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HomeMy WebLinkAbout032-2054-10-075 0 CO) 0 1 3 0 C r� ° 0 C �»' f o, T A V m m m ~ 3 ' ... O m o a, o c w l o cn ° w• .. O CD N CD CD a m N o j m O N C) fA OO O a N td O J O 0 W [O[JJ O C C CD •�+ Cn ° D O A7 to 3 a o N N ?! o Lnn p !a m to w a p m n v to v D m a Cl) co 1 w a J W CD C Q O fD• I - 0 CL ° Z p p 0 0 0 CCDD , n r C Ca CL 0 0 0 1 r! I � I < W z cr vv°+ j CD m a �' y Oo m I N m m Cn n r co Z M ` l � _ ° z z D - 7 O o. � 1 CD C CD �. CD 0 3 C.D�� z ° ' p z n N c �_ M v ° rz z o t" T C4 C) cn CL 3 z O co 3 y z A CD A I I o n c a m ° 'm c 0 ° I N I v D I 3 I a o e ° N O � O q I I o CD A 4 '0 A 69 0 ti W O CD a y Parcel #: 032 - 2054 -10 -075 07/29/2010 11:55 AM PAGE 1 O F 1 Alt. Parcel M 15.30.19.702A -30 032 - TOWN OF SOMERSET Current fX_., ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - PARENT, KENNETH J KENNETH J PARENT 1504 63RD ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): "= Primary Type Dist # Description * 1504 63RD ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.970 Plat: 4659 -CSM 18 -4659 032 -2003 SEC 15 T30N R19W PT SW SW CSM 18 -4659 Block/Condo Bldg: LOT 03 LOT 3 (4.97 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 30N -19W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2006 835352 QC 07/20/2004 769236 2619/490 WD 11/26/2003 747713 18/4659 CSM 2010 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.970 57,800 158,200 216,000 NO Totals for 2010: General Property 4.970 57,800 158,200 216,000 Woodland 0.000 0 0 Totals for 2009: General Property 4.970 57,800 158,200 216,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/07/2005 Batch M 05 -7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 032 - 2054 -10 -075 04/25/2006 09:57 AM PAGE 1 OF 1 Alt. Parcel #: 15.30.19.702A -30 032 - 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): O = Current Owner, C = Current Co -Owner O - PARENT, KENNETH J KENNETH J PARENT C - BENERT LAURIE A BENERT LAURIE A 1504 63RD ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1504 63RD ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.970 Plat: 4659 -CSM 18 -4659 032 -03 SEC 15 T30N R1 9W PT SW SW CSM 18 -4659 Block/Condo Bldg: LOT 03 LOT 3 (4.97 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 15- 30N -19W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 07/20/2004 769236 2619/490 WD 11/26/2003 747713 18/4659 CSM 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.970 57,800 158,200 216,000 NO Totals for 2006: General Property 4.970 57,800 158,200 216,000 Woodland 0.000 0 0 Totals for 2005: General Property 4.970 57,800 158,200 216,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09107/2005 Batch #: 05 -7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2054 -10 -075 Parcel Number 15.30.19.702A -30 OWNER NAME: First SAM Last MILLER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1504 63RD ST SECTION 15 TOWN 30N RANGE 19W 1 /160 SW 1 /440 SW Line Description Line Description TOTAL ACREAGE 4.970 PLAT CSM 18 -4659 032 -03 LOT03 BLK 01 SEC 15 T30N R19W PT SW SW 15 02 CSM 18 -4659 LOT 3 16 03 (4.97 AC) 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildingbivision , INSPECTION REPORT Sanitary Permit No: 430588 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: Miller, Sam I Somerset Township 03 CST BM Elev: 'f Insp. BM Elev: BM Description: f r Section/Town /Range /Map No: I M . c'� .O� �Z Pl)L F c CST gm 1 15.30.18.7 fi\ TANK INFORMATION ELEVATION DATA 3 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic ro Benchmark O 1 ta �.a Dosing Alt. BM Aeration Bldg. Sewer 8 •�� s •o n I Holding St/Ht Inlet I o . - 4 • 3 6 1 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLJQGve Septic to Air Intake ROAD Dt Inlet �( Dt Bottom Dosing Header /Man. Z , $ 9/. 