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° C) 0 N c d 0. 0 0 1 o o t� a) o m © O O) y , b > w c N C C N o j c N a) O O N 0 7 0 o� LicE�O 1 m m ° > 0'^�1 Ea)La)m O C — O c o = /°n 3 .4 EL 3 0o ai a) ow j, y 3 I Ea) I a) O v) !n CL CO O Ca E O uTi c 0 'O U C z E 21 T� C z N f0 f0 m a� m o.o mQ LL 0 N 0 0 U L O 3 >> a a)�c c a) - 0 a) C O a a �' ca 3 o c E Q c> a) Q m o CL a) U O V O V N O m I Z w E E co O _ O Z 4) 4) w a m a m z 0 c t9 o 5 -O 0 Z 1} c _U c CL zo) ca E - a E -0 U v M a �_ � N O7 O N N 3 VJJ 7 3: O 7 co Q) •� O U 0 O O I., IL 15 E 0 O Q O Q O a) Q Z 5 Z o Z m Z N � Z ' m c` m E E c " m E E O is Y _ is Y > LO a a) c v a o v a) C Q a` -0 c -° _ 0 o a` a c Q m CJ U H H H U !v E 333 ° z x333 ° 1 • ;� a a a I E a a a 7 O y N N y 00 O (n fn J L) Z O O Y Q) a) m CD N N_ N N` .-. Z O N N j r N Q .�- .= 0 7 co O y O O� 0 �.. C7) A O V O N y N .�. N N 1 W 0 3 H e cD 2 c ° o ° o o c v o 00 o a c O N F a) U C 0 7 IL 0 0 0 � � C N 1 > }, o rn� r y E � N N N c E E O co O C c 0 -0 _M _M O C w O UJ c Q) « 3 v H Ir @ C N O 0 U p C1 to O E • y' O U) m M z N Z U) Cl) O Z Ll cO CQ I i m ar 3 a a' L a w t A u a 2 O H V O w 00 Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divlion i INSPECTION REPORT Sanitary Permit No: - 399499 . 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: BRAUN, SHANE I Star Prairie Township 038 - 1180 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: I OU lOv o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark S G70 y 1 S• � !� Dosing S Z / / Alt. BM Aeration CP Bldg. Sewer mg t/ It Inlet P TANK SETBACK INFORMATION o �'" tTd r r 0o qY � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S , *2, 11. 39 t ,z Septic 4- Dt Bottom Dosing ��- / i � Q / :�..� � � Header Man. Aeration 0 Dist. Pipe Holding Bot. System L L Final Grade PUMP /SIPHON INFORMATION 3a G. Manufacturer Demand St Cover / p GPM Model Number risCY TDH Lift ction Loss stem Head TDH Ft Forcema' Length Dia. Dist. to SOIL ABSORPTION SYSTEM s� BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 3 • �J Z SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM Ma a u r: INFORMATION Type Of System: I (3 p O / AMBE OR Model Number: r ✓ � > 5, DISTRIBUTION SYSTEM Header /Manifold Distribution I x Hole Size I x Hole Spacing Vent to Air Intake / Pipe(s) Length -� Dia 9 Length q- -�� Dia Spacing `I — L / SOIL COVER x Pressure Systems Only xx Moun Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil roll Yes [N� No rp] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ n 1_(2Z_ Inspection #2: Location: 1116 212th Avenue New Richmond, WI 54017 (NE 1/4 SW 1/41 / 5 T31 N R1 8W) Apple Rive Parcel No: 15.31.18.902 1.) Alt BM Description = 7 < S //Y'� ee /10 're- I/ (a 2.) Bldg sewer length = eX�S�f� 1�Dr Gtr rt - amount of cover Plan revision Required? ❑ Yes # No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) Safety and Buildings Division County VN201 W. Washington Ave., P.O. Box 7162 ` rconsrn Madison, WI 53707 - 7162 Site Addmss De artment of Commerce Sanitary Permit Application Sanitary Permit Number 1n accord with Comm 83.21, Wis, Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number f ] , 3/, 18,� c7Z , C 4k 8^ Property Owner's Mailing Address I / Property Location f 'f S T &I N. R City, Statc Zip Codc Phone Numbcr Lot Number Block N ber r Subdivisi ame CShf14VTnber II. Type of Building (check all that apply) c3 ity 1 or 2 Family Dwelling - Number of Bedrooms ❑Village O Public /Commercial - Descnbe Use XTowruhi O State Owned Nearest Road f III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B If applicable) A. 1 ❑ New 2 10 Replacement System 3 ❑ Replacement of 6 0 Addition to For County use S to Tank ON Existing System B • Check if Sanitary Permit Previously Issued Pernilt Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) Filter 50 ❑ Constructed Wcdand 1 a4 Non Pressurized In -Gro 2111 Mound 47 ❑Sand r ' u 22 ❑ Pressurized In Ground 4l ❑ Holding Tank 48 ❑ Singlc Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 O Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other C& r x -P s V. DispersaUTreat ment Area Information: S - /o iN , - / .c r Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed katc(Gals. /Days /Sq.Ft,) (Min./lnch) fo.zy Elevation i VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallon Gallons of Tanks Concrete Constructed Glass New Ezistine Tanks Tanks do Holding Tank Dosing Chuntner �w VII. Respg usibWty Statement- I, the undersigned, osuzrle responsibfiity for instaIIation of the POWTS shown on the attached plans. Plum r' ame (I' ' ) Plumbe s Si a MF/MPRS Number Business Phone Ntunber i Plumber's Address (Street, City, State, Zip Code) VM. County /De artment Use Onl Approved LDtion roved Sanitary Permit Fee (includes Groundwater Date Issued Is ' AAgeaa Signature (No Stamps, Surcharge Fee) l ! to C> �C"'i'` Givco Initial Adverse as 6O! ro cz � IX, Conditions of Approval/Reasons for Disapproval lia -6 tom w...���,,;n�1 �.r w�►,�F;�w�e � �Pu:� "�..8 t'n`� %�►7.3 'o eltJ.)X.ts0: M qe c ord&^ •-4. •�,�'� 1�e rZ - f rou.cq/ Se.! �4r vs��f�"' [avr- w.4K.. -1 CL� w .o.�lsar i<stt. t/`eY�y S C t�( �rG <S � /tof i�r Joi /S wi5/� •fog/ a bsw(XI s,.xvy,(� vtvslts+t T.e a1 (a,!'''�� S.e.�(j��„ S .��►F,t'! tL 1,,�wia.�� ta0a' dtf # Sft'L, Actaci P (to the Couotr odyl for . oa popes oot tw thaa A1R x 11 tocbv to afxe AcEd�as� aeFd: fil�e� 40 i sc r`- �i.,(e �- � SBD -6398 (R. 05 /01)@ ,,,.t,P S .f��E vl �� .F�� � ,t'i9cCi✓ -Al ll -- __ Q / _ I � I _ J _X 9 7s_- -- _ I le /-eust - ,- - /0t.�L _ _ _ 1 E4 qi� 1 i r - _ i, __ _ _� ' -- __ __ _ __ -- -- __ - -- - I __ __ __ � i __ i __ __ ____, _- -- --L - __ - - - -- I -- -, -- - - -_ _ _ _ - -- - -_I -_ __ ° - - - ,- .