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HomeMy WebLinkAbout038-1111-50-000 Wisc,onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sof&y and Building Division INSPECTION REPORT Sanitary Permit No: 506379 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Pla;a 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: Backes, Gerald I Star Prairie, Town of 038 - 1111 -50 -000 CST BM E!ev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: I M D 4— 28.31.18.470 TANK INFORMATION ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 2 - f5 S Benchmark /0 Dosing - 7 6 S Alt. BM 8 Aeration Bldg. Sewer ,03'/ Holding t/Ht Inlet �2 •L (/i '/ SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L W E�jL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / LL t Bottom U� � ! /7• � Dosing He ader / Man. ti . .1/kd Aeration Dist. Pipe Holding Bot. System Final Grade *' PUMP /SIPHON INFORMATION Manufacturer Demand n �/ q GPM -7• S � Model Number D p S 0 TDH Lift Friction Loss System Head � — TD� / Ft 6 C Z7 Forcemain Length I Dia. 2 �� Dist. to Well / 77 i t aft. i SOIL ABSORPTION SYSTEM BEDITRENCH Width i Length No. Of Trenches ,,,DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /O �Q SETBACK SYSTEM TO P/ WELL LAKE /S EAM I EACHI Manufacturer: INFORMATION - CH R OR Type Of S stem. N t 4 Model Number: DISTRIBUTION SYSTEM 5 a / Ox Hea er /Man it ,} Distribution x Hole Size x Hole Spacing Ve t t — ta �C ke (�t a,t/��,,� Pipe(s) qL/ // Lengt Dia Lengtha_ Dia Spacing /�?/ 6 1 / SOIL COVER x Pressure Systems Only xx Mound At - Grade ems O nly Depth Over Depth Over xx Depth of xx Seeded /Sodded xx i u ed Bed/Trench Center Bed/Trench Edges Topsoil / — Q d Yes 1 , No Yes ]No J COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:�/ `� / d Inspection #2: // Location: 1974 110th Street New Richmond, WI 54017 (SE 1/4 NW 1/4 28 T31NR1R18�W)nN_A�L,ot,n Parcel No: �2y8..,3,1 .118.44770[ 1.) Alt BM Description = 'v�� ��(,d�/�N ' � - 2.) Bldg sewer length = yS � L✓�^'tR +0 ✓ � Q-( t - amount of cover =� u It Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) L�✓ Date Insepctor's Signat re Cert. No. corn merceml.gov Safety and Buildings Division County n L 201 W. Washington Ave., P.O. Box 7162 ( /� % s Co n s n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) ■ Department of t,omtrleroe 56 9 Sanitary Permit Application N.04 State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this forth to the appropriate g men Q unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned PO are dress (if different than trailing address) l77AI submitted to the Department of Commerce. Personal information you provide may be used for secon a4_ //,o p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Slats. 1. Application Information - Please Print All Info*matioin Property Owner's Name Parcel # 035 - Property Owner's Mailing Govt of Addre / RC�IX Property Location ;7,/ / L�7 S ' COUNTY` City, State Zip Code Phone Number 1A y., Section G r (' o D/ T�_ N; R E kW le 11. Type of Building (check all that appl Lot # 2 Family Dwelling- Number of Bedr ms Subdivision Name Block # ❑ Public /Commercial - Describe Use ❑ City of CSM Number El Village of ❑ State Owned - Describe Use � / /D -�- /40 ^ , a ✓-- own of S,�a / ; - 0 60l III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑ New System Iacement g p Y g y (explain) ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System ex lain ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) d✓ ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground de ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/rreatment Area Information: Design Flow (gpd) Design Soil A plication R�te(gpdsf) Dispe sal Area Required (sf) Dispersal Area Proposed (st) System Eleva[ion Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ;? c d _ V U U N New Tanks Existing Tanks U Septic or Holding Tank ��— Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume respW!M for installation of the POWTS shown on the attached plans. Plumber's N me (Print) Plumber's Sign re MP /MPRS Number Business Phone Number 2 7 rti l aG Plumber's Address (Street, City, State, Zip Code) VIII. County e artment Use Onl Approved E] �Reason Permit Fee Date I sued Issuing nt Signature ❑ O enial 1X. Con didOWW" tasons for Disapproval 1. Septic tank, effluent filter and 3) dispersal cell must all be services / maintained !.✓� >cA M+• . as per management plan provided by plumber. 2. All setback requirements must be maintained 1 r a retti- 5p a O et O t ac r to complete plans for t e system and submIt to the Cou only on paper not less than 8 12 _ x I e hes in size Csara V6 w6t. ^ A SBD -6398 (R. 01/07) Valid thru 01/09 L\ �j /� �1_ _ _/_ �J� _ _(J PLOT PLAN PROJECT Gerald Backes ADDRESS 1974 110th St. New Richmond Wi 54017 SE 0 4 NE 1/4S 28 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.4' BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .ABSORPTION AREA 1000 # o chambers none ,BENCHMARK V.R.P Bottom of Siding ASSUME EL N 100' Filter BEST GF10 -8 ❑ BOREHOLE WELL * H. R. P. Same as W Nv 110th St � Scale S�`�� /4" = 1 ' 40 Acre Pa_ r�q �0 O 1320' Property Line Old Sy em to be pump and buried D Area 15' below system is Faile s stem to remain undisturbed 9% Slope 95.5' 800' 96.5' Existing 4 Huffcutt bo B-3 97.4' Bedroom House Tank 97,5' Weld o� Tank is to be properly bedded and provided with Grading is to be done to lockdown covers with divert run -off away from approved warning labels -2 system �9 f 1 PLOT PLAN PROJECT Gerald Backes ADDRESS 1974 110th St. New Richmond Wi 54017 SE 04 NE 1 /4S 28 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.4 BEDROOM 4 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none Ilk BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100 Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 110th St. 40 Acre Parcel Scale = 1/4" = 1 O' 1320' Property Line AL Old System to be ^ pW pumped and buried �J Area 15' below system is ST Failed system to remain undisturbed 9% Slope 9 5.5 800' 96.5' Existing 4 Huffcutt Combo B-3 97.4' Bedroom House Tank 97,5' B- 98.5' p B.M.* Well Tank is to be properly bedded and provided with Grading is to be done to lockdown covers with divert run -off away from approved warning labels B-2 system Safety and Buildings 4003 N KINNEY COULEE RD Co111111erGe.Wl.gov LACROSSE WI 54601 - 1831 TDD #: (608) 264 -8777 isconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 24, 2007 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2009 Identification Numbers Transaction ID No. 1477034 SITE: Site ID No. 731736 Gerald Backes Please refer to both identification numbers, 1974 110 Street above, in all correspondence with the agency. . Town of Star Prairie St Croix County SETA, NEIA, S28, T3 IN, R18W FOR: Description: At -Grade / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1158480 Maintenance required; Replacement system; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, Version 2.0, SBD -10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. r l • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. DE R7 1 0 0 N tJ• 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. SSE G :� • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 10/24/2007 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated. Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday. charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. A - 1 noz z z iDO C EA1303a Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 10/18/07 8 07 Owner: Gerald Backes Location:SE1 /4 NE1 /4 S 28 T31 N,R18W Star Prairie 1974110th St. System type: At -Grade Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706 -P(N. 01/01) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Con 'gency plan 9 -11. Soil test Shaun Bird `gVally Signature WED License numbe 6900 )F COMME cY lNGS ONDENCE I i i >rj PAC . A ! G p �.MA� � 4 = . up7 G TT "' • T k-- DtSY'itsTtar1 i1►YI.R.AI A r > 5' 1. /C B 1/613 � 1f2B I L .11 �+ �,• C£it AiCs6/cE.�sit�TE t�pPttiti�t�a SX� Fab�io Distribu tion Lateral f1 - Sail Cover STAz;mI - tmb Observdtiv�t --- Wel i • � �.It`1F.R� 5` � > 5 Gross S; of pi At•r=� Unit with $ PIam Vice ax%4 Site Single AbsatgtiarL Araa on a Sloping g �j tic n� Src. �• AL P age Of Distribution Pip DeWl for Lateral *twork . ACcesf ' TuRN - �CL�il�Ot1 T} - PPVC Fame Main PVC Distribution Pipe - --- -- P Last hole Should Be Next To ruR�i- vP Q iameter �- /_,� finch p 0 Ft.. Ho i� X ` Inches Lateral Diameter r. Inch(es) Y Inches Force Main Diameter Inches �� of Holes /PiPe p q Invert Elevation Of Laterals / � / Ft- Signed; License fir: Date: •. �C'F I Sp£CIi ICATIONS ROSS S C SEPTIC TAN" RW .. 34TH. AB GRAaE �� fl14 BOX APPRt1vED OV C ©N I2 T ROL£ CO's ER G ` v E iT pI'P£ I wl1 , I OW OR WITH Co 43! PADLOCK E gl +! 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[/ pLilfP £ y+r£a�R wj:R"ll6fs 'PFg EL gy ;TC8 TYPE ���,,F I PIP£ Z FEET FATE T DIS DISTR V � FEET p TtI SC --� fiN33 _ IR p Or - . • R t4 - EN - - +CTS FEET $E - - OW FA rmENCE ESSU E FR ;CTI v ER �` s€ pPLY X > i 4 T - �€ L DY OiA � ifi ± TSINIH pEE IN � - t's�M ..--- fi 'I gflR j WinTH b or T^" LIIQUID L Nsl DAIS I NA LICENSE ?I88 • Sent By: HP LaserJet 3100; 1 775 OU Otfizr May -O-Vo t•wrm, 1 °a" " " w a .)EH SERIES SUMP /EFFLUENT PUMP • 0 icstionss tea am lereoww mea a OWN )erwBlBalpB�� solo MIL 14 ad PAM i1S= B` erns Afi W aa� P ,/ tP 0 32 taa 27 24 4.11111.64x824 Sol 4 5082aa wCsa 480 1* 34 , a0 woo 70 64 65 65 woo 4 55 A 32 ta4 2a 24 9.11 01.6 AN 981-m soa3ao t4Rx► +TO 280 ,9p 70 6 4, 32 , a 6 W 27 &11111.64:424 ON434M 500.950 WO 44" 0 1 ,5 9N ,3A ,000 70 64 SS n 111 sm*ff SM 4M 230 cw4h.ors DutyR�roO --� e�ca�o. �mror�., esa,. em. arnr> ��a� +Mra�.rw�wiwnyra+�a�tat�uso.r�r constntretion FLOW- LI T E4/S /H" Motor Ho 7Cy Coated Cast Iron 0 two 2000 3000 Poly CubotmW iinpeliec Material lobed Vane to — — Volute / r '. Power Cord SnW A Mechanical Shalt Seal Name with oaf and camnic s f STaitlless Steel :o Sha - _- -_ Stainlela Seel 2.5 Be nSs Lipper Sleeve and Laver Bail Bearings 0 20 40 60 so FLOW- GALLON"- PUMP PERFORMANCE CURVE win Lime CH"t ftmp CO. 1113Y bum PO Box 1200. - CSMOBK73157 tto r.4OLY471SU • ]P": 466.228 '1564 9"236-07103 9"236-07103 www Littl4eG1anWump.COm �3 Form G .