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f C! toO 3f 0 d CD rr 3 I � o o 0 p N 0 w w °C • m �' 3 c 9 4° v w a° j v co a z w CD N . CL _ _ ` 1 O O O h N n S O co CD a w 3 fD o o °o N m o p' ^_ c a to < D m A ° _ a N N d 7 v C m CD c c ry N 3 O C O 0o ° o o ° w co a cn o z :z n ° cn » c OD OD 0 0 0 0 o 0 g 3 ry o o a y Ch cn n �s 0 L d N A S 3 y o CL M 0 C L a N z z W � 7 �i O a ZY N C CD �p w a z CD p z c I CL s� z 0 I W T w a3 z c " z ao �? z I w f a C m a � o' I m c � 3 c o o a CD N F CD ty I E t fi I A I � I N O I o O� o O CD A O D'Q I � e» O c O a, y a I O i ti y 0 to O' 0 ai O S a n d `o1 .. 3 n 3 t� V n a n n m c • a� CD v o RD cn m o � �_ cn wo . S O C N O � N N C CO C7 W C O f.r CD 'z N f-,� J� CD 7 7 CD N T� N) w fD 3 N N °CD v m I� co � w? C N N Q O N �. N Ia 7 7. N O O O 7 O CD O CC) w 3 0 ° 3 >> o _ 3 o o Py 7 (n CD 7 y � ; � O C t+► M y v — in y 7 S m n 0 a �2 o v u: D m G � D A co a A CD SZ N G O CD EiS ? Q v co n N CO 00 O ° O O G �^}� Ul O (') O� N N A m co coo Z m� o o v C1 r c CD y OD OD CD N v V O- — a N O O O? a O O O' a ¢ c CA cn CA d co 0 0 < N j CD < �r o d a n q d - o a tv L w y O < .�.. y < A Cl v a Z o. A A Z Ca Z co Z Z G) Z V 7 0 0 0 _ D a CD 0 o p D m N N v CD O O O CD fD CD CD CD U1 Ul D CD m e n M c CD CD c m CD ca CD N <o Ul N T C A CL < C1 Z -i W T W w w 03 03 �z 3 ~ 3 Z y Z y CD (D "O A (D rn CD n Q 7 D 3 � ) O. N CO . j . 7 O co O m a a c CD Na CD m 0 0 o a n o g Z C a °' f o N N F N cn CD eT _� CJ (D O CL CD N Cn 0. j CD - v F (0 0 J N Cb N O O va -00 CD N (D O p 4 (D X 3 N N a N o CD Q n N N = O 3 n CD o 6 N V A 0 0 0 w ° b m m o s o O ° z q CD 0 O Cl O Q v r Vyiseonsin Compartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499279 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: Wickham, Michael Star Prairie, Town of 038 - 1154 -10 -000 CST BM Elev: Insp. BM Elev: BM Description* _ Section /Town /Range /Map No: J �b ►M LS 1 13.31.18.705 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ',15 CAPACITY STATION BS HI FS ELEV. i Septic Benchmark e, Dom!— iZSO 6.6 ioa icv Alt. BM R, 1 a �, SZS F,' I �; 6 3, j 9s • �.� Aeration Bldg. Sewer 4 S(, - Holding St/Ht Inlet T-61 '76, TANK SETBACK INFORMATION St/Ht Outlet -3 qb qJ • G TANK TO n P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ „ o Septic i Dt Bottom �- 7!J -7 /O Q 27 Z 7 Dosing Header /Man. le.z� 91? ,73 Aeration Dist. Pipe I )b.z� $ 7.7 _5 Holding Bot. System r PUMP /SIPHON INFORMATION Final Grade Z$ Manufacturer Demand St Cover GPM F�1�.. Cou q. 33 Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain L Di Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 Z t— �. SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: EZ G oa INFORMATION CHAMBER OR Type Of System: n / UNIT Model Number: Ca �e�t,�r 3d �`{- 160 DISTRIBUTION SYSTEM Header /Manifold i/ Distribution x Hole Size x Hole Spacing Vent t `r Ike� R P ipe(s) Z Length Dia Length Dia Spacing �°✓+ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 42 Depth Over xx Depth of xx SeededlSodded xx Mulched Bed /Trench Center 3 Bed /Trench Edges Topsoil \ \N1 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / 1 nratinn• 91Q7 (nnnfu Rnar1 C. Npw Rirhmnnd WI 54017 (NW 1/4 NW 1/4 13 T31N R18 Prairie Rich Addition Lot 1 Parcel No: 13.31.18.705 Y coffpe,v.4,� Safety and Buildings Division County . 201 W. Washington Ave., P.O. Box 7162 � t! hrG 1 t (iun sco n s i n Madison, Wl 53707 -7162 Sanitary Permit Number (to be filled in by Co.) of � T�Z Sanitary Permit Application State Transaction Numb" In accordance with s. Comm 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental / " A— unit is required prior to obtaining a sanitary permit. Note: Application forts for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary C purposes in accordance with the Pri Law, a. 15. i m , Stats. .j� Z f - I. A icatiou Information — Please Print All Inf '7 D 0. Property Owtwr's Name L-E Parcel # Property owner's Mailing Address 6 .a JAN � 2 0 0 7 Property Location Q l" 7 �"` K C vt. Lot I City, State ZrP Lt..) '' /, � A, Section ,.� - ' ��u� (circle ore / �D Lot # - T I N; R H. Type of Building (check that apply) Subdivision Name m - Vbor2Family - Dwelling — Number ofBedmos- -_ - -- _- 1 Block # ❑ Public/Commercial — Describe Use l © City of CSM Number ❑ Village of _ ❑ State Owned — Describe Use g G A Town of <7t, C 9 f III. Type of Permit: (Check only one box online A. Complete tine B if applicable) A. ❑ New System 9Q Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Otter Modification to Existing System (explain) B. ❑Perot Renewal ❑Permit Revision ❑Change of Plumbs (I Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S temiCom nent/Device: Check all that a i Non- Ptessurzed In -Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in o 'table soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis reatment Area Information: Design Flow (gp Design Soil Application Rate(gpdst) D Dispersal Area Proposed (sf) System Elevation 0 U� t 7/ 9.5 /� VI. Tank Info Capacity in Total # of Manufacturer �q Gallons Gallons Units u v g New Tanks Existing Tanks _DositW-C3ramber - - - -- VII. Responsibility Statement - I, the undersigned, assume usibility for installation of the POWTS the attached plain. PI ber's Name (Print) Plum . ber's bt /MP umber Business Phone Number c�,� u G S 6 ' S 37 7 LS v I Plumber's Address (Street, City, State, Zip Code) S`tK 4u Q tVq_ eA MOA WA SY Q I VIII. Coun /De partment Use Onl Approved � D, Permit Fee Issuin nt Sigoatttre Ow Given for Denial $ �Sb • D7 IX. Conditions of Approvtdd casons for Disapproval d �7 (p O L �5 + 1 SYSTEJIA OWNER: fC V o tj 1. Septic tttttk, tilHluent Inter and dispersal cell must all be services / maintain as per management plan provided by plumber. 