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032-2022-10-200
consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division Sanitary Permit No: INSPECTION REPORT 567283 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Westmoreland, Margene & Paul Somerset, Town of 032-2022-10-200 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 00 6 M t G'S r' 06.30.19.550C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 5.3 '41. L /a5 [fig 4.15 J Alt. BM $• C� `j5,�j W I GS.c•• JO 0-s.e,, a. 6 '751 cj 'Gil CoL .... J Bldg.Sewer F,' C.-- `, ,i-e- I�1 r' ri 1_,..„., 6,4 60-11 Holding St/Ht Inlet r St/Ht Outlet 5. •� y7. 7 TANK SETBACK INFORMATION �- TANK TO P/L WELL BLDG. `Vent it Intake ROAD Dt Inlet /1463 9/, Septic / i Dt Bottom /9,S3 V$'. 4,7 /oca 7 5a �'dap /(. — -- ---Dosing i Header/Man. S 7 /6/ � i4a //7 1/7 — � 7. Aeration way J.. Dist. Pipe S•? c'. Co ,, 7 ''G., Holding 1.11.11."-- Bot. System b•S `PG' ' Final Grade / 5 PUMP/SIPHO I` •RMATION 3. b Manufacturer ( Demand St C er / p• py Za lR•t GPM rtii z.c.kC�_ 0 ' / s. 5 Model Number 6/0 1 /` 1 16 ` ____„ TDH 'Lift Friction I.op System Heaq� TDH I Forcemain Length / Dia. if Dist.to Well ) SOIL ABSORPTION SYSTEM BED/TRENCH Width ( Length r No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 16/j-II. iG•,• 4A N._ SETBACK SYSTE M TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacture , .1::1/1,4-1 a INFORMATION CHAMBER OR .1::1/1,4-1 t w c"-- Type f System: nn / UNIT Model Number: n ("04LAr...44',CAA.oJC- 7(s �92 �l,Y, /" Qacl - 4 Si-m....bC I- DISTRIBUTION SYSTEM Z 3 Al yk Z.Z t-c Header/Manifold. ii Distribution x Hole Size x Hole Spacing VenT/1�Air Intake Length Dia '? Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a .....L. °-�� Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 271. 5 Bed/Trench Edges\ Topsoil Yes E No 2..LE No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 455 180th Av ue Somerset,WI 54025(NE 1/4 NE 1/4 6 T3ON R19W) NA Lot 1 Parcel No: 06.30.19.550C 1.)Alt BM Description= V Glj.c,,`.. 1" !� 2.)Bldg sewer length= ,p / 1 -amount of cover= ejl:bin ^' T�uw ri _ Goan. $47147' -G� 4-• V on f.. � L {{ / !• / 7 Plan revision Required? Yes No 6 fig / Use other side for additional information. �� �:/ - —--- 1 Date Insepc *s Signature/ Cert.No. SBD-6710(R.3197) County /; , 4- 7/1 - 4/79-€_, eiq:c4 r Safety and Buildings£Division . -1 C ( X P f ' 201 W.Washington Ave.,P.O.B 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-71W % 7Z �� State Transaction Number Sanitary Permit Application �/1� In accordance with SPS 38321(2),Wis.Adm. bmission of this form to the appropriate governmental unit is required prior to obtaining a sanitary penni 5 •lication farms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Profession. �3�"ersonal information you provide may be used for secondary purposes in accordance with the Pri.♦ f 5.04 m),Stats. Gyrrlj t/5 /� 4,, L Application Information- ' 'r' 1 Information D /�/ Property Owner's Name Parcel# PAUL MAT 0 E 'tlE`r 1•Z\ZR-C L \Ut t32 2o21-16, 2a) Property Property Owner's Mailing Address \ Property Location ( 660 C.-.. :c 1 L 1Th( �-1U" Govt.Lot // City,State ` , / Zip Code Phone Number / O y., kir �y4, Section 1Le <. 1. � V�7 '29-7-stn T c� N; R I-1(circlEoone l II.Type of Building(check all that apply) Lot# A1 or 2 Family Dwelling-Number of:-n• Subdivision Name ` t Block# It❑Public/Commercial-Describe Use Cv✓t ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 1� �07 Town of St)�� r Z Ural-' Ce�L(5 w u t- z3 G�.u..�.te_rs 4( is PJ III.Type of Permit: (Check onl one box on line A. Complete line B if applicable) Ype ( A. ❑New System Xteplacement 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 Date Issued I Before Expiration Owner -1-:/‘.Fi/�1 1-r Q U eC1E,-1 IV.Type of POWTS System/Component/Device: (Check all that apply) 51-a.A-Se r.Q P Lu. s N � on-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil G1^ -'^'`(O e--.P5 ❑Holding Tank ❑ er Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Trea eat Area Information: q Cc)(Olt 6-1 041 Y1 c)Z S Design Flow(gpd) Design Soil Application Rat e(pdsf) Dispersal Area Requir Dispersal Area Proposed st) S S Elevation VI.Tank Info Capacity in Total #of Manufacturer o o o Gallons Gallons Units ! 13 U L . Y New Tanks Existing Tanks / / / I� ✓� a�i :: '°'a� '�— c� 4') ,0 a 5I"3 N LI i c� �. Septic or Holding Tank . /O( .G (OM 1 / X, Dosing Chamber 5-C) 15 L 1 IA)61- t Z ,x VII.Responsibility Statement- I,the undersigned,assume responsibility for inst lation of the POWTS shown on the attached plans. Plumber's Name(Print) P is Signature Business Phone Number - -F- 0,c Vow �• 2732'.12 i15=155 Z `I t)1 Plumbe r's Address(Street,City,State,Zip Code) f( . r1,-, I» Se:1,i . X1ii `_7, `iong VIII.County/Department Use Only Permit Fee Date sued Issuing nt Signature / Approved ❑ • $ "� ❑ wen Reason fo nial `5. Z )3 IX.Cond' ' a>� aReasons for Disapproval 01F 1 1:.'Septic tank,eftitiantfilterand dispersal cell must all be services/maintained as per management plan provided by plumber. 2. AN s k requirements must be:maintainid as per applicable code I'order. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 111 inches in size SBD-6398(R. 11/11) i . rP,Lit ,4 K\fliPE, ii G WwS-v L-i\N ■04( JJc IA S( -r3o i ) E._ I Ql iv vm CAP 1J\ i S&'-r Qy ii4( N._ , J3ti'1I �, t� ?