� PLAN POWTS ow 's l u L s re cVI CA MNS ^. j-- a NA �s SePdcT -�. O rw SOPOO o t�� l # Mot "Model G'f � o l� PumF T MOW of � � U Ramp Y NMnbet of _ flog (j cTrj . piam ❑ x 7.37 PurnP tA el f]es�n 11.aw (Pes:4 i P t Unit C1 Peat t� SO AN t Montt�Y eve e 0 D wet+and Inftc�ec F � 08 & G� o (FOG] 0191 p n D Omer: � soya: tY �) tAOCOW average ai I (g Ct Mou (P TOW P auaW ODs :530 m� 13 -9 e O Mound - ®n Oe� ( S30 rrig& 9 D Ocher '�'� Owed Solids �) si O° CWfj OOm1 GI - toy eeD � ray M„mr.ns me Feed Cow y . inch diameter «. fOrp sid Pale size S�rvles Frequency M�H•�1t� Sq{EpULE s) (M 3 yM-) Event rnonths sue' At feast once eve's' m equals onetturd (Y,) of tank volume peaconcMn oftank(s) Wtsen combined sludge ands • r(s) (MiLgimurst 3 yrs -) �, tank(s) ❑month Z7 � .1000 PUMP con � At kmgst once every 0 c p s c(s) t dlspe�� ceU(s) At least once every ' s) O NA II Clean s ffluetfmr At least once every � n U III a) 0 NA Inspect pump, pip °ontrors b afarc+ At w ast once every Q II year(s) 0 NA Flume and test At Unist once every II mCn fl yoar(�) p NA o0w- At lPy9t Once "Very ocher : fang fiOenfi or one of trw sepme MAWT9NAfX* OW oftssnks mil ddia�'� ° WM be made by 89 Res Seer pp 's t P ea = tt I d o r bc back on of tfse tsmw up ODOM Plumber. Whew P ' de a ja i inapeatl a � ism and tv d= �� bvels jgg�. Maw cow Tank inspec tions; mum ure 3tee volume of combined l„specbed s tits ant on the seiaw ha r war any packs or leeks. +Hess The disPOr� osif(a) stfa� � . The po � � w- on t" gad - d-uyg of efflue A an the �� n of the � te9 ' or POCA&V Of dMXM POW and to diet n and requlr+es the ilrmedia� n - or mote of �nK � � NR in to obsenFAWn �► a a� 9urn in Sergi g LLOb dip of to ground wjff&M tank shag be rem a SePta9e - t comp��• mid OW 113. W Admsnls Code. p S$urbmd POVM OOMP ts. a POWTS Ma,n of j of .12 mont!'fs of less shall s e ew The s ther � latory arity witfi�� 1Q of come On of any Or ffalfwkv A.1AV r be >oc� utho for p .1 QUO O 0#0 START L(p ANO OPERATION ofthe s if concen to t Pri°r f e' For DOW ate P� POw'rs arl� • r dam gB #�e �' � 5 �- �' �bor�s phi t°� tr s ed try a sePta9e servic.�ng us - det+ec�ed I G: at the ink su� !! Std trOL 110CGlf ytfiert ns arie irk p owe r is fesUxed ft mess SysEe m stall levels mutt in [ha ng r oP t�nalY a srs °SB• tank removed by a wed d o ttre the contents Cis siftsadw Duri of the PtP POWt'S m " zd � a of too the ezuent pump or a Piun dOMbr� normal Wels vfthfn the pumF tank s S dtWfG ppei fp gone a� in n � P � p - . DO not give ar Palk Over- of �ompac W rA d(W or pak v�bt over and de soil abs"flon area- ihe wgMa is tee down shPS Of ally � stl�a may impwv v the perfom�a = and the lie R� � �aW(l COW � ' � bulls; condoms; Cotton swabs, degreases=: t l� of tie POWM � �� frta?t and �� l � � meat � bt drag {sr3mP . =rdtw napkins: tarnpon5 ",and water sof scraPs; r� she fnua na steps straff by taken to k[srrre that an WP fads WWI or priance �h ch -ceComm 83.33. � � �w systr=m is praP s Y and the abandoned pipe �t All ptp to tanks and pits shall be � and proper d•�p�od r of by a Se~ •Se vldtg Operator The co *KVfs of 2tt[ t=rice and P ,,. ,.0 taste aW removed or ttietr �^6rs err�ovecr end trss WOW sp.eae • After prFrrrp g. aQ te2 arsd h shad frd matedal- tMed yydh Wolf,• grav+ei °rang inert � e a code CON[�'[NIGENC`! P6.M ttt� measures have been, or mast be takgM Psov )f the POWTS f� and n of a �t sod cornpGant �ertt �' beer: crated and may be dfr d for urb corn and should f10t D A � � ' should be pro f � �� W � and we0r., FA&M to ab�sorpWn system- s morn existing and proposed a suGabie be rnfrn�ged upon � m in the need for a new soil and srte �� °Rep�enL -teins must oarriPiY with the rul so in a at fta& B ad�� in POWTS t=ree is no t able to setback and/O the fae'led PO D A� � � � be as a fast re to t area Upon faguum of See POINTS a sab.and a surtable replace' area is available a Zbe st6e has rat bean. a �� - a. su1Mbie rePlaoe'?ient ate- if no repot site e last. rt to replace the fad PC s of the biomat at rern oval hok&V