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HomeMy WebLinkAbout038-1073-95-200 c � tz ? 0 0 � f** T ' 0 7 7 7 0 °& ƒ; \ Z E f± q,: 1 f E _ , w �; J_ ■ m ® 9 { G - / CL ; % & ® I \ i . E ƒ G @ @ CD e ( E E -4 ° I Q U) § @ z CD T \ > �_ 9 a 0 2 §m. 0. C @ § cn \ § Er "a n r ■ a c ! & S z 0 0 0 2 2 § § I; < z / R § ■ ■ ■ § a > ƒ 9 7 ° ° � E D ' 2 Ln g . ; CL A 0 .. / 0 >>0 � ƒ 7 CL "vA. i m 7 a ` \ } k \ / % i z E CD } f W 14 CL Z 0 i q 2 / z C.) % k 0 � � � 0 % m » � � $ � § � 2 i � � # 0 8 ° f ? § CD C> \ 2 r - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488274 0 GENERAL INFORMATION (ATTACH TO PERMIT) Sir Plan ID No: -ro A Personal informa� ion you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2 = / s A . * Permit Rol jer's Name: City Village X Township Parcel Tax No: Rivard, 'rice I Star Prairie, Town of 1 (5538 - /673- 9 5'— RtO CST BM Elev: Insp. BM Elev: I BM Description: "r Section/Town /Range /Map No: � I °p'`ED / Z 17.31.18. Vp TANK INFORMATION ELEVATION DATA A zo TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark L �� f [!s+ Dosing Alt. BM �\ O 3.00 f Aeration Bldg. ewer � �o C ? 3 � r o ing ' St/Ht Inlet ly r I0•40 `14b St /Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. V ent o Air Intake ROAD D Inlet �. ep is o om 1 r kv �• .� � 3sin 9 t � ea de r/ ain << `' `` q X90 x/60 Aeration Dist. P ipe off. b o o ing Bot. system ,4O r dD. go i r PUMP /S HON INFORMATION �� : �( p�- /Z t � Manufacturer eman over 5-•0 r�'saS g,•. ��, rr t Lrnix, GPM .60 um er ( %h Z . I o 2.9 2 iio 9. o J IL IT I Riction oss s New 1235 .1 1 3. ICI •Z Z' It-orcemain ILeq;tn na q� Is 1 1 2 IMENSIONS ,{� r L c n� Q J �[ INFORMATION . CHA R OR � N -T - ) U I M&zAk �Z) -, 2 0 Length to Ali 111t3ke � Pipets) 64 &A , 2 ' " I '� , 3 114 r' Length Dia ^ •)ia Spacing x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No , iOM NT S: Linclude coqe �� discrepeiyFies ,,per�onss� Locatio 971 Brave D v pres�nt, etc.) ` Inspection #1: Inspection #2: n: ,- Drive Prairie W�I 5�40 ( N '1 /4 / 1 + R'l8W) NA Lot 1 P rcel No: 17.31.18. i 1.) Alt BM Description 2.) Bldg sewer length = 53 y«rad(/ 0+ -'4dt; tiv�G.N,/J L�V6� u - amount of cover = L -I • , Plan revision Required? ( Yes No Use other side for additional information. -- - -- ------ I ig afore Cert. NQ. - p SBD -6710 (R.3/97) Al Safety and Buildings Division Coun MV 201 W. Washington Ave., P.O. Box 7162 , 1 *ilsc Madison, WI 53707 Sanitary Pe tuber (to be filled in by Co.) (608) 266 -3151 Ma I Z Department of Commerce State Plan I.D. Number Sanitary Permit Applicatio In accord with Comm 83.21, Wis. Adm. Code, personal infonnation you provid may be used for secondary purposes Privacy Law, sl5.04(1)( Proje AddresT(if different than mailing address) Information — Please Print All Information J b 4l I. Ap I _ _ PP Property Owner's Name Parc�I # Lot # ' Block # Property Owner's Mailing Address Property Locatio 0 _ 4 � D Ei �/4, . Section City, State Zip Code Phone Number aE c on N; rW II. ype of Building (check all that apply) Subdivision a CSM Number I/ amilyDwelling — Number of Bedrooms � / �� ( 1 Z I ❑ Public /Commercial — Describe Use -` J / ❑ State Owned — Describe Use ❑City_❑ Villag s III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. . ystem [I