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038-1192-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579074 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Village Township Parcel Tax No: Chad Hanson F77 TOWN OF STAR PRAIRIE 038-1192-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 9!v•loZ 'Tg„n,ll_ 0JdAe,A 11.31.18.989 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ! ~o Dosing Alt B t. ~1e..> 1'0 ~1a {c l~e,a N1f1Q 5 $ ~1a'S . / Aeration Bldg. Sewer Holding ~~~JJJ St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL, BLDG. Vent to Air Intake ROAD Dt Inlet Septic z1f Z g Dt Bottom Dosing r Header/Man. Aeration Dist. Pipe (rc. 941. / Z Holding Bot. System cr (Pt~,, 93. tZ ek Final Grade PUMP/SIPHON INFORMATION 5• Manufacturer GPn and StCppver 11 Z . ~J O ~Qd /q /Vt~,J W1o.~Ytol~. Ge O Model Nu TDH Li Friction Loss System Head jTDH, Ft rcemain Length Dist. to Well SOIL ABSORPTIO SYSTEM BEDITRENCH Width Lengt-ht / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 "I~ 'z a _4 _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufa tune INFORMATION CHAMBER OR 7.1 t' Type Of Systerg1: 1-7 "7 a~ UNIT Mog Numger: (jj Cam. i w. ..0 DISTRIBUTION SYSTEM 12. GJ , '7 A'S: = y Header/Mando d rl Distribution x Hole Size 7pacing Ven,] to Air Intake Pipe(s) I l @ 5 LDia 4 Length Dia Spacing_ I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth of xx Seeded/Sodded xx Mulched Depth Over xx Bed/Trench Center w Bed/Trench Edges Topsoil es Q No es 7gNo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1284 220TH AVE 1.) Alt BM Description O 2.) Bldg sewer length f ,K1 J - amount of cover = V Plan revision Required? Yes No Use other side for additional inform. o Date Insep 4Signre Cert. No. SBD-6710 (R.3/97) 2oti""xn'tenr E County ~+t Safety and Buildings Division -j Q = 201 W. Washington Ave., B 71 Sanitary Permit Number (to lled in by Co.) S K P JEP Madison, WI 537 - 1 CROIX COON M NT 57c7 JOM tate Transaction Number anitary Pe it Application rm in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. 1 _ I. Application Information - Please Print All mation 9? /V 14 V Property Owner's Name 1 Parcel # i (2 0~~ Property Owner's Mailing Addres~s,~ Property Location L = Govt. Lot J City, State Zip Code Phone Number /a Section S f 71.5 - 7 P v ~1 y T l N, R lE one~ti Type uilding (check all that apply) Lot # "(J ~1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name ' Block [i El Public/Commercial -Describe Use ❑ City of CSM Number El village of El State Owned -Describe Use G 2 2 L,)l Town of p~ l I ~J in. Type of Permit: (Check my one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. 11 Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New Before Expiration Owner 353 z4 V (c ?Se) W. Type of POWTS System/ Com onent/Device: Check all that apply) KNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ► ~~r V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (st) Dispersal Area Proposed (s System Elevation ( JS 7 7) 6 ~ ~v ® CI o7 , S ✓ ~J,j - VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U New Tanks Existing Tanks P, LA, a U v; w V C Septic or Holding Tank ©Q ho Dosing Chamber `e 1* VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POR TS hown on the attached plans. Plumber's Name (Print) Plumber' Sign e RS Number Business Phone Number /4~~ J(N~V IMAP Y Plumbe 's Address (Stree City, State, Zip Code) VIII bun /De artment Use Only Permit Fee Date Issu Issuing gent Signature Approved g > even eason for Denial 3 IX Condi~gsftl~WVIlReasons for Disapproval 1. Septic tank, effluent filter and 3) pla ✓ ~yC °~`~V dispersal ceB.must all - aervt~es't mUzf . vs Per management plan Provided _by plum*,- Aar- 2: Alit sc 1 Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 a 11 inches in size SBD-6398 (R 11/11) now 7 77 'Q 0- X15` r/ -6 3'1 lc~~p S7- t3/~-~ 1 -1 "COPY CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: ~T Owner's Address: fJ r..