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Home My WebLink About032-2032-20-050 0 ? � § � � ; � � $ 7 � 7 � 0 J u E z ° $ E S Q ' ; ; : } [ \ 4 « k 3 EY k % - 2 § 2 § % j ± k \ % (A % # 7 § e G( /$ a� 2 S Q ® ( / d E E K § § ( 0 • to J o § g / i ¢ [; 3 0 \ \ § \, � =:z ƒ § q t t / § N a' o r ■ o o o c « §: § &_ �- 0 0 0 ; 0 7 ■ ■ 0 0 § 2 � - ~ § T Er 2 c \ k�lq' � E \ z — z in > \ 0� % < / E; a ' ` k m � \ // �2z� � z o I R R (D m ! § / 2 z � 7 % 2 . 7 7 4h- . 0Ee> �3 7 k � •f� � � � CD i(( k \; � L 7 CL 7 % I 2 L °s m@ § 1p o � CD § 0 / j Parcel #: 032 - 2032 -90 -000 02/01/2010 08:55 AM PAGE 1 OF 1 Alt. Parcel M 08.30.19.596 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -owner 0 - VON HOLTUM, LAURA L LAURA L VON HOLTUM C - BRENIZER, JACQUELINE K JULIE A PASELL,ET AL C - PASELL, JULIE A 173 WHITE PINE RD C - STRUEMKE, KATHLEEN L LINO LAKES MN 55014 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T30N R19W 40A SW SE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/30/2007 849399 QC 04/04/2006 822098 QC 08/05/2005 802486 2859/448 QC 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 1230 Use Value Assessment Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 4.000 100 0 100 NO AGRICULTURAL FOREST G5M 36.000 72,000 0 72,000 NO Totals for 2009: General Property 40.000 72,100 0 72,100 Woodland 0.000 0 0 Totals for 2008: General Property 40.000 72,100 0 72,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515184 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)). Permit Holder's Name: City Village X Township Parcel Tax No: Struemke, Timothy & Kathleen I Somerset, Town of 952'2- 0 - CST BM Elev: Insp. BM Elev: BM Description: `�� Section/Town /Range /Map No: QD Y 1 l ( G� 08.30.19. TANK INFORMATION , ELEVATION DATA TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV. i Septic Benchmark W � F: � l Z V (o /OV 4 Alt. BM Aeration Bldg. Sewer tl� 143 r / 7 Holding St/Ht Inlet 7J "Y � Z.l TANK SETBACK INFORMATION St/Ht Outlet 1 12 ,36 ' FY, Z- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet — Septic Dt Bottom `- Z S "_. Dosing Header /Man. 9 • 'C ' Aeration Dist. Pipe 17. qS 1 kj Holding Bot. System �� ,� --70Q . 1y ate. PUMP /SIPHON INFORMATION Final Grade �Z •� C ! 3.1 Manufacturer GPM Dem and St Co�Gei Cou2,� $ • 17 S G C�S Model Number �1� 5 1�tf �D � .. �„ a TDH Lift Friction Loss System T Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ¢ No. Of Tr enches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /J(J\ -2 r � SETBACK SYSTEM TO �� P/L BLDG 1 WELL LAKE /STREAM LEACHING Manufacturer: .LIB 4F INFORMATION CHAMBER OR -�, Type Of System: 3.3 UNIT Model Number: CN� I 6Q ✓till 'U DISTRIBUTI SYSTEM 25+ z = 5v 4 Header /Manifold I Distribution x Hole Size x Hole Spacing Vent to Air tak Pipe(s) D Length_ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center._ < ��( Bed/Trench Edges ` Topsoil \ Yes No Yes F] No N J • O q COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 171 / Inspection #2: / / Location: 445 165th Ave SOMERSET, WI 54025 (NE 1/4 SW 1/4 8 T30 R1 9W) NA Lot 2 Parcel No: 08.30.19. 1.) Alt BM Description = 5 a • I s Ca, f�, 6 T �,t�- 6 e_,t - 2.) Bldg sewer length = / - amount of cover = Plan revision Required? Yes [] No Use other side for additional information. - Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) ALMb Iommercemi.gOv Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 , ' W i s cons in Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) epartrMnt of Gomnwme 5isf 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 �e IJA" unit is required prior to obtaining a sanitary permit. Note: Application forms for state - owned POWTS are Pr *ct Address (if different than mailing addre submitted to the Department of Commerce. Personal information you provide may be used for secondary S-, purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. AWL I. Application Information - PI se Print All Informatio Prop wner's Name Parcel # r� 7 Property Own s ailing Address OCT 2 9 2009 Property Location 2� ?