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042-1084-70-225
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463319 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Pearson, Jon I Warren, Town of 042 - 1084 -70 -225 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No Ar L 5 30.29.18.475C10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark posi%- Alt. BM - n Bldg. Sewer C1 Z( Holding St/Ht Inlet Ci / cL / 58 TANK SETBACK INFORMATION St /Ht Outlet II • I Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Zo 1 Dt Bottom Z Dosing 7 5L)' Z� �6 Header /Man. rf` Zz Aeration Dist. Pipe ZZ � Holding Bot. System O c.J PUMP /SIPHON INFORMATION A Final Grade 7 95 Manufacturer P n aand St Cover G / �0 Mod umber , if 1 3.1 $ 1 TDH ift Friction Loss System He H Ft I L Forcemain j 6e-th D' Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Lengt7 No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 W 4-- 76 Z I rz^ L ,. SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: I%Z �/a� INFORMATION Type Of System : INFORMATION V : (� I , , A CHA OR Model Number: G or. ti J v�c�Y DISTRIBUTION SYSTEM fo G 7 �ow�*�- ✓3 ��� c fa. Header /Manifold IDistribution I I x Hole Size x Hole Spacinb Vent to Air Insa Length 3 Dia_ Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only G. Depth Over + Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges \ Topsoil - g p < Yes �I No � ji Yes I � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 982 70th Avenue Roberts, WI 54023 (SE 1/4 SE 1/4 30 T29N R1 8W) NA Lot 2 Parcel No: 30.29.18.475C10 1.) Alt BM Description = 54- 0 ^^�� a • s �� =� C 2.) Bldg sewer length = Z 1 - amount of cover = , s" - - - -- - -- -- - _ - -I -T Plan revision Required =; Yes No . L�J Use other side for additional information. I Date Insepctors gnature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County /y N VI sconsin + 201 W. Washington Ave., P.O. Box 7162 5 Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 608 ) 266 - 3151 Sanitary Permit Application O State Plan I.DMA, er In accord with Comm 83.21, Wis. Adm. Code, personal information you pro v q may be used for secondary purposes Privacy Law, sl5.04(i)(m) O Project Address if differe tan l . ing address) G Q 7 I. Application Information — Please Print All Information / 'w2c Property Owner's ame Parcel # Lot # Block # Property Owner's Mailing Address LZ0 N11'N(G_ �' Pro eriy OFFICE 3 0 , 5 75 O d � v� ' /,, SLR ' /., Section City, Statee' J �c Zip Code Phone Number ` � circle one) T N; R E o II. Type of Building (check all that apply) �yUf Subdivision Name C Nu bpr, Y6 2 Family Dwelling — Number of Bedroo Subdivision / ` � El Public /Commercial — Describe Use I w lc� j� b 1 �'► 7 0 3 7 c � 1 w,/1 1 ❑ State Owned — Describe Use ❑City_❑Villagwnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision El change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S'stem: Check all that appl 6544on — Pressurized ht- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized hi- Ground ❑ Holding Tank ❑ Peat filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Drip Line Gravel -less Pie ❑ Other (explain) V. Dispersal/Treatment Area Information: — / S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) I Dispersal Area Pr s (sj ystem E fl VI. Tank Info Capacity in Total Number Manufacturer -- Site Steel Fiber p i Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit _ / —L!2 - Dosing Chamber W Aw 4 VII. Re sponsibility Statement- I, the undersigned, assume response ' 'ty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' igna a 'MP/MPRS Number Business Phone Number Plumber's Address j t City, State, Zif Code) 3 2 VIII. on /D e artment Wonl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date )ssued ssuing Aatur tamps) Surcharge Fee) Q O1� d El Owner Given Reason for Denial A Soo IX. Conditions of Approval/Reasons for Disapproval O �� // � YSTE M OW Cann a 