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HomeMy WebLinkAbout032-2157-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisibn INSPECTION REPORT Sanitary Permit No: 463477 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: Stout, Richard Somerset, Town of 032 - 2157 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No. 'j Pi Al ) G 12.30.19.1356 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Wec 3 A l Benchmark &Qczln t _ Alt. BM TIAA— Z - 7–cl /d Aeration Bldg. Sewer Holding St/Ht Inlet b,\ TANK SETBACK INFORMATION St/Ht Outlet 4. Cr $ �$ TANK TO P/ ; WELL BLDG. Vent to Air Intake ROAD Dt Inlet c� Septic 1 / Dt Bottom f4ct i z Z' Dosing Header /Man. Aeration Dist. Pipe (0.77 C= Holding Bot. System '7.`7) `7 7. 3Z6k, - Final Grade S d /06 0 PUMP /SIPHON INFORMATION Manufacturer Demand St Cover ii // GPM �Z-`� fOZ •7�7 Model Number TDH Lift Friction Loss System He TDH Forcemain L D' Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9 ! ('e, n \ SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: t INFORMATION [� ��(( CHAMBER OR Type `I!� 7 5 ! �,j� UNIT Model Number: ca A1f2, ^4, b� 0 DISTRIBUTION SYSTEM 23 Z3 = - f Header/Manifold �� Distribution x Hole Size x Hole Spacing Vent to Inta� / Pipe(s) ` g `` �� ____1 3 `J 1 1-ength c'" Dia Length Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Z Depth Over I xx Depth of j xx Seeded /So ed xx Mul hed Bed /Trench Center Bed/Trench Edges Topsoil s No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1690 89th Street Somerset, WI 54025 (NE 1/4 NE 1/4 12 T30N R19W) The Highlands Lot 14 Parcel No: 12.30.19.1356 1.) Alt BM Description = � 2.) Bldg sewer length - amount of cover s K Plan revision Required . Ye ' d Use other side for additional informat _ L_— - -- -.- Date Insepctor's ig ture Cert. No. SBD -6710 (R.3/97) Permit Number (to a filled in by Co.) Safety an gc.L2iyj ion ounty S 1*i 201 W. Washi on 7 ���n��� Madison, 3 7 ` itary Department of Commerce (608) 266- _ /_ 7 Sanitary Permit Applies n app State Ian I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal informati you pr idde� •' may be used for second purposes Privacy Law s15.04 m M N Y �' o'ect d s ifdiff n P TPo Y ( ) ; � J res ( different than mailing address) I. Application Information — Please Print All Information Property Own Name / Parcel # Lot # / Block # �� 03Z ZaS�- y -oUb / G Property Owner's Mailing Address Property Location City, S Zip Code Phone Number ' /,, ' /4, Section �lZ (circle ) T N; R�E ot) II. Type of Building (check all that apply) 6k a5 P &C kts- Y 1 or 2 Family Dwelling — Number of Bedrooms Subdivi 'on Name CStiat>ti' ❑ Public/CommercW — Describe Use ❑ State Owned — Describe Use L.� �5 ❑City ❑ ' Iage Township of III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. New Syste y _ ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El 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 Owner IV. Type of POWTS System: Check all that a pply) Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ 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 hin Chamber ravel - less Pipe 11 Other (explain) V. DispersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate( equi (sf) Dispersal Area Proposed (sf) System Elevation ' 1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 11 Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ Aerobic Treatment Unit Dosing Chamber VII. Respgasibility Statement- I, the undersigned, a ume respon sibility f or