HomeMy WebLinkAbout032-1037-50-000 Wisconsin 13epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Stwfety and Building Division
INSPECTION REPORT Sanitary Permit No:
515159 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:
Germain, Richard I Somerset, Town of 032 - 1037 -50 -000
CST BM Elev: Insp. BM : BM Description: n Section/Town /Range /Map No:
ICJ /c es IF 13.31.19.186
TANK INFORMATION 19 ELEVATION DATA
TYPE MANUFACTURER C,% ,�,� CAPACITY STATION BS HI FS ELEV.
i
Septic ' �"C I Benchmark aZ /dam
2• 1 `
s ') Alt. G
�' o � ' 3 boa
Aeration � Bldg. Sewer
Holding St/Ht Inlet 5'S 94+ • .7
! I
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO W /L . WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic I /12.0 t Z 1 Dt Bottom IS Dosing Header /Man. . 9
Logo
Aeration Dist. Pipe I- 95
Holding Bot. System
S� a IJ
PUMP /SIPHON INFORMATION Final Grade 3 • 0
Manufacturer Demand St Cover
/-_ GPM 166.
Model Number /
TDH Lift Friction Loss System He TDH Ft
Forcemain Leng la. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length . No. Of Trenches PIT DIMENSIONS No. Of P ALS Inside Dia. Liquid Depth
DIMENSIONS 3 W I /- JS (ew �--
SETBACK SYSTEM TO Y � � /L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: / UNIT Model Number:
'z 36 J, U` , 74 L-j
DISTRIBUTION SYSTEM /6 4--1 to ` 3
Header /Manifold Distribution x Hole Siz x Hole Spacing Vent to Air Intake
Pipe(s) %,._ 1\
Lengt Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only a
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil � ���
Z � E No Yes L ] No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 2107 Hwy 35 SOMERSET, WI 54025 (SW 1/4 SW 114 13 T31 R1 W) 40 acres Lot Parcel o: 13.31.19.186
1.) Alt BM Description = � 5, �
4
2.) Bldg sewer length
- amount of cover = — t v
Plan revision Required? 0 Yes o
Use other side for additional information.
Date J Insep is Sig re Cert. No.
SBD -6710 (R.3/97)
y 1 ,� Safety and Build County
Buildings Division
201 W. Washington Ave., P.O. Box 7162 � � C7 1
n s � Madison, WI 53707-7162 Sanitary ermit Number � filled is by Co.)
Sanitary Permit Application
In accordance with s. Comm. 83.21(2), 11Vis. Aden Code, submission of this form to the appropriate govemmmW
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 you provide may be r ndary s j �l
purpo in accordance with the Privacy Law s. 19. 1 m Stats. s / V hLa
I. Application Information - Print All Information
Property Owner's Nadu Parcel # '
2009 030
property Owner's Mailing Address S� G �p� ON OFFIG Property Location
City, State
V Zip Code Phone Number Gp of y� j �!/ A, Section
�/ s�J le o
So rr' l L? d- I T 3/ N; R E W
U. Type of Building (ch all that apply) Lot #
�, Subdivision Name
1 or 2 Family Dwelling - Number of i3edro
�� Block #
101 Public/Commereial - Describe Use �_ ❑ City of
CSM Number ❑ Village of
❑ State Owned - Describe Use Town of
III. Type of Permit: (Check on�ne , x o n line A. Complete line B if applicable)
A. ❑ New System bat ement System ❑ Treatment/Holding Tank Replacement Only ❑Outer Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permi;t Revision ❑ Change of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Owner r
IV. Type of POWTS System/Component/Device: Check all that a
oNon- Pressurized In -Ground ❑ P�essur=' d 1n- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound< 24 in. table soil n
❑ Holding Tank ❑ Other Dispersal;Component (explain) C1 Pretreatment Device (explain)
V. Dis rsal/Treatment Area Information: S ion
Design Flow (gppj Design il Applicat'rpn Rate(gpdsf) Dispersal re Regtu sf) Dispersal Area Propctsod ( System Elevat
` s, �- -3
J�
VI. Tank Info Capacity in Total # of Manufacturer B
Gallons Gallons Units a v 5 „ ss
New Tanks Existing Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement a undersigned, sass nsibWty for installation of the POWTS sbown on the attached plans.
