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042-1086-40-300
Wisconsin Department %f Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and L►uildirtg Division INSPECTION REPORT s 'tary Permit No: 430306 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: r Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). k A Permit Holder's Name: City Village X Township Parcel Tax No: Stout, Richard Warren Township 042- 1086 -40 -000 CST BM Elev: Insp. BM Elev: BM Descriptiop: Sectionri own/Range/Map No: 00 . .1 g k � # # a 4u'X( - w 31.29.18.483A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3 S_ 105-.3 16 Dosing /J � Ait. BM A C6 � 9 7 Aeration l � Bldg. Se er Holding St/ t Inlet $.3S 7• LO TANK SETBACK INFORMATION S Ht Outlet/ ; 363Y g -7 s 161--l- TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 25f' Septic } �00 `� � r Dt Bottom Dosing eader an. 14 — � iL► �fr �I.2�' ydy � 3 Aeration Dist. Pipe I p y s 0� Holding , Bot. System L 4 .- Final Grade PUMP /SIPHON INFORMATION 7 - (og 7, V7 Manufacturer GPM St Cover ! S S ?�.7 Model Number TDH Lift Friction d TDH Ft Forcemain ngth Dia. Dist. to Well SOIL ABSORPTION SYSTEM G BEDITRENCH Width / `_ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO 4 , P/L JBLDG IWELL LAKE /STREAM EACHING anufa�ture I / /_ INFORMATION CHAMBER OR J In - "W r T Of System: UNIT Model Number. D IBUTI N SYSTEM (J U-4 S Header! anifold Bribution x Hole Size x Hole Spacing- V�gnt2oAiraatake -- Length�_ Dia gth 0 Dia Spacing � a C SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 3 rd �S •2Vaf Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes � No � Yes R] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_J_/ `S / k * Inspection #2: / Location: 936 65th Ave. Roberts, WI 54023 (SE 1/4 NW 114 31 T29N R18W) 40 acres Lot D Parcel No: 31.29.18.483A 1.) Alt BM Description = 5'f C6 Vt✓n Ao-, h�,7� �- ///-?/o 2.) Bldg sewer length= - amount of cover = �3 Plan revision Required? 0 Yes V Use other side for additional Information. SBD -6710 (R.3197) Date Insepctoes re Cert. No. Safety and Buildings Division -�- — Co�unty r 201 W. Washington Ave., P.O. Box 7162 N) Pis" n j Madison, WI 53707 - it Number (to be filled in b of Department o Commerc (6013) 266 -315 RE �EI E� 7,30..30 Sanitary Permit Application State Plan I. . Number In accord with Comm 83.21, Wis. Adm. Code, personal information you pr, vide JAN 1 2004 _/ IA _ may be used for secondary purposes Privacy law, sl5.04(1)(m) I Project Addr I ss (if different than mailing address) CROIX GOUNTY 4?3 I. Application Information - Please Print Ali Information CFFIGE Property Owner's Na me -- - -YT - , Parcel Lo X v BI ck D 2 i��b - z j Property Owner's M ailing Address — Location (� City, State Zip C:xte Phone Number [A 'A, Section �/ (circl TO p (circl 11. Type T -7� N; R /S� Eor& ype of Building (check all that apply) 1 A 1 or 2 Family Dwelling -- Number of Bedrooms Subdivision Name CSM Number _ Q yG� El Public /Commercial - Describe Use _ *70 t A� �. State owned -Describe Use 1lI r Jr �i�+ f — — [City ❑Villagt�'Township of fz III. Type of Permit: (Check only one box on line A. Complete line B if applicable) �y� �}� A. rN System _ ❑Replacement System Treannert/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 pate Issued I Before Expiration Ptum`aer owner IV. Type of POWTS Sys tem: (Check a ll that apply) w Non - Pressurized In - Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in, of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recir culating Synthetic Media Filter �Acaching C hamber 1 Line ❑ Gravel -less Pipe ❑ Other (explain) I V. Disper sal/Treatme nt Area Inf a y Design Flow (gpdi Design Soil Application Rate(gpdsf) /]�i-sper 1 Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info in r Total Number Manufacturer Prefab