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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514895 0 GENERAL INFORMATION 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: Swanber , Donald & Loraine I Somerset, Town of 032 - 1004 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / O c> ,G Irv) I L T 02.31.19.24A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Q�3 CAPACITY STATION BS HI FS ELEV. Septic Benchmark C-> �aoo (b M I c"51 4 /6y , b � b Alt. BM 7, Z; �� to 5 A � � � � � � Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION q •S I `71 l TANK TO CCo P /L' n WELL BLDG. Vent to Air Intake ROAD EX Inlet 3o � 9 • 1 �1 5� �,� Septic t Dt Bottom 9 3 Z , 7 7 �f �. G �J $ 3 / ' X3 / Header /Man. ° f . c-P7 `J y -9 Aeration Dist. Pipe 9.e 9y•94 Holding ------- Bot. i "_ Syst m c Final Grade PUMP /SIPHON INFORMATION U Ife.•c Z -53 16 2.0% Manufacturer Demand StCgver� ` 4• �I GPM tt��CC���� 3b �0D, Model Numb TDH I Lt Friction Loss Syste TDH Ft \ Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width j Length No. Of Trench ` _ ,, PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z.. (GwGW� _� �— SETBACK SYSTEM TO /L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �n , INFORMATION Type Of System: CHAMBER OR Model Number A.) Ga+e -..1, 33 �a 1 /� 6v; Li DISTRIBUTION SYSTEM Spd411, aa +- i e- ' !4 �—/ 6 = 3 Z. Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ' \ � 3 ' d 5+�, Length -(� Dia Pipe(s) Length Dia Spacing Z J SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Z•.- P/C.-I E S th Over Depth Over xx Depth of xx Seeded /Sodded r Mulched Bed ench Center $ i5 Bed/Trench Edges \ Topsoil Yes E] No Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2356 Hwy 35 New Richmond, WI 54017 (SE 1/4 NW 1/4 2 T31 RI 9W) metes & bounds Lot Parcel No: 02.31.19.24A 1.) Alt BM Description = We.ek-5 2 -""t �� V e•'` 6�1•tr� o^. L t eeks 4" 2.) Bldg sewer length = ,_j - amount of cover = Plan revision Required? ❑ Yes o Ft� ! �C� Use other side for additional information. L__ _J a " Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) �$� �� fi b2 ����, �� � x� ►�i U �°� �� ��, � �4� r - cotrnrherce.avi.gov Safety and Buildings Division County -, 201 W. Washington Ave., P.O. Box 7162 'Wi sconsin S Madison, WI 53707 -7162 Sanitary Permit Number to be filled in by Co.) Department of Commerce 51 g Sanitary Permit Application State Transaction Nu mber / 1 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental N unit is required prior to obtaining a sanitary permit Note: Application forts for state -owned PO Project Address (if different than mailing address) ti submitted to the Department of Commerce. Personal inf m you provide geytdary �`� / L 3 aes in accordance with the Privacy Law, s. 15. 1 V I. Application Information - Please Print o ti Property Owner's Name ' eel # JUN - /1b 4� 5 - cC6 Property Owner's Mailing Ad CROIX COUNTY I n't petty Location w!,, ST. nmIN OFFICE Lot Ci , S I Zip ode p � I /., A/11) ' /,, Section (circle one IL Type of ing (check 211 that apply) Lot # 7 T �L N; R _ E org/ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of C,c�.l w I / f-/ W—nof Sotr -(-5e I IIL Type of Permit: (Check o y one box online A. Complete line B if applicable) A- ❑ New System R laccme-nt S Y eP Ystcm Q TrcatmmtlHoldmg Tack Regl.eement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Penuit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ` IV. Type of POWI'S S stem/Com onent'Device: Check all that a pply) A Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound >_ 24 in of suitable soil ❑ Mound < 24 in. of suitable soil G ",�, ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersalfrreatment Area Wormation: Design gom (gpd) esign Soil Applies i te(gpdsf) Dispersal Area Required (sfl Dispersal Area Proposed (s } System Elevation VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o v New Tanks Existing Tanks U vs w C7 Q. Septic or Holding Tank / J Ctmmber VII. Responsibility Statement I , the undersigned, assume responsi ' t for installation of the POR''TS shown on the attached plans. Plumber's are ( ' t Plnmber's goa _ MPIMPRS Number Busitxss Phone Number �I ( Plumber's Address Street City, S te, Zip Cod .5A S VIIL Cotm /De Partin t Use Only roved Permit Fee Date IS Issuing ent Signature pp Given Reasonl'or Denial - IX. Condi ' aeons f— Dittapproval 1. 