Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-2137-10-000
t o N 0' 0 fA O g i n d r1 0 0 c .. o A 3 AL o < N G ° o L l o m w o ° o o ! o w °w 0• W < C O W N 0.-1 r l Q. __ o n CD p�j j n 7 �D O �' N M c 3 1 o � 3 D o g m a o > > 7 y N 7 N N O O cn = m CA m to In a `° a a. Q o a a 3 O ° oC/) O ° -4 s TVI (D �,. Z N N (D F, Z N (n 0 ' O N N a O .. C m °° O O N N O N C V V C O' 3 � 3 0 CA co � 3 6 vv _*i Q �00 L m N M y CD - I CD CD 0 � '—'' t�D 0 d = l�1 CL Im D 0 O D o 0 0 Tr m - s O tD fD c y X O c m a F ' c G C N a C a CD af° `° (n (6 �pzm n fl C v W v m a w cD m o z i a C g `a A ° o c cc x CD Q C N N Q O X O G p < V CD N C D) C Z fl. 7 CD O D CD N 54: CD CD 0 O 2 � 3 CD w N) N• N C N N N a c o a rn y W Cl) N ? C, I 3 ti W X b I �. m A ti o O o o Wisconsin Department of Commerce Count Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 506378 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Reinke, Thomas I Somerset, Town of 032 - 2137 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Oa ,!� C S / 13.30.19.1213 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. i Septic t � Benchmark Alt. BM , � 0 0 Aeration _ Bldg. Sewer • g7• - 7 Holding St/Ht Inlet St/Ht Outlet 1 7- 4 15 9 5 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet U j - of I Septic y 2 , s / N A— `f 7 75 Dt Bottom Dosing Header /Man. p q ?, '7 Aeration Dist. Pipe �Q • p '73 . 3 Holding Bot. System Il, a CIZ 35 ok. PUMP /SIPHON INFORMATION Final Grade S G 7 75 Manufacturer Demand St Cover GPM �.\ t 3 ID� •b Model Nu er TDH ft Friction Loss SyjDist m Hea TDH Ft " r Forcemain Leng . t o Well ^— j SOIL ABSORPTION SYSTEM BED /TRENCH Width ♦ Length 0, No. Of Trenches _ l - _ PIT DIMENSIONS No. Of Pits Inside Dia, Liquid Depth DIMENSIONS 3 F YI Z �G �'K�� - _._ —``- --�_ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System CHAMBER OR : +' / NIT C ( -2ZS w I — -- �� D Model Number: J ` t� LJ DI�t�� *� �V / T DISTRIBUTION SYSTEM d,. Z 4b , Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai Inta If Pipe(s) \ \. �'` . \ G n.�t"` Length 6 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only w Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center !�• Bed/Trench Edges Topsoil � `5 Yes I J No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1574 84th Street New Richmond, WI 54017 (NE 1/4 NW 1/4 13 T30 R19W) Stonewood Lot 11 Parcel No: 13.30.19.1213 '--_ �. 1.) Alt BM Description = � � `"' � In q, $ ,+"!j ©�. 2.) Bldg sewer length = �� - amount of cover = I Plan revision Required? LE] Yes N No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' ignature Cert. No i ._ , ..__. , �..._.. ..�..._.,+..._+....._.- .�._.... . � ......- ..._�.T— _....�........._ _.......rte ».rte- — ^_..�`.'.'! commerce. Safety arui Buildings Division County -�•- e 201 W. Washington Attic, A.O. Box 7161 cons Madison, WI 53707 3ania nary PermitHermit Number (to th filled in by Co.) Dopartmortt of Com ntart: o - -- _ Stara Tran� rnber j Sanitary Permit Application in accordance with s. Camrn, 8321(2), Wis. Adm. Copt¢, $00`1634in of 11113 fvnn to tie AW01irlak govrrn;rielrial unit is required prior to obtaining s sanitary permit Note: Application forms flat state-owned POWT S are Projet:t Adders 0I different than i - ail'mg address; � s,rbrnuted to the Depann, nt of Corruneree. Pr:sonal information yo provide may be used for serundary / 5 !7,1 d� >n 4- u rusts �!it accordance w ith lln Pri vac�Law, s. 15 to Stars. _ _ _ __ O 1, A�rpl}cat I nformatio n rise __. _ ['tu pet ty Owtxr'v Name r�. Panel 0 f Property Owner's Matlink A ddress OCT 2 6 ZOO t.rrca� ictn 0? C' /Z i l 6 . �.� _ _/C✓ G 3� _ Govt. Lot �- . City, Scare ____ ST. KPOOUNTY hone Nltmber � �� J /� •_ " ` m`+.*J � (circle ocre) .�. i ti. Tape of Building (check all that apply) _ Ok. e..o l ut P• 2 Family th, etlinil - N'un,[ er of Bedrnnms Sutdiviaiar Marne ❑ fubhc;: ° mmilttrcaa! l)esai(w Use ; (j City of P - � Viila g of e ❑ Scam Owned - fivscritx Use CSM Number _ . _ Tuwn of �G iii. Ty of Permit: (Check o ox o line A. Co {ete line 8 if applicab n t k oae b n l ra .. n p _ New System Cl Replacement System 0 rreatnmitrrrolding Tank Replacement C„ty ❑ Other Modification to f:xisitng System texpiatn) i List Previous Permit Numtxr amt Ustiissued I R- ! ❑ i'ernur Renewal ❑ Permit Revuton ❑ Change of Plumber ❑ Pvrmrr Transl't.r to New Retort i xptrattOtr Lowrier 1 kV. Type of POW'IS System/Com nent/ Devire: (Check all that alflai - W.N on•Prrssw ized In -Ground C3 {ndi Pressurized