The URL can be used to link to this page

Home My WebLink About038-1099-80-001Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you Provide may be used for secondary purposes (Privacy Law. s 15.04 (1)(m)] Ag Storage Shed CST BM Elev: TANK INFORMATION TOWN OF STAR PRAIRIE TYPE MAN F CTURER w �} r CAPACITY Septic lL-= E2 Dos Aera Hol TANK SETiACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ti 24 t �� ( r Dos Ae n Ho PUMP/SIPHON INFORMATION SVQTPM TION DATA STATION BS HI FS ELEV. Benchmark 2.041Oi.o Jae .o All BM Bldg. Sewer SI/Ht Inlet SI/Ht Outlet DI Inlet DI Bottom Header/Man S.40 gii. 30 r Dist. Pipe s+o gb,3or Bot System 6 .2 •2$ Final Gr e Z S oy? L at ENCH DIMENSIONS WCN r Length I No Trenches PIT DIMENSIONS No. Of Pits inside Dia Liquid Depth D SETBACK SYSTEM TO PIL BL G WELL LAKE/STREAM LEACHING Manutayurer� INFORMATION CHAMBER OR T OI Sy y system f f •_4AJ�CV"�l�_IX) 2 O � �r UNIT Model errSµ' DFSTRIBU I ION(f YSTEM HeatleriMan la Lengt Dta� n�u ......�.. Distribution Pi s Lengl Oia Spacing x Hole Size�1��HOIISpacmg�Vent to Air Intake 1 Zi S Q%AL %.VYCr% x Pressure Systems Only xx Mound Or At -Grade Systems Onl Depth Over Depth Over xx Depth of xx SeedediSodded xx Mulched Bed/Trench Center Sed/Trench Edges zJ Topsoil (� Yes No Ves No COMMENTS: (Include code discrepancies. persons present. etc) Inspecion #1 Inspection 02. Location: 2050 HWY 65 1.) Alt BM Description = 21 Bldg sewer length = Ip r - amount of cover = DuT 3> vwft n eaoe 1.;' to Plan revision Required? ' ,Yes No Use other side for additional information' S D-6710 (R.J(97) Date Insepctors Signature Cert No r I eY — i. ► ,► --mo t, Cl l%A4 .d 116�ce� . 2 �77County Industry Services DiJision 1 J jj 1400 E Washington Ave \^ P.O. Box 7162 A Sanitary Permit Number (to be filled in by Co.) JUG G my adison, WI 53707-7162. Gto 1x IoPrt' en nt elTllit Application *Ts. Stare Transaction Number In accordance with SPS 383.Adm. Code, submission of this form to the p to g ve men unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS arc ubm' d to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing addrtss) ✓ purposesin accordance with the Privacy Law. s 15. ])(in), Slats. /Z h j I Parcel q __ __ L Application Information - Please Print All Information Property ner's Name ---- --- - - Ach/hvni Property Owner's Mailing Address Property Location f2c) '9 0 141 • Govt. Lot I 5r'/., Section _ City State Zip Code Phone Number �l 1karcle El Ill. T f Building (check all that apply) { 2 Family Dwelling Lot 0 or - Nr wAtipo hedlooms _ Subdivision Name Block k ! ❑ Public/Commercial - Describe Use 1 ❑ City of / 1 ❑ State Owned - Describe Use El Village of CSM Number, own of A�/Lr Ill. Type of Per it: Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) r I B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. ;2=f POWTS S stem/Com nent/Device: Check all that apply) _ on-Pressurv.W InGroun ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil LJ Holding Tank U Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Treatmeat Area Information: Design Flow (gpd) Ito Design Soil Applications RaWgpdsi) I / •7 Dispersal Area Required (sf) Dispersal Area Proposed (sf) fZ90 SygsteCin Elevation ! 7 . V I. Tank Info Capacity in Gallons a e To#Of Gallons Units Manufacturer 4 e U a New Tanks ,:wag Tmks r, septic oriioWio9 'frglc Dosing Chamber *-e-ref VII. Responsibility Statement=l, the undersigned, *NA04 respoosibility f i stallation of the POWT'S shown on the ansched plaaa Plumber's N 'nt) II Plumber s . ign MP/MPRS�(Numbcr 3 02 Business Phone Number ?