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038-1071-30-100
sin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ,ry and Building Division 0 INSPECTION REPORT sanitary Permit No: 404992 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: Wilson, Burton I Star Prairie Township 038- 1071 -30 -100 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. IOMD Septic � Benchmark f � I- 5 �J J vw Dosing Alt. BM Aeration Bldg. Sewer co ') 3• S / 03. S� Holding St/Ht Inlet �.Lfq !O St/Ht Outlet (( f TANK SETBACK INFORMATION 5• - 7 S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �j l�0 d V Septic 5D / 3 r f � Dt Bottom Dosing r Header /Man. Aeration Dist. Pipe Z. S`O ru e z. Y V V o Y. Z .3 Holding Bot. System e� Final Grade ?7 d !? ll •l O 3•* / 0-3,-3 PUMP /SIPHON INFORMATION d�� Manufacturer GP and Cover Model Number I � 3S ,. 1 j-. ` TDH Lift ' / Frict' n47s System Head TDH Ft �j Forcemain Length D ( Dia. �� Dist. to Well SOIL ABSORPTION SYSTEM Ca — rl 10 BED/TRENCH idth 1 ngtth No. Of Trenches PIT DIMENSIO No. Of Inside Dia. Liquid Depth DIMENSIONS T J t SETBACK S O /L JBLDG WELL LAKE /STREAM ACH G Manufacturer: INFORMATION CH R OR Type ' a 5 ' �L / NI Model Number: I &"111A J DISTRIB _ N SYSTEM Header/ anifold Distribution x Hole Siz x Hole Spacing Vent to Air Intake Pi s � . Length / Dia a Length ' 7 Dia 2 r Spacing 7 / ( b 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 Ed es Topsoil g p Yes j� N Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #Z. / Location: 2148 100th St Somerset, WI 540 5 (SE 1/4 NE 114 17 T31N R18W) +t[�� Lot 2 el I'v 31.1 . fly( VIPs 1.) Alt BM Description = / , ��7 I A/S —f Y`z S� _' 7 2.) Bldg sewerlength = Z `/ / v - amount of cover 3.) Contour Plan revision Required? Yes _ . o Use other side for additional information. Date nsepctor's Signature Cert. No. �S -6710 (R.3/97��1 Safety and Buildings Division County \*. 201 W. Washington Ave., P.O. Box 7162 rj�' &consin Madison, WI 53707 — 7162 Site Address tment of Commerce �d - Sanitary Permit Application S 641 r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision ma be used for secondary purposes Privac I. Application Information - Please Print All Information LR2 ED sate P I.D. Number Property Owner's Name Parcel Number n s 002 -5 Property Owner's Mailing Addre ss NT -Y Property Location , T 1 �E ✓ ' �= !4; S N. R E City, State Zip Code Phone Number Lot j4umber Block Number A q/, 10 Subdivision Name CSM Number es H. Type of Building (check all that apply) = ab p er/ S "� ❑City or 2 Family Dwelling - Number of Bedrooms []Village ❑ Public/Commerc Describe Use I )up ,r- ❑ State Owned awJ�e+ -i ° 102— 30 Nearest Road C $' >< $-+' ItAett,Q ► o'Ci2° s M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use w 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to stem Tank Only Existing S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) &,1'yv_Q. A r 44 ❑ Non - Pressurized In- Ground 2Iound 47 El Sand Filter 50 El Constructed Wetland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Disperns alJTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Race stem Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) Elevation Ll .'14 1 1 � /0 - ) 67 3 -3 A� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank d�t7 Dosing chamber U �� VII. Responsibility Statement- I, We undersigned, a responsibiffitq r installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, e) f VIII. Count /De artment Use Onl VI Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) drD ❑ Owner Given Initial Adverse �- ✓- Determination �J2� iX. Conditions of Appro al/Reasons for Disapproval _�� Jt /( r r oad I `�(�` �(^ r f,�,1 � �6�Nta ta+t.c p ✓Ra�etS I+v&a5f bt i x 5���* ,�tuoiott Iw zlec( r �- h ve���n�:b w.r,cw�tt,�w� � $IVt1�'S� r�t� �(^kll l►t2 wfuvalwi.ek M�cucs��^`� • Wi 3 P,sa,�r`� wctw► c— t plete p (to the y x 11 Inches in size SBD- 6_398 (R. 05101) PUM PE PUMP PERFORMANCE CURVE !JTJ :J; EFFLUENT MODELS • •� SOLI PA SSING ■,NOON■■ ©wmm Em ©�0�" Sun" �mi-im0w ®i mmmm mum QUO W71m"am9mmEhA ■,mOOm■ ■ ®m=�"Wjm C�� ©��p�N=mmm ■ ■ ■ ■ ■ °moveaeemvvvvv"OEM om ©tea ®m °oe°e °ov°voomommom0m NEW ■ ■N■omea� °eoeov4veemmee ®r,�m® oIMMOMM eev °v °em0eeoevm ■■■■■ o� oo e e a� ° ■ ° e ° e ° e ° ev ° e ° e ° o ° ° ° ° ° °d ° ° ° o■ ° a ■ N■W NOON ono aio ee ° ° ° e v vov ° o ° a ° e° ° °e °O ° ° ° ° ea ° ova■ °eeaoeoeeee■aeee°o °oe ■�� ■� ■■ m�■ee� sae °veveaveeeeeve ■■ WINS m■ ■ tee ° e ° oe ° o ° v ° e ° v ° eve °O d ° oe O ° evo ° o ° ° eo WON \1100 013A°.