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261-1304-02-600
a o er o0 �v 4 rj w 0 0 N N n� C `LS v I NO N •N V O `IV V/ C O w L'. F.1 ftS G � )I o of m c 0 O 2 ? d' � � r CL N M > FL t! -j U V C 0 o E LO O U C-4 N N o m 3 N N Z M `- O Cl) y , N N U w xs a E a, .Y i C 0 d � c O ,. O m N c o N N > in o � o LO a _ c -- Z Z o U_ N L CL m w 3 ,� y z o c" a` o a a a N co M O O N N C O N O o rn o w c .a � � m � 3 w c J y = 3 O O c o y O CO O 2 LO O w a m a c r- 0 U) U C 0 E Q s O C E r N .0 (n �_ O 0 m C Z co 76 2 a ° } E 0 d 0 U a E m a (D d Q Z E Q C (n :; O O $ Z r d N IL m i O 2 ? d' � � r CL N M > FL t! -j U V C 0 o E LO O U C-4 N N o m 3 N N Z M `- O Cl) y , N N U w xs a E a, .Y i C 0 d � c O ,. O m N c o N N > in o � o LO a _ c -- Z Z o U_ N L CL m w 3 ,� y z o c" a` o a a a N co M O O N N C O N O o rn o w c .a � � m � 3 w c J y = 3 O O c o y O CO O 2 LO O w a m a c r- 0 U) U C 0 E Q s O C r .0 (n �_ _7 FL m N } O Z Y o o a E m d Q n n Q ° $ $ E o c CL i N 0 L m 0 r qy (D c c C 0 2 w w 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)]. Permit Holder's Name: X City Village Township Hidden Hollow Land Mana ement I City of New Richmond CST BM Elev: Insp. BM Elev: BM Description: Aeration MA 1 ( 1l 1 b C, 1 as 1 Q) (,(\ 1 G TANK INFORMATION Vi A CS TYPE MANUFACTURER CAPACITY Septic f J�K.►c� O 19esing Friction Loss A) /t Aeration MA 1 ( 1l 1 b C, Length Holding Dist. to Well 24.31.18.2325 TANK SETBACK INFORMATIOW A-b r,,, Pl � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Friction Loss A) /t 16 Z � Length Dosing Dist. to Well 24.31.18.2325 Bldg. Sewer Manufacturer: INFORMATION Aeration 911 • St/Ht Inlet • Holding St/Ht Outlet Z� .d 3•4; PUMP /SIPHON INFORMATION Manufacturer St. Croix Demand GP Model Number ELEV. TDH Lift Friction Loss System Head H Ft Forcemain Length Dia Dist. to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: FS ELEV. 506308 0 State Plan ID No: !! / Parcel Tax No: SETBACK Alt. BM 261- 1304 -02 -600 Section/Town /Range /Map No: I WELL 24.31.18.2325 ELEVATION DATA STATION BS HI FS ELEV. Benchmark No. Of Pits !! / Liquid Depth SETBACK Alt. BM P/L BLDG I WELL LAKE /STREAM Bldg. Sewer Manufacturer: INFORMATION ' 911 • St/Ht Inlet • '7 , 55 St/Ht Outlet Z� .d 3•4; Dt Inlet Dt Bottom Header /Man. / V j C g�z • 9 Dist. Pipe , 3 9 Z •9-5 Bot. System 7 Final Grade St Cover 99a f _ BED /TRENCH DIMENSIONS Width 4P 3 Length / vo v No. Of Trenches t � & / ` �6pacing PIT DIMENSIONS No. Of Pits Inside Dia. _� Liquid Depth SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT �•1 Type Of System. C OdI/Ue.N.�""'b 0, Z� /JA- /J A Model Number: ) r W DISTRIBUTION SYSTEM G 14-- ZU ___V4.Aa1 Header /Manifold Length \ Dia I D istribution Pipe(s) Length \ Dia ` �6pacing ` x Hole Size `p,..,, x Hole Spacing Vent to Air I ake 7 SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Bed /Trench Center L.