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HomeMy WebLinkAbout034-1014-70-000 is `nsin gepartment of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix iaiatNand Building Division INSPECTION REPORT Sanitary Permit No: 514873 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Ball, Jeff & Sheree Winzer -Ball Springfield, Town of 034- 1014 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / as (�m � —r 07.29.15.102A TANK INFORMATION 1 1 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e ' g 1 066 Benchmark 5 , 1 /bs • t /Uv Dosing Alt. BM Go ,N, b 9. S Soo Gat 060r 2 .� t I to . (A Z z3 q. �� Aa;a4on F. I �� t a k. I z5 Bldg. Sewer J Z '9 7. 78 Holding St/Ht Inlet y 11` /3.3 87.3 TANK SETBACK INFORMATION St/Ht Outlet TANK TO Rt L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` \ Septic \ &Z " Z5 z5 Dt Bottom ZZ • 5 p2 Dosing > � / W 3 / S / Z5 j Z _ Header /Man. Z• � /Oz. 3 Z Aeration Dist. Pipe z .*72 /a2.38 Holding Bot. System V ' -7 .� 3 . y ,W PUMP /SIPHON INFORMATION Final Grade 1- 163.3$ Manufacturer ZoG l � Demand St GPM ✓ ver - 7 .5 9 - 7• Model Number 3 5 3 o r 5• i do TDH Lift Friction Loss System Head TDH � Ft -- Forcemain Length I Dia. Z o f I Dist. to Well 3 SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Trenchesl PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type stem: J �� �� / - I UNIT Model Number: ` O eJ � /� DISTRIBUTION SYSTEM Header /Manifold 11 I Distribution I x � z i Hole Size x Hole Spacing V to Air Intak /e , 1 Pipe(s L�O , S II � u le i Length 3 Dia / Length / Dia / Spacing f to Z SOIL COVER / x Pressure Systems Only xx Mound Or At - Grade Systems Only C IF Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ` !, Bed/Trench Edges ` t Topsoil !. Y4'". El No Yes E] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: % / 3 / 0 1 . Inspection #2: Location: 2705 110th Ave. Woodville, WI 540 NW 1/4 NW 1/4 7 T29N R15W) metes & bounds Lot 4�1 %; Parc I No: 07.29.15.102A 1.) Alt BM Description = ( - " �r 4!1�,lo%�5 2.) Bldg sewer length = 25 iP10 t..j ok - amount of cover = G /•� Plan revision Required? ❑ Yes No i 7 Use other side for additional information. SBD -6710 (R.3/97) Date Insepct s Signat Cert. No. • t P a)dN br'VJC� commerce.wi.gOv Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 St. Croix It isconsin Madison, WI 537 162 Sanitary Permit Number (to be filled in by Co.) epartment of Commerce 5/ Sanitary ermit A p p lication State Transaction Number Y pp 1533460 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this tformto e riate governmental unit is required prior to obtaining a sanitary permit. N - Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal inf rmatiouse for secondary purposes in accordance with the Privacy Law, s. 15.1)4(i)(m), tats. I. A lication Information - Plea se Print All Information r O n ' P o w er s Name U _ _ Pertl' MAY Parcel # 034 1014 -70 000 Jeff Ball S E � Al. W11V C�2 --l3 Property Owner's Mailing Address ST. CNTY Property Location 1177 Fithian St. ZOE �� 102A) Govt. Lot Al 1 4 City, State Zip Code Phone Number NW Sd,NW �- A Hammond, WI 54015 715- 796 -2188 (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 15 w ®1 or 2 Family Dwelling - Number of Bedroo s 2 Subdivision Name _ � N/A N/A Y r [�W17 _ ` u Block # ❑ Public /Commercial - Describe Use J �„ /l �9 2 t£Glt�it h / 1 7A_Y � j N/A 1 7 F City of ❑ State Owned - Describe Use L L _ r " ` "/" L71 CSM Number ❑ Village of �C Qiiy� N/A ® Town of SPRINGFIELD 11I. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision El Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Ex iration ! IV. Type of POWTS S stem /Com onent/Device: (Check all that apply) 7V &Q e n dYL nwi ❑ 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) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: 10 ! f7 ! Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 300 1.00 ©, /`n 5 A� 300 7 5 1300/ 101.70 VI. Tank Info Capacity in Total # of Manufacturer w A Gallons Gallons Units ¢ U H w o H H i a N New Tanks Existing Tanks z Septic or Holding Tank 1000 1000 1 WIESER CONCRETE ® ❑ El ❑ ❑ Dosin Clamber 500 500 1 WIESER CONCRETE ® ❑ 1 11 ❑ ❑ VII. Responsibility Statement- I, the unders assu responsibility for installation of the POWTS shown on the attach plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number BENNIE HELGESON 220292 715- 772 -3278 S - (zb -i ctd Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VI . County/Department Use On V Approved _ Disapproved Permit Fee Date Issued I Iss ' g Age�ture _ Owner Given Reason for Denial y D � IX. Conditions of Approval/Reasons for Disapproval ! _ SYSTEM OWNER: °d:u�� 1 Septic tank, effluent filter and Z 7 � U7t, �- dispersal cell must all be serviced/ maintained as er management p Ian r ' p p provided by plumber. 2. All as per applicable` 9 f81p - ands s or e m and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 l 0 rio s� oj C J �LZ ko v J Cl d 01 o co O .� d • L a zc r w a \ J If / b--- t C Y J \ I c W r �n �= _ Safe and Buildings s 9 3824 N CREEKSIDE LA commerce.wi.gov HOL.MEN WI 54636 ■ TDD #: (608) 264 -8777 sCO n s i n w�.� ommerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary May 05, 2008 CUST ID No. 220292 ATTN. POWTSInspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/05/2010 Identification Numbers Transaction ID No. 1533460 SITE: Site ID No. 736917 Jeff Ball Please refer to both identification numbers, 110TH Ave above, in all corres ondence with the agenc Town of Springfield St Croix County NWl /4, NW1 /4, S7, T29N, R15W FOR: Description: Two Bedroom Mound System / New construction l Multiple bldgs. / Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1180800 Maintenance required; 300 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual - Version 2.0, SBD- 10706-P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior tooccupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodc cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the ap rp oved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which max include local inspectors P.O.W.T.S. Cenditionall y 3 PPROV BENNIE W HELGESON Page 2 5/5/2008 i Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telelhone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 6 v -- Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3 :30 P.M. INDEX S HEET PECE iv & - ) APR 3 0 2008 SAFETY & BUILDINGS PROPERTY OWNER: JEFF BALL 1177 FITHIAN ST HAMMOND WI 54015 PROJECT NAME: JEFF BALL PROJECT LOCATION: NW 1/4, NW 1/4, S 7, T 29N, 15 W MUNICIPALITY: TOWNSHIP OF SPRINGFIELD COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: W 1000 /500 -MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed. Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: April 29, 2008 DIVISION Of SAFETY AND BUILDINGS e SEE GUKt - Sl�t)NUNI; J\ Co -Sb .4 CP I N o` � r A 01 s c` .41 IZ QW/Jc, T6 Synthetic Covering ,/45TM C 33 Distribution Pipe Medium Sand 3 Sa Topsoil — = = =_— �%_= F D 3 E l l; e an�cUl , 51e-u '100' O G � % Slope �� �.i�.O f 2 » — 2 2 Force Main Plowed From Pump Layer Aggregate D /, 7 Ft. Cross Section Of A Mound F ,ga Ft. 0 Ft. A Ft. H / Ft. Signed: B Ft. License Number: K Ft. - BPJAA I) � L U Ft. (b�fO Date: J 7 Z Ft. - Ft. W Ft. Observation Pipe - W _ J Distribution �` = Of i — 2 '2 w14 Pipe Aggregate Observation Pipe