�° o fsmH■ ■ ■ ■ ■ ■ ■ ■ ■■ mm\m11►■■■■■■■■■ ■\■■15■\■■■■■■■■ E SON �■\ ■111 ■■ ■ ■ ■ ■ ■ ■■ MEN mE m umm ��► �11����� ■ ■ ■ ■ ■■ 0m0m0ma ° ©o0mmo0m v ©mms� ®eaov0v0o ©m 0vomomaavomo ®0 ©m mo ®maoisa ammo0 a ©m ����� ■� ■ ■��� ■ ■ ■ ■■ 0 ©voo�aovvomv0v °m ■ ■ ■■ 40 ®v0 ® ©4vomom ©m \\ \1111 \ \ ■ ■�\ \NOON■ a ®■�a ® ©tea �._ a°°av0�ao ®m ®mom °m 412 50, 19WIN N ■ ■W N ■ ■■ e°°a0oaa ©mom ®m ©m eaaav°aa ® ® ©oo0 ©m m 1 Qa91W80ILI ■■► NOON � ° ° ° aa °d am ° ■ ° ° ° a ° ao ° ° ava ° eo® ■ N0110I■■id■■ ■4 ■■ ° ■ ° ° ° aa ° e ° ° ° ° a ° eeeae ° s0o \N� io ZV!\ ■ ■ ■ ■ ■ ■ffl■ ■ ►S'! 01 Z1► ON \P\'■■■\ ■ to ■ ■11 \1� ■I �■�� \NOON■■ �_ ■■1■ ■ ■ ■ ■� ■ ■ ■ ■■ ■ ' SEWAGEAND I= my-2 arm EwmUffammm omo ®o ®m��m�mmm ® ®� DEWATERING mmmmmmmomomoo ® ©mmmmmmomm m ©000m® o ■ ■ ■ ■ ■ ■ ■ ■ Emno ®o� ®,moo ,\ NONE ■ ■ ■o ®m ■mm ■■ mmmmemomo® ■� \'■ ■ ■ ■■■ �mmmm��mmm�mm� mmmm ■ ■ ► \ ■ ■ ■ ■ ■ ■ ■� ■■ ■NOON ■■��■ � ■ \` ■ ■� NOON , . ����■N'■�■�■� ■■ NOON■ ■ N ■ \`�►���■��' \►NOON■ NOON ■ ■ ■■ ®NOON ■r ■ ■ ■ ■N■■ &-am— sub to less than 15 feet TD ..... z P ` OT PLAN ,.IECT Burt Wilson ADDREss 2168 Shore Drive Somerset Wi 54025 1/4 NE 1 14S 17 /T 31 L ;' !R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 /' 3/11/02 3 CONVENTIONAL E BEDROOM I1V- GROtyND PRESSURE CONVENTIONAL LIFT s/ DATE HOLDING TANK MOUND �OOC SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 805 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of SW Lot Stake +— ASSUME ELEVATION 100' Filter Zabel A -100 BOREHOLE O WELL 'H.R.P. Same as Benchmark SYSTEM ELEVATION 103.3' Scale = 1/4"= 10' Pro ert Line Well is to meet all setbacks found in Tanks are to be properly Comm. 83 bedded and provided with lockdown covers with approved warning labels 0 Weeks ST Pro 3 s Bedroom o7 In House p B -1 ic2 y ' Area 15' Below system is to remain undisturbed D,1 Z 1% lblope 2 - 1 5 B.M. 102.3' Property Line -d Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www.w w ww.commerce.s tate. wi. us/sb isconin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary March 28, 2002 CUST ID No.226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2004 Identification Numbers Transaction ID No. 718796 SITE• Site ID No. 642151 Burt Wilson Please refer to both identification numbers, 100 St above, in all correspondence with the agency. Town of Star Prairie O l l'T C St Croix County p. FOR: New mound, 450 GPD C Object Type: POWT System Regulated Object ID No.: 832967 01 l The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod � � OF C and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in k EP :�tl�i chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. p (G The following conditions shall be met during construction or installation and prior to occupancy or use: SE E GORRES General Approval Conditions: • 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- 10691 -P ( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 /01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Slats. • 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. Slats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner SHAUN R BIRD Page 2 3/28/02 of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). 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. 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 addressees vide a copy of this letter to the owner and any others who are responsible for the installation, o eration o maintenanc of the POWTS. Si Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shand POWTS Plan Reviewer, Inte to ervices W SMART code. 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 3/11/02 Owner: Burt Wilson System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) ally Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 10 cE 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 22696 3/11/02 PLOT PLAN PROJECT Burt Wilson / ADDRESS 2168 Shore Drive Somerset Wi 54025 SE 1/4 NE i l4 S 17 /T 31 ., /R 18 ; W TOWN Star Prairie COUNTY ST. CROIX l � R MPRS Shaun Bird 226900 - DATE 3 /1 1/02 BEDROOM 3 CONVENTIONAL IN -GRrD PRESSURE CONVENTIONAL LIFT HOLDING D G TANK MOUND )00( SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 805 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none LL BENCHMARK V.R.P. Top of SW Lot Stake ASSUME ELEVATION' 100' Filter Zabel A - 100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 103.3' Scale = 1/4" = 10' ProRerty Line Well is to meet all Tanks are to be properly setbacks found in bedded and provided with Comm. 83 lockdown covers with approved warning labels j Q ks ST Pro 3 Bedroom House cr B -1 0 Area 15' Below system is to remain undisturbed 1% B - 0 loe B -2 102.3' Property Line z•d dEE : 20 20 LZ Jew Designer so Date -J l —4q 4" Observation F:;pe perforated Non - Woven Filter Fabric Below Filter Fabric r ,,pistriDution pipe ASTM C-33 Sand L - 11 Topsoff a 11R s i i 19 Slope Bed O! Y 2 %: FOeCe Main " %,_F'tOwtd Drain Rock From Pump Layer 'D Cress Section Of A Mound 'S stem _Using A Bed For The Absorption A►�to F A „ Ft. H I � S Ft. I Ft. Ft. K ')-Ft. L Ft. w 'q 5 j? ''t' t �.... sL _._.