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HomeMy WebLinkAbout038-1069-60-000 o to O 0 m O! 3 0 C7 r� 3 A: �1 R !* Z 2 m Z O Ja T CA 3 .0 T N z O Cn _T N O `� • O N m O A fD 3 0) N m C O• 0 (D m V o W Ol 3 o co 3 3 0 m w 3 C a a H to 9 a@ O 3 co 3 !° C) c 5 ! d. w t O m T cn N o a =• ta m o b� O 3 CD (D o�� m w o m o o c o o m o T o ,ma Pi 3 7 3 y j %- 0 0 (� t3A C N O C o A O 5'i m A C cn Z D o m w cn v D a y D e O ti a m (a a v, '� w C CD , o o a I -0 m j cc a M� A j I 3 �O ° g co V J (O (O CL 0) V ry Z O D O N .T S 0 0 n r yr O a 3 v' m "i V 3 3 7 c c 000 a 000 ��• = 3 CO) (A c o cn 1 /q (D CD 3 I 3 cD M a 9 O O N y i 1 0 i 9 n N O A Q (Y 01 3 •• N C �• m 7 � °-' I � T N O. o ? o D(D 0 I O D D o 0 A O v I N N a) N S d S CL (D � • ((A COT1 (D y N I I s C N O CL Pi 3 m a 1 co y C V! C J M a I 6 A Z - W I M V CL A o O '* z M y ;u H A 0 0 0 0 N n N CD mm ro 0 n D 3 a W m a m c w a m O o C a C' ag CL m D �(Q n m s o�i c m (D 3 c a� c Z a m (o 00 Z CL CD m O V x�< CO Cn� H .� .0000 o C If -�. OD 'O =1 7 7 --40 O CL N O O y H F O C V y S M. Cn O n. N A am w N �3a� „, Q m cc �° c?. H m o y 0 o o p w m m i o O O o 0 o CL Wis - onsin Department of Commerce County PRIVATE SEWAGE SYSTEM St. Croix Sefe�j and Building Division INSPECTION REPORT Sanitary Permit No: 506330 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: Fleming, Peter I Star Prairie, Town of 038 - 1069 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /Gb /jrn ! G - ' 17.31.18.293F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 67, 34 /00 Septic / Benchmark Dosing Alt. BM (.7 CIS, z Aemttaff l a e'L_:: 7 Bldg. Sewer Holding St/Ht Inlet Zr TANK SETBACK INFORMATION St/Ht Outlet qZ 17 0!5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2- 7 0 95 J5 / �7 3� 5 Dt Bottom 15-95 V f, C Z Dosing r / W f Header /Man. D J 35 .35 6 (4 /61 32. Aeration Dist. Pipe �sdo AD, .3Z_ Holding Bot. System �7 /6o. � PUMP /SIPHON INFORMATION Final Grade S Dia 1bZ 3 Manufacturer Demand St Cover Zoe. GPM T, 67 � Z_ Model Number X5.2 z1 " 7 C ,�-' 7.7 9?, /S TDH Lift, Friction Loss System Head T Ft y g? Forcemain Length Dia. ;, Dist. to Well e /hth 2 SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length y No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D,ppth DIMENSIONS G 3-1 8 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of 0 LJ.N � ZZ / i / UNIT Model Number: `_ I /V DISTRIBUTION SYSTEM ,o - A-d 4A* Header /Manifold // Distribution x Hole Size x Hole Spacing Vept to Air Intake r // Pipe(s) 3 ri it --T 1 1 -ength -10— Dia Length Dia ��� Spacing 3 /(D 3� GkeE SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center �/ Bed/Trench Edges ` Topsoil II fl—, es No Yes No r COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /G / 4 7 Inspection #2: Location: 2184 Island Drive Somerset, WI 54025 (NE 1/4 NE 114 17 T31N R18W) metes & bounds ,L �� �� P T Parcel No: 17.31.18.293F 1.) Alt SM Description = F 14 " G �`' ¢ '� t cr J ( , 2.) Bldg sewer length = 35 P/Ou4i - amount of cover = ; Plan revision Required? ❑ Yes fNo -- — /31 Use other side for additional information. Date Insepct s Signa Cert. No. SED -6710 (8.3197) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ,S Ali _ SCOI�SIII Madison, WI 53707 — 7162 Sanitary Permit Nu ber (to be filled in by Co.) aa (608) 266 -3151 ©� V Department of Commerce Number Sanitary Permit Application State Plan I.D 1J.1-2 510 In accord with Comm 83.21, Wis. Adm. Code, personal information yo vide may be used for secondary purposes Privacy Law, s15.04(1 x f ddress (if different than mailing address) y 1 Sc P.O, 1. Application Information — Please Print All Inform tion REC �2S - /. S- O Property Owner's Name OG9 -60 Bloch # SEP 1 7 2007 03[3 -1 10� G s -0 Property Owner's Mailing Address Property Location ' - Zq 3 F ST. CROIX COUNTY /� / L Q L �[� 'h, N& 'A Section City, State Zip C ode­ s (circle one) 15 AA C1 .5 �- 1 — Y-I T 3L N; R /8 E or H. Type of Building (check all that apply) YL f'Dfc.