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HomeMy WebLinkAbout042-1088-30-050 c 1 9 0 C 0 0 d I � O cp - 0 — V -' Z O A (n w �= m 3 fn o � d m 3 o y �p ww ° g ^' I O � fe y O m .O. R O N N C N c < C O ' O Oo O Na 7 Nn Si = m C 3 3 3 w v o o � �_ e o D ° (nZ (nz> m 0z (nz> —�� »' e� m UZI D (n D y m f5 D fH A y $ 7 C � ?. a IW = a a IW o m N 3 � 3 ° ° °c0°oCD O CL < z < z o o m y m O m o 0 0 0 y y W W 3* a �• z Z O O O I ° (n (n v ° (n U) � � ae � c 3 �i c c 3 (A N N N 3 3 3 3Q vvc c� i m m m m m m� y 1 m N < < N C C C L 3 3 0 3 3 = y o I d m Q d m 0 o a-V d a m a a H 7 7 .. y LO o fo w z °� CD z > > m � A y y O0 M y N O P Z 0 0 �3 0 3 a A Z o °t m °i m R i o o �_ O 3 O z N . CL 0. W Z 0 CD to a m o FF CD _ 3 m m z W 4/ O. O s d f G. o il 8 m� m 0'D O O. a N 77 m N'O < a N_ 0 2L ID N � < �. CD I �� (�pp c m -O. a o CL . N �. y 0 C1 S� N �. y 7 71 m K S' < CD O y . fD K S < 7- 7 a� c Dy m m aI D c y m o a CD m o'n 3 m m m o 3 m y O y < N y m ^_' O to �< y y m Cl D m j 3 m n y m j 1 v 3 A I •O �y •O .�.d 3 ��y w S m OO D = m OO tc 0 ��p m� aO_<e W y f p f M a0CD �. f0 N '00 0 0 — N fG H� R O � it a 8 2, 9 9 M ;a m C o o 3 n . A am<. a aa_ 3 0 0 a M. G-1 0 ' o ID O . ? O A 7 �O I W W O o ti l m pro p I O O O O qb o y O o o o a N PARCEL B //DD S T °z A PARCEL OF LAND LOCATED IN PART OF THE SW1 /4 OF THE NE1 /4 , PART OF THE NW 1/4 07 T SE1 /4,PA OF THE SW1 /4 OF THE SE1 / 4 AND PART OF THE SE1 4 THE SE1 4 OF (cqo ZlV SECTION 31, T29N, R181i, TOWN OF WARREN, ST. ROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS; BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 31; THENCE N00 °01'11 "E ALONG THE NORTH -SOUTH QUARTER LINE OF SAID SECTION 31 A DISTANCE OF 2629.88 FEET TO THE CENTERLINE OF 65TH AVENUE; THENCE ALONG SAID CENTERLINE S89 °52'38 "E A DISTANCE OF 210.00 FEET; THENCE S00 ° 01'11 "W A DISTANCE OF 1560.23 FEET; THENCE S89 0 32'50 "E A DISTANCE OF 1104.65 FEET; THENCE S00 0 05'46 "W ALONG THE EAST LINE OF SAID SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER A DISTANCE OF 763.66 FEET; THENCE S89 0 33'04 "E A DISTANCE OF 265.04 FEET; THENCE 300 °10'22 "W ALONG THE WEST LINE OF LOT 2 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 17, PAGE 4540, AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE A DISTANCE OF 303.58 FEET; THENCE N89 0 40'44 "W ALONG THE SOUTH LINE OF THE SOUTHEAST QUARTER OF SAID SECTION 31 A DISTANCE OF 1577.84 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 41.62 ACRES. SUBJECT TO RIGHT -OF -WAY FOR 65TH AVENUE AND SUBJECT TO ALL OTHER EASEMENTS, COVENANTS, AND RESTRICTIONS OF RECORD. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1088 -30 -000 Parcel Number 31.29.18.490 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 SE %40 SW Line Description Line Description TOTAL ACREAGE 40.000 PLAT LOT BLK 01 SEC 31 T29N R18W 40A SW SE 15 02 16 I 03 17 lv 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 171- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, 178- History, F10 -Exit LEGAL ST. CROIX COUNTY WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1088 -20 -000 Parcel Number 31.29.18.489 OWNER NAME: First RICHARD O & JANET P Last STOUT PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 973 65TH AVE SECTION 31 TOWN 29N RANGE 18W 1 /4160 '/440 Line Description Line Description TOTAL ACREAGE 52.000 PLAT LOT BLK D 01 SEC 31 T29N R18W 52A NW SE 15 02 ALSO PT NE SE ESC AS OM 16 03 E1/4 COR SEC 31; TH S 89 DEG 17 04 W 867.45' TO POB; TH S 89 18 05 DEG W 449.31'; TH S 0 DEG E 19 06 1298.51' TO SW COR NE SE; 20 07 TH N 89 DEG E 356.68'; TH 21 08 N 3 DEG E 905.84'; TH N 2 22 09 DEG E 394.48' TO POB (12A) 23 10 & INC PT SE NE S OF 65TH AVE 24 11 & W OF 479B 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 - 1088 -50 -000 Parcel Number 31.29.18.491B OWNER NAME: First RICHARD 0 & 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 10.000 PLAT LOT BLK A 01 SEC 31 T29N R18W 10A SE SE 15 02 EXC N 30 ACRES 16 ( w J -6 -6 03 17 04 18 j 7 J4�� 05 19 C ' U 06 2 n A 07 21 1 � T 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 I No I I o I Hill I I ---- - - - - -- - - -_ )7�f7 Ohm - - - - - -- / DM aO WM � 6 A&D i AO b b0'u /i� g b 35• Coe M'ZZ.o \ - -- - - - --I i ---------- - - - - -� °�l0ln� N0 °l ° °g°a �` N O b - - - - - -- RL•OZ9 3.,60.9bo0oN j r o F U W b U- $ x r r �U cD U-E (D m O i aD OD w Zz, w J co M z = E n, J D F O OD r c V) l z 3 w z U Q a. � � W z U a + w LO 00 - �n M p °o F- L °L-) pop N r W 0 ll U) U) Q 2 W NO11O3S A 006 J U 1975P 613 Ea Car 2�56 STATE BAR OF WISCONSIN FORM 1 -1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER D EEDS CO., CO. Document Number RECEIVED FOR RECORD This Deed, made between Frederick G. Leneriz AKA Frederick G. 09 -16 -2002 10:15 An Lenertz SR.. sinale . Grantor, and Richard O. Stout and WAR AI Y DEED Janet P. Stout. husband and wife , Grantee. EXEMPT t Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of YRANS 1 Wisconsin (the "Property'): COPY FEE: PAGES: FEE: R000rdina Arse Nam* and Rdum Address Rldtaed t Janet P. abut R obe street Roberts. , W1 WI 54023 OF SE' SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WES , S7. CROIX'GOUNTY,VNISCONSIN EXCEPT THE NORTH 30 ACRES THEREOF.�A 0.1 042- 1088 -50- 000.0424088. W -000 OF SW Y44 OF SE % OF SECTION 31, TOWNSHIP 29 NO RTEI Parcel Identification Number (PIN) This Is not homestead pwy. RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN. pe} (Is not) Together with all appurtenant rights, title and Interests. Iona Grantor warrants that the title to the Properties good, Indefeasible in simple fee and free and dear of encumbrances except Dated this ]e day of August ,. (SEAL) (SEAL) FreAerick G. Lenertz (SEAL) (SEAL). AUTHENTICATION ACKNOWLEDGMENT Signarise(s) State of Wlsconaln, WEN ._..,,c p } as. wl s�j� "+ice SL Croix County authenticated tF�o ^, Personally game before me this 1a day of Aug 2M the above named Frederick O Lenertz AKA Frederick O. Lenertz SR.. Single to me known to be the person who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing kat ment and acknowledge the (H � me. authorized by §706.06, Wis. Stats) 1) THIS INSTRUMENT WAS DRAFTED BY z Coidweil Banker Burnet Notary Public, State of rlsoonsin 1301 Coulee Road Hudson, WI 54016 My commlas Is perms erlL (If not, state expiration date: 2 -37876 U ) (Signatures may be authentkateQ or acknowledged. Both are not necessary.) • Names of Persons slgnlng In wry capacity must be typed or PrInted below their s nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1910 Milwaukee, wis. V 1975P 592 690254 STATE BAR OF WISCONSIN FORM 1 - 1988 KATHLEEN H. WALSH WARR/WTY DEED REGISTER OF DEEDS ST. CROIX CO. , MI Document Number RECEIVED FOR RECORD This Deed, made. betwveen Frederlok G. Lenertz Land Arid Cattle 09 - 2002 10:15 AK Company, LLC. A Wisaonaln im @pri Liability Coo nv Grantor, and WARRANTY• DEED Richard O Sto and Janet P Stout, husband and wife EXEMPT t Grantee. REC FEE: 21.00 Grantor, for a valuable consideration conveys to Grantee the following TRANS FEE: 1178.70 described real estate in St. Croix County State of COPY FEE: Wisconsin (the 'Property'): CERT COPY FEE: PAGES: 1 NIIa'fl % OF aE ! OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CR , W}>�G{ N51. ame &- in Area A PARCEL OF LAND ', THE SE`'s OF pid d SEMON 31, TOMS HIP 2>i – ICE 't8 WEST.. Janet P. Seoul TOWNSHIP OF. N APRElY 5T� t NTY, WISCONSIN, x oath Street OW$: COIWMENCING A1' Roberte,wl &= c o - j "�_ MORE FULLY D q F�l. THE E' /, COFil1�lR Q $E.01lON $1, THENCE W28 ALQW THE EAST WIEBT QLYdt SECTION LINE 867.45 FEET �, o ' TO THE PO TNT OP BECUNNINO; THENCE VV ALONG _ OF LINE 449.3], TfjEWF SO° ALONG THE . - -- . E WESTERLY LINE OF SAID NE ' /, THE S E U. A DISTANCE OF M8.51 FEET TO TlIiESOUTHWEST CORNER OF Par Roacaw mxww(PIM SAID NU. THE SE THENCE M9 ALONG THE SOUTH L OF SAID NE' /, OF THE SE /, A DISTANCE OF _ This is nor. homestead pmperfy. 356.68 FEET; THENCE N3 90.84 FEET; Qs) l6 not) THENCE N2 394.48 FEET TO. THE POINT OF BEGINNING. Together with all appurtenant rightiL title and interests. figili Grantor warrants that the title to the Properties good, Indefeasible In simple fee and free and dear of encumbrances except Dated this 10� day of August . - (SEAL) (SEAL) F rederick G. enertz .