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CROIX CO., MI RECEIVED FOR RECORD St. Croix County 10/01/2004 '01:30PH Occup ancy Affidavit AFFIDAVIT Q p Y EXEMPT It REC FEE: 11.00 TRANS FEE: Name — (Owner) Typed or printed COPY FEE: cc FEE: being duly sworn , states, under oath, that: PAGES: 1 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 2&3 Page /a9 Document Number e7 . Croix County Register of Deeds Office: Recordinc Area Name and Retum Address /,� A 1 of land 12 tad in the S N/ �. of the i %. of Section 2 3 h C MS �'A�t�-.�7A T N — R O W, Town of -5'4 /A/T -TIM ✓'P , St. Croix /43Z, TH�Z.EU Comity, Wisconsin, being duly described as follows (include lot no. and �U C. (�Z T'" $ Z subdivision/CSM or detailed legal description): /_or Z 9 SE /HZ 'S �Z.g�✓ 5UGD, 0 30 -2/ 3 / - -coo , lof 7 Parcel Identification Number (PIN) As owner of the above described property, i acknowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of 4 gpd. The design now is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently 2 occupants living in this residence; &occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to acc omodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. IZI?w LA Dated this day of DG C?bt?� vo , . . 1�' AUTHENTICATION ACKNOWLE • Signature(s) STATE OF WISCONSIN ) "� "' - .•.+N` authenttcated this day of St. Croix County. ) -t- P morally came before me this �S % day of * °0 n4 �a TITLE: MEMBER STATE BAR OF WISCONSIN (If rat, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Comma s on I permanent. ff not, state expiration date: necessy,) Date: ar D "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" Thb Ir*ww0on must be completed by su6rNttec ofherkwamation such as the gr&i*V caress, begat deaalptiom err. may be pbood on Uds firer paps d ft doair wd or maybe precsd an addilkwW papas of the dootmoric bM Use of ft corer papa adds one papa to yow dowraM end AZ00 to the rerorl fim lies. Wismiab Stahrres. 5p ti17. r sc nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CfOIX dafet and Building Division INSPECTION REPORT Sanitary Permit No: 506131 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Maier, Dennis & Angela I St. Joseph, Town of 030 - 2131 -29 -000 CST BM Elev: Insp. BM Elev: BM Descri t' Section/Town /Range /Map No: 23.30.20.1083 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 7 Benchmark Dosin .,; Alt. B 0 a-D Aeration Bldg. Sewer " 1 U 111c SG U(�. to (� Holding St/ t Inlet S t TANK SETBACK INFORMATION ot, le t TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Bottom G 1� - Dosin T J Head r /Man. /T r � Aeration Dist. Pipe - 7 - �d P a 4 Holding Bo l. Syste �Z 11 Yt h ( I �0 ` PUMP /SIPHON INFORMATION final Grade vp 2 i 3 2l / 3 0 06. Manufacturer Demand St o r GPM Z f (- - Model Number TDH Lift Fri ©ion o3 System Held TDH Ft Forcemain Le i Dia. Dist. to Wel SOIL ABSORPTION SYSTEM CW L09 } BED /TRENCH Width ) Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ACHING Manufa r 1 INFORMATION AMBER Typ f System �.� � � / i UNIT Model Number: 13' D STRIBUTION SYST Bader/ anifold 1[2065oh ( / x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) �- Length Dia Length D Dia Spacing_- �' 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 u n Yes No Yes 70No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: L l 2 1 Inspection #2: / ! Location: 1432 Thelen F�a Trail Hooultto�n, WI 54082 (SW 114 SE 114 23 T30N R20W) Settler's Glen Lot 9 Parcel No: 23.30.20.1083 1.) Alt BM Description = �1 "d� 6 � ;�0v'q 4 2. Bldg sewer length 9 5� 7 S �t = c �'t� ` � - amount of cover =� , Plan revision Required? ❑Yes o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St Croix Madison, WI 537077162 Sanitary Permit Number (to be filled in by Co.) — - -� _ State Transaction N D - t Application -- ,bmission of this form to the appropriate governmental Project Address (if different than mailing address) _ Tote: Application forms for state -owned POWTS are Information you provide may be used for secondary SaMe n), Stats. �rmation 1D I Parcel # -,:2l3 030 - 283-3-48 -880 Property Location Govt. Lot /0 -� - - - - -- T Code Phone Number S W '/. S ' /., on 23 -- - -- — - - -.�� circle one) — _ 9 � 4082 T 30 N; R - -_ o ft — — - -_ r Subdivision Name 14• r{O �K S oc MH _ Settler's Glen — _ NasT. CROIX COUNTY ❑ City of - - r CSM Number ❑ Vill of own of St. JOSe - — -- - - -- .8� V nh - - -- h a A. Complete line B if applicable) - -- ❑ Treatment/Holding Tank Replacement Only EKOther Modification to Existing System (explain) Val Ve _�o u 6Oht a a4 g. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber 1 ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 5,0 �Ob IV. T of POWTS S tem/Com onent/Device: Check all that a t Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil 11 Holding Tank ❑ Other Dispersal Component (explain) Ce 11V1 15 - ❑Pretreatment Device (explain) V. Dispe rsal/Treatment Area Information: 60 Infiltrator "Q-4 W" chambers e 20.0 s .ft EISA / chamber + 4 pair end c 5.8 EISA - 1,223.20 sq. ft. Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (s I System Elevation 600 gpd ,� 0,5 in -situ soil / 1,200.00 sq. ft. ✓ 1,223.20 sq. ft. 98.0', 99.0', 100.0', 101.0' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c New Tanks Ex isting Tanks cif d i� 3_7 ZOU U v Septi or Hold1ng Tank 1,000 1,000 1 Weeks Concrete w X to o 1,000 1,000 i 1 Wieser Concrete Com X Dosing Chamber 600 1 6004 i 1 Wieser Concrete Combo. X VII. Responsibility Statement - 1, the u dersigned, assq6e responsibility for Li! o of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signatu MP/MPRS Number Business Phone Number James K. Thom son -"&-- 30021 715) 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceol WI 54020 -5413 VIU.,tounty/Department Use Onl Permit Fee Date Issued Is mg Agent S' pproved ❑ Disapproved $ ❑ Owner Given Reason for Denial % 0 _� L W provaUReasons for Disapproval 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 G�f�� ��•�iid/ �'�uL G� GT%t' —� as per applicable code /ordinances l �r -✓ Cdr Attach to complete pl fo5 h to the oenty yon paper not kss tban s 12 x 11 inehes in size SBD -6398 (R. 01 /07) Valid thru 01/09 ► l /) P6 hi De a,/ AQVA� commerce.W1.90v Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix ,tic sco n s' n Madison, WI 53707 -7162 Sanitary Permit Number (to be tilled in by Co.) a of Comtnerce Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note_ Application forms for state -owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary Same purpos in accordance with the Privacy Law, s. 15.04 1 m Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # Dennis B. & Angela R. Maier 030- 2033 -40 -000 Property Owner's Mailing Address Property Location 1432 Thelen Farm Trail Govt. Lot City, State Zip Code Phone Number SW ' /,, SE . Section 23_ (circle one) Houlton, WI 54082 T 30 N R 18 w II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling — Number of Bedrooms 4 29 Subdivision Name ❑ Public/Commercial — Describe Use Block # Settler's Glen Na ❑ City of ❑ State Owned — Describe Use CSM Number ❑ Village of Na ❑ Town of St. Joseph III. Type of Permit: (Check on ne box on line A. Complete line B if applicable) A. E] New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) It. ❑ Permit Renewal i6crmit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration owner IV. of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil El Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: 60 Infiltrator IV4 W ' chambers @ 20.0 sq-ft EISA / chamber + 4 pair end caps A 5.8 EISA = 1,223.20 sq. ft. Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 gpd 0.5 in -situ soil 1,200.00 sq. ft. 1,223.20 sq. ft. 98.0', 99.0', 100.0', 101.0' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 d New Tanks Existing Tanksop 4 ts~ U Cn Setie or Holding Tank 1,000 1,000 1 Weeks Concrete X 500 1 500 1 1 1 Wieser Concrete Combo. 2 Dosing Cbamber 1,000 1 1,000 1 1 Wieser Concrete Combo. X VII. Responsibility Statement- 1, the un ersigned, assn a responsibility for JIstl4a of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signatur MP/MPRS Number Business Phone Number James K. Thompson t--- 30021 715 248 -7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 -5413 VIII Coun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Iss —T-1# uing Agent ature ` ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval G Attacb to complete plans for the system and submit to the County only on paper not less than 8 t/2 a 11 inebes in sin SBD -6398 (R. 01/07) Valid thru 01/09 Maier 4 bedroom Dose Conventional Pump Chamber Calculations 1. Force Main: Diameter 2" Length 50' Flow rate 40.00 gal. /min.± Friction loss 1.65' (50')(3.30ft./100ft.) = 1.644 ft. 2. Total dynamic head: Min. supply pressure 0.00' Vertical lift 4.75' friction loss 1.65' Total dynamic head = 6.40' 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge approx. 4.0 gpm @ 6.40' TDH 4. Dose chamber: Manufacturer & capacity: Wieser W1000/600 MR Comb. ST /PC - 51.00" i , 11.82 gal. /inch (602.82 gal. actual) Sizing: A) One day holding capacity: 33.90" = 400.75 gal. B) Alarm setting: 2.00" = 23.64 gal. C) Dose volume: 5.50" = 64.96 gal, (600ga1.)(20% Design flow) + (.164)(50') = 128.20 gal. Max. Dose D) Reserve storage: 9.60" = 113.47 gal. TOTAL 51.0" = 602.82 gal. Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---� Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E--- Alternate outlet location Forcemain diameter Wieser W100 Manufacturer 2 in. Capacity 602.82 Gallons Volume 11.82 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 33.90 400.75 C B 2.00 23.64 Pump off elevation (ft) C 5.50 64.96 96.55 D 9.60 113.47 D Total 51.00 602.82 iF Dose tank elevation (ft) 3" Bedding uncTer tank. 95.75 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BN53 692 F57 � 3" V) r `• Q 61 may 5° `O Q 1 C < a �� c OT r a s C V" < z 0 C fTi ` En TI H 7- O C ZN I�*I (X O d p ? O y b C y i m , Z Z 04:> rq p "On>0 m - D Vna 2 �2 ��I* �i�Z x C-) 0 En, =tea' p n Lo CAN 0 60 1 o c: ct c, Ln w O CA z W n > ° o ° D C 2: 2 r -r n X co �? 1 > DD Cn p --1 C) ± M S b C7 z 1 4 m 0 F5 a r- m D rrn m C c z n rn a r, z m _, N CE S OIL $t SI EVALUATION SCALE! 7 /4" 1' REV N0. DATE: MIEREN ci llIETE `-+ DRAWN sY:swT W3718 u5 NWY1o. MAIDEN ROCK, WI 54750 DATE' JANUARY 2407 775 -7787 800- 84 FILE: W1000 500 - Mk ZO /ZO 39Vd 313dONOO d3S3IM T8T5Lb95TL 617:13T LOOZ /17Z /b0 r eJa /ua���o+f Sea /e; / ps+fn/S /Y� %ir��d�o., Lot 29, 0 6 0,C Se /Gr 5 C- /e Sc.�r�l SFy Of _Ile - 4, Sf • Cr u:i viol /k /. #pap- z /31 .Z9 - cco r !� tc �I 0 0 t6 d• - 8o66orn o{ `' S:d;.�. E /ev.` : X03 03' dce,< E",risd' cve -ens ; uZ17 Rcs,'dsncP � f3d.e S,�w /�4,bc/A -icy v eWlusa Ca - d e -sec S. e.. "ff Ao/ /0"r d r %u�� >�e✓af - rA6Ctl o �ara9e �Ac% cc F /iv'_ ia�73 9 �- ai ' A a• �. f dniAO y krunve p C5f/ i f �oF �;t i Twos �r.„c lcs Tn� /b c- `itM+bYJ Propos c(, - s ' Xrs Cel(, Foul (,/� tre ic4es a , \ Cl u m hers fo 15a-/. , 0 1 . o ' (/o -7 r e la /"a�:on�4i'� ♦ e (eda16;o,, o{'s/ope 5 c a /e / ` WIC" O /i /a60� $ �cr5 cIen ScJ1� SF�s! 3eC. z.3, of Se. 3o - Seoh, sf • Cnolr �. �< I� p Pr S 5 (l�. 4-0f. SC6& r> 07" 0 eri�s6nJ EX /s� J .� 7 We// yl btalr�avrH Wee,< p/oPo�.rcal u.i / �scr �-, c roc Rcs,'dsgcP , CAP S� W /x��,6�//i -icy w �,oc�- , sr,p� -� / - - 'p[ -szs :7 t'S.r e4/u c't/>`�✓af R o i r r t dn im I E,Yi'Sfi' d ;s�srsa /you. (zl� tl en ti es o-t ' A52; �t 0 (/a-7 (,A o rA no Sca /e � p A �^ ti w z d P v\ ^ 4 CD t r , a —� Now D m M z N ■ ®� - > Lwl D ■s•� a , o ^ p o t p am= � e ■vim >r I I j I � I Maier 4 bedroom Dose Conventional Pump Chamber Calculations 1. Force Main: Diameter 2 Length 50' Flow rate 40.00 gal. /min.