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Wisconsin department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety ancrBuilding Division 1 INSPECTION REPORT Sanitary Permit No: 515090 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: Scheid, Christine M. I Star Prairie, Town of 038 - 1074 -40 -100 CST BM Elev: Insp. BM Elev: BM Descripti06 Section/Town /Range /Map No: . `j $ 17.31.18.308A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic • r Benchmark T 36 Dosing Alt. BM 5 •. f4J.�,„ ."I � 'ii b- -�_..- � I•'j"F.� • �< 4r "�..1.,•, Aeration Bldg. Sewer Holding SUHt Inlet �• TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f . Dt Bottom g(w . 7 •t Dosing i ' ti Header /Man. Aeration Dist. Pipe Holding _ Bow. y7m �, � E J %z �Z. � �✓ S '5y f s PUMP /SIPHON INFORMATION s Final Grade 3. •... P f. r ' Manufacturer Demand St Cover • C . �,.rJ �� "`... GPM � `i• tw..a._ '* j'. / ":� �� Lr '� Model Number / Ct VQ TDH Lift , Friction Loss System Head TDH Ft ., .� fA , ...- 5.15 '7 2 • `7 3 • • . s.. -. a .a f . , a FOTcemain Length Dia. t I Dist. to well e SOIL ABSORPTION SYSTEM BED /TRENCH Width Length or No. Of Trenches( PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: + / } UNIT Model Number: DISTRIBUTION SYSTEM; Header /Manifold Distribution , t.,i' ,r , x Hole Size ,� x Hole Spacing ,, V Air Intake P e' Pipes) Length Dia f Length � � . l � Dia / ' ^ Spacing � i •' �, .� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ► Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil ` j • � �! I q Yes � No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 Zb / O ! Inspection #2: I Location: 2114 100th Street SOMERSET, WI 54025 (SE 1/4 SE 1/4 17 T31 N R1 8W) NA Lot 2 �JSQ Q Patel No: 17.31.18.308A50 o / 1.) Alt BM Description = +� �, �; t . (...' hC." . 2 • „ -. ! l0�•�1 2.) Bldg sewer length - amount of cover = le Plan revision Required? Yes ) No Use other side for additional information. Date InsepcW's Signaturo” Cert. No. SBD -6710 (R.3197) commerce.wl.gov Safety and Buil D�'vis County _ 201 W. Washington)' ox 7162 / • y CA 0 % X 'sco n s' Madison, WI 53707621 Sanitary Permit Number (to be filled in by Co.) Department of Commerce �' 5 f 5 6 Sanitary Permit Application State Transacti y on Numbe In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate ental 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 used for secondary / V p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. Application Information — Please Print All Informatio Prope r pp wner's N 9e Parcel # tif J �� £� JUN 292009 036-1 - u , -1e)6 $T rR01X COUNn Property Owner's Mailing Address Property Location y (, 3d�A � 3 5 7- C IO u Al l " - AN NING & ZONING FICE Govt. Lot ING O City State Zip Code Phone Number S�- /e, Section 1 - 7 1 `/G 6 8 Z Ili" J / •572 - ( circle one) II. Type of B uilding (check all that apply) 2 D T 3 N; R E or W ❑ 1 or 2 Family Dwelling - Number of Bedroo l ms 3 a Subdivision Name �jUbv�. �o ❑ Public /Commercial - Describe Use ❑ City of / / C Number ❑ Village of ❑State Owned - Describe Use C -k 76 0✓ 1 Z 2 � P. � / [Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' bN ew System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of PlumTowner Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration IV. Type of POWTS System/Component/Device: Check all that apply) + ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade W Nlound > 24 in. of s uitable soil ❑ Mound < 24 in. of sui bl soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. DispersalfIrreatVient Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Require Dispersal Area Proposed System Elevation Y�C /. '7 ►ILA / JL ° ! X3.,58 ✓ VI. Tank Info Cap city in Total # of Manufacturer Gallons Gallons