12. I Aeration Dist. Pipe Z_ $ c 1 Holding Bot. System ) . q0 . c'D PUMP /SIPHON INFORMATI Final Grade Manufacturer Demand St Cover /� P • 0 Model Num r / TDH Lift ' ion Loss System Head TDH Ft Forcer6ain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM RENC Width Lengt No. O Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S 3 • �S 2Q SETBACK SYSTEM TO PIL 4f.Cr LL LAKE /STREAM LEACHING Manufacti erg INFORMATION CHAMBER OR Type Of Sys r UNIT Model Number: , D p DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length A�� Dia length Dia 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 g p Yes No Yes ] No COMMENTS (Include cod discrepencies, persons present, etc.) Inspection #1:{/ Inspection #2: Location: 1504 63rd Av me Somerset, WI 4025 (SW 1/4 SW 1/4 15 T30N R19Wu) N ( A ( LLoot`3 Parcel o: 1 0.18. ' 1.) Alt BM Description = S ' / -� T � "`�"'�"" 0-t- 2.) Bldg sewer length - amount of cover = 2 60 3 Plan revision Required? s Yes No X0 1 SBD - 6710 (R.3/97) Use other side for additional information. Date Insepctor s Signature Cert. No. RE CENE Safel e and Buildings Division County 201 W. W shington Ave., P.O. Box 7162 , L� C Ic 2003 M 'son, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) con Dep artment of Co mer (608) 266 -3151 ,C{30�r�g$ Sa ��GII�II#c1� cation State Plan I.D. Number In accord with Comm 83.21, Wis. Aim COde,-pers mfotmation you provide may be used for secondary purposes Privacy Law, s15.04(lxm) Project Address (if different than mailing address) 1. Application Information - Please Print All Information )SO l0 3 Property Owner's Name Pa q Lot p _bwg "fi 5 7 A - AA A4; n I SO- 1 00) ( l 3 Property Owner's Mailing Address Property Location 3oX/l car /S' City, State Zip Code Phone Number Section (circ le N; RAE or VW 11. Type of Building (check all that apply) 13 l or 2 Family Dwelling - Number of Bedrooms T Subdivision Name D� * CSM Numb r ❑ Public/Commercial - Describe.Use S to Owned - Describe Use % ❑City_❑ VillaUe XTownship of Sp rh cf s IT 1. pe of Permit: (Check only one box on line A. Complete line Rrf applicable (d # !o 3 Z — A. XNew System ❑ Replacement System ❑ Treatment/HoldiagTank Repla y ❑ Other Modification to Existing System U B. C1 Permit Renewal ❑ Permit Revision ❑ Change of C1 Permit Transfer to New list Previous Permit Number and Date issued Before Expiration Plumber Owner IV. Type of PO WTS System: jCheck all that a 1 A6 W A - / rS o F1 L7 1F 2 on - Pressurized In- Ground ❑ Mound > 24 im of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter G Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis pe rsaVl'reatmeat Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal AreaReq ' (sf) Dispersal Area Prop ed (sf) ystent Elevation (p oc 0.7 S7 933 D, oo' _ VI. Tank Into Capacity in Total Number Manufacturer Prefab Site Steel Fiber plast;c Gallons Gallons of Units Concrete