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038-1136-40-118 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 648441 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Chris Neuman TOWN OF STAR PRAIRIE 038-1136-40-118 CST BM Elev: Insp. BM Elev: BMcription: Sectionfrown/Range/Map No lop I: t ' ,- 33.31.18.556C-30 TANK INFORMATION ELF-VATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration TANK SETBACK INFORMATION 11°yS/_i C I• n i rAQ TANK TO P/L WELL BLDG. Vent fo Air lnta e ROAD Septic \ Dosing I f Aeration Holding PUMP/SIPHON INFORMATION kl, UCV qd' Manufacturer Demand L\ GP Model Number -;1 0 k/%•• V TDH Lj,Q 'c� Friction L System Head TQF� (/ Forcemain Len h, \ Dia. �;• Dist. to Well t SOIL ABSORPTION SYSTEM VA , -=MUM �WAtW= NOR St/Ht Outlet ._i✓nkS 'Cerk-1L BEDITRENCH DIMENSIONS Width r Len S No. No. OfjrenekEs PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO I P/L JBLDG 1WELL LAKE/STREAM LEACHING I Manufacturer: INFORMATION CHAMBER OR UNIT Type f ystem: I glI n \ IModel Number: DISTRIBUTION SYSTEM----Jr,/Af rnl jj IM 1W4/ Header/Manifold ' Distribution Length_ I\ ` Ix Hole Size 3 r x Hole Spa Vent to Air Intake Length Dia Dia Spacing SOIL COVER 1 r r1 x Pressure Svstems Only xx Mound Or At -Grade Svstems Only --- Ifrr7! % •fly\ 1 IN A VY I Depth Ov A Depth Over xx Depth of „ xx Seeded/Sodded xx Iched Be VT ch Cent `• Bed/Trench Edges Topsoil i Yes 0 No �. Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #r1: Inspection #2: Location: 1841100TH ST �y • l V`/1/► : ve .yA,p of �./�Gt"5l 1.) Alt BM Description = Y ' CO y/,`!f V��I` `\4•`,, 1 /�� ((,,j (,'/ 2.) Bldg sewer length = rX it �l Y 0 T� o l l w fA - amount of cover Plan revision Required? Yes FNd I I 4:11 L xeml-" 0 r� Use other side for additional information. SBD-6710 (R.3/97) Date Inse or-s Signature Cert. No. ' �,rArRT��yf. ; Industry Services Division 4822 Madison Yards Way Court ty St SAN-2023-054 ` P APR 2 8 2023 Madison, WI 53705 P.O. Box 7162 'Q62 Sanitary Permit Number (to be filled in by Co.) 6 Madison, WI 5370 y$yy' rox I ��. 1 t Application Co _ ate Transaction Number In accordance with S 383.21(2), Wis. Adm. Code, submission of this form to the appropel�M4 WTS�3D0632—G Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. f611 Ocift br I. Application Information Please Print All Information — l Property Owner's Name Curl Parcel # - t -q0-- Nck, v\, o I IS Property Owner's Mailing Address Property Location (911 10 0A, 4 Govt. Lot '/4'/., Section City, State NtWF,-1dA!&n21 Zip Code Phone Number 5gon T J N R _&_E or JQ II Type of Building (check all that apply) Lot # Subdivision Name 1AI or 2 Family Dwelling — Number of Bedrooms Opublic/Commercial — Describe Use Block # City of State Owned — Describe Use illage of CSM Number (.Z?- — 533 3 I 2, �--M � � �� P �: 13Z g own of nf� III. Type of WT ermit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i1 applicable.) A. [:]New System Replacement System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B' Holding Tank In -Ground Elt-Grade Mound Individual Site Design Other Type (explain) (conventional) i 2 q C. ❑ Renewal Before Revision Change of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: 15 X5771 fnfl = .2 YA0 Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Ar�equired (sf) Dispersal Area Proposed (sf) 1 Syst m Elevation c ' V ??. L,) I Capacity in Total # of Manufacturer , Tank Information Gallons Gallons Units `,1 W— -I� Q 2 c U 0 6 N n New Tanks Existing Tanks a U in ) w C) 0. Septic or Holding Tank Dosing ChamberF7 WI 11R V. Responsibility Statement- 1, the undersigned, assume res ir" for installation of' (lie 11OW1'S shown on the attached plans. Plumber's Name (P int) Plumber's re MP/MPRS Number Business Phone Number 5 ��IA, W t1,& �,` Plumber's Address (Street, City, State, Zip Code) If-i fi V J rtrnmd AoU- s o V1. County/Department Use Only Approved ❑ pproved Permit Fee Date Issued Issuing Agent Signature ❑ ner Given Re for Deni Conditions of pprova 31�' �_ r-�ee..o-�' SY M OWNER: ✓ '-t- Qft,� her' �- .LO . 