« z -1�_. _ __ _ Plumber's Address (Street, City, S e, Zip Code) �Sb04 7bg� Vlll. CountyADepartment Use Only Approved ❑ DisapMd�� Permit Fee —T Gate Is ued I AgeSi at nt ❑ Owner Given Reason for 0.roraf {, S J2\5 � Z2 EM OWN APPrn I'Veamne o.. n iTlis .. - Septic tank, effluent Alter and �24ICQa t4rY a �!Sr e a e 1 tts �G( Tyr dispersal cell must btieerviced I rtlaintained as per management plan provided by plumber, (C�� All setback reguirements must be maintainedC per applicable COde/0(t f; Ip to plant for the systt d •�•Amit 1, It6e County only on pap r aol leu than B IR a I I inches is 'me � 01.�.20.- a� o� ,1,,. Ts d�,QQ,s,t„eQ t�YtJp K4 0 o ao pro J or- yo Uhlesg ndtCd poe,,a. Marv, =100.0 sld; 05 �So�l ,fis P 8, F�L - 163- ba WA jcL *I-pmno. �ZIVC&S PrOR" l N'lZ, SE44 , S0141-MI 0, Rtqo PDXCA 4. on- 109�-8e-001 NsAems Tow„ � S-r,,, PMASr� s, - C-r-o -t?o Co. ,, C O pY A9 , -DrMy:�,EA.D rs a1)44��2AW1 ,Stir-LL qo' jrZG1vw Fjj Bi ■ �'s g3 ■ YrOPpw� M; b04 "tql S�" 13 .a �,— �1Aot Arr.�,iYJ r (,�COpY Sd lef 35iD' 1b I UA1 �11 Z Project Name: Owner's PRIVATE ONSITE WASTEWATER TREATMENT SYSTEM OCA S Index and Title Page Owner's (� ,`� Address:_ P6). -g" � `t `6� /'/`/� i /L/�' I �li Z) Legal Description: N r �i �� Sr Municipality: -it Town, +14Ve,V-vf IS / T� County: '-� Ir 41 Subdivision Name Lot Number: Block Number: Parcel I.D. Number: L 50 — le�)`'9 — g0 - Qo / Page 1 QZ 71—zllr Page 2 �gz)T 'RG'o\/ Page Page Page Page Page l dt!%A16W-S 400C-11 PA/ Page 8 Page 9 �7D>� A� 7 Page 10 C // 7z1;< T r - Page 11 Page 12 Page 13 Page 14 Page 15 Name of Designer: Q Signature:_ DESIGNED PURSUANT TO TH (N.01/01) r Z License Number:_ bqp l��y Date: & /zifi SOIL ABSORPTION,COMPONENT MANUAL FOR POWTS (SBD-10705-P 1lll • �. • 1 '_14D WA%es$ nd" RR.c. rr � = too. 0 S-141 N5 osod pl g, - 4S•7' p-CR'3� ba WA. fCiEillrJ Ir roM.\ ST �(Ori i.Nts cM tAL * -:�-oNr%G, �Z�uCA5 ProPX N`Iz,SF,IM, SO) y,T3IA), R a W Pam. II on, lo9�-8b LIS-Acre-g SI- C-rD -,?oCo. Aq SroclE :�,� �Sr�r2L �10FZG/�ry SyStr� �e� ProgovA lair 004 agw 0" a_e pux,ae's - F1eo$- ur ,fj MU. 'puL PiDf, IS t 7U6500- b3o3L/ �V4JA � G I 1 u122 B3 ■ 9 q?�I U U` x� wE� tjseprrc- 3so, --lb Nwy t4� 4" CAST -A -SE 0 w ccy w Iin INLET - - c (n - N i7 SIDE VIEW WLP750—MR TANK SPECIFICATIONS DIMENSIONS: WALL- 2 1/2- Borrow 3" 4" CAST -A -SEAL COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT. 54" OUTSIDE DIAMETER: 7'-0" BELOW INLET: 42" LIQUID LEVEL 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EOUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 790 GALLONS PUMP PAD LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN 110 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: z OF PRODUCTS NEEDED BY: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with F71203HP Bundles 3-ft Trench (down -sizing credit) :=.iu_ _ _ .._ IIL��11 SOIL COVER ;ii 120min. trench HighestTrench System Elevations 4?.57 ft; ft; .....: :.... TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Lowest Trench (as applicable) ft; ft; ft TYPICAL TRENCH (Show location of Inlet I outlet pipe connection on plan view.) PLAN VIEW (NO Scale) 4.� ooa.rv.Aon pip• soul a InalaAad at WCOM tWw•n NC MU. Perforated Lateral --•-w— m-- (t/pical) B�ft (typical) INSTALL PER TRENCH: ' 10-ft bundles @ 50 fP EISA/unit = ft2 Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No Snb) Sc".Typa or ,• . . F=ad Grada SAP cap Poose) j°, (rrulrhad 6 aa•Cad) EZ1203H Bundle (typical) (rrlfd by InWtraor Systems, Inc.) Install pursuant to manufacturers h8ftUCtiOns. + 5-ft bundles @ 25 fP EISA/unit = ft' = Proposed EISA per trench = Zoo ft' Required Infiltration Area = t2 x trenches = Proposed Total EISA =D ft' — TopsDA Cow (rrAn. 1 