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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 488063 0
ATTACH TO PERMIT)
GENERAL INFORMATION ( State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /;? Ct`- /!: ] . , `1 %•'' 1
Permit Holder's Name: City Village X Township Parcel Tax No:
Livermore, Kirk Warren, Town of 042 - 1031 -10 -500
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
Z)/, 6 S Ne, -) gA\ SE 66t& . P,'^_ 12.29.18.177A50
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
I
Septic Benchmark ti
i t .`1 3.6 lo9.
Dosing Alt. BM
Aeration ; Bldg. Sewer
'd.; •1 S. b5 �d7
Holding St/ Ht Inlet
L
TANK SETBACK INFORMATION 77R
et
lANKIU P/L WELL BLDG. Vent o it IntaKe ROAD Dt I
ep Ic + / Dt Bottom ,
osing F 755050175
A eration Dist. Pipe ,tom-
A. - z
A
o mg o . system (�
F Rial Grade
PUMP /SIPHON INFORMATION ,... }':�� f_
anu ac urer Deman ove r, ) ,/
GPM +.•.�' " { °. ;� T•S' /pS' t -,
model um er t
C owdou 5.7� ND3.0
I F riction L055 � Y s em r1ea
i
1� - orcem a l n IL en , 151. 10 vVell [
SOIL ABSORF TI(JN SYSTEM
jLeflyul 01 L49MI66 Prru11v1r_N51v1m3 190. 01 PIL I wid. 4 U.13�epin
C _ _
-OKE NSIONS ? f
INFORMATION CHAMBER R
UNIT
Length .' 171 Dia f + `` Length T t jDia' Spacing j • ` fS
x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes FJ No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / / o(C Inspection #2':11 y f
C'L\• -
Location: 1088 150th Street Roberts, WI 54023 (NE 1/4 NE 1/4 12 T29N R1 1W NA L 5 Parcel No. 12.29.18.177A50
1 Alt BM Description=
2.) Bldg sewer length = i t ,' Gl � out r� qO+
z
- amount of cover =
` — - - - -- -- — — --1 �L /
Plan revision Required? Yes , No
Use other side for additional information. -
SBD- 6710(R.3/97) - 71 1 g JO(.0 (j$,3 #L 75
1
Safe ty S
and Buildings D' ' 'on County
201 W. Washington Ave., P
x7
gto a
In
■ C!AOnsin Madison, WI 53707 - Permit Num (to be filled in by Co.)
Dep artment of Commerce q 8 p ro(03
Sanitary Permit Appli ation �'°" � l
' In accord with Comm 83.21, Wis. Adm. Code, personal ation' d 1d f l (� 1 2 O 0 1 0
= TR,t1 n15 • 1
/
maybe used for secondary purposes Privacy Law, 15.0;; rn j Prgeot Address (if different than mailing address)
L Application Information - Please Print All Information S
zo F5
/sa Sr. a6�2,4,
Owner's Name Parcel # Block # Lot #
Property rj.
Property Owner's Mailing Address Property Location
a 9 rr! S 1Y %, CVs Section �.
� City, State Zip Code Phone Number
wrote o) y]
T21N. �o4 ! / hq
II of Building (check all that apply) 1 rt d S CSM
N 1 or 2 Family Dwelling - Number of Bedrooms 'P q
❑ Publio/Commercial - Describe Use S t1A.r- •
❑ State Owned - Describe use `�t • eity_. a ow°ahip of 'Cit '✓
IIL Type of Permit: (Check ody one box on line A. Coihplete line B if applicable) 0 _ / — C) —
A New System ❑ 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 Owner
IV. Type of POWTS stem: Check all that a 1
❑ Non Pressurized In- Ground Mound > 24 in of suitable s ❑ Mound <24 in. of suitable soil ❑ At Grado ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized ln- Ground ❑ Holding Tank [] Peat Filter ❑ Aerobio Treatment Unit ❑ Rooirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: .
