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HomeMy WebLinkAbout038-1080-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety anal Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515095 0 GENERAL INFORMATION 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: Klemesrud, Mark & Jane I Star Prairie, Town of 038- 1080 -90 -000 CST BM Elev: Insp. BM Elev: BM Descript' Section/Town /Range /Map No: C'ri 19.31.18.337 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark la7,7V / 00 d Dosing /1 _ a X & 0G Alt. BM s Aeration Bldg. Sewer 3o-5 V -1v S D 1 1 341 93.6 Holding St/f t InIet ��/ � � ' p � 1 73 qp TANK SETBACK INFORMATION S Ht Outlet /r TANK TO P/L WELL , LDG. Vent to Air Intake ROAD Dt Inlet Septic f Dt Bottom Dosing � Header an. Aeration Dist Pjpe Holding Bot. System 'T,c Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St over C. CG ,� 5 3 1 3,( i Model Number ��� ) �i -7 I , G J� 2 2 IO TDH Lif>2 Frict�'on Loss System HAad TDH G Ft Q f r7 J t / -/ Q0, d Forcemain Len Dia. 4 Dist. to Well f t SOIL ABSOR TION SYSTEM BED /TRENCH Width t Length -7 No. Of Trenchgs� PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS // SETBACK SYSTEM TO P/L _ jBL9 WEL LAKE /STR AM ACH G Manufacturer: i INFORMATION CHA R OR Type O System: ' f r Model Nurry¢er� DISTRI84T40N SYSTEM i1`y c�tt76T1 ?� �' fd. L' ' ci ax' (! _'U r- �'C d' Gt ►�` cfL.t1 Head r /Manifold Distribution x H e Size x Hole Spacing Vent to Air nta7e I Pipe(s) / G r Length Dia Length Dia Spacing - — SOIL COVER x Pressure Systems Only Mound Or At - Grade Systems Only = % t� C6 , -f Depth Over Depth Over xx Depth of �� xx ed ffdulched C�7. Bed/Trench Center /� Bed/Trench Edges ./ Topsoil f �. G' r `1 eyes No []Yes No l ✓ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Jnspection #2: Location: 2034 90th Street New Riich,QQm��ond, WI 54017 (NE 1/4 SE 1/4 19 T31 R1 8W) 40 ores Lot u Parcel No: 1 1.) Alt BM Description# = Z h `�'"'� 2. Bldg ewer length = j r f 1 ry ' 9 9 �0 3D�i - amount of cover Plan revision Required? E] Yes /No - Z ') I0 `� �z j f �� / G J 5 Use other side for additional information. u _ _ __ _I __ t"- �__�� y 1 <Yv SBD -6710 (R.3/97) Date Insepctor's Sign ture Cent. No. N K PUMP PERFORMANCE CURVE M E MODEL 151/152/153 TOTAL DYNAMIC HEAD /FLOW s0 PER MINUTE 14 45 153 EFFLUENT AND DEWATERING 12 MODEL 151 152 153 35 10 152 Feet Meters Gal. Liters Gal. Liters Gal. Liters S2 30 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 8 25 151 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 ° 6 20 25 7.6 16 61 34 129 42 159 30 9.1 — — 23 87 33 125 4 15 �..,, 35 10.7 — — 22 85 10 40 122 — — 11 42 Shutoff Head: 30 ff. (9.1m) 36 ft. (11.6m) 44 ff. (13.4m) 2 5 0145088 0 GALLONS 10 20 30 401 50 60 70 80 90 100 LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508A Model 151 Models 1521153 h ., 67132 8114 3718 4518 327132 458 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and a 327132 supplied with an alarm. 3n6 • Variable level control switches are available for controlling ® 3716 3 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. 12,/8 151115211 MOD ELS Control Selection --� Model Volts-Ph Mode Amps Simplex Duplex 43M 51M N151 115 1 Non 6.0 1 2or3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2or3 SK2444 SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 El 52 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2or3 E153 230 1 Non 5.3 1 2or3 SE1531 30 1 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float A CAUTION switch. Refer toFM0477. 