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CROIX CO., NI Document Number Document Title RECEIVED FOR RECORD 11!11 /2005 18 :30AK St. Croix County AFFIDAVIT EXEMPT # Occupancy Affidavit REG FEE: 11 08 � N ( � �� iA TRAYS FEE: © COPY FEE: 2.00 CC FEE: Name — (Owner) Typed or printed PAGES 1 being duly sworn , states, under oath, that: 1. He/she is the owner /part owner of the followm parcel of land located in St. Croix County, Wisconsin, recorded in Volume 2 0 Page Document Number (p1S St. Croix County Register of Deeds Office: RepordingAma / / Name d Re } dress A parcel of land located in the K of the '5 %, of Section _, 6ft P67 L— J T '31 N —R l , W, Town of ��I'41� &kgjg- , St. Croix g2,0 County, Wisconsin, being duly described as follows (include lot no. and —X1 r 7 t6r subdivision/CSM or detailed legal description): Low Z 7q-0 1 - t /NCr 0.44X -SvR . B' - Q - Parcel Identification Number (PIN) As owner of the above described property, 1 acknowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of qSV gpd. The design flow is calculated by assuming 150 gpd for 2 Individuals per bedroom. There are currently �3 occupants living in this residence; _L occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I .< understand that if there are intentions to exceed the number of permitted occupants, the system Will need to be modified t o accomodate any increased wastewater fl o w s and /or contaminant loads. I also acknowledge t h a t I wilfmake this information available to any future parties interested in purchasing this property. Dated this �� day of (V V Can 'C * �s' t •.=e • ! ry ',�' . �,. " s AUTHENTICATION ACKNOWLEDGMENT Signau"s) STATE OF WISCONSIN ) )SS. authenttcated this day of St. Croix County. ) 11 NOVEMBER P came before me this day of the above named * T ONT M PFRRTN - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing by § 706.06. Wis. Stats.) instrument and acknowledge the same. THIS INS ENT WAS DRAFTED BY A S * PAULETTE ORF Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not state expiration date: necessary.) D 12/31/06 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" Tft irNamu fion must be completed by sub Afeer: + name a return address. and jW #f reQcrlred). OtherirdomwBon such as the granting dauses, leagof descdpilon, eta ma be placed on this first page of the document or may be placed on add IlOnst Pallas of the doctownE ft& Use of this carer page adds one page to your dDWMOM and S2 00 to the mcordlrw fee. W=onsM Statutes. 59.517. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerB r - 7 fe,+D L 6N Mailing Address E Property Address `� 1E� (Verification required from Planning & Zoning Department for new construction.) City /State -- Y '�5�7 - j /, V. )'-- Parcel Identification Number C'�.30 co / / - "� % • l� LEGAL DESCRIPTION I , Property Location -5W � '/4 , S + � i/4 ,Sea �g , T d 1 N R Town of - Subdivision p LL A J /4- ox-k C Lot # I � Certified Survey Map # , Volume , Page # Warranty Deed # !n `.� , Volume Z-8 6 , Page # 3 Z- Spec house yes no Lot lines identifiable Oe 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 staring 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. Numb of bedrooms 3 '�'' � Qa.T1 -S be -5 n - See � c da, �1"*2 y SIG A URE 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) ST. CROIX COUNTY WISCONSIN ial PLANNING & ZONING OFFICE °' fffffN�N• r��r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 ~^ (715) 386 -4680 FAX (715) 386 -4686 November 9, 2005 Bradley & Loni Perrin 820 210' Ave. Somerset, WI 54025 RE: Remodeling/bedroom addition, Town of Star Prairie, St. Croix County Lot 20 Rolling Oaks Subdivision Parcel # 038 - 1201 -70 -000 - Computer #18.31.19.1071 Dear Mr. & Mrs. Perrin: You have requested the Zoning Office review q g your remodeling/addition project for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling, you are required to examine whether or not the planned modifications involve an increase in design wastewater flows to the Private On- site Wastewater Treatment System ( POWTS). I have reviewed your remodeling plans for the above residence. The project involves finishing one additional bedroom in the lower level of the structure. The septic system was designed and installed based on wastewater flow for three (3) bedrooms with a maximum occupancy of six (6) persons. This project will increase the total number of bedrooms to four (4). Technically the POWTS will be undersized for the number of finished bedrooms within the residence; however, current occupancy does not exceed the design wastewater flow for the POWTS. An Occupancy Affidavit is required to disclose the disparity between number of bedrooms and septic system sizing to any future owner(s) of the residence. This affidavit will be submitted to the St. Croix County Register of Deeds office for recording against the deed prior to issuance of a building permit from the Town of Star Prairie. The original system was installed in October 2001 by Schmitt & Sons and was inspected by zoning staff at