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Home My WebLink About038-1031-40-200 + 0 Ea d r� ° a, c O #m n to 3• a Z x Z m Z Vi g a Z x Z N Z O w e ( n a c) • m d o m o N O n N m o m o N o m 3 < c m M 3 n 5 ' a m o 00 I c\ 2 A O m m E N Q °. m p CD m - N W a ° M C c m O m 5 c o c m m 5 w. eD O CV a 7 7 Q N N Q. 7 7 Q N O W� = G = n °O -0 A = C 7 mn-. A O CD CD a C. O W 3 d it • m O W ° N :3 O O ~• U) CD O A � v CP Z cn v D w cn Z (o v D m o m co D m 4' N m cc� D �' N a ° > > co > > w c C a a °° a a ° c o o 3 V O O 3 O p cn cn :p m � Z m F4! Z o o m C• a Ow N N 0) ! I I n ° 0 ai ° 0 CD ° o ° o _ N o e o o C Z :. tJ CD 1 1 C G M O Z o Z O O O IAO w w o AO w wv_ 3'I <mz aQ ° a a( ° 2 a n 3 to Ch N o D a a a a- O cQ p S 3 cn cr O O ? =r m N C ? 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C N p m ^N' 3° m S AO �.� ° y' 3(c ?w �.m o '°-' ° ay y v c 5n � O aN �N m e :3 a o0 C1 N O <. O N C1 CD 7 <. CC] m =0 m =0 a N N O O b I A CD A O O p O '69 p N a O O a O O CL N Parcel #: 038 -1031 -40 -200 02/03/2006 02:24 PM PAGE 1 OF 2 Alt. Parcel #: ' 8.31.18.144A -30 038 - TOWN OF STAR PRAIRIE 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 ERHARD BAEHNI O - BAEHNI, ERHARD 84 OAK ST ST PAUL MN 55115 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 967 CTY RD H SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 4.418 Plat: 3921 -CSM 14/3921 SEC 8 T31 N R1 8W PT NW NE BEING LOT 6 CSM Block/Condo Bldg: LOT 6 14/3921 Tract(s): (Sec- Twn -Rng 40 1/4 160 1 /4),�ry�Q / r 08-31N-18W NW NE/'�" r7I Y�y Notes: Parcel History: Date Doc # Vol /Page Type 12/04/2001 663951 1779/460 WD 01/05/1999 595119 11323LI43 TI 07/23/1997 1 192/5 WD more... 2005 SUMMARY Bill M Fair Market Value: Asses 118779 62,400 Valuations Last Changed: 10/13/2004 Description Class Acres Land Improve Total . State Reason RESIDENTIAL G1 4.418 44,100 17,200 61,300 NO Totals for 2005: General Property 4.418 44,100 17,200 61,300 Woodland 0.000 0 0 Totals for 2004: General Property 4.418 44,100 17,200 61,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 038 - 1031 -40 -100 02/06/2006 08:44 AM PAGE 1 OF 1 Alt. Parcel #: 8.31.18.1144A -20 038 - TOWN OF STAR PRAIRIE 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 EMIL & ANGELINE KUCERA O - KUCERA, EMIL & ANGELINE 3098 HAMLINE AVE N ROSEVILLE MN 55113 Districts: SC = School SP = Special Property Address(es):, `= Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.621 Plat: 3921 -CSM 14/3921 SEC 8 T31 N R1 8W PT NW NE BEING LOT 5 CSM Block/Condo Bldg: LOT 5 14/3921 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-18W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 10/03/2000 631021 1547/568 WD 01/05/1999 595120 1393/147 WD • 01/05/1999 595119 1393/143 TI 07/23/1997 1192/581 WD more... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 118778 68,800 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.621 50,100 17,500 67,600 NO i Totals for 2005: General Property 5.621 50,100 17,500 67,600 Woodland 0.000 0 0 Totals for 2004: General Property 5.621 50,100 17,500 67,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 126 Specials: User Special Code Category Amount • Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 038 - 1031 -40 -100 12/27/2005 08: AM PAGE 1 OF 1 Alt. Parcel #: 8.31.18.144A -20 038 - TOWN OF STAR PRAIRIE Current X I 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 - KUCERA, EMIL & ANGELINE EMIL & ANGELINE KUCERA 3098 HAMLINE AVE N ROSEVILLE MN 55113 Districts: SC = School SP = Special Property Address(es): �� " = Primary _ Type Dist # Description H w a SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.621 Plat: 3921 -CSM 14/3921 SEC 8 T31 N R1 8W PT NW NE BEING LOT 5 CSM Block/Condo Bldg: LOT 5 14/3921 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-18W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 10/03/2000 631021 1547/568 WD 01/05/1999 595120 1393/147 WD 01/05/1999 595119 1393/143 TI 07/23/1997 1192/581 WD more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 118778 68,800 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.621 50,100 17,500 67,600 NO Totals for 2005: General Property 5.621 50,100 17,500 67,600 Woodland 0.000 0 0 Totals for 2004: General Property 5.621 50,100 17,500 67,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 z 2 2aao FILED AUG 0 3 2000 .y $1. CROIX COUNTY KATHLEEN H. WALSH l URVEYOR'S RECORD ��2 2 SLC roix S \ CO, .m a am �brod h� N ? 