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038-1108-50-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488249 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: Claassen, Neil I Star Prairie, Town of 038 - 1108 -50 -300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: N—) �jl(1n G� 27.31.18.456A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER %A APACITY STATION BS HI FS ELEV. Septic Benchmark 3.4 /63-46 Alt.PII�I �- CO V 4.-- - I w Bldg. Sewer� Holding St/Ht Inlet l TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet F;%k (v- 94. Septic y ` m .' (0 $ 9( • �o� 135 '54 � 33 � > 30 � Header /Man. 1 7- 5 Z g5 .73 Aeration Dist. Pipe . 9 S .93 .�3 4 .IVL Holding Bot. System Final g rade PUMP /SIPHON INFORMATION 3S Manufacturer Demand St Cover GPM �,1 � 10 . 6 Model Number TDH Lift Friction Loss System Hea TDH Ft 37 ?3 •� Forcemain th D' Dist. to well T. 6 .5 7z ,V 7 SOIL ABSORPTION SYSTEM BEDITRENCH DIMENSIONS Width J Length Z � NoTrenc r PIT DIMENSIONS No. Of Pits Inside Dia LiquicLDepth SETBACK SYSTEM TO i0 P/ BLDG WELL_ y^ LAKE /STREAM LEACHING Manufactur, INFORMATION Type Of System: ` j CHAMBER OR i S p 1 11- 7 f UNIT Model Number�Q (Lt�7 /�/ DISTRIBUTION SYSTEM 4.5 (� �'1 x-17 + 1 5 I Header /Manifold if IDistribution \ x Hole Size x Hole Spacing Vent to A' Inta Pipe(s) \ \� Z (a L Length Dia 1 Spacing I I SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of i xx Seeded /So dad xx ched Bed/Trench Center /� Bed/Trench Edges Topsoil -(-$ �' No Yes 0 No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1987 115th Streeet New Rich m nd, WI 54017 (NE 1/4 NW 1/4 27 T31N R18W) NA Lot 7 Parcel No: 27.31.18.456A30 1.) Alt BM Description = F' 'oV1—^ 6Z (�OJ 2.) Bldg sewer length = o - amount of cover = �I Plan revision Required? Yes ZNo —7 Use other side for additional information. d SBD -6710 (R.3/97) Date Insepctor' Signatur Cert. No. Safety and 'Buildings Division County 201 W. Washin Ave., P.O. Box 7162 G ro r ` �Ol�S,I� (6 Madiso , 453 Sanitary Per it umber to be 7162 filled in by Co.) 08) L f n '2 Department of Commerce State Plan I.D. Number Sanitary Permit Applica do In accord with Comm $3.21, Wis. Adm. Code, personal information you pro may be used for secondary purposes Privacy Law Project Address (if different than mailing address) 1. Application Information — Please Print All Information .� $_S-0 — Property Owner's Name r N Parcel of # Block # 2i /C�4 Property Owner's Mailing Address GG -yl Property Locati fw �7 /� � Y., Section /Z C State Zip Code Phone Number r L eZ v�� / E cleon 3 T N. IY E o II. Type of Building (check all that apply) - � CSM Number 1 or 2 Family Dwelling - Number of Bedrooms _ ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑VillagqEWown ip of� � t 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. permit Renewal Permit Revision Change of El Transfer to New List Previous Permit Number and Date Issued ❑ ore ❑ g /13 _ l �l f� / 3 Before Expiration Plumber Owner ( 1 J ✓ (J f / IV. Type of POWTS System: (Check all that apply) z Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ ecirculpti g Sand Filter J Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain V. Dispersal/Treatment Area Inform ton: ° Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (Sf) ,$ystemvation Y` — El _ VI. Tank Info Capacity in Total Number at factur Prefab Site reel Fiber ! Plastic Gallons Gallons of Units W /,7�jL� /� ��`I C �T I Concrete Constructed Glass New Existing Tanks Tanks Sept r Holding Tank Aerobic Treatment Unit e?1 Dosing Chamber VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plum s gnature MP /MPRS Number Business Phone Number r s Plut er's Address (Street, City, State, Zip C 2 ., Vlll. County/Department Ilse Onl Approved ❑ tsapp Sanitary Permit Fee (includes Groundwater Date Issued Is uing A cot Signatur (No Stamps) Surcharge Fee) ❑ er ven Reas for Denial , V 3� « io Ia. Conditions f p r 1 �' 1 J _ () _ 3) ` Ve-I r Q.1C f SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 9I/2 s 11 inches in size SBD -6398 (R. 01/03) r � PLOT PLAN PROJECT Neil Claassen ADDRESS 1987 115th st. NewRichmond Wi. 54017 NE 1/4 NW 1 /4S 27 /T 31 N/R 18 W