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Parcel #: 03.31.19.36A 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 - CROTTY, NKA L & D ACRES NKA L & D ACRES CROTTY Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 35.480 Plat: N/A -NOT AVAILABLE SEC 3 T31 RI 9W SE NE EXC PT TO CSM Block/Condo Bldg: 15/4068 NKA L & D ACRES ('03) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 03-31N-19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 04/07/2003 716265 9/56 PLAT 07/23/1997 849/230 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/03/2004 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 032- 2165 -02 -000 03/25/2008 11:31 AM PAGE 1 OF 1 Alt. Parcel #: 03.31.19.1409 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 - CROTTY, LEO S & DARLENE M LEO S & DARLENE M CROTTY 2370 CTY RD I SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2370 CTY RD I SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 29.470 Plat: 09 -056 -L & D ACRES LOTS 1/2 032 -03 SEC 3 T31 N R1 9W PT SE NE L & D ACRES LOT Block/Condo Bldg: LOT 02 2 (29.470AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 03- 31N -19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 04/07/2003 716265 9/56 PLAT 2008 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 138,100 186,100 NO AGRICULTURAL G4 26.470 3,300 0 3,300 NO Totals for 2008: General Property 29.470 51,300 138,100 189,400 Woodland 0.000 0 0 Totals for 2007: General Property 29.470 51,300 138,100 189,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/07/2005 Batch #: 05 -7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 032 - 2165 -02 -000 04/07/2006 01:03 PM PAGE 1 OF 1 Alt. Parcel #: 3.31.19.1409 032 - TOWN OF SOMERSET Current 19; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - CROTTY, LEO S & DARLENE M LEO S & DARLENE M CROTTY 2370 CTY RD I SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 2370 CTY RD I SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 29.470 Plat: 2154 -L & D ACRES LOTS 1 & 2 032/03 SEC 3 T31 R1 9W PT SE NE L & D ACRES LOT Block/Condo Bldg: LOT 02 2 (29.470AC) Tract(s): (Sec- Twn -Rng 40 114 160 1/4) 03-31N-19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 04/07/2003 716265 9/56 PLAT 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 138,100 186,100 NO AGRICULTURAL G4 26.470 3,300 0 3,300 NO Totals for 2006: General Property 29.470 51,300 138,100 189,400 Woodland 0.000 0 0 Totals for 2005: General Property 29.470 51,300 138,100 189,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/0712005 Batch #: 05 -7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charge$ Total 0.00 0.00 0.00 -- �����.. �....��...-- V via... ♦Y-la Vl \6 Y , TOWNSHIP_ b T rsP_t _ T R�_W 0. ADDRESS ST. CROIX COUNTY, WISCONSIN. '3DIVISION , LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,L A 41 60 F I -`TIC TANK(S) MFGR. 7 CONCRETE "--S TEEL NO. of rings on cover �0 Depth � DRY WELL NCHES NO. of width length area J no. of lines width 47 , length < <; are . de th to top of pipe �� �REGATE � y7 _1K RATE AREA REQUIRED �- J1 AREA AS BUILT , :claimer: The inspection of this system by St. Croix County does not imply complete j 'pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for :tem operation. However, if failure is noted the County will make every effort to -ermine cause of failure. ..ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. 