~-~ ~ y a f 1 Legal Description: _ Township: /(.e.wtL2 f County: S T C~{se-t~ Subdivision Name: Lot Number: s Parcel ID Number.gj Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat f~Attachments: Soil Test & House Plans Designer/Plumber: License Number. Ocac C5 ~5~ Date: - / - Phone Number Signature Designed pursuant to the In- ound Soil Abso tion Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 c"t cj"tK - a d, ell gooq ~o 0 ,363 y y . l bo o G4A.ST n J .I Soil Absorption System Cross Section 4° Schedule 4o Final Grade PVC Vent Pipe With Vent Cap Leaching Chamber a~ j ft System Elevation ft ft Soil Abson3 lon System Plan View ft aft 1 ft Vent Or Observation Pipe Leaching Trench 1 Chambers 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating 07d sq ft per chamber Soil Application Rate gpd/sq ft god Design Flow Soil Application Rate T -2L~) EISA = ~a( Chambers 2 rows of-L7-chambers each. 7.: 1 Page of c.n mtpS c~rr ~n~O GO rto C-- 0 Np _~i \ C-n S cn -p G) W M -rn m r G) co O x c-> o O C iL7 C7 S p O m f7 a3 = r 7'. =m mrn d a --4 cn ° i Y _ I ` o Cr> m cJ. o0 - - - " --=1 w w w cy, a N o )7 Alt Il it P- 'I £113H:31Id 95t8-gz2_009 OOZ Ndr n32i Z ~ ost*g 1M 'rooa N301VW 01, "H Sfl 91LEM iynNyW OI1d3S af10d-1SOd 31V0 OLOZ AatlflNVf 31V0 w 0 A3a 8nod-38d o-j = w t, E31vos 1MS xa NMVao 313NDO0D 11d13a 01SINVO 831113 v=i V) ~ J J Q Q Q J ^ \ I- w O `n w X11 J LLJ Ole Qcn Uw w z \ ~ Z o or_ ~ wQ UO~. o, p U a LA M N W N 1 0' ~ Z _ N - IL J UN Q - Q w V O s~ N S cl Z OJ J ~ ~ Q d a US N w > 'NIW „8l w z o ~ Qpi U J W U Ilz wow' „9 Z L£ V) N 11 Q~tV JU I Jd(O ,.z 00 wy)J N ZJ V~FQ- K J Q Z w Q -0 w NNw xo w O QQ U U N CL CL W N Q u£~ -1- POWTS OWNER'S MANAGEMENT PLAN FILE INFORMATION `SYSTEM SPECIFICATIONS t)V1'NER _ S tic Tank Capacity /0,W Gal. ❑ n/a PERMIT # s Septic Tank Manufacturer ❑ n!a Effluent Filter Manufacturer WW& Gal. D n/a DESIGN PARAMETERS LpMuent Filter Model D n/a Number of Bedrooms Q n/a Pun Tank Capacity Gal. a Number of Commercial Units n/a Pun Tank Manufacturer a Estimated Daily Flow der Pump, Manufacturer n/a Design Flow (Peak) st x 1.5 der Pun Model n/a Soil Application Rate , der ft2 Welly ratmert 1 it *rn/a Influent/Effluent Quality Monthly Average 0 Sat,Gravel Filter . 0 Peat Filter Fats, Oils & Grease (FOG) < 30 mg/L CY Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5 } <220 mg/L O Disinfection Q Others: Total Suspended Solids (TSS) < 150 mg(L Pretreated Effluent Quality n/a Monthly Average Disprsal Cell (s) Biochemical Oxygen Demand (BOOS) 5 30 mg/L o and gravity D In-ground (pressurized) Total Suspended Solids (TSS) <30 mg/L D At-grade ❑ Mound Fecal Coliform (geometric mean) 10, cfu/100m1 D Drip-line 0 Other: Maximum Effluent Particle Size % inch diameter MAINTENANCE SCHEDULE SERVICE "ENT SERVICE FREQUENCY Inspect condition of tartk(s) At least once every f months ears Amnm 3 years) Pun out contents of tanks When combined sludge and scum uals one-third ('/3) of tank volume isp~ersai cell (S) At least once every ,j_ months s ximar;, 3 ears Clean effluent filter At least once every months ❑ ears or as needed Inspect pump, pump controls and alarm At least once every ❑ months ❑ ears Erna Flush laterals and pressure test At least once every D months ❑ year s fl Va Other: At least dace every ❑ months ❑ ears Dt h/a Other: At least once every 0 months ❑ year (s) "a Maintenance Instructions Inspections of tanks and dispersal cells shall be made by a individual carrying one of the fol owing licenses or certifications: Master Plumber; Mater Plumber Restricted Sewer; POWTS Maintainer; Septage Servicing Operator. Tank inspection 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 parading 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 authority. When the combined accumulation of sludge and scum in any tank equals one-third 3) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION 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. Page Z of 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: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replac3ment 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. 