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HomeMy WebLinkAbout038-1099-80-300 Wiscons!i, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S @ety and Building Division, 506126 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: Penecostals of New Richmond I Star Prairie, Town of 038 - 1099 -80 -300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / a!> I (b AA 1 e,S 24.31.18.417A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ' CAPACITY STATION BS HI FS ELEV. Septic rw µ a MD Benchmark /60 v �fo� a o• o S L /.9 J ���i.. -� '�7f�fe��a �c.00.�... 9g.1 Aerlition & Cr 46 Bldg. Sewer (�,s5 q 3 • y5 vv � �65o St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet q6 of TANK TO L WELL BLDG. Vent to Air Intake ROAD 641tilet 2 n • 1� 9�� 5 L Septic ' S C�1 ! f Inr wQ� _36 R/. q8 / ! _ ader /Man. `Z> • �� q 0 �p Aer tion Dist. i e 9 Y Holding Bot. Syst m f0• Ib YC� • Final Grade I PUMP /SIPHON INFORMATION 5.5 7 ' S Manufacturer Demand St (;over pv�. e� 9 •' GPM (e .ha— Gp Model N7 166r / TDH LI t Friction Loss System He I T Ft 7 -:5b . Forcemain Leng la. Dist. to Well p 0 SOIL ABSORPTION SYSTEM BEDITRENCH Width , Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: _ INFORMATION Type Of System: nn �� CHA OR Model Number:,/ r „ ` '• �� DISTRIBUTION SYSTEM I er/ ifold x Hole Size x ppcinVe to Ai Intake I DistributioHole jk Pipe(s) � \ D �4 h Dia y Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center -2 (1 / Bed /Trench Edges \ Topsoil \1 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2024 Highway 65 New Richmond, WI 54017 (SE 1/4 SE 1/4 24 T31 R18W) 2 Parcel No: 24.31.18.417A30 1.) Alt BM Description = 6 ' — + �, ^"S I., k:5 wf3o t c 2.) Bldg sewer length amoun of cover = P Plan revision Required? Yes Xon o Use other side for additional informat �e rZ �11 Date Insepctors ignature Cen No SBD -6710 (R.3197) and Buil " Division . t�tllfigtyV Safety �8s 201 W. W �� sconSi h WI s PamitNambear �.) 0mot of COMIMMO So 12- ( Sanitary Permit App lica on - �T� 3 g 3 y (� in acamjance with s. Comm. 83.21(2), Wis. Adm. Code, sabasission of 1his to the unit is required prior to obtaining a sanitary PwmiL Nate: Apphostion f Y. Ade)rass (if ddferant than madmg address) submitted to the Department of Commerce. Personal infosmation you may used for saaondary es in woordswe with the Priv Law a. 15. I m Stale. Zb Z 4a9 k � S L A 'c#tion Information - Please Pont All leeforIUMtion Propmty Owner's Name Patord # Ph P C a S f L J a Property Ownces Mailing Address Property Laost`on city, state Zip code PLoae Nanrbex f �, V, Ts - V,, S". a L C � , J4 U v1 ( t T t N; R / d o E�oa( I1. Type of Btbtding (check all that apply) ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Nadu Block # J91 -Describe Us C � ❑ City of ❑ State Owned - Descr use t Namba /or Vie P q .a of IIL Type of Permit: (Check only one boa on lute A. Coaaplep* Non B if applicable) A. View S;r.tem ❑ Repkoeount System ❑ Trmam 01oidiae Tam Replacement Only ❑ Other Ian to Existing System (explain) B. ❑ Pamit Renewal ❑ Permit Revision ❑ chaaxa ofPiombex ❑ Pe nit Transterto Now List hem Perta t Number and Dde Issued Before Fxpirstion Owner 1 i TV. of POVM C t�Device' (Chock all that angy) L? ZJA Lb -RM. Pr ❑ Pressuazed Lr -Ground ❑ At-Cxade ❑ Mamd >_ 24 m of suitable soil ❑ Mound <24 in. of suitable soli ❑ Holding Taok ❑ Othex Dispersal Component (eaeplain} ❑ Prokas mart. Devioc (esptaia) V. Di rssl/Preatmeatt Area Information: Design Flow (gpd) Design Soil Applicat Retexgpeitt) Dispersal Arcs Roquir°d (at) Dispasv Ares Proposed (ef) syston P.levatian /yyy / Za7b Z) b 93 L Tank Info capacity G c t in Total M°°°fi0�w New Tanks Existing Tanks 4ji g W u l _l 1 A., 71 s V] Septic or Bolding Tank 1 (/ Z-- (j F C Dosing Cha nbor V IL Responsibility Statanent I. dw oadersipaed, asew®e respaward ky fir men ateaae POW TS eebawn so the aethmW plans. Plumber's Name (Print) s MPMIPRS Nambar Bosinces Phone Number lumber's Addtross (Sfrzgt, City, State, Zip Code) VIII ono artrneut Use Only X A ' ;p.