HomeMy WebLinkAbout032-1008-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
552384 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:
Hillview Dairy LLC, C/o William Haase Somerset, Town of 032-1008-50-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
13 M ( 65 04.31.19.51
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z ' Benchmark 1XI
Dosing Alt. BM
GF' io g' 9'3.z
Aeration Bldg. Sewer Q7
Holding St/Ht Inlet
Iz. 7 ~ 7• Z
TANK SETBACK INFORMATION St/Ht Outlet f 2.91
TANK TO 1 P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 84 / /7,T / I/ 7 ) Dt Bottom _
Dosing ' Header/Man. 1/4- O "FT -7
Aeration Dist. Pipe IT6
9
S7
Holding Bot. System /S I
Final Grade
PUMP/SIPHON INFORMATION ta4- 8-7-
I
Manufacturer Demand St Cover
GPM t 8`.G5 9',3
Model tuber
TD Lift Friction Loss System Head DH Ft
Force main is. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ✓;(7 Z
SETBACK SYSTEM TO ~ P/L BLDG WEELLLU LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR V
6 ~
Type Of System, + ~A UNIT Model Number
~ Q ,/VILr ~,+V7 4
DISTRIBUTION SYSTEM /JarA.- 17,f-)-7 P wJS
Header/Manifold/ i/ Distribution x Hole Size Ix Hole Spacing Vent to Air Intake
iLength__'7 Dfa Pipe(s)
Length \ Dia \ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Dept of xx Seeded/Sodded xx Mulched
BedlTrench Center , / Bedrrrench Edges Topsoil Yes- 0 No Yes No 13 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection `#1: /
/ Inspection #2:
Location: 2367 & 2371 45th Street Somerset, WI 54025 (SW 1/4 NE 1/4 4 T31 N R1 9W) 40 acres Lot Parcel No: 04.31.19.51
1.) Alt BM Description= I "Do V.- 5jc wJ 6 4- 4je
2.) Bldg sewer length= 1►Cx~ ~rF-,~ n J Otl5e5n lJd-~(1- u,~~ ; \ ~^a~ a~_' Ckl- -~C~
- amountofcov r eG, ,I .o.
/56
Plan revision Required? Yes No 7~
Use other side for additional information. F' 4 _
SBD-6710 (R.3/97) Date Insep is Sign re Cert. No.
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RECEIVE Safety and Buildings Division -
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
"
JUN 222012 Madison, WI 53Z07-7162
y 5
~oFFasror*tii~ 1' l:ttUln
P ffni& erMlt AN., atlO1l State Transaction Number
afy
ppli In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmental unit 07 Z Y,/
t ma in
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Pro'e3 ct Address ( ren
than. il• Q addr9ss)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary rA4
purposes in accordance with the Privacy Law, s. 15.04 1)(m), Stats. 2 2 j s I. Application Information - Please Print All Information J
Property 917`er's//Name Paz el #
03Z- lade S6-00o 0
Property Owner's Mailing Address Property Location I S~
c2 3 (o l / f Si' Govt Lot
City, State Zi Code Phone Number r r
P ~y..1 /V Section
isre CAL ,3'V02-S circle one)
T 31 N; R EorW
II. Type of Building (check all that apply) Lot #
❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Block # ~IA-
Wpublic/Commercial - Describe Use 17
/ t? ❑ City of
El State Owned - Describe Use (102- CSM Number ❑ Village of
IR Town of cJ O I," f%C 5$ £ -f
III. Type of Permit: (Check o ox o A. Complete line B if applicable)
A. ❑ New System Replacement Syste ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New r' ~7
Before Expiration Owner pQ (2 y3 -(~O6>
IV. Type of POWTS System/Component/Device: Check all that a 1
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)h- Pretreatment Device explain)
V. Dispersal/Treatment Area Information: 41;_ cc-IF-t 5
Design Flow (gpd) Design Soil Application Rate( Dispersal Area Required (s~ Dispersal ea Propos d (sf) System Elevatio _
3~3L. S < u ✓ C~3$ tom' ~4~oi ~OSI 8b.6
:~,j
VI. Tank Info Capacity in Total # of Man Adorer
Gallons Gallons Units a o
New Tanks Existing Tanks nns c g ° a c`"a
~E s~ l d ~G U vm n rn w c7 i=,
Septic Holding Tank 92- le w 6 ~j Gl w
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS show the attached plans.