5elptic tank, effitient rdter and dispersal cell must all be servk:es'/ maintained as per management plan provided by plumber. 2. AN setback fequilements must be maintained as Attach to complete plans for the system and submit to the County only an paper not less dme 8 in :11 inches `size SBD -6398 (R. 01/07) Valid thru 01/09 is EcopY r - i L I `� JUN '1 008 2008 1 Wisconsin Department of Commerce Sol �/ TI N RE TOUNTY Page /Of 3 Division of Safety and Buildings ZONING OFFICE in accordance with Comm 85, Ad - County Attach complete site plan on paper not less than 81/2 x 11 inches in size. PI ust include, but not limited to: vertical and horizontal reference point (BM), direction Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to neare ad. 0 3 2 " / '/ "Sd — 66 Please print all information. Revie by Date Q Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner Property Location )jtf Govt. Lot 1/4j/ 1/4 S I T N R Z E (or Property Owner's Mailing d Tess Lot # I Blo # Subd. Name or CSM# City Stat Zip Code Phone Number E3 City ❑ Village ® Town Neares Road ( _ 5 ❑ New Construction Use: R Residential /Number of bedrooms _ �� Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material ��, �s,Jr95t/ Flood Plain elevation if applicable ft. General comments and recommendations: ��s AR- F/-] 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 *Eif#2 7 q R - -c 7 4 i t Boring # Q 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. Cpnt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 q u — 1 4 4 3 _ 4 i" ►l i)A rl � I _j *Effluent # BOD > 30:s 220 mg/L and TS9 >30 150 mg/L * Etfl . nt 12 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Ple nt) Signature CST Number 9 f Address to Evaluation Conducted Telephone Number 2 ns+.� nnnn mnnr xm t�F f v� Y , Properly Owner /_1�c ��oa1X ,�Sroel ID# Page , of Boring # ❑ Boring - 7 JZ pit Ground surface elev. 14 'c « "" 75 2 ft. Depth to limiting factor J in. Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 Allge 9 q T Boring # F 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/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I ❑ 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS 5 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 (R07 /00) Property Owner /_�.� c �L9 ��a el ID # Page of _ Boring # ❑(�t Boring ` 1a pit Ground surface elev. - 7 ft. Depth to limiting factor 0 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 4 4 Y Y ' 4 a 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 GPDtfF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Efr#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 (8.07/00) �h Ik D 0 q. r N 7 i M � o W + s 5581 Od 70A WSO + a V 0 M o \ I co i co `` H199 m N jD 717 M C4 N W N ' N (f I � LL (^I j N ' v LU ! N I en LU Z cn N m CA Vr M r ' L o ! Jo I I 0 - c ` o E cl l� C � � ` • C •. F p a_� __ —.� J J . • j V i Is NW L Y I ` !. ~ Q F • t_3> > y ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ;�;�c,h��'G residence located at: Section 2, T�-?/_N, R __Z W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Z=�2 —(�7 5 Did flow back occur from absorption system? _ Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Pr -g ab Concret Steel Other Manufacturer: (If known) : �ri✓s Age of Tan (If known): r (Sign ure) (Nam 6) Please print (Title) (License Number) �?