0 -2 W 5 PPROVIED LZ O O ib OIX COUNTY y ? co ~ p tv w Flan ' g Parks Comm tt a c A 30 w ►� O. C� a mm �. N r � �\ I IC o p O G n rn n n ded within 30 dpys of I-0 m o� �' m pproval date approval shall be C c4 �, y 91 CJ n d Hutt and yaid I I Z 0 C " emu,, N� LOT 10F v� m o y `� CERTIFIED SURVEY MA_P I 10 .. - �, 0 VOLUME 1, PAGE 150. I I. cD ° a , STREET 1 �. °, y I ° cD n ° y ROADWA ES_MT_. 10 ' 0 q �. � 8. a 9 E p ��AtE i39� c) 00° 39' 02" W 213.9T t ° t5°.na.'Q 6�� 15 1M 2W ' -(R 317 2 50'I �' a' ": p o �'• c �D 6 184 12° A .0 0 48 3 00° � 39 02" W t- 157 8' '� 3 912 °W - ''x. 1 I p , Ni °553 X O ao 50. I 35 9 o °'49 (fQ��I CD ca DO IV z O y r• CD 0 z ., o ,., n J z jr; -I O r c i ZNZ p Nn �� , I m `^ °�� g __ m� c yc 0 o D t I m . , 0Sc `� cn �zm � r / I �',.� A I a,r.•� ►1y1 Q1 z O p i s a �. 3 �I z ° c z�Z b ? b cn H� [\71zt�7J po I I z o c rn n n 0 a o m - I� l� m .. .. m I 0 I I G Sao � ~ o;o � CD - r� ,m =m" I I� �� co c ° ° I y m d z v, r^' ° o z o �. Imlm '" o` N wl xl Im 429.40' m 5 _ M 9.53' 10 1 _ N 01 ° 53' 51" E 488.93' ' I ► - 1 I I� O aI Iy �! O N z m � n i �`• 45' I, a O cn m X n I I �IZI n A I tD r W Z y ' I CID Z Z U? Inc y✓ 0" G7.. P•• m O .e' -• a ;;7• rri $ O X A r N m !71 rr. i s d un �C, o � IO1�v! m k o. O 1 Q I m 85'I o s7 �. D O p At Z I I I I z p v EAST LINE OF THE NMh /4 OF THE N'E'I f4 I v� N = I I o 0 _ — --k- ' ' W .'J IT! S 00° 28' 25" W 489.13' o J 7 o ry W UNPLATTED LANDS o N a I I Go G. f I N .. �. vZO jj I .d CD O v7 O nr 0 O �� L�W�. C y 0 ' 0 O D Ong �#� z� w bC m C� �y ,n N 'n ' rn m C 2 z�In�ro ��5' p y a� - � Az z� p�z n� m �nny� ��[�1 �r� G)�� n zoo _u m o rn 2 J °N CG 0 `° °' try En r+ CO 0 co iu y ►., Nt" Oct ctrl z � c) CD "' cp , Y0 v Vol. 14 Page 3921 Wisconsin pepartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix f n Building -Safety and Bu Id n tY 9 Division INSPECTION REPORT Sanitary Permit No: 101 GENERAL INFORMAT ?ON - (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Barr, Robert I Star Prairie, Town of 038 - 1031 -40 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 08.31.18.144A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TtTIt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air intake ROAD TM S eptic Dt Bottom osing Header/Man. A eration Dist. Pipe 7661 ng Bo t. bystenn F inal Grade PUMP /SIPHON INFORMATION anu ac urer Demana St Cover GPM m odel um er i nc ion LOSS System mea o last. to vven SOIL A11350IRPTION SYSTEM DIMENSIONS INFORMATION CHAMBER OR UNIT 100dul 110111bul. MUM Spachly Pipes) Length Dia Length Dia Spacing x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench Center Bed/Trench Edges Topsoil I Yes ? No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 967 County Road H New Richmond, WI 54017 (NW 1/4 NE 1/4 8 T31 R1 8W) NA Lot 6 Parcel No: 08.31.18.144A30 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes a No — — - -- — Use other side for additional information. I - -- — — Insepctor's�ignature- -. -- SBD -6710 (R.3/97) County Sanitary P t lic taaQp 4 7 %T. T. CROIX COUNTY WISCONSIN In accord with Chapert 12 S roi ou Sa itary i r PL NING & ZONING DEPARTMENT Personal information you provide be ed for econda CR IX COUNTY GOVERNMENT CENTER t�� i [Privac w . 