fool) InBArNlon Surlsoa Distribution Method: Mow 1203H - GEO 12" EZflow BUNDLE (TYP.) 36" MIN. TRENCH WIDTH NOTE: PRODUCT CONFIGURATION AND INSTALLATION DEPTH MUST COMPLY WITH APPLICABLE REGULATORY REQUIREMENTS. NATIVE BACKFILL 4" PERFORATED PIPE 1� EZflow ", , NATOR INFLTRATOR SYSTEMS INC. 4 Bohn Park RA. OW Say roak. CT 08475 EZlbw 1203H - GEO OFH I %� 7 Of 1 11 vj ifeti me fl lte,r The Best Just Got Better The most efficient, the lowest maintenance, the most economical effluent filter! • Nearly Twice the Filtering Capacity • Estimated to go 3 Times • Longer Between Cleanings • • Cleaning Made Easy • • Does Not Retain Solids Between Plates • • Lowest Price • O twig I 0 - Eliminates the collection of solids inside the cartridge. - Nearly twice the filtering capacity of any other filter. - By eliminating solids between plates drastically reduces the need to clean. - Cleaning made simple and efficient. O �- LT-1 /8: 3500 GPD/Residential Strength Filtration 1 /8" - IT — 1 /16: 3350 GPD/ Residential Strength Filtration 1 /16" - LT — 1 /32: 3000 GPD/Recommended for Commercial use with Residential Strength - FiltratiOn /32" - LT — 1 /64: 2500 Gl /liecammended for Commercial usage with Residential Strength - Filtration 1 /64" - 2700 Inches of Linear Filtration (Nearly Twice the Comnetitinn) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of FILE INFORMATION OwnPXo er Permit # DESIGN PARAMETERS Number of Bedrooms —E3-W Number of Rmkiis Facility Units -EMA Estimated flow (average) gal/day Design flow (peak), (Estimated x .5) ��j,� gal/day Soil Application Rate al/da /ft' Standard Influent/Effluent Quay Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD.) 5220 mg/L ❑ NA Total Suspended Solid (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (B0D61 530 mg/L Total Suspended Solid (TSS) 530 mg/L 13'f�A Fecal Coliform (geometri mean) 510' cfu/100ml Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA 'Values typical far domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE evert" coccrcrra.nnus VSeptic Tank Capacity gal ❑ NA Septic Tank Manufacturer �� ❑ NA Effluent Filter Manufacturer r7r ❑ NA Effluent Filter Model L%� Qj ❑ NA Pump Tank Capacity gal A Pump Tank Manufacturer ❑ A Pump Manufacturer NA Pump Model NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: NA Dispersal Cell(s) round (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tankis) At least once every: 3 eonthls) (Maximum 3 years) earls ) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 onthls) (Maximum 3 years) earls► ❑ NA Clean effluent filter At least once every: ❑ onthls) earls) ❑ NA Inspect pump, pump controls & alarm At least once every: ) ❑ m year(s) ❑ yearls) NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) A Other: At least once every: ❑ month(s) ❑ year(s) NA 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 tanklsl 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 ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. .7 A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 1/ Page _ or _ START UP AND OPERATION For new constriction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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 property and safely abandoned in compliance with chapter SPS 383.33. Wisconsin Administrative Code: • All piping to tanks, pits and other soll absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall 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 falls and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary or a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wil 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soli and site evaluation must be Performed to locate a suitable replacement area. 11 no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomet at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER Name: L�Z !