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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
' Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
487990 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:
Pechacek, Chris I Troy, Town of 040 - 1236 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/' I 3.28.19.1193
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic a Benchmark
Dosing Alt. BM
�f "A iii Sr �e�� Z.
Aefegen Bldg. Sewer
Holding P , "f r SUHt Inlet
TANK SETBACK INFORMATION t- St/Ht Outlet
TANK TO P / WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Se t / / Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe j
IO
Holding Sot. System
Cheri
/ l
PUMP /SIPHON INFORMATION Final Grade ? AIQ
Manufacturer // /1 Demand St Cover
GK,�jI�iA !Vfc Y✓�C• / 5•
GPM �
Model Number ZC� 7 2
TDH Lift Friction Loess System Head TDH Ft
Forcemain Length Dia. il Dist. to well
ass I I
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L J BLD WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR , Z (r /G!
Ty Of System: 1 , I A UNIT Model Number:
DISTRIBUTION SYSTEM -° 1 « Z llit z• y
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) ` \
Length Dia `T Length Dia Spacing J
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil
Yes ] No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /I / /S / 6 5 Inspection #2: / /
Location: 621 Oakely Circle Hud on, WI 54016 (NW 1/4 SW 1/4 3 T28N RI 9W) Country Wood 1st Add Lot 56 Parcel No: 3.28.19.1193
1.) Alt BM Description =
2.) Bldg sewer length = /
- amount of cover =
r I .._
Plan revision Required? ] Yes No
1_ 05
Use other side for additional informa ' n. ! _ ✓ J —
Date Insepctor' Signature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division founty fit,
201 W. Washington Ave., P.O. Box 7162 St
isevnsin Madison, WI 53707 - 7162 Sanitary Permit Number (te be filled in by Co.)
Department of Commerce (608)26 I V 87VU
Sanitary Permit Appli ti State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, per 1 i ation provide
may be used for secondary purposes Priva I Project Address (if different than mailing address) K RECEIVED I. Application Information - Please Print All Wormation
Property Owner's Na me �� I `, Q Parcel N Lot X Block #
P-r "�,)'1
li'111� ; ' (AW Sew
-, Q e ll `
Property Owner's M fl ailing Address
ZONING OFFICE Property Location (p
122-1 01AKIr C y U� , ��� I � ' ) 1 i' 1
City, State Zip Code Phone Number
N1 -A, SW ',Section 3
l � ua S on 1L 1 (4 ' 7 I � 7 - 7 - 0141 ^ (circle It
II. Type of Building (check all that apply) / T °radio N; R 1r ) 6 0.
Subdivision Name CSM Number
❑ 1 or 2 Family Dwelling - Number of Bedrooms /fp
❑ Public /Commercial - Describe Use ; d c (.t - fyl Wood 2
❑ State Owned - Describe Use 605C ❑City_ ❑VillageKTownship of /fit /
III. Type of Permit: (Check only one box on line A. Co mplete lin B if app li cab le) _ Z (p - 76 - 6DO
A. ❑ New System ;K Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber
IV. Type of POWTS System: (Check all that apply) OR q -
N ❑ Mound > 24 in. of suitable soil oun tn. o suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Decion Flnw (orxl) Design Soil Applicati n Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
o5- 2l `
� �
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Filer Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing Lac D
/ Tanks Tanks �✓ I�,Q� /( 6� r
Septic /0 ID00 9 0 1 + A - A
Aerobic Treatment Unit
Dosing Chamber X
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) I PljmTtxr s Si gnature MP / "D.s: `oer- Business one Number
` c rte a
Plumber's Addre ss (Street, City, State, Zip Code)
�I t
' -0-) < IYZr IBS, I,v is SVOZ2_
VIII. County/Department Use Onl
Approved Sanitary Permit Fee (includes Groundwater Date Issued Issuing gent Signature S s)
Surcharge Fee) G
O r Denial 0 c ) �� �6 J
IX. Conditions of Approval /Reasons for Disapproval n
I CcLt e `J ' " �
SYSTEM OWNER: ( r t �-
1. `Septic tank, u tt b and
dispersal cell ll must t all be services /maintained D �t c t` !L� S87 4
as per management plan provided by plumber. J
2. All se(back requirements must be maintained
as per applicable code /ordinances. ( r r
Attach complete plans (to the County only) for the s em on paper not less than' 81/2 x 11 inches in size
SBD -6398 (R. 01/03) '
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NOV -09 -2005 16:25 From:STEINER PLUMB 715 425 881E To:3770141 P.1/1
ST. CROIX COUNTY
SG1'TIC TANK MAINTENANCE AGR FIE MENT
AN
OW1V1'RSHIP CFRTIFICATION ('ORM
q k
OWnC1' �' S
M.ailing Address
Property Address
0 ( OfrzkL e Y ei R c [ c
(Verification required from Planning Ucpurtmcnt For new Witstruction.)