TOWN StarPrairie COUNTY ST. CROIX MPRS Byron Bird Jr. 22052 DATE 6 - 22 - 06 BEDROOM 4 CONVENTIONAL XXX At- de CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 000e 260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1500 # of chambers 51 hk BENCHMARK V.R.P top of slab walkout ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =95.5 T -2 =94.2 T -3 =93.5 > 12" of Bio Diffuser with Cove 31.1 ft ^2 per 6' chamber i Ik -Grade at System Long 34" Elevation Garage 12' Well 10' Dec 4 Bed IHouse 50' BM 115th St. 20' 40' st st O ob pipe Fail Bed 55' 106' 95" r_ 97 96 �rxr PLOT PLAN PROJECT Neil Ciaassen ADDRESS 1987 115th st. NewRichmond Wi. 54017 NE 1/4 NW 1 /4s 27 /T 31 N/R 18 WW TOWN StarPrairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 Aklzi2 f .DATE 6 -22 -06 BEDROOM 4 CONVENTIONAL XXX At- de CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 000e 260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 13 LOAD RATE .4 ABSORPTION AREA 1500 # of chambers 51 BENCHMARK V.R.P top of slab walkout ASSUME ELEVATION 100' ❑ BOREHOLE O WELL - H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =95.5 T -2 =94.2 T -3 =93.5 >12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per + chamber 6 —Grade. at Sys= Long 34" Elevation Garage 12' Well 10' Dec 4 Bed House 50' BM 115th St. 2 st st 0' O ob pipe Fail Bed 55' 4' 7 l 106' B 95" . �, .... 97 96 �nrn RECEIVED Wisconsin Department of Q mmerce SO IL EVALUATr► -R &PORT Page of Division of Safety and Buildif gs J UN 2 a 6 with omm 85, Wis. Adm. Code J County , Attach complete site plan n papg{n¢�� 11 i hes in size. Plan must include, but not limited to: erticafl?l l int (BM), direction and Parcel I.D. percent slope, scale or di ensions, north arrow, and location nd distance to nearest road. / - D " ✓ l! " Q Please print all information. �rJ 5 � 6 q Re wed by Date Personal information ou provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) Y P Y 10 Property Owner Property Location Al e; cla-a, e-,V7 Govt. Lot /!� 114 114 s,21 N R If E Property Ownbes Mailing Address Lot # I Block # I Subd. Name or CSM# C State Zip Code Phone Number ❑ City ❑ vil ge Town Nearest Road [� New Construction Use: (Residential / Number of bedrooms Code derived design flow rate 7 ,06 GPD Replacement ❑ Public or commercial -, _-- _- .__ -• -- Parent material /�' /p-C r u/ OG� 09 5 j 4 Flood Plain elevation if applicable ft. General comments �- / ;- 9S �- S and recommendations: T� ,0Z =- 7" 3 Boring # Boring q/ 7 ❑ Pit Ground surface elev. / (� - ^ ft. Depth to limiting factor �2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l d- ,a �- y l Boring Boring # � ❑ Pit Ground surface elev. S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 1150 mgA- ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST (Please Print) t Signa D CST Number J Addreid Date Evaluation Conducted Telephone Number Property Owner � :51:57 cn k7 Parcel ID # Page of �1�.7 5 Boring # Boring 1 ❑ Pit Ground surface elev. ft- Depth to limiting factor , i n. Soil Application state Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � rn G sn' a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Application Rate Horizon Depth Dominant Color Redox Description • Texture Stnxx<xe Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mgA- and TSS >30 150 mgA. ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L 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 - 2648777. S8131-8330 (R-6/00) Soil Test Plot Plan Project Name Neil Claassen By d Jr. Address 1987 115th st NewRichmond Wi. 54017 CST #220527 Lot Subdivision Date 6 /22/1906 —Count ST. CROIX NE 1/4 NW 1/4S 27 T 3 1 N /R W Township Prairie n Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft Top of walk Doorway System Elv T -1 =95.5 T -2 =94.2 T -3 =93.5 H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted nriveway Garage 12' Well 10' lJecl 4 Bed House 50' BM 115th St. 20' 40' st B 10' Fail Bed 55' B2 B 6 , & ' 300' PL � 200 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS d - e � Owner Septic Tank Capacity O ga l ❑ NA 4e ki Permit # 12 t� Septic Tank Manufacturer Q ❑ NA �j DESIGN PARAMETERS / Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model / ❑ NA Number of Public Facility Units A Pump Tank Capacity al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate g al/day/ft 2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly f average * Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :9220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :_30 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fec al Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) _ ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 3 ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA % year(s) month(s) � Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) *NA Flush laterals and pressure test At least once every: [3 year(s) � Other: At least once every: ❑ month(s) MNA ❑ year(s) Other: A 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 IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) i 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. J The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 �^� , ,,�L Name c 4 Phone — 6 "7'e5 4 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name e�' �r f" Name �i'p r �O zo dt Phone 6 5 7 9 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. r. uK0 X COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer k 5 5 le Mailing Address - _e" Property Address �A tw (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Locations '/4 '/, , Sec. c;; T N RZ2(W, Town of J� /a'r ' Lot # . Certified Survey Map # 1 °���� , Volume G , Page # b Warranty Deed # �U , Volume ID , Page # D Spec house yes Lot lines identifiable es 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 SIGN OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the N 61 L-- C I. A-A ss&"'j residence located at: Ll (! : T- 1 /4, Nal l / 4, Section 2 , Town N, Range R W, Town of ,5t Pr2 pp-++(P-(E , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 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): Age of Tank (if known): (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP /MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) . 7� - DOCUMENT No WARRANTY DEED -1415 5.. E RC'.CR'+lD 01014 Rf CORJ NG D�'a STATE BAR OF WISCONSIN FORM 2 -1982 5%2197 lot 109SPAef 0 Ronald Wohlers, a/k/a Ronald A. Wohlers, a single ST. C; person,. - . _ Rey';: 'zr r':iaord OCT 6 1994 (, 1. conveys and warrants to .Neil J.. Claassen and Anyrine D. A 10:00 � M Claassen, husband. and. wife, ... .... ... .. ..... .. ....... -.. .. . -.. .. ..... .... Rrru RN ro St. C the following described real estate in .. _ _ ...... ..... ........_. .. County, acate of Wisconsin: Tax P:+rcel 'o:.....-•- -- ----• - -- --- - - --- A parcel of land located in the Northeast Quarter of the Northwest Quarter or Qua TownshZiu NE 1/4 of NW 1/4) of Section Twenty-seven (2 7), t 1-one (31) North, Range Eighteen (18) West, described as follows: of Certified Survey Vap filed December 3, 1992, i Volufre 9 of Certi rvey Maps , pag 2570 as Doc. No. 492435. 0 This 1S nOt homestead property. ,+r "(is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 3� day of September 19 94 - . __.. ....... -_.... _ (SEAL) /v,e� iSEALi Ronald Wohlers, a/k /a Ronald A. Wohlers ; - ------- . -- .. _(SEAL) _. (SEAL) f s I !I AUTHENTICATION ACKNOWLEDGMENT Signatures) �W� --� - ---- - - - - -- - - -• -- STATE OF WISCONSIN ................................... ...•.._•---•-..--•-•--•-•-•-------••-- � ,,. � ,, S_L._.CrOi.x__. -- ..-----..County. authenticated thisMt.lay of_!IG 4!h^ '(, 19.4 Personally came before me this - ... day of . --- September. ................... 19... the above named - - - -- 1 W Rona _ d • Wohlers, • - a(k1a. Ronald- A.-- Wohlers -- .....I � ? I•� / >' -.. E c.4 - - - - -- - - - - - -- - - -- - -• - -- - - - -- . ........ -- - - - -. . TITLE: MEMBER STATE BAR OF WISCONSIN ------ ------- ---- -- li (If not . .. .. ... ........................................ ---- - - --- .- -- authorized by § 708.08, Wis. State.) to me known to be the person - . .... ... -. who executed the foregoing instrument and acknowledge the same. ,I THIS INSTRUMENT WAS DRAFTED BY I I I ------------- Kristina ..0gland.- . .............. - - - - -- Attorne at Law - --•------y..