± Friction loss 1.65' (50')(3.30ft./I00ft.) = 1.644 ft. 2. Total dynamic head: Min. supply pressure 0.00' r Vertical lift 4.75' G friction loss 1.65' Total dynamic head = 6.40' 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge approx. 4.0 gpm @ 6.40' TDH i 4. Dose chamber: Manufacturer & capacity: Wieser W1000/600 MR Comb. ST /PC - 51.00" 0), 11.82 gal. /inch (602.82 gal. actual) Sizing: A) One day holding capacity: 33.90" = 400.75 gal. B) Alarm setting: 2.00" = 23.64 gal. C) Dose volume: 5.50" = 64.96 gal, (600gal.)(20% Design flow) + (.164)(50') = 128.20 gal. Max. Dose D) Reserve storage: 9.60" = 113.47 gal. TOTAL 51.0" = 602.82 gal. Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - --► Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented < E--- Alternate outlet � location Forcemain diameter Wieser W1000/600MF Manufacturer 2 in. Ca aci 602.82 Gallons Volume 11.82 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 33.90 400.75 C B 2.00 23.64 Pump off elevation (ft) C 5.50 64.96 96.55 D 9.60 113.47 D Total 51.00 602.82 Dose se tank elevation (ft) 3 - Bedding n er tank. 95.75 C� Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BN53 TOTAL DYNAMIC HEAD /FLOW LLJ LL PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55157/59 EFFLUENTAND DEWATERING s 20 MODEL 53/55/57/59 x Feet Meters Gal. Liters 15 5 1.5 43 163 z 4 10 3.0 34 129 10 15 4.6 19 72 o f0 ooeW7 Shut off Head: 19.25 ft .(5.9m) 2 I 5 37/8 rl 3/18 I FF- 4 Wrl 1 12 -71 12 NPT 0 i o_ 10 20 30 40 50 3 713 GALLONS LITERS 0 80 160 FLOW PER MINUTE 4 CONSULT FACTORY i i i l FOR SPECIAL APPLICATIONS I i • Variable level float switches available. • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. i • Alarm systems available. ,ov,s I I • Duplex systems available. i i 33/32 i J_ SU5e singleseal Control selection Lis on s SELECTION GUIDE Model Volts Phna Mods Amps Simplex Du ex CSA UL 1. Integral float operated mechanical wAch, no external control required. M53155 8 M57159 115 1 Auto 9.7 1 - -- Y Y 2. Single piggyback variable level float switch or double piggyback variable level N&W 8 N57159 115 1 Non 9.7 2 3 or 4 8 5 Y Y float switch. Refer to FM0477. • BN53 115 1 Auto 9.7 -- y y 3. Mechanical alternator 'M-Pak' 10-0072 or 10-0075. BN57 115 1 Auto 9.7 -- N Y • 863157 230 t A"10 4.8 Y Y 4, See FM0712 for correct model of Electrical Alternator. D53155 & D57159 230 1 Auto 4 1 _ _ _ _Y Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53155 8 E57159 230 1 Non 4.8 2 3 or 4 & S Y Y Aflernator (3) or (4) float system. • Single pggyback switch included. ♦ CAU110N For Wormallion on addlitionall Zoellerprocitucts, refer to cataiogon Piggyback Variable Level Roat Switches, FM0477; All installation of controls, protection devices and wiring should be done by a qualified ElecticalAltemator, FM0486 ; Mechanical Alternator, FM0495, SumpJ SewageBesins ,FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Conlrol/Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ---- - - - - -- MAIL 7D: P. 0. BOX 16347 le, Louisville, KY 40256-0347 Manufacturers of.. ff SHIP TO: 3649 Cane Run Road ® o LoWs KY 40211.1981 Qzw/yr P +Pa S/NCE /9.99 http;tAvww.zooller.com PUMP !O. (502) 7782731.1 928 PUMP FAX (502) 77 -3 624 -------------------------------- © Copyright 2004 Zoeller Co. All rights reserved. 2066 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site County p pl an on paper not less than 8%: x 11 inches in size. Plan ust St. Croix include, but not limited to: vertical and horizontal reference pant (BM), dire nd Ilk percent slope, scale or dimensions, north arrow, and location and distance lllParcel I.D. 030- 2131 -29 -000 Please print all information. O R evi ed By Date Personal information you provide may be 5.04 (1) (m)). / 3 Property Owner roperty Location Dennis B. & Angela R. Maier ovt. Lot SW 1/4 SE 1/4 S 23 T 30 N R 20 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 1432 Thelen Farm Trail 29 na Settler's Glen City State p Co City J Village 16 Town Nearest Road Saint Joseph WI St.Joseph 1432 Thelen Farm Trail New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 4#1 Replacement Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.5 gpd loading rate. Dosing required to reach system elevation. Install trenches at 48" below existing grade. Boring # I Boring !I Pit Ground Surface elev. 102.12 ft. Depth to limiting factor >112" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -12 10yr313 none mixed fill na mvfr as lfm 0.0 0.0 2 12 -21 10yr3/3 none sl 2fsbk mfr cw 2f,1m 0.6 1.0 3 21 -39 7.5yr4/6 none scl 2msbk mfr cw 1fm 0.4 0.6 4 39 -77 7.5yr4/6 none Ifs 0 sg ml cw - 0.5 1.0 5 77 -112 10yr4/6 none cos &gr 0 sg ml - - 0.7 1.6 H#5 contains approx.30% coarse fragements - 20% gravel & 10% cobble & stone. Boring # I Boring 0 Pit Ground Surface elev. 101.83 ft. Depth to limiting factor >1 18" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PDlft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -3 10yr3/2 none sil fill 1fsbk mvfr as 2f,1m 0.0 0.0 2 3 -24 10yr4/3 none scl 2msbl mfr cw lfm 0.4 0.6 3 24 -34 10yr4/4 none Ifs 0 sg ml cw - 0.5 1.0 4 34118 10yr4 /6 none cos & gr 0 sg ml - - 0.7 1.6 H#4 contains approx.45% coarse fragements - 25% gravel & 20% cobble & stone. * Effluent #1 = BOD 30 < 2 0 mg /L and TS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson t S.