1. Septic tank, effluent filter and dispersal � 1 �4twvvl�;� cell 5- � 4X7 ��. to$ �� �P�_ S Q't must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. r Attach to complete plans for the s stem and submit o the County o ly on paper not less than 8 t/2 x 1 inc es �n size � � sue` �� � SBD-6398 (R. 03/21) (gyp �t-u,,c Pe 1Mawv-� U " Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 sbi rd @ frontiernet. net 2/28/23 Subject: 1841 100th st. septic failure M7--� •7 [�7 APR 2 8 2023 St. Croix County Community Development The septic at the above property has failed. Backup into the house is going to happen very soon due to the fact that the house is a walkout gravity system. Sincerely, Shaun Bird MPRS #226900 715-781-0653 if you have any questions System PLOT PLAN PROJECT Chris Neuman ADDRESS 1841 100th Street. New Richmond Wl 54017 NW 1/4 SW 1 /4 S 33 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.0' 4/19/23 3 DATE BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE 750 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of Chambers BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Lifetime DBOREHOLE (D WELL * H , R . P. same as benchmark Pond Area below mound to yv,,c�•. 1.� Scale 1 "- 40' remain undisturbed .�� o 04 �� I P B -1 161. Slope 9 fi' 0' 401 80 971 98 9 9'` B_3 Old System Failed Property Line To be disconnected COPY O Well r— Grading to be done to divert B - 2 ff away from system Wieser pump tank 3 Bedroom House ao�9 TO 100th Street Wisconsin Department of Safety and Professional Services Division oflndnrtry Savices 4822 Madison Yards Way PO Box 7302 Madison, WI53707 April27, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2025-4-27 Plan Review: PWTS-042300632-C Shaun Bird 1432 120" St New Richmond, WI. SITE: Neuman 1841 100" St St Croix County Town of Star Prairie NW Y SW Y S33 T31N R18W FOR: �6PA0.iMp„PJ fi' n Phone: "dsbs G2WV Web sQ,,/sconnneov � < Email. dsys(rDwiscovsiaeov Tony Evers, Governor nnv Dan Hereth, Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE Description: 3 Bedroom-450 GPD mound-26" to limiting factor -Effluent Filter- Mound Component Manual —Ver.2.1,SBD- Maintenance required. 10691-P (5/22-5/27) Pressure Distribution Component Manual—Ver. 2.1 (May 2022-2027) i Verify proper dose is achieved and system is not being over dosed. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and priorto occupancy or use: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use onlytracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no riskto public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, 7&jh r 11Tc" Loy Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)634-5124 Joshua. rowleyPwisconsin.gov Cover Page ,. a M1 1R: Conditionally Bird Plumbing Inc. APPROVED 1432 1 ZOSh SS. DEPT. OF SAFETYSERVICES PROFESSIONAL DIVISION OF INDUSTRY SERVICES New Richmond Wi 54017 715-246-4516 SEE CORRESPONDENCE Date: 04/18/2023 Owner: Chris Neuman Location: NW1/4 SW1/4 S33 T 31 N,R 18W 1841 100th Street, Star Prairie Manuals Used: Mound Component Manual Version 2.1 (May 2022-27) Pressure Distribution Manual Version 2.1 (May 2022-27) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingencIan Attachments: soil test �7 Shaun Bird License number 228800 Pagel of 9 System PLOT PLAN PROJECT Chris Neuman ADDRESS 1841 100th Street. New Richmond WI 54017 NW 114 SW 1/4S 33 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.0 DATE 4/19/23 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND xxx SEPTIC TANK SIZE 1000 LIFT TANK SIZE DOSE TANK SIZE 750 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of Chambers BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Lifetime BOREHOLE O WELL *H. R. P. same as benchmark Pond Area below mound tor51D yv`k5j— Lae. 0.+- Scale 1 "= 40' remain undisturbed ,,,,,, o H " K^ B-1Slope 96' r' 0' 40' 80' 9T 98' Grading to be done to divert B- runoff away from system Old System Failed To be disconnected Line Wieser pump tank 3 Bedroom House TO 100th Street C Mound System Cross Section and Plan View --------------- - - - - - - - - - - - Topsoil = ASTM C-33 Cap Material sand fill GFabri ile / G Fabric 7��" _93,, Ft Contour Clean aggregate = 4 in. sch. 40 pvc f f %to 2 Yz in. dia. 0 observation pipe H 1 q9.0 rt Slope Direction �y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 'A inch soil wire when a sample is rolled between the palms of the hands. - ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed; the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07lgj Page -. 