HomeMy WebLinkAbout032-2156-50-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420675 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)]. 14
Permit Holder's Name: City Village X Township Parcel Tax No:
Ma gnuson, Justin Somerset Townshi 032- 2156 - 59-466
CST BM Elev Insp. BM Elev� BM Description Section/Town /Range/Map No: �
6 1- Q ,,M Z �"/ / -rz 12.30.19. j
TANK INFORMATION ELEVATION AT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i
Dosing c Alt. BM
6a 1564is o1 -5) 0 9y l0 /
Aeration (,J/ Bldg. Sewer /a Q
7
Holding St/Ht Inlet
TANK SETBACK INFORMATION SVHt Outlet
TANK TO / WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > 14- Dt Bottom
5� ax /ns I y� d•l�
Dosing / py� Header /LI n. y
3 z // ]n. �• 6 �.
Aeration Dist. Pipe i $. o 4; q7. b . S-_
(?
Holding Bot. System 4
D
PUMP /SIPHON INFORMATION Final Grad g v ' s- v
Manufacturer Demand St Cover
GPM - 7
Model Number E -
TDH Lift riction L � s System ad DH O2 Ft
Forcemain Length / Dia. �, Dist to Wel
2 Z I > 50
SOIL ABSORPTION SYSTEM / 3
BED/TRENCH Width 77 ength INo. ches PIT DIM�SIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 `
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EACHING Man'?,7r:.Lh�
CHAMBER O �Q 7
INFORMATION Type Of System:
`_ n 56 , 3� J� Model DISTRIBUTION SYSTEM �j G<J� Number:
����+ 3
Header /ManifgId I D istribution y �� x Hole Size x Hole Spacing Ven Air Intak
9 h P1P9s) / J �/ � 9�
Len th Dia Len th Dia – "S aan �—
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
�� Yes D No Yes [gn]! No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:1 /b /_ 3 Inspection #2:
Location: 891 167th Ave So WI 5402E 1/4 NE 1/4 12 T30N R19W) Highlands Lot Parcel No: 12.30.19.1347A
�btia 6S IN8 L6 F n�Q %' W-tz( I-, V ('
1.) Alt BM Description = 41 ✓► ° 1
2.) Bldg sewer length = Z5
- amount of cover = /
Plan revision Required? n Yes �_ No
Use other side for additional information.
SBD -6710 (R.3197) Date Insepctor's Sign ure Cart. No.
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 / 7 �O (K
N visconsin Madison, WI 53707 - 7162 Site Address f
Department of Commerce 4 Cy G �'J " A" "
Sanitary Permit Application Sanitary Permit Number
in accord with Comm 83.21, Wis. Adm. Code, personal info r 1 ° ❑ Check if Revision
may be used for secondary purposes rivacy Law, s15.
I. Application Information - Please Print All Information State Plan I.D. Number
F erty Owner's Name Parcel Number Z �
3 A) 111o
Property Owner's Mailing Address perty Location
Z `7" / V �f `t f'l l 6 -k 1E 'k 12. T N, R Q
City, State Zip Code Phone Number Lot Number L B� ber Y
Subdivision CSM Number
M AV 5,� _ 8 Z 9_ dwal+ tin f
H. Type of Building (check all that apply) ❑City O 3 aZ — 02 L .5 — � - t 0
K-1 or 2 Family Dwelling - Number of Bedrooms ❑Village t Q t 3o< (9 t j 3 g 7 A
❑ Public /Commercial - Describe Use IRTownship '
❑ State Owned 3 T 0 7 r I 3/,X ) Nearest Road
.s-a,vd" ►- 4K, clot "� 16 v 6
III. Type of Permit: (Check only one box on line A (numbering4heme for internal use). Complete line B if applicable)
A. 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 11 Addition to For County use
System Tank Only Existin System
B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) E /S,4 ' 3 (,
44 I9 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 1p F1 Q her
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area S oil A - li a io Percolation a
Required (� Proposed Rte (Gals. /Days/ q. t.) (Min. /Inch) b '�� Elevation
� 1213�� r `_ 9 9
VI. Tank Info Capacity in Total Number anuf fa u Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks )C ` Concrete Constructed Glass
New Existing A A
Tanks Tanks
Septic or Holding Tank 1=i /a O �1 2 (; f
Dosing Chamber G f ed
/ V° r
VII. Responsibility Statement- I, the undersigned, assume jesponsibility for installation of the POWTS shown on the attached plans.