Site Steel Fiber astic Gallons i Gallons of Unit, )6 Concrete Constructed l Glass y New Existing Tanks Tatilcs Septic or Holding' Iank - — Aerobic Treatment Unit -- Dosing Chamber - fk) V II - Responsibility Statement I , the un dersigne d , assume responsibi for irnst llation of th POWT shown on the attached plans. Plumber's Na me (Prim) a lumber's Si gnaturePRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) VII e unt /De artrnerrt Use only- Approved ❑ Disapproved Sanitary Permit Pee fincludes Grro�undwater Date Is s ed suing Surcharge Fee) `fd{f J g Age t Signature o "tamps,),, ,J= I Owner Giv en Reason for Denial V ' #pprova! /Reasons for Di pprpya f 1 1 Septic tank, effluent filter and M rl S� dispersal cell must all be serviced / maintained D !,� � «— � �0_ as per management Alan provide v p um er. 'w( � All se ack requirements must be maintained as per applicable code /ordinances. �S Atlach comple piarns (to th ounty only) for the system ea paper not less th x 11 htch�s to siz CST / SBD -6398 (R. 01/03) C r 4�GY f' ��%�y e l Jv�✓� DZJ as!s� A c - Ile i G X13 � Avg . •� G !� f V1 -3/0 s G . � y ; `ia�r� 5'fi � S�a=��- P a'•y� e l _ _ T°'w�r/ 4�ZJas��to r/ r RECEIVED Wisconsin Department of C mmem4AN 1 4 2004 SO IL EVALUATION REPORT page l of Division of Safety and Buildii gs ST. CI;M� "Oe with omm 85, Wis. Adm. Code County Attach complete site plan Fi 'f12 x 11 i ches in size. Plan must include, but not limited to: vertical and hortzontal reference point (BM), direction and parw I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. P Q — - 00 b Please print all Information. viewed y Date Persona( information you provide may be used for secondary purposes (Privacy law, s. 15.04 ( (m))• Property Owner J jj Property Location ro G (c1 3' TZ7 j Govt. Lot V j 114 V 114 S S I T Z — ' j N R J g E (oreN' Property Owneess Mailing Address Lot # Siock # Subd. Name or CSM# p7'rft( Cay State Zip Code Phorve Number ❑ City ❑ Village ® Town Nearest Road ) - - 5o,, 5 ( - 7 /S) S'Yf - G L,/a rr c - ® New Construction Us Residential /Number of bedrooms _ _ Code derived design flow rate o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 r z 4,-�j Flood Plain elevation if applicable ft. General mendations: 5 0 e vn e- (c v ' 4o {� q�. 0 d f� w e rCl3, SZ� /s�r� ce �VU)�. j ce- S►- P -�.c�• 3 �J 3 �5 l 6' ® Pit Ground surface elev. fi t. Depth to limiting factor » in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 10#1 `Efl#2 6 ` 10 S ZmSb C ✓ CS . S� e z Bori # B oring Ground surface elev. 9G•�Qd ft. Depth to limiting factor in. soil 8Mficetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 �' s �s - - , 1 l Effluent #1 a BOD > 30 < 220 coal. and TSS 40 < 150 mg& ` Effluent #2 = 90D < 30 mgll and TSS < 30 mg1L CST Name (Phase p&* CST Number a ,� �l ww Z5 2 Address Date Evaluation Conducted TaWphorre Number 7/S 7Gp .ate r I � a 1 1 'LLLS"Z A-U d0 1 I E - 99Z - 809 i luatulasdap AP IMtt ossold 'asewq{ ois awls tts ul lsu23eut paau so soo,naos ssaoos of Malslsss peon noAjI - .toAolduto pus Jopinoid oolmos 4jumioddo lanbo us sl 001 awmoZ)3o luougndoa oqL lAu o£ > SSl Pue 'UBtu of >'OOS : Z# 1LMY13 . os t > m, SSl PUB JAM OZZ > o¢ c 0 009 = t# Sue W3 . 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I I 66'OLE JM„ E9.69 °OON will v O d A I c co — f W c I I o � I col ,D Cil C11 Ul I co °I I s� tT� W I s °� ca CU J A I I I 6` 'z 1� I 2 U S N i Y N N 5. J) co 41 11) O bn { ,....,,„" I 'tea •�.:. W S02 "W 1084.10' 284.22' L ( NO2°Ory11 "L NO2 ° 00'1 1 "E 1368. ARC-9 L° lON lid38 Ol a3W f1SSV '9E I — _ — � . — �' -- — — � { t01103S 30 b /l3N 3H13O 3Ni l 1SV3 1 \C) ? -{ !H1 01 030N383338 388 SJ Nl8V38 � L5 '? ° o cn \ , �p �� i c,' Cl; Z i ui �� k 1 � - I , di r. m m o I I 0 :0 VA3N 3H13O 3NIl 1SH3 r 'IC NIMI ,fl(1'7,f ?F �.. /b07_n%1C� •.