3 S� / i��2d ep disp er s al tank, effluent filter er , �Q� � Glf t � � d Gl� ce must a e service /maintained ` /'f'L� Gtr as per management pan provided y 2. se ac requiremen s mu as per applicable code/ordinances. a/ ;✓I� ( . ��ILLf� Attach complete plans (to the Ciiidity only) for the system on paper not less than 8Y2 x 1 ches in SBD -6398 01 k ,4 cR ) d P � ,�W�11/ w\rvev\ f � - ` t Now 1� ^ka,- - r) _�`� �, ; 4-r Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems JON PEARSON l Owner's Name 2/18105 Review Date r N �Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 450 Igpd Estimated Daily Peak Flow 0.70 gpd /ft` In -situ Wastewater Infiltration Rate 642.86 W Chamber /Unit Area 50.00 EISA ft / Unit 13 # of Chambers /Units 90.9�ft Proposed SAS Elevation 26.50 Bottom Area ft` / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 92.90 99.90 1 93.90 120 86.90 92.90 Yes 2 1 95.60 120 88.60 94.60 Yes 3 98.10 120 91.10 97.10 No ,d a 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03 s ck �> SQ a C - r l 1 0 i 2185 Wisconsin Department of Commerce SOIL E ALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Wis. Adm. Code Certified Soil Testing County Attach complete site plan on paper not less than 8% x 11 inches in size. jt;Ao St. Croix include, but not limited to: vertical and horizontal reference point (BM), dire percent slope, scale or dimensions, north arrow, and location and distance d. Parcel I.D. 9.18.475C -10 Please prl _ . .� R iewed By *1 Date Personal information you provide may used fo ti' o�Yq� Law, s 15.0 Property Owner Property Location Pearson, Jon w ZUO j Govt. Lot SE 1/4 SE 1/4 S 30 T 29 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I qq o 1 992 70th Ave. 2 - J _V( - 1 44� City State City N Village J& Town Nearest Road Roberts WI 1 54023 715 - 749 -4105 Warren 1 70Th Ave. V1 New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement ja Public or commercial - Describe Parent material sandy /loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install "conventional" in- ground trench system w/ 0.7 gpd /sq ft loading @ system elevation 6' below surface contours as trench center lines F T] Boring # Boring Jig Pit Ground Surface elev. 93.9 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -6 10YR 3/3 - sl 2 m gr mvfr cs 1 m .6 1.0 2 6 -24 7.5YR 4/4 - sl 1 f sbk mvfr gs 1 m .4 .7 3 24 -36 10YR 4/4 - Is 0 sg dl gs - .7 1.6 4 36 -120 10YR 4/4 - s 0 sg ml - - .7 1.6 occasional gr & cob in upper horizons Boring # -=3 Boring 16 Pit Ground Surface elev. 95.6 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 10YR 3/3 - sl 2 m gr mvfr cs 1 m .6 1.0 2 10 -28 7.5YR 4/4 - sl 1 f sbk mvfr gs 1m .4 .7 3 28 -36 7.5YR 4/4 - Is 0 sg ml gs - .7 1.6 4 36 -120 10YR 4/4 - s 0 sg ml - - .7 1.6 occasional gr & cob in upper horizons ' Effluent #1 = BOD 30 < 220 mg /L and TSS >3P < 150 mg /L ' Efflutat #2 = B < 30 mg /L and TSS < 30 mgr CST Name (Please Print) Signa rdi CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 2/16/2005 715- 233 -0398 Property Owner Pearson, Jon Parcel ID # 30.29.18.475C -10 Page 2 of 3 F3 ] Boring # Boring Pit Ground Surface elev. 98.1 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 - 42 10YR 2/2 _ ` s1 2 m gr mfr cs 1f .6 1.0 2 42 -120 10YR 4/4 _ s 0 sg ml - - .7 1.6 this profile per pit 5 description of Bird report, 7/20/2000; Bird benchmarks not found; elevations per new benchmark; other Bird pits added to plot plan by scale from his plot plan ❑ Boring # �j Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots MIT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 F-1 Boring # j Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If ou need assistance to access services or 9 P P Y need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing r z c,- �0 3.A,��, t�SC-1V, \ lawn' `N t.vvly� ON kz cl IL f � t j IL p e— e1 HOC I Q O W. +�; I � 1 0-0.0 OoA— 02/18/2005 09:34 FAX 715 233 0398 Certified Soil Testing St Croix 004 I �o a•l 1 �%r10c. k . i f � . 