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181-1009-10-000
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Vi D K ® - n>f ea] - 'ST.Ifi — r 1xi0 pop &II eo, tm.e xio xio o g I m- b o o I• `'/ 0 110A t7 ON 4 $ mo O aD G ® N 1 o > L ® �g 5 a � LybJ ♦126 4> ��� I 3 3 1174 4123 S . p A ti I ]ee.0 zt a.x I 2sl.o Parcel #: 181 - 1002 -60 -000 09/22/2006 08:21 AM PAGE 1 OF 1 Alt. Parcel M 35.31.19.9A 181 - VILLAGE OF SOMERSET Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - FLOAT -RITE INC FLOAT -RITE INC 515 SPRING ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 35 T 31N R1 9W OL 9 EXC COM NELY LN Block/Condo Bldg: SPRING ST 1031' NWLY OF SE COR OL 36, NWLY ON ST 100', NELY AT RT > 200', SELY Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) AT RT > 100', SWLY AT RT > 200' TO POB & 35 -31 N-1 9W EXC COM NELY SPRING ST 408' NWLY AT W LN OL 36, NWLY ON ST 100', NELY AT RT> 200' more Notes: Parcel History: Date Doc # Vol /Page Type 05/04/1999 602498 1423/599 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/23/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 0.000 342,800 315,000 657,800 NO Totals for 2006: General Property 0.000 342,800 315,000 657,800 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 342,800 315,000 657,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 181- 1002 -30 -000 09/22/2006 08:22 AM PAGE IOF1 Alt. Parcel #: 35.31.19.713 181 - VILLAGE OF SOMERSET Current )Xl ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FLOAT RITE PARK INC FLOAT RITE PARK INC 1868 CTY RD I SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 7.110 Plat: N/A -NOT AVAILABLE SEC 35 T31 N R1 9W PRT OL 7 ALSO IN OLS Block/Condo Bldg: 36,42,& 8 COM INT E LN OL 36 & N LN SPRING ST NWLY 915' NELY TO CEN APPLE Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) RVR IN OL 8 SELY ALG RVR TO EXT E LN OL 35 -31 N-1 9W 36 SW TO POB VIL SOMERSET INC (P8A) 181 - 1002 -40 & 181- 1006 -95 (P36B) Notes: Parcel History: Date Doc # Vol /Page Type 06/05/2006 826741 QC 02/16/2001 638672 1588/08 WD 07/23/1997 809/18 2006 SUMMARY Bill #: Fair Market Value: Assessed with- 0 Valuations: Last Changed: 08/27/2001 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.110 40,500 16,400 56,900 NO PRODUCTIVE FORST LANDS G6 5.000 37,000 0 37,000 NO Totals for 2006: General Property 7.110 77,500 16,400 93,900 Woodland 0.000 0 0 Totals for 2005: General Property 7.110 77,500 16,400 93,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 181- 1002 -20 -000 09/22/2006 08:21 AM PAGE 1 OF 1 Alt. Parcel #: 35.31.19.7A 181 -VILLAGE OF SOMERSET Current XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FLOAT -RITE INC FLOAT -RITE INC 515 SPRING ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description " 710 SPRING ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 35 T31 N R1 9W 2A PRT OL 7 AS IN VOL Block/Condo Bldg: 218/389 VIL SOMERSET ASS'D W/181- 1002 -60 (9A) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 35 -31 N-1 9W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 430/631 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 181- 1002 -60 -000 Valuations: Last Changed: 09/27/1994 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 181 - 1003 -30 -000 09/22/2006 08:20 AM PAGE 1 OF 1 Alt. Parcel #: 35.31.19.9H 181 -VILLAGE OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - FLOAT -RITE INC FLOAT -RITE INC 515 SPRING ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 35 T31 N R1 9W PT OL 9 THAT PT OF OL 9 Block/Condo Bldg: AS DESC IN VOL 974 PAGE 482, EXC THE LAND DESC IN VOL 974 PAGE 384 ASS'D Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) W1181- 1002 -60 (9A) 35- 31N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 974/482 QD 07/23/1997 974/384 QD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 181- 1002 -60 -000 Valuations: Last Changed: 09/27/1994 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 181 - 1003 -30 -002 09/22/2006 08:19 AM PAGE 1 OF 1 Alt. Parcel #: 35.31.19.91 -10 181 - VILLAGE OF SOMERSET Current "X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner FLOAT RITE PARK INC O - FLOAT RITE PARK INC PO BOX 276 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): `= Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.420 Plat: 4371 -CSM 16/4371 181102 SEC 35 T31 R1 9W PT OL 9 BEING CSM Block/Condo Bldg: LOT OL 1 16/4371 OL 1 (0.420AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 35-31N-19W SE NW Notes: Parcel History: Date Doc # Vol /Page Type 06/03/2004 764722 2588/143 WD 09/11/2002 689964 16/4371 CSM 07/23/1997 974/38 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/02/2003 Description Class Acres Land Improve Total State Reason OTHER X4 0.420 0 0 0 NO Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' • INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430073 0 GENERAL INFORMATION State Plan ID No: ��� / Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 10 Permit Holder's Name: City Village X Township Parcel Tax No: JKRC, LLC I Somerset Township 181 - 1003 -40 -060 CST BM Elev: Insp. BM Elev: Description: Section ( rown /Range /Map No: d 35.31.19.10H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2 l • l� /dl� a. D � WL0, ", �' &Cam/ Alt. BM w J� 27- Aeration Bldg. Sewer W - . 3 Holding St/Ht Inlet b• 3 � 3� TANK SETBACK INFORMATION S Ht Outlet 3 TANK TO P/L ELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 30 / N f Dt Bottom D /+ ` Head 1 .v 3 q2, Aeration 2 Dist. Pipe I i G+•Og Z• ff 7 Holding Bot. Syste ` I PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number i i TDH Lift Fri n System Head TDH t Forcemain L th Dia. is SOIL ABSORPTION SYSTEM ( aj v y BED/TRENCH Width Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 -r / SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manuf r INFORMATION n ,' /f / CHAMBER O Typ f Syste �� �r / UNIT Model Number: DISTRIBUTION SYSTEM ) Header /Manifo d Distribution / x Hole Size x Hole Spacing Vent to Air Inta,E Pi 0 � � Zrt � Lengt Dia Length Dia Spacing 2 i SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center (l Bed/Trench Edges Topsoil l d [:J Yes [J? No Yes L No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 112 / /0 Inspection #2: Location: Somerset, WI 54025 (NE /4 SW 1/4 35 T31N R19W NA Lot 10 �� Parcel No: 35. 31.19.1 OH 1.) Alt BM Description = �" �'vl Sd� ' """+'� / L 2.) Bldg sewer length = J - amount of cover = O Plan revision Required? I ;j Yes :',' No Use other side for additional information. �� SBD -6710 (R.3/97) Date Insepctor's Signature V Cert. No. A Safety and Buildings Division County 201 W. Washington Ave., P.O. Bo ( )1 Z 2 isconsin Madison, WI 53707 — 708 Sanitary P nit mbe (to bi filled in by Co.) Department of Commerce (608) 261 -6546 C-O Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Cod i Ponca-, iou.�ort rovid4 }4 TUC. - 1 .# may be used for secondary purposes 'vacy�t� `I'SI1' r" Project Address (if different than mailing address) I. Application Information - Please Print All Infoi mation Pro Owner's Name Parcel # Lot # I e Block # Property Owner's Mailing A dress I v , r Property Location & , /., J`W '/. Section City, State — Zip Code Phone Number circle ) T� N; RE a �'' II. Type of Building (check all that apply) ❑ 1 of 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number g Public/Commercial - Describe Use a j ❑ State Owned - Describe Use ❑City Qvill a a OTownship of III. Type of Permit: (Check only ne box online A. Co plete line if applicable) A. New S tem ys ❑Replacement System ❑ Treatment/Holding 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. Type of POWTS System: Check all that appl VNon - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade 11 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized ht- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit L Dosing Chamber VII. Res risibility Statement- 1, the undersigned, assyme responsibility for installation of the POWTS shown on the attached