pqjg
umber's Name (Print Plumber's Signature MP~MPWumber Business Phone Number
CL 1c£ Rw~i S w Z~Z~7~ ~l7Z- Zyzl
P umbers Address (Street, City, State, Zip Code)
VIII oun eDartment Use Only
Approved ❑ Disapproved Permit Fee 00 Date Issued Issuing Agent S gna
El Owner Given Reason for Denial $ / tj 2 2 /
11GMcU 1>QiFmlRApproval/Reasons for Disapproval '.3 /i!t
Septic tank, effluent filter and -
dispersal cell must all be serviced / maintained
/,~pOQ~~ ~p
as per management plan provided by plumber. ~ - / , -
All setback regtm~rlp~pl~ m}lte,rr~a inta/)
as era licabl``e''co``88e'77ordi~rnn n ~~J F' m 9 lai_ w4ro-'q& r' ~ 4b2 .SP 3. jj
Attach to complete plans for the system and submit to the County o on paper not less th 8 In a 11 inches in size
SBD-6398 (R 11/11)
` -yAR~arE Safety and Buildings
10541 N RANCH ROAD
>5 s HAYWARD WI 54843
D ' Contact Through Relay
3 $ P www.dsps-wi.gov/sb/
www.wisconsin.gov
fi
A~O~ssroINAL'~ Scott Walker, Governor
Dave Ross, Secretary
June 19, 2012
CUST ID No. 222872 ATTN: POWTS Inspector
JACQUE M HAWKINS ZONING OFFICE
HAWKINS PERC TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA
2659 150TH ST 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 06/19/2014 Transaction ID No. 2092411
Site ID No. 780049
SITE: Please refer to both identification numbers,
2367 45TH St Dairy LLC above, in all cones ondence with the agency.
2367 45
Town of Somerset, 54025
St Croix County
SW1/4, NEIA, S4, T3 1N, R19W
FOR:
Description: Non pressurized in ground, 1 bedroom, 1 floor drain, 10 employees
Object Type: POWTS Component Manual Regulated Object ID No.: 1374865
Maintenance required; Replacement system; 383 GPD Flow rate; 118 in Soil minimum depth to limiting factor from p.0.
original grade; System(s): In-ground POWTS Component Manual, SBD-10705-P (N.01101); Effluent Filler COn (tL
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed Ap P
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. ON OF S
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
SEE COR
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.0b!
stats.
/ The following conditions shall be met during construction or installation and prior to occupancy or use:
Key item(s)
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in the "In-Ground
Soil Absorption Manual System" are complied with. A copy of this information must be given to the owner
upon completion of the project.
• This approval does not include plans for the general plumbing systems or sewer piping leading to the
septic/holding tank that may be required for this project. See section SPS 382.20, Wis. Adm. Code, to
determine if plan submittal and approval is required.
• SPS 383.02. This appr~v_al cnverc only the domestic wastewater directed into the POWTS. The Department of
Natural Resources must be contacted regarding the treatment and disposal of non-domestic wastewater,
including those mixed with domestic wastewater. Please refer to the following website for more information:
hM://www dnr state wi us/orgJcaer/cea/co pliance/auto/wastewater.htm#septic.
• The gravelless system components must be installed in accordance with the manufacturer's printed instructions,
the plan approval, and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's
instructions and the plan approval, the plan approval and code requirements will take precedence.
JACQUE M HAWKINS Page 2 6/19/2012
• The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation
of float switches or relays that contain mercury.
