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038-1172-40-000
� o N o ° o ° ti a C C t �� w w N 1 � 45, 1 C C Hw-') d) m SO- 3 L c w H c`o H 1 o Q v 1 .p .� N,: C1 -.o O (C cn C � O w f0 7 C t 0 0 `' 3 LoLL a�i cY 4)m M= v.- m a - N aw (D `o8 a; E 0 Ns o cEo O o a)Z p p 4_ C C cLi O ; �i c m� c $Ow LL p C y LL cc N „T,c �n L - C >�L•N N 'O X N > CO H w E Q w Q wvcn 4vtw twin � I I D M 3 Cl) v I I N N C N Z Il) 'c6 w E E ,0) Z :+ O a.➢ O v o V N IM- Z d m a m 0 CL I a°i I E (7 O Z c p c °o. (ti 9 o o Q (ii H r' w c' Na. E o d v r. E ° N N N N N N •� a > O O as 1 o 0 z U z z m z N � C C14 CN � o o a 130, ca 000 U) 000 �i IL > > > 1 cr O O �\ °M' N N y °O' c ° z rn rn O .... Q m 4 O Z E °) :3 O C a Q0 V Q= Z (n N c Q n (n U _ C 0 ^ CO '� g C N lC C N N r2 a N m d ' Q LO a t N C c � L M N N C C 1�1 ap M a Iq w l6 (0 C L �' M +0 � m m • M O ., M T O N T T U (D O N T T O N (n O Z a' a' (n O Z m Uii BID p ost a � (L a � r`I�i w a �' 'c c �i C c C cc r A cia22 O (nv U) o Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574373 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Ralph, Mark H &Jenny A I Star Prairie, Town of 038-1172-40-000 CST BM Elev: Insp,BM Elev22 BM Description: , l Section/Town/Range/Map No: 166 ,3 tic- b 6 �— 29.31.18.839 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark%6 Z. Z IOZ.s 146. 3 Alt.?z- Aeration Bldg.Sewer r 1 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L� J WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. ,-7 Aeration Dist. Pipe flo, 7 q b .18 5,73 Holding Bot. System 7• Io$ ?4j 94, 74 Final Gr�d 4-3 '77 5 PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM EZ. Goae� I'`T Model tuber TDH Friction Loss ISystem Hea TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trencch-ees-� PIT DIMENSIONS No.Of Pits Inside Dia. Liquid De tp h DIMENSIONS SETBACK SYSTEM TO V P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer:�� �-/O INFORMATION Type Of System: CHAMBER OR Model Number: Coy✓er a /m 9tS /Z9 5�—a ... •c,f DISTRIBUTION SYSTEM `7 *--7 = y Pi-•a f' Header/Manifold 1 Distribution Ix Hole Size x Hole Spacing Ven to Aiir_Irytake / 'r Pipe(s) \ � �O Length -7 Dia 4 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth f xx Seeded/ odded xx Mulched Bed/Trench Center 3 7 Bed/Trench Edges Topsoil_ No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 984 198th Avenue Somerset,WI 54025(NW 1/4 NE 1/4 29 T31N R18W) Country Living Lot 8 Parcel No: 29.31.18.839 CL. 1.)Alt BM Description= 2.)Bldg sewer length -amount of cover= J Plan revision Required? [ ] Yes in o T�� L Use other side for additional informa Date Insepctor's Sign re Cert.No. SBD-6710(R.3/97) loe KNUDTSON PLUMBING& CONTRACTING,LLC 927160TH ST.648447MPRS ROBERTS,WI 54023-85 6 C 65 7 17 f r 3 Af Ufa I� f A7 IS an 1 G •ee�� /d oa�Q L 57- 1 ,(3�m 3 9d.- r O � hb�sc 4- lop- 4 s T�._ 4_., Coun -� r Safety and Buildings�ja6srol5 M- 1 �l••a ' (fl S 201 W.Washingt 7 6 Q.R& 2 Sanitary Permit Number(to a filled in by Co.) P Madison,� "-7162 t1 3_7 Sanitary Permit Application o9,0vnn(CVV%-0 teTransactionnN)um In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the a '��'�i vLrmmental unit /v is required prior to obtaining a sanitary permit. Note:Application forms for state y�S are submitted to Project Address;(if different th mailing address) the Department of Safety and Professional Servies. Personal information y rovide may be used for.Mmilary purposes in accordance with the Priv Law s.15. 1 m Slats.L A lication Information-Please Print All Information �� Property Owner's Name Parcel# /%m"-fs aL Property Owner's Mailing Address A Property Location Ly / v`e Govt.Lot City,State Zip Code Phone Number/. f /4, Section /�' ♦IQ circle o I.�L TyT of Building(check a_II that app ly) T Lot# T ,�N; R E o L9"I or 2 Family Dwelling-Number of Bedroom ^ Subdivision Name / t Block# �d C. J ❑Public/Commercial-Describe Use ►M2 ❑City of ❑State Onwned-Describe Use V2— CSM Number ❑Village of f 3 �- e.L� t�J -7 D 1j �l'awn of�S' Ill.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New System k1teplacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) �:IOIPermit Transfer to New List Prr vii Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber _7L- 3 33 Before Expiration IV.TXpe of POWTS System/Component/Device: Check all that app Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable / ❑Holding Tank ❑Other Dispersal Component(explain) El Pretreatment Device(explain) O V.Dispersal/Treatment Area Information: ✓vt Design Flow d) Design Soil Application Rate(g f) Dispersal Area Required(sf) Dispersal Area Proposed(s System levation o - © ?Y. rs VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks _/d d , c d r R 0 a` U iz rn is. C5 W Septic or Holding Tank 60 Dosing Chamber 171q I VII.Responsibility Statement-1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's MP/MPRS Number Business Phone Number'Y� Plumber's Address(Street,City,Stat Zip Code) / VM,CountvMepartment Use Only pproved Perlm�it Fee D a t e sued L.