HomeMy WebLinkAbout038-1013-50-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
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:
Robert & Jacklann Pitzen
City Village Township
TOWN OF STAR PRAIRIE
CST BM Elev:
Insp. BM Elev:
BM Description:
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
lO E� S� Q-
l 250 54.
Dosin
Aerati
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
�44Q
Dosin
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Nu ber
TDH
Lift
on Loss
System Head
r�7F t
Forc n
Length
Dia.
SOIL ABSORPTION SYSTEM 70 / A L__/J�
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651253
State Plan ID No:
Parcel Tax No:
038-1013-50-000
Section/Town/Range/Map No:
03.31.18.35B
STATION
BS
H I
FS
ELEV.
Benchmark
D
06
Alt. BM
Bldg. Sewer
St/Ht Inlet
0
i
OD
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
®
2
Bot. System
Final Grade
D
r
St Cover
�
WL
10- c�
BED/TRENCH
DIMENSIONS
Width
Length
T Z
N . Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturers
Type Of System:
�
� �
5 3
Model Numb
� •4
DISTRIBUTION SYSTEM C- IZ' L-� co-A4-jXD
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipe(s)
Length Dia
Length Dia Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only � v
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
O MENT (InAAclhk'de co a discrepencies, persons present, etc.)
Location: 23CARDINAL DR
- I
1. p
Alt BM Description C)
2.) Bldg sewer length
- amount of cover = I v�
3 4s a2e ve-nte JQ
Plan revision Required? ❑ Yes No IO
/ZLf
Use other side for additional information. 2 Z3
Date
SBD-6710 (R.3/97)
Inspection #1: 1 b �2� l Z Inspection #2:
r
(A)a��s s s i
A,
(w) to .00� iz .9of ll• 20 - 9l•� �j���
30
(010.00`jZ'90 lx•20 = //170
A
Insepctor's Signature
# 2 (,
Cert. No.
r
lk3
�i
_nzi T f I 'Lld L,I',, 4F Sc)-vices DivisiI m
[F� F - -7, 11 �.e
_7 r N-2 Madkon Yar( s Way
Cowily
4_jl AV-11
W] .53705
AU '0 8 2023 11, Nix '? 16' 3
sallilaiv Fientl Namlier (6j ix filk(I itj by Co.)
0,
Madison, W1 53707-7162
LA, Slate Transactiun Ntunber
Saw 1-1)wmit Applicati"on
IUri wilh SPS 38121(2), Wis. Adin. subaws](In ()f Ihis f6mi to the approptriaie govemmL,,ntal uniL
1!.N f CO I I I I k: "i I, P C I r to obtai n Ing a sa"i lary pe�Tv 11 -11 t. N, (it:. Ap P I I C. 1111,011 1,0 Rn 1i I 0Y 11 ate, I ki� are �,;ibmltletl to P -ect Address (if di t than mailing addtes,0 R)i
I f k �- I k-Pa ri me 111 a f Safe I y iuld Pf 1) I'V", Sit) 11'ai SC I V I Ce,�. I Y L i ii �i I i i i r'( j I 111 ILI 11011 provide nii y b,e us42 fill smondazy
pkI I pt Ps v, s' in cj c,� to rh i anc,�� w I th I hC Pf Ivic y 1", a w T1 111 %IF
L Appli-co0on Information — Please PH tit All IuNr 41AM
Propen OV 1ici's N-Ljjjj.� 4
14le C—)
13: r Ovr t�y Nin i I i n T Addrers. Property Localm
Oovt.
C I S [C Z 11) Cwic Pliniic Ntitr�)er
7��
114 J I/P C�C 'Lon
q 0& P
.................
pt w
IL Type of Bulkliiig (chech- all that apply) - N R r:2--L oo
4 Suhdivibloll Niwric
Cam; pd.O(Ce
D;1lb11C"COn1MCfCF--d - D-,,Crihc Use tv of r
[],SlatC 0" 'Ll Cd DC-,C,F 11:11: t j &C (ISM Number VI'Aage tif
113,P f lj()WL, I lei" lint, A. (Awk oue box on. Hue 113. C"twimpik-te line C It
Permit (Clieck eillici I 'ew or "Replacciiiew" awl otbe applicable an li
El i� Ca V.
