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HomeMy WebLinkAbout038-1072-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538872 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)]. Parcel Tax No: Permit Holder's Name: City Village X Township 038-1072-90-000 Leier, Bernard "Ben" Star Prairie, Tow=of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: C~ 17.31.18.302A2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY EAItM TION BS HI FS ELEV. 2. 36 16Z'5 A6 LL) ei4~ Septic Dosing y j jel 2 / fj 06 L Ae r~4+en Bldg. Sewer ~ 1P10I Holding SUHt Inlet/, St/Ht Outlet ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet All Septic 4 Dt Bottom /5 ' ST Z Header/Man. C Dosing s / z 7, Z5 / 7 CC 67 Aeration Dist. Pipe c 3 S Holding Bot. System C~c~ =~a Final Grade PUMP/SIPHON INFORMATION 45 .75 94 - S Manufacturer / 'Demand St Cover 11-C V~,vj GPM F~I~w LGlti Model Number ® 5V -77y~ - TDH Lift Friction P ystem Hea ^ ITDH~% 9/. ~ 21 -7 75 0 Forcemain Length f Dist. to well c~ /6z 1 SOIL ABSORPTION SYSTEM BED/TRENCH W Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di a. Liquid \h idth ~ ~ t i_ DIMENSIONS 3 G,d 3 1 1--- rre.tic.l~.~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR ---a. / -f AA- UNIT Model Number: INFORMATION Type Of System, , z , T-7 ©v j/y(7 DISTRIBUTION SYSTEM ven oAirlntake Header/Manifold d Distribution x Hole Size x Hole Spacing .f- Pipe(s) Length 2Z Dia Length ` Dia \ Spacing \ a SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mulched Depth Over xx Depth of xx Seeded/Sodded Depth Over Bed/Trench Center Bed/Trench Edges Topsoil ` es [E No NSQ Yes 0 No Inspection #2: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Parcel No: 17.31.18.302A2 Location: 2151 90TH ST SOMERSET, WI 54025 (NW 1/4 SW 1/ 17 T31N R18W) NA Lot 2 60, /u O i % a ~ ~ G~ l I. 10-J, 1.) Alt BM Description = 2.) Bldg sewer length C) - amount of cover Al #Sia Plan revision Required? Yes ~No Use other side for additional information. Date ICert. No. SBD-6710 (R.3/97) commerce.m.gov ~ Safety and Buildings Division County O1 W. Washington Ave., P.O. Box 7162 ,577 e~ti Mad ison, WI 53707 .6~ Sanitary Permit Number (to be filled in by Co.) Itlepa erce I p 7Z Sanitar IR A plication to Transaction Number In accordance with s. Com .83.21( is. rn ~o of this form to the appropriate governmen unit is required prior too ining h sani \1 e Cn Application forms for state-owned PO WTS are Project Address (if different than mailing address) submitted to the Departmen of Cora3tje~ information you provide may be used for secondary u oses in accordance with th Priva 04 1 m , Stats. _ 19 1 . Application Informatio riot formation j G 31171, Property Owner's Name / Parcel # Cl) Q F 0- U 7,2- A Properfy Owner's Mailing Address Property Location 6 6 / f p GovL Lot Z City, State Zip Code Phone Number tiW J GL-~ y., Section L1 s2 f 7~S 7 a f T N; R ircle one H. Type of Building (check all that apply) Lot 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name 1~'^ Block ❑ Public/Commercial - Describe Use "^'s4 ❑ City of ❑ State Owned - Describe Use CSM Number El Village of b-.64- ~t~~t!J f )kTown of 5;t zC /C.&~ III. Type of Permit: (Check only o box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ` on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 1q 0S ❑ Holding Tank TO Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil A lication Ra dsf) Dispersal Area Required (sf) Disper Area Prop ed f) S stem Elev ti YY 7--.3 V VI. Tank Info Capacity in Total # of Manufactur Gallons Gallons Units o o New Tanks Existing Tanks f. {I~ 2 y p° 6 V•~ 1V! t.. Zj " U in y W w C~ P. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS h_ own on the attached plans. Plumbe Name (Print) Plumber' a kWA4PRS Number Business Phone Number c m, v F,~1 035 7r5 _ 7Ga v ~Y6 Pit Address (Street, City, State, Zip Code) VIJAL, County/Dipartment Use Only Approved pprove Permit Fee Date I ued Issuing ent Signatur 75. 10126111 ❑ Own en Reason for vial IX. Conditi rO&UffWasons for Disapproval ~4 4 N~4 I; Septic tank, effluent fitter and 3) Q ~cA dspers9l cal( must all be services / maintained G i as per management plan provided by plumber. ?1A_ 2,- At setback requirements must be maintained P6r Attach to complete plans for the system and submit to the County only on paper not less than 81a x 11 inches in size SBD-6398 (R. 02/09) jq I Nru iy~yy' 5 D « lc.~vz-~1 ~ ° 3 ~1 ~z ~Sl 38 I Y CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: I8 GO. Legal Description: 21'0x-5 7-, 7 3 /2/ n r Township: r County: 157-. Gl-~~C Subdivision Name: Lot Number: Parcel ID Number: 0,3 D f b 7 ,3 _ C? DO Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: `Soil -Test & House Plans Designer/Plumber: ense Number: 63.s Date: Phone Number Signature Designed pursuant to the In- nd Soil Absorption o ponent Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 f ~ I N~ 3 = ga, 3a T3 7a~ i o~ Soil Absorption Svstem Cross Section , 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft 4 l 9.7 yy~ Leaching T 91,38 Chamber 3 ~O, 3.2 ft System Elevation ft ~ft l ft Soil Absorption System Plan View ft 3 ft Y° ft Leaching Trench 1 Chambers 4° Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leachina Chamber Specifications Manufacturer And Model z 4; 4k''q /J5 EISA Rating _D sq ft per chamber Soil Application Rate gpd/sq Sb gpd Design Flow - S Soil Application Rate - D~ EISA = Chambers 3 rows of ~ chambers each. y S Page of -0 -0 D r m ~ N PL> ~ Z Cn O 'n r P-) O = w m c.n C O ~mCf) N=O r --l Z cn C G) cn cn -0 -v = O G7 - O N C_- 0 W r cn FJ mG T Co O m c7 -0O u ccn m m <-v rn= z~ C7 z m --i n O ~ rn m o C7 rAi = -mv z c 4 o O Z t,71 v o - o~ w ~ csi o0 w w o w w w cn 0 N 0 no 111111 I I I o 0 0 111110 0 IMIM11111HUM Mum 0 0 MIMI 911196 IIII B91 0000 U U CV O E N N F-- co E M U N U 9 c0 O N 0 nJ N U O O V U O co N co co u tf') AIR It I U~ U LCJ Cl) rn N I-- U co ~ L0F1~~90E ~ E co U N ti O U:) u W O U ¢ f/=7 ~ M O ¢ U3 m OffiffiWAMM i N .11 C4 O L3 ZZ -j z CA cn U C) cr C/3 C/3 CD U) Ci to O = X (n N W LO M LJ~ f'-' ~ O J OLL~ w c Z~ p ¢ UI Ow LL U O w ¢iL Mil p ~E-C'1 Y LL - C) Cn v' o Z po Lo L 10 Q W M - orn U J ~ m J N ~ ~ Ll LD :D Lo J !i U) N p U) U O W r f,- Wu LL LL -j -j /~ov~wuv ~»vG~~i / W °aMoo 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner I Septic Tank Capacity d ©CD al ❑ NA Permit # Septic Tank Manufacturer CAA.A~ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer P044X ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model a j ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) Son gal/day Pump Tank Manufacturer, ❑ NA Design flow (peak), (Estimated x 1.5) ~j gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day /ft2 Pump Model 0 NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ 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 A19-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510• cfu/100m1 ❑ Drip-Line ❑ 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 JWyear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: a 13 month(s) (Maximum 3 years) ❑ NA ,121 year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA X year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: a 43 year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) 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 (Y3) 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. 