2. AN se[badt requirements must be maintained ag per- -a sys&m aad sabmit to the C ..n y ealy on paper aot tess than a ltt a l l iacbes io size SBD -6398 (R. 01/07) Valid thru 01/09 9 Mwo Mgt$ra ;Ai AjxcPo,� AA i A a� 2 ,5 iF a 3 � ti• r_ i 1 �r 2E 7— i -/ON-; 0 aao Owner Michael Wickham Bench Mark Description Address: 2197 CTY TK C BENCHMARK Gty,State,Zip: NEW BM is located at the NW comer of BACKHOE PIT p RICHMOND, WI 54017 house bottom of siding AUG BORING p Drawn Sy: Calvin Powers ELEVATION o ELE Address: 1969185th Street ELE PIPE o City,State,Zp: New Richmond, WI 54017 O VENT PIPE • Phone. (715)246 5135 SCALE 1 �' WELL C(l here to uninck PDP :Kit.NET Generated by PDFKit,NE'T { L? r2 -5 A . � ti• 0 r. V S- 7 — as ©5 1 - Owner Michael Wickham Bench Mark Description BENCHMARK Address: 2197 CN TK C BM is located at the NW comer of BACKHOE PIT p City,State,Zip: NEW RICHMOND, W154017 house bottom of siding AUG BORING p Drawn By: Calvin Powers ELEVATION a Address: 1969185th Street o OBS PIPE o City,State,Zip: New Richmond, WI 54017 VENT PIPE • Phone: (715)246 -5135 SCALE: 1•_ D'r WELL Cffrk here ro !!niori< I __ Generated by PDFKit.NET Evaluation Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of . Division` of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County SAINT CROIX Attacj complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 038- 1154 -10 percent slope, scale or dimensions, north arrow, and locati0 distance to nearest road. please print all information. Revie d by Dat Personal information you provide may be u for ( Law, s. 15. f Property Owner Location Michael Wickham Govt. Lot NW 1/4 NW 1/4 S 13 T 31 N R 18 E (or) W Property Owner's Mailing Address Z0 Lot # I Blo& # I Subd. Name or CSM# 2197 CTY TK C 1 N/A PRAIRIE RICH SUB Sr A City State Zip ode Pho b�tTY (� City (' Village (: Town Nearest Road NEW RICHMOND WI 5401 248 -7423 STAR PRAIRIE CTY RD C & 220 AVE (' New Construction Use: (? Residential / Number of bedrooms 4 Code derived design flow rate 600.00 GPD Replacement C Public or commercial - Describe: Parent material PITTED OUTWASH Flood Plain elevation if applicable N/A {f(. General comments and recommendations: F 1 Boring # C Boring g C pit Ground surface elev. 9 480 ft Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fb in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR3/3 sI 2msbk mfr cs 2f 0.6 1 2 8-26 10YR4/6 sI 2msbk mfr cs 1f 0.6 1 3 26-44 10YR5/6 Is 1 msbk mvfr cs 0.7 t6 4 44-130 10YR6/6 s Omgr ml 0.7 1.6 �3 Comments: 2 1 Boring # C Boring (*— Pit Ground surface elev. ft. Depth to limiting factor 125 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR3/3 sI 2msbk mfr cw 2f 0.6 1 2 6 10YR4/4 / sil 2msbk mfr cw 2vff 0.6 0.8 3 20-32 10YR4/6 Tel, 1 sI 2msbk mfr cw if 0.6 1 4 32 10YR5/6 Is 1 msg mvfr cw 0.7 1.6 5 45-125 10YR6 /8 ?,' s Omgr mI 0.7 1.6 Comments: * Effluent #1 = BOD r > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) &ignature CST Number Calvin Powers 4 ,, ,�� 220537 Address Date Evaluation Conducted Telephone Number 1969 185th Street, New Richmond, WI 54017 1/11/2007 (715)246 -5135 Clic fiere to MOCK I . SBD -8330 (R07 /00) Generated by PDFKit.NET Evaluation Property Owner Michael Wickham Parcel ID # 038 - 1154 -10 Page 2 of M in C, Boring Boring # (, p ft Ground surface elev. ft. Depth to limiting factor 25 . Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 - 8 1 OYR3 /2 $l 2msbk mfr cw 2f 0.6 1 2 8-20 7.5YR4/4 sl 2msbk mfr cw 1f 0.6 1 3 20-32 7.5YR5/4 Is 1 msbk mvfr cw 0.7 1.6 4 32-125 10YR6/8 s Omgr ml 0.7 1.6 n rJ •� . Comments: F-1 C� Boring Boring # Ground surface elev. ft. Depth to limiting factor in. (' pit 9 Soil Apelication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 "Eft#2 Comments: Boring # C' Boring (' pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Comments: * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5 < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SB"33arest (0.07/00) Click here to unlock PDFKit.NET Generated by PDFKit.NET Evaluation E ck l r 1 Q V c' Owner. Michael Wickham Bench Mark Description BENCHMARK A Address: 2197 CTY TK C BM is located at the NW comer of BACKHOE PIT p City,State,Zip: NEW RICHMOND, WI 54017 house bottom of siding AUG BORING a Drawn By: Calvin Powers ELEVATION e Address: 1969185th Street OBS PIPE o City,State,Zip: New Richmond, WI 54017 VENT PIPE • Phone: (715)246 -5135 SCA LE: ^ ' WELL Click here to unlock PDFKit.NET h rl S h RR dF; PRAIRIE RICH A SUBDIVISION OCATtblk THE NW 114 OF THE NW I/4 OF SECTION 13, T 31N, R 18'W, TOWN` OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN dl. rzA,iiNES 4EFLN4fxEp i +'>+E - _ fEsi Nw£'::: {i THE 19 4 SEC x3iv,plGw EA55Y1PF v RF Ni R'N! - SS Al ' H015 1 0, to � a1N,ar srA .., bltCf EJkO .. s fN a7 sY F b75 4f Y; alrrt �: rw n,.