HomeMy WebLinkAbout036-1059-95-000 (2)OR
LM
K�CTt/ I
y
Sanitary Permit Ap
In
Safety & Buildings Division
201 W. Washington Ave.
accord with Comm 83.2
See reverse side for instructions r � i 'on
PO Box 7302
of Commerce
Personal information you provide used u oses
ilfseconda
y PSubmit
Madison. WI 53707-730_'Department
[privacy La s. 5.04 NiET
completed form to coup f not
( P county t
V
state owned.)
Attach com lete plans (to the county co • onl y'3b the system. on paperDpt Ie n 8-1/2 x 1 1 inches in size.
County
/29
StateSanitary Permit Number CTt�eck y��vrsiogt r ppl au
11 (1
fate Plan 1. D. N m ,,,
r
u
S / T� �S
I. Application Information - Please Print all Information 01 ;,iY-Location:
Property Owner Name
20►'ItNGOR
Property Location
/�
„i1/4 %1/4, T' E r
Property Owner's Mailing Ad/dress L
,N,R�
Lot Number Block Number
City, State
Zip Code
Phone Number
Subdivision Name or CSM Number
II Type of Building: (check one)
1 or 2 Family Dwelling - No. of Bedrooms:... e, 111-c-,
❑ City
❑ Village
❑ Public/Commercia describe use): 4*#1-1_,-Z__
X-Town of
❑ State-owned cv. ,
III Type of Perm. it: 4kChcck only one box on line A. , cck box on fine B if applicable)
Nearest Road
A) 1. InNew System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to
Parcel ax Number(s)
g
'
S stem Tank Only ExistingSystem
36 lQ o
B)
❑ A SanitaryPermit was previouslyissued
Permit Number
pyw_k�
$ 3 � _ � 3$ 3 Z
IV. Type of POWT System: (Check all that apply) —(�
'Jon -pressurized In -ground Mound ❑ Sand Filter ❑ Const cted Wetland
❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grader O Aerobic'Tre Treatment Unix a ❑ circulating ❑ Other:
et_ 20 L
V Dispersal/Treatment Area formation:
1. Design Flow (gpd)
•'
2. DispersalArea .,
Required
3. Dispersal Area
Proposed �a`'
A. Soil Application
"Rate (Gals./day/sq. ft.)
5. Percolation Rate
6. System Elevation
7. Final Grade
��
�� �
�� �
(Min./inch )
r
Elevation
.C)
9 2.0
VI Tank
Capacity in
Total
# of
Manufacturer
Prefab
Site
Steel
Fiber-
Plastic
Information
Gallons
Gallons
Tanks
Con-
Con-
glass
New
Existing
crete structed
Tanks
Tanks
G
XT
VII Responsibility Statement
1, the undersigned, assume res onsibili for installation of the POWTS shown on the attached plans.
Plumber's Name (print)
Plumber's Signature (no stamps):
MP/MPRS No.
Business Phone Number
Plumbe Addres (Street, City, State, Zip Code)
VIII County/Department Use Only
P!
❑ Disapproved
❑ Owner Given Initial Adverse
Sanitary Permit Fee (Includes Groundwater
Surch Fee)
Date Issued
Issuing Agent Signature (No stamps)
,Approved
Determination
ge
F 3 oZ s .
-z3
IX. Conditions of Approval /Reasons for Disapproyal: Lt'o lw E
SBD-6398 (R. 07/00)
STATEMENT
Byron Bird Jr. Plumbing, Inc.
MPRS #220527 CSTM #220527
4A*a 896 68th Avenue - Amery, WI 54001
Phone 715-268-7616
Deposit required on all jobs. Full payment due upon completion.
FINANCE CHARGES OF 1-1/2 % per month (which is 1 B % per year) are applied to amounts 15 days past due.
1 year warranty on all parts and material (labor not included).
I
CRIS STE FARMS 7s-2a6
STEVE OR MARY BETHKE �sse ' 7346
B320-7965-4105-03R B320-5905-5669-OSR }
1923 190TH ST. PH. 715-246-56j4. -. ate e 7d ,
NEW RICHMOND WI 54017
h
_ /// [�
or tot a +, gas .. b��,^-"`r 7`.. .. �/1 .fGi
orderAIN-L of"� (/
3
ANK�...�.
NEW ; RICHMOND
715,-246-2265 -'
OFFICES IN STAR PRAIRIE, WI
NEW RICHMOND, WI WITT # '
For K f e r¢ Cj/j!Qi.91
1:0 9 3180 28801: 903 90 61I' 7 3 4 6 11110000 13P3000,11
CRIS STE FARMS 79"2881 7462
STEVE OR MARY BETHKE s1a
B320-7965-4105-03R B320-5905-5669-05R
1923 190TH ST. PH. 715-246-5644 Date 4.-
NEW RICHMOND, WI 54017
Pay to the - I s
order o4
j W-- ` �arr—lflollars 8
BANK OF
NEW RICHMOND
715-246-2265..- '
OFFICES IN STAR PRAIRIE, WI
NEW RICHMOND, WI 54017 0 p
F.
1:09 L80 28801: 903 90611' 746 2 111000 L000000,1'
09-10-0008-0
RCPC
&�241538
6-6 8674 e,676 20
3
69252000 Bromor Sank 0 19960'1041 b-
09i0-0008-0 OF
470236686 RCPC
470236686 09-26-00
470236686 8542 8483 20
MUM
.r Z
F Deparanem of the Treasury - 4rtemal Revenue Service
R 1040 U.S. Individual Income Tax Return 1999
M
(99) IRS Use Only - Do not write or staple in this soace.
For the year Jan. 1 - Dec. 31, 1999, or other tax year beginning 1999, ending
0108 No. 1545-0074
Label
Your first name and initial
Last name
Yoursomw seurdty ember
(see
L
STEVEN R BETHKE
3 9 2- 5 8- 4 3 3 7
instructions
on page 18.)
a
0 a joint return, spouse's first name and initial Last name
Spouse's social seamy ranter
Use the IRS
�
MARY J BETHKE
3 9 6- 6 2- 8 8 5 5
LAW .
Otherwise,
H
Home address (number and street). If you have a P.O. box, see page 18. Apt. no.
IMPORTANT!
please print
type.
R
1923 19 0 TH STREET
You must enter
or E
City, town or post office, state, and ZIP code. If you have a foreign address, see page 18.
your SSN(s) above.
Presidential
NEW RI CHMOND , WI 54 017
Yes
No
Mder Checking'Yes
X
_
Election Campaign Do you want $3 to go to this fund. ....................................................
change your
Wtax noor
(See page 18.)
If a joint return, does your spouse want $3 to go to this fund? ...............................
e your
refund.
X
1
Single
Filing Status
2
Married filing joint return (even if only one had income)
X
3
Married filing separate return. Enter spouse's soc. sec. no. above & full name here ►
Check only 4
Head of household (with qualifying person). (See page 18.) If the is but dependent,
one box.
qualifying person a child not
enter this child's name here ►
your
H
5
Qualifying widow(er) with dependent child (year spouse died ► 19 ). (See page 18.)
6a Yourself. If your parent (or someone else) can cra .-.t you as a dependent on his or her tax
Exemptions
return, do not check box 6a................................................
b ® Spouse........................................................................
No. of boxes
checked on
6aand 6b 2
If more than Six
dependents,
see page 19.
c Dependents:
(1) First Name Last name
(z) Dependent's social
security number
(3) Dependent's
relationship to you
(4) Chk if qualifying
child for child tax
credit (see page 19)
DANIEL BETHKE
389-96-2455
SON
X
JULIE BETHKE
391-98-0253
DAUGHTER
X
KIMBERLY BETHKE
399-08-3105
DAUGHTER
X
d
Total number of exemptions claimed........................................................
Income
nnach
Cavr 13 of yourm
r-onns w-z and
W-2G hem
Alsoallmh
Fwn 1099-R it
tax was rwtttheld
If you did not
get a
see page age20.
Enclose, but do not
attach any payment.
Also, please use
Form IG40-v.
7
ea
b
9
10
11
12
13
14
15a
16a
17
18
19
20a
21
22
Wages, salaries, tips, etc. Attach Form(s) W-2.......................................
Taxable interest. Attach Schedule B if required ......................................
Tax-exempt interest. DO NOT include on line 8a .......... I 8b
Ordinary dividends. Attach Schedule B if required ....................................
Taxable refunds, credits, or offsets of state and local income taxes see page 21 ..........
( P 9 )
Alimony received .............................................................
Business income or (loss). Attach Schedule C or C-E?................................
Capital gain or (loss). Attach Schedule D if required. If not required, check here P. ❑ ........
Other gains or (losses). Attach Form 4797..........................................
Total IRA distributions ..... 15a b Taxable arrcO n.t (see Pg. 22)
Total pensions and annuities 16a b Taxable amount (see pg. 22)
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .......
Farm income or (loss). Attach Schedule F
(l)..........................................
Unemployment compensation...................................................
Social security benefits ..... 120a I J b Taxable amount (see pg. 24)
Other income.
Add the amounts in the far right column for lines 7 through 21. This is your total Income .....►
7
ea
9
10
11
12
13
14
15b
16b
17
18
19
20b
21
22
Adjusted
Gross
Income
23
24
25
26
27
28
29
30
31a
32
33
IRA deduction (see page 26) .........................
Student loan interest deduction (see page 26) ............
Medical savings account deduction. Attach Form 8853 ......
Moving expenses. Attach Form 3903 ...................
One-half of self-employment tax. Attach Schedule SE ......
Self-employed health insurance deduction (see page 28) ..
Keogh and self-employed SEP and SIMPLE plans .........
Penalty on early withdrawal of savings ..................
Alimony paid. b Recipient's SSN ►
Add lines 23 through 31a.......................................................
Subtract line 32 from line 22. This is your adjusted gross Income
23
24
25
26
27
1,135
28
2,612
29
30
31a
..,.:...:..:
. ......................