/ __ r i A�IJC 1-tNn 1112.E�I �r' r�#- 7( #ill e. FI Pl- 1cU inn. gf A EEIJO t4/14 ,KkL 2 TOt c` - SAC"lc 00VCR_ 'LrV - I()Z r Ln Z, SO(L._ I�Q. _I N(1S ./-------- ICS - c � 1 LID ` / � S / - / ti 6) I i co.‘.--t £?i L COMPONENT ESIGi Residential application INDEX AND T—TITLE PAGE � � RU L MARCH 1.1 �CZ C-' L kJ � ,�a `^• s_ YIAT]RQ_-- �' u"cs�'�✓, GGi�11 iit�.Y a f ,` -� s r► jai 14°� S . ��50 tv k ICI (41/ Legal DescriPon: Lot Subdivision: Teti'►: K I County: ,5`f c L X ilk z- Parse! IDS p '-• z-- 2 0 2 2 1 - tg 2 C) O 1PtumbeC - ���c- License# /�PAS 2Z `12, Signature. Co�+nien ts Designed pc,r�uaratfid to-Ground Safi Effie►Component Manual for PO S Version Z© nee Soil Absorption System Cross Section 4"Schedule 40 PVC Vent Pipe With Vent Cap ♦- ft Final Grade�? ' - Leaching Chamber n ft ♦— System Elevation =3 ft ft Soil Absorption System Plan View ft ft { II 10 I� 1dft V Leaching Trench 1 Vent Or Observation Pipe r Chambers 1 I III I I I _ M r \4"Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model IK1 tTp4' ? Clt C i EISA Rating Z(. sq ft per chamber Soil Application Rate / gpd/sq ft "'I S gpd Design Flow_ . S Soil Application Rate ÷ 2 0 EISA= t-P5 Chambers 2 rows of 2Z-r 73 chambers each. Page of . --- `y , `. INSTALLATION INSTRUCTIONS _ , . - FILTER PL-5255IPL-625 FEATURES& ENEFiTS 4 1 , Features & Benefits: . - a Rated for 10,000 GPD a PL-525=525 Linear Feet of 1/18"Filtration PL-625=625 Linear Feet of 1/32° Fiiltation f PL-52i 5 PL-625 *Accepts 4" and 6$SCHD.40 pipe The PL-525/625 Effluent Filter should operate efficiently a Built in Gas Deflector for several years under normal conditions before a Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every o Alarm Accessibility three years. If the installed filter contains an optional eAt2iepts PVC Extension Handle alarm,the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a *edified septic tank pumper or installer. __� w_ RECOMMENDED PRODUCTS : - - ' -s - _ � " '- - F y '' 1 Polylok PVC Fitter $ Extension Handle .L-,.-1,,--,.-77.-:-- --- ----: --.-.:4 ti,....7z:17;-----;:::::4-1 :,. .,:--,;...z,_,..-.---_,:t---.._..,.x.,;-1 - Y om- F ^1 _ 7 +c42 F 'Y — L}>:-F mix r �+- V- +-4= r Sri 3 ,. ec -_ - -''d% Ftl#er Mann Panel and Risers Riser Covers Extend&LokT° Riser Screens SnrarMann nel and Poiyink ets bring your Polylok Extend&Laki°s Polyjdc safety switch tank cover to grade. is a simple,easy to use prevent tr�c p { ern Partefs septic locating and solution that can extend from �.by r and lok titt alarm a nets visual allows easier the inlet or outlet pipe and and pets falling into open and audible nofv davi of - d time saving by eraru- - make.fitter and/or bale septic tank entrances. and tank installation a snap. �` - , :. to find tank servicing_ dsggn9 Fits 3"and 4'pipe- entrance. tOfl<t �itWy1►. 8 �O�C. list of Polylok products please visit our web site at p For a full olylo p Dose Tank Cross Section And Pump Performance Specifications 1 Tank Manufacturer 'CZ Minimum Pump Performance Required Tank Model Number W 3c) <3? GPM @ Ft TDH Total Tank Capacity So CAA L Max. Bury Depth g I Total Dynamic Head(TDH) -Feet Pump Manufacturer ZoCILEIZ, Elevation Head 7 Pump Model Number $I3 '1$ I Distal Pressure Alarm Manufacturer R L yy\KS Network Pressure Loss Alarm Model Number Force Main Pressure Loss i, Switch Type 1;3 L 41 u(1"1 Total 10 >6, Manhole Min.4"Above Grade 1 1 With Locking Device Vent Min. 12" Weather-proof Above Grade Junction Box With Cap j p 1 ID — " — - - Finished Grade — — — . . . . . Depth of Cover Ft \Disconnect 1 — lir — — Means >S}{s ia{ >i r ♦ >S:<♦S r i t }i> }i:i}air :i i}i> Y<}{a i>{> : >S} }S}i}{r i}, i i i}i> >i>S♦<}i' S}{ i i ; { Y Outlet } Switch Settings and Reserve Capacity _1 }i Inlet f i> Tank Volume= !'5 0 GPI 20-18 • y YSY '4'' Dimension Inches Volume Gal. A i;i e (reserve) A -IS - 301, i i ,/4r} >i: (alarm) B 2 90 J B —f-- ; i;i Weep y ♦— ; ,>, Hole }S Y (dose) C -;c? ` // ;,j I Off Elev.>} > > Y > > Y > Y Y > Y } } } > } > } Y Y } Y Y > } Y > > Y > > Y Y Y Y } } Y Y Y Y } } Yi Y i ' (dead) D 9 S C( Ft i?i >i> . ■i Total 3-7 75 S i i}{ D YiY {r{ , IL Ft} Bottom of Tank Elev. } }t} y {}{Y < { <}{Yl S}i GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's roduct approval pproval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without rior approval. Manhole covers exposed to p pp p grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis.Adm. Code. 03/05 Igj Page of 08/18/02 07:56 FAI 661 731 9767 _COMPANY -! P� �u 4 givr.v . _- -- TOTAL DYNAIMC HEADIFLOW PER E r; MINUTE PEE1 WIVE: E'er AND mon& monorionas _ Jfi 11119311 a 237 11(7 -311 1 1011111W. 2 12= .41111111111111 265 i . -1-6,--iwunt iiii111023111E1111 in WU zEn 1110111311 20 111:111111111 20 11E41101114:A=. 1 11111100111111 a 113:111111011110111 23 WIN 33 I 125 35 Mg 101111011111151110111 ri 55 le::51 VA 0. , 11111001=11111 0 40 fflD MUMS . o a, , 24o - Mode115 now Pat IMMUTE timmostr CQNSULIFAC R. spaALAPPLiaT a _ q 3 7f � J . V ! a i''�F ;,j .rr'\ 17LS • 3'A_ A , 40siadoeutavesoolage=wwwitsausteggemam ---J.:5_ -- , f iiiiii- i 110 , iSit46211111Sodet 11111-11111-- - 1#- - _qa ffi i b9 F ""'1111113 - I=EINEWIrlitansit wed %a 1.,.. 11C0111:=2 43 tramarms nN. N1 - f- 11 � ��"-f - 3 . Fv..k.w....faRESrEPuzvaa..p.OWEREDriESIGN. . ila -'--------=7.