�_ •�•• = � { Y.. �' "r. f i LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1086 -40 -000 Parcel Number 31.29.18.483A OWNER NAME: First RICHARD O & JANET P Last STOUT PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 31 TOWN 29N RANGE 18W %160 '/.40 Line Description Line Description TOTAL ACREAGE 22.740 PLAT—, LOT BLK 01 SEC 31 T29N R18W 02 EXC W 298 FT OF S 33 16 03 &EXC THAT PT TO ST OF WI AS 17 3 � 04 DESC IN 913/201 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1086 -20 -000 Parcel Number 31.29.18.482A OWNER NAME: First RICHARD O & JANET P Last STOUT PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 31 TOWN 29N RANGE 18W %160 '/440 Line Description Line Description TOTAL ACREAGE 22.700 PLAT LOT BLK 01 SEC 31 T29N R18W SW NW 15 02 EXC CSM VOL 1/221 & EXC PT 16 03 TO ST OF WI AS DESC IN 17 04 913/201 & EXC PARTS TO QC'S 18 05 1436/464 & 1436/469 & EXC 19 06 CSM 13/3678 EZ -U- 1648/138 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit bo PARCEL D C%L� A PARCEL OF LAND LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4, PART OF THE SW1 /4 OF THE NW1 /4, PART OF THE SE1 /4 OF THE NW1 14, AND PART OF THE SW1 /4 OF THE NE1 /4 OF SECTION 31, T29N, R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS; COMMENCING AT THE WEST QUARTER CORNER OF SAID SECTION 31; THENCE N01 ° 16'38 "W ALONG THE WEST LINE OF THE NORTHWEST QUARTER OF SAID SECTION 31 A DISTANCE OF 703.09 FEET TO THE POINT OF BEGINNING; THENCE N01 0 16'38 "W ALONG SAID WEST LINE A DISTANCE OF 775.92 FEET; THENCE S85 °11 "E A DISTANCE OF 452.65 FEET; THENCE S55 0 43'34 "E A DISTANCE OF 1501.30 FEET; THENCE S84 ° 38'39 "E A DISTANCE OF 1293.10 FEET; THENCE N56 ° 53'56 "E A DI TANCE OF 1187.27 FEET; THENCE S02 ° 00'11 "W A DISTANCE OF 1084.10 FEET; THENCE S89 ° 30 1 33 "W ALONG CENTER LINE OF 65TH AVENUE A DISTANCE OF 2250.96 FEET; THENCE N00 0 59'53 "W A DISTANCE OF 310.99 FEET; THENCE S89 0 57'39 "W A DISTANCE OF 265.04 FEET; THENCE S00 0 59'53 "E A DISTANCE OF 313.08 FEET; THENCE S89 0 30'33 "W A DISTANCE OF 45.38 FEET; THENCE N00 0 39'51 "W ALONG THE EAST LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 1, PAGE 221 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE A DISTANCE OF 273.81 FEET; THENCE N37 0 29'33 "W ALONG SAID EAST LINE A DISTANCE OF 238.41; THENCE S89 0 03'45 "W ALONG NORTH LINE OF SAID CERTIFIED SURVEY MAP A DISTANCE OF 442.43 FEET; THENCE N50 ° 36'59 "W ALONG THE NORTH LINE OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 13, PAGE 3678 AT .SAID REGISTER OF DEEDS OFFICE A DISTANCE OF 294.98 FEET TO A POINT ON A 80_00 FOOT RADIUS CURVE, CONCAVE SOUTHWESTERLY, WITH A CENTRAL ANGLE THAT MEASURES 81 0 06'17 ", A CHORD THAT BEARS N52 0 07'29.5 "W AND MEASURES 104.02 FEET; THENCE ALONG THE ARC OF SAID CURVE AND ALONG LAST SAID NORTH LINE A DISTANCE OF 113.24 FEET TO THE POINT OF TANGENCY; THENCE S87 0 19'22 "W ALONG LAST SAID NORTH LINE A DISTANCE OF 457.00 FEET TO THE POINT OF BEGINNING. PARCEL CONTA 55.72 ACRES. SUBJECT TO RIGHT -OF -WAY OF 65TH AVENUE AND SUBJECT TO ALL EASEM , AND RESTRICTIONS OF RECORD. VOL '1371. p4cf 568 590366 s WARRANTY DEED Document Number: _ ' Erl TFR'S OFrIC �T, CROIX' itq, ReC'4 '�r rt�seN Return Address: OCT 3 41998 ' - 11169101W of DNds Parcel I.D. Number (PIN): 042- 1088.10 042- 1086 - 20: 1042. 1085.50: 042- 1085.60; ,.020- 1108 -50; 020.1108 -80; 020.1108-70: 020 - 1108 -80 This Deed, made aetween Frederick G. Lenertz Land and Cattle Company, L.L.C., a Wisconsin limited liability company, Grantor, and Richard 0. Stout and Janet P. Stout, husband and wife, as survivorship marital property, Grantee, Witnesseth, That the said Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: ' NE 1/4 OF SECTION 36, TOWNSHIP 29 NORTH, RANGE 19 WEST, ST. CROIX t COUNTY, WISCONSIN THAT LIES SOUTHERLY OF INTERSTATE HIGHWAY 94. 