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Home My WebLink About032-2117-60-000 o o o CD m o' B to it cn o < o � o o? 3 j N A\ a O N N U ( f C " A cn N N d o C) O 0 N � d n N I O � O � tD C �1 O p 7 C O O v t, v D � a O A N t 4 _ v CQ CD p (D OZ A 0) O ! O to i cn Z O CAD O O N y 0 C CA 3 .. a c m M CL z 000 A_ O _ o 0 00 N CO) N p =r N O + 7 cr W m I� 0. CD z - _ N a d N Q N z _ o z z I D T o 00-. 'O N N y. T1 0 CD "Me 0 CD CL CD 0 n 3 3 � a d N N n 3 N J C 0) -0 = n O A Z n p O N C r -" n �_ O A Z O O 0 3 N p D_ � O N N C4 z W W M w cn (7 m CD Z = 0 a 3 A z w m m m 3 m A n . y Z W f A li I OO n n r N o ? v c CD v Z a li 0 ti CD z O N o a 3 0 a = 4 N CD CD a H C O a N N O O V I A 0 A m raav m O N F O O C CD O �- I � . � / A WS4, � ■ 2 � E � � «■ ;— z o w r @ 0 2 n ,= o w, o a �- �7 i�E §k §�_� @ ` § a � \ � #E w { }( [ �j% E a § o _ Vic§ CL (D / § £ % $ 0 } RD 4 z # k U CL 0 / m \ \ ) n r (A � f �- � 2 Cn z 0 0 o — Or o q } 0 § ) § ■ § 2 / . E ; m ° ° 2 ■ ' B / 3 J - E , 7 ■ 5 EJo k ( N I R / 0§ ƒ °�<. %_, af§E� °° o $0 �k /�gD'3 CL m gal S. k k/ k 3 �_ k � _ § � � �k CL ��9 0 �E z -� § % CL \ CA) a o4 o f # 0) CD o r z $ #R 2z M� M # f ® � ®0 BCD § a CZ % % 0z 8{A z kS ° §% � .§ 9 \ C k _ q � } � cz CD E % 0 _< § � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: • 370294 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: Langer, Greg Somerset Township 032- 2117 -60 -000 CST BM Elev: Insp. BM Elev: I BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. , Septic Z 4P0 r. Benchmark 3, r a l Dosing Alt. BM , 0 Aeration Bldg. Sewer if Holding St/Ht Inlet C ` 1 0 ,lp0 TANK SETBACK INFORMATION SUHt Outlet • l� R6. 3 / TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' S� r f Dt Bottom Dosing Heade Man. _ �- r Aeration Dist. Pipe Holding Bot. System C 1 I PUMP /SIPHON INFORMATION Final Grade �•�� Man turer Demand St Cover GPM Mode umber TDH Lif Friction Loss System Head TDH Ft F cemain Length l . SOIL AB ORPTION SYSTEM s o« RENCH Width Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM (2 SETBACK SYSTEM TO t BLDG IWELL LAKE /STREAM LEACHING Manuf��[urer INFORMATION CHAMBER OR .n # Type Of System: I UNIT M I Number: DISTRIBUTION SYSTEM Header /Manifold K Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ' Length Dia Length pacing )' -' 5 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 FBI Yes [W No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: L // Insp tion � T ) Location: 2180 59th Street Somerset, Wl 55,4�0225�(NW 1/4 NE 1/4 t T31_N �R19VV) Shadow Lot L r e 19.1076 1.) Alt BM Description = 6� ` r / Dom / JET P' `"' C 3 tti*h 2.) Bldg sewer length = t"1 - amount of cover =_" ^+ V i-a be� A-(at 01, S - r- Plan revision Required? ❑ No U e other side f ar a ditiona infor t' n. _ Vp �S: T7edL � /rTl�l .Date Insepctor's Signat f No. mgr OR++� CdIQd�[ o c - s:rr du P(PQ°"�C�tk-6,..`6F -) s5(��• Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 AIN. - 7162 Srte Address Madison, WI 53707 � 11 *&a�nsin t Department of Commerce � � , ti � Sanitary Permit Numbe J r Sani Permit Apphi ' ' ''� �-o In accord with Comm 83.21, Wis. Adm. Code, perso tQ9tmadon you jovide \. \ 3 `9Check if Revision may be used for s econdary purposes Privacy *v ,45. I. Application Information - Please Print All Informati State Plan I.D. N - Property Owner's Name _ . 7 ooj _ Parcel Number 15. 