Design Flow W4 Design Soil Application RatcWdsf} Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
o /03. Z ee.) r0o t
VL Tank Info Capacity in Total Number Mmmfacturer Prefab Site Steel I Fiber Plastic
Gallons Gallons of Units 4s * � - Concrete Constructed Glass Now li..:g
Tedcs Tadu
Septic O60 — /0a 0 / L✓ /ESE�t �o.JG misl ✓
Aerobic Treatment Unk
Dosing Chamber 6a `�� / �� i� ✓
VIL Responsibility Statement- I, the undersigneA assume responsibility for InstaHadon of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber7
WINO A6 Number Business Phone Number
s
EaQ G °E�x�
Plumber's Address (Strut, City, State, Zip Code)
L.? X? r. o?S !� u2.o.✓v �✓� y7�G
VIIL Coun /De artment Use Onl
X Approved ❑ ved Sanitary Permit Fee (ir#udes Groundwater Date Issued Issuing Agent Signature 04D Stamps)
❑ vex Denial Surcharge Fee) sso t
IX. conditions pro 31 D ►�l�s C S? `1 � �
SYSTEM OWNER: / C
1 Septic tank, effluent filter and tam �5; � Niue Zon (a tee
dispersal cell must all b2 §erviced I met
intain�� ,
as per management plan provided by plumb, n
2. All setback requirements must be maintained U,,L`Q,l P-Q S, So � 1a' 2d3�
as per applicable code /ordinances. - � tl I N�
1
Attack complete (to the County cal the System on paper act less than 81/2 s 11 imcbes In mdse
P P� Y p
N � c..,aswr fad-- P.�. = 9� •t-4�
SBD -6398 OL 01/03) S ca"""r its P`^` = 10 l• 0'r r
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Safety and Buildings
EE
commerce.Wl.gov LA CROSSE WI 5460$ D
TDD #: (608) 264 -8777
isconsin www.wisconsin.gov
sin.go
iscosin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
December 02, 2005
CUST ID No. 3412 ATTN.• POWTS Inspector
HERB J PELKE ZONING OFFICE
PELKE PLUMBING ST CROIX COUNTY SPIA
N6298 STATE HWY 25 1101 CARMICHAEL RD
DURAND WI 54736 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 12/02/2007 Identification Numbers
Transaction ID No. 1220010
SITE: Site ID No. 707986
Kirk Livermore Please refer to both identification numbers,
150th Street L above, in all correspondence with the agency,
Town of Warren
St Croix County
NE 1/4, NE 1/4, S12, T29N, R18W
Lot: D
FOR:
Description: Proposed Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1054031
Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/0 1), Pressure Distribution Component Manual - Version
2.0, SBD- 10706 -P (N.01 /01); Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the approved plans, and the "Mound Component
Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.O1 /01).
• The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the
sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS
(01/81)".
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil
compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site durin
construction and open to inspection by authorized representatives of the De artment de local
inspectors. Conditionally
APP ROVED
DEPARTM OF COMMERCE
r
HERB J PELKE Page 2 12/2/2005
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely,
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633
jswirn@cornmerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Private On -Site Wastewater Treatment System (POWTS)
Index and Title Sheet
Owner:
Project Name and System Type: 4-11" /Vd
Location: JSa �~ .Sr
Street Address
A/-- - ,t/1C /W -77,d4 1841 La r D
Legal Description
Township /County
Contents: Page 1:
Page 2: G't o r
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Page 4:
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C.3 Page 8'
•
Page 9:
IDWO
Attachments: ".4 ,- NpENCE
SEE GG
Plumber r: Z" Signed:
Credential Number: Date:
N
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SEPTIC TANK !i'PUMP CHAMBER CROSS SECTIOW AND SPECIFICATIONS
4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF
?' /0' FROM DOOR, WINDOW OR JUNCTION $OX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS
W/ PADLOCK 8
F /vlxwero WARNING LABEL
y i �oEtow �,�.c� 4 " MIN .
18" IN.
INLET
I'
'
WATER TIGHT SEALS GAS-
Zoe TIGHTi i
Ali. rix A SEAL 1. i )APPROVED
JOINTS WITH
APPROVED A /oo i ALM APPROVED PIPE
PIPE 3' r4 B 3' ONTO
ONTO SOLID c • ON SOLID SOIL
SOIL' PUMP OFF ELEV . 95.0 FT. --- I '4* RISER EXIT
OFF
• PERMITTED ONLY
D
IF TANK
MANUFACTURER
HAS APPROVAL
3 APPROVED BEDDING UNDER TANK
CONCRETE .PAD
SPECIFICATIONS
SEPTIC./ DOSE
TANK MANUFACTURER: /1� Zucar NUMBER DOSES PER DAY: S.1 & fP..�
TANK SIZES SEPTIC 1 06o GAL. DOSE VOLUME INCLUDING 89.1 f33=
DOSE ego FLOWBACK: 9A y GAL.
ALARM MANUFACTURER: .S,J. E y°� �s CAPACITIES; A = ,? / INCHES = 257.8 AL.
MODEL NUMBER:
SWITCH TYPE: zl61jc4 B = _2 INCHES = �.� G GAL.
P62dP MANUFACTURER /D'YD/loN.4rie- c = S. s* INCHES = y,?, y GAL.
MODEL NUMBER: - � —
SWITCH TYPE: ryoilcu2�
D.= INCHES = _ l.?G GAL,
REQUIRED DISCHARGE RATE , GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC
,, VERTICAL 'DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /d. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE J. 3 FEET
+ M I FEET FORCEMAIN'X /. -i' FT /100 FT. FRICTION FACTOR ';3 FEET
TATAL DYNAMIC HEAD = , FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 ; WIDTH 7d ; DIAMETER
LIQUID MPTTH
I
•
0 SD33
VS33 SW50
i
Typical Application' Sum /Effluent um
_ . _P pump Typical Application' . Sump /Effluent pump .
