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HomeMy WebLinkAbout032-2177-14-000 sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division t INSPECTION REPORT Sanitary Permit No: 463356 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: Perro, Steve & Sara I Somerset, Town of 032 - 2177 -14 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: , yk I 6 -r 11.31.19.1518 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar Dosing i Alt. BM A f'r Bldg. Sewer 13 3 Holding St/Ht Inlet St/Ht Outlet IP TANK SETBACK INFORMATION 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Z' ��l Dt Bottom I$ 4 cd y Dosing / //� _ 4Z i , Header /Man. I -J Aeration e Dist. Pipe Holding Bot. System Final Grade 7 PUMP /SIPHON INFORMATION O. ( Manufacturer Dem and St Cover q 9 �— r Model Number I'S 1 q9• Co TDH Lift Frictions Loss System Hpa TD � Ft Forcemain Length $ Dia. Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width J Length No. Of T nches PIT DIMENSIONS No. Of its Inside Dia. Liquid Depth DIMENSIONS Q� "75 SETBACK SYSTE TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O tern: �� '/ , /� �� UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold �� Distribution Gz� (� j x Hole Size ? � x Hole Spacing Ve Air Intake Lengt 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 Bed/Trench Center ) II'' ]� Bed/Trench Edges To soil / i T� g p t < s � No ?'Yes I No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 0 ✓ Inspection #2: / / Location: 650 222nd Avenue Somerset, WI 54025 (NE 1/4 SW 1/4 11 T31 RI 9W) Hidden Hil / Lo e 14�� cat No: 11.31.19.1518 1.) Alt BM Description 2.) Bldg sewer length = c[Z - amount of cover = / J Plan revision Required? �__ Yes o —7 1 Use other side for additional information. I Date Insepctor's net a Cert. No. SBD -6710 (R.3/97) County ri Safe and Buildin s Division f ' 201 W. Washington Ave., P.O. Box 7162 f Madison, - 7162 Sanitary ennit Number (to be filled in by Co.) (60 266 - Department 1*is Consin of Commerce CEIV 3 5-& Sanitary Permit Applicat on s Plan LD. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal inform on yo ? �, 4 2 / may be used for secondary purposes Privacy Law, sl S. (1)(m Pr ject / Ad - dress (if different than mauling address) 1. Application Information - Please Print All Information ZONING OFFICE Ol Pro rty is Name D Paz_ t Bock # ro er's Mailing Address C �� Q Property Loca �o`n � — 1 l ` L,'i'c°�. S4, A �t -v` /., Section / ` City, State Zip Code Phone Number f (ctrc o ) ��� T_31N; q Et II. Type of Building (chec all that apply) Subd w' ion N e CSM Number r 2 Family Dwelling -Number of Bedrooms 4 , ❑ Public /Commercial -Describe Use J ❑ State Owned - Describe Use (jYi t7 City ❑villagewnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable A. P<V ew System ❑ Replacement System g p Y g Y ❑ Treatment/Holding Tank Replacement Only El 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) ❑ 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 eat Fiber Aerobl Trc�eatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pie ❑ Other (explain) -� r V. Dis ersaLrfreatment Area Information: Design Flow (gpd) e sign Soil Applicati n Rate(gpdsf) Dispersal Area Re ` ed (sfJ tspersal Area posed (sf) ation Sy m E r ✓ 6 / v �, �t15 60o i 60 6 o 5 �i7_j VI. Tank Info Capacity in otal 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 L 'W VII. Responsibility Statem t- I, the undersigne ume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's ature MP/MPRS N ber Business Phone Numbe Ob Plumber's Address (Street, City, State, Zip y _ VIII. koun /De artment Use Onl V P proved El sapprove Did Sanitary Permit Fee (includes Groundwater Date ssued Iss ' Signature (Id ps) Surcharge Fee) 1 6 O ^ ❑ Owner Given Reason for Denial M Conditions