Units 2 o N o New Tanks Existing Tanks aU� e ji0or Holding Tank �00 O N Y_ osing Chamb 1, � J VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS skgw on the attached plans. ber's Name (Print) lumber's Signature /MP Number Business Phone Number a C_ k � A 'L " # jK t-5 l ZZZ87v Y 2- -1- V z, Plumber's Address (Street, City, State, Zip Code) 7/5 1 - fir ., 573 V11k Use Onl pproved Disappro Permit Feeee� Date ssued Issuing ent Sign e iven Reason enial $ tOV✓ IX. Conditions of Approval/R or Disapprov 1. eptic tank, effluent fNter and 3, P &,. �r'+R> dispersal cell must all be servluel / maintained / as per management plan provided bypkrnber. �005e_ ✓b�" o"� o ""`' q ... _ _ y r , e system and submit to the County only on paper not less than 81/2 x 11 inches in size ' as p!f ;� P= C000 OfCI e ,Zb =6^� ow\- C5vv\. 1 0 6cx: SBD -6398 (R. 02/09) Valid thru 02/11 / Ll Al x h 33L R� �� 1 1� 01A !" a4 j p V e P;? E ex �'•� . � v 5 t c.k � ooa Q moo f ropms�d � x'7�' i� d C�11 a) Sy- 3+e -y V• of 73= VIA CL _5 CaVe- i �-�e�frV2.�y a�di �f� �• QL. ff 1� Safety and Buildings 141 NW BARSTOW ST FL 4TH commerceml.gov WAUKESHA WI 53188 -3789 Contact Through Relay Itl sco n s i n www.commerce.wi.gov /sb/ ep of Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary June 24, 2009 CUST ID No. 222872 ATTN: POWTS Inspector JACQUE M 1 AWKINS ZONING OFFICE HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA 2659 150TH ST 1 101 CARMICHAEL RD LUCK WI 54853 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/24/2011 Identification Numbers Transaction ID No. 1679159 SITE: Site ID No. 748960 Christine Scheid Please refer to both identification numbers, 100TH St Lot 2 above, in all correspondence with the agency. Town of Star Prairie St Croix County SETA, SETA, S17, T31N, R18W Lot: 2, FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1230024 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01/01) 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 and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706-P (N.01 /01). C— - 2 1 0 In the event this soil absorption system or any of its component parts malfunctions so as to crea hazard, the property owner must follow the contingency plan as described in the approved plans. In ad ft er must comply with the operation, maintenance and monitoring duties as described in sectio III of d component manual. A copy of this information must be given to the owner upon completion of the p ct. All holding/treatment tanks are to comply with Comm. 84.25(7)(a). C Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. JACQUE M HAWKINS Page 2 6/24/2009 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. 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. Stars. 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. 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 /instal lation/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. erely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis - Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis @wisconsin.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN RECEIVED Residential Application INDEX AND TITLE PAGE JUN 1 5 2009 Project Name: Christine Scheid Mound System SAFETY & BUILDINGS Owner's Name: Christine Scheid Owner's Address: 332 County Rd. E Houlton WI 54082 Legal Description: Parcel in the SE1 /4 -SE1 /4 Sec. 17 T31 N -R18W Township: Star Prarie County: St. Croix Subdivision Name: Lot Number: Lots Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Jacque Hawkins License Number: MPRS# 222872 Date: 06/11/09 Phone Number: 715 -653 -2324 Signatur e l l �°� 1 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691 -P (N. 01/01), and both S4; p SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) C 1p Version 5.1 (R. 06/06) Pagel of 8 011/ Gs tick Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) Note: Dispersal cell adjusted for concave 12.00 Site Slope (%) deflection on site. 92.58 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 76.001 Dispersal Cell Length Along Contour (ft) = 6 Cell Width (ft) 0.99 Dispersal Cell Design Loading Rate (gpd /fe) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highestp2int in the distribution J Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 6.00 fe/orifice 2.00 Forcemain Diameter (in) 130.