Replacement System ❑ Treatment/Holding Tank Replacement Only [I Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ 4soild mit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plur I 1 IV. T e of POWTS System: Check all that appl &UA ' ❑ Non - Pressurized In- Ground 11 Mound > 24 in. of suitab in. of suitable soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: — on D7 * n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose sf} System Elevation J `Z� L 40 1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Qallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 7. Aerobic Treatment Unit Dosing Chamber D< 630 VII. Responsibility Statement- I, the undersigne aVQ responsibility for installation of the POWTS shown on the attached plans. Plumber's _N e (Print) umber's t MP /MPRS Num er Business Phone Number Plumber's Address (Street, City, Sta o VIII. Coun /De artment Use Onl Sanitary Permit Fee (i ludes Groundwater Date Issued Issuing Age Signature (N S s) Approved ❑ Di pro Surcharge Fee) �] / Ju ❑ O 'ven Reason for enial 53 ~ 1 IX. Conditions o pro SYSTE WNER, 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances, Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) • PLOT PLAN 'PROJECT Price Rivard ADDRESS 2140 100th St. Somerset Wi 54025 NE,, 1/4 SE 1 /4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 101.7' 1.3' sand Lift! BEDROOM CONVENTIONAL XXX AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL # H. R. P. Same as Benchmark Brave Drive(to 100th St.) Scale =1 /4 = 10 Tank is to be properly bedded 1_0 Ac1Le., Sr rt and provided with lockdown covers with approved warning labels Pro 3 Bedroom Property Line (not House to scale) Huffcutt Combo Tank Grading is to be done to divert run -off away from system B-3 B -1 Well is to meet all setbacks found in Comm. 83 101, Area 15' below 100.4' system is to ❑ remain 100' B-2 undisturbed 99' ❑ B -4 98' 7% Slope Vol 9 7' B.M. * /Alt. B.M. Property Line (not to scale) Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wi.gov LA CROSSE WI 54601 -1831 TDD #. (608) 264 -8777 .� w i ww.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 02, 2006 CUST ID No. 226900 ATTIC• 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: 06/02/2008 Identification Numbers Transaction ID No. 1276344 SITE• Site ID No. 713568 Price Rivard Please refer to both identification numbers, 100` Street above, in all correspondence with the agenc Town of Star Prairie St Croix County NE1 /4, SEl /4, S17, T31N, R18W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1078246 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Effluent filter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 POWTS 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 area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required'. Maintenance information must be given to the owner of the tank I?p q explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. P0. T- 0071t, �'��z . 