% , cd ❑ ' eroved saamit ee Dda -7 heaeiog Q eau Denial - y �� o DL Conditions of A pproval/Reasons for Disapproval .3 ti� 5� (� Le— SYSTEM OWNER:. 1. Septic tank, effluent filter and �,� t t-Gc,� t,1e`5 dispersal cell must all be services / mainf fined / l as per management plan provided by pkmtw. t3 Q ('v 2. All setback requirements must be mahtta%W WIM syda. and wda•k to tre Cewdy ady an papar not lea tmew g :u else ,5 1 S D (R. 01/07) Valid thru 01/09 5 (�S � —/ r A, ( T Z • 3q Cs) , Ljae_r 60,A Pick - 0.0 roiv-0, ;i Pet j , , c� �ctdr i-o PdeJ�S n PaMIT w; ►l 1�. Qe✓ J i � N � W C L t N z o `y � t ' Iz f . - CL Ll uj oc � ww �� N t L A I v i RECEIVED F Wisconsin Department of Corn roe APR 1 0 2007 SOIL EVALUATION R Page of Division of Safety and Buildings ST. if tb � Corn 85, Wis. Adm. Code County l Attach complete site plan on min in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewa by D Rj t Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f D7 Property Owner Property Location Govt. Lot 1/4 1/4 4 � � To/ N R / E (o Property Owner's Mailing A ress Lot* I Bf Subd. Name or CS � City State Zip Code Phone Number City ❑ VII ge Town Nearest Road e s� 1 ( ) � New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement f 9 Public or commercial - Describe: Parent material / n J, 9 - 5'.l 9 Flood Plain elevation if applicable ft. General comments _ / i 1 and recommendations: ,5 ' z ' ( g7Q bcq Boring # Boring Pit Ground surface elev. 2 � ft. Depth to limiting factor 7/ �2 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 I *Eff#2 - - s ` � v Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor > Z-�� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 AJ d s >, - - 1 r I * Effl t #1 = BOD > 30 220 mg/L and TSS >30 150 mg1L fll nt #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Na nt) Signature CST Number Address Date Evaluation Conducted Telephone Number �� S AP "�/ Properly Owner_L N7� Parcel ID # Page s of Boring # Boring (� pit Ground surface elev. -. 9Zft. 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 I *Eff#2 -3 - W 4 q 4 t 1 Boring # Boring Pit Ground surface elev. f1. Depth to Ilmiting factor in. Soil App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - 3 �3 s a a u a 4 5. 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * 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. SBD4330 (807/00) Property Owner Paroel ID # Page of E Boring # ❑ Boring ® pit Ground surfaoe 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 3 a 4 s m 4 I n Boring # ❑ Boring I J I 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/fP - in. Munsell Qu. Sz. Pont. Color Gr. Sz. S//h. U - Eff#2 3 �h Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication 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 I *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- " 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 -onoo) s IA v � / - 1 Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce. on sin.gov Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 