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032-1037-40-100
7 ? : 0 % k ID � ° � Cl) ■ _0 -0 ¥ z c) P. _; 2 CD Q » E 3 3 o § 7 o w § - E « = : 2 ) o / K ; k k CA : / \ r ; $ § \ 3 ( E E 4 4 ° g § \ a 2 a #ƒ 2 R S E = = e I. 2 E a R o t 3 o & LO 2 & r CL F:P 0 i3 4 - § § m' n r CA f B Cl o 9& e / \ 0 0 0 q : $. 2 o 0 0 0 % % - 0 < C. z CD d = CA CO) (a -. $ > Or o § k \ � i' # CD CA) � 7 . 2 z , w � f � ° } \ / / f c ƒ e Oro � E & i / R_ a � F 2 CO) 0 # §9 § 2 CD CR g 9 $ 2 © m $ 7 2 W $ / � om#= -> CA) CD D / / -4 �� \ � -o�, 7 £® §,tea ®7 kf \�z % § » =r 0 CD C CL CD 3 CL CD § \ \04 % \27)) / 2 Sf ® e $ {�' °_ e�C) ¥ �\�ko \3]& \ E © ® o E E < i e CL ■ ƒ @ CD % - o � § Parcel #: 032 - 1037 -40 -100 07/31/2006 05:15 PM PAGE 1 OF 1 Alt. Parcel #: 13.31.19.185D 032 - TOWN OF SOMERSET Current X, 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 MARK BOHNEN O - BOHNEN, MARK PO BOX 323 WILLERNE MN 55090 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2149 HWY 35 SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.050 Plat: 3847 -CSM 14/3847 SEC 13 T31 N RI 9W NW SW BEING LOT 3 CSM Block/Condo Bldg: LOT 3 14/3835 CSM 14/3847 SUPERCEDES CSM 14/3835 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13-31N-19W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 10/15/2001 658995 1737/76 EZ 01/10/2001 636577 1574/84 WD 03/15/2000 619647 1495/491 QC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.050 53,200 40,700 93,900 NO Totals for 2006: General Property 4.050 53,200 40,700 93,900 Woodland 0.000 0 0 Totals for 2005: General Property 4.050 53,200 40,700 93,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Comm3rce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building division INSPECTION REPORT Sanitary Permit No: 420340 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: Bohnen, Mark W. I Somerset Township 032 - 1037 -40 -100 CST BM Elev: Insp. BM Elev: BM Description: /00- 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark to f W 1(f> Dosing J D Alt. BM rn Z .28 C(-1 g�J Aeration Bldpj Sewer /Q Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO /L YVELL LDG. Vent to Air Intake ROAD Dt Inlet O Septic d ? /tiJ / Dt Bottom Dosing Header /Man. uXX 6• Aeration DI q p S�,P -{pe 0� Lek- 3) ! 3- `� Holding Bot. Sys em 2 2 R .S Final Grade PUMP /SIPHON INFORMATION R7 �3 Manufacturer Demand St Cover M Model Number TDH Lift F n Loss System Head TDH Ft Forcem ' Length Dia. SOIL ABSORPTION SYSTEM BED /TRENCH Width t Length / No. Of �gnches PIT DI MEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f SETBACK SYSTEM TO P/L � BLD L LAKE/STREA LEACHING Manufact reir / / �✓ INFORMATION T f System: CHAMBER OR / TYQ y y / Model Number: DISTRIBUTION SYSTEM ` - Header /Manifold Distribution , ` x Hole Size x Hole Spacing V it Intake bR4 1 p Pipe(s) Length Dia Length / Dia Spacing �� �— 1 5 - SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over �Q�<� Depth Over xx Depth of xx Seeded /Sodded j xx Mulched Bed/Trench Center / Bedrrrench Edges Topsoil - �..� #! Yes ] No [ J Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /�/ Q Inspection #2: Location: 2149 Highw Somerset, WI 54025 (NW 1/4 SW 1/413 T31N R19W) NA Lot 3 Parcel No: 13.31.19.1850 1.) Alt BM Description ='� "'" d � S �t b ' - ' ✓1 /_ - fat — a� -1- t�,. 2.) Bldg sewer length = 2 - o *v S 4?j - amount of cover Cal- ut.Q.,� �.. � .�ysJ- <ii -:i•, fig. S`�+�.�C ��/�"""" �'�G�LZe�/h� -- r - Plan revision Required ?I Yes � �tiYt��./ - S Use other side for additional information. . ___ 13z = -- - Date Insepctor's Signa ure I �� Cart No. SBD -6710 (R.3/97) `��,�� 0 _ Safcty and Buildings Divistuit County —� 1 J) e 201 W. Washington Ave., P.O. l3ox 7162 jSCOnSIO Madison, Wl 53707 - 7162 Site Address artment of Commerce S,nituy ermit Number v Sanitary Permit Application in accord with Comm 83.21, Wis. Adm. Code, perso n ❑ Check if Revision may be used for seco ses Privac w sl v State Plan I.D. Number 1. Application WOrtion - Please Print All Intornsatlon ma Parcel Number O P Owner's Name ourvT� Property Location Property Owner's Mailing Address BONING OFFii;E Lt/ 54 ',f ' S N R • Lot Block N mbcr City, State Zip Cate Phone Number Su Name CSM N r I ll. Type of [3uildutg (check all that apply) ❑City I or 2 i-smily Dwelling - Number of lkdroonu .,._.__. --- ate — ❑Village owruhi � � U Public /Conunercial - Describe Use � Nearest Road ❑ State Owned M. Type of Permit: (Check oaly one box on line A (numbering scheme for interval use). Complete line B if pplicable) For County use A' ment 1 New 2 ❑ Replacement System 3 ❑ Replace of 6 ❑ Addition to S stem Tank 0nl Exis S stem Date Issued Permit Number B. ❑ Cbeck it Sanitary Permit Previously Issued -fay- ErsA -�a� d IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 5-{-d�4.d 44 - Pressurized In-Ground 210 Mound 47 ❑ Sand Filter So ❑ Constructed Wedand of 31• if 22 ❑pressurized In -0round 4l ❑ Holding Tank 48 ❑ Single Pass 51 ODrip Line 45 C3 At-Grade 46 C3 Aerobic Treatment t ❑Other - i V, Dispersal ent Area Informal ion: s e c System Elcvacion Final Grade Design Flow 4N) Dispersal Area Dispersal Area of tea on Elevadon