A, ]NC'W SYstum C11[acetne"t S I-011JI PFOICOW)efll I Jill, 1 k (tXPJL11;
E y _�i tit ID Ater Modifitation To L-.xNfiugSyiw Ln 113A(Idi i
10,
9-" 1 D MOUnd TS71 Odieir 'Type texplain)
[:]H old i ng Ta n k I ', A I n .( j i-o ki nd� 1jidividtin? Rile D&
14kJ
t Prcvioas Pennit Number and Dale 1swed
Rviiewal Before�haP�il S t
C - FIR�,,% i�Jon nge o 1' 11 1 Li m ki��i ()v�acr
qS g 98
IN'. Distqsa14rQ0(MC_nt Areti andTank Inforwatiow
_312
7L, n Now Di%pe"- I Area Requir,�d (q) Disper-,;,A Area Prtqx)%AA (sf) Sy�,t�nvi Hevarion
z
�%111
Told I %L 11!pd
r(-V.
I t�l t
Tank Intl) F 71 �.160fl GA Ion Gj a I lowi Units Q
Tonks 1-I
Q
&_
a. U (A 96
seplic or 1101ding Tim k
Dot.* ChKmbet F-1
V. Re-sponsibilily Slatemen t- 1, the ii n4 e rkilned, ,i ss, umv rts 1w n s I h I , It v for I noa 11 a ho n 4 if t ti c I j W[S sh ow n on I he a I (a ch-LA p la ns.
r 1�kt) P111111 0 S IL IML MPIMPRS Nufllhcr Nmub(�r
7
Plumber s dWIVIN'S (AC)
V-1. Co u n ly/Deps ri m Only
AAppi ov.-d lS" j1prov I r"re I. lkik[M Ism i i -n r. A veiA �%L
(P f
DO
liur, _011 fol I Z3
o r) d I i L) n s o 1,A p I-) r t 5 v d, i T?T,, rq7n%-4)-r- F141i _C-d
�C_& J-D b
jA*__4t,_ W<O
`Y
S'Y STE I0 N N E R. 0. tf. LCq VA
nffluc cFdj ScritIc tank, m --rand d
I q) A UZ, C-br � D�� l
must b--., serviccd / main!ainal as pec M Y
managerneni pk-J-i __-FOV'K_."&.J olurnber. tUP lw� 6C
2. A 11 setbac k iequ, roments rnu st be ii,il;i I nta ined
per app, icab le code / ordina ri cus
.4k f I ;I C tj I (I C I j p1j jokle phi is% for Jh� sad mibtrilt to the Count) only oit aper aul le%% thiia A 112 'L I I illches Ut We
SAD-6199 (R. OY2 1
Oil
m
9
CONVENTIONAL COMPONENT DESIGN
Restdenva1 Applicatbn
INDEX AND 71TLE PAGE
Project Name:
viol 91
Owner's Name: —
Owner's Address:
PW
too
Lg"lD9wdpthn, --wpm
Phi ID Nu t e , .--� --. -0 - ,�J
Page 1
Page 2
inftx and We
Plot plat+
Page 3
System fixing a dross-Ssati�an
Paged
Finer Specs
Pie S
Nalntenance inwmtbn
Pale 8
Management Man
� �r • - � i r r rr� r
Page ?
St. Croix Sea Tank Uabftnance Form
Page 8
Dsed
pays 9
CSM or Plat
Attachmeft Plans
1
DeaipnerlPlumbet: IC4,,,_,_,ticense Number.
Date: c��.�.� Phcne Number
Signature
Dai�f pwwant to No MAroand 5oN Abmpwon CaMw" Msmpd for POWYS Wrslon 2.0 SWi0706-P (N.Otroi).