� Issuin gent Sigma tr o ven Rees r Denial $ m1 it 1 Z ,/ IX.Condit ti > Weasons for Disapproval / G1 ptid tank,efflubritflter and GX �'j v_ e—f dispersal cell must all be services/maintained i-t�•- as per management plan provided by plumber. 7• All stack Fegttirernents must be maintained C.t4 vk-%e VJc- C;LrtCL as Per applicable code%ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 81/2:11 inches in size SBD-6398(R. 11/11) 1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Ralph Replacement Sewer Owner's Name: Mark&Jenny Ralph Owner's Address: 984 198th Ave Somerset Wi. 54025 II Legal Description: NW 1/4 NE 1/4 S. 29 T 31N R 18 i Township: Star Prairie County: St. Croix Subdivision Name: Country Living Lot Number: 8 Parcel ID Number. 038-1172-40-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Ctyr Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber. Keith Knudtson License Number: 648443 Date: 09/12/2014 Phone Number (651)470-1737 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 I(NUDTS0N PLUMING CONMCTING BLLC & 927 16 TH ST.6418447MPRS ROBERTS,WI 54023-85 6 CE 65 7 17 c s er'sil�►3 B 2 �' ie 0 /6P Ay V A\ G 9'9�a cu 3 B�� a 4 s SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page of_ Project Name: AL �T No.of Cells "7 Per Cell Ly ft Cell width Total No of • T ft Cell Length sq ft EISA Per Cell ft Call Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating infV6r3tor EZ1203H-5ft 5.9 25.0 EZ1203H-10ft 10.0' 50.0 / r Gravelless Leaching Unit Manufacturer: „L YL Ez fro d Gravelless Leaching Unit Model: Typical Cross Section Finished Grade Observation Pipe with approved cap or vent .•r • r:;;::;;:;:;•;>:-;;•:':•:.::::. :':.is�:'• :':•: •:•:■ ■:.:•>:.:.:;:'>:•:':':•:•:•:;.::>:. :::.:;::; : ::::;.:■ Soil Backfill ■:• <'>: ': :• :•>:.:':.:' ........ : :•':::.;:. Geotextile Fabric r c;'.:!:<'i•i i s iC: i rCit•i........... - - ft Infiltrative Surface 12 In O I • 7 Limiting Factor -- i in Slotted and Anchored Vent/ Observation Pipe with Cap ■■rr■■r■■r■■rrrrrrrrrr�i�i■■r■■■r■rr■■■■■■■rrr■r■rrr■■a r■rrr■r■rr■rrrr■■ Plumber/Designer Signature: License#: Gc�.� Date: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner af4M 2 J1 I Septic Tank Capacity (,J�.5 gal ❑ NA v n�. Permit # 5-7 443 7 Septic Tank Manufacturer /6nol' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer zmLa,¢Q ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model �} %� ❑ NA Number of Public Facility Units )VA Pump Tank Capacity gal Estimated flow (average) 3rO al/day Pump Tank Manufacturer >01A" Design flow (peak), (Estimated x 1.5) s4!5 C) gal/day Pump Manufacturer A Soil Application Rate 0 ,-7 gal/day/ft' Pump Model Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disp al Cell(s) z ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ><NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :_10°cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size a in dia. ❑ NA Other: RNA Other: ❑ NA Other: �A *Values typical for domestic wastewater and septic tank effluent. Other: 415NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 years) ❑ NA ry� � �ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: "3 ❑ earlsl(s) (Maximum 3 years) ❑ NA ❑ onth(s) ❑ NA Clean effluent filter At least once every: ht f year(s) ❑ month(s) Inspect pump, pump controls & alarm At least once ever y' ❑ yearlsl AT-NA Flush laterals and pressure test At least once every: ❑ month❑ year(s) ) 'VA r(s) Other: At least once eve ❑ month(s) " every: ❑ year(s), "�� ° Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. Page 2 of y 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 T aluat g a o in ank be ' e ai a '�Rp}.�I E5 7T�1� �D�N/$b✓ �NSj7Ztl�TID ❑ 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 ,nV Name Phone �G r 4 17,517 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name s�', l (SUN 20& Aj Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) &(3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address)984 198th Ave Somerset wi. located at: NW 1/4, NE 1/4, Section 29 , Town 31 N, Range 18 W, Town of star Prairie , 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 SPS. 384.25, and it (they) appear(s)to be functioning properly. Most recent date of inspection or service Sept.9 2014 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer(if known): Weeks Age of Tank (if known): 9 YRS Permit mber (if kno ) 463335 Keith Knudtson (Licensed Plum er Signature) (Print Name) Plumber 648443 (Title) (License Number) MP/MPRS 09-12-14 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 2 1429 REPORT 3 IL EVALUATION R page of Wisconsin Department of Commerce SO 9 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Steel's