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038-1191-70-000
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CD - 3 0 Q N CD 4 O 'O 7 O CA Q CD CD W I � o X03 a o 0 CD p W CD Q CD 00 O 0 N O A i CD q O b C) CD ti a 00'0 00'0 00'0 le;ol saBje43 4uenbullaa seBje43 leloadS s ;uewssessy IeloedS ;unowy AJOBa;eO opo3 IeloedS jasn :sleloadS :# 404e8 :a ;ea uolleoUI:peO 0 :;uno3 wleI3 : ;Ipaao A.la ; ;O"I 0 0 000'0 puelpooM 006'L06 006'9Z 000'L8 000'0 f4jadad IeJauaE) :9002 Jo; sle}ol 0 0 000'0 PUelpooM 006'LO1, 006'9Z 000' 1,9 000'0 A:padoJd lejeuaE) :9002 Jo; sie;ol ON 006'LOL 006'9Z 000'1.9 000'0 1,9 IVUN301S38 uoseaa eje ;s le;ol anojdwl pue-1 sway ssela uol ;dposaa VOOZ /£ 1,/01, :Pa6ue43 ;se muOl;slljeA 0 :411nn passassy :enleA p4jepll ile j :# Ilia Auvwwns 9002 woW OM £Z9/L9K 6K£1,9 6661,/Z0/1,L OV OOE /ELt L L5E171.9 666L/EZ /LL OM LE /5991, 17ML9 ZOOZ40310 00 SZS/L£LZ EZ£80L EOOZ /5020 edAl abed /IOA # ooa a ;ea :Ajo ;slH IaoJed :sa ;ON M8 L LE - 90 (ti/ L 09t b/ L Ot BUN :(s);oejl 8Od 013 i=I 9L SNIM01M1=15LN2i00 3S30N1=1009 :Bp18 Opuo3/31 T M ld 9L9 WOO 3S 3S Id M8 1,2] N M19 03S 3I8VIIVAV lON /N :1e1d 000'0 :sajoy :uol;dljosea Owl 011M OOL L dS 30VNVIN V 8VH8 3MVI MVfiOS 0508 dS ONOWHORi M3N Z96E OS NI NISVO 01 . uol;dljosaa # Isla odAl tiewiid = , :(se)sseippV A:pedoJd leloadS = dS I004 = OS mole ;s!a 1,0t OO N30I09 (181S31103Nld bLOEZ NOSOfIf V vuve ve V V2iV82iV8 'NOSOfIf - O jeumo- oO;uajino = 0 'aaumo juanno = p :(s)jaumO :ssajppy xel 0 00 edAl ;IwJad # ;ItuJad # uol ;eollddy easy sales # deW a ;ea leoliomi-i ale(] uol;eaja NISNOOSIM '.11Nf10O XIO2iO '1S � ;uejjnO M:11"d 2iV1S 30 NMO1 M 3951,'8 L' 1,£'80 :# lowed ' ;It/ L d0 L 3OVd wd CV90 900Z40i90 000 :# 1a3a8d Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420565 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal intormatioh 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: Smith, Mike I Star Prairie TownShi 038 - 1191 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer /D' 7• 2 7. 3 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet & 9 TANK TO P/L WELL tBL Vent to Air Intake ROAD Dt Inlet �- Septic Dt m Dosing Header /Man. Aeration Dist. Pipe a 2 g. ye.S Holding Bot. System [ 3 X15 Z PUMP /SIPHON INFORMATION Final Grade •� lam, 33 Manufacturer Demand St Cover pp Model Number TDH Lift oss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM_ BED/TRENCH Width 1 Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 fi O 1 / 1;�� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHIN nf2�t S INFORMATION Ty Of System: 3 0" � CHAMBER R I r 1 3 6 / / ,J DNI Model Number: DISTRIBUTION SYSTEM C Lzs,, Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Intake Pipe(s) Q l 1 ...- �- +� T�'�/ Length lY Dia Length O Dia 4 p ca g Jul / " SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 1 IV, 6 lut,f/ Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / i Bed/Trench Edges Topsoil ❑ Yes Dj No [] Yes [ No ANTS: (Include code discrepencies, persons present, etc.) Inspection #1:_c)�/ / 0 / inspection #2: ' Ave New Richmond, WI 54017 (NW 1/4 SW 1!413 T31 N R18W) Northga a ll-ot 38 Parcel No: 13.31.18.987 <T' WV6p rK6 rq & y c d.d.e C( 4_ - �d t�,►�ac — C6�s �- Soc:Q y -ID J� — hPA/ie e�cCsW albv1do 10 �unKj Yes No (OL �� -- - - - - - -- ` -I Information. � _ _ _ _ -� - - - -' Date Insepctor's Sig ature Cert. No. f Safety and Buildings Division qty m a. 201 W. Washington Ave., P.O. Box 7162 IsClansin Madison, WI 53707 - 7162 Site Address /-A 'Dep artment of Commerce -Za - 3 �/U 3 Z_L 1305 o 2 / AIA Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision way be used for secondary gMR2= Privacy Law, s15. 