30, 2007 CUST ID No. 221044 ATTN: POWTS Inspector DANIEL LOUIS STOIBER ZONING OFFICE STOIBER PLUMBING ST CROIX COUNTY SPIA W1414 ROCK CREEK RD 1101 CARMIC14AEL RD SPENCER WI 54479 -5208 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/30/2009 Identification Numbers Transaction ID No. 1383146 SITE: Site ID No. 712340 Pentecostals of New Richmond Please refer to both identification numbers, State Hwy 65 L above, in all correspondence with the agency. Town of Star Prairie St Croix County SE 1/4, SE 1/4, S24, T31N, R18W FOR: Description: Commercial Non - pressurized In -ground POWTS for Church / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1124335 Maintenance required; 1,449 GPD Flow rate; 120 in Soil minimum depth to limiting factor from original grade System(s): In -ground POWTS Component Manual, SBD- 10705 -P (N.01 /O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Effluent testing per Comm 83.44(2), Wis. Adm. Code shall be conducted on a quarterly basis after the new POWTS is put into operation; (see management and contingency plan on page 7). Test results shall be submitted to the county for review. • This approval does not include plans for the general plumbing systems or sewer piping leading to o the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during 0. , S. construction and open to inspection by authorized representatives of the Department, which may include local F: �� inspectors. Cali ��pR'CMENF D 6 9 E9%TA Of Sp // DANIEL LOUIS STOIBER Page 2 3/30/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 4ea M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I INDEX SHEET FOR PENTECOSTALS OF NEW RICHMOND co 0 Z_ 'Q ~°o ** *CONVENTIONAL SAS SYSTEM Lu N ru z OWNER: PENTECOSTALS OF NEW RICHMOND WI. ui ATTN : DON GRANT Q 1459 WILLOW AVE NEW RICHMOND WI 54017 r� LEGAL: SE 1/4 SE 1/4 SEC 24 T 31N R 18W TWN : STAR PRIAIRE PG 1 INDEX PG 2 SIZING, TANK, CELLS P3 3 PLOT PG4 dIM. CELLLS LAYOUTS PG 6 MANAGEMENT PLANS DESIGNER: DAN STOIBER ( STOIBER PLUMBING L.L.C. ) W. 1414 ROCK CREEK RD SPENCER WI. 54479 659 -5121 *507 -0254 FAX: 659 -4489 (715) SIGNATURE: M.P. 221044 .....; ... ........ ................. ............................... DATE: 3 -22 -07 IN GROUND SOIL ABS. COMPONET MANUAL SBD 10705 -P (01) >1 D1N�S Pp NpE s�E C'o PG 2 SIZING: CHURCH WITH PART TIME KITCHEN: 168 PERSON CAP. X 5 GAL EACH = 840 GAL 4 FLUOR DRAINS X 25 GAL EACH = 100 GAL. i rT 2 EMP. X 13 GALS EACH= 26 GAL TOTAL= 966 GAL EST FLOW 966 EST. FLOW X 1.5 FACTOR = 1449 GALS DESIGN FLOW RATE TANK SIZING 1449X 2,088 FACTOR = 3025.512 GAL MIN SEPTIC TANK PROPOSAL = HUFFCUTT 2 - 1650 GAL TANKS WITH ZABEL A 100 FILTER DISTRIBUTION CELLS - 1449D WF -.7= 2070 SQ FT MIN AREA PROPOSAL = ADS BIODIFFUSER ARC 36 84 ARC 36 CHAMBERS ELSA 25 PER SQ FT. 84X 25 = 2100 3 ROWS = 3 F X 140 FT 28 CHAMBERS IN EACH PER LAYOUT PG4 f PG 4 DISTRIBUTIN CELLS: LAY OUT (NO SCALE) SC(v Yo 3 oe u'�a �( / 3� cha.vt�Pl PocG, F y r � 7 0 o / y bPGj- ScJ, Yd to fa **************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CROSS SECTION (NO SCALE),_ ch t? d v✓ 9 � as P �� �, P Oc- � r°UaL -�o f y y �. y ,- >��d f 2- A..ti y� � / �� `,, s7�le TEL P. @8 PUWTS OWNER'S MANUAL & MANAGEMENT PLAN Page . FiLG RUPGRMATLOLt 6YSi€eM S*W*CRZWATi0till6 OWn ' S Tank Capacity f ��. � s! ON Permit, f Septic Tank Manufaetwer F �_ ci ❑ NA DE61011f PARAfV(EMR5 Effluent tmitw Manufacturw u , /G ��+ 0 RYA Number of Bedrooms ji NA Effluent l=ifter Model 0 NA Number of Public Facility Units_ 9 1 0 NA Pump Tank Capacity al JMNA Estimate flaw (average) _.