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CD 3 s m I m m m c a' CD 'T 0 0 m m v I CD =r � N N c Q. 3 0 0 °p ° m oa ;n a, Cl n ° o a �, RECEIVED Wisconsin Department of Coff ercer,EC 1 1 2006 SO EVALUATION REPORT Page of Division of Safety and Building UU in accordance with Cornm 85, Wis. Adm. Code Attach complete site plan o papeAj7t Os'rr1���x� rnaWYN� 1 inc es in size. Plan must County O include, but not limited to: ve0cal and horizontal reference poirit (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location r/ lJ e— r J r n 61 Govt. Lot A 'j 1/4 � 1/4 S 3 T j N R E r) W Property Owner's Mailing Address 0 Lot # Block # Subd. Name or CSM# 3 . ; G Cily State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road A �NOWCOnstructiOrl Us . Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or mmercial - Describe: Parent material Flood Plain elevation if applicable inl jf t ft. General oorniments and reoonunendations: System Type /�W12 2w1 System Elevation U F6-1 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ju ndary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 ff#2 <I �? � � .410 S OJ F Boring # O 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sigrqt4jiV CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducte Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ 715 - 246 -4516 Property Owner _ Parcel ID # Page of a Bori ng # F1 Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. go_t�lApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. - go — ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure ' Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring F El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:E 150 mg/_ ' Effluent #2 = BOD < 30 mgA. and TSS 130 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. SBD -8330 (8.6M PLOT PLAN PROJECT Ken Overina ADDRESS §3,4 Summ Pines Circle Hudson Wi 540 NW i/4 SE 1 /4S 13 /T 31 N/R 18 OWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 Z E 11/30/06 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26 kk BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.8/93.6 6' below qrade B. M. 129' A1t.B.M. 41' 49' 5' 10' 10' Plans Designed Using B -1 Vents B -2 Conventional Powts Manual Version 2.0 43' -3 3' 12' ST 2 -3' X 69' Cells B -4 -6 with >3' Spacing 30' B -5 250' Pro 3 Bedroom House 250' Property Line Vent >6 „ ARC 36 Biodiffuser of Cover Leaching Chamber with 25 ft2 of Area 5' Long 11 " 34" Grade at System Elevation It Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479388 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: Oeverin , Ken I Star Prairie, Town of 038 - 1210 -10 -000 CST iWElev: / Insp. BM Elev: BM Descripti n: Section/Town/Range /Map No: .(00 !• is( 13.31.18.1139 TANK INFORMATION f ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchm rk i CM �81 3. I b Aj ozio Dosing Aft. BM Aeration Bldg. Sewer 6•t,fo 'q6 - 30 ' Holding St/Ht Inlet 7•3o q 5 - , ((0 TANK SETBACK INFORMATION St/Ht Outlet 7• 9s.r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r r Dt Bottom l^ Dosing Header/Man. "¢� 9p q�•�i � Aeration Dist. Pipe Holding Bot. System O •/O 92. to � PUMP /SIPHON INFORMATION Final Grade 3ao 99.6D Manufacturer Demand St Cover GPM Z • Yd 36 Model Num er TDH Lift Friction ss System Head T?XFt Forcemain Len Dist. to SOIL ABSORPTION SYSTEM R OI Width Length No. O Tr nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: f r CHAMBER OR Model Numb r �� DIS , !QN SYSTEM Header /Manif Dia I I Distribution x Hole Size x Hole Spacing Vent to Air Intake �^ Lengt Pipe(s Leng Dia Spacing SOIL COVER x Pressure Systems Only xx M ound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bad/Trench Edges Topsoil El Yes 0 No Yes No CON�AENT,S•�(InclNde c e iscr Gi��es, prgsept, etc.) Inspection #1: / 1 0 Zt�9 Inspection #2: Location: 1350 212TH Avenue New Richmdnd, W1 54017 (NEE 1/4 S - W A 1_/4 13 T31 N R18W Northgate II Lot 49 Parcel No: 13.31.1_8.1[1.39 _ 1.) Alt BM Description = S • (.