1 m. I. Application Information - Please Print All Information State Plan I.D. Number e;7, P is Name v Parcel Number PtcValty Owner's Mailing Address Property Location 9S �/ 7e � /- �\ }F1� /�/!.!/ if �S�i S T� N. R / 'E City, State Zip Code Lot Number Block Number Subdivision Name CSM Number U. Type of Building (check all that apply) "" 3 l3�2 tP� []City 0 1 or 2 Family Dwelling — Number of Bedrooms Qn e. ❑Village ❑ Public/Commercial — Describe Use izGlee r ❑ State owned Nearest Road /�LC ' th III. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B V applicable) A. 11 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank Only stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ,KNon— Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed We 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D ent Area Information: UN Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate_ stem Elevation Irmal Grade Required Proposed4q,� Rate(Gals./Days/Sq.Ft.) (Min./Inch) r — I Elevation VI. Tank Info LN:c city in Total Number Manufacturer Prefab Site Steel Fiber Plastic llons Gallons of Tanks Concrete Constricted Glass Tanta Septic or Holding Tank _ Dosing Chamber VII. Responsibility Statement - I, the undersigneil, assume responsibility for installation of the POWTS shown on the attached plans. P is Name (Print) P igmture MP/MPRS Number Busimss Phone Number 2 a is Address (Street, City, State, Zip Cod VIII /D_!partment Use O nly Approved ❑Disapproved Sanitary Permit Fee (mcl Groundwater Date Issued ing Age Signature Stamps) Fee) ❑ Owner Givm Initial Adverse / 9 J/ Determination IX. Conditions of Approval/Reasons for Disapproval y ,� S�s ->�, 2/•eva,�io�t O�' 6- �"�odc. c�ia�.�,o- wiles?- `�q /�'� lob dou.��,� ��r� Z ry �Athch compla�e t� County mbl for me �an g]�toelww�n c� �IQ scJhd�i 7 SBD -6398 (R. 0510 y y/w 3 I GL), S' NO I 10 k or (00" llama sys�ew.el�v. G t 3l 66 t�6 V �� pW gnu = vhld y6. ` \ 100.0 ` �s� • /�° � �`� yew ����/s' /� T�� /✓ ��'� I r 1 5VL A,L4- l co , {� N W lO�sarVgy 6-ta s��e 4-Aat- ax �f 1 ! p ✓ D f" (00 a h 2 1 6Y 1 ) Gr . i I Qe� gam- ►��d- ��-s� �� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (B a end % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distan e _st road';; 038- 1055 -20 APPLICANT INFORMATION — PLEASE P Tl L INFOMAT` RE IEWEDBY 7 DATE f l � v PROPERTY OWNER: __P�OPERTY LOCATION ' Greenwood ]Enterprises, I� P LOT va SW 1 /a,S 13 T 31 N,R 18 _t (or) W PROPERTY OWNERS MAILING ADDRESS r t0 # BLOCK # SUBD. NAME OR CSM # 2141 Ct . Rd. - sr- 1 99,9 na NorthGate Y •� CITY, STATE ZIP CODE H($15A t�fffjF CITY []VILLAGE [MOWN NEAREST ROAD New Richmond WI. 54017 2 R-E 1 Q Star Prarie 214th. ave. New n Residential / N r of 4 Addition to existing buildi e Construction Use u [x] � 1 � [ 1 g g (] Replacement [ ] Public or commercial descrl Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /0 .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem :kS 11 1. Eks ❑ U fl S ❑ U ® S ❑ U ®S ❑ U EIS ® U SOIL DESCRIPTION REPORT -G✓ t5 f, 7i Depth Dominant Color Mottles Structure D /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. T 1 0 -11 10yr3 /3 none 1 2msbk mfr cs if .5 .6 2 11 -26 10yr4 /4 none sicl lcsbk mfr caw if .2 I.3 Ground 3 26 -84 1 7.5yr4/4 none co s Osg m1 na na 7 .8 elev. 10 ft. Depth to limiting 4 _ r fact S yS�tin �j S Remarks: IF If flew e Boring # 1 0 -14 10yr3 /3 none 1 2msbk mfr cs if .5 .6 2 2 14 -30 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 0 -84 7.5yr4/6 none cos 0Sg ml na na .7 .8 Ground elev. 1 IDD— ft. Depth to ' limiting o factor +84 11 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Avo,,New RichmondjWI 54017 Signature: Date: 4_27_99 CST Number: m02298 ae - PROPERTYOWNER Greenwood EnterprisesSOIL DESCRIPTION REPORT Page 2 . 