►
32
33
No. of your
children on
6c who:
lived with you
did not live with
you due to divorce
or separation
(see page 19)
Dependents
on 6c not
entered above
Add numbers
entered on
lines above ►
15,894
1,124
7,296
16,059
40,373
3
3,747
36,626
Form 1040 (1999)
tr Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 54
� 01
-11
/
Wisconsin Department of Commerce
Safety and Buildings Division
GENERAL INFORMATION
0,,...,.,..,1 i..r..,..,., H..... �.... ...a �,._
(roSSt(3L.1~ G3lz— l—1 Ai L
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
y-- V. ., _r luary purposes irnvacy Law, s.15.04 (1)(m))•
Permit Holder's Name: ❑ City ❑ Village -0 Uowno
Bethke, Steve Stanton Township
CST BM Elev.-, Insp. BIVI Elev.: BM Description:
r ct r ( oA*_t
TANK INFORMATION
U
TYPE
MANUFACTURER
CAPACITY
Septic
t.L�� S
l030
Dosing
W.S
�
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P / L
WELL
BLDG.
ir
Air I tontake
ROAD
Septic
Sd `
> SO
a,a
—
NA
Dosing
?5-0
gjp'
3�"
? 35 '
NA
Aeration
NA
Holding
PUMP/SIPHON INFORMATION
Sq4ABSORPTION SYSTEM
ELEVATION DATA
County
St. Croix
Sanitary Permit No.:
370350
Late Plan ID No.:
MVs IL-* = JAIZ,ZO S-)
Parcel Tax Nn
036-1059-95-000
STATION
BS
HI
FS
ELEV.
Benchmark (A)
:
� v /
Alt. BM
Bldg. Sewer
fLK,'S
St/Ht Inlet
I'�f �I
7.ez
St/Ht Outlet
�3,fI,
Dt Inlet
S•ZS __
Dt Bottom
% /. 00
`J 3.2 0 �
Header / Man.
/. 90
(oZ -90
Dist. Pipe
2.00
)oZ.4o '
Bot. System
.0o
O p
Final Grade
St cover
13y
-SD
I Cb. o '
B / 11fNiFLIH
width r
Length
No.O e
PIT
No. its
Inside Dia.
Liqui h
DIMENSIONS
5-
DIMENSIONS
SETBACK
SYSTEM TO
P / L
BLDG
WELL
LAKE /STREAM
LEACHING
Man urer.
INFORMATION
CHA
Type O'f
/
I
pio
Model Numbe
\
System:
1
a
-----
NIT
DISTRIBUTION SYSTEM (, 1-�-iZ 5T& w �e )
Header/Manifold
DistributionPipe(s)
x Hole Size
x Hole Spacing
Vent To Air Intake
�
Length �� Dia. 2
/ " 36 ifI
Length � Dia. 2 Spacing
3//(0
I � L p
I
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth Of
--r❑
xx Seeded/Sodded
xx Mulched
Bed /Trench Center
Bed /Trench Edges
I Topsoil
Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) co (P(-.,) �"S(14UAL J)
Inspection # 1: I 1 10`r / 00 Inspection 2: I1 / l o / W
Location: 1923 190th Street, New Richmond, WI 54017 (SW 1/4 SW 1/4 25 T31N R17W) - 253117383D
1.) Alt BM Description =
2.) Bldg, sewer length = zz.
? — Caca�►� .� �K�Q chi �n i-l�+t .
-amount of cover = 1
31.) �co�ntopur = ( loo• 2rz) S (.'t ., 4.S'a$2
'f i.�2 We!
Pfan revision required? ❑ Yes No
Use other side for additional information. 1( 2 -1 2
SBD-6710 (R.3/97) Date Inspector's Signature Cert. No.
K 6V1 /TC &kRClfJ I
o
# nzL
Sanitary Permit Ap
In
Safety & Buildings Division
201 W. Washington Ave.
accord with ComAes
Visconsi
See reverse side for instructing i on
PO Box 7302
Departmenerce
Personal information ou rovidd seconds ur oses
y PSubmit
Madison. WI 53707-7302
[privacy La C
completed form to coup if not
( P county
Attach com
,A
lete plans (to the county cop), only)-4pf the system, on paperopt le"An 8-1/2
state owned.)
x I I inches in size.
County
State Sanitary Permit Numbereck ' io t r ppl ati
tate Plan 1. D. N mb r
70
I. Application Information - Please Print all Information 0' 51N1Y
ocation:
Property Owner Name 70w1NG0
Property Location
G"� f v // // L \`1/
/�
,i 1/4 %1/4, T' R� E r
Property Owner's Mailing Address
,N,
Lot Number Block Number
City, State 7Zip
Code
Phone Number
_
Subdivision Name or CSM Number
II Type of Building: (check one)
1 or 2 Family Dwelling - No. of Bedrooms:_ �a fIe_ e-,- XAe,
❑ City
❑ Village
❑ Public/Commercia descr'be use) A l�
X-Town of
❑ State-owned 00 • 30
III Typc of Pt: rtit: 4k,heck only one box on line A. Check box on line B if applicable)
Nearest Road
�ofj
A) I. New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to
Parcel ax Number(s)
S stem Tank Onlv Existing System
lQ• �—
B) Permit Number D&W .{sue
❑ A Sanitary Permit was previously issued 1 1 6(5. 131. . 38 3 L
IV. Type of POWT System: (Check all that apply) —[�
'Jon -pressurized In -ground Mound ❑Sand Filter ❑ Conty cted Wetland
❑ Pressurized In -ground
❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grader ❑
_ t Aerobic Treatment Unit � circulating ❑ Other:
S " = I •� not 20' Z
V Dis ersaVrreatment Area formation:
1. Design Flow (gpd)
2. DispersalArea
Required
3. Dispersal Area
Proposed
4. Soil_ Application
5. Percolation Rate
6. System Elevation
7. Final Grade
.,'},'
Rate(Gals./day/sq. ft.)
(MinJinch)
Elevation
VI Tank
Capacity in
Total
# of
Manufacturer
Prefab
Site
Steel
Fiber-
Plastic
Information
Gallons
Gallons
Tanks
Con-
Con-
glass
New
Existing
crete structed
Tanks
Tanks
AT
❑
❑
❑
❑
VII Responsibility Statement
I, the undersigned, assume responsibility for installation ofthe POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number
Plumbe AAdddrres (Street, City, State, Zip Code)
VIII Courrty/Department Use Only
AApproved
❑ Disapproved
❑ Owner Given
Sanitary Permit Fee (Includes Groundwater
Surch Fee)
Date Issued
Issuing Agent Signature (No stamps)
Initial Adverse
ge
Determination
3 S •
-Z*; -?,bb0
IX. Conditions of Approval /Reasons for Disapproyal: Lt"o tN =
0-4 FA- COkC
SBD-6398 (R. 07/00)
Nvisconsin
Department of Commerce
October 11, 2000
CUST ID No.220527
BYRON BIRD JR
896 68TH AVE
AMERY WI 54001
RE: CONDITIONAL APPROVAL
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www.commerce.state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
ATTN: POWTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
PLAN APPROVAL EXPIRES: 10/11/2002 Identification Numbers
Transaction ID No. 442205
SITE: Site ID No. 200280
STEVE BETHKE - RESIDENCE Please refer to both identification numbers,
ST CROIX County, Town of STANTON; 1923 190TH ST above, in all correspondence with the agency.
SW1/4, SW1/4, S25, T31N, R17W
FOR:
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 766038
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. On page 4, based on the ground elevations provided, the slope in the mound system area is actually 8
percent.
2. On page 5, I = 15.69 feet and W = 32.49 feet.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation/operation.
Inquiries concemyg this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhe A'
7/7
Sincerely
P T E PA�6 L, P WTS LAN REVIEWER II
Integrated Services
(608)266-2889 , M - F, 0745 - 1630 HRS
PEPAGEL@COMMERCE.STATE. WI.US
cc: STEVE BETHKE
DATE RECEIVED 10/02/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
WiSMARTcode: 7633
PLOT PLAN
PROJECT Steve Bethke ADDRESS 1923 190th St. New Richmond Wi 54017
SW 1/4 SW 1/4s 25 /T 31 N/R 17 W TOWN Stanton COUNTY ST. CROIX
MPRS Byron Bird Jr. 22052' / DATE9/27/00 BEDROOM 3
CONVENTIONAL IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND XX)OC SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 375 # of chambers
BENCHMARK V.R.P. Top of Walkout Slab ASSUME ELEVATION 100'
❑ BOREHOLE O WELL «H.R.P. Same as Benchmark
SYSTEM ELEVATION i ng n
No.
Tanks are to be
properly bedded with
approved warning
labels and lockdown
covers
Existing 3
Bedroom
House
Well O
B.M.
101.0'
B-1�Weeks
Existing System is
to be pumped and
buried
Property Line
ST — DT
Zabel A-100
filter
ST
100,
Failed System
F— 1 0
B-4
Please note: errors that
were found on the
original soil test were
fixed on this plot plan.
System is to be installed
along the 100.3' contour line
98.5'
Area 15' Below
system is to
remain
undisturbed
1 01 .0'
/�❑B-3
98.5'1
❑l
6%
Slope
CORRECTION NEEDED
SEE CORRESPONDENCE
1 50'
111141iy
P.L.
r I I STATE BAR OF WISCON
i DOCUMENT N0. QUIT CLAIM 0
�' r VOL 557 'n E 2`•q`+n THIS SPACE RESERVED FOR RFCOA t ill�A;
341551),
REGISTERS OFF T. �=
BY THIS PFhl; Christian A. _Bethke_
ST. CROIX CO., WLt .
Reed, for Record this_
quit•claimc to Steven Bethke____ day Of juh A.D. 1417
i� Grantee iu hle ,nns d ration One Dorlar and other.
II V31La�le COn3� eration
the following d, ' :'d iI-! estate in __.$: _ CROIX C-+unry, Stet, of tXtvc onwin: _
1 RETURN TO
REINSTRA & VAN DYK, S.0
201 South Knowles Avenu
New Richmond,_ Wf-'__5_4-01
Tax Key x —
This is, not—.hornestead property.
That certain parcel of land located in the SW 1/4
of the SW 1/4 of Section 25, Township 31 North, Range 17 West, Town
of Stanton, St. Croix County, Wisconsin, more fully described as
followsi Beginning at a point on the West line of said SW 1/4 of
Section 25 a distance of 1328.98 feet South from the West 1/4 corner
of said Section 25; thence go South 880 221 00" East a distance of
390.00 feet; thence South parallel with said West line of the SW 1/4
a distance of 279.35 feet; thence North 88e 22' 00" West a distance
of 390.00 feet to the West line of said SW 1/4; thence North along
said West line a distance of 279.35 feet tc the Point of Beginning,
the above described parcel containing 2.5 acres, more or less,
including the Westerly 33 feet thereof presently used for Town Road
purposes.
TRANSFER
J - 3G FEE
Executed at -New Richmond., WI this __ 24.-th (ray of --_-- 191Z.