7� SHAUN R BIRD Page 2 6/2/2006 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfinnctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 Oe M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i I4E�CF Cover Page MAY 2 3 ?006 SArEyy UI LD INGS Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 5/ 18/06 Owner:Price Rivard Location:NE1 /4 SE1 /4 S17 T31 N,R18 W Lot 1 100th St. Star Prairie System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature , fMEN'l OF COMMERCE DIVISION OF SAFETY AND BUILDINGS License num 226900 �; � CORRE� !DENCF PLOT PLAN 'PROJECT Price Rivard ADDRESS 2140 100th St. Somerset Wi 54025 NE,, 1/4 SE 1 /4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 101.7' 1.3' sand Lift! BEDROOM 3 CONVENTIONAL XXX AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark riv 1 th t. Brave D e(to 00 S ) Scale =1 /4 " = 10 Tank is to be properly bedded �rCf -e StTe and provided with lockdown covers with approved warning labels Pro 3 Bedroom Property Line (not House to scale) Huffcutt Combo Tank Grading is to be done to divert run -off away from system B-3 B -1 Well is to meet all setbacks found in Comm. 83 101, Area 15' below 100.4' system is to remain 100' B-2 undisturbed 99' 0 B -4 98 7% Slope 97' B.M. * /Alt. B.M. Property Line (not to scale) f -greet No Date Non -Woven Filter Fabric Pipe Perforated 4 Observation p �Distribution Pipe Below Filter Fabric AST K C-33 S a n d --�� �� Topsoil r v 7. Slope ,- i Flowed Forte Van t _ ��. Bed Of �� 2 �Z - Lay Drain Rock From Pump Y ' tg •� cress section Of A W - ovnd stem Using F _ A Bed For The Absorption Area G . A g• ft. T- t . Ft. K �� ,_ ft -- - -- � j Ft. . L eObservotion Pipe -� — K __-------- - - - - -- F CfCt Mo ire - - -- - - -- - - -- �____ From PumP ° _7 ed � C) isiribution B Qf Yz� 2 '2 i � 4 Pipe Drain Roc,K 4 Pipe= :�a.�a Permanent Marker .CG�i"'f"F.GP or Rods Pion View Of .. Mound Using A Bed for 'T Absorption Arco FAGS.,,, OF-....— r Fes #orated Pipe D e tail Et+d Vit,r s Botts Locates Qa Bat7om. Are Egwrfy spocea �. Pvc F Main ^ s I, - Ft1tST ttC+t.L ttitcicT re CaetnsC } *can PVC `! marpfold p-pe Ol l3istriaat,a� a! A� Di stribution P ipe Lay out p �I Ft. r x inches 9 Inches. // Sig ned: H ole D ameter /6 Inch Lateral ." Inch( es License Number: Manifold Z inches Date: Force Main " ? Inches of holeS/pi o =avert Eievdtion of Later < t, SEPTIC TANK E PUMP CliAt48£R CROSS SECTION AND SpECIfICATIONS MIN ABOVE GRAB£ wFATWRPRWF VFAt'T PIPE alNllo r £�R JUNCTION BO APPROVED of `Rom Dom, WITH CONDUIT MANHOLE COVER FRESH ,AIR INTAlm F1°MM 11r W/ PADLt�CK jg WARNING LABEL :D GRADE 4" HIM. i �iKtM- IE INLET GAS i WATER TIGHT SEALS — T — TIGHT- E �PPfi4YED Fc.R A SEAL JOTNTS WITH 3LT _#._. j ALM RO PIPE APPROVED -- -- - N SOLID SOIL PIPE 3` C t ONTO SOLID OFF SQiI PUMP or EL£1l < F'T- D 3 a ApFROV rX BEDDING UNDER TANIC MCR£TE PAD SPECIFICATIONS SEPTIC 1 DOSE NDMB£R DOSES PER DAY. .,�,. ---- -- TANK MANUFACIURER: . �CL � TAIiiC SIZES SEPTIC GAL. . DOSE VlDLDME 1NCLUD - 1017, -) GAL- -- DOSE GAL. : � �� 10- ' CAPACITIES: A °` ' 3:fic iES = 7 ALARM MANUrACTURER MODEL NUMBER': �-- ell g = 2 INCHES , = 3o = CAL. SWITCH 'TYPE C = INCHES = 7' �rGAL. PUMP I'IAi irAC'TUR£R : / MODEL NUMBER: - Ab' D = � INCHES = /-?J G AL - SWITCH TYPE= c° •, e REQUIRED DISCHARGE RAT E _ GPM !SF E Ai�iFt1 t WIRING AS PER I LHR tt 15.23 WAC � ' ERTYCA £. DIFFERENCE BETWEEN PUMP C3F AND F DISTRIBUTION DISTRIBUTION PIP£- Z9 FEET t3Ai + MIMI NETWORK SUPPLY PR£SSllRE _ ERI— F EET FEET FORCEMl LN X � 3�- FTCI€ii� FT_ FRICTION FACTOR FEET TOTAL DYNAMICil:Ai) / � ; d W� TH C