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HomeMy WebLinkAbout032-1070-10-000 0 o� 0 p C o o m 0 I sy� � O c N N L f0 C C I O C O1 n T � v N I a L E d E C I C m O T3 N O. I W a cu (ti COL O I r a E ° O a >t o I �°� m p f0 U p z y 0 I = 0 s C LL c O -0 v I ti c U m I o rnE o CD cE E Q G ° I 000a c) o v W I € I fl) I z rn 3 E E c S I S z ,I v I a` c N m a m I a m o w o o z fn F- Y a N N O a N > > L I CO N a' d' co .. I N y d ( O L N y CO C Q Y O a Y O V C z c D I z m D I z F- y c I y c O 12 w to c to Y CL M CL �I o v 'co a` a� I Noo a` n c c � NI to CD o v) I it 0 ,It 4) a a a �' a a a V; a. 2 E o tq U V) C , ° E rnrn ° 0 O N N Z V) Z O N CD - 0 O I O N .!- r a E c� 10 co c I Q co y c d }� •O Q 'a N N . U) a d Q Z C/) I N a d Q V) f0 I C O O W C N V d T p V 1. 41.1 O Y V O i co I J O C d' N oM °' I co r a'iv I �' y' I L - c (D e ca l CD c) ui o! c`a ( ° a p I L °' ° w E m O N (A m v 0 z z W N O z c fn w d CL IL V #6 a I a 0 � + E 2 'C r A (3 0 0- U) i 0U)o Wisconsin Cgpertmentof ComArce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division '. INSPECTION REPORT Sanitary Permit No: 463038 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: Brantal, Donald Somerset Townshi 032 - 1070 -10 -000 CST BM E Insp. BM Elev: BM Description: n Section/Town /Range/Map No: / ll� 8 ry1 ( � 25.31.19.346A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. D Benchmark / � I y � 1.0 ✓ �} D to Dosing / Alt. BM 2- 65 164- Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /3-6 13 97 Septic t i Dt Bottom ,,t'5 i /�.31 % � (a S Dosing 1 e 1 Header /Man. C r +Z F* Aeration Dist. Pipe 1� r's 5� 5 L i•51 Holding Bot. System M is ; 4 y, L PUMP /SIPHON inal Grade ON INFORMATION T5 Manufacturer Demand St over Model Number 5_!S TDH Li 1 Frictio Loss System Head TDH t i Forcemain Length Dia. I Dist.toWell �O SOIL ABSORPTION SYSTEM BEDITRENCH Width f Length o. Of Trenches PIT DIMENSIONS No. Of Pi Inside Dia. Liquid Depth DIMENSIONS 3 l�L� f3 { SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: i INFORMATION CHAMBER OR Type Of System: i ! UNIT Cz (� Model Number: DISTRIBUTION SYSTEM I $ Ld / /Y\ 3 74W. Header /Manifold i f Distribution x Hole Sipe x Hole Spacing V nt to Air I ake I .4 ' Dia L Pipe(s) \ \ Length 1 Length Dia Spacing � \\ le SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only �J Depth Over w Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �:` Z � � Yes E,] No Yes 1<� No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 710 191st Avenue Somerset, WI 54025 (SW 1/4 SW 1/4 25 T31N R19W) NA Lot 4 Parcel No: 25.31.19.346A f 1.) Alt BM Description = 4a Anvv` 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No Use other side for additional information. _ 1 ._._.J —___ SBD -6710 (R.3/97) Date Insepc is Sign a Cart. No. Safety and Buildings Division County N visconsin 201 W. Washington Ave., P.O. Box 7162 S T. o zr Madison, ) 266 „� Sanitary Permit N_ filled in by Co 6 "°'-- ....... Department of Commerce ( �'����' WK State Plan I.D. Nu be Sanitary Permit Applica ion r In accord with Comm 83.21, Wis. Adm. Code, personal info ation ybd vid¢ ) i L, may be used for secondary purposes Privacy Law, sl .04(1 xm) Project Address f different than in address) 1. Application Information — Please Print All Information % 'ONING ' C ,F � 1 Property Owner's Name arcel N Lot N 1{ Block N D -DDp Property Owner's Mailing Address Property Location /t f CQ /-t Q L- 5 j2/— v., ,Sf&'/., Section _ City, State Zip Code Phone Number fir— i ircle ) (= — / J e S T y N; R E o&V II. Type of Building (check all that apply) 3 � Subdivision Name CSM Number 1 or 2 Family Dwelling — Number of Bedrooms " ;C ❑ Public/Commercial — Describe Use Y YQ �+ ❑ State Owned — Describe Use 3 bt5�'. Z- 4 I ❑Village ®Township of J e17 92Se7 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System 2 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner Z D ZGl (/� 1 f � l TV. Type of POWTS System: Check all that appl 8 Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter i Leaching Chamber ❑ Drip Line ❑ Grav - gss Pipe ❑ Other (e lain V. Dis ersal/Treatment Area Information: ($ Ih 1 = J Design Flow (gpd) Design Soil Application Rate( gpds Dispersal Area Required (st)/ 7 0ispersal A rea Proposed (sf) �Hy�' em Elevation 9� a r � I ✓✓ . 