/
- ---- ,1 �7r
SIGNFD A%n :Fer
State of Wisconsin WISCONSIN FUND - PRIVATE SEWAGE SYSTEM Safety and
Department of REPLACEMENT OR REHABILITATION PROGRAM Buildings
Commerce Division
OWNER'S APPLICATION
Instructions For Property Owners: TO BE COMPLETED BY COMMERCE
You may apply for a grant award for up to three years after you have received Application Number Date Received
a determination of failure and after you have obtained a sanitary permit.
Complete Part A of this form, attach evidence of your annual income explained
in section #7, and send those items to the governmental unit listed below.
A�AT
.- I r+. . v LJ" vvnlrLC 1 cv n 1 1 r7C I-KUrr-K 1 T UWNtK
Owner Name*
Social Security No.**
Additional Owner
Social Security No.**
Address
Attach documentation of additional owners if needed.
I q. ` --s
City, State
Zip Code
Telephone Number (include area code)
**Note: Your Social Security Number may be used to verify your
*Grant awards will be issued in the name and address of this owner.
income and status of child support or maintenance payments.
1. Was the failing private sewage system serving the principal residence or small commercial establishment constructed prior to July 1, 1978?
Yes ❑ No
2. This application is for (complete both if applicable):
Principal'RBsidence Do you occupy this residence at least 51 % of the year: X Yes ❑ No
❑ Small Commercial Establishment Do you occupy this small commercial establishment at least 51 % of the year: ❑ Yes ❑ No /
Small Commercial Establishment Name:
DeAcription of Small Commercial Establishment (farm, restaurant, etc.):
3. Was the private sewage system replaced as part of a real estate transaction or change of ownership? ❑ Yes No
If yes, explain:
4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private sewage systems? ❑ Yes No
5. Will a portion of this system be funded by another source? ❑ Yes X No
If yes, explain:
6. How did you hear about the Wisconsin Fund -Private Sewage System Replacement or Rehabilitation Program?
t 6'er,d' to cc_ I ketrt, Sc s4-er,- av,& rece(LloCO 4-k(s
7. Evidence of income. Attach a copy of your federal income tax return for the year of or prior to the enforcement order or
determination of failure if you are applying as a principal residence. If you are applying as a small commercial establishment,
submit a copy of your federal profit and loss forms for the year of or prior to the order or determination of failure. If you were
married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of
income for each owner (and for each owner's spouse) listed above. Evidence of income will be kept on file at the governmental
unit and is subject to verification by the Department of Revenue and by the Department of Commerce. If you or any owner listed
above were a part -year resident or did not file an income tax return, contact your governmental unit for further instructions.
8. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this
form and all attachments are true and correct.
Owner's Signature
Date Signed
Co -Owner's Signature
Date Signed
1a �.17��
l� �Z,
--ld, unvrrnauon you provide may oe usea Tor secondary purposes [Privacy Law,'s. 15.04(1)(m)].
SBD-9163 (R. 1/2000)
PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT
1. VERIFICATION OF OWNERSHIP
Does the owner(s) name(s) as listed on the document used to verify ownership agree with the name(s) of the applicant(s) on
Part A of this application? ■ Yes ❑ No
What document was used 4rf Q Page Number 60-
to verify ownership?
If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property
when the order/verification of failure was issued or the system installed and incur the cost of replacement? ❑ Yes ❑ No
2. Is this application for a replacement structure? ■ Yes ❑ No
If yes, have all requirements outlined in Comm 87.20(4), Wis. Adm. Code, been met? Id Yes J No
3. Is a public sewer available to this property? ❑ Yes ® No
4. Has a previous grant been awarded for this property under this program? ❑ Yes III No
5. Principal Residence evidence of income. Please indicate applicable annual income: It
Federal income tax form ' d Line 33 'Year �°�� Affidavit of Year
Other form used Line , Year
Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $
Profit & loss form used: Line , Year
6. Date of Order or Age of the
Determination of Failure: 2 0M0 existing failed system:
Separating Distance from the bottom of the existing failed system to a limiting factor:
7. Private sewage system failure caused by discharge of sewage to (check all that apply):
Surfacewater or groundwater............................................................................................................... ❑
Category1 A zone of saturation............................................................................................................................ ■
Adrain tile or zone of bedrock.............................................................................................................. ❑
Category 2 The surface of the ground..................................................................................................................... ❑
Category 3 Back-up of sewage into the structure served....................................................................................... ❑
8. Replacement System Type:
❑ Conventional ❑ In -ground Pressure ❑ At -grade ■ Mound ❑ Holding Tank
❑ Experimental System ❑ Monitoring ❑ Other, explain
Uniform Sanitary Permit Number Date Issued
Plan Approval Number 44 Date Approved
Experiment Approval Number Date Approved
9. Eligible N or Ineligible ❑ Reason ineligible:
10. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this
form and attachments and that they are true and correct to the best of my knowledge and belief.
Signature of Authorized Governmental Unit Representative
Title
Date Signed
w.:`.
State of Wisconsin PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and
Department of OR REHABILITATION GRANT PROGRAM Buildings
Commerce Division
GRANT WORKSHEET
Owner's Name: �It
n I'Governmenntal
Unit:
l'JU
PART 1. GRANT FUNDING TABLES
A. Site evaluation and soil testing. Grant amount $250.
$
B. Installation of a replacement or additional septic tank.
Minimum Gallons Required
Grant Amount
750....................................................................................................................$500
975.....................................................................................................................550
1,200.....................................................................................................................650
1,425
.....................................................................................................................725
1,650.....................................................................................................................750
1,875.....................................................................................................................875
nn
5�(�
2,100 or more........................................................................................................950
$
C. Installation of a pump chamber and lift pump or siphon:
Number of Bedrooms
Grant Amount
1 or ...............................................................................................................$1,100
(Ur 4
. .....1,200
5 or more......................................................................................................
...................................................................................... ...1,250
$ 11z. O'a
D. Installation of a non -pressurized or in -ground pressure soil absorption area.
1. The following table shall be used for systems sized according to percolation tests. Grant
amounts determined by number of bedrooms.
Percolation Rate Design Loading
When Properly Rate in Gallons
Filed with County Per Square 1 2 3 4 5
Each Addl
Before 7-2-94 Foot Per Day
Bedroom:
Minutes Per Inch
0 to less than 10 0.7 or more $ 800 $1,100 $1,225 $1,400 $1,725
$150
10 to less than 30 0.60 to 0.69 900 1,175 1,400 1,800 1,900
250
30 to less than 45 0.50 to 0.59 1,050 1,450 1,650 1,950 1,975
300
45 to less than 60 0.49 or less 1,150 1,900 2,200 2,250 2,275
300
E. Installation of an at -grade o o soil absorption area. Grant amounts determined by
number of bedrooms.
Type of Design 1 2 3 4 5
Each Add]
Bedroom:
At -Grade $900 $1,300 $1,475 $1,825 $1,950
$250
High Groundwater
Mound 2,250 2,325 2,550 3,400 3,775
250
High Bedrock Mound 2,350 2,950 3,000 3,400 3,525
275
Slowly Permeable
Mound 2,900 3,100 3,250 3,400 3,650
300
un with less than
24" of suitable soil
or greater than
LID
12% slop e. 3,050 3,400 3,475 .i 3,550 4,500
375
$
F. ns on of a holding tank. -- "
Addl
Number of Bedrooms: 1, 2 or 3 4 5 6 7 8
Bedrooms
Grant Amount? $2,250 2,925 3,100 4,000 4,200 4,750
$225
$
G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity.
Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000
or more
Grant Amount: $550 $650 $750 $800
$900
alp. "Q itIII IcI nI yuu NIuvwe nay M usea Tor seconaary purposes (rnvacy Law, s. 15.u4(1)(m)).
SBD-9167 (R. 1/99)
PART 1. GRANT FUNDING TABLES continued
H. Installation of an Experimental System.
Amount Requested
For Installation:
The Department on a case -by -case basis reviews installations of experimental systems. If you
are requesting funding for an experimental system not covered by the grant funding tables,
$ _
please submit a copy of the plan approval letter and experiment approval letter with
corresponding identification numbers signifying that the experiment has been accepted by the
Amount Requested
Department of Commerce.
For Monitoring:
List the total cost of the experimental system and monitoring that is being requested separately
at the right. Copies of paid invoices must be submitted with this request.
$
I. Installations not Covered by the Grant Funding Tables.
The Department on a case -by -case basis reviews installations not covered by the Grant
Funding Tables. If you are requesting funding for an installation not covered by the grant
funding tables or listed in Sections A-H, please explain your request here, attach a copy of the
paid invoice, and request 60% of the cost of the installation at the right.
TOTAL PART 1.
$
PART 2. GRANT AMOUNT CALCULATIONS
A. Enter the total from Part 1.
$ 5
B. Is the applicant a licensed plumber or contractor who installs private sewage
systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is
less.
C. Enter the smaller amount listed in sections A or B.
If this application is for a small commercial establishment and the annual gross income of
the business that owns the small commercial establishment is less than $362,500, this is the
total grant award. Cary this amount forward to section F.
If this application is for a principal residence and the annual family income of the owner(s) is
less than $32,001, this is the total grant award. Cary this amount forward to section F.
If this application is for a principal residence and the annual family income of the owner(s) is
greater than $32,000, goes to section D.
If this application is for an experimental system, carry this amount forward to section F.
$
D. Enter 30% of the amount by which the applicant's annual family income exceeds
$32,000.
Annual Family Income
Subtract - $32,000
Subtotal X .30 =
$
E. Subtract line D from line C. This is the maximum grant amount for this applicant.
Cary this amount forward to section F. (The amount in section E must be at least
$100 to be eligible for any grant award. If the amount calculated is less than $100,
enter $0.00 in section F.)
$ I'
$
F. Total grant award requested for this applicant.
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7966�9 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
IVM41 NS1N1yy,ffec 25 T31-R17 Sftassi Plan LD.Number
1TWW��i'.'' W 4' JS ' ❑ CONVENTIONAL' ❑ ALTERATIVE (If assigned)
Town of Stanton
91T.Tn 'PA l Onrt, Qt ❑ Holdina Tank ❑ In -Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER:
ADDRESS OF PERMIT HOLDER:
INSPECTION DATE:
Chris Bethke
Rt.3 New Richmond WI 54017
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV:
CST REF. PT. ELEV:
Name of Plumber:
MP/MPRSW No.:
County.
Sanitary Permit Number:
Calvin Powers Jr.