�� Z Depth Over Bed/Trench Edges xx Depth f Topsoil xx Seeded /Sodded NS;,,Yes xx Mulched I l i c Yes No ❑ No ❑ a COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1366 200th Ave New Richmonc WI 54017 (SW 1/4 SE 1/4 24 T31 R1 8W) NA Lot 3 Parcel No: 24.31.18.2325 1.) Alt BM Description = � 2.) Bldg sewer length = /� - amount of cover = / i / PvC Plan revision Required? ❑ Yes ( No Use other side for additional information. SBD -6710 (R.3/97) Date Insepc#Signre Cert. No. K_ am 1 01, 91, A M11 J I commerce.wi.goV Safety and Buildings Division 7162 County V 201 W. Washington Ave., P.O. Box Sanitary P ermit Number (to be filled in by Co.) s co n �+ i n t r i oepartment Madison, WI 53707 -7162 Of com 5u (D Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Pr=-w mailing address) submitted to the Department of Commerce. Personal information you provide may be used for n u oses in accordance with the Privac Law, s. 1 5.04 i)(m), Stars. l �• / 1. A lication Information - Please Print All Information Property Owner's Name Parcel # 2� 1- /3d� � 6Z " ct- Property Owner's Mailing Address 2 J Property Location Y t l � Govt. Lot __ y, '/4, Section City, State Zipp Code PhorNU@tbt 8 0 rem..,, c � d rcl T�N; R or W 11. Type of Building (check all that apply) Lot T. IX Subdivision Name ❑ I or 2 Family Dwelling - Njp of Bedrooms # / /�� , A �jy y�Q,Q,Q Block / 1 /1 Public /Commercial - Describe Usk Q (�'� \ _ City of t-A✓ `�''� �.� i0 CA_i CSM ❑ State Owned - Describe Use ❑Village of Town Number $ Z 33 l s� L.,) V. 1 2 1 51 of 111. Type of Permit: (Check ofily one box on line A. Complete line B if applicabl A` ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Owner List Previous Permit Number and Date Issued w it t Before Expiration t IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 44 L-nJ ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVCreatment Area Information: Design Flow (gpd) �Design Soil Application Rate pdst) Dispersal Area Required m Eldon V t. Tank Info C apacity in Total # of =WManufactu Gallons Gallons Units V A New Tanks Existing Tacks Septic or Holding Tank o Dosing Chamber VII. Responsibility Statement 1, the undersigned, ass e r sponsibility for installation of the POWTS shown on the attached plans. MP /MPRS Number Business Phone / L mber� P ber (Print) y Plu S' ature Plumber's Address (Street, City, State, Zip Code VIII. County/ e artment Use Onl Approved ❑ approve Permit Fee Date/sued Issuin gent Signature re $ Sb �S a'7 n ven Reason r Denial . IX. Condi easons for Disapproval 1. Septic nk,.effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as p appiable code / ordin t m. Attacn to cormpiete plans ror Intl sybten1 -nu aaouuc w u¢ vv - — : ,... y.q._. ......_.._ SBD -6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJECT Hidden Hollow Land Manaaement ADDRESS 1366 200th Ave New Richmond Wi 54017 SW 1/4 SE 1/4s 24 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 92.2 4' below arade CONVENTIONAL XXX AT -GRADE CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE 270 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 405 # of chambers 20 ,BENCHMARK V.R.P Top of Steel Fence Post ASSUME ELEVATION 100 Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 3 . a c'+^2 p rr- Y ( Pro pe rty _Une Well is to meet all i95' Property setbacks found in . i ne Comm. 83 Manufacturing Building Scale = 1/4" = 1 Max. 10 employees 2 floor drains No Retail Space GPD HOLDING TANK 695' Property Li ne 2 Tank is to have lockdown Q �---i covers with approved warning Floor drains do not \—W labels discharge to catch basin, system is to for domestic wastewater only! fps rCN C)'VA_ 9- ui#'l' 1' roz�, Huffcutt ST Calcs:10 employees @ 13 gpd /employee= 130gpd2 floor drains @ 25 gpd /drain= 50 gpol 80 total gpd X 1.5 for peak