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Parcel #: 032 - 1048 -40 -000 12/19/2008 03:16 PM PAGE 1 OF 1 Alt. Parcel #: 17.31.19.242B 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 O - TRUC, JUDITH A JUDITH A TRUC 10565 ESTATE DR EDEN PRAIRIE MN 55347 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 351 RICE LAKE RD SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A -NOT AVAILABLE SEC 17 T31N R19W 3A PT SW NE & NW SE Block /Condo Bldg: FROM NW COR GO S 710.5' TO S LN, TN RD, S 68 DEG E ALG RD 208', S 342', S 41 DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) E 103.7' TO POB S 41 DEG E 600', S 50 17 -31 N-1 9W DEG W 194.7 FT CONT ON SAME COURSE 75' TO RIVER, NWLY ALG SHORE 600' TO PT S 50 more Notes: Parcel History: Date Doc # Vol /Page Type 08/09/2004 771124 2634/354 CO 05/13/2002 678851 1889/357 WD 2008 SUMMARY Bill M Fair Market Value: Assessed with: 279156 207,700 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 150,000 0 150,000 NO 05 Totals for 2008: General Property 3.000 150,000 0 150,000 Woodland 0.000 0 0 Totals for 2007: General Property 3.000 150,000 0 150,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420524 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Truc, James A. I Somerset Township 032- 1048 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map NO: 17.31.19.242B TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding ?TN t TANK SETBACK INFORMATION utlet TANK TO P/L WELL BLDG. Vent it I a D Dt Septic Dt Bottom Dosing Header/ n. Aeration i Holding Bot stem PUMP /SIPHON INFORMATION Final Grade Manufacturer ZDend St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es To soil g p YesEr No Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 351 Rice Lake Road Somerset, WI 54025 (NW 1/4 SE 1/4 17 T31 N R1 9W) NA Lot Parcel No: 17.31.19.242B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ] Yes [E No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cent. No. Safety and Buildings Division City M 201 W. Washington Ave.. P.O. Box 7162 N visconsin . Wt 53707 - 7162 Site Address Department of Commerce J Sanitary Permit Application Sanitary Permit Number �' Z0 sz� In accord with Comm 83.21. Wis. Adm. Code, personal information you provide ❑ Check'd Revision may be used for seen Privacy Law, s15. i m I. Application Information - Please Print All Information State Plan I.D. Number Property is Name o - Parcel Number �� O Property Owner's Mailing Address G �✓ Property Location ' S T� N, R Lf City, State Zip Code C` =. '54 Lot Number Block N r Subdivision Name CSM Number � i0 II. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms `� ❑Village ❑ PublidCommercial - Describe Use ❑TownsWp . ❑ State Owned Nearest M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A lKpcw 1 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank Only I Existh m B. g Check if Sanitary Permit Previously Issued Permit Number Date Issued, IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 1e . 44 on - Pressuri e zed In- Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 Pressurized Iii-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Offie V. DispersalfIrreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Hull Grade Required Proposed Rate( Gals. / Days /Sq.FL) (Min./Inch) Elevation 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 _ C Dosing Chamber VII. Respo bt7ity Statement- I, the undersigned, aprume responsibility for installation of the POWTS shown on the attached plans. FPLIZre� Plumbe ' Si MP/MPRS Number Business Phone Number I)pr-// / Of rs (Street, City, te, Zip Code zll J z VIII. Coup /De artment Use Onl KApp!f ❑ Disapproved Sanitary Permit ) Fee (includes Groundwater Date Issued Issu' Agent Signature (No Stamps) 11 Owner Given hvtial Adverse Surch7 Determination • CID IX. Conditions of ApprovaUReasons for Disapproval `T'ow f:Ef- CC- bw S t (P Attach essupide plans (to the County adz) far the system on papa not less than SM x 11 +aches in size SBD -6398 (R. 05101) Parcel #: 032 - 1048 -40 -000 11/08/2005 09:37 AM PAGE IOFI Alt. Parcel #: 17.31.19.242B 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 JUDITH A TRUC O - TRUC, JUDITH A 15136 BOULDER POINTE EDEN PRAIRIE MN 55347 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 351 R LAKE RD SC 5432 