__. - - -_ -- Ptlnlp Tank Manufacturer J%NA jLaVday Design flow (peak), (Estimated x 1.5) a((dey Pump Manufacturer Soli Application Hate d Ift2 Pump Model .I2KNA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ONA Fats, Oil & Grease (FOG) 53o prig& 11 Sand /Gravel Fi er © Peat Filtet Biochemical Oxygen Demand 1000.) 5220 my/L NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids fTSS) 5150 mgX 0 Disaffection 0 Other Pretreated Effluent Quality Monthly averages Dispersal Collis) ONA r Biochemical Oxygen Demand tBOD s3O nig/L )d Irt- Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 531? "IL ONA E3 At- Grate 0 Mound Fecal Colifo (geo metric mean) 51W cfu /looml El trip -Line 0 Other: E m Effluent Particle Size Y in dia. 0 NA �� 0 NA ©NA Other" 13 NA 'Values typical for domestic Waste and seMic tank eftitom, Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Rawomy Inspect condition of tanks) At least once every; month( ;) (Maximum 3 years) ❑ NA � earls) Pump out contents of tank(s) When combined sludge and scum equals orle-thirtl fY of tank volume O NA Inspect dispersal celf(s) At least once every: monthfs) IMa timuen 3 yearsf 1l NA ear(s) Clean effluent fitter At (east once every: 0 month(s) � 13 - — �Ye;ls3 NA Inspect pump. pump controls & alarm At least once every: 0 monthts) ANA - --- -- - B ytaar(s) Flush laterals and pressure test At least once every: monthfs) D IVA Othcr: n Year(S) At )east once every: DNA Other- C1 y earts) D NA MAINTENAryCE INSTRIfCTfONS inspections of tanks and dispersal cells shat( be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Seaver; POWTS inspector; POWTS lVlagi t aHieT; Septage Servicing Operator, Tank inspections must include a visuaf inspection of the tank(s) to "identify any missing or broken hardware, identify any cracks or leaks, m easur e the volume of combined sludge and sewn WW hWW to check for ony back up or pg"` of �ff'alt:tt -on the g rrxllxl surface, ' r he dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipe, and to check for any ponding of effluent on the ground surface. The ponding of effkient on the ground surface may indicate a failin re i�nrnedi rtQ notification of titre local regulatory authore(p_ 9 condition a n d r e quires the When the combined 3 CCUMUlation of sludge and scum in any tank equals one third (Y or more of the tank volurne, the entire "Ments of the tank shall ue i c -mcved by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wiscanso, Administrative Code_ All other services, Matuding 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 carolled POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days Of Completion of any service event. I EL, $TART UP AND OPERATioK For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other ehemi*eis that may impede the treatment process and /or darnWe th dispersal oog{s1_ if hiPh concentrations are detected have the contents of the tankist removed by a septage servicing operator prior to use. System start up shalt not occur when soli conditions are frozen at the islfilrrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wilt be discharged to the disperse( cen(s) In one large dose, overloading the ceNW and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank ran ived 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 —trots to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive at park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or a"rade soft 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; oigarette butts; condoms; cotton swabs; daWeasws; 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 he taken to insure that the system is Property and safety abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Coda. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. * The contents Af all tanks and pits shag be removed and property 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 faits and cannot be repaired the following measures have been, or nxrst be taken, to provide a code compliant replacement system: IN A suitable replacement area has been evaluated and may be utilized for the iceation of a replacement soil absorption system_ The replacement area should be protested from disturbance and ownpaction and should not be infringed upon by required setbacks from existing and proposed structure, tot fines and wells. Failuro 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, LJ A suitable replacement area Is not avaiiab(e due: to setback and/or soil rimitations. Saying advances in POINTS technology a holding tank may be installed as a last mart to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon faWas of the POWTS a soil and she evaluation must be performed to locate a suitable replacement area. if no replacement area is available; a holding tank may be installed as a fast resort to replace the failed POINTS. ❑ 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 tune. < < WARNING> > SEP71C, PUMP AND OTHER TRF_ATMEiMT TANKS MAY cOwAfN LETHAL (GASSES ANDIOR RiSUMC"T OXYGEN. UO NOT ENTER A SEPTIC, PUMP Off OTHER TREATMENT TANK UNDER ANY CIRCUWrA#ACES_ DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERiOR OF A TANK MAY BIE D1Mc{1LT OR gwrossmKE. ADDITIONAL COMMENTS POINTS INSTALI Flt i 3 iba POWTS MANiTANIIEA Name - W1 2 a ,, ;lock Creek Rd Narzsa Phone S r W1 Phone SEPTAGF SERViCIIJa 'OPERATOR (PUMPER) LOCAL REGULATORY AUTHOFM N alma _ Name — Phone Phone — This document was drafted in compliance with chapter Comm 83.22(2)Ibl(1)(dl&(1) and 83,54111, (2) 8 (3), Wisconsin Administrative Code. l _ PENECOSTALS OF NEW RICHMOND 3 -22 -07 MANAGEMENT AND CONTINGENCY PLAN SYSTEM EFFLUENT IS TO BE TESTED PER MIXED LIQUOR QUALITY ON A QUARTLY BASIS. PER POWSTS MAINTAINER ( STOIBER PLB. POWTS LIC 221044) IF TEST SHOWS HIGH STRENTH WASTEWATER PRETREATMENT SYSTEM WILL HAVE TO BE INSTALLED AT EXTRA J TEST RESULTS SENT TO: COMMERCIAL TESTING LAB OF COLFAX 514 MAIN ST. P.O. 526 COLFAX WI. 54730 # 1- 800 - 962 -5227 WIS. APPROVED LAB #19 RESULTS MAILED TO; SAFTY AND BUILDINGS DIV. AND; ST. CROIX CO. ZONING z r r� 55' 4 8' 44' Ln I' 4' DIA. 111 1 --1 r r 1 a < 'I 'I N N r7 2D' 2' btl bb O O n rn < m \ n £ D < Z r•I z n A 2 m n rT --� N E7 p D D O C t7 a Q T- Z N 2 rya �r r'i 3 D N r c • o , f'1 c Z 1 C� • � y ❑ Co iti s m w r n a Y � N n r r c 1 a n- ;o A p c T , 1 - p E P pqT try � ET i � � @011 -Q * S r=, r i7 c e ♦♦ c� spy 6 • ^ rq z n d — QIV'15 n r A z C3 o wl 'D n rq ri D to r^ _ L)< A �z ❑ r < b m �a p El z ti 45' 10' Z N 42' a 4' DIA. Z' C D w — 5' DIA. W 7s a lA rn c -f r r1 20000 737 HERBERT STREET MEMBERS OF A = TANK: a7abvz NUEECUTT CONCRETE GHIPPEVA FALLS. VI 54729 NATIONAL PRECAST CONCRETE ASSOCIATION i 1650 GAL. LOW PROFILE <7L5) 723-7446 x FAX <715) 723-7111 WISCONSIN PRECAST CONCRETE ASSOCIATION r z -A C80Q) 924 -1516 z (U SEPTIC, HOLDING, AND PUMP TANK THIS DRAWING SHALL NOT BE COPIED OP SUBMITTED TO OTHERS WITHOUT CONSENT OF THIS COMPANY J ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND A OWNERSHIP CERTIFICATION FORM Owner /Buyer tl of /q, lI D Ve z Mailing Address l �/ �- t t/, / /�, w ,P c- '/`` / ,,, 'e c /7 -q �/ -r -y u i Property Address (Verification required from Planning "& Zoning 'Depa for new construction.) City /State Parcel Identification Number 63'9- 1 674 76 - �qcp LEGAL DESCRIPTION Property Location _' /4 , '/4 , Sec. Z�� , T _-?