flow= 270 gpdTank size = 270 gpd X 2.088 = 564 gallonsUse Huffcutt 800 gallon septic tank 31ope is <11% 270 gpd /.7gpd /ftA2= 386 ftA2 X Thus no contours 1 chamber /20ftA2= 19.3 chambers, use 20 chambers + 1 set of end caps = 405 ftA2 200th Ave PLOT PLAN PROJECT Hidden Hollow Land Manaaement ADDRESS 1366 200th Ave New Richmond Wi 54017 SW 1/4 SE 1 /4S 24 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 92.2 4' below qrade GPD 270 CONVENTIONAL XXX AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 405 # of chambers 20 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 3, C cT-e f'a rc property Well is to meet all 5 95' Property setbacks found in .i ne Comm. 83 Manufacturing Building Scale = 1/4" = 10 Marc. 10 employees 2 floor drai ns No Reta i I Space Tank is to have lockdown covers with approved warning labels 595' Property Li ne 8 -2 ❑ 8 -3 Floor drains do not discharge to catch basin, system is to for domestic wastewater only! fps f r� =�.� s- ��� ►• �r r� .K Huffcutt ST Calcs:10 employees @ 13 8-1 gpd /employee= 130gpd2 floor drains @ 25 gpd /drain= 50 gpol80 total gpd X 1.5 for peak flow= 270 gpdTank size = 270 gpd X 2.088 = 564 gallonsUse Huffcutt 800 gallon septic tank Slope is <1 270 gpd /.7gpd /ft ^2= 386 ftA2 X khus no contours 1 chamber /20ft ^2= 19.3 chambers, use 20 chambers + 1 set of end caps = 405 ft ^2 13. M. * 200th Aire commercemi.gov I sconsin epartment of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 27, 2007 CUST ID No. 226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/27/2009 Identification Numbers .......... Transaction ED No. 1433934 SITE: Site ID No. 729567 Hidden Hollow Land Management Please refer to both identification numbers, 1366 200 Ave above, in all comes ondence with the a enc ., Town of Star Prairie St Croix County SWIA, SE1 /4, S24, T31N, R8W Lot: B, FOR: Description: Non - Pressurized In- ground / Commercial (Shop) Object Type: POWTS Component Manual Regulated Object ID No.: 1148898 Maintenance required; 270 GPD Flow rate; 110 in Soil minimum depth to limiting factor from original grade; System: In- ground POWTS Component Manual, SBD- 10705 -P (N.01 /01); Commercial System, Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The changes made in red to this plan on 8/27/07 by this reviewer were acknowledged and approved by the system designer. • The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes. Condid ,+ MENT 0 SEE CORRES • State and federal regulations prohibit the discharge of hazardous wastes to a private sewage system. Accidental discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural Resources or the Wisconsin Division of Emergency Government. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. SHAUN R BIRD Page 2 8/27/2007 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open fo inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation,'operation or maintenance of the POWTS. Sincerely, Charles L Bratz POWTS Reviewer II , Integrated Services (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633. cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Cover Page Date: 8/22/07 Owner: Hidden Hollow Land Management Location: SW1 /4 SE1 /4 S24 T31 N,R18W Lot B 1366 200th Ave System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance a ontingency Plan 6 -8. Soil Test I e Signature_ License num &A' � CE �vF AUG 23 D S,gF 200 SU140 1,11U S pa * ' MFRCF M'GS ')ONDCNCC Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 1 of 1 cells Quick 4 Standard -W To be >1' above grade Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates Typical Installation Vent Grade 3 � 1 411 x/30/34 From Septic Tank Grade at System Elevation Finish grade elevation 964 1 -3' X 82' Cell Same on other end Observation tubeNent 10' ti/ A 20 chambers per cell System elevations: A__92.2 page JAL MANAGEM Powys awrtFR`s s ►N I SP �cA — T - 10 . Tank D t►IA a a arliC %l:� II tdw ttt F� MWWkCUM J / Q 6K of Be&W - NA Pump•Tat* t Y H of WAS �a pump TW*M8MftcWW x�, flW ! p - .imp WW rsA D tioa�► (d It f.5} Pu[npol son Mme°^ � ave D MM t3 Pon Mar Quaf G) m9R- I D tjocha�ntcal DHsec' s220 mg1L I ❑ CWrdbcftn Tow SLipwo"—d 9kAdA got (,NA Mock► a } v3�y� 13 (p`° Demand S30 `ng& Q 'grade � other_ sdlds (TSM � � mt � TOW SUSPWVL4 a if Fis d n>a�n> inch v.R�es sbreaea�stlC d P*r0da S'tae K bra far w I AMW SC. —CRULE serrtee Fr.aaencr Sertr� Event 3 p -non" Z¢yae�(s3 (�tlsudsnusa 3 rrs.} At toast on squa o ne-third (x,) of tank volueme tnsped n of 1XWS) When Comb ad sludge and scan► of tanlga) p $) ;t�lwdmuea 3 yrs i�vrnp otlt t�ntlDnts At Least o p tnon s) Inspect COW At joust On NA WD storms s} CW= tettusinifftr Ie ��nbrtsts & eilarsre At ast O p 13 s) NA Inspect p . . pip At lust on p rno p $) NA Flush isberab aid Rt seRSt on Q 13 �(S) NA At leas o000 axss of Ilse fo>�8 iuxnses MAvn'E1+L B 11�t8TiiUC �� s� be nw0e by , p p STS lnSp� l' � � � or brown tn:peee ft of Pkan Ptur+� � �cf Ifs tantQal id and S W be* up Tel* � tttto! vole � std to check of e" Swvk*V gym' uTtte wows) ttte 9t'c3urld P of ettttsmt on than parAft an tt�e gwwd azafa°e' of Surface- loam in Ow 0 avad s n r� ths' medbabo n a' errs° NR MOM c1f WW go =Mbk� d ate' of movw by � r3sAa� of In " with dt s be 11 •' conpaw mid MY 113, W Ad�tlVa Cade. t� oomP Va pOV n M.1"N er bY arxw or 'fie � of n i 9 . 12 nshs , o f arty std eV � m t* local � a � v�ritf�m '� d� or atl'r:� srArtr UP AIM O uae Pow arlt �cts3 ivy OW are For MW � A� arwor $9s M dor to to& deWded fmS ft conoff is of the h Y a Se 9e P _ P P-'9e System start u p �#f not 0c= wiled s a'�itions arc f vwn at the inft - v tnve widace.. $bo+re s:otz}aai ti }tivracyex ievgets. When MW is ms&KW dw e D 3s" t ° lip fi?tt1C3 �l Md(s) in one let Je dose, overloading the �( Y r in the �wffi be �fi as;ufaas d of Ta avoid is sc'boct tt2tve.the «nnbectt5 of the pcimplzlrlk tertlaved by a iav + for powerfi Ito esliueat pump Or a PAC m �is6n ffWW Y oP die PWW' to tpsflort} nonrlat tevefs veithitt € pump tank 0o raddW crPwkVd9dW o wfti b and dlspersW its. D° not drive orpwk ter, orAmIft &Ub ct=pct, the wesa W*dn 15 leer down Slope of ter MOUW to atVWe salt absotpOW M& r editcaon tx• tiai oftlae � the wastewabec'sfieam may imp me to penal m(� a and plalmw the free of the PC�iKt �� 'eft butte condo; aoWn swabs deg dWW ffoss PUMP) water. d� tat focei�n AWI {autitp d; end vegetable peeSttgs � liteat swaps; #0AV p i o& � p ax y i+s; ismporrss: w softener bl. Out of se A V%M rUIwiRE�lT tter: service the f0VowhV steps siratr to tdm w ire am the v the POW't'S � and/or is paxn>aae�y ta .aft abandoned in empfiance wfth c h- Comm 83.33. Wfseortsin Adn*1h lrlE f" Codec A� prpfig m tanft aced pits � be �onxiecte d and the abassdanod pipe OP~ . The a on5 craa tanks and pas shall be removed and prgM11Y dsspassd Of by a Sop(ege Opera • After pcsrVkg, all !orrice and pft shaft tie "cavatad and removed c+r tttelr cpviera mmavadond tha Void spore tzed yNk sue. gmwe o f =WOW inert sold rrrai� CONTWGENCY PLAN if its Pow is tails and cwwAot bet 2w f�Dfiowtng measures have teen, or must be ttiaeR m prt�vid ®a code (,A pplacernent ?ms been evWuated and may be utFzed for Vw kC860A Of 8 [A0MIO1t MR absorption yys The moment area should be protected from disturbance and compaction and should not be infringed upon by o **Sd sesbacft from e'asbn$ arl proposers SWJC ure, lot lines and wails. Failure to profit the replacernent am wB result in the need far a now soil and site ewWu2dw 10 establish a suitable repiacement area. Reps Wonent syStww must compy vAth the rules in effect at brat tircn& D A suitable r+eptaoenWA area is not avac7able•due to settzacic and/or soli rinzita*mr,. Barring advar=s in POWTS kcW)dkW a holdiri tw mW be Installed as a last resoet to rePlwm tits faced POWTS. © The s%e has not bear: evehotod m idereW a suitable replacement area Upon Whim of the POWTS a so"d and site. evWuation roust be perm oed to locate a suitable replacement area if no rephuxwnw t area is avallable a holding tank frW be installed as a last resort to replace the faired POWrS_ Q Mound and at -grade Soft � s may be reconstructed In place tranaval Of bianrat at the &dftzfte surface. Reoartsbresdf 0= Of such systarm must compty with the Mes in ttiect at fiat Ww- c<WARNING" SEf�C, PUtiMP AND C THER Tj%FA7 AWff TANKS MAY CONTAIN LETftAL GASSES ANDlOR IMSElE'FItXFJITt' OXYi�I. 00 HOT EiWrM A SEPTIC,. t?1JMp OR O'I M TREATMENT TANK UNDER ANY CtRCUNISTANCES- DEATH MAY RESULT_ RESCUE OF A pElism FROM THE mikPIOR OF A TANK MAY BE VWFIC OR RW0SSZBLE. • ► i f f•f , ; i r OYY�'S mrsrALLER PO WTS '_>A r Name Phone ��� - a� - 5/.► —! Phar:e 7 /v �O — 7T- f� SEPTAGE SFRViCIiYG OPMATOR LOCAL REGULATORY JLtII'HMY Name ! p•� P ho n e ✓� — �oi✓ Phan o_ Arts aioca�.eetwats Qratmd r,�rlr+ri stags dtlrr L kow Latra. JrtsrWm t avid Wamima County Z.orft and Sar�l . '!tile meets u:e t:tia3auart � atdL CUM 8$_Z l( X1XdXM and 83-540). 0) b (3). WiSMIS a A� Cade Umb of title do=wel d00 tnt waranwe t!>t m to mancs of the Pows. GAM M) RECEIVED r A r �' Wisconsin Department of C L e S IL EVALUATION REPORT Page of Division of Safety and Buildi AUG 2 8 2007 in accordance with mm 85, Wis. Adm. Code 11��NT County ��' Attach complete site plan �Tn�h e9i4&rQS 172 z 11 in hes in size. Plan must include, but not limited to: and horizontal ref t (BM), direction and parcel I.D. percent slope, scale or dis, no arrow, and location and distance to nearest road. Please print all information. Re ' ed by D i2 zq �46 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location I J Q/t— I L&L ce Govt. Lot j,,? 