4- Manifold Pressure Lateral Layout Two Laterals — End Manifold - Threaded Cleanout Lateral Turn -up Plug IN Q*�—+ I li Long Force Main / Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded ceaoout plug and are enclosed in a 6- 8 inch diameter lawn sprinkler valve box accessible from finished grade. • • l✓ •e��• Grade ����•��'u 6-8 Inch Lawn Sprinkler Valve -► Box Page 14 oL 03/05 lgj Dose Tank Cross Section .And Pump Performance Specifications Tank Manufacturer 1 Tank Model Number Total Tank Capacity -7 Max. Bury Depth Pum Manufacturer p Model Number nufacturer del Number @iqtchType V inlet mimum f i p Performance F..aquired u(� PM Q-� rj). FtTDH T to nande Head (TDH) -Feet, Elevation Head Distal Pressure Network Pressure Loss Force Main Pressure Loss 74p- ToffiI C Vent Min. 12" Weather-proof Above Grade. Junction Box With Cap — — — - Finished Grade — — Depth of Cover Ft Switch Settings and Reserve Capacity Tank Volume =2Q Z GPI Dimension Inches I Volume Gal. reserve A -ti5 qj9 (alarm) B 2 - (dose) C ,7 .3 (dead) D flUbl Total S7� Bottom of'Fank Elev. Manhole Min. 4" Above Grade With Locking Device �1k II, Means Outlet A /4" Weep B Hale Off Blev. C Y.S Ft GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight.. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05 lgj Page 6 of W 280=SER/ES 112 hp Submersible Effluent(Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: • Vortex style impeller permitting passage of solids up to 1;" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing * Epoxy powder coat finish • All fasteners -corrosion-resistant stainless steel • 1 `/P Discharge • Stainless steel bottom screen -easily removable • Maximum fluid temperature: 140' F. 280-Series Cord Lengths Model 1V 25'(-2) 35'(-3) 501-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional N/A 287 Standard Optional WA N/A 10' card length standard on all models. For optional lengths, add "-2, -3 or-5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series .ov000.o.o.iu . mo111111mpon��.RNNNE��Monson -ant - son ���\on���������11!\70►\011owns r oor000m11111�11111n�����n ��so1�11�������11��\III►\1��� Llm��moo���\��������11111���� , \nom1omensommom� �11mlmmo4 i , r r r r , r r ... moon U.S. Gallons Per Minute I F I I I I I 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29lbs. Height: 13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10n Factory switch Model 281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle Moat. Differential adjustments can be made easily by tethering the float to the dis. charge pipe or other mounting point. Vertical float model 287 is not adjustable. Model 280 Model 281 Model 283 Model 287 Manual, Wide angle Wide angle VMF-Series no switch float switch float switch Vertical mag- with quick- with series netic float for disconnect (piggy -back) smaller pits - plug will operate in a 10" diameter sump SS,PIM�.1 SAa � c us Certified ^ /� BpecllicallaneerecubiBp bdvnq Willpulncllce, (/)!•/•T/ Liberty PumPs • 7000Apple Tree Avenue • Bergen, New York 14418 • Phone 800-543-2550 Fax (585) 494.1839 www.11bertypumps.com Copyright® Liberty Pumps, Inc. 2017 Nil rights reserved. LLIT 2000 ROV17 FIOWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_ ILE INFORMATION Owner �` 1r1�� Permit# (DESIGN PARAMETERS Number of Bedrooms 3 111 Number of Public Facility Units NA Estimated flow (average) ailda I Design flow (peak), (Estimated x 1.5) alida I Soil Application Rate al/da Rtz Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L . Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 ri I NA Fecal Coliform (geometric mean) 510° cfull00ml (Maximum Effluent Particle Size 34 in die. ❑ NA [Other ❑ NA 'Values typical for domestic wastewater and septic tank effluent. NIAINTFNANCE SCHEDULE Septic Tank Capacity Wu 0.1 ❑ NA Septic Tank Manufacturer W j ❑ NA Effluent Filter Manufacturer U� frM& ❑ NA Effluent Filter Model (I " ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer W ❑ NA Pump Manufacturer �' ❑ NA Pump Model Up❑ NA Pretreatment Unit It NA ❑ Sand/Gravel Fllter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) El At -Grade Y,MMound ❑ Drip -Line ❑ Other: Other. ❑ NA Other: 11 NA Other: p NA 1 Service Event Service Frequency (inspect condition of tanks) At least once every: monthear a (s) (Maximum 3 years) ❑ NA (Pump out contents oftank(s) When combined sludge and scum equals one-third ($) of tank volume ❑ NA (inspect dispersal cell(s) At least once every: J monlh(s) (Maximum 3 years) earls) ❑ NA Olean effluent filter At least once every: month(s) ears) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ear(s) ❑ NA 1.1ush laterals and pressure test At least once every: a �g�s) ❑ NA )their At least once every: 0 ean(s s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Seplage Servicing Operator. Tank inspections must include a visual Inspection of the tanks) to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate noli icallon of the local ngulatory authority. lRhan the combined accumulation of sludge and scum in any tank equals one-third ($) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. tall