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032-1089-60-110
\ 0 2 § 2 $ w j 2 f CD \ % m m / 2 E E 2 � � 2 2 K IS k §/ q {B ( D 2 t: ] ]E 2®4 m V } V k LL D$ ƒ k ) \ \ - \ k� §A k J r k n ¥ t J z J M k V Cl) j§ CL 2 a m I § B 2 2 ) q ■ R - k / E / = e = e Cl) CD 5 a e I � i -� ƒ/ Q ƒ }_ q k k } k k } .. .. } i k k k k ] C14 6 C ■ • , ■ k m 2 § m$ 2 .07 § CD } _ \ �/ k L . 0 CD # E a � E o ) - # / a a a \ a a a IV § 0 � , o k@@ o ( k\ D u :A z m 04 w = o ) Cl) \ _ § (D k _ § / \ / o 0 2 7/ G 2 (D I§ 2 $ 2 3 2 < 2 2 J z cn k 0 § 0 7 § 2 ° 2 kt ° £ ' k 2 :5 4) k § § Q ° 7 e= m 0 = o o / \ \ \ \ Q) m � f r § k ) 7 \ \ \ k �\ j \ k k \ k k - f C-4 Cl) Af o ) / § q o z / k) \ £ a » 0 � �) 1 k a§ / a§ k L) 2 2 0 2 0 J 2 o Parcel #: 032 - 1089 -60 -110 12/13/2006 08:38 AM PAGE 1 OF 1 Alt. Parcel #: 33.31.19.4281310 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 ROBERT D CARUFEL O - CARUFEL, ROBERT D 1924 45TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description ` 1924 45TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.500 Plat: N/A -NOT AVAILABLE SEC 33 T31 N R1 9W 3.5 AC PT NE NW LOT 1 Block/Condo Bldg: CSM 8/2104 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33 -31 N-1 9W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 924/354 2006 SUMMARY Bill M Fair Market Value: Assessed with: 145726 220,200 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 50,500 116,500 167,000 NO Totals for 2006: General Property 3.500 50,500 116,500 167,000 Woodland 0.000 0 0 Totals for 2005: General Property 3.500 50,500 116,500 167,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i v v L 448238 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE} OF THE NWJ OF SECTION 33, T31N, R19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN.. r Rt FILED 2 g MAY 2 6 1989 ,...,> JA MES O'CONNELL Register of Deeds , OWNER Co.,W► s St Croix Robert Werner �'' +'c',�i,?.�1 O. n. Rt. 2 Box 275K U< w , r'(V iI'%C' Hudson, Wi. 54016 Z s{ l♦ 11 �l' Zi ii � y v LEGEND V A Section Corner monument,- Aluminum cap in concrete. • Section Corner monument - Cast iron. APPPO V Et' 0 1 x 24 iron pipe weighing 1.68 pounds per linear foot, set. MAY 2 3 1989 4L C71k COUNTY PAIKSPLAt" NW CORNER N} CORNER unplatted lands owned by platter SECTION 33-31-19 -------------------------- - - - - -- SECTION 33 -31 -19 NORTH LINE OF THE NWJ OF SEC 33 S89 0 5 7 1 52 11 E 2716.03' - - - - _ - S89 482.65' N 438.66 43.99' I CD 0 CO 66 0 �_ ° 0 � LOT 1 �'� ` I T 'ri y j rdi- O O - r; 1 1 r rt I v d S d 1 1 1 r7 r O � -� O ro - I o_ - 1 �'� C• ....t,n- = In o I m N 1 1 a house under u 1r m + - 1 a I 0 " co N construction d N m I S I I O to N 10 I I N I IL I N O I i m; i d a D 1 a- r , Cr 152,460 sq. ft. (3.50 acres) INCLUDING ROAD R/W oI ° ° I� �' 138,614 sq. ft. (3.18 acres) EXCLUDING ROAD R/W v' n I I rt. I.p O I rr N 7' I O - • - i ; t O 1� N O I m 00 -1 .p rt p I C .n 42.21 m N 440.44 N89 482.65 M-- unplatted lands owned by others , SCALE - 1 N FEET___ 100 50 0 100 this instrument was drafted by Douglas Zahler job no. 89 -10 -189 SJ CORNER SECTION 33 VOLUME 8 PAGE 2104 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _ _ TOWNSHIP SEC. 2L T fLN -R W ADDRESS Q ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ' /liSd 7 3y , INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used -' -� Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ��;;,, ';A;y Liquid Capacity: Number of rings used: ✓ Tank manhole cover elevation: Tank Inlet Elevation:__97, Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,® Rear, 0 {� _ feet From nearest property line Front, 0 Side, 0 Rear, 0 h Q feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: �. Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front i S de, Rear, Ft. 0 0 Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: _ 41 Lengfth; Number of Lines: � Area Built:����,� --- Fill depth to top of pipe: Number of feet from nearest property line: Fron , Side, o Rear,o It 1 '4 Number of feet from well: Number of feet from building:` (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box o or distribution box o been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK'' Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, o Side, o Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: �- Plumber on job: i License Number: - T 3/84:mj it \ I • ----- - - -- - -- - - �� V y L 42- dt��� I -- - - - - - - -- j I , I o 0 0 j - -- - - -- -- -- -- -- - - - - -- 1 — -- — , : ; I I 1 12 D ...... - -- - - -- De - r t 5 -/ ills I Well 1 , i t - - -- - T -- -- _ ( - I 1 I i + � I I I 1 I , 1 . i -- -- -- - -- - - -- -- - - -- I � i : I i i I - j I t i I L I I I _ I j I I r ttt I I i i I i -� I f I I I I -- I - IL _I I I I ! I f DEPARTM4NT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.Q� 