HomeMy WebLinkAbout181-4123-00-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 538896 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City X Village Township Parcel Tax No:
Kramer Family Limited Partnership NO 1, C/o Village of Somerset 181-4123-00-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
1/V\ G'S T 04.30.19.1099
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER • CAPACITY STATION BS HI FS ELEV.
Septic a Benchmark
Ex: ti w~~ ~ o0
Dosing Z
4g. S
C.J rrtlL.,,, z 7~ Alt. BM
66
Wrin SPwar S
L a Z boob A--
Holding St/Ht Inlet 756 / • 19 A/ S
St/Ht Outlet (p ~/~3Z
TANK SETBACK INFORMATION 7SD 9T
TANK TO P/j- WELL BLDG. Vent to Air Intake ROAD bt Inlet
w-.
Sec 1 Dt Bottom
aoo $7 L5
/ $ y 5v / Header/Man.
Aeration Dist. Pipe
Holding Bot. System
G
PUMP/SIPHON INFORMATION Final Grade 7 V
Manufacturer Demand St Coverer~ Z 3 qg s~
GPM l
Model er
TDH L' Friction Loss System d TDH Ft
Forcemain Length Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
If I
DIMENSIONS ~ ~
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: r
INFORMATION CHAMBER OR `n. A 1<F
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM 4''-
Header/Manifold i~ IDistrtbutx Hole Si~ x Hole Vent to Air I take
Pipe(s) ie
Length 6,11 DiLengh Dia \ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 7-15epth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center .v 6z Bed/Trench Edges \ Topsoil \-1 0 No Yes No
.v
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 599 Cty Rd. V V SOMERSET, WI 54025 (NE 1/4 NW 1/4 4 T30N R1 9W) NA Lot 4 Parcel No: 04.30.19.1099
1.) Alt BM Description = r/
2.) Bldg sewer length
- amount of cover
Plan Use other revision s de for u additional information.- o JZ7 / _J - -
Date Insep or's Si ure ,Cert. No.
SBD-6710 (R.3/97)
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1. ov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
Madison, WI 7-7162 Sanitary Permit Number (to be filled in by Co.)
nepartmer►~ e e 63'35
' 1 State Transaction Number
L, 't Permit Applicatio
V
I
n accordyv4 Adm. Code, submission of this form to the appropriate rnmental
unit is re uirtC Y tary permit. Note: Application forms for state-owned POWTS are Project Ad ss if~eWt than mailing address)
submit- p' o Commerce. Personal information you provide may be used for secondary -
ur s m ' ance with the Privacy Law, s. 15.04 1 m , Slats.
1. Application Information -'Please Print All Information L_J
ProperOs Name Parcel #
! " I / -
k~
Property Owner's Mailing Address Property Location
Govt. Lot
~ J
ILIZ
City, State Zip Code Phone Number y, Section
circle one
T 5~ N; R E or
II. Type of Building (check all that apply) Lot #
1 or 2 Family Dwelling - Number of Bedrooms GD_ ir Subdivision Name
Block # 4-
El Public/Commercial - Describe Use ❑ City of
❑ State Owned - Describe Use CSM Number Village of ~7Trm tT
t-J Z6g6ii w f 1 6114 Town of
JI/
III. Type of Permit: (Che only one box on line A. Complete line B i appl ble)
A.
11 New System R
X
eplacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision El List Previous Permit Number and Date Issued
Change of Plumber El Permit Transfer to New
Before Expiration Owner I'At;`J§
IV. Type of POWTS System/Component/Device: Check all that apply)
X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Gt~c►
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information
Design Flow (gpd) Design Soil Application ate(gpdsf) Dispersal Area Re red (s Dispersal Area Proposed (s System Elevation
~Z
~ t
VI. Tank Info Capacity in Total of Manufacturer
Gallons Gallons Units o $ _
New Tanks Existing Tanks c
Y
0 ;E.
y s C7 6
Septic or Holding Tank ~y r , I
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume respo sibility for installation of the POWTS shown on the attached plans.
