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Wisconsin oepartment of Comcnoroe PRIVATE SEWAGE SYSTEM
Safety and Buildings Division ount
INSPECTION REPORT I. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you pro M may be used for secondary purposes [Privacy Law. s. 15.04 (1)(m)). 384123
Permit Holder's Name. ❑ City ❑ Village 0 of : State Plan ID No.:
trong, Derek Somerset Township
CST 8M Elev.; Insp. 8M Elev.: 8M Description: Parcel Tax No.:
032- 2108 -20 -000
TANK INFORMATION ELEVATION DATA eo° '9f i0 /<O
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
LLt-4-� 2� (' s /1J OAS" (co.b f (rp.O
Dosing Alt. BM
Aer." Bldg. Sewer 6 -18
ng
Holdi St / Ht Inlet �D • Z
TANK SETBACK INFORMATION St/ Ht Outlet 9`/• /0
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet --�
Air Intake
Septic } ' ( , 5 NA Dt Bottom
Dosing NA Header / Man. - (a p [ 3•oS r
Aeration NA Dist. Pipe
Holding Bot. System
PUMP ' /SIPHON INFORMATION Final Grade
Ma De and St cover
Model ber PM
TDH I Lift Friction System TDH Ft
Ftless Force In Length Fi wen
IL ABSORPTION SYSTEM
8ED / TRENCH Width 3 53. r Length 1 No. f Tenches PIT No. Of Pits Inside Dia. Liquid Depth
I DIMENSION
LEACHING Ma urer
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM 7
INFORMATION Type 3, CHAMBER M e Number:
System: OR UNIT
DISTRIBUTIO SYSTEM ( — �,.'�' car r w C.9- .
Header / Martif d Distribution Pipe(s) x Kole Size x H Spacing Vent To Air Intake
r
Length �_ Dia.
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Feed Over �r Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
rench Center 5 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include co f de discre
l �� pancies, ersons present, etc.)
(l , �j� Inspection #l: 6S/63/61 Inspection #2:
Loca ' n: 817 -165= Avenu So ( eerset, WI 54025 (SW 1/4 NW 1/4 12 T30N R1 9W) - 1230191016 North Bass Lake
Estates
o T M� �01�S -C "� a
1.) Alt BM Description=
2.) Bldg sewer length=
-araount of cov
lA� v. %kr .
`F
Plan revision required? 0 Yes Q No
Use other side for additi formation.
SSD -6710 (R.3197) a 1
In or'sSignature Cert. No.
�•'C AwAw �
_ - _ _' V 54
S)
s�
� r�
tiyrt�K+�p"�v�} � ��( �g
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-� s �. � �
C
I} S Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
�,
�� �� � See reverse side for instructions for completing this application PO Box 7302
Personal information you provide may beused= =for secondary purposes Madison, WI 53707 -7302
OePartmettt 4t_Gar'irn�ras .
[Privacy Law; s. 15.04(1 (Submit completed form to county if not
state owned.
Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County- cn w 1 State Sanitary Per jt Number ❑ Check if revision to previous application State Plan 1. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
1/4 JVJ/1 /4, SI Tjb N, or
property Owner's ling Address Lot Number 81ock Number
d / ; 2 Z
City, State fip Code Phone Number Subdivision Name or CSM Number
0A ,� &7 0- ss'dI/?- ( &S y S� a"�9 a�.ss Z'.e" .esiKT {S
II. Type of Building: (check one) L/ — ° t ' P� g'� 0 city
� I or 2 Family Dwelling - No. of Bedrooms : 7 O Village
KTOwn of
• Public/Commercial (describe use):_
❑State -0wned '• � �
Nearest Road rt s T
3 f K r z_ 2 / (1 _ Parcel Tax Number(s)
III. Type of Permit Check only one box on line A. Check box on line B if applicable) - O "O O O
A) 1. j9 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only O, ('' / 6' Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was p reviously issued
IV. Type of POWT System: (Check all that apply) :ZAf - -
44 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
• At- de ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dis ersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Arse 4. Soil Application 5. Percolation Rate 6. System Elevation — 7 Grede
Required Proposed Rate (GalsJday /sq. R) (MinJinch) Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
xso l2sa
VIII. Responsibility Statement
I, the undersigned, assume res risibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) PI s ignature (n ps): 1WRS No. Business Phone Number
2Z i </7
Plumber's Address (Street, City, State, Zip Code)
3 - 2 /I/O TIC S7—
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Isis ing Agent Sign (No stamps)
`�1,Approved ❑ Owner Given Initial Adverse Surch a Fee)
Determination aS- Z.o
X. Conditions of pprov /Reasons for Disapproval:
f i�^^ ' �� (C�t• �"� ad�ldGCTf` l � ..1. l
t1 tit. S 4e4— Ao
all
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7
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. v° Z Z O 'y I /O
Please print all information. R viewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` l o t- - 0 0( -0 1
ProM Owner Property Location
Govt. Lot 54✓/ 114 N0 1/4 S j 2 T 3Q N R /9 E (or)
Property Owner's Mailin Address Lot # Block # Subd. Name or CSM#
0 fll' BASS L AIX— ES'rA -
City StA Zip Code Phone Number
M. El city (:1 Villag ®Town Nearest Road
mot V4^ 5.5 X/ ) - U` YI SGly.�e 3Y 7V S r
New Construction Used Residential / Number of bedrooms _ Code derived design flow rate --- D
❑ Replacement 171 Pub is or commercial - Describe: _____ __
Parent material �« Flood Plain elevation if applicable ft.
