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HomeMy WebLinkAbout038-1061-20-005 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574312 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: Measner, Douglas I Star Prairie, Town of 038-1061-20-000 CST BM Elev: linsp.BM Elev: BM Description: Section/Town/Range/Map No: 0-0%C /ev C-1 4f),,G"�, 15.31.18.265A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept i C 1 )U j Benchmar + Alt. BM Dosing l 'i �. � �-�li-�� �.G�- ��L.i rl'YDrh 7✓ Aeration ��r BI .Sewer , Holding St/Ht Inlet < 7y S utlet TANK SETBACK INFORMATION 7 .R 'r— TANK TO P.L WELL BLDG. vent to Air Intake ROAD Dt Inlet —I- I 1 Septic / i t N Dt Bottom / 6 eader7lan. r/ 0 7" q1 —7 ' tL Aeration Dist. Pipe � �; • L,- l .0 Holding Bot System Z� y �� r Final G PUMP/SIPHON INFORMATION ! / �- •2 Manufacturer Demand Cov GPM CL! �C U. S Model Number TDH Lift Friction Loss tem Head TDH Ft _ Forcemain Length ia. Dist. well SOIL ABSORPTION SYSTEM BED/TRENCH Width .3' Length No.Of Tren es PIT DIMEN IONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS (/�l SETBACK SYSTEM TO P/L BLD W LAKE/STREAM LEACHING Ma cturec INFORMATION CHAMBER OR Eli Type Of Syst r, 611 >q r i UNIT Model Number. DJSWIBUTION SYSTEM �-4t t , . c ' Bader/ anifold Distribution / ix Hole Size x Hole Spacing Vent t r Otake I Pipe(s) a� _� G 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 Yes No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 2160 Goose Lake Road New Richmond,WI 54017(NW 1/4 NW 1/4 15 T31 R1 8W) metes bounds Lot Parcel No: 15.31.18.265A 1.)Alt BM Description 2.)Bldg sewer length= -amount of cover= Plan revision Required? ] Yes No r - ...-- tr Crt Use other side for additional Information. _._ Date Insepctor's Sig n a u .No. SBD-6710(R.3197) Name 1pbu3�/O1 -7 Address z 66.3t L,FAe JI(lwi�C ^2v� G.Z s't(.Gj7 �i l / ° Date — . Benclnnari: 1 c ti. Bench r,1ark ? CL¢,�l�v lel,IS- ❑_ Soil Borin` __� S unable Area s es�,j Sc�'t•c T� r� (a'� f�� I" =40' Scale /e!- u P l'fie i ►cell I 6�r ! l Y} �� ie�� ' I y I I i 1 I i i 1 j jva f<<I POIY 16 c i ; } { 1 _ � I 1 i ! ,T- - —'1--� i I I j I "'a ® Safety and Buildings Division County S�. C/1 t � 8 t ar ��!` 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be tilled in by Co.) 7yo �S �Q�Q AT IF 5741312— OpESSt "` Q State Transaction ri� her .� ermit Application In accordance with SPSI'3'3 j1�} a is.Adm.Code,submission of this form to the appropriate governmental unit is required prior to 0 a sanitary permit. Note:Application forms for state owned POWTS are submitted to Project A es21 Tent an mailing addr ss) the Department of ty and Professional Servies. Personal information you provide may be used for secondary oses in accordance with the Privacy Law,s. 15.04(1)(m),Stats. 'S� "Z?,e I. Application Information-Please Print All Information Parcel#(`� Pro Owner's N/a/me �yJ /CQ n� "/Q�,/ Z 0- 00 d �D ``r S C c e l Property Location Property Owner's Mailing Address '2 / �j r O U �C�1 S'-C L @ i'"�C �� Govt.Lot C�ityj State / /f Zip Code Y Phone Number L/ (y/ MW/ '1.,�'/a, Section (Y eU� /1 C.I! �''1-94 d' J l I ! f5"� 7 ^�D V T f N R ��irc1E one II.Type of Building(check all that apply) Lot# Subdivision Name ❑1 or 2 Family Dwelling-Number of Bedroom Block# ❑Public/Commercial-Describe Use 1 ❑ City of CSM Number ❑Village of ❑State Owned-Describe Use Town of -s-k , 04d r r/' III.Type of Permit: (Check only o 51 box on line A. Complete line B if applicable) A ❑Other Modification to Existing System(explain) ❑New System Replacement System ❑Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑ Permit Revision ❑ Change of Plumber I ❑Permit Transfer to New ^Before Expiration Owner — IV.Type of POWTS System/Component/Device: Check all that apply) V.Non-Pressurized In-Ground ❑Pressurized In-Ground ❑ At-Grade ❑Mound>24 in.of suitable soil Mound<24 in.of suitable soil L L (�p El Holding Tank El Other Dispersal Component(explain) 11 Pretreatment Device(explain) ( $VL ersal/Treat eut Area Information: Dis a al Area Proposed(s System Elevation Design Flow(gpd) Design Soil Application Rate(gpds Dispgrsal2 Area Ke4�z(sfl /s� Y L D` Capacity in Total #of Manufacturer nk Info Gal lons Gallons Units l-t. ° New Tanks Existing Tanks ` P. U S- y cn w C7 R W ec1Gf )C Septic or Holding Tank 2 l(a©Q Lta t Z- Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Sign MP/MPRS Number Business Phone Number Pl{flu�mber's Name Plumber's _ff -7 lJ� li�l lC��"�LZ'� ( G I Plumber's Address((Street,City,State,Zip Code) �?2 Ct) VIII oun /Department Use Only Permit Pee Date Issue / / Issuing ent Sign Approved is $ Owne en Reason for enial LY Condilleasons for Disapproval disWsal cell.must all be ry es I maintained \ as per management plan provided by plumber. 2 -1411 s�Ao�i�quira�nents nmtst�a'.mainfa�tied as par atpp�altite eodr%ortJlit»as. Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application J� INDEX AND TITLE PAGE ry� Project Name: po tr5/a_ y- /a^ r le cclnrt Owner's Name: �J �lj�l /�' /� n Owner's Address: L v G�' -fie �_ *1 —/ �Y IV.e w /C (rc-4 �o-c.0 &.1 Jr- .S l 0 f 7 Legal Description: Gu ky S'.e'c / T -ASR /f w Township: County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance&Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber: License Number: Z J 13 /y Date: 7- 6- /Y Phone Number 715-- 7-Y7 3 Z 03 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWfS Version 2.0 SBD-10705-P(N.01/01). Page 1 f , )he�snc� S r Z IR y S Cj2 t C i 30 0f, / X (2, 2 q3q, �6 / //,?,- 14�-D, 6 q g-r �2(fif.� �� � / GJO�f�/ �(''� Jy1?s! �/"'�t�•�(TPi?rC '�/a7E� 6 VZ,1f` r 6 � yf L� P4rti Y° z�6��• u ( 6 5-0. Y fi�� O WNE F-1, Name IDOQsA,.