15 4(1)(m)] S 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386-4680 Fax(715)386 -4686 Attach complete tans for the ystem on paper not less than 8-1/2 x 11 inches in size. C my Sanitary ermit # ❑ Check if revision to previous application I. Application Information - Please Print all Information Location: Property Owner Name 1/4 Ne 1/4, Sec R 0 a E' P-7 N, R g E (or Property Owner's Mailing Address 0 Lot Number Block Number a� �� •k or. �� 71S 7h - to 6) 1(D City, State Zip Code hone Numer Subdivision Name o SM Number 2C v tct akl s Sy 02 zto- ss o AS Ty a of Building: (check one r�7 /� amity ❑ Village ow n of f 1 or 2 Family Dwelling d oo 3 - No. of Be r �S✓ / �N ��' � 11 Public /Commercial (describe use): ,p r p A �� .{ ^ k ❑ State -owned Ne st Road 1 IL Type of Permit: (Check only one box o line A. Check box on lie B if applicable) • k Parcel Tax umber(s) A) 1.0 Repair 2. ?(Reconnection 3.❑Non- plumbing 4. []Rejuvenation %7 Sanitation 8 - t 0 - 31 -L 4 0 ?0 d B) Permit Number Date Issued / // ` State Sanitary Permit was previously issued g - - c 0 IV. Type of POWT System: (Check all that apply))�- K Non - pressurized In-ground Mound ❑ Mound >_ 24 in. suitable soil ❑ Mound :5 24 in. suitable soil 11 Mound A +0 ❑ Sand Filter li�/�n BL ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground �d ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: Co A E - T 2 N5f7a ( - Lfl'JZ — G 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Ele ation S 7 4 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks 000 1 19 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumber's Name (print) Plumber's Signatur (no stamps): T 47/MPFS No. Business Phone Number ♦�anc� at�S ow,sQ X30 %7(0(0 Plumber's Address (Street, City, State, Zip Code) �7Z X7 VIII. Coun Use Onl Disapproved San Permit Fee a lss}�ed wing ent Signa o stamps) UY Approved Owner Given Initial Adverse �l /1 �o I/ � W Determination v(/ ,-� yt u(/j'(/l-� IX. Conditions of Approval /Reasons for Disapproval: 3 Q� �✓ ' N n (- BG1 SyS�m L e71 2000 0 f //V� ri EM OWNER: G' /��✓'/� ryt [� /5��7e.SA -c.- C - U r 1414 - VE- A VAL1/ iSp spersal uent filter and - m 7��?/�E- "ss,tJl7i�� C�YC�� 3 cell must all be serviced / maintained G � P as per management plan provided by plumber. y-� es A . 2. All setback requirements must be maintained f'FFLL &XT_ F/L IZ l t/ S 11US� � 0/J IR6 "T as per applicable code /ordinan /12J) 6eW u� cvn 2067D - Z. z m m z ( m i n v O m -� X X 0 —I U) m O cn I� 0 (n M �i -a n CA < a 0� CO O r �, r m z ° c n � — G)m z ° m O 0 � v ZO m C m C/) Z Z CO CO v r o C /� i m C -n (n c `„ C/) 0 0 C/) Z � N °a � —i O -� -Zj m O � �' � n 5 - Z - n - z - h z m z m L to = m X m g m y m n a c v (1) v I ° w If °,0 a m o,� o m 0 CD N c O co la y Ol fQC O v N O m m ° (D ql 1 '° O N 1 O y .. C H r ^ d O �. X? x y O . N 7 '� (A 7 o a w o v Na a _ 3 s ,� m m D �c g o w a �W o� w cr ID N ri m o 3 n of o ° 3 � � 3 � o c °-= a.m m O m ° m I (A cl . m N m z r z m z =i m o o Z o �` m C O Z z Z =r y q d m Er� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer (,Z 2 lc Mailing Address S O B R i Je j P� `` U f, Q �V�/ �-��5� w I S' 22 Property Address C R d. 14 S�q / ra f i e LL (Verification required from Planning & Zoning Department for new construction.) City /State ST f Pf(u Parcel Identification Number 03y- LEGAL DESCRIPTION Property Location NW '/ , ]�E '/ , Sec. 6 ' T _ N R I B W, Town of s+c, ( P ral r e Subdivision , Lot # Certified Survey Map # V7 Z ,Volume ,Page # ni Zj Warranty Deed # 82-u Z - 7 8 , Volume �3 06 , Page # Spec house ❑ yes 60 Lot lines identifiable yes ❑ 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. I I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County 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. I /we 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 3 "12.r) ,S /I /of. S16NATUItE OF APPLICANT(S) 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) // 624274 KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIK GO., MI RECEIVED FOR RECORD Document Number Document Name 05/03/ 10:10Al1 �G 186 2_90 YARRANTY