• The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to
the filter for cleaning must be provided per ss. SPS 384.25 (7) and (8),Wis. Adm. Code product approval
conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of
the filter is required. The outlet filter shall be installed per product approval stipulations.
Reminder
• Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance,
material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and
ch. 145, Stats.
• Surface water drainage shall be diverted away from the system area.
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
• Insulate building sewer per SPS 382.30(11)(c).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addresse rovide a copy of this letter and the POWTS management plan to the owner and any
others who are re nsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shand
POWTS Plan eviewer tegrated Services WiSMART code: 7633
(715) 634-78 0, Fax• 7 5) 634-5150 , M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@ . onsin.gov
cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
a
1-5
Index and Title Sheet
Project: Hillview Dairy Sanitary System
Property Owner Hillview Dairy LLC.
Address: 2367 45th Street
Somerset WI 54025
Legal Description: SW1/4-NE1/4
Sec. 4 T3 IN - RI 9W
Township: Somerset County: St. Croix
Subdivision Name: NA Lot: NA
Comp. #/Parcel ID: 032-1008-50-000
CONTENTS
Page: 1 Index and Title Sheet
Page: 2 Plot Plan and Plan View
J T
Page: 3 Sizing Calculations
panCLily
ED
Page: 4 Cross Section of Cells 1 + 20 V
Page: 5 Maintenance and Management Plan ;ed
~ESPO N
Attachments : Copy of Soil and Site Evaluation r
In-Ground Soil Absorption Component Manual Used = SBD-10705-P (N.01/01)
Plumber : Jacque Hawkins License # 222872
Signature. Phone # (715) 472-8446
Date: 5/16/12
REC iO ®
MAY 18 2012
SAFETY & BUILDINGS
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Page 3 of 5
Sizing Calculations for the Hillview Dairy
The Hillview Dairy is replacing the sanitary system for their milking parlor. The system
sizing will include the following:
1. 10 Employees x 13 gals. = 130 gallons
2. 1 floor drain x 25 gals. = 25 gallons
3. 1 bedroom x 100 gals. = 100 gallons
Total estimated gallons = 255 x 1.5 design factor = 382.50 DWF
Septic Tank Sizing = 382.50 gallons x 2.088 = 798.66 gallons 1000 gallon tank proposed.
w N N Page 4 of 5
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Page r of .5 1
POWTS OWNER'S MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
OWNER Hillview Dal LLC. Septic Tank Capacity 1000 Gal.
PERMIT # _3 45 ZO i v Se tic Tank Manufacturer Skaw Concrete
Effluent Filter Manufacturer Best
DESIGN PARAMETERS Effluent Filter Model GF-10-8
Number of Bedrooms 1 Bedroom Pump Tank Capacity Na
Number of Commercial Units See Sizing Secs. Pump Tank Manufacturer Na
Estimated Dail Flow 255 gal/day Pump Manufacturer Na
Design Flow Peak Est. x 1.5) 382.50 gal/day Pump Model Na
Soil Application Rate .6 Uda 1ft2 Pretreatment Unit n/a Influent/Effluent Quality Monthly Average ► Sand/Gravel Filter I Peat Filter
Fats, Oils & Grease (FOG) 30 mg/L Mechanical Aeration Wetland
1 1
Biochemical Oxygen Demand (BOD5) 220 mg/1- Disinfection Others:
Total Suspended Solids TSS :5150 mg/L
Pretreated Effluent Quality n/a Monthly Average Dispersal Cell (s) 2 cells (pressurized)
At--gradeground gravity ; Mound
Biochemical Oxygen Demand (BODS) < < 30 30 mm~L 1 X in
I In-ground Total Suspended Solids (TSS) -
Fecal Coliform (geometric mean) 104 cfu/100m1 1 Drip-line 1 Other:
Maximum Effluent Particle Size '/R inch diameter Quick 4 Standard-W Chambers Eisa of 20 sq. ft.