Required Proposed kate(Gals. /Days /Sc�Ft.) (Min./lnch) / Prefab Site Steel Fiber Plastic Capacity - l Number - Manufacturer VI. Tank info P Y in total Concrete Constructed Glass Gallons Gallons of Tanks New F.xistirs= Tanks Tanks � Septic or Holding Tank S I)oftag Chamber VII. Res ibluty Statement I, the undersigned, a rrsponsiblllty for installation of the pOWTS shown on the attached plans. Plumber' ame (Fruit) Plum is S' a MPIMPRS Number Business Phone Number i I r s Address (Street, City, State, Zip Code) Count /Department Use Ocil Sanitary Permit Fee (includes Groundwater D to Issued Issu' eot Sigmtun (No Stamps) Approved 0 Disapproved SurchargcFee) -1 ❑ Owner Given Initial Adverse Detcr minatiun IX, Conditions of Ap prove l /Reasorm for DLsapprovul rrt [2� �» �3 .!� ?-/ A� JW'"C2� -rdr3 h k4 4w_ K.# b �¢ Pu4_1z- /.ut�l C� > l 0 /'1't !/Li ST �/ " 71' ,� z� u -JIV 6 coop ew taw (( the Cou ty only) for tb em per not lest 1/1 t° tdu SI3 D-6398 . 05 Ts�° %wit 1 �X -mss iZ Le 9 is / 7.1 EL. _ u_ a ' I L J r E�. /ov ' D�0 � Iv'kas's \ ue a I l Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County - Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all it orr►> C EIVED R evie _ d by Date Personal information you provide may be used for se ondary purposes (Privacy Law, s. 15 4 (1) (m)). Property Owner AUG 1 5 200 Prop rty Location Govt Lot 1/4 1/4 S T N R E (o W Property Owner's Mailing Address ST. CROIX COUNT Lot ock # Subd. Name or CSM# NING OFFICE `/ City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest oad (Z ) - 5� New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: z s� 96 ' & ��� �� c f77?�- ? n Boring # ❑ Boring ❑ Pit Ground surface elev. X,-3 ft. Depth to limiting factor /f?/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 4 / /6 ❑ Boring # ❑ Boring Pit Ground surface elev. _ � ft. Depth to limiting factor 9e in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST INApi6 (Please Pr' t) igna a CST Nu I r J Address Date valuation Conducted Telephone Number ( Z SBD -8330 (R07 /00) Property Owner ®�)n/ Parcel ID # ' /�}5� 7 —,� Page :-�Z of Boring # ❑ Boring 7 f4 Pit Ground surface elev. ft. Depth to limiting factor r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring El 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) At 9 -7 ` o i l r wisconsin Department of Commerce � SOIL AND SITE EVALUATION Division of Safely and Buildings Page ' of Bureau of Integrated Services in accordance with s. ILHR 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 ` r 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 Dale Personal information you provide may be used lot secondary purposes (Privacy Law, s. 15 04 (1) (m)). Property Owner Property Location G C. Govt. Lot Y 1/4 SM14,S ) j ,N.R / I (or , ri Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# / 3.5' Q w" �- u lr e e 7 City State Zip Zip Code Phone Numb o Ci ty r Village ® Town Nearest Road � f 46,1 W Y (/ /S ) ;f 5 71 .S v � ,= , f < f — ), //W .�S L3 New Construction use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement. // �� ❑ Public or commercial • Describe: Recommended design loading rate • �J gpd /ft� Code derived daily flow O � v gpd s a �/ bed, :+ trench, gpditlz Absorption area required _ 3 f bed, It 2 trench, if 2 Maximum design loading rate ` ' bed, gpd /tt ! . trench, gpd /n Recommended infiltration surface elevation(s) _.._J �_"� ._ It (as referred to site plan benchm0k) Additional design /site considerations Parent material _ _.____ C d D / � tl al U4 r t"" Z Flood plain elevation, if applicable n /�� S Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank U = Unsuitable for system S u S O u 2 S ❑ u C2 S u ❑ S ® u ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Monies Texture Structure Consistence Boundary Roots GPD r. in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bea T -e ^c Ground 3 z. 9� /�j /� % ✓� /1 �t sf C� ��y G o 7 . J �j elev. - -- Depth to limiting M i Remarks: Boring # V S 6k J41f� c w J , Y s 2 -37 7; O s Gs Ground 9 lev . �f t. Depth to lim � in, Remarks: CST Name (Please Print) P Signature Telephone No. m Z y7, Address p p �j w e �•� {/ J Cv Date CST Number J ` ..I " s G PROPERTY OWNE ��h C SOIL DESCRIPTION REPORT Page of T_ PARCEL 1,D.# Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Ou. Sz. Cont. Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed .r „�... /Y / 4 Sid 21i� �F/ 4f j , s Ground 3y -7S /0, ms'fC/ '5' elev. Depth to limiting factor _ Remarks: Boring # a 1 Ground elev. Depth to limiting la for ��in. Remarks: Horizon Depth Dominant Color Mottles Structure rG,it` in. Munsell Ou. Sz Cont Color Texture Gr. Sz, Sh. Consistence Boundary Roots g , Beu Boring # ' J+ S� i/� �� �ylcJF'i .S 2 = 7,� y,� z ZP7.rd4- _ a1 j rn .s o Ground 9� It. Depth to limiting fa for <_(L in, Remarks: Boring # Ground elev. Depth to limiting factor --in. Remarks: SBD•8330 (R. 07/96) OWNER Page 3 of 3 ._Name , 7� � - G - �� G , Brian Parnell Address /3S 0 wu tax e ' ri,• CST 231314 -&-k J n 4 Date — 7 Benchmark 1 P i_ pc G�ej r j' �,;, j XZ U //z� .