HomeMy WebLinkAbout032-1067-10-225 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law s 15 04 11)(m))
Permit Holder's Name City Village Tow^sh,p
TOWN OF SOMERSET
CST BM Elev Inap BM Flev SM Description
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
�� j it) $.5
V�41S�v/ V G9
00 v
Dosing
ce VMoo cam+
S
Aeration
H
1'
TANK SETBACk INFORMATION I " VC .1• r
TANK TO
PIL
A,�
WELL
BLDG.
vent to Au intake
ROAD
Septic
7 t
2?`'
�� I
Dosing
Ch
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer Demand
S GPM
Model Number :r f 1 0
TDH Li� ` Frict n oss System Head T /0 Ft
`b I
Forcemain Length Dia ^ S• ❑ st to weI) t
w �.. a nAf1flTIfAA1 l+V I�TCaA\-A
t:LLVA 1 IVIV UA 1 A
County St. Croix
Sanitary Permit No.
645424
State Plan ID No
Par^el Tax No
032-1067-10-225
Section/Town/Range/Map No
24.31.19.330A-25
STATION
BS
HI I
FS
ELEV.
Benchmark
Y I
I0,�-,1I
100.0
Alt. BM
17 0
5't-1l
Bldg. Sewer
\
U`
St+Ht Inlet
SI1Ht Outlet
Dl Inlet
Dt Bottom
Of
j
HeaderlMan.
_'L
lD0
6111
10 1
101
Dist. Pipe
Bot System
Final Grade
t Cover
I—'. 0
—1 01
BEDITRENCH
DIMENSIONS
Width �, Length
No Ct Trenches
IV\
PIT DIMENSIONS
No Of Prs
Inside Ma
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L N
BLDG
WELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
rer
✓
T Of System
er"J
q q •
t
^ �O\
b
EE
DISTRIBUTION SYSTEM -
HeadedMandold DlsVibution Ix Hole Size le Spann V nl to Air Intake
Q X Plpe(s)
Length V Dia Length Di Spacin /�
c �n nnvro - n r.. .. Um,-4 Ar At_rrarin Svcfnm.R Only / \
Depth Over I
Depth O er
epth ct ed'S ee ded
Mutche
BedlTrench Center 2 t
\,Axx
BetllTren dges
Top it J Yes No
�' Yes No
COMMENTS: (Include code discrepencies. persons present, etc) Inspection #1
Location! 2001 72ND ST — V�y� OA
1.) All BM Description =9�-C-tv
2.) Bldg sewer length =,9-0
I
- amount of cover = ��
Plan revision Required _ Yes XNo l
Use other side for additional information. ( - -
Dale In epc is nature
SBD-6710 (R 3197)
Inspection 02
I S, Cert No
I,
V': County
RECEIVED jAnd Se Divi St.Croix
0M/" 1 E Ing on Ave Sandy Permit Number (to be filled in by Co.)
162
Ir = . S � Q 2 0 2 `,r ' O. Box 707
-Madison, WI 53707-71fi2
nl elTnit Application State Transaction Number
In accordance with SPS 383.21(2), Wis Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note. Application forms for state-owned POWTS am submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary Pro1ect Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15. I m Stars. 2WiUi Wway-35 ;
1. Application Information - Please Print All Informa ' �0 2t"0Q 1
#
Property Owner's Name Parcel
Property Owner's Mailing Address Property Location
2021 1lighway 35
Govt. l,ol
City, State F54025
Code Phone Number S W '/4, SL ''A, Section 24
Somerset, WI (circle one)
T31N R19EorW
11. Type of Building (check all that apply) Lot # I
® 1 or 2 Family Dwelling- Number of Bedroom ,— Subdivision Name
❑ Public/Commerciai - Describe Use Block # NIA
❑ City of
❑ State Owned - Describe Use _ 3� ElVillage of
CSM Number
P 6 ®Down of Somerset
Vs
I II. T e of Permit: Check only o oz on ire .Com fete line B if a licable
A. New System ❑ Replacement System ❑ TreatmettUHolding Tank Replacement Only El Other Modification to Existing System (explain)
B. ® Permit Renewal ❑ Permit Revision Change of ❑ Permit Transt'er to New List Previous Permit Nylmber and Date Issued
E PluExpiration Plumber Owner2Q22-
1V. Type of POWTS S stem/Com nent/Device: Check all that apply)
ssurized In-Gro ❑ Pressurized In -Ground ❑ AI -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
El Holding Tank Other Dispersal Component (explain) El Pretreatment Device (explain)
V. Disperse I/Tresitm cut Area Information:
Design FI ) Design Soil Application D
ispersal rsai Area Proposed (sf) System Elevat tA"
6W Rate(gpdst) ' I`�*All��/ 0.5V1. Ta Capacity in ,Gallons{pManufacturerNeu' Tanks Existing Taa U in C7u- C7 f7,
Septic or Holding Tank 1000 1 Wieser Concrete
Ikosing Chamber 650I I 1 W icser Concrete
V 11. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWIS shown oa the attached plans.
Plumber's Name (Print) Plumber's MPIMPRS Number Business Phone Numbcr
John Schmitt 223760 715-760-0496
Plumber's Address (Street, City, State, Zip Code)
586 Valley View Trail, Somerset, WI 54025
Vill. Coun /De artmeennt Use Only
P1 Approved ❑ Di Permit Fee a Issued 1 sd g Agont_Sign u
❑ ()wrier Given eason for Denial is r �� ZZ {
IX. Conditio )
3Imo. , r�C 2t t
1� ter.