City /State l7yosaa , (,t�T Pntv.el .ldentiticAtion Number
LEGAL, IDESCRIP' O
W i/, , L' /, , Scc,. T '28 — N li--� `� W Town o I a_V _
.Property Location �,^.
tr w � ,Lot #��
Subdivision
I 5� �IRT OF C�cuNncYW ,2 V o l ume 6 #
�iasT FIOO iT�oN i2ec�,a.v.o !} ume P age
Certified Survey Map #
Warranty Deed #
(0 73 7 , Volume! �� • Page #
Spec haute: yes no Lot linen idcMil inblc i .yeti na
SYS'iT MAINTENANCE i
Improper use and maintenance of y u u se eve st t hree uld rresulsonnerr�necded by liven ad pumpe+ w hat you pal into
trinmlCnnnCti consiNtu of pumping out die rep eve
Kluge in the wodlC disposal systatt•
the system can affect the iimctkrt uFt.hc septic tank as a treatment
The property o t o wner agrees to submit St.. Croix County Zoning l)cparueent a yi.g certi fication tone. signed by the owner and oft wa
by n master plumber..iotirneymtn plumber, restricted plumber or a licensed I " imp �rioc b3 in lh (�dc e tank s It�s s litt ,
n1/3 or 1
,ystom is in proper opernting Candltion and /or (2) ,filter mspeCUan :aid pump g
shidgc.
Uwe, the undersigned huvc read the above requirements and agree to maintain the private sewage disposal bystcm with the
and the standards net forth. here our se p t ic b 010
system ha s eat r C m mu be c petccl De p a rtme n t nd rc n ud o the St, Croix C:onry Zan ng
Ccrliftcutio setting t y
sec y ear
e xpiration date.
i 1�cpudmtc 'within 30 days of the Y p � n
OS
DATE
SCGNATUItE. OF AI'PLIC T
#� TlF'1C '1� S ON
ltwe c;crnty that all buttcn on this lean arc true to Ute bit. of my /our knowledge. I /we um /are the awner(s) al - the
property - cribod above, by virtu of a waminty decd recorded n Register of 13"'dr 011icc. of—
SIGNAT OI" A.PPLIC T
arlmcnl, Errs••
•r+ +.* Any information shut; is miil rcprcacntcd may result in the sanitary permit being revoked b r he Zoning Dep
11teILK19 with this upplicada» u stamped warranty deed from the Register of reeds Office and a copy of the cartirwel survey mat+ if
rc1'crencc is made in 111c warranty decd
— VOL 14411Jn(;1.125
STATE BAR OF WISCONSIN FORM 2 - 1998 FsQ771
KATHLEEN H. NALSH
noc—rit Number WARRANTY DFFD REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between James L. Krueger a married person RECEIVED FOR RECORD
Chris A. Grantor, and 07 -23 -1999 10:00 AN
chace an an ce a ec ace ,
Husband and Wite, SUT vivoi`ship Marital Property A Y DEED
EMPT CERT COPY FEE:
COPY FEE:
Grantee. TRANSFER FEE: 535.50
RECORDING FEE: 10.00
Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 1
the following described real estate in St. Croix County, State of Wisconsin
(The "Property "):
Recording Area
Name and Return Address
ATTN: Mortgage Dept.