SCH D OF SOMERSET SP 1700 WITC 0� Legal Description: Acres: 3.000 Plat: N/A -NOT AVAI BLE SEC 17 T31 R1 9W 3A PT SW NE & NW SE Block/Condo Bldg: FROM NW COR GO S 710.5' TO S LN, TN RD, S 68 DEG E ALG RD 208', S 342', S 41 DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) E 103.7' TO POB S 41 DEG E 600', S 50 17 -31 N-1 9W DEG W 194.7 FT CONT ON SAME COURSE 75' TO RIVER, NWLY ALG SHORE 600' TO PT S 50 more Notes: Parcel History: Date Doc # Vol /Page Type 08/09/2004 771124 2634/354 CO 05/13/2002 678851 1889/357 WD 2005 SUMMARY Bill #: Fair Market Value: Assess ith: 0 Valuations Last Changed: 07/23/2003 Description Class Acres Lan Improve Total State Reason RESIDENTIAL G1 3.000 150,0 0 150,000 NO � Totals for 2005: General Property 3.000 150,0 0 150,000 Woodland 0.000 0 Totals for 2004: General Property 3.000 150,000 0 150,000 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 Parcel #: 032 - 1050 -10 -000 11/08/2005 09:58 AM PAGE 1 OF 2 Alt. Parcel #: 17.31.19.250C 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 JUDITH A TRUC O - TRUC, JUDITH A 15136 BOULDER POINTE EDEN PRAIRIE MN 55347 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 N R1 9W 3A PT SW NE & NW SE Block/Condo Bldg: FROM NW COR GO S 710.5' TO S LN TN RD, S 68 DEG E ALG RD 208', S 342'S 41 DEG E Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 103.7' TO POB,S 41 DEG E 600' S 50 DEG W 17 -31 N-1 9W 194.7' CONT ON SAME COURSE 75' TO RIVER, NWLY ALG SHORE 600' TO PT S 50 DEG W PF more Notes: Parcel History: Date Doc # Vol /Page Type 08/09/2004 771124 2634/354 CO 05/13/2002 678851 1889/357 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 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 wisconsintae e ntofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labcr and HuM' Relations Drvlsiondf Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code OU St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. • not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. 032- 1050 -10 -000 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION J. H. Dielentheis GOVT. LOT NW 1/4 SE 1/4,$17 T 31 ,N,R 19 JV(w) W PROPERTY OWNERS MAILING ADDRESS OT # BLOCK # SUBO�i E 399 � 385 doc. #274481 15.05 Ni First St. ZIp M �� 3yy CI Stillwater, NN. 55082 CODE t") 4 98 -4814 CITY ors SOWN NE k.. Rd. [ 2f New Construction Use [X] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - trench, gpdtft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft2 - 8 trench, gpol11 Recommended infiltration surface elevation(s) area A= 96.20/B =97.00 ft (as referred to site plan benchmark) Additional design I site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S - Suitable for system T CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IV FILL HOLDING TANK U - Unsuitable for system I ®S 1 U ®S ❑ U ®S ❑ U 4:1 ❑ U 13 ❑ U O S L.FU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTw& Y 1 1 — 34 10 r2/2 none s1 Zmgr tnvfr cs 2m .5 (.6 2 1 34-90 5yr4/4 none co s Osg ml na na .7 .8 Ground 9��7 ft. Depth to limiting factor +90 Remarks: Boring # 1 —35 10yr2/2 none sl 2mgr mvfr cs 2m 5 .6 .; r w lv 2 5 -90 5yr4/4 none cos Osg Ml na na .7 .8 Ground elev. 9 Depth to ' limiting a c 90" Remarks: CST Name:. -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th, v . New RictiMondrXI 54017 Signature: Date: 8 -17 - 99 CST Number: m02298 Depth Dominant Color Boring # Horizon p Mottles Structure Structure GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence B Roots < _ 1I t. 1 yr2 2 none si r my r cs Bed 2 0 -90 5yr4/4 none cos Osg m7. nor nor .7 Ground {� Depth to limiting factor fi# +90 �f3 Remarks: Boring # x 1 —21 10yr2 /2 none sl 2mgr mvfr cs 2m .5 .6 d > 4 < 2 1 -90 5yr4/4 none cos Osg ml nor nor .7 .8 E Ground elev. 10 ft. Depth to limiting factor + 90,� Remarks: # Boring # 1 _7 10yr2 /2 none sl 2mgr g mvfr cs 2f .5 .6 2 -41 5yr4/4 none sci 2mgr mvfr gw 2f .4 .5 I 3 1 - 90 5yr4/4 none co s Osg ml nor nor .7 .8 Ground H tv2 it. Depth to limiting factor +9 0 Of Remarks: Boring # Ground etev, ft. I Depth to limi ting factor STEEL'S SOIL SERVICE 1554 200th Ave. Gary L. Steel J.H. Dielentheis New Richmond, WI 54017 CSTM2298 Nwkuk S17- T31N - R l9w (715) 246 -6200 MPRSW -3254 town of Somerset lot #25OC -csm N 1 „=40 , i y tri BM.= nail in Elm tree L el. 100.00' \ ti Alt. BM.