1/4:5F1/4 S).. T 3 / N R E (or W Property Owner's Mailing Address Ave— Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number `_✓City V�ge Town Nearest Road v. ujK.c � 1 6� 0 f) 20 0 v A New Construction Use:32f Residential / Number of bedrooms ,' Code derived design flow rate c� - 7 0 GPD El eplacement Public or co eraal - Describe: / " I p, � C " -)f — Parent material ©� F lood if applicable ft. General comments and recommendations: System Type 6 Iva System Elevation I�i Boring # [] Boring P Pit Ground surface elev. ft. Depth to limiting factor f / D in. Soil Anoliration Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff `Eff# •Eff#2 -o 0 -1 Z_ / ,r - 3 ^ I/o - L .z ,r ® Boring # j Boring 9 / Pit Ground surface elev 1 ' � ft. Depth to limiting factor // 0 in. Soil Aooliration Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff `Eff#1 •Eff#2 -o 1(9 312 - 2 - L Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 T Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 — -;� — o -2 715- 246 -4516 Property Owner _ Parcel ID # ® Boring # Boring pit Ground surface elev / ft. Depth to limiting factor �! in. Page of Soil Aonlication Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 ) A1!2f T�7 1 3 a---- C E Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Snil Annliratinn Rate 00�= Redox Description Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 ❑ Pit Soil Anolication Rate Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SOD -8330 (ROOD) Redox Description. Qu. Sz. Cont. Color Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SOD -8330 (ROOD) I Property Owner _ Parcel ID # Boring # ❑ Boring ❑ Pit Ground surface elew ' ft. Depth to limiting factor 11 in. Page of Soil AoDlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 l ) c2 m , F-1 Boring # ❑ Boring I ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aooliration Rate 1:1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appli Rate nw ", w, M , Redox Description Qu. Sz. Cont. Color 1:1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appli Rate Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -2330 (R.6=) Redox Description. Ou Sz. Cont. Color Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -2330 (R.6=) Soil Test Plot Plan Prbject Name Hidden Hollow Land Management Shaun Address 1366 200th ave Lot B S W 1/4 SE New Richmond Wi 54017 CS Subdivision ----- --- Date 1221 1/4S 24 T 31 N /1118 W T nshi StarPrairie F1 Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation 92.2 Property Line 695' Property Li ne Scale = 1/4" = 10' Calcs: ■ ow p County ST. CROIX Top of Steel Fence Post * H R PSame as Benchmark Manufacturing Building Max. 10 employees 2 floor drains No Reta i I Space Floor drains do not discharge to catch basin, system is to for domestic waste water only! 695' Property Line 8 -2 10 employees @ 13 gpd /employee= 130gpd 31ope is <1 % 2 floor drains @ 25 gpd /drain= 50 gpd Thus no contours 180 total gpd X 1.5 for peak flow= 270 gpd Tank size = 270 gpd X 2.088 = 564 gallons Use Huffcutt 800 gallon septic tank 8. M. A #226900 200th Ave a: MM Lu � W w z W w - W Za0 W?0CQ 0! � cr cr 00 CL ca W O0 ^ z LO d Z M O� V mzxx OgP CO) ulza2' 0 0 0 .p NWaW LL Op 1=NLL a�Z l Q �� W � VW N GNILL O p X co w �- I- op IL. O NLL O TWO � �30 �N m > - W ■w LU = VZ?W M LL Z W � oCO Op Z mm .( OOo �i.a?3Wv F�?P� �WW Z O ° L x Cl) 108'388 31139, LVOOOS �3 I , @3 4@ °®d ° Ob 131 00!