Pl ber's Name (Print) Plumb 's Signature MP /MPRS Number Business Phone Number
3
k o bl�x * 7 ?4
Plumber's Address (Street, City, State, Zip CIr )
6— Ll W 6V4 - W 1 J ftt1
VIII. ount Department Use Onl
Approved El Disapproved
Sanitary Permit Fee (includes Groundwater j Issued Issuing A nt Signature (No Stamps)
Surchat a Fee) e2
❑ Owner Given Initial Adverse 2'L 5 j D -2
Determination
onditions of ApPP�.r9vaUReasons for Disapproval � � �� (gQdt rd i fSL'�i'►
Cani'rrvn Sock 5 }rum -urc VCST or�i��'t^4- �'ltnnta.
49(pV�L�Z�`-
(1 la�At �h�! i✓l b�Sap1'1t'Cw - fit - (��aMd �OG�vns)
Attach c la (to the County ore) for the sys not less than 81/2 11 in ize
SBD -6398 (R. 05101) S� 1-( ivtc &ses / C�it k, P�,ct� f Cu. �� �� � '
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PAGE_ �I_OF_
S� yT LOT# 5 LEGAL DESCRIPTION 5 F X Air i4 ,S 17 T 3 ,N,R. I g1 E(or�
.:ALE: V=
BM 1 ELEVATION /O0 • C)
BM 1 DESCRIPTION o f 3 fT��
BM 2 ELEVATION O
JBM 2 DESCRIPTION 3 T�� , Pc c ' 1
SYSTEM ELEVATION
ALTERNATE ELEVATION
CONTOUR ELEVATION 106- o,lol. oo , y9.00 9-7, or
ScC — SaM�,`��
r ti= S r P
ov4wral\ f 2,4 9
56 q� (2 , u� d� s S�
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o v, 50 &)
AlAP in
SIGNATURE , _ DATE
? /S —760-0.)--79
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e °-
wn
MIN. FFE 941
L 't'i � f ' •�j� `- - .�,oyt 3- '7L:.L L. �.�_
T ; �A �� ` �; i I � T,�a • -. ��. �`_ : �i� -� i.a -- a
ss1� r�; �- ^•+ '^ b . • r � \, per•^. ".�L. /�- "� a � + � v
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ewe`.!' "! L . r , - • 'K s
v
Y[, U `i4t -,�� ,i'� E=al�' ,_; ' �� r'� E.R ' • , i•.;z: •
(ambinaCion SepGic ,'Tank and
PUMP CHAmL' ER CRO55 SECT101J A�10 SPECIFICA'rI0ti1S
VEUT CAP WEATHt =K PROOF
��-- JUUC -,rlc ! box
1` C I. VCIJT PIPC APPFOV[ 0 LOCKI14C.
! ' FROM GOOK, MA?JHQLE COVE K't
wr�.Rr� LP. Q,EL.
•.11UDow oR FRESH T
�iJs��z nog t�� A�P IuTAK�
K
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1f3 "MItA.1.