96 S� r VI. Tan k Info Capacity in Total Number Manufacturer Prefab Site Steel Ftber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank , — Aerobic Treatment Unit Dosing Chamber S L 2 // a (�� U sponsibility S tatement- I, the undersigned, assume responsibility for installation of the PO WV; shown on the attached plans. Plumber's Name (Print) Plu 's Signature M umber Business Phone Number -6 Plumber's Address (Street, City, State, Zip ode) L E t z VIII. oust / e artment Use Onl Sanitary Permit Fe includes Groundwvter Da a Issue ssuing Age t Sig at re (No p A roved ❑ Disapproved O P PP P Fee ..� Surcharge )� �7 a ❑Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval " /_ SY STEM_41pLplE R: S 3. Z - ) , tD,r,J lti[t'.[ o eptictank, effluent filter and v �\ dispersal cell must all be serviced /maintained as per management plan provided by {umber. 2. setback requirements must be mai ine 3 to lam to the County on for the $ rn on paper not less than Blft z 11 inches in size Attach complete p ( ty ly) ri te SBD -6398 (R. 01/03) i s I i -- -_ , I j i s i 1, fi f 3 aao I u I A i o s i It jI I i I i i I wio w � I i I I f i i /7 To i � ( S�N - � �I n n' ' �i � :_1S V�TE1'! . ��= �/�i.I 7� �'•s� i i r _ QA Oo22-i7YI C /EPPP�X et = /vo i t r c 3 D r v^ - - - - - VALUE 69- (�gRAGE NoGrG � I( -- -- - -- - -� _Top- 27 p �rngw- C - —. 8 t cT� T_ .f ,ol car' J C OL i I I i X2/7'/' __ __ -- __ __ __ __ __ __ - _. __ _ __ __ __ __ _ - HEAD CAPACITY CURVE w w � MODELS 53- 55 -57 -59 Model "53/55/57/59' 25 Ft. Meters Gal Ltrs. 6 20 5 1.52 43 163 W 10 3.05 34 129 S2 15 15 4.57 19 72 } 4 o Lock Valve: 19.25 ft. (5.9m) Q 10 0 ~ 2 3 15/16 6 5/32 5 — 4 5/8 1 112 —11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 / 3 15/16 LITERS 80 160 0 4 1/16 FLOW PER MINUTE easa9, CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. • Alarm systems available. 10 1/16 • Duplex systems available. 1 3 3/32 SK858 SELECTION GUIDE Single Seal Control Selection Lislings 1. Integral float operated mechanical switch, no external control required. Model Volts -Ph Mode Amps Simplex Duplex CSA UL 2. Single piggyback variable level float switch or double piggyback variable level M53/55 & M57159 115 1 Auto 8.0 1 or 1 & 7 — Y Y float switch. Refer to FMO477. N53155 & N57/59 115 1 Non 8.0 for 2 _ &6 3 or 4 & 5 y Y 3. Mechanical alternator "M -Pak" 10 -0072 or 10.0075. BN53 115 1 Auto 8.0 — y Y 4. See FM0712 for correct model of Electrical Alternator. ' BN57 115 1 Auto 8.0 — N Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical ' BE53157 230 1 Auto 4.0 — Y Y Alternator (3) or (4) float system. D53/55 & 057/59 230 1 Auto 4.0 1 or 1 & 7 — Y Y 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simpiex or E53/55 & E57I59 230 1 Non 4.0 1 2 or 2 & 6 1 3 or 4 & 5 Y Y 2 pump operation, P/N 10 -0002. ' Single piggyback switch included. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, PIN 10 -0003. j A CAUTION 1 For information on additional Zoeller products referto catalog on Piggyback Variable Level Float Switches, FMO477; All installation of controls, protection devices and wiring should be done by qualified Electrical Altemator, FM0486; Mechanical Alternator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should befoilowed including the most ' Simplex Pump Control /Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. "- MAIL TO: R0. BOX 16347 L . Louisville, KY 40256-0347 Manufadurersof.. \ 7 SHIP TO 3649 Cane Run Road ` ® Louisville, KY 40211-1961 i vG[/TY PutfPB iVCE �i9c�cF ( p httpYAvww.zoaller.com PUMP LO ) 78- 2731.1(800)928 -PUMP Q 502 7 • 'FAX(502) 774.362 0 Copyright 1998 Zoeller Co. All rights reserved. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the aa4 134 AM 7 -A L residence located at: ( 5 U> Y., is 1 /,, Sec. _ �� , T _ N, R Town of 20M�/1j c T St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be function' properly. Last time serviced �,i� � /yyy /�iDB�i.�.GGL �iIZ�Z4� Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete !�_ Steel Other Manufacturer (if known): tLjg= - - Age of Tank (if known) : f Z j ( 17 ( ignature) ( ame) Please Print 1`'P1 ?S .2121 2V/ (Title) (License Number) ? V (Date) Form to be completed by licensed plumber (s 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name S r . ff - , m l - Signature MP /MPRS LATIO . _. 1255 Wisconsin Department of Commerce SOIL EVA A''' page 1 of 3 Division of Safely and Buildings in accordance with Comm 8 W Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. mSt. C foix include, but not limited to: vertical and horizontal reference point (BM), d r Parcel I.6 percent slope, scale or dimemsiors, north arrow, acrd location and d�tance to ne f 032 -1070- 10-000 Please print all information. R Dot Personal information you provide may be used for secondary purposes (Privacy Law, s. 15,04 (1) (m)). Property Owner Property Location vc J Brantal, Donald And Carol Govt. Lot SW 1 /4 SW 1 k S 25 T 31 NR 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 710 191 st Ave. 4 Vol. 10 P. 2776, Doc. * 517969 City State Zip Code Phone Number I City I Village a Town Nearest Road Somerset I WI 1 54025 1 Somerset I 191St Ave ; j New Construction Use: jo Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Pitted glacial drift Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.4d 1sgft r ating Possible system elevation for replacement area is (high trench) 96.5' (mid) 96.5' (low ) S5.B`- Boring # Boring Pit Ground Surface elev. 98.66 ft. Depth to limiting factor $4+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf 'Eff#1 *E 1 0 10yr314 none sl 2fsbk mfr cs 2f .6 1.0 2 5 -23 10yr4/4 none grsl 2msbk mfr gW If .6 1.0 3 23-38 7.5yr4/6 none sl 1 msbk mfr cs .4 .7 4 38-62 7.5yr4/4 none sicl 2fsbk mfr cs A .6 5 62 -84 10yr5/6 none Is 1 msbk mvfr - - .4 .6 Horizon 5 has 1" bands of 5yr4/4 sicl 2fsbk. Boring # Boring jg Pit Ground Surface elev. 100.56 ft. Depth to limiting factor 91+ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF *Eff#1 I "Eff#2 1 0 -5 10yr4/3 none sl 2fsbk mfr cs 2f .6 1.0 2 5-13 10yr4/4 none I 1mpl mfr gW If .4 .6 3 13-46 j 7.5yr6/4 none grsl 1 msbk mfr cs - .4 .7 4 46-67 7.5yr4/4 none sir 2msb mfr cs ---- CO .8 5 67 -91 7.5yr4/6 none sl 1 msbk mfr --- --- .4 .7 Mfg. -2 2" z% ' Effluent #1 = BOO ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <, V mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Eyaluatjon Conducted Telephone Number 1595 72nd St. New Richmond, Wl 54017 C/ 0 715 - 247 -2941 Property Owner Brantal, Donald And Carol Parcel ID # 032 -1070- 10-000 Page 2 of 3 3 ] F Boring # Boring Pit Ground Surface elev. 98.16 ft. Depth to limiting factor 84+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 '0112 1 0-9 10yr3/3 none sit 2mgr mfr cs 2f .6 .8 2 9-19 10yr4/4 none sit 2fsbk mfr gw 1f .6 .8 3 19-35 10yr5/4 none sl 1fsbk mfr gw — .4 .7 4 35-70 7.5yr5/4 none sl 1 msbk mfr cs --- .4 .7 5 70-84 7.5yr4/6 none vfsl 1 msbk mfr — — .4 .8 ❑ Boring # .! Boring f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 F—I Boring # �j Boring ,.j Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots *Eff #1 'Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <,0 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil and Site Evaluations Name: Donald and Carol Brantal Thomas J. Schmitt, CST 227429 Address: 710 191st Ave. 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: CSM VOL 10 Page 2776 Doc. No. 517969 Lot No.: 4 Legal Description: SWl /4 SWl /4 S25 T31N R19W Township of Somerset Bench Mark EL IOO.O0' Top of inspection plug on septic tank Alternate Bench Mark EL 104.43' bottom of siding on attached garage Slope= 8% Contour Line EL NA Scale I"= 40' 9 $ 4 o1,J - r-e.,.C4 QU 1 i l Z• ern �L i 7S 1 1� 3y w1 L -10 V. f 133 �� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer 13/1,4 N 7 j Mailing Address 7J l9/ sr At/ Property Address 7 — (Verification required from Planning Department for new construction) City/State c3QMLE !1 sr i � fie' . Parcel Identification Number 63-1- //0 7D - /0 - 0100 i LEGAL DESCRIPTION , 3q( i Property Location SW_ V 4, • ,S W ' /,, Sec. . T 3i N -R_j _W, Town of F11 C�4s4 - Subdivision Vo �P) � , Lot # . Certified Survey Map # j_7 / , Volume _ ff� . Page # Warranty Deed # 7 713 g , Volume 4 3 , Page # / 9� Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 3 ,59 q SU G� P D SS/.s- e r use and maintenanceof your se' ptic system could result in As premature failure to handle wastes. Proper maintenance �P ro Ix 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 e, mastCrplumber, journeymanplumber, 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 daysdthe three vearexpiraW n date. / L SIGNAMUW OF APPLICANT DATE OWNER CERTIFICATION 1 (w) certi fY e (that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the ,pmperty describe.0 above; by virtue of a warranty deed recorded in Register of Deeds Office. - DATE 5IGNAPCJR? OF.APpLICANT A in the sanitary permit being revoked by the Zoning Department. y information that is mis- represented may re •t Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - L of ?i FILE MFORMATION- SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l ❑ NA Permit i Septic Tank Manufacturer — ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 80O gal ❑ NA Estimated flow (average) g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer - CL E/2 ❑ NA Soil Application Rate , gal/day/ft'. Pump Model .5 3 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit P NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L * ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA L i i= u 11 Other: ❑ NA Other: ❑ NA �\ 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA i MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 o (1(s) (Maximum 3 years) [3 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once'every: M Yea�� GIs) (Maximum 3 years) ❑ NA Clean effluent filter n�t At least once every: ® 0 ye month ar(s) ) ❑ NA um ❑ month(s) [I NA Inspect p pump controls & alarm At least once every: 0 year(s) Flush laterals and pressure test At least once every: ❑ Y ear( ) (s) 8 N Other: ❑ month(s) ❑ NA I At least once every: ❑ year(s) Other: ❑ NA r MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding ` r 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- 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment i 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the um tank removed by a Septage Servicing Operator prior to restoring P P power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics, baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT service the following steps When the POWTS fails and /or is permanently taken out of se g s shall be taken to insure that the system is P property 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 bDp repaired the f llow in�g� measures have been, or. must be taken, to provide a code compliant replacement system: w Cx �n — a s lcr • A suitable replacemiAt area has been evaluated and may be utilized for the location of a replac&nent s it absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 10 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name , C — Phone r Phone l i SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name U Phone Phone 71,51 This document was draped in compliance Code. i onsin Administrative 4 1 Z& 3 W sc Hance with ch Comm 83.2212)Sb1{1)td{ &if) and 83.5 t ), () (), P P - i ,I 2636 ? 03 -7 -7 JL --3 -7 c9i STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Eric R. Peterson and Christine L. RECEIVED FOR RECORD Peterson, husband and wife Grantor, 08/11/2004 10:09AN and Donald G Brantal and Carol A Brantal husband and wife WARRANTY DEED Grantee. EXEMPT i Grantor, for a valuable consideration, conveys and warrants to Grantee REC the following described real estate in St. Croix County, State of TRANS E FEE: 727.50 Wisconsin (if more space is needed, please attach addendum): COPY FEE: Part of the SW 1 /4 of SW 1 /4 of Section 25, Township 31 North, Range 19 CC FEE: West, St. Croix County, Wisconsin described as follows: Lot 4 of PAGES: 1 Certified Survey Map filed June 17, 1994 in Vol. 10, Page 2776, Doc. No. 517969. Recording Area Name and RetuTIVY&ER BANK PO Box 188 �. Osceola, Wl 54020 032 -1070- 10-000 Parcel Identification Number (PIN) This is homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of Au¢ust 1 2004 * * Eric . Peterson — * * Christine L. Peterson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Eric