� - _ _ ' - -- - I I �. _- -- _- _ _ -' -- i- __ __ _ _ ,i _ __ _ - ;_ __ - __ I i - - i, I __ -- _ _ _ __ _'__ _ - - - -I- __ _ ' _ _ __ __ ___ _ -I ' - -- I ', I - - -- __ i I _ _- , -- __ - _ - -- ___ - ___ ', � v - /3 -a! wisconsinDeparmentofCommerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re by _ Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (mN. A1�- i° Property Owner Property Location Sti a tj e- �- Cln e r i 1�3 rck rt Go Lot 1145 W 1/4 S 5 T3 N R I 64G4 W Property Owners Mailing Address Lot # I Block # Subd. Nam or CSM# City State Zip Code Phone Number []City [ Village 1ATown Nearest Road RI 3X �1 W I 5 C17 (71 y g - i-c,(L itz.lX_ 2.12 }k AV Q New Construction User Residential / Number of bedrooms 3 Code derived design flow rate GPD eplacement 13 Public or commercial - Describe: I — I ij ` ' _� Parent material GgS5 O y 2(' Q u t L_1GS\ri ` Flood Plain elevation if applicable p,. � General comments Y-e U t `•�9 } 1 Q� °t 1. s o �..'r0 . �CEIVEO and recommendations: �' L SEP • �,;.., Boring # Boring a M Pit Ground surface elev. l 4 4) ft. Depth to limiting factor } D 7 in. Soil A lication f2ate 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 6 - 2.10 IO r Z St a fvj%dX !'1 r C S CS - . '7 1. 46- 40 to LS /4 s l 1 s k C5 - `-` •� S r.o -ito 7.S r y/q s 050, 1 rn - .7 1. Z h -7 l .CZ 7 s sla ° I O, foS Boring Boring # _ ng I bs Pit Ground surface elev. 77 ft De pth to l imiti ng 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. I *Efr#i `Eff#2 S Plsb W t CS I " • S Z 10%/ z L - si t �r C s g 3 At -15 ►a rzfz Is r LS .7 1.2 i r M✓ r C-'7 — • 1 1 Z S 40.4b 10yr31 — s 1 ,r rY1 ✓ 5 .7 1 .2. 4 410 - 5 0 fo ('3 — ( I�gbK CS * Effluent #1 = SOD > 30 220 mg/L and TSS >30 150 mg/L t #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number 1 ►, a M 4 s nQA_5 a n 22-7 3 6 7 Address , Date Evaluation Conducted Telephone Number 1 4 3 2 12v 1., rl�.c,.t 2 r c ty o .� �1 (.,) C'- 1 - G -I 1 Property Owner Parcel ID # Page Z ' of Boring # Boring % 1� Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture k Sz . Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont Color *Eff#1 *Eff#2 -17 10 r $ 1 Z 1 t6 1 r' a 2 - to sb pr CS 3 51-5"q 1a r 2 1-1 — S 1 1•' r y 651 r — s l 1 sbk cs - • y S 2 114 — C, .5 Boring g Ground surface 'tr •4 1�•{►'l S `� • 9 r c ❑ Borin # Pit el f elev. t Depth to ling in. � � i -- �SoiApvlrimcabon 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 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Applicati on 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 * - > < > < 0 L * Effluent #2 = BOD < 30 and TSS <_ 30 mg/L Effluent #1 - BOD 30 _220 mglL and TSS 30 _ 15 mg/ , _ � I 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. 9BD- 8330Test(R.07 /00) i , p CC, wvl W 1 $ r b 21 W- 51 ae` `O- 135 al P "evrh a5 ► l tlg "I Zz.-7 3 S7 / l �[ SAFETY AND BUILDINGS DIVISION /— Field Operations Bureau ,Q g 13 East Spruce Street Y� Chippewa Falls, WI 54729 � V- www. commerce. state. wi. us isconsin Scott McCallum,Govemor Department of Commerce Philip Edw. Albert, Secretary January 24, 2002'ti X Shane and Cheri Braun "� �. 1116 212th Ave 2 New Richmond WI 54017 T Dear Mr. And Mrs. Braun: Re: Undersized System Use Lot 36 Apple River Bend NE, SW, 15, 31, 18W Town of Star Prairie, St. Croix County In response to your question regarding whether or not you would have been required to increase the size of your onsite system when a bedroom was added, I doubt it would have been required. The policy in place from September 24, 1981 to July 1, 2000 would have been the following: "We would like to clarify when complete system evaluations (with soil borings) must be done for existing systems. Complete system evaluations must be done when modification is made to the structure that could add new wastewater load to the private sewage system. The addition of bedrooms, that are intended to house additional occupants, moving a mobile home of the site and replacing it with a permanent home, replacing a old home with a new home, or installing plumbing in an existing structure for the first time are example cases that must have a complete system evaluation. "Installations such as garages, sheds, porches, dens, family rooms, artist's studios, the addition of bedrooms where family size stays the same, or other structural changes that don't add wastewater flow, should not be construed as parcels that automatically need a complete system evaluation." "As with the letter of October 27, 9980, we feel that sites that are non - compliant as far as system sizing, or sites that are non - compliant from the new site criteria, the department will expect that an affidavit be filed with the deed for the site, to alert potential buyers that this site is a non - compliant site." As a result of this policy statement, the attached ONE AND TWO FAMILY' form was developed (dated 11 -81) and used state -wide. It's purpose was to run with the deed and serve as notice of a non- compliant situation such as undersizing due to an increase in the number of bedrooms in a home, for example. It was standard practice to allow the addition of one bedroom to an existing home when occupancy did not exceed the original capacity of the onsite system. If is my understanding that nearly all counties used such affidavits to allow an additional bedroom to be constructed even though the onsite system was not originally for that use. Please also be aware that many instances of bedroom additions were not recorded since the addition did not involve the issuance of a county or town building permit to remodel the interior of a building that may have resulted in an increase in the