installation of the POWTS shown on the attached plans. Plum r am (Print} PI is Si a MP/MPRS Number Business Phone Number Mr, I � 3 Plumbers Address (Street, City, State, Zip C ) VIII. Coun /De artment Use Onl Nw�p;roved ❑ D' d Sanitary Permit Fee (includes Groundwater Date ISSU IrSignatu (No ps) r1i ❑ er eason�rf)en Surcharge Fee) ab , co � I � e IX. Conditions of Approval/Reasons for Disapproval ^ 3 YSTEMOWNER: 1 Se tic tan > e cent filter and d m a provided by Pklm w 2. AN neiwk require nWft mutt be as per atppliable taoda oldYwroas. 4. Attach complete plans (to the County only) for the system on paper not has than SW x 11 inches in SBD 6398 R. 01/03 I / l d tnti2 ow CI �� 1 . if3 st •G'+j "'F ' "`9 *Y;. e�5 �fll liilefTl 9d Wrr 8tnsl lg -opts ''*,Jlgr• nA .: - Soommba ! ow utd s vsq as Q i COPY 4 �---'( I'z -\ Wisconsin Department of Commerce SOIL E\V/ LIAT�IgO RE T Page of Division of Safety and Buildings in accordance with Comm Wla. AYttn. Cq��G ounty Attach complete site plan on paper not less than 81/2 x 11 inches in s' . Plan Doi ' include, but not limited to: vertical and horizontal reference point (BM), di ion nd1. Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance ne road. DSZ— Z1 413 " 6�:O Please print all information. Revi by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �f J Prope Owner Property Location Govt. Lot 1/4 � 1! S T N R E (or Prolierty s Melling Address Lot # Bic Subd. a or CSI# A114 5 Ciiy Sta Zip Code Phone Number ❑City ❑ village J G§ Town Nearest Roa f New Construction Use: Residential ! Number of bedrooms Code derived design flow rate 4 �,�:' GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood. Plain elevation if applicable 4 4 Az ft. General comments and recommendations: S F/ I Boring # El Boring ® pit Ground surface elev. ,1, / 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. Qont. Color Gr. Sz. Sh. *Efl#I I *Eff#2 Z44ZIZ A1104- hi C l 3 n Boring # E] Boring _J ® Pit Ground surface elev. ft. Depth to limiting fador 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#9 *Eff#2 � A � s- — a a I * EfflimyntV = BOD > 30 mg/L and TSS >30 150 mg/L * EfBuen #2 = BOD < 30 m91L and TSS a 30 nVL CST Na ri Sign atu CST Number Addre s Date Evaluation Conducted Telephone Number i J Property Owner -� • T Parcel ID # Page � of 12 Boring # ❑ ,Boring pit Ground surface elev. �!�� /� ft. Depth to limiting facto 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 I *Eff#2 Z 0 44 3 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # El Boring E] pit Ground surface elev. ft. Depth to limiting factor in. Soil Appli cation 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mgA- * Effluent #2 = BOD, < 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 /OD) I 'Yl o �o �b W � \ Rq tl* v o J 1 � I II M i , I i O l rd ma 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ' of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Cro/'x 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. 3 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 '�,,c — / Please print all information. eviewe b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (!/ L Property Owner Property Locatio 1 11 Govt. Lot IVC 1/4 /UL 1/4 S I Z T N R/ q E (ore Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I X53 e i ILA - Ih 5 City State Zip Code Phone Number ❑ City ❑ Village (B-T Nearest Road So hJl 5 U1 ( ) 5�l -1n131 5 e I A CA- New Construction Use: je Residential / Number of bedrooms – L l Code derived design flow rate ❑ Replacement ❑ Public or commercial - Describe: Parent material 6u4wa56 Flood Plain elevation if applicable ft. General comments '• �� and recommendations FLA.