Capacities SW /SO/VS33 • to 48 GPM (3.01 /s)
Capacities SW/SDNS50 . to 44 GPM
Heads SW /SDNS33 - to 26 ft. 17.9 m) Heads SW/SD/VSO to 14 fl. (1.3 m)
E eeuical SW /SDNS33 . 115V, la, 10.0 FLA, 60 Hz Electrical SW /SD/VS50 • 11A 10, 8.0 FLA, 60 Hz
Motor SW /SDNS33 - 1/3 HP shaded ole w /lhermol
p Motor SW/SD/MO -1/2 HP shaded pole w /thermal overloa . d
overload 1550 RPM 1550 RPM
Minimum Recommended SD/VS33 = 12" (304.8 mm)
Minimum Recommended SDNS50 = 12" (304.8 mm)
Sump Diameter SW33 =18 "(451 mm) Sump Diameter SW50 =18" (457 mm)
Automatic Operation SW = Wide-angle float switch Automatic Operation SW Wide-angle float
(manual available) SD = Diaphragm pressure switch (manual available) SD = Diaphragm pressure switches
VS = Vertical float switch VS = Vertical float switch
Mmeriols of Consnuction Cost iron and engineered thermoplastic Maleriuls of Construction Cast iron and engineered thermoplastic
Impeller Thermoplastic vortex Impeller Thermoplastic two vane semiopen
Discharge Size 1 -1/2" NPT (38.1 mm)
Discharge Size I - I/2" NPT(38.1 mm) _
Solids Handling 3/8" (12.8 mm) Solids handling 3/4" (12.8 mm)
Poser (ord 10' , S1TW,(20' optional) Power Cord 10' , SJTW optional)
Superior Features • Carbon /Ceramic mechanical seal
• Oil-filled motor w Superior features •Carbon /(eramic mechanical seal
/automatic reset
• Oil- filled motor w /automatic reset thermal overload
thermal overload • Uses single row ball bearing construction
• Uses single row ball bearing construction 9 uc
g Piggyback plug available for easy maintenance and
• Piggyback plug available for easy
replacement
maintenance and replacement
9 30 40
S 03 ,SW33 S33 30
6 =20 _._._ - _ _ ._ _ - - ' _ _ _ SW /SO/VS50
tt _. - .
°¢
Zz F — 20
x g j
t .
3 0 10
10
Capacity-U.S. G.P.M.0 10 20 30 40 50 10 20 30 40 50 60 10
firers /Second 0 1 p 3 GPM
�, Switch A
• POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Se tic Tank Capacity oQO r3 NA
Owner 1 v� a Sc tic Tank Manufacturer s ❑ NA
Permit # 3 Effluent Filter Manufacturer Z .4QEZ C3 NA
DESIGN PARAMETERS NA Effluent Filter Model - /oo [3 NA
Number of Bedrooms 100 r oom 3 ❑ pum Tank ci Cho 1- NA
Number of Commercial Units NA Pum Tank Manufacturer iESe'�c [3 NA
Estimated flow (average) pun, Manufacturer yoRo ric [3 NA
Design flow (peak), estimated x 1.5* yr aUda Pum Model S41) ❑ NA
Soil Application Rate . D ft Pretreatment Unit �'NA
Influent/Effluent Quality (NA ❑) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter
Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland
en Demand (HODS) ❑ Disinfection c3 Other:
Biochemical Oxyg < 220 mg/L Model:
Total Suspended Solids (TSS) Manufacturer
5 250 m Dispersal Cell(s)
Monthly Average * ** In- ground (gravity) 13 In-ground (pressurized)
Pretreated Effluent Quality ❑ ❑ gr
Biochemical Oxygen Demand (BODO < 30 mg/L ❑ At -grade 'Mound
Total suspended Solids (TSS) 5 30 mg/L C7 Dri line ❑ Other:
Fecal Coliform (geometric mean) <10 cfu/100m1 ❑Leaching Chamber Manufacturer
d
Moel Laying La in Length/Chamber
Maximum Effluent Particle Size 1/8 inch diameter ft z
Soil Application Rate _ g pd /ft Area Req. ftz
*Wastewater Flow Verification and Calculations: Infiltrative Surface/Chamber -ESIA Rating
(Other than bedroom based) Minimum Number of Chambers
❑ A e ate Desi Flow/Loadin Rate
ft min
** Values typical for domestic (non - commercial wastewater Materials: materials i� pe ure SPec� Cod
and septic tank effluent. and a royal letters.