�ONDV SWATZRAI Fi$T�414Y R11BL10 —t- (SEAL) (SEAL) :STATE OF WISCOIwIS(i"r1 • f AUTHENTICATION ACKNOWLEDGMENT SIgnstw*e) Stet• of Wisconsin, } se. authenticated this — day of St. Croix County Personalty came before me this 1M day of Aug Sl4S. 2= the Above named FrgdeticY G. Lenertz Arv� GptMe Company. LLO, A • Wisconsin Limited LiabRay Camoenv. by Frederick G. Lenertz. TITLE: MEMBER STATE BAR OF WISCONSIN - EMIdent to me known to be the parson who (F not executed the foregoing and acknowledge the authorized by §706.06, Wis. Stats) s$I�Ae11�,J1 THIS INSTRUMENT WAS DRAFTED BY "'— Coldwell Banker Burnet c 1301 Coulee Road Notary Public, State Pf WisLonsin Hudson, WI 64016, 237876 1wy commission is L (if not, state a pkatlon date: Both are not necessary.) Names y be aubmtkated or acknowledged. • Names of Persons sla In any capacity must be or pri nted below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM Na 1 199 Milwaukee, Wls. 4 VOL 590366 WARRANTY DEED Document Number: iEYTF_S 0 F1 E FT,' MIX 0" WI Ree'4 'ir h�rrrd Return Address OCT 3 01998 Ill. a= 50 Re 13iier of Deeds Parcel I.D. Number (1 042-1086-10:042-10$b-20;042-108640;042-1085-SO; 0.2. 1086.60; 042.1085-40; 042- 1086.20; 020 - 1108.60; 020. 1108 - 60;020.1108 -70 :020. 1108.80 This Deed, made between 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 r� COUNTY, WISCONSIN THA — - NW 1/4 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING SOUTHERLY OF INTERSTATE HIGHWAY 94 EXCEPT CERTIFIED SURVEY MAP IN VOL. 1, PAGE 221 AND EXCEPT PART IN j' VOL. 634, PAGE 138 AND EXCEPT PART IN VOL. 913, PAGE 201. NE 114 OF SECTION 31, TOWNSHIP 29 NORTH, RANGE 18 WEST, ST. CROIX COUNTY, WISCONSIN LYING NORTHERLY OF 65TH AVENUE AND SOUTHERLY OF INTERSTATE HIGHWAY 94 EXCEPT PART IN VOL. 913, PAGE 201. This is not home ea property. Together with all and singular the hereditaments and ap thereunto belonging: 9 9 PP And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of i encumbrances except easements and restrictions of record and will warrant and defend the same. l i Dated this 30th day of October, 1998. FREDERICK G. LENERTZ LAND AND TRANSFER CATTLE COMPANY, L.L.C. i � o �t r n:L — Steven S. Goff, Power of Attorney Frederick G. Lenertz ACKNOWLEDGMENT STATE OF WISCONSIN ! 1 ss. ST. CROIX COUNTY 1 i Personally came before me this 30th day of October, 1998, the above named Steven S. Goff to me known to be the person who executed the foregoing instrument and acknowledge the same. 1 ' Aerie Pamela A. Skorude, Notary Public K l ip St. Croix County, Wisconsin My Commission expires: March 17, .Z THIS INSTRUMENT DRAFTED BY: , , r''!•• "; c , v S. � •�� Steven oft G , Sys, Goff & Rohde, Ltd. PO Box 167 River Falls, WI 54022 j SSG%LENERTZ\CLAPPID1WD r WARREN PLAT T -29 —N • R -18 —W t (Landowner) Will 11 1 11 11111 RICHMOND PAGE 48 Sea Page 112 For Additlotaal Naaaa. 19 in E Game U1dtd \ REE Clarence & a H1% Club Inc ES Mart , y„, _ AVE a 158 is 6 118th p a Maq ~ R f 65 O Mueller �c 73 o 1 + e �b Derrick Pt ]58 r AL .� Co 114th 2 1 G a C 275 )ohA �� 0 0. Rorly AVE L. •[home s6ro..d 'B ad ckelson 1IAcis�oo + nve 12 f 36 Maloney , r ra. • o Allen A Donald Ds1s° n 'mow Gre field ` 7 3 � ff r•eeo $ iLwd 1101 VE 1z.•9 g 1�& 216 z 180 154 318 240 39 TM" ,. 107th AVE M b— 1 a 60 Herhdc g 2s Ro nald J �� 80 110th AVE a p = I ti 1 , B S 8aedid 1 rn RHK Itl 67 au 06 54 "S . m mrard " A 80 t- Inca I,id, t 160 40 310 120 Tntl ck 1 AVE Raymond & ]Lomas : Rusmar b 104th s Patricia Nona Gordon Farms v AVE n s• r s 1 Sensid Suliwold { TruesdW v P N " 3 n 4 '^ .0 142 If 15 145 _1s 138 : • , 200 T�,� w ]50 160 160 470 I St Cro M9 2 D � „ + 3 bra M J avid & 1S " Walter 4 100th AVE Burl i 160 I Girl m ST 15 ° 23 CK mP) Frederick BO 80 r w Nechville VanBee! ,$ In Bloom AV - ° \ tr Henry r �0 232 Ir.'3S r tr • "' NechvWe 10 1 a u 168 80 Vi� 195 w qI oan Fmntler q Tepe FDe&Ior« 1 3 Zltl Hold- 811 al$rown d� ~ D Diane g � J Dean do T� 2 ScbuRe Farms Holden _i Uverttt r McKenna a ° Corp M71eRer Trust Inc J D . 1 Trust $ i 6 = a 148 " ^ 80 ^ is&C > of n a s4 a 119 7 8 3 x s 44 3 Mue� 150 160 240 316 s JP sae. Horan as 12 s t p 3. 