= nail in Oak tree 0 el. 100.30' `� 0 e ®• 3y � o � L. Steel 8 -17 -99 I^Ct 5 •� Safety and Buildings Division County 201 W. Washington Ave.. P.O. Box 7162 N *Iscon in Madison. WI 53707 - 7162 Site Address l)e artment of Commerce Sanitary Permit Application Sanitar Permit zo Numbe n accord with Comm 83.21, Wis. Adm. Code, personal information you provide 11 Chtc Revisio may be used for Law, s15. 1 m L Application Information - Please Print Ali Information State Plan I.D. Number Property is Name Parcel Number or O Property Owner's Mailing Address ; 2 Property Location U) 'Id 14•S T� N,R if City. State Zip Code ; - ne C c. Lot Number Block N Z( Su 'vision Name CSM Number III. Type of Building (check all that apply) ❑City A , or 2 Family Dwelling - Number of Bedrooms Dvinage ❑ Public/Commercial - Describe Use ❑ State Owned Nearest III. Type of Permit: (Check only one boa on line A (numbering scheme for internal use). Complete Iine B if applicable) A. 1 ew 2 ❑ Replacsment System 3 ❑ For County use Replacement of 6 ❑ Addition to Tank only I Existing System B. )( Check if Samiary Permit Previously Issued Permit Number Date Issued, *3 5 - 3344 '"^��`, IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) itZ A -..(tom 4t�on - Preswrized hi- Ground 21❑ Mound 47 ❑ Sand Filter 50 11 Constructed Wetland 22 Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Lira 45 O At -Grade 46 ❑ Aerobic Treatment Unit 49 O Recitcnlating 30 ❑ V. Dispersalffreatment Area information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.FQ (Min./Inch) Elevation VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existio� Taaks Talcs Septic or Hoklit� Teak K ^ VII. E!qo llity Statement - I, the undersigned, responsibility for installation of the POWYS shown on the attached plans. r' n Ph nbe S' MP/WRS Number Business Phone Number Plumbers A&V= (Street, City, c Zip Code VIII. Coup /De artment Use O Approved ❑ Disapproved Permit Fee (mcludes Groundwater Date Issued Agent Signature No Stamps) ❑Owner Given Liitial Adverse • OD Determination 7v i K. Conditions of Approval/Reasons for Disapproval `r'?-W s PEQ.- bD*Y S f P pE ,5�('�Ylti v►<<( .;u+.e_ 'tQc��iwM -5 twao0 ��3D)� - P+�a c,- ��tv� / Attach oompkte pkw (Ito the Cobiq oath) for the system on pper not I= tuba 5112 a 11 tnebn in ruse t. _. pL SBD -6398 (R. 05101) �J 1889P 357 67685 J. STATE BAR OF WISCONSIN FORM 2-1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., VI This Deed, made between J. H. Dielentheis and Lillian E. RECEIVED FOR RECORD Diele ntheis, hus ban d and wife 05 -13 -2002 3:40 PH — WARRANTY DEED EXEMPT # Grantor, and James A. Truc, a married person REC FEE • 13.00 TRANS FEE: 599.70 COPY FEE: CERT COPY FEE: - - -- PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in S C roix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address See Attached Exhibit "A ". ff-�jyo �_Ccjc. 33a rn,nrie�� 9 rviu5 032 - 1048 -40- 000,032- 1 -10 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of ,4prif - 'f f t- - 2001 H. Dielentheis / + Lillian E. Dielentheis s AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) _ ) ss. �►tiL>lx County ) authenticated this Personally came before me this = day of I DIANE INA. BA A 2002 the above named J H Dielenthei nd Lillian E. Dielentheis, husband and wife State a Vdom t TITLE; MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin H W 54 l My Commission is permanent. (If not, state expiration date: - ll-a � Qo� —• (Signatures may be authenticated or acknewtedged. Both are not necessary.) Information Professionals ompa ac Cny, Fond au L, WI • Names of persons signing in any capacity must be typed or printed below their signature. 