Constructed Glass Ncw Existing Taney Tanks S,ptic or Holding Tank Aerobic Trcarmcat Unii Dosing Cbambcr V11. Responsibility Statement - 1, the undersigned, assume responsibility for tastatiation of the POWTS shown on We attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) a o .S 4V V1LL Coun /70aDi1pprortmt Use Onl ,Approved ved ermit Fee (includes Groundwater Date Issued Issuin gent Signature o S.antps) Fee) wner Given Reason for Denial 2 " EC. o l.X. Conditions of Approval/Reasons for Disapproval 3) SYSTEM OWNER: f 4J U J 0� Q Q C 1 Septic tank, effluent filter and `� U u✓ C U--� dispersal cell must all be serviced / maintained as per management plan provided by plumber. �o'r sn 2. All setback requirements must be maintained I� c_d l �etK COY as per applicable code /ordinances. Attacb complete plans (to the County only) for the system on paper not loss than 81/2 s I 1 inches in size SBD -6398 (R. 01/03) SHm o l .7 3 yr S ` u c� s /Lr. joa,l /i -1 o VJ� 4 � 1 J, PY s - , $ • T. ( p 8 e ft �UL. 9G _^ AN � � • d. o v, ,� � .,�� FAQ 4 Te .�..,� S m m I I c. / oT .7 3 / S — o / & ,o( 5� �1 z5o��ll 5 T w vdz- DWI. All I .G� g � I• - l Da. act a. Te T a 7,o S EQ` 4 I RECEIVED 1759 WisconsinpepartmentofCom NOV ;j 1 200POI EVALUATION REPORT page 1 of 3 Division of Safety and Buildings with m 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ST. co " County Attach complete site plan r�Gfll�n6cl(1Emches in ize. Plan must St. C(OD( include, but not limited to: vertical a zon re er ), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. 032 - 2054 -30 -000 Please print all information. a By Date Persona) intonation you provide may be used for secondary pwpw- (P-3cy Law, s. 15.04 (1) (m)). Dc<. 0 y Property Owner Property Location Sam Miller Govt. Lot SW 1/4 SW 114 S 15 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 3 Plat Of Survey City State Zip Code Phone Number City j Village a Town Nearest Road Hudson WI 1 54016 1 (715) 386 - 2769 Somerset I 63Rd Street ✓! New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _ Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 90.00' using 28 leaching chambers. ❑ Boring # --- Boring el Pit Ground Surface elev. 95.96 ft. Depth to limiting factor >1 in, Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 1 0-6 10yr314 none sil 2fcr ds gw 2f,1mc 0.5 0.8 2 6 -18 10yr4/6 none sil 2fsbk ds cw 2fm,1c 0.5 0.8 3 18 -30 10yr5/4 none sil 2msbk mfr gw 1fm 0.5 0.8 4 30-45 7.5yr4/6 none gr Is 1 msbk mfr gW 1fm 0.7 1.2 5 45-136 10yr5/6 none gr s 0 sg mfr - if 0.7 1.2 to - 0 F $' / I Horizons #4 & 5 contain approx. 3096 gravel &cobbles by volume. �. an • SZ 7 a Boring # _._? Boring Pit Ground Surface elev. 95.52 ft. Depth to limiting factor >123" 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 I *Eff#2 1 0-6 10yr3/4 none sit 2fcr cis gw 2f,1 me 0.5 0.8 2 6 -14 10yr416 none sil 2fsbk ds cw 2fm,1c 0.5 0.8 3 14 -29 10yr5/4 none sit 2msbk mfr gw 1fm 0.5 0.8 4 29-41 7.5yr4/6 none gr Is 1 msbk mfr gw 1fm 0.7 1.2 5 41 -123 10yr5/6 none gr s 0 sg mfr - if 0.7 1.2 .z`f 2. Z 7 briz S contain approx. 15% gravel & cobbles by volume. * Effluent #1 = BOD ? 