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038-1087-40-000
oN0 c Cn0 C- c C v1 G - u 1 1 CD v 3 m A� 3 (n 'y Z Z y z O n m vi o p r 1 �^ w `� !r • _ (n cD m a Q m ° ° u rn ° ^ m m e ro O< a p @ co N N °- O 3 3 (0 °" O O j• O to Ut p O O° c A N N Q �' N C O O 0 W o w o a) 3 Q Q o w l 3° m f pp (p y Ro N 41 O �y v ur C D � a� � vi v D m fl- N CD cn ° I y a ° 1 m (Q ? �' .. O W C N 4W N O. O W O O c 3 Q 0 o 0 0 l 3 o 0) L" ° p 0 O O O N (D O z w am O ! 0 CL O 01 v OZ ( (VO 7 O CD O p °' 0 0 C N.0 (D (D 0 O O O Q• Q O O O (D • co 0 C C ° c c m 3 0 S y N N N O L N CA N O p Q O _0 ( (/J I(D y CD �=r O O .p U N O IQ z z D (D a D 0 O m ' 0 m cn m c m p c C CD C O Q I f D• n. I m N O 7 CD t6 to ° z 0 Q Q A a N G N < j o° C m w z y z (D C a N � N (D 7 3 Q O O O O Q N d m ° V, a o 3 a P . o p o° y a EH -n v .3f° o° -n won' w c N a• D v c Z a y ° mcso Z a o° v O w a�'� ' O CD a CD 0 P. 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Q a CD n m ° w CD n v f, CD co ! -1 to O N O 7 p y D O A n 3 m A z O a m m a O (D CD g W a Es 3 W a a 0 CD a z a I P o CD o O r: O `� z oD m � CD w N A w m f 9F° a CL v m 0 T s a m c °o ° � ° z a a) Vim' 0 4 0 0 N O m N N 0 s C C N O D Q O ca 0O O 3 9D �p ` M O N S co O �' p w O w N 0 7 aoCA; pN � 01 °o O I 0 0 CD Ji d C, 4 0 C ° b °O a ° o a ti wi n � e rtmenlrof Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf f'and Building Division 4 INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 515064 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: Larson, Roger G. I Star Prairie, Town of 038 - 1087 -40 -000 CST BM Elev: p Insp. B lev: BM Des ' tion: Section/Town /Range/Map No: �(J-g 7T' f /�;' Jv�� t 21.31.18.3596 TANK INFORMATION ELEVATIOWDATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 61� Benchmark / � • G /O 3 •`' 1-79 • v � I d Dosing � � Alt. BM 7- / D Aeration Bldg. — Sewer Holding St/Ht Inlet j D C k t ID 1�•� TANK SETBACK INFORMATION St/Ht Outlet 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet SS Septic / Dt Bottom 5 S� > 25 > o Dosing )�5,� Hea an. �� G Aeration D ist. Pi pe G � / Holding Bot. System p/ 4 35 V VAV (o• / Final Grade 1 7• PUMP /SIPHON INFORMATION —' S• —° { Manufacturer _/ Demand St C rir, GPM p^>L * / f.. A �0 - . v Model Number / r�l � `V> TDH Lift Friction Loss S ad TDH Ft 10 Forcemain Length Dist. to Well ['U yet ���'` ��:2c U�� G' �� SOIL ABSORPTION SYSTEM O lCtttl BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 31 Z/o + SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREA LEACHING Manuf INFORMATION CHA Ty Of System: ` , ` UN � IT OR Model Number: ^ DI IBUTION SYSTEM 1 L10 w Sc Hni Dis tribution j x Hole Size x Hole Spacing Vent to Air take JPies) ! �' Dia Le p ngth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only y Depth Over r Depth Over xx Depth of xx Seeded /Sodded t-7 ulched Bed/Trench Center 7 Bed/Trench Edges Topsoil 3 Yes [] No 0 Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 0 / 1 6 1 Inspection #2: Location: 2072 County Road C Somerset, W� I (SW 1/4 NE 1/4 21 T31 N R1 8W) metess�& bounds Lot T � 9 ��� Parcel No: 21.31.18.359B 1.) Alt BM Description = -rdP 4 °'u- 2. Bldg sewer length 75 - amount of c 7 � 2 L / Plan revision Required? Yes L'rvu Use other side for additional information. - - - - -- Date Insepctor's Signature Cert. No. SBO -6710 (R.3/97) I I r D Safety and Buildings Division County calornmWWWOV '201 W. Washington Ave., P.O. Box 7162 * • l D I «� Madiscm, WI 53707-7162 �� aaihry Pe[mit Number (to be filled in by Co.) 5 6 40 tote T Number C atiun Sanitary Permit. APPhc i A- In accordance with s. omm. 83.21(2). Wis. Adm. Code, submission of this form to the ap sow unit is required Prior o obtaining permit. Application forms far state-owned POWTS are projoet Address (if different than mailing i to a sa ) submitted to the Department of C Personal intimation you provide may be used for secondary t csc:c es in accordance with the Pri LAW L 15. 1 m State. I, lication Iriformatloa - Please Print AR peel # Property Owner's Naas ®� - G r ID LUUZ; Property Owner's tug D Gotrt Lot NTY j City, State Zip Code P ING �GrJ y,, ��Y., Section I T ucie o N; R W II. Type of Building (check all that apply) Lot # Subdivision Name or 2 Family Dwelling - Number of Bedrooms C ep S s o /- <� / l� Block # i ❑ - Describe U � ❑ City of 'SM Number ❑ vdkp of- p State Owned - Describe Use / own of 1*� • O t S I III• Type of permit: (Check a one box on line .Complete line B if applicable) A. system ❑ Replacement System Treatatent/Holdins rank Replacement Only ❑ Other Modification to Existing System(Whun) i 1 List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑ Permit Revision Change of Phnaber hermit Transfer to New Before Expiration I IV, of POWTS S Component/Device; Check all that a pressurized In- Ground ❑ At -Grade ❑ Mound >_ 24 in. of suitable soil ❑ Mound < 24 in. of suitable $oil la-Cround [I ❑ Holding Tank ❑ Other Dispersal Component (explain) ) oa• ac Area Informati n r E sYs� V. Drs (sf) Q - Design ow (gpd) Design Soil Applreau °n Dispersal Ana Raluired (sf) , / 7, J Total # of VI. 