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Adm. Code County St CRD / Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan p include. but not limited to: vertical and horizontal reference point (BM), direct' and Parcel I.D. o„30 ' -2 40 0 & ' / f� • UQ Percent slope, scale or dimensions, north arrow, and location and distance t d. Please print all information. Reviewed by Date Personal information you provide may be S. t . (m)). i v y MARK �¢RL So�V Property Location o Govt. Lot $ F 1l4 S f im S 3 rj T -30 N R,20 E (or) W Lot BIB# U . ACS P2.1 3/ Pr operty y 5 ���'`� h'd �� 3o b( City State Zip 7 Photid ❑ city ❑ Village RI Town Nearest Road IF W 00P13A New Construction Use: f � Residential / Number of bedrooms 3 - Code derived design flow rate yJ�a O d GPD ❑Replacement ❑ Public or commercial - Describe: Parm t material �/ �/S 3 D U 1• W �' Flood Plain elevation 'rf applicable y ft. General comments # and recommendations: • -4455 - TF S7"E� /P�"QU�iPES /¢ /yOUivV SS/S7 -j ?!S/A)G- IA fl S f;i 11 Wig, 8 r X 75 C27�, F Boring # o Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Sod Applicatiori Rate Horizon Depth Dorinant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 Y#? 3 o•�o /o 1 ---- — s A014 3 f • y . 2 a •io io yl �- Ifs 6 t nom► cs I . Co 3 •1 /o YR .S S /Z- I - FS bk nM i c 4 • 5z /o �Q C M oTf 5 1t- A u'►'t4 u f t O . L 7 •s A yiG 2 Boring # 0 Borin .- 97 o Z 5 sss ® Pit Ground surface elev. ft. Depth to limiting factor in. Sofl Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o • 8 /o .�/ L ! fS K 1W u cv . 3 .4p 2. • i /0 R ifs nM cry Z 3 •Z iv S/L I+ShK A% f i C S' S• S 16 M s c 2 M s s -7. S Effluent #1= BOD > 30 < =0 M91L and TSS >30 < 150 mg& Effluent #2 = BOD < 30 ";& and TSS < 30 mgfL CST (Please Print). Si j --- Nurmber ML-G I C( T 2Z-lo 3 S Address Date Evaluation Concluded Telephone Number S0AE l • - 14 77 • 3 yy rlc Associates a � Private Sewage Consultants L5 • Z d D / / 2812 1 Oth Ave. Spring Valley, WI 54767 NOT �% S % f SD�••e �- p GINAL QUA' /A+ r, . �: s 4'x,1 0T no�,5 q o� S OIL 15'e 7 8/f Cr /PAS i c T 74 f�oN i S l� 7` . 7A) 5 5h // /3� )U olvNm D'� 8 U Y r::vS j. sD /QrRG -- z. 3 Property Owner Parcel ID # Page of # ❑ q g. z, � 2 sss Q Pit turd surface elev. tt Depth to kw&V factor 7 in. Sol Applicafim Rem Horizon Depth Dominant Color Redox Desuxiplion Texture Structure re Causidwm Boundary Roots GPON in. Munsa Ou Sz Cont Color Gr. Sz Sh. *SM I 'E1f#2 / 0 .7 id R 3 — Z - I fs k 's"ufe w 3f y • C.0 2 • I - G / fshk for . to .2 If S i g _F' G f 9 . G i T s�L D f �' o Z A9 Z ,S M y F-1 B oft # ❑ BoAV ❑ Pit Groundsurfaceetev. R Depth to finbV facto in. Rate Horizon Depth Doff*wtCokx Redor Dwm"on Texture Structure Consistence Boundary Roots GPM In. Munsell CkL Sz. Cont. Color Cx Sz Sh 'C -tf#1 TIM F-1 ❑ BmV 11 P8 Grand surface etev. ffr tD lirru�rp tacaor in. Sou Rate Horizon Depth Darn Color RedoxDesaiplion. T Structure Conswence Boundary Roots "'"" C~ in. Munsel Qu. Sz- Cant Color Gr. Sz SK 'EB#1 'EM F ❑ Pit Gtourtd surliaoe tL Depth >b factor in Sou Rob Horizon Depth Dorrinarut Color Redact DeAmiplim. Ten" Stunt re Consistence Boundary Roots GPDO in. Munsd QL Sz Cbm Color Gr. Sz. Sh. �71 Effirrent #i = BOD > 30 < 220 ffq. and TSS >30 150 ffv& ' Effluent #2 = BOP, 30 n & and TSS _< 30 ffQ& 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 . fonat, please contact the department at 6U-266-31 51 or TTY 608- 264 - 8777. aeoaawpwoo) • I D2i v �l l �'� 7 I / ! Z-o yo �r 0 g g.zcf l� ljl 0 t2- a q-7,90 4 �•{/ "F I i/ 1 R 3 z / 6l 1 7 ? , f (I 1 r � . TO of l s � I n; 2 G 2 769 13 � e ,L d T 10 0 r t� s � r 13i4cK Li;0 46 g® so 1 i DIY �i J ( ft f t r{ I 1 , ®_ Ulbricht & Associates 3 Private Sewage Consultants 2812 10th Ave. Cnrinn ihlin.. A! G w -YL%-s PARCEL (MORT•) VOL. 1003, PG. 195 / 2a WIDE ACCESS EASEMENT / �o j `•. 