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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
506250 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Oevering Homes LLC, C/o Kenneth J. Oeverin Star Prairie, Town of 038 - 1237 -05 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
16.31.18.1256
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY 7 � STATION � / d i p FS ! ELEV. J
Septic l I 2 Benc mark Y• / I61` 0 /00
Dosing GGt� �,ZS -7 Alt. B M 7
it
Aeration Bid Se er�
Holding D t/Ht Inlet
St/Ht Outlet f
TANK SETBACK INFORMATION
TANK TO P/ WELL BLDG. Vent to Air I ke ROAD Dt Inlet J
/D, g
Septic f ! z0� Dt " -m
Dosing ` 1 2 Header a v � r ��
Aeration / 1 J l Dist- Piped �6r/ lr
d03 -DS
Holding Bot. System /oy /D
Fin Gra de S �
PUMP /SIPHON INFORMATION /�p . S s� ld 3
Manufacturer [_�41e �r GPM Dema St Cover / S 7 / • ��/
Model Number ^ / \.1 r /� I � /
TDH Lift Friction Lo System Head TDH 2 Ft c. � .gyp 7 1/ S 3 t 5 A
2 • as 1 �--
Forcemain Ler}gth� i Di �� Dist. t y ` , , 1 � L �
SOIL ABSORPTION SYSTEM NU, t 1� F� 7
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/ BLDG IWELL LAKE /STREAM CH Manufacturer: / n
INFORMATION CHA R OR / 7 f ` P
Typ Of System: � Ts '� NIT Model Number:
DISTRIBUTION SYSTEM f- Vl' -VA 6+ I'►r►� ° 4 Header / Manifold Fpe(s) istribution 21. S � x Hole Size x ole Spacing r r Vent to Air
ntake 3 /
Length Dia y ength Di �' ' Spacing Z �
SOIL COVER x Pressure Systems Only Or At - Grade Systems Only
Depth Over Depth Over xx Depth d xx Seeded/ oS_ dd6d e t xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Y rW i N Ye a No
6
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / !� / �� Inspection
Location: 2184 108th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 16 T30N R18W) Maple Haugen Lot 4 Parcel No: 16.31 8.1256 `
-ro 1.) Alt BM Description =
2.) Bldg sewer length = q0-A 6J '363Y f � =
- amount of cover = , ► A479 2 n k,
1_ Vv
Plan revision Required? Yes No r �'J l)� & , U
Use other side for additional information. t /
Date Insepctor's Sign ure < �(, Cert. No. /
SBD -6710 (R.3/97) At f 1,V Q�
Safety and Buildings Division County St Croix
201 W. Washington Ave., P.O. Box 7162
Pisconsin Madison, WI 53707 - 7162 Sanitary PS ,it Number (to be filled in by Co.)
Department of Commerce (608) 266 -315 s ��
Sanitary Permit Application 4 Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you p
may be used for secondary purposes Privacy Law, s 04
C EIV E D ject Address (if different than mailing address)
I. Application Information - Please Print All Information 'e• ��0 7 ��r7 7
Property Owner's Name Parcel # t /# Block #
Oevering Homes, LLCoduist _
CROIX COUNTY - 5
Property Owner's Mailing Address Property Location /
P.O.Box 179 NE '/4, NE 1 /4, Section 16
City, State Zip Code T7'15-760-0001 one Number l
New Richmond WI 754017 T N; RW
II. Type of Building (check all that apply) • 13 !�
G- l �- Subdivision Name CSM Number
X 1 or 2 Family Dwelling - Number of Bedrooms 4 -� n ✓) /D,� t /
❑ Public /Commercial - Describe Use a Maple Hau en
❑ State Owned - Describe Use ❑City ❑Village X Township of Stay Prairie
III. Typ it: ( heck only one box on line A. Complete line B if applicable)
A. �Ystem ❑ Re lacement S stem p y ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
i
IV. Type of POWTS System: Check all that apply) O
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil C R Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter 111. y
Recirculating Synthetic Media Filter ❑ Leaching Chambq ❑ Dip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: 17
Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
600 r SI' sor , o i' � 600 // t0 a 600 / y(r y J ba.,�7
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existin
Tanks g
Tanks
Septic or Holding Tank 1254 1254 1 Skaw Pre -cast X
Aerobic Treatment Unit
Dosing Chamber 754 754 1 Skaw Pre -cast V t04-yn �,i
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Tom Gustum 227618 715 -658 -1344
Plumber's Address (Street, City, State, Zip Code)
N13450 937 Street, New Auburn, WI 54757
VIII. oun !De artment Use Onl
Approved El Disapproved Sanitary Permit Fee includes Groundwater Date Issued uing Agent Si ps)
Surcharge Fee) / (; 3 0 7 Gtc rt,...
