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Home My WebLink About032-1032-30-075 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SaNaty and Building Division INSPECTION REPORT Sanitary Permit No: 506360 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 Plourde Richard Somerset, Town of 032 - 1032 -30 -075 CST BM Elev: Insp. BM Elev: BM Description: R Section /Town /Range /Map No: f6 �bQ M GS ( 11.31.19.154A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L ) 3 0 ✓ % / Z Benchmark Alt. BM 1 7-S Aeration Bldg. Sewer 9A Holding St /Ht Inlet `33 7r r ( a TANK SETBACK INFORMATION St/Ht Outlet J T TANK TO R P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet O ` Septic Dt Bottom 7 Sao �A„ z� 3'1 ^ Dosing Header /Man. Aeratio Dist. Pipe 835 9 Z ZS Holding Bot. System + C , 33 Final Grade / 7 PIJMP /SIPHON INFORMATION 1 j'S Manufacturer Demand St Cover C1 Go Model er TDH Lift Friction Loss System H TDH Ft Forcemain Leng la. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches ches 1 PIT DIMENSIONS No. Of Pit Inside Dia. Liquid D tth DIMENSIONS Q 3 �I` _ ..1. n /� — \ U """��„"..."' """.+.�� ""111 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufactures, INFORMATION CHAMBER OR TypgOf tem: – 7/0 ie j Aj r �/� _ UNIT Model Nu fiber J<- 41 DISTRIBUTION SYSTEM 17 -1 F = S/ Header /Manifold 1� Distribution x Hole ¢e x Hole pacing Vent to Air I take It Pipe(s) c3 C' B 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 xx Mulched Bedfrrench Center - ! Bed /Trench Edges \ Topsoil \ Yes No Yes No 3 1 \ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 625 222nd Avenue Somerset, WI 54025 (SW 1/4 SW 1/4 11 T31 RI 9W) NA Lot Parcel No: 11.31.19.154A10 1.) Alt BM Description = � G6ve �i Z.. G0 j 2.) Bldg sewer length = 30 - amount of cover Plan revision Required? Yes No ,S Use other side for additional information. l Date Inse tor's S' Pure Cert. No. SBD -6710 (R.3/97) I r commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Iti L", �- s eo n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Depertmerrt of CornmerCe ? - 1., t Sanitary Permit Application tate Transaction Nt}m er In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approprta e gov ernmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information yo Vida tnay p urposes in accordance with the Privacy Law, s. 15.04(l) m , Stats. I. Application Information — Please Prin Al Information 2 Property O is Name Parcel # OCT 0 5 200 X, Prope Owner's Mailing A dress Property Location ST. CROIX COUNT J Govt. Lot E City, State Zip Code o — t /., S 1) y., Section l' circle one T —?/ N; REo iI. Type of Building (check all that apply) / Lot # I or 2 Family Dwelling — Number of Bedrooms $1lhdtvisleu Alatgp Block# ❑ Public /Commercial —Describe Use 'c ,... .o L. e •`'" ❑ City of i r ❑ El State Owned — Describe Use CSM Number Village of Town of intx°SE r tit i i ,°---- -- _._-__- 111. Type of Permit: (Check onl f one box on line A. Complete line B if applicable) RB. New System ep4cfli" $Xstym El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) ❑ P ermit Renewal ❑ Permit Revision El Permit Transfer to Ncw Change of Plumber List Previous Permit Number and Date Issued ❑ Before Expiration Owner IV. Type of POWTS S stem /Com onent/Device: Check all that apply) yNon- 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) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Ratc(gpdsf) Dispersal Area Required (4t) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 t y N New Tanks Existing Tanks °i ❑ :: i p w co Septic or holding Tanks" 7C Dosing Chamber VII. Respon ibility Statement- I, the undersigned, assume respo ibility for installation of the POWTS shown on the attached plans. Plumber s . me (P 'nt) C Plumber' Sign MP /MPRS Number Business Phone Number _ Plumber's Address Strcet, City, Statc, Zip Code j ),7 VIII. Coun /De artment Use Onl PProvcd Dia2ppTOVCd Permit Fee Date lqued : Issuing Agent Signature fl A .F ❑ Owner Given Reason for`f)cpial a i IX. Conditi Rs_&f easons for Disapproval ? a oMYIVER: r 1. Septic tank, effluent filter and dispersal cell must all be services I ftobikM as per management plan provided by pkpnbw. 2 AN adtback re(p*W lento must be MftftkM all PO 1 M ibe system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 i T /•�j= ^ / < / /mT:.!r.� - �jCG.c 1 � ` l e 'l u � f p I ' j ( j i - �y �I „F r' ^ ' 06Y its �i= •al.�i j/ �h�- �- 7�• ,� �! Cr: /_s �✓: -�: < /C�.0 ` 11 1 �-"/ ��_�;, ��-/ . ` off= •�� --1- -> p ��, � � � 1� Wisconsin Department of Commerce SOIL EVALUATION REPOR Page Of .3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Courriy 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 print all information. RevW / by r .- Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r , Property er RECE {VED ropertyLocation � ovl. Lot 1/4 1/4 S T N R (or l Property Owner's Mailing Address t# Block Subd. Name or i1w OCT 0 5 2007 City Sta Zip Code Phone Number ❑ City ❑ Vllage Town Nearest Ro ST. >ROIX COUNTY t 0 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: Boring # Boring pit Ground surface eiev. ft. Depth to limiting factor ,5_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Allz as c Boring # E] Boring 'tb � y . N J Pit Ground surface elev. �,� ft. Depth to limiting factor -— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 m i G G Q q R it * Effl #1 = BOD > 30 220 mg/L TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mgA- and TSS < 30 m91L CST Name P wide Pri j Signature CST Number Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # Page of 3 , Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor //-5 in. Soil Application R ate 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 -405-1 / G f7 /la At J1- �6) � 9 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 F-1 Boring # ❑ Boring G ❑ Pit Ground surface l it Depth limiting f surace eev. ep to mng actor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mg/- and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (R07 100) Property Owner i l? Parcel ID # F 31 Boring # ❑Boring Page � of Pit Ground surface elev. {t, Depth to limiting factor i Horizon Depth Dominant Color Re Soil ication Rate dox Description Texture Structure Consistence Boundary Roots GPD/fh in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑Boring # ❑ Boring 1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # El Boring [] pit Ground surface elev. ft. Depth to limiting factor in. p Soil Application Rate Horizon Depth Dominant Color Redox Description lion Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Efr#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mglL 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 -6330 M07 /00) fill _ f , r / 7 1 yr ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND l OWNERSHIP CERTIFICATION FORM Owner/Buyer W i( " � y r)c. Mailing Address Z - ZZ n ' �� .L] e - ✓ ' �, �� /' �� Z S Property Address (� Z ? 7 �� ory► r c= G✓) (Verification required from Planning & Zoning Department for new construction.) City /State G1 e_. rLc Parcel Identification Number (? 3'1 - % C 3 2 LEGAL DESCRIPTION Property Location Sl r/ , S �' '/4 , Sec. I I , T 31 NR lc Town of <om e e- , Subdivision -- , Lot n Certified Survey Map # , Volume , Page # Warranty Deed # SS Z 3 , Volume / 2 0 9 , Page # 3� ) Spec house yes Ono Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTMCATION 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. 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the s tazdar::s set forth, herein. as set by u e Department of Commerce and the Department of Ni atural 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 Dena- anent within 34 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 amiare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ) D `I / Z '3/ v•7 SIGNATURE OF APPLICANTS) DATE *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * ** with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -_ .e -e:! C e is made in the warranty deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —/_ of FILE INFORMATI N SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacturer — ❑ NA 1 DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — ❑ NA Number of Public Facility Units NA Pump Tank Capacity al ONA Estimated flow (average) gal /day Pump Tank Manufacturer --A3 NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer El NA Soil Application Rate gal /day /ftz Pump Model 2� NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit L'S NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N.A. Biochemical Oxygen Demand (BODO <30 mg /L � In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L �NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ 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 eve ❑ month( axmum El s) (Mi 3 ears) NA every- 1 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) ry - year(s) (Maximum 3 years) El NA Clean effluent filter At least once every: ❑ month(s) ❑ NA Wyear(s) nspect pump, pump controls & alarm At least once every: ❑ month(s) Ja NA ❑ year(s) FILXA laterals and pressure test At least once every: ❑ month(s) J3 NA ❑ year(s) �r� r At least once every: ❑ month(s) $ NA ❑ year(s) ,;trier: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined .accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and 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. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede Y p de 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 INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S' Phone Phone - This document was draftee '- :_-chance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page , of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ro p cess and /or damage th that may impede the treatment g P g e dispersal cell(s). If high concentrations are detected h contents of the tanks removed ected ave the is () moved by a se to a servicing o P 9 g Aerator 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 I 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 INSTALLER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S Phone Phone I ---// q1) _1 ��j This document was draf;et '- :_- piiance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Docur*wnt No. TRUSTEE'S DEED 55231 ray 3209POAT _ __� 1101S T Cpl J C7i : SE CRCIX CO.. VA Firster Bank Wisconsin. &Wa Firstar Trust Department, Trustee of the trust mmited under the Will of . Ralph Wilfred Plourde, 8 1996 for a valuable cor*deration. conveys, withc4 wanw ty. to RW u d Plourde, ' t he � blowkV described real estate in St. Croix County, a`4: P. M State of Wisconsin: e *WSW d SW % of Sea 11, T31 N, RI 9W Except that panel contained In CSM Volume 3, Page 847 Filed on 8-20 -1979 Return to: Richard Plourde _ 524 220th Ave. - Somerset, KI 54025 f. EXEMPT 032- 1031 -95, 032- 1032 -10, 032- 1032 -30, 032- 1032 -40 (Parcel identification Number) This is not hor.�estead property. Dated this day of wE M.6t - . 1996. FIRSTAR BANK WlfCOKSIN BY: N 4 ? j . its i STATE OF WISCONSIN) Eau Claire County - %ld= , By Dame before me this / day of Afa yP111�! . 1996 the above - named iti pl :. to me known to be the person who executed the foregoing instrument a nd the same. Nota Public, • , State of Wisconsin My oom / � 3as M ' X ILI* " Mv THIS INSTRUMENT DRAFTED BY: ESA k y� c vn QXPv« Mey , Stephen R. Schrage - Lawyer State Bar #01013907 PUBLIC