- eX Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection o inch ove outlet baff Nam le). Si nat i g ure ., ,� MP /MPRS POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer _ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units E5 NA Tank Capacity f a l ❑ NA Estimated flow (average) al /day P+wpfl Tank Manufacturer — ❑ NA Design flow (peak), (Estimated x 1.5) L gal /day Pump Manufacturer ❑ NA Soil Application Rate gal /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) n N.A. Biochemical Oxygen Demand (BOD 530 mg /L A In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L P�NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size % in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once eve ❑ month (Maximum (s) (Mi 3 ears) ❑ NA every: )Z ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume ❑ NA inspect dispersal cell(s) At least once eve ❑. month r(s) ) y every: 25 year (Maximum 3 ears) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA 19 year(s) Inspect, pum p ❑ month(s) PUMP, pump controls &alarm At least once every: ❑ year(s) NA r`fusl la-erals and pressure test At least once every: ❑ month(s) Ja-NA ❑ year(s) At least once every: ❑ month(s) ❑ year(s) ❑ NA OJret` ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (% or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page ____2 of I& For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: J"' A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or, soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL R POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR iPUMPER) LOCAL REGULATORY AUTHORITY Name Name r Phone Phone This document was dra` - ;�;h chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1) & (3), Wisconsin Administrative Code. STARTUP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ,that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; of Painting products; pesticides; sanitary napkins; tampons; and water softener brine. p 1� ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL FIR POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR ;PUMPER) LOCAL REGULATORY AUTHORITY Name Name a Phone Phone _ l , rhis document was drat - ;_— ;; chapter Comm 83.22(2)(b)(1) (d) &(f) and 83.5401 & (3), Wisconsin Administrative Code. I ' �C1C'1.fr•r fi; r��O_ ;3 - r�y STATE O R OF V41SCO . S!r: — FOR_ 2 35 13.2 ot rtEG15 i €RS OFFICE AN utr � ,ana RLm_a - HEI SON .hus_bAnd__a, - wife - - -- ST. �Rv"�iY. Co., WIS. - - - ° --- --- - --- -- 2ec'd_ for Retard rtui :_ I - - cre�o�l�e� to — fIX31lI'it��i�Svt ER G nd_LGI21llI� - - - - -- r - y� NIL 7' - te0AUts.------ -------------- - -- --- l sg_dmcri6adriazZ a ftle __ .5_tr:... i n735- .----- --- --- -- ----- CanetY. Part of Om Southeast quarter of the Northwest quarter (SE 1/4 of NW 1/4) of Section TWO (2) Township TRIM -OKE (31), Range HINETirM (19) described as follows: Goflmncing at the center of said See TWO (2); thence S 88 47" Best on the South line of said_ Sovdieast quarter of the Horthwost quarter tSE1/4 of Nisi. /4) 126.83 feet to the f Trunk i hw 5" and Place of "e innin - 4lr�ter7 line a State Tru H 3 a 9 9� .Y - g atY thence S 88 58' 47" _ West on Bald Soufih line 11':6.65 feet; thence North 0 14' 00`` West 400.16 feet; thence K 88 58 47= East 1118..81 feet to said Westerly line of highway; thence S 11 16' 09 East on said Westerly tine 406.61 feet to the place of beginning. IMAN9FER F r .C. ThLg ....... Ilom+astcad property. !i.9) (is not) Errrpuoo to warranties: r]at.ed this ................. day of ......... .................... � J / . ...... .. ................. ...... .. .(SEAL) .+; �•" -'-1 f J r.:� -,i-c •s1 ....(SEAL) ............ ......... .... .. ....... ...... . . . .. • Ro)?e_rt.P..... Ltels_o -- - - - - -• -- _- -• - - -- - -' - (SEAL) ..'.: .. ' ;'` ° ¢ - '--- - -- --.... (SEAL) , Puth E. Nelson • ....... .... - - - .. ......... ....... .. .......................... - -- A U T 5 0 N T I C A T 1 0 N ACKNOWLEDOMBVIT Signature% authenticated Lh:a _......... ...... ooy of -STATE OF WISCONSIN 1 . .. . . ..... .... .......... Ia - - - - - -- / ss. � - -- County. Personally came before me, this -- y :.............day of ....... -- ' - - -- ------ - . . .. ..... .... . _.... -----_-------- - -- the above named TITLE: - MEMBER STATE, BAR OF WI SCONSIN Robert. _P_34elson,.. Ruth. -E_ Nelson ------ ------- (If not. ..