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032-2117-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572826 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)I. Permit Holder's Name: City Village X Township Parcel Tax No: Dullea, Charles and Judy Somerset, Town of 032-2117-40-000 CST BM Elev: Insp.BM Elev: BM Description: /L Section/Town/Range/Map No: �! • (iJ 15.31.19.1074 TANK INFORMATION CIZ. G ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS 9 FjJ �FS ELEV. Septic Benchmark IFZ, `6 O Alt. By � 62 Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL FA ir Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. IV Olt OoMp Fn i ILA". Q�S0 57 � —� Dist. Pipe Holding SC Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover G, GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth Z. DIMENSIONS -7X Cg SETBACK SYSTEM TO U P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Z �� INFORMATION CHAMBER OR Type Of System* SQ , 1.77 UNIT Model Number: �Q LA JI.✓ r DISTRIBUTION SYSTEM . P7 Header/Manifold /I IDistribution ` x Hole Si x Hole Spacing Vent to Air Intake_ / Pipe(s) \ �`� &S Ab Length—Dia Length Dia Spacing k SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Cak-'S om%_ Depth Over Depth Over xx Depth xx Seeded/So ded xx Iched Bed/Trench Center Bed/Trench Edges Topsoil 3 es E No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 2172 59th Street o er_set,WI 54025(.NW /iNE 1/4 15 T31 R1 9W) Shadow Pines Lot 17 Parcel No: 15.31.19.1074 1.)Alt BM Description= I bJ 2.)Bldg sewer length= tf 5�) -amount of cover= 1 Plan revision Required? Yes No Use other side for additional informati l (Q Date Cert.No. SBD-6710(R.3/97) e1 County i 6 Safety and Buildings Division ST. CROIX 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) r _ r� Madison,WI 53707 7162 i vk oc� 2 '1N� 7 p� MutAl nrtary Permit AppliMion state Transaction Number In accordancer99 SPS 383.21(2), Wis. Adm. Code, submission of this form to a appr overnmental //VJ�11L unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) submitted to the Department of Safety and Professional Servies. Personal information you provide may be used q for secondary purposes in accordance with the.Privacy Law,s. 15.04(1)(m),Slats. 021 7Z / I. Application Information-Pleas rt All Information Property Owner's Name r Parcel# CHARLES & JUDY DULLEA 032-2117-40-000 Property Owner's Mailing Address Property Location Govt. Lot�2172 59TH STREET (116-74) _ City,State Zip Code Phone Number NW y4, N F,_ 1/4, Section (circle{�n e) SOMERSET , WI 54025 N/A T 31 N; R -19 EorVK II.Type of Building(check all that apply) Lot# IX 1 or 2 Family Dwelling-Number of Bedrooms 3 N/A 17 Subdivision Name ��r�r"e Block t{ SHADOW PINES El Public/Commercial-Describe Use N/A ❑ City of ❑ State Owned-Describe Use CSM Number ❑ Village of 2 6:6�- CeA6 L...)/ 7 CZ' al-L, N/A 1 Town of SOMERSET III.Type of Permit: (Check only o e box on line A. Complete line B if applicable) 0o X A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. List>?�vjoy�✓`J���� � sl� Ad ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New �j t0 Before Expiration Plumber Owner IV.T of POWTS System/Component/Device!: (Check all that apply) C EX Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V. Dispersal/Treatifient Area Information: Design Flow(gpd) Design Soil Application Rate sf) Dispersal Area Required(sf) Dispersal Area Proposed( System Elevation 450 .7 643 700 84.3 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks v C 2 a M Septic or Holding Tank 0 1,000 1,000 1 HUFFCUT X FILTER 'BASIN 50 0 50 1 ORENCO ( X VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbe ' gna a MP/MPRS Number Business Phone Number PAUL KOEHLER 225,410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 74- ✓rL3 J Z Z8 321 WISCONSIN DRIVE, NEW RICHMODN,WIT54017 VII ount Department Use Only Permit Fee Date sued Issuing ant Signature Approved ❑ D' $ q ❑ O ner en R s n for Dettial ' �fJ IX.CondriWek4&jg&sW/Reasons for Disapproval I" tank,effluier>Ftifterand' 3� ik y A r� dispersal.cell must all be services%maintained as per management plan provided by plumber. ' t � 2. ;A#iotmKk r€quirements,must be:maintairfW � as code%ordirw'wes. Attach to complete plans for the system and submit to the County only on paper not less than S l/2 x 11 inches in size SBD-6398(R. 11/11) t-LL LARL,wr-ti45/I 7E �� rior.4S (715)468-2434 sr pip H`� � -� !' a w�`.. ,� ort� Gig 4� ��►� °�� ppyy .