIRAAWGE EASF~l71/T ~ ( s
------------r--i b l~
. C*4, Lora S
i 109.399 sq. ft. ~ z
2.51 acres
30° S 89036'09" W 556.03' i
14 ow(r
:ABLE ! p1, AT
L 844.o j v'
SXI
/`btu ~ ~,1~ ~
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
i
Owner/:Buyer -0-6 7. ~ f__ - -
Mailing Address -t- rAv
D ~7~ -
Pro erty Address. q0
(Verification required from Planning & Zoning Department for new construction.)
City/State A&4J& t~znn w : Parclel Identification Number <23 9 - 9- OUr0
LEGAL DESCRIPTION
Property Location &~-J '/n , M-J 1/a , Sec. , T 11 NR 1 0 W, Town o
Subdivision P~ #
Certified Survey Map # Volume Page #
Warranty Deed # Volume Page #
Spec horse C no Lot lines identitiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of puinpinp, out the septic tank every f ree ,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. Owner maintenance
responsibilities are specified in, §Comrn. 83.52(1) and in Chapter 12. St. Croix County Sanitary Ordinance.
The property owner agrees to submit to ,St Croix County Planning & Zoning Department a certification form, signed by the.
owner and by a master plumber., ;journeyman plumber, restricted plumber or a licensed pumper verifying that (l) 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 4/3 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: ofNat:ural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and :returned to the St.- Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to die best of my/our knowledge. I/we am/are the owuer(s) of the
property described above, by virtue of a warranty deed recorded in Register of. Deeds Of3:ice.
Number of bedrooms
' DATE
IGNAT n
*`"*.Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed froth the Register of Deeds Office. and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
1111111111111111111111111111111
$ Tx34110878 0
974423
BETH PABST
REGISTER OF OEEOS
ST. CROIX CO., WI
03/05/2013 1:07 PM
EXEMPTO: NA
REC FEE: 30.00
TRANS FEE: 33.00
PAGES: 1
DOCUMENT NO.
SPECIAL WARRANTY DEED
THIS DEED, made between Central Bank, a Minnesota banking
corporation, sucessor-in-interest to The RlverBank ("Grantor"
whether one or more) conveys to Oevering Homes, LLC, a
Wisconsin limited liability company ("Granted', whether one or
more), the following described real estate in ST CROIX County,
State of Wisconsin:
Lot 8, Ptat of Prairie Pond Breaks In the Town of Star Prairie,
St. Croix County, Wisconsin.
RETURN TO
St. Croix County Abstract & Title Co. Inc.
219 S. Knowles Avenue
New Richmond, WI 54017
Tax Parcel 038-1221-08-000
This is not homestead property
Seller of covey title by Special Warranty Deed without covenants of the title or the equivalent for the state he
property is -located. Seller makes no representations or warranties, or any kind or nature whatsoever, whether
expressed, implies by law, or otherwise, concerning the condition of the title to the property.
Dated this 1st day of March, 2013.
Central Bank, a Minnesota banking corporation,
successor-in-interest to The RlverBank
By Zach McBroom, its Assistant Vice President
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF MINNESOTA
20_ 1
COUNTY OF WASHINGTON f SS.
a
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 1st day of March, 2013, the above
(If not, named Central Bank, a Minnesota banking corporation,
authorized by § 706.06, Wis. Stats.) sucessor-in-interest to The RiverBank, by Zach McBroom, its
Assistant Vice President to me known to be the person(s) who
executed the foregoing instrument a~nd(~acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Y``'^^- ` k~
Robert L. Loberg / Loberg Law Office • ~~C7.V\ro l 'K~ V~~
13135291 Notary Public Washington County, MN.
alp
MARIA L. ROOLUND
Notary Public
Minnesota
1 of 1 Q01,W Cam EVWsAv"31.2015
Parcel 038-1221-08-000 03/19/2013 10:06 AM
PAGE 1 OF 1
Alt. Parcel 31.31.18.1208 038 - TOWN OF STAR PRAIRIE
Current 1K ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - RIVERBANK
RIVERBANK
304 CASCADE ST
OSCEOLA WI 54020
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1872 90TH ST
SC 5432 SCH DIST OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 2.510 Plat: 09-080-PRAIRIE POND BREAKS 3/37 2003
SEC 31 T31 N R1 8W PT SE NE PRAIRIE POND Block/Condo Bldg: LOT 08
BREAKS LOT 8 (2.510AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-18W SE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
10/20/2010 925022 SD
08/14/2003 735549 9/80 PLAT
2012 SUMMARY Bill M Fair Market Value: Assessed with:
196177 24,800
Valuations: Last Changed: 09/13/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.510 26,300 0 26,300 NO
Totals for 2012:
General Property 2.510 26,300 0 26,300
Woodland 0.000 0 0
Totals for 2011:
General Property 2.510 26,300 0 26,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
cm Q
1161 1
7,110 1 111111
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