'INSPECTOR DATED , _ /� PLUriBER' ON 3flB LICENSE NUMBER ` 2 r RRPORT OF I1ISPECTI ON- - INDIVIDUAL SEWAGE DISPOSAL SYSTEM Sanitary Permit / •• State Septic_ 1E T&INSHIP t, Croix Coun ty SEPTIC TA`!1 rl Size gallons. `cumber of Compartments Distance From: We ft, -� �-� 12% or greater slope ft. 1 r Building ' ft, Wetlands f. 11ighwater ft. DISPOSAL SYSTF•: Tile Field or Seepage Pit(s) Distance From: • T7ell ft, 12% or greater slope ft Building A ft, Wetlands f; FIELD High-water ft. Total length of lines )d L ft, Number of lines Length of " each line ,' ft. Distance between lines s ft. Width of the _= trench- ft. Total absorption area sq. ft. Dept:: rock below file m in. Depth of rock over tile in.. Cover v er.. rock Depth , �.. ept o tile below rade / �« in. Slo a of . . �J - ---� -- g P ( trench in per 100 ft. Depth to Bedrock ft. Depth to ground water ft. PITS 'lumber of pits 01Aside diame- er ft. Depth below inlet ft. Gravel arQ d j no. .Total absorption area __ sq. ft. Square feet of seepage trench bottom area required :square feet of �s, Tpp nit a s required . °7 r t Inspect ec) < : --;_ _.* �� :- , . Title':... Approved 197 " Rejected Date 197 EH 1 15 _ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 _ REPORT ON SOIL BORINGS AND PERCOLATION TESTS '' /a LOCATION: � /a, ,Section 7V-N, R 4t' E (or) W, Township or Municipality _5e7 4 '. i" 5r %C- Lot No. , Block No. County ubdivision Name Owner's Name: L e. 0 i'� ���/ Mailing Address �' L o�� TYPE OF OCCUPANCY: Residence �� No. of Bedrooms - Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT ��— DATES OBSERVATIONS MADE: SOIL BORINGS f PERCOLATION TESTS SOIL MAP SHEET - SO L TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 �- f �` SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) k e PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas Indicate number of square feet of absorption area needed for building type and occupancy. P Z 6c/ Indicate scale or distances. Give horizontal and vertical reference poiiktsj. Indicate slope. r -� 1 1� !1 �N h d I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name( rint Certification No. y Address r A l c Name of installer if known CST Signature COPY A — LOCAL AUTHORITY PLB67 State and County State Permit # Permit Application County Per 't # for Private Domestic Sewage Systems Count *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY �r - Mailing Address: B. LOCATION: JL'� '/4 ' Y4, Section -_, T_3�t N, R_!-7E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township f c C. TYPE OF OCCUP ANCY: Commercial *Industrial *Other (specify) * Variance Single family k` / Duplex No. of Bedrooms 73 No. of Person D. TYPE OF APPLIANCES: Dishwashhee L ES NO Food Waste Grinder YES t- Mg # of Bathrooms?, Automatic Washer YES G� IVO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks 4 *Holding tank capacity Total gallons No! of tanks New Installation Addition Replacement — �/� Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolatio ate 1) 2) 9 - 3) ; .S Total Absorb Areasq, ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. 0 Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length 5,�2: Width / Depth Tile Depth ` " No. of Lines �Z- Seepage Pit: Inside diameter Liquid Depth Tile Size y Percent slope of land y;� Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifie Soil Tester, NAME t-�� �/�f ��1>,� / �� C.S.T. # Il� and other information obtained from (owner /builder). Plumber's Signature �-WP /MP SW# . l e c l Phone Plumber's Address I PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Q is L� sp � ,v Do Not Write in Space _Bel W FOR DEPARTMENT USE ONLY Date of Application ,�5 Q Fees Paid: State O Co ty a � 0 Date Permit Issued /R (date) 5����C� Issuing Agent Name �CQ�J T Inspection Yes__XNo Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 I* Wisconsin Department of Commerce - Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count�t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sa