Pap 1
CIO
I
I
Leaching 1p,
Chamber
Soil Absomtion System Cross Section
I L
ft
4' Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap
ft
ft
System Elevation
ft
Soil.Absomtion System Plan View
2°
)12.
ider
LTren=ch3
LeachinA Chamber Smcifications
Manufacturer Arid Model
EISA Rating, sq ft per chamber Soil Applicatio
Af ur,, gI pd Des+gn Flow + < So -I Application Rate +
3 rows of . —J(" f-hm1hph
2 o x 46-
r
Pac
I'l f;6.ril- �41S F'n Pre?-;-rst, Dri i'nige 16 Zabel'
4, A [vV,,5;or el Pay Inc
MOMM 11=1
PL-525 Effluent Filter
"Flee PL-525 Fil ter is ra teal for J ROW C_11 PP (gallons per day) nicking i t one of the I a rest filters in i is cl riss. I t has
325 linear fc'et of 1/161, ultra tion Slots, Like the Polylok PL-122, the Polylok, PL-525 has an automatic shut-off ball
installet] with every filter, When the filter is removed for cleaning, the ball will floaL iij) and temportarfly shut off
the SV Stem so the, ef fl 1jent W011"t leave the tea [I k.
Rated for 10,000 ("J'111D (ga I lons per dav)_
5 3 2F 11 near feet of -1 /- I OFF filtration.
Accepts 4" aiid 6"' SCHD 40 pipe.
Bijiltin gas deflector.
r.Atitoniatic shut-offball when filteris rernoved.
A I a r in, acc ess i 1) i I i t Y.
Accepts PVC extension handle.
Ideal for residential and con-miercial waste flows tip to
MOW gallons per day (GUID),
L I swate the outlet of the septic tank,
2. Remove the tank cover and -pump tank it necessar y.
3. .flue t he f liter hou sing toy this 4" or 6"' ou det pig. if
the ail ter is not centered under the access opening usea
of y lok Extend & Lok or piece of pi pe to cen tt-r f i I ter,
4, Insert the ILL..- 525 filter into its housing.
Alarm SwItch
(OPI MAO i on a])
(0 GPD) Accepts I" fwc
Extension Handic,
SCI ID 40 p i pe
.5. Replace am the se tic tar ik cover.
PL-52.5 Maintenance -of 00 NOT (emove ffiter if water $"of �s,o-om ho
Th e P L - 52 5 E f f I u e n t 1�1 t e r s w i o pe r 777 -e-f 1 11 cl e- n", 11 y- 'f—o-r—
c urew I to irc iiinAe-ir ne-yr"-% I , J;" � f I
Ra4ted for
10,M) GPD
525 Linear Ft.
of 1/uller
Filtration slot-7
Certified to
NSFIANSI Standard 46
YJ I kYA L I L I t &;%I ILA L J
cleaning. It is recommended that the filter be clew ned
every time the t-i-Ink is pumped, or at feast every three
years. If the lnsta I I ed fi I te r con tallatl Optional atal-111,
the owner wdl be notified by an aharm when the filter
nm,ds servicing. 1-_'K%r,vicing should L'w, doms by a certified Cas Deflector
Septic tank PtiTirlpare or in stAaller, wornatic
I n 1-0cate tht, outlet of the septic tank-
2. Remove lank cover and ptimp tiank. if necessary
3. Do not use plumbing when filter -is removed. lee
4- PLIN YT-11525 cartridge ou( of the hotAsing.
5. Hose off filter over the septic tank. Make sure all
sr lids fall back into septic tank. not into filer housing.
6. Insert the fiTter cartridge back into the hOLISing making 0 tdi I i P3 ill. I I Iter. I I i In Uxt(mid �.4 Uok"I
sLC t I te ffl tc r Ls prcq-wrl y I- i tigjwd and coi n pl mf'lly i nsA:*rted.
W Polyloki 711bd N��t filter-L, accept Easily installs
7. Replacei-and secure septic tan�, cover. tine 15nurt F 'I I t c, vl& sw t ic I , and a I a ni i, ITIto exishlig t,-anks.