MAINTENANCE SCHEDULE
SERVICE EVENT SERVICE FREQUENCY
Inspect condition of tank s) At least once eve I months 3 ears azimum 3 ears
Pump out contents of tanks When combined sludge and scum equals one-third s of tank volume
Inspect dispersal cells At least once every months 3 year (s (Maximum 3 ears
Clean effluent filter At least once every I months 1 year or as needed
Inspect pump, um controls and alarm At least once eve months 1 ears n/a
Maintenance Instructions
Inspections of tanks and dispersal cells shall be made by a individual carrying one of the following licenses or certifications: Master
Plumber; Mater Plumber Restricted Sewer; POWTS Maintainer; Septage Servicing Operator. Tank inspection 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
authority.
When the combined accumulation of sludge and scum in any tank equals one-third(/ O 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, pretreatment 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 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.
2
During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be
discharged to the dispersa'. 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 of the 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.
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. SPS 383.33, 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:
S 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 structures, 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 rules
in effect at that time.
T A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
',*The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be
installed as a last resort to replace the failed POWTS.
Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
< Warning> Septic, pump and other treatment tanks may contain lethal gasses and/or insufficient oxygen. Do not
enter a septic, pump or other treatment tank under any circumstances. Death may result. Rescue of a person
from the interior of a tank may be difficult or impossible.
Additional comments: The contingency plan could be to remove the biomat causing system failure and
replace with Astm C 33 Sand, then clean or replace leaching chambers. This may require an individual
site design and state plan approval.
POWTS INSTALLER POWTS MAINTAINER
Name Jac ue Hawkins Name
Phone 715 349-5533 Phone
SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORITY
Name Raska Se tic Service Name St. Croix Co. Zoning
Phone 71 755-4888 Phone 71 386-4680
` ,~~CE~VED
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Wisconsin Department of Commerce q SOIL EVALUATION REPORT Page / of .3
Division of Safety and Buildings ~Ul 2 2 ZQA L
in accordance with Comm 85, Wis. Adm. Code
r tC County 54, C."R o
Attach complete site plan on paper'.O til§-~gf314.*q)?1 x 11 inches in size. Plmust
include, but not limited to: veRidaN orizontal reference point (BM), directiss Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and dist• e 0 3 Z -/6G8 --V ~O 6 0
qllilklk
Please print all information. Re ewed by /Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Propertner Property Location
;Vj'l f V i Do, ,2 Govt. Lot 5-w 1 /4 N f 1 /4 S T N R/ 9 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
a 3 C, -7 -/"5- -~h jt~
City State Zip Code Phone Number ❑ City ❑ villa e ETown Nearest Road
❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD
Replacement ❑ Public or commercial - Describe: F /c* 4 X21- j 7 ' lde I- <14 ti ) A-1
Parent material Flood Plain elevation if applicable ft•
General comments
C J
and recommendations:
Boring # Boring p c'
F/-1 Pit Ground surface elev. / Z • J ft. Depth to limiting factor > l 7- 0 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
d2 e-aj s® f t6 /c- / A t W i 7
J ~s'fo`i7-~~yiY rmrbK w - , Z 3
Boring # El Pit Boring > j
P Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
v
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
v-P - `f • 7
//7' e? t~K Vdp 13
7i zi D y~C.y~ Y O - o Z
* Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Na a (Please Print) J Signature CST Number
C? 4 t / a ki.t S l 2, Z'-877
Address Date Evaluation Conducted Telephone Number
ZL~ 5 9 J- YB-3 `/7Z-BI/Yb
1
Property Owner Parcel ID # Page of
Boring # r❑y Boring 9!
