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HomeMy WebLinkAbout038-1121-60-000 I 0 N O 3 n d a A o > ? 4 3 ID ci CD 'a M CD 4t � :s r �� -= Z °o� wW O ,w _ p fD N O (D ►'9 W� 3 p 0 ° 0 N a 7 � O �3 ° n O. fD O R O D Cr 3 N C U) M cn z D a m m co D G. y � W 3 n c°n n _ i O p1 Q) v W `_ N N N N (q G — � 3 Q D g .. l�I. 0 000 t l i l Z OIQ j' m IQ m O a 2 = m H j a) d. CD =r 3 °; yr N W � j > > o a Z o D D o O w O o a -4 �. p N ;o p O C N c CD a 3 Z m cn O 3 O ? n N. CL A 7 o. W m m w z c cn 3 � OD y Z W CD O N d � Q I W ~• _ O 0 N D1 C O O Q < C) N O O N I f0 h A O O N O O A O w O DO O O !0 ti O 0 N VV CD ° a- ~ y ti Wisconsin Departm: - it of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 1 Safety and Building ision A INSPECTION REPORT Sanitary Permit No: 405010 0 GENERA... 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: Greenwood Enterprises Inc. I Star Prairie Township 038 - 1121 -60 -000 CST BM Elev: f Insp. BM Elev: BM Description: too 100 ' Vc TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark A) & 1 h� y Dosing Alt. BM Aeration BI g. Sewer Holding + St/Ht Inlet 7,ab 97. o St/Ht Outlet � Q d TANK SETBACK INFORMATION 7-32 /6.2 0 TANK TO P/L ELL BLDG. Vent to Air rake ROAD Dt I t��i < =, r ;j _:rte �•; �;% .1 ��� `� l'i�' Septic � Dosing Header /Man. Say mt as /p le - Aeration Dist. p iped 7 7 Chu- ri►AX4-s - f a i Z I q3 7 < 17 Holding Bot. System 4a a3 Final Grade PUMP /SIPHON INFORMATION _ s / _ U Manufacturer — De St C ver Model Number J / TDH Lift 7 F 'c ' n Loss System Head TDH Ft i Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j r - I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf rec - INFORMATION / / „,, 'CHAMBER O Typ Of System: Model _ , . UST . � umpgr. / / // DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i� � Pipe(s) • 1, � _ Length L Dia Length ' � Dia _i Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over l Depth Over T Depth of xx Seeded /Sodded xx Mulched Bed/Tr Center ' Bed/Trench Edges Topsoil Yes No [ 1 Yes [ i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / _. / r . 1 -- Inspection '.ocation: 1347 212tew mond, WI 017 (NE 1/4 SW 1/413 T31N R18W) Northgate Lot 64 Parcel No: 13.31.18.1154 Q 'it BM Description = �j %Z sewer length •mt of cover - -- - 7 — - -- _ V d tional information. Yes :.. No Date Insepctor's Sig Cart. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Nviscons r Personal information ma ou p rovide be used for second u Madison, WI 53707 -7302 Department of Commerce y p y p urpose s (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the n paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number Che if revision previous application State Plan I. D. Number X �. �I`OI yDSO /0 — I. Application Information - Please Print all Information Location: Property Owner Name Property Location r --� Vj 004 Ei1 J- f r" r�S (If 114 W 1/4, S 13 T3) ,N, RIFE (o W Property Owner's Mailing Address Lot Number Block Number /Y/ � . C b4 6 y City, State Zip Code Phone Number Subdivision Name or CSM Number Ntw -59' - 7 ( 767 ) - ?