Plum er' am (Prim Plumbe s Sign MP/MPRS Number Business Phone Number
Plumber' Address (Street, City, Sta , Zip Code)
VII oun !De artment Use Only
Approved sapprov Permit Fee Date ssued Issuin gent Signatur cc)
en Reason foTHetria~ $ / 75. ~0
IX. Condit fJ#teasons for Disapproval
1. Septic tank, effluent fik®r and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. All.se(back requiOements mustbe,Maintalned
a$ PK Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 02/09) Valid thru 02/11
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name:y
Owner's Address: 77
Legal Description:
Township:
County:
Subdivision Name:
Lot Number:
Parcel ID Number: 3 _ /9/,~ -/q/,"
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing
Page 4 System Cross-Section
Page 5 Filter Specs
Page 6 /Maintenance & Management Plan
Page 7 ! Septic Tank Maintenance Form
Page 8 / Warranty Deed
Page 9 CSM or Plat
Designer/Plumber: License Number
Date: Phone Number 7/5-- _~R/-79'7
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
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Soil Absorption System Cross Section
ft
4' Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
a
Leaching
Chamber
System Elevation
_,3 ft f ft
Soil Absorption System Plan View
~D ft 7'~f~ rc~/ 3 X 7e
ft Leaching Trench 1
Chambers
4° Dia.
Trench 2 Header
Vent Or Observation Pipe
ow
Trench 3
Leaching Chamber Specifications
Manufacturer And Model ~ ~ ~
EISA Rating,-_a~2_ sq ft per chamber Soil Application Rate_ gpd/sq ft
gpd Design Flow r Soil Application Rate + EISA = ~ Chambers
3 rows of chambers each.
Page of
1
Codas. INSTALLATION ~ INSTRUCTIONS
we
&'Nasewetew. a:er Products
Innovations aosnrtotPoylokin4 PL-525/f~L-625 t=tt_TER
VSTALLATION INSTRUCTIONS
l Center filter
with opening
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Additional pipe or
Polylok Extend E Lok" Glue
for centering
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ep 1: Step 2: Step 3:
) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the
) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe.
lecessary. (B) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so the filter can be housing, making sure the filter
removed from the tank for cartridge is properly aligned and
maintenance and service. completely inserted in the housing.
41NTENANCE INSTRUCTIONS
'I r'.1~1 t:r li- r^
MEOW,
P 1: Step 2: Step 3:
ate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back
r ~ +r rky~ if necessary. into the the housing making sure
It 11 ~i (B) Pull the filter out of the housing. the filter is properly alighed
(C) Hose off the filter over the septic tank. and completely inserted.
USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover
WHEN CLEANING FILTER septic tank.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-dof
FILE INFORMA TION SYSTEM SPECIFICATION lew
Owner Septic Tank Capacity al n NA
Permit # Septic Tank Manufacturer ! , ^ ;C ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Model ❑ NA
Number of bedrooms A Pump Tank Capacity al ❑ NA
Number of Commercial Unit §eNA Pump Tank Manufacturer ❑ NA
Estimated flow (average) p gal/day Pump Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Model ❑ NA
Soil Application Rate gal/day/ft' Pretreated Unit
Influent/Effluent Quality Monthly Average* ❑ Sand/Gravel Filter ❑ Peat Filter
Fats, Oils & Grease (FOG) <30 tng/L n Mcchanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Disinfection o Other:
Total Suspended Solids (TSS) <150 mg/L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly Average" Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) <30 m O(In-ground (gravity) ❑ In-ground (pressurized)
❑ At-grade ❑ Mound
Total Suspended Solids (TSS) _<30 mg/L ❑ Drip-line ❑ Other:
Fecal Coliform (geometric mean) <104 cfu/100mL
Maximum Effluent Particle Size '/8 inch diameter * Values typical for domestic (non-commercial)
wastewater and septic tank effluent.
