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HomeMy WebLinkAbout032-2177-10-000 °'r`-"'r":.~'''" PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT "n"'yl'C1v1°' (3UU318 GENERAL INFORMATION ;ATTACH TOPERWI) Slate plan to No I"r:5una1 tnf:,'naiaa Yp: Pr'wiM nal t-..ed'c a v:dmY pulp- F'r I-y Lda ::d 111-:1 Pr rv C Haute's N 3m e- 1-11 Iagc ivrvn. t ip na:cel'a. NO Joe & Amy Hutter TOWN OF SOMERSET 032-2177-10-000 GSl EAr Elev. Ircp FAI F Ia•: ITN Ile', I'll Irl Scai.. .w,1pa,gc:6lnp No /bbr 1 16 ✓V t c-'ST 11.31.19.1514 TANK INFORMATION ELEVATION DATA TYPE NIANUFACTURF CAPACI IY S'A, ON BS 19 FS LLLV. SC•`J!r - 1 BebChleaf< e 6e-r TL, 3' to , l5 /oy./ /od ~srF,g Art BG9 Fl Pd ~o~ 17Z.5 Tr,1i.1- Gore (04 /j 3 y Acrlbon - _ Ultlg. Seeer 31 2L /so 13, 3 .~..J,,.y s`tlr lmct s~• 1• 99.33 ti9• TANK SETBACK INFORMATION ;ntt oWC•t 5, o-7 d TAN<TO pp P:L ALLL DL, :er uAp'r u-r, ROAD DI htlel _ti pnc y _ 518ouvri 50' /~f} 17 7 /OU Uas,nq HeadeU6/dn /11'7 53 7/ 7 lip- S 93 31 nt syNtrm //.8 92.3( f~ PUMP/SIPHON INFORMATION ~O• bt~l~ n:,Gnr rrr _ _ - UrntarrT c":'nvcl /d 3 -a{ 7 t 711 LA1 - inn loss SVS1EIn'leatl---"- ~'-`DH II - _ _ / fnrm:nair' Lcnylh Um tc Ytrl - - _-~r. SOIL ABSORPTION SYSTEM RFDITRCNCII 'JJrvnr / ::511: / 'JI lre^¢ne5 PIT DItAEN510N3 Im. k-,. I':ts Ins:ne ~i Ln:m IJepe: DIMENSIONS 3 NoZ SETBACK ;iYSI_SI IC Pn 9:_73 ILLL LAKL-SIRLALEACIUNC L/a~•~rarniF:f. INFORMATION CHAMBER OR 17 'tisrr - 1 71 $}i'e'I. ) /Sd / . I I /F 1 UNIT 11ccr, N.. nei G 1 y ✓Ci ..<.y Gewt/enf~a ~ r ✓•~/e /oi~S DISTRIBUTION SYSTEM 'rein y7+Z' C• rh iS rI ~..,..ryf uil r t~.~t~on ' .1-oM S,c_ .'.tdc:;pecr„ 'vn0 0,✓~-~-`I1 , I'll L n'~ II- ;'pa^ra ~ !1- -OL SOIL COVER I X Pressnw Systems Only xx Mound Or At Grado Systoms Only - :ept t O x apm ~ x. Sec ocJ'3addcd • v..mnca tl ch%-Ier L RldT r'a9<::. 1 ~:an. ~,Ytz Nc ~rex No J COMMENTS: IncGude Code tlisclUUeIli perSOFS present. FIG) InspCChJn %1 Inspection 92 tt~- a i n Locafiont 2247 CTV RD I : Alt 9M `-CGCIpUOn - ~ a•~ ~,,,_g 7 I Bldg sewer Iengtn ~Q amount of cover = j/ "tvisson ae„are0 yes ~Nn 3 20 f - ro s,.3y if, ccr I,- I side 'w adc'n'+nul nlou,.a9 on 'scGrm ::~r( en \o .:fL 1: ;P Vii::.-", J Industry Sorvi= Division T - : _ Y~ 0 ~l 140C E VVashington Ave Sanitary Permit Number Ito he filled in b) Co.) ~.I s p AN 2 a 2018 S F~ P.0 Box 7162 soq,YVl X3707 _ 7192 - T pNpx L' Sanltarx Permit I~Yf. h709 Sorts T,,naction Numxr ^utaV unit r In acwfdnncc a th SPS 3121t2r A's. ;lctm t-0rl . suhm. <l,. of 0;;;., 11 m'. GAZ2 is required prior it, cbtainarE a sam4 Nnnn Note . Appl cat xi forms lo -1+le-olVIav. • .nitterl ht - Prnjmi Addrc>5 (if di0uenl than mating :ddtnc) tl;e Lkpaaeoem of Safely and PYOMSIL n_I Sus 1 Cil Pason.J "nsr.:lion you P1 de may be m._ cwndarv y pnr;ms~c inceeord:nec with the Prisxs i am s 15N f! init Stns 1. Application Information-Please Print Alt Information 7I (Ant 1 +f'1 Property Ossner s Name Parcel s I roperty Dome a gladma Addrets Prcrysenv I ccrn.n r i , .l Go". Lot C:ts Slate Z.ip Csxde Plxme Nwnlsrr Section (circle onc) 7 ! N R LMxv 11, Type of Building (check all that apply) Lot= - - I or 2 family Dxellml; - Number of Bcdronms Subdivision Name ❑ Puhlic/Comniercial - Describe Use - - Block - _ t' ❑ CLLs of ❑ Slab Chrmd - Ikscril:r Usc _ _ -1 ❑ Ville;c of CShf Nunteec ❑Toxn of 11. Tv a of Permit: (ChcT_k only one box n 'in",': r!I!lete line B if applicable) (a Neo S)Skm !URePlaccn:n15t5tem ❑ TrcauricnVHniding Tank, Replacement ()ndy +❑Ofhe, hledlfaallon to Exisun_ SN.icm lcxplanl i B. ❑ Pcrmil Rsrrs cal ~ ❑ Pe:mil Krs ❑ Chance of ❑ 'crmi: I ran>fa to