10 • y'• D.ryl add Le°dn ' Y a e °� 5 RP �6 37 L Q.P..t., Farms 'd h(� + s P>ny Doroehy s4 11 s 25 Inc 8 79 1o94s �j A*4 w 158 s h ]48 t f3�_ 160 78 6 t 3� G , n 132 tr Sonnenta 1 ' AV Violet 67 w 1 $ A E Ltd 3s ]16 p moen ^ y$ n t a' I Grace & 2 s § # IRmr Graham 1 Mark as � 4 1 G ci yt� 122 z a e Gas ary o a .q G a ` tr 163 x 9 5 �oi0 TS ItOB _ w 108 154 3�8 3 Z p PhllBp $ 99th •a `* 7: a L ` zl 2 TT •� ST Mal I Maia +5'tl W �°' �'" 2 aEBa 1 e L� & S s "Buun2 34 Dal. p p 1( Trust P , 3tewart rN'1 O+id 3 6511$ u 2 Bl OCanneR ,` m 2 1 4 E Hadar 40 39 s9 Donald & 44 70 \ 307 Mark IQ s. r (� Boyx t r Edie n z Haman 2 160 p C Came IC6NsIhle 1 Anderson n y r Idie x w Crai m x a IH dwn 41 $ _ 41 40 164 w• 4 th P TWIN 98 Cana n w herd 110 H g 8o r3 �• crau.9 I R & TWIN 19 s YdtL a S Smi & .. C LAKES 1l 2 An n hike De� a� n } 1 85 160 143 Nvr m 70th AVE s 187 80 S 63 4 4 a 7rkbw 45 Putt Macr �• 2 1 3 & 75 94 4.0 87 Sonnentaa Clara n Dtmves ` LNEX Ri d & ran r , • O 1 Family peskar O / Farms Sl J ,'•- Ian 132 11 ■ ,o RA -V . san w n W Ltd Inc z Land 641 s mrr 1 i T reat A . _ n a u 99 tr 2 115 160 P 223 tr 110 Inc U) n v , 31 - Co Bren 1 Deen a 'STAR Andrew& 40 g t da a 1 ■ V ' ae 7 ^ LN R iIl Glenda ~ a ` a6w eant 1r..• * Bray .gabs Anne ,�$ KER 7 n d �>mK n Hansen L gg au�> M.s ppg 0� 50 Y _ °a 176 'n°d0 2e Butle50. kar 92 °t w e !� 194 tr 4 60th AVE 126 IQNNICKINNIC PAGE 18 Hwy. 65 P.O. Box 14 ROBERTS GROCERY P.O. Roberts, WI 54023 Phone 715- 749 -1718 MEATS - GROCERY a PRODUCE Fax 715- 749 -1719 NorthLand Su rveying, Inc. HOURS: Monday - Saturday 7 :30 a.m. to no p.m. Boundary Surveys • Certified Survey Maps • Major Subdivisions • To 8 p Y S u r veys o a h Su Sunday 9:00 a.m. to 6:00 p.m. Edwin Flanum Michael Erickson (715) 749 -3840 RL.S. No. 2487 R.L.S. No. 2592 ROBERTS. WISCONSIN F;1 sconsi n Department of Commerce P SEWAGE SYSTEM County: St. Croix , and Btwiny Division A NSPECTION REPORT Sanitary Permit No: • 43031 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 40 7— Permit Holder's Name: City Village X Township Parcel Tax No: Stout, Richard I Warren Townshi CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: v o •0 31.29.18. TANK INFORMATION ej ; n fir ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (00.00 Dosing t, C f4 _ to V Alt. BM Aeration - Bldg. Sewer 363 V Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet S ES q6 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic .-c. , I S r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System sk /� • v S - ty PUMP /SIPHON INFORMATION Final Grade 7 -7 ` �c Manufacturer GPM Dema St Cover � YZ_ Model Number TDH Lift Fric I oss System Head TDH Ft Forcemain ngth Dia. Dist. to well SOI BSORPTION SYSTEM BE /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' I �r 15 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: �* INFORMATION CHAMBER OR r� Y �+ Y h LrS Type Of System: ' i Q � ' �U UNIT Model Number: CG n mss,:► -� : t.,.. t c� "Z� ..��: � St�. DISTRIBUTION SYSTEM P 'f 4 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) _ ,q� / _._. Length !b Dia Length Dia Spacing ---��_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched c Bed/Trench Center �l Bed/Trench Edges Topsoil �-- Yes f No [ !Yes q No COMME � t (Include code discrepancies persons present, etc.) Inspection #1: lu / ZZ / O2 Inspection #2: p �� Location: 95565th Avenue Roberts, WI 54023 (NE 1/4 SE 114 31 T29N RI 8W) 40 acres Lot Parcel No: 31.29.18. t 1.) Alt BM Description = -Fb 2.) Bldg sewer length = 3 1 5 9- C - amount of cover = 14 5`` o t �e quired . j Yes No /•O . i or additional informati K Date Insepctor's Signature Cert. No. J7) d e +t-� � �k. y �•'��a -v� �7'�a � �i� Y� �.� !� GS' /� ����t� G/� G✓A ray o w t t IF Safety and 3gilgines D ivisio n County 201 W.'Washing n Av (� ma � �SCD�S,� Madison, 1 537t) - fH x tutary Permit Number (to be RI in by Co.) Department of Commerce (6ft 266- 3151 Sanitary Permit Applicat on ` to Plan I. D. N in r In accord with Comm 83.21, Wis. Adm. Code, personal inform lion may be used for seconder �� � i9c�, � � � i ' ' ' ' y purposes Privacy Law, s15. 1}(my0 - Oject Address if different than mailing address) I. Application Information - Please Print All Information w Property Owner's Na me / Parcel #, _ / Block M + Property Owner's M ailing Address -<-- :2 Property Location City, State Zip l one Number .. 