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032-1090-60-000
Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499293 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: Brunell, Christopher Somerset, Town of 032 - 1090 -60 -000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town /Range /Map No'. CST BM Elew Insp. BM Eew 7 /oD l C S 33.31.19.4326 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,• CAPACITY STATION BS HI FS ELEV. Septic Benchmark (,J e,_ k �3 F - ►�.. �e F 1 � AI F Aeration Bldg. Sewer Holding SUHt Inlet 3. �8 /a z . - 7 TANK SETBACK INFORMATION SUHt Outlet .3, S' /6Z. 3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic w3 3 yS ioo , __- Dt Bottom Dosing Header /Man. /l•32 Aeration Dist. Pipe 11.51f 94. 37 Holding Bot. System 93 q 7 6h- Final Grade /Z PUMP /SIPHON INFORMATION (p, �] r 'l 9• Z j ' Manufacturer Demand St Cover GPM ('; lt�, Lod Model Number TDH Lift Friction Loss Syst ead 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 — W U 1 7- _ "�_ \ __1 w J►.Uti�v SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufactured ° r INFORMATION CHAMBER OR —L7�t" • �t'I�aa �dL Type Of System: n i UNIT Model Numb L Ov ✓e ,,�� orn,X. 3 ° 9n /3L ��, c✓ DISTRIBUTION SYSTEM 1`7 1 = 3 d- Header /Manifold � Distribution x Hole Size x Hole Spacing Very AiS Intak � � f ' I ' l Pipe(s) \ `� \ V .t�' Length �7 Dia �7 Length Dia Spacing G 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 5 . •74, es g i Topsoil Bed[Trench Ed 4 ':I No es Q No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! / Inspection #2: / / Location: 1844 45th Street Somerset, WI 54025 (NE 1/4 SW 1/4 33 T31 R1 9W) NA Lot 1 Parcel No: 33 1.19.432B 1.) Alt BM Description= ` 1 `"� -l.� ���- 61 " 2.) Bldg sewer length = C.. y <t S, , - amount of cover = It Plan revision Required? Yes X1 No Use other side for additional information. 7 Date I Signatur Cert. No. SBD -6710 (R.3/97) Commeree.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 , I scMadison, 537W -71 SanitaryP Number (to he filled in by Co.) epartment of Commerce action Ntrtrrber Sanitary Permit Applica State T � A In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 (m ), Stats. _9&4nZ I. Application Information - Please Print All Information Property Owner's Name n Parcel # Property Owner's Mailing Address Property Location y l J Govt. Lot City, State q Zip Code ne _4L y., Section (circle one T -31 N; R ,Zq E orW H. Type of Building (check all that apply) Lot # / I or 2 Family Dwelling - Number of Bedrooms ubdivision Name y rooms �i'� S>/Al - ✓/ Block # ❑ Public /Commercial - Describe Use 'vJ El city a CSM Number ❑ Village of El State Owned - Describe Use � / }31 Town of 7.c9/sa.��Sk III. Type of Permit: (Check only one box on line A. Complete line B if applicable) RB. L1 New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ ther Modification to Existing System (explain) WW S List Previous Permit Number d Date Issued El Permit Renewal ❑ Permit Revision 11 Change of Plumber El Permit Transfer to New / Q Before Expiration Owner 2 {/ / .V 2— IV. Type of PO WTS S stem /Corn onent/Device: Check all that appi X Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) retreatme t Device (explain) S - V. Dispersal/Treat ent Area Information: s 3 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersal Area Propose (sf) System Elevation p , 1 Sb 93. S VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units W U y b m N New Tanks Existing Tanks p o. U in ti on w C7 G4 Septic or Holding