800.655 -2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2.1999 U 1889P 358 EXHIBIT "A" A parcel of land located in the Southwest .Quarter of the Northeast Quarter and the Northwest Quarter of the Southeast Quarter of Section 17, Township 3I North, Range 19 West, described as follows: From the Northwest comer of said Southwest Quarter of the Northesit Quarter, go south along the West line of said Southwest Quarter of the Northeast Quarter a distance of 710.5 feet to an iron pipe stake on the south line of the town road; thence South 68 degrees 42 minutes East, along the south line of said Town Toad a distance of 208.0 feet to an iron pipe stake, thence South l degrees 08 minutes West along the west line of an easement hereinafter mentioned a distance of 342.0 feet to an iron pipe stake, thence South 41 degrees, 04 minutes East along the southwest line of an easement hereinafter mentioned a distance. of 103.7 feet to the point of beginning for the parcel to be conveyed herein; thence, South 41 degrees 04 minutes East along the Southwest line of said easement a distance of 600.0 feet to an iron pipe stake; thence South 50 degrees, 26 minutes West .a distance of .194.7 feet'to an iron pipe stake on the Brow of the hill; thence continuing on some course a distance of 75 feet, more or less to the shore of the Si: Croix River; thence Northwesterly along said shore a distance of 600.0 feet, more or less to a point South 50 degrees 26 minutes West of the point of beginning; then North. 50 degrees, ; 26 minutes East a distance of 60 feet, more or less to an iron pipe stake at the brow of the hill, thence North 50 : degiaes,26 minutes. Fast a distance of 117.2 feet to the point of beginning; including an easement for an access road'33 feet in width adjacent to the above described parcel and extending to the town road as above mentioned, St. Croix County, Wisconsin f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croi Safety and Building %vision. V INSPECTION REPORT Sanitary Permit No: 404945 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: Dielentheis, J. H. I Somerset Township 032- 1050 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMB OR Type Of System: T Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes �j No �� Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 351 Rice Lake Road Somerset, WI 54025 (NW 1/4 SE 1/417 T31 R1 9W) NA Lot Parcel No: 17.31.19.250C 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ; No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) L ty and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 - N visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce ' Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal info yP>�'Ypi0 idk `11 k. �� may be used for secondary Privacy Law, s 1 ! r ❑Check if Revision I. Application Information - Please Print All Information :' \ State Plan I.D. Number ------------- Property Owner's ame C0 11 " Parcel Number t T • •' • 2 0 - 10 So - D - om Property Owner's Address - roperty Location t;+Pt t L li �!Q • S 7 T N, R 19 X City, State Zip Code ber Lot Number Block Number Subdivision Name ? �g CSM Number S 1l II. Type of Building (check all that apply) Duty 1 or 2 Family Dwelling - Number of Bedrooms []Village ❑ Public/Commercial - Describe Use JgTownshi - ❑ State Owned i r r J u t. Nearest Road 2 -5 x 2 -7 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete hne B if applicable) A. 1,0 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑Addition to For County use System I I Tank Only Exis ' S stem B. Chec Permit Number Date Issued k if Sanitary Permit Previously Issued 3 1 2. 0 /ZMe> 1V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 d°' Non - 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 Treatme nit 49 ❑ jtecirculatlM j , 30 ❑ Other V. Dispe rsal/'IYeatm t Area Informal' Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min. /Inch Elevation 6e 3 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 Dosing Charnber VII. Respops ibility Statement- I, the undersign , e responst y or ' lion of the POWTS shown on the attached plans. Plum is ame rint) Plumber' Si , MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip VIII. County/Department Use Ot11 V Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse 5 cr Dete IX. Conditions of pprov easons for Disapproval y- t,,.�,5 a..�,,,,w.�Q � � R.�e�.>�'�. � R � p,:.�•,, `�. � sue-- ��...