Soil Service Inc. # � Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County St.Croix indude,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimernsions,north arrow,and location and distance to nearest road. Please;prlrt Reviewed By Date Personal inforrnabai you provide day be r� " M%,.yl aw,s.15.04(1) Property Owner Property Location Marson,Robert MA", t 4 ','00z: GoA Lot na NW 1/4 NE 114 S 29 T 31 N R 18 W Property Owners Mailing Addres4 Lot# f Block# Subd.Name or CSM# 2008100th St 8 I _na Country Living City J City _J Village 16 Town Nearest Road Somerset WI 1 54025 1 715-246-4568 Star Prairie 190Th Ave Use: Code derived design flow rate 600 GPD New Construction !6 Residential/Number of bedrooms __4 J Replacement J Public or commercial-Descnbe: Parent material outwash plains and stream terraces Flood plain elevation,if applicable no General comments and recommendations: Conventional systerm,system elevation 95.10ft.trenches spaced and depth to code 4.00ft below grade. D Boring# J Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft` in. Munsell Qu,Sz.Cont Cdrx Gr.Sz.Sh. `Eff#1 'Eff#2 1 0-14 10yr3/1 none sl 2msbk mfr cs 1f .6 1.0 2 14-32 10yr4/4 none sl 2csbk mfr gw 1 v .6 1.0 3 32-39 7.5yr4/4 none Is osg mvfr c^,S na .7 1.6 4 39-61 7.5yr4/4 none cos osg ml cs na 7 1.6 5 61-100 7.5yr4 none ms osg ml na na 7 1.6 °1S. / 9S Ff )t C41 F21 Boring# oring sm Pit Ground Surface elev. 99.10 ft. Depth to limiting factor ._ 100 in. Soil Applicetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs `Eff#1 I `Eff#2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 1 0-14 10yr3/1 none sl 2msbk mfr gw 1 f 6 1.0 2 14-38 10yr4/4 none sl 2csbk mfr gw lvf .6 1.0 3 38-48 7.5yr4/4 none Is osg mvfr gw na 7 1.6 4 48-54 7.5yr4l6 none Cos osg ml gw ne .7 1.6 5 54100 7.5yr4/6 none Cos osg ml na na 7 1.6 I1 � 9.� 3s`• � `Effluent 01=BOD5>3 D 4g/L and TSS>30<150 mg/L •Effluent#2=BODS<_30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature: CST Number David J.Steel 248856 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG,New Richmond,WI 54017 5/16/2004 715-246-5085 Property Owner Marson,Robert Parcel ID# Page 2 of 3 a Boring# J Boring l�1 Pit Ground Surface elev. 98.30 ft. Depth to limiting factor 100 in. Sol App&ation R� Horizon •Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 1 0-15 10y13/1 none I 2msbk mfr gw If .6 1.0 2 15-27 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 27-72 7.5yr4/4 none Cos osg ml Cs na .7 1.6 4 72-100 7.5yr4/6 none Cos osg ml na na .7 1.6 _ I i ❑ Boring# .J Boring _)Pit Ground Surface elev. ft. Depth to limiting factor in. Appliiorr R Horizon Depth Dominant Color Redox Description Texture Stikure Consistence Boundary Rails GROM in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `EfW1 `Eff#2 F-1 Boring# J Boring J Pit Ground Surface elev. fl. Depth to limiting factor in. Sill Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods In. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 'Eff#2 Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<_30 mg/L and TSS<_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. I Page 3 of 3 STEEL'S SOIL SERVICE INC. bavid J. Steel 1564 Cty Rd GG CST-POWTS Robert Manson New Richmond,W] 54017 Lic. #248956 NW1/4,NE1/4,S29,T31N,R18W Bus.(715)246-6200 Town of Star Prairie,St.Croix Co. Fax(715)246-9372 Country Living Lot,8 Legend 1"=40' Benchmark Ele. 100.00ft Top of 3/4"PVC Pipe •• Alt Benchmark Ele.99.95ft "fop of 3/4"PVC Pipe ❑=Borings Boring Elevations B1 =99.10ft B2=99.10ft B3=98.30ft i B4=00.00ft � ID � 77 25` .3 ' 3 Z,o I 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mark and Jenny Ralph Mailing Address 984 198th Ave Somerset Wi. Property Address (Verification required from Planning&Zoning Department for new construction.) City/State Somerset Wi. Parcel Identification Number 038-1172-40-000 LEGAL DESCRIPTION Nw NE 29 31 18 Star Prairie Property Location Y4 , '/4, Sec. , T N R W, Town of Subdivision Plat:Country Living , Lot# . Certified Survey Map# , Volume , Page# # (before 2007 Volume Page e#Warran ty Deed jq� q Spec house❑yes Ono Lot lines identifiable ElyesQno 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§SPS.383.52(1)and in Chapter 1.2-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 Safety And Professional Services 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. Uwe 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 b edtooms 3 SIGNATU 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.04/12) _� 111111111111 IIIII 1111111111111111141111111 Ilii 1111 * 8 9 6 4 2 9 3 896429 BETH PABST REGISTER OF DEEDS SPECIAL WARRANTY ST. CROIX CO., WI DEED RECEIVED FOR RECORD Document Number 05/27/2009 09:OOAM This conveyance is exempt from the transfer SPECIAL WARRANTY DEED fee pursuant to Section 77.25(2). EXEMPT t 2 REC FEE: 15.00 PAGES: 3 Mail Tax Statements To: Mark H. Ralph Jenny A.Ralph THIS DEED,made between FEDERAL HOME LOAN Recordin Are Return to: Re d Reco After ring MORTGAGE CORPORATION, GRANTOR and MARK A TCT Recording Re4 H. RALPH and JENNY A. RALPH, husband and wife, GRANTEES. aX51 36+h Ave. JVf 211 �'Yl,nnea po1)6 -7n Al -55q-2) Dated this v day of ,2009 D Q-vTjr-�' PARCEL ID NO.