** *Values typical for pretreated wastewater.
DESIGN CRITERIA
[3 "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et x1 d E.J. Tyler.
E3 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J.
Publication 15.22 - it Absorption Systems" Publications 9.6
So
"Design of Pressure Distribution Networks for Septic Tank rP d "Design Manual -
_ gn
❑ SAE Publicatio ns 5 -77 an
's A
« 1 Soil Absorption Trenches and Bede'. R.J. Otr
❑ Design of Conventional rP
Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980
❑ SBD - 10570 -P (8.6/99) "At -Grade Component Manual Using Pressure Distribution"
❑ SBD - 10567 -P (8.6/99) "In Ground Absorption Component Manual'
❑ SBD - 10705 -P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0
❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Mannar'
�° Recirculating Sand Filter System Component Manual"
_ Slit Bed R g
P .6/99
10656- ) P
E3 SBD (N
❑ SBD - 10572 P (8.6/99) "Mound Component Manual „
'SBD - 10691 -P (N.O1 /01) "Mound Component Manual” Version 2.0
❑ SBD - 10595 -P (8.6/99) "Single Pass Sand Filter Component Manual"
E3 SBD - 10657 P (R.6/ 99 ) "Drip -line -line Effluent Disposal Component Manual"
❑ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual"
A ' SBD - 10706 -P (N.01 101) "Pressure Distribution Component Manual" Version 2.0
❑ Drip -line Effluent Dispersal Component Manual for Multi-no Onsite Wastewater Treatment Units
❑ MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING SCHEDULE Service Fre uenc
Service Event condition of tank ( s ) months 3 earls) (Maximum 3 .)
Ins ct conch
'
At least once eve ❑
pum out contents of tank(s) When combined sludge and scum uals one -third (1/3) of tank volume 3 )
I ct dis rsal cell(s) At least once eve r3 months 3 ear(s) (Maxi auni
Clean effluent filter At least once eve M months [3 ear(s)
Ins ct um , um controls & alarm At least once eve ❑months 3 earls) ❑ NA
At least once eve ❑ months earls) ❑ NA
Flush laterals and press are test months ❑ ear(s) NA
Valves At least once eve
At least once eve
Other: ❑months ❑ year(s) ❑ NA
Page_j-of
START UP
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other.chetnicals 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.
OPERATION
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
❑ Valves
Valves shall be operated in the following manner:
Alarms
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service
POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any
problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing.
INSPECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
Septic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground
surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more
frequent intervals than stated in the maintenance schedule to keep the system operating.
Pump Chamber/Treatment Tanks Component
The inspection must include.a test of all electrical equipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters.
Any service needs or repairs shall be promptly taken care of.
❑ In- Ground Gravity Component Dispersal Cells
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending
hydraulic failure necessitating more frequent monitoring.
Page $ of-7—
Mound, At- Grade, In- Ground Pressure
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure
necessitating more frequent monitoring.
The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals
should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to
ensure that equal distribution of effluent is occurring to promote the longevity of the system.
REPORTS
Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative
Code.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. 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 nind 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 other 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 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.
and/or soil limitations. Barring advances in POWTS technology a
❑ A suitable replacement area is not available due to setback
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 maybe 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 CONTIAN 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 WTERIOIR OF A TANK MAY BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER
POWTS MAINTAINER
Name ex E �K� /'��' 3y�.? Name
Phone .9' 6 7,7 - s.?« Phone
SEPTAGE SERVICING OPERATOR (Pun er ) LOCAL REGULATORY AUTHORITY
Name Agency Sr. Lit of o ire W'
Phone Phone
K: \WPDATA\EMPOWTS OWNER'S MANUAL.doc PagejofI-
Maintenance
The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a
wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years.
The Zabel'" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the
septic tank is normally inspected and pumped. However, our filter is virtually self- cleaning. The continued action
of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of
the tank. if your filter contains a SmartFilter"' alarm, you wi!! be notified by an alarm when the filter needs servicing.
To service the filter:
'Servicing any Zabel filter should only be done by a certified septic tank pumper or installer.
Locate the
outlet of the
septic tank.
.t Firmly pull the filter handla
and slide the cartridgA 0.Ut .