be reoonsons� in place frsQowing 1 wnd and at -grade sole a of Waal must camPty with fhe nries in elfedat�attirsa~ the ftdftVrMM �cYftARltilrNG�� T KS l3IfAY CONTAIN LMWAL GA -gSES. A "Yop- iNSt:IFF[C[t:71fr OXZ' - SEPTIC. pLW AND OTHER TREA RF.A z1zF�1TMENY TANK UNDER ANY C[RCUMSTAN�' DEATH KAY DO rwr ENTM A SEP'nc. PUMP Ott OF A TANK MAY BE D[FFiCtJt -T OR tIkEPOSS[BLE. RESULT , RESCUE OF A PERSON FROM TH �� ADDMONAL C0�1Y[F -M POVVTS MAINTAINER POWfS INSTALLER n 4 Name Nam Phone Phwe SEPTAGE S�� ppp�4TOR i:OCAt- REGUtJ�TO/R�Y AtJIHOK(rr , E e,, , cy C ✓' i I- � N2M Phone T,& w co�cr z 9rd s �• Ttas arne�tt�s dr:ibd by,16 Oft Of 09 Gif m Lake• mid 83.St(iy. (2y � (�. �° � Codes fuse of m doctmteot dons � u e rr s of eh. L'.orsrca Si It GUW ( 20t) prawn of the POWIrs i Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings • in accordance with Comm 85, Wis. Adm. Code c^ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County V include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. l percent slope, scale or dimensions. north arrow, and location and distance to nearest road. v / / VV Please print all Information. Reviewed by Date Personal irdornmatlon you pVv May be used nor secondary purposes (Privacy Law, s. 15.04 (1) (m)). PropertyOwner l Property Location Govt. Lot„$ 1 14idoe /4 S �8T 3 N E( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 7 v city 42, t Code Phone Number I]� ❑Village NZF S a ) Q New Construction U ' rttiai / Number of bedrooms Code derived design flow rate GPD aosment �ublic or cornrnerdat - Describe: -- -- - - -- - -- Parent material %• ` Flood Plain elevation fl applicable �L ft. General comments and r000mmerdations: �+ System Type / System Elevation ❑ Ong # Booing Pit Ground surface elev. ft Depth to limiting factor In. Rate Horizon Depth Dominant Redox Desaiptim Texture Str Consistence Boundary Roots GPD/fF in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. n 'Eff#1 *Eff#2 7 .s ' # loner ❑ Pit Ground surface elev. ft Depth to limiting factor 3'7 in. O SID lion Rarte Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary D/W in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#2 A J � Z a -37 ,s 1. fl 37- 70 0111- I Alp • Eftert #1 ■ WD > 30 <_ 220 mgt and TSS 2-30 5150 ' Effluent #2 = WD ,: S 30 mg/L and TSS < 30 mg CST Nang I P*t CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 "O property Owner parcel 10 # page of E Boring # ❑ Boring S ® --pit Ground surfaceelev ft. Depth to limiting factor in. Rats Horizon Depth Dominant Color Redox Description Texture Structure Corslstence Boundary Roots . GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '802 —L j i0 �/ / ✓/ - Boring # ❑ ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dorinant Color Redox Description Texture Structure Consistence Boundary Roots GPDI'fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Et f#2 F-1 # ❑ Ground surface elev. ft. Depth to krnoV factor in. ❑ pit Soil Application Rate . Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAF in. Munssil Qu. Sz. Cont. Color Gr, Sz. Sh. 'EW *EW Effluent #1 BOD > 30 5 220 ffg& and TSS >30 1150 mgL ' Eill cent #2 = SW,, _< 30 mg& and TSS _< 30 mglt. 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. sewuoetAW) 4 ' Soil Test Plot PI Project Name Gerald Backes Sha ird Address 1974 110th St. New Richmond WI 54017 M #226900 Lot ------ Subdivision ----- --- Date 0/18/07 SE 1/4 NE 1/4S 2 8 T 31 N /R W Township StarPrairie [] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 97 -HRpSameas Benchmark 110th St. 40 Acre Parcel Scale = 1/4" = 10' 1320' Property Line r DW Failed system ST 9% Slope 95-51 Ro o. 96.5' Existing 4 B-3 97.5' Bedroom House B.M.