of Approval/Reasons for Disapproval SYSTEM_O NE.B `i T L 3P 7 Septic tank, effluent filter and C P - ��� dispersal Cell must ail be serviced /maintaine as per management plan provided by plumber / u • 2. e ac requirements must be malntalned as per applicable code /ordinances Attach complete 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) PLOT PLAN PROJECT Steve Perro ADDRESS 1479 24th St. St. Joseph Wi 54082 NE 1/4 SW 1 /4S 11 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 101.5' S' sand lift! BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 763 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 HOLE O WELL * H. R. P. Same as Benchmark B.M. /B.M. #2 being to f 1 " i e @ 486' Property Line 1 .49' 100.5' 100, 96.5' Contours are based on field verification and boring B -1 3� elevations Grading is to be done to divert run -off away 6% Slope from system B -3 �C__VO ---%❑ Area 15' below system is to remain undisturbed Huffcutt Combo Tan Well is to meet all setbacks found in Comm. 83 B -2 Pro 4 Tank is to be properly Bedroom bedded and provided with House lockdown covers with approved warning labels 534' Property Line To easement Property Line accessto 222nd Ave x Safety and Buildings 4003 N KINNEY COULEE RD commerce LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w w ww.co e.w i. gov/s / isconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 22, 2005 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/22/2007 Identification Numbers Transaction ID No. 1120823 SITE: Site ID No. 696048 Steve Perro Please refer to both identification numbers, 222ND Ave L above, in all correspondence with the agency, Town of Somerset St Croix County NEI /4, SWl /4, S11, T3 IN, R19W Lot: 14, Subdivision: Hidden Hills FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object 1D No.: 1009295 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); 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. Cn: ?di No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. A P P F The following conditions shall be met during construction or installation and prior to occupancy or use: DEP�4RTMEN7 ,i OF Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • 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 • A Sanitary Permit 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. t SHAUN R BIRD Page 2 3/22/2005 • Inspection of the private sewage system 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 may 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 --2 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer lI , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ` r Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 3/17/05 Owner: Steve Perro Location:NE1 /4SW1 /4S1 1 T31 N,R19W Lot 14 Hidden Hills 222nd Ave Somerset System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve OF 7 -8. Maintance and C ntigency plan �r coMMER 9 -11. Soil test sp O/ypE Shaun Bird Signature License numb 226900 RECEIVED MAR 2 12005 SAFETY & BUILDINGS PLOT PLAN PROJECT Steve Perro ADDRESS 1479 24th St. St. Joseph Wi 54082 NE 1/4 SW 1 /4S 11 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 101.5' .5' sand lift! 4 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 763 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P . Same as Benchmark B.M. * /B.M. #2 being to of 1 " v ipe @ 486' Property Line 100.49' 100' 96.5' 100.5' 98. Contours are based on field verification and boring 3tp I elevations B -1 Grading is to be done to divert run -off away 6% Slope from system B -3 � �/O� �❑ Area 15' below system is to remain undisturbed Huffcutt Combo Tan Well is to meet all setbacks found in Comm. 83 �Z B -2 Pro 4 Tank is to be properly Bedroom bedded and provided with House lockdown covers with approved warning labels 534' Property Line To easement Property Line access to 222nd Ave i i No • Designer_ Date - Non -Woven Filter Fabric „ e Perforated ,D1stribvtion. pipe 4 pbServation Pip ; Below Filter Fabric ASTtij C -33 Sand {H Topsoil, i % Slope ��` r • � � Force Moin piowed (r, Bed Of f� z From Pump Loye ;e-.