Pit Ground surface elev. ` g ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
,2 -3o !D ,c 113 / lz4k w /V-r
❑ 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
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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)
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Apr-16-2012 02:12 PM St. Croix County Plan/Zoning 715-386-4686 18/18
1 2873? 498 aizzt-az-o
STATE BAR OF WISCONSIN FORM 3 - 2440 KATHLEEN H. ifAt,SH
QUIT T ' CLAIM DEAD REGISTER OF DEW
Document Number ST. CROIX Co., M1
This Deed, made between WILLIAM W. BA_ ASE_and OPAL H. RECEIVED FOR REr. 0
HAASE, HUSBAND AND WIRE AS TENANTS IN COMMON, AN W/24/29f5 19: ISAR
IJNDTVIIII?D ON&•HALF IMREST TO EACH. QUIT CLAIM DECD
- rtlp: #
Gmntor, and HILL VIEW DAIRY, LI.C, A WISCONSIN LIAJTlED
REC FSEs II.~O
LIABII,M COMPANY, --TRANS rn
COPYY It =
CC FEE;
Graatrt. PAGES: i
Grantor quit claims to (3rantee the followhig desalbed seal estate in
ST. CROIX Cotmty, State of Wisconsin (if wore
apace h neoded, please attach addendum):
Southwast Quarter of the Nortkeatt Quarter (SW14 of PtX* of Ssedoo Fear
(4N Towashtp'1 Thirty-One (31) Nort), Ratige Ttliedets (IR) West. Recording Area
Now as Retnm A ress
St. Cralx County, Wfsconsta LEO A. BESKAX
RODLI BISKAR DOLES & KRU&GER, S.C.
219 NORTH MAIN STREET, PO 13OX lag
RIVER FALLS, WI 64022
Parcel Iden0c0on Number (PDI)
This h homestead property.
(is) ( }
together with all appuuWant rights, title and hiterssts.
Dated ihie in day of 0CTO=R 2404 .
* WILJAAM W. HAASE
AUTN"TICATION ACKNOWLEDGMENT
Signature(s) WILLIAM W. HAASE and OPAL H. Ii<AA$ STATE OF )
} ss.
County )
tvi auduss In dsy of Oi .2004 Personally came before me thk day of
dwabove named
Leo A. r
TITLE: MEMBER STATE BAR OF WISCONSIN to me Imowa to be i4se p*xo{s} 4D exeautea the fbre$o'sng
au not, instrurtiemt and eakmowiedged the same.
utiumsed by ¢ 706.06, Was. S=.) TMS DaMUTAENT WAS DAAP= BY
ILEG A. BEM UR Nowy Public, State of
RODLI HESKAR DOL 93 & XIMEGER, S.C. My Cotttttdasion is pemmne t. (if not, state axplratien dabs:
(3l~nturm nql` be rrttamtluud or aetemtvledbsd. Baer aro mateeaeurx~l.} +
Now of persons siplag in any capachy umbe typed or ptiod below '2r slgas zL
STATE EAR OF WISCONSIN WO-PP-0
tsBDia f w.nuWapro[amscam
QUIT CLAIM DEED FORM No. 3 - 3000
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Parcel 032-1008-50-000 12/10/2010 08:43 AM
PAGE 1 OF 1
Alt. Parcel 04.31.19.51 032 - TOWN OF SOMERSET
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - HILLVIEW DAIRY LLC
HILLVIEW DAIRY LLC
324 230TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2367 45TH ST
SC 4165 SCH DIST OF OSCEOLA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 4 T31 N R19W 40A SW NE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-31N-19W SW NE
Notes: Parcel History:
Date Doc # Vol/Page Type
02/17/2010 912000 EZ
07/24/2009 900769 EZ
08/24/2005 804339 2873/498 QC
10/04/2004 775964 2668/35 EZ-U
more...
2010 SUMMARY Bill Fair Market Value: Assessed with:
63309 Use Value Assessment
Valuations: Last Changed: 10/12/2010
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 30.000 4,200 0 4,200 NO 05
OTHER G7 10.000 53,000 525,200 578,200 NO 05
Totals for 2010:
General Property 40.000 57,200 525,200 582,400
Woodland 0.000 0 0
Totals for 2009:
General Property 40.000 48,400 589,400 637,800
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
Jisconsin Department of Commerc& PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
488043 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ~l
Personal information yo provide may be used for secondary purposes [Privacy Law, s.1 5.04 (1)(m)). (ZZ 3 '~7w5• /,64)
Permit Holder's Nam
city Village X Township Parcel Tax No:
VIE 1 (C Somerset, Town of 032-1008-50-000
,
Hasse, Bill .