I WO o.: Personal information you provice maybe used for secondary purposes (Privacy Law, j.15,04 (1)(m)1. � r it s Name: ❑ City ❑ Il e T : r � i �ot $e s�t �"'ownship n of State P an ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel , Np006 -40 -000 1 Z . z w U J 11 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se '`iI c p �ntis 6o6 Benchmark 3v � - Z e g Alt. BM Bldg. Sewer H ng S Ht Inlet N TANK SETBACK INFORMATION O/ Ht Outlet J _ss' TANK TO P/ L WELL BLDG. Ventto ROAD Inlet '}� z Air Intake ><r r Sic ' ;> ZS�/ -7 ~ J S / NA s , 5q eZ NA Header /Man. 771 ire NA Dist. Pipe �t f 1 ba Ho ding Bot_ System L fA /a. 0 F� S PUMP / SIPHON INFORMATION Final Grade M cover er Demand Model Number M TDH Lift Lriction m TDH F ea Force In Length Dia. Dist. To SOIL A8 ,/ SRRPTION SYSTEM BED /;M EN04 /;MEN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N 3 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA ING Ma �` u cturer: INFORMATION TypeO ) d r r � AM E Mo e System: S 7S7 OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) y x Hole Size x Hole Spacing Vent To Air Intake Length / Dia. _1_ L ength Dia. � Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1. 120/ el Inspection #2: Location: 2370 Cty Rd I, Somerset, WI 54025 (SE 1/4 NE 1/4 3 T31 N R1 `W) - 02311936 1.) Alt BM Description= `{�S 2.) Bldg sewer length - - amount of cover 6 6 S� ✓J am V S r'k 54a 11v ; Z C ev �p� rcU Clams, Plan revision required? ❑ Yes No Use other side for additional information. Z( od SBD -6710 (R.3/97) Date Inspecto 's gnature Cert. No. ( .31 a, of 9 ,z ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ° f�� ......... . . .. .._ a ., e ,........ .. .,. ..... _. __ ..,. �" ,... .t ,.,. 22 t E s { # d e 1 { i 111111 e s � � f { 4 { { s t 3 x r � T F f s 9 �R f { ## s f 3 } 3 a � 7 ` ( a # t ... _ �. .. �.. p ,_ �.... �.. » _ € t f t m . f { a e ,.., r ..e ,. ..ro. m 1 d t s 3 t _ x �m x ,. _.,.,,, ..a ..... ,., _ ,....., ,y,. ..., x ,.,...»......,,,., � ...d ,. °..,.. , e.......,....»e�...., J..�w S d Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application 15 Box 7302 PO SeonS,� Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce p (Submit completed form to county if not (Privacy Law, s. 15.04(1)(m)j state owned.) Attach complete plans (to the county copy onl y}forfhe'i*systefil on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number, [] if revisioN w previous application State Plan I. D. Number I. Application I nformatio n - Please Print all Inforniatigtt sti.. "- Location: Property Owner Name Property Location " f 0 c� 4;" p �, 1/ I/4, S T,3 ,N, & Property Owner's Mailing Address ? Lot Number Block Number Zc °� TY City, State Zip ode 8�umbe - .� Subdivision Name or CSM Number / II. Type of Building: (check one) ❑ City k 1 or 2 Family Dwelling - No. of Bedrooms: ❑ _Yillage �Q -y� ❑ Public /Commercial (describe use): eq own of din E'r� -c ❑ State -Owned Nearest Parcel Tax N ,2_ /pp III. Type of Permit: (Check my one box on line A. Check box on line B if applicable) 2 . 3W./f. 3 New 2. eplacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 9Pressurized N- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment A rea Infor - 2 - 5,' 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed S - / y Rate (Gals. /day /sq. R.) (Min. /inch) T — / Elevation r� VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ A9 0 0 VIII. Responsibility Statement I, the undersigne assume re sponsibility for installation of the POWTS shown on the attached plans. Plum 's Name (print) Plumber' ignature (no stamps): MP/MPRS No. Business Phone Number P u Address (Street, City, StalF, Zip Code IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issulm Agent ignature (No stamps) (Approved ❑ Owner Given Initial Adverse Surcharge Fee) //� Determination Z - C/ U (X Z & 1621 14d-, X. Conditions of Approval /Reasons for Disapproval: Qnd w0�Lj s, �< 4 do I x 1 'r eg p ey , tia° �/r 4 P(Z . 