Nos Litt Previous Pm, in rumba- mxf fin; lcwcd BeKnc Expiation Plumber I\'. Type of POWTS Systmm ComponenfUcvice: IChrek all that apply' _ I(,~'I Mr-Pr ,,vriml In-Ground ❑ Pacun+ed In-C-rocnd ❑ AL(ir de ❑ ?Erin J 1 m. of twtab!e ton ❑ Mound <:4 in d...mile soil I/•% } L H,Idinv Tm& ❑Othcr!)ispcwf C'omr>,,ncnt tc%plaml ❑ Pretreatment i kvree!C%Plam) ~1-\ UtsYandUl7eatmeat Area Information f1 i Ss c,nn IikrNion lJesr'n Clos {.pd) Us-ien Sal App] -ULM - - DiSPnsa! rte a R quired CI! i Ui>p _ d :11" Proposed 11 Ral Y°pdsl) r - r F 1'L Tank Info t'apxil)in n O Ga1lClls Total Vol TsNdl .i mmincturer nor. la.~h: E,otinK Tads G;dl n Unit, 2 q C V. a. ' Scpa-er Iloldins T.m6' ! - © 0 0. -E1 E, El El \ 11 Respoosibilth' Statement 1, the unders fined atcume respontjblJlrs fur u.callabao of the PO\\l S sbo, a on the alarhod plans !luml fr"Name Prylll v I Plumber tiuataturc S1t,>ti'K$"Number Bm:ns nh \umFr Plumber's Adorns JSt ccl.Cn,. State. Zip l ak), Vlll. Count,_Dcpartment Use Only ❑ Appr« ed [Fj D,,appr sed Psmmrt Fore Ual' Ismcd Issmn 7tit Signaune Lu rh.ra t n. i ..uiw n t : D"'Ji IS. Condi 4icamn% for Disapproval 1. l9w. titre. ttflt.4rc tar m1 uhpnr3 cad twat ad he t+n•.!c+a:lili?]1~4L ~ / n par MW26*rnew plan P•o load by fAbakip: 2 Ai rxArk roct.Metxms mUaiw r.,rrtri,.e 'I _atp~clpptlrshfat»CSl:rd"urea - - .r loam to wnryd,yy<-pl:m fa<,nc shun.. mi •ubmi~,u tl:c ('..,v . nnh ..,pvya n.r, 1.,• canu,S:.:. 1I rn<hcs m .i r \ ti I iA CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owners Name Owner's Address: _ Legal Description Township: County- Subcivision Name: Lot Number: _ Parcel ID Number - Page 1 _ -Index and title Page 2 Plot Plan Page 3 System Sizt & Cross-Section Page 4 - Filter Speus Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page tt Warranty Deed Page g CSM or Plat Attachments: Soil I est & House Plans Designer/Plumber _ i License Number. - Date: _ Phone Number Signature / l~ omnited pursuant to the In-Giuund Solt Absorption Component Manual for POINTS Version 2.0 S810-10705 Page (N.01104 I i I ~y I ~ I I I~ I 1' 'oC II Iif~ III I I I I I i fir ai6 Alsst?tion_ C ass ~acgeors 55 r°sd+~ueav PVC Ventf 8 xm. vent cqo ' Q Leaching fT Chamber - SyE~j pcvalion IT Q~f3 Absorption Svstertt ~ Viw n i ' 1 :_earh7ns r _Tn=ncn 'i _ft ,l Vent Or Observation PIPL bare 4" Dia. Tisn~ii 2 Header f C;"yC~ ".;zer i Manufacturer And Model _ EISA Rating - sq ft per chamber Soil Appficalion Rate gpde4 ft gpd Design Flow - Soil Application Rate . FJSA= Gharnbers rows of chambers each. Page 04 PL-525 EFFLUENT FILTER ( ^ . -1 Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 s rated for over 10,000 GPD Alarm ~l - Accepts PVC !gallons per day} making it one of accessibility extension handle the largest commercial filters in its avg. class. It has 525 linear feet of 1/16° filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1116" z filtration slots Rated for over removed for cleaning, the ball will tn,ooo GPD float up and temporarily shut Off the system so the affluent won't leave the tank No other filter on the market can make that claim? Accepts 4` & 6'• SCHO. 40 Pipe c,.. A the PL-525 Effluent Filter should is operate efficiently for several years _ under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed fitter contains an optional r,~1 alarm, the owner will be notified by an alarm when the filter needs Gas deflector servicing. Servicing should be F1 done by a certified septic tank - } Automatic shut-off pumper or installer. ban when river is removed 1. Locate the outlet of the u.;. varent No€ ems,488 septic ank. s.a;t,vw 2. Remove tank cover and pump outlet of the tank if necessary. 