-:-- -. - ! r , . {C11. mtwormoMMISMIF 411Comd9hMeattaseaNGSAINOWSWed. :- I I- 111 Z Z V f//r����"'3 (D Y 4; o co u.a 0 1L' a)Z Z WW C r W W < N Et Vf V► WO — 3 � ' 0 Z Y� tW- Z W U U W a 0 O. 0 J O r O I's L.) A o Cr0 L.-°P Q a Z _ as N p o 0m ova z cti > z ��� ,� Q Qd L.4 4QU •< COp VG O V I to w j Ch 1 f p a to 1T, -La ul W 0 (L(o�'y I' z Z O 4J 1—��•7 8 Z I F O WzVt -< a-0 N JF j g r, ; 7 Q N �O ,,,o 1...... N mVl� N WQ Z> 0 /Y�/ �V. N= *IL - J u W Fa- } Q O = I- N J ..W—-J 1= Y J 41 Ili 1 0r22=-'tea= �03Y �VS d <Wa w = NZ SS Y ZOa00ai..I--I W z: q4q ZOO (.j V:((j O CI YJi <CU Z3mU�=Om=13 aa(� a�... c ZO< Z Z 4 N Q ' chi $ < r W NJ Z 1— ° z - .7J _ -J s 3< U) D V J W ,,Z,=`N r p fai ate.Q c., Z z `cam tt1u Oz< N ma- .b \� I i 1 � II J� `Iiiiài ni 1Lai i8 O „l 9 FILE INFORMATION SYSTEM SPECIFICATIONS Owner a N\FV.651 - JCSA roOKL I'i j) Septic Tank Capacity it.pn gal ❑NA Permit# Septic Tank Manufacturer WC-- s ❑NA DESIGN PARAMETERS Effluent Filter Manufacturer �-1 `ti K ❑NA Number of Bedrooms 100gpd/bedroom , '3 ❑NA Effluent Filter Model ('C SZ 5 ❑NA Number of Commercial Units SC...NA Pump Tank Capacity 5`1 gal ❑NA Estimated flow(average)* ��p gal/day Pump Tank Manufacturer vu 2 ❑NA NA Design flow(peak),estimated x 1.5* 1-1 5 Ogal/day Pump Manufacturer ZC(,(C-fZ ❑NA Soil Application Rate ,j gal/day ft2 Pump Model ❑NA Pretreatment Unit Influent/Effluent Quality(NA0) Monthly Average** ❑ Sand/Gravel Filter ❑Peat Filter Fats.Oil&Grease(FOG) < 30 mg/L ❑ Mechanical Aeration ❑Wetland Biochemical Oxygen Demand(BOD5) <220 mg/L ❑ Disinfection ❑Other: Total Suspended Solids(TSS) Manufacturer: Model: _< 250 mg/L Dispersal Cell(s) Pretreated Effluent Quality❑ Monthly Average*** ❑ In-ground(gravity) ❑ In-ground(pressurized) Biochemical Oxygen Demand(BOD5) < 30 mg/L ❑ At-grade 0 Mound Total Suspended Solids(TSS) < 30 mg/L ❑Drip-line ❑ Other: Fecal Coliform(geometric mean) <10 cfu/100m1 ❑ Leaching Chamber Manufacturer 11.`tRRA(A Maximum Effluent Particle Size 1/8 inch diameter Model DWI._ C( Laying Length/Chamber L *Wastewater Flow Verification and Calculations: Soil Application Rate . d/ft2 Area Req. `TOO ft2 (Other than bedroom based) Infiltrative Surface/Chamber-ESIA Rating ZQ ft2 Minimum Number of Chambers 11 ❑Aggregate Design Flow/Loading Rate= ft2 min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Adm.Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ' ❑ "Wisconsin At-grade Soil Absorption System,Siting,Design&Construction Manual"(Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System:Siting,Design&Construction Manual"Converse,J.C.and E.J.Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems"Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds". R.J.Otis-ASAE Publications 5-77 and"Design Manual- Onsite Wastewater Treatment and Disposal Systems".EPA 625/1-80-012 October 1980 ❑ SBD- 10570-P(R_6199)"At-Grade Component Manual Using Pressure Distribution" g'SBD- 10567-P(R.6/99)"In Ground Absorption Component Manual" ❑ SBD-10705-P(N.01/01)"In Ground Soil Absorption Component Manual"Version 2.0 ❑ SBD- 10628-P(N.6/99)"Recirculating Sand Filter System Component Manual" ❑ SBD- 10656-P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572-P(R.6/99)"Mound Component Manual" ❑ SBD - 10691-P(N.01/01)"Mound Component Manual"Version 2.0 ❑ SBD - 10595-P(R.6/99)"Single Pass Sand Filter Component Manual" ❑ SBD - 10657-P(R.6/99)"Drip-line Effluent Disposal Component Manual" ❑ SBD - 10573-P(R 6/99)"Pressure Distribution Component Manual" ❑ SBD - 10706-P(N.01/01)"Pressure Distribution Component Manual"Version 2.0 ❑Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units 0 MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Insect condition of tank(s) At least once eve -3 ❑months L ear s aximum 3 s. Pu . out contents of Y I s When combined sludge and scum equals one-third(1/3)of tank volume Ins.-et dis a ersal cell s) At least once eve ..3 0 months Eg -. s aximum 3 . Clean effluent filter At least once eve ( ❑months r. i:.. s) Ins ect . I., a ... controls&alarm At least once eve ❑months .4 ear(s) ❑ NA Flush laterals and .ressure test At least once ev- - ❑months _A e. s ❑ NA Valves At least once eve - ❑months to -. s ❑ NA Other: At least once eve ❑months ❑ -• s ❑ NA Page of START UP . 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports.The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS.The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume.Also the brine or waste from water softeners, iron removal units,other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible.Note:this does not include laundry waste,showers,dishwater,etc. This system is designed to handle domestic strength wastewater,however the disposal of food based greases and oils,vegetable/fruit peels and seeds,bones,and food solids such as those produced by a garbage disposal should be minimized.Toilet tissue is the only paper that should be discharged into the system.Other non-biodegradable items such as baby wipes,tampons,sanitary napkins condoms,cigarette butts,dental floss,and cotton swabs should not enter the system.Chemicals such as petroleum products,paint, disinfectants,pesticides,antibiotics,solvents,etc.,should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week.Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner.If an alarm sounds,contact an individual licensed to service POWTS,There is normally a 1 day reserve under regular operating conditions,however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications:Master Plumber,Master Plumber Restricted Sewer,POWTS Maintainer or Septage Servicing Operator(per the attached Maintenance Schedule). ❑ Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface.Access openings used for service or assessment shall be sealed and/or locked upon completion of service.Any defects shall be promptly corrected.Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third(1/3)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 Chapter NR113,Wisconsin Administrative Code. The outlet filter(s)shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications.Provisions are to be made to retain solids in the tank.Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps,alarms and floats.A visual check must be made for leaks,backups,surfacing,missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ❑ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding at depths greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ❑Mound,At-Grade,In-Ground Pressure The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing.The laterals should be flushed at least once every three(3)years.Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS • Reports for maintenance,inspection,and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch.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 other 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 from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations.Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface.Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 -Z(6 Phone SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULATORY AUTHORITY Name Agency rt (!( (y. eT `2C)k)iNe, Phone o e Ph n ► - 10/2006 K:IWPDATA\ERIPOWTS OWNER'S MANUAL.doc Page of ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM wne..03uyer I VL. .S7 fiN �.'6 1-1W fl Mailing Address Pi 5s 181N hi ,� met .SAC'--t ( -5`I bas Property Address 5'1\11,\G (Verification required from Planning&Zoning Department for new construction.) City/State Parcel Identification Number b? -2 6 2Z I 6200 LEGAL DESCRIPTION Property Location iW • '/4, )3 L '/ , Sec. (� ,T <3h) N R IC} W,Town of SO t ic25G`Y- Subdivision Plat: ,Lot# f Certified Survey Map# �j'?j -7y � ,Volume , Page# Warranty Deed# -53D 7 89 (before 2007)Volume //3(c; ,Page# 3.?`/ Spec house yes no Lot lines identifiable yes rL�no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm.83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification staling that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. • I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Nua,erofbedr ..s lik SI e A URE OF ''LIC (S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.09/07) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify th t I hire inspected the septic tank presently serving the West NLe I4(4..,J Q� residence located at: AJE 1/4, NE 1/4, Section (o , Town 3O N, Range /1 W, Town of 5e,e, e-rreA-- , 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. f Most recent date of service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X Steel Other Manufacturer (if known): \A eats Age of Tank (if known): ik../1A/ rF Vl U � (Lice / _ umber Signature) (Print Name) / courepor6 ,viPec' .z3Zyz. (Title) (License Number) MP/MPRS a/3113 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) II ' .I State Bar of Wisconsin Form 3 -- 1932 II HH95050058 II ii QUIT CLAIM DEED If IIii OOCJMENT NO _.._. I---- V!ii. 11.3GPAGE 324 —II ;•-'----___..-:_ --_ - !I If------- --- — I I I II ! �I �Fmn o cur t-.,, ,...- II li -• Liergenv, SCE May a simile persona ----- --- 1 AUG h C I995 II I quit-r.laims to —_ Ma�ene A. Mayer-Westmoreland and �•� ,. 12:00 P. ,7.1__ Paul Westmoreland,.. wife and.husband — I I r}'':-.:u,,,,-,!;_ __ t... ., II --— ll . tz,....2(..:1..*4.......1 II the fallowing described real estate in St Croix _ County, — '="—" v \yp\~!'Yy~` 1 Department of #1718 3s , SOIL EVALUATION REPORT ~p Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 = Professional EprintaH Schmitt Soil Testing, Inc. • County Attach complete site plan n 8'% x 11 inches in size. Plan must St. Croix inc lude, but not limited v l reference point (BM), dire d~ percent slope, scale or nsi, and location and distance to ios Parcel LD. 032-2022-10-200 easormation. evi tl Dat % Personal information you provide may be used for secondary purposes (Privacy LaJ, s<: f5.*# (r .f "I I /1 Property Owner Prpperty Location Westmoreland, Paul & Margene Govt. L$ti'lx '01 /A, NE1/4, NE114, S6, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 455 180th Ave. 1 CSM 10/2967 City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road Somerset WI 54025 715-247-3633 Somerset 180Th Ave N on Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand (Amery-Cromwell Series) Flood plain elevation, if applicable NA ft. General comments Replacement drainfield area is suitable for a conventional system witha a 0.5 gpd/sgft rate. Possible system elevation for and recommendations: replacement area is 94.9'. l Gl ~J7~ S r~~ y l e c~• Y Z A A 1/1 1 Boring # F-1 L] [j Boring Pit Ground surface elev. 99.90 ft. Depth to limiting factor 125+ 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#t 'Eff#2 1 0-7 10yr3/3 none sil 2fsbk mfr gw 2vf 0.6 0.8 2 7-13 