-54trrr) pJeV.(� Q 3 rJ (Ow�r -e 4v. ❑Boring �' v ' � / � � � YM.vs�i- ,cC�2- Tl Boring # Q�_ 8 ft. Depth to limiting factor I ®pit Ground surface elev. O p g � n. _ ' 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 I 'Eff#2 I - 31 sr' 2 r»r,,.bl Mfr cs V T .5 — .3 Z I`1- N t y -- s' C Z k m r- e 3 y l014 Ll m Os rnI a Boring # ❑ Boring pit Ground surface elev. Sot Depth to limiting factor / / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 n 'Eff#1 'Eff#2 I O-Is l Zrn S t+ 5 g 2 I 3- 8 9 14 5 Z►-,ab ; - • , 4 qjL rn5 �S rnI — - . cf 3. 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 2 1 �� Zs3 �9 Address Date Evaluation Conducted Telephone Number t zs /0-50 -61 C his) ZSF7- tVW 8' SBD -8330 (R07 /00) ' = a Property Owner Ta U T Parcel ID # Page 2- of J P 15 E] Boring Boring # 97, 10 ft. Depth to limiting �� ®, pit Ground surface elev. g factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O 1 Z 5: 1 k m-rr CS (vc S c/ Z ryinbk. fir C5 - �( Os — — t </ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 ' 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) PAGE 3 OF NAME 5 k cJ LOT# /K LEGAL DESCRIPTION f, F X .vG X } S lZ T acs ,N,R `I E(o SCALE: V= � BM 1 ELEVATION /00 BM 1 DESCRIPTION 3P C3_ F %/ DyG Q� + BM 2 ELEVATION AM AOL BM 2 DESCRIPTION SYSTEM ELEVATION f :-io ALTERNATE ELEVATION , ,3o Lo 9 2.3 G CONTOUR ELEVATION 7 :73 0, Z,36 SIGNATURE DATE /0 dl� 03/2005 �1�: 1-7152473622 PAGE 03 •�.... � rav you wbtlCf 0003 PAGE OF Le7' # t.rc� nucr.'.p�i& tti � �7 ,/ ,�� , SCALE: I" BM i DBSCRII'7xON BM 2 ELIVA71ON 0 8M 2 bE3CR.JP'ITOm a %�A+ arc SYSTEM EL VATl C,,3,e Aujoe 9W 3 0 ! j ALTERNATEETEVA�'JON CONTOUR ELEVAnON SJC?ATCJXt DA 0 - 'Of7W S Z I cn � .,. L99 A � j j Z� /� �i ' � I �l9•EI r �2 CA) \ t z k4 ` r e� Z ,y _Y3 Ilk. Of co rA J t 7 r ,. mot. • \\ �� N j\ �'`� 01/03/2905 10:37 17152473622 p PAGE 02 . - .[• v.. vv. Vi x'ILt1 1111 t}rS� �r/V t1 � . CI 1.u3la 002 ` WsconWitD 'nC°mmo= SOIL EVALUATION REPORT Division of Ss1'aty and Btridptps ne cCVdgMe ugih to r1Yr1 85, Wis, Adm. Code pne of —3 Ate, con"lo 800 pw paper not fees than a Ml 11 inches in •rte. Men must �T . C J hafude. out rwt phtiW fat "w ttf and a0b ontV nMW44 point f94> dfredipn and A�ane elrips, s oefe 0r d;menadorrs, north ar*ow, and 1ee00n and dilerapes to neanatsr rand. Parcel tb pmasa pffnl all lnf4rrr��ron. Qats Pwaorlet tnrortn.lieel you rs.euide mey tae wed tlrr seedgary purpan� fFvY LrRw, as f 6,q r (1 f (mu. l Prqmly RICyelt�r 4 LOatl -t GcwL Lot N0 1!4 NG S J T N R J E (rx W Ownsr'3 Malfhg Addrsas Lot Su , Nmme or CSlus A P gme fi er CxY � vl llege T Iv�rest iecad New ConstrucOm use: %aidenraf / Number of bedrovm9 L f Cods derived design flow rata (� fRapiaeesrtent ❑ Nublit: cr ccmr wcw • Dmcrbe: ienettt nlsUrilf C�C3 FIoOd MANI ekvaYon if apoNtade y r3eltefai cortltrtenla ft. • . and a r ® heft QrO" sulfsw Bf@v. � 7 - L IL Oath 10 9MIting % tGr /ey a IrL Sod Talon tea Horizon Depth DomInant Color RwM poscmffon Todum Strudurs Consistence .BoundWry RoM in. Murl" Gu. 8z. Cont cdw Car. SL Sh. *emu 1 2. .r 5 ;l CS v • z. 1 4 , C.� • r'!J soft* Wing ® felt Ground sur4ce etev. ?• .][a. Depth to tirtttting (actor � in. Sall Ap iWO Haricot Depth DanimpM CoW Rmdox Oesw"an Tut n 5trtrmm Consistence Ba etdary Rook a in. Mucus Qv. St Coot. Odor Gr ft Sh. 