5 c- e - S ( 4� 1 2.zz-t 1 44 43 4A �\ 11 v l e� �w °I t•, lit h � ib� -- riv �. S r yse f.be• k., IL Gl 2 00, AL 02/18/2005 09:34 FAX 715 233 0398 Certified Soil Testing St Croix 1j003 Property Owner Pearson, ]on Parcel ID # 30.29.18.475C - 10 Page 2 of 3 r 3 ] Boring # J Boring Pit Ground Surface elev. 98.1 ft. Depth to limiting factor > 120 in. SON AppJ108don Rate Horizon Depth Dominant Color Redox Description Texture Slnrcture Consistence BDUndafy Roots ' in. Munsell Qu. Sz. Cont Color Gr, Sz. Sh. *1501 "Ef 2 1 0-42 10YR 2/2 sl 2 m gr mfr CS if .6 1.0 2 42 -120 10YR 4/4 Z s 0 Bg ml - - .7 1.6 this profile per pit 5 description of Bird report, 7120/2000; Bird benchmarks not found; elevations per new benchmark; other Bird pits added to plot plan by scale from his plot plan Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Gp in. Munsell Qu. Sz. Cunt Color Gr. Sz. Sh. 'Efftl `Eff#2 ❑ Boring # is i' Boring Pit Ground Surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth C Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Com Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 c ISO mg /L • Effluent #2 = SOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an cqu81 opportunity Service prdvider and employer_ If you need assistance to access services or need material in an alttrnatt format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. srsu -x.330 (R.ullf>a) Cwdfiad Soll Tcatlng 02/18/2005 09:33 FAX 715 233 0398 Certified Soil Testing St Croix Cilool T, 02/18/2005 09:34 FAX 715 233 0398 Certified Soil Testing St Croix 1?1002 2185 Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 of 3 _ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site Ian on paper not lase than 8% x 11 Inches In slze. Plan must County P P Pa St. Croix Ind ude, but not Ilmiled to: vertical and horizontal reference point (8M), direction grid Parcel I.D. percent slope, scale or dimensions, location sions north arrow, and and distance to nearest road. 30.29.18.475C -10 Please print all information. Reviewed By Date Pemnal informelan you provide may be used for secondary purposes (Privacy Lan, s. 15,04 (1) (m)). Property Owner Property Location Pearson, Jon Govt. Lot SE 1/4 SE 114 S 30 T 29 N R 1 W Property Owner's Mailing Addre$ Lot # Block # Subd. Name or CSM# 992 70th Ave, 2 1 17 -4441 city State Zip Code Phone Number (,,l� City village M Town Nearest Road Roberts WI 1 54023 1 715 - 749.4105 Warren 70Th Ave. ?" New Construction Dsa'$ Residential / Number of bedrooms 4 Cade derived design flow rate 600 GPD Replacement EiiJ Public or commercial - Describe Parent material san dy /loamy outwash Flood plain elevation, If applicable _ NA General comments and recommendations; install "conventional" in- ground trench system w/ 0.7 gpd/sq ft loading C system elevation 6' below surface contours as trench center lines F TI Boring # ?Rs Boring Pit Ground Surface elev. 93.9 ft. Depth to limiting factor > 120 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GEC in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 WJ 1 "E 1 0 -6 10YR 3/3 - sl 2 m gr mvfr cs 1M .6 1.0 2 6 -24 7.5YR 4/4 - si 1 f sbk mvfr gs 1M .4 .7 3 24-36 10YR 4/4 - Is 0 sg dl gs - .7 1.6 4 36120 10YR 4/4 - s Ogg mi - - .7 1.6 - - occasional gr cob in upper horizons F2 Boring # j Boring A Pit Ground Surface elev,. 95.6 ft. Depth to limiting factor > 120 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsMence Boundary Roots GPD/fl in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. "Etf#1 'Eff#2 1 0 -1 D 10YR 3/3 sl 2 m gr mvfr cs 1m .8 1.0 2 10 -28 7.5YR 4/4 - sl 1 f sbk mvfr gs 1M .4 .7 3 28 -36 7.5YR 414 - Is 0 sg ml gs - .7 1.6 4 36120 10YR 4/4 - s 0 sg ml - - .7 1.6 occaslonal gr & cob in upper horizons " Effluent #1 = DOD S ? 