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036-1016-60-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488160 0 (ATTACH TO PERMIT) G.ENER'AL INFORMATION state Plan ID No: _ Personal information ou p rovide may be used for seconds d y p y second purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jensen, Dave Stanton, Town of 036- 1016 -60 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No 08.31.18.1068 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER jf CAPACITY STATION BS HI FS ELEV. a _ Septic 1 Benchmark) Y: t Dosing Alt. BM M s Aeration Bldg. Sewer Holding St/Ht Inlet 0 ` TANK SETBACK INFORMATION St/Ht utet en o it n a e t o et ep Ic s _ o om osmg era ion Is . Ipe o Ing o . ys em 3 Ina ra e 3 C7 PUMP /SIPHON INFORMATION +� anu ac urer eman over d `GPM 2 5 a ✓ o e u er I UN I me Ion os yS em ea or em In eng J DIMENSIONS (� 1, INFORMATION CHAMBER OR _� �.., ,� • f UNIT ' , e _�, - Length Dial_ Length f1da .__._... _. Spacing - 3 x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed /Trench Center ' ed/Trench Edges Topsoil Yes j No J Yes E No CO ENIT$: ,•(Include ode persons present, etc.) Inspection #1; j,. ,J1 = ' �,:? Inspection #2: ' --- f - - 7 '" " - Locatiop 2279 150th Street Star Prairie, WI 54026 (NW 1/4 NW 1/4 8 T31N R18W) NA Lot PIrceo: D8.31.18.106B ` . Y (js _µ_"_...__ C L . 1.) Alt BM Description 2.) Bldg sewer length ' r l I'�• "J' d+ - amount of cover = -• . � ..�. �� .. a , ,•.� . ± �- .�� -��pp ' ±�.- Plan revision Required? ] Yes No f i Use other side for additional information. f - -- - -�— Date SBO -6710 (R.3/97) pt RECEIVED MAY 0 1 2006 ST. CROIX COUNTY Coun 1 *hsconsin 201 W. Washington Ave., P.O. B 2 Madison, WI 53707 - 708 Sanitary Permit Number (to be fillod in by Co.) De artment of Commerce (608) 261 -6546 y$Z / ( Sanitary Permit Application State Plan I.D. In accord with Comm 93.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if different than mailing address) I. Application Information - Please Print All Information 15O Property Owner's Name , Parcel M Lot Block M b� A Jam. faf� -�� _ -� Property Owner's Mailing Address 6 ` 0v �dress Property Location 7 o h Nw 1A �(/ K, Section l7 City, State \ Zip Code Phone Number is 5 S O/ 7 rr aYG - 02 Subdivision Name T �� Ni R tJ E ort�) CS u IL Type of Building (check all that apply) 1 or 2 Family Dwelling -Number of Bedrooms �� ��ti esrnb Public)Commerzial - De Use 3 , C1 State wn oed - Desaibe use ► � R�` 1.J 19 t / q t l9 L�- --6er5 ❑City_ V• ]age ownship of ILL Type of Permit: (Check only one box on line A. Complete line B If applicable) „ _ L. System R A lacement S t ^ V ^ ep ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision 0 Change of 0 Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that app l y) Non - Pressurized !n Ground C1 Mound >_ 24 in. of suitable soil ❑Mound < 24 in, of suitable soil At -Grade ❑ Single Pau Sand Filter ❑ Coasmx ed Wetland 0 Pressurized "round 0 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit 0 Recirculating Sand Filter ❑ Rzcirculitting Synthetic Media Filter Leaching Chamber ❑ Dri yel -less Pi ❑ Othe (explain V. Diz ersal/I'reatment Area Information: - e Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S tem Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons ons Gallons of Units Concrete Constructed Glass Na Existing Tanks Tanks scpuc or tioa;n Tank Aerobic Tmat wrx Utut Doc cL+,nbcr VII. Responsibillty Statement- I, the undersigned, assume responsibility for In tallstdon of the POWTS shown on the attached plans. PI s Na (Print) Plumber's nature MP PRS Number [ ; �ness Phone Number �lG as �S Plumber's Address (Street, Ciry, ute, Zip e) VIII. County /De artment Use Onl p Drov� ❑ Disa rov Sanitary Permit Fee (includes Groundwater Date Issu Issuing cnt Signer re S Surcharge Fee) Jt� . / 0 Own ven R for Denial U /� IX Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: t. Septla tank. O kwnt filter and � e6dut f �.� : n— a teC . daperaat 90111 must all be servtctes /maintained P as per mar"Wnertt plan provided by plumber. \ Z• AN aNpaolt nq*e ode / must be maintained ''1' J OIL � +0 P+► code ordi nances. 