*, / Drain Rock stem Us►n � Section Of A 1u!ound 5 ._- ---- -� f Cress A g For The Absorption A rt G A � Ft. h / I Ft.• Ft. K.L� =.3 Ft.. L Ft. � ►3Q a ! Ft. - t L 4:'pbservatian Pip_ e"� � K Force Main A ------- - - - - -- - - - - -- 1 From PvmP c f % —2� o Distribu Bed 0 Z Pipe Droirs RocK i 4nObcervation PiPe=-�`'�t�:f� -� permanent Marker pipe or Rods Ploy► View Ot M ound Ut:l� A Bed For The absorption Area PAGE OF— Qer4arated a�D! Oetaii 0 En V = e = Per torat f u Z Pv:. P De elates 6o=ate4 On 8otoom. Are Equolty SPOCert C /�4/e vt.C✓E /rl f I V , % V } 4 B } PVC Force Moir �FeRST ViatL itixT z'e CvnrleG }nor PVC t/a6low Pipe Oke, L3iS P ipeA�Ori Ft. I u n — L 1 1 - 1 0 � tgisirit:ution Pipe l.oyaut _ X c:;2! Inches Y Inches Hole Diameter Inch Signed: Lateran'; Inch {es} License Number: Manifold Inches_ Gate: Force Main, Inches of holes /pipe Invert Elevation of Lateral s_r � PUMP C {�AMSER CROSS SECTION AhD SPECK ICATI©NS SEPTIC TANK P WeATHERPROOF APPROV PIPE IZ NiXtIT '= MIN. ABOVE GRADE � JU NCTT 0 N BOX HOLE COYER w += Gk VENT wI�tDOW 4R wITH CG w1 PADLOCY, t y I}` rRO D04k, WAMING LABEL FRESI: TR IKTA1Cr Pltt ^D GRADE I i� z•t s = INLET GAS" ' D TIGHT SEALS SEAL = Jt?I i� PE APPRDYM MATER TIGHT ' • ALM 3. O = Oi3 8 SID SOIL APPROV0 C. ` OFF PIpE 3 ` ONID 5th Ii1 P O FF T . SOIL �H pPRO�ED B EF}i}T3iG UNDER T.Ally t� CONC l TE PAD 3 A !'� as. SPL'CIFZCA'fl t0Utf8 DOSE 5 DAY; -� SE C p4SE ;3fl5E VOL J:NCLUD 2? GAi.- PlAt+ti1FAC'TURER : r AN CAL • / S D y xsAL TANK SIZES : ICr� GAL . INCHES SEPT _ DOSE �? t� CApAC gTI£S = }3 -2� INCHES ALA MANUFAC j ---�" MODEL AJ,49' ; S N t C -., INCHE S £R T = - 7, GAL �ITC 1r€ q'YP£ I GAL MAlfJI'AC'iultER = S � L-- I um TucliEs 16.3 ' PUMP E,1,, Nut'�SER : � �e.���.� I NG A P � swITCH TYPE- `'` o pUttiP E ALARM 4IIR � FEET C. t •Ef pia PIPE . ,�...r�►FEET R,:C)UjREO DISCH"G£ $ EEN PUMP flFF AND I T-!> _ _ _ . ` FEET VERTTCAL DIFFERENCE PRESSURE - gR ;CT FACTOR - FEET 3 FT1Ii�g FT zIC HEAD MINI,3II ti£TWaR1C SUPPLY DIAMETER FEET FORC£MA;N Tp'fAL DYE / wil LENGTH ENSI4I�5 OF PUMP TANK' LIQi�II? INTERNAL DIt'i DATE: LICENSE w _ L SIGNED: _ I TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLU N T AND DEWATERING HEAD CAPACITY CURVE —� MODEL 152/153 MODEL 752 t53 W G � Feel Meters Gal. Liters Col. Liters 50 5 1.5 69 261 77 291 15 10 3.1 61 231 70 265 12 40 152 15 4.6 53 201 61 231 20 - 6.1 44 167 52 197 _ 25 7.6 34 129 `42 159 30 `-' 30 9.1 23 I 87 33 1 %5 8 22 • E5 z 35 10.7 -- -� ° 42 20 4 0 12.2 -- 11 0 Lock Volve: 38.0 FL (11.6m) 44.0 ft. (114m) J34SJe 4 10 0 20 40 60 80 100 6 t/a GALLONS LITERS 0 80 160. 240 :. 320 - 3 27/32 a 5/ FLOW PER MINUTE 3 27/32 FACTORY FOR SPECIAL APPLICATIONS - - CONSULT ® 3 27/32 • Timed dosing panels available. with . F ectrical alternators, for duplex systems, are available and supplied 1 an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggybacK variable level float switches are available for variable level long and short cycle controls. I ` • t ons. See FM1420. Sealed Cmik-Box available for o � outd on requarled i II •over 130 °F. (54 C.) special q i 2 1 /8 - 1521153 Series 1N53 MODELS Control Sel 'on /d 5 t 5L Am s Sim lex Du lox 8x2064 Model 01 Ph Node A 8.5 1 2 or 3 -- — N152 115 1 Non 8 Included 2 or 3 BN152 115 Auto 1 20f 3 1 Non 4 3 2 or 3 E152 1 � 4. 