the time of installation. The system was found to be code compliant at that time. Inspection report and sanitary permit documents are on file with the zoning department. To prolong the POWTS lifespan, the septic tank should be pumped at least once every three years or when the tank becomes 1/3 full of sludge and scum. The effluent filter on POWTS installed after Aril 2000 g p should be backwashed as needed to prevent clogging of the septic tank outlet. In addition, water conservation measures are recommended, such as repair /replacement of leaking plumbing fixtures, reducing i shower time, running the dishwasher only when full, avoid using a garbage disposal, using a wash machine with a suds -saver feature, etc. The long -term function of your POWTS is dependent upon proper maintenance of the system. If this POWTS should fail at any time in the future, the system will be need to be inspected by a licensed plumber or POWTS maintainer to determine if it requires replacement according to state code requirements in effect at that time. The proposed remodeling and room addition project must comply with all applicable building codes. Please contact the Building Inspector for the town of Star Prairie to obtain a building permit. Should you have any questions, please contact this office. Si , amela Quinn Zoning Specialist Cc: Brian Wert, Building Inspector Donavin Schmitt, POWTS Installer file Pargel #: 038 - 1201 -70 -000 11/09/2005 09:13 AM PAGE 1 OF 1 Alt. Parcel #: 18.31.18.1071 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 BRADLEY A & LONI M PERRIN O - PERRIN, BRADLEY A & LONI M 820 210TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 820 210TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.479 Plat: 2418 - ROLLING OAKS 2000 SEC 18 T31 N R1 8W SW SW FRL LOT 20 Block/Condo Bldg: LOT 20 ROLLING OAKS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18-31N-18W SW SW Notes: Parcel History: ate Doc # Vol /Page Type 09/1612005 0/32 WD 806614 2890/ 01/25/2005 785743 2736/373 LC 10/10/2003 743346 2433/434 0C C 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.479 28,400 130,900 159,300 NO Totals for 2005: General Property 1.479 28,400 130,900 159,300 Woodland 0.000 0 0 Totals for 2004: General Property 1.479 28,400 130,900 159,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 304 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Departure n PRIVATE SEWAGE SYSTEM county: St. Croix Safety anal Buil inr " , I-- INSPECTION REPORT Sanitary Permit No: 395125 0 GENERAL INFORMATION (ATTACH TO PERMIT) State P n ID o: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. (0 � eBK ) Permit Holder's Name: City Village x Township Parcel Tax No: M & G, Inc. I Star Prairie Township 038 - 1201 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: _ TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS S ELEV. f ti H� Septic Benchmark "Ua' Dosing C � > � Alt. ��► Y ' L Aeration g. Sewer � ,� •ZZ Holding St/Ht Inlet � TANK SETBACK INFORMATION SUHt Outlet l�t'O qS•6�( TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet t ! /SKf 9S `to Septic Z / / Dt Bottom S 23 Cl ( Dosing C / 3� 3o I 0, Header /Man. t Aeration Dist. Pipe Holding Bot. System (p, .t UDC Final Grade StG PUMP /SIPHON INFORMATION `f Manufacturer Demand St Cover ri �aQ,QQQ/ GPM S• � 01. Model Number Ai dPH I Li % Friction Loss t System Head TDH Ft Forcemain Length t Dia. Dist. to Well F I A (C.0 SOIL ABSORPTION SYSTEM X5.23 7. S 7•6 0 MgVaAENeM Width Length No. Of TponsMeo-- PIT DIMENSIONS No. Of Pits side D a. Liquid De th DIMENSIONS D CL 5" l SETBACK SYSTEM TO l J P/L BLDG WELL LAKE /STREAM LEACIJIJING M acturer: INFORMATION CHAMB OR,,, Type O ystam: ,� ��( �— UNIT Model Number: Mo�.lnnm 1- ""— DISTRIBUTIO SYSTEM Header /Manifold U Distribution u x Hole Size u x Hole Spacing Vent to Air Intake Q t , t Pipes) I I u Length B Dia Length Dia /2 I/ Spacing Iy 2. SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of T7;eded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil FE] Yes [a] No [Is] Yes �] No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /� /� Inspection #2: D / - ao � sue}-, Location: 820 210th Avenue Somerset, WI 54025 (SW 1/4 SW 1/418 T31N R18W) Rolling aks of ��(.» Sb arcel No: 71 1.) Alt BM Description = ►�H �Q S � A �, • 6 ( . 2.) Bldg sewer length = )T 4 �� amount of cover= �.O`k'g— � S9i � C.OVar �(� _ Plan revision Req ed? Yes X No t other sid r additional informs 'on. ,. �w�lQec i�N ! 4"C ' Date Insepctor's Signature Cart. No. -6 t0, �� = S l�ve '� e•�.L�n+Y a�'�.i _ 'to �'C .� Y � f� l v � �'T �� 1 y ! ; .T { .� -. .�.' i � 1 � it '� i i 1 � 1 ' � ~_, .._.._..