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038-1014-95-200 (2)
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: City Village Township Kevin Amys TOWN OF STAR PRAIRIE CST BM Elev: Insp. BM Elev: BM Description: ©- oo . �' s�� at�x_* l � t�f pvr✓ TANK INFORMATION TYPE MANUFACTURE CAPACITY Septic ZDO �o cl, Dosing r Aeration Holdi TANK SETBACK INFORMATION TANK TO P/L WELL i� *I-llSo LDG. LAP, \�To Vent to Air Intake ROAD cc K•0, Septic 3�' 2D Dosing Aeration, Holdi PUMP/SIPHON INFORMATION Manufacturer Demand o l�.L_�,s GPM Model Number c �I PC TDH Lift 6AD Friction Loss Li System Head TDH Ft C\0 2. Forcemain Length I Dia. << Dist. to Well 2.®o Z SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651310 State Plan ID No: Parcel Tax No: 038-1014-95-200 Section/Town/Range/Map No: 03.31.18.41 AB-1 STATION BS HI FS ELEV. Benchmark 2-- 25 02,26 / ©� o Alt. BM Bldg. Sewer St/Ht Inlet AJ&.3-- � _ r St/Ht Outlet " r Dt Inlet Dt Bottom - zo 4z � Header/Man. �[os gg,zo Dist. Pipe Cal r Bot. System Final Grade 3 �� St Cover 7 K&x< c vA& w` co, krb-dev - G i- 7g 6g i C--�4 • S `T` Ow� j D _ 2 . � I r 92.0 4 is S -D� �t hear �e . D W . 2� r /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L DG << WELL LAKE/STREAM LEACHING Manufacturer - INFORMATION CHAMBER OR UNIT 1 vA CRu. Type Of System: � � ZD 2 � Co Or ' / Model Number: R vt c a DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Vent to Air Intake P Length Dia eipn th Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 11 3-2Dz3 Inspection #2: Location: 1149 CTY RD H r 1.) Alt BM Description = `40-Dry` .v ' 2.) Bldg sewer length - p�rVto�•�loi �- C� ? - amount of cover = to -rrewt A-" %' -�o ctaC o4 Q-a rb 01� 5 V-4 6e dt4 - 'q� Plan revision Required? ❑ Yes X No l c .9g 7 / Use other side for additional information. Z� `� D to Insepctor's Signature Cert. No. SBD-6710 (R.3/97) , c 1/V�- dAOA.4� S n n W -w�3-217 ,�r 0 rr ndus I 1'� !;4�l vices Divi.,,ion Mitdi.iorl W.'�y L 1 8 2023 L I"-0, 13ox 7162 —4. F�,CW Mi,.disuii, W! 537117- 1 L Sanitary Peml*t Application III aft C(1rda:Wt' With SPS 8 1 1 L.; A di it CL I I I C, sil b-mission of this ftmu t t) tk- appi, ate gm-emmeiltal Umi V-b IctrU1111Cd :M4.) r t c) 4;,,11 al 11), olillary 11VI niiii NolcApplication forms lior statc-tm-m-LI Pow I'S are h-JI'm rinent 44 Persufufl intim-maiion YiNU PIDVidC 1111:y bC USW t'0F y 1 -5 0 4 1 )(In.). Stntn 1, Appikaftm toorma i; I i,, j i Pkm Print A property Addn"L V Yip Code 60-2L 1.-'-.Z I 1.'Vype of Building (ir-herk idi that apply) r"-n I (n 2 B, ml I y I Iwe I Im V N hini b in t i 1'13,L-d r(nims pia ���� . U ubliQ/Cormutacial - Dcsc 11�: D au lat (. Own Cd - Desc I I 11C Use. 1111AVIC [Number Lf'PT B lock 0 CSIM Numl-wr —1-k County Sallitary PCITnil N404r (to lie filkd ill by Co-) to 3 Ia S li-I ICTI-allmact till I ba I'mitu i A ddrL�5,, (0- dif f-crent than maliling addmss) pascel # Propmy Lo-cation Crayr. Lot V4 L 11city of r7l fown of L41 W.Typik. of POWTS Fetmit.- (Ch"k saber ""New" OT "' Replace ru enV' a n d other applicable on Un e A Ch cc k one box on Hue H. Campill0te Use C It Opp Icable.) - JPV -- A, ew e -eplacement, Sy-st-em Mic i - h4cr;li ficat i on ti 4 E'-, i ";T i 9p, Sys T(!in (exp k I n) Addifinnal Pretreatmew T-WI 6D B. I f ()I(j lily g rl FPM1 ank In-GlouW okt-Cmde E]Motmd hidlyidkotl Site lksip 01herype (explain) List Pro mill,� j1c gait NtjmW r aW Dale Issued C• Renewal Bdbft Rey it�ion 'bump of Plumber ElTmifer to New Owner 10- - I IV. Wymavrii-entment Area rindTank Information: 3)CD 1�� C� Desigil 1-1-ow Q!jAA) Diviogm Soil Aplilmnson RAtt:-(gjXVFf) Mkkrml Area Require(I (4) "Dikpcmal Aica Propos&+d (Fd) Syst-L;ra L.Itwstion (.1111MCIty its t xx1 Maim fniturcT�o .� s F I 311k (A)MIar, Gallons Gallms ion -J, 7 Ur Septic or Ift"06 Tmtk Li ILJ V R MPODOWNty S1 a I eme R 1- 1, the 114 6 d I i 41 iL 11, asw*m rewRiftil I ty for InOolls tie n of the POWTS shythe ItUacbed ptans. T —7 F ILI WAMW Nuff6cr Busuws PtK%nc K-umbtr EX nil w I - V - Z Lu nitle C-s Atldrk!�s (Slim k. Cj ty swe" Zip CcAl-L) 'e- VI Coin ty/Dq)v rl m On t Use 0 n I TCm Putmit Fee Date ISSU' Issu ulg Ageol Sigiiature L 011arr Give- 141 i C I '1 101 19 1 0 IV r1rr �Cf -1i fi:w��rT �Fni C oi)di t io n p 3. This Sanitary Permit will serve 2 other properties: s Uq- A pw)�F SYSTEM OWNER: - 1148 CTY RD H existing house with holding tank (3 bedroom) 1. Septic tank, effluent filter and dispersal cell - 1150 CTY RD H existing (2) bedroom house with no known septic records. must be serviced / maintained as per This house may eventually be removed/reconstructed in future; all required management plan provided by plumber permits and approval will be required. 2. All setback requirements must be maintained 4. Any existing tanks that will be utilized for new POWTS design must be as per appliGable code / ordinances. certified as code compliant. 5. There are several Easement Deed for Ingress and Egress documents that have been created by the property owner of all three properties, in order to provide for a shared POWTS (septic system) to be used by all three properties, and also for the system piping to cross property lines, etc. ST. CROIX COUNTY CANNOT PROVIDE LEGAL ADVICE AND ALSO DOES NOT MAKE EVALUATION OF THE LEGALITY AKIM E)AhA1E71f-%A-r1t-%K1C t1E7 AKIN r1E7 -I-UCCE: CACCRAMKI-1-01 II�D COPY Old 1 ZP[ i 1 I t . 1 �JN /4n fj f - / 1A) y ■ •� 8 70 0 tyq ..,.�� .. � ._ �- .- .• ... � f....... ,..� . .�.-..r-••. .mow. - .., S .-« � � � � - � ... - .. �. - � �� - - -• r f i + �.�. �...w.r..are,r�.,,..,��.•-«,s.�,,,a�++M#:�rf..r�.i i 1 • �y'►7---� •..^+..►�.- }---•u +•err—.w� i_�.. 94— ! - r-lvil Flo 4 ' ; ioL,I _ F T i 1 i j t � � { { f ■1 EXHIBIT D Terms and Condition Property ID 038-1016--50-000 and property ID 038- I 0 16-70-000 will equally share the east of maintaining the Septic System. This will include all costs associated with the Septic tank located on property ID 03 8-101 6-50-000. Deeds.com Uniform Conveyancing Blanks EXHIBIT E Deeds.com Uniform Conveyancing Blanks CONVENTIOWAL COMPONENT DESIGN RvsltlsntlalApn HEX AND TITtE PACE Prof eot Name: ownses ftma 16,1'wr Fos W- count 8UWMWm Nw ' LC! 1►wnlbw: ftel llwa swft ftp2 PbtE Pop 3 Eft's ��awn P� pqp 6 I-In"t"am` papo A0ox-m-14 r�-� pop aIAN C%MorPW a lr* ` ■ Jt phow Leaching Zd" h am be r ft �f t Soil Absorption Sntem Cross Section 1 4" Schedule 40 PVC Vent Pipe With Vent cap ISoil Absomflon System Plan View ft Trench 2 22 2 ft Firial Grade Z L-f t System Elevation Trench 3 Leaching Chamber S oecifica M a n u fact u re r And Model EISA Rabing,-',41L sq ft per chamber Soil Appkafion Rate gpd/sq ft Ch qpd Design low + e_�, Soil Application Rate f EIambersSA 3 rows of chambers each, W t� s kwavotions r*0 Prewti orsinw Z q & wistm arer PIO&C fs A OMMm of Pot$ck W. PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPI] (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PLC-122, the Polylok PL-525 has an automatic shut-off bald, installed with every filter. When the filter is removed for cleanin& the ball will float up and temporarily shut off the system so the effluent won't leave the hunk Ab Features: Rated for 10,000 GPD (gallons per day). 525 linear feet of 1 f 16" filtration. • Accepts C and C SCHD 4o pipe. Built M" gas deflector. Automatic shut-off ball when meter is removed. Alarm accessibility. • Accepts PVC extension handle. PL-525 Inst-Pllation: Ideal for residential, and convnercial waste flows up to 10,000 gallons per day (GM). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if nece&sary. 3. Glue the filter housing to the V or V outlet pipe. If the filter is not centered under the acmes opening use a Polylok Extend & Lok or piece of pipe to center f0tear. 4. Insert the PL.-525 filter into its housing. 5. Replace and secure _the septic tank cover. 1/16" Filtrab Accepts C & b" SCHD 40 pipe 4. rm Switch tfoaail -cepts 1" PVC ,tension Handle Rated for 10,000 GPD 5 25 Linear Ft. of 1lle Filtration Slo#s Cortmed to WSPANS1 Standard 46 -pis WN-s- The PL-525 Effluent I tern will operate efficiently for f 47. several years under normW conditions before requiring �• .. `gyp eleaning. It is recommended that the filter be cleaned �, � ti every twee the tank its pumped, or at least every threes years. If the installed filter contain an optional alarm, the owner will be notified by an alarm when the filter needs servicing. &nvking should be done by a certified Gas Lector septic tank pumper or installer. Automatic 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. M not' w pli 'bh*;,wbw- r :W 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure ail solids fall back into septic tank, not into filter housing. 6. Insert the filter cartridge back into the housing rrta�king sum the filter is property Aped mid 7. Replace and secure septic tank cover. � Shut -Off Balt Outdoor Smartfilter Atom F%tend & Lok";' Polylok* Zabel & Best fRters accept Easily installs the SmadFii.te* switch and alarm,. into existing tangy. Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 Tou Free: 877.765.9565 Fax: 203.284.8514 www.polylok.comt V Septice-Dose Tank Cross Section And Pump Performance Specifications V; T .. ;i; �i 1. 311 1 "I'll k ME I=. . U, i ►rFil- U Filtor 11�u Fittar ModelWNumbewr 4 M � - Minienwn Rang P�ar�ara�aace Requirod GPM Ft'I'DH Oudet MtpWhole Min. 4" Above Cimde With �odciag Devioe,, Islet Mwltok < 6" Hetaw trade Sealed Wabaftt �T DRA cif _ZCO Ft LArttet Fiha Switch -fl.-g- sM Rjesem xakVolumm OR 46 VQIUM GWr rev A i 13 2'. 0 C D 'how M_ I &.a., z `I'otC - Ft Ekwadw Head Di" NetworkLaw FL1m Main LOSS TOW SmuWy Mounted jUwtkMBgar No oft me am MO Vat WUL I Abo" Omde with Vat cap w * r IP ]p wEr is !�Offftmwon ! Ft ! ►_i_�_�_�_•_�!_!_f_aye._.�_f_�_�_�_i_f_�_�_�_i_i_�_i_►_i.�_i_i_►_�_M_�_!_i_'!.i_!_i_►_i_i i_ Manhob Min. 4" Above ande wfth111%n�+ ftft No ==1 � DiaoomNeot Meoae "*..w a.�.w �rw � +� r► r w rr► +� rr► � � � �. s 'f� weep f. Hole ap.-M. ! C ! s 1 ' V -W - w -!4 -A Ft 4 ! GZPTMAL INBTALIATION: The is battled wd back Stied in With We �wAdurar'a uat a,+ov�l epscifl . Maiaaum depth of bmy asapeci8ed bye the mn�iotanet may �t be e�cc.�eded wi�oat prior approval. Maohoie oonrars aocpo�ed to made barns �n ad%a�iva loom davioe (l�dlook) �talte8. Pipat t!a inbt end owlet is of approved m�rLd. 000neoled to die irk with wa�e�lrt Wd on dsbte mil to pi+avaaat or .Ts+oo he lbmda is deeved witi� 4" 3�. 40 WC to bridge the tmlc axcavadon wa mo alcove is seeiaa W111mtight. Sbctrbai ea&e coawliea wid► riBc 300 na Can 1628 wAC. Of 02JOs i.I POWTS OWNER'S MANUAL & MANAGEMENT PLAN asea�m_ FILE INFORIWATIQN .! FPerm�t# r 4_4 DESIGN PARAME I RSr Number of Bedrooms: - ❑ NA Number of Public FacRity Units: 2� NA Estimated (average) Flow: (gaWay) a Design (peak) Flow (eshrnated x 1.5): (gal/day) In Situ Soil Appffcaffon Rate: (091fty ) Standard (Domestic) InffueWEffluent Monthly average Fats, OR & Grease (FOG) S30 mrg1L Blachem" Oxygen Demand (BOD&) s220 rnWL ❑ NA Total Sus dsd Solids EMS s150 High Strength Inf#uer"Efuent Monthly average (FOG) >30 MWL (13[105) >220 mg& NA Prdreated Effluent Monthly averNp (BODs) sW m9A_ (TSS) !s30 mg/. NA Fecid Colforrr ft mean si tip Maximum E treat P"de Size % in da. ❑ NA c3d'�eri ❑ IA MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Tank Manufacturer: e 4c"-17 ❑ NA Septic ❑ Dose ❑ Holckng Votumw. e (gal) Tank Manufacturer, ❑ NA t9 Sepfic 0 Dose ❑ Holding Volume. � � �,�, (gal) Vedical D19anoe Tank Battocn(s) to Service Pad: (ft) Horizontal Distance Tank(s) to Se xfte Pad: (h) Speeft servidng mechanks must be provided if mat is >15 feet or g ho tontat is > i tO feet. Spscft Ins"22 to be provided on shack. Effluent Filter Manufacturer: � Effluent flitter Modet. -�g - �?