First National Bank of River Fails
PO Box 166
River Falls, Wi s4
040- 1236 -70
Parcel Identification Number (PIN)
This is not homestead
Lot 56, Plat of Country Wood First Addition, Town of Troy, St. Croix County, Wisconsin.
i
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
Dated this day of July, 1999
* 0 Ja s L rue r
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
uliY►
_aRa P o )SS.
authenticated this_ day of publ f'
St . rah x County }
Shea= Personally came before me this - day
* of July 1 %%%hove named James L. Krueger,
a marri rson
TITLE: MEMBER STATE BAR OF WISCONSIN t me known lit the person(s) who executed the
(If not, foregoi instrument acknowledge the same.
authorized by § 706.06, Wis. Stets.)
THIS INSTRUMENT WAS DRAFTED BY * n a ou in
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 My Commission is permafT�. /Tt, expiration date:
(Signatures may be authenticated or acknowledged. Both are not / 7j / BOO
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRAWM DRF.D SCATF. RAR OF WISMNStN
FORM No. 2 -19"
INFORMATION PROFESSIONALS COMPANY FOND OU LAC, YJI 000455.2021
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N►TH LINE OF THE NWI/4OF — THE SWI /4
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORM SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity a 190 ga l ❑ NA
Permit # Septic Tank Manufacturer ; ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer Za be_ ❑ NA
Number of Bedrooms /V ❑ NA Effluent Filter Model 0 ❑ NA
Number of Public Facility Units XNA Pump Tank Capacity gal ❑ NA
Estimated flow (average) gal /day Pump Tank Manufacturer Md vect ❑ NA
Design flow (peak), (Estimated x 1.5) 6 gal /day Pump Manufacturer ❑ NA
Soil Application Rate gal/day/ft' Pump Model 14) ,ZS ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit I`NA
Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODO 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 /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: 7 LL , �/ s 11 NA
Other: ❑ NA Other: L 7 ❑ 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 3 R year(s)
Pump out contents of tank(s) When combined sludge and scum equals one - third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
C? year(s)
Clean effluent filter At least once every: Kmonth(s) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: /, , Z month(s) ❑ NA
ttss�i ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month ❑ year(s) ) firNA
Other: At least once every: ❑ month(s) ❑ NA
❑ 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 (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 <_12 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.
START UP AND OPERATION Page of
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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name 1e h • Name e/h t'r
Phone 71 5- 41,2 i/y Phone _ yy
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Q vre u K Name
Phone _ Phone E
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.
START UP AND OPERATION Page ____ of
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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
e Name e h er =Name
115- -'0 y Phone 15 - _ 2 r _ yy
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Q vre D aiin Name
Phone '�/ 'f 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.
v
/3
Performance Data
Pump Characteristics 32
Pmu /Motor Unit Submersible
Monual Models SW25M1 SW33M1 le 24
Automatic Models SW25A1 SW33A1 W 1/3 HP
x
Horsepower 1/4 1/3 s
Fall l oad Amps 8.0 10.0 i 1/4 HP
Motor Type Shaded Pole (4 pole) °
R.P.M. 1SS0 0� s
Phase 0 1
veltage 115
Hertz 60 0 0 10 20 30 40 50 60
CAP C -U.S. G.P.M.
Operation Intermittent Ifi
Temperature 120 Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
hm ktlon aass A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Disc h rge Size 1-1/2 NPT
Solids Nandh" 1/2" Dimensional Data
Unit Weight 30 lbs. 3-1/2 �- 5-7/8 1. AN Amwom in WSes
Power Cord 18/3, SJTW, 10' std. 4 -1/z 2 cm pnem 6nensions may
(20' optional) ray ±1 /81ah
1 -1/2 NPT 3. Not for conslruchmwpme
3 -1/2 DISCHARGE Wa teraM
Materials of Construction 4. °101 si ma i o e t s
approxin*
Handle Steel 3 - 1/2 s.