number of bedrooms. Many county and town building permits are only required if the outside dimensions of the building are changed or increased. January 24, 2002 Braun Letter Page 2of2 If you have any other questions, please feel free to contact me. Sincerely, O erovy GYJansk Y Wastewater Specialist Field Operations Bureau Ljansky @commerce.state.wi.us (715) 726 -2544 Voice (715) 828 -5902 Cell (715) 726 -2549 Fax cc: St. Croix County Zoning Enclosure J . ONE AND TWO FAMILY *The existing system must be inspected for compliance to bedrock and high groundwater requirements of the code. If the existing system does meet minimum requirements—for groundwater and bedrock depths and if it is functioning, an addition can be added in most n the existing s without updating 9 stem. If the existing system is y instances p 9 utilized for the addition, every attempt should be made to locate and reserve an area which is suitable for a code complying replacement system for when the system fails. If the addition will substantially increase the wastewater discharge the existing system shall be replaced with a code complying private sewage system. (Subdivision & Lot -- Section Township Rural oute Address Post Office Zip Code (I)(We) , plan to (build an addition to, remodel) the building at the above named location. The present private sewage system has been working satisfactorily as far as disposing of wastes. If the present private sewage system does fail, it will be replaced with one that is code complying. (1) 2 wner s Signature) Date Subscribed and sworn to before me this day of 1 9 otory Public County, Wisconsin My Commission Expires COUNTY - (County Authority I Plot plan attached (show location of building addition to drainfield and septic tank). 11 -81 f rn v c � a E O OR D CL u C- a c c'' CF N' p c 3 Z H.' C C W O a ¢ w a m Z E c 0 �° o ` cr �. M C ~ -14 ~ U o Cn d m m c 3 L o N N O N m m v o m raa Q c N O o o v cri N O a ZZ C N U W f0 L 3 a �- Z m ;o o o. CO r z Q _ C w N L— LZ — L i O ; ; L m U N O N Q N N Z r N Cl) L 2 _ o T v Z iii w - Q U CO M M Y - N 3k ` N O c c Z O E O O �U 00 a O CL y c y U O U Z U CD C Y Z O N m U m O p O T L,� Cl a w � a N qy a o Q Q m = c v Z c O C C, 7 N O d N ru (D S U) O U) c r� O Z n d °� O' N O m U c°v SAFETY AND BUILDINGS DIVISION .� Field Operations Bureau 13 East Spruce Street ECTIOWREPORT Chippewa 54729 1 *hsconsin www.commerce erce.sto tate.wi.us ^ i• Scott McCallum, Governor Department of Commerce ^ Ph ilip Edw. Albert, Actin Secreta Date of Inspection: October" 01 �S lum + er Name and Address: 6 , Kim A. O'Connell, MPRS 224263 Project Na "Braun �� L 504 3rd Ave Use: Exi�g Residential L Osceola, WI 54020 Legal Description: NE, SW, 15, 31, 1 Lot Number: 36 Certified Soil Tester Name and Subdivisia(t1s Apple River Bend Robert Ulbricht, CST Municipality: Town of Star Prairie 655 O'Neil Rd County: St. Croix Hudson W 1 5401 Plan Transaction Number: NA aT Sanitary Permit Number: 307778 Owner Name and Addr .� Shane &Cheri Br am Gl� Zo Wastewater Flow: 600 gpd 1116 212th Ave Persons Present: S. Braun New Richmond WI X1 MUM An onsite inspection was conducted at the request of the owner regarding the early failure of the soil absorption system serving his home. The owner stated that water usage is normal to low in the home based on water conditioning regeneration periods he has observed. Low flow fixtures and appliances are used throughout the home. The system was installed in May 1998 and has been in use since that time. The owner recently experienced a sewage backup into the home and found that there was more than 15 inches of effluent ponded in the soil absorption system. A pit was dug adjacent to the soil absorption system that allowed it to drain lessening backup problems, but creating a potential safety and human health hazard. The pit should be filled in as soon as possible. The owner hired Tom Nelson, CST 227387, to conduct a soil and site evaluation for a soil absorption system replacement. During CST Nelson's evaluation he felt that the soil textural conditions observed did not support a 0.7 gpd /ft"2 soil loading rate at the depth the soil absorption system was originally installed. However, this observation was not confirmed next to the soil absorption system. My observations lead me to believe that the soil texture immediately below the soil absorption system may be compacted or slightly finer than conditions a foot or so deeper. This is based on the collapsed and undercut pit walls arcumd and below the soil absorption system and should not used in !ieut of a sail texture analysis at the depth of the system. Further verification is necessary to establish if compacted conditions or slightly finer soil textures exist below the soil absorption system. In addition, it may also be advisable to verify conditions in the area tested by CST Ulbricht to determine if the results can be duplicated. In an attempt to correlate the site information I collected and that of CST Ulbricht and CST Nelson, I learned that the plumber did not install the soil absorption system within the area tested by Ulbricht. This is important in that the certified soil tester (CST) should only be accountable for conditions within the tested area and not elsewhere on the lot or parcel. According to Comm 83.09(4)(b), Wis. Adm. Code [Reg. Feb. 1994], at least three soil borings were required to establish a soil absorption area and suitable soil conditions. The location of the soil absorption system as installed is in violation of the above referenced code section. In addition, it is my opinion that the CST's original intent was to have the soil absorption system installed at an elevation of 95.00 