0 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. T is 0"*jM-9 o mg jank alua ' e ' e a~ a ~fZD4415 T7~ ni2- A/6w GflfVSTRc1-t DN O 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 G Name Phone O QZ,2~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name CkD l (?UN 2()~ll~ Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM' OwnerBuyer~ Mailing Address ~G Property Address (Verification required from Planning & Zoning Department for new construction.) s~®/ 1 b / City/State 9~e. EJ' Parcel Identification Number /a 6 0(2~ LEGAL DESCRIPTION Property Location S r/4 , S 1/4 , Sec. Z , T N R < W. Town of ' Subdivision Plat: . , Lot # - . Certified Survey Map Volume , Page # # (before 2047)Volume Page Warranty Deed # 7 66 L 41 Spec house D yes W no Lot lines identifiable lkyes Q no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result inits 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. Owner maintenance responsibilities are specified in §SPS. 383.52(l) and in Chapter 12- St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal systemwith the standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to a best of my/our knowledge.. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed reco d in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE * * Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV, d4/i2) a + LAJ try J 4+x;4"C f ` a LOT ` 96.265 SQ. FT. a . 2.21 ACRES 33 33 ~ 7. . . n m. T a , w A. 2 20 A or' ~ 1 (R BE `MEDICATED TO THE PUBLIC) ~n nme w, .wisconsitt Department of Commerce SOIL AND SITE EVALUATION Page of Division of Safety and Buildings Bureau ofJntegrated Services in accordance with Comm 83.09, Wis. Adm. Code , G Y c ! Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal 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 I Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner C ~e D Property Location 114 Govt. Lot 1/4 1/4,S T J?/ N,R E r Property Owner's Mailing Addr Lot # Block# Subd. Name or CSM# City ~ Plate Zip Code Phone Number C3 city ❑ villa e 0 Town Nearest Road Q ~ New Construction Use: (2fiesidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate ___,?_bed, gpd/fl2trench, gpd/f12 Absorption area required bed, (t2_,'Zj_trench, ft2 Maximum design loading rate i2bed, gpd/it2 --V trench, gPW Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional designisite considerations G~ cz s' Flood plain elevation, if applicable ft Tank Parent material S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill I1Uolds [~U U unsuitable for system S ❑ U Es C1 U i4s C3 u ❑ u ❑ S ,0-u SOIL DESCRIPTION REPORT Boling # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDIft2 , Trench in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Ground 44a Depth to Iln~iuag ~lZ• factor tfL in. )1.ler_ F-. Remarks: tsoring # G ZII, 4;e /eyo- 'oor l 0I W-W f G A Grooun7, , Dot, to limiting factor /,z in. Remarks: CST No" (Please Print) Signature Telephone NO. r Date CST Number 'odd aoe O~SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground' C v ' T- elev. Depth to t limiting Z. facto / Remarks: Boring # Zzf Ground elev'_,1 Depth to limiting 5 factor ~160- Remarks: J" Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ~ -fl Ground ev. ft Z- 74-1 D Depth to limiting ` factor -7In. Remarks: Boring # 13, Ground elev. ft. Depth to limiting factor 'n' Remarks: SBD-8330 (R.9/98) Soil Test Plot Plan Project Name Gary Peterson Byron $ird Jr. Address 635 W. 6 th St. New Richmond Wi. 54017 CST #220527 Lot 5 Subdivision Date 3/22/0 SE 1/4SE 1/4511 T 31 N/R18 W TownshipStar Prairie [a Boring Q Well PL Property Line County ST. CROIX ,BM or VRP Assume Elevation 100 ft top of walkout System Elevation 92.9 H.R.P. same as alt. BM i Alternate B.M. SE CORNER OF PL. 220th Ave Driveway P.L. GARAGE 3 Bed House PL B4 30' B2 509 *B.M. 315' EP. A. PR. B3 60' 30' I'd B5 B1 lt. 15' 