� Phone: l�� 3c•— 7% POWTS MAINTAINER qP Name: fiL NZ Phone: — ZZ % SEPTAGE ERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name: Nr Z L4� Name: Phone: gr s .7 Phone: / — old This document is intended to meet minimum requirements of Ch. SPS 383.22(2)(b)(1)(d)8(Q and 383.5{(1), (2) 8. (3), Wisconsin Adminirative Code. Use of this documerit does not guarantee the performance of the POWTS. G i jif (Rev.3/13) r Wisconsin COPY sconsin Deparbnentof Saferyand Professional Services DMsion of Industry Services (1 SOIL EVALUATION REPORT In accordance with SPS 385. Wis. Adm. Code County Attach complete it plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix but not limited to: eNcal and horizontal reference point (BM), direction and percent slope, Parcel I.D. scab or dimen , north arrow, and location and distance to nearest road. 038-1099-80-001 Please print all Information. Reviewed by ,rsonal informatior you provide may be used for secondary purposes (Privacy Law, s. 15.04(1Nm)). Page 1 of 3 Date Property Owner Property Location 0 21 Dick & Jonn a Klucas Govt. Lot N 1/iti SE v. s 24 T 31 N R 18 E (or) W Property Owner's K tailing Address Site Address or CSM and Lot #: P.O. Box 141 1 2050 Hwy 65 City State Zip Code Phone Number ❑ City ❑ Village M Town Nearest Road Star Prairie I WI 54026 1 ( Star Prairie Hwv 65 LJNewConstrucha� Use:UResidential/Numberofbedrooms Code derived designflow rate 76.5 GPD ❑Replacement 0 Public or commercial -Describe: 'Sibc2n c Qfj Flood Plan elevation if applicable ft. Parent material General comments nd recommendations: Conventional Sepbc-Hodzon#4 has 114" bands of Cos 7.Syr3/4 Boring #3 has random 120 sift balls/with mottling(County inspector was on site to view) Boring #eoAng 98.7 96"+ ■ Il Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Horizon Dep In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft7 'Eft#1 'Eff#2 1 04 10yr2/1 sl 2mabk mfr cs 1f .6 1.0 2 8-1 7.5yr2.5/3 sl 2mabk mfi Cs 1 Vf .6 1.0 3 134 2 1Oyr3/4 cos Osg ml cs - .7 1.6 4 22- 0 1 1Oyr4/6 s Osg ml CS - .7 1.6 5 30-S6 1Oyr4/4 s Osg ml - - .7 1 1.6 aBoring # ❑�nc 98.3 96"+ spit Ground surface slev. ft. Depth to limiting factor in. / elev. ft. c-u ♦--,:--.:--o-'- Horizon Dep In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'GPDIF12 'Eff#1 'Eff#2 1 2/1 sl 2mabk mfr es 1f .6 1.0 2 2.5/3 sl 2mabk mfi CS 1 Vf .6 1.0 3 V44-10YWA 3/4 Cos Osg ml cs - .7 1.6 4 4/6 s Osg ml Cs - .7 1.6 5 s Osg ml - - .7 1.6 i CST Name (Please rint) Signature CST Number Mark Weis 657274 Address 2500 College Dr.1 Rice Lake, WI 54868 Date Evaluation Conducted 4/26122 Telephone Number q 715-736-1994 l Iffluent #1 - BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg(L t SBD-8330 (R04/21) Page _ of Boring # ❑ Boring 98.7 Pit Ground surface elev. ft. 96"+ Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FI' •Eff#1 •Eff#2 1 0-j2 10yr2/1 sl 2mabk mfr cs 1f .6 1.0 2 12 0 7.5yr2.5/3 sl 2mabk mfi cs 1vf .6 1.0 3 20 5 1Oyr3/4 cos Osg ml CS - .7 1.6 4 25 i8 1Oyr4/6 S Osg ml CS .7 1.6 5 38-06 .10yr4/4 s Osg ml - - .7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Snit Annliralinn Rat. Horizon Dth � ln Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eff#1 Eft#2 ❑ Boring Al ❑ Boring ❑ Pit Ground surface elev.-___ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots wn ry.ynw .......... GPD/Ft' •Eff#1 'Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L It, - 1 "I un�tS5 no` eA ®_ PAACk IVlarVt y�l � 1T7 6,-45•7' Ajo wfa w4� CST'gj (057A.?L( 1! 