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 21.21 Forcemain Drainback (gal) 8.08 Vertical Lift (ft) 68.24 5x Void Volume (gal) 4.48 Friction Loss (ft) 89.44 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 40.93 System Demand (gpm) i` 17.11 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Skaw Precast Compad Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 642.331 Dose Tank Capacity (gal) JZabel Filter Manufacturer 16.471 Dose Tank Volume (gal/in) A -100 I Filter Model Number Skaw Precast Co. Manufacturer Project: Christine Scheid Mound System Page 2 of 8 Mound Plan and Cross Section Views T 1/10 B . :�: J ' Observation Pipe — K T ♦ ` 5 1 A W ................. '' I L Mound Component Dimensions A 6.00 ft E 20.64 in H 1.00 ft K A25.17 ft B 76.00 ft F 9.50 in z 14.12 ft L ft D 12.00 in G 0.50 ft J 5.06 ft W ft 456.00 (if) Dispersal Cell Area 1 1528.91 (fe) Basal Area Available 5.92 (gpd/ft) Linear Loading Rate 7.60 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.37 (ft) - -► .,f �..,.. G H I F 94.08 (ft) Lateral Dispersal Cell 93.58 (ft) - ► — Invert Dispersal Cell Elevation E D ::::::::: f ., �, � i • i, ;. .{ : { { {. �•. ;, i ~ i ; { �{' ; ;, i i Vii, i ?;, { ;, ; i i i i ,i { i i ; i, i, ,i, ;. _{ �; ; i, 4 i, '., 1,~ f, . i r. ; . ..' 1 •..f 1 , i , i i. ; ;_:_i. 1._;._ i. ;._1. +. _:_._1. ;._J. _ ;. { i 1. ;. - �•- �•��..{ i J i. i i ; �i., i ; i,• ,{ �. �_ i i 92.58 (ft) Contour Elevation 12.0 %Site Slope Geotextile Fabric Cover Shading Key 'o $" T Dispersal Cell See lateral details on 1� _Topsoil Cap 3 0 ° 1.5 ft Page 4 for number, size, © }f• {f Subsoil Cap 0 o: and spacing of laterals. © ASTM C33 Sand Z ; :• •;:° F Laterals are equally ® Tilled Layer m 0.5 ft Typical Lateral :::; spaced from the Aggregate ° ;.5 I distribution cell's ° ��' "�'` " ^ *+ centerline in the A distribution cell (AxB). Project: Christine Scheid Mound System Page 3 of 8 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at : point. Laterals are identical P S �= Turn -up vvlball valve or I - x.— +IEs12 I x12 Laterals & Forces main of PVC Soh 40 cleanout plug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 37.19 ft Orifices per Lateral 19 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 W /orifice Lateral Flow Rate 10.23 gpm Manifold Length 3.00 ft System Flow Rate 40.93 gpm Manifold Diameter 1.50 in Total Dynamic Head 17.11 ft Forcemain Velocity 4.18 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Disconnect Electrical as per NEC 300 and –� Comm 16.28 WAC 4 in. min. Tank component is property vented F— Alternate outlet location Forcemain diameter Skaw Precast Co. Manufacturer 2 in. Capacityl 642.33 Gallons Volume 16.47 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.57 322.31 C B 2.00 32.94 Pmp off elevation (ft) C 5.43 89.44 —t 86.00 D 12.001 197.64 D Total 39.00 642.33 il Dose tank elevation (ft) 3" Bedding uncTer tank. 85.00 Alarm Manuafacturer JSJ. Electro Alarm Model Number Tank Alert Pump Manufacturer JGoulds J Pump Model Number EP05 Pump Must Deliver 40.93 gpm at 17.11 ft TDH Project: Christine Scheid Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Tri-County Sanitation Phone 715 - 386 -0114 POWTS Regulator's Name St. Croix County Zoning Office Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 456 f: Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •��������00��• •�������������• Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve . Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Christine Scheid Mound System Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code cieneral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01101), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 5 , 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Preb+aatrnent Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 NGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 �r APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. Conad • Heavy duty sump matic models include • Water transfer Mechanical float Switch ■Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic BouldsPwois150SIMwg wecl. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/4 maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: V/2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous METERS FEET 140°F (60cC) intermittent. • Fasteners: 300 series 10 stainless steel. 9 30 _ sc • Capable of running dry without damage to 8 zs Fr components. 25 °a 7 Motor: _ • EPO4 Single phase: 0.4 HP, v_ s zo 115 or 230 V, 60 Hz, 1550 �d RPM, built in overload with o s 15 automatic reset. a a y o ' .. • EP05 Single phase: 0.5 HP, o -- 115 V or 230V, 60 Hz, 1550 '' 3 10 RPM, built in overload with EPO4 automatic reset. z • Power cord: 10 foot s standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 ° 0 0 10 zo 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug o z a s B 10 1�z n (standard on EP05). CAPACITY G oulds Pumps ® 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Wisconsin Department of Commerce t VALUATION REPORT Page 1 of 3 Division of Safety and Buildings in a%MMwwAMWIM, Wis. Adm. code CounlY St Croix Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 34Y/) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q 3r1 /f} � ` � Sa Please print all infonnafion. Re by Date Personal mforna*m You provide reay be used , s. 04 (1) (m)). Properly Owner P perty Location A Tenney Crichto SE 1/4 SE 1/4 1 17 T 31 N R 18 a yy Property Owners Mailing Address NOV 2 A LUU Lo # Subd. Name CSW 67') -- 2118 100th St 1 city State ZQ Code Phone []Village ■ own Neared kaid Somerset W1 54023 ( 100th St Stu Praric ■ New Construction Use Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Public or commercial - Describe: Parent material Flood Plain elevation if applicable R / General comments r r • Lr • and recommendations: OJ Bori # Boxing 9 0 . '5'K Q Pit Ground surface elev. 90 R Depth to GrNtirg factor 24 in. Soil Application Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDR in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. - EW '0111:2 1 0-12 10YR3 /3 SL l F GR MVFR C W 1 F 0.4 0.7 2 12 -2 YR4 /6 S O'K6U ML CS 0.7 1.6 3 2434 7.5YR3/4 F M D 5YR4/6 S 0 N O ML C S 0.7 1.6 4 3472 5YR3/4 C M P 5YR5l8 SC 2 M BK MFR 02 0.3 ❑ Boring y�''� ❑ Borng # Q Pit Grand surface elev. 96'2 " R Depth to limiting factor 84> in. Soi Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Mansell Qu. Sz Cont. Color Gr. Sz. Sh. - EM •EM2 1 0-12 10YR3/3 SL 2 M GR MFR C W 1 F 0.6 1.0 2 12 - 84 5YR4/6 SL 2 M BK FMI 0.6 1.0 Efeuent #1 = BOD > 30 220 mg& and TSS >30 < 150 mglL = BOD < 30 rrglL and TSS < 30 mglL CST Name (Please Pmt) Signature CST Number Dale R. Stewart 220879 Address Evaluation Conducted Telephone Number 757 107th St Roberts, WI 54023 11/21/2006 715 749 -0145 Property Owner Crichton, Tenney $� . 