' tore MPIMPRS Number Business Phone Number
Plum Plumber,
is Name (Print) 7
Plumber's Address (Street, City, State, Z' ode)
VIII. oun /De ent Use Onl
Approved isapprovc �fr Permit Fee Date I ued Issuing t Signs
M van R Real
IX. Conditi®bppeasons for Disapproval 3) 1 5
1. Septic tank, effluent lifter and
dispersal cell must all be services / maintained 0,.(. G8
as per management plan provided by plumber. /
2. AN setback fequirsments must be maintained
Attoeb to eomptete plans r e system and subadt to the County oaly on paper not leas than 8112:11 iaeber !a size
SBD -6398 (R. 01/07) Valid thru 01/09
P PL N
PROJECT Richard Germain DDR S 2107 Hwv 35 Somerset Wi 54025
SW 1/4 SW 1 /4S 13 /T 31
/ W TOWN Somerset
CO S
LINTY T. CROIX
MPRS Shaun Bird 226900 10/5/09 3
DATE BEDROOM
CONVENTIONAL XXX IN -GR ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TA SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651
# of chambers 32
BENCHMARK V.R.P. Bottom of shed siding
ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATI 96.
ON 3/95.7 4
below grade low side of cell
unless ss otherwise
noted
Plans Designed Using Well
Conventional Powts Hwy 35
Manual Version 2.0 AL
50'
20'
Old system to
be pumped
and buried Garage �10, Existing 3
Bedroom
D W 35' House
65'
O
50' 25'
ST 60 , B -3
Vents
20' 900'
Garage 0'
L__� B -2
.M. 50' 50' 15'
2 -3' x 68' cells with > 3' spacing B -1 20 ' 7% Slope
ent
jA Quick4 Standard -W
Leaching Chamber
with 20.0 ft2 of Area
5.8ft ^2 /pair of end caps CC C PY
3491 Grade at System Elevation
1320' Property Line
P PL N
PROJECT Richard Germain DDR S 2107 Hwv 35 Somerset Wi 54025
SW 1/4 SW 1/4S 13 /T 31 / W DATE TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 10/5/09 BEDROOM 3
CONVENTIONAL XXX IN -GR ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TA SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Bottom of shed siding
ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H, R. P. Same as Benchmark
Scale is F = 40' SYSTEM ELEVATION 96.3/95.7 4' below qrade low side of ce
unless otherwise
noted
Plans Designed Using Well Hwy 35
Conventional Powts
Manual Version 2.0
50'
20'
Old system to
be pumped T
and buried Garage 10 , Existing 3
Bedroom
House
DW 35'
O 65'
50' 25'
ST 60' B -3
Vents
20' 900'
Garage 0
B -2
B.M. 50' S0 15'
2 -3' x 68' cells with > 3' spacing B -1 20' 7% Slope
Vent
> 6» Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12 5.8ft ^2 /pair of end caps
34" Grade at System Elevation
1320' Property Line
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County "
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' r
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. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner c Property Location loor
2)C t V`, ` Govt. LotS� 1 /k5Lj 1/ S 13 T 3 N R E (o W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
CC City State p Code Phone N ❑ Ci Village � Town Nearest Road
Jv rr.e / S ( ) ar o N►N OFf 5
P_
❑ New Construction Us sidential / Number of bedrooms Code derived design flow rate , GPD
Replacement ❑ Public or commercial - Describe:
Parent material C-!,, Flood Plain elevation if amWicable _A- % ft.
