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HomeMy WebLinkAbout008-1091-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INF•JRMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). ermit Holder's Name: City Village X Township Merth, James Eau Galle, Town of ST BM Elev: Insp. BM Elev: BM Description: ld b k~m t ' i TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' t, Z ~,}- W t-'r' SZ.'~ . .9~• ~ Z Dosing ~wew" Gam. ~ ~ V ~i .J Holding _ _ _ y ___. TANK SETBACK INFORMATION TANK TO P/L WELL i BLDG. Vent to Air Intake ROAD Septic / ~ ' ~ ~ ~ ' ~ ~ / ._,.` Dosing Aeration Holding P U M PIS I P H O N1Nf~6R1btAT I O N Manufacturer ------- ~_.~ Demand GPM Model Nu er TDH ift Friction Loss System l- TD Ft Forcemain Leng ia. Dist. to WeII S(')II dRSnRPTI(~N SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 463397 0 State Plan ID No: Parcel Tax No: 008-1091-40-000 Section/Town/Range/Map No: 32.28.16.483 STATION BS HI FS ELEV. Benchmark ~ ~ ~ is ~.~ ~~ t. BM ~i~ R5+`~•bZ. Bldg. Sewer ~ + ~ aC / St/Htlnlet G.Z~ '9S ~ ~~ SUHt Outlet / ~~ VG C "~~ j Z Dt Inlet ~ '` Dt Bottom ~ .. i Header/Man. . I 9„~ . ~v ~. Dist. Pipe ~ , e> •~5 eT3, Z Bot. System ~~ a Final G ~ de r. G St Cover ~ ~ .~- ~I `Z •Z; `1Z.•$ iZ 9" Z_ 3 1 Q g BED/TRENCH DIMENSIONS Width i /~ Length f3 /~ ~ ~'v No. Of Trenches ~ ~ L ~~ ~W PIT DIMENSIONS ~ No. Of Pits ~-• Inside Dia. ° ~ Liquid Depth ~~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: /~ ~/V"i ~ a Type Of System: /~ ~~ CJQ~ Q~~ ~ 1 t ~ 7 ~0 J ~/~~ ~~,1. J r7 UNIT Model Number: v,~ I'11STRIRIITInN SYSTEM ~5 0.. , ~ _ ~S la~~, Header/Manifold ~~ ~ ~ / Length~_ Dia `j Distribution Pipe(s) ~~ ~ ~ Length Dia Spacing x Hole Size ~w ~ x Hole Spacing \ V~t7to it Intak~^ / e` y ~~ l~ 1~.~• Cf111 C[1VFR ., ore«~..e c.,~•e.,,~ nni.~ ,,,. Mnnnrl nr Jlt_Aradp Svwtems ~nlv Depth Over ~ Depth Over - xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~' <~ Bed/Trench Edges \ Topsoil ~ ., Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 19 220th Street Woodville, LWI 54028 (SW 1/4 SW 1/4 32 T28N R16W) 40 acres Lot 1.) Alt BM Description = ~54~+= /'~ ~~~ ~ ~~.,ac.; ~S ~ l~ ~ ~' 2.) Bldg sewer length = 57 '' -amount of cover = i J/ /I l3+- Zk.. = 7 y~L ~~ ~ lg Plan revision Required? ; Yes No ( ,Z Use other side for additional information. , ____ _ ___ ~~ -- Date SBD-6710 {R.3/97) Inspection #2: / / Parcel No: 32.28.16.483 ~~3~ ?S Cert. No. Safety and Buildings Division County ~ ~ W. Washington "~2 L t di ~ be fill Co J t d i b P i N i ~~~~ ~~~O sc um r ( o e n y erm t tary San t Department of Commerce `J `•/ 8) 2 3151 l'033 Sanitary Pernut App~c pR 1 .Number tare Plan I.D A In accord with Comm 83.21, Wis. Adm. Code, persotral info 'on you prov~~eX Cp~NTY i " T t NG OFFICE may be used for secondary purposes Privacy Law, s15 1)f$-~.ON oject Address (if different than mailing address) 1 I. Application Information -Please Print All Information ~~ - LG3~',d ti.~L Property Owner's Na me O Parcel # 'l,ot # Bock # Prope Owner's M ailing Address Property Location ~a SO 'k Sec6on 3Z ~ ~~ ['~ City, State Zip Code Phone Number , ' - G S' p0 2 (circle one) E ot~ ~~ N Rf~ T II. Type of Btti ding (check all that apply) _ - ; . ~~ Cc,S ~ ~n.oJS~- P ~ ~ 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ~ ^City_^Village ~'ownship of ,Es,ta ~~LtT III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Ig'New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Ty of POWTS S stem: (Check all that a 1 ) l~'NOn -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constmcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Fitter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe II __ ^ Other (explain) 3.fp~ vp~t~..) 