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026-1101-20-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399626 0 GENERAL INFORMATION (ATTACH TO PERMIT) aW Plan s I D D No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. O J ►�J / Z "T/�GLNS , / Permit Holder's Name: City Village X Township Parcel Tax No: Starks, Tim I Richmond Township 026- 1101 -20 -200 CST BM Elev: 1 Insp. BM Elev: I BM Description: n (� Section/Town /Range /Map No: TV CS t Rw� 2 }' t�r�dC�T�. 36.30.18.552620 TANK INFORMATION PELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark - • Z 9 `,t Dosing 1 t Alt. BM Aeration `•'I C�+nn.J� Bldg. Sewer r Holding St/Ht Inlet 4'qD 3• SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2 i t Dt Bottom I3- I / • 3V Dosing Lk I Header /Man. l 3s 9 Aeration Dist. Pipe 3, qL 3 Holding Bot. System �,'" PUMP /SIPHON INFORMATION Final Grade 12f 5 Manufacturer O t t Demand St Cover (yam GPM t 1 .20 Q�• Model Number 35„fl t p tSZ- q.� p Lift Friction Loss System Head TDH Ft cemain Leng Dia. �� Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No.64—ren Q7181 -, PIT DIMENSIONS No. Of Pits Ins a Dia. Liquid DIMENSIONS 2 u `" 6 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufac r INFORMATION CHAMBER OR _ Type Of System /� � 4 1 � � UNIT Model Numb DISTRIBUTION SYST� ~_ L�wtweIL- A qS Header /Manifold Distribution ( II 1 x�� x Hole Spacing Vent to Air Intake Length Dia Length is + S acin SOIL COVER x Pressure S ystems 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 5; Yes [] No [E Yes 2 No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #43 ZM3 Inspec Location: 1294 150th Street New Richmond, W) 54017 (NE 11 NE 1/4 36 T30N R18W) ) A` of 2 r el No: 36.30.1 / 8.552820 1.) Alt BM Description = �j •T I,#Adw �- Rb4--k�'. / �� w�`S `^'� ` CAS" u' t�! "� >�C 6M q ' 2.) Bldg sewer length - (� w amount of cover �{�• CJhltd'; 3) �Ff.oi Plan revision Required? Yes X No t Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) :.� I I � ,.,,� J Ib � �� S � m ,fib h � \ ,. „�., -�.. --� � b Y �- �- , T � � y -7/.I Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Iviscon Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach corn lete plans (to the county copy only) for a system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number 0 if revision to previous application State Plan I. D. Number 3% Z 3$8( 09 0 8332 I. Application Information -Please Print all Informati n. BECEIVED Location: 2 / S ST. Property Owner Name d� perty I ocation $ Si 1/4 Ag 1/4, S T 3D,N, R (& (or) Property Owners Mailing Address Lot Number Block Number 1 4-7 9 30 -f h ST CROIX CULIN I r 02 City, State Zip e u ivision amegg RM Number 't/ N ew 15 4 , Di (Zt EAl2' [o;LSZ C 40V J ai{ 1 FN H. Type of Building: (check one) 14 �, �Qiyr�2 �� ❑ City O � I or 2 Family Dwelling - No. of Bedrooms : ❑ Village ❑ Public/Commercial (describe use):_ mown of ❑ State -Owned D S OArc d Gv/ S/ X /2y' dza f' Nearest o+'t °ten q �, o 7 �t R D Z — ZO e-5 S Q o f "D arce p III. Type of Permit: Check only one box on line A. Check box on line B if applicable) A) I. A New 2. U Replacement 3. E3 Replacement of 4. 5. 6. 13 Addition to S yslern System Tank Only Existing System Permit um er / ate Issue B) V A / Sanitary Permit was previously issued 3 to 3 200Z IV. Type of POWT System: (Check all that apply) • Non - pressurized In- ground RrMound Z`f s °' ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: S� 7 4 94,e 1.0 d 1. Design Flow (gpd) 2. Dispersal Are . Dispers Area 4. oil App i ion 5. a anon Rate 6. system Elevation 7. Final Grade Required (�(�D'C Proposed 20 Rate (GalsJday /sq. ft.) (Min. /inch) Elevation VII. Tank Capacity it o of Manifacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Off /� Con- Con- glass New Existing � crete structed Tanks Tanks rt fil:e' Z-- � 12. Zov I Wd woo rr �s� p Mb 12 0 0 VIII. Responsibility Statement I, the undersigned, assume responsibility for' lati OWTS shown on the attached plans. Plumber's Name (print) ps : Plum be ignatu o MP o. Business one Number L NP ��39�6 z -71j 23 r- 26 Plumbers Address (Street, City, State, Zip Cc@e -141 Y 7292r A116 b6W - St "75" IX. County/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue ssuin gent Signatu stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) dU S/ / Determination / X. Conditiods of Approval /Reasons for Disa proval. OnT L4[ O to M /Ml r - y Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 '\ Visconsin www.commerc .wis ons Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary February 14, 2003 CUST ID No. 139462 ATTN: POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 j� CONDITIONAL APPROVAL � 3 91 K ev' e PLAN A EXPIRES: 02/14/2005 Identification Numbers Transaction ID No. SITE: ���� S Ch, / �`t 5/20 ! Site ID No. 638866 Tim arks Please refer to both identification numbers, 130th Avenue above, in all correspondence with the agency. Town of Richmond St Croix County NE 1/4, NE 1/4, S36, T3 ON, R18W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 891714 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. PeVls c( so' 1 4 s t 4e flci.. t,-- • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of these tic tank outlet filter is required. The access dpzntn - g - u - s - eUt — o — se - r - v - jc - e - tTe filter shall terminate at or above finished grade with a watertight cover. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. w C011ditiodZq►'j' TODD L SINZ Page 2 2/14/03 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 Henry F Grote, Certified Soil Testing RECEIVE, FEB 13 2003 Tim Starks -Mound A, ;� Tiy 0 Transaction # �`� ®� V� Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD - 10691 -P (01/01) Pressure Distribution, SBD - 10706 -P (O1 /O1) Location: NE 1/4, NE 1/4, Sec. 36, T 30 N, R 18 W Town: Richmond County: St. Croix Date: February 4, 2003 Owner: Tim Starks Address: 4 130th Ave. ETjd Richmo , WI 54017 Plumber: Si Signature: License # 39462 Attachments: 4 -Plan Approval Application SBD -8330 page 1: cover 2: design criteria & calculations 3: plot plan V E D 4: system cross section 5: plan view, lateral detail DEPARTMENT OF COMMERCE RIVISIQ F SAFETY AND BUILDINGS 6: pump tank exit detail • 7: pump curve 8: system management SEE CORRE ONDENCE page 1 of 8 Design Criteria Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L Anticipated septic tank effluent 30 mg /L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg /L 4 Bedrooms x 100 gal/bedroom/day x 1.5 1 0-t=. gallons /day hydraulic load Design Calculations In situ designed loading rate I s gallons /sq. ft. per day s 1 _-/V _-/V � • but (Aa.¢aF Cdr Depth to estimated high ground water 3 Z in. Depth to bedrock 4b in. Cross slope at system (°•ze' ov w ,. Force main length ft. of Z in. Manifold /header length Z , r ft. of Z in. Drain -back gallons Lateral length ft. of 1 Z in. Lateral elevation ft. @ bottom of lateral Lateral hole size 3 1�b in. in. ft.) Spacing 3 holes /lateral S` 2 holes total Lateral volume Z- $ gallons Total lateral discharge rate 34 . 3 z gallons /minute @ 2 'S� ft. head Network pressure compensation losses ft. Elevation difference �'''t� ft. Friction loss 3'� 3 ft. @ 3 gallons /minute Total dynamic head 3 ' x " 3 ft Pump /s*on !�3 gpm @ t ft. of head Manufacturer � O �� t01r Model # t Z Dose volume �33•ta gallons Lift/sip'ton tank ` Q' �� C J-, : - f'O gallons Septic tank tz � gallons Effluent filter d F 5 Is $zZ AAA_ Q A Measurement pump on and off '`a in. Height alarm from tank bottom l in. Reserve capacity �� gallons specs.calcs.res Page Z of • F.d. PAGE - 3 OF _2 SCALE: V= yd BM I ELEVATlUN (Gtr. U -r ......... PM I nFSCRIPTION BM 2 ELEVATION + IQN i SM 2 llESCR1PTION e r ��., , L �, t I I SYSTEM EL EVATION q$ ,S'U I 1 SYSTEM' TYPE S ewt Co t- TOUR ELEVATrON � o I 9 i I n 7 I � � J �� I Y OC. C t'1.$3 a2 o-a 17 o n �0 1 \ C.w�e.w�o-�tdl. r 1 • All - RIC - 10 S "• a' �-' Z 4 a' 0 4 V C_ e. L.CJ� C W L A..N V a. T c v. t..., t 1 o' 1 c •r C !. t - 1 „ QV C ET T 2.S` • (��, ►o (so.c� �bV ��4�5 l � YLr �+� �• Y: ti�� ���C. 1x 1p O 1 l o �. \ : •+ 1 • � �L ( J� \ N+ �� • ' J H JCS QX cU U' r WEi' NERPaOJF LACKIwG CovER Lae c� � I 4�IcK Da�couu�cT --� 4 " Pvc no rrD15TuRUD S o i l _ C" (1 24" 1.0, II w IAOLA r� our Gp)' R.OvLO 5KZT ,SOJ 7J FLE IyN E LT O KS P ints' � p I s[PTIc c SPEC�FICATIO }�� DO TAU S MAUUFACTURCR: IJUMBER OF DOSES', TA1JK SIZC: ,1 GALLOWS DOSC VOLUME 011 LA0.M KAwUFACTUii,GR; S , ��` �c Yv lKICLUDING aACKFLOW: MOOCL QukAtCR: CAPACITIES! A= Zq'z 11JCHCS OK 4gg. 5wiTCH TJPC: z 1 8= uCHCSOR C'4.MP h1AQUFACTURCR: -'— G a � �ucNCS OK ., MODEL WUMDCR: JWITCH TiJPE, VMQ.V••{v w r MOTE: PUMP A1JD ALARM ARC TO C[ MIWIMUM DISCHAPt" RATE 34 G ►M INSTALLCO OQ 5E. PA RATE C KC ICo�L DIFFERCIJC CCTwCCW PUMP OFF AlJO OI6TRIbUTI0W PIPE.. ��Z� FEET Qi#1 UM NETWORK SUPPLY PRCCGUKE . . . . , . . Z •l ' FCCT 4 '` D '�"S ZS FEET OF FORCE MAIN X_ F� 3 .Z3 3 �' l00ItFKICTIO►J FACTOR. FEET TOTAL OyJWAMIL HEAD Z. FEE T 1.44" lAL DlMEf.lb10WS ' 0/ 7AIJK: LE►.IC.TH --- -. - ..._;WIDTH LIQUlO OCPT H �R "\ 6 u¢ - - - - TOTAL DYNAMIC HEAd /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 w MODEL 152 1 153 50 4 Feet Meters Gcl. Liters GaL Liters 153 5 5 69 261 77 291 , 12 40 152 10 3.1 61 231 j 70 1 265 0 15 4.6 53 201 61 231 a z 20 6.1 44 1 30 67 5 97 - - -+ --± --- — M 25 7.6 34 129 42 59 a 8 z 30 9.1 23 1 87 3 125 Q 20 35 1 1 10.7 - - - - 22 8 r 40 2.2 j -- -- 1 4 2 4 ` Lock wive 38 0 -F (1 6m_� 44 C__— 4 1. 10 t• t .D 014 508 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 - FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS e Timed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with e an alarm. =-- Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Owik -Box available for`outdoor installations. See FM1420. Over 130 °F. (54 °C.) special quotation required. 152 I53 Series 1521153 MODELS Control Selection Model_ _ Volts -Ph Mode Amps Simplex Duplex -- 4 - — N152 115 1 Non 8.5 1 _2o0 —— 6N152 115 1 Auto 8.5 Inclu _ 2 or 3 8K2064 __E152 __230 1 Non 4,3 1 2or3 -L - - '--� _B 1 52. 230 1 Auto 4.3 Included 2or3 - ,. N . 153 . 115 1 Non 10.5 1 2or3 BN i 15 t Auto 10.5 Included 2 or 3 SELECTION GUIDE E153 __230 _ 1 Non 5.3 1 2or3 BEi53 230 1 Auto 5.3 included 2 or 3 1, Single piggyback variable level Float switch or double piggyback variable level float - - -� — switch, Refer to FM0477. a CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 �-� Louisville, KY 40256.0347 Manufacturers of, Z = % SHIP TO: 3649 Cane Run Road Louisville, KY 40211.1961 �7 • (502) 778.2731 - 1 (800) 928 -PUMP QUQ[ /TV PUMPS 51#C'_ 1917F http: / /www,zoeller.com PUMP CO FAX(502)774.3624 © Copyright 2000 Zoeller Co. All rights reserved. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715- 235 -2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water - saving apl3liances whenever and wherever possible. 3. Repair even small water leaks as soon as possible, 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1, The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.5.1 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ST CROIX COUNTY SEPTIC TANK MAINTENANCB AGREEMENT AND OWNERSHIP CB,RT1HCATION F0 Owner/Buyer _ . _ Mailing Address ,1„ 4� 1 q y 'L- r--- -- Property Address S,e2 2 Sv � ST erification required from Planning Department for r**COnstiuction) City /State �'- R" , �--� 1r Parcel Identification ba 026, // 6 ` - ZJy 3 (0. 