( z ALicireSs Z/G 0 6 CCJe 4 QAe Date - Bend hi-rian", c o ypu /&Oi t mos Soil Borifla -I' SUnable An a 40, Scale &c e. 41 J 1-1 lxi 77 17 N, V ........... Vill I A J too, P rz -T f F I --7 -—--------- 1 T- r Soil Absorpdon System Cross Section 9�.S ft 4°Schedule 40 Final Grade PVC Vent Pipe With Vent Cap �' ft Leaching —► no,�ft Chamber '7 System Elevation J _ft S� ft Soil Absorption Svstem Plan View P,�ft Leaching Trench 1 Vent Or Observation Pipe Chambers /Ij60w' ��a s R 4'Dia. Trench 2 Header Leaching Cham/b±er`Specifications Manufacturer And Model � F �' / ✓e fir �� �Q•�0 C t( EISA Rating_sq ft per chamber Soil Application Rate_�gpd/sq ft i gpd Design Flow , 7 Soil Application Rate EISA=t2�Chambers 2 rows of /z chambers each. i Page of f� INSTALLATION INSTRU CTIONS m � PL-5251P -625 FILTER INSTALLATION INSTRUCTIONS center sir r wy opening x 8: Y,4 Aj 4 ( °' h`os`t! J t `l'e.Z'r�tF: 4th _r*,f{-'fi �IY*l� yy , •+{ �. Step 1: a Step 2: Step 3: (A)Locate the outlet of the septic tank. (A)Before installation,place the (A)Glue the fitter housing on the (B)Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. If necessary. (B)Make sure that the housing (B)Insert the filter wIrldge in the is positioned so the filter can be housing,making sure the filter removed from the tank for cartridge is property aligned and maintenance and service. completely inserted In the housing. MAINTENANCE INSTRUCTIONS mo VF xy t 5 cam. up'iq. }4c s:.r+a '^xj, 3.G,�s s •- �sli G1y..r „�., gY': 'Z•`, t;� ,n *k ,t'T Fi.w '� c ' o � 1 J� z.�' '`���: -'�'"ac•c2 a�'ai�', .,,tsr"'1,���5... t 'Y�c r Y 1 Y• '-j �p e2Y �i^Y•sr A.K` -. 2� ,,.: y ,� ..rr.�x :.CT`s"•' - Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the flier cartridge back if necessary. into the the housing making sure • NOTUSE (B)Pull the filter out of the housing. the f iter is properly alighed REMOVED and completely inserted. WHEN FILTER IS (C)Hose off the leer aver the septic tank : USE .l Gt:Q S: Y: ' Make sun:all solids fail back into the (B)Replace septic flank cover , z .. `JUtiEN„GL�At?�I,f�I.ts.1=,l�TER;,... septj��8►7� START UP AND OPERATION Page of 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 tanks) 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 property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall•be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot fines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLEEL POWTS MAINTAINER Name Name Phone 71S-- 2 L/ 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was draftee'- -�;r..ciiance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1).(2)&(3),Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of FILE INFORMATION SYSTEM-SPECIFICATIONS Owner `Qs �— a/2-1ete 977 qecpsae" Septic Tank Capacity /000 gal ❑ NA Permit# Septic Tank Manufacturer - ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �p L®/C CI NA Number of Bedrooms ,j ❑ NA Effluent Filter Modell �Z S� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al (R NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer 13 NA Design flow (peak), (Estimated x 1.5) 5_0 al/day Pump Manufacturer ® NA Soil Application Rate © , 7 a gal/day/ft' Pump Model 0 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ® NA Fats, Oil & Grease (FOG) :930 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODr,) 5220 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 (SODS) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L IX NA ❑At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑Other: Maximum Effluent Particle Size Y.in dia. ❑ NA ref: ❑ 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 ev ❑ month(s) (Maximum 3 years) 13 NA eft' 3 Is ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 13 year(s) Clean effluent filter At least once every: 3 ❑ mon( ❑ NA �years)s) aspect pump, pump controls& alarm At least once every: ❑ month(s) ❑ NA❑year(s) ❑ month(s) ❑ NA =' = `aterals and pressure test At least once every: ❑ year(s) At least once every: ❑ month(s) ❑ NA ❑year(s) Other: O 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 (Y3) 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:0 2 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 cells) and may result in the backup or surface discharge of effluent. To avoid this situation have th rt e e 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. %BANDONMENT When the POWTS fails and/or is permanently taken out of service the €ollowing 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. 'ONTINGENCY 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. Q A suitable replacement area is not available due to setbabk and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS 'OWTS INSTALLER POWTS MAINTAINER Name Name Phone 71.5 Z. YT 3z(J� Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone his document was drafYet`- can„fiance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L) u'5'la S c/- 10 th r- /-q P e,�_- s'a e,/ Mailing Address 2 0/6 J, tl-o / 2`�` New Property Address Sa (Verification required from Planning&Zoning Department for new construction.) City/State - Parcel Identification Number 03r- LEGAL DESCRIPTION Property Location N w '/4, N u' i/4, Sec. > ,T 3t NR .� W,Town of Subdivision ,Lot# Certified Survey Map# ,Volume ,Page# Warranty Deed# � 7 �,Q ,Volume Page# �3 Spec house yes no` Lot lines identifiable/ 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 stage in the waste sal system. Owner maintenance the system can affect the function of the septic tank as a ge disposal 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. I/we,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 stating 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#ds 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 7ra"y deed recorded in Register of Deeds Office. Number of bedrooms _ fi,or_� SIGNATURE OF APPLICANTS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** L=Iude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -eerence is made in the warranty deed ,REV.0810-9 I ST. CROIX COUNTY ZONING OFFICE I CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify h t fy t at I have inspected the septic tank presently serving the CQ 0 6072S-ca residence located at: of 1/4, kk) 1/4, Section IS' , Town_3 / N, Range / Z W,Town �— g , of_S f-� �� t , St. Croix County Wisconsin. Upon inspection, I Certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 6- 7- Y- 20 1�1 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ���� Construction: Prefab Concrete Steel Other Manufacturer (if known): C c Age of Tank (if known): l 9 7 r (Licensed Plumber Signature) (Print Name) 2�13/f� (Title) (License Number) MP/MPRS 7- (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) No.SA. Warmly Deed—Mort Form (STATE OF WMCONSM) PoEttab-a DsEm atlas soar 6 ebtlo W (Be—28d.381 W)e.Stetotn) Fora No. 304061 aaar log, FAA (941$ JnhftttUrk, Made by Raymond H. Peterson and Alice V. Peterson, husband and wife grantors ,of St. Croix County,Wisconsin,hereby convey andwarrantsto Douglas D. Measner and Pamela Measner, husband wife"_fe"_ as j omit tenants grantee s ,of St. Croix County.Wisconsin,,for thesumof Thirty Thousand ($30,000.00) Dollars . the following tract of land in St. Croix County,State of Wisconsin: The Northwest Quarter of the Northwest Quarter (NWT of NWT) of Section Fifteen (15), Township Thirty-one (31) North, 'of Range Eighteen (18) West. TRANSFER REGISTERS OFFIC9 - ST.CROIX CO.,WIS. FEE Recd for Record this_8th-_ day of__Max9Y1.___A.D.1973. atc. _�Lj3g- .A,.M. 7Jtt Wt1%V0#ilk bergot,the said grantor s havehereunto set their hands and seal s this let day of March A.D.,1971. Signed and Sealed in Presence of Raymond H. P SEAL) Alice V. Peterson Edward R. Kaiser (SEAL) ex ....(SEAL) Ruth A. Johnson - •• .datf�fton�fn, �•, H County ss%2ert" scam ,lgP a me,this let day of March ,A.D.,1971. .> voawe and H. Peterson and Alice V. Peterson, husband and 'p �G i e to.h arsons who executed the foregoing instrument and acknowledged the same Edward R. Kaiser Notary Public, St. Cro' County,Wis. ? _ My commission a sC is/rerman Drafted by- Edward R. Ka;aer, Attorney at Law, New Richmond, Wisconsin X CL p.etox(S ceanaee,wfineo t. rhos to raa shau he"vamw viftted Cr ftWvtn= uaa Property Owner 1'4�fs��fe@�/I P' Parcel ID# 6 �- l Page 2 of 1-71 Boring# ❑ Boring / ❑ Pit Ground surface elev. � ` b S ft. Depth to uniting factor'? in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure bonsister= &xindwy Roots GpDIR 3 in. MunseN Qu.Sz. Cont.Color Gr.Sz.Sh. ft#1 ff#2 t 0-3- P7-7197/7- AIA- m (Q, ,Y 0-7 Z �--SH 7,r79% IVA /n.P 7 6 , O T,70 1,07151, V T A,S- OS, A 4- C41 0, 7P v l ,6 9 Z5, i l , l E Borino# ® Boring pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate � �� �eCivi iuc Domiiaii:Color i vnSiSiciiG2 �undai37 s?vif5 vl�sn.J,i ii Z s t i f f It 1 1 t i n t>Vilny Boring# � Ground tt D ii, i;m,tinq s n+ �j pit �i0un l S 7ii8 2 21Ev. i+�Gin w aiioaniy is avi in. Soil,4pplication Rate . ? nri-r; -cn_'.h.. nn in .n s. -`n-l'n-r rnr-n-r..n r ecrimnptnn i TpxrfurQ i 'Structure- e ncndanr 1 i Rcrc_ i 1 i Effluent 41=BOD ;>30<220 mc1L and TSS?30 <150 mg1L `Effluent#2=BOD s<30 rng/and TSS <30 mgiL The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-5330(RI VI I) PAID Wis.Dept.of Safety and Professional ServONI IL EVALUATIO ORT Page ' of 2 Division of Safety and Buildings 385,Wis. Adm. Code County Attach complete site plan on paper not Iess�tPl�n 172 x 11 es in�ize.Plan must include,but not limited to:vertical and ho al regr�i ,direction and Parcel I.D. 0- /Ov _ Q.: 00 percent slope,scale or dimensions,north A!i-t a,111d and distance to nearest road. Please pri(n� 0 Vrmation. Revr by Date Personal information you provide may b"'§ed for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner r r Property Location G I� ,, , e���P/ Govt.Lot IV V 1/4d 1/4 S i T N R �0 E(or)(& Property Owner's Mailing Address ^ Lot# Block# Si bd.Name or M# Z/ 60 (� 0LIse &aAe j city r n State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road IvY�i`i�/►mo•7J1 CST -Y- D17 (��� ) Z Y�- �6� StOl /a, ^e �oese L4k•e ❑ New Construction Use:[D Residential/Number of bedrooms 3 Code derived design flow rate yS GPD ®Replacement Public or commercial-Describe: Parent material C Iu``a n''&- Flood Plain elevation if applicable /1// � General comments and recommendations: LO/oI,� "� /y �� ✓'�,r5 ` G5 �ti✓ 4C2. b / At-1 Boring Q` � ��� � 1�F1 5 Boring# ® Pit Ground surface elev. / G' �S ft. Depth to limiting factor> �yy in. Application Rate son Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#2 2 3-56 7.si/�'/6 W4 3 �-78 10M P71 1-16 c tk-' — 0, 76 l,6° iDiX �/y it F2_1 Boring# [] Boring r ® Pit Ground surface elev. G ft. Depth to limiting factor «Z in. SolApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure istence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. ff#2 l U-f �� �{7/z SG d j k T 1' 1'r C I- /M 0 Y 10. 7 3 �'-71 /C'%/? y� �`S ( rh G c ti. f v F 74 7, 71-1-77 /6i/t %v Effluent#1=BOD >30:5.220 mg/L and TSS>30 <150 mg/L "Effluent#2=BOD <30 mg/L and TSS <30 mg/L ......_...... ..-.. Print), _. -a..-r ST 0.f '--, 3//e)%(rwase { Siy=:d _ C� ,.um. i Address Date Evaluation Conducted Telephone Number 6-20.- / % 7,-s-ZYZ-32 n3 SBD-8330(Rt l/11) �D� �� e @�np� 690- /DPI-ZO-��p 2 of Property Owner S S Parcel ID# Page Bohn # Boring / 3 g pit Ground surface elev. �(` b s ft. Depth to limiting factor IS-6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Donsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 01 *CO2 L16 1L L,,�f�,� m� � cw �� , 6 / , 0 — 10, 70 ��6a 1 : 9 t Boring pit Ground surface elev. ft. Depth to limiting fiactor in. SO4 App liz'.;orRate I i:•nw! art E vc a __......_..i'vve3ri ieaj_t ii$s:niir?zv 3 Texture s ii:uCuie +n 5i3i$ir vi3i:ua>`y 1:tvvs- 9 j E I 1 i 1 • 1 l 1 1 1 t • !1 1 1 1 i i r-, i 3c^,rt: iii ;cring rl P li ^rou"d Su &;�2':2Y �£ic to factor .. (I yfs i:ucaiJn Rate j 1r • ? 9 i t _ ..:r 1-�_..=;na;;:;..�i...l v��.ty;;?= _:. '•c°r 'a ? LT('.3'_"-J.'2 _ �.___ ...c^ �'vv3rs' i .___ : ft i I l _� Effiluent,#;_-ROD 5 30<220 gr" a;�u TSS>3• —150-,911 mw;2 E cent#2'=B30D 5<30 m>,9 and? S <30 mg/L The Dept.of Safety and Professional SenIces is an eaual:opp'ainunity service pIovider and ell 10—,'er. if roll need assistance to ip,access services or need material in an alternate format;contact the department at 608-266-3151 or TTY t,rough Relay. SBD-3330(1211!H) OWNER Name ^,If- Address 2`/dO CocJe ZeZ _/M Date Berichi-nark I _-Fof ly ?o c (9,,s, Soil Bof,1112 SUITabic Aria F 40' Scale 110Y- 10- 117' qA C�1011. Z -Z r J .............. __T M Oe g 0 m k (D e § k ! ) 0 E o [ m w � \ E $ G c $ 3 E m }, § {f f 2 Q. a s /2 C 2 ) ^ ° 2 ® R § .2 7 3 \ 7 ) D 3 \ # < £ E < w «_ » C k e . \ z 2 . . o . o Lo \ \ % 2 ED � � / z . e y , 4 \ e ] @ 5 CL 2 , LD , 4) LD a. c ) 7 ) Q �~ z co z ) z z « 2 k 4 E 2 4 § k 0 C ) J 0 E 2 ) \ °�- . � �k f 2 f .E _k ƒ ) ■ m t \ !