'i W 1/4 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING SOUTHERLY OF INTERSTATE HfGHWAY 94 EXCEPT CERTIFIED SURVEY MAP IN VOL 1, PAGE 22j-I EXCEPT PART IN j' VOL. 634, PAGE 138 AND EXCEPT PART IN VOL. 913, PAGE 201. H, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING NORTHERLY OF 65TH AVENUE AND SOUTHERLY OF INTERSTATE HIGH This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging: And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this 30th day of October, 1998. FREDERICK G. LENERTZ LAND AND TRANSFER CATTLE COMPANY, L.L.C. Steven B. Goff, Power of Attorney t Frederick G. Lenertz ACKNOWLEDGMENT STATE OF WISCONSIN ! 1 ss. ST. CROIX COUNTY 1 1 { Personally came before me this 30th day of October, 1998, the above named Steven B. Goff to me known to be the person. who executad the foregoing instrument and acknowledge the same. I Parn et'a A. S orude, Nc Public St. Croix County, Wisconsin �40., a My Commission expires: March 17,ZQ� ` r THIS INSTRUMENT DRAFTED BY: •••' "" c .. r Steven B. Goff Bye, Goff b Rohde, Ltd. PO Box 167 River Falls, WI 54022 SBGILENERTZ\CLAPRD 1 WD i o num��tar r i ums s nq FAX N0. . 7153863121 Jun. 10 2003 02: • ST CROM COLLN'`ri SEPTIC TANK MAIN .A,CREEMBNT AND R ' tV'z'_"'k () WNE�HIP CERTIFICATION FO ®waerfouyer mailing Addinsa _ S ft'u!a1Lt e T , (� Property Address (Vori stic�n regcairad item !attain& Department for new consuuctisua;... .,... Ci ty/ State Parcel I'deatiflctttion Numb.,-r Property Location *g t/. T ' /4 Sec., „„Y, -RA Town of , y2 — 2a � °� �tr Subdiviait n - 3 , L SS- 7�i�cres' CertMed Survey Map � � �........ Volume .� page #r: vkcn Warri+lrtty std # Volume, page # s�o Spec house &M 0 to Lot lines identifiable Yyes 7 no YI = MA1=4=L Ympmper was *admaimeaa:tcaof your septic system could remult is 4U promm'Mra fai�un to bacdle wastes, Propor tray couaiste of p4apiag out tba septic t=k every thmr, yeere or sooner, if rro4d by a Iiceased pumper. Whit you pat iz :o tL s At :L :,. oau affbot the fmtiaa of the septic tQr k as a U*At==t stalls in tse waSx disposal System. The property o3wner agrees to subs* to St. Croix Zoning Deputmeat a cartiflcation corm, signed by tats o X Mr d masterplumber, jouraaymt► nplumber, zrstirictedplum` �. rasa�iceacedpv�parveaii�tbat�l )tttaas -site �asts�.vaterck :�pn�, ,;��, is in proper opMdus coaften aadlor (2) after iaspett it!t alld ptuaping (if noccaeasy), the upkic taros is leas tttax•. ; _ll o% r; . Ilwv, tbA wusersigaed have read she above requitem*31ts and %grca to caaint= the privats $swage dispoaaJ sYR= wit!: ';be set fbrtb, herein, art sot by the Depsrcutent of Co=arco sad the Dspartmact of Nstural Rssourcaa. State of Wisconsia Cur' F stati,cp !hat your e00a system has boars mai*4 edmcsst be complored and rett =sd to ztae St. Croix Comfy ZOV4 OYT" Ce q ' drys of this !brae year oxp+i"On date. Rxt"- . (S� '! iitm .//S 0 � 7 SIONA71W OF APPLICANT DATE ()Mm CAjt MI ^.j'x'lt0 I (we) oertify that sl? ststssuaass ce this fora art true to the best of ray (our) Imowledge. I (we) as: ( are) tl:t o%%:- the propasry da icAbed tbove, by vim= of g u zMnty deed recorded i71 Resistor of Deeds offue. log SIGNA'fM OF APPLICANT DATE +saes *$ Aria idorntation flsat is :nia ropY96oatod may result in %�* seaitary psmut bring revoked °vy Uha ZoaiaLg Dgar,-,. e.: "* Include with tlita applieatiou! a suaspad watzenry deed From dta Rallater of fide office a copy of the certified survey map if refe=e is made iz the w ar maty deed ° r - { Wisconsin Department of Commerce SOIL EVACUATION REPORT Page -I— of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper less do" 81/2 x 11 inches in size. Flinn must Include. but not limited W. vertical an o nt BM), direction to n and parval percent slope, scale or dimensions, h a �e ca to