__._— eObservotion Pipe- T 1� w A. Q M ' W ____ ------ •-- - - - - -- .----------- ---. -. -.._ F ' Force Main z _ - ._.,... �..._......_..._ ....rr�,` ...�.... Fr Pump 3 p Distribution Bed Ot I V — Z ! = M Pipe Drain (Rock 4 Observation Pipe Permanent Marker Pipe or Rod* Plan View 01 Mound Using A Bed For The Absorption Area P ^OE__ - -0ir r Pesforol ±ae�C�ro�i1 ' Perro►ar�o " PVC P�pf 1teNt 1, 04efetl On fjelt Chin �� Are C w"y $"Be* a r PVC Ract !Mein � PVC rwtwsoie Pipe 141 // C41ripyfilm Pipe LayOtrl p Ft. R ....... Ff. x !mane I s 3 1 6 Y � tnctNI Signed: tot• Diameter «cense Number: Latera 1 �4 {vim Inch( - -� oa to ; �7> -dam Man ifold " e52' Inchts. Fares Mai " finches M of hot es/ f pa Invert eiev4tjon of Laterals /` I +w1�� ,^' R • .. i . .mow..... ism .,�..� •C.,. at�t r +ae f wt�r�rc�rKOp� is *+1sr.M Sax �►IrRpv a �.00,It lA)G •NWw0i1 +�Ilt�y ��.M.� 'M�RiMO1.P COVtirt GRAOt' � • ! 1 WAIN, I C01►,ourr ..,.r � tr► r aSiZ )AILRT rRav�cc i "AP AP"OVED PIPE 3 Oro $0410 s0% LOwC R[Tt KQCK 1 t)�1rR Cfcr+T ri�,+t i1TR0 C1/►ll,y )i TAtrllt �'1�ipi►11i:TL1RCR t1Ati sWiM A!rlROvA6 sell lk"o +011ill �'AAtyRACTVRlA �� tAW01 i1sR Q6"694 OR bases. 0049 W"W C, �� ,.� � / �G C,�p� �+�ttiwy0tN6 OARKIf.1Mls "���� NYM ?,�..._ , �.:.rf � e�I�CITIRaI+ �.� • � j N ' ►ti�tw� $Mon" TOrtt .•..�A1CN�i OK�'MI�I.Ok� AAIr1iMAtTIdRtAi 0i W1 1 Must on 6A61,41jf M0666 MYM• C . ' � + wCS OR i *wows AWITCM Tyy = �t G.- • �.�... t1iiC++ss QA OAL66 is Awkilml DI SC iR tirt•�. ate' L !' uar l ^IWO 1h6A"tm A lts Tr zK vitiT)tA� 01 ►wRRiNCt �Y�OAI 'Wry►, rf G ► ►1 ►NiTAi.+.RO O st'+�11ATt QiNrA4�Ti a MA BtiTR)0,1lT 4w rl�C. �� ROSY + M +RttAlffM NCTW*R14 SUMN N0tiRCRUltt :- �.2f:...f91T O!' rORCR MAtN x "' --"�► �'CR9' �� saerpt,.,�,�M �RQ�r iS .43 f� ?f�A��fr A)MlA�fa� Qt 7'�IA�K: 4Rt�l6Th � .• � � /./ , Mr � t ►QIJIO CC�TM4 �' I • • Details SHEF40 Performance Data 40 30 EF PUMP Characteristics Ilrel6r unN 20 tllet w tiledeh sNSP4oA1 SW40:1 AMMtoltcMedete SM40AI SNEF 10 4/10 Fd law Amp 12 F 6.3 1Mnr ShWW Pate (4 Pots) 0 RPJL I s" 10 20 30 40 SO 60 70 Pbae 10 -11WINVIN 115 230 Nertr 'TOW Head (feet) 10 1 14 17 21 ZS 28 30 33 120° F am FW rA) 3. 1 S. 1 MA A GPM (US GPM) 70 60 SO 40 30 90 10 0 bubo" (late A ( rs /tree) 4.4 1 S. " W Dimension Data SeNO 31 ..���........_... ,.... now ze IbL 3 - 7)AWr 6-w (ift'm 1. AN di nisioas in Inches. (Mft for ?"U Cud 16/( M4 W 20 &L 20 .� na>7 international use). e1NUrett Materials of Consltructilon ` �' 2 ' 1/8 in may 3. Not for corlstrrrd w 4 (98.4 °;8 ">vF ° unless certified popm OWN Fos CWU — s�vsr"rcH 4. Dimensions and weights are approximate. Nledteiskal Seel Ff"t Ceeiers /Commic S. We reserve the right to make ae#r seer Seel $*. A"al W Sae( �- rev(sim to our product ad their stepiie:s Steal specifications without rake. i 1.318" (a88'6�) (288,78) i a" (50.81 (68.07) LW #tspb WW ro moplatic C 1998 Hydroma P A lard, Oh io, Ail Rights Ra o Fi HYDRt►MATIlC " vour or oc0 �� bulor - 1640 Boney Road Ashland, Ohio 44805 TO: 419.269.3042 Pox: 419.481.4061 %b Sire, www.pee4airpat4swn SALES OFFICES IN ALL MAJOR CrrIES AND COUNTRIES Refer to "Pumps In the yellow pages of your phone directory for your 1=1 ONAutor Item #: W -02.6680 1198 5M G. y Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715- 246 -5148 St.Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 3/11/02 POW Tai OWNER'S MANUAL. & MANAGEMENT PLAN Page of , PA INFORMAT SYSTEM SPECIFICATIONS Owner t4.r . _� Septic Tank Capacity 1 al DNA P *. _ Septic Yank Manufacturer o NA I>ESKKiNN PARAMEMRS _ Effluent Ffriar Manufacturer D NA Number of Bedeo"W o NA Effluent FRer Model _ D NA Number of Comcnerdal Units _ Purnp Tank Cap8dly al DNA Estimated ftow (atrprage) _ � Pump Tank &hwwfadurer D NA t Design flow (peak), (Estimated x 1.5) J ' Pump MarK&Cttxer ,r NA Sop Ammon Rolle a al/d aW Pump Model DNA InnuenNEffluent Quality Monthly average* Poetnsaanertt Unk , Fetts..O1 & Grease (FCH3) Sap mg/L D SwApa evel Filter D Peat Filter Slodhemical Oxygen Demand (SOCia !9220 mg& O Meohanj ell Aeration D Wetland Total Suspended Solids (TSS) slbo Mg& O okkftcdon 0 Other. Manufacturer Pretreated Effluent Quality O Rk Monthly average" Dish mss) Biochemical Oxygen Demand (800 sap mg/L D In-ground (gravity) O In-groumd (pr"surized) Total Suspended Solids (TS S) 00 mglt_ 0 AtVrade j "lEound Fecal Cotiform f9oorneft mean s10' cWi00ml D O Other: Maximum Effluent Particle Size K inch diameter • vows: typw w donwstio (non- oommerdo westewster end SOP00161* « VoWn tolml ror probated weateweter. MAIN TENANCE SCHEDULE _ Se rvice Event Service Frequency inspect condition of tank(s) _ At least o nce every D months r(s) (Maximum 3 yrs.) Pump out contents of ta nk( s ) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cefl(s) _ At least once every D months alts) (Maximum 3 yrs.) Clean isfflueret )Nisi' At least once every w 1 D rrtonths years) Inspect pump. pump controls & aiarrn At least once every D months - & - yeaq s ) DNA At bast once every D months r(s) D NA Flush iatetals and pressure test D �" D year(:) O NA OW; At least once every pq At least once every O months D year(s) D NA MAINTENANCE INSTRUCTIONS one of the following iioenses or l� of tanks and dispersal Cellls, sha0 be made by am individual carrying pOWTS Maintalner. Septags mss: Master Plumber, Master Plumber Restricted Sewer; PO of S I S to ideMifY any misskt9 Of broken Sig Operator. Tank Ins pectiat►s +rust include a visual inspection and scorn and to check for any back uP hardwaro, i st any eadks or leaks. measure the volume of combined sludge qw effluent levels 4 of fif Y any on the ground ;surface. The dispersal ceps) shell be and s visua kespect a pon of effluent on the or pond ng a te( to check for any ponding of effluent on On the gro und n of the kx al re9ulstory authority• In th � PIP" and requires the lmmedlate g surfiawe may ired'ecate a faat V x n ais one�hird (K) mops of the tank volume, the When the combined accumtAation of ;sludge and scum { e Sery dung Operator and disposed of in arxordanCe with ch. NR entire contents of the tank shall be removed by a Septag any 113, "soonsin Administrative Code compo nents, ��atr M0% componetta, and The serv of effluent fitters, medvanicat or pressurized POWTS eomPo by a oeni� pOWTf3 Malntatner. at intervals of 12 months or less shad be Perfom�+ comp l e tion of any service event• ether m8 {ntenance or monitorin d to the local regulatory authority w�titln 10 days of A W449 repot shall be proOd uds or other STAftT UP AND OPERATION tment tank(:) for the presence of painting ontl s are prior to Use of the POVVTS check tree 3 Cel if high con For new opnstruCtiOn, a the tre. tment process and/or damage ) ator prior to use chemicals that may imPed removed by a ssPt detected have the contents of the ta nk( :) System start UP shall not Occur wlt.!s n soil' conditiona are frozen at the Infiltrative surface. -- DuM9 P0r outages Pump tanks may fill above normal higtrwater levels. When power is restored the excess wastewater wkil be discharged to thu dh"real aNl(s) in one large dose, overloading the oegn) and may result In the backup or surface dischttl+ge of efkl� lent. To avoid tires situation have the content$ of the pump tstk removed by a Servicing OpeMbr Prior tici'rssbring ' powser to the effluent pump or contact a Pl umber or POWrO Maintainer to i assist In manu* operating the pwip' consols to restore normal levels within the pump tank. Do not dtin or pane vehicles over tasks and dispersal owls. Do not drive or park over, or otherwise distiurb or Oompad, Me area tMtittn 15 feet down elope of any mound or st- gniide sal absorp&m area. Reduction or elirnimtlon of the I*WNkV from the wastswR w abeam may Improve the perliorriw as and prolong the Gfe of ON PO WTS: anabtottsss; b8& vlrppeer ctam butts; oobon a+n►abs; degrealsera; dental floes; dishfats; fat; fouildWon elndn ('mwW p�P2 ; *uk and vegetable Pings: gam; lip: herbicides. +treat medtCatlons; op; P nQ pil>'dttcts; peslSoldes; sanllalry naipkin$; tampons; r and water soften w b&w ABMDO Where the POWTS We and/w Is jmmiul oy.taken out of service the fe>R wing steps shall to taken to insure that the system Is properly and s of y abanckmed In compliance with ch. Comm 133.33, Wisconsin AdmkAsb rye Code: • AN piping to tanks and pits shall be disoonnoded and the abandoned pipe openings eeellsd. • The contents: of all tanks and pits shall'be removed and Property disposed of by a Septage Servicing Operator. e After pumping, alt tanks anti pica shall be excalvated and removed or their covers removed and the void space filled with $oil, gravel or anot w inert solkl material. CONTINGENCY PLAN It the POWTS falls and cannot be ropaired the following measures have been, or must be taken, to provide a code camPllant r8placernent system: ❑ A suitable replacement'area has beers evaluated and may be uteized for the location of a replacement soil absorption system. The mptWoment area should be protected from disturbance and compaction and should not be inMnged upon by rsqukedl setbacks from existing and proposed structure, lot lines and weft. Failure to protect the replacement areal wN result In the need for a new soul and sae `evaluation to establish a suitable replacement area Replacement systems must comply with the rtes in effect at that time. O A suitable replacement area Is root availlable due to setback and/or soil limitations. Basrtng advances In POWTS techralM a holding tank may be ku tW as