1563
St. Croix
128712
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑ YES ❑ NO I I ❑ YES ❑ NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST ---►
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
/`/1WVC61Tln1dA1 CVCTPU-
WIDTH:
LENGTH:
NO. OF
DISTR. PIPE SPACING:
COVER
INSIDE DIA.:
# PITS:
LIQUID
BED/TRENCH
TRENCHES:
MATERIAL:
PIT
DEPTH:
DIMENSIONS
GRAVEL DEPTH
FILL DEPTH
DISTR. PIPE
DISTR. PIPE
DISTR. PIPE MATERIAL:
NO. DISTR.
NUMBER OF
PROPERTY
WELL:
BUILDING:
VENT TO FRESH
BELOW PIPES:
ABOVE COVER:
ELEV. INLET:
ELEV. END:
PIPES:
FEET FROM
LINE:
AIR INLET:
NEAREST
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH:
LENGTH:
NO. OF
LATERAL SPACING:
GRAVEL DEPTH BELOW PIPE:
FILL DEPTH ABOVE COVER:
BED/TRENCH
TRENCHES:
DIMENSIONS
MANIFOLD
PUMP
MANIFOLD
DISTR. PIPE
MANIFOLD MATERIAL:
NO. DISTR.
DISTR. PIPE
DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.:
ELEV.:
DIA.:
ELEV:
PIPES:
DIA.:
ELEVATION AND
DISTRIBUTION
HOLE SIZE:
HOLE SPACING:
DRILLED CORRECTLY:
COVER MATERIAL:
VERTICAL LIFT CORRESPONDS TO
INFORMATION
APPROVED PLANS
❑ YES ❑ NO
❑ YES ❑ NO
PERMANENT MARKERS:
OBSERVATION WELLS:
NUMBER OF
PROPERTY
WELL:
BUILDING:
COMMENTS:
FEET FROM
LINE:
❑ YES ❑ NO
❑ YES ❑ NO
NEAREST -
Sketch System on
Reverse Side.
SBD-6710 (R. 06/88)
Retain in county file for audit.
TITLE:
��1 L,■-, SANITARY PERMIT APPLICATION
u now nsm In accord with ILHR 83.05, Wis. Adm. Code
COUNTY
—Attach complete plans (to the county copy only) for the system, on not less than
STATE SANITARY PERMI#
paper
8'/z x 11 inches in size.
/j
ElCheck if
—See reverse side for Instructions for Completing this application.
r vision to previ us application
STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER
PROPERTY LOCATION
�/a t/a, S`T N, R E (O�I�x
PROPERTY OWNER'S MAILING ADDRESS
LOT # BLOCK ##
Cl1Z
7 , STATE,
ZIP CODE
PHONE NUMBER
SUBDIVISION NA OR CSM NUMBER
I
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VIL AGE NEARESJf ROAD ✓ �41
MeT
❑ Public 1� 1 or 2 Fam. Dwelling—# of bedrooms _� PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) J
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ® Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary
Permit was previously issued. Permit # — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In -Ground 42 ❑Pit Privy
13 Seepage Pit Pressure 43 ❑Vault Privy
14 System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PR(O'�POS/END (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
7�� l t�l l" / c a �-
S C �'`''" r . � Feet Feet
VII. TANK
CAPACITY
INFORMATION
in alions
Total
Gallons
## of
Tanks
Manufacturer's Name
Prefab.
Concrete
Site
Con-
Steel
Fiber-
Plastic
Exper.
App.
New
xisting
Tanks
Tanks
structed
glass
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsi sewage system shown on the attached plans.
Plumger's ame (Pr' ): Plum �r's Si nature: No to s) MP/MPRSW No.: Business Phone Number:
um b is Add ess (S eet, City, S Zip Code): n
IX. COUNTY/ EPARTMENT USE ONLY
pproved
❑ Disapproved
❑ Owner Given Initial
Sanitary Permit Fee (includes Groundwater
Surcharge Fee)
Date Issued
Issuing Agent Signature (No Sta
Adverse Determination
�[
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
CRn_RVon a.. . —
- �• v • i v • t vio i rnou i wrv: Original to Gounty, One Copy To: Safety & Buildings Division, Owner, Plumber
r
APPLICATION• FOR SANITARY PERMIT
9TC-100
This application force Is to be completed in full and signed by the owner(&) of
the property being developed. Any Inadequacies will only result In delays of
the permit Issuance. -Should this development be Intended for resale by
ovner/contractoc,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------------------
Owner of property
Location of property -A&,L 1/4 /4, Section ,Ly�'� T.I-It V
Address of
subdivision
Lot nu"r
Pravlous owner of property
Total also of parcel
Data P42cel was created
Are all corners and lot lines Identifiable? Yto _ No
Is this property being developed for resale ('spec house)? Ya PIo
Volume and Page Number �� as recorded with the Register of Deeds.
-------------------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWINCt
A VAtiAMTY DYED which includes a DOCUMENT NUMBER, VOLUME AND PAGE MUMSZR, and
the SEAL OF THE REGIBTER OF DEEDS. In addition, a certified survey, it
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified survey
Map shall also be required.
--------------------------------------------------------- 7---------------------
PROPgRTY OWNER CERTIFICATION
I(Ve) certify that all statements on this form are true to the best of my (out)
Rnovledgel that I (we) am (are) the owner(s) of the property described In
this information form, by virtue of a warrantyrflyfd recorded In the Office of
DOCUMENT NO, STATE BAR OF WISCONSIN FORK 3—
QUIT CLAIM DEED
444957 832 pvt 482
tiar, Ais......... ... Beth.Ke .... a.nd ... ............
......... h.usl�*'p ..... Apo ... W.if e . ........... ................ ......................... ..
. ......... ...
.... .. .. ............ .... .........
quit -Maims- - . - to - -Phr i s t i a n A. Be t hk e -and_..Lorp.t t.4 ...........
Bethke, husband . - - and
wife, -.as - �._;��qryiv.qrs.h.ip..
----------------
M arital.pr9per-ty ................. ..... ... --------------------- - ...........
..................... -- ----- ..... ----------- - * ----------- ----- --
- -* --- ---------
. ...........
the foliowing described real estate in ..S.t.—Cr.oix --------- county,
State of Wisco n a in
N� of NA EXCEPT South 340 feet of West
512.5 feet thereof; N� of S� of NA;
All in Section 25-31-17.
S� of S� of NWk and N� of SWk of Section 2 5 ;
NEC of SEk of Section 26;
All in 31-17.
THIG IWACC R960MM FOO NSCOVIDMO DATA
REGISTER'S OFFICE
ST. CROIX CO., WI
Rec'd for Record
JAN 271989
of 8:30 A.#A
�R9810V of Do*& W% -
WIETURN TO ATTORNEY AT LAW
113 E. ELM ST.
RIVER FALLS(. WIS. 54022
Tax Parcel No: --------- --------- --------
N� of NEk, EXCEPT East 24 rods thereof; and
SEk of NEk of Section 25-31-17, lying West of Willow River.
This ...... is-
.............
(13) (is not)
Dated this -24th
homestead property.
day of ,January 19.89
(SEAL) (SEALi
Christian A. Bethke
(SEAL) (SEALj
Loretta Bethke
AUTHENTICATION
Sigmature(s) ..Chr-i-s-ti.a-n -_A,,..Bethke- and.
Loretta Bet hk e ..... .... . -
authe ca i� day ----- Jarivar-v is -69
.. .... .. ...
C. L. Ga Ord
-- - ----------- TITLE: MEMBER S TE BAR OF WISCONSIN
(if not, - ..........
a—%orized by § 706.06, Wis. Stats.)
ACKNOWLEDGMENT
ST kTE OF WISCONSIN I
as.
......County.
Personally came before me this ..day of
----- ----- - 1 19.... the above named
..............
.... ..... ............. ... . .. ....
.................. ............
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number_
CITY/ STATE ZIP� -----
PROPERTY LOCATION ' ,1', Section,, TN, R '�7 W,
Town of,
St. Croix Coun y,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Prover maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can al 'Ft the unction or t�eptic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their system properly
maintained.
The property owner agrees to.submit to St. Croix County Zoning a
certification form, signed by the owner and by a matey plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on -site wastewater disposal system is in proper
operating condition and .(2).after inspection and pumping (if nec-
essary), the septic -.tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED /�/lQ_� 1
DATE /_/ ,( 4- 14 `z / l
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
H
0
9
N
r•
b
DEPARTMENT OF
INDUSTRY,
LABOR AND
HUMAN RELATIONS
REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
PERCOLATION TESTS (115) MADISON, W 53707
(ILHR 83.Q9(1) & Chapter 145)
LOCATION: SECTION:r �J ) TOWNSHIP/ UN H'A'M_Y: LOT N IBLK. SUBDtVI ION NAME:
,� 1/4/ 13,N/Il Z (or
OJJ NTY: OWN R'S BUYER'S NAME: MAILING ADDRESS
ISE DATES OBSERVATIONS MADE
Residence
I —PR-0—F-11CDESCRIPTIONS: IPER OLATyONTESTS:
❑N Replace
i.a i nv%.3: a= ane suitaoie Tor system U= Site unsuitable for system
ONVENTIOIVAL: MOUND: IN-GROUNDPRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDEDSYSTEM: (optional)
s ou as ❑u as ❑u as au as ou��.�
If Percolation Tests are NOT required DESIGN RAT If any
portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate. ' , Floodplain, indicate Floodplain elevation:
n_ PROFILE DESCRIPTIONS
BORING
NUMBER
TOTAL
DEPTH K
ELEVATION
DEPTH TO GROUNDWATER
-INCHES
CHARACTER OF SOIL WITH THICKN SS, C LOR, TEXTURE, AND DEPTH
TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
OBSERVED
EST. HIGHEST
B-
B-
B-
B-
PERCOLATION TESTS
TEST
NUMBER
DEPTH
INCHES
WATER IN HOLE
AFTERSWELLING
TEST' T ME
INTERV L-MIN.
DROP IN WATER LEVEL -INCHES
—PERIOD
RATE MINUTES
PER INCH
1
PERIOD2
PER1003
P-
P_
P-
G
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
so-
i
I
fN
T
WAL
JAL
!
EEd
-
r-}--
r=
- i
-+--1--I--- tI ---�---1 ---
It
:
I
_
I
ITJ
t-
-----
-----
i
.......