7r _v- ,:c. L. C - 1. septic Locate tathenk. 3. Do not use plumbing when filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6' outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Raplaca septic tank cover. 5. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN title of FILE INFORMATION SYSTEM SPECIFICATIONS rF:",t' Tank Manufacturer: ❑ NA _LZ 0 Septic L) Dose U Folding Volume - (gal) DESIGN PARAMETERS Tank Manufacturer 6f NA Number of Hedreoms - - ❑ NA ❑ Septic El Dose ❑ Folding Volume: (gal) Number of Public Facility Units: [I NA Valical Distarce Tank Bottom(s) to Service Pad: (n) Estimated (ave~age) How Hnri,ori Distance Tank(s) to Service Pad. ;O) Design (peak) Flow _ (estimated x 1 Ci): Igapday) opcah: servicing mechanics must he prumded if vertical is 115 feet of d huc<unlal Ms %150 foot. Sa cJfic, instmOt:uns l be provided of back. In Situ Soil Application Kate: (gapdnpr?) Effluent Filter Manufacturer. ' ❑ NA Standard (Domestc) Influen:/Effluent Monthly average Effluent Filter Modcl - rats.OJ&Ova"( IFOG) •:30 mgiL Pill lip Manufacturer. aiodremical Oxygen Demand (BOD;) -220 mg+L U NA q NA I Out Suspended Golds (TSS) _x;150 my+L Pump Model High; Strength Influent/Efflueit Monthy average ('revealment Unit (FO^,) 130 mg+L Manufactuler. (ROD;) 1220 rnty'L (,,.I NA O n NA (I SS) _ > 150 mgiL O Wrichanical Aeration (7 Peat Filler Pretreated Effluent Monthl averse (71 wetland Y 9 LJ SanandrGia vul Filler ❑ Other (uUU,) 30 mgr( Soil Absorption System (TSS) <_30 mg.'L lEj NA _ FecA Colifornf (gconekic mcu_r_) -:to' In Ground (gravity) Ll In -Ground (pxessure; LI NA Maximum Effluent Particle Size in dia. Fl NA AI-Gra ❑ Mound n Unpl_ina n Odiel outer - _ - Li. NA Other. ❑ MA MAINTENANCE SCHEDULE Service Event Service Frequency Pump cut eorntems of tank(s) fJ Whon rnmbined sludge rind sc.urn rgi.❑ls pre shirr. (Y...) of lark volunm tI When the high water alarm is actr:atcd Inspect condition o'tank(s) At least once eve-: U f y eeaar'.si) r'~ (Maximum 3 years) [_J NA Inspect dispersal cell(s) At least cnce every. F1 muAtif') (Maximum 3 years) ❑ NA [3 yearts) _ _ Clean effluent filter At 'east once every: 13 11101rn(s) n NA _ _ ):1 Years) Ins feet ran Fi, F' uuM p controls & alarm At least once every. .J morti(s) :1 guars) - - EfNA Flush laterals and pressure test At least once every. 1°°°[h(s) [I NA G per - - At least once every memh(s) O NA yc xi`J ctnei Ll NA MAINTENANCE INSTRUCTIONS Inspections of tanks aid soil absarp:.on systems shall he made by an ineividual carrying one of the following licenses of ccrthcations: Master Plumtor. Master Pltarber Restricted Scv:rr, FOWTS Irspecter, POWTS Maintainer or Septage Scive:ing Operator (pumper). Tank inspections rnu's1 ineude a visua il5peclun of the tank(s) to identify any Missing of broken hardware, :dent fy any cracks or leaks. ! measure the volume of combined sludge and scum anti a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the efguert 'wets in the observation pipes and to check for any pending of effluent i on the ground surface. the pending of efuent on the ground surface may inciorve a failing condition and regcnres the immediate robfication of the local regulatory authority. When the combined aCCLIn O+tlon of sludge and scum in any trealmem tank equals one third (G) or more of the tank volume. the entire contents or the lank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance wi:h chapter NR 113, Wlscerisn Administrative Code. All other services. IrvJudmg but riot limited to the servicing of