i-; PROVIDE i — --
11`1LE T ;' ' AIRTIGHT SEAL
�FFLC I
pPKOYED JO1>r
A
aAPPKOVE.D JOItJTt�s8���
w / c _ p1P�ox�v Tank construction I II
ALARM
shall comply with I II I
I:LF R ()3.15 and 33.20
� I I
1
PUMP --_
> OFF
0 C0IJCKCTC
Z FLOCK
-- --
R15CR EXIT PER.MI7ED OQLU IF TAUK MAQUFxCTUREA HAS SUCH APPROVAL 1 &zooI
5CPT14 F SPFCIFICATIOKIS __LL
DOSE Vj 2 2� Z C6)LJ C CZf
Tn3.JK5 MAi.1UF,�CTLJRCR.: 1JU.MbEFI OF poSCS: PE:K Qd.y
TA1.JK aIZE ; �� _ GAL.t_OIJS D05Z VOLUME
ALkKM MAiJUFAC7uR.zR:
MOCLL QUMOCK: CXPACITIES: A =231 AlCHCS OR - CALLOUS
PUMP MAQUFACTUKCK: y� � � C�1 :1ULHE5 OR �QALLOUS
MODEL >JUMfjEK: -- - -� /�� D —10— IAiLHES 0KL34�ALLOIJs
5WITCH TYPE: r � u= EJ�c�r W E: PUMP AW ALAKM ARC To i IL
MIF..IIMtJt` D15CKARGE RA7 - E. — - _ M ..GPM INSTALLED OR! SEPA1t�,TE CIF,CIJI
YEKTTICAL DIF DETWCEU PUMP OFF AQO..D15TRIbLITIOU PIPE.. r ECT C
t M1RJIh101M AIETWOKK SUPPLJ PRESSUKC , ; , , , _ _ FEET
-f ® FEET F T FT
L 0 FORCE � � TIO FACT _,
f1Al�J X � FKIC u OK � FEET tC,
TOTAL. CtQAMIC HEAD f 7 , FEET
As per.T;Lanufacturer al /sn.
� a
a✓t)
M E40 Series
4/10 HP Effluent
and Drain Water Pumps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40 12
35
10 to
�j 30
8
Z 25 Z
Q
20 6
J
15
0 4 O
t--
10 ~
5 2
0 0
0 10 20 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3326 7/91 Printed in U..�.A.
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Wiisconsin�'DepartmEntofCommerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings Ilk 1-
in accordance with Comm 85, 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 not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. yp -6G�
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 032 -ZqW -- /D —p
Please print all information. ew by 4 Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). �[ /� i 03
Property Owner Property Location
Govt. Lot 1/4 AE: 1 /4 S/ Z T 3o N R E (or)(&
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
3 ee Tr • .� I
City State Zip Code Phone Number ❑ City ❑ Village EATovmj Nearest Road
40 1 So t1
New Construction Use: fS Residential / Number of bedrooms 1 �# Code derived design flow rate 6 )QPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 4 11 Flood Plain elevation if applicable
General comments
and recommendations: �jY�Em 2��(, �'�"• "" OvJQt s
X�� -
1xt4. e1ev. �I2• g S'
S GL l5 WW 6 Y - 4 - 0 A
Boring #
F] Boring UJ u. — V' ✓ f k u�" f yli give ,..
17 1 t(,piC .
pit Ground surface elev. ft. Depth to limiting factor in.
- Soil `lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I - Z <-' 1 z k cs I VC
LJ
Z (- y s r zms m
dens - sih A
Boring# Boring
9 1 Pit Ground surface elev. 9�.� ft. Depth to limiting factor / • / in.
TT Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
(
n-13 (C) -Si 2 abk s 5
2 ► - t i c.l Zm c-
SL
•� soi is 4ra?v c n be- ✓r o c n-e
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
Ac4 am Sch 253
Address Date Evaluation Conducted Telephone Number
2��3
M' SoMfM# tot 154,n 10 - 30 -o 1 C 2y7-Ydd
1
Property Owner 4— Parcel ID # Page 2 of
Boring # ❑ Boring
Pit Ground surface elev. le ft. Depth to limiting factor 11 9 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
f o -ia (0 1z 5i1 e 5 .5 .1
zm c —
4z iti� �t� s>✓ as 1 � — 5 _
❑ 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 GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Ground surface elev. ft. Depth to limiting factor in.
F-1 g #
❑ 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 * Effluen #2 = BOD < 30 mg /L and TSS < 30 mg /L
The Department of Commerce is an equal opportunity service provider and employes . If you need assistance to access services or
need material �n an alternate format, please contact the department at 60 -266 -3151. or ">;"I 608 -264 k77.7. +
If
SBD -8330 (R.07 /00)
Property Owner —31 J Parcel ID # Page 2 of
Boring #❑�ryry Boring /v�
ICJ Pit Ground surface elev. �c.y-� ft. Depth to limiting factor 11 9 in.