5 Parcel 1D # paw 2 of 3 3 Boring 9 # Q R Pit Ground surface elev. 89'7 Depth to 9 factor 36 M n Sot Application Rage Horizon Depth Dominant Color Redox Description Texture Structure Consislence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff l - E1t2 1 0-17 10YR4/3 SL 1 F GR MVFR C S 2F 0.4 0.7 2 17 -36 10YR3/6 SL 2 M BK MFR C S 1 F 0.6 1.0 3 36 IOYR416 FID 5YR5/8 S 0 5 ML 0.7 1.6 F-1 Boring # �9 Pit Ground surface elev. fl. Depth to hurling factor i► Soi Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsel Qu. Sz. Cont. Color Gr. Sz Sh. 'EM1 - EfW2 Boring F-1 # Boring Pit Ground surface elev. R Depth to lrrrfirg factor in. Sot Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roos GPDHP in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. " EMM 'E1102 EtAuent #1 = BOD > 30 < 220 rng& and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& and TSS < 30 mglL 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. sBW933ffcd (Rmroo> 4 3c�l3 NE LOT c c P" NCR � i s M coo' /// s S S+ f-fr I oa'S' G �f T pof l�l' V P ZO 7 A x leQ = - 7 Z ®o 31)( c00' 3to0 s f T 3 X I c: � ,r ,� i '� rh � � � 7 �I PL 9,70 t- P - -_____ _ - - - -- -- ' � t — a..7 BI 96 7 " SCALE I" B q` �3 - 7 0 MA/C R: 7 E Al A/ F Y C TeW HvcJSE .540 - V- r too b�z 0 0 0 0 0 eD a m o o m Comm. eD Ok V1 46 W N CA d x � 0, CA rD s C� 00 IQ CJ o � � o b � �� a RECEIVED 13 3 APR 6 2007 846729 VOL 22 PAGE 5374 KATHLEEN H. ST. CROIX COUNTY REGISTER OF DEEDS CERTIFIED SURVE1uRv1 f' cORO ST. RECEIVED CO. , C WI RECEIVED FOR RECORD Located in part of the Southeast Quarter of the Southeast Quarter of Section 03/19/2007 02:16PH 17, Township 31 North. Range 18 West, Town of Star Pruirie, St. Croix County Wisconsin. CERTIFIED SURVEY HAP REC FEE: 13.00 COPY FEE. 3.00 BF=Af.INGS ARE REFERENCED TO THE SOUTH LINE OF PAGES: 2 THE SE 1/4 OF SECTION 17, TOWNSHIP 31 N., RANGE 200 a 200 19 W. WHICH IS ASSUMED TO BEAR S88 GRAPHIC SCALE SCALE IN FEET: 1 inch — 200 feet Fos! 7:4 Cor. -r <r Section LOT 1 NG..TH C 7 U 7 S.M. VOL_ 12 ir NPI of 7Z- /_ A /VL> ; PA C, - 34 48 S88.18 -50.1 1302.45' f 12ao. t t' 22.34' � `! LQT 1 ci f: r,s7; • c , =1 cc Total Area: `I 755, 62.5 sq- ft. �/� r ' N88'20'03 "W 17.55 acres t I I r i! Area Except ROW. 236.00 I 759, 353 sq. ft. v /;� ,.5� ,.,,� 00 22.40• �. I 17.4 acres 'u!uu6ying O L� I rn'j -11 Toto/ Area 620 2.79 ac. res' N Area C. c j ROW 87, 32? sq. C , 2.00 acres N88'20 0 W 1305.7 25x.46' _ 1R i8 a! E 1305. B:' J / !, 0 Z I (te .risrin GE 652 rwoy fr- G. S. !? -�. -- L U1 .3 PA _ l i `� 1 0 V101 _ 13 t PA v_1- 35, M .`��c( ion i ?- ;7 - /,V -. SnuLbeasf Cnrncr �: �aln rl Si:r vey Nuii% - >��/inn 7 /-- 31 —lR. (F�l•nd urvcy Ne: /� a :O'TF: The parcels shown on this map are subject to Stute, County and NCEE. Toimship laws, rulea and regultitrons (i.e. weilonds, ruin ?mum tot size, ocrsss to , ULTZ • �c e parcel, etc.). Before purchusing or developing any parcel, contact the St. Croix C' 031 HUa _.un 2 ty 7uning Office rind the appropriate Town Board for advice. � O : P e # d by- SU22 Section Corner Monument " Consulting Group, Inc. of Record Prepared for and at the request of: O • Set 1" O.D. x 18" Iran Pip wei hin Tenney Crichton Phone No. (715) 246 -4319 1.13 pounds per linear foot s g 2 118 — 100th Street Far No. (715) 246 -3830 O Found t" Iron Pipe Somerset, 1 41 54025 P.O. Box 325 I < .