_s ❑ NA Pump Manufacturer --C a /V ❑ IAA PumpModel: Pretreatment Unit Manufticturer: NA an ❑ Mechicat Aeratlon [IPeat Filter ❑ Disim on ❑ Wetland ❑ SandfG ravel Fier ❑ Gamer: Soll Absoroon System A In -Ground (grav#y) ❑ In -Ground (pressure) NA ❑ At -Grade ❑ Mound ❑ Dro-Line 0 Other. CWW. ❑ NA Servie Event Service F Pump out c wtents of tan(s) When combined sludge and scum squats one-Wrd (IS) of tank volume 13 When the high water alarm is activated Inspect comfifion of tank(s) At least once every: At IeWonce every: month(s) (Maximunn 3 years) 9 yw(s) month(s) mqs) (mourn 3 years) ❑ NA ❑ NA Inspect disprsal call(s) Clean effluent filter At least once every: ms� year() 0 NA Inspect purnp, ptrnp gals S alirm At least once every: Al least once every: month(e) yes) ❑ mo th(s) ❑ ems) ❑ NA .e NA Flush laterals and prime test Other, At lit once every: month(s� ❑ s ❑ NA Other: p NA MAINTENANCE INSTRUCTtoNS lnspedions of tanks and sail absorption systems fit# be made by an Indivldual tang one of the following licenses or certifications: Master Plumber, Masser Plurnbw Restricted Sewer, POTS Inspector, POWS Maintainer yr ,Septage Servidng Operator (pumper). Tank inspectlons must Include a visual lnspe don of the tankgsj to identify any m1wing or broken hardware, identity any cracks or leaks, measure the volume of combined sludge and scum and a dick for any back up or ping of efuent on the ground surface. The soil absorption system shall be visually Inspected to check the eMuent kwels in the observabon pipes and to check for any pondincg of effkxmt on the ground surface, The ponding of efgu$nt on the ground surface may Indkate a failing cxu Non and requires the Immediate noNcabon of the local regulatory When the cornbined ac cumuldon of sludge and scum In any treatment tank equals on6-ftrd ( ) or mope of the tank volume, the entire contents of ft tank shWI be removed by a &#age Servicing Operator (pumper) and disposed of in accordance wth chapter NR 113, Wsconsln AdministmOve Code. All other services, including hurt not limited to the servkft of efflux ffiters, rn or presswized cornponwft pr&eatment units, and any servicing at Intervals of -.02 months, "I be PW furriwad by a ce#fled POWTS Maintainer. A service report shal be provided to the local regulatory suftft vAthin 30 days of completion of any service event. GMW-W5 (02105) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. if high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an ovedoad that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or PATS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or pads vehicles over tanks or the soil absorption system. 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. Reductlon or ellmination of the following from the wastewater strew may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers; dental floss, dlapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). Auer pumping, all tanks and pits shall be excavated and moved 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 Poll owi ng measures have been, or must be taken, to provide a code compliant replacement system: C� 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 resun 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 the time of their permit issuance. C3 A suitable replacement area is not available due to setback and/or sal limitations. It the soil absorption system cannot be rehabilitated and barring advances in POVV S technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suftable replacement area. Upon failure of the POVVTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place folloyhng removal of the biomat at the infiltrative surface. Reconstructions of such systems must cm ply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN! LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER Eam4 _ SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER EName Phone .. LOCAL REGULATORY AUTHORITY Name . Phone This document was drafted by the staffs of the Green Lake, Marquette and waushara County POWTS regulatory agencies in compliance with sections Comm 83.22�2)(b)(I)(d)&(f) and 83.54(l), (2) & (3), Wisconsin Administrative Code. wieserconcrete.com z Cz/ Innovalion, Quality and Service Si we 1905 OUR DRETE -_�;It.2, L! -7, ? Maiden Rock, WI (800) 325-8456 Fond du Lac, WI (800) 641-5937 Portage, WI (800) 362-7220 Spooner, WI (800) 336-3416 Wis. Dept- of Safety and Prof es,91,&)al Is SOIL EVALI)ATION REPORT Page Division of Safety and Buildings in accordance with SFAS 385, Wis, Adrn- Ccxie rl C ty ou Atta ch compl ete site pl an on paper not less than 8 11 x 11 1 nch es i n s iz F-),. P1 a n rn u st include. but not limited to verb a. nd horiZontal reference point (13M), direction nd Parceri I-0. pa reo n t slope, scale or dimensions, n o rth affow, and loca fi on a n d distance to nearest road. Z!� �L Please print all Information. Reviewed by Date Pe-r,qonal intomi,ation yo4 prmde may be used for secondary purposes (Privacy Law. s. 15-04 (1) (m)). P roperty - Fy b�v--;'r Property Location E (or) W Govt, Lot 111/4 S _31 N R Z -F-m�pert)� Owner's Mailing Address Lot # block # , Sulad. Name or CSNW �7 ctty" State Zip Code In Number ih Ville Lfrownd Nearest Road New Construction User) Resiou!ritiai) Number of bedrooms Code derived design flow rate: Z. GPD Replacemenl Public or commercial - Describe, Parent material ca Flood Plain elevation if applible General mments and recornmendations, 4-� Of, �`S Boring L Bodng # Pit Ground surface elev. t i 9 tin firnitrig factor Soil Application Rate Horizon Depth Dominant CC) lor Redox Descdobon Texturiz,, structure onsistence, oundary Rwt�i GPDIft in, Mansell QFU. Z. Cont. Color Gr. SZ Sh, n7 X'd z �xi #1 I I L] Boring bonr,q # 0 Pit Ground surface elev. tt, Depth to iiiniitin g factor. 2 !F.Snil Annlication Rate Hoirizon: Depth �Dominant Color Redo Descniption Fi: x 7 1. trur undary Roots GPD/ft ff#1 pffff#2 in. Munsell Qu- Sz, Cont. Color Gr, Sz. Sh. i L2 I'd zi x * pin,, inns iii t- ann � F:PP . 7r)o .A a rwi TR q '> I r%n Anil I * Fffluent a2 = non < 30 mcvl- and TSS < 30 -mcUL CSNarne%"Jp 0 1%1 1: L I U T n I 2/ CST Number Mdnam F M& Evaluation Conduclod Telephone Njrat Ch ti r-1 Lo -? r-6 11) 11 i1 1 -P.J V k Ax I 1 I j , L 1 .. ,�..'� of Property Owner Par+v� 1Q # MP.M.W"I A /WA M- 4 M M M r-vAo- `� ,� W s _ � � � I _ � • ,:� � � ram■ � ■ !� � • i r � Pit Ground surface elev. ft.Dept to lirrti�ing factor in. SoN Apodlcation Rate * Effluent #1 = SM 5 } 30 t 220 m9L and TSS >30 : 150 mg/L * Eftx)nt #2 = SM 6 :� 30 mg/L and TSS 130 mg1L The DepL of Safety and Professional Services is an equal opportunity service provider and cmploycr. If you nced assistance to access services or need material in an alternate format, contact the ent at 608-266-3151 or T FY through Relay. SUD-V.West (R11/i i ) 1 r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) located at: 1/a, 1/a, Section ,Town N, Range W, Town of , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Tank Capacity: Construction: Prefab Concrete Manufacturer (if known): Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) (Title) (Date) Yes No gallons Steel Other (Print Name) minutes (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 State Bar of Wisconsin Form -2003 WARRANTY DEED Document Number 11 Document Name BY THIS DEED, Bradley N. Peterson, a single man and Cynthia Lour Fonseth- Peterson, a single woman (hereinafter "Grantor," whether one or more), convey and warrant to Maka Real Estate, LLC, a Wisconsin limited liability company (hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: See attached legal description Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated �J- , 1161737 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12/ 02/ 2022 03:32 PM EXEMPT##: REC FEE 30.00 TRANS FEE 1,500.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, Wl 54017 €138-1014-95-200103 8-1014-95-400, 03 8-1016-10-000 Parcel Identification Number {PIN} This IS homestead property. 1 I % 1. i r�� I �' r' +C• -.r' ... (SEAL (SEAL) * radley,,. Peterson *Cynthia Lour Fonseth--Peterson 10, (SEAL) (SEAL) * AUTHENTICATIO k ACKNOWLEDGMENT NS Signature(s)����� :�`.,......., ���• STATE OF WIS CONS IN ) authenticated on ss. COUNTY OF ST. CROIX ) ■ r . C r ✓r r ti * f `••. ,, .. _ .. . ,..•' C� 7� Personally came before me on the QL day of December, 2022. .......... . .. , ,��`►the above -named BradleyN. Peterson a single man and TITLE: MEMBER STATE BAR OF � �` C #hia Lour Vonceth.Peterson a sinal woman (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract &. Title Co., Inc,, by Amy Monson at the direction of the Grantor 22-S35090 t to me known to be the person(s) who executed the foregoing instrume t and acknowledged the same. Notary Public, Stafe of Wisconsin My Commission (is permanent) (expires: 9,10.441 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED (D 2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. 5t. Croix County 1161737 Page 1 of 2 Legal Description Parcel 1: All that part of Government Lot 4 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin located South of County Highway "H" EXCEPT the parcel conveyed by warranty Deed dated October 23, 1888 and recorded in the St. Croix County Register of Deeds Office in Volume "41 ", page 221, as Doc. No. 88853; INCLUDING, a parcel of land located in part of Government Lot 8 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, being part of Lot 1 of Certified Survey Map filed October 26, 2099 in Vol. 14 of C.S.M., pg. 3980, as Doc. No. 632476, described as follows. - Commencing at the South Quarter corner of said Section 3; thence, on as assumed bearing along the north --south Quarter line of said Section 3, North 99 degrees 88 minutes 12 seconds East a distance of 1354.95 feet to the southwest corner of said Lot 1, this being the point of beginning; thence, continuing along said Quarter line and the west line of said Lot 1, North 99 degrees 88 minutes 12 seconds East a distance of 1055.92 feet to the northwest corner of said Lot 1; thence, along the northerly line of said Lot 1, South 64 degrees 21 minutes 38 seconds East a distance of 17.66 feet; thence South 91 degrees 31 minutes 99 seconds West a distance of 36.16 feet to a set 1 11x24" iron pipe on the southerly right of way of County Trunk highway "H"; thence continuing, South 91 degrees 31 minutes 99 seconds Vilest a distance of 1012.40 feet to a set 1 "x24" iron pipe on the south line of said Lot 1; thence, along the south line of said Lot 1, North 89 degrees 28 minutes 43 seconds West a distance of 6.99 feet to the point of beginning. PID No. 938-1914-98-299 Parcel 2: The southeast Quarter of the Southwest Quarter (SEI/4of the SW/4) of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. P l D No. 938-1916-10-009 Parcel 3: Outlot 2 of Certified Survey Map filed May 3, 2994 in Vol. 18 of C.S.ltll., pg. 4738, as Doc. No. 761499 located in part of Government Lot 4 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. PID No. 038-1014-98-490 St. Croix County 1161737 Page 2 of 2 LEGAL, DESCRIPTION EXHIBITA A parcel of land located in Government Lot Five (5) of Section Three (3), Township Thirty (31) North, of Mange Eighteen (18) West; Town of Star P rai riie, St Crux County, Wisconsin, desc ri bed as follows Commencing 100 feet East of the Northwest comer of said Lot 5, thence directly South to the North line of county Trunk "H", H' i, thence East along the North line of said County Trunk "H" tD a point in a line running North and South and which line would be 931f2 feet directly East of said last mentioned North and South l i ney thence Northerly tD a poi nt 112 'I 2 feet directly East of the point of commencement, thence west tD commencement, Excepting that part thereof lying East of the follows described line, beginning on the centerline of County Trunk H ighway "H"a distance of 155.6 feet due East of a poi nt on the west l i ne of said Covemment Lot 5 which is a distance of 2338.0 feet North of the South quarter comer of said Section 3, and running thence North 21 ° 46 East from the centerline of said highway tD the share of Cedar Lake. (37226. PFD/ 37226f31) St, Croix County 1100715 Page 6 of 6 4JI tf"08FAGE240 QUIT CLAIM DEED -'. :x ,.... KEVN AMPS, aWa KEVIN IAMES AMYS and JENNiPER AMYS do hereby quit elhA"m, to KF.VP4 AMYS or jENNWER AMYS, trustees) or mmxwr trustee(s) as trustee(s) of the KEVIN AMYS REVOCABLE ZINC TRUST dated Febtvary 28, t 99a4, the following descri W-- !Mat-' estate in St. Croix County, State of Wie*nsin: 4ST" CRO1X Cop, 1 P- 'd 1br Record MAR 0 1994 ' M i� .... ...... oil Tax Parcel No: �e r � .......n-m . A ..,. "s %-A.�:.,.. : 4ta~4 �� �.rYlncx, • t''eti.rwkme;no at inte~raArtinn 1�L►� lines of staid Goverment �.ot ili� UI VVr�7I� #� L747N"Wai ., .,AL 4%F, wwwvw� .K, .........as■ ...,,.,,.,..,........� ._.,..�_.r__.�.._ "5"' and N line of county Highway "�"; thence North 10' 08' Esst 210.5 fee#; ►� nce South 48" 38' �t 12.8 i'arA; duzoe S parallel with W line of said Covet Lot "5" 198.9 feet to N line of said ,county 11�ghway "H"; thence North 66° 33" Vest 100 feet to the place of begkming. All that land lying between. NEly line above described parcel and Sly shoreline of Cedar Lake and between the Ally and Ely tine of above parcel extended Nay to mid Sly shore line of Cedar Lake. h This / S'.homwwad property. Dated this 28th day of febnwy, 1994. SATE of iNIR��SOTA )SS RENMPIN COUNTY r , AMYS rNNIFER A S ACMOWLEDOEMEENT Personally came before me this 28th day of February, 1994 the above Awed KEVIN AMYS and JF_NN`I:FER AMYS to me known to be the persons who executed the foregoing ' t and acinowledged the same. f IONU U. C3TEN NOTARY PUBLIC-MINNESOTA HENNEPIN COUNTY My Corrin;ssivn Ex043 OCL 29,1 M who" Ronald M. Otten, NoWy Public Hennepin County, Minnesota My comnusaion expires fctober 29, 1998 This ' t was drafted by Colleen A. Cowles, ATYORNEY-AT-LAW 1.324 W. Clairemont Avenue, Eau Chin, Wisconsin 54701 i } I Document Number State Bar of Wisconsin Farm 2-2003 WARRANTY DEED Document Name THIS DEED, made between GENE J. RANDALL and RAMONA RANDALL, husband and wife "Grantor," whether one or more), and KEViN J. AMYS AND JENNIFER T. AMYS, AS TRUSTEES OF THE IEVIN J. AMYS REVOCABLE TRUST DATED FEBRUARY 28, 1994, AS AMENDED AND KEVIN J. AMYS AND * ("Grantee," whether one or mare). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in ST CROIX County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE ATTACKED EXHIBIT A FOR LEGAL DESCRIPTION * JENNIFER T. AMYS, AS TRUSTEES OF THE JENNIFER T. AMYS REVOCABLE TRUST DATED FEBRUARY 28, 1994, AS AMENDED 1100715 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/20/2020 10:27 AM EXEMPT#: REC FEE 30.00 TRANS FEE 495.00 PAGES: 6 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area. Name and Return Address Polk County Abstract PC Box 666 St Croix Falls, WI 54024 File 37226 038- 1016-50-000 ** BOB RANDALL signs as Attorney in Fact for GENE J. RANDALL and Parcel Identification Number (PIN) RAMONA RANDALL, under Power of Attorney documents, copies of which are This is not homestead property. attached hereto and made a part hereof. (is) (is not) Exceptions to warranties: All easements and restrictions of record. Dated April J'1>13 2020 ................ W (SEAL) (SEAL) * *.GENE J. RANDALL by BOB RANDALL, Atty in Fact ** (SEAL) (SEAL) * * RAMONA RANDALL by BOB RANDALL, Atty in Fact ** a� . � ♦ i♦*ii liiiii ifiiiii -��� ♦• ii ii iii •• iii ♦!i!!lliiifii iii iiiii iiliiii authorized by Wis. Stat. § 706.06) `PHIS INSTRUNIENT DRAFTED BY: Susan D. Lee Attorney at Law Polk County Abstract ACKNOWLEDGMENT STATE OF MENNESOTA ) ` ) ss. was kt �� � 0 V\- COUNTY ) Personally came before me on Aril Z , 2020 the above --named BOB RANDALL, as Attorney in Fact for GENE J. RANDALL and RAMONA RANDALL to me known to be the person (s) who executed the foregoing t and ackn wle the s e. l 0 * No Public, State esoa My Commission . permanent) (expires: (Signatures may be authenticated or acknowltdged. Both are not necessa NOTE: THIS IS A► STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD B C ID W DEED C 2003 STATE BAR OF WISCONSIN :',�`,� �ITFTED. -�� '1 ,��;�� ype name below signatures,Ir.. N . J f . r,aa..rr.• r �'�t,i 11i�tr:;:3 iw ' �_ �� �tt_.,>w.' � H 11y� ■3■3 � hl _ St. Croix County 1100715 Page 1 of 6 ": S14-- C-.R01X COUNTY SANITARY SYSTEM File Office Use Only OWNERSHIP/ADDRESS FORM created 212o2i Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary systern! This information will be provided as part of our ongoing efforts ,,-,o protect public health, your well, groundwater, surface water, property values, and county resource.s. Once approved, this completed form and educationa': information will be sent to you by email. If you would like to view your issued sanitary permit online, YOU can do so by using the weblink. Owner/Buyer MLA M. =*or* Gty/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found an the property tax blil) NE go W SYSTEM. Property Location A4,c' 1/4 114 , Seic. -3 Subdivision Plat: L DESCRIPTION N P,2,? W, Town of aI Certified Survey Map # ��s . -, Volume Page # Warranty Deed# 5-tc)?32,- ( afore 2006)Voiume Page # Number of bedrooms Spec ho se 0 yes )9 no Lot lines identifiable 0 yes o no OFFICE USE ONLY New Property Address (Ven-ficat-ion of ne ddress requireci on Community Development Department fc- new constructu'on.) (Staff Initials'l; Patile) T/7is form must be submitted with all Private Onsite Water Treatment System (POWFS) applications. New System: Include with this forrn a recorded worranty deed from the Register of Deeds Office and a copy of the certified sLirvey map if reference is made in the warranty deed. Cornmunity Development Departrnent — Land Use Divislor, 715-386-4680 St.. Croix County Government Center 715-245-4250 Fax 1101 Carmichael Road, Hudson, W1 54016 Document Number: Return to: Kevin Amys 1148 County Rd H New Richmond, WI. 54017 Parcel ID: 03 5-1014-95-200 EASEMENT DEED FOR INGRESS AND EGRESS KNOW ALL MEN BY THESE PRESENTS, this 15th day of September , 2023 , that for and in valuable consideration of $0. the receipt of which is hereby acknowledged, the grantor, MAKA Real Estate LLC. PID 03 8-1014-95-200 1149 County Rd H New Richmond, wI. 54017 hereby GRAFTS to the grantee, Kevin J Amys Rev Trust and Jennifer T Amys Rev Trust. PID 03 5-1016-50-000 1150 County Rd H New Richmond, wI. 54017 a(n) Non-exclusive easement for ingress and egress and incidental purposes over the following described real property ("Servient Tenement") in the Town of Star Prairie , County of St Croix State of Wisconsin, Parcel Identification Dumber: 035-1014-95-200 as shown in Exhibit A attached hereto and incorporated herein. Said Non-exclusive easement is appurtenant to and for the benefit of the following described real property ("Dominant Tenement") in the Town. of Star Prairie , County of St Croix State of Wisconsin, Parcel Identification Dumber: 03 5-101 6-50-000 as shown in Exhibit B attached hereto and incorporated herein. This appurtenant Non-exclusive easement is described as a portion of the Servient Tenement and more specifically described in Exhibit C attached hereto and incorporated herein. This appurtenant lion -exclusive easement shall run with the lands described above and for the sole benefit of the Dominant Tenement and shall bind the heirs, successors and assigns of the grantor and grantee Deeds.com Uniform Conveyancing Blanks 11tirpose ol,ea semelit: on true( a sept ic system on property 11) 038- 10 14-95 -2 00 u) connvc i to i kc scptic holding flan installed, On I , J t -i, t h C propertv 11.) 03 8-10 1 6-50-0W The eascment N�vl I I bc 1'()i- a 200' bv S0 M-c- � -ts noted it c atfached drawing. W e COL1111\ Recorder is hereh%, instructed to index this Easemem Dcc,(] I'Or Imin2ss an(l Foress M the Grantor/ Iv I ill&X Ulldel- the naines t)t'thc respective p-artics. U In with s fiereof. the grantor KAs tied and se a I ed these 1) rese tints on the d,,LtN� and ear Fi rst a hove written, . .......... S�ig4ature Key'n AM if'--r Amys I ennj C Print Name MAKA Real Estale LLC. Owner,,2,6`11/ Sign attire %,tillfieNv- Amv�, Print Name MAKA Real L'state LLU. 0wrier 24`,(`l CapacilN Print Narne MAKA Re.-L11 ill'state LLC. Owner 26% Capacity Signature -Kalherine Amys 11rMi Name , I F state LLC. Owner 24', 0` MAKA Re-L.1 Capac ity UUITS'1171C ill/ ICIWIS With /hV 4 gencle-1- 4111d quawill, tvqlli�-ed hY Mc -�c!ave 01,117is THE STA rl,E OF Wisconsill SOU NJ " Y 0 F St Croix 2 This foregoing instrument was acknowledged before me the ��-e day of 0� Print Name htle R�,nik N1% conimission I peNires.- 5 1 PL 30 V1 "I"his InstrUmerat Drafted by: Kevin Amys 1 148 COUlitv Rd 1-1 New Richmond.'Wl, 54107 C)TA)y�, NIX UBOG *ion 4P88,006MO OF W\ti�l EXHIBIT A Sery i ent Tenement Description Assessor/Parcel number: 03 8-1014-95 -200 Commonly known as: MAKA Real Estate LLC. Legal description: SEC 3 T31N R18W PT GOV LOT 4 LYG S OF HWY H ALSO PT GGV LOT 4 LYG N OF HWY H & WLY OF FOLL LN COM E LN GGV LOT 4 & N LN HWY H WLY ON HWY 613.4 FT TO POB NLY BY DEFL ANG OF 86 DEG TO LEFT TO CEDAR LAB. EXC P41 B, C & D V624/228 ALSO COO S 114 COR SEC 3; TH N 00 DEG E 1354.951; TH N 00 DEG E Deeds.com Uniform C'onve_vancing Blanks EXHIBIT B Dominant Tenement Description Assessor/Parcel number: 03 S-1016-50-000 Commonly known as: Kevin J Amys Rev Trust and Jennifer T Arms Rev Trust Legal description: SEC 3 T31N R18W PT GLS COM SHORE OF CEDAR LK 100 FT E OF W LN S TO N LN HWY ELY ON HWY TO PT 193 1J2 FT E OF W LN NLY TO LK AT PT 212 1/2 FT E OF W LN NWLY ON LK TO POB EXC PT LYING ELY OF A LN BEGIN 2338 FT N & 155 1/2 FT E OF S 1/4 CORNER, TH N 21 DEG E TO LAKE AS IN CORRECTION DEED IN VOL 544 PAGE 430 Deeds.com Uniform Conveyancing Blanks EXHIBIT C Easement Description Easement description: Property ID 03 S- I o 15-50-000 is requesting an easement from property ID 03 S- I o 14-95-200 to utilize a new septic system. The existing holding tank for property ID 03 8- I o 16-50-000 will be connected to the new septic system installed on property ID 038- I o 15-95-200. Deeds.com Unitonn Convevancing Blanks EXHIBIT D Terms and Condition Property ID 03 8-1016+5 0-000 and property ID 03 8-1016-7o-000 will equally share the cost of maintaining the Septic System. This will include all costs associated with. the Septic system located on property ID 038-1014-95-200. Deeds.com Uniform Conveyancing Blanks EXHIBIT E Deeds.com Uniform Conveyancing Blanks Document Number: Return to: Kevin Amys 1148 County Rd H New Richmond, W1. 54017 Parcel III: 03 8-1014-95 -2 o0 EASEMENT DEED FOR INGRESS AND EGRESS KNOW ALL MEN BY THESE PRESENTS, this 15th day of September , 2023 , that for and in valuable consideration of $o the receipt of which is hereby acknowledged, the grantor, .NIAKA Real Estate LLC. PID 038-1014-95-200 1149 County Rd H New Richmond, WI. 54017 hereby GRANTS to the grantee, Kevin 1 Arnys Rev Trust. PID 03 8- l01 C-7o-000 1148 County Rd H New Richmond, W1. 54017 a(n) Non-exclusive easement for ingress and egress and incidental purposes over the following described real property ("Servient Tenement") in the Town of Star Prairie County of St Croix State of Wisconsin, Parcel Identification Number: 038-1014-95-200 as shown in Exhibit A attached hereto and incorporated herein. Said Non-exclusive easement is appurtenant to and for the benefit of the following described real property ("Dominant Tenement") in the Town of Star Prairie , County of St Croix State of Wisconsin, Parcel Identification Number: 038-1016-70-000 as shown in Exhibit B attached hereto and incorporated herein. This appurtenant Non-exclusive easement is described as a portion of the Servient Tenement and more specifically described in Exhibit C attached hereto and incorporated herein. This appurtenant Non-exclusive easement shall run with the lands described above and for the sole benefit of the Dominant Tenement and shall bind the heirs, successors and assigns of the grantor and grantee Deeds.com Uniform Convevancing Blanks 11PL11-POSC Of C-'ClSe[11011: Construd ca septic system oti, properly ID 038-10 14-951 -2)("M connect to 1he septic holdinig, tank installed oli p' r roperty It) 0_38'- 1. () pen 16-50-000. The etiscit wi I I befor ta 1()0b,N- 8()' kireti �ts noted in the r'lliziched drawffl(24 "Recorder 's hcivh1 nstructed toy ll&X this Easemcnt Deed f'Or 111 T T.'CS S atid Foress in the W] Graiilor/ Z 61-aantec - Index undet, the rarnes of the respective parties. In kN itness ��K!rcol I F ra n it) r 11 as� s 1 L! tied an d sealed these presents ii t h c &Lt N Lurid cq, v, I 11, st ,I bove NN, r 1 He n. ure Kevirt AmVs nn i fer Amvys Print Name Print Name MAKA Rea .Estate LLC. Oxxyncr 16% iMAKA Real Estatc LLC. d_26% Capacity Signature, M,atthew Amys Ili-int Name MAK A Real Estate LLC. Omer '24"'i"I L Ca Pa C I t v S I i-I Il'i t I, I re Kathei-ine Amys 11 /1 1d19 Cf 11rim, Namc M A KA Real estate LLB'. Owner 24% 'on.Wnlc 4111 lel-nix 101h lhc c1fid ql1cm/1,111, )'(!qH17Wd h1v Me scnvc ()fihiv decel. ME SJ'ANIT, OF Wlsc()iisllll. C()UNTY OF St Croix Th i's foregoing instrument was acknowledged before me the I (.o —day of by _X=_ -NOW111WIM119M. 1. m1W. via sig'I lure C4ztr AAL6 I it I I P P 11rint Name M C FA $100 ON jo?, %. )t * 1-itIc Rank T AR MIN My commission expires: IN INN L This Instruiiient Drafted by. +0 OF VV \So Kcv1DAmys .00 1148 County Rd New Richmond, W1. 54017 1cvd,, ct 1 rn I n i I t orm Conve,,s anc ing Blanks .. • '� • < . 1=�.