15' 5' 316' PL 5' i I i I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: ' Safely and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 353286 Permit Holder's Name: Village ToLwn o : State Plan ID No.: Peterson Gary ❑ City Star Prairie Township CST BM Elev.. Insp. BM E ev.: BM Description: Parcel Tax No.: e W pending TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Oa Septic /Ove Benchmark jai 10U4 Alt. BM Aeratio Bldg. Sewer 3, q Z olding Ht Inlet TANK SETBACK INFORMATION Ay Ht Outlet L Vent TANK TO P/ L WELL BLDG. AirIto ntak ROAD Air Septic ~j~r Zr r ~N NA 9y.3 r Dosin NA Header / Man. , sp Aera ' N Dist. Pipe z T 4. -r oWolding Bot. System a)tI 3 4 PUMP / SIPHON INFORMATION Final Grade " 33 It. en M nufacturer Demand St cover Z Model Number TDH L' Friction S stem TDH Ft Loss F cemain Length Dia. Dist. To SOIL ABSORPTION SYSTEM s BED / ENC Width 3 / Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI EFh!QN1 I DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK A BER INFORMATION Type Mo Num er: System: A451 + O DISTRIBUTION SYSTEM Header / Manifold Distribution Pip/e s x Hoe Size x Hole Spacing Vent To Air Inta e Length / Dia. Length C W(. 7 Dia. A Spacing -7-4 Al 11 A 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #14 /Z L /Go Inspection #2: Location: pending, New Richmond, WI 54017 (SE 1/4 SE 1/4 11 T3 IN R1 8W) - 11.31.18. -Lot 5 1.) Alt BM Description= 2.) Bldg sewer length = 2,f- -amount of cover = > 3' we(f u.41 ~Iti j Y) gGrc i s vo n, for a rsp~ac~.r.a Plan revision required? ❑ Yes No Use other side for additional inform tion. a SBD-6710 (R.3/97) Da Inspector's s tur e Cert. No. h Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 353286 Permit Holder's Name: ❑ City ❑ Village ❑ TgLwn of: State Plan ID No.: Peterson Gary Star Prairie Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: v a /,u pending TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ppU Benchmark lo l. pa Alt. BM Aeratio Bldg. Sewer 3 q~,1 Z olding Ht Inlet ' TANK SETBACK INFORMATION t Ht Outlet L TANK TO P/ L WELL BLDG. AirI to ntak ROAD Jple n rl Septic ~~r Zd _L _ NA Dosin NA Header / Man. , sp 9Y tr Aera ' N Dist. Pipe C~) i T -14olding Bot. System z PUMP/ SIPHON INFORMATION Final Grade 33 iC vv Manufacturer Demand St cover , Z Model Number TDH L* Friction S stem TDH Ft F ,e Length Dia. Dist.To SOIL ABSORPTION SYSTEM s 1_ q BED / ENC Width / Len E No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth MStGN DIME 3 Z IM N I N Manufacturer: SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING SETBACK A '"En INFORMATION Type 0 / Mo Number: System: Z1 A 14 j /V O DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size T Hole Spacing Vent To Air Intake Length Dia. Length Z Dia. ALIL Spacing 21 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/Tr nchCenter Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: q / iL /CJo Inspection #2: Location: pending, New Richmond, W1 54017 (SE 1/4 SE 1/4 11 T3 1N R1 8W) - 11.31.18. -Lot 5 1.) Alt BM Description= 2.) Bldg sewer length -amount of cover = > ~ buelrf V_r~ rr j 4 Y) 1 erc ; 5 voov__ tty a r-yo6Ge.,J Plan revision required? ❑ Yes No Use other side for additional inform tion. a (P SBD-6710 (R.3/97) Da a Inspector's S ture Cert. No. h ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: wem s e r E j a a a i E f z ~ ~ I 9 I I I ~ ' ~ ~ ' ~ ~~I I : s ~ E i gggx E .a.. ...mss f 4 i r e v 9 e z, Y~~~ISIoN~~ Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 W Washington Avenue P O Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707-7162 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ( L"/ • See reverse side for instructions for completing this application State Sanitary Permit Number 35 P -W Personal information you provide may be used for secondary purposes 1'L 22~ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan Review Transaction Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope y Owner am Property Location P lA 