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030-2073-50-000
T - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division i + INSPECTION REPORT Sanitary Permit No: 430022 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)]. "wrt';4 . p Permit Holder's Name: City Village X Township Parcel Tax No: Thielke, Stefen St. Joseph Township 030-2073-50-000 CST BM Elev: Insp. BM Elev: BM Descriptio ii r Section/Town/Range/Map No: j 0 U •a ( 2 (~vt._ ~Vw = t70.0 36.3 .19. 25C TANK INFORMATION ELEVATION DATA Z 0 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark--) l,~ iL 1 U°fl 3s os' 3 p 4 d Dosing Alt. BM ,1 L J C- G-4 Aeration Bldg. Sewer IO.7A Holding St/Ht Inlet 13-f-6 q/.71' TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom f Dosing , r > Iva ' Header/Man. s•` -~7 r Aeration Dist. Pipe 5~.16$ s, 9~~g3 !o Holding Sot. System ~ i~ ~ 24 I ONt Final G de d d PUMP/SIPHON INFORMATION Vj w:(,t_ (ye rZ Manufacturer and St Co r GPM Model Number 3q't40 em Q S TDH Lift 1 Frictio Loss System Head TDH Ft •?,0 .oS 3.25 2(.50 qp'L~ orcemain Length f Dia. tt Dist. to Well f > t SOIL ABSORPTION SYSTEM VIA S. Sl ~oS.St B D Width Length No Of T"~~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth -9114ENSIONS -+5-'.D (4) SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN urer: INFORMATION Type Of System: t ' CHAMBER ~!M 5b ber. J6 l~ 1 DISTRIBUTION SYSTEM 7 F_ 13. y HJ Dipestribution x H e x Hole Spacing Vent to Air Intake i Q, Pingth Dia Z Length) i ' Spacing 3.0 3 30 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of reded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil -1 Yes [ j No L Yes No COMMF-NjS' (Include c~d~ylj~cre es, persons present, etc.) Inspection #1; / 'Z- 43 Inspection #2: I l 1 Lo ion: 2 5 122nd Ave Hudson, WI 54016 (SE 1/4 SE 114 36 T30N R19W) NA Lot 1 ftAj T Parcel No: 36.30. 9.625C Cj~ 1.) Alt BM Description = t1) kgaa.S - ~0 2.) Bldg sewer length t{ 3 " 'D x 3 --~-r.a„~ s 4 -amount of cover= ~"Ws„f CA vim,, i( t t3,`$ Plan Use otheri Required? for additional Yes No ~t b fr j b 3 information. 56D-6710 (R.3/97) Date Insep or-s 6 re ` Cert . No. f Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 t - QQ IK Nvisconsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) (608) 261-6546 oe artment of Commerce 30 DZZ Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Informati n Property Owner's Name MM 2 2 2003 Parcel # Lot # Block # t 036 -141-2-4-00-60 .6.257G Property Owner's Mailing Address Pro Location ST. CF:OI'X COUNTY PAY (003 U) ZONING OFFICE 4ZAA City, State Zip Code Phone Number Section. S l/ L S ~ T _3A N, (ci ole OW if P C II. Type of Building (check all that apply) st,, ./✓y ~l or 2 Family Dwelling -Number of Bedrooms 3 ubdivision Name CSM Number ~ • t>w ❑ Public/Commercial - Describe Use - ZO r 3 ` S 2 8 `J t VJ "-1.0 17-" ❑City-❑Village Qrownship of ❑ State Owned- Describe Use (v x-45' 57, 6- 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner r IV. T e of POWTS System: heck all that apply) 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 "round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dis ersaVI reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation SD 50 Ll 15,0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Clamber O C-5 VII. Responsibility Statement- 1, the unders ed, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s ignature MP/MPRS Number Business Phone Number Irl 4&W S34W r ;7 91' S~Sy S~ Plumber's Address (Street, City, State, Zip o rJ CL~~ E r - _ / y VIII. Coun epartment (Ise Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued l uin gent Signa re o Stamps) Surcharge Fee) Qz ❑ Owner Given Reason for Denial I Conditions of Approval/Reasons for Disapproval _ ~ . l~ sR-~ fJti Wa+IAXIl~ vVl ~ Attach complete plans (to the County only) for the system an paper not less than $1/2 z It innch. Ins n aE No lw-t S~ SBD-639 08/02) v~ - PabE $TF~Ell1 ?HIELhE : ! =qo i 9a$ x 21.6' 1~'0 - ~13 rn '76 c) 'Pli 'Ez. 10&00 - - L B ToP 2 +C-_ 7 -1~- oPo -$046! _POLts - : wEwi~ scoAe --6_ - - 5sre fit. = Q.