'Tank Info Capacity in v Gallons Gallons Units New Tanks Existina'rlcs 'rA fa. t� n. Septic or Holding Tedc �f Dosing Chamber VII Ras nsibility Statement I, the undersigned. i ity for installation of the POwTS ahmtn an the Sumba Plaza. Plumber's Si MP/lvlY'RS Number Business Phone Number plumber N atne (Print) � �� � � ✓.� Plumber's Address (Strut, City, Stan. Zip Code) ... � fir i VU Co un /De ant Use Oal issuing signature Permit F'e'te Date I g proved isapplroved $ / S • 2� D9 van Reason for IX. Condit � { 1691 a°na for Diaapp>;oval 3) S +. G/a:W o -, 1. Septic tank, effl0ent filter and / o dispersal cell must all be services ' 7 ` maintained s, ( A' O, u • V as per management plan provided by plumber. / �- 2. All seeftwk requi(emeMs musj,be maintained 49 4, J.( [; n 0 15 a system cad asbaait to tba Coaaty cola oa per' aot tart tYaa S ] It :1 i btcha i t 4 'S • SBD -6398 (R. 01/07) Valid thru 01/09 __ k PL PLAN PROJECT Roaer Larson DDRESs 2072 Ctv RD C Somerset Wi 54025 S� 1/4 NE 1/4s 21 /T 31 / 18 W TOWN Star Prairie COUNTY ST. CROIX 00 � � 5/22/09 MPRS Shaun Bird 2269 DATE BEDROOM 0 CONVENTIONAL XXX IN. UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 411 # of chambers 20 ,BENCHMARK V.R .P. Top of steel fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 200' Property Line SYSTEM ELEVATION 97.5/97.0 3' below qrade Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Pro! Manual Version 2.0 Accessory Building 0 GPD 10' to have no living quarters ST B-2 10' 4 B -4 5 35' 150' 30, . __ o , -- ents 0 ' 100' 7 % Slope B -3 70,� 40' Driveway t B.M.* Cty Rd nIQ N �P Vent Well > 6" Quick4 Standard -W of Cover Leaching Chamber 20' Propert with 20.0 ft2 of Area C 5.8ft ^2 /pair of end caps "� �� 1� / 4' Long 12" vr4 kNdZt/l� J Grade at System Elevation Existing hom 34" I PL PLAN PROJECT Roaer Larson DDRESS 2072 Ctv RD C Somerset Wi 54025 SW- 1/4 NE 1/4s 21 /T 31 / 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/22/09 BEDROOM 0 CONVENTIONAL XXX IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 411 # of chambers 20 BENCHMARK V.R.P. Top of steel fence Post ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 97. 3' b el o w qr 200' Property Line Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Pro Manual Version 2.0 Accessory Building 0 GPD 10' to have no living 35' quarters ST B -2 10' B -4 45' 35' 150' 30' ents 0' 100' 7% Slope B -3 70' B -1 40' Driveway t B.M.* Cty Rd C 5 ' Vent Well 1671 Quick4 Standard -W of Cover Leaching Chamber 20 Property Line With 20.0 ft2 of Area 4' Lon 12 5.8ft ^2 /pair of end caps g Grade at System Elevation LExistinghome 34 nc COPY Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C J C J � I � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must v / include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. —coo Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ZG Property Owner Property Location Govt. LoL(.,,) 1/4 /Vr 1/4 T 1 N R f E (o W Property Owner's ailing Address Lot # Block # Subd. Name or CS M# a o 7 'a, C_ City State J Zip Code Phone Number ❑ city ❑Village KTown Nearest Road L4 -�ti 1 - 5Y0.25 JZ New Construction Use:5KResidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 4 Flood Plain elevation if a licable General comments / fJ �/�Gli T's �171'i r r Bel Lt:Jt -G/ and recanunertdations: o System Type ! D System Elevation / � // 7� Z) 5/1 Boring # Boring /�� ❑ Pit Ground surface elev. /� ft. Depth to limiting factor / Z +1 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 1 •Eff#2 Z 6 -ate U, s �- S �s ` - • � I i F-1 Boring E] 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 • Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WjfA101 7 - — 715 - 246 -4516 Property Owner _ Parcel ID # Page of F-1 Ong # [] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F -1 Boring # El E] ❑ Pit Ground surface elev. ft. Depth to limiting factor )n . - goi — lApplication 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 # E] Boring 1:1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD 130 mglL and TSS 130 mg1L 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•9330 (8.6/00) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _7? 7 s 1�u r K uyN Mailing Address 9 L -So ,e 1 S Property Address Saw -t-- (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 3k,) '/4 ,/ '/4 , Sec. , T _N R (_W, Town of Subdivision , Lot # Certified Survey Map # , Volume " ` , Page # Warranty Deed # , Volume , Page # Spec house yes V ) Lot lines identifiable 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 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County 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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 7SIGN f bedrooms d r-,? ,r.