round ❑ At -Grade ❑ Mound > 24 in ofsuitae soil ❑ Mound < 24 in. of suitabic su:l 0 Holding Tank 0 Other Dispersal Componem (explain F+tt nt Device v. D is ersalfTrearmen( Information: Des I a Flaw (to) t7esign Soil Applicatiun , tetffipdsf) i. ca Pr f ed tsij sys"mm Vl. Tank Info f Capacity in — Total M of Maaiufacturer d l l Gallons _ Cra,ions thins p New Tanks l Cixiitina I'aake t �,'' , ScyncnrHollui TT'aek �s f ( - Vii. Res onsibilit Statement- 1, the underslaned, assunu responsibility for i o fthe POWTS s-kkffn on the attached plans. / Y'.untbe / r's Name Pnnt) ` Plumber's Signature PA RS N t3usaness t'lton�e Number� Plumber's Adr:res.: (Street, City, State, Zip ode) I Vllil. C 'o,rnt /De p er tme Use OnIY -- Permir ce ate rar aeE Is3uuta enr Siyrut J� pp � .d ❑ ov ; _ ❑ lien on for Denial ` s � I t Z -- IX. Conditl r,��y rov ssott h � s far Dis, i roval I t. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN sfteck requirements must be maintained j 1 e , • Me syst,41 and suttnrit to 14e C. punt?. Only Un paper not leas Gets a in i t r inr" in size I Eill•G39!? (R. 1)1/07) Valid thru 01/04 t 8n o w � V v ,J ;.�.2� 8mz d C Z , o lif re �� C r - Y , 1554 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance.to nearest road. 032 - 2137 -10 -000 Please pdntall s second By _Date Personal information you provide may be used f ) (m))• - 02 ?C0?— Property Own6r Prjq Location Darcy & Sue Borst Go Lot NE 1/4 NW 1/4 S 13 T 30 NR 19 W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 1226 172nd Ave. s 1 Plat Of Stonewood City State Trp t Pf[®N@I FICE City j Village Town Nearest Road New Richmond WI - 54017 715 - Somerset 84Th Street 16 Nev Construction Use: Residential / Number of bedrooms _ 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 3 trenches at 95.50' using 39 high capacity leaching chambers. M jo Boring # Boring Pit Ground Surface elev. 100.88 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' *Eff#1 *Eff#2 1 0 -5 1 Oyr4 /2 none sl fill - - - - - - i 2 5 -12 1Oyr3/2 none sl 2ffsbk mvfr cs 2f 0.5 0.9 3 12 - 1Oyr4/4 none Is 1msbk mvfr gi 1f 0.7 1.2 4 20 -54 1 Oyr4 /6 none Is & s Osg ml gi - 0.7 1.2 5 54 -108 1Oyr5/6 none strat. s Osg ml - - 0.7 1.2 (,I A-fe / H#4 consists of an unsorted mix of Osg Is & Osg s. ❑ Boring # :j Boring *I Pit Ground Surface elev. 100.13 ft. Depth to limiting factor > 113" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0 -7 1 Oyr3 /2 none sl fill - - - LfM0. - 2 7 -17 1Oyr3/2 none sil 2ffsbk mvfr c s 2 0.8 3 17 -33 1Oyr3/3 none sil lmsbk mvfr gs 1 0.3 4 33 -56 1Oyr4/4 none sl 2msbk mfr aw 1f 0.5 0.9 5 5 7.5yr4/6 none Is Osg ml gw - 0.7 1.2 6 90 -113 10yr5/6 none s Osg ml - - 0.7 1.2 5%.5(o � 1-1#5 contains 1/2" -1" 4/41csbk Is - does not present a restriction to horizon loading rate. Effluent #1 = BOD ? 30 < 220 mg/L and TS >30 < 150 ffl t #2 = B013 < 30 mg/L and TSS <30 mg/L CST Name (Please Print) S' ature: CST Number James K. Thompson --"� 3602 Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 20 5/30/02 715- 248 -7767 property Owner Darcy & Sue Borst Parcel ID # 032- 2137 -10 -000 Page 2 of 3 Boring # Boring E Pit Ground Surface elev. _ 98.82 ft. Depth to limiting factor > 120" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots * Eff#1 *Eff#2 1 0 -8 1Oyr3/2 none sil 2fcr m as 2f 0.5 0.8 2 8 -32 1Oyr4/4 none Sid 2msbk mfr cs 2f 0.4 0.6 3 32-42 7.5yr4/4 none sl 2msbk mvfr aw 1f 0.5 0.9 4 42-80 1Oyr4/6 none Is Osg ml gw - 0.7 1.2 5 80 -120 1Oyr5/6 none strat. s Osg ml - - 0.7 1. F4 ]Boring # 16 Pit Ground Surface elev, 98.86 ft. Depth to limiting factor > 105" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJft *Eff#1 *Eff#2 1 0 -11 1Oyr3 /2 none sii 2fcr mvfr as 2f 0,5 0.8 2 11 -20 1Oyr4/4 none sil 2fsbk mfr cs 2f 0.5 0.8 3 20 -29 7.5yr4/4 none Is 1 msbk mvfr aw - 0.7 1.2 4 29 -54 1 Oyr4 /6 none Is & s Osg ml gw - 0.7 1.2 5 54 -105 1Oyr5/6 none strat. s Osg ml - - 0.6 1.0 H#5 contains 1/16" - 3/4" bands of I Oyr4/41 csbk Is at 1" - 3" intervals - thicker bands restrict permiabilit. Horizon loading rate adjusted to reflect red permiability. F51 Boring # Boring - Pit Ground Surface elev. 98.23 ft. Depth to limiting factor _ >99" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' Eff#1 *Eff#2 1 0 -9 1Oyr3/2 none sl 2fcr mvfr as 2f 0.5 0.9 2 9 -17 1Oyr4/4 none sl 2msbk mfr cs 2f 0.5 0.9 3 17 -27 7.5yr4/6 none Is Osg ml cw - 0.7 1.2 4 27 -52 1Oyr4 /6 none Is Osg ml gw - 0.7 1.2 5 52 -99 1 Oyr5 /6 none strat s&gi Osg ml - - 0.7 1.2 * Effluent #1 = BOD 5> 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. of /of She. �lw- 9S, 37 ' � `Jor � e�/a /ua�ian �0► "� U �,l 5ca e. / " =40 ' (= eKCe�OOsE. f}ssk.