{ r r � r II Tap 4�e. ,' , ��VI—I Ze- Q�ry o� !Y I � 4 1 i t k t CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: CHARLES & JUDY DULLEA Owner's Name: CHARLES & JUDY DULLEA Owner's Address: 2172 59TH STREET SOMERSET WI 54025 Legal Description: NW 1/4 NE 1/4 SEC 15 T 31 N R 19 W Township: SOMERSET County: ST. CROIX Subdivision Name: SHAROW PINES Lot Number: 17 Parcel ID Number: 032-2117-40-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber: PAUL KOEHLER License Number: 225410 Date: 10/23/14 Phone Number 715-246-2660 Signature —•►��./ j Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01 101). Page 1 HELL v+nE,m (715)468-2434 �nSh ' f vv IL IVr�J s.VRjVL J-rsF�,l prtr�o T � r V 1 poor �{ Na C', � X16 K ToP��� �� (--C$ Tae o QSac, j i' i ji Soil Absorption SVstem Cross Section 4" Schedule 40 CJ ft PVC Vent Pipe with Vent Cap Final Grade Geotextiie • Barrier Material T �- 36, -> �J System Elevation ft Soil Absorption System Plan View ft �W 3 ft y _ft Trench 1 f Tren 2 Vent or Observation Pipe EZFlow 1 Chambers Leaching Chamber Specifications Manufacturer and Model /yr.� EISA Rating Sp sq.ft. per chamber Soil Application Rate / gpd/sq•ft. y ' 7 Soil Application EISA= Chambers gpd Design Flow_ heation Rate-�_ 2 rows of chambers each t Model Codes for Ordering Effluent Filter Basin with Extension to Grade 18-in. External Effluent Filter Basin Lid (ordered FTB 18 24 08 12 separately) \ c�Y3S4k :vn�k � gY�1�k 3�' Titter cartridge height:12"(305 mm)standard E & TRIV diameter.8'(203 mm)standard Basin height:24'(610 mm)standard 4 Basin diameter:18"(457 mm)standard rf 41\ Riser Biotube effluent filter basin (ordered a, � y�Y �.•` Ida separately) v \\ Handle assembly (extensions h not included) Grade ring insert (included with ;r 24-inch tall HE basins) \\ dye ti. Vault Influent holes Biotube"filter cartridge Distributed By: APS-FTB-1 Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA Rev.1.6 0 11/13 800-348-9843"541-459-4449"www.orenco.com Page 2 Y i ! NMI= 718-inch External Effluent Filter Basin Applications General The 18-inch(450-mm)External Effluent Filter Basin provides an ideal External Effluent Filter Basins are composed of an 18-inch(450-mm) solution for retrofitting existing residential septic systems.External diameter section of ribbed PVC pipe with a fiberglass base,and an Filter Basins eliminate the need to make costly,and often hazardous, 8-inch(200-mm)diameter Biotube"'Effluent Filter(U.S.Patents No. modifications to existing septic tanks with restrictive access openings 4439323 and 5492635). or to unusable outlet baffles or tees. Orenco Biotube Effluent Filters are used to improve the quality of efflu- ent exiting a septic tank.The Biotube cartridge has an extendible han- dle for easy removal.The FTB1824 is designed to connect to 4-inch (100-mm)diameter schedule 40 PVC pipe,using a 4-inch(100-mm) diameter grommet on the inlet side,and a 4-inch(100-mm)diameter Schedule 40 PVC fitting that is solvent-welded to the ribbed pipe for Grade ring insert the discharge side. When connecting to 4-inch(100-mm)diameter 3034 pipe,order a Handle assembly FTB3034KIT,which contains an 0 ring for the inlet grommet,and an adapter coupling for the discharge outlet.An 18-inch(450-mm) ,a diameter grade ring insert is supplied,but the riser and a fiberglass lid should be ordered separately to bring the basin up to grade. Vault Standard Models ---.-Influent holes FTB1824-0812 Biotube filter FTB3034KIT—for connecting to 4-inch(100-mm)3034 pipe cartridge Product Code Diagram FTB 18 24 08 12 Materials of Construction: Filter cartridge height: Filter Basin: Ribbed PVC Pipe 12 = 12 inches(300-mm) Filter Basin Base: Fiberglass Reinforced Polyester Filter diameter: 08 = 8 inches(200-mm) Biotube Enclosure: PVC Biotube Cartridge: Polypropylene and Polyethylene Basin height: 24 = 24 inches(600-mm) Biotube Handle Components: Sch.40 PVC,Stainless Steel Basin diameter: Inlet Grommet: EPDM Rubber 18 = 18 inches(450-mm) Discharge Fitting: PVC Biotube�effluent filter basin Specifications Biotube Mesh Openings: Nominal 1/8-inch(3-mm)diameter, nominal 30%open area Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA•800-348-9843.541-459-4449•www.orenco.com NTD-FTB-FTB-1 Rev.1.1,®08/14 Page 1 of 1 DIVERTER