Plan View Of Mound f � R: JEFF � ALtr PA C-,L- PorloroleA Pip• ooio End VI +.r ) POH0101co / PVC P i P t Holes Located on Bottom are Equally Spaced C )f'(�o %C, j a Okillbullon.. PIPO Di5criLurjo1 Pile Layouc- P < R S 3� x _ Y a '' Hole Diameter Inch Signed: •• Lateral " Inch (es) License Number: Manifold " _� Inches Date: Force Main "._ Inches �o f4/ � /mss •_ $� Page ) yFr � A L-c SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATION: ` 4 Of� - 4" Pik VENT PIPE 12" MIN. ABOVE GRADE b WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE T WITH CONDUIT MANHOLE.COVER W1 PADLOCK E _ WARNING LABEL MIN. 18 IN. INLET � WATER TIGHT SEALS GAS- T TIGHT # �IAPPROVED FILTER --= A SEAL JOINTS WITH Ft APPROVED /�O —f — ALM APPROVED PIPS PLPE 3'., "F� ON SOLID SOIL ONTO SOLID C SOIL PUMP OFF ELEV . O TT. OFF D- 3 APPROVED BEDDING UNDER TANK. CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE a TANK MANUFACTURER: X TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING DOSE Soo GAL. X2.4 Cat, FLOWBACK: 7(c• � GAL. ALARM MANUFACTURER: 5, <T, CAPACITIES: A = c` O INCHES GAL. 'MODEL NUMBER: J o f (-F SWITCH TYPE: cL. B = 2 INCHES = 1 . 6g GAL. PUMP MANUFACTURER: C = /0 INCHES = GA .L• MODEL , NUMBER : 1.53 SWITCH TYPE: «� - D = ! INCHES = /g GAL. REQUIRED DISCHARGE RATE GPM PUMP .& ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE I. 2 FEET + MINIMUM NETWORK SUPPLY PRESSURE Wit, FEET + Q oo FEET FORCEMAIN X A,j_ /100 FT. FRICTION FACTOR �! _ FEET TOTAL DYNAMIC HEAD = q, OS INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTT SI `' I L Plc�a, e se `j" H k s c5 n e SIGNED: LICENSE NUMBER: DATE: 1/88 aw 009 /OOOtM:311.4 95tr8 —,M� -008 b00Z 'NV 'A38 toot k8vnNvr :31VO 09019 MA 'HOOa N301VVV '01 sn s«cM ivnNdW OI1d3S Z \ 1MS 31300000 V3131M Ae NMb W \ :31V0 'ON A3a la „4 t :31VOS 8W-009�000 N O 'w W N z Lo Lrl J LLJ U w Z Z m o w W of U � > W O O N w LLJ W LJ n �/� J W O r N cn Q U � - U U Z O W d m pW = O z 0_ Z V LLI O c O a tQ z z ti- O w U O Q i Q O J U J ..I N �- > F- N p O Q I V o0 O m W ~ W �� w 3 w z 0 w O oo m J SON > r Gi !n O VO X O _ N\ to � J W Q �O 00 0 W Q (j d D W N mV) - ZOa p G N U N 0 .. N O� J d F- 1 F- Q = W O_ \ O IAJ O aq � - � ° � J�^ F J �z� �_ z �� _ \a Nm LLJ W O Nr 1 ..J .. � .. ON � ZO_' U (.7 = i W U W Z Q LLJ �[ O�o >z�z of) o� oNr a ° Y -j z w � �N o Qoo<QwpwC3 Z: Z -O U (� Zvi Q Q N O pY Z N a m Um m J§ m J3 Q d Q �.i Z Q U N Z L Q W W O Q Z Z p r Z Z Q OJ M N U D < z Q W Q Y Z Q „trS O \ w 1 1 as 3 u W u L LI a w I w �, W I 0 O I zoJN �W 1 . !— v t9 Q t \ � Z V =jw < / rn �S „£ N ). \ O.QU ti0m I 1 / w N J Z ,1t - S6 „�69 C�14a 1(�L1� �G LL PA G r-- TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 Of I w MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3:1 61 231 70 265 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 C-) - 0,/ 25 7.6 34 129 42 159 8 >- 30 9.1 23 87 33 125 0 20 35 10.7 -- -- 22 85 4 10 Lock Valve: 38.0 ft. (11.6m) 44.0 Ft. (13.4m) 01450 0 20 1 40 60 80 100 GALLONS LITERS 0 80 160 240 320 6 1/4 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with 3 27 /3z an alarm. • Variable level control switches are available for controlling single phase systems. I • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. i 1521153 Series 12 1/8 j T 1521153 MODELS Control Selectio Model Volts-Ph Mode Amps Sim lex Duplex 5 1/8 115 1 Non 8.5 1 2or3 BN15 BN152 115 1 Auto 8.5 Included 2or3 sxzoa E152 230 1 Non 4.3 1 2or3 BE152 230 1 Auto 4.3 Included 2or3 N153 115 1 Non 10.5 1 2or3 BN1531 115 1 1 Auto I 10.5 Included 2or3 SELECTION GUIDE E153 1 230 1 Non 5.3 1 2or3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 included 2or3 switch. Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Alternator E,Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ,7 Louisvft, KY 402560347 ManulkAmOf.. - L Q SHIP T0: 3649 Cane Run Road t arkville, KY 40211.1961 SN CE /9.99 Ai " http: / /www.zoelJer.com PffMP �O (502) 7762731.1(800) 928 PUMP FAX (502) 774 -3624 0 Copyright 2001 Zoeller Co. All rights reserved. RIGINAL 2068 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8' %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I. D. 034 - 1014 -70 -000 Please print a information. Re ewed B Date Personal information you provid may be A. ... . o�sb�3 (Privacf law, s. 15.04 (1) (m)). ' 0 Fr ..-.. 9 Property Owner f tu Property Location Eau Galle Creek Farms, LL , n Vt. Lot NW 1/4 NW 1/4 S 7 T 29 N R 15 W Property Owner's Mailing Addr t # Block # Subd. Name or CSM# 4 929 CTHW D 7 tL�P,4 City 3tate ZV(($po )ppOJtluumber I City Village IM Town Nearest Road Woodville WI 1 54028 j 715 698 - 3098 Springfield 1 110Th Ave. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD W - Replacement Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 5' x 91.2' rock cell mound on 100.0 contour as upslope edge of rock w/ 17 sand fill F T] Boring # Boring VJ' Pit Ground Surface elev. 100.0 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 1 0 -8 7.5YR 3/2 - sil 2 f sbk mvfr cs 1Urn .6 .8 2 8 -15 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .7 3 15 -24 2.5YR 4/4 - sl 1 m sbk mvfr cs 1m 1 .4 .7 4 24 -53 7.5YR 3/4 - s 0 sg ml as - horizon 3 sbk occasionally parts to 2 f pl a Boring # _J Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 1 0 -8 7.5YR 3/2 - sil 2 f sbk mvfr cs 1 f/m .6 .8 2 8 -16 7.5YR 4/4 - sl 1 m sbk mfr cw 1m .4 .7 3 16 -24 7.5YR 4/4 f2d 7.5 6/2 /8 sl 1 m sbk mfr gs 1M .4 .7 4 24 -48 7.5YR 4/4 - sl 0 m mfr cs - .2 .6 5 48 -68 5YR 4/4 - sl 0 m mfr - .2 .6 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effiu nt #2 = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Signature: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/27/2004 715 233 - 0398 s Property Owner Eau Galle Creek Farms, LLC Parcel ID # 034 - 1014 -70 -000 Page 2 of 3 , F3� Boring # Boring i/ Pit Ground Surface elev. 97.5 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -12 7.5YR 3/2 - Sil 2 f sbk mvfr cs 1f /m .6 .8 2 12 -15 7.5YR 4/4 - $l 1 m sbk mvfr cw 1 m .4 .7 3 15 -17 7.5YR 3/4 - s 0 sg ml cs If .7 1.6 4 17 -26 7.5YR 4/4 _ - sl 1 m -c sbk mfr CS if .4 .7 5 26 - 40 5YR 4/4 f2d 10YR 6/2 sl 0 m mvfr - - .2 .6 redox p OYR 6/2 - 7.5YR 518 below 34" F4 Boring # j Boring Pit Ground Surface elev. 98.5 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -11 7.5YR 3/2 - Sil 2 f sbk mvfr cs 1f /m .6 .8 2 11 -22 7.5YR 4/4 - sl 1 m sbk mvfr cs 1m .4 .7 3 22 -30 5YR 4/4 f3f 10YR 6/2 SI 0 m mvfr cs 1 m .2 .6 4 30 -40 5YR 4/4 - s 0 sg ml - - 7 1.6 horizon 4 has occasional inclusions mcos a 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 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 /DO) Certified Soil Testing f (`� r f w N O O i c eo CIO cl Lf � i � 3 ri I n t �n s n ° r so 9 i rr a f Q. v L! ► 1 0 \ �� �`' :J ✓ j d t 9 J Parcel #: 034 - 1014 -70 -000 06/14/2007 03:51 PM PAGE 1 OF 1 Alt. Parcel #: 07.29.15.102A 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area Application # Permit # Permit Type Map Pp YP 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BALL, JEFFREY & SHEREE WINZER- JEFFREY & SHEREE WINZER- BALL 1177 FITHIAN ST HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 17.720 Plat: N/A -NOT AVAILABLE SEC 7 T29N R1 5W FRL N 1/2 NW NW 17.72A Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/26/2004 769714 