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HomeMy WebLinkAbout020-1025-70-100r /~` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Sommerfeld, Bruce Hudson Township CST BM Elev.; Insp. BM Elev.: BM Description: `1~ •°IZl R 6.9 ~ to ~ ~ esr- g~. Z TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~p Dosing Aeration Holding TANK SETBACK INFORMATION. . TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ^- ~ ~' ~ ~- ~ --- NA Dosl NA Aeration NA Holding PUMP /SIPHON INFORMATION facturer Model Nu G I TDH I Lift /I'~Llon I System I TDH ,fit I I Forcemai'n I Length I Dia. I ELEVATION DATA County: St. Croix Sanitary Permit No.: 370376 State Plan ID No.: Parcel Tax No.: lye-- /D Z~`'l0 !OL ~ ~s , Z9. ~ ~~o~-~d STATION BS HI FS ELEV. Benr~tt~~ ~. R ( I~ •83r 98.92 elf ~ rtit (e ~ ~- oD.11' Bldg. Sewer ~, ~8 .3~' St/Ht Inlet ~ ~~.,3rf I St / Ht Outlet f to S . I ~ r Dt Inlet _.---~ Dt Bottom -- r--~' HeaderlMan. .~Z ~(e, ~ ~ ~ 5 R'•a ~- Rio •s~' Bot. System I l • 30 . 38 RS•S3 , S• 4S Fin Grade ~ s ~Z~ ~q. (p( 5 ~ f ~BovE ~ SOIL ABSORPTION SYSTEM S ~9EB TRENCH Width ~ Length No. f T enches PIT No. Of Pits Inside Dia. Liquid Depth IMEN 1 3`~"~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING anu ct rer: M ~~ SETBACK ~ ~~ INFORMATION TypeO ~ f I u I ~ s _ CHAMBER OR UNIT Mo a Num er: _ ~ System: l~, ~ '~ 00 f u.cc • v DISTRIBI.~TION SYSTEM Distribution Pipes Header / old o!e Size x Hole Spacing Vent To Air Intake ~ Length c`~ Dia. ~ Len Dia. Spacing 'L~S r 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 Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~~/ 1~'/ °l Inspection #2: =-t"~'~ Location: 699 McCutcheon oad~son, WI 54016 ($E 1/4 NE 1/4 15 T29N R19W) - -Lot 5 a ~i 1.) Alt BM Description - ~ ~5 r / ~ 2.) Bldg sewer length = X6.0 ~~ ~ O ~C~~L~ 1 Ptt~~ • ~ S' -amount of cover = > i8 ~~ ~~ -- °" P'.. [~-"''~ . 3) ~~- q--y I rr° lam' ~ ~~ o~~~f~ ~~ ~ ~ ~ ~~ ~ ~ Plan revision required? ^ Yes ~No ~ O 1 'D ! ~ Z Us other side f r a dition Infor atiQne, ~y 5~ ~~" ~ ~ ~li III ~ . p~ ^~. Inspedor'sSignature Cert. No. SB 671 (R.3/97) c~-li'7i< <.,t~'Qld.~n, ~,pet~~ Sy.tR ~ri,t7t;~tn PaNLu,QJf ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ..__._% i m~._ _.. .~. ~~ I ~ ~ ~~ ~_ ~ 4 l ~~l`~ ~/Yl , ( ~ ~J.~', In%1 f/1 fir; Sanitary Permit Application Safety & Buildings Division ~~ ~ `~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washington Ave. PO Box 7302 sconsin Madison WI 53707-7302 Personal information you provide may be used for second u oses ~ p ~ , Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the-system, on paper not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number ^ Check if revision to previous application State Plan I. D. Number I. Application Information -Please Print all Information ~ _~`,'~ , Location: Property Owner Name , ~ , - Property Location ~ c _ ' ., ~ `~6~1~~' ~~ 1/4 ~1/4, S ,N, (o~ Property er's Mailing Address ~ '•. ` ~ ~, ,~ r C.RJiX Lot Number Block Number 7 ~ QUr'~ J ' 1 r _ I. City, Sta Zip Coe ~ '~Phongdllll ~.,,~,,~ `, Subdivision Name or CSM Number . ` II. Type of Building: (check one) =~___ ...