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Parcel #: 8.31.18.158A 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WORWA, CATHERINE T ET AL CATHERINE T ET AL WORWA 4824 CAROLYN LA WHITE BEAR LAKE MN 55110 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 8 T31 N R1 8W N 120 FT OF SE SE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 02/12/2001 638311 1585/421 WD 07/23/1997 431/118 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 104,900 53,000 157,900 NO Totals for 2007: General Property 0.000 104,900 53,000 157,900 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 104,900 53,000 157,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` i INSPECTION REPORT Sanitary Permit No: 420347 0 (ATTACH TO PERMIT) GEN'EF2AL 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: Worwa, Catherine T. I Star Prairie Township 038 - 1034 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: c b -a Iczo c� 'r RUC CSr (g114 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l!� 61 OVD Dosing br) � Alt. BM � Aeration Bldg. Sewer Holding St/Ht Inlet , /3. /D) �• • � gs QS St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > Gz Z Dt Botto2 .oS'� r: 3 $U - t'� f �. S S �, f J Dosing ,� .i t . ` Header Aeration L Dist. Pipe Holding Bot. System • 3 & �i s 4' Final Grade P /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number w &*3 << L 2 AA DH Lift Friction Loss System Head r TDH Ft t . \,,'k'� .6 (" •SV I 'L'& 0'A p� ftr l3• 82 .95 Forcemain Length t I Dia. �� Dist. to Well ^- .2Cfl 2 > I w SOIL ABSORPTION SYSTEM Zl, 6 Z BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. uid Depth DIMENSIONS t " D SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHIN ufacturer: INFORMATION CHAMBER O Type Of System: 394 >00 ate" > 3M UNIT Mo DISTRIBUTION SYSTEM Header /Manifold Distribution , y « x Hcle Size x Hole Spacing Vent to Air Intake t� Pipe(s) 8� I ��, d •t / 1/ LDia Len th G a 'f Spacin 9 /p SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes U No Yes j] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 0' � / OZ Inspection #2: . /0' Location: 2220 Cabin Lane Somerset, WI 54025 (NE 1/4 SE 114 8 T31 N RI 8W) NA Lot 3 Parcel No: 08.31.18.154C3 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover( w, 3.) Contour= S a ZS v : C `a an revision equir �1? [ i Yes No Use other side for additional information. d O SBD - 6710 (R.3/97) Date Inse p ctor's Signature Cert. No. � bI9bnC, 201 W, WmdjWe P.O. Bic 7163 n mamma. Wl 33T0'1- 7162 Oft Addmn Dww tMnt of CplttitftetP M Suda" Now6w Ss F m aaowd VA& c am. wk. Adm Cods. Pnowd bgsm s*s Ym tw"k 0 Ca* to t L � �ursrdsa rbt !ela AS UNesatdta W.0443 Ptea LD. 0 -7- Piow,y Owmes mU Pa►oei Na" o _ S Wwly Oweer s Mhos AdA ew 1'°"'d°° SN XS� 'A S T f NR Code �1 0� 1 L u. type w tslrtek a/ me.� T Ott i or s Dtc - float= ar tt� o � x�S�IJ �,r L(.UEL�I�I p ❑ ' - Desrtfe um 0 smOwaed / lnZ4r,( w/ lo'XSa , � tiatestlm.d vn on��..�� 9 s . 37 �u "D "- /.o sated // Or — Lop �` S . 11L T"s ot P+eewm: r MW A ire wire Hr iAtead WO cawlsoism s f appoa*ft A t❑ Pk Z P 0 Repitoeeteat ct 6 0 AAMM es c..w..R B. D Check u r rr. lane hood IV. - ftr of Presis» "O ft a1 so is Qtr 6ttetad tte) 22 0 P+omellri - I lm43rovW 4t To* ss 0 go& Pr St 0 Ddp Lies as 0 A*Akwft 46 0 A=mAAc Twomom trait as D 30 0 Oder V. M• P H "ciadior JIM seymom Biaadei. Piled tl uk Dodp PAW (00 Di�tw1 Aeea Dim Ales sum App imom Hisyation > Pmprd tlt�e / iII D 4 ) [ P 3D 00 � in TOW Atasiet !talYb SYee raw t>stic VL 7'wi[ dYaat Gomm of 71ails Caecrae C,carataraai tllas Nagy soft "detTu* QOa ` 1 CID nalrtchw6w L X , o� r lstlertAm of da rOiWIN the wa w dw ododtbd pbm 7 Ar@R3 iNsat� lien tPtt P1rbw Pteeerlsr's t�eie � - 11 -s PhmiWs A46M (Skue. CbY. SMWe ZIP Cede) �`cK . 