& && . 2 K K K Ff a - f a a a f a a a IL ■ ') m co ƒ � 2 0 U) '£ %§ a « 8 ° ) : k k = / § § 2 / 2 ! 0 2 8 S k Jƒ f S k < z f o § 5 G § » § o & § ■ a 0 S 8 k a § § ƒ° ° k § \ a) E k o G k 7 4) / m 5 � b r— o ° a § - z S I .\ J 0 , m§ @/ E 0 k m k §( $ b 0 o CN z_= w W o z/ IL z Q ® un 2 2 % } % } E —s # » E I J a 0 U) v 0 & 2 f Parcel #: 038 - 1061 -20 -000 12/01/2006 12:29 PM PAGE 1 OF 1 Alt. Parcel M 15.31.18.265A 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 DOUGLAS &PAMELA MEASNER O - MEASNER, DOUGLAS & PAMELA 2160 GOOSE LAKE RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2160 GOOSE LAKE RD SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 33.000 Plat: N/A -NOT AVAILABLE SEC 15 T31 N RI 8W NW NW EXC CSM 3/637 Block/Condo Bldg: EZ -UT- 1226/569 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/0512005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 152,400 177,400 NO AGRICULTURAL G4 17.000 2,600 0 2,600 NO UNDEVELOPED G5 15.000 35,700 0 35,700 NO Totals for 2006: General Property 33.000 63,300 152,400 215,700 Woodland 0.000 0 0 Totals for 2005: General Property 33.000 63,300 152,400 215,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 212 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 .'ER , T05JNSHIP j ; SEC. / f T ,IS� / N, R �. W ,0. ADDRESS �� y , ST. CROIX COUNTY, WISCONSIN. '3DIVISION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of 1162.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N ,::`TIC TANK(S) MFGR. / _ . CONCRETE �� STEEL NO. of rings n cover S Depth DRY WELL '.N'CHES N0. of width length area > no. of lines width /z ' length depth to top of pipe ' CATE -:K RATE ,,�" AREA REQUIRED C_ 16 1T� AREA AS .claimer: The inspection of this system by St. Croix County does not imply complete j = Pliance with State Administrative Codes.' There are ether areas that it is not possible % inspect at this point of construction. St. Croix County assures no liability for _item operation. However, if failure is noted the County will make every effort to :ermine cause of failure. 'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. y� - "INSPE ' �� q PL ON DATED /� JOB. LI ENSE MMER i Parcel #: 038 - 1061 -20 -000 08/18/2006 05:32 PM PAGE 1 OF 1 Alt. Parcel #: 15.31.18.265A 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 DOUGLAS &PAMELA MEASNER O - MEASNER, DOUGLAS & PAMELA 2160 GOOSE LAKE RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2160 GOOSE LAKE RD SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 33.000 Plat: N/A -NOT AVAILABLE SEC 15 T31 N R1 8W NW NW EXC CSM 3/637 Block/Condo Bldg: EZ- UT- 1226/569 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 10105/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 25,000 152,400 177,400 NO AGRICULTURAL G4 17.000 2,600 0 2,600 NO UNDEVELOPED G5 15.000 35,700 0 35,700 NO Totals for 2006: General Property 33.000 63,300 152,400 215,700 Woodland 0.000 0 0 Il i Totals for 2005: General Property 33.000 63,300 152,400 215,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch M 212 Specials: User Special Code Cat Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I • S E N LAND SURVEYING* HUDSON , WISCONSIN 54016 -- 366 -2007 t ^ Name ouglas and Pamela Measner 1 Q Address 2160 Goose Lake Rd. -- New Richmond, Wi- 54017 Description A parcel of land located in part of the 1I11/4 of the NW1 /4 of Section 15, T3111, R18W, Town of Star Prairie, St, Croix County, Wisconsin further described as follows: Commencing at the NW corner of said Section 15; thence S00016'28 "W, along 'the west line of the said NW1 14 of the NW1 /4, 1316.84 feet; thence S89 1, along the south line of the said NW1 /4 of the NW1 /4, 336.10 feet to the point of beginning; thence continuing 58955'08 "R, along the said south line, 600,00 feet; thence NO2039'07 "W, along the west line of Certified Survey Yap recorded in Volume "3", Page 637 at the St, Croix County Register of Deeds Office, 436,09 feet; thence 118905518 "W, 600,00 feet; thence S0203917 "R, 436,09 feet to Ih� point of beginning. Above described parcel contains 6,00 Acres and is subject to right -of -way for Goose Lake Road and all easements of record, This description is for mortgage purposes only and may not be deeded as a separate land parcel. A -97 Waiver 1, Allen C, Nyhagen, 1, Douglas Measner and I, Pamela Measner agree to waive the requirements for land surveys as set forth in A -97 of the Wisconsin Administrative Code as the corners of the land parcel described above have not been monumented. o Allen C. Nyhage 11 Date NW Corner of Section 15. // 2 , >- Doug as Measner Date d wfn/ L 0 I y /o Pamela Measn Date 3 N89 11 W 600.00' r U ? 4- o o 6.00 Acres o a 261,360 Sq. Ft. shed !`.1 -_ JI house 00 O N � Goose Lake Road S89 0 55 1 08 11 E_ 600. 00' South line of the NW} of the N.WJ ST.. CROIX COUNTY — SURV MOWS RECOR State of Wisconsin ) County of St. Croix ) sa, SCALE OF MAP - I INCH = 200 Feet 0 IRON STAKES FOUND 1, Allen C. Nyhagen , registered Wisconsin Land Surveyor,do hereby certify that on October 6 19 92 , 1 surveyed the above described and mapped property according to the official records and that the accompanying map is a correctly dimensioned representation to scale of the boundaries,that all buildings and improvements lie wholly within '�� lines, and that no encroachments by adjoining owners appear from said survey.f��. ALM 1 4 1 92 - ALLEN! L., Map No.. B . R . B . WYHAGEt� L,�it•t/ Drown By 6 S -�i407 1 C , H UDSON, � , 'trv':S. ,�' Q,� 0 7 �Z 4 ,w o LTA i o og#13� &a��"1'� i REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itaAy PeAm.i 2 0`, State Septic' DAME Tawnahip likL.1 � 'L, ' St. CAO.ix County I I- Yv Locat.i,.o &. 