�! Subdivision Name CSM Number ® 1 or 2 Family Dwelling — Number of Bedrooms - 44) ❑ PubliclCommercial — Describe Use ❑ State Owned — Describe Use ❑City_ ❑Village frownship of III. Type of Permit: (Check only one box on line A. Complete line B if app icable) A. ❑ New System t Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued -F B. ❑ ❑ g Permit Renewal Permit Revision ❑Chan a of ❑Permit Transfer to New _ , / / Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that appl ❑ Non — Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 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) r r V. Dis ersaVrreatment Area Information: Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal ea Proposed (sf) System Elevation V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is S,' to MP/MPRS Number [ ;TBusinessPhone Number 6d 5 y -GGS/ Plumber's Address (Street, City, State, Zi ode) C L E t t I g' �— Vill. Dc artmeni Use Onl Sanitary Permit Fee (includes Ground eater Rl s sued Issuing gent it ice ( mps) Approved El Disapproved Surcharge Fee) ll 17d ❑ Owner Given Reason for Denial ' r IX. Conditions of Approval /Reasons for Disapproval ((�/ SJ /` `' �✓ YSTEM OWNER: }yvyrl , D .j 7 - f.C�ve1 l/h ' S^ Septic tank, effluent filter and dispersal cell must all be serviced/ maintained aA G_k c :` as per management plan provided by plumber. .. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not Ins than AIR x 11 inches in size SBD -6398 (R. 01/03) W /CErM 57; �? a �n � � J � 6L M i m 2 i `J a I J +u ti M ce r Q a CL t Nj lz n Qj �- -t.l r , w Y • 7:5 QC C'5 a� " Safety and Buildings 4003 N KINNEY COULEE RD ,t commerce.wi.gov LACROSSE WI 54601 -1831 ic TDD #: (608) 264 -8777 sca n s i n www.commerce.wi.gov /sb/ epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 07, 2007 CUST ID No. 223760 ATTN. POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/07/2009 Identification Numbers Transaction ID No. 1435904 SITE: Site ID No. 729848 Peter Fleming Please refer to both identification numbers, 9ISy Island Drive above, in all correspondence with the agency. Town of Star Prairie St Croix County NE1 /4, NEIA, S17, T3 IN, R18W Lot: 444/443, Subdivision: CSM V2147, P508 FOR: Description: Mound / Two Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1150240 Maintenance required; Replacement system; 300 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01101); Biofilter 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance.,, information must be given to the owner of the tank explaining that periodic cleaning of the filter is required ,,e GEPARii� - ; OF • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. , • OF EY • A Sanitary Permit must be obtained from the county where this project is located in accordance with the 'SEE- C(sl�; :i- requirements of Sec. 145.135 and 145.19, Wis. Stats. sr 1. JOHN F SCHMITT Page 2 9/712007 • 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. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charies.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I 1 KID= & SONS EXCAVATING S86 Volley View Trail Some7s4 W154 ©25 71S -549 -6651 MOUND SYSTEM For: Peter & Carole Fleming Address: 4 Edacombe Place St Paul , MN, 55116 Legal• N a, NE %, 517, T31N, R18W Township: Star Prairie County: St. C Contents tents RECEIVED page 1 Plot Plan A U G 3 1 ) 2 007 Page 2 System Cross Section Page 3 Pipe Lateral Layout SAFETY & BUILDINGS Page 4 Dosing Chamber Page S Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment Aerial Photo Mound Component Manual (Version 2.0) SBD 10691 - P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SBD- 10706 -P(N 01 /01) By: MPRSW 223760 Date. 8/25/07 )VEi) CORMERC �NUENCECZ� Page 2 Of 6 Straw, Marsh Hay, Or Synthetic Covering ASTM C33 Distribution Pipe Medium Sand 6" Topsoil _ _H ._ "'= G J i E - -- ; - F .SYS. ELEV. 100. 6 0 , 3 Y % Slop Bed Of Z�- 2 %Z Force Main Plowed Aggregate Layer (6" Below Pipe) D 1.50 Ft. Cross Section Of A Mound System Using E 2.06 Ft. A Bed For The Absorption Area F 0.79 Ft. G 0.50 Ft. A 8.0 Ft. H 1.00 Ft. Signed: B 37.5 Ft. License Number: 223760 K1 0.72 Ft. Date: 8/25/07 L 59.0 Ft. j 7.0 Ft. I 12.8 Ft. W 27.8 Ft. L Observation Pipe j 115 To 1/10 B From End of Bed --------------- - - - - -- - - - - - - -? - a !•- - -- - - -- ---------------------- - - - - -- - - - - -•( _ Force Main W 1--- --- I ---- " - - -_ - -�) Distribution Bed Of i - 2 1 Pipe Aggregate Observation Pipe Permanent Markers 115 To 1/10 B From End of Bed Plan View Of Mound Using A Bed For The Absorption Area 3, 6 - Perforoleo Pipe Oslo" yy oy.r6.dCw' ` � Pvffofolqd PVC P•90 Moles Loesfed On Boll 0M. Are Equally spored S ' A 8 »w EAd C&PS� 1 Q PVC Force kidw Disuipu�0^ Pipe PVC +�ol+i +ad Pao• Pipe LOYOUt P 36-25 Ft. pietrib� lion R 6.0 Ft. S 3.0 Ft. X 30 InchRa Y NA Inches Hole Diameter 3116 Inch 1�Zr��l Lateral 1_•,,_ Inch(es) Signed: Man 12 inches License Number: (2 223760 Force Main " ? __ Inches 8/ 25/ 0 7 # of holeslpiPe 1_5 Date: Invert Elevation of Laterals_ • Ft- PAC,t 4 GF 6 PUMP CHAMBER CROSS SECTIOU AMD SPECIFICA•r10k!5 VEMT CAP 4"C.I. VEUT