DEED EXElPT t THIS DEED, made between Erhard Baehni, a single person REC FEE: 11.00 ("Grantor," whether one or more), TRANS FEE: 216.00 and Robert Barr and Holly Barr, husband and wife COPY FEE ( "Grantee," whether one or more). CG E' PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St Recording Area Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Part of NW 1/4 of NE 1/4 of Section 8, Township 31 North, Range 18 West, St. Northwest Land Tltle, Inc. Croix County, Wisconsin described as follows: Lot 6 of Certified Survey Map filed pp Box 520 August 3, 2000 in Vol. 14, page 3921, Doc. No. 627512 Milltown. �r5•'a�S', y� � 028- 103140 -200 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated pY 1 ) � a oJ to (SEAL) Q 1 9 (SEAL) * *Erhar4 Baehni by Gary Ififflargeon,lis Attorney in fact (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) {. authenticated on STATE OF ) ss. LRY C IrN►X COUNTY ) * TITLE: MEMBER STATE BAR OF SIN sonally came before me on AIDYi) 1 y. z�,� (If not, HON above -named Erhard Baehni, by Gary Baillargeon, his authorized by Wis. Stat. § 706 6) 8YJA1y�N me in fact N t e known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: 'fh �strument and acknowledged the same. VA Kristina Ogland. Estreen & Op-land rviJa m • /91 304 Locust Street. Hudson, WI 54016 * �• ci Notary Public, State of 1, ► ` b (1S► �` My Commission (is permanent) (expires 9-16'U� ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. INFO -PROTM Legal Forms 800-655 -2021 www.infoproforms.com i of 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION' SYSTEM SPECIFICATIONS Owner o6EK- - Septic Tank Capacity ILg oo gal ❑ NA Permit # Septic Tank Manufacturer y4 UA/ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer A Number of Bedrooms ❑ NA Effluent Filter Model 0XA Number of Public Facility Units A Pump Tank Capacity a l A Estimated flow (average) gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ A Soil Application Rate Q , gal /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Ir A Fats, Oil & Grease (FOG) :_30 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 Dispersa Cell(s) , � -? Biochemical Oxygen Demand (BOD 530 mg /L - Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ¢� NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100m1 ❑ Drip -Line W Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2, �j ❑ EVy ear(s) aiith(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: 12 -3 onth(s) (Maximum 3 years) ❑ NA years) ❑ month(s) NA Clean effluent filter At least once every: ❑ year(s) Inspect pump, pump controls & alarm At least once every: p yeast ►(s) NA Flush laterals and pressure test At least once every: ' ❑ month(s) A ❑ 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 :_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the 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 ils and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replaceme ystem: Sa� 260() �6/ L i� 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. T he alua ' a o mg tank be ' e failed AD41'D rr� f$ R- �6✓ Ca N S?7zc1� D ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name b Name Phone j' L -9- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name ST. ( U ()N 20/ 1 Phone Phone 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. wiscpnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363833 Permit Holder's Name: []City ❑ Village ❑ Tgwn of: State Plan ID No.: Robert I Star Prairie Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: p' l� ,0 / S� " = CST 038 - 1031 -40 -000 TANK INFORMATION AEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE V. Septic Benchmark C �, jp ipp Dosing '°^�� Q Alt. BM Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St / Ht Outlet .SO ` go-at) TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic ] Sp' �- r (' NA Dt Bottom Dosing NA Header /Man. 1° fs' �( - $S ► Aeration NA Dist. Pipe