other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 612 months, shall be performed by a certified POWTS Maintainer. . A service report shall be provided to the local regulatory authority within 10 days of completion of any service event Page __ of _, START UP AND OPERATION For new construction, prior to use of the POWITS nheck treatment tank(') for the presence of painting products or other chemicals their may impede me treatment process andlor damage the dispersal cell('). If high concenfratlone are detected have the contents of thi: tank(sj removed by a Beptegs servicing operator prior to use. frozen at th System start up shall not occur when soil conditions ere e infiltrative, surface During power outages pump tank, may fill above normal highWater levels. When power Is restored the exceed wastewater will by discharged power the dlepemel cell(,) In one large dose, overloading the cell(') end may result In the backup or aortae( discharge of eito Fluenit. TOeffavoid this situor cointact eePthe lumber for POVJI'S Mantalnetanr to assist mremoved y manually operas oe Seperating the pump corator ntrolarior t 1 0 ,lore normarl levarys within the pump tank, the area within Do not drive or park vehicles over tanks and dispersal cells. De not drive or park over, or otherwise disturb or Compact, 15 feet down slope of any mound or at -grade soil absorption area. e the performance and prolong the N Reduction or elimination of the following from the Wastewater stream may Improvsound fond rain antibiotics; baby wipes; cigarette butte; condoms; optionMobs; ;deg herbicides ; melist et scraps; meldications, oil; painting lion drain (sump PUMP) water; fruit and vegetable peelings; gasoline; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls andlor is permanently taken out of service the following steps shall be taken to Insure that lha system Is props} y and safely abandoned in Compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The Contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pile shall be excavated and removed or their covers removed and the void space filled with still, gravel or another Inert solid material CONTINGENCY PLAN following measures have been, or must be taken, to provide a code comp upn If the POWT8 falls and cannot be repaired the replacement system: aluated and may be ❑ The suitable replecement serest should bebeen promctad from disturbance alnd,compaction anr the d shouldon of a anot be nfringeld upon lby equled setbacks from existing and proposed structure, lot lines and wells. Fall ue to protect me replacement area will result In the nsl for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:An In effect at that lime. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances In POWI'S technology a holding tank may be Installed as a last son to replace the felled POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POW/TS a soil and site evaluation most be performed to locate a sultable eplacemanl area. If no replacement area is available a holding tank may be Instelledl as a last resort to replace the failed POWTS. in " sMound urfacesReconstructionsdat-grade t-of such systems maybe with the steTU1eds in placefollowing atthattime. removal of the biomal et the Infiltrative <tWARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO 40T ENTER A SEPTIC PUMP OR OTHER TREATMENT N F CULT A Y CIRCUMSTANCES. DEATH MAY RESULT. RESCUE D� A PERSON FROM THE INTERIOR OF A T ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER -r— Name N.Ulm � Name Phone ISFPTTAGE SERVICING OPERATOR PUMPER) _ LOCAL REGULATORY Al1THORITY--�/,.--7�-,,5��� 1 Name flyyl /-ll7ynp{ f, Name tq`^i'yy�- Phone '1 �S-`L06—,!T1H�7 I hone, 1rs'�� U(D Pt Tnls document was drafted In compliance with chapter SPS 3B3.22(2)(b)(i)(d)&(f) and 383.84(1), (2) & (3), Wlsconeln Administrative Cade. l Cry co 0 0 -4 CD 4V I wlamnnDepartment ofcommefc 301E EVALUATION REPORT Dnrisixx of Safety and Rulldinps o a dsn a with Comm 85. Wis. Adm. Coda Cosrty Aaetlt mmplece site plan on paper not lase than 6 1/2 x 11 Z.. Plan must indods, bLdrotlunitedto:rertel and hodmntel referenceirector, and PendpercentBops, cale or dimension,norutsmox, and ldcetioee N nearest road. RaNs Pieties print all informatioPertdaal Mfonneaen Yw erdNAa may ba u.. for Secondary Ne �''•r g Page _ of ila/t�(/1/d S N R T 91ak X Suhd. Nems a CSIAp ntlal / Number of bad=ms _ 3 Code da"d design flow rats- er mmmerdal - Describe: Food Pain elevation H applicable Paronlmateria 4 v w 1 G'ana:d wrnms+9s and ravr+arrerdatlons: 0 S)Srsm Type e yye---- sorbv * eodrg l� EA Ptt Ground surface elev.! it Herten Depth DOMInam Redov DMCrPtlan ) System Elevati` on 7, r De{MteeniWgfeW Cr - in. Ssucdae Cdnsistarwe Sounc py, pit Gmuntl surface Nev. LI —R. Depth trt IYniting Hcfor Dominant Cola Redoz Deacrplion TexWre Seudure Cauisterde Sound Forizon Deptlt `Efguara at x SOD.