am : DIAMETER INTERNAL D114E �IOt�� 01' F�!LP TANK: I D L NUMBER = DA T E - SIGNED: ?f88 ' Stunt 8y, Wp k-umr ltt %IM, 1 715 552 8827 May -5 -06 2:56PIA; Page 213 - ._ 9EH S ERIES SUMP /EFFLUENT PUMP 8.95 Q 0 SpecNications 8L iL LKM lu W3S SIWS83"E wnlr�c l9HI1t11cESi►11gt1)� SWM rrccl! low 1pt1mo UL 1M BL W4 ta3 1lrottnrs P t9 1s• Otl Eu 01x1 nstx� 98I-am 509330 OL A 4IS0 115 V 13A 100➢ 70 64 55 41 32 1368 20 24 9.11711.64x&94 9941A 8G9340 MCI 4 "•0 230 39 6.5 1000 70 64 55 41 32 lab 23 29 9.11 x 1154 x 894 981-74•W 509350 WM 4 1 314 13.0 1000 70 U 55 41 32 13.9 2FY 27 9.11 :1154 x 914 9E}GCIi EM 50.9860 OWSA ec 210 3A 6b 1000 70 6d 55 41 32 13.8 20 27 a I x N 64 x p ae Gor4lnuous0alrwtao ' Y.& Oe6+ �awuaaamrcua�psaoeeaescw+ Trtvgysallrasbnoasn+ eyarennswllpn, �cea�deed►minpsloieflsesur'ws.- F 0 LITE>?S /ttp�lft Construction o ln0o 2000 3000 Motor Housing g C foxy _, oared Cast Iron Irnpeiler Material Poly Carbonate 30 10 Im ell er'I a Closed Vane Volute " W 7z W Power Cord SJTW - A 20 W Mechanics.! Shaft Seaf Nitrile with carbon and 5 A cetauuc faces z Fasteners W Stainless Steel ��� S haft l a z.s _ Stainlccc Steel Bearings ' Upper Sleeve and Lower a 0 I RalI Bearings 0 20 4 b0 so FLOW- GALLONS/MINUTE PUMP PERFOR CURVE 135v bO14Z Little Giant Pkimp Co. , , ,t a P41 Be= 1291# • LWSbOMa City OK 73137 Phoars 4ib 9172521 • Fau 4#5 2281558 WWW.LfttleGiantPt MP.com F.m,�t: easlaorrs�etean 0 Farm 995235 —07103 OWNER'S MANUAL & MANAGF-ME14T PLAN POWTS Pag of - s�rsTEM sPEccFrcarfoxs VkFORMA septic -rants CsPadY 0 NA Owner /� ✓ /'� Sep�c Tank Mangy' 82 Efffuent F Manufaaum ❑ nu OEMGM PIAWdMO— - Q NA C-f[iuenf Friter•Model o NA t4Wberof0 _ Pump-Tank Capa* D Cal D NA Numberof Cottuneraw untts pump Tank Man rer NA 'aday flaw (awcr-W) pi rnp Manufa ch er J .� in low (P �� � ( x S 5) � d Pump Model � ❑ NA p Rabe t Unit went Quality Monthly average` Q � F'Rer i3 Peat Flfbec G) S30 mg/L p Mechanical AeraWn D Ylfetland Pats, abc�� oxygen Demand (B� s) --Q-20 m g r ' ❑ DssMMecSon © other Total $'rids {TSs) 5150 m /L manufacturer Qua�Y Monthly average" Dispersaa C Ks) Pry Eflit� ❑ NA ❑ in round (gra -gvy) 13 in- ground Unwsuri eQ OD . S30 Mg/L ihtw Biochemlcal O Demand (B s} :530 mg/L {3 qt grade p Other_ Total Suspended Solids (TSS) -,t cr cfufl oomt Q Dri e - Fecal COW= (geometric mean) VaLWr tcai for doe wmft X, �nchd<ametsr - sepr= as xpric t el�iue:it Ma)&num Effluent Par�rc9e Size .. values LyprrBl ror vre w"�° NfENpNCE SCHEDULE Service Frequency Service Event E3 months s} (Maximum 3 y rV ) At ;ease once every e4 i rd (K) of tank volume Inspect aondiidon of tank(s) uais one -tti When com>ained sludge and scum • t(s) (Maximum 3 yn= -) pump out contents of tank(s) '? L3 m cells) At least once every r(s) Inspect dispersal Al least once every months C3 m Clears effluent filter months s} DNA m pump controls 8 alarmAt least once every s} 0 NA lnspe�t Pump, P At t once every Q months Flush gals and pressure test � tseonth 5 0 yWs) 0 NA Oflia At least once every over_ At least once every ❑months II years} ❑ NA INSTRUCTIO TRUCTIONS on insped3ans of tanks and d cells shaft tie• made by an individual CStryin9 e of the wHowfng licenses or i pOWTS Maintsu,er; So~ vim;. Master . Master Pturrsbes Restricted Sewer, F'O�11f t tanks to