�, c LOCATION SKETCk' I IE �"9I S n i Vr otpuxm ta,� I. �' a..x I I 1 , S w a ;a y f , m 4(a e I ^ �yY i•44 ppgVd 1 1:tF ^.n FNE C SMAFFEF, 4 {CISTfNfG LANG S.>RYIEYUO, HEREBX EEATEY 'HA' IN VD �:•• �' - -: AfI„yC€ # TH THE PROV 135 OF CHAPTER'. 23S OF TiE W40SIN StATWTE5. He °.JBC VIM RECa1LAT'QNS Ox TIE TORN OF STAR FRAIRtII MIR THE r I" �a w� OCT% f� OL HA.REIN, OWNER Df SAID LMI I HAVE MIMIC% DIMID AND S AMID MANI R%H 741 SLw FLAT MECTLY REPRESENTS ALL UTIMIR t17°JN�WNES AN'O'THE SOELH#ISO OF T}E LAND SORVEXEG, AND 'Hbx TlHS LAW IS t i6wE@BtsSE'wt;14 #' THE Nwo JK SFCTV,l rM" R06 T60OFETAR: FRAM E,ST CROIX pUHTt N Sf6t455 , T0• N4TI KING AT AT THE" tORMER OF SAO SECTO 13, ALSO BEING THE POINT ,a _9EG11NdIG THEW SBDDiw35''E -A.ON6 THE 319RTH LINE OF $A?D RGTNAt l3,T ^ c •• f �i. -_ z' KIT ?327 FEET, IryENt! SCO'Ofld3 N, b3t045 FEET, THENEE M- EA�OT =51 w,I , 1 s ar s s st vex9 MR FEE:, TKE Ht IMT 51 •••ACE 6,90 FEET, THE14 N S8+•4T:5F' w, $I:OS FEEL, k dH a ANY • �,,�, e " rc NORTSF,4601# PEST, TNEKE N GG' $0,15 FEET t0 THE NEST an e Tit 19 Y[NYi NI01e F� CI a..h.. i . ..,,u 'w:O L+AE OF Ti£ Nww OF M SEMON E3; NQRTH ALONG THE $T 4 DF _ I T4E SA10 Nf vc 3050'FEEt TONNE nwir OF 6EA4v m Ino y G. SN - 9EGISTEPEO LARD SON1EXlY1 'Y`' Y h i S•1325 ;YNt Ss w; Jr E - 9ATE0 THIS -11—c Y or OCTWR, 1977 IY, 1 4 1 4 _ REVSFM T,s S14 UY V � 'OE.EtABFR, 1471 Y i OL I It - �.56M I `Ir r I i wRlWiE +'M,4rS � � 21" A - 1 y y rl y 1F; 1k, V r 1 ebr.ar.arr sit of !. , - TMS Rz84HlI�NT 1145 C6AFT® i1' Cm.1t�.k.:91,,,�_ _ .r�. � i� 4 • c EZ1203H TTf OTf♦ .♦y• •', S % °` ••, •• • ♦OTT 9TT IV Iry PPTO♦ � t• •' $� •TTTTf9T Tv •• ' } ,•• vTTTPf9 VV L `r� '�"�_ •.'yMr r�tt�� ffT4VVV '111 i V v V " TTT ti • K T . TTT vv ti vv• A i •- QPT 4.625'' vvT vvv TPw vvi 1 tt 1/2 Circ. = 18.84" vvs sTV vvv ♦vv 9VIP v9T VQ Ovvvvvvvvvv' vvVV7T4 �ffTPV P vTV VP V TVVVVT vv qv" TTTTVTV P 'WV PVVvv 99 VTT9VV9TTw 9.VTV9VF VvTTT4VT9 VV Vv Vvvwrv- 2 4it ® Bottom 36 Veil Volume 12 -1/2" DIA. (typ.) Soil interfareArm Void C -fr=iM in Aggregate given at 57.4%. a�4 1 Sidewall (2 Sidawails) 2 } 1 a'"n O.D. of 4" pipe < 4.625 inches t tin o 3.14 ( 23t z5:t }= 1fr -0.117 fe Bottom !R Void volume per!'rtrwr ft = 3.14 • 1 . 12ia / ft 2.00 O.D. of camercytinder -T2.5 inches Total Soft Interface Area S.14 SQ.FT Void volume in aggregate of center cylinder = 3.14 w 4.25in _ } 14 y ( 2.3lMin ), 1'� { Ct2in�ft� 12m 1.514s.423tY O-D, of Outside cylinders= 12 inches Projected Trench Area Void volume in outside cylinders - 2 - 3, t 6m -574-.901 Sidewall Height = 12 in. '2 = 2.00 Sq.Ft, ' 1 tin i ft, * fN Bottom = 36 in. = 3,00 Sq.Ft. Void volume at bottom between cylinders s 162inift 2oai • (inn Got t2in/frjJ P 1 1 °0.215 it' Projected Area - 5.005 .Ft. 12mtft ) q Void volume at Outside bottom earners (1/2 of void volume between cylinders) 0.215 1 2 -0.108 f Total void volume = 0.117 + 0. 422 + 0.90! + 0.215 + 0, t 08 = 1.763 cubic ft I ft Gallons per ft = 1.763 X 7.48 a 13.2 sallons r►er ilnear !t 3 to X l 0� = ISO EPS Aggregate Trench System EZ7203H Z ow Ring'-lndustrial Group 65 industrial Park Rd. Oakland, TN 18060 SCAtE FU to tZ12G3H -va1. SHEEP 1 of t 11-27-01 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l I I i r Mailing Address _a I I ? "I 0 jC Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number b 3g -11 S LEGAL DESCRIPTION Property Location 10 W '/4 , N U) '/ , Sec. 13 , T 2) _N Rj�'LW, Town of _S4 g , Q Subdivision -- eCa,`, % Q k4 S L , Lot # 0 Certified Survey Map # , Volume , Page # Warranty Deed # Loo L4 I s 7 , Volume ) t-[ , Page # !�4 9� . Spec house yes Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a waster 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. I/we, the undersigned have read the above its 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a warranty deal recorded in Register of Deeds Office. Number of bedrotims _ SIGNATURE OF APPLICANTS) 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. 08/05 POVWTS OWNER'S MANUAL & MANAGEMENT PLAN Pew � of FILE Septic Owner. permit # Tank Capacity al D NA Septic Tank Manufacturer LO c . P � D NA Number of. Bedrooms D:AfA. Fa D NA Maniftaturer Number of Public Fir Units D NA nk C_apadty D NA Estimated flaw (average) 00 ank Manufacturer DNA Design flow {peaks. (Estimated x 1.5) ©O aUd Pump Ma D NA 5a7 AppNcat(on Rail fle Pump Model - D NA Standard :Influent/Effloont Quality Monthly average* Pretrasurant Unit D NA Fats. Oil & Grease (FOG) 530 mg/L D Sand/Gravel Filter D Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L O NA D Mechanical Aeration D Wetland Total Suspended Solids rMS) 5160 r*ntifi- ❑ Disinfection D Other: Pretreated Effluent Quality Mouathty average &eNlc fl NA Biochemical Oxygen Demand (BODE,} S30 mg/L Ain - !around lgr�t.Y) E3 in-Ground (pressurized) TOW Steed Solids (I ' 530` rgWL D NA C7 At -Grade ❑ Mowed Fecal ColiMorm,(geometric, mean) - 510 cfu /100 D Grip -Line D Maximum Effluent Particle Size Y in die. © NA 00 0 - NA Other. D NA _ Other. ❑ NA 'Values typical for domestic wastewater wW septic tank effittem Other: D NA iA1110'E lt.1= 3S"Wice: event Setnrice hmpeat chit on of tarik(s) At least once every; El � WAW16mm 3 Years) DNA ta Pump out cents of tanks) When combined sludge and scum equals one-third NJ of tank volume DNA Inspect dispersal cell(s) At feast once '' Cl manth(s) Carts) � 3 years) D NA Cleats e�ffhtent finer : At (east once every: D ! (ss O NA i )- ` s Inspect pump, pump controls &alarm At least once every; 13 a (s} DNA Flush laterals and pressure test n D month(ss C) -NA At mast once every. Other 13 .At few opoo everp: D !E03 NA MAIRITEXANCE NYSTR)CTWNS lospections of tanks and dispersal cells shall be made by an individual carrying one of the following kcenses or certifications. Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector POWTS Maintainer, - Septage g Operator. Tank inspections muss include a visaed _ ktspection of the tank(s) to .i 1entIf V any missing or broken hardware, Identify any cracks or leaks. measure the volnrne of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 0e11(s1 shall be visually mWepted xo the ell rent ievale in the vbsOrvatibn Am and to check for any pondin8 of effhrent on the ground surface. The pending of effluent on the ground surface . may indicate a fairing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals ono-third (Y or more of ' the tank volume, the entire contents of the tank shall be removed by a Septagg Servicing ,Operator and disposed .of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services. including but not limited to the servicing at effluent filters, mechanical or pressurized componente, prea units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shaft be provided to the #Dees regulatory authority within 1O days of completion of any service event. START up AND OpERATM For new con s t ruct i on, prior. to use of the POWTS check irOOMNi[nt tanks) for the that may a the tent process andlor of DamtinA Products of W , _ of the tank(s) removed by a swVIcbV ' prior to darrretfa the t U99. ce sl. [# higfn ooncentratlons are detected have co ats o use. olntents System start up shaft not occur when sole 001 are, frozen at the infiltrative surface. During power autases pump taunts nway fill above none of er fevers. When discharged to the cepld).in one power is restored the excess.wall water uAll be the e (twit. To avoid this situation the ctontsnt8 tsl and may reennit in the backup or. sulfate drseAarge of Power to the effluent Pump or c a' or POWTS tank removed by a Septage Servicing Operator prior to M�ntainer assist in manually operating tine ie restore normul levels withi the pump tank. In to Do ' area not drive or park vehicles over tanks and disperse cells. Do not drive or within 15 feet down slope of any mound or st-g ade soil . park over, car otherwise disturb or compact the area . Realuct+on or ellmination of the following from the waste+nrater MOM may Improve the perform mace and prig the fife of the POWTS: andbiotics; baby wipes. cigarette butts; co roti: m. a ten R 1 swabs; degreasers; der" floss; diapers; disirdecte f0lx ion drain (sump pump) water; fruit and vegetable peelings, one;. > fi Pig l�ducts. �: meet scraps; medications; oil; �% sal+ := tarrrparrs; aril water softener�brine. ABANDONMENT When the POWTS fa" andlor is permanently taken am of service the foE mft peps shall be taken to insure that the system is P "w#V and safety abandoned in compliance with chapter Comm 83.33, Wisconsin A hs Codes • AN Piping to tanks and pits shop be discormected and the abandoned Pipe openkVs sealed. • The contents of all tanks and pits shaft be moved and properly disposed of by a SeptaW Servicing Operator, • After pumping, all tanks and pits shag .be excavated and removed or their covers removed and the Void specs fitted with sail gravel or another kWWt solid material. CONTINGENCY PLAN If the POWTS fads and Cannot be repaked the fbWWNV messwes have been. replacement system of must be taken, .to provide a Cade compliant _ A Misoerrrent area, has been avainxeted and may be utirtzed for the location of a replacenuot s oil absorption system. The replacement area mould be protected from disturbance end cs� and shiould =Cbrr d upon by from mW proposed stye, lot lines and wells. Fa ure to prolon t arc area will result in the need for a new soil and aite. evaluation 4o establish a s�bte-�t . pram comply with the mules in effect at that tine. A suitable replacement area Is not available due. to setback and/or sob limitations. Barwfrrg advanoes in POWTS tgy a hokng tank may be installed Tas a last resort to replace Una failed POWfS. Q The site has not been evaluated, to klantify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perfornned "' karate a suitable reptacemsnt area. if no repiaeerrneht area is awl a ftoldittg tank may be Installed as a fast r�eaort -to replace the failed POWTS. ❑ Mound and st -grade 8011 abeorp W systems may be reconstructed in piece fowling removal of the bloneai at the Infiltrative surface. Reds of such systems must comply with the rules in effect at that tune. SITYM W AND- OTHER TREA'i MW TALCS MAY CONTAIN LETHAL GAWW ANDIOR B �IYT OXYGEN. DO NOT 111 M A SEP M, PUMP OR Mr TW MEIIIT TANK I ANY ANL:ES. DEATH MAY RESU RESC D OF P IMSON 17tOM THE R OF A TANK MAY BE D .T OR �. ADDIT11NAL C lM6TALLEIt ptiW=4 A N �� ` M. None: Phone t S f Phone �raetE TOe � LOCAL R�R,ATonY A Name Name Phone � n . n p1hone -7 1-S has do0m"W t was drafWd in corrwiianoe %*h etWrtW Comm 83.?. 