2JolZ2 61e_v_ Ar- -:Y-oa VtuCAS P(DP I N`Iz,SF_'IM, Say,-ral01 Rao Pc�c�Q 03g-1o9l�-b-oo1 Os- AcM5 Tpe�►nm s7b, Pral-r� PCOPO A I#o' wt'4' Slims a_ �j►.pLoy u.'S ST. CR NTY SANITARY SYSTEM OWNERSHIP/ADDRESS FORM qua Community Development Department will utilize this information to provide the property owner WM information regarding operation and maintenance of your new or replacement sanitary systeffd This information will be provided as part of our ongoing efforts to protect pubCmc health, your WIK gnubweter. surface "rater, property values, and county resources. Once approved, this completed form and educational information will be sent to you try email. Owner/Buyer, , Mailing Addre City/State/Zip j OWNER/BUYER INFORMATION Phone Number (rern,;,edl - 2>0 Email Address Parcel Identification Number 0 9 d (found on the property tax bib) __11��-A NEW SYSTEM: LEGAL DESCRIPTION erty PropLocations'+ � % . �5f- Y+ , Sec t T ILN kL?—W, Town of 'Sl-&y- era i64, Subdivision Plat f Lot s P Volume Page i lT` I iD3 (before 2006)Volume � Page s� Number of bedrooms Spec house G yes O no Lot fires kkxvdfmi* O yes O no omfita use ONLY nm 2 50 `( (o5- folcl GC S awo/ wmdnn M**W Iran eommtnk, Ce+�bpre»nm w aanwuc�lau v Z Z ZZ r+ulro (omra This farm must be submitted with ofi Private Onske Water Treatment System (POWTS) op kvhort>: NOW fj.anmr kXIAA* trill► 0* ibrm a rec=W ware mW deed lm time Requagr o/ Danis Office aM a oW a(Me cetiisd *may map et#bwtae a made Ind* warranty deed. >'ts•iea-moo �+dty t �� - Vna use Division MUMMA I 1101 Cbwk Wl S4016 St Crl* County Gavemnent Center 71544S-425o Fm I I I ! I ! I ! I I i i I � ► t I ! I ! I ► t ! I � i I ► ! t ► ! I I I i I I I i I I I I I 1 f i v1011 "TvlT0T0" T0' -,-T0" -} T0" 84' 0" 1 12" I4' 101 4� ' 9 3l4" I 41/2" IT9314" 0" 1 j Is4 1 1B 4 searsfi so lilt" rr 410GCS STO CR O f 1\ T l http://www.sccwi.gQMhp:Nwww.gessoftware.com) St. Croix County Web Portal Tax Year Prop Type Parcel Number Municipality Property Address Billing Address 2022 Real Estate 038-1099-80-001 038 - TOWN OF STAR 2050 HWY 65 RAIRIE Tax Year Legend: = owes prior year taxes 9 = not assessed ®= not taxed Property Summary Parcel#: 038-1099-80-001 Alt Parcel #: 24.31.18.417A-01 Parcel Status: Current Descripbon Creation Date: 11/29/2018 Historical Date: Acres: 0.000 Property Addresses Primary A Address 2050 HWY 65 NEW RICHMOND 54017 Owners Name Status KLUCAS LIVING TRUST, RICHARD L CURRENT OWNER KLUCAS LIVING TRUST, JONNA MARIE Z CURRENT CO-OWNER MATTHYS, JONNA M FORMER OWNER Parent Parcels Parcel Number AL Creation Date 038-1099-80-000 Child Parcels No Child Parcels were found RICHARD L KLUCAS LIVING TRUST JONNA MARIE Z KLUCAS LIVING TRUST PO BOX 141 STAR PRAIRIE WI 54026 Delinquent Current Ownership Type Interest Abbreviated Legal Description (see recorded documents for a oompWe legal description) SEC 24 T31N R18W PT OF N1/2 SE 114 DESC AS COM E1/4 CDR SEC 24 POB; TH S 0 DEG E 717.38'; TH S 89 DEG W TO W LN NW114 OF SE1/4; TU ♦I TI1 XI r k11 \I nO \I. H CC11. T/l n^O CV� n1 T^ CTATC CV^ 1'1T NIIN Ilp 111 O/I7C /IC 1� �.TIICCO CV! lInn IV IN VV VVn, In CMLV IV UVVr IN IVL OCIm I VrV CIor I I VJIMICGAVrIInvvI rnVjozju-u-GI I JUJUIJ, I If WWJ, I I I YVJVUCAI csM zs-ssss Search powe..d by Public Land Survey - Property Descriptions e'GCS rimary T[Section A Lown Range rou 40 Qtr 160 Gov Lot Block/Condo Bldg Type # Plat 24 - ! 