VD -Zo •93' 0 � Holding Bot. System 4 PUMP/ SIPHON INFORMATION Final Grade $.d C., « Manufac emand St cover (.L9 R .10 Model Number GPM TDH Lift Fr' � n TDH Ft Forcemai Length Dia. Dist. To well SOIL AB RPTION SYSTE TRENCH Width 1 Lengt No f Tenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 7J .5 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu rer: SETBACK CHAMBER Number: _ INFORMATION Type O 5 + + oZ , �� - Mode System: OR UNIT DISTRIBUT ON SYSTEM Header/ 1/ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Lengt Dia. Length- Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over u Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: OS /o3 /00Inspection #2: - Location: 967 County Road H, New Richmond, WI 54017 (NW 1/4 NE 1/4 8 T3 1N R1 8W)'!- 08.31.18.144A2 1.) Alt BM Description= N/k r 2.) Bldg sewer length= II- _ - amount of cover .��1 wf tk L (oj-Ly ski Plan revision required? ❑ Yes SR No Use other side for additional information. 1 05 d II ' o 1 0 1 MKA&--- SBD -6710 (R.3197) Date Inspector's Signature Cert. No. l ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r • gg S i g@ gg e S � E 3 � i , 3 I I . I `. , €� 1 r PLOT P AN PROJECT Robert Schmidt ss 967 Ctv Rd H New Richmond Wi 54017 NW 1/4 NE 1 /4S 8 /T 31 N W TOWN tar Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 ATE 4 /24/00 BEDROOM 3 i CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18 BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100 ❑ BOREHOLE O WELL *H.R.P Same as Benchmark SYSTEM ELEVATION 86.4 Alt. BM Top of Septic Tank Cover @ 94.6' Well 15' Existing 3 Please note: septic tank is to 30 Bedroom be pumped the day of * House installation, also 's to be M. installed if possib a to utilize existing system 20' Alt. 1 Q xis�000 Gallon Tank 15' 15' 1' 1 2-3'X 56' Trenches with 6' Spacing 30' 0' 12% B -3 slape Vent -2 Vent x Vents Sidewinder High -� > 12" Capacity Leaching a 110 of Cover Chamber with 31 0 6 ' Long 16 " ft ^2 per chamber 0 34" Grade at System Elevation 100' Property Line I r Safety and Buildings Division 14 sconsin SANITARY PERMIT APP ATION 2 01 W. Washington Avenue P o Box 7162 Department of Commerce ' In accord with Comm 83 , VQ(s r�i�L�c)Ne r Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for th7 r7 ] ",o q o a er nt Tess County than 8 vi x 11 inches in size. y % (' °' 7< C ,. `� t • See reverse side for instructions for completing this apliatin State Sanitary Permit Number Personal information you provide may be used for secondary purposes, �. � �� Ch p A ision to re s application [Privacy Law, s. 15.04 (1) (m)]. Mate Plan Review Transaction Number I. APPLICATION INFORMATION -PLEASE PRINT t `-MIO WIG N Property Owner Name _ �... j . Prope Z � �/4 : � 7 on 2o �S , S T 3 N, R (ol) Property Owner's Malin Address Block Number City, tate Zip Code 7 Phone Number `3 Subdivision Name or CSM Number .5 ` — i -23— >2i l -� ✓ b� 11. TYPE BUILDING: (check one) ❑ State Owned ❑ it 3 Nea st oad p vii age / Public or 2 Family Dwelling - No. of bedrooms own of S � 111 BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) G/ . Hif pf /1 2 1 ❑ Apartment / Condo ��— U 3 r - O� V 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 box on line A. Check box on line B, If applicable) A) 1. ❑ New 2_eplacement 3. E] Replacement of 4 E] Reconnection of 5_ E] Repair of an ------ Syrstem---- , - - "_ Sys - tem ---- ------- - - Tank Only _ --- __ - - -- Existing System - -------- - Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 1 seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy ❑ Seepage Pit 43 ❑ %/ Dr;. 14 ❑ System -In -Fill S 6 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) c' �/ tie t' n -S d �� r Feet aeet au VII. TANK Cap t Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App New — Existin g strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans. Plumber's : (Print) Plumber' at . ( St mps) MP /P&RSW No.: Business Number: l � 4_eL_ 5��I_ z—A d�! DG 6 Plumber's Address (S reet, City, tate, zip de). 