nearest road. v d Date Please riot aft lrtfonnallon. Parsonnf mformalion you provide may b used fond f y po rp-ps o s Privacy ew, s. 15.041 Property Owner ( PrapeAy Location ST_ CROIX COUNTY GovL Lot 5,6 1/ S < T o77 N R `� E (o Property Owner's Mailing Address C E Lot 9 Block # Subd. Name or CSM# ZUY State zip Code Phone Number 0 City Cl Village Urrown Nearest Road (7 [F New Construction use: Residential / Number of bedrooms; Code derived design flow rate O GPD {] Replacement ❑ Public or commercial - Describe: _ Parent material G 0 f �h a Ste_ _ _ . �^ Flood Plain elevation N applicable ft• General cot mtents ys�` L e(-e 0 ' � q� 4U Lo U. e f 9p a r3 and recommendations: ' / f Boring # `] Boring �y� z� ft. Depth to limidn faco � in. 111 tit 111 ❑ PR Ground surface elev- g factor Son tipf Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPD in. Munson au. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •EW2 0 -4 u N3 f i ® Ong # ❑ Boring � Pit Ground surface elev. �7' �U ft. Depth to limiting factor ` in. Sol A Non Rate Horizon Depth Dominant Color Redox Description Texture StruGuse Consistence Boundary Roots GPOR in. Munson Ou. Sz. Cant Color Gr. Si. Sh. d "8101 - Eff#2 0 - 3 ��� 2m 5 b V 1329 ry4 r 1 sit -�31 0-s I Efltuent 01 BOD > 30 220 mg/l. and TSS >30 1150 mgfL ' Effluent 02 : BOD, = 30 mg/L and TSS = 30 mg& CST Name (Please Print) Signature CST Nurt"t Address Date Evaluation Con=ed Telephone Number f Page _ � property Owner ��fG� Y Parcel 10 # Wv` r �1t 1 3 Boring # 0 Boring stxface ei� L= -ft Depth to 9 factor -�--�^ _ in. Sol Rate a Pit Ground Consistence Boundary Roots GPM Horizon Depth Dominant Color Redoz Description Texture Structure 1 •>rffi2 In. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. — ✓ C Z i ' � # ❑ Boring in. ❑ — R. Depth to limiting factor Sol A oNea6Wr Rate Pit Ground surface elev. Roots GPDIff Horizon Depth Dominant Color Redox Description Texttae Structure Consistence Boundary 1 •EtBf2 Qu $z. Cont. Color in. Mansell Gr. Sz Sh. Boring R. Depth to limiting factor in. E] Boring # Ground surface eiev. — Sol AoaNcadOrl Rate ❑ Pit GPDIIF Texture Structure Consistence Boundary ; Roots Horizon Depth Dominant Color RedoxDeaaiptitin •Eff#1 'E2 in. Munseii Chu. Sz. Cont. Color Gr. Sz Sh. { I l • Effluent #2 = Bt1D : 30 mglL and TSS <- 30 mcyL • Eiduent #S = BOD, > 30:S 220 mglt and TSS > 30 : S 150 nlgiL s - 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 -877 SHD- ivN11R.bNOC) I I r PAGEZOP-3 NAME LOT# LEGAL DESCEMON:_1 /3 1/4,3 T, ,N,& _„E(or)W1 SCALE: I �d F ( ELEVATION: 10 V . K . BM 1 DESCRIPTION• u ' h // BM 2 ELEVATION: BM 2 DESCRIPTION: �v c Z � �,� SYSTEM ELEVATION: �o � , V �- 7 4 - p o SYSTEMTYPE: �S A' CFO G. I 0 i o Z- �r•l 11 � SIGNATURE: Safety and Buildings Division County �role 1 t sT 201 W. Washington Ave., P.O. B ox 7 1 62 ,s� 0nsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Dep artment of Commerce (608) 266 -3151 D 30( k Sanitary Permit Ap Aication State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, pens ttal i YonV �'1"0, may be used for secondary purposes Privac La 1, " "" ° Project Address (if different than mailing address) i. Application Information - Please Print All Informati n i l 0 0 3 ��� W� FPR-V., b Property Owner's Na me Parcel # Lo P� Block N cYl°s U Property Owner's M ailing Address P " Arty Location Z J k 3 a Lr t°c- T Yc2 t �/ I !3s' Jj W � .3/ pJ �t, a,5ection City, State Zip Code Phone Number 02 (circle o e) T N; R /� E o II. Type of Building (check all that a ly) I1 or 2 Family Dwelling - Number of Bedr s .