---'" ^ City 1 or 2 Family Dwelling - No. of Bedrooms :~~ ° ~ ~G-r ~u,v~„ I i (b/ o~ ^ Village ^ Public/Commercial (describe use):_ (Town of ^ State-Owned Nearest Road ~ Pazcel Tax Numbe s) III. 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. 5. 6. ^ ddition to System System Tank Only Existing System $) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ' V. Dispersal/Treatment Area Information: ~ ~ __ y ,~ 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed G R ate Gals./day/sq. #t.) (Min./inch) Elevation ~ tS - i VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ~ ^ ^ ^ ^ - c_-. _- .' ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installa 'on of the POWTS shown on the attached plans. Plumber' am (print) Plumber's Sig re o s~ MP/MPRS No. Business Phone Number lumbe s Ad ss treet, City, State, Zip C de) IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) G~ ~ ~`~ t ~ V ~ ~+~ Determination / ~ ~ © --- X. Conditions of Approval /Reasons for Disap royal: ~'1"L'~~ ~'V~-~~C ~-M dr~s(N~cci~n~i~~c~c ?P~1 f _ _ ~ ~ ~ V . li~`r`~ "ti'Ll~J .11V 3 I ~.°a~l.~ ~,~ ~ r' I D. ~~ ~ . ~_ ~ `~' SBD-6398 (R. 07/00) u,~,~ ~~~' ~~m~ ~~/ . _ ~ :~ ~ ' / ~=~ sc~-,~ ~~fs~/S~~s1` ~~' /~ .jam ~ ~",~p ~ /.a', ~~~ ~~ ~~df~/~J.~,~~ a~~~~ ~~~Q _ a~ \~`• ~ •ar ass ~~ ' b ~ ~p`~ ~ . v p~~ ~~ ~ _ - / ~~ \~~ GAT i I ~ ~~~ '~ ~~ ~ ~~,~~~~ ;,~ ~J~ir ~~ ;,, ay ~~~ o ..._~ ,~'~ ~~~ti.~~~t~ 8~~ G ~~~~ 8~ ~g ?x, ,tea c ~'~`~~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil .Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications - Sanitary Permit Number - + ?o ~7 - Number of Bedrooms - Design .Flow -Peak (gpd) Cc~ - Estimated Flow - Avera a (gpd)- - - - - Septic Tank Capacity (gal) - Soil Absorption Component Size (ft2) - Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorpti n Component Design Flow -Peak (gpd) ~/ Maximum Influent Particle Size (in) 118 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) .150 Tab le 3: Maintenance Scneduie Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~a4~ 5 Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may .indicate surge flows or an impending continuous alarm.. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced: Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. . Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the. tank is no longer used as a POWTS component. . Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. -~ ~- -L~--~-~ (~...,, ~,,,,~ ~~~e, - ~l t s--~~ -~ ~ a~a 3 ~, .. ' Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVAL TION REPORT Page ~ of in accoroance wttn Comm rso, vvis. Ham. t,oue County S ~ rtI st i i Pl h 8 ,, an mu n s ze. 1/2 x 11 inc es Attach complete site plan on paper not less than include, but not limited to: vertical and horizontal reference point (BM), direction and per( l.p, ~ ~O ~~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~ Please print all information. evie ed by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). y~ , ~ t ~ v Property Owner ~ ~ Y Y' ~ I ~ Property Location 1/4 S (~ T ~q N R ~ q -~ W t ~~ ~,1/4 n ~ t L G C] Y l ( Y~.Q C ~ ~C ( , ov . o Pro a Owner's M 'ling dq~ress ~~~ - ~ ~ ' p 5 #' ' ' 5 Block # ~ :: ~ - = ~~ c r,,~ ~t~ ~'' - ~ .~ ch~c~t 1c. ~ ~ o . City State Zip Code Phone Number I~}hC~so~ WI SyvIG (7-S)~y"~--~4-~~~ ^ City ^ Village Town Nearest Road ~~c~so~ M New Construction Use: Residential / Number of bedrooms Code derived design flow rate ~ t!o ~U GPD ^ Replacement 11 ^ Public or commer al -Describe: Parent material 1 0 'f.S S c U L2. b ~.~aS~. ,~,~ ~ Flood Plain elevation if applicable ft• General comments and recommendations: Boring # 1a Boring ^ pit Ground surface elev. ~ ~ ~r ft. Depth to limiting facto ~ ~ ~ in. Soil A lication Rate l t C i Descri tion d R Texture Structure Consistence Boundary Roots GPD/fg Horizon Depth in or nan Dom o Munsetl ox p e Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 . D'q 0 rr -- S ~ ~ r~Sb~' ~1 r ~W 2 t 5 =b' 2 qr-~(P r -- st sMSb~ .~ Cc,J ~, a -iro ~ -- ~ ,t,, ~~ sl , ~ >a.~ ~~,~ Boring # ~ Boring ,Q ~j ^ pit Ground surface elev. ~ v ~ ft. Depth to limiting factot~ ~ O in• Soil lication Rate H i D th lor i t C D Redox Description Texture Structure Consistence Boundary Roots GPD/ff or zon ep in. om nan o MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U-(o5 iu f- - s ~ ~.rnsbl~ M r Cw 2 . S -{- ~ * Effluent #1 = BOD > 30 < 220 mg/L antl T55 >30 < ~5u mg/L - ¢n - o~~ . ~~ „y~~ °~•° • = •••~•- CST Name (Please Print) Signature ~ CST Number ,~ 2 27 3 Address Date Evaluation Conducted Telephone Number 1~3~ l~~°~~±~ i~~~;C~~`k7M ~ 10-~2~.-00 `trsa~ -.2 S~ 2 ~2 I Property Owner S O M ~ e Q ~ IN Parcel ID # Page 2 of "~ Boring # ~ Bonng O / ^ pit Ground surface elev. ~ ' ~ ft. Depth to limiting fador / //~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 '1 0- V ID f3 ~ - SI aMSb~ MF-' ~-~ Z rs 3 -, lu ~. S r ~!f - S S r, - , ~ , ~~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting fador ~n• Soil lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~] Boring Boring # Ground surface elev. ft. Depth to limiting fador in. ^ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent f#2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6/00) ~. J 1.~ r ~n C 2 S o i•-~ r~ t R.. ~L ~ cX coq s r~ c c ~t~ ion 2 ~ I-~Rs a ~~ (,~ I S ~{ o f (p T z..9 ty - ~ ~ ~ W Tow -~ ~ F I-{ h ~ 5 o Y-, ~! N ~'1 c C ~ ~c~ .e o h ~ ~ N~ 1°~ _.s, ~ `I Q e- ~ t- v v .-•~ 11 o v. S ~.. dM 1 i~p o~ `~~.