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030-2016-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf,:ty and Bbilding Division INSPECTION REPORT Sanitary Permit No: 499104 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: a/ Personal information you provide may be used for secondary purposes [Privacy Law, s.15,04 (1)(m)]. A1 A Permit Holder's Name: City Village X Township Parcel Tax No Kri er, Karl & Joy I St. Joseph, Town of 030 - 2016 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No tII 1 Z I bo 36.30.11.418A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I r 'tr'X. � S T/ N W t E�SuQ.. cn70 3 •a'0 l 03.0 (3U • � Alt. BM N �S 261 Aeration Bldg. Sewer 1 S J Holding St/Ht Inlet OF j+S_41 SUHt Ou tle t TANK S BACK INFORMATION �gu� �'• . 30 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f > t i Dt Bottom 30 2S 2 2 r Header /Man. � 7 .9S 9 .c� Aeration 7e q• 33 3• Holding Bot. System � r 9'Z• S3' Final Grade PUMP /SIPHON INFORMATION s'� %1 Manufacturer Demand St Cover 2) IB il�=tr5 qua S• r- U tS Model Number S 3 Z W 6 0.E TDH Lift Fri n Lo System Head TDH Ft 7l ST► Forcemain Length Dia. o Well SOIL ABSORPT ON SYSTEM BED /TRENCH Width Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 g�. Sb gCL C2� SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Tj►�FI� -�� 5 ' Type Of ` S r ystem (O � 1 > UNIT Model Numbe I2 w DISTRIBUTION SYSTEM Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake �µ/ Pi (s) r Length Dia 1 Len Dia pacing 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 Jam Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 Inspection #2:_ _ Location: 875 Willow River Drive Hudson, WI 54016 (SW 1/4 SE 1/4 36 T30N R19W) NA Lot Parcel No: 36.30.18.418A 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = -- - — Plan revision Required? Yes 1J No Use other side for additional information. _- __ _- - -- V Inse ctorsSi nature �`�o SBD-6710 (R.3/97) L71 & j., (f K 4ate p 9 Safety and Buildings Division County N Viscon 1 W. Washington Ave., P.O. Box 7162 n Madison, WI 53707 — 7162 Sanitary Permit umber (to be filled in by Co.) Department of Co (608) 266 - 3151 Sanitary Permit Application State Plan 1. D Num ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide W14 - may be used for secondary purpos s15.04(1 xm) Project Address (if different than mailing address) I. Application Information — Please Print All Information Prope7 Owner's Nam AUG 0 3 200 e parcel # \ Lot # Block # Proferty Owner's ling ddre s C OUNTY Property Location o r � � 3 City, State Zip Code Phone Number >�L �� "° �"��• Section (circle e) II. Ype of Building (check all that apply) T _0 N; RL!UE o� 1 or 2 Family Dwelling — Number of Bedrooms ' / �—p C M Number El Public/Commercial — Describe Use 5 ❑ State Owned - Describe Use ❑City_ ❑Village Urrownship of f III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 _ Z©( - JO _ A. ❑ New System XReplace 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 t 0C A IV. Type of POWTS System: Check all that apply) x 6 Z. e u 0 Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter X L - Whing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispe rsaVIrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersal Area Proposed (sf) yteem l vation Goo 8 0. c r do VI. Tank Info Capacity in Total Number nufa r Prefab Site Steel Fiber Plastic Gallons Gallons of Units W(Z �' 1 Concrete Constructed Glass New Existing I 4ky 2.60 C w/ Q (),,) �I Septic or Holding Tank Tanks Tanks e Aerobic Treatment Unit akj Dosing Chamber VII. Responsibility Statement- 1, the p4dersiped, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) lu 's re MP/MPRS Number Business Phone Number Plumber's Address (Street, ity, State, Zip Cod 0 (Street, A ups VIII. Coun eiDartment tke On pproved ❑ Disapproved Sanitary Permit Fee ncludes Groundwater Date Issued Is uing ent Signature o Stamps) (( Surcharge Fee) p eason for ial Q O IX. Conditions of Approv 1 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 x I 1 inches in size SBD -6398 (R. 01/03) , o a A4 3's'btv\ Roo meesier ST� LO�ca� ion q� f r Z iCf2aUR 1 flo' 30 we {► yS o aS a 3 �00U 9,0 f Lk1 Sfij1LC� c i 1 s C O V4 Qoftur, 1) �2FNG�S 9ao�a o M A4 me KAY) 44 r- Tm u mee s G�Ge�se �!�dqo� TaO NUk S a UTL IOU eL Ba � s i ¢ :t�oM � S• b a �� II d 30' w�11 a �S �B )Io" 3 �OOU 9 � �kl sfilhrq d(j3� c J� i l rteN��s 9� e Sd A.C.E. Soil & Site Evaluaidons James K. Thompson 340 Paulson Lake IL11. Osceola, WI 54020 (715) 248 -7767 To: Zoning - Attn; Kevin fax #_ (715 )386 -4686 From: Jim e - . -Monday - August 07. 2006 �_ �^ 2 C - e ages including cover : --4" _ - - If fax is incomplete or illegible, please contact Jim Thompson at elephone number listed above. Kevin: Attached is a complete and accurate copy of the original soil evaluation report that 1 completed for the Karl Kriger proporty. 