(PIN) 038-1172-40-000 This property is is not homestead property. THIS indenture, made between FEDERAL HOME LOAN MORTGAGE CORPORATION, with a business address of 5000 Plano Parkway, Carrollton, Texas 75010, GRANTOR, does hereby convey, sell and warrant to MARK H. RALPH and JENNY A. RALPH,husband and wife,GRANTEES,residing at for the sum of and /100($ ), the following tract of land in St. Croix County,Wisconsin: LOT EIGHT (8), PLAT OF COUNTRY LIVING IN THE TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN, TOGETHER WITH AN EASEMENT FOR INGRESS AND EGRESS AS DESCRIBED IN EASEMENT Page 1 of 3 1 of 3 RECORDED AUGUST 23, 2004, IN VOLUME 2642, OF RECORDS, PAGE 163, AS DOCUMENT NO. 772367. SAID EASEMENT WAS AMENDED AND CORRECTED BY SCRIVENER'S AFFIDAVIT, DATED, OCTOBER 10, 2007, RECORDED: OCTOBER 15,2007,DOCUMENT NO.862321. THIS CONVEYANCE IS MADE SUBJECT TO ALL RESTRICTIONS, EASEMENTS, RIGHTS OF WAY, COVENANTS AND CONDITIONS CONTAINED IN THE DEEDS FORMING THE CHAIN OF TITLE TO THIS PROPERTY. BEING THE SAME PROPERTY AS CONVEYED TO FEDERAL HOME LOAN MORTGAGE CORPORATION BY SHERIFF'S DEED DATED FEBRUARY 10, 2009 AND RECORDED MARCH 13, 2009 AS DOCUMENT NUMBER 890849 IN ST.CROIX COUNTY, WISCONSIN. PROPERTY ADDRESS: 984 198`h Avenue, Somerset, Wisconsin 54025 The legal description was obtained from a previously recorded instrument. This deed warrants title only against claims held by, through, or under the grantor, or I against encumbrances made or suffered by the grantor, and it cannot be held to warrant title generally against all persons. Grantor does.further covenant and bind itself, and its successors and assigns to warrant and forever defend the title to the property to the said Grantees against the lawful claims of all persons claiming by, through or under the Grantor, but no further or otherwise. THE Grantor hereby covenants with said Grantees that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land, hereby specially warrants the title to said land as noted herein and will defend the same against the lawful claims as stated hereinabove, and that said land is free of all encumbrances. (THIS SPACE WAS INTENTIONALLY LEFT BLANK) Signature page to follow Page 2 of 3 2of3 i IN WITNESS WHEREOF, Grantor has executed this Deed on the date set forth above. Signed, sealed and delivered in our presence: FEDERAL HOME LOAN MORTGAGE CORPORATION _ �-ylo n y ph aV� By: Printed Name Its: )J �- Print Name:�r1G Authorized Signer of'National Default REO Services, a Delawure Limited Liability Company doing business as Jtn 0 Rvi,/j First American Asset Closing Services (`•FAACS), as Printed Name Attorney in fact and/or agent. STATE OF 64'F(J rht } COUNTY OF Yh�1 } ACKNOWLEDGED AND EXECUTED BEFORE ME, on the 21 day of Ai0ri , 2009, the undersigned authority, personally appearedb-IE 41eA7&— , who is the Authorized Signer of National Default REO Services, a Delaware Limited Liability Company doing business as First American Asset Closing Services ("FAACS"), as Attorney in fact and/or agent for FEDERAL HOME LOAN MORTGAGE CORPORATION, on behalf of said corporation, with full authority to act for said corporation in this transaction, who is known to me or has shown as identification, who after being by me first duly sworn, deposes and says that he/she has the full binding legal authority to sign this deed on behalf of the aforementioned corporation. h10t, ,M1 . HMATI 0Commission# 1679458 Notary Public-California -111;iMy orange County N R L Comm.Expires Jul s,2010 y Commission xpires The preparer expresses no opinion as to the title the Grantee(s)will receive. The preparer has not had any contact with the Grantor(s)nor Grantee(s)herein. No legal advice was given to any party herein. Information contained in this instrument was provided to preparer by an agent for said Grantor and/or Grantee. No title search was performed on the subject property by this preparer. The preparer of this deed makes no representation as to: the status of the title; property use; any zoning regulations concerning described property herein conveyed;or any matter except the validity of the form of this instrument. No boundary survey was made at the time of this conveyance. PREPARER IS NOT RESPONSIBLE FOR CLOSING,the collection of taxes nor the recording of this instrument. The conveyance amount was not made available to preparer and was added after the preparation of this instrument by agent for Grantor. Drafted under the supervision of- Robert W.Silvestri,Esq. 20700 Watertown Road,Waukesha,WI 53186 By:Law's Specialty Group,Inc 235 W.Brandon Blvd,#191,Brandon,FL 33511 866-755-6300 Page 3 of 3 3 of 3 i i r RECEIPT & WAIVER OF LIEN Tf is imnnrtant that Ih.