HomeMy WebLinkAbout032-2156-40-100 Wisconsin Department of Obmmerce f PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 463138 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Stout, Richard I Somerset Township 032 - 2156 -40 -100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
9 N I I C 94./6 G - 7 1 ) C,-3,T 12.30.19.1346A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ?� Benchmark
�I Z`5 I L cc /p( 14 16
Alt. BM , \� J � 4' / • S
Aeration Bldg. Sewer
Holding
St/Ht Inlet St/Ht Outlet �
, +, tO1 J �
TANK SETBACK INFORMATION L 4 .91 1 lo l
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic � I Z / ' Zr Dt Bottom `, \
Dosing l Header /Man.
Jc • 3 �.�
Aeration Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM 7
Model Nu7
TDH Lift Friction Loss ISystern H H Ft c� 3 .
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
uid Depth
BEDITRENCH Width ; Length r ; No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liq
DIMENSIONS '.� �c�� Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. tt
INFORMATION II�H� ( CHAMBER OR
Typ cc'"\'; (W�r l 9 / 7 cw /V ,/1 UNIT Model Number:
DISTRIBUTION SYSTEM l � Z Zz ys T�
Header /Manifold Distribution \ x Hole Size x Hole Spacing Vent to Ai Intake
f 4
Pipe(s) \ Dia \ \ \ 3
Z
Length Dia Length Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded/ dded xx Mulched
Bedrrrench Center � Bed/Trench Edges \ Topsoil \ [_ Yes E No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1679 89th St. New Richmond, WI 54017 (NE 114 NE 1/4 12 T30N R19W) The Highlands Lot 4 Parcel No: 12.30.19.1346A
1.) Alt BM Description = F ' I `^" 61 e,,— (�IJ
2.) Bldg sewer length = 30 V
- amount of cover = 5 /
Plan revision Required? 10 Yes Xion o I C L
Use other side for additional informs
SBD -6710 (R.3/97) Date Insepctor's nature . Carl. No.
. SaSyan d Buildings i is' County 2Q1 W. gton Av . ox 7162 �sconsin
M -7162 Sanitary Permit N tuber (to be fill d in by Co.)
De art lent of Commerce ( )26 6
"
Sanitary Permit Applica ion ` tare Plan I.D. Num r
A In accord with Comm 83.2 1, Wis. Adm. Code, personal infor ation � 40+et�y 100 _
E
may be used for secondary purposes Privacy Law, s .04(1)(m) Project Address (if different than mailing address)
j� ST. CRQ
{ I. Application Information - Please Print All Information ZONING OFFICE Sr'
Property Owner's ?Na me Parcel # a��� t Block #
S �w / o3a.
Property Owner's M ailing Address Property Location / 3 y b
C ty, State Zip Code Phone Number
(circle e)
T
y`� N: RE o i
II. Type of Building (check all that apply) __
1 or 2 Family Dwelling - Number of Bedrooms _ ` Subdivision
�N�ame CSM Number
❑ Public /Commercial - Describe Use _ _ / (� Ii'%O
❑ State Owned - Describe Use _ h (fir ,L.l (A Z - 3 ❑City❑vAlageiRfownship of 5e)J
III. Type of Permit: (Check only one box on line A. Complete line B if ap
i
A. New System ❑ Replacement System ❑ Treaunent/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber I Owner
i(V. Type of POWTS System: (Check all that
y ' Non - Pressurized ❑ Mound > 24 in, of suitable soil L Mound < 24 in, of suitable soil '❑ At -Grade ❑ Single Pass Sand Filter��
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter OLeaching C a r ❑ Drip L' e ❑ Gravel- e s Pipe Other (xplain)
V. Dis rsal /Treatment Area Information: n S '—
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Are7 Required (sf) Dispersal Area Proposed (sf) s ys t e m
VI. Tank Info Capacity in Total Number Manufacturer Prefab
Gallons Gallons of Units Concrete Constructed Glass '
New Existing
Tanks Tanks
Septic or Holding Tank ,p t
Aerobic Treatment Unit /lO +
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for in tallation of the POWTS show on t attached plans.