1 will drop the original in the mail later today, so you will hopefully have it by tomorrow or Wednesday at the latest. Thu s for letting me handle this this way, ,Jim Too Z "IVAd 3,LIS V 'IIOS 3 0 F V9LL 8bZ STL XVd 99:80 900Z/L0/80 RJ L" 1985 • Wisconsin Department of Commerce SOIL EVALUATION REPORT �..�.•��....•�+, PajW 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code R.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D percent slope, scale or dimensions, sions, north arrow, and location and distance to nearest road. 030-2016 0 - 00 Please print all information. Review y Da Personal information you provide m be useREK@E l V�aMvacy , s. 15.04 (1) (m)). �S G Property Owner Property Location Karl & Joy Kriger AUG 0 $ 2naG Govt. Lot SW 19 SE 19 1 36 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 875 Willow River Drive I ST. CROIX COUNTY 5 1 CSM Vol. 9, Pg. 2674 City St to Zip Code Phone Number City Village jM Town Nearest Road Hudson WI 1540161 (715) 246 - 7902 St.Joseph I Willow River Drive J New Construction Use: tM Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS @ 0. 7 gpd /sq.ft. Install three trenches (3'x 62') at elevation 92.50' using 4 Quick 4 Infiltrator chambers. Boring # J Boring 0 Pit Ground Surface elev. 98.52 ft. Depth to limiting factor >128" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -15 10yr3 /2 none sil 2fsbk dsh cs 2fmc 0.6 0.8 2 15 -30 10yr4/4 none sit 2fsbk ds gs 2f,1mc 0.6 0.8 3 30-45 10yr5/4 none sic[ 2fsbk ds cw 1fm 0.4 0.6 4 45 -51 10yr4 /6 none Is 0 sg ml gw if 0.7 1.6 5 51 -128 10yr5/4 none s 0 sg dl - - 0.7 1.6 Z *Effluent #1 = BOD 30 < 220 mg and TSS >30 < 15 mg/L * E nt #2 = BOD < 30 mg /L and TSS < mg/L CST Name (Please Print) Signature CST Number James K. Thompson - S 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceow 154020 6/7/2006 715- 248 -7767 F 2 ] Boring # J Boring 01 Pit Ground Surface elev. 98.33 ft- Depth to limiting factor >125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/2 none sit 2fsbk mfr gw 2fmc 0.6 0.8 2 16 -28 10yr4/3 none sil 2fsbk mfr gs 2fmc 0.6 0.8 3 28 -30 10yr5/4 none sicl 2msbk mfr gw 2fm,1 c 0.4 0.6 4 30 -39 10yr4/6 none sl 2msbk mfi cw 1 f 0.6 1.0 5 39 -47 10yr4/6 none Is 0 sg ml cw - 0.7 1.6 6 47 -125 10yr5/4 none s 0 sg It dl - - 0.7 1.6 Property Owner Owner Karl & Joy Kriger Parcel ID # 030 - 2016 -10 -000 Page 2 of 3 E I 3 f Boring # I Boring 11 „ 11 Am Pit Ground Surface elev. 97.98 ft. Depth to limiting factor >119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in, Munsell Qu. Sz, Cont. Color Gr. Sz, Sh. *Eff#1 *Eff#2 1 0 -16 1Oyr3 /2 none sl 2fsbk dsh as 2fm,lc 0.6 1.0 2 16 -33 10yr5 /4 none sil 2msbk dsh Cw 2f,1mc 0.6 0.8 3 33-42 1Oyr4/6 none sl 2msbk dsh cw 1fm 0.6 1.0 4 42 -119 1 Oyr5 /6 none s 0 sg dl - - 0.7 1,6 r } \ , 4] 1✓ Boring # J Boring Pit Ground Surface elev. 97.58 ft. Depth to limiting factor >100" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 1Oyr3/2 none sl 2fsbk dsh as 2fm,lc 0.6 1.0 2 14 -27 1Oyr5/4 none sicl 2msbk dsh Cw 2f,1mc 0.4 0.6 3 27-41 1Oyr4/6 none Is Osg dl cW 1fm 0.7 1.6 4 41 -100 1Oyr5/6 none s 0 sg dl - - 0.7 1.6 F -sl Boring # Boring V/j Pit Ground Surface elev. 97.79 ft. Depth to limiting factor > 110" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -20 1Oyr3/2 &4/6 m1f 7.5yr4/6 sil /sl fil 2med pl dsh Cs 2fmc 0.0 0.0 2 20 -32 1Oyr4/4 none sil 2fsbk ds gs 2f,1mc 0.6 0.8 3 32 -44 1Oyr5/4 none sicl 2fsbk ds cw 1fm 0.4 0.6 4 44-48 1Oyr4/6 none Is 0 sg ml gw if 0.7 1.6 5 48 -110 1Oyr5/4 none s 0 sg dl - - 0.7 1.6 Redox. features in H#1 are due to compaction of fill material during house construction. They are not indicative of groundwater, and are not a limiting factor for this site. * _ Effluent #1 BOD > 30 < 220 mg /L and TSS >30 < 150 m /L *Effluent #2 = BOD < 30 m !Land TSS < 30 m 9/- 5 _ _ 9 9 _ 5 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) A.C.E. SON & Site EvaWdon$ � .5o : /edc�ica�v+�� - le �? • /ocafsed�Orc�jo. Q rive —_ lgrus� � fi cs BL � Benc B s d; f�rsa rnca( �Ka ~, 81 mice- es �� J grade e !ur - * fle&=y'fl7 • �� P� 4e5,'11¢17ce - 66 9�0 - I 1985 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis, Adm. Code A.C.E. Soil 8 Site Evaluations County Attach complete site plan on paper not less than 8% x 11 Inches in size, Plan must St . Croix Include, but not limited to: vertical and horizontal reference point (8M), direction and Parcel I.D. percent slope, scale or dimemslons, north amm, and location and distance to nearest road. 030 -2016- 10-000 Please print all Informat/on, Reviewed By Date Parwnal information you provide may be used for awndary purposes (Pdvay law, s. 16.04 (1) (m)). Property Owner Property Location Kart 8 Joy Kri er Govt, Lot SW 114 SE 104 S 36 T 30 N R 19 W Property Owner's Mailing Address Lot !f Block # Subd. Name or CSM# 67 Willow R iver Drive 5 CSM Vol, 9, Pg. 2674 City State