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Aew 1ey1 sleo!wayo iaylo io sionpoid Bulw!ed ;o eouasaid ayi io1 (s)iIuei iuawleail joay3 SIMOd 841 ;o esn of solid 'uo!13niisuo3 Mau sod ;0 aged NOIlVH3d0 ONV do IavIS 2 2 Page 2 of 7/ 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: • 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. T r/ ey_a ' repMVWTWM-aTUa[. it 110 avadl o ing ank ~RD}d18 77 X12 JJr'W_ CoN5TRc1 00 b e tailed- ❑ 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 Name Phone 71,5- _ 6 C) Q Gf Phone - SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name sue(', C ( e)u khN/ 2oAJt4J Phone Phone/S- 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. Valil/6Vt!$ la - A ArAA ~y~7~ ST. CIMIX CUUNT'Y S TALC MA NTENANCE AGREEMENT AND OWNER5M' CERTIFICATION FORM f Owner/Buyer - Mailing Address.. AV 6 ~ - Property Address < S 7 (VerifacahM required t for new construction.) Q i; ht+Dtri plennittg & city/state •5.~ 1' lt6_tA ~ Parcel Iden cation Number LEGAL RLKRipT1QN /V (,~l S W 1/. , Sec.x T N R /9W, Town of Property Location Lot Subdivision Plat: c, Certified Surrey Map # 3 7 VolumePage # Warranty Dead # (before 2007)Volume page Spec house n ycs)no Lot tines identifiabic yes t.l no SYSTEM MAIN TT E_NA.NCE AND O11 NER CERTIFICATION Improper use and maintenance Of your septic system could result in its ptemattue failure to handle waste -Propt You " put into maintenance consists of pumping out the septic tack every three years or 51, if needed, by a licawcd gtunp the system can affect the function of itu, septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 8152(1) and in Chtyster 12 - St. Croix County Sanitary Winance- The property owner agrees to submit to St. Croix Ceiunty Manning & Zoning Department a certification form, signed by the owner and by a rr,a w plun*er, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in prupc;r operating condition anti/or (2) after inspection and primping (if necessary). the septic tank is less than 1 /3 fidl,)f sludge. ee to maintain the private. sewago disposal system with the t(we, the. undersigned >ksvc read the above requirements and ab+r standards set forth, heroin. 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. t/we certify that all statements on this form arc into to the best of my/our knowledge. I/we ain/are the owner(s) of the property described above, by virrue of a warranty aced recorded in Register of Deeds Office. Number edrooms i S1C;NAWURE APPLICANT(S) l7ATE *"Any informat;on that is misrepteserited may resent in the sanitary pefmit being revoked by the Planning & Zoning Department. Include with this spplication a recorded wcuranty decd from the Register of Deeds Officc and a copy of the c;eraificd survey map it reference is made in die warranty deed. (REV. 08105) Quick4 Plus Standard Cham 'e and nd 'dews 48" (EFFECTIVE LENGTH) 12" - ~ ~ I(S.1 3'~ Td zap ~~L~ 34" Quick4 Plus All-in-One 12 Encai ° Side and End Views 13" 8" INVERT 8" INVERT 5.3" INVERT j ~--18.2" 33"~ Quick4 Plus All-in-tine Periscope OUICK4 PLUS ALL-IN-ONE PERISCOPE-\ (s6o•swrvEL ) \ T 6" 12.7" INVERT QUICK4 ALLOW-ONE 12 I IlaENOCAP Quick4 Plus Standard Chamber Specifications Size (W x L x H; 34" x 53" x 12" (86 cm x 135 cm x 31 em) Invert Heigh' 0.6", 5.3", 8.01', 12.7" Effective Length 