3o tr.55 LWAL DESCRIPTION Property Location Location ' /�, t /4, Sec. 3tv . T N -R . T Of Subdivision Lot # Certified Survey Map # (o�� l -• Volume , _ —, .Page # Warranty Deed # _ Volume , Page # Spec house 0 yes )& no Lot lines identifiable. yes 0 no SAM MAINTENANCE Improper use and makft anceof your septic system could result in its premature failure to handle wastes. Proper maintenance eoasists of pumping out the septic tank every three years our sooner, if needed by a licensed pumper. What you put into the system can affect the function of the sic tank as a treatment stage in ffic waste disposal system The property owner agrees to submit to St. Croix Zoning Departs a certification form, signed by the owner and by a mastcrplumbm journeyman plumber, resrricte dpluml>er or a licensedpgroper dying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if may), dw septic tank n less than 1/3 M of sludge. I/ tt undersigned have read the above requirements and agree to maintain tier private sewage disposal system with the standards set fortb, herein, as set by the Department of Commerce and the Department of Natural Resotu+oes, State of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St. Croix Cotmty Zoning Office within 30 the throe expiration date. TURN OF APPLICANT DATE OWNER CERTIFICATI I (we) certify that P statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the d = a by ' e of a warranty deed recorded in Register of Deeds Office. b L L i O/ SI43NATUR.E OF APPLICANT DATE ssssss Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « + « «+ ss Include with this application: a stamped wamwty deed from the Register of Denis office a copy of the certified survey map if refer vww is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner rX 13 r �, �- KS Septic Tank Capacity / Z � a l NA Permit # 3 l 16 3 S 3 Septic Tank Manufacturer 91FFC1U77_ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Q,Qdd ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model P- © g 7,z 1q 5A ❑ NA Number of Public Facility Units NA Pump Tank Capacity G'dyyl 80 251) al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer }� vl%({�j - ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate /.0 33 gal/day/ft' Pump Model S Z ❑ NA Standard InfluenUEffluent Quality Monthly average* Pretreatment Unit A NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD _5220 mg1L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /l_ ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 5_30 mg /L XN A ❑ At - Grade Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other' ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency - -- - - ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: Z — earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y o an vo ume ❑ NA Inspect dispersal cell every- s) At least once eve 13 month( ar(s)) (Maximum 3 years) ❑ NA 2 � � yer(sl ❑ month(s) ❑ NA Clean effluent filter A en .Ez> At least once every: I � Z years) Inspect pump, pump controls & alarm At least once every: — ❑ month(s) ❑ NA year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: — Z year(s) Other' At least once every: ❑ month(s) E3 NA ❑ year(s) Other: ❑ 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 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 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 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 2 of Z � START UP AND OPERATION For new construction, 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil 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 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 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 cells. 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; 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 replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil 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 structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ 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 POWTS. 9 �A ❑ T he site has not b °� s *d'� *^ i " "� l" - s �'�• o f t P�VI�? S a coil an s ite e If nn ru in ,r -hla hnld t 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 INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name - 7_,0D D -S I AJ 7_ B //'JCT- Name Phone —71L - Z 3 S' — .2 & 4 Y I Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY r Name Name r✓Au! Phone Phone 1 -7 1 S� -- 3 ff (— -f (p �d This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(fl and 83.5401, (2) & (3), Wisconsin Administrative Code. f PAGE,, 3 OF Q 5 �...r . � r nr# rc DF crrr — —1 p 1/.. 1 SCALE:I " - y d BM I ELEVA'T'ION 100, C) µ � HM I DESCRIPTio -, BM 2 �j .... 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Cody CIWhI riffhm 6wo112s1 nQoNfW'PMTmust rr►awwr ru II so nn� Q Mcwa. a, rnwaw+ �xwl�w►. nrns►eow�•n�o.arx�+�•ar+or...na rralta� �� Ao. �ps.opls s► dTM1>rp� M� tl1M• tuuO lOOM�� YM) �MMaso r ngiM1 rotr0 by t>N PIww prwt aN altt t r ou L 3 D nr +M.wMr..t..Nrrvn..•,a�wrru..s. r1�I 1 10 E for Lot M1 aN i T 3Ow R ---' . t�fmrr a V 15 (o 7 9 T toc. 2 �► '""'' TI " AV-III: app 1? urn ust�" 1M """` aeeiao«e. .—. — RA ow d Neale or .pns �l►e t1o00 pW de+a�► 2 `4- "r'�.. --- I wrwdQw -we GyI PR car Usk" lou"o, R.od o..am�w R.s..a�alad� •a1a ►IOroan of•w aw t e. c ow a. rd, an. Q M'Ip 1 0 l Groud srIM� ow. C.. -sue. - ti D�D�n a IMrYnY OCw . Soi MAW � I R p mt cab► ROM Gf6rMb" TsoWf '[�? llo�or OeY11 Du. 9t .2 r .Q CST i I X30 Itttl ot� • 6nW.N R K70 s fo �n sro rrwlrev . - Soo >xs3aDlMn �ro s �av tiT w+r RIw /.