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HomeMy WebLinkAbout038-1121-50-000 Wisconsin Department of Commerce r PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430062 0 GENERAL INFORMATION State Plan ID No: Personas informatio! you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. i�-- ---� - Permit Holder's Name: City Village X Township Parcel Tax No: Germain, Dennis I Star Prairie Township 038 - 1121 -50 -000 CST BM Elev: l lnsp.BMElev: BM Description: Sectionlrown /Range /Map No: 6IR • '5 i d .7 • 30.31.18.5028 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark Ot L�i�sine 2 $ Alt. BM t Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD raiji Id, p Septic y ! / 1 _ Dt Bottom _.L 2 Header /Man. Im•3 Z > sa 5D 3 ---- i:c.4 Aeration Dist. Pipe Holding Bot. System IZ •� 8S PUMP /SIPHON INFORMATION Final Grade ( •Z ' 93.0 Manufacturer T) Wand St Cover sz, 14 qS Model Number P) TDH Lift Fri ' oss System Head Ft Forcemain Len D' SOIL AB RPTION SYSTEM BEDITVRCH Width I Length # No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMPNSIONS '1 74b AA.� (2'.") 1 �7 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man fa • fir: INFORMATION CHAMBER OR Type Of System: t r ( UNIT Model Number: c _ _ _ Ur �i DISTRIBUTI ST M ead / istribution x Hole Size x Hole Spacing Vent to Air Intake Pi) Pies Lengt Leng Dia Spacing • '7 J 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 __ TB d/ Edges Topsoil ] Yes No El Yes r No CO MFF�jTS: (Inc[ ode discrepencies, persons present, etc.) Inspection #1:� I � aZoP31nspection #2: Loa io 111 2 Cty Rd C Somerset, WI 54025 (SW 1/4 SE 1/4 30 T31 R1 8W) NA Lot 1 50? 8 1.) Alt BM Description = /' �VV•wV�k- C r l J C.�"�'"� _ (00 2.) Bldg sewer length= - amount of cove = ?,� ^ n /1� °�^ t�¢�t�, r .�. c�•�v� 3 c,Q��.� j_..`�` daY(u„ -- -- -- -- Plan revision Required? [..; Yes E] No Use other side for additional information. S 71 �� ate Insep�o r's�sipnatyte � Ce No. �X.. 7ti 4 ,�j�7►C' �/7't�t� -4t• -fit//' ~+�x•' i Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14 sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 D&partment of Commerce (Submit completed form to county if not (Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system 3es5 - 1 inches in size. County r ` State �e� [it umber ❑ Check if revisi n top at i State an I. D. Number I. Application Information - Please Print all Information jLoca ion: Property Owner Name a t t , rope Location / N, Ro ��/'�/ S �/' /•�! -f � ST ( ,_iIX CUU ^�! 1 1/4, Property Owner's Mailing Address 7C;P<! i : -.. r - ber Block Number City, State Zip Code Phone Number Sabdivisietriie me CSM Number y ►5 ' �� .. ] /3; ),9't7.5.5%, Cs 310 991 C v, 1 1P 5 Type of Building: (check one) ❑ city 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village Town of ❑ Public /Commercial (describe use):_ i ❑ State -Owned (-2) X Nearest Road C.- AV C !✓elm /` /`r /c G Parcel Tax Number(s) III. Type of P ermit: (Check only one box on line A. Check box on line B if applicable) p — AZI — So — Qt1D - SbZ19 A) 1. ❑ New 2. ), Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) 11 Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System a on Elev 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 7 a C Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel F as er- Plastic Information Gallons Gallons Tanks Con- Con- s New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ f� �� ❑ ❑ 13 ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumr's Name (print) I Plum Signature (no ps): MP/MPRS No. Business Phone Number u is Address (Street, City, State, Zip Cod IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued sui Agent Signature o stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination Z.zS -- l0 2aa 3 X. Conditions of Approval /Reasons for Disapproval: tl .jE. S..tg ` ja , , ,, v�„ �,,�r�y .Apg9,�.UQ_ „ A.