Loading...
HomeMy WebLinkAbout032-2021-20-100 W;;Sl County: consir,DepartmentofCommerce PRIVATE SEWAGE SYSTEM St. Croix � :Saibty and Building Division INSPECTION REPORT Sanitary Permit No: 506398 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village X Township Parcel Tax No: Herink, Elaine Somerset, Town of 032 - 2021 -20 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 05.30.19.549A10 TANK INFORMATION A ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 5.7Z. 05 7 Z /oc5 Septic // � pp ///��/�� - / j ' 'i. ' L / Benchmark Dosing i Alt. BM FI inn Bldg. Sewer 3, '85 161 Holding St/Ht Inlet 1,17 9 LY 5S 4 3 / TANK SETBACK INFORMATION SUHt Outlet -7, TANK TO P/L , WELL BLDG. Vent to Air Intake ROAD Dt Inlet /4,5 9 � , Septic /50 7 ZS �- Dt Bottom A - 51 Dosing y Sd > S � I �, t y Header /Man. 7 .5 4) Z. Z Aeration �0� O d Dist. Pipe J 3.53iaz.is Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 2 3 ..5 /63. /9 /.eL Manufacturer Demand St Cov r I % c GPM 0 ,1-e� Model Number TDH L System Head TDH F( Forcemain Length Dia. if' Dist. to Well /5v z SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (� 75 G - '___\ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of tem:� t CHAMBER OR UNIT Model Number: 1 >/ 7 >/� ^`A DISTRIBUTION SYSTEM t14 Header /Manifyid tj IlDistribution x Hole Size It x Hole Spacing Vep(to Air ake Pipe(s) C / A 1 Length 3 Dia /'� Length 3r�'25 Dia �'� Spacing 3 •� jC� .3� Ghdt „�, 6J_, 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 /' C Z Bed Trench Edges Topsoil t �� >C s � -1 No es !`' No / -r COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 1 / / / ? Inspection #2: Y Location: 1724 50th Streeori,erset, e 54025 (SE 114 SE 1/4 5 T30N R1 9W) NA Lot " Parcel No: 05.30.15.549A10 1.) Alt BM Description = �� 2.) Bldg sewer length - amount of cover 5 `'j Plan revision Required? Ji Yes Ix No f 1 Z t - 1 Use other side for additional information. I 1 SBO -6710 (R.3/97) Date Insepctor' Signatu Cen No. cOmmerce.Wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix ' M Permit mi 2 Number n Madison, WI 53707 -7162 Sanitary be filled in by Co.) 'S �7 D Q Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this f the appropriate 1 I qD governmental unit is required prior to obtaining a sanitary permit. Note: Application AM oa'D te-ed Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal information you prov' for 1724 5U Street, Somerset, WI, 54025 secondary purposes in accordance with the Privy Law, s. 15.04 ( 1)(m ) , Stats. I. Application Informatio - Please ftft All Information Property Owner's Name RECEIVED Parce # 03 Z- Zozi - z- v00 John & Elaine Herink Property Owner's Mailing Address Property Location 1207 Bass Lake Road NOV 1 5 200 7 Govt. Lot City, State Number SE i' 1'a, section 5 Hudson S COU�tTy 7 5 -549 -5795 (circle one) II. Type Of Building (check all that apply) �\ p T 30 N; R 19 ® or 2 Family Dwelling - Number of Bedrooms 3 ) a (MO C Subdivision Name �/ na 2 7, (. Z Ae,re5 Block # F1 Public/Commercial - Describe Use City of ❑ State Owned - Describe Use 5 M CSM Number ❑ Village of 7 / Drs r V1528 P583 ® Town of Somerset M. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System System (explain) B. ❑ Permit ❑ Permit Revision Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration IV. of POW TS S m/Com nent/Device: (Check all that appl o o.