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber. end plate, wedge and other accessory Manufactured by Infiltrator ( "Units'), eVier: installed and operated ir: a ieachfield of an onsite septic system in accordance with Infiltrators instructions, is warranted to the original purchaser ("Holder') against defective materials and workmanship for one year from line dale that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, :he warranty period will begin upon the date that installation of the septic system commences. To exercise ifs warranty rights Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, cT Connertic.-t with n fikeen (15) days of the alleged defect. Infiltrator will supply Lin i tr nrts determined by Infiltrator to be ccrvere+. ::y this Limited Warranty. IInfiltrator 's liability specifically excludes the cost of removal and/ Or Installation of the Units. (b)THE LIMI FED WARRAN i f ADD REMEDIES IN SUBFARAGRXPH (ar ARE EXCLUSIVE THERE ARE NO OTHER W.AHRAN (ILS WITH RESPE C r, TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHr'ANTABIL-ITY OR.. FITNESS FOR A PARTICULAR PURPOSE (c) This Limited ''Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty ! N F I LT R AT O R"~ does not extend to incidental, corsmuential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. systems Inc, Specifically excluded from Limited Warranty coverage are damage to the:;nits duc ro ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units, the Units being subjected to vehicle traffic or other conditions Which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 terms set forth in L^:is Limited Warranty. f=urther, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860,577,7000 • FAX $60,577,7001 third party resulting from installation or shipment. or from any product liability claims of Holder or any third party. For this :!mired Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator 's installation instructions. 800.221.4436 (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than. the W WW. i nfiltratorsystems. com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator 's Corporate Iie.adquarte in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, arid should carefully read that warranty prior to the purchase of Units. Ir- U.S. Patents: 4,759,661; 5,017.041; 5,156,488; 5,336,017. .401,116; 5,401,459; 5.511.903; 5.716,163; 5:588.778,5.839.B44 Canadian Patents: 1,329,959: 2.004,564 Other patents pending. In:filirator, Equalizer. Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour Swivel Connection: is a trademark of Infiltrator Systems Inc. 'J 2009 Infltrator Systems Inc. Prirted in U.S.A. PLUS0510101SI-2 COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must eidend to a point as greater must extend at least than 6" Below Finished Grade 4" Above Finished Grade / , Cover with WZA~ eE : UDr , V f wr`"r''C' .-C- r-~k~- Lockia~q Device b„f .89y PPea`~ CAP (typical) Finished Grade W 1Z ./t9iNirnvm saw e-p- 30 Min. 23° Access Opening 012. W5UtA*-E- Min. z3" Access Opening P► f 4 ' Z ""RIVE r'wE1hR11k1 Oulet Effluent Filter i ~,virr/ if ~OyG Sc'E Union 4wzoYEA P/P6- 3 P1; Inlet Baffle O/~a SOS-/a .SO/L Pu p 3 " ,Sa,n d o r ra vr; l ~h u n al e ~ w ~ ~ c~eh~er Z " /auer yLfra h Pc! ps Two Compartment Septic/Pump Tank (h loo.., 4tle~~ on ov~sia~e uxc//f) SPECIFICATIONS s TANK MFR: DOSES PER DAY: TANK SIZE: SEPTIC 006 GAL. DOSE VOLUME: 78 GAL. DOSE 60O GAL. (INCLUDES FLOWBACK&'<20% OF DWF) ALARM MFR: CAPACITIES: A= alJ -INCHES = 3 Cad 3 GAL. MODEL # It, Switch type: B = _2-INCHES = 33r5~bAL. Cj- PUMP MFR: C = 