__ 3602 Address A.C.E. Soil & Site Eval ns Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/27/2007 715 - 248 -7767 Prop owner Dennis B. & Angela R. Maier Parcel ID # 030 - 2131 -29 -000 Page 2 of 3 111 0 Boring # I Boring Pit Ground Surface elev. 105.11 ft. Depth to limiting factor >122" in. Sod 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 -12 10yr3/3 none sil 2fsbk mvfr as 1fm 0.6 0.8 2 12 -24 10yr3 /6 none sil 2fsbk mfr cw 2f,1m 0.6 0.8 3 24 -37 10yr4/6 none sicl 2msbk mfr cw 1fm 0.4 0.6 4 37-64 10yr4/6 none Ifs 0 sg ml cw - 0.5 1.0 5 64 -88 10yr4 /6 none cos &gr 0 sg ml aw - 0.7 1.6 6 88 -122 10yr5 /6 noone s 0 sg ml - - 0.7 1.6 H#5 contains approx.30% coarse fragements - 20% gravel & 10% cobble & stone. F 41 Boring # Boring im Pit Ground Surface elev. 99.88 ft. Depth to limiting factor >86" 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 0-10 10yr3 /3 none mixed fill na mvfr as 1fm 0.0 0.0 2 10.25 10yr3/3 none sl 2fsbk mfr cw 2f,lm 0.6 1.0 3 25 -34 7.5yr4/6 none scl 2msbk mfr cw 1fm 0.4 0.6 4 34-44 7.5yr4 /6 none Ifs 0 sg ml cw - 0.5 1.0 5 4486 10yr4 /6 none cos &gr 0 sg ml - - 0.7 1.6 F "` H#5 contains approx.30% coarse fragements - 20% gravel & 10% cobble & stone. 5 I Boring # Borin i � Pit Ground Surface elev. 98.26 ft. Depth to limiting factor 63 " in. Sol 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 -21 10yr3 /3 none mixed fill na mvfr as 1fm 0.0 0.0 2 21 -37 10yr3/2 none sil 1 csbk mfr cw 20m 0.0 0.2 3 37 -53 10yr3/6 none sicl 2msbk mfr cw 1fm 0.4 0.6 4 53 -63 10yr4 /3 none Ifs 0 sg ml cw - 0.5 1.0 5 63-71 10yr4/3 f2d 7.5yr5/8 Ifs 0 sg ml cw - 0.5 1.0 6 71 -97 10yr4 /4 m1d 7.5yjV8 -. _ - - - sif - -- - lfsbk_ - - mfr - - 0.4 0.6 H#2 compacted during placement of fill - structure parts to 2medpl. * Effluent #1 = BOO 5> 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD S 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. S8D -8330 (R.07/00) A.C.E. SON & Me Evak edws •66i/ e✓ aA.a�6'on�o, �� re cc c� m o { .s lope S'c a P 0 e 8o66om o{ yl6cQI�QOM ' �,ri5�%, GJC.C�S ; U2D C.u.l - d e •Sam � • 71 GCen �a�a'e n1v.,l�e% Cv�* E�salc r � r ` i � 1 Ira, •� Se r r C- 44M / 4r, 0 ' A5.2 I f .o r ��,30t.3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /auk �»r>>� �. {��n.9uct Inai'e� Mailing Address _7�e. /e!2 /Cars, 7rtai/ Property Address 6a.,ne (Verification required from Planning & Zoning Department for new construction.) City /State ttouL iri, uJ /. Parcel Identification Number O 30 ' 2 - 033- ,<0 -CC LEGAL DESCRIPTION Property Location S ZJ t/a , SE t/a , Sec, ; , T 30 N R -20 W, Town of 5 • - Subdivision J��e/ :s C/Lh , Lot # �9 Certified Survey Map # /4 , Volume Page # Warranty Deed # '77140 Volume . el , Page # /2 9 Spec house K no Lot lines identifiable yes 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. 0 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 7 y / Y / 07 SIGNATURE OF APPLICANT(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) I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify tha I have inspected the septic tank presently serving the , ,4�w4 A yy/Q, residence located at: c,) '/4, �5E '/4, Section 23 , Town 3p N, Range zd W, Town of 5�, — St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service ,'zr 7 Did flow back occur from absorption system? Yes P-" No (if no, skip next line.) Approximate volume or length of time: gallons 9d minutes Capacity: eQz Construction: Prefab Concrete v' Steel Other Manufacturer (if known): y Acr Tank (if known): 3 ver�,rs icensed Plumber Signature) (Print Name) (Title) (License Number)[MPRS (Date) Form to be completed b licensed p lumber s. 14 06 W p y p b ( 5. Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) _ 17 2634 P 129 771107Ea - KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIR CO.. WI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 08/09/2004 18:00AM THIS DEED, made between Grundhofer Construction Co., Inc., a WARRANTY DEED Minnesota Corporation Grantor, and Dennis B Maier and Angela R Maier, EXEMPT # husband and wife, survivorship marital property Grantee. REC FEE: 13.00 Grantor, for a valuable consideration. conveys to Grantee the following TRANS FEE: 1270.50 described real estate in St. Croix County, State of Wisconsin (the COPY FEE: "Property "): CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 551 12 #240972 Together with all appurtenant rights, title and interests. 030 - 2033 -40 -000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 22nd day of July, 2004. Grundhofer Construction Co., Inc. CIZ) a _ Jerome C. Grundhofer, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF Minnesota ) _ WASHINGTON COUNTY. ) ss. authenticated this 22nd day of July, 2004 Personally came before me this 22nd day of July, 2004 the above named Jerome C. Grundhofer, President of Grundhofer * Construction Co *a Minnesota Corporation Inc. to me known to be the person(s) who executeX instrument and TITLE: MEMBER STATE BAR OF WISCONSIN (If not, i acknowledge he same. authorized by § 706.06, Wis. Stats.) IT HIS INS I WAS DRAFTED BY *Nancy J. L nt Notary Public, State of nnes My comm is p ermwen (If no ,state expiration date: Greg Booth Attorny 1900 Silver Lake Road Suite 200 New � , Lt ) Brighton Mn 551 12 �.., �.. (Sienatures may he authenticated or ackn(wledged. Both are not necessary.) NANCY J. LENTZ 'N ;ones of pers+ms signing iii .ury capacity must be typed or printed below their signature - NOTARY PUBLIC My Comm. Expttaa Jan_ 31. 