�p�,,
1. Septic tank, effluent filter and dispersal cell
must be serviced !maintained as per t'l'�" �
L_i.� P —20Zo— p
m t
Mich to m e.pjgas!for a sYs a Paper not duin
C� U" f�
1�cable code 1 ordinances.
ter)-6398 (R03114 Cyr l-4 'o p4� &-W I Yn�ItAr�
� M T
' Industry Services Division
1400 E Washington Ave
`f fib. Box 7162
County
St.Croix
Sanitary Permit Number (to be filled in by Co.)
Mad . WI 37 7
�LF •
State Transaction Number
S Pe it Apl>tc
In accordance ith SPS51t34.f Z 1 ubmission f this form to the appropriate governmental trait
is required prio to ote: Application forms for state-owned pOWTSr are submitted to project Address (if different than mailing address)
the Department and Professional Services. Personal information You provide may be used for secondary 2021 highway 35
u s in accordance with the PrivacyLaw, s. 15.04(1 m . Stats.
I' ti I f rmation — Please Print All Information
1. A tca oo n o
property Owner's Name
Lorraine Germain
property Owner's Mailing Address
2021 Highway 35
City, State Zip Code
Somerset. WI 54025
11. Type of Building (check all that apply)
® 1 or 2 Family Dwelling - Number of Bedrooms
Q.L f
❑ Public/Con mercial - Describe Use 1
❑ State Owned7:zzfje
be Use5
Phone Number
Lot #
Block #
Number 30 ��
r l09 e8�
III. T of mit: Check on1 one box on line o hweawmsnt B if a
A.
® New System
❑ Replacement Svstem
❑ Treatment/Holding T
B
Permit Renewal
Permit Revision
❑ Change of
�cf
.. �? WR.
Plumber
IV. Type of POWTS System o vice: Check all that anni
1 -Grou ❑ Pressurized In -Ground ❑ At -Grade ❑ M
1i
Holding Tank Lj other Dispersal Component (explain) ❑ Prettral
V. Dispemffreatmeat Area Information:
Design Flow (gpd) Design Soil Application
600 Rate(gpdsf) =1200
0.5
VI. Tank Info
Capacity to
Gallons
Total
N
Gallons
U
New Tanks
Existing Tanks
Septic or Holding Tank
1000
1
1
Dosing Chamber
650
VII. Responsibility Statement- 1, the undersigned, assame responsibility for It
Plumber's Name (Print)
Plun)kr s Si
John Schmitt
Plumber's Address (Street, City. State, Zip Code)
586 Valley View Trail, Somerset, WI 54025
VIII. Couo /De artment Use Onl
❑ Approved CO] Disapproved Permit Fee
Date
❑ Owner Given Reason for Denial S
IX. Conditions of Approval/Reasons for Disapproval
Attach to complete plans for the syseea and strb0it to the
Replacement Only
Parcel #
032-1067-50-100
Property Location
GovL Lot
SW 1A, SE 1A. Section 24
le one)
T31N R19Eor&
Subdivision Name
N/A
❑ City of
❑ Village of
® Town of Somerset
❑ Other Modification to Existing System (explain)
] Permit'frmsfer to New List Previous Permit Number and Date Issued
wrier
>und > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
rtent Device (explain)
ed (st) Dispersal Area Proposed (sf) j SYste
1200 ` 96.6'
0 9
of
Manufacturer
tiu
& v ° n
Wieser Concrete
Wieser Concrete
71;
n of the POPWTS shorn on the attached plans.
MP/MPRS Number �77�60-0496
Number
223760
Issued IssuingAgent Signature
e�ly a PapK ant less than 1! to s 11 itrcttes 's sae
SBD-6398 (R03/14)
t y
r'""' �
14, 1- ' fr) -1 trVe Urrtxf
s ,
.0 1162
101
Sanitary Pcrmlt Arrlil-:al- I
I 'Lo ITI " I %I P1 .0 1. -t 14 OA I '. All: 1k II'm 01,411mv
via, %cr% i o Ill"N 10, 111-so, 1. Aj Im
Prinil %I joilcormsivitin
go
N0, I
II
jLoo PC 411 Itudding icheck all tl%Al aPPh I
OL
Elslati: l K%Iw,I k-1
Oq
cl
It hirA -ml� -one I-- o mloctir lint B if applo
imit "wiJA t ),a,: 1,
Ol 14 "A k -C
.a w o;ilmni I'v I
r%xI rvAtm ent % r rot In1..rmmiri-il
VIA,
I `iA w,,-, 1 nu, 11 I, l U U I U LJ
%h— n isn thr otilac" plmosoo�
IL Fool —1AIIALb-'a
or
44
,,jnt% IllorparlMor"I l It tlnly
A
7 �z
rut
IV tolloo AIA kk I-ko-
to
to.
C-I thor 1-to I 11.4pook,
4 ..w wish
cv L 41L
SYSILM PLO ill AN �
Germain a Bedloo m S"'TtIC SYSIf!nl
_, .. �T � _V - v ::•i...•J..: /�l. 11 •'�
c O
�N T I
x����..� + IwaK�s�CJ
N t o [+ mcr+ so MH ,+ f f 00D PAIN
h� �FPTK rl>Y';I ' A4n WJUNOARY PER IOA09A
ib9 45 _ � �♦` \ I
■ fFVN1 j
METER �'��'•' ` .�
PROp[JSf D f LlCTRIC C1Nr
ti
` � PRAPQSED ElC
1
1
PROPOSE D DRIVEWAY - _ 1
S89'10'24'E 595 71'
PA{* 2
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
ovd.ln .