__w--- --•- ° --- , ( f 1 s i - w� p Icr S 7 Xba IV ' I i MAI Tt AIL 1, 1 - A fiCUlSIU /0LLI1rG AI'LC.S 1 -DI .40 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ®�.S COnS ®n Personal information you provide may be used for secondary purposes 1 2/ /a`5� Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system on p aper n less th an 8 -1/2 x 11 inches in size. County State Sanitary Permit Number Check ' revision o previous application State Plan I. D. Number coo he 3S 2 9 I. Application Information - Please Print all Information Location: Property Owner Name Property Location L G 'J f(,J 1/4 54() 1/4, S T j ,N, R 6(or Property Owner's Mailing Address Lot Number Block Number u , - — — /1. d 2 O IVA - City, State Zip Code Phone Number Subdivision Name or CS Number S / ( /.) ) Sy /701-1 /N(r V Ks II. Type of Building: (check one) ❑ City W 1 or 2 Family Dwelling -No. of Bedrooms : ❑ Village ❑Public /Commercial (describe use):_ ® Town of ❑ Stat Owned S7,412 A11?&; 9 . 1 Nearest Road 83,fa ST, r X C I S O . � 3 f to k 5 Parcel Tax Number s) -70 III. ype of Permit: (Check 7 �onnlly i- one ( box on line A. Check box on line B if applicable) / / 1 7 1 A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued IN A Sanitary Permit was previously issued J t 1 -{� IV. Type of POWT System: (Check all that apply) A- —100 - ` ❑ Non - pressurized In- ground DI Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment A rea Inform 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 1 16 - 0 Z15 q5 ZOO, 71V A0.2 53 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks g oo Soo l ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on ttached plans. Plumber's Name (print) a ignature (no stamps): M PRS No. Business Phone Number '4�. S- — Plumber Address (Street, City, State, Zip IX. Cou nty/Departme t Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surp harge Fee) Determ' tion 0 . LID ® ©� 2 00 X. Conditions of pprova easons for Disapproval: _ n MV s i ev. cru •'� * 3 �t Sl Mo CQ�R 5 ae- ,o�t,l csM�.c��s �s„�.. �o.,�,s a �.,,e�Q a.•� �" � Ce c,e �c..n ;�c�,,.. u.�'P,�,a""� SBD -6398 (R. 07/00) �'/ Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N *isconsin r * ` ? r www•commerce.state.wims /sb \`) `" =� www.wisconsin.gov Department of Commerce 4 Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 19, 2001 CUST ID No.221741 ? ATTN: POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL Identification PLAN APPROVAL EXPIRES: Numbers Transaction ID No. 669799 SITE: Site ID No. 628398 M & G Inc. - Mike Germain - 210' Street Please refer to both identification numbers, St. Croix County, Town of Star Prairie L above, in all correspondence with theagenc SWIA, SWIA, S18, T3 IN, RI 8W Subdivision: Rolling Oaks - Lot 20 FOR: Description: Three Bedroom Mound System - Revision Object Type: POWT System Regulated Object ID No.: 788117 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on May 7, 2001. All other portions of the plans shall remain the same. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01/01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. DONAVIN L SCHMITT Page 2 9/19/01 • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to 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 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. Sincerely, FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WiSMART code: 7633' j swim @commerce. state.wi.us YEV1510 Al ROBCOVC• �I'( cS Lai o�0 SCHMITT & SONS EXCA VATING RECEI 516 Valley Frew TMU SE D Saamrset, wr 54 025 sAf P 1 9 2001 ?IS- 549 =6651 E rY BLDG s Dl V. For: _ �" G. � JV G• /`' � KC Ir � l?'1 � � !� Address: 1S Legal._ ca'Ul} l ,S Towns 67 � 1 . E _County: ST C,L'Ql X -- it ,ents Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 Mound Component Manual (Version 2.0) SBD- .10691 P(N. 0I/01) Pressure Distribution Component Manual (Version 2.0) S 1006 -P{�W 01/01) By: O MP�rsW -___ � r `� l p' ' i Date: G - c� s w / N►�, pEPPR� S� pip BW pN1S�oN Of See C RR �� . . �_ i r .� *�, �� b. y � � �. • ` T ^ ., ��..` � _��1� � +a .� ' •.. St raw, MorSh Hay, of �yntheti;. C��ering ``� DistriDutton ripe Medium Sono ASTM C33 6 Top F .......„t f 'y. E 3 % Slope Bird Of ��— 2 `� LForce Moan N" Plowed Aggregate Layer (6 Beivw Pipe Cross Section Of A Moino System Usistg ` f �3 Ft. A Bed For Thar Absorption Aran F .7 Ft. G „J Ft. A Ft. ! Ft. Signed: R L % Ft;, License number: oI Q1..1., K Ft. Date: — O/ L ,._ Ft. j Z Ft. I / C1 Ft. W a5.` Ft. L ......... ... Obsorvotior, Pipe r - �...r_ w. �.... �....r...� .�.. _.. T A For Mcin W __.....� ...._..� ......., .� __ ..,.. _.......... iJir►tf� l�tieR ' \, , S. ►d O f _r �j Pi ;e �r . Aggregotf Observation P'i06 Pormarent Mvksrs rO J/J L Plan View Of Mound Using A Bed For The Absorption Axed >• i t r ri f YJ r 1 �veboK � +ar®4 pi¢4 Dttofo 0 �r v . �Ptrtcr�t�0 r / J �PYL P�p! "also Located Oe aottorn, s , Are C aaaity $00649 S nmdw Eric ws r s 4 Q i PVC Force Mai Diit+ Abu t i0� MottifWd Pipe Dietribgfion PiP LC70ut P g3.75'Ft . wrr •r r�.aw�. rwrw R �_ S - X Inchar. Y .,�... inches #1 Hole Diameter Inch Signed: Lateral Inches) license Number: 2a / 1 � Manifold „ inches Force Mai n Inches Date __ #of holes /pipe Invert Elevation of Laterals/Vt. yFt. I0(.7.4 TWA-) i L � R t K �, ? pump `AAA, 4P� Ip. Cu.(.' sEC;l31J A?JG SPfQFJ AT7U�J L � vcmlr GAP rl VENT PIPC W[4TWEKPK00f i AflPROAD LOCAIAIG JULICTIOU box MI WWOLE COVER a t5 Fitoe't 0001t, i Wimbow OR F;trsA AtR WTAKE ! 