2. See FM0712 for correct model of Electrical Alternator E -Pak. 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 \` L0'sville K 40211 1961 S NCE' , KY 40256 -0347 Manufacturers of.. SHIP T0: 3649 Cane Run Road Louisville, Y - Qua[ /TY PUMPS http:Owww.zoollercom PUMP CO (502) 7 FAX (502) 773624 PUMP © Copyright 2004 Zoeller Co. All rights reserved. RECEIVED P I b t qnng DprrulfelhCS.wi.yo V Safety and Bttildings Division 201 W. Washington Ave., P.O. Box 70CRO T [ ,� SCt�o� Madison, Wl 53707- 716RLgN NING & Z't (to be fiikd in by Co.) >n«tt / State Transaction Number Sanitary Permit' Application ro In aceordanct with s. Comm 83.21(2), Win. Adm. Code, sub pussion of this form m th e app governmental unit is required prior to obtaining a sanitary permit. NoW- Application forms for state-owned POWTS are Project Address (if ditYeeent than mailing address) submitted to the Deparnr�ent of Commerce. Personal int�rmation you provide may be used for secondary in wmdanxx with the Pril Law. & 15. 1 m „State. L Lion Information - Please Print Alt Iaformation pares! # p °wner�Natae /I l 0 ✓ � r v � v —� D Property f A QGMM GOVIL Lot Zip code Phone Number 'V, � ys section . city, stow - k ode) Ck/j / T � N; R BorW s� 1[i or Baaildiag (¢heck an that apply) '• Lot # /� Subdivision am or 2 Family Dwelling – Number of Bedroorna ^, { f� Block # 1 i ❑ PubliclCommercial – Describe Use ❑ City of CSM Number ❑Village of _ _�— ' Q State Owned – Describe Use I jt 1 A Ile I III. Type of Permit: (Check only one boz on line �. Complete line B if app ble) i A. ❑New System t System ❑ TmatmenNHolding Tank F-60=1- Only ❑ Other Moddiicwon to Existing System (explain) I Lint Previous Pemait Number °� B. ❑ Permit Renewal ❑ Permit Revision j ❑ Change of Phm ber ❑ Pemrit Transfer W New �' ,SG 0\ Before Expiration Owner . of POW'I'S S nont/Device: Check all that a A ❑ Non - Pressurized In- Ground C1 Pressurized In -Ground 101 At Grade ound ? 24 in, of suitable soil ❑ Mound < 24 is of suitable soil !( ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Prareatment Device (expbuin y / Di uired (at) reatment Area Information• h I J V. Dis n spersal Ares Dispersal Area A �� Elevation (�) Design Soil App . v � p � ;ry Total # of VI. Tank Info Gallons I Gallons Units New Tanks Existing Tr+ks Se pet or Holding Tank Dosing Chamber VII, Reg risibility Statemen the underalped, rasponsibint9 for Installation of the POVPTS shown as the atcaehed plate. P ' Name (Print) PI ignaturo MPAUil B Number Business Pbone NurpW1 Z76 Plumbe Address treel City State, Zip oust IDs t ere Od Sigs l , to Permit Fee Date Issued leaning '° Approved ❑Disapproved $ na for Disa ( d >� Owner Given Reason for WV �" t%r�- � -{�--� �, � �,A1 DL Conditions of Approval/Ra►so PP � , � , (� f z � y�, SYSTEM OWNER: C n � : fG �:� _ r- �� ' 3 + 1 Septic tank, effluent filter and -k `C# " j' d all be serviced / maintained real cell must a , _ d- �,� dispersal i t. G'� /nc as per management plan provided by plumber. 7ry� y(,��.