6, 34 - `fd'" Ik w oY; Q rade ld {M a (K 1� 3 St pe, rd-01. L4K Uer / iw 3 � c pIQ;r. o1C = G C SBD -6398 (R 07/00) D G PLOT PLAN �O .� ' y PROJECT. i° !^O y ADDRESS L 1/4 1 /4S /T N/R w TOWN `OUNTY MFRS Byron Bird Jr . 220527 DATE '� BEDROOM >� CONVENTIONAL XXX - Grade CONVENTIONAL LIFT HOLDING TANK LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE e; HOLDING TANK SIZE LOAD RATE/ AREA S # of chambers IL BENCHMARK V.R.P. p� f����js{ ASSUME ELEVATION 100' ❑ BOREHOLE O WELL sg,R,P, Vent SYSTEM ELEVATION Sidewinder High Cov Capacity Leaching Chamber with 17.2 of t ^2 2 per chamber —16, — Grade At Systern Long 34" Elevation 4 bed house CoRdI 50' Driveway o� �,( e B 40' 1 10' 30' Ob pi 62 W+ 60' 743 1 , B3 >400' to PL 40 >400' to PL B2 ao - al Wisconsin�epartmentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8, 192 "x 11 inches in size. Plan must include, but not limited to: vertical and honzgnt' reference point (6M), direction and Parcel I.D. percent slope, scale or dimensions, north Orow, and location and dlstarnpe to nearest road. Please pri t alb infor�'- wed by Date w. .,. Personal information you provide may be Used for secondary purposbs rivacy Law; . 15.04 (1) (m)). ZD O Property Owner l ; # operty Location ` i t t 1 ovt. Lot 1/4 1/4 S T FZ N E Property Owner's Mailing Address as of # Block # Subd. Name or CSM# City State Zip C e 4n� 0 City ❑ Village Wown Nearest Road �^ orncr c D al ( Y /� • � e'�^SC • Z New Construction Use4 Residential / Number of bedrooms Code derived design flow rate 1& GPD Replacement // Public or comme ial - Describe: Parent material / � c t Cc 7� Flood Plain elevation if applicable ft. General comments i / �� and recommendations: �r, Jr F —/ Boring # [] Boring C3 Pit Ground surface elev. ft. Depth to limiting factor 7©? 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. �^ *Eff#1 *Eff#2 ID A g�l .i r � L , r ❑ Boring # Boring `�D • D 4° 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Ile YX 2 N � // * 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 NaAe (Please Print) f Signature CST Number r os Addr s ��Ealuatlon Conducted Telephone Number SBD -8330 (R07 /00) I Property Owner Parcel ID # Page of Boring # ❑ Boring a rJ © 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 • '00 , 3 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit 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. *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.07 100) Soil Test Plot Plan Project Name Leo Crotty Byron P#d Jr. Address 2370 Cty Rd I Some Wi. 54025 CSTM #220527 Lot - Subdivision ---------- Date 6/12 S E 1/4 N E 1/4S T 3 1 N /R W Township Somerset Boring Q Well PL Property Line County S T. C ROIX ,BM or VRP Assume Elevation 100 ft top o slab at house #alt�BMtopof slab at we1197.2 System Elevation T-1 =88T -2=87.8 �,�H.R.P. same as B M 4 bed house CoRdI 50' Driveway e , �e t ►v.w�� j e SO �- /►vim dPa�h.