K P/ L/ L
-16114A
CST BM ElevK Insp. BM Elev: BM Descripti : Sectionrrown/Range/Map No:
Ca• 0 OtD • p ' 04.31.19.51
TANK INFORMATION ELEVATION DATA
TYPE ANUFACTURER CAPACITY STATION BS HI FS ELEV.
PL s2
Septic Benchmark /
lva %60 3 2 t3v . v
Dosing Alt. BM
Aeration Bldg. Sewer ~•r
Holding St/Ht Inlet s I I
.~3 I -r-
St/Ht Outlet /
TANK SETBACK INFORMATION .S. 00
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
~ r Dt Bottom
Septic ' t 576 /00,
Dosing Header/Man.
Aeration Dist-~f to p~ b r
Holding Bot. System rio 1 S'
. (0
PUMP/SIPHON INFORMATION Final Grade t
Manufacturer Demand St Cover
GPM 2. EM
Model Numbe
TDH Lift icti oss System Head DH Ft
Dia. ell
Forcemain r110 I F
SOIL ORPTION SYSTEM 9 a-A
,rS RENC Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufa
INFORMATION CHAMBER OR
Type Oc f SYS~ , t j UNIT Model Nu~gr.
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size le Spacing Vent to Air Intake
)9' - -7
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes j No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: IZUZOQ Inspection #2:
Location: 2371 45th Street Somerset, WI 54025 (SW 1/4 NE 1/4 4 T31N RI 9W) 40 acres Lot Parcel No: 04.31.19.51
1.) Alt BM Description = N/A'
2.) Bldg sewer length = (p 1
- amount of cover = S-J ta&UA,-
Plan revision Required? Yes No '
Use other side for additional information. __l
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
Safety and Buildings Division County
AN m 201 W. Washington Ave., P.O. Box 7162
isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
De artment of Commerce (608) 266-3151 4/? F0 3
anitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 62 2 3 ^ "12tNS • W*)
be used for secondary purposes Privacy Law, s15.04 I m) ject Address (if different than mailing address)
L Application Information -Please Print All Information 7 Lit IF\ :U
Property Owne 'sNamid DEC 2 ¢ 2005 a # Lot # Block #
Property Owner's ailing Address ST. OIX COUNTY Property Bocation
Section _
City, State Zip Code Phone Number
(circle
24 T_ N; R_/LE o
II. Type of Building (check all that apply)
#lubd»tisieri Nw"e ESM-P>uabx
❑ 1 or 2 Family Dwelling - Number of Bedrooms / _
~D • d Gt uL-
XPublic/Commercial - Describe Use 144 19Ai • 0144A)
❑ State Owned - Describe Use ❑City,❑Village Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) c)-!>Z- )Dp g _ 50 _ , 5-
A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply)
X 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 Leaching Chamber Drip Lin ❑ Gravel-less Pipe ❑ Other (explain)
V. Dispersal/Treat ment Area Information: Y -Q A -Sp / W 61
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
5.