* B -1 98.5' O Well B -2 Wisconsin Department of Comme SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accor Mh Comm 85, Wis. Adm. Code County Attach complete site plan on paper s than 8 1/2 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. eJ OV Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / 6 l b� ) Property Owner Property Location t�t® of � 1 /4/j/�1 /4 S T 3 N fjl E( W Property Owner's _Mailing Address # Block # I Subd. Name or CSM# 7 IIA4, �' : v City late . Zip Code Ph a Nu WT 3 20 ;0 City E] Village Nearest Road ❑ New Construction U sidentia1 / Nurriller of bedrooms Codi derived design flow rate 642y GPD Replacement ublic or commercial - Describe: __— Parent material �– l Flood Plain elevation if applicable General and recommendations: System Type 1__ / System Elevation a Bori ng # ❑ Boring Ip� pit Ground surface elev. ft. 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 C' 02--�- Z -2z �y -: n s- 1 -6 s Boring # Boring ✓ Pit Ground surface elev. ft. Depth to limiting factor 37 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 37 -7 � s Effluent #1 = BOD > 30 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� _ 715- 246 -4516 Property Owner _ Parcel ID # IS] of Boring Boring # ❑ ® -Pit Ground surface elev. � ' � ft. Depth to limiting factor l Ls_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eft #2 o 3 a (^- I ol a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. -- go — ilApplication 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 a Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. 59EKilication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf 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/_ ' Effluent #2 = BOD, < 30 mg/_ and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (8.6100) i Project Name Gerald Backes Soil Test Plot Plan Sha ird Address 1974 110th St. New Richmond Wi 54017 M #226900 Lot - -- --- Subdivision "' "' 0/18/07 Date SE 1/4 NE 1/4S 2 8 T 31 N /R18 W Township StarPrairie [� Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 97.4' *HRpSame as Benchmark 110th St. 40 Acre Parcel Scale = 1/4" = 10' 1320' Property Line 9 DW ST Failed system 9% Slope 95.5' 800' 96.5' Existing 4 B-3 97.5' Bedroom House B.M.* B -1 98.5' O Well B -2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e c Mailing Address 1974 4 /1Ieee Z f C it � s/ l7� 7 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 5 I- 1 /4 , r %4 , Sec. �-- �, T 31 N RW, Town of Subdivision Ste' , Lot # Certified Survey Map # _, Volume , Page # Warranty Deed # �`7 �'� / , Volume �, Page # Z AV Spec house yes 0 Lot lines identifiable ye 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. Uwe 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. Nu er f bedrooms SI NATCTRE 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) _ RE_+C rtv l: "� aJR REC:'7 NOiliG DADA DOC:UME_Nt rd t.. aT_ \ "1 F: i; :ti;. ul!' \Siff FOP QUIT CLAIM DEED 117 PAGE 4 � � c-• � . yn; � Gerald_ P.._ Backes and Marccl,],a. -.L.. - 33ac -- - -- y husband and wife _ - -'- - -'- - - - - ---- A PR 2 a9gu quit- claim:; to Ge l e G• 3 rad P. Backs and Marcella L. , A n S Backes, as trustees_und succes trustees oF - the Gerald P._Backes - and Marcella L. Backer Revn.c:ab.le . L -wing. Tx.us.t_ dat -ed . �ai•1?.,i.?x�y ? , - -. i . � S 19.90 _ - . _ .. the i'oliwimr descrihed real estate in County, State of Wi,�consir•: !r{ ✓ " A, �\ 4- q T iG�r " r - Tax pal'..el No: _.. 