'of 3 1 PARCEL I.D. # 038- 1055 -20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxl ry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTiench "< 1 0 -12 10yr3/3 none 1 2msbk mfr cs if .5 .6 3 €< ................. 2 12 -28 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 28 -84 7.5yr4/6 none co s Osg mi na na .7 .8 elev. 1 00.4 ft. Depth to limiting factor Remarks: Boring # 1 -12 10yr3 /3 none 1 2msbk mfr gw if .5 .6 4 2 12 -30 10yr4 /4 none si 1 lcsbk mfr gw if .2 .3 3 0 -84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. L0�,1ft• r Depth to _ — limiting ' a factor a Remarks: Boring # 1 -14 10yr3 /3 none 1 2msbk mfr yw if .5 .6 5 2 14 -27 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 7 -84 7.5yr4/6 none cos Osg ml na naF .7 .8 Ground elev. 10 ft. Depth to limiting factor + 4' Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: 9 11F SBD- 8330(8.05/92) • STEEL'S SOIL SERVICE Gary L. Steel Greenwood Interprises, Inca 1554 200th Ave. CSTM2298 NW4SW4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #38- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1" =4 BM.= top of mid lot survey stake @ el. 100.00' Alt. BM.= top of NW lot survey stake C el. 100.50' A 4" / � O ` V k tk� . IL <� Gary L. Steel 4 -27 -99 . r J Aggregate SAS • Caf 3� SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems Permit Number 7/18/99 Date x ffX• Gravity Distribution only 1 Pressure Distribution U 4 3 ft Suitable Soil , 6 in Aggregate Depth 2 in Nominal Pipe Diameter 600 gpd Estimated Daily Peak Flow 0.80 gpd /fe Wastewater Infiltration Rate 750.0 ft Minimum SAS Size 96.40 Ift Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 98.90 100.73 1 100.20 84 96.20 98.70 Yes 2 100.10 84 96.10 98.60 Yes 3 100.40 84 96.40 98.90 Yes 4 100.10 84 96.10 98.60 Yes 5 100.30 84 96.30 98.80 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS F r Se ic Tank Ca acit ❑ NA t �— /?� r t P� P Y al # Septic Tank Manufacturer @e ft ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) p-�� al /day Pump Manufacturer ❑ NA Soil Application Rate al /day /W Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended S olids ( TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At - Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency / Inspect condition of tank(s) At least once every: ❑ m on s) ` (Maximum 3 years) NA Pump out contents of tanks) When combined sludge and scum equals one - (Y volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ mont (Maximum 3 years) NA ❑ year) Clean effluent filter �� At least once every: ❑ mar( 1 ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month ❑ year (s) 1 ❑ NA ls) Flush laterals and pressure test At least once every: ❑ year(s) month(s) ❑ NA ❑ month(s) Other: At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page 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: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site ✓ evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the 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 Name l ' Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ Name r �rl _ �✓�o i Phone — Phone _ This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAIlsTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Properly Address D S- (Verification required from Planning Department for new construction City/State Parcel Identification Number 7C L EGAL DESCRIPTION ��// 2 o r Property Location /W V4, V4, Sec. � T %� N -R W, Town of ��� /�� 6 -74 �L Subdivision `� . Lot # 3� Certified Survey Map # S �22 _ . Volume . . Page # Warranty Deed # �. Volume / s; ti :5 _ , Page # /✓�'� Spec house /. yes O no Lot lines identifiable 'yes O no M NANCE 1p3ji