6 J••15�- � �I i N 57 - Ucl f -3 �3 rA r fig 9 0 X 133 � -a o3 ' _ y - H `- -q o � 3 -19 , IDb 4 tic) AA �� y 1 X � -a 03.5 y -q N r RECEIVED Wisconsin Department of Comme 6 2 � OIL VALUATION REPORT Page of Division of Safety and Buildings A 2 In accordance with Comm 5, Wis. Adm. Code ST. ROiX COUNTY County G a 6 Attach complete site plan on pap r not less t an 8 1/2 x 11 inches i size. Plan must in e, b of I' ed to: vertical ), direction and Parcel I.D. nt sl e, t n or dimensions, north arrow, and location and distance to nearest road. -. 14 1 6 �" O 0 Please print all Information. Review by Date - -_ P ers nal in o ou provide may be used for secondary purposes (Privacy Law, s. 75.04 (1) (m)). Property Owner Property Location ll P r Govt. Lot N td 1/4 W/4 S T N R E (or) Property 0" es Mailing Address Lot # Block # Subd. Name or CSM# 10 W, �. 7 % rG01 r City State Zip Code Phone Number ❑City ❑ Village [ Town Nearest Road w S Yo i c �� )a -��3 - S �Ir- 5 o'r S-fi , ❑ New Construction Use: ❑ Residential / Number of bedrooms L4 Code derived design flow rate _ fn D C- GPD 5F.Repiacement ❑ Public or commercial - Describe: Parent material - -. _�1s. � G f ' �\ Flood Plain elevation if applicable ft. General comments �' 5U5 ��°S — � a "'1 t'c,Y�r;,� �S C 77 J Fo r �G► C._ Ne and recommendations: Boring /� � Z J Q c � !� S C• v • � h `�` Boring # 9 9', a f J in. br w'1':a ril ® pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 I 0 -1d /D YA b !- Ib / �_� _ a y (:LL- til _ b ►M �r � L.t-� C a9f 53 7.5 Y2 yl , L_ -- .7 ) • rf lo• ® Boring # Boring �]• Pit Ground surface elev. A Q •pA 1 ft. Depth to limiting factor �S In. Soil tication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rEfl`#1 'Eff#2 ,a -5 tv y y . rJ R. / c t_ ) y 44 34 -95 7. s Y `l/ �.. C' VI�-� L . 7 5• Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD _< 30 mg/L and TSS :5 30 mg/L CST Name (Please Print Signature CST Number S, -+C IL a 1 y Address - Date Evaluation Conducted Telephone Number 1 7 - 35,2 Y Property Owner V +� Parcel ID # _ Page �_ of F,31 Boring # ❑ Boring 621-pit Ground surface elev. ! ,7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ® ) I 3j .(o , g t 1 4/ - CV sb w, ✓ L w . L4 • 1p I t 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 /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # E] 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 GPDt1f In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 <_ 220 mg/L and TSS >30 5 150 mg/L Effluent #2 = BOD, 5 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. S8D•8730 (R.6=) Property Owner ` ,.� +1 Parcel ID # Page of F,31 Boring # ❑ Boring Q !� ®"pit Ground surface elev. _ ( e � A ft. Depth to limiting factor ,� _ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots°= °' 'GPD%if In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Tv- 1';t 10 Y r" qfy CV SJ, r, F� - V- Lw 3 8 -3-;i to ' /t.- - `'7,5 YK �; CL Ws mF; CU-) 10F •3 F-1 Boring # C] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ca li lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 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 GPD/ff 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 5 30 mg/L and TSS 5 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. SBD4330 (11.6/00) r 0 acm 12 fi 1 �^` ! 1`�A.a�1��. �` 4 911 is r _ tJ T o. x 4E3 1 0 9 8692 VOL A PAG E 5084 REGISTER OF DEE — CERTIFIE0 SURVEY MAP RECEIVED hECORD 10/06/2065 10:30AK LOCATED IN PAFrr OF THE NW1 /4 OF THE NW1 /4 CERTIFIED SURVEY HAP OF SECTION S. TS7 N. R7 7W, TOWN OF STANTON. REC FEE: 13.00 COPY FEE: 3.00 ST. CROIX COUNTY, WISCONSIN PAGES: 2 THIS CEATYWC1 SURVEY MAP IS CREATED UNDER FARM CONSOLIDATION I N w CORNER SE CTION e OWNER I (COMPUTED FROM WITNESS HOWARD AND MARGARET KRUEGER ` MONUMENTS OF RECORD) 1 LEGEND � � PREPARED FOR 3/4• X 18' IRON REBAR SET, WEIGHING RUTH WILLARD N I I] 1.50 LBS. PER LINEAR FOOT N4881 C.T.H. M uj 100' BUILDING SETBACK LINE m MENOMONIE, WI 54751 I X X OUSTING FENCELINE SURVEYOR nn nn n GRANBERG SURVEYING, INC. 1235 NEW C.T.H. NEW RICHMOND, WI 54017 I N89 ErIS6w 569.27' x —x- 33. I w 3T I OBIN SHED - C ffST1NGDRIVE_r SHED❑ I a I W I ®WELL. W I ku HousE r I N N LOT 1 N o i I «t777SSS I 8.95 ACRES INC. R/W C°3 Ip I 389,857 SQ. FT. Z SEPTIC VENTS I s S 8.43 ACRES EXC R/W I - 367,300 SO. FT. � S 0 /y I G e ilr e � NEW RICHMOND +. WI