�a�t�. C �- t,o�.... s� no 1 00 Attach coTff preff (to o y Wrl on papa' not less than 1/2 x 11 inches in size SBD -6398 (R. 05101) L 1 ^ t r I 1 Ct?JIlep 1 , i s jL)A5 �r c �7fo l 1 a c a t Jt POWTS OWNER'S MANUAL a MANAGEMENT PLAN Pate _L of � FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # _ D Septic Tank Manufacturer >E ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms 0 NA. Effluent Filter Model _ ❑ NA Number of Commercial Unit IZ NA Pump Tank Capacity gal 19NA Estimated flow (average) gal /day Pump Tank Manufacturer -U'NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer f9 NA Soil Application Rate ,,� gal/day/ft' Pump Model d NA Influent/Effluent Quality Monthly average* Pretreatment Unit -0 NA ❑Sand /Gravel Filter C3 Peat Filter Fats, Oil at Grease (FOG) 530 mg /L ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand (BODs) x220 mg/L ❑Disinfection ❑Other: Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality 0 NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :00 mg/L ,0 In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade 0 Mound Fecal Co((form (geometric mean) 510' cfu /100ml ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non- commercW) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every O months 0 year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every � ❑ months 5(year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 0 months ayear(s) Inspect pump, pump controls ez.alarm At least once every 0 months 0 year(s) �Iff NA Flush laterals and pressure test At least once every 0 months ❑ year(s) 9'NA Other At least once every 0 months 0 year(s) -( NA Other At least once every 0 months 0 year(s) 19 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Maste 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 (Ys) 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 component, pretreatement 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 chemical: that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a sentage servicing o , :.tor prior to use, System start up shalt not occur when soil condlUvm are frown at the inflltrative surfacer, During power outages pump tanks may All above normal highwater levels. When powtr Is r*storvd the excess wastewater will Gv discharged to the dispersal cell(s) In one Tarp close, overloading the cell(s) and may result In the backup or surface discharge u: effluent. To avold this si(uaUon have the contents of the pump tank removed by a Sepup Servking Operator prior to restorer, power to the effluent pump or contact a Plumber or POWT5 Malncalner to assist in manually operating the pump controls to restore ncrmal levels wlthin the pump Link. Do not drlve or park vehicles over sinks and dispersal ceils. Do not drive or park over, or otherwise diswrt) or compact, the area within 15 Net down slope of any mound or at-trade soil absorption arts. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of cr>e POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dlslnfectanu; (at, foundation drain (sump pump) water; fruit and vegetable peelings; gasoNne; grease; herbicides; meat scraps; medications; oil Painting croducu; wesucides; sanitary naekins tampons; and water softentr brine. ASANDONEMENT When the POWT5 fails and /or is ptmiantntly taken out of service the following sups shall be taken to Insure that the system is proprrly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Cocky • All piping to sinks and pits shall be disconnected and the abandoned pipe olmnings sealed. • The contents of all tanks and plu shall be removed and properly disposed of by a Septage Servicing Operator. • Aher punsping, all t.snks and plu shall be excavated and removed or their covers removed and the void space fllied wi;r s61, g: avel or another Inert solid matrrlal, CONTINGENCY PLAN If the POWTS falls ante cannot be repalred the following measures have been, or must be taken, W provide a code Compliant replacement system; A sultable replacement area has been evaluated and may be uUlhed for the location of a replacement soli absorption system. The replacement area should be protkcud from disturbance and compaction and should not be infringed upon required setbacks from exIsUng and proposed urucwre, lot (Ina and wells. Failure to protect the replacement area wiii result In the need for a new soil and site evaluation to establish a suitable replacement aria. Replacement systems rnust comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and /or soil limitations, Barring advances in POWT5 wchnuloa, a holding tank may be Installed as a last resort to replace the failed POWTS. Q 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 w locate a suluble replacement arts. If no replacement area is available a holding tank ma be Insulled ais a last resort to replace the failed POWTS. Q Mound and it-grade soll absorption systems may be reconstructed In place following removal of the biomat at the InflltraUve surface. Reconstructions of such systems must comply with the rules In effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM TKE INTERIQR OF A TANK MAY lilt DIFFICULT OR ImpnWRt F ADDITIONAL COMMENTS P OWTS INST POWTS MAINTAINER Nan,e Na me Phone 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER LOCAL REGULATORY AUTHORITY Name 77 7 Phnne _Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division 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)1. 