Tank znnn Dosing Chamber d J VII. Responsibility Statement- I, the undersigned, assume respons' i 'ty for installation of the OWTS shown on the attached plans. Plumber's V c (P ' t) Plumber's igna MP /MFRS Number Business Phone Number _ S Plu er's ddress (Meet., City, State, Zip Code) 5 VIII. ounty/De artment Use Onl Permit Fee Date Issued ssuing Agen igna e Approved Disapproved $ ❑Owner Given Reason for Denial r-- a, o- IX. Conditions of Approval/Reasons for Disapproval 3 E/ 1 S7_IN G SEPTIC 771AJK e1g1A1r1-r1- t 7 SYSTEM OWNER: BI` 1.gI4,ov/DO' Nc Pr. Dory), -r` r3.3:?. i Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber_ c o m ete lane for the system and submit to the County only on paper not less than 8 I/2 x 11 inches in size as per applicable code orc5 I SBD -6398 (R. 01/07) Valid thru 01/09 ��l�� C-�Yis �Fi�r�l -� ��1r -..� �¢u..,���� /1���- si-J� �.�c� 3�.s' - T.� /� � �'�� .. ��- � i � /,,gip ���� - d` .��� � ��� _ _ -- ✓� r �a� " a 0 � e �� I i � � �� � �� �.�' 9S /ir 7 �--- -- ____ �G � � i C : � �� , c� _3,i��S � / -�� ,mac ���; ��/ � ' - �� C - jl�"is�Pd.E� -� /fiin.�..Gr �u.�.��/ /J��� s6J� .S�'e ,3�- T...� /.11v �J�'GL ������Ef t�� � ��� // / � ,I �' � G ..�C..P' /,� r mGO� f � —�/l�p W� /l •�� ���. ;� ,8,v,� _ � �J��J� y - ��`` -� ,_ ✓mot ��� �J rraarlF o? t] _ - _ _ 'o a ___ _ _ � �� 8s9s ��_ /ii �� �f�c �� /�'DG%��� lU.��r's Wisconsin Department of Commerce S EVALUATION REPORT Page of J Division of Safety and Buildings -- in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not ess an 81/2 x 71 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /� - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 Z- 10/ 4 o " b Please print aH information. I Revs Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). (�� w Properly Owner n Property Location f ,!// - G 1 gell Govt. Lot NE 1 /45 `,/ 1 /4 S ,3,3 T3 / N R 2 (00 0 Property Owners Mailing 9��th S Lot Blo 'Stibd Name or CSM# y 76MeT State Zip Code Phone Number El city ❑Village Town Nearest Ro 7 l t- 5V,O' i (7/.3`) 217- Sa/n �h Sf ❑ New Construction Use: 21 Residential /Number of bedrooms Code derived design flow rate GPD 6.Replacement ❑ Public or commercial - Describe: r� Parent material r 41) C) 6t VOJ4 /at.'.17 MIM Mon if i pplicable General comments � �G and recommendations: FEB 2 0 2007 ROIX COUNTY Boring # E] Boring pit Ground surface elev. L 7 1 O ft. Depth to limiting factor Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I *Efr#2 © -l6 �oYR 14. SL / as Irn D, y v 2-] F Boring # Boring " ® Pit Ground surface elev. ft. Depth to limiting factor 7 �� S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f ! in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 2 /2- 7�YiQ 6 I " /M 6' �, 6 2� ya /oY� 6 011 �s me c c" * Effluent #1 = BOD > 36 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BOD < 30 mg1L and TSS 5 30 mg/L CST Name (Please Print) p� � � / e / r SI� Address /✓ Date Evaluation Conducted Telephone Number Property Owner C� e ll Parcel ID# 0 .32 Page 2 of 3 a Boring # ❑Boring /" [� pit Ground surface elev. 7 ft. Depth to limiting facto Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 r -io r,�� P1 Pr C L- 2- , L 0, � 2 10-22 7 /1 `� /j/ S•� Z/�SG/� /��� &J e-, 0, `/ 3 36 I'4�Q s SG s�� m 0,( 1, Z t ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Efi#2 * Effluent #1 = BOD, > 30 < 220 mg1L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mg/- and TSS < 30 mg1L 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- 2648777. SBD -8330 OL07 /00) OWNEk Page 3 of 3 Name Brian Parnell Address CST 231314 sorr► Pis�� Gv�' Syp:2S Date A Benchmark 1 OP 1 PC /D6. A Benchmark 2 70f Co ,7clete 6,.r4 e -Pl o, ❑ Soil Boring _ i Suitable Area 1 " = 40' Scale = T ' Tp 3 fle R6O 4 e I H ouse i I U �S pry 4- o. a JA 3 ` ►a` � So y t ti y ` C 3 -O ✓ 7 i /D pe f� 6. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # 2 9 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units �,O NA Pump Tank Capacity al j'NA Estimated flow (average) gal /day Pump Tank Manufacturer -9 NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer J� NA Soil Application Rate 7 gal /day /ft2 Pump Model / 46 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ONA 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 (BODO 530 mg /L *In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :!930 mg /L X�NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :00 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA n'' a y ear(s) y 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 eve n'' u ❑ month(s) (Maximum 3 ears) ❑ NA year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) aspect pump, pump controls & alarm At least once every: ❑ m l ❑ yeaarr((ss ) ) (NA .:s� aterals and pressure test At least once every: ❑ month(s) ,ANA ❑ year(s) - At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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 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. START UP AND OPERATION Page C_� of 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 p p tank removed b a Se to a Servicing Operator Y P 9 ator riot to restoring 9 P P 9 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manual) o perating t o y p g e pump c 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 When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to,providee a�code compl'ant repla system: � Z .��z��J � -74 �� ���(//N Ly' A suitable replacement area has been evaluated and may be utilize for the location of a replacement soi absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 INSTALL FR POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone -<�'q'n _1 �:j This document was dra` et ::,rp5ance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) (3), Wisconsin Administrative Code. ST. CROIX COUNTY .SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 01"erification required from 1'lannine. s Zoning Department for new cons(ruction.) City /State Parcel Identification Number - LEGAL DESCRIPTION Pro ert Location � Y J/ , .'tom , Sec. E . .21 N R-.2 LW, Town of I Subdivision ;Lot # Certified Survey Map #' , Volume 5 5' ,Page # 211, Warranty I)eetl Page # x;'_,71_ Spec house yes Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION lmhroper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofputnping out the septic tank every tluec years or sooner, if needed, by a licensed pumper. What you put into .the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the o site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the Stan g private sewage disposal system with the stan dards set P Y 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 retumod to the St. Croix.County Planning & Zoning Department within 30 days of the th►•ec year expiration date. 1 /wc certify that. all statements on this 10 are trtic to the best of my /uurknowledge. I /we ani/are the owner(s) of the Property described above, by virtue of a warranty deed recurdod in Register of Deeds Office. Number of bedrooms _ V� f� Z 1 2 rl d� SIGNATURE OF