76-0 INCHES= loZuT 7 GAL. MODEL o SWITCH TYPE: D= .5 INCHES = 3,8nGAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = ZO FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + - FT. d FT. OF FORCEMAIN x /j .S7 FT./100 FT. FRICTION FACTOR _ + FT. TOTAL DYNAMIC HEAD (TDH) = o~ FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH_ 9P= /6,76 MP/MPRS SIGNATURE: LICENSE NUMBER: t?,-)b S S- E Rump f EP04 Series APPL-ICATIONS • fully submerged in high 8 EPOS lmptller: Thermoplas- ■ Watings: tipper and lower Specifically designed for the grade tttrbine o4 for tic enclosed design for ham, ditty bell beating fallowing uses: lubritation and t improved pedormante. cttruttion. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available fw a ak and thermoplastic design provides AGENCY LISTING • farms rtAartual opetatiat. Auto- superior strength and crxrumn " • Heavy duty sump mak resistance. ('j. C-4" U&MIrds • Water transfer models include nk re ttitasay Mechuwc4tl out Switch i Motor Housing: Cast iron • tia►ids t~rrgic K ISO 9Mt Oewatering assembled and preset at the for effic:*rtt heat transfer. f strength. and durabi ity, SPECIFICATIONS ■ Motor Cover. Thermoplastic • Solids handling capability: FEATURES cover with integral handle and maximurrr- float switch attachment points. • Capacities: up to 60 GPM. a EM It1p cliff: Themloples• ■ Power Cable: Severe duty • Total heads up to 31 feet. tic smhopen design with rated oil and water resistant. Yr• NRT, pump out vanes for Mechanical • Discharge sizes 1 sew seat- oubort Drotecuon, rotarytcetamic-stationary. BUNA-N Oastomers. • Temperature: 1044f {4M continuous 140% 160*0 intermittent. METERS FEEL • Fasteners: 300 series to sta+r'less Sleet. . _ 9 • Capable of running GPM ) dry without damage to a components t- z.s rx 25 I Motor' • EP04 Single phase: 0A HP, 115 or 230 v. 60 Hz, 1550 a RPM, built in overload with > 5 / automatic reset • EP05 Single phase: 015 HP. ° a l 115 Y or 130V. 60 ti;, 1550 o Foos RPM. built in overload with automatic reset. z i • Power Cord: 10 foot 51. _ standard length, 16/3 S1Tu with three prong grounding plug- Optional 20 0L oQ_-.._ _ fro. ,th. 16/3 Stfw whit o zo . )0 so GPM *,hree prang grounding plug !standard on £P051. e z 4 6 6 To tz mom CAPACITY Goulds Pumps t 1003 Goulds Pv-os C tttecl,rrivtr.1001 iTT Industries e3er Q~ ) TRANSFER O DEATH TO BENEFICIARY 8035436 Tx:4025686 DECEDENTS NAME DATE OF DEATH 340651 Dorothy Leier alk/a Dorothy L. Later July 27, 2011 BETH PABST ADDRESS OF DECEDENT AT DATE OF DEATH CITY ST ZIP REGISTER OF DEEDS 2151 90'" STREET SOMERSET Wl 54025 ST. CROIX CO., WI RECEIVED FOR RECORD PRESENTATION OF DEATH CERTIFICATE 08/26/2011 12:24 PM I certify that I have viewed a certified copy of the decedent's death EXEMPT ///Y) certi 'cafe. REC FEE: 30.00 pJ. A Q~AQ I PAGES: 6 REGISTER OF DEEDS SIGNATURE DATE Recording area Name and return address: THE INTEREST OF THE DECEDENT IN THE PROPERTY NOTED HEREIN 15 HEREBY TRANSFERRED UNDER THE FOLLOWING STATUTE: Remington Law Offices, LLC 126 South Knowles Avenue s.867.046 which pertains to nonprobate transfer of real property under 705.15. New Richmond, Wl 54017 An interest in real properly may be transferred without probate to a designated TOD beneficiary on the death of the sole owner or last to die of multiple owners. (You must provide a copy of the document establishing interest in property.) 