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J ftyl woo 17Y Data Prra" Wom-Wien Imm prvide may tm Lwvd for 5OXMIY rumons (Pri Wc Lt*y, & i 1.0i i j N,Si 1 WjW11 OWrW* 'AW" Addr.03 N roar M ks CKv L Stan dip C;ods Ph*ft Number C] Cil 0 11111&g# Towtt NKIW P1044 Z ! " 3 New Cwwructm jvw ResidgmW J Number of 1*00mr. AICK01 11, EA1.119 mik6rig Lj pepificorwl Futft or roWnSM121 - Dewbilt Cade dMvtd daily Flow g"j AboarpH." area requi•od I Z od, ft* 0) (re"h, fir 2 AddWortill d4xlQrVN19 ctmoldvabanti Potent nudllirillil a quitable ter symm 0--i.. 81 in- Groute pre"Gure I •c rode E Vilern in !fill J*Wng 7%6'lk U unsuftabif foe NNYe"M i E-DIS Eau We 0Lj as 2u n a a x) ❑ a EM u E]a Qs u SOIL DISCHIFTKIIN RIM" h NIMOM Qu. ez:. Cora. calvir Or. 9z. Uh. sod LON 13 7- 11 j6,rtqj.S i _2L. Z W%c rn 4 c_ :_1 few" JASir-SI-L 15,11 ILI C= Z _ ve CIS .4 .,!S Ground -r1a 1 y C 4 NP L5 41� I M pMlflrtg feoler CST Name (pimn pft) TMphwe No. r 4 0$7 Numblife 08, 930.41 TI•U 08 AS FEU ?a.t 398 4886 ST (AX CO .ZO":iING Zo)j . w vkra �gaps"T -V OwNat _r. GOIL OCCGAIPTION AF PORT p z. PASIMAL LDI Boling* 40"a o Wvthl Owimsol Color MOON ruxtvro � S:rcictF* Cenutlww eaurmr7 moca ` !n. MiLTMWI Qu. Sz, t7ar,t cd Gr, $. i h Sod Trench -21r 1 4 Qwwra "' E,. i, ylf�l�l.4 �1( =l ayf`± 141 i��' lfCl°�►� m - P L.* �� �• 'l �$ Lm!Ci?� h .. R p Li —n DWh it *"" Haim D"Ilh DorrimM COx !dotdee Twh" 5truch n ConsMMA Doundwy Rwts km mumell Qu. U. CAM odor Or. 6z. fir. bald , Trench 13 BOnmp if Grnurld , slaw — t7gAhio urr,mnp i�hpr — in. wemarks: boring 4 Li t3rarmr . 91W Ow* is uRtr►p }Astor ��'• Re rnprkrr: S604= (R.IVQO) 08, '3u. THU 0: 46 FAI 71.5 YSt .it:•40 J'1' LK3 CU tui�.::v�, u�4, V-A ... ,,... ....,� of �•�c>, 4u suplJ`G !@006 f�F�'�7��1�1 1 '' 4,S if T (,- ,R iS E or)(D $CA'.E iihl I LLL•' VAil l lti._��t�•- ,�.,��..,,,,,�„�__,�� Bn� l I}�'SCRL�'TIQ�'i -i'- I� � �'.*c..yrfhoy . I uM 2 ALE :'ATfON,,,,,, IM 2 DLyCRlPT1ON {3 (,yam' -►h, ��- 1 SYS T EM ELt V ATION AI.TERNAM Ei EVATIAN_! I CONTOUR ZLEVATIr]DT 91' 9-1 1 1 PA rE i 1 I r • Mound System Management Plan Pursuant to Comm 83.54, W13. Adm. Code Se tip 'c Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. Th outlet fi r shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that Dug off t e e when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced it the ala—, Is pmivnfo .d vnollnsenttaly. Inforrn filrwr nimievo ntpy lodiCg surgo nnwe or an imponrfinu rrt ntintrouit alarm. The liepou tank allail have da outteults iCw4vCU when the volume of aludde aid ywnr In the rank CAGe t/J We liquid volume of the tank. 11 the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall approved for septic tank use by the Department of Commerce. Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of he infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather Installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mgA, BODE. 150 mg/LTSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified In the permit for this installation. Fhe pressure distribution system is provided with a flushing point at the end of each lateral, and it Is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure testis peformed it should be compared to the initial test when the system was installed to detemsine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shell be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above a inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 8244 Wis. Adm. Code, and shall maintained in accordance with its' component manual (SBD- 10572 -P (R. 6199)) and local or state rules pertaining to system maintenee and maintenance reporting. No one should ever enter aseptic or pump tank since dangerous gases maybe present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33. Wis: Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be seated watertight upon the completion of service. Any opening deemed unsound, defective. or subject to failure must be replaced. Exposed aeoess openings greater than B- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. Contingency 'Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be repaired or replaced immediately with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to dscharge wastewater to the ground surface. it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintence of this system should be directed to your county zoning or health inspector. ��E I or 7 OPERATION, MAINTENANCE AND PERFORMANCE MONITORING A. The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make pelifulic impeclimin (WIhe vollilimu-111,n, clu liar siniilce (lisel illge. treated elllueut levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. B. Design approval and site inspections before, during, and after the construction is accomplished by the county or other appropriate jurisdictions in accordance to ch. Comm 83, Wis. Adm. Code. C. Routine and preventative maintenance aspects: 1. Treatment and distribution tanks are to be inspected routinely and maintained when necessary in accordance with their approvals. 