APPLICANT(S) DATE ** *Any information that is mi'sre'presented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds OfflCe and a copy of the certified survey map if reference is made in the warranty deed. (REV, 08 /05) ti7 7486'92 2 4 7 1 P 2 2 6 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD QUITCLAIM DEED 12/09/2003 01:00PH [Exempt from Fee Pursuant to aUITEXEMPT# DEED Section 77.25(8m)] Document Number REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 MADE his day of 2003, by and between CHRISTOPHER TODD BRUNELL a now married S , man and PAMELA A. BOERUM n/k /a PAMELA A. BRUNELL, a now married woman, whose post office address is 1844 -45` Street, Somerset, WI 54025, Recording information Grantor, and CHRISTOPHER TODD BRUNELL and PAMELA A. BRUNELL, husband and wife, whose After Recording Return to: h post office address is 1844 -45 t Street, Somerset, WI MW r9lAfdirlg,l'Ot<Jtrl 54025, Grantees. recording information W. AccuRe Inc. t90 obo3 I WW PROPERTY TAX ID #: 032 - 1090 -60 -000 WITNESSETH, that said Grantors, for in consideration of the sum of TEN ($10.00) DOLLARS, and other good and valuable considerations in hand paid by Grantees, the receipt whereof is hereby acknowledged, do hereby remise, release and quitclaim unto the said Grantees forever, all the right, title, interest, claim and demand which the said Grantors have in and to the following described lot, piece or parcel of land, situate, lying and being in St. Croix County, Wisconsin, to -wit: THE FOLLOWING DESCRIBED REAL ESTATE IN ST. CROIX COUNTY, STATE OF WISCONSIN: PART OF NE 1/4 OF SW 1/4 OF SECTION 33, TOWNSHIP 31 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, WISCONSIN, DESCRIBED AS FOLLOWS: LOT 1, CERTIFIED SURVEY MAP DATED APRIL 30, 1982, FILED MAY 19, 1982 IN VOLUME 4, PAGE 1166 AS DOCUMENT NO. 377686. PROPERTY ADDRESS: 1844 -45` Street, Somerset, WI 54025 PROPERTY TAX ID #: 032 - 1090 -60 -000 TO HAVE AND TO HOLD the same together with all and singular the appurtenances thereunto belonging or in anywise appertaining, and all the estate, right, title, interest, lien, equity and claim whatsoever of the said Grantors, either in law or in equity, to the only proper use, benefit and behalf of the said Grantees forever. Page I of 2 I 2471P 22? IN WITNESS WHEREOF, Grantor has hereunto set his hand and seal the day and year first written above. Signed, sealed and delivered in our presence: CHRISTOPHER TODD BRUNELL Witness Witness Printed Name cm#� Printed Name STATE OF MltdtjCSC07A ) COUNTY OF V1 ASaJ 1 LX2?] 11.1 The foreg in instrument was hereby acknowledged before me this &day of 2003, by CHRISTOPHER TODD BRUNELL, who is personally known to me or who has produced ` , as identi cation, and who signed this instrument willingly. JU A JOVE idAHM000 jN a>ty PublicL�ult@ A IqQ NOTARY PUBLIC• MINNESOTA My Cxnr „swan Expires Jan. 31, 2037 y commission expires: ( 31 IN WITNESS WHEREOF, Gr has hereunto set her han and seal the day and year first written above. Signed, sealed and delivered in our presence: 6 PAMELA A. BRUNELL f /Wa PAMELA A. BOERUM Witness Witness Printed Name m Printed Name STATE OF MISS COUNTY OF .k l The fore oing instrument was hereby ackno b efore me t his l � A da y of NOVC�MRL e 2003, by PAMELA A. BRUNELL, who is personally known to me or who has produced I as iden ification, and ho signed this instrument willingly. , lj, o aiy Public Ju, I e a Me iq vorl y commission expires: 1I 1 No title search was performed on the subject property by preparer, The preparer