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038-1126-60-000
o ca 0 c CO) 0! ic •v 0 d v1 e CD 3 1 c CD 3 3 Pq 7 CD 7 13 Al • ` d - (D 1 3 - 3 " �a O w co to T. z n O a r cn w O • O ' CO V) c f.„ U1 O J < O- N -4 O j \ cl Z d N M a) = � O a �-`� O � CD '.�i�. r (a O CD W 3 Mp G) CD O d �• W O r ` O d 7 Q N N O d P3 N (D j 0 O 10 W 0 C CD • a' O c N ° W j p Z O r�r 3 Q w 3 °! '', j C) C � p M m C) o m t D ID N °' " V D C7 �° z ° CA 0. O �_ ..� -� W c -4 O C O co C O c O OD M O N O CCD �Q. N 0 Ca O N N N - C d CD co co K N CD X m O O 0 ( ! c W W OA Ln cn .. O z O O O n z O O O N �+ - ;r c N N f�A ° Q c y y N� m Q T e a m 0 � •0 O C h o d CD co o CD m m c" 1r O N G CD O CD N CJ mod+• N s (D 3 �_ j N �Q = 3 N 'Z N z ° Z CD 0Z cn o y T o N D ° -b w ° CD CD fD o • CD N CD fA CD p R in c m CD 5 n m w cR a w co � a CL 3 E a 3 a� z CD co z N o ',�, Z CY _ R.z0 0• d y d _ O O O O z w w CD CD (D W (D Z' Z CL 0 3 '0 3 A o " z p� 3 3 m CD N CD w w m CD Qa n (D o a CD ± °o a g o CD co O N En T 'O fU O T 7 7 O (Q O C - m F z a �o z a ° ° O CD y (n a 1 ro CD = v CD d CU CD Lino w ° 3 X CD o N a W to � Cr O a I f0 O CD � Op D CD ryG (,q O EA Q CD I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetytnd Building Division INSPECTION REPORT Sanitary Permit No: 487932 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: Leonard, Albert 4 p 77-1 V Star Prairie, Town of 038 - 1126 -60 -000 CST BM Elev: Insp. BM Ele BM Description: Section/Town /Range /Map No: ( OD .ID 1 100-0 5 WJWk,.C&"— 31.31.18.516N TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 4 0 Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION - 7 7 96.8'3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 35 1+ S-D/ to I � Dt Bottom VW Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System O cep Final Grade pop �. PUMP /SIPHON INFORMATION Me Manufac rer Demand St Cover GPM Z • �Z QO r Model Num r eus TDH Lift Friction Loss System Head TDH Ft� Force in Length ia. Dist. to Well SOIL ABSORPTION SYSTEM O Voulle- INUTRENON Width r Rg No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIM NS () SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf tur F INFORMATION Type Of ystem: i f t CHAMBER OR ri UNIT Model Nu er: L— I DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size Ix Hole Spaci g Vent to Air Intake Pip Length Dia Length is pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil T q 21 Yes M No H Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: W % . 1 1 4 2 45 , / / � Inspection #2: ` 7 " — I Location: 1887 Cty. Rd. C Somerset, WI 54025 (NW 1/4 NE 1/4 31 T31 N R18W) metes & iSignatur 31.31.18.516N 1.) Alt BM Description = ap 2.) Bldg sewer length = `p c 1 �►! _ 'T� to , " - amoun of cover C ; Plan revision Required? ❑Yes No � � Use other side for additional informati J Cert. SBD - 6710 (R.3/97) No. Date Ins Safety and B ildings Division Corm+ /� 201 W. Washington Ave., P.O. Box 7162 ? S C(ZO J In 0 ls'�OIS', Madison, 53707 — 7162 Sanit Permit Number ( be filled in by Co.) Department of Comme (60g 266 -3151 Sanitary Permit A p lica ` - std Plan I.D. Mum In accord with Comm 83Z1, Pis. Arun. C33TTROW information you provide � /V / maybe used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information — Please Print All Information ` oi- � 0 e ).. G • Gv • t� Properly Owner's Name arcel # Lot # Block # De (z V T Ff 1 / L /64te7` � 3 o vN n s Property Owner's Mailing Address Property Location _ City, State F�< p Code Phone Number sce6o 31 S t,14E2 Grp /- o i S ? �C �rz, T y / N; R Eo A W IL Type of Building (check all that apply) A l or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe use ❑City_❑Vill e VT of t j /4 t 1 IIL Type of Permit: (Check only one box on line A. Complete tine B if applicable) A. ❑ New System �( J°j RTjN=W"yft, ❑ TreatimenVHolding Tank Replacement Only ❑Other Modification to Existing System B. 11 Permit Renewal 11 Permit Revision ❑ Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner /�'1 / O" 2 P 3 '64 41 IV. Type of POWTS System: Check all that a v oLtp 0 6 9 Non - Pressurized hi-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable i1 ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Welland ❑ Pressurized In-G _ d ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Fiber U6aching Chamber Q PHp Line ❑ vei -less Pipe ❑Other ( I ' ) - 7 V. Dis ersaVrmatment Area Information: Design Flow ) Design Soil App cation Rate(gpdsf) Dispersal Area Required (st) Dispersal Area (sf) System Elevation t 7,5e) / 07 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existia8 Tacks Tanks Septic or Holding Tack / �d 1 Aerobic Treahnent Unit f Dosing Chamber / VII. Responsibility Statement- I, the undersigned, assume nslbility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign RS Number Business Phone Number "R.ZlI 22C� 7/5.7 •3cl Plumbees Address (Street, City, State, Zip Code) Coun /De arttnent Use On Approved ❑ Disapproved Sanitary Permit Fee (' lodes Groundwater Dr1o ed ing Ag Sign ps) Surcharge Fee) e () I ❑ Owner Given Reason for Denial , M ti ns of WN A pproval/Reasons for Disapproval c tank, effluent filter and dispersal cell must all be serviced / maintained /� as er mana eme r vided by plumber. t%/GC' 2. All setback requirements must be main as per applicable code /ordinances, ch temple • — the Coun only) fyr the sys on p kss than 8112 x 11 inches is AGM V" -k V ✓ Gn W , i r ' ,C 2 3 r1 SBD -6398 > .01/03 •SW W' /20nj P /PE aj SOD l a eiv V • O 38 ' / /2(0" (riO'OOU Y/f.4c -- ••....r � s s 130RWC.T 1 s R O � t3 p,2 ,Nt� 2 = 9 q • �j 6 ' 13oRtNc7 3 9 00 $c q t..