Zip Code Phone Number -J City _]Village id Town Nearest Road Hudson WI 1 $4016 1 (715) 246 -7902 St.Joseph I Willow River Drive I New Construction Use: d Residential / Number of bedrooms 4 Code derived design flow rate 600 GPO 01 Replacement J Public or commercial - Describe: — Parent material Glacial Ou _ Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS @ 0.7 gpd /sq.ft. Install three trenches (3'x 62') at elevation 92 .50' using 4 Quick 4 Infiltrator chambers. ❑ Boring # I j Boring 0 Pit Ground Surface elev. 98.52 ft. Depth to limiting factor >128r' in. Sol Application Bale H*dzen Depth Dominant Color Redox Dascriptlon lexture Structure Consistence Boundary Rood GP In. Munseli Ou, Sz. Cont, Color Gr. Sz. Sh, •E(f#1 Eff#2 1 0-15 1Oyr3/2 none oil 2fsbk dsh es 2fmc 0.6 0.8 2 15-30 1Oyr4/4 none sit 2fsbk ds gs 2f,1me 0.6 0.8 3 30 10yr5/4 none sicl 2fsbk ds Cher 1fm 0.4 0.8 4 45-51 1Oyr4 /6 none Is 0 s9 ml gw if 0.7 1.6 5 51 -128 10y none s 0 sg dl - - 0.7 1,6 A R Z•5Z ) Effluent #1 = 6OD? 30 < 220 mg and TSS >30 < 15 mg /L ' E ant #2 - BOD <_30 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature CST Number ds James K. Thom 3602 Address A.C.E, Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Os 1 54020 6/7/2006 715 - 7767 F Boring # J Boring 8 33 fL Depth to limiting factor > 125" In. Sail ate ApplI alllon R 16 p;t Ground Surface elev, 9 , Roots GPD!!t_ liofizat Depth Dominant Color Redox Description Texture Structure Consistence •Eff#1 'Effay2 In. Munsell au, Sz. Cont Color Gr. Sz. Sh. 1 0-16 1Oyr312 none sit 2fsbk mfr gw 2fmc 0.6 0.8 2 16 -28 1G no sit 2fsbk mfr go 2fmt 0.6 0.8 3 28 -30 1O yr5 /4 none sicl 2msbk mfr gw 2fri,Ic 0.4 0.6 4 30 -39 1Oyr4/6 none sl 2msbk mf , ew 1fm 0.6 1.0 5 39A7 10yr4/6 none Is 0 sg ml CW - 0.7 1.6 0 47 -125 10yr5/4 none s 0 sg cil - - 0.7 1.6 (Oct 9 (o �• 6 Z0oz " IVAS 3,LIS V 'IIOS S 3 V t9LL M 9% %Vd 99 :90 9002/LO/80 Property Owner Kad &I Kriger T Parcel ID # 030 - 2016 -10 -000 Page _2 of 3 F I Boring # J Boring II ✓J Pit Ground Surface elev. 97.98 fl- Depth to limiting factor >1�g" in. Sal ApaIcatlon Rate Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Raab Gp in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. `Etf#2 1 0 -16 10yr3/2 none sl 2fsbk dsh as 2fm,1c 0.6 1.0 2 1633 1 Oyr514 none sil 2msbk dsh ew 2f,1 me 0.6 0.8 3 33-42 1Oyr4/6 none sI 2msbk dsh cw 1frrt 0.6 1.0 4 42 - 119 10yr5/6 none s 0 sg dl • - 0.7 1.8 -- Ci Z -so I 4 ]Boring 0 -1 Boring u Ad Pit Ground Surface elev. 9758 R- Depth to limiting factor >100" In. S Applkalln Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. 5z. Cord. Color or, Sz, Sh. "Efr#1 'EfW2 1 0 -14 1Oyr3/2 none sl 2fsbk dsh as 2fm,1c 0.6 1.0 2 14 -27 10yr5/4 none sid _! 2msbk dsh cW 2f,1mc 0.4 0.6 3 27-41 1Oyr4 /6 none Is 06g dl cw 1fm 0.7 1.6 4 41 -100 10yr5 /8 none s 0 sg dl - 0.7 1.6 E I Boring # J It, Boring l d Pit Ground Surface elev. _ 97 -?9 • Depth to limiting factor >110" in, Soil gpplicallnn Rate Hortzon Depth Dominant Color Redox Description Texhne SWcture Consistence Boundary Roots "Et1#1 'Efgf2 In, Munsell Cu, Sz. Cont Color Gr. Sz. Sh. 1 0 -20 10yr3 /2&4/8 mtf 7.5yr4/6 sills) fil 2m pi dsh ccs 2frnc 0.0 010 2 20 -32 10yr4/4 none sil 2fsbk ds gs 2f,1mc 0.6 0.8 3 32.44 1Oyr5/4 none sic[ 2fsbk ds cvtr M 1fm 0.4 0.8 4 44.48 10yr4/6 none Is 0 sg ml - gw if 0.7 1.6 5 48-110 10yr5 /4 non a 0 sg dl - - 0.7 1.6 Redox. features in M#1 are due to compaction of fill material during house construct ion. They are not indicative of groundwater, and are not a limiting factor for this site. • Effluent #1 = SOD 30 < 220 mg /L and T'SS >30 c 150 mg/L - Effluent 02 = 800 -5 mg/L and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. Iryou need assistance to access services m or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 609. 264 -8777. 50"30 (R.o7roo) A.C.E. Soli a Site "uawns coo in - 1VA3 31IS 'S UOS H 0 y b9LL grz 4TL %Vol 95.80 90OZIL0190 � ,Sb : /gd2�sra�ani7� AL E /eda�o� r j ve. 6,-u4Z oeEiecs dI e r ToP , P m <v BS P. 3W b000 " IVA3 ails v iios a D F t9LL M 5TL XVd 9590 900Z /Lo /90 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the krl residence located at: %, 5& %, Sec . _, T __Yo_ N, R / 9 W, Town of Y j f �t?,q� St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good cond'tion and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No ✓ (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: / Construction: Prefab Concrete I/ Steel Other Manufacturer (if known) : W��3kf Age of Tank (if known) : I W� 3 (Sign re) (Name) Please Print P\R �s �_ 74QJ`' // (Title) (License Number) 3b d� (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition,.I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name S� r� y� akY' - % rejig Signature MP /MPRS �a� U POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __ of FILE INFORMATION SYSTEM SPECIFICATIONS E