ft on the east side of the tested area instead of between 95.59 ft (county inspection) and 96.23 to 96.42 ft (this inspection) as was installed. This may not have been related clearly enough by CST Ulbricht, but one would have to question where in the tested areas the proposed system elevations (i.e. 96.5 and 95.0) applied in order to design the system. A i - 1 Braun Onsite October 3, 2001 Page 2 of 3 greater installation depth may have penetrated coarser soils and reduced or eliminated the early hydraulic failure experienced by the owner. It is difficult to accurately correlate the results of Nelson's soil test to the existing system since it is 20 feet or more from the system area, slightly down slope, and the stratification present in the upper 60 -65 inches complicates extrapolation of results. The only creditable way to evaluate what's below the existing system is to conduct several evaluations adjacent to the soil absorption system. Only then will we be able to say with confidence that the soil loading rate should have been lower and the size of the system substantially larger. If there are any questions regarding this report, please contact me. V G. Ja lopecialist y ewa�ter J Ljansky @commerce.state.wi.us E -mail 715/726 -2549 Fax 715/726 -2544 Voice cc: ®County ® Plumber 9 CST 93 Owner ❑ Other ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ftA MAI Mailing Address I to Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number -A a - 70 - QO � LEGAL DESCRIPTION Property Location _ N s '/4, S w ' /,, Sec. , T_ N -R1 - W, Town of Subdivision PAO ..0 _1"L , Lot # _. Certified Survey Map # , Volume , Page # Warranty Deed # 5 7 2� _N j Volume 1 3a 1 , Page # k3b _ Spec house ❑ yes [X no Lot lines identifiable W yes ❑ no 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 St. 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 wastewaterdisposal 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 Zoning Office within 30 da ys of the three year expiration date. J "- 1 1 &,it aa"4.- SIGNATURE 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. a /o //7/ D/ 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 S NArt.l>t.' C w> B Rrsu�l for 3( APPLE. Rtvea AND sw - Is - 3(- rg W J F S ;-AlZ f'fZs� s iZ i r_ T. C PO rx CCu w r S .P. - LEVp DA-rl too.ap` ° %A# -I Top (X- (a W t.oTGo E� LOt .74 = Bkt *I- Wit? 4i' q-1. puc. U�TPt IaZ. 4 93Yt. TOP or Fat v4Drm . za SIS- EX Soi-. a ajP46 ( gL . 4z - ..s`ts1i•t. `sc. car l�EN7' P'i PE W'uK. q3 sl f n CL a O Z Gam±` zj alt_ �'6► - fir- - - -- - Esc- ff"w: OF __ l- �' APPQ4xcf,w SE cot ER cF UI_6R14 i PM try LIME r�gg J � • =•tom. c�oP��+t A'u1�R�.sS Cllto 'ZI.Z -�` A vg . PEW Rtctt -MOVIN w S40tl to�3�ot • r ST. CROIX COUNTY WISCONSIN OFFICE OF COUNTY CLERK ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 ~ (715)386 -461 Fax (715)381 -4400 October 10, 2001 Greg Timmerman Corporation Counsel 1101 Carmichael Rd. Hudson, WI 54016 Dear Greg: On October 10, 2001 I was served a Notice of Claim and Circumstances of Claim for Shane A. Braun and Cheri L. Braun vs St. Croix County and St. Croix County Zoning Department. The original is on file in the County Clerk's office. Sincerely, � -�. v v Sue E. Nelson County Clerk c WMMIC Dawn Budrow Risk Manager i V - { L - a*Avkd I P k ,, f s 44,;j ~Uvt r .j jj /9 - /O-d f jLC,O Ga t o C/? St.C.o C 4 0 un t�c1 OA cn� � _ &j c d 1� U�- a-0 1,c72 Q 11 4 l�/t4 " ©U & r �Q/lCL c u dP� Q!2 QL[ q, Sri ; Cd tt D JL QrL S� -30 aJ 6 n hct� Pyc.. enoCIUC& off 06 a4t�k &d uo -e a u:c�'.co to 64&a-Z, o f &d Ji sA&d b �a ya 63 an Jr- olb v C OUn 7 Z vn in� � • Gd 4 C rJ" T - V 1SC i j Z ton Sri otp,,� ao tjW 0o an � . •r a l r . moo; v- ctx.cl (56 c ntx,� t "„ an e, � C' �eri � rauti -- , � � a.c,c� f�l •� (n t ial"cf to v *Xa cy t.J Co h,'h- �C'6 � &MM 83 .09��{����� [REG. Fea, i994] a i 61 o u1, ct . i i Sy�� 7 SAFETY AND BUILDINGS DIVISION Feld Operations Bureau 13 East Spruce Street Chippewa Falls, Wl 54729 INSPECTION REPORT www.commercestate.wi.us 1*isconsin Scott McCallum, Governor Department of Commerce Philip Edw. Albert, Acting Secretary Date of Inspection: October 3, 2001 Plumber Name and Address: Kim A. O'Connell, MPRS 224263 Project Name: Braun 504 3rd Ave Use: Existing Residential Osceola, WI 54020 Legal Description: NE, SW, 15, 31, 18W Lot Number: 36 Certified Soil Tester Name and Address: Subdivision: Apple River Bend Robert Ulbricht, CST226375 Municipality: Town of Star Prairie 655 O'Neil County: St. Croix Hudson WI 54016 Plan Transaction Number: NA Sanitary Permit Number: 307778 Owner Name and Address: Shane &Cheri. Braun Wastewater Flow: 600 gpd 1116 212th Ave Persons Present: S. Braun New Richmond W154017 An onsite inspection was conducted at the request of the owner regarding the early failure of the soil absorption system serving his home. The owner stated that water usage is normal to low in the home based on water conditioning regeneration periods he has observed. Low flow fixtures and appliances are used throughout the home. The system was installed in May 1998 and has been in use since that time. The owner recently experienced a sewage backup into the home and found that there was more than 15 inches of effluent ponded in the soil absorption system. A pit was dug adjacent to the soil absorption system that allowed it to drain lessening backup problems, but creating a potential safety and human health hazard. The pit should be filled in as soon as possible. The owner hired Tom Nelson, CST 227387, to conduct a soil and site evaluation for a soil absorption system replacement. During CST Nelson's evaluation he felt that the soil textural conditions observed did not support a 0.7 gpd/ft ^2 soil loading rate at the depth the soil absorption system was originally installed. However, this observation was not confirmed next to the soil absorption system. My observations lead me to believe that the soil texture immediately below the soil absorption system may be compacted or slightly finer than conditions a foot or so deeper. This is based on the collapsed and undercut pit walls around and below the soil absorption system and should not used in lieu of a soil texture analysis at the depth of the system. Further verification is necessary to establish if compacted conditions or slightly finer soil textures exist below the soil absorption system. In addition, it may also be advisable to verify conditions in the area tested by CST Ulbricht to determine if the results can be duplicated. In an attempt to correlate the site information I collected and that of CST Ulbricht and CST Nelson, I learned that the plumber did not install the soil absorption system within the area tested by Ulbricht. This is important in that the certified soil tester (CST) should only be accountable for conditions within the tested area and not elsewhere on the lot or parcel. According to Comm 83.09(4)(b), Wis. Adm. Code [Reg. Feb. 19941, at least three soil borings were required to establish a soil absorption area and suitable soil conditions. The location of the soil absorption system as installed is in violation of the above referenced code section. In addition, it is my opinion that the CSTs original intent was to have the soil absorption system installed at an elevation of 95.00 ft on the east side of the tested area instead of between 95.59 ft (county inspection) and 96.23 to 96.42 ft (this inspection) as was installed. This may not have been related clearly enough by CST Ulbricht, but one would have to question where in the tested areas the proposed system elevations (i.e. 96.5 and 95.0) applied in order to design the system. A :.y am S 9A..'JFL We B papu Lor 3 (.. APPLF- Rtvt<R. AF-oo 18. �+J T5wJ � t= s7X1iZ �f Zr* t � i G. s CR.o 1x cc",- ri-1 W t ' E �LEUptiTtor.1 � �- t00 aK*tq Tbp or:--_' (a— t►E Lci -c z Get gip or t1C..vF,�T or f%twwR 96.: z3 trK . o�. saw ROefriT' . 3. _ .40 ��ts��t .- - .. - — -- - - - -- - -- - - - -- - -- - .- r OP E J i s- ... I TV 9E cofFJZ ol= _ �,% ULBRi 4+t{ lo31 of 0 - -�-. ` ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner `1 Address City /State i OlV11V � CiFF�� Legal Description: Lot _ Block — Subdivision/CSM # Sec., T„.5 -RAW, Town of PIN # ozy -z/& - yam -o 15.31.1g,�Qy SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC, Setback from: House Well P/L Pump manufacture_ r. Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width _ /=? Length Number of Trenches Setback from: House Well P2 Vent to fresh air intake ELEVATIONS Description of benchmark Elevation /� /2 Description of alternate benchmark Elevation Building Sewer 7 ST/HT Inlet ST Outlet 27Z PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System ( ) () ( ) Final Grade () () ( ) Date of installation Z &,S' P mit number _ �r�;Z7 State plan number Plumber's signature License number _ s6?l_ Date s /2, 1911 Inspector , Complete plot plan . I NOTICE Please provide the following: I • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. PLAN VIEW 9 a 3 G�tL1G.� ys � /tea usr INDICATE NORTH ARROW Wiscon.�in Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryP eft Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)). Per & Cl INC e: ❑Sii� CI Vj! x i rn of: State Plan ID No.: CST BM Elev.: Insp- BM Elev.: BM Description: �,lAK 1'KA Parcel Tff l�._1180-70-000 Ile TANK INFORMATION ELEVATION DATA A9800167 y�y TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �rP Benchmark Dosing I Z 13,iK /-2 Aeration Bldg. Sewer 9 71 7 11 Holding St /$ Inlet g — 7 00 TANI( SETBACK INFORMATION St/ }eft Outlet 9. Zd' 97 TANK TO P / L WELL BLDG. AirI to ntake ROAD Dt Inlet irl Septic YIA NA Dt Bottom - -- - - - - -- Dosing NA Head- pfl e , Aeration NA Dist. Pipe HoW ng Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demands Mod um GPM TDH Lift L oss ction 5 stem TDH Ft Forcemain Length Dia. SOIL ABSORPTION ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS SS Q SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM._,LEAC Manufacturer. INFORMATION Type O � C R Mo Number: System: R UNIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole To Air Intake Length ' Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or -Grade Only f Depth Over Depth Over xx Dep xx Seeded /Sodded xx Mulched Bed/ Trench Center Bed/ Trench Edges Topsoil E] Yes ❑ No ❑ Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) LOCA'T'ION: STAR PRAIRIE 15.31.18,NE,SW 1116 212T AVENUE Plan revision required? es ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i l A c 5o , Safety and Buildings Division w SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. 