of this deed makes no representation as to the status of the title nor property use or any zoning regulations concerning described property herein conveyed nor any matter except the validity of the form of this instrument. Information herein was provided to preparer by Grantor/Grantee and /or their agents, no boundary survey was made at the time of this conveyance. Prepared By: William E. Curphey & Associates 2605 Enterprise Road, Suite 155 JULIE A Clearwater, Florida 33759 MAHMOOD EQ NOTARYPUBIJC • MINNESOTA * c0tetttis M Et#%Jan.31, 2007 Page 2of2 �b s FILED OCT 051989x► 0 JAMES O Repisw ot Deeds / 4 x 2141 St. Cloy( CO.. VA CERTIFIED SURVEY MAP LOCATED IN THE NEI /4 OF THE SWI /4, SECTION 33, T31N, R19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. OWNED BY: CHRISTOPHER 8 PAM BRUNELL R T. 2 SOMERSET. WI 54025 NOTE: THIS MAP IS A SUBDIVISION OF LOT 1 OF THE CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 OF CERTIFIED SURVEYS. PAGE 1(66. oI z I T i I' i E E Li F: 4 E Y 1' A Y, ✓ L. 1 �_ _P J_L. _ . 1. I - 6, . � W Z O caOiF WEST LINE SE- NW �F• �• , EXISTING CENTER OF SEC. 33. 66' WIVE ROADWAY EASEMENT =0 E -W QUARTER LINE T31N R19W - ; u NB9. 30'00 'W (R. R. SPK. FOUND). 13 24. 35 ' 1 389 30' 00" E 1324.55'(TO SECTION LINE) 1 n !281.33' I SB9.30'00 "E 1291.61' 33.02' I e1 .40 CORNER _ O Ip existing house CD 1 ^ . O f N M I W b LL) existing drive I �1 j t � II Z LOT I , II ` 3 O _ 3 0 SB9• 30' 00"E 666.95' { { {{ 3 3 3 15.03 ACRES u M f 635.66' W O m (654,731 SQ. FT -) .r W Y , 31.29' N t/) 18.5 AC. EXC. R.O.W. 1 1379.541 SO. FT.! O M It ' O 1•- L OT c 5.01 ACRES o4o�.' c 'o Q - n (216.216 SO. FT.) rm INI J - n tA O w 4.30 AC. EXC. FT.) _ .1 � _ O (167.479 SQ. FT.) " 89_30' 00" W6 65.1 0 , _ 62 2 9.56' 3 -46' 0 - �., -- -- - W - 666.13' — �• a N 89 0 3 0'00"W 13 (To S ECTI O N LI 626.90 1 Q - EXISTING E 66' WIDE ROADWAY EASEMENT E J• ' d , 3• E R I I F L c: ,.,) S ) Fl ✓ E Y f!.? A (� r VC.. L_ • I , F' A G F 10 E� o N - N A 4 z v WEST LINE NE -SW S1. COP. SEC. 33.731 ". Rio W (COUNTY SURVEYOR'S N MONUMENT FOUND). oz ft- RECORDED AS O O s SET 1 "x24" IRON PIPE WEISHIN6 dry OdL; � � ME$t�, �• s V0: 1.13 LBS. PC LINEAL FOOT. V �2L WESEp S O C W ti O • s IRON PIPE FOUND ��7 S' 18 SPRtNG�ALLEY C? ,�+ tWN SCALE 1 "x 200' ;.? 9�0 F Y U W E zzx 0' 100' 200' 400' IoSp6MN Bozo JAMES . 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Parcel #: 33.31.19.431D-10 032 - TOWN OF SOMERSET Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 12/31/2009 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner %BERNARD R MARTELL O - MARTELL, VICTOR & EDITH VICTOR & EDITH MARTELL 4420 SW CRESTWOOD DR PORTLAND OR 97225 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 33 T31 R1 9W PT SE NW PT LYING W OF Block/Condo Bldg: CSM 1- 106 &E OFWLNOFSENW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 31N -19W SE NW Notes. Parcel History: THIS PIECE WAS DISCOVERED WHEN CSM Date Doc # Vol /Page Type 24 -5678 WAS CREATED. THIS WAS NEVER 11/29/2004 781141 2704/499 QC INCLUDED IN CSM 1 -106 & SHOULD HAVE BEEN 06/12/2001 648039 1658/361 WD TREATED AS A REMAINDER. PUT BACK IN 10/10/1995 534794 1143/424 QC ORIGINAL OWNERS NAME FROM CSM 1 -106 & 07/08/1987 428782 784/466 WD more... I more... 2010 SUMMARY Bill #: Fair Market Value: Assessed with: 64068 Use Value Assessment Valuations: Last Changed: 10/12/2010 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 0.100 50 0 50 NO 05 Totals for 2010: General Property 0.100 50 0 50 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 