> 30 «e nwo. CST Name (Please Print) Bird Plumbing, Inc. Shaun Bird Address 1432 120th St, New Richmond, WI iM: wd TSS 130 MWL CST Number 715-246-4516 Page of Property Owner_ `/f�Paaml ID S.�BOINgk �DAng Ground urte le "n� Depth to liff"ng facer _._Z.2 In. Still ilcatiml Pit _ r—�I�Sounci INI RooW GPDM' pm N Mansell Du, Sz Cont. OdGr.or. 2 Bodog p. Depth M limiting fades In. ❑ ❑ PII nek Groundsufamelev. Sod and ea6an Rafe Saundery Ratite GPDkP N. EMuant kt = BODr> 30 1220 mgn. and TSS>30 <_ 160 nOL • EMusM k2 = SOD, 130 mg4 and TSS 130 mglL The Depamnent of Commerce is an equal opportunity service provider and employer. if you need assists", to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264.8777. sao-mo0.&eol Soil Test Plot Project Name Chris Neuman Address 1841 100th Street New Richmond, WI 54017 Lot 4 Subdivision N W 1/4 S W 1/4S 33 T 31 N/R18 W Boring Q Well PL Property Line BM orVRP Assume Elevation 100 ft. Bird `¢ TM #226900 _ Da 4/19/23 Township Star Prairie County ST. CROIX Bottom of Siding System Elevation 99.0' *RRPSameasBenchmark 1 Scale = 1 /4" = 10' Pond I:MI Old System Failed Line 10 % Slope 0 Well Scale V= 40' 0' 40' 80' B-2 3 Bedroom House to 100th Street ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK `Phis is to certify that I have inspected the septic tank presently serving the �'�.�js'" ° �'��1 residence located at: Section �, T.�-/- N , R W , Town of es6lf ,� , Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. . L.,ast time serviced. I)id flow back occurom absorption system? Yes i� No (If,no, skip next line) Approximate volume or length of time: capacity:/k-�A-o /..Construction.. Prefab Concrete gallons minute Steel Other Manufacturer: (If known) : Z4- Age Tank (If known).:—�lew.�l~ Q r ignature) (Name) Plea e print - ft 2 fp4lz -r - �/� (ri le) (License Number) Z/7 .-�� Date 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 requi ments of ILHR 83, W' Adm. Code (except for inspecti n openicg v r outlet baffle). Name Signature MP/MPRS ' File #: ST C Ro° �SsaTy SANITARY SYSTEM Ulkl WiMs-OWNERSHIP/ADDRESS FORM Office Use Only Created 2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/ FN©RMAI'QN Owner/Buyer Mailing AddrE City/State/Zip Phone Number (required) 71 z& o � Email Address (required) e Parcel Identification Numb 0 � 9— A-~ 4/6 f (found on the property tax bill) f NSW SYSTM: LEGAL [DES"CRfP- Iio' 3 Property Location/ v 1I4<,�A , Sec. �3, T 31 N RI W, Town of Subdivision Plat: , Lot # `T . Certified Survey Map # 1 3 , Volume �Z Page # 3 3 Warranty Deed # LoT� i (before 2006 Volume Z . Pa e # Number of bedrooms Spec house ❑ y no Lot lines identifiable;p[�es ❑ no O.F.F:ICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi,aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov DOCUMENT NO. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2 -- 1982 �.�. V - t:V ' l 3 � PAGE ._WayneStraub and _Agnes .. ife---as..j_ont__ tennt............................................................. ....................---..............;.......--------------.....---------...------------------------------------. conveys and warrants to_Ch.ria..P_..._Xeumaia..anc1._Lsrnri-_.M._-._.-_.__. ..Neuman.,.. as marital property with rights of ._...... _ surv?44'.�i-p------.._._ ..... I ----------------------------------------------------------------------------------------------------------- .............................--_..-------------------------..__....._-•----.._._._-------•------------------..._. ..................•------...._...._-••----••_•---••-------.-.._._-...........-----------------------------_.-.... the following described real estate in S qt.- . .................County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA LFIEGISTERS OFFICE ;'a. CIZOIX CO., WIS. Rtm'd, for Rtiz-7-cord this 10th r,ay of Feb . A.D. 19 86 8: 30 A Roobler W • C=4j' Depu RETURN TO Tax Parcel No: ------------------------._---- A parcel of land located in part of the Southwest Quarter (SW34) of Section Thirty-three (33), Township Thirty --one (31) North, of Range Eighteen (18 ) West, further described as follows: Commencing at the West 1/4 corner of said Section 3.3; thence South 010 10' 04" East along the West line of said Southwest Quarter (SW)4-), 66.00 feet to the Point of Beginning of this description; thence continuing South 01G 10' 04" East 744.55 feet; thence North 890 28= 34" East, 1242.