10yr4/3 none sil lmpl mfr gw 1vf 0.4c 0.6 3 13-35 10yr4/4 none sicl 3msbk mfr gw 1vf 0.4 0.6 4 35-63 7.5yr5/4 none vgrsl 2msbk mvfr cs 0.6 1.0 5 63-125 10yr6/4 none s Osg Osg 0.7 1.6 Boring 2 ]Boring# Pit Ground surface elev. 99.90 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t •Eff#2 1 0-8 10yr3/4 none sl 2mgr mvfr as 1vf 0.6 1.0 2 8-63 10yr6/4 none s Osg ml as 0.7 1.6 3 63-110 10yr6/4 none fs Osg ml 0.5 1.0 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 6/19/2013 715-760-1978 SBD-8330 (R.07/00) Property Owner Westmoreland, Paul & Margene Parcel ID # 032-2022-10-200 Page 2 of 5 Boring F3 Boring # E Pit Ground surface elev. 99.20 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Efr#2 1 0-9 10yr3/2 none sl impl mvfr gw 2vf 0.4 0.6 2 9-26 7.5yr4/6 none sicl 3msbk mfr gw 2vf 0.4 0.6 3 6-4 10yr4/4 none SO 3msbk mfr CW 1Vf 0.6 0.8 4 48-64 10yr6/4 none S Osg ml as 0.7 1.6 5 64-115 10yr6/4 none fs Osg ml 0.5 1.0 Boring F4 Boring # pit Ground surface elev. 99.40 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-10 10yr3/3 none I lfsbk mfr gw 2vf 0.4 0.6 2 10-18 10yr4/3 none sil ifsbk mfr gw 1Vf 0.4c 0.6 3 18-67 10yr5/6 m2d 10yr6/6 10yr6/2 sil lfsbk mfr gw 0.4c 0.6 4 67-96 5yr4/4 c2d 7.5yr6/6 sl Om mfi 0.2 0.6 7.5yr6/2 Boring F - I 5 Boring # Pit Ground surface elev. 99.70 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none A 2fsbk mfr as 2vf 0.6 0.8 2 10-17 10yr5/3 none Sil lfsbk mfr gw 1Vf 0.4c 0.6 3 17-28 7.5yr4/6 none sl imsbk mfr gw 1Vf 0.4 0.7 4 28-96 5yr4/4 c2d 7.5yr6/6 sl Om mfi 0.2 0.6 7.5yr6/2 I * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ` Effluent #2 = BODS < 30 mg/L 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. SBD-8330 (R.07100) Schmitt Soil Testing, Inc. Property Owner Westmoreland, Paul & Margene Parcel ID # 032-2022-10-200 Page 3 of 5 F"6 Boring ]Boring # Pit Ground surface elev. 96.30 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 '01#2 1 0-10 10yr3/3 none sil 2fsbk mfr gw 1vf 0.6 0.8 2 12-22 10yr3/4 none sil imsbk mfr gw 1vf 0.4c 0.6 22-44 1 r4/4 cld 10yr6/6 sil imsbk mfr gw 0.4c 0.6 3 OY 10yr6/2 4 44-78 5yr4/4 cld 7.5yr6/6 7 5yr5/2 sl Om mfi 0.2 0.6 ❑ 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/ft° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 F-1 Boring # n Boring D 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I " Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BOD5 < 30 mg/L 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. Schmitt Soil Tesdng, Inc. SBD-8330 (R.07/00) Page 4 of 5 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Paul & Margene Westmoreland Thomas J. Schmitt, CST 227429 Address: 455180th Ave. 1595 72nd St. City, State, Zip: Somerset, W154025 New Richmond, WI 54017 Phone: 715- 60-1978 PID: 032-2022-10-200 Signature Lot No.: 1 Date 13 Legal Description: NE1/4 NE1/4 S6 T30N R19W ® Backhoe Pit Township, County: Somerset, St Croix County A Bench Mark 1 El. 100.00' Top of 2" PVC pipe. Q Bench Mark 2 El. 102.38' Top of Septic Tank Cover Slope= 13% 11. l Yoh ~e A lB ~i MA3 Y3 7° 13 9a - o Sr,~Atr / r YO os-;." ca~~ EPP(- l ~ I CG~~' Ste) I • tom' ~F : E !•m s ~ ;h, 'df ; ~•a'yxa C `:'.%.`n'r w9 ,n;f •~y J 1 ~ ' o t A~,YS r» '~"-.4, vst r°'~ $t 3u ^A ,t,,".: ~1~1 t., ? k sn~ ,,.x '~KM1• ~i J 4 ~~I{ e:~nn ft~:,. > v'' +1:. ~ 5~ ` _K£~ : :.5+'$ phi;. i~ 'iP. A 431. 7 g >N NN ( 'N r M.~ 3 CC r'" 00 ' aK f p 4 0 °-a' ° M ~ p 6o o c c a a 0 ~ I M O N D n O C Q d D O. Lf) X N ~ III Y N ~ I O N U O a O a N m C Z H c6 U) c O m a N c fO c LL o rnO N a 00 'M Q ° ow I M 3 ~ z z = o M L C z (D 4) o co H z d co o z E v 0 N v as 2 ~ c ~ N F- r ° N E N __V N O 7 ~O N N Q 0. CL G y O O O N ! Lo a 'p N (6 N N c H ;L) w N O O O N Q It z m z C z o N Z II coo d E N N m O d _ N CL E v ) G C a E as co U) U) E z ! 3 3 3 a m • Qaaa O r a g °m 4j (D (0 o m N V) V Lo rn rn } M M 'O O b M a) 25 b C) a O N N N 0 0 O N N N C w N 0 0 N 'O d Q ~ CA f6 ~ w N O \j O C fyd C Q 0 501, H co aUi c°n cn o a 0 0 0 0 1 V i N y d O U N N N N 0 N N O ` O O C CO N G N O N O N L L n O O f-l N M yu7 a0,+ 7~~ C N C) C> C-4 C) z 2 O ~ V1 a € a L a. 'v I C • a a~ d r c m c E as t A Ci a 0 v ii U ..r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER AkAI + I'IAR KR weJ-~mU ~K1Nb ADDRESS_ Mt Nj-Q SUBDIVISION / CSM# LOT SECTION _T_ N-RW , Town of )p m,91Z S ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~&ksG 3 (,ORovrn IS' o 3s On'~.St ~ ~ 9I Wto . 1' AtA o I.? ; S eve ~ aut i Pfi Bp FFIP N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ORK BENCHMARK: N P? I N TKA0 L= 9 17 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: w uz~5 Liquid Capacity: WOO ov e~ s o ~ Setback from: Weller House 15 Other ~v Pump: Manufacturer Mode~~ Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: Length 5 U1 Number of trenches Distance & Direction to nearest prop. line: ~yef"- Setback from: well: OVQ'R 51 House l Other vi R ~U.