- _ - - -- --- ... aothorizcd b § �OIi.Ut:• Wis. Sta +s.i _ --------------- - — . ......... -- ---- -- 7!-f,5 :N5 J'.9cn! WAS DRAFT EO BY _..$..,__.. who g7C¢rlUted 11 11 to mE l;no�n to be the person i ANDERSON- FPEI - TAG� - forceoing acknowledge the same. Nevi Richmond, WI 54017 • . ........ .. .. . 4UMALD F HAHYIEWS.. / (Sirmaturc -s mZ; hn au then ticate9 nr acknowiedzcd. Both Nocarp Public How► a?utti(C......county, Cris. arc. not. necesnars.; my Comniiscien is peigtWt"t4Vgi+7&h9�Wte expiration date .. ) lily ca iliffision lEiipirts I •tia -rv. P ^r -one ni¢r.:na in eny ee PncitY .h....lrl h- ;.vPM or i.r; —A b.lna- th'ir tP4F.It:.NT7 OFT. STATE: EAR OF WISCONSIN I.cgwi M."l C.. 1— FORM No. 2 — 1977 Fl l+ca + ec. wiw. (Job 83099) 0 ? r w M e / ? / 2/ o ° S E E§ S e i§ E E § ;: 2 e , / / } Ei \ / 2 o E § \ d \ / o \ t ) e i■ k 0 7 2 @ > E E ' E � ; U) CL 0 . c CD _ {. 3 CL ® 2 2 CD CD k d \ C , . k k . w w $ ■ F w: 2 2 T V ■ �. z 0 0 0 ƒ " / R ■ ■.■ �: 2 0 f 7 J 7 \; § 2 9 1 k � . � & ■ � � � & z = z e' / o E § �! . / ( C I ] N c , Q . C a } § 6 w o c k - / k R ¥ / (D . m 2 2 z j � E S E k 2 © 5 ■ a ` G 0 % . 0) i z � � � \ 0 _ t \ D\ \ i o � # 'Parcel #: 032 - 1004 -50 -000 05/11/2006 08:42 AM PAGE 1 O 1 Alt. Parcel #: 2.31.19.24A 032 - TOWN OF SOMERSET Current EX:1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LORAINE SWANBERG O - SWANBERG, LORAINE 2356 HWY 35 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC i Legal Description: Acres: 8.640 Plat: N/A -NOT AVAILABLE SEC 2 T31 N R1 9W 8.64A IN SE NW COM CEN Block/Condo Bldg: SEC 2, TH S 88 DEG W 126.83'N 11 DEGW 207 .7' TO POB; S 88 DEG W 417'S 11 DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) E 208.7' TH W ON S LN 779.65', TH N 02 -31 N-1 9W 400.16' E 1118.81' TO W R/W HWY 35, TH S 11 DEG E 198.91' TO POB Notes: Parcel History: Date Doc # Vol /Page Type 03/22/2002 674320 1859/203 TI 351325 580/279 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.640 76,200 84,400 160,600 NO Totals for 2006: General Property 8.640 76,200 84,400 160,600 Woodland 0.000 0 0 Totals for 2005: General Property 8.640 76,200 84,400 160,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 515 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC- 104 j AS BUILT SANITARY SYSTEM REPORT w - OWNER fl C j TOWNSHIP � �c3�? 2 �^,$ �.t SEC. �` _ T,� N R W ADDRESS �fo� ,�'. J ST. CROIX COUNTY, WISCONSIN SUBDIVISION '�- LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM / INDICATE NORTH ARROW 44 3s" BENCHMARK: Describe the vertical reference point used d'v�j�r�i ► zJ CpyyZ� Elevation of vertical reference point: 0 Proposed slop at site: 2 7 SEPTIC TANK: Manufacturer: �la t Liquid Capacity: J� / Number of rings used: ,,*�,I,G Tank manhole cover elevation: 2? Tank Inlet Elevation: , Tank Outlet Elevation: ! A� , Number of feet from nearest Road: Front, Side,O Rear, O �� feet From nearest property line `Front 1 0 Side,O Rear, O feet Number of feet from: well _ E5 , building: 652� (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 PUMP CHAMBER a r Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: x Trench: Width: Z ___1 / Length: 5 Number of Lines: " Area Built:�� Fill depth to top of pipe: // Number of feet from nearest property line: Front, O Side, 0 Rear,0 Pt. �a i Number of feet from well: ! 3� Number of feet from building: / (Include distances on plot �, p � lan) . _ / SEEPAGE PIT 7 Size: Number of pits: Diameter: ' Liquid depth: Bottom of seepage pit elevation: Area-Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: fP Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 33�� 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING M AD ISON, W 1 53707 SE'''% NWT, S2,T31N —R19W PCONVEN!TIONAL ❑ALTERNATIVE State Plan l.D.Number: (lf assigned) Town of Somerset El Holding Tank El In-Ground Pressure ❑ Mound H . 