~O ; ; : I i ; I 4YID Q ! I I f - oug' :Ave 76 C"L il #6 $f C 1031 vi w#-.04e : I Safety and Buildings 4003 N KINNEY COULEE RD LA GROSSE WI 54601-1831 TDD (608) 264-8777 *isconsin www.commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary May 16, 2003 RECEIVED CUST ID No.223760 ATTN.• POWTS Inspector MAY 2 2 2003 JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVAT G ST. CROIX COUNTY ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL ZONING OFFICE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/16/2005 Identification Numbers Transaction ID No. 867077 SITE: Site ID No. 659079 Stefen Thielke Please refer to both identification numbers, 122ND Ave above, in all correspondence.with the agency. Town of Saint Joseph, 54016 St Croix County SE1/4, SE1/4, S36, T30N, R20W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 903304 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Comm 83.44(6)(a)2.The orientation of the cell is to follow parallel to the surface grade contours on sloping sites. The upper effective edge of the cell is to follow the -98.20-foot contour. Conti'<'! • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption Irot area. chs. NR 811 & 812c RTMEN t 1 API • A Sanitary Permit must be obtained from the county where this project is located in accordance with the / K OF f,~l requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CORRUI • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat JOHN F SCHMITT Page 2 5/16/03 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 ?G~~~Z DCJG Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726-2544 SCHMITT & SONS EXCAVATING S861VaUq rww T'rad Somerset, W154025 71S-549-6651 MOUND SYSTEM For. StCfen Thielke Address: 603 W. Maple St. Legal:_ SEa SEa S 36 T0$ 20 W Township:_ St. Joseph County: St. Croix Contents RECEIVED Page 1 Plot Plan MAY 12 2003 Page 2 System Cross Section Page 3 Pipe Lateral Layout SAFETY & BLDGS D1VP ge 4 Dosing Chamber Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 none Mound Component Manual (version 2.0) SBD-10691 P(IV 01/01) Pressure Distribution Component Manual (version 2.0) SBD 10706-P(N 01/01) By: 17 MPRSW 2-91-3 760 Qna//y DaEe: 5/1/2003 EL) )FACiuOAIMFRCEF p LOOL 'PONDENC pae e ~ ~F 6 ~EGEIl1 TH/ELkE SccE _ J_'` = No _ _ - ~ QRDPo~ _ p W U-L 1000'&aL s.; 3 p o 9a.8 X ZJ.6' /no(4AJ4 Wlz.4eei, oo _ G Cots+~'u 2 WE 6t. = 9f1.7,fl F Bm = 70P o.= Z„ PVC EZ /06 40 L B TOP r 2 " ✓ ECG -"/DO ,vEw' st oRE 6 ~ _DR _ - _ 5~3~ ern, EC, = 9Qr~0 800ac_ P.C. r;17 j?~y 071, Faec~ Illo y, $coGe \ 83 \ _ - d 61 C,oA i ouP LIA)E l ZZN~ 97'6 Av. 9$ --,Al-,r 0 BiM cp paoP~Yy ,tit F _ ~'►.c 0 $f C W STILUV -Tee )WA) S50 e ;L ~J a~llG~S~T IVL 54~t)~ S s oU3 7C 0 . Page 2 Lf 6 1 Straw, Marsh Hay, Or synthetic Covering ASTb{ 039 Distribution Pipe Mod um Sand 6" Topsoil = x ST& SLEV. 99.- 2 0 gin Slope 1304 Of r- 2 Force Main Plowed Aggregate Layer (61+ Below Ptpe) Q 1.0 _ Ft. E 1.36 Ft. Cross Skectlos► Of A Mound system Using F 79 Ft, A 1304 For the Absorption Area G 0.5 „ Ft. A 6.0 , _ Ft. H 1 0_ Ft. Signed: B 75.0 FL. 2K 8.92 Ft. License umber: L 92.8 Ft. Date: 5Z1420 3 J 5._84 Ft, Alternate position I 9.71 Ft. of W 21.5E't. Force Ma i n moo" L PIP0 ' v YowoSFinat. 0of"d K - r-«-rr • r r/1..1 Force Main Al E - -«--rV ►F M M-~ ~ Bed Of, r' Z ~a pistribution Pips Aggrtigote y Observation Pipe Permanent Markers , 1/5,T o 1115 13 From Find of Bed Plan View 01 Mound Using A $ed For "The Absorption Area Page 3 of 6 Turn-up with Cieanout Acoees Bqx Plug or 8*11 Vahle PVC Faroe Main D!W bution Lateral PVC Manifold LL i X-tx X/2 Distribution Lateral Layout P 3„6. 25 Ft. S3.OFt. X30 Inchm. Hole Diameter 3/16 Inch Signed; lateral " 115 Inch(es) License Number: Manifold " 1~ Inches Oats : _ 5 1 L,2 0 0 3 Force Ma 9 n " 2Inches fof holes/pipe, i5 Invert Elevation of lateral$99 ?oFt. .0m kfJ0 SPECif1CAT!