(0(Q ^ WG G ~Ny- 90,`{ _ 4~• ~~i ELEVATIONS CoVff'p- Q lr Building Sewer ST Inlet. J v. ST outlet 1 ottom Pump Off PC inlet PC bottom-- II Header/Manifold Bottom of system W45 pj~.OU ~pIfccl rc _r -fv,\ Existing Grade 73, 1 ~j Final grade 3.1 $ fi~ 89 5~~3 DATE OF INSTALLATION: I I~ PLUMBER ON JOB: 1"rh_2~r LICENSE NUMBER: INSPECTOR: 3 / 9 3 : j t Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labo~and Humon Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Y GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village p Town of: State Pla o:: _ WE.STINORELAiND, _MARGrENE .A & FA, I, JC X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA y TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C', C 01~d~ Benchmark ~U(J Dosing 10 A(~. Aeration Bldg. Sewer Holding_- St/>P(inlet TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 3v > NA Dt Bottom Dosing NA Header /-tea IP, /7/ ,s Aeration NA Dist. Pipe 3 35P Holding Bot. System 13af 9,5,67'_ PUMP/ SIPHON INFORMATION Final Grade Manufacturer emandc~ Mo el Number GPM TDH Lift I Loss tio System Forcemain Leng Dia. Fi Dist. To Well SOIL ABSO.ROTION SYSTEM BED/TRENCH Width Length No. Of Trenches T No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `rd DIME SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA anu act SETBACK INFORMATION Type O fnt0' v.r R Moe Number: ~L OR UNIT System: Q' UZI DISTRIBUTION SYSTEM Header /fly- Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length 7 Dia- Length AL Dia. 7 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys my Depth Over Depth Over xx Depth Of 11re-E / Sodded El Yes Bed /Trench Center Bed /Trench Edges Topsoil _Px ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET, f , 30,29W, NE`, NE, 280TH AVE CAP C_% G(X l.~ L•~yt~.P Y..~'f,~C.~~ ~ ~-f'/o ~ C~<"' Y'~ ' ~CO Plan revision required? Ej-re-s ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: v Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. 1n accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. S - O • See reverse side for instructions for completing this application State Sanitary Permit/ Num r . The information you provide may be used by other government agency ~ c~o✓ / `1~7 Y programs check if revision to pre ous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name I I Property Location ~C d ~J WQSI~O4 P~1 f1/4 1/4, S T30 r N, R E (or) W Pro erty er's Mailiri Address Lot Number Block Num ~Jtv, State Zip Code Phone Number Subdivision Name or CSM Number a 5-1- S U ( ((9 ID )4 36-1 3 92 II. TYPE OF BUILDING: (check one) ❑ State Owned Ity Nearest Road E] Vile Public 1 or 2 Family Dwelling - No. of bedrooms Town OF So e-I~S III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo U a a 1 U a 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12E] Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. RNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 MSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43E] Vault Privy 14E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6_ System Elev. 7. Final Grade q50 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 9 U U .5 71,0 Feet ~.3a Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. - Fiber- Plastic Exper. New Existin Gallons Tanks Concrete Con- Steel glass App. strutted Tanks Tanks Septic Tank or Holding Tank U 0 , e j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamp) MP/MPRSW No.: Business Phone Number: Plumber'sAddre (Street,Cit State, Zip ode): ~ Q N1\ \k 0 ~)SL O IX. COUNTY/ D-EPARTMENTUSEONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing entSignatur A roved Surcharge Fee) pp ❑ Owner Given Initial ~ / Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-6398 (R. D5/94) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any nevi criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be a.pproved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair: V. Type of system: Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR_ VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic , tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer;'D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. P. a. L.._ 6 -r f L CST n ~~i ► c.: I U I_1, ~.~h _ .1 T 1A, 1 .M.../.~...~...._ ..r..~.r..~ =NAME Au d~~'IAV` QN~ eJ ~1o~cq~ANI~ M ~m oLcr\ L 0 A I N1.j a a..._. . F i. C E N S__. t. _ A P.00 ~I' N : bd jpe-p~ IAfi aQ A acA Up«mfi Not SO ' I T~pw sp ~t to IL .,9 QPNC~npIL~~ I Np~1 .N daK rg-~Q O3> ' o = gook 1.~e p. ~s -6 of WkifiIP S~P4 loon p) PSe S~l c r• W~~~ ~,~ho;~ E.le~--1~U.0 is ~ FRESH Ail. i0W-'.'rS AND ODSERVATiOtJ PIPE C11OSS SECTION _ Approved Vent; Cap Minimum 12" Above Final r7ilG__ 3a lig A" Cast: Iron Above Pipe Vein pipe To Final Gradc - • . - wsoensin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Divisiori of safe & i3uildngs in ac rd with I HR 05 Wis. Adm. Code _ COU `Attach co es an paper no less t a S 1/2 x 11 the VYan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ,e, LLD. dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION . REVIE ATE T", RTY OWNER: PROPERTY L 'TION W GOVT. LOT 1/4 1/4 S J N,R E( OWNER':S MAID ADDRESS LOT # BLOCK # SU YOOE t TATE ZIP CODE PHONE NUMBER ❑CITY EIVILLAGE .toy / V 1) t New Construction Use t*)f Residential I Number of bedrooms ' [ ] Addition to existing building J Replacement [ ] Public or commercial describe Code derived daily flow 4_ gpd Recommended design loading rate S bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 0 trench, ft2 Maximum design loading rate • S bed, gpd/ft2 • ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred o site plan benchmark) Additional design / site ginsiderations yr rl )?do 0 ,,G Parent material ~s Flood plain elevation, if applicable ft $ _ Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S E] U E3 S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bar>cL~ly Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdi 13 i " k 0 'f 3 Z Nn~ S s r v. v v) I j S" b 5 V ,~-.ig tpfly c to - S ~ Ground C w ` Depth to limiting facWr t Remarks: H r w to m"7741:046- 6eee- . fn!,../~3 Boring # 0-13 1 /0 YP( 34, .e, 13" Y/" i0_19 3, 4 -It Ground &IOU Depth to limiting factor Remarks: FSi~onat Name.