1U Uas oub stweeey t�a.tt Pepe omc"n amoadwaee: Hexed a Ud :7� © Ow �J � aee ldieea od A#rase � Z � co. nrsi.M IX dlueee:.rA� ftr p lum bw4. p er vs o-wtitivt�l M� l�l� h'►�u�` `c LL �� � r+••a ar ebe ., Pw •d aY! t 1t e.a.. !. den zoo nt / � 3. 3 —/• �(/� � <� -�i� c SiC ' /. S T3 I N RrF� w eco ak y ,ie uV'-Q- p Z� p 3£s b00% - a 4 /Zulu -� ss `71 a No r t 'Y SO Gay � 943` 8o� ou 1 �► r gn„ =tap -s. i 7 cicre 0. S� Tc, �► r D. O F �L1 v i 0 LA w „N Safety and Buildings 4003 N KINNEY COULEE RD _ _ _ _ _ _ kA- EROSSE WI - 546044n1---------- -- V ksco6sin - www TDD #: (608) 2648777 www.commerc .wis c on i sin.gov .wisonin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary August 15, 2002 CUST ID No.220537 ATTN: POWTS Inspector CALVIN W POWERS JR ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMIC iAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL -3 PLAN APPROVAL EXPIRES: 08/15/2004 Identification Numbers Transaction ID No. 775586 Site ID No. 648964 SITE: Please refer to both identification numbers, Catherine T Worwa above, in all correspondence with the agenc 2220 Cabin Lane Town of Star Prairie St Croix County NEI/4, SETA, S8, T3 IN, R18W FOR: Description: Two Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 865157 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 "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ¢� Soil com action excava vehicular traffic and other similar activities that nnpact the tre atment an tsp ar�eproh; • An end mainifold serves the distribution laterals. This manifold is to be located 12 inches from the end of the cell cov'i "d �i 54 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c DF.r^ARTM s 'C N OF 'A`,' T • 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. SEE CORkE: • 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. Stat • 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. CALVIN W POWERS JR Page 2 8/15/02 • The changes made to this plan on 8/15/02 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and 7 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. 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 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 (A TITLE SHE PAGE I OF DATE: - )5 -0 9P - >,, ;�> MOUND RSYSTEM ,� � A_ BEDROOM RESIDENCE �tA Q� This plan has been p rpared in accordaince with the Mound Component Manual G SBD- 10572 -P and the Pressure Disbn mica Manual SBD- I4573 -P. CR. 6/99) LOCATED IN THE 1V L 1/4 O THE 1 /4 OF SECTION &_,TAN, R1W, TOWN OF ST. CROIX COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 PLOT PLAN PAGE 3 OF 7 PLANvIEW CROSS SECTION PAGE 4 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 7 PUMP CHAMBER CROSS SECTION PAGE 6 OF 7 SYSTEM MANAGEMENT PLAN PAGE 7 OF 7 PUMP CURVE PREPAR FD FOR V - ) ,D rw CA -'4 �c ay " ,,ot y La why La. A) ssn A P BY POWERS EXCAVATING INC. 1969 185' AVE. NEW RICHMOND, WIS. 54017 PHONE: 715- 245 -5135 FAX: 715 -246 -5135 D =C OMMERCE i AN U S PONDS i . 06T�. 1 /4 T3 N Rrl� PAN 5511 t) S�a,ru`, P� �. /ST C'ra y _p r ,& 7_jD Q 3� —�l7 3y j�oa� czQ seP� �c•�Zcetm�- � ilk W t suers �orn�o x is rOc(I ncA 3 cD, 3 X x so IZ 0 n'l A pift I 0 i 1; Page �. OfL r Synthetic Cov.ring t . j q' v Dist ribution Pipe- Med M - C33 Medium Sand G -Sys" . Topsoil U .37 ---� E 3 s� Slop Bed Of 2 Force Main Plowed Aggregate Layer D Cross Section Of A Mound System Using E A Bad For The Absorption Area F G 16'1 m. 1 .. A Ft. y Juineae B a E) F t. Desi n :oadin -r Rate= BPD /�� PT K 1 0i I Ft. L '70, Ft. Ft. ,. Position 3 I Ft.,.Z1 of Force Main W , Ft. 3 2 , q — L Observation Pipe -------------- ---------- - - - - -- --- s * B o ,� .