use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consiss'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 masrerplumber ,lourneymanPlumber, restricted plumber or a licensedpumpervenfym on -site wastewater g that (1) the 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the hree year expi on da c SIGNATURE O APPLICANT DATE 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 the property described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. vATURE 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 ' STATE BAR OF WISCONSIN FORM I - 1982 632695 N KATHLEEN H. WALSH WARRANTY DEED I REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. - V01 1555PAGE 15 RECEIVED FOR RECORD Greenwood Enter prises, Inc.. �! 10 -30 -2000 11:30 AM This Deed made between rP a Wisconsin Corporation, WARRANTY DEED EXEMPT I Grantor CERT COPY FEE: COPY FEE: and Michael A Sm; th and Dnnna J. Rmi t-- husband TRANSFER FEE: 18.30 and wife assu D N F 0 RECOk I O EE: 1 .00 marital r S2)ertX, i' PAGES: l t. Grantee, Witnesseth, That the said Grantor, fora valuable considerati �I conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN (.Qp ES 1 rt , Li To: Edina Realty Title 400 South 2nd Street Suite #115 Hudson, WI 54016 038- 1191 -70 PARCEL IDENTIFICATION NUMBER Lot 38 the Plat of NorthGate, recorded in the Office of the Register of Deeds for �I St. Croix Co y, Wisconsin on y , 1999 in Volume 7 of Plats, at Page 46, as �f Doc t No. 603503. ii I i This i s not homestead property. j (is) (Is not) li with all and singular the hereditaments and a in I: Tog ether n I r g g� g'-t appurtenances thereunto belonging; And - ranYnr I I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any of record, I and will warrant and defend the same. �l Dated this 27th day of Clrtnlpr 1m9 2000. G13i:>W700D I INC. I (SEAL) By: Lp /fi( /t < (SEA 11 « James E Rusch. its President (SEAL) By: A (SEAL) CY AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. _ St. Croix County. authenticated this day of ' 19— Personally came before me this 771 }t day of October, 2000 XK —, the above named ,Tampa Fi Rtt•;oh, its president a_cd Mary R I' usrh its se ary 11 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, cling authorized by 5706.06, Wis. Stats,) to me known to be the person S_ .e a +6 s nt and d sa m [rume ,� /� 'knowledge the 4I (r U •, J THIS INSTRUMENT WAS DRAFTED BY / fx - Mary P RIJGGh, Gr-99n GQd Ent fin^ �'• J Npw Ri ehrinnrl, wiamnai n e;4017 Notary Public, St. C:rn ix (Signatures may be authenticated or acknowledged Both are not My co is tory is pe anent. (If ntq, :Ol p' date necessary.) C iL/ �f , ttt,� �� �! • Names of p—roi signing in any capacnv should by typed or printed below their slgnatares STATE BAR OF WISCONSIN Wisconsin Legal 81anls Co I" WARRANTY DEED Form No t - 1982 MiMaukee. Will I ADVICE TO NEW HOME BUILDERS: It is suggested that new house grade be set so that top of foundation is 14" above the center line of street grade. This will look high at first, but will assure much better drainage/less chance of water in the basement after proper backfill and landscaping, and the house will have much greater curb appeal and probably better resale value. i X003.0 <; t 1004.2 t .: 1 002.2 r x GG •i 21002.0 i J01 : 4 , ' ` X t 001.5 , . 1 �r/ (fff����-,,,� 1004.2 X 996.1 — POINT OF BEGINP NG — -x 24 3 p' 2- O 2 2 � ❑ C3 �1`�Oq.l. ❑ ❑ gFOP1Qli•. A�Ehtf ;C 1 02.6 P�1AX.POP +D EU. t ❑ ❑ a - 1003.3 1003.1 a x X i 100 =� -moo s �� 5l�E I00t •7 X �� 1 999 0 7 r,3 G•} - -- c 0. / (I c' t1,3+) �1aE�7 2 7 , — — -- I $J - 176•' ± r r ./ x.'12 ` . '— x 1004.3 — � ;C A u — _ X 1402.9 1003.5 16.92` .' �� a o G N 3 5 O 1. G AG o X o r.zo� t) r d I a +). (0 / 1 05.5 . 