30 < 220 mg/L a TSS >30 < 150 g/L In' #2 = BOD -S mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 5-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 11/182003 715 - 248 -7767 340 Paulson Lake Lane, Osceola, 1 54020 E -1 Property Owner Sam Miller Parcel ID # 032 - 2054 -30 -000 Page 2 of 3 y 31 Boring # Boring ✓I Pit Ground Surface elev. 93.32 ft. Depth to limiting factor > 115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -8 10yr3/4 none sil 2fcr ds gw 2f,1 me 0.5 0.8 2 8 -26 10yr4/6 none sil 2fsbk ds cw 2fm,1c 0.5 0.8 3 26 -36 10yr5/4 none sil 2msbk mfr gw 1fm 0.5 0.8 4 36 -59 7.5yr4/6 none gr Is 1 msbk mfr gw 1fm 0.7 1.2 5 59 -115 10yr5/6 none gr s 0 sg mfr - if 0.7 1.2 Horizons #4 & 5 contain approx. 20% gravel & cobbles by volume. F-1 Boring # _J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # _. i 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff #1 'Eff#2 • Effluent #1 = SOD 5> 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. V o �` lay, /6" III ' I �cara9e _ _ -- � - �i'o�s 3 6Qd,z�, o M r / I r t 1 Q _ AsS Ge.nld `_ 8 �_l5 /0,0� 1�?_ 96.oj�l�. �,�. Tai a�fi� /�d.C. /o;,oe• 1769 �o 3 r N V • y P / C 07 Sc 3 c, 6� � 03 13 0 5� .1io l o'co ■ �ar`9e. - p „o 3 beds, / o Kes;�:lc rlc.e- \ R ta ch Ur -e: TP o” ' 45suma e- lot 1 _ 7 f'�`i Elea. ■ 83 - - - - - -- polo' -- ---- -__ - -- _ -92.4 ' 30f3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner S /L G / Septic Tank Capacity Z j V al ❑ NA Permit # o 5 0 0 Septic Tank Manufacturer w F. /S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z /4 ` / ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model - / ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l NA Estimated flow (average) al/day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) ©CJ al/day Pump Manufacturer i�NA Soil Application Rate �_� al /da /ft2 Pump Model T NA Standard Influent/Effluent Qu nthly average- Pretreatment Unit E�NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L A n-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 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 every: ear( amonth (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once eve ❑ m th(s) 13 NA f r Z ear 1 Inspect pump, pump controls & alarm At least once ev ❑ t ) ❑ NA S) Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: • month(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 dispo$ed 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. Page 2 of y START UP AND 'OPERATION 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 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 ermanentl taken out of service the following steps shall be taken to insure that the system is P Y 9 P 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 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: 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 ,, r technology a holding tank may be installed as a last resort to replace the failed POWTS. S I" T alua ' o ing t nk a e ai a �R�I - �18 Tim �� A/�✓ NS7R(!�'t C�+� ❑ 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 �� /k ) . // Name Phone / _ lj / 2 - /p ,S"-- / ,� 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15t. C ( d 20 1 �tl Phone Phone '7 1s— 3:?40_ (p 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540 ), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �''� 1P IG L Eft g Mailin Address Property Address S ° y (n 3d s_ S (Verification required from Planning Department for new construction) City/State < W Parcel Identification Number LEGAL DESCRIPTION