effluent filters, mecharea or pressurized components. pretreatment unds, and any serviang at intervals of 512 months, shall be performed by a certified POWTS Mamtamer A service report shat be provldeJ to the, local regulatory authority within 30 days of completion of any service event. a,mv-nos lozin5) i Page of START UP AND OPERATION For new oonstrucfion, prior to use of the POINTS check treatment tank(s) for the presence of painting products, solvents or other themcals or sediment that may impede the treatment process andfor damage the soil absorption system.. If high concentrations are detected have the contents of the tank(s) to-i rd by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power uncer these conditions is not rocommencdect as the excess wastewater wil'. be discharged to the soil absorption system in one lau ge dose causing an overload :hat may result in the backup or surface discharge of effluent and darnage to the system To avoid this situation have the conterts of the pump tank removed by a Septage Serwcmg Operator (pumper) prior to restoring power to the pump or contact a Plumber or POINTS Ma ntainer to assist in manually operating the pomp controls until normal effluent levels are restored within the pump tank System start up shall not occur when soil ocnditions are frozen at the ir~fi.trative surface. Do not drve or park vehicles over tanks or the soil absorption system Dc not drive or pars over. or otherwise disturb or Compact, the a:va within 15 feet down slope of any mound or at-grade soil abscrption area. Reduction or elimination of :he followrig from thr. wastewater stream may improve the performance and prolorg the life of the treatment tanks and sol absorption system acids, antibiotics, baby wipes, cigarette butts. condoms, cotton swabs, degreasers, dental floss, diapers cisirdeclanls, fats, foundation duaau (s(xrp pump) discharge, fruit and vegetable peelrigs, gasoline, greases, herbicides, meat scraps, medicitlois, oils, painting products, pesticides, sanitary napkins solvents, tampons, and water softener brine (ischarge. ABANDONMENT b^: hon Oe POW I S fads and/or is permanently taken out of service the following steps shall he. taken to insure that the systern :s lyoperly and safely abandoned in compliance wit) s Comm 83.33, Wisconsin Administrative Code. • All piping to tanks, pits and other Sol absorpt on systems shall be disc:unnected and the abandoned pipe openings sealed • I he conterls of at tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper) • Afte• pumping. all tanks and pits shall be excavated and removed or their covers removed and the void space filled wit- set. gravel or another inert solid material CONTINGENCY PLAN F the POWYS Pals and earn/ be repaired the following measures have been, or must be taken, to provide a code compliant replacement systern. w A so table replacement area has been evaluated and may be utilized for the locaoon of a replacement soil absorption system The replacement area should be protected from disturbance and mmpartion and should riot be infringed upon by required setbacks from existing all(] proposed structure, lot lines and wens. Failure to protect the replacement area will result in the need for a new sal and site evaluation to eslaolisn a suitable replacement area Replacement systerns must comply wi:h the riles in effect at the time of their permit issuance. J A suitable replacement area is not available cue to setback anJot suit Innitalilxts If the scil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be nstalled as a last resort. x71 