30 _< 220 mg /L and TSS >39 5 150 mg/L ' Effluent #2 = GOD < 30 mg/L and TSS << 30 mgr CST Name (Please Print) Signa CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 2/16/2005 715 - 233.0398 f • 2 Subdivision - -- --- Date 7/20/00 S 1/4 S E 114S 30 T 29 N /13 W Township Warren Boring O Well PL Property Line County ST. CROIX tk: BM or VRP Assume Elevation 100 ft. Top of 1" pvc pipe System Elevation 89 *HRP Same as Benchmark Apt. BM Top of White Stake with Orange Ribbon @a 101.1 a 14% I Slope moo IA (10#1 TO- L System area � 4 0 ' � M. p( 1 10 A .10 B -1 45 45 l B -3 r' 10 I B -3 is for referen e - ---- -Y - ' '�" due to the unusual B -2 it - so s found ui B 3 � / C X 110' j 200, 70th Ave as:33ii[9 F-:: t '6' v � v � $ 1 i ' 1 l I f 1 Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems Jon Pearson Owner's Name 2/15/05 Review Date N �Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System t 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 450 Igpd Estimated Daily Peak Flow 0.70 gpd /ft` In -situ Wastewater Infiltration Rate 642.86 ft Chamber /Unit Area 50.00 EISA ft / Unit 13 # of Chambers /Units 88.50 ft Proposed SAS Elevation 26.50 Bottom Area ft / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 90.50 97.50 1 99.80 124 92.47 98.80 No Cut required 2 99.80 124 92.47 98.80 No Cut required 3 97.80 50 96.63 96.80 No Cut required 4 93.50 120 86.50 92.50 Yes 5 93.80 120 86.80 92.80 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03 Wisconsin Department of Commaros SOIL EVALUATION REPORT Division of Safety and Buildings pop of In aocordence with Comm 85, Wis. Adm. Coda Attech compleb site pMn on paper not less than a 1/2 x 1 Inches in size. Plan must County „- r 1 Include, but not limited to: vertical and horizontai reference point (BM), direction and parse) I.D. percent slops, sale or dirnersions, north arrow, and location and distance to nearest road. O - Please print ell Informl R Q Data Personal iniorrnatien you provide rmy be used rru a. 10.04 (1) (m)). rty 5=67 \ r' f Location 6 ft/ rn Lot 21--� 114 _�114 S3 N R E ( W Property Owner's Melling Address Block # Subd. Name 2 ! K� �y (�;, � 5T CROIX � `� ❑V�° C�'s�^ NearsstRoad New Construction esidsntlat / N ! ke ` ' Code derived design flow rate GPD [) Replaoensnt [] Puf 4 or commar t = r Patent material Q I1xz / flood Plain elevation if apphc We �. f l� ft and mo Genera o oanrneats tk =�-`/ end rscmme N ��" 5 7� �-.- 2 e- V r q 2 'f/ B S TDr t �r? c�c� n IE acting rw ❑• &xta Pit Ground surface elev. / / Of t, Depth to limiting factor in. sop AppliCallon Rats Ffodzee Depth Dominant Color Redox Descr#rlion Texture Structure Conatatenes Boundary Roots (3PC/It° In. Munew Cu. Sz. Cont. Color Gr. Sz. Sh. •EfMR1 ' a sa / d .3 Boring # C3 8oIng /� a Pit Ground such= etev . ft. Depth to ti n" factor �� !n Ra ft Harbor Depth Dominant Color Adidox Description Texture structure Cor�isbnce 8ourwary Hoots IM )" In. Munseil ou. Sz. Cont. Color Or. Sz. Sh. 'Lqm *EfM2 I r ' !flhmt *1 ar 90D s ; , 30 a 2Z0 mplL and TSS >30 a 150 n*% ' EfNuent 02's BOD a 30 molt. and Tsfs < 30 mgr. CST N (Plow Print) 73 CST b1twidw Add ress Date EvakmWon Coodumer Telephone umber Property Owner _ Parcel ID # _ Page - -of Boring # ❑ Boring �J 731y c � �• pit Ground surface elev. z !L R. Depth to limiting factor in. Soil Applicallm Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/M In. Munsell Qu. Sz, Cont. Color Gr. S . "EfF#1 "Eff/k2 X& ;? YV W Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 1 E11#2 c s le .3 Boring # � Boring Pit Ground surface elev. �ft. Depth to Writing factor 14o in. Solt Applicallm Rate Horizon Depth Dominant Color Redox Description Texture Consistence Boundary Roots GPDHf In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 I "Eff#2 C Effluent #1 = 800 > 30:s 220 mgt. and TSS >30 < 150 mglL " Effluent #2 = BOD, 130 mg/- and TSS c 30 mgt - 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. SOD -8330 (R.60) Soil Test Plot Plan _ Project Name Jon Pearson Sha Address 992 70th Ave / Roberts