= Drafted by Nicole Gulick Nay' Richmond, WI 54017 Recorded As Sheet 1 of 2 Building Setback Line (50' from Right of Way) Vol. 22 Page 5374 08 08:01 AM Parcel #: 038 - 1074 -40 -100 04/04/20 1 OF 1 Alt. Parcel #: 17.31.18.308A -50 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/19/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SCHEID, JUAN P JUAN P SCHEID 332 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 2114 100TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 2.190 Plat: 5374 -CSM 22 -5374 038 -07 SEC 17 T31 N R1 8W PT SE SE CSM 22 -5374 Block/Condo Bldg: LOT 02 LOT 2 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 04/19/2007 848806 WD 03/19/2007 846729 22/5374 CSM 07/23/1997 1157/250 QC 07/23/1997 1069/554 WD more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/30/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 13 3 VOL 22 PAGE 5374 KATHLEEN H. NALSA -- REGISTER OF DEEDS CERTIFIED SURVEY MAP ST. CROIX Co., MI RECEIVED FOR RECORD Locates; in part of the Southeast Quarter of the Southeast Quarter of Section 03/19/2007 02:16PM 17, Township 31 North, Range 18 West, Town of Star Pruirie, St. Croix County, CERTIFIED SURVEY MAP Wisconsin. REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SE 1/4 OF SECTION 17, TOWNSHIP 31 N., RANGE 200 0 200 18 W. WHICH lS ASSUMED TO BEAR 588'21'15 "E. _ 1!!! 11 GRAPHIC SCALE SCALE IN FEET: 1 inch - 200 feet L - as1 1 14 corner - LUG 1 1 - 1 C. S M.. _ VOL _ 11 � .1 U/Vf'L ED i_AND`' PAGE JW- S88'18'50" 1302.45' r. 41280.11' 22.3 F-shr,g o LaT 1 Total Area. ; 765,625 sq. ft. N88'20'03 ocr -- - -- 258.40z Arec Except RCN! � 236.00 — I T� 759,353 s ft. V "!; ,s c "'d c��, 7 X13 22_.4c' 1 acres c�- �r:r,.,,., p L07 { M Total Area: -1 I r 95, 620 sq. I Alec ROW. 87, 32 sq. ft. 2.00 acres - 1047,22 - - - -- - - -- - - - - - -- O - - - 22.,46',-1 ! ! W I N88'20'0 W 13`05. 2513.46' / / 1 ( =5'874 O! E 1305.8.'J� C:rLs!ing � I 'Way C. S. fill. Vil:V. .3 cJ7 .3 Paa �° ~ o - -- f:rAGE 652 3.'51 X �. , , ,!h 1, �/ Gr:rner - SBH�•/ "!5'L °F?.?.2x " -- - ..�•clion Nuiij •;(.);F: The parcel0 shown on this map ore subject to State, Count and � � FKNCEE. O Tov:nahi; laws. ruiaa and regulations (i.e. wei{onds, min.mum Sat size, ❑cos =s to , ULTZ parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix (, C ,unty Zoning Office rind the appropriate Town Board for advice. ( 3 JOR a Su2z6 I FC ND : ��i�� .S U ft Section Corner Monument 'O C ons ui tingGroup , Inc. of Record Prepared for and at the request of: - ' -� " -- - i Set 1" O.D. x 18" iron Pipe weighing Tenney Crichton Phone No. (715) 246 -4319 1.13 pounds per linear fool 21 i8 - 100th Street Far. No. (715) 246- -3830 O Fund 1" Iron Pipe Somerset, W'i 54025 P.Q. B 325 12- Recorded As Drafted by Nicole Gulick Naw ".ichmond, WI 54017 Sheet 1 of 2 • • • •. • • • • Building Setback Line (50' from Right of Way) Vol. 22 Page 5374 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner C A /—) " S i , _ 1 Septic Tank Capacity /06 a l ❑ NA Permit # Septic Tank Manufacturer 37'ffcL ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer S f ❑ NA Number of Bedrooms �j ❑ NA Effluent Filter Model C? F /D ❑ NA Number of Public Facility Units JZNA Pump Tank Capacity 600 aI ❑ NA Estimated flow (average) gal/day g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 3 al /day Pump Manufacturer V v �t/s ❑ NA Soil Application Rate v gal/day/ft' Pump Model r1 S ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit EMA Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L _J ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L 12 NA ❑ At -Grade "n Mound Fecal Coliform (geometric mean) _ <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. 12 I A Other: ❑ NA Other: ❑ NA Other: Q NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) s) At least once every: Tear(s) (Maximum 3 years) ❑ NA 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 every: ❑ month(s) (Maximum 3 years) ❑ NA J B'year(s) Clean effluent filter At least once every: months) 13 NA (p ❑ year(s) Inspect pump, pump controls &alarm At least once every: -8—month(s) 0 year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA -B 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 (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. GMW (4/01) of the tanKlsl removes oy 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 INS7ALLER Y POWTS MAINTAINJER Name c Q W 1! t., Name Phone I y 7 L 2 L/ Z - / Phone ZY Z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name �<5t c.. Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Il ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIIFICATION FORM Owner /Buyer 564 t' � G/ Mailing Address 3 L ecl p i,✓ ," Z. U 8 � Property Address J �1`, (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 037 .0 CDT/ -• LEGAL DESCRIPTION o 36-94 5 6 Property Location 5 � '14,3r '4 , Sec. 17 , T S j N R 1 9 W, Town of Pdk A , "L Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yes, VO Lot lines identifiableyyes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we ain/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms - - - 4 �' � �-_- "' �' 6, i z7 O SIGNATURE 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) {IlII{ IIIII Illil lIII{ lIII{ Illfl lIII IIII!{ till illl * 8 7 4 0 1 4 1 STATE BAR OF WISCONSIN FORM 3 -1998 874014 KATHLEEN H. IVALSH REGISTER OF DEEDS Juan P. Scheid, quit - claims to Christine M. Scheid, the following described ST. CROIX CO., WI real estate in St, Croix County, State of Wisconsin: RECEIVED FOR RECORD 05/02/2008 01:40PM Lot Two (2) of Certified Survey Map filed March 19, 2007 in Volume 22 of QUIT CLAIM DEED EXEMPT t B C.S.M., page 5374, as Document No. 846729, being located in part of the Southeast Quarter of the Southeast Quarter of Section Seventeen (17), REC FEE: 11 .00 Township Thirty One (31) North, Range Eighteen (18) West, Town of Star PAGES: 1 Prairie, St. Croix County, Wisconsin. Recording Area I/ Name and Return Address Hendrik W. Van Dyk VAN DYK, O'BOYLE 8 SILER, S.C. 201 S. Knowles Avenue New Richmond, WI 54017 f 038 - 1074 -40 -100 r � Parcel Identification Number (PIN) This is not homestead property. Dated this 0 day of April, 2008. Juan P. Scheid ` AUTHENTICATION ACKNOWLEDGMENT Signature(s) Juan P. Scheid STATE OF WISCONSIN ) )Ss. St. Croix County ) authe t' ated thj.5. jLbd of nZ 8. Personally came before me this day of t j y April, 2008 the above named HendY ilc W . Van Dyk to me known to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowledge the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Hendrik W. Van Dyk Notary Public, State of Wisconsin VAN DYK, O'BOYLE & SILER, S.C. My Commission is permanent. (if not, state expiration date: 201 S. Knowles Avenue 20_. New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3 - I"S INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800- 655-2021 June 30, 2009 Ryan Yarrington St. Croix County Zoning Department Hudson Government Center 1101 Carmichael Road Hudson, WI 54016 Dear Mr. Yarrington, This letter is in regard to the attached plan for the house that will be built on my property at 2114 100 St. in Somerset. The plan is meant to allow for a 3 bedroom, 2 bath home that includes the possibility of a bar in the basement level. This plan is not meant to be a duplex and will never be a duplex. It is a modest, single - family dwelling that will allow for a future entertaining area in the basement level. The plan includes a stairwell from the upper level to the basement, and the basement level will be unfinished at the point of project completion. If you have further questions, please contact me at 715 - 549 -5244. Thank you. Sincerely, Christine Scheid 332 County Road E Houlton, WI 54082 Enclosed: house plan • �a 4 �G §� a G �a 1 t•' 3� i C� Jill FI a as a � 3 m $ � � ills � 1111 P 1111 1 _ 3 f m co ` c o $ �s oi � $ gi If 11 F I-- lilt ..... ...... li t lip vi vi i'lli mill MRV'A�� fl ) J Q Am i i I i t i t I I b tog ................ 110 0. 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