-E ,3 ENGHM-4RfC I =Top OF ST. MA1tHOh. coVCA> = IOa.00 f3£Nc -H M4RK = l3oTToM OF Sr,c>/Ne - JO ! �2 5 YS i jaM �L�V. = q �Y.77 FU V� D SuRV E`rbR: A pple- 100.0 THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # f 4 _ 1 n o { d GARA[gE 3$�DR[�oM 2e ! N ��tl 4 � 7 ---y� TAN K Z� 2 1 ✓I 32' 3 ry 5(o� Ex ISr,NCT 5 .0 NO e5 , Q 1 3 v 1 / r Fovrj D. SVRVE`t'��S I' .2 P A �o L i6� �-r �2 0 G ''� 7 &&-000 F3 ♦ - gpRW� ! _ 9 '7 87 d = oD21N6T 2 ® aopuNC43 = 9 9.00 SG gLC '3 EJ1""M" -K 1 = - ToP OF 57r. MAnIHop,E CoYE)2 = /ov.00 Ip Zo, f3J5Nr-P -= 13aTTaM of S,oini¢ = j0 2 S T . F-FFUt- -N-r L vL_ = 9(o - 5 YS i F-iv1 F- LEv, = q 'S� '77 F ovN D SuRV e4 - blZ` APPic- R 1veR xP 100 • o T POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A-- /app GARAyE 3$�b>2Lb,►n yiE Zg> 0 , �_ 50 > , Cox �n�� ,. E.705r,�ci 13Asin� /pa TAN 5 32. �z 3'X. SE d, _ny tea _,".;rte 1 t5T,NCT �.{ SYSTEM 1 `L 7 ' r New b53' 13vt l V k` SV RvE�iaS 1 = p 00 Z, 9 �Y XD G G CL ���'� ULSRICHT & ASSOCIATES CO. 2812 10th Ave. - Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Primate Sewage Consultants PROJECT INDEX t PLAN ID # DATE � 5— �5 OWNER p L�-ou PHONE ADDRESS l g g 7 G� ��• C ! LEGAL DESCRIPTION l-AIUte. 576 /V i j IV 3 F.11X6 - 6- , 6 7 TOWN OF .Sf�Q� �i�j¢!'I� <'� COUNTY st- C (r CSTM TE AJAIX 2tLQ Rt'C_tt -� LOCAL AUTHORITY/ SUPERVISION Sr. C" ,.. X PROJECT DESCRIPTION: • ae �� - N i s ys 4� CC AAj ( N co ae, • 45 iK IMAI - f " 5 1 S 4d - tL LEA i.v i ,q-C7 d=ole /?011 UACuP�_ &es,ol, 9� 15 6 0Pz - CO:Z h 2 Go THIS POWT SYSTEM SHALL Rte (— 4�4�— INCORPORATE PER COMM. 83,44(2)0 A PROPER ZABEL Ulbricht & Associates FILTER MODEL # Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 Pq.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN � 0 /� a �! P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 " it 11 of it P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9•6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING T PG•7 (OPTIONAL) PUMP PERFORMANCE SPECS. ANK. The attached la p ns and specifications are based on "In-Ground Absorption Component Manual For Private Onsite Wastewater Tracttmani• Cva }Qma n (�Tarci nn 7 _ n� CRT1 - n75 U(N(11 /(11 _ 7 z Zf b � . g- o b JW I o � o L T . MO nr - t w z � C6 kA 1 CeO SS SEC IoA) ©�c TiPfti4�s" SIA) (- INS Z- 7,CA 7 -ORS U c_ Z � S w, lq-1 Sic r/40AJ cq- p�c�ry 1 SAE/ _.�,�„ -� c-,os s' s�• -�{-- , AA 4&4R U .rs7' Cep vv iuS�1 �t T /ov Iff S P C OVER: See Reverse Side for Vent/ Observation Pipe Details. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 'DO pO Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacturer ( ❑ NA DESIGN PARAM Effluent Filter Manufacturer Z [, ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ` 0 — 0 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 5 t9 gal /day Pump Manufacturer ❑ NA Soil Application Rate z Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* P treatment Unit ❑ NA Fats, Oil & ease (FOG) _ <30 mg /L ❑ and /Gravel Filter ❑ Peat Filter Biochemical Oxygen emand (BOD <_220 mg /L ❑ NA Mechanical Aeration ❑ Wetland Total Suspen d Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Othe Pretreated Effluent Quality MUSILIl average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L gin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At - Grade ❑ Mound Fecal Coliform (geometric mean) < a 1 El Drip ❑ 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: —�`y ❑ month(s) (Maximum 3 years) ❑ NA Wyear(s) Pump out contents of tanks) hen combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA n'' Z X year(s) y Clean effluent fitter S At least once ever months) ❑ NA rV y �z�y► ❑ year(s) Inspect um ❑ month(s) p p, pump controls &alarm At least once every: �i' ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) - ❑ NA 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 tankis) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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.. • w Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 -7 -7 • 3 �-� z--- I - START UP AND OPERATION L Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or other chemical: that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content; 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 tc 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 It the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: t / 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. E'1 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. ❑ 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 OXYG DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A EN. PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS UlbdCh rlvate t & A ew s age Consultants s POWTS INSTALLER POWTS MAINTAINER Name Spring Vajle Wl 54767 Name Phone S• ? � Phon SEPTAGE SERVICING OPERATOR (PUMPER) OCAL REGULATORY AUTHORITY Name '� 1 .S itll' '�G�f - f - � D Name Phone J 1 D Phone ? l 7(40 This This document was drafted in compliance with chapter Comm 83.22(2)(bJ(1)(d) &(f) and 83.54(1) (2) & (3), Wisconsin Administrative Code. QWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for ro er maintenance of this System. Re operation and periodic inspections Y Regular p p and servicing is necessary for the safe healthy operation of,this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS c (Ile 0(y_ CT y. * Governmental authority/ inspectors: 7 �cS 3 * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: Zz1.