Wi 54023 S #226900 Lot 2 Subdivision ----- -- Date 7/20/00 SE 1/4 SE 1/4S 30 T 29 N /R W Township Warren E] Boring 0 Well PL Property Line County ST. BM or VRP Assume Elevation 100 ft. Top of 1 " pvc pi System Elevation 8 9.0 *Hgp_Sa Benc ark - Alt. BM Top of White Stake with Orange'Ribbon @ 101.1 \ a 0 14% Slope s 25 B -5 90 1 System area B � 4 - Alt v M. , 0 B �� p 1 9 S , B _ 45' 45' Q 10 1 B-3 ('6 10 B -3 is for referen e, due to the unusual B-2 I soils found in B -3 110' s I 70th Ave ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FIRM Owner/Buyer .T n �E,q 'r Sd N — I o� ._....._. -_._.1 e JT Mailing Address 9 q o2 7 0 A� c �T�� _ - - -_ .; �_ '� - -- - -_�_. Property Address vim 7D 4 4vF 4 - (Verification required from Planning Department City /State i�© 6 a-,- s to Parcel Identification Nut p LEGAL DESCRIPTION Property Location 5 C Y4. Y4. Sec. _34 , T �_.� ._.. Subdivision S m ?Q I t i3 t o 12 2°jI 7 ly► CSC � y �- �- � , . __--� _ __. Cer�tif Survey Ma�# 3 7A) , Volume Page # Cexli��Ur r . Warranty Deed # 55 3 a 7 / Volume 1 / 3 , Page k S Spec house yes Lot lines identifiable (0� no SYSTEM MAINTENANCE 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 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. Uwe, 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 tem has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 da of the ee ear expiration date. 7 "ATL11111OF PLICANT DATE OWNER CERTIFICATION Uwe certify that all state on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property descri d 7bo;v by oA warranty deed recorded in Register of Deeds Office OF'ATPPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department" * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed.. POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORrOATION SYSTEM SPECIFICATIONS Owner , v Septic Tank Capacity ; ,r Z7 gal [3 NA Permit # ' Se tic Tank Manufacturer p S� [3 NA DESIGN PARAMETERS" Effluent Filter Manufacturer 6 j� p' NA Number of Bedrooms 1OOgpd/bedroo n O NA Effluent Filter Model ❑ NA Number of Commercial Units Pump Manufacturer Pump Tank Capacity gal 'a W A Estimated flow (average)* C� gal/day Tank (ANA Design flow (peak), estimated x 1.5* 3a gal/day Pump Manufacturer ANA Soil Application Rate � 7 gal/ Pump Model A Influent/Effluent Quality (NAp) Monthly Average ** Pretreatment Unit [3 .Fats. Oil &Grease (FOG) O Sand/Gravel Filter p Peat Filter Biochemical Oxygen Demand (BOD)) < 30 mg/L p Mechanical Aeration [3 Wetland Total Suspended Solids (TSS) 5 220 mg/L ❑Disinfection C3 Other: ;g mg/L Manufacturer: Model: Pretreated Effluent Dis Dispersal Cell(s ' >ded;So - monthly Aver age*** p 1- ground (gravity) 13 In- In-g r Biochemical Oxyges) < 30 mg/L &' (pressurized) Total Suspen ) ❑ At grade ❑Mound Fecal Coliform mean, S 30 mg/L ❑Drip -line ther: <10tcfu/100m1 �' var 1, ^ = -l.e b �.� Manufa X--,z G /�... Maximum Effluent Particle Size 1/8 inch diameter Model l - z /a�.� ,[j� Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate 7 gy dde Area Req. y�ft (Other than bedroom based) Absorption Area Credit per unit S'" fe Minimum Number of Chambers /S p Aggregate Design Flow/Loading Rate= ft min * * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. I and approval letters. DESIGN CRITERIA E3 "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) C3 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 M . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 13 "Design of Conventional Soil Absorption Trenches and Beds ". SJ. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 p SBD - 10570 -P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual" p 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 Manual" Cl SBD 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" C3 SBD 10572-P (86/99) "Mound Component Manual" CI SBD 10691 --P (N.01 101) "Mound Component Manual" Version 2.0 E3 SBD - 10595 -P (8.6/99) "Single Pass Sand Filter Component Manual" p SBD - 10657 -P (86/99) "Drip -line Effluent Disposal Component Manual" C3 SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" p SBD - 10706 -P (N.01 101) "Pressure Distribution Component Manual" Version 2.0 E3 Drip -line Effluent Dispersal Component Manual for Multi flo Onsite Wastewater Treatment Units 13 MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every p months 412Lyear(s) (Maximum 3 yrs Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months IM:year(s) (Maximum 3 yrs.) Clean effluent filter At least once every O months 6 Inspect pump, pump controls & alarm At least once every O months p years) NA Flush laterals and pressure, test At least once every ❑ months ❑ year(s) A Valves At least once every p months ❑ years) a NA Other: At least once every ❑ months T3 years) tS:�:KA Page of START UP 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. 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, vegetablelfiuit 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. INPECTIONS 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). �p4eptc 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. E3 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 the filter. ` 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 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 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 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 beprotected 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. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank ay be installed last resort to repla�.�IedPO�� �#ZA e site of een eval to i - a suitab ure o an site evaluation st be orm eplace t area is available a holding tank maybe installed as a last resort to rep a the failed PO Mound and at-grade soil absorption - systems may be reconstructed in place followingremoval 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 INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name_ /ylr` : 5 Name Phone Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency hyo i x Phone Phone K:\WPDATMEBTOWTS OWNER'S MANUAL.doc Page — 3 0f3— I . Parcel #: 042 - 1084 -70 -225 01/05/2005 11:30 AM PAGE 1 OF 1 Alt. Parcel M 30.29.18.475C -10 042 - TOWN OF WARREN Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * JON & CHRISTINE M PEARSON PEARSON, JON & CHRISTINE M 992 70TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 982 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.294 Plat: 1619 -CSM 17 -4441 042 -03 SEC 30 T29N R18W PT SE SE FKA CSM Block/Condo Bldg: LOT 02 14/3991 LOT 2(2.93AC NKA CSM 17 -4441 LOT 2 (2.294 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) ' v /-Y -1 K A CS m C Q lLmo 30- 29N -18W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 01/09/2003 705153 17/4441 CSM 07/23/1997 r X 1213/258 W D 07/23/1997 954/279 07/23/1997 758/163 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 38580 44,300 Valuations: _ Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.294 39,000 0 39,000 NO Totals for 2004: General Property 2.294 39,000 0 39,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M 220 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 042 - 1084 -70 -325 02/17/2005 03:52 PM PAGE 1 OF 1 Alt. Parcel #: 30.29.18.475D -10 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * PEARSON, JON & CHRISTINE M JON & CHRISTINE M PEARSON 992 70TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description * 986 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.293 Plat: 1619 -CSM 17 -4441 042 -03 SEC 30 T29N R18W PT SE SE FKA CSM Block/Condo Bldg: LOT 03 14/3991 LOT 3 NKA CSM 17 -4441 LOT 3 (2.293AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) yt C S/'-? �D� 30 29N - 18W SE SE Notes: � Parcel History: Date Doc # Vol /Page Type 01/09/2003 705153 17/4441 CSM 07/23/1997 1213/258 WD 07/23/1997 954/279 07123/1997 758/163 2004 SUMMARY Bill M Fair