353344 Permit Holder's Name: ❑ City ❑ Village [I kown of: State Plan ID No.: . Somerset Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032 - 1050 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I to 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 Syestem TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. T iquid Depth DIMENSION DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK 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 P P P Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: / / Inspection #2: Location: 351 Rice Lake Road, Somerset, WI 54025 (NW 114 SE 1/4 17 T3 IN R19W) - 17.31.19.250C 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 f ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: E °er e 3 . ..3.r:,) / e ( cam- ( et>. SANITARY PERMIT APPLICATION Safety and Washington Division 201 W. Washin ton Avenue *Sclld P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper no ess unty than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this appl' ation Sta a Sanitary Permit Numb p r i i 35-3 Personal information on you provide may be used for secondary purposes p� heck if revision o prewous application [Privacy Law, s. 15.04 (1) (m)]. C,./, / State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL NFORM TI N Property Own Name Broperty Location .-.I va 1/4,5 J7 T , N, R (or Property Owner's Mailing Address Lc Number Block Number_ Cit tate Zip Code Phone Number Subd' ision Name or CSM Num er 11. E OF BUILDING: (check one) ❑ State Owned [I Cit Neares oad OF Public 1 or 2 Family Dwelling - No_ of bedrooms c ro w a n OF I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) vp 0 1 ❑ Apartment / Condo 2 ❑ Assembly Hall \E]M al Facility/ Nursing Home 10 ❑ Outdoor Recrea,�i nal Facility 3 C Campground andise: Sales/ Repairs 11 E] Restaurant/ Pr /Dining 4 E] Church / School Home Park 12 E] Service St�on / Car Wash 5 E] Hotel / Motel / Factory 13 ❑ Other: . ecify IV. TYPE OF PERMIT: (Check only one box line A. Check box on line B, if applicable) >' A) 1. [4 New 2. ❑ Replacement ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ______ System___�____System___________ _TankOnly______________ Existi _ Existing System B) ❑ A Sanitary Permit was previously issued. rmit Number Date Issued V. TYPE OF SYSTEM (Check only one) Non- Pressurized Distribution Pressurized Distrib ion ,experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1210 Seepage Trench 22 ❑ In- Ground Pressu 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑System -In -Fill ' K�s� VI. ABSORPTION SYS INFOR A OM 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loadin Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed*. ft.) (Galstday/ . ft.) (Min. /' ch) Elevation F et Feet VII. TANK Capacity in gallons Thtal # of Prefab. Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacture ame Co ucn- glass App. New Existir) r's Concrete strted Steel Tanks Ta s Septic Tank or Holding Tank — ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILIT7SEMENT I, the ndersigned, sponsibility for insta tion of the on ite sewage system own on the attached plans. P ' ame Fin Plumb s ur o ps) MP /MPRSW No.: Business Phone Number: P umber's Address ( trget, Cit State, ip Code): ZJ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Sign ture (No Stamps) IApproved ❑ Owner Given Initial �.�C Surcharge Fee) Adverse Determination o�e� •� O X. CONDITIONS OF APPROVAL /6 RE SONS FOR DISAPPROVAL: t �-- 6k- ..n or a �-I'Z u -r . tiGe— Olt. SBD-G3 .4199) DISTRIBUTION. 