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POtVIS a soil and site evaluation must he performed to locate a suitable replacement area If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POINTS. I I Mound and it grace soil absorption systems may be reconstructed in place follnwerq remova' of the Manna/ at the infiltrative surface Rocco stn.diwis o` such systems roust comply wth the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS. AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. r ADDITIONAL INSTRUCTIONS: POWTS IN TA IER POWTS MAINTAINER < - Phone - rp=loee SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TO Y AUTHORITY Nacre Name ~ _ ✓r _ Phone Phcne Thn dueument was drafted by lire staffs of Ihe. Green Lake. Marquette and Wausli County POWYS regulatory agencies in compliance with sections Cavm 83 77(9)(0); 1)(d)R(f) and 83s4(1) , (7) $ (3). Wismm n A.1ministratiw.. Code. i Pap START UP AND OPERATION For new construction. prior to use Of the POVs'TS check tr_a5'nent tanks} for the pre;;ence x paintirg probucts solvents or ether chemicals o, sediment that may impede the treatment process and+or damage the soi'' absorption syq'ern. If high coanent-ations are detected have the contents of the lank(si removed by a Seatage Sermcmg Operator (pumper; prior lc use. Pkrrp tanks may fill above normal h,ghwater levels prior to startup or due to pump failures. Start up ar restoration of power under these <,nditions is hat recommended, as the excess wastewater will be discharged :e the soil absorption system in ate large dose causing an overload that may result in the backup or surface dscha•ge Of effluent any camage to the system -o avoid this situation have the contents of the pump tank removed by a Septage Sevicinq Opel (pumper; pro- to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump Cori until normal effluent levels are restored within the pump tank System star, up shall not occur when sai conditions are fro i at me infiltralive surface. Jc net drive o. park ve'ucues ever tanks o' the soil absorption system. UP not wive or park over, cy otherwise disturb or tompa-. the area within 95 fee,. down scope of an mound nr at-grade scat ahsorpdon area Reduction or elimination of the -ci inn from the wastwvater stream may improve the performance anc orators; the life of the treatment tanks arc soil abscrptms system acids. artoictics. Baby wipes. cigarette hutts, condors rottor, swabs. degreasers dental floss, diapers. dsintectants, fats toundation drain {sump nuri discharge, fruit and vegetable pecings gasoline, greases. herbicides. meat scraps. medications, oils, painting prpdkns, pastiodes. sanitary napkins, solvents, tamoors. and water softener brine dischaaoe. ABANDONMENT When the POVVFS fails andror is penrani taken our of cervix the fello•rnm, steps shall be :aker to ins re that the system is properly and safely abandoned in compliance wild s. Comer 83 33. Wisconsin Administrative Code. • NI piping to tanks, pits and olhe soil absorot on systems shah be cl swnnected and the abandoned p pe openincs sealed. • The contents of all tanks and oils s,sall be rehovet anc properly cispcsec of by a Septage Servicng Operator (pumper). • After p::mning all tanks are nits shay. be excavatrx.. and removed or their covers removed and the void space filled w1in soil. gravel or anollwr inert sold material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been. or must be taken to provide a code complaint replaoement system A suitable replacement area has beer evaluated and may be utilized lo' the location of a repiactir