Plumber's Na me (Print) Plumber's Si gnature 0 1MPRS Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zip Code)
< !> - 7 - �I —
VIII. ount Department Use Onl
pproved C3 Disapproved Sanitary Permit Fee (includes Groundwater Date i sued suing ent i afore tamps)
Surcharge Fee) �r T2 G —
❑Owner Given Reason for Denial
IX. Conktioons� of Approval/Reasons for Disapproval
Y ST�M OW NEB_ %
(1 Septic tank, effluent filter and Sv 3 S SYn p�-� Qy� ✓�
`-' dispersal cell must all be service / maintain
as per management plan provided by plumber. (/Lt L
e ac requirements mss e m �I -
as per applicable code /ordinances. �'�
Attach complete plans (to the County only) for the systeniKionppper not less than 81/2 x 114n h in�:
W 77
nnry Gino !D r11 !!1Z`� J /`"L/
<� a:Y <� .5 T�lL7 � ° T 7 / � e- py; �i �-.✓ d s ,� �yt Gr�✓�T
Ile) r�
S'
b
a
�'f � ��fi �6Y� -� � / � ,� O T `j �/� u°s �� � �a-.r/ o�S � jy1 ���
i
uick4�
STANDARD CHA1146l
Quill Standard Chamber r -- - -48 _ -- —�
(EFFECTIVE LENGTH)
N I 111 WIN
im
im
— - - - -- - -- 34 " - - -_ _ — SIDE VIEW
SECTION VIEW
MultiPort End Cap _
- -- L _ R
I I F j
� � JJ
12" ,
r
- —' -- - -- 34 "— '1 SIDE VIEW TOP VIEW
FRONT VIEW
Quick4 Standard C hamber Nominal Speciiicatooitis , MuHMO- t, End C'apf Nominal Specifications ;" x rat ,� t 1 rjr .:
r ,
size (W x. C H) —11 "1" --16-x12-
Effective Length _ 48" Invert Heigh 8" or 1.25"
Invert Height g"
RAM SVSTEAN INC. STAND B2_LiM WARRANT
lu1 me sr :IUm1 _t J 1t r , rambar, eruf Pate, wedge on a thm ,rcuesvxy nwnurachnxl by t atw ( I I is h w . -. - tiflod and tyxiral(b?
In 3 10achaW ] p rr o to se {,t = s, stem in au'c rdana w4h I N Itr tor's inotr� I rs, rq werranlen t , tY 7 1 ., nut pur_h sw f H 'der) agarnsr �ale.+;Gve
orate Ols and wp Art ",ship for o, a year f— the d de th511116 Seofw ,,d rs ;�.ued to, Ire ccpar. r:y5lan. ctlnfau,In] Inn I.k.rr;; (,arded, hcN+rcwlr
stet fllfil fxxn f Is rat rerhtl di Ly appfcat in law, the w&, My pa,".j wdl L upon it - eta that InatalNtion of (ha septic sys ar ,onanexes.
ie exo rsa its wa a dy ruins, N der must neatly fltrala I wit ; at is C, rtwrate Rea Jq Ir1 K; ar r)Iq Saybrook, i,onryearAd ihn, :Itaen ft51
days n1 the allayed delf Infra alms w II sapply e4lacer,"i Lj.4, : for units Jr. e;m neu by Ir Thaler to ht: covered by ;hrs Jrrelcsd Mar ants ;T , •
inrlaalord liability 9pa,if .aY/ e,. [udea the QoSt Of ran%wal arty(o, of the Units. an
1A h h L'MI T C RE C MA ANTY ANL) REMEDIES IN SURPAFAC PAAI i (.rj /F F ExC'WF3lVE uU4E ARC N ^OTHER VJARRANiIES yV1TH RESPECT o
I,) 10-1E N rS- INGL, DING NU IN PUE) WARRANTIES Or Mt HANTAD Yn UR `ITNL F('n A PARTICULAR PURPOSE. STE ^ /� URPOSE. SY S INC
r,) 1h L.nlect V t ly F,;. r vd 4 ally Part of th n y I - .nr nau lacturol by " ,vu s otf r' a:ar: Inirt attar. The L,mlex Warranty does T f , v'
o tEn 1 n' .1enw onaoque wl. s3oc at n e><lirect danlagr nll l: Mb eh7l not be ole to or Ipquidaled damages nclucing loss ;i Environmental Onsill Wastewater Solutions
lnt7ht rich and p orts W an nal '»I5 Overhaa;l 00515 or Ot`,er lossa is Pxr.ertvn n -r.?
" d lsy yhe Holder or any third party.
r 7m �prx.lt�ahy
ezr I Jde< I Lim 1M Vya and u e age l e d mass to the 01)d rue 10 aUr 7,y weal olld air a.I! wr accident oisuse, abuse a neglect of
ihr. Units: the UFA$ 1:.' 1 s..bid... 1 tc eY wia traffi . or other oond tons w +I art: MI pa n Ilad �y Iihe installation iml lc1i01r5: faiiure to tnaraair the
rcvnimt m greurki ores t k ah i, !tat ny tataton rrslructionc the u oberrroM 0r impmpe+ mawria1, ir:k) dw syalem oontraninq the Units. 1.6- of 6 Business Park Road P.O. Box 768
Iho 141t s _,t n ilea I r ro,;a ailin impropef Sty g , n e .—S.— wall - "r g rease d,spo 1, of Imprc,per opwaron: Or Old Saybrook, CT 06475
ar,y other l,r 1 F l nrlt etu, 'Mr ,rte,/ WAnanty Shall be ,otl d tho Hnkier a'I. p o wth all Of the terms ;.et forth in this L,miled
Wa qtv 860- 577 -7000 IF FAX 860 -577 -7001
Further u oenl 1 IilbatC,r L laspons "A" kx any loss o durtvpe ro itU .Ide!; the ;has W any third party r Barg from oshdiatior 0, shp 800
merit t f ! 111 any Pro! url labs d 13 rfr5 of Flok or W ar�y li ird party FOr hl5 IJm.ad WMI nll to apply. the U vt; lnuv. ba mstalled In aCa Hance
,e
wish vl S of d r ohs required by style ar'd to,.al codes:. 611.,thcr F-PPli axle Ia vs: and In it rates o n lr.5a,elions.