� ' NowPressurized In -Ground ❑ Pressurized Ih -Groin At -Grade 4!2! > 24 in. of suitable so il ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: a AA- ' Design Flow Design Soil A ication Rate(gpdst) Dispersal Area Required (sf) Dispersal (st) System Elevation 450 0.60 ✓ 750 1350 l y Z'S 101.57 ✓ VI. Tank Info Capacity in Total 1f of Manufacturer Gallons Gallons Units in F New Tanks Existing Tanks 1 / �Q x a Q Septic or Hsiang Tank 1000 0 1000 1 Week's C. P. ® ❑ Dosin Chamber 800 0 800 I Week's C. P. M L1 10 1 0 LI VII. Responsibility Statement- I, the undersigned, acsmae responsibSity for installation of the POWTS shown on the attached piaw. Plumber's Name (Print) Plumber' MP/MPRS Number Business Phone Number John Schmitt 223760 715 549 -6651 Plumber's Address (Street, City, State, zip Code) 616 150' Ave., Somerset, WI, 54025 VIII. Co /De went Use Onl �ppro ved _ sapP Permit Fee Date )ssued/ Issu' ert Sigma ner Give so ' r:>�nial $ IX. Conditions of Approval/Reasons for Disapproval \ SYSTEM OWNER: 1. Septic tank, effluent fitter and ll 1 dispersal cell must all be services / maintained G °CCL42- as per management plan provided by plumber. I A �� 2. All ie1 beck requirements must be maintained `i` p� AeJ 4 v S : 4e. c h� a Per to complete ans the system and submit to the County only an p4er not rem than $ x 11 inches in size : -" a POOw���e._ �(� Page I of 7 N pectjt ery LIn1E 841 EL. = /,6o.ee' TE er z" pt'c P ,OE ALT, 601 I' m �t3DkE h��ttS L v, ScoAr = /jf� P14 ec6L = Z7, &Z Aces ►1 10 SLCO J E \ 1 1 { " 8y p3 Arro (I le L/AN E f c "�vsriN+o � ® �GA�2AG -- 1 - + 6AL s.T. w1� POL1�0tC I�auS� �e2 awe ni c F oe �L 4 //V6 -y' J H 1U 1 Y6k /,u K I Z.o7 6455 2 A &t�. /Hitt) sO 5�/OaZJ CZ 64L < sf V sz ' /y, 5�; %3Da/, R /Fhl g.3 76 0 Page Lof 7 I �.Sek�T"H �K'Or�fe'ry` LINE N MO,Cc' TEP e, 2" Pi.c P,`e 4r. 6oI 1_=L. _ /c c, 9c' % e Z P11) ® Bcl"E I46Cts; C o AJ c k L./NC EL. = 10E. !cS �G 5Z_ Cie // Ac P )4e(L = Z7, 6Z ACetS - a Q B6 'ice a► 5cePE � � 1 ccNrcL( g1 '; I 1$C` -Z" ; Oet e mAl �wsnNe LAN I A g �� f D . RivF P C ELL �cZ roc y8 6 ® 000? AL ,T. 1 G S PcL'/Lf K Ex�Sr t E Lt r1 e looz Awlti Foe Di?AWin I? y / {tt4)SON Wr 54'0 56)lyl CKSt T WT 5 L1Oa2,J Zt�64 L 4 S F /y, S ' /9' 5S; 73DA� R / 9 t) 1 411 PP S 9 .2 ,3 76 0 Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 07, 2007 CUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/07/2009 Identification Numbers Transaction ED No. 1481409 SITE: Site ID No. 732300 Elaine & John Herink Please refer to both identification numbers,, 50 Street I above, in all correspondence with the agenc Town of Somerset St Croix County SE1 /4, SE1/4, S5, T30N, R19W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1160745 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101 .01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • 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 OF .RFTIW:r ;,.. pF • A Sanitary Permit must be obtained from the county where this project is located in accordance with the !I QF f a ELI requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CCGi ; ; S • 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 JOHN F SCHMITT Page 2 11/7/2007 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /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. i Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART'code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I SCHMHT & SONS EXCA VA TING INC. 4 0,E 586 VALLEY VIEW TRAIL w 0' SOMERSET, WI 3 MOUND SYSTEM s FOR: ELAINE & JOHNHERINK ADDRESS 12O7BASS LAKE ROAD,' HUDSON,, WI 54016 LEGAL SE % SE M, S5, 730N, R19W TOWNSHN SOMERSET COUNTY ST. CROIX CONTENTS Page 1 Plot Plan Page 2 System Cross - Section Page 3 Distribution Lateral Layout Page 4 Dosing Chamber Page S Pump Curve Page 6 & 7 Management Plan Attachment I Soil Evaluation Report Attachment 2 Tank Anchoring Mound Component Manual (Version 2.0) SBD -10691 P (N. 01 /01) Pressure Distribution Component Manual (Version 2.0) SBD-10706 -P (,N.. 01 /01) B MPRS: 223760 Date: October 22, 2007 'KW1y D COMMERCE �� INGS ;'ONDENC Mound System Cross Section 'age 2 of 7 Synthetic Covering A STIW C33 Distribution pipe Medium Sand TQpsctt __ �� o Sys. Elm 101 Beet 3 E �� D % Slope z Farce Main Plowed A�OKegv3`e Layer, 11% 5100 D = 0.92 Beet E T ,,, feet F = 0.79 feet G 0.50 feet A = 6.00 feet H =100„ feet Signed: r.