Remove the tank of the cl . '
and pump the * Note: A tee handle may
necessary to pr to be used it the fitter is
any solid below round level to
0 .�
escaping to th han dles
contac Zabel for Info
when the f
rem
9 4 w 5
While holding the crttidl$ QYB�'_ :; r ► '
the access opettln :..l a x: Insert the f111160. d ;r3
cartridge with fray t back in the
careful to rinse 11 sure the flit
properl
•Note: it is not neces completely i
'spotless' The biom
aides in the pretreatme
be left may b di ass Replace t
MADE NI USA
The product(s) shown are covered by one or more of the following patents:
-U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683;577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621
U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824,
Other Patents Pending
Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 221 - 5742 - Website http: / /www.zabeLoom
A100/300d•M.61499
tCT. 20, 2005 9:59AM ECOLAB 1NC � � NO. 541 P. 2
�� 1546
�NViaconsinDepartmentofComm®rae SOIL EVALUATION REP 1KR 0VWAW RECEIVED P a t 3
blvlefan olSsrety and Bulld)ngs In *o=d9noe Witt, Comm 85, Ws, Adm. Code A.C.E. t & ft Evaluations
Attach oanplete elte plan on paper not Iasi than aY =x t 1 inner+ in sae. Plea must S JUS roix
include but not limited to wrdr,el and horizontal reference point {SMI, direction and
penxn{ slaps, scale or dunematons, no* arrow, and IoeaUon and o n - tance to nearest road. 119T, CROj0 -00
Please Plfnt all r'nrormatron.
PW%" iWoaaatbn rpu povida maybe aeon ror WOMIXY PPM (P W4Y tsw, % %04 (1) (m)), eY Dade
Pre Property Location
RHK Faun INC. - Mike Kamm Govt Lot N5 114 NE 19 8 12 T 29 N R 18 W
P 'li
Owner's A!!ai Addr+�ts
�Pa+4+ Lot # Block # 3ubd. Name or CSM#.
1392110th Ave. TO I Proposed CSM
City State Xlp Code Phone Number City Village Tovm Nearest Rood Roberts WI 54023 1'16 -749 - 3597 Warren 150Th Street
10 New Construction Use: IN Rftlde let I Number of bedro" 4 Code de %sd deeipn Now rate 600 t3PD
W Replacement 10 Public or cent mwdet - Describe:
Psmnt material loess over glacial till Flood plain eW adore, if appik,able
QWWW commepts no
and teceer►rtlerldetiorss:. Install mound system at elev. 104.47' at 10" above 103.63' contour,
EE Bcring # Is Pit GrWnd Surface elev. 103.41
NO to limiting facts 28" . in. Soil Ra
Horizon beplh Danba7l C or eft escription Trxtun re d
o"IsWu rtddry. Roots
f
1
040 10y13/3 none al 2fsbk mvrr as 21`,1 m 0.6 0,9
2 10-118, 10yr414 none
tit
2msbk ntyfr
ow 2f,1 m 0.8 0.8
3 18 -26. 10yr4/t3 none is tmsbk mvir ow 1f 0.7 1.2
4 28-38 7.5yr#14 f2f 77.5 sl 2msbk mfr cw if 0.5 019
5 36 -45 7.5yr414 u� d i0y�i � si 1cebk mfi , - - 0.4 0.6
„ • R
"0 Pit
Ground Surface slay. 10_ 3,31 ft. Depth to llrarQ facto o in. 8p1 tlon Ra s
rix on D Apps i
Dominant C
ola Rad
ax DeecnpGon Texture 81ru «re s�stenoe ndary Roots HO ME:
1 0 - .10yr3 /3 no ne sl 2f$bk mvfr as 20m 0,5 0.9
2 7 -16 10yr414 none sl 2msbk mvt
r
w 2f 1 m 0
3 18 10yr514 none 81 2msbk mfr ow if 0.5 0.9
4 26-35 10yr514 f2f 7.6yr5/8 al 2msbk mfr gw if 0.6 0.9
6 35 10yr614 s
m� 1 sl 1esbk _
mfi
�. - 0.4 os
` Effluent lf1= BQa a ? 20 122D mpn, an
d TSS 30 < 150 !!2 BOt) 30
CST Niune(F .' POiiU; U(a s _ � and TSS <j30 mgf(,
James; i T6 HT' Num ber
m son
R 3802
Addrt:SB AC.E. Solt Bc $it6.Evatuations ate Evslua(lon Conducted Telephone Number
340au�tiorrl a"e lane Osceola Vvl 2D 5002 715 - Z45 - 7767
i
XT. 20. 2005 9 9AM ECOLAB INC N0, 1 , 41 P. 3
' oeily owner RHK Farm. INC. - Mike Kamm Parcel ID # 040- 1031 -10 -000 Page
# �� Ground Surface elev. 102.5 R. Depth to l'mvting facia 27^ h
I
SdtAppllca' Rate
Horizon Depth Dominant Cdor Redot De3alp Texture Structure Consistence I Boundary Roots
'i:t4#�1 �Etf#2
1 0.11 10y/3/3 none sl 2fsbk m vi r as 2f,1m 0.5 0.9
2 11 -17 10yr4 /4 none sl 2msbk mvfr 8w 2f,1m 0.6 0.9
3 17 -27 10yr6/4 none $l 2msbk mfr cw 1f 0.5 .0.8
4 27 -36 10yr5 /4 f2f 7.3yr5 /8 tl 2msbk mfr aw if 0.5 0,8
S 38.48 10yr514 m3p 7.5 /8 &
txt2d l /2 s{ 1 csbk mfi - - 0.4 0.6
Bwng # Boring
19 PR Ground Surface dv. ft Depth to limiting fador In. � � Role
lioriton Depth Dominant dor odox Dos plicn wuro Structure onsistence Boon
- 'tcfF4i •tcff�
I
Boring # t Wng
Pit Ground Surfw* elm ft. Depth*tc lhhing factor _ in. Sd
Ham' Depth 15 0 ant 00107 Redox 7 n cture Cona�atence Boundary ' 'Roots
i
Effluent #1= 80? 30'c 220 nV& and T88 v3o c j 00 ffV �
Effluent # 213 B0D <_30 nrVl., gnd TSS c30 mgr'ir
The Department of Commerce i an equal °PPOft* "iee provider aad.cmployer. If you need urist ee to access services or
need material in an alternate format ukase 00niact the deparbnent at 608-266-3131 or TTY 608 - 264:8777.
