HomeMy WebLinkAbout032-1066-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 556334 0
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:
Germain, Louis & Lorraine Somerset, Town of 032-1066-90-000
CST BM Elev: Insp. BM Elev: SM Description: , Section/Town/Range/Map No:
/oo'd D - i~J01, -Y14W S/' 24.31.19.329F
TANK INFORMATION EL VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 'woo Benchmark 2 - / 2
Dosing Alt. BM
roAeration ~7
Bldg. ew r
Holding Ht Inlet
7,7
TANK SETBACK INFORMATION t O
501
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
041, ~ t cheer
Septic 1Y 14 Dt Bottom /
~l
Dosing ~J eade Man. i
Aeration Dist. Pipe "s,
✓j'
T, `t'om"
Holding Bot. System
•ti &1 1;1 DDS ~_ais `~2 y
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand t Cove
GPM 10O.Z
Model Number
TDH Lift Friction Loss TFH Ft
Forcemain Length a. Dist. to Well
SOIL ABSORPTION SYSTEM G C
BED/TRENCH Width t Length No. Of Trenche&Z__. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/ WELL LAKE/STREAM ACHI G Man r ,
INFORMATION Type Qj System: r HAMBER OR ✓
~ )I o \ (0i / 1> i o UNIT Model Number:
DISTRIBUTION SYSTEM o Val I
Z > go waf,
S l
Header/Manifold 3~ a Piserisution I r x Hole Size x Ho Spacing Vent o Air Intake
r
Length A) DiasD j Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ( Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center /L,16 J5 Bed/Trench Edges Topsoil
Yes No ~ Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:4_0/ % I / I Inspection
Location: 2021 State Hwy. 35 SOMERSET, WI 54025 (SW 1/4 SW 1/4 24 T31N R1 9W) metes & bounds Lot Parcel No: 24.31.19.329F
1.) Alt BM Description = f P X572 j~77 allC 63 15-
2.) Bldg sewer length
- amount of cover
0 L4
17Lm O~tSf-~~~ .
Plan revision Required? Yes No
Use other side for additional information. L22-~-
Date - _ _ ` l'/ J
SBD-6710 (R.3/97) Insepctors Sign lure Cert. No.
PLOT PLAN
PROJECT Louis Germain ADDRESS 2021 Hiahwav 35 Somerset Wi 54025
SW 1/4 SW 1/4S 24 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/11/12 BEDROOM 2
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 620 # of chambers 30
BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 92.192.0 7' below qrade
of tank, piping shall be Schedule 40. Well is to meet all
Scale is 1" = 40' setbacks required by
unless otherwise WDNR
noted NC
30' Well,/ 60' V"
~j Existing ;4~
Pro 2 30' house to Bedroom be torn G
Scale is 1" = 40' House down
unless otherwise
noted -
2s' p V
Vent IX
100'
>6" Quick4 Standard
of Cover Leaching Chamber ,
with 20.0 ft2 of Area 60 50'
12„ 10.2ft^2/pair of end caps S Shed
4' Long
Grade at System Elevati
34 B.M.*
25' 3 80'
10' ~O0' cm's
Hwy 35
70' B-3~~6v!ti- Ili S'x
1 5-e~ ~l
2-3 x 62 cells with 3 spacing 1% Slope Property Line
Q B-2 vents j
commerce.wi.gov Safety and Buildings D' a, County
201 W. Washington Ave., P O 0
il~^1;° r
Madison, WI 5370'JT7162 sanitary Permit Number (lo be fi led in by CO_)
Qel3artmeM of Commrerc A IN
/
! .r.
Sanitary „Permit Applieatioij v, / State Transaction umber
in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropri$t6`glrY,Qrumental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWYS = Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. ® 2DZ)
I. Application Information - Please Print All Information
Property Owner's Name Parcel #
40 Ge 0 Vo 6
Property Owner's Mailing Address Property Location f' ,3ZJ
2_47 2 / G vt. L
City, State J► Y Code Phone Number Section -
Ss C l u ~ f 1 1 le on
II. Type of Building (check all that app p~G Lot #
Subdivision Name
~dl or 2 Family Dwelling- Number of Bedr ms
II Block # d
❑ Public/Commercial - Describe Use l4L~Q.t
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of 1 i!~LJoek Town of _c% a
Z p:a~ L.~
III. Type of Permit: (Check on one box on line A. Complete line B if applicable)
A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
g Lis r oys P rm um er jar Issued
B. El Permit Renewal El Permit Revision El Chana of Plumber ❑ Permit Transfer to New
Before Expiration Owner f i• i ~4
IV. T e of POWTS S stem/Com onent/Device: Check all that apply) S+WA.UeLQaU
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) El Pretreatment Device (expla'
V. Dis ersal/Treat ent Area Information: Y3 4
Design Flow (gpd) Design Soil Application (gpdsf) Dispersal Area Required (sf) Dispersal Area Propose SY~ to E vat'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units U
New Tanks Existing Tanks °o -2
Y
/J ems. ~i u U v~ n r/) fz C7 GL
Septic or Holding Tank l~7 v~
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ass esponsibility for installation of the POWTS shown on the attached plans.