'ii r r _ Sflvenf � ppp s 30 < 220 rngA. 0110 T9S >30 c 150 milli, Rll9uent !i2 - 80 C 34 rtglL snO TSS c 30 mg+l, COT me (Pl P ) Signettlre COT Number �.._ zs3309 Address — - Deft EvoloWn Cmdwsed eta Number 5ND4330 (R07r00) 01103/2005 10:37 17152473622 PAGE 04 vo.ui ryA !A* 3Ott 46$6 r Property owa Parbet PD 13 . ap of+ z PR Qm" surfaca e7ev, (Q �. t; to kldft war t r i r,on+�.nt cwo� Reft ossari Texturs 5trt�cbure constste�ce a on ' 00 �n Mumm Qu. 8L cam cam Sr- uc sty. Z. cs 1 S • �' J Q P3 Oaared eufftce ftw. _ R- D" to Imitin9 !a'cmr ►'� Depth Dorntnent Peleloec Daiatptl0n Twurg 8�buCM h hun t ay. 197- Cont. cow ^C° liauneary � WON Boring 0 Booing Ground surface elev. R 00th to rani Sol Azoaquan Rate Nprt m Depth Dominant Color ftdoa DMAPIon Texture Stmoftwe Conaistemas t3dun4ary hoots BP h Munsdt t'3u. 89. cons cow Or. tit. Sh. *ta ►t 'rtaR2 • MUent *1 t30D a 3D t 220 RTYL arxi "0 m30 a 150 n+glL • F -Muent 42 a 500,130 mg& and Ttit3 1 30 mWL meat of Coo=cm s an i tool � service pxwider and eatrplWa. if you need assist� to access services ex The Dtp ease goat act the dgaaetment at WS-M-3151 or TIY 60"6 need matenal m am t►lttkt�att~te mat, p l , �,�:,� < , . ; � : , • . ■''- x �,rr . , •; - . 01103/2005 10:37 17152473622 PAGE 03 . �• x �.. r rer aev wn�sty @O03 r ' PAGE :3 OF 7 . - I�O2* /'f TXrtALW ��C�1,�TLS N& a SCALE: V �'� ` �_....., .... BM I ELEVATION DC• C B M I DBCRIMON �� o� �v� c. I�%• � -� � .� I BM 2 ELIVATI „ a i BM 2 DESCRMTOt T �� I SYSTTM BLEVATJ0N S 4! 3 g t i ALTERNATE � ATB E.E a VATJ N o CONTOUR BLEVAnaN c) qq '3a / u ,�.,_.. --_ pt b'� a � L� POWTS OWNER'S MANUAL & MANAGEMENT PLAN, , , page of FILE INFORMAT ON SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ N `` 1 Permit N Septic Tank Manufacturer , ,, O N' DESIGN PARAMETERS Effluent Filter Manufacturer ' O Ni, Number of Bedrooms O NA Effluent Filter Model ❑ NA acit k Ca Tank an Capacity ga NA Number of Public Facility Units NA f Estimated flow (average) gal/day Pump Tank Manufacturer NA I Design flow (peak), (Estimated x 1.5) ai /da Pump Manufacturer ,�7 NA Pump Model Rate .�9 NA Soil Application a al /da /ft ' „ J� N k ffiuent Quality Pretreatment Unit Standard Influent /E V Monthly average Fats, Oil & Grease (FOG) 530 mg /L C3 Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O Mechanical Aeration ❑ Wetiand Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated reated Effluent Quality Monthly average Dispersal Cell(s) ❑ Nl -1 Biochemical Oxygen Demand (BOD 530 mg /L 0 In - Ground (gravity) O In - Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA ❑ At-Grade © Mound Focal Coliform (geometric mean) 510' cfu /1001111 ❑ Drip-Line M Other; Maximum Effluent Particle Size Y in dia. ❑ NA Other, ❑ N Other: 0 NA Other: O NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency monthls) " ( Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one -third .(Y,) of tank volume ❑ NA At least once every: ❑ month(s) ' (Maximum 3 years) ❑ NA Inspect dispersal cell(s) 9year(s) Clean effluent filter At least once every: ❑ month(s) C3 N;., i - ayear(s) - -{ ❑ month(s) Inspect pump, pump controls & alarm At least once every: p y ear(s) 0 month(s) 1 NF Flush laterals and pressure test At least once every: O year(s) CI month(s) QN N.. Other; t l east 0 ev A l a i nee a ry Q e a r! s 1 Other: O 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; Septaga 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. arse) cell(s) shall