❑ Owner Given Reason for Denial 6
}X. Co ' pprovaUReasons for Disapproval
SYSTEM OWNER-
1 Septic tank, effluent filter an
d � D�
rsal cell must all be serviced / m ' ed G y �� S /
as per ma
2. All setback requirements must be maintained
P
as per applicable code/ordinances.
Attach complete plans (to the County only) for& system on paper pot less than 81/2 x 1 i ches In ize o
Plot Map
'4" pvc Pipe- also HRP
r pvc pipe- also HRP welPropos
Y t
proposed
4 Bdrm House �`
Q� t
STM D3034 or 1
I 4" PVC pipe �y
Insulate 11 -`
82.30(11)(C) d
.r
2000 Combo `
Tank / s 9
2' ForcemaI
10 x 60 Aggregate 7, � /
Distribution Cell
62
101.1'
C l 3,E Sm 1
f.3'
Nels Gromuist
P/L r J 1 S M2 (71 24&7278
Y � " y 416 ft Ave. NE
Minneapolis, MN, 55413
Town of Star Prairie
NE%of NEY. of Soo 16 T31NR1ON
Page 6 of 6
Safety and Buildings
PO BOX 7162
commerce.Wl.gov MADISON WI 53707 -7162
TDD #: (608) 264 -8777
is c o n s i n www.commerce.wi.gov /sb/
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
June 25, 2007
CUST ID No. 227618 ATTN: POWTS Inspector
THOMAS GUSTUM ZONING OFFICE
GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA
N13450 937TH ST 1101 CARMICHAEL RD
NEW AUBURN WI 54757 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/25/2009 Identification Numbers
Transaction ID No. 1404268
SITE: Site ID No. 726419
Neis Gronquist - Dwelling Please refer to both identification numbers,
220TH Ave above, in all correspondence with the agency.
Town of Star Prairie, 54026
St Croix County
NE 1/4, NE 1/4, S16, T3 1N, RI 8W
Lot: 5, Subdivision: Maple Haugen
FOR:
Description: Mound
Object Type: POWTS Component Manual Regulated Object ID No.: 1135659
Maintenance required; 600 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual - Version
2.0, SBD- 10706 -P (N.01 101)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with the component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P-0
requirements. coed
No person may, engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats. DEPT
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to oivis
inspection by authorized representatives of the Department, which may include local inspectors. All permits '
required by the state or the local municipality shall be obtained prior to commencement of SEE CORR
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
THOMAS GUSTUM Page 2 6125/2007
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
ter E Page
Private Sewage Plan iewer , Integrated Services WSMART code: 7633
(608)266-2889, M - F, 0630 - 1500 firs
pete.pagel@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
Mound System ps 1 of 6
Cover Page
Project Name: Nels Gronquist GPD Mound
Owner's Name Nels Gronquist
Owners Address 416 8th Ave.NE
Minneapolis, MN. 55413
715- 248 -7278
Legal Description NE +/ NE �/, Sec 16 T 31 N, R 18 W
Township Star Prairie
County Saint Croix
Subdivision Maple Haugen
Lot# 5
R ECEIVED
Parcel ID#
JUN 0 4 2007
TY
Table of Contents SAFF & BUILDINGS
p 1 Cover page
2 Mound Sizing Calculations
OLL. 3 Pressure Distribution Layout and Dynamics
4 Dose Tank / Pump Curve
1�D1 5 Management and Contingency Plan Z�tw T, $,
6 Plot Map oh
?0
4 7 �
total # of pages: 6 'S
Designer Name: Tom Gustum
License #: D1201
Date: 5/31/2007
Ph. #: 715 -658- 4
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01)
per " Pressure Distribution Component manual for Private Onsfle Wastewater Treatment Systems" (Version 2.0) SBD - 10706 -P (N 01/01)
i
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715 - 643 -6068 email: 3ba @3badvisement.com
I
l
'Mound System Page 2of 6
Mound Sizing Calculations
Project Name: Nels Gronquist GPD Mound
Site Conditions Design of Entire Fill
Project Type: i or 2 Family Dwelling • Cell depth at upslope edge (D): 14.0 in.