nil{ I`r MPreWnNLva of HIM has the - Ilxmly L'; ctL3ngo nr uxtn,rt les Umdnd Vyarrardy. Vic waifIIFry Appiirra to arty party Olt ¢a.? tre Origi-
nal How'r
Fh,- aboys -P W4s that Standard urrrilni Warranty olfared 6y IM9lralor. A Irrilctu • of stales and cu,•nlias h
I—AS. Any ave ,ilMerenl warranty requira
pVrchaser of Units s'. aln1: Inf2!.yt0"a C:' Wale HaeOW"frets "r Old Saybrook, C prior to such Putcr— 3, to oblaln a
—Py ur :l:!' applicable wavanly, anff �M,Fld ca15114V read that warranty l to that Ptnerase of Units.
7 Prtenls 4,75066 5,017041; 5,156,488: 5.336,017; 5,404,1 1C), 5.4C1 45l 5,511,903 5.71C,163; 5, 589,778; 5.B39,844
Canadian Palcnl s. 1 .329,9'59 " 0 Other patents pending
Infiltrator Equalizer a o 5'r 1e'JVin der are registered trademarks ol Infiltr Systems Inc. lnfll rai IS 8 registered trademark, Ill Francs. Infiltrator Systems Inc.
Is a reg s erect trademark in Mexico Contour, Contour Swi t ect,Cn, Mjcrol-eacYriog P(JfyTU?, Sn.7pLock, Chamberspacer, Posiiwak, OulckCut, QuickFlay RFCYCLEOPAPFR
,ins Quick4 are trauRmlarl of InfiI1r;atnr f,uatoms Inc tra aflm Il R,Pofnrn¢ Inn a,i.,t.A in I e: 4
..
f _
N B !. R r . C ' r 1 • • y . �. _ .� ^ +wrr.w
ASOV£ G:,AD£ g 15' 1 aEAT'�!ER�ROi�F
M DOOR W;NDOW OR
FRESH AIR TNtTAKE -- �•.--- w- ...�. JUNCTION Box APPROVED
WITn CONDUIT V.14HOLE wGVF -R
GRADE '�
i� W1 PAD L4C K i
s+" CI R 2 SER �--• W LABEi
If X . f tt
WATER Tl*"'*T SEALS GAS
'
TIGHT F ' F
� A SERI. + ' PRBVED
APPROVED s JOINTS WI
�Ip 3, a�AI.M RPPRQYE� PlP
X4.1.` SOLID, SAIL
pUMp OFF ELEV . r F, J
I { 1 �'N RI'SER EXIT
D i ; FERMItTED `+VLF'
IF TANK
NANVFACTURER
3 " APPROVED BEDDING UNDER TAINIX HA5 APPROVAL
COYtt ,R£I`E PAD
' -PTIC i DOSE
"A:VK MAWFACTURER: �b!l ��tCr' l�ti!43ER "OSES PER DAY:
: .. S,W.,: zrS: SE ?" f GAL. ,n, r �p ��+r!,,, �+
DOSE dV ■� GA L, OS w CIL.'1:
� �' LO�vBACX. !� GAL.
�irARH FiA1dL�PACIVRER: CAPACI.2E5: A -
- �r... MODEL lV j22 INCHES v . _...SAL
SWITCH TYPE: 8 s 2
A2Z;E,t'A - -. -.-�.. INCHES x - GA..
',,;,,; MAI+IUI'ACTURER:
MODEL NUMBER: _Gd� .'.r- G INCHES = ,... l GA,.
SWITCH TYPE: °
"
• RED D: SCHARGE RAT D s � INCHES s �,�� Y
£Qu - • .1.. .+.
�.. .. GPM PUMP f A:.q�iM �+SR1KG AS PER zi,h'R 16. wA
ERT +CAL DiI'FIr` rxCE BEM
:INIMVM NETWORK SUPPLY PRESSURE �' Al�D DZ5TP,? BU; I ON Fa PE /a EE',"
- ._.... FFEET FORCEM X FT/loo M F iT
,;,�c I' , �f R: FE
I T; Obi FACTOR �'E 'T
I MA L DYNAMIC HEAD s
O'ERNAL DzMEN- - %voXS c:F gZ,,'ya FEM�.