�5� EXHIBIT A Servient Tenement Description Assessor/Parcel number: 038--1014-95-200 Commonly known as: MAKA Real Estate LLC. Legal description: SEC 3T31NR18WPTGOVLOT 4LYGSOFHWY HALSO PTGOVLOT 4LYGNOFHWY H&WLY OF FOLL LN COM E LN GOV LOT 4 & N LN HWY H LILY ON HWY 613.4 FT TO POB NLY BY DEFL ANG OF 86 DEG TO LEFT TO CEDAR LADE EXC P41B, C & D V624/228 ALSO COM S114 COR SEC 3; TH N 00 DEG E 13 54.951; TH N 00 DEG E Ueeds.com Uniform Conveyancing Blanks EXHIBIT B Dominant Tenement Description Assessor/Parcel number: 03 8-1016-70-000 Commonly known as: Kevin J Amys Rear Trust Legal descr*ptlon: SEC 3 T3 IN RI 8W PT GLS BEG INT W LN GLS & N LN HWY H,TH N 10 DEG E 210.5 FT, S 48 DEG E 72.8 FT TH S 198.9 FT TO N LN HWY H, N 66 DEG W FOR 100 FT TO PGB Deeds.com Uniform Conveyancing Blanks EXHIBIT C Easement Description Easement description; Property ID 03 8-1016-?0-000 is requesting an easement from property III 03 8-1014-95-200 to utilize a new sepfiic system. Deeds.com Uniform Conveyancing Blanks EXHIBIT D Terms and Condition Property ID 03 8-1016-50-000 and property ID 03 5-1016-70-000 will equally share the cost of maintaining the Septic System. This will include all costs associated with the Septic system located on property ID 035-1014-95-200. Deeds.com Uniform Conveyancing Blanks EXHIBIT E Deeds.c©rn Uniform Conveyancing Blanks Document Number: Return to: Kevin Amys 1148 County Rd H. New Richmond, WI.54017 Parcel ID. 03 8- l 0 l 6-50-000 EASEMENT DEED FOR INGRESS AND EGRESS KNOW ALL MEN BY THESE PRESENTS, this I5th day of September , 2023 , that for and in valuable consideration of S0. the receipt of which is hereby acknowledged, the grantor, Kevin J Amys Rev Trust and Jennifer T Amys Rev Trust. PID 03 8- l 0 l 6-50-000 1150 County Rd I I New Richmond, WI.54017 hereby GRANTS to the grantee, Kevin Amys Rev Trust. PID 03 8- l 0 l 6-70-000 1148 County Rd H. New Richmond, WI.54017 a(n) Non-exclusive easement for ingress and egress and incidental purposes over the following described real property ("Servient Tenement") in the Town of Star Prairie , County of St Croix State of Wisconsin, Parcel Identification Dumber: 03 8- l 0 l 6-50-000 as shown in Exhibit A attached hereto and incorporated herein. Said Don -exclusive easement is appurtenant to and for the benefit of the following described real property ("Dominant Tenement") in the Town of Star Prairie , County of St Croix State of Wisconsin, Parcel Identification Dumber: 03 8- 10l 6-70-000 as shown in Exhibit B attached hereto and incorporated herein. This appurtenant Don -exclusive easement is described as a portion of the Servient Tenement and more specifically described in Exhibit C attached hereto and incorporated herein. This appurtenant Ikon -exclusive easement shall run with the lands described above and for the sole benefit of the Dominant Tenement and shall bind the heirs, successors and assigns of the grantor and grantee Deeds.cam Uniform Canvcvancing Blanks purpose ofeasemerat p Install tand 111LI-111(mil ajoint use Septic Holdty 1,ink and puniping st�ttlon toy he Lised 1'()r proper-l�! ID 03 8-1016-50-000 Lind pi-operly 11) (.)3,ls'- 10 16-70-000. Comitx. iecoi-dci- is i[IS11-Lict.ed to index this easement Deed f'()r lfiorcss -Lmd I't.press in the z t-,,L] I I t 0 r Z 'dex W.IS JI'antee -,i 11' Lilidei- thc names of the respective part' III �Niniess hei-eol le t-mitoi- has sig ned Ltiid se.i led I licse prcscnts on the da\ LHid ecti- I Irst �It)()\ e N\ [-I llcv S14, [I a t L I re ture C�) a 1C i- v 1 n A i i i Pnnlfpr AT" Print Name Print Name ffik.bncr Owner Capacity Siim.iture C�Ipacity I Signature Print Name Capacity 4,111 1c.1-Ins 111117 117c, �cmlcv- cintl qitantin, rvqziiivci hv ilic' AVILS'C Oft/7is deed, I] IF, STATF OF Wisconsill C01,ATY 01 St UFOIX This ('Orcgolng instrurnentwas acknowledged bef'ore me the..LLLday of 4it 10 20 )3 by Signature Print Natine Tide/Rank, My commission t!xpires; ),z Thl,s InstrUrnent Drafted by: Kevin Arlivs 1148 County Rd H Nek-v [Zlchmond, WL 54017 Lom Uniform Convevancing Blank,, EXHIBIT A Servient Tenement Description Assessor/Parcel number: 03 8-1016-50-000 Commonly known. as: Kevin J Amys Rev Trust and Jennifer T Amys Rev Trust Legal description: SEC 3 T3 IN RI 8W PT CL5 CCM SHORE OF CEDAR LIB 100 FT E OF W LN S TO N LN HWY ELY ON HW Y TO PT 193 1 /2 FT E OF W LN NLY TO LIB AT PT 212 1 /2 FT E OF W LN N WLY ON LK TO PCB EXC PT LYING ELY OF A LN BEGIN 2338 FT N & 155 1 /2 FT E OF S 1 /4 CORNER., TH N 21 DEC E TO LADE AS IN CORRECTION DEED IN VOL 544 PACE 430 Deeds -corn Uniform Conveyancing Blanks EXHIBIT B Dominant Tenement Description Assessor/Parcel number: 038-1016-70-000 Commonly known as: Kevin Amys Rev Trust Legal description: SEC 3 T31N R18W PT GL5 BEG ITT W LN GL5 & N LN HWY H,TH N 10 DEG F 210.5 FT, S 48 DEG E 72.8 FT T H S 198.9 FT TO N LN H'WY H, N 66 DEG W FOR. 100 FT TO POB Deeds.com Uniform Conveyancing Blanks EXHIBIT C Easement Description Easement description: Property ID 03 8-1 a 16-70-aaa is requesting an easement from property ID 03 8-1 a 16-50-aaa to utilize a new septic holding tank. The existing holding tank for property III 03 8-1016-70-a00 will connected to the new holding tank on property ID 03 8- l a 16-50-aaa, Deeds.com uniform Conveyancing Blanks State Bar of Wisconsin Form -2003 WARRANTY DEED Document Number 11 Document Name BY THIS DEED, Bradley N. Peterson, a single man and Cynthia Lour Fonseth- Peterson, a single woman (hereinafter "Grantor," whether one or more), convey and warrant to Maka Real Estate, LLC, a Wisconsin limited liability company (hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: See attached legal description Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated �J- , 1161737 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12/ 02/ 2022 03:32 PM EXEMPT##: REC FEE 30.00 TRANS FEE 1,500.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, Wl 54017 €138-1014-95-200103 8-1014-95-400, 03 8-1016-10-000 Parcel Identification Number {PIN} This IS homestead property. 1 I % 1. i r�� I �' r' +C• -.r' ... (SEAL (SEAL) * radley,,. Peterson *Cynthia Lour Fonseth--Peterson 10, (SEAL) (SEAL) * AUTHENTICATIO k ACKNOWLEDGMENT NS Signature(s)����� :�`.,......., ���• STATE OF WIS CONS IN ) authenticated on ss. COUNTY OF ST. CROIX ) ■ r . C r ✓r r ti * f `••. ,, .. _ .. . ,..•' C� 7� Personally came before me on the QL day of December, 2022. .......... . .. , ,��`►the above -named BradleyN. Peterson a single man and TITLE: MEMBER STATE BAR OF � �` C #hia Lour Vonceth.Peterson a sinal woman (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract &. Title Co., Inc,, by Amy Monson at the direction of the Grantor 22-S35090 t to me known to be the person(s) who executed the foregoing instrume t and acknowledged the same. Notary Public, Stafe of Wisconsin My Commission (is permanent) (expires: 9,10.441 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED (D 2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. 5t. Croix County 1161737 Page 1 of 2 Legal Description Parcel 1: All that part of Government Lot 4 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin located South of County Highway "H" EXCEPT the parcel conveyed by warranty Deed dated October 23, 1888 and recorded in the St. Croix County Register of Deeds Office in Volume "41 ", page 221, as Doc. No. 88853; INCLUDING, a parcel of land located in part of Government Lot 8 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, being part of Lot 1 of Certified Survey Map filed October 26, 2099 in Vol. 14 of C.S.M., pg. 3980, as Doc. No. 632476, described as follows. - Commencing at the South Quarter corner of said Section 3; thence, on as assumed bearing along the north --south Quarter line of said Section 3, North 99 degrees 88 minutes 12 seconds East a distance of 1354.95 feet to the southwest corner of said Lot 1, this being the point of beginning; thence, continuing along said Quarter line and the west line of said Lot 1, North 99 degrees 88 minutes 12 seconds East a distance of 1055.92 feet to the northwest corner of said Lot 1; thence, along the northerly line of said Lot 1, South 64 degrees 21 minutes 38 seconds East a distance of 17.66 feet; thence South 91 degrees 31 minutes 99 seconds West a distance of 36.16 feet to a set 1 11x24" iron pipe on the southerly right of way of County Trunk highway "H"; thence continuing, South 91 degrees 31 minutes 99 seconds Vilest a distance of 1012.40 feet to a set 1 "x24" iron pipe on the south line of said Lot 1; thence, along the south line of said Lot 1, North 89 degrees 28 minutes 43 seconds West a distance of 6.99 feet to the point of beginning. PID No. 938-1914-98-299 Parcel 2: The southeast Quarter of the Southwest Quarter (SEI/4of the SW/4) of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. P l D No. 938-1916-10-009 Parcel 3: Outlot 2 of Certified Survey Map filed May 3, 2994 in Vol. 18 of C.S.ltll., pg. 4738, as Doc. No. 761499 located in part of Government Lot 4 of Section 3, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. PID No. 038-1014-98-490 St. Croix County 1161737 Page 2 of 2 Document Number State Bar of Wisconsin Farm 2-2003 WARRANTY DEED Document Name THIS DEED, made between GENE J. RANDALL and RAMONA RANDALL, husband and wife "Grantor," whether one or more), and KEViN J. AMYS AND JENNIFER T. AMYS, AS TRUSTEES OF THE IEVIN J. AMYS REVOCABLE TRUST DATED FEBRUARY 28, 1994, AS AMENDED AND KEVIN J. AMYS AND * ("Grantee," whether one or mare). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in ST CROIX County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE ATTACKED EXHIBIT A FOR LEGAL DESCRIPTION * JENNIFER T. AMYS, AS TRUSTEES OF THE JENNIFER T. AMYS REVOCABLE TRUST DATED FEBRUARY 28, 1994, AS AMENDED 1100715 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/20/2020 10:27 AM EXEMPT#: REC FEE 30.00 TRANS FEE 495.00 PAGES: 6 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area. Name and Return Address Polk County Abstract PC Box 666 St Croix Falls, WI 54024 File 37226 038- 1016-50-000 ** BOB RANDALL signs as Attorney in Fact for GENE J. RANDALL and Parcel Identification Number (PIN) RAMONA RANDALL, under Power of Attorney documents, copies of which are This is not homestead property. attached hereto and made a part hereof. (is) (is not) Exceptions to warranties: All easements and restrictions of record. Dated April J'1>13 2020 ................ W (SEAL) (SEAL) * *.GENE J. RANDALL by BOB RANDALL, Atty in Fact ** (SEAL) (SEAL) * * RAMONA RANDALL by BOB RANDALL, Atty in Fact ** a� . � ♦ i♦*ii liiiii ifiiiii -��� ♦• ii ii iii •• iii ♦!i!!lliiifii iii iiiii iiliiii authorized by Wis. Stat. § 706.06) `PHIS INSTRUNIENT DRAFTED BY: Susan D. Lee Attorney at Law Polk County Abstract ACKNOWLEDGMENT STATE OF MENNESOTA ) ` ) ss. was kt �� � 0 V\- COUNTY ) Personally came before me on Aril Z , 2020 the above --named BOB RANDALL, as Attorney in Fact for GENE J. RANDALL and RAMONA RANDALL to me known to be the person (s) who executed the foregoing t and ackn wle the s e. l 0 * No Public, State esoa My Commission . permanent) (expires: (Signatures may be authenticated or acknowltdged. Both are not necessa NOTE: THIS IS A► STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD B C ID W DEED C 2003 STATE BAR OF WISCONSIN :',�`,� �ITFTED. -�� '1 ,��;�� ype name below signatures,Ir.. N . J f . r,aa..rr.• r �'�t,i 11i�tr:;:3 iw ' �_ �� �tt_.,>w.' � H 11y� ■3■3 � hl _ St. Croix County 1100715 Page 1 of 6 LEGAL, DESCRIPTION EXHIBITA A parcel of land located in Government Lot Five (5) of Section Three (3), Township Thirty (31) North, of Mange Eighteen (18) West; Town of Star P rai riie, St Crux County, Wisconsin, desc ri bed as follows Commencing 100 feet East of the Northwest comer of said Lot 5, thence directly South to the North line of county Trunk "H", H' i, thence East along the North line of said County Trunk "H" tD a point in a line running North and South and which line would be 931f2 feet directly East of said last mentioned North and South l i ney thence Northerly tD a poi nt 112 'I 2 feet directly East of the point of commencement, thence west tD commencement, Excepting that part thereof lying East of the follows described line, beginning on the centerline of County Trunk H ighway "H"a distance of 155.6 feet due East of a poi nt on the west l i ne of said Covemment Lot 5 which is a distance of 2338.0 feet North of the South quarter comer of said Section 3, and running thence North 21 ° 46 East from the centerline of said highway tD the share of Cedar Lake. (37226. PFD/ 37226f31) St, Croix County 1100715 Page 6 of 6 4JI tf"08FAGE240 QUIT CLAIM DEED -'. :x ,.... KEVN AMPS, aWa KEVIN IAMES AMYS and JENNiPER AMYS do hereby quit elhA"m, to KF.VP4 AMYS or jENNWER AMYS, trustees) or mmxwr trustee(s) as trustee(s) of the KEVIN AMYS REVOCABLE ZINC TRUST dated Febtvary 28, t 99a4, the following descri W-- !Mat-' estate in St. Croix County, State of Wie*nsin: 4ST" CRO1X Cop, 1 P- 'd 1br Record MAR 0 1994 ' M i� .... ...... oil Tax Parcel No: �e r � .......n-m . A ..,. "s %-A.�:.,.. : 4ta~4 �� �.rYlncx, • t''eti.rwkme;no at inte~raArtinn 1�L►� lines of staid Goverment �.ot ili� UI VVr�7I� #� L747N"Wai ., .,AL 4%F, wwwvw� .K, .........as■ ...,,.,,.,..,........� ._.,..�_.r__.�.._ "5"' and N line of county Highway "�"; thence North 10' 08' Esst 210.5 fee#; ►� nce South 48" 38' �t 12.8 i'arA; duzoe S parallel with W line of said Covet Lot "5" 198.9 feet to N line of said ,county 11�ghway "H"; thence North 66° 33" Vest 100 feet to the place of begkming. All that land lying between. NEly line above described parcel and Sly shoreline of Cedar Lake and between the Ally and Ely tine of above parcel extended Nay to mid Sly shore line of Cedar Lake. h This / S'.homwwad property. Dated this 28th day of febnwy, 1994. SATE of iNIR��SOTA )SS RENMPIN COUNTY r , AMYS rNNIFER A S ACMOWLEDOEMEENT Personally came before me this 28th day of February, 1994 the above Awed KEVIN AMYS and JF_NN`I:FER AMYS to me known to be the persons who executed the foregoing ' t and acinowledged the same. f IONU U. C3TEN NOTARY PUBLIC-MINNESOTA HENNEPIN COUNTY My Corrin;ssivn Ex043 OCL 29,1 M who" Ronald M. Otten, NoWy Public Hennepin County, Minnesota My comnusaion expires fctober 29, 1998 This ' t was drafted by Colleen A. Cowles, ATYORNEY-AT-LAW 1.324 W. Clairemont Avenue, Eau Chin, Wisconsin 54701 i } I "'ARY SYSTEM R1%J`0KT U I L T I 4S U w I �'R OWNLS11T P- S E c T;j N - R W C 0 0 NT Y W I SC 0 N S 1, N A k. ADDRESs- 4t' S 1-1 B DJ V1 S I Q N LOT LOT S I ZE I pip �11 I and dimensions t-o 1,iiuet requirements of' H63. BENCHKARK. M--r-manent reference Point) Describe. 