038-1072.90-000 Presentation of recorded document establishing Interest in real estate. Parcel Identification Number SEND TAX STATEMENTS TO: DOCUMENT # VOLUME/REEL PAGE/IMAGE RECORDS/DEEDS 913279 Records Ronald Later 375 E. 2ne Street New Richmond, WI 54017 Description of the real estate. ® See Attached DECLARATION: 1(We) declare that this document is, to the best of my(our) knowledge and belief, true, correct and corn lete and is in conformity with the Provisions and limitations of the Wisconsin Statutes. Name and Address Applicant's Applicant Signature(Notarized) Date (List all beneficiaries. if more Interest in Property (Print or type name below signature) space is needed attach a es. Ie: bensficier Donald Leler remainder August 15, 363 Audubon Lane interest 2011 Hudson, WI 54016 -2j oval Leler This document was drafted STATE OF WISCONSIN, County of St. Croix by:(print or type name below) Subscribed and sworn to before me on: Judith A. Remington by the above named person(s): Donald Leier NOTE: SEE DIRECTIONS. Signature of Notary of other person st C Wisconsin Register of Deeds authorized to administer an oath (as per Association Form TOO-110 s 706.06, 706.07) Website Version 05/2010 Print or type name: Title: Notary Public Dale Commission Expires:rs ~Grl~1QYIU? THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 1 of 6 1 of 6 DECLARATION: I (We) declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. Name and Address Applicant's Applicant Signature (Notarized) Date (List all beneficiaries. If more space is Interest in Property (Print or type name below signature) needed, attach pages.) Ronald Leier Remainder interest 375 East Second Street New Richmond, WI 54017 August 15, 2011 Ronald Leier Judith Mikunda Remainder interest W6955 County Road M August 15, 2011 Beldenville, WI 54003 W-V J ith Mikunda Bernard Leier Remainder interest 1856 County Road C August 15, 2011 Somerset, WI 54025 Z~~, - - -,j Bernard Leier Debra Berning-Reed f/k/a/ Remainder interest Debra Berning W 1693-890'' Avenue )August 15, 2011 Spring Valley, WI 54767 6 ebra Berning Reed This document was drafted by: STATE OF WISCONSIN, County of St. Croix Judith A. Remington Remington Law Offices, LLC Subscribed and sworn to before me on: August 15, 2011, by the above named person(s): 126 S. Knowles Avenue Ronald Leier, Judith Mikunda, Bernard Leier, and Debra Berning Reed New Richmond, WI 54017 NOTE: SEE DIRECTIONS. ' Wisconsin Re ister of Deeds Association Fdrm TOD-110 Website Version 05r20I0 ' Signature of Notary or other person authorized to administer an oath (as per s 706.06, 706.07) Print or type name: Judith A. Remington Title: Notary Public Date Commission Expires: permanent. THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 2of6 LEGAL DESCRIPTION FOR TERMINATION OF DECEDENT'S INTEREST Dorothy L. Leier A parcel of land located in the NW `/4 of the SW'/4 of Section 17, T3 IN, R18W being part of Lot 2 of C.S.M. recorded in Volume 4, page 1016, as Document No. 378962 described as follows: Beginning at the West Quarter (W'/4 ) corner of Section 17, T3 IN, RI 8W; thence South 88° 50' 34" East, 12.43 feet to the point of beginning; thence continuing South 88° 50' 34" East 435 feet; thence South 260 feet more or less to the North line of Private Road; thence North 891 22' 50" West 270 feet more or less to an angle point; thence South 83° 19' 17" West 94.55 feet to point of curvature of 100 feet radius curve concave southwesterly, whose central angle measure is 48° 38' 28" whose chord bears North 63° 46' 05" West 82.35 feet; thence Northwesterly along the arc of said curve and said private road 84.89 feet; thence North 0° 07' 12" West 235.29 feet to point of beginning. 3of6 FORM N0. 