PIPE WEATHERPROOF APFROVED LOCKING JUIJCTIOAJ BOX AWHOLE COVER � 25' FROM DOOR. wINDOW OR FRESH 12 "MIU. AIR INTAKE I GRADE I i "MIAJ. I f � 18 "MIU. COAIDUIT ---- - - - - -- ' 11� IAJLET PROVIDE I - - --- 7 AIRTIGHT SEAL 1 I III / * A 21.76 gal /inch I I ALARM 13 I I *APPROVED I I oN . C JOINTS WITH I I ELEV. FT. APPROVED PIPE — f 3' ONTO PUMP OFF D SOLID SOIL CO►.ICRETE CLOCK RISER EXIT PERMITTED OWLy IF TAIJK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIF'ICATIOUS Do51< Week' s C. P . R DAy TAIJKS MAIJUFACTURER: IJLIMBER OF DOSES: +Or -5 PE TAWK SIZE: 800 GALLO►US DOSE VOLUME ALARM MAUUFACTURG.R: Septronics Tankmate INCLUDING BACKFLOW: 65 -28 GALLONS MODEL IJUM6EK: TM -1 CAPACITIES: A= 20 IWCHES OR 435 . 2 GALLOWS SWITCH TYPE: Mechanical B= 2 IWCHES OR 43.52 CALLOUS PUMP MAWUFACTURER: Zoeller C= 3 IWCHES OR 6-9 .28 GALLO MODEL NUMBER: 152 0- _1.2__— INCHES OR 2 J L 2 GALLOUS SWITCH TYPE Mechanical MOTE: PUMP AND ALARM ARE TO DE MIWIMUM DISCHARGE RATE 29.7 GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFEKE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 15.00 FEET + MIIJIMUM NETWORK SUPPLY PKESSUR . . . . . . . . 3.25 FEET + FEET OF FORCE MAIN X F l o O►LFKtCTIOU FACTOR 1 • 36 FEET TOTAL OyIJAMIC. HEAD = 19. 61 FEET IIJTERIJAL DIMEWSIONL OF TANK: LE.KICsTH ;WIDTH :z' ;LIQUID DEPTH 1 7 51GUED: LICEQSE IJU M5 ER: 223760 DATE: 8/25/ TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 UJ U'z w MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 30 8— 25 7.6 34 129 42 159 o 30 9.1 23 87 33 125 Q 20 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 4 10 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) ousoe 0 20 40 60 80 100 GALLONS LITERS 6 1/4 80 160 240 320 0 3 27/32 4 5/8 FLOW PER MINUTE I CONSULT FACTORY FOR SPECIAL APPLICATIONS ! 3 27/32 • Timed dosing panels available. e • Electrical altemators, for duplex systems, are available and supplied with 3 27/32 an alarm. • Variable level control switches are available for controlling single phase systems. { • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 1/8 1521153 MODELS Control Selection Model Vohs -Ph Mode Amps Simplex I Du lex 5 1 /8 BN1 115 1 Non 8.5 1 2 or 3 BN152 715 1 Auto 8.5 Inducted 2 or E152 230 1 Non 4.3 1 2 or3 sKZaea BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 1 Included 2 or 3 SELECTION GUIDE E153 230 1 Non 5.3 1 1 2 or :3 Single le 1 back variable level float switch or double p variable level float BE153 230 t Auto 5.3 In 2 or 3 9 pigg P 99Y switch. Refer to FM0477. I A CAUTION 1 2. See FM0712 for correct model of Electrical Altemator E•Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAII T0: P.O. BOX 16347 Loui 3 KY 40256. �i � SNIP T0: 3649 Cane Run n R oad manufacturers of. oad p ® ® Louisville, KY 40211.1961 Q P utIPB SNCE �93�! httpYAvww.zoafter . com PUMP !O. 021778 X(502) ( 74- 3 928•PUMP FAX (50 ?) 774 -3624 0 Copyright 2001 Zoeller Co. All rights reserved. COTS ST, •a a � r M � r 1 f S V `I' , n V V 1 >; o z fl J , ►: S J � 3 J ti3 ku v Qj u 'V ' Li Q J fl 0 tit \L i 3 4 , V POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6A of ,6 FR E INFORMATION - SYSTEM SPECIFICATIONS Owner Peter Fleming Septic Tank Capacity 8 0 0 g a 1 E 103 NA Pet:nit 1 Septic Tank Manufacturer . p , NA DESIGN PA RAMETERS Effluent Filter Manufacturer of O NA Numbet of Sedroonu 2 O NA Effluent Filter Mode! rri 0 -8 O NA Number of Public Facility Units ■ NA Pump Tank Capacity 800 al O NA Estimated flow (average) 200 cal/day Pump Tank Manufacturer Week C. P. O NA Design flow (peakl, (Estimated x 1.5) 300 gal/day Pump Manufacturer Zoeller O NA Soil Appgcation Rate 0. 5 gal/day/ft' Pump Model 152 O NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ■ NA. Fats, Oil & Grease (FOG) S30 mg /L O Sand /Gravel Filter O Peat Filter Blocher *,W Oxygen Demand (BODJ 5220 mg /L O NA O Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L O Disinfection O Other: Watroated Effluent Quality Monthly averago Dispersal Cells) O NA Biochemical Oxygen Demand (BODJ S30 mg /L O In Ground (gravity) O In Ground (pressurized),, Total Suspended Solids (TSS) S30 mg /L �`tJA O At -Grade ■ Mound L 2 yrr 44 Sr Fecal Colifotm (geometric mean) S10' cfu/1 O Drip -Line O Other: Maxleri un Effluent Particle Size Y in dia. , O NA Other: O NA O NA Other: O NA 'values typical for domestic wastawatar and septic tank et(luent. Other. O NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tanks) At least once every: O month(s) (Maximum 3 years) O NA 3 O ear(s) pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume