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HomeMy WebLinkAbout038-1208-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county' St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488219 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes IPrivacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Wirth, David I Star Prairie, Town of 038- 1208 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: JW I fi� M LET 14.31.18.112 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e " -=, l Septic Weeks �• Benchmark Alt. BM 3 ,1 Z l q `7, 1 Aeration 0-4 Bldg. gewer Holding St/Ht Inlet 7. TANK SETBACK INFORMATION St/Ht Outlet — 7 1a[ 5Z. � TANK TO f/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 Z r /LiA, 3 � 1 Dt Bottom Dosing Header /Man. g Is C IZ (o Aeration Dist. Pipe Cl Z - t Lp i �5 Holding Bot. System Z4 c1t Q377 5 II I PUMP /SIPHON INFORMATION Final Grade Z Z I . 7 Z I clitz, Manufacturer Demand St Cover l , GPM C IS . 7 Model Number TDH Lift Friction Loss System H T UH Ft Forcemain Le Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Uq epth DIMENSIONS 7 Z SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ; v r Type Of System: i UNIT r C L1 L � Model Number: Gay DISTRIBUTION SYSTEM Alr�L- ��{� �4 Header/Manifold r �� Distribution ` x Hole S x Hole Spacing Vent to Air ntak p Pipe(s) t Length Dia Length Dia Spacing Q v`cl SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over s Depth Over xx Depth of xx Seeded /Sodded xx Mu ched Bed/Trench Center Bed/Trench Edges " \` Topsoil Yes No Yes F0, No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1278 217th Ave. New Richmond, WI 54017 (SE 1/4 E 1/4 14 T31N R18W Prairie View Estates Lot 33 P rcel No: 14.31.18.1128 1.) Alt BM Description = /` t `�' °�� c � � e L C�6v �'`� �' f "'X 2.) Bldg sewer length = , j� - amount of cover � 3t� Plan revision Required? [] Yes -)<No -7 -7 6(j Use other side for additional information. — I Date Insepctor's ignature Cart. No. SBD -6710 (R.3/97) Salety and Buildings Division County AIN 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 — 7162 Sanitary Per Nu (to be filled in by Co.) Nvisco (6 Department of Commerce . umbe Sanitary Permit Applica on State Plan .D N r ,., � In accord with Comm 83.2 1, Wis. Adm. Code, person maybe used for secondary purposes Privacy w, sI5 D Project Address (if different than mailin dres 03 < ( — I. Application Information— Please Print All Information 0 6 2006 0 3/ U tar %,— ✓ 0 _ e© JUN Property Owner's NotT Parcel f t N Block # QI/ / a 11 ST. CROIX COUNTY Property Owner's Mailing Address ,/r Property Location . 112 D ' /., %,, Section City, State Zip Code Phone Number / ' T N. R� II. T e of Building (check all that apply) a �L� Subdiv Sion Name CSM Number or 2 Family Dwelling - Number of Bedrooms / I s ❑ Public/Commercial - Describe Use C1 State Owned - Describe Use ❑City_❑vilta a wns ' of J � K III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. �ew System E) Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision Change of ❑Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Che ck all that a l Y Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Fitter ❑ Constructed Wetland ❑ Pressurized In -G d ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line ❑ Gravel -less Pipe 9ther (explain) V. Dispersal/Treatment Area Information: /0 A / "T!)� Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sp Dispersal Area P oaosed (st) System Elev do J r j � - O Vl. Tank Info Capacity in Total Number Manufacturer Prefab Sic Ste 1 Fiber Plasti Gallons Gallons ofunits Concrete Constructed Glass 5 Nav Existing Tanks I Tanks Septic n 14olding Tank tcTv tmcntUnit Dosint; Chamber Vv VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown an the attached plans. Plum er's Name (Print) , `` Plu Signature MP /MPRS Number Business Phone Number Lol h er's Address (Street, City, State, Zip VIII. nh' /De artment [Ise Onl pproved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued t ing A ni