>�llnwin.r r7irortinnc hn rincr•Iv fnllnw.zrl ac nthr.nuicrz thrz rnrrzint Wll 1 AI(1T R1J i !ss Charles 8orgStrom IW !SS Olores orgstran of Wisconsin) SS ty of St Croix ) ,W mily came before me this of ocr 19—"above vaned Charles and Dolores Borgstrom to me known to e persons who executed the foregoing instrument and miedged the sane. ry Public, ,Wisoan�in J. :omission expires G-15-4s 0:) 5 LOT ----- ?UR✓EY MAP PG. 280t� 641.57' 1 -►, - T l K aF THE NE I/4, SECTION 29---, ---s 463.62' ACCESS TO LOT 8 IS FROM LOT 2 OF C-S-M. VOL. 10, PG. 2800. w y 8 V � n w 6.7 ACRES _ 291.852 SO.FT. o a2 m a I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building DivisioA + INSPECTION REPORT Sanitary Permit No: 463335 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'. Marson, Robert I Star Prairie, Town of 038 - 1172 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: &D tn , 29.31.18.839 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic L.Jeelv6 1.1 , 1 ,400 Benchmark 3 /0.� M /z Alt. BM Z, $S w Aeration Bldg. Sewer 3.53 99. (,o5 Holding St/Ht Inlet 5-11 949- 07 St/Ht Outlet TANK SETBACK INFORMATION ZEM 97, 93 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / //� , �, Dt Bottom Dosing AIA 3 Header /Man. fo 96 TIr b V ? z9 Aeration Dist. Pipe ( Holding Bot. System _171 7, 13 9!v , 05 �.fr -f- 9 4 � S. O �, PUMP /SIPHON INFORMATION Final Grade 4,0 Manufacturer Demand St Cover 2 . 56 GP Model Num TDH Lift Friction Loss System Head TDH Ft Forcemain Length la. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenched PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -5 /_ CZ\ Z t, [ SETBACK SYSTEM TO IFJ P //L BLDG V WE�LL LAKE /STREAM LEACHING Manufacturer: S INFORMATION CHAMBER OR 3 � 6. Type 5 System: � 3 I / y A)� UNIT Model Numbe i r i DISTRIBUTION SYSTEM P eacl, ZZ � Header /Manifold Distribution x Hole Size I x Hole S acing Vent to Air I ke p / Pipe(s) \ Length 1 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only a�S� Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges \ Topsoil \ � -i 3 Yes ` No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 984 198th Avenue Star Prairie, WI 54026 (NW 1/4 NE 1/4 29 T31 R1 8W) Country Living I Lot 8 Parcel No: 29.31.18.839 1.) Alt BM Description = LjG-k Tr. 0 `) k— (!�— Z c". C 17��'ev�' 2.) Bldg sewer length = U3 t_d� 0 �. - amount of cover Plan revision Required? Yes o XXG Use other side for additional information U ✓' lJ - -- Date Inse ctor's nature Cert. No. SBD -6710 (R.3/97) Safety turd Division County 201 W. Washin Box 7162 Ci' �"o / X VIsconsin Madison. Sanitary Permit Number (to be filled in by Co.) (608) 266. 3 3 3 s Department of Commerce ----®„ State Plan I.D. Number Sanitary Permit AD iC tion� >_ In accord with Comm 8321, Wis. Adm. Code, personal w4nnatwn you dtovldbi � � Address (if difTorent than ailing add ) may be used for secondary purposes Privacy Law, 015.04(1 Xm) 1. Application Information — Please Print All Information 3 _ t Parcel a Lot M Block N P Owner's Name „� / _�- Property j .. Property Location Property owner's Mailing Address / -%- ©O ]�� '/. 11 1 /4, Section City, State Zip Code Phone Number X,Z,e-, .0 C v2 S 4 T N: V!�E II. Type of Building (check all t t apply) S ' Subdivision Name ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑ PublwXommercial - Describe Use ❑City ❑Yillage_W40 ►p of - ❑ State Owned - Describe Use 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) �Z - ' DDD ' 3 A. ❑ Other Modification to Fitisting System lew System ❑ Replaopnent System ❑ Treatment/Holding Tank Replacement Only _ B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWI'S System: Check all that a pply) Non - Pressuriaod_ln- Ground ❑ Mound >_ Un it ❑Recirculating Sand Filter 11 24 in. of suitable soil ❑ Mound < 24 in. of suitable sol ❑ Grade ❑Single Pass Sand Filter ❑ Consuucted Wetland ❑ Pressurized in -Ground ❑ Holding rank ❑ Peat Filter ❑ Aerobic Tremnent Unit Recirculating Synthetic Media Filter WLeaching Chamber ❑ Drip Line ❑Gravel -less Pipe ❑Other (explain) V. Din rsal/Treatment Area Information: p (sf) System EI ton Design Flow (gpd) Design Soil Application Rate (gpdst) Dispersal Area Required (s t) Dispersal Area `� e� Manufacturer Prefab Si Steel Fiber P antic VI. Tank Info jTjanks ity in Total Number Concrete Constructed Glass ons Gallons ofunits Existing J Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - L the undersigned, assume respotWbllity for installation of the POWTS shown on the attached plans MP/MPRS Number Business Phone Number Plum 's Name (Print) � Ptum t re row , Plum 's Address (Street, City. State, Zip Cod , V -5�t �i Lill o 5 VIII. County/Department