O NA hupect dispersal ceA 3 (s) At least once every: O mo nth ■ ea ls) (s) l (Maximum 3 years) O NA Clean effluent filter At least once every: 1 O mo D ear(s) al O NA year(s) inspect pump, PUMP controls & alarm At least once every: O months) O NA 1 ,1 year(s) Flush laterals and pressure test At least once every: O month(s) O l,(A 1 i yearW Off' At least once every: O month(s) O NA O earls) Other: O NA UMTENANCE INSTRUCTIONS inspections of tanks and dispersal calls shag be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Pkmtber Restrictod Sewer; POWTS Inspector; POWTS Maintainer; Septags Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, . r:teasure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cats) shall be visually inspected to check the off luant levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of of fluent on the ground surface may indicate a failing condition and requires the inu:sediate notification of the local regulatory authority. Whan the combined accumulatloa of sludge and scum in any tank equals one - thud (Y,) or more of the tank volume, the entire contents of the tank shag be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, MRsconsin Administrative Code. All other services. Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing st Intarvais -of S12 months, shall be performed by a certified POWTS Maintainer. A service report shag be provided to the local regulatory authority within 10 days of'completlon of any service event. I Page - of ' START UP AND OPERATION For now construction. prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that troy impede floe treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to Systam start up shill not occur whbn soil conditions are •frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be dischargd to the dispersal call(s) In one largo dose, overloading the call(s) and may•rosult in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do-not drive or park over, or otherwise disturb or compact,•the area within 15 feet down slope of any mound or at -grade soil absorption area. 'Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTd: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation draft (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following stops shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaid the following measures have been, or-must be taken, to provide a code compliant repiacarrmt system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing :and proposed structure, lot lines and wells. Failure to protect the replacement. area will result In the need for s now soil and sits evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area Is not available due to'setback and /or soil limitations. Barring advances in POWTS 1, technology a holding tank may be installed as a last resort to replace the failed POWTS. .. E3 The site has not boon evaluated to identify a suitabia replacement area. Upon failure of the POWTS .a soil and site: =valuation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank':: may be installed as a last resort to replace the failed POWTS. ■ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT I ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name John- Schmitt Name John Schmitt Phone Phone ( 715) 760 -0486 . Y SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ice Name St.-Croix Cty. Zoning Phone Phone 715 386 -4680 Thls docurrAra was drafted In compliance with chapter Comm 83.22(2)(bl(1)(d) &(t) and 83.64(1), (2) & (3), Wisconsin Administrative Code. I 14 ' sconsin SOIL EVALUATION REPORT #1578 Dep artment of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Ina Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must County St. Groot include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. - 1069 460-000 Please print all irrformatlon. R B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner RECEIVED P operty Location Fleming, Peter & Carole G M. Lot NE1 /4, NE1/4, S17, T31N, R18W Property Owner's Mailing Address Let # Block # Subd. Name or CSW 4 Edgcombe Place S E P 17 2007 / CSM V2147, P508 City State Zil i Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road St. Paul MN 5 116$T. CROIX COUNTY Star Prairie Island Drive ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 300 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Glacial till (Amery Series) Flood plain elevation, if applicable NA ft. General comments and recommendations: Area is suitable for a mound system. System gleverkon is 100.60' based off contour line established at 99.10 Slope is 7 %. Depth to limiting factor 18 ". F-11 Boring # P, �- Ground surface elev. 99.25 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Effr*1 *Effn 1 0 -8 10yr3/3 none sl 2fsbk mfr cs 2m,2f .6 1.0 2 8-15 10yr4 /3 none sl 2fsbk mfr gw 2f,ivf .6 1.0 3 15-21 7.5yr4/6 none sl imsbk mfr gw if .4 .7 4 21 -36 7.5yr5/3 m2d 5yr5/6 sl Om mfi - -- -- 2 6 5yr6/2 a Bonng # f Ground surface el 9940 ev. . ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfW1 *EfW 1 0-12 10yr3/3 none Si 2fsbk mvfr c5 2m,2f .6 1.0 2 12 -20 10yr4/3 none sl 2fsbk mfr gw 2f,2vf .6 1.0 3 20-27 7.5yr4/6 m2d 5��6 sl imsbk mfr gw if .4 .7 4 27 - 7.5yr5/4 c2d 5yr5/6 sl Orn mfi _— __ -- 2 6 5yr6 /2 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <_30 mg/L and TSS < 30 mg /L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �fG y / 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 8/22/2007 715 -247 -2941 SBD -5330 (R.07 /00) L r Property Owner Fleming, Peter & Carole Parcel ID # 038 - 1069 -60 -000 Page 2 of 4 F_I " � # ❑ P"i Ground surface elev. 98.10 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2 1 0 -8 10yr3/2 none SI 2mgr mvfr fs 2m,2f .6 1.0 2 8 -18 10yr4/4 none SI 2fsbk mfr cs 2m,2f .6 1.0 3 18-24 7,5yr4/6 m2d 5yr5/6 S1 imsbk mfr gw if .4 .7 5yr6/1 4 24 -36 7.5yr5/3 c2d 7.5yr6/6 SI 0M mfi --- -- - --- .2 .6 7.5yr6/2 F-1 Boring # D Ground surface elev_ ft. Depth to limiting n. C factor i Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 *Eff#2 F 1 Boring # Dep th to limiting f Ground surface elev. ft. Dep g actor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in_ Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 " Effluent #1 = BOD 30 a 220 mg /L and TSS >30 <150 mg /L " 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 (8.07/00) Schmitt 5011 Testing, Inc. - Page 3 of - 'Conducted by: - Conducted, For: Schmitt W Testing-Inc. Nam: Peter & Carole Fkming - - Thomas L Schmitt, - CST 227429 - Address: 4 Edgeombe Plane 1595 72nd St. __ City, State, Zip: St. Pail, MN 55116 - New R bmond, WL 5017 Phone: 715- 247 -2941 _ -- _ Subd.Narne: _ _ CSM V2147, P508' s - _ _ _ Lot No.: - 444/443_ Legal Description: NEI /4 NEI/4 S17 T31N R18W ■ Sh�w�t pit Township, County: Star Prairie, St. Croix County L Bench Mark EL 100.0(Y Top of 2" pvc pipe a Alternate Bench Mark EL 100. f2' Top of r pvc pipe - - Slope= _ 7°+if _ _ Contour Line EL 99. 10' Contour Length 38' Scale l "_= 40' fit 0 � t AmIMS Viewer Page �f of y I w I TN S IL1U 71 •` 111�� http: //72.21. 230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 8/22/2007 ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� % CQ r4 &if //Y G- Mailing Address 6AC STi Property Address (Verification required from Planning Department for new construction) �r City /State - \ G 14 0 f° 2. 7 4 , Parcel Identification Number 0 J 6 Q - 6 0 LEGAL DESCRIPTION Property Location t�� ' /a, ' /., Seca 7 . T / N -R—LLW, Town of JA Subdivision �� . Lot # Certified Survey Map # . Volume 7 . Page # ®� Warranty Deed # 91 17 Volume Page # y 3 3 Spec house ❑ yes no Lot lines identifiable E4 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stttlii�that yo stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 W y expiration date. 3 PLIC DATE OWNER CERTIFICATION I (we rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of pe d above, by virtue of a warranty deed recorded in Register of Deeds Office. Al A _ 4 / �6 / � Si PLIC DATE « « * * «* A 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 �L ay . x i" 7 N4 �� fig , � ,}} �� i r '�,��,,Yy, � OFF x co" V" f�00! fill RBGtlPCF F S. . clay of_. A.a �___A.Q.19 _.., ..... ,... ,. part q of the first pa}^t and M. Peter d "leming ^ Arlcl_, • Wlliam C. Hut�t, in c oinrnon .... .....: ft or ' eeds ........ ........ ..... Part. s,..of the'second part, W I t n e a se t h, That the said part i.e S..of the first part for and m constderatton RETfJ N tQ of the sum of:,+ 7 .7C...tr� ?:911S.t1K.,.£# JRdI ...t.QlaQ,.:f Q.� 8]E • ...... ............. ... - • -- - -. r to• - - - -••• .......... in hand paid by the said partl,I3;R,.,of the second part, the receipt whereof is hereby confessed and'acknowledged, haS!'