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 maybe renewed befole the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative "Code will be applic��I 3. All revisions to this permit must be approved by the ero t, sluing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumpedby a licensed pumper 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. - To be complete and accurate this sanitary permit application must include: I. Property Owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be'instarled. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 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 replacement, 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 gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete 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 is to fill in name, license number 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 must be submitted to the county. The plans must include the following: A) plot pl'ari,'drawn to scale•or'with complete dimensions, location•of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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 specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the countyj) 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. r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page i of 3 Labor and Human.Relations "Division of safety & Buildings in accord with ILHR 83.05, 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 St. Croix not limited to vertical and horizontal reference point i c i �d % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista t �r �d :` 032- 1050 -10 -000 [ R1EWEDRBY . 6 ,,, DATE APPLICANT INFORMATION — PLEASE P LL FMATIf�N' UAk PROPERTY OWNER: z \ .11i PROPERTY LOCATION J. H. Dielentheis --` fr GOVT. LOT NW 1/4 SE 1i4,S T 31 N,R 1 9 XR(or) W PROPERTY OWNERS MAILING ADDRESS `�' LOl # BLOCK # SUBD. NAME OR C SM # 1505 N. First St. 4, ; /X `50c na vol. 399 — Pg. 385 doc. #274481 CITY STATE ZIP CODE CITY ❑VILLAGE DOWN NEAREST ROAD Stillwater, MN. 55082 x`15) Somerset Rice Lk. Rd. [ New Construction Use [x] Residential ! Nu old 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft2 - 8 trench, gpd /ft Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) area A= 96.20/B =97.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft L S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for stem ®S ❑ U ®S ❑ U ®S ❑ U T7 S ❑ U [3 S El U ❑ S 13U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color G S z. Sh. Bed Trends .................. ................. 1 0 - 34 10yr2/2 none sl 2mgr mvfr cs 2m .5 .6 2 34 -90 5yr4/4 none co s Osg ml na na .7 .8 Ground elev. 9 9.7 ft. Depth to limiting J, 7 fac tor 90 of Remarks: Boring # 1 0 -35 10yr2 /2 nc gr mvfr cs 2m .5 .6 :.:::.........:::» 2 2 35 -90 5yr4/4 nor. co s Osg ml na na .7 .8 Ground elev. 9 9.7 ft. Depth to limiting 2 l S fact Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AMO.. New RicWondnWI 54017 Signature: Date: 8 -17 - 99 CST Number: m02298 i PROPERTYOWNER J.H. Dielentheis SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # 032 - 1050 -10 -000 ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 -30 10yr2 /2 none sl 2mgr my r cs m 2 0 -90 5yr4/4 none co s Osg ml na na .7 .8 Ground 1 Depth to limiting factor + 9011 Remarks: Boring # 1 -21 10yr2 /2 none sl 2mgr mvfr cs 2m .5 .6 4 2 1 -90 5yr4/4 none co s Osg ml na na .7 .8 Ground elev. 101.0 ft. — Depth to -- limiting factor +90" 5 Remarks: Boring # 1 -7 10yr2 /2 none sl 2mgr mvfr cs 2f .5 .6 5` 2 -41 5yr4/4 none scl 2mgr mvfr gw 2f .4 .5 3 1 -90 5yr4/4 none co s Osg mi na na .7 .8 Ground 1d ft. Depth to limiting factor +9 0 Remarks: Boring # Ground elev. j ft. i Depth to limiting factor Remarks: SBD- 8330(8.05/92) 7 �J� � /rt/ �/9ki/ � y 33 V k I J s yam � 7 A SS � fls/r- I i 7� r/ STEEL'S SOIL SERVICE Gary L. Steel J.H. Dielentheis 1554 200th Ave. CSTM2298 NW4SE4 S17- T31N - R 19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #250C -csm ✓1 " =40' JEA BM.= nail in Elm tree el. 100.00' Ski Alt. BM.= nail in Oak tree C el. 100.30' � w C"� gV%k S (o 4 ? A kA 3� fl� g � Ilk Gary L. Steel 8 -17 -99 1 -19 -1995 8:18PM FROM P.1 1 STEEL'S SOIL SERVICE. Gary .L. Steel J.H. Dielentheis 1554 200th Ave. CSTM2298 NWkSEJ 517- 731WR19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #2500 -cm N Q 1 EM.