Use Ont Sanitary P it Fee (includes Groundwater Date Issued 1 sui Agent Signature o Stamps Approved ❑ D pprov Surcharge Fee) ❑l Denial 309 — M 0 Zel� s IX. Conditions Approv SYSTEM OWNER: n 1 Septic tank, effluent filter andac.wt t 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 eompkte Plant (to the County naly) for the system b paper aot {era than at/2 : l l lecher In size SBD -6398 (R 01/03) PLOT PLAN Robert marson PROJECT ADDRESS 2008 100th St Somerset Wi. 54025 NW 1/4 NE 1 /4S 29 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 c� DATE 3 -1 -05 BEDROOM 3 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 642 # of chambers 22 IL BENCHMARK V.R.P. top of 3/4 " PVC pipe ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =95.10 T -2 =95.8 qs >12 ,9 Of Bio Diffuser with _ Cove 31.1 ft ^2 per chamber 6" �I 1 >' Long 34' Elevation e B2 13' / O b pipe Z 25' 188 B3 , I 68' 95' � J Y� 25 7 1 164' st BI 25' 3 Be J House 320' PL Ga 2 - veway 200' > 500' co crr� PLOT PLAN PROJECT Robert marson ADDRESS 2008 100th st Somerset Wi. 54025 NW 1/4 NE 1/4s 29 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 3 - - 05 BEDROOM 3 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE •7 ABSORPTION AREA 642 # of chambers 22 BENCHMARK V.R.P. top of 3/4 " PVC pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =95.10 T -2 =95.8 qq� 1 > 12" q Of Bio Diffuser with Cove 31.1 ft "2 per 6„ chamber > 6' ,'P� Long 34 " Elevation B2 13' Z99 O� pipe b J 25' 188' B3 , 68' 95' \ J 25' 164' st B 1 2 3 Be House 320' PL Gar 2 6veway 200' > 500' 1429 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc. Attach ' complete complete site plan on paper not less than 8'% x 11 inches in size. ounty e. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. PleBS Reviewed By Date Personal information you provide pay s au )Privacy 1_aw, s. 15.04 ( (m)). Property Owner Property Location Marson, Robert i�A J 4 d'JC Govt. Lot na NW 1/4 NE 1/4 S 29 T 31 N R 18 W I � Property Owner's Mailing Addres4 Lot # Block # Subd. Name or CSM# 2008 100th St 8 na Country Living City - - Wi ,. -- `f City ` J Village a Town Nearest Road Somerset I WI 1 54025 715 - 246 -4568 Star Prairie 190Th Ave e New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material outwash plains and stream terraces Flood plain elevation, if applicable na General comments and recommendations: Conventional systerm, system elevation 95.1 Oft. trenches spaced and depth to code 4.00ft below grade. Boring # I Boring 11 Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10yr3/1 none sl 2msbk mfr cs 1f .6 1.0 2 14 -32 10yr4/4 none sl 2csbk mfr gw 1vf .6 1.0 3 7.5yr4/4 none Is osg mvfr cs na .7 1.6 4 39-61 7.5yr4/4 none cos osg ml cs na .7 1.6 5 61 -100 7.5yr4/6 none ms osg ml na na .7 1.6 0,t- Boring # Boring Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10yr3/1 none sl 2msbk mfr gw 1f .6 1.0 2 14 -38 10yr4/4 none sl 2csbk mfr gw 1vf .6 1.0 3 38-48 7.5yr4/4 none Is osg mvfr gw na .7 1.6 4 48 -54 7.5yr4/6 none cos osg ml gw na .7 1.6 5 54 -100 7.5yr4/6 none cos osg ml na na .7 1.6 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L KZ Effluent #2 = BOD <30 mg /L and TSS < mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 5/16/2004 715- 246 -5085 Property Owner Marson, Robert Parcel ID # Page 2 of 3 F3 ]Boring # I Boring 1/ Pit Ground Surface elev. 98.30 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon • Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -15 10yr3/1 none I 2msbk mfr gw 1f .6 1.0 2 15 -27 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 27 -72 7.5yr4/4 none cos osg ml CS na .7 1.6 4 72 -100 7.5yr4/6 none cos osg ml na na .7 1.6 F-1 Boring # Boring _;] Pit Ground Surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. 'bavid J. Steel 1564 Cty Rd GG CST -POWTS Robert Marson New Richmond,WI 54017 Lic. #248956 NW1 /4,NE1/4,S29,T31N,R18W Bus.(715) 246 -6200 715 Town of Star Prairie, St. Croix Co. Fax ( ) 246 -9372 Country Living Lot, 8 Legend I" = 40' Benchmark Ele. 10 Top of 3/4" PVC Pipe �. • Alt Benchmark Ele. 99.95ft `Top of 3/4" PVC Pipe ❑ = Borings 16 — dcl Boring Elevations B1 = 99.10ft B2 = 99.1011 B3 = 98.30ft B4 = 00.00ft 711 7; a G _ / q^ 1 of 5k, 3df f 9y 3L� ' — ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �, �6`� z ��,. ow �v► 5 - o °z5 Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number —Z I 76 — � � coo �. X39) LEGAL DESCRIPTION p.� , �r�t t)rt � %4, X v '/4 See. 'r N -R W, Town of Subdivision .