T. 20. 2001_10.00 AM. ECO! AB INC
S
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1545
Wisconsin Department of Commerce SOIL EVALUATION REPORr RECEIVED P ge 1 of _ 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sc it & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must C
S . root
include, but not limited to: vertical and horizontal reference pant (BM), direction and IR
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. T. C R TY
Please print all information. Z N 1 x-10 Up
Date 11
Per sonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location
RHK Farm, INC. - Mike Kamm Govt. Lot NE 1/ NE 1/4 S 12 T 29 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSW
1382 110th Ave. �' Proposed CSM (� y 3'"]
City State Zip Code Phone Number j City ; j Village _e Town Nearest Road
Roberts WI 1 54023 1 715 - 749 -3597 Warren I 150Th Street
IM New Construction Use: jo Residential / Number of bedrooms _ 4 Code derived design flow rate 600 GIRD
=j Replacement �j Public or commercial - Describe:
Parent material loess over glacial till Flood plain elevation, if applicable na
General comments
and recommendations: Install mound system at elev. 104.47' at 10" above 103.63' contour.
Boring
� Born # g
ig Pit Ground Surface elm. 10 3.41 ft. Depth to limiting factor 28 � —�+' Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe
70.5 1 0 -10 1 none sl 2fsbk mvfr as 2f1 m 0.9
2 1 - 18 10y r4/4 none sl 2msbk mvfr cw 2flm 0.9
3 18 -28 10yr4/6 none Is 1 msbk mvfr cw 1 f 0.7 1.2
4 28 -36 7.5yr4/4 f2f 7.5yr5/8 sl 2msbk mfr Cw if 0.5 0.9
m3 7.5yr5/8 &
5 36-45 7.5yr4/4 m�d ltyl r6/2 sl lcsbk mfi - - 0.4 0.6
Boling # = Boring
Pit Ground Surface elev. 103.31 ft. Depth to limiting factor 2 6 " in. Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDfltz
*Eff#1 *Eff#2
1 0 -7 10yr3/3 none sl 2fsbk m vfr as 2f,1m 0.5 0.9
2 7 -18 10yr4 /4 none sl 2msbk mvfr gw 2f,lm 0.5 0.9
3 18 -26 10yr5/4 none sl 2msbk mfr cw 1f 0.5 0.9
4 26 - 35 10yr5 /4 f2f 7.5yr5/8 sl 2msbk mfr gw if 0.5 0.9
m3p 7.5y� /8 &
5 35-41 10yr5/4 mZd 10yr6/2 sl 1 csbk mf - - 0.4 0.6
* Ef 1uent #1 = BOD ? 30 < 220 mg/L and TSS 30<150 #2 = BOD -s mg/L and TSS < X mg/L
CST Name (Please Print) Si:20 unw. CST Number
James K. Thom — - -� 3602
Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 5/2/02 715- 248 -7767
r
property Owner ' RHK Fclrm, INC. - Mike Kamm Parcel ID # 0 40- 1031 -10 -000 Page 2 of 3
Boring
3
F � # Pit Ground Surface elev.. 102.45 ft. Depth to limiting factor 27" i n Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Rood 2
*Eff#1 *Eff#2
1 0 -11 10yr3/3 none sl 2fsbk mvfr as 2f,1m 0.5 0.9
2 11 -17 10yr4/4 none sl 2msbk mvfr gw 2f,1m 0.5 0.9
3 17 -27 10yr5/4 none sl 2msbk mfr cw 1f 0.5 0.9
4 27 -36 10yr5/4 f2f 7.5 r5/8 sl 2msbk mfr gw if 0.5 0.9
5 36-48 10yr5/4 m2d Sy r /8 2 sl 1 c sbk m fi - - 0.4 0.6
F-I Boring # � Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
F—I Boring # J Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD /ft
*Eff#1 *Eff#2
I
I —
i
* Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the devartment at 608- 266 -3151 or TTY 608- 264 -8777.