3 I ., ST C.AOIX � Property Owner's Mailing Address 1;:.,` ZONNVG % Property Location AW 14 A6j i4: S T N, R� City, State Zip Code .1 Lot Number Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) ❑City �U or 2 Family Dwelling - Number of Bedrooms ' ❑village ❑ PubliclCommercial - Describe Use ownship ❑ State Owned Nearest Road i III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 *New 2 11 Replacement System 3 ❑ Replacement of 6 ❑ Addition to system Tank Onl Eris ' sum Permit Number Date Issued B. ❑ Check if Sanitary Permit Previously Issued _ IV. Type of Permit: (Check all that apply)(ntlmbering scheme is for internal use) 44 PkNon - Pressurized In- Ground 2111 Mound 47 ❑Sand Filter 50 ❑Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe rsal/1Yeatment Area Information: stem Elevation Final Grade Desr' gn Flow (gPd) Dispersal ' Area Dispersal Area Soil Application Percolation lation Sy Elevation Required Proposed Rate(Gals./Days/Sq.FtJ (Min./Inch) - Irlo --�? .4 X/ /v VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ®D r+ Dosing Chamber VII. Responsibility Statement - I, the undersigned, asstmm ponsibility for installation of the POWTS shown on the attached plans. Plumber's ante Plumber's S' MP/MPRS Number Business Phone Number Phmiber's Address (Street, City, State, ip Code) VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issu' Agent Signature (No Stamps) X Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse CID Determination CI r,�?tz ( K I a A d IX. Conditions of A roval/Reasons for Disapproval , PP `S t' y 4 L "� Attach complete plans (to e C ' for thestem Ixr no ess han E� x 11 Inches to size dAo,lka 4.0 - SBD- 6398 (R. 05101) r , G K 'Jew X X75 � 7 )v - 1L 4�I T � S CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e Mailing Address Property Address z:�af,'r'3 (Verification required from Planning Department for new construction) City /State y de -l_)S /�,f Parcel Identification Number �j� —�- c ry LE GAL DESCRIPTION Property Location jt _ '/4, A, L_ '/4, Sec. ,-< T ,?L -R_Z.2_W, Town of Subdivision r' ,,( , Lot # � . Certified Survey Map # , Volume , Page # Warranty Deed # , Volume �� Page # Spec house O yes .® no Lot lines identifiable ,n yes 0 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 roe owner agrees to submit bmit to St. Croix Department certification d e owner and b P rtY � Zoning Departm a rhficatton form, signed by the y a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiratio ate. AP ICA 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 property described above, by vi of a warranty deed recorded in Register of Deeds Office. 110 A F LICANT 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 STATE BAR OF WISCONSIN FORM 2 - 1998 ,WA Y DEED 6-a& K,ATHI EEN H. WALSH Document Number PAGE 76 RL:GISTER OF DEEDS 5T. CROI }; GO., WI This Deed, made between RECEIVED FOR RECORD RI CHAR_0. J P _ _ 06 -25- 2001 9:30 AM _husband and wife, _ WARRANTY DEED Grantor, EXEMPT 0 and _ GREG T LANGER and NANC A T ANGER CERT COPY FEE: husband and wife. — COPY FEE: – TRANSFER FEE: 176.70 – — _ RECORDING FEE: 10.00 -- -- Grantee. PAGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in _st C•rnix County, State of Wisconsin: Lot 19, Plat of Shadow Pines, Town of Somerset, St. Croix County, Wisconsin, Name an Return Address First National Bank of New PO Box 89 Richmond New Richmond, WI 54017 0 32- 21 17 -60 - 000 Parcel Identilicallon Number (PIN) This is not homestead property. (is) (is riot) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 2 gt day of -- ,7une , 2001 (SEAL) 't _J�" —" (SEAL) Richard O, stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, 55. St. Croix County. 111 authenticated this day of Personally came before me this 21st day of June _, 0 01 , the above named Richard 0 Stout a-ad :ran1 i— P. — S t7 0 TITLE: MEMBER STATE BAR OF WISCONSIN ^ _ [�. _ to (if not, me known to be �:h seOTA � _f$U�'puted the foregoing authorized by §706.06, Wis. Slats.) instrument and acS TdrWOR dSCONS(w THIS INSTRUMENT WAS DRAFTED BY FCERNON BAST _ Janet P. Stout .. 