Septic Tank Capacity ❑ NA # 1 Septic Tank Manufacturer WvA S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer zp¢' ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model p , I U 13 NA Number of Public Facility Units i�*A Pump Tank Capacity al NA Estimated flow (average) *U g al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) Go(j gal /day Pump Manufacturer NA Soil Application Rate ' r? al /day /ft2 Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand IBOD 530 mg /L PF In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA other: ❑ NA Other. Other: ❑ NA ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: l ❑ month($) (Maximum 3 ears) ❑ NA a ® ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) 13 NA Ryear(s► y Clean effluent filter At least once every: ® month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA Other: 13 year(s) At least once every: ❑ month(s) NA Other: ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. Yo avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 0 ThO bane Into Of all fflltkb OHM itilti Ah011 110 0Or"%V*jd AMP OPMOMPOV W01006110 v►i OV 0 88"jiiild wefVIMIHpI 0141100400 0 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: �. 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 evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY DIFFICULT OR IMPOSSIBLE. a ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER 3 Name Name Phone �, U d Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULAT ORY AUTHORITY Name I N yL 1 S D (A W 0 Name <t CYL U 0\ VV Phone - (� Phone D � ' U This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L,49 t_ f2,�� Mailing Address 075 W I ( ( W IL lver D rlVf e- g Property Address (Verification required from Planning & Zoning Department for new construction.) City /State f J 5 I qo Ib Parcel Identification Number Q, /(U � 1 LEGAL DESCRIPTION `' Lan J Property Location �� '/4, '/4 , Sec. ,?,4_, T ,; NR Town of 5 y 4 Subdivision , Lot # . Certified Survey Map # 5o� , Volume _� , Page # Warranty Deed # �e 74,E Volume 1 7y , Page # Spec house yes no ` Lot lines identifiable K es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 vir of a warranty deed recorded in Register of Deeds Office. Number of bedrooms "T 2/�_p _)4r� 7 / Z3� y ( 11 1 SIGNATURE OF PLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 1874P 074 It 6 - 7 ss�4 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALS WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO.. MI This Deed, made between Alan R Roettger and Heidi J. Roettger, RECEIVED FOR RECORD husband and wife 04 -17 -2002 10:00 AM WARRANTY DEED EXEMPT # Grantor, and Karl P. Kriger and Joy K. Kriger, husband and wife REC FEE: 11.00 TRANS FEE: 749.70 COPY FEE CERT COPY FEE: Grantee. PAGES: 1 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 Name and R ` Part of Southwest 1 /. of the Southeast '/A d on 36, Township 30 North, °I RN TO: Range 19 West described as follows: of of Certified Survey Map cj 1 } B urtlet Title recorded in Vol. 9 of Certified Survey Maps Page 2674 as Doc. No. N L -1 5 5o 1= ranoe Ave. S. 504458. �—� �� First 'Floor ./� F-dina. Mai 55435 030- 2016 -10 -" Parcel Identification Number (PIN) This Is homestead property. (is) FiL M Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this � day of February 2002 4 JULIE A. WILSON NOTAIRY P1 IHLIC • Alan R. Roettger STATE OF WI ,ONSI kyjy;Ja � r • Heidi J. R AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF LA3Z;64 ^ - M , ) ss. :!�4 Ci\o ' X County ) authenticated this day of j Qom-- da of Personally came before me this d a y February , 2002 the above named Alan R. Roettger and Heidi J. Roettger, husband and wife • TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. State.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristins Ogland No Public, 9tate of Wisconsin H udson, WI 540 16 MY19binmission is permanent. (If not, state expiration d ate: (Signatures may be authenticated or acknowledged. Both are not necessary.)' • Names of persons signing in any capacity must be typed or printed below their signature. wwmmoon Prot sbnab Ca Pw. w. r W WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 1 7L9Z a$Ed 6 •I °A Iv •3u9hl£Zo68N ° , N ,)eaq o4 paunsse '9B uot330S Jo 13S 8 44 40 d c c t au nos a o aaua,ia a,) a� 6u . i 4� 43 � p j e s tjea8 O ... p N v u W d W 0 N N 0 1-4 fA U2 W W `+ O ti y Yo j v, S L 2 lC s 4 • N iv 0 c . `� % - f as - 0 3N co O 3 v v o , � ,-4 c, LU \ CJ c� a O a �N oN+ E rte* y °tn� E4 E, o aox. o -, ., o d. , 1 W O W w N UJ r rj M ." V 0 �a. z N H - o LL- O � `�° ►--� N 3B �t F— O ) 4-) _ C U 41 •� 0 \ • f7 W N O s ffOC r. / ° M ul N rhr U ���\ Q,� 0 O / �� �� 261 ��\ \ +� T Ll r J W • . Z K J I 1 1 � y °r °2 l0 1/ M 41, '9 V \ En Cl LC) Wi y am/ o y .` �r 2 6 �. 0y o o s� ° Ao ti } `, \ V nfi \ Of7 \ N N to ( 0 I .