idenfffY any g or txvken r. Tank Dec flans must include a visual lnspecdo n of the lge a scum and to chock for any back uP hardware, iden any cracks or leaks, rneasure the volume of combined sl inspe to check the effluent levels or pordruV of etltuent on the ground surface. Tb � PO effluent an It groun surface The ponding of efttuent on the in the obser Pipen and a check for any a 9 requ the im notifxcOtian of the k,rdl regulaflory �� gmund atttf8oe may indwate a fanTirig condl5on and rest or more of the tank volume. the of sludge and scum in any tams equals or and lsposed of Mn a�lt#arxae with Ct NR When the co ra of sa h la*ion a $edge Suing Op entire corlUen� of the tank shalt be re moved by � - 113, Wa=tSIM Administrawe Code- - onents. pretrea nt Co mponents; and anY The sel�g of effluent Alters, mechanical or pressures or Tess sha POWTS Damp t[ be donned by a cerflfied POWTS Maintainet_ of 12 months ieiron of any s,,,iop_ event fflWrnalntena W or monitoring at intff r of comp A ShMll plwided to the local regulatory authority wid7in 'f Q d� START UP AND OPERA310N the P resence of paNng products or Other For rww c0nsbruation, prior to use of the PDWTS c h ec k treatment tarts {s} e� p li s . if oortoenbatiOtlS crt�ts mat may knode the treatrnent process andlor damage the disp t r r to use deteCW hate the contents of the tank(s) r�emaved try a septage servicing operator Q per of Sy bern,sbad tip shah not occur when sofl'conditions are frozen at the int4ftrative surface_ E) +9 P�'r oLdaNges tip tortes nay 0 above normal highwater levets_ When power is resWred the excess ay em c a c0 g0ctjarge arged to t k n d To at avoid this situation have the cones ts pi tank remov b e t a srxrtaa d� of e�t - Se a ServrairrQ OPT tam i ng power to the eMuent pump or contact a Pfualbw- or POWTS Wtrlaber to ikt m� o n9 Me P=P � to restore normal revers vvifttial lute pump tank. Oo not drnre or park Vd** s over acs and d1sP&S2J CBa_ DO not drive or park oven or tferwise &tub or comp the area WMM 15 feet down sbpe of any momid or at -grade sail absorption area Reduction or- enrol melon of ffm WOWM9 frorn the wastewater sbaam may improve the perkw anoe and ptotorrg the rife Of the POWTS: armb babY 'c9a;rette bums; condoms, cotton swabs, detirsaserm denfat floss; drapers dry; fat; ftndarKm drab (sump pump) %ater fruit and vegetable peermg.% gasoline; grease:. MUM [w meat soaps; 4; Pg&lft PiaducM. pesttades; sanitary napkins. tampons: and waW SOMW brine. ABANOONOMENT When the poWrS !alts andfor is penyjarwrltiy.taken out of service the fonovAng steps shall tre taken to insure that the system is Pn3Perly and salty abandoned in compliance with ch. Comm a3.33, Msoonsin AdmirsrsiraWe Code • All pfpfng to tanks and pits shalt be disconnected and tie abandoned pipe openings sealed • . The contents of ail tanks and pits shall be removed and proper disposed of by a Sege Servidng Operator_ • Auer pumping. all tanks and pits shall be excavated and removed or lfteir covers removed -and the void spate filled with soil; gravel oranomer inert so &d rnateriaL COMMC;ENCY PLAN if the POWTS la ss and cannot be repaired the fb1fowirsg measures have been, or must be taken, to provide a Code compliant replacoernent system C A suftabfe rieptacernent area