1000 _ - - c _- X 1 05.1 -�; o 1.1 A 2 4.3 O t EASEMENT — MAX. PO D EL J % 9• 1. g } I .r Opp \C P - 9CJ .; co TV ti � -M � t -t Q� � /t• - i �: 1R -- t • - 76' _ ° >� A I � p a� 9� S � � g Wisconsin De jArtment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 labor sar1�. Human Relations Division of safety 8 t3uildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL J.D. # dimensioned, north arrow, and location and distance to ne Toor , 038 - 1055 -20 -000 R IEWED BY DATE '', APPLICANT INFORMATION- PLEASE PRINT " %)F61MAT1 ©,A1 :� (n Ib PROPERTY OWNER: R� „ *}` nn R ERTY LOCATION ° �'�� � J G LOT NW 1/4 SW 1 /4,S 13 T 31 ,N,R 18 �(or) W Qr_eenxoQd PROPERTY OWNER':S MAILING ADDRESS i''~' i r T a: L© BLOCK # SUBD. NAME OR CSM # 1416 Third St. �._v. �- •.a 199 na csm CITY, STATE ZIP CODE PHONE NUMBFfUROIX ❑VILLAGE [ 'OWN NEAREST ROAD Hudson, WI. 54016 {,71� tar Prarie C.T.H. "C” (� New Construction Use [x ] Residential / Nuftaper Of bedrogms. 4 (J Addition to existing building j J Replacement [ J Public or commercO�it;+e` ' Code derived daily flow 600 gpd Recommended design loading rate _ .7 bed, gpdm = R trench, gpd/ft Absorption area required 858 bed, 11: 7_ 0 trench, 11: Maximum design loading rate _ _ 7 bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) 95.55 It (as referred to site plan benchmark) Additional design / site considerations na Parent material rmhwar'h Flood plain elevation, if applicable r�3 It t:�U umituitable able for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK fors stem ® S ❑ U 1RI S ❑ U ® S ❑ U Ga ❑ U [0 E] U ❑ S @ 11 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 1 0 -11 10yr2 /2 none 1 2msbk mfr gw if .5 .6 ..... x < 2 11 -2 10 r4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 22 -84 7.5yr4/6 none co s Osg all na na .7 .8 elev. 9 Depth to limiting factor + Remarks: Boring # 1 0 -12 10yr2 /2 none 1 2msbk mfr gw if 1 .5 .6 2 2 12 -2 10yr4/4 none sit 2msbk mfr gw if .5 .6 3 29-84 7.5yr4/6 none ms Osg ml na na 1 .7 .8 Ground elev. 9 9.45 ft. Depth to limiting factor Q Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Am., New Richmovd, WI 54017 Signature: Date: CST Number: m02298 10 -13 -9 PROPERTY OWNER Greenwood Ent . SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. k 038 - 1055 -20 -000 Boring # Horizon Depth Dominant Color Modes Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmr& 2 10 -24 10yr4 /4 none sil 2fpl mfr gw if np .3 Ground 3 24 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 9 £95 ft. Depth to limiting factor +84 Remarks: Boring # ,; 1 0 -10 10yr2 /2 none 1 2csbk mfr gw if 1.5 .6 r - ma"a 2 10 -22 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 22 -84 7.5yr4/6 none ms sOg ml na na .7 .8 Ground elev. II I 9 8.95 ft. Depth to limiting factor +84" I Remarks: Boring # 1 -12 10yr3 /3 none 1 2msbk mfr gw if .5 .6 u 2 12 -27 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 27 -84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 98.95_ ft. Depth to limiting 6 .g factor +84 1, Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Greenwood Enterprises, Inc. New Richmond, WI 54017 CSTM2298 NW4SW4 S13- T31N -R18W MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #4 -csm N 111 BM.= top of NE lot stake @ el. 100 Alt. BM-= top of SE lot stake @ el. 100.45 7?' b� i .3 1 ib -Z Gary L. Steel 10 -13 -98 FILED NOV 1 0 1998 ► to WHMKWMM sccro6c o 11 X91311 ti � `� CERTIFIED SUR VEY MAP GREENWOOD ENTERPRISES, INC. Part of the Northwest 114 of the Southwest 114 of Section 13, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Q MI W114 COR. SEC. 13, r3/N, R/8 W Q � f COUNTY SURVEYOR'S MON./ N N1 in VI at S/6N EASEMENT _ UNPL A T TED L Ira S89•07'26 "E 480.0/' V� 60.0/' 20' I 420.00' O , S , 60 I o , LOT 3 3 O: O IN 1.983 ACRES C 86, 386 SO. Fr. /. 