'a 0 1 //0 E 10 as. leration of vertical, reference point Slope t it� Liquid SEPTIC TANK: Ma n u fa c t u. r e r Number of rings on cover -TanT-manhole cover Tank out.ler- Elevation-, e ".7 d '%- 10 T o3 PLJM11• Manufacturer: Number of gallons aclLy or— L ga I Ins tot Junaber of gal� pump set or a cycle e distriburion lines gallon, size of pump had gallon per minute bran name of pump and model nwitner Type of warning device HOIL.-DIN("i TA�IK: Mdnu f a c turer— Number of gallons of manhol.e L�over__ Type o� w,a-rniiLg device SEEPAGE IAT SIZE; r 6 t p if —s 116Pf— d - soeji'oge pit Litlie-T—Pipe -elevil L ion---,-- eet quid eEE --I-- bot.Lom of seepage pit c- evaLl,on feet- 7 S- --�Wj- �IdR-1-1 r-jV L le depth I EIA`PACF� BED SIZE: ri�imht-�r of I incs SEEPAGE TRENCH. width XU, A � —'k E—( Ft I REO �lengtli— I F, A� �B�Lf PERCUI.AT1014 RATE DATED 1,,4 S P FC70 R ,"WHBEER ON JOB 1,1(',E.NSE NUMBI-A'K 1 Wiscon!5in Department I of "3'ommerce PRIVATE SEWAGE SYSTEM Safety and Duftfing Deviislioll INSPECTION REPORT GENERAL INFORMATION AT_ ACT TO PERMIT) Personal information you proves may t* used for socondary purposes [Privacy Law, s. 15.04 (1)(m)j Permit Holder's Narrie- C Ity Village X Township -Amys, Kevin I Star Prairie Township CST BN1 Elev. In BIM Ellev. BM Descripton- TAM K INFORMATION ELEVATION DAT TYPE MANUFAC7URER CAPACITY Septic Dosing Aeration Holding acb f L TANK SETBACK INFORMATION U TANK TO, P/L WELL BLDG. Vent to A i r I ntar. ROAD Septic Dosing Ae 30e_, I ding jo 6" 1 -I.- oftA2 E tJ igcw . in PH;.jl% VON PU M PA , ,.-N MATIOTY Manubcturer Model Number TDH Lift Faction Loss SYS Head For main Lnngtt Dia. 10 *el SOIL ABSORPTION SYSTEM BEDITRENCH Length Wo, Of Trenches DIMENSIONS SETBACK SYSTEM TO BLDG INFORMAT1,0N [Type OfSyster:'�� Demand GPM TDH F1 WELL DISTRIBUTION SYSTEM aMAJ J4�:b� Header/Manifold W. All L th. SOIL COVER x Pressure Systems Only Deptt) (--)VeF D-eplh der Bed[Trench Center 16ed/Trench Edges I County: st, Croix Sanitary Permit No: 420652 0 No, —Frub44,6, Parcel Tax No-. 038-1016-70-000 PIT DICIE N=JCS INO. Of Pills I Inside 01-a. —Aw4wkMop LAKE/STREAM LEACH, anufacturar: C H OR UNIT NIT Model Num�. M; PM !Vent to Air I ritak.-i xx Mound Or At -Grade SysteMS Only XX Depth of YX S,,-_�d,ed/SDdded xx Mulched Topsoil Yes No j No Yes COMMENTS: onclude code discrepencies, persor75 present. etc.) inspectior P In 44W _/_1 spection #2, Location. 48 Cty Rd H S'ar Prairie, Wl 54026 (Government Lot 5 3 T3 IN R 1 8W) NA Lot Parcel No- 03.31-18,52 1.) A -It BM Descriptiop, /V/4 2.) Bldg sewer lengti; 13 amount of cover I g No Plan rievision Required? Yes X Ar4 I z Use other side for additional information. sia 'r, Can. No . Date ;Sf�pc 0 S Sig re SBD,6-710 (R �1197) Safety and Buildings Divistion I W - Wash ington A ve., P - 0, Box 7082 isconsin M ad I son, Wi 51? 0 7 - 7 0 82 (008) 2) 0 1 --6546 Department of Commer e Sanitary rr. Ap In accord with Comm n 8 3, 2 1, Wil -,;. Adm - C od c. peTs may bt u%-ed fto rwmunOary purposm Mvw 1. Application Information - Please Print III fiffor.matito Pr �Owner "s Na= PrOP" Chwner'% \1 at lting Aul .3 City, Zi stwi c Phone Numbcr p "Cod <7:3 I T pe or Building (check all that apply) i or 2 Family Dwelling - Number of Bedrooms Tr GPI - DC-tjL T k t)C L 1,%C State Owned - Di=cnbe Use .0_ t al in Law, s 15 .04 (FX m) 'IN 16 003 ZONiN(";' OFFICE County Sanitary Famit Number (to be filled in by Co.) , / I Llr-�r' 0 6p_ z5 SLOtc Pixi I.D- Number Project Addrc= (if diffeivrit dum mailing sd<U=s) /- Parcel # LDt # Blmk # Property I. %.x- i i:.:, i S t T EXWl Subdivision Name CAS Nurnbcr 111. Type of Permit 4. (Check on I y one box ant I I ne A. Cotoplet e lint B if appli ca ble) El New S ystem 1>*11"MMI System )0 Trot t/Holding Tank Rcplacer uml Only Other Modi ficaticm I o Existing System • List Previous Permit Numb and Date 6sued 0 Porn it Rmcw3l Fetmit RcvWm 11 Chmge of El Perm It Transfer to New Before Expimtion Plurnber I Own Cr I V. I of FOB S stem: (Check a I I that ap p!n C Non -Pressun*2ed tn-Ground rl M ound > 24 i n. cif ul tablit so I I Mound < 224 in- of' suitable &oil At-Gmde SKW I& Pass SaxFilter Constructed Welland El Preurized In - round 3z olding Tank Per Filter Aerobic Trealmont Unit RreeirCUIating Sand F11trr D vsG RociKulating SynEktic Media Filter D Lzaching Chamb-L-r U Drip Uric D Grave I - less P I pe (-Ahef (cxpiain) V. DispersaMeatment Area information: Design Flow (gpd) Design Sall Application Ratf) Ds-spem] Area Requ'Lmd (sO 01spem] Ares Pred (0) System Elevation 1kr1. Tank Info Capacity In Total I Number M a nufactu rcr I Prcfab Site I Sty 11 Fiber plastic Gallons 6aliong of Ullits Concrete Constructed Glass �sting T nka Tactics s A ------- 3 "Ic or HoldinS TzrA Arrob 6CTreatnici1 Unit Dosing,Char V1 I. Respom ibility Stalemvq -I,, i h v u ad eirsign " � _0wspousl bility fe r looWlation o f Th e PO WI-S sbown 0 a th e a Un cbed PIZ aS. Plumber's arne (Print) Plumber'5 S' t MI. PIMPRS Numb -or Business Phone Nornber L Plumber's Address 'Street, C it, sate , z I e-5 '41 VII ou n ty/ eps rt men t 'U s e Oral S f anitary Permit Fee (Includes Groundwater Date Ismeo = ;in g ent Sirature'pjpef�arnps) KApproved El Disapprowd Surcharge Fec) C1 Ownc-r G i'ven Kcaso�n for Dcn i al 00 rl /0 F1 X. C o ad i t io n s of A pp rovatrReitso s for D isa p p r o v;a .- -111� A 'i- J [--�"t dt, q"--. - j14J Aai�� 1�69& 441i ;tom L I A ic 34 C Qmpkte P1 021 (to the Coon Ity on 1j)-ver tbAyv per na4 lost than R610 x I I lwb4m in SUO S.BD-6398 (R. 08/02) ILI St. Cro" County Planning and Zont*ng Thu rsdaj-, October 12, 200 6 at 3.03 W- 18 PH PCIA1 sallitary 111fol-111 -Gil I W 11 Page I of I Computer #.- 038-1 Q V3 - 7 0-" SublPlat- metes & bounds Section: 3 Parcel 9: 03.31 � 18.52 Lat TNIRNG-, T31N 118W M u n i c1pality. Star Prairie, Town of CSM-. 1A V4-, Gov'1 Lot 5 Owner- McHugh. James 1148 Cty Rd H St a. r Pra i H P. 'w'V 1 026 State Permit: 4285 Issued*. 07/2911970 POWTS 131"mrsal.- -Pressurized In -ground Per-mit, Nev�, eN - W1 Fund-.FONTScountyPermit: Pretreatment: NA Notes Is-suer/Inspector As Bu0t PI 0the Re premer:'- Harold Bauer No Powers, Calvin Not determined Signed Off, No Owfior-. Amys, Kevin 1148 Cty Rd H Star Prainie, W1 54026 State Pi,rrnlit: 420652 Issued. 0 111712003 POWTS DI s p c, rs a I Holding Tank County Permit: 0, Installed: 0411212OD4 POWTS Detafl.- NA POWTS PTetti-tram ent-. NA Note s IssuerflnSpector As Built Plum b-er Other Regqwements Not determined NA Bird, Shaun Kevin Grabau Signed Off: Yes Mainten-Linc,e Schedul(-1,-d Pump Date Pumped 1 st Noti ficati on 2rid Notification 3rd Notification 4112J2007 �ACjtional Note:5 file With hc4d* tank in 20,04 M9 Permit.- Replacement Bedrooms: 3 1 1 Fund: Additional Notes H old inn tank agreeme nt recorded 0 111610 3 #705995 This was related Plb, 0.67 3/70 TY.P1 or USE BLACK INK 'Wisconsin Dep&rtmut of Health &a 390ila 54TY100m Mylsion Of '140L�Llth S E PT 1 C TA ',,,TK PEP',Mll APY1, 'ATICIN' A, 'OWNER,-_ OF PROPLRTY Address (Stroq%'o Ci4ty# lip C*&) V Bo LOC A T I ON OF p R OD L+R 7y W rEk S Y ;°F,"M IRILL CONSMUCT0 ALTYRET OR EXTEKDED COUNTY C'' -6ok One: CITY VILLAGE LEGAL DESCRIPTION , > Lj I LR No P ER:� I T -e 1% F F':17 '4�7PEQUIRED FOR TiilS 'P�ORK? IS LOC IL Do so FW eIN �e 9 %. --r. -T 0 14 5EPT11" -"k1-11K1 flIVACITY lions NEW INSTALLATION RL P LA C M h O MATERIALS` Prefab Conorete P;)ured in Plaze ther NUMBER OF MUS TO BE 1NSTAL=: TYPE OF OCCUPANCY Gook One: One or `L`wo, Fazlly ki�slderze C othar V ,N,,jmber of Persons to Aced Lted qk�lr N=k. 0 yi,. Autoumaotic� Cjct�ho.q Wftsher YLS NO A Food Waste Grinder L tic PPLIANCES, EM --kommm� —mmmmmmhm� -o�a�o YLS NO Dishwasher YO NO Automatia P Other (SPee ij, r > Add r%scoi a License 'Numberi IMP m Signatur6 of Appliat-nt: C yo-r •JL e t e d. by 19 -S u I r14F, f A P r) i i GA t 10 P! Permit Nv;mber k 71 date a IL lop L roll I Ag e t (Na-m e 1� 7 P, P Village, to y CaLmty, etc. (Spee I ry) ,-e answered ewd the L IL Not e a - p I i R -- i n 'I I f I I of t,,-Ie above questiOns a, ree paid. kt-. k, r. t !i wit 1 for--vard i)r ".Qu for *ach cup'AG t".K and ths tnl*QpY Q L t o,,) k -s an-L -dtrs src;uld be -�f 1;r:o per--It c kLr. to the j)jv4 s j -z� f H E- C mQneY Or L "L -W tne Div!: SOD of He&Lth, L'o rLgt Porl:o in gpa-',e belc-0ME FOR DEPARTKINT USE ONLY is DArE mcElm FEE MC- EIM 'tag 0 IR Ey I'-1 y ACCFPTED 3Y 144kLID. INC. �A RETUMM (D&t e) o ru 5 3 0 PM I T 00 Aj-1PP.CV iTi DAYS (Yes or NOT COM?LATE OTHER 5IDE r1i SEPTIC TA,-('K PE�CIA"fmr N."). L I P 0 k T 0 H 5 0 1 L P t R C ID L A T 1 0 N T 9 S T A N D 5 0 1 B 0 R I N G 5 i k E, DIVISICki 07 HEALTH SIM71* P.%Box J'69, 537%,J-1 Plirsumt to H 62*2310 404ts. codo Test JD*ptJi' facto* of !�o—i—i Hours Water 7 0 A T i'm is Dr -op in Water Level In0hes Utes der laah6s ThUkness In Dwhem Since Hole in Hole interval Second -49 Next to Last iptr�od 0 j?ajjL F st wetted 0VqrnjjjLd in K in ut 9.9 Last Pertad La3t Period 4te Inch P 0 361, ?22-soli LON CAM 2611 25 Yes or No 3U- 112 60 L L P tl ZZ A�4 a N� mppqp RECORD D ATA FROM MIND" OF 3 72ST HOLES COMVU�4 SiZO Of' at) 5; 0 n rLrt in a-Ilcord :�--,2.20 Wis.* Adainlsitmtive Code. 5 0 1 L B 0 R I N S 36)1 Rely d- A I�Qz-p 11, 1 on - - � 01 M 0 r I Lag, T 1) t .--11 'D �A t o Ground Wa-Wer I Quth to loodrock ,q,.nar In a I Observed Zxtim&%od Ob,,served Estimated okneain Chamete:r of Soil with ThiPM s Inches -oh 0 721, 72pi Bllacv, Top 5oil 12t1j-2.La 8 -Sand 18"i Gravel 24" #-4 C2, C, PXCjMr'1D FROM KINDM 01' 3 BORE HOLES R351UNCE2 NLimber of Bedrooms ( OTHERs Speuify) Number of Persons V L AUOMMEM-%�* - o Auto Clothes Wert Yes No �OD 'PT ASS` E GRLVDKRs Yes N,) \� D 13 5 h e t- t Yes Na4h -o"4506ftm— mw� k T jj DI.Si'133-AL SYSTU'l: x �-74 "'T KN3 11,3N 7 Trent Width Depth Number of Lines 1 Is, S I z it Wo . Lin.,F a ov, amnww-,� Seepage Bed; L6-.,gth Width Depth mwhw� Tile Size N0.6, Une-3 Shopaq-,e Pit& Inside, Diameter Liquid Dspth qw the undersigned,, hf.-reby aey-lilp-Jfthat the Pero o.Lation teate reported nn this form wer6 mad* by me or rindor my super— vision Ln L1.,-.Ord wi-.�i the Pr-QC,5CLzres and method speoined In Chap- 4er ii -j2.2'-j �i'3), 'Wisoonsinn AdministmtIve C000;, and thp-� the dat" r000rded and locatJort oftestholes are aorrswt to th-e, ,-,ost rjo* my k-,,rjw.,a,dae &nd beiiqf. Ile NAM: TITLE IN, (Tipej r ?r I n -w pW REGISTRATION NO ADDRESS IDA "IE -7--- 5 IGNATURF6 �0'11lVtfRCIAI TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 900 - 962 - 5227 FAX - 715 - 962 - 4030 ST * CROIX CUM WVBNW CENTER 1101 CAFNICHAEL ROAD HLMSON, W1 54016 ATTN: THOM Co NELMN REPORT HO * + 45330/01 REPOT DATE: 7/23/93 DATE RECEIV0*0 7/24/93 �+ Kevis Aiys LOCATIO + 1148 Coo Hwy; N t New Richmond CaLt.ECTCR: Jis Thompson DATE CCLLECTEM ?-19--93 TIME CALM TED � 1100pe SOME OF SAMU34 Cuts i de tap DATE ANALYZED:7-20-93 TIDE ANALYZEM2100pe h COLIFORM# M *f 0 /140 ■ i I . ATION't Sac ter i a Lag i ca L Ly SAFE NITRATE -No { f ppe Above 14 pp■ exceeds the recaeeended PubL i c Drinking meter Standard e Ca o f are Dac ter i s/10D ■ L Nitrate-4N i tr ages: ig/L. jut w �i sTTM LAB TEGNIGIANi Pats Gana NI Approved Lab Flo. 19 � < ftdtts "LESS THAN" Detectable level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 PAW i 93 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST- C—R-0A COUNTY COURTHOUSE 911 FOURTH STREET e HUDSONO W1 54016 (715 -4680 'L.,3'EPTTC 1NSPF:'C_-'q'I0N WATER TEST REQUEST FOMr! Specity des.i�c-d test(s) & remit appropriate fee with api-jilf"ioni out side. watCL- lines, are often tui-ned off during winter months, making access to the hume necessary. Please make arrangements with this Office to insure a time when entry can he gained. .r) t I C 25.00 $1 S -ci C1 Water (1,70C's) - - -11 0 Water (Nitratr• T�acterla) 35.00 (Visual inspection (2:5: 0 OD Ctj o;n em) ted by: ri Owner. R ess: Address: 6efil ( M City & SCater: At C ity & St ip Code: NI: Z IL P 'c) d C' 7L e, e W: Telc Property address (Fire Na & Street Lo cat n T s0c. N R W Town f o St. Croix coo, Wi. Tax 16 W_ Parcel ID r:Lock Como oA Box Coo. House o .6 _� Realty (,' W t i -n a ;C 10 C a o To BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH , 0 HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwell�ncj ctirren-I.-Ty occupied'? Pf- yes 0 No it vacant., datclast occuplcd: jl Year: s y s t e- in i i i L-; c d b y ji MA CA�1� �c tank last, ser-viced b D a t e 11-1 I "r ev i. ous Owne r,' s N a -rkie V" lfaw_-s any of the been observed" 12 slow r1r-cainage from house,. 11 Y ;�N Sewage Back-up i1nto dwelling. DY ON Sewa-c d4,.scharge to ground surface road ditch or body of water. • W 0 Y ';M Slow drainage from the dwelling. 