[(1Vv'll'hlJ til1.1 �1'.. l'r
%tibdrvr,r(ur N.m t, NA
I nl Nurnhl•, 1 Block Number
1'.rr(l'I 11 Nwtlb,'f pal of 032 1067 50 100
',l' +
i�c1P■ ar4
ng h."1Ci Sf �: fir.
•.',r,a�e�nc�t and xnt n,ge^C'i
Srpnc 'gin.. Ma ntfnarcr. ag.,.E.r.,l.,.!
ed,jr,an!y Deed
i
CSM cr Plat
All,u hriwfil 1
Surl [valuation Report
Dv%lgnol 1(lhn %( hrnrlt
L1cnese Nun1tiet MV16 11 i I(A)
Date H/ i 11"wo
Phone Numbe, Il', 160 049 T
n�........ I `ern, Atr•.w( non
(omoone,n! Manual Verc,r,n 7 () Sf;l) 1W(1') P IN 01/(111
Pago 1
SYSTCM PLOT PLAN
Germain 3 fiedroom S(,W,c- System _,.. ,.. , . ,. •,,,. ' .
LU
jai t
I FLOW PLAUV
AOUMpA1tY PER IOJNA
I \\
t
METER ram' t>r_gr.
f00
PROPOSEUELECrRIC IIM( / I
1 PRdigSED L
A � j
PROPUSEO DRIVLWAY
d 10 71
589'10')A'F 595.71'
E
P&G"
SYSTEM PLOT PLAN
Germain 3 Bedroom Septic System I
""'"" 0"' N
Attarh dsrtiyn flow GIVA 101's Ior
P+njk�,.t AOCrt-m ;W-•'.nd :.�.o... u,utincrGa� p4w++
DM! symtxA A UM Clevatgn'r PW Matenals.'A-SIM SLVldxd she 1` = 100'
BM i-*-.[.tplKNt Top of I " FV:: p9e Ta"s VA 30.3 & 384 30 5 u 100 ISO 700
BM2 Sy-rbo Q 9M F'4:va:r0r 98 7%1'
UM UeSUtptatrt l op of I" PVC P Fe • _ � a�•
S (xameni of 1Ps1rd Arta j 3G34 4" PVC pW IASTM Cx3� 1
1NCN SymtKA (d apohcwD4e1 I
Nows Soo I'lat Map t(v <:Lw-4x's ntap
4 �•
9+
rrrtf ..n�.yr.• �;
5
- 1 i
I@ Rif •n
v wt+ as
r 1 \
... Pnft*mnrrerew!`�. ,t
i J
ua n 1 f
1R5f N'1 5R ^. 5
Page 3
Page
POLYPgx
I ,! It;, ! I I!(('1
11 iv I'L-'+'?'+ FiItor I•- ratrcl -i'r I1l,IIlIII (JIf) t1',aIlon� p,.•r dait I makln}' it t,nc aif the (arp—st filter. In Ii, cIass It h,lv
;2? I scar Icct t,l 1 / It••' Iiltratte,n ,Il rtti I .Ike the I+olta+k 111 -1 ??, the hilvlok i'I - +2 ; Ila% an aullltllatl: shut-ttlf ball
rtlslallctf with rt'1 rc Wtcr Wiu.•it iht• Idler v� reniolo eta (I)r a lv.111n1I;, :Its 1).111 ,t ai! 111+,II up Li71tl temporarily �Jhul Of
tIc'1swill it the eltluctlt wilil't Iv.lte the tank
Kilted fur h1,IXKI( TIT I 1)t'r tl.It'1
12:; knvar It•c; of i I., In" Illtraltlal
Accepls 4" and t, ' -Cl irl 411 I'll -
Runt m HLi. tit.Itlectur
Auttitnatu Ault_ott hall whoi filter it rvint,t•ed
Alarm aox s,th htt
Accept" I'\'L, c,%ten>nuT h.lnall.•
Ideal fair rr••,Itlt•nh.11 .Intl commercial ww,ty Ill,ws up t.,
10,11(xt gallons 1-cr ll,ly (( XI II
I i (Kato OIL' I,utIt't Ut 01c scpl,c lank
'_ Remot e the tank Clivvr and pnmp tmin II nect•s.Trt•
i (.Ilia' 1111' 1111er howotlg 11, f lit•;.• w- U'' OUtIt'l plpc II
the llller 11 I11'1 t 1•ittt7etl tut.l,•r IN av o,s oltening Lit' ,]
I'Vk-1%ak F\It' I)d �t 1 „k .ir 1+u•cr• to hi pc it, o,cnla•r IaIta•a
.1 insert :hc lot -52�; Illtcr :Ittr IIti 111+u,ut);
;. I�e1,Ltt t' and ticr11rc Idtc .o}ttu' t.1111k hotel
I he I'L-.L+ FffluonI FiItvr-, ++ill itper•.ite a•IIit i,'nth for
xw%cral vvar, cinder n,+rnlLi; crlitlmon, Iv sort• I'Vilusnmg
cicariing It 1• rt•t nnuncntit d Ihal Illc hlicr he t Icmwd
dery lints the• tank I- ptimpeti, air at h•.l" stem• thine
`-car, 11 kilt: 111st.11l.•.i Illtcr r,rtltalrl, all torilw1.11 .11,1rm
the owner tt111 Its ilttlllil'Ll I.1 Lill JIM III tthen tht' filter
ntvd-. stem icing tit'n icing should bU chine M. a ,'erttttcd