©L ` PUMp CMA,m i~R CROSS SEC . VF:Wlr CAP wcATilER PxACY► APPROVED LOCKNUG 4%.%, YC#A'f' P{PC ANNQL.C COVRR frt 7 .XTIom U'01R rusi ~ r N' ► R+r~4 Iulr,lr , ~ 1 ~tfJUUw uN f RF.~yL +a`Mi►~• I aIK tRiTItKE GRADC y" MIN. fir, A) cowt~uiT rw w w PROVIDE iML-CT AIRT14b4y SCAL. ! s i 1; APPOV90 JOiNU Areltorrco aot"It / i w/c. PIPS W/ t"T. PI F% ! (1 ALARM LVEmo}N6 3 9KTt?jb1b1Cr 3' ! ONTO i01.}0 Wil ONTO 601.10 so9t 21 .76ga1./inch ! } ! 1 OW C ! i i C.LCV. $.2., 7 fT. PUMP w. off jy{{ C OUCRETC $LOCK , . K}$C!L CXIT PCILM11TEr, GQL`.i IF TANK MAQWFACTURLIt HAS SUCH APPILOVAL.igEpplNii SEPTIC f SPCWFiCATIC3MS DO$R Week's C . P . 5 ~K , MA~ltiiwCT'u1LCR,: Mj^bCR OF oosCB: +or- PEIL WRIt TANK 61ZE............. Q4......: tsAi..LOws DOSE vol uMC LA MMiu Septronics Tankmate_ IAICLuoruL bAGKf40Wi _ 87:..04 ~.AttioNi • t~AtTUR[R. - - 3 l . iNODi`L M}JN10CIt:.,, TM-1 C,%PACiTIESi A at iNCHCS OR ±j.--4-1Ai.f.QM8 swi,rcm rupt., - p rcj; ry,.-r b ~....2.~.. tutmes loot f 'r Zoeller a. L1.OAIf LIMP MAUUfAZTUItClI: C 4..,..: ...tLiLNCi Olt . 8 _ 7.,.e g..4 A00cl. ►jumjwC Rt 152 o- _ 12 ,1MC11E& Ot 2.§ 1.- 26ALLOUt. Sw%1rC14 YVAOC: _ Mechanical Nole PUMP Atio ALAILM AR[ 'TO sC NWIMUM DiQSCIARCig RATE: -39-ti G,►M INSt&A.LEG OIJ S£PkRATE CIRC UITS VERTICAL DiffCREMLE p£'TWCEU PUMP OFF A~SD bTRlbUTiOW PIPE.. 10, 0 FECT + ImulAUM NETWORK 6UPPLt1 k'iLESSu%C . . . . 3.25 FLET } 170rEET Or FORCC MANtii x .3-4 f 0ttFRiC710M FACYOR..5.51_ FELT 'i"oTAL.Od1JAMiL NtiAO 18.76 F£CT IUTER1446 oiMrlt.Ia;pKl or TAaiK: irE isG►7 K .~..,~.....r.'WIDTH -j LIQUID DCP-f t4 3 SlbhiCD: ' ` l ICE►.ISE ►sunt6i~it: 223760 TiA7¢i 5/1,40 Page 5 of 6 TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER M1tVUTf EFFLUENT AND OEWATERING MODEL 152/153 o- W MODEL 152 153 50 Feet Meters Gal. Liters Go!. Liters 153 5 1.5 69 261 77 291 12 40 1 10 3.1 61 231 70 265 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 v 30 25 7.6 34 129 42 159 8 ' 30 9.1 23 87 33 125 0 21.5'0 20 35 10.7 22 85 40 12.2 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 0 014M 0- 2'0 160 80 100 GALLONS D LITERS 0 80 160 240 320 6 1/4 3 27/32 4 5j8 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ Timed dosing panels available. ® 3 27/32 Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase I systems. Double piggyback variable level float switches are available for variable level tong and short cycle controls. • Sealed Owik-Box available for outdoor installations. See FM1420. Over 130°F. (54°C.) special quotation required. 1 I . I i 1521153 Series 12 1/8 tion 10163 MODELS Controf-23 Model Volts Ph Mode Amos SI x u x 5 1 j8 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 6.5 Included 2 or 3 S Q064 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included or N153 115 1 Non 10.5 1 2or3 BN163 115 1 Auto 10.5 Included 2 or 3 SELECTION GUIDE E153 230 1 Non 53 1 2 or s ~ 8E153 230 1 Auto 5.3 1 Single piggyback variable level float switch or double piggyback variable level float Included ~ 2or3 ` switch. Refer to FW477. A CAtMO- 2. See FM0112 for correct model of Electrical Altemator E•Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10.0225 used as a control activator, specify duplex (3) licensed electrician, All electrical and safety codes should be followed including the most recent Nallonal Eiectdc Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN ~ For unusual conditions a reserve safety factor is engineered into the design pump. of every Zoeller MAIL TO: P.O. 60X 16347 Ladsv&, KY 4025&0347 Manufacturers of. . SHIP TO. 3949 Cane Run Road Louisville. KY 40211-1961 pAASNP /939 ® (502) FAX 778.2731.1(800) 928•PLIMP ~ P1lMP ! (502) 774-3624 ~ o hKP./lwlyly.zoeller.com Copyright 2001 Zoeller Co. All rights reserved. © POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 16 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner T h i e l k e, S t e f e n Septic Tank Capacity 1000 al ❑ NA Permit # Septic Tank Manufacturer Week "s C . P . ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Zabel 13 NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A-100 ❑ NA Number of Public Facility Units IN NA Pump Tank Capacity 800 al ❑ NA Estimated flow (average) 300 al/da Pump Tank Manufacturer Week's C.D. 0 NA Design flow (peak), (Estimated x 1.5) 45 al/da Pump Manufacturer Zoeller ❑ NA Soil Application Rate al/da /fe Pump Model 15 ❑ NA Standard Influent/Effluent Quality. Monthly average' Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 0 NA ❑ At-Grade i Mound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ 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: 17 month(s) (Maximum 3 years) 13 NA W ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 3 ® year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ® year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 1 0 year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 1 M year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: 13 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 (Y3) 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 512 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. ~I Page of START UP AND OPERATION 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. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade 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. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ 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 BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name John Schmitt Name Owners choice Phone 5 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Owners Choice Name St. Croix Ct . Zoning Phone Phone 715)_386_4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 54- .S1' 1152 /Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom_ Schmitt Abeh omiplet sb pian on paper rootless ein a%x ii kdlea in size, glen must County include, but not lirrrhed to. vertical and horizontal reference point (BM), direction and St. Croix perms slope, scale or dimensions, north anew, and location and distance to nearest road. Parcel I.D. 7j4 . Z(,1 S G :.Please print a!! 1n1brmatlon. Reviewed By Date Powd irdormdm you Provide may be used for sewrdagr purposes (Privacy Law, s.15.04 (1) (m)). Property Owner Property Location Thielke, Stefan - G&L Lot SE 1/4 SE IX S ' 36 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 603 W Maple St. Croy Y State Zip Code Phone Number City Village ✓ Town Nearest Road Stillwater MN 55082 St.Joseph 122Nd Ave. ✓ New Construction Use: ✓ Residential/ Number of bedrooms -3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe:- Parent material Glacial Till Flood plain elevation, if applicA NA General comments, and recommendations: Area is suitable for a mound system. System elevation is 99.20'• sadtabli ed at 98.20'. Limiting factor is 24", slope is 6%. 3 2003 Boring # Boring ` ✓ Pit Ground Surface elev. 98.85 fL Depth to limiting fad r 33 in. Application Rate Horhm Depth Dominant Color Redox Description Texture stru tuna ' rice #WWxy In. Munsell cKi. Sz. Cord. Color Gr. Sz. Sh. F ' - 'E 1 if#L 1 0-11 10yr3/2 none I 2mgr mvfr gw 2m, 2f .5 .8 2 11-21 1Oyr4/4 none sl 2csbk mvfr 9W If .5 .9 3 21-33 10yr416 none sl 2msbk mfr gW .5 .9 4 33-43 7.5yr418 m25I 8 1 scl 2msbk mfr gW - .4 .6 4 .6 5 43-56 7.5yr4l4 c 1 d0 yrfi/60yr6/2 sl 1 msbk mfi gw - 6 56-84 5yr4/4 cl $7.5 yr&8 sl lmsbk Mill 4 6 ]Boring # Boring ✓ Pit Ground Surface elev. 98.681 ft Depth to limiting factor 24 in. Soll ApplicOm Rat Horizon Depth Dominant Cola Redox Description Texture Sbaclure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cond. Color Gr. Sz. Sh. •Eff#t1 'E 1 0-9 10yr3/1 none sit 2mgr mvfr cw, 2f .5 .8 2 9-14 10yr5/3 none I 2msbk mfr 9W 1f .5 .8 3 14-24 10yr5/4 none sl 2fsbk mfr 9W .5 .9 4 24-48 7.5yr4/4 c2 51 /8 /l sl 2msbk mfr dw .4 .9 5 48-82 