40M 0 Y A�4 Foul, odors. ............. Other comments relative to �-,ystem operation I certity that thQ above In for,riatiC-in ].S comj?jet(� cavnd true tc th�� best of rty knowledge., 0 1) 71, rr6 Go I Oyam` NERLL.11STGNATURE: TO BE COMPLETED BY INSPECTION 'I - -cy System design &/oi- permit on file? Mes shect 0 soil ser3,esw) Pel:" 'S Soil survey Ty c� o ript i on sys tem: Wre- I ow qrd. OAt-Grd DMound pe_ pf so i I Approx. size OGravity ODO OPressuri'zed OBed OTrench ell Ft r �yw DHolding Tank Ooutfall p3-pe OBSERVED DEFICIENCIES C10ther ti 1c, t DProp. 1i Setbacks: �]House EjWel 1pe.__ Dose t. a ri Y', Setbacks: Mouse ItIN I ell OProp. 1;L'rie 400ther AA- - FLock1ngcovr)r /Z:DWarn-tpglabe,1 �L+_OPump/Floats 0Alarm-AA,---uE1ec* wiring.Or- Soi.1 AbsprDtion S stem S We' 11.pra ILJ-ne 00therHouse p I r �40L,111111w .0 L-6-A \1910 6 Ifit le 7r 9VA— M ,Tt-ily 21.r 1993 1,I" Co. Hwy. H ?--*ow, Piciaiiiond, WI 54017 V1- Dear M-L . Aimys: ST. CROIX 001T�TY WISCONSIN 204"ING OFFICE ST. CROIX COUNT'Y COURTHOUSE I 1 01 Cil rMc i chaeJ Roe,] 1* Fftidsofj, �jj zli An inspection of the sept,l--c system, servi,ng your hore- located at thcl- ..,bove address, was conducted on July '19,, 1993-o At 'the same time a water i--,anple- was olbtained -i,.n order to tcst for the presence of C0141.1f(DI'M 0,-icteria Nitrate c-ontamination. This inspection was 13ascd upon ZI surfacc inspection of sa-ld system and did not involve any excavating or chemical analysis. Accordingly,, there may be 'I , f�idd-c-:,,n defects In the system not discoverable by thl'-s. inspection.. Our records do to back to the tiii:e this system was metal lo,`., so it is impossible to determine exactly what the system consists of or how many, square -11,�7eet of drainage area there may be. At the III time of the a-P.Spection, the septic -system appeared to be functioning, but not at ful-I calpacitylo, j,t was noted that sew-c-ige effluent was ponded within the drywell Lndicating that the sy,stem ra� .1)e approaching fallure . Given these factors JLt is very difficult to estii-iiate the useful life remaining In the system and I cannot guarantee or warrant that this system will continue to function Properly in the future,, I cannot predict how long this syste-ni w1*11 continue t-�D accept sewage: effluent nor how soon, the system will fail completely. In an effort to pr-olong the system's life as long a��; possibl.e, I recommend that steps be take-,-,n to the house which enters the minimize the wastewater flow from sysDtem. For example, repaill- any leakang water fixtures and/or replace them with water conserving fixtures, reduce time spent in the showei-, wash clothes and dishes only when there 'is a full load, use a washing machine with a suds saver feature., etc. I would also recommend, that you have the septic tank pumped at a Tainimum of once every three years,. 11 Based ci-i page. 3 c) the S. C. 11,31 ScL' I survey Manual of St Coo ix the size and topoqraphy of the property, and field findings of �-mil conditions in the ii-nPne-diirea, j-t appears that when the s,e,,---)tiC system is replaced a holding tank will be necessary. jo d a It was a I �,-(D t1h1-:it there may be deficl-encies -in sytem setbacks as required by c,urrer'it code. This constitutes a violation of WI* Admini.strative C"'o(le s.ILUR 8:3.10(1) relates to a def-ici-ent setback requiremei-it. Di-Mc-i-isfl-. septic tak on standards such as setbacksn , -andfathered. So long as capacity, draiii1'.1''mo d s,.-',Lzo, etc., are "" gi, the system is functioning properly, which Tneans that it IL dt we wot isposing the sewage effluent as well as t.re;1,11 n zating' Condemn the syster, ns Should liave Lqny quest- Jons or concer please feel free. 'L,-o cc)iitact me at this 8 * 00 afra. - 00 pm. f Mc--)rillay Friday. M i n c e I Y rMn e S K Phompson A�-',sjq.'taj1,tL 7C)j'-jnq- A(A.rnit'rator ("7C, 0 Earl Rose file that I can clarify for you, office between the h.ours of HOLDING TANK SERVICING CONTRACT Contract Date This contract Is made between the Iding Tank Owner(s) Name(s) and Pumpees 4vVN7 J9 Al v 0 v�- �� 1 e PIG`— owina pr2rty*. We acknoWedr,(-L 1he install adion of (a) holding to on the foll (Provide legal descdpbons.-) O:,.,__7 W-/ '45 X., -rs XQ somon mosommoso mo� Gloom MMO." � wG= �qww�� MM=64�� oomiw Goo= MomormosoliM 4014hor omowmoM� OW11(�F agrees tc) filc a copy Of tLhis contract with the local grovemmental unit that has signed the ank hd H" pumping agreemew reqLU- -'"& ja Comm 83.52(1)(c) 1. WL's. Adm. Code and t e approveoldinL� Cornponent Ntanua,', This agreement will also be Tiled with the St. Croix County Zomi,ng Dera-Ttry ent. L _rce.�� tc) I ed by the pumper and guarantces to permit the pumper -T w iave the holding tank(s) servir The ovvwi L tO 11KlVi2 �I(XCSS Md to enter upon the property for the purpose of servicing the holding ta.nks). The mvncr 4qprocs to the ace-ess -r();idor drive so that the pumper can service the holding with the - pumpi ng eq uip me nt - T h c o wncr further agrees to pay the pumper for a I I c harges inc wed sere Icitig tile holding tan_k(s) as mut u a I I y agreed upon by the o w , er and pumper, . 3. The pumper agrees to submit to the local governmental unit thathas signed the pumping agreement and to C h the County, a L Vport fbr the servit;lag ol the holding tank(s) on a senuannual basis. The pumper fur.t C'T agrees to in&)(ic the folio wing,in the semiannual report: a. The naiiie and address of the person responsible fo- servicing the, hold`ngp Tank; b, The narne of the owner �i i'the holding tank, c 1'he location of the propeiiy k)n which th.--holdir.Ig iaak is iT,still ck.' dr The sanitary pernuit number issued for the hulc'.ing tank; eL The dates on which the holdirg tank was serviced, The volume in gallons of the contents pumped from the tank for cash king; 7 g. The disposal sites to whip h the conicnts from the hold i �� ij r) k de I'1 ve,red. .I. i i i n -the event of a 4. ihlS ageement wililremwn in cffct�t unn! the owner or pumper temnates this contmu. I change in this con track, the owner agrees zo file a copy of any changes to this service contrast or a copy of a risescr,-Vi cc contract with love local gmmental unit aun :end the Cot%-' named above within ten (1usinew days from the date of chan ge to this se ry i c e contra c I Owner(s) Name(s) (Print) lOwnerts Signature(s) Subscribed and sworn to me on this date: Pumper's Name (Print) Purn pe,�'s 1-i stT a, Lion Number 10/ Pumpers Signature TodaVs Date �rlj iP,irsconsin Department of Commerce January 14, 2003 CUT ID No.226900 SHAIN R B-00 SIRD PLUMBING-, INC 1008 192 ND AVE liLTW RICHN10NI) W 1 54() I'Ki CONRITIONAL APPRO�' IAL 1 4 PLAN APPRO NTA L PI ES : 01/ 14/2005 A TTN: POWTS Inspector 7ON ING OFFICE S'['(-"ROIX COUNTY SPIA I 10 1 CARM ICHAE L RD HUDSON W1 54016 b SITEIP Kevin Amys 'Ct�hl J_ b T Town of Star Prairie St Croix courilty Govemment t(s)1,S3,J,31tN,1Zi'�k FOR: Replacement holl _3 be��Jdence O 71� S,��.qer 'tted Object I D 8 87 811 bject T�pe-� PO Safety a nd B u il ding-9 10541 N RANCH ROAD HAYWARD W1 .54843 TDD #- (608) 264,8777 www,cornmer-0e.statie* .u,s/sb wwwmisconsiitgov James Doyle,, Governor Cony L. NWMG8, Secretary T h e submittal d e scribed above has been rev 1 ewed for c o nform a t ic t; V,'I' Ll'i applicable W i sco is n d mi n i s trati ve Cod - and W is co n � i i i Statu tm - The s u brfflivwl has been CO NDITION ALLY APPR 0 VED . The ow n c!-. as de fin ed in chapter 101.01(10), Wisconsin Statutes, is responsible for rompliance with all code requirements, I The following conditions �hall be met dizing construction or installation and prior to occupanic'v t)T' title' gmeral Avwoval Coiidiflo Ti)is system is, to bc constructed and Iocated im ack:ordance_ with Lhe enclosed approved plans and with the- "Holdi ng Tank 0) n1pollent Man,UAI SBD- 105 7 1. -P (R.6/99) I'* In t 1i e e vent t 1i J s ii u I cl I ng tank rn al furi L: Lions so as to create a 1i ea i a iu ard, the p f o pe, rty owner must fol 10 ° ILI I -C Contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maantcnance and mu nit ring duties as des ribcd the Holding Tank C p,,,,�ent ;,,�v4�)Tare compVledvet tia.A cl�y o-Fff is- MTo m�a t i () n must be g i v e n to the ti w n e ru-Pb-n--cZMPk7Mf r?TMe-: p TOTe noviow Nntp,.q Manhole cover or service port to be no more than 25' from service road or drive ruc*r Holchng Tank, Manual, Table I Reminders a A meter shall be installed by a properly licensed plumber on the mat r s stern, fat adequately measures the &6ZZ--ntof Wzter used by the structure, excluding hose bibs and, all hydrants,, w h i c o not discharge into ffie 9 Sanitary system. 0 Anchcr nece,�,v-v to [jetr.1.1te forccs Nr COMM 91.43(8)(g)- a Ntllci'iak, �hJl conform to the requirements of COMM 84, Abandon failing system per COMM 83.33. A c opy of the appro-� ed 1) 11 ants, spec i fi %,W- a t I o n �, aii 6- t h i s letter s'ha I I be, on-s lie during construction �,t i id n t � i ) inspection by autharimd vepresentatives of the Depar=ent, which may include local inspectons. All pem-uls required by the state or the local municipality shall. be obtained prior to conmwencement of cons tructi(,)nYlnstallationtoperation. 16 a I SHAUN R BIRD Paps 2 1/ WO 3 .In gran t I fig (fil'S -Lt[)P:-L) Val the Division of Safety & F3 uild in reserves the ri ght to req wire changes or addl tions should con d i t i o i is ar I se m k, t k ire hem m n=essary for cod c c of q) 11 a nc e per sta to sta ts 10 1.1 2(2) ., nothin 6 i n tip I s i- e N' i c w , Or Component- C e shall relieve the designer of the responsibility fuf designing - build Ing, strucli'llr Lk Note-, Counlv 1,egulatious concerning the prohibition of holding tank's may vary. Ch"k with the 1()C�O per-jai I L; 11) 9 zi , 41P N 1 10 WTS hol d i ng and treatment, components, inc I ud ing ge p (1c tat,. ��und hoid in ilam,, is required, to 1v pertoj-'Nlej by licensced P. (I MPCTS under chs. N'R 113 and NR 114, Jde to me r e. te I ephk) ne i u ri flhei� fisteJ he I k) �.v, oi- -i L the A -dress Inquinies Concerniing this corrcspondlence ri,4 iy hc, mL-iL on this letterhead. The aeft addree shad rovida kf th' ette r I I'LI 0 %V 11 C r a F'�J C-4 11 hers who are responsible for the bm'c ssel pe. c)�)y os installation, operati r in nanceof the POW"I'LS- S i roc e rA Fee Required 60.00 a Fee Received Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Re -viewer, sated ServiceS WiSMLART cWc: 1633 (7 15) 6 34- 8 10, Fax: (7 15) 634-5 150 , M - 1" pshandorf@ commerce. state, W1.US 2' � 4 cc -. Le roy G Jansky , 'wastewater S pec 1 a I i, �, 7 15) 7— 6 - 25 4 1 k.io%ver Page Shatin Bird Bird Plumbing Inc. 1008 19,2nd Ave New Richmond W1 54017 715-246-451,6 M, Wwner- Kevin AT Location - Cty Rd H Systc-'.,m type-, Holding Tank Manuals Used- Holding Tank ManLia,' version 1.0 1-1 Page# 1. Cover Page J 2. Hoid;,ng Tank Plot Plan 2 _70 I I Mound Cross Section 4-6. Maintanceand Contigency plan 7-8- Soil test Sjgi�a:jre License num 1/6/03 P[..(.-)T PLAN PROJin Amvs �I)jqz-S�s 75,40 Dona la Ave, Racine Wi 53402 IV,j, Kev 1 .'4 1/4s 3 IT 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX 1/6/03 BEDROOM 3 NVhams Bird 2126900 DATE 0 N N'll'o N11 () N A 1, %T - RA D 1A L 1, 1 FT 1101.1)ING 'FALNK CIONVENJION S F P'F I C ' FA NA S I Z L" SIZE 00SF TANK SIZ11, IF AN s[Z11- 30C-0 gallon LOAIL� RA'1%1," NBSORPTION of chdinbers N"!A ASSLIM[', ELL t e I- zabel-A,- - t 0 El BOR11,110LI-A, d-�� 11. R. P. S W comen of.properly — I � c, A, je S' I F I EN, ATI N none Cedar Lake 20 -7 act ads.? )e properly provided with wer with arning label �tem is to be fand buriedd ._lam 4" C. I. Yet MP01 Slind -Cole ray Hp1.0i116 T111aC CROSS-SECTION A i�tther Pno�of Jvactfon BM roved Locking Manhole Corer Mitb Wrning Label Attached MiniAln 120 � �L /Final Grade 4" IMniar� ,sp ar joint ..�._,. High AiaTm SPECIFICJITIOIS TANK New . Exi i JIL acturer: Tank Size: -Sil"t'ota ALIYW `acturer: �w . '� Modet Nu�er: Switch Type ;e7s GOIF MMER OF BIDA�S:� A/ a• of e4di ng unarm TMA i 0mr"s an: XrK2 =_jg� - - 6*&& Layd sery on Tawuhtp/Munteiy�, Comte: PLI�R/OESI6NER signatum: Llcaae : aL 6 roa Date : /#1776—aa AWroned Joir r/ C.I. Pipe Extends�g 3' Ito Sotid So Maintenance and Contingency Plan for a Holding Tank System Maintanance-, 1. Tank is to be pumped when alarm sounds off. Never turn alarm io silent. Upon sound of a [a rm, 1i rr it usage u nti I pumper arrives. 2. Owner agrees to use conservative wa+I.er usage practices, i,e. water saving fixtures. 3. Owner Wilinstad a water meler for internal water usage use only. 4. In time owner will be able to monitor water usage and shood be able to follow a routine pumping schedule. 