1.~4 V. Dis rsal/Treatment Area Information: l.f.CL ~ ,3 .z - '' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersai Area Required (sf) Dispersal Area Propo sf) System Elevation G-/ ~/~ q~ ~'S 7 / ~ 70. ~ c -i ~/ 6 ~ - . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existing Tanks '' /m(J ~il~- !~ L S. Septic or ~etaiug Tank 2 O -- .Z 37J ~ _, Aerobic Treatmen[ Unit Dosing Chamber - VII. Responsibility Statement- I, the'iwtlersigaed, assume responsi for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnatur~ -9vlg/MPRS Number Business Phone Number _ Fogerty Plumbing ~~ i T/~ - .3S - 960 Plumbe~r~e~ ~t~~tt~~tate, Zip Code) 7/S-~3S = S =2 ~~ I~X Spooner, WI 54801. 6.i'i- o.~- od - VlII o se Onl - y70 7 L Approved ^ Dis rov Sanitary Permit Fee (includes Ground ter Date su Issuin gent Sig tur o S ) ^ Surcharge Fee) ~~/.~ ~ ~ °`t ~ /~ ~G J Owne easo r-Henial ~-C.J IX. Conditions of ApprovaUReasons for Disapproval SY TEM OWNER: S tic tank, a luent filter and . dispersal cell mus a I be serviced /maintained as per _ agement plan prow a __y plum er. 2. All setback requirements must be main alne licable code/ordinances. .~~ Attach complete plans (W Ute County only) for the system on paper not less than Sl/2 x 11 inches in size i~ ~ A # d 5 ~ ,c ~' ~ ~~ l~ i~ 1~ ~, ~r ~ ~~ ~ .~ ~ ~ 0 ~ ~' ~ b a ~i ~ ~ ~ ~ ~ ~ ~ `" ~ 1 ~ H y ~ ~ ~ y ~ ~ d 1u t ~ ~ ~` ®, ~ °_ ~1 ~ ~ ~~ ~ r ~ ~~ ~ ~ n ~\ ~ ~ ~ i ~, w ~ ~ ~ r ~ h ~ .~x h x o -. A o ~ ti' ~, d ~ h ~, b h~ ~ , h i ~, ~ r ~ °~ `~ r ~~ ,~ ~ _` ^I - ~ ~ N ~ ~~0c ~ h ~ _ ~ H d h / ~ ~~ o _ ~ _ 0 ~o ~ o ~ ~ _ . -~~- ~N o, 'y ~) '~ ~' ~ 3 0 # a ~ ~_~~,~ ~, a R o~ -°~ '`~I ~ ~O ° m w~ \ n ~ ~ - +i ,~~ ~~ we '" d 5 ~ ,c ,~ p. la ~~ 1~ ~ ~~ w ~ 0 a ~ ~ .~ ~ y r A N ~ ~ N ® ~i ~ ~~ M b o ~i ~ ti ~ l ~ ~ ~ - d ~ ~ s ~ ~ ~ ~ o n e ~ r ~ .,~, a r D ~ o ~_ n ~ n w n 1 ~ ~ ~ ~ o ~ ~+ ~ ' x N ~ ~ ~ / ~ . r ~ ~ h o ~, y ' ~h b~ ~" ~~ ~ ~` x Q ~ A ~ r ~ ~ r ~~~ ,\ -- ~~ - / r` ,~ O a 0 ~ b- r F \ ` h u ~ ~ `" ~~ ~1- ~ ~ ~ N ~0 ~ h ~ c ; ~ ~ d ~ ..~ N Q ~~ ~ ~ ~~ ~# h ~ "V w~X~9 `` ~ 3 ~ ~~~~ 0~ ~~~~ ~svr ~~~2TN ..,,, pitilrtbietK ~iv~~R Fogerty #221180 28288 McW' Ss4801. Spooner, LeT (715) 635'9609 Cross Section of an Inground Component Cell Using Leaching Chambers Observation/Vent Pipes Finished Grade = fy~v . ` , Slope % _ ~d / ~;! Original Grade = pYG ; Top of Shell = Qz. ~;'~ m - `-- yam.. System Elev. _ ~ ~ _~,, c i !~ ~~ n a .~ ,, •:~ u `.--_~Finished Grade =9y ~ ~~ . ~ .. ~ ~~/~). i ~j.~~ Original Grade = ~~G J Treatment and Dispersal Zone ~F---- __ Limiting Factor Observation/Ventpfpes to be constructed and capped with approved materials for the particular use. ~,~ _~ 0 ~' 0 n a p a CD a "~ C CD c~ w a ~' c~ ~_ n -~-+ ro t~ e fl o p `~ ~. 0 oa ~m '~ °~ ! ~., cu s f~ ., ' ~ • ~ ~ '~ ....: =.~ ~• • Li •• _ _. 1 i _ - ~~ ' __ ._._~._ -~ ~ ~,+ ;.~ • i ~:. .- -s d° . ~ ~- ~. ~ ~- ! i. - _--.-o. f _ : ,. _ _ ,~ _.- ,, . - . ;~~yi cn ~"~' . ~ _ r ~~ ..r C y 'd ~ ~ II , 0 C'~ Cs' -~"! ! ~ '~ ~_ 1O ~~ ~_ a. CD II c 0 'c3 c~ '; : ~~ II a n' a t a II V~ s c~ a a (D { t a *d e O rVr^+ V+ ^~ l• ~d •• ~~ ~ ry C'~ Q ~ N 1~-+ C~ ~ ~~ ~, o ~ t1. 0 ran N VO N ~ r o U17 ~~~ N W ~ ~ --"O cn_.