+� �,,� 2.) Bldg sewer length = - amount of cover = 'f7_ Plan revision Required? Yes [❑ No i Use other side for additional information. SBD -6710 (R.3197) T Date Insepctor's Signature Cart. No. 1 t y Safety and B'ildngs _ ivision County 1 j 201 W. Washington Ave., P.O. Box 7162 3 4 . ' Coo j I 2 (608) 266 -315x - S Madison, WI 53707 - 716 anitary Permit Number (to be filled in by Co.) COnSIII 01 Department of Commerce St a Plan LD. Number Sanitary Per is r� i; In accord with Comm 83.21, Wis. Adm. Cod in rm • io provide may be used for secondary purposes c 1 (1)(m) 4 � \; , ` roj t Address (if dill rent than mailing address) 4 . I. Application Information — Please Print All Information Property Owner's Name1. (� Parcel # f Block # o t Property Owner's Mailing Address � Property Location JCS ✓ri yu��il/ n�O C/C�f/�� 1� ' /< -v '!., Sectio City, State zip Code / 7 Phone Number / 1 'S " 0 1 14 �J . , 0 " T_ � N; or W e � 11 39 II. pc of Building (check all that apply) Subdivision Name C umber Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use ❑City_ ❑villa ship of J /� ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. stem [01 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ermit Renewal ermit Revision ange of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. a of POWTS System- Check all that apply) ST - Pressurized In- Ground [I Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable so ❑ At -Grade Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground El Holding Tank El Peat Filter El Aerobic Treatment Unit El Recirculating Sand / Filter ❑ Recirculating Synthetic Media Filter ❑ Drip Line El Gravel -les Pipe 11 Other (e / �l V. Dis ersal/Treatment Area I ormation: is Area Syste Elevatio ` Design Flow (gpd) Design Soil A pplication Rate(gpds Dispersa Area Rewired (sf) D a � � C � O VI. Tank Info Capacity in Total Number b /(l�Manufacturer Prefab Site : Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank l Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigne me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature MP /MFRS Number Business Phone Number Plumber's Address (Street, City, State, Zip e) i VIII oun T /InartmentUse0ni v Sanitary Permit Fee (i eeludes Ground water D atIssued I ing Agent na ps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Reason for Denial ��PP (Q (J y IX. Conditions of AXproval/ReasonsLfor_DisaRproval 0 3. G�— Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Y DRESS PLAN PROJECT Ken Overina 838 Summer Pines Circle Hudson Wi 54016 NW * 1/4 SE 1 /4S 13 E/TE31 8 ' W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/8/05 BEDROOM 3 CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H.R.P. Sameasl3enchmark SYSTEM ELEVATION 96.0/95.9 4' below grade B.M. 129' A1t.B.M. 41' 49' 5' 10' 10' Plans Designed Using - -2 Conventional Powts Manual Version 2.0 43 3' is B -4 IV � f 2 -3' X 69' Cells 0' with >3' Spacing -5 250' ST 30' 3� Pro 3 Bedroom House Vent jLong Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area " 3 4" Grade at System Elevation PLO PLAN PROJECT Ken Overina DRESS 838 Summer Pines Circle Hudson Wi 54016 NW ' 1/4 SE 1 /4S 13 /T 31 / 1 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 [ DATE 8/8/05 BEDROOM 3 CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100 , Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 96.0/95.9 4' below qrade B. M. 129' A1t.B.M. 41' 49' 5 10' 10' Plans Designed Using B 35' B -2 Conventional Powts Manual Version 2.0 43' �B 3' Vents B -4 2 -3' X 69' Cells 30 with >3' Spacing B -5 250' ST 30' Pro 3 Bedroom House Vent >6 » Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11 " 3 4„ Grade at System Elevation Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Co ency Plan ption # . If system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 Wiscon§in Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labdr and Hurnan Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach corVJ„ete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S not Knited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned north arrow, and location and distance to nearest road. 038 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION VIE ED BY /„ DATE r Jt�vl• PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 N,R 18 k(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 1416 Third St. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN I NEAREST ROAD Hudson, WI. 54016 (715 386 -3674 Star Prairie I 214th Ave. [� New Construction Use [ ] Residential / Number of bedrooms 4 ( Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate 7 _ bed, gpd /ft gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate bed, gpd 1ft trench, gpd/ft Recommended infiltration surface elevation(s) 95.90 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 I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑U EIS ❑U ®S ❑U us ❑ U @ S ❑U 0 [RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 >' - if . 5 .6 2 9 -27 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 27 -84 7.5 r 4 6 none ms OSQ ml na na .7 .8 elev. 9 9.6 ft. Depth to limiting factor Remarks: Boring # „ > 1 1 0-8 10 r 3/3 none 1 2msbk mfr qW if .5 i i .6 2 1 8 - 26 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 26 - 84 7.5 r 4/6 none ms osci ml na na .7 .8 elev. 9 9.5 ft. `` \ Depth to limiting factor +841 0 3 - 1998 i 44; BF Remarks: s' COUNTY Z0NlNGrWrU_C I CST Name: -- Please Print G L . Steel Phone: 715- 246 -6200 Address: 1554 200th. Av w Rich I 54017 Signature: Date: 11 -5 -98 CST Number: mO2298 PROPIERTYOWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 038- 1055 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 'BPD /yt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh L -%-- .-.-.-,.-.-.-.-.- 3 1 Q- 12 10yr 3/3 none 2msbk 1 f 2 2 12 -26 10 r 4/4 none sicl 2msbk mfr qw if Ground 3 26 -84 ms 0sa IM1 na na elev. 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -9 10 r 3 3 none 1 2msbk mfr if .5 .6 "4 2 9 -30 10 r 4/4 none sicl 2msbk mfr if .4 .5 Ground 3 30 -84 7.5 r 4/6 none ms 0SCI ml na na .7 .8 elev. 99.64t Depth to -- limiting factor +84" Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6 2 12 -30 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 30 -84 7.5 r 4/6 none ms OSQ ml na na .7 .8 elev. 99.9 ft. Depth to limiting factor +84" Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page � 1 of _ 3 Labor and Human Relations Divisior+ of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach com site plan on paper not less than S 112 x 11 inches in size. Plan must include, but St. not li sited to vertical and horizontal reference int BM , direction and % of slope, scale or PARCEL I.D. # Po ( ) P dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -10 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION X VED BY / DATE I CA 1.N- S t PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 N,R 18 k(or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1416 Third St. 49 n; NorthGate HONE NUMBER CITY VILLAGE CITY, STATE ZIP CODE P ❑ ❑ [3TOWN NEAREST ROAD Hudson, WI. 54016 (715 386 -3674 Star Prairie I 214th Ave. (�] New Construction Use ( ] 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 ed, gpd /ft gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 95.90 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 IJ= Unsuitable fors stem RIS ❑U EIS ❑U ®S ❑U ®S ❑U CxIS ❑U ❑S Giu 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 Trench _ w if .5 .6 2 9 -27 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 27 -84 7.5 r 4/6 none ms OSQ ml na na .7 .8 elev. 9 9.6 ft. Depth to limiting factor Remarks: Boring # 1 0 -8 10 r 3/3 none 1 2msbk mfr qw if .5 .6 '`'...2....i< 2 8 -26 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 26 -84 7.5 r 4/6 none ms osg ml na na .7 .8 elev. 9 9.5 ft. Depth to limiting factor r +84" 1141a I Remarks: COUNTY ' CST Name. -- Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av w Rich I 54017 Signature: Date: 11 - - CST Number: m02298 STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. ' 1554 200th Ave. CSTM2298 NE4SW4 S13 T31N - R18W New Richmond, WI 54017 MPRSW - 3254 town of Star Prarie (715) 246 - 6200 lot #49 NorhtGate sa tisfy a zoning requirement, it may or may This soil evaluation was co nd uc ted to sa y g equ Y Y 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 1 pvc pipe C el. 100 Alt. BM.