�
i• i- i I I ��
i--
- I
-- -�
-
--
-
F.7
I
i
339694 ST. CROIX COUNTY
CERTIFIED SURVEY MAP SURVEYOR'S RECORD a
NEAL KRUMM
Part of the Southwest 1/4 of the Southwest 1/4 of Section 25, Township 31 North,
Range 17 West, Town of Stanton, St. Croix County, Wisconsin
W V4 Cow. SE.c. 25-T3I1.1- RI7VV
SOUTH 1 32 8,98
33 33I
°e
N in
M �
O 1`
� N �
I N 8822,00"W
3 3 1 331 3 90.00
0 Indicates 1" x 241, iron pipe stake weighing 1.13 #/ft.
Description:
That certain parcel of land located in the SW 1/4 of the SW 1/4 of Section 25,
T 31 N, R 17 W, Town of Stanton, St. Croix County, Wisconsin, more fully
described as follows; Beginning at a point on the West line of said SW 1/4 of
Section 25 a distance of 1328.98 feet South from the West 1/4 corner of said
Section 25, thence go S 880 22' 00 " E a distance of 390.00 feet; thence
South parallel with said West line of the SW 1/4 a distance of 279.35 feet;
thence N 880 22' 00" W a distance of 390.00 feet to the West line of said SW 1/4;
thence North along said West line a distance of 279.35 feet to the Point of
Beginning, the above described parcel containing 2.5 acres, more or less,
including the Westerly 33 feet thereof presently ased for Town Road purposes.
State of Wisconsin )
St. Croix County )
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction
of the Owner, Neal Krumm, I habe surveyed and divided the lands shown hereon
according to official records and in accordance with provisions of Chapter 236.34
of the Wisconsin Statutes and the St. Croix County Ordinances; and that the map
and description shown hereon are a true and correct representation thereof.
Dated: 18 February 1977 \o```�`����� C 1
\ /
Vol. 2 Page 362 '
Certified Survey Maps pit w
St. Croix County Records dam s L:
g
St. Croix County, Wisconsin ei c d `land MiArqYor OR 2
I _t • - , . • s&.� - 919n
A- /*
Wiscor,ain Department of Commerce
Safety and Buildings Division
GENERAL INFORMATION
cposs ( vsLf:; (,, -
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
— ria, ,,,,.,,,,,a.,.,,, y.,,. ,,.,,., „K.y , "lluary purposes Wrivacy Law, s.15.04 (1)(m)].
Permit Holder's Name: ❑ City ❑ Village _CI Towri o
Bethke, Steve Stanton Township
CST BM Elev.; Insp. BM Elev.: BM Description:
r ,OtA
TANK INFORMATION
"
TYPE
MANUFACTURER
CAPACITY
Septic
��
l
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
Air e
AirI tntako
ROAD
Septic
57-0
> 5'"0r
�,a:
—
NA
Dosing
> 57-0 /
gjo
> 35 r
NA
Aeration
= -_
---
NA
Holding
PUMP/ SIPHON INFORMATION
SO -,ABSORPTION SYSTEM
ELEVATION DATA
County,
St. Croix
Sanitarv. Pormit No.:
370350
tate Plan ID No.:
r
__S /A-* = if `fro S)
rcel Tax Nn
036-1059-95-000
STATION
BS
HI
FS
ELEV.
Benchmark Ga>
:1
Alt. BM
Bldg. Sewerr.5
St/Ht Inlet
I,yr$er
7.IYZ
q� q$ `
St/Ht Outlet
�j,/►o
C�,6 r
Dt Inlet
8"ZS'v
• SS ,
Dt Bottom
/, 60
, zo l
Header / Man.
/. 90
102.90r
Dist. Pipe
2' /10
o '
I z•�o
Bot. System
.80
O ,0
Final Grade
St cover
(Cb. 0 r
B /
Width
Length I
No. OPa
PIT
No, Pits
Inside Dia.
Liquid Depth
DIMENSIONS5-
DIMENSION
SETBACK
SYSTEM TO
P/ L
BLDG
WELL
LAKE /STREAM
LEACHING
Manufacturer:
INFORMATION
CHAIJV B
Type O
/
i
,
>
Moe Num 4`
System:
I
a
$0
OR'[1NIT
DISTRIBUTION SYSTEM (*1 L__�, 1_�-b Srdt ce* loef! � koLt.4-0—
Header / Manifold
Distribution Pipe(s)
x Hole Size
x Hole Spacing
Vent To Air Intake
�
Length 1(� Dia. 2
/
I Length � Dia. 2. Spacing 36
3/ ii
/l
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth Of
xx Seeded / Sodded
xx Mulched
Bed /Trench Center
Bed /Trench Edges
IopsoTil
❑ Yes ❑ No
[I Yes ElNo
COMMENTS: (Include code discrepancies, persons present, etc.).,rk (�'>
Inspection #1: 0 1 / 04 / ob Inspection 2: I l / 10 / oo
Location: 1923 190th Street, New Richmond, WI 54017 (SW 1/4 SW 1/4 25 T31N R17W) - 253117383D
1.) Alt BM Description =
2.) Bldg sewer length = z.z. o
-amount of cover = ? —cA"%"j &k -4xi feefit"
3.) contour = ( foo.2i�) 5 �.'E , �.S-a$ 'ftl : lo`f- } �J
l �,.r„� �,rd�e W � la- l S " s►�: Q cxx-j-
Plan revision required? ❑ Yes � No
Use other side for additional information. l ( 2 2 (o
SBD-6710 (R.3/97) Date Inspector's Signature Cert. No.
•A .W
.W
Sanitary Permit Ap
Safety & Buildings Division
C
In accord with Comm 83.2
201 W. Washington Ave.
gt
See reverse side for instructions r ng � p7ic�eion
PO Box 7302
Department of Commerce
econdary purposes
Personal information you provide usedNEB
[Privacy Laws.5.04
Madison. WI 53707-7302
(Submit completed form to county if not
I state owned.)
Attach com lete plans (to the county copy only) fbK the system. on paper pot le th
n 8-1/2 x 1 I inches in size.
County j /
C/ry
State Sanitary Permit Number eck r� iolt r appl ati
3
ate Plan 1. D. NN b r
r 1<
I. Application Information - Please Print all Information (P'Location:
Property Owner NametNG
Property Location
G-ct— f v G
� 1 /4 /4, T-jr,N, fE r
Property Owner's Mailing Address
Lot Number Block Number
City, State
Zip Code
Phone Number
Subdivision Name or CSM Number
II Type of Building: (check one) ✓
1 or 2 Family Dwelling - No. of Bedrooms:_ 12Q"�1e- "ell����
❑ City
❑ village
❑ Public/Commercia descr-b
X.Town of
❑ State-owned CV , 30
rrr Type e u _.� .. \�� only r i `u line c
... T• ^c �.. e.- .t.. . cc k only one box on line I,. Cficc� box on B i. applicable)
Nearest Road
yD ��
A) 1. New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to
Parcel ax Number(s)
S stem Tank Onlv ExistingSystem
36 �O • . o
B)
Permit Number
Date-4ssved
❑ A Sanitary Permit was previously issued
S 3 (. . �J$ 3 D
IV. Type of POWT System: (Check all that apply) —(oo
'Ion -pressurized In -ground Amound ❑ Sand Filter ❑ Const cted Wetland
❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade r ❑ Aerobic Treatment Unit rr ❑ Recirculating ❑ Other:
�S " uez
= 1.4 20'
V Dispersal/Treatment A rea"M formation:
1. Design Flow (gpd)
2. DispersalArea
3. Dispersal Area
4. Soil Application
5. Percolation Rate
6. System Elevation
7. Final Grade
Required �7
Proposed
Rate (Gals./day/sq. ft.)
(Mn,/hn
Elevation
VI Tank
Capacity in
Total
# of
Manuf cturer
Prefab
Site
Steel
Fiber-
Plastic
Information
Gallons
Gallons
Tanks
Con-
Con-
glass
New
Existing
crete
structed
Tanks
Tanks
'K
❑
❑
❑
❑
VII Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber'sName (print)
Plumber's Signature (no stamps):
MP/MPRS No.
Business Phone Number
Plumbe Adddrres (Street, City, State, Zip Code)
VIII County/Department Use Only
❑ Disapproved
Sanitary Permit Fee (Includes Groundwater
Date Issued
Issuing Agent Signature (No stamps)
AApproved
❑ Owner Given Initial Adverse
Surch ge Fee)
Determination
-ja-S. �
—Z3. 200
IX. Conditionsof Approval /Reasons for Disapproal: LL*10tN E C
11 ^^
SBD-6398 (R. 07/00)
Visconsin
Departn;,�nt of Commerce
October 11, 2000
CUST ID No.220527
BYRON BIRD JR
896 68TH AVE
AMERY WI 54001
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/11/2002
SITE:
STEVE BETHKE - RESIDENCE
ST CROIX County, Town of STANTON; 1923
SW1/4, SW1/4, S25, T31N, R17W
FOR:
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www.commerce.state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
ATTN: POWTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
Identific i umbers
Transaction ID No. 20
Site ID No. 200280
Please refer to both identification numbers,
190TH ST above, in all correspondence with the agency.
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 766038
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. On page 4, based on the ground elevations provided, the slope in the mound system area is actually 8
percent.
2. On page 5, I = 15.69 feet and W = 32.49 feet.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
:T4ERE
DATE RECEIVED 10/02/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
EL ,r0745
PLAN REVIEWER II BALANCE DUE $ 0.00
Integrated Services
(608)266-2889 , M -, - 1630 HRS
PEPAGEL@COMMERCE.STATE.WI.US WiSMART code: 7633
cc: STEVE BETHKE
,
fisconsin
Department of Commerce
October 11, 2000
CUST ID No.220527
BYRON BIRD JR
896 68TH AVE
AMERY WI 54001
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/11/2002
SITE:
STEVE BETHKE - RESIDENCE
ST CROIX County, Town of STANTON; 1923 190TH ST
SW1/4, SW1/4, S25, T31N, R17W
FOR:
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www.commerce.state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
ATTN: POWTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 766038
Identification Numbers
Transaction ID No. 442205
Site ID No. 200280
Please refer to both identification numbers,
above, in all correspondence with the agency.
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. On page 4, based on the ground elevations provided, the slope in the mound system area is actually 8
percent.
2. On page 5, I = 15.69 feet and W = 32.49 feet.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
Inquiries concermgg this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead]
Sincerely
r
r � ,
7.
P T E PL , P WTS LAN REVIEWER II
Integrated Services
(608)266-2889 , M - F, 0745 - 1630 HRS
PEPAGEL@COMMERCE.STATE. WI.US
cc: STEVE BETHKE
DATE RECEIVED 10/02/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
WISMART code: 7633
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the at -grade is to be inspected via the inspections pipes in the at -
grade. The laterals are to be inspected via the cleanouts.