� , •� ` Ssa� 3t'p nn.cu.�o..� -r. C..o� ..�A.qc�� v�l�u�� � 1Z GUS SBD -6398 (R. 07/00) Soil Test Plot Plan Project, Name Dennis Germain By Address 9152 CtRd;C ommerset Wi. 54017 - T W#220527 Lot Subdivision Date /20 County CROIX S W 1 /4 1/4S T 31 N /R W Townshi Star Prair R Boring a Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.base of siding System Elv. T -1 =91.0 T -2 =90.5 H.R.P. Same as Bm Driveway oRDC 55' well 2s' BM 20' st 20' 4 bed hous 90' 45' B2 �jc,`� Alt BM ss' PL I l _ i Soil Test Plot Plan Project Name D ennis Germain Byron Brd Jr. Address 9152 CtRd,.C;Sommerset Wi. 54017 C #220527 Lot Subdivision Date /20 County CROIX SW 1 /4 1/4S T 31 N /A W Townshi Star P r a irie n Boring Q Well PL Property Line# Alt. BM kBM or VRP Assume Elevation 100 ft of siding System Elv. T -1 =91.0 T -2 =90.5 H.R.P. Same as Bm Driveway oRDC BB . 55' well 25' 20' � st 20' 4 bed hous 45' x B2 �yc Alt BM ss' PL 1' 94' Wisconsin Department of Commerce SOIL EVALUATION REPORT page of Division of Safety and Buildings in accordance wi (vpde a a t 4 4 County Attach complete site plan on paper not less than 81, x 1 inches in size. Plan must ` include, but not limited to: vertical and horizontal reference int (BM), direction and Parcel I.D. c percent slope, scale or dimensions, north arrow, and locati and Ii lst c jo je " @' oad. Please print all informal n. ! Reviewed by Date i Personal information you provide may be used for secondary pu as (P?"cjLitW' Property Owner Win e r Govt. Lot 114,Sr114 S d T ,1 N R E (o Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# C State Zip CWe Phone Number ❑ City ❑ Vill g Town Nearest Road ew Construction User Residential /Number of bedrooms Code derived design flow rate `Q Z2 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ��� e- ' S ' � �� Flood Plain elevation if applicable ft. General comments and recommendations: T- _ 5; F/ - Q 7/ , '0. 5 • Boring # � Boring �� O ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O O o2 A r 5 Boring # 9 ❑ pit G �ndelev. ft. Depth to limiting factor _�/�117 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 *Efi#2 p -W- IYt sr ► `7 AV A-�-� off 21 42- loll t z.. ' i- 9 f. D / `--_ * Effluent #1 = BOD > 30 < 220 mg/L 6nd TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 nVL and TSS < 30 mg/L CST Name (Pie Print) f r— Signature CST Number He f r >a Address o to Evaluation Conducted Telephone Number �1i-- i �� r • >!'i'i77u� r Property Owner /� Parcel ID # Page of [y] Boring # Boring 3` 5 ❑ Pit Ground surface elev. J� ft. Depth to limiting factor '7 ° fg:� in. Sal Appilication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 AW WAL -2 2� 0 .5 - ff Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Apocation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor - -in. Sal 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 I Effluent #1 = BOD, > 30 _< 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS _< 30 mg/L I 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. SBD8330 (807/ Soil Test Plot