~ ~~ a~m•°Q ao o ~ ~ r+ A ~ ~~, ,,,,, Wisconsin Department of Commerce SOIL EVALUATION REPORT - Division of Safety and Buildings ' in accordance with Attach complete site plan on paper not less than 1/2 x~i~~ inducts, but not limited to: vertical and horizontal ference pant (BM), direc6ort percent slope, sale w dimensions, north arrow, loptioprt andldietaop4~ne Please print all inf at~hR 1 11 LL~~ NTY Date 5 05 G E (or)b Parcel I.D. road. Rerv~ed by information you provide may be used for p, ,s.oa c cm)). - ~ Owner petty Location Govt. Lot sw 1/4 ~j 1/d ~ 3Z T ~ N R e Owner's Mailing Address Lot # Block # Subd. Name or CSf1A# ury State Zip Code Phone Number ^ ~;ty ^ Village ['rTown Nearest Road ` 062- ( ) ~ ~ s .z.o'~y .s T. [~ New Construct~rt Use: (Residential / Alumber of bedrooms ~_ Code derived design flow rate Lm0 GPO ^ Replacement ^ Public or canmerdal -Describe: Parent material ffr/Tt~D rtcr Lo~~~ /~ .8 Flood Plain elevation if applipble ft. General comments ~ ~ t' `~ and recommendations: cFtc ~~~ ; /rr®rcx~~ a~ ~fx[G F.rosu 6 -Y Page of ~~ 8ortng # ~ Bonng - - Pit Ground surface elev. Q7 .~ iL Depth to Grniting factor ~_ in. Sod AppNCatlott Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOlft2 in. Munsell Qu. Sz. Cont. Odor Gr. Sz. Sh. 'Eff#1 •Eff#2 Z z 7~ 3. - L s cs 3 z-Jy • s' - -- s c - -- - ~i ~t/ ~ i~ 3 r T 7- - d NDS ^ 2 Bones # ^ eonng .,- [~ Pit Grotmd surface elev. ~ tL Depth to limiting factor _ P~ in. Sal Apptica4on Rate Horizon Depth Dominant Color Redox Desaip6on Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Etf#2 • s- 3 --- L sv v `Effluen t #1 = 80D_ > 30 < ~p rrrmlL and TSS >30 < 15 0 molt. '~(fluent. ff2 = BOD. < 30 mglL artd TSS < 30 mglL-~ - . 5 Fogerty Plumbing & Perk T sting ~ Date Evaluagott Candttcted Telephone 28288 MctCen~ie Rrt G/is/D f~ CELLS L~+IiS- ~ii~~ Property Owner ~'~i*? /fir-KrL'f Parcel ID # ©~/~.~~-+~ Page ~ of .3 Boring # ~ Boring pit Ground surface elev. _~S ___ ft. Depth to limiting factor _ ~L in• Soil ication Rate l tion x Descri R d Texture Structure Consistence Boundary Roots GP D/fF Horizon Depth in. Dominant Co or Munsell p o e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ?s-~ "- L 2ncs z ffS Z -_ - L s .~ . 6 ' / 7 U Boring Boring # Ground surface elev. _~~ __ ft. Depth to limiting factor _ 7 - in. [~ pit Soil iratan Rate i i Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth in. Dominant Color Munsell on pt Redox Descr Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t -- L S ~lr ~ G - -- sL s ~ .~ - 6 - s s~ ~ . s ~ o b s .r rr7L >. o 6 3 -- 7- s- - 3 -- s ~ ~ . ~ Z- F s- s- ~ 7• - s mss ~G l iM , G. Boring 1fE 7 z'NG ~ uA~S ~ ta~cr.~t a~ Y - y c~t1'cvK/rrrvrcu , .~ ~ -,~-~...,~ ^ Boring # Ground surface elev. _ __ ft. Depth to limiting factor in. Pit Soil A 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 'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =6OD5 < 30 mg/L and TSS < 30 mg/L The Dcparuncnt of Commerce is an equal opportunity service provider and employer. If you need assistance to access servrccs or need material in an alternate format, please contact the department at 648366'-31$~l or'TT~ 608-264-8777. SDD-8730 (R.6Po0) +---•~ ,~ _~ '" ' ' ~ A ~ ~ # _. ,+ ` ~~ ~J ~ p U ~ ~I ~ b ~l y ~ ` i1 1~ 1 ~ ~ ti • ~ `~C `~C ~l ~ ~ ~ ~ O • it ~ ~ ~ ~ H d ~ 1 ~ d 0 ~ ~ p ~ '~ o n b i °, ~ r .