-Please P ' Phone:. Z;, Tess: Q ,ate Scri. .S OfG u re: Date: CSI Num PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2-,.of,-3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Baxxbry Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench f 0-2t' AO Vt 31A. Ott S yh ! l' /y1 e,&-) v Ground ef.~ Depth to limiting Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. It Depth to limiting factor LL Remarks: Boring # Ground elev. tL Depth to limiting factor Remarks: SB 4MO(R.05/92) 3~~ 3 f yo (3 9 ~ L o~ 0 0-- vo D 1,90, *ye- c 93.92- Safety and Buildings Division r~~•~r■`l~n' SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County/ do, th an 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State a9~Number The information you provide may be used by other government agency programs E] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ,~+1 i/4 AJE_ v4, S T 30 , N, R /q E (or)V ncl- Prope.rW Owner's Ilin Address Lot Number Block Number, City, State Zip Code PDone Number Sub ivisi Name or CSM Number ,V Sa ~ W ) j r 5 y 0 IffIg W30 .Slt~" 17~ l/o . -A96 II. TYPE F BUILDING: (check one) ❑ State Owned ity Neare oad ❑ village _-Amers go Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 63 D V a a- 0-c.) d 6 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 1 1)q seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft_) (Min./inch) Elevation Y.5 90A 700 9 . d Feet Feet VII. 'TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. - Fiber- Plastic Exper. New Existing Gallons Tanks Concrete Con strutted Steel glass App. Tanks Tanks Septic Tank or Holding Tank to 4 Q ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature- (No Sta ps) MP/MPRSW No.: Business Phone Number: Alves ee ~ 7/5 -3810 - 90~p Plum/bnerr''s Addr ss (St eet, Ci y, State Y\ LOT , Zip Code): 4 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit F e (includes Groundwater ate Issue Issuing nt Sig re (No m roved Surcharge fee) pp ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number- of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.)., address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic , tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through"these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. . r ~ VILI r 1 PLOTA N 1) Cl S-(, ) O S S J I r ..I~. N A M E ? 1a4,J N AM T,4rnes 6u,~nee~ N .'-LOCH 10 DC C_.._.._ PL 0 "I~ M A _P ~ QR )N f , 1~1 ate t45 ~'IARX B~sx Aj~k f1 66aM Note` ; lev ~ Imo, ~ fi S b5kpej~ 3 S0' S j-;c U = e~~ t, es (4yp , a o Sol . c . MAR By a - T7 3~ ~la~.~ sa ► ~ ~ ~ .sO yo. FRESII 1111: INLETS AND ODSE1tVAr1ot Yx.QE C120SS :SECTION - Approved Vent Cap Hinimurn 12" Above I 7 )1JA ~ G~P~ Above Pipe 4" Cast Iron To Final Gradr- Vent Pipe w c9osin Department of Industry, SOIL AND SITE E O R T Page _ of tabor and Human Relations Division of Safety & Buildings in accord with 1 .05, Wis.,Adm. COUNTY cf. Attach complete site plan on paper not less than 8 1/2 x 11 in n size. Plan Mu tide, r / not limited to vertical and horizontal reference point (BM), dire tii5rt ° `Cf sldp% sc ar PARCEL .D. # dimensioned, north arrow, and location and distance to neare ~r REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INF ~1TI~ PROPERTY 9YVNER- ROPER N / W 1/4 IVEll4,S ' T b N,R E( r) PROPER OWN RIM LING AD E E01 N_ I BLOCK # SUBD. NAME OR CSM # CI STATES IP ODE PHONE NUMBER ❑CITY ❑VILLAGE ❑TOWN NEAREST RO Gc / v K New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow pd Recommended design loading rate bed, gpd/ft2, trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ~'5) bed, gpd/ft2 /-G trench, gpd/ft2 Recommended infiltration surface elevation(s) 0. ft (as referred to site plan benchmark) Additional design / site con 'derations • 0 Parent material Flood plain elevation, if applicable _11/ ft S = Suitable for system C NVENTIONAL MO ND IN ROUND PRESSURE 77s DE SYST JN ILL HOLDI NK U= Unsuitable fors stem IN S❑ U S❑ U S❑ U ❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 4?;::?G:ib:•i:;:i;:ii Ground Al 4/ 011ev.,e- t. Depth to limiting factor,/ 7 Remarks: Boring # Ground / elev. t Depth to limiting factor 2, Remarks: CST Name: Please Print Y , Phone: S , 6 7 E ~J Address: i 5444001 _7 Signature: Date T Number: PROPERTYOWNER 4S&. DESCRIPTION REPORT Page =pf PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Fca Y? 2, 0 ~~'~j7yj Ground ele . ~~ft. Depth to limiting factor Remarks: Boring # 442 Ground elev. Depth to limiting factor Remarks: Boring # YlA- Ground A31f t. Depth to limiting fa 0 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Paul Westermoreland Byron Bird Jr. Address 14625 62nd St. North Oakpark Heights Mn C 4~1-~ 7 M #3479 Lot Subdivision Date 7/8/95 NE 1 /4 NE 11/4S6 T 30 N/R19 W Township S. Somerset ❑ Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of White Stake Red Ribbon System Elevation 97.0 * H R P Same as Benchmark Property Line 00' o3 c Bedroom House a 30' 75' M.20B-1 20' 20' B-4 3% Slope 25' 50' 0' Pri A B-3 Rep A >20% Slope 20' B-2 