Soil Dominant Color Horizon Depth Redox Description Texture Structure Consistence Boundary Roots GPD/fF lication Rate
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
r o -ia cp Iz cf) .5. .g
l - 47- Sic 1L
z -119 ib
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 GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
E Boring # El 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
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 jV an alternate format, please contact the department at 608- 266 - 3151 - pr M 608-264-k7-7.7. r
SBD -8330 (R.07/00)
w A
- �1�' °' ��r , ►. ,�C- .�A'f, `�a�rll' .�..�.1 1 ��C% er// Ci/�
1•
` PAGE__S_OF 3
NAME s?y VT LOT# 5 LEGAL DESCRIPTIONS F X N(: 1 4 ,S 17 T 3n N,R 1 `t E(or&
SCALE: 1 "= y(�
BM 1 ELEVATION /()0 • y
BM 1 DESCRIPTION - l a p o f 3 a vc-
BM 2 ELEVATION 6 7q, �5 Cl
BM 2 DESCRIPTION - 16 - c C '
- -4Q
SYSTEM ELEVATION :J:sP f, ,o U Lowe r !Z2, c O
ALTERNATE ELEVATION 73,
CONTOUR ELEVATION 166 <>,/ %GV gg, Q -7, a
a -Z 9I ao
b �s
�Gp
SIGNATURE DATE
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 Specification
S anitary Permit Number a Q 5
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Avera (gpd) yop
Septic Tank Capacity (gal) A 266 61Yzxz"Z?k
Soil Absorption Component Size (W)
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size
(in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect pact 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
i
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 septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain 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 intt) the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
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.
PAP— T ; OCC sa AJ PI- 9 6 _7 s -_2� 7
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�
3
ST CROW COUNTY
SEPTIC TANK MAINTENANCE AGR13EMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer •JlI s4ih Mf n�SD pi
Mailing Address hr a i l (i 3 ��' .5� 11Lc1 _A -- -- //w M 56'a
Property Address I ' {"
(Verification required from Planning Department for new construction)
City/State arcel Identification Number _3 2044 — !tD poo
a,,d 3 2- a0ifq•- Gib
DEGAL DESCRIPTION
Properly Location 'f6' '/a, Ni5 V4, Sec. T.N -RLLW, Town of
Subdivision Th 11 7ilb 1a d S . Lot #
Certified Survey Map # , Volume . .Page #
Warranty Deed # X356 , Volume Page # .3 q
Spec house ❑ yes 19 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-
1 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
maswr 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and 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 a three year expiration date.
' ,� AtCtX OF APP ANT 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 owners) of
the propo#y described above, by virtue of a warranty deed recorded in Register of Deeds Office.
A16MAtJRP, OF APPL10ONT DATE
* * * * ** Any information that is misrepresented 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
7 (D 7a56 Il
U 2122P 591
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., wI
Document Number RECEIVED FOR RECORD
This Deed, made between 01/28/2003 03:15PM
RTC'HARD O- STOi1T and�TANFT P gTQ(j_T_ EXEMPT #
_husb and wife, REC FEE: 11.00
Grantor, TRANS FEE: 193.50
a nd �111-STIN P MAGNUSON COPY FEE:
CERT COPY FEE:
PAGES: 1
_ Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate in St, Crc)i Y County, State of Wisconsin:
/
,/Lot 5, Plat of The Highlands, Town of RecCxdiny /irea
Somerset, St. Croix County, Wisconsin. Name and Return Address
TOGETHER WITH the following described KRISTINA OGLAND
property: ESTREEN & OGLAND
304 Locust
A parcel of land in that part of Lot 4, The Highlands, Hudson, WI 54016
Town of Somerset, St. Croix County, Wisconsin,
described as follows: Commencing at the southeast
corner of Lot 4; thence South 85 degrees 37 minutes 58 032 - 2044 -40 -000
seconds West, assumed bearing, along the south line of 032 2044 - 10 - 000
said Lot 4 a distance of 248.32 feet to the point of
beginning; thence continuing South 85 degrees 37 Parcel Identification Number (PIN)
minutes 58 seconds West, along said south line, a This is not homestead property
distance of 42.75 feet to an angle point in said south (is) (is not)
line; thence North 35 degrees 05 minutes 20 seconds
West along said south line, a distance of 118.36 feet;
thence :South 49 degrees 46 minutes 34 seconds East, a
distance of 144.93 feet to the point of beginning.