- -- ---- --------------------------------- .�? Distribution Of 2 �2 Pipe.. Aggregate Observgtion Pipe nf►cho r s I Pan" ly Plan Vlew Of Mound Using A Bed For The Absorption Area Diycributioa Pipe Layout poge ` 1 of Z I P.taae the hales at the t bo tom of the distribution but pipes at equal s t P Q F Ciug. Remove all the a® burrs f r r pipe and holes. F dye and of o ch jwww up wwft #a aw of laog oaa or 43• Mwg a apo int scc h " w of* Md VdR TOWN* do vg* s(dw l■tn:* v6 a vofM end cap or deeded am= pine for the t�ardeel jw or dtdndad Pbs• i - .�cc�ss ieax_ T L Cttas E N MM�Ii j�� i i � �+►+3 v ass~, — _ r I - -4 i P Ft. We Masatar �� Inch x InNs Manifold_ Inches Fore loin ' a Indies of holes /plpe Invert Elevstioe of Lnterals ]Ft. SEPTIC TANK 6 PUMP CHAMBER CKOSS St-l:llui Ali � •-�- �_ - ar 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHER PROOF' 25' FROM.DOOR, WINDOW-OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE C E 4" Cl RISER WARNING LABEL 6" MIN . ----- ABOVE GRADE MIN 18" IN N LET • , I' WATER TIGHT SEALS GAS- 1 l TIGHT i V 4 �, A rpQ A SEAL APPROVED ' JOINTS W/ CI 21 PIPE B ; ALM PIPE 3' ONTO 3' ONTO �{— ON SOLID SOIL SOLID SOIL �i� C �. OfF RISER EXIT PUMP OFF ELEV . $ T • PERMITTED ONL) D Jr. TANK . , MANUFACTURER - HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE S TANK MANUFACTURER : NUMBER 'DOSES PER DAY: , TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING S � D GAL. DOSE .._ GAL. FLOWBACK:. ALARM MANUFACTURER: CAPACITIES: A = __.fit,._ INCHES = GAL: MODEL NUMBER: _Au B : 2 . INCHES = GAL SWITCH TYPE: _ PUMP MANUFACTURER: � C = S INCHES = GAL MODEL NUMBER: 0 33 _ 9j GAL SWITCH TYPE: D = .jj____ INCHES REQUIRED DISCHARGE RATE a GPM PUMPS ALARM WIRING AS PER ILHR 16. 23 WA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . g FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . .t. . FEET � + � FEET FORCEMAIN X 'A FT /100 FT. FRICTION FACTOR Lay FEET qy TOTAL DYNAMIC HEAD = N INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ^ 's WIDTH i DIAMETER Ih LIQUID' DEPTH -----� Goulds P°,Y- o� Sulnslble Effluent Pump 3885 APPLICATifllts • Overload protection must smooth operalbL Sfcon can be operated continuously Speciticaly designee! for the be provided In starter unit. bronze Impel ava fe as without damage. following uses: • Shalt: threaded, 400 series an option. - °; ■ Bearings: Upper and stainless steel. a • Homes Cam Fast iron volute lower heavy duty hall bearing • Farms • ftrkW. ball bearings type for maximum efficiency. construction. • Tralier courts upper and lower. 2` NPT discliarge adaptable ■ Power Cable: Severe duty • Motels • Power cord: 20 foot for slide rap system rated, oil and water resistant. • Schools standard length (optional W N seal on motor end lengths available). • �I Seal: SB.�tI �+' R Single phase: } seconds • Hospitals len CAflB� H5. SILti:0�1 pravidrs second moisture Industry . lb and h se -16J3 SJTO CARBDE faces. baffler In case of outer jacket • Effluent systems with d V or 230 V three steel metal parts. damage and to prevent oil BUNA - N Rig Rlug dast rs wicking. ing. SPECIFICATIONS • % -1 % HP -1413 STO with w W9& Cornoston- resistant ■ tl -ring: Attunes positive Pu ban: leads. stainless sled. Threaded sealing against contaminants • Solids handling capabilities: Three pie: design. Loner on three and oil leakage. VV maximum. • '%-1 % HP -1414 STO phase models to guard • Mscharge size: 2 NPT. with bare leads. On CSA against cwpxwd damage AGENCY LISTINGS • Capacities: up to 128 GPM. meted models 20 toot on acddenW reverse rotation. • Total heads uR to 123 feet length SJTW and S'f W w !Bola: Fully subnr* in � tea Asmra�on MH. are standard. high-grade turbine of for • Mechanical seal: silicon k b b tbn NW effir heat Q �01"`� tsEwtaror�et carbide- roMy stfatisHicon NATLWS transfer. ca l . 