�31 * Licensed service / inspection agent other than installer: 1C7 1325V /`' ole6;fti 3 (,o -,z?,, f 3 O * Electrician, for pump, electri �rrErols, wiring units: lec 7`7W N -4- IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shove*ing, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! system can be hydrolically overloaded and destroyed. This sys�em was designed for a maximum wastewater flow of -f5,0 gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage. disposal unit, or any other unnatural sources of waste Any introduction of such waste 'materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leaka'ge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative - "cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a yl cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated Into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify tha I have inspected the septic tank presently serving the � a�� V y residence located at: 1/4, -- , 1 /4, Section , Town 3 / N, Range W, Town of PRiF%� i , 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. gP . p Y Most recent date of service 7 0 L `l ` -*I-o a S Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: D0. f gallons minutes Capacity: Construction: Prefab Concrete x Steel Other Manufacturer (if known): , Age of Tank (if known): b 2 3 R, 1 17 - o l x 7 Z� G R R I `C 4 (Licensed Plumber Signature) (Print Name) M &d&A &J2� - 3 --� —5 (Title) (License Number) MP/MPRS 2 0 � S (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) I _ Wisconsin Department SOIL EVALUATION REPORT Page — of 3 Division of Safety and 8 "' county 5? Agach complete site F aWananage not le ss than 8 12 x i 1 hx;hes in size. Plan must bxtude, but not Nrr ed fo: ve Catari3hor"�nn�t nce point (BM). direr i in and Parcel I.D. 0 30 - 112-6 60 -00-0 percent slope. scale or dimensions, north arrow. f + and dletadce ill nearest Please print all info anion Re ate i }I 11lliJiV t )' Ir/�� Personal h6orrrwtion You provide may be used for Pore � ` X5.04 (�) W Propert Owner p (Z t�. H `1' i ^C- O tJ A T2D Govt, Lot IV W 1/4 C 114 S � ` T3 Ply Oe>'s S q lot # Block # Stud. Name or �t /O87 C-FY R� , /WzP>dS 3 /3ov -v DS City State np code Phone Nwnber ❑Cry ❑ village 19 Town Nearest Road S0A4C sJ;�T W/ 5-y_oj (_76 -2K7• y ,O S -7,4rz PIZA2 I crrrea ❑ NewCoristruction Use �k Residential i Numlber of bedrooms 3 Code derived design lbw fate } *50 GPD ❑ Pubic or commerdal - Describe. Parent material t a ND Y 0 147 - W-4 SH Flood Plain elevation d applicable ft. Gerwrat corrxnerft and Area X „ Spot Tested suitable bf a conventional Inground system (P.O.W.t.S.) F � # Bones ® Pit Ground surface etev. 7 ' 7 R Depth in factor 9 in. SOi Rate Horizon Depth Dominant Collor Redwc Description Texture Stuv t" Consistence Boundary Roots GPD/fF in. Munsell Qu Sz. Cont Color Gr. Sz• Sh- '011#1 *Eff#2 �# I 0-)2- t b L R Z fi - 2 mp I f s 3 F 40 2 12, 10(9 312 2mb m-f r C5 3 v I= • b 3 --1 1vkrz 31 2. 0Q. S Q S el d / as 3 V 'I 1 1 q 4 -56 I Vyt ' /ro _ S/ C bK M-f r 0.5 2vP- (o 1.0 J5 ,a- y ` - S I 3C bK M-f a 2''F / .p (� 71.96 10 vim - ; / 3f bx mf 1 - IvF 8 F 2_1 S.V # ® Pit Grorrrd srrface elev. 1 ft. Depth to Wrrtirrg factor. 98 in. Sod Ax&Aw Rye horizon Depth DomkMtColor Redox Description Texture Structure Consistence Borridary Roots GPM in. Munsell Qu. Sz. Cont. cow Gr. Sz. Sh. *EM •EfE112 1 o -q 1vYa Yt - .Q 2 mbK r C S 3 -� �L -$ 2 9-30 I oira- 3 /2 - � iC/ 2mbK m l ai 3 -f (v 3. 30-:01 1 0Vw - '/1 5 gel p to m f S I V -55 I DY1z `'& - 2m W mf r a s Zv-f 5 -9$ L DYE ` 5; 1 2 f bK r✓1f - l ✓f g •Effluent #1 = BOD > 30 a 220 nX#L and TSS >30 < 150 mg1L • Eflluerrt #2 = BOD 1 30 mg1L and TSS 1 30 mglL CST t4arne (Please PnFIQ CST Number J e t.1 rJ-c �5993'St' A Date Evak9MW Conducted Telephone Number 2912 in'rr+ �JE SiaCLulOh 1ALIUEr W1 q -Z -05 ?15- -77 Z - 3.942- OWGUNAL For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 2812 10th Ave. Spring Valley, WI 54767 715 - 772 -3442 Property owner `/- eatV A R i> Parcel tD i! 03 pag Z. of 3 IB Pit Ground surface elev. Depth to li P m,tiny factor > 90 in: Horizon Depth Dominant Texture S Color Redox I?escri trop Soli ication Rate P ucture Consistence Boundary Roots GPDlff in. Munse11 Qu. Sz. Cont. Color � Gr. Sz. Sh. 'Ef1#i tv YR Z/ -a ' 3 1 m s 3 �» 2 m ! hi -fi as 3 g 3 8 --%b t v YR`f /(o _ SX 0 m bK /vt f r d S f 05 # t Boring II Pit Ground surface elev. -- ---__. ft. Depth to limiting factor in. Horizon Depth Dominant or Redox Description Texture Structure Sofl ication Rate in. i4turill Consistence Boundary Roots GPDlff Qu. Sz. Cont Color Gr. Sz. Sh. *Etf#1 *EO2 Banrrg # n ft-7� Boring 0 Pit Ground surface elev. ft. Depth to fimiting factor in. Horizon Depth Dominant Colcx Soil Application Rate Redox Dom_ Texture Structure CM;fstence'SoundAryl Roots GPD/tf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = B OD > 30 < 220 rrv/L and TSS > a 30 -` 150 mglL •Effluent #2 = BOD c 30 mgt and TSS < 30 mglL 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. seas�o rR.bronr i L r, v 130RtNC� 1 = q-7-87 f3 bRlntt� 3 = 9 °O Sc q V c t3�NGHM RK 1 = Top of ST. MR,vHo co ye,e = loo.00 t „ _ 2 f3 j5NGH M7} R K 2 = 13o T'rolo O F S) DI,Ver = / b ' 12 - ST. F-F --ewr L vt = 96 • - 72 S bSiEM L tl = q 4 F D S�RV E`r�Rs 100 .O 9 GA RAt3 E RC OI A tto us E y�l L� 2rj' � io• r5' L i 82 0 � - o SYSTEM I 4X b5' SU V s P o CL Oct 06 05 09:30a Dave Hracht /Jack Harrison 1- 715 -247 -4880 p.2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT :AND OWNERSHIP CERTIFICATION FORM Owner /Buyer - DD (Z L �IJ 2 7 S �1 Y7 Mailing Address a 6 C . /�- !