..... given, granted, bargained, sold; remised, released, aliened, conveyed and- confirmed, and by these presents do ... give, grant, bargain, sell, remise, release,` alien, convey and confirm unto the said part ... ie.Sof the second'p"lleilMirs and assigns forever, the following described real estate situated in the County of ..... C ..._rr.A.1X .:.........and State of Wisconsin, to -wit: All that part of the South 75 feet of the North 225 feet of the Northeast quarter, of Northeast quarter. of , Section: 17 Town -sbip 31, Range 18, which is bound on the West by the shoreline of Squaw Lake and on the East by the Westerly line of the following described right of way. Also a right of way 33 feet wide, the center line of which is described as follows., to --wit: Commencing on the North line of said Northeast quarter of North east quarter at a point 540.25 feet West of the Northeast corner thereof, and. running thence Southeasterly by a deflection angle of 96 75.5 feet to the Point of Beginning; thence continuing; on ileflegtion line just described 151 feet; thence by n deflection angle of 7 26' to the left 232.2 feet; thence by a deflection of 8016' to they right 502.66 feet;, thenc by a deflection angle of 73 to the left 335 feet, more or less, to the center line, of the traveled road. All of the sumo lying and being in the County of St. Croix and colitainin .2 of an acre more or less. (IF NECESSARY, CONTINCIE DESCRIPTION ON REV ERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or to any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said part �..L.'. -,f the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and'appurtenances. To Have and To Hold the said premises as above described with the hereditament and appurtenances, unto the said part..l_e_�f the second part, and to._ ]Ie'lrheirs and assigns FOREVER. And the Bala:.: 2lenry tar _ypld_ and- .-}Iar.r.iP_1— 1✓,,... l - ,_..}lusb:exici.. ixld- w f.e------- -- - - -- - - -- .. .... ........ .. ... for:-- t -- - -- hemSe1VeS the . r,. , „ ....heirs, executors and administrators, do...... ... covenant, grant, bargain, and agree to and with the said :partl hs..of the second part, th:C i r, _- - -- heirs and assigns, that at the time of the ensealing' and delivery of these presents t h:eY - ire .... well seized of the premises above described, as of a good, sure, - perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever. - _ - - -- --- _ .. ........ ...... .. - -.. -. ..... -. . n o of con i and that the above bargained premises in the quiet and peaceable possession the said partijaS.. the second P *I1.E?l.lheirs and assigns, r against all and every person or persons lawfully claiming the whole or any part thereof ....... teh .VY.will forever WARRANT AND DEFEND. In Witness Whereof, the said -part: - .Sof the first part ha..YE._.hereunto set . ... .th- e-ilhand -._ -and seal- _.- S...this- ...3D......... day of Jtt.IY... :.:: ..._...., A. D„ 19::.:68 -.. SIGNED A S LED I - PRESENCE OF (SEt)L) F ex�x.Y,..:1.3.xeys�� d . ................ �• �✓ (SEAL..) Wm. W. Ward Harriet E Brevold r .... ............ �.� � t � � : '• "M^- •,,.'" '-" '� (SEAL) °- f . Lorene Johnson (SEAL) ........ ......... ......., . ............ STATE OF WISCONSIN, St Croix County:, se .. Personally came efore me this 3Q dsy of my A D 19_6 the above named. _ len Brevcic3 tnf d.�..._}a1�a,Izsi_..si..�ra. to mle known to be the person 4� .trhoie�tecttted the f � ant:and 4 t 4 X d Tllib;tgsttuntent draft blt r, a �3 .^ �Rl •�:, ��tu fi ,� , s°�;�,t �� '�c � +� " tk .O1`tlth( 1@Ek k� r.' ✓�r:�y��,�yy�,q" �, w � �.� � N , � x� ., Hx� 5 it �.. '{"' y � x1 "�' ��r ✓ ufix'1k. � e + � '�t � 1 J, � . Parcel #: 038 - 1069 -20 -000 01/11/2006 10:35 AM PAGE 1 OF 1 Alt. Parcel M 17.31.18.2938 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address Owner(s): O = Current Owner, C = Current Co-Owner STEPHEN L PITSCHNEIDER O - PITSCHNEIDER, STEPHEN L r' ' V � 989 ISLAND DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 989 ISLAND DR SC 5432 SCH D OF SOMERSET SP 8050 SQUAW LAKE RHAB &MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 RI 8W PRT NE NE S 75 FT OF N Block/Condo Bldg: 950 FT BOUNDED ON W BY SQUAW LAKE &ONE BY R/R ALSO COM NE COR SEC 17;TH S 00 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) I DEG W 1049';TH N 77 DEG W 364.3' TO 17 -31 N-1 8W POB;TH N 77 DEG W 105';TH N 03 DEG W 14.2470 THE S LN OF THE N 950' OF THE more Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1087/158 WD 07/23/1997 WD 07/23/1997 96/374 07/23/1997 r528/617 e7 LC 2005 SUMMARY Bill #: Fair Market Value Asse 119149 182,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land t122,800 ve Total State Reason RESIDENTIAL G1 0.000 56,500 179,300 NO Totals for 2005: General Property 0.000 56,500 122,800 179,300 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 56,500 122,800 179,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 502 Specials: User Special Code Category Amount Special Charges Delinquent Char Special Assessments pe es g q 9 Total 0.00 0.00 0.00 0 V1 0 C 'U n O C1 f C O at � 1 ` CD CD CD Cn Z 2 m z O A - n (A O lv G3 3 N w O A O N j OD •�„� � 3 O` CD :3 CD N CCyl . A J a a 7 O W A Q, 0 0 0 7 N CD CD W Q O Cb A N C N T O 3 f o !1r 7 0 w 7 O p CL U) Z D m a 0 o m c� O (n a ! W < ? ro m _ 00 0o a Xz C o o m 0 0 m O !