a last resort to replace the faked POWTS. sibs has not i been evalurt had to iderltlsy a suitable replacement area. Upon fsailtrr+e of the POWTS a ssati and site evaluation must be perfamed to locate a suitable replacement area. N no replacement area Is availsble a holding tank may be Installed as a last resort to replace the 161W POWTS. and at-grade sod absorption systems may be moonstsix ted in place foltowktg removal of the biomat at the kllgtradve surface. Rewrobuodons of such systems must comply with the rules in effed of that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCBS. DEATH MAY RESULT., RESCUE OF A PERSON 1 THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITION coMMElivTs POWTS INSTALLER POWTS MAINTAINER Name Name i I i ✓ Phone Phone Z Jrl 11 FPTAGE SERViCMi OPERATOR ( PUMPER ) LOCAL REGULATORY AUTHORITY Name A+9e�Y Phone -- Thk decuar" was dished by ere stems of Ow (bean take. Marquette and woushara County torkq and sar*sdon agerrdes. This document meets the minknmm i6qulrom•n!2 of dr. Comm ss.r (:iXi 1 X+a" wW 92. 64(1), (a) a< ( wevwrsk, Adprk Wxli0n Code. Use d v" d= ma does not guarantee the performance or the POWTS. GmW (2/01) Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Dives n of sgfetg & Buildings in accord with ILHR83.05, Adm. Code COUNTY pap not less t an 8 1/2 x 4 inches in size. Ptan must include, but St. Croix not limited to vertical and horizo al reference point d'{{r t % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista' Y'roa � 038- 1071 -30 }lea eft b., AFVIEWED BY NE APPLICANT INFORMATION — PLEASE P IN.'ALL NF�RMATIN , L1 PROPERTY OWNER: ,ti. ' P PERTY LOCATION John Luger - GO . LOT SE 1/4 NE 1/4,S 17 T 31 N,R 18 R(or) W PROPERTY OWNERS MAILING ADDRESS i - LOt # BLOCK# SUBD. NAME OR CSM # 2721 Division St. N. ST gpl)( na csm Cni CITY, STATE ZIP CODE CITY ❑VILLAGE EYOWN NEAREST ROAD N. St. Paul, M. 55109 '. 779 - Star Prarie 100th. St. New Construction Use [x ] Residential / Num r 4 [ ]Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gp d Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd/ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .5 bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 103.20 ft (as referred to site plan benchmark) Additional design / site considerations system el based on contour line of el. 102.20' Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ® U ES ❑ U ❑ S ®U 1 ❑ S ER U ❑ S ®U ❑ S a ll SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BoLnxtary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch 1 0 -10 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 ... ...1. `. 2 10 -27 10yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3 27 -35 5yr4/4 none scl lcsbk mfr gw na .2 .3 4 35 -55 5yr4/4 c2d 7.5 r5/6 scl lcsbk mfr NA NA .2 .3 10 4 ft. y y Depth to limiting factor 35" Remarks: Boring # 1 1 0-9 10yr3 /3 none sl 2msbk mfr gw 2f .5 `:.6 2 >> 2 9 -26 10yr4 /3 none sl 2msbk mfr gw if .5 .6 3 26 -50 5yr4/4 c2d 7.5yr5/6 scl lcsbk mfr na na .2 1.3 Ground elev. 10 ft. Depth to limiting factor 26" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. e. New Richrwnd, WI 54017 Signature: Date: 5 - - CST Number: m02298 PROPERTY OWNER John Luger SOIL DESCRIPTION REPORT Page? z of 3 PARCEL I.D. # 038- 1071 -30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundEry Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ='= 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 3 2 9 -24 10yr4 /4 none sl 2msbk mfr gw if .5 .6 Ground 3 24-39 5yr4/4 none scl lcsbk mfr gw na .2 .3 elev. 1 4 39-59 5yr4/4 c2d 7.5yr5/6 scl lcsbk mfi na na .2 .3 Depth to limiting factor 391 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ................ . I Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330 (R.05192) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 John Luger New Richmond, WI 54017 MPRSW -3254 SE4NE4 S17- T31N -R18W (715) 246 -6200 town of Star Prarie lot #2 - csm N 1 =40' BM.= top of SW lot stake @ el. 100 Alt. BM.= nail in Aspen tree C el. 101.70' s F 0 8 . l�D Gary L. Steel 5 -15 -98 i I • ' • • • • .• - 1 . • • • • ••- • - • • MANFIXIMIZU- roll - • ■■■ �1 \7 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■11■iil ■1� ■��'�ii�■ ■ice!! ' • � . h�:*!!►'7h! fit ■! ■dlll ■ ■ ■ ■i■ ■■►f I!!!�.■ 1711 L��I !11�.�1�IJ ■I� ■ ■ ■ ■ ■■ % ■�i ■ ■;:; �•a ■ ■A ■ ■ ■ ■ ■■ Ifii��i■ �: Z�►.:! f�Jt�� ►�!!'l.�h�'U':� ■ ■ ■C! ■■J ■S ■ ■■ ■1111! ■i� ■ ■■ • - . . I��■ R1�J! f1�'' ��Lt 1�i�i�iC r�3ii ■ ■ ■ ■IIL"�J.�1 ■iN ■ ■1� ■ ■ ■ ■ ■ ■ ■■ - . I11!■ JI�I �■ 1�11�1111 11! R '�!� / ■ ■ ■ ■ ■!