2. Inspections of the mound component performance are required at least once every three years. These inspections include checking the liquid levels in the observation pipes and examination for any seepage around the mound. 3. Winter traffic on the mound is not permitted to avoid frost penetration and to minimize compaction. 4. A good water conservation plan within the house or establishment will help assure that the mound component will not be overloaded. Names and phone numbers of local health authority: St. Croix County Zoning 715- 386 -4680 Name of service contractor in case of failure or malfunction: Schmitt & Sons Excavating, 7115 -549 -6651 F , 4 brz 7 of 7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSi-IIP CERTIFICATION FORM Owner/Buyer �X)t c, Mailing Address 13_ " A ATui �i'� �vDseyJ wN Si4M L_r Property Address %-1 ` @ V`\-f J S� 'C o (Verification required from Planning Department for new construction) City /State o rc 4 5.0 Parcel Identification Number 031� " I aio I LEGAL DESCRIPTION Property Location 5 '/<, wee Sec.-tl , T 3i &R�, Town of Subdivision Lorr �k_O yL AT c,J:R Q oLL t - 0 C, 4 A K S ,Lot # � Certified Survey Map # , Volume , Page # Warranty Deed # 6-3 ?94 ,0 , Volume l.5 9 7 , Page # Spec house a yes ❑ no 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 wastewaterdisposal 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 g q g P g. sP 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 retumed to the St. Croix County Zonbtg Office within 30 days of the three year expiration date. / --�i'1 SI ATURE F % APPLICANT DATE OWNER CERTIFICATION I (we) certify that ail statements on this form arc true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. L , J 1 2/-04 SIG ATURE O APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed `Y - Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for PO Box 7302 1*isc p et(ttg�t ii§ application Madison, WI 53707 -7302 Dep artment of commerce Personal information you provide y'( used for secondary purposes p [Privacy La , s §c04(1)( (Submit completed form to county if not De state owned.) Attach complete plans (to the county copy onl the sy er not'(ess, an 8 -112 x 11 inches in size. County State Sanitary Permit Number .. heck if revision to previous applica 'on State Plan L D. Number ST= CZo1)C S 12 A g 1 *10 I. Applic Information - Please Print a ll Informati - Location: Property Owner Name�Y Property Location C l rr-CRLYA Saj 114 ,5aj 1/4, S fB T3 N,R r Property Owner's Mailing Address !` j ' r "4. Lot Number Block Number CUA E T `° } O WA City, State Zip Code Phone Number Subdivision Name or CSM Number / O ( '2 i s) 5W — S 71 Pi t - 4,1 nr 11. Type of Building: (check one) .rg P.s z,.,l. ❑ City 9 1 or 2 Family Dwelling -No. of Bedrooms: V'0- . (wz. ❑ Village • Public /Commercial (describe use):_ Q RTTown of • Stat -Owned S 7A- G' q , 1 Nearest Road / mw j �-,,n , o S/' W "l S I t V 10� l A r I rf O tr 0 $3 Parcel Tax Nu ber(s) III. Type of Permit: (Check only one bo on line A. Check box on line B if applicable) A) 1. K New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. `" 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Da' Issued ❑ A Sanitary Permit was previously issued_ IV. Type of POWT System: (Check all that apply) . ❑ Non - pressurized In- ground \0Ae ❑ Sand Filter ❑ Con tructed WetlAd ❑ Pressurized In - ground ❑ Single Pass ❑ Drip Line ❑ At -grade Un Reciroulating ❑ Otherk V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal 4. 1 A ati9rf S: ercola i Ra 6. System Elevation 7. Final Grade Required Proposed Rat (G s. /dag %sq. (Min. /�ckl Elevation O YV6 'p Are 7 mod, o3. VII. Tank Capacity in Tot M, of ufac r — Prefab' Site Steel Finer- Plastic Information Gallons Galltsns Trrks G6n- Con- glass New Existing / crete structed Tanks Tanks af E RIC D 0 _ VIII. Responsibility Statement I, the unde rsigned, assume responsibili for installation of the POWTS shown on the attach laps. Plumber's Name (print) Pl b is Signature (no stamps): M No. Business Phone Number iTT Plumber's Address Street, City, State, Zip Code) s Ew IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I ui Agent Si na a (No stamps) [Approved ❑ Owner Given Initial Adverse Surc ge Fee) Determination 5 32S' — . ?Z0 X. Conditions of Approval /Reasons for Disapproval: L �s-hnStJCc i 5 j� S► t� '� Q( CQQ O�nQ d� /iM ao ) -6398 (R. 07/00) Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 Ap TDD #: (608) 264 -8777 �scons�n J ' S'rf �� ��' www.commerce.statemi.us /sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary May 07, 2001 \ r . CUST ID No.221741 �TT�T POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/07/2003 Identification Numbers Transaction ID No. 637101 Site ID No. 628398 SITE: Please refer to both identification numbers, SITE ID: 628398, M & G Inc. I above, in all correspondence with the agency. St. Croix County, Town of Star Prairie SW1 /4, SWIA, S18, T31N, R18W Subdivision: Rolling Oaks - lot 20 FOR: Description: Three Bedroom Mound System ! Object Type: POWTS System\Regulated