� ' 4r %,/t w Lot # . Certified Survey Map # �5� .5 � , Volume Page # Warranty Deed # , �� , Volume Page # Spec house ❑ yes 0 no Lot lines identifiable & yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 mastorplumber, journeymanplumber , restrictedplumber or a licensedpumper 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 .... F ^rta, herein, ass set by the Department of Commerce and the Department of Nat"Ural Resource--, Sty: a of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of thq ee ear a p on date. �� r �� ✓ SI OF PLICANT DATE 0 /? ©s O C R ICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property des bed Dove, y virtue of a warranty deed recorded in Register of Deeds Office. / SIGMA F L DA � rr� 3 7�1 revoked b the Zo epartment. * * * * ** « «« y ,m ti t is mis- represented may result in the n tha sanitary permit being x «« 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 l POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner © z, n, GC � Septic Tank Capacity �g �-z� al ❑ NA Permit 6 3 3 Septic Tank Manufacturer / l O NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms O NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity al I M NA Estimated flow (average) co g al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) q g al/day Pump Manufacturer ONA Soil Application Rate al /da /ftz Pump Model O Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L /In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510• cfu /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 IR y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 years) ❑ NA ear(s) O month(s) O NA Clean effluent filter At least once every: y ear(s) ❑ month(s) O NA Inspect pump, pump controls & alarm At least once every: ❑ ear(s) Flush laterals and pressure test At least once every: ❑ m ❑ year(srls)) ❑ NA Other: ❑ month(s) O NA At least once every: ❑ year(s) Other: - O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to, check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding o f effluent on the round surface. The of effluent on the ground surface may indicate a failing condition and requires the p ondin 9 9 immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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) 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 conta a Plum or POWTS Maintainer to assist in manual) operating the um p the effluent pump or conta mbe Y P 9 pump controls to P 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. manE t b evalu ed to ' tify a s 'able rep a ent ar Upon du of th WTS a �) a d sit p or to ate suit le eplac ent are If n re camen ar is av ' a holdin nk as a 1 esort replace fail S. ❑ 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 I POWTS INSTALLER POWTS MAINTAINER Name r'Ol'Z. / ^ e � Name „Q r Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name rL p G' ' Name li'ro , Phone 5! 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. i r E� ;. r r c 5� _ l U 2 650P 224 773531 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., KI RECEIVED FOR RECORD This Deed, made between Wendy DeGear, a single person 09/07/2004 18:80AM Grantor, and Robert Marson WARRANTY DEED Grantee. EX9V II Grantor, for a valuable consideration, conveys and warrants to Grantee REG FEE: 11.80 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 135.08 e space is needed, please attach addendum): COPY FEE; Lot Plat of Country Living in the Town of Star Prairie, St. Croix CC FEE: Wisconsin. Together With and easement for ingress and egress PAGES : 1 as described in Easement recorded August 23, 2004 in Vol. 2642, Page 163, Document Number 772367. Recording Area i Name and Return Ad 03 &1172 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. PL Dated this of September 2004 - * - - -- - - - -- - - -- * endy DeGear AUTHENTICATION CKNOWLEDGMENT Signature(s) STATE OF ) ss. -._— -- - - - - -- - - -- - -- -- � U- �Q'� - - - -- Cl County ) authenticated this _ day of `' \C+ of ( 5 Personally came before me this N `1 soon � day September _ 2004 the above named - - - -�- - - - - -- CJ�a�e - - -� —� W endy DeGear, a single person — TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me nowMof executed the foregoing authorized by § 706.06, Wis. Stats.) ins ent e. THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Og land _ 1 Hudson, WI 54016 otary Pu - - -- 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 their signature. Information Professionals Co., Fond du I=, Wl STATE BAR OF WISCONSIN 8OD- 655 -2021 WARRANTY DEED FORM No. 2 -1999 I as Charles Borgstrom as Dolores Borgstrom of Wisconsin) SS ty of St Croix ) )rally came before me this -O day of 19` I Ibove named Charles and Dolores Borgstrom to me known to e persons who executed the foregoing instrument and )wledged the same. �� eR ry Public, , Wisconsin :omission expires - 2 - 5 - Ts • [5 L11 1 0ER i I {r--rN ZPURVEY MAP Vol . 