& -36 NG r - II. Type of Building: (check one) ❑ City P( 1 or 2 F aaknn Town of ily Dwelling - No. of Bedrooms : ❑ Village ❑Public /Cott (describe use):_ ❑ State -Owned a Fr o�' r -% s Nearest Road �l-:2 I% . Parcel Tax Number( )3.31 III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 0-3 6o - 000 A) 1. jKNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued A Sanitary Permit was previously issued qb 5 © �/ ( /0 IV. Type of POWT System: (Check all that apply) •-X- A - E-f {', F-i Imo,,.- - �(Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland /❑ Pressurized In - ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line / ❑ At -grade ✓ } ❑ Aerobic Treatment Unit ❑ Recirculating ❑ O ^ l N &F — - 7 V. Dispersal/Treatme Area Infor 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 'T) = 9q.5 Elevation 111-5 �y3 6Y4/ a o ,0 0­­7 er = W. 33' 9 8. a5 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ C Y ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) I Pl ber's Signature (no stamps): MP/MPRS No. Business Phone Number .JgY►�eS �i C ev, a. (7/$) 8 3 —175 1 Plumber's Address (Street, City, State, Zip e) (6 ),3F ^ G / (0 5 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss 'ng Agent Signature (No stamps) - I Approved ❑ Owner Given Initial Adverse Surch Fee) Determination T � 1 nditions of oval /Reasons for Disapproval: (� �j ,_,{ O c�`�+ Q� Vmjr— jamCj e s 40 ti'7/"' C#f& .07/00) Cj t �� G�c .ALjooj En�t?r'. xS , lnL �Prope Ooinlr k 30 ` W' T' 1 N • Nt /v , S /v, S /3 � 3 /Z Pla r\ 1006 ' ju 91. 57 a....1L d •� -M � .. .r � (off Ti;k =7 t f P� l V ` E i P — CIO,r �. c te r �,, ✓.,;,,� ;�, At I\k -510 /d Goo ploy G� W ood �n ►��r'� XS , �nL. ( Prof * vin er, 0 �m =- g oo. o " �� �/ � " P ✓G � ; ©_ (�rcPosed �,J�tl 'Tan L' cl ;�}'•�^� -c e „, �c�st -a� so or 7 9' 1 ; Y� I - WiscbnNia. Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor ind Human Relations 'Division of Safety & Buildings in accord with ILHR 83.05, 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 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 VIEWED BY DATE V olt , /1 PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NE 1/4SW 1/4,S 13T 31 N,R 18 Igor) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1416 Third St. 64 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE JUOWN NEAREST ROAD Hudson WI. 54016 115) 386 -3674 Star Prairie I 212th Ave. [x] New Construction Use [ j Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement [ j 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, 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 MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 0 S ❑ U ®S ❑ U ® S ❑ U ® S ❑ U ®S ❑ U ❑ S MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed ITirench ................. .................. ................. .................. ......> 1 0 -12 10 r 3/3 none 1 2 12 -30 10 r 4/4 none sicl lcsbk mfr Ground 3 30 -84 7.5 r 4/6 none cos osa ml na na -7 elev. 99. ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -11 1 1 2msbk mfr 2 11 -3 sicl lcsbk m Ground 30 -84 elev. 9 9.8 ft. Depth to limiting factor ` 9 {E - Remarks: CST Name: -- Please Print jQjary L. Steel Phone: 715 - 246 -6200 Address: 1554 200th. New Richmonc6WI 54017 Signature: Date: 11 -8 -98 CST Number: m02298 PROPERTYOWNER Greenwood Enterprise DESCRIPTION REPORT Page 2 7'6f 3 PARCEL I.D. # 038- 1055 -10 " 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 0 -10 10 r 3/3 none 1 2msbk mfr QW 2 10 -24 10 r 4/4 none sicl lcsbk mfr if .2 .3 Ground 3 24 -84 7.5 r 4/6 none os osa ml na na .7 elev. 9 9.8 ft. Depth to limiting fact qb . ,� I + 2 4 �� N Remarks: UAt ney, 0 1 L. Y& & Boring # 1 0 -12 10 r 3/3 no .5 12 -24 10 4 Ground 3 24 -84 7.5 r 4/6 none cos I OSQ ml Ina na 1 .7 .8 elev. 99.8 ft. — Depth to - limiting factor Remarks: Boring # 1 0 -11 10 r 3 3 none 1 2msbk mfr if .5 .6 5:: 2 11 -20 l0yr 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 20 -84 7.5yr 4/6 none cos I osci ml na na .7 .8 elev. �- 100 ttl Depth to b . 