2 Xb)(t)(d18M and' "83.54(1), (2) & (3). WWWndn AdrMhbuative Code. ' - - —• -,.... v�cnN r rvn For new constructim. Pct 2 use of the POWTS Check Pegs of h nay impede the the eloper tank(s) for the Presence at painting products o?he;_.chemtcats that treatment Pct and/or Of the tank(s) rtrmioved.by a g operator prior to use. + u ce sl. tf high concentrations are detected have the coletohts SYstere start up shag not occur when soil s are frozen at the infihreave surface. Dig power outages discharged Pump tanks may fill above normal highwater levels. When Power is restored the excess WesEewater w111 be . to the disperso Cell {a! - in one age -don, oyerbading the �(sl and may result lo the backup or. sure discharge of effluent. To avoid this situation have the contents of the Pump tarok removed by a SePtage Servic` O Power to the effluent Pump or contact a or POWTS M�tamer to assist in m9 Palatal prior m "restoring. restore normal levels within the Pure tank, manually operating the 1 ►P controls to Do not drive or park vehicift Over tanks and d tregs. Do not drive or ark over, or otherwise tiisiturb or can pa within 15 feet down slope f art P w. Nee area. Pe Y ir�otmd or at -grade soil. absorpii� yea. - Reduction or elimination of the following from the Wastewatw stream may Improve the performance and POWTS_ �; prolong .the fife of the inundation drain ;n baby w�' cigarette butts; swabs; degreasers; dental floss; des: diakefectents; fat;. mP PUMP! water, fruit and vegetable .:Peace: - grease; herbicides;: meat swaps; medications; oil; Pig Products; Pesticides; sanitary nspkirm and water softener trine. ABANDONMBff When t aced PO fait and/or is Penance vdv taken out of service the followifeg. steps shall be taken to aesnure that the system Is safely abandoned in canPgantre GIWWW Corhrn 83.33, Wiaconsin Admin e All Piping to tanks and pits shag be disconnected and the abandoned pipe openings aeaNd. e The cOnMM of all tanks and Pits shag be removed and properly disposed of by a Septage Sore rg Operator. e After pumping, , ag all tuft aced Pits shall -be excavated aid removed or thek covers removed and the void spoon felled with s, gravel or aother inert solid material. CC - -FVWGEMCY PLAN If the POWTS fella and cannot be repaired the following measures have been, or .must be taken, .to Provide a code compliant replocerr OM system: sedlalHe teplacerreeni area has been evaluated and may, be utilized for the location of a absorption system. The repiscemmt area should be protected from disturbance vex# and and s for a shwa bb Moen by result setbacks from and pr o p osed - ft. eval stir . 1 W, lot tines and wel. Fadttre to Prey ' went area will fit in the meet! reeve a* ite. morn m establish a stdtabie replacxmrent area, _ Repiqalorient systems must corphr with the rules in effect at that time. 13 A suitable replacement area is not available due. to setback and/or soli limitations. Furring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. L7 The site has not been evaluated._ to identify a suitable replacer neat area. Upon failure of the POWTS a soil and site � i evaleon must be performed to locate a Suit" replacement area. If no replacement area is available a holding tank may be mad as a last resort -to replace the failed POWTS. !7 Mound and atipade soil al loon systems may be reconstruots a place foamNing removal at the bkxltar at the Infiltrative surface. Recosestructiotes of such :systmns must comply with the rules in effect at that time. < <wANle> > arm. PURR AND OTHw THEAT TANKS MAY CONTAIN LETiiAi. GASSIiS ANDJOR � OXYt3ENi. 00 NOT ®ITL�i A MM. AIABP OR OTl . TAtl;A 7NENtT TANK tAl ANY MAMMOrAMMS. DEATIf NAY IiEBum RESCUE OF A VBMM FILM THE WTMM OF A TANK MAY BE D FACULT OR 1IMPOSSIBLE. ADDIT MIAL C, sOMTS OBTAUSt PEiWIStM�TAiNt&R. Name �u ` Name PEnoree l S / E hone �'TAGE NI g O>°�ATOR AY ! LOCAL lBfiM"TOW Alf! HOtiITY_ Nacre Name Phoi,e 7Is his doceateant was drafted In carepliance with deaptae Coentn.l 22 (2)(b)( ?)(d) &(fl and`83.54tt),' (2) & 13i. WW=mfn Administrative Code. 4'l'i. 1430n u 491 6 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLE OF DEEDS ocurnent Number I DEED ST. CROIX CO., WI This Deed, made between Keith E Brown and Gloria J. Brown, RECEIVED FOR RECORD husband and wife 06 -0E -1999 10:15 All Grantor, conveys and warrants to Michael W. Wickham and WARRANTY DEED Jodi R. Wickham husband and wife CERT COPY FEE: COPY FEE: TRANSFER FEE: 385.50 Grantee. RECORDING FEE: 10.00 PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address First National Bank of New Richmon PO Box C New Richmond, WI 5 038- 1154 -10 Parcel Identification Number (PIN) This is homestead property. Lot 1, Prairie Rich in the Town of Star Prairie. Part of Lot 2, Prairie Rich in the Town of Star Prairie described as follows: Beginning at the SW corner of said Lot 2; thence S89 07'38 E along the Sly line of said Lot 2, 15.00 feet; thence N04° 17'02 "W, 200.79 feet to a point on the W line of said Lot 2; thence S along the W line of said Lot 2, 200.00 feet to the point of beginning. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2�'� day of May, 1999. * Ke h E. Brown * Gloria J. Brown —o- * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Keith E. Brown and Gloria J. Brown husband and STATE OF WISCONSIN ) Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /��f �/ d TOWNSHIP �7ah ' -�u iri e SEC. T -?