� o o N N = I / = W 189-0 J Li �� ` SoE, c —1 41t g Lo w o N Q I$ o U)I 7 y Q I f t ° o ti � y I ` r ZI 41 v� p M a- I Cna o F -I y �'7\� 3B a°Die 00 1 45 ZI 41 o co QI Is s c �I JI m co _JI M . Al ,09 ,Ori h OI � I a. I U I LI -)1 �o j 1 0 Lr) - M N N 'o So Go • MII SO z to O M Z S v c 0 c l ,11 I 4S is ..may C c o .0 6/ L co N d O i N N w Z6i *ON 'ford >laoelsa18 uejj Aq pa;je,Ip quaenigsui sigl sp"010;91sl6ad BS��OS 113NN00.0 S3AVr 2 ,, Z66L 9 z end x v� cn f� . 0N0 3v0 C l.�( � co � �• m v p� i R � O �o�o �'IIN�W. 3 C + O (D 3 °. CD y N p O N r7 N c@ fD A O N O pO 1 CD CD N N a O O 0 n O N --1 OO O O co N J 3 M 7 a O D C, O O 0 C � CD m cn < ID 4 m �n CA �' a A co 'm �° o CA co l o A m 3 T a Z v z 00 0 0 0 a °' • A ° A O G C G Cn Z 0 0 o c N D zt N N Q 6 T C 0 O 0 C O CD f D M y CO CT CT 7 d D Z CO 3 O v A z � N cn ° z co O 0 D CD 0 O a CD m y C N D C CD CD z tQ p Z CO) O y A Z O 0 a O O o' W m < O 0) CL j z 3 ;u ° O ^' cn N z m C4 CD A I a o m C O o a I � N 2 O y+ I � rp H I li A fi 3 1 � O I V N p a A ' O CD pq ti 49 0 O O I ti STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 5 A /" 1YI 1 C L. 2 ADDRESS $©)C:0 z $ Z SUBDIVISION / CSMJ S p q 4 LOT SECTION 3 (- T 38 N -R L , Town of S1, fps E Pik ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM W /CLa rj iv�2 rzoq /Yo A,T H t o -r / i N A I R I yyCIL 110 13 _ • -- tIV i I%';� Pr— E 5. i 1 �— r o s` �L N { A n � w y ' 3 s $.11). To P o F 1'' PIP E coy WE5"r Lorr L INE k-1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. II I BENCHMARK: % off of i" - PE o w£S taT LIAE AF / 0.00 Z 20 � ALTERNATE BM: — 1, , ? of µov3t ��UWD11�Z(O - 2 • 2D r — ���ta© SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: f Liquid Capacity: Setback from: Well ,5 S House 2 / Other /30� ra/y tk Pump: Manufacturer Model# Size Float seperation - Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM r � Width: Length t/O Number of trenches Distance & Direction to nearest prop, line: Yo" wm4�1 � Setback from: well: /� Z House /o _f Other 7 M, ELEVATIONS r Building Sewer — ST Inlet : 7• ZO = 9 "o ST outlet 7, SO PC inlet PC bottom — Pump Off r Header /Manifold g•Zg Bottom of system q.y Z 4 �8Y Grade 'St SO f C77 Existin Existing Fi grade S7-o - 1 7 7• 7 DATE OF INSTALLATION: PLUMBER ON JOB: 4 -1n5 �ch LICENSE NUMBER: 5 INSPECTOR: 3/93:jt Wisconsin Department of Indu PRIVATE SEWAGE SYSTEM County: Laborland Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: PQ LEYS der' JOHl & SAM MILLER ❑City ❑village [ Town of: state Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /00. S it c) vej . ,c t..° TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /�<) a Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 9 7,0 j TANK SETBACK INFORMATION St/ Ht Outlet �,�%; �� 75 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Air Septic 5 55 ' a >ds--, NA Dt Bottom Dosing NA Header /Man. 711, 8 KS ?2 Aeration NA Dist. Pipe 7 X Q S 74� Holding Bot. System YE a,, lL f PUMP/ SIPHON INFORMATION Final Grade ,(,5 9$,97 Manufacturer Demand �; 3 3 106 .3 Model Number GPM TDH Lift Friction System TD Ft ead Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length !.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSION S /� </p / DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typeof 777J CHAMBER Model Number: System: ` lUS l / 3 a- OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 Y Bed/ Trench Edges �� J Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.36.30.19W, SW, SE, Lot 5, Willow River Road Olt L Plan revision required? ❑ Yes ZNo Use other side for additional information. 5 Q� ., kc1c, SBD -6710 (R 05/91) Date Inspe or's Signature Cert. No. SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CO STATE SANITARY PERMIT –Attach complete plans (to the,county copy only) for the system, on paper not less than E] Q `t'i 8% X 11 inches in size. Check if revision to pre ous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION – PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 3 LF_ f SAM M14-LiS #2 sw1 /4 s� ' /4,S ,36 T-3 /9 E(or pa( PROPERTY OWNER'S MA LING ADDRESS LOT # BLOCK # z- I A R Lo LA TQa /L S CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER TILLU�l47L= R M N, sso Z t /z y3s - o4p y c_ S vo% y LJ II. TYPE OF BUILDING (Check one) El State Owned ❑ VILLAGE : NEAREST ROAD si TeS £�N t!/ittOw,2ivE+� Joao ❑ Public 0 1 or 2 Fam. Dwelling --# of bedroom PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 03 O — -. 