I
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 6v- oky1 C � r . L l U v Hn - 6 , c - QJ
Mailing Address [ f j �{;,� 1 AA S 5 0 0 4
Property Address
(Verification required from Planning & Zoning Dep rtment for new construction.)
City /State Vu,'t , Parcel Identification Number Qua_ -- f 03l - I o- g o z)
LEGAL DESCRIPTION + +t + 1
Property Location N 1 /4 , N 1 /4 , Sec. 1 , T N R 1 ' �K W, Town of
Subdivision , Lot # ns
Certified Survey Map # Volume l , Page # 37
Warranty Deed # S , Volume �.`� 0 , Page # 3 3
Spec house yes no Lot lines identifiable e no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Numb r of rooms
3
off: =-'`�
IGNATURE OF APPLIC ( DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
r T
OCT, 20. 2005 0;00AM ECGLAB INC NCB, 547 P. 5
I
EM - 4. �o � 4
1531 SQ. Fr. (OUTSIDE FLOOR)
r A . 0 -1 1 6 pLUWM G Y9W LOrAIM
'I
FLAT CEILING ENTIRE
044 uy (low f (2Mo) (KOM 13) (KGN 131
Nn
in
.._..fR UP -
Kiatow. ••.........� -:
s_�'s...Y r' ti MASjFJi
8A
' :r•:' - t�_ !:!.::r•LS_s_rvr:'- W
R �i
� _ ✓ uwa "EDgO f
Lam"" R ON3 BEO A? ROOM v
O�A M5
1 I f
tae• rca' T.a• • ,ate �al�• .
Modular
Code
s V� h
rrrrrrr p p
r rr
EM -454 WITH STANDARD 3/12 ROOF PITCH
OPTIONAL DOUBLE DOMR SI BUILT 0 STO D OOR AND SHUTTERS GARAG
THE OVERALL DIMENSIONS OF HOMES FLOOR DNS AND RENDERINGS C ARE SUSjECT TO CHANGE WITHOUT NOY CE. EXTERIOR
CONSISTENT PRODUCT IMPROVEMEN
ELEVATION$ SHOWN MXi INCLUDE OPTIONS ORADDITIONAL ON SITE WORK.
JAN, 24. 2006 9 :44AM ECOLAB INC N0. 276 P. 2
U_,.eU40P 339 813777
State Bar of Wisconsin Form 1 •2003 KATHLEEN H. WALSH
W ARRANTY DEEP} REGISTER OF DEirDS
Documcut X
umber Doaumeut Nano ST. CROIX CO., WX
TMS DIED, made between R. H. K. Tara &, Inc, . a Wisconsin RECEIVED FOR RECORD
Corporation 12/07/2805 02:05PK
( "Grantor," whether one or more),
ANTY
ttd Kirk Livermore d Severs J. Livermore husband NARR DEED
E'llE1Pt
an survivorshi marital ProPer
( "Grantee," whether one or more). 7 8
11
COPY FEE-,
Grantor, for a valuable consideration, convoys to Grantee the following CC Ffifi:
described real estate, together with the rents, profits, fixtures and other PAGES: 1
appurtenant interests, in St, Croix County, State of
Elc ' in ( "Property ") (if more space is needed, please attach addendum).
of Certified Survey Map recorded in Volume 16
e 4379 a s Document No. 6919'74 being a part of
_
the Northsa t u rte a.. or east Qarterk '4_ >Zecord;n Ica -�.__
of X94) , Section 12, jownship 29 North, Range 18
west, Town of w arren Wisconsin Assured Title, LLC
1810 Crestview Drive #1B
Hudson, 'WI 54016
042- 1031 ^14500
parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fae simple and free and clear of encumbrances except:
Roadways, gassments, or Restrictions of Record
Bated
Q
(REAL) (SEAL)
* R .K. rarms Inc.
by Richard H. Kamm, President
(SEAL) (SEAL)
� a
Slgttature(s) STATE OF WISCOArSIX )
Groix COUNT
authenticated on GLA
Personally came before me on _ -
the above - named Richard H. Kamm as
� e . K. In
TITLE: MEMBER STA'I'R BAR OF me own to a the on(s) who executed the
(If not orego' iuistrument d o the game.
authorized by Wis. Stat. 1706.06)
THIS INSTFLUMEW DRAFTED BY:
Michael R. Vorecki Attorne y "ctwy Public, to of risconsia
Eau Claire, Wisoonsi.n M Commissio is permanent) (expir
(SiXnatures maybe aut�henacsted ar ackuowledged. Bot Are of neceaary)
NOTE: THIS Is A STAND41W FORM. ANY MODIFICATIONS TO Tim FORM 5 L& AE CLEAR YID NT FI
WARRANTY DEED '00 -. 1 bM . - A �� ,' STATE BAR OF WISCONSIN FORM No. I -2003
'Type name below signatures.