� 5 w Subdivision Name CSM Number ❑ Public /Commercial - Describe Use J j T.2 �tiYt°s 11 State Owned - Describe Use ❑City ❑Village lXtownship o fjrJetvy'e,✓ III. Type of Permit: (Check only one box on lin Complete line B if app able) A. ANew System ❑ Replacement System Treaanent/Holding Tank eplacement Only 13 Other Modification to Existing System B. CJ Permit Renewal El Permit Revision ❑ C ge of ermit Transfer to New List Previous Permit N tuber c D Before Expiration Plumbe wner 1 IV. Type of POWT5 ftsteur (Check all that appl / Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soADri Mound < 24 in. of suitable soil t] At-Grade El Single Pass Sand Filter ❑ Constructed Wetland C] Pressurized In- Ground ❑ Holding ❑ Peat Filter 11 Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter C3 Leaching Chamber Line ❑ Gravel -less Pipe Other (explain) V. Dispersal/Treatment Area Information: X Q.Qk k Design Flow (gpd) Design Soil Application Rate(gpdsf) Di rsal Area equired Of) Dispersal Area Proposed (sf) + System Elevation 5'd _T VI. Tank Info Capacity in Total Nr nufacturer Prefab Site Steel Fiber Plastic ! Gallons Gallons ,It s Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank leae e_ 11 e V Aerobic Treatment Unit Dosing Chamber to / Z J, e5 e Y' VII. Responsibility Statement I, the undersi ed, assume responsibility for i mtallation of the POWTS shown on the attached plans. 1 Plumber's Na me (Print) Plumberl Si gnature MP'/ PRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip C e) VIII. Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ui Agent Sign re (No Stamps) Surcharge Fee) $ 2 ,r/� �--. . - I ❑ Owner Given Reason for Denial �+ IX. Conditions of A roval /Reasons for Disapproval f�� �� Ap 3 N ° > 2c� c a..,.. 62- �I t'Swwvv( °- SYSTEM OWNER: 1. Septic tank, effluent filter and '�� dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less then 8112 x 11 inches in size SBD -6398 (R. 01/03) °GGcc.��w ��. 2o' r' to 5 v F "o W g3 ee,c ! fl �5�� M � LZAL -- P'� ' P -D Wisconsin D of commerce SOIL EVALUATION! REPORT Page of _ l__ -� Division of Safety and BuBdmgs . in accordance with Comm 85, Wis. Adm. Code County Attach complete silo plan on paper not less than 81/2 x 11 irfcdles M in direction and si t Parcel I.D. include, but not limited to: vertical and horizontal reference point ( ). direction percent slope, scale or dimensions, north arrow, and loc oWn and distance to nearest road. by Date Please print all lnfbrmatfon. Pemnei information you provide may be used for secondary purposes (PAvacy Law. S. 15.04 (1) (m))• Propertyowner < L Property Location `G a t S Lot S�J 114 1l4 S �[ T a2 Q N R E {or Property Owner's Mailing Address 0 . Y , ` Lot # Block # Subd. Name or CSM# �j s s. - 1a 6j,�Vie S s �- City fate Code Phone Number ❑ Village [Town Nearest Road sin � t S /(r (7l `1 - 6r 7 (iva I'r e [� New Construction Use: 1�3 Residential / Number of bedrooms 3 ` t—_ Code derived design flow rate D// O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material UU c S { Fkrod Plain elevation f app t le __LfLI General comments s y Z, a recommendatirms: � � d.d4 J-•-�- At 6 � .� + "' '' U� 3 � e e C s CS I 15 1 LX k w t Boring # Pit Ground �_ (� stxfatx, elev. _ ft. Depth to limiting factor _ in. tion Rate Horizon Depth Dominant Color Redox Description Texture MConsistencee Boundary Roots GP IfF in. Munsell Qu. Sz. Cont. Color 'Eff#1 'Eff#2 - i IUD (31 S lZ_3 �. L/ /� — SQL/ � 3g /0 ' L& .4- 94. Za ❑ p � ` ® Boring # Boring Pit Ground surface elev.Z ft. Depth to limiting factor - in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I v 33 W / -- _ 1. QZ A IA • Effluent #1 WD 5 :- 30 < 220 mglt and TSS -30:5 1511 mglL ' Eftert 02 - BOD < 30 mg1L.and TSS <_ 30 mglL nature CST Name (Please CST Number " Z, 5 Address �� Date Evaluation Conducted - Telephone Number �e1^i/I- c,/ yoz5 — — its`- 7�a....az Parcel ID # Page Z- of _ Property Owner _ -- 8or.