5. Ona*gahk
we O rmmre the 4d to
LIIIbrl bg 00 Dielectric Oil �_ make revisions to our
W&kts and their
Motor Housing Cost Iron S"Aaaom WWW ""ace
Pump -s
Casing Cast Iron
Shah Steel
Mechanical Seal Faces: Carbon /Ceramic
Shaft Seal Seal Body: Anodized Steel
Sprin Stannles Steel
Bellows: Buma -N PUMP 11 -1/8
ImPollo Therm lastic 10 -1 /8 ON 9 -1/2
U r Bowing Bronze Sleeve Bearing DISCHARGE --,
IG
Lower Bearing Single Row Bull Bearin
Strainer / Base Plastic 3 3 -112
PUMP
Fasteners Stainless Steel OFF
_Z
0
W
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z
0.
AURORA /HYDROMATIC Pumps, Inc.
1840 Berney Road, Ashland, Ohio 44805 Y
(419) 289 -3042
I
ST. CROIX COUNTY ZONING DEPA ,
AS BUILT SANITARY REPO A.
Owner ,
Address fd t
City /State to 5T 0gO1X
COUNTY
Legal Description: %',rINOF
Lot Block Subdivision/CSM #
Sec. 3 Ta$N -R-aW, Town, of Jfb =41 O -7
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer �L0 104 e ST/PC ! y W"tetback from: House Wel _ P/L
Pump manufacturer Model S a
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fr�sli air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
C4/1 c.14A V14
Type of system: +T Width Length Number of Trenches
Setback from: House S Welh/ P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark T3 0 u 10f Elevation I O<D
Description of alternate benchmark gAodwh sue, u sr' ma c? u Elevation6o f_ '
Building Sewer J ! ST/HT Inlet Cv ST Outlet PC Inlet
PC Bottom CP� Header/Manifold S�F Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System ( ) !9r( 33 ( )
Final Grade ( ) ( ) ( )
1 i n /91�Permit number State number
e
Date of insta lat o S p
r
Plumber's si u License number dy Date
Inspector
Complete plot plan
X
a
a
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATE NORTH ARROW
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Wisconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM y�
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 Z U 7 ff /
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
7A k� e r — IT" ,c
CST BM Elev.; Insp. BM Elev.: BM Description: C /-- Parcel Tax No.:
IO'D I !o ro 1pf / o � L 3 fo - —dam
TANK INFORMATION ELEVATION DATA �99�3 iI
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1Vt '� Be /,;LS &/ M - l0
Dosing �f11 1 4 - & - I N 7.
Eldin Bldg. Sewer
St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TAN O P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic Z S f NA Dt Bottom
osin PJ A NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System R�, 33
PUMP/ SIPHON INFORMATION Final Grade I Z-4 Gj�'(,7
Manufacturer h Demand c v rA vw, OL ("
Model Number 7 GPM
TDH Lift Friction System TDH Ft
Forcemain Length ! Dia. Dist.ToWell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 �s o'�- DIMENSION
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Ma � facturer: fib_
INFORMATION s CHAMBER
f r OR UNIT Mo elkum er: �'
yst m
DISTRIBUTION SYSTEM
Header / Manifold `' �t Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake i q n Length 10 Dia. 7 Length �S 1 ��� �4 r Spacing -
&r - 1 , (Z L(1 .{y`KG + lZ A
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) � ,Q bbd Le+
1 Ir01� � . Z.$ L . 1cl / W' (/•� %J (j2,1 .� (4wr C!` rCJ0_ '�66 I.t.K�1 ✓� �b
z p c. ,N� el - , lkc,.{ ik, s�rarvw �w r4l-K.W (S — 5W
�►
sion r equired? ❑Yes /_
Use other side for additional information. l� g� 7 7
SBD -6710 (R.3/97) Date Inspector's Sqlature <2 rt N
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountNrl, . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaW4rgn4yo.:
Persona i you provice may be used for secondary purposes [Privacy'Aw, S. 15.04 (1)(m)].
R UEGjWer's lyarne Village E] Town of: State Plan ID No.:
CST BM Elev.. JAM Insp. BM Elev.: BM Description: ParcelQ400.1236-70–
la 0 l 1 o +
TANK INFORMATION ELEVATION DATA A9900015
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
eptic r C Be r �. •• f ' Z 'S to1.L� O�
Dosing C'o �rI ,. N1 (
Aeration Bldg. Sewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Aenttake ROAD Dt Inlet fZ
eptic "� ZS NA Dt Bottom
osing N NA Header /Man.
I � Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade zs'�•
Manufacturer D man all
Model Number W Z GPM
TDH Lift Friction System/ TDH Ft
oss —' mead I
Force main Length ?�� Dia. fir' Dist. To Well
SOIL A TION SYSTEM
BED E
DTRENCH _, t Length 7S / No. Of trenches PIT No. Of Pits th
(; I DIM
SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Mjnu�a; t r
SETBACK CHAMBER INFORMATION Type O , / � M e Nu er:
Syste : p �� Al OR UNIT
DISTRIBUTION SYSTEM tj
Header /Manifold r � Distribution Pipe(s)/ Wit x Hole Size x Hole Spacing Vent To Air I ntake
Length �17 Dia. Length 7-<,L .Wfa. T 7T Spacing ' 2.�N Cd �Q
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, p ersons resent, etc.)
P P P Z r��' 1 {� /L 71� 1(� /
LOCATION: TROY 3.28.19,NW,SW 621 OAKLEY CIRCLE – / COUNTRYWOOD LOT 56 C611
Q W ell wok i ks 1 4.4 4-F 1 40a I I r��� �✓ /} "& b V'L
i
Plan revisigtequired. [:]Yes &No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
! r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
r�
Safety and Buildings Division
w■r■■>t SANITARY PERMIT APPLICATION Bureau of Building Water System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County p
than 8 112 x 11 inches in size. T (f
• See reverse side for instructions for completing this application state sanitary Permit Number
3; /`f_
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION �—
Pro ert caner Name Propert Location
/4 1 /4, S ��6
Propert Owner's Mailing Add
r ress Lot Numbpi Block Number
3
t , State ip de Phone Number Sub ivision Name or CSM Number ��,
t.�7 ®o t � O I CZ ) � o Er
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
❑ Village °-�-► ^ 1
Public 1 or 2 Family Dwell - No. of bedrooms Town OF ! hc� c�.1�� IQV
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 3. g1r, 9
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 New 2 ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
System _____ - __ System ___________ __ Tank Only_____ ________ Existing System ________ Existinci System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
F V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
121!q,Seepage Trench 22 ❑ In- Ground Pressure r j 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABS SY STEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
4 57a Re wired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Q� / Elevation
(� � / �G Feet �eet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name concrete Con steel glass Plastic App
New Existin structed
Tanks Tanks
S Ic an or Ing ank �Q �QO V ? S El E] ❑ 1:1 11 ift Pump Tank pi"M - t- amber S'O � [? P re ❑ F1 ❑ ❑
El
VII . SPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu ber's Name: (Print) Plum er's Signature: (N tamps) I MP /MPRSW N O.: Business Phone Number:
Plumber p ddreess Street, City State t Zip � Code): t
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent S (No Stamps)
/ 0 Surcharge Fee)
Approved [I Owner Given Initial � V �/ �rl��
Adverse Determination V /6� JJ
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
i
SBD -6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety 8 Buildings Division, Owner, Plumber
i I
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608- 266 -3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
If. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
CFO
Red Cedar Plumbing and Heatin
N4792 STATE ROAD 25 - MENOMONIE, WI 54751
eI/ �►�� PHONE 715/235 -7341
FAX 715/235 -1056
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ENGINEERING DETAILS - SW25/33
Performance Data
32
Pump Characteristics
Puns /Motor Unit Submersible
Manual Models SW25M1 SW33M1 W 24
Automatic Models SW25A1 SW33AI °a 1/3 HP
W
Horsepower 1/4 1/3 16
1/4 HP
Full Load Amps 8.0 10.0
Motor Type Shaded Pole (4 pole) °
R.P.M. 1550 $
Phase 0 1
Voltage 115
Hertz 60 0 0 10 20 30 40 50 60
CAP C TV -U.S. G.P.M.