'k,Section i Ph /C I I II. Type of Building (check all that apply � g (circl e T ) pp y)� N: R E 1 or 2 Family Dwelling - Number of Bedrooms �� ai(� Subdivision Name CSM Number ❑ Publics Commercial - Describe Use I ❑ State Owned - Describe Use _i — ❑City ❑Village Township of A / III. Type of Permit: (Check only one b ox on line A. Complete line B if applicable) A. lew System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal Permit Revisior. ❑ Change of 11 Permit Transfer to N ew �List Previous Permit Number and Da:Iss Before Expiration Plumber Owner � 0 1!V. Type of POWTS System: (Check all that a IPP }') _ � � Non - Prrssuriz ed In Gro und J Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ At Grade ❑Single Pass Sand Filter L) Constructed Wetland ❑Pressurized In- Ground ❑Holding Tank ❑Prat Filter ❑Aerobic Treatment Unit ❑ Recirculati Sartd Filter ng ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑Drip Line ❑Gravel -less lr!ipe ❑Other (ex lain) f V. Dispersa ! /Treatment Area Information: y Design Flow (gpd} Design Soii Application Rate(gpd� Dispersal Area Reyuired (sfj Dispersal Area Proposed (s Sysfdm Elevation / VI. Tank Info Capacity in Total Number Manufacturer 7p � 7 e fab Site Steel Fiber Plastic Gallons Gallons of Units / Q /v D rete Constructed Glass New Existing ` T anks Tanks/ LS tic p or Holding Tank -e Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, th undersigned, assume res ponsibility for a Ilatio of the POWTS sho wn on t attached plans. Plumber's Na me (Print) Plumber's Si gnature &eA4PRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) VIII. aunr/De rtment Us e Only Approved isapproved Sanitary Permit Fee (includes Groundwater Dat Issued ssuing A nt Sig mr Stamps) Surcharge Fee) wner Given Rea for Denial j IX. Conditiops of Approval /Reaso for Disapproval vr� y'�tQ t9 - Zivl /� !mot llt `��LO Attach complete plans (to the County only) For the system on paper not leas than 8I /2 x 11 inches in size 1 SBD -6398 (R. 01/03) i R too qs/ 6 r Av 1175 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parc Please print all information. Reviewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z/ 6 3 Property Owner Property Location Stout, Richard ( Govt. Lot NW 114 SE 114 S 21 T 29 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. 7e or CSM# 1353 Awatukee Trail B �OZ City Stale Zip Code Phone Number J City J Village a Ton Nearest Wd Hudson I 1 54016 Warren 65Th Ave. e New Construction Use: e tiat / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement I Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area l is 96.0 Boring # I Boring 60 Pit Ground Surface elev. 99.07 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz *Eff#1 *Eff#2 1 0 -7 1Oyr3/3 none sl 2fsbk mfr cs 2f .5 .9 2 7 -1 1 Oyr4/6 none Is 1 msbk mvfr gw 2f .7 1.2 3 16 -96 Ll 0yr5 /6 none ms Osg ml - -- - - -- 7 1.2 Boring # I Boring i� Pit Ground Surface elev. 99.07 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -7 1Oyr3/3 none sl 2fsbk mfr cs 2f .5 .9 2 7 -15 1Oyr5/6 none I 2msbk mfr gw 2f .5 .8 3 1 3 1Ory4/4 none grls lfsbk mvfr gw 2f .7 1.2 4 23- 6 1Oyr5/4 none grcos Osg ml cw - - - -- .7 1.6 5 - 7 1Oyr5 /6 none ms Osg ml - - -- - - - - -- .7 1.2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature` / �!�'� � — CST Number Thomas J. Schmitt , 4 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 10/12/03 715 247 - 2941 1 -- pale 3 o 73 F P ac'ce � 6 A�� ,G f rra�e� � 1,>v� �`�• ��• � i 'rr qoi /f Al q q 0 C S TM a a 7 y,J F f�udfM� lnJ .Z ��� /5fS 7,2nO 51. P�IrLel� Safety and Buildings Division County r N V1 41 111 co w 2.01 W. WAshidgton Ave., P.O. Box 7162 ���YO e X _ A, /tSlrl Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 Sanitary Permit Application state Plan I.D. Number In accord with Comm $3.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information �sr t0 t�Ver 1 Property Owner's Na me Parcel # at,I,otA_ _L g r t Block V-ZA/ Property Owner's M ailing Address Property Location r -r l3 S3 A)o u- e `e �Y`Q � ) W - ,Section city. State Zip Code Phone Number f (circle ) II. Type of Building (check all that � ply) 3y6 G 5 y9— 73 _ l T °?9 N; R � E o Ir 1 or 2 Family Dwelling - Number of $ ms S rd� Subdivision Name / CSM Number ! ❑ Public /Commercial - Describe Use © State Owned - Describe Use ❑City ❑'Village Township of III. Type of Permit: (Check only one box on e A. Complete U a l3 if applicable) A. New System ❑ Replacement System Treatmen lding Tank Replacement Only ❑ Other Modificatio to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ nge Cl Permit Transfer to N List Previo P Number and Dat ed Before Expiration Plum Owner IV. T of POWTS System (Check all that apply) XNon - Pressurized In- Ground ❑Mound > 24 in. of suite a soil l� Mound < 24 in. of suitab soil At- Grade El Single Pass Sand Filter ❑ Constructed Wetland C1 Pressurized In- Ground ❑ ding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Fil 11 Recirculating Synthetic Media Filter ❑ Leaching Ch r C1 Dri e C1 Gravel -less Pipe C1 Other (explain) l T q.