/ N R_`�Town of ,✓ 7��� / �� f Subdivision , Lot # 2 , Certified Survey Map # 7 q8� , Volume /7 , Page # Z /.a2 3 . Warranty Deed # 7 4 O S - 2, , Volume ,2 1"4 , Page # f 6 e 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 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 1 4'* � 4loSYo7 SIGNATURE 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) 1 2350 16`f � , 73412352 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed made between Curt A. Volkert, a/k/a Curtis A. Volkert RECEIVED FOR RECORD and Mary Volkert husband and wife, Grantor, and _ 08/06/2003 08:30AK Pentacostals of New Richmond WARRANTY DEED EXEMPT # _ Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee COPYSFEE: 186.00 the following described real estate in St. Croix County, State of Wisconsin CC FEE: (if more space is needed, please attach addendum): PAGES: 1 Lot 2 of Certified Survey Map, dated February 24, 2003, filed May 27, 2003, as Document No. 722981, Vol. 17, Page 4523, being part of the Southeast 1/4 of the Southeast 114 and the Northeast 1/4 of the Southeast 1/4 of Section 24, Township 31 North, Range 18, West, St, Croix County Recording Area Wisconsin. Name and Return Address 7/ SUBJECT TO AND TOGETHER WITH a 66 foot access WESTconsin Credit Union easement as shown onabove described Certified P.O. Box 269 Survey Map. New Richmond, Wi. 54017 038 - 1099480 -100 & 038 -1100- 30-000 Parcel Identification Number (PIN) This is not homestead property (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this �` ' n day of Julv 2003 * * Curt A. Volkert, a/k/a Curtis A. Volkert * * Mary Volkert AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) — --- - - - - -- - - - — -- ) ss. St. Croix County ) authenticated this day of �T t +nap, -• Personally came before me this 30 p?iy of i! /. o r ' —= J uly 2Q¢3 - im jL e i ew •,''; Curt A. Volkert a/k/a Curtis A. Volkelt,yhid * Mary Volkert, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who exedbt`Qt a 9egoiq& 4 authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. %, .� ' �...••�'',�,•• �., b �►rl THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI Notary Public, State 6f My Commission is- permanent (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) Aj/' ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du U WI STATE BAR OF WISCONSIN 800.65' 2021 WARRANTY DEED FORM No. 2 - 1999 h 7 2 9 8 1 VOL 17 PAGE 4523 XAAMEM H. MKESIT REGISTER OF DEEDS ST. CROIX CO.. MI R RECEIVED FOR ECORD CERTIFIEM SURVEY MAP 05J27/2003 02 :50P„ LOCATED IN PART OF THE SE1 /4 OF THE SE1 /4 AND C SU HAP IN PART OF THE NE1 /4 OF THE SE1 /4 OF SECTION COPY FEE: 5.00 24, T31 N, R1 OW, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. I WEST LINE OF THE SEi /4 OF THE SE1 14 WEST LINE OF THE NE OF THE SE Ic N01 °7 1'09 "E 1254.81' APPROVED ;C p ST. CROIX COUNTY O Ptanninq Zonino and Parks Committee w M AY 2 7 2003 If not recorded with rova shall be approval date app null, and void CE52 Z lo AzNT m zym O p N01 °07'38 "E 300.04' p m m �_ O gmco zo .Q ?C5' r r 0 D I cr ' 0�Zr -cD z z o Eat --1 C) N ro ro co `°W �OE -n m r m l fu Om�L7 = S a D O p Nnl ON X n r r mZ O� r y0„m� mm