/ N -R W ADDRESS �� ST. CROIX COUNTY, WISCONSIN r / SUBDIVISION LOT LOT SIZE 122 U• �� PLAN VIEW Distances and dimensions to meet requirements of IIHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C o _ GG L � 3 60 /17 _ ba �0 a E T / l lT C,5 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used d em o �" kh, 4Ow - ��fj /�Z -ten. Elevation of vertical reference point: /� / Proposed slop at site: D S/ SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: �_ Tank manhole cover elevation: � "Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: '( Side,0 Rear, O feet From nearest propert line Front,QSide,ORear,O _ feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I - - t PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: Lenth: / Number of Lines: -.^I Area Built: bs? Fill depth to top of pipe: l � Number of feet from nearest property line: Front, Side, O Rear, 0IFt. ^ Number of feet from well: Alt Number of feet from building: (Includ distances on plot plan). �� SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: / Dated: q Plumber on job: /? 'Z22 6 License Number: `��� ✓`3l 3/84:mj t DEPAWTMENT OF INSPECTION REPORT FOR SAFETY & BUILDINGS ON I LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMB DIVIS P.O. BOX 7969 MADISON, WI 53707 � p - pI _ N(U %,N W4- ,S13,T31N -R18W U CONVENTIONAL ❑ALTERNATIVE State Planl.D.Number III assigned) Town o4 StaA PAa xie ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound County Road C NAME Of PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: Keith & GtoAia Bt own 235 W. 3Ad Sttceet New Richmond WIT 54 17 f - o� L3 g� � �U BENCH MARK (Permanent reference poml) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber: MP /MPRSW No.'. CoumV: Samtary Permit Number: I SUAcin Bad J�il i 1 St. CAoix 1127 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. T OUTLET ELEV.. WARNING LAB L LOCKING COVER t(4V PROVIDED: PROVIDED. YES ONO DYES 5QN0 BEDDING'. VENT DIA.: VENT MATE: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. (VENT TO FRESH �� T // ALARM FEET FROM �r� LINE ' ` AIR INLET OYES MNO fl I CX ❑YES ONO NEAREST d 0 . DOSING CHAMBER: MANUFACTURER BEDOING : LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO YE O [:]YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PROPER7v W LL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER ERI A D MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH I N OF DISTR. PIPE SPACING COVER ENBER INSIDE IA -PITS - J ILIOUID BED /TRENCH TRENCHES 1 MATERIA DEPTH DIMENSIONS �� GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. ST R WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEEV. ELE END. /y) PIPE LINE AIR INLET fl 6t i� r� M — }�' MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1 NO SOIL COVER TEXTURE PERMANENT MARKERS I OBSERVATION V11111 ❑YES 1:1 NO 1:1 YES ❑NO DEPTH OVER TRENCH'BED J OEPTH OVER TRENCH /BED [7PSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ONO ❑YES ❑NO ❑YES ON PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MATERIAL I ND DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA. ELEV, PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING GRILLED CORRECTLY COVER MATERIAL VERTI LIFT CORRESPONDS TO APPROVED EYES ONO 1:1 YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: 2 (� DYES ONO 1 DYES 1:1 NO NEAREST F � � Sketch System on ` Retain in county file for audit. Reverse Side. TITLE 7 GNA E Zoning Admi DILHR SBD 6710 (R. 01/82) =&, H�R SANITARY PERMIT APPLICATION COUNTY I n accord with ILHR 83.05, Wis. Adm. Code 5 ' STATE SANITARY PERMIT /,9 2 — Attach complete plans (to the county copy only) for the system on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES o PROPERT OWN PROPERTY LOCATION 0I'7cc /4 /a, T,�r/,N,R E(o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SU IVISION NAME Ysr X c STE , ZIP CODE PHONE NUMBER 77 IT 1 ARE ROA KE OR LANDMARK 71 LVI�' b . VILLAGE :5jr'c! II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ECblic (Specify): 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable) 1. a. XNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. Xonventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. XSeepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3, ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): �( (f� < ✓ �• Feet .+�1 Private ❑ Joint ❑Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumb 's Name (Print): Plumber' nature: (No Sta s) w MP /MPRSW No.: Business Phone Number: Plu er's dress (Street, City, S e, Zip Cod : o p , C _ Name of Designer: VIII. SOIL TES NFORMATION Certified Soil ter (CST) Name CST # CST's ADD S (Street, City, State, Zip Code) Phone Number: IX. OUNTY EPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issui g Agent Signature (No Stamps) Approved ❑ Owner Given Initial r1 „ Sqrshaarg Fee Adverse Determination GGJ o �� F 010J 7�Q0 WN" 19,2 X. COMMENTS /REASONS FOR DISAP ROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) shc.:ld be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have cl concerning yor private sewage system, contact your local code administrator or the, State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. T complete n To be comp,..t. and accurate this sanitary permit app�icat on must include: 1 Property owner';, name and mailing address Provide: the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; Vi. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection aaw. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco irl`a a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasurQ is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. 0 The monies collected. through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground - f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (8.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractpr,,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property V�Ir 4 2W Location of Property _6LI&L _ It, Section — , T A g - It W Township Mailing Address ;3 S VY - r �c L� mp w 1 54oc 7 Subdivision Name Lot Number I • . Previous Owner of Property _ ' G ' ndkrioW A L- &AijIC- or-- lk w 9jd iIMbVt 0 i Total Size of Parcel 1:15 X 2 Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes .1 �.._" No Volume 3 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warrant M 2. Land Contract •�. 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to.avoid delays of the reviewing process. If the deed description references to a Certified Survey' Map, the the Certified Survey Map shall also be required. I--------------------- ------------------•----- PROPEOWNER CERTIFICATION ATION 1 (We) eeAti.6y that aet atatementa on thiA 6onm an.e true to the beat 06 my (OUA) knowledge; that 1 (we) am (ane) the owner. ! a) o6 the pnopent y des cA i..bed in this 16onmation 6onm, by v ttue o6 a wattanty deed recorded in the 066"iee o6 the County RegiAteA o 6 Deeds as Document No. 4"!2 4 4o ; and that I (we) pnea entty own the pro poa ed A to bo the a iwag�poa dZ 6 yatem (o I e) have obtained an easement, to nun with the above de cA i,bed ptopen ty, 6 on the Bona tAuct ion o6 s a.i.d s ys tem , and the same h as been duty recorded in the 0 6 6.i ee o6 the County Reg.isteK 06 Deeds, ae Document No. 4 -34407, ) . SIGNATURE OF OWNER SIGNATU OF -O W6 (IF APPLICABLE) DATE SIGNED DATE IGNE r DOCUMENT N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA Y �® STATE BAR OF WISCONSIN FORM 2 —1982 i REGISTER'S OFFICE �0 r-v 06 ST . CROIX CO. WI Recd for Record ' First National Bank of New Richmond Richmond,___ .. Feb. 10, 1988 -• ----------- ----------------------- --- -- •- •• ----------- .------------ Wisconsin a t 8:30 AM -- - - - -• -• ----------•---------------•--•••-------....---•-------------•------...--------......------•---------- -- -- -- - -- - - - -• -- ..... .. .. - . . - - -- - -- •. - .. .. . . . -- •----- - - .. - -- ........... ` Register of Ue,:ds conveys and warrants to .Kelt...... -- B . rL7WI1 _ a11d Gloria . . J. Brown, - husband -- and - w fe�._as_.m�C t l - gxope> ty,-- czith..rig ."- °f - - -... su I, i�toxSbip.................................................. ............ ......................... .......... _----------------------------------------------- ----------------- - - - - -• .._... _ ..................................._............--------•---...__.---....---. _............._..._...... -_.... ......... . ....................... ............ ........................................... ......................... RETURN TO First National Bank - --- -------------•------------ •----------- ......... -• ------- •-- •---- •---- - - -• -- New Richmond, WI 54017 -----...-----------------••------•---------•---•-•------••-•-------•-------------..........------- the following described real estate in . .St....Croix .................. ..........County, State of Wisconsin: Tax Parcel No: .............................. Lot One (1) Prairie Rich Addition to the Town of Star Prairie, located in the Northwest Quarter of the Northwest Quarter (NW; of NA), Section Thirteen (13), Township Thirty -arse (31) North, Range Eighteen (18) West. This deed is executed solely for the purpose of correcting the description contained in a prior deed between the parties hereof dated May 23, 1986, recorded May 29, 1986, in Volume "741", page 389, as Document No. 412603. EXEMPT" This . -. 1S- nOt...-- ...._.. homestead property. (is) (is not) Exception to warranties: Dated this 5th- - -- day of ........ 19 ... $$.. I NEW RI yL- P/L�{ �. .(SEAL) ............... (SEAL) aa>aes- •E_- -Shera , -_Vises .President ;1�'l•��!'��1'Zs�t/f 1 -- - - -- (SEAL) . -- - --. (SEAL) AND James..G,.- Heel�???c� Vice__P..scnt ....... ..... .. AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................................................ STATE OF WISCONSIN 38. --------------------•--------------------......----------------------- •--- - - - - -• St. -- - Croix ` - ----- --- -- ----- --- --------- - - - - -- County. authenticated this ........ day of ........................... 19 ...... Personally came before me this ........th.....day of Eeb r ua y ___ ______ ___ _____ ___ _____ 19.88... the above named ..------•---------------•---------•--------•-•--•--- ....._••- ••...-- •--- •••• - - -- Jw) a5..F.._.Shexac: k.- and._Sames..G..._Heebink-F.... '-------------------------------•-----....