� ■ ■ ■I ■�r� ■I ■ ■ ■ ■ ■ ■ ■ ■■ � IL�i�! f1ii�C ii�i�ilLi■■■ ■I■ ■ ■ ■ ■ ■ ■1 ■ ■ ■I ■ ■ ■ ■i ■ ■!J�'1! ■ ■ ■■ , - . . ' ■■ ■■■ ■ ■■ 111■■ ■ ■ ■i ■r1V■■�i■ ■■■ ■ ■ ■�i1 ■■■■ - z, m EROSION CONTROL PLAN CHECKLIST u Imo, m Check ( ✓) appropriate boxes below, and complete the site diagram Q with necessary information. � H I z Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. Location of existing drainageways, streams, rivers, lakes, wetlands or wells. i Location of storm sewer inlets. irll Location of existing and proposed buildings and paved areas. r al - The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after grading operations. < Overland r qoff flow) coming onto the site from adjacent areas. [ *tali �fo �S �a Erosion Control Practices / C3 Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑,' Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide vegetative strip) that will prevent eroded soil from leaving the site. Location of sediment barriers around on -site storm sewer inlets. Location of diversions. Note: Although not specifically required by code, it is recommended that concen- trated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. Location of practices that will be applied to control erosion on steep slopes (greater than ................ 12% grade). ................ ................ Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or seeding with use ...............: of erosion control mats. ❑' Location of practices that will control erosion on areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale rip-rap. barriers erosion control mats, staked sod, and ro ck When used a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year round flow). ®Location of other planned * p r actices not / already noted. 4u m _R Indicate management strategy by checking (✓) the appropriate box. 4 Management Strategies Temporary stabilization o istur t areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1 and September 15), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible lawn establishment). • Indicate re- vegetation method. ❑ Sod ❑ Other • Expected date of permanent re- vegetation: • Re- vegetation responsibility of: C1 Builder wner /Buyer • Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15?_fes ❑ No "ii� Use of downspout and /or sump pump outlet extensions. ✓ Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. . Trapping sediment during de watering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the height o f the barrier. Breaks and gaps in sediment fences and barriers will be repaired imme- diately. Decomposing straw bales will be replaced (typical bale life is three months). f All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through the State of Wisconsin Document Sales, (608) 266 -3558. Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, (608) 262 -3346 of the Department of Commerce, (608) 267 -4405. EROSION CONTROL REGULATIONS Erosion control and stormwater regulations can be complex. Local, state and, in some cases, federal regulations may apply. Before construction make sure you have the appropriate permits. LOCAL ORDINANCES Check with your county, city, village, or town for any local erosion control ordinances including shoreland zoning require- ments. Except for new 1- & 2- family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. UNIFORM DWELLING CODE (DEPT. OF COMMERCE) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT. • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes. • Department of Commerce, Safety and Buildings Division, • Access drive. P.O. Box 7969, Madison, Wis. 53707, (608) 266 -2128. • Straw bales, filter fabric fences or other barriers to protect on -site sewer Inlets. • Additional controls if needed for steep slopes or other special conditions. I STORMWATER''PERMIT (DEPT. OF NATURAL RESOURCES) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Erosion control measures specified in the Wisconsin . Department of Natural Resources, Storm Water Permits, Construction Site Best Management Practice Handbook. P.O. 7921, Madison, WI 53707 -7921, (608) 266 -7078. • Measures to control storm water after construction. This publication is available from county UW- Extension offices or from Extension Publications, 45 N. Charter St., Madison, WI 53715. (608) 262 -3346 or toll -free (877) 947 -7827. A publication of the University of ,,,, Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources. jFaemion i I ©1999 by the Board of Regents of the University of Wisconsin System. Send inquiries about copyright permission to: Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Dr., Madison, WI 53706. University of Wisconsin- Extension is an EEO /Affirmative Action employer and provides equal opportunities in employment and programming, including Title IX and ADA requirements. I GW0001A Standard Erosion Control Plan for 1 bt 2 Family Dwelling Construction Sites h' Printed on i DNR WT-458-96 R- 02- 02- 2M -10 -S Editing and design by the Environmental Resources Center, University of Wisconsin— Extension. to recycled paper ST CROIX COUNTY t SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer j stjoa Mailing Address Property Address / (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION r Property Location�� ` /.