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION �7�77 WI 53707 n, Q��T N 4 M 4, S28, 13 1�..L9 S tate f assigned) Number. T wn of Somerset � CONVENTIONAL ALTERATIVE 1�2 & 45 ❑ Holding Tank ❑ in- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION A : Robert Werner I Route 2, Box 275K, Hudson, WI 54016 5=10- %,1 q ova BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix 119416 SEPTIC TANK /HOLDING TANK: MANUF ER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCK COVER PROVIDED: PROVDED: ° fa3 YES ❑ NO ❑YES R NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: I VENT TO FRESH ALARM: FEET FROM ^�, LINE: N ^ AIR INLET: ❑ YES 54NO G� ❑ YES NO NEAREST — 0 + �GOw l4 d DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED PROVDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ) ❑ YES ❑ NO NEAREST —11110� � I SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: #PITS LIQUID TRENCHES: ATERIAL: PIT DEPTH: DIMENSIONS �, _ox .� GRAVEL DEPTH FILL DEPTH DISTR. PIPE I DISTR. PIPE I DISTR. PIPE MATERIAL: NO. DISTR . NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: �'y ^� PIPES: FEET FROM L l b ! E �,�,� 1 ,3 AIR INL T: , - ( 9 -7,01 eari 1 c NEAREST —♦ c)W l 3 MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: E:1 YES ❑ NO ❑YES El NO ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF LATE L SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE I MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO COV ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM ❑ YES ❑ NO ❑ YES ❑ NO N 21 C j �7y �3 Sketch System on t Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD -6710 (R. 06/88) C 4—x-- Zoning Administrator I DILHR SANITARY PERMIT APPLICATION COUNTY C O/X In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # //9 '//(-- —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION (� 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES L7y. NO PROPERTY ER PROPERTY LOCATION 2, (,� t~( IV E '/a N, R ° f (or) W PROPERTY OWNER'S MAILING AQDRESS OT NUMBER BLOC)C� UMBER SIJ)p ISION NAME CITY, S ATE ! " ZIP CODE PHONE BER CITY NEAREST ROAD, LAKE OR LANDMARK u (,tJt l J — o/ 4 l n is—)}*— E3 VILLAGE: i p t II. TYPE OF BUILDING OR USE SERVED: r Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): NI. PURPOSE OF APPLICATION (Check only one in #1. Check # 2,3 or 4, it applicable) 1, a. � New b. ❑ Replacement c. ❑ Replacement of d. El Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. � Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. M Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 4 - 3 1 6/5 Feet C ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ## of Prefab. Fiber Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Map OOO �� Lift Pump Tank/Siphon Chamber ❑ ❑ I LJ F _E1 VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation f the private sewage system shown on the attached plans. Plumber's Nap Plumber's Sign ure: o Stamps) AVIMPRSW No.: Business Phone Number: Cw- s t S6 ��s Z y� s�3 Plumber's Add (Street, City, tats, Zip Code): Name of Designer lup- � 1- 3 1 V �.�. rr LAS I U Vlll. SOIL TEST INFORMATION Ce led Soil Tester ( ST) Na e CST #� 7 o 3r CST's ADDRESS (Street, C'ty, State, Zip Code) Phone Number: l.� 5 o I 26 - IX. COUNTY /DEPARTMENT USE ON ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) ® Approved 1 Owner Given Initial Surcharge Fee Q (,,,� Adverse Determination 12-d. UO �c�5 C� 9� v I �h h , b 1. X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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 appro by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transter /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary p e rmit app p y pe app cat on must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, - indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; S) 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater b; II Ground at�r.. -- included the creation of surcharges (fees) for a number of regulated practices which Wisco Itl' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried tl3�351l1Q is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) I _ STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER Ao6u2-T C ROUTE /BOX NUMBER R T9 T�D JC 7 � FIRE NO. CITY /STATE CJ7Sc ZIP yv02 rH(oA6k6 5oF•' AA A-)w IN 33 7 rr IE Pj u0, �oftcrtEs PROPERTY LOCATION: x_ 1 /4 5 , ec ion , T _ N, R Town of ��25�� , St. Croix County, 50 Acts Subdivision , Lot No. 