3 5' 0 limiting factor +84 Remarks: Boring # LMj Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inca 1554 200th Ave. CSTM2298 NEgSW4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #64- 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 p ipe �A el. 100.40' \\ A O tt rn �/ .� 3 1 s� �° 2A ON to y Gary L. Steel 11 -8 -98. PR RTYOWNER Greenwood E4terprise DESCI RE - page of 3 PARCEL I.D. 038- 1055 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Cor>sWw= 8anciwy Roots GPDift in. Munsell Glu. Sz. Cont. Color Gr. Sz. Sh. fled 17imh WM1` " 1 0 -10 10 r 3Y2 1 2 10 -24 10 r 4 4 none sici mfr w Ground 3 24 -84 7.5 r 6 COS Qffa na elev. Depth to limiting factor Remarks: Boring # ? 1 4 < t: m 2 — Gmund 3 4 -84 7.5yr 4/6 none cos 0SQ ml na na .7 .8 elev. 99.8 ft. Depth to - -- liroiting factor _ +946 Remarks: Boring > r32 -11 1Q r 3 3 nane i tots mfr if .5 .6 5 i1 -20 0 4/4 none sicl icsbk mfr if .2 .3 fi r Gramd 0 -84 .5 r 4/6 none cos ml na na .7 .8 100 ttl Z-0 S �' z'- A, t Depth to limiting facto + „ Remarks: Boring # ) JI etev. � ft, Depth to knsrtirrg factor I I a POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner WesD G VWJ 2lSti`S Septic Tank Capacity a l ❑ NA Permit # SD�O Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model /4��Jp ❑ NA Number of Public Facility Units A Pump Tank Capacity al K Estimated flow (average) `30'0 gal /day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer A Soil Application Rate gal/day/ft' Pump Model A:NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A M A 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 Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ! I - Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ JNA Other: �NA Other: ❑ Other: f k N A * Values typical for domestic wastewater and septic tank effluent. Other: �& MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ year(s)(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: i_yearl 1(s) (Maximum 3 years) ❑ NA 2 ❑ month(s) ❑ NA Clean effluent filter At least once every: years) Ins Inspect pump, pump controls & alarm At least once eve ❑ month(s) NA P P P P every: ❑yearls) Flush laterals and pressure test At least once eve ❑ month(s) year(s) A P every: ❑yearls) Other: At least once every: ❑ month(s) ❑ year(s) � 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. 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 safe) abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: P Y Y • 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 ank be installed as a last resort to replace the failed POWTS. 9 may ❑ 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 6-tLtt Name Phone �h S , 1[83 —R-91 Phone 6n _ L C (PUMPER) LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PU ) Name Name C20 ?12ho /A Phone Phone r. ------------- This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3). Wisconsin Administrative Code. APR -04 -02 12:57 PM RASMUSSEN 7157553473 P.01 '� . - • -- •••u +V . 