1 20' WIDE ACCESS EP �, e �/ DESC. IN VOL. 556, PC / DESC. IN VOL. 615, PG. 76 a -`. ! X VOL. 651, PG' as / PARCEL ro / VOL. 1023, PG. 262 0 0' ti im 1O h - h N / 25, 80 / PARCEL / VOL. 1023, PG. 262 0` ea • . ss'�/ �c <. cd eLVFF k��Ck� NorFj o pry n'J c\ PARCEL m �l- h VOL 556, PG. 120 / bu _1° < , PARCEL VOL. 1119, PG. 131 / PARCEL AREA 1.42 ACRES I 61,874 SO. FT. / MORI) - i Q / PG. 277 ° p o Ri m 0v 0 O ,,° Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463242 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be :;sed for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Carlson, Mark I St. Joseph Township 030 - 2066 -90 -000 CST BM Elev: Insp. BM Elev' BM Descriptig ) Section/Town /Range /Map No: 35.30.20.609D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic LJ , ��/ '] 4C 66 Benchmark -2611 t CJ� / Dosing b A- b� t,), I Z5 1�Z t 3 � Aur � l Bld .Sewer J � ` G3 . /3 Holding St/Ht Inlet J TANK SETBACK INFORMATION St/Ht Outlet TANK TO P /L. BLDG. Vent to Air Intake ROAD Dt Inlet Septic if / Dt Bottom + L, -Zq <3q ., , / 7iD � Ito � J T l � ` '( Dosing �'d / / / Header /Man. 7, I3B Aeration Dist. Pipe Holding7 Bot. System -J (D PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St -Geyer P ' d S Dom w Z 3 Model Number G-P TDH Lift? Z'( 1 Friction Loss System 44ead TDH Ft Forcemain Len th i Dia. z n Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH DNS Width i Len th No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 3 f SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type Of stem: Z�I Z' / UNIT Model Number: e\� a 53 sd� a DISTRIBUTION SYSTEM Header /Manifold �/ Distribution \ i x Hole Size x Hole Sp�g Veto Air Intake I / Pipe(s) G �t=� Lengt Dia Length 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 Z,7 Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 191 Riverview Acres Ro d Houlton, WI 54 (SE 1/4 SE 1/4 35 T30N R20W) River iewAcres Lot 10 Parcel No: 35.30.20.609D 1.) Alt BM Description = �- 2.) Bldg sewer length - amount of cover Plan revision Required? Yes No '4y 7t; Use other side for additional information. �_ _ __ _ 4Sigure Date Insep Cert. No. SBD -6710 (R.3l97) ' Safety and Building County ` . gp Ix IMF I�cOn�i Madison, WI 537 - 71� 201 W Washington Ave. O. E' t Pe t Numbcr (to be filled in by Co.) Department of Commerce (608) 266 - 51 2 2- Sanitary Permit Application L " T - 0 7 Plan 1. .Numbcr In accord with Comm 83.21, Wis. Adm. Code, personal information yo CR OIX may be used for secondary purposes Privacy Law, sl5.04(I)(m z iN Co N*JJ ct Ad ess (if different than mailing address) OF C E Q I. Application Information - Please Print All Information 191 rI J K D 0 Property Owner's Name arcel # Lot # /O Block # ZO (o - ogfl Property Owner's Mailing Address Property Locat , � ✓�i 6 r\a 5 1C_ /., Y., Section J City, State Zip Code I Phone Number I Z 1- f 9 87 (circle v z � 6 r� �� 5 8 Zo T X� N, R � or� II. Type of Building (check all that apply) W .3 S ' Subdivision Name 6SSA4- NamtrtT I or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village!KTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System p y g p Y g Y ❑ Replacement S ❑ Trca[mcnt/Holdin Tank Replacement Only ❑Other Modification to Existin S B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) Q i S Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravcl -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) I Dispersal Arca Pr pose (sf) System Elevation VI. Tank Info Capacity in Total Numbcr Manufacturer, //y) Prefab Site Steel Fiber Plastic Gallons Gallons of Units t'rj 4.