5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. The owner agrees to save this plan.
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, remove bio-mat, replace removed sand, reinstall pipe and rock, recover mound.
3. Replace any other failing components as needed. P;O.W,T.S.
Conditionally
AF")-R-
10OVE
Byron Bird Jr. Do OMM E /
DIVISFE AN D)N J
Jr (j
#220527 1�
E CORRESPOND NCE
r y ew49
�,�/�
CORRECTION NEEDED
SEE CORRESPONDENCE
0)
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the at -grade is to be inspected via the inspections pipes in the at -
grade. The laterals are to be inspected via the cleanouts.
5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. The owner agrees to save this plan.
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, remove bio-mat, replace removed sand, reinstall pipe and rock, recover mound.
3. Replace any other failing components as needed.
Byron Bird Jr.
#220527
CORRECTION NEEDED
SEE CORRESPONDENCE
v�
P.O.W.T.S.
Conditionally
SEE CORRECPON
14L(2zo5
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In -Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within the
parameters of Comm 63 and 84, and the conditions of approval by the department, agent, or
governmental unit. The approved plans and penrilts for system are on file at the county zoning
or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In -Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak gpd)
Estimated Flow - Average (gpd) ,,7ij:�
Septic Tank Capacity (gal)��
Soil Absorption Component Size (ft2)
Type of Wastewater Domestic
Table 2: Soil Absorption Comnonpnt . 1-imitfi of Roliahla r)nrkratinn
Septic Tank Component
Soil Absorption Component
Design Flow - Peak (gpd)a—
Maximum Influent Particle Size (in)
NA
1/8
Maximum SODS (mg/L)
NA
220
Maximum TSS (mg/L)
NA
150
Maximum FOG
NA
30
Table 3: Maintenance Schedule
Septic Tank inspect and/or service once every 3 years
Outlet Filter Should Inspect once a year and clean once every,3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least once
every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper
operation. The filter cartridge should not be removed unless provisions are made to retain
solids in the tank that may slough off the filter when removed from its enclosure. If the filter is
equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an Impending continuous alarm. The septic
Management Plan for a Septic Tank and Soil Absorption Component
tank shall have its contents removed when the volume of scum and sludge in the tank exceeds
1/3 the liquid volume of the tank. if the contents of the tank are not removed at the time of an
assessment, maintenance personnel shall advise the owner of when the next service needs to
be performed to maintain less than maximum scum and sludge accumulation in the tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSiYA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank maybe difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing.
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least once
every three years. The inspection shall include recording the levels of ponding, if any, in the
observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage from
the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen Into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
Plantings of deep-rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
C '3/
PLOT PLAN
PROJECT Steve Bethke ADDRESS 1923 190th St. New Richmond Wi 54017
SW 1/4 SW 1 /4 s 25 /T 31 N/R 17 , W TOWN Stanton COUNTY ST. CROIX
MPRS Byron Bird Jr. 220527 DATE9/27/00 BEDROOM 3
CONVENTIONAL IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND )0= SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 375 # of chambers
BENCHMARK V.R.P. Top of Walkout Slab ASSUME ELEVATION 100'
❑ BOREHOLE O WELL -H.R.P. Same as Benchmark
SYSTEM ELEVATION 102.0
Tanks are to be
properly bedded with
approved warning
labels and lockdown
covers
Existing System is
to be pumped and
buried
Property Line
Existing 3
Bedroom
House
B.M.
Please note: errors that
were found on the
original soil test were
fixed on this plot plan.
System is to be installed
along the 100.3' contour line
1 01 .0'
^C7B-3
101.0'
B -1 98.5'
Weeks ❑
ST — DT
Zabel A-100
filter
ST
1 0 0'
Failed System
B-4
98.5'
Area 15' Below
system is to
remain
undisturbed
6%
Slope
CORRECTION NEEDED
SEE CORRESPONDENCE
1 50'
1 50'
P.L.
Cy7
Designer
Date
4" Observation Pipe Perforated
Below Filter Fabric
Ir
%k /` A ".p C.
ASTM C-33 Sand
" Topsoil ----�
__ i
1
Non -Woven Filter Fabric
Distribution pipe
E to
7
Slope
Bed Of ��— 2 % Force Main � Flowed
From
Drain Rock 2\
Pump Layer
D
Cross Section Of A Mound'S stem Usin , E.
A Bed For The Absorption Area F ' ?S-
G -.L ,-
A Ft. h / 5-
s 7 Ft.
J / , 8 Ft.
K • .!- Ft • CORRECtION - NEEDED
t. Lee. Jf. Ft. SEE CORRESPONDENCE
eObservotion Pipe
V I
�-------------------- ---------------------
c � Force Moin
t -- From Pump
�° Distribution Bed Of %2�— 2 %Z
Pipe Drain Rock
4 Observation Pipe Permanent Marker
Pipe or Rods
Plan View Of Mound Using A 6td For The Absorption Area
PAGE OF
C%Q
Perioroted pipe Detoit
,r
Ct, I /L — fps Distribution Pipe layout
Signed:
License Number:
Date:
f Loratsd On SWIM
Egvdny soored
FIRST i4OLL ucx•r re Gonnsc� cn
P %2 Ft.
R 3 R.
X Inches
Y Inches
Note Diameter 3314 Inch
Lateral 02 ' Inch(es)
Manifold Inches
Force Main C Inches
# of holes/pipe3ol?
Invert Elevation of Lateralsboa,% Ft.
c.:. v4::I Afpr"
AAOw ok VFtcsw
AIR ;AI"AKE
AJLCT
*
C:CV.V__.7FT
5 J`"F' CHAl",b R CR055 SECTIOI'J c r ce
- � � asa:m smiiar�a���---rem- • 1U .i C c i� 7 u a �r � o � � 5
VCNT CAP
` T_ ---,-
I ;
W::ATHERPRO0F
.104'r1oki Box
IQ..N.�u.
E
I GRACE --�
CO1JDUIT
*APPROVED
JOINTS 4ITr
APPROVED PIPE
3' ONTO
SOLID SOIL
V '
PRoviC£
AIRTfilk'r SEAL
PUMP _"
COuCRETE DLOCK
APPROVED LOCKIA!;.
MAA;HOLC COVER
N" MAJ.
_j i W MIA;.
RISER CXIT Pr6KA!TrED "Lt IF TANK
/n4QUFACTUR1wR HAS SUCH APPROVAL,
SEPTIC i SpECiF1"Ito
1S �-ao9alGoA4
xst
TANKS MAWUFAGTURCit: --
TAus'c s,�� : 11a o
--PER oAs
CALLOUS
ALARM AAN�JP'ACTURCR: ���sc�ir"'
DOSE VOLWME ��
IAICLUCIMG
��•
MoDr-L WUMBCR:
�-
SWITCk
OACKFI.9) GALLONS
CAPACrrlEsr A.= I�cHEs —
OR
TyPC; �.rSL
°�P
SALLONs
D
/1ANURAGTLIRCR: /'O
IIJGMtS OR GALLONS
MOGi L UUMOCK'
C "+u►MC6 OR 4ALLGU!
SWITCH -rwpc:
DR— (:7INC'4ES OR
GALLOA)i
M'WIMUM DISCHA1:Gt RAfC �_r.pm
�TF PUMP AND ALAfit', ARt TO DC
INSTALI-GO ON
v[RTICA4 o,a<fcRC1JEC DETV"CM PUMP Off ^IUD DISTRIbUT:ow
t
SEPARATE CIRCuiT3
PIPE_-4, 4_ FECT
M�IN�IM-UM NETWORK SUPPLtl t'Rt45tLJRE ,
��-=—•�
Rit-r
f lo
r'CET OF FORCt' pIAIAI XY. ,yo FRFRICTION FACTOA..�
TOTAL O%uAMIC NERD
� FEET -
�_ FACT C 7/
it)TF>RUAL 0i!''1EAjAIQAS OF TAQK: L E►JGTN _...;WIDTH
/
- ;,I.IgU10 (�
, CEPTH
�j
------- .� _ IC C Q c
F Vt. . _ ..
Puma Characteristics
Porn/Motor Unit
Sahmerswe
Maned Mo"
SHEF40Ml
SHEF40M2
Aetomatk Mo"
SHEF40A1
1 SHEF40A2
Horsepower
4/10
Fall load Amps
12 1 6.5
Motor Type
Shaded Pole (4 Pole)
R.P.M.
1550
Phase
10
Voltage
115 1 230
Hem
60
Tewtperorwe
120° F Max. Fluid Temp.
NEW De
A
Iastrfotfon
Class A
Disch Size
1 1 /2" NPT
Solids Hon
3/4-
mitt
28lbs.
Power Cord
18/3, SJTW, 20' std.
(30' optional)
Materials of Construction
Howie
Stainless Steel
Lebrkatf OB
Dlelectrk 011
Motor Ho"
Cost Iron
P (using
Cast Iron
Shaft
Steel
Mechanical
Shaft Seal
Seal Faces: Carbon/Ceramic
Seal Body: Anodized Steel
Spring: Stainless Steel
Bellows: Buna-N
Impeller
Engineered Thermo asll
upper B
`Bronze Sleeve Bean'
Lower Seoiring
Bottom Plate
Sin le Row Ball Beor1 ;
P.elVes'tor Coated Steel .. >•;
fasteners
Stainless Steel
Performance Data
■
NOME
ENNURSEEMEN
MMEEN
ON
Dimensional Data
3.7/8'
(98.42)
3-7/8'
(98.42)
3-718"
f98.42)
e-&V (1U.27) 1. All dimensions in inches. (Motric for
-B" (127) international use);ion�: 2. Component dimenmay
vary ± 1/8 inch.
DISCHARGE 3. Not for constructi'ln purpose
t.Irz" NPT unless certified.
FLOAT
SWITCH 4. Dimensions and weights are
approximate.
5. We reserve the righl to make
revisions to our product and their
specifications without nolce,
s
<'"4�`
eg ENgilleeredjThermoptastk�> .x «>
Cy 1998 Hydremotic" Pumps, Ashland, Ohio. All Rldht- Reswvod.
IHYDROMATIC ® _ —Your Authorized local Distributor-
.