Object No.: 788117 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component mane are complied with.. A copy of this information must be given to the owner upon completion of the projec • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to 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 construction /installation/operation. ' r DONAVIN L SCHMITT Page 2 5/7/01 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. Sincerely, DATE RECEIVED 04/09/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM jswim@commerce.state.wi.us WiSMART code: 7633 r E o T G L1 A A_ Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 - TDD #: (608) 264 -8777 www.commerce.state.vA.us/sb www.wisoonsin.gov .wis c onsin.gov .wisonsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary May 07, 2001 CUST ID No.221741 ATTN: POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/07/2003 Identification Numbers Transaction ID No. 637101 Site ID No. 628398 SITE: Please refer to both identification numbers, SITE ID: 628398, M & G Inc. above, in all correspondence with the agency. St. Croix County, Town of Star Prairie SW1 /4, SWIA, S18, T31N, R18W Subdivision: Rolling Oaks - lot 20 FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 788117 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to 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 construction /installation/operation. ` DONAVIN L SCHMrf r Page 2 5!/ /ol 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 Sincerely, DATE RECEIVED 04 /09/2001 _ n Y FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM jswim@commerce.state -wi.us � �e 1hJ E; Y, SHEET SCHMITT & SONS EXCA VA TING 586 Valley View Trail Somerset, W154025 715- 549 -6651 v MOUNT) SY,SI M For: 1 �4f1' /'I //Cf' C'F4►LyA��I/ Address: 135 _ 6r�� j f' Legal: — _, '(d f y / s� /8 T 31 R 1,r.[,1 Township dAbe County: S %. C 12 o/ 1C Contents Page Im ,Soil Evaluation Report v o t r Page UP"? Plot Plan Page 3vP7 System Cross Section Page i "}oF7 Pipe Lateral Layout Page 5or-7 Dosing Chamber PAGE b OW7 PutIP G4QUE PAGE 7,70. /`yAirAGEigEX� PGAA! ,oR 7 Icy: r Address: Valley View Trail, Somerset, W1 54025 Tel. 5- 549 -6651 MPRSW # _�! 7 �� Date P Q n d nal Y A wAD COMMERCE r y ra r DEPARTMENT 1,ND BUILDINGS DIV{S10N OF ` SEE ORRES DENCE 1 i i I 1 I i I � I , { , I ' I t3rr I 9 1 IV W ca j 1 d1 i � /ter r ! ! .- QGb GG I i i ! i ! l i I pia — os�.p , ec ( t Koo 6 ? - I • ! ( ? t E4i— I It a t Di i 1 i f TA/ p y l , N` ,P 1 t PAS Z of 7 413 %08%'01 THU 13:40 FAX 715 386 4686 ST CHI CU" LUN1NC. 10004 WKW&Jn Department of Cornmerca SOIL. AN SITE EVALUATION o 3 be"!f Setety and BuMdings Page I�uresu Of Integr Services in accordance with 9, Vis, Adm. Code Attach complete site plan on paper nct less than 8112 x 11 inches In,3le': hteul mush ' ounly 1 r Include, but not limited tcx vertical and horizontal referer06 point (eivl)'s �lPectl ate: ° ° ,, _ Q � i • ti n G t �1 percent slope, scale or dimensions, north arrow, and location and ; -Ot nee to nb0(;i i; dad., Pa el LD. APPLICANT INFORMATION - Please print aU fnfd T itlot'i: "levi by Date Poroonel information you provide may be used for 9ay"7ndary purpuaee (Privacy Law, e. 15.14 Naginly CiW�,�, Prhlturly'd:xm1111n.n1 N,n r ,Kl < rn 1 ra) .) ichC �•�,t� k ctr,�i. i.ul �,� ,�J 1 1 Property Owner's Mai ing Address -- - Let;# 519pkif Sub , Name or G # 6\11 ;r, Ci ks City State Zip Code Phone Number ❑ Cit ❑ Village �'�- Town Nearest Road iA (] N ew Construction Use: Residential / Number if bedrooms _ y Addition to eAsting building ❑ Replacement ❑ Pubrc or commercial - Descrbs ' Code derived daffy flow gpd Recommended design loading rate bed. gpolf? + ! trench, 900 Absorption area required r z o c, bed, ft� 1 trench, ft z Maximum d "ign loading rat# `5 bed, gpdpt L N a — .trsnch, gpolO Recommended infiltration surface 9levotron(Q) — / �— ft as referred to site pion benchmark) Additional design/site considerations !"G' >^ 4r �e U - Parent material ->/ r / -- Flood plain elevation, If applicable — S = Suitable for system Conventional Mound In- noun ressura AT -Grade System In Rlii rr9 Tank u - Unsuitable tow oystorn [�l s ❑ u ❑ s ®u EIS L2 u A 0S MU ❑ s u SOIL DESCRIPTION REPORT Boring RD61 th Dominant Color Mottles Texture $truUf° Consistence Boundary Roots P . mungeIf Ou. Sz. Cont. C*r Gr. Sz. Sh, Bed Trench Ell � v Ground G Olev ' 9 rl R Depth 10 Iirttiting factor ,3p� n. Remarks: - Boring # x cS IN C5 Lf Ground % -461 1() vr H l i - 1 • V r L5 else. WO W smrn9 tatter 3�e i n. Remarks: CST Name (Please Print) Signature Telephone No. cla r,� Chf tom- �'( A, fees Date CST Number PA( e; a of Z OV08 /01 fHU 15:41.1 FAX 715 350 V5 "i1 IUKA UU LUlyllvI-1 lffluV7 BOIL DESCRIPTION REPORT � � nr 3 PROPARTv oWNBR �>J Pape PARCEL 1.0.9 Boring Hrxizon Depth Dorninent Color Mo111ea � ure Structur9 Gpn=Iptanoo Boundary Rants !n. Mansell Qu. Sz, Oont. Color Or, $z Sh. Bed ,Trench 3 I to tt� ground z4o 3'1 ilk wr`Ilte i Uy1 -. I�� l_S lrrti m� c.w l '"t �S 1L• L% ft. . Depth to Gmitlng factor 20tH. Remarks: Coring # mom dround R Depth to limning factor in- Remarks: Hwkw Dept Dominant Color Mottles Texture Structure Consistence Boundary Roots D In. Munsell du. sz. Cont Color dr. Sz. Sh. Dad , Trench Boring # Ground elev. — Depth to limiting rector In. Remarks: Boring # 13 13mund _ 9I9V- ft. Depth to Imldng factor in. Remarks: S9Q -8331) (R.9/t181 PA b o s 7 b� /03'01 THU 15:41 F.Cl 7 386 4686 ST CRY CO ZONING to 006 PAGE,, –OF NA,'1$E c-) LOT# 0 E3 _ �, ._ �, LJJC3AL CRiPTION �w SCAVF I"= t3M i �LLVAilufv - BM I DESCRLPTION 4 kar BM 2 ELEVATION (s BM2DESCR]P ION «- FiEwF'As� SYSTEMELEVATION L0q ALTERNATE ELEVATION CONTOUR ELEVATION- — I '-- .4 _ SI.G ' TURE ' rte~ •' DATE P &E- ( C of 7 r i r I t r+ , 02. al I 40N I f � I t ! 