Q _ O SOUTH LINE OF THE NWIA OF THE NW7 /4 33.00" 538.29' x —x r- 889°3"2'E 569.29' I W1/4 CORNER M tmul)[1 -a u to MmloD g SECTION ------------------- I Z (RECEIVED COORDINATE FROM COUNTY SURVEYOR) SCALE IN FEET 1 100' THIS INSTRUMENT DRAFTED BY MICHAEL EPoCKSON JOB 100 0 100 NO. 05-71 DATE 7 -25-05 SHOWT1 OF 2 SHE Vol. 20 Page 5084 STATE BAR OF WISCONSIN FORM 3 - 1999 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX CO., W1 RECEIVED FOR RECORD This Deed, made between Ruth H. Willard, an undivided one -half interest; Dianne M. Jensen a /k/a Diane Jensen, an undivided one -sixth 01/11/2006 09:00AN interest; and Steven M. Jensen a /k/a Stephen Jensen, an undivided QUIT CLAIM DEED one -sixth interest EXEMPT # Grantor, and David A. Jensen, a single man REC FEE: 11.00 TRANS FEE: 387.30 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Northwest Quarter of the Northwest Quarter (NW 1/4 of NW 1/4) of Recording Area Section 8, Township 31 North, Range 17 West, Town of Stanton, St. Croix County, Name and Return Address Wisconsin described as follows: Lot 1 of Certified Survey Map recorded in Volume 20, at Page 5084, as Document St. Croix County Abstract & Title No. 808692. 252 South Knowles Ave New Richmond, WI 54017 Part of 036 - 1016 -60 -000 Parcel Identification Number (PIN) This is not homestead property. �x) (is not) Together with all appurtenant rights, title and interests. Dated this � day of January 2006 * Ruth H. Willard * Steven M. Jensen a/k/a S hen Jensen * Dianne M. Jensen a/k/a Diane Jensen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of Personally came before me this da3a< January 2006 the above name ' Ruth H. Willard, Dianne M. Jensen a /k/a Diane Jen It►ti1,' nse * Steven M. Jensen a/k/a Stephen Jensen TITLE: MEMBER STATE BAR OF WISCONSIN I 11 (If not, to me known to be the person(s) who executed- the instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.)� THIS INSTRUMENT WAS DRAFTED BY * _ dith A. Remington Judith A. Remington of Remington Law Offices, LLC Notary Public, State of Wisconsin w P.O. Box 177, New Richmond, WI 54017 My Commission is permanent. (If not, state expiration•d to e: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Company, Fond do Lac, wi STATE BAR OF WISCONSIN 800- 655 -2021 QUIT CLAIM DEED FORM No. 3 -1999 V4/ L0/ VO lUG u 1; c• rnn I i0 ST, CROIX COUNTY =NT SEPTIC TANK MAINTENANCE AGRIEML AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address - p r ro e,rty Address _..,_ a��,. � S b � � 1 �^� .� TQ✓ Pr4 r � ��. w� ea 6 - (Verification required trom Planning & "Zoning Department for new construction.) a 56 - a - Parcel Identification Number .. City/State - LEGAL DESCRIP'I'iON / Property .Loca _ NW Y ec. , T - 31 — N R l� W, Town of tion Subdivision " G , Volume 07 , Page # � Certified Survcy Map Warranty Deed # - Volume _.._ Page Spec house fl yus U no Lot lines identifiable 1 yes 0 no SYSTEM MATNT>li.tvANCE AND OWNER GE TIHCATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance CO n 3t5f` of pttnll)mg 011t th Sep t1C ta every three year or , oRCT, if ncexled, 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 m.9intenanCe responsibilities are specified in §Gomm. 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 fonn, 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 systcrn is in proper operating eratin condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. in the private sewage disposal system with the l /wc, the undersigned have read the above requirements and agree to maint Standard. 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 Iepartment within 30 days of the three year expiration date. 1 /we certify that all statements on this form are tr to the best of my!our knowlcdge. 