-�:1' �(?, BI , 40' 36 k o Z =�o 10' 30' Ob pipe 62 50' 60' 15' B3 > �/�(� �' to PL 40' 2' >400' to PL B2 J ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have ins ected the septic tank presently serving the c rd T residence located at: Section T, R�� W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: of G Did flow back occur from absorption system? Yes _ Z No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concret Steel Other Manufacturer: (If known) : Age of Tank (If known).: 4�� — ' r �; z' , (Signa re) (Nam d Please print (Title) (License Number) & Date - -� Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name r Signature , MP /MPRS d s aj ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNE RRSHIP CERTIFICATION FORM Mailing Address ®� Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number Ll , : (;Al, DESCRIPTION Property Location t /a, _� /4, Sec., T > -R�, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �` fg Volume , Page # Spec House ❑yes C no Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a rnraster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system i s in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been aintained must be completed and returned to the St. Croix County Zoning Office within 30 Jays of = piration t . S1GNA I' APPLIC T DATE OWNER CERTIFICATION I (we) certify that statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the propert escribed ab , by rtue o a rranty deed recorded in Register of Deeds Office. ;7 S1 KT- OF APPfICANT 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 POINTS OWNER'S MANUAL at MANAGEMENT PLAN Pa of — FILE INFORMATION SYSTEM SPECIFICATIONS P iintz Owner ' y Septic Tank Capacity jo s o gal ❑ NA Permit # Septic Tank Manufacturer ee / ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms Ll ❑ NA, Effluent Filter. Model ❑ NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) p gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) S gal /day Pump Manufacturer ❑ NA Soil Application Rate ; 'L gal/day/ft' Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil a Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality ❑ NA Monthly average ** Manufacturer Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L On- ground (gravity) ❑ In- ground (pressurized) Totai Suspended Solids (TSS) 530 mg/L At -grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/ 100 m 1 ❑ Drip-line ❑ Other. Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months fiiryear(s) ( Maximu yrs. Pump out contents of tank(s) When combined sludge and scum equals one -third ()S) of tank volume i Inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Clean effluent fllter At least once every ❑ months )i�year(s) Inspect pump, pump controls ez alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every , ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ 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 Malntalner, 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 nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (%) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND 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 Page of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks. may fill above normal hlghwater 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: antlbiotics; baby wipes; cigarette butts; condoms; icotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation draln (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil, aaintina products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. 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 technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perfonmed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be'reconstructed in place following removal of the blomat 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 iMPn ACITH.t:. ADDITIONAL COMMENTS `. ezz POWTS INSTALLER POWTS MAINTAINER Name :^ ®rr sr s Name Phone l Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Mb f1l_ Agency - 4 rpo >: DOCUMENT NO. °'"ATE BAR OF WISCONSIN FOI'M 3 - 19N TNI• 9--F eesawio FOR 1019CORDINO DATA QUIT CLAIM DEED 450810 Ro! 849PAGE230 FOGISUR , 5 OFFICE '.' Viola R. Crotty, - - - a . iii 9 woman ...... .......... ............ $T. CROiX CO., WI ` ..... ....... ..... . . ........... ..........._. . • - -'- - '-- ..... "'•" ----- ...... Recd for Record .. .. . . . ................ .............. ... quit -claims to Leo S. Crotty and Darlene M Crotty,. AUG 221989 hu.s.band. and wife,- . her._ life - estate- in _ al 10:20 A. AA _ .............. V { ilryiBS► of Geed the following described real estate in ..... _ St_.- Cro- ixX .............. County, State of Wisconsin: p,TIRN TO The Southeast Quarter of the Northeast Quarter (SE} of NE}) of Section 3, Township 31 North, Range 19 West, St. Croix County. Tax Parcel No: A EYTN This, 5..<..:. homestead property. (is) (is not) ,r Dated this .. ..... - day of _ ----- 19_c_�.. (SEAL) . ...... ....(SEAL) Viola R. Crotty .(SEAL) ---------- _ - (SEAL) Y Y AUTHENTICATION ACENOWLEDGMENT Signature(s) of ..V -io1 a. .-R.-- _Cr- otty-- ------- ----- --- STATE OF WISCONSIN ss. -- ----- - - ---- --- -- -- - -- -- -- - - -- County. authenticated th_is_1.3 ---- day of.April------ 1g89__ Personally came before me this ..... .. .... .....day of /' • -, '1� - / l - • -- .......... ---- ---- --•---- --- 19........ the above named •. -os¢Ph P' Guidote Tr - - - - - -- - - -. -. - - - - -- - -- ------ - - - - -- - - - -- ---------------- - - - - -- ---- - - - - -- - ... TITLE: MEMBER STATE BAR OF WISCONSIN ..... ............. .. . ....... ' .......... - --- - --- (If not- -- --- --- --- ----- - -- authorized b - - y § 706.06, Wis. Stats.) to me known to be the person -.. _._. who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTFn 9V DOAR,.. DR11L.. & -. SK.OW..._. S.. C ._... Bo- 6 9 • - New Richmond -- W -- 54017 tiotary Public County, Wis. (Si-natu+•es may be authenticated or ackrowle icon. Both �f} Commission is permanent. l If not, state expiration are not necessary.) d tte: QUIT CLAIM DEED XT %TF. RAR OF WISl'ONSIN W'ac i. F gC Runk Co. Inc. FORM No. 1 — 198 2 Milwauk••e, VV u. i COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 800 - 962 - 5227 C3:1k ST. CROIX ZONING REPORT N0.2 34897/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 10/12/89 COURTHOUSE DATE RECEIVERS 10/11/89 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Leo S.6 Darlene M. Crotty LOCATIONS 2370 Cty Rd. I, Somerset COLLECTORS St. Croix Zoning SOURCE OF SAMPLES Yard spigot COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE —NS 5 ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE LAB TECHNICIANS Pam Gane Ctl ;L PL WI Approved Lab No. 19 n 0 CT { 3T cq V yOF .WDEVF/.p FNl ( 9 t J < Means "LESS THAN" Detectable Level Approved by2 I ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 i SEP25 W9 ST. CROIX COUNTY ZONING OFFICE "` ` 3T C �?1 x ,r Ct;�I/WTY St. Croix County Courthouse `, r "� ;;�, 911 4th Street Hudson, WI 54016 Z� f Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING- - - - - -- -FEE: $ 25.00 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 25.00 (Determines if system is properly functioning at time of inspection) Property owner's name Leo S. Crotty and Darlene M. Crotty Property owner's address 2370 Cou Trunk Highway I. Somerset, WI * .Legal Description 1/4 of the 1/4 of Section , T N -R Town of Somerset Lot Number Subdivision Name FIRE NUMBER 2370 LOCK BOX NUMBER N/A Color of house White Realty sign by house? NO If so, list firm: Water facet on well PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant and h been een so for some time the water r li ne must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case lease make proper arrangements