� G �' ZG 1`r and sebaak to Ike Conaty only on paper not less tkan H 1!1:11 faskes ia�s as per applicable code /ordinances. :3 )) r . l 2, /, r-,, I- _M 1 &k7 G��,�, ,xy, SBD -6398 (R. 01/07) Valid dint 01/09 PLOT PLAN ' PROJECT Mark Klemesrud ADDRESS 1206 Ctv Rd C New Richmond Wi 54017 NE ' 1/4 SE 1 /4S 19 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.0' BEDROOM 3 CONVENTIONAL 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 steel fence post ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Scale =1 /4 " =10' 40 Acres �^ 90th ST. Well 50' Existing 3 = bedroom house C V D Old tank is to S Tank ' to oper ednd be pumped and IN p ST buried ith approved warning lab'ls M 600 verflow B-1 Huffcutt Area 15' below system Combo tank s-` is to remain B - 3 undisturbed 3% Slop Grading is to done to divert run -off away from system B-2 ECOPV 95.5 96.5' 96' zt ^mil 1320 Property A, Safety and Buildings ' commerce OV 141 NW BARSTOW ST FL 4TH g WAUKESHA WI 53188 -3789 Contact Through Relay i sconsin www.w www.commer isco govsb, isconsin.gov Department of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary July 02, 2009 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2011 Identification Numbers Transaction ID No. 1681916 SITE• Site ID No. 749338 Mark Klemesrud Please refer to both identification numbers, 2034 90TH St above, in all correspondence with the agency. Town of Star Prairie St Croix County NE1 /4, SEIA, S19, T31N, R18W FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1231615 Maintenance required; Replacement system; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): 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) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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 "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" 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 er must comply with the operation, maintenance and monitoring duties as described in section,VIII of th ocomponent manual. A copy of this information must be given to the owner upon completion of the projec T All holding/treatment tanks are to comply with Comm. 84.25(7)(a). OA ���� Maintenance information must be given to the owner of the tank explaining that perio ing oke filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval . ions. 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. • 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. 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. erely Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis - Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis@wisconsin.gov Cover Page Shaun Bird RECEIVED Bird Plumbing Inc. JUN 2 4 2009 1008 192nd Ave SAFETY & BUILDINGS New Richmond Wi 54017 715- 246 -4516 Date: 6/ 20/09 Owner: Mark Klemesrud Location:NE1 /4 SE1 /4 S 19 T31 N,R18W 2034 90th 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 /Pi a Layout p p Y 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -12. Soil test Shaun Bird Signature License number 6900 r� ,CGv/ SCE SSA �p� tiU� uC C F PLOT PLAN 'PROJECT Mark Klemesrud ADDRESS 1206 Ctv Rd C New Richmond Wi 54017 NE ' 1/4 SE 1 /4S 19 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.0' BEDROOM 3 CONVENTIONAL 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 steel fence post ASSUME ELEVATION 100' Filter BEST GF10 - ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Scale =1 /4 " =10' 40 Acres 90th ST. Well 0 350' Existing 3 bedroom house Old tank is to Tank is to be properly bedded and be pumped and provided with lockdown covers buried with approved warning labels ST B. M. 600' 1 \ Overflow B-1 Huffcutt Area 15' below system Combo tank is to remain ❑ B-3 undisturbed 3% Slop Grading is to done to divert run -off away from system B -2 95.5' 96 ,E 96.5' 1320' Property NO Date Nos — Waves gilter Fabric 4" ObsezvatlOn Pipe Perforated Distribution. Pipe Below Filter Fabric r AS= C-33 Sand q 7z iCs ° Tapsoll ss�az�mT r x a�wed 1r,0 slope Foyer ■ c' Main Bod Of PUMP e►p LQXer Drain Rock f Gress Section Of A Mound' s I F'y� A Sed Far ",ht Absor tiara Area G. l � Ft. \ 7 Ft. T7 Ft.. y _ rip L obser vation PIP K ` . Main a�rra aw �aa r.rwaa ww_.r - �prCE e A aMa�awMaM Frclrn' PUMP a rrra w......