1/we am/are the ow,ier(s) of the property described above, by vi,tuc of a warranty deed recorded in .Register of Deeds Office. Nit► er of bedr urns _ DATE SIGNATURE OF APPL MAN'r(S) * * *Ax,y information that is tt,isrepresented may result in the sanitary permit being revoked by the Planning & Zoning Depanrncnt. ' *� Include with this application a recorded warranty deed from the Resister of TDceds Office and a copy of the certified survey slap if refer rice is made in the warranty deed. (REV. 08/051) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 5as ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity . --- al ❑ NA Estimated flow (average) 5C6 g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer ❑ NA Soil Application Rate 7 gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510• cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank 0 eaarr ls) s) At least once every: a ❑ month (s) ) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA sib year(s) Clean effluent filter At least once every: ❑ month(s) 40 year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: — ❑ month(s) ❑ NA ❑ ear(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA Other: ❑ year(s) At least once every: ❑ month(s) ❑ NA Other: 13 year(s) ❑ 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 poriding 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 %) 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, 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 e S I'AAT UP AND OPERATION Page 7-2 of ?/ For new construction, prior 'to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detectsd have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the 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 controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT 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 ,, r technology a holding tank may be installed as a last resort to replace the failed POWTS. The-site 1 `r alua ' 0 Fj t b e ai a �f1D+d 1817 . fbR_ �f Ca N S7RUC- -A - k ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Na Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S C ( 20W11,4W Phone Phone 3WC0_ (10 CD This document was drafted in compliance with chapter. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. x &2 T /2" Rc 3a Z #EE 32 03Z NN O n I- m 22x3 P d Iv L� ` WAS -1r — DRY {c y H O N L V A A TE a C rn. \ r 4 8 I c r�i tee c° m n A ~ I T I R 'YG i.Fl. CVENT GFI PANTRY -... T�- y C, ¢" A `? G CCT8 30� n �Y_ /an 2 71 P \ ROOF VEM J l w x x m n. r F � N z w SHtP CQQ BY WH z' u_ N \. K: OAK FZAILING- w U =N / S - D;Z \ C \ p � � I I I N< x Iv- m N X . R Sx a �am I ten. �. - N 2, 72 N - J GF1 ° 4N - Vr w 3 - W r N F z a V� RC 2 ._ 2 /2 " GDH2CTa -1 C 0 s o r 7 r a 0 2 � c T m m § $ ƒ / o ° 0 0 2 _ — S § \ - E ' § 2 0 _ _ ■ M OD ` ° / \ § ; f ; 0 k CO 2 »' § k k 3 � (A (n E @ « ƒ E E ) E � m f .. @2 G k: \� \ / co S § 0 E cr _ ( T T T �: ■. 0 0 o E: " 2( / §§ 0 A e / f § ■ ■ @ a _ Q v n . � \ U� �(d�'� d � E ¢�/ } ( " / ( .. / o \ \ . ƒ / \§ � . ƒ / ( in ( D k ' 2 / 4 w Ch \ z ■ z $ . � R Z ¥ co . k } § } � § ` / $ ask § \ ƒ/ §3 � Eg\ � 2%( \ 0 a . /\ ; \ CD 22 � ©} � � � R � f Cb n 2 2 i $ \ 0 N < § % _ o B / I 2 DEP RTMEN F SAFETY & BUILDINGS INDUSTRY T ° REPORT ON SOIL BORINGS LC AND DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: ITO WNSHIP /MALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NW 1 / 4 NWI/4 8 /T N /R 173& or ) W Stanton n/a I n/a n/a COUNTY: OWNER'S NAME: MAILING ADDRESS: St. Croix Howard Krueger 1 2279 150th. St., Star Prarie, Wi. 54026 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION T esidence 3 n/a ❑New Replace 3 -16 -92 3 -16 -92 7 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: -INFILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ®S ❑U EaS ❑U LA ❑U S gU ❑ S �U conventiaonl If Percolation Tests are NOT required DESIGN RATE: Q I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS p age 4 SHA BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHVt ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.33 99.60 none >7.33 .2%1.1. 1.00bn.sil. .33bn.l.s., 4.75bn.c.s. B_ 2 7.08 99.00 none >7.08 1.08bl.1., 1.25bn.sil., 4.75bn.c.s. B_ 3 7.00 99.25 none >7.00 1.25bl.1. ,.92bn.sil., .50bn.l.s., 4.33bn.c.s. B- B- B- decimal PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 1 3.60 none 3 6 6 6 <3 P- 2 3.00 none 3 6 6 6 <3 P- 3 3.25 none 3 6 6 6 <3 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. SYSTEM ELEVATION 96 .00 F M E (� ! Q c / ` � _ _ __ _ r _� TN 3 A� -- -c - - I j i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedu meth in thj0lis onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge an f. I L �I�I` NAME (print): TESTS WERE C 4 1 J Gary L. Steel 3-1 sr ci01R ADDRESS: CERTIFICATION ER: PffiLOW"i UMBEI�(.p� Hall: 1554 200th. Ave., New Richmond, Wi. 54017 229 z F CST T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — l INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 6395 To be. a complete and accurate soil test, your report Must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5= Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8, Make scare your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the for and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Snail Separates and Textures Other Symbols St - Stone (over 10 ") BR - Bedrock cob Cobble (3 - 10 ") SS Sandstone gr - Gravel (under 3 ") LS - Limestone xs Sal r'rd HGW - Hiah Groundwater cs Coarse Sand Perc Percolation Rate med s - Medium Sand V'f -- WeII Is .- Fine Sand Bldg - Building is - Loamy Sand �> -- Grsater Than sl - Sandy Loarn < - Less Than I - Loanz B Brown # sil - Silt Loam BI Black si - Silt Gy - Gray cl - Clay Loam Y Yellow scl - Sandy Clay Loam R - Red sic[ _ Silty Clay Loarn mot - Mottles sc - Sandy Clay wf - with sic - Silty Clay fff - few, fine„ fa "int c -Clay cc -- common, coarse pt - Peat rxlrrt - Many, rM ilium rn - Muck d - distinct p -- prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request ve rification of this soil test in the field prior to permit. issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP , � SECTION T _ N- ,Z W ADDRESS 2 Z 72 J ,5 - J � ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE && PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SY EM 4�� 4 0 4 , INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK :Manufacturer : ' `J A < C ? Liquid Cap. 1 , 7� Rings used:,,CLManhole cover elev: �'� grade elev: Tank inlet elev.: Tank outlet elev.: 9 7 No. of feet from nearest road:Front --- S e , Rear Ft. 7 From nearest prop. line:Front 4-- Si de , Rear Ft. No. of feet from: Well "71- , Building: -7 Z (Include this information in the above plot plan) (2 reference dimensions to septic tank) ) SEE REVERSE SIDE t A . ' 1 PUMP CHAMBER Manufacturer: iqu -- Capacity: Pump Model: Pump /S' hon Manuf act .: Pump Size Elevation of inlet: Bottom of tank elevation r Pump on elev.: ump off elev.: Gallons /cycle. Alarm: Man.: Switch T ype: Location Distance fro nearest prop. line: Front_ Side Distance ear_Ft. . tance om. W el 1 Building SOIL ABSORPTION SYSTR,4 Bed: Trench: _Seepage Pit: Width: 5 Length zp Number of Lines: !? Area ilt S'e S'q Exist. Grade E 6® Bu lev.. �-- P roposed os p ed Final 6© Grace Elev. Fill depth to top of pipe: �s No. feet from nearest prop. line:Front Side , Rear Ft . No. feet from well: No. feet from building � _ / HOLDING TANK Manufacturer: Capacity: No. of rings used: evation of bottom tank: Elevation of inlet: No. feet from n rest prop. line:Front Sid , Rear Ft. Noo feet fro . Well__, building nearest road Alarm Man acturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: 6 /90:c i I LOCATION: STANTON 8.31.17.105 8,NW,NW, 150TH ST. Wiscpnsin Department of Industry PRIVATE SEWAGE SYSTEM County: L d Human Relations S INSPECTION REPORT ST. CROIX Safety fety a n�l,Buildings Division , f (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 147301 Permit Holder's Name: ❑ City ❑ Villages] Town of: State Plan ID No.: KRUEGER, HOWARD & MARGARET STANTON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: U g l lJ 01650000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �c Benchmark 9,92 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet -2- TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic q NA Dt Bottom Dosing NA Header /V K- Aeration NA Dist. Pipe g Holding Bot. System a (p,cl q C1 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM T Lift Friction System TDH Ft m ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L I BLDG I WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of Mod Number: System: - 70 l66 OR UNIT DISTRIBUTION SYSTEM Header / Man Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length -f--i -) Dia. Length 4= Dia. Spacing �- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ ❑ ❑ No Yes No COMMENTS: (Include code discrepancies, perso 'resent, etc.) 3 /�a Plan revision required? ❑ Yes ❑ No Use other side for additional information. z SBD -6710 (R 05/91) Date n e br's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s � ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE SANITARY PERMIT # — Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /,,.c5 8% x 11 inches in size. application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Howard Krueger M-1 % WT t /4, S 8 T 31 , N, R17 )&(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 2279 150th. St. n/a n/a CITY, STATE ZIPpp P}JQyE NUMBER SUBDIVISION NAME OR CSM NUMBER Star Prarie, wi. 44UU 6 / 1177 39 22 / �SI�1 A II. TYPE OF BUILDING: (Check one) ❑State Owned CIL : Stanton NEAR 17Utri St . ❑ Public � 1 or 2 Fam. Dwelling -# of bedrooms AR AX NUM ER( ) III. BUILDING USE: (If building type is public, check all that apply) (5.3 6 —/ C' 41(3 1 ❑ Apt/Condo 2 ❑ Assembly Hall. 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) E1 lN A) 1. New 2. eplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Ekseepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day/sq. ft.) (Min. /inch) ELEVATION 450 585 585 .77` >3 96.00 Feet 99.60 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks I Tanks structed Se tic Tank or Holding Tank X TTee'.cs Concrete x Lift Pump Tank/Siphon Chamber —"" -- '" El F1 I IL-11 r Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installat' n of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' gnature: (No2amg4 PRSW No.: Business Phone Number: Gary L. Steel 4 3254 715 246 -6200 Plumber's Address (Street, City, State, Zip ): 1554 200th. ave., New Richnond., wi. 54017 IX. COUNTY /DEPARTMENT USE ONLY �( F-1 Adverse Sanitary Permit Fee (Includes Groundwater Date ssue Issuin Agent Signature Stamps) LEI, Approved ❑ Owner Given initial T �T Surcharge Fee) �T Adverse Determinatio X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Pib -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your !ocal code administrator or the State of Wisconsin, Safety & Buildings Division, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. Vil. Tarok information. Fill in the capacity of every new and /or existing tank, list t "e total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation cifferences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) STC - loo 7'llis application form is to be completed In full and signed by the oWner(s) of the property being developed. Any in will only result in delays of the permit issuance Shoul this development be intended for resale by owner contractor d C this Douse), 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 Tioward Krueger Location of property N<a 1/4 N 1/4, Section 3 Township Stanton flailing address 2279 150th. St., Star Prarie Wi. 54026 Address of site 2279 150th. St., Star Prarie, Wi. 54026 Subdivision name nla Lot no. Other homes on property? es y No Previous owner of property .�S— Total size of parcel SO acres Date parcel was created / -. 1- Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house)? Yes x No $nd page Number �"� of Dee ds . as recorded. with the Register of Dee INCLUDE WITH THIS APPLICATION THE FOLLOWING: - A WAREtMITY DEED which includes a DOCUMENT NUIWER, VOLUME AND PAGE TIUMDER & THE 'SEAL OF THE, I2EGISTbl of DEEDS. In addition, a certified survey, if available; 'would be helpful so as to avoid delays of the reviewing process. references If the deed description to a certified survey Map, the certified survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am the property described in this information form, by virtue sof o f warranty deed recorded in the office of the County Register of Deeds as Document No. own the proposed s ite for the eewage� disposal and t system o r I e (we j Obtained an easement, to run the above described ro e the construction of said system, and the same has been duly recorded in the office of County Register of deeds is as document Signature of ap�1 nt Co -a 1 Pp cant Date of signature Date of s gnature Na S-9. Warranty Deed —Short Form (STATE OF WISCONSIN) Published by Eau Claire liook & litationerr Co. ,. (Sea 236:18, Wia. Statutes) Form No. 9 r f 4pa »I 9�d�ti8� tip$ i', iir' t'E. 7:V Ilm!,-i rd er Mar rot, j "rue, r l County, Wisconsin, hereby conveys and ivarr,:ntsto ��o:73r�1 1�rUE: "P" 1'i i, "(]�'F 'f.T ze1 ,,Er' hllsbamci , ,in,! : 0 ten<.int;, ;;rantee s of :_;t: , Croi;: County, Wisconsin, for the surer of Cno Do ; -1 T' .zn(; ^,,t,; , r` V'1�LU;3; ,.0 cor,: ldei a';1on c fol]OWir,,< 0VICt C- ! in ;t r :•, County, State of Wisconsin: `. >ect on t ( ) . �..,;,�., r� .'r:ir r - on(� (3i) P�ortii, of' . �1 f � a f. .. 