2005 WAR RA Tl N ' DEED STATE BAR OF W'ISCONSI RM No. 1 -2000 U _.Z63y P 130 EXHIBIT A Lot 29, Settlers Glen located in the Town of St. Joseph. St. Croix County, Wisconsin i R G N E SWI /4, PART OF THE NEI /4 OF THE SWl/4, OF THE NWl /4 OF THE SEl /4, THE SWI /4 OF )F THE, NE1 /4 OF THE NW Ii4 OF y \ SECTION 26, v, �SEPH , ST. CROIX COl_1NTY, WISCONSIN. \ i i i SEE SHEET 2 \ LC LOT 29 r m. .OT 31 �5 LOT 30 CONSERVATION F- EASEMENT \ Wiscon:.in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430697 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: St. Joseph Development Cor Insp. BM Elev: St. Joseph Township 030 - 2131 -29 -000 CST BM Elev: BM Description: _ Section/Town /Range /Map No: 100 .0 -461 cso.o ST 6� = l .1 r 23.30.20.1083 TANK INFORMATION ELEVATION DATA TYPE MAI`6FCTU�E CAPACITY STATION BS HI FS ELEV. Septic Bench ark , r i u, ( � -3a Dosing Alt. BM Aeration Bldg. Sewer r �{'•� o2•fao Holding St/Ht Inlet S V TANK SETBACK INFORMATION St/Ht Outlet (o •OZ 0 1.X2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD jDt Inlet Septic > 50 1 I �^ Dt Bottom Dosing ) eader M@w. Aeration Dist. Pipe ( y t;,:6 9.35 •9 S' Holding Bot. System . lo•#Fo .90' Final Grade r PUMP /SIPHON INFORMATION �•� aID Manufacturer Demand St Cover u r G �•� i. rl 3•s� 03.3 Model Number TDH Lift Frict System Head TDH Ft Forcemain Dia. . SOIL ABSORPTION SYSTEM Q- T ENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI I CZ) 3 �S eaL. SETBACK SYSTEM TO P/ WELL LAKE /STREAM LEACHING Manufa r: INFORMATION CHAMBER OR Type Of System — I� t [ /" ` �= UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) > 5D Length Dia Le i Spa i SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z� /Q Inspection #2 r- Location: 1432 Thelen Farm Trail Hudson, WI 54016 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 29 J Parcel No: 23.30.20.1083 1.) Alt BM Description = 5 ' t ' �'' q /2 2.) Bldg sewer length = AW-64— - amount o over = � . �� �bo �'�` , ( 3) No well. ('u-lr - .�. Pldn revision Required? No Use other side for addition I In ormatlon.� �_ , _ - J ; -( - SBD -6710 (R.3/97) mxo.3 1 to t r nsepctor's ignature � � �2C.�� N�O 11M a ? J � ( /V� 1+`_s.Vt' u J our° !q !' 64A �- ��'� , C — Safety and Buildings Division County ` � Aff 201 W, Washington Ave., P.O, Box 7162 AA l '�"onsin Madison, WI 537M 7162 Sanitary Permit Number (to be tilled in by Co.) Department of Commerce (608) 266 -3 51 RECEIV 43010 q Sanitary Permit Application State PI i I.D. Number —T - In accord with Comm 83.21, Wis. Adm. Code, personal information yo proviFED 1 9 , may be used for secondary purposes Privacy Law, s15.04(1)(n Project ddress (if different than mailing address) ry/ I. Application Information -- Please Print All Information L ZONING 9 I QE -Z Property Owner's Na me Parcel ✓Y Lot — Block k &4ls A In e Property Owner's NI ailing Address - - -— -- Property Location City, State Zip Code Phone Number - - - -- L- �� / i(/ ✓1�� Q l�- i. (circle one) Type of Buildin T� N; 12 (� E or YA g (check all that apply) � �� _ II. T (5 . -- -- - - -. -- or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM NUMI)CI' ❑ Public /Coi nneicial - Describe Use /�� t ❑ State Owned - Describe tlsc 2 (.V� S �3 X9Z - OCity Ovillage XTowuship of - III. Type of Permit: (Check only one box on line A, Colnple line B if applicab p 3o - ZI 31 - 2q A. W New System ❑ Replacement System ❑ T eatrnent/I-Iolding Tank Replacement Only ❑ Other Modification to Existing Systeut B. Pi Permit Renewal ❑ PerIniL Revision U Change of -L t Transfer to New List Previous Fermit Number and Data Issued Before Expiration Plumber - VV. Type of POWTS System: (Check all that ap) ly) ------ - - - - -- - -- -- Va, Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Consci ucted Wetland ❑ Pressurized 111- Ground ❑ IIolding Tank ❑ Peat Filter ❑ Aerobic T reatment Unit ❑ Recirculating Sand Filter U Recirculating Synthetic Med r _ Le aching Chamber ❑ D'' Lin ❑Gravel - less Pipe ❑Other (explain) V. Dis ersal /Treat Area Inl'ormatioii: — Q K titrl L of `X — � DeSI �n Flow (glx1) oil Design S Application Rate(gpdsf) Dispersa rea R quired (st) tspersal Are Proposed (SO Sys em Elevation VT. Tattle lnfo Ca acit m To P Y Total N — umber Manufacturer retab Site Steel Fiber � . Ga a Z lasuc Ga l lons Gallons llo ns of Units — U is Concrete Consmucted Giass New Existing Tanks Taaks Septic or Holding Tank _ — Aerobic Treatment Unit Dosing Chamber - VII. Responsibility Statement- 1, the Undersigned, assume responsibility for installation of the POWTS shown on t attached plans, - - -- Plut fiber's Na me (Print) Plumber's Si gnahtre MP /A4 §Number -- / DUsiness Phone Ntunber �Z Plumber's Addre ss (Street, City, ` C Y, Gip e) /-- VTII. County — /Departme nt Use Only Approved ❑ Disapproved Sanitary Permit Fee (it dudes Groundwater Date Issued Iss in Agent Gi Signat''e o Stamps) ❑ Owner ven Surcharge Fee) Ranson for IX. Cont TEM OW of Approval /Treasons SYSTEM for Disa nova 1 1 3 / - - - ✓ - 1 Septic tankk, , of pp effluent filter and dispersal cell must all as per management plan provided by plumber, ^n t 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County onl for the e syste Oil paper not less than 81/2 x II inches ill size - SBD -63913 (R. 01iO3) r Wisconsin bepartnent of Commerce SOIL EVALUATION REPORT Page of _ Division of Safety and Buildings in accordance with C pp���++��`� `/CC � ode 's? lN�rr U E otmty C Attach complete site plan on paper not less than 8 112 x 11 in sin � � i ` �c include, but not Dated t: vertical and horizontal reference pc nt (SM), direction and arr�l I.D. percent slope, scale or dimensions, north arrow, and location nd dis;tanncq t 1 nearest road. Please pant all lnformalto II'' ttSS 9 4 av' by t2tel, Personal information you provide mey be used for seeondery purpos (Prry 'M 1 (m l / 2D Property Owner ZON MMMlylk,wation r v N ct K C ` � t Govt. Lot SLj 1/4 S F 114 S &I T 4, 0 N R Z(} E (04_1 Property Ownees Maiiing Addres�� Lot # Block # Subd. Name or M# 2 CC „ S tt �1� !ll• ( �Ljr city State 0 City Q Village ® Town Nearest Road r �'n 0 New Cons =Wn Use-W Residential / Number of bedrooms � _. Code derived design flow rate 0 U GPD ❑ Replacement a r ❑ Pubic or nmerclal - Describe Parent material OC�i� 5 Flood Plain elevation if appkcable ft General and recommendatio: Sys- �-�v►n -2.1A U i ns q Boring # Soring Pit Ground surface elev. i ft. Depth to limiting factor. - In. Sofl Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munseli Qu. Sz. Cont. Color Or. Sz. Sh. '0#1 'Eff#2 lu Z Z7-?