3 ■ mrpe0er. Cast Iron, semi- w geed tiff u0th was parts, BUNA -N elastomers. open, � wbtf� • Temperature: out wanes for mechankW seat recommended working limits, 104 °F (40 continuous protection. Balanced for 140-F (60-C) intermittent FUT • Fasteners: 300 series so stainless steel. S9 13M 3W ** SOLIDS • Capable of running dry, Es f without damage to - '" - - SG M components. m Motor 20 �1 Single phase: Z •'� HP, 115 V, 200 V, 230 V, 0 60 Hz. 1750 RPM; % HP, _ 's 115 V, 60 Hz. 3500 RPM; a 40 HHP -1%HP, 230V, 60 Hz, 3500 RPM. /0 30 • Burin overload with o� automatic reset. Z2 � • Class 8 Insulation. '� ,a. s ' Three phase: • K HP -1'h HP 200/2301 a o 460 V. 60 Hz, 3500 RPM. o to 30 40 50 60 70 eo go too 110 1 20 130GPM • Class B Insulation. 0 10 20 30 rnVh CAPACITY �� EltedWe May, 1995 831995 Goulds Pumps VVV• Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t— of 3 Division of Safety and Buikiings in accordance with Comm 85, Wis. Al Code County S1 CROxx _ Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (SM), dtrectlon and Parcel I.D. 3S ! p � y _ 95_ ^ J � percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print all Information. Reviewed by Pemonot Information you provide may he wood for secondary purposes (Privacy low, s. 15.04 (tl (n+)1• Property Owner Property location N� 114 1/4 S I T 51 N R I$ W (all I Property Owner's Mailing Address Lot fl Bl # Srbd. Name or CSMq -. �- ;7C,.. 414 '182 CA7<{OL N � Nearest Road 11y State p e hone Number ©City ❑ Village own ll�J}�t'fE 5 Sl t ST R RR1R 4Z CR W LANE ❑ New Construction Use)6 Residential 1 Number of bedrooms 2 Code derived design flow rate GPD %Replacement ❑ Public or commercial - Describe: _ Parent material _ t�� Flood Plain elevation if applicable �` A. 8' Genral e comments s O.5 OA � '-' F " —D and recommendation: /V\0L"V SM 5'r-C:^ I.0 5r1lJ[� 'F ►-�- s���� E� q( ,.- 5? , • Z zu� L _ JUN 0 4 2002 Boring ST. CROIX COUNTY a Boring # 2 D epth to Ilmifin factor -3 )n.ZONING OF p ;l Ground surface elev. _ h. Dap 9 n Race GPD/IP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#t '002 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t 0 -9 to�tc� -- t•- Z� t_4b r,nv r o.b 3l{-CO 0 S .g z a -30 ID -4K 3 f- L era m r as Z +� -c Or 5 0. 3 0 -4Z %04K 313 s 14- t-� fir' aS ` - co Z- s c21 Ij -L Ya Y .r�-rn 0.y 0 0. a Boring # ❑ Boring Pi; Ground surface elev, 'M ft. Depth to llmiling fact or _ y In. m qr - cs Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 1 0"� 1t7 Yl2z t it f � b 2 4 - v R 3 )3 r L - r 3 t 7 24 o v _L 6b r aS -nt 4 0.6 pp - 4 i o v,c 34 tOVR 4 ` nr� 1vF-+n ao 0 Effluent #1 = BOD > 30' 220 rngA and TSS >30 1150 mglL ' Effluent 02 a SOD _< 30 mgll and TSS < 30 ml CST Name (Ptease Prints Signature CST Number hl J O H t. ST E TTeiaphon N a umber Address Date Evaluation Conducted W98T5 b9 0 { �AOE, V T-ALas WT 59OZZ o5- t�-OZ (."1i5 L42-6 Property owner WO KYI}7t J Parcel ID # — O 1 0'SN _ 4S ' 00 0 Page Z. of .3 Boring F3-1 D �t� na # Pit Ground surface elev. 0 2 9 ft. Depth to limiting factor 27 � n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA! In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '002 I U -S 10`Ie -V �- �^ 3� fr 0- 5 O. �- Z 10 V 3 h:t, 5 I 2f-rn r a5 j j,&- 0.9 S( tm ❑ Boring # D Boring D Pit Ground surface elev. ft. Depth to u miting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f! In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#1 'Eff #2 Boring # Boring El Pit Ground surface elev. _ ___ ft, Depth to limitin factor in. Sort Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD In, Munsell Qu. Sz. Cont. Cotor Gr, Sz. Sh. '0101 'ESfN2 Effluent #1 = 500, > 30 1220 mg/L and TSS >30 < 150 mg/L ' Emuent 92 = 500 < 30 mg1L and TSS 130 mq L The Department of Commerce is an equal opportunity service provider and employer, if you need assistance to access services or need material in an aitemate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. saD -i)ro (a.6=) Pl�01'ERtY OWt R: CAY1trr..Ytw� o ail l.WW: /=q PvGP�PE 7 i '-" a N S ouu - u . 0 ' Towm OF I T 44 2- AI IE 5 . CRDI IA+J1 WI k.ovVljl3 2: 100% [_]- 501, v O�NG w/ DAC*a� NO COMM 65 5MACK PROOLeM5 (MDu,vO 54 51 p,ts0 51, gAll, \ ,.� ❑gam 0 o q 7,37 L7 8� m o ❑ B2 8 5.37' q3, 57 q t, 3 w 2 WDtiD S �9 W a U rt\v E why c J. Fk H h � F o•r �i u _o 51GN�n C5t LS � sTA `J a �! 22{$32 PA 05-3 1 -OZ- ! Safety and Buildings �► 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 \ Visconsin RECEIVED www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov AUG 1 5 2002 Scott McCallum, Governor Philip Edw. Albert, Secretary ST. CRCIX�FF�ICEy ZCNING August 15, 2002 CUST ID No.220537 ATTN: POWTS Inspector CALVIN W POWERS JR ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2004 Identification Numbers Transaction ID No. 775586 SITE: Site ID No. 648964 Catherine T Worwa Please refer to both identification 2220 Cabin Lane numbers, above, in all Town of Star Prairie correspondence with the agency. St Croix County NE1 /4, SE1 /4, S8, T31 N, R18W FOR: Description: Two Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 865157 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 "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • An end mainifold serves the distribution laterals. This manifold is to be located 12 inches from the end of the cell CALVIN W POWERS JR Page 2 8/15/02 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat • 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. • The changes made to this plan on 8/15/02 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. 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. r CALVIN W POWERS JR Page 3 8/15/02 Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services (608)789-7893, 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 cbratz @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 6� �/14/6E / 14 0C_ f e'/ a — Mailing Address ��� t�f� OG //t� G�1✓G�a 17�� '� – / /e) Property Address ' � � (Verification required from Planning Department for new construction) City /State Ngk) R 14Yn n , L,w Parcel Identification Number _ 6.�i �qg _/ D LEGAL DESCRIPTION Property Location & '' /,, SE '' /,, Sec. , T.2L_N -R Town of Subdivision Lot , Lot # 3 Certified Survey Map # 3 �� . Volume , Page # 712V% � 7 x Warranty Deed # /a Volume Page # Spec house CI yes 9 no Lot lines identifiable) yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification fora, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein. as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days a RE OF year expiration date. //� Z12 SIGNATU APPLICA DATE OWNER CERTIFICATION I (we) certify that all statements on th' form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the bed above, by virtue of arranty deed recorded in Register of Deeds Office. � /Cot /4dZ- GNA OF APPLICA DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •* include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed .PCL (017 • POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Peoe ( of ALE NYOR#NATION sYSTHN ScanolWS I CL Septic Tank Capacity to Co g a DNA o 3 Penmit # / Septic Tank Manufacturer c`^ f) PARAMETEW Effluent Fitw Manufachra► : 0 NA Number of Bedroom 0 NA Effluent Filter Model � 0 NA Number of Public Facility Units Pump Tank Capacity al 0 NA Estimated flow leverage) a atsVt Pump Tank, Manufacturer 0 NA Design flow (pearc), (Estimated x 1.5) g al/day PUM Manufacturer 0 NA Soil Application hate 1- 0 I n becL • So ` . l s n y u � ..Pump Model 0 NA Standard Influent/Effluent Quality Montw average' Pratrestment Unit A Fats, Oil & Grease (FOG) 5M mg/L 0 SwW/Grsvel''Filter 0 Peat Filter Biochemical Oxygen Demand fBODj 5220 mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other- Pretreated Effluent Quality Monthk average Dispersal Cells) 0 NA Biochemical Oxygen Demand (BOOJ 530 mg& 0 In- Ground (gravity) 0 l 1peessurizW) Total Suspended Solids '(TSS) 530 mg/L IN NA 0 At-Grade ; Mound Fecal CoNform (geometric mean! 0 1oom1 0 Drip -line or: Maximum Effluent Particle Size Y. in 0 NA Otfcer; 0 NA Other 0 NA Other: ❑ NA • Values typal for domestic wastewater and septic tank effluent. Other. 0 NA MAIN?ENM)CE S CHEDULE L2L L2a 9� Service E"M Service Fmgmmy Inspect condition of tankfs) At least once every: 2 -13 M t (Maxdnnum 3 ys rs) o NA Ramp out contents of tankis) When combined sludge and scum equals one- third (Y of tank vokuna 0 NA I � Inspect dispersal, 0 month(s) ceiifs! At feast once every: .� 3 Years! 0 NA C t filter 5 IJ At least once ; 0 mon#" 0 NA 47 Year O moeth(s) inspect Pump. pump & alarm At bast once every: `� �- s! 0 NA -� montfttsl ` Flush laterals and pressure test At least once every Ci O NA : cr es"Al Omer: At least once every: 4 mart s ls! 0 NA Other: 0 NA Inspections of tanks and dispersal cef, shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Pkrrmbw Restricted Sewer; POWTS Inspector; POWTS Msbaainer; Septa" Servicing Operator. Tank Inspections must include a visual inspection of the tankfs) to identify any miffing or broken hardware. identify any cracks or leaks, measure the volume of corrcbined sludge and scum and to check for any back up or pondang of effluent an the ground surface. The dispersal cellIQ shah be visually inspected to check the effluent levels in the observation pipes and to check for any parading 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 4Yg) or more of _the tank volume, the entire contents of the tank shall be removed by a Septa" Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. AN other services, indWi ng but not limited to the servicing of effluent filters. mechanical or pressurized components, pretreatment units. and any servicing, at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shah be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) • Fagg of M TART UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicil that may impede the treatment process and /or damage the dispersal callus). If high are detected have the content of the tanks) 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 b discharged to the dispersal cell(s) in one large dose. overloading the ceNsl and may result in the backup or surface discharge o effkient. To avoid this situation have the contents of the pump tank removed by a Se~ Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in mmivaly operating the pump controls tt restore normal levels within the plump 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; degrsesers; dental