� ` /a, Sec. J W, Town of # Subdivision r-- Lot /l Y P Certified Survey Ma It b �-� Volume / . .Page # Jyl Wnrmnty Deed # h � ' Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ 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 mastcrplumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification 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. 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 ,�j V-4 , 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 VOI. 1 789PACE 97 � S I A tl lSAtt or t415t`l1NNIN N11R41 3 - lyyy bocmucut Nwubci WARRANTY DEED This Deed, made between Julie M. Orf, Grantor, and Burt W' _1Ls,ar&. T 1 Wilson, Husband and wie Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Itccoa�hug Arca Name and Return address Part of the SE .4 ot'N1 ' a of Section IT Township 31 North, Range 18 West, St. Crop County Wisconsin described as follows: of 2 IF Certified i 4'z Survey Map filed September 4, 1998 in V ol, 12, P age 35 14, Do No. _ .•� - -CC �F: f%��� 586615. 03 8- 1071 -30 -100 Parccl Identification Number (PIN) I his is not homestead property. (Xi (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any, Dated this day of December 2001 Julie M O * * AUTHENTICATION ACKNOWLEDGMENT Sipnature(s) SI'A FE OF WISCONSIN � authenticated this day u) „J'.� Personally came betiire nnc this day of December 2001 the above named REFER * SEVERS Jul M. Orf, TITLE: MEMBER STATE. B QF SIN _ -- - (►t nut, t� to me known to 4e2fie person( who executed the foregoing -- tntitru t dA4nowicdged the same, authorized by § 706.06, Wis. Stats.) I HIS INS FRt MEN 1 WAS DRAFTED 13Y Attornev Krishna Og Notary I'uhlic. Slate of Wisconsin Hudson, WI 54016 My `otntntssiun is per anent (Ifnot_ state expuatiotr te: (Signatures may be authenticated or acknowledged. froth are not necessary.) * Names of persons signing in any capacity must be typed or printed below their sigt6turc. information Profesemnats company, Fond du Lac, wt STATE BAR OF WISCONSIN 800 {55 -2021 WARRANTY DEED FORM No. 2 - 1999 ' T /.7 'Nr.Q ED Ot SEP 0 4 1998 ► 4 KATHLMH. WALM kisterof oft 586615 a Croix CoyM s C R T I F ED S LUR V E Y MAR Located in the Southeast quarter of the Northeast quarter of Section 17, Township 31 North, Range 18 West, Town of Star Prair'e, St. Croix County, Wisconsin. w K Northeast corner rni Section 17 I 6 6' I N v 00 (2" Iron pipe set, W I :...... "...:;::. ;':" I o —I see note.) .................... o S 8827'47 E 314.51' I 2 "IP M a 269.49 45.0 I Owner: o of I John Luger - - I Zv LO 7T 4 1 66 2721 DivisionSt.N. 1 I N. St. Paul, Mn 62944 Sq•Ft. (1.45 ac.) �i 55109 a Including right -of -way. .1 54227 Sq.Ft. (1.25 ac.) o 0 — — — Excluding right -of -way. NI N • y V Y• I 1 . • F. S 88' 52' 20 - "E 305.03' I i 263.38 • 1.65 W 1 I - - — - —1 IL ®7T 3 (J); W„ 633 0 S .Ft. 1.46 ac r 9 q ( •) I ' — — — I Including right -of -way "1 $ 54901 Sq.Ft. (1.26 ac.) N - - .< Excluding right of way . N Ito o it L} Q . QD cL 1 CU 03 Cn S 88'52'26 0 E 290.50' Iw w 252.40' Irn36.1 FIVCj � �' LOT 2 7 � m ti „ cY (n q4 o CL 59874 Sq.Ft. (1.38 ac.) I T3 ° m Including right -of -way. oI o N j I z 52177 Sq.Ft. (1.20 ac.) NI ai o LL o _ — : _ —1 N Excluding right -of - way. cvl CU — z _ �_ . — — of LL Q \ W " ' ' S 883910 E 276.15' k Q , w I � 241.57 34.5 I ? - - - - - I o ° IL0 T 1 I 66' I -. Qz 56840 Sq.Ft. (1.3.0 ac.). 13 1 6 1 6 ° Including right -of -way. oI oo y ? 4 49890 Sq. Ft. (1.15ac. N Excludin g g ri ht -of -wa Y .C'Q N 1 `:. I I I Oil S88 ° 25'55 "E I I 491I.00' I I 230.73' 1 31.0s 1 N 88'25'55 "W 261.79' 1 — — -- West quarter cor. I IEast quarter cor. Berntsen monu- - 6 6 Section 17, (see ment. found. :. .: -.,: .':.. note) Bearings referenced to the East -West quarter section line, assumed N88 ° 25 1 55 "W This instrument drafted by 4972569 VOLUME 12 PAGE 3514 / k : r ' ° / , . � a 3 � J};!�II � 2 E } e r . 0 7 E 0 2 k \) S 7 E ` "# « E Lo 7 - i 2± 7 a 3 m @ 1, » ' o . / \ / ° CD © \ ° ° E e CA m . ! § & / . % >_ ca CL $: @. � 4 � � § \�\ � z E 2 2 n r CO) ° B B 7 § R "*A- . z 0 0 0 0 ■ O � 7 0 - .. / \ { CA CA Ch \ 0 ~ § E $ E § § § ) I § # . z = o \ \ f 0) E� » o CL % 3 CD m % 3E m m5. CL c §K� z 3/ 2 -f ■ , ■z, § / z E CD R .. CD + i3 w M \ $ ) /ƒ A z2 § 00 �f ® ' ` w $2 a \L } C / m .. co \ / 0 C 7 . � J � § � ' � [ 0. . kli so ■ � . � « 0 ? o ; EE �2 Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 A www.commerce.statemi.us /sb Department of Commerce R vrww.