Si ature ( amps) Surcharge Fe) p U /, / GZ /%� ❑ Owner Given Reason for Denial U l� �` IX. Conditions of Approval/Reasons for Disapproval 0 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. s` 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system an Paper not less than 812 x It inches in size SBD -6398 (R. 01/03) ����, k, �� "A I PLOT PLAN PROJECT David Wirth ADDRESS 1020 Tamerade Place NewRichmond W. 54017 SE 1/4 NE 1 /4S 14 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 6 -06 -06 4 y 22052 BEDROOM DATE CONVENTIONAL XXX At -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. Top of steel fence post orange ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as BM Vent SYSTEM ELEVATION T- 1=92.2 T -2 =92.2 >'T9 Of Bio Diffuser with Cove 3 1. 1 ft ^2 per 6„ chamber IN,. ('1rade at SysteM Long 34 Elevation 1 100' a;B O ob pipe 90' ` Town toCoC 50' _ BM 1 B o 5 , 30' 1, q 7 20' st \ 2001 15 PL 4 Bed House Garage g Driveway - L 01E PLOT PLAN PROJECT David Wirth ADDRESS 1020 Tamerade Place NewRichmond W. 54017 SE 1/4 NE 1 /4S 14 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr . 22052 DATE 6 -06 -06 BEDROOM 4 CONVENTIONAL XXX At -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE O LOAD RATE •7 ABSORPTION AREA 857 # of chambers 28 IL BENCHMARK V.R.P. Top of steel fence post orange ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.p. same as BM Vent SYSTEM ELEVATION T -1 -92.2 T -2 -92.2 >12" of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber s 6' L � Long 34„ Elevation 1 ' S 100''`' q;B O ob pipe 96 Town toCoC 50' BM B1 � 5 A `� ! � 5 30 20, �s st 200' 15 \ PL 4 Bed Hous Garage Driveway - 0 �: 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 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. fi percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ____] Property Owner Property Location �.`� r r Govt. Lot 1 /4 �` -'l /4 S T 3 N R E( W /lo L r� �. Property Owner's Mailing Address / Lot # Block # Sulxt. Name or CS fi lr Q TGt f� e I ek el- c Cjty r / S Zip Code . Phone Number ❑ City ❑ Village C&Town Nearest Road M,New Construction Usex Residential / Number of bedrooms Code derived design flow rate �� GPD ❑ Replacement ❑ Public or commerd - Describ - - - -- -- Parent material /'r�� G . ca �detGtJI'% Flood Plain elevation if applicable ft- General comments and recommendations: -r7 1 9 a Boring # Boring Pit Ground surface elev. q, A Depth to limiting factor - 5� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ol ff 1' /- �Z 2 oring # Boring G- ` r7 pit Ground surface elev. �tJ • � ft. Depth to limiting factor in. Soil Application Rate n Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff42 Z.z Effhrent #1 = BM > 30 220 mg/l. and TSS >30 150 mglL ' Effluent #2 = BOD < 30 mgA.. and TSS < 30 mglL CST Name Print) Signatu CST N UMber i y t< r V /✓ Address/ Date Evaluation Conducted / Telephone Number r f <7 Page of Property Owner /y .GE. � t � / �' `�" ` Parcel ID # a Boring # ® Boring Pit Ground surface elev. R. Depth to limiting factor in. Sof lication mate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E1#2 � _ l G% F-1 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E] Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg1L 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. SM (8.6/00) I Soil Test Plot Plan Project Name David Wirth Byron B'rd Jr. Address 1020 Tamerade Place NewRichmond -� Wi.54017 CST #220527 Lot 37 Subdivision Prairie View Est. Date 6 /6/1906 — County- ST. CROIX S E 1/4 N E 1 /4S 14 T 31 N /A W Towns hip StarPra iri e Boring Q Well PL Property Line# Alt. B ,BM or VRP Assume Elevation 100 ft.top of steel fence post with orange ribbon System Elv T -1 =92.2 T -2 =92.2 H.R.P Same as BM SCALE 1" = 40 ` Unless other wise Noted �� 95' 2 60' - l oo' B cfS 96 Town Rd. toCoC 50' BM BI 45' 30' �, /1 40' 200' PL 4 Bed Hous Garage Driveway t Wisconsin Department of Commerce SOI E UATION REPORT Page of Division of Safety and Buildings in accordance with Comm Wis. dm. Code i County Attach complete site plan on paper not I l siz Ian st include, but not limited to: vertical and h rizonti P ), dire 'on a Parcel I.D. percent slope, scale or dimensions, no arrow, and location and distance ar Please grin all in I f ,q IT-2006 Reviewed by Date Personal information you provide may ba use for secd�ld purposes (Privacy Law, 15.04 (1) (m)). Property Owner ,ST.CROIXCOUNTY ropertyLocation r of ,) %1/4���14 S T 3 N R(' E( W Property Owner's Mailing Address Lot # Block # Subd. Name or CS In Q TGff�ey'a'� �� 3 7 1!