General comments
and recommendations:
V/ At/
F/_1 Boring # Boring
❑ Pit Ground surface elev. Depth to limiting factor 7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
'0 /0 3/3 _ / Zws6 /i f'% a &i G �,S
S IC °,C' ^ - - If Li ' , y
3z 7 YYe c Cis 17 /1
F-1 8o ^r=g # E] Boring —
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0 �'tF
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L TSS <_ 30 mg/L.
CST Nam (Please Print) ignature CST Number
Address Date Evaluation Conducted Telephone Number
327
Property Owner _ Parcel ID # _ Page of
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 I GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth . Dominant Color 7 Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
F - 1 ❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777.
SBD -8330 (RAM)
r_
. 1% 7 4
sw Ncl s rz. /A w
�s
NF zo C t
T ' 4`4�7- /O d _
g) x' 6n •LOT ce�.
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VI Department of Industry SOIL AND SITE EVALUATION R E P 00 T Page 1 of _ 3
Labor and Human Relatiohs
•D;Aslon of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but qt_ Crnix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
road.
„ a
dimensioned, north arrow, and location and distance to nearest � Z �' S
IEWED DATE
BY
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION 02-
PROPERTY OWNER: PROPERTY LOCATION
Gerald Smith GOVT. LOT SW 1/4 NW 1 /4,S 12 T 30 AR 19 f W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
11160 190th. AVe. N.W. 22 na N. Bass Lake Estates
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
Elk River, M. 55330 (612 441 -8888 Somerset 8
[x] New Construction Use (x] Residential / Number of bedrooms R [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate gy bed, gpd /ft = g— trench, gpd/ft
Absorption area required 643 bed, ft 56, _ trench, ft Maximum design loading rate ___7— bed, gpd /ft trench, gpd /ft
Recommended infiltration surface elevation(s) 94.05 ft (as referred to site plan benchmark)
Additional design / site considerations alt. site system el.= 93.22' & 91.95'
Parent material outwaGh Flood plain elevation, if applicable = a- ft )
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK J
U = Unsuitable for system CI ❑ U7 S El U7 S El ®S ❑ U �1 S El El ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench
.. <'
2 9 -24 7.5yr4/4 none sl 2msbk mvfr gw if .5 .6 •S
Ground 3 24 -82 7.5 r4 4 none cos oscr ml na na .7 .8 •�
elev. —
9 7.8 ft.
Depth to
limiting
factor
+82 11
Remarks:
Boring #
.S�
2 2 9 -27 10 r4 4 none sil 2msbk mfr if .5 .6 S
Ground 127-R9 7
elev.
97.5 ft.
Depth to
limiting �• lot.
factor _
+ °
Remarks: �' s
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200t New Rich nd WI 54017
Signature: Date: CST 1V er: m02204
4 -17 -97
PROPERWOWNER Gerald ,"r_ Smith SOIL DESCRIPTION REPORT PageL�2_
PARCEL I.D.# 3 Z
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed T
3
1 0 -8 10 r3 3 none sl 2msbk mf .6
............... ..
_ 1'
Ground
3 124- 7.5yr4/6 none COS nqcl M1 na na .7 8
elev.
9 7.05 ft.