- •-•- •......-- .--• ................ Notary Public - County, Wi-. - (Signatures may be authenticated or acknowledged. Both My Commission is permaneit.(If not, state expiration are not necessary.) - •g ) date: --- - - -- ------ -.._ . -- - - . ... - ... . ..... - - �. I !i *Names of pet ons signing in any capacity should be typed or printed below their Amnamres. 1 i i+ WARRANTY DEED STATE BAR OF WISCONSIN Waronsm Legal Blank Co.. Inc. l, JRM No 2 i — lyBY of a N. . n .. , , '. -... ... Y c 1.A - iµ u= - + t - - u .y. _.:.n !, F,. �.. Y �M ;, S" SI w uk ee 4. . s+. S#tL.�� r • . . a .�f� FILED 3 DEC 0 31992► JAMOIEW o D ` 4 SL CfObI �.. V!I s 492435 a , CER T.IEIEO S(JR VE Y AIA P Located in the NE1 /4 of the NW 1 /4 of Section 27, T31N, R 18W , Town of Star Prairie, St. Croix County, Wisconsin. Owned by_ Harold Olson 1968 115th Street New Richmond, Wi. 54017 UNPLATTED LANDS NORTH LINE OF THE NW1 /4 N 89 "W �j s 89 57'22"E S 69' S7 ' 22 "E 303.25' 330 .00 II 1953.26' NW Corner 6' 10, 17' N1 /4 Cor. Section 27 Sec. 27 T31N, R18W � ® � 7 T31NR 18W (1" iron found) (1" iron fnd) ( St. Croix Cty mon. set.) 191, 390 Square Feet (St.Croix Cty mon. (4.394 Acres) set) Bearings referenced to the North line of the NW 1/4 of Section 27, assumed S89 57'22 "E O p O 01 CU INO Q wA I c.9 Ld QI a �� W � of w) CU j a+ to 0 p O p J i A J Go1vSi���� >1 z f �VIP �I ;% cnl HARVEY G. �C` CV! 100' building setback line JOHNSON S -1899 1 HUOSO 1 �• WIS 01 • o -JI Si q` APPR — — — — N 89' 57 ' 22 " W 307.26' a -3 — �o RU@ IC ROAD — — — 5T. CP=tOMM i o Section corner monument I Z+oMMklgaWl (as noted) ' Perks ConwM em • 1" Iron pipe found >ifMwt f�« x- Fenceline wWsM30d*Vac" "P 0 &A "i - SCALE IN FEET I " = 100' fhtlm*w WHEM09 Ems l" i vc4d 0 d 25' 5' 100 200' 300' This instrument drafted by: -).W.&. 491-1865A VOLUME 9 PAGE 2570 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 4'o �'J�C' G-AyzO`z..c� SUBDIVISION / CSM# LOT # SECTION -R W, Town of ST. CROIX COUNTY, WISCONSIN CG t r c� f3 / 'f' \ PLAN V A SHOW EVERYTHING WITHIN 00 FEET OF SYSTEM t3� 0 /7111t 1 3R �cn c f INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. �r 44 lO G /1 BENCHMARK: ��T S G vr/t c v` [7 17 -&t S� ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: e, e- Liquid Capacity: 411� Setback from: Well vG.IZ / Other /T/v Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: a Length ��S / Number of trenches Distance & Direction to nearest prop. line: , /QO Setback from: well: House Other / ELEVATIONS 6 7 Building Sewer -v ST Inlet ; y� ' � ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade_ Final grade DATE OF INSTALLATION: PLUMBER ON JOB: 4 v7 A lf LICENSE NUMBER: �3 INSPECTOR: 3/93:jt r LO IO*D I idRIE. 27.31pg* ,ftft A% SYSTEM county: Labo�and human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitar crni GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village []Town o : State P X V.: p. BM Elev.: BM escripti Parcel Tax No.: TANK INFORMATION ELEVATION DATA A930 182 ZLQ � E 72& TYPE MANUFACTURER CA:EOITY STATION B5 HI FS ELEV. Septic Benchmark �- Dosing------ (o, fd, 100 Aeration Bldg. Sewer G c .6 z"' Holding St /�Vf Inlet 7 ry9/ TANK SETBACK INFORMATION St/Pf St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic a ° NA Dt Bottom Dosing NA Headers 9 ��'',�� Aeration Dist. Pipe ' �6 ;,2' Holdirwyl Bot. System Da PUMP/ SIPHON INFORMATION Final Grade jai Demand {° S. 7, ll� SLength--- GPM ction S s TDH Ft Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ! / . No. Of renches pl No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING any a urer: INFORMATION Type Of �, r / CMAM Moe Number: 3 System: , r` , y /l� ' ( 4 OR UNIT DISTRIBUTION SYSTEM Header HVhjnffC1l_ �, Distribution Pipe(s), x Hol x Hole Spacing Vent To Air Intake �� v / Length i Dia. Length 'S Dia. � Spacing ( Q SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ S ed xx Mu Bed/ Tfe�Eenter Bed /irg%-Edges - Topso ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE,27.31.18,NE,NW,�OT 7 9.3 113 lilt G Ga/� KJ� O ct� _ Y Plan r ision required? [t].ys E] No p Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signatu a Cert No r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e