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once ever o months ears (MaAmum 3 rs)
Pump out contents of tank(s) When combined sludge and scum equals one third of tank volume
Inspect dispersal cells At least once eve ❑ months ~4 year(s) (Maximum 3 rs)
Clean effluent filter At least once eve ❑ months 7 V year(s)
Inspect pump, um controls & alarm At least once eve ❑ months :3 ears o NA
Flush laterals and pressure test At least once eve ❑ months ❑ ear(s) A NA
Other: At least once eve ❑ months ❑ ear(s) aNA
Other: At least once eve ❑ months ❑ year(s) ❑ 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 ('/3) 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 ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 months or less 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.
r
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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tanks(s) removed by*a septage servicing operator prior to use.
~ of ?
START UP AND OPERATION page
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.
19 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
WTS iNSTALLE POWTS MAINTAINER
Name f Name
Phone 17 ~7 9/ Phone
PTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
this document was dra',=J =_-;:'sance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer f
Mailing Address
Property Address
(Verification requfred from Planning & Zoning Department for new construction.)
Ciiy/State 21- % Parcel Identification Number /
LEGAL DESCRIPTION
Property Location i/4 , /AL !/4, SeC. T ~N R 4_W, Town of
S11hriivic;nom
LCit
Certified Survey Map Volume , Page #
Warranty Deed # R 7 , Volume `1 7 , Page #
Spec house yes U Lot lines identifiable C% no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
.-maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site
,vastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
:ess than 1/3 full of sludge.
Uvv:-e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
tanua:- , set forth herein. as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin-
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zonis- D e oar ;m ent within 30 days of the three year expiration date.
I/~,e certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of b rooms
SIGNATURE OF APPLICANT(S) DATE
"Any Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department
sue -with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
,c' , is made in the warranty deed.
7' 7 f` €'n5~
CERTIFICATE OF ANNEXATION
Pamela Donohoe, Village Clerk
Village of Somerset
St. Croix County
Wisconsin
-to-
The Public,
I, Pamela Donohoe, Village Clerk of the Village of Somerset, do certify that the following
described territory was detached from the Town of Somerset, St. Croix County, Wisconsin and
was annexed to the Village of Somerset, pursuant to Section 66.0217 of the Wisconsin
Statutes, by an ordinance adopted by the Village Board of the Village of Somerset at a regular
meeting held on the 20th, day of January 2009.
Parcel Descriptions: 534 Cty Rd. W Parcel Described as: DOC. NO. 673221,
`VOL1851, PAGE 491 SECTION 4, T30N R19W 2.6 ACRES NE NW COM NE
COR NW
1/4 S 186 TO CL ST HWY 35&64 SWLY 426.7 FT -POB SWLY. 247.55'
TH BY DEFL> TO RT 104DEG N 240 FT BY DEFL> TO RT 76 DEG NELY 427'
TH DEFL> RT 104 DEG SELY 240'- POB ALSO INCLUDES PARCEL AS DESC
IN 914/140 EXCEPT PARCEL AS DESC IN
914/138. Town of Somerset 032-
2014-50-000.
599 Cty. Rd. W Parcel. Described as: DOC. NO. 811947, VOL 2927, PAGE 457
SECTION 4 T30N R1 9W CSM 01-0199 030-75 PT N1/2 NW'/ LOT 4 CSM VOL
1/199 ALSO INCLUDES PARCEL AS DESC IN 914J138 EXCEPT PARCEL
DESC IN 914/140 2.8 ACRES. Town of Somerset 032-2014-10-000.
MBR: 13326
Dated this 22nd day of January 2009.
PRINTED MAP - ATTACHED
Pamela Donohoe, Village Clerk '
Village of Somerset, Wisconsin
Subscribed and sworn to before me
this day of , 2009.a"aq•,,,,
ro
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Q.•'~oter.
Notary Public
St. Croix County, Wisconsi
My commission expires Quj?j
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Sec. 9-2-7. Connection required when possible; permit for private sewage disposal system.
(a) The owner of each parcel of land adjacent to a sewer main on which there exists a building
usable for human habitation or in a block through which such system is extended, shall connect
to such system in the prescribed regulated manner per Title 8, Chapter 1 of this Code of
Ordinances.