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 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 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, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED q �y DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386 -4680 Sign, Date, and Return to above address r- PAGE OF Fresh Air Inlets And Observation Pipe s�10)b Approved Vent Cap Mlnlmum i2" Above Final Grade 20 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Marsh May Or Synthetic Covering win 2" Aggregate Over Pipe Olstrlbuili n — Us 0 0 0 0 0 Ag Beneath Pipe a Perforated Pipe Below 8e o — Cooping Terminating At Bottom Of System ��eJr -� tors SOIL FILL DISTRiBUTiOVI PIPE AP $NTH PROVED ET1C COVER 2 "OF g6GRE GATE --� o e — O R RI^W Hk'l OF STRAW (a OF 2'/2 AGGREGATE �., ELEV. OF 2� FEET --.j j ..� \� %�. DISTR19UTIfDM PIPE TU BE A LEAST INCHES BELOW ORIGIQAL. GRADE AMU AT LEAST20 INCHES BUT 1,10 MORE HAJ 42 FICHES BELOW FINAL GRACE IWIM DEPTH OF EXCAVATI(DO FROM aWIWA rDK Aot: WILL BE 2_ INCHES IA114 Wrti O EA MOM 01K I61 MAL G R49E WILL BE �� INCHES 51GUE1) LICEIJSE DUMBER: i DATE: ` "3--9� ` >>o j. . '@ ; n ^' �, `w .dyeaw a � a+ v rcyr,� -r .-wu.,z .*+nw .. sw•- W ..c- .v � � i } $'; i�' .� I?ARR flF SAFE#Y & BrII;t�IN�a� US1 R PORT ON SOIL BORII ; . AiVISIO r r k AND , PE CC PERCOLATION TESTS ICAO sO 53 • RELA TIONS QLHR $3.08(1) ,& 145! /MUNICIPALITY: T NO.' LK NO.: SUBQIVIS E: N7Y. MAILIN AD R S: t` DATES OIBSIiRVATIONS MA!!E � New ❑Rep lace 'L7�/ :EATING; Sm Site suitable for system U6 Site unsuitable for system V :MOUND: IN Gt$JUN ILL LDING TANK: RECOMMENDED SYSTEM: optional) lrrcosatlon bete are NOT required ESIGN RAT If any,portion of the tested area is Irra#rs If, P / r+` ' Skt s. 1LHR 89.09t5 indicate; Floodplain, Indicate Flooskslain elevation: PROFILE DESCRIPTIONS D EPT H D A R- CNES A SOI WITH THICK COLOR �• OR1N 1N ELEVATION 0 S V TO 0 K IF 5 ` VED l E.ABBRV.ON BACK.) I lea. © > P . 9 f , PERCOLATION TESTS ' H WATER 1 HOLE T 5 I A s PE CH N •. �• I AFTER SALLING INTERVAL-MIN. z: �G a ry � L � P. s ►LOT PLAN: 161tow locations of percolation tests, soil boring and the dimensions of suitable soil areas. Indicat4:ac+►te or distances. Describe whet are reference ir+ts and show their location on the plot plan. Show the surface elevation at all borings sntl the dniirotitlrt sad raontal and vertical elevatio Po l q# land slope. �•-,�► �aYS EN! ELEVATION 1 t 49 P -4 I + r – I F I x the undersigned, hereby certify that •h!R soil tests reported on this form were made by me in accord with the procedures and`tt+ethods £s+eci#ieddrr tho vlllic t �... Administrative Code, and that the date recorded and the location of the tuts ere correct:to the best of my knowledge and belief, ,' r TEST V>y R COMP LEtED ON M rinY : P t Aga ro /� • dam_ AD ' –"— CERTIFICAI ION NUM9£A: pHONE NUfNt�lERlogt CST I N ; f: v. .z r �n S oil Tester e r d owne � S O w h Prop erty I Aut Orit _ � to Local Y. n one co DISTRIBUTION. original a O R. (R 1Q/83) OVER - v . x Q1LHR•58Qr6395 f `r'�Y y t - k4 i APPLICATION FOR SANITARY PERMIT STC -100 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 :G0E -kT7 ie N Ok7V{ 10 ReRCS or, A)C //y /ULJ - 1 1 , V, 5EcT /0#U 31 N - (� 9 CJ Location of property S L 1/4 - 1/4, Section 3 3 , T N - _J_�j_ Township orALr25 E 1 Mailing address Address of sit SO/1/f�%��'� COT Subdivision name Lot number Previous owner of property l9 LEX ) AE Total size of parcel 5 d A e r E 5 Date parcel was created 3 , 3 , 2 q Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes _N0 V Volume and Page Number 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 I (we) am (are) the owner(s) the property described in this information form, by virtue of a warran d ed recor ed in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ). , - - fi 21 Signature of Owner Signature of Co -Owner (If Applicable) Date of Signature Date of Signature r DOCUMENT NO. i STATE BAR OF WISCONSIN FORM 1 -1982 RE SERV ED .. FOR THIS SPACE RESERVED FOR RECORDING DATA i WARRANTY DEED 4458G4 J vOL 835 91 This Deed made between ..... GLEN BRAE_, a Partnership ST. CP(0)X CO. w' consisting of_ Roger L. Baker, William M. Baker and •• -• -• Recd for Record Henry__.T, Rutledge___ „ ;� ;cya . ---- - - -• -• ••.... -- . - •- • --• ...••-- •--- •-- -- -- •- -• - -• - -• ------- .. Grantor, tiff rVi>ii . U <� 1989 and --------- Robert E Werner and Teri L. Carlson, . P. .................... - ••• -•• - -- joint tenants. .... --- • - - - -- --------------- .. egister f Deeds - - ---------- ............ ........ I Grantee, Witnesseth That the said Grantor, for a valuable consideration_... -. ;= conveys to Grantee the following described real estate in ---- St, ,CTOix __ RETURN TO County, State of Wisconsin: _ _7 7 7: The Southeast Quarter of the Southwest Quarter of Section 28, AND the North 10 acres of the Northeast Quarter of the Northwest Quarter of Section 33, all in Tag parcel No_ T 31 N - R 19 W. i �� FF,� • V ) FEE I - This - ---- _is,_no - ------- homestead Property. X (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And --- GLEN_ B_ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except recorded easements and rights of way, and will warrant and defend the _ Dated this .. . .. . v-3 .. ....... ...... day of .....