35 4V77,M 01 NAME OF PERMIT HOLDER: J ADDRESS OF PER IT HOLDER: INSPECTION DATE Don Swanberg Route 2 Box 151, New Richmond, WI 54011 14,2 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No .,l Cnu My Sanitary Permit Number: Byron Bird Jr. 33181 , St. Croix 99030 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LCAPACITY: TANK INLET ELEV.: TANK OUTLEj ELE .: WARNING LABEL LOCKING COVER // /�)� PROVIDED: PROVIDED: �V DYES ❑NO DYES ❑NO BEDDING: VENT DI A.: VENT MAT HIGH WA NUMBER ROAD: PROPERTY WELL BUILDING: JVENTTOFRES H LAR ��� LINE ^ AIR INLET: DYES ONO FEET FR N N DOSIN G CHAMBER: old MANUFACTURER. BEDDING: LIQUID CAPAC Y PUMP O L. PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO I DYES ONO GALLONS PER CYCLE: PUMP AND CONT OLS OPERATIONAL. NUMBER PROPERTY WELL. BUILDING: JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ❑YE 1:1 NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth Of plowing LENGTH DIAMETER MATERIAL AND MARKING FORCE or excavation. (If soil can be rolled into a wire, construction shalllcease until MAIM the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDT LENGTH. J NO.DF DIS R. PIPE SPACING. COVER INSIDE DIA.. #PITS. LIQUID BED /TRENCH TRENCHES ' MATERIAL: P17 DEPTH: DIMENSIONS b r' •.f ! E MATERIAL: NO. DISTR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET EL V E D PIPES. LINE f AIR INLE GRAVEL DEPTH FILL DEPTH / DISTR E EL4 ' P DISTR PI FEET FROM /� 9 5 /E7� 2- NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound Systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES 1:1 NO 1:1 YES E NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPS OIL. SODDED SEEDED: MULCHED. CENTER: EDGES. 1:1 YES ❑NO OYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: EI)lTRF.NCiIi WIDTH LENGTH TRENCHES LATE AL SPACI ,G: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER j#idIOrS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.. DIA.. ELEV. PIPES. DIA.: )EIEVATI.ON A140 I 0,0OI MATION IBUTfON INFOR HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM. ❑ YES O OYES El NO NEAREST I 5 ��cZ � � d a o, Sketch System on ounty file for audit. Reverse Side. SIGNA U TITLE: ---] Zoning Administrator DILHR SBD 6710 (R. 01/82) 7D DILHR SANITAR PERMIT APPLICATION' COUNTY ' G r I � In accord ith ILHR 83.05, Wis. Adm. Code STAT ANITARYPERMIT# 9 903 —Attach corimplete plans (to the county copy only) forth system, on paper not less than STATE PLAN I.D. NUMBER 8'h x 11 inches in size. —See reverse side for instructions for completing this pplication. PETITION 1. APPLICANT INFORMATION —PLEASE PRINT ALL IN ORMATION FOR VARIANCE ❑ YES NO PROPERTY OWNER PROPERTY LOCATION C.) 4 e CF '/4 /4,S T,3 /,N,R (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCKNUMBER SUBDIVISION NAME CITY, StATE ZIP CODE 7 1 PHONE NUMBE O r7 CITY QEAFfEST ROLA, LAKE OR LANDMARK L D VILLAGE : ' r C/ 11. TYPE OF BUILDING OR USE SERVED: /W Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION (Check only one in #1. heck # 2,3 or 4, if applicable) 1. a. ❑ New b.X Replacement c. ❑ R placement of d. ❑ Reconnection of e. ❑ Repair of an System System S ptic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. P rmit ## Date Issued 3. ❑ An Existing System has been inspected and oil conditions meet minimum requirements. 4. ❑ The System is shared by more than one own r /building. Attach ComMon Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. WConventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c.❑ Pit P ivy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. R seepage Bed b. ❑ See age Tre nc i c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4 ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): P IOPOSED (Square Feet): Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in alions Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tank Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of t e private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's S' ature: ( o Stamps) MP /MPRSW No.: Business Phone Number: d6 0 t O / J- /' !