5. Tarp. Is to be inspected at the time of each pumong for c-r(-'-icks or leaks in the tank- 6, OwnerVA'111 save this plan. Contingency- 1 If tank fails, repiace tank. If alarm fails, replace alarm. All, other components should be replaced if necessary, Phone Numbers- Plur-not.Dr- Shaun Bird 715-246-4516 Pumper- Tom Mondor 715-246-5148 Zoning.. St. Croix County Zo,-�ing 715-386-4680 1/06/03' jG V%OF ZYUI 0 PILF- caps* 0 NA 0---Mrmmmp-� --- Cl NA F� FIW WAS WMW of C4nwmmW PuMTU* C*Mft Pmv To* emwoftd &W Lm"W) GF Fun*pbXw rp mp� 49A AA X I'Pesip PCW (Es*nsftd .. P -- W Apokabn lbw I 'a' (3 ftat FMW Mbnd* grm swoerewim Fww Fats, Cd & Gmase (FOG) --M mglL IL- -ml 13 %VeUWW A 0XV2WOmna-W (BOW 11 Dbi*C&M 0 Oftw- Milm"Nalm a jjjMUr9a= MIUMIK %A%bcA"4Y oxygen 04m Tow &wpaidM ..a lnpr. - -' 'IV " A� .Plx % L Owe WWW w"aamblhm Lad. -10�1 5-610 V4STfU?CTPU"b AL-40- -IL- AornENANM Wft aM &PwjA CEft aml be made by an kxkW*SW cw*Q aye Ol the POWMmw of 1mrFILO ResMcWd SaSewer.POWM kmPOCWr v Mink M % iE--- a( to Wx*jde a vkmW wigs) to We"* SerAft Opmaw- Twik kapedlow mad - - Ilk badge and mnn and w dheck I mv cracks or Woks. ffmasum 00 VoiLffm of k"p9cWd to chex* Ow �Wmy► The diipw3d OW9) SW be vhxm* , of eflkwd on,#* qmwW wftw. P - --rift SmAlliftim The pondbV of I or pmxft %,KA M&MANOMOL an Sm 1PUR-M of IMO in We &DWO&M aM to chw* W " *W M-_4-- Wn&V _W" VMLP" m%n it m--wwftdn noNCO&M Of M9Lm MPW M "S I Fel rA a imkO I WE ", z "OMMILM Vim 4 1 Mpm ww� - -ap - to du 110 rq)(Xt Shan be pmwi&ad AM CMPERA-noN -S dvy* "gmerd W*11) W 00 presence ot paki" produC a OOM PdorD ,e of 13OWT mvd cj*s� it tdgh MwWba 2wTUwrwf in tho fNwj2FM mcKar.0-IMA I %A - gm NWLX I LN 44 IV P-406WE %I 1!%A ad um oftopOWT& utmw 131 "ch bUft AL -it. Ar -*-Ljfff - a fkampWA I (WAW PRO wabr, ha I 91 c ri BOA I No, I kBANDONNUBff mm ft PCWW too mxw Is U&M at$ 0(v .3-yowl" IMF .1 Is gm im -ImEwum WN All rdrgrwv M tmrdm AM rd N. AhM be &mnwnmA%d mow - qmm-omm lk bymmm IN um w nN)bKxmrmKt,wm hm tx al.* The nwbmrm mpdm ff---*, - Wftjed upw by -ed sedu W the napWcemcit am wN m [Aevwrwxnf sarom Fbw*wwwnar* in 77111P'Mi =-� 11171p1m, MU FV61gy as U W IJIM RXTF�� n wmkbK UMV �.m rm . Mi % rjmdbmmr py i " 1 01m nnftvm 3KINEmaefflim" the mi-IfivAmpubm sw I - a, R90x&*Uc&)m of'sLich syskwm umm coff#f %1M a* rules in d4W at IJ *v PWAPJMG>> P: I PUW AM OTHM TWATKOff TAWS MAY CUffAM LETHAL GASSES ANDM WSUFFK3 30 NOT m nR A SEPTIC, PUMP OR OTHOt TREATMENT TAW UNDER ANY CIROUMSTANCES- DFJ WSULT. RESCUB OF A pEFtSON FROM THE KTERK)R OF A -rANK MAY BIE OWFICULT OR IMPOSM 111MCH"LL Comsmaw" WM iNSTALLER .001 POWTS NAWARiM /-I Nam ho I pphom ne I— j ?TAW SERVX*AG OPEPATOR (PUMPER LocAL RmuLATMY AUTHORITY Name Phone Phone wmpmmm�- - - = OEM d collirw Zwftc- Lis d0cwrwK dndW by Ow stdb of to Com I eke Ak AL - -------- L a cK owmn 83 2MX I~ aid "I).ratA"- 1 1100 CoM use ate* docmat Me.,- th.- 0w%ffhrFrL2hr1 GO Of Doe MANTS. 0 W Wiswnsln DepartM of Commerce SOIL EVALUATION REPORT Page DqVISIC)n ot Safety am avikj"'�3 -;i arcoydanoe vAh G=m i!s- Adrn. Code Anac.h wmPiele s i t e Pia n on pater rat less flian 8 112 x 11 Oiches in size . Man must Cwry irvdude, tau ratilml'ied to, vertical and horizon( reference point (BM). drecdon and Pan:�A I D. ey -711 016 u pe"nt slope , style or dimensi ons. north anvw, a nd locabon a nd dista n ce to nearest road, rz off' Please print all information. Feb7v* by Date Pe ru Gaal. i.nf ormai, an ytx,- �Y, ov -.6a may be u S M LEW 15 04 (1) (M)) Pr0PWtY0WrW Locafibdubd i C" --Lot kiv im 1 /4 s T N R E (or) k u j�uuf C&jr lock # S- Na" o-r CSN" Pvopwty Ownees MaWng MAs6 B L Jl I Y C* 1,d T-1 �14 I t!L� E) .5tKe zjj;p> fVN LaTown ciy t-, New ComstrucbM Use: 8 Raw'denbal / N u mber of b ed,rcx_)m s Code denved ftsign ftcw rate GPD Replacement DPubk or uxri in, & r, c�a D es Qhbe 7 Flood Plain elleviotion if applicaNe Parent rnate6al Ck/4 14-,6 ; e lFre is Z.4 General oDauT� and reccmimendatims' Gmndsuffacoelev. ho, pit 0 Redox Desmptm Qu. Sz- Cont. Color lie not r- : M04. MM FMWd #1 80[) 30 < 2X mg& aW TSS >30 1150 ffiqk CST ` Priv. Address _177 MR3 - =bv1wT"s17--,T- Effluert #2z BMI:� M ffV& and TSS:S 30 mqfL GST N r-Fker Date Evaluabw Conducted TeWphom NfLirnber 171 9 W M 17 U 7 mill. Ek�pnrxg # Pit Ground surface elov- ft- COPM -to 1,ML�N facux A j?E�icsbw Rate_ FkwVw Depth DomirLant for %-1 tinseN Redox Desai OU, sz. cont color Texture Sbvctxe Gr_ Sz,.. Sh. 13 RQots GPOM "'Eff#1 'aEff#2 BOHN) # 11 so" ids N 6 - M_�- P71A044M M a aSh- M. e :M0 Bo r i r)g Bodng # G rou nd surf" eH ev. ft, NPth to knung facW in - Rate SRwes GP[)M Jk*zw Depth Ignant GOkK Reck,)x Desaipfim Textljre tuck" C gm;rm;l�" al Wiz,. Cont- C4kx GA, SZ� SJh � I ID [MY unselt I I i _Eft#11 j 'R'E1W * Effloent P 1 m 6 OD 5 > 30 <, 220 nN& wYJ T SS > 30 - 150 MQ/L ■ Effluent VZ. = 800� f 30 rrv4l- and TSS < 30 mg/L The Department of Commcrcc is an equal opportunity service provider and employer. If you aced assistance to access serviccs or need nuterial in an altemate fornwt, please contact the &parumnt at 608-266-3151 or TT Y 608-264-8777. S b f ) - 0 x 3P 11 FL 6.10r) I it I 14- '��-z ��3�uRl�� 'e-{ar y q Coe C7. 6-- 0o 7 tvQw �3,•L�jn�On�i s o 1 KEVINAMYSs &W6 JAMU AMS �a1 bum trams) VIN AMYS UVOCARL8 UVM TRUE d lg%o d6s fulkwimg red 400ft 60 jl:wmdy.0 sift ST, CROIX Coop Reed fbr Raccrd MAR9 1994 R 8 1: 30 . M"MINSaIt&"m 1.1 a - - - __lq_= Um of w6d - -Not w � ii &�D* �B"�7 8� Owk I utaigm F WiAh w 0 198.9 Mwa 0 *Wed 100 hd so f, Law dim 9ft md Ely Sm of Ao""to mid &= me drC"ii I. � fteadaft ai.r �viorr �► �► z'�k dq d Fir��, 11944 riors,.rd Dv1t�t AM".r JBtOtQBa AM" Is a. 1o�awa �a be *a.p+r�a■s rr�a �s�c��ri tL fwyrri� arlru�e and ae�■arl�d�i to �• 4 T• Fqww y � 1� 'MY�y w i • I T• F p9 A, ommAmprips r T LM We;� am Maer ,■fir Alms IL *W Sr CLIM RLN c fk +7 m y,:'r' r, i ' FiN'!1 dfw` � I �" a �ap41."1TF��' � J,r.,F. l e$13,n �.� � 4��{������ I7A7I �+ {,. �� W mow�J'�'F� �r■■y . ILSO t Tp " 8chm Gnory Wt 1 �1� r• I'veRodney _ r��:r�d � MPO'.k4y �. 1'�lE� L T 7AJ 411 ; i �"'' f.�.�-,,�Y + � fT H eLso l 3w.� I I +�" v 12 , SfrndwN 4 Away n Bruiv lt�i'wr� Tn C bw t3�1 J it ►�[ Alice i{wl a Hew, FAH i � _� a q, C;I �r •'oman OD L OU& Ca u d N 1.4rsm QW10 _ C T 1 r a w&RIE Daniel �� � or s l Will me m '"" , - & Jcyce% EauL- Gary - " In n LOW. + ' 39.E T&J 0 20 Km* � Y BawargPO brum Y K & VAS �6&n �1! 31 Nmev r"'K, yda� 1 9 4 lam. 1 L 40 :1 Vvi►+r" )now Pr *v I � Q 1J�# 6 i 552 � Fkf '1 ] 3 * w+ it+� LLIiiLTr 1 �iC)S[1 ;.$ Ivy's H� a0, �„� , +nd� ,11�rL _. s 4 A, 7 4` 1 _ +lit VirgMa artir .* r sMh" Harlan � � � @_ Ill ' c � I ' r �rs�. _11_, 1 x_, Wciin` ail ! _14 W � � S' 0, 5' � t� C�tai Aq 7. & %r n err a # ' Wam6di fat 00 Lmnpm KkWWWWd Ent 10 Imo. LL`1 * i� '�' r ` +� 1M Nmkmam '►i �rw 3 etYAW E R"med r6molk..'L a , I S-T-1 Tr o 72.4 Rivatard � Syr, Gennia, � � � u� � , � Tr. ! i and a Cry 010m* At Room 1W a • Phii�a� ' Gerald -7 7 142 � W � � Klmmmmbd ZIL# �x� � � �,� r C� � WY v&mlEV-S R �.��; d� 15 j WA Wit. �rir1 � � �" v WiNry v Pmm Tr k 4 19WO c.. _ rp QI� jr 100{ ®. w a. •7 4 Owl t- fIIl . ..W., ai 1X4 1�.: ,E �T 11�r 4Ti�I VitTfA +fir46,nra' • Comty & Mary 4a Newby mi Boucher Y � 4 Flan&i�_k by 40 1 U ? �r4r q� ' Fy , es:, i# d d!w �iaW Rk& n 64 •P Ali"L� i~e'lar�c de leoriti a (_ O'er d 1' � � �' - +fit l�,a ' x ` $ _ Inc I" e I-- �. 49 �` 1sCetli� C" lk w 7„]6� 10•, U 2 0 9 1 Doaumwd Number -1 DowmW TM S. Croix County Holding Tank Agreement to Plan Transaction Name — (Owner) q�4d or printed being duly swom !states, under oath, that.: -7 4a n C3 C-50 n KATNLM N. WALSH RESIST (IF DEEDS ST. CROIX CO., V1 RECEIVED MR RECORD 0 1 / 16 / 2M 049: 25A 14 _WME, REC FEET 13- 00 TRANI-3 FFE- C 70PY FEE, CERT COPY FEEi PAGES: 2 1. He/she is the owner/part ovmcr of the folio arcel of in St. Croix County- 0 Wisou , asin. recu rded in of age NurnbeC,4,�f�&2St. roix County Rq'sW dDeodsOffim. jz,7J�& r 1�7 'A arc el of land I 00t d W the 1/0 of '/4 Of Section A." SCro -Lx if N—R W, Town 0 t� Pt. 67 County, Wisconsin, being duly dSri b-ed as fb][JiDws (include let no. and sum visionICSM or d-ttalled lcgal de&cn'ption)-,5ee Agreoawmt Date_ Yr ea-ZI Mantj*4jtj(jr, Number (PIN) vy e souxr*46ge that apolcion is being rn ads for M-m installation of (a) holdIN tank(&) on the aboys daacdbed property or that ccwltinued use of the eod at rg prornis" Ares that a N:)Idirg tar* bs I n6jW106 on that 1 "fty for the purpose of propax ooctal nment of sewege, + property cannot rcw be wood by a munl6pat $erwer. of any athw We 01 pjvqtq 0n&4a wait ter treatmont system as pewrnted urwder C-h C-omm 63., VVs, Adm. Code, or CK, 145, Wis- Stata. As an inducernent to the r,.ounty to is:s-ue a sanitary permit for Me above-deIscrilid PrVarry, we agree to do the fofloyAng. Owner agrees to oDnform to s1l applicabW requjn?jj*ntjq of . C-omrn 8:3, 'WIs. s. Adin. CoDde mA OrV to hNdlng tank*- If ft Owrw fells to N vf� the lt-"dlrig to party err tn Mspi0fte to Dfdars WsuM by the governnwtal unit or the D"rbrent of Cornnwte to Prevent Of abate a human hesil-11h haurd as described In a. Z54.59, Suft,, ihe govemnwtal unh (Town I may enter upoo " propedy &qd � the tank or cause to have ft tao to he servk:ed and &sfga tt* Owner by placing the duwpea on the tax b411 as a, special assessment for Mrm-ril services rendered, The charges will be assessed ab pceschlxid by s, 68.0703, state. 2. The owner agrees, pursuant to s- Comm 93-54 (2), and Comm 82-43(3ye). Wis. Adm. Code, to have a water melei r iinsilailled In the stnxtufa. The water mwer shall be installed by a p4umber suftrizod by tha DeWmort! of Commerce To make such instal lath cna, vMh said Ins tall'alion cmolying with State reQuiations and "nufa4ftun" $pecificalMons- The mvner iagree; to be frrafsdWly MisPonside for the purchase, I ristalls4on, maintenance, and repair of the water r nepter, a agnwis to allow the gove, nmental urImt or th, a beparlmisni 0 Cornmeme ;o enter the, abcirva-descf1bod proWy on a regular basis to read and)or Inspect tho water meter, 3 Ownw agnma to pay all charges aM its Incurred by the U*%wnnvnt9l unit or county for in%Wbon, pumping. "UDV, or OVMPOse ser*Jng and mal rL1, al nlng t h e hoWing Umk In such a m9nner are to prwvont or abate any human health hazoM causod by the holding 'tank , The governirrvental unit shag, ratify the owrw of any costs which aiiall be peed by the owner vAtNn [Nrty (30) d" from U* date of nobcs. in the event Me owner des nol is the costis MthkrII tNrty (30) days, re awrw spectfomity agrees thal &M the costs and chargft meiy bo Owed on the %x roll as a s� essessment !Orr the abatemant of a hurran healthhazard, and the tax shall be colleted as pmAded by low, 4, The owmr, agrees to oor0rad %4th q pwson who 4 if ~ Ch. NR 113r Wis. Adm. C40de, to havg &wo roding ta,rtk "rVic'ed and to file a copy of the oDnWmd with the govornmental unit- That owrw hMiosr a"es to Me a wpy of any changes to, U-m a& -vice cionlract. CW a copy of a new service contraci. with the govemrnen tat kin,it W tNfl tan (10) buoines s days frorn the da to of change to *Fhe se rice contract 5. The awnst 6qreas io contract with a peraw Ilounder Uh. N R 113, Wis. Adm - fie, wpio "Il subrntt to the county on a &armannubl be a re-W. d4taill,rg the servlof the hNdlng Lw*. The govememntal uNt or county may entof upw Mm property to irrvestigato 11ha cordMon of the hcAdlrig tank when purnping repons aM meter readings may jrv&,%W.e that the hcillding tank Is not being arty rnainlairved, 6. This agreement W11 remain In affed only until ft ccwnty off m respomible V the regWaSm of pdvste onshm wastewater treat rat systerns rtM'6LS ftt ft prnpffrly 15 so.-. ed by either a mu Ndpal se wee or a prilvate onsite wastowetiar baMyneft X)MWn ftt 00M Pil es with Ch - C �om ITI 83, WIS- Adrn- Coda. ir, aH;-Mon, this iq�rae(Twt may b3 Cancelled executng and n%xw0ng &W cadlfic*ton with reference to tbis agreement In sucn miantrey van 'th will pe�-nht th I , e "stance at the ceriffication to be deteernined by referwries to " Prop". 7�i-; Ficare p.meni shall be Nridpng upon Ithe owner, the hatrs *f ft owrw, wW assdgneft of the oww. The awrw &W subrMl tMJS nmenleni ,o the i-ogritAr of doods. and the agroernent ".11 be rocc,-doj by theregister ol de*ds In a rnwner whk:h VM parmh the wastence Of ThO ag ruerr, 9 r- c, be dal armined by reference to the propwty whev the hc4dft tw* is I ntl all ad. i Chwwr(sl Namys� Please F>rint I il I ��e I - Governmental Unit 0Mc4 Narne, Thl a - �t 'I SUbSO&Wd w4 sworn to barkire me on thm date: 4D , e2, N� Public r W C won Ey*es :fn4 C"dal SignMure Uralloo P&Sonel inform 13don you provide may W USW for sewmary purPOSIDS (Prl-vacy N, C. 1616' W Q n, L Nk� -m 144 L S, 15-040)(MA -TH 15 PAGE IS PART OF THI S LEGAL DOC U M ENT - 00 NOT R E M OV E" This fMbMVKkM Must too CoMplefed by submiftOr 9!21 amn2 - OffieriiftrMbon such 0S 09 grannrip dauses, AWiri` do acriptko. etc. may be Ara cad on this Rrst ~ oif th,9 docuirrmf or nwY be pia ced cwl a d0h3nal pages sae the documerit. ftic Use of this cover Pwo adds one psqu,fcj yovr, docum@nt &r fee, Msconsin Sfirf Vas, �59. 5 17. F.