+g # ❑ Bonng Sol Pit Ground surface elev. ft. Depth b knifing factor / C - in. Rate Horizon ED h pom�rarrt Color Redox Description Texture Structure Consistence Boundary Roots 7GP Gr. Sz Sh. tf #2 Muni flu. Sz Cont Color 3� IO, Ile 60 ❑ Boring # ❑ Boring ❑ Pit Ground,surfece elev. R Depth to Cunning lector in. Sob Rate Horizon Depth Dornsrant Color Redo. Description Textue Structure Consistence Boundary Roots GPDf1P in. Munseq flu. Sz Cont. Color Gr. Sz Sh. •EtT#1 *01112 Boring in. # b lurutir) factor ❑ Boring ❑Pit Ground surface elev. R Deli g Soi Rate ou Horizon Depth Dornirrmrtt:olor RedoxDesaipfion Texture Structure Consistence Boundary Roots GPOW lo Munsen flu. Sz. Cont. Color Gr. Sz Sh. *MI •01112 i I • Efti ent #1 = BOD, > 30 <_ 220 mgll and TSS >30 <_ 150 mglL ' Effluent #2 = BOD, <_ 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 60 9-266 -3151 or TTY 608- 264 -8777. I I t � PAGEaOF 3 NAME: �"'� LOW \ LEGAL DESCRIPTION: 1/4 1 /4,S_T ,N,R, E(or)W SCALE: 1 %b Y (3(A1 ELEVATION: 100 ( A BM i DESCRIPTION: !6 d, BM 2 ELEVATION: g S� BM 2 DESCRIPTION: C e / Z Azc 42, < SYSTEM ELEVATION: SYSTEM TYPE: OOJI V' n � d✓� a N I% VA e_ P D CL a b 4 �. o b jol SIGNATURE: „s ._ ATE: 7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS EOwne NA Septic Tank Capacity Q(1 C al ❑ NA o3olp Septic Tank Manufacturer r �, 0 NA Effluent Filter Manufacturer (q DESIGN PARAMETERS ❑ NA Number of Bedrooms 3 ;103N A Effluent Filter Model �Q d`4 Number of Public Facility Units A Pump Tank Capacity �;? al ❑ NA W Pump Tank Manufacturer 3 -� y O NA Estimated flow (average) �� al/da Design flow (peak), (Estimated x 1.5) Pump Manufacturer a aoA t7 NA ',,� al /do Soil Application Rate galidulft Pump Model 0 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fets, Oil & Grease {FOG! 930 mg /L ❑ Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L O NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS1 9150 m g r- ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Collis) ❑ NA Biochemical Oxygen Demand (SOD,,) 530 mg /L O In- Ground {gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA CI At -Grade ❑ Mound Fecal Coliform igeometric mean) 510` ofu /100mi ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: C] NA Other: © NA Other. C3 NA "values typical for domestic wastewater and septic tank effluent, Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency mont s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one-third lY of tank volume ❑ NA onths) (Maximum 3 years) O NA Inspect dispersal Collis) At least once every: 3 lEearts) month(s) ❑ NA Clean effluent filter At least once every: earls) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: r Cl earls) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: r ❑ year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ ear Other: O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal Collis) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized Components, pretreatment units, and any servicing at intervals of 512 months, shalt be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of ' START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) 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. �� ❑ d site 001 e tank ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS I _ POWTS INSTALLER POWTS MAINTAINER c .. Name Phone r _ V � Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5T. CQp /)C C�r1' �7prJIN Phone Phone — 4f T. 3EEG. 4G&0 This document was drafted in compliance with Chapter Comm 83.22(2)(b)l1)(d)bif) and 83.54(1). (2) & (3), Wisconsin Administrative Code. ' SEPT TANK PUMP CHAYBER CROSS SE — !ON AND SPECIFICATIONS SEPT 4" CI VENT PIPE 12" M IN. ABOVE GRADE WEATHERPROOF ? 25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER 1 W! PADLOCK FINISHED GRADE WARNING LABEL 7 4 C I RISER l} „ MIN. wr ** is" IN. 6" MAX. INLET r l WATER TIGHT SEALS GAS- IPE 3' TIGHT APPROVED A SEAL JOINTS WITH PPROVED -j— ALM APPROVED PIPE B ` ON 3' ONTO NTO 3' —C�"" ; SOLID SOIL OIL ** OFF ELEV . FT.