o -,� 2 , a G J t 0'1 5 - 1" Properly Location f) it) i /s, -� � V4, Sec. , T 3 0 N -RLq W, Town of o r Subdivision C S l , Lot # 3 Certified Survey Map # -7 y 7 - 1 I , Volume I , Page # `� S Warranty Deed # &O / 0 1 a y , Volume / 977 Page # �Z— Spec house( yes ❑ no Lot lines identifiable) yes ❑ no SYSTEM / 1Vi41NTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system - The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards WA forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year N�on date. 3 GNA PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property d :r virtue of a warranty deed recorded in Register of Deeds Office. I/ / zoo "-� ATURIS 6F PLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department- * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed C 1706 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 4 Division of Safety and Buildings A.C.E. Soil & Site Evaluations in accordance with Comm t35, Wis. Adm. Code Attach complete site County cal plan on paper not less than 8'r4 x 11 inches in size. Plan must St. CfOUC include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dim sw s, lance to nearest road. Parcel I. D. 032- 2054 -30 -000 Plea print all a b Reviewed By Date Personal information you provk may be used for seandarY purposes (Prim y Law, s. 15.04 (1) (m)). nn Property Owner Property Location Sam Miller CRO Govt. Lot SW 1/4 SW 1/4 S 15 T 30 NR 19 W ST. Property Owners Mailing Add ZONING OFFICE Lot # Block # Subd. Name or CSM# P.O. Box 151 3 Proposed CSM City State Zip Code Phone Number _j City J Village 01 Town Nearest Road Hudson I WI 1 54016 (715) 386 -2769 63Rd Ave. New Construction Use: M' Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD , Replacement f Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 104.67' at 6" above 104.17' contour. System area limited due to complex slopes and limited visability. See memo page. Boring # �J Boring sm Pit Ground Surface elev. 105.72 ft. Depth to limiting factor 48" M• Sal 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 1 0-13 1Oyr3/3 none sil 2fcr ds gw 2f,1mc 0.5 0.8 2 13-30 10yr4/3 none sil 2fsbk ds cw 2fm,1c 0.5 0.8 3 30-48 1Oyr4/4 none Sid 2msbk mfr gW 1fm 0.4 0.6 4 48 -57 10yr5/4 f2f 7.5yr5/8 sil 1 msbk mfr gW 1fm 0.2 0.3 5 57-82 10yr5/4 m2d 7.5yr5/8 sil lcsbk mfr - 1f 0.2 0.3 a Boring # J Boring Pit Ground Surface elev. 103.61 ft. Depth to limiting factor 5 3 " 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 1 0 -16 10yr3/3 none sil 2fcr ds gw 2f,1mc 0.5 0.8 2 16-29 1Oyr4/3 none sil 2fsbk ds cW 2fm,1c 0.5 0.8 3 29-53 10yr4/4 none sil 2msbk mfr gW 1fm 0.5 0.8 4 53-62 1 Oyr5 /4 f2f 7.5yr5/8 sil 1 msbk mfr gW 1 fm 0.2 0.3 5 62 -85 1Oyr5/4 m2d 7.5yr5/8 sil 1csbk mfr - if 0.2 0.3 " Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/ ffl #2 = BOD <30 mg/L and TSS <� 0 mg/L CST Name (Please Print) 5 ure: CST Number James K. Thompson S-- 3602 Address A.C.E. Soil & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 81122003 715- 248 -7767 P Owner Sam Miller Parcel ID # 032 - 2054 -30 -000 Page 2 of 4 F3 ] Boring # `j Boring Pit Ground Surface elev. 103.12 ft. Depth to limiting factor >70" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 1 0-8 10yr3/3 none sil 2fcr ds as 2fm,1 c 0.5 0.8 2 8 -17 10yr4/4 none gr sl 2msbk dsh cs 2fm 0.5 0.9 3 17 -33 7.5yr4/4 none gr Is 2msbk mfr cw 1fm 0.5 0.9 4 33-48 7.5yr4/6 none gr Is 1 msbk ds cw 1f 0.7 1.2 5 48-70 10yr416 none strat s 0 sg dl gw - 0.7 1.2 Ws 2, 3, & 4 contain approx. 