— 5 l Plumber' *Address (Street, City, State, Code): Name of Designer: _ VIII. SOIL TEST INFORMATIO Certified So'I Tester (CST) Name r r CST 00� CST' A E S (StreFet, CRT State, Zip Code) Phone Number: 10 4 A IX. COUNTYIDEPARTMENT USE ONLY ❑ Disapproved Approved nitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) ® Approved ❑ Owner Given Initial ��11 Su char Fee Adverse Determination 3V'�i�v cx) X. COMMENTS /REASONS FOR DISAPPROVAL: n v� J I SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original tolCounty, One Copy To: Bureau of Plumbing, Owner, Plumber r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ° APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. 4 new permit may be n )eded if there is a change in your building plans, system location, estimated wastews3er flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to t submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary,. usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator )r the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconne:tion or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replac 3ment system areas; and the location of the building served; B) horizontal and vertic�d elevation reference Joints; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; bump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption sys em if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------ - - - - -- _ ----------------------- - - - - -- •--- - - - - -- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was ' - ie result of over 2 years of steady negotiation and public debate. The groundwater bi'i Ground Bt8. W included the creation of surcha; ges (fees) for a number of regulated practices whk '� Wisco ir;<'S 0 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water'nat buried reasur!) is used in your building is returned to the groundwater through your soil absorplic >, o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater ft : )d adminis- tered by the Department of Natural Resources. These funds are used for monitorir I ground- t water, groundwater contamination investigations and establishment of standards. ;groundwater, it's worth protecting. SBD -6398 (R.03/86) , APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 17nAlgZ0 ,S�f g ,,� �, 1 C' Location of Property k �(.J 1%, Section T J N -R W Township fp 1A C - �l'SG - 7 - Mailing Address E7- Z _F6 Address of Site S / W 6 NM aN0, �,J `�6 / Subdivision Name Lot Number Previous Amer of Property /'z O 9 N CL 5 o n/ Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number ° 1 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer - ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - PROPERTY OWNER CERTIFICATIO I (toel cmti.6y that att statements on thiA ane true to .the best o6 my (o uA ) hnowfedge; that I (we) am (cute) -the owneA(.sf the phopenty de�scAi.bed in thiA in6o"a.ti.on 6ohm, by viA -tue o6 a WaAAanty deed kecoided in the 066.tce o6 the Count yy RegiAten o6 Dee6 ws Document No. 136 5 and that i (We) p)tee en,t.Cy own •the pnoposed site bon the sewage potat d yes em (on I (we) have obtained an cgucment, to nun with the above deg c i.bed pnopent'y, 6orc the eonatnucti.on o6 said aystem, and the name h as been duty neeonded in the 066.tee o6 the County Reg.ibteh o6 Veedd, as Docment No. ), SIGNATURE OI► OWNER SIGNATURE OF CO -OWNER (IF PLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN —FORM 2 V !N! ��1/ NNWyyy WARRANTY DR= 3513�?5 ,1101 l �J a 58® PA � /9 THIS SPACE RESERVED FOR RECORDING DATA • � KEGISTERS OFFICE RQBERT._P.�._.NELSQN _ and. RUTH .E.._1�lELSO�I,__huS�and._and_ �(ife_____ ST. CROIX CO., WIS. .as._ j oi.n t. tenan_ts------------------------•-------------.-.---------------------------.---------- ---------------------------------------------------------------------------------------------------------- - - - - -- 2ec'd. for Record this t •--------------------------------------------------------------------------------------------- - - - - -- dy of t.t A. D. 19 78 conveys and warrants to - • - _DONAD_M SWANBERG and LQRAI_KE-- _- _ -_ - -.