1 d rAA '115 385 4588 ST CRX CO ZONING Q003 ! ST (a= COUNTY 9BMC TAM MARCMANM AGREEMNT MD O WriMHM CIIR'iWICATION FORM i a bbWng Add 2(i/ (fa 2d/. C— _ (Va;ificdion roWaid flram Pbndnt DVanmat fw saw ooastrudian)_, i Cti /state �c� ��- ►+►�orJO o los5JO tY Parcel Identification Numbs _ 3 9 — I LW L MAO=ON Property Location �., S ic1 y Sac. J T 31 N -R`$ W. Town of Sl r- i SubdivWoa -� 2 'A d2 Lot # . Ca ds " Balvey4k S # ✓i Q Volume _ .. Page # A oc . 4f3 S82 i j Wamaty Deed # _ . Volume . Page # i span house Q0 yes D no Lot Hum identifiable El fires 0 no i�topropot are s>dd msiotenaaaadyaur ar�dc syatan coWd aoatttl is itt promstare fsilttte M ht�e wsstAe. Fttper tmlatettsoce oondset etpmft wx to septk taa3t CvW &W yam m sMW, g wo tbby s Hceased puatpa. What yon put into 60 gatm I No Gftd de fimctlm of the saptia Usk as a umtetaaaa arose in the waste dupa"I 0 i j tlts ptOperty 0"m sfitwa to sabnolt to St. Grant Z Wg Depu mew a asriamun fens. dpad by dw owner and by a � �Orptoeabat� j0amsyssaopbuanber. tastcictadphaaher � a ticaaecdptuapavi 71st (t) the oa.dts wadawaserdiepoet syaeem j Is iR papa opmda= 000&tkm wd/a (3) after bspwtkm sad paoaplog (if wccsaaryX de Olptic tack k ku than iii &11 otstudes. 1 I/w% dw wdsa4Wd have road dw abwn tegnierments sad ap w to msmbb the ptva b sewage dbpmd q0m with the swAuda set bdk hurls. u set by die Daparttaaat of C nmwn sad the Depatmant of Natarst Rawutas. 8tttle of ati M00W. Catttsatioa ebft that yasr sepft system hat bait mdadined mast he a x*01cd wd roft"d to We St. Croix Ca =y Zoning Office within 30 t rise three year do& date. OF AFMCANT DAIS 1 I (we) ea ft d t alt statements an tale foam are tmc to tae best of say (oar) kwwkdge. I (ere) sat (ere) tie owna(a) of die d,acn'hea dw^ by virtue a w nsaty deed recorded to ltogiseer of Dads Me, C GL ,'JAM OF,(1PPSLC DES il'X— D �� 1 ••w" Any bf K orme�tioa ttxat is eew•rrprareatedmsy matt � the saninlryperu,itbeir� mrolaed by t!►e ZosdaB DeP+rf�t. •s•••� a •• Wade woo tics application; a saAed waaanty abed from the Redittar of Deeds olden a aopy of dc oadfied ptvey mop of rofawoe k tatade to dw wuncty doet> 1 i i 4,1S1+ v7 &A.. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vi soonsin P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the s stem, on paper not less County than 8 1/2 x 11 inches in size. _Sf , Cr t) " I �• See reverse side for instructions for completing this appl catioRECEIVED State Sanitar Number Personal information you provide may be used for secondary purposes A PR E] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. R O S ZOO2 State Plan I.D. Number fP ropert I APPLI ATION INFORMATION - PLEASE PRINT LL INE I Owner Name ZO N ocati n 1i ,S l3 T �? ,N,RJE(or) Owner's Mailingg ddress Lot NulTier Block Number City State n Zip Code Phone Number Subdi " vi s ion Name or CSM Number ew I����wtor. _ ► Ya ► ( 8�- 3fo7tl rvo, 4 P1�wst 1. TYPE F BUILDING "" one) ❑ State Owned ° Cit Nearest Road Public EM 1 or 2 Fa2& DwelIin - No. of bedrooms _ ° To w a n OF -�'�a rQ, % U . Y III BUILDING USE: (if buildin. ypeispublic,checkallthatapply) Parcel TaxNumber(s) � 31. IT. [l 1 ❑ Apartment/ Condo 03$" uk— 60—am i 2 ❑ Assembly Hall 6 ^ C] Medical Facility/ Nursing Home 10.