(1 1s 41 I w-x ✓' w - E —A 4q -S� 3,( � 2- [i] Borin , s0 # 2 Pit Ground surface eiev.' ft. Depth to limiting factor T . 3S — in Sol W icedon Rate Horizon Depth Dominant Color Redox Description Texture Struch" Consistence Boundary Roots GPOM in. Mu nseq Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a (3/3 T 5 Iv 3y' M _ -S& v✓► 4 YA-� r C S — s W • Effluent #1 =SOD > 301 220 mg& and TSS >30 < 150 mg& • Effluent #2 a BM < 30 wq& and TSS 1 30 mg1L CST Name (Please Prh) 9 4 , S ature CST Number Address - S `// Date Evaluation Conducted Telephone Number 2 S/= 4 ,-0 1 S5'�ZS 1 Z4 - -0y 15_- 7 &o -c3z 1 Property Owner a V— � --� � .� Parcel ID # Page � cf Borktp p f ❑� Boring a[. Z o ❑ Pit Ground surface elev. ft. Depth to limiting factor 1 3�2— in. Soil Appligation Rate Horizon Depth Dominant Color 1 Redox Description Texture Strxture Consistence Boundary Roots GPDIfF In. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 r CS /.f ,s C5 - �s 0A s Y T� a Soeov # ❑ n9 ❑ Pit Ground surface elev. fi. Depth to Wn ft factor in. Soti Rate Horlmn Depth Dorr*wd Color Redox Description Texture Structure CormWence Boundary Roots GPD/ff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 •092 i� BorkV pit Ground surface elev. ft. Depth to Nrrlitirg actor in. SO Application Rate Hortron Depth Dominant Color Redox Description. Texture Str Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •E1f#1 'Eff#2 Effluent #1 = SOD, :P 30 220 mglL and TSS >30 1150 rnWL ' Effluent #2 a BOD, 130 nV& and TSS 130 mglL The Department of Commerce is an equal opportunity F 4 service provider and employer. PP tY F p oyer. If you need assistance to ac services access c or need material in an alternate format, please contact the department at 608 - 266.3151 or TTY 608.264.8777. 39"330 (11.600) d / Y %1� SL 2 v cl _ /oc) . O RG 4 Q �I iA V I N 9 � I ti vlfl sconsin P Dep artment of Commerce SOIL EVALUATION REPORT `!�� Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. R by Date Personal intmmation you provide may be used for secor T , . .T w. (�) (m))• t �(�liyl�r^- 3f/•� 03 Property Owner `` rope Location �A e l p(Yl� Govt t $�ti Pro pe rty Owners Ma l 114 S 1/4 S L S T 30 N R 1 0 E (or� Mailing Add of # Block # Subd. Name or CSM# ., City State Zip Code PhotieNurtibef ❑ Ci ❑ village &Town Nearest Road S+i Ilwc� e� I� 9 nt 1 55082-1 - 55v 8Z (� t) - i 4 �l - �v� h 3 [ New Construction Use: [ Residential / Number of bedrooms Code derived design flow rate a U GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material , ou -( ,j u s h Flood Plain elevation if applicable N / /47 #• General comments 5�5� C V �S • U and recommendations: ^ CaYl,�r1� ��- o'>-.•- (32 ��� /load /Gib • a CJh. � Boring # Boring 1 © ® 2 Pit Ground surface elev. /00 / 0 ft. Depth to limiting factor to in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 D -10 10 X31 `t S L Zrirr c S Z l0 3S 1O LAVA 3 _ 12 C 05 DS rY Boring # Boring ® pit Ground surface ele . 6 Depth to limiting factor l 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Des xture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I 0- 10 r 314 5L Zn --abk m C 5 ) 5 G Z (G r 14 ILA — 5L ZrY)s mVr CS 5 q Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) siq ture CST Number MOM der _ 2-5 3309 Address Date Evaluation Conducted Telephone Number 7113 FAT'= S�. Some , bl) S�oL 5 l�—oz C�15)24� -4 ©03 e Property Owner ay :K 6 X' � eg Parcel ID # Page Z 3 Boring # ❑ Boring of ® Pit Ground surface.elev. g ft. Depth to limiting factor In Horizon Soil Application Ra Depth Dominant Color Redox Description FT�e Structure Consistence Boundary Roots GPD/itz In. Munsell Qu. Sz. Cont Color Gt. Sz. Sh. •Efftfl •EfiN2 m5 c Iv � 1.2 s � - - .^7 I.Z E Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rai Horizon Depth •Dominant Color Redox Description.._ .. Texture _Structure Consistence Boundary Roots GPD /f1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2 F Boring # Boring Ground f ❑ : - ❑ Pit roun surface elev. IL Depth to limiting factor in. Soil Application Ra1� Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ftz In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'EffFl1 •EffN2 Effluent #1 = BODS > 30 < 220 mg/t- and TSS >30 < 150 mg/L • Effluent 92 = 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. SB68330 tR07100l i r • PAGE_,3 OF NAME ('C:t r ( i cti!2�g LOT# Z 1 LEGAL DESCRIPTION SLj YSf `a S T 30 N R Za E(orl� SCALE: I "= BM 1 ELEVATION / BM 1 DESCRIPTION j Q � ��, BM 2 ELEVATION BM 2 DESCRIPTION , p a . std Q"D t SYSTEM ELEVATION 6 SYSTEM TYPE CON'T'OUR ELEVATION /pd d ® i ' 1 ��L • I S Lrl may 8'Z DATE SIGNATURE c0 �- �'Z ' �Z- IV Lk NJ L � L Vq �m Z c o /Xo 7,5- zzb 1 lV - X h IV L gm� iq' �m /�.o 7,5- 02/19/2004 12:31 FAX 715273 0444 NELSON- PLUMBING 1a002/002 — Quick4�M STANDARD CHAMBER 82' — -- -- OuicM Standard Chamber 49 ' (EFFECTIVE LENGTH) e 1 " 8" 347 SIDE VIEW SECTION VIEW Multipart End Cap a i 12• (( I r t 1 34" 910E VIEW TOP VIEW FRONT VIEW •r R -4— , v � \ I' j � INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY W lIr ebudu d H= of arch c4wn w and pWw, waaSa vb saw baceaewy nrmAaori ed by InAleala f %wow), Vw Ytttalud arc aporarad In • hatMtlaN d an otvao saptb eY+ty^ n etxupertce vrhlt InAhMtpr's htarARtlantt. I wwmmad to 04 ptphW P/Chaw CHM ftSYrtal rclve MENOMONIE maeeaq end ` -aletu onip br one year Yon Aw da s trm ns mpW psmsh Is Issued 1v to up* watvn comasYV Oro ums; pwoawd, how" , mn A a septic pw" It nol WpAmd by aPWa+ble Iew, UM whmb" PwW Wit bdOn Won the dale M&I hWJJMI r of ft moat %mein commences 1e mwrd» ha mvwty row