a =LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATES ITARY PERMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ C i revision o previous application –See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWN PROPERTY LOCATION D �r a %, T g,N,R E(o PROPERTY OWNER'S MAILING ADDRESS rOf# BLOCK #' .2' Z 2oo / " / CI STATE / ZIP CODE PHONE NUMBER SUBDIV IO NAME OR CSM NU VBER 11. TYPE OF BUILDING: Check one CITY NE AREST ROAD ( ) ❑ State Owned VILLAGE ❑ Public 1 or 2 Fam. Dwelling -# of bedrooms P A FI L N T • u D III. BUILDING USE: (If building type is public, check all that apply) 3 -- // P 0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ¢# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE I /G/ REQUIRED sq. ft.) PROPOSED sq. ft.) (Gals /d y /sq. ft.) (Min. /inch EELEV TION `_r�7 P L- Feet / �Feet VII. TANK CAPACITY in allons Total # of Prefab. o Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con n- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb Name (Print Plumbe ' nature: (No Stam MP /MPRSW No.: Business Phone Number: Plu er's Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue ui g Agent Sign to (No Stamps) Surcharge Fee) Approved ❑Owner Given Initial Adverse Determination 40 ;) i X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at ft time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to th'F, permit must be approved by the pern - :it i3suing authority. 4- Changes in ownership or plumber requires a Sanitary PerrO Transfer /Rerc; wal Form (SBD 6399' to be a,ubmilied to the c:oi_irty prior to installa61on. 5. O^ °,ile sew s ys ib'rns must be properly Maintained. € he _ >�, ,, ptic tank(s) rm st be pu :ded by a licensed pumper wherever r°ecessary, usually every 2 to 3 years. 6. If you leave questions concerning your onsite sewage systerri, contact your local code administrator or the - State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's namE� and mailing address. Provide the -4egal 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. Ill. Building use. If building) type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete.line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Abs ^tuff= gin system information. Provide all information request .d in #1 -7. VII- Tank, , ,fc rr Elf =`n. Fill irl the c=apacity of every new and /or existin tank ` ;vt It _ total gallon��, number of tanks yin•:` M;.: u`acture•'s name ,ndicata prefab or site constructed ands Y:ajk material r::ornplete for all - sep':c, r,u, ,rr7isiphon and holuiog tanks too this system. Check experirnE :.;:_,1 d::pproval or iy if tanks received exp( rirnt.nta product apprcvai from DI?_1 Vl!l. Respo ^s +bility statement. Installing plumber is to fill in name, license n>.r k)e. with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must ;Jgn application i_; fn. IX. County /Department Use On! X. County /Department Use Only. Corriplett. plans and specifications not smaller than 8% x 11 inches must be 4;ubrnitted :o this covn'y. The rr^t_t ir�c r,de the. folic;w gig. plot 7itn, drawn to scale or Yrit� l n �': di r ensions, 'ovation of ^Oi_WI iankisi o f)1her ir atrrient tanks; bUlldinG r, ;, v-veli;; water maifrS `water service.; . ino lake -.' .?tlnlp U! ';iph i! tank._., .0isr.ribution boxes .' - ibso systems, re „Jitic ernent system areas, aiid the 'CCaticii of the 1 )u{Iding seeded :3j horiZOnta! n E^rtical elevation referer-( -e points; 0) complete specifications fclr pumps and controls, dose voiur:a; - ,;evation 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 inclided the creation of surcharges (fees) for a number c` regulated practices which can effect groundwater. The collected through t ese surcharge ; ri �: eF+ ,� . � rr ` h 1 .'lt<,ter :� c;vid_ Wdt +'r CCnf`dt7s;rlgt;t ) r1 rove; lig o-r?