fJm W o0 O v � cf)C7 N �' o p m N m mon OO r zS G' W °Z ► m m ;� 0 p _ M �!o�In I i0 i - — — IGJ�m;v7 0 , m;Dlrn L7 w c1 � I m El (1\100 °0809"VV) p O �' 0 1= � O 0 m So 178W0 M 1 -Af 1 I Sn2 a ;c:m ;mlz SHEDS G7 _ rn - .w I m CO m to N pg ---- ---------------------------- ---. ........... SETBACK_�INE FROM RIGHT OF WAY.................._..... . m S01 *10'36 r o E p �` 110' HIGHWAY LINE FROM CENTERLINE m � r�i 66 01. ; 49.63' ACCESS R STRICTED SEE ACCESS RESTRICTIO NOTE PAGE 3 EXISTING DRIV 1 798.59' 801 "07'38"W 9 .00' - ° q � EAST LIN OF THE S_E /4 OF S 24 Q _ EXISTING CENTERLINE s�T.H� --65 `� —NO1 °07'41 "E2627.56' --' �C1 dLaMD�S__(D W _ _GD Eff (9)UNE Gig -V o M A q^ N c p N _________ __ _ __________ _______ _ ______ -___ _ _- _- ______ 9 M M p r v ® • • O =o o'M' zR3ooh c'0 �e oz r ° z 03 = : :E z ... M 5:z a m z oo m o =o D ,X m > =o 'z om cn -=w r- OQ M O rn rm C) `"�o'�p �� n y� m L/ _ cn O ca OHO p '71 O ?> O � -'L'�� O��o�� m�Pa TI�� $ 111 70 c C O m0 m Q D z m p o L7 m aZ Z '^-' c v m ma _ cn n n m z z m z �; O - -_ —, m a c o o -0 = v = — 11 'c 0 y o -o �r z �fTT17I r 7 C m cn! NN m o o O Om o U A v D 0 Z L7 O ° z SEP.RINGS ARE REFERENCED TO THE p EAST LINE OF T HE SE1 /4 OF SECTION 24. ASSUMED TO BEAR N01 ° 07'41 "E. THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 03 -04 DATE: 2 -24-03 Vol. 17 Page 4523 Parcel #: 038 - 1099 -80 -300 04/06/2007 02:40 PM PAGE 1 OF 1 Alt. Parcel M 24.31.18.417A -30 038 - 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 O - PENTACOSTALS OF NEW PENTACOSTALS OF NEW C - RICHMOND RICHMOND 1459 WILLOW AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 2018 HWY 65 SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 6.200 Plat: 4523 -CSM 17 -4523 038/03 SEC 24 T31 R18W PT SE SE CSM 17 -4523 Block/Condo Bldg: LOT 02 LOT 2 (6.200AC) HWY PROJECT 8936 -06 -21 EZ -1- 2157/098 '03 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 24-31N-18W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 10/08/2003 743083 2432/89 WD 08/06/2003 734052 2350/164 WD 05/27/2003 722981 17/4523 CSM 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason OTHER X4 6.200 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 L ottery Credit: t• � Claim Count: 0 Certification Date. Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED Wisconsin Department of Commer IL ALUATION REPORT page of Division of Safety and Buildings A 2UP- in accordance with Comm 8 , Wis. Adm. Code County Attach complete site plan on papa of leiwtl{ah' V Ni ches in ize. Plan must f include, but not limited to: vertical a horiz6hW direction and Parcel I.D. t / percent slope, scale or dimensions, Wort arrow, and location and distance to nearest road. Fe f1 ; h Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location M C r+ + f•,o- L ke-v Govt. Lot E 1/4 : 61/4 S T3 ( N R 9 E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 0 5 �5 C State" Zip Code Phone Number ❑ City [:1 Village ® Town Nearest Road * New Construction Use: C9 Residential / Number of bedrooms _3 Code derived design flow rate �/ S� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material CMG : a y 'f s-v at. c,�j Flood Plain elevation if applicable ft. General comments S V Q - 6 4-76 - 1 0 d""-- and recommendations: S S �-, h � �o oC . S �'1�.� Foe T 3 ( 9jo,4-7') 5,4e- > ♦ d 7 (9 ' 7 - 3 S' � CU.-�� � 5 .�,,� a ` � . ) y C F-11 Boring # I� Boring 9 / t� Pit Ground surface elev. 0 .3 g 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 I 'Eff#2 t o -t a o'ff� z 5�-- _ w► r d r !V-11 7 . 