4. I t 7 } tr.. Jua ti�(,tilr.,. ^ U.fGt • L .. fl.,t..:1� ' ��.,- fsly' me.' , _,1..19 T �.. i acknowjrd aic, : CZ O' x Cqurt; L " ✓is. 7 f' (? T rr: i Yl Ur.;a:t � Drafted oy_ T _ nr'1 r T i' 'I (\.3. —Ch. S) Wis. Stets. p.a 4o t.u.t n'I mc:tromcnt, to he pluinly ,�r1 •. tvu typnN rift KS t:k'r!l::• ^..my •.7 t: grant,i,• jl zranta.•n, sritn_su and notary.) SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BgnWX Howard Krueger ADDRESS: 2279 150th. St. Star Prarie, wi. 54026 FIRE NO: 2279 LOCATION:_ NW 1/41 '1/4, SEC. 8 T 31 N - 17 W TOWN OF: Stanton ST. • CROIX COUNTY SUBDIVISION • n/a LOT NO. n/a 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 to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the 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 ins pection and i pumping (if necessary), the septic tank s less than 1/3 full of sludge and scum. Certification from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED : A I 1 9 OZ- DATE: 7 7 St. Croix County Zoning Office 911 4th St. - Hudson, WI 54016 INDU STRY iTM , OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDU, � DIVISION LABOR AND P ERCOLATION TESTS (115 P.O. MADISON WI 53107 HUMAN RELATIONS (H63.0911) &Chapter 145.045) LOCATION: SECTION: ToWNSHIP /MMXXXPALI L OT NO.: BLK. NO.: SUBDIVISION NAME: NW 1 /4NW I /4 8 /T 31 N /R 17 *cor► W Stanton n/a n/a n/a COUNTY: OWNER'S NAME: MA LING ADDRESS: St. Croix Howard Krueger 1 2279 150th. St., Star Prarie, Wi. 54026 USE DATES OBSERVATIONS MADE F NO. BEDRMS.: COMMER A DESCRI TION: RO I S ON �esidence 3 n/a ❑New Replace (3 -16 -92 3 -16 -92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U 2S E1 ❑U 1 EJS9U10 S )E1U1 conventiaonl If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a ' Floodplain, indicate F elev n/a , PROFILE DESCRIPTIONS 13 age 4 SHA BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTI -I t ELEVATION OBSERVED EST. HI HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B -1 7.33 99.60 none >7.33 .25bl.1. 1.00bn.sil. .33bn.l.s., 4.75bn.c.s. B-2 7.08 99.00 none >7.08 1.08bl.1., 1.25bn.sil., 4.75bn.c.s. 13-3 7.00 99.25 none >7.00 1.25bl.1. ,.92bn.sil., .50bn.l.s., 4.33bn.c.s. B- B- B- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER WjdRS AFTER SWELLING INTERVAL -MIN. PER 1 PERIOD3 PER INCH P- 1 3.60 none 3 6 P- 2 3.00 none 3 6 6 6 <3 P- 3 3.25 none 3 6 6 6 <3 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. SYSTEM ELEVATION 96.00 y � � ' i �s I - T lip I, 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: Gary L . Steel 3-16-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi. 54017 229 715 CST T DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DIL.HR -SBD -6395 (R. 02/82) — OVER — L_ STEEL'S SOIL SERVICE 1554 200th, -tea Gary L. Steel C.S.T. 2298 New Richmond, WI 54017 MPRSW -3254 (715) 246 -6200 Howard Krueger M 4M'-'; S . 8- T31N -Rl - M , Stanton to , ,mship 4y l JfO m ��f s '�� �, 3 / j Flo U w nnas �o c�C < 9f 6° dj✓ r4ciew 9 20 Gary L. Steel MPRSW 3254 4 -7 -92 i REPT131 STANTON ST. CROIX COUNTY ZONING � PAGE 1 05/'06/92.,16:40 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 8/92 "�,� AREA: MJ Activity A9200147. 5/ Type: CONVSEPT Status: PENDING Constr: ` Address: STANTON 8.31.17.105,8,NW,NW, 150TH ST. Parcel: 036- 1016 -50 -000 Occ: Use: Description: 147301 Applicant: KRUEGER, HOWARD & MARGARET Phone: Owner: KRUEGER, HOWARD & MARGARET Phone: Contractor: GARY STEEL Phone: 246 -6200 --------------------------------------------------------------- ..---------------- Inspection Request Information..... Requestor: GARY STEEL Phone: Req Time: 13:05 Comments: (1:30 "K) Items requested to be Inspected... Acton Comments a Time Exp 00012 FINAL INSPECTION .A6_ ___.... .,___...._- ---------------------------------------- _------------- ------- --_..-- Inspection History..... Item: 00012 FINAL INSPECTION REPT131 STANTON ST. CROIX COUNTY ZONING PAGE 1 05/06/92. 