Plan Project Name Dennis Germain Byron. bird Jr. Address 9152 CtRd C Sommerset Wi. 54017 z� CVI #220527 Lot Subdivision Date /3 /200 County CROIX S W 1 /4 1/45 T 31 N /R W Townshi Star P r ai rie R Boring Q Well PL Property Line# AIL BM ,BM or VRP Assume Elevation 100 ft.base of siding System Elv. T -1 =91.0 T -2 =90.5 H.R.P. Same as Bm Driveway Co RD C B 1 55' well 25' 20' � st 20' 4 bed hous 45' x 132 Alt BM 55' B3 PL I 93' Page of P POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa O s FILE INFORMATION SYSTEM SPECIFICATIONS Owner r , ( Septic Tank Capacity a l ❑ NA Permit # 4 3 D 6 Z Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) Cr-v gal/day Pump Tank Manufacturer ❑ NA Design flow !peak), (Estimated x 1.5) �- �_> al /day Pump Manufacturer ❑ NA Soil Application Rate al /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Month! average" Pretreatment Unit KNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ :_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended So lids (TS S) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD _ :30 mg /L ;k(n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geom mea n) 510" cfu /100m1 ❑ Drip -Line [3 Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cel(s) At least once every: yeast )(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA OL years! Inspect pump, every: ❑ year(s) ❑ month(s) p p, pump controls &alarm At least once eve - Ins Flush laterals and pressure test At least once every: ❑ ❑ yeaarr(s) (s) ) � m A Other: ❑ month(s) NA At least once every: ❑ year(s) Other:VA 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) Pageof START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: pipe openings sealed. • II be disconnected and the abandoned Il i All pi in to tanks and pits shall P P piping 0 The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name "f Name d Phone �- Phone 7� SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ®� Name Gra X ` r Phone 5 Phone mss" ' c� This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .6� ^/ 5 Mailing Address Property Address •-� �� f c `� �' (Verification required from Planning Department for new construction) City/State Parcel Identification Number ��rZ� LEGAL DESCRIPTION Property Location /4, /4, Sec. G T N -R W, Town of Subdivision . Lot # Certified Survey Map # �l ll 7 , Volume j . Page # Warranty Deed # °2 ,��d , Volume l Page # Spec house ❑ yesA no Lot lines identifiableyS yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber , restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 15 full of sludge. Uwe, 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 Zoning Office within 30 days of the three year expiration date. 2 G >'/ 6"i SI vATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property descoW above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * *« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * «« ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • DOCUMENT No. STATE LI OF WISCONSIN FO 3 --1982 °M1s ,.ACS ecuRVCO IOpt RtGORO1N0 DATA QUIT CLAIM DEED 4525 S P>, r 4SI REGISTER'S OFFICE ST. CR OIX CO., w1 Robert R. Mait•e)ean and Doris A Maitrejean, Reed for Retard .... ... ........................... StP2 0 .990 h sband and -."" at _ "•' 8:30 A nnM�� �i,ie�a��s to ...Den...... .: Germain, and Velma -- �A1c ' Ger,nain,. husnd and wife, ..................... ........ ". ............. a rofoeads ...... ................... ........... .................... ........ ................... •••- ••• " "' C`.un y' the following described real estate in ....... S.L. - ..C .I Q.LX..._._.- [TURN TO State of Wisconsin: t See attached Schedule Tax Parcel No: ... ----------- -------- - --• -- This quit claim deed confirms and corrects.a prior conveyance and also conveys additional property. S_ F This ..... s.. homestead property. (is) (is not) Dated this day of - -.- _Septembe- r............ a .(SEAL) -- - - - - -. SEAL) a ....... Robert R. Mai.tre�ean • - - -- • ... (SEAL) (SEAL) _ .- ......... " ..............•... ........ ............... .. t Doris A.. e Maitr_._ . n __,__ -... -. AIITggNTICA ION ACSNOWL&DGBIEN STATE OF WISCONSIN e an....- signatures) Gf..�Qh�.T.�..R ..Malt- reJ - - - -- ` gs. A. Maitr 1 ;! ' e an and Doris . .... • ....... 19 ..•........ - - - -- aunty. ............ ............................... 19 [ day of authenticated this - .__... Personally cams before me this __. 1 °-- --.day of _...-----•-- °-- °... -- °• ---- .Sep.temb.er ............:.. 19.. x!).. the above nam Rob.ert._R....Ma1trelaan _.and „ i tre }ean-- •-- ..--- - - - - -• .----------------- G. E. Norman IIor . is.. - - TITLE: MEMBER ST BAR OF WISCONSIN YVINS -- who exec 1 foregoing instrume t an j acknowledge the same. u ted t.:e THIS INSTRUMENT WAS DRAFTED BY "- � ��' - J - .1..0 - -' -- �- �� "' ' ' - - � " - F BAKKE, NORMAN, 5CHUbtACHER, • tephaaie.:A_....Desi.no •-- _ Wis. s; ' STC I NIVEK "• �'-- WALTEK; S•: �C � _.. ". . W� 54D17--- -- --------- -•-- - -- Notary Public ..-- ._Sty.. -CT .iIf no --County, Nest. " R rtv Commission is permanen iciaond...... . � (9ignatu t.lIf not, state expiration • 1 res may be authenticated or acknowledged. Both date: .... 19.9A are not necessary.) SMMWK A. DESM + + µrl.rnnxin T.•Ral HIAnk Ca Ire. } RT. %TE FI%R of WIN('OXy1N milwa e. a�a• ....r ... aA nvn � r .... . 7 � I4NS 310999 C E R T I F I E D S U R V E Y M A P Certified Survey Map number Vol. 1. Page 54 Sheet 1 of 2 sheets 33.00' � • ••• uap N � i S 56 197.66' .`` G. ROBERT cm SHEFFERS 40 S-908 o y EAU CLAIRE + rn 9 WIS. t O co �i 1, r ,,•e ,� ,�� o LOT I - � '` SUFZ 3 o "E - S T ° 44% 00 o C.T.H. "C" SCALE: 1 = 60 6 ,99.66 N M 0 M M W - �1099 0 N ... O ti LOT c M - 02 0 ��, FILED�� z o N$ 9 6 AN 29 11972 ,--1 DAVID H N 33.00' crax dam! Will. W % o >r Z� 222 h o0 9 29 O ° M A ffidavit 6( %1 -1190 aC $ N Affi.d.'ivit 601 -491 z Z O O 1" x 24 iron pipe weighing 1.13 pounds 2 35 9 per lineal foot SOUTH 1 4 7 CORNER PS G 30 -31 -18 This instrument drafted b Pa4e o co O z n n N O 0 O ° W CD y < c .+ ° w ° r- �l , w Q 2 �� � ro y rn N 2= Q 3 N m (J1 0 C C n CD N O O CD a O N CO !. O v u> v D Cp a N CD 3 � Imo' a v CD W < CD 3 0 ° c ao CL O o z ° CD W W CD N 0 CT l�V1 I C N 3 C� o ° 000 !1 _ W_ !V < z a c C, c�A CA A °— D .�' .. N 3 m o N :. z N ° zcoz 0 > 0 C7 N N N �. CD z C CD 7 .a O N O D p A? A m c El ° z 0 O 7 W V $ rr cn N m A 0 z > O 0 S C/) O� C CD CC N Dl G O 'QC 7 D p 4 U) O C X N 7 jy r O N < 'rJ N N f N A n 1 ( I 3 ` O N N CD cl, O �I CD O b O b iv A roe Parcel #: 038 - 1121 -50 -000 02/10/2006 08:51 AM PAGE 1 OF 1 Alt. Parcel #: 30.31.18.502B 038 - TOWN OF STAR PRAIRIE Current 1 , X f ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner VELMA GERMAIN O - GERMAIN, VELMA 1952 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1952 CTY RD C SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.510 Plat: N/A -NOT AVAILABLE SEC 30 T31 N RI 8W LOT 1 AS