= nail in Elm tree @ el. 100.00• < Alt. EI. = nail in Oak tree 0 el. 100.30- jJ ` V (�Vup/•�lN'Av 00 pAP YAM, \ ' Y • � \x' U �0 s Ga L. Steel 8 - 17 -99 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 'j ► Mailin g Address ' Property Address I� CA (Verification required from Planning Department for new construction) City /State , AL Parcel Identification Number LE GAL DESCRIPTION Property Location JLI '/4, -S" 1 /4, Sec. T -YLN -RA W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 2 4 21 , Volume -299 , Page # Spec house ❑ yes ,Z no Lot lines identifiable 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 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 ys of the'three year expiration d e. SIGNA 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 he p ope described above, by rtue of a warranty deed recorded in Register of Deeds Office. J SIGNXATKE 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 1 ' Nw a•l. W-Mir Dwd- Common Form (STATE: or WISCONYI \) • ' am 235.14. WI& 814tutm Fn No. 1 Omh • 3blbMq f0. 274481 This Indenture, tirade this 16th day of November . A. D., 19 63. between Elmer Carlson and Dorothy Carlson, husband and wife, • part ies of the first part, and J. H. Dielentheis and Lillian E. Dielentheis, husband and wife, ' part ies of the second part MIM900rt4: That 'the said part ies of the first part, for and in consideration of the sum of One Dollar ($1.00) and other good and valuable consideration, to them in hand paid by the said part ies of the second . part, the receipt whereof is hereby confeaaed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed. and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, their heirs and assigns forever, the following described real estate, situated in the county of St. Croix , and State of Wisconsin, to -wit: A parcel of land containing approximately 3.5 acres located in the South- west Quarter of the Northeast Quarter (SW) of NE'h) and the Northwest Quarter of the Southeast Quarter (NW4 of SEo) of Section seventeen (17), Township Thirty -one (31) North, Range Nineteen (19) West, described as follows: From the Northwest corner of said Southwest Quarter of the Northeast Quarter (SW4- of NE)4-), go south along the west line of said Southwest Quarter of the Northeast Quarter (SA of NEa) a distance of 710.5 feet to an iron pipe stake on the south line of the town road; • thence South 68 42' East along the south line of said Town Road a distance of 208.0 feet to an iron pipe stake; thence South 1 08' West along the west line of an easement hereinafter mentioned a distance of 342.0 feet to an iron pipe stake; thence South 41 04' East along the southwest line of an easement hereinafter mentioned a distance of 103.7 feet to point of beginning for the parcel to be conveyed herein; thence South 41 04' East along the southwest line of said easement a distance of 600.0 feet to an iron pipe stake; thence South 50 26' West a dis- tance of 194.1 feet to an iron pipe stake on the brow of the hill; thence continuing on same course a distance of 75 feet, more or less to the shore of the St. Croix River; thence Northwesterly along said shore' a distance of 600 feet, more or less, to a point South 500 26' West of the point of beginning; thence North 50 26' East a distance of 60 feet, more or less to an iron pipe stake at the brow of the hill; thence North.50 26' East a distance of 117.2 feet to the point of beginning; including an easement for an access road 33 feet in width adjacent to j II the above described parcel and extending to the town road as above men— tioned. COQttlet with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said parties of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. Co i)abt anb to It)oib, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, and to their heirs and assigns FOREVER. Anti i4t %alb Elmer Carlson and Dorothy Carlson, husband and wife, for themselves,-- theirheirs, executors and administrators, do - covenant, grant, bargain arid" " agree to and with the said part ies of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrences whatever, except easements of record and that the above bargained premises in the quiet and peaceable possession of the said part ies of the �.. ✓f Wes,�,11ne N , 92.8 S 89 - N z � 0 0 /9/.4 S 69'33'E h 3 0 • 94.2 y . , 5 89033'E � o \ wb Scale; o � 5 0 Z a O �? S io ,0 y 50 .o .� • 0 0� ( 1 I r 7 �N O N O C) Zt / N N 1 N • � O