+��aw... •'- . -awa,w r�.a. �r,����.�. Bas of Z Q D iS �T ibut i0il Cram Rock Pipe I 4 0bServa Lion pi PerMaftgn marker P; pe or Rods p Bed for The Absor t *on Arta Pon Viet 0j.Mound Usin pwtorated Pica 4et+tl, • • ,;' Zvi._• " Pes fwarea • Pvc- P.PC • iyMS Leee,s! Qa It+otii� Am ggwwr Cv4cc. S V. PvC Farce Nib �� . tar "C &Wogo NOW tftirft,eeica pipe I-crow P : Ft. t Pte. �"• ,• R .,`�.,._ �� �'�� iactKS s , : 7 q: .. " Ro Diu meter inch Signed: �t+irra� �" : � Inch(es) License fir: _ 1ftnifold " 2 inches ate: Force XRl • ~ * 2 - Inches # of holes /pipe 2.:::� 71 Ft Invert Elevation of Lateratsi� P#3M� CliArfB£R flSS SLC'IIt3N AND SPECIFFCAT'Itti�S gLP'TIC TANK WEATlM"Ri►R ApFRO V FD �' M ;1� . ?�BOV E GRADE JU NC'£ION BOX MOLE COv Eat V I+ZP£ .Ii�tlgDow OR QYTH COD MI PADLOCK DOflR. womIMG LABEL FRESH �: ;A 19WE 4" KIM - Ilf 1 to t IptL£!I GAS ` ED ' TIGHT. SEAN: TIGHT s MISTS WITH 'WATat A SEA �}I PIPE ?F3;L;C.v. 8 s 1� 33% QtflSplt APPRViP C. PiPE ;3 000 SOIL pump �E O AP3?R4vED BEDDING UNDER 'fA3iK.. �i . COICCBETE PAD • � . , . SPECIFICATI DosCs. 0 Y- sr-l DOSE cs s= c c,AL- TAN K �E V °�,"'t GAL. '/ 6liL TASK SZ Z£s: SEPT% GAL 0 ?7' S IBS HOSE Cp p^CITZ£S = A 8 = 2 r ZpC= I3ES ----- Au n.2S,AWJFAC1t3 i t/ c C CUE � MODELPE' _ , J IIi T�?C8 - -- . ES AcTitltvR _ f� II PER i6.23 TA LC PUMP � . , � � � I L� MODEL titlRTiaG AS g 'TYPE -' PUMP AL+AR (� FEET D�ISCHARCa Z ;SON PIPE - - FEET RF 32RFa }IP OP Tr AND DZST3t - - FE£T ESSURE FR�CTI� - FACTOR - 1s. BEET VERTICAL. D�� �PPL7C �. 3 �J I00 FT- . t Mlii�. AL TOT 4, rzET FO 'SANK: LEN GTH . . �fl�� I NAL D lt4VS " 'LICENSE FG�tED= oo i 715 Wzi gy; HP LG 3 mom 9 EH SERIE SUMP /EFF LUENT -PUMP age - 0 ...�t rant lawa�+ -9— = s m r gpow iala CL aps �► rat arm salatr 70 m, ;► tit g v &1131 a. n . mm , rr »s j= )G K ss a mr v as WON Na J= w6om an in a s rear- et*t+�s�+ Moms o moo P000 �etkc'Mstar+a� ��_ . r...._ -- . � voluu --• qT - ,� sbaa sed N � sts � on at+d 8 V sun" and tdoww L ` . as t P c a � g7RvE room q=V irtl laa+K La+m � iafA� qq�- -071OS ER'S MMUA'. 8` [1tEa G' POWTS o spy a NA gkmorw2k DNA Y SepooTor* 5 " 1- Q NA f FA Bftot A� !?esz MOdet 0' I E3 NA 0 NA 6 of Purrs a NA � r W unb 3 TtW a� a NA x i-5) - 7 a� PLQVP DesignPct - f3 Pest Mor Row avera8s' Oteaaa �� D n II 0 = G ., D und &Gmutedl coo 4iu;i1,nd1od ft pj . �� p at- a o� men Sr 0`�pQmi Q w ax Ox H T S « v �� � dom sow "a Op MMCM Fecd 00 K �d-iametsr S9pfttw* Nk VasWA� Pa m Swe v�rws wvsaet r Fnquonw w s yra.) MAN Ser+ Crv++st qt least once O%WY o (30 of �'otcnre tr�spr or ts►ntctsl When t�ltsed sludge and sccsrn (nnarss 3 Yom-) pum ut p o caaas of tanks) d rnorffi+s At least once ewtY ( crx s) tn"s pmd �i{s) once swrY s) p NA Clean entf�er A, least once evwh+ rrs s) Q NA .07 13 l pur:np, PAP ° afsra+ At least Once' awry II Yes) O NA O #1u.8b saw am PFWOI" At MOSt Oros e+WY a nwrdm a yow (x) 13 NA odw- At least once OWNY of � aid a� ° pk P ter' �■tlfai) " ''"�" �a�y back UP � �' t [ILot ks a � e a� � swots d c c W&w 1svgb to j" volunno Of Sonok" r areyr cracks or