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Home My WebLink About038-1211-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463491 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 q �S j Star Prairie, Town of 038 - 1211 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �j — G5 13.31.18.1153 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark -' 1> , � a ` Cn , J >✓� iR,; �S � J 5 1 Alt. BM Aeration Bldg. I3ewer Holding St/Ht Inlet `7 -7 016-195 �5 TANK SETBACK INFORMATION St/Ht Outlet 7• 2 I 5, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 Z� A� 3(Dj ? � r Dt Bottom �` Dosing `7 Header /Man. '1 35 C /s , Z. q,L4 95, Aeration Dist. Pipe q . 35 95 . Z Holding Bot. System T1 y.3 9 y - Z T cry► , d PUMP /SIPHON INFORMATION Final Grade 4. 99. Manufacturer De Viand St Cover Model Num er TDH Lift Friction Loss System Head TDH Ft Forcemain L gth Di Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( v 1 9 / a &, SETBACK SYSTEM TO � P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: F INFORMATION CHAMBER OR ) Type Of System: / UNIT Model Number: 4z. 1 /�A- AJ 1�" l�d-� r DISTRIBUTION SYSTEM 63 �J p c,,� = Z Z Header / M # Distribution x Hole Si_ ze x Hole Spacing Vent to A'' Intakq Length Dia Length Dia Spacing ' 7 o- T r�- 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 .5, �5 Bed/Trench Edges `� Topsoil � Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1351 212th Avenue New Richmond, fil 54017 (NE 1/4 SW 1/4 13 T31N R18W) Nort gate II Lot 63 Parcel No: 13.31.18.1153 1.) Alt BM Description = t o `� `�� ` � 6 N� 2.) Bldg sewer length 4nature - amount of cover Plan revision Required? YesfVo ��r es', `�� Use other side for additional information. ✓ ` �✓' �!J D 3 Date Insepctor' Cen No SBD -6710 (R.3/97) I Safety and Buildings Division County � j 1*is onsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) department of Commerce (608) 266- ] Sanitary Permit A V u C I State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso f provide �may be used for secondary purposes Privacy La ) k y • Lfroicet ddress (if di rent than mailing address) I. Application Information - Please Print All Information >11Q /` jJ`/ — /z +t— Add 7L &R n Property Owner's Name Lu, /NG G� JN / 1 Par el # Lot # Block # / �,,.� et1e�,� F '�F D) Property Owner's Mailing Address operty Location Ci ,State Phone Number / - �'° ', Section Zip Code 1 ), e g 0 1 � -r one 1�1 / 111 T� N; VIE r W II. ype of Building (check all that apply) ---> 4K 2� Qe r or' V 2 Family Dwelling - Number of Bedrooms r Subdivision Name CSM Numir 11 Public /Commercial - Describe Use aptpz� lutr 1 1 El State Owned - Describe Use t Q.,�IEa � � ❑Ci ty_ ❑Villa wnship o L /' III. Type ? Permit: (Check only one box on line A. Complete line B if applicable) P - A' stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑Permit Renewal 11 Permit Revision ge of Permit Transfer to New List Previous Permit Number and Date Iss ed Before Expiration Plumber Owner �J R IV. a of POWTS System: (Check all that appl / / on - Pressurized In- Ground 11 Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 11 At-Grade ❑ Single Pass Sand Filter El Constructed Wetland ❑Pressurized In - nd ❑Holding Tank 11 Peat Filter ❑Aerobic Treatment Unit El Recirculating Sand Filter Recirculating Synthetic Media Filter achi Chamber ❑ Prip Lie El Gravel-less Pipe 11 Other (exp!airo y V. Dis ersaVrreatment Area I ormation: Desig�l� d) Design it application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S Fiber Plastic Gallons Gallons of Units Z A- Concrete Constructed Glass a New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the under i ed, assume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (Print) PI s Signature MP/MPRS N ber Business Phone Number Plumber's Address (Street, City, State, p ode) VII