4 o b r Sec ianLLT3 f'N, R 18 w SEPTIC TANK Size lgatton Number ob CompaA$mentd Diztance FAOm: Wett ? 12% an gnea eA agape it i Bu.itd.ing it. Wettands Highwaten it. DISPOSAL SYSTEM D.i.atance Fnom: Wett > it. .12% oA gneaxeA ztope Bu.itd.ing wettands Ft. H.ighwateA it. FIELD DIMENSIONS: Width o6 t&ench it. Depth of Ao betow t.ite.4Lin. Length o6 each tine it. Depth o4 Aock oven t.ite in. Numbe&. a o6 tines 2- Depth o6 tite below grade �� .in. .d Totat en th tines � � g � � it. S.Cape aj tAench .in pen 100 it. Distance between tine�s Depth to bedeck _ Totat ab4anbt.ion area U 6t Depth to gtoundwateA 6t. Requ-i.Aed area it 2 P T DIMENSIONS: NumbeA og p.itz Aavet a&ound pite yea n Out6ide d.iameteA f� it. Z epth below .inlet it. 2 Totat abzoA Lam a it z 4 Aed ` it rn f I SPECTED TITLE A PR OVED , 19 7 . R JECTED ,DATE 197 i U r PL867 State and County State Permit # j� Permit Application County Permit for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWN R OF PROPERTY Mailing Address: B. LOCATION: J '/4 Y4, Section / �5, TJL N, (or) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family $-_� Duplex No. of Bedrooms -3 No. of Persons „3 D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES # of Bathrooms_— Automatic Washer (­� NO Other (specify) E. SEPTIC TANK CAPACITY . 1 _ Total gallons No. of tanks *Holding tank capacity � Total gallons No. of tanks New Installation `� Addition! Replacement_ Prefab Concrete t� *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) �!� 2 ►_y 3) Total Absorb Area �(4 sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Lengt Width Z / Depth Tile Depth q No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size � Percent slope of land D' J_ a7 /0 1 - Distance from critical slope "- 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Ce Tied Soil Tester, I NAME _ ye,.�/ Z i `�'irP C.S.T. # and other information obtained from 1 ,� , �J��ti(r" (ownen(kiwlilder). Plumber's Signature MP /MPRSW# i - Phone # y6- Sys 9 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). e e _ f Do Not Write in Space op FOR DEPARTMENT V�E ONLY Date of Application Fees Paid: State County Date 2. Z Permit Issued /Rejected (at Z _Issuing Agent Name Inspection Yes No Valid# Date Rec'd 1. county (w ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) _ Revised Date 6/1/76 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ' F DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TEST�S LOCATION :a "'.a' /a, Section/= , T31N, R/ E (or) W, Township or MxM1r Lot No. , Block No. County Subdi i ' n Name Owner's Name: -� Mailing Address: 6 A : � � 1 1 TYPE OF OCCUPANCY: Residence No. of Bedrooms "- Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN /IN P_ w / � SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate numbehof square feet of absorption area needed for building type and occupancy. �.� /� �� LI ,( �Q� R. /gbiE Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. C� s' 0 _ _ 1 1 IV 1 t N o _ = H4 r 1 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to.the best of my knowledge and belief. Name (print) n � � " � � / / Ce tiff i � Z Address Name of installer if known CST Signatur COPY A —LOCAL AUTHORITY Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420494 0 GENERAL NFORMATION (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: Measner, Douglas I Star Prairie Township 038- 1042 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft 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 SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Di a Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed[Trench Edges Topsoil I Yes FA- No i Yes [ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: J / Inspection #2: I I Location: 2160 Goose Lake Road New Richmond, WI 54017 (NW 114 NW 1/415 T31N R18W) NA Lot Parcel No: 15.31.18.186 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Use revis u No additional information l other side for —� —�— — — _ - -- , — SBD -6710 (8.3)97) Date Insepctor's Signature Cert. No. Smi aye 2 N N v s DM dm 201 W. WU*bOOa Are.. P.O. On 7162 < � " I II IIA eea. WI 33707 - 7162 ' yy1e �errss 1! Us " 0- � a j r - t�a.le1Wedisr L d ..w lime �, , Cbo* if R..W" oC CJ Aplieatieo )n ftmmtl«. - An aftnew b. rim Owmes Me.e 7 - d i4" /A .• t+omler 4 o~111 I Il d W zo c Ode Piece Nsea►a N. it I � � Blodt lvaimiu IL p t 15• R to c ter mere eppi� 1 or 2 Al Dwd ft — I%mier at esiioorre D plawmMmi - Deecae ue Dvri,� . Rood nt. 1}pe or Faralb lime A (mmmal sighaes i gr itiecnad Mo. c..eFler !V s >< ) 1 D tin►• 311 a 6 D Adl Ia" �r4 aae s. D c ka it srdeey Made !i."isQe� berme Pbe>aeit rre.eer ne brred AT. gyp dFu (Cfeeeic an geat l.rte ecMwe W fhr ireremd sera 6s D t'iom b Ommed 21p( 47 p Smd FNW 30 D rs D reae�.ea brilrouad caoa,�*,d W�.m a1 D aaa� 43 ❑ X Plea 510 04 Lice as D 46 D AmmW 1mal ti k O 3o D v �►rs Dadgm Mm CpdD Dipead M.m 3� . time ssyri<ra pored ` sn,v. Par..io pad Glil fin, Rl /.o ✓ Hw" i �. /s ql��, s �taos �oa� s Tiak lob Talial 01 Swift Gdkm of UNIX Plastic Chuml oon I `esers vn. s Naaer ; Kim P 16 OR its M!Lb 1e bsb a Plume tbmeier �s 537 � AWWvW D Dbgpeonwd l swchow y Piawe Pie (ialydee oreu.uerreer D.es l bindAdi Ill 47V ) =Z Comai0 m D d tom: d. nrczo'it rIt �tml �� - � o„h b'3. 4f S �., .... `/� n; �`�y Sic. j S 7 A? 0 (� Lkj itr� 1\ oss�.l tt al�aA a rc�`� L P m _ IC:�O. Goes �:��;_ ��.Q�v�p� c.