be v1 n T he dis P visually I inspected ected to check the effluent levels in the observation pipes and to check for any ponding Y P i condition and requires the: o e ff lu ent on the fail d of effluent on the ground surface. The ponding f e flu round surface may indicate a fall g 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 S12 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. GMW (ai0 t START UP AND OPERATION Page, of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products of other chemicals that may impede the treatment process and /or damage the dispersal collie). 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 collie) in one large dose, overloading the collie) and may result- In•tho backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator priouto 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 arQEj 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 ;; - 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 syswr i is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: 9 All piping to tanks and pits shall be disconnected and the abandoned pipe openings Sealed,, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage ..Servicing Operator. • After pumping, all tanks and 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: ', ,; e ,,. „+ , , 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. 0 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.—­­ 0 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. 0 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 POWTS INSTALLER POWTS MAINTAINER Name Name Phone / _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AVTHORITY Name Name r Phone Phone (his document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 3 w N - A NI) CSR Parcel Ide V It D yc's L] ric ce of Y= E}+:1. p(lc tystm could Tt'sulf, �J� 't p Cat c x,at� of out. tL - ia �Llpnzl t to �L� 7 "'M F M 1, , ., — y � �� tlntt -, ") : I 8 ��, lmTtctcn and pum Cs thag pm r CC -t,56 the abcv�, rzTlirpam—nn, W 6 agvcr hav , A of Na "o ll!vlle t�,e, %M� Commt�cr. wnd the Dt�� n� ry1 Vy the lay bet 6PS7, w n:-� out �41ITtir!L r —1. oilt All Tt&tmic%t.3 �a D c. C, �1aa it .ortiloci in 4 Ow:� "I'OpIrty 4a ribed j bovt, by v�l If -- CV-V ? Ti A51 "�-o 1 0 tj t1w i n ro J.S 0,�)rwnoad mr ' Ttful!,. in nc'm6l b&injw, A1,Y f-t3rn t�,�e Dccdo r�fficv -*Ith thA Ipplicaam a st, i� mlkdc �n tie V01.1? 3 PAGE 196" STATE BAR OF WISCONSIN FORM 2 - 1999 659504 WARRANTY DEED ::A ; - HLEEN H. WALSH Document Number REGISTER OF DEEDS 34.. CROIX CO., WI This Deed, made between Thomas M. Boumeester and RECEIVED FOR RECORD Elizabeth C. Boumeester husband and wife, - 10- 2:i -2001 8 :00 AN WARRANTY DEED Grantor, and Richard O. Stout and Janet P. Stout, husband and wife EXEMPT N CERT COPY FEE: CONY FEE: TRANSFER FEE: 1530.00 RECORDING FEE: 11.00 Grantee. PAGE: i 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 NE 1/4 of NE 1/4 and N1 /2ofSEl /4 of NE 1/4 of Section 12-30-19, St. Croix Name and Return Address County, Wisconsin. KRISTINA OGL AND ESTREEN & OG 304 Locust 032 - 2044 -10 & 032- 2044 -40 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (is) NX00 Dated this �~ day of October _ 2001 * _ * AM�i eester *— zab th C. B oumeester AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas M Boumeester and Eliz C . STATE OF WISCONSIN ) Bo . umeester, husban and wi fe, ) ss. County ) authenticated this {� of Oct 2001 // -- Personally came before me this _ _ day of C the above named e Kri stine Ogland - - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized b y � 06 06, Wis. Stets.