.eplt tank 1+1uu1tt•r air rllst,tller
I tx•atc the uullet of IhL•.rpt i lank
KirTtltt'r 1,111k t'tltcr.inJ 1•uinl, tank it noLetiti.In
1 i)u nttt u,t• 1+lur1th1nto vdivll liltcr i, rvittowd
d. 1'uII I'I -r+_t aFI11,1gt• t,ul Lit tho. hnu�lnt:
. I lti,c wt tilter Vt et 1ht• •.chtl. tank N1akt' all
snlittr fatal 1,a, k 1111n tit•}`tic t,+rlk
ti hist•ri the IL11cr ,.titntlt; • hack into 'he llt+uti101, 1n.1k11ig
I-ull' lax' tilts r Lti lirtilr+t rl(• ah�,rtltl an.1 itinllilrleli.' uT.etitvl
Kepl.IkV.111d antiart'.ep11c i.111k c1TCt'r
O `�- Alarm',%, a. 1•
t ' (r)pliulull
�10,000 GPD "
1\.1,,., I St �-
•,( 11:1 11: ,.11„
Rot t t•ai Ida
111.1\lt L:I'fT
IQ', 1 inrar tl
of I. 1h•
t•Itllat,t,h riot,
Cvlttlird to
NSF ANSI Standard 46
(wa• :104A•,,r
Aub.r,t.u1:
Chu: a Tit N.tl I
I'.,'t I,,l. 1•ilti ! A ltttii tilt, r, .x rr1 r 1 _>`tit ::L U;:-
I•,,•�-m.trtl ..11•n'•-•,\,tl 1••I.,a ..tr•u lntt„�r•nni, lark,
11tth•I,tk. Ina ; I Mi-licld iih'.1 Wallingford. ('I' 11111102 'pill I.rcce 8'%7 7(15 y5(>5 1'.Ix _'lit 2i..1 s514 www poh'lok.l;orn
Paz* 5
PAGE 5 OF 6
SEPTIC : PUMP TANK SPECIFICATIONS
(No Scale)
Ali.. _ • :, - v
Arwr,,r
i�ur•r,.rrrt', ., ., tttidi.�+Ul ` � r•a.,r s,.. ,...rr�....e
r _QGz_,
a '
17
q 1 Li
B 20 3.:
!C. 85 ; ?;
D 12 204 �> e
PUhIlP-orr
r " ELEVATION = 73 ft
*Purr+tr 1.1111k t ryu[cl Level = 38
iNS1DE BOTTOM
f orcee Main Diameter = �� n r' � •.i ';';' ELEVATION = 72.0 h
(120
Force Marrs Lrenyth _
vertical ► IPac' _ n
1956 ;;•�
MIN PUMP DISCIiARGE RATE = 2- '7{, / 1 = —C—AL ^u1 NAMIG -1EAD = 2�81n
i'UMP TANK SEPTIC TANK(S)
Vc1lt►ITlce 650 gal 1 3 ToLil VulumC = 1000 gal
Wieser Concrete ` Wieser Concrete
M,rnutac:turler• Manulacture►(s )
Pu'>>l M•r'ru!a,.turar Zoeller
152
r ,nt• Iti Al.e-r, F,' v ,rt;i....•er SJE RH0',1B1,S
%o^ttc is warn, Mcoel AB
rr , ill .,pp-n. pC elf Iuer,t f,llpr at file scei,lrc: tank cxillet
r "ir'.!_ate v was;�Pc� cf tt e pi,imp ItiInK In14'1.
PoYok
525
• • f a
agog
Model 151
151 WIN t 1,
Vm S—p..
ham wirr r -�4.
silo'.
Models 1521153
[A
q_! 1. , cic%rig ry et�h
If LIVI'*S Order the V-rv1F'
7 wyli,
.40jiV jr, -a-se, irVske Uy OuWli; SmUXIN A, V
i.�- Ki
Page 7
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PAGE 3 OF 5
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Installation Instructions for asEZ,.,1MFILTow-
EZ' , �, Systems in Wisconsin RATOR
Matenals and ECu,pmen: "seeded
Ins',allation Instiuctia-s
t 203H-G£O
..........................................................................................
Par.4. 11
PAGE 4 OF 4
In -ground Dosed -Gravity Management Plan
IMPORTANT:
1 he owner of this in -ground doseC-gravity system shall be responsible for its perpetual operation and maintenance
pursuant to ruquirements of SPS 382-384. W:sc Admin Code Pursuant to SPS 383 52 (2), Wisc Admin. Code. this
system shall be considered a humar health nazard if •jot mairlaireC in accordance with this approved management
plan Furthermore, all inspection and maintenance activities shall be pertomiecl by a registered POWTS Maintainer in
accordance with SPS 383.52 1,3j Wisc Admin Code
Maximum Dispersal Area Operating Limits.