Plumber*s (Print) Plumb i_ gnature MP/MPRS Number Business Phone Number
ZZ 7i~ -
zct~,,
Plumber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Only
Permit Fee Date Is ed Issuin ent Sign re
p,roved /~7 a6 1 / Z
O even Reason r Denial $ `7 L'
IX. Condi"V0bK_ ,Reasons for Disapproval 3) Ot 44 ~K.
1.eptiC tank, effluent fiker and t ~v7 1 /
dispersal cell must all be se AS$ fm01011A ed Lp
as per management plan provided by plug.
2. Alt.isau+ack requ)rements.mtlst be,maintainild
as , , ble CO& /
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (R 02/09)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 9/11/12
Owner: Louis Germain
Location: SW1A SW1A S24 T31 N,R19W 2021 Highway 35 Somerset
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License numbe # 26900
PLOT PLAN
PROJECT Louis Germain ADDRESS 2021 Hiahwav 35 Somerset Wi 54025
SW 1/4 SW 1/4S 24 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/11/12 BEDROOM 2
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 620 # of chambers 30
BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 92.192.0 7' below qrade
of tank, piping shall be Schedule 40. Well is to meet all
Scale is 1" = 40' setbacks required by
unless otherwise WDNR
noted
30' Well 60'
Existing
Pro 2 30' house to
Bedroom be torn
Scale is I" = 40' House down
unless otherwise
noted
25
Vent 50'
100'
~6„ Quick4 Standard
Leaching Chamber ,
of Cover with 20.0 ft2 of Area 60 50'
12 10.2ft^2/pair of end caps S Shed
4' Long
Grade at System Elevati
34" B.M.*
5' 30 80'
10, 25'
0'
Hwy 35
70' B-3
2-3' x 62' cells with 3' spacing 1% Slope Property Line
B-2 vents
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft 2 pair of end plates
Finish grade elevation
Typical Installation 99.0'
Vent ~ Grade Vent
Ail 3'
Septic Tank
5' S' Long 1
3619 Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 62' Cells
Same on other end Observation tubeNent
At end of cell
A
B
15 chambers per cell
System elevations:
A__92.1
B 92.0'
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
•
OWNERSHIP CERTIFICATION FORM
Z
Owner/Buyer
n '
Mailing Address_ 3
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State
Parcel Identification Number
LEGAL DESCRIPTION
Property Location _ ! Sec. '2//, T_,?/NR.
W, Town o.f
Subdivision -
Lot #
Certified Survey Map #
VolumePage #
Warranty Deed #
Volume Page #
Spec house y no Lot lines identifiabl
yes 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 li-tensed 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 furl of sludge.
[/we, the undersigned have read the above requirements and agree to maintain the private ;{ewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned tc the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on thi orm 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 Warr my deed recorded in Register of Deeds Office.