General comirnents
and recomirnendations: '7 /
System Type System Elevation
M Boring
E] Boring
Bon # pit G surface elevF 1 L 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 I •Eff#2
! c - l . v iz •--- .S/ ,�,,.. f�' C �-- t:.,., � � , �
1
it
F z - 1 Boring # C] Boring l
bf Pit Ground surface elev ft. Depth to limiting factor l ✓J in.
JAZFI
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 •Eff#2
J
IJ
{
Effluent #1 = BOD > 30 1 220 mg/L and TSS > < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 '3 - 715- 246 -4516
Property Owner _ Parcel ID # Page of
Boring #
❑ Boring
pit Ground surface elev. / , W! 3 3. Depth to limiting factor 1,2 j )_ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ! 'Eff#1 / 'Efff#22
Al
1
00
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ 11 Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon ')epth 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 = BOD > 30 < 220 mg/L and TSS >30:< 150 mg/_ ' Effluent #2 = BOD 130 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 -6330 (8.6/00)
Property Owner _ Parcel ID # Page of
Boring # ❑ Borings
�+ pit Ground surface elev. to Depth to limiting factor icl ( L in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z - "241 C
34.7 ,! ;� .7 w/
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor )n• 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
❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El Pit
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 mg/_ 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 (8000)
Soil Test Plot Plan
- project Name RichardGermain Shaun B'
Address 2107 Hwy 35
Somerset Wi 54025 CS 226900
Lot ------ Subdivision ----- --- Date 1
S W 1/4 S W 1/4S 13 T 31 N /R W Township Somerset
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Bottom of Shed Siding
System Elevation 96.3/95.7 *HRpSameasBenchmark
Scale =
S e �s 1 40
unless otherwise
noted Well Hwy 35
50'
20'
Garage �35 Existing 3
Bedroom
House
DW 65 ,
O 25' Ibld
100.5'
B -3
900'
B -2
Garage 60' 15' 30' 98.5'
15'
50'
B.M. 50' 50'
B -1 20' 7% Slope
1320' Property Line
I
` ST. CROIX COUN'T'Y
SEPTIC TANK MAD ENANCE A
AND
OWNWHIP CERTIFICATION F RM
Ownernauyer C, a j '
Mailing Address a ` S b
Property Address
(VeriSieatiom required from Plaaming & Zoning D for new won)
Ci ty /State Parcel identification Numb P3 c; '/ 5 au
i�F�GAL DESCRON
j
Property Location 1 /4 , Sec. / 3 , T N R , Town of Jo c''t Pl s 2
Lot # '—
Subdivision
Vo
lu�ne r— Page #
Certftfaed Survey Map # r1 —
# t� 6 -f Voluimef� p� #
Warranty Deed
'
Spec house yes o Lot lines able 6;� � M�nv�rr�NSNCE AND OWNER C
SY5TE TIFICATION
83.52(1) and in chapter Of septic system could result m 0 probe W= to handle wastes- Proper i �
use and meaintemnce your � . What you per
ImQrapes by a laiommed
soonest
ant the tank suety throe years �n the w�dtsposal system.
nee
consists of prompim$ O�vaner
can affect the hn tkm of to septic tank as a treatwent .
res po system 12 - St. Croix Co y Sad"ry'
resnsibilities are spcdSed in §Gamoon. iSication form, signed by the
The property owner agrees to submit to St Croix County Plaaoming 8t �rm°dDt a car tw (1) the on-site
amen cs pbimbea;, joutnaYmM p, restricted Plumber oar a li P septic tank is
owner and by a
is is proper Opaggxng condition and/or (2) aver ' aan+d PAS ( °�')'
wasocwatar diispoaal sysbera .
less than 1/3 full of sludge-
�� � P� sewage dal systcam with the
lave, the signed bare read the above requirewmb and agree to of Natural Reno, Comm
of State of Wisconsin.
erce and the D
standards sec frith, baarei�o, as not b3'the Department be and row ned to the St C MM County Plan mug &
Certification stating that your septic system has been manntaia� mmst comp
0 of the three year expiration date.