I. County/Department Use Onl Approved isapproved Sanitary Permit Fee (includes Groundwater Date sued lssui gent Sign ps) Surcharge Fee) ❑Own rven Reason for Den' �[XJ • � 5 � �✓ IX. Conditions of Approval/Reasons for Disapproval 3 \ n J; � n �� 5TPV� 0W�P �� N � � J G �1 ,SYSTEM OWNER: � y�t✓..J �OMe.a-v^er 1. Septic tank, effluent filter and dispersal cell must all be services/ mtiiinfihtd nL 1 ' as per management plan provided by pksfi �22d� 1 d ✓� D r• 2. All setback requirements must be 1,rlsMtfaNled ? J �` U Per aPPIC" Code / ord nenm. Attach complete plans (to the County only) for the system on paper not legs than 81/2 x 11 inches A size 1 elegy. a ^-- a�- C) 5 • SBD -6398 (R. 01/03) I vxkvwiq dd bqt - ;wq : ,FI as b ad +asam afriama1�R,:aez Al sjfsm HA S wwwribm % sboo - rkts30gG m as PLOT PLAN PROJECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 NE 1 /4 SW 1/4S 13 /T �: N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/18/05 BEDROOM 3 CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SI 1000 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 95.9/96.0 4' below qrade 358' Property Line Plans Designed Using P rty Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by WDNR Pro 3 Bedroom House 30' 30' ST B-4 60' -5 80' 1 ^ 80' 0 B -3 2 -3' X 69' Cells with >3' spacing -1 0' Vents B -2 Vent 15 10' B.M. Alt. >6" Standard Biodiffuser 30' 30' of Cover Leaching Chamber with 3 1. 1 ft2 of Area 20 6' Long 11 Grade at System Elevation Property Line PLOT PLAN PROJECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 NE 1/4 SW 1/4S 13 /T NCR 18 W TOWN Star Prairie COUNTY ST. CROIX • 5/18/05 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIR 1000 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 7-abelA -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 95.9/96.0 4' below qrade Plans Designed Using 358' Property Line Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by WDNR Pro 3 Bedroom House 30' r-5 ST B -4 60, 80' 80' B -3 2 -3' X 69' Cells with >3' spacing B -1 0' Vents B -2 Vent 10' 15' 10' B.M. Alt. >6" Standard Biodiffuser * 30' 30' of Cover Leaching Chamber B.M. with 3 1. 1 ft2 of Area 20 6' Long 11 „ Grade at System Elevation Property Line . Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 Y ears. r filter is being installed in 2 Effluent filter is to be cleaned once a year. Please note: a Large order to extend the maintenance interval of the filter. the ins actions pipes at the ends of 3. Once every 3 years, cells are to be inspected via p the cells. e into the system. 4. Owner agrees to limit greases, garbage, and water conditioner discha r g 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. d as per Comm. 83 8. Discharge into system is not exceed those require p CgoptIlegitncy Plan - -. ption #1. system fails, determine cause of failure, use emate of and install new system in tested replacement area. elevation, by removing chambers, removing biomat, O p tion #2. Install system at a Power and install new system. ble for replacement area, and system elevation p p tion#3. No adequate area is suita cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -45 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -51 Shaun Bird #226900 Wiscdnsin Departrpent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division i INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430377 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin , Ken I Star Prairie Township 038 - 1211 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 13.31.18.1153 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet SUHt Dt O TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. o Air Intake ROAD Septic ottom H D Dosing eader /Man. Aeration ist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer errand t Cover GPM Model Number 1 TDH Lift