R. Peters and Christine L. Peterson, STATE OF ) husband and wife ) ss. County ) authenticated this day of Aug_us_t_ _ _ 2004 Personally came before me this day of the above named * Kr istin Oglan TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY - Attor Knstina Ogland Hudson, W I 54016 Notary Public. State of I All De�� wZo is o f Y(4�.4 517969 CERTIFIED SURVEY MAP LOCATED IN TIIE SW 1/4 OF THE SW 1/4 OF SECTION 25, T. 31 N., R. 19 W., TOWN OF SOMERSET, ST. CROIX COUN'T'Y, WISCONSIN. OWNER LEGEND LINDA I1ILERS Found Aluminum County Section Corner Monument 223 -- 13TH STREET • Found 1" Iron Pipe HUDSON, WI 54016 o Set 1" x 24" Iron Pipe weighing 1.68 pounds per linear foot. UNPLATTED — LANDS S88 0 47'47 "E SURVEYED BY : i 1 8. 29' T NORTH LINE OF RON JOHNSON LAND SURVEYING S 1/2 OF S 1/4 OF SEC.25 - 19. P. 0. BOX 194 NORTH AMERY, WI 54001 s AFOPI' V y tt)8 -2601 o <v z hi 1 7,'941 I z - - - 0 F �� SCALE= I '= 100' ° O ST. CROIX COUNTY i� 0 ��',, 2�6 /1 0 50' loo' 150' - ,omprehensive Plannir 1-1 r N �S� 2 r a zon M t 10 - - M - . LOT 4 �i �� F4*ks C ppirYMte9 1 131,266 SQUARE FEET if not recorded tS \ M Within 3() days of i - - 3.01 ACRES % Cn approval date h approval shag be o 1/4 CORNER SECTION 25, pG�' o N T.31 N., R.19 W. - - - yE J r L t ' if Ln Q \C� O a+ 6+ \ Ln to I Z aj 0J /\' O' CD z I--1 O 1.= RIGHT -OF- 6 rp �o�� � \Z \J� H zz WAY. �� M O Se9 "E 59.39' 0 , ,' f 1.3 P ° N I o 3.4 0 i 95 ..� -- -- Z ^� ' z - -192 7 19 P3 ERG' M N �I 0. o PRIVATE ROA FILED A w - N89 "W ,33• °5 £ W A 139.68 JUN 1 7 1994+x- 9 JAMES O'CONNELL o ; �W Z Register of Deeds C. S. M . SL CrotX Co., Wi 'n Cil 0 -- m , I - V. 9� P. 2436 n 1V N Radius Central Angle Chord Bearing Chord Length w 0 ;L N CURVEQI•' 167.00'' 32 °43 S74 °18 11 W 94. 07' CURVE(k) 233.00' 32 S74 *18 5 "W 131. ` S W CORNER SECTION 25 Tangent Bearings for Curve 1 and 2: S57 °57 "W T. 31 N., R.19 W. N39 0 19' S3'1V This instrument was drafted by Ronald F. Johnson .5/nf lo % » �d .2 ?J VOLUME 10 PAGE 2776 �N�L' STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / _ _ �.�,�/� ADDRESS SUBDIVISION / CSM# Z /Q�22 7e-" LOT SECTION ,.-� 5-- T -R W, Town of ST. CR IX COUNTY, WISCONSIN PLAN VIEW SHOW EVERY EET OF SYSTEM 7` Ali B / i i i i /d INDICATE NORTH ARROW Provid 'setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank ivanhole cover- BENCHMARK: _ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: J/j),�p,�� Liquid Capacity: Setback from: Wel House �� ' Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length _ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House S� ' Other ELEVATIONS i Building Sewer ST Inlet. R7, ST outlet PC inlet PC bottom Pump Off Header/Manifold ��� � 7 Bottom of system 1 r'Nas - ?X,99 Existing Grade y�q_7 Final grade 7 DATE OF INSTALLATION: PLUMBER ON JOB: ` LI LICENSE NUMBER: INSPECTOR: w,�con b Department of Industry PRIVATE SEWAGE SYSTEM County: abor and Human Relations ' ST. CROIX Safety and Buildings Division INSPECTION REPORT (ATTACH TO, PERMIT) Sanitar Permit No.: GENERAL INFORMATION P r;riL N In NDA R ❑ City ❑ Village R Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No 0, X94nQ41R TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z �. -� Benchmark 05 / 60, Dosing j � Aeration Bldg. Sewer Holding St /Ht Inlet `7.6.7 q7.7( TANK SETBACK INFORMATION St/ Ht Outlet 753 TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic > J, / >50 ' NA Dt Bottom Dosing NA Header / Man. 2A qT,1 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TD H Lift Friction System TDH Ft Forcemain Length [ Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �a �P I-, I DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufa SETBACK 0 CHAMBER INFORMATION TypeO � _?t o Mode Number: System: 5U u;r.0 1.1 f 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.) � LOCATION: SOMERSET 25.31.19.346A,SW,SW,LOT 4,191TH AVE. 4, Plan revision required? ❑ Yes ❑ No %? Use other side for additional information. �- OZ f G 1 SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 i 3 m I SANITARY PERMIT APPLICATION ��- In accord with ILHR 83.05, Wis. Adm. Code COUNTY . STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than ❑ �� q "'A 9 8% X 11 inches in size. Check i revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION ` '/4 ' /a, S T jr, N, R (or)660 PROPERTY OWNER'S MAILIN ADD SS LOT # BLOCK # CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION N ME OR CSM NUMBER _ ITY II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD " ❑ Public ICJ 1 or 2 Fam. Dwelling --#� of bedrooms-- ARCEL AX Nu ERO C rJ Ill. BUILDING USE: (If building type is public, check all that apply) /Q /Q 1 ❑ ApVCondo 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 ❑ Hotel /Motel 9 ❑ Office /Facto 13 ❑ Other: Specify 5 Office/Factory IV. TYPE OF PERMIT onl Check one in line A. Check line B if applicable) ( Y A) 1. ®New 2. El Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued i 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 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill 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.) PROPOSED (sq. ft.) (Gals/day sq. ft.) (Min.i(nch) ELEVATION j / Feet Feet VII. TANK CAPACITY Site Fiber- Exper. Manufacturer' INFORMATION in allons Total # of Concrete Prefab. s Name Con- Steel Plastic New istin Gallons Tanks glass App. Tanks Tanks structed Septic Tank or Holdina Tank " 0 El Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatiofi of the onsysp ewage system shown on the attached plans. Plumber' Name (P int - Plumber Si re: o s) MPJMPRSW No.: Business Phone Number: Plumber's Address (Street, CI , State,, Zip C e IX. CO NTY /DEPARTMENT USE ONLY F Disapproved ry Permit (includes Groundwater a e ssue Issuing Ag t Sign Approved F1 Owner Given Initial �/� urcharge Fee) / �+ Adverse Determination Q X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber T INSTRUCTIONS s �, 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. 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 pumped by 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 & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; 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 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, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) 9� ' ` � a- -17© rte' 62, , 01- o /.il / ��r � J�l��1D.�'/ii,�i,, f' (,.o�c �SW�S<J� J S <cr�S - � /. �� /� �/��✓ SV �\ 3. a \ �Qr � � .37 Wisponsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of Labor ar4 Hurnan Relations g 'Divisipn of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT ': 114 1/4,S T N,R G Z(o& PROPERTY WNER':S MAI�G DRESS LOT # BLOC # SUBD. NAME OR CSM # CITY STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE ' MOWN I NEARES ROAD ) [� New Construction Use [x] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd /ft , ti trench, gpd /ft Absorption area required bed, 11 91X/ _ trench, ft Maximum design loading rate _bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) Shy y ft (as referred to site plan benchmark) Additional design / site considerations Parent material �Pl r _ �� /A /D� q r1�� �� Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [OS OU 0S 0 ®S OU [CIS OU OS ®U OS CC U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxtdary Roots Bed Trends Ground elev. Depth to limiting factor Remarks: Boring # f :.;• r Ground elev. ff ft. r� S — / Depth to limiting factor ;7 Remarks: CST Name: — Please Print J Phone: Address: S Signature: / Date: CST Number: �, PROPERTY OWNER SOIL DESCRIPTION REPORT Page.,,,?—of-3� PARCEL I.D. # t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTrench \4: - Lj ff'��.. )•: }•kFi.J i Ground 3 elev. Depth to limiting factor Remarks: Boring # / :a >..:: Ground j elev. Depth to _ limiting factor ; a Remarks: Boring # Xj Ground /- elev. 2L7 ft. � _ _. Depth to limiting factor > 9is9is Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 76 Undale a bevel (715) 247 -3079 ament Land Development C90oration % . . M ��' qA 964 192nd Ave New Richmond, W1 54017 U _ O 1�_1�fjr j(mj�j BEDROOM 2 13 -3 x 9..11 MASTER BEDROOM 1 1 -3 x 14 5 y x4 I BEDROOM 3 9 - -10 x 9 -II G iWi I i 1 HAIH 1 JEjAIH 2 (( �i KITCHEN GARAGE 9 -10 x ,0_F , - 4 FOYER y I LIVING DINING 14 -11 X 17 -3 10 - 1 11- 1 0 Garage is Included. Model............ .....................R23 Length... 