VI. Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing `
Tanks Tanks
Septic or Holding Tank / -
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber' ame (Print Plum s Si MP/MPRS Number Business Phone Number
tier's Address ( treet, City, S Zi Code
VIII. Coun epartment Use Only
X Approved ❑ ved Sanitary Permit Fee (includes Groundwater Date Issued Issu. g Agent Si (No Stamps)
Surcharge Fee)
❑ iven Reason r Denial'
IX. Conditio of Ap r Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Attach compl to plans (to the County only),for the system on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 01/03)
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Safety and Buildings
4003 N KINNEY COULEE RD
commerce.wi.gw LA CROSSE WI 54601-1831
,tic TDD (608) 264-8777
s c O n s' www.commerce.wi.gov/sb/
www.wisconsin.gov
epartment of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
December 19, 2005
CUST ID No. 224263 ATTN: POWTS Inspector
KIM A O CONNELL ZONING OFFICE
K.O. CONSTRUCTION ST CROIX COUNTY SPIA
504 3RD AVE 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 12/19/2007 Identification Numbers
Transaction ID No. 1223380
SITE: Site ID No. 708355
Bill Hasse Please refer to both identification numbers,
45th Street above, in all correspondence with the agency,
Town of Somerset
St Croix County
SWIA, NEIA, S4, T3 IN, R19W
FOR:
Description: Commercial (Ag Operation) Non-pressurized In-ground System
Object Type: POWTS Component Manual Regulated Object ID No.: 1055940
Maintenance required; 96 GPD Flow rate; 78 in Soil minimum depth to limiting factor from original grade;
System: In-ground POWTS Component Manual, SBD-10705-P (N.01/01); Commercial System, Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06 CO~`Fd1i IOl
i
stats. p''
The following conditions shall be met during construction or installation and prior to occupancy or use: DER TMENT OF
OF~EY i
Reminders
CORRESF
SEE
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manuals listed above.
• The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan
approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the
manufacturer's instructions and the plan approval, the plan approval and code requirements will take
precedence.
• The plumbing for this project discharges to a private sewage system. The approval covers only
domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted
regarding the treatment and disposal of all industrial wastes.
• State and federal regulations prohibit the discharge of hazardous wastes to a private sewage system. Accidental
discharge of any hazardous substance to a private sewage system must be reported to the Department of Natural
Resources or'the Wisconsin Division of Emergency Government.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
'KIM A 0 CONNELL Page 2 12/19/2005
I
• A Sanitary Perniit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated
county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat
• Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on-site during construction
and open to inspection by authorized representatives of the Department which mqy include local inspectors.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS. '
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WSMART'code: 7633
(608)789-7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544
r
RECEIVED
DEC 1 6 2005
SAFETY .
BUILDINGS
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12 MIM. ft-,~ F FIAIRL GRADE.
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PO'WTS OWNER'S MANUAL & MANAGEMENT PLAN Page _--r of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity 91111)0 al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms JS NA Effluent Filter Model - ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity al aNA
Estimated flow (average) gal/day Pump Tank Manufacturer IHNA
Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer )Zf NA
Soil Application Rate gal/day/ft' Pump Model IS NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit )--NA
Fats, Oil & Grease (FOG) !530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODr,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s).. _ Q NA
Biochemical Oxygen Demand (BODS) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) S30 mg/L 19 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: ❑ month(s) (Maximum 3 years) ❑ NA
'year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
O year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
0 year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) O~NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) IS NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
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 (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
• Page ell of
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 permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits 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 performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALL POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name 771 Name
Phone _
Phone
This document was drafted in compliance with chapter Comm 83.22(21(b)(11(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Wisconsin Department of Commerce OIL 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 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please p fRevli4ved by Date
Personal information you provide may be u d -..=a y La , a. 15.04 (1) (m)). . 2~
Property Owner Property Location
L-Z DEC 2 7 2005 Govt. Lot 114 1/4 S T N R(or
Property e s ailing Add Lot # Blo # Subd. Name or CSM#
ST. CROIX COUNTY
City Sta, Zip C P11191116 NUFA ❑ City ❑ Village ~D Town Nearest Road
New.Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations: S~s Ent 14
Boring #
F-/ I Boring
fZ pit Ground surface elev. ,2Z75 ft. Depth to limiting factor cT8 in.
So{{ tian Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munseit Qu. Sz. Cont. Color Gr. Sz. Sh. *EfftP1 *Eif#2
9 4'
9 4
2V-G3
Boring # Boring
® Pit Ground surface elev. gj qD ft. Depth to limiting factor 7A in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
e- C
r
4 y
* Ertl t #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L * ent #2 = BOD 130 mgA- and TSS < 30 mg/L
CST N Signature CST Number
Address - Date Evaluation Co ucted Telephone Number
i
1
K
Property Owner : Parcel ID # Page of
Boring # ❑ Boring
® pit Ground surface elev. 14- G ° ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f'
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
a
7 -T-
cJ
a p
• L Z
❑ 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 GPDMI
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *002
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ff. Depth to limiting factor in.