/1 HO 13HIlg3ll@ I Z M®R IN31SAS 31VNIGUOOO h. � 0) 3 kLNnoo m686 '1S 3Hl Ol r i 3 $ a ° o E 030N383=138 38V SJNIFib99 ` �» y � IIUIIarri�i, O Sl � c V z .. y i T � � r cb C N m 5 a-- > O.8 �� �U) -2100 a is U- Cc �� ` o c in E 3 c-9 2 Ev; i MIS m � O N to U in C C 2 0 IC ruunnanl�aa s b F L 7 U 7 S C 3 zz s z a my 2 E :S39Yd 0" a3 3 AdQ9 00 'S T • 33d 0373 dYH d3AHnS Q3IdI.LK39 QYOT :TT 9002 /0Z /60 QH0034 Hod Q3AI333S SON do KS'[YA 'H 1�33SH.LYx 96LS 219Vd LZ '10A - 9 T ',r-- E7 �8 $ 217.03' O N N ® EXISTING £0'L LZ cr uj x0 o,- ww • w cl� �.T 616' £ CIO I u T MIDI miz I W I !O. I I oii to I 331331 W l w� I � II il 0 I W Z I� 96LS a6Ed LZ 1 S133HS E d0 L 133HS �jD ory�o�o UUVV 6 LL�I/11J � W399 M&,L LiEbo00N ntiL f l9'Z9£ b /43S 3H130 t?/MS 3Hl 30 3NIl isv3 �i� N o ° z Nm° �I N z LL �w 0. z u z�Z =', o �3 Z �o w W o ° —`c 7 S mi �� W � ZW z O � z �S 0 W z � , ° xw� 3Z J �$ � ? b? �jD ory�o�o UUVV 6 LL�I/11J � W399 M&,L LiEbo00N ntiL f l9'Z9£ b /43S 3H130 t?/MS 3Hl 30 3NIl isv3 �i� N Nm° �I N N Q N; I C I I ` 9\ Cc U O CC � W N Z Z V U O 9 State Bar of Wisconsin Form 2 -2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between John Gearin and Kimberly Gearin, f/k/a Kimberly Miner, husband and wife ( "Grantor," whether one or more), and Hidden Hollow Land Management, LLC ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): That part of SW1 /4SE1 14 Sec. 24- T31N -R18W being part of Lot 3 of Certified Survey Map recorded in Vol. 20, page 5120 described as follows: Lot 3 of Certified Survey Map recorded in Vol. 21 of Certified Survey Maps, page 5196 as Doc. No. 823316, St. Croix County, Wisconsin. 11111111111 illll Illll Illll Illll Illl illlll 1111 IIII * 8 5 7 6 55 8 1 857658 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/15/2007 04:OOPM WARRANTY DEED EXEMPT ti REC FEE: 11.00 TRANS FEE: 297.00 PAGES: 1 Recording Area Estreen & Ogland — 304 Locust Street (017 Hudson, WI 54016 261- 1304 -02 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated A ! a Gearin, f/k/a Kimberly Miner AUTHENTICATION Signature(s) John Gearin and Kimberly Gearin, f/k/a Kimberly Miner, husband and wife authenticated on f . • Kristina O land TITLE: MEMBERS ATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) ACKNOWLEDGMENT STATE OF ) ) ss. COUNTY ) Personally came before me on , the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 " Type name below signatures. INFO -PROT" Legal Forms 600.655 -2021 www.infoproforms.com 1 of 1 R Owner/Buyer Mailing Address Property Address City /State LEGAL DESCRIPTION Property Location L 1 /4 , 5� 1 / a , Subdivision ST. CROIX COUNTY ANK MAINTENANCE AGREEMENT AND CERTIFICATION FORM (Verification /S(0 C, OD 0-1, from Planning & Zoning Department for new Parcel Identification Number - 2- y D.2 - 6O a T N Rj �_W fM06bf Lot# 3 . Certified Survey Map # Warranty Deed # Spec house yes Cam' Volume Z , Page # 5.j.. 9 L — Volume , Page # Lot lines identifiable no Improper use and maintenance of yob�' septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septieltank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm 83.52() and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pl�mber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the ab�ve requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this �orm are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. G.� = a - �0 Number of bps SIGNATURE OF ** *Any information that is misrepresented Include with this application a recorded reference is made in the warranty deed. DATE result in the sanitary permit being revoked by the Planning & Zoning Department. * ** deed from the Register of Deeds Office and a copy of the certified survey map if (REV. 08105)