LIQa IP`'""''"TN4� D��r TE R ----,
NGOULDS PUMPS Submersible
AM Effluent Plump
3871 EPO4
EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer.
• Effluent systems ■Casing and Base: Rugged
thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and
superior strength and corrosion
• Farms manual operation. Auto- �. Canada standards association
• Heavy duty sump matic models Include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".)
factory. strength, and durability,
SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 9001 Registered.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'Y maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: V /2" NPT, seal protection.
• Mechanical seal: carbon -
rotary/ceramic - stationary,
BUNA -N elastomers.
• Temperature:
1041(40'Q continuous
METERS FEET
140°F (60°C) intermittent.
• Fasteners: 300 series 10 -
stainless steel. s 30
• Capable of running
dry without damage to $ zs Fr
components. 25 -
7
Motor: x
-�
x
• EPO4 Single phase: 0.4 HP, S' s 20 -
115 or 230 V, 60 Hz, 1550 _
RPM, built in overload with s
automatic reset. ° 4
• EP05 Single phase: 0.5 HP, c EPOS
115 V, 60 Hz, 1550 RPM, 3 10
built in overload with
automatic reset. 2
EPO4 —
• Power cord: 10 foot 5
standard _
standard length, 16/3 1 i
S1TOW with three prong
roundin iu 0 tional20
9 9 P 9• p � 0 0 0 10 20 30 40 SO GPM
foot length, 16/3 S1TW with
three prong grounding plug -
(standard on EP05). 0 2 4 6 s 10 12 m /h
CAPACITY
Goulds Pumps
® 2000 Goulds Pumps ITT Industries
Effective February, 2000
83871
SOIL EVALUATION REPORT �Page - �_--cf
Wsconem CVpartment of Commerce
Division of Safety and Buildings
in accordance with Comm 85, Wis, Adm. Code County b I
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. Date
eviewed b
Please print all infon'natfon. - a 6 3
Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)).
EProperty wner Prope rty Location
Govt Lot 1 T � N R E
wners Mailing Address lot # Block # M#
r4u.x� ` (-. l
State Zip Code Phone Number city ❑ Village {� Town Nearest Road
J v�Qt (�7�5 `731 se+
(�I New Construction Use: M Residential / Number of bedrooms Code derived design flow rate '4 2 -1- - 0 L O GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material
Flood Plain elevation if applicable _ k
General comments 2
and recommendations: SLASk� ektY. Z . - t0 O w2f
r .7� n
F - il Boring
Boring # E 1,9 pit Ground surface elev. Depth to limiting factor m Soil fi ate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary *Eff#2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
i L
Boring Swing a g ®. pit Ground surface elev. 93-a) ft. Depth to limiting factor 1 in, Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structu re Consistence Boundary Roots GPDIf
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2
k r CS Iv 8
Z -I tnn S l — — r 2
-o
`
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
Ada rn Sc Al - Z53-
Address Date Evaluation Conducted Telephone Number
2113 365 Sore - (4025 /d -3o -0, C71 217- `t!
Property Owner s t V L Parcel ID # Page of
F31 Boring # t7]1 Boring
es+ pit Ground surface elev. C i Iy 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
5 2.Ima 5 5
7- 14-31 0V q1q 5'
3 l 1.2
F] Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Ap
plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
F-1 Boring # ❑ pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD 5 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:. 6iWjr l in an alternate format, please contact the department at 608 -266 -3151. or TTY 608 - 264$777.
PAGE 3 OF_.�_
NAME
1„1,.., � cf -� LOT# LEGAL DESCRIPTION ye Y4,6 E I 4.,S L T ,N,R, I q EIorXW
SCALE:1 "= yo'
BM 1 ELEVATION (OC • D
BM 1 DESCRIPTION tfL
BM 2 ELEVATION It 4 ' 0 �
BM 2 DESCRIPTION Z4 , �1G. sr
SYSTEM ELEVATION ,
ALTERNATE ELEVATION lD. 0 G
CONTOUR ELEVATION 1&.00
--
i
i
i
gas
-7
Z v aft — ,rte`
7 G.od
SIGNATURE DATE
r
PAGE 3 OF
NAME s � TOT# LEGAL DESCRIPTION yE X, E Z ,S Z T -50 �R I of E(or)O
SCALE: 1"= yo I
BM I ELEVATION too • p �
BM 1 DESCRIPTIO 3 Uc - D pt-
BM 2 ELEVATION
BM 2 DESCRIPTION fop a3jW s �
SYSTEM ELEVATIO f Z, 20 L 2e
ALTERNATE ELEVATION OU
CONTOUR ELEVATION __
6`
U
•
• dim �
I
SIGNATURE DATE
T
• r �
,j
NO
h
Y �
J
I
d p—
W.