� Benchmark 2 7V,�/�' ' ❑ Soil Boring _ Suitable Area 1" = 40' Scale o P S l T F4 ce I - --� I I i j T-� r r -- l T I I 1 4 G I j I _ II \ I I I I I i I ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERT IFICATION FORM Owner /Buyer Mailing Address oQ-3 gtkt `L A 09 Property Address (Verification required from Planning Department for new construction) City/State ,�h >,�srf �y� 5�d�s� Parcel Identification Number ?�� 12_537-,Zi L = E GAL DESCRIPTION Property Location AL ' /,, ' /,, Sec., T_N -R_/_�7 W, Town of Subdivision , Lot # Certified Survey Map # �7�,�1/ ,Volume , Page # Warranty Deed # ��fS 77 ,Volume _L �., Page Spec house 0 yes lino Lot lines identifiable kyes O no r 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 tic 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 disposaI system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. IGNATURE OF APPLICA T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tn,c to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described abov , y virtue of a warranty deed recorded in Register of Deeds Office, SIGNATURE OF APP ICANT DATE Any information that is mis- represented may result in (fie 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4ur �2 FILE INFORMATION SYSTEM SPECIFICATION Owner Septic Tank Capacity al o NA Permit # Septic Tank Manufacturer o NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms o NA Pump Tank Capacity al 9 NA Number of Commercial Unit ONA Pump Tank Manufacturer ANA Estimated flow (average) gal/day Pump Manufacturer 2f NA Design flow (p eak), Estimated x 1.5 gal/day Pump Model o NA Soil Application Rate _ gal/day/ft, Pretreated Unit Inl'lUent /l;fl1uent (Quality mol)(111y Average* to Sand /Gravel filter to feat l iltcr Buts, Oils &Grease (FOG) <30 mg /L n Mechanical Aeration LJ Wetland Biochemical Oxygen Demand (BODs) <220 mg /L o Disinfection ❑ Other: Total Suspended Solids (TSS) <150 m L Manufacturer Pretreated Effluent Quality O NA Monthly Average" Dispersal Cell(s) i'In- ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg /L ❑ At -grade O Mound Total Suspended Solids (TSS) <30 mg /L ❑ At - line o Other: Fecal Coliform (geometric mean <10 cfu /100mL Maximum Effluent Particle Size '/8 inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. / Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequenc ns ect condition of tanks At least once every o months tX ears Maximum 3 rs ump out contents of tank(s) When combined sludge and scum equals one third % of tank volume Ins ect dis ersal cells At least once every o months ears Maximum 3 rs lean effluent filter 62f�f� -? — At least once every o months earls Inspect punip, pum p controls bi. alarm At least once every u months o earls >A NA Flush laterals and pressure test At least once every o months o year(s) sa NA Other: At least once every ❑ months o year(s) NA Other: At least once every ❑ months o ears 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 ('/3) 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 ch, NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: _,,//��P� , /✓FJ✓ Pugeof� System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal 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 soft absorption are. 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. ABANDONEMENT 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 ch. 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. o 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 the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTALLOt POWTS MAINTAINER Name - Name Phone - - Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Namel Name ' Phone Phone ; o vni..1574 84 STATE BAR OF WISCONSIN FORM 2. 1999 636577 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between M & G, Inc., a Wisconsin Corporation RECEIVED FOR RECORD 01 -1] -2001 9:30 AM WARRANTY DEED Grantor, an Mark Bohnen, EXEMPT N CERT COPY FEE: — COPY FEE: TRAIWER FEE: 120.00 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in SL Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the N W '/. of SW '/4 of Section 13, Township 31 North, Range 19 Name and Return Address West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified 9 109 IM ' UOSpall Survey Map filed May 10, 2000 in Vol. 14, Page 3847, 052. No. 69£ tO Together VVIth an easement T or ingress an egress as o s wn on Certified PUSI20 $ U;x S rV Survey Map in Vol. 14, Page 3819, Doc. No. 620263. (Tn r lop E_ � I I r IZ 032 - 1037 -20 Parcel Identification Number (PM) This is not homestead property. 0f) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this I _ , day of January 2001 M & G, Inc- 4 + Michael d. Cl ermain, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) M & G, Inc., by Michael d Germain, President, STATE OF WISCONSIN ) ) ss. County ) authenticated this 5 day of January 2001 Personally came before me this _ day of the above named r Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing y0 authorized h 706.06, W is. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristine Ogland Notary Public, State of Wisconsin lludso WT 5401 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I ' Names of persons signing in any capacity must be typed or printed below their signature. Irimmstkm Prafaa ais company, Fond du tae W1 STATE BAR OF WISCONSIN 80o855 WARRANTY DEED FORM No. 2 - 1999 •s } i',J1JAl.D F. SI Lg JOH[•lSa I l 1LXD 4 6� &I , t Y E 0 2020 f Ah1�.ftY. ♦I� B j..M' l e ,w 1Md C ° ' ° ,,RTIF VEY MAP Located in part of the Northwest Quarter of t Quarter of Section 13, Township 31 ,North; Rp West, Town of Somerset, St. Croix County, Wisconsin. PHIS MAP SUPEIMMES A CM7F]ED SURVEY MAP RfLY,>MM OV WXUW 14 PAGE M75 Prepared for and at the request of:� tion Corner Monument �O OWNER: S I Michelle M. and Michael J. Germain * Set 1" x 24" Iron Pipe weighing f 1359 Awatukee Trail a minimum of 1.13 pounds per Hudson, N 54016 lineal foot. O Found 1" Iron Pipe R= Recorded as I NOTE: The parcel shown on this map Is subject to State, County and Township laws, rules and regulutlons. (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing O j ZZ any parcel, contact the St. Croix County Zoning Office and the _0 wi rril OI is appropriate Town Board for advice. <I I NOTE: WHEN LOT IS TRANSFERRED, AN �� U ai V J I EASEMENT FOR INGRESS AND EGRESS MUST ALSO BE TRANSFERRED FOR THE LOT. 1 --'ai -- 701 - -1 �� 1 EAST V4 CORNER 0! >'I 70' -- L — LOT 1 C.S.M. VOL. 14 PAGE 3819 SEC. 13 -31 -19 21 5TH — — -- - - - - — _ _ (FO(INO 2" IROW PIPE) -- -- 66' ING EXS77NC ORIVEWAY A V E_ EASEMENT ------ NBB'25'42 'E 5293.20' - - -- N88'25'42 "E 180.16' 70.19 89.97 g — — j 1 S fijZ • E N8825'42'E 5078.04' n i w �� 1 1;� I i I IL I'tl O 13 1 _ -70 ,__ o 1 n; I > £AST —WEST 114 LINE Of SECTION 13 I � �Iz Co Z in CAUTION: o a l BUILDING SET9AG`IC LINE O SETBACK COU HWY. o PROHIBIT IMPROVEMENTS — I I ni SEE PAGE 2 OF 3. I I r'31 Z N O W s l I N IlA 1 LOT g W I �� + t ABEII: W M o Ih z f j 176,453 50. F. i z 4.05 ACRES 0 / — z w I +n p 3 I I~ 11 OJT i J Z O ' 0 I a t_I 1 i 3 in OI ZEN fC i IZ N �1 W n �l v ' 10 K Y b I �aN IM Z 3 0l ~ 0U qNN w � I 4 y W JI C) UJ i n O : O W Z V M 111 2 0 I r' Q 1 I O UI W O I IIZ I C-4 I.. Q p a: Z 2 1 W W Vj IZ Z o CL �FZ of I �I �i 1Y Y Z 71 W in V) <I ' \ co " 1< < ��< NO TH 101 1 I I W 'n cZ .r ti <1i WI X : N) I mV z l l t I ~ I 9 loo o 100 3 - Z I GRAPHIC SCALE i 0 1 Z SCALE IN FEET: 1 Inch 100 feet :U Drafted by. Allen C. Sehllpp SBS'19'27 "W 262.25' JOB p98019A R =58822'41 E Prepared by. A & E 4 I LAND SURVEYING & CIVIL ENGINEERING LQT l _IVL.9_ PAGE 2525 Phone No. (715) 246 -4319 Sheet 1 of 3 109 East Third Street, P.O. Box 325 New Richmond, WI 54017 V01.14 Paqe 3847 CERTIFIED SURVEY MAP Located in part of the Northwest Quarter of the Southwest Quarter of Section 13, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. 7H /S MAP SWWME5 A GERM D SUR&EY MAP RECQ141 M AV H X M/E 14 PAGE Prepared for and at the request of: OWNER: Michelle M. and Michael J. Germain 1359 Awatukee Trail Hudson, WI 54016 D.O.T. TRANS 233: As owner I hereby restrict all lots and blocks so that no owner, possessor, user, licensee or other person may have any right of direct vehicular ingress from or egress to any highway lying within the right —of —way of S.T.H. "35 ", as shown on the land division map; it is expressly intended that this restriction constitute a restriction for the benefit of the public as provided in x.236.293, State., and shall be enforceable by the department or its assigns. No improvements or structures ore allowed between S.T.H. '35" right— of —woy line and the highway setback line. Improvements and structures include, but are not limited to, signs, parking areas, driveways, wells, septic systems, drainage facilities, buildings and retaining walls. It is expressly Intended that this restriction is for the benefit of the public as provided in section 236.293, Wisconsin Statutes, and shall be enforceable by the Wisconsin Department of Transportation or Its assigns. Contact the Wisconsin Department of Transportation for more Information. The phone number my be obtained by contacting the County Highway Department. This restriction applies to the 50' State setback only. The lots of the land division may experience noise at levels exceeding the levels In s. Trans 405.04, Table 1. These levels are based on Federal Standards. Owners of these lots are responsible for abating noise sufficient to protect these lots. No structure or Improvement of any kind is, permitted within the vision triangle. No vegetation within the vision triangle may exceed 30 Inches In height. D.O.T. AGREEMENT. "The following agreement is between Michael Germain, owner, and the Wisconsin Department of Transportation executed this 10th day of May, 2000. Property location: An existing driveway is located off State Trunk Highway number 35 that enters the land of said owner, easterly of said highway approximately on the East /West quarter line of Section 13, Township 31 North, Range 19 West, Town of Somerset, St. Croix County. Wisconsin. The Department of Transportation will hereby permit the said existing driveway to be used for two (2) lots only, which have sold Department's approval per Trans 233. Lot 1 of a Certified Survey Map recorded In the Register of Deeds Office In sold County in Volume 14, page 3819, has sold Department No. 55 -35- 3027 -2000 and Lot 3 of a Certified Survey Map recorded in Volume 14, page 3835, has said Department No. 55 - 35- 3026 -2000. If more than the above said two (2) lots or building sites are created, the said existing driveway shall be Improved to at least a type "Bt' intersection as described in the WIsDOT Facility Development Manual (FDM) at no cost to the Department. Engineering plans for a type "81' intersection have been approved by the Department on March 31, 2000.' %% C0 o rs C7 RONALD tr JOHNSON = y 6 —ilea Alkirtp Y. VVIS. y * � q 4. 