AND BACKWATER VALVES Diverter Valve Here's the simplest, strongest, and most economical diverter valve ever invented for septic tank leach fields. It is made of tough molded plastic that will not shatter, bend, rust or corrode. It is lighter in weight, easier to handle and less expensive to ship. Functional The diverter valve stem flow may be controlled to individual or multiple fields (up to three) in any combination. With a three-way valve stem, flow may be diverted to any two outlets. To allow flow through all outlets,the valve stem may be removed from the assembly. Easy To Install Connect 4"plastic sewer and drain pipe to inlets and outlets on the four way distribution box. (Unwanted outlets may be sealed by installing caps). The Diverter shield which houses the diverter stem may be cut to desired length. 6i 305 I Pkg. Product I--I Part No. Descriptwn Color City. (l(Ibs.) Class PVC 575P 4"PVC Diverter Valve White 4 9.50 35PV ABS 575 4"ABS Diverter Valve Black 4 7.50 35AB CLOSED 2 3 o o\) M � TANK --),. TANK TANK 4 5 6 4.125"O.D. O TURN TO *IAPM0 Listed 0 0 � #2 OR#4 REMOVE CAP ���LJJ CAP 1" 6" TANK TANK INNER STEM TANK Gravity Backwater Valve The NDS gravity flow Backwater Valve is designed to protect low areas or basements from the backflow of waste from street sewers. It is available in 2", 3", 4"and 6"sizes PVC material. It is a cost effective and a chemically resistant alternative to cast iron valves. Backwater Valve The quick action flapper allows unrestricted uni-directional flow. Elastomeric gasket in the flapper ensures a watertight seal. Flapper can be easily removed and replaced if required. Threaded access cap is designed for hand tightening.Access cap neoprene gasket provides a positive seal. Valve hub outlets fit 2", 3", 4", or 6" DWV pipe and may be adapted to 2", 3", 4", or 6"sewer and drain pipe with NDS DWV to Sewer& Drain Adapters. Lightweight, easy to install. Horizontal installation required, with arrows on top of the valve hub pointing in the direction of the flow of water.Access riser with cover offers a simple, economical Item Number A B C Riser Height Riser Dia. assess to the valve for inspection and 27SI,Z ."" A4 AS ,0 ". maintenance. The riser may be cut to 275PR 2.18 5.03 3.53 16 4 7.56 „ . +. . ." the desired length. " 375PR,375R 3.51 7.56 6.10 16 6 475f5 4.47': 475PR,475R 4.47 11.18 7.18 16 8 675P,,'67§, A s _ is #t. i \. C 16�... 10 MEMBER M Approvals applicable to valve only. I� B � Note:All dimensions are nominal.All weights are for shipping purposes only.Availability is subject to change. For customer service, please send your fax to: 1-800-726-1998 or call 1-800-726-1994. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner CHARLES & JUDY DULLEA Septic Tank Capacity ❑ NA Permit # 1,000 qal _ Septic Tank Manufacturer CU la NA DESIGN PARAMETERS Effluent Filter Manufacturer ORENCO ❑ NA Number of Bedrooms 3 Q NA Effluent Filter Model FTB18240812 ❑ Nq Number of Public Facility Units NA Pump Tank Capacity gal !O N a. Estimated flow(average) 300 gal/day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) 450 qN/da Pump Manufacturer ® NA Soil Application Rate .7 81/day/ft2 Pump Model 0 N,q Standard Influent/Effluent Quality Monthly average* Pretreatment Unit X❑ N—A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L IXNA 1 ❑ Mechanical Aeration 11 Wetiand Total Suspended Solids (TSS) 51 SO mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) O N,k Biochemical Oxygen Demand (6OD5) S:iO mg/l %tl In-Ground Igravityl ❑ In-Ground Ipressurrzed) Total Suspended Solids (TSS) 530 mg/L NA ❑At-Grade ❑ Mound Fecal Coliform (geometric mean) 510"cfu/100ml 0 Drip-Line E3 Other: Maximum Effluent Particle Size Y in dia. 1p NA Other: 0 NA Other: . ❑ NA Other: ❑ NA *values typical for domestic wastawater and septic tank effluent. Other ❑ Nib MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 0 month(s) (Maximum 3 years) ❑ NEB Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume 3YEARSd A Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA 3 ®year(s) FInspect nt filter At least once every: 1 e 0 year(s) ❑ NE` p, pump controls & alarm At least once every: ❑month(s) ❑year(s) and pressure test At least once every: '❑month(s) X3 W.❑ year(s) Other. ❑month(s) At least once every: ❑year(s) ❑ NF, other: ❑ N.P. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cert(fleations: 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 pondtng 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 (Y) 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 11:1, 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. WjVL START UP AND OPERATION Page Z of For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemici that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contern 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 b discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge c effluent- To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoris Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t 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 are within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.ellmination of the following from the wastewater stream may improve the performance and prolong the life of th4 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; coil, 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: C A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkm system. The replacement area should be protected from disturbance and compaction and should not be infringed upon qy required setbacks from existing and proposed structure, lot fines and wells. Failure to protect the replacement area x ill 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. • 40 bee not been amivated t"slue _ m ate A a&1SM0Cg1 W ,k ❑ Mound and at-grade son 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 NC T ENTER A SEPTIC, PUMP OR OTHER TRI=ATMENT 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 INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLE Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name 21N Phone 715-2 -5738 Phone This document was drafted in compliance with chapter Comm 83.22(2)Ib)(t1(d)&(f) and 83.54(11. (21 &(3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMEN 0V 0 7 1 014 AND S7:CROIX OWNERSHIP CERTIFICATION FOFb(MUN17-y pCOUNTY Owner/Buyer 1� n6t Ju � 1�L1 l" ENT Mailing Address .VT 9b,rwm e W ) Property Address st (Verification required from Planning&Zoning Department for new construction.) City/State SD I-v%iY SLR W Parcel Identification Number LEGAL DESCRIPTION Property Location 1/4 , 1/4 , Sec. , T_2q_LN R_R W, Town of Sp rne.f $ci Subdivision Plat: S hjow P� ntrs , Lot# . Certified Survey Map # , Volume , Page# Warranty Deed# 77 5-06 (before 2007)Volume_2 �o � , Page# OF-7 Spec house❑yes❑no Lot lines identifiable❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS. 383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 'S �Lk%� I NA OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) 2 6 4 3 P 0 8 7 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX Co., MI STATE BAR OF WIS ONSIN FORM 2-2000 RECEIVED FOR RECORD Document Number WARRA TY DEED 08/24/2004 02:15PH WARRANTY DEED THIS DEED, made between Raymond A. S hbeen and Cynthia J. EXDPT # Strohbeen, husband and wife,Grantor,and Charles . Dullea and Judy K. REC FEE: 11.00 Dullea,husband and wife,as Survivorship Marital Pr perty,Grantee. TRANS FEE: 1665.00 Grantor, for a valuable consideration,conveys d warrants to Grantee COPY FEE: the following described real estate in St.Croix Court ,State of Wisconsin: CC FEE: PAGES: 1 Lot 17,Shadow Pines,Town of Somerset,St.Croix ounty,Wisconsin. I Recording Area RETURN TO: METRO LEGAL SERVICES,INC. 330 SOUTH 2ND AVENUE,SUITE 150 Exceptions to warranties: Lj MINNEAPOLIS,MN 55401-2211 Easements,restrictions and rights-of-way of record, f any. EDIRET 441408 A 390098 WD 309813 032-2117-40-000 Parcel Identification Number(PIN) This is homestead property. Dated this 5th day of August,2004. �v R mond A.Strohbeen * this J.Stro6geen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. )ss. authenticated this 5th day of August,2004 Personally came before me this August 5,2004 the above * named Raymond A. Strohbeen and Cynthia J. Strohbeen, husband and wife to me known to be the person(s) who TITLE:MEMBER STATE BAR OF WISCONSINN executed the foregoing instrument and acknowledged the same. (If not, authorized by §706.06,Wis. Stats.) (4q of 1(40 14 JJ to P i 40995�—- THIS INSTRUMENT WAS DRAFTED BY No Public, State of Wisconsin Peterson,Fram&Bergman—Steven H.Bruns My c fission is permanent. (If not,state expiration date: 50 East Fifth Street,St.Paul,MN 55101 i (Signatures may be