26231392 WD 04/11/2000 621010 1501/517 WD 07/23/1997 2001/23 WD 07/23/1997 1089/236 LC more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/14/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.470 1,150 0 1,150 NO UNDEVELOPED G5 1.250 50 0 50 NO Totals for 2007: General Property 17.720 1,200 0 1,200 Woodland 0.000 0 0 Totals for 2006: General Property 17.720 1,200 0 1,200 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of b FILE INFORMATION SYSTEM SPECIFICATIONS Owner JEFF BALL _'5" Er VV11V2,&� 1-3 Septic Tank Capacity 1000 gal NA Permit # Septic Tank Manufacturer ❑ NA Wieser Concrete DESIGN PARAMETERS Effluent Filter Manufacturer Pol `❑ NA Number of Bedrooms 2 ❑ NA Effluent Filter Model PL -525 ❑ NA Number of Public Facility Units 9 NA Pump Tank Capacity 500 g al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer Wieser Concrete ❑ NA Design flow (peak), (Estimated x 1.5) 300 gal /day Pump Manufacturer Zoeller Pump Co. ❑ NA Soil Application Rate g al/day/ft' Pump Model 153 ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit l NA I Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L 12 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :!= mg /L L2f NA ❑ At -Grade ER Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in di ❑ 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 every: 2 ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 2 IR year(s) Clean effluent filter At least once every: ® month(s) ❑ NA 13 ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls &alarm At least once every: 3 Q year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA 3 Q year(s) Other: 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. I OWNER: JEFF BALL Page 8 of 8 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,cborwcals 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 w111be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharpe.of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controlsAo 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 provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil , 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. IN 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. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name qANTTATTUN Phone 715- 772 -3278 Phone 715- 273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST CROIX COUNTY ZONING Phone 715- 273 -5811 Phone 715- 386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b) &(f) and 83.54(1), (2) & (3), Wisconsin Admini$trative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer ��Iz� ff. � --L (,�I16 - z- E 114 Mailing Address 117 7 Fj 7 xj S f /�¢ 7 rn o N D 1 w I SAO /5 Property Address to .42 (Verification required from Planning & Zoning Department for new construction.) City /State �� W` Parcel Identification Number D — 1 0 t L1- - 1 0 O I LEGAL DESCRIPTION f--1-4 Property Location A/to % , , jo 1 / , Sec. � 7 T N R _L5__ W, Town of jp ja 6 e- jj Subdivision ^— Lot # Certified Survey Map # 6/6 A , Volume X A Page # Ai A Warranty Deed # - 7C Q q '] 1 z! , Volume d 6A 3 , Page # Spec house 0 yes I no Lot lines identifiable )iryes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 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. Uwe, 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms NATURE OF APPLICANTS) DATE ** *Any information that is misrepresented 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 Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 2 6 2 3 9 2 - 7ac3 - 71 4 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Eau Galle Creek Farms LLC A RECEIVED FOR RECORD Wisconsin LLC Grantor, 87/26/2084 10:00Alf and