164(1 Boney R,,ad Ashland, Ohio 44805 Tel: 419-289-3042 Fax 419-281-4087 r
Web Site: www.pentairpumpxom SS
SALES OFFICES IN All MAJOR CITIES AND COUNTRIES
Cer7fe
Refer to "Pumps" in the yellow pnges of your phone directory for your local Distribute I>
Item# A 02 6680 1 198 5M
J k
Wisconsin Department of Commerce SOIL EVALUATION REPORT
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Page of
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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. C� 3 1 d 5 _ C'
Please print all information.`Reviewed by Date
Personal information you provide may be used for secondary purposes (PPI4acy La��%
(1)(m)), -� O' 7S-CID
Property Owner Prooerty Location
L/ ,T
Govt. Lot-s�til 1/4 '1/4 S6;�
T_3'1 N R f E
Property Owner's Mailing Address ST
� 7
Lot #
Block #
Subd. Name or CSM#
COUNTY
COUUNTY
.2
City State Zip Code Phone Number;U UFFICE
❑ City ❑ Village kTown
Nearest Road
❑ New Construction Use: Q Residential / Number of bedrooms Code derived design flow rate
GPD
Replacement ❑ Public or co ear - Describe:
-vial
Parent material �/ F�j 4�� Flood Plain elevation if applicable
ft,
General comments
an ecommendations:
U`�A llrri<h �F�� %�_ l
�c% �c
ter• c . �, c
/Boring
# ® Boring
❑ pit Ground surface elev,,'/G�• ft. Depth to limiting factor lam` in.
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft2
'Eff#1
I 'Eff#2
L
7
�
•.
/`
Sri
121 9 Boring # Boring l �7
Pit Ground surface elev. /7J- / ft. Depth to limiting factor4 in.
Horizon
Depth
In.
Dominant Color
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz.
Consistence
Boundary
Roots
GPD/ft2
•Eff#1
'Efff##2
/Munseil
��Sh.
v?
-1w43
cuwnnL It I - ovva - w Z "V ni}yL rams 100 +w - 1 w mg/L crnuent w,& = t3Vuy < 3U mg/L ana 1 bb < 3U mg/L
CST Na (Please Print)) Signatur CST Number
Aaayess ,/ v Date Evaluation Conducted Telephone Number
t ! V.
Property Owner J e �� L ��1 A �- Parcel ID # 1` Page
Boring #
Boring VA,-
M
❑ pit Ground surface elev. ft. Depth to limiting factor in.
of
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ftz
'Eff#1
'Eff#2
Gza-
ell
Boring # ® Boring �•�
❑ pit Ground surface elev. �S " / ft. Depth to limiting fac.,�r fn.
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
C=Istence
Boundary
Roots
GPD/ftz
'Eff#1
•Eff#2
1
F
Boring # ❑ Boring —
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
'toundary
Roots
GPD/ftz
'Eff#1
'Eff#2
Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and'rSS < 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-9330 (R.6100)
Project Name Steve Bethke
Soil Test Plot Plan
Byron Bird Jr.
Address 1923 190th st
New Richmond Wi. 54017 CSTM #220527
Lot --- Subdivision --- Date 9/25/0452
SW 1/4SW 1/4S25 T 31 N/R17 W TownshipStanton
Boring Q Well PL Property Line County ST. CROIX
Opor VRP Assume Elevation 100 f to�of alkou�slab�
System Elevation 99.9 H.R.P. same as BM
.7
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
-Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County
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 Property Location
J t Govt. Lot 1 /4 1 /4 S �, T,7 N R! E
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number ElCity ❑ Village Town Nearest Road ,
'611'2241 �/, `r o/ (i
❑ New Construction Use Residential / Number of bedrooms Code derived design flow rate U GPD
Replacement ❑ Public or commercial • Describe:
Parent material ��/ L,��`� Flood Plain elevation if applicable ft.
General comments
and recommendations:
171 Boring # ®Boring ❑ �
Pit Ground surface elev�G!5�.'7 ft. Depth to limiting factor � in.
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munseli
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft'
'Eff#1
I 'Eff#2
-
y
�u J�
r
,
Boring # Boring ��
Pit Ground surface elev. /L'2ft. Depth to limiting factor 4ZI_ in.
Snil Annlir-gtinn Rats
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh`.
Consistence
Boundary
Roots
GPD/ft'
'Eff#1
'Eff#2
a
777
Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #Z = 13t7D5 < 3U mg/L and t Ss < 3o mg/L
CST Na (Please Print) Signatur CST Number
Add s �f Date Evaluation Conducted Telephone Number
Pro:)erty Owner CyyJ 4t77/ Parcel ID #
LBoring # Boring
❑ Pit Ground surface elev.� ft. Depth to limiting factor-4� in
Page of
Hr rizon
Depth
in.
Dominant Color
Munsell
Redox Description
Cu. Sz Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
•rr••
GPD/ftz
•Eff#1
'Eff#2
_
G u -2
/!7
!� Boring # Boring
❑ Pit Ground surface elev. �S =� ft. Depth to limiting faOor 19, in.
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Com'stence
Boundary
Roots
•rr••
GPD/ft'
`Eff#1
'Eff#2
1
7❑ ❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor _ in.
Pit
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
ltoundary
Roots
GPD/F
•Eff#1
'Eff#2
i
I
l
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and, rss < 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 TITY 608-264-8777.
SBD-9330 (R6/00)
Soil Test Plot Plan
Project Name Steve Bethke Byron B*rd Jr.
Address 1923 190th st
New Richmond Wi. 54017 CSTM #220527
Lot --- Subdivision --- Date 9/25/Od
SW 1 /4 SW 1/4 S 25 T 31 N/R17 W TownshipStanton
Boring Q Well PL Property Line County ST. CROIX
,BM or VRP Assume Elevation 100 ft.top of walkout slab
System Elevation 99.9
H.R.P. same as BM
7
,. J
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the S7<«� ,/��f%� residence located at:
f ;,J ;, Sections,5- , T_N, RAW, Town of
Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced: /® %- cx--r�
Did flow back occur from absorption system?
Yes C< No (If no, skip next line)
Approximate volume or length of time: Z gallons minutes
Capacity:
Construction: Prefab Concrete__ Steel Other
Manufacturer: (If known) :Q��� 5
Age of Tank (If known).:
(Signaturey
(Title)
l o - 1�
Date
(Name) Please print
(License Number)
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR 83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
NameSignature -�— AMP/MPRS
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Ej f,ee a42!�4-'
Mailing Address /f-,- /®15�;
Property Address �� � X.- G
(verification required from Planning Department for new construction)
City/State AI"'� " Parcel Identification Number
LEGAL DESCRIPTION
Property Location /.,,`CC% '/4, Sec P7- T _N-I.�W, Town of --
Subdivision `���� �� Lot #
Certified Survey Map # 3 3 , Volume o�2 , Page #
Warranty Deed # y , Volume ,Page #
Spec house ❑ yes J( no Lot lines identifiable,iires ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
ntaster plumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewater disposal system
is iii proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set fortli, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year eYp. ion date.
SIGN'A TtlftOF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the proper described 4bvye, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNA`i`URE OF APPLICANT ` DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
' * Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
' STATE BAR OF WISCONS 3
QUIT CLAIM Of W
DOCUMENT N0. ,
• PtAv� 557 9NE 29Q THIS SPACE RESERVED FOR RECOROINjo DATA
3.11552
VOL
REGISTERS OFF: I
�BY THIS ItEFD ST. CROIX CO., wig.
Rec'd. for Record Ws 714th
Grantor
Steven_. day of July A.D. 1917
quiE•claima to-"""�J--
--- --- t=ala-
a i
--- - One Dollar and other
Grantee t IuNhle Inns}' etion —� __ __ _. -_
luaVle consl eration
—SST. CROIX Gun+state vt Wiscnn�cin:
the following de,-ntu�d Ieal estate to y,
RETURN TO
REINSTRA & VAN DYK, S.Ct;j
j 201 South Knowles Avenui
New Richm66f 4,7 —+34_61
Tax Xev ' ---
This is nOt_homestead property.
That certain parcel of land located in the SW 1/4
of the SW 1/4 of Section 25, Township 31 North, Range 17 West, Town i
of Stanton, St. Croix County, Wisconsin, more fully described as j
follows) Beginning at a point on the West line cf said SW 1/4 of
Section 25 a distance of 1328.98 feet South from the West 1/4 corner
of said Section 25; thence go South 880 22' 00" East a distance o tj
390.00 feet; thence South parallel with said West line of the SW 1/4
a distance of 279.35 feet; thence North 880 22' 00" West a distance
of 390.00 feet to the West line of said SW 1/4; thence North along
said West line a distance of 279.35 feat tc the Point of Beginning,
the above described parcel containing 2.5 acres, more or less,
including the Westerly 33 feet thereof presently used for Town Road
purposes.
L,s.ti1- 3G 1
Executed at New. Richmond. WI
SIGNED AND 'SEALED IN PRESENCE OF
Signatures of ------
authenticated this - _____— day of
Ai�SF ER
FEEII
I
this-- 24th ,+ay of _—_-_Ma=— 1977...
(SEAL`
Christian A. Betake
1 (SEAL)
(SEAL)
(SEAL)
Title: Member State liar of Wisconsin or Other Party
Authorized under Sec. 706,06 viz. --
STATE OF WISCONSIN
ST. CROIX -_ - County. 9S'
- --• 19�Z.
Peraone ame betore me, this ____ 24th--_--_—_-- day of
the above n.i7-d Christian -A.— e- hk€— ------_._._ -- --
to me know:+ n, ho thedge
r p. rson who executed the fcregoing instrument and acknowld some. �,
339694
Part
Range
CERTIFIED SURVEY MAP
NEAL KRUMM
of the Southwest 1/4 of the Southwest 1/4 of Section 25,
17 West, Town of Stanton, St. Croix County, Wisconsin
Q"fi
W /4
Cow. 5E,:. 25-T31N- R17VV
SovTH 13Z8.98
33 33I
5 88'22an" E �5�n nn'
4
Q
0
5�
33
1 33
oo c. G vU YV -1) y0. 00
0 Indicates 1" x 24" iron pipe stake weighing 1.13 #/ft.
Township 31 North,
N'
Scq�� 1 1" = 100'
Description:
That certain parcel of land located in the SW 1/4 of the SW 1/4 of Section 25,
T 31 N, R 17 W, Town of Stanton, St. Croix County, Wisconsin, more fully
described as follows; Beginning at a point on the West line of said SW 1/4 of
Section 25 a distance of 1328.98 feet South from the West 1/4 corner of said
Section 25, thence go S 880 22' 00 " E a distance of 390.00 feet; thence
South parallel with said West line of the SW 1/4 a distance of 279.35 feet;
thence N 880 22' 00" W a distance of 390.00 feet to the West line of said SW 1/4;
thence North along said West line a distance of 279.35 feet to the Point of
Beginning, the above described parcel containing 2.5 acres, more or less,
including the Westerly 33 feet thereof presently iised for Town Road purposes.