� Zc� 2 GU �-- v 3 }� _� in ;UUN i Y Govt. Lot City, State — Pho '' // WNbBf & ZON � ' /s, ,Slt� ' /s, Section LY (ci� one) (, II Type of Building (check all that apply) Lot # T_&9 N; R / 9 ctJ CK 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ r� Block # 125.11 Public /Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use `� CSM Number 9a ❑ Village of ZS „�,�, Town of • III. Type of Permit: (Check ofily one box on line A. Complete line B if applicable) A. New System FIReplacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (eN - --"" System B. Permit Permit Revision ❑ Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner / Expiration 4A IV. Type of POWTS System/Component/Device: Check all that apply) G Non-Pressurized In- Ground Lj Pressurized In- Ground At -Grade LJ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank Other ispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application R e(gpdsf) Dispersal Area Require Dispersal Area Proposed (sf) System Elevation / rf� ✓ ✓ /Ong 16, ✓/ ✓ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a z New Tanks Existing Tanks Septic or Holding Tank Dosing Chamber VII. Respor. ' ili Stateqie 1, the undersigned, assupie respop, for installatioll of the POWTS shown on the attached plans. P erne Plum ature MP/MPRS umber Business Phone Number - � /' Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use Onl pproved Permit Fee Date Psued Issuin gent Sign e Owner Giv eas enial $,q p a 1461 lb, IX. Condi*fWWAeVV &**Reasons for Disapproval 3 J'14 A :514 �+ l & i3Wre, -A 1 1. Septic tank, effluent filter and dispersal cell must all be setvlces !maintained q 4- NIS A•44u(1O M�CG w !(a 'L as per management plan provided by plumber. ' U p �T( Mck 2 All setback requirements must be maintained 1 �� / M: �- � ` 3 f�'rc.i as per spCable code / ordinant�s. : L„ 1IC., dt" Attach to complete plans for the system a;.db mit to he Connty only on paper not less than S 1/2 x 11 inches if size I 4 f /1 A 6We.VCA_ SBD -6398 (R. 01/07) Valid thru 01 /10 .3G !�c]Co PV to // .a r' A.# Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must �- 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. Z - ? j 2 - ✓} , SC/6� Please print all information. Rev' Date (� Personal information you provide may be used for seconds u oses (Privacy Law, s. 15.04 (1) (m)). Property r Property Location L J ,;t 1 -5�w A 1 Govt. Lot _ 1/4 114 S T N R E (or Property Owner's Mailing Add RV 1 Lot # Bock # ame or CS r = Z - A 0, 0 City S Zip Co ~ No OFFIC .. ❑ City ❑ Village Nearest Road ` New Construction Use: Residential /Number of bedrooms Code deri esign flow rate GPD ❑ Replacement Public or commercial - Describe: S CLr l ues late S Parent material _`;�,, ; Flood Plain elev6n if applicable / ft. General commer>ts / and recommendations: / �U f' (� J T5 F/-1 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 Roots GPD/fF in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 9 9 Zo- 5 � R �d .L Boring # 0 Boring ��L_ la l Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. (;ont. Color Gr. z. Sh. *Eff#1 "Eff#2 3. c AY , — f g� _ • �i "Effluent # = BOD > 3Q 220 1L and TSS >30 < 150 mg/L n #2 = BOD < 30 mg and TSS < 30 mg1L CST Name Print) Signature CST Number Address Date Evaluation Co ucted Telephone Number S 7 — S _ Property Owner Parcel ID # Page of F Boring # ❑ Boring pit Ground surface elev. 2 y, 9 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 > a r J 8 1 � 3 R L N � F 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 Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F] Boring # E] Boring 11 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. *Eff#1 *Eft#? * Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 5150 mg/L * Effluent #2 = BOD 5 30 mg/L and TSS 5 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) Property Owner ID # Page of ❑ Boring # ❑Boring IM pit Ground surface elev. 9 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 -. Gt. Si. Sh. *Eff#1 *Eff#2 a Q N Q'7 04 F-1 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 Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 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 Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg1L 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 OL07/00) ' i IIIIIIIIIiII'' � ''IIIIIIIIIIIIIIIIIIINflllliffl 9 1 4 1 8 2 905418 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI CERTIFIED SURVEY MAP NO. 566, RECEIVED FOR RECORD Located in the Northeast Quarter of the Southwest Quarter, 10/16/2009 08:OOAM CERTIFIED SURVEY MAP Section 8, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin VOL: 24 PAGE: 5662 OWNER: REC FEE: 13.00 COPY FEE: 3.00 John E. Walsh PAGES: 2 Scale in Feet 433165th Avenue Somerset, Wisconsin 54025 0 50 100 PREPARED FOR: Timothy T. and Kathleen L. Struemke Aluminum capped survey 1 Inch = 100 Feet 1433 165th Avenue 3 monument at the N1 /4 Somerset, Wisconsin 54025 Comer of Section 8, centerline of travelled road�, T30N, R19W ... —�. -- - - N 2214.28 _ M 165th AVENUE nn I 2676.30 N89 °53'12 "E - ' - ' — S89 12 "IN 441 .81 - ---' ` N89 °53'12 "E • N89 °20'43_W 44 . %� Magnetic nail survey n, E114 -SW 1/4 it f n n e r v' monument at the E114 r o r; 30N, R19W I s t i ' OI Comer of Section 8, � � 2 ri �I T30N, R19W <<�z to a I T ee f c n NOTE 1: Denotes slopes W Q o r !l4 -SW114 greater than 12% and _ less than 25 %. 