� C/ Property Address C (Verification required from Planning & Zoning Department for new construction.) S City /State r� ! ' Parcel Identification Number J LEGAL DESCRIPTION P'-P L Si 6' Property Location /� � '/4 , ��'%' /a , Sec. , T N R 1 W, Town of s�l�fE Subdivision , "Lot # Certified Survey Map # Y �GC�J , Volume , Page # Warranty Deed # �U/ , Volume oZ - 7 7 , Page # - 3 Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic systein 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 §Comn 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 113 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATU10 OF APPLICANT(S) DATE * **Any information that is misrepresented may .result in the sanitary permit being revoked by the Planning & Zoning Department * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. I (REV- 08/05) Parcel #: 038 - 1126 -60 -000 10/07/2005 02:36 PM PAGE 1 OF 7 Alt. Parcel #: 31.31.18.516N 038 - TOWN OF STAR PRAIRIE Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner ALBERT F & DOROTHY R LEONARD O - LEONARD, ALBERT F & DOROTHY R 1887 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 0.270 Plat: N/A -NOT AVAILABLE SEC 31 T31 R1 8W PRT NW NE BEG PT ON E Block/Condo Bldg: LN HWY C, 765.1' N & 272.7 FT E OF SW COR: E 133.7', N 100', W 100.3', SLY ALG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) HWY 105.17' TO POB & STRIP E TO RIVER 31- 31N -18W Notes: Parcel History: Date Doc # Vol /Page Type 11/04/1997 567907 1274/325 WD 11/04/1997 567906 QC 07/23/1997 1102/356 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.270 58,500 162,900 221,400 NO Totals for 2005: General Property 0.270 58,500 162,900 221,400 Woodland 0.000 0 0 Totals for 2004: General Property 0.270 58,500 162,900 221,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 l i Document Number Document Title ^ ' E C 7- t i ST, r f NOV U 4 1997 9:00 Am ?n yht ^> of Dn�da Recording Area Name and Return Address o© ' re T1� r73. 2 Pastel Identification Number (FIN) �I Part of the NW 1/4 of NE 1/4 of Section 31- 31 -18, St. Croix County, Wisconsin, described as follows: Commencing on the Ely line of County i Trunk Highway "C ", 765.1 feet N and 272.7 feet E of the SW corner of said NW 1/4 of NE 1/4; thence E para ?lel to tine S line of said NW 1/4 of NE 1/4, 133.7 feet; thence North 0 degrees 28 minutes west 100 feet; thence W parallel to said S line, 100.3 feet to the Ely line of said highway; thence Sly on said Ely line 105.17 feet to the place of beginning. Also all land between the Ely line of the above parcel and the Wly shore of the Apple River and between the N and S lines of the above parcel extended Ely. TRANSFER $ 333 0 0 FE . "THIS PAGE IS PART OF THIS LEGAL DOCUMENT -DO NOT REMOVE" This information must be completed by submitter: document title. name & "rum address, and PIN (}f required). Other information such _ as age gnsbng chutes, legal description, etc. may be plated on this fins page of the document or may be placed on additional Paget of the docmonv Note: Use of this corer page adds one page to your document and $2 00 to the recording fee. Wisconsin Statutes, 59.517. WRDA 11916 I „,- t' i `:a '? <or -t ic, •s,,_ ::r �.':rtn < {c .a & � '� ir'�i•:� DOCUMENT NO. STATE BAR OF WISCONSIN THIS SPACE RESERVED FOR FORM 1 - 1982 RECORDING DATA WARRANTY DEED THIS DEED, made between Cheryl Claire Bunish, a single person, Grantor and Albert F. Leonard a d Doroth R. Leonard tiusband and w gran�ees WITNESSETH That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: See Exhibit A attached hereto RETURN TO: ChandJ4�r and Mason, Ltd. 1607 pioneer Building 33VNorth Robert Street Se. Paul, MN 55102 w! Tax Parcel No.:038- 1126 -60 -000 i This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging: And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances excey:t for easements, restrictions and rights of way of record, if and will warrant and defend the same. Dated this day of ! -f 1997. Cheryi /laire Bunish AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF authenticated this day of COUNTY OF 19 Personally came before me this * day of 1997, the TITLE: MEMBER STATE BAR OF WISCONSIN above named Cheryl Claire Bunish, a (If not, single person, to me known to be authorized by §706.06, Wis. Stats.) the person who executed the foregoing instrument and 4 ackn6 ledge the same. THIS INSTRUMENT WAS DRAFTED BY: i CHANDLER AND MASON, LTD. `{ " ` V 1607 Pioneer Building i 336 North Robert Street Brenda Pou w- St. Paul, MN 55101 Notary Public- (612) 228 - 0497 State of Wi " Public ' : Kr 1 County, My commission permanent. `It not, (Signatures may be authenticated state expiration date: or acknowledged. Both are not necessary.) * Names of Persons signing in any capacity should be typed or printed below their signature. bunieh.wd - & r i 0 3B_ C' Tao T. R PRAIRIE fr . 200 T`�O'`�d• _ N I,a coR. / fY 513 LOT 3 C 1 5141 sEC.I I °2 $ C_ ICI I .. V. I 13. PG.. 2 3 9 E 13 A VE. _ ro 150 /��(qf,us224'. / - 267. e�'Iw�� 6[ c, s 516H _ 516P , ,, 4 63 o3ssl� 3t'� ,�n� i C ci W� i5 3Zi 51 �1><h taaul 1 516 , ^�\ 334.4' 6.6' / W� 516S 16/ 26 � w s e ��la`d s.6' 71' 262.61 �i LOT I 161< 516 io 3 � I T /14 3 IE 114 / 516N 5158 (j; , 0 516E 8 i c�cc r�oo l z° ' j 516 U , I �! '"` t2 e s.6 , ti 8 d w 2 I 3 ° T �� N 9, 5 515 - a 16 B L 57G a LOT 3� S_ M /2407 516 D 8 2 26.5' %60 C-25 - .30) / NTi 2515 -3 // N T, loB vK¢ 516 A �c 516.L a• 6 / 227.9' 05 F ,a 5'16 1887. CR- C,.Somerset, { 1 W I 54025 jjKW Ave i I 4 s r_ 137.7 • AS BUILT SANITARY SYSTEM REPORT OWNER , TOWNSHIP �' P p _ SEC .3 T31N -R &W ADDRESS tvrz Stu 162 J�: ST. CROIX COUNTY, WISCONSIN. SUBDIVISION �� � P.. LOT LOT SIZE Q e �rQ, PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S. . t W I di at 1w W. S 4) Ger t" o1 /a'y� . BENCHMARK: (Permanent reference Point) Describe: l p Elevation of vertical reference point : /Q ! Slope at site: .C?N! S+L. SEPTIC TANK: Manufacturer: Liquid Capacity: Aw 0.1 Number of rings on cover f Tank manhole cover elevati n: 1004-3 Tank Inlet Elevation: 9�,�3 Tank Outlet Elevation: Q7_ PUMP CHAMBER Manufacturer: 1 k Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer 4 Number of gallons Elevation of manhole cover ; Type of warning de SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe - elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of line width length 3$ tile depth �PPAGE TRENCH: width I A length PERCOLATION RATE C. AREA REQUIRED AREA AS BUILT — INSPECTOR DATED__,1,6 /L?3! PLUMBER ON JOB r 1r _ LICENSE NUMBER Z I I , - -- -_ -_ -, * �� � ,. l ? � � °� I 21 l ( j c._ ` f "� j � I DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. 