Y
Polylok, I 11a' L 3 I - 'it i Hie W Blvd, Watfingl"Ord, CY 06492 '1611 Free: 877.765.956.5 Fax. 203.284.85 14 �vww.polylok.com
40
JnTffo
114� J6
Pill M.
FILE INFORMATION
- FOwner
61 17— 1 .
P�rr�it 0
DESIGN PARAMETERS OW, 1M.11-11 Imm
Number of Bedrooms: 10 M
Nmber of Public Fac4ity Units, gl NA
Esfimataver agelow (qaLjdBy)
Desig n, (peak) F1 ow � (estim ated X 1. 5), (gaVday)
In SftU S61 AppficeUon Rate'. (g *Ida y1ft')
Standard (Domesfic) InfluenVEffluent ,
F ats, Oil & Grease (F 0 G) �30 L
Biochemical Oxygen Demand (SOD,$) �22U rngIL
Total Suspended Solids �150 MWL
High Strength Influent/Effluent Monthly averane
(FOG) >30 ing/L
(BODS) >22U rn9A_ NA
(TS§) >I 60 mg/L
Pretreated Effluent Monthly average
(13ODs) <A mg1l.
(TSS) nO mg/L NA
FeCW CoNorm.f9eometric mean) 51
Maximum Effluent Partide Size in die. 0 NA
Other, [I NA
111 Z I I tC,1TWiq_Wr6K1.KT_:�
SYSTEM SPECIFICATiONS
Tank Manufacturer: I
Cl NA
0 Septic E) Dose 0 Hoichn.9 Volume.
(gal)
'Tank Mai dacturer:
[A NA
0 Sept ic 0 Dose 0 Holding Volume.
(gal)
Vertical Qielanw Tank Sottom(s) to Servilae Pad-,
00
Horizontal Distance Tank(s) to Swvice Pad.
(h)
Speeft s ervictwj mvch ank,.s must be pfovided it vwbc a] Is > 15
feet or
if hwizental M150 W, Speoft lnstrucli1� tie provided on back.
Effluent Filter Manubcturer+
Effluent Filter Model:
t3 NA
(Limp Manufactui
NA
Pump Model-
Prettftment Unit
, "V ,anufactures
0 Mechanical AeraVon Peat Filtet
NA
0 DisInfecton F] weft
U San&GrarNjer clhet-
S
Soil Ab-sorpbon Systern
- I
KIn -Ground (gravity) D In -Ground (pressure)
'At
0 NA
-Grade 0 Miound
0 Dr Lin M Other.-
Other'.
DNA
PW Service Event
Service Frequency
P um out contents of tar*($)
sludge s,
ffWhen cornbined and equal rie-third (X) of tank volume
C3 When the high water alarm is activated
Inspect condition of tank(s)
At least once every,
month(s) (Maximmn 3 yeam)
2 year(s)
NA
[J NA
Inspect dispersal c811(s)
At least once every,
0 month) (Maximum 3 years)
0 NA
E) NA
C lean effluent filter
At least once every:
At least once every:
_70
monih(s)
0 month(s)
0 yaar(s)
r _J]
Ll NA
tA NA
Inspect pump, pump controls & alarm
Flush laterals and ure test
press
At least once every.
rnonth(s)
0 year(s)
C4 NA
Ot,
her
At least once every .
El NA
othef
0 NA
MAINTENANCE INSTRUCTiONS
Inspe0ons of lanks and saiii absorption systems shatl be made by an Individual carrying one of the folloming licenses or certfications:
Mwter Plumber, Master Plumber Rest�cted Sewer, POWlS Inspector,, POWYS Maintainer or Septage Servicing Operator (purnper).
Tank inspections must IrrJude a visual inson of the tank(s) to ideofify any missing or broken hardware, idenfify any cracks or leaks,
meastre the volume of corriNne-,i SlUdge and soum and a cLeck for any back up or ponding,of efflue!nt on the ground si-irfacA. The Soil
absorption system shall bevisuc-l" ',(,�pected to check the effluent levels in the obsetvation Ppes and to check for any pording of effluent
or. tl'ie ground surface. The po,,,-L, of effluent on the ground surface may indicate a failing wjwiboii and requires the Immecriate
notffication of the local reguiatofy auti i0tity.