Operation Intermittent
Temperature 120 °F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Size 1 -1/2" NPT \
Solids Handling 1/2
Dimensional Data
30 lbs. 3-1/2 �— 5-7/8 1. AN dimensions in WAM
P 18/3, S1TW,10' std. a - /2 2. Component dimensions may
very ±t /Bind+
(20' optional)
1 -1/2 NPT 3. Not for mmtruAiaipurpose
A3-1/2 DISCHARGE unless Certified
4. Dimensions and weights are
Materials of Construction awoximate
S. On/Off level adjustable
Handle Steel 6. We reserve the right to
mks revw m to our
Lubricating Oil Dielectric Oil �- products and their
Motor Housing Cast Iron speaficmtmis without n otice
s•.
Pump Casing Cast Iron
Shaft Steel
Mechanical Seal Faces: Carbon /Ceramic
Shaft Seal Seal Body: Anodized Steel I
Spring: Stainless Steel 11 -1
Bellows: Buna -N _ PUMP
ON
Impeller Thermoplastic 10 -1/8 9 -1/2
Upper Bearing Bronze Sleeve Bearing DISCHARGE
—�
Lower Bearing Sing Row Ball Bearin HEI GHT i
3 -1/2
Strainer /Base Plastic 3 PUMP
Fasteners Stainless Steel ?
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w
Z
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AURORA /HYDROMATIC Pumps, Inc.
1840 Baney Road, Ashland, Ohio 44805 Y
(419) 289 -3042
l
SEPTIC TANK PUMP C DUR CROSS SECTION AN
U SPEC q ICATIO k4
NS 1
4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF
? 25' FROM DOOR, WINDOW OR
JUNCT BOX APPROVED
FRESH AIR INTAKE
�- --WITH CQNDrI?T MANHOLE COV
FINISHED GRADE '� \ �i i= AiDLOCK
4" CI RISER i �WARNING LAB
y ' 4" MIN.
18" .1IN. E" MAX.
x NIT, >rT
WAT TIGHT SEALS GAS-
�� TIGHTS `
A SEAT, vAPPROVED
APPROVED --�- ALM JQINTS WITH
PIPE 3' B APPROVED PIPE
ONTO SOLID t - ON 3' ONTO
SOIL ! C � � SOLID SOIL
PUMP OFF ELEV , FT. --- OFF RISER EX
D PERMITTED 0
IF TANK
! MANUFACTURE;
HAS APPROVA
3" APPROVED BEDDING UNDER TANK (J ki lr4
CONCRETE PAD
SP ECIF I CATICNS
SEP'I'iC f JOSL
TANK MANJFAC TUBER : i NU`iBF,R DOSES PER DAY:
TANK SIZES SEPTIC GAL, DOSE VOLUME INC,UDING
DOS GAS,. FLOWAACK:
ALARM MANUFACTURER: - < ( CAPACITIES: A 0SINCHES = S Or7�AI
MODEL NUMBER:
SWITCH TYPE: - .��,� J10 B - 2 INCHES = _ 39 GAI
PUMP MANUFACTURER: j ,� � -' C - ' INCHES
,
MODEL NUMBER:
- � I�9 RAJ
SWITCH TYPE:
.yV�L�Ccrtf u2 D INCHES = �O GAI
-..
REQUIRED DISCHARGE RATE P5 GPM PUMP ALARM WIRING AS PER ILHR 16.23 w
VERTICAL DIrFERrNCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE .FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .�!'EET
+ FEET F ORCEMAIN X /. / rT/ 10 0 � FT. � FRICTION FACTOR . FEET
.%OTAL DYNAMIC HEAD - FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH
H ( g ; W D DTAMETER
LIQUID �� - --
SSGNED: LICENSE NUMBER: vo p c) 42 DATE: /
1/88
WiscoMin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or . PARCEL I.D. 0
dimensioned, north arrow, and location and distance to nearest road. pendin
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Richard Stout GOVT. LOT ; Nw_ 1/4 SW 1/4,S 3 T 28 -' N,R 19 for) W
PROPERTY OWNERS MAILING ADDRESS LOT I BLOCK # SUBD. NAME OR CS M # `
1353 Awatukee Trl. 56 na, .W06&/
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 99OWN NEAREST ROAD
Hudson, WI. 54016 1715) 549 -6731 1 Troy Tower Rd.