floss; diapers; disinfectants. fat; foundation drain Isump pump) water; fruit and vegetable peelings; gasolirm grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS faits 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 property 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 fads and cannot be repaired the following measures have been. or must be taken, to provide a code compliant replacemerit system: ❑ A suitable replacement area has bow evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compactlon and Should not be infringed Capon by required setbacks from existing and proposed structure, lot pries and wells. Failure to protect the replacement area will result in the need for s new eat and site evaluation to establish a suitable rat sms. ROPISCM systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or sod limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS- 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomet at the infiltrative surface. Reconstructions of such systems mast comply with the rules in effect at that tame. < < WARNING > > SEPTIC, PU MP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A 8EPTIC, 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 tWSTALLER POWTS MAWTAVI EiR Name . S Name Phone - It s of 13 S Phone SEPTAGE SERVICING OPERATOR 15MtI'+Mt) LOCAL REGULATORY AUTHOFWTY Name Name S-t- e rQ , `' v� Phone Phone S Ica Thee docennant was dratted in congoisrtce with chapter Coma► 83:2212)tbl 1 #t d)&lf) and 83.5411), ( 2) a (3). Wisconsin Adm*iatr l*m Code. VOL 1585 PAGf 421 DOCUMENT NUMBER 6,. JB *3 1 1 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Magnus F. Budzien and Constance C. Budzien, husband and wife, Grantor, 02-12-2001 9:30 AN conveys and warrants to Gerard P. Budzien, Pauline K. Raatz, Kurt Budzien, Catherine T. Worwa, Ruth A. Cain, Karen J. Wardell and Frank WARRANTY DEED L. Budzi , Grantee, the following described real EXEMPT N 8 estate in St. Croix County, state of Wisconsin: CERT COPY FEE: COPY FEE: TRANSFER FEE: THE NORTH 100 FEET OF THE SOUTH 1300 FEET OF THE WEST 620 FEET OF THE RECORDING FEE: M DO SOUTHEAST QUARTER OF THE SOUTHEAST QUARTER (SE 1/4 OF SE 1/4) OF PAGES: 1 SECTION EIGHT (8) , TOWNSHIP THIRTY ONE (31) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF STAR PRAIRIE. TOGETHER WITH a roadway easement from the East line of above described parcel to a trail now located on part of said SE 1/4 of BE 1/4. LOT THREE (3) OF CERTIFIED SURVEY MAP IN VOLUME TWO (2) OF CERTIFIED NAME AND RETURN ADDRESS 341 Leo A. Beskar, Attorney !/ COUNTY REGISTER OF DEEDS OFFICE ON JULY 2T, - r9T ; BEING LOCATED IN THE RODLI, BESKAR, BOLES & KRUEGER, S.C. NORTHEAST QUARTER OF THE SOUTHEAST QUARTER (NE 1/4 OF BE 1/4) OF 219 North Main Street, P. 0. BOX 138 SECTION EIGHT (8), TOWNSHIP THIRTY ONE (31) NORTH, RANGE EIGHTEEN (18) River Falls, WI 54022 WEST, TOWN OF STAR PRAIRIE. Subject to 100L" Street Right -of -way. 038- 1035 -90 -000; 038- 1034 -95 -000 Parcel I entr ica'cion Nu er The Grantors herein reserves the right to occupy the premises being conveyed hereunder. Said rights to occupy shall terminate when it is no longer feasible for the Grantors to occupy said residence due to health or other reasons. This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this r day of January, 2001. (SEAL) (SEAL) Magnus -^n Constance C. Budzien (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) Magnus F. Budzien and Constance C. STATE OF WISCONSIN 1 Budzi , ) as. COUNTY ) P auth t ed this da of January, 2001 Personally came before me this day of 2000 the above named sionacu :ei to me known to be the persons(s) who executed the foregoing is trumeat and acknowledge the same. Leo A Beskar (Name Printed nc T—d) TITLE: MEMBER STATE BAR OF WISCONSIN (Si awtur -) (If not, e.:thorized by 5706 06, Wis. Stata. ) tsame minted ez Twed� THIS INSTRUMENT WAS DRAFTED BY, Notary Public County, Wis. Leo A. Beskar My commission is permanent. (If not, expiration date:) Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 River Falls, WI 54022 34178 z �► r� . 