❑ Outdoor Recreational Facility 3 ❑ Campground 7 E] 'Merchandise: Sales/ Repairs 11 ❑ Restaur Bar /Dining E] Church/ School 8 171 MobileHomePark #] S it ation / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office Factory i�3 ❑ 4h J plfy - V. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable . A) 1. �f New 2. ❑Replacement 3 ❑Replacement of q ❑ Recon ` t of d ' M Rep - r ofu System System _____ _Tank Only______________ Exlstiny9tem ____ ___ ; � . A___ f _ B) ❑ A Sanitary Permit was previously issued. -;, Permit Number Issued V. TYPE OF SYSTEM: (Check only one)-)C-1zL.t . �;W p Non- Pressurized Distribution Pressurized Dis0lbution Experiments) th F1 Seepage Bed 21 Mound 30 S Holding Tank` 11 ❑ ❑ Y g 12 5qSeepage Trench 22 ❑ In- Ground Pressure ,`w � , 42 C] Pit Privy 13 E] Seepage Pit 1 43 ❑ Vauiivy 14 [] System-In-Fill 2 .51 l r1lik _b a" c VI. ABSORPTION SYSTE c I 1 F RMATION• �, 1. Gallons Per Day 2. AbsoFp3 ea 3. Abs ro p. Area 4. Loading Rate 5. Perc. Rate . Sy El;eet ' I Final Grade Re fired (sq. ft.) Proposed (sq. ft.) (G day /s (Min. /inch) ''^ Elevation . � `�9_ 17 Feet VII TANK Cap acity gallons Total # Of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existin structed Tanks Tanksl Tanks I Septic Tank or Holding Tank S-e ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onset ewage syst the attached plans. Plumber's Name: (Prfzt) PI u ber's Signature: (No Stamps) M No.: Busines Phone Number: Plumber's Ad (Street, City, State, Zip Code): '71S �/ 83 ^175 [ /�Qx 477 211 1 er^ i . COUNTY DEPARTM US E ONL E] Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) pproved ' ❑Owner Given Initial yrcchar 9 a Fee) - Y Adverse Determination 2 atlon J• (2 X. CO I NS OF �►PPROVAI,/ REASONS FOR DIS P ROVVA�L �A-1,l Q — �w.��ta��o.� �L, W 1 Qu�Z:���s. ` SBD -6398 (R. 4199) 111 1STRIBUTION: Original to unty, One copy T fety Buildings Division, Owne , Flumber , INSTRUCTIONS ' A 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed beforefthe expitaation date, and at a time of renewal any new criteria in the Wisconsin Administrative -Code will be applicable. 3, All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Proper owner's name and mai+ing address.' °Provide the legal description and parcel tax number(s) of where the system to be led. II. Type of building being served. Check only one and complete # of bedrooms if i or 2 Family Dwelling- r' III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. X ' VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab orosite ton;tructed -Arjd tank r.oeterial.. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smalfo rtt an 8 112 x 11 inches must be submitted to the county. The plans must in h following: A Ian ratan t scale or with complete dimen ions location of holding tank(s), septic include the lot d o s ca o to s se t ud ) P p P O. p 9 tank(s) or other treatment tanks; building sewers, wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ----------------------- - - - - -- - --------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I� i ( pro peIr o o n! V- IC ,.e } a 9,3 ! r M P D 4 �l� s (Pr OWheY") /3 , "x' 31 N ©� Prosed t t j •, t� �1c�t We; se r 1 a— �t be lout fe B ��� �► Tan 4 "N l owt .