►led radeaE 17arc�, 5ke- &rs prop, lot +( o 560 agLocce/ 5 " bd.vis ;-o, : /07.64.'. 30 n, i 0. 1Q "), , Th , o � C ID ' ai �. Ivi Slgac w y �a P 3 of'3 3 /0, 6-Y , Aet LA— To of /of Sbz�le. leu- = 9S, 37 ■ �o,'t eda/ua�on ,or "& � Eleda �ic� � pp z sp -nc-k ma r k: n Propose-d �bd, ✓ JCct Q, /" VO ce�OOSE. 45SQ -,La d WA fn9 � 5ke &,-s4- prop. tot it o f 56oneu -6d 5,- bd,viS:o1�� y Pro posea 1,2,6 - 0 Joe. z prew�-eed 7 o{ pr ll i ■ a. w �n �a Q i YO A a 42 a W Y+nMaifltFOwMM SIxM ' N r. N ww Ha A.9M 4wra9 MY1f171 .. , vrr�S � r M 41 paw M 4 A THI OTHIEST Q� MTER, TW S�UT'TEWST G M £k THE Ii4Rt} NAT t.IpR W y AAA W'm AM �� #��W�'� �� ' :'tAt �I�S�CFICRTiJ, T 3iTNC6tTE�a RX14G� f8�5�, TCri�i QF:S�JMa &RSET, ST� C+t�h CCJ.rSVTY, 0�5CChSIN, .�"sfwraoa{!+�� sAG�' irshea�aMarx+uW +'E��'kf hwo Gxm -ra w.'* A** Ri !I t 4` � I . b .l t;�.. ..4aa vfA W. fla - n 6A. h v �;« S5 fGt 551 ,d7Mtt4'+I4F x-'�"i _ W,e'dv t3 ,.. � .. ,+'NFf aA!r 3 e. rg 5M rr: ,5aawa f(ly.9 aN'hwauo 9 tit a,af hu,Via. i.wge 'I1 p ,} I m 4, I a 4M�EM R16.[M<N�9E AIM n� Y "� ?eC77:. /nar tnn•sr, ,A � 4 r I pC7 " r '^ 4 ^•, - #- A g. 14A 6,T a. I,C S4 SCq 9f { t W r � F(fCF " ✓� � � � t ' � � T � _ r - 9]45 MaA f � , A 3 i A a $ WW V W,v. L Q t f T '� ! L 0 T f i L T9 to CG? ?�S>7, ^ x Vv ,'KFS h6'AX5 wbV f�ft�lxr n AV LOT ul NO � Tw a ' 54f �GkaY`� � ' a a � , .\ „�N wA M ' ai➢Qt A aT 1JS�lAec Atrtt45' SI R N 4A' to //�� ^�+ g q t 01 50 3,➢&4 � � �,� 4y r } L .V l cJ rw R s s r sr ; of pp :+lravd EW7rty, m . _ p r :6 99 v a"^41'1���p9” �,,� � ,rat m s+� M vs - ..�� ' •� pMp • '.j:y y �g0• A 5 9 9 i 1 ._ ✓_ a �i W! 1 r � w Q T 43 a u rn5. 4 T4 A t i Fu ��C'vr 1 `47. .yr .I4x 5 Cauv' -o' 9' �' �� y . �' Y m fk +^ { p y t W10 F 1 S r^!} 4161 s5 i � � r r ! E47 ar�:r $s J ON fir & LdT i, , y pp a jtfr�# + TT q fEa & •, �?, y ay •� 4 L V T 7 i A [ " �A h �{ A , - Sr AwA0.kFFx -AtS u /� r 9 w ? i >c Y.} f 1. L 0 V '04,4 Al V I 2 ,r` S 7 v t "J UaYC i45 A ,x ry:r, 3 Ma44E441.E•9a41 rrA�w +S:RS tuKx'F F - Lr h € 44,f$v Fr h An� �; °' At ii x• uvx4Fll aYC , V 4-7 f t fi T 4 w g JS AC AS' Ply; !` �Mawt w� *ct.x; � aw�tatzr• i �k y L g r waau�� s r � axwa rf( -w 1 f F C r Y1,kOC "4 'tJ: vue iNd.1C' , fl U xr ;WSii •A n trr6i � � lug r,.- i M" . x rore. w irllt M 4 �& Nri, l�apJ 7 e , w gMxt A a(x5 d r 1 Al" f3^bfi7 �. #kiC a r A�Xor'9WxatA"lx�z9 r a 5 51ki}" "1LkU1 sa r,59t.9tK - � T A �5P,9i hP[ €t ,stir' ,G39 1rsM� s9zwt: m+»; �arrr'M c+tir�. x xar 9GAarswnucae €�saaraffcuwnrur,+wnrw W ,3, MX lot rFx, »^A�.k't �r^r. a*�ra>'c I,v, s4 .IS saw ,n' :.ra t aSa ta"a ice. a +ia • .• pL aYRAI NasM+ral�£'p PN%k, ::ce a3 ,la ;''�' a7" .' @` , gxPJAfA"E A7"rw? .NSF A - .1 +.0 ati Ill ,"n' uv.9' ia7 %gfC uT:v A ^e ffi5flE�1NMA6a'�4, E9M7AE44nM R Alm �iA N13d 1f91 5157W' 1SQ'A�59 St ` ^'V«f'M ' 361 1uf. uC tt ^4,5. A15^#SMSt SE59 �TAtM'Et wv 90 yN,r t M 45'�Xw' 9S/M'C 1a 19 at 3Ar d"A. YP WR'A$Y4 3�'N3Y - Sy # ppr:M v1EA' Wt9 �PJ SSA Gt wE, � 14r k.' 1W9;,, OAS" 111J5 T4 l tr'.Yf Sfl07 +T S71M91f9 - a rlr' y . ?' YMrkMM. 7tI VAM$Y ffiA3+SM SP9It5[ S;fr= ht?9t :J:1E z't t5 ;Air ^ ' IA 61 gq.#A k1Nk , gr a sfis* nA +r 77*s M nA9 urrati srraa us�5w Y N �. �>ET3IP#'r9WWlp}'9 n+ ,P FF Mw 1 � Y3H'kC� L.4Mk'A: �GiW4Si4 . x� >Y NO dM1'lN ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I � Owner/Buyer Mailing Address Property Address J / 8� �% /rte ,i �✓�.� ��� (Verification required from Planning & Zoning Department for new construction.) C i /fate gow V Parcel Identification Number J —OU U C ty S V, LEGAL DESCRIPTION Property Location 1 /4 , N '/4 , Sec. T' 1V IOW, Town of G�tittiQ 5�7' Subdivisi n - ��U/Ui � C�U�? .- � LOt # Certified Survey Map # , Volume , Page # Warranty Deed # e 64 ce Volume , Page # Spec house yes no Lot lines identifiable 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. L` --e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stazdar s set forth, herein. as set by u e Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Deoar—unent -,iithin 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number edro _ l0 l .