~b~.2 -uo' a ~ ~- ~ ~ ~ ~ ~'~Q, 64 ~ 9 s . q Z (31 ~oi,WB B~ lob, q~ ~~ ~~M o~~-e2 ~-e~,~" X02,32 s~e~ ~s~ H ~~QJ ~ S'~ ~~ ~ ~''=30' ns duo II 3% ~ SI p ~2 ~,, , ~3 ~~1oN-~ S ~Ie~Scv \ 2 2 ? ~ 3 ~? ~--~_-_~ 2. n -~~ 1~5~ I~ ~0* t~ qo ~~~. 1~ -, 13~ '~ °I-- t l~~ I vo' .~ ~ ~.~,Y ~~ Wisconsin Department of Commerce Division of Safety and Buildings ' SOIL EVALUATION R PORT Page ~ of m accorgance witn Comm a5, vvis. Hgm. ~,oae -- County ~ C~ ~ t mu Pl i i i 8 1 2 1 h ~ c an s ze. nc es n s x 1 / Attach complete site plan on paper not less than include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~,6 ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b Please print all information. R viewed by Da e/4~ / 9 by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Property Owner _D ~ ~ ( Properly Location I W ~ 2 q ~ (.~ C) (~'1 (''~ Q ~ (^ ~ C Q ~ ~~ q~ C Govt. Lot S ~ 1 /4 h ~ 1!4 S -E{ee) N R , Prope Owner's Mailing ddre ~~ ~~S ~c I~ he Lo~ Block # Subd. Name C s, ,~ .3s~s C' State Zip Code Phone Number 1 ~ ~ [] City ^ Village f~Town (` Nearest Roa } ~O (ors) S~-~~3 ~ +~c ~an ,1,J I S~© New Construction Use: Residential / Number of bedrooms ~_, Code derived design flow rate ""1 S ~ GPD ^ Replacement ^ Public or ~mercial - De e~ ' • I I , I` ~- ~ Parent material ~ o e S ~ u y fi O N T~4 S ~~-`' Afalp~elevation if applicable ft• General comments ~ % ~~ t ~ S ~ ~ h ~ ~~~ ~ , 4• ~~ ! and recommendations: ~' ~ ~`~' ~ ~ ~ ~ ?` ° ~ n ' ' f'~ ' `~ ~ i "1 .. f ,~ i - , f ~ - Boring , ..- c:~ ,.,,,y' ~ ~ i Boring # i ~,-• -- ' ~ Pit v ~t."`~~Frl; epthto mrtmng factor~~ ~ in. Ground surface elev.' ~ Soil lication Rate Horizon Depth Dominant Color Redox Descrip~\, . , Textarst ~. ;-~~octure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color '' ~- L_ ~-' ~ 'Gr. Sz. Sh. 'Eff#1 'E F O-'' to r3 2 - g I K r' ~ r5 ~- ro r ~/ - s ~ . r c~ ~ ~ S 3 I ~ 3 7S r ~ - S I.' tJ. r C~J ' ~ ' ® Boring # ~ Boring !n~ ~ pit Ground surface elev. ~ V~~ ft. Depth to limiting factor~~ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1~ ~ r ~- S i d 4; r "Eff#1 •Etf#2 5 , to ~ :~ 7 ~ l.~ ~7 ~ a " Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) a CST Number ~ ( ~~ Q t?b 21 ~' 3 ~ 7 Address Date Evaluation Co ducted Telephone Number Ic{ 3~ 1~U ~~ ~f , ~' ~ a 7r S ro24~-~.~s !- , ~. Property Owner ~ J ~ f`'1 ~ 2 TZ'(.~t Parcel ID # Page ~ of Boring # ~ Boring ~~ ~ ~ ~p ~ i o 0 pit Ground surface elev. ~~1~ V _i ft. Depth to IimiHng factor 1 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ! o~ l l t IJ r~ Z ~- s r I ~ fY1 r C. ~ 2 , S r -2 ~o r - 5i lC r C~ I S <<S , '7.5 f - ~. 5~~.~ Y'r'11! r C ~ - , 7 ~ -ruo 5 r ~ - S ~. ~- , ~ Boring # ~ Poring (~ ~ ~~,, I/y Ground surface elev. _ 1 V r /'/ ft. Depth to limiting factor? r V ~ in. Soil ~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Root C in. Munsell Glu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 h v-3dt ~©~ - -- ~~ .