60ilim In accord rd with ILHR 83.0 Wis. Adm. Code P.O. Box 7969 Department of-Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. ' • See reverse side for instructions for completing this application State Sani ary Permit Number j o'7 ` The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property O ner Name Property Location 1/4 v4, S T (or) W Propn Owner' Mailing Address Lot Number Block Num r Cit tate , Zip Code Phone Number Subdivision N me CSM N er I. TYPE F WILDING: (check one) E] hone Owned It� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Z ❑ Town O r t2IZ� A -i<-_ III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 [M New 2, ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. E] Repair of an System _System Tank Only Existing System - --------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 [4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 E] In -Ground Pressure r )f °'-� 42 [] Pit Privy 13 E] Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./i�(ch) Elevation // Feet Feet Cap aclt VII. TANK in li Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks eptic Tank k jj ° ® El ❑ 1:1 El El Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the yndersigned, assume responsibility for install on of the onsite sewage system shown on the attached plans. Plum er' 7am r(PNt) Plumber's re: a p MP /MPRSW No.: Business Phone Number: Plumber's Ac dress (Sting t, Cit ), State, Zip e): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate $sue Issu ng entSi nat re (No Stamps) A roved Surcharge Fee) pp ❑Owner Given Initial Q Ov �� Adverse Determination uu((// 7 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ,. 1. A sanitary permit is valid for two (2) years. , 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority_ 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. if 1 or 2 Family Dwelling. in ry Ch Check only one and complete # of bedrooms a II. T e of building be served. e p y YP 9 9 Y III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer;.D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. . hI S 9f cr a 3 � ran s Imo, 41 Wisconsin De partment of Indus M. SOIL AND SITE EVALUATION REPORT P / of 3 Labor and Human Relations � — • Division of Safety 8 Suiklings in accord with ILHR 83.05, Wis. Ad a 11 r. cRo Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan de, b� not limited to vertical and horizontal reference point (BM), direction and % of slop , le o '�� %��5 � PARC dimensioned, north arrow, and location and distance to nearest road. co APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION " .. ^ IE DATE PROPERTY OWNER: PRON LOCATI r l '1 k'i'c h.4 RD 5To v 7 GOVT. " �" �t ��f�,S � 3 f ,N,R A? E (oo PROPERTY OWNER':S MAILING ADDRESS SUB 0 f , M 1353 14 w ,4 7-0k�:= rf'. t'" 1 CITY, STATE � ZIP CODE PHONE NUMBER CITY OVILLA NEAREST ROAD I+U So0 5y0f(& (7/5)541 U 111-Iy. cc (I,4ew Construction Use [ 4-ftesidential / Number of b6drooms 3 +0 4 () Addition to existing building ( ) Replacement ( ) Public or commercial describe Code derived daily flow T, gpd Recommended design loading rate bed, gpd/ft trench, gpd/11 Absorption area required g bed, 112 7!5�o trench, 11 Maximum design loading rate " bed, gpd/ft ' S Trench, gpd/It Recommended infiltration surface elevation(s) SEA }`h . ft (as referred to site plan benchmark) Additional design / site con rations NJ Parent material $ I t p /�;,� �; E�� Flood plain elevation, K applicable R S = Suitable fo system 00NV TQ UL MOU10 ❑ U IV•G 0 PRESSURE AT -GRADE S FILL HOLDING T C U- Unsuitable for stem U M p U ❑ S O U 91 01.1 ❑ S off EXt f role "_ 4 ,4 X S0IL DESCRIPTION REPORT 4 � /e = Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TWnch ^r► t1AX 9S zf .7 .8 Z i zz io ye /;. 7 �. Ground 3 Z'3 75 y,P Y S �, S G�i� CS 7 • f3 elev. _/ p /D /• Yo ft. - �1 - /O /Z (® ---- s' d G�iC - , 7 • Depth to limiting factor 1> 79- Remarks: Boring # / 1 0 -0 - /oYk 3/3 5 14" w trf,2 CS 2f •� .f3 /s /�., Ground' 3 22'33 /O,W 3 ,1lr tirt 1 ; , -7 e ie CS .7 .0 elev. 3 to 75 YIP 1�/1v U' S — — • g �9•a ft. Depth to limiting factor �-- Remarks: CST Name: — please Print R 8 t R T— . L n R k T— Phone. 7 Address: 'J ? — Signature: Ulbrleht & ASSOC Date: CST Number: Ptivats Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL PROPERTYOWNER Pl? -44,Ph 5400-7— SOIL DESCRIPTION REPORT pap Z' of PARCELI.D.ft 1 -07 3Co iE /11 E� 8L'.va Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boutx�ry Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be Wnch / 0- ,o � 3 /3 S 7Z �►•� f,2 ACS 3 f 7 8 /© Y/? 2/ Z- Ground 3 3 -3 / _r/ ---- S /�s�,� f Cw elev. �8 ft. 3y- /o Depth to = limiting factor 7 Remarks: / ?E l eP1S /o e"f c_ Sao 7 Boring # / O-/3 Io YR 313 ..::...:...::. z 13 -2 10YX 31 4 61 e cw /f . 7 .g Ground 3 122 7.5 S. o s ! .8 elev = /o •Io ft. r Depth to i limiting fac tor X40— ! i Remarks: Boring # / 1 io YR 3/3 /e v -F/2 S 3 f .7 ' •8 Ground:.:. 3 �o• 3 8 7. Y2 1 1 5 X I C 0 IhAtS O, 7 /o 7 ft. i Depth to i smiting factor , Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 0"—M - I I C Gor 37 S'P +7 NF /-or c0,0ve P /b0.0 . No . • I— . L T 3r a' D 3° 3� ., 3 0 T- 3/ �D 0 3 0 c y 41,6 Ili POWS — SC : I ' 30 3 9g S 13 y 162- . /a /3 /60.70 Sys • M 13 2 - B f 5 ) /60 7 9. o ��, 3af3 — ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuy'A' Mailing Address Property Address ( required from Planning Department for new construction) City /State �� ,��i�e,� �1 Parcel Identification Number = - //-60 - 70 - _— LEGAL DESCRIPTION Property Location 1 (/, '/4, ' /o, Sec. T _ N -R Town of _ 5 1 -_ Subdivision %,7 - ,Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume /f-_21 , Page # Spec house CD yes ❑ no Lot lines identifiable JZ yes ❑ no 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 care affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the c-,mer 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 fitll of sludge. I/we, the undersigned have read the above requireiiients and agree to !naintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Cormi.erce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained :rust be complet(J and returned to the St. Croix County Zoning OL Ice within 30 days of the three ye Z/11� . ation date. ,- SI ,NAT F APPLICANT DATE O WNER CERTIFICATION I (we) certify that all statements on this form are true to th:: best of my (our) knowledge. I (we) am (are) the owner(s) of the property described abojvc, by virtue of a warranty