6'10X 7969 BUREAU OF PLUMBING MADISON, WI >53707 ®CONVENTIONAL ❑ALTERNATIVE rte Plan I.D. Number: ❑ Holding Tank ❑ In- Ground Pressure El Mound assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Marvin Bumish RR# 1,Box 162E, Somerset, WI 9 CST REF. BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: PT, ELEV.: NW4 NE4, Sec.31, T31N —R18W, Town of Star Prairie �,. Name of Plumber: MP /MPRSW No County: Sanitary Permit Number John P. Sykora,III I 3212 St. Croix 38526 SEPTIC TANK /HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET E� EL.: TANK OUTLET ELEV.: WAR NG LABEL LOCKIN VE , t ]Nol x /I ,� � r ,. ' P IDED: PROVID, y •I -- _' L YES ❑NO BEDDING: I VENTDIA.VENT MATL: HIGH IN ATE ROAD: PROPER V WELL BUILDI G: VENT TO FRESH / ALARM: I AIR INLET: f BEET FR ❑YES LJNO C • "!' ❑Y LJNO MEA6iEST` DOSING CHAMBER: MANUFACTURER'. rj G IN: LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER . - NING LABEL LOCKING COVER RO IDED: PROVIDED: YES ONO -ES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NV wroo�o rF PR PERTV� WELL - . BUILDING: VENT TO FRESH 1 IFFERENCE BETWEEN F NE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NIw SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGT r DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, constructiop shall FORCE ee until A � the soil is dry enough to continue.) /� 1 [ / ` r1L•N(�I CONVENTIONAL SYSTEM: /�/ J j " �+ " WIDTH: - LENGTH" NO. OF DISTR. PIPE SPACING. COVER '.INSIDE CIA .: #PITS: LIQUID I�i6, TRENCHES: MATERIAL: PI- - --'-- DEPTH: z =1 ��s J, � -w 6. GRAVEL DEPTH ]FILL PTH STR. PIPE DISTR. PIPE DISTR PIPE MATERIAL: NO DISTR NVB�. OF PROPERTY WELL: BUI ING: VENTTO FRESH BELOW PIPES COVE ELEV. INLET ELEV, END: PIPE.$, LANE AIR INLET. 14 J () EET FROM , C ? NEAREST'— �W--µr MOUND YSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE PERMANENT MARKERS BSERVATION WELLS O ] ' OYES ❑ O ❑YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL rDED SE EDE D; MULCHED CENTER. EDGES. ❑YqS ❑NO ❑YE ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: �C ■�s��y��r WIDTH. LENGTH: NO. OF LATERAL SPACING: GRAVEL DEP H BELOW PIPE. FILL DEPTH ABOVE COVER: H" TRENCHES: j > ` MANIFOLD PUMP MANIFOLD DISTR . PIPE MANIFOLD MA r ERIA L: NOY DISTR. DISTR. P E DISTRIBUTION PIPE MATERIAL &MARKING: ELEV.'. ELEV.'. DIA.. ELEV ` PfDES'. DIA.: t TION JANp "'- HOLE SIZE HOLE SPACING. DRILLED CORRECTLY /;' ETERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: OYES 1:1 NO DYES ONO NT PERMANENT MARKERS: OBSERVATION S: IM ER JrE JEW, A o L WELL: BUILDING: El YES El NO DYES El NO NEA1 U 3 c/ n ' .h System on Retain in county file for audit. se Side. SIGNATURE - -� >' TITLE: ,_.._. <.. SBD 6710 (R. 01 /82) , -- �•� ',` `., mmmonii wiscons!n APPLICATION FOR SANITARY PERMIT DILHR (PLB 67) NI C 4' A IT r OUNTY � oEpRp1TT1EnT OF UNIFORM SANITARY PERMIT # KI InO JSTRV, LRBOR 6 HumRn RELRTons — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ,rvi b IF I,&s �- I PROPERTY LOCATION 6FPfT NW 114 N 1/4, S 3/, T3), N, R E (or W TOWN OF: S 4\r P r oo ' e i OL LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ---- -- / A . /$ " TYPE OF BUILDING OR USE SERVED ) 1 or 2 Family Number of Bedrooms: ❑Public (Specify): N/A THIS PERMIT IS FOR A: ;( New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS -IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #0 Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): (Q J5 6 4 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signa ure: /MPRSW No.: Phone Number: 3Z1 Z.^ (?15')568'yNe) Plumber's Address: Name of Designer: Z 7 COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: I Fee: Date: EJ Disapproved Q ❑ Owner Given Initial ✓ (� �a� ,� Approved Adverse Determination Re son for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 f To be complete and accurate the permit application must include: 1. Property owners name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); I 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.)., location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Fu rill - S T C 100 Owner of Property ��/7e2 L 4,g1ev11✓ /Jj, te ,/' r Location of Propert N GU - ES L , Sectiol T 3 N i2 _/,p W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property &/92Le Total Size of Parcel . Da 7 a Date Parcel was Craated i9"- o Are all corners identifiable? _ Yes No Include with this application one of the following .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the bast of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 3 9i - ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an asemen H t, to run with the above described property, for the construction of said system, and the some has been duly recorded in the Office Of the County Register of Deeds, as Document No. 3S6-V'21 ), Y SIUNATuar of OWNER SIUNATURE CO.OWNER (IF APPLICABLE) ay �a9 DATE SIUNED DATE SI NED CO W j. 000TH. _ J No. 262TJ Earnest Money Contract. WHITE — Office Copy YELLOW — Buyer's Copy PINK— Seller's Copy IR[Vla[P JUtI [, 10731 t PURCHASE AGREEMENT FORM APPRV%k BY MINNESOTA ASSOCIATION OF RCJ/ LTORS 0.1 .. na''�� L foY N 10,1x' N A my.. July . ........ _..... �.............. 19.23— RECEIVED OF ... Qh.( yY l ...Q......$.U -5h...aAd- ..Ma]; Vin. .M _... B uAish......h.usband..and .wife the sum of _rif keea..Tho..us.and...aad..Nof 10A0__ ....... ............................... (S.15. ..... ) DOLLARS cash ............. .............................as earnest money and in part payment for the purchase of property= (Check. Carh or Note — State Whkb) Put the ...,$►11Q.Te...Of— the... APPl e ... Rimer . Wiscons ................... ..... ........_ _ . _ . _ _. _. situated in the County of .................. 