umber of bedrooms
SIGNATURE OF y iA
APPLICANT(S ) ***Any information that is misrepresented may result in the sanitary permit being revoked by the PI.4nning & 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. 08/05)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION _ SYSTEM SPECIFICATIONS
Owner
koui..n 6e c Septic Tank Capacity 600 al ❑ NA
Permit # Septic Tank Manufacturer 1KAq ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capacity al NA
Estimated flow (average) i 2pv gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) 00 gal/day Pump Manufacturer NA
Soil Application Rate al/da /ft2 Pump Model NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) :_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) !050 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (SODS) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L XNA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size in dia. ❑ NA Other: NA
Other: ❑ NA Other: NA
*Values typical for domestic wastewater and septic tank effluent. Other: NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
ear s
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
ear(s)
/
Clean effluent filter At least once every: month(s) / ❑ NA
year(s)
Inspect pump, pump controls & alarin At least once every: ❑ month(s) NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other: At least once every: ❑ month(s) NA
❑ year(s)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap; 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
replace ent 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. Replacemeni 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. Ban ing advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name S A
Name E Z
Phone Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Y Name
Phone -0'- / 1 Phone _r- _Z5
1 :2 j',SL 2) Q
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
I
3
F"ILTER CARTRIDGE INSTRUCTIONS
Installation
STEP I Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either Insert
more
pipe into
the
tank through the outlet or solvent weld
(!rlua additio
p{pe, 1 additional pipe onto the outlet
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3A-inch pipe needed to brace the filter to the tank end wall If utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
'y' FPI 'For installations Utifting the optional supplemental side support:
solvent weld the y.-inch pipe onto the filter case. If side support method is hot r
utilized, proceed to step four;
Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
If a VAS switch is utilized: insert into the filter and luck by g
clockwise 90" turning
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and filter, "
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firms
y pull up on the filter handle to dislodge the
cartridge from the case. :,~}P ; f
S. Slide the cartridge up and out of the case for cleaning,
b. If a VAS switch connected to an alarm is present, the switch
should he removed by turning counterclockwise 901 and cleaned
with water only, ;
7. While holding the cartridge nn its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water `i:• r;;
only, making sure all septage material Is rinsed back into the tank.
6. If VRS switch is utilized, replace by inserting '
turning clockwise so into filter and
,r °rXr
9. Insert the filter cartridge back into the case, pressing down until'
the filter locks into the bottom of the case.
lo. Replace and secure the access opening on the tank.
it :nb.- ;•aac`~.J'~~:~c rlu~r:, ..,...I.rai';.l'~ :x;.t,cr•:.~~.
www.bearouMte.com 877-MLikILTERS (653-4583)
12
No. 8454 Land contrneb--lmwanee Clanaa (STAYS OD WISCONSIIi) rabn t+w WrAsn eist:e13mk & StAdOU v CO.
Sae. 855.18. FVL, statutes) Vora N
DDK 10 PARE
Sbiz- Axtirle of 0 areement
]Made and concluded this 29 day of May , A. D., 1971 ,
byandbetween Cecilia Germain, Widow -
part y of the first part,
and Louis Germain and Lorraine Germain, husband and wife
part l e s _ of the second part.
Mttl 900ftb: First, That the said part i e s of the second part hereby agree - and bind -tli ems el s
-their legal representatives, to pay or cause to be paid, ro the said part y- of the first part,. -her
heirs or assigns, the sum of Fifteen thousand and no/100 - - - - - - r - - Dollars,
in the manner following: Aline hundred eigh'L- and no/100 - - - - - - Dollars,
at the ensealing and delivery hereof. balance payable x..+''133 .00 per m•onthf -wI tiilout
interest. It ±.%further understood and agreed that parties of second
part. -drill continue to pay $133.06 a-nd interest until such time as t}!e
Mobile Home purchased by the j)ar-ty of first part Lind financed by Bank
of Menomonia has -boon paid in full, £aae than the payments wha.ll be-
-made directly to party of first part.
The said payments to be made to the part y of the first part,'st` S Omer .6t, - ATi s .
and the same being intended to apply, when-fully completed as the purchase-money for the following tract,
piece or parcel of land, situated in the County of Std. Croix and State of Wisconsin, to-wit:
S of Sla and SW'-4 of SE,,-' of-Section 24, l!ownexip 31 Range 19 =CEPTI1LG
that part of SST;- of SL-+`a lying North and Brat of a lake on said 40 acre
kno4Tn pa Turtle Lake, also E;:.CMP*T'IXG Commas:cing at the titl corner of --aid
SIT of Silk. Section. 24, €hance-North 36 rods; ti once East 20 reds-; .thence
South 36 rods; thence Hest 20 rods on South line of said S`14'V' SV-s of said-
Section 24 to t`ce mtart -ing ,foinf,, and also z`~•CL+P`CING a parcel of land
described - s -Po-Mows: beginnina at 9. point which is 36 rods North of
Southwest corner of Stl'~, Section. 24, Township 31 North Range 19 thence North
6 rods; t73c3n.co-Y;a.st 20 -rods-;. thonce South 6- rods; thence West 20 rods -to
vlac_e of beginni•oq and EX EPTING a_ parcel of land desc=Ib- ed. as: Beginning
liaginnin;; at a, point vt-leh is- 33& feet q of NW corner of S1 of 8~7¢ of
Section 24, Tot.nsl-ilp 31 N Ftrange 19 St. Croi-x coLui-ty, th. E- 168 feet;
th. S 92 feet; th. W 168 feet; th. 2u 92 .feet to point of- beginning.