�o G ATURE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &Zoning Department I de «zth this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if _, -ence is made in the warranty deed. $ 8 6 2 9 8 5 1 State Bar of Wisconsin Form 2 -2003 862985 WARRANTY DEED V KATHLEEN N H H. . W AISH Document Number Document Name REGISTER OF DEEDS ST, CROIX CO., WI RECEIVED FOR RECORD 10/25/2007 10:45AM THIS DEED, made between Darcev R. Borst and Suzzette Borst, husband and wife WARRANTY DEED EXEMPT t ("Grantor," whether one or more), REC FEE: 11.00 and Thomas Reinke a sinzie person TRANS FEE: 228.00 PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address OG interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is 3E 04 NA & O G LA ND D needed, please attach addendum): ESTRTR Lot 11, Stonewood. St. Croix County, Wisconsin 304 Locust Hudson, WI 54016 032- 2137 -10-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of- , if any. Dated 0 -7, v/ O � - (SEA (SEAL) * cc R. B (SEAL) (SEAL) * *Suzzette Borst AUTHENTICATION ACKNOWLEDGMENT Signature(s) Darcey R. Borst and Suzzette Borst husband and wife STATE OF ) authenticated on D �— ) ss. COUNTY ) *Kristina O land Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson, WI 54016 _ My Commission (is permanent) (expires: } (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infopm(brms.com I Of I • POWTS OWNER'S M4NtJ4 & MANAGEMENT PLAN Mace of FILE INFORMATION Tank Manufacturer ❑ NA Owner IDY8T8M BPECIFiCATIONS Permit # -- Ftjo Tank Ca pacity /�S�j, al ❑ NA -- l ic ' DESIQN PARAME'T'ERS ent Filter Manufacturer DNA Number of Bedrooms CI NA Offluerit F ilter Mod el �µ _ O N A Number of Public Facility Units NA ~-- ----y- - . __ PUMA Tank Capacity O 17 O NA Estimated flow (average) ( , Go - �. - ---- -- � a l /d Pump Tan Manufacturer W `C _ S e R C NA Design flow (peak!, (Estimated )t 1.5) Pump Man ufacturer O O sal /da � Gs a %X-k 0K 11 NA Soil Application Rate al /da . /ft t Plante Model O NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit O NA Fats, Oil & Grease (FOG) ' s30 mg /L CI Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (8OD 5220 mg /I. f i NA p Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L q Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cella) O NA Biochemical Oxygen Demand (BOD 330 mg /f. )n- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) s30 mg /L Q NA (Q At - Grade O Mound Fe Coliform (geom etric mean) s10" cful100ml D Drip- Line_ ❑ Other: Maximum Effluent Particle Size Ys in dia. M NA Dfher: ❑ NA -- C3 NA Qthpr, 0 NA "Jalues typical for dornestie wastewater and septic tank affluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month s! -- _ y �l ea rls) { Maximum 3 years) 0 NA Pump out contents of tanks) When corribinad sludge and scum equals one -third Iva) of tank volume T O NA Inspect dispersal cells! At least once ewer 4 month(&) -- y: _ R yearls) ( Maximum 3 yearsi� ❑ NA Clean effluent filter At least once every: 13 month(s) ❑ NA - At yearla) Inspect pump, pump controls & alarm At least grace +every; r.._, C3 month(&) 4 - d NA ❑ year(s) _ Flush laterals and pressure test T At least once every: i2 month(e) O NA ❑ year(s) _ _13-month(s) At least lance every: ❑ NA Other: year(s) --_ ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersa! cells shall be made by an i 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 cells) shall be visually inspected to cheek the effluent lovels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent or) 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 un ts, and any servicing at intervals of st 2 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. Page ___ of - START' UP ANO 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 disoor'sol catillsl, If high concentrations are detected have the contents of the tankis) removed by a septage servicing operator prior tQ adb, System start up shall not occur when soil conditions are frozen at the infitrative surface. During power outages pump tanks may fill above normal h!phwatpr levels, When power is restored the excess wastewater will ue discharged to the dispersal call in one large dos *, overlaadloo, the ceiils) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents 0 i'het purno tAlik r oyed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber dr POWTS Milistt 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, 00 riot drive or park over, or otherwise disturb or compact, the area within 16 feet down slope of any mound or at- grads! soil llobsor�? #font exalt. 