- _ - -..T" _.. -... - ...-- ....., 19.89..... - - - -- ... � GLEN BRAE ' By `.. -. /, cti� (SEAL) B �' .....V_ r. -c- Girl/L< c (SEAL) I ' Roger L. er, P tner Henry T. Rutledge, Part`>•fer - - - - - -- -• -• -- _ . ...................... ...... • ......... ...... ........ B . ......... (SEAL) (SEAL) am M. Baker , Partner - ------ -- ------ ------ --- ---- - - -- •-- ••-- - - - - -- (SEAL) ------- • - - - - -- ---------------- •---------- - - - - -- ......... I AUTHENTICATION ACKNOW LEDGMENT Al I'- - C Signature (s) (� r.� �0 ss. • - - - -- - - -• -- / ----------------- - i --- --- -- County. authenticated this -------- day of ------------- 19 ...... r � ersonally came before me this _ �3___:____day of w ;I - - -- - -- 19 89 - -- the above named Roger L__ Baker, William M. Baker and * •--- _ - - - -- .__Henry T_ e Partners of GLEN TITLE: MEMBER STATE BAR OF WISCONSIN BRAE, Partnership _ (If not. --•---------------------------•-•---•-••--•------•••--•----- authorized by § 706.06, Wis. Stats.) to kn n to be the p rson _S___ -___ -_ who executed the 'f fo goi g instrum t acknowled a the same. THIS INSTRUMENT WAS DRAFTED BY II I �I LAWSON, RALEIGH, MARSHALL li - - - -- --- - - - - -- _ _A --------- &-- MCDONALD.,._P---------------•---------- o 0 / I� 3880 Laverne Avenue North " - - -- - - - - -- .. ...........`. ----- Lake -- Elmo ; - -MN - - -- 55042 -- -- •------- - - - - -- Notary Pub i County, (Signatures may be authenticated or acknowledged. Both My Com /,Y �`e�[not. H �t� expiration are not necessary.) A 1. date: ..... . -sfR Not;-iryPrlbfic-- Mimsota -- 19---- - -...) *Names of persons signing in any capacity should bet . yped or printed below their aignatu �' !'1t, ';Va$i11t1QtQrl County " N, Com tlieCuop Expires 8/x/94 _ Yv.Y�rwy�?g�`��v' RCMn1e.Corrfmny� STATE BAR OF WISCONSIN FORM No. 1 — 1982 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDIJSTR DIVISION LABOR AND PERCOLATION TESTS (115 P.O. MADISON Wl 79 HUMAN RELATIONS ' -7— (ILHR 83.09(1) & Chapter 145) LOCATIO : SECTION: N /MUNICIPALITY: T T NO.: BLK. NO.: SUBDIVISION N E: f /T N/R E co est -- NTY. MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I TS: Residence New ❑Replace I � RATING: S- Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUNDPRESSURE: S STEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) r S OS DU SDU Cis [Ru E]SRU If Percolation Tests are NOT re wired DESIGN RATE: Q If any portion of the tested area is in the 4i under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: _71 t PROFILE DESCRIPTIONS f BORING TOTAL DEPTH T 0 QROU NDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH f' NUMBER DEPTH IN, ELEVAT #ON OBSERVED EST. HFG TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- f b — / n 9� 1� i�.. f �c 7 9 AN •t�G � /o o / � �, n 5' � — /ao /%jig Sk r B- y �n� 9 B- ,� PERCOLATION TESTS TEST DEPTH • WATER IN HOLE TEST TIME D 1 WATER LEVEL-INCHES RATE MINUTES It� NUMBER IS AFTERSWELLING INTERVAL -MIN. PER IOD t FERIOP 2 P PER INCH P- / 'z -e 3 P- — G P- P- P. PLOT PLAN: 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 slope. SYS EM ELEVATION �—� t - � I f , • i i ► i i_ f � � i f'k go 1, the undersigned, hereby certify that The soil tests reported on this form were made by me, in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that.the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): / TESTS WERE COMPLETED ON: J ��ea . /'�' — ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN R DISTRIBUTION: Original ano�.p copy to Local Authority. Property Owner and Soil Tester. DILHR SBO.6395 (R 10/83) – OVER – Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisiort INSPECTION REPORT Sanitary Permit No: 0 399607 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: Carufel, Robert I Somerset Township 032 - 1089 -60 -110 CST BM Elev: I Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic - , � Benchmark /'� ei' Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet D TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , 50' �lfm / `/ Dt Bottom Dosing Header /Man. x• 9s• s Aeration Dist. Pipe th `,�.35 _♦ `fS•GS � Holding Bot. System S� f 9� 3� PUMP /SIPHON INFORMATION Final Grade ' �o � } Manufacturer Demand St Cover GPM Model N ber TDH Lift tion Loss System Head TD Ft Forcem ' Length Dia. is SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liqui epth DIMENSIONS (11 C 2 SETBACK SYSTEM TO JPIL LDG WELL LAKE/STREAM LEAC G Manufacturer: INFORMATION CHAMB Type Of_ System: 24 f 38l / Ti T I Nu DISTRIBUTION SYSTEM Header /Manif Id u Distribution ( u x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) r Length � -Dia Length I � Dia Spacing I 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 discrepencies, persons present, etc.) Inspection #1: 17- /i / O f Inspection #2: . -L .