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY A ttorne y Kristina Ogland Notary Public, State of Wisconsin H udson, W 54016 — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ _ , _ _ J * Names of persons signing in any capacity must be typed or printed below their signature. lnrormat Proresswnais company, Fond du L ac, WI WARRANTY DEED STATE BAR OF WISCONSIN 9M6552021 FORM No. 2 - 1999 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Thomas M. Boumeester and Elizabeth C. Boumeester husband and wife, Grantor, and Richard O. Stout and Janet P. Stout, husband and wife, Grantee. 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 NE 1/4 ofNE1 /4 and N1 /2 of SE 1/4 ofNE1 /4 of Section 12- 30 -19, St. Croix Name and Return Address County, Wisconsin. 032 - 2044 -10 & 032 - 2044 -40 Parcel Identification Number (PIN) This is homestead property. (is) %X00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of October 2001 ell ti _ * * — homes M. Boumeester * lizab th C. Boumeester AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas M. Boumeester and Elizabeth C. STATE OF WISCONSIN ) Boumeester, husband and wife, ) ss. rr,, County ) authenticated this V of October 2001 Personally came before ' me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stets.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney risti na O land y g Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If 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. Information Professionals company. Fond du Lac, wn STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 2 - 1999 Lli U- .--� >. L L jai �- X �s •. u N N 0 goo LL N z II CY)� ` Lu II I LL i CV J cr) + LL • LL N a ji u) Ob co N In m M �' Lf7 44 6'' J II LLI X rn j i . '85 CD ��� S & N Land Surveying, Inc. 2920 Enloe Street Hudson, Wisconsin 54016 (715) 386 -2007 Fax: (715) 381 -5338 FAX Transmittal To: LzI D G�h/,t/ Fax No: 2 47130 From: Fax No: 715/381 -5338 Project Lo 1 Project Number DATE: —_ ; , /3/7., MEMO FROM : FAX NO. . Ma 1 2005 07 M „� Mar. 3 33A �' /y ;s.: � v _ ). S b :: L :; .: .: .... ':::: .. .�.... . l ''�! �'.. \ .. . h/y V :. ... }<' :. ,. d . .. � ..,.' , .. . , .:.." .... . `" u ^ C a' �' �'' p n. , , 4 ,...... ; b Q : n. , =R: \ ! ;'', a:,,' _,.., „.' . ° it r .,,..,! ,.. .��. ::. .. ,.., ti . v ... 1 1, a ?: P, � @ 3-.. -- r. 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Parcel #: 12.30.19.1356 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 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 * 1690 89TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2090- HIGHLANDS,THE 02 SEC 12 T30N R19W NE NE LOT 14 THE Block/Condo Bldg: LOT 14 HIGHLANDS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 30N -19W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 10/23/2001 659804 1743/196 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 52,500 0 52,500 NO Totals for 2005: General Property 3.000 52,500 0 52,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.000 52,500 0 52,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Char ecia sse es g p P 9 4 Total 0.00 0.00 0.00 170TH AVENU�� --------------- Nrf cw Nm /41 4 V, Apo? I MIA' FT am ing- ME k A7 -40 Its MIES BUDDRETE www.wieserconcrete.com 8' Maiden Rock, WI (800) 325 -8456 Fond du Lac, WI (800) 641 -5937 Portage, WI (800) 362 -7220 Spooner, WI (800) 336 -3416