Depth to
limiting
factor 3
+82" —
Remarks:
Boring # _
1 0 -8 10 r3 3 none 1 2msbk mfr 2f .5 ':.6 S
`..4....' 2 8 -22 10 r4/4 none sicl lcsbk mfr 9w if .2 ` .3 Z
Ground 3 22 -28 7.5 r4 4 none sl lcsbk mvfr na .4 1.5 •`>`
elev. 4 28 -8 .8 }
94. ft
Depth to
limiting
factor
+ ',
Remarks:
Boring #
- •S
5 2 1 11-32 10 r4 4 none sit 2msbk mfr qw if .5 .6 .�
.................
Ground 3 32 -36 7.5 r4 4 none sl lcsbk mfr aw if .4 .5 -
elev.
9 4 36 -80 7.5 r4 6 none cos os ml na na .7 .8 •�'
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Gerald Smith 1654 200th Ave.
CSTM2298 Sw4NW4 S12- T30N -R19w New Richmond, WI 54017
MPRSW 3254 town of Somerset (715) 246 -6200
lot #22 -N. Bass Lake Estates
N
1 =40'
BM.= top of NE lot stake C el. 100'
Alt. BM.= top of SE lot stake C el. 98.45'
CA n '
ro ,
Z7�
�G7o
V
�„ b o
'off
Gary L. Steel
4 -17 -97
1 1101 Carmichael Road
Hudson, WI 54016
Phone: (715) 386-4680 Cr oix Co unty
Fax: (715) 386-4686 Zoning Depa rtment
Fm
To: .... From: Z lV /V Co
Fam o� ` (o Da te:
Phone: Pages: 4L
Re: �C� / c y A / CC:
❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
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 I2
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) G��
Soil Absorption Component Size (ft)
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Zip 2 - as N
Maximum Influent Particle Size (in) 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 sepf and outlet filter shall be assessed at least
once every 3 years by inspection. The ut et fil s hall b Ian d as neces ary tQ Pis �rP _
proper o eration. The filter cartridge shou not be removed unless provisions are made to
re ain 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
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
y 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.
3
ST. CROIX COUNTY
_f WISCONSIN
ZONING OFFICE
I I mpg If N N a .��.r ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Roa
Hudson, WI 54016 -7710
~ (715) 386 -4680 Fax (715) 386 -4686
FhX
To: Dennis Gille From: Rod Eslinger
Fax: 715- 268 -6637 Pages: 3
Phone: 715- 268 -6637 Date: 02/0
Re: Erosion Control Plan for lot 22 - North CC:
Bass Lake Estates
❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
Dennis,
Here are my comments regarding the erosion control application you submitted for lot 22 in North Bass
Lake Estates. This lot has a small pond located within its boundaries. See attached copy.
Please show the following on the erosion control site plan:
♦ Location of the pond, location of the drainage easement, location of the septic system, define the
grading limits, show all setbacks from the right -of -way (100 foot requirement) and indicate road
names.
Is the plan scaled or dimensioned?
It is difficult to determine if the erosion control practices (silt fences) are installed on the contour. I
recommend you indicate on the site plan that the silt fences must be installed on the contour so that we
don't overload any section.
Please make the necessary changes to your application and resubmit them.
i
Hopefully these comments have helped. Call me if you have questions or concerns about this plan.
Thanks Rod
/05/01 MON 10:30 FAX 715 386 4686 ST CRX CO ZONING -`' ^� �i003
Standard Erosion Control Plan
P'ECF- o
for 1 & 2 Family Dwelling Construction bites rA _
According to Chapters ILHR 208 21 of the Wisconsin Uniform Dwelling Code, soil erasion contr a-
tion needs to be included on the plot plan which is submitted and approved prior to the, issu
permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control = in ions of the
Uniform Dwelling Code are enforced. This Standard Erosion Control Flan is provided to meeting
this requirement.
Instructions:
1. Complete this plan by filling in requested information, completing the site diagram and marking ( ✓) appropriate boxes
on the inside of this form.
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading.
Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application.
Site Diagram Scale: 1 inch = feet
EROSION
CONTROL PLAN
LEGEND
PROPERTY
LINE
_ EXISTING
DRAINAGE
TD TEMPORARY
DIVERSION
FINISHED
DRAINAGE
LIMITS OF
GRADING
~� FENCE
'I STRAW
BALES
GRAVEL
VEGETATION
SPECIFICATION
b TREE
�6 PRESERVATION
Ak - rev
a STOCKPILED
SOIL
Please indicate north
by completing the
arrow below.