� F B = 7'5, .0000 feet -- K = 7:b feet License m mber Q 3 660 L= 9n�M feet `i :3 . ; `! r = 5.00 feet Rivised Date: 11/07, /0T I = 13.00 feet W = 24.00 feet Alternate Positio of Force Main �. L It :To'T /1 Q �mrir 9i 4 of Bed — A _ t Force Mdin ( �i�i Pipe Aggregate Qbservati•oo Pipe Permanent Markera 115 -To U10 B From End of i3ed Ran'. View Of trtorind Page 3 of 7 TipWM CA"nout s 13 x.�,��„ PWO 33stE V PVC Forae tMlatn Oistslbcttion t..�t�rl�i PVC Manifold P % X —t x - • X/2 Distribution WOW La Ycvt - P 36.25 feet S 3.0 feet X 30 inches Tole Diameter 3116 inch Lateral Diameter 1 112 inches Manifold Diameter 11/2 inches Force Main Diameter 2 inches # of holes/pipe 15 Invert Elevation of Laterals 102.07 feet Signed: r� License Number: 223760 Revised Date: 11/07/2007 page 4 of 7 PUh1P CHAMBER CRO5S 5EG i l0i•J A tjC i 5 VEI.lT GAP • /Fri 4 L. I. vE�lrt FIFE WEA7HEKPRo01 APPROVED L.QCKINIC. juixriom 90X ttiti11F(QlE COVEn ZS' FROM DaOR. tt�ltlU. WIUDOw OR FFCC$H Aftt iuTAKE I GRADE ! y" Mild, { couaulT -- leMtN. � y ti l imu FROVIDE ' � A1f; SEA II AL^RK 21-76 GALLON94KCH *APPROVED .ELEV. 87 07 FT, C JOINTS WITH � APPROVED PIPE _ _ S' ONTO PUMP ---- _ O rr SOLID SOIL r LD1JLRf`T� D�OCx ;Kjsr.x ralT PERAIllEED 01�,{ FTAb �UFACYURLR HAS SUCH APPROVAL. SEPTIC & S EE DOSE TANKS ' MANUFACTURi IZ. WEEKS C.P. N1UNIBER 4F DOSES +nr- 7 FER DAY TANK SLZE: 800 G,A►L ONS _ DOSE VOLUME INCLUDING BACKFLOW: 10&8 GALLONS - MANUFACTUREIL - SEPTROXICS TikNK YlATE MODEL NUMBER: TM4 CAPACITIES: A;= 18 INCITES OR, 39, ,,1.68 GALLONS SWITCLI TYPE: MExIJRY T3= Z INCI OR 43.52 GALLONS C- 5 INCHES OR 109.8 GALLONS PUMP MANUFACTURER: URER: ZOELZ, E J D=12 INCHES OR 261.12 GALLONS MODEL NUWER: 193 SWITCH TYPE: MECTLANICAL NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUI'T'S If NRvf UM DISCHARQF RATE; 39.6 GPM VERTTCAL. DIk RE;NCE BETWEEN PUW OFF AND DISTMUTION PTPE: 15.00 FEET + MIND4UM NETWORK SUPPLY PRESSURE: 3.25 FEET + 150 FEET OF FORCE MAIN X 3.24 FT /100TH' ETtICiE•[ON FACTOR: 4.86 FEET TOTAL DYNAMIC HEAD= 23.11 FEET DLOWT R OF TAD X: 90 INCHES IjQUIDI DM-fK - 37 INgARS SIGNED: LICENSE NUMBER.: 223'1dtl REVISED DATE: 11 /200 I ' i - Page 5 of 7 TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N V) MODEL 152/153 w� I w MODEL 152 153 50 Feet Meters Gal. liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 l 70 265 1 0 15 4.6 53 i 201 61 231 = 20 1 6.1 44 167 52 197 30 a 8 25 7.6 34 129 42 159 0 30 9.1 23 87 33 125 a 20 3 10.7 -- -- 22 85 40 1 2.2 -- -- 11 I 42 4 10 Loci 'Valve: 3 8. 0 F;. '.6m) 44.0 Ft. (I 3.4m) 014508 0 20 60 80 100 GALLONS LITERS 0 80 160 240 320 3 27/32 —7+ 5/8-� FLOW PER MINUTE. e ! i CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. a a I • Electrical alternators, for duplex systems, are available and supplied with e 3 27/32 an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. T • Sealed Qwik -box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. I 1521153 Series 12 1/8 1521153 MODELS Control Selection Model volts -Ph Mode Amps Simplex Duplex 5 I/8 N152 115 1 Non 8.5 1 2 or 3 BN1521 115 1 Auto 8.5 Included 2 or 3 sKZOS4 E152 230 1 Nan 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or N153 115 1 Non 10.5 1 2 or BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level Float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Altemator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA!. or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ` Louisville, KY 40256-0347 ar �� ® Manufacturers ol.. SHIP TO: 3649 Cane