14 -- t 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -ln -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) d , ELEVATION q,5_0 (4 q 3 7 o 7 Feet 981 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank d W.Z- ; 5 ✓ Lift Pump Tank/Siphon Chamber El I El E]� 0 1 El El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: ( s) MP /MPRSW No.: Business Phone Number: D 2 4 3z 3 Plumber's Address (Street, City, State, Zip Code): J� ups syo�, IX. COUNTY /DEPARTMENT USE ONLY P ❑ Disapproved Sapjtary Permit Fee (Includes Groundwater ate Issued Issuing A nt Sig lure (No am Approved ❑ Owner Given Initial ,� surcharge Fee) Adverse Determination �� X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber r O ` �0 4Z) © � LU d \ LAI W k � I O Q' o � v v LA-1 .1 N L- r Waccnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 ., .L:at or and Hinman Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference Po int BM , direction and % of slope, scale or PARCEL I.D. # � ) dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION John Leys GOVT. LOT St 1 /4SE 1/4 T 30 N,R 1Q ) qNor) W P�OPERTY OWNER':S MAILING ADDRESS LOTS# B n�a # cs 9 O1 4 pg 1114 1 44b611 Arcola Trail CITY, S ATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE @GOWN NEAREST ROAD Stillwater, IV. 55082 (612)439 -0641 St. Joseph Willow River Rd. :kd New Construction Use [xt Residential / Number of bedrooms 3 [ j Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft2 . 8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.14 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material outwash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem IY6 ❑ U ITS ❑ U I [as ❑ U M S ❑ U EIS U EIS U U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence BoLlrtdary Roots Bed Tmrch 1 0 -11 10yr3 /3 none L. 2 /m /gr invfr c/s /f .5 .6 2 11 -29 10yr4 /4 none scl Ifsbk mfr g/w 1/f .2 .3 Ground 3 29 -80 10yr4 /4 none is. 0 /sg mi n/a n/a .7 .8 elev. 98. ft. Depth to limiting factor >8 a. Remarks: Boring # 1 0-10 10yr3/3 none, L. 2 /msbk mfr c/s 2/f .5 .6 7. `< 2 10-19 10yr4 /4 none scl 1 /f /sbk mfr g/w 1/f .2 € .3 U 3 19 -82 10yr5 /4 none co.s. 0 /sg ml n/a n/a .7 .8 Ground 12 elev. 98. ft. Depth to limiting factor > 82" Remarks: CST Name:— Please Print 1 ..�• �} Gary L. Steel 71 P2 14 - 6 Address: 1554 2 . AVe . , New ichmond , L•TI . 54017 Signature: Date: CST Number: ���,. 7 -21 -93 cstm 2298 PROPERTY OWNER John Levs SOIL DESCRIPTION REPORT Pag <2 of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -13 10yr3 /3 none L. 2/m /gr nfr /w 2/f .5 .6 3` 2 13 -32 10yr4 /4 none scl 1 /f_ /sbk mfr g/w 1/f .2 .3 Ground 3 32 -42 10yr4/4 none ls. 0/s ml n/a n/a .7 .8 elev .6 4 4 42 -80 10yr4/4 none co.s. 0 /sg ml n/a /a .7 .8 Depth to limiting Remarks: Boring # 1 0 - 10yr3 /3 none L. 2 /m /gr Mfr c. s 2/f .5 .6 4 2 9 -29 10yr4 /4 none scl 1 /f /sb1c mfr g/w 1 /f- .2 .3 3 29 -42 10yr4/4 none ls. 0 /sg n1 g/w n/a .7 .8 ................. Ground eelgv. 4 42-80 10yr4 /4 none co.s. 0 /s9 ml n/a n/a .7 .8 Depth to limiting factor >80" Remarks: Boring # 1 1 0-16 10yr3 /3 none L. 2/m /sbk mfr /w 2 /f_ .5 .6 U 2 16 -36 1 4/4 none scl 1 /.f /sbk mfr � g/w 1/f .2 3 3 36 -40 10yr4/4 none ls. 0 /sg ril n/a n/a .7 .8 Ground elev. 4 40 -84 10yr4 /4 none co.s. 0 /sg ml /a n/a .7 .8 98. ft. Depth to limiting factor >84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) i STEEL'S SOIL SERVICE 15 -54 hr eve Gary L. Steel C.S.T. 2298 John Leys New Richmond, WI 54017 MPRSW -3254 S`dl -SE% S36- T30N -R19W (715) 246 -6200 town of St. Joseph lot #5 -csm. l'4 -pa-e 1.114 )q 661- -t Pi �� 3 ka� 3 Oq&Ws 1' ap r Gary L. Steel 7 -21 -93 cn I - - - - - - - - - - - - - - - - - LA Cl � I m � z I I I m m i I o� `4 �1 I rrl I r I � D I I I j O I I I I I I j -o I I I le - o U) g� O z ; m I i i - u F; IA i h I I � I Z G I C7 ' -u El i i m J �- V = m O � - v z b Ej m m m X0 c � n co FOB, : D (A 2619" 504(�5 • ES O'CONNELL egislo( of Deeds WI This instrument drafted by Fran Bleskacek Proj. No. 78 -85 -192 -n cn ni o A- o o M ATCN L F• o (See 5 rNE o 0 7 110' ~`` Sheet 2) vs 511057105n N _ L , I r C2 i C In I D O O 50' so' ; c5`� . I > rn o o CJ Co I- I j I ` rn i Q) Irn M .. �� I CJ I ` a ;n°; v, ° a I I r) IF I I IZ 1C7 r„ L .C� I an r ' Q cn I(/) I z r� \ \ D, �y rn 51105), v, v`",_ ( rrl Cn Co D N s oC� 2 fp \ \C ' C " ,, p > •': , _ Rl Ln qqx�p c � ° n a / Z7 fn l•-c 4 v� `r6i ! f \(. ro a - - 1- . co �� C1 `5 l� ✓ ' W C) (t 1 ^ f 0'. p, 7 (D \� • c�p : \ T r p o cD a ' ,y ' c l rr x o 00 • Y ,7 l ^' Fes• !!) tt En n 1� (D r In N 7 N M w O \ w cn ~ H, C7 M o (DM ze 4.1 =C n o, o M -n. ! (7 . w 0 yl- M O O O W C d t ,aeac :.. x O1 m C/-) 8 44r En In [ t O 03 0 yy , -3 H I t -r i� .. . T CL Co t 0 F- D iir ll F U) C,) cT'_1 ") Z; £ (D to O z --i o n . Ln N 00 6�:• cn a rn m M (D N �. O N N O M ry m (n C) O rt Bearings are referenced to the south line a G , of the SE•J of Section 36, assumed to bear v o N89 Vol. 9 Page 2674 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER SO ✓f K L c - S MAILING ADDRESS / Z 1-16 / AE4o L A % efl / L ST llly ,eTiF4 SS , 0& 2_ PROPERTY ADDRESS S 7S GyjGLDcr/ ,C /UE/L Xoje0 Alzti !y/ Sya /to (location of septic system) Please obtain from the Planning Dept. CITY /STATE &1,05411 W L PROPERTY LOCATION SGcJ 1/4, S' 1/4, Section 36 T 3a N -R Z± W TOWN OF Sr 7050 P14 ST. CROIX COUNTY, WI SUBDIVISION G SM 1/0 /, ' y / '# 4 LOT NUMBER S CERTIFIED SURVEY MAP SO /SV VOLUME7 ,PAGE Z 0 `I, LOTNUMBER S 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60 % . of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex iration date. SIGNED: DATE: - -- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property SAM /N /LLZW— Location of proper y S[,c� 1/4 S E 1/4, Section ?