3 Included SELECTION GUIDE BE152 230 10.5 1 2 or 3 back tra dable level f I 140A N153 115 1 10.5 Included 2or3 back variable level float switch or double pig9Y m53 11 1 Auto 2 or 3 1 • Single pi99Y E753 t 5.3 1 2 or 3 switch. Ref t FM0477. Refer o 230 Non 1 5.3 Included AU10 2. See FM0712 for correct model of Electrical A,ltemator E BE153 230 d 3 o cnuTioN 3, All installation of controls, 9ro�t0n devices and wt Variable level control switch 10 -0225 used as a control activator, specify P ( } codes should be followed Including the most or (4) float system• r should be done by a qualified licensed electrician• All electri NEC and the Occupadonal.Safety and Health ActtOSHA). recent National Electric Code ( ) or-SERVE ERVE POWERED DESIGN • n ineered into the design of every Zoeller pump. safe ::factor Is e g For unusual conditions a reserve IMa1L TO. p. sox 16347 LouisviNe• KY 40256 -034 Manufacturers Of • - SHIP TO: 3649 Cane Run Road err pL1P9 sly-aE Louisville, Ky 40211 -196 (502) 77 &2731.1(600) 928 -PUMP FAX (502) 774 -3624 h zoeller.com p Copyright 2000 Zoeller Co. All rights reserved. ST CROV CpUN A C E OREEM " SEP'T'IC - T � " FORM �WNE Mp CER'T'IFICATION Owner/Buy _ °2 ' a • D Beni for now construction) ss Plag eP — Al I Property Addre (ye1ifuation in quired from patcl Identification Number city /state , 1 5 1 � 5 ,D 3 IO _R y�, Town of N LE �' E CR ' � N ) IL T�A. r,1/., Sec• Lot # y Page # Subdivision Volume -- � ,,II Certified Survey Map # Page # Volum ## es D no Deed Warrsnty t lines j)—l. identifiable` Lo Sp house C2 y k handlewastes' Propermainumance Sp c ould result is its Premature failure to What you put into the system -.r R s septic system d if needed by a licensed p eer. use sad every spree Yaws or sooner, waste disposal system. and by A Owner consists of Pa °m the septic tank stage sa a certification form. ash disposal system ss a ticeatment can affect the functioa.of the septic bve on si111W 1/3 full of sludge- to , { oix Zoning Dep erifyi:1 that (1) t owner agr m c�tedPl�r or s licensed P ��necessaiY) , ti' Septic tank is lea P eymanplum�bez� r i inspect and P� ay with *C standards ropaLly is in prop l Cr o pastius cos stad/� (2) sir and agree to maintain the private s a S�� isconsin- gn 3 0 Ulastill: a rtsnent of Natural � Zonings above a� D t.. Croix the sbo the eP to the S read and d have re erce returned i/wa, the un the Depsstt °f Comm be complied and set forth, m' set $ 5� his been min must Jr stating Y e pcpiration date- DATE days of F APPLICANT form e am (arc owners) °f E "a W= to the best of my (our) knowledge* l ( w ) ( we) Certify that all statemetits_oa this deed recorded in Register of Deeds Of&e• bed above, by virtue of a w��' the P DAIS PLICAN'r P rcv okcdby the Zoning DeP%ment- SIGNA GF `°� c raut bring on that is �. may fault is the sanitary :assts piny iaforma� ed from the R of Deeds office deed wed wssM U�► de p if reference is made in the w Include wlth this P! atnnty a lication: i copy of the certified survey es Page _ _ EµT PLAN - , ER'S MANUAL 8, MANAG�� 901NTS p N SYSTEM SPEGIFIGA p NA Septic Tai ►k C2►pacutY NA c7 Septic utai:t` 0 NA aL.F_ naFOti ►noN e- owner 35 Effluent Titer NianutaTef p NA Pence$ 0 NA EffluentF� Modie�l �, at 0 NA �ESiGN P� Pump -lank Capa NA Number of CO MM Units aYda Pump Tank Man u factu rer Number Of ] atld PiimP Martin J s ❑ NA Es�tulated flow { , ailed " 1.5) Pump M ant a 1� r flow E.sttm aVda pretr arm Unit C1 Peat Filter SoD Apps' Ram O Sa�� Flter O Wetland gyerage u Quat - �cY G� Monthly m9n- ❑ Mectlanical Aef © Other. irrfluen Fats,. on g, Grease (� 420 mg/ C3 Disinfect BOD5? ufacbjrer BiodheT� Suspended Sol (T S) Monthly aye 9e" Uispe Celts) p .ground (prassurtzed) NA 1r1 in.ground (gravdY) �und went QuaiRY e m9� [ 3 Al-grade p Other_ Pt en Oemand (BODs) one w and � - �etnical O Soli : 530 o mg /L Values typical for dCWAS [7 Dn ' d a r�.