`> and establishn r r .:' trlC- jat SIB D-6398 (R.11/88) r NLOI PLAN PROJECT �R- S ADDRESS/, ` Ot, ✓�� /�� 1/4 A)„ 1 /4/S1) /T3 1 N/R /g W TOWN t I r CO NTY -51, 0- r o) X 'a'117 MPRS Byron Bird Jr. 3318 DATE -26- BEDROOM CLASS PERC -_ CONVENTIONALX_ ROUN PRES RE CONVENTIONAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE IOG(3Aa,l LIFT TANK SIZE DOSE TANK SIZE HOLDING SIZE ABSORPTION AREA a 1g P ERC RATE - 7 BED !Z / _ s E IL Benchmark V.R.P. Assume Elevation 100 Location of Benchmark Qse, -i - -1 O Borehole Q Well Scale = Feet 0 Perc Hole System Elevation 2 Uent 12" I Gradp TYPAR COVERING 2" 4 4 12 3 6 O 3 6- Sewer Rock 1.2' S �o 21I � 3 B V 5f o 3 5 Z I e ven 12' �ti �o �w �0 C DEP OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS . IND USTRY, DIVISION 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (l HR 83.0911) & Chapter 145) LOCATION: SECTION: WNSH UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1 / '/a /T N/R (or �o�, -� r•�. G �r /� �o CO TY: MAILING ADDRESS: U ME DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IPERICOtATION TES Residence �. New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVE MOUN IN- GROUN - PRES SYSTEM- IN FILLHOLDI NG TANK] RECOMMENDED SYSTEM: (optional) (OS OU J O� J EA EIJ OU E]J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: y G 4 Floodplain, i Floodplain elevation: dl�a PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) a 0, 513 az �/Or7 B -a f4:� o, / B- , J1 7 B- B- B- PERCOLATION TESTS -c TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER Wj"" AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PERT D PER INCH P _ G c P_ G P- L P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ? ,[ SYSTEM ELEVATION ��• l • t f w r 3 A . ......... 1 ti �� . __, _ �'�� �f� �. aim �! ...•.....,. _ F N E o 3 I Jr O I, the unaersignea, cerTITY tna Tests reporTea on t is rm were ma yitte+a accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the testsare or�egt,to'tl5e best,of my knowledge and belief. Z A, NAME (print): _ ��� e ; TE TS WERE COMPLETED ON: ADDRESS: IFICATION NUMBER: PHONE NUMBER goo Lt }C� IGNAT E: / ` ._)N�N f ? � 5 DISTRIBUTION: Original and one copy to Local Authority, Property Own 'a /d o T st r y� DILHR -SBD -6395 (R. 10/83) - OV L , INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols at — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sic[ — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay III — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water ' Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I FILED 3 0 DEC 0 3 199210- ,LAMES 6'C0NNELL 4 dater of Deeds SLCMIXCo••WI s 492435 CEP . T I E I ED S UP V E Y 14A P Located in the NE1 /4 of the NW 1/4 of Section 27, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. Owned by: Harold Olson 1968 115th Street New Richmond, Wi. 54017 UNPLATTED LANDS NORTH LINE OF THE N w1 /4 N 89 "W II S 890 57'22" S 89 303.25' 330.00' 1953.26' NW Corner s' l0' 17 N1/4 Cor. . Section 27 Sec. 27 T31N, R 18W T31NR 18W (1" iron found) u ' ® � 7 (1" iron fnd) (St. Croix Cty mon. set.) 191,390 Square Feet (St.Croix Cty mon. (4:394 Acres) set) Bearings referenced to the North line of the NW 1/4 of Section 27, assumed S89 0 57 1 22 "E �t O O O I of � � I Q wi wl W 3 JI QI I al aD I -t CID W I °D V (U al �I JI O O O G oNN�.,,� '� z cn 51 of ,!'= IARYEY G. UI 100' building setback line JOHNSON Z S -1899 ' I HUDSO a WIS �l 01 i� O o J i q APPROVW - - - - N 89' 57' 22 "W 307.26' — — ROAD LEGEND PUE'L CC_, — _— - - — — — - � — fir CRW Comm :.arrtar Ml"Umv Wvi� -�- Section corner monum Int I Zonirslg aw as noted d ) p2fki C0ffM1f'jtbY • 1" Iron pipe found I if t+lot tacacddd ,c ,< Fenceline w0l&30de"* SCALE IN FEET I " = 100' approval dift moral a wese 0' 25' 50' 100' 200' 300' t1Ur & void This instrument drafted by: J.W.G 491 -1865A VOLUME 9 PAGE 2570 PLOT PLAN PROJECT ..%Cohoc 4-1 /Z(� X 4 . - e C l ADDRESS / a?ew o °f/� �✓ <�cli� -c� /T/�1 1 /4 /Sa7/T/ N /R /�GV TOWN a.- .