with this P P P g office to ensure time when entry may be gained. Firm or individual requesting services: RANK_.UE SOMERSET /.Ar -ag— Re ardon Telephone Number 247 -3348 REPORT TO BE SENT TO: Rank of Somerset, Attn- Arlpnp P_ Rparrinn PO gn2 closing date _. • • &44 Signature ` ** LEGAL DISCRIPTION: a of NEa; EZ of NE',- of SE4 N 24 acres of SE' -, of SE! of Section 3 -31 -19 ORT"SOMERSET T.31N- -R.19W. 51 DL POLK -ST CRO /M P, � 4 � • J COUNTY b / /o.,..,00 /.e It•A4. /i " O 10"y Cu Co a :� t 4�.,fz LYfe/'st / /•, r/.Sa JS ,; k ,,. `� FERR. /2.5/ �c�kJ T•: !, a S^hic•R' /�)fql, /t.X Po 01 (� CAN N SMALL 9 c. hir /er � rz o i o • P /a/ `IC1 "J�h A� /Ptt T cTS _ 40 a I k � R.c% �j e ✓d r✓'r/ lchoch7r rrr' n S •,V �u4 • /s,// u7 � V, �VW� • $o 0 ° ` Porlu� f /'! 6)/]7//' k oC , G 'o nlon 4o y J m�a 6J s �.�vsc� �, i t P O \ • ?� �o rr 0 y U c .r•U!9c' UV' u 11 /c Fo 7a . d oh 9v0 Q t C /hem kf! a Char /es o och L! 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S g I 45l • �• n h 'Eu9enC, ' iT • a v Hna//n Zswckcy /la/9con • u . .nLRAr. 70 h k,( p .,j 57• i;@ 2 � N o Joe (DOr!/!6 !_oua e 1 •r- � V X0 Sh � 4 : °' ° � KPF'e / _ ,n P .I,A q. "\ • zoo. v.. a\ Dawn s Lw 9i 2 ! �i c Neu/lllNn o/K' G F a� p nsC /l 3 1 4 Ve.,.r�dn ✓aiv, E Le'o rrd ' "'' .mp C ,va a � g �co�� r fri�x"'� - / ' ,nda z2 ] s ond Codf J9 .Tdrr! N r e s ClJen W .s du d /l qie n �` v La Af 74 '� F redo A JN lM ./o Z4v ek y Wig / 5 ae w�aq /Yourr/,, JO J .LO cSar Pa:/- Yfc Drrrrh>/ do v 2 N7 1r / • vnit fia/]c.•� Dc✓4n /d A /.! /ell, P /a/ 6M 1NS i Bd j Vernon Mar/ n Oet/ /��/// :. . e I.. Jf /, . N r/ LO - O l4(r^ I'TS (• /a/ Lamlre 3 v r; 999 6M^ e e v F /eon ly b yU X 00 0 ti Flo k r J0 : •�- J �� oa r L u r- `O ✓9 \ 1 ✓s os . ra' :r; 00 /NE RT,� 33 `', rR� L 'J r - „ 64 G1 1.98& rpockford ^ "Pub /s, In� fC or Cou P✓ BANK OF LONDRY SOMERSET Lf1NVSCHP1nG -�--- Save With Us -- Help Build Your Community Black Dirt - Crushed Gravel - Driveways MEMBER FDIC; Landscaping - Fill - Blacktopping Phone: 247 -3.148 247 -3480 or 247 -3791 SOMERSET, WISCONSIN SOMERSET r _ 1. � � qo� 3 S E P 2 51989 ST. CROIX COUNTY ZONING OFFICE C€ANT� / r 0� St. Croix County Courthouse G O I 911 4th Street ,' /, Hudson, WI 54016 • =I 4� Si Uk 1 Telephone - (715)386 - 4680 The Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. k:ompletion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 25.00 (Determines if system is properly functioning at time of inspection) Property owner's name 1_eo S. Crotty and Darlene M. Crotty Property owner's address 2370 County Trunk Highway I, Somerset. WI .Legal Description 1/4 of the 1/4 of Section , T N -R Town of Somerset Lot Number � Subdivision Name FIRE NUMBER 2370 LOCK B X N/A color of house White Realty sign by house? No If so, list firm: Water facet on well PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: RANK OE SOMERSET /Arlene R- Re ardon Telephone Number 247 - 31a.g REPORT TO BE SENT TO: Rank of Somerset, Attni Arlene P_ Raardnn Pn Rnx X 20 'S'�A1rE .. .' .� Signature i 1 - 19 r E LEGAL DISCRIPTION: a of NEB'; Ej of NEB' of SEA N 24 acres of S I of SE�r o f Section 3 - ST. CROIX COUNTY �M F WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 October 9, 1989 Bank of Somerset - Arlene Reardon P.O.Box 220 Somerset WI 54025 Dear Ms. Reardon: An on site investigation of the septic system on the property of Leo and Darlene Crotty at 2370 County Highway I, Town of Somerset was conducted on October 9, 1989. At the same time I also obtained a water sample and submited it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance.of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J k'ns Asst. Zoning Administrator