1O' ♦,s NO E SU JOB 198019 Prepared by A & E LAND SURVEi1NG & CIVIL ENGINEERING Phone No, (715) 246 - -4319 109 East Third Street, P.O. Box 325 New Richmond, NA 54017 Sheet 2 of 3 Vol. 14 Pare 3847 CERTIFIED SURVEY MAP Located in port of the Northwest Quarter of the Southwest Quarter of Section 13, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. TN /S A/�IP PIUMMES A CERTFA D SURWy AUP RECORDED NV b XUW 14R PAGL� SURVEYOR'S CERTIFICATE 1, Ronald F. Johnson, a Registered Wisconsin Land Surveyor., hereby certify that by the direction of Michelle M. and Michael J. Germain, I have surveyed, divided and mapped a part of the Northwest Quarter of the Southwest Quarter of Section 13, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin described as follows: Commencing at the West Quarter Corner of said Section 13; thence, on an assumed bearing along the east /west Quarter line of said Section 13, North 88 degrees 25 minutes 42 seconds East a distance of 55.00 feet to the point of beginning of the parcel to be described, this being on the easterly right -of -way of State Trunk Highway 35; thence, continuing along last said Quarter line, North 88 degrees 25 minutes 42 seconds East a distance of 160.16 feet; thence South 84 degrees 21 minutes 38 seconds East a distance of 111.24 feet; thence South 01 degrees 34 minutes 44 seconds East a distance of 651.09 feet to the north line of Lot 1 of a Certified Survey Map recorded in Volume 9 page 2525 in the Register of Deeds Office in said County; thence, along last said north line, South 88 degrees 19 minutes 27 seconds West a distance of 262.25 feet to said easterly right -of -way; thence, along said right -of -way, North 02 degrees 17 minutes 24 seconds West a distance of 665.58 feet to the point of beginning. Containing 176,453 square feet (4.05 acres). Subject to all easements, restrictions and covenants of record. 1 also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Somerset in surveying and mapping the same /J o ald F. � �1E+7�s�1a..�.zi R , o nson Reg. No. 1186 DDa a — � A & E Land Surveying Telephone # (715) 246 -4319 P. O. Box 325 New Richmond, WI 54017 �RiYfit1Y� RONALD F. JOHNSON $ B -1 1F,9 ArotErzr. wIs. < woe 0 'e ,; o s u'a � end Sheet 3 of 3 Vol. 14 Pane 3847 / $ 0 2 . � f f/ 0 q $) S � #: e - t + + \ / @ § ' ° \ \ \ / \ § j § ID & ° ° 6 �i f > % ,: \ E $ �' \ �E� ƒ \ 2 � c � 9 0 0 0 0 _ \ < z / § ■ ■ § a > 7/ EV $ 0 _ k ; < 2 / f ® > > 0 g ' m } & / E 3 — CD k � z E E o 9 § w E§ �z : k m § F 2 $ 7 z E E 0 % $ § ± § ƒ § > ¥ c 8 [ m a z \ ° � q $ � � w a � � ■ g ° t § _ o § § � 2 , � /* , Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary7ermit2No Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: M & G Inc., Somerset Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 1037 -50 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft oss H ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2149 Highway 35, Somerset, WI 54025 (NW 1/4 SW 1/4 13 T31N R19W) - 133119185A -Lot 3 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = Plan revision required? E] Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: wm w. , �w e _ e e € S d ( € a ,. M ...,._a....._ � .�...� p . _yv. '..�.,.,..a.�,.�...... . .......�,...�...........,,..._» ...._�.�.........m..�L, .e..,.._ �..._.__— j ..A....� �.,_.»...., �.-.. ..mm..P..y._. , av ....v_ .. ..... Y � t I E _ E p f � IIIIII � L «.«..,,,.>.. ....,�..:,.,..... Mau ».. a. ................... ...«i.....�.. ; .�.,.. w. �..«� ,........1......� - a r h t — 4 N m � �. #'2 y `� y 3S Sanitary Permit Application Safety & Buildings Division 1 In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions g for co 4his application PO Box 7302 `�SCOnS1 Personal information you provide ma { e s d1 r o)1cfa�� purposes Madison, WI 53707 -730 Department of Commerce ] J ] r i Privacy Law b�ltl m) \ (Submit completed form to county if r [, . - < / state owner Attach complete plans (to the county copy only fQr litie syst n6tlessffian 8 -1/2 x I I inches in size. County ST n l State Sanita Permit Number heck if revs i ibus applicat on State Plan 1. D. Number 6 CRO l , - I. Application Information - Please Print all Information' _ Location: Property Owner Name Olh Property Location U lAic NW1/4 SiOl /4, S 3 T N, R or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Subdivision Name or CSM Number S o ( /S ) Y - s 1 L. II Type of Building: (check one) ❑ City 0 1 or 2 Family Dwelling — No. of Bedrooms: as �" r ❑ Village Public/Commercial (describe use): Town of ❑ State -owned CRS tF T - III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 57A7ZE MW lV 3,6" A) 1. ['New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Additdto Parcel Tax Numbe (s) S stem Tank Onl Existin B) Permit Number Date Issued 13.3 1. I R •I ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) . /D� 5f Non-pressurized In- ground ❑ Mound ❑ and Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade 's ❑ Aero is Treatme t U i Recirculating ❑ Other: d V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System E e . rade Required Proposed Rate (Gals. /dam /� &) (Min. /inch) p / Elevation Soo so I VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks Or ❑ ❑ ❑ ❑ saaT 14 �} /D ©C) / �E�� VII Responsibility Statement I, the undersigred, assume responsibility fcr installation of the POWTS shown on The attached plans. Plumber's Name (print) Plu s Signature (no stamps): I 1=1Na--> Business Phone Number G 7 / Plumber's Address (Street, City, State, Zip ode) S - 7- ` O VIII County/Departme t Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) (,Approved ❑ Owner Given Initial Adverse Su%hargFee) � Determination , — � �' wup�, I IX. Conditions of Approva Y for Duval:, ,�Q�� � C, L r I S �C S 6h Cam' •3� S 6Q&U O 71T't� 0 ,t l . 11pp L �p AW4 L+1n. ot> w� c c s OL-S, A- 2 ^�� ,�,,, .� .A� I SBD -6398 (R. 07/00) 3 F � L T tu of f ; " i 1 A 2W 6p xr Z A9t¢ NNN I � r y -- fit - - I I , i 1 ( , r _ r I t " r 4-4-- f i r � 1 � 1 i f � _ 1 _t Wisconsin Department of Commerce SOIL AND RTE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordan ith` s; I�Wt X399, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 ig6rfes in size,t�Rlan must County include, but not limited to: vertical and horizontal reference,9ihV(BM), direction and ✓ �. ��/ D percent slope, scale or dimensions, north arrow, and locati6n -arid distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all`, fo'rmatic4i Reviewed by Date Personal information you provide may be used for secondary purposei4privacy Property Owner j Property Location 07 _ �� c. s� �ovt..Lot,. N 1/4 S /4,s J3 T3 /N,R / 6 (or6) Property Owner's Mailing Address o # Block# Subd. Name or CSM# 411 b V t �fl City State Zip Code Phone Number El City ❑ Village © Town Nearest Road 9 � dl6�i 14a 1 .5 , � V /l (7 15' ) 5,0- S 971 New Construction Use: ® Residential/ Number of bedrooms Addition to existing building ❑ Replacement. ❑ Public or commercial - Describe: �f Code derived daily flow gpd Recommended design loading rate • / bed, gpd /fi — .0 0 trench, gpd /ft Absorption area required J bed, ft trench, ft 2 0 design loading rate : bed, gpd /f 8 t • trench, gpd /ft Recommended infiltration surface elevation(s) � , S_ ft (as referred to site plan benchmark) Additional design /site considerations /' Parent material C d AZ �` tr�� Ocet 4—c-_, 7 1 2 5 - /0 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 0S ❑ U HS ❑ U I © S ❑ U I [[ S❑ U I ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench AIA 52 -r A07 Ground elev. Depth to limiting � - fa or 6 in. Remarks: Boring # _q l o r e / �S �7//i C Jl'� • �/ mS 2 -13 / 7, S"•�P S%L 2/'�f pfi S /J� • S' , Ground 9 ft. Depth to limiting f �V in. Remarks: CST Name (Please Print) Signature Telephone No. )3rran : e :X. 7 ZyJ 3 03 Address ate CST Number 1� /y &we sow {f re�- � y - 99 23 /3 /� PROPERTY OWNER (?L C SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l2 jG� j � l S l tvsSA Awl'- Ground 37" /o% p 6 �/� /' /ff rrnsd�vr (J / i �S .r., . elev. ft /" i1' y d Depth to limiting factor 75' in. , Remarks: Boring # y 2 as�i 7,�y/l .S%L Ground elev . Depth to limiting fa for Min. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 0 4 0 , 0 /? 3 / Jill SL /M-( 6k MuFr C to Z pn ., S s 2 - IY - 7-TV `n Ground kh pi 0 / " — . � • 7 ^ lev ft. Depth to limiting factor - in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER 3 of 3 Name d' G �� C - Brian Parnell Address l .3S> 0 U a-t-a� e Ti� CST 231314 11 c f ro n GUZ. Date Benchmar ioo e G�e St�'c v c /, - � t hC k A Benc ar ❑ Soil Boring Suitable Area 1" = 40' Scale S ee L ©A w VT - r 34 fil / 1 i ce L (n e I I ` I I I � J � S i a r e AN I .. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND L.cri 3 w 3 S_'" OWNERSHIP CERTIFICATION FORM Owner/Buyer vv \`�'-^ Mailing Address j 5 `I t 1 to Property Address (Verification required from Planning Department for new construction) City /State ���( �mQYS+Z� Parcel Identification Number 07- a - )03 - - ? - 1 3.31 • I `� . I gS.