Holder mAl Co no* hainn �oypoa t whhp w he rww f wAltwum in OM a*tf *. commdcut w" finnan (is In6 ' n Il a= *' pt � of wnwd www h of 4+s Urn mnla.ro w Iw m seed by ma I Amax werrnlµ ) IN (to THF, LIk*M WM M A PAW AND ADAM tS wim%Mawin N Am M wi!, Tmtii : N IC m OTmcR wAmFiA=R mN R EC ' iSPT �l'STE M S I 1 V TU THE UH 15. UMO, W RAPUED WARRAMM OF ME MOHANrABILITY OR F"4111511 FOR A PAAMIL AR PURPOSE W T1W 1)Y41.d wmAy anw W , w d any pan o, uw chsrvv 9~ N nvxdwmmd by w w o0w Van nMralo. Tho LYnlrm Wwongr dons urn auaot d m in Amntd E wim msnta/ Onsib Wsstowow SoIGdORt: " prontrllon er4 woos, roe end mewar, ttWlrfwerl twela. e• rw wI kwtee nr ,.p.rrM. 1'nu+ad Dy dw MmhLt v emy vad parry s peatkaly e•ehneel ham U"Hrd Wer•ena m+eraoe ve tAtmtga Le Ass Unha due a ordhtvy wav and tev, sheraWn, aesldam, mlauta, uAwaa or naghet of a,e urns, v. txRS balr S etq.msd to rdAdo wnb or aav wnanloro `decr ae naI potmhroe W ets na olwton weucaorw muse to rtwfmAht trrt 6 Business Park Road a P.O. Box 788 mnmam pavrd eavra rt fens the hytaApan Irra1nO14ts, Irr psw►nenl of :npe,var mgtrv4r wo rho ww+ea eemat«hy dw u,ke, lasso d Old SBybrOOk, CT 06475 pse ltnhe a IM eapde system dur na Etexolwr dlnp v Ynpropsr atotp, egwapa, wWer wsie hnvmpx Iieeee dlsooral, ar Ynpreprr oavNkn, a o n aoan rtd atlsae by ro Naro eats Lmlm tNUtonry srtae 1>• vdd E O,a Honor mEa ro aornWy .mn d d tM to me ttet raV1 n aw 4Mred 860-577- n Iw r m �oo e FAX 8 ww 6 qq 0 -577 -7001 f•Lrder n no amt slsoll nAlvola w nmparohr br" o, w the Holds, ter L hhs, o+ " ihnl awry sau11L% hem YwWWIm a W tr 000�221I �ee�YJ6 man, d aern ' tvgdvOr Asttity dahte d Molder a er'f' Nhd Pw* Par No Lh ar elud VnrAy le apply. eta Unto must be hotaled dan �M A eha ca dlkee ttrguYed by ME and wool caeca; all ottetr eaolloebb b; orb InAlmtoM himalinion Ymniwlons hW H ddv atlalhro of 4sAhralvr 1� eta taAttcrhy to alsvrpo a oaterb ne Urtriad yyanantY• No o-arraurpr applies to any tatrry gdter ptin ar tyl The no ne MWamm2 atorsivd LAnhaa iMirmty ofie by eAlaawr A snood metwe of stag and m.110 he•a CON*" wrervtb MLILJ o- owe, Airy PJMhU* at lAda N,nAU ewaael MMamra Cerpotes lleadqueim In Ok iaphm* Cwraetlwa POW to Uwh pteohaaa, to mtah a copy d do appaamr wow", wtd shoal am 4* reed dot wvmty pfl)r a the pUdtws of LNft U.S. F219nta 4,768,561, 3,017,041; S.ISSAft. 5,9,16,017; 5,401,116; 5 6,611,003; 6,715,163, 5,599,779, 6,839,944 Catlat UA Pal6nta• 1,329,959, 2,004,65A 01hor palanip pording. Inftllrato , Egta twat and SideWlndar arc roolstatod wadwnvlts of InAlcawr S warns Inc. Indhralor It a tooletwad Irodwrwk N Franca. Vdkmlor Syatonra Inc. la[CyUttmPa�f Is a rapalwad eadenwk in Maauco. Contour, Cormur Swlvd Connection, MlcroLawhIng, PdyTu9, $nnpLotx, Cttpmt;w$pww, Pos. Look OtackCut, O.Aakfty and QuIc" prat lrpdprrwrks of InNlralor Syaleme Ina 0 2006 Infiltrator Syalame Inc. Pdntad In U,BAA, 0011203HP -0 a Z e Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 30 6�1 Number of Bedrooms 3 Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorpti n Component Design Flow - Peak (gpd) D �2 4 - Maximum Influent Particle Size (in) V 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se and outlet filter shall be assessed at least once every 3 years by inspection. T outlet filter hall be cle proper o peratio n. The filter cartridge shou not be removed unless provisions are made to re amain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PL jt , 6 71�_- :a 7 3 �YY co /U C 2 ( .4- r- 715 6 4 - 7 C O C 9 o C Z N C/l1 f r r 6 ,J -719 0 73 6 74K CO, 3 . \7 I U 2634 P 129 7-7 ILQ'-7 z KATHLEEN H. WALSH REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 1 - 2000 ST. CROIX CO.. W1 RECEIVED FOR RECORD Document Number WARRANTY DEED 68/09/2004 10:09AN THIS DEED, made between Grundhofer Construction Co., Inc., a WARRANTY DEED Minnesota Corporation Grantor, and Dennis B Maier and Angela R Maier, EXEMPT III husband and wife. survivorship marital property Grantee. REC FEE: 13.00 Grantor, f a valuable consideration, conveys to Grantee the following TRAITS FEE: 1270.50 described real estate in St. Croix County, State of Wisconsin (the COPY FEE: "Prop CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 #240972 Together with all appurtenant rights, title and interests. 030- 2033 -40 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 22nd day ofJuly, 2004. Grundhofer Construction Co., Inc. �OJerome C. Grundhofer, President * AUTHEN'rlCAT1ON ACKNOWLEDGMENT Signature(s) STATE OF Minnesota ) _ WASHINGTON COUNTY. ) ss. authenticated this 22nd day of July, 2004 Personally came before me this 22nd day of July, 2004 the above named Jerome C. Grundhofer. President of Grundhofer * Construction Co *a Minnesota Corporation Inc. to me known to TITLE: MEMBER STATE BAR OF WISCONSIN be the person s) who executed the for going instrument and (if not, _ _ -- -_ acknowledge he same. * e. authorized by �� 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY *Nancy J. L nt Notary Public, State of Nunnes4a My comm•ssion is perm�lr. en (If no ,state expiration date: Greg Booth Attorny 1900 Silver Lake Road Suite 200 New 1 13 -5' e, Z ) Brighton Mn 55112 (Signatures may he authenticated or ackn(i%aledgcxl. Both are not necessary.) NANCY J. LE NTZ *Names of pets+ +ns lignin¢ in any capacity must be typed ur printed below their si NOTARY PUBLIC•MINNES0 I Q My Comm. Expired Jan. 31, 2005 WARRANTY DF.F.D STATE BAR OF' RM No. 1 -2000 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L�� r Mailing Address �l \� S" S f L Property Address 1 3 T ` L F - N - PAP, T R �- V/� (V erification re quired from Planning d epartment for new constru ( V er i ficat i on va aaaw...... ....Lw.a...a .a..... Planning ✓v - -.