10 PG. 2800 641.57' - NORTH LINE OF THE NE 1/4, SECTION 29 — — �• 463.62 ACCESS TO LOT 8 IS FROM LOT 2 OF C.S.M. VOL. 10, PG. 2800. p M N O D 8 (DD m —i n Lei 6.7 ACRES w 291,852 SO. FT. _ O M _ rn N N au rn L4 W a •6&W W : , n ■ ■ n 0 � 0 § J % ; 6 7 ® ■ w E C _ z o #_ e K) o , a q f @ Lo 90 /§ 2 w 0 - u 2 k : § m f � -4 § °'SDC ■ CD CO i [ (a 2' > ¢ )� o e \ C. o7 fc f 8 @ n r CO) a % § & C7 . _; V rr o o o 5: / ) §) \ [ f 7 J 2 \ C- ��f� 2 = §E0 \ $ I n @ 7 = 3 ; m a / �(D « § ■ E CL + § R T Z ) § 2 0 CL ¥ j / , 2 , e�m> o =0= \ =�wi]�$E o CD * \ CD V C& $ } / e, CL 77#Ea3EBE e # # \ &m - C a D § §)K /( \§ 2 E47EC&Z2 2 7 kc2 E14 k \�� \§4 ) �aEE a W <FE& -03 $ §�2( CD0 2CD2in 0 �]kk \ m ■ f CD % o � 77 �a 0N10 3vc1 C r `1 1 O Oa � C O 7 � A M ' # S v a o � a) CD ° w °C • 3 (D W p o N w d- o w cc d A 0_ cn zD a D C, o D Q7 CD a O D 0 w m V W C !aimI N CD Cil 0) N S o00 W � CD 00o �4 CO c ° N A CD c� r D v z 0 o a = I y 41 CD S c C 3 N I � v a 3 g (D _ 1 N c ;6 CL A G 3 I co M �z;CD a 3 z � A � o o FF z w H z m CA) CD ' I No Vi. =.4 coC.m o m a o' ID Nam v m c T '•m8 °! z a o� .;0 0 0 0 o I niD 3 m o ( (� A Q � M fD ac N (D -1 a fD °v a *3 . Up � `f N r: C a, N h f N CD CJ S EF O . a N N * 4 D) y f) 7 v VC CT 0m a� a31 R7a' o m� m 33 � y ti -. o o CL CD .vim. I:z o_ b �^ I � ov v �o I o O ° o CL ~' ti I Computer #: 038 - 1172 -40 -000 Parcel #: 29.31.18.839 Municipality: Star Prairie, Town of Address: 984 198th Avenue Star Prairie, W 1 54026 0710812003 DeGear, Wendy Jon Sonnentag She indicated that the Town wanted me to come out and look at the situation, because they can't meet the 200 ft. driveway seperation off of Nighthawk Dr. I explained that I didn't think it would help for me to come out to the site, but I will look at the history of the situation one more time and get back to her. 0712112003 DeGear, Wendy Jon Sonnentag I left a message for her that I have reviewed the history once again and that the previous letters sent by Mary Jenkins are correct. A site visit by our staff will not be of any help. Either they must extend 198th Ave. or attempt to apply for a variance to the road standards, or take access through lot 2 as it was approved. From previous conversations she indicated that they cannot get access from the West through other lots. 0911812003 DeGear, Wendy Jon Sonnentag A meeting was held at the Zoning office with Ms. DeGear, Doug Rivard, Steve Fisher, and myself. We outlined the options and gave everyone a copy. 1012912003 DeGear, Wendy Jon Sonnentag She stated that she me with Mr. Bracht, Doug Rivard, and Tom Mondor and they concluded they could go ahead, because Mr. Bracht does not intend to build a house at this point on his property. I explained that they must at least still record deed restrictions identifying that the town culdesac will be extended when the 3rd access is constructed. We will not issue a sanitary permit until 1 of the 3 options we identified are executed. 1211112003 Rivard, Doug Jon Sonnentag He received another call from Wendy and wanted to better understand what was still needed. I explained that I don't believe they recorded any documents with the Register of Deeds agreeing to the responsibilities should the 3rd access be constructed. 0212012004 DeGear, Wendy Jon Sonnentag I explained that she should title the one document as a Covenant and correct the spelling of CSM. She will also have to have the parcels numbers identified. 0512712004 DeGear, Wendy Jon Sonnentag After speaking with Roger, I sat down with Wendy and directed her to complete the following items: 1. Obtain easement rights from Bract across lot 5. 2. Obtain easement rights from Nygard across lot 1 3. If they can't work it out with Nygard then they could jog the driveway to the north slightly across the Lee property (Lot 7) if they obtain an easement from them. 0512712004 DeGear, Wendy Jon Sonnentag She came in to explain that Mr. Beavers believes that they cannot use 198th Ave. because it was reserved for future road extension. I'm not clear why it would not be possible so I will contact Mr. Beavers directly to better understand the situation. 0512712004 Beavers, Roger Jon Sonnentag I left a message for him to return my call. I talked to him later and he explained that they do not feel document 2268/453 legally granted Wendy access rights, because Borstrom did not own the land at the time. He has reserved the right to extend the road, but he cannot transfer that right. 0310812005 Unknown, Unknown Jessie Nye Easement recorded 8/23/04 document #772367 i Jessie Nye �3 IU95 wcC) ao31 From: Jon Sonnentag Sent: Wednesday, October 29, 2003 4:12 PM To: @Zoning Department Subject: Country Living - lot 8 Please check with Steve or myself before any septic permit is issued for the property (Wendy DeGear). The parcel is flagged in the database. Jon S onne ntag Zoning Technician St. Croix County Zoning Office 1101 Carmichael Rd. Hudson, WI 54016 (715) 386 -4680 Fax (715) 386 -4686 jons @co.saint - croix.wi.us <mailto :jons @co.saint - croix.wi.us> Zoning Department Web Page <http: / /www.co. saint- croix.wi.us /Departments /Zoning /default.htm> 1 I