Friction Loss System Head ', T Ft f Forcemain Length Dia. Dist. to Well F Sy SOIL ABSORPTION SYSTEM BED/TRENCH Width Length N '.Of Trenches PIT DIMENSIONS NIV Inside Dia Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG IWELL LAKE /STREAM LEA G Manufacturer: INFORMATION CHAMBE R Type Of System: UNIT Model Number: '1 DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia 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 01 Yes 0 No L] Y=F] COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1351 212th Avenue New Richmond, WI 54017 (NE 1/4 SW 1/4 13 T31 R1 8W) Northgate 11 Lot 63 Parcel No: 13.31.18.1153 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes E] No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. • surety and Bins Divlsiofi � ?AI W. wa llem W1 Ave, P. O. Bofc 7182 loo., wi S37Or/ - 71 saaiafP Rfsit Pies er (b be f®ed i. by Co.) De artment of Commerce (09) M&3151 L 1 3o � a000� Sanfta t w0b C iiiia W x. IWIL Ad.. Omk 'C P ym � ,de 7 , v j /'1 may be aw d for aesnefty pupow rr vM Pfojoct Ad&M fNOWM isa meaft 0keW L A ppfierfi m >deI>e earth m - p1 FEW Ai hellbroaft L ye ✓ Propatyowaers r>ta ass � M e _ t a _ff — I.of - G Preperty Chimes lrlaft, ZONING OFFICE PfopefyLoeadm 1��3 8s Chy. soft zilp oade Pbose Nrhfber �!i• 'zsrecfifa _ t f Berw II. Type of *be& A that _ Pt o W �� rr sabdTVIMoa Name ___GW Dumber W, or 2 Flimmiy Dweft - limber of Bedeeoats ! - / ❑ Dewitt Un -�l? ❑ St ft owned - Dear Use - Des ► Dvafot at NL AV IQ. Type of I'Ierafit: (Mak em1ly eft beam om ire A. CW&kftfte 8 A.. &KNM � _ D Rep Mctmeafspsrem D �► ❑ other i 0 > ,l B. ❑ Pft Reaewel D rermk Rex�im ❑ chww of D r+e Mk Twoder a Nvw Liss Piesirae Her�if liwber and Date boxed >a�e Player /a / Iv. JDW of MRS s fcbo& am that ,2 . Jr - -P to LAoe W D Mww > M bL of asiubie) I at is. of MOW =1 11 At Made ❑ MWe PUB Sava Fiber ❑ caesancfed wiab w ❑ rfeasat I - hAkeaad D O pen D Andie 1learaehs MA D ReellmdafSfR Shad Piber 11 � spait Veda Filer (a] UM D ripe ❑ vier OWW v. Dispw=dnywA=vgt Ana hAnoWim Desip Flow l� >� s a A41�• � � ��cdl s�►araleh+ffioa ,✓ .�• v. : s In. Tank ftfo cpacw in Toni ft She Sled Fiber Pftbs c Gd1M (mans s o is C1311Met oaauaa aei cif SWic or fa�eefst- _ �►nebie7�m[ Unit VM ReWwwftft >4t`e asfaafe irlfnWRft�afd�elOWlS wieatfaeitedpleas. Si 'RS 1liffber Rueioess Piooe tiataber #221180 9 8 1 >88 McKenzie RA_ z 7 is- — Fwd 0 �'t� -, Vwr !.4-!w$I!a ftft Z!rCS 15) 635 -9609 cAgg Ilse M+ ❑ > w dW y r+eraaf Fag ® Grodwarz Dompluand 11 ow■er Giwa Reafa fw Denial > ;,dispersal ptic tank, effluent filter and mow � SZ - 0 cell must all be s—i /maintained �1 � u � S-Q� 134) )a as' per management plan provided by plumber. I setback requirements must be maintained ner appli ^able code /ordinances. Y3. t6-/ �Mliaas��eC9rbrb)Rrfie �apa�astlef�aaf/2 :11 :� «:� , f. k �. �_; � • �; �i 4 �� J( :. .. 1, r� . �. �: i i_ I Fogerty Plumbing ' #221180 28288 McKenzie Rd. Spooner, Wi 5 8801 (715; 535 -9G09 I o' Faw� 1 � 1 3 ,d�9F t dew, A/ oP K ®re- ,rAi ' rl S jr Ay �Y �•�GT.E� fs.8s c -2 62.s ' P�• 6 ps•� i �' Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 53 -96 lot ' '011014 tVAF .a -- a #s - .xr4eA" y s Pic `&Y FF rs' PE• l f S.8s H i f 0 C t 1 o it ►+ � O '• .► i • - fit ; = a SZ• 47- CA RL A+ ♦ ^ Fj CA i ao o ° o � 11 11 i "� ••m � N`�' ►-+ j 01- f1 N - it °o' 00 l ow A NgconsiA Depp tment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labdr and Humar, Relations Division m fSafety„ 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complate site plan on paper not less than 8 1/2 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 I.D. # dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION FkVIEWED BY DATE a.1 1f PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4,S13 T 31 N,R 18 -j (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 E TOWN NEAREST ROAD Hudson, WY. 54016 (715) 386 -3674 1 Star Prairie 212 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 ed, gpd /ft 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) 96.10 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 R1 S ❑ U ®S ❑ IL ® S ❑ U ® S ❑ U ❑ S [ILI 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 Trench ................. .................. ................. .................. 