= top fo 1 pvc pipe 7 F E1. 99 !� d r� Q - 0 01 ° / A )&-d Gary L. Steel 11 -5 -98 Safety and Buildings Division County an 201 W. Washboon Ave., P.O. Box 7162 Mahon, WI 53707 - ; Sanimy Permit mN er (to be tilled in by Co.) De ar tment of Commerce x 30Q 3�- Sanitary Permit Application J VUJ Sate Plan LD. Number in axed with Comm 83.21, Wis. Aden. Code. Pasoml information you pro may be used for secondary purpom Pr"+ey Lass,-sUA4 jXJn}_ ..- - _ ._ (if diffecem than mailing address) L Applicabon Informatim - Phme Print Ali Infarasadion x Propety Owner's Na me y t ! / Let I Block A ,�' 5'f • 1�3q Property Owner's M ailing Address Property Location AM 1f. �E� u,Secdon (Sty. State Zip Coda Phone Number A - O 7�J - 7 T S/ N R �L,� rde, II. Type of (check aR that ) WI or 2 Family Dwd ft - Number of S u�b C Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ Stme Owned - Describe Use - ❑City ❑Village W( o III. Type of Permit: (Check only one buzz on Complete line B if k) A. 'New System ❑ RVW:ement System T WOW to J 1 4 System B. ❑ Permit Renewal ❑ Permit Revision ❑ Permit Transfer to New l Before Expiration Phrmber � IV. Type of POWTS Systamc (Check A flat WPW 2 -S - s" "' IVNon - Pressurized In -Ground ❑ Mound > 24 m of suitable soil < 24 in. of soiobla sort ❑ At -Grade ❑ Single Pass Sand Filar ❑ Constr Md Wetland 11 Pressrized Inam nd ❑ H kKUog ❑ ❑Aerobic Ttatment Unit ❑ RxRVfatiag i Sand Filter ❑ Recuculamrg synhdic Media Filter ❑ Leadme Chamber ❑ Line Pipe ❑ Odra (aaplain) V. DispersalffreatmeW Area Information: Design How (8Pd) APPliesdan Raae(gpdst) Ara Rsgrmed (aft Ara Pr oposed (sf) Syste - 9' LQS3•I c — Qs•- VI. Tank Info in Total Number ) Manufacturer Prefab Site sad Fdrer Plastic Gallons Gallons of ' Cannata Ct�rnded Ghm New > tt Teats Tools Septic _ ,L Aerobic Tteam mt Unit Dosing Chamber VII. ResponsWillfty - L he affsignad, w respq for iustalkdan of the POVM shown on the attached Plans. Pbnrbe:F'ojftuyr(ftiuprrt ttg 's Si SRS Number Business Phone Ntmnber #221180 -- M r ss s rn (715) 635 -9609 /- ap2— VIII. Use Only Approvod ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Aget+rt Sionaftee No Stamps) ❑ Owner Given Reason for Dental 1X. C 1 0"flons of ApptovaURtmaaos for Auaci liana ro an conew -W thr the system ere paper act has tea. Un x 11 ieches is sine Lid y 9' Foger #2221180 28288 McKenzie Rd. Spooner, WI 54801 (715)635-9 JF ! vc , f, d,�c•� - *4- d•7 7� � ttr�E' ! j • 19 uN-6 44 cv,.vAZ-< w� Rya J A ' 7 acx. •ractC ;Z ,, X 6Z 6* RY � 14--10 r � - 2 PC - C -L a><y �-✓ Z 8 -s ya , 3 8DR►� I I ttI 2� 2 Y jO y Fogerty 1180 Std rYm 28288 McKenzie Rd. Spooner, WI 54801 ,f r'Pvc tea' (715)635- FauN_ o Lei cv,�,v w� /tea /•' C- r �f'/ �trav 3n 6475 �7 ate. a -Z A X f a -Y g -r i� Z 3 &DRv� I I c ;2 �. E� � `j� II m a C14 1 W c #N on �� II II U L6 00 _ O 4r CA Cd cd cd ''(� i� ( �,� %�`� SLR , . � . • •' . 4 4-4 C11 II 1-4 ° N .• .' •04 G t a3 : Ch N1 ,t cdi 'ouo o Il H Page POWTS OWNER'S MANUAL & MANAGEMENT PLAN of ' L 'ME NIFOMYI IM SVSTM SPE MATIORS Owner Septic Tank Capacity ga l O NA Permit 3 } Septic Tank Manufacturer O NA Df PARANIETBIS Effluent Filter Manufacturer NA Number of Bedrooms El NA Effluent Filter Model 0 NA Number of Public Facility Units )NA Pump Tank Capacity o af 13.E Estimated flow (average) galiday Pump Tank Manufacturer Q NA Design flow (pew, (Estimated x 1.5) d gailday Pump Manufacturer 0 NA Soil Application Rate _ al/d /W Pump Mode! O NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit . CI . NA Fats, Oil & Crease - (FOG) 530 mg/1- a Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/f_ ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quaky Monthly