(b) Permits. No private septic tank and other private sewage disposal systems may be installed
or replaced in the Village of Somerset without a permit approved by the Village Board. It is the V p
property owner's obligation that the private septic tank or other private sewage disposal systems L
conform to State of Wisconsin Plumbing Code and rrDep~ment of Natural Res urces J
regulations. vefb~ O1'c- Ic.o'p WL~ d►' 8✓~ - ~J'~ re J'~Cwtr Ia f fA i t0
(c) At such time as a municipal sew becomes available to a property serve by an individual )
wastewater treatment system, a direct connection shall be made to the municipal sewer in ( 3d I
compliance with this Section, and any septic tanks, cesspools and similar individual wastewater
disposal facilities shall be abandoned and filled with suitable material at the owner's expense.
(d) No statement contained in this Section shall be constructed so as to interfere with any
additional requirements that may be imposed by the Health Officer or other authorized Village
official.
(e) In lieu of the above, the Somerset Village Board at its option may impose a penalty for the
period that the violation continues, after ten (10) days written notice to any owner failing to
make a connection to the sewer system of an amount equal to one hundred fifty percent (150%)
sewer charge based on metered water usage and size of water meter or estimated water usage and
estimated meter size. This sewer service charge will be payable quarterly for the period in which
the failure to connect continues. Failure to make such payment said charge shall be assessed as a
special tax lien against the property, pursuant to Wis. Stats. § 144.06.
(f) This Section ordains that the failure to connect to the sewer system is contrary to the
minimum health standards of said Village and fails to assure preservation of public health,
comfort, and safety of said Village.
Secs. 9-2-8--9-2-9. Reserved.
Sec. 8-1-7. Connection to sewer and water system required.
(a) When Required. Whenever a sewer or watermain becomes available to any building used
for human habitation, the owner of the property upon which the building is located shall connect
the building to such main or mains in the manner prescribed by law, except the Village Board
may defer connection to such water or sewer main or mains for those properties which have
existing septic systems or wells whose construction was permitted by the Village of Somerset,
but such deferment shall not exceed five (5) years from the date of installation of such main or
mains.
(b) Notice. Whenever a sewer or watermain becomes available to any building used for human
habitation, the Health Officer shall notify the owner or his/her agent in writing by registered mail
addressed to the last known address of the owner or his/her agent.
(c) Health Officer May Cause Connection at Expense of Owner. If the owner or his/her agent
fails to comply with the notice of the Health Officer or Building Inspector within ten (10) days of
service or mailing thereof, the Health Officer or Building Inspector may cause connection to be
made and the expense thereof shall be assessed as a special tax against the property.
(d) Privies, Cesspools, Etc., Prohibited After Connection With Sewer. After connection of any
building used for human habitation to a sewer main, no privy, cesspool or waterless toilet shall
be used in connection with such human habitation.
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Wisconsin Department of ommerce OIL EVALUATION Page ~ Of
Division of Safety and Buil ings
NIL
in'accord nre with mm 85, Wis. Adm. Code my
1
Attach complete site plan n paper, not tes i§ ~q ' has in size. Plan must
include, but not limited to: 3@ytd h, ce point (BM), direction and Parcel D. percent slope, scale or di arrow, and location and distance to nearest road.
Please print all information. Revi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Property Location
T Govt. Lot 1/4 1/4 S T _3D N R E (or)®
Property Owner's Mailing Address Lot # / BI Subd. Name or CSM#
7 ` /
City Ste Zip Code Phone Number ❑ City ® Village ❑ TowIS Nearest Road
s ( )
❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD
Replacement P Public or commercial - Describe:
Parent material `T/ Flood Plain elevation if applicable
General comments as o a s , -9/,~ I~t AM and recommendations:
F-/1 Boring # Boring
1m 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. nt. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
~G
s - - 7a 9
I
i j0TW
ola
Boring # ❑ Boring
pit Ground surface elev. 2 ft. Depth to limiting factor y in.