Design Flow = 450 gpd: BODS 5 220 mgL_'. TSS S 150 mgL", FOG 5 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of system
nuisance factors (i a odors. user c:c wplainls, etc ;
mechanical malfunction (i e . pumps. valves, switches, floats, etc. )
inaterial fatigue (i a leaks, breaks coirusiufi. etc 1
solids volume in avaerobir ireatmant tank(s) and any disinbutior appurtenarce(s) (i.e.. distribution 1 drop boxes)
neglect or improper use (i c . exceedirg design capacities, prohiUded activtties. etc )
extent of ponding in dislnbutior cell prior to dosing
dosing irregularities - if applica ale (; v sump re -cycling, float switch settings, etc )
elecincal components - if applicable (i e . wiring. z;onnections, switches, controls. timers, alarms, etc )
distribution lateral or lateral onf re plugging (measure lateral distal pressure — compare to design specification)
surface discharge of effl.ient or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
Septic nd dose tanks shall be pumped by a certified septage servicing operator licensed under s. 281 48 Wis
Stats when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordirance Disaosal of consents shall be pursuant to NR 113. Wisc. Admin. Code
Effluent filterfal shall be inspected every 3 years ano shall be de:arned when necessary to remove any
accumulated solids acco•ding to manu`acturer s specifications A servicing period wit always be greater than 12
months
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.SS Wisc. Admin_ Code. Report any component failure or malfunction to.
Name of individual or company John Schmitt
Phone 715-760-0486
I. ocal government unit. St. Croix County Community Development Phone 715-386-4680
Local government unit address 1101 Carmichael Road, Hudson, WI zip 54025
Any defective part of this systern shall be repaired, replaced. or removed pursuant to SPS 383 51 (1), Wisc. Admin
Code. Repair or replacement of 'ailed or malfu•uaicxung components shall comply wish SPS 383, Wisc Admin Code
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc Admin Code
Contingency Plan
In the event that any failed treatment component of this POWTS canrot be reoairec, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and aporoval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component -n a pre -determined area of suitable soils
System Abandonment
It use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383 33, Wisc Admin Code
pugs• 10
til . ( I401X ( (N N I 1
til I' I It 1 \\h MAIN I I N-N%st I MIRI I Nil ' !
\N'I ►
1 I�{ \l l(NI III, CI it 111 H •\ I Il ►\ I 1 ►h1%1
(�\�l11IIi11\t't Louis Germain, Jr.
2021 Highway 35, Somerset. WI 54025
2001 72nd Street
. I' .\ / 11':' I>r'1+irinlctli 1++1 ni>'+ t+wt5lttl�Tn111 I
I. Isla:l' Somerset. WI I+s..c. I:.;It.AIt1011111111Ik-r `
LEGAL DESCRIVI 101
SE SIN
I'flllx'n\ 1111i1ar[I: --- `t:♦
`ll;kil\ .Slltll I'1.11.
( crtiTied Sump Mall is 1096873
Marr2no Deed a 1099280
{4 19
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ST. CRO I,NTY SANITARY SYSTEM File #:
i `.tip <<�r.r�r Office Use Only
OWNERSHIP/ADDRESS FORM Created 2/2021
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the Prol2eqy Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer L o sed 4 i oV e I LO u
Mailing Address cZ <Pj r & "K-' "� 3 S
City/State/Zip .5 a. t Jl�'s .r T t 5 cl o a
Phone Number (required) / S ` -7(c 0 / 3 Z q3
Email Address (required)
Parcel Identification Number Dad - /L,)(9 7 - 570 - f00
(found on the property tax bill)
r !V
NEW SYSTEM: LEGAL DESCRIPTION
Property Location ��'/a , '/A , Sec. �� , T 3 N R�W, Town of
Subdivision Plat: Lot # �.
Certified Survey Map #_�0�� �� 3 Volume Page # d 75,?
Warranty Deed # / (2j( .� Q D (before 2006)Volume _ Page #
Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable ® yes 0 no
New Property Address
(S ff Initials)
OFFICE US
AONLY
-2� s
{Verification of new address required from Community Deve
1�1/av Z2
(Date)
G cJ
nt for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form 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.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd0sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
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LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
Al IACI;r0I NT ' AI ;I II I r ) -'. i 1 ;`t �IL. E 1t,'..I I
I i GAL PROPERTY DESCRIPTION (CONTINUED)
.�r.�I-I�C��. ..I ' I!• .,�i" , .. . ! � . _ � I ... �I i •, c u=1 � �i .,•fY.e!!1`
n l 'i1 C1Cn5 :"I .I;111 25 "_"YI I;) .14"L'r11.I ,.I ,• ,,t 31" :'1. I .•I, 11 .:11l I . i tI; ;::i 1 I Ilr:rxwe of )"I II!et to
tl .• I N1 c 111, "'4N'Nt; 11 ,•, '• "r a I
. I• SO I IIN •1'; 'ild •11k'I11 'I !' `.1 I: il: ...I 'i� er 'I ..• ' 57•
'I �" 1' I I �� bL tc .I .I. 'u.r• JI II -i.:t, i ii•1 .I ;,
I` I � -1 .. ;L11 . '!t � i .�, . .1. ... � C .. i,,1��• •. .! k, , ",� �:'. 'iI' .j '�".� °L• g
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the
preceding 1 Property )
110rholls of this p!ojx?rty, trill Ilot the sollit-1.1 I,i the i )art+ rnur?atlpt /tannin?Nnt dtictJilwnt, play it-viAm in thu
filll'Cr.il Food 11.I. 'ifA Are,-] 1 h,•rl.Iortj .I" ..tu'h ''.1II'-.,,f ' -I- '•• ',II'i`,taw A! 1'1'I .`orre"1 oil the properly
70NF A (This Additional Consideration :applies to the preceding 1 Property.)