authenticated or acknowledged. Both are n;tSTE ENotary nHouten *Names of persons signing in any capacity must be typed or printed, nature PUbIIe isconsin WARRA NTY DEED BAR OF WISCONSIN FORM N9.2-2000 \ � 2 § � Nn ) » \ k��a � � �-Z \ 'n E»26 & \ \n �2� (k ) -4). o _�e , k � kkk@ LL � L) )m � \ a. =)f[ f § � � % i t f k k B 2 2 / ) § J g U) e m ¢ N m CD S m d + � ƒ § e < . z = z § ) } $ ) . § $ § E ,e $ C k \ § k a ) # $ m m k t D a 2 f IL E ' k \ § k \ \ / fn q e o _ - CD o - § § § f a © 8 8 U) S E 2 2 ƒ k \ \ C < } ƒ ) � % § 2 2 § # f k § o @ - § C - § § § § § 2 f § ; c 2 o n a § § § \ ) 2 \ k > f / / E ® R - § § G 2 m o 2 / ) ) 2 ] 2 " � \ + = % \ 0 m ; o J a 2 0 U) u • Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363931 Permit Holder's Name: []City ❑ Village ❑ TUwn of: State Plan ID No -: Strohbeen, Ray Somerset Township CST BM Elev -: Insp. BM Elev.: BM Descr ption: Parcel Tax No.: ap , a r ( ,y� . 032- 2117 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark 3.v q�,� 1CO - Dosing Alt. BM `* �' 98• }Z Aeration Bldg. Sewer 3.q5` 01- Holding St /Ht Inlet 8 3 $g•(o3' TANK SETBACK INFORMATION St/ Ht Outlet $ 4 (4• 32 / TANKTO P/L WELL BLDG. Aierintake ROAD Dt Inlet �— Septic > tip' f ---- NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe 12•_+ Hold Bot. System -30 PUMP/ SIPHON INFORMATION Final Grade Manu rer D St cover �j�. 3Z q 2 . Model Number GPM TDH Lift Fric ' S stem TDH Ft S ad Forcem ength Dia. Di Well IL ABSORPTION SYSTEM ENCH Width Length No t renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 (o�Z.S i � I DIMEN 1 N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manuf ur SETBACK CHAMBER INFORMATION Type O ( M el Number: System: cow, , >SO OR UNIT DISTRIBUTION SYSTEM Header / anifold U• Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing �S 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 #1:01 /�� Inspection #2: Location: 2172 59th Street omerset, WI 54025 � 1/4 NE 1/4 15 T3 1N R1 9W) - 1531191074 Shadow Pines -Lot 17 1.) Alt BM Description= s ec ' J'- % 2.) Bldg sewer length = 1 1.0 1 t -amount of cover = > 8 "� ��' ,' ppn•-._, /�� � p- � 3) Sis4 -- &StAm_k��4- AAX4 - a �%N- Plan revision required? ❑ Yes No Use other side for additional information. c) 4 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. _?�: al 72- 5_1 - 5v-- Safety and Buildings Division 14sconsin SANITARY PERM Phbit ►T N 2 01 W. Washington Avenue n P O Box 7302 Department of Commerce In accord with Co $SiQl3; Wis. m. Code- =..i,. Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for ste*ova not Ids! count than 81/2 x 11 inches in size. �• i c- , r C • See reverse side for instructions for completing this pplicati jN tate Sanitary Permit Number TAX 3 Personal information you provide may be used for secondary purpose _�lT"/ < `' ❑ Check if revision o previous application [Privacy Law, s. 15.04 (1) (m)]. ` 6 pr=F1GG� ; �,I State Plan I.D. Number . I. APPLICATION INFORMATION -PLEASE PRINT A '1 � FLot I Pro y Owner Nam? e ocation •P t o f��4, S T �� N R E. w) W ropert Owner's Mailing Address ber Block N 77 b d Crt ,Sate Zip Code, Phone Number Subdivision Name o M dumber !� /a c�Y II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Neare Road ❑ Village L Public 1 or 2 Family Dwelling - No. of bedrooms own OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) y0 1 ❑ Apartment/ Condo 1 ' S ' 3 • �Q• 107y 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 ❑ Restaurant / Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. � New 2. E] Replacement 3_ Q Replacement of 4. E] Reconnection of 5_ E] Repair of an ______System ________ System _____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 E] In-Ground Pressure r 42 ❑ Pit Privy 1 Seepage Pit � Z$� 43 C] Vault Privy 14 E] System-In-Fill r^r & p f VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation - 7 t '�r;k Feet $ 7 Feet Cap VII. TANK in Ca allo s g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks 04 01 e tic Tank r Holding Tank — lvelu r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu 2 1y , is Name: (Print) � Plumb ' Si ature: (No am ) MP /MPRSW No.: Business Phone Number: Plumb 's A dresslirtreet, City, St to Zip Code): �. C . 17/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Q Owner Given Initial Approved Surcharge lee) I �s - ` Adverse Determination X. CO DIT =)F APP / RE.QS F DISAPPROVAL: ` SBD -6398 (R. 4/99) D15TRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at i 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 author ty. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Rer ewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly mai rained. the septic tank(s) m ust be pumped by a whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division,, 608-266-3151'. - Ta,be complete a accurate insanitary permit application must include: I. Property owner's name and mailing address. Provide "I`ega)`desr_ ipt orfand parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedr )oms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes tha apply. IV. Type of permit. Check only one on line A. Complete line B if permit is f :)r tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for lumbers 1 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank mat arial. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanl s received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license n imber with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only., X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches ML st be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with completed mensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainshrater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete spe( ifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump m�)del and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. KEN SCH M ITZ INC.. Septic Systems Design & Installed MPRS /CSTM 224173 P.O. Box 160 H (715) 468.2434 , C . �d��� Z � + L��,� /SRS o R� a r r A AX r � r y r � (' J o 6v /DO N9 I �m v 1 t 0 76 /11.r1� 41�w Wi sconsin Department of Commerce SOIL ANDS EVA ` TION Y Page of Division of Safety and Buildings g Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than S 1/2 x 11 inches 1rf size. Plan must �•� County 1 include, but not limited to: vertical and horizontal reference point (BM), directiQD and '\ 15,71- percent slope, scale or dimensions, north arrow, and location end distanc&toi&� � road Parcel I.D. # l� APPLICANT INFORMATION - Please print all ormat{Qn, , ;ytj _ 4iewed by Date Personal information you provide may be used for secondary purpose rPriyacy Las�.'15.04 Z)). " /Z&m Prouo Owner ,( rtv Coc��/4 j w�� ���ot 1/4,S / T 3 N,R fir) W Property wnees Mailing Address Lot # # Subd. Name or QSM# c , ;2 110M �4ary /��►,s City State Zip Code Phone Number ED City El Village ICI Town Nearest Road ,&/ re/maly lll r 1 5017 1 (7/57 V34% 'l% 749 7 M New Construction Use: IQI Residential / Number of bedrooms 3 Addition to existing building Replacement ❑ Public or commercial - Describe: c� Code derived daily flow 4 4,0 gpd Recommended design loading rate bed, gpd/ft f/ trench, gpd /ft Absorption area required s / ff bed, ft , � trenr�, ft �Ivlaximum design loading rate /7 bed, gpd /ft _T trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material �r`/1rCi.f L c�+'.1�- Flood plain elevation, if applicable �/��/y' ft S = Suitable for system Conventional �dol�nd In cro�nd Pressur Grade System in Fill Holding Tank U = Unsuitable for system � S ❑ U U �S [E] U ❑ t ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Rests Bed Trench lzo Ground L4 7 S l elev. Depth to limiting $2 p factor O B 4 Remarks: Boring # 0 7, Ground elev. Z OA $ Depth to limiting factor Z in. Remarks: CST Name (Please Print) KEN SCHMITZ INC.sign Telephone No. Septic Systems RS CST 224173 Address P.O. BOX 160 Date CST Number SHELL LAKE, WI 54871 �� (7 4658-2434 PROPERTY OWNER �(fXf' ,_ DESCRIPTION REPORT Page ?,--, PARCEL I.D.# I& 3 /a 47 "/Q Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground --- elev. lli5ft. Depth to limiting factor 12a Remarks: Boring # i.p ow K � C ` Ground a✓�t /¢/�' ��G ✓� elev. — ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # PX rc:^ Ground elev. ft. Depth to limiting , factor in. Remarks: Boring # ..............w. Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) KEN SCH M ITZ INC. f Septic Systems Design & Installed MPRS /CSTM 224173 P.O. Box 160 SH L (715) 468 -2434 ° L _ 191A oe 10Y r R� r -7 �' l � �` Z ,;4 X4 ��' z _ t2 r .7i.,</ /P /y am ZL- 4 1/,91e 0 Wisconsin Department of Commerce SOIL AND SITE EVA ATION - QjjisiorW€SafetyandBuildings Page 1 of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach paper on complete site Ian a er not less than 8 1/2 x 11 inches in size. PI t Co P P include, but not limited to: vertical and horizontal reference point (BM), dire o f , St . Croix percent slope, scale or dimensions, north arrow, and location and distanc rest '� q � \ F p 1 � d. parced.f:D. # f ILi.ID E L 'E APPLICANT INFORMATION - Please print all informati , iewed by. Date AP 21 1��' Personal information you provide may be used for secondary purposes (Privacy La 04 (1) (m) �T CROIX \ Property Owner c" ropertyQ01;ft l'S Richard Stout yt /4.jq.F 1/4 T31 N,R 19 E (orkW Property Owner's Mailing Address l' B1/�� bck #' Sut L— ame or CSM# 1353 Awatukee Trail 1 - Shadow Pines City State Zip Code Phone Number ❑ City ❑ Village 91 Town Nearest Road Hudson Wi 54016 (715)549 -6731 Somerset 160th Street [k New Construction Use: Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft Absorption area required 8 5 A bed, ft 7 5 fl trench, ft 2 Maximum design loading rate . 7 bed, gpd/ft 88 trench, gpd /ft Recommended infiltration surface elevation(s) SPP nl cat- nl An ft (as referred to site plan benchmark) Additional design /site considerations Parent material CoC2 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 I P S 1 :1 U S❑ U S❑ U I ❑ S f:1 U ❑ S F�1 U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -4 10yr2/1 -- sil 2#IA mfr cs if .5' .6 1 ; 6 2 4 -4 10yr4/3 -- sil 2rr14 mfr cs -- .5', .6 Ground 3 41- 4 1 0yr4 /6 -- ms osg ml cs -- .7: .8 elev. 95--7-9 Depth to limiting Q Z-, O factor _gain. Yaw -I Remarks: Boring # 1 0 -4 10 r2/1 -- sil 2.rAAbK mfr cs i 2 2 4-36 1 0yr4 /3 -- sil 2 ynam mfr cs -- . 5 :. 6 3 36-88 10yr4/6 -- ms osg ml cs -- .7�.8 Ground elev. 9 2 -- 40- ft. ; Depth to limiting factor _8$_ in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Richard Stout SOIL DESCRIPTION REPORT I PROPERTY OWNER — Page –2 , 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 3 1 0 -10 10yr2/1 sil 2mob/f mfr C 1f 2 10 -28 10yr4/3 sil 2 n, .A6f4 mfr CS -- .5 '.6 Ground 3 28 -91 10 r4/6 rns os elev. – – 93 Depth to °cf 4 Z ro / limiting , factor 91 in. Remarks: Boring # 1 U-10 1 0 r2 1 2,h 41 2 0-24 1 0yr4 /3 -- it 2 Y,,6le mfr cs 3 14-85 10 r4/6 -- s Ground elev. 92. tt. Depth to limiting factor -&-5— 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 # 1 -4 1 0yr2 /1 -- it 2 W"ble mf 2 _4 2 10 r4/3 Ail 2 A mfr (I 5.... 3 2 - 9 -- 10yr4/6 -- ms osg ml CS -- .7 .8 Ground elev. 95. tt. Depth to limiting factor 9 0 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r Ow 7` �. o `T t 7 ✓ �� Gf �I Q� r 1 � .L_ S a 2 ga VF r 3 �C 7- �� t f t I r p r� dornlllo 'vdi sconsin De a nt of `L SOIL AND SITE EVALUATION Division of Safety and Buildings r / Page 1 : of 3 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper riot less than 8 112 x 11 inches in size. Plan roust County include, but not limited to: vertical and horizontal reference poin direction and St. Croix percent slope, scale or dimensions, north arrow, and location < ,d, distance npst road. -. $lte� ; Parcel I.D. 8 APPLICANT INFORMATION - Please pri►af a "IMU017. reviewed by Date .il n rr Personal inlornnation you provido may be used for secondary purposo (Piryacy L: ` , ISA4 / y ' � ). J 7C` _ Property Owner calieri Richard Stout Lot 1 /4Nj 1/4,S1 5 T31 N,R 19 E(oie - - - - - -- ------ - - - - -- - — Property Owner's Mailing Address 6'1 431 ft Subd. Name or CSMff 1353 Awatukee `1'rai_1 1 7y�- Shadow Pines City State Zip Code Phone-Number ❑City ❑ Village ;® Town Nearest Road Hudson Wi 54016 (715)549 -6731 Somerset 160th Street (�{ New Construction Use: Residential / Number of bedrooms _ Addition to existing building ❑ ReplacemQnt Public or cornnrercial - Descdbc: Code derived daily flow 600 gpd Recommended design loading rate _ 7 bed, gpd /11 • 8 trench, gpd /ft Absorption area required 8 9_8 -_bed, ft` 7 5,0 ___trench, fl Maximum design loading rate . 7 bed, gpd /ft 8 trench, gpd /ft Recommended infiltration surface elevation(;) _ Sec _ p1oi__p1an_ — _ - - -_It (as referred to site plan benchmark) Additional design /site considerations Gou Parent material _— _ _ _. _ .__.... _ _ _ - -__ Flood plain elevation, if applicable _ It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tarik U = Unsuitable for system ] S (] U _ QS ❑ U S❑ U S❑ U ❑ S O U I [JS (o U _ SOIL DESCRIPTION REPORT Boring it Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPdTft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 1 0 -4 1 0 r'?