1111 -50 038 - 1121 - 1 0 038 - 1111 -20 038- 1111 -30 038 - 1111 - E0 038 - 1111 -70 See attached. description. EXE i. This -- -- ------- s - --- - - - - - -- homestead property. (is) (is not) mated this _ ____4th_.. day of ...._ ._Parch - .... .._. -6.. (SEAL) :�1Gc�r ! .�t '�' (SEAT.) _..... ` GER.ALU P . BACRES 7 -- _. (SEALI r / JI r c t -. �� (SEAL,) AUTI-1 BNTICATION A C K N 0 W 1, r-: 1C) a b4 RNT Signature (s) ------- - - - -- STATO OF WISCONSIN - ----- ---- - . ---- - - ' .( -- ....-- • - - c --- -- -- S'i'- CROIX County. ( t e a owe es '--' ----- 1 authenticated this 3a - c._. ._... 1'J ---- Personally came before nip this --- 4At h- -- - '-day of h named MaFh is -.9 6 -. b 1 Gerald P -' Backes_ and - .- ..-... Mare 11a L . - Placices - , - husband and TITLE: 1TF,MRER ST ATF. 13-N, it CIF W1SC0NSIN --- -. wife -- - ---. --- lifnot, - - - - - -- -....- .._.- _. . -... ........ authorized by 706.0(j. Wis. S- .ats.) to me knot�n to be the person - S \tho executed the tore• ^ist� ,tciii A ReTnina in < / +a {/ eo4 / an n '1 i a the same. VA .IRaF.F_D V1 _ T-4...1/� RPi�tlNczTON LAW OFFICES - - udith . ,7udith A. Re*liizigg � , ..__ .. - .... ...., . .. ..- _ .. , New Richmond, WI 5401'7 Notnrt i' 1? . . .st 0 Crolk G unty, wis. (tii..roal.11 rr•'- nr: }- hl .:�+t':c mica ird Ilr a.•I: noa •'crl. L'. ±eh 1T C�nln,ic;-iou is permlmer. . t tt nod; - ,state ex piration d al... .. .._.. -_> a.) . - -..., - :x/'\'1 le: \1: lll' \a'Itit(bt vl\ tC :�. -..:- I.•e - .. nrvk !•n. In. )Lr i'F C(, .11 h5 T:1•: 1-: r +_(Ilf ♦1 . \... — I'.n_ .. ... n.. ..... tb -. A parcel of land in the Nor r- theas Quay 'u of r-he Northwest ouarter and the Northwest Quarter Of ti-le Northwest (_)uarte of Section 28, Township 31 North, I tlj 4t:11 Range iii ries- t- I principal meridian, located in and f-£1c4 -1 a P-IC c-I L lt�_: L , `1 St. Croix County, Wiscoasi", UtIore Fown of Star Prairie, particularly described as follows: Commencing at the North Quarter corner of said Section 28, the point of beginning; thence South 00 West, 1., 286.15 feet along the East line of the Northwest Quarter of said Section 28 to the Quarter Of the Northwest corner of the Northeast Southeast Quarter of said Section 28; t hence South 8 9 0 31' 13 West 2.271.77 feet along the South lint- of the Northe:<Ist Quarter of the Northwest Quarter and ti Norv_rxwesv-t_)ucALu­j- Northwest Quarter of said _.;e- 1) 0 ction . in a meander line of the T pple River; thence North 09 52" East, 164 .17 feet along said meander line; thence North 42 ' EaSt, 174.17 feet along said meander line; thence North SSOIS East, 926.24 feet along said meander line; thence North 38 East, 597.8 feet along said meander line to point in the North line of the Northeast Quarter of the Northwest Quarter of said Section 28; thence North 88 East, 995.01 feet along the North line of the i Quarter of the Northwest Quarter of said Section 2 8 to the noint. of becrinninq, containing 2, 190 acres Land lying between the meander line and Lrie this Apple River is included in this description. Bearings used in this description referenced to the North line of the Northwest Quarter of said Section 28, assumed bearing North 88 East. North I one-half (N 1 of the Southwest Quarter (SW 1/4) of the Northeast Quarter (NE 1/4) of Section 28, Tow-.1ship 31 North, Range 18 West. T - Ihe East Half of the Northeast Quarter (E 1/2 of NS 1/4) and the Northwest Quarter of the Northeast Quarter (1,94 1 of NE 1/4) of Section Twenty-eight (28), Township Thirty-one (31) North, Range Eighteen (18) West.