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, oonooms; Cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable pelalinee; jog , tlllra9i grease; herbicides; meat scraps; medications -i; painting products; pesticides; sanitary napkins; tarnponi; and rotor aofton brine, ABANDONMENT When the POWTS fails and /or is permanently taken out of seryipe the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm $3,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the atbondoned pipe openings sealed. + The contents of all tanks and pits shall be remove d anO 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 w th soil, gravel or another inert solid material. CONTINGENCY PLAN of the POWTS fails and cannot be repaired the following inosesuros have been, or must be taken, to provide a code compliant replacement system' G A suitable replacement area has been evaluated and may i7e utilized for the location of a replacement soil absorption system. The replacement area should be proteCted from di sturpance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot 11 and wells. Failure to protect the replacement area will result in the need for a new soil and site evalul0iol to eatlabfish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 17 A suitable replacement area is not available due to sotbeck and /or soil limitations. Barring advances in POW S technology a holding lank maybe installed as a last resort ttn re .path the failed POWTS. 0 The site es not en evaluated to identify a suitable replacement area. Upon faiiure of the POWTS a soil and site N evaluation p be erformed to locate a suita4la rerihllcornaint pros. if no replacement area is available a holding tank may b tails s a test resort to replace the feiltid s'017V'T& C3 Mound and at -grade soil absorption systems relay be reconattrocted in place following removal of the biomat at the infiltrative surface. Reconstructions of such systerna Must oomplyr with the rules in effect at that time, < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAX CQNtAiN THAI. GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OT14ER TREATMENT TANK t NI R :A#�Y C I IC:t4MSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE i�1FFi6140 OR MPOStIBLlE. ADDITIONAL COMME POWTS INSTALLER P 1 TAiNER Name ` tAt�. t.�jV.'Y't,Qti A,. Name - Phone �t / ^' ,� g "' / e .� Phone SEPTAGE SERVICING OPERATOR (PUMPER) QCAI. 0. LATORY AUTHORITY Name Larne J'� • GrA� ire✓ Phone tion,p 7 /S` " `fIoSO i J Administrative Code. This document was drafted m compliance with chapter Comm >I3.32(2)Ibl0)id) *l and 83.54(1). (2) & 131, Wisconsin r SF+C SEPTIC TANK E PUMP CHArl5LA CEO$$ AND SPrCTF'ICATIC!v k" CI VENT PIPE 12" MIN. ABOVE GMDD 6 WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRAIIE WARNING LABEL 4 " Cl RISER "--' ..� MIN. 6" MAX. "` J if INLET � WATER TIGHT SEALS GAS TIGHT �•IAPPROVED A SEAL ; JOINTS WITH SPPROVED ,,�#,... � -ALM APPROVED PIPE °PPE 3' ON 3 ONTO INTO SOLID "" SOLID SOIL ' "DUMP OFF ELEV . FT. � jpA OFF' ' RISER EXIT PERMITTED ONLY IE' TANK MANUFACTURER HAS APPROVAL 3 APPROVED BE AA INP UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: 4/ TANK SIZES SEPTIC 1`x,.5 GAL. DOSE YULUME INCLUDING _ DOSE _ era GAL. F'LOWBACK: 159 GAL. ALARM MANUFACTURER: Lpmel a& M CAPACITIES: A = INCHES = GAL. MODEL NUMBER SWITCH TYPE: Ty\ 0. 8 INCHES = AL PUMP MANUFACTURER: �� L C = INCHES = Ip$ GAL. MODEL NUMBER: A d SWITCH TYPE: mA� D = INCHES = CPL• REQUIRED DISCHARGE RATE '40 GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WAG VERTICAL DIFFERENCE BETWEEN PUMP O AND DISTRIBUTION PIPE . jQ_ :BEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 2.5 FEET + FEET FORCEMAIN X SOFT /100 F'T. FRICTION FACTOR . 7. f FEET TOOL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER --'�- L:QUTA DFI TtT'•, 3 f CY�L pee 1 SIGNED: y / GG a .� ---�_, - -- LICENSE NUMBER: qq l'� DATE: _ ��aa i GOULDS PUMPS Submersible Effluent PUMP EPO4 1 387 EP05 APPLICATIONS • Fully submerged in high ar Ep05 Impeder: Thermoplas- ■ Bearings: Upper and lower grade turbine orl for tic enclosed design for heavy duty ball bearing Spedficaliy designed for the lubrication and efficient improved performance. construction. following uses: heattransfer. 