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert. Secretary l 1 20p? sr SRO /k March 28, 2002 ZON /NG � O CE Y CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 03/28/2004 Transaction ID No. 718796 SITE: Site ID No. 642151 Burt Wilson Please refer to both identification numbers, 100 St above, in all correspondence with the a Town of Star Prairie St Croix County FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 832967 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 Conditions: • 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- 10691 -P ( N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 /01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the SHAUN R BIRD Page 2 3/28/02 owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • Provide frost protection per COMM 83.43(8)(c). 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. 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: J RECEIVED Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 APR 0 1 2002 TDD #: (608) 264 -8777 www.commerce.state.wi.us/sb ST. CROIX COUNTY www.wisconsin.gov ZONING OFFICE Scott McCallum, Governor Philip Edw. Albert, Secretary isconsin Department of Commerce March 28, 2002 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 Identification Numbers Transaction ID No. 718796 Site ID No. 642151 Please refer to both identification numbers, above, in all correspondence with the agency. CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2004 SITE: Burt Wilson 100 St Town of Star Prairie St Croix County FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 832967 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 Conditions: • 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- 10691 -P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 /01). i SHAUN R BIRD Page 2 3/28/02 • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). 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. 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. Sincerely, Patricia L Shandorf POWTS Plan Reviewer, Integrated Services (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@connnerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 _ TDD #: (608) 264 -8777 �sconsin www.commerce.s i www.wiscon isconsin.gov n.gov Department of Commerce colt McCallum, Governor Ph Edw. Albert, Secretary March 28, 2002 s ,p �Q CUST ID No.226900 ATTN. POWTS Ins T �'Qp 1) �L� Q0� SHAUN R BIRD ZONING OFFJCE BIRD PLUMBING, INC F 1008 192 ND AVE 1101 'CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2004 Identification Numbers Transaction ID No. 718796 SITE: Site ID No. 642151 Burt Wilson Please refer to both identification numbers, 100 St above, in all correspondence with the agency. Town of Star Prairie St Croix County FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 832967 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 Conditions: • 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- 10691 -P ( N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner SHAUN R BMD Page 2 3/28/02 of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • Provide frost protection per COMM 83.43(8)(c). 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. 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 s vide a copy of this letter to the owner and any others who are responsible for the installation, o eration o maintenan_q of the POWTS. Si Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shand POWTS Plan Reviewer, Inte to ervices WSMART code:.17633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: I Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor RECEIVED Philip Edw. Albert, Secretary �� MAR 2 8 2002 I sconst n ST Z CROI OFFICE Y Department of Commerce March 28, 2002 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 Identification Numbers Transaction ID No. 718796 Site ID No. 642151 Please refer to both identification numbers, above, in all correspondence with the agency. CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/28/2004 SITE: Burt Wilson 100 St Town of Star Prairie St Croix County FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 832967 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 Conditions: • 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- 10691 -P (N.01101) and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). SHAUN R BIRD Page 2 3/28/02 6 • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). 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. 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. t addressee shall provide a co of this letter to the owner and an The above left copy Y others who are responsible for the p installation, operation or maintenance of the POWTS. 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