0 0 FILED _ ° JUL 22 1977 o� 1AAIES O' CotaM W �_ 00 N"mw of owd � m ( Z It C a n t y , r O cn O 9 z o z _� O D 8 G, bo D m 0 z SQUAW oN LAKE U gm = 1 N 34.�J4' D0 A g? y N� ?Fo °DZ - 3O A N ' O N d• F 1.0 AC. •` L tv - I m X a z Q [gyp 0°00'48 ° E N [1 C 1 < � W \ .50' yp r 0 o �►- -? - - �5 0£ Q o �, w D z I ' �, �� x t Q w / o Z O 1 aD o 0 � yC2 p opt Q A a .7'd� ro O A m O. ;*1 \ N t rn m w N � z 4 w 268 ° 23'35 " ?5.. ~ Q ro a� cn m � G o cn W tOA= N W A CD' 0 z 0 m 0 rn O 1 fil - r*i n? n W N T t0 z IR D 0 D w �� I N M W 0� T N� N m 0 1 m n. z A° 0W o J �, z o Z° rn Z 4 v '-1 O D m = -U-1 Q W o Q OD 0 ro C 0 09 Z m � r r-p 0 n ' ��-� oW co w> W 1 rt > > � 'C _� W -� A o -I OD z 2 X11 Cob m O O G1 —I O p m O Z D m - D m Lo 7p D OD D 1� Z la Z > m V m V ;u koL X r r OD m m b 334.G I' - SOUTH G76.35' v m - OOA4 194.76' - - Z w w SOUTH W - - '� _ OM D ommI 629. o_ APP CENTERLINE c n 8 o TOWN ROAD OF ROAD SURFACE -10 '� z c m0 O O z 0 z c m m z Volune 2 Pace 414 �� 1 � � 3� ��� , Z� � �� s �� Ao - • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Z Division of Safety and Buildings in acd:ordenos with Comm 85, Wis. Adm. Code t.ourtly ST. Attach complete site plan on paper not less than 8 112 z 11 Inches In size. Plan must include. but not kntted to: vertical and horizontal reference point (811 direction and Parcel I.D. percent slope. scale or dimensions. north arrow. and location and distance to nearest road. 039- - 4$" OOD Please print all Information Reviw+ed by Date Personal Inronns$on you provide "be used for secondary purposes (Privacy Low,*. 15.04 (1) (m)). Property Owner Property Location Cpl E9,0JGF T. W OV, W A a� 001 met- )4 C- 114 SE 1/4 S S T Z I N R 18 w Properly tTvnera Matlrlg Address Lot 1t. Block 11 Subd. Name or CSW 4`�a c �1�0 � .LANE 3 --- Vol.2 �r41y State p s r 0 City ❑ VlRaga Town Nearest Road 1TE �►t�i 1 V 5TA R V RA 19-1 E t F ❑ New Construction U$e:X Realdential I Number of bedroom$ Code derived design flow rate _ -- D $Replacement ❑ Public or wmrmrdel • Describe: Parent materiel T i LL Toro Plain sta �a;ior it alp~ !cable General comments s 5 M 2 OOo "l_. Mt JJ t M _ 5 end rec:arnnandadon$: HOLD 1f.�(� ZAJJK V f � 2LZO CAt71I (.A.J E El Bori 0 C] Boring ❑pit Ground surface elev. _ R. Depth to limiting factor In. lion Rate Horizon Depth Dominant Cot Redox Description Texture Structure Consistence Boundary Roots •Eff- / 'Eft114 In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 b EM lb ?t ED Boring i1 ❑Boring ❑ pit Ground surface elev. R. Depth to limiting factor _____ In. � �� Rate Horizon Depth Oominant Color Redox Dascripton Texture $uucture Consistence 5ounda: f Pasts �Ef>#Gpa�Eff#2 in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. • Effluent !11 - BOO > 3() 220 mglL and TSS >30 < 150 mgll 'Effluent 02 BOO S 30 n4& and TSS 130 mg/L Signature CST Number CST Name (Please Print) �, n g- M H D L L ST E K Tel Number Date Evaluation Conducted P Address W911 fo'40 AVe. VE 'FAtu WT 5`1 22 - 7t5 y2b -1'1�s PL�r PLAN kKLO% EL13, tA cO iv i LE 2L 0 q z 1 LDCA F D W IWE e r sc ' \ a c. V q 4 ti sf • �. 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