5F_114, S 1 f T , N, R (or IV Property Owner's Mailing Address Lot Number T lock Number 3 r _ ubdivision Name or M Number N C t g~t r vl W~l g (hS~mb or eA-J / r[ C~j1 CJ 11. TYPE ILD N : (check one) ❑ State Owned ❑ ity Nearest Roa ❑ Village Public 12 1 or 2 Family Dwelling - No. of bedrooms Town of RAfQI F_ 1111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo C) ~ $r- l D L( - 5-0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreate al Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ~Sy!s em System Tank OnlyExisting System Existing System B) A Sanitary Permit was previously issued. Permit Number 3rr, Date issued / - 2ayy V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12ASeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill LTiqm$S Llg VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 4 -0 5"7Q3 5--j-2_ 0, e CIE) Feet Feet VII. ANK Ca naut lons Total # of Con- Steel Fiber- Plastic Exper. INFORMATION igal Manufacturer's Name Prefab. Site New Existin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ' stallation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbe ' nature: ( tarRp MP/MPRSW No.: Mhone Number: Sa 26~ -l ~ umber's Address (Stre City, State, Zip 46 Code): ~O D IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved SanitAry Permit Fee (includes Groundwater ate Issued Issuing Agent Si nature(NoStamps) pproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 5 Y r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (11.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 7 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. if building type is public, check all appropriate boxes that apply. iV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and takes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump. manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can _ effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I Gary Peterson PLOT PLAN PROJECT ADDRESS 635 W. 8th St. New Richmond Wi 54017 SE 1/4 SE 1/4S 11 /T 31 N/R 18 w TOWN Star Prairie COUNTY ST. CROIX Byron Bird Jr. 220527 f 3/23/0 BEDROOM 3 4IZ4~±z DATE CONVENTIONAL XXX IN-GROUNP4RESSURE /CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •8 ABSORPTION AREA 572 # of chambers 18 BENCHMARK V.R.P. top of Curve Stake ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.9 Alternate B.M. SE CORNER OF PL. 220th Ave Driveway P.L. GARAGE 3 Bed House PL B4 30' B B.M. 25' 20' 315' REP. A. Vent 2-3' X 56' Trenches B3 with 6' Spacing >12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 30' 6% „ Jl ft^2 per chamber lope 6' Tong 16 Grade at System Elevation BS ~ 34" At. . 15' 5' Vents 316' PL 5' WWsconsih Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau ofJntegrated Services in accordance with Comm 83.09, Wis. Adm. Code f2ev`-zo n- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ` include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # l 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 JL = 1145 1/4,S f T _~?/,N,R E Property Owner's Mailing Addr96 / 74 Lot # Block# Subd. Name or CSM# /11-4 7 / City plate Zip Code Phone Number ❑ City ❑ villa e Town Nearest Road A'4'(141-w4 L3~ .0/ 71( let e- t2-New Construction Use: residential / Number of bedrooms 2 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpdtW -trench, gpd/ft2 Absorption area required abed, ft2~-Xjtrench, ft 2 Maximum design loading rate __~_7bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) o?. ft (as referred to site plan benchmark) Additional design/site considerations Parent material G < 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 S ❑ U pt ❑ U ❑ U ~Z-6 ❑ U T ❑ S 2u ❑ S K-U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ZOO. Ground / `c _ i0,~ft. 1 Depth to linal'ig factor tfZ Remarks: boring # fir//~ ~,~/j y Ground ete ~ ; Depth to to limiting factor ,/min. Remarks: CST Narryq (Please Print) r Signature Telephone No. Addre Date CST Number PROPERTY OWNER ~c,,,SOIL DESCRIPTION REPORT ' Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Mlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Jl / L ~Yl ~ gam' Ground' elev. Depth to limiting factor in. ; a- / Remarks: Boring # Ground , elevl-., Depth to limiting factor ~7~o212in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PDht2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 771~/ © Ground 4pev. eft. Depth to limiting ; factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) Soil Test Plot Plan Project Name Gary Peterson Byron $ird Jr. Address 635 W. 8 th St. New Richmond Wi. 54017 CST #220527 Lot 5 Subdivision Date 3/22/0 SE 1/4 SE 1/4S11 T 31 N/R18 W TownshipStar Prairie Boring Q Well PL Property Line County ST. CROIX ,BM or VRP Assume Elevation 100 ft top of walkout System Elevation 92.9 H.R.P. same as alt. BM Alternate B.M. SE CORNER OF PL. 220th Ave Driveway P.L. GARAGE 3 Bed House PL B4 30 B2 50' B.M. 315' REP. A. PR. A B3 60' 60' 30' BS 3,4_ IF B1 Alt. 15' 15' 10.M 5, 316' PL 5' lo~~ AP Safety and Buildings Division . p~~/~+~ T 201 W. Washington Avenue SANITARY PERMIT ~SCOnS~n I P O Box 7302 Department of Commerce In accord with Comm 83.0y 1NJs'-JWfn. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on pa @ Rt12t,le~s Chu ty than 8 1/2 x 11 inches in size. ~R • See reverse side for instructions for completing this application State anitary Permit Number ] Personal information you provide may be used for secondary purposes Ol `r C k it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. r~C' U FI r Sta Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RM TIO Property Owner N e r itty' Oc ti ,7 d /4,5 T . N, of,? (o Property Owner's Mailin ddress Lot Number Block Number City ate Zip e Phone Number Subdivision Name or CSM Number I U TYPE F BUILDING: (check one) C] State Owned ❑ lty t Nearest Road ❑ Village Qr+ Public 1 or 2 Family Dwelling - No. of bedrooms 2ti own OF v~L~v J~Z-,c III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 3 r Ld 44- 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational ility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12E] Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1.ANew 2. ❑ Replacement 1 [:3 Replacement of 4. Reconnection of S. E] Repair of an - Existing System ------System System Tank Only ___________`__Existing System _ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12„E5Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43E] Vault Privy 14 ❑ System-In-Fill Gc Gam/ ~~.-t~ VI. ABSORPTION SYSTE INFOR ATIO : 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ( Required (sq. ft.) Proposed (sq. ft.) (Gals/day/ . ft.) (Min./inch) C~ Elevation 7v • - g/ Feet ?2 Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ El E] 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumber' nature: (No St s) MP/MPRSW No.. Business Phone Number: Plu is Address (Street, Cit , State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) ' Adverse Determination e r da I OD X. CONDITIONS F APPR VAL / REA O S FOR DIS~,pPROV L: c e e✓ vi 1 fir= 0-t)e~i/ ) SBD-6398 (R. 4199) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation b 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151.. - - - To be complete and accurate this sanitary permit application must include: Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. PLOT PLAN 3S - PROJECT ADDRESS 4:: i /4S rf /7'N/R l~ W TOWN ~ ~JCOUNTY MPRS Byron Bird Jr. 220527 DATE- ~~q~ BEDROOM CONVENTIONAL >OOC IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE,/&-&-z!::-' LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE , ABSORPTION AREA ~~a # of chambers BENCHMARK V.R.P. ASSUME ELEVATION 1Q0' ❑ BOREHOLE O WELL sH R p Vent SYSTEM ELEVATION X12" Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ft^2 per chamber 6' Long 16" 34" Grade at System Elevation /loo 3G f ~ 1 V y~ p ~G~1 ~ y I~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labo and Wtiman Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County r+ include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 638 APPLICANT INFORMATION -Please print all information. Reviewed by _ bate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 1 (m)) O . Property Owner Property Location ~Govt. Lot ft 1/4 S F1/4,S N R (or W Property Owner's Mailin Address Block# bd. Name r C M4,,, j,. /f,-2 7,4,C' s City State Zip Code Phone Number Nearest Road City Village Towh/ tvo c~~s' ),2y 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/ft2 • _Y trench, gpd/ft2 Absorption area required6 Y-3 bed, ft2.'