ieakss�urIWO_ JMM dlst� O W ) *w g�nd sutft°°` P°"� � 'wtl+or�l and any POM room &Vbm n m e s g e mid saum In � � t O W dp0� of h oo� � so' ch %Nwmmvumd to ,�on,d by s sew! OPW and any code. 1' 3, 'Y' r =d Pc)W S Corr fpm p�1 ' 'ta'"�1 ors. m� a The mWq be W bffod 11 d interygts of 12 mo S a 10 d* of � o f SW P m to mat moubm Y a do* wft* I or otw STAW U P AND flp�TIDN use � � Pam ctreck 'erii tar' 3 t� �; �ns are For mw cock• � to ,arecJror � � to reek dw by a sept�ge sarvtdrti8 open P�'°` __ of the rage ane ctions k." at t. iname sham nottyoa:rwtten pond' gyswn strict up {N above Wa Lee cWs in the OuttnQ r°c�9s pump a ( ows) in one tare d� `� tank by dhVW via wN see dim To . W this s� hacve eontents.ofthe PMW h or POWt'S �� �'° t!o the effluent pump °r at P tam Otmawpcior.� n PMW tt w tin tYse pump - MSWM amain tut e p t h and djS; off Do not drive orpat#c OWIj �� t or "" ' Vdddis 80 1 o f mo at-grdde soi(abs rp ' - me rye Qum ire the aka stream may lmpt � m do t /n h� lute Of the POWM WdmoWKAW drsird fe sa nitar y 1amP' stud scat - the fnttowing a� to taken t o icmm ow the VVhm Um PPOWTS tams andloc� � ra m � mm 83.33. s shag be cosco nnected and tfie abandOnOe A" S t9 • AN P�9 to t� . be rarxsaved and PropenY of by a e�..roi� ap.c�e The mnmrss;a d oov�r�r r+en vad �►fte:• � sQ tanlae end ptls shaII b Paa.� and ^en watt so4 t3�� oranodw fro t solid n=WOL ffied • i a a code must be t4 >q Pe COMYN W S be �� � *00wfttg +cr:easurrs have teen, o� sm! if the t m oment sysbs and may lie utd for �he ioeatiote of a � should net comps ' • O A subme . has �gr+ea a sho be protected fmm a;s urban s and watts- m to systen+. Y7i+e ro fr+ofi pasting and proposed sorurtnue. ua� ID a suitable l be nftVed � by mutt in the need for a new soil ands 0*14 at t ti¢�rB the r� must oamptywitfi the rules in �fied rru9 in POWTS repwoment an.�..��ent �le'due to setback and/or soil rrnnita c� Ba - p R� meted as a last resort to replace the.faned Me POWTS s sW •� -• The aft t not be=. Ans wated to identify a suitable replacement u,ea Up no arse is an+sa bug a sloe evaluation must be pew to locate a suitable repplaeecnent arm if no mph hokmng tank > as a last t�usori to replace the fatted d n phi �vA of the blomat a' be s may be reoonSM in vP � elhe� at that tm e - moun an d at-grade m eons of such sysse� must oamPty <cYitARN1Nt� TANKS S&AY CONTA N LETHAL DES ANt? O �FFtCtENT OXY{�7wt. SEPriC. PUMP ANA OTHER Tt4EA TP TANK UrmE.R ANY d�AN�' DEATH MAY 00 NOT IHCTER A Stott: , tRJlfl[P O M U TH FOR OE A TANK MAY M t)iFFTCi1t -T dR li3POSS1l�.E RESULT-. RESCUE OF A PERSON FRO ADI)MONAL. COM1il[ NTS POVVTS i�iAttYTAtN� POWTS 11N57741.Lt`R Name r dame J If 11 ' Phone S Phom LOCAL REGULATORY jW HORRY SEPTAGE SS WO14G OPERATOR MAVEN � Agency' tame - C7 PhD �Z rts T* Ott � Phone 7/ Z and S`mnB�ioa This dooyrie�et � Q .0d byttr stills of tlr s1ci M La" f ° � �'�'�' C0 � ' � � . (bs of M�is docrs� � n0t stx ran aE Goerma xtX f and 5. (4 & t3). Wisconsin A4tr�nts t �pOt} gu=atee 9+t poUwm °° of the P(]W S. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer I Mailing Address 's Val Property Address ?D (Verification required from Planning & Zoning Department for new contraction.) ` Parcel Identification Number li' City /State �v , c� ,?' � ; l LEGAL DESCRIPTION L Pro Location i/4 '/+ , Seca T ��N R�W, Town of P�3' ,c Subdivision Lot # Certified Survey Map # �� Volume , Page # Warranty Deed # l ! b , Volume , Page # Spec house yes no Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to Dandle wastes. Proper maintenance consists of pumping out the septic tank every tbree 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 is the waste disposal system. Owner maintenance nsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. respo D The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the the on -site owner and by a masW plumber, journeyman plumber, restricted plumber or a licensed pumper v g that (1 ) the tic teak is wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), septic less than 1/3 full of sludge. have read the above requirements and agree to maintain the private sewage disposal system with the I/we, the undersigned standards set forth, herein, as set by the Department of Commerce and the Dep artment 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. Dove certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above , by virtue of a warranty deed recorded in Register of Deeds Office. Number 400 S G F APPLICA NTS) 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) RECEIVED Wisconsin Department of Commerce SOIL EVALUATION REPORT JUL 0 6 Z Q%e of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code CountyJ J NN �R� ONING OFFICE Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan t� 7 include, but not limited to: vertical and horizontal reference point (BM), dire a Parcel I.D. percent slope, scale or dimensions, north arrow, and location and dis o oad. (9 j f ^ C9 — 71) UVD Please print all information. kv, Reviewed b Date Personal information you provide may be used for secondary purposes (PrivjWLa 5.04 (1) (m)). Property Owner Property Location r- k lP In es r bA Govt. LotA e 1/4 1/4 S 12 T �j / N R E( Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City Stale Zip Code Phone Number El city ❑ village Town Nearest Ff ad c� ' ❑ New Construction Usesidential / Number of bedrooms _,,�_ Code derived design flow rate 'y_, GPD )4Replaoement Pu c or qQr1mercial - Describ Parent material L 2� SG "c �� Z' Flood Plain elevation if applicable General comments '1 r' and recommendations: /� itk t r�� �(� Sx G�• S . C G- �— 2o ZL( LO / �s(�( 1 y �i /l . Lc CL� u( l�C4 "0 System System Type a S 7`�•►/ System Elevation � � � F - 1 dW pit Ground surface elev. 5 t ff. 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 0 Z /0 _�6 3 U- 70 Boring # Boring g Pit Ground surface elev. l `� l it. 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 e 31z - .i d'u— �7,y2 o, Cz S - y , O v Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD 130 nxA and TSS < 30 n-4L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /� 715- 246 -4516 I - Property Owner _ Parcel ID # Page of ❑ Boring * o�# Pit Ground surface elev. ft, ';Qepth 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 Y I ��►� o , z s, 11 2 a� s - 3 z s r sc - ✓ / a F-1 Boring # ❑ Boring — ❑ pit Ground surface elev. 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 F Boring # C] Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 I 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 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. SOD -9730 (8.6/00) Proj Soil Test Plot Plan ect Name Mark Klemesrud Shia ird Address 1206 Cty Rd C New Richmond Wi 54107 M #226900 Lot ------ Subdivision -- -- -- -- Date 6/20/09 NE 1/4 S E 1/4S 19 T 31 N /1418 W Township StarPrairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation 97.0' *HRPSame as Benchmark Scale =1 /4 " =10' 40 Acres 90th ST. Well 0 350' Existing 3 bedroom house ST B M. � y � 600' B -1 Overflow ❑ B -3 3 O Slope B -2 95.5' 96.5' 1320' Property Line 1111111 1111111111 NIN 11111 11111111! 