1 I i ' I I ' � , A e _. WIA ' I i O p p s �; � Rao ,7 f aa�s L � v i � 313 D 1 _ l o t �p Ao PA i , 1 I r ' t t I ` t ` j I � SAC ; Jr PA6F- 2 -OF 7 Page — , �' — SLR iN Lt /VGT1� t tLL. Synthetic Covering Distribution Pipe M��liurn �:rrrirt 6 t upsuil -. ._..._ D E 3 11 , u 1, b % Slope Bed Of - 2 %Z Force Main Plowed Aggregate Layer (6" Below Pipe) D Cross Section Of A Mound Systern Using E �Z• ' r f A Bed For The Absorption Area " G A Ft. / 'Z- Signed: B 7 S Ft. License Number: AI 7VJ K 91 L/ Ft. Date: L 91, Y' Ft. /7 Ft. �. Ft. W 1g� Ft. Observotion Pipe i F B K j W Distribution Bed Of 2 2 i Pipe Aggregat e ' Observation Pipe Fo�.,� Permanent Markers /N % c EYVC rid P1iiu�� t , .; Plan View Of Mound Using A Bed For The Absorption Area 1 , ::::.: Pam 3 or 7:. r • i • Page Of ' r Distribution Pipe Detail For A Four Lateral Network � Al ternate Position Of / i���nn� Cup Force Main PVC Force Main I PVC Distribution Pipe `� } P r *,,..Boles Equally Spaced PVC Manifold Pipe On Bottom S * Last Bole Should be Next To End Cap. P t. s 3 Ft. x Z y�f nches Y Inches Signed: Hole Diameter 3 Inch License Number: �/ • Lateral Diameter I �Z lnesi► Ante: d.� �_,_..��_ __ i �� M;tez i tolel Ui acaater 1 /�- 1 :►chess Force Rain Diameter _ Z Inches J Holes Per Pipe Invert Elevation Of Laterals 00/i Ft. C'1�C�E g oi= 7 P UMP CIR.f)SS SECTiOtJ ANG 5PECiF1CA �i V c m*r CAP I(C. v EN"T PIPE � ,t +5' FROM DOOR, WCATHEKPI'i00F APPROVED LOCKING - — T fF .iuucTlow box- MAWHOLt COVER W INDOW rip r-RrRH iL "Mlli. AIR IAIIAKL I GaaoE ( 1 '1' 1rt111. t • CctJOUtT -� __ 18 -- +— � r� 1N L E T PROVIDE � -T A1RTi4N 7 SEAL * I A Il l ALARM i I C *APPROVED i ! om ELEV. JOINTS WITH i { FT. APPROVED PIPE l 3' ONTO D SOLID SOIL w, OFF COMCKETE ISLOCK i KISER 1;XS'" PLKAIWEV OWLb Or TAWK MAUUFACTURER HAS SUCH APPROVAL E - APE re t S E. Do � O � � � �" ,S A-IJ! � MAMUFACTLIRER: ..,�5 ,r� -- iJUfASER OF DO SES: PER OAS A TAWK SIZE: ' PER 3AL.Lt�*,{8 M� MAuiJrAcrUKr,.R: �_ D05>< VOLUME O7 4 �- V�L �t 1lel� M Cr,UDIL IC, BACKFLOW: O7 AODILL WU M!lSIRI,.. LP CAPACITIES: A a, " IUCAES OK y�`�'�`� CALLOW T3>At�; -j P� p d a opt y3. 7 GALLOU �''IAtJ'LIFpLTlIR>iR: INCHES C 7rt / �, r t� MODEL AIUMBER: �7 G a,",�� — „IUCHE6 opt �,!„ GALI.OIJ SwIlck TwPE: - • —tNCf� QR ALLOW MIfU b13C1i1411tGE RATL OTE: IN5TAL ED OAI EDARATC CIRCUITS VERTICAL QIFFEILEMCE BETWEEM PUMP OFF AMO 0 PIPE.. L FEET ♦ MiIJ1MUM AIETWORK SUPPLw PRESSURE . `.Zl•PS 6.�L�r�t + 1 oU FEET OF Fo RCt MAIN x f�JrJ� Fs ET --• +� +`1dOFLFFICTIOU FACTOR. O � FED? r... TOTAL, 0 6%JAMIC. H E Ab FEET IUTERIJAL DIMEUStOA,I>r OF TAQK: HeiSki. O <r �_ " ,1111 T ,11 ;LIQUID DEPTH �� t*k)E D: LICEQ uUtwar 9417` l PAc-.; �? ot✓ � mom m ■ ■ �1 ■I► \��� ■ ■ ■\ ■ ®m�m� Mummam�m�m�m�m�m�mm ®mmmmmmm mmm ®m ®mmmmmmmmm�m �mm0mmmm m ®mmm®�mmmmmmmmtm mmmm = mmmm ®m ®mm mmmmm ® ®mtm m mmmmmmm®mm . mmmmmmmmm ®mm�m mmmmomm ®mmmmmmmmmm ®m ®mm�m �mmmmmmmmm ®mmmim mmmmmmmmm �mmmmmm®0m mmmmmmmm�m Mmm mmmmmmmm ®mmmmmmmmmmm,m �mm�immmmmmmmmmm mmmmm� ®mm �m■Mmm m mmmmmmmmm mmmm � � mmm • mmmmmmmmm mmmm memo mm,m mmmmmmmmmCmmmm�m��mmmmm�m ■■■■ ■ ■■ ■ ■ ■■ ■ ■�■ mmmmm,® �mmmmmmmmmmmmmmmm ■ ■ ■■ ■gym � o 8 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page � of 3 Division of Safety and Buildiggs , , ituieau of Integrated Services in accordance with Q pxx>r 3Q9 Wis. Adm. Code - " .founty Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 1 include, but not limited to: vertical and horizontal reference point (pm) directio 6' „ S+ • Y o I �( percent slope, scale or dimensions, north arrow, and location and- oisfsrtce to nearest road•= ParQel LD. # a ' APPLICANT INFORMATION - Please print all infdrmetioh. 0 Fi e wed by Date Personal information you provide may be used for secondary purposes (Privacy Caw, s. 15.04 (1) (m)) Property Owner Property tjorZation r1IC.hu 4 Govt. Lot s . 1/4 S I j� T 3 (,N,R f E (or) 111 Property Owner's Mailing Address Lot #, Block# I Subd.NameorCSM# City State Zip Code Phone Number ❑ City ® Town Nearest Road ' I ty ❑ Village � C` ucl LO I Sy (o ( 1 ( � ) 4�i-L0-1 S4 r r-, r, Z/Q (� New Construction Use: Residential / Number of bedrooms 3-4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 06 gpd Recommended design loading rate - <_ bed, gpd/ft !