has been evaluated and maybe Utilized for the location of a replacement s absorption system The replacement area should be protected from disturbance and compaction and should not be infringed upon by requined setb acks from existing and proposed structure, lot fates and wells- Failure to protect the r+eplaoement area will result in the need for a new soil and site =evaluation to establish a suitable replacement area_ Replacement systems must comply with the rules in effect at that time- 0 A suitable replacement area is not available due to setback and/or soil limitations_ Barring advances in POW rS tedtnology a twldmg tank may be installed as a last resort to replace the failed POWTS_ -- e site has not been evaluated to idenfifY a suitable replacement area Upon failure of the POWTS a soil and s evaluation must be performed to locate a suitable replacement area_ if no WkMe tent area is available a holding tank may be Installed as a Iast resort to replace the failed POWTS_ ,Mound and at- grade sa absorption systems may be reconstructed in place following removal of the biomat at e irfittrative surface, Reconstructions of such systems must comply with the rufes in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOK INSUFFICIENT OXYfEN DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES DEATH MAY RESULT RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR WPOSSIBLE 'ADOMONAL COMMENTS POVVTS INSTALLER POWTS MAINTAINER Harris Marne u �✓ Phone z zno Z ?L z , Phone SEPTAGE SERVICING OPERATOR PUMP' LOCAL REGULATORY AUTHORtIY Name +Yr Agency Phone . Phone This aomenem *as drdead by Cie idle of the Green Lake, Marquette and Waushara Garnty Zcning and Semi ton agewW, This daormteRt arse is rite m6r6mvm regrrrrensar�s cf ctL Conan 83Z2(40X and 83.56(1). (2) & (3), Wfsaonsin Aa- 9r&trZ&e Codes Ust of this docv 7=r dva5 riot cjUmitee tilt perbmuaw of the Powrs. (''MW (101) �.� 4A'FQ Wisconsin Department of Comme MAY 1 ® )o �PIL AL N REPORT Page of Division of Safety and Buildings in accordance with Comm 5, Wis. Adm. Code _ /s ST. Ct r)i:C co I County 1 X Attach complete site plan on pa r not less than 8 1/2 x 11 Inches i size. Plan must include, but not limited to: vertica an int (B ), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location an (stance to nearest road. j Please print all information. Re w by Dat � Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 5 Property Owner Properly Location A - lei> ija.,L & Govt. Lot - 1/4 � 1 S � T N R' � E (o) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I D J10 0 City State Zip Code Phone Number ❑ city C) village J9I.Town Nearest Road "^ i LSD S� New Construction Us esidential / Number of bedrooms .3 Code derived design flow rate U GPD ❑ Replacement ❑ Public or commercial - Describe: __— Parent material Flood Plain elevation if applicable A - ft. General cornments and recommendations: /� j r System Type L9L6 [ r 3� 30 �CX � � System Elevation Boring # Boring f I Pit Ground surface elev. ' 3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 U "t_ Si` o ff,^, M'4- �r Z 8 2Z—q 7r s Cc�Q 1 b G r / f✓ /. D' U ® r- Boritlg # ❑ Boring / , Pit Ground surface elev. ft. Depth to limiting factor v in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 2-- Z6 