When the combined amun)ulafion Of SlUdge and scum in any treatment. tank tvuivals one-ftrd (X) or acre of the tank volume, the entire
contents of the tank shall T'emoved by a Septa ge Servicing Operator (purn per) and disposed of in acwrdance mAth chapter NR 113.
Wsconsin Administrative Code.
All othef services, incAuding but not limited 'to the seising of effluDnt filters, mechanical or pressurized components, Pretreatment units,
and any servicing at intervals of !912 mo{it hs, shall be performed by a ceftfied POVVTS Maintainer.
liq
15F.W.." U741 Nii,111111ollir
� 11 1 it I C
GM -N5 (02106)
Page - -- 0
START UP AND OPERATION I
For new construction, prior tu use of the POWTS check treatment tarik(s) for the presence of painting products, sdivents or oth",
chemicals or sediment that may impede the tteatment process and/or darnage the soil absorpfion systern- If high concentratiolls
detected have the contents of the tank(s) removed by a Septage Sefvidng Operator (pumper) p6or to use.
Purnp tanks may fill above normal highwater levels prior to startup or due to pump faflures. Start up or restorafion of power under the
conditions is not recornmended, as ft excess wastewater will be discharged to the soil absorption system in one large dose causing a
o,�erload that may resUt in the bad(up or surface ditscharge of effluent and damage to the system. To avoid this rOuation have thg
;1
contents of the pmp tank removed by a Septage Servicing Operator (pumper) pdor to resto(ing power to the pump or contact a Plumb
or POWTS Maintainer to assist in manually operating " pump controls until normal effiquent levels are restored vAthin Ule pump tank. I
1111�pziiipiipiq
Oo not drive or park vehicles over tanks or the soff absorption system. Do not ddve or park over, or otherwise d1stuTb or compact, Vie
area Wthin 15 feet down slope of any niound or at -grade soil absoiption area,
Reduction or efirnfriabon of the folloWng from, the wastewater streai ,d- may improve the perfdmance and proilong the life of the treatment
tanks and soil absorption system, adds, antbiotics, baby vApes, agarette butts', c4ndoms, Cott"i swabs, degreasem, dental fims,
d.
diapers, ftnfectant6, fats, foundation drain (stmnp pump) discharge, fruit and vegetable peelings, gasdine, greases, herbiddes, meal
scTaps, medlications, oils, painUng products, pestia'des, saNtary napkins, solvents, tampons, and water softener brine discharge.
AB)ZWfj;iLEAT M
When the POWTS fails ancVor Is permanenGy taken out of service the following steps sball be taken to insure that the system i's propedy
k
and s,afely abandoned in compliance With s. Comm 83.33, Witsoomn Admirdstrattvie Code:
EMM
a The contents of all tanks and pitsshall be removed and properly disposed of by a Septage Servicing Operator (pumper).
* After �umping, all tanks and •pits sftWl be excavated and removed or their covem removed and thel void space filled with soil,
gravel or another inert sdid material.
r-, k
lo 0 ATTiVj E NCT PK4 N
If the POWTS falts -and: cannot be repaired the folloWng measures have been, of must be taken, to prNd,e a oDde compliant
replacement system',
A suitable replacement area has been evaluated and may be Wlized for the locafion of a replacement soil absorption system.
The replacement area shoLdd be protected from distLrbance and compaction and should not be infringed upon by required
sett)acks from exisbrig and proposed structure, lot lines and wells, Failure to pfotect thv-, r�plaicement area *11 result In the need
for f--.1 new soil and site evaluation to establish a suftable replacement are . Replacement systems must comply vAth the rules In
eff (-,-.,ct at the time of their perm it ua We.