deed recorded in Register of Deeds Office. - // 99 SI .NATURE F APPLICANT DATE * *' " ** Any information that is mis- represented may result in the s; iiiitary 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 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 - �-- (715) 386 - 4680 June 30, 1998 Re /Max Team 1 Realty Attn: Mike Germain 103 Main Somerset, WI 54025 RE: Septic Inspection for M & G Inc. located at 1116 212th Avenue, Lot 36 of Apple River Bend, Town of Star Prairie, St. Croix County, Wisconsin Dear Mike: A septic inspection of the above referenced property was conducted on May 20, 1998. This property is located in the NE /4 of the SW %4 of Section 15, T31 N -R1 8W, Lot 36 of Apple River Bend, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. erely, ames K. Thompson Zoning Specialist /sm r STATE BAR OF WISCONSIN FORM 2 — 1982 5787 EA WARRANTY DEED DOCUMENT NO. — VOL I'V varr'610 RE�fStfAt T. CRO1X Ct,� Wi rf RICHARD O. STOUT b�si�ri , I CO. MAY 07 1999 conveys and warrants to M & Q, INC. Re Iptpr of Dsads THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, ',! (`(�1 K z G e m p , State of Wisconsin: Lot 36, Plat of Apple River Bend First Addition, Town of Star Prairie, St. Croix SloI� County, Wisconsin. 038- 1180 -70 -000 PARCEL IDENTIFICATION NUMBER RA !,� $ SEE It This is not homestead property (is) (is not) Exception to warranties: easements, restrictions , rights -of -way and covenants of record. Dated this 4th day of May A.D., 19 8 Richard O. Stout (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT j Signature(s) State of Wisconsin, ss. St. Croix County authenticated this day of , 19 Per o t lly came before me this Ith day of 19 the above named TITLE: MEMBER STATE BAR OF WISCONSIN PEA J. G (If not, �G� F� authorized by §706.06, Wis. Stars.) 9 me known to be the person who executed the foregoing 2 strument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY —' s ® _Z Janet P. Stout siL1C 1353 Awatukee Tr. Hudson, Wi . 54016 " �F S Notary Public, v County, Wis. (Signatures may be authenticated or acknowledged. Both M ommission is rmanent. (If not, state expiration date: necessary) 1 '5 . 19 ) Names of persons signing in any capacity should by typed or printed below their signatures. srATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis. • APPLE BEND LOCATED IN PART OF THE NWI 14 OF THE SWI 14, PART OF THE SWI/4 OF it -E yr rr[c avvii - r, r - -[n E vl NEI 14 OF THE SWI 14 AND IN PART OF THE NWI /4 OF THE SE1 14 ALL. Ir. `EC DON 15, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. A a • _ Y Y ` N89 E - . _ ... 2IAA 35' w •.E a LOT 27 ; . LOT 26 - 9r 9S Sa sr LOT 39 x [.< Gar �� - ` \•f :]], 2L :O It , n �0, r!6 50 I "'6 • 1' sC E.I E— 2 ] >I aC 13130• +'19'E ♦9r r]' __ u vJ )O.e :♦ ;0 fT SU IT EIc es-I — LOT 25 _ A h 6..06] ]n' LOT 28 zol 2 90.0.2 SO.I O �\ ,�, EIC ESM� ..5 V LOT 38 S q. . �.��♦ )66 90 E T . .?r, nee']r 2 J2 AC LOT 24 S . 006 w IT. E "I r S M1 a ryv LOT 29,' ��E B] 22 C E I.S. w IT )22. �W 9TZ m r Tr LOT 23 !..')I 4 i C I sae'-, ]e'. 132.8. [n r m r r e — — l LOT 37 1 2 1 7. ac ry 1T' t ? ! LBJ AC. r •A ac ESC `T U♦ , /� /y5 r nQ 1 1 v. w9 so Ir I i LOT 30 I Q I cl. <— �' I SOT 22 [� I' 2. �. 1 / l 5 N , '1 a LEGEND — _ m I 1..1• -. -s.. ' m� iiI 9 6EU:.:nun ccunr• s6crv. cw' 1 6 �' NBi'!< 3>'•,v 3" 59. LOT I • z':non 13,.E —o • n/ I ,n -3 ' i , ' 19] .C.�r• ,� �; I � / � \t • r un S iT ♦ O LOT , 31 • 1 « �; 1].]6) 50 IT , LOT -- 1 __ _ 12 -CE uT- r E"EK- i N 509.5",16 E _130.:+ 5 i i N LOT 35 L0 " fr \ ! „e_E - 2( or' _rosEO •�wr oBra r� O t I 1,91 K. ''� ly, .E nc'r• - -^t I •.__E I a CS.vE OCaT::n •;- 9].0 ♦6 w IT LOT _ — w -wvE9 i.nE LBT 32- ^` I ob ` �� +< 19 E - ET. n C.. S )09 S6 Ja'E ]]• ]9' O� 39. •5• sC IT l] J, _ �[. ♦o n r.UT L21 ,,, r 1EEI . I LOT 34 z Zz a - 107 7 1 °, \ ! 2i to No rE I ,. 1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the z_ � m eg aA l residence located at: -5 U)_ ; , Section 1,ff T j_N, R Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: X690 p,/ Construction: Prefab Concrete Other Manufacturer: (If known): Age of Tank (If known) : _ l f 9;5' ;;J4�1a - ' (Signa ure) (Name) Please rint (Title)� (License Number) /D - /7 -1 / Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name / Signatu MP /MPRS POWTS OWNER'S MANUAL at MANAGEMENT PLAN Pa of, FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity g ❑ NA Permit # Septic Tank Manufacturer - S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 0 NA, Effluent Filter Model A - ❑ NA Number of Commercial Units 12 NA I i Tank Capacity gal ❑ NA Estimated flow (average) gal /day _ Tank Manufacturer S ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer 0 NA Soil Application Rate gal /day /ft' Pump Model 9 NA influent/Effluent Quality Monthly average* Pretreatment Unit PL NA Fats, Oil az Grease (FOG) :530 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) _5220 mg/L ❑ Mechanical Aeration ❑ Wetland 5_150 mg/L ❑ Disinfection ❑ Other: Total Susp Solids (T SS) Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg /L 0 in- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size !i inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ® year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume Inspect dispersal cells) At least once every ❑months 12 year(s) (Maximum 3 yrs. ) Clean effluent filter At least on every ❑ months .l1 year(s) Inspect pump, pump controls 8z.alarm At least once every ❑ months ❑ year(s) JZNA Flush laterals and pressure test At least once every ❑ months ❑ year(s) I0 NA Other: At least o nce every ❑ months ❑ year(s) .JX NA Other: At least once every ❑ months ❑ year(s) It NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Masts Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectior must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure th 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 (h) 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 ch. NR 113, Wisconsi Administrative Code. The servicing of effluent fliters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 chemica that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content of the tar\k(s) removed lay a sentage servicing operator prior to use. r — P,1� o� System surd up shall not occur when soil condltluns are (roan at the InfUtrative surface, During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will Ge dischargtd to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In the backup or surface discharge tai effluent. To avoid this situation have the contents of the pump tank removed by a Sepuge Servking Operator prior to restorint power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operadng the pump control) to restore ncrmal levels within the pump tank, Do not drive or park vehicles over links and dispersal cells, Do not drive or park over, or otherwise dlswrb 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 wsam may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; clgarette butts; condoms; cotton swabs; degreasers; dental floss; duper; dlsln(ecunu; fat; foundation draln (sump pump) water; hit and vegeuble peelings; gasoUrR; grease; herbicides; meat scraps; medicatium; oil, palntlnst Products: vesticldes; sanitary naokins: tampons; and water softener brine, ADANDONEMENT When the POWTS (ails and /or Is pemsanently taken out of servlce the following steps shall be taken to Insure that the system o properly and safely abandoned In compliance with ch. Comm 83.33, Wlscoruln Admintstradve Coder • All piping to links and piu shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and plu shall be mmoved and property disposed of by a Septage Servicing Operator, • Afier pumping, all tanks and plu shall be excavated and removed or their covers removed and the void space flllcd win soil, gravel or another Inert solid material. I CONTINGENCY PLAN If the POWTS fails anti cannot he repaired the following meuures have been, or must be taken, to provide a code Compliant replacement system: �31 A suluble replacement area has been evaluated and may be udltzed 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 requlred setbacks from exlsdng and proposed strvcwre, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation w establish a sultable replacement area. Replacement iys tmn rnwt comply with the rules In effect at that drne. O A suluble replacement area is not available due to setback and /or soil ilmitations. Barring advances in POWTS technolod, a holding tank may be Installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a sultabie replacement area. Upon fallure of the POV rS a soil and site evaluation must be performed to locate a sultabie replacement area, If no roplacenwrit area Is available a holding unk ma be Installed as a last resort to replace the failed POWTS. C Mound ,end it-grade soll absorption systems may be reconstructed In place following removal of the biomat at the inflluaUve wrNce, Ke<onswctloru of such systems must comply with the rules In effect at that tlme. < <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 RLSULT. RESCUE OF A PERSON FROM TK9 INTERIOR OF A TANK MAY aL DIFFICULT OR IMpnttlRl F. ADDITIONAL COMMENTS POWTS INSTALL , POWTS MAINTAINER Name - _ Na mf Phone P SEPTAGE SERVICING OPERATOR (PUMPER LOCAL REGULATORY AUTHORITY Name Mercy Phone APPLE BEND GATED IN PART OF THE NWI/4 OF I HE SWI/4, PART OF THE SW)/4 OF I-E 1/4 OF THE SWI14 AND IN PART OF THE NWI/4 OF THE SE114 AL I.% CEC FION 6, T31N, R18W, TOWN OF STAR PRAIRIE, CROIX COUNTY, WISCONSIN. liNPLATT Z fag 39 T LOT 27 LOT 26 c LOT 39 E�c 1�� 54 c .68, x EK Es., l o 0.,ms w Id LOT 28 LOT 25 1.5 2 o7 l y.- 'Al Ea Es.T jj- LOT f 38 'N 33.-. 6 �6 W FT. LOT 24 z. (.c LOT 29" . 8$ �,, / , ]2 .9a] z . . ' . IaC Z IT / 17 LOT 23 4 , . I I LOT 37 of Z- "'I" '.* 35 c 1-c c-1 I; �4 .87 c. III. So'll so 2 LOT 30 Is I z lei 411 C). c 22 LO Or LEGEND LOT —,36 N85��!4 37--� 384 59 Ft LOT 31 T3 so IT !.OT 7 1 ..c .0o c-..- sE 3.. o 13 o-1 LOT 35 L:)T 20 9s...6 so 11 LOT --f 'E LOT 32----N —T 33 '6. LOT 34 I z 'c No rc C,13 5SW 13 ��I E B�R OF Mil-SCONSIN FORM 2 11)82 WARRAN1Y DEED DOCUMEW NO M & G, Inc. REGIST�R S' 0 -- ---- :;T. CROIX Co., W1 AUG 2 8 '998 col "e)-ilu-'ralltsto ---Shane A. 51-4--u-n--a4d Cheri L. 9.00 M ---�Br-au-n.- 'hus-hand and Wi f e. 3 Re later of Deeds A: % NAYF A�.,) the follo%%mg dcscnF*-d real c St. Croix 038-1180-70-000 Lot 36, Plat of Apple River Bend First Addition in the Town of Star Prairie, St. Croix County, Wisconsin. TRANSFER is --not _ i� XXXX Easements, restrictions and rights-of-way of record, if any. P'll"d till" August 98 BYi-- (SFAL) NJ 4" - ------ Germain �HAL) � 4 AUTHENTICATION ACKNOWLEDGMENT M & G, Inc. State of Wisconsin, ---Michael J. Germain, its ixtienucated tills Cnunty -ZA ay o f 8 ---A— 9 .— Per�)nailv '7,une �k-fore ille tills day of ---- Lzv— the aho%enained K ina 0qIA d ---Kri -st, I i I LL M EM BE R S I A I F BAk )F t1t "ol, AlthOrj:%�d hy §70o 0(,. %\ ,jts) Zo me t o he I. i ic Pe rit i I ho e xec uted I he forcgoil ig Instrument and ackno%% ledge the same, THIS II`JSTRUMFNT WAS ['RAFTED By Attorney Kristina 0gland Hudson, WI 54016 Notary pu County, �Vis 'natures inx bt authentiLated or aL kilo%% Ldged. Both ire not iary) per'llaticill (If not, state txpiranon date h—, K"M NO 2 - 1482 ly . .... . ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C7 q S zfi s