-94 feet; thence North 011 10' 04" West 744.55 feet; thence South 89' 28' 34" West, 1242.94 feet to the Point of Beginning. Parcel contains 21.00 acres, excluding Town Road right of way. Subject to an easement for Town Road purposes and all other easements of record. This conveyance is given in satisfaction of a land contract between the parties, dated July 8, 1985 and recorded July 9, 1985 in volume,715, page 609-610, Document No. 403325. This -----�S__S?�___..____ homestead property. (is) (is not) Exception to warranties: La . FEE Dated this...-----•-----..7_th-------------------------- day of ------------- February. ....................... 19..$.6.. - -------(SEAL) _... - CL 2lG- --------- (SEAL) .--•--------------•--------------------------------------, ,, ., Way Straub -•---------------------------------------------------------------- --............................................................... ...-----•---•------------------------•---------....----•----•-----_.. (SEAL) / ..Q ... /�- C C!L ........... (SEAL) ------------------ - - + Agnes Straub__- ..................................... ----------------------------------------------- AUTHENTICATION Signature(s)------------------------------------------------------------ authenticated this -------- day of___________________________ 19-_____ ------------------------------------------------------------------------------ TITLE: MEMBER STATE BAR OF WISCONSIN (If not- ------------------------------------------- -U; by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED 61' --Reinstra , Van Dyk __ &__ Needham, ___S : C New Richmond, Wr, 54017 ------- ---------------- ( Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ss. St. Croix ------------------------------------- County. Personally came before me this ___7th------ day of Febr ____--l:n !MKY ------------------- 19__8 6-_ the above named Wayne__ Straube __nd __pgn-e- s__tr_auh__________ ---------------------------------------------------------------------------..--- --------------------------------- -..,.U,----------------------------------------- to me known to be the,per�� S'::,_,_____ ,who executed the for g instrument 4zci ackno*1radbp the same. I 4?e0- --------------------------- Rut h A �'.o n scirr ' -- -- A. ..._ .--r. - - ---•- ` , - ---------- Notary Public ------- --.e-tU.aQr-bi}c-Ile __-_-- .County, Wis. My Commission i'q, Perm ne.;(riot; sate expiration date: 2.f_` �G '- = 19 - - ------ -- - • .---.---- .....) •Llames of persons signing in any capacity should be typed or printed below their signatures. tiC.Mitle r Compery® ru. w.•.. WI••M.I. STATE BAR OF WISCONSIN FORM No. 8 ^ 2982 Stock No. 13002 0 N N N .0 a) (0 In w w w NOTE: THESE PARCELS AS DESCRIBED BY DEED AND PREVIOUSLY MAPPED EXTEND INTO AND INCLUDE PART OF THE FOND AS SHOWN BUT ARE SUBJECT TO THE RIGHTS OF THE PUBLIC BELOW THE ORDINARY HIGHWATER MARK. Wi4 CORNER, SECTION 33 ( ESTABLISHED FROM COUNTY N4T66.W W COORDINATES) ss.oa 1 0.i :XIS` ING 1•EIU60WING 111"AY of - Z y�1 $1 23.28' j gl li �I I I i 22.93' : PROPOSED ae' WIDE PRIVATE JOINT EASEIENT BULT TO TOM ROAD STMEAFOS z 3 I 1: 1 I oo M -a 5 :DI w 1 a u- O z�6j �c � I 3 i 21,9V I l CERTIFIEDSURVEY MAP NOTE THE HISTORY AND TITLE OF THESE LOTS SHOULD BE SEARCHED FOR DEED RESTRICTIONS LOCATED IN PART OF THE NW Y4 OF THE SWY OF SECTION 33, T31 N, R18W, TOWN OF STAR PLACED ON THESE PARCELS AFTER THE LOTS PRAIRIE, ST. CROIX COUNTY, WISCONSIN, BEING A SUBDIVISION OF LOT 2 OF CERTIFIED WERE CREATED, NO ADDITIONAL SUBDIVISION OF SURVEY MAP IN VOLUME 10, PAGE 2726. THESE LOTS CAN OCCUR UNTIL SUCH TIME AS A DEDICATED TOWN ROAD EXISTS ALONG THE LOT 3 CONTAINS NORTHERLY BOUNDARY OF THESE LOTS. 393,552 SQUARE FEET (9.03 ACRES ) INCLUDING RIGHT-OF-WAY LEGEND 392,027 SQUARE FEET EXCLUDING RIGHT-OF-WAY UNPLATTED LANDS ; _ — — LOT 4 CONTAINS 313.971 SQUARE FEET (7 21 ACRES) INCLUDING RIGHT-CF-WAY -0- . INDICATES SECTION CORNER MONUMENT 308,581 SQUARE FEET (7.08 ACRES) EXCLUDING RIGHTOF-WAY (AS NOTED) 256,975 SQUARE FEET (5.90 ACRES) EXCLUDING RIGHT-OF-WAY AND 0 . INDICATES 1" X 18' (OUTSIDE DIAMETER) IRON EASEMENT PIPE WEIGHING 1.13 LBSIUN. FT. SET N69'2834'E 1242.94' 1219.66' ; S89'28N'W 813.26' 790.33' LOT4 LOT zj 4? 