� LEGAL DESCRIPTION Property Location N u3 '/4, -_ ' /4, Sec. L3 , T 3L N -R W, Town of CfX�n�tYs e,T Subdivision , Lot # 3 Certified Survey Map # & 2- 2 g , Volume t ' _ , Page # Warranty Deed # U 1 k - A a. D , Volume NQ 1 , Page # :A_ Spec house yes ❑ no Lot lines identifiable LN yes ❑ no SYSTEM Ai41NTENANCE 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, thr 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 statin g y our septic tics stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 P Y P days of he t ee year xpiration date. SIGNATURE 6�APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of the pro described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN TURF OF APPLICANT DATE * * ** ** 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 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number C(, Z Number of Bedrooms Design Flow - Peak (gpd) pp Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ftz) 25D Rl- ; t S S W2S Type of Wastewater llomestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 �- ln,���r�r► I 6 1 1 720 KATHLEEN H. WALSH DceumentNumber Document Title REGISTER OF DEEDS �± ST. CROIX CO., WI yrl. 1461 RELIVED FOR RECORD 10-06 -1999 9:30 AN WARRANTY DEED EXEMPT I CERT COPY FEE: COPY FEE: TRANSFER FEE: 585.00 RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Return A4 � D� ��rs�hCiUs fi-idkV rr►ti %5 .3oI 0 -� 103T /L9 44 03� ma 070 Parcel Identification Number (PIN) i This information must be completed by submitter: document title. name do return address, and M (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. [WL Use of this cover page adds one page to your document and 52.00 to the recording fee Wisconsin Statutes, 59.43(2m) WRDA 2199 21 (2" Form No. 3 •M— WA DEED minnes U 1044 co.ra>•atsale 1404. b Q rim • I divWual (s) to CorWatlon — - , or Partr»rsAfo VOL i f AE �� ai ' No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed ( ) not required Certificate of Real Estate Value No.— 19 County Auditor by Deput STATE DEED TAX DUE HEREON: S Date: SEPIEMIER 24TH '1992— (reserved for recording data) FOR VALUABLE CONSIDERATION, DCNM L11tiTi_n_t_F. AND MARY 1. 11_e�rtll - = SWF AS 'I13WO IN CIIMfl1 (Marital status) Grantor (a), hereby convey (s) and warrant (s) to W. INC. Grantee, a fpRP IICN under the laws of WI903M real property in ST. UPI County,Wisconsi It described as follows: NE - CF SW i AND N I CF Mk CF S t ALL IN Sg. Ui 13 -31 -19 THE SELLER CER11FUS THAT THE SEiIER DCF'S NN K" CF ANY WELLS (N THE rEgMM) WL P11YM. (if more span is needed, continue on back) together with all heredi,aments and appurtenances belonging thereto, subject to the following exceptions: Affix Deed Tax SLainp I Jere STATE OF MINNESOTA i SS. COUNTY OF AIWA The for instrument was acknowledged before me this 24111 day of _SUMMER by , (irantos (sh NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) aaN or rslesoN zwcwd wts=NOwlsneMSNs ' ANGELA L. BURKHALTER Tam ""es s j I. d t.eLsar e.t d." be ee.t� aurae aAdsesr of taa)t to NOTARY PUBUC - MMINESOTA MY Cemrtrssbn E�irtS Jm. 31.2000 M&G' 31C., :t?nv 1359 NO= TMM HUM, Iff 54016 THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRUM: DDERSUM REAL ESTATE CLCBERS, Ili. 7671 CENUtAL AVE. N.E. #104 FREM, MN. 55432 e Y' z RONALD F. g JO HN SON lee { A WIRY J�' D MA + d 5 SU a E R Y I F c�0"w VEY MAP Located in part of the Northwest Caarter of t Quarter of Section 13, Township 31 North, flange 19 West, Town of Somerset, St. Croix C ounty, Mai n. 7H /S MAP S&F&?CWES A L - R7yW WRWY MAP RECaWW !N KXWE 14 PAGE A&Z Prepared for and of the request of: LEGEN OWNER: * Section Comer Monument Michelle M. and Michael J. Germain 0 . Set 1" x 24" Iron Pipe weighing 1359 Awatukee Troll a minimum of 1.13 pounds per Hudson; N 54018 lineal foot. O Found 1" Iron Pipe R- Recorded as NOTt:: The parcel shown on this map Is subject to State, County I and Township laws, rules and regulations. (i.e. wetlands, minimum Col lot s.ze, access to parcel, etc.). Before purchasing or developing °II I I :k any parcel. contact the St. Croix County Zoning Office and the l _ I d opprrpriate Town Board for advice. l 3 j�1 \„ tA � OTE WHEN LOT IS TRANSFERRED. AN cS i o.I [F FOR INGRESS AND EGRESS nl {I _ -70 w— I MOST ALSO BE TRANSFERRED FOR THE LOT. r { J I EAST 1/4 CORNER 14 PAGE 3819 SEC. JJ —Jf -19 _ (FOUND 2" IRON PJPF) 5 66' INGRESS .tGRfSS &IS MWWAY L 4 — A V E.. EASEWENT - - -- N$8'25'4Q "E 5203,26 -- — — r r 70.1E 89.87 Sg ft��Z N88'25'42'E 5078.04' 0 ml< n j FAST —REST 1/4 LINE OF SECT JJ { ^ ar I elf � a I � CAUTION: °' I 8111LDIIdG COX STAX AND COUNTY HWY. I 2 l Sj ti I SETBACK RESTRICTIONS N PROHIBIT IMPROVEMENTS — I SEE PAGE 2 OF J. D OT 3 I� R A W Il) a 176,453 SQ. FT. f I c 01 1 4.05 ACRES 0 1 to 00 I ?r m =1I� w �� 1 cl �•!0 Q ¢ Ir � i 1 i # o' 3 It 7 Q I 1 112 ` Z O I W W r 8i - Iz ol� I �1 a a; l {y 51 1 1 1 ' c�i � i m (A NO TH 1 I< too 0 too 701 3, L GRAPHIC SCALE tir l I O 1 Z SCALE IN FEET: 1 inch +• 100 feet 1 Z 1 - =--1w• U Drafted by. Allen G Sehripp j I 586"I9'27 "W 262 25 JOB �198019A t RsSBB22 41 F Prepared by. � t 3 A & E cr1 t _• AGE 2kK LAND SU &CIVIL ENGINEERING LQT— Z — wLS — P Phone No. o, (7 (715) 5) 246 - 4319 109 East Third Street P.O. Box 326 Shoat 1 of 3 New Richmond. WI 54017 i VOI.14 Page 3847 C_._ U31 lU /O0 WtV ID:10 nia 110 JOO 4081 ur vzr.0.7 CERTIFIED SURVEY MAP Located In part of the Northwe4t Quarter of the Southwest Quarter of Section 13. Township 31 North, Range 19 West, Town of Somerset, St_ Croix County, Wisconsin. THIS MAP SUPERCEDES A CERARED SURWY MAP RECORDED IN KXWE 14 PAQE MM j SURVEYOR'S CERTIFICATE 1, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, hereby certify that by the direction of Michelle M. and Michael. J. Germain, I have surveyed, divided and mapped a pant of the Northwest Quarter of the Southwest Quarter of