0 Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY t.ISTING • Homes Available for automatic and superior strength and corrosion • Farms mar" operation. Auto- resistance. w Coadi assadatft • Heavy duty sump mark models include Motor Housing: Cast iron (CSA listed model numbers end water transfer � Not �� far efficient heat transfer, in "F" or "Co.) • Dewaterfrrg assembled and preset. at the hox and durability. y. stye. SPECIFICATIONS II Motor Cover. Themrapiastic Goulds �+'vs Is o0 9W1 iteykrend. FEATURES cower with Integral handle and • Solids handling capability: float switch attachment points. ' le maximum. ! EPO4 impeller: Th IN P ower Mile: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechaairai • Discharge size. I IW NPT. seal protection. • Mechanical seal: carbon - rotary ceramk- stationary, BUNA•N elastomers. • Tempe rature: 104°- (40°Cy continuous METERS FEET 140°F (60°C) intermittent, t o - • Fasteners. 300 series stainlesssteel. ---�— ..�....,,, _.._ _. ; .. —SGPnn ._ 9 30 Capable of running dry without damage to e r z s rr components. zs! i Motor. r _ ... ........ __..... _. . • EPO4 Single phase: 0.4 HP, 6 20 .1 . 115 oT 230 V. 60 Hz, 1550 51 RPM, built in overload with rA is autom atic. reset. q } tp05 • EP05 Single phase: 0.5 HP, Q 11 S V, 60 tiz,1550 RPM, 3 t �• _... . built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 ' standard length, 16/3 51TOW with three prong 1 grounding plug. Optional 20 0 ' ° c eo zo sG a0 se GPM foot length, 16/3 S1TW with - three prong grounding plug c - 2 a 6 (standard on EPOS), CAPACrnr Goulds mumps ITT Industries ®2000 Goulds Pumps <& Eryective february, 10x9 93971 Wisconstiri Department of Commerce' PRIVATE SEWAGE SYSTEM county: St. Croix 'Safety ana B:Jldinq Division It INSPECTION REPORT sanitary Permit No: 408211 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Borst, Darcy & Sue I Somerset Township 032 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HX FS ELEV. Septic Benchmark Dosing 00 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFOR50<ON TANK TO P/L LL BLDG. V t to Air Int a ROAD t Inlet Septic Dt of Dosing He r/Man. Aeration Di t. e Holding Bot. Sys PUMP /SIPHON INFORMATIO Final Grade Manufacturer Demand Cover GPM Model Number TDH Lift Friction Loss Syste Head TDH Ft Forcemain Length Dia. rAto Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tr es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO jP/Lj ABLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution I x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of T eeded /Sodded xx Mulched Bed[Trench Center Bed/Trench Edges Topsoil t Yes !] No L Yes ! No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1574 84th St Somerset, WI 54025 (NE 1/4 NE 1/4 13 T30N R19W) Stonewood Lot 11 Parcel No: 13.30.19.1213 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes E. No Use other side for additional information. _._ j J _ _ _ _ __ _ _ J_ 1__ i......'. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) g�th STS Sanitary Permit Application Safety & Buildings Division 201 W In accord with Comm 83.2 1, Wis. Adm. Code . Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N visconsin Personal information you provide may be used for secondary purposes (Submit co Madison, to ounty 1 7302 Department of Commerce r � pry Law, s. 1 3 SAS 5.04(l)(m)] mpleted form to county if not L 26 S state owned. Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. Co-'y State Samta y Permit Number ❑ Check if revision to previous application State Plan 1. D. Number $� . C r0 i Z -- s.._. --- I. Application Information - Please Print all Infor atio Location: Property Owner Name Property Location > /3 �e- 4 J �5L /1, l/4 T�,N, �' property n s Ow Mailing Address Lot Number Block Number � Name a&G8Wrh1 City, State Zip Code 70 jIRJ[c�nb?Pi1)er Su al t Jl. S O / 7 S VUUM � ,,pp VK - Z 097 1 -0/ S7Dxet c a( IL,TYpe of Building: (check one) as '"`` Y ° � S ' ❑ vil W 1 or 2 Family Dwelling - No. of Bedrooms :� R- own of • Public/Commercial (describe use):_ s omer5 & • State -Owned Nearest Road g (t 5 1 . 3) 3' X S1 2 f S Parcel Tax Number(s)QU - 24 - III. T e of Permit: Check only one box on line A. Check box on line B if a licable 5 6. ❑ Addition to A) (. ew 2. ❑ Replacement 3. ❑ Replacement of 4. Existing System System System Tank Only Date Issued B) Permit Number ❑ A Sanitary Permit was previously issued 1V. Type of POWT System: (Check all that apply) * &W_ A'(Ua ❑Sand Filter ❑Constructed Wetland ®fin- pressurized In- ground ❑ Mound ❑ Sin le Pass ❑ Drip Line • Pressurized In- ground ❑ Holding Tank g • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. t- ersal/Treatment Area Information .fdaq / / &6. cko nAces at EzSA r vtj = 3/. 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elev on E 7. Grade Required Proposed Rate (GalsJday /sq. ft.) (MinJinch) Elevation i l0� ?