Exceptions to warranties: easements, restrictions, rights -of -way and covenants
of record.
Dated this 271 day of y 2003
(SEAL) (SEAL)
* Richard O. Stout * Janet P. Stout
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
ss.
St. Croix County
authenticated this day of Personally came before me this 27 day of
January 20_0.3 the above named
Richard C) S nut and Janet P
*
S _
TITLE: MEMBER STATE BAR OF WISCONSIN _ to
(If not, me known to be the person -q who executed the foregoing
authorized by §706.06, Wis. Stats.) instrument and ac ac k n o wledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Janet P. Stout - - --
1353 Awatukee Tr.
Hudson, WI 54016 Notary Public, State of Wisconsin
My commission .4 a e e I on date.
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
Narnes of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co . inc
WARRANTY DEED FORM No. 2 - 1998 Milwaukee, W s
I
I 23 32 � I
\ ` 13 \ 12' oa
N81 °09'49 E I
33.43'\ \ Z 1 \ 3.355 ACRES T
146,155 SO FT W
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30' DRAINAGE Z
\ \ \ \ EASEMENT I
N88 °02'45 "E 386.2T L -33
ACRES o \ T — — 30' DRAINAGE ,
o
30 SO FT ; \ Moi 7.549
Cg — rEASEMENT ' I
1
L -21 � 7 H.W.L. = 912.0 I x
�Tv11N. FFE = 914.0
�! � o
3.36ACRES C5
146,610 SO FT c*�
NOTE EACH PARCEL
60 / SUBJECT TO ST
O / LAWS, RULES A
c WETLAND, MIN'
PARCEL, ETC.) E
DEVELOPING Af
,� p CROIX COUNTY
31.0 TOWN OF SON/
- -- � � �OcS°
323.5
psc� N85 °37158 "E 301.06 NOTE MIN. FFE IS THE
ELEVATION OR
O WINDOW OR D!
A�
6 ji9 NOTE NO OWNER OR
3.000 ACRES WHICH WOULD
130,686 SO FT :' THE OPERATIOf
COMPREHENSI`
N _ _ -_ -- EROSION PLAN
_ BUT IS NOT LIM.
OBSTRUCTING,
` 3.244 ACRES EXCAVATING, C
w \` POND 141,312 SO FT EASEMENTS, \
V
m
H.. F WATER RUNWF
= 939.0 - - N
,CRES p \ MIN`FE = 941.0 ___ - - -- OR GRASS SEE'
N
SO FT 1 ` - MIN. FFE = 941.0
Q2 J�� i \ H.W.L. = 939.0 NOTE SEE COVENAN
m T,, �/. o RESPONSIBILIT'
O OF DRAINAGE E
RETENTION ARI
10 / / ... m \ SEE COVENAN
N ` NOTE RESPONSIBILIT
O yu / 70, m THEIR LOT.
Q MIN. FFE = 945.2
<��� /' H.W.L. = 943.2
X SURVEYOR:
242.221 DOUGLAS J.
?42.32' L - 17 268.35' S LAND S
2920 ENLOE
1320.23' SOUTH LINE OF THE N1 /2 OF 'T
04 ���� THE SE1 /4 OF THE NE1 /4 SUITE 101
----------- HUDSON, WI
3Y HIGH WATER MARK w (71 S) 386 -20
SHED BY ST. CROIX COUNTY 4 V ENGINEER:
OFFICE ON 10/30/01. b O
NIA AUTH CONSI
ST. CBOIx COUNTY, WISCONSIN
i ts; about 15 percent coarse Runoff is medium, and the hazard of erosion is mod -
by
volume; strongly acid; erate. In most areas erosion has caused tilth to deteri-
boundary'. orate and has reduced the content of organic matter
reddish brown (5TR 4/4) in the surface layer.
moderate medium subang- This soil is suited to oats, alfalfa, and a limited
ncture; friable; thin patchy amount of corn. Controlling erosion and maintaining
scale uncoated silt and copy of good age- nt mat uniti I factors l
on faces of peels;
abort 15 percent coarse frag- group 1o1.