— Location: 1924 45th Street Somerset, WI 54025 (NE 1/4 NW 1/4 33 T31 N ) NA Lot 1 / Parcel No: 33.31.19.438B10 1.) Alt BM Description = &/,+ f'� u.s � h �' �' ` ��� 2.) Bldg sewer length = 1can�, - amount of cover � � � - ttI ze �e,u,f�� s �4.jM w Y� an revision Required? ❑ Yes No © D Use other side for additional information. SBD -6710 (R.3/97) Insepctors Signature Cert. No. I Safety and Buildings Uivisiun County 201 W. Washington Ave., P.O. Box 7162 _ VVISconsin Madison, WI 53707 - 7162 Site Address T De artment of Commerce 0ao7 -- ORd 71 `'� auT Pe Sanitary Permit Application saw b er In acrd with Comm 83.21, Wu. Adm. Code, personal information you provide Q Check if Revision may be used for secondary ses Privacy Law, s15. l m I. Application lnformatlon - Please Print All Information State Plan I.D. Number Property wtxr's Name Parcel Number 3 1 9 . Z8 g Property Owner's Mailing Address Property Location T N, R,/9 67 City, State Zip CoJc Phone Number Lot Number ` Block N bey , �^ Subdivision Name CSM Number II. Type of Building (check all that apply) J / PCCE try I or 2 Family Dwelling - Number of Bedrooms _ -_- Villa e 1 8 ❑ Public /Commercial - Describe Use ownshi - -r ❑ State Owned t $j G " x � ►t! I ; st Road M. Type of Permit: (Check only one box on line A (numbe ' e or e)., IC plete line B if applicable) 1 A, Unit ❑ New 2,9 Replacement System 3 ❑ Replacement of 6 ddio T �7 use 1 tIng S sum Tank Ord Exis B. X Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(nurnbering scheme is for internal use) 44 W Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 Cl Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Urut 49 ❑ Recirculating 30 ❑ Other V. DispersalfTreat ment Area Information; ski' kS Design Flow (gpd) Dispersal Area Dispersal Area Soil ApphQauon Percolation Rate System Elevation Final Grade Required Proposed Kate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation 1� 7 1 V . Tank Info parity in Total Number manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks _ StPdC Or Holding Tank U l / Dosing Chamber VII. Responsibility Statement- I, undersigned, a responsibility for installation of the P'OWTS shown on the attached plans. Plumber's am (Print) Plumber's Si gna MP/MPRS Number Business Phone Number Plumbers Address (Saret, City, S tc, Zip Code) VIII. County /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Sumps) Surcharge Fee) dp �z ❑ Owner Given Initial Adverse - __ _ Deter mination - 225 Ku J.A --- IX. Conditions of Approval /Reasons for D' approv I C T? AA �i,�Ce� 1( �t�.e � ,M st cQQts� � rv�'t,. � fie., ,Matt.. S C — O c o RLWU (to the county only) (or the em as ps tea ills a tl caches In a SBD -6398 T 05101) } E C (FLO- p p Lhr ►J - - -- - - Safety and buildings Uivisiun _- — County 201 W. Washington Ave.. P.O. box 7162 — in IScQnS Madison, W1 53707 - 7162 Site Address De artment of Commerce Sanitary Permit Number Sanitary Permit Application 399'6 0 -+ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for seco purposes Privacy Law, s15. t m I. Application Information - Please Print AA Information State Ptah I.D. Number Property war's Name Parcel Number - S 1 9 . Z8 g l _ 032 ` lDg� '(04 //O Property Location Property Owner's Mailing Address �J 'A Alid City, State Zip Cak Phone Number Lot Number Block N tuber Subdivision Name CSM Numtxr » U. Type of Building (check all that apply) f% pE / '�Cuy !Q 1 or 2 Family Dwelling - Number of Bedrooms �`. `� _ -D _ ', �QVlJlagc ❑ PubliciConunereial - Describe Use r Owned ' 1 ownship -� ❑ State Owd r 1 r.., ST CPQX , Nearest Road M. Type of Permit: (Check only one box on line A (number' e e or e).;'Complete line B if applicable) use A ' I E) New 2,t Replacement System 3 ❑ Replacement of 6 ddiod�s� �� System Tank OnlyEris " B. W Check if Sanitary Permit Previously Issued Permit Number Date Issued W. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 JA Non - Pressurized In-Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Con mcted Wetland 22 ❑ Presnwized in- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip lane 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treat ent Area Information: �' .�S Design Flow (gpd) Dispersal Arw Dispersal Area Soil Application Percolation Rate System Elcvation Final Grzdc Required Proposed Ratc(Gals. /Days /Sq.FO (Min./Inch) Elevation 1 5 / V . Tank Info pacity in Told Number manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tucks Septic or Holding Tank i Dosing Clamber VII. Responsibility Statement- 1 undersigned, re essponsitidity for installation of the POWTS shown on the attached plans. Plumber's am (Print) Plumber's Sigma re MT/MPRS Number Business Phone Number S Plumber s Address (!