ha Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �v — 715 - 246 -4516 Property Owner _ Parcel ID # Page of El Bori # E] Boring / -1-- - v 1 Ground surface elev. V t ft. Depth to limiting factor V in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z- -Z I Boring # ❑ Boring Q IT Pit Ground surface elev. ft. Depth to limiting factor U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 �O Q F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. F SoiiAppiication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 < < Effluent #1 = BOD > 30 < 220 nxlll. and TSS >30 < 150 mglL 'Effluent #2 - BOD _ 30 mg/L and TSS _ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) f Soil Test Plot Plan Project Name Price Rivard Shaun Bk Address 2140 100th St. Somerset Wi 54025 CST #226900 Lot Subdivision ------- Date 5/10/06 NE 1/4 SE 1/4S 17 T 31 N/R 1 8 W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 101.7' *HRP Same as Benchmark Alt. BM Top of 1/2" pipe @ 100.4' Pro Property Line Brave Drive to 100th St. -% AL Scale = 1/4" = 10' unless otherwise noted! B -3 60' B -1 ape y Line Z , 5 1 f 0 % Slope 60' 101' Pro 3 Bedroom 70' House 99' B -2 ZA -4 70' 97' B.M. /Alt. B.M. Survey was not completed at the time of testing! ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICAT ON FORM Owner/Buyer Mailing Address 0l LD Property Address b r �n D (Verification required from Planning & Zoning Department for n '' ? ew construction.) City /State Parcel Identification Number l LEGAL DESCRIPTION Property Location' /a � ,5 rya , Sec., T N R� �W, Town of , Lot # Subdivision ) �� Volume Page Certified Survey Map # / , , # Warranty Deed # _ ,- ,Volume Page # , Spec house yes na Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 pro described above, by virtue of a warranty deed recorded in Register of Deeds Office. 7 /Z_/12/_, SIGN ATURE OF APPLICANT(S) ) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11 Ail -- k . 0 an N O s+a s +a ..�.� -.....----- ------ ------- -.��.. -..- N we s( N \ _, f FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12 tillm WSJ �• . as C __. lug 4 M ` a _ - -_ _ —_ - -- - - _ -- _____ State Bar of Wisconsin Form 3 -2003 5D( QUIT CLAIM DEED REGISTER OF DEWSS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 07/11 /2006 08:00AM THIS DEED, made between Patric J. Rivard and Joseph F. Rivard QUIT CLAIM DEED EXERT # ("Grantor," whether one or more), REC FEE: 11.00 and Price Rivard, TRANS FEE: 120.00 ----T COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 1 Recording Area Grantor quit claims to Grantee the following described real estate, togetherwiththe rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin Name and Return Address ( "Property") (if more space is needed, please attach addendum): Part of the NW 1/4 of SE 1/4 and part of NE 114 of SE 1/4 of Sec. 17 -T31N W, Town of Star Prairie, St. Croix County, Wisconsin described as follow Lot of Certified Survey Map recorded in Vol. 2 1, Page 5231, as Doc. No. 828521. Part of 038 - 1073 -70 -000; 038 - 1073 -95 -000; 038- 1074 -20 -000 ;038- 1073 -80 -000 Parcel Identification Number (PIN) This is not homestead property. Dated (SEAL (SEAL) * *Patric J. Rivard - - (SEAL) (SEAL) * * seph . Rivard" '(tE ENC AUTHENTICATION ACKNOWLEDGMENT .''