+G —. t.�el�en. Mulnw r !r � ! 'y AMnw 1 2tt 3 �r •fit Y.tl� � woLr= :d wtl95::t 100 92 "+�0 I L 02/27/2003 05:28 FAX 17152952592 TLSINZPLtTXBING 0 - go o2 12:20P pOm%G Excavating (7151796 - 25 19 P• • i p ea.�o ti oaoN a w PAM GPo ow ing 0 Pa Gteund .ease aa. �� t� a►w s+verw° �, •Hws wr=n Ga L Mum Ci. as Oar• COW woo �� ara�nd7�a�"' TaW� aD�W� Con /aMnae �4unOMy RaW apt raa�a+ Dom' DWWANO Corer or. $ S'. COW. sr- CAWmC OL I �;apnno• IG . p�np,wr.aaN... -- r<, saute. �erwo.nl Rwli �, —J LJ Via T.�n Or SIL. se. H~ oa06� p L CW* w. 1 aOO,S)� r^a'� w* TO . awn n • 900,> 1c S 214 ayll aid T95 s )6 190 OWL r ; Tf aatrrca p�'�+ � a°'p�0y „. if yor nut a�iNU►cc w accaW s��e a cua toRea+ es ►�~ st ti 0 &1Ah or Y 6US.164 -e' The Dwar S7. "Mmof Cori p i tlf A equal oPYO� sore maru++t �n an sit row N vo.ranrwa 'ON WJ4 Ewe 9Z -00 2/27/2005 05:28 FAX 17152952592 TLSINZPLLTMBINCI 00 _.. . , Jj tau •9015 10.3 PAC4_3 OF .3 wAm s .. I DTt L I265S�pT1t'�+►�t %��� r B yCA T _ ' R J i;( 6 t� SCALE• i "� y4 / ..__.. _.- y � BM 1 ELEVATION AM. V AM I nFSCRWrION! & .ot l",,J c 4 + W2 CLEVATION !ff.:b_ !IM 2 UESCR MON SYM fL S� i i SYSTEM TYPE _ mA u nat S a_c Le OWTOMELEVATIOW 94'. 5 � al 1 t 1 4 r s' l 1� r 1 Off, 14,V 1 ho l�U Z;NATIlIIF Zci wkf95: t ZW? 3 0 'QN Mj wotlj i o 4" cnras � _J W a $ ni Q W . ro •.i Cu � ••� ZWH A Q 7— •• W rir W cC5 ®►— =H E'ER T I F I ED SURVEY MAP NO. VOL UME I PAGE 4096 LOCATED IN THE NE 114 OF THE NE 114 OF SECT 36, T. 30N. , R. 18W. , TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN a cnx 2 R r • 0 W�cr 0 ~= w UNPL ATTED LANDS .. ° ' _ . ............................... ��*+ ± C-) X WEST LINE OF NE 114 -NE li4 o m QD _NW-NE N00' 28' 13"W 577-51' I C v z NE-NE 544.5 I' _ '� 1 : 3,3.00' (A t3 z : r` 2 ~ 100 m'o w ° w c� � 8 a � z C) Cz s 1 I m cr 33.00' n 4 544.51' y NO0 13'W 577.51' o U 1 0 APPROVED ro ST. C IX CtwNTY lrs w a ro 1 m Funnina Zonina and Parks Co mAtee N y � a ,�°� N ria MAY 2 9 200 o — 2 2 C O► (o 7bb t0 v w ,rrOO w N N O � °' I� If not recorded within days of 0 Q . y ro y y a y r„ z pproval date approval( shall be I �! o x o N 1. c null and void -n 33 1 3 -1 2 Op r. ZO�'rt Z� m: 3I Hwy w HIGHWAY L I NE °f n Qw... SETBACK..Q............ 1 c NOO* 45' S5' 54' W R 500 S5' E R 544. ^� 206 7. 71' — i - Z i g �.. 45 � 5 � . J. c��r - to oAZ 26 •25' 1 o U X$ O 2 EAST LINE OF THE NE I i4 I I DOCUMENT NO. BTATS 1M.2 OF WIBWNSIN FORM I— Twos 4ft" ft""M PON "Coltoodo "I% W"Rom DMI 492020 IVOL' 982W'1 598 REGISTER'S OFFICE Thi "d made T Harold R. Yates .&Ad. r... ...I......................_.... .... * ..... * ... ' ST. alox CO., W1 _Csxv At .... T49A i . heat for Record ..................................................... ......... ......................... tarke ...... ................. ................. 4 9:31 M- A M ................ ...... ......................................................... ............................... ...... .................................................... ..................................... .................................................................................................. �4 s Ntffie wtb. That the said Grantor for a .doable consweration ...... . .................... alrW ............ ........................... ........ �7s 1 ix .......... �n conve w Grantee the following described real estate is ..St_.zfQ County, State of whmnoin: L The North 35 rods of the Northeast Quarter (M) of the Northeast Quarter (*Mk of Section Thirty Tax parcal No:. ._ .... . . . ............... Six (36), Township Thirty (30) North. Range F (18) West. FM This deed is made in fulfillment of that land contract dated August 9, 1989, rmcorded August 11, 1989 in Vol. 848 of Records, page 402-403, as doc. no. 450508, in the office of the St. County Register of Deed*. is not This ............................ bmwftad P"Wty. (1A) (if not) Together VU all Mths, & r a ces dwounto belonging; a &" h s a rm AM ........... .......... es e p lt d appurtenanp ................................. . ................................................................ ................................. warrants that the We is good, Wisfessille in fee simple and free and clear of secumbrances cteept and WW warrant and defend tbo sams. November 92 Mud ...•............ day of ............................................................. —....,W ........ ...... . ........... .......... .• ............. . .... . ............... ............................ • .................---•..._ ................... . . . .... . ......... Ha�rold%. Y es ------------- - - ------ --- . ........ . ............ . .. . ........... . ........... . . . ........... Oki -. . ... ............... (SICAL) .... .. . . . . ........ ....... . .............. . . ... ........ W Carol A. Yate .................. . ..... . .......... . ........................... AOXXOWLADGNBNT STATZ Or W18WXWX IL Pierce X pleraftaft cassis use tbefb7 srol it a at siro s i m -3-7 an z XMBJM BTATZ "a OF WU10ONm 6"barlsed IV I 1i Wf& stow who assevied hressing Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services i ccordapce with s. ILHR 83.09, Wis. Adm. Code Y'7 - Attach complete site plan on paper not less t n 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and hor' ntal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1 /4,S T N,R E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number Nearest Road ❑ City ❑ Village ❑ Town ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 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 El El ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U I ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 Ground p elev. ft. ` Depth to limiting factor in. Remarks: Boring # Ground ✓Gc elev. N ft. g Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure Texture Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # Ground elev. ft. Depth to , limiting factor I F ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and BuilditIg Division INSPECTION REPORT sanitary Permit No: 399626 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: Starks, Tim I Richmond Township 026- 1101 -20 -200 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. 4 %ystem PUMP /SIPHON INFORMATION FinalOpt Manufacturer Demand St GPM Model Number TDH Lift Friction Loss System He TD Forcemain Length D Di ell SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of TrencNhP MEN SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG F#ELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 eeded /Sodded xx Mulched xx S Bed/Trench Center Bed/Trench Edges Topsoil Fill Yes * No ® Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1294150th Street New Richmond, WI 54017 (NE 114 NE 114 36 T30N R18W) NA Lot 2 Parcel No: 36.30.18.552820 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? I Yes ( ) No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) Safety and Buildings Division County All 1111 201 W. Washington Ave., P.O. Box 7162 cry isconsin Madison, W1 53707 - 7162 Site Address Department of Commerce ke_� — - 17.q 4 ISM Sanitary Permit,Ppli Sanitary Pennit Number In accord with Comm 83.2 1, Wis. Adm. Co pers yb acy, Qpo i� � Clli& if Revision i may be used for secondary Priv 1. Application Information - Please Print All lnformadjk,' P I , State Plan I.D. Number MINED Property Owner's Nam Parcel Number 0 Vo - 110 up Property Owner's Mailing Address ST OF40X Property COUNTY Location ZONINGOFFICS ' L��I. S ;4, T_;t) N, R/9 J�L) City, State Zip Code Phone Number C/, Lot rbet Block Number Subdivision Name CSM Number �jr _94,bo 771 q/6G;2-S_�- 162n L' , q6 Vo i I 5_2 4 9 11. Type of Building (Check all that apply.) CAS 0 Cit A'1 or 2 Family Dwelling - Number of Bedrooms OVillage 0 Public/Commercial - Describe Use 1 own" fl 0 State Owned I Ne a res t R oad 6b X 12D &� ap� ) I /W& III. T of Permit: (Check only one box on line A. Numbering is for Internal use.) (Complete line B, If applicable.) A. XNew Replacement of 6 0 Addition 3 2 [] Replacement System C3 tion to For County use Sy I I Tank Only i Exisfim system I B DCheck if Sanitary Permit Previously Issued I Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering Is for Internal use.) Ak Z- -iCD 440 Non - Pressurized In-Ground 21 Mound 47 0 Sand Filter 500 Canstnlcted Wetl and 22 0 Pressurized In-Ground 41 Holding Tank 48 0 Single Pass 51 Drip Line 45 At 46 OAcrobic Treatment Unit 49 0 Recirculating 30 00ther V.Vis Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Ratc(GaIsJDays/Sq.Ft.) (Min./Inch) Elevation boo u VI. Tank Info Capacity in Total Number Manufacturer Prefab Site steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Ex isting Septic ov W91 Tan Tanks Tgnk3 a)* 1 Z15_0 0 Dosing Chamber ED I Z&V I VII. Responsibility Statement- 1, the undV4�� s . rjVponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ^ PI u p6ber Si MP/MPRS N Business Phone N umber f '�>94b z- zt>�� Plumber's Address (Street, City, State, Zi C 15 VIII. Coun partment Use Only U Disa Sanitary Permit Fl(.'.Iude. Groun&,ater Issue Is Agent Signature (No Stamps) 13 )kApproved Owner Given Initial Adverse' Surcharge Fee) S 0 3 2ao I Determination 1 IX Conditions of Approval/Reasons for Misaproval AA Attack to plate Piano (to the coanly only) for the systa:Zpor not Ins than $1/2 a 11 inches to size RRD-639R (R. 05/01) Safety and Buildings Division IN W. Washington Ave., P.O. Box 7162 � Madison, WI 53707 - 7162 Site Address Department of Commerce Z 1 Sanitary Permit Appli Q y Sanitary Permit Number in accord with Comm 83.2 1, Wis. Adm Code, You pr3vrdt/ f Z C219 421° inn inny be used for .041)(m I. Application Information - Please Print AU Informs D� rC LC IV L . tate I.D. Number '! Property Owner's Nam `' ; Parcel Number 3( . '� 0 • • ZD S r iQ-2 S a r 7 ��rr zoo - -1101 ZO Property Owner's Mailing A 1 ,, ; CROIX _ ' Y Location /' � / COUNTY _ �h � 6Y.; S .;(- T Q N, R/ 0 fftG `7 20N City, State Zip Code �\ , Phone Number - / Lot I�Lanber BI Number i Subdivision Nam CSM Number au l m- fit r Mn M 4)�llo Va s 4 k 11. Type of Building (Check all that apply.) 4k5 yr„/ taw• , Q rn poly t 1 or 2 Family Dwelling - Number of Bedrooms n .., Qo g Ini�+'� ❑ yi e Public/Commercial - Describe Use T o i AA 0 State Owned / Nearest Read W. T of Permit: (Check only one box on line A. Numbering is for Intemal use.) (Complete line B, If applicable.) A. 1 New 2 3 O Replacement of 6 O Addition to For Conn use SYUCM O Replacement Y TankOnl System Count B. OCheck if Sanitary Penult Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.). - Io0 Constructed Wetland 440 Non - Pressurized In -Ground 21 ❑ Mound 47 ❑ Sand Filter 500 22 Q Pressurized In-Ground 410 Holding Tank 48 O Single Pass 510 Drip Line 45 At 46 OAembic Treatment Unit 49 ❑ Recirculating 30 OOtber 1g pe rsalrrreatment Area Information: Design Flow ) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(GaIsJDays/S%Ft-) (MinJinch) Elevation Zo o q66) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Septic owMaldWs Xonk IJJo i zi /— o ! 