20% cobbles & stones. F-I Boring # - I Boring Pit Ground Surface elev, ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color a. Sz. Sh. •Eff#1 `EfM2 ❑ 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 GP 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 S30 mg/L and TSS <V 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. 7aG . • / 6 33 Soy l Ob serr/af o., J E/eva -6e0,1 �c -C*x c� 6 b • /oco.�, "aro .+ncc �s a ap,�,�, � � in 4'cnce.gssw.,Cld ju e to ul: � "cv. coo o N c a / 07 tb. B. 1a on E7eAA 9y. Z' r3 : �, X02.0' to r 0 M I I r i i i PROPERTY OWNER: Sam Miller -z- SOIL AND SITE EVALUATION 1706 Page __ of 4 PARCEL I.D.# 032 - 205430 -000 A.C.E. Soil & Site Evaluations REPORT MEMO Site contains extremly complex slopes and contours and is heavily wooded with pines, making visibility very difficult. Contour length of tested area is 60% limiting system area to accomodate 2 bedroom residence. Contour length may be longer than indicated on site plan, but total length cannot be determined until trees are removed. Location of building site unknown at time of evaluation. Additional soil testing may be required when building site is determined. F THE S E 0 D, NORTH UN ,red for and at the request of NOR 4 OF THE SW 1 / �-�'' � SW 1/ D, n Miller NP�ATTE, R=N86-21,E 21.0 udso 5 D. , n, W 54016 — N86' 125 n, ...,......_.- ,-_. - -- - 1 -23� I rafted by. Howard H. Herrild III 33,11 I � I h Section Corner Monument .y �33 33'1 of Record 0 ,�� �, PRROPOSED // Set 1" x 24" le° Ilnear footghing ` /DRIVE' / I 1.13 pounds p I a p Found 1 -1/4" Iron Pipe �� LOT 1 N I e�' -P- 01 R- Recorded As �, T07AL Contiguous Buildable Area 162,010 SQ. FT• o! o` I '' 3.72 ACES/ Building Setback Line (100' from ROW) eizFA / I R Q.N1 I �I 143 38 � w v I nooZZ AD� ovi/ X c-6 o g N 86' 10 * 23" W 446.60' z ^ �o� C" °gam NO TH 413.56' oI m - -N DRIVE 4 N n N N , W (n/ r0 c So 2; 33.0 o m m � ,o �, ;o 0i o - ° LOT O rn 0.:j V (A aoo r �.' A��e. m - a ]151 - I c�J� ::r I� 157,628 SQ. FT. 0 �I� CL °� o ? 0 �� tD_ 3.62 ACRES / wI Co c " I� 0 A o A I� sRFA DC (;t O.W.: N cn I 0 _ W.3 ro rn 0 i Q FT' 6z v _ N C I Oi� 0 14 3.35 6 ACRES/ Ijw � m W o A ICAI � Q ' ,{ II��� on v m f p F�'I'�I w / /// ', I I�I o °o `: c� I� 1--\ w / 33.04 I Ir , ID ,'o Y D I . . IIZ 0 S 86' 10 ra , 407.41 I� Ir I CL. o > jj 10 23 E 440.45' I ItD IC I r` ' c 3 0 , w � m Inl = R =S86'16'E 441.48 � m� 5:�{'� CIO o PROPOSED I 1 $ 3 0 � DRIVE D � o 0 0 m QIn a, m b Z LOT . 3 DI Z n h m ao ao �zj / J 1 00 - n � a ' �' on 1`OTISL B6FA: ! I m W o n m o i Z on t° w to 216,296 SO. FT. I i on W � ^ ''0 4.97 ACRES O 147,066 SQ. FT. � D 3.38 ACRES' II y o SOUTH LINE OF THE SW 17 GAS u i ,� SOUTHWEST QUARTER SEC. 15 -30 -1 rt (FOUND ALUMINUM p / �. ! COUNTY MONUMENT) - 222 -� /, 1311.98' W , 17 SST" 18. _ —- T- 67'05' 4310' - _ _ - , WEST 273.80 8 i 1� 150th Ave._ „ _ — SOUTH QUARTER JOB evio57SU10 - 2 -- -- ` — FAST 2.623.95' CORNER Prepared by. _50th Avenue_ SEC. 15 -30 -19 J ConsulGng 1170. ^ (FOUND 1 -1/2" (J11/p��TTE_D_ �4 _N_DS IRON PIPE) Phone No. (715) 246-4319 Mme occcocrur•cn Tn THE SOUTH LINE OF THE - J i BioDiffuser SpecifiCatiOns c:M T Chamber Height i �� � .