zA
I Wz
ff Air h
� .Le,�s„� +"�" � ._ . ' TTY• ^•-
'
♦ A
Q ++ 4 'Y� r" 4. FFE 941.0
j 9 39 . 0
t
lw
X 936.6
• 4 {,']�
at .! �.�, .�'+ • •
~ j•
\ I
" 7� - ••mss' -✓
r••. +... w:,, .� .emT'..�061Y: O - tli�4SdR.s. a
w POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __L of y
FILE INFORMATION SYSTEM SPIECIFICATIONS
Owner Septic Tank Capacity ,? gel 0 NA
Permit a Septic Tank Manufacturer O NA
p68KltN PARAMETERS Effluent Filter Manufacturer ,� O NA
Number of Bedrooms 9 7 / 0 NA Effkient Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capacity ei Q NA
Estimated flow (average) r f l
es ge} � &lids Pump Tank Manufacture eSeY ❑ NA
Design flow (peak), (Estimated x 1,S) 6 41 d g al/day Pump Manufacturer 0 NA
Soil Application Rate Q . 7 al /da lftt Pump Model O NA
Standard lnflusirWEffluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil S Grease (FOG) 530 mg /L (3 Sand /Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD.) 5220 mgiL 0 NA 0 Mechanical Aeration 0 Wetland
Total Suspended So (TSS} j 5150 rng /L ❑ Disinfection 0 Other:
Pretreated Effluent Quality Monthly average gDIssai Cali(s) 0 NA
Biochemical Oxygen Demand (BOD,) 530 mg /L XNA and (gravity) Q !n - Ground )pressurized)
Tota6 Suspended Solids (TES) 530 mg /L rade C1 Maund
Fecal Coliform (geometric mean) 510` bf 7 oorte! 0 Drip -Line 0 Other:
Maximum Effluent Particle Size Y in dia. O NA Off O NA
Other: 0 NA Oar: 0 NA
*Values t0icel for domsstic wastewater and septic tank effluent. Other: ❑ NA
MAIN ANCF scHeouiA
service Event Service Frequency
inspect condition of tankis) At least once every: 3 eu s e (Maximum 3 years) Q NA
Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume 10 NA
Inspect dispersal cell(s) At least once every: Fn=nthle) onthis) (MaxMwm 3 years) D NA
Clean effluent fiber At least once every, O NA
l (e)
Inspect pump, pump controls S alarm At least once every: monthis) 0 NA
0 s)
Flush laterale and pressure teat At least once every: non (s) 0 NA
O arts)
other: O month(&) 13 NA
At least once every: _ (3 ears)
Other:
Q NA
MAINTENANCE WSTRUGTiONS
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 tankis) 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 JY 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 w ith chapter NR 113,
Wisconsin Administrative Code.
All other services, Including but not limited to the servicing of effluent filters, mechanical at 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.
•apo3 OAIieJlslulwPV ulsuO081M '(E) R (Z) 'It149'f8 pus 41)91R)(1)(glIZ1ZZ'S$ WWOD J 4UM aou811dwoo ul peKeJp sam lusumoop sly!
Ou04d - eu04d
OWO
� OuNN
A.UaoH1
X wo lvi nvi a 1VOo1 (l13dWn 341
d) mo.Lv 0 E ONIC ' ) E IA V39 39V.Ld3S
Ou04d l%fd' ! G 9ua4d
a3NIV1NIVW 91Mod U311VISNI S1MOd
S1N3WWOO IVNOLLMV
'3 990dW1 Ei011nOldam 39 AVW )INVI V AO VOIN31NI 91 WOad NOOM34
V 410 3nOS u 'llnsav AVW H1V3G '830NVLsmoiilo ANV a3min )INVI 1N3W1V3f11 V3H10 HO dwnd '011d39 V 1l31N3
ION 00 'N9DAXO 1N310IddnSNl NOroNV 8399VO 1VH131 NIV1N00 AVW 5HNV1 1143WIV3a1 a8H10 aNv dwnd '0114139
< <DNINWVM> >
•ewll ie41 ie weas ul selni 941 411m Alduioo wnw swoisAs 4ons ;o suol3oni3swoohl •ace ;ins 9Al1BJ1lBu!