5yr4/4 cl 51 /6 /1 sl 1msbk mfi - .4 .6 Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mgA- ue #2 = BO0, <30 mglL and TSS S.30 mg/L CST Name (Please Print) Signatu ' CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, W1 540W 4111/03 715-247-2941 5f 5L ielke Stefen Parcel ID # Page 2 of 3 ,oPerty owner Tt1 - . Boring # Boring Ground Surface elev. 98.00 ft. Depth to limiting factor 26 in. Application Rate Pit . Sol Horizon Depth Dominant Color Redox Desm"m Texture swch ne Consistence Boundary Roots 'Eff#1 'Eff#2 in. Mansell Ou. Sz. Cord. Color Gr. Sz. Sh. 1 0-10 10yr3/2 none I 2mgr mvfr cw 2f .5 .8 2 10-17 10yr5/4 none 1 2fsbk mfr 9w 1f .5 .8 3 17-26 10yr4/6 none sid 2msbk mfr gw - .4 .6 4 26-49 7.5yr5/4 map 10yr6/2 sl 1 msbk mfi dw .4 .6 5 18 map 10yr612 sl Oma MA - .3 .5 5 49-80 5yr4l4 7,5 /6 Boring # BOA Pit Ground Surface elev. ft Depth to limiting factor in. Sol Application Rate Horizon Depth Dominard Color Redox Desaiption Texture shictune Consistence Boundary Roofs 'Efl#1 'EN#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring # Boring Rate Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Applicalm Horizon Depth Dominant Color Redox Description TeAM swichxe Consistence Boundary Roots 'Ett#1 'Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _30 mg11. and TSS _30 mg1L 0 < 220 mg/L and TSS >30 < 150 mglL Effluent #2 = BODs < Effluent #1 BOD > 3 < 5 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or nonii mo4nr:o1 in on oltarnotn fnrmof -1-- -f-t thn ii-rtmnnf or Ane-,mA-i 14 1 nr T'1'V 4r12-71ut-2777 I Ls. ~e-Vie,,,,. ~1 ~ 3d~ /0v-'Mr G . G Add 1 - Lid . F ll ; ~ .yak 1 ' . - - - -4 14V 71 I : JIV I Spa . St. 'rl !;36 TT W, 426tJ X.7 q. J-0 YL 1152 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page i of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dam, north arrow, and location and distance to nearest road. Parcel I.D. Please print all imonnation. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner RECEIVED Property Location Thielke, Stefen Govt Lot SE 1/4 SE 114 S 36 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 603 W Maple St. MAY City State Zip Code Phone Number City Village ✓ Town Nearest Road Stillwater MN 11 550~~ROx COUNTY St.Joseph 122Nd Ave. ✓ New Construction Use: ✓ Residential I Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable NA General comments and recommendations: Area is suitable for a mound system. System elevation is 99.20' based off contour line established at 98.20'. Limiting factor is 24", slope is 6%. ❑ Boring # Boring ✓ Pit Ground Surface elev. 98.85 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roars GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-11 10yr3/2 none 1 2mgr mvfr gw 2m, 2f .5 .8 2 11-21 10yr4/4 none sl 2csbk mvfr 9w if .5 .9 3 21-33 10yr4/6 none st 2msbk mfr gw .5 .9 4 33-43 7.5yr4/6 rri25yrjg~1 scl 2msbk mfr gw .4 .6 5 43-56 7.5yr4l4 ° t dp /6 2 sl 1 msbk mfi 9w .4 .6 6 56-84 5yr4/4 cld57.5 r /2 sl lmsbk mfi - .4 .6 618 ❑ Boring # Boring ✓ Pit Ground Surface elev. 98.68' ft. Depth to limiting factor 24 in. Sol Application Rare 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 0-9 10yr311 none sil 2mgr mvfr cw 2f .5 .8 2 9-14 1Oyr5/3 none 1 2msbk mfr 9w 1f .5 .8 3 14-24 10yr5/4 none sl 2fsbk mfr gw .5 .9 4 24-48 7.5yr4/4 c251 /8 /1 sl 2msbk mfr dw .4 .9 5 48-82 5yr4/4 c151 16 /t sl 1msbk mfi - .4 .6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt /M" 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, W154017 4111/03 715-247-2941 I Property Owner Thielke, Stefen Parcel ID # Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 98.00 ft. Depth to limiting factor 26 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPD/fr in. Munsell Qu. Sz. Con. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10yr3/2 none I 2mgr mvfr cw 2f .5 .8 2 10-17 10yr514 none I 2fsbk mfr 9w 1f .5 .8 3 17-26 10yr4/6 none Sid 2msbk mfr 9w .4 .6 4 26-49 7.5yr5/4 m35 I0 r6/2 sl lmsbk mfi dw .4 .6 5 49-80 5yr4i4 map 1"/2 7 5 /6 sl Oma mvfi - 3 5 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsetl Qu. Sz. Cont Color Gr. Sz. Sh. *Eff91 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor 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#l *Eff#2 * Effluent #1 = BOD > 30 < 220 m9/L and TSS >30 < 150 m9d- * Effluent #2 = BOD5 L30 30 mg/L and TSS <30 mg/L 5 - _ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or -A motPriol ;n on altPmota f--.* -1-- -t-* the 4--t-f of G(14_7rf•_11 G1 - WV rnR_7f4-8777 S e- ~J PUP 3a 1 elo e )S UN +STut D ~r fAOIA tpf / / Yom ~ ~ r r f - - 1lr.Zr ~j~ 7r ,SoLt~ 1~~o er~j/ Li/Ye P ly, . 7 3DN -T-wdke rdwr~~ by; ~s Sc,h.n, 6 03 bi OA r.,e IQ s 4 C- S 7-In y Illej ~C1 S~1 s 3,6 T-W 2?oti f ° s~ .T osPy ~i i ~,fR / 1152 • Wisconsin Department of Commerce SOIL EVALUATION REPORT 1` Page 1 of 3 Division of Safety and Buikfings in accordance with Comm 85, Wis. Adm. Code P Tom Schmitt Attach owoete site plan on paper not less than S%: x 11 inches in size. Plan must Coun St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or downsions, north arrow, and location and distance to nearest road. Parcel I.D. U 3a J Q-7 r---/) -crq Please print all information. Reviewed By Date Persond information you provide may be used fa secondary puPoses (Privacy Law, s.15.04 (1) (m))• Property Owner Property Location Thielke, Stefen Govt Lit SE 114 SE S 36 T 30 N R 20 Property Owner's Mailing Address Lot # BDock # Subd. Name or CSM# 603 W Maple St. City State Zip Code Phone Number City Village ✓ Town Nearest Road Stillwater MN 55082 St.Joseph 122Nd Ave. ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable NA General comments and recommendations: Area is suitable for a mound system. System elevation is 99.20' based off contour line established at 98.20'. Limiting factor is 24", slope is 6%. Boring # Boring ✓ Pit Ground Surface elev. 98.85 ft. Depth to limiting factor §,3.- in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture structure' Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont cow Gr. Sz. Sh. 'Eff#1 -E 1 0-11 10yr3/2 none 1 2mgr mvfr gw 2m, 2f .5 a- 2 11-21 10yr4/4 none sl 2csbk mvfr 9w 1f .5 .9 3 21-33 10yr4/6 none sl 2msbk mfr 9w .5 .9 4 33-43 7.5yr4/6 m25yc /Ovr6/f scl 2msbk mfr gw .4 .6 5 43-56 7.5yr4/4 cId01 yr6/2 sl lmsbk mfi 9w A .6 6 56-84 5yr4/4 cl 57'S S 2 sl lmsbk mf - .4 .6 F2 ] Boring # Boring ✓ Pd Ground Surface elev. 98.68' ft. Depth to limiting factor 24 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods in. Munsell Qu. Sz. Cont. Coker Gr. Sz. Sh. -Efl#1 -Eft#2 1 0-9 10yr3/1 none sil 2mgr mvfr cw 2f .5 .8 2 9-14 10yr5/3 none I 2msbk mfr 9w 1 f .5 .8 3 14-24 10yr5/4 none sl 2fsbk mfr gw .5 .9 4 24-48 7.5yr414 c2 5yo/g /l sl 2msbk mfr dw .4 .9 5 48-82 5yr4/4 c l ds 1 /6 *11 sl 1 msbk mf - - .4 .6 ' Effluent #1 = SOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S30 mg/L and TSS S-30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 4/11/03 715-247-2941 Property Owner Thibike, Stefen Parcel ID # Page 2 of 3 3 ] F Boring # Boring ✓ Pit Ground Surface elev. 98"00 ft. Depth to limiting factor 26 in. Sot 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 10yr3/2 none 1 2mgr mvfr cw 2f .5 .8 2 10-17 10yr5/4 none I 2fsbk mfr gw 1f .5 .8 3 17-26 10yr4/6 none sicl 2msbk mfr gw .4 .6 4 26-49 7.5yr5/4 m35 10y r6/2 SI 1 msbk mfr dw .4 .6 5 49-80 5 r4/4 map 10yr6/2 SI Oma mvfi .3 .5 y 7.5 /6 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munset Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsetl Qu. Sz. Cord. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * - - Effluent #1 - BOD > 30 < 220 mglL and TSS >30 < 150 mglL Effluent #2 - BOD < 30 mgA- 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 ncwil motr+r:ol in on oltP.n.tn £nrrr.ot nl..oea nnnt.~nt the (l-t.n>nt of (.r1R_7(.f-i i it - T-rv fr14-7FA-9777 j lilt 1 ~r f /Ov L-° _ f 1 J_1 r I ! I ! !