~1/7 trench, ft2 Maximum {~desig oading rate bed, gpd/ft2~trench, gpd/ft2 'r e Recommended infiltration surface elevations A ,,e (7 Z, O ft (as referred to site plan benchmark) 1117 00, Additional design/site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system C ventional Mound In-Ground Pressure AT rade System in Fill Holding Tank U = Unsuitable for system S❑ U xfS ❑ U S❑ U S❑ U El S U El S C-7f U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench o- a-11Z S Z, q~ 7 Ground g lev. Depth to limiting -3 T /73-12- n. / Remarks: Boring # Ground Depth to limiting factor n. Remarks: CST Name (Please Print) Signatu Telephone No. Address ~ Date ~ CST Number _3 22 2, PROPERTY OWNER SOIL DESCRIPTION REPORT ' Page of 49, PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 111,4-4 7 Ground Depth to limiting ZZ .,a fa r ~n• Remarks: oring # AA, 114y- 41-P IV oq- P,1.1,4 Ground 01 Depth to limiting f tQr Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # d Ground ~I v. ft Depth to limiting ~f O Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) 6/7 77- , la-1 ~o a ~ off' ~ of X S~ %y ~ ~y ll 7-51 AJI JQ -5X' Ele4-40 74V ~~t1 Zo R3)-4r,7 Irv ..3 • ~ ~P~ c' to ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT _ AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address r (Verification required m Planning Department for new construction) City/State Parcel Identification Number O LEGAL DESCRIPTION party Location /4, Sec. T N-R~W, Town of 1/a, ~ ' Pro Subdivisions r'/l u acct Lot # ✓r` Certified Survey Map # Volume Page # Warranty Deed # Volume Page Spec house J9 yes ❑ no Lot lines identifiable,9 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department 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 da of the three year expiration date. SIGNA F APPLICANT bATI~ OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG OF APPLICANT 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 479 Phu 269 SPATE BAR OF WISCONSIN FORM Z -1998 6157 94 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CRDIX CO., WI This Deed, made between Clay A. Edin RECEIVED FOR RECORD Grantor, conveys and warrants to Gary R. Peterson and Suzanne K. 12-21-1999 10:00 t1M Peterson. husband and wife YARRAHTY DEED Grantee. EXEMPT I Grantor, for a valuable consideration, conveys and warrants to Grantee the ~T COPY FEE: CDpT FEE: following described real estate in St. Croix County, State of Wisconsin Cme TRPASFER FEE: 66.00 'Property'); RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address KitI:MN OGLAND Zilz, Estreen & Ogland P.O. Box 359 Hudson, W1 54016 P4. Of 0.38- IO49 -50 Parcel Identification Number (PIN) This is not homestead property. Lot 5, Huntington Meadows, St. Croix County, Wisconsin. Exceptions to warranties, Easements, restrictions and rights-of-way of record, if any. Dated this t day of December, 1999. ce~ + -Clay A. Editr } F ACKNOWLEDGMENT STATE OF WISCONSIN ) AUTHENTICATION ) ss. County ) Signature(s) Clay A. Edin Personally came before me this _ day of December authenticated this day of 1999, the above named December, 1999, to me known to be the 1 person(s) who executed the foregoing instrument and acknowledge the same. F Kristin Og an TITLE: MEMBER STATE BAR OF WISCONSIN + (If not, Notary Public, State of Wisconsin authorized by 0 706.06, Wis. Slats.) My Commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. 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