~I
i
- I
The said parties of the second part further agree that they will pay when due and pay-
able, all taxes and msesssments which have been assessed or levied on the above described premises since If
I( the 1st day of , .-U3YZ y, A. D., 1971 , and also all such as may be hereafter assessed or levied thereon or J~
upon the interest of said party of the first part in said premises, and also all taxes and assessments
now or hereafter assessed or levied against any mortgage which may exist against said premises or
against the note or the indebtedness secured by such mortgage or against the interest in said premises ~u
of any party holding a mortgage against said premises during the term of this contract and promise
and agree that the interest of the part y of the first part and the interest of the part I e s of the
second part in said real estate and the interest of any party holding a mortgage against said real estate (Ij
during the terra of this contract shall be assessed for taxation and taxed together without separate
! valuation as unencumbered real estate and shall be paid by the said part i e s of the second part and the
said part of the second part hereby waive all rights of offsets or deductions because of the payment ifr
of any such taxes and assessments, until the aforesaid purchase money shall be fully paid, in the manner
above stated.
i The part i e s of the second part further agree that the said part y of the first part shall
3 insure and beep insured against loss or damage the building now on said premises and such as may
hereafter be erected thereon during the life of this contract in the sum of at least
Full Insurable veluc Dollars,
3I against loss or damage by fire aid extOllded. coverage
in the name of the part y
of the first part as owner in fee, with clause in said policy that the said part ies of the second part
ha v'e a land contract interest therein and the loss, if any, under such insurance shall be payable to the
said part y of the first part to the extent of !.er interest and the surplus, if any, to the
said part i e- s of the second part, subject, however, to the rights of mortgagees, if any, respecting such
insurance; such policy or policies to be held by the said part y of the first part,
heirs, legal representatives or assigns, as collateral to this contract; and the said part i.es of the second
part shall pay the premium on such policy or policies when due, and in case of the failure or neglect of
the said part ies of the second part to pay, such premiums when due, said part y of the first part,
her heirs, legal representatives or assigns may pay the same and charge the cost thereof
with interest thereon at the legal rate, to the said part ies of the second part, and the some 'shall be
considered and taken to be an additional part of the consideration of this contract.
The part ies of the second part further agree to hold the said premises from the date hereof, as
the tenant by sufferance of the said part y of the first part, subject to be removed as
BOOK 473 PAz0263.
tenant holding over, by process under the statute in such case made and provided, whenever
default shall be made in the payment of any of the installments of purchase money, interest, taxes,
assessments or insurance premiums as above specified; and also to beep the building , fences and
improvements on said premises in as good repair and condition as they now are, except ordinary wear and
decay, and not to do any act whatsoever which tends to depreciate the value of said ,premises.
. Second, That the said part y of the first part, hereby agree and bind her heirs, executors
and administrators, that in case the aforesaid sum of Flf teon thoLtsaiul and no/100 Dollars,
with the interest and other moneys shall be fully paid and all the conditions herein provided shall be
fully performed at the times and in the manner above specified, she will on demand thereafter
cause to be executed and delivered to the said part i e s of the second part, or their heirs
or legal representatives, a good and sufficient Warranty Deed, in fee simple, of the premises above described,
free and clear of all legal liens and incumbrances except the taxes and assessments herein agreed to be
paid by the part ire s of the second part, and except any liens or encumbrances _ created by the not 'or
default of the part if-sof the second part, -bbemse3ves, vh.elr heirs, legal representatives
or assigns
Third, It is distinctly agreed and understood by and between the parties hereto, that if the said
part ies of the second part shall fail to make any of the payments of purchase money and interest
above specified, at the times and in the manner above specified, or fail to pay the taxes and assessments,
or fail to insure and keep insured the premises herein as above stipulated, or fail to pay any or all
insurance premiums herein specified or violate any other terms or conditions herein contained, this agree-
ment shall at the option of the said party of the first part be henceforth utterly void without any
notice whatsoever, and all payments thereon forfeited, subject to be revived and renewed only by the act
of the part Y of the first part, of the mutual agreement of both parties; and whenever such default or
violation shall occur, the parties of the second part shall have no further right to collect rents from
tenants, if any, of the said real estate, or any part thereof, but such rents shall be collected by, and belong
to, the part y of the first part.