1. I Dosing Chamber VIL Responsibility Statement I. the a e nsibiflty for lustallation of the POWTS shown on the attached plans Plumber's Name (Pent) Pl MP/MPRS N Business Phone Number lO1'D L N z W 1M`� Z �1 z3tS ?.bt;L Plumber's Address (Street, City, State, Zip C ) 6�:5 9 - 709 ��/ Vul. Conn iDe artment Use Onl Disapproved I Sanimry Permit F (includes Groundwater Date Issued lss ' A lent Signature (No Stamps) Approved ❑ Owner Given Initial Adverse' Surcharge Fee) 0 u �p Determination �, IX. �Condition 5 Approval/Reasons for Disa proval 06 �� �l C,&eL cOtl� ( PAA Att�s • plote plans (te the County only) for the system en per not less tba■ 31/2 111 In ches i size ,, n RRI) -6398 !R. 05 /01l - 1� N \ ,Rr� •a Cal ,. �3 �a. o.�. O ••. �c wr.,. w .R-�— s44•o 4' d yCt. (n1 0 Jrt J 7�r•laala.�� �Sl.�� L�l I 3 12' x Aso' Y�a�c i l t c i H Safety and Buildings ' 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.commercew n.gov Department of Commerce www.wisoonsin.gov Scott McCallum, Governor Philip Edw. Albert, Acting Secretary November 15, 2001 CUST ID No.139462 AM. POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/15/2003 Identification Numbers Transaction ID No. 690118 SITE• Site ID No. 638866 Tim Starks - 130th Ave Please refer to both identification numbers, St. Croix County, Town of Richmond above, in all correspondence with the agency. NEIA, NEIA, S36, T30N, RI 8W Subdivision: CSM No. 4096 - lot 2, vol. 15, page 4096 FOR: Description: Four Bedroom At -Grade System Object Type: POWT System Regulated Object ID No.: 820745 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570 -P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis, Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. Owner Responsibilities: • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. TODD L SINZ Page 2 1 1/15/01 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)789-7892, Mon - Fri, 7:15 AM - 4:00 PM WiSMART code: 7633 jswim@commerce.state.wi.us I� Tim Starks - At -grade System Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: At- grade, SBD- 10570 -P (6/99) Pressure Distribution, SBD - 10573 -P (6/99) Location: Lot 2, CSM 4096, v. 15, p 4096 NE 1/4, NE 1/4, Sec. 36, T 30 N, R 18 W Town: Richmond County: St. Croix Date: November 9, 2001 Owner: Tim St s 1479 1 0th Ave. Address: G Ne ichmon I 5401 r . Plumber: To 8 S' z Signature: G License # N P 394 Attachments: 6748 -Plan Approval Application SBD -8330 page 1: cover Q 4 .T.S. l 2: design criteria & calculations P ltipnal y Coed 3: plot plan 0 ov K 4: plan view, system cross section PP R M ERCE 5: lateral detail ENt pf j,"D , pE0 to AND BIHLW�G3 6: pump tank exit detail p%'415% of 7: pump curve S PENCE 8: system management SE E CORD page 1 of 8 Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg /L Anticipated septic tank effluent 30 mg/L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg /L Bedrooms x 100 gal/bedroom/day x 1.5 6'_-O gallons /day hydraulic load Design Calculations i In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock 4- in. Cross slope at system % Force main length 2_0 Z ft. of Z in. Manifold/header length H ft. of in. Drain -back 33 • t gallons Lateral length @ ° ft. of z in. Lateral elevation ft. @ bottom of lateral Lateral hole size 3 16 in. @ 2 `; ' ° in. ( Z ' ° ft.} Spacing 'S o holes /lateral ° holes total Lateral volume gallons Total lateral discharge rate 19 gallons /minute @ ft. head Network pressureecompensation losses ° '�" 1 � ft. Elevation difference t b ��� ft. Friction loss ft. @ gallons /m' t nute Total dynamic head Z L '� ft• Pump /si' Kon A' gpm @ ft. of head Manufacturer �� �� Model # �� 3 Dose volume 3 d gallons Lift /sifron tank `� ��'� ��- `z» �» ��� �� gallons Septic tank gallons Effluent filter Measurement pump on and off in. Height alarm from tank bottom �� ' in. Reserve capacity gallons specs.calcs.res Page Z of ` t .� ` 7 • �1. � w1.. `.e � Z. U1M �'c7910 v o \ I \� �}t7 a110 TAI N � = 4-\6 u s ' er I S10 �v�r`w Tj� ✓ _ 3 � 1 Z' x ltO' Y u CL cA- 5' 5' Iza•o� s� � 2• 1 ` 0; 0b1�►va� toy w.21� C l Fabric Distribution Lateral Observation ,.� Soil Cover Well o R $.p r• � 1 ` . o l a �No ct X11 b � �,, o' .� o � 1 .. �- iw cs�..,.� o� �iO� a M. � •, �.� ,o„ � � \\ 1 r� A MnH wkAT'HERPR00F LOCKING GOv6R .TUNCTIQN k1XI& LNG A llf8E . GIIJIC DI�CO�WLCT --� "roan G4. ro Cc to >1 ilL Cr -,�-- w 4" ('yc ,. �. , �7111T 7 4 ° PIPS 3' no N016TURUD '`�^ So) L_ z4w Z.D. �{ 4" 4 VchT; MAX uOLE • T L � �wwG..v - - oW 2� ovcD A SKE T 3brrr J 4 +� WFLE AL 3' ow- 0 KN E CT 1 0 044 `"/ K `� t Q, FA V'l7 T ON - G U w O T � C PUAP COAl"rrc . L>ry MOCK f 5[PTIG t _ SPEC.IFI'CAT10Q Avg DOSE v TA /.S MAWLIFACTLI LCR: � � WUMOER OF DOSES: __PEK OAS TAWK SIZE; GALLOWS DOSE VOLUME ALARM MAAJUFACTURCR: S `� '�-��� INCLUDING OACKFLOW: GAL�Or S /'MODEL WUAa - ER: CAPACITIES; A= -zg WCHES OK GAL. LG 5 5wITCH TYPE: Z 34. 