^sc r^i "c COUNTY MPRS yron Bird Jr. 3318 DATE BEDROOM CLASS PERC CONVENTIONAL, VG ROU RESSURE CONVENTI NAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA 6 PERC RATE _ BED SIZE ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark o� e; «�, L Borehole Q Well Scale = Feet O Pere Hole System Elevation �– Vent 12" Grndp TYPAR COVERING 12" 3' 4 6' O 3' I 6 „ Sewer Rock i 1, 2' to 6 I o �' a r b a ® , v r �v Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW PROPERTY LOCATION Oh k �p/�� S GOVT. LOT �� 1 /4 /4,S rT N,R E (or)(g5 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3 /1 To CITY, STATE ZIP CODE PHONE NUMBER ❑VILLAGE 29OWN NEAREST ROAD c yD1 7 (2 New Construction Use [ Residential / Number of bedrooms [ J Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow q ,5 - 0 gpd Recommended design loading rate 7 bed, gpd /ft - trench, gpd /ft Absorption area required 67q,: bed, ft 3�Z trench, ft Maximum design loading rate - 7 bed gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material ®u / �,.E •5 /7 _ Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 1 5ZS El U CC'S ❑ U S ❑ U JAS ❑ U ❑ S 1 ❑ S R U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Of Ground a C // , e Me, e el l � ev.. .,� Depth to limiting � factor 10 Remarks: Boring # oe Ground lev. Depth to limiting O factor 3 5 Remarks: S t CST Name: — Please Pri Phone: Address: B7v c er Signature: Date:�r her' 1 7 PROPERTYOWNER 14 VAOQ /LJVI SOIL DESCRIPTION REPORT Page_af PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. Depth to limiting facin 3 s Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Plot Plan Project Name 4iC©.417 A Byron Bird Jr. System Elevation e ® ��� fsr.:�c -� CST# 3479 Benchmark - - - - -- H.R.P. CD Boring Well D Ax- I o' fm - ioo� r� �3 5� I � D n 14 Ly 2 T�S 4a 1s �z ' licCc c fo STC -loo . 'Phis application form is to be completed in full and Sig ned b the ocvrner (s ) of the property being developed. Any inadequacies will only result in delays of the development be intended for resa by /c n•trachtord this Douse), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property v .- -------- - - - - -- Location of propert /V� ] 4 �I/W . / 1/4, Section � N -R�W Township 2, T� V Mailing address O D • w� r �l Address of site S f� , f /C" Subdivision name Lot no. Other homes on property? yes No Previous owner of property Total size of parcel (f Date parcel was created Are all corners and lot lines identifiable? —2— ' Yes No Is this property being g Qveloped for ( spec house) ? Yes �No volume /40,3 and Page Number — �-L___ as recorded. with the of Deeds. Register ---------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAIITY DEED which includes a DOCUMENT NUjjBM, VOLUME AND PA NUMDI R & TIIIs SEAL OI' TI1 GE 1; ItEG S x z cIt o certified surve F DEEDS. In addition, a y, if avails ble; ,would be helpful so as to avoid delays or the reviewing Process. If the deed description to a certified Survey Map, the Certified curve Ma shall also be required. Y P PROPIIZTY OWNER CERTIFICATION ( certify that all b of my statements on this form are true to the b (our) knowledge that I ( we) m the property described in this information form, by virtue sof o warranty deed recorded in the office of the Count Deeds as Document TIo. G -� p Y Register of oo;n the proposed site £ortll Zage disposal I (we) presently P System or I (we) obtained an easement, to run the a the constructio hove described property, n oL a P for said Y. recor system, and the s ded i same has n the been office of del No. 7 County Register of deeds as Document si ature of apFlicant CO i 2-2 Date o Signa ure Date of signature S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER ADDRESS ! 02 p If �(/� FIRE NUMBER �� CITY /STATE / (/'' C PROPERTY LOCATION: ik 1/4 , L ✓L- - l/4 , SECTION, T_�LN - / W TOWN OF St�� r , St. Croix County, SUBDIVISION I t s �r� A&LCA 4d&JP 4 i 0T NUMBER_. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)• the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I /We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED• DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 !I y o CUMENT N °' WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 49"7587 VOL r R EGIS TERS OFFICE ST. CROIX CO., VA Harold Olson and Barbara Olson, husband and wife F- orRemrd - _ .------------------------ •--- •---- - - -.._ - - - - - - -- - - - - -- ------------------------- - - - - -- ---------------------- ......................................... ---------------- - - - - -- ---- - - - - -� ------------------------------- - - - - -- APR 19 1993 • - - - -- 8:30 A, .... ......... conveys and warrants to --- Ronald. _ WQhlers __and__RQse_- WQhlex ,_-- ._____ husband.