- gyp. Abe l A i ®o F ;1�-cr i b O 1 s MPQdO - 7313 5 ` 0 17 C.L ' DOCUMENT NO. STATE 13AR j F WISCONSIN FORM 1 -1982 5877 1. W RRAVTY DEED �e� r 474 This Deed made between Walter H. Kraemer, a ST- CROIX CO. F WI single person i Ras'el for dusord -�-- -- - - - - -- — li �I SEP 2 4 1994 I and Greenwood Enterp rises Inc. a Wisconsin cor oration �� 4 ' ,� Rs titer of psale Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN TO conveys to Grantee the Iollowing descrlbed real estate in St. Croix LAWSON, MARSHALL, MCDONALD Cnunty,&lateofwisconsin: 3880 Laverne Ave. No. Lake Elmo, MN 55042 See attached Exhibit "A". 0 03 1o55T95 Tax Parcel No: - 6 it 5 o?L7 C D TRA�kFER This is not homestead property - (IS) (isnot) Together with all and singular the heredilaments and appurtenances thereunto belonging; And, warrants that the [life is good, indefeasible in lee simple and free and clearof encumbrances except and will warrant and defend the same. Dated this stay of ,71 (SEAL) —2u (SEAL) • Walter H. Kraemer (SEAL) (SEAL) AUTHENTICATION ACKNOVI LEUpMENT + I Slgnature(s) STATE OF D1ut30t=wmMINNLSOTA WASHINGTON ) ss. County. } authenticated this day of... Personally came before me Ihi� (Jay of —� f g�the above named Walter H. Kraemer a single p erson TITLE: MEMBER STATE BAR OF WISCONSIN (11 not, to me known to be the person who exculed the authorized by § 706.06. Wis. Stals.) Ioregotng Instrument and acknowledge the s me. THIS INSTRUMENT WAS DRAFTED By LAWSON, M ARSHALL, MC s CA).()WLTZ - - 3880 - Laverne -Are r -No-.- —__._ _ _,_�i(hM�`� i . �✓ Lake Elmo, MN 55042 --- W9-V ]Qne: ((s51) 777 -69b0 '�s I�ac���� �( inne x (Signatures may be authenticated or acknowledged, B01 iA m1 1931 n' i$" � �� MK are not necessary.} 1 56 1V10RtII I � ' ) t. (If not, state expiration Pf3 /21000 19 Names of persons signing in any capacity apoufd be t➢ped or Printed below their seona+ures. ) WARRANTYDEEO STATE BAR of WISCONSIN S61 NTF pppe FORM No 1 --1982 Nelm Prins. p O Box 10200, Careen Bay, WI 54307.020e 1-d 11s00L 131,2 SAIL woii3nNisN00 0001113N01S eES :EO 00 92 46S i z �nl P59pm475 EXHIBIT "A" �i i 3r i A parcel'of land being all of the NE1I4 of the SW 1/4 and all of the NW 1/4 of the SE1 14 and all of. the NW 1/4 of the SWI /4 except the North 47V of the West 463 of said NWl/4 of the SWIM, all being in Section 13, T3 IN, RI $W, Town of Star Prairie, St. Croix County, Wisconsin. I .. ...............orate " r,b day of '19 S , Pona Ily came before me this day of 19 flf the above named ter H. Kraemer a sin le erson TITLE: MEMBER STATE BAR OF WISCONSIN (11 not, authorized by § 706,QB yyis. Stats.) to me known to be the person —who excuted the TruS INSTRUMENT WAS DRAFTED By loregoing inslrurneni and acknowledge the s me. LAWSON, MARSHALL, MCDONALD & t.ALOWL -r ---3880- Lave r►ze -Ave No. - - -- �_._.___ •",v. �,.,�J , Lake Elmo, MN 55042 i��h� - ti� ✓ TP I g WQnk 1? 