-ra 1I 1"ftz�. ) i' ;,I -ts a
I mac` II,i.' co Area 91 it
.. k.�. "•�: rl'
,anti h.iS r:01 bc.l'11
1:.:'71aIIZC:1
111rvUgt? 'nl ,',it*dard I ()k i r.s for Cti:;il v;t,inq 7a •1
i.,wi; e ;,vxiorr, published In
1F?r I Iood In-'lir.ir't
I! Study
I III'; flood olt.v•Ition Is `;wltle(A to cila 1(IIt
STA1 E AND LOCAL CONSIDERATIONS I T this Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT (RI MOVALI)
Ploom: i to ''.;Je or :,..I;i'1til:ae any :;1•ItI: or ,nc.Il IAM;eaur"rl or SUbstanlive
I)10Vls W)S :Vtl!I i, 111i ly Hphl! to 1',Iulp'wl 371endit i'nts to Sta"k-- (n
:Z:..11 i .:i: a' a .'! 1' T' �; . Y. 1 i .. :� �• �n� 1', l' t' u
Page 2 of 2 I lUdLe: vecemoer <u, iu ly I�,ase NO.: zu-ua-uoIuA I LUMP%
ob Federal Emergency Management Agency
Washington, D.C. 20472
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
LEGAL PROPERTY DESCRIPTION (CONTINUED)
COMMENCING at the quarter corner common to said Sections 24 and 25; thence along the section line between
said Sections 24 and 25, S89"10'24"E a distance of 314.86 feet; thence S33"16'53"E a distance of 83.13 feet to
the POINT OF BEGINNING; thence N 33" 16' 53" W a distance of 1398.65 feet; thence S 890 28' 03" E for a
distance of 554.79 feet; thence S 22' 57' 14" E for a distance of 430.72 feet; thence S 51 ° 10' 17" E for a distance
of 259.37 feet; thence S 20" 15' 07" E for a distance of 141.49 feet; thence S 360 09' 23" E for a distance of 158.30
feet; thence S 17' 56' 50" E for a distance of 80.22 feet; thence S 54' 26' 36" E for a distance of 79.39 feet; thence
S 30' 14' 16" E for a distance of 79.69 feet; thence S 00' 2.5' 58" W for a distance of 90.31 feet; thence S 22' 57'
15" E for a distance of 71.31 feet; thence S 87' 51' 34" W for a distance of 69.12 feet; thence N 89° 10' 24" W for a
distance of 387.20 feet to the POINT OF BEGINNING
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the
preceding 1 Property.)
Portions of this property, but not the subject of the Determination/Comment document, may remain in the
Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property
remains subject to Federal, State/Commonwealth, and local regulations for floodplain management.
ZONE A (This Additional Consideration applies to the preceding 1 Property.)
The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that
was determined using the best flood hazard data available to FEMA, but without performing a detailed
engineering analysis. The flood elevation used to make this determination is based on approximate methods
and has not been formalized through the standard process for establishing base flood elevations published in
the Flood Insurance Study. This flood elevation is subject to change.
STATE AND LOCAL CONSIDERATIONS (This Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT (REMOVAL))
Please note that this document does not override or supersede any State or local procedural or substantive
provisions which may apply to floodplain management requirements associated with amendments to State or
local floodplain zoning ordinances, maps, or State or local procedures adopted under the National Flood
Insurance Program.
'his attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the
'EMA Map Information eXchange (FMIX) toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency
4anagement Agency, Engineering Library, 3601 Eisenhower Ave Ste 500, Alexandria, VA 22304-6426,
Luis V. Rodriguez, P.E., Director
Engineering and Modeling Division
Parlaml Inmirn— o 4 KAi+i—+inn Arl...in irlroFinn
C o
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SWl/4 OF THE SE1/4, THE SE1/4 OF THE SW1/4, AND THE NE1/4 OF THE
SWl/4, ALL IN SECTION 24, T31N, R19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN.
TOWN TREASURER'S CERTIFICATE
State of Wisconsin)
County Of St. CroIx)SS
I, Jeri Koester, being the duly appointed, qualified and acting treasurer of the Town
of Somerset, do hereby certify that the records in my office show no unredeemed
tax sales and no unpaid taxes or special assessments as of 0- D Z
affecting the land included on this Certified Survey Map.
a a_ - C-)S - a ;;,-p
JerfSoester Date NORTH
Town Treasurer SCALE: 10.= 150'
COUNTY TREASURER'S CERTIFICATE O 150 300
State of Wisconsin)
County of St. Croix)SS
1, Denise Anderson, being the duly appointed, qualified and acting treasurer of
St. Croix County, do hereby certify that the records In my office show no
unredeemed tax sales and no unpaid taxes or special assessments as of
0QI01n1a0Q0 affecting the land included on this Certified Survey Map.
6C" G YocAm OC3 jOfD LQ10a 0
Denise Anderson c Date
County Treasurer
CURVE DATA TABLE
NUMBER
RADIUS
LENGTH
CENTRAL
ANGLE
CHORD
BEARING
FC.ORD
LENGTH
ARC
LENGTH
TANGENT
IN
TANGENT
OUT
C1
80.00,
48*44129"
SB1'20'S4.S"W
66.02,
68.06'
S56'58'40"W
N74'16'Sl"W
C2
233.00'
26'07'07"
S20'13'19.S"E
105.30'
106.21'
S7'09'46"E
533'16'S3"E
C3
167.00'
26'07'07"
N20'13'19.5"W
75.47'
76.13'
N33'16'53"W
N7'09'46"W
OUTLOT 1
536,800 SQ. FT. t \ \
12.32 ACRES t \ \ G
<01
r
` F
•��' APPROXIMATE ZONE A-1 \ \ \
I\ FLOOD BOUNDARY PER
FIRM PANEL 55109CO043E
3 s\
e �d�Cy�Y E S19 i 1Lp.0A
CO fJ ZAHLER
* t 8-2145
12119
PREPARED FOR:
LORRAINE GERMAIN
2021 HWY 35
SOMERSET, WI 54025
LOUIS GERMAIN JR.