4 ^L ? , N68°O6'32'E SEPTIC VENT c "E EXISTING DWELLING E ORP _ N80939135'W �_35, AY b o LOT 1 ? CERTIFIED SURVEY MAP VOL.10 PAGE 2726 SW CORNER, SECTION 33 ( ESTABLISHED FROM COUNTY CCORDINATE$-) THIS INSTRUMENT DRAFTED BY KRI STIN J. GRANBERG * ; • JosE�W):- wGRAWES 2295NFW RICHMOICtia su1.A N88 0633 ( NOT SHOWN IN DETAIL) —- -, _ i2S PROPOSED w - • , BUILDING W!LL LOCATION $ a POLE SHED u., _ �75 S eaCK FROM Of% J __ b 8 APPROXIMATELY \ / N 1 ACRE OF WATER N APPROXIMATELY c / \ POND / 1.73 ACRES OF WATER \ z 195.51' 488.58' _ • - 1.25" IRON PIPE FOUND •••••• • - INDICATES 100' SET BACK LINE FROM RIGHT. OF -WAY LINE. 0 W O oM w3 z v mow Lu #Z— 0 boa wM� w(� Lu Li v) cm z�o OWNERS CHRIS & LYNN NEUMAN 1833100TH STREET NEW RICHMOND, WI 54017 PREPARED BY. GRANBERG SURVEYING INC. 1235 C.T.H. "E" NEW RICHMOND, WI W17 PHONE (715) 246-7529 JOB NO.05-072 �C Mb. b. N11 SB9.2T34'W 684.05 11 UNPLATTED LANDS 1 o' 209 409 60Y SCALE IN FEET 1'=200' NOTE: THE ORDINARY HIGHWATER MARK OF THE POND MUST BE DETERMINED BEFORE ANY BUILDING PERMITS WILL BE ISSUED CONTACT THE ST CROIX COUNTY ZONING OFFICE FOR MORE INFORMATION REGARDING THE DETERMINATION OF THE ORDINARY HIGHWATER MARK. SHEET 1 OF 2 MM NCx7•N-1��0 W 11 N M 1-I N M►-a NMOM •M ICI-+X7 F+ we �o m< N�7MGM mM ••M M N � �C w Ilk 10 1 - LL" APR 20 2023 4C, ' j ( j 14-- IF, ��iL M AkL�A I fON �ErOK I f Wisconsin uepartr`�ent of .: mere . Croix County � � ! � D�visio.-o`Satet�•altB:�i mmunity Deve!o,pme_r-_`„ G5 7 _ 3�( 3pE o {. .� Con,-, 85:.OJ* nor??. Cooe I County I kttac;� oornpiete site plan or paper n3, less than, 6 '2 x ' ' in-hes ir. size. Pia; � mus: F v ` ' ` f �•'/ � ! r a , r (; F direction o f I r, n l inducle..rut no.limited tc: v e:t ,, a an,: hog tzon.a. reference point 'E paw � percent slope, scale or dimensions, no-t-- arrow, anc location and distance tc nearesi rcae. a-Q 2' -_ U1 2 t J O —IL Flease print all infomatior, Persane Infom. utior vo, provide Teas be user, tot ss�naary purposes f� t Pnva-y Law: t. `:. S.GE !'; (at) . t I Ir wed py Date /r��r� l GVG- I Property der ! C i Property Location Gov,:. Lot (� `' %L (J` ; S T / N R ZYE' Prape•ty Owners Maiiing Address 7'q i Lot # ( Bloc # taW, Subd. -ne o- CSYf -^ ;ate zjF. Gee Phone Number ( � City � \�liageTown Nearest Road `} ,Frie+R Construo ion , sE Esidenta ;' Number o` bedrooms �_ Code derived design, f1ok' ratrz 7J72 GPD ,Repiament t i PuX/14"f or ca-nr�erai - Describe' ----- -- --____-- — Parent matena( V14,wtot4 use Eiood ?iam eieva .0ri i* appiicabie A/ -- ft. Gerte-a �xrr+ients Sat u LA'S 'and recornrnenaatia-ts: CA c-.-stem Ty'Je System: Eievation / s Boring Bonng- E E& Pit Ground surface elev. l ' � ft. Dept. to limiting ;`actor � O in. I � I SCNl l-nrSiFCaflDrs R3tE Horizon Depth in. Dorinant Coior Munself Reaox Description Qu. Sz. Cont- Color Texture ; Structure i Gr. Sz. Sh. Consistence Boundary Roots 'Ef #1 ( 'Eff#2 r ( I Boring # Bo►rng I Pit Ground surface elev. 9-1-' ft. Depth to limiting fa or Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Desoiption Qu. Sz. Cont. Coior Texture Structure Gr. Sz. Sh. consistence! Boundary Roots GPD/fg 'Ef #1 'Eff#2 ----' <<, �n --Z JA V/Xl 1 Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 4- ' Effluent #2 = BOD< < 30 mg& and TSS < 30 mg2 CST Name (Please Print) CST Number Bird Plumbing, inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, Wl 5401 4/---/ K — ?.,-3 715-246-4516 Property Owner — Boring # ❑ Boring Pit Parcel ID # Ground surface elev.4�ft. Depth to limiting factor ��. Page of Sail Aool&tinn P.Z 0 M FMO FMj YA" fir W), IFWA M ME Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate MWMffVM#-T=, Qu. Sz. Cont. Color Gr.-Sz.- Sh. �Mwffi 74"Ir"to Boring # El Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Rail Annliratinvrn Rate 0 Ai Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mglL • Effluent #2 = BOD5 < 30 mg/L and TSS ! 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. ssa8330 (R.broo) Soil Test Plot Project Name Chris Neuman Address 1841 100th Street New Richmond, WI 54017 Lot 4 Subdivision N W 1/4 S W 1/4S 33 T 31 N/R18 W Boring Q Well PL Property Line BM orVRP Assume Elevation 100 ft. Bird `¢ TM #226900 _ Da 4/19/23 Township Star Prairie County ST. CROIX Bottom of Siding System Elevation 99.0' *RRPSameasBenchmark 1 Scale = 1 /4" = 10' Pond I:MI Old System Failed Line 10 % Slope 0 Well Scale V= 40' 0' 40' 80' B-2 3 Bedroom House to 100th Street R�949t_ S446^ C96)X COUNTY No. L119LIll STATE SANITARY PERMIT j gql /too*, - PREVIOUS NO. 5D6/Y/ OWNER CItRI,S i LAW 4.t wt,Eit! TOWN •' • I SEC �3 T -2.5 t N, R_16 _V�29 AND/OR , BLOCK ARE X CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. AUTHORIZED ISSUING OFFICER -DATE !.