The said part i es of the second part further promise and agree that in case of the commencement
of an action to foreclose this contract apd also in case of the foreclosure thereof, they
will pay in addition to the taxable costs and expenses incurred a reasonable sum of money as attorney's fees.
In W#tne0o IlUtiereat, the said parties have hereunto set their hands and seals this 29 day
of W.Lay 19 71.
Signed an eale in PresC a of (Seal)
i Cecilia Gerrle.xn
____(Seal)
Louis ' Gerr._a.in
(Seal)
(Seal)
L +~ent- Janr>son
Mate of Mocanotn, sa.
St. Croix County.
Personally came before me, this c9 day of A. D., I9 71
the above named Cecilia. Gerieala,, Louis Gor:isin a.=_d t,orraine
G .C.;4 husb2 L a,--id -v:Li e
k~y►A;tpA- be the persons who executed the foregoing instr, me Itd t0knowle ed the same.
~n~~~L~G' Notar};Public, St. Croix County, Win.
%
My Commission expires Perr:anel: D., 29
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RECEIVED
Wisconsin Department of Commerce SOIL EVALUATION Rf'EP~I_ Page of
Division of Safety and Buildings n,
k,I Ir 2- QnZWkiance with Comm 85, wis. Adm. Code
County i
Attach complete site plan on paper not~atre '~x 11 inches in size. Plan must - {
include, but not limited to:i:Ae titVicF4l ~tt'aN ce point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 32-- /4 (p ~d ,
Please print all information. eview y Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 D k
Property Owner Property Location
P/ ~VL o f Govt. LoJ 1 /4 50 /4 S2 T~ N R E (o W I I j
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Code Phone Number ❑ City ❑ Village `Town Nearest oad
~ r s~i~~ > rte- 3~
❑ New Construction Use: Residential / Number of bedrooms
AsZ- Code derived design flow rate [ GPD
Replacement ❑ Public or commercial -Describe:
Parent material ~?ZLc~ J Flood Plain elevation if ppiicable N ft.
General comments So At t ~t a/r O 11J~
and recorrrnrendations:
System Type tit~ / System Elevation 70`1 X
Boring
FP 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/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
2- .0
®-6o 10,
`2
r
t,
® Boring # ❑ Boring C
E9 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / 'Eff#1 'Eff#2
o -q 0 , le- 3 ,
7 Z,
• Effluent #1 = BOD > 30 < 220 mg1L and TSS >30:5 150 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
er
CST 1Vwrte (Please Prim) Si r Number
Bird Plumbing, Inc. Shaun Bird CST ST Numb
226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5401 O` 715-246-4516
~T
t
Property Owner _ Parcel ID # Page of
Ong # Boring
Pit Ground surface elev. CJ ft. Depth to limiting factor >Z1 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
S -C,
72
Boring # ❑ Boring
F ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
I
i
I
Boring # ~ Boring
Ground surface elev. ft. Depth to limiting factor in.
F-1 Pit
❑
Soil Application Rate
Horizon ')epth 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 = BOD, > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD, < 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.
SB68330 (RAM)
Property Owner Parcel ID # Page of
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor ~ ---7- 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
0 1.,
72
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
I
❑ Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
El Srn1 ication Rate
Horizon ')epth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
H
Effluent #1 = BOD6 > 30 1220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS 130 mglL and TSS 130 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.
SBD4330 (PUMO)
Soil Test Plot Plan
Project Name Louis Germain Shaun d
Address 2021 Highway 35
Somerset Wi 54025 #226900
Lot Subdivision Date /28/12
S W 1/4 S W 1/4S 24 T 31 N/R19 W Township Somerset
F1 Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Bottom of shed siding
System Elevation 92.1/92.0 7' below * H R pSame as Benchmark
Scale is 1" = 40'
unless otherwise
noted
30' Well 60'
Existing
Pro 2 30' house to
Bedroom be torn
House down
i
I
25'
100'
60' 50'
Shed
B.M.*
25' 30' 80'
10'
0'
Hwy 35
70' B-3
1% Slope Property Line
B-2
MAR asis Bepmrtaeat of mouth aad social Services
rib* #61 3170 ~ Oirisiom of laalth
`SEPTIC TANK PERMIT APPLICATION
L ~ TYPE or WE BLACK In xr
A. ow OF PROPERTY L A y
Jim" ~.v^r 41'::~t, Address (street. "U. Zip code)
Be A ION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED' AIXER0 OR EXTOW COUNTY
Check Ones
EITT TILLAGE LIMAL DESCRIPTION
TOWNS a % f! Gf/ . , _ c~ ^ . 1.`v...