- /0D II-- CT'f•.C,. ) / Concrete Constructed Glass New Existing Tanks Tanks r Septic or Holding Tank � �, Aerobic Treatment Unit It Dosing Chamber at 6 VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Namc (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber Address (Street, City, State, Zip Code) 3i26 `z0 F) VIII. County/ e artment Use Onl Approved isapprovcd Sanitary Permit Fee (includes Groundwater Date Issued 1 suin Agent Signature o Stamps) ( - Surcharge Fee) ��— O 4� ner Give Reason fo cnial � p (� IX. Conditions ova ppr a r ^- TO ° - - d1 �_ 1 _ (1 . SYSTE NER., CRy ' 1 Septic tank, effluent filter and yW,, i 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 81/2 x I I inches in size SBD -6398 (R. 01/03) f JOB / 4 v � s 6 y► TIMM EXCAVATING SHEET HO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772- 32.14 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE �Q ........... ...;.......: Y , ..s t ... ........... . ....... .... :........... :... �... . .. .... ...... .. .......... .. :.:;::::.: .....:........ ........:.... ,F w 0 �: ........... ...... l ?� 3...... _ ..... p.........e.l ............. . L �. .... .. . ............ . .. 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OF WILSON, WISCONSIN 54027 CALCULATED By �� = DATE A 4 0y (715) 772.3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ! ................ ....................5.......... !......................... ` .......... a..........................................:......... ........ ............ ..... ..... ±............ .........i..................... .....�. . ...................i........... ._. i ...... .... .. ..... .... ... ........ �J i a 1q. i ! f 11 ...... _........ .......... .......... � ...... ; ....................j.. _..........±................................ i.................. ..............i...........i.... .... . i .... .... �.. .... .......i.......... / }.... .... ! ! a }.. . »..... i ................... .......... ..... ........ ....` ...... ... ... .... .... ..... .... .. .... 5 ... .. I T . ... }.... ......... ... .... ...:... ...I... ...i... i ... }........� t ! ...................... ....... ... 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SS .... ..a. !i ................... ........... .................... ........ �.......... +......... ..,..........:................. j........... ° ..........!........ ..... ........i...........'... ..... ..... ..... .... .. .... ..... .... .... E ! i .........!.......� ..... ............ .a. , ...........:.......---......... :...........t.. .... .... .... .... .. ... .... ' ' i�.... a 1 < i i : i i ; 1 i j � .. i i i ... ..... ... '.......... i ... .... ..... .......... �............ :. ... .. ...... T a ! . ..... ....... ...:...............:..�,......_ .... .... . _r �......... .. ..... .. .....j. ..... ...... .......f................... « -.. . .....;.... ... ...,..... i ..... ........... . ..h .. . . .............. ............................... ................' .... .... .... ... .. ... I , ? 1 i ! ! i ! i i ` t ! : 4 . . i i v L i ,� it ... ! ................. .............. i ! ..... am n .....:......... , ...:.......:......:... : : . . : : o: ! :......... .:..........:.........:........ ... .......... ........ ...:........ ...........:...... ....... .... .... V r .... �v.. # IR Q K � 7 ....... .. «........... > ................ ., ... i .. .. .. .... .. .... ... ..... ..... ..... .... .... .. .: :... .. ...> ..... ... .... ..j.. ....................:....................... :........... :........... :.................... ...................... i........ ..... ..... ..... .. .. .... ... ..... .... .... ..... ........... ..... ..... .... ... 3 i } ............................... ..... ..... p .. ... ... . , .... ✓ ..................... : .. ...:... ...:... ... .. v . ...... ... .... I i PRODUCTM141 !m, Groton • Mm.o,o;. T TOLL FREEMoPaeM JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE li ° y (715) 772.3214 (715) 386-5443 MPRS 03224 WI MP" #696 MN CHECKED BY DATE SCALE .. .......... ........................ ....... I ............. 1 .......... .......... .......... ......... ........ ...... ............ ......... ........... .......... ........... ........... .......... .. ......... . .......... ........... .......... ........... .......... .. ...... {...........;...........3 .......... ........... .......... ......... . ......... ......... ........... . ......... .... ...................... ........ . N .......... .... ............ ........ 4 .......... ........... ......... . .......... .......... ........ ..... ... .......... ........ 4 ... .......... ........... .......... ........... .......... .......... ........... . ........ .......... .......... .. 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I- . . ......... ........... ........... ........... .......... ......................... Groton. MM. 01471. To Order PHONE TOLL FREE 1400,225$000 2165 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings, in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 030 - 2066 -90 -000 Please print all information. evi ii46d By Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15,04 (1) (m)). .d Property Owner Property Location Carlson, Mark Govt. Lot 4 SE 19 SE 19 S 35 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3047 Meadow Brook Court 10 City State Zip Code Phone Number City 11 Village Town . Nearest Road Woodbury I MN 1 55125 1 651 261 - 1987 St.Joseph River View Road New Construction Use: #M Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ,;I Replacement M Public or commercial - Describe Parent material loess over outwash Flood plain elevation, if applicable NA General comments and recommendations: install "conventional" in- ground trench system w/ 0.5 gpd /sq ft loading @ system elevation 94.8 (below 95.8 and above 94.1) � Boring # - '" Boring Id Pit Ground Surface elev. 101.1 ft. Depth to limiting factor > 148 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1R' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -9 10YR 3/3 - sit 2 m gr mvfr gs 1 m/C .6 .8 2 9 -19 10YR 3/4 - sil 2 f sbk mvfr gs 1m .6 .8 3 19 -37 10YR 4/4 - cl 2 f sbk dh cs 1M .4 .6 06 4 37 -63 7.5YR 4/4 - fsl O.M dvh Cs 1 m .2 .5 5 63-110 7.5YR 3/4 - Icos 0 sg dl gs - 7 1.6 6 110 -148 10YR 4/4 - s 0 sg ml - - .7 1.6 occasional gy si coats on pads in horizon 3; fine gr below 49 "; gr /cob /st between 63- 110'; Icos in horizon 5 is occasionally 1 c abk (dh), oversize .5 f r conservative loading E Boring # j Boring Pit Ground Surface elev. 101.1 ft. Depth to limiting factor > 144 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 1 0 -6 10YR 3/3 - sit 2 m gr mvfr gs 1m .6 .8 2 6 -12 10YR 3/4 - sil 2 f sbk mvfr gs 1M .6 .8 3 12 -39 10YR 4/4 - cl 2 f sbk dh cs 1m .4 .6 •U ` 4 39 -52 7.5YR 4/4 - fsl 0 m dvh Cs 1m .2 .5 III 5 52 -125 7.5YR 3/4 - Icos 0 sg dl gs - 7 1.6 6 125 -144 10YR 414 - s 0 sg ml - - .7 1.6 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Efflue #2 = BOD < 30 mg /L and TSS _< 30 mgC CST Name (Please Print) Si a re: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date&valuation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 11M 04 715 - 233 -0398 Property Owner Carlson, Mark Parcel ID # 030 - 2066 -90 -000 Page 2" of 3 a Boring # Boring to Pit Ground Surface elev. 100.3 ft. Depth to limiting factor > 144 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 -8 10YR 3/3 _ sil 2 m gr mvfr gs 1 m .6 .8 2 8 -13 10YR 3/4 - Sil 2 f sbk mvfr 9 s 1M .6 .8 3 13 -35 10YR 4/4 - cl 2 f sbk dh Cs 1M .4 .6 4 35 -53 7.5YR 414 - fsl 0 m dvh cs 1 m .2 .5 (pt`p 5 53 -144 - 7.5YR 3/4 - [Cos 0 Sg dl - - .7 1.6 107 - F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I I I i I I * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing I � S X30- �.ol.ls- cco -n �� S1: S�- 35'.Zo.2pw r� i Y � 4+ `L L. HtOt.