F3, A suitable replacement area is not available dus to set -back and/or Soil limitations, It the salt absorption systern cannot be
rehabilitated, and barring advances in POWTS tecJinclogy, a holding tank may be installed as a last resort
it The site has not been evaluated to identify a suitable replacem,ent area. Upon failure of the POWTS a soil and site evaluation
I
must be performed to locae ta SLAable rem placient area. If no replacement wea is avaMab;e a holding tank may be instalted aa s
last resort to replace the fajW ROWTS
Mound and at -grade soil absorption systems may be reconstructed in plaGe following removal of the biornat at the infiltrative
surface. Reconsbructions of such systems must cwpiy YAh the rules in effect at that time -
WA RNI NG
TREATMENT TANKS,, PUMP TANKS, A14D HOLDING TANKS MAY CONTAIN POMONOUS GASSES OR LACK
SUFFICIENT TO SUSTAIN LIFE. NEVER ENTER ANY THAN UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE r- ROM THE INTERIOR OF A TANK MAY NOT BE POMBLE.
F.11111 0111 I&MY-AM lz 6-11all" 1 [all 13
Powrs INSTA6!L& J 6L
Name %
Phone
it e7
POWTS MAINTAINER
Name
Phone
IWO
Phone
This documeni wa-s drafted by the staffs of the Gre" Lake, Mxquette ard Waushara County POWTS mgulatury agemies In cornpliance with sections
Comm 83 22(2)(b)(1)(d)&(f) and 83.64(l), (2) & (3), Wiscw-sin AdminMrative Code.
ST. CKo UNTY SANITARY SYSTEM File #-.
1, 1, fficduZoonty
OWNERSHIP/ADDRESS FORM Croeate21
1 1
Corn niwiity Development Department Will UtlliZe t111S 11'If'01111at'lon to Provide the property owner with
infon-nation regai'dire g operation and maintenance of your- new or replacement sanitary system! This
information will be provided as pail of our ongoing efforts to prated PLA-AC healtli, YOLP- Well, grOUndvat et',
surface water, property valsaes; and co�jnty rescouroes. Once aplDroved, this completed fornn and educatonal
information will be sent to you by If JOLI �vnuld like to vievv youi- issued sat-'iitary perrnit creline, YOU can
d0 ®)("j [.islng the Prope-U Files Scanned 4,%teblink.
r '01TA I IL 14' 11 IQ -12J, vi TMEN Is] k" I
Owner/Buyer
Malling Address aL,01 /AV J/ 'Ie� -ll
City/State/Zip
Phone Number
Enisi l Address "requir-ed)
Parcel Identification Numbe r
JOUrid on the ptopc-rty tax, bill)
2 14111AW161 111114 I'll M 4 tcy 11 a 111111*14 111, I:A. trol I I
Property Location 1/4 1/4 , Sec. T N R
Town of w.
Subdivision Plat:
Cerfified Survey Map # o lLt mf Pane #
3 - L.
Vd. a .r!, n. .".4Vj' Deed # D ore 2006)Volurne I clae 11
Y (bef -Ld
Aot -4
Number of hedroorns Spec house 0 yes 171, no Lot lines identif ia ble 0 yes 13 no
OFFICE USE ONLY
New Property Address 1\114
(Verification of new address required from Cornmunity Development Department for new construction.)
(Staff Initials)
(Date)
his form must be submitted with all Pr,ivote nsite Woter 7reohiient Sys teen (POWTS) opplicotions.
New System: IncItide with this fort7i o recorded worranty deed froni the Register of Deeds Office and a copy of the certified
survey oiap it reference is made in the warranty deed.
COTIIniunily Developr-rierat Departr)c,�nl - Land Use, Division
715-386-4680 St. Croix Ccunt y Govei-nnient Center. 715-245-4250 Fax
cdd@sccwi.gov "110 1 Ca i-ni ich ael Road, H udson, W154016 wwwsccwi.goff`
I'ax 11) Not : 038-101 a-5 -000
IN WITNESS WHEREOF. the said C3rantor(s) has/have signed and sealed this deed, the day and year
above written.
r
R0BERT'vl.l'IuFN -
JA KIANN I'1TZEN
F3 ,r E K. K01-13�
r
R S EANN P K61..f3
COL!COL!N, 1-Y C)l. ki ry 8 ram
ca,llc before me [Ills___,-)) clay of V , 20/ , Rf)B1-:RT %4. I'1'1'1_l N'
_
AN13 JA klA�N TITLE N, the above named GRANTOR(S) to
me known to be the p ratlrl(Swho
CXCLUIC(I [ho forcgoi lg lrlstruiri nt and aelknowled�zed the same.