�ras�sws Total Suspended ds ri) 510` cful W (no °O^ ""` Feel Corifom y, inct+diameter UU *emuenc. � , K , S ater. um Effluent Particle Size .. values types. for p� Ma)drn Frequen Service Fre4 y ar(s) (Maximum 3 yrs.) NANCE SCHEDULE p m onths MAl a Event st once every in-, O ne -third (4) of tank volume Servrc At lea a and scum e4u r(s) (Max 3 yra-) Inspect cc of tank(s) i/Vtsen combined Sludge month co ntents of tank(s) At least once every Pump co months s) C] NA inspect API cell(s) At least once every p months s) p NA Glesr► effluent filter At least once every p mo nths Inspect P!rn''P, PUMP controls & alarm At least once every' p months 11 YeaKs) � NA Flush laterals and Pressure test At least once every a months g year(s) O NA ott+� At least once every orhef one of the following 6 Cens or MaIntainer. � CE INSTRUCTIONS made by an rimer t S Inspecto O a missing n MAINTE> dispersa! carts shad be � broken up Inspections o f �� plumber: Master Plumber Resm� on of the tank ( check e effluen We cert�t�: Master iclude a visual i form a and scum and t the tor. Tank inspections ust n s me of combined S tu' inspected to d��of effluent on sovidnO QP any packs or leaks, ure the volu The dispersal ceil(s) shall be ndrng �ocitY- of effluent on the groun local d surface- The P° hardware. MonttfY round surface- ding don of the fe9ulatorY or M of SMUent on the gro for any Pon cit the immediate notifica tank volume, the p and to ch condition and req lid (Y or more of NR vvith in the obse �d�te a fang min any tank eq���� of in accordanc e ch- ground Sum a and scu a Sendng Op rand disPos mbined a tank sh al l b of re moved by a Sep g t Compon and any When the Combin snail be Meinta�ef d o tank onents. pretreatfn' entire conten f the Arninistm Mode. com ponents. POWTS comp ed by a Ceitified PO 113, Wig anical or pressur~z event. - • of effluent filters. meth is of V months or Tess sham 4 Completion of any semtx Th Serlli6 g nRoring at interva regulato authority witfi daYs other ntalnt�nce or M0 the local or other A senrige repo shall be Prove the prSenCe of painting Prod ant tanks] tratio are START UP AND opEaaTioN POyy - fs aleck treatm Ce 11Es). if high cone p, prior to use of the r ppe5s anNor damage the pis o for prior to use. For n6V Wn�C . pede rite treatment er P rocess by a septage servicing Para that cheMiGBIS detecMd have the contents of the tank(5) n at the irif trative surface e=m red froze is t� { o ondibons men P result in the an . t not occur vfie above normal h�9 2e dose. ovettoa�n9 the p6rnp a S start up �'� one tang removed by es P ip tanks °eti(s) in the contents.of the P WTS Maintainer to o vo ' °u ed to I ' isPe= this sitvsation have t� a Pl umb" a PO , rater tie d ��e of effl�L TO - power to the effluent Pu rl will► the pump tank flacicuP or sir pperatfior t � ��s fo restore normal ieve ar otherwise di>`i A or COmpad' sere"" Ong the Pump _ . Do not drive or park overt as de lion area - Do not �� m park vehicles � mo ld Or at'grede soli absorP Im rye the pe�0mlance and Prolong the Gfe the area vr8hln IS feet down stops from the wastewater stream may p d dental floss; "Pers � or -e��tk of Ills following �orede butts; candoms; cotton sw asoline: 9 e; herbiddes; meat . gntibloba; baby! W. Ovate atY nd naPvegetable ns: bmP peefing� g ulster sower brine. of the PO � � diatct de5 r s [a s: . and d'�sutts - oft; Qainbn9 P taken to i that the rttedir shalt Screw. the followirTg Steps taken out of service in Admin�We Code: pgANI)ON�M POW TS and/or is pew I'ranoe with ch. Comm 83.33. �i�sSealed. When the ro and Safely aban�aM. in isco and the abandoned Pipe o a $ervicing OPemtor. system u Properly tanks and pits shat! �be disconnected and propefi! disposed of cov ers a � .