Run Road op Louisville, KY 1 (800) 9 2 8-P UMP Q&UrY P Ud/PB S NCE 19,/ N PUMP !O. (� 778-27 X (502) 74-3 928 -PUMP httpJhvww.zoeller.com FAX (502) 774 -3624 © Copyright 2001 Zoeller Co. All rights reserved. POTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of W RLE INFORMATION SYSTEM SPECIFICATIONS Owner Elaine & John H e r i nk Septic Tank Capacity 1000 a l , ❑ NA Pernut 0 Septic Tank Manuf acturer Week's C . P . i3 NA DESIGN PARAMETERS Effluent Filter Manufacturer Promold & Tool O NA Number of Bedrooms 3 O NA Effluent Filter Model nP 1 0— 8 O NA Number of Public Facility Units W NA Pump Tank Capacity 800 a l O NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer Week's C. P. ❑ NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer Zoeller ❑ NA Soil Application Rate 0 , ( gal/day/ft= Pump Model 153 O NA Standard lnfluant/Effluent Quality Monthly average* Pretreatment Unit © NA Fats, OU & Grease (FOG) 5:30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg /L O NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L O In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade O Mound Fecal Coliform (geometric mean) . cfu /100m1 O Drip -Line ❑Other: Maximum Effluent Particle Size Y a in dia. O NA Other: O NA Othar: O NA Other: O NA ' 'valves typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 0 ear(s) (s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y.) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) ❑ NA 3 ® earls) Clean effluent filter At least once every: O month(s) O NA 1, O year(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ NA 1 W year(s) Flush laterals and pressure test At least once every: O (s) O NA 1 WY earl 1 Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) 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 icwiediate notification ui the local regulatory authority.. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) 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. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals-of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 7 of 7 START UP AND OPERATION For new construction. prior to use of the POWTS check treatment tank(&) for the presence of painting products or other chemicals that may impede the treatmant process and/or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior %,use. System start up shall not occur whbn soil conditions are- frozen at the infiltrative surface. During power outages purrtp tanks tray fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal calls) in one large dose, overloading the cell(s) and may•result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to I restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do.not drive or park over, or otherwise disturb or compact, the area within 15 fast down slope of any mound or at -grade soil absorption area. 'Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antiblotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is parmanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ali 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 pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN It the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing 'and proposed structure, lot lines and wells. Failure to protect the replacement. area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time, ❑ A suitable replacement area Is not available due to'setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. ® The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the.: infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. - ADDITIONAL COMMENTS 73'ArTS :.:;;TALLEP• PO','.75 MAINTAINER Name John Schmitt Name John Schmitt Phone Phone ( 715) 760 -0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name iCe Name St . Croix Ct . Zonin Phone Phone 715 386 -4680 This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(t) and 83.64(1), (2) & (3), Wisconsin Administrative Code. W isconsin SOIL EVALUATION REPORT #1586 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8Y: x 11 inches in size. Plan must County St. Croix 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. 