�.... r. r. r..r r. r. rr �� r r •� �. r r r� �� r �r _ �� �, 1 Chamber MOO End Ww Universal End Cap Chamber 11" Stan- 14" High 16" High Av ailable Dimensions dard Capacity Capacity fYW b h r v��;�Y' a'•Yl..$uU�� }��7R�'v.C: �._'t�'�j'G� �+�GL .i M-4 � 1 s u v a � laMi ' a• �3 _----- . 1 1977P 292 II 6 9 0 3 6 4 a S7 3AR CF w }SCCNSIN FORA4 I - 1993 KATHLEEN H. MALSH wa2R. r' DEE ; i REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Bernardo M. Medellin and MaryCarmen Medellin Grantors, and �I 09 - - 2002 10:15 AM Sam Miller Grantee. EX DEED EXEMPT i II Grantors, for valuable consideration, convey to i REC FEE: 13.00 grantee the following described real estate in TRANS FEE: 618.00 St. Croix Count COPY FEE: RT E COPY PY FEE: I State of Wisconsin (the "property "): I PAGE 2 arc_al Of land located I Nan.an aa•.p — q in the South�.est Quarter of the Souc'nuest Quarter' (S4, of 5W, of Section 13, T3C "1, 819E +', described•as follows` Commencing at the .CUC'r.west corner of said Seccion 15; thence North . =5.% feet; thence Easc 838.78 feet to the Feint of thence South. 86 ° 16' East, 44,1.48 feet to 'U '- `� 3 �I7� i c ,fL i n ,:,,a I ,n ,n, ce. ^,:_, -aine of the Town Road; _fiance South 0 °31 We;*_ s cng said centerline to the South line of said (Parc- Iide,Gficat:onNumber) Ili thence nest along the Scur_h line of said This 13 NOT homestead property.;. lorry to a point which is directly South of the point of beginning; thence Nor - *_h to t;1e it co.nc of beginning; ASO a parcel in the Southwest Quarca -r of Southwest Quarter (S'W' of SW ­) of Section 1. T30N, R.l9W, described as follows: From the Southwest corner of sail, Section 15, go North 546.74 feet and East 858.78 feet to the point of beginning; ,ence Nor:h 43'03' East_ a distance of 356.1 feet; thence North 86 °21' East a distance i o` ' feet to the center of Town Road; thence with th canterline of road South 00 es C, 810.88 feet; thence North 86 1 j� Wesc, 441 .48 Meet to the point of beginning; II! o er .4 M.ner LO Cx h, h, Meer- r99 fu /1[t /(t, cy-s Opt rn !I To•.;c J..r yl all ay vurt grunt n5hta. Utle and ,ncar.s '! ...sntor :,rr an to that cne :ttL- to c,e ?ro par:/ V good. Inde(eastble In (Ge s4nptC a,td fre.: ano char of --b- 11— 1—I1 D0 (sF„u (SEALI ; I ?.UTHENTEGATION ACKNOWLEOCMENT I; I� 4,. ..,,; �T,� state of„wEsconeln. 1 (� County. 1 d+ of z �� ally a are n,a tn,a - ar t kP n 4j L .j '.- -_e: McA':u2 STarE GAR OF WISCONSIN cu I `r' nC'' m• knO�vn t� a :i.a periOn 1 \J ' aJ tin fOra(alnf au r,orecd ny §706 06. Wes. Stam) tnurutnent tno.,l•d., ih• me �j�q�LJjJ /,�y/ I� '�Ij INgta UaaE NT r+.5 ClaalTfO 9Y � �"t - /S I l� yfc A/ AP-t) 0 t- Al M /I Notary f` bhc. Sute or W=.naln �) I �� C,v �( TCf �� /f� �S V � My Gomr.,salon is tyfj / v l to e, pl radon Jac. �l _ -,>\ _e au cn °Tea aC or aerne wlGd �c J. oa In are nor / g!z 7 1 _ = .',.... > v .,An AF N,a:Ori�iN I.GY l�•n: � ]L.7 FJR`A Vn. I .)fy Ns,.ma .a✓r au „. n,u,. 