-✓y- ! GAG L /6a-/o 1 -ice { 1 ` l - Ir p ~~P-E'S1~ Slo~a~ (,tvcgr / ocNc~~ I o ! a~ { - - / - U +~s It p j4r - $ 1 i 014 ( / / dyj GtiR L ggA ff 71 Arope►-~ .y i , i S~ . T os ep,~ 7 3~M,G~ F@ a3 Sc T7 ~p /e $4i : S 77,1n .9-? Yot' 19 Co Q3 Ind Uvt~ S ~ V VI N. SO 8 2 w 4,4,"n,4 Z-l-Z spa/ 7 S'C~ S~1 S 3!6 'T-z'V 2,20ej 70{ r i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer % f!=/V 1~/EG Mailing Address /z0 3 GP) MAL 55082 Property Address (Verification required from Planning Department for new construction)_ City/State ,~[a/) s D/~l t,~/ Parcel Identification Number 0 30 - 10 73 "50 - 000 LEGAL DESCRIPTION Property Location ,SE -5-E Sec. rte T_ 30 -N-R_ g W, Town of i, ~ 49 Subdivision . Lot # Certified Survey Map # 314512 F , Volume ~Z ..Page # - S3S / Warranty Deed # / I P `l ?q , Volume . 1 s.~ . Page # Spec house ❑ yes g no Lot lines identifiable 0 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, joumeyman 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 zoning office within 30 days of the three year expiration date. SI TURE 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 deed recorded in Register of Deeds Office. ZZ& ,I, s / G / 03 ~ r°-* - - SIGN&LYRE 0 APPLICANT ii DATE revoked b the Zoning Departmeut. Any information that is mis-represented may result in the sanitary permit being by ~ p 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 ' )D 1536PAK 81 STATE BAR OF WISCONSIN FORM 1 - 1998 62 49$ WALSH WARRANTY DEED REGISTER H. DEEDS ST. CROIX CO-, WI Document Number _ RECEIVED FOR RECORD STEVEN TI. JOHNSON AND THERESA M. :j 08-21-2000 10:00 M &s Deed made between JOHNSON, HUSBAND AND - WRRROTY DEED EXEMPT 1 Grantor, i! CERT COPY FEE: and `STEFEN W. THIELKS AND KARL: ;J.a'.THI LKE, HQSBTND TRAYHSFERFEE' 208.50 AND WIFE SDIHO FEE: 10.00 RECOR Grantee. Grantor, for a valuable consideration, conveys to Grantee the following ;i ST. CROIX County. State of Wisconsin I Area described real estate in - - Nam_S 'T _F" TN (E t.Y.~ co3 M qp to ST¢F_ T PART OF THE SOUTHEAST QUARTER OF THE SOUTHEAST ~lj~ Ll_ t)}AT~ , MN Z QUARTER (SE[ti OF SEI%) OF SECTION ST. JOSEPH, TOWNSHIP 30IBED NORTH, RANGE 20~...d TOWN OF AS IOT ONE (1) OF CERTIFIED SURVEY MAP, VOLUME 2, PAGE 555, FILED IN THE ST. CROIX COUNTY REGISTER OF DEEDS' OFFICE, ON FEBRUARY 15, 1978, AS DOCUMENT 030-2073-50-000 346802. FORMERLY PART OF LOT W(2 OF CERTIFIED PAGE STr DOCUME~: Pafcel identification Number (PIN) SURVEY MAP, IN VOLUME 2, This IS NOT homestead property ;i 345228. J["~5 \ (is not) i Together with all appurtenant rights, title and interests. ces except Grantor o Rthe Property ESTRICTIONS, indefeasible AND ROADWAY simple and free and cAGRElear RECORD. EASEMENTS, COVENANTS, day of AUGUST 2000 Dated this f (SEAL) (SEAL) STEVEN bt, JOHNSON it (SEAL) (SEAL) THERESA M. JO N AUTHENTICATION ACKNOWLEDGMENT :i 'i Signature(s) Steven M. Johnson and State of Wisconsin, ss. jl Theresa M. Johnson County. ^ day of 16 of - ~ -f - ! Personally came before me this the above named authenticated this r Sal a R. TITLE: ME ER STAT R OF WISCONSIN who executed the foregoing (If not, me known to be the person instrument and acknowledge the same. authorized by 5706.06, Wis. Stars.) I' THIS INSTRUMENT WAS DRAFTED BY i 204 LOCUST STREET Notary Public. State of Wisconsin HUDSON, WI 54016 My commission is permanent. (If not, state expiration date: (Signatu yr amse amse a authentlcated or acknowledged. Both are not necessary.) _ Wisl;Onam LOGO Dank Co.. Inc ` Names of persons signing In any capacity most be typed or printed below STATE BAR OF WISCONSIN Milwaukee, W. FORM No. I - 1,998 WARRANTY DEED $ 3 0 N y w zz o ASS - o r,) . ~ ~ 3~ a~sd ~ ~ a~u\nZop N ~ l: o oL) ,00'L99 H1nOS ZG N01103S o Lo H18ON '10£ H1nOS 00 Z£'(;9£ H18ON 3NIl M.O.a GO U) 0 ~O c 3 oM W ~ n W lA d to Q a W V Lo p ° O Q 'J 0 O W 0 0 O M M G6'999 S£,ZIoO N az ,GG'99Z- W/N Ct W O O ~Q r O co v 0 LL W Q LLJ 0) W IL