31 N 18 W (http:/MQX46�6#Ware.com) District Code Description Category -- - ----------- LOCAL 3962 1700 ST. CROIX COUNTY STATE OF WISCONSIN SCH DIST NEW RICHMOND NORTHWOOD TECH Associated Properties No Associated properties were found OTHER DISTRICT OTHER DISTRICT REGULAR SCHOOL TECHNICAL COLLEGE I57 `�rsRrVr� tn av�� A� 4.Ygvf nt of Safelyand roress I ices OR1G IN2S IL EVALUATION REPORT A Coen� o nee with SPS 385, Wis. Adm. Code County Attach complete sitx lo 11 inches in size. Plan must include,St. CrOIX but not limited to: vreference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 038-1099-80-001 Please print all Information. tw Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04(1)(m)). Page 1 of 3 Property Owner Property Location LJ ❑✓ Dick & Jonna Klucas Govi. Lot N 1/'ev. SE v. s 24 T 31 N R 18 E (or) W Property Owners Mailing Address Site Address or CSM and Lot #: P.O. Box 141 2050 Hwy 65 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Star Prairie I %A 54026 1 ( 1 Star Prairie I Hwv 65 M NewConstntction Use: U Residential/Numberof bedrooms Code derived designflow rate 76.5 GPD ❑Replacement ❑� Public or commercial — Describe: D r'g Flood Plan elevat_ igp if apP4caalq t Parent material Lath SP(irt�C SiG(e4jre�[f General corn nts and endations: Conventional Septic-Horizon#4 has 1/4' bands of cos 7.5yr3/4 t qS )! Boring #3 has random 12' silt ballsMith motding(County ins or s srta o view Bori a Boring # I 1p� Ground surface elev.98 % ft. Depth to limiting factor96M+ in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eff#2 1 0-8 1Oyr2/1 sl 2mabk mfr Cs 1f .6 1.0 2 8-13 7.5yr2.5/3 sl 2mabk mfi Cs IV .6 1.0 3 13-22 10yr3/4 Cos Osg ml Cs - .7 1.6 4 22-30 10yr4/6 s Osg ml Cs - .7 1.6 5 30-96 1Oyr4/4 s Osg ml - 7 1.6 Boring # ❑Boring 98.3 96"+ spit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz •Eff#1 'Eff#2 1 0-13 10yt2/1 sl 2mabk mfr Cs 1f .6 1.0 2 13-24 7.5yr2.5/3 sl 2mabk mfi Cs 1 Vf .6 1.0 24-36 1Oyr3/4 cos Osg ml Cs - .7 1.6 436-44 1Oyr4/6 s Osg ml Cs - .7 1.6 N53144 -96 10yr4/4 s Osg ml - .7 1.6 CST Name (Please Print) Signatu CST Number Mark Weis 1657274 Address Date Evaluation Conducted Telephone Number 2500 College Dr., Rice Lake, WI 54868 4/26/22 715-736-1994 Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L SBD-8330 (R04/21) Page of aBoring # ❑ Boring 98.7 Pit Ground surface elev. R. 96 "+ Depth to limiting factorin. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •ER#1 •ER#2 1 0-12 1Oyr2/1 SI 2mabk mfr cs 1f .6 1.0 2 12-20 7.5yr2.5/3 SI 2mabk mfi cs 1vf .6 1.0 3 20-25 1Oyr3/4 cos Osg ml CS .7 1.6 4 25-38 1Oyr4/6 s Osg ml cs .7 1.6 5 38-96 10yr4/4 s Osg ml - .7 1.6 ❑ Boring # ❑ Ong ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 I •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil ApDlication Rate Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD. 5 30 mg/L and TSS s 30 mg/L -51'"'V qi,,uSS, s,n+tatkla-'C q*S .h%a .mR rOlwd °) -'4"QXD - , S 5aab/-517 r►b��'n�eJ-�h�S �hlISSlzl,� iIJ.Ao'd SJ 1)1?` ro.,vo-z-t -47 1 a titi/V1�� 'Ues -f► (cy"-tON 0 a f m ory yr to.cio1 �ov Ssa�vY1 ,Oh Li1 ah QC O A& sib"" 8"* 0 4c couNnr NO. 644747 STAT OWNER CRY PERMIT s� PREVIOUS NO. -^ PLUMBEI(1'��)/�� LIC.# 139�162 TOWN OF IE SEC �,T 7�_N, R $ AND/OR LOT BLOCK + SUBDIVISION pq-g""`' MJHORIZED ISSUING OFFICER - PERMIT EXPIRES �Q�'t�t� CHAPTER 145.135 (2) WISCONSE4 STATUTES (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit Is based on regulations In force on the date of approval. (c) The sanitary permit Is valid and may be renewed for a specified period. (d) Changed regulations will not Impair the validity of a sanitary permit (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1991 c. 314 Note; If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. DATE M UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)