5.t.. CrY Ol} C„ „,,,,,,,,,,,,,,,,,,,,,,,,,,,, State of �, and legally described as follows, to -wit: See Exhibit A attached hereto and made a part hereof. wi Ow shades, blinds (including venetian blinds), curtain rods, traverse rods, drapery rods, lighting fixtur I um ing fixtures, hot water tanks and heating plant (with any burners, tanks, stoke ' ipment used in connection there- with), water softener and lj uid gas tank and c perry of seller), sump pump, television antenna, inciner- ator, built -in dishwashe , ovens, cook top stoves and central air conditioning equipment, if any, used and all of which property the undersigned has this day sold to the buyer for the sum of: ..S.eventeen.. Thousan.d... Dollars .................................. .............................4 17. DOLLARS, which the buyer agrees to pay in the following manner: Earnest money herein paid = .... 1.5.,.0.0Q..O0d $...2., 00.0...0.0 iW.3MXXXXXXXXXXxxxXxX.cbcgkK 4kotwio& by Buyer executing a note to Seller in the amount of $2,000.00 with no interest, payable on demand; said note to be executed and delivered to the Seller by the Buyer and secured by a mortgage upon the above described property. Real estate taxes due in the year 1983 and installments of special assessments due in the year 1983 shall be pro rated as of the date of closing. Subject to performance by the buyer the seller agrees to execute and deliver a.. ...... I_ ..... General ......... ....... ............. ....... Warranty Deed (to be joined in by spouse, if any) conveying marketable title to said premises subject only to the following exceptions: (a) Building and zoning laws, ordinances, State and Federal regulations. (b) Restrictions relating to use or improvement of premises without effective forfeiture provision. (c) Reservation of any minerals or mineral rights to the State ofX0MXoc0w Wisconsin. (d) Utility and drainage casements which do not interfere with present improvements. (e) Rights of tenants as follows: (unless specified, not subject to ten• gqcies) None The buyer shall pay the real estate taxes due in the year 19 . 4 and any unpaid installments of special assesments payable therewith and thereafter.. Seller warrants that real estate taxes due in the year 19 ...8.4 will be ... ...... .......... _..non ................ homestead classification ( full, partial or non - homestead — state which) Seller covenants that buildings, if any, are entitely within the boundary lines of the property and agrees to remove all personal property not included herein and all ,debris from the premises prior to possession date. The seller further agrees to deliver possession not later than ..closingq .. - . provided that all conditions of this agreement have been complied with. Unless otherwise specified this sale shall be closedon or before 60 days from the date hereof. In the event this property is destroyed or substantially damaged by fire or any other cause before the closing date, this agreement shall become null and void, at the purchaser's option, and all monies paid hereunder shall be refunded to him. The buyer and seller also mutually agree that pro rata adjustments of retip, intsrest, insurance and city water, and, in the case of _ income property,. current operating expenses, shall be made as of Q.ate...o. ...0 OS1ng.._ ....... The seller shall, within a reasonable time after approval of this agreement, furnish an abstract of title, or a Registered Property Abstract certified to date to include proper searches covering bankruptcies, and State and Federal judgments and liens: The buyer shall be allowed 10 days after receipt thereof for examination of said title and the making of any objections thereto, said objections to be made in writing or deemed to be waived. If any objections are so made the seller shall be allowed 120 days to make such title marketable. Pending correction of title the payments hereunder required shall be postponed, but upon correction of title and within 10 days after written notice to the buyer, the parties shall perform this agreement according to its terms. If said title is not marketable and is not made so within 120 days from the date of written objections thereto as above provided, this agreement shall be null and void, and neither principal shall be liable for damages hereunder to the other principal. All money theretofore paid by the buyer shall be refunded. If the title to said property be found marketable or be so made within said time, and said buyer shall default in any of the agreements and continue in default for a period of 10 days, then and in that case the seller may terminate this contract and on such termination all the payments made upon this contract shall be retained by said seller and said agent, as their respective interests may appear, as liquidated damages, time being of the essence hereof. This provision shall not deprive either party of the right of enforcing the specific performance of this contract provided such contract shall not be terminated as aforesaid, and provided action to enforce such specific performance shall be commenced within six months after such right of action shall arise. It is understood and agreed that this sale is made subject to the approval by the owner of said premises in writing and that the under- signed agent is in no manner liable or responsible on account of this agreement, except to return or account for the earnest money paid under this contract. The delivery of all papers and monies shall be made at the office of: Chandler and Mason, Ltd. 1407 Pioneer Building S Pau], � 55 O1 a; tcxxXXXXX.xxxxxxxxxxxxxxXXXXXxx I,�the undent�thed, owner of the above land, do hereby approve the above agreement and the sale thereby made. I hereby agree to purchase the said property for the price and upon the terms above mentioned, and subject to all conditions herein expressed. ... ..................... (SEAL> � 1, (SEAL) Charles L. McKe"*e ........... .....,.... ................ ” """ 7r '.................... Chery C. SIX B*fiish au— (tit AnM.A '- �....:.. ( SEAL) .... ............................... ( 7 Seller , Marvin M. B lSf Beatrice M. McKenzie 19 THIS IS A LEGALLY BINDING CONTRACT. IF NOT UNDERSTOOD, SEEK COMPETENT ADVICE. DOCUMENT NO. STATE BAR OF WISCONSIN —FORM 3 VOL 660 PACL4 QUIT CLAIM DEED � THIS SPACE RESERVED FOR RECORDING DATA :tl"sGISIIRS OFFICE Charles L. 'McKenzie and Beatrice M. McKenzie, ST. Croix CO., • husband and wife, Rec'd. for Record this_ 29th quit- claims to Marvin M. BLn.ti sh and Cher„y1 C. Bunish day Of ; : July __ AD. 19 as_ tenants, and not as._tenants in common at M. the following described real estate in' y St. Croix County, State of Wisconsin: RETURN TO Chandler and Mason, Ltd. 1407 Pioneer Building St. Paul, MN 55101 1 (612) 1 228-0 497 Tax Key No. Part of the Northwest Quarter of the`Northeast Quarter (NWl /4 of NE1 /4) of Section 31 -18, described as follows: Commencing on the Easterly line',of County Trunk Highway "C ",765.1 feet North p , and 272.7 feet East of the Southwest corner of said Northwest Quarter of the Northeast Quarter (NW1 /4 of NE1 /4); thence East parallel to the South line of said 14or•thwest Quarter of the Northeast Quarter!,(NW1 /4 of NEl /4),• 133.7 feet; thence North 0'28' West 100 feet; thence West parallel to -said South line, 100.3 feet to the'Easterly line of said highway; thence Southerly on said Easterly line 105.17 feet to the place of beginning. ALSO all.,land between the Easterly line of the above parcel'and the Westerly shore of the Apple River and between the'North and South lines of the above parcel extended Easterly, The property is subject to the vendor's interest under a Contract for Deed dated June 16, 1981, with Verne D. Passage and Ruth Passage as Vendors. This not homestead property. r• (is) (is not) Q Dated this _; 7 0'� / day of — ,1983 . ' � (SEAL) (SEAL) �t cL A 22) (SEAL) (SEAL) Beatrice M. McKenzie AUTHENTICATION ACKNOWLEDGMENT rr. Signatures authenticated. this day of STATE OF �..l ` consin • 19 as. c' County. Personally came before me, this 20th day of # July ,1983 the above named Charles TITLE: MEMBER STATE BAR OF WISCONSIN L., McKenzie and Beatrice M. McKen .i P IF (It not, husband and wife authorized by $ 706.06, Wis. Stets.) This instrument was drafted by • S r ' r a nd Mason Ltd o me know�ttW ' the -*erson�L who executed the fore- Chandle a r r g instr{fine a a wledg46d the ame. - v 1407 Pioneer Building St. Paul, MN 55101 (Signatures may be authenticated or acknowledged. Both Notary Public -' • . n `F r c ix : County, Was. are not necessary.) My Commission ts. fet�ianent..• (If not, state expiration f date' Vas z Ya '1965 QUIT CLAMI Dsso -STETS ISAR of WISCONSIN. FORM NO 3-1977 STOCK NO. 13003 Prepared for and Intended for use by commercial banks in transactions y o � . , governed - O Wisconsin Lew. Wisconsin Banker's Association uQl �• ►' REAL ESTATE MORTGAGE rIZEGaS.l:S OFFICE "� (May use for (1) business purpose loan, (2) loan to an organization, (3) loan exceeding $25,000 ST, CROIX CO., WIS., or (4) loan of $25,000 or less if not governeO by the Wisconsin Consumer Act.) R {oc'd, for Rewrd this _ 1St Marvin M ski' Bunish d C eryl C Bunish usband h day ° �up' A. D. 19 and 'wife ( "Mortgagor ", `. O6 10:00 whether one or more) mortgages, conveys and warrants to Charles -McKpnzie and Beatrice M McKenzie R.aM of 9 ( „ Lender ") 1 .> In consideration of the sum of Two Thousand Doll ij2x2fiR3c Dollars ($ RETURN TO 2 00 loaned or to be loaned to Ma.f Vlri_ M. Bunish a($ .00 )I Chandler and Mason, Ltd. 6herYl C 1407 Pioneer Building Bunish ( "Borrower ", whether one or more), St: Paul, MN 55101 evidenced by Borrower's note(s)K43I6X of even date' herowi t-h ' the real estate described below, together with all privileges, hereditaments, easements and appurtenances, all rents, leases, issues and profits; all awards and payments made as a result of the exercise of the right of eminent domain, and oil existing and future improvements and fixtures (all called the "Property"). I. Description of Property. (This Property is not the homestead of Mortgagor.) Tax Key # (is) (is not) ' Part of the Northwest Quarter of the Northeast Quarter (NW1 /4 of NE1 /4) of Section 31- 31 -18, described as follows: Commencing on the Easterly line of County Trunk Highway "C ", 765.1 feet North and 272.7 feet East of the Southwest corner of said Northwest Quarter of the Northeast Quarter (NW1 /4 of NE1 /4); thence East parallel to the South line of said Northwest Quarter of the Northeast Quarter (NW1 /4 of NE1 /4), 133.7 feet; thence North 0 West 100 feet; thence West parallel to said South line, 100.3 feet to the Easterly line of said highway; thence Southerly on' said Easterly line 105.17 feet to the place of beginning. ALSO all land between the Easterly line of the above parcel and the Westerly shore of the Apple River and between the North and South l ines of the above parcel extended Easterly. la 11 checked here, description Is continued on reverse side or attached sheet. 2. Title. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordl- nances, current taxes and assessments not yet due and the vendor I s interest under a Contract for I Deed dated June 16 1981 with Verne D Passage and Ruth Passage as Vendors 3.