� ,,pp V. D rsal/Treatmant Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area R fired (sf) Dispersal Arta Proposed (sfl Sys n ° VI. Tank Info Capacity in Total Number Manufa rer Prefab a Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank R / , Aerobic Treatment Unit i Dosing Chamber 4) J j n c' r VII. Responsibility Statement- I, the wiersigneti, assume responsibility Por ipa4llatlon of the POWTS shown on the attached Plumber's Na me (Print) Plu ber's Si gnature / PRS Number Business Phone Number ,CJ,'�t•� M s'a�ik.,d,.afl�r �a ?F pd 7l� -s �� � 3;�� Plumber's Addre ss (Street, City, State, Zi ode) VIII. Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 4UH�IrAgent Signature (No Stamps) Surcharge Fee) 2� .09 Z=3 ❑ Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval 3) S 1 (AS Qo *Q SYSTEM OWNER: a l sou" 40 LAKZJ-AA, 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintainW as per management plan provided by plumber. S 1 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) Por the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) /7frc-e.( 43�✓� /y O wl �2e keys � 131 %sT �/•�►� /De: ° u ,, • �'t 2d���� ldd l�•.•�'Q�� s�k� p� r�� /3�/G S�j� S3l ��y�l��v � ��vot� Lr/�v�e,r! 5/9, �l a2e��cYS � d� d1 A5 Wisco"m Department of Commerce SOIL EVALUATION REPORT Page _ of _ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete she plan on paper runt ss le than 8112 x 11 &napes in size. Plan must C2, 66 include, but not limited to: vertical and horizontal reference point (BM). direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. e • ed by Date Please print all /nfornta d n o . ,gyp Personal information you Provide may be used for secondary Purposes (Privacy Law. s. 15.04 (1) (m)). x / Property Owner Property Location Govt. Lot 1l4 1/4S T N R E (or) W Property Owner's Mailing Address t1 Block # SuW. Name or CSM# City State Code Phone Number ❑ City ❑ Village IgTown Nearest Road I n I ). LI - C4 r Residenfiai i Number of bedrooms _ : Code derived design floor rate � � Q P G� M New Construction Use (w Replacement ❑ Public or commercial - Describe• _ __� ---- — - Parent material C ' u Sh Flood Pain elevatlo --- - -- General comments ft. and recommend S y S �✓y� /�Va c/. P haw e Fa e? , a d Bonn # ❑ egg Boring ; F 1 ®P(t Ground surface e1ev. lft Depth to Ikttffiag tailor - in. Soo 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 `Eff#2 0 2 T I C 2- 12- 1D tt l — 5' d 2m mfr c5 3 / ,mss - .7 1.2 ❑ Boring # t❑t Boring f IaL Pit Ground surface elev. J Q_ ft. Depth to limiting ter! U in. s Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD& in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efr#1 J 'Eff#2 I IO Z 5 2mC.b r C ' s Z Iy - yl � — °c 2 k fn�r Qs — g l e C' too °l Eftent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg1L ' Mont #2 = BOD < 30 mg/L and TSS < 30 mg& CST Name (Please.Print) Signature T Nurser CI Lj Address Date Evaluation Conducted Telephone Number � Z . Property Owner — 1 SibU� ----- ----- Parcel iD # ----------------- ____ -- Page __ - -- of _ � -- a Boring # ❑Boring Pit Ground surface elev. _ ! _ ft• Depth to limiting factor 1 �— in, Sod 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 *Eff#2 I'If . S 2 - — sty 2 V - �} y b I V-01 Boring # ❑ Boring F] ❑ pit Ground surface elev. `_ ---_ ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Go. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F El Boring # Pit Ground surface elev. _ k Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *01#2 ' Effluent #1 = BOD 30 <220 mgiL 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. i i 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. / '84D- 8330(8.47/097 PAGE _OF NAME S SCALE: 1 "= - - -- - - -- 4 BM I ELEVATION I BM I DESCRIPTION a I BM 2 ELEVATION (D U I I BM 2 DESCRIPTION SYSTEM ELEVATION 1 SYSTEM TYPE 0V A y - P - ll-a ( _ CONTOUR ELEVATION �5 Av'e 1 oU cf 1p o � 5 p G - - -- - DATE SIGNATURE " - CROSS S� .aroN AND `SEPTIC TANK & PUMP CH � _ " CI /VENT PIPE 12" MIN. ABOVE GRADE 8 WEATHERPROOF ?:25 FROM DOOR, WINDOW OR JUNC TION BOX APPROVED WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK & .FINISHED GRADE WARNING LABEL 7 4" CT RISER M � 4" MIN. 18 to IN. 611 MAX. :;N 9 � 4 ' NLET � � GAS- WATER TIGHT SEALS i -`-- TIGH' �IAPPROVED � A SEAL JOINTS WITH -._,. , ALM APPROVED ?IPE PPROVED B k ON 3' ONTO IPE 3' -T SOLID SOIL s NTO SOLID c ' RISER EXIT OIL PUMP OFF ELEV. T• OFF F PERMITTED ONLY D IF TANK MAN"UFACTUR£R HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: y TANK MANUFACTURER: TANK SIZES : SEPTIC �46d' �_ GAL DOSE ?� 4LUME YNC LUDING GAL . "—' DOSE GAL, FLOWBACK: �r ALARM MANUFACTURER: eF s CAPACITIES: A = 1 INCHES = _ GAL. MODEL NUMBER: a v B = 2 INCHES = Yi2 GAL' SWITCH TYPE: yrlet -� - _PUMP MANUFACTURER: 6- � C = $ INCHES = GAL. MODEM NUMBER: Q � D = INCHES = SWITCH TYPE: REQUIRED DISCHARGE RATE �� GPM ?UMP � ALARM WIRING AS PER ILHR 16.23 WA C ,2 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET FEE + MINIMUM NETWORK SUPPLY PRESSURE • • ... ---- FEET f C;�7 FEET FORCEMAIN X . FT/ lOQ FT.OTALIDYNAMICFACTOR HEAD = • -� FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH....,.....,. --' DIAMETER LIQUID Dom, Qi'� L ICENSE N'L iM BER : a?.� 7��d DATE: -� SIGNED: 1/S8 submersible Iffillent PUMP Oman= 3871 E NMI$ ho tanswo ' WIT jPFAVJw J ip4 hMtt alNlllr"�+rlr erma ie Aw ir! wtaaatto Md , s�lcr+� IFM p ! * �1 o� V, 00 Z 1550' �m war • v' '' RPM, bdt In OWr1W WM �8M ad. SU* tlo not W'" MRi� 10wor ....�.�..... 1 Y, oo P �� bu wlth n yy1 �1n�lte. fit�mo- « I t uptO86 ON. M , 181 800 m!oluoU aw OM"Oa. # ( ' up to 24 twtr wld+ ihrlr pco p- %ur�Mp t vo o 1'MOP � b� � AV oo+� numbtrs • wt P$ Q wpm c WNW n OW an " � P" or « t�hrN ' 1 i w d" Pfd �mprould am �� on ° EP08)r • ad wrr qua r tlu =� d*n pro " 141 �mr ,..,...... M"r'a"o goer •, `....,._..� N41 . A Go UK &1ft NFF�T- r � r 4 ' i I 1 14" WMWL a i t D ip _ � �--1 <' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 40 a1 ❑ NA Permit # 3 j Septic Tank Manufacturer /e e ❑ NA Effluent Filter Manufacturer 6 4 ❑ NA DESIGN PARAMETERS E 0 NA Number of Bedrooms � ❑ NA Effluent Filter Model � �4 Number of Public Facility Units ❑ NA Pump Tank Capacity Q ai ❑ NA Estimated flow (average) �f � al /da Pump Tank Manufacturer s e w 0 NA Design flaw (peak), (Estimated x 1.51 � g al/da y Pump Manufacturer a.0 u � ❑ NA Soil Application Rate al /dayift z Pump Model O NA Standard influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, 011 & Grease (FOCI 530 mg /L C) Sand /Gravel Filter O Peat f=ilter Biochemical Oxygen Demand (BOD 5220 mg /L O NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 51 50 mg /L 0 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Diap'a Cel!(s) O NA Biochemical Oxygen Demand (BOD 530 mg1L n -Ground (gravity) 0 in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA Q At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100mI ❑ Drip - Line O Other: Maximum Effluent Particle Size Y in die. 0 NA Other; A Other: 0 NA Other: "A *values typical for domestic wastewater and septic tank effluent. Other OA MAINTENANCE SCHEDULE Service Frequency Service Event rnont s) (Maximum 3 years) ❑ NA inspect condition of tank(s) At least once every: 3 ear s Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 0 NA months} QNaximum 3 years) 0 NA Inspect dispersal COMB) At least once every: 3 g ear(s) month(sl ❑ NA Clean effluent filter At least once every: , earls) month(sl ❑ NA Inspect pump, pump controls & alarm At least once every: :: ?1 3 ( ear($) ❑ monthis) 0 NA Flush laterals and pressure test At least once every: ^ - p yearW ❑ month(s) p NA Other: At least once every: ear(s) ❑ NA Other. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on this ground surface, The dispersal cell($) shall be visually inspected to check the effluent levels in the observation pipes and to check for any p onding 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 gomponents, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal celi(sl. If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) in one large dose, overloading the cellis) 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 1 5 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 dram (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 (imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. $A ❑ s't site its MMAMC E3 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the b(omat at the infiltrative surface. Reconstructions of such systems must Comply with the rules in effect at that time. < <WARMING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name c ``f, �,., y , Name Phone 7 r - _ .4 Phone SIEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATOR AUTHORITY Name Name C(Zpl C& Phone Phone S - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d V) and $3.54(1), (2) & (31, Wisconsin Administrative Code. ��nuniarcar rlurn�lnq FAX NO. 7103863121 Jury. 10 200 32'�: ST CROIX CUL!LyTj' S E PTIC TANK - MAINTENANCE AGREEMENT ,ma A.Nr ( OWNERSHIP CERTIFICATION FORM QY`l �� + Qwnoe��,yez 1�`ct.. ;MailinS Address ..._ Property Address qS _r7 114e� (Verii1wiOu required from Planning Department for new consuuctian;� City /5ttzte Parcel Ideatilication Number I Property Locatioiy t /<, 1 4, Sac, Z—/ T 2L N -R Town of Subdivisiot , Lot # C'erditsd Survey Milp # , Volume � ,, Page Warranty Deed 0 �( � Volume Spec hot a yes 0 ZO Lot lines id='dfiable Xyes C n o AM= a+r"=r A=U hwropas u" snd.Mainteaustcaof your sepdC system Could xosult im ito prate muxe failurs to bundle wastas. l'rapar a.i ::e ^at fioUIRA of pumping out 64 eeptL' tank ovary throe years or sootier, if zooded $y a licensed pumper. Wht you pat irz 3 tk F ° Oall toot ft k otion of the septic tank as it tMtMout st&go in rim waste d'fiw=4 system. TU property owner agrees to submit to sr. Croix Zoning Depatmteal a canification form, signed by tb4 0 m masterpluraber, jourslelrnlazspIumber, rrstrittedpi= or a licsnwdpuxpsrvetifyirtg that (1) the on -cite wastinvaterciypoi a ;Q is M proper apattti:tg anttditian =&or (2) after iaspecti= and pumping (if mccsswy), the aaptic taak is teas than 113 U! or Vera, the Un6tsigaed heave rtutd site above requitemonts &ad &grog to maintain the private aewpge disposal system wit': .he 5 r set fmtb, hueirl, AS set by tW DOMMe of Castlmar sad the Dsputmant of Natural Resounds. State of wisconsitt. Carr . E t stag tlmt your OVdc system has been ma,.tm edrimug be eompinad a reh t the St. Croix Cat:alty Zazs4' Q."f Ce %::_:'; 4 a Of fain &" year e.P*irataon date. k_X away 8' P WW I= Of AP1'IICA�ZT DATE IQMM QATinQjjM X (we) orrgfy that at! ststas+wuss On this f0m are true to that best of my (t ux 1,�tawledge. l (w ai:� the property deearibed above, by vLn= of a wzrraaty deed recorded in Itesistor of De -tdss 4i:ftt;e. SIGNATM CP APPLICANT DATE e r a * ** Agy iafaratstiozr'tbst m4y result in L ssz itary ra it being revoked'* the Zoaing Dtp arr_e,;: Include with this application: a su =pad warrsnry deed hom that 1Zog1atar at IMede dfitiee a copy of the certified survey map if ro fezeace. is made is the wazrtl:ity deed MVa gym - QGmw aw hgaems Pu'I 0 on /* S1308Vd 380`d + 5S ram 3w m m fa NISNOOM 'AlNf1O0 X1OW IS 'N3HSVM d0 NMOI cL —Z90i a,u aw Mg -ws-su w as" -m-cu, sv "a-w %DIM " me L8 'N6Zl 'l2 N01103S NI JdOd08d �✓Qv°° "° "`°'9 m � ,�►��" 1f101S a2�bH012� >m�om va e m � amoza mur� ;w mwvw I I i S00 °26'47 "E 982_00'_100TH ST. I S00 °26'47 "E _ _ _ — — — Q ` 1118.58' J - 1 W M I ' EAST LINE OF THE NE1 /4 �I 1 CC � z c I 0 = I I 1 w o w I W nQ �,nQ�, z LL I \ Z - i I \ a 5 i Z co - I L °� I I BEARINGS ARE REFERENCED TO THE m � Z c M I I v� EAST LINE OF THE NE1A OF SECTION c ` 36, ASSUMED TO BEAR 1401 °1638"W AA W I 3" L L-00°ZON ,0 L'b801 M. L L.00°ZOS n N n I o ZZ'b9Z 1— Q Q I 1' '2 r M � eq cp N Z O C Of O eY N W V �V,\ I I l Z Q o' �Iv J Umzz co pq I 9 II Q N� I ° ~ N s I g Q I I� A �cm W g�ng' cy— ::) zE i u U Z U U U� I w I I Z v ��d I / I I / / N00 59 � rn 310.99' I I cy 313.08' I / OD S00 °59'53 "E L — -- — N00 °39'51 "W 273.81' .4c, (�f Ln o to I zZ / C ° N ° CC 0 cr UU / [� zM LV WEST LINE OF THE NW1i4 CC Z Z� / 2 , WEST ' N01 °16'38 "W 703.09' "W 775.92 � � NO % 16'38 "W 535.01 S01 °16'38 "E 606.3G `U / P�4 OO CO44 0 U) 1 • 1