Jeffrey A. Ball and Sheree Winzer -Ball husband and wife Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXElPT # the following described real estate in St. Croix County, State of REC M. 11.00 Wisconsin (if more space is needed, please attach addendum): TRANS FEE; 225.00 W % of N 1 of N % of NW' of Section 7, Township 29 North, Range CC FE FEE /. E; 15 West, St. Croix County, Wisconsin. PAGES; i Recording Area Name and Return Address WESTCONSIN CREDIT UNION P 0 BOX 269 NEW RICHMOND WI 54017 034-1014-70 -000 Parcel Identification Number (PIN) This Is not homestead property Exceptions to warranties: Easements, restrictions and rights - of - way of record, (is (�i y ot) Dated this day of July 2004 4 u Gaffe Creek Farms, LLC * es G. Weyer, Member - -- * Mary E. eve r, Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF ) . authenticated this day of County ) Personally came before me this _ _ day of - — - - -• __ -.— _ July , 2004 the above named Eau G alle Cre F arms, LLC * _ _ - - -- TITLE: MEMBER STATE BAR OF WISCONSIN By: Jam G. Weyer and Mary E. Weyer (If not, to me known to be the person(S) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowled THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina O land g * Hud W I 54016 -_- - Notary Publii, -- -- _ . N (Signatures may be authenticated or acknowledged. Both are not ne cessary.) MY Cdtl - ration date: # Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN io rofessionals Co.. Fond d LLac, Wl WARRANTYDEED ~+ ..4 M- `SS hM..�I O - WL FORM No. 2 -1999 1 07/19/2006 15:16 6087859:i::;b 5FY- Y AND tR_JAsS rH ac I I • AFFIDAVIT FOR MULTIPLE BUILDINGS ON A POWTS i Thls agreement Is made pursuant to C OMM 83222(2)(b)5.b, Wis. Adm. Cody Agreement date Plan Transaction Number I Property Owners) Property Owner(s) Ad ress + Legal Desc"ption of Property /Vucoi,� Avyll Je . �7 / ra �e JS cv Parcel Handle numbe �( /oiy -?0,- a v - lI—� l fi �� � plan to have rnuulpla buildings connected t0 one PtivatC (7naite Wastewater Treatment System (POWTS) on property owned by me. Property Address: 1`0 Building dc�sCriptivns: fit' cr�i The proposed POWTS system operation and maintenance will be my responsibility. Date signed : Owner Name (Print) Subscribed and swum t before me on this data: Notarized Owner Signature O �- Owner's Address My commission empires R ' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer V e0:__6gE f�� � � fit LCD ,Mailing Address //77 7h�l.�N �I'T. �/�4- rn opt/ D i Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Wk Parcel Identification Number 0'5 y — r7 1 t-1 -- O y ® . LEGAL DESCRIPTION Property Location A140 % , A &) j , Sec. 7 , T .__� R W, Town Subdivision — _ _ .. Lot # Certified Survey Map # A Volume Page # /U A Warranty Deed # - 7( a q 7 z , Volume R?6A 3 , Page # 5�Q Spec house O yesl no Lot lines identifiableKyes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATLON Improper. use and maintenance of your septic'system could result in its premature failure to handle wastes. Proper..:. . maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What YOU put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 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. Uwe; the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set foie. hsrin, as set by the Department of Commerce aad 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds.iOffice. Number of bedrooms V N _ ATU OF APPLICANTS} DATE ** *Any information. that ismisrepresented may result y in the sanitary permit being revoked by.the Planning & Zoning Department.. * ** Include with this application a recorded warranty deed from the Register of Deeds Office -and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 26Z3r 3�2 769714 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED SEG EDS DE This Deed, made between Eau Galle Creek Farms, LLC, A RECEIVED FOR RECORD Wisconsin LLC Grantor, 07/26/2004 10:00AK and Jeffrey A. Ball and Sheree Winzer -Ball, husband and wife WARRANTY DEED Grantee. EXEMPT ; Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of TRANS FEfi: 12.00 Wisconsin (if more space is needed, please attach addendum): COPY � W rh of N r /2 of N t h of NW r /4 of Section 7, Township 29 North, Range CC FEE: 15 West, St. Croix County, Wisconsin. PAGES: i Recording Area Name and Return Address WESTCONSIN CREDIT UNION P 0 BOX 269 NEW RICHMOND WI 54017 034-1014-70 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this t day of July 2004 au Galle Creek Farms, LLC * * es G. Weyer, Member * --.Mary E. Bye Member - -- - -- —^ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ) - ) ss. ------- - - - - -- County ) authenticated this _ -- day of Personally came before me this day of July , 2004 the above named Eau Galle Creek Farms, LLC * By: James G. Weyer and Mary E. Weyer TITLE: MEMBER STATE BAR OF WISCONSIN _ (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowled ftiC THIS INSTRUMENT WAS DRAFTED BY Attorney Krist Ogland * it Hudson, WI 54016 Notary Public My Cd1li piratton date: (Signatures may be authenticated or acknowledged. Both are not necessary.)�� .j * Names of persons signing in any capacity must be typed or printed below their signature. MM116. o rofessionaIs Co., Ford du Lac, W1 STATE BAR OF WISCONSIN +. �....... 800- 655 -2021 WARRANTY DEED FORM No. 2 - 1999 Parcel #: 034 - 1014 -70 -000 05/13/2008 10:23 AM PAGE 1 OF 1 Alt. Parcel #: 07.29.15.102A 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BALL, JEFFREY & SHEREE WINZER- JEFFREY & SHEREE WINZER- BALL 1177 FITHIAN ST HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 17.720 Plat: N/A -NOT AVAILABLE g p SEC 7 T29N R15W FRL N 1/2 NW NW 17.72A Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/26/2004 769714 2623/392 WD 04/11/2000 621010 1501/517 WD 07/23/1997 2001/23 WD 07/23/1997 1089/236 LC more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.470 1,500 0 1,500 NO UNDEVELOPED G5 1.250 200 0 200 NO Totals for 2008: General Property 17.720 1,700 0 1,700 Woodland 0.000 0 0 Totals for 2007: General Property 17.720 1,700 0 1,700 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 - m , r n O m o2 � m i Ij i WIMP S7`. 'CROIX CO. N _ HIGHW -4 m ' Z m m 0 I 0 0 - N O O ° O wrn D o I N CD V�� 3 O O N o I V V l r _ ., � ' ^ "1a;•�i�Jh 1`: 1b 5�87B75�r :�° SA�El`, 4ri1i EiLDu �liifll 1111111111 !1111 Iilf i llllf Till lllfll fffl Ili! * 8 7 4 8 4 4 i 874844 AFFIDAVIT FOR MULTIPLE BUILDINGS KATHLEEN H. WALSH REGISTER OF DEEDS ON A POWTS ST. CROIX CO., WI This agrsement Is made pursuanr to Com 83.22(2)(b)5.b, Wis. Adrn. code RECEIVED FOR RECORD Apre®rnen ate Plan Tranuotion Number 05/14/2008 02:45PM 533 v(eb AFFIDAVIT EXEMPT I i Property Owners) Property Owners) Ad rocs REC FEE: 11.00 3 PAGES: 1 Legal Des otion n m vly WYX 7, 7 Parcel itlentlEer number - -.. - -- -- d �-(- /0/4-70 - Doy I, J t`'`4 idg t b-(" , R& t'e}� Ga � plan to�hav/ multiple bulldNlgb connected to one Private Onsiie Wastowotar Treatment System (POWTS) on property owned byve gl n Property Address, / a•7 ty Building descriptions: 7 % 1 The proposed POWTS system operation and maintenance will be my responsibility. Date signec: Owner Name (Print) Subscribed and swam b beribre me on tt4Aj0G: *, 'notarized Ovmer 8ipnawre Owner s Address My commission exprre01 /.Z 3/ i L�G , t o �: . rlr ryt'i 1 of 1