1353 Awa ik P mr, C !lr� J. _ Hudson, WI 54016 Notar Public, StateOf.. sconsin My omml ip`� (If not, state expiration date' (Signatures may be authenticated or acknowledged. Both are not �) IIJJ necessary) — -- ' Names of persons signing in any capacity most be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN wiscoosin Legai amm, Co., inc. FORM No 2 - 1998 Mowaoaee. wl_. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division St. Croix • , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar i : Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village ❑ TSwn of: State Plan ID No.: Plourde, Charlene Somerset Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 2117 -60 -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 TANKTO P/L WELL BLDG. Air to I ntake 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 TD H Ft Forcemain Length Dia. H 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 I BLDG WELL LAKE/STREAM LEACHING manufacturer: INFORMATION Type O 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: 2180 59th Street, Somerset, WI 54025 (NW 1/4 NE 1/4 15 T31N R19W) - 15.31.19.1076 Shadow Pines -Lot 19 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. 'I ` ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ ¢ d € S €. ..... On- s F t j 3j I i s � 1 E � r f I i i E 218a sk. Safety and Buildings Division SANITARY PERM �1�T. 2 01 W. Washington Avenue NN & C 6nSii, P0Box7162 I n accord with Com 83. \ Is. Ad e Madison WI 5 3707-71 62 Department of Commerce � d , • Attach complete plans (to the county copy only) fort em, oh`PYMt les unty than 81/2 x 11 inches in size. • See reverse side for instructions for completing this a tio N ? .3 2000 to Sani ary Pertnit Number ST CROIx 3TO zq ` f Personal information you provide may be used for secondary purposes COUNTN Cr Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)J. 0 20MIIrl30MCE State Plan Review Transaction Number I. APPLICATION INFORMATION -PLEAS E PRINT ALL Prope caner Name P ocation /4 v4, 5 T 3 , N, R E (ore Property Owner's Mailing A l ess Lot Number Block Number 1 1 City, State Zip Code Phone Number ubdi ion Nam or CS be yj IJE ( ) r II. TYPE F ILDING: (check one) ❑ State Owned Ity Nearest Road p Village �— Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1S 3 ion 1 ❑ Apartment /Condo — a� "�-- —=0 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. M New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of.an ______System ________System __ Tank Only______________ Existing System ________ Existlnci 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 5& Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit ault Privy 14 ❑ System -In -Fill ' j X 5 .7- 5 — g VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals(day /sq. ft.) (Min . /i ' c h) Elevation Feet Feet VII. TANK Capacit gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App Tanks Tanks New Existin strutted Septic Tank or Holding Tank ❑ 11 El 11 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst4liation of the onsite sewage system shown on the attached plans. Plumber's N e: rint Plumb 's Si o Sta ) MP /MPRSW No.: Business Phone Number: Plum er's Ad ress (Street, City State; Zip de): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (InciudesvGroundwater D ate I ssued Issuing Agent Signature (No Stamps) surcharge Fee) t JA Approved []Owner Given Initial Adverse Determination� 6`26 -Leda 1 1 jx X. C " NDITIONS OF APPROVAL / RE ONS FOR DISAPPROVAL: &Ww w1a" 6t D -6398 (R.12199) DISTRIBUTION: Original to County, One copy Td: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) yirs. 2. Your sanitary permit may be renewed bef�r rth4 egpiJgj�on date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be app a�b��.. 3. All revisions to this permit must be approved by #4e'ppFwit issuing authority. 