941 le lewotq 041 JO leAOWD Bu!Mollo; veld ul pelommoo0i eq Asw swaisAs ua13d1o9g9 }!oo apsis•ie put punoyy 17
x119 o uk
ails p 119
a 1 D
'S.LMOd P 041 Ooeldel 01 1JosOJ key a se pellelsu! Oq Aew xua3 Sulplo4 a ABoiou4o01
SIMOd ul s9oueAps BulJJeS suopeilW!l 11os Jo /pue 110eg1e9 of anp 01gellene iau s1 9919 luaweasidaJ 9}gpyns V p
'ewll 1041 ie 100140 ui 991ni atp tpl n Aldwoo
isnw swalsAs lueweooldaI 'vale luewsoeldei e1gn1ns a 49t1ge1se of uollenlena ops pus l!os mou t Jo; peau s4i ul llnsaJ
111M 9919 luaweoaldeJ 041 joeloid of ainyvd 'sllam pus saull iol 'ainloniis pasodoid pug Bu!isixe woJi w4oegles peilnbeJ
Aq uodn peSul4u1 aq iau pin049 put uopedwoo pug aoueginls!p wai; paloaloid eq pin049 9916 W OW9081dai 9 41 'lu ew As
uolidiosge pas wawsoaldel a ;o u0110001 041 JO; pezlllin eq Asw pus pOlenlsA9 u9eq seu Ran wowooeldeJ e)gv3lns V
:w03sAs 1u0 sooldeJ
luelldwaa apoo a opinoid o1 'u9 -181 eq is nw Jo 'u0aq 9A24 sainseew Butmollo; 941 pejmdeJ eq iouueo pus ails; S1MOd 0 41 11
NVId AON3DNIINOO
'WAGIB P008 lJeul J 0 4 1 0u0 JO I9ARJ6 '1109
Om Pali!) coeds p10A 941 pue peAOweJ sJenao ;!O41 Jo paAOweJ pus pe1sABOx9 Oq lle4s slid pus slluei lie '()uidwnd 191 ;V e
.Jomado Su1oimag obeideg 9 Aq ;o pasodslp Aliedoid pue panoweJ 9q gegs slid pug sxuei lie ;o slueluoo e4i •
•polaes s8u!uedo edid pouopuege 041 put peioauuooslp 0q 11049 sud pus s11u21 of Suldld 11V O
.epos anliallslulwpV ulsuaaslM 'M CS wwo3 J01de40 4i!m sous11dwoo ul psuopuege Ale ;as pus Apedoid
S1 w91SAS 041 3941 einsw of uexei eq 11048 sdels Su'mOIlo; e41 eolAJes ;o ino uaxel Allueumied s! Jolpue spe; S.LMOd 0 41 u
1N3WNOONVBV
•ou1Jq Jau9i ;0s Jaiem pus :suodwel :sui ldeu AJei!ues :soploiised :slOnpoid 9uguied
:1t0 :suolleolpew Isdoias leew :Sap101gJa4 '*"OJB :eu1109e9 :sBulleed 91CIVIaSOA pus 3!nJ; :Je1em (dwnd dwns) uleip uollepuno;
:lei .'slUeloo ;ulslp !siedelp :8901; leluep :smovoiSap :sgems uolloo :swopuea :silnq OiiOieBlo :8ed1nA Ageq :8ol1 olgl3ue :S1M0d
aq4 ;o epj e4i Duoloid pus sauewJoped 941 OAaidw! Aew weeks ieiemetsem e41 woJ; $u!m0l1o; 941 ;o uolleulw}le Jo uoponpea
-swe uolldlosgB ilo9 apeJB -le Jo punow Aue ;o adols uMop as*; g t u1
esie 941 'loedwoo Jo glnislp esimim io Jo 'JOAO )Ind Jo SAIJp iau a0 'sfleo lesiedslp Put sJluel JaAO 90101 And 10 9A1Jp iau OO
•11usi dwnd 041 ulgl!m 919A91 19WJOU eJOlaa
of slonuoa dwnd e4i Bulleiedo Allenusw ul islsse of Jeulglu!t3W S1MOd Jo J9gwnid 9 laeluoo Jo dwnd wenig 941 of JeMod
BupolseJ of Joi1d JoieJadp Su!01Aleg Peoldeg a Aq p9AOweJ xu9 dwnd ayi ;O s"augiuoo 041 9A94 uollenlls 9141 plane 01 •1uent}40
io a8JeWslp aospns Jo dnxoeq etp u1 ilnow Aaw pus (8)1100 041 SulpeotJGAO 'asop 98)01 quo ui (sl{len Iesiodslp 941 01 pOSJe40slp
aq 111AA Ja19melsom sseaxe 941 PeJolsei s! Jemod uogm 'slenwl J91em4 IeU)JOU enoge Il .few sxuel dwnd sOSelno Jamod SuunCI
•gas ;ms 9AIle43l! ;U1 041 19 u*204 On 9uo111pu0a 0100 u04M Jnnoo lou 11248 do IniB wO1sAS
*eon of Joud Joleiedo Sulolnies e8vides v Aq pOAOUJOJ (s)xu91 0 43 ;
slualuaO ayi ane4 pelOelep aye suo!lenueouoO 48(14 ;i •(s)llOO 199ieds(p a4i e69wep J01pue sssooid wawieaii 941 apadwl Attu 1041
sleolwogo hullo Jo s 3 onpoid 6ulluled ;o eousseid e4i Jo; is)Jluel iuew3e94 x0040 S1MOd Dui ;o eon o Jo!ad 'uollonilsuoo M au JOA
NOI1VV3dO aNV do laV1s
��0 f abed
7 1C31 ,1' L-- I L -A
FF' "�'l
Sr S'r CROIX coul"
AC
AND
0
,4ERSHIp CSPLTIFICATION FO Um
- TV
Address
? Mdrtu
(VeM0464t required f rom pj=itg D*91=Wt rOl n
I � >,r.�►M�h � ��r��l I�cntl�c�,�.ic�� Numbcr
/ 4 ig 'Ap 13 IF 0Y
1 1 , 3q(,A
N-PTLW, Town of -�
Location sec.