O OD 1 J Cf) C) 0 a '/rte a o ~0 N 1..J.. vtn A , _ Z W lV U CL. Q ~ z DI co Q c = u, O L~Ov O u. w ci 0 N = ;ZOO ,8G 99 „L0,5Z " { C89 3OVd 13Wnl0A NI 030HOO3a1 Z SV ddW k3A8nS 0313I1830J r' r Z 0 z W CT) O to o 2O O eQ U~v W O X U, Z 00 3J > Oaz QW.W a O i~=N LL Z 4 z 'n w z O a o o` U cr 0 (n Ljr) a c M 8 xx u 0 t ~W in DeparWwtofCCo ffWce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code o ` Soil 8c Site Evaluations Attach complete site plan on paper not less than BYx 11 inches in size. Plan must ounty include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsion,s, north arrow, and I and distance to rarest road. Parcel I.D.# 030-2073-50-000 APPLICANT INFORMATION - P it t 411 ktl<Oirftlat/OR, Personal information you provide may be used ry purpos (Privacy Law, s. 15.04 (1) (m)). yed B Date Property Owner Property Location Susan Franklin ovt. Lot SE 114 SE 1/4 S 36 T 30 N,R 20 W Property Owner's Mailing Address of # Bloc # Subd. Name or CSM# 366 W. Park St. 1 CSM Vol. 2, P g.555 City Stag . Zip Co* 't'~~td" -nber9667 ❑ City River Falls WI`, ~54Q2~ ❑ Village ❑ Town Nearest Road StJoseph County Hwy. V New Construction Use: idellti ti, T 61 rooms 3 ❑Addition to existing building ❑ Replacement ❑ Public escribe Cafe Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpdff .6 trench, gpd/ftz Basal area required 900 bed, ft' 750 trench, ft" , Maximum design loading rate .5 bed, gpdff .6 trench, gpdffl2 Recommended infiltration surface eltation(s) 95.85' at 12" above 94.85'.' It (as referred to site plan benchmark) /Site CotSlderations Mound to be installed in a "M sha, P fnllowin&mntn„r_ Finish grading should include placing fill at upper Additional design Parent material Glacial Till Flood plain elevation, if applicable NA ft S--Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ❑ S ® U ®S ❑ U ❑ S ®U ❑ S ® U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPDM Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 1 0-7 10yr3/3 None sil 2fcr mvfr as 2f&m 0.5 0.6 2 7-16 1Oyr4/4 None sil 2fsbk mvfr cs 2f,lm 0.5 0.6 Ground 3 16-29 7.5yr4/4 None sl 2msbk mfr cw if 0.5 0.6 elev 92.04' ft 4 X14.34 7.5yr4/4 f2f7.5yr5/6 A 2msbk mfr cw - 0.5 0.6 Depth to 5 34-56 5yr4/6 U7.5yr5/8 A Om mfi - - 0.3 0.4 limiting factor 29j - Remarks: 2 1 0-10 10yr3/2 None sl 2fcr mvfr as 2f,lm 0.5 i 0.6 2 10-19 10yr5/3 None A 2fsbk mvfr cs 2f 0.5 0.6 Ground 3 19-30 1Oyr414 None sl 2msbk mfr cw if 0.5 0.6 elev 91.83' ft 4 30- 6 10yr4/4 U7.5yr5/6 sl 2msbk mfr cw - 0.5 0.6 0• . - - - Depth to 5 36-51 7.5yr4/4 f2d7.5yr5/8 scl Om mfi limiting factor 30" Remarks: CST Name (Please Print) Sig re: Telephone No. James K Thompson 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 9/21/99 3602 1105 I I 000PERTYOWNER: Suse FrwMin SOIL DESCRIPTION REPORT ++os Page 2 of 3 PARCEL UM 030-2073-50-M ACE. Soil 8c §6 EvaltiiW u Horizon Depth Dominant Color Mottles Texture Structure ~sistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-8 10yr3/2 None sl 2fcr mvfr as 2f&m 0.5 0.6 2 8-19 10yr5/3 None sl 2fsbk mvfr cs 2f,lm 0.5 0.6 Ground elev 3 19-29 10yr4/4 None A 2msbk mfr cw if 0.5 0.6 96.66' ft 4 P-38 10yr4/4 f2d7.5yr5/6 sl 2msbk mfr cw - 0.5 0.6 Depth to limiting 5 38-55 7.5yr4/4 U7.5yr5/8 scl Om - mfi - - factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: I - own~.~: S c,~ S a-r~ ~ra.r► Alin s 36~ n ~.,.Pks c.Ji. K i U`e.~ 7~ ■ Sail t9&serU~ ~ P:6 ♦ E/e dash rm Sri-~fe 4esm d z, ~.sss 5 Z'f- SCf%, Sec . 3~, T. 3oii., ,p2o cJy Tn• o~st.~St . Cro;X y c Jl. ~ + s w ~ N 1 1 Shoe, 1~- ■ 1 1 /ono nbor: 1 ,gssu,Ked vest =i 1 19 N lE . B.w(.: y~a;t in DQ.~'~rec. Flat. =/do. Z5. C-1 ~ ~~a~d Eascrn.on t • Jessie Nye Subject: Don Schmitt/ 430022/ Steffen Theilke- Final Location: 275 122nd Ave., off Cty. V north, St. Joseph Start: Tue 10/7/2003 9:00 AM End: Tue 10/7/2003 10:00 AM Recurrence: (none) 36.30.20. - west edge of Twp. Pam did contour/plowing on 10/2/03 030-2073-50-000 36.30.20.625C 1