4 PUMP t1AQUFACTUKCR; � C a � - b IUCNCS OR 130.p VA`•v`- MODEL WUMDER: IN�HES � OZ ' 4Z GA��G�. JWITCH TYPE; VA ~ WOTE• PUMP AWD ALARM ARE TO DE MIWIMUM DISCHAR" RATE INSTALLED OW SE PARATE cicccu �, vtRTICA.L DIFFERENCE P MP F CCTW[EU U OF AUO OIJTRIOUT{ON PlPE.. FELT + Mikjth1UM KJETWORK SUPPL PR t UR y f i E FCCT + FLET OF FORCE MAIIJ X . S ' l r onFRICTIOW FACTOR__ ., FE£T TOTAL DyUAMIC HEAD o ZI ' FECr IQTERUAL DIMEW61OWS 0► TAWK: LF-W&TH�.,. ,;WiDTH ;LIQUID DEPTH _1 It' At L`l'\AM;(: HrA'�/('.0%A",IlY .or -i mlly.;Te HEAD CAPACITY CURVE r irNl' ANI) v) MODEL 152/1-54 so- F OWE -tv) flirt(,, ciii. Idws ) 9 40 16 '14 167 r /.6 . A 1 2 :: 4; 2u fir. 0.7 A 42 4 j.vi n. 1.6r, 0 4.o h f i i- lu - Data i 0 20 40 00 80 100 WL6 6 160 240 120 FLOW PER MINUTC CONSULT FACTORY FOR SPECIAL APPLICATIONS 7 owing panels avallaDle• Electrical aliernaw(s, for duplex systems, arc available and SUPIAad with an alarm. variable level control IMIChas are avallaole for controlling single phase Douo* piggyback variable love) Moat switches are availlable for variable level long and short cycle controls. Sealed Wk•8ox available for wWwr Installations, See FM1420. Over 130"F. (54T.) special quo�atlon required, ELa G I}ntrd aNecuon ( � �� t IWO" r if ) ay- Duo- I — �52 115 "" km'. U 1 ?nil 8Kti2I t15 __ 1 Ls IIAXW 2 ot 3 AU10 IAA)Aod 2W3 Ti y — j — 716 - 1 Nan dou 1 20 * r ' 3 i A 5-3 1 $k m i lnak4w 2 3 $ELECTION GUIDE � 1 2*0 y ; I '44�dld i —1 W3 230 1 . Vk pWybwX ywWw vel A iu v orlich deuce pogyteck vionable lvvv fleet BE %S3 230 1 1 Auto Mich. Refer to FMO477, o CA 2. $so FW712 for correct model of Electrical Aittmalor E-Pak. Ail in wiauan of ovN*s. pm"oa 4"ku ind vAM9 iftu)4 N Ons W a qWMOO 3. VorWbis level control switch 104225 used at a corilrol sclivew, spec(ty dwplox Kinsad tiomwan. All olicukal and *#41y ood" should be followed including the most ncertc M4n4l El 00C Code (NEC) W the 000upiftnal testy and Waam Ad (01HA). or (4) float arlerlot. RESERVE POWERED DESIGN For unusual conditions a reserve aefety factor It eNifo*0red Into the design of every Zoeller pump, AUL TO: P.O. BOX 16347 �� L&kw*, KY 402564Z47 Uwadmrs of. W TO: 3049 CwA, Rw Rt-W 1,013".Ky 40211•fil6f 2) �&&"'-'aaww /9.99 httP!'ofWWW'70*0*r. 00M FAX (M) 774-301.4 0 Copyright 2000 Zoeller Co. Ail r4;hts meerved, � T System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715 -235- 2644, or the St. Croix County Zoning Office, 715 -386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water- saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contain s.specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within IS' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 t w► artment of Commerce SOIL EVALUATION REPORT Page / of 3 Didlsron of D and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach comp let e site plan on I n paper not less than 81/2 x 11 inches in size. Plan must S4 p pe include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and distance to nearest road. e ie by Please print O t . ion. R wed Date , Personal information you provide may be u ry Wses (Privacy L , s. 15.04 (1) (m)). Property Owner [ K EE N a Property Location s ir o' ` yr Lot E 114NF 1/4 S 3lo T N R I S E (ore Property Owner's Mailing Address l i of # Block # Subd. Name or CSMff /3 v ST CROIX City State Zip ,� l l ( ❑ City [3 Village ® Town Nearest Road ' , Vew Mora w sy ) � y� - l2 New Construction Use: ER Residential / Num ?, — Y Code derived design flow rate / �n o GPD ❑ Replacement 9 ❑ Public or commercial - Describe: t � Parent material 1 Flood Plain elevation if applicable fl• General comments S 5 to W\ e (c v _ 1 ; 7 - • � - U and recommendations: q 4j • pc) Kc.o.� r ? �° o a --fie c i\-e L cv,'n L t ��, ,'� Boring © Boring # d ft Depth to limiting factor 3 pit Ground surface elev. q . ?� p 9 in. Soil AppllcaW n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0 3 S; I a b s G. ZW5 M F ❑ Boring # Boring z [� Pit Ground surface elev. ft. Depth to limiting factor _!�ZQ_ 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 *Ef'f#2 p -// l Pr' c - 9 3 ya - 0 is v t 31 t- 3m * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu�r% -- CST Number 253.30'i Address Date Evaluation Conducted Telephone Number 2 / l Lh v5 Property Owner �� S Parcel ID # _ _ — Page Z of _ ❑ Boring # ❑ Boring 3 [� pit Ground surface elev. F;z qd ft. Depth to limiting factor mil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EffP1 *Eff#2 c,— Sj 6 v Z q-J — c 3 .31- 3/ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Solt Application Rabe 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 # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * 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- 2648777. SBD4330 (R.07/00) I �� � f � "mil . • • _ -. PAGE - OF- NAME s l f 5 LOT# LEGAL DESCRIPTION F- tir' /a S 3 G 3pN,R J19 (or) SCALE: BM I ELEVATION LQ O BM 1 DESCRIPTION fop n BM 2 ELEVATION 3 BM 2 DESCRIPTION �o d 3 1� Co,� P, *D 9 SYSTEM ELEVATION q -?-. S - ALTERNATE ELEVATION l CONTOUR ELEVATION & (ja U W5, a �► ii- ♦ SIGNATURE -�� DATE 1Z I r Nk A I N f D rang � �r i 2 r- D F IS I I !3 I l � �,�, I r , �� d ti l es �`���r11.n1. R .� . ; +�• `�� .. Y 1 •r �• n� ply iL „� • J h �� . I _;;,, SV •Opp� A�i y'' ^� •I IN '..� '•qtr ; , y l 3 � 4 • rr rte — Ir � • • • � t AMC. � , { i • '� ' "ski. ' �''.,`'� "� � �' w;;�" ..�,� \ : ..t:. � �' ., t l y�;a'' e k" 1, o K r, (e' «�,�} 3�'.. + I• I . t UA 111111W . .e jr I• lf��� `'~ • •Y f. A • ' O d r �.s �tr,4 � . } f. � '. p,��w r��� >•�ry,` ; �gw� s �,�•� r ,� t �, � d ' . may 1° � , �S�II t' 4,,,�•��.L.•,,,• ,�� � ' r+� /L+,r. �p;�+•. ti e , �i .•� '� 1ti J . \ .� 1 � �„yr�� ` �r,� r +'y�, 1.V�',�'J �n r All . A m, Ac IIIA �a + I� '1 • ST CROIX COUNTY SEPTIC TANK MAIMMANCE AGREEMENT AND OWNERS - HIP CERTIFICATION FO1tl4!