1 ' 1 0 -13 10 r 3/3 none 1 2 13- 9 10yr 4/4 none sicl lcsbk mfr 9W if .2 .3 Ground 3 29 -8 7.5 r 4/6 none ms 0SCI ml na elev. 99 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -12 2msbk mfr qW if .5 .6 2 " 2 12 -32 10 r 4/4 none sicl lcsbk mfr w if .2 `:.3 Ground 3 32 -84 7.5 r 4/6 none ms os ml na--- - .7 `:.8 elev. 9 9.5 ft. \ Depth to limiting factor Remarks: '+VIPtG OFFIC f CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 e. New Rich o d WI 54017 Signature: -r Date: 11 -8 -98 CST Number: m02298 PROPERTYOWNER Greenwood Entergris_ DESCRIPTION REPORT Pi9e'--2-of 3 PARCEL LD. # 038 - 1055 -10 ° Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10yr 3Z3 none 1 2msbk mfr qw if .5 .6 2 10 -26 10" r 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 126-84 7.5yr 4 6 none ms 0SCI ml na na .7 .8 elev. 99 ft. Depth to limiting factor +84 q6, Remarks: Boring # 1 0 -15 10 r 3/3 none 1 2msbk mfr gw if .5 .6 4 2 15 -26 10 r 4/4 none s'cl lcsbk mfr 9w if .2 .3 Ground 3 26 -84 4/6 none ms os ml na na .7 .8 elev. 99.85 ft. — Depth to limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6 S 2 12 -28 10 r 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 28 -84 7.5 r 4/6 none ms OSQ ml na na .7 .8 elev. 9 Depth to limiting factor _ +8 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER Greenwood Enterprise S O I L DESCRIPTION RE P O R T p r age of 3 PARCEL 1.1014 # 038 - 1055 -16 a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouhcaly Roots ' GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench . : :.... :,... 3 1 0 -10 1 1 2 mfr if .5 .6 ,. 2 10 -26 10 t 4/4 none sicl lcsbk mfr gw if .2 1 .3 Ground 3 26 -84 7.5 4 none ms 0scl ml na na .7 .8 elev. 99 ft. Depth to limiting factor +84 Remarks: Boring # ,x¢ & 1 10-15 10 r 3/3 none 1 2msbk mfr gw if .5 .6 .< 4 '<< 2 115-26 10 r 4/4 none s'ci lcsbk mfr if .2 .3 Ground 3 26 -84 .5 4/6 none ms 0SCI mi na na elev. 99 ft. — Depth to - limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6 5; 2 12 -28 10 r 4/4 none sici lcsbk mfr gw if .2 .3 Ground 3 28-84 7.5 r 4/6 none ms OS9 mi na na .7 .8 elev. 9 Depth to limiting factor +R4 Remarks: Boring # ria Ground elev. 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 NE4SW4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #63- 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 1 pvc pipe C el. 100 Alt. BM.= top of 1" pvc pipe @el. 99.80' J 0 Gary L. Steel 11 -8 -98 ST CROIX COUNTY SEPTIC TA14K MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM C e l l, � r� r OwnerBuyer / ! .Mailing Address UGi�►t i/S �rr �G��%r�so� Property Address IT S (Verification required from Planning Department for new construction) City/State Parcel Identification Number ",f-- 1Aa —Sy —eme LEGAL DESCRIPTION Property Location ,,,(,F '/4, Ste /., Sec. /3 . T_&_N -RAW, Town of aw ' y►� Subdivision Lot # 'A t Certified Survey Map # '�— . Volume Page # — - Warranty Deed # ?.