� •- '�- I r / � C' /—J/1 ?- 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. 08/05) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees . to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 ency Plan Option #1. f system falls, determine cause of failure, use aitemate area and install new in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ;STATE- BAR OF WISCONSIN FORM .1 -- 1982 `A'AR[IiAhTY DEED - In t ti - ,_ .. .: "JOGJriCrJT'Nc7 I tf'�pt • 1 ' - � C i �'*�`�� - ` - d caT• This Deed made between Ju.t to •`A 01 son, r� dI ,r r __ _I s n_Zlel son,_ T�GJ JLE = 1 ; t �0L 8 1996;: (.. -- _ j � La1 scn. T f a - a s`inr�: e''.. per son 1 ark P.ott >.. .._ 1 tc _�. Grantee 3 :. SrfiYCD FOR AF CORDiNG DATA Wttnesseth, Thdt tha said Grantor, for a V'j able constdt ration k u rs srncc qE NJMG AND RETURN_AMFIES -Z: Croi�c con Vgys,to Grantee she fDliowtng desenbed In real astute in � County. State of Wisconsin:: j �I ZY 4 - (Parcel' m Identification Nuber) Part of the SW 1 /4'of "NE -1/4 of Secttori 21 31 18 dascrtbedl as foll,;ows Comfttenctng'at the,, Northwest cort5er of said Southwest1j4 of the'Northeast 1/4 af,sa�d Secfign 21; thence East !1 on tbe orth; line of said' Southwest' for 40b feet tq the ;place of �} beginning; thence South X29 fee# thence East- naraliel with the North line of said Southwest; ; /4 of =the Northwe t - to the West rtgti`t of way Lne of you lfy'Trunk� C thence ; r Nor`tlieastecly alon `saki West right gf,a♦a }� ltl2e f. cunty'T►ull Iitgliway�C to,the "i�lorth ? , line of said Squthwest.l /4,of Elie N4rtheast,'1 %4, thenc(;'We`st on said North line for 542'feet' o t11e``plaet i f beginning, `P'R` rl.'raER f' � I This-. _ S _ _.homestead propeny., t' (is) (.> not) i1 .Together: wish all and singular the hereditamcnts and appurtenances thereunto belonging; } � Grantor . -- - - warTant� (hat ttie tette r- good indefeasible in fee simple and free anu'ek -ar of encunrhranCes ca4epi ,munac7.pol zaiiIylg: bV•dInaticcs and easetnent� oi: �ecorci fF �? and«vi)i wlrrant and defend the came 3 U wk t-hss -- - - `� _ tiay Of >_ - ^_ - - - - _. A 01son , (SEAL) _._ -__: - - - -. - (SFAI,) AUT14ENTICATION ACKNOWLEDGMENT 5,gnarur�(sl STATE OF IVISC0N$(N — -- _ - -. ss. _.._ Cowtty authenticated this day of -_. _..- �_ _. _. -_.. __ . 19,- - Personalty came hrfo+ r me th, . day tit _.•) u l » - -- _ 19 t? :he above named _ -.. -- <_ _ __. ittl i -d: a. Olsoli Trmr.: MEMBER STATI. 13AII of WISCONSIN authorized by706AG, LVic. S.sts.) rs mr kn., v�i u, h tQ�4rcCSwo - O. who executed the forcgtung i ar 10. a31(n M P Jr It THIS IN$T H tj Mf NT WAS ORAFTFp BV l,�1)6 I Z 1'tctt -C Ili \o1% R I C 111110TIZI r IY 1 yd .1.. \nrary PubGa , .• C 1. I 1 .1 04tFnmures n,a� he awlicli icarcd or ackc,traelratq ;r'6 nr+( tly ca,nlTUi.aon.ity � ,,I l(;'w;�il si " e4c .. nca�l• <s:r� 1 l �'= M� 'yY "ry�r'r e � 19 �-= 1 \ \.\Hn N %I DI "1 0 - ti1 %11 It iN (Ir k% I'( ON"N .. 4 (Parcel #: 038 -1087- 40-000 12/08/2006 11:36 AM PAGE 1 OF 1 Alt. Parcel #: 21.31.18.359B 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 ROGER G II LARSON O - LARSON, ROGER G II 2072 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2072 CTY RD C SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.250 Plat: N/A -NOT AVAILABLE SEC 21 T31 N R1 8W PT SW NE COM 400 FT E Block/Condo Bldg: OF NW COR SW NE TH S 229 FT, TH E TO W R/W HWY "C" NELY ALG HWY TO N LN W 542 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) FT TO POB 21 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1082/227 WD 07/23/1997 883/564 07/23/1997 854/226 07/23/1997 451/58 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 175381 60,300 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.250 26,800 26,500 53,300 NO Totals for 2006: General Property 1.250 26,800 26,500 53,300 Woodland 0.000 0 0 Totals for 2005: General Property 1.250 26,800 26,500 53,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wiscc Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix r Safety eknd Building Division INSPECTION REPORT Sanitary Permit No: 79425 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Pla D N Personal information youArovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parce T x Larson, Roger Star Prairie, Town of f 010087-40-000 087 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No: 21.31.18.3598 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final G e PUMP /SIPHON INFORMATION Manufacturer Deman St over GPM Model Number TDH Lift Friction Loss System Head TDH t Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenche PIT DIMENS NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L J BY6G WELL LAKE/STREAO LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems O ly Depth Over Depth Over xx Depth of xx Seeded /Sodd xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes l] No ] Yes 7MN, COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2072 County Road C Somerset, WI 54025 (SW 1/4 NE 1/4 21 T31N R18W) NA Lot Parcel No: 21.31.18.359B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ; ,� No T Use other side for additional information. Date Insepctor's Signature Cert. No. SBO -6710 (R.3/97) I - Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 M adison, 7` Grp o r is on, WI 53707 - 7162 m ry Permit Number (to be filled in by Co.) c ®nsin Departmf+nt of Commerce (608 F-C EN �ZS Sanitary Permit Ap lica State Ian I.D. Num r In accord with Comm 83.21, Wis. Adm. Code, per sont(�inf' ou n �, 2 may be used for secondary purposes Privacy Law, .04 Projec Address (if different than mailing add ) Y G Q I. Application Information - Please Print All Information 2 2 > 7Z FIC ZONING OF 0 Property Owner's Name Parcel # Lot # Block # a , - -107- 5fo - Property Owner's Mailing Address Property Location h, Section City, State /�� Zip Code Phone Numb / v cal `�Z /It ��© �S �l� Z2'�� FY�n TN; R/ E Type of Building (check all that apply) Q f t _5 or 2 Family Dwelling - Number of Bedrooms - r� J,/ Subdivision Name CSM Number ❑ Public/Commercial -Describe Use /� ❑State Owned - Describe Use A Bey} -. ❑City_ ❑Villa Townsh of i III. Type of Permit: (C ckydly one box on line A. Complete line B if applicable) A. st eplacement System E) Treatment/Holding Tank Replacement Only [I Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Aon - 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) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application R te(gpdsf) Dispersal Area Required (sf) Disp sal Are Proposed System Elevation r (o$ Gam{�G -r ) 94 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel i er Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic o olding Tank G I Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. PI is Name (Print) Plumber' gnature MP/MPRS Number Business Phone Number PI ber's Address (Street, City, State, Zip Co VI .Count /De artment Use Onl 79 ZZ Approved ❑ isapproved Sanitary Permit ee (includes Groundwater Dat ISSU Issuin gent Signatur (N amps) Surcharge Fee) Db Z9 Owner n Reason o ' IX. Condit q i4Ap�N for Disapproval 3 \ ) I Septic tank, effluent filter and C~ dispersal cell must all be services / maintak.W as per management plan provided by phlmbai'. Z AN nbeck mgWrwvw is ttWd be MWnMW M'(NF Oflda / OI�I�WM. Attach complete plans (to the County only) for the system on paper not less than 81/2 it 11 inches in size SBD -6398 (R. 01/03) bwrufr,�em 3�11t►. + . G�a�n5r��4p�, �:a5dfl8 hR S NOfIN1�110 1 sbw Nq n I Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 4 7 0 G� 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. Larson, Roger Star Prairie Township 038- 1087 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 21.31.18.3598 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution I x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 r Yes E] No _; Yes [ J No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 2072 County Road C Somerset, WI 54025 (SW 1/4 NE 1/4 21 T31N R18W) NA Lot Parcel No: 21.31.18.359B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? L Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ` isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Nu be ❑ Check if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information �' : ':; `.�� ! Location: Property Owner Name l - L- Property Location ,7 Property Owner's Mailing Adhifss ; i ; , s. Lot Number Block Number City, State Zip Code PhonF Subdivision Name or CSM Number 2 �/L rj II. Type of Building: (check one) t / ❑ City �1 or 2 Family Dwelling - No. of Bedrooms: ❑Village o 35`9 ❑ Public /Commercial (describe use):_ Town of ❑ State -Owned In Nearest Road h f ('� Parcel Tax Number(s) g !� III. Type of Permit: (Chec me A. Check box on line B if appy a le A) 1. ❑ New (,, Meplacement 3. Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) � o -p l essurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurizee n -grown ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. DispersaL/Treatment Area Information: 1. Design Flow (gpd) . Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. R.