P&gc
2,OL/q
MAP te �
QL'0-014;� �41 - page,
to bje >C yE% L7, no
Spec tic
Lit tin s iden
c system COU16 lesult;'n. J�& prmat= failure to harl&-'
4 lzStd Pampc ct
,Uj?M.ilfftAmnce of Y0 96.Pt . Vp you pt�t izitn tb,*, W;t
of t t} "Ill
tiz t evm-y t�lte -years 0V by
Mc
in, tat Otem
S�gnzdby t,Nt ' l v q j �'r and My
'; wastewalv'rdispcml S�F'V.crm
'vcs 10 fit, Croix 7 per veri41tL� that {
1 ) Or's �cftWd P= Chi 1,13 fL'll of Shid&C,
tj�e is
Of nt
re
ih in proper opmtins ac tditiOn ' nsptC with tb'-�
i'm ( , :ertiflcatiora
Stat 0� Wi gc= S
- zt Rej&W=
Unj i tt Silsaed have resd the abo
i by the DOPI=erlt Of commercr and the De utmerlt Of'NaLml �'Tlt'y Zoning
' Cro �' Cc
must be eOmplvtOd = to * ' L
Ming hm been =it�a
CiA--llf the thi YIMV
/0 4<wL
—
- - L " - � - ' L624
s
of'
this fo=,tre best of MY am (arc) tbx ov,
I (we) tut all r=l�cd in mottr r"'Otcis cm�'c
4asoribed 260vt by V'r'u of
1 4 T
1 m �
DAE
Voked by the, Z,ttltng
ftM the Register of Doedl r'fficc
a copy �t.
Include with thil 00 a mads in the, w3XT doed
of t',Ec certif survey rngp
I'
w)i..1 --" 3 PAa 196
STATE BAR OF WISCONSIN FORM 2 - 1999 ES 94EI U4
WARRANTY DEED r'N HLEEN H. UAL 3H
Document Number REG ISTER OF DEEDS
3I'. CRO.IX CO., aI
This Deed, made between Thomas M. Boumeester and RECEIVED FOR RECORD
Elizabeth C. Boumeester husband and wife,
10-2 ,-2001 8:00 AM
WARRANTY DEED
Grantor, and Richard O. Stout and Janet P. Stout, husband and wife, EXEMPT #
CERT COPY FEE:
COPY FEE:
— _ TRANSFER FEE: 1530.00
RECORDING FEE: 11.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
NE1 /4 ofNEl /4 and NI /2 ofSEI /4 of NE 1/4 of Section 12- 30 -19, St. Croix Name and Return Address
County, Wisconsin.
KRISTINA OGLiAND
ESTREEN & OGLAND
304 Locust
j4iirj-,nn, W1 54016
032 - 2044 -10 & 032 - 2044 -40
Parcel Identification Number (PIN)
This is homestead property.
(is) NX00
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of October 2001
■ homas M. Boumeester _
liza th C. B oumeester
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Thomas M Boumeester and Eliz C . STATE OF WISCONSIN )
Bo umeester, husband and wif ) ss.
County )
authenticated this V ` l of October 2001
C Personally came before me this _ day of
_ the above named
• Kri stina Ogland - --
TITLE: MEMBER STATE BAR OF WISCONSIN - -
(If not, to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by b 706.06. Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
A ttorne y Kristina Ogland _ Notary Public, State of Wisconsin
[[ udson, WI 5401
My Commission is permanent. ([f not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) __ .. _. _ - . -- _ .)