(,,_ -R� Township 5r Josc',a Mailingaddress JAy6! �.ti. ,r ✓ - o8y Address of site 1,07`347SIZI.� , 7We-� Zd S ! 6 Subdivision name GSM Vol ,J I - -?,4LE //I �( Lot no. S Other homes on property? Yes t- No Previous owner of property Total size of property -�, 60 � L!? F S Total size of parcel ,Coo Date parcel was created s'- So -26* Are all corners and lot lines identifiable? �' Yes No Is this property being developed for (spec house)? X Yes No Volume f? and Page Number �-oj as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded i the office of the County Register of Deeds as Document No. 3 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. 3y 913-7 9/ '�r A t- Siqnature of plicant Co- Applicant y / f or-- Date 6f Si natu e g r Date of Signature DOCUMEn,T No. � � • •� 1rn! STATE OF WISCONSIN —FORM R 34939 • II I 11110 SPACE REOEItVED /Oq gaC012UIN0 DATA I '1111S IND.1'NI•U11F, Afade b Richard John Stafslx)lt mid i ..... ....................................... . ....--- •-- •--- ..............._ ........ - _ K. Stafshol , husband and wife. REGISTERS OFFlLE .......................... ----- ••••-- ••- • . ..............: ST. CrO1X CO., Wis. grantors... of .................. St., - i Rec L -cord d, for Rd Hlis 0 ................ ........................County, Wisconsin, i t - - - — hereby conveys and warrants to ...... Jo)?n- .Lys ............ . day of ?i ;r A.D. 1 ........ ............. . ....................................... ............................... .........--•• ......................................•-•----...........---.......---•--..............-----•-•--• ......_.................._..... , I ........... . ...................... .... .. .•... .......--- ............ . ........ .......grantee........ of �i Reglstee of beedr' St. Croix county for the Burn of ......._ ...................................... ............................... One Dollar l : 00) and Other Good and Valuable t nE, t,gN TO i Consid� ration ................... ............................. First National B ink ............ ...........................•••• ................................................................ .......•••••--- •••- •- •--- -• - -•- log L. Second St. the following tract of land in ................St. Croix.__. ..County, New Rielnnond, 1ri. 5 Wisconsin South East Quarter of the South Westl.Quarter; South One half of the South East Quarter and the North East Quarter of the South East Quarter of Section number TI -Six (36), Township number Thirty (30) North, of Range number Nineteen (19) West; Also North West Quarter of the South West Quarter of Section number Thirty -One (31), Township number Thirty (30) North, of Range number Eighteen (18) West, Excepting and reserving from said above described premises a piece or parcel of land heretofore conveyed to Lk -iniel Donohue by warranty deed recorded in volume "L" of deeds, on page 191 described as follows: Com- mencing at a point in the center of the road on the Town line between Townships 29 and 30 of Range 19, thence running west on said Town line 8 chains and 38 links to the quarter section corner on the south line of section 36- 30 -19; thence west on said line 20 chains h ins thence North 12 chains and 80 links; thence east, parallel with said town line, 34 chains and 35 links to the center of said road; thence south 25' west along the center of said road to the place of beginning containing 40 acres, more or less, and also excepting any lands heretofore conveyed for railway right of way over and across said premises or any part thereof and also excepting that part hereof lying Southerly and Easterly of the Railroad right of way. Said lands g Y• being in the Ccx.u of St. Croix and State of Wisconsin "a being in total 72 acres more or less. EXCEPT, Part of the Southeast Quarter (SE 1/4) of the Southwest Quarter (SW 1/4) of Section 36, Township 30 North, Range 19 West, described as follows: Commencing at the quarter section corner on the south line of said Section 36; thence [Jest on said line 20 chains; thence North 12 chains and 80 links to the Northwest corner of the parcel of land conveyed to David F. Anderson and Susan C. Anderson, by deed from Melvin R. Moodie, and wife, re- corded January 23, 1976, in Volume "533 ", page 219, Document #331226, which corner is the POINT OF BEGINNING of this description; thence North 150 feet; thence Fast parallel with th( South line of Section 36, 291 feet; thence