^a ^r e� City stale Zip Code Phone Number ❑ City Village Town Nearest Road MNew Construction UseX. Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commerce - Descnb : Parent material iY1a� i c��✓�c ALtle� Flood Plain elevation if applicable �� ft• General comments and recommendations: F- 1/ Boring # Boring pit Ground surface elev. 9 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ®Boring # Boring j - Pit Ground surface elev. � fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '042 - a Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 ffx CST Nam Print) t _ 1 Signatu CST Number Address Date Evaluation Conducted Telephone Number ,tom Property Owner IPA 0 G / Par6elID Page of Boring # Boring N' a Pit Ground surface elev. -1 -i�= Depth to limiting factor -�' L �"— in.I lication hate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDhT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 j _ ❑ Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. F — sciA pp l ication 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 Q Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 1220 mg1L and TSS >30:5 150 m9A- ' Effluent #2 = BOD, < 30 mg1L 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- 2648777. S13i}8330 (R.W00) PLOT PLAN PROJECT David wrth ADDRESS 1020 Tamerade Place NewRichmond Wi. 54017 SE 1/4 NE 1 /4S 14 /T 31 N/R 18 w_T owN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr . 22052 DATE 6 -06 -06 BEDROOM 4 IV CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 k BENCHMARK V.R.P Top of steel fence post orange ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P same as BM Vent SYSTEM ELEVATION T - =92.2 T - =92.2 > 12" of Bio Diffuser with Cove 3 1. 1 ft A2 per chamber 6" —Cyrade at System Long 34" Elevation 100' 95' B2 60' 100' B3 O ob pipe 90' � Town toCoC 50' BM B1 45' 30' 20' st 200, 15 PL 4 Bed Hous Garage Driveway Soil Test Plot Plan Project Name David Wirth Byron B' Jr. Address 1020 Tamerade Place NewRichmond �" Wi. 54017 CSTM #220527 Lot 37 Subdivision Prairie View Est. Date 6 /6/1906 _Count ST. CROIX S E 114 N E 1/4S T 3 1 N /R W Towns hIp Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft top of steel fence post with orange ribbon System Elv T -1 =92.2 T -2 =92.2 H.R.P Same as BM SCALE 1" = 40 ` Unless otherwise Noted 100' 95' 2 60' 100' B %' Town Rd. toCoC 50' BM J BI. 45' 30' 40' 200' PL 4 Bed Hous Garage Driveway I ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 4li ghes in size. Plan must include, but not limited to: vertical and horizontal reference pbi�11qkM), direction and Parcel I.D. y percent slope, scale or dimensions, north arrow, and location oRdyifstance to nearest road. pending A IJ6 0 Please print all inforniWtign. ;; ,. Reviewed by Date Personal information you provide may be used for secondaty'pN[pDaas (Privacll.hew s. 15.04 (1) (m)). Property Owner .�� i ropertyLocation E�alen Pro rties Ltd. Povt. Lot SE 1/4 1/4 S T N R W(or) W Tj p Property Owner's Mailing Address T' ' ` of # Block # Subd. Name or CSM# 1430 220th. Ave. 33 na Prai City State Zip Code P ne Number r ❑ City ❑ Village ® Town Nearest Road New Richmond Wi. :1 54017"- � 'I5 1 Star Prairie CTH 11 C" [3: New Construction Use: ER Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable na ft. General comments and recommendations: trenches @ el. 96.20' Boring # F] Boring 100.2 +110 1 ® 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 1 0 -10 10 2/2 �S 2f .5 .8 2 1022 7.5vr 4/4 none