985•A Kcrw..cd.o..,® Flt D s N ©V E41380 7 MYi of CDNII W 36'7~~2 amplaw Doe* CERTIFIED SURVEY MAP w a.a, ca mv, TRUE BEARING 8 U N P L A T T E D LANDS EXISTING TOWN _6 _ © - ?N0°07'12"W i Il1.48' ®N0007'12"W _ 7RIGHT-OF- WAY LINE 327.59' I 1 co 1~ 235. 29' N w N cD C w wo O i N f^ 6 6' O H Z ~ Oy to -3 ' _ 1 N ~ V 6 6' 0 3> ° a+ cn f r w i,, rn to ca M 0 0/ 352.05' $ w NO ° 0 7' 12"W o I Cn L„ 0 F..a F O rnn u-I i.1 c 1 1,4 I CA ~ Z ~ to ~ I r z \c!~ ! .P I co f L-4 co 0 J.-g cc L O t;; I L'z'7 O Cn •A N 'V w y ? ? C77 _ N .a M Io .war to n ~ N a f rr - IN o 6 ? ' la ~ o f f+ o `r Iz r• _ in o •P ~ v 1 2 \'L W I G N• C=> N N ® 00 F•-+ O tp N I cn N C r, tO V' Qq V 5~gp 9 lp.`~11 CA 1y.L-~° p w CD CO-tTj it w a p t O N W co C H O w N "1y (~71 _ rn pj" V tr7 y t7 40 Tc' 'J'1~ ~334``~ Sly°p lgs 3p, APPROVED N H w'` I 1g2 p w,2} Iwo CR01X C©11ti7Y co COMPREFIL%q\fd MRKS }LAt1N1N0 N N AND 20,41140 GOMWA"" w CA LA ® 357.39' W co 317.12' ' SO° 35' 38" E ~ 674.S1'1 !z i -tj f Iz l~ I~ Icn Itn fd Volume 4 Page 1016 03/15/2©11 11:58 7154859246 POLK ZONING FAY. PAGE 01/02 O 4 uVsconsineaepa~hrrientofGomm~rrr, ~L EVl~LUA 00NOWWfl Page ~,~,,,.,,of_ pivision of Safety and Bullortys in ac ordanre wit a Adm- Code Aitach complete site Alen nn paper not lefts than 112 inches in ¢Iz,9. Pk th'u d parrot t,4~ include, but not limped to. vertical and tlorizcntal reference pant (5m), k1buCAM1'411, percent slope, scale or dimensions, north ar`ow,'And location and distance to neaswst road, u~ Date ,F Qase- 1J6pif ail hif 40'n ' R l P=oewol wnrmatlori you rrnvide may be used Tor snc danf pwpc"wk P v ay rjW, e_ 15.04 (1) (m)). l 0// -712.,o Prnt7e F'rnpe Owner % lty 1 ovation Govt. Lot W 1/45 M'`114 S 3 N tt , ~ (a Property Own r's Mailing Address ~ Lot ( Block V Subd, Name r 0 NW . o ( I(y State Zip Code phon© Nutrw ~ City 1lillage SiTown (\learest R8afi Neu,, Constrtaction Use: esidential / 1`lu bet of lb-, roams _-3- Gode derived design flow rate GPD raplarement C~ i'4kb[ir ort>r~it~m•3rr'a r.++ rkN c.' Parent rr kena Flood Plain elevation f applicable _ ~ ft- I. coal+nenfs and mr and rerorn+xaandatians~ T. 9a.yq T.3 9p. 3a' L% F:-+ w;~~ b . ~f._..t_.~._ ~ ~ • ~ N cam- l Borlnp #f G T1 - j tiring urouno 9urrace elev. 9 S /a Deil,oth+ to limisinq f,,ictor J aQ y In Pit 5011 A ItCetion Rate Horizon Depth Dominant Color Redox 03 1'; riptlon Tr?xturP. `^rfn.+Ctul'P Consistence Soundary Roots GPD/ft In. flArinsall Q,u. Gant r for (Xr. Sz. Sh. "~ff#1 T02 10-10 JS S7 AM- N , 7 ~o~i •5` sS s ! - 1 LLD- orIng p 1 Boring i f .Q u S Pis Gcoand sur£aoo aleu ~{irtda _ DeW, to Ilmitlnrg factor Soil A liralinn Rate f lorizon I Depth Ciom+nallt Grlor Redox f?ESC lktltan Te~rture tructure Col'+slstente~ Boundary Roots GPDM in. INllunsell au r. cont. color Gr. Sz. Sh. *Eff#1 '`Ef(#2 j~ 3 75 R~ --7-5 P5 - fluent v I v 001), 3,0 M ZO unco- and T-S r 30 u 154 mg;i P-1 font *2 130p c 30 mK+/L anti TS8 < 3tl mflJ4 ~T Name (Ple»ae Print)- aigttat+are GST Number ddres~ s+..y 1~ ~ 'r pete, Fv:~lwelioi~ GonGluCte41 eIT optlortrr plumber Akj G.j/ 1 w L1711 11:58 7154859246 POLK ZONING FAX PAGE 00'02 ~ Proparty Qwnar ~PbL1-~ L r Parcel ID # page Q- of - Boring # .1 Boring • Ground surface elev.,_/ ft. Depth to limiting factor fl in. Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description 't'exture Structure Consistence Boundary Roots GMT in. Munsell Qu. Sz. cont. Color Gr, Sz. Sh. *Fff#9 *Eff#2 s_s s yRy Fs b~ t4 56-wl $I F-1 Baring # Boring ❑ Pit Ground surface elev. Depth to limiting factor in Soil A l cation Rate hlarizan Depth Dominant Color Redox resorlptlon Texture Structure Gonsislcrr poundsry 2oat3 GPDJIC? In. Munsell Qu. Sz, Cont. Color Gr Sz, Sh "Eff# I "Eff#2 ❑ Doring Boring # Ground surface elev. .