Market Value: Assessed with: 38581 44,300 Valuations Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.293 39,000 0 39,000 NO Totals for 2004: General Property 2.293 39,000 0 39,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: 220 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I u u 7Qi51 53 MAR — Q 2M4 KATHUEA H. WALSA REGISTER OF DEEDS ST. CROIX Co., WI ST. CROIX COUNTY RECEIVED FOR RECORD SURVEYOR'S RECORD 01/09/2003 09:15AN REC FEE: 13.00 COPY FEE: 3.00 CERTIFIED SURVEY MAP LOCATED IN THE SE1 /4 OF THE SEI /4 OF SECTION 30, T29N,R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN, BEING ALSO A OF THAT CERTIFIED SURVEY MAP PREVIOUSLY I�F�E6 D IN VOLUME * 14, PAGE 3991 AS DOCUMENT NO OWNER /SUBDIVIDERS _. NO : THIS MAP IS MEANT TO SUPERSEDE THAT CERTIFIED SURVEY MAP FILED I JON 6 CHRISTINE PEARSON VOLUME 14, PAGE 3991 AS DOCUMENT NO. 633359 IN THE ST. CROIX COUNT 992 70TH AVENUE REGISTER OF DEEDS. A CALCULATION ERROR WAS FOUND INVOLVING THE ROBERTS, WI. 54023 BOUNDARY OF THOSE LANDS SURVEYED FOR JON 6 CHRISTINE PEARSON BEARINGS REFERENCED TO THE SOUTH LINE ON THE PREVIOUS SAID MAP. THIS MAP SHOWS THE CORRECTED BOUNDARY. OF THE SEi /4 OF SECTION 30, PREVIOUSLY RECORDED AS AND ASSUMED TO BEAR E114 CORNER, SECTION 30 S89 0 50'34 "E. ( ALUMINUM CAP FOUND ) SCALE IN FEET 1" = 250' w 9' 125' 250' 500' o 0 U3 V 22• UNPLATTED LANDS M -N- /l N89 0 49'41 'W 1317.87' N 20' NORTH LINE OF THE SEI /4 OF THE SEI /4 v uii NOTE: THESE LOTS ARE SUBJECT TO THAT m ELECTRIC LINE EASEMENT AS DESCRIBED F N VOLUME 674, PAGE 462 -463 IN THE Z 1 D ST. CROIX COUNTY REGISTER OF DEEDS. gi m a LOT 4 N 1,435,999 SQUARE FEET ( 32.966 ACRES) m INCLUDING RIGHT-OF-WAY N Q 1,418 836 SQUARE FEET 32.572 ACRES al m EXCLUDING RIGHT -OF -WAY 0 0� rn Z FZ-1 ' 0 CO fn N gl En J a �s IRON PIPE FOUND S89 0 31'01 "E 13.03' Q Z FROM COMPUTED POSITION. o 16' B' 8 "E z w 200.00' R dD0' "E G I CC �. ARAGE $1 0 0 DWELLING � S ° 50'34 "E 600.30' � 7 Q I N u ' 1 i 300.3 300.00' O Q�8 n �1�id cow T w a LOT - LOT O I L u cn �--' m((' m m Ri LO 0 m S m ° m m m m �• 0 .. co.. . o .. m...... . -� m 0 !00 m o BUILDING o SETBACK LI FROM R. -O. -W. o V IOL m S89 ° 50' "E �°, �°.� 1119.93' m m __300,00 - - -- m - - -- 300 - - - - -- m--- - - - - -- 5 9 _ 93 ----- - - - - -- m 152 .12' -' - 300.00' 300.00' _ OIL S89 --m ------ - - - - -- --- -- - S89 50_34_'E _ 1!19.95' ---- ---- -- - - -1 (--- Si /4 CORNER, SECTION 30 70TH AVENUE ( ALUMINUM CORNE CAP T FOUND ') ( I" (O USURD E D IAMETE R ) SOUTH LINE OF THE SEI /4 I uu NAIL FOUND.) CERTIFIED SURVEY MAP 9 1 1 V_O WM_E 16 , PAOE 44 LEGEND OT TAN : 99,927 SQ. FT. 2.294 AC.) II INCL. W. - INDICATES SECTION CORNER MONUMENT 90,039 SQ. FT. . ( ( 2.2.067 AC.) / l ,. •• •••.;, -.Z. .�� a, ( AS NOTED) EXCL. R. -O. -W. • I Z ICATES 1.25" (OUTSIDE DIAMETER) LOT 3 CONTAINSL 'SFPH IrV. IRON PIPE FOUND. 99,883 SO. FT. ( 2.293 AC. ) A ci y FG CL , INDICATES 1" X 18" ( OUTSIDE DIAMETER) IN. R.-O.-W. I. IRON PIPE WEIGHING 1.13 LBS. / LINEAR 89,995 SO. FT. ( 2.066 AC. ) N I .)r fv9Uhi1'. FOOT SET. EXCL. R. -O -W. ( R) - INDICATES PREVIOUSLY RECORDED PREPARED BY: GVI INFORMATION. '•," ti �—x- - INDICATES FENCE. F7RAN8ERb' 5 1AVEYIN& ' 1? • "�O � 1239 C.T.H. "E" u „.. NEW RICHMOND, WI. 54017 THIS INSTRUMENT DRAFTED BY: PHONE ( 715.) 246 -7529 1a JOSEPH W. GRANRFRG. JOB NO. 00 -039 ( CORRECTED ) SfUFT 1 OF 2 � Vol. 17 Page 4441 STATE GAR OE WISCONSIN EoRhi 1 – 1981 WARRANTY Di- 00CUMENT NO. �` l itisllecc madebaween LOUIS C. STARZINSKI and t ' -Cs GLOkA M. STARZINSKI husband and wife _ ; 5T. CFiCL(C J., V',''1 P,ac'a for Recora 3 f . x1 - JON�EARSUN and CHRIS'T'INE M I'L'A pN Grantor. 