DESC IN CSM AS Block/Condo Bldg: IN VOL I P 50 EXC PART TO CO HWY AS IN 774/484 0.07ACRES PARCEL ALSO INCLUDES Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) LAND AS DESC IN 881/481 -483 ADDED LAND 30- 31N -18W IS EAST OF 66' PRIVATE RD EASEMT & WEST OF LOT 1 CSM 1/54 Notes: Parcel History: Date Doc # Vol /Page Type 09/02/2003 738461 2397/074 TI 07/23/1997 881/481 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 119705 141,800 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.510 28,600 110,800 139,400 NO Totals for 2005: General Property 1.510 28,600 110,800 139,400 Woodland 0.000 0 0 Totals for 2004: General Property 1.510 28,600 110,800 139,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 102 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 s ,. 310990 C E R T I F I E D S U R V E Y M A P Certified Survey Map number Vol. 1, Page 54 Sheet 1 of 2 sheets 33.00' o � 11 �., gNin�atpt S 56 21 00 E ' I C 0NS� 197.66 G. ROBERT SHEFFERS ? t EAU CLAIRE • _ WIS. �i 0 S o LOT I - G . J� ti N y�Its R ��N 3 0 0 44 00' E 0 7� , 0 n n SCALE: I 60� M S 19g g6 N i C.T. C 0 M W 0 0 a •1G� LOT 2� 0 F1 0 �a9 6 fl' JLJN 2� q, Z DAVID "M - 33.00 Y ,, 2y o 0 0 d bt)1 - L;90 ao - N Ikk k f i da.v i t 601 -491 Z O 1 x 24 iron pipe weighing 1.13 pounds 3 5°� per lineal foot �2 SOUTH 2r CORNER 5� 30 -31 -18 EP 1 This instrument drafted b Pam � i QQ I _ ' County: Wisconsin Department of Commerce :M St. Croix Safety and Building Division Sanitary Permit No: 430062 0 GENERAL INFORMATION 44 State Plan ID No: _ Personas informatio.1 you provide may be used for secondary pu ^---�" —� Permit Holder's Name: Parcel Tax No: Germain, Dennis O !za vnshi 038- 1121 -50 -000 CST BM Elev: Insp. BM Elev: BM De, ( Section/Town /Range/Map No: �.a epep 1. 6 - 5 CE , rxa4W— . 30.31.18.5028 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark MCI CL) VW4 ✓ s oo , 1 Alt. BM t Aeration 6 Bldg. Sewer Holding St/Ht Inlet � TANK SETBACK INFORMATION St/Ht Outlet �'•IZ IS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD laualat -- 7 Septic ! / 1 Dt Bottom a J" f Z S3 ! Header /Man. la •3Z a > 57D 3 co.4 Aeration Dist. Pipe Holding Bot. System L i iZ •'4 • SS Final Grade PUMP /SIPHON INFORMATION C�.ie I Manufacturer GP and St Cover Model Number TDH Lift Fri oss System Head Ft Forcemain Len D' SOIL AB RPTION SYSTEM BED/TR^CH Width Length 1 I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM SIONS - 1 74b J a SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man4fa • fir: _ INFORMATION Type Of System: v+ �a CHA UN OR Cvw Model Number: v DISTRIBUTI ST M Need Spaci istribution x Hole Size x Hole ng Vent to Air Intake ipe(s) , %D Leng Dia Spacing J �+ 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 Bed[Trench Edges To soil g p FL-11 Ye s fifl No [] Yes [J No COV ME�jTS: (Intl ode discrepencies, persons present, etc.) Inspection #1:A�1��7�v3Inspection #2: Loddfion 11952 Cty Rd C Somerset, WI 54025 (S �1�/4 d SE 1/4 30 T31 R1 8W) NA Lot 1 el No: 30.31. 