~ 4 -o ~ o Lu n b x v w ~ ~ / ~ X h ~ ~ ~ <<3 •~ W I R ~ ,~ h ~~~f~ x `-~-~ b-moo m` ~ h ~ r N ~ \, 1 ~ V O N g q r o ~ ~ 2 \ 4 G1- n N ~~ lc ~ ~~ ~ N O~ ~ N a J ~ 1~+ a A ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT - - AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~irr n~ ~ Mailing Address ~~ ~s Y Xs~ '~~ sT .l~c~~~ ~~~ s yo+~ i _ Property Address (Verification required from Planning Deparhnent for new construction) City/State ~~~a EGG G,, (~~ Parcel Identification Number BBp -,~/-~ -_6G~ LEGAL DESCRIPTION ( l - Pro Location ~' w ' ' `~ ~83 J - perry /, S~,rJ /,, Sec. _ 3 2 • T 1 d N-R~V~, Town of .c~~.t ~a~1~ . Subdivision ~ -- -- -_ ~ ~~1 - ,Lot # --- _ CertiCed Survey Map # l- ,Volume ~ , Page # ---r = ~~+ "d # 2 Volume ~ ~ Page # - ~~ ~ r ~~ Spec house ~ yes Gino Lot lines identifiable Ct~'yes O no ' SYSTEM MAIIVTENANCE Imprapervsc and msinteaamxat'po~nr system coaldieserit isn its premadmG far'he~e to bandk wastes. Proper nrainttenance consists of prmapisg ad the septic tank every thtre years or sooaey if needed by s licensed ptuiaper What you put into the system can affect the fimctioa of the septic coot as a toealrneat stage in die waste disposal system. The property gamer agrtxs to solnnit to St Cronr Zoning >~u~mteat a man foan, sig~oed by the owner amd by a masterplnmber, joagaeynmmplamobey restricbedpiaimbero~c a ~oensedpomperv~fying that (1) the on-side vra~ratxxdi~osal system rs m prop~x apetatmg eon and/or-(Z) atler ~ p (~'y~ ~ tonic is kss than I/3 full of sledge. Uwe, the nadasigaod have nnid dfe above regnir~s and agree to the pmate seasge disposal system with the standards set Earth, herein, asset by the Deparmxot of Com®eioe a~ 1he Dep®utment of Idatocal Resaaarxs, State of Wisconsin. Certification stating that yarn septic system has taco d meat be oomplebcd and tuned m the St. Cram Camly Zoning Otlicx within 30 days of the three year ex~r~on dates ~ - SI NATURE OF APPLI DATE OWNER CERTIFICATION I (we) certiljr that all statements on this fomr an: true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of the property dAescnbed above, by virtue of a watraaty deed recoiled in Register of Deeds Office. ~ . SIGNATURE OF APPLICANT C- ~ DATE- _ *"**«* Any inforr~tion that is mis-represented may resnh in the sanitary permit being revo)Ced by the Zoning Depa=ent. *"`«*« ** Include with this application; a stamped warranrty deed fmm the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST CROIX COUNTY . SEPTiC TANK MAINTENANCE AGREEMENT ' __~ - AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 7 ryr,F,~ .Mailing Address ~l ~sy ~/.~??9 ~'~ T, , k- ~ ~~,,~ cw~io Property Address / ~ _2 2p ~-~ (Verbcation required from Planning Depar6nent for new City/State Parcel Identification Number ___ DG~- l~I ~ -~a-~ _ LEGAL DESCRIPTION - Property Location ~' cy %, lGrJ '/., Sec. 3 2 • T 1 ~ N-Rf~_V~, Town of .e-~nnLC ~ ~-~__. Subdivision --- _~_- -~ ~ Lot # _ CertiCed Survey Map # '~~ .Volume '-- .Page # e # ~ z 3 Z~' .Volume ~--~ .Page # Spec house ^ yes Cimino Lot Lines identifiable Cl~'yes ^ no SYSTEM MA>NTENANCE Iasgaaperaese-a~ndaf]rogrsepticsya~emeo~dirsa~~ ~spfst'[~eiulr~dtewr~s. Pioper~ntte~ce cis of prm~g out the saptie tatdc every dace pests a sonnet; if needed 6y a putgeer. What you put into the system. -- can attaxthe fimr~ of dee septic timir as a Uta~t stage is the vmste disposal spsteto. The popetty ovmer aapees ~ salt to St. t~onc Zug Depa a eeatift~oa faom, signed by the owner and by a ~'P~IP~resttictedpisouberaca>iicea9edpamperv_etifyi~that(!j Wean~ibewa~eovalerdisposal system is m protect opt oaaahtioa a~oc(1) aRer iiespoctioa sad f¢neoessary~ dee septic taal~ is kss-dean 1/3 full of stodge. Dare, the wed have toad file aEba*e tegnin~als std agree