Zoning Deparom� watbnn 3 days ,
Uwe certify that all statements on this foam, are um to the best of my /our I nowledge. Uwe am/are the awnu(s) of the
pzaperty deacxa
M Re of D Office.
bed
above by
abo viardre of a waaanty
deed recorded gister
'
camber of ms J
- � D ATE
S AZ: OF APPLICANT(S)
� * *Aaxy information that is hearted way result in the sanitary permit being
revoked by the Planning & Zoning l)epmt m1 **
I=ht& with tha application a recorded warranty deed from the Register of Deeds Office and a copy of the =dfwd survey nW if
refereme is made in the warranty deed. i
i
(REV. 08/05
I
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
C y Plan
Op ' # ,. It ystem fails, determine cause of failure, use alternate area and install new
sted replacement area.
Option #2. nstall system at a lower elevation, by removing chambers, removing biomat,
nd inst ew system.
Option #3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
STATE BAR OF WISCONSIN FORM 3 - 1998 6.1 9647
QUIT CLAIM DEED K ATHLE EN OF DEEDS
ST- CROIX CO. , WI
Document Number ,.- ,'
_ ,,i
RECEIVED FOR RECORD
This Deed, made between 03 -I5-2000 9:00 AM
QUIT CLAIM DEED
EXEMPT A aM
Grantor CERT COPY FEE:
and - - -- - — COPY FEE:
TRANSFER FEE:
Richard C and Sharon ermAin RECORDING FEE: 10.00
PAGES: 1
husband and wi,Ee Grantee.
Grantor quit claims to Grantee the following described real estate in
St. Croix County. State of Wisconsin:
.. ; ...
The Southwest quarter of the Southwest quarter Name and Return Address
(SWI of SW}), and the Southeast quarter of the Richard C. & Sharon S. Germain
Southwest quarter(SE} of SWJ) of Section Thirteen(13) 2107 Highway 35 N.
Township Thirty -one (31) North, Range Nineteen (19) Somerset, WI 54025
West;
The Northwest quarter of the Northeast quarter - -
(NWI of NE
}) of section Fourteen (14), Township Thirtyone (31)
North, Range Nineteen (19) West; Parcel Identification iv� ,mt_1 - - - - --
Sellers Land Contract interest in the following This is homestead property.
real Estate: (is) (is not)
Land :: - 10 - 000 with Computer # 032- 1037 -50 -000
The Northwest Waltra Germain: PAR4f13.31.I9.186 (40.000A)
quarter of the
Northeast Comp1060 -40 -000 Computer # 032- 1037 -60 -000
quarter PAR #4 (40.000A) PAk #13.11.19.187 (40.000A)
(NW1 of
NE }) and the Comp1060 -10 -000 Computer # 032 - 1038 -20 -000
Northeast PAR #3A (29.030A) PARii14.31.19.193 (40.000A)
quarter of the
Northeast quarter
(NEJ of NEJ) EXCEPT the East 22 rods thereof in Section Twenty -three (23),
Township Thirty -one (31) North, Range Nineteen (19) West.
Together with all appurtenant rights, title and interests.
Dated this / S� day of March 2000
- rC\
� a� (SEAL) - -- (SEAL)
Richard C. Germain
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of Wisconsin,
55.
S� Count
authenticated this day of Personally came before me this l y day of
A AA ��h s 111, the above named
i L ilv� C tM w.si i_✓1
r
TITLE: MEMBER STATE BAR OF WISCONSIN to
(if not, P tpe khov,h to be the person who executed the foregoing
authorized by §706.06, Wis. Stats.) t men acknowledge the same.
��Q�, t
THIS INSTRUMENT WAS � DRAFTED BY �
S h a r o n C e,r vv i r3 2 , 4 ' Itch H_
tart' eubljq State of Wisconsin
cS"ptis ion is permanent. (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 Wisconsin Legal Blank CO., Inc.
QUIT CLAIM DEED FORM No. 3 - 1998 Wwaukee, Wes.