� ;2-/?. W O .s /1 A 9s.zs' ?81W =d ie 8� VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks I Tanks 5 c t� ? d i eSCr t - O' nC t 0 1 0 70 VIII. Responsibility Statement I, the undersigned assume res rs'L ; 1ty for installation of the POWTS shown on the attached lans. Business Pl:onc T:ur bar Plumbers Name (print) PI„ r' Si a nos MP�� ( ` � o/ Q / ZZS S O,i Plum -es Address (Street, City, State, Zip e) / J 70 o o/. IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps) 10 Approved ❑ Owner Given Initial Adverse Surchar Fee tS7 �Z 2tD2— Determination ' X. Conditions of pprova4 /Reason for Disap royal: -X p 6- vv�cti 1 l ll cw""� C 3 /o. s9 ,fie{' l.E. S.M. 70 of /of ■ �o; l er/cc /ua�ah A ;� 6 1aa.lion t]�n yY�. � i Proposed �bd � CAL: e(eat = /OD 1o 7.ro' 5L"e &r5 prop. t Lot it o f `SEon¢"XJbd 5 � bdvis:ol -,, Pro (vstj 1,Z6 - 0 Scp+�cA---�K• � o poscd ".Scfi• S/O Ad.G' , wQtl 1 ems' /ua,E Pipe . ■ 4r o i Si O 6 42 i B i ' Dlf f user Specif ications ` 4, � T 'cS 9 74 76" I O CEO OD OC OD O �� OC �� ' , o �o 00 00 00 00 00 00 00 o OO OD OO OD OD DD OD DD Chamber �'� DD o� oo OD fl0 a0 DO Oa Height ' �� OO OO 00 DD DO DO DO DO �� � DO OD DO OO CEO OD O� OD _ r—� OO DO DO OD OO OO DO O�� i — ��� I00 O�� O� O� CEO OD OC7 OCR t<, wit"t4tnd insalle�d wlt RJR r �` Chambe( and P9, T PA � � Height §t for 1.0 loa si End View � t Capacity : b ` iopiff , 'a designed for ,l-.1, L),:1 b �r 34" . � A minimum of ti$ "s v 'i` required for H= 201oad ' 4" Knockout Universal End Cap Available Sizes ' Length��7" .`76" 76" Width fr 34" 34" 34" Height 14" 16" Invert 6.5 9 11.3 Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. Th outlet filt 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG /L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your plumber, Jim Eichten at (715) 483 -5194, or the Polk County Zoning Department. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 5u e Mailing Address /Z z4 /72 AjAf. Property Address X (Verification required from Planning Department for new construction) City /State t Z 1 , Parcel Identification Number 0.32--2-137-1. LEGAL DESCRIPTION Property Location /1&' '/4, 1) 0 ' /a, Sec. Z 3 , T 30 N -R —W, Town of Subdivision 0" /a D,' �&ne W cOcl , Lot # Certified Survey Map # . Volume . Page # `— Warranty Deed # (- , Volume Page # Lf Spec house ❑ yes E?no' Lot lines identifiable P ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above 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 ma' . ' ed must be completed and returned to the St. Croix County Zoning Office within 30 days, /qf the three year expi Lion te. S i A O PLICANT DATE OWNER CERTIFICATION I (we) certify that all st tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e property ed abov b virtue of a warranty deed recorded in Register of Deeds Office. SIG ATURE O PPLICAN AT DATE l * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * ** ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed yn. 1,837PAGE 495 • STATE BAR OF WISCONSIN FORM 2. 1999 671314 r'.. >i i rluEErf ti. WRLSH Document Number WARRANTYDEED REGISTER OF DEEDS i . CRT1 x CO., WI This Deed, made between Hermie Enterpriess, LLC, a RECEIVED FOR RECORD Wi sconsi n Limit Liability Company, OZ 18 9:30 AM — — — -- — "— WARRANTY DEED EXEMPT A Grantor, and Darcey R Borst and Suzzette B orst, husband and wife_ CERT COPY FEE: OPY FEE: TRANSFER FEE: 155.70 __ _— — - - - -•— RECORDING FEE: 11.00 — PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot I l Plat of Stonewoo St. Croix County, Wisconsin. Name and Re Add 4V 032- 2137 -10 -000 _ Parcel Identification Number (PIN) This is not _ homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this _ 6 _ day of February 2002 Hermie En r+P iess, LLC P7 AUTHENTICATION �ACKNOW ED NT Signaturc(s) Hermie Enter riess, L LC, a Wisconsin Limited STATE OF WISCONSIN _Liability Company, by � [e- ,(,^a.Dt n - Cn tvr�s �']� ,— County ) authenticated this day of Februar 212 N — -- �- Personally came before me this day of i � r va r �/ :�G the above named s Kristine Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the on(s) who executed the foregoing (lf not, _ _ instrumiot-a1f3I a fed-ed the same. authorized by § 706.06, Wis. Stars.) /" -•� THIS INSTRUMENT WAS DRAFTED BY • 4r/� �.