N—
PROJECT LOCATION 'T Z,4
BUILDER OWNER
WORKSHEET COMPLETED BY DATE
i
09/2001 07:21 7152686637 GILLE TRUCKING PAGE 02
61/ MON 16:30 FA: 716 9cQ AQOa 7152686637 CO ZONING A ura
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGRE$MBNT
AND
0
WNERSHIP G33RTIIiICATiON FORM
Owner/Buya �E �k S ;/�' V
5 /, / /1 /vi 7/ 7 - 7-1
Mailing Address 1 31 . t ,rte S , S i 47,E 5:7/ - 0( o 5 Y(:'0 Yi•cL Ave A l CAi� rtmv�s 4 Z
Property Address 81 16 S S a.�2sc
(VedfkA k1kn required from Planning 'Department for now const<uetioo) r�
City/State T , Parcel Identification Number
L Q" DE6CRIPT�O
Property Location 5 � �.;, N`� t /�, Sec. T . O N - R,._W, Town of
Subdivision 0 E±k , &,,455 LAKe I S+A _ Lot #
CertfEied Survey Map # _ __ . Volume . .Page # 5 �J -
'Q wTanty Deed # �� „ % yeS . Volume Page #
Spec house ❑ yes ❑ no Lot lines identifiable yes O no
MMIM MAINTENA.r% (7E
Improper use and main b mane of your septic system could result In its premature failure to handle wastes. Proper maintenance
consists of pumpiug out the m vie teak *very three years or sooner, if needed by a lioensed pamper. What you put Into the system
can affect the function of tits tank as a treatment stage in the wasee disposal system.
The property owner a ;rtes to sabmit to St: CM* Zaaigg Department a certification form, signed by ft owner and by a
mastetplundw journeyman pl n -aber, rastrictedplumber or a lieensedpumper verifying d at (l) the oawlte wasbnwaterdisposal system
is is proper operating condil :oi t :md/or (2) after inspection and pon4 ft (if aeoeuary), the septic tank is less than ll'3 full of sludge.
I/we, the undem1pod have reA 1 %e above tegttizemenes and agree to maintain the private sewage disposal synmti with die ataindards
sot forth, herein, as set by the: '.I h Tactment of Commerce and the Deparimout of Natural Resources, State of Wisconsin. Certification
slating that your septic system tins been maintained must be completed and rewraed to the St Croix County Zoning Office within 30
days of tare dwm year expired. ref. date.
SIGNAT E OP APP LIMN I' DATE
OWNER CE �
I (we) codify that all 913tements on this form are truo to the beat of my (our) knowledge. I (we) am (are) the owner(s) of
the pmpetty described above, rye virtu of a warrantyy deed reawded in Register of Deeds Office.
0/
SIGNATURE OF JOPLICA1. i' DATE
** *'** Any information that 6 arils- represented may result in the sanitary permit being revoked by the Zoning Department, ”"
** Include with tide applies rem: a stamped warranty deed from the Register of Deeds office
a o0 of is de In
COP tlu txttlfled gtttlro tea If tofbranao ma t11e warranty Y P deed
VOL 1425PAGE 481
' tFa02��8
STATE tiAR 0 VvMICOHM FORM 2 - IM KATHLEEN H. WiLSH
REGISTER OF DEEDS
ST. CROIX CO. MI
TMs Deed, a oral Oai<a Condos, Le., a 1Nioneaoh i>iEEM FN RE=
C.orporatloa, Grao
;D,, R. Grat�ee.
t3ranmor, for a .:e now conveys and warrarm to Gnome W11-19" 1 :31 M
the Mowing descr% d red estate in St- Crok County. Same of Wisconsin (The FIERY I Ka
.
CRT Ciiw_ FEE:
CPT Fff
North Boss Lake Estates in the Town of Somerset, St. Croix County, TWO180 FEE: 11L7#
Wisconsin. M=D* FEEL 14.00
Will
Recordim Ara
Name and Raurn Addmm
t I
2vC SA
o.
CIL
'7
Pacd tdomfi oboe Number (mot)
This k ear _ bow -mad property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
Dated this - 16— day of May, 1999.
Forest Condos
BY:
BY:
AUTEBOMCATION ACW40WIZDGNMM
Sitoadue(s) _ S TATE OF WOMNSIN )
m6coticated *is __ dry of Persoo.11y came before me th of �Q - ,_day of
1 19 1 tfA'k h
w me wiz m be the persons) wbo 1r eSaq
• arowledge the ea.