A"omey Miahtel H Pate& 9x51 ORkwood FUS Pkwy ft 1, Pau Claire W1 S4701.7wA Thane: (7lS) 635 -��9 Fox; (715)135-4112 Rk[�•�lvern;are
Tid* O u ProWior Group Prodvow With z0FOrm by RE FormBNet, LLC 79025 Moon µFe Road Chnian Tevrnahlp, MWhloan ae S. (800) 493 -95M E M -A MM—SO
,
APPROVED 6 9 1
ST "CROIXCOUNTY VOL 76 PAGE 4379
Planning Zgnin'
KATHLEEN H. WALSH
SEP 2 g 2002 REGISTER OF DEEDS
ST. CROIX Co., MI
IF not RECEIVED FOR RECORD
19COfOeC wiplrn 3U g =YS of
aAAroval date app—I shall be 09 -26 -2002 10:30 A
nun rno , mid
CERTIFIED SURVEY MAP
RE
CERTIFIED SURVEY MAP COPY 330
R.H.K. Farms, Inc. PAGES: 2
Located in part of the Northeast % of the Northeast I/. of Section 12,
Township 29 North, Range 18 West, Town of Warren,
.St. Croix County, Wisconsin.
OWNER'S ADDRESS
1382 100TH AVENUE
ROBERTS, WI 54023
N LEGEND
BEARINGSARE L Q INDICATES I- 114'O.D. x 18'IRON
TO THE EAST LINE OF THE PIPE SET (MIN. WT. - 1. 13 LBAL F_)
TNORTHEAST A AS 1 � A SOIL BORINGS (PROPOSED SEPTIC SYSTEM)
S 01'16*30' E 0 SEC77ON CORNER MONUMENT (AS NOTED)
-94 PROPO SED DRIVE WA Y L 0 CA TION
SCALE IN FEET f' 200'
1 0 1 0
I UNPLATTED_LANDS I I3 ,33 UNPLATTED
� 1 - ""
NORTH 1H CORNER { LANDS
SECTION 12, T 29 N, R 18 W - S 90 E 2886.77 - NORTHEAST CORNER
(FCLIND CONCRETE TIC NA2/ SECTION fZ r29 R!BW
.� I _ 7 1 QTI (FOUND 1- 112.O.D IRON P i L- VENU
�
1741 , -- too' -_ - iav S 90 °00'00" E 945.62' e`$ S 44 w — — — —
NORTH E NE114 9 00.017 646.62 _ 46.16
7 33.00' 300 W 33.00' 613.34' A
$ - S 90°00'00' E 913.34' -
COUNTY 8UNO1NC _ _ SETBACK ° LINE i
— — - - - -- '— LOT .3 -- _ 100• I
LOT _ 1 LOT 2 $ 148 664 SQ. Fr OR 3.413 AC. A ( I iv
0 198.000 SO. FT f (127,881 SQ. FT OR 0T I A b
CERTIFIED o OR4.SIBAC. R �Ac CLVaNG 1k NN LOT 4
CE (188,100 SQ. FT. ` 1 144100 SO F
OFWAY) �O . . T. OR w v
l�RVEY MAP w $ OR 4.318AC. ; s� 3.30
.308 AC.
„ EXCLUDING 9 (129,791 SQ. FT. OR 2.9WAC.) y '
i5 g ROAD RIGHT I EXCLUDING ROAD ° Z
VOLUME 2, o OF WAY) 1 RIGHTOFWAY)
°
8 ,
PAGE -577 d s 90'00'00' E W6.S1 A
Z -
° LOT 39.0,' -'' $
136,140 SQ. FT. OR 3171 AC.
o (131.209 SO. FT. OR 3.012 AC. } 100 �� W Z
EAST UNE w EXCLUDING ROAD RIGHT OF WAY)
LOT t - 927.11' -. N
300.00 627.11' - 660.12 - 433.01' 30•
N 90 0 00'00" W 960.12' T
n
LATTE NP D LANDS
w15u; � U
�'�`S� 1
LAUREN E
W. ,
M Gg
* 13 y'
RIVER ir DATED. H
�� p FALLS. D g JUNE 14, 2002 0
J EAST 114 CORNER
SEC
TIONSZT291�R1L+W
g u No ND COUNTY ARNTSEA
THIS INSTRUMENT DRAFTED BYJERALD L LARSON SHEET 1 OF 2
Vol. 16 Page 4379