scl 2msbk mfr 3 22 -110 7.5yr4/6 none ms osq ml na na 7 1 2 ❑ Boring # F] Boling 100.4 +110 ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture E 2msbk Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color 'Eff #1 'Eff#2 _ mfr cs 2f .5 .8 7.5 4/4 none mfr 9w if .4 .6 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L ' Efflqej #2 = BOD < 3P mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel 02298 Address Date Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 12 -4 -2000 715 - 246 -6200 l Property Owner Teri Properties, Ltd Parcel ID # _ppnrli ncl Page 2 of 3 F�3 Borin # Boring g ©Pit Ground surface elev. 100.6 ft. Depth to limiting factor +110 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 I 'Eff#2 1 0 -12 10 2/2 none L 2msbk mfr cs 2f .5 .8 2 12 -28 7.5 4/4 none scl 2msbk mfr 1f .4 .6 -11 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor �" 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 I Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit I 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 i ' Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& 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. SBD -8330 (R.6100) I STEEL'S SOIL SERVICE Gary L. Steel Ewlen Properties, Ltd. 1554 200th Ave. SE-I S14- T31N -R18W CSTM2298 New Richmond, WI 54017 town of Star Prairie MPRSV1l -3254 (715) 246 -6200 lot #3.3- Prairie View Estates 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 teat was conducted. 1 " = 40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. ,BM.= top of 1" pvc pipe @ el. 100.60' 4 ` o °\ s { (, • Gary L. Steel 10 12 -4 -2000 sl. URUIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address /e2, /Q' e ^uc% 1,7 Property Property Address / 7 l fl ! \Q (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number - `-' /o?- E LEGAL DESCRIPTION Property Location' /4 G 1 /4, Sec., T -7,/ N RZZW, Town of Subdivision �ra r rt �-IL 6 (j 5 ' , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �j �� , Volume �� , Page # l Spec house yes Lot lines identifiable 1AV no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedrooms Lj SIGNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �J Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer lL ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units q A Pump Tank Capacity ga l A Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) (� gal /day Pump Manufacturer ❑ NA Soil Application Rate . r 7 gal /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD _ :220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L fl(in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /LNA ❑ At -Grade ❑ Mound Fecal Coliform (geom etric mean) :_ ° 100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) 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: ❑ month(s) (Maximum 3 years) ❑ NA IX year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ 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. GMW (4 /01) Page 2 , y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: f A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a- suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T e a- s o been luated to ' tify a suit a placemen are . Upo ai re of the ' P a sot d site val ion st e p rfor ad to I ate suitabl replace ent a. If n aceme area availabl oldin may b in ailed s last r sort replace he i ed POWT . ❑ 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 ,^o n < rG� �• Name Phone l� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name r G ya ` < Phone f c Phone 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. U -2582 P 31 7641afS STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIK CO., WI RECEIVED FOR RECORD This Deed, made between Angela L. Larson and Patrick L. 05/27/2084 mew Larson, husband and wife Grantor, and David V. Wirth and Robin R. Wirth, husband and wife WARRANTY DEED Grantee. EXW It Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRAITS FEE: 77.70 (if more space is needed, please attach addendum): COPY FEE: Lot 33, Prairie View Estates, Township of Star Prairie, St. Croix County, CC AGES-. 