- V _ V �� 1 - SWANBERG -,..hmsbanA.�amd- wdi- f.-- .as._j aint -- tenants ,------------------ - - - - -- - -- --- --- ----- ----------------- R�yist -- RETURN TO •-----------------------------------------------•-----__--------------•---------_----------•--------------------- i the following described real estate in ......... ----- ------- --- - - - - -- County, 1 State of Wisconsin: Tax Key No- -------------------------------------- Part of the Southeast quarter of the Northwest quarter (SE 1/4 of NW 1/4) of Section TWO (2) Township THIRTY -ONE (31), Range NINETEEN (19) described as follows: Commencing at the center of said Section TWO (2); thence S 88 47 West on the South line of said Southeast quarter of the Northwest quarter (SE1 /4 of NW114) 126.83 feet to the Westerly line of State Trunk Highway "35" and Place of Beginning; thence S 88 58' 47" West on said South line 1196.65 feet; thence North 0 14' 00" West 400.16 feet; thence- N 88 0 58' 47" East 1118.81 feet to said Westerly line of highway; thence S 11 16' 09" East on said Westerly line 406.61 feet to the place of beginning. I TMiSF£R $ T3 D FEE � This - - - - -_ S__ --------- homestead property. (is) (is not) Exception to warranties: Dated this -- - - - -.-------- y �t 7 ----- _ - --__ da of -- - - - - -- .__ �ie_�4 -------------------- - - - - -- `b�� -� f - --- .. -_.. SEAL ---- - - - - -- (SEAL) -.- ( ) ` ----------------------------------------------------------- - - - - -- ` ------------------------------------------- ---- ---- ------ -- -- -- -- - --- (SEAL) : _S:I C ..- •------------ •--- - - - - -- (SEAL) Ruth E. Nelson i AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this ----- -- ----- - -- - -- day of STATE OF WISCONSIN --------------------------- - - - - -- --------- - - - - - p 18 -- - - - - -- ss. c� - - - -- - ° _ county. -------------------------------------------------------------------------------- ---- - - - - -- - -- - -- - -- - - - -- Personally came before me, this __ __ `l?%� Lday of * --------------------------------------------------`s- �s.�.- -.._.. the above named TITLE: MEMBER STATE BAR OF WISCONSIN _Robert __P_ Nelson,_. Ruth -_E___ Nelson ------------- (If not, -------------------------------------------------------------------------------- authorized by § 706.06, Wis. Stats.) - -- ----------------------------------------------------------------------------- THIS INSTRUMENT WAS DRAFTED BY to me known to be the person --- S------- who executed the � I ANDERSON- FREITAGx __INC,_____ ________________ foregoing instrument and ackn'wled the same. --------- - - - - -- New Richmond, WI 54017."?c_- -,(�� - - -z%' ----------------- ------------------ _------ r (Signatures may be authenticated or acknowledged. Both Notary Public ----- ---------- !X>P11IM ----- County, Wis. are not necessary.) My Commission is pe>I to piration date: -••••) i *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 2 — 1977 Milwaukee, Wis. (Job 33099) H z H a ST C- 105 r a . H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER /BUYER AAfAZ/� J'%l�/✓13F'�'G ROUTE /BOX NUMBER 2 / 5 / Fire Number CITY /STATE �JEtJ /��/t'len/17 AJ/� ZIP JOi7 PROPERTY LOCATION: Sr ) 4, h1 kl _ 1 4, Section T 3 / N, R W, Town of _501- 'a tS , St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o E I /WE, the undersigned, have read the above requirements and agree W to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. p SIGNED Ol DATE 5 �7 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715 - 796 -2239 or 715 -425 -8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS ( P.O. BOX 7969 HUMAN RELNTIONS \ / MADISON, WI 53707 • (H63.09(1) & Chapter 145.045) LOCAT�C N: SECTION: TOWNSHIP UNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: 5 '/ a /TJ N /R/ (o •S0m elsC --__ 22 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: / _ 14 ZZ2 cro tc /` CcJ C 7 n o �`S S� S T USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESC 9TION: PROFILEDESCRIPTIONS: ER OLATION TESTS: Residence �.