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks W/ �f� 7�� Con- Con- glass New Existing crete structed Tanks Tanks -k t / 7 t ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, th undersigne assume responsibility for installation of the POWTS shown on the attached plans. Phu is Name (print) / Plumb ignature (no stamps): MP/MPRS No. Business Phone Number Pl is Address (Street, City, State, Zip Co �-� IX. Co nty/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D Issued Issuing A nt Signature tamps) lb Approved ❑ Owner Given Initial Adverse Surcharge Fee) �-D °/ ;" a 0 3 < Determination u X. Co of Approval /Reasons for Disapproval: �- -ey;�� � -mum �,4t. ' 600 � s SYSTEM OWNER: _ 1 Septic tank, effluent filter and FeKC4 R dispersal cell must all be serviced / maintained W as per management plan provided by plumber. SBD -6398 (R. 07/00) as per applicable code /ordinances.Co - MI., 'F& yArJ I Y• PLOT PLAN 3 'as 3 PROJECT ADDRESS 2072 Co Rd C Somerset Wi. 54025 SW 1/4 NB 1/45 21 /T 31 N/R 18 W TOWN StarPrairie COUNTY ST. CROIX 8 -13 -03 BEDROOM 3 MPRS Byron Bird Jr. 2205 ` DATE CONVENTIONAL XXXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE o LOAD RATE .7 ABSORPTION AREA 642 # of chambers 22++ BENCHMARK V.R.P Top of fence Post ASSUME ELEVATION 100' ( C_ . 7DYVW�-" ❑ BOREHOLE O WELL *H.R.P. Same as BMA-- A>1259 nt SYSTEM ELEVATION T -1 -95.9 T -2 =95.5 Standard Leaching -4o cdLr,,, d Chamber with 31.1 ft ^2 per chamber e-at System Long 34 Elevation 200' PL 150' D ri Garage v e 3 bed House w a y ,,� , 20 35' B2 9� of -_._. --❑ 6 sr 8 8.°I bA Clot PL , �q. 20' S' B3 x'18 7 BI 98' $00 > 100' to PL O ob pipe BM 99' 75' `" alt "M �p to Co Rd C C P a ? well Old Trailer to be removed copy Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c Attach complete site plan on paper not less than 8 1/2 x 11 inch ( i ' 2""o include, but not limited to: vertical and horizontal reference point BM), �� ® rcel I Z � D percent slope, scale or dimensions, north arrow, and location an distance - fo nearest road. / — Z Please print all information. 14 2003 iewed b Date Personal information you provide may be used for secondary purposes ( 'vacy & . 15.04 (1) (m)). Property Owner ST FW� 1dh F� /4 S T N R, E (o Property Owner's Mailing Address/ Lot # I Block Tubd. Name or C M# City State Zip Code Phone Number ❑ City E] Village )blown Nearest Road e ❑ New Construction Use:ji3.Residential / Number of bedrooms Code derived design flow rate d GPD Replacement ❑ Public or commercial - D: A.A2*!l scribe: G Parent material ���Gt i me Oc, 'Flood Plain elevation if applicable General comments and recommendations: Boring # R Boring �j� 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff42 Ui koring # 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 .�S o AV -d * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (PI Print) t Signatur CST Number 7 , v - PJj'I /`r 417 Address Date Evaluation Conducted Telephone Number Age SBD -8330 (R07 /00) Property Owner L o Parcel ID # 0 3� �� ��� Page of - 3 D Boring # oring vy� Pit Ground surface elev. �'• e ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # [] ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 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 (R.07 100) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c Attach complete site plan on paper not less than 8 1/2 x 11 in include, but not Limited to: vertical and horizontal reference point BM),il '.' E D rcel I.D. percent slope, scale or dimensions, north arrow, and location an distance o nearest road. Please print all information. i 2003 sewed b Date Personal information you provide may be used for secondary purposes ( 'vacy La�iv; 15.04 (1) (m)). 'LP Property Owner Locati on 4� Z /4 S T N R/ E (o Property Owner's Mailing A dress Lot # I Block # Subd. Name or C M# _ A G •- city State Zip Code Phone Number ❑ City ❑ Village own Nearest Road e � � h , p/c- ❑ New Construction Use-,&-Residential / Number of bedrooms Code derived design flow rate a GPD Replacement ❑ Public or commercial - Describe: Parent material 6LIa G1� O�, �`�`'�7— Flood Plain elevation if applicable General comments and recommendations: n Boring # Boring 9 pit Ground surface elev. �' ft. Depth to limiting factor _�7�in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / 'Eff#1 I 'Eff#2 l+ / • G- �G G w � • [2[ Boring # K-1- Boring Pit Ground surface elev. ft. Depth to limiting factor in. rEff#1 il Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I - Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (PlqW Print) Signatur CST Number 43 07 Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) i Soil Test Plot Plan Pro'ect Name Roger Larson Byron Bird Jr. Address 2072 Ct. Rd C Somerset Wi. 54025 CSTM #220527 Lot Subdivision Date / / County CROIX SW 1 /4 NE 1/4,S T 31 N /R W Townshi StarPra [] Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft Top of Fence Post sa"Y' � locA*V�- ? System Elv. T-1 =95.9 T -2 =95.5 H.R.P. Same as BM 200' PL 150' D ri Garage v e ""'--- -- 3 bed House w a Y 35' B2 PL 20' B3aa 70' B1 98' R00 > 100' to PL 40 BM 75 Cov�'�rcNLa� alt e, ( c �- i well Old Trailer to be removed PLOT PLAN PROJECT (/ Z A r ': pvj ADDRESS 2072 Co Rd C Somerset Wi. 54025 SW 1/4 NE 64S 21 /T 31 N/R 18 W TOWN StarPrairie COUNTY ST. CROIX MPRS Byron Bird Jr. 2205217 DATE 8 - -0 BEDROOM 3 CONVENTIONAL XXXX At -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 642 # of chambers 22 BENCHMARK V.H.P Top of fence Post A SSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =95.9 T -2 =95.5 ' 12" Standard Leaching CC Chamber with 31.1 Cove ft ^2 per chamber 6 " Long 34" Elevation 2W PL 150' D ri Garage Zp� v e 3 bed / w a y 20 35' B2 sr 68' PL 0' 20' S' B3 7 BI 98' $00 > 100' to PL O ob pipe BM W 75' alt t M to CoRdC �_ ell Old Trailer to be removed Soil Test Plot Plan Pro ect Name Ro ger Larson 1 9 Byron Bird Jr. Address 2072 Ct. Rd C Somerset Wi. 54025 CSTM #220527 Lot Subdivision Date 8 / 1 3 / County CROIX SW 1/4 NE 1/4S 2 T 3 N /R W Townshi StarP n Boring Q Well PL Property Line# Alt. BM 22Z /( X `ma es' �- VM or VRP Assume Elevation 100 ft Top of Fence Post System Elv. T -1 =95.9 T -2 =95.5 H.R.P. Same as BM 200' PL 150' D ri Garage v e -- 3 bed House w a Y 35' B2 PL 20' B3 70' BI 98' IW > 100' to PL 40 M 99' 75' alt M to Co Rd C well Old Trailer to be removed ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4 1& r .Car s r �► Mailing Address Property Address �"'� ` (Verification required from Planning Department for new construction) �5� , City/State Parcel Identification Number LEGAL DESCRIPTION Property Location V4, �V4, Sec. , T_:L51N -R Z Town of l r dr Subdivision . Lot # Certified Survey Map # Volume , .Page # Warranty Deed # Volume /0 1 Z- Page # Spec house ❑ yes 9 no Lot lines identifiable ,lei yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 13 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNA APP CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn above, by virtue of a warranty deed recorded in Register of Deeds Office. /D SIGNATURE O PLIC DKTEE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWT OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION— SYSTEM SPECIFICATIONS Owner er �u a Septic Tank Capacity a l ❑ NA Permit # O rl Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model � ❑ NA Number of Public Facility Units A Pump Tank Capacity al WA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer ❑ NA Soil Application Rate g al/day /ft2 Pump Model ❑ NA tandard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease—WOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L L Ijn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /LIA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: Other: ❑ NA El NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequen Inspect condition of tank(s) At least once ever ❑ mont NA P Y' 2 ' ❑ ears) Pump out contents of tank(s) When combined sludge and scilin equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ ear( nja6th(s) (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter gDeD At least once every: Z— years) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage 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, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the round surface. The ponding of effluent on the round surface may indicate a failing condition and requires the 9 p 9 9 immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page Z of ` 2 START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the 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 use. System start up shall not occur when 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 discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 Maintainer 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 cells. 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 life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (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 steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement stem: A suitable replacement area ias 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 a new soil and site 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 technology a holding tank may be installed as a last resort to replace the failed POWTS. Thg site o evaluat identify a site �( ev')ua�on t be ed e a suit eplacemen If no replacement area is available a holding tank a stalled as a last resort to re a failed ❑ 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 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 IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name " Name u Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 6' O Name Phone Phone fj This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page L of 2 START UP AND OPERATION ". For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) iemoved by a septage servicing operator prior to use. System start u shall not occur when soil conditions are frozen h infiltrative surface. Y p at the During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 Maintainer 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 cells. 