E88 205TH AVE.
SOMERSET, WI &W25
SURVEYOR:
DOUG ZAHLER
S & N LAND SURVEYING
2920 ENLOE ST. SUITE 101
HUDSON, WI 54016
NOTE:
This lot is subject to the St. Croix
County Floodplain and Shorelond
2oning Overlay Districts. A land use
Permit may be requlmd for
construction or grading activities.
Consult with the srofJ`at the
communlry Development office before
any constructlon or grading an this lot.
NOTE: Any land below the ordlnary
high water mark of a lake or
navigable stream is subject to the
public trust In navigable waters that
is established under ortide 14K
section 1, of the state constitution.
= 361.0
\ rrr O tp 3'S p2 \99 pS \ LAKE ELEVATION ON
\ \ N ya. \ 412 6119 = 861.1
I -CP v:
\v DTI
rp 3.12 ACRES f J \
569*20'24"E 59S.71
66 _ _ 634'3 \ \
' J
235.14' 79. 1' I 430,71' \
Si/4 CORNER 16S.00'
SECTION 24 589.10'24"E 675.42'
SOUTH LINE OF THE SE214 S89'10'24"E 7131± \
U_NPLATTED LAND
DRAFTED BY: &000ZA11LL'R PROJECT: 07849-001 DATE: 4125119. REVISED 0113012020 � \
St. Croix County 1096873 Page 2 of 3
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Page 1 o1 2 I luate: ueGe1r10Cr CU, LV IV it-ase No.: Lu-uo-voiuA I LVIYIH
Federal Emergency Management Agency
Washington, D.C. 20472
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
COMMUNITY AND MAP PANEL INFORMATION f LEGAL PROPERTY DESCRIPTION
ST. CROIX COUNTY, WISCONSIN A portion of Section 25, Township 31 North, Range 19 West, as
(Unincorporated Areas) described in the Warranty Deed recorded as Document No. 511462, in
Volume 1059, Pages 36 and 37, in the Office of the Register of Deeds,
COMMUNITY St. Croix County, Wisconsin
The portion of property is more particularly described by the following
COMMUNITY NO.: 555578 1 metes and bounds:
AFFECTED NUMBER:5510900043E
MAP PANEL
DATE: 3/16/2009
FLOODING SOURCE: TURTLE LAKE I
APPROXIMATE LATITUDE & LONGITUDE OF PROPERTY:45.153182,-92.660879
SOURCE OF LAT S LONG: LOMA LOGIC DATUM: NAD 83
DETERMINATION
OUTCOME
1%ANNUAL
LOWEST
LOWEST
AT IS REMOVED
CHANCE
ADJACENT
LOT
LOT
BLOCK/
SUBDIVISION
STREET
FROM THE SFHA
FLOOD
FLOOD
GRADE
ELEVATION
SECTION
ZONE
ELEVATION
ELEVATION
(NAVD 88)
(NAVD 88)
(NAVD 88)
--
--
--
2021 Highway 35
Portion of
X
—
--
892.0 feet
Property
(unshaded)
Special Flood Hazard Area (SFHA) - The SFHA is an area that
would be inundated
by the flood havina a 1-nPrrent rhanrP of hainn aniiaiart nr
exceeded in any given year (base flood).
ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.)
LEGAL PROPERTY DESCRIPTION STATE LOCAL CONSIDERATIONS
PORTIONS REMAIN IN THE SFHA
ZONE A
I his document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment foF
the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have
determined that the described portion(s) of the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent
chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject
property from the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply.
However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy
(PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed.
This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this
determination. If you have any questions about this document, please contact the FEMA Map Information exchange (FMIX) toll free at (877)
336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, Engineering Library, 3601 Eisenhower Ave
Ste 500, Alexandria, VA 22304-6426.
7
Luis V. Rodriguez, P.E., Director
Engineering and Modeling Division
Federal Insurance and Mitigation Administration
Page 2 of 2 I luaLe: ueuernDer zu, zu iv Lase NO.: Zu-uo-ubruA I LVIVIM
Federal Emergency Management Agency
s
Washington, D.C. 20472
0���1 N n SF�`•
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
LEGAL PROPERTY DESCRIPTION (CONTINUED)
COMMENCING at the quarter corner common to said Sections 24 and 25; thence along the section line between
said Sections 24 and 25, S89"10'24"E a distance of 314.86 feet, thence S33°16'53"E a distance of 83.13 feet to
the POINT OF BEGINNING; thence N 33° 16' 53" W a distance of 1398.65 feet; thence S 89' 28' 03" E for a
distance of 554.79 feet; thence S 22' 57' 14" E for a distance of 430.72 feet; thence S 510 10' 17" E for a distance
of 259.37 feet; thence S 20' 15' 07" E for a distance of 141.49 feet,- thence S 360 09' 23" E for a distance of 158.30
feet; thence S 17' 56' 50" E for a distance of 80.22 feet; thence S 54° 26' 36" E for a distance of 79.39 feet; thence
S 30° 14' 16" E for a distance of 79.69 feet; thence S 000 25' 68" W for a distance of 90.31 feet; thence S 220 57'
15" E for a distance of 71.31 feet; thence S 87' 51' 34" W for a distance of 69.12 feet, thence N 89' 10' 24" W for a
distance of 387.20 feet to the POINT OF BEGINNING
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the
preceding 1 Property.)