�K o 0 O O Z 0 a m n r to o A A N Q �Tv ! 0 0 ' O N N N N N N (D 9 CD O O = y CD rr CD m to (� lei 7 ' CD Q M w 1 O ul N 7 3 d a CL 3 N Z ° 4 D CD o a 7 < O CD N � � N C CD W CD Z CD Cp O 7 `A Z A N N (1I A 3 O Co 7 Q _ D Z W V W m m a Z CD 'o g a 3 m w co H m a zt co CA N p� n CD .O d Q C N Co W (D C1 a r N - S - N C 7 CD goCDv o � �� N m v O N 3-,a N O Cn 7 O A N C O CD 4- ti CA C1 < 7 CD N �j O I a CD A N EA 0 O CD o CD a I �s r I +yam �....4 y' � `�i i � � , /V , 1 �w✓� v., 17— err � rn O � V c 0 F m o d A ! M �' ^ 0 � o 0) (1) � o c m m d i o w � �• a° a ? m o CCD o En b. CD Q w cn 0 c �, N N N a 7 N W fD W �3' coo ? N C O 3 7 y CO O C lV y 3 d Z D m a m CD a ° O co .� a a W co \o a o o N N 3 0 P? O O O = o t� � n O e ? A 3 ? Q T O 0 °� �• 0 0 0 y C ooh' cr �v CD � 3 N ': v 0 - co m � — N 7 3 •• d r — a Z 0 I o =� D 7 o a N. 0. m U ID CD m Ca p zy A N o v Z -I c T m C V z o�i a � � � p fT Z o y A < I o v f/r N pj co fD CD O �, d O 7 � 0 fD O O j I� < y y Z o Q x W 7 �\ �� m m 1 a o�v v � N p O A Ch O i A f \ O co CD N X. a . C y O 7 �o a A O. 0 ti O O m q p CD qb Gr0 V A a I 0 I Parcel #: 038 - 1069 -60 -000 01/06/2006 10:03 AM PAGE 1 OF 1 Alt. Parcel #: 17.31.18.293F 038 - TOWN OF STAR PRAIRIE Current _XI, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner PETER J & CAROLE FLEMING O - FLEMING, PETER J & CAROLE 4 EDGCOMBE PL ST PAUL MN 55116 -2308 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 N R18W PT NE NE S 75 FT OF N Block/Condo Bldg: 225 FT BTW LK & R/W ALSO S 75 FT OF N 225 FT LYING E OF SD R/W & W OF TN RD Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 17 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 02/20/2003 710433 2147/598 EZ -WL 444/4435 2005 SUMMARY Bill M Fair Market Value: Assessed with: 119152 207,500 Changed: 10/13/2004 Last Chan Valuations: g Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 102,600 101,300 203,900 NO Totals for 2005: General Property 0.000 102,600 101,300 203,900 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 102,600 101,300 203,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category i p Amount I r Delinquent Char Special Assessments Special Cha ges es q g Total 0.00 0.00 0.00 I DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MA WI 53707 ❑CONVENTIONAL El ALTERNATIVE I State Plan I.D. Number: (If assigned) F-1 Holding Tank ❑ In- Ground Pressure El Mound TANK REPLACEMENT NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PeteA Heming 616 S, Lexington Pkwy.,St. Cpau, M N55116 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.'. NE NE, Section 17, T31N -R18W, Town o6 Stmt PnaiAie Name of Plumber: MP /MPRSW No.'. pmy ' . Sanitary Permit Number Poweu 1563 t. Croix 49455 EPTIC TANK/ OLDING TANK: MANUFACTURE LIQUID CAPACITY'. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ❑NO ❑YES [:]NO BEDDING: VENT DIA.: VENT MATL'. HIGH WATER NUMBER C)F ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET OYES ❑N '. O ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER. 7ING : LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL L COVER PROVIDED: D: ES ONO DYES ONO S ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES 1:1 NO NEAREST' io SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH I DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH. NO. OF DISTR. PIPE SPACING. COVER J INSIDE DIA.. #PITS. LIQUID ORH TRENCHES MATERIAL: PIT DEPTH: °m C?IMI« GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER'. ELEV. INLET ELEV. END. PIPES -. FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS. DYES ONO YES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH;BED DEPTH OF 70PSOIL. SODDED SEEDED. MULCHED: CENTER. EDGES'. ❑YES ONO DYES ONO [ ❑NO PRESSURIZED DISTRIBUTION SYSTEM: "per+ WIDTH. LENGTH. NO.OF LATERAL SPACING'. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: '{t{5�,i� TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING'. ELEV.'. ELEV.'