� the void space i in u _be ' r wve r P 9 stla the All P its or th and P removed o f tanks ed and The eontenls o �, Shah be eXCa� After Pumping' alt tanks and p filled soli. gravel or another inert solid material. !towing measures have been. ar. must be taken, � provide a code CONTINGENCY S. an the fe rep lac ement soil If the POW'�S W S and cannot be repa . n and should not nt replacement system been evaluated and may be utilized for the location of a rep comps rotected from disturbance and compactio Ie repia t area i� ent area should be p strucuro, lot lines and wells. Failure to ❑ A suibb a suitable n sys tem. The replacement from existing and Proposed abSO n by reQuired se tback s for a new soil and site (evaluation establish be infringed upon Wi ll in the need at that time. noted the replacement area must comply with the rules in effect advances in POWrS p tacement syste and/or soil limitations_ 13arrin9 _ ReP setback S. re placement area is not available due to the failed POWI -2 cnflald,_ O A suitable replacement area b installed as a last resort to replace n failure of the P QVXIS 0109Y a holding tank may " lacement area Upo area is available a The its has not uated . a su to Iona unable rd mWPOWTS- PIK rt to replace ti's faF ed r . em � of the biomat at t reso [fowir�S lily fo installed as a w in Place that time. holding tank may be lion system may be reconsir 1 with the rites in effect at Mound and at -grade son �' moons a such'ms's must co Y e inifitrativ'e surface . Recorls ' TMENT ^TANKS MAY GONTA[N LETHAL GASSES ANI310R iNSUFF[G[F.1dT OXYGEN. <NYARNtN © K UN > CIRCUMSTANCES. DEATH MAY SEPTIC, pUrAP AND OTHER TRIER A 3EpTiC, PUMP QR OTHER TREA'T'MENT TANDER ANY 18L DO NOT ENTER PERSON FROM THE INTERIOR OF A. TANK MAY BE DIFF1Ct7LT OR UIIrPOSSE RESULT. . R ESCUE OF A AW)MONAL COMMENTS POWTS NiA1NrTA /[TIER PO WTS INSTALLER N ame Name / a Gc �'` -� r Phone 7 /.'' Z� J Phone � I = �l `� LOCAL REGULATOR A l TOR PUMPER L O� SEPTAGE SERVICING OPERA Agency Name Phony Phone 7 This do '— 6 ✓ `�/7 nt mew uette and Waushara County Zoning and Sspita6oa Mendes. arme not This doammut�ras jmW by Ow staffs of the tl( Lin farce. Mart! 83 Ss(t}, (2) 8 (3). Wisconsin Admtrtlstr�e Cady Ilse of d* rlourr� does SMW (M1) Me minimum rnauus rents of dt Comm 83=(b)( ft y �arantee the performance of the PawrS. Wisconsin [.;apartment of Commerce SOIL EVALUATION REPORT page...,,_ of & Dlv :, ion Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but riot 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. �Rgviewed by n Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15,04 (t) (m)). 2 ` -- Property Property Location Govt. Lot 114 114 S T N R (orkjo! Pro perty Owner's Mailing Addr Lot # I # I Subdr or CSM# / L City Ste p Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Construction Use,9 Residential / Number of bedrooms Code derived design flow REM BPD ❑ Replacement Public or commercial - Describe: Parent material 7' Flood Plain elevation if applica _ ft. General comments � ry and recommendations: ST. CRO1X COUNT`' \ ZONING OFFICE Boring # O Boring pit Ground surface elev, ft. Depth to limiting factor in. Soil Appillcatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiff _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft. -42 At S R s Boring # C3 Boring loll Pit Ground surface elev. ft. Depth to limiting factor 44 - In. Soil Applicatiot Rate r 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 6 > > _ • Effluept #1 = BOD > 30 1 220 ma/L and TSS >30 < 150 mg& Effluent BOO, 30 mgk and TSS 1 30 CST Name 09a6e Print Signatu CST Number Address Tele phone Number ' 2�' L L 6Z - � .3 /-5- 1 Property Owner Parcel ID # Page ,- ;, of 3 E2 C] BorkV Boring # a 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/N In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Etf#2 