* Names of persons signing in any capacity must be typed or printed below their signature. trdo—anon Notaasmnab company. Fond d,. Lac. vin
STATE BAR OF WISCONSIN aoo ssssoai
WARRANTY DEED FORM No. 2- 1999
Parcel #: 032 - 2156 -40 -100 10/22/2004 05:04 PM
PAGE 1 OF 1
Alt. Parcel #: 12.30.19.1346A 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): * = Current Owner
*
RICHARD O & JANET P STOUT STOUT, RICHARD O & JANET P
1353 AWATUKEE TRL
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description 1679 89TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 2090- HIGHLANDS,THE 02
SEC 12 T30N R19W N1/2 NE1 /4 LOT 4 THE Block/Condo Bldg: LOT 04
HIGHLANDS E AS DESC 2044/68 jus-6�11
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
�S 12- 30N -19W NE
I
Notes: Parcel History:
Date Doc # Vol /Page Type
Z -U
11/12/2002 698122 2044/68
10/23/2001 659804 1743/196 �—
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
59,200
Valuations Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.310 54,000 0 54,000 NO
Totals for 2004:
General Property 3.310 54,000 0 54,000
Woodland 0.000 0 0
All 3.310 54,000 0 54,000
Totals for 2003:
General Property 3.310 54,000 0 54,000
Woodland 0.000 0 0
Total 3.310 54,000 0 54,000
Lottery Credit Claim Count: 0 Certification Date: Batch #:
I
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• 7�i7356 I �
U 2122 P 591
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., MI
"Document Number RECEIVED FOR RECORD
This Deed, made between
01/28/2003 03:15PN
RICHARD O STOTIT and JANET P STOUT, 1 EXEMPT •
busband anA wife
REC FEE: 11.00
Grantor, TRANS FEE- 193.50
and JUSTIN p MAGN IIRON CER FEE: Ffifi:
PAGES: 1
Grantee
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
I
described real estate in Rt , Crni 3c County, State of Wisconsin:
Lot 5, Plat of The Highlands, Town Of Rt,cotain {, nrFa
Somerset, St Croix County, Wisconsin. I Name and Return Address
KRISTINA OGLAND
TOGETHER WITH the following described ESTREEN & OGLAND
property: 304 Locust
arcel of land in that part of Lot 9 The Highlands, Hudson, WI 54016
Town o omerset, St. ro>x County, Wisconsin,
described as follows: Commencing at the southeast
corner ol Lot 4; thence South 85 degrees 37 minutes 58 032- 2044 -40 -000
seconds west, assumed bearing, along the south line of 032- 2044 -10 -000
said Lot 4 a distance of 248.32 feet to the point of
beginning; thence continuing South 85 degrees 37 Parcel Identification Number (PIN)
minutes 58 seconds west, along said south line, a This is not homestead property
is distance of 42.75 feet to an angle point in said south (is) (is not)
line; thence North 35 degrees 05 minutes 20 seconds !�
West along said south line, a distance of 118.36 feet;
thence South 49 degrees 46 minutes 34 seconds East, a
distance of 144.93 feet to the point of beginning.
• I
ii
;s
i
�
Exceptions to warranties: easements, restrictions, rights -of -way and covenants
of record.
I'
Dated this 7 7 t }1 day of t7a nuarT
(SEAL) dq (SEAL)
. Richard O. Stout Janet P. Stout
ii
(SEAL) (SEAL) fl
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) R'
State of Wisconsin,
ss.
St. Croix County.
authenticated this day of Personally came before me this 2 day of
.Tantrary , 2_Q..O. « .,Jt)f.abovenamed
Rir-harrl O_ Rt-nu
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person s = V 1 4ro ecuied "e epv Ing
authorized by §706.06, Wis. Stets.) instrument and acknowledge the sabaevy'.,
THIS INSTRUMENT WAS DRAFTED BY / !�
-
Janet P. Stout -
1 353 Awatukee Tr.
Hudson, WI 5401 Notary Public. State of Wisconsin
My commission �- /L a expirarlon date:
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
` Names of persons signing In any capacity must be typed or printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. 2 - 1998 Milwaukee. Wis.
• 10/22/20
Parcel #: 032 - 2156 -40 -000 04 05:03 PM PAGE 1 OF 1
Alt. Parcel M 12.30.19.1346 032 - TOWN OF SOMERSET
Current ❑ ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 2
Tax Address: Owner(s): * = Current Owner
* STOUT, RETIRED
RETIRED STOUT
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.366 Plat: 2090- HIGHLANDS,THE 02
SEC 12 T30N R19W N1/2 NE1 /4 LOT 4 THE Block/Condo Bldg: LOT 04
HIGHLANDS
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
12- 30N -19W NE
Notes: Parcel History:
Date Doc # Vol /Page Type
10/23/2001 659804 1743/196 WD
2004 SUMMARY / This parcel will not get taxed. It exists soley Assessed with:
�J for parcel history tracking purposes.
Valuations Last Changed: 07/08/2002
Description Class Acres Land Improve Total State Reason
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
All 0.000 0 0 0
Totals for 2003:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Total 0.000 0 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
ffi m II Cr' �' CA) W G
� cr n
sm c�nn
O E
�cn
� 3lEQb c�("v , �\\ • � Mlle. FF _ /^ •\ J
H 9 0 \ —.
4gCK $
V
DTI � T .. 1�• � (� � .�
/
Ile
co
1 ' ICI o
/ ............. : .
RIJ
1 VI
sfJv �
II i ' II II o
Coco
"j
1944.11'
_
452.12' 1 380.90' m
N00 °20'44 "E
to *pz
z z �
0
o � �
z p �8' g�
r m C G r m-
� N T � mp v
O �O E -1 N m yDcn
Z r•m Z = yZ
m
0
m cn r r= �