52'-()" Depth., ................................ 47'-6" Living Area .............. s,f. STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER - E .,-, L MAILING ADDRESS �.,Ly I !2 !-p - rev 41-e ✓� r -� Ec / r ` PROPERTY ADDRESS �f Q f Cf/ / ,, 1 �n�, v ►- c}�(?� Lam/) (location of septic system) Please obtain from the Planning Dept. CITY /STATE ,� r s'� ," y PROPERTY LOCATION ( !O) 114, ( d 1/4, Section T N- R TOWN OF �ti �^ ,f ST. CROIX COUNTY, WI C SUBDIVISION - T� a7 NUB 7 CERTIFIED SURVEY MAP 10, PAGE ,- 26 , LOTNUMBE R 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, t by the Wisconsin DNR. Certification stating that your septic has been maintained must be com eted an returned o the St. Croix County Zoning Officer within 30 days of the three year expiration te. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i 517969 CERTIFIED SURVEY MAP LOCATED IN 11 lE SIV 1/4 OF 1'11E SIV 1/4 OF SECTION 25, T. 31 N. , R. 19 W. , TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. OWNER LEGEND 9 Found Aluminum County Section Corner Monument LINDA 0ILL''RS 223 -- 13111 STREET • Found 1" Iron Pipe HUDSON, WI 54016 o Set 1" x 24" Iron Pipe weighing 1.68 pounds per linear foot. UN LANDS S88 047'47 "E 7 _ SURVEYED BY : -. (I8. 29' ` -NORTH LINE OF RON JO[tNSON LAND SURVEYING S I/2 OF SW 1/4 OF SEC.25 - 19. P. 0. BOX 194 NORTH aaAh{I;RY, IIV��Iyy 54001 N-F�RVl/��8 -z601 ` �G z ° ° JGii 17341 I z -. - - " �` SCALE= I 100' a Poo fit_ Iv 0 50' 100' 150' ST. CROIX COUNTY I w ;amprQhensive Plannir Zoning and I� LOT `" c� �O to O„� ay Farks Committee I m p Cn 131, 266 SQUARE FEET H I. not recorded 3. oI ACRES S� within 30 days of _ _ _ "� approval date n Cn 4 approval shag be 0 1 ' no .0 .4 0 W 1/4 CORNER o O M SECTION 25, �OP��' o T•31N.,R.19W. - - - 0 g�, n ° �' w I D Qo J��� °' Z � ° o:, b o .� I Z J 0 Z N_ W 1 1 i .06 �O Z °\O p z � I= k RIGHT-OF- N�(7- WAY, G� nl O 589 "E 59,39' r O , ! P S � Q / N t o 133.40' �li� co S89 19 P3 E -' M z 192 rn N ; 0.0 wP � AILED o . PRIVATE R�A� Pi N89°19'53 W 05 n JUN 7 1994 a- a 139.68' ` 1 8 - _m� ` JAMES O'CON � NELL a Z Register of p8Od3 0 1� I C. S M . sL Croix Co., WI 0 I V.9� P. 2436 N m -- N N Radius Central Angle Chord'Bearing Chord Length Lt w N �o CURVE(D 167.00' ' 32 °43 S74 °18 11 W 94. 07' ' CURVED 233.00' 32 43' 07" S74 °18' 33.5 "W 131.2 5' ,\ SW CORNER SECTION R Tangent Bearings for Curve 1 and 2: S57 °57'00 "W T. 3 IN., R.19 W. N89 ° 19' S3 "W I 'This insti unent was drafted by Ronald F. Jolvison (VOLUME 30 PAGE 2;7 <� S T c - 1 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Location o property /4 &( 1/4 , Sect on _ , T I N d _ W Township Mailing address Address of site 7 ) Subdivision name - y` �_ Lot no. Other homes on property? Yes �� No S IfW. ��� a77� Previous owner of property r' V ct Total size of property Total size of parcel a 4e r.�S Date parcel was created Are all corners and lot li es identifiable? 41- No Is this property being developed for (spec house)? d es No Volume /6 and Page Number 0 as recorded with the Register of Deeds. -•----------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that•.,Y (we) _4;R-(are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. �'� `� D _ � and that- --I- (we) presently own the proposed site for the sewage disposal system -ar- I --(vet e same s een du iy re s er o ee s ignature of Applicant Co- Applicant n,4 n of 4irrnat i1YE? t� .. i y uPt ut uct �. �.u�a� . a ,v conv� nnccs �xu t A E +' t CLAM DEED 16 7 PAGE 21 1 � - �- !LT. C. 'JUN 2 1994 quit - claims to 5 :00 - P Lin a e Development Corporation �� "►� �. 3!