b the private aevrage disposal sysUettt with the standards set faith, herein. as set yr the DepawMreat a!'Co®aneitx sad the Depnmaeat of I~ntai Re~xs, State af' Wisootesm. G`e~tification stating that yoar septic system has 6exa wed tetast be co®pietod asid=etamod to tltie ~ Croix County Zug Oll-ioe within 30 days of the ihtet: Tar aepit~iata da1~ ~ ~ . - _ <~~ , / SIGNATURE OF APPLICANT ~ DATE IY~''P'~ OWNER CERTIFICATION I (we) certify that all statements on this force an; foie to the best of my our) knowledge. I (are) am (are) the oarnei(s) of the property descn'6ed above, by virtue of a wattauty deed recorded in Register of Deeds Office. -- / / SIGNATURE OF APPLICANT DAT7;- s*ssss Any infornoation that is ,nis-represented ma rCSillt in the sani *sssss y tary permit being revoked by the Zoning Dep~ ent. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the otrtifeed survey map if reference is made in the warranty deed _. .... ~~ rnrvruww. n,.. Owner Permit ~ - - DESIt3al PAftAMrrr~ Number of Bedrooms ^ NA Number of Public Facility Units : ~~ Estimated fbw (average) D aUd Design flow (Peak), (Estimated x 1.51 pD aY Soil Appl-cation Rate aUdaYlft~ Standard lnfluent/Effluent Quality MorKhly average` Fats. Oil & Grease {FOG) S30 mg/L Biochemical Oxygen Demand (~D5) ~O mg/L ^ NA _ Total Suspended Solids {TSS) <_150 mgll. Pretreated Effinent QuaCrty Monthly average Biochemical oxygen Demand tBOO~I ~ ~ Total Suspended Solids (TSS) ~ ~3fi- ^ NA -.Fecal Conform (geometric mean) g7p'` cfu/10Qmt Maximum Effluent Particle S¢e Ya m ~a• ^ NA ether; ^ NA , 'Values typical ~ dO Mrastewater eM seeps ~u~ enn~n. MAINTENANCE SCH®ULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cp(s) ~., ~ Clean effluent filter Inspect pump. PAP controls & alarm Flush- laterals and pressure test ~~ ~~ Septic Tanis Capacity - ~ ^ NA Septic Tank Manufacturer ^ ~ Effluent Faber Marwfactur+ef ^ NA Effluent f Model _ ~- 0 NA Pump Tank Capacity al Pump Tank Manufacturer Q NA Pump Manufac~uer ~`j ~NA Pump Model tJ NA Pretreatment Unit CI ~ ^ Satwd~Gravel ~~ ^ Peat Filter - ^ Mechanical Aeration ^ Wetland ^ D'rs«rfection ^ ~' _ Disperse CeBts) - ^ NA un-Gra~und 19~R'~-) ^ In-Ground (pressurized( ^ At-Grade ^ Mound_ ^ ~R-I-ine ^ Other: p~ ^ NA pt~ ^ NA Otl~: DNA At least once eYe<Y= lMaxinwm 3 years) [~ NA When combined skrdge and srsurr equate ate-thud Uri of tank vokane ^ NA ^ month(s) t g yam} ^ NA At (east once every: ~j ~ yeartSl ^ mortthtsl DNA At least once every: ~ ~ year(s) ^ month(s) ~ ~},NA At least once every= ^ year(s) ^ momtrls) [j NA At least once every: ^ year(s) ^ month(s) _ j~ NA At least once every. U years! Q;NA vu~~. MA}}yT9YANCE INSTRUCTIONS one of the folbwin9 licenses or certis: Inspections of tar-ks and dispersaA salts shall be-made by an individ~ POWTS Maintainer; Sepmge Setvt~ng Operator. Tank Master Plumber: Master Plumber Restricted Sewer, pOWTS Ins ~ broken hardware, iderrtifY ~,y cracks a leaks, inspections must include a visual inspecliori of the tank(s) to identify any ir>is~in9 ~ of effkient on the ground surface. measure the volume of corraf>uied sly and scum and to check for any back ~ Pow aid to check for ~Y pondin9 in to check the effluent levels in the observation p~ and requires the The d'~spersal cdlts) shall be visuaNy spected ~ effluent o~ tl-e gro~u-d ~~ may indicate a fa~ig ~ of effluent on the ground surface- Tt>e Ping immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank eq oals~ ath~~)ofrkmorace off ~Ce ~ °~ p ~~ 3e contents of the tank shall be removed by a Septage Servicing Operat Wisconsin Administrative Code. ~ c~pcece~, pretreatment All other services, including but not Canned to the servicing of effluent filters, mechanP01NTS Maintainer. units, and any servicing at intervals of <_72 months, sha{{ be perfom~ed 6y a certified A service report shall be provided to the local regulatory authority within~l O days of completion of any service event. , sittT UP AND OPBILA~ION mince of painting products or other chem~ats For new construction, prior to use of the POWTS check treatment tankisl for the pr that may impede the geatment process and/or tlartl~ge the dispersal celiis). H high concentrations are detected have the contents of the tankis) removed by a septage servicing operator prior to use. System start up shall not occur when soli conditions are-frozen at the infiltrative surface. Duri~ power outages Pump tanks may fGl above normal highwater levels. Why Power is restored the excess wastewater wiU be discharged to the dispersal cell(s) ir- one large dose. ovwloading the cell{s) and may resuR in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Se"~ng Operator prwr to restoring power to the effluent pump or contact a Plumber or POWTS Maittainer to assist :m manually operating tfie PAP controls to restore normal levels within the pump tank. - Do not drive or park vehicles over tanks and d'~spers~ ce11~• Do not drnre 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 folloviimg from the wastewater stream may improve the perform~ce ~d prolong the Gfe of the POWTS: antibiotics: baby wipes: cigarette butts: condoms: cotton swabs: degreasers; dental floss; diapers; disitfectants; fat; foundation drain isump pump) water; fruit and vegetable peeCmgs; gasoline; grease; herbicides; meat scraps; medications; oil; painting products: Pesticides: sanitary napkins: tampons; and water softener trite. - 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 shalt- be excavated and removed or their covers removed and the void space filled with - soil, gravel or another inert solid material. - CONTINGENCY PLAN tf the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide acode-compliant replacement system: _. ^ A suitable replacement area has been evauated and" may be utrTized for the location of a replacement soli absorption system. The replatsttttent area should be Protected from disturbance and compaction w+d ~Id not be infritged upon by required setbacks from existrmg and proposed structure. lot lines and wells. Fagot's to protect the r~lacernent area will result in the need for a rtevv sorT and site evaluation to estabish a suitable ~ ~" ~P}'t ~ 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 CONTAIN LETHAL GASSES AND/OR WSUEflC1ENT OXYGEN'-DO NOT %ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY C~CtIMSTANC~' DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ' - e - - #221180 - - - c emus - (715) 635-9fi_09 ~ POWTS INSTALLER POWTS MAgI1TAMER Name I ~'( t~ Nmne Phone ~7'/.S- ~3 O~ ~~ f - - 'S SEPTAGE SERVICWG OPERATOR (PUMPER) LOCAL f~Ct1' LATORY AUTHOiBT1~ - Name Name ~ 1 ~.~ f x C~.e,~,/~l~ phone Phone ~s ' p`~ ~ _. This document was drafted in compriance with chapter Comm 83.2212}lbldltldl&lfl and g3.5411}, (2) di 13}, Wi~onsin gdmirrstrative C~• ,, ra~o~ • ~Y~ 200 ~ ~.: fiE~. ~2~s ~ '7~ i ~~~~ 9~ f f STATE OP WISCONSIN, CIRCUIT COURT; ~ F2 -R COUNTY IN THE MATTER Of THE ESTATE Og It•'n ga_n_apn 1~,~ T an Hanac~n FINAL .IUDGMENT o.