4. Changes in ownership or plumber requi.resj Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be prgperly maintained..,,The septic tank(s) must be pumped_by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your oniite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division 608 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and pzrcel tax number(s) of where the system isto be installed. H. Type of building being served. Check only one and complete # of bedrooms if 1 cr 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank reF !acement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total callons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Corr Mete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber isto fill in name, license number wit; 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 must be subrr lied to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, vocation of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water servi -,-.e; streams and lakes; pump or siphon tanks, distribution boxes; soil absorption systems; replacement system areas; and he location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications •ar pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and p� ,mp manufacturer; D) cross section of the soil absorption system if required by the county; E; soil test data on a 115 frt; m; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regu: ated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination irivestigations and establishment of standards. CJ`,.a�.lj S's�,E if/rJX14 I—' S ,ors e 14)_r .S s a i \ Wisconsin, Department of Commerce SOIL AND SITE EVALUATION 6ivit,36--.n of Safety and Buildings Page 1 of 3 Bureau of Integrated Services in accordance with s. I,LHR 83.09, Wis. Aden. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches Size.. Plan m st County include, but not limited to: vertical and horizontal reference point ((3M),.`directfgn _r, \, St. Croix percent slope, scale or dimensions, north arrow, and location an�di3 ance tc(tteare$f o d. p rcel I.D. # APPLICANT INFORMATION - Please print all in rmati4 1 Reviewed by Date � r Personal information you provide may be used for secondary purposes (P$vaq , ,Law, s. 15 ®4I Property Owner ">,, ZC ,�p@pPrlfftQfcatin. Richard Stout � %_ Govt. Lot 1 /4 1 /4,S 1 5 T 31 ,N,R1 g E (orj;i� Property Owner's Mailing Address Lot # Subd. Name or CSM# 1353 Awatukee Trail 9 Shadow Pines_ City State Zip Code Phone Number ❑ City El Village [R Town Nearest Road Hudson I Wi 154016 1(715)549-67311 Somerset I 60th Street ® New Construction Use: U Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 C) p gpd Recommended design loading rate 7 bed, gpd /ft $_ trench, gpd/ft Absorption area required 858 bed, ft2 7 5 0 trench, ft 2 Maximum design loading rate = gi bed, gpd/ft &— trench, gpd/ft Recommended infiltration surface elevation(s) S p 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 1 [3 S❑ U ER S❑ U @S Ely U S ❑ U I EIS W U ❑ S k1 U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 - -- m1413 -z .3 2 1 4 - 24 10yr3/2 -- is 1 y mvfr cs -- .7 .8 Ground 3 124-99 1 0yr4 /6 -- ms osg ml cs -- .7 ; .8 elev. 98 ft. Depth to i limiting 44 11 . s factor in. 1c • Y Remarks: Boring # 1 0 -4 10 r2/1 -- sil I M 40A mfr cs 2 2 4 -24 10yr3/2 -- is 1.ndf mvfr cs -- .7 ;.8 3 24 -99 10yr4/6 -- ms osg ml cs -- .7'.8 Ground elev. 96 ft. Depth to limiting factor Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number V L— PROPERTY OWNER R i cha rd C +Q,, + _ SOIL DESCRIPTION REPORT Page' 2 'of 3 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 -4 10 r2 1 -- sil 1 MA t3K mfr cs 1 f 2 4-32 10yr3/2 -- is IM443r mvfr cs -- .7 .8 Ground 3 32-96 10yr4/6 IRS osg ml cs -- .7 ..8 elev. 9 7 .