Portions of this property, but not the subject of the Determination/Comment document, may remain in the
Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property
remains subject to Federal, State/Commonwealth, and local regulations for floodplain management.
ZONE A (This Additional Consideration applies to the preceding 1 Property.)
The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that
was determined using the best flood hazard data available to FEMA, but without performing a detailed
engineering analysis. The flood elevation used to make this determination is based on approximate methods
and has not been formalized through the standard process for establishing base flood elevations published in
the Flood Insurance Study. This flood elevation is subject to change.
STATE AND LOCAL CONSIDERATIONS (This Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT (REMOVAL))
Please note that this document does not override or supersede any State or local procedural or substantive
provisions which may apply to floodplain management requirements associated with amendments to State or
local floodplain zoning ordinances, maps, or State or local procedures adopted under the National Flood
Insurance Program.
-his attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the
'EMA Map Information eXchange (FMIX) toil free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency
Aanagement Agency, Engineering Library, 3601 Eisenhower Ave Ste 500, Alexandria, VA22304-6426.
Luis V. Rodriguez, P.E., Director
Engineering and Modeling Division
Federal Insurance and Mitioation Administration
Oh& Dept_ of Safety and
Division of Safety and IN
Mara oomplsls lain phn an
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Phimse print a1 bdbnnation_
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Properly Owner Property Location LT�/
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access services or need material in an alternate format, contact the department at 609-266-3151 or TTY duDugh Relay.
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access services or need material in an alternate format, corrtact the department at 64&266-3151 or M throuith Relay.
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PART OF THE SE1/4 OF THE SW1/4 AND THE SW1/4 OF THE SE1/4 OF PREPARED FOR:
SECTION 24, AND PART OF THE NW1/4 OF THE NE1/4 OF SECTION 25, ALL LORRAINE GERMAIN
2021 H WY 35
IN T31N, R19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. SOMERSET, WI54025
SEP Off, 20 SCALE 1" = 150'
ST0 150 300 NORTH
e �1
11 1/-20M AV I //
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9 •. yoQ' � \\ �3 i��l \� APPROXIMATE ��\\\� II111 1�lllllll��
SURVE �N
\ 'ONE A BOUNDARY
10 / 10 / I9 �•� — "T FROM FIRM
Z
I, Douglas J. Zahler, Wisconsin
Professional Land Surveyor, herebyAl
W 114
certify that this Stake -out Plan was
SUF l �l^ /� /� / \\`9z ✓ �\ \, \`Y �1, I 1 IIII; ``\11111 1% C
be: LO&IA a %Q✓eGf � \�\o
Z/20(C}\\ 11 \ \� swi14' I _\11111111�1 I r
IW II �' m
X( SVppOl*-fifly
M , I l ~,,?%°R,V,
I►1Gf�L/l(,i�J �i(,� ��/ X_ `�q`9—� \ l,y/ / 111`\ �1Ir)I� m
6`7 30 1 e t'4 \\\\ D'4; n a OHWM 861.0 =
De° r / ) asp 1 _ _ ) )
892 CONTOUR
A F 10A l), A Lt f �/ a 5w1/4 and 533; 5 \ r � r _ JL ��\��r `� — I' IF
0 517.56'50' E )
part of the SWl/4 of the SE1/4 of section Lw, and part of the a 53., r e0.22' I /I
NW1/4 of the NE3/4 of Section 25, all in T31N, R19W, Town of
Somerset, St. Croix County, Wisconsin; described as follows: \ �O r �� _~ _�910/l I (\ll 11I'l'lf�I
Commencing at the quarter corner common to said Sections 24 / \� J ` \' o S4'26'36"E\\ 111 11�[(TAKE ELEVATION ON
and 25; thence along the section line between said Sections 24 / �/ /Iry� s�� �� 79.39''� I \ 4/16/19= 861.1
and 25, S89°30'24"E a distance of 314.86 feet; thence S33°16'S3"E '/ N�
530IIII �`
J� _'14'16"E
1,
a distance of 83.13 feet to the point of beginning; thence N 33° 16' ) / Nay �4z, o 79.69'
53" W a distance of 1398.65 feet; thence S 89° 28' 03" E for aNe7
distance of 554.79 feet; thence S 22' 57' 14" E for a distance of
430.72 feet; thence S 51° 10' 17" E for a distance of 259.37 feet; \ \ ��o_ 1 \ \ /�/ / S00'25'Sa-W
thence S 20' 15' 07" E for a distance of 141.49 feet; thence 5 36° \ I L' / /f//r / i90 3�1'
09, 23" E for a distance of 158.30 feet; thence S 17° 56' SO" E for a = \� \\\ l ((,,
distance of 80.22 feet; thence S 54' 26' 36" E for a distance of \ \ ' \ \ /1 / 522.57'15"E
1 �S87-5i'34" I 71.31'
79.39 feet; thence S 30° 14' 16" E for a distance of 79.69 feet; \ / `(jL
thence S 00' 25' 58" W for a distance of 90.31 feet; thence S 22° 1\;\\` Il i) i l/ (/Z� FLU I I
57' 15" E for a distance of 71.31 feet; thence S 87° 51' 34" W fora�) r. \
distance of 69.12 feet; thence N 89° 10' 24" W for a distance of l) • )Iif, r
387.20 feet to the point of beginning. Containing 13.70 acres.
LORRAINE GERMAIN s
LORRAINE GERMAIN PROPERTY +onono
TOM OF SO110tSET, ST. CROW COUNTY, WISCONSIN
LOMA MAP Aid. CannItinl/' sWARRiea