6 �^ I Denotes slopes M 25% and greater. • o� g M Denotes 0.50 acres of buildable land. o� I � Nearest building is 142 feet al a 10/ g� q� W L west of the most westerly line ;+ cP� LOT n of Lot 2. 0�� e ke ° ' L O From the driveway to Lot 2: oc INCLUDING R.O.W. O There is a driveway wire fence ` ' 5.252 acres M headin south 700 228,797 square feet -n 8 feetwest. of ` W' .' EXCLUDING R.O.W. Z I There is a driveway Y V Z I heading north 700 LO 5.043 acres W S( feet east. gl N �q o 219,656 square feet Z F= al ai co There is a field entrance �I m heading south 1000 0 0 W w feet east. In W In Sight distance from Lot 2 O driveway is 500+ feet to the NOTE 2: -� east and west. a � Distances are in feet and decimals of a foot. ' I The north line of the SW1 /4 of Section 8, T30N, R19W, ' bears S89 W as N89'S3' 12 347,32 referenced to the St. Croix 3 County Coordinate System 41jVPLATTED }�VQ NAD 83. LEGEND: 0 Denotes 1 inch outside diameter by 30 inch long :�� ••• •• ~• v. Aluminum capped survey iron pipe monument of no less than 1,13 lbs.Ilin.ft., monument at the S114 set, unless otherwise noted Comer of Section 8, 4 1 Denotes found survey marker as described ' T30N, R19W Denotes P.K. Nail set in pavement ' ' (,► Denotes septic soil boring hole ��i� 49 1 Landmark Surve It? e parcel shown on this map Is subject to State, County and y 9 In r1C. Township laws, rules and regulations (i.e., wetlands, minimum • 21150 Ozark Ave. North Office number: 651.433 -3421 lot size, access to parcel, etc.,). Before purchasing or P.O. Box 65 Fax number. 651433 -4781 developing the parcel, contact the St. Croix County Zoning Scandia, MN 55073 E -mail: Inthefield (afrontlemet.net Office and the Town of Somerset for advice. page 1 of 2f 0 This instrument drafted by W. 5016 on the 15th day of October, 2009 Job No, 2009 -28 Vol. 24 Page 5662 Soil Absorption System Cross Section 9_ ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap --- ft Leaching --► Chamber �— System Elevation 3 ft ft Soil Absorption System Plan View /c 2 ft ft { 1 ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber S pecifications Manufacturer And Model EISA Rating sq ft per chamber Soil Application Rate gpd /sq ft gpd Design Flow + �� Soil Application Rate : r"> EISA = Chambers 2 rows of chambers each. >> Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Z- of FILE INFORMATION SYSTEM'SPECiFiCATiONS Owner � Septic Tank Capacity ga l ❑ NA I Permit ;ff Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturers ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal J2f hA Estimated flow (average) gat /day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) X gal /day Pump Manufacturer ANA Soil Application Rate gat /day /ftz Pump Model tf NA Standard influent /Effluent Quality Monthly average* Pretreatment Unit ONA Fats, Oil & Grease (FOG) 530 mgfL ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L LT_ OA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality ty � Monthly average Dispersal Cell(s) NA Biochemical Oxygen Demand (BOD 530 mg /L 1 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L XNA ❑ At -Grade ❑ Mound Fecal Co)iform (geometric mean) <10 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA .MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA �`' [S" ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA :-sped ❑ month(s) (Maximum 3 years) ❑ NA dispersal celi(s) At Least once every: a years) Clean effluent filter At least once every: ❑ month(s) ❑ NA 6 year(s) ',)Szect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) Fivsd: )ate-ais and pressure test At least once every: ❑ month(s) ,M NA ❑ year(s) c t' er: ❑ month(s) At feast once every: ❑ year(s) O NA e�s ❑ NA WA1NTENANCE 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined .accumulation of sludge and scum in any tank equals one -third (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. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page c� or For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) in one large dose, overloading the cells) 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 restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) 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 permanently 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shat( 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 if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: Ni 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. !kDDITiONAL COMMENTS 'OWTS INSTALLER` POWTS MAINTAINER Name Name Phone 7 1 Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �s Phone Phone /5 'his document was dra` s-t '- c::- °ance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page 1 1'� OT 4 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shalt not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, 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 restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) 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 permanently 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits sha11 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 1f the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: L 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 'OWTS INSTALLED., POWTS MAINTAINER Name J Name Phone 715 Z� El I Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J � Phone Phone 5 .::? 'his document was dra ,et -_:-r:; ance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ''T VA C -'= ' L � 1/i A .4-1. � � �� S � f � t yy �t P Mailing Address 4 4:5 3 i In S +-L' S C yv`st� S �'D i ✓ o Z �_ Property Address 165 4h (Verification required from Planning & Zoning Department for new construction.) City /State SO wte.r S Parcel Identification Number Q LEGAL DESCRIPTION ?AI, CA- Property Location _ j E 1 /4 , _ 1 /4 , Sec. ' j<, T' 5 N R ► 9 W, Town of S C "'u AL-'t� Subdivision . Lot # 2 Certified Survey Map # 5 Z. , Volume 2 'A , Page # 9 U le Z Warranty Deed # , Volume , Page # Spec house yes ( no) Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Owner maintenance responsibilities are specified in §Comm 83.52(1) 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 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 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the tandards set forth, herein as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cerdficaton stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Deja;u within 30 days of the three year expiration date. Uwe certify that all statements on this form are tare to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o a warranty deed recorded in Register of Deeds Office. Number of bedrooms , rL4 0 . 10 DATE 9 SIGNATURE OF APPLICANT(S) ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * ** -z i ade with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if - e -ence is made in the warranty deed. hill! lilii lilll iilli illil lliii illi illlf i llll Ilii State Bar of Wisconsin Form 3 -2003 905596 QUIT CLAIM DEED BETH Y ABS T REGISTER OF DEEDS !1T R ", - ...T Document Number Document Name 1 , l ttUlh l,U . , Wl RECEIVED FOR RECORD 1U %f9%LUUU 03:15PH THIS DEED, made between John E. Walsh QUI CLAIM DEED CALIIFI R 8 ( "Grantor," whether one or more), REC FEE: 11.00 and Timothy T. Struemke and Kathleen L. Struemke, husband and wife, PAGES 1 as joint tenants, ( "Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and e m d r Lot 2, Certified Survey Map No. 5662, recorded October 16, 2009 in the office of .--j o 'r 1/ �y the Re Wisconsin in Volume 24 Page 5662. %J Register of Deeds for St. Croix County, g 3 g �/ 3 .i � t* 032- 2032 -20 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Dated October 19, 2009 (SEAL) (SEAL) * n E. Walsh (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on Washington COUNTY ) * Personally came before me on October 19, 2009 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named John E. Walsh (If not, k to be the person (s) who executed the foregoing authorized by Wis. Stat. § 706.06) to me known p O g g instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Robert G. Briggs, Eckberg Law Firm, 1809 * A r (,1)nr\ 0, K. /} Northwestern Avenue, Stillwater, MN 55082 Notary' Public, State of Wisconsin My Commission (is permanent) (expir JUUE M. VALSVI K (Signatures may be authenticated or acknowledged. Both are not necessary.) i' yyy�� I NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLE � 0 QUIT CLAIM DEED (D 2003 STATE BAR OF WISCONSIN * Type ni O signatures. 4i f � u kYaX $ t t z�z4{ y e� s f. t :F UA u v ; +S 9 � � IRS ' �1 y. Asa c F t t F ' f I r r I k I LLI LLI L1 ,, u