~ms~6K r 5 7~ / S ~" 7 ~ y S v~ ^ Boring # U Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate H i D th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP or zon ep in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i `Eff#2 'Effluent #1 = BODS > 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. ca i,a r~ SBD-8330 (R.6/00) .~ .. '. J\ F qqa ~ g~,~ ~ ._ ,... { ~1 ~2 ~~ ~~ iDy,S~ r~~•~~ ~ ~ ~ ~' ~~ ~;a .~ < .~ 2 va. ~~~ ~ ~, v ~ ~~~`~~ ~~ {~~ is t {{> a~.~ ~ ~ -~ 632~6~ ~ ~lLED ~~ OCT 2 5 2000 - _ THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON RMep/is~t~e{r~o/t~~Deeds W I~tOiH COn d04_ ~ j doll 9 `' ,'o ~ i ~ m O ~ r ~ {~ Z '~-h~_._.-~ Z i ~~//,,~~ MM ~/7 n ~ G,~ n G7 % o ~°~°L11%lJ° ~LN V ~L~o ~ g -LY~°-CS U ~ ~ I I m I' i ~ ~ v w i^ -----~- -------------------------------------- I Z I Z ~ t° w~~ i ~ Qaa~a __~oQO I z ~ i z ~~~~~ ~ z m N ~ ~ - --- (PRIVATE ROAD) - ~ J I m I ! ~ ~ G O ~C ~i - - ~ - - - - (N00°54'E 455.8') - - - ~ `~ i ~ i Po °, N00°37'22"W 457.49` `~- ~ ~ ~ ~ P ~- I - - '0 ' 0~~ - - - NQO°37'16"W 422.21' - - - ~ ~ ~ ~ 'tl ~ ~ ....................N......N ......................... ~ a~ I ~~ i ^n v y O i$ N r ~ oz ( I ~~~~ ym ~ ~ ~~ O o ~ xm N v z~ O~y ~" cwo ~ ~ ~ O "'~ m ~ ~ m ~ I~ ~ I m ~ ? 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G3G~t7u ~~i ]i C~L~4 ~ ~ ° ~ z - -- - 7 - ~ o i . ..... ........................... ~ . ~ g O ~ N ~ ~' ~ ~ ~ Q O • ~ ' V ~ y rn ~ Z ~, C1 ~ ~ ~n ~ ~ ~ c°d~0 ~g Z ~ m o~ m_ ~c~~~ A o a~ to j~ ~~ r• cn ~o Q m z ~ ~ ~~; 454 13 ~ ~ Z ? n m Z ~g ~ o O ~ ~ O W- o c~ ~ ,.~ rn . r, ~ Z~ ~ m O O r a z n g ao z ~z cn o - m m ~'' ~ C ~ Z ~ v mC m G7 ~ ~ m Z cn m0 m ~~ Z rn m ~i Z~ ~~ O ?o z ~ m xz n n ~ ~~ .T, n0 A ~~ r ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~~~LiF_~,m~-,~~r`,~~D Mailing Address l ~S' ,~/r~~-h,~„Q ~~/ Property Address (Verification required from Planning Department for new construction) ~~ City/State Parcel Identification Number „L~-~~,i~7s"-- 7a~~o~ LEGAL DESCRIPTION Property Location._S`~ '/., ,~/~'/., Sec. , t-~'`. 'P.~~.N-R~.~W, Town of ~ Subdivision S1a-~ .Lot # ~_. Certified Survey Map # -~~ ~l~ ,Volume ~~ . ,Page # ~ 39'~ ~ Warranty Deed # ,Volume ,Page # Spec house ^ yes ,(,~ no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is in pmper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yeaz expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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. SIGNATURE OF APPLICANT / / DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with thls application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed State Bar of Wisconsn Form 2 -- 1982 j S3JS ~O ~' WARRANTY DEED _ _ __ OGCUMENT NO 1___- -.:-~:-----~~?~!p-A ~ lJv l }~_-_ _ _ j REG1STEf,'S Gi~r~~E ST CROiX CO., th'i Rac'd (~r f?ccord Todd M. Ramlet and Michele S. Ramlet, '.I ACT 3 4 1995 - - _~ ___ husband and wife, j - -- --- - - t 11:00 A. c•~w~eysandwarrantsto B_ruce_J Sommerf4_ia dn_d ___ _ ; c:y..::tt_ ~.;-~ .Nancy L. 5ommerfeld, husband and wife as survivorship marital"pro~ertyr _ __ _ ____ _ _ _ __ __ THIS SPACE Rf SER VED FOR AF!'OAJiNG nwtA -__ - " -_~_~I_p__~.