� OwnerlBuyer 1 , n -, S r , Mailing Address 14-4 19 , S O h t4 pro Address �-9 S • Pte' (Verification required from Planning Departmoa t for " w*co 0n) t? � R 1 c_N h\�Parcel Identification Nowber city/State L KQ" DESCRIPTION M (� s + �, Sec. 3� . T N - R� 'W. Tdrv�t Of ,! ,, MO ------ ft,wty Location '!M , Subdivision Lot # • �_--- __ - -_ -_ - Surve Ma # . volume . Page # 9�j a Certified Surv P Warranty Deed # Z 0 2r� . Volume ct 8 - Page # 5 Spec house Cl yes ,& no Lot lines identifiable yes D no — MARU NANCE Improper nse and man tenanecof your septic system could result m its premature failure to handle wastes. Proper maintenance oonsift 130 end the c tank every three years or soon, if needed by a licensed pumper What Yw Pat into the system can affed d function of the septic tank as a treatment stage in *c waste disposal SY • The property owner agrees to st"nit to St. Croix Zoning Dew a cerfi5cation foEM, signed by the own« and by a masWpl=be4 j0MMeymanplamber, restrictedplumber or a licensed vexifYing dlat (1) the on -site wastawatrrdisposal system is in p operating condition andlor (2) after inspection and pumping (if necessary), the sepic tank is loss than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set ft% herein, as set by the Department of Commcroe and the Department of Natural Resources, State of Wisconsin. Certification s t a ti n g that your septic system has been maintained must be eomqulctod and rcV=0d to the St. Croix County Zoning Office widun 30 the three capitation date. 2 - "-/ L/ i jR& j - bFM OF APPLICANT DATE pgR C F'R CATION knowledge. I (we) am (are) the owners) of I (we) certify that M statenwats on this form are true to the best of my ( our) abre, by c of a warranty dead recorded in Register of Deeds Office. desed v SIt1MTURE OF APPLICANT DATE « « « « «« . «ss «« A information that is rods- rcpresontcd may result is the sanitary Pcrnu t being revoked by the Zoning Department. ;« Include with this application: a saunped warranty dead from the Register of Deeds office a copy of the certified survey map if refaencc is made in the warranty deed C7ocUMv4T No. BTAT2 W.A OF TIHICUNSIN "JM 1— WON WMRAM MM 492020 a - "' - L* 982wr 598 Harold R. Yates REGISTER'S OFFICE This P"d, me& betw"n .. ...... a ........ ST. coax CO., W1 And .. an W4 for Raw ........... .................................................. ........ I ............. . ............... 4 7rj it-ai,ii -T ............ * -------- _ . ..... .. .. ...... ...... ................ ............................................................... . ............................... ................................................................................................................. ----«-- . ............. .. ..............•- -- ............. . ................................... , Gnaw% UU That tbA " G"Wift, foe a vahable coniddamdou ...... ...................................................... —,., . . ............... --si eonveys Yo G County, state of WbWMMAU: ram a$ Telft naUm the Mowing 4senibed real mtste i. -E:mCf4ii, .......... The North 35 rods of the Northeast Quartet (M) of the Northeast Quartet (1,Z%y of Section Thirty TRA Pond Six (36) . Township Thirty (30) North. Range' F (18) West. FM This deed is made in fulfillment of that land contract dated August 9. 1989, r#-corded August 11, 1989 in Vol. 848 of Records, page 402-403, an doc. no. 450508, in the of of the St .Croix County Register of Deed*. w propsetg. This n at ............. 0A) (b not) TftWbw r aU and ?r d appwrtenonew thftwato bobu&g; ..... awe . .................................... t 8 p r r r .................... es ... . ....................... .................... ....... ............................ ..... wanes is dim As tft% is gook indOeaa" In I" An& &PA free MW $War of McumAraam Owe$ a" WN vwnwt &M Wend Ma 7 . . ........ . .... &Y of .............................. ........................... « - -- .... November . 92 .... . . gated tAit ----------- ------------------------- Or") arold R. e4 ?o i� R. Y s . .. »._._ .. . . .. . . . .... . * H .. ......... ....... --------- ------------------.- _ - «. -. -- . ..... . ..... . . ««.«.«.. W ---------- t *Carol A. Ya evV - - -- - - --- - - .................. .... . . . ....... . ... . . . ............ . ..... AVTZNXTICATION ACUNOWLNDGMBXT RTA= OF WISCONSIN aAt lo�ttts oil Ws ---J ft Pornowavy ease do M ....sue[.. #__ft of tA.,aber+�s sawed Yates an aro w, Y at es t UMMM STA= B" OF iii "emb" Wb. ftww- dw ON& %VA6 CNAFM Wf 4 .� � ��', � � '' Dlways lit la�i� ti► ]r. oo Lbb ra aw be b4&%WW&W*W J ' X rl) r-+ �w to A 3 _ ° r QW 1:3 13 ri Cu CU _{3AO ° o LAi w w LAJ { = o LL. I wo �nZLX" LLJ W W Wt7 a a was w� LL. 4 � J (A V "'' Ci+ " CL rn w W to F— =1— 7- O W = p.� C..) I =W C7L V[,p t—C'> a �i � WbGWOOCWQ ?e LCm CERTIFIED SURVEY MAP NO. 4096 VOLUME 15 PAGE 4096 LOCATED IN THE NE 1 i4 OF THE NE 1. OF SECTION 36, T. 30N. , R. 18W. , TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN z nn� a O W�Cn ;u- „ „ 0 •? A20 Gf a) ;o %v - UNPL AT TED LANDS ° I m � I ; .................................. r- X N WEST LINE OF NE 114 -NE 1 14 I I m co --- W -NE NOO ° 28' I3" W 577, 51' � o z = � A A 0 NE -NE 544.51' 33. 00' Lo rn J o : r- Z C7 v = - 10011 b . . �'z wow i. ;0 :10m w r , n�:� to a: � I to cn y�v�p p v v �m� „� to a x ro © m tx C) yryyy C!-y� I ' o cn o 33. 00' cn ►' 544.51' ►� i 'r N00 28' 13" W 577.51' co :v a = APPROVED ro ST. CROIX COUNTY N ; m I m Plannino Zoninn and Parks Committee O :1 O � I MAY 2 9 2001 cp w w N If not recorded within 30 days of (p N 0 ro b ut z approval date approval shall be m 0 D. o k n null and void Oi - 7 1 c) n c 33 33 cz o"1 m• 3 �-4 w HIGHWAY L I NE 6 c� W ............................ . I z 1 0 SETBACK - C � NOO 45' 55" W °- S00 45' 55" E g 544.54' O m 2067.71' - — _ — — W — ( z lZ� -� -� W�0�45�5,L 5U. 54_ 0 �m o � O a 'z n 2645. 25' , EAS L il/t Ut' THE NE 114 ° UNPLATTED LANDS o t7 cn -l 0�$�ti zni�o �zzm 0 o�m'm cn \n K a da .4 rn a _ �rnyy � t - cn rinO .� VA Q : o ° :q w oz rn 2 JAMES M. WEBER S -1804 • = SHEET I OF 2 DATEDN -"A LAND z SURVEYING - 2000299A THIS INSTRUMENT DRAFTED BY JIM WEBER Vol . ] 5 Page 4096