� ;a✓� /e�m�pe's���A- � 1Ci a �3 x 9q. 9q s' J t Att Jam 'I .,c EI t4,5' ,a I : 1 i Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Viscons4W in www.commerce.state.wi us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 07, 2002 CUST ID No.220537 ATTIC- POWTS Inspector ZONING OFFICE CALVIN W POWERS JR ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/07/2004 Identification Numbers Transaction ID No. 792154 SITE: Site ID No. 72032 Douglas Measner Please refer to both identification numbers, 2160 Goose Lake Rd above, in all correspondence with the agency. Town of Star Prairie, 54017 St Croix County; Fire Dept ID: 5502 NW1 /4, NWI /4, S15, T3 IN, RI 8W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 872259 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, li mited activities are allowed in the area 15 feet down slope ofthe—component area. ,7 int . / Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment an ispersal Co itZd are prohibited. APP • The existing PO WTS must be properly abandoned per Comm 83. Wi Co de. DEPARTMENT OF PnPRON OF SAFETY • A Sanitary Permit must be obtained from the county where this project is located in accordance with the / �J requirements of See. 145.135 and 145.19, Wis. Stats. SEE CORRES) • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. • The changes to the calculated TDH don't effect the system's performance based on the pump chosen for this design. If the pump is changed out, the performance of the pump shall meet the system demand and minimum required head. CALVIN W POWERS JR Page 2 10/7/02 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/ instal lation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 l � Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 TITLE SHEET DATE -Sepk_5 PAGE I OF MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan bas been Prepared m accordance with the Mound Componva Manual SBD- 10572 -P and the Pressure DistnN#jon Manual S13D- 10573 -P. CR. 6199) (GR- 6199) LOCATED IN THE L) 114 OF THE N 4 �, _JN, ` �1 /4 OF SECTION T 3 R 1�W, TOWN OF ST. CROIX COUNTY, WISCONSIN. alto �Q- - DQE—X PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 PLOT PLAN I� y PAGE 3 OF 7 PLANVIE W CROSS SECTION Y AGE 4 OF 7 DISTRIBUTION PIPE LAYOUT S E P 1 200? PAGE 5 OF 7 PUMP CHAMBER CROSS SECTION PAGE 6 OF 7 SYSTEM MANAGEMENT PLAN A F E` f & B LDGS DIV. PAGE 7 OF 7 PUMP CURVE t PRE- --OFD FOR 't c sh'Qr 5 101 7 REP D C POWERS EXCAVATING INC. c)DOS3 7 1969 185 AVE. / 11a fl NEW RICHMOND, WIS. 54017 � PHONE: 715 -246 -5135 FAX: 715- 246 -5135 M ANO aU� IN GS ONDENC k\ L+JZ Syo 7_ m �I /oa A a _ ,'` � t a 1 : 4.1 • r Page ..a 0 l Synthetic Cov "ring / 1 Distribution Pips M- C33 ' 1 Medium Sand Topsoil � /� -� i a i 9� 13 % Slope Plowed Bed Of 1'.-2;,p Farce Main Layer Aggregate D 1�2 Cross Section Of A Mound System Using F A Bed For The Absorption Area G b A �_ Ft. N �d2 Ft. ' .1 ate= �aD /�h ?T 4 B Ft. yixzear woad i �; Design ,uoadin� Rate= xPD/ �� PT K Ft. 3 Ft. Position I / , 3 Ft. of W J Ft. Force Main • Observation Pipe J 6 K �t -L 7�� �at5 v _ "1 A - - - - -_- _ _ _ e - _--- -•I+FT ---- -------- - - - - -- Distribution��. Of Pipe, Aggregate Observation Pipe aACt►or Ss c� nt r Plan View Of Mound Using A Bed For The Absorption Area Distribution Pipe Layout page L of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. F.xreud the ead of each l 144 up with the use of Iong tum or 43' fitting to a poiau withim six iaches of the &d SM& Tetmim oe the W& of the is=$ls whit a valve. 4zaded cap or ft"ded plug. Provide acc ms fim fiaal Sale for the valve, thmuW cap or tl:coaded plug. vv C vV� C. U t"l Mwamd Let" uO t h re4 PO.D s - -4 lbac� r+tTw P 377 Ft. Hole Diameter Inch ' S Ft. Lateral " � /� Inch(es) x , Inch's Manifold " of Inches Force plain " —T� Inches of holes /pipe l- invert Elevation of.LateraIS Ft. icy ,r---- -. SEY'1 iC TANK &­ P U M P CHAMBE CKUSS bLUTIUN NNu ZrW-Al �••���.. -- ' ? 4" Cl VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF ' ( \ 25' FROM.DOOR, WINDOW. OR JUNCTION BOX PPROVED FRESH AIR INTAKE . WITH CONDUIT MANHOLE COVER 40 Cl RISER W/ PADLOCK S 6" MIN. ---, WARNING LABEL ABOVE G ADE 4" MI N . Jail MIN MIN INLET `WATER TIGHT SEALS GAS- ` TIGHT: �f 411 A,co A SEAL : e APPROVED CI PIPE ... i ALM JOINTS W/ CI 3' ONTO II PIPE 3' ONTO SOLID , ON SOLID SOIL C � r SOIL PUMP OFF ELEV . T. ►- -- — Y Off �'t RISER EXIT D PERMITTED ONV.. IF. TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS -^ SEPTIC / DOSE S TANK MANUFACTURER : t o=? NUMBER 'DOSES PER DAY TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING r } DOSE GA FLOWBACK: d J5 GAL. ALARM MANUFACTURER: CAPACITIES: A = INCHES = /6 7, AL. MODEL NUMBER: lal SWITCH TYPE: B = 2 INCHES = GAL. PUMP MANUFACTURER: / C = Co INCHES = jDo GAL. MODEL NUMBER: C'S ✓ _ SWITCH TYPE: D = INCHES = 3 GAL REQUIRED DISCHARGE RATE G M PUMP & ALARM WIRING AS PER ILHR WA( VERTICAL DIFFERENCE BET P OFF AND DISTRIBUTION PIPE rS PrEET + MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . .5 FEET + �L_B FEET FORCEMAIN X 1,12_ T/100 FT. - FRICTION FACTOR ' . . FEET TOTAL DYNAMIC HEAD FEET = -'R INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; LIQUID DEPTH b / 1 vZ r i Goulds P a � i r Effluent Pump �.._ UND73 C 388 APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specifically designed for the • be provided in starter unit. bronze impeller available as without damage. following uses: Shaft: threaded, 400 series an option, - -���:X . ■ Bearin s. U er and • Homes stainless steel. ■ Casing: East iron volute lower heav g • pp • Farms • Bearings: ball bearings type far maximum efficiency. co nst r uctio n. lower uty bail bearing • Trailer courts upper and tower. 2' NPT discharge adaptable • Motels • Power cord: 20 toot systems = Power Cable: Severe duty for slide isc . • Schools standard length (optional rated, oil and water resistant. • Hospitals lengths available), ■ Mechanical Seal: SIUCON Epoxy seal on motor end • Industry Single phase: CARBIDE VS. SIUCON provides secondary moisture • Effluent systems ' % and 'A HP —16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket with 115 V or 230 V three Stainless steel metal parts, damage and to prevent oil prong plug. BUNA -N etastomers. wicking. SPECiFiCATIONs • 3/ -i % HP —14/3 STO with ! Shaft Corrosion- resistant ■ 0-dng: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. % maximum. • % % HP — 14/4 STO phase m odels to guard • Discharge size: 2' NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities. up to 128 GPM. listed models — 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor. Wily submerged in @ Canadian Mandards A=dalton TDH• are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat undcnwiten raewateries carbide -rotary seattsilicon FEATURES