e ; strongly acid; clear elopes,2 Sae tia o - Antig s III m is comp ex are on mo-
yellowish red (51'R 4/6) rain d glacial drift. Most areas are Irregular
bum; Weak medium sub- in shape and range from 10 to 120 acres in size. These
structure; friable; few soils formed mainly in silty sediment and in the under -
percent coarse fragments lying sandy loam till or sand and gravel outwash.
acid; clear wavy This complex is about 50 percent Santiago silt loam,
25 percent Antigo silt loam, and 25 percent other soils,
owisti red (51 4/6) mainly Onamia soils and loamy till soils underlain by
• �,eaking to weak sand and gravel. Positions of these soils on the land -
we ; fe v roots ; about 10 var , but ener of is on mod-
le is by volume; erate l rod n don sli htl concave foot s opes.
e Antigo soil is in drainageways, but is also corn
-
wark hwhes in thickness. ntonly on eroded, convex parts of knolls and ridges.
thick, The Ap The Santiago and Antigo soi his com lex have
li or dark grayish profiles similar to the ones escribed as re resents i
r Y O eir respeC iye Se nev, but ey are m Owed- -
ies, : )ban or heavy loam. alfd coffin sli htl more san s. aisv, iu uian
loam— In most t e n i o soi as a su I rm artly in
coarse frag- r is and in places the soils in tfus
,gym, and the C hori- comp ex have a dark surface layer 6 to 10 inches thick.
Included with these soils in mapping are many soils
ted 'Kasnor soils. in drainageways that have a dark surface layer 10 to
;-moderately well 30 inches thick and small areas of sandy and gravelly
poorly drained soils on the crests of knolls. Also included are many
small areas of wet soils and ponds and some small areas
i11t mopes- This where slopes are more than 12 percent.
0 areas are Runoff is medium, and the hazard of erosion is mod -
,f tram 10 to 120 erate. In most places erosion has caused tilth to dete-
described as riorate and has reduced the content of organic matter
si in the surface layer.
fine ate areas of Most areas of this complex are cultivated. These soils
areas of are well suited to oats, alfalfa, and grasses, and are
included suited to a limited amount of corn. Short steep slopes
tum, in this complex are well suited to red and white pines.
t Controlling erosion and maintaining tilth and organic
t 5 5 i<s alight. matter content are important factors of good manage -
iu It is ment. Capability unit III& -1; woodland group 101.
on
tally ScD2— Santiago- Antigo complex, 12 to 25 percent
YR of good slopes, eroded. The soils in this complex are on end
group moraines and pitted glacial drift. Most areas are irreg-
ath>m ular in shape and range from 10 to 100 acres in size.
slopes, These soils formed mainly in silty sediment and in the
Most underlying sandy loam till or sand and gravel outwash.
from This complex is about 40 percent Santiago silt loam,
Aar 25 percent Antigo silt loam, and 35 percent other soils,
scn
ate as mainly Onamia soils and loamy till soils underlain y
er is sand and gravel. Positions of these soils on the land -
u � ; shape vary, but the Santiago soil commonly is on
moderately broad ridges and concave foot slopes. The
d Antigo and Onamia soils commonly are on knolls, very
in- narrow ridges, and convex parts where the soil is
`- more eroded. They are also in some drainageways.
ew The Santiago and Antigo soils in this complex have
t t profiles similar to the ones described as representative
�) :^ of their respective series, but they are more eroded
`t
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LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SOMERSET
COMPUTER NUMBER 032 - 2156 -50 -100 Parcel Number 12.30.19.1347A
OWNER NAME: First JUSTIN P Last MAGNUSON
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
891 167TH AVE
SECTION 12 TOWN 30N RANGE 19W %160 NE 1 /440 SE
Line Description Line Description
TOTAL ACREAGE 0.000 PLAT HIGHLANDS,THE 02 LOT05 BLK
01 SEC 12 T30N R19W SE NE 15
02 LOT 5 THE HIGHLANDS 16
03 ALSO PT OF LOT 4 DESC AS 17
04 COM SE COR LOT 4;TH S 85 DEG 18
05 W 258.32'POB;TH S 85 DEG W 19
06 42.75';TH N 35 DEG W 118.36' 20
07 TH S 49 DEG E 144.93'POB 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, 174 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
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