Soil icetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfF#2
.G
t
t
1001A 10-
' Efflu t #1 = BOD > 30 1220 mg/L and TSS 30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name t) I Signature e' CST Number
1 ~
Address Date Evaluation Conducted Telephone Number
72-57--, 22/- 797 7
Property Owner Parcel ID # Page _ of
Boring # Boring
® Pit Ground surface elev. g7~ ft. Depth to limiting factor T~ in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
s'
r
•
4 IV
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in Soil A-Pplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring ❑ Boring
# Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit 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
Effluent #1 = BOD5 > 30 1220 mg/L and TSS >30 < 150 mg/1- ' Effluent #2 = BODS < 30 rrKA and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SOD-8330 (8.600)
*N
Property Owner Parcel ID # Page-.,--2- of 3
Boring # ❑ Boring
a pit Ground surface elev. _ ft. Depth to limiting factor _ in. Soil ligtion 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
r
S
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil -Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2
F-1 Boring # ❑ pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
" Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD5 > 30 < 220 mg1L and TSS >30 1150 mgA- ' Effluent #2 = BOD5 < 30 mg& and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD48330 (8.6/00)
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State Bar of Wisconsin Form 3-2003 KATHLEEN H. WALSH
QUIT CLAIM DEED REGISTER OF DEEDS
ST. CROIX CO., NI
Document Number Document Name RECEIVED FOR RECORD
11/14/2005 10:30AM
THIS DEED, made between Brenda K. Bredahl a/k/a Brenda May Kramer, Kay QUIT CLAIM DEED
Arlis Larson and Brent G. Kramer EXE)PT #
REC FEE: 13.00
TRANS FEE: 477.00
("Grantor," whether one or more), and Kramer Family Limited Partnership No. 1, a COPY FEE :
Minnesota Limited Partnership CC FEE:
PAGES: 2
("Grantee," whether one or more).
Grantor quit claims to Grantee the following described real estate, together with the
rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area
County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Name and Return Address
Heywood, Carl & Anderson, S.C.
See attached 816 Dominion Drive, Suite 100
P.O. Box 125
Hudson, WI 54016
032-2014-50-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Dated November 2, 2005 ~J
A~"~ - ~C.~ ~LIL (SEAL) (SEAL)
* Brenda K. Bredahl a/k/a Brenda May Kramer * Brent G. Kramer
(SEAL) (SEAL)
* Kay Ar is L n
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Brenda K. Bredahl a/k/a Brenda May STATE OF WISCONSIN )
Kramer, Kay Arlis Larson and Brent G. Kramer ) ss.
authenticated on November 2, 2005 ST CROIX COUNTY )
Personally came before me on Novembe ' ,
* the above-named Brenda K. Bre
TITLE: MEMBER STATE BAR OF WISCONSIN Kramer, Kay Arlis Larson and
(If not, to me known to be the rson s
Pe (),j tt foieSoi{tg
authorized by Wis. Stat. § 706.06) -jI~try~men nd wledged t s p ♦ =
/
o
Q.
THIS INSTRUMENT DRAFTED BY: . -0-- SAW.
-F7 It 6 - U / ~ 1
Heywood, Carl & Anderson, S.C., 816 Dominion Drive Notary Public, State of WISCONSIN
Suite 100, P.O. Box 125, Hudson, WI 54016 My commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM NO. 3-2003
*Type name below signatures. 0 State Bar of Wisconsin 2003 INFO-PRO' Legal Forms - (800)655-2021 - infoproforms.com
Part ifa parcel of land described Volume T66, P 5 1865, as Document Number
302622, located in the NE 1/4 of the NW 1/4 of Section 4, Township 30 North, Range 19
West, Town of Somerset, St. Croix County, Wisconsin, further described as follows:
Commencing at the NE comer of the NW 1/4 (NIA corner) of said Section 4; thence
SO°41'30"E (Assumed bearing referenced to the centerline of Wisconsin State Highway
"35" & "64" which bears N63°35'E 455.33' previously recorded as South along the East
line of the NW 1/4 forl86.00 feet to the intersection with the centerline of Wisconsin
State Highway "35" & "64"; thence S63°35'W 426.70' along said centerline of Wisconsin
State Highway "35" & "64" thence S63°35'W 426.70' along said centerline of Wisconsin
State Highway "35" & "64"; thence N1 2'25'W 162.45' along the Easterly line of the
parcel described in Volume 466, page 165, as Document Number 302622 to the point of
beginning of Parcel "A"; thence N 12° 25' W 84.49' along said Easterly line of parcel,
thence S63°35' W 149.93', thence S84°0441"E 153.26' to the point of beginning. This
parcel contains 6,145 square feet, more or less, being 0.141 acres, more or less.