/ I -- sit 2 sabk tnfr Cs I f . 5• .6 2 4 -4 10yt / 3 -- sit 2 sabk mfr Cs -- .5. .6 Ground 3 41-$4 4 1 0yr4 /6 -- ins osg ml Cs -- . T. .8 elev. - - - -- - -- - -- - _. 9s-z® Depth to - - -- - -- limiting factor -- — - 84 - -- in. Remarks: — Boring if _� _.... �_..- _--4-- -1.y�) - - . _ - - - - -- sil 2sabk m Cs if .5, .6 _ 2 2 4 -36 10yr, 3 -- sil 2sabk infr Cs -- .5 .6 3 36 -I 8 10yi-4 -- ms o m Cs -- .7 .8 Ground elev. 2 - - -- - - - Depth to - - - -- - - - -- - -- limiting — factor, in. Remarks: CST Name (Please Print) — Signature Telephone No. Address Date CST Number f , Richard Stout SOIL DESCRIPTION REPORT Page 2 of -3_ • PROPERTY OWNER -_ PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary moots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -10 10yr2 /1 _ -- sil 2sabk mfr cs if 2 10 -28 10yr4/3 -- sil 2sabk mfr Cs -- .5'.6 Ground 3 28_91 10yr4 /6 -- s os elev. -- q 3 - 8-0- Depth to -- — — limiting factor 1 in. Remarks: Boring It 1 -10 10 r2 1 4 2 10-24 10yr4 /3 - it 2sabk mfr cs - 3 Y 4 -8 1 0 r4/6 i s __ �8 Ground elev.. q 2 .8 0' ft. Depth to - -- limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /0 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ Bed , Trench Boring It 1 -4 1 0yr.2/ 1 _ — i 2sabk mfr CS If 5 ;6 2 -42 10 r4/3 -- il 2sabk 5 - -- - - - 3 4 2-90 10 6 __ ins osg ml cs -- .7 &8 Ground elev. - -- - -- - -- — -- - Q S Depth to -- -- - - -- — limiting factor 90 'n ' Remarks: Boring It • Ground ft. ' Depth, to - -- - limiting j factor in. Remarks: SBD -83$0 (R. 07/96) ,C� �7 �.z , ! /Y,'bb.+ •.✓ i,l�,�otC!•a Oa.�f le0 � el T Av fJV n�ov`l 9� .o 1 4 4 7- Vo BS Y •S IN .Bma 'Y83 • � r DoT /6� r i 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �J� C O (� D Dj Z J r Property Address _ 4 o - f z - �A — S (Verification required from Planning Department for new construction) S C, City/State om Lome- - Parcel Identification Number a 49 - LEGAL DESCRIPTION ® 3 Z.. 1 �• 3 f. � q. (��`f Property Location Sec. } . T N -R 1 W, . of �,o►•��e Subdivision ( <� (t J �� ✓1 S Lot #. Certified Survey Map # 9 Volume , Page # Warranty Deed # &�' -2 Volume ✓c-o� Page # J _ Spec house ❑ yes V1 no Lot lines identifiable I�L yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da the three year expiration date. IG ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the perty described above, y virtue of a warranty deed recorded in Register of Deeds Office. 91 GWATURE 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 i STATE BAR OF WISCONSIN FORM 2 — 1982' 6221 d WARRANTY DIED j KATHLEEN H. WALSH n � + REGISTER OF DEEDS DOCUMENT NO. 15061"M 4�1 ST. CROIX CO., WI RECEIVED FOR RECORD RICHAnn n cmnrtm , 05-01-2000 10:00 AM ii blichanA And wi VW"TT DEED E CER�T SPY FEE: ii conveys and warrants to RAyMnbln A ;I COPT FEE: CYNTHIA T TROHRWPN, hughanA and <fp L REC DDER FEE' 100.00 R IM6 FEE: 10.00 THIS SPACE RESERVED FOR RECORDING DATA 'INAME AND RETURN ADDRESS the following described real estate ¢t St County, I, �,} {\ Y State of Wisconsin: t j Lot 17, Plat of Shadow Pines, Town of i Somerset, St. Croix County, Wisconsin, — - / 032 1042 50;1042 -40 tI I� P R E DENTIFICATION NUMBER II ?��- 301042 -10 l �i I ! f i u ; ri :i I I I� ' r ' This i at n ni - homestead property E I �i (t5) (IS not) li Exception to warranties: easements, restrictions, rights -of -way and covenants I of record. Dated this 27th day of Apr il A.DXODZIlIlO. i �. (SEAL) (SEAL) - Richard O Stou (SEAL) (SEAL) i' AUTHENTICATION ACKNOWLEDGMENT I i Signature(s) State of Wisconsin, �i �j St. Croix County !I y authenticated this day of , 19_ Personally came before me this 27th day of April oXBZQQthe above named Ri a -hares Gtorrt an _IIanet _ P. Stout TITLE: MEMBER STATE BAR OF WISCONSIN (If not. NOTARY PUBLIC authorized by 9706.06, Wis. Stars.) to me known to .-TAT A �� ' © � t �� N&[7 the foregoing instrume ac1oA Wc-BAS THIS INSTRUMENT WAS DRAFTED BY Janet P.Stout wa u ee Tr. ` t• ITV 6 • #� TA X —� 4 S 1 6 Notary blic, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My mmiss'o i per�tanent. (If not, state expo te: necessary.) ( ' Names of persons signing rn any <xpwity should by typed or printed below (heir signatures. WARRANTY DEED STATE. 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