average Dispersal Cell(s) 0 NA Fmc hernical Oxygen Demand (BODJ :5W mgr- ).Q m- Ground lgravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/l. O NA ❑ At -Grade 0 Mound _ Fecal Colifomn (gam mean) 510` cfu/1 OOrrd 0 Drip-Line O Other. Maximum m Effluent Particle Size Ys in do. O NA ' ❑ NA other: ❑ NA Other: 0 NA 'values typical for domestic wastewater and septic tarok efilumc Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Requency Inspect condition of tank(s) At least once every: - 0 months Wwdmt= 3 years) 0 NA Kyearw Pump out contents of tank(s) When combined age and scum equals one's %) of tank volume O NA Inspect dispersal cell year(s) s) At least once every: 3 [] m lMaucurrnrt 3 years) O NA rts} 17 months) O NA Clean effluent filter At least once every: year(s) Inspect pump, pump controls & alarm At least once every years) : ❑ m a r() 1 q D Flush laterals and pressure test At least once every: ' D months) a NA O yearts) Other. At least once every: El month(s) a NA years) other ELNA 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 Sewn; POWTS Inspector. POWTS Maintainer: Septage Servicing Operator. Tank inspections must kK*We a visual inspection of the tank(s) to identity any rr6ming 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 cen(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent of the ground surface. The ponding of effluent on the ground surface may indicate a fang condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. .. Page of 2 " UP AND OPBiATION For now construction, prior to use of tfie POWTS check treatment tank(s) for the presence of Pain** a re detected have the contents that may impede the treatrrnertt process and/or damage the dispersal C61111311 If high conoworations of the tanks) removed by a septage servicing °PWR°f prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During p ower outages pump tanks may fit above normal ti�wetm levels. When power is restored the excess wastewater will be g p° the CO N S ) and may result in the backup or surface discharge of discharged to the dispersal ce in one b� dose. overloading 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 Maintamor 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. Redaction or eruriination of the following from the wastewater stream may approve the performance and prolong the rife of the POWTS: antibiotics; baby w 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, CM; painting product's: 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: ' L A suitable replacement area has been evaluated and may be utilized for the location of a t soil absorption 1- system. The rephumment area should be protected from disturbance and con4taction and should not be infringed upon by structure, lot lines and wells. to protect the replacement area will Failure required setbacks from ex" so u and p ile end rea. Replacement systems must result in the need for a new soil and si evaluation to establish a suitable replacement a comply with the rules in effect at that tine. ❑ 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 sod 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. < <WARNWG? > SEPTIC. PUMP AND OTHER TREATN�IT TANKS MAY CONTAIN LETHAL GASSES AND10R � OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATUIENT TANK UNDER ANY CIRCUMSTANCES- DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DffRCULT OR RAPOSSME #221184 r c� .