-_.ft. Depth to 11witing factor in. I..,.t Pit Sot1 AppliGatlon Hate tivrizon Dcp(h OQminarrt Color Rodox DoecriFrtion Texture structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh.. Eft *E Effluent #1 ~ BOD, > 30.< 22U trig/L and T55 y30 ~ 100 my/L " Cflluant #2 = BOD, o 30 rnl h- and TSS a 3n mpll Tine Department of Commerce is an equal opportunity service provider' and employer. If you weed asstscance to avc css ycn•icc5 or need material in an altcmate tbrrnat, please contact the department at 608-266-3.151 or TTY 608-264-8777. S6D-9110 (8-07100) UJI l0/ 21711 11:58 7154859246 POLK ZONING FAX PAGE 021'02 Property pwnar ~e~~ ~L • Parcel ID # Page ~ of poring # Boring II 11 pit Ground surFdce elev. ~ y 5 ! Pt. Depth to limiting factor ~ 0 in. Soil A lication Rate Horizon Depth Ddrnltlant Color Redox Description Texture Structure Consistence Boundary Roots GPD1 in. Munsell Qu. 5z. Cont. Color Gr. $z. 5h. "Eftl REff#2 ► o-J ,p~ R 3 a L a F5 b K %'A'7 Jo-y ID'1~ y L Sb►~ h S-~ TOM Fs b U.' - p s Yl - FS b k y >I Boring # goring ❑ pit Ground surface elev. ft. Depth to limlUng faetar _ In soil A llcatfon Rate Horizon Depth Dominant Color Redox Description Texture Structure Gonsialcrtie 13oundary i toots GPD/f[l In. Munsell Qu. Sz, Cont. Color rr, 5z, Sh_ "Eff#1 "Etf#2 coring F-1 Boring Ground Surface elev. ft. Depth to lifniting factor in- p ii Sod A icatlon Rate Horizon Dcptii Dominant Color Redox Doeaription Texturs Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz, Cont. Color Or. Sz. Sh_ "Etfi#1 *EW " Bffluent 01 = BOD, > 30,a ?2U mglL and TS5 y30 l,'50 my/L ~ " [{tluant #2 = gt50y _ 30 mg/L rind TSS a 3h moll 1: he Departrtlent of Commerce is ari equal opportunity scrviee providor and employer. if you. need assistance tU aVfiL`$4 SCrYlGCD or nccd waterial in an altcmat)e format, please contact the department at 608-266-3.151 or TTY 608-264-8777. 8131 ,110 (R07100) S /V w3 y~ s w;/y 6~ ,1-7, 1 ~ ~ Eby to .ass . T3~t N fZ ~ 8 t~ ~ ~ h ~ ~ ~ S~''ark ~r ( r o N v5 e.. N trJ 4s a To ~Q a-6r o _ _ st S _ 93- P+ -W el l 10011- - t Sop CSo- i i J-7- 4 i I i I - j i Parcel 038-1072-90-000 10/17/2011 04:54 PM PAGE 1 OF 1 Alt. Parcel 17.31.18.302A2 038 - TOWN OF STAR PRAIRIE Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - LEIER, DONALD DONALD LEIER C - BERNING REED, DEBRA RONALD LEIER,ET AL C - LEIER, RONALD 375 E 2ND ST C - MIKUNDA, JUDITH NEW RICHMOND WI 54017 C - LEIER, BERNARD Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 2151 90TH ST SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Legal Description: Acres: 2.600 Plat: 1016-CSM 04-1016 038-80 SEC 17 R31 N R1 8W PT NW SW PT LOT 2 OF Block/Condo Bldg: LOT 02 CSM VOL 4 PAGE 1016 DESC AS; BEGIN AT W1/4 COR SEC 17, TH S 88 DEG E 12.43' TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB, TH CONT. S 88 DEG E 435'; TH S 260' 17-31N-18W NW SW MORE OR LESS TO N LINE OF PRIVATE ROAD, TH N 89 DEG W 270' MORE OR LESS TO AN more... Notes: Parcel History: Date Doc # Vol/Page Type 08/26/2011 940651 TI 09/01/2010 921803 CO AFF 03/17/2010 913279 TOD 05/13/1998 578996 1322/638 GD 2011 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/13/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.600 26,800 100,300 127,100 NO 10 Totals for 2011: General Property 2.600 26,800 100,300 127,100 Woodland 0.000 0 0 Totals for 2010: General Property 2.600 35,000 118,500 153,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00