transfer, carbide - stationary seat, 300 ■Designed for Continuous series stainless steel metal • Impeller. Cast iron, semi - Parts, BUNA - elastomers. open, non -clog with pump- Operation: Pump ratings are • Temperature: out vanes for mechanical seal within the mote manufacturer's 104 °F (4n) continuous Protection. Balanced for recommended working limits, 140°F (60 °C) Intermittent. • Fasteners: 300 series "ZMft FEET stainless steel. so 1 • Capable of running dry, 25 so SIZE W -SUDS without damage to - WEI RPK' VARIOUS components. scPM 70 � Motor 20 - 5Fr Single phase: W 60 • H HP, 115 V. 200 V, 230 V, _ 60 Hz, 1750 RPM, % HP, +s so 115 V. 60 Hz, 3500 RPM. c 60 Hz 3500 RPM. 230 +o ac • Built -in overload with automatic reset. • Class B insulation. s Three phase: ' +o • if HP —1'h HP 240/230/ a o 460 V. 60 Hz, 3500 RPM. 0 +a 20 40 so 60 7 0 so 90 too ++o + zo t3ocPra 0 • Class 8 insulation. ,o 30 W/h 0 1995 Gou105 Pumps CAPACITY EllecN" May, 1995 n��ee 7 3& 4 335' I vvb=u , o.P. tmd of c nvmve SOIL EVALUATION REPORT P. a Ohistan dSafatyardl Ash aon�plale aM pM�n an pa�sr nat irss Dan 81R x 11 inciNS in fqw weekdo Y butnctiaiaddoe d hoetaonw , MINM�c. q, :` ° pa,a to. Li oa van& P pf" a0 for.. 1 7 2 Dow P..�rtM�wrwwye+ rrs..w+tira�oww►Nrw.wlwM+ ear a �s ea 01 pl "7r"7 -.- r)u-q��s Mpa- s L J%� s 15 N a Jg ow w t�o�iz �• sues. �a� -.2 1 s Rm �bm AM E3 .33 4c reS a� 1 74" G'i�► - Yawn Nersst � N N 1 S y a 3 V -� a M.-A, CC lba w danfai/ erdb�ooais � caod.d.�.danbnao�►.ar� c a +t 0 P+itiaoramsawa d -o mobw Pon "Modomod�F � �4��. e In FADdFWAM oi rappi ift A pU)YI-cQ 8y soft 3 Q Fc �o�nd.�.do..iw a Dom (D ho" h VMS owdwd CAN a TWA" :huaaa k wn..i ou. sz am& cdw 3 CA -L rn $ a l i 6 r ✓hU r .3 /9 -31 ,. s r ,r in l ►a y I kL lAw"a SL CWd. Cdor er. 8x UL 5 bk M4 R „i i I 6 � I Emmt ? 30; S=0 mWLmW TSS z%V < 1S0 * EMmd f2 s BW and TW 130 rvgL oa.. err, j g 5 N s a s �w Munm �.. OR � E �OW7 �, s ` G UCl 1 ltC1C,T ©t` 1 N t Nail I wQ I k `a J r �5 ` J r �� � re- _ Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 e ° ' TDD #: (608) 264 -8777 IscOns,n www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov ( �, ftl i Scott McCallum, Governor Philip Edw. Albert, Secretary October 07, 2002 CUST ID No.220537 ATTN: POVVTS Inspector ZONING OFFICE CALVIN W POWERS JR ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/07/2004 Identification Numbers Transaction ID No. 792154 SITE: Si te ID No. 72032 Douglas Measner Please refer to both identification 2160 Goose Lake Rd numbers, above, in all Town of Star Prairie, 54017 correspondence with the agency. St Croix County; Fire Dept ID: 5502 NW1 /4, NW1 /4, S15, T31 N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 872259 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. CALVIN W POWERS JR Page 2 10/7/02 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. • The changes to the calculated TDH don't effect the system's performance based on the pump chosen for this design. If the pump is changed out, the performance of the pump shall meet the system demand and minimum required head. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. CALVIN W POWERS JR Page 3 10/7/02 i Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 cbratz @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 •. 13/x` d � POWTS OWNER'S MANUAL at IiAAlIiAtN�il111'T PLAN y V of iOIriAT1OM Slia m iMl PC-- - - M6 O�wrntlt Petnnit ♦ — ~ �1 �'` S"Ac Tank G wcav Q� g a 0 NA T Sepdo Tank Marwtsmw ° , 0 NA OEfflidlf !lilRgiif 7llfg L'"kmw f#1ar #erwhoterw DNA frattanber of 8adrootnna C3 NA Eillttrntt FfNer Model ❑ NA WHIR ar of hd sic Fw ty units 13 NA Ptnmp Tarn!* Capacity � d O NA Esdma ed flow (*wrap) !7� PWO Tank Manufacturer NA i ptS NA Dweign flow Week), it stirnartad x 1.5) '� Plnanp Manufar.Kurar S U NA Sad AOPkcatiaR Rate n Nt' P1anp Model W � 0 } 0 NA dlard Stan iMbant/Eifl*tant ow0ity MorNdy ,n w,� • P1+rprettnsent U nit A Fa m Oil 6 Gresee (FOGI s30 njgA 1 13 SNuVGrwwl Ffftw © Peet Filter if Od"mic l Oxygen DOmard 1900,1 5220 np{L C] NA ❑ h1schonkal Aeration 0 Wadend Tow Suspended Solids (TSSJ s 160 a"& 0 Oidilhction O Other: Permed Efiktent 0 "a$* yr average Okpold cow (p 75/ 0 NA Slud w.' i Oxygen Demand iflDO ao INiO& O In- Caround fgwsvity( tpmour'ited) Tow Suspended Solids CTSS s30 enpR 0 N ❑ At -Grade Feca Cali wrn (O"awinic main) s1p' 100"0 p tMp`i irte O Ottnanr Manknaan Meow Pantioie Siae Y. in die: Q NA Odnrr ❑ NA Ottnar: — 0 NA Othn 0 NA `Vat*us nYPieet tow dannwtic w�eteweasr and P w* w"lum rt. CwW. 0 NA �f,�E di�'i1ULE Saettlpt BMW g bwpm condition of tank(sl At least once awww: ?� 3 El Purrw out contents of tankisi When corrbotod sludge and sour+ quaffs one -"d (X of tonk volume ❑ NA knsvect diopsd eWNal At Mfest once every: 13 y� er 3 fe�ewt 0 NA clan effluent tiller 5 � At i nest once *very: o O NA Inspect "WO pur p controls a Storm At best once every: r nortd>isl ❑ NA Rush istwuls and pres"M 'tout At issw orme ersry: ❑ NA Other. RInEW At least once every: ©snor*" ❑ NA OIMr D NA iaANTE'gApCE 1�T1ltJCT1ONS baipections of tanks and +di.peraal coiht shell be rnaft by an swWidud carving one of the toMowing licenses or cartificatians: Mawr" Pkm*w. Maarten Ptwnbw Rssarietad Sewer: POWTS kwpsctw: POWTS h4sirnainer. Septag 1 Servicing C i Wstor. Tank enspeostirats natal inotrrde a viand b Meehan of the tankful to idwvWv any rrnissing or broken hander% kkn Wy any orecAw or leaks, masstas the v AAM of cornbbned sludge end scan► and to - t for any bed* up or pending of eflkrwnt an dw Watel l surface. The d*wwd cellsj shelf be via+allr k"poe"d to dtadh Ow effluwa !orris in the o0eervedon pipes and to dwok for any powbng of eftfuent on Ow ground sunfsm. The parading of effwsnrt an dot ground surfsos they indicate a faibtg cr diction and rogt*4e Ow Knrrnedisa1rr 1 7Offastion of the local mWAS"" ,. When the combined accun>ulation of sludge and scan in any tank equels one -*►lied IV or mots of the tank voNxne. dw ent" 00""npt Of the tank shall be removed by a 5eptaprt Serirk=V OpenKw and disposed of in aeeondance with ch"*w NR 113, 1 Niaeon - min Adnninistret" Code. All odw swvitfs, kwdudbn but net 61 wited to the savvitrbng of efflrset files. me herwrA l or Womirirsd carnpanents. wwomment units, and any senv(rittg at intervals of s12 rnoradss. shah be owfvmnd by a c:erctfid POWTS Maintainer. A serve report shah bs provided to the lord roguletory stntnonty watnin 10 days of ccrnpietion of wW service event. GREW f4/011 i= o* nsw cones la►+o► � � . treeta�t prtt`aai � $ +Mee:k trNtn'te►rt (anklet for the Pam � Of' of $I►stem Start �4d Q CO sl_ , lei, M entra h thaw (coif conter, During Power +a Dad to Pu"IP cafe WW ON above sM frozen ghw n rpm inf�rop� Face. ft pare normal tent. To cMte1 in acts � lavab_ When Power in d Mae lion hem lard dose. o+Arba(L1rtQ the caMt Power 4 restored the ft to tfts usrrt �° contents of the of and tngr rst+uit In t!