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 rife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (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 steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement stem: / �Z , area ' A / suitable replacemment as 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 a new soil and site 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 technology a holding tank may be installed as a last resort to replace the failed POWTS. Th site evaluat identif a site ev ion t be ed e a suit eplacemen If no replacement area is available a holding tank a . stalled as a last resort to re a failed ❑ 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 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 IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name — Name r Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 6 p Name G ro i err Phone " Phone 6 6 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I .s STAR PRAIRIE PLAT -- T -31 -N • R -18 -W s E See Page 112 For Additional Names. (Landowners) n FOLK CO. 1100 CARDINAL DR 1200 1300 1408 1100 - 900 POLK/ST CROIX HD 1000 S PC W o f ^ CEDAR r T ° STAR w r K c �o Randall & o Douglas a , CEDAR "PhyWs 85 PRAIRIE mulls Rivard p $ LAKE N A T p I u� ng S & D G eher = >PC N ' �' 261 z CEDAR TO DR 2 9 r. a0 '� DR a d'g� Grego & 200 `o o ! sane 30 Linda RodnG3' p y V g a 5 Nelson Rivard gz J: 7d $ o n r E ws' Vincent & r ° M 1 g F- asa. a 128 q � "a. y C I Doreen tr , C2 126 e«� pa q ++�� �{ x p" y Yt Wiils�o�n��TSTO N M� 39 40 c 0 95th CVt� F+ F. 1Z m& b 22 � \14 SM 9'�_ — H — John & Susan — $ 20 TO A/ -x wn^ a far call a 41 38 r`°e' 3g gg p$ Gate- E �- I nttreda 8 H tr Gene& t sltleaw ++ JZ 2i$ 60 mmm° 39.8 Larson &w caob Nelson g Q a 13 tr o Normat� pp '•, v . �,.P to St ,. s g A � n D "F O� BB Z I 121 cal v p u r rn '" NG k � 10 m � 1� FraMey 1 n 6 240 �= UA 80 20 Fem lea m OLD M B I 1s Ye a CBfford &)can & 6 20 &1 KE rs.aa 1 &s Mw ° rd sins Pearson D 12 ° 15 DPb&ivtde V a e s u ap PuneB Mm o RD Ah new 40 ° '�° T^-+ ii —H 'w o a a e e a c m wax E-F 15 °8 ; s 30 rsra o Gary N Bruce a aalm h' Q u- M G1vlm! N 'Q Q JGSBGn 0 W N N C 24 FA IO O EID[F Vo°- r i GL. 63 Pamda Y N Ems° y r ° " a vw� 5 tr i 15 OUC7 0 � � Fg ao 0g° ` Mm 40 ss 64 Q t 32 t[� & 35 f t _40L 40 s 117 tYa_aer _ 37 7 �. 0ar 3 Sandor & Patricia s� R g QX a5nes & _ N R n Anderso ry 22151 5 g w Ymelp M Cnsdh OIDG Richard CC B 4 g g 1 et lr ° e `r 7 S o ° 5 o' AVE Hansen Norman cw� Nemeth 77 58 LE 82 Farm x >r.F cu 20 srr Inc 65 1 L V. wca to Erlc n s w, Jante Scott Richard Harlan C srKl M 1"'n raMS so Well a0 �` g M 6 - Cou nter 5 zl Vehrs 158 zo sdm tr 109 ° ds RV 13 80 � 1 I � 78 Penman void 40 is Qe c, Wallrieh ies� Mark 0 &; m tr pt M1 wac gg gr Robert mn.b v •` 1 Estates Orcenxeod rbewM l to Bell 0 v h + w Pahic & ° 5 r Patsy s d 1` Inc 77 56 A V s 75 a 5 20 AVE Brenda w a r o t �p oi I Alitt .2a I ' 6M m Doris Clamlce & Rivard t & R 20 ) & o zo S z David + q -S Z YB Soden Leo Ia 42 cr&slmo alonsoll - Cook tr I 80 135 05 EO° 5 2 E.'30. ^ a Newmann E & M °.. RM g . Trust 100 Dupre 20+v s R &L t5 rr'� 1 s z e - Nell � 3 B Alice 4 nICe210th VE myn > 2 0th A Joseph a Everett r S; e F ^ o r z c-o. s S 17 llrr H ®m" y Eme[son a Ge&< vo®e 1 u �--4= wa7 Thomas o '8 T '� ° Cto n et e - ems° bs 38 39 Mary a0 w 75 m Trust 77 p ,< O 55 B r Patricia Jones 9 Steven & �7 a I,i I �, !� ¢een z ^ Rv o D & �, ) .e�. P a & F m 5 C d m i 37 80 G 2 1 _ .4- 0 M 2051 �.-.a0 VE 3 g ° F °lie 79 127 A AN ate& I hauler 2 a zs I za ac eaus c Ralph &L zo David °saes zs 1 s & Mark & 10 Geral hLd M& Mond n g - Railsback ma 91 a 140 �& Dab 4 b gems- wi 70 5 ra 5 �� x Stewart 2 7s RI a1 11 :i VoBsat gF� "s Dc 9 � CC tr a a 1 'L 14 Apia so\ - "A 102 tr 45 40 so _ sc s KM a wo 6 156 r_ _ _ 75 _ ` 200th AVE Gary a2 �s1�p — _ d& a 1' Steven I Dam aeonnk sa° & Mary Inc 2G :" cal F 7 tr s Trrusst " �- tr f ;ClsristY� Francois e Geneviev M l RI N � suu iF a & 1 100 217 zl 97 220 1— o�" 160 1 195th AVE • BaM w 38 ¢ V 90 6� sa 9 zo li tr R AK aaa 1r Daniel a a 40 C asey o»dtfr y9 95 r 9 _ ; o P ate- 40 go go rqM e tr ° t aMaa t< 1 St Croix -'Helene' — a Gun- U 192nd AVE " 3 r m tr n ^ s - 3 County Farm Houle Its s 2a it t[ 5 m D & A ) & L 22 ly Victor 120 11 r^ r y r z: 80 1 _ 72 : Q 130 N 3a wwrct 11 Myers Ill_ 113 - u�_� 40 _ _ _ - ?fi 190th -- ` w C.6& Kobest 8 amen & a ' ° o '�'oix - Of St ty o J { r ..ens Co Health 1 - Of St Croix AVE P lourde arlgh Per r y '" Cra �-'v I Mme, '^r Center 120 �¢ 42 qo Irpn ao 40 '� i'3 t'p shcrman 40 Ginn c.>s .a ° r h I 6x r � & Mary I n2: Ii KK & J J l DP k „ O BOncher Cblb la Newby 120 Rivard G ° tl & 1 50 0 c - 158 ao 40 7 M K 13 t 185th AVE 40 papa eaMS 7 M as Jensen u & It Russell a Is c 56 C-1 s & n pu.o 10 MK 13 sled 136 Flandrick Ya- Mesta Michael& RC Foods p m— m — m 75 >z 90 yes x m Kale Kathleen 117 K +b Friday 24 Ceeow y n,w carP ++ F - � 140 •'tt GD10 � 58 5 m ss 59 tr z s7 urz 176 K 180th AVE RALEIGH RD WINDING TRAIL RD RICHMOND PAGE 48 SOMERSET'S' PAGE 62 . FARMINGTON MUTUAL INSURANCE CO. �j.