�1 the following described real estate in t • Cr OlX County, State at Wisconsin: RETURN TO SEE ATTACHED DESCRIPTION Tax Parcel No: �.. At V i This iS not homestead property. gy*� (is not) 2nd day of June Dated this , (SEAL) SEAL) , (SEAL) (SEAL) AUTHENTICATION , ACKNOWLEDGMENT Signature(s) "�`� STATE OF WISCONSIN C� ,� X ss. L c� `�1 U� � \ County. tk- tg _ came before me this day of authenticated thiday of ­ 1 9 the above named ry/ e �. •0 TITLE: MEMBER STATE BAR OF WISCONSIN to me known to by the s who a ute the oin fore (If not, ck wle ;` ,q ame. authorized by § 706.06, Wis. Stats.) foregoing Inst ument an ��"''r'' THIS INSTRUMENT WAS DRAFTED BY Linda R: Ehlers • Notary Public ` ~tee ounty, Wis. My commission (Signatures may be authenticated or acknowledged. Both ssion is ermanent. (If no , state expiration l are not necessary.) date: °� 19') 883 NTF Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Grew Say, W154307 -0208 QUIT CLAIM DEED FORM No. 3 -1982 VOL 1081PAGE212 Land Contract Leonard W. Brown to Linda R. Ehlers DESCRIPTION The South Half of the Southwest Quarter R an(})(19) West o EXCEPT the Township Thirty -one (31) North, o g e Nineteen parcels: 1. commencing 16.5 feet North of the Northwest Quarter of the South Half of the South Half of the South Half of the Southwest Quart er (NW} of Si of Si of Si of SW}); thence North on the West line o said South ai Qu est feet; thence East, parallel with the (SW}), 660 feet; thence South, parallel with said West line, 396 feet; thence West 660 feet to the Point of Beginning. 2. Ccamencing at the intersection of the East line of State Highway 35 and the North line of the Southwest Quarter of the Southwest Quarter (SW} of SW ; thence South 577.5 feet; thence East 157 feet; thence North 577.5 feet; thence West to the POINT OF BEGINNING. 3. Cccnvancing 742.5 feet North of the Southwest corner o 7 hetS outhwest N Q uarte r of the Southwest Quarter (SWj of SWJ)% thence Eas 211.1 feet; thence West 157 feet; thence South 211.1 feet to the POINT OF BEGINNING. 4 Lots 1 and 2, Certified Survey Map, recorded May 18, 1978 in Volume 11 2" page 1 591, as Document No. 348684. 5. Certified Survey Map, recorded August 8, 1978 in Volume "3 ", page 654, as D No. 350754. orded May 31, 1979 in Volume "3 ", Page 810, 6. Lot 1 of Certified Survey Map rec as Document No. 357220. • 7. Lot 2 of Certified Survey Map, recorded February 10, 1988 in Volume 11 Page 1938, as Document No. 434415. 8. Lots 1 and 2 of Certified Survey Map, recorded in Volume "8 ", page 2109► as Document No. 448489. r uepartment of Revenue �� " "`' — — U Reject I 0 the SURVEYOR'S CERTIFICATE: I,Douglas J. Zahler, a Registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped a part of the SW 1/4 of the SW 1/4 of Section 25, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing at the southwest corner of said Section 25; thence, on an assumed bearing along the west line of the SW 1/4 of said Section 25, N00 °40'07 "E a distance of 742.55 feet; thence S89 °19'53 "E a distance of 192.79 feet to the point of beginning of the parcel to be described; thence N00 °23'24 "E a distance of 575.87 feet to the north line of the south half of the southwest quarter of said Section 25; thence, along last said north line, S88 °47 "E a distance of 118.29 feet; thence S32 °03'00 "E a distance of 451.21 feet to the northerly right -of -way of a Private roadway easement; thence, along said right -of -way, S57 °57'00 "W a distance of 312.00 feet to the point of curvature of a 167.00 foot radius curve concave to the north, whose central angle measures 32 °43'07 "and whose chord bears S74 °18'33.5 "W a distance of 94.07 feet; thence southwesterly along the arc of said curve 95.37 feet to the point of tangency; thence N89 °19'53 "W a distance of 6.60 feet to the point of beginning. Containing 131,266 square feet (3.01 acres). Subject to all easements, restrictions and covenants of record. Together with an easement for ingress and egress on a 66 foot parcel that adjoins the described parcel on the south, with the north line of said 66 foot parcel extending westerly, from the southwest corner of the above described parcel, to S. T. H. No. 11 35 ". I further certify that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the subdivision regulations of the Town of Somerset and the County of St. Croix in surveying and mapping the same. G Dougla J. Za ler R.L.S. No. 2145 bate Of wls Ron Johnson Land Surveying 4� CO P .O. Box 194 4 DOUGLAS J. Amery, WI 54001 CO) ZAHLER = * S -2145 HUD30N, W1 . O� COUNTY GENERAL NOTICE SUFN c� Each parcel shown on this map is subject to state and county laws, rules and regulations (i. e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office for advice. I VOLUME 10 PAGE 2776 i