[ New Construction Use be J Residential / Number of bedrooms [ J Addition to existing building
[
Replacement Re Public or commercial describe
it p ]
Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /0 .6 trench, gpd /ft
Absorption area required 900 bed, ft 2 750 trench, ft 2 Maximum design loading rate .5 bed, gpd /ft •6 trench, gpd /ft
Recommended infiltration surface elevation(s) 94.39 ft (as referred to site plan benchmark)
Additional design / site considerations alt site system el. = 93.56'
Parent material pitted outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ES ❑U ES ❑U I ES ❑U ®S ❑U ®S ❑U El KIU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrt h
}x 1
1 -14 10 r2 2 none 1 2msbk mfr cs if .5 .6
2 14 -29 10 r4/4 no sicl lfsbk mfr crw if .2 .3
Ground 3 9 -80 7.5 r4 6 none Ifs osq mfr na na .5 .6
elev.
96 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 -12 10 r2 2 none 1 2msbk rnfr cs if .5 .6
4\?
2 2 -24 10 r4/4 none sl 2csbk mvfr CrW if .5 .6
Ground 3 4 -90 7.5yr4/6 none fs osq mfr na na .5 .6
elev.
95 ft.
Depth to
limiting
factor
+90"
Remarks:
CST Name Print Phone:
Gary L. Steel 715 - 246 -6200
Address: 554 200th. Ave., New Richmond, WI. 54017 m02298
Signature: Date: CST Number:
4 -19 -96
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2, .of 3 ' .
PARCEL I.D. # pending Lot #56
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
' 3 1 0 -10 10 r2 2 none
``'` 2 10 -29 10 r4/4 none sicl lfsbk mfr C1w if
Ground 3 29 -84 7.5 r4 6 none 1
elev.
97.3 ft.
Depth to
limiting
factor
+8411
Remarks:
Boring #
1 0 -15 1 r2 2 none 1 2
" 4 2 15 -32 10yr4 /4 none sicl lfsbk mfr C1w if .2 .3
Ground 3 32 -90 7.5 r4 6 none lfs osa mfr na n
elev.
9 8.56 ft.
Depth to
limiting a
factor
Remarks:
Boring #
1 1 0-9 10 r2/2 none 1 2msbk mfr cs if .5 .6
ry `
€;,.......<::;< 2 1 9-18 10 r4/4 none sil lfsbk mfr Qw if .2 .3
Ground 3 18 -28 7.5 r4 6 none sl 2csbk mfr aw na .5 .6
elev.
9 7.99 ft. 4 28 -80 7.5 r4 6 none lfs osa mfr na na .5 :.6
Depth to ,
limiting �� 7
factor
+80
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 Nw4sW4 S3- T28N -R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246 -6200
f lot #56- country Wood
N
1 = 40 '
BM.= top of SE lot stake @ el. 100'
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G N
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nn
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Gary L. Steel
4 -19 -96
I
From: Jennifer Krueger To: Kevin Lannon Date: 1/14/99 Time: 10:01:38 AM Page 1 of i
1
ST CROIX CUUf fff
SSMC TANK MAWrBNANCE AGREEMENT
AND i
OWN6)tSHIP CERTMCATION FORM j
Owner/Buyer
Mailing Address 9 c \ C. tr—. �.. C : f ,► r �2 �d [[ ..? - i
Property Address • �
(Verification required ttom Planning Departnreat for new xtion) .,....� i
City /State Parcel Identifieati(al Number &cf o - f 2 — " 6 — O -o o
LEGAL ONSCRI[ �
V
Pt�opctty Lorsatitxi� W y,, y SM T:21)�RaW, Town of - %t 0 1
�.,. 1
Subdivision C� �t �,t t•J.a �l �.lr? t f: r� Lc t # (�,,t I
1 7., t V&r; ^'o' % Lo-f-j-& Plate o4 '(e...��
Certified Survey Map # . Volume . page # _ r
Warranty Deed # . volume
$pee house* yea O two Lot )rocs identifiable Q Yes D no ;
mYS'1<'EM M&BURNM
Improperuseandmaimcnaneeofyours optic :ystem could =wit in its prematura4iluretdhandle Wastes.pnoperrr_ -
consists 04=0319 out the septic tank every ibree years or sooner, itmatkd by a iteensed putow. W! tat you put into the systwrt
can affect the hnotion of •` - - —^ hwlr u a treaftent stage in tine rVaste disposal system.