�� flsceola1111a t Inca 1 s 7I3 COUNTRYSIDE VETERINARY CLINIC, S.C. DR. JOHN SWINGLE, DVM DR. LORI VON RUDEN, DVM DR. BRIAN KELLER, DVM DR. KRISHAWN KAIBEL, DVM DR. MEREDITH SMITH, DVM Fid Service Veterinary anti: 11.14 How Emergency Service Professional Pet Grooming 11- Boardng 715 - 246 - 5606 1231 N. K NowLFs AvF. 715- 248 -7041 NFw RKHm ND, Wt5coN51N 54017 Fax 715 -246 -9256 E -Mall: cvck"pressenter.COM 66 Parcel #: 038 - 1087 -40 -000 08/29/2005 10:23 AM PAGE 1 OF 1 Alt. Parcel M 21.31.18.359B 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 ROGER G II CARSON O - LARSON, ROGER G II 2072 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2072 CTY RD C p SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.250 Plat: N/A -NOT AVAILABLE SEC 21 T31 RI 8W PT SW NE COM 400 FT E Block/Condo Bldg: OF NW COR SW NE TH S 229 FT, TH E TO W R/W HWY "C" NELY ALG HWY TO N LN W 542 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) FT TO POB 21 -31 N-1 8W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1082/227 WD 07/23/1997 883/564 07/23/1997 854/226 07/23/1997 451/58 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.250 26,800 26,500 53,300 NO Totals for 2005: General Property 1.250 26,800 26,500 53,300 Woodland 0.000 0 0 Totals for 2004: General Property 1.250 26,800 26,500 53,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 118 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n� cn 2 S00'42'24 "W 5255.55' i N00'42'24 "E 3932.58' S00'42'24 "W caw c i 1322.96' o ZC)� Q cn ICA I a m ro = m \ � 46 �' .. _ 16 oz w ° o � in�En z Rio 2 ° c o �Rt rnyy �Im N m o ONm 5 :0 ' N \� O CR nom m II m rt F �� 0 rt N W - Do �I O� ° a 0 v 00 o a 0 z � a ° a ; co y 0 mD vlj CL � I Z I• ° 1 a o m 0 R =SOUTH I F o nl o m oo = S00'15 50 W 229.00' ° rD `° a� D N00 ' N w _ CID * cart °wa T :U fn %o Z I N z co I �c t0 n r to (J °' _ I �► o a ° �\ TG e Z1 nm t in �; v ° c z •° '� e W 07 0 CD m / / / /r � r rrgr� 1111111 \ \ \ \` � �k a n * =r ( y \ a 0 I m 0 C N Le . po Puu T Uvo 5A o, v, o EMU Ir I o a F \ \\ ?p• CA CD (A f \ a °. mo� �p I \\ �G2\\ �r1 Na �mm `y'� 4 \\ \ \\� C - ) o � , z ° O m n o �` \ \\\ - X s 3 � CT j "(A 0 (A \ m m m -� m \ ` 9� o PL o o m \ \ �0 g to v W t c x o' o cn N O zt \ �'� a ° L4 o a \ \ O co m \ \ c X N co m c \ \ CD O -P ~ ° \ 1 O F a N \ .. cn ° \ \ .« S .+ m y m I 2 c m rt I 0 STATE BAR OF WISCONSIN FORM 1 — 1982 WAR Ty DEEIJ - 0 3GUME:NT Nci. _flea•{ -� �... :. �Ulvrc.l. ><: ul CRtlibt This DeCCI, trldc be[wcen 3 U L1 e A. ll ] 5 Cc�4lt r t si t 1e ne son, JUL 8 )89t. - -; Grin I or at 8:00 k Ina nac cl — (;. ]_it sen T f 1 s tnc per5otl _.. - - - - -- — - — ;Grantee, I I-ItS SP0.CC l;f :C-.nVCJ FOR P.FCOn91N6 pnTA Witnesseth, TI at the said (.rrantor, for t valuable consideration P1� con veyc to:( following decenbcd real esittCC in L..._ �i 1 _ County. State of: Wisconsin: _ ` (ITarcet Idesttifi�atipn Number) -_— Part of the -SVV 1/4 of NE -1/4 of Secti6 121 -�i t desc- iiie °d is follows:'' mmencing aC`the Northwest corner cif said Southwest lf4 of the Northeast 1/4 'of °said Section 21; thence Easf' on the North line 'of said Southwest 1/4, of `the• I`7ortheast-.1 /4 for 400 feet to-the dace of beginning; •theme South 229 feet thence East Tiara €leiwith.the- Nor-th-'line of said Southwest _ 1/4 of the. Northwest 1'/4 ,to•the VJest'right'ol way line of County °Trunk C ;''thence , Norilieasterly' alori said West cl>�ht. of W33. Zs ^e , f. ^runty'; it u,ik- 14igl way " to the Nortl �f Brae of said Southwest 1%4 of <•tlie Northeast /4, ti�enct - V',?est op said North line.fo`r 542'feet to the place.- ,�f beginning. `i'R3S�t; This•_._ 1_ _ _. homestead property,. F EE Tpgethel with all and singular thealiereditaments and`appurienanees thereunto belonging; 1 And G -- wurr..�nlG that:the title iS good. indefeasible in fee Simple and `'Cree and`c.ICar pf encumin ]n.L1riaC:1.11 O'r < }111i111'CC.S n Cl C7SC'C'I11.> v?I ICCt:OI'C1 and will warrant and defend the same. ivac+thss ._. 1 Ll) (l h 1SI =r11.1 ` (SEAL.) __. _.:_...... _ _ ___ . __.._.. w_- (SEAL) — _ .._ (Sr AL) AUTHENTICATION ACU NOW LE DGMrNT tiig+�anne(s) _. SSTA - m OF WISCONSIN Cou 11.1 SS autlleniscated this la. oC .... t9 Pcraonaily uimc hcfPrc,nx lilac dac uI } 1.1 1 N7 1 `s h. the ah m tive na ed _ _ .. .. 1't CLF ML-MBFR STATE. BAR. OF WISCONSIN .. ..... _. (if h L(. S; l ithonzed by §70(, Wks SIMS.) us InC kno V. Iv bc•tlte% -Frt _ 1 0 who executed dw folegving i krtrn)�CtQq� F svt Itt +clgc slm l IN '1 H1 nELNT VJaI ;i :Jf2AFTF_D 13Y r -r _ t � 0 0 1 1 (' t� i f` l Acw li.l C11111ULiC! - ; }4 { 5:'.1 �? (, _ Nts1: 11'F• Public f .`+1"n iml, nna, 1,y :FmhcmiC3IC.d or {il, , lcllx ` it nt � -(L �_t2nZlpl tl Ltt�_t1Q 71.15Y�Cn: J��J 1 ,V� .. .... f t�•.