~....d i~.ew.~r. IN PROBATE File No. ~ ~~ ~ ~ PETITION for the final settlement of this estate having been heard, and the petitioner having appeared in person and by snd On all evidence, records and proceedings herein, the Court finds that: 1. The petition came on for hearing upon 1[0pmt) ' (waiver) as provided by law (tol ' (by) all persons entitled to notiq; 2. Native has been published for determination of the heirs of the decedent 3. The expenses of administration, funeral, last sicknesses, and the claims against the estate have been paid; the Closing Certifiwtt forFiduciaries of the Department of Revenue is on file and there is no unpaid income tax; and the CERTIFICATE DETERMINING INHERITANCE TAX of the Department of Revenue is on file. 4. The decedent died seized of the following reel property in joint tenancy with ` 1~aONE who survived decedent: 5~ The decedent at the time of death owned personal property in joint tsnanctraESet-fa b: in the inventory on file. NON.E_ f3. The decedent at the time of death had a life estate in the following property: NQIJE 'Strike as appropriate. Ne. 49A 119tf01 f~NAL JUDGMENT REGISTER'S OFFICE ST CROIX GO , Wt Recd for Recotd NOV X019$7 a S~~ M .u,4, C?' Reo+a.r of oe•de ..~~/ sJ36i.17 =r~`':~'i:a.i'.,~.crts: rs'<£:~_. 'at°~".".._.Ti'~k'fi'.~+::Fc~?;?i~.c+..4T,'?~!<i~`5.".'!".aft: g~,..,~~,. .~,~-'~sv.-x*:::~.~:g~~s.+.. <:;Y?~v:.i~s~' -- - ~-~ < = _ ,. , 7. Distributions ha r been heretofore made as follows: NONE ~ ' - •'~+~ .': 8. There remains property for distnoution as follows: SEE ATTACHED SUPPLEMENT A -Real Estate ~ B - Secured Interest in Real Property C -Personal Property A. Real Estate: 1. E~ of NEB and E~ of SEA of 6-27-16, excepting therefrom parcels of land described in instruments recorded with the Office of Register of Deeds, Pierce County, Wisconsin, in Book 67, page X97 n~A ~., n....t. c• ---- ^^ -• - 3. ~ 32 rods of E 25 rods of SEA of SEA of - - , ro CtAtt~liT Z, s• B. Secured Interest in Real Property - NONE. C.' Personal Property: SEE ATTACHED SUPPLEMENT TO FINAL JUDGMENT. NOW, THEREFORE, IT IS DETERMINED AND ADJUDGED THAT Tvan O Hannon a~~f~__I~/~.+ v~ ~ .. died --- testate on ? i R'i' and the following were the heirs of the decedent (Refer to Proof to Heirship: ~" :~ ~'.; " - ~`~ Harlan3 Hanson brother Lorne (Loren} Hanson brother ~ '~ .,< James D. Merth no relation ~, I Y I . _ I ~ ~ i ~~t s` ' ~. Ail atxounts of tM persortal representative on file sn approved. _.. r ,~, ~ • • iMCt tALt l`'` tT tS FURTHER AQIUDGED THAT • • . Ths attorneys fees, persa~=! represengtiws faa~pt!-{~utdiana~d~tllmto~fvcare spprowd. TM property described at finding No. 7 b assigne0 to the distributeels) as of tM dste of distribution, ThR property dewibed at finding No. 8 is asstgrted is follows; A. Real Estate : ~ ,, Parcels at No. 1 to Lorne (Loren) Hansom parcels at No.'s 2 and 3 to James D. Merth. C. Personal Property: SEE ATTACHED SUPPLEMENT TO FINDING NO. 8s Personalty at No.•s 1, 2, 5 and 6 to Lorne 'Loren) Hanson. Vehicles at No. 3a, c, d and a to Lorne (Loren) Hanson. Vehicles at No. 3br q and h to James D. Merth. Vehicle at No. 3f - 1/2 to Lorne (Loren) Hanson and 1/2 to James D. Merth. Farm machinery at No. 4a to Jamea D. Merths farm machinery at No. 4b to Lorne (Loren) Hanson. All in accordance with the terms of the Last Will and Testament of the deceased. Zht ~ xas7tint]®aatttittinsdtatahoarssasailp adomdlc AniifR ioatb~aai~r~oauo Dated Noy~ml~r~r 3 ~ 19$'7 8y tM Court JOI'Ln G. Nett-inC~n_ Attom~y P _ O . Sox 1 4.7 _ Addnw Baldwin W7 S4pp2 Address 'Strike as sppropriate. /s/ Rohert W. Wing Cha+k Jttd~ r: .nr .. c.O,v t° 6rrir'~L}O.:r~ ~:,: ~: ~ '., L. y/• ~ • A. . d- •r ~,:, .