% Slope: g.5 1 Cell depth at downslope edge (E): 25.4 in.
# of Bedrooms: 4 Distribution cell depth (F): 9.5 in.
Depth to limiting factor: 22 in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: 0.6 gal /ft /day End slope width (I): 10.3 ft.
Effluent quality Eff #> Fill length (L): 80.6 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 5.8 ft.
Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 14.4 ft.
Fill Width (W): 30.2 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 600.0 gal/day Basal area required: 1000 ft
Distribution cell width (A): 10.00 ft Basal area available: 1464 ft
Distribution cell length (B): 6 - ft
Area of Distribution Cell: 600.0 ft / Observation Pipes
Contour Elevation of Mound: 101.10 ft ✓ Location from end of cell (Z): loft
System Elevation of Mound: 102.27 ft✓
Final Grade of Mound: 104.06 ft
Mound Plan View
Observation Pipes
z
VV
x +
B K
Tilled Area/Fill Material
L
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric G
Distribution Cell
e
System Elevation ° 6 h a, �� F
d 1
Cover Material E Lateral p
Fill Material Invert
Tilled Area
Slope Forcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6' aggregate below lateral and 7' above.
Mound Page e System Pa
Y s
Pressure Distribution Calculations
Project Name: Nels Gronquist GPD Mound
Lateral Layout Lateral /Manifold i
Lateral elevation: 102.8 ft Lateral diameter: 1'Y2 w In.
Rows of Laterals: 3 Lateral spacing (S): 3.5 ft
Manifold type: Center • Lateral to cell edge: 1.5 ft
Orifice diameter: o.1ss • In. Lateral discharge rate: 6.59 gpm
# of Laterals: 6 System discharge rate: 39.53 gpm
Distal Pressure: 2.5 ft Manifold diameter: 2 . In.
Lateral Length: 2g.5 f Manifold length: 7 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 37.26 Inches Forcemain length: 55 ft
3
Orifices per lateral:: 10 Forcemain diameter: 2 • In.
Avg. ft /Orifice: 10.00 ft Friction loss in forcemain: 777
Lateral Side View
Manifold Lateral Lateral
x x x x x x x x x x x x
2 Z
Lateral Length F Lateral Length
Lateral Plan View
Lateral Length I Turn-up wlball valve or deanout plug
° °
S
° ° t
S
° o
Orifices on bottom of PVC laterals and forcemain to comply with
lateral equally spaced specifications per Comm 84.30(2)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean -out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Coll
6" Minimum L may be used in
Long Sweep 90 place of 318" bai
or two 45's 3JS" Bar
Lateral
Mound System Page 4of 6
Septic, Pump and Dose Tank
Project: Nels Gronquist GPD Mound
Tank Information Dosage Volume
Pump tank manufacturer: Skaw Precast Does forcemain drain
Pump tank size /model: 754 back to tank? C �
Pump tank gal /inch: 16.05 Lateral void volume: 18.7 gal
Tank bottom elevation (inside): 88 ft Dosage to absorbtion Cell: 93.5 gal
Septic tank manufacturer: Skaw Precast Forcemain volume: 9.6 gal
Septic tank size /model: 1254 Total dosage: 103.1 gal
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft /
Effluent Filter: 8" bio -tube , System head (distal x 1.3) 3.25 ft
g Q P !� Vertical Lift ( "D" to lateral) 14.27 ft Note: Access o nin ofsufficientsize to ro ded
removal offter. Opening to terminate at or above grade. Friction loss in forcemain: 1.78 ft
Pressure loss from filter: 0 ft
Total dynamic head (TDH): 19.29
Pump Tank Diagram
Watertight Locking Cover Dose Tank Levels
4 inch With Warring Label finished
Minims Grade In. Gal
A Reserve 32.6 522.5
Altemate B Pump off to Alarm 2.0 32.1
oUlet
Location C Total Dosage 6.4 103.1
Elect. per Comm D Effluent depth for um 6.0 96.3
16.28 and P pump
Forcemain NEC 300 Total Capacity: 47.0 754.0
Mep Ho A
Hob
or Anti• B
Siphon
Device C Pump Curve: 9EH
FLOW- LITERS /HOUR
D 0 1000 2000 3000
30 t0
V1
W 7.5 W
2r) W
f
Pump must be capable of: 39.5 GPM A 5
and head pressure of: 19.3 Feet = 10
2.5
0 0
0 20 40 60 so
Little Giant FLOW- GALLONS /MINUTE
9EH PUMP PERFORMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to conwn 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and /or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to
keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be
occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents
must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an
approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must
be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be
routinely inspected to be watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during
removal. The pump, float switches and alarms must be inspected at least every three years for
proper operation. Pump /dose tank should be routinely inspected to be watertight and of good
repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...)
could compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in
winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the
cleanout points at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the
time of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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I SOIL EVALUATION REPORT #1701
W isconsin
in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Department of Commerce steer 5011 service Inc.
Division of safety and Buildings
County
►ttach complete site plan on paper not an 8% x 11 inches in size. Plan must St. Croix
nclude, but not limited to: verWal at reference point (BM), direction and parcel I.D. WD
eercent slope, scale or e"b"s, tto and location and distance to nearest road.
S Reviewed By Date
Personal information yo r ide may used RE !SO(Priwi Law. s. 15.04 (1) (m)). L
roperty Owner Property Location
3ronquist, Nels AN ` 12005 Govt. Lot na NE114, NE1 , 516, T31 N, R 1 8W
Iroperty Owner's Mailing Address Lot # Block # Subd. Name or C M#
116 8Th Ave. NE ST. CROIX COI NTV 5 na MapleHaugen
:ity Statd Zi C City ❑ Village H Town Nearest Road
Minneapolis MN 1 55413 1 715 -248 -7278 Star Prairie 220Th Ave
New Construction
Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPO
Replacement ❑ Public or commercial - Describe: na
parent material _Ground and end moraines, pitted glaical drift
Flood plain elevation, if applicable na ft.
general comments M ound design, system elevation 102.27ft based on contour line elevation 101. 10ft
nd recommendations:
1 I Boring # D Boring
r { pit Ground surface elev. 101.10 ft. Depth to limiting factor 30 in. Soil Application Rate
iorizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/11
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-4 10yr3 /1 none sl 2msbk mfr cs 2c .6 1.0
2 4 -30 10yr4 /4 none sl 2msbk mfr gw is .6 1.0
3 30-96 5yr4/4 fif 7.5yr5/6 si om mfr na na .2 .6
] Boring # ❑ Boring
I � pit Ground surface elev. 101.10 ft. Depth to limiting factor 22 in. Soil Application Rate
Consisten /ftz
Structure Boundary Roots GPD
Horizon Depth Dominant Color Redox Description Texture *Eff#1 *Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-6 10yr3 /2 none sl 2msbk mfr cs is .6 1.0
2 6 - 22 5yr4/4 none sl 2msbk mfr gw if 6 1.0
3 22 -72 5yr4/4 fif 7.5yr5/6 sl om mfr na na .2 •
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5.30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature- CST Number
David d. Steel � � 24$956
Date Evaluation Conducted Telephone Number
Address Steel's Soil Service, Inc. 6116!2005 715 - 760 - 0347
994 200th St. Baldwin, W154002
- Property Owner Gronquist, Nels Parcel ID # pending Page 2 of 3
F3 1 Boring # ❑ Boring
❑ Pit Ground surface elev. 97.30 fl. Depth to limiting factor 30 in. Soil Application Rafe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -19 10yr3/1 none I 2msbk mfr a is .6 .8
2 19 -30 10yr4/4 none sl 2msbk mfr cs if .6 1.0
3 30 -39 10yr4/4 c2d 7.5yr5/6 sl om mfr a na .2 .6
4 39 -72 5yr4/4 c2d 7.5yr5/6 scl om mf na na .0 .0
F -1 Boring # Boring 0 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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # El El Boring
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
* Effluent #1 = BOD 30 < 220 mg/L and TSS >30 <_150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
SOD -8330 (R.07 /00) steers soil service, Inc.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer V Z - i
Mailing Address Ad '/` e i,.