. DIA.. ELEV.' PIPES. DI A.: E4LiV ,, 710N A GI �" IOi ° HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED I�fiRMAI�,� PLANS: DYES ❑NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER (}F PROPERTY WELL: BUILDING: FEET FROM LINE: DYES 1:1 NO DYES El NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLE: DILHR SBD 6710 (R. 01/82) S I MEMEsimmm Wisco APPLICATION FOR SANITARY PERMIT DILHR A UNTY oEPRRTIT1EnT OF (��� ��� UNIFORM SANITARY PERMIT # IL: I InDU5TR4, LR60R 6 HumRn RELRTIons y 9 4 ISS — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8 %x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT _ A j -_#t 4 ` PROP T Y OWNER MAILING ADDRESS 1�� 1 04 vn PROPERTY LOCATION CITY: i I VILLAGE: �iT�3 N e X1/4 NC 1/4, S , T J, N, R (or) W TOWN OF: r c� \ Y' l LOT NUMBER BLOCK NUMBER I SUBDIVISIONNAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER S t 72 TYPE OF BUILDING OR USE SERVED K 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. �- ❑ Seepage Bed ❑ Seepage Trench Seepage Pit ❑ Holding Tank El System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity /4040 Co Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: ". P _" IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): /V 4 N (4 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of ber (Print S e: MP /MPRSW No.: Phone Number: Oc w5 )JA, IS (oL3 17 /f ►fib S�3S Plumber's Address: Name of Designer: s:c I WL CIOUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Age: Date: ❑ Disapproved `/ 9 - �� / ❑Owner Given Initial (p (9 ° 7' Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber R INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: I 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Violation Number Form - S T C - 101 PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township /Municipality Lot No. Blk. No. Subdivision N� ME 1 7 R W Procedure prior to sanitary permit issuance where a septic tank must be replaced during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be _ failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY PERMIT: the undersigned do hereby acknowledge that I am receiving a sanitary permit to 9 tol k without a soil and system evaluation due to inclement weather or health emergency. Furthermore, I acknowledge that a soil and system evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin Administrative Code, it will be replaced with one that complies with Chapter I L H R 83 of the Wisconsin Administrative I Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. x SIGNED DATE /3 -' A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. - s" Sign ture of Applicant Date e y Subscribed and swork to'before me STATE OF WI75t'9N9tN This ` day f 19 SS. COUNTY OF Notary Public, State of My Commission Expires: AAMAAMAN AM -* stEVM o. sow', WtARY Pty — A �all.Y�v� �` y 9 y 5 � • Parcel #: 038 - 1069 -70 -000 01/06/2006 10:06 AM PAGE 1 OF 1 Alt. Parcel #: 17.31.18.293G 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner GENE C & VIKKI JAMIESON O - JAMIESON, GENE C & VIKKI 987 ISLAND DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 987 ISLAND DR SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 R1 8W PARCEL IN NE NE S 75' Block/Condo Bldg: OF N 875' BNDED ON W BY SQUAW LK & ON E BY LN COM 540.25'W OF NE COR TH SE BY Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) DEFL> 96 DEG 75 FT TOPOB: TH CONT 151' 17 -31 N-1 8W TH DEFL> 7 DEG TO LEFT 232.2FT, TH BY DEFL> 8 DEG TO RT 502.66 FT, TH BY DEFL> more Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 119153 276,100 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 82,500 188,900 271,400 NO Totals for 2005: General Property 0.000 82,500 188,900 271,400 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 82,500 188,900 271,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 038 - 1069 -80 -000 01/06/2006 10:06 AM P A G E 1 O F 1 Alt. Parcel #: 17.31.18.293H 038 - TOWN OF STAR PRAIRIE Current 1 X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner DUANE E & CONNIE A HAUPT O - HAUPT, DUANE E & CONNIE A 2174 ISLAND DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2174 ISLAND DR SC 5432 SCH D OF SOMERSET SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 N R1 8W S 75 FT OF N 800 FT OF Block/Condo Bldg: NE NE LYING ELY OF LAKE EXC TN RDS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 119154 219,700 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 102,600 113,300 215,900 NO Totals for 2005: General Property 0.000 102,600 113,300 215,900 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 102,600 113,300 215,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00