�.,� uui cworlT (715) 63 A POWTS INSTALLER POWTS NIABNT Name 1 Name Phone S - ` _�-hI Phone _ — D SEPTAGE SERVtCWQ OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY t Name Name 1 ��IK C AA'o Phone This document was drafted m con*hawe with chapter Cann 83.22(2NM0Hd1&(f) and 83.5M7). (2) & (M. Vosconsin Adminisaativ• fie• I i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e/t .Mailing Address CJ A r1 4 Property Address -/-I j (Verification required from Planning Department for new construction) City/State Parcel Identification Number o38 /o awO LEGAL DESCRIPTION Property Location ' /,, -rkl 1 /,, Sec. _ 12 T N- R_ZLW, Town of S7* of d cAr. Subdivision �y� �q �� - - - - , Lot # 1 - Certified Survey Map # Volume . Page # - Warranty Deed # 7/ 9 -r r y Volume _ 2i -. , Page # i o :E Spec house ❑ yes L°.I'no Lot lines identifiable CYyes ❑ no SYSTEM MAINTENANCE Improper use and maintwallmof 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 soon, if needed by a licensed pm#4er 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 Deparfimeut a motion foam, signed by the owner and by a masterplumber, journeymanP , restnctedp os a be ansedpmr W vcnfyi mg that(1) the ova -site wastewaterdisposal system is in proper operating o andJar (2) after and pumping (if aryl the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirenmmts and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Dept of Commerce and the "a � been �� must be completed of Natural �Reso�xs, State of Wisconsin. Certification days of a � fs �y Zoning Office within 30 SIGNATURE OF APPLI 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 p descn ve, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLIC DATE- a 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 J 2 2 2 1 1 P 2 0 t{ 7 1 9394 f aP STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH y WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD i t 04/30/2003 09:15AN �I This Deed, made between _Q;gjardqbgrjr_} � Wisconsin Corporation _ �f WARRANTY DEED EXEMPT i Grantor, II REC FEE: 11.00 and _ KannPi - h J_ Cieyeri ng 1Gt f i P TRANS FEE: 69.90 COPY FEE: 2.00 CC FEE: - - -- — PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following i' described real estate in qt-- l'rni X County, State of Wisconsin i (the 'Property"): Recotding A . ea , I Name and Return A r -- ess ,,�- of the P lat of NorthGate II, recorded in the to �Ili`e ELLI w1 — t7ffice of the Register of Deeds for St. Croix County, pp 501.1 � 11 Wisconsin, on June 20, 2001, in Volume 8 of Plats, at I �+ttif01&n ' uor SyU u Page 55, as Document Number 648882. 16c • is 038 - 1210 -10 -000 Parcel Identification Number (PIN) I I'. This is nn homestead property. � (is) (is not) j I is I �j I I i � Together with all appurtenant rights, title and interests. yyr Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except I easements, restrictions, and reservations, if any, of record. li I I Dated this _ 2 day of April 20 L OOD INC. ENT (SEAL) �.,a (SEAL) I «J ames E. Rusch President i I i (SEAL) _ (SEAL) l _. —_._. *M arvR, usch, Sec /Treas ii AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, lI J it St. Croix _ County.J , authenticated this day of Personally carne before me this day of 4pri I 2003 _ -, the above named ry i --- TITLE: MEMBER STATE BAR OF WISCONSIN _ _ •`v r — to (If not, me known to be the person Whp'`s�b lta: /�uI authorized by §706.06, Wis. Stars.) ins[ru t and acknowledge the THIS INSTRUMENT WAS DRAFTED BY --Va R. Notary Public, State of Wisconsin 's l' ..... _ New RichMond, WI 54017 My commission is permanent. (If no 1 9 e�pTt��o ;111"te: (Signatures may be authenticated or acknowledged. Both are not a ��� n„ u t� c ) efltllb< e � necessary.) o, , 2004 ' Names of persons signing in any capacity must be typed or printed below their sag iature. STATE BAR OF WISCONSIN Wisconsin Legat Blank Co.. Inc. WARRANTY DEED FORM No. 1 - 1998 Milwauke , Wis. J I N 89*0 2139.00' 134.00 57.00* 18 245.00' 245.0 ao - cu -4-9 L&J 50 1 55,766 sq. ft. • 1.303 ac. cu T (65,278 sq. j 8.44 . , rn • p 0 1.499 ac. 1 75 0 gar... Z - 24 7-58 19 2� t •r� � 5' 4' OO AP .�.+ �� 8 "ter.. 26-05 k 00 02.33 e_ flf 5..4k_xE11'. WG NMVJ' A.l Y20.l ILNIlAt481ALA 'lAI.NF: ?'IL. }C.AVtl13LLGII9S' J>wXXxa: ': nn¢slm'.cuevnusyaxniviceuex \ OR'1'}IGATF. 11 , .: • i,Nn.Y:.m.::'ti. ire:: +aw.q:w: n rxl:N¢R riePlurntl W;m+rn:nl.alMawaY'+. K+e`raan:I.:o rte1,:>•rJ +y j to PYtM rY R v wn^ y nePw .m Pnxrxsx::,.lPm lw.i vakr,u:v:mt mJ hl,n ' . v„rn ...n'.mnt4 'n: a „n:: •,aN i':i%lx YliW.. lVi1.' f.' 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