16:40 REQUESTS FOR INSPECTION WORK SHEETS FOR: 5/ 8/92 AREA: MJ * INSPECTION REQUEST SUMMARY Address Time Activity Type STANTON 8.31.17.105,8,NW,NW, 150TH ST. 13:05 A9200147 CONVSEP Item: 00012 FINAL INSPECTION SOMERSET 14.31.19.195F,SE,NE, 215TH, LOT 4 14:05 A9200170 CONVSEP Item: 00012 FINAL INSPECTION 1 8 m 8 6 9 2 VOL KATHL PEj GE WALSIV -- REGISTER OF DEEDS CERTIFIED SV � RECEIVED k OLD 1 10:30A!( LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 CERTIFIED SURVEY MAP OF SECTION 8, T31 N, RI 7W, TOWN OF STANTON, REC FEE: 13.60 ST. CROUC COUNTY, WISCONSIN COPY FEE: 3.00 N PAGES: 2 THIS CERTIFIED SURVEY MAP IS CREATED UNDER FARM CONSOtJDAnON I NW CORNER � sECr1oN s � I OWNER I I MONUMENTS OF MRECORD) f? HOWARD AND MARGARET KRUEGER LEGIEND ° _ PREPARED FOR ET 3/4•X 1W IRON REBAR S. WEIGHING RAM WLLARD 1.50 LBS. PER LINEAR FOOT N4W C.T.H. 'Y` I � � - • - 100' BUILDING SETBACK UNE � SURVEYOR QR ' X X EXISTING FENCEUNE GRANBEF(3 SURVEYING. INC. 1235 C.T.H. 1-' -------- ----- - - - - -- NEw FK*IMOND. WI 64017 N8W48'56'W 569.27 x —x- 33. 636.27 RECEIVED I 33' 33' I pBIN APR 2 5 2006 ST. CROIX COUNTY SURVEYOR'S RECORD SH I _ f-- ousnNQ DRIVE _— EDO N OWELL to i 1 = i I LOT It 1 i I 8.95 ACRES INC. RJW I r j ( 389.857 SQ. Fr. I S SEPTIC VENTS Z 9 I s s 8.43 ACRES E XC R/W 367,300 SO. Fr. II G B I 6 I NEW RICHMOND 3UEiV�Z� J US I 0 0 SOUTH UNE OF THE NW7 /4 OF THE NW114 33.00' r ` X —X � sa""z -E 5e9.2W I W1/4 � ER MM[p[La [E) 1 3 RAH � (RECEIVED COORDINATE F ROM COU NTY SURVEYOR) SCALE IN FEET 1.: 1 OW THIS INSTRUMENT DRAFTED BY MICHAEL ERIC (SON JOB NO. 05-71 DATE 7 -25-05 SHEET 1 OF 2 SHEETS 00 0 100 Vol. 20 Page 5084 • Parcel #: 036- 1016 -60 -200 07/05/2006 12:23 PM PAGE 1 OF 1 Alt. Parcel #: 8.31.17.1066 036 - TOWN OF STANTON Current Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/16/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner O - JENSEN, DAVID A DAVID A JENSEN 701 W LINCOLN RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 8.950 Plat: 5084 -20 -5084 SEC 8 T31 N R1 7W 40A Block/Condo Bldg: LOT 01 20 -5084 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 31N -17W NW NW Notes: Parcel History: Vol /Page )� ;01 L1/2 06 816149 20/5084 CSM 19/2005 795398 2805/459 `1 t 10/01/2004 775836 2666/570 TI more... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 05/18/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 5.950 900 0 900 NO UNDEVELOPED G5 1.000 800 0 800 NO OTHER G7 2.000 14,000 130,800 144,800 NO Totals for 2006: General Property 8.950 15,700 130,800 146,500 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 I • Parcel #: 036- 1016 -60 -000 07/05/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel #: 8.31.17.106 036 - TOWN OF STANTON Current X i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/16/2006 00 5 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WILLARD, RETIRED RETIRED WILLARD Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 2279 150TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T31 N RI 7W 40A NW NW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08 -31 N-1 7W Notes: Parcel History: Date Doc # Vol /Page Type 05/19/2005 795398 2805/459 TI 10/01/2004 775836 2666/570 TI 10/24/2002 695480 2021/249 QC 07/23/1997 443/82 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/16/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t Parcel #: 036- 1016 -60 -100 07/05/2006 12:23 PM PAGE 1 OF 1 Alt. Parcel #: 8.31.17.106A 036 - TOWN OF STANTON Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/16/2006 00 0 Ta ress: Owner(s): O = Current Owner, C = Current Co -Owner O - WILLARD, RUTH H UTH H WILLARD 4861 CTY RD Y NOMO 1 54751 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 31.050 ;l1ock/Condo at: N/A -NOT AVAILABLE SEC 8 T31 N R17W 40A W NW N EXC C SM Bldg: 20 -5084 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-17W NW NW Notes: Parcel History: Date Doc # Vol /Page Type 10/06/2005 808692 20/5084 CSM 05/19/200 795398 05/459 - Tl 10/01/2004 775836 2666/570 TI 10/24/2002 695480 2021/249 (�C mor .. 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 05/18/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 31.050 4,800 0 4,800 NO Totals for 2006: General Property 31.050 4,800 0 4,800 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