%1ZQa3 THIS PERMIT EXPIRES- gi 12,,2 6 -UNLESS RENEWED BEFORE THAT DATE SBD-06499 (R11/20) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I Permit Holder's Name: City Village X Township Neuman, Chris & Lynn Star Prairie, Town of CST BM Elev: Insp. BM Elev BM Description: 160 P__>IIA c �5 r TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , cV 5 �rtw PL, L It, ic- 5z5 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r6 ' N , 3 -7 ZJ4 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lif Friction Loss System Ft Forcemain 47Dist. to well Snll ARSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 506141 J�50 State Plan ID No: Parcel Tax No: 038-1136-40-118 Section/Town/Range/Map No: 33.3 1.18.556C30 STATION BS HI FS ELEV. Benchmark z l62•I46 iw.M Alt. BM, (-, \ %.,,,. �u .+ �z c 13 % Bldg. Sewer C� W, `t 5..3 `V 5t/Ht Inlet 7, 7-3 q4 - _1415 SUHt Outlet U? 7. %ry 7� Dt Inlet T`J Dt Bottom Header/Man. IS '7 3 1 Dist. Pipe Qa Z. c' C) Bot. System eA. Final Gradq #1I,` r33,Z St Cove r� ..J. L; Ako BED/TRENCH Width / Length j No. Of Trennh gs PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ��` A - Z_ ve J Isb SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT 1.. I►r. Ii;v C Type Of Syste r I Model Number nISTRIRHTION SYSTEM L_ . 4 - 1-7'_ 1 �,.+ Header/Manifold I IDistribution x Hole Size x Hole Spacing Vent o Ai -Inca 73 i. 15 i� � �� J Length Dia Length Lengs) Dia _ Spacin�_ SOIL COVER v Praccnra Svctamc Only YY Mnund Or At -Grade Svstems Only Depth Over ' Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 d . J j1 Bed/Trench Edges Topsoil \ Yes �No Yes No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / / Inspection Location: 1831 100th St(reeet Star Prairie WI 54026 (NW 1/4 SW 1/4 33 T31N R18W) NA Lot 4 1.) Alt BM Description = \ r 4 � 2.) Bldg sewer length = I ?j - amount of cover = Z Plan revision Required? Yes o G a"' Use other side for additional information. `J Date SBD-6710 (R.3/97) Parcel No: 33.31.18.556C30 LC <,ks o -,,- Cert. No. commerce.wi.gov Safety and Buildings Division P.O. Box 7162 County n S'r `ILo-i'r 201 W. Washington Ave., Sanitary Permit Number (to be filled in by Co.) is co n s i n Madison, WI 53707-7162 ioepartmertt of Commerce S O 4't4 Sanitary Permit Application StateTransaction Number A In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for o PO S are submitted to the Department of Commerce. Personal information you provide m e u fors onda / S+ purposes in accordance with the Privacy Law, s. 15.04 I m , Slats. /YS t 1. Application Information - Please PrintAll Information Property Owner's Name Parcel # RECEIVED Property Owner's Mailing Address Property Location 55G C - 30 / M / vo-f - s-t - MAy 1 5 2007 Govt. Lot -- � I/, S W y., Section �_ City, State State Zip de Phone Npum�beer/� N&� tcr{#v,aAJ !t_J S d Ste.CR N�'�i �t l%_y—CW` 6� / T 31 N. R ircleo� If. Type of Building (check all that apply) Subdivision Name " I or 2.Eamily Dwelling- Number of Bedrooms Block v # l ❑ Public/Commercial - Describe Use /• 2 1p,53Q3 ✓ ❑ City of CSM ❑ State Owned -Describe Use El Village of �R �/LNk-JRf� Town of � Numb er 2� 0� .J ��� 17 G III. Type of Permit: (Check only one bdx on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal Permit Revision ElChange of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ,,.= r IV. Type of POWTS S stem/Com onefi;Device: Check all that apply) Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Applicatu Rate(gpdso " Dispersal Area Required st) 2 Dispersal Area Proposed t1 System Elevation 4.s-v e , e9z. 9 (oka k . . VI. Tank Info Capacity in Total # of Manufactur r y ?* Gallons Gallons - Units /) �t f d o rn y rn LZ 3 = New Tanks Existing Tanks �" j o. U Septic or Holding Tank / [~ Dosing Chamber VII. Responsibility Statement- 1, the undersign d, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P tuber's Si Lure MP/MPRS Number Business Phone Number /J. A -e 7 y�5 7��! 3-252v Plumber's Address (Street, City, State, Zip Code r-- /SS SA'D5 ti -4 VIII"Xounty/De artment Use Only pproved Disappro Permit Fee Date}ssued Issuing t Signature $ 9�' "� 51 �5/d 7 O rven Reaso for Denial IX. Conditeasons for Disapproval t I. S"ft tank, etlluerd filter and dispersal cell must all be services / maintalned �Lw �f as per management plan provided by plumL%r. Z AN sdiback requirements must be maintained Atracn to complete plans for me system anu suomn mane —1-ty omy SBD-6398 (R. 01/07) Valid thru 01/09 C All S l-yAIAI J&UALA �J AJw -Teo An s33 7'3!At R !8w S`T,49, (FzA 1 titE -7' ,.1 -,,J S-to P Y( CX6-a 8ru.,rr � 00.4J 9(- q-4a4• S CA-L& l 46, al q rh��es � Z l0 7 9�5