i Boring # ❑ BOting El pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate t sorizon 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 Boring # ❑ Boring C3 Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP Dfif In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg1L 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 TT'X 608 - 264.8777. ssn aw (RAW) l- I �o I I j I / r zL � �2 164 Parcel #: 032 - 2177 -14 -000 03/24/2005 03:23 PM PAGE 1 OF 1 Alt. Parcel #: 11.31.19.1518 032 - TOWN OF SOMERSET Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/01/2004 00 0 Tax Address: Owner(s): * = Current Owner * RICHARD L PLOURDE PLOURDE, RICHARD L 624 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 650 222ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.980 Plat: 10/13- HIDDEN HILLS 032/04 4/15 SEC 11 T31N R19W PT NE SW HIDDEN HILLS Block/Condo Bldg: LOT 14 '04 LOT 14 (5.98AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11- 31N -19W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 07/01/2004 767565 10/13 PLAT 12/31/2003 750406 2483/200 EZ -U 09/03/2003 738643 2398/532 EZ -1 1209/341 TD more 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/25/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: 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 0.00 600 Parcel #: 032 - 1031 -95 -000 03/24/2005 03:21 PM PAGE 1 OF 1 Alt. Parcel #: 11.31.19.152 032 - TOWN OF SOMERSET Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 3 Tax Address: Owner(s): * = Current Owner RETIRED PLOURDE " PLOURDE, RETIRED Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 11 T31N R19W NE SW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11-31N-19W Notes: Parcel History: Date Doc # Vol /Page Type 12/31/2003 750406 2483/200 EZ -U 09/03/2003 738643 2398/532 EZ -1 1209/341 TD 1171/355 FJ more 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 04/27/2004 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 160,000 0 160,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U, 2 7 4 1 P 1 17 7'663A3 �� State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO.. WI Document Number Document Name RECEIVED FOR RECORD 02/01/2005 12:@SPN WARRANTY DEED THIS DEED, made between Richard Plourde a/k/a Richard L. Plourde and Dena EXEMPT # M. Plourde, husband and wife ( "Grantor," whether one or more), REC FEE: 11.80 and Steve V. Perro and Sara A. Perro, husband and wife TRANS FEE: 300.00 strvi vorshi p marital property ( "Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1' Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Return Address Lot 14, Hidden Hills, St. Croix County, Wisconsin. LA i TLE, M', 'J: 'L NO. ! 114 Part of: 032 - 1031 -95 -0 Parcel Identificat n Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated JANUARY 28. 2005 (SEAL) 'R� Z (SEAL) * *Richard L. Plourde (SEAL) (SEAL;, * *Dena M. Plourde AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF MINNESOTA ) ) ss. WASHINGTON COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on �/a 46 S (If not, the above -named Richard L. Plourde and Dena M. Plourde, authorized by Wis. Stat. § 706.06) husband and wife to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instru ent and acknowledged 1he same. Attorney Kristina Ogland Le — Hudson, WI 54016 * •+ Notary Public, Stale of I / 1') Sal My Commission (is permanent) (expires: 1131 2,a to ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 ' Type name below signatures. # A INFO -PROT' Legal Forms 800 -655 -2021 www.inloproforms.com NANCY J. LENTZ Notary Publio- Minrilmota Oonwnlarlon Jan 31, 2010 • 1 ,$ ja l y V OD i "w 0 ?' `� w 1 0 ... - �� .-- 320. r y L4 4 r- ' �\ I I (D Q o w1 rr 101 1> O loo o 0 �. 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