717 696 (Signatures may be authenticated or acknowiedged. of 'll r� bfi Inne ,..sofa 2 olyi1f X 3[ are not necessary.) /r�( g ig" t, {If i not, stale expiration VUIIlfR ISSIUfI tXA{f9S �)R�(� 'Namesol eraenssi nin in an ca 19 ) 9 9 y PeGity Should be typed or Prim led bNOw their si nalurea. WARRANTY DEED STATE BAR OF WISCONSIN 581 NTF OOW FORM N. 1 -1082 Neira Fnrins, P.O. 13or 10200. Green pay, WI 54307•ozo8 T'd 1P00L 81�2 91L wono Nisw00 000M3W01S egS :EO o0 92 des NORTHGATE II IM of tlr SW IM and is pre of We NW W orth lof, S phhn of the NE ' 1 atthe PMt d NaWGate. as recorded m Volhrrhe 7 of Plats. Prhge 46 ordre S<Crotx y . inSectionl7. T31N. RtSW. rowsorSurPrairie . Q w s oixCotmty,wISoti " Avu E 1/4 CORNER SECTION 13 `731N. R18V Ita[tlhlYb 8 -210 7,0r ft SECTION CORNER MONUMENT FOUND N --, r . ALUMINUM CAP _ °' 1 2' X M• ROUND IRON PIPE WEIGHING ' It t n 3AS LBSIFT. SET Q S i IM'IRON PIPE FOUND 9 SCALE IN FEET 1' IRON PIPE FOUND Z IT unUTY EASEMENT PARA WITH i 0 100 200 300 s . LOT OR RIG HT-OF -WAY LINE al # - \9coNS�� a E RuaeA. RLS - BUItAING SE18AIX IJNH -WNTH SHOWN � Vertical Detum is US.OS.1929 AdjnTSnent egi�taed Wizomin Laid Swveyor ,µy�� PONDING OR DRAINAGE EASEMENT LINE Dated trite 26th day of February 2001 11 MHSRW >} ALL OTHER LOT CORNERS ARE MONUMEN TFD 3 at s ,archon d: WITH I'X24' ROUND IRON PIPE I l a wh. jO WEIGFONG 1 a 61SlFT. _ _ - -- _- .. N u 30 W 29 h' m " 31 36 �' '" 35 to , 32 n N N o ru 34 W 33 N o 0 n = z z I o NORTH ATE N . z z z Volume 7, P► tS; Page 46 b .00' z 2400 N89'0T26' 213 NO i 0 .17.00 f 41.00' - �,RI,)C �X�i -M i 28.00' 78.00' 111.00' 1185.00' SB.00' 1]].00• 67.00'_ 183.00' 209.00 :\ 190.00' 209AW 225.00 209.00' 238.00' e `� 4NL - IQ tTa1Ki1RCf l W CAsewAT 17i 200.00' r 1 p CKCKMT n o , P N Y.40' X30.20' ua a N N Z W J J'_ lye N N h 47 2 „ ct No P T ' 45 W 46 m np m n q = 42 z N - 43 - a tea 44 - - - - ^ 1 y� - - = g 441 .- -. - - ly v r' Z - - i N 2 Z - h -. 114.49• - 200.00'- - 20000 - 209.00 - - 207.47 57�a t a '00 270.00' ry N 89'11'00' V 930.96' a0 63.95' - -- 180.00' -- - Z - - - - 212 AVE. © " tea/ z6.0s - / . N - S 89-11 - E 930.96' - \� u 178.98' - - -- - _207.00' - - -- - _205.98• - -- - -- 211.99 -- 127.01'_ -_ ^ ^ 15' / N ml / / P !7 W / / WN•'. ' W 64 C �� W WI � c n 69 N - 68 n " 67 :h 66 65 z z ° 70 7 �I 9g S 88'50'52' E o o S 88'50'52' E z _ S 88'50'52' E lu S 88 E ol'l� ]5,00' z h _ _ i 7& 205.99' Z 207w z ( S 88'50'52' E 1927.33' 1plfp4 awp ptaWart C KMi h°x CLEV. Ie"O I r a0 STRXTtRCS K s W EASDVMT 207.39' 30.00' 195,00• 137.01' 70.00' 205.99' 212.00' 157.39' 216.65' 1 180.00' 1 \ 88'50'52' E COUNTRY_MEADOWS FIRST ADDITION_ - 1rJ / 16 I ---- 3. ----- -- - --- _ _ -- owNFRS: - --- --------- VOL. 6 O F PLATS, P. 2 ♦ ---- --- -- ----- Gromwood Fsnaprisn, Ise. 2111 C.T.N.'+C" GENERAL NOTICE STATEMENT: The parcels Yawn on this plat we whjm to Sate. County o New Rk--d. WL S4017 end T-Vft Iwo, des and ih;gda M C-A. wetlatda, minimum 1011 AMC. soar 90 Pared, ate.) > oo° ►`73y'01• f Before purchasing or deveWng my parcel. moan the St. Curia County Zoning Office and the SURVEYOR: appropriate Town Board for advice. This swement put on this plat at the direction of the St. . Croix County Fuming. Zoning and Parrs Comminee. �.� 49 s6 3 / luxes E. Rharh ' 2141 County Road C \�J f New Richard, VfL 34017 . .. This irhstrhanhem dnfled by lames E Rusch Sheet 1 of 3 shceu g< ? > z (j) v, z �— v c cu z m E r o � O vZ rn ❑ ..m M ° �° Z Do M �, m r "n TJ m � (� O 0 1'. ' - ,� Z - 0 m W m C/) Z �7 m O O X c > mmmj z c X Z Cl) � = m O M � oo _ cn m ° Z c o 0 - �' r z z — CO) r C'1 y y cn m > ;u G) C r z o 171 O � � „ NOUN ^o p o m Z O m< C a) O �� `� �m o W m ��^ �gSO Z o >> m a a a Z G) M ;a � � � � cOn n ^ m `I c� �mro�x'a�g��o O � �� a Is _ + N Cl) ,� n � � g� 0 wx _W o n fir ° c � o z a V