�� 0 .f Ne�L &I'A We, L � 3 ill System Management Management of this system is critical. As a condition of approval of these plans this system management section must be rep iewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water i n a manner to protect ground water quality and public health. I If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. a Never pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 ''o paper products other than tissue should go into the system. ',o chemicals should go into the system. 8 .A�oid surge flows of water; try to spread laundry throughout the week. Maintenance The septic tank must be inspected every three years by a properly licensed person. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacit} to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or r� days should pass before any necessary repairs can be made. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8 .avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. , 4 Particularly avoid winter traffic such as sliding or snowntobiling which might compact snow and lead to increased frost depth. 0 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OW NERSHIP CERTIFICATION FORM OOwner/Buyer / CL Y r 1 / d 6 Mailing Address 3vy7 ✓� e � l6 Br k 6/ lJaa ECr / S�71 5 Property Address R i &Q rl e. J /�c �rQ (Verification required from Planning Department for new construction) VA City /State 9,,J 61 k z Parcel Identification Number y30 - Z04, 4 - %u - 0 406 (� 1v X e4 rJ.e.,r) LEGAL DESCRIPTION v� f � _ u � s 6 oj` L`' / Property Location SC 1 /4, s � '/4, Sec. rL, T 3e N -R ZO W, Town of Subdivision tie" t 0j— , Lot # Certified Survey Map # . —� Volume , Page # �— Warranty Deed # 74? 6 ZD`2 , Volume - �� ` . Page # 2- Spec house ❑ yes .LI no Lot lines identifiable X 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 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 requirement and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. _ /- SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty (feed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *' Include with 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 U 2598P 213 STATE BAR OF WISCONSIN FORM I - 2000 WARRANTY DEED R EGIST ER O DEED i REGISTER [!F DEEDS Document Number ST. CROIX Cil]. � VI This Deed, made between Gail Solberg, a married RECEIVED FOR RECORD person 06/17/2009 01:20PIl Grantor, WARRANTY DEED and Mark Carlson and Pam Carlson, husband and wife as EXDPT # survivorship marital property REC FEE: 13.00 TRANS FEE: 502.50 Grantee. COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate in St. Croix + County, State of PAGES: 2 Wisconsin (the "Property ") (if more space is needed, please attach addendum): See Attached Addendum Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 030 - 2066 -90 -000 Parcel Identification Number (PIN) Together with a[I appurtenant rights, title and interests. This is not homestead property. (is) (is not) ` Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. I Dated thi day of 7 , 66ii S lb AUTHENTWATION ACKNOWLEDGMENT Signature(s) O' Pveli STATE OF WISCONSIN ) /� ) ss. - f 41 k County. ) authenticated this day of MAY V, Pe„�,' onally came before me this day of &,a P_ t e above named t il Solberg TITLE: MEMBER STATE BAR OF WI WWIS�+ (if not, to me known to be the person who executed authorized by §706.06, Wis. Slats.) the fore o'ng instru nt and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Michael H. Forecki, Attorney Notary Public, St o isconsin Eau Claire, Wisconsin My Commission is ermane t. (If not, state expiration date: ( Signatures ma be authenticated or acknowledged. Both are not necessar . t •Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 2000 % ttomey Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701 -7928 