l soi absorption system The replacement area sfrou:d tie Protected fl cLShl'panCe and compaction ant shouter not be mtrnaed upon by recoiled setbacks frcm existing and propcsed structure, lot Lnes and wells. Fawre to protept the replacement area wit result in :he need Iv a new soil and site evaluation to estaoist a suitzoie replacement area Replacement systems must comply ;nth tae rules in effect at the time of their permit issinnoe. ❑ A sudapie re; laccmem area is not avai.able due. to setback andror soil limitations 1' one soil absorption system cannot be renabilhalec and barring advances m POvb'TS techndcay, a no ding tank may be Installed as a last i ❑ The site has not bien evaluated to identfy a suit891e rep:acement area Upon failure of the PWt'`S a soil and site evaluation must be performed to locate a suitable replacement area It no replacement area is avalable a holding tank dray be inslaliec as a last resort to replace the `ailed POWTS. FI Mound and at-grade sot abscirphor systems may be reronstructec in place fohowrnc rsmcva' of the biornat a the infiltrative suit Re-consuorliona of such systems must eorTlply Wit'r tnO rubs it cftect at that tine WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK . SUFFICIENT OXYGEN TO SUSTAIN LIFE NFVFR ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEAT-1 MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS IN TA ER POWTS MAINTAINER Nam= Name i~ Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGUL TORY AUTHORITY, Name Name Phone More This document was draftee by the mafi of the 8ree.r lake. Marquette arxf waushara County POA-S rerjulalmy agenaes in compliance with sections Comm 83.22(2)fbjt1)I,d)&(Q err $"354;1).17; & (3i. bV,r;wnsn nrlmmslrahva:"Ode. ST. CROIX COI INTV ' SEPTIC I'ANK MAIN'I'I?NA\( F A(iRI+AIkN I' AND (AVNERSI IIP CER IVICAIION FORM OwnerAluyer Hutter / Behrendt Mailing Address _ 2247 County Property Address Road I tVct ifieation retluirt-d from Planning A /wring Departrenl for new conslrurlion I Citv%Statc Somerset. WI Parcel Identification Number 032-2177-10-000 LEGAL DESCRIPTION Property Location Yi . 5I , Sec. 11 .1. 31 N R 19 W, Town of Somerset Subdivision Plat: Hidden Hills 04 Lott, 10 Certified Survey Map # Volunle . Page N Warranty Deed # (before 2(f07)V0lunfc Page # Spec house❑yes0no Lot lines identifiablel]ycs❑no SVSTEN1 MAINTENANCE AND OWNER CERTIFICATION hill .roper nse .and mairtrnanec ufyour xepl -e'ysunn could re.ull io in prrmalure fniltvc Io handle wastes- Pieper maunen.Ince..... "f pmupiop, nut the wpnc lank every duce vru., or "incr. it nceded. by I., eowd pumper. what you pet into the syerecl can of ecl the funetior (if the optic tank as a (I'ealmclit stage in the wasw disposal syNrcir Owncr niainrcnsncc reaponsibtlities are specified in jSPS. ?Sl i-(I;t and in ('haptrr I? - SI Croix Cotnty Sanilary Ortiman:c I he ptuperty owner agrees ;o ,ubmrt to St. Croix Courly Planning k /"ring Ocpanmcnt a ccrtificauon loon, signee by the o-,cncr and by a n:a"ter plumbu,juurncymxn pluntbcr, rrstrteted pluntbcr )r a licemed pumper scrifying that ( I ) the on-site w: sw%%atcr disposal syatcn is in prover ollcra inn? condition and to (2) allc~ inspecuor and ptrupiny (if necessary'), the ncpuc lank is lee: than 1 r3 f oil of sh.dgc. Five. the undersigned hace read the about, w(lLirements and agree to maintain the pro ate sewage c isposd syslcut unfit the standarrz %,-I forth. herein, as sct by the Department .11 Saf ly And Professional Scri ices and the Dopartmtni of Satural I(csoures, Slate ul AViscu:ul:I. Cerlil icauon'Ialing that yam Ncptic