(a w tawwor wR t 'sacra nonitd Puntf► a contact a Ptartp tank ratttoysd a backup or eta taco Nvals widtin the Pt�P or P WrS MaWnslnw p the 4+r 00 not dnve or tank. to assist in mares, pefor to Mgt Park > ,aPe es Oyer oparaairtg con the purnp� es t wiMin 7 5 fist down �e 0 , O ver LtM(a and dhParsol �. 00 not Drive 061 *1 0t i on of or ntotwtd a at sW area. or Park o. a 4xb ar conrpect. the acre; e baby "" ft %w*V trorn ti. w...w..r str. Products,' �• btrit ((webs.' d�►easera: Por and p^ O�g the We at the sanitary rr#ine: tonwons • Onume; mss: +factatts: tot, Wham " and "Wer sOttener brute• : rr+edicttian ail; POWTS f pr+ t ► and safely P Y faken out o/ service the s AH g tQ ws "" t�Ptar Gomm( 83.33, be man to Ensure Mat #* system is tacks and pits shay be ftconn ad std the PiPa istrat9ve Cods The watts of all tanks artd P" sMN be removed MW seated. Attar OW. Wavel or +rtA. all w ks and pig shah be ex P dwPwad of bye Saptage Sar pperotor. PLAN kw? saw ((tatenaf cevatad arMi ratrroyeb or titer covers rernoysd aid the void op we filled with If the POWTS fails and cartt+at be � syste(n: relaaitsd the t 4 A suitable ropls�nt as hays beet(. must takes to Provide a dada o area has been ev be 3MM' The repaired n I add be � �om for the bcation of a rep�s�t sod and Old rook in the rtesd for a new seti and P seed • kx an" aM t cONIVaction and ' wind t"et be pon by 0 1v with the rages in a4ia tltae to establish aabis t Pt�[�� area will auitadws Systems must t �t ar:e not available due to setback artdJa t T he $ has not echnology a he**V tack may be inGt011sd as a last mean to ra an the Milled POWTg � advances ih POWTS " be POVIOt"Ved been to w nttfy a ral"CornoW Ovolkoation may be irartaMad s �loCaRe a suitable Upon foNure Of the POWTS a eoii NW site Mound and rsMsce ttte failed POWTS, t° ►, area is avaRabie a holding tank at-Wade soN "W IMAg a<trface � ofd owh Mahe must co removal of the biome( at the TUMT TAW "IC PLirLAP naft in affect at that forme. _AND OTHER T� M MAY CONTAN LETHAL GA=M AFAVM R PWU TW Nip T A � 7 TUN � O � OXYGEN. DO M07 "HER i1pNp, t S MKT OR E DEATH MAY Ri�Ut T. �SCLJE OF A i i116/� one �� F'ot�lfrtr MAi1MTA�+R Mae Naas NE Phone no 1.t}CI1L AEAtp ATdRY AU THCWTy 1e Nears 5 . O mova w dreftid in atee with i IW" s 3 Ofa Cann 83 . 2 2(211bMjf "&jrl and 83.64{1). f2) b (3), AdmirtbtfreUivs Code. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer D S Mailing Address a \ Lo O o ` �� P& n' Property Address sV0c2' (Verification required from Planning Department for new construction) _0 City /State k_ ' LMQ Parcel Identification Number LEGAL DESCRIPTION Property Location �N -R W, Town of L Sir �t�,r 4Q___ P rty w ' /,, �� %,, Sec. T , Subdivision 3 3 , Lot # —"— 7`' Certified Survey Map # , Volume , Page # Warranty Deed # Volume Page # 3 Spec house 0 yes no Lot lines identifiable yes O no I SYSTEM MAINTENANCE 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. The property owner agrees to submit to SL Croix 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 after 2) proper operating condition and/or inspection if necessary), the septic tank is less than 1/3 full of sludge. P ( �P and pumping in P g ( I/we, 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. /,b/ 0 ' Z- SIGNATUkE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. "• " ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed No. &D. wamaa Daa/—BEort roan (BTAT6 Or WtSCO raeitaod to Me cmtm Boat • 3r6ko.v Q 'I (sec. 235.16, Wis. statutaa) For N r -- -- -- I I I 30n061 kbrititirp, Made by Raymond H. Peterson and Alice V. Peterson, , husband and wife grantors , of St. Croi County, Wisconsin, hereby conreys and warrants to Douglas D. Measner and Pamela Measner, husband and wife �I � as joint tenants I. grantee s , of St . Croix County, Wisconsin, for thesumof Thirty Thousand ($30,000.00) Dollars the following tract of land in St. Croix County, State of Wisconsin: The Northwest Quarter of the Northwest, Qu. -irter (P�,� of tue; ) of Section Fifteen (15) , Tcwnshi r 'i hi rty -one (31) rtiorth , of 1�an7e Ei (18) i '� ,� 30• o0 rttGISTERS UFFIGE $T. CROIX CO.. WIs. 1 1, Rec'd f(x Record this day ot- _Yiar -Qh -- - _A.D.19?J- at-- U--- -A 42 414; tR to of eAs i I S N LAND SURVEYING HUDSON, Wi. 386 -2007 NAME First National Bank of New Richmond 109 East Second St. ADDRESS New Richmond WI 54017 DESCRIPTION NA of NWa of Section 15 -31 -18 EXCEPT Lot 1 of Certified Survey Map in Volume "3 Page 637. Douglas and Pamela Measner. i PLAT DRAWING N This is not a complete Land Survey i 3 i O O_ U i 10 s Q OJ 3 > S O H 2 Y Z CSM Vol. 11 Page 637. 0 U I shed house GOOSE LAKE ROAD The Location of improvements on this drawing are approximate and are based on a visual inspection of the prehiises, the lot — dimensions are taken from plats and deeds of county records. This drawing is" for informational purposes only and should NOT be used as a complete Land Survey. First National Bank of New Richmond has agreed to waive these—requirements of A— E7.02, A— E7.03, A— E7.04, A- -E7.05 (1)—(5), AE7.06 1 — 5 and A— E7,07. The purpose of this paragraph is to comply with A =E7.01 (2). Map No. 92 -01 -37 m d Drawn B B.R.B. y�� � E-N /�� Date 1 0/01/92 1" 200 b4 ALL. 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