Phone: (715) 835 -3029 Fax: (715) 8354112 Michael H. Forecki T4862773.ZFX Produced with ZipFormT" by RE FormsNat, LLC 18325 Fihean Mile Road, Unton Township, Michigan 48035, (800) 383 -5805 U 2598P 214 ADDENDUM TO WARRANTY DEED Part of Government Lot 4, Section 35, Township 30 North, Range 20 West, Town of St. Joseph being that parcel of land described in quit claim deed recorded in Volume 1119 on page 131 also known as Lot 10 of Riverview Acres, described as follows: Commencing at the SE comer of Section 35; thence N.00 0 38'38 "E., along the East line of said Govemment Lot 4, 718.62 feet; thence N•89 0 2122"W., 459.41 feet to the centerline of the monumented private roadway easement being the East line of a parcel of land recorded in Volume 1023 on page 262 at above said office; thence S.25°4&66 W., along said East line, 109.75 feet to a found 1" iron pipe being the point of beginning of this description; thence S.64 °1 1'05 "E., along the Northerly line of above said Lot 10, 20.00 feet; thence S.08 0 20'55 "E., along the Easterly line of said Lot 10, 128.00 feet to a found 1" iron pipe; thence S.14 °53'05 "W., along said Easterly line, 143.18 feet to a found V iron pipe; thence S.28 along said Easterly line, 330.30 feet; thence S.52 along said Easterly line, 96.72 feet to the monumented South line of Section 35; thence N.89 along said South line, 23.00 feet; thence N.00 0 54'41 "E., along said Westerly line of said Lot 10; thence N.00 0 5441 "E., along said Westerly line, 68.95 feet to a found 1" iron pinch top pipe; thence N.24 0 01'16'E., along said Easterly fine, 350.61 feet to a found 112" iron pipe; thence N.25 °48'55 "E., along said Easterly line, 260.11 feet to the point of beginning. Subject to a roadway easement being the Southerly 33 feet of the above described tract of land. Together with a 66 foot road easement over all that land described in Exhibit A attached to the warranty deed recorded in Volume 439 on page 461 as Document No. 291105. Together with a perpetual non - exclusive easement for an access road from the 66 foot roadway referred to immediately above over and across a strip of land 20 feet in width parallel to and adjacent to the Northerly 130 feet of the Easterly boundary of a parcel described in paragraph A of the description in the Warranty Deed to T.E. Janssen and wife, recorded in Volume 615 on page 76 as Document No. 365511, which easement was reserved in said deed. Subject to easements, covenants and restrictions of record and together with right of access to the St. Croix River beach and the right of use of said beach. Together with a perpetual easement for an access road from the 66 foot roadway referred to in the third paragraph above over and across a strip of land 20 feet in width as described in Volume 651 on page 132 as Document No. 379422. For Reference Only: Tax Key No.: 030 -2066- 90-000 Hudson, WI 54016 I ALTA Commitment Valid Only If Schedule 8 Schedule A and Cover Are Attached. JLv• - - °35 HIGHWAY = 423.05 0 210.06 0 o LOT 1 --1 L 0 607A 7A -2 0 6 C.S .M. VOL. 7 PG 20 330.00 I 423.05 ►8A LOT 3 Q E 114 —SE 4 607A -3 41 �8 I ' 607A 1497 3 ? 11 I N 6078 5 1 ' LOT 7 e 2 S4 oa X1 88-- 609A JAN 9j 05 c " 19 . 96.90 553.23 ��o pp6 5/514 �,c .' 9149179 Ual11�S 1 G. 57 �,� ti 60 P, - 1s�.4o 60 S.M. VOL 1 . — 1�� ��6�9M 09P -2 I 145 .00 9 .s1�� 18 i5ua 593/13 /537 609 - 0 h��� y 2a.76 0 ° M 17 2 09V 1 404 41095/514 ti ,�,y�`•' S�� ry °000 609T 1* 6 \0\+,�` a � / 9 ` �o� ,� ,�O °o 150.37 , 15/184 � 16y 609-1 695/84 ^��� � 609NI �$ 609J Q �/ • N E L r° 4 7 8/263 09G h N 4: �' n �ti 1095/514 191 825 o 2.9 / 6 /12 No �3 609C 153a �617 1 102 262 �•�$� 609U 6096 ,� s6 6 433.90 726 /497 177.60' 256.30' p 0 19/1 A. 90.00 ti W N � 609 1 �609R �"° '���� 609K 609E & F 518/61 N 120.3 I 6. 0' 600 eL`r SE COR. SEC. 35 >;tiy