40 B-5 20' >20% Slope >20% Slope 531'741 CERTIFIED SURVEY MAP Located in part of the NE1/4 of the NE1/4 of Section 6, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. LEGEND OWNER Margene Mayer Aluminum County Section Monument Found 1787 38th Street • 2" Iron Pipe Found Somerset, WI 54025 • 1" Iron Pipe Found 0 1" x 24" Iron Pipe Set, weighing 1.68 lbs. per linear foot 100' Roadway Setback Line % Existing Fence Line ~,11ISCONSIN CENTRaL_VN( J ~ 'V U - --T- _ I80T ia'JNUUt North line of the NEk of Section 6 N89°16'42"E a FILED at N89°16' 42"E'- i_NE Corner Section 6 DI- J U L 2 6 1995 _im 2235.29 I S89°52'14"E 404.76' 1 J KATHLEEN H.WALSH N> Corner 1 ~n R9QLtte(OtDeeds Section 6 L ` SLCroIzCo.,WI S Q N ~L Co IF zco v °a I O I-1 N s Ir W W I-i Iy LOT I F7, - (f1l a co °i I -1 z 10.00 Acres Inc R/W C) I C7 % r ° CD 11771 :4 435,641 Sq. Ft. t1i a, rh N I ~J a n 0 9.89 Acres Exc R/W Ir Z CD CD - w 430,641 Sq. Ft. ~ I Y pp 7 i 00.0110 0 0 0. I C7 IF- 10~ °'(1 i; Iv o F (D 00 m0•m ICJ C) S ~ O O N N rt O 7 O rh CD I3 ~ a 0 & v AL 14 CD 0 ~htYH G as M C1 S87°24'36"W 404.76' ° • Wis. lc ~I f ' y L96Z d95'd OT "Ion • a0T.-pp aoj papog uMos ajptadoaddp pup aoTjjO BuiuoZ AjunoD xzoaD IS agq gopluoo Taoapd .pup Fu-tdOTaAap ao fiuzspgoand aaogag •('oqa 'Taoapd oq ssaoop 'azzs qOT mnuiTunu 'spupTIDA '•a•t) suoTgpTn6aa pup saTna 'smPT dTgsuMoy pup AqunoD 'alpgS oq goalgns sz (geTd) dew sTgq uo uMogs Taoaud gopg -amps buTddpm pup buTAa4ans uT xtoaD •qS go AqunoD aqq go aousutpap uozsinTP~S Pup'I aqq Pup sagngpIs u-rsuoosiM agq go 9£Z aagc3pgo go suoisTnoad quaaan0 aq~ gqiM patTdmoO ATTn_4 aapg I Ipg:t :p9gta0s9p pup paAat►ans Aappunoq aoiaagxa aqq 10 aTuos oq uozjuquasaadaa goaaao0 p ST dpw AaeanS pazgzgaaD sigq gpgl Xjzjaa0 osTR 'I •pao0aa 30 squamaspa TTp pup (9nu9AV gg08T) ApM-jo-gg5zg ppo-d uMos oq goalgns sz Tazapd p9gTa0sap aaogv (,:Ia 'bS TWSEV) saaoV 00'0T sutpluoo Taoapd pagzaosaa •BuzuuTB9q go qutod aqq oq gaaj 99•v0v 'auTT 111aoN plus buOlp 'H„Zfi,9TO68N 90uagl :uozgOaS pips 90 V/TaN aq:l 90 OUTT ggaON DIP 01 gaaJ OZ•E80T 'M„OT,ETOTON a0uagq !9L*VOV 'Mu9E,VZOL8S aouaq:1 :199J 00'000T 'uozloaS paps Jo V/TgN aqq 90 auTT gsug DIP SuoTV 'guOT,EToTOS 90uagq !9 uozgOaS 90 aauaOD aM aql Te 15 . : sMoTTol se paqTaosap aagpang !uzsuooszM 'AqunoD xzoaD *IS 'gasaamOS 90 UmOl 'M6TH 'NO U '9 uozaOaS :10 V /THN auM :10 T, /-EHN aqq To gapd uT paquOOT pupT ;fo Taoapd V I y i C ~ I STC - 105 i SEPTIC TANK MAINTENANCE AGRf, E;MENT St. Croix County OWNER/BUYER Y*' /RYI) MARANG ADDRESS I a~ IVa 4s~ ~&& PROPERTY ADDRESSES / - y (location of septic system) Please obtain from the Planning Dent. - 1 CITY/STATE s0 m SQ,~ PROPERTY LOCATION IVE 1/4, AJC 1/4, Sectio~tr TOWN OF 50✓!~ X524_ST. CROIX COUNTY, W1 i SUBDIVISION e ~h1 ~/o'r• /!J~ LOT NUMBER CERTIFIED SURVEY MAPS. 17 I , VOLUME PAGE x%7, LOT NUMBER I 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. Mlle property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I ) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and t pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. [/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration dale j SIGNED: i 1 DAT _ 5A G St. Croix County Zoning Ofhce Govcnuncnt (-.enter 1101 Carmu.hael Road Hudson, W1 S'1010 11/93 s l i ~r C - 10 0 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted- to this office with the appropriate deed recording. -------------------------------)--------------,-----1------JJ- Owner of property /na ere A I tG~ cr o G la t pu T WP Tiryt 4 (Z l,4n Location of property lVC 1/41/4, Section o N-R 0 W Township Snv►~ e✓ .SZ~ Mailing address %~GaS 1t/"d S~ sy,` ~~i,✓a ~e✓ /M A/ SSU Address of site Subdivision name CSn~ ~6~✓~^ `77 Lot no. 1 Other homes on property? Yes ✓ No Previous owner of property Total size of property Total size of parcel Date parcel was created 7 Are all corners and lot lines identifiable? tel""_Yes No Is this property being developed for (spec house)? V Yes No Volume 1~4, and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE . NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as-to-avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. -:7,34W , and that I (we) presently own the proposed site for the sewage disposal system or` I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Sig ature-of Applicant 4-A cant Date of Signature Date of gignature - M . ..Y '::Y i i•l 1';•...11".i 532789 St.. Bar of Wisconsin Form 3 - 1982 QUIT CLAIM DEED DOCUMENT NO. Vol.1136PAG!_-324 _ I :bi: tUl i-1V1rL~.. i Margene V Mayer, a single person AUG 2 1' 1995 quit-claims to yer-Westmoreland and 12:00 P. .1 Mar gene A Ma s t ! a ,i Paul Westmoreland wife and.husband "'-gym ~...LYr THIS SPACE RESERVED FOR RECORDING DATA the following described real estate in St. Croix County, State of Wisconsin: NAME AND RETURN ADDRESS Heritage Title (Parcel Identification Number) Part of the NE 1/4 of the NE 1/4, Section 6, Township 30 North, Range 19 West, described as follows: Lot 1 of Certified Survey Map filed July 26, 1995 in Volume 10 of Certified Survey Maps, Page 2967 as Doc. No. 531741. This is not homestead property. (is) (is not) ~(o day of --August__----- 199.x. Dated this (SEAL) nontL (SEAL) * Marge e V. Mayer (SEAL) (SEAL) s AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) - SS. _2t_GrQiX County. l C/~ na,any came before me this ` day of