735 ACRES EXC. ROAD R.O. W. m Z 2 • J h ° 75, 586 SO. Fr. Q p 2 ( N t N 89 "W 480.01' O Q W o.o/' I ^ I 420.00' A a m 3 40 LOT4 va JI I 0 1.983 ACRES o h X !l • to 4 O° � W 06,386 SO. Fr. m. Z 2 H /.735 ACRES W ff M 75,586 S0. Fr. mJ 60.0/' -I- - 20 E Q 420.00' 3 N "W 480.01' 4 ACCESS GAS&M-Avr UN T TED LAND SW COR. SEC. 13, 7 31 N, R /8 W. /COUNTY SURVEYOR'S MON./ , ,�N ��. \ gC O NS •,. qb O 50' 100' /50' 200' 300' LA R E ST'W PHY o • 1713 = a •. R ER FALLS, �� •! WISC. •'• Q Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM o.nS�f. Croix Safety and Buildings Division INSPECTION REPORT GENERAL JNFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.: Personal Information you provlce may be used for secondary purposes (Privacy Law, x.15.04 (1)(mg Permit Holders Name: Q City ❑ Village 7C own of: State Plan ID No.: Insp. BM Div.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic KS Benchmark -3-7-0 o3 • a0 • `fS / Dosing 2. G Aeration Bldg. Sewer .1 Holding St /Ht Inlet 5 - *5 $, o' TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic NA Dt Bottom .� Dosing NA Header /Man. v� LAI cfrc,n Aeration NA Dist. Pipe _?0 S , Holding Bot. System rigf. 95 � PUMP/ SIPHON INFORMATION Final Grade $ , 31' Manu urer Demand Model Num ®''' GPM TDH Lift Fri S stem TDH Ft Forcema' en 9 th Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI I 3 (o On D IMENSI ONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf acturer: SETBACK I CHAMBER INFORMATION Type O I 6 a r OR UNIT Mo Number: System: Co DISTRIBUTION SYSTEM Header / Manifold Distribution Pip s �� � �Sp ng V ent To Air Intake Length Dia. Leng Spacing 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 Q Yes Q No ❑ Yes Q No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: D41 Vko l Inspection #2: Location: 2135 Cty Rd. C New Richrpond, WI 54017 (NW 1/4 SW 1/4 13 T3 IN R18W) - 133118237F -Lot 4 l.) Alt BM Description j Ww- 2.) Bldg sewer length = 1 V ($ y - amount of cover = ; 1^'�'- -� . `tom- -•�`� Plan revision required? ❑ Yes No Use other side for additional information. 1 04 1 � l o t SBD -6710 (R 3/ff7) Date Inspector's Signature Cert. No. 21.35 GTI — fety & Buildings Division Sanitary Permit Application Sa In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -730.^ Department of Commerce (privacy Law, s. 15.04(1)(m)] (Submit completed form to county if r Ivisconsin state owner Attach com lete plans (to the county copy only) for the system. on paper not less than 8 -1/2 x 1 I inches in size. County ( State S�ta[P�3 Number ❑ Check if revisi� previous application State Plan 1. D. Number J .7 I. Application Information - Please Print all Information �'� Location: Property Owner Name ` crrCC`,C(n� Property Location ? CLCI YLU 0(1 /45Ud 1/4, S !J T 31 / N, R/ l or Property Owner's Mailing Addre 15 2000 Lo4 Number Block Number S sr CF40)( ' R_ 'Z577&A1CY- '6 City, State 1 Zip Code Ph a be ` bdiv sion Name o Sh umber ,59 n —/0 { II Type.of Building: (check one) / • j f�.. ; ,�' ❑ City ❑ Village A( I or 2 Family Dwelling - No. of Bedrooms: Town of ❑ Public/Commercial (describe use): r ❑ State -owned s III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road G y` - C A) 1. #,New System 2. ❑ Replacement 3. ❑ Replacement of 4. El Addition to Parcel Tax Number(s) System Tank Only Existing System 1 03 - J 06 B) 1 Permit Number geed ❑ A Sanitary Permit was previously issued • 3 g . 