1� J 1977P 2`i3 X That certain parcel of land or tract of real estate located in the SW % of SW % of Section 15, Township 30 North, Range 19 West, Somerset Township, St. Croix County, Wisconsin further described as follows: From the SW corner of said Section 15 go North 546.74 feet and East 858.78 feet to the point of beginning for parcel to be herein described; thence due North a distance of 508.77 feet; thence N43 a distance of 356.1 feet; thence N86 a distance of 210.0 feet to the center of Town Road; thence with the centerline of same 800 a distance of 810.88 feet; thence N86 a distance of 441.48 feet to the point of beginning. ALSO, A parcel of land located in the SW % of SW %, Section 15, Township 30 North, Range 19 West, St. Croix County, Wisconsin described as follows:. Commencing, at the SW comer of said Section 15; thence North 546.74 feet; thence East 858.78 feet to the point of beginning; thence S86 a distance of 441.48 feet to the centerline of the Town Road; thence S0 along said centerline to the South line of said SW % of SW %; thence West along the South line of said SW '/. of SW ' / 4 to a point which is directly South of the point of beginning; thence North to the point of beginning. NORT ;he request of: H LINE OF THE S W 1 /4 OF THE SW 1 /4 ����, nI AT _ 821'E 210.0 211 B.2 5 8 H,{ Toe ul 33.1 ,� � 33I Corner Monument �.OP ED I C-) Record oD4 /DR I o c,t x 24" Iron i Pipe weigh �� �ro w . pounds per linear foot L �, –t 4" Iron �?,t�� Pipe � T JJ v I U-) - / �l a, Rerorded As ,2 :/ n I 2,010 S� 'Fl - cn;iauous Buildable Area - ��✓ /3.72 /ACRES/ IQ - k Line (100' from ROW) wilding Setbac 147,066 SQ. Fl 3.38 ACRES �+ / _ � � . 2 / n 0 0 o I A Ln N 86'10'23" W 446.60 V) �- o -0 o q 4136' °� :,0 � c c NO o I� o DRIVE ?- ,// 33.0 .ro I` m u, cn a II /� v o m iD n Cn :3 rn o �� o IC °° N N LOT 2 L,/ c v ° � w � � (.,n I a C � ° n, w I� rn / - Lnn l cnn ° 0 u u i0� 157,628 S �+a, cb r� � I � �� 3.62 E ID I I� a° o� N� ICI� `° I a o co o m C7 I� II� z 2 14 88 ACC ES 'v o f IIIQ t� 0 M c 0 m F� �'� w �/ /33.04' I �II� IO , 3 I I I II 407.41' S W10'23" E 440.45' II� D _j w fM I� R= S86'16'E 441.48' I rTl' . � 3° J 4i� © P POSED l I 2. N w I �. o 3 0 lQQ c L , 4 LA � L � �^ `n o > ig �� .. .V■ i CB Co $ `� —C c 70 'I m a z J a w 216,29 Q FT. 11 ca rn � �'o / 4.97 ACRES 0 41 Ln 147,066 SQ. FT. 3.38 ACRES' > f f T' F GAS uyE SOUTH LINE OF THE SW 1/4 ' r-SOUTHWEST QUARTER SEC. 15 -30 -19 o 00 (FOUND ALUMINUM � O' COUNTY MONUMENT) 222 -A - 1_13' _ ��` 17 �L E1T 1483. G 05' _- B_` - i T 867. 73.80 i � � 2 EAS - WESf _ — 15 Ave._.i 2623.95 M057SUIO ' SOUTH OUA lE' a p' - -- / FAST CORNER ,T ^ ;red by /SOtI/ /'VGOO SEC. 15-30-- FOUND _1 - V-0 Consultin Group Inc. TIED ANDS IRON PIPE; UIL�P�A 715) 246 -4319 orrrocurt r� T(1 TNF SOUTH LINE OF THE � f ' ^' • S6MEkSET `S' PLAT T -30 -N • R- 20 - 19. (Landowners) See Page 112 For Additional Nana.' RICE�NOND PAGE 48, iS ulse 1500 ,O ~ Q •nP. 9 s e ^.� • $ g is PEES a �+ �a a aum �n n T u 8 _ pp 7 1S3lJJtlH a 2 we w n Am 7P 9M g O O 001 " $n E M1 INA d W IEVES�E° r ; W 9 �^ C .0 C — �� n Y�" 08 +��„ ", �a5 —I8 a V v Co., Inic. E " mOMx 15.x, x BOX 157 E n $ 08 l o SOMERSET, WISCONSIN 54025 s In (715) 247 -3376 A 6L yYLL h tL . UPULZOD o. c. x►wi.f tz N� 1S R 76 Apple River Dental Care Y A [ 8 Dr. Douglas S. Wolff D.D.S. [' A a J -3 �S J g +was x 1S 41LY w NI $ 124 Spring Street >I I^ P.O. BOX 87 Somerset, WI 54025 t N is Pl/zv y -� 715 247 -33 18 yyy 9 b I r ( s nt 6 , W W DEERS 3 1S 418E i S .� b d L JV3 Q ' g BAR o� ) " �� rn 0 r- eluir N w IPA. 14 Or 11 9 - b f T 6 N R Ch F � a so FOOD &SPIRITS • ON & OFF SALE • LIQUOR ANTIQUES • GAME ROOM Q ld� b a Deer Park, WI 54007 715 - 269 -5252 r � x a B b d b ° cc C W J 1s �_ w r �, S �I8 LO r 62