C.. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES No n PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION j(_ IMPLACEMENT ADDITION
MATERIAiSs Prethb Conorets ^ Poured in Plao,? Steel other
NUMBER OF TANKS TO Bt DISTILLMs _ s-~.
r
. .
....wfw.Vr . a. o,.. , w- :.N w. .ra"i~"+ .:?.y.Y.'.r+Ja•rv,,.
TYPE OF OC
CUPANCY Book Ones Ono or Family orCosseroiwi Issirtrial OClwr
Number of Persons to be Accommodated } Number of Bedrooms
F. APPLIANCES, ETCs Food Waste Grinder YES ANO Automat3s Clothes Washer YES NO
Dishwasher YES NO Automatle, Potato Peeler YES= No
,N 7. ; Other (Specify)
G. MASTER PLUMBER MAKING INSTALLATION
Names ~'71~'_A Address ` /r Sr - ~r►~r Zl/TLisense Numb ere
Signature of Applicants MP RN
Addreass ) c-
H. (To be Completed by Issuing Agent)
Date of Application /-a Fee Paid
Permit Issued (date) - - / Permit Number
Agent (Naas) Fort , Town Village, City, 'CouiYty, etc. .
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered and the
tee paid. Agents will forward application, the fee of $1.00 for each septio ta=ut and the third copy
of the permit (canary) to the Division of Health. Checks and money orbs should be mnde payablo to
the Division of Heaath.
I
Do not write in spaoe below - FOR DUARZKNT USE ONLY
I. DATE RECEIVED ACCEPTED 'BY RETURNED
FEE RECEIVED VALID. No. PIRMITMO. Se Carr s.
)
es or-TOT-
REVIEWED BY APPROVID DATE
(Initials) yes or No
r
_ i
iIPTIC lANr PIRMR NO.
_ ~ s ter' s}'
RsPORT ON 501L PS100LAIION Ti ST
'3t is a c { e
AND SOIL BORINGS
y v wti, - r F.` 1 r tit
a e
ss DI TISICK OF HEALTH • PUMING S201140
P O.Boz Madison Wls. 53701 4 PurcuRnt to 2 62.20, xis. Adsdaistratin Code
PiRCOLATION TIST?...:..:
~„in hater Level Coshes es
Test Depth Chsraotor of Soil Hours Water E3O
Umber Iasbes Thlskness in Inches Sinoe Hole Insole Second to Next to Last a 1x11
is Wetted Orerssi Minutes List Period Last Period cried Cher ah
1TxampIs
! • 0 36" To Soil 10" C 26" 25 Yes or No 1 1/2 Ift 60
w
^ 3 10
RSOOBII DATA PR HIND 424 ~ OF 3 TEST ilOh.I3
1 Compute size of absorption area in acoord with H62.20 Wis. Administrative Code.
S 01 16 B 0 R I N G S• Minimms 36» Below Pro sed Ab lon stM
Boring Total Depth Devth to Ground Hater De th to Bedrook
Umber Inches Observed Istimsted Observed Estimated Character of Soil with Thlelnsess In h"
9le 72M 72" Black To Sell 12» C 18a Sand 180Gravel 24
JMM BATA Flesh MIN2M Or 3 BOOM HOLiI~
OF OCCUPANCYs -Number of Persons
RESIDINCEs Number of Bedrooms OTMI (Speoiry)
POOD WASTE GRINDRRs Yes No Xw Dishmshers Toe_ No Automatic Clothes Washers Yes, No
YMENT DISPOSAL SYSTZMs NEW IXTENS-IM, ADDITION' Rhlrrsnuff
' Tile Size NO.Lin.Feet Trench Width Depth Number of Lines
i Seepage Bed: Length Width Depth T~ Tile Size so. Lines
i Seepage Pits Inside Diameter _ Liquid Dspw`_
I, the undersigned, hereby certify that the persolation tests reported on this berm were aade by as or under my super-
vision in aooord with the prooedures and method speolfied in Chapter H 62.20 (13), Wisoonsin Administrative Code, and
that the data reoorded and looatton of test holes are oorreat to the best of vW knowledge and belief.
NAM TITIS
e or Print
REGISTRATION N0* or MASTER PLUMBER LIMSI NO. A P k1 a
ADDRESS ' W / C.s.✓ L
DATE SIGNATURE