� KEVIN AMYS, wicht KEV-N JAIM AjwryS md MqNWU AMyj W"by qmk C" 10 1XVIN AXY3 (x JENNEFM AMY3,, trv@mKs) at mopcomw 0 WwAss(s) of the KEVIN AMYS REVOCABLS LrM40 TRUST &dW Fwm 220 1994F the "kwint rW muft mi 31L CnAx 03imql, 3ft" of Wjmx=A&- R i G is I Ei% C Q M CROIX Color wl RWd *w Reccrd 14AR 9 1994 8 4p 30 A. m Lot 0500 swdm 3-31-100 wmwa a kikmv --4 as iffiftl -Ak N W HM Of MW GUMIMONd LAA, 4W N lim 4d Coommy jj3rjjjjjjmmwV qRs -P jg� p N�m* 10m 096 Efid 21" Imts dmma S&A 42* 34' got 72,8 imm4 dw� I pwaW 'wi* W Hm Of mid Ommmmmm Lot *5 * 190.9 Am b N lim of nid Quoty WWimmy -Halp dmm Nor& 66" 33" We* 100 hd iD dba plaw of b 11 11"N'lls- AD thst 6ad w" -NE]y lb" abow dwerapW pwca aid Sly dkm"s of CAdar Lds md b - m the Wly wd My �ms of *bon PNCW mumd" Nly 10 mw sty Amps hm Of cadw t mks Tb�s N...aW V.V, Daud tb�s ZMh &Y, of Fabruaq, ice. - � D+�-F�,-43 Y �-- - T 7 11 --! Z I i 616- bW6 2ft d" d Febmw7m, 1"4 do shm u0nd XEM AhM md MOMM ANY$ I* be " pwwm *be "mm"d &D to 0 mwmd ad ackmaw6dpod &a mm� w7v-v V w qrmrvrTr V v F IT n& i I meM mm &Wtwd by C48m A. COWAN,, AWCWWAT-LAW 13U W. w- Avumw* BML Qe^ %*=Min $M1 r y , r W� u , t...- ° a 7177 „ p � x n W aw .. � s 1 u_ N' r � n N 4 & WW w n v Y � Y v` s- n w x 4hP6. 4. awnp y y 9� 3 Me. u r i yr yY M1 ry V v ' ,rr a� -ram �- v a•.. APPLICATION A SAFETY & BUILDINGS DEPAPTNIENT OF + FOR SANITARY DIVISION ,INDUSTRY,. PERMIT P.O. BOX 7969 LABOR AND (PLB 67) MADISON W1 53707 HUMAN RELATIONS ilk ilk Attach plans f or thcr .y-stem of 1 I:,-)aper- riot io�s ! ha n x inches in size. include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points rnust be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. Al! 11idex rmge or each page must be signed, sealed and dated Oy the designer. If designed by a Master Plumber. the date, signature and license nuinuier r_11LW be shOWn. The owners copy or a legitfle reproduction of the soil test report must be included. p`roArty owner: I ally dd r ess A4 * a h 254& i6a . Cf, tv v I I i age c r 'T oIN ns,Kii P - County: Pi-Ir periv Location,, V 7_ Ni R (or) W 7At ti�; A ave Plan I.D. Number- FTu_b_ji_v I s 1 o n N 9 rn e; kcad, Lake or Landmark: Lot Nurnher: BIk N' I I I assigned I TYPE OF BUILDING Public* 0 Variance" [:1 Other (specify)*' FCA W5� I or,2 Family *State Approval Required. Nomber of Bedroom$, TOTAL NUMBER P R 1�- r- 9, POURED -IN N E VV REPLACE-' OTHER GALLONS OFTANKS N�.. Fl- PLACE STEEL FIBERGLASS INSTALLATION MENT (Spec If y CO SEPTIC TANS, CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA Experimental S�eepage Bed El Seepage Pit Winutes per inch) , PROPOSED (Square feet). New Replacement Seepage Trench 171 Alter niative (Speci f y) zarll k Water Supply: Owner's Name as Listed on Soil Test Report (If oThar than present owner): 52 Private El Joint El Public I If the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans, ld� ? 1 1 ��7 MPRSVV No,: PNumber, Name of Plumber, Signa;LqeI . .1 MP/hone 140"0 Plu err5. Address. Name of Desigr r i tzd, COUNTY/ DEPARTMENT USE ONLY 01 Sanitary Permit Number. Sig at, 'r f issuing AVgent.- Fee PROVED AP 01 V DISAPPROVED Z/ 0 4. - Reason for D;�approval: Aiternate c:ourseis) of Action Available: Cliarage of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in. stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: Whire-County, Canary -Bureau of Plumbing, Pink -Owner, Goldenrod -PI umber D I L H R -S 8 D -63981N.03181 0*7 !�I'4 REPORT OF INSPECI' ION [NDIV IL .WA(1E SY STEM Stati j,� YOWNSHIP ;05V I A M E 7T 0(pi lit y .1 e 1. 0 C A T'l 0 N e c I,. 1 0 rl L S L'. j i v i i SEPTIC TANK S t Nuinber uf compartment!i 4 1- o m weli E U il d 1 ag 12% slopt� Highwater (IJAMBER Size gallons PuMp ManUfa,L!Lurer-----,-.--,,—,.-Mod,E!1 NLei rnber-.----. HOLDING TAN'K Size gallons Pumper nietance from: Well Highwater ABSORPTION SITE Number of Comi),artmerits A I a i- iii S y ti L t? Tnz-�� 6 gild i n g 12% slope Bed Trench 1) 1 a L *Inc e- f r 0 In: We II B U 11. ill 12% slope F Highwater ABSORPTION [)IMENSI.ONS Width of trench t ke-Huired area f t i.engrh of each line 6 f t Depth of rock below the I n Number of 1 Ines Depth of rock over tile in Total lengLh .5f lines t t L)e j.) u. h of t Ile b +,! 1,Lj w g ra d L . I In. DtEvrsecs between lines f t Slope of t renc li--in per, 100 f .1 ULal absortptiun area f t y T) e of L) v C r 111T DIMFNSIONS Numbi--L- Outside diameter t 1).e.low inlet L TOL01 absox-ption area ft Area required f L INSPEXTED BY TITLE REJECTED U AT E 198 i�EASON FOk REJECTION DEPRTMIENT OF REPORT ON SOIL BORINGSAND SAFETY &BUILDINGSIVIOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, P.C. BW1 53707 HUMAN RELATIONS N. , ECT I (Y-T---- W T OWNSH IPJ k4(jNl C I PAL I TY ri I Nu," I U t-K. W. ION NokMF-: /T N/R Elar) '/4, 4 C QUNT Y 6WKJE-W-FEI U Y E R'S NA F--1 E M IN4 G ADD H E SS DATES OBSERVATIONS MADE USE OMM-El 41 --ESCAiPTION LE-MCRIPTIONS, ITION TFS NOFIEDR I'! i'A t NeW Rev late Q A T I Nr,' site for system U= its urv%uilablF for SYSTEkk (011h019-411 N-F NG TANK Elf— -�.L1- 01 L Elu I EIS Elu s ou 7s Liu LIS U �� -� T-1 E I Pefrc!1.010" Tesii -irp. NOT ria�(Auir#d DESIG-iN R 51Ij arl-voorijur, of the lal is in ght u odei &.H63.0q,,f51i0jI. ind-icale: F 100dPiff4n. 1,%dicaEe Flood lain elevA! 'Cls PROMS DESCRIPTIONS 'H FS-6147 ING'� Q E'P 1-11 DvvA7Eq-INCP-jE�--CTHAR' T E R 0 F 50 1 L'VVI T �-1 TH(cKN ErS. COLOR. TEXT VF(E, AND DE PT M E, LE VAT E: ST. 77-- _A85FIV, ON RACK.1 M13-03 DFF`T�-' IN. ES T TO 8 E 1) R 0 C, K I F 0 B'S F i� V E 0 tSE E I LY, 11 7A 13- 41 -'J a 1 21 1—u- V 2 PERCOLATION TESTS -TEST DEPTH VVA TE H IN HOL F T Er,-T T I M E E 1. !N% E: RATE MINUTES ---------------- PER INCH NU ER INCHES AFTER SWEL LI NG I N'T ERVA L r-ol I N . .......... P, P. PLAN VIEVY. Sfu-pw%� loc;afionj of percolation telts, so ljLtrw�js and the dimensions 01 uJilable iOii U086. Indicale scalf or distance%. Descrit)e Wh'at '47L' %tire :omial aevver-i-r.,al elitvation reference points and show the;f lor:,vion on v4c, plot pIgn. Show tple surfacg ejuvuljot, at all boFinp and the diraction j,ri(I peacanx of land slop - SYSTEM ELEVATION X % A i$' L IL I/ L L A L 2#14 4� 1, *11D Undersfgnpc1. Plpmlby cgr-t'tFv %]),it the soil tests roper-k-d im this farm �Or4-t"&Tib� n-le in arxrviJ With the Procodu r� rro 1hd$ $per-jfr+-4j In 1l143 Arl-nim'-.1rAliva Codv. 4nd !h,9t Me davi rec-orded anrl The location of lht losts SrP t-orri�-rt to the hv%1 etf rily knowledge and befiot iNAME (Ptifirl 1 : ESTS WFAE COMPLETE 0 ON, A D D 1`4 ESS N P013ER f, F+UNS N. MJ po C �5 T 4j U u J DIS'TRIBUTION' Original-l-o"I AulhorlrV. 2nd pa�-Buroju Lif PIUMINng, 3141 Dj�)V-F'Q+Perry owner, -Ith pi44R Sod 'I e-sti,-r- 01 1-HP-S0ID-6395 IN. 0181 ' rr .. � / \ \ \ \ ^ � x .//. ''. 1� ,x ~ ' ^� ` / . ` . Parcel#: 038-1014-95-200 09/2012DO5 11 58 AM PAGE 1 OF 2 Alt. Parcel 3.3 1-. 18.,41 AB- 1 038 - TOVVN OF STAR PRAlklE Current X ST. CROIX COUNTY, WISCONSIN Creation Data Historical Date Map # Sales Area Ap[Acation # Para ,iit 9 Permit Type 0 510 3/2 004 00 0 Add0;;Curromovwi-le;; r, CCurr,enc- tC0wner Tax ress: Owner(s): 0 - �-)ETER SON, BRADLEY N BRADLEY N PETERSON 1149 CTY RD H NEW RICHMOND W1 54017 Districts: SC = Schooi SP = Special Property Address(es): Primary Type Dist # Description 1149 G1 Y RD H SC 3962 NEW RICHMOND SP 1700 '41V I _r C Legal Description: Acres- 0_000 Plat- N!A-NOTAVAILAB LE SEC 3 T31N R18W PT GOV LOT 4 LYG S OF BlocklCondo Bldg, HWY H, ALSO PT GOV LOT 4 LYG N OF HWY H & WILY OF FOLL LN COM E LPG GOV L01 4 & N LN Tract(s): (Sec-T,.Aifi-Rng 40 1/4 160 1/4) HWY H WLY ON HWY 613A FT TO POB NLY BY 03-31 N-18�N DEFT, ANG OF 86 DEG TO LEF T'TO CEDAR LAKE EXC P4 16. C D V624.-228 ALSO COM S �4 MOM'. Notes,. Parcel History, Date Doc # Vol/Page Type 05/03/2004. 761400 18/4738 CSM 0212-1/2001 638925 1589/400 AF F 02/21/2001 638924 1589f399 QG 07/20/1999 607110 11439.'67 WD MOM, 2005 SUMMARY Bill Fair Market Value' Assessed with, 0 Valuations Last Changed- 03/24/20f,-j5 Descriptioll Class Acres Land improve Total State Reason Totals for 20054. General Property 0-000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #. S pe c I a I s, U�(,r- sp-m-1111.1i Code Category Amount Special Assessments Special Charges Delinquent Charges k") 0 %0 Total 0,00 0.00 16 Parcel M 038=1014=95-200 09/20/2005 11:58 AM PAGE 2 OF 2 Parcel History: cant. 07/23/1997 1080/519 QC 07/23/1997 709/390 07/23/1997 624/228 Legal Description: cant. CDR SEC 3;TH N 00 DEG E 1354.95';TH N 00 DEG E 1055.92';TH S 64 DEG E 17.66';TH S 01 DEG W 36.161; TH S 01 DEG W 1012.40';TH N 89 DEG W 6'PDS & EXC CSM 18-4738 Pcarcel 038-1014-95-100 09/2012(.'�k P '_ AG ' E 1 OF 2 Alt. Parcel #: 3.3 1. 184 1 A B 01 038 - TO�'VN OF STAR PRAIRIE ST, CROIX COUNTY, WISCONSIN Current x Creation Date Historical Date Map # Sales Area Apptication # Permit # Permit Type 05.10302004 00 4 Tax Address, Owner(s), C,-.jrrerit owne-r. C Current Co-Ovvner 0 - PETERSON, RETIRED RETIRED PETER SON Districts: SC School SP Special Property Address(es): Pri.rnary Type Dist # Description 1149 CT'Y RD H SC 3962 NEW R]CHMOND SP -1,700 WITC 30.767 Plat, N;A-NOT AVA!LABLE Legail Description- Acres- SEC 3 T31 N R 18PT GOV LOT 4 LYG S OF BlocklCondo Bldg: HWY H ALSO PT GOV LOT 4 LYG N OF HWY H & WLY OF FOLL LN COM E LIB LOT 4 & N LN Tract(s)- (SLec-Twn-Rng 40 1/4 160 1/4) HWY H VVLY ON HWY 6,13.4 FT TO P013, IDLY BY 03-31 N-1 SW DEFIL AN G OF 86 DEG TO LEFT TO CEDAR LAKE E X C P4 18, C & D V624/2 28 ALSO COM S V4 more... Notes', Parcel History: Date Doc # vollpage Type 0212112001 6 38 9 2 5 1589141,)(j, AFF 02121 '12001 638924 1 15 8 9.:'3 9 9 QC 07i20`1999 607110 1 0 4 3 7 VV D 07123.1,41997 11), Eli 0 `5 1 S-ji oQ(; mrO 2005 SUMMARY Bill Fair Market Value- Assessed with-. ,., Vations: alu , " Last Changed' 03!24.;2005 Description Class Acres .and Improve Total State Reason Totals for 2005: General Property 0,000 Woodland 0.000 0 Lottery Credit.,, Claim Count: 0 Certification Date., Batch #: Specials: User Special Code Category F.'T117= Special Assessments Special Charges Delinquent ChargeS Total 0.00 0.0 0 0.010 Parcel #: 038-1014w954 00 09/20/2005 11:48 AM PAGE 2OF2 Parcel History: cunt. 07/23/1997 07/23/1997 624/228 �-- )2v J Legal Description: cv t, f C CDR SEC 31-TH N as DEG E 1354.95';TH N 00 DEG E 1055.92';TH S 54 DEG E 17.66';TH S 01 DEG W 36.161; TH S 01 DEG W 1012.400;TH N 89 DEG W 61PDB STAR PRAIRIE T 31 N7- R.18 W. 51 A OL K] C 0 4(Vf jAVf T JF I edL, % 0 r• CEDA R Z_ F- 13 'j kh do 01 v %r, Z02 •lu t 5c dd JL 'F r 1 7 A L 4 ir V -e7 w q % A J�- � A ,j ST A t oil "I L L %: HUN k. 7:p .P _51 A 10V 1:1,7" ; RAI d it A 7 2 L 7 L6n 7, r*.r c 7� 4.0,4 1w s 0 C A f L • L SQUAW L - L N VVI IF "e A a -e7 L- . . . ...... 6 /5 ti f Y ei d.N. ndr r " r• 6 If/ 3P, 7" 7eq Lki i6. q, ., 4''" .� ot "rell yo "a 'K /0 o kQ p �4j k4j 4r 0e, ip 7, 31HIMP-7 p.d I '-J I- " . 1 0 H NIN E S EB3 PGm e- rr - I r-e-itia ,` Aq ef z, - Wb '-%, Y. T �IaA dp 4r hor 0 19 78 CoJ 0 10-1 F MM b"I I if L EfixA V nJR e47 4r f. Z ie.,/ &7 4f* -7 403 4 rC61 WFL-" A jV�fit 4 41wf 30 WOOF Y L. , bL A, lu Orr?."` _rl CAP �LfA 7 E0 L 64 1- 44L:0 c ,kip jhr qr Ak. 1h x. q, A 3 wu� ic 33 EW RI MON AL cr c, Ito —4— A j tjt E 7, 1 '31, 4 45 QP6 IL? a fit E PACE 53 -PA 4 j NA I t) E NORTHTOWN UTGAARD'S HATCHERY HIGHWAYS 64 & 65 NORTH, VOUL TRY BUSINESS SINCE 7907 NE-W RICHMOND, WISCONSIN 54017 Year Round Poultry Service POULTRY FEED - EQUIPMENT - REMEDIES PHONE. 246-2236 Phone: 248-3200 or 248-3209 TWIN CITY 1 Ills) 1 I k STAR PRAIPIF, wiSCONSIN -54026 1 N PHONE: 439-2905 11 If il 0 T 7 r 4 St. Croix County Planning and Zonin Tuesday, Srphmber1Q 3005 a(I]:Oh56 PM Detail Sanitary Information Purge I of I Computer #: 038-1014-95-200 Sub/Plat: metes & bounds Sectlon: 3 Parcel #: 03.31.18.41 AB 1 Lot: TNIRNG: T31 N R 18W Munlclpallty: Star Prairie, Town of CSM: 114114: Gov`t Lot 4 Owner: Tilseth, Robert 1149 Cty. Rd. H New Richmond, Wl 54017 State Permit: 18863 Issued: 11 /09/1981 POWTS Dispersal: Non -Pressurized in -ground Permit: Replacement County Permit: 245 Installed: 1Ill 7/1981 POWTS Detail: Bed- Seepage Bedrooms: 3 W1 Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other ReQuirements Additional Motes Money Owed Torn Nelson Yes Powers, Calvin As -built shows an existing house (not connected to $0.00 Signed Off: Yes POWTS) 39 ft. south of the 18 x 62.5}bed, which was connected to a 1000 gal. Powers concrete tank to a trailer house. Doesn't show a septic system for the house, but a well was 42' south of house Maintenance Scheduled Pum Date Pumped 1 st Notification 2nd Notification 3rd Notification S BEMs � Lo COUNTY ............ ..... OWNER ,e��N rj"M100500 VN/FE� Atu1.Y ev.1eU.SI t rv'%LUMBE R�� uv� (� G��niEl.l_ LIR'.."O# 7zqz TOWN "0""' F STIR ?PjtiRAF CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval.. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of # ca authority. t e erm�t lease contact he uu h permit, P ty a t . ... ... ... vwwww M ..... ..... SBD-06499 (RI 1/20)