>- yl0 3 Volume 22 d�o , Page # Spec house O yes Eki�o Lot lines identifiable U;Jes O no SYSTEM MAINTENANCE hqwWwwe-mdm=nftummafyowscpbcsyslcmemMnmkmgsprmmtmhdmibhmmRcwask&Ptopumamtmmce consists of pumpiOg oust the septic tank every three years or soowxs if needod by a licensed pu nqw. What you put into the system can affect the famtion of the septic tank as a treaament singe in the waste disposal system The property owner agues to sabmit to SL Crane Zoning Drpubaeat a boa faM signed by the owner and by a xnaswplumberjourneymnuph=bm restricted Plo oc a fiemsedpdmF - vadfying that (1) the an -site waskmat.erdisposal system is m prot?Q oonditian andl�or (Z) atier inspection and pmmpb g Cif necesmyl the tic task is less bran 113 full of sludge. Uwe. die undersigned bm read the abolfflunwrements and agree to maintain the pavatie wwaga disposal system with the standards Stier fa k herein, os sa by the Dimrimem of Cac®u am and the Dqmunest of Naftal Re umm, Stale of Wi*oonsin. Certification 7 0f 11ra - maktamed must be completed and retnan d 0 rice St Crone Cannty Zoning Office, within 30 - /!6,/U SIGNATURE OF Al'PId DATE OWNER CERTIFICATION I (we) c oMy that all statements on ibis form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of rice desc a by virtue of a warranty deed reooided in Register of Deeds Offim 7 SIGN&M OF APPU 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 r POWTS OWNER'S MANUAL & MANAGEMENT PLAN PAP I of L 'ITT SVSTM SPIOCKWAR _ Owner _ Septic Tank CapandtY j .. gd O NA Pennnit _ _ Sepfim Tank Marmiscow 11 NA OBS18N P Effluent Eioair Manaf�urari' •- O NA Nu nber of Bedroom O NA EHictent Filler Modet —Z'O'O O NA ms Namer of Pubic WMW tests NA P9mP Tad* CsPadtY 0 NA JA fEstimaeed flow (averagel Pump Tad* Nlanufacburer DNA mwad Design flow (peaki. (Eaim mill x 1.51 Pump j� NA Soil Application Rate _ w - Pump Model n XA Standard Idluaa/Effiuemt O ftv 1► Ps'eWeaanlennt Ufa ts, NA Fa On a Grease " (POW 530 n 0 SanaKraeei Fiver O Peeet Iffier sodremicai Oxygen Demand fBODJ 6220 mg& O NA O Medmical Aeraf o O Wetland Term Suspended Soils (ISO 5750 W01. 0 oi*dicdm O OWAr: Pnstteated Efeuent Ouaity Monft average COINS) O NA Biodnemncal Oxygen Damand, PXXDJ 53o mg/t. � ln- (,irovnd �raviEYl O in- �d %w ed) Total Suspended Solids (ram 530 nrgfl NA O At -Grade O Maand Fecal Ceiform (georneanic meant 510` cfun O Drip -Line O Ottrar: inn Effluent FW61cle Sim iin die. O NA O NA Od . O NA curer: O NA *values typical Im doaresd I r�awmw =4 septic tat : O NA �t SCHEME So fie E-vard Servtoe FregaenaV NA Inspect con�on of tandds) At least once every: °� nm S > 1 O Pump out con to ts of tank(s) vam combined sludge and scan equate a 4ltied (YJ of teal* volume O NA Sp I " I dSPGFsd a left) At least ace every: 3 13 magi 3 vows) O NA Cleary effluent filter At team ones every. ' — Z ° nvxdtW O NA Inspect puss. ,Pump conntrols & atam At feast once evert O y6wid TINA At least once every- 13 martlr(s! 12 NA Rusk laterals and pressure test ysartsl . O nrandrtsl � NA odor. At least area every_ ° . Yeastei over: L1.�► Inspection Of tanks and cuWersai cells shall to grads by an individual carniM are of lire fdlow9 heaves or moons. Master Pbdnec Master Plumber Resuicted Sewer. POWM Insrecaor: POWYS Maintainer; Sepfage Servicing OPesaror. Tank irrspactions mum induda a vkus, inspection of the tat*W to iderrltll/ MWIF nt tram idenft arty cracks aria" measure the vokxne of con""d dud" are scum and to dyad* for any had* up or polling of efNueM an the ground surface. The dispersal eeW shall be vesuaiy k"pecfed to dick the effluent levels in the observation PiPea ad to died* for any pond surface inrdreatie a failing aondi ion and �i the of effluent an the ground surface. Tire parting of effluent on the ground rnsY 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 entae 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, prMOatnMt units, and any servicing at intervals of 512 months, shall be performed by a certi ed POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event- paw L of - a Mkt V KT UP AND OPERATKIN far the P P or cid, ctw"1*011 that may impede the • la'OpO O dosage to d I, have the canto" celNsi. IN hi8h �ooracartrations am detected of the twMsi removed by a e swv aPOrAcr Fria to uas' System start up shall not occur When sail am