3 IV. Type of POWT System: (Check all that apply) `( KNon pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At- grade , ❑ Aerobic Treatment Unit ❑ eci Other: rculating r V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) /''Elevation O 375 377 1 / 95.5.5- VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks �5 d0D tbc� ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement the undersigned, assume responsibility for installation of the POWTS shown on the attached plains. Plumber's Name (print) Plumbe ign re (nos P PRS No. usmess Phone Number G a � 3�� 7 (-,/ Plumbers Address (Street, City, State, Zip C e) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse SurWge Fee) � 41 Determination , P Xas )2 IX. Conditions of Approval /Reasons for Disapprova 0. " 'v' c_ 3 - P_ � .ts- *__%1MA+4trl- l�++y vie .�..- wsA Waxp.� �os� , A�t�rh eo cxQeca� t=.s w ^ sY " _._ _ pt`J •o , `�`' l . (}a, .,.a�%(,r_ Cys�ew- ` - 6`t V , - b e WD.� La `c°'"" L C l� 1tk�tK t_ W .�o� s M►+�a - be_ V�b�- '1�aA,�R� �sf s f t,, OJ w, re.c Dtxc SBD -6398 (R. 07/00) rte_ et al 9 3�. �3 �J ' � (-(_• - 0�w�.•�ass'r15, wew r wa<w. <.ar � PRE1JMwutY PLe 9; 14TJ Y_` € ' _ 3 i ( 1 /' Q ' f]�►ls • v<. NcrthGau / /\ lodJNow vWIIJ l li. .SW - t -. o S1 i J RIM. 1 af," f w f d girrr. r. 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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor ant Human Relations Ltn�r:ion of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code CNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but tix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. - 1055 -20 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RBY DATE I &, 4 jTq PROPERTY OWNER: PROPERTY LOCATION Greenwood r' ses Inc. GOVT. LOT NW 114 SW 114,S 13 T 31 N,R 18 X (or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # q 1416 Third ST. 38 na NorthGate , 1 7�_ CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE []TOWN NEAREST ROAD Hudson, WI. 54016 (715) 386 -3674 Star Prairie I 214th Ave. [ New Construction Use [ x] Residential / Number of bedrooms 4 [ ) Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft2 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 95.85 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicablen ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem a ❑ U CA E] KI S ❑ U C36 El &I S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 1 1 0 -13 10 r 3/3 none 1 2msbk mfr qw if .5 I .6 2 13 - 10 r 4/4 none sicl 2msbk mfr 9w if .4 .5 Ground 3 28 -84 7.5 r 4/6 none co s osg ml na na .7 .8 elev. 9 g - Ri ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 i .6 2 12 -29 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 29 -84 7.5 r 4/6 none cos osq I ml na na .7 .8 elev. 9 9.65 ft. , Depth to limiting L w �V factor NOV ST CAOiX t�w Remarks: '' COu OFFICE CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 -62 Address: 1554 200th. Ave. Richmond W1,64017 Signature: Date: 11 - - C m02298 it PROPERTYOWNEIC Enter= ri Gec SOIL DESCRIPTION REPORT Paged -of PARCEL I.D. # 038 - 1055 -20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. 3 '. 1 0 -12 10 r 3 3 none 1 2msbk mfr gw if .5 .6 2 12 -24 10 r 4/4 none sici 2msbk mfr 9w if .4 .5 Ground 3 _ w elev. 99 ft. 4 130-84 7.5 r 4/6 none cos os m1 na na .7 .8 Depth to limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3 3 none 1 2msbk mfr if .5 .6 4<< 2 12 -30 10 r 4/4 none sici 2msbk mfr 9w if .4i .5 Ground 30-84 7 na na .7 .8 elev. 99.7 ft. Depth to -- limiting factor +84" Remarks: Boring # - w if .5 .6 5 `'' 2 12 -25 10 r 4/4 none sici 2msbk mfr QW if .4 .5 Ground 3 25 -84 7.5 r 4/6 none cos osg m1 na na .7 .8 elev. 9 95- ft. Depth to limiting factor +84 Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 WIWI' S13 T31N - New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #38- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of SW lot survey stake @ el. 100' Alt. BM.= top of mid -lot survey stake @ el. 99.60' Li Vo �j 141 2 P it D o t X� L A kt Q Gary L. Steel 11 -3 -98