+.•+ F Signature(s) , * N ®TARP t authenticated on STATE OF , COUNTY ) . TITLE. MEMBER STATE EAR OF WISCONSIN Personally came before me on 71 1 0 (If not, the above -named Patric J. Rivard and Joseph F. Rivard, authorized by Wis. Stat. § 706.06) .to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. Attorney Kristina Ogland Hudson, WI 54016 * &-.) Notary Public, State bf / My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 ' Type name below signatures. INFO- PRO Legal Forms 800 -655 -2021 www.infbprofbrms.com 3 8�8�z i VOL PAGE 5231 �. REGISTER OF DEEDS ST. CROIX CO ' L WI RECEIVED FOR K ECORD CERTIFIED SURVEY MAP NO. a6l- �A/2 006 08:30AM VOLUME PAGE CERTIFIED SURVEY MAP REC FEE. 13. oo PART OF THE NW 1/4 OF THE SE 1/4, AND PART OF TH821&F f N80 THE SE 1/4, SECTION 17, TOWNSHIP 31 NORTH, RANGE 18 WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN N 1/4 car. 4 k 17 -31 -18 r Fd. Berntsen Alum. - UNPLATTED — LANDS I� \ WIGWAM S HO�tES ADDITION � p _� South Line of the `` \ 1 ----- -- --•---- ------- - 00 �!° SEr1 /416.5' of the �, RAVE_DRIV �{ nl 688'16'24 "E S88'1 6'24"E \ 4',jF5,62' (PRIVATE ACCESS L 884.36 1 7 .14' _ r7 I 260.48' /� �`� / SSg'OS2T'E — 1716 rnl P.V.B. N45'48'43W_' 3.77'� 1 I s� Proposed Driveway South Line pf theJ i ZI xl O 4.76 Locotion ( North 416.5 of the 50 _ Highway Setback - - - -� N SE 1/4 co IUD z r :0ii W1 0l I O IA IC C -C' o I ° N ' Iq 1� j� z ;� LOT 1 i ,,; Id Ib r a Including R.O.W. L w j� 0 130.609 SO- FT. to Iz 3.00 Acres I i� ic O Excluding R.0-W. I W It-j S 1/4 cor. Z o 130.002 S0. FT- N N O 17 -31 -18 o O Fd. Berntsen. Alum. 2.98 Acres z z I N88'16'24 "W 435.62 I UNPLATTED LANDS I RETAINED BY OWNER Note: � a As long as Brave Drive exists as a private access. °-° 0 no other driveway accesses are allowed to Lot 1 of RONAS.D D. in this survey or the remaining lands to the east of JA-RpEnsoN Z a+ said Lott x S�25 4 .k 3 0 DURAND, M V WIS APPROVED: Town of Star Prairie• O � T G - ice e , ° Signotu Dote �Q• l7— IDCso C% ° o z n E N LEGEND ..........Found Government Corner (as noted) o..........Set 3/4" x 18" iron rebar weighing 1.502 tbs. /lineal ft. • ........_.Found 1" O.D. Iron Pipe SURVEYOR= o ..........Found 2" O.D. Iron Pipe Cedar Corporation o ..........Borehole Locations 604 Wilson Ave. SCALE: 1" - 100' Menomonie. N 54751 PREPARED FOR: Price Rivard Drafted 0' 100 2140 100th Street Ron Josper son 200' Somerset, WI 54025 Sheet 1 of 2 Sheets 1of2 Vol. 21 Page 5231 q. 2110 r ZD L � / Parcel #: 038 - 1073 -95 -200 03/15/2007 02:42 PM PAGE 1 OF 1 Alt. Parcel #: 17.31.18.306A -20 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/25/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - RIVARD, PRICE PRICE RIVARD 2140 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 971 BRAVE DR SC 5432 SOMERSET SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 3.000 Plat: 5231 -CSM 21 -5231 SEC 17 T31 R1 8W NW SE NESE CSM 21 -5231 Block/Condo Bldg: LOT 01 LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 31N -18W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 07/11/2006 829289 QC 07/10/2006 829152 AFF 06/30/2006 828521 CSM 06/30/2006 828520 EZ -1 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/25/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00