sy,Irnl has teen maintained 11111,E he Cuugrkeed and returned III the Sn Croix County Planning k Zcning Department within 10 days of the three year cxpa'ation date. liwe ccrlCfy that all statements on this form are true to the best o' my our knowledge. liwc anllate the ownerlsl of the properly deacl ihcd above, by cirune of a wananly decd recorded in Register of Deeds Ollicc. Number bedrooms 5 SIGNATURE OP APPLICAN F(S) DATE '**A ny information that IN nuut,presa Icd ntay result in flee sanitary pct mil being tevokcd by the Planning k /suing Ilepartmmll- Include with (his application a recoralcel warranty deed from the Register of Deeds Office and a copy of Ibe certd ied survey map if reference is made in the warranty decd. (REV. 04/12) u ~ r Ott x 1:~ J J'I 3Y -~SJ ~ Y` ♦a< i`YY Y \ t -LJr fi 0^.. ' e't O ~ + t F n { F yYnS: ~ 1 Y i t93: • t 1 h~t: b1 4 bb eY'. } ~ N ~ r~ ~1 b O1. lS. ~ ➢ •S! .L eK F .i "OHS . w ~s b s~ O e R J i` ~ j t Y~ iS i i~ Y VE f s ' -tax .:l MLI~H :MIIHL =UNIl07 KY O A j f~, g ; t .AFyaY' ;l r i S F iei -.i sf V. Ddf. cc ` t } \ } A 1 }`S xf i- - rI- ' t~ i x s -f j x 17 [1 ' i c a r z rYyi j ° r' I 17 ~ kf 11• !i l SI { { t f A Y ~ A. ij I I >.np OoOp a.a: ~ np~ 3y~o '^F r 7: i. ~ NciQ °zn - m `eo z ~zio Z Yr PiHWW~I)1~)INE ST Nm^ in '^4m O h1 I (POI%(DIINIY a N ~C ART, C~ CWRUIINI(SYSIFM S C It\ 70 1 2 2 \lE NI I}I aaa~ I FofeN 1 'o y I R.a ~ "30 I I= ~~UII':i1l ISP I ~ - el ll, NIp IJ'JS WS58.,-.a LOT 10, HIDDEN HIl1S ~ _ - JvRJI o aaoQY. n. aaz moor. aJXaaJ _ _ BOUNDARY SURVEY SITE PLAN /rA Cmd+ry/modnr Wsm I Parcel 032-2177-10-000 o>vl l: o4' I PAGE OF I OF Alt. Parcel 11 3'..19.1514 032 - 70VVN OF SOMERSE I Current X ST CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07;01;2904 00 0 Tax Address: Owner(s): 0 - Cwrenl Ovmcr, C - Curren: Co-Owner O- WICKMAN, JEFFREY T& S f ACEY L JEFFREY T & STACEY L WICKMAN 11090 DOGWOOD CT VVOODRURY MN 55'•29 Districts: SC - School SP - Special Property Address(es): = Priri! Type Dist # Description ` ? 222ND AVE Sc 5432 SOMERFET SP 170':) WiTC Legal Description: Acres: 6.540 Plat: 10-013-HIDDEN HILLS 032-04 4!15 SEC 11 131N R19VV PT NW S%.h' HIDDEN FIL. S Block/Condo Bldg: LOT 10 '04 LOT 10 (6.64AG) Tract(s): (SecTw.n-Rng 40 V4 160 1,4) 11-31N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type J4±C5r 200)) 791428 2778;238 IrJD )7+:',2004 1615(:5 Or13 PLAT 12+3'20173 751)40;3 2483!20(1 E2-U Jfl':3,2003 738643 2398!532 177-1 2008 SUMMARY Bill Fart Market Value: Assessed with: 0 Valuations: Last Changed: 08r'C%2005 Description Class Acres Land Improve Total State Reason RCSIDEN-IAL (I 72,2(;C NO Totals for 2008: General Property 6.640 72,200 0 72,200 Woodland 0.000 0 0 Totals for 2007: General Property 6.640 72.200 U '2.200 Woodland O. J00 0 U Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total OOD 0 .JC O.OC 1C]If7?Jl4N .U13GI 9 "3 I / M I1.lnl4'<wv 9 301 G i) F- u C Ul lr f - i5 Y III i~ I I I L. r I Ll i 4 Ir-.IL. 're ~__LJ a LJ 1 I N f ,oao L'~; Ti ~~.~YM Irv MH Nx1lIJ V VIA /8:111f1H.(WV,?wf Y i IIIIi1E~ ~ II I li „ t) I r JI i) I \ t I (j Y tf, 1 3Hd1>K3!A5 I 14aon AlurnJ azz ' laua~a~~~rl~~vu•ruinaLra.cwvv u:f b.,. ,n q,•nl III I u -4 1 I ur~ 11II Y a I 7 1 - - '7° .1 t id f i rte. , L I l l:U 1211178,0138 9 U 1L I OW114 AWM 4 70( III J., 0 1- U ~ N is r I • r I .........i j 1 vlsconsin Department of Commerce SOIL EVALUATION REPORT Page _ ~ of Division of Safety and Buildings in accordance with Came 85, Wis. Adm. Code Attach complete site plan an paper not less than 8 112 x 11 inches in size Plan must County mc!ude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or danensions, north arrow, and locatron and distance to nearest road. a ( ] _Lr_ Please print all information. Reviewed by Date Persmal i inne,atiorh you Mi,,,de may be oser: for secondary purpowu (Pnvaq• I aw, s 15 04 (t) (roll , Y1~ .I lu{ • t' ' 4 %l Property Owner Property Location - y, (C Govt. _ot 114 1:4 S T N R ' 9 (or)I?