0 EG 1 3 1996 husband and wi at 11:00 A. M wllfliSSeYYi,Tdlu the saki Gautu+ Hri7istarut fora ,a valuable.uklennitw eauvcys to Grantee the following described real estate in St. Croix THIS SPACE RES F R DATA County, State of Wisconsin: -__ :__ _._ - -_ NAME AND AETUAN ADDRESS Thv SE 1/4 of the SE 1/4 of Section 30, Township 29 TNT ST i "r= TL71 -E North, Range 18 West the South S00 Peet of 7i79 37-vi. si . C.T./J, the W 200 feet Town / of unty, , � Warren, St. Croix Co l.iSCOit3itt. L..o-7- `J�d � This deed is given in complete fulfillment of a certain land contract executed between the above parties oil June 4, 1992 and recorded on June 8, 1992 in Vol. 954 PARCEL DENTIFICATION NUMBER Page 279 av Document Number 484426 in the office of the, Register of Deeds for St. Croix County, Wisconsin. A M �� C'S� �9 90 i 7,U -7ii� 2-1 TRANSFER $ !07 ; o 'fills is not (Is) homestead property. (is not) Together with all and sin the hereditaments and a Tpurtenantts thrrcuntu helonging; And rantors LOUIS C. STARZINSKI and GLUKIA M. STARZINSKI wartnols Ilia( Ale title is gaud. Indefeasible in fie simple and bcc and clear of cnctoubrauces except any ea5t:menta, covenants or restrictions of record and any liens or encumbrances created by ac or default of the grantees and will warrant stud fend the same. Dated tilts _ day f Y "�– (SEAL) (SEAL) Gds_. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) Slate of N9(sYalE)675 JW4 MINNESOTA ss. WASHING•11M audxntkated this da of County. rwnally came hcfure me 'his !:: � day of 19197 ,'he . ve named -LOUIS C TqR TN4KT AND fT• IA M TIT1411EMBERSTATE.BnRof WISCONSIN STARZINSKI (if not, I _ autilull" by TI Wls. stars.) to me known to be the persull < Z who executed the foregohtg THIS INSTRUMENT WA 0 17 WTED DY instru and ackngl3ledg the Notary i'ublic, unty, Wis. 'j (signatures may be authenticated or acknowledged. DuQt are not I t ) M con Is necessary. Y ..: x ��� lion date: M tiaESM t+ i! • t•4urcf ar < '< WV i Y< suna t,6nma many npa<ny sfku.W by iY1xJ .0 pnmeJ below ,bar s + WAK"N rY UP. SIAIF I'll. tip "'1", UNtiIN ■ � Pone Nu. l , 191r2 ° airn oyol IAurY, Co., q1e. MAwa tree. wo � 0 ? . o R ; 3 % q a E 2 • � CD � # E � / 7 ƒ/ o m 2 \/§ 2 § \ \ \ Q R / 2 a) J % \, �0 2 0 - / 5 \ § ƒ / -4 t \ § 2 CD 4 k / 2 o E E\\ a 6 m o � g■ . (D ® § 0 k \ _; 3 e k � co � k \ § / S 2 \ o 0 0 0 � �- ° E _ § § A < z / ƒ { o o \ 0 o ; - ■ 7 CD 7 / g Co § f / CD z \ § 2 { l / 2 �- D § ® 2 A C: ° E z a / ` � � - � § 7 . { w M $ --4 N X ! \ \ � k \ 2 / % > _ § � / c z % CD , � � § I � � � \ 0 \ � * § \ 6s §i �] Parcel #: 042 - 1084 -70 -425 02/17/2005 03:52 PM PAGE 1 O 1 I Alt. Parcel #: 30.29.18.475E -10 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * PEARSON, JON & CHRISTINE M JON & CHRISTINE M PEARSON 992 70TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 992 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 32.966 Plat: 1619 -CSM 17 -4441 042 -03 SEC 30 T29N R18W PT SE SE FKA CSM Block/Condo Bldg: LOT 04 14/3991 LOT 4 33.215AC NKA CSM 17 -4441 LOT 4 (32.966 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30- 29N -18W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 01109/2003 705153 17/4441 CSM 07/23/1997 1213/258 WD 07/2311997 954/279 07/23/1997 758/163 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 38582 Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 25,000 142,100 167,100 NO AGRICULTURAL G4 22.000 3,300 0 3,300 NO PRODUCTIVE FORST LANC G6 8.966 26,900 0 26,900 NO Totals for 2004: General Property 32.966 55,200 142,100 197,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 554 Specials: User Special Code Category Amount 018- RECYCLING SPECIAL ASSESSMENT 15.00 I Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 7 Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Joy\ Project Name and System Type: Location: Street Address Legal Description Township/County Contents: Page 1: Page 2: Page 3: Page 4: - 7 Z . le Page 5: Page 6: Page 7: , -,L -s Page 8: CO Y q,� �� (e. aree d Page 9: jyL iG �v�� /yG Attachments Plumber/Designer: Signed: .Credential Number: Date: o� .It /` \ _ Y ___ = �,�` Y �... . (� v � ........ . ... _,._. v f 1 I 1 C y' i ..- �\ j, ,, \ i ,�,,. / \ ,f �'�J V i,.