a >r
Property Address — / U z t-
- t = /�/' ;e' "A/
(Verification required from Planning & Zoning Department for new construction.)
City /State f' H !1
Parcel Identification Number o�_�K 7 — Q S -061)
LEGAL DESCRIPTION � 2 5 O
Property Location / '/4 , '/, , Sec. �' , T f N R l , Town of S �4
Subdivision v , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume 23 Pag
.,
Spec house yes �ti of lines identifiable 4 ye9 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/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
SIGNX4VRE 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)
Parcel #: 038 - 1237 -05 -000 07/03/2007 09:07 AM
PAGE 1 OF 1
Alt. Parcel M 16.31.18.1256 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/19/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - OEVERING HOMES LLC
OEVERING HOMES LLC
PO BOX 179
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 2184 108TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 2.070 Plat: 10 /072 - MAPLEHAUGEN LOTS 1 -10 038/05
SEC 16 T31 RI 8W PT NE NE LOT 4 CSM Block/Condo Bldg: LOT 005
16/4342 NKA MAPLEHAUGEN ('05) LOT 5
(2.070AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4)
16-31N-18W NE NE
Notes: Parcel History:
Date Doc # Vol /Page Type
04/23/2007 849000 WD
01/19/2007 842879 QC
10/07/2005 808793 2905/059 2905
08/19/2005 803988 101072 PLAT
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/27/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.070 32,400 0 32,400 NO
Totals for 2007:
General Property 2.070 32,400 0 32,400
Woodland 0.000 0 0
Totals for 2006:
General Property 2.070 32,400 0 32,400
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 (Illl(11181if11 ili(I !1111111(1 111i 11fi1(liil sill
8 4 9 0 0 0 1
State Bar of Wisconsin Form 1 - 2003 849000
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number Document Name ST CROIX CO., WI
RECEIVED FOR RECORD
04/23(2007 12:50PH
THIS DEED, made between Nels A. Gronquist WARRANTY DEED
EXEMPT t
( "Grantor," whether one or more), I REC FEE: 11.00
and Oevering Homes, LLC TRANS FEE: 122.70
PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property ") (if more space is Name and Return Address
needed, please attach addendum):
Wisconsin Assured Title, LLC
Lot 5, Ma lehau en Town of Star Prairie, St. Croix 1810 Crest View Drive, #1B
P g Hudson, WI 54016 -rG.j(p�.
County, Wisconsin.
038 - 1237 -05 -000
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:
Roadways, Easements, Restrictions, and Rights of Way of Record
Dated Anril 20.2007 A
(SEAL) (SEAL)
* "Nels A. Gron ui
(SEAL (SEAL)
AUTHE 7 ,0 0 1 0 1 ! -
20 En ACKNOWLEDGMENT
Signature(s) C
STATE OF WISCONSIN )
authenticated on # Y ) ss.
� St_CroiX _COUNTY
p )
o J ��
* 7 \ \t-,— * b � iI20, 2007
(�'
TITLE: MEMBER STAB
list
(if not, who executed the foregoing
authorized by Wis. Stat. § 7 �
same.
THIS INSTRUMENT DRAFTED BY:
Richard K.Y. Lau - Redmon Law Chartered _, 1 unlic, Sta of Wisconsin
2217 Vine St., Ste. 204 Hudson, WI 54016 My Commission (is pe t) (expires:
(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 some below signatures.
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