6 IX. COUNTY/ DEPARTMENT USE ON Y ❑ Disapproved Sa itarq Permit Fee (Includes Groundwate, ate I ssued Issuing Agent Signature (No Stamps) � 'Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination Za5 . c� --- X. CONDITIONS OF APPROVAL / REASONS FOR DI A IPRO AL: SBD -6398 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a tirne 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 / Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. 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 on 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 for nurribers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/watE service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharge_ s are used for monitoring groundwater contamination investigations and establishment of standards. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have in pected the septic tank presently serving the ` ae ,,,e residence located at: Section T R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. � / Last time serviced: / Did flow back occur from absorption system? Yes �� No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete >< Steel Other Manufacturer: (If known) :1 ye1Mr_11 Age of Tank (If known),:, ( gnature) (Name) Please print � (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). N >O ame _T S ignatu r MP /MPRS �.` Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wi Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County _ include, but not limited to: vertical and horizontal reference point (BM), direction and 5 C f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 3 $ APPLICANT INFORMATION - Please print all information iewed by Date Re Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S I — Zc av Property Owner Property Location Govt. Lot 114 f1 /4,S T / ,N,R / g E ( ) W Property Owner's Mailing Address Lo7*BIock# Subd. Name or CSM# 7 City State , Zip Code Phone Number ❑ Ci ❑ Village Town Nearest Road ❑ New Construction Use: �sidential / Number of bedrooms Addition to existing building X Replacement El Public or commercial - Describe: /l Code derived daily flow _ gpd Recommended design loading rater bed, gpd /fi • `/ trench, gpd/ft Absorption area require /_ bed, ft + 5��3 trench, 112 Maximum design loading rate - bed, d /ft 5� � gp trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations �1 Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding T k U = Unsuitable for systems ❑ U �❑ U ❑ U U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground �j S /l/J / JF ft . / Depth to limiting facto - -- in. Remarks: Boring # 3 7 Ground Depth to limiting b �- fac r _P_ n. Remarks: CST Name (Please Print) Si atur Telephone No. Address� C) Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench L7� Ground 1 l i� -411 A /V1 A � el �� ev jj��'�� =e ft• �� Depth to limiting O 80 , �( , factor /to n. Remarks: Boring # �.. . Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) - Soil Test Plot Plan Project Name 'Robert Schmidt Shaun Address 967 CTY Rd H New Richmond Wi 54017 7iTM # 6900 Lot ----- Subdivision ---- --- Date 4/24/00 NW 1/4 NE 1/4S 8 T 31 N /R W Township Star Prairie ❑ Boring 0 Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Base of House Siding System Elevation 86.4 *HRPSame as Benchmark Alt. BM Top of Septic Tank Cover @ 94.6' Well 15' Existing 3 30 Bedroom House B 2 Alt � .M. Existing 1000 Gallon Tank 15' 15' 30' 0' J 12% B -3 Slope Vent -2 x 110' 0 0 U 100' Property Line r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT` AND OWNERSHIP CERTIFICATION FORM � i OwnerBuyer - 4 Mailing Address /i��t� Property Address _— (Verification required from Planning Department for new construction)' City/State Parcel Identification Number i LEGAL DESCRIPTION Property Locatiou'6/_ /. �/,, Sec. , T _&N- R_,ZdW, Town of i ict,�.