TME: hUME t STATE BAR OF WISCONSIN
Lk
(0 nm
authorized by 1706.06. Wis. Stan.) W
THIS INSTRUMENT WAS DRAfTBD BY Notary Public, Sate of W'
q
VAN DYK. O'BOYLE & SELER, S.C. Mr" t Lt�O 'r(lf oar s 'rKiwt e:
Post Office Box 127
New Richmond, WI 5017
( Sinmalum may aribeoucated or mcImwkdmp& eab arc nor
receuary.)
i
NOi�TH LAKE � O ATES _ Tha SOUf)la0at ,/4 N» NOrtlteOd BAW 1r 4�,Nat
LET' Wisoonain Canted 170. RailroOM all in 4= 1 i Townslwp ]0 North, R of 19 wa T South.ed t/4 tM NorN+eat 1 of the
met• Goie C oT tlN Sa+1Mad 1/4 of f11e NoAllwed 1/4 ar $ dqn 12. TowW* 30 No tK ilong0 19 Wed. AN in tho Torn
1KDeonDin.
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tl C- LDT 7 8 3 DO' 1003!' 100. 4' 56 1 M 4T S 40'20'
763.00' 201.0 196.72' S S22• 04' N 4T
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3. 41 4• 3. 4• 71'18' I' 4T
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N - J LDT iD 1 .00' 183,25' 160.71' S 36'34'1 E 3JOT1 N 7T4 ' S 10
ACRES � � _ N tDT 1 ]I .00• 159,02 137.35' N 8 30'1 W 44'3 N 4 ' S 1020
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is \'\ tb. `� ♦\ M�
130.935 SO_ FT.
y 3.01 ACRES ♦ �C ♦ 6
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j •� \� ` AREA �9EGRE f �1 / oC �
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j 3.08 ACRES oS c� t 0 Canty um C
scan« Menwnent
\�4 I'REA ro MEAIaOt tAIE o1 Reard
1 . \ 121.276 SO. FT. �\ 9C' \• ® D.c t -1H' wee ft - 01.q
\ \\ 2.78 ACRES \ �< 4• ♦ 4.3 parade per Root
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a minwnum d 1.13 m molls W
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A '\ O Found Sr- pl"
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j � � �S �a i • \ � - X- EdelNq
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\; •+•^• a• 13h SO . FT. '\ .� BEARINGS ARE GRID BEA18NO3 REFERENCED To
\ �
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3.13 ACRES THE Sr. . CROIX COIY COORDINATE SYSTEM
� t - ♦. �/
e . t� j t 1 SE 9 CTONi M) . MMORTH SO 5 Q LINE W 28'ZT W.
ALL UNEAR YEASUREMENrs iMVE E•EII MADE TO
TEE NEAREST =t) NUNOREDIII OF A FOOT.
% 1 / ALL ANGULAR REttENTS WERE NAPE ro
% 4 � �.. t <,:. { t \ • / T TH NE rE (5) SECONDS AND COMPUTED
-50%. !N 89 W 206.54' - _ : S \ 4 � i/ y'L to Srat�COwty. and -M, bee. n k.
e
en
t \ / d rnuWi -I (le. wetland+. ml6ty- Rot
( 1 s 1 / size. ae to pa-1, Me.. 8doro purcm kw
SL CrIaK
lh� way wm i'
1 149.687 SO. FT. 4 1 EI ` - -- .. '.. an d - FProPdaw Toen B tar 4dNee.
1 .1 3.43 ACRES 1 1 el t PER REOUIREMENIS OF ILME 20 AND 21:
t IL AREA TO WANDER '� 1..'' / L- c*-" Pi-" ---t be wbmiMW to
Y^ 141.639 S0. FT. 1 y� 1 1 St Crook County Z.*.g Tor w.tw prior to
kemaIwo
3.25 ACRES �.'/ '
T er *.h Rot M one Pete
♦•♦ 114 A 77eQJ' 4 ► 11160 J. s w NW
498.1T ELK RhFR. MNMESOTA 55330
w wwuar OAF= er Tenn A zx.eor
-5 8P3Y1iP W e
-N w3rur E�529181Y (TO EAST 1/4 CORNER SECTION 12) -- ,. - roan solo
e "Nw pe/me �
11.x. - 1e0 Rod SMTr 1 4F 3 SEIM"
PAEL /MINA R Y
P19W/E12' J -17 -D7