1 Wisconsin. Recording Area Name and Return Address S &C BANK PO BOX 10 BALSAM LAKE, WI 54810 038- 1208-30 -000 Parcel Identification Number (PIN) This homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and right -of -way of record, if any. t Dated this day of May 2004 - * — -- - -- — - - -- -- s .Larson - - -� — P _ Patrick L. Lars - -- AUTHENTICATION ACKNOWLEDGMENT Signature(s) —_ STATE OF (,J AJ% t't a�n. ,`.� ) ) ss. - - - - - -- — - -- — - _ S'I Cj-v i 1i ___ County authenticated this day of Personally came before me this to _ day of MAy , 2004 the above named — - -- — — — - -- -- Angela L. Larson and Patrick L. Larson, — * husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument a cknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ Attorney Krisdna Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. information Professiotats Co.. Fond du Lae. WI STATE BAR OF WISCONSIN 800 655 -2021 WARRANTY DEED FORM No. 2 -1999 Parcel #: 038 - 1208 -30 -000 06/08/2006 03:19 PM PAGE 1 OF 1 - Alt. Parcel # 14.31.18.1128 038 - TOWN OF STAR PRAIRIE Current X , ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DAVID V & ROBIN R WIRTH O - WIRTH, DAVID V & ROBIN R 1311 STARDUSK DR NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): "= Primary Type Dist # Description " 1278 217TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2.010 Plat: 2351 - PRAIRIE VIEW ESTATES 038101 SEC 14 T31N R18W S1 /2 NE1 /4 LOT 33 Block/Condo Bldg: LOT 33 PRAIRIE VIEW ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 14- 31N -18W NE Notes: Parcel History: Date Doc # Vol /Page Type 05/27/2004 764035 2582/311 WD 05/27/2004 764034 2582/310 WD 11/05/1999 613378 1468/556 WD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 26,000 0 26,000 NO Totals for 2006: General Property 2.010 26,000 0 26,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.010 26,000 0 26,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 vY ' ootia go l o t s n YA r CI s • 1 as • t IX S 62'26'13" W UKAINAUt ANU JVIL tKUJIVN ELAN I'VK 11'11, VLAL 11415 INULUUt, N 89'01'50" W BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, N 89'01 50 W FILLING, OR EXCAVATING OR PLANTING IN ANY POND EASEMENTS, S 00'00'40" W WATER DRAINAGE DITCHES, WATER RUNWAYS, WATER CULVERTS, - S 05'32'05" •E BERMS OR GRASS SEEDINGS. �`gGOM S 00'00'40" W Each porcel shown on this map is subject to State, County, and Township S� S 00'00'40' W laws, rules and regulations (i.e. wetlands, minimum lot size, access to S 65'38'57" W parcel, etc.). Before purchasing or developing any parcel contact the (i NALD R, S 32'49'49" W St. Croix County Planning, Zoning and Parks Committee and the appropriate JOHNSON S 65'38 57 W Town Board for advice. 9 N 00'00'40" E A WIS Y, S 39'12 41 E BEARINGS ARE REFERENCED TO THE EAST LINE OF THE ' N 56'40'11" E NE 1/4 OF SECTION 14, TOWNSHIP 31 N., RANGE 18 W. N 10'12 55 E WHICH IS ASSUMED TO BEAR S00'00'40 "W. V 00'00 40' E 3v ��� 5' 7" W ALL LINEAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST ONE (1) 0'00'40" E HUNDREDTH OF A FOOT. ALL ANGULAR MEASUREMENTS WERE MADE TO N 0 S 0 8 E THE NEAREST FIVE (5) SECONDS AND COMPUTED TO THE VALUES SHOWN. S 70'44'25" E BENCH MARKS N 44'1 '11" E OF IRON PIPE N Oo' '4 " E UNPL A T TED LANDS Elevations of -------------------------- E 2643.19' NORTH LINE Of THE S£ 1 4 OF TH£ N£ 114, SEC1701V 14 210.21' 514.30' N18'54'29 "W � VAR /ABLE INDTH 33.77' • 87, 387 SO. FT. Q " 32 2.01 ACRES � 1 72,494 SO. FT. `,n • ' 1.66 ACRES o M X5 96 33. 3 81, 775 SO. FT. 7 l ` 1.88 ACRES o 2 " O H - v t, �� \\ O \ r 5 W.E. (DF— 3�3 , f , N 00 DRA/NA6F J 92,468 SO. FT. I � ��„ 2.12 ACRES � _6, , • L S88V2 36 r . t ............ M 67, 615 50. FT. 1 ACRES 12 1 M/N F. E. F =389.4 I 1 89,294 SO. FT ,1 i , N89'01'50 "W 277.77' 2.05 ACRES i iv N89'01'50 "W ^ • © O • 318.04' S89'01'50 "E 38700 350.05' - -50 - - 0 76, 767 SO. FT. Aldft o_ 10 oo ` M 1.76 ACRES