- aid._ �tifQ,--- as__ auxviv_ Qxsh3, p-- maxital._pxopertx------- - - - - -- R��l�tero�Deed,! �. ----------------- --- - - - -- ---------------- ------- - - - - -- --------------------------------------------------------- -------------- •--- - -•••- ----------- ••--- •---- - - - - -- ----------------------------------- - - - - -- I ------ - - - - -- - - -- ......... ............ RETURN TO __ __________________________________________________________________________________________________________.- the following described real estate in ...... St. Croix County, -..._..-----•--------------- State of Wisconsin: Tax Parcel No_ _______ _______ ___ _____ ________ A parcel of land located in the Northeast Quarter of the Northwest Quarter (NEi of NWT) of Section Twenty —seven (27), Township Thirty —one (31) North, Range Eighteen (18) West, described as follows: Lot 7 of Certified Survey Map filed December 3, 1992 in Volume 9 of Certified Survey Maps, page 2570, as Document No. 492435. ANTE s ab41a Uli This _______ is- _}}Qt-- ------- homestead property. (is) (is not) Exception to warranties: Dated this - -- ------ --- ---- -- -- -- -- -/ --- ----- -- ---- day of ---- - - - - -- A pril - - -- - - - - -- --------------- - - - - -- - - 19._ - ---- ----- --- ------------- - -• --- --- •- ---- - - - - -- ---- --- --- --- - --- -- (SEAL) - -- / � - - - -- --- -- --(SEAL) Harold Olson --------------------- ---- ---- ------- •-- --- - - -- - -- - - -- --------•----- (SEAL) -,1�� -------- -- •��- �- ------ -- ---- - - --- -- ---- -(SEAL) Barbara Olson AUTHENTICATION ACKNOWLEDGMENT Signatures) - _Ha.rold Olson and Barbara STATE OF WISCONSIN - -- -- -- -- ----- --- - -- - - - - - - Olson ... -----------------------•----- ss. - --- ----- - -- -- - -- --- — •-- ------- - -- -County. ed is _ �Sday of - _April_--- 1 9 93_ Personall came before me this ------------ ..day of 19- the above named * Sc t R. Needham - •--------------------- -- --- -- --------- --- - - - - - ---------------------- - - - - - -- ----- i d --------------- --------------------------------------------- TITL . MEMBER STATE BAR OF WISCONSIN (If not, ------ •----- --- -- ---- ---- - - - - -- authorized b ---------------------------------- --- -•- -- -•-------- --- --- - -• - -- -- ------- ---- -- y § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED 4�1 Rein tra,_ Van_Dyk & Needbam -- S ._C.__ - _ 201 South Knowles Avenue, BoV127 *___________ _______ __ New Rlehritond; -- W1 - - -- 54017 ---- ---- •---- ---- ----- - - - --- Notary Public -------------------------------- County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATF, PAR OF WI900NgTTT Wisconsin Legal Blank Co., Inc. , ii I I " .r I 1 en - I ? 1,056 s ff. EE.SF 21 9x8 a KIT- on o 6 �I 11,OOB,CU. ff. 1 ' Your first impression will be that the un c1 -1 plan is too long and :too narrow but •C closer study will reveal that .maximum : inch of BEDROOm LIVInG CARPORT S ace. use has been made `for every 9'•0X12 18 14 p .. Should an additional lavatory be do- CL CL sired it would only: , require • two , extra fixtures in the area :that: could also be a general storage closet: oro even• cedar •' of c•49i 48.0 141.0 lined for winter garment storage z An optional carport has been';induded ' G21•o in the blueprint "plans. ' c 711 a , e a 5 0.0 �SP�dufst C -300 1,120 iq ft BEDROOM . BEDROOM o 2 1 80 to ,2 ft. 11 10 11 CL K.IT•Din 111x 131.3 Exterior finish consists of a hip roof, asphalt sh CL les shin siding verti redw siding 1 le s d c above 9 � 9 9• 9 N on a O brick faci of the front, double CL A glazed picture window with brick planting area.. E H R L L below. In addition to three bedrooms and bath, 4 CL this plan also includes a large living room with uvinG•Dm coat closet and vestibule screen, kitchen with cab - T inets and equipment arranged to leave a generous BED .Room 20.OX13•'� _ IV•2x91.O B dining space; and 'a full basement. $ The center bedroom, connect @d to the kitchen CL v and rear entry, is ideal -for use as work or room. A towel cabinet and recessed tub features' the bathroom and a large linen cabinet is located DEr1Gn c •BO O _11hir n in the bedroom hall. poll d v {� L ♦Yf I �'� y Jggwstt,, d t Sly; , s <