-- OFF RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC ! DOSE TANK MANUFACTURER: c�e__..e ' NUMBER DOSES PER DAY: TANK SIZES SEPTIC & , e le GAL • DOSE VOLUME INCLUDING DOSE ,lp �`4 GAL. FLOWBACK: j'� _ GAL. ALARM MANUFACTURER: �/ ��a �r�s -+ CAPAC I i IES : A = INCHES =GAL • MODEL NUMBER: SWITCH TYPE: rte_- B = 2 INCHES = YQ� GAL. PUMP MANUFACTURER: C = S INCHES =GAL. MODEL NUMBER: SWITCH TYPE: /��p -r D = _ ,,, INCHES = , GAL. REQUIRED DISCHARGE RATE � d GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET + MINIMUM NETWORK SUPPLY PRESSURE -8iff FEET + FEET FORCEMAIN X .2. FT /100 FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD = ZFEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH; DIAMETER __,�___. LIQUID I)EP'ITT " �• ��✓� �. ., SIGNED: LICENSE NUMBER: ?�77EfO DATE: 31 1 1 _ Ay I /$$ y Submersibl Effluent Pump t Ems' EP05 on glow �tiiron • WAS • f�l all MIA %no r , tort w ,04 # �0yo1Q1 to hMt den, t1Nr'+� h w1ww leer 1YtOm a aw y TOetv — � FUN t p �Ue: 0.+4 #�P� t1t� 1OINpN p,OMN� Came. Swan dui>t + lOtV, s4 N=,10 M M�d w�r� ' RPM, t►ttla Ovetlold Ii MIMw� ' � wmn�sio ngnt. �,g • ��� 1pwet 4Y��t a 160� iiPM' �iNtWla U d OUR t with tdi lttht: firm' ' MO� ' = w w ,108jTD f �Ot � put WN for �1�1'INO 1 u0 #e hrl, n ( t;BA ii N mcKW nu m bom A ow, t h irph'� with c �dM� end In "F" or C".y abd * rn ,iJfIN IMPON Pw*Mww th ronp II&AIna plug +aal Rua�d Ott ' thlrmo C dWF P W* MOM MAR WWI i tzlplbiN�y, �6 Mam"M� to �NrJ. U WAS i 4 t � Q WD M a a� •- '3 E o � w o °o E cow m w N a az c CO a " y a b w v c 0 c `� c c > • o 0 i 0 C N C � `p N to � Y I m > O O Q O> p 2 O N N E N _ h O- 0 _0 C a N � row a y��rn - > • C N L N 3: h N . 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C N + = @ w y �. O O N .0 0) L N O C O IL C c Y 0 a c'v 7 N �y Z (n D w Z I c c m N Lo N — N a N CL o m c o 1 CD C1 4 a� �n o aA Z CL iL IL a � I • 7 O N M d C QQ } N O` 0 E C) o 0. Q m U _3 NQ U') � Q Z to m A CO ' 9 w H c v _ C cc u ° o ~ U ° C 0 � N t0 C rn N �) E C L )�1 t � O + • Cl) U) Cl) O Z C a O I V • w ° r m c _1 A ti 0. oUS) Parcel #: 042 - 1086 -40 -025 11/30/2007 09:20 AM 1 OF 1 Alt. Parcel #: 31.29.18.483A -10 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/23/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - STOUT, RICHARD O & JANET P RICHARD O & JANET P STOUT 1353 AWATUKEE TRL HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ` 936 65TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC i Legal Description: Acres: 55.720 Plat: N/A -NOT AVAILABLE SEC 31 T29N R18W SE NW EXC W 298 FT OF S Block /Condo Bldg: 330FT & EXC THAT PT TO ST OF WI AS DESC IN 913/201 & EXC AS DESC WD 828166 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) ASSMENT INC 042 - 1085- 50- 025(478A) & 31- 29N -18W 042 - 1086 -20 -015 (482A1) Notes: Parcel History: Date Doc # Vol /Page Type 06/23/2006 828166 WD 02/21/2006 818902 EZ -U 10/30/1998 590366 1371/568 WD 10/30/1998 590360 1371/554 CO more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/08/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 20,000 138,500 158,500 NO 2 UNDEVELOPED G5 54.720 82,100 0 82,100 NO Totals for 2007: General Property 55.720 102,100 138,500 240,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042- 1085 -40 -000 Parcel Number 31.29.18.4778 OWNER NAME: First RICHARD O & JANET P Last STOUT PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 31 TOWN 29N RANGE 18W 1 /4160 '/440 Line Description Line Description TOTAL ACREAGE 0.300 PLAT LOT BLK 01 SEC 31 T29N RI 8W PT NW NE 15 02 S OF HWY 94 EXC PTT -s F 16 03 WI DESC IN 913/201 17 04 18 05 19 V 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. 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