� Atto Kristina Ogland Notary Public, State f Wiscons ,t• Hudson, WI 54016 My Commission is permanent. ( o MAX, Or ti n d (Signatures may be authenticated or acknowledged. Both are not necessary.) � • Names of persons signing in any capacity must be typed or printed below their signature. t^f0""u 5.2021 STATE BAR OF WISCONSIN Oe `fIIsLO WARRANTY DEED FORM No. 2.1999 Wisconsin Department of Commerce S OIL AND SITE EVALUATION Division of Safety and Buildings Page __/ of Bureau of Integreted Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and J percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for seco ry Vu o� n w, s. 15.04 (1) (m)). Property Owner \ �, Property Location Govt. Lot 1/4 1 /4,S T N,R E (or&11 Property Owner's Mailing Addres Lot # Bloc Subd. Name or CSM# City State Zip honA Crr �_ City ❑ Village Town Nearest Road - S (� New Construction Use: F%A Resll nliai fe"mobe' woomS' Addition to existing building ❑ Replacement Public or dri a Code derived daily flow �_ gpd Recommended design loading rate bed, gpd /fe L Y gpdht Absorption area required Q'S bed, ft ft Maximum design loading rate bed, gpd /fe trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site oonside ations Parent material ��� Flood plain elevation, if applicable It /44 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system X] S❑ U 21 S El U 2s El I E S El U EIS M U ❑ S 19 u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ...... fl /4 125 Ground 3 elev. s y� –ft• Depth to limiting factor _ > 1 26 � in. Remarks: Boring # S/ Ll 1 -2 _5; Ground elev. 9z2ft. Depth to limiting factor 1 >A2Jn. Remarks: CST Name (Pleas rint) Signature Telephone No. Address Date CST Number ,pia a - -x 3 lgf SOIL DESCRIPTION REPORT PROPERTY OWNER 4 / Page of - PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench �. Ground _ elev. ' ft• _ I Depth to limiting factor ?,Lein. Remarks: Boring # ,- ? s 3 _ P Ground elev. r 9 Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. tied ,Trench Boring # / Alp Ground _ elev. s ft• ' Depth to limiting factor >/ Remarks: Boring # 1114- 1 is +s Ground elev. Depth to limiting fa ctor in ' Remarks: SBD -8330 (R.9/98) • :• • • • •c•i DordnantCo M ®® MM M W.A :..Dominant Co C o l or f� ' • .. ... i � I • _ -__-� -- it - PVT - - - 94 1 i -_ -- __ �� _ _ _. _ �� . i __ I -. _ ___ r _� - _ _ __ _ __.J. I ___ -- _. - - -_ I _ _ _ _ _ __ - _; lslls, Srn. Y .wnr.! f�5 ► N E W O O D r� wed "vr° m nor S.t 1 . 24' Nm �E t. NYC e. �, a mY.W— .7 1.12 p,.,d. pr /, THWEST QUARTER AND THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER, "w hat. RTH, RANGE 19 WEST, TOWN OF SOMERSET, ST. CRO(X COUNTY, WISCONSIN. o F E 3/e ► .a s cn A ovv ....... f>s�F s �y I Fsom -71-w Folm /' AWN RPE UNPLATfED LANDS -- r o.N... - 1...a„ AFww.a. i J EsN11r,1 — M01=In 213L r - -- -- - --- K" m10 WA. a..u. _ N1Y35'se E I� I NAL M10 MatF r�ilw�mY o� " \ T '�-. - •'418142• - - - -- y owlmt. N iMNr/1wu.,e MESr 11Nf of itE WE 1/4 t! TIE NM 1/4 �• 7� I AL � 411.46 AL Al, -- r- r� -r-rti• -FENCE (TYP.JJ I LOT 12 AL 146,717 SO.. FT. \ _ _ ........ . I .137 ACRES I x I I g MZM7*46'E 161,44' Q ..... 91 I< � LOT 14 T 10 la LOT 11 LOT 13 P s i' Q P 1 4 DI 4 s CRES 191.369 Sol F7. 2 S 61ACRES� 7 SO FT ACRE'S q J 6.69 ACRES I YgIMAIY F.F.E - M M' I NNYUM FFF. -4ILV I Z G4.M I s F - l I 1 \ , 1 �� g LOT 15 > M2 Sa F7. .I82 ACRES I.. 2 l/n 8 MINIMUM F.F.E- 027.!' O �, � 1�� J I 11 1 j� ✓1\I / �, � \ ,` \� p � - �' - L�� ` � �� y I 81! YftSF Ol \ \ 221.3. LOT 5 ' `�'`'��•........ '' / 132,95J SO.. F7 : � I I 27.n• 0 I `G•. t .I 05 Aa?E � I I s 1M1U11 FIX-042M - ' •• •\ - - - - - - 7 z i & LOT ..,f LOT 3 ;0 145,204 SO.. Fr. I L O T 1 `•• I M7 ,I.I1 ACRES YINWY ff.E-143r 13Q868 S0. Fr [ IIO �b U . .100 ACRES �' L O T 2 130,856 5 Fr FFii IICA C� MA4121 FFE.643 _ _ $ 300 ACRES 3� ACRES °RAIN .V.E o2z0 ML MINIMUM F.F.E-g0 WINUA F.F.L.536.0' O i< NM.E. 510.1 RAINAOE F,15ElIU/T y 2220!' 21401' 446.34' 460.10' 131.4 -V 20&25* �` 1 EAST WE OF 7NE WE 1/4 OF TIE NM 1/4 H.M.L Dcaaftm& I 108DYS11M llii f4�- - -- ; � 7e w NO NM oope I I UNPLATfED LANDS � CURVE DATA - SET VIKE AT OENTMIE OF TM *W EX1vn0 TO 9E NCRTHMY FDCE OF 15001 AW WE. (ELEVATION -84CIn A 138 �� War 5157Y24'E 50072 sM 25 E TAL 25S.S 244A6 DEL 503 17095 $2870U5'E 0177 S15 24 500'2 i37 — 25 lLT 12 2403' &111 131711 12"'14- STSp WIN SMW3rW 7'1 5 5557 47.51 5377 63595 17 182.51 177Ar 44dIWIIr 50oze3o' 52172 WRZI Z 2 N0010 128' ..25'11' 10 52570' 523. '40 2289005'E 75, S30.143 Stb' 25 520 AL 011. 6/617 OS•4/ NOV 5370 52075 5 107.25' 105.M' 1770'}1 COT 5274r565� -- I5Qw--Z;wPF 613.00' 177.49 17587 6SW43E 66394 010' 51674717 555 l0T 7 03300' 200.1.7' 26147 10 55504 N5M10'16'E 5'31 507 82200'00 S3S'01 40700' 630.67' 01627 001751 55107'04.5'E 5157005'E N6T UM SHEET 1 OF 2 SHEETS