South 150 feet; thence West along the North line of the parcel described in Volume "533 page 219, 291 feet to the POINT OF BEGINNING. ALSO, that certain parcel of land locafed.ih the Southwest Quarter (SW 1/4) of the South- east Quarter (SE 1/4) of Section 36, Uawnship 30 North, binge 19 West, Town of St. Joseph, St. Croix County, Wisconsin, more fully described as follows: All that part of the South 12 chain 80 links of said Southwest Quarter (SW 1/4) of the Southeast Quarter (SE 1/4) lyinc Past of a line described as beginning at a point on the South line of said Section 36 a distance of 430 feet East of the South quarter corner of said Section 36; thence bearing N32 0 18'50 "E across said South 12 chain 80 links. (The South line of said Section 36 assumed to bear due East). In Witness Whereof, the said grantor. s.. ha. Ve... hereunto set...... their ............. hand s and seal.. S. this ........z..6............ day '.- •-- •- • - -• -• . ....................I A. D., 19 ... 7$ --- TRANSFER SIGNED AND SEALED IN F12ESENCE OF "'. "' ' " " " "' " "'.' ......................... ........................ .••-•-- -..(SEAL) Ric John S tafsholt i F ......... ............................... _ t'.:..:: .......... s.. /.....- -.:.:..,::r(SE1L) ......... Judy K. Stafsholt / .................................................................... ............................... . ..- • .. ......................... (SFAL ) ..................•---......................_.................. ......................_........ (SEAL) State of Wisconsin, St. CrolX County. Personally came before 11 this nth da OE..._r�a:' ............... ...' A. D., i.9. 78 .................. ................... the above named ..Richard John Stafsholt and Judy K. Stafsholt� • -- ..._....---• ........................•-••---..........._......._........._.....--•.......---- to me known to be the persons.... who executg4,*,th ...... -" r �, jpregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY �.l'hOlTl:i017 — N 1r' Public .............St. Croix RICHARDS & WAL.L nL Rk Y r County, �' ✓is. ................ .. '. "HGMSC)" r1y cvnunission (expires) (is) r ' N c.g ,,2te•o! rc....X1`2 . . r.cc" ,on �rp•..;s (Section 39.51 (1) of the Wisconsin Statutes provides that all instnlments to he rrcordctl shall have Mainly plrnted or tyre -riucn thcrrm the names of the &rantors, grantees, witnesses and notary. Srction 59.513 similarly requires that the name of the person aho, or govern mental agency which drifted such insUTUncnt shill hr rrintr•rl tchn•:rmcn, stamhcd or wr nrn thtrcon in + L •14 ... ,. .. 2 Y L a a �= v� Air % a v � • vN btu �� '. fob r - w 1 oY 93 H r f J G I v A i n No Add r r 5 - ab + �r w T f N j• 1 1 1 1 1 1 a . 1 I I I i St. Croix County Final Property Report Page 1 of 1 St. Croix C_ounty__2008_ Property Re. port Print Report Generated: 10/3/2008 3:52:12 PM Data Updated: 10/3/2008 1:00:00 AM PARCEL COMPUTER NUMBER: 030 - 2016 -10 -000 PARCEL MAP NUMBER: 36.30.19.418A NOTICE: All payments received by County Treasurer will be posted the next day. 2002 2003 2004 2005 2006 2007 2008 < -- Click on the year to select the annual record. (* & ark red = delinquent Property Description Billin Inf i p rty g Information Municipality: 030 - TOWN OF SAINT JOSEPH Name / Attn.: KARL P & JOY K KRIGER Document Number: 676524 Address: 875 WILLOW RIVER DR Volume & Page: V 1874, P 74 Public Land Survey: SECTION 36 T30N R19W City, State, Zip: HUDSON, WI 54016 Quarter: Country: USA QQ / Tract: Ownership Plat: NOT AVAILABLE Primary Owner: KARL P & JOY K KRIGER Description: SEC 36 T30N R19W PT SW SE BEING LOT 5 OF CSM 9/2674 3 ACRES EXC Secondary Owner: PT TO TN RD AS DESC 1037/499 (ADD'L HIST QC- 1010/322) Total Acres: 3.00 ACRES Site Address: 875 WILLOW RIVER DR Assessed Value Other Valuation Date 6/1/2005 Fair Market Value: 0 Assessment Type Acres Land Improved Total Assessment Ratio: 010000 Value Value Value Net Assess. Val. Rate: 0 G1 - RESIDENTIAL 3.00 75,500 243,400 318,900 School District: 2611 - HUDSON Totals - -> 3.00 75,500 243,400 318,900 Tax Installment Dates Tax Detail Please pay 1st and 2nd installments and delinquent taxes to the Tax Balance County Treasurer Category Amounts Paid Due Period Pay To: Date Due Amount Real Estate Tax Due 0.00 1 County 0.00 Lottery Credit ( -) 0.00 2 County 0.00 Net Property Tax 0.00 0100 0.00 Total Taxes - -> 0.00 Special Assessments 0.00 0.00 0.00 Tax Payment History Special Charges 0.00 0.00 0.00 Date Paid Receipt Number Amount Delinquent Charges 0.00 0.00 0.00 NONE Private Forest Crop 0.00 0.00 0.00 Specials Woodland Tax Law 0.00 0.00 0.00 Category Amount Managed Forest Lands 0.00 0.00 0100 NONE Penalties 0.00 0.00 Interest 0.00 0.00 Totals - -> 0.00 0.00 0.00 Notes http: / /www.landinfo.co. saint- croix. wi. us / website /LRPortal /total _process. asp ?ID V alue =03 ... 10/3/2008 I