liftis are frozen at the lafftadve •a UIB e70Cea.S war will be During power outages Purrnp taroks m�af► above normal i b a ding W- aid may power discharged m the drsPersal ceWsi in one large dose, averioadrn9 the ceMsi and reed in the badarp a scarface �ctnarge of e�Efltaerrt. To avoid #ft situation moire the corms of the pump tank removed by a Septage Servicirng Operata prior c restoring Fewer to the effluent pump or ooh a Fyuuru6er a POW('S der to assist in nageno Y operating pump to restore nommal ievels within the pump tank. Do not drive or hark over tanks and dispersd colh Do not drive or park over. a Otherwise drsdx6 or rwrrnpact. the area WWM 15 feet down slope of any �d or at sal area. the perfomnarnce and prolong the life of the Redyctiorn or eli nirnation of the f050wing horn the wastawater streams may improve dented floss~ AIIPertti d'�% f&t pOWTS: a m6iotics: ba wip e% C%pjatte buttr. condoms: cotton swabs: degreasers% water. fndt and vegetable peens% gam% Wages; herbicidW meat srx aps� �% aN% foundation drain 4sump iite y and water sofMW brkie. painting Products% perstiddee: ssi 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 $3.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. die of by a Septage Servicing Operator. • The contents of all tanks and pits shall be removed and properly Pow _ • 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 beers, or.must be taken, to provide a code _ compliant M7 system: A s SVSN *area has deers evaluated and may be utfted for the location of a replacement soak absorption systain. The replac:ernem area should be pfd from disAabance and cO w and sh odd not be itrErirngo ' upon by required setbacks from wfttkW and proposed sftucttam• lot Ines and wdb. Feise to pmt tine mphoement area Will result in the need for a new soil and site evolution to establish a suitable mpleOement area Replecornent systerm must coritdl► with tine rules in effect at that tarns. ` El A suitable replaoeirnarit area is not available due m setbactc and/or $oil - Barring advances in POWTS technology a holding tank may be wed as a last resort to replace the failied POWYS• to a sii m acerriart upon fab" POMITS a sot and site s no is a tank be to torate su may installed as a pasort to replace the failed POWTS. ❑ Mound and at -Wade soil absorption systerna may be nsc 1.0bucted n Ids fo rarriovaf of the bicmat at the infiltrative surface, R of such systems must cm'4* with the rides in effect at that: time. < <WARNNIG> > SPf'M. PUMP AND OTHER. SES ANDIOR NERN quamol TREAUM0 TANKS MAY CONTAIN LETHAL t3AS OXYoBHIL DO NOl ENTBi A S�T W IC. PU' On O OR TREATMENT TANK I ANY ANCEL DEATH MAY i�11.T. OF A pERWN FROM THE gffoWR OF A TANK MAY BE DBfKN.T OR VI POSSNILL �18D (715) J POVV= NWAtJ.Bt P01NTS MANrT Name Sa'TAQE SERINICNK3 OPIMATOR (Pll li I.00AI. REMJIATORY AUTHONRY Nests CAM C&uIJIIIIJ� Name �pp�� Q� Phone Phone( This doc+irneirt was than ad in oorepiacioe witli chapoer comcn 83.22M►Iltltd M and 83_WIL ul a IM. V1110=10in Adx*dsuarir• COde' 724103 li STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH +� v WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD 06/02/2003 10:15AN This Deed, made between Greenwood hhterprises Inc., a WARRANTY DEED Wisconsin Corporation EXEWT # i Grantor, ,I REC FEE: 11.00 TRANS FEE: 70.50 �I and Kenneth J Clsvoring COPY FEE: 2.00 CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St - Cmi x County, State of Wisconsin (the `Property "): R Area - — ,. -- � Name and Return Address - - - - -- - -'- Lot 63 of the Plat of NorthGate II, recorded in the Office of the Register of Deeds for St. Croix County, Edina Realty Title Wisconsin, on June 20, 2001, in Volume 8 of Plats, 400 S. 2nd St., #115 at Page 55, as Document Number 648882. Hudson, W154016 I 1203 z3� n3A-1 21 -50-00n i Parcel Identification Number (PIN) This i s not homestead property. h' (is) (is not) I � Ii i� � i it I� Together with all appurtenant rights, title and interests. ii Grantor warrants that the title to the Property is good. Indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, and reservations, if any, of record. I Dated this day of May 2003 OD EVTERPR NC . i (SEAL) (SEAL) E- Rusch, President i (SEAL) (SEAL) •Ma . Rusch Sec Treas � AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this / �t /' �-" day of _ May 2003 , the above named James E Rusch its President and Mary R Rusch, its Sec ftMas • I TITLE: MEMBER STATE BAR OF WISCONSIN ,• ` '�/ to (If not, me known to be the person S_ wh(j!4INFbAd the foregajrig authorized by §706.06. Wis. Stats.) i and acknowledge the same. U c) s t THIS INSTRUMENT WAS DRAFTED BY Mary R Rnsnh • qqrjdra Gehrkp O� Notary Public, State of Wisconsin ry J New RiChmorld, WI 54017 My commission is permanent. (If not state expiration date (Signatures may be authenticated or acknowledged. Both are not September 14 2003 ) necessary) ' of Names _ __ persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank (q., Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. IJVI E-Z" ''EBM7(' OD w :^• r ' � „ - � CA / to 1 ii. ! .. 4 r w 1 C3 lZy q ? W / w w I 'L C A ( ♦ G, t ) • is (A % 'gym wO t m *.. til 1 N 0 E '339.70' 1 tJ . O rl 1 iv 1 s N 0'5234' E 248.63 I c� cn I ti 1 C o cn f U w ,a. l00' - �. J> -� 100• f < 1 ° ru z ; ru A � Ul wa) oo ' C) ro I N 0 E `311.54' i � -- CD �- f 33 33 �+� ° o ru q � � J w i i f N 0 E 284.26' fix Co t Z . 40b. r Z Ul OD p�.ZZ•0t N \ t �; r • t \\ C) �► \ J` G 2 ON Co o o ° o `` ® 'Soo fS�a �2 2 O. 0� M Z Q 1 pj DD C) O O 1 Q„ �� O S� Q S o 3 �o_ •QO t Cil O 14 (JI o . 38.0 3 I r �S ° �° O' �► S 0 m O of N o p C; Im W vo I 1 qA - co I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County / 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 (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location r ( Govt. Lot 1/ /4 / T N R E (LW Property Owner's Mailing Address Lot Block # Subd. Name or M# State - Zip Code Phone umber ❑ City ❑ Villag wn Nearest Road ew Construction Use:—Residential / Number of bedrooms Code derived design flow rate J GPD ❑ Replacement ❑ �Pu�] lic or commercial - Describe: Parent material 64 J� Flood Plain elevation if applicable ft. General comments _ and recommendations: Boring E] Boring Bon # pit Ground surface elev. I ft. Depth to limiting factor 1 -4 in. 5EIEKplication 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 `/ az All F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Iication 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 1 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Eva ation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� 715 - 246 -4516 f i Property Owner _ Parcel ID # Page of Boring # ❑ 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 T_ F-1 Boring # E] 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 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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. SOD -8330 (8.6/00) PLOT P PROJECT Ken Oeverino AD 838 Summer Pines Circle Hudson Wi 54016 NE 1/4 SW 1/4S 13 /T 31 N/R W T N Star Prairie COUNTY ST. CROIX 5/18/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL )00( IN- GROUND P S RE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 00 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 95.9/96.0 4' below qrade Plans Designed Using 358' Property Line Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by WDNR Pro 3 Bedroom House 30' 30' ST B -4 60' AL B -5 80' 80' B -6 B -3 2 -3' X 69' Cells with >3' spacing B -1 0 ' Vents B -2 1 0' 15' 10' B.M. Alt. jf ��— Standard Biodiffuser od * 0' 30' Leaching Chamber B. M. 3 with 31.1 ft2 of Area 20' Grade at System Elevation Property Line ON-