11!!111111 NI1 State Bar of Wisconsin Form 2 -2003 8 9 9 2 8 1 1 WARRANTY DEED 899261 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Arthur N. Christensen 07/02/2009 08:OOAM WARRANTY DEED EXEMPT I ( "Grantor," whether one or more), and Mark J. Klemesrud and Jane A. Klemesrud, REC FEE: 11.00 TRANS FEE: 90.00 husband and wife, as survivorship marital property, PAGES 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more Name and Return Address space is needed, please attach addendum): Ronald L. Siler An undivided one -half (1/2) interest in the following described premises: Van Dyk, Williamson & Siler, S.C. The North Half of the Southeast Quarter (N 1/2 of SE 1/4) of Section Nineteen 201 South Knowles Avenue (19), Township Thirty -one (31) North, of Range Eighteen (18) West. New Richmond, WI 54017 This conveyance is given in Satisfaction of that certain Land Contract between Arthur N. Christensen and Violet P. Christensen, husband and wife, as Vendors, 038- 1080 -90 -000 & 038 - 1080 -95 -000 and Mark J. Klemesrud, as Purchaser, dated January 21, 1991 and recorded Parcel Identification Number (PIN) January 22, 1991 in Volume 891, page 260, as Doc. No. 465823. Violet P. Christensen's interest was transferred to Arthur N. Christensen by a Transfer of This is not homestead property. (is) (is not) Affidavit. Exceptions to warranties: Subject to all easements, restrictions and covenants of record, and any lien created by act or omission of Grantee. Dated .. �(o� 200 9' (SEAL) - ' (SEAL) * * Arthur N. Christensen (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on ST. CROIX COUNTY) Personally came before me on 612 GJ M * the above -named Arthur N. Christ nsen TITLE: MEMBER STATE BAR OF WISCONSIN oo (If not, to me kno n to be the person(s) who :e�t� •t1►e� for Ong authorized by Wis. Stat. § 706.06) instrument a d acknowl d ed t same. 1`.•'� 1 r�•• O I THIS INSTRUMENT DRAFTED BY: * C , < < ~' - , t,!'• Ronald L. Siler, VAN DYK, WILLIAMSON & SILER, S.0 Notary Public, State of Wiscon in " >� ? 201 S. Knowles Ave., New Richmond, WI 54017 My commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) rA NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIF`1'Efl...r " WARRANTY DEED @2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 "Type name below signatures. INFO - Legal Forms • (800 )655 -2021 • infoprofomu.mm 1 of 1 Parcel #: 038 - 1080 -90 -000 07/07/2009 09:29 AM PAGE 1 OF 1 Alt. Parcel #: 19.31.18.337 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KLEMESRUD, MARK J & JANE A MARK J & JANE A KLEMESRUD 1206 CTY RD C NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2034 90TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 19 T31 N R1 8W NE SE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 02/08/2000 618095 1489/156 QC 07/23/1997 891/260 07/23/1997 668/479 2009 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2009 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 6,400 0 6,400 NO 05 UNDEVELOPED G5 2.000 1,100 0 1,100 NO OTHER G7 2.000 25,000 68,100 93,100 NO Totals for 2009: General Property 40.000 32,500 68,100 100,600 Woodland 0.000 0 0 Totals for 2008: General Property 40.000 31,700 68,100 99,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00