-r�:tt- Depth to limiting -Q°(. So factor lr 96_ in. Z ' Remarks: 34 L E Boring # — — — ✓Vl�' GS 1�2 Ali 4 L324-99 -24 1 Oyr3 /2 -- s 1 m�h� mvfr cs -- .7 8 10yr4/6 -- s osg ml cs -- .7 8 Ground elev. 96 ft. L (.Z r` Depth to V �- limiting factor 9 9 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# . r- •3 1 0 -5 10 r2 1 sil n; 5 2 5 -24 1 Oyr3 /2 Is 1 ph4o mvfr cs -- .7 ;.8 3 24-99 10yr4/6 -- s osg ml cs -- .7 ..8 Ground elev. 95. ft. Depth to limiting factor 9 9 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) 490 7 eys c a.C' / " YO 1�ro.►o st*J Cot�,vev V 1947 1 �Q` e Oa A&.,;/t✓ .'yif .P.'hho -V / ®� d �✓ ? �+or�e D� /Yu/, �.�/a•'l.� /p.I6h..a id d, d ✓ .iyST� rn f c u ,dr,'lnc r+�9' j�.Sl� ( T q�g'j0 � s l( 6 ST CROIX COUNTY SEPT W TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ..e� i- wl-61yE S• l�Lca y�2,�� PINONE 2 f7 — 5446 1 Mailing Address Property Address (Verification required from Planning Department for new construction) City /State SDme2sgr Parcel Identification Number 1 7 _�o e6 S�S LE GAI, DESCRIPTION Property Location Nw '/4, AID '/4, Sec. /S , T I �N -R Town of SOwtersG4 Subdivision - 5ACJ'n:� W Lot # Certified Survey Map # N , Volume , Page # Warranty Deed # `C M a c) , Volume L/ , Page # 3 � Spec house 0 yes X no . Lot lines identifiable X yes O 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, restnctcd i lumber or a licensed pumper verifying that (1) the on -site waste water 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. I 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 he completed and returned to the St Croix County Zoning Office within 30 days of the three year e iraliou d te. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tnre to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr9perty described above, by virtue of a %�arranty deed recorded in Register of Deeds Office. 41 AI IA. / SIGNATURE 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 %VIrranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 - 1998 609420 WARRANTY DEED KATHLEEN H. WALSH A K n REGISTER OF DEEDS Document Number W .1452PAGE339 ST. CROIX CO., WI RECEIVED FOR RECM This Deed made between RTCHARD !l_ 9T(lfiT and _ 06-27 -1999 9730 AM MIT, husband and wife, _ BARRIWTY DEED Grantor, EXERT D — i - -- CERT COPY FEE: and URDF. _ a s:i nal a nprR_ _ nn_, . COPY FEE: _. TRAMSFER FEE: 140.70 - - RECORDING FEE: 10.00 -- - - — - PAGES: i Grantee. Grantor, for a valuable consideration• conveys and warrants to Grantee the following described real estate in $i: rr-i -x County, Stale of Wisconsin: ' (lgi;�!di11(� Area Lot 19, Plat of Shadow Pines, Town of Name and Relum Address Somerset, St. CRoix County,Wisconsin. �� /f S`O J�r 032 - 1042 -30- 000 1042 -50 ti N — This i g not homestead property. (is) (Is not Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 26th day of Augusx 19 RinhwrA n Rfl (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. CRoix County. authenticated this day of Personally came before me this 26th day of August 199 . 9 , the above named _ Richard 0. Stout and Janet P. Stout _ TITLE: MEMBER STATE BAR OF WISCONSIN NOTARY po nix to (If not, me known to b8TAT "rxa6jj, 0NSffgd the foregoing authorized by §706.06, Wis. Slats.) instrument and ackr'KMNOaae.BAS THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. _ Hudson, Wi . 54016 No ry Public, State of s onsin M commis�siq `is� anent. Qf not, state ex i ration �.� date: (Signatures may be authenticated or acknowledged. Both are not K ,KJ Q� d.[�C, ,) necessary) Names of persons signing man capacity must b typed or printed below their slgnaove. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin sepal Blank Go., Inc. FORM No. 2 - 1998 Milwaukee. 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