210 h - C> G I Q c Fol Boring # n� Boring 99 o L]5 pit Ground surface elev. g 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 I 'Eff#2 0 -11 p 4IV ;L --- - S L � R., rn fit•- -3 a P • 5 a t )-;t .5' / -- ---- -- b - V11 L dY-loc 7, S Y S 4 - 5 - ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS 1 30 mg/L T Name (Please Pit- Signature CCSTNuumber �., a a I A �( ?� a D p - f- 5+ Date Evaluation Conducted Telephone Plumber 3. � u r T-} I �►6t, Y� l� t � Ll Property Owner V O' KGt�-� ! c` Page , Parcel ID # P e of Boring # ❑ Boring / F - 3 1 pit Ground surface elev. b`1 5 ft. Depth to limiting factor 1 /�/ rf in. Soil AWication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 b -1i olp" SL- a R OF gS 14 ,, Y - Se- 3 8 .30 "71 5 V - 1 4 h _g iM L -7 !. 3b-11 0 7.5 t, - 7 F - Y] B oring # ❑ Boring R pit Ground surface elev. � D� Depth to limiting factor J 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. i 'Efr#1 'Eff#2 l b -I S L-- a -6 rK r .5 a a /-- �--- -� �. a� m 3 A�_` y,� �_�___ -s ML Cw iof , - 7 1, , 'f - -)SY s --- ------ L '' , 7 . ❑ Boring # Boris . ft. ❑ Pit Ground surface elev . Depth to limiting factor in. Sal 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 5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD a 30 mg/L and TSS 1 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 /00) rn 1- ^` �^- Zr � c T LA ti c o • a Id 00 Vl* % 05� G o, _ f, 1A p_ e _ N c V _ UL> CF Q LP a '6 T cn •.1- w o C� 4 n — W 4- 1 } �a 04/1 10:06 7152469321 iOWld GOUNTIRV REALVV PAGE 33 I I • CERTIFIED SURVEY MAP LOCATED IN PART OF 7 THE SlEl /4 OF THE SE1 /4 AND IN PART OF THE NEB /4 OF THE SEA /4 OF SECTION 24, T31 N, R I 8W, TOW IN OF STAR PRAIRIE, ST. OROIX COUNTY, WIS CONSIN. - --------------------- ---------------------------------- 1 , 1 JEST LINE OFTF 2 SEi/4CF THE SE,/4 — V;E8 LINE OF TKa N THE SEIM 11 N01'11 I'09"Ll 1254 1' w � A rso N r AIM : M I S t • $� N ' .10 C2 ;j, 01 '41 178.04' J� ,7' M .............. .. .......... 11"' KGHWAYSETBAC4 LINE FPOM CENTEV%:KE ..... ...................... r ................... . ...... . ...................... ROD 2 JI 13441 NO ACCEW 79E.59 E)OSTIK$ DRIVE 5olww w , 3vp3.00'0 !kS 24 1 EXIS; NG CENTS --N0l R I r. MJ DJ 9 D 1. T 19 D :. I K1 �; 9 �, Co) TY KI [ 9 Do 1 -5 "Y 00 �- X, 3 A! 9 ---------------- I ....... --------- ---------------------- -------------- ------------- V C. 0 m Muc Mim 0 3; M L2 A sn SA T n f m 1 +d�mp� xl�fn 0 5 c- rn Fn rr rrl — z A G m - n is I..4sTRjmr= CRAFTED RY mC.LiAEL EPIQKSON NO, o-04 DATE; 2-24-03 4. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County J?z - G �`d G� �C C . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner / r �L, Property Location / CO 1 Fa1-� d T / ( �'�✓ I A7 h /. Govt. Lot .f 1 /4 -S 1/4 SOZ Y T N R E Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /Yr 1 7 Cc/< //cicc/ City State Zip Code Phone Number ❑ City ❑ Village ,Town Nearest Road ke wart,h'V0' of w s`�U /� ( ) .^ <" 6 J — ew Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: C` U" Parent material Flood Plain elevation if applicable ft. General comments and recommendations: 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 GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 f` 3 a te - 7 � 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/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = OD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Pli t Signature CST Number Cf ecn K a Address Date valuation Conducted ? i Telephone Number / sfciv L