�u�e�et, City, S te, Zip Code) VIII. Count /De artment Use Ot11 12 Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stumps) Surcharge Fee) Qp Cl Owner Given Initial Adverse 225 - Dctcr /2/0 D I GtJrlh - — - IX. Conditions o Approval /Reasons for U' •al ov I . e All wt4� � vv.0 -t` t Ch:2 cnmpkte PLWU (to the County ody) for the an oa Pa aot 8111 s 11 ineha b 0 ,{- t SBD -6398 O ff- 05/01) Sor>.F.�J �X S�Qa� �.�c,� L4Pi dE�Jr► � yak /� �SL N LU 1 L s 6 6 1: j d 4;-/ 41-1 � rnc8 l�PidE�JA� �sB 11 l �Jn I i � �a p s 6 6 i �f • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County D Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information I Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Prope wn r 1. C Property Location ? P–/ P–/ / Govt. Lot 7() 1 t 1-6 1/4 /Y*14 S 3 T > N R /C/ ! (or O Property Owner's Mailing Address Lot # Block # Subd.. Name or CSM# Iq City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 50I #d' W L SyO S' ( 1ig - ) Zy7 -3zoj S 0131e .-s-er J1 ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate I GPD Replacement ❑ Public or commercial - Describe: Parent material V [� 7L�i✓�J /9 �� �? Z Flood Plain elevation if applicable ft , General comments IXLUCIVLU and recommendations: NOV 2001 s T CROtx oOUNTY 7 [-6 E] Boring # Boring ® pit Ground surface elev. • ft. Depth to limiting factor / ( —� in. IA� tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'IVA S � ms�r v �� c C., /LA a 1 3 OP 7 3 R i A4 C 6 - 1 �� .7 y 6o -lzo 7a g% IVs" 1'4J ©: �-- . 7 tf' A0 F-1 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '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 < 30 mg/L CST Name (Please PP - nt) gna ure CST Number en CL i Address Date Evaluation Conducted Telephone Number 3 fy 0� ' SS`ozs c 0 7 - - 7 /S- Z �Z 0 3 SBD -8330 (R07 /00) Property Owner Parcel ID # Page of F] 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 GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a Boring # ❑ Boring © Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 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/11: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '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 < 30 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. SBD -8330 (R.07 100) OWNER Page 3 of 3 Name 0 Brian Parnell Address 9 2 Y CST 23 L314 Date 9 Z 0 / FZ, Benchmark I 7 70,f &t�"f /(/, Benchmark 2 )76)h rb k'z Soil Boring Suitable Area 1" = 40' Scale 7 -7- A - 7 — T — A I D! L c- hel C- 1 - + -4-- r 4--; � 11 ' 11 .. .. ... . .... ---------- F t� ORT ON bu ciV►R w�s�a�,;,rr�,l .�• X. PO No �q TiON a' TESTS MA(J1SOAIWI' S E9C1 r . E P .� 1q� ` OLHR 83.0901 & 145) ti /MUNICIPALITY: / T NO. L NO.: U DI ; /T N/R E I. a�sc c e ..s w NIAI LI A S: NTY. zZle DATES OBSER1tdI►TION ter. E, j4New" []Riplace afx'It i�tATING; S• SKa sy,table for system U� Site unsuitable for system N. ILL , OLDIN G TANK: RECOMMENDED SYSTEM: optiorgll MOUND: Q � IN'G S S U D S U is , a : DESIGN RAT If anY, portion ofI1e tested area it (atH1t f. P�rootation Tate are NOT required �j FloodPlain, indicate Flood0ialn aasvt ion: ' hoar S. ILHR S3,0915M), indicate: / PROFILE DESCRIPTIONS L• pI o, A CH V E AB "Y. ON B K. * WIN 1 Molt, Of— PERCOLATION ELEVATION K IF A f {i f • '� ..ik �.• �� '�'" fix= T STS. ION E ' -1 1 DE ER I HOLE TES Fi ATl PER IN( r ( AFTER SWELLING ' IN R1 ALL-MIN. p. _ a 'r i j rr ra 1 K ' s r $ •t� P- — Describe what a q.. ` fiLOT MAN: $how elevation refero ce perco potnt L ana r tshowbheirg e Jocat on 1 henplot =plan suitable Show l a n d vartkel e th surface elevation lt 11 borings�snd tM ditactbn `=otKa " of land dope 95 Q e� Y t ,SYS ENS; EL L EVATION c t v , I " � a r � � • !, the•`undersipned, hereby certify that rho soil tests reported on this form were made by me In accord with the proeedures and'methods specified'in " 3 Admtpistratiw Code, and that the date recorded and the location of the tests are Co. Correctao the best di my knpwledge end belief. { MPLETED ON: TES 'W R ¢, /'►D•/'1 .A' --- CERTIFa A. 1 N NUMBER: PHONE NUMB M1r a h 4 DISTRIBUTION: Original ano ope coPY to Local Authority, Property Owner and Soil Tester. nt, wa.artnFs395 la. 101831 OVER — ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to cert' that II have inspected the septic tank presently serving the �f �C°r residence located at: ;, Section - �' T_,,�LN, R Town of < ; �.."C.es, -/ . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: q �� Did flow back occur from absorption system? Yes �� ; , 4 No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known) : yes_ CJ•ry Cl�) Age of Tank (If known) : N (Signature) (Name) Pease print (Title) (License Number) 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 pening over outlet baffle). Name Signature MP /MPRS i POWTS OWNER'S MANUAL 8E MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS ` Owner _ Septic Tank Capacity al ❑ NA Permit # c�c� o - Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 0 NA. Effluent Filter Model ❑ NA Number of Commercial knits [a NA Pump Tank Capacity gal ZI NA Estimated flow (average) gal /day Pump Tank Manufacturer Q NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer .®' NA. Soil Application Rate 7 gal/day/ft' Pump Model O NA. Influent/Effluent Quality Monthly average* Pretreatment Unit Z NA Fats, Oil 8t Grease (FOG) s30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) :5220 mg/L ❑ Mechanical Aeration ❑ Wetland :_ 150 mg /L ❑ Disinfection ❑ Other: Total Susp Solids (TSS) Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) _ :30 mg/L V In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) X10' cfu /100ml ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non - commercial) 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 ❑ months JZ 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 cells) At least once every ❑ months 0 year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every `� ❑ months -8) year(s) Inspect pump, pump controls 81.alarm At least once every 11 months ❑ year(s) .® NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 1S NA Other: At least once every ❑ months ❑ year(s) JZ NA Other At least once every ❑ months ❑ year(s) 0 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 inspection. must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure th 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 (Is) 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, Wisconsi; Administrative Code. The servicing of effluent fliters, mechanical or pressurized POWTS components, 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 chemic3 that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contend of the tank(s) removed by a sentage servicing operator prior to use, Sy >tem surf up shall not occur when soil conditions are frown at the Inflivative surface. During power outages pump tanks may fell above normal hlowater levels. When power Is restored the excess wastewater will by 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 cont of th pump ta nk removed by a Septage Servktng Operator prior to restortn; power to the effluent pump or cuntact a Plumber or POWTS MAlntalner to asslst 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 diswrb or compact, the area within 15 feet dawn slope of any mound or at•;trads 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 wlpes; cigarette butu; condoms; cotton swabs; degreasers; dental flow; dupers; dislnfecunu; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat straps; medicatiuns; oil painting Producta, oemdoes; SanitirY nJoklns Campon7; And water softener brine. AAANDONEMENT When the POWTS tails and /or Is permanently taken out of service the following steps shall be taken to Insurt that the system o properly and safely abandoned In compllance with ch. Comm 83.33, Wisconsin Adminlsvadve Coder • All piping to sinks and plu shall b e disconnected and the abandoned pipe openings healed. • The contenu of all tanks and plu shall be removed and properly dssposed of by a Sep tage Servicing Operator, • AhPr pumping, all tanks and plu shall be excavAted And removed or their covers removed and the void space oiled witr pail, gravel or another Inert solld mdtrrlal. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be liken, tC provide a code compllant replacement system; L7 A w1wbie replacement area has been evaluattd and may be utilized for tht location of a replacement soil absorption system. The replacement area should be protected from disturbance and compactlon and should not be Infringed upon required setbacks from exlsdng and proposed strvcwn, lot (Ines 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 ana. Replacement systems rnust comply with the rules In effect at that dme, O A sultable replacement area is not available due to setback and /or loll Ilmltatlons. barring advances In POWTS technology, a holding tank may be Installed as a last resort to replace the failed POWTS, �a1 The site has not been evaluated to Identify a suitable repfacement area, Upon failu of the PO WTS a soil and site evaluation must be performed w locate a suluble replacement area. If no replacement area Is available a holding tank m.