032- 2021 -20 -100 Please rint all information. P Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Herink, Elaine & John Govt. Lot SE1 /4, SE1 /4, S5, T30N, R19W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1207 Bass Lake Rd na CSM V1528 P583 City State Zip Code Phone Number ❑ City E] Village ® Town Nearest Road Hudson WI 1 54016 1 715 -549 -5795 Somerset I I 50Th St. ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial - Describe Parent material Glacial till (Amery Series) Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a mound system. System elevation is 101.56' based off contour line established at 100.65'. Slope of system area is 11 %. Depth to limiting factor is 25 ". Boring # ❑ Boring Pit Ground surface elev. 97.40 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -9 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 9 -25 10yr4 /4 none sl 2msbk mfr gw ivf .6 1.0 3 25 -36 7.5yr4/4 c2d 7.56/6/6 7.56/6/2 sl lmsbk mfr gw - - - - -- .4 .7 4 36 -40 10yr5 /3 c2d 10yr6/6 sil 2fsbk mfr gw - - - - -- .6 .8 10yr6/6 5 40 -65 7.5yr4/6 m2d 1 sl Om mfi - - -- - - - - -- .2 .6 106/66 (1 /1 Boring # ❑ Boring Xl Pit Ground surface elev. 98.4 ft. Depth to limiting factor 28 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure ConsistencE Boundary ` Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 -12 10yr3 /3 none sl 2fsbk mfr as 2vf .6 1.0 2 12 -28 10yr4/3 none sl 2msbk mfr gw ivf .6 1.0 3 28 -39 10yr4 /6 c2d 10yr5/6 sl 2msbk mfr gw 6 1.0 10yr5 /2 - - - - -- 4 39 -47 7.56/4/6 m2d 7.5yr6/6 7,5yr6/1 sl lmsbk mfr gw - - - - -- .4 .7 5 47 -68 7.56/4/4 c2d 5yr6/6 syr5 /, sl Om mfr - - -- - - - - -- .2 .6 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 30 mg /L and TSS <30 mg /L CST Name (Please Print) Signature CST Number Thomas J. Schmitt quo r 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 10/31/2007 715- 247 -2941 SBD -8330 (R07 /00) Propety Owner Herink, Elaine & John Parcel ID # 032 - 2021 -20 -100 Page 2 of 5 Boring # F Boring ® Pit Ground surface elev. 94.50 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Iconsistenc6 Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr3/3 none sil 2fsbk mfr as 2vf .6 .8 2 13 -22 10yr5/3 none sil lmsbk mfr gw ivf .4c .6 3 22 -55 7.5yr4/6 m2d 5yr6/6 5yr5/2 sicl 2fsbk mfr - -- - - - - -- .4 .6 Fil Boring # Boring Z Pit Ground surface elev. 96.0 ft. Depth to limiting factor 17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -13 10yr3 /2 none sl 2fsbk mfr as 2vf .6 1.0 2 13 -17 10yr5 /4 none sl 2msbk mfr gw 1vf .6 1.0 3 17 -30 10yr5 /3 m2d 5yr6/6 sl imsbk mfr gw - - - - -- 4 7 5yr6 /2 4 30 - 48 7.5yr4/6 m2d 10yr6/6 scl lmsbk mfr gw - - - - -- 2 .3 10yr6 /2 F�l Boring # F] Boring Pit Ground surface elev. 97.75 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary I Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff #2 1 0 -9 10yr3/3 none sl 2fsbk mfr as I 2vf .6 1.0 2 9 -25 10yr4/4 none sl 2msbk mfr gw ivf .6 1.0 3 25-40 7.5yr4/6 c2d 10yr6/6 sl lmsbk mfr w lvf .4 .7 10yr6/1 g 4 40 - 52 7.5yr4/4 m2d 7.5yr6/6 scl lmsbk mfr - - -- - - - - -- 2 3 7.5yr6/1 * 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 -8330 (R07 /00) Schmitt Soil Testing, Inc. Rropeity Owner Herink, Elaine & John Parcel ID # 032 - 2021 -20 -100 Page 3 of 5 17 Boring # [] Boring ZI Pit Ground surface elev. 101.75 