-_ -__ new constru Cit �� w -� s�r� Parcel Identification Number c' rk r' LEGAL DESCRIPTION Property Locations i /., ' /., Sec. , T 3c' N -R Town of -y4 Z C/ Subdivision s Lot # Iv\ Certified Survey Map # , Volume . .Page # -j"TA�,STY-� DEED -d '7 O o S �� �� , Volume Page # Spec house ❑ yes no Lot lines identifiable'I yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a that 1 the on -site wastewaterdisposal system umber 'ourne lumber restricted lumber or a licensed pumper verifying ( ) masterpl rJ Y�nP r P P 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 'Department of Natural Resources, State of Wisconsin. Certification stating that your 'c system been maintained must completed and returned to the St. Croix County Zoning Office within 30 d oth�ree -Xirati to_ r �/ Sl 16F APPLIC / DATE OWNER CERTIFICATION I (we) certify that all stateme on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of e a b v , by A e f �w ran recorded in Register of Deeds Office. c SIGNAtUREKOF APPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed `J 2 0 6 5 P 5 9 8 70056 ti KATHLEEN H. WALSH Document Number TRUSTEE'S DEED ST. cROIS , DEE IIII HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/20+02 01 :00PH Henry J. Lentz, for a valuable consideration conveys without warranty to EXEMPT # ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota corporation, Grantee, the following described real estate in St. Croix REC FEE: 13.00 County, State of Wisconsin: TRANS FEE: 4590.60 COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE, I;;3 D 1900 S:: _'.. OAS FILE NO. I I ;I 9 /55112 030 - 2032 -50 -000; 030 - 2032 -10 -000; 030 - 2032 -70 -000, 030 - 2033 -20 -000; 030 - 2033 -40- 000;030- 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this day of 2002. "Henry J. L Trust r " *Bernice A. Lentz AUTHENTICATION / ACKNOWLEDGMENT Signature(s) 2 Ct ✓� STATE OF WISCONSIN r r► Ora— Ai, LQ �, ST. CROIX COUNTY 1 Personally came before me this _ day of authen ' ted t is of ��/ aka 2002, the above named Henry J. Lentz, as Trustee of the Henry J. Lentz Family Revocable Trust, and Bernice A. Lentz, to me known to be the person(s) who executed the signature � ^ foregoing instrument and acknowledge the same. type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: Robert F. Wall ) "Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesDeedStJosephDevetopment -02 �oY RT•OF THE NEI /4 OF THE SW1 /4 `� Q \ N89 54'07 "E 8 1 1/4 OF THE SE1 /4 THE SW1/ 4 OF -- � s 4 OF THE NW 1/4 OF SECTION 26 i o ,��, ��i` 8954 7 °w E ;ROIX COUNTY, WISCONSIN. < :6,h- \ 4T H SEE DETAIL \ — - ' h •'�!, ON SHEET a � LOT 15 \ \ 3.000 ACRES 130,681 SO FT LOT 29 \ \ SSE DETAIL � \ ON SHEET 4 3.000 ACRES � ' . \\ \ ••• .��� Nr 130,682 SO. FT. \ \ a43 w • \ e 77 15667 co f \ \9 113 cfl \ � N LOT 14 LOT 30 \ '. cP� 3 000 AC-ES 3.000 ACRES 1 30 685 5c: : 130,682 SO. FT. a \ �• CONSERVATION \ � - ' — EASEMENT 0• , ...... ......................................... ................... 463 74• 240.73' 223.01' S89 0 59'28 "E 1329.95' N89 0 59'28 "W 2659.90' 20 RECREATIONAL -_ TRAIL EASEMENT _ — — -. CORPORATE OWNER'S CERTIFICATE OF DEDICATION ST, JOSEPH DEVELOPMENT CORPORA ION A eCORPORATIONSDULY O AN'. �\ ST. CROIX COUNTY WISCONSIN ZONING OFFICE N ° N 111 N F N 10 _ 16 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road ��•' -- _ - 1-�--y Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 October 1, 2004 Dennis & Angela Maier 1432 Thelen Farm Trail Houlton, WI RE: Remodeling project, Town of St. Joseph, St. Croix County Parcel # 030 - 2131 -29 -000 (23.30.19.1083) Dear Mr. & Mrs. Maier: You have requested the Zoning Office review your remodeling/addition project for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the planned modifications involve an increase in design wastewater flows to the Private On- site Wastewater Treatment System ( POWTS). I have reviewed your remodeling plans for the above residence. The blueprints indicated that the project involves finishing two additional bedrooms and an office (no closets) in the lower level of the structure. The septic system was designed and installed based on wastewater flow for three (3) bedrooms with a maximum occupancy of six (6) persons. This project will increase the total number of bedrooms to four. Technically, the POWTS will be undersized for the number of bedrooms, however, current occupancy does not exceed the design wastewater flow for the residence. An Occupancy Affidavit is required to disclose the difference between number of bedrooms and septic system sizing to any future owner(s) of the residence. This affidavit has been submitted to the St. Croix Coula Register of Deeds office to be recorded on the deed to this parcel. � &Gd'tcW� �1 The original system was installed4`n April 2004 by Roger Nelson and was inspected by zoning staff at the time of installation. The system was found to be code compliant at that time. Inspection report and sanitary permit documents are on file with the zoning department. As a reminder, to prolong the life of the system, remember to have the septic tank pumped at least once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The projected life span of this system is dependent upon proper maintenance of the system. f If this POWTS should fail at any time in the future, the system will be need to be inspected by a licensed plumber or POWTS maintainer to determine if it must be replaced according to state code requirements in effect at that time. The proposed remodeling and room completion project must comply with all applicable building codes. Please contact the Zoning Administrator for the town of St. Joseph to obtain a building permit. Should you have any questions, please contact this office. L Sincer , ela Quinn Zoning Specialist Cc: Dwight Farnham, St. Joseph Z.A. file I