� be Installed as A last resort to replace the failed POWTS, Q Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the Inflltrative surface. Reconsuuctiotu of such systems muss comply with the rules In effect at that Vme. < < WARN ING> > 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 eCRSON FROM TWS INTERIOR OF A TANK MAY BE DIFFICULT OR IMPMCIRI F. ADDITIONAL COMMENTS POWTS INSTAL POWTS MAINTAINER Name Na me Phone _ — 5 — r Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name App 1 Phnnr I �- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t ?d 4; cct V k. (e Mailing Address Property Address �S24�n (Verification required from Planning Department for new construction) City /State Parcel Identification Number LE GAL DESCRIPTION 33. 3(. Property Location Y4, Arne '/4, Sec. „, T_ZLN -R_,�q W, Town of Subdivision , Lot #. Certified Survey Map # Z:� X' J- , Volume 9 , Page # Warranty Deed # x/7/9 , Volume , Page # �S Spec house 0 yes tZ no Lot lines identifiable R- yes O no SYSTEM MAINTENANCE Improper use and maintenanceof 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 days o the three year expiration date. SIGNATURE 9VAPPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE PP ALICANT 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 w , I DOCUMENT. • STATIC BAR N aCe Iseeeaveo floe owcomi'.e DATA BAB O! WISCONSIN ?ORY 1— i!M . _ WARMWY GFD a . w 924 PALE 4 47 REGISTER'S OFF1C This Deed, made bet—es, R013ERT.- l;....ldF lElZ - -az?d. .......... ST. CROIX CO., W1 TERM ... L,...WERNER,..f. /k /.a..TERI. L... EARLS .OIC..hustaand... .... ......... Reed for Record and - wi. fe -------------------- ---- - - - - -- -- - - - - -- - -- - - -- - _s ass.--- ....... ---------------- _ ............ .......... ....................... Grantor. 1,91 and _..RO.BE.RT...D. C_AR B... qS�E ..."LIC-9.QI3 ..__ ......... .. .. 2:40 P• M ........_............... _ ............. I . . I ............... ........................... sees . ........... . ..........._.. -- _..... Grantee, OeeelR Witnesseth, That the said Grantor, for a valuable consideration. _.. ... I .......... .................... ...... . -. a[TURN To ............. sees.. .................... -.- .. conveys to Grantee the fallowing deaeribed real estate in .5.t._ Cr.oi- X ..... .... ... County, State of Wisconsin: TaiParcel No: ................................... PART OF THE NE1 /4 OF NW1 /4 OF SECTION 33, TOWNSH 31 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, WISCONSIN DESCRIBED AS FOLLOWS• L T OF CERTIFIED SURVEY MAP FILED MAY 26, 1989 IN VOL. 8. PAGE 2104, DO 448238, no I / 4 This -- - . ...... ........• - --- homestead property. (ia) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; A,,1 ROBERT. E._ WERNER. and. TERI L, WERNER. flk /a TERL L....CARLSON,._husband..and _ w.i-fe j warrants that 4,e t. , ,� ' `�a� ble in tee simple and free and clear of encumbrances except I i and will warrant and defend the same. I - V 0�.� i Dated this ._..- •- __ --...�t.'.........- sees... day of i C ' -less.. ........._..._ -sees, 19....t... I / I X e �.. .-(SEAL? V.. �.�........ Lr r .......(SEAL) I ROBERT..E,_.14U U..__------- - - -- -- - - . • T ER .I 1.._�LERNER,...f /k /a ARLSON _ CARLSON _._.. - - - - - ...- - - sees ....... (SEAL) ...... (SEAL) • sees . .... - I AUTHENTICATION ACENOWL=DOMBNT I Michi � Signature(,) ......... -------- - - ---• --- -- - - ---- STATE OF �K>)gi7C1�900.v ss. -- ••------ - ----- ---------•-------------- •-- ...........----- .. ......... DICKINSON ----------------------- •--- ----------- county. authenticated this ........day of........................... 19...... Personally came before me this ... blh ......day of November ........... . 19...9.1. the above named -. -- •--- - ------ ----- -- --------------- •--- ... - -- --------- ........ ..... ..Roherx..E....1�.erner- and :.Ter.i..- L,...Werner.- �• - -•- •_ - - -- sees--------- - - - - -- --------- ---- - - - - -- f. /k /.a -. Ter ..i ... L. - -- Carl .sQn...hU5baDd..and.... ----- TITLE: MEMBER STATE BAR OF WISCONSIN ,W1. f e ----- ................................-.-- .- .- -......... :rr. :........... I (if not. .. . ... .................. ......... ..-_............... _ ------- ---------- --- ------ authorized by § 706.06. Wis. Stats.) to me known to be the person ..5 ... -. (, �_ ex utea•t�e foregoing instrument and acknowledge ttt,� satib. V THIS 'NSTRUMENT WAS DRAFTED SY y« , i'v\ ,( Q ` . - . — f - .0 2` .John. F,..Morr e.ale,_Atty. Jean M O'Dette - �- - ........... ....•--sees - -- Glen.E1 -1 n IL 60137 = ^ 449 Taft. A.ve.,., ...-.. ... -- y-..t.......- ...••------- - - - - -- Notary Public .__ Dicklnson �...,,. E..idi1L (Sivnatures may be authenticated or acknowledged. Both My Commission is permanent. (If nof;%t tato are not necess date: . .._.. y....._ ...............'.; *Names nt persons sisnine in a _r eapaei'r should be typed or printed below their denatures. i aA rTB BAR .e OF WISCONSIN Wion.In taral Blank Ca Ina WARRANTY DEED FORM Ne, I -116 Liilwaukse. wr. 67026