~j,.y-Q--~~-gyp _ .~_~_~y. /~ u~ ___ . _~ _.__ -._.._ .._.__ I ~~111J1 IltA1MMIbR6iR1Mt, K rM~ __ - - _ P 0 60X la! IJ ihrt follnv Ong described real estate m St . CrO1X __ _ _ _ ~r _ ~.}{~D+~~ ~ ~~1~~-. _ __ ._ _ County, State of Wisconsin: J~ `^ ~~ (Parcel Identi cation Numhrr{ Part of SE 1/4 of NE 1/4 of Section 15-29-19 described as follows: 3eginninq at the Northeast [:orner of said SE 1J4 of NE 1/4; thence S1°33'W along the East line of said Section 15 a distance of 452.6 feet] thence N88°59'W a distance of 446.36 feet to the East line of a 66 foot wide strip reserved for highw~•• easement; thence S83°39'VJ a distance of 33.27 feet to the centerline of said easement; thence .rith the centerline N00°54'E a distance of 455.8 feet to the North line of said SE 1/4 of NE 1j4; thence with said North line 589°06'E a distanca of 484.5 feet to point of beginning, the above described parcel containing 5.003 acres, store or lass, including that land presently being used °or public highway. This _____ls _______ homestead property. (is- (is not) Exception to warranties: Subject to easement,/ reservations and restrictions of record. Dared this _- ~ t; ~ __. day of _ _.____. October ___ ___,_ __, ly 95 , r Sgaature(s) - altaitenticated this day of ,19~ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ___ authorised by §706.06. Wis. Seats.} THIS INSTRUMENT WAS DRAFTED BV STEPHEN J. DUNLAP Hudson Wisconsin L~~ ena[ures may be authenticated or acknowledged. Both are AUTHENTICATION (SEAL) ~ ___ ~_ _. (SEAL- + TODD M~.~,RAMLET (SEAL) ~~~~LS4~ ~ (SEAL) + M-~ S. RAMLET ACKNOWLEDGMENT STATE OF WISCONSIN ss. __ St_ Croixi _ County. Personalty came before me this __ . _ day of October , 1995 the above named Todd M~ Ramlet and Michele S. _ Ramlet, _ ___ be the person ~_.-_ _ who executed the neat and acknowlydge the same. ~t~_C~t2iX ___ _ ~ County, Wis. n is.rtar (If got, state expiration s ate: i ~. ~, , GO X ~ 6~~36~ ~ FILED ~ OCT 2 5 2000 - _ THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON Repisterof Deeds "' SLCroixCo~W1 -~ r I ~, O N 0 d04 ~ i 404__9 ~ m A .~ ~ ° ~ ~ _ ~ ~ o ,~ OoOo~o _oa_dodo_~s_pc~o ~9~ ~ I ! ~ I ~ ~° v w ° i --- -- --- -- --- I ~ I ~ ~ o m w ~'~ ~ o Qa~a ~oa~ ~ ~ I ~ ~ I~ ~' ~ ~ z ~~ ---------------------------------------- i i Z l~ l /I ~ 1 ~ II ~ m N N ~ (PRNATE ROAD) ~ 0~ - - - - - (N00°54 E 455.8 - - - .._ J ~ I ~ ~' ~ O P 0 ~ N00°37'22"W 457.49' ~ I ~; C~ ~ P O ~- -- -- --- i0 ~ 0'~ ~ ~ N00°3T16"W 42221' I I ~ ~ ~ ~ ~ ~ .....................N ..................................... ~~I ~~ ~~ ~y~ _ _~ ~ o~ I I E~1 ••wwm ~' ~g ~D r = 2 Tz ro ~~'~ Y/` ~m ~m O ~ v ~O ~i .°v' ~~ Z ~~ ~~° '~ N ~ ~n ~ ~ F ~m I r ~-n f ~, o ~ ~ ~ ~ Z lid . 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