The pt*pesty owner agrees to submit to SL Croix Zoning Department a caditcation form, sig. and by the owner and by a
roaster plumber, joatneyauta plumber, mttic:Wpluntber or a licvwedpwwwverify tg that(1) the on -site arsstewaterdispossl system
rating condition and/or (2) atkr inspection sod r•. --;ha (if o ,-rq-o<grvl. the static tank is '.yss than 1/3 full of sludge.
Nov. the uodasiVwd Mve read the above requirements and agree to waietain the private sawsso disposs ! system with the standards
sot tocui, .,aelu as set by the Departmentof Comurerce and The Department of Natuml Resources. State ►f Witaoesin. Certification
stating that your septic systan has brier mainalacd must be camplcsad sad Beau red to die St. Croix Cow ty Zoning Offaae within 30
s: expiration date.
a -WANT JDATe �
OWNLR CE tIRMATIU
I (we) =rbf a y that all statmusa on this form are tract to the best of mq fora) kaowladge. I (a e) am (arc) th 00 wzar(e of
the p above, by visue of a warmty dead recorded in Register of Deeds Offtee.
C !ZY1
SU ?!jtgURb r p ICA.N•t: � DATE �
•fele+ Any information that is ink-npcsaedwel tnsy result in the sartlfirrypemt(t being =Y0kC4 by the Zonias Depsrtmt..
,uQuuc xtsu ua. _, r ...,,, ..... "ampou rvarraucy dood from"RSSi U of Deeds Otfwc
a copy of the cediflcd survey asap ttrtfamme i$ made in the warranty dead
Te - d Snell n£Z nTZ 7tVI8W�11�1d 21vu�� u�
VOL 139 .5 PACE 107
STATE BAR OF WISCONSIN FORM 2 — 1982 59;5G5S
KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
DOCUMENT NO. ST. CROIX CO., WI
RECEIVED FOR RECORD
RICHARD 0. STOUT 01 -13 -1999 10:50 AM
WARRANTY DEED
EXEMPT N
CERT COPY FEE:
conveys and warrants to JAMBS I,. KRUE �ER A MARRTF.n COPY FEE A•O
TRANSFER FEE: 107.70
PERSON RECORDING FEE: Io•oo
PAGES: 1
THIS SPACE RESERVED FOR RECORDING DATA
St. CroIx NAME AND RETURN ADDRESS
the following described real estate in County,
State of Wisconsin:
EAGLE VALLEY BANK, N.A.
Lot 56, Plat of Country Wood First Addition, 1301 Coulee Rd., Unit
Town of Troy, St. Croix County, Wi Hudson, WI 54016
140- 1236 -70 -000
PARCEL IDENTIFICATION NUMBER
This is not homestead property.
(is) (is not)
Exception to warranties: easements , restrictions , rights -of -way and covenants
of record.
Dated this I -1 t h day of Janua A.D., 19 99._
Richa-rd 0- , tout (SEAL) (SEAL)
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
St. Croix
County
authenticated this day of 19 Personally came before the this day of
.T ;; n tin r y 19 the above named
_Rir ar Stout _
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, t , 1
authorized by §706.06, Wis. Stars.) Bre�a� O;:' me known to be the person who executed the foregoing
taYy T ,, d acknowl ge the same.
THIS INSTRUMENT WAS DRAFTED BY r1Q 1ST'
Janet P. Stout State e
1355 Awatakee Ti. lIe4 / lg t
Hudson, Wi . 54016 Notary ublic, - C p ot County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, tate exjAration date:
necessary.)
Names of persons signing in any capacity should by typed or printed below their signatures.
WARRANTY DEED STATE EAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
Form No. 2 — 1982 Milwaukee, Wis.
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