plans. Plumb (Print) t Plumber' Si e a MP/MPRS Number Business Phone Number Plumber Address (Street, City, Style, Zip ode) S � ►• VIII. County /De artment Use Onl Approved ❑ Disapproved rs itary Permit Fee (includes Groundwater Date Issued Issui g ent Signature Stamps) cha rge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval f (� &a..,, Attach complete plans (to the County only) for the system on paper not ku than 81/2 x 11 inches in size SBD -6398 (R. 08/02) +J� f ob - -- G+ � (� Flo 5 )t 4 AN I - - 1 °� Safety and Buildings �� 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www.commerc n www.wis .wisconsiin.gov n.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary May 21, 2003 CUST ID No.224263 ATTN.• POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 05/21/2005 Transaction ID No. 867630 SITE: Site ID No. 659173 JKRC, LLC — Outdoor Concert Site Restrooms Please refer to both identification numbers, 515 Spring Street above, in all correspondence with the agency. Town of Somerset St Croix County NE1 /4, SWl /4, S35, T31N, R19W FOR: Description: Proposed Commercial Non - pressurized POWTS - 1106 gpd Object Type: POWT System Regulated Object ID No.: 903638 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: Conditions of Approval: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10705 -P (N.01 101). • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. .. KIM A O'CONNELL Page 2 5/21/03 Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633' jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ► r A c1 RECEIVED MAY 14 SAFETY & BLOGS D _ 07 VA �m," l o� , J /�' / ✓rR / 75 p/,/ ��- s /6�J.'/� I , �o� J� (/ 4- vOnJ.t�.�: �/ ✓C / �YE/✓5< �/i �� /��G 3 ��✓�ru�� . ` ce yis' -osl 7?17 4044 4) sm; / /f�so�Pa >o,J �o� ��� /7 /�ua�� rc� ©IAJ�.S IL 1 fop p � r iV0 , �(if� o g Q�$2Cd 0/J lJ4nI� /�1KS O✓ J � f/COJYNrvJ owo y c �r 04 ed rJ t� it 1'U 1Y'I' U\YNl:il'S MANUAL Jc MANAQLtyl :NT PLAN r0 FILE INFORMATION SYSTEM SPECIFICATI Owner Se tic Tank Capacity al o NA ', Se tic Tank Manufacturer o NA Permit ii Effluent Filter Manufacturer 4 o NA DESIGN PARAMETERS Effluent Filter Model - Q NA Number of bedrooms NA - Pump Tank apacity gjil O NA Number.of Commerciul Unit ggg s - o NA Pump Tank Manufacturer O NA Estimated now averse al /d Pump Manufacturer or NA Design -, flow eak Estimatd x I.S al /da Pum Model cyNA Soil A )lication Rutz, _ g;tl /dn /fl Of Pretroutod Unit Influent /l fl'luent Qw1lity Nlunrlily Ayvrube" a ti;uttl /C;rnvui I filler to Neil I iilvr Fats, Oils & Grasso (FOG) _,IU nib /tr rt Mucluuti�;�l �erntiatt a W� tl;ut�l Biochemical Oxygen Dcmund (9ODs) 5220 mg/L T o Dislofoction o Other; Total Suspended Solids (TSS) 5150 m L Men Monthly Average ** Disperss al al C Cellll( s) Pretreated Effluent Quality O NA 1(ln•ground (gravity) o In- ground ( prossurized) Oxy�cn Demand (DOD ) 510 mb /l., o Al-grade. Mound BioChvmicul `lU m /L Total Suspended Solids (TSS) < , b o Uri lino o Other: Fecal Coliform (geometric mean <10" c fu/ IOOmL Maximum Effluent Particle Size '/A inch diametor • Values typkwl for domosrlc (non- commorciill) wauewstar and septlo trlutk eftltttsnt, T. •• Values typical fvt ptvt[oraW woiiwwowr. MAIN'T'ENANCE SCHEDULE Service Event Scrvicr Fro uvnc Inspect condition of funks At leust once evc"Y o months curs hluximurn Pump out contents of tank (j) When combined sludge and scum equals one third 'h of tank velar; Ins ect dispersal cells At least once every o months eats M ximum 3 I n Cloun effluent filter At loust once ovory o months id yourW Inx )ect um mln)2 controls & ;1kirtti At least once uvury u months o uur s Nn Flush laterals mid pressure text At least once u-yvry o months Q ours aNA' At least once every o months o ours NA..... _. Other: At least once every o months 4 curs aNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following lieonsos or certification Master Plumbor; Masto Plumber Rostrlctod Sewer; POWTS Inspoctor; POWTS Maintainer; Soptago Sorviring,Oportitor Tank inspections must includa•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 t: ground surface. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check. for any pending of effluoncon rho ground surface. Tho ponding of effluent on Cho ground st�tfgco taaay.indicate a failing conditiowand requires the immediate notification of f;he local mplatory authority. When the combined accumulation of sludge and scum in any tank equals one, -third ( %) or more of rho tank velum;;, the crlt. contents of the iatnk shall be removed by a Septa�e Servicing Operator and disposed of in accordance with ch, N.R 113, 'Wisconsin Administrutivo CUde. 'The s' drvicing of effluent I•iltors, mechanical or pressurized POWTS components, protroutmont components, and uny other maintenance or monitoring at intervals of 12 months or lesghull be performed by a certified POWTS lytaiintitinc/, A se. rvice'report Shull be provided to the local rebulutory nwhority within 10 days of completion of any sorvico event.' STA UP AND OOLKA'T ION For now construction, prior to use of the POWTS . treatment tank(s) for the presence of painting products or other chemicals that my impede tho treatment proces> and/or damage the dispersal coll(s), U high 99noono4ontl Attu 4O.W144 hue the contents of the,tenks(s) removed by a sept..,,. servicing operator prior to use. Owner: Page z0f � System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal higwater levels. When power is restored the excess wastewater will be discharged to the dispersal 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 soft absorption are. 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 scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT 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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or 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 replacement system: X 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. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ `The site has not been evaruafed to ickfr tify� 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 J „ , 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 F#ust comply with the rules in effect at the time. <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INS TA L R POWTS MAINTAINER Name Name Phone — Phone SEPTAGE SERVICING OPERATOR UMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 7, T A50 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --/— of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must S include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ Please print all information. Re ewed by Date you provide may Personal information �- y p y be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 12. Property Owner Property Location Govt. Lot 1/4s O 1/4 S L N R (or) W Property Owner's Mailing Address Lot # Blo # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village % Town Nearest Road Z 7�w New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate �_ 7. 5� GPD E] Replacement Public or commercial - Describe: - r Parent material Flood Plain elevation if applicable ft. General comments / RECEIVE and recommendations: S�s7f� �'� �3 MA 2 0 2003 COON!' M Boring # ❑Boring ZONING OFFICE 14 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 �- r I& 93• yZ) �o•�� Iola -�' n Boring # ❑Boring '// ,� Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i 3- � Z * 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 Nagneoease Ph ) j Sign CST Number Address / Date valuation onducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # ��� /di" 9— i'0 Page 2 of ❑ ❑ Boring # Boring —�� Pit Ground surface elev. 7�'� ft. Depth to limiting factor ��1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 h s - - 7 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu.'Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) e I ' � 3 437n.2 \ I 68 � A h� -e sD ��N r - GRADED :'AREA TQ BE �WAT Ep POWN I , �. 1F DUST-' BEP'OMES A PROBLEM 1 1, , .