✓s� Subdivision . Lot # Certified Survey Map # , Volume , Page # a Warranty Deed # J / z , Volume , Page # 1 �� Spec house ❑ yes -El Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (Z) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year e ' tion date. Z A / UD SIGNATURE OF PLICA14T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described abo e, by virtue of a warranty deed recorded in Register of Deeds Office. / /Zot�c7 SI NATURE OF APPLICANT 15ATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1393 F',Aiu 1 5 STATE 1 1AR OF WISC0N ;1 1 ORM 2 11482 K IfHLEEN H. WALSH WARRANTY DEFD REGISTER OF DEEDS G- NO 31. CROIX W1 RECEIVED FOR RECORD Timothy Hassl?r, a Single jersor, 01 10:45 AN WARRANTY DEED EXEMPT 0 C R T C OPY FEE: COPY FEE: convcys and warrants to TRANSFER FEE: 385.50 - - - -Schmidt. bia.qband and--A.f-e, RECORDIK FEE: 10.00 PAGES: I -S SPACE qEStHVFL FOR RECORCiNG uA''• NAME ANDAETI,RN ADDRESS the follo%Ing de - cnbed real estate in County, - 7 State of Wisconsin. 038-1031-40-000 A parcel of land located in NW 1/4 of NZ 114 of Section 8. Inwaship 31 Nort'h ?ange IS West, Town of Star Prairie. St. Croix County, Wisconsin being fur, he. described as follows: Commencing at N 1/4 corner of section 8, thence South 87 degrees 62 minutes 32 seconds East along North 1 -ine of said SecCion a distance of 368.80 feet to point of beginning: thence continuing South 8 degrees 52 minutes 32 seconds East 919.86 feet to East line ot NW 1/4 of NF 1/4 of section 8; thence South 00 degrees 30 minutes 56 seconds East along said forty line 489.13 feet: thence North 87 degrees 52 minutes 32 seconds West 835.98 feet; thence North 16 degrees 39 minutes 12 seconds West 184.15 feet; thence North 12 degrees 48 minutes 32 seconds West 104.39 feet; thence North 3 degrees 17 minutes 32 seconds West 214.36 feet to the point of beginning. rl,ts is homestead property (is) XDCKk Exception to war-anties: Easements, restrictions and rights-of-vay of retard, if any. Dated this _ if December I Q 98 day L A D --- (SEAL) n. (SEAL) Timothy HAqsler (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGNIENT S;gnature(s) State of Wisconsin, St. Croix Coun authenticated this day of yi Personalty came before me 0 - day of L lecer t> - 19 96 , the above named Throothy Hassler, a single :eK�sqn,_ TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authonzeO by §706.06, Wis. Stats.) to me kn,)%%n to be the :son - ho executed the fo-:gomg ' in-qru M e ge the sae. TKS!NSTRWj,:; j.T !A/AS GRAFTED 8Y T nd ackno acknow f - .o ?kttcrney Kristina Ogland r Hudson, WT 54016 'Signatures may he authenticated or acknowledged. Both are not My commission is permanent (if no T/rx 4tra!ion date: necessary) 0 0 / 1 ;',old be typed orprinted below zhei--j 4' - STATE BAR OF WhCONs[N -%ARRA:,TY DEED F,— No. 2 - 1482 .4 �� _-___ `` �� \�^ \ '�' l \v c� �� Wisconsin Department of Commerce PRIVATE S Safety and Buildings Division EWAGE SYSTEM Coun 9i. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanit1659mjtNo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. J bb 3 Permit Holder's Name: ❑ City ❑ Village ❑ �Town n of: State Plan ID No.: chmidt, Robert Star Prairie ship CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Ta 03 103 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B HI F O 5 S ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft L oss Forcemain Length Dia. Ff Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: / / Inspection #2: Location: 967 County Road H, New Richmond, WI 54017 (NW 1/4 NE 1/4 8 T3 IN R1 8W) - 08.31.18.144A2 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover Plan revision required? ❑ Yes ❑ No Use other side for additional information. 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T..,.. ,ma ...�,.. _. e »m m m., . �.d a e , f e m,..{.,. ' 3 s E % , �,.. .. ».� ._. m.._ ._. �. .. s t � � 7 ” ; � i f... € e = t 's i k � ; a j e � . t j � v