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. °Sz. Cont. Color Gr. Sz. Sh. I *Etf#1 _`Eff#2 1 0 -9 10yr3 /4 none sl 2fsbk mfr as 2vf .6 1.0 2 9 -25 10yr4 /4 none sl 2msbk mfr gw ivf .6 1.0 3 25 -36 7.5yr4/6 c2d 7.5yr6/6 7.5yr6/1 sl imsbk mfr gw - - - - -- 4 7 4 36 -52 5yr4/4 m2d 5yr5/6 scl imsbk mfr - - -- - - - - -- .2 .3 5yr6/2 Boring # EJ Boring Z Pit Ground surface elev. 102.15 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 16 -31 10yr4/4 none sl 2msbk mfr gw ivf .6 1.0 3 31-48 7.5yr4/6 m2d 7.5yr6/6 sl imsbk mfr gw - - - - -- .4 .7 7.5yr6/1 4 48 -56 7.5yr4/4 m2d 5yr5/6 scl imsbk mfr - - -- - - - - -- .2 .3 5yr5/2 ❑ Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots GPD /ft in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /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 -8330 (R.07 /00) Schmitt Soil Testing, Inc. _ Page 4/of S �Ccnducted by Conducted For: _ - Schmitt Soil Testing Inc. Name: -- Elaine & John Herink _ Thomas J. Schmitt, CST 227429 _ Address: 1247 Bass Lake Rd. 1595 72nd St. City, State, Zip: Hudson, W154016 New Richmond, W1. 54017 Phone: 715-247-2941 // Subd.Name: CSM V1528 P583 Signature I C.�.;?O Lot No.: NA (27.62 Acre Parcel) Date %� / J / 1 ,2UZo 7 Legal Description: SETA SETA S5 T30N R19W Backhoe pit Township, County: Somerset, St. Croix Bench Mark El. 100.00' Top of 2" pve pipe Alternate Bench Mark El. 100.90' Top of 2" pvc pipe Slope= 11 % Contour Line El. 100.65' Contour Line Length 80' Scale 1" = 40' Al, r 4 S � lm go 414 -NOW 1� _ovv-e c `I sconsin SOIL EVALUATION REPORT #15136 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions. north arrow, and location and distance to nearest 032 -202. 20 - DO Parcel I.D. Please print all information. tion Date Personal informa you provide maybe used for secondary Purposes (Privacy Law, s. 15.04 (1 // / S / p'7 Property Owner Property Location Herink, Elaine& John Govt. Lot S 1/4, S /4, S5, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or tSM# 1207 Bass Lake Rd na I V1528 P583 City State Zip Code Phone Number ❑ City ❑ Village N Town Nearest Road Hudson WI 1 54016 1 715- 549 -5795 Somerset I 50Th St. ❑ New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent materia Glacial till (Amery Series) RE Flood plain leva�n, if applicable na ft. General comments ((�� and recommendations: Area is suitable for a mound system. S stefrl*VatjAs�%0j .56' ba off contour tine established at 100.65'. Slope of system area is 11 %. epth to limiting fact 5 ". ❑ Boring S Boring # B / ® Pit Ground surface elev. 97.40 to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EW2 1 0-9 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 9-25 10yr4 /4 none sl 2msbk mfr gw ivf .6 1.0 3 25 - 7.5yr4/4 c2d 7.5yr6/6 sl lmsbk mfr gw ----- 4 7 7.5yr6/2 4 36-40 10yr5/3 c2i6 6 Sil 2fsbk mfr gw .6 .8 5 40-65 7.5yr4/6 m i /6 sl Om mfi — .2 .6 F ] Boring # ❑ Boring ® Pit Ground surface elev. 98.4 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. *Eff#1 *Ef#2 1 0-12 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 12 -28 10yr4 /3 none st 2msbk mfr gw 1vf .6 1.0 3 28-39 10yr4 /6 c2d 10yr sl 2msbk mfr gw - - -- 6 1.0 4 39-47 7.5yr4/6 m2d 7.5yr6/6 sl lmsbk mfr 9W ---- -- .4 .7 7.5yr6/1 5 47-68 7.5yr4/4 c2d 5yr6/6 sl Om mfr - -- -- .2 .6 5yr6/2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ' �� -�-�� 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 10/31/2007 715- 247 -2941 SBD -8330 (807/00) i Property Owner Herink, Elaine & John Parcel ID # 032 - 2021 -20 -100 Page 2 of 5 F Baring # E] Boring ✓ M Pit Ground surface elev. 94.50 ft. Depth to limiting factor 22 in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. 8z. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-13 10yr3/3 none sil 2fsl* mfr as 2vf .6 .8 2 13 -22 10yr5/3 none sil imsbk mfr 9W 1vf .4c .6 3 22 -55 7.5yr4/6 m2d 5yr6 /6 5yr5/2 sicl Zfsbk mfr -- ----- 4 .6 4 Boring # Boring Pit Ground surface elev. 96.0 ft. Depth to limiting factor 17 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'EfW2 1 0 -13 10yr3/2 none sl 2fsbk mfr as 2vf .6 1.0 2 13 -17 10yr5/4 none sl 2msbk mfr 9W lvf .6 1.0 3 17 -30 10yr5/3 m2d 2 6 sl lmsbk mfr gw - - - - -- .4 .7 4 30-48 7.5yr4/6 m2d 11006 sd lmsbk mfr 9W - - - -- . 2 .3 F il Boring # 0 Boring Ground surface elev. 97.75 ft. Depth to limiting factor 25 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Efr#1 •Eff#2 1 0-9 10yr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 9 -25 10yr4/4 none sl 2msbk mfr 9W 1vf .6 1.0 3 25-40 7.5yr4/6 c2d 10yrt /6 sl lmsbk mfr lvf .4 .7 10vr6/1 9w 4 40 -52 7.5yr4/4 m2d 7.5yr6/6 SCI lmsbk mfr --- --- .2 .3 7.5yr6 /1 " 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 IDepertrnmt of C nmlc a is an equal opportunity service and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266-3151 or TTY 608 -264 -8777. SBD -8330 (R.07/00) Schmitt Soy Teov, hic, Property Owner Herink, Elaine & John Parcel ID # 032 - 2021 -20 -100 Page 3 of 5 6] Boring # Boring h �j pit Ground surface elev. 101.75 ft. Dept to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color. Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 02 1 0-9 10yr3/4 none sl 2fsbk mfr as 2vf .6 1.0 2 9 -25 10yr4 /4 none sl 2msbk mfr gw ivf .6 1.0 3 25 -36 7.5yr4/6 c2d 7.5yr6/6 sl imsbk mfr gw .4 .7 7.5yr6/1 4 36 -52 5yr4 /4 X scl imsbk mfr -- - - -- .2 .3 Boring # ❑ Boring ® Pit Ground surface elev. 102.15 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3 /3 none sl 2fsbk mfr as 2vf .6 1.0 2 16 -31 10yr4 /4 none sl 2msbk mfr gw 1vf .6 1.0 3 31-48 7.5yr4/6 m2d 7 .5yr6/6 sl im sbk mfr gw ---- -- .4 .7 7.5yr6/1 4 48 -56 7.5yr4/4 m2d 5yr5/6 scl lmsbk mfr - -- - - -- .2 .3 5yr5/2 FT I - I I I ❑ Boring # El Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Efr#1 *Eff#2 * 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 Departrrtent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266-3151 or TTY 608- 264 -8777. SBD -8330 (8.07/00) Sdm tt SoN Tes&V, Irx. Page y of - Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Elaine & John Herink Thomas J. Schmitt, CST 227429 Address: 1207 Bass Lake Rd. 1595 72nd St. City, State, Zip: Hudson, WI 54016 New Richmond, M. 54017 Phone: 715 -247 -2941 Subd.Name: CSM V1528 P583 Signature u�.. /, Lot No.: NA (27.62 Acre Parcel) Dare /Q 71 1 ,2yZ Legal Description: SETA SE114 S5 T30N R19W Backhoe pit Township, County: Somerset, St. Croix Bench Mark El. 100.00' Top of 2" pvc pipe Alternate Bench Mark El. 100.90'Top of 2" pvc pipe Slope= 11 % Contour Line El. 100.65' Contour Line Length 80' Scale 1" = 40' f1k r r k �, �� j S�• T QVII 9 \ A s - W 9 ��E wtuu� 1S c r Cn , Coki V-e x 5 ---------- ArcIMS Viewer Page S $- F�.tt 1 a7, i h ki 4 h� Y }dL" "� I r F E 3. „ http: //72.21. 230. 178/ website/LRPortal/ARCIMS/MapFrame .asp ?PIN= 11/4/2007 wi I C - a dE > t fib i aA S. r 3s. i.. Y; C_ a S "•�� Y+s 5 w Y v- 7 a } 3 _ , i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer E M /�9' Mailing Address (, �� b Ik px� 41 UAS , UA � t Property Address (Verification required from Planning Department for new construction) City /State c GY11 Se �c L Parcel Identification Number 0301, a. -1 4O t6O LEGAL DESCRIPTION Property Tocation './s, 1/4, Sec. TAN -R L 9 W, Town of 56 w► e,r s e�b Subdivision . Lot # Certified Survey Map # . Volume . , Page # Warranty Deed # 'foZ� / , Volume Page # Spec house ❑ yes 1� no Lot lines identifiable ❑ yes ❑ 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. i �9� � SjopkTM - O? P'I'LICANT I 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT * * * * ** Any information that is mis- represented max result in the sanitary permit being revoked by thmZoning Department. * * * * ** i ** 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 i _ . _ . — DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 42 4339 E �� __._.