« sadELEa p ox L LAG. E' ELEC. \ . - ELEC. I \ i ! 1 PA Lp I ELEC ELEf, BOXES C V ' ELEC• \ O � MINIM'AL ,GRADINq TO LOPE t l 1 LAND- TO CAT' H BALI , \ BUILDING E6EC,' BOX ..'ELEC. BOx ELEC. BOX 99 ; WA T E R , ,- 4 7 o, oE LP y, 'LP t i� / TEL �b ll — /'' EL§O. BOX � a I, 06 �? M , / E OATf��+ 1 I ,I t\ , I 1 \ 1 i 1 ` •1 1 I \ \ \. ... if ' if - � ^ - TT I / \ 'p0 "r,. `•, \` '\ t� .r • � X96.86' r .� � + , ,� ... •..._... • — ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ��" /� - 5;�' ;1/� s� �x� �. ,����s ,�, ILL Property Address (Verification required g red fro m Planning Department for new construction) P City/State Parcel Identification Number �A LEGAL DESCRIPTION Property Location V,, --IL %., Sec. Y� TY_N -R _W, Town of Subdivision Ilot # L O Certified Survey Map # , Volume . Page # Warranty Deed # (0 S 3 , Volume I` t It) , Page # S I Spec house ❑ yes In 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 em eve three ears or sooner, consists of pumping out the septic tank every y , if needed by a licensed pumper. What you Put into the cyst 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 maskr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 year 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 descr above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE « « « « «« being revoked b the Zoning Department.""" Any information that is mis- represented may result in the sanitary g Y w this ap a s warran Include wi pp stamped deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I _ � U 1970P 151 t3 STATE BAR OF WISCONSIN FORM 2.1999 E' 6 9 5 3 7 HATHLEEN H. YALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between Anna L Belisle RECEIVED FOR RECORD -- _ -- 09 -06 -2002 9:30 AN - - WARRMTY DEED Grantor, and JK LLC, a Wi sconsin Limited Liability Company, EREMDT it REC FEE& 13.00 TRANS FEE: 19.50 — COPY FEE: CERT COPY FEE: Grantee. PAGES: 2 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A ") Name an t �Ifgf PRX OGLAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 Pt of 181.1003- 40.000 Parcel Identification Number (PIN) This is not - _ -- homestead property. ()I) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this _7 day of _ August 2002 7 + + Anna L Belisle — - AUTHENTICATION ACKNOWLEDGMENT Signature(s) A nna L. Belisle STATE OF WISCONSIN ) ) ss. County) authenticated thisz d of August 2002 - rt Personally came before me this _ day of the above named • Kr istina Ogland - TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoir.3 (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + __ Attorney Kristiaa Ogland Notary Public, State of Wisconsin Hudaoa, W 54016 — -_ My Commission is permanent. (If not, state expiration date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. wdmmeacn P,ere.. ll Cmnpeny. Fens du Uo, YN STATE BAR OF WISCONSIN 80DA155-2021 WARRANTY DEED FORM No. 2- 1999 U 1970P 152 EXHIBIT "A" A parcel of land located in part of the Southeast Quarter of the Northwest Quarter of Section 35, Township 31 North, Range 19 West, Being part of Outlot 10 of the Village of Somerset, St. Croix County, Wisconsin described as follows: Commencing at the East Quarter corner of said Section 35; thence. on an assumed bearing along the east -west quarter line of said Section 35, South 88 degrees 11 minutes 00 seconds West a distance of 3097.55 feet to the southwesterly right of way of County Trunk Highway "I" and the point of beginning of the parcel to be described; thence, continuing along said east/west quarter line, South 88 degrees 11 minutes 00 seconds West a distance of 208.28 feet to a set 1" Iron pipe; thence, North 28 degrees 26 minutes 37 seconds East a distance of 104.96 feet to a set 1" iron pipe on the southwesterly right of way of said County Trunk Highway "I "; thence, along said southwesterly right of way, South 61 degrees 33 minutes 23 seconds East a distance of 179.90 feet to the point of beginning. St. Croix County, Wisconsin.