_y Property Owner's Mailing Address Lot # Blotch # Subd. Narne or C541# city `Stwle Zip Code Phone Number I] city I-] Village ❑ Town Nearest Road New Construction Use: I] Residential t Number of bedrooms Code derived cosign flcv rak: GPO Replacement ❑ Public or commercial - Describe: Parent material 2_ C< -r w.,; . p Flood Plain elevation if applicable General comrmnts n and ruwrnnheihdatiahs: - ti. L .f Boring Raing # - - - Pit Ground surface elev. ft. Depth to limiting factor in. gz:,l Athphc bran Rate Horizon Depth Dominant Color Room Descnption Texture Structure Consistence Boundary Roots GPD1W in. Mun<_e!I Ou. Sz- Cont Color (N- Sz. Sh. 'Elf#t -Eff#2 J Bourg # ❑ Boong 0 Pit Ground sudace elev, -ft. Depth to limiting factor in. Sod Apol:catien 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 'E".2 h~ ' ( f _I 'Lit Yf ; Effluent #1 = BCD, > 30 < 220 mgtl and TSS >30 150 mry'L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mgR- CST Name fFjlease Print) ) Signature CST Number Address hale Evaluation Conducted Tele;;ncne Number i WD-W,D lR07rou) PropeMDwner f_ Parcel ID#__._-. page of M Boring # ❑ Boring 4` Pit Ground surface elev. B. Depth to limiting favor i in. Sal ApPicalwn Rate Horizon Depth Dominant Color Redox Description 1 exture structure Consistence Boundary Roos GPDMr in. Munsell Cu. Sz. Gont color Gr. Sz. Sh. 'Etf#1 •Eff#2 7-„ ~>-y~ _r ~ii'- r•1~, iii. ~ C;I ~~Lt i ❑ Boring ❑ Boring # ❑ pit Ground surface elev. H. Depth to limiting factor in. Sag Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD P in. Munsell Ou- Sz. Cont Color Gr. Sz. S'l 'Eff#1 'Eff#2 E] Boring F-1 Boring # Ground surface elev. It. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Darninanl Color Redox Description Texture Structure Consistence Boundary Roots GPDM? In. MunsOf Co. Sz. Cont color Gr. Sz. Sh. 'Elf#1 -Eff#2 ' Effluent #1 = BOO. > 30 < 220 rrx,/L and TSS >30 < 150 mNL ' Effluent #2 = BCD, < 30 mryt and TSS < 30 mgr. The Department of Commcrce 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 008-266-3151 or 1TY 608-2648777. Saox%10(107 o1 L. 0-7 Property Owner 91'4 - r /D(e e Px l ID Page of • _ -1 Boring # Boring 96. ® Pit Ground surface elev. 7 rt. Depth to fimitlng factor SOS _ in. Sat Applir2tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RML% GPDMr M. Munsell _ Qu. S_z. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 74 VW -Yf ❑ Boring # ❑ Boring ❑ pit Ground surface elev. h. Depth to limiting facia in. Soil Application Rate Horizon Depth Dominant Color Rodox Description Texture Stmct re Consistence Boundary Roots GPD1W in. Munsell Qu. Sz Cont. Cola Gr. Sz. Sh. 'Etf#l 'Eff#2 ❑ Borng # ❑ Baing ❑ pit Ground surface elev. ft. Depm to limiting fades in. Soil Applirdtion Bale Honzon Depth Dominant Color Redox Description Texuue Structure Consistence Boundary Roots GPD4t' in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mg7L ' Effluent #2 = BODr < 30 mglL and TSS < 30 nVL 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 sanumrxmrou> OWNER Page 3 of 3 Name le Brian Pamcll A(Liress• 2 2 CS1 23131-1. ~ C ~-T- Date A Benchmark 1 L_ A•- Renchmark 2 LJ Soil Baring Suitable Atca I 0' Sca --T - - i. I i ` L + ~ 1 I ~ + I T 711 = > t; .f- l_ } - •