},v ar.~ L L n w:nps~• tayr • r ..~ ~ • : ~ R ,x,l'' i -.:~~ . ~~ ,~ ~ ~ ~ 1 P ~ ~ ~ ~ 78Pa667 Managed Forest Law -Order of Designation issued by Wisconsin Department of Natural Resources ORDER NO. 56 008 2005 EFFECTIVE DATE: JANUARY 1, 2005 ----------------------------------------------------------------------------------Page 1 of 2 In the matter of designation of land located in St. Croix County, Township of Eau Galle as Managed Forest land under Chapter 77 Wisconsin Statutes, for a period of 25 years on petition of the following parties: Petitioner (s): James D Merth Register of 13eeds: Retum document and invoice to: Department of Natural Resources, Forest Tax Section, P.O. Box 7963, Madison, WI 53707 Address: N8754 450TH ST BALDWIN WI 54402 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 11/22/2884 83:45FM ORDER E%EMPT it REC FEE: 15.08 TRAI[S FEE: COPY FEE: CC FEE: PAGES: 3 PIN: 008-1091-30-000 FINDINGS OF FACT 1. The Petitioner has filed a timely petition under Chapter 77, Subchapter Vl, Stats., to enter the Sand as Managed Forest Land. 2. The lands described in the petition meet the eligibility requirements of s. 77.82(1), Stats. 3. The facts in the petition are correct. 4. A merchantable stand of timber wi11 be developed on the Land. 5. The use of the land as Managed Forest Land is not incompatible with the existing uses of land in the municipality. 6. There are no delinquent taxes on the land. CONCLUSIONS OF LAW The Department of Natural Resources, pursuant to s. 77.82(8), Wis. Stats., based upon the foregoing Findings of Eact is required to approve the petitioners' petition and designate the land described in the petition as Managed Forest Land. ORDER It is hereby ordered that the following lands be designated Managed Forest Laad: Parcel Identification No. Township 28 North, Range 16 West Section 32 NWSW, PART OF Notice of Appeal Rights on reverse side of this page 008-1091-30-000 TOTAL ACRSAGB FOR ORDER Pursuant to s. 77.91(6), Wis. Stats., the authentication requirements of s. 706.05(2)(b), Stats., do not apply to this order. This instrument drafted by State of Wisconsin Department of Natural Resources Open Acres Closed Acres Total Acres o. o0o zz. o0o za. o00 o. o0o zz. o00 22. o00 Date: NOV13M88R 03, 2004 State of Wisconsin Department of Natural Resources For the Sercret~ary BY Robert J. Mather FOREST TAX SECTION - (608) 266-3545 Form 2450-167 lR 11/04) N657 Parcel #: 008-1091-40-~~~ 04/14/2005 04:26 PM PAGE10F1 Alt. Parcel #: 32.28.16.483 008 -TOWN OF EAU GALLE Current ' X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 i -_ Tax Address: Owner(s): * =Current Owner * MERTH, JAMES JAMES MERTH N8754 450TH BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 32 T28N R16W 40A SW SW Block/Condo Bldg: EZ-UT-1505/120 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 797/192 Anne ci innnneQV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 46688 Use Value Assessment Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 27.500 2,600 0 2,600 NO UNDEVELOPED G5 6.500 2,500 0 2,500 NO PRODUCTIVE FORST LANC G6 6.000 7,400 0 7,400 NO Totals for 2004: General Property 40.000 12,500 0 12,500 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 15,000 0 15,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00