State of Wisconsin )
St. Croix County )
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction
of the Owner, Neal Krumm, I habe surveyed and divided the lands shown hereon
according to official records and in accordance with provisions of Chapter 236.34
of the Wisconsin Statutes and the St. Croix County Ordinances; and that the map
and description shown hereon are a true and correct representation thereof.
Dated: 18 February 1977 \�������_,�C,
Vol. 2 Page 3G2 d -� %�6 'y •�
Certified Survey Maps `?'�
S C Count Records L �i'h���
t. Croix y
St. Croix County, Wisconsin egiq 4 land silk eor; � � R 291sn
WI FUND APPLICANTS - 2001
Invoice attachment 11/9/01
Date
Applied
Applicant
Address
Amount Due
12/12/2000
Bethke, Steven R.
1923 190th Street, New Richmond WI 54017
$4,087.00
06/28/2000
Bos, George O.
2299 200th Avenue, Deer Park WI 54007
$1,527.00
11/15/2000
Erkeneff, Nick
2310 200th Avenue, Deer Park, WI 54007
$4,550.00
11/29/2000
Haworth, Helene
316 170th Street, Hammond WI 54015
$5,314.00
06/12/2000
Jensen, Lester A.
293 310th Street, Wilson WI 54027-2703
$5,250.00
11/03/2000
Lokker, Paul
857 220th Street, Baldwin, WI 54022
$4,325.00
07/05/2000
Radigan, Mary Ann
2264 205th Avenue, Deer Park, WI 54007
$2,164.00
10/03/2000
Simmon, Stephen
1156 County Road D, Glenwood WI 54013
$5,475.00
09/10/2000
Swanepoel, Joe/Lekme, Trisha
1977 County Road P, Glenwood WI 54013
$2,300.00
12/18/2000
Stoner, Gaylord
799 Highway 64, New Richmond WI 54017
$5,054.00
$40,046.00
NNNNNNNN■
October 4, 2000
STEVE BETHKE
1923 190TH ST.
NEW RICHMOND, WI 54017
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680 Fax (715) 386-4686
NOTICE OF VIOLATION
RE: Failing septic system at 1923 190th St.
Town of Stanton - St. Croix County, WI
Computer # 036-1059-95-000
Dear Mr./Mrs. Bethke:
Parcel # 25.31.17.383D
As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of §
254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix
County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category
I). This violation was first noted on.
The violation noted is sewage failing to zone of saturation. An on -site soil test inspection on 10/4/00 did reveal the
septic effluent discharging to the zone of saturation in the immediate area of the existing drainfield. If fines and or
forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 10/4/00 in
accordance with Chapter 145.12(4) Wisconsin Statutes.
THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS
AND NEEDS PROMPT ATTENTION.
REQUIRED ACTION: You have already contracted with a certified soil tester to have a soil evaluation conducted.
The soil evaluation has determined that a mound type septic system is needed and it's location. Contract with a licensed
plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be
installed no later than May 1, 2001.
If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look
forward to working together to resolve this matter.
Sincerely,
�ev=Grabau
Zoning Technician
cc: file
Nvisconsin
Department of Commerce
October 11, 2000
CUST ID No.220527
BYRON BIRD JR
896 68TH AVE
AMERY WI 54001
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/11/2002
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www. commerce. state mi. us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
ATTN: POWTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
SITE:
STEVE BETHKE - RESIDENCE
ST CROIX County, Town of STANTON; 1923 190TH ST
SW1/4, SW1/4, S25, T31N, R17W
FOR:
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 766038
Identification Numbers
Transaction ID No. 442205
Site ID No. 200280
Please refer to both identification numbers,
above, in all correspondence with the agency.
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. On page 4, based on the ground elevations provided, the slope in the mound system area is actually 8
percent.
2. On page 5, I = 15.69 feet and W = 32.49 feet.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
Inquiries concermpg this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhe�.
Sincerely
P T ) PA EL, P WTS LAN REVIEWER II
Integrated Services
(608)266-2889 , M - F, 0745 - 1630 HRS
PEPAGEL@COMMERCE.STATE. WI.US
cc: STEVE BETHKE
DATE RECEIVED 10/02/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
WiSMART code: 7633
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the fifter.
4. Once every 3 years the at -grade is to be inspected via the inspections pipes in the at -
grade. The laterals are to be inspected via the cleanouts.
5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. The owner agrees to save this plan.
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, remove bio-mat, replace removed sand, reinstall pipe and rock, recover mound.
3. Replace any other failing components as needed.
Byron Bird Jr.
P.O.W.T.S.
Conditionally
A PP OVVEDEPAR E T 0 OMDIVISIO AFE AN
Lam( � -
#220527 SEE CORRESPONDINCE
/f,`/
CORRECTION NEEDED /C_ n e/
SEE CORRESPONDENCE
PLOT PLAN
PROJECT Steve Bethke ADDRESS 1923 190th St. New Richmond Wi 54017
SW 1/4 SW 1 /4 s 25 /T 31 N/R 17 - W TOWN Stanton COUNTY ST. CROIX
MPRS Byron Bird Jr. 220527 DATE 9/27/00 BEDROOM 3
CONVENTIONAL IN -GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND XX)OC SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 375 # of chambers
hL BENCHMARK V.R.P. Top of Walkout Slab ASSUME ELEVATION 100'
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION i ng n
Tanks are to be
properly bedded with
approved warning
labels and lockdown
covers
Existing 3
Bedroom
House
B•M•
101.0'
Well
B-1Ej�
Weeks
Existing System is
to be pumped and
buried
ST
100,
Failed System
Property Line
ST " DT
Zabel A-100
filter
El
B-4
Please note: errors that
were found on the
original soil test were
fixed on this plot plan.
System is to be installed
along the 100.3' contour line
98.5'
Area 15' Below
system is to
remain
undisturbed
101.01
/�❑B-3
98.5'1
■❑
6%
Slope
CORRECTION NEEDED
SEE CORRESPONDENCE
1 50'
1 5 0'
P. L.
TANK INFORMATION
"
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
LJ ec�S
Aeration
Holding
]]�
TANK SETBACK INFORMATION
TANK TO
P / L
WELL
BLDG_
Air a
Air Inttoke
ROAD
Septic
5_6 r
> SO
'rDA
—
NA
Dosing
> 50 /
gjpr
35
? 35 r
NA
Aeration
NA
Holding
PUMff/ SIPHON INFORMATION
Manufacturer
Model Number
TDH Lift a `Lo Friction 3 o Syst
L He
i
C�• Forcemain Length r Dia. Z'
nABSORPTION SYSTEM
(BLIX/ Width , r Lengtf
0-9 Demand
5v GPM
t2, T D H Ft
Dist. To Well
r 1 No.
* (__re,5S51 %Lt,
wiscorisln Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
PPrsrxial information you provice may be used for secondary purposes (P,tivacy Law, s.15.04 (1)(m)].
Permit Holder's Name: ity Village 1?4WR0
❑C
Bethke, Steve Stanton Township
CST BM Elev.: Insp. BM Elev.: BM Description: �,•�
nl PVATInN DATA
t. lil__ — Gu Ari\ I
County
St. Croix
SanitarKUfrnit No.:
370350
rate Plan ID No.:
fg,w-; IL* = # fZZOS)
Parcel Tax N-
036-1059-95-000
STATION
BS
HI
FS
ELEV.
Benchmark Gd/
s
to�f'}"
r
( , C7
Alt. BMA
Bldg. Sewer
5
St/ Ht Inlet
Isyrgp�
7• eZ
St/ Ht Outlet
g.l (o
Q(D •6 I
Dt Inlet
g"Z-
•SSr
Dt Bottom
f l• 6o
T3.Zo I
Header/Man.
90
IOZ•901
Dist. Pipe
2.t
)oZ • 4o
Bot. System
2,8o
O ,0 r
Final Grade
St cover
(3rvt
`f �D
I Cb. o r
PIT No. Pits I Inside Dia.
VImCry r ry - urer.
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING
SETBACK CHA Model Num�
INFORMATION TypeOf l D r ? g p' NIT
System: I
DISTRIBUTION SYSTEM e4 W Jew.
Header / Manifold DistributionPipe(s) x Hole Size x Hole Spacing Vent To Air Intake
J_/ r` 36 n !
Length � (� Dia. 2 Length 3 Dia. 2 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) LA� (P() •s��`l
Inspection #1: I 1 / 01 / 00 Inspection 2: I l / 10 / 00
Location: 1923 190th Street, New Richmond, W1 54017 (SW 1/4 SW 1/4 25 T31N R17W) - 253117383D
1.) Alt BM Description = *rl,+ (14) q
2.) Bldg, sewer length = 2Z • c
-amount of cover
3.) contour= ( 100•21')5(�,
I� b¢- wt Is car ► -
P an revision required? ❑ Yes ra No 2
Use other side for additional information. F 2
Date Inspector's Signature Cert. No.
N*isconsin
Department of Commerce
October 11, 2000
CUST ID No.220527
BYRON BIRD JR
896 68TH AVE
AMERY WI 54001
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www.commerce.state.wi.us
Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
A7TN: POWTS INSPECTOR
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/11/2002 Identification Numbers
Transaction ID No. 442205
SITE: Site ID No. 200280
STEVE BETHKE - RESIDENCE. Please refer to both identification numbers,
ST CROIX County, Town of STANTON; 1923 190TH ST above, in all corres2ondence with the agency.
SWl/4, SW1/4, S25, T31N, R17W
FOR:
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 766038
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. On page 4, based on the ground elevations provided, the slope in the mound system area is actually 8
percent.
2. On page 5, I = 15.69 feet and W = 32.49 feet.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
inquiries concerning this cor.espondcace may be made to :ne at the telephone number listed below, or at the address
on this letterhead.
Sincerely,,,`
j.
�1 c 3�
T R E PAGEL , PO S PLA REVIEWER II
Integrated Services
(608)266-2889 , M - F, 0745 - 1630 HRS
PEPAGEL@COMMERCE.STATE. WI.US
cc: STEVE BETHKE
DATE RECEIVED 10/02/2000
FEE REQUIRED S 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
WiSMART code: 7633