__ BOOK_.__ u51 ...._ _..... REGISTERS OFFICE I _.. . - ST. CROIX CO., WIS. is Raymond E. Ostendorf and Ruth A. Ostendorf, husband an d Recd. for Record this 10th wife. as martal - with -- rights of survivorship, y �{ A_p A.D. 1987 -- - - - - -- 8.30 A M. quit - claims to _ I Elaine_ H. _ HeriI'llC - - - - -- - 1. - - - - -- .: I �j ---------------------------------------------------------------------------------- - - - - -- - •-------- _-- - - - - -- { boNew O�.e1 „ .......................... -------------------------- ----------------------------------- -......................... l; the following described real estate in -------- S _t...Cro1X___ .............. __ County, I I State of Wisconsin: iii 1I RETURN TO ;j H Tax Parcel No:..- 1 !i The Southeast Quarter of the Southeast Quarter (SEJ of SEJ), Section Five (5), Township Thirty (30) North, Range Nineteen (19) West, SUBJECT to easements of record, AND EXCEPTING the following: CCrmencing at the Northwest corner of said Southeast Quarter of Southeast Quarter (SE$ of SEf); thence East along the North line of said Southeast Quarter of Southeast Quarter (SEA of SEA), Seven (7) rods and Four (4) feet; thence South Eight (8) rods; thence in a Southwesterly direction Four (4) rods and Seven (7) feet to a point which is Four (4) rods an d Nine (9) feet East of the West line of said Southeast Quarter of Southeast Quarter (SEA of SEA); thence in a Southwesterly direction to a point' on the West line of said Southeast Quarter of Southeast Quarter (SEJ of SEJ), which point is Eighteen (18) rods and Eleven (11) feet from the said Northwest corner of said i� { Southeast Quarter of Southeast Quarter (SE1 of SEA); thence North said Southeast along the west line of I If Quarter of Southeast Quarter (SEJ of SEJ), Eighteen (18) rods and Eleven l (11) feet to the Place of Beginning. I' I j This is i . ..... . ... . .. homestead property. (is) (is not) Dated 1' this ---- ------- - -� - -- -- --- •---- ------ -- - - -• -- day of -------- ch a r------- -- •--------- - -_- -- k 6 -- - - --- -- - -- -- •------ -- --- - - -- ------- - - - --- -- -(SEAL) .......... ------- 0z ...... ------------ ... Ra d E. Ostendorf * . Ruth- A.__ Ostendorf------------------------ - - - - -- - - - -- -- - ---- - ----------- - --- -------------------------------- (SEAL) (SEAL) !i --_-- •---- -- is AUTHENTICATION ACKNOWLEDGMENT Signature (s) Q_ympDd_.__QtpxldQx•_and__.__ STATE OF WISCONSIN .....County. auth ated thisc;Q .. _ _..day of.... rCC�l------- ------ 19. $.7.. Personally came before me this ................day of f, - - - - - - ---- ----- -•- ---- -------- - -- --•- 19 ........ the above named t R. Needham TIT MEMBER STATE BAR OF WISCONSIN !, i (Pf -•----------------------- ----------------------------------- aut�rei'rt'erF bgs� pia 6�tabss) --- --- - -- ----------------•--------------------- to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Reinstra Van k Dy &Needham, S.C. -------------------------------------- - - - - -- i ----------- - - - - -- --_-•---------------------- - New.. Richrmnd wj_sconsin_ - -5 -4017- _0122- - -- -- r Notary Public --- -•-- ------ -- --- ---- -- - - - - - -- - -- -- ----County, Wis. I! i (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19 ) I *Names of persons signing in any capacity should be typed or printed below their signatures. HC_ IT� STATE BAR OF WISCONSIN u,r- W,.. -.. Sn ,. rry ►�^�+ FARM Nn � _loon CA_.1- ►1_ 7 wAAw