Section 1.3. Township 31 North, Range 1.9 West, Town of Somerset, St. Croix County, Wisconsin described as follows: Commencing at the West Quarter corner of said Section 13; thence, on an assumed bearing along the east /west Quarter line of said Section 13, North 88 degrees 25 minutes 42 seconds East a distance of 55.00 feet to the point of beginning of the parcel, to be described, this being on the easterly right -of -way of State Trunk Highway 35; thence, continuing along last said Quarter line, worth 88 degrees 25 minutes 42 seconds East a distance of 160.26 feet; thence South 84 degrees 21 minutes 38 seconds East a distance of 111.24 feet; thence South 01 degrees 34 minutes 44 seconds East a distance of 651.09 feet to the north line of Lot 1 Of a Certified Survey Map recorded in volume 9 page 2525 in the Register of 'Deeds Office in said County; thence, along last said north line, South 88 degrees 19 minutes 27 seconds West a distance of 262.25 feet to said easterly right -of -way; thence, along said right-of-way, North 02 degrees 1.7 minutes 24 seconds West a distance of 665,58 feet to the point of beginning. Containing 176,453 square feet (4.05 acres ). Subject to all easements, restrictions and covenants of record. .1 also certify that this Certified Survey Map is a, correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision ordinance of the County of St. Croix and the 'town of Somerset in surveying and mapp the � s a . Rc ial.d F.'Adhnson Reg. No. 1186 Da e ? A & E Land Surveying Telephone # (715) 246 -4319 P. O. Box 325 New Richmond, WI 54017 n 4igrc �ay�+CP3p�� ;. RONALD F. JOHNSON E a -1 1 no AN I.? Y, , W y h oo Sheet 3 of 3 Vol -14 Pape 3947 CERTIFIED SURVEY MAP Located In port of the Northweiit Quarter of :he Southwest Quarter of Section 13, Township 31 North. Range 19 West, Town of Somerset, St. Croix County, Wisconsin. =7N-TA0APSU SYMIICS A CERMED SURWy MAP RECORDED IN DUNE 14 PAGE 3835 Prepared for and at the request of OWNER: Michelle M. and Michael J. Germt•lin 1359 • Awatukee Trail Hudson, N 54015 D.O.T. TRANS 2W As owner I hereby restrict all lot> :,ne blo ks so that no owner, possessor, user, licensee or other person may hove any right of direct vehicula, ingress frarn a egress to any highway lying within the right --of -way of S.T.H. "35 ", as shown on the land division map. it is expressly intended that this restriction constitute a restriction for the benefit of the public as prov lec in s.23t- 29M State., and shall be enforceable by the department or its assigns. No improvements or structures ai 3 chi wsd bet. een S,T.M. "35" right -of -way line and the highway setback line. improvements and structures include, Lit are nc.' Annited to, signs, perking areas, driveways. wells, septic systems, drainage facilities, buildings a: d retainirt� .;oils. It is expressly intended that this restriction is for the benefit of the public as proviced R seetlon 2.5.293, Wisconsin Statutes, and shall be enforceable by the Wisconsin Department of Transportation or its assig-c. Contact the Wisconsin Department of Transportation for more information. The phone n.jmbr my be obtuned by contacting the County Highway Department. This restriction applies to the 50' State setback only, The lots of the land division may erxper,ence noise at levels exceeding the levels in s. Trans 405.04, Table 1. These levels are based on Federal ':3tanc.ards. Owners of 'hese lots are responsible for abating noise sufficient to protect these lots. No structure or improvement of on. kint is,permitted within ctie vision triangle No vegetation within the vision triangle may exceed 30 inches in he ight. D.O.T. AGREEMENT; "The following agreement is between 1 Garr,:-in, owner, and the Wt- ^ansh Department of Transportation executed this 10th day of May, 2000. Property location: An existing driveway Is located off .sate Trunk Highw y um.,er 35 that enters the land of said owner, easterly of said highway, o. on ti,° East /West qu..r,er lino of Section 13, Township 31 North, Range 19 West. Town of Somerset, St. Croix County, Wisconsin. The Deportment of Transportation will hereby permit the said e:.�sting driveway to Le -sed for two (2) lots only, which have sold Deportment's oppraval pair Trans 233. Lot 1 of c Certified Survey i op recorded in the Register of Deeds Office in said County in Volume 14, page 3819, has said 7epartmeni No. .i5- :5- 3027 -2000 and Lot 3 of a Certified Survey Map recorded in Volume 14., page 3835, has said OE iorti er: No. 55 -35- 3026 -2000. If more than the above said two (1) lots ur building sites ore created, toe said axi. tirej - iveway shall be Improved to at least a type "81" intersectinn as described ;n the WisGCT o- "acility Develor:me i`, Manua: (FOM) at no cost to the Department. Engineering plans for a type '61" intersection haws , op oved by the Deportment on March 31, 2000." Aj 1 RONALD F. JOHNSON s -tiae AN41FRY, Wis. r .. sr�s < 9 0�~ o /V o Ro 0 "0 JOB #95019 Prepared by A & E LAND SURVEYING & CIVIL ENCIN£ERING Phone No, (715) 246 - 4319 109 East Third Street, P.O. Box 325 New Richmond, W 54017 Sheet 2 of 3 W1.14 pactie 3847 i 1