��ta�+eaUxt�EOgst: x x 3 ages u+ eldaaores> �a�l��t���t��ox�ot ;��Z(xt��c4ktxl:�;�� (will) (will not) a. Additional Provisions. Mortgagor shall observe and comply with the Additional Provisions on the reverse side, which are incorpo- rated herein, and shall not permit an event of default to occur. The undersigned acknowledges receipt of an exact copy of this Mortgage. , Signed and Sealed thi 29th Jul day of Y , 1 SEE REV ; = (SEAL) FOR ADDITIONAL PROVISIONS AA iidiiCXE.Fi3ie3[+XDfi3C ) (SEAL) By: (SEAL) cr XiXXXXXXXXXXXXX�i�k� �' X o (SEAL) • ` Cheryl C_ R n i sh_ Vl N Attest: rn (SEAL) ( SECRETARY DR -' (SEAL) 1 3 u - MINIMI ALITHENTICATICIN OR ACKNOWLEDGMENT STATE OF WMEOM RJE S C o ) " Signatures of St. Croix t ss. � r� -u )) Personally came before me, this 29th day ;t` _ 19133 the above named Marvin M. Bunish and Chery (NAMES Or INDIVIDUALS AND THEIR SPOUSAL authenticated this day of 19 husb and and wife RELATIONSHIP If ANY OR NAME Of OFFICER AND TITLE) Title: Member State Bar of Wisconsin or t ` rtie Itnown to bathe p$r n s who executed the foregoing authorized under Sec. 706.06, Wis, Slats. )' Rte T /T nfic vRl d the same. E J ( J � , This instrument was drafted by Icy I. on nl h r' o U County, Wis. Chandl & pgagQn T trl My ,, � " °rr�llssion I1 >Ik+irps) me 'Type or print name signed above. ,• i � k r i a 8 DEFWT OF REPORT ON SOIL BORI '9 SAFETY & BUILDINGS INDUSTRY DIVISION LABOR AND' �� P.O. BOX 7969 HUMAN RELATIONS PERCOLATION (� C MADISON, WI 53707 LO CATION: • j - S� j l0 % T3/ TOWNSHAA64 WOT_ K. .: S IdV�SIO ser. t(�Q AMe-.1 Ls COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: , .`X /�'7i¢r tc.cr /` r 4 se USE RVATIONS ADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 11 New ❑Replace 1 f /—?— RATING: S= Site suitable for system U= Site unsuitable for system G ! ��, .10 CONVENTIONAL: MOUND: IN- GROUND PRESSURE: SYSTEM- IWFILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ZS ❑U S DU ❑ S ®U If Percolation Tests are NOT required DESIGN RAT If an portion of the tested area is in the /� under s.H63.09(5) "(b), indicate: Floodp i ndica t e Floodplain elevation: PR FIDE DESCRIPTIONS re BORING TOTAL DEPTH TO GROUNDWATER bide FER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH 'WC E ' NATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i , •8B/s /,a.a n /sue -�r rSBn F /S� A3/h -s B- / �.0 96, // y C- ' / �f B- 02 CJ• .C� �O.t[ 2 O. /r 9 A S �.s' , A I S/ s/, ,?. 0 8n 15 + -�.rr� 3,S By Me s, B- Y '7r�' 99.x' moue �.s� r` � B1;'s' --�, /s ..2 opt -Cc B- �J /r B- PERCOLATION TESTS TEST DEPTH' WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER fNPa•lE AFTERSWELLING INTERVAL -MIN. PERIOD PERIOD2 PER PERINCH /0 /3 j P -3 3. I' A �- 3 P- P- i . 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 t all borings nd the direction and percent �• of land slope. L e, k,Jp.)�Pr— 40,. X/ = J0 S' S �S:'6' �APr` `"'�'�`'� �60#4_ "�°'''� SYSTEM ELEVATION ....... ..e..,... .._. _...,_,_ -, _.._... _.. _ r _ e 6 _ y �d? f 5- or 1 r I R E s'Ct Q I �-_ - - R� _4__ _ i r T N I � 1 _ r 1 (711 Y, c i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pr TESTS WERE COMPLETED ON: 1.Vl`s 43 -o?1 DRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SI TURE: TION: Original and one copy to Local Authority, Property Owner and Soil Tester. -6395 (R. 02/82) — OVER — L e . � INSTRUCTIONS FOR COMPLETING FORM 116 - SBD - 6395 Try,I�e'v'cbrnPlete and acc>ar< c: soa test, your report�hr3 st inc6t te: 1. Complete; legal description; _ "he use sectionitrtust clear lVJl - 1kj Cate +etiirether this is a residence or commdtc�aj prcae' q; 1 MAXlittiflM number of bodrooms or commercial use Manned; f . Is this a n evv or repl7 Lcernent system; Coltapl<t - the s,st�abilrty rating boxes. A SITE IS SUITABLE FOR A HC b TANK ONLY IF ALL OTHER SYSTEMS AAF ( ULED OUT B;ASC-D ON SOIL CONDITIONS; 6. - PL2SE rise the a- bbi,oviatvions`shown here forvw4titig profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately 4ocating your test locations. Drawing to scale is preferred. A � sel»aMte slvfwrr3),b� , if desirei!; d. Ma! <e sure your benchmark and vstt'tical elevation Deference point are clearly shown, and are permanent; all app} ap.,zte boxz�s as to dates, names, adrlicsses, flood ptlain data, percolatio test exemp titan'; iI al:>proP1'tt3}..'; . 10. If the i (such as flood plain, elravation) does not apply, place N.A. in the appropriate box; 11. Sign the roan and place yrout current address and yot.n'.ce�t.ification number; 12, Make legil'e copvv:.: and distribun� as required. ALL SOIL TESTS MUST BE FILED WITH THE fC1RIT"f�tivt�TH[.N30 DITyS`)F"; MPLET(.Ol . a r is • ., s. - a \ � yr \l '•} .. H R VIA'TIO IS,F{39.4CF SOIL TESTERS � VA € Bata 4tas acrd, TaAlrey Syr - nbois st( - P , � ( €3vel 10`1 BFI Bedrock col; L.£ t Ne (3 - 10") SS - Sandstone lr _ Gr;svel (andes 31 LS Limestone x -- rSano HGW High t;rctt.tnc r \ a�.,e W •,. •;ViC, ..._ P Yt'La[Zionn "Rata', ■Ay 27 :g7 3. -.._ ni €'€41 "I ,"iuraj .a ` - v1' — tvo - t `a;it3 „ 1 ZI(c4 — is siCilrC1 i� G reater ! __ sandy Loatxt Less hatn Loa nn fan — Brnvvn l E € L. {:a�traa 131 EaltatF V w; G4 Loam i,a .A Y y i (e• , j is Giiw i. &a'm - A ` , - ? , Nd _ulra a .SNt' Clay Lola . mot fvloti_ >s sc, - wdy Clay " krrlth �. - -- a .Clay __ _ . #fr „{. ^ #t:`+B,-f-a"t, � z': �.. tl. ... i.17mf tw coal i�z a la, _. [ T�c;c d di s tita ^r pi ` HVV L Pl'gh vvATrA I', Sig £ ene al soil lexum' —, a, {acre .Y.atE't t. v. (ichjid V %Ste disposal BM Sr1cli Iykark V VttP __. VeTtr < -$C't L'T1C€ f 0 0 TO TIFF OWN E R: ?a,3 r?, rt;lacxrt_ is r first >t =gip ins r,l- i =,'it,r, <i sanitary pear a;t. 1he county �3 tfie [3 l artment rrta' Dec;caest 1 ``( {;ati0 .3t . ,_ sc, i � ;S'. wl the held K l iol o perm iss uance . A € o - npl. t`' sr3t of p� ans for thr' privtiA0 3 AEa f.. Iet,t dlHsl lt;.at4JJl r„us, 5e 5ubnl;tted to t['m sl( °prof3Haw local withorS`y in ordcr to ! an(; po -t£;rl pricir to tl;e star] c acy �� ST9 / s 40 Pi 40 IM IA co m tA co �- J �_; I f J'''' r _ ' K E1 M s 49 � n, Q 9 `' J kA V)