Sol lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *0#2
* Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < ISO mg/L * Effluent #2 BODS < 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.07l00)
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
1
Mailing Address - ,
Property Address C
(Verification required from Planning & Zoning Department for new construction.)
City/State „ - e7L Parcel Identification Number 03 Z - / LU - S~ - T&O
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LEGAL DESCRIPTION
Property Location_ 1/4 '/4 , Sec. , T l N R W, Town of
Subdivision ~b_ ,y 4litk- G~c , Lot #
Certified Survey Map # Volume Page #
Warranty Deed # Volume `(0 ! , Page # Or
Spec house yes Lot lines identifiable '`yes o
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle roastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/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 maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Nuul~ er of ed ms
SI ATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
I
2 6 Z 3 P 4 9
STATE BAR OF WISCONSIN FORM 3 - 2000 KATHLEEN H. WALSH
QUIT CLAIM DEED REGISTER OF DEEDS
Document Number ST. CROIX Co.. WI
This Deed, trade between WILLIAM W. HAASE and OPAL H. RECEIVED FOR RECORD
HAASE, HUSBAND AND WIFE AS TENANTS IN COMMON, AN 08/24/2005 10:15AN
UNDIVIDED ONE-HALF INTEREST TO EACH.
QUIT CLAIR DEED
Grantor, and HH,LVIEW DAIRY, LLC, A WISCONSIN LIMITED REC FEE : 1 I.00
LIABILITY COMPANY, TRANS FEE:
COPY FEE:
CC FEE:
PAGES: 1
Grantee.
Grantor quit claims to Grantee the following described real estate in
ST. CROIX County, State of Wisconsin (if more
space is needed, please attach addendum):
Southwest Quarter of the Northeast Quarter (SWI/, of NEIK) of Section Four
(4), Township Thirty-One (31) North, Range Nineteen (19) West. Recording Area
St. Croix County, Wisconsin Name and Return Address
LEO A. BESKAR
RODLI BESKAR BOLES & KRUEGER, S.C.
219 NORTH MAIN STREET, PO BOX 138
RIVER FALLS, WI 54022
032-1008-50
Parcel Identification Number (PIN)
This is homestead property.
(is) (isxttx)
Together with all appurtenant rights, title and interests.
Dated this 1st day of OCTOBER 2004
+ WILLIAM W. HAASE
Ow /V
• * O AL H. HAASE
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) WILLIAM W. HAASE and OPAL H. HAASE, STATE OF )
) ss.
County )
authen
ti& n this 1st day of C OBER , 2004 Personally came before me this day of
the above named
• Leo A. r
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. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY •
LEO A. BESKAR Notary Public, State of
RODLI BESKAR BOLES & KRUEGER, S.C. My Commission is penrtanent. (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.
STATE BAR OF WISCONSIN
QUIT CLAIM DEED FORM No. 3 - 2000 INFO-PRO (500)855-2021 www.infoproforms.com
F SOMERSET `N°' PLAT T-31-N • R-20-19-W ~
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180th AVE SOMERSET'S' PAGE 62 180th AVE
"The Real Estate Guys" RF/,MW
Team 1 Realty
Buying or selling on this page David Bracht & Jack Harrison
712 Rivard Street, Suite 100 E
or Any other page call Somerset, Wisconsin 54025
Dave & Jack! Office: (715) 247-5900
Toll Free: (888) 223-3283
"You've got a friend Fax: (715) 247-4880
Dave's e-mail: dbracht@daveandjack.com
in the business" Jack's e-mail: jarrison@daveandjack.com
Website: www.davidbracht.com'
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