5O J8 1.) Alt BM Description = 5 'T- A2 M1) j Cr J r� ` / 2.) Bldg sewer length = (� amount of cove = ?, �� Got- -Q 1rXs I AAADA Plan revision Required? Yes r 1 No Use other side for additional information. ate r C , In r's�s�n /� Ce No. +7{ �h\..i. L '� ; C I ]C� Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Wisconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system - x 1 inches in size. CountiY _ / r State �e it;4 mb r ❑ Check if revisi n top i State an I. D. Number I. Application Information - Please Print all Information % Jocalion: Property Owner Name I 'Propely Location ��� r'f✓��f r ST. Citojx COON 1 1/4, S�T �/ N, o Property Owner's Mailing Address ` ZONIi ber Block Number City, State Zip Code Phone Number 9"b4ioildiftrNme CSM Number Type of Building: (check one) ❑ city VP 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use):_ Town of i ❑ State -Owned Nearest Road � 2Ud� Parcel C- Parcel Tax Number(s) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 039 A) 1. ❑ New 2. , Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) 11 Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment A rea Infor mation: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elev 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) j „ a on C Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigne assume res ponsibility for installation of the POWTS shown on the attached plans. Plum y s Name (print) 1 Plum Signature (no ps): MP/MPRS No. Business Phone Number u is Address (Street, City, State, Zip Cod C� �•� f o IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued sui Agent Signature o stamps) �( Approved 11 Owner Given Initial Adverse Surcharge Fee) N Determination S� 110 zzo 3 X. Conditions o /Reasons for Disapproval: tt SBD -6398 (R. 07/00) Soil Test Plot Plan Project, Name Den nis G By Address 9152 CtRd:C-;Sommerset Wi. 54017 C #220527 Lot Subdivision Date /2003 Countv CROIX S W 1 /4 1/4S T 31 N /p W Townshi Star Prairie Boring Q Well PL Property Line# AIL BM ,BM or VRP Assume Elevation 100 1t base of siding System Elv. T- 1=91.0 T -2 =90.5 H.R.P. Same as Bm Driveway oRDC 55' well 25' 20' 20 90• st 4 bed hour 45' BB2 Alt BM 55' 1 • `--- PL 1 93' 94' i I Parcel #: 038 - 1121 -50 -000 01/0512006 10:18 AM PAGE 1 OF 1 Alt. Parcel #: 30.31.18.502B 038 - TOWN OF STAR PRAIRIE Current X I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner VELMA GERMAIN O - GERMAIN, VELMA 1952 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1952 CTY RD C SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.510 Plat: N/A -NOT AVAILABLE SEC 30 T31 N RI 8W LOT 1 AS DESC IN CSM AS Block/Condo Bldg: IN VOL I P 50 EXC PART TO CO HWY AS IN 774/484 0.07ACRES PARCEL ALSO INCLUDES Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) LAND AS DESC IN 8811481 -483 ADDED LAND 30- 31N -18W IS EAST OF 66' PRIVATE RD EASEMT & WEST OF LOT 1 CSM 1/54 Notes: Parcel History: Date Doc # Vol /Page Type 09/02/2003 738461 2397/074 TI 07/23/1997 881/481 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 119705 141,800 Valuations Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.510 28,600 110,800 139,400 NO Totals for 2005: General Property 1.510 28,600 110,800 139,400 Woodland 0.000 0 0 Totals for 2004: General Property 1.510 28,600 110,800 139,400 Woodland 0.000 0 0 Lottery redit � Claim Count: 1 Certification Date: Batch # 102 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I o § o ■ - 0 n 0 � k ) E � V ,; @ � ƒ £ ƒ / o ° S � \ § E • E\ E E# 8] 4) c - \rg m® qE: 2 CD :3 go ° C Cr ] o � » § 2 ; a M CD \ OD / 10 3 CL E E £' § 8 E 3 , C A n: 2 CDL 3 / f 2 2 2' C ® z G § ©� ft-4 e z o 0 0 n r■ ° .0 S S 2 i E Z §' Z a \ �: ■ , z 0 0 0 .. 2 z / R § ■ ■ ■ \' % > Oro E 7 J 0 Ui e C §7A . / § z { .. 5 > > 0 \ / i. 0 CD 7 I ` Oro a R 3 5 � z E , _ ■ = a � k z 9 q � ■ � � 2 � w CL CD 2f © f ® 7 m 1 M # � 7 k CD \ 0 a \ 0 ( � � ( 0 / X . £ W & § 2 \ 2 i � \ 0 P � ® § _ o � § , �