AND
Lot Four (4) of Certified Survey Map recorded in Volume One ("I") of Certified Survey
Maps, page 199, as Document No. 330375 on November 25, 1975.
EXCEPTING therefrom: Part of Lot Four (4) of Certified Survey Map recorded in
- Volume 1, page 199, document 330375 located in the NE 1/4 of the NE 1/4 of Section
Four (4), T30N, R19W, Town of Somerset, St. Croix County, Wisconsin, described as
follows: Commencing at the NW corner of said Lot 4; thence S2°33'35" W 247.08' along
the most Westerly line of said Lot 4 to the point of beginning of said Parcel "B"; thence
S0°33'35" W 86.76' along said Westerly line of Lot 4; thence N63°35' E 161.91'; thence
N84004'41" W 141.89' to the point of beginning-
Part ofa parcel of land descriied 1n Vofiu ~ ~66, P Ve 1865, as Docwnent Number
302622, located in the NE 1/4 of the NW 1/4 of Section 4, Township 30 North, Range 19
West, Town of Somerset, St. Croix Coupty, Wisconsin, further described as follows:
Commencing at the NE corner of the NW 1/4 (N1/4 comer) of said Section 4; thence
S0041'30"E (Assumed bearing referenced to the centerline of Wisconsin State Highway
"35" & "64" which bears N63°35'E 455.33' previously recorded as South along the East
line of the NW 1/4 forl 86.00 feet to the intersection with the centerline of Wisconsin
State Highway "35" & "64"; thence S63°35'W 426.70' along said centerline of Wisconsin
State Highway "35" & "64" thence S63'3 5W 426.70' along said centerline of Wisconsin
State Highway "35" & "64"; thence NI 225'W 162.45' along the Easterly line of the
parcel described in Volume 466, page 165, as Document Number 302622 to the point of
beginning of Parcel "A"; thence N 12° 25' W 84.49' along said Easterly line of parcel,
thence S63135' W 149.93', thence S84°0441"E 153.26' to the point of beginning. This
parcel contains 6,145 square feet, more or less, being 0.141 acres, more or less.
AND
=Maps,page'1o9f9, ertified Survey Map recorded in Volume One ("1 of Certified Survey
as Document No. 330375 on November 25, 1975.
EXCEPTING therefrom: Part of Lot Four (4) of Certified Survey Map recorded in
Volume 1, page 199, document 330375 located in the NE 1/4 of the NE 1/4 of Section
Four (4), T30N, R19W, Town of Somerset, St. Croix County, Wisconsin, described as
follows: Commencing at the NW corner of said Lot 4; thence S2°33'35" W 247.08' along
the most Westerly line of said Lot 4 to the point of beginning of said Parcel "B"; thence
S0°33'35" W 86.76' along said Westerly line of Lot 4; thence N63°35' E 161.91% thence
N84004'41 " W 141.89' to the point of beginning.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) located
at: 1/a, A/A/ 1/a, Section , Town_2,,n N, Range W,
T-@-'Vvn of , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service A1--/- -
Did flow back occur from absorption system? Yes N0;2~'-
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity:
Construction: Prefab Concrete X Steel Other
Manufacturer (if known):
Age of Tank (if known):
Permit num. er (if known)
, j,
17
sa
(Licensed lumber Signature) (Print Name)
(Title) (License Number) MP/1VIPRS
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008