---------- •--- ••-- ••---- •---- •• - -•• -. to.m.knQwn- .to..be __Vice- .Presidents..of -------- TITLE: MEMBER STATE BAR OF WISCONSIN the _ First_ Nationai _- BMk_.Qf..NeW..Ei__ChTIl rKL (If not, ........................................................... authorized by § 706.06, Wis. Stats.) to me known to be the person S. who executed the foregoin st ument and ackno edge the same. THIS INSTRUMENT WAS DRAFTED BY Reinstra, Van Dyk & Needham, S.C. ----- - - - - -- ". °��� "-� ----------- ------ Aftoi7ieys " af' 7�aw-----------•---. ...---- ••......- ••------- - -• - -- I= Carrie Hanson — ------------ - c�------- - - - - -- ---------- - - - - -- -- •- - - - - -- N e w - klisccnsin. -- .58017 0127_._....... Notiary: 31�c ..St._ - Croix ----- County, Wig. (Signatures may be authenticated or acknowledged. Both 1 VIv siq'b' is permanent. (If not, state expiration are not necessary.) da e�;.: 1! j-.- 21---------------------------------- ----- 19 89..) •Names of Demons si¢nin¢ in any capacity should be typed or printed below their si¢natur @e:" STATE BAR OF WISCONSIN itCMillarConpuy� FORM No. s -- 1982 Stock No. 13002 rx..wn. wus..m cn H . a STC - 105 r SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County x t � OWNER/BUYER W A - o omd 6g (moo 21 S • 1�) V - o N" rn ROUTE /BOX NUMBER 3Y� S +. Fire Number CITY /STATE J &w _ Z EP � � PROPERTY LOCATION: NW k, aVV k, Section T N, R W, Town of '5TA St. Croix County, Subdivision 41y& 4teJt 4" O� l Lot' numbe • I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents m_ y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if•nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned Co the St. Croix County Zoning Office within 30 days of the three year expiration date. _� S I C N E D� �-^- � r , DATE St. Croix County Zoning Office P.O. Box 96 Hammond, WI 54015 715 -796 -2239 or 715- 425 -8363 Sign, date and return to above address. DEPARTMENT OF RE PORT ON SOIL B AN D SAFETY & BUILDINGS INDUSTRY, - _ s ____._ __ C DIVISION BOX 7 LABO9 AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: 1 SECTION: TOWNSHIP UNICIPALITY: ] LOT NO.:BLK. NO.: SUB IVISION NAME: cJ '/4 +J �/ ?j /T N /R/fE (o Q r r COUNTY: WNER'S B ER'S NAME: MAILING ADDRESS: 5 .cror`X `6cc)H 3J' w r 5 2 r<J /ec USE DATES OBSERVATIONS ADE 6 NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: EFI OLA ION TESTS: esidence 3 „� New ❑Replace _ .7 RATING: S= Site suitable for system U= Site unsuitable for system H D CONVENTIONAL: MOUND: IN- GROUND- IN- FILLOLDING TANK: RECOMMENDED SYSTEM: (opt' 1) ❑ NS U ❑ $ u $ ❑U T OS [:]S U required DESIGN RATE:, If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: !/!f" Floodplain, indicate Floodplain elevation: If Percolation Tests are NOT O PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B l o .4/0 Z a ZZ6 B- oil B- p 0 Of o-- iG� /mss, /1F Ile B- ��� PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER Wt9ft5 AFTER SWELLING INTERVAL -MIN. PERT D 1 PERIOD 2 PERID D PER INCH P_ C O 4 .2 P- P- P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION & y� 3oo. 37 C_ it /fic 05 /gre,�,. / v -3 4eV,,47 IN A 17 �J� , /J0 L o- 4 I, the un ersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administ ative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ONE/ ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): d Goa' oo 7 2Z2' 9 -� <�� CST SIGN RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 116 a SBD — 6596 , To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must c:li:.arly indicate; whether this is a residence or commercial Project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a nevv or replacement system: 3. Cornplew the 5uitaiaility rating boxes..A SITE 1S SUITABLE FOR A HOLDING TANK ONLY 'F ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6, PLEASE U.Se, the abbreviatitans shown here for" writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make. sure your henchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, 1€ the information (such as flood plain, elevation) does not apply, palace N.A. in the appropriate box; 11. Sign the form and plane your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 39 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR -. Bedrock cot) — Cobble (3 - 10 ") SS — Sandstone cis" — Gravel (under 3 ") LS - Limestone * s Sand HGW — High Groundwater cs Coarse Sand Perc — Percolation Rate need s — Medium Sand W — Well fs - Fine Sand Bldg — Building Is — Loamy Sand > Greater Than sl Sandy Loam < — Less Than 'I Loam Bn — Brown sil Silt Loam BI - Black si _— Silt Gy — Gray "cl — Clay Loam Y ...... Yellow scl Sandy Clay Loam R — Red sicl — Silty Clay Loam mot Mottles Sc Sandy Clay wr. — with sic — Silty Clay fff -.... few, fine, - faint 'c Clay cc — common, coarse pt — Peat nam — Many, medium m —. Muck d — distinct I) — prominent HWL — High water level, Six general soil textures surface waste" for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report its the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. l PLOT PLAN / PROJECT c���! vYarr� ADDRESSo Le,-&) f t� 1 /4 9/ 1/4/S/ N /R/ W TOWN ur //atL eCOUNTY MPRS Byron Bird Jr. 3318 DATE -- BEDROOM CLASS PERC_ CONVENTIONAI, I*GROUND P SSURE CONVENTIONAL LIFT_ MOUND_ HOLDPG TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE ' BED SIZE �✓ � Benchmark V.R.P. Assume Elevation 100' �� p Location of Benchmark c a & e ®�e * H.R.P. �- 0 Borehole Wel l Scale Feet O Perc Hole ;�`+ 6-� Syrem Elevation 3' TYPAR COVERING I 2" 12" 3' 4 6' © X 6" Sewer Rock 12' i v� d I 3 � Af o 51a,p e- ell / ?C6(5 ��7