FORM NO. 985•A M.C.M.,IrCpprry® Stock No. 26273 U 0 1 CERTIFIED SUR MAP LOCATED IN THE NE 1 /4 -SW 1/4, T31N,R19W, / TOWN OF SOMERSET, ST. CROIX SC0NSIN. OWN BY: VICTOR MARTELL RT , SOMERSET, WISCONSIN. (� I, Arthur L. Wegerer, registered land surve or. hereby certify: That in full compliance with the provisions of Chapter 26.34 of the Wisconsin Statutes and the provisions of the t.Croix County Subdivision Ordinance and under the direction Victor Martell owner of said land, I have surveyed, divided, and - i – m - pped Baia r1larid, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the NEk of the SW4 of Section 33, T31N, R19W, Town of Somerset, St-Croix County, Wisconsin, to -wit: Commencing at the >r corner of said Section 33 ; thence N1 "W along the East line of the SW a distance of 2014.71' to the point of beginning: Thence N89'30 "W 1322.67 thence N1'31 "W 660 .06' to the North line of the SW , thence S89 1 'E along said North line 1324.55' to the East line of the SW ; thence S1'22 along said East line 659 to the point of beginning. Contains 20 .044 acres subject to an easement for ingress and egress purposes over northerly and southerly 33 thereof and is also sub j ect to exi.oivF'Tft,,�oad right -of -way over the easterly portion thereof. DAW% day of f�Pr�LIt ,1982 J C�� l ARTHUR L A rthur L. Wege er S- C WEGFRER Kozel, Wegerer and Assoc., In 5 -9.53 River Fa lls, WI ELLSWORTH I ; wls. t.`r� ;;�� SJ,4 Al,a ✓OL..� , Ja�17 •••...... o� . 00��� CENTER OF SEC. 33, 1 66 WIDE ROAD EASEMENT O y T31N, R19W I R. . SPK. rM S89 "E 1324.55 ' (TO SEC. LINE) F0. 6 47.20 1291.53 IP- I.P. 644.35 33 UJ kv I J 0 0 U LOT I 3 3 133 33 A 0 20,044 4CRES - :FG:9A6 w v !n (8 73)16 SO. T.) 17. 611 AC. TO R. .W LINES l0 0 �. e =1HON PIPE FOU 1 M 666.13 1293.1 1.P. -1.P. 626 1' 29.56' rn .98' — — — N89 30 00 W — 1322.67 (To SEC. LINE) _ — — — — — — — — — — — 3.46 ' 1 0 , Z v 66' WIDE ROAD EASEMENT O' U 1: r_.4 is `�? s�,; �Y. v4P VOL. ; PAG 106 ^ , zoo aQ:tA W J: 4 Wo O LL 3 L U o f O � » �. WEST LINE NE-SW W „ O o vi SCALE I = 200' 0 4na N Z 0' 100 200 400' S 114 COR. SEC. a W 2 33, T3I N, R19W 2 m 1 82-32 SOUTH LINE SEC. 33 COUNTY SURVEY - _ - - - - _ THIS INSTRUMENT DRAFTED BY "'_^ `� " MONUMENT f0. 'osZ d.W AoA.1ns ples ivoij Ieadde siaumo 6u1u1olpe Aq sivawgop.onua ou leyi pue 'sauy Aiopunoq aUi UILIlim AlloyAA ail siUPU.16AOJdW1 pug s6ulplinq Ile ielli 'saliepunoq ayi jo aleos of uolieivasaidai pauoisuau,lp Ali:*ijoo e sl dew AwAuedwoaoe ayi ipyi pue spaooei 1etogjo ayi of 6ulpi000e Aiaadoid paddew pue paquosap anoge ayi paAaA.1m. 1 61 _ _-_ -__ - - .._.__ _ 5L sI ��bnae�� 1� Yeyi Apon Agaiay op 'ioAaAjng pup - 1 ulsuoosiM paiaislBa, H38393M ' 8nH16 V 'I (IN i103 s'3xE'.LS NOM s Zaa� OOZ It)tiI I jk jo :a`fb ";)S ss I 3 2i31d }o AiunoO ti'4ANTd S N08I i WSUODSIM JO aieiS M618 - N I £1-- 'O3S '800 17/1 HinOS --- , M ONO 113 �a N z 0 _0 A N N. 1N3W3SV3 OVO8 301M 99 M,0£o 81� - 11 0 19Z£I _ — —LIL (301M 99) Q0 O 3N1 93S Ol L9'ZZ21 — \00 OV08 NMOl M I So1,9 \� O oi ££ '03S b/1 MS 3N1'l 1SV3 ,Q I I I 1 Z II ££ Z A I O Ol � p W o S380V t�t70'OZ 0)_ o cf) I � N � I ' J+ c O� 1N3W3SV3 OVOM 301M 99 %p 3N1 M /6 1 — — — — — — � _ ,�S 3N1 93S 1 8 � Ol SS'v,21 OZ'Lb9 w —c�B 3 O�o68 ££ '03S 831N30 20 22 — — I b/I MN 3N1 1SV3 woadljosso ssoippv r ' ewvN a� i ulsu0o611A 'sllo3 JOAQ1 Duo •,"DID n03 NOIS30 emai s ONIA3ANnS ONNI • ONIa33NION3 "IWO AUDdwoa 6wiaouibua j jofjjsp y I AS BUILT SANITARY SYSTEM REPORT OWNER r e S 1� TOWN •0 M -.r S SEC 3�T� -Raw ADDRESS S'D rn r ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE_ PLAN VIEW Distances and dimensions.to meet requirements of H63 ING WITHI Loo FEET OF SYSTEM 1 1 ' v . I di a e o th Arrow ' I 1 � BENCHMARK: Permanent reference Point) Describe: °Q 0- Elevation of. vertical reference point: Slope at site: SEPTIC TANK Manufacturer Liquid Capacity: Number of rings on cover TanTc manhole cover elevat on:` Tank Inlet Elevation: !l Q Tank Outlet E levation: /oo• s PUMP CHAMB2R Number Manufacturer.: of gallons Number.of gal. pump set or a cyc a gallons; tote capacity o distribution lines g allon: s"� a of pump head; gallon per minute horsepower brand name of pump and model-number Type of warning device' HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits feet diameter feet liquid depth seepage pit inlet pipe- elevation bottom of seepage pit elevation feet. , y SEEPAGE BED SIZE: number of linesw t length tile depth�'�,� SEEPAGE TRENCH: width. lengt_Hi PERCOLATION RATE _ I___ B INSPECTOR r DATED w -3 PLUMBER O B LICENSE NTIMRFR I D Sg DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR � b 0 SAFETY & BUILDINGS LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, Wf 53707 CONVENTIONAL ❑ALTERNATIVE State siPlanl.O.Number: El Holding Tank ❑ In- Ground Pressure ❑ Mound f It asgn edi N PERMIT H LDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: 1 BENCH MARK (Permanent reference pooO DESCRIBE FFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. 33 10-0 ) Na a of PI MP /MPRSW No.: Counry: Sanitary Permit Number: /X\ ^ V ~ SEPTIC TANKPHOLI TANK: S L 5 - LO MANUFACTURER: t LIOUID CAPACITY: j166ROAD: V.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER n PROVIDED. PROVIDED: 9 a / 1 O ❑YES ❑ NO ❑YES ❑NO BEDDING: VEN DIA.: VENT MATL.. HIGH WATER PROPERTY WELL: [�DING . VENTT O RESH A LARM. LIN AIR INLET: V YES ❑NO O 1�20A D SING CHAMBER: MANUFACTURER B : LIQUI C PACI7v P MODEL. PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES O OYES ONO ❑YE ONO GALLONS PER CYCLE; PUMP AND CONTROLS OPERATIONAL.a yy PROPERTY WELL. BUILDING: ENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET x, PUMP ON AND OFF) OYES ❑N0 SOI L ABSORPTION SYS M. C ec Lhe SOII oisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil ca be ro into a wir , construction shall cease until i 5 the soil is dry enough to continue.) CONVENT_ IONAL SYSTEM: L a- ;" WIDTR LENGTH. N DISTR. PIPE SPACING. COV INSIDE D PITS. LIQUID TREN� S. ERIAL: 13 5 tMi DEPTH: ,b a R V L DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. D "PROPERTY WEL : BUILDING: VENT TO FRESH BELOW PIPES AB VE C ER. ELEV, INLET EL i �N // D: PIPE LIN AIR INLET: .�Q MOUND SYSTEM: 7. 2 Mound site plowed perpendicular to slope ec a texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslye m nd systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- s criteria for medium sand. TIONS MEASURED. OYES O ZZ SOIL COVER. TEXTURE. PERMANENT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES NO DEPTH OVER TRENCRBED DEPT O RTRENCH/ D U TH IF TOPSOIL. SODDED SEEDED. MULCHED. CENTER EDGE OYES 1:1 NO OYES ONO [11 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: N . OF LATERALS IN G E DEPTH BELOW _. FILL DEPTH ABOVE COVER. ENCHES. MANIFOLD PUMP MA FOLD STR PIPE OLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.. ELEV. DI ELEV. PIPES. DIA.: HOLE SIZE HOLE A ING. D ILLED ORRECTLV. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES NO DYES ONO COMMENTS: PE NENTM RS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: ❑YES ❑NO OYES 1:1 r, Goo 17-48 S r ( I s. BOO ®o.q I loo Sketch System on Re in county file for audit. Reverse Side. SIGN TITLE: i DILHR SBD 6710 (R. 01/82) I ,/'� Y B• State and County State Permit # W/ d Permit Application County Perm/4 f Private Do County or ri Sewage stems Domestic Se a Systems Y DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER O F PROPERTY Mailing Address: / (f 1 f! e r ` B. LOCATION: % W Section3 , T31 N, R Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township , <A A*V g p S e.- C. TYPE OF OCCUPANCY: Commercial 'Industrial `Other (specify) Variance Single family 1��_ Duplex No. of Bedrooms 3 No. of Persons 73 D. SEPTIC TANK CAPACITY /O-VV Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel f Fiberglass Other (specify) New Installation L ---' Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New L/_ Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width De�th Tile depth (top o. of Trenches Seepage Bed: L2 Length _ Width — Depth ' Tied pth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land _ Distance from critical slope WATER SUPPLY: Private Y Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if o ther than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified oil `Tester, / NAME / W C.S.T. # t and other information obtained from • (owner /builder). Plumber's Signature Mp/ PRSW# ZD S f Phone # Plumber's Address ew PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E E 77 i I 3 3 t t � P E 1 t,. t j c F t 3 3 ' 3 .� .. ... m e �............ .. ,. -..e.. e ... _.....,. „,,. ,. ` .. -.,. .,. ,.. �....., _ ..,. ., ,.. .e .,�,,..... .,,. .m .W, v, P 1 1 t , I ' S 1 4`1 .. ,i. n,.. a,......� ... E.... , . . F . ....,. ... a.. »., m F.-, m. .m. ,...m..� i a.. # � 3 7 i .«. 1 r s Y .._ _ . -., .... _.,..... } I t I E Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT E ONLY Date of Application ��o� Fees Paid: State (p 1 Co my Date ' — d Permit Issued /Re}oeted (date) _,/0 i°l� lssuing Agent Name Inspection Yes_No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 i ` 9 , TM ENT OF REPORT ON SOIL BORINGS AND F °' NGS INDUSTRY, INDUS ISION LABOR AND '� Rf 7969 PERCOLATION TESTS ( 115 � �J(f HUMAN RELATIONS _ \ J 1 LOCATION: 370 G/ - 4 19 LOCATION: S CTION: TOWN ITY: OT NO.:BLK. NO. DI I ME: fJ� '/ ' 33 /T31 01 (or) w COUNTY: OWNER'S BUYE�'S NAME: MAILING ADDRESS: T Crd r C r i >e > !K7 G'i o .0� USE / DATES OBSERVATIONS d 3 �,/ NO. BEDRMS.: COMMERlAL DES RIPTION: $: STS: l_7Residence New ❑Replace C Gap DD _ 3 ;L RATING: S= Site suitable for system U= Site unsuitable for system E:JU C� NTIO O: IN- GROUND - PRESSURE: J SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RATE: S S �( If an portion of the lot is in the � under s.H63.09(5)(b), indicate: g` 6 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGR TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I go 10 B- l! D f� T (! b 01 _3� B- r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD I PERIOD2 PERIOD PERINCH P 1 P $ �' : r� P- L-� Syt0 P -_ J P_ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION �. IJ �.,. i � , �_- .. O VA . .,�.. _ 1 _ IN , ,! ,�-.. E I 9 y - { >`- _ _w 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME rint : / TESTS WERE COMPLETED ON: ADDRE CERTIFICATION NUMBER: PHONE NUMBER optional): o 4Z " 5 /'3/1- ;a 'y s s'3_ CST SIG TUBE: hi DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. ,DILHR -SBD -6395 (N. 03/81) I . 3 r+^ .a/ .sue ? �v o, r r._ . i L s � . -t' .. f _ Y J 1�3n��� �� � 3, 4 �-�...�. � �. . ...