° trench, gpd/ft Absorption area required 0 Ubed, ft O U 0 trench, ft Maximum design loading rate t S bed, gpd/ft , 6/ trench, gpd/ft Recommended infiltration surface elevation(s) ' 3 • ft (as referred to site plan benchmark) Additional design /site considerations U- F9. 91 Parent material - Lr (/ Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S [a U WS ❑ U ❑ S ® U ❑ S E� U ❑ S T El S 501 U SOIL DESCRIPTION REPORT 4& 154L '6 I 1 ` Horizon Depth Dominant Color Mottles Structure GPD/ft2 W Boring # P Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 10 313 S.1 2 nn-�r L 1 v �' , • ( . S Z 1 16 m rJI3 5i 1 Zrnabk 4i C_ S •S Ground 30- 1a { 13 `!� (0 5 L( 3 C S — L4 elev. 9 — I ft. Depth to limiting factor ..a in. Remarks: Boring# ( �- -s 2 5� I Z m fr C �J�- •s ' .� .S' Ca ►► - 28 10 �/ `-t� 3 S ( Z rn bk rYl < < 5 S , . Cc .S 3 2$ -3(, It , rqlq — I Ground y -20 11 ) vrH (to F - 1• s r I L s l m m rrr• c 1;.$ elev. 9 88( ft. Depth to limiting factor ac in. Rem arks: CST Name (Please Print) Signature Telephone No. da Sch key `�� � s ) 24 - ?-y vv Address Date CST Number 2113 W +-b Scme rse+ 1 14OL `� -(5 -0 1 PROPERTY OWNER SM Oy-'i' SOIL DESCRIPTION REPORT , page _,Z l qz 3 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 3 I b- la r _ 11 3 Ground 3 2 4 - v v r 1 r .5 `-! � �0 �- S m �✓ G.5 �l elev. Depth to limiting factor .Z(c in. Remarks: Boring # I" Ground elev. ft. Depth to limiting ^r Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground , elev. ft. Depth to limiting ; factor ' "' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) I � r PAGE__S_OF� NAME S"b c-A LOT# Zp LEGAL DESCRIPTION 5c,,64.Y 4,S IX T 3 1,N,R 15 E (ork V) SCALE: I BM 1 ELEVATION BM I DESCRIPTION -kp o- z (/u c p y<- �/ F /`°1 BM 2 ELEVATION qy 6 BM 2 DESCRIPTION 4,,e ? "fit p a(, SYSTEM ELEVATION ALTERNATE ELEVATION CONTOUR ELEVATION y �/ 2 a J' rnZ ant as � °r SIGNATURE DATE a . ► VEIL 13 f PAG: 5p (o STATE BAR OF WISCONSIN FORM 2 - 1998 639960 WARRANTY DEED r,ArHL-EN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between —_ -- 03 -0? -2001 10:00 AM uTnunnn n emnnT anA TAN F RTniiT _. b u s ha n r3 and sa i f o� —� WARRANTY DEED Grantor, ER F' Y __ —.-- - - - - - -- CEki COPY FEE: -- TN( _ COPY FEE: and �L - &_5�, - -- — TRANSFER FEE: 111.60 RECORDING FEE: 10.00 - - -- PAGES: 1 -- - -- - - -- — - -- Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St Croy X County, State of Wisconsin: LPaif Plat of Rolling Oaks Town of Star Name and Return Address St. Cr, x oun y, Wisconsin. m Ic kkP"t'L ( h.A rJ 13Sti A WAlck( C- '�P. I.1�0 St!:� W 1 SVDI E7 038- 1201 - -000 Parcel Itlentificatbn Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 92nd day of ^ February 2001 (SEAL) _ (SEAL) Richard 0. Stout Janet P.Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. S Croi County authenticated this day of __ Personally came before me this _ 22rid _ day of Fehriiary 2001 the above named Richard O— Stout and Janet P. -- q't 7111 - -- -' - ' I` - - -- - - - - -- - _ to TITLE: MEMBER STATE BAR OF WISCONSIN - -' — (if not. —_ me known to be the person $_ -_ who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. g CHF_RYI-JACOBSEN Vota Public TNIS INSTRUMENT WAS DRAFTED BY � . S:-tt� n{ Wisconsin . Janet P. Stout , __ . _ 1 353 Awatukee Tr. Hudson, WI 54016 Notary Public, S e of Wis nsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _ - - - -- -- - - -`') necessary.) • Names of persons signing in any capacity must be typed or printed below• the,, signature. Wisconsin Legal blank Co. Inc. STATE BAR OF WISCONSIN W l Blan GO Wes WARRANTY DEED FORM No. 2 - 1998 LING OAKS ' SW1 14 OF SECTION 18, T31N, R18W, TOWN OF STAR PRAIRIE. INCLUDING LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN NOIC To 1 l.40.0.7r.. 10.1/. 12.13. 140 A11! � AA TO SANITATION PlgIR 1•s„ED• PLAN Y 7O THE ST. OIIOE( QOUNTr MOM40 DST AND r p I',OTH TAN0104111 170,2r N DOW4r E N •P40rs,' E C O IMA• N 4007rr/• ■ N 2PM7r ■ t �1 IYAO N 240 ■ N sl2rw IT p? 7 son" r4040www a wm2rw a=FFi sl./! • 1Nr.M w w 40 6"'N • W 711 111.74 SrTISYPw S 2r4r3r W i i T e 40,.sr s 240'••77 w S ao+rot• W E•sAe s 40Y1r21• w s 00-2~W 122Ar • 40rs" W S zw4mr W ,20Ar S 20'47%$r w s 400-2244 w LANDS OWNED _BY OTHERS NORTH LINE OF THE fvl /� OF' avl /� 8 B1i'38'6>i' E 812.42' TLAND � t WETLAND ERDU40•tr HI • I � � WATER LINE . 40l •O �.-I- .WETLAND p 14 1 ,J SgOQ 13 74,2411 00 FT 27ssA011d \ N� �S:i • 12t 2T2 r0 PT / � _ �pS1 W i DOUGLA J. ZAH : 1 212 WALNUT STREET t - • HUDSON. VA 54013 7:°0° A m: WAM&M Wi RICHARD 0. STOUT 01 JANET P. STOUT �, ice/ /�` y ; 1353 AWAIUKEE TRAIL y Q HUDSON, MA 54016 I 1 W ¢•�� �/ W < �I i A27 ADORN 64,37A 00 PT /' ±�� r a M 7 L7 i 18 I• 1 :.:.17 Aches 2A17 AC/leS 97A97 W PT i i ,0.4024 EO PT j I Nss'srls'w 1 1 t 1 44&W 109.7r 1 _ 1 1 r 1 1 1 •tom. _ I � F ,BO PARCEL IN �`�' • ,w740wcnn ,AS40AG1ls m we ro PT $ 483/526 I wt 1 t�tt. I I I ® ao 1 1 L EIISTIMG DRIVEWAY 1 -_. N •rart40' W W.7'r NEr]7'16•V SIM A / EN QQ DEDICATED To THE PUB _._ _40_40_ _40_40_._. asamN 7s y sate• w ez.aa ---------- '�-.s1av - -- % -- H 0TH AVENUE 1A`0.4, DATUM OF low 'ED LANDS OWNED BY OTHERS SHEET 1 OF 2 SHEETS