—� -- El New Replace 43 ._ y „Q/7 �- L - 1 I- RATING: S= Site suitable for system U= Site unsuitable for system / D r ONVENTIONAL: M O U ND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: optional) ❑U ImS ❑U S ❑U []S ®U []S U 6h If Percolation Tests are NOT required DESIGN R T : If any portion of the tested area is in the under s.H63.09(5)(b), indicate: V � �Floodplain, indicate Floodplain elevation: / / y . PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- - � d- 3 d^ 4 /5 3-� 49h owl- c /o o j " B- .3 D/� /ya Imo a 6 cep /5 JL2 B- B- B- f- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER fi AFTEF3SWELLING INTERVAL -MIN. PERIOD D 1 PERIOP 2 PERLOD 3 PER PER INCH P_ 3. ;Z 4 L P- 0 L P- WA e to G P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION y 5� t � f f , 1 jl E 3 i ' C e , o _ , , t y 1 E , E ____ a�� b I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wis nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: is 4— lr7 ADDRES CERTIFICATION NUMBER: PHONE NUMBER (optional): Q !! O ©d.3y /.5 -29 '_7 CST SIGNATUR w DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD 6395 Tobna complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is residence nr*ommorcia| project; 3. MAXIMUM number uf bedrooms nr commercial use planned; 4. Is this o new or- ,,p|acement,vmem; 5. Complete the SUitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF Al-L OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; G� PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot p{en; 7, MAKE /\ LEGIBLE diagram accurately locating Your test |acohpno. D,avvingto scale is preferred. A separate sheet maybm used ifdesired; 8� Make sure your benchmark and vertical n|,vadv^ reference point are clearly shown, and are v°,manr'«; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain dmm percolation test exemp- tion, if appropriate; 10. V the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12� Nbkv legible copies and distribute as n,vuired. ALL G0|L TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stolle (overr l[r> BR — Bedrock *ob — Cobble (3 lO^) 5S — Sandstone � Ur — Gravel (under 3") LS — Limestone °o — Sand HGVV — High Gmumdvitete/ cs — Coarse Sand Pm,c — P*mn|ationRo*: � maJo — Mediomsand VV — Well b — Fine Sand Bldg — Building � b — LonmySand > — Greater Than °s| — Sandy Loam ( — Less Than � °/ Loam 8n Brown � _ _ ~ni< — Silt Loan 8| — Black � u — mx Gy — Gray � °cl — Clay Loom y — Yellow vJ — SomlyOay Loam R — Rod sid — Silty Clay Loam mc* — Mou}nu se — Sandy Clay m/ — with sic — Silty Clay fff — few, tine fa�ntl °o — Clay co — ownmon.co�rm pt — Peat mm — K8wny mmdium m — Muck d — distinct ` p — prominent HVVL — High wowr|w�! ° Sixyonera| mil texture's surface��, for liquid wmuxdisposal BM — Bench Mark VBP — Vertical Ro,uronoe Point TO THE OWNER: This soil teu report is the fit st step inoecurinOasani��,ypermic The oountvur the Q*pmumcntmayrcquen verification of this sod test in the finN prior to pnrmil ioouance. A momu|e�e not of plans for the p,iv*/e s�iwaye system and a permit application must be submitted to the app/opriate local authority in prdtr u, obmina pn,mit. The sonitary pomnn muu be ub«ain:d and po pt iorto rhn -;tart ofmny construction PLOT PLAN PROJECT 49 art a ADDRESS �� ►/ 6th 11418 . /T�� N/R , W TOWN ,YCOUNTY 61 G MFRS' Byron Bird Jr. 3318 DATE 5- 7 �7 BEDROOM CLASS PERC CONVENTIONAL�(IN- GROUND PRESSURE CONVENTIONAL LIFT MOUND _ HO ING TANK SEPTIC TANK SIZE ©� LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE � ABSORPTION AREA 6 PERC RATE BED SIZE 1116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark - 7'v - ,/ ^0 �: * H.R.P. DG air I:3 Borehole Q Well Scale = Feet 0 Perc Hole System Elevation TYPAR COVERING_ t 2" 12' 3' 0 6 3 6' Sewer Rock 12' �r a 4. . j or d J oZn r �JO� �a � 'E � '8 '� V 'E ��� 'a c