}gyp
ILL(tar'V' Public. State 0
.., Mli�°�.F ,�,
IVTAv CorlltllissIO 1 is peal ancrlt,
1j
� 4-}
2 4,6,�.}RSi1k'.�.-7i1.
R
(if not, state C4r 11'ritiMl ticlie: �
� 4 .fir' 31C-a-8
STATE 01
COUNTY OF ? {firj 6, rd,
t ` �
1 AND
Iycrsoiially came before me this daV of 20 , BLANI': K. OLB
-.
l OSEAXN' I' K01 li t1:e c111c7N e narlled CYRAN`I'C)R(S) to me known to he the persun(s) Whti executed the
fnre;ooing and ackiw'ti l,ydl ed the same.
MV collimissioll IS rel-11KI]W11'-
'
(if not. state cllir i'3� n :I.lrt .#
r-� re O7It% LAN
fi It
FOAL
i "x.
Ni N 'A
I,+y Ca.^ mi!b:,Ur
r Ir,s .tan 31 2018
A ! 1 10 1 F(.'l i'tI)_'-,(J Pk l Lk". 1l1'
lt() ! 1 1 ""I i'lTZEN AND JA('K I A �.- P111 �"N
'I' (: [NAL DRIVE
NL_l4 WI 54017
File No. � I N029050-02C
r3 3 8 2 1 6 5
1031969
HETH PABST
REGISTER OF DEEDS
ST. CRGIX CO., W1
07/11/2016 I0:28 AM
EXEMPT#: 15
4?j o �o �s 3,, 4
,4
PAGES: 3
I l l I S IN S`I l I i N `l L 1tA l TE D BY : When �seoordeij Return to'.
FRANK 1'. M:C::, ESQ. Indect�rn��1 Global Se��k�
MAIN ST. As Recording Apen� Only
CI.ARENC'E, NY 1 031 1260 Energy Paz
8wi-333-3081 ^4, Paul, MN 5510B
. QUIT CLAIM DEED r
s r-
T1€IS DEF1) 111Rde 'tmd entered into on this d,` stay of & " , 20 by and between
ROBERT MPI' Z1--'N ;••lNDJA(l'KIANN PITZE , 11L)S13AND AND W1FL AND BLAME K,
KOLB AND IROSE NN 11. f OLB, HUSBAND AN 1) WIFE, a rliaihn,-, ad-lre:)s (11'2355 CARDINAL
DRIVE` NI W RW1ii` ION1), WI 5401 rc1-c•rrcti' to as Grantoi-0,) rind RO BERT Ni, PITZEN
ANDJAICKIANN 1'ITZEN, HUSBAND AND WIFIj', AS SURVIVORSHIP MARITAL
11ROPFUTY, si niaillini2 address ol'2385 CAR-DINAL DWVl , NE:W RICHMOND, WI 54017.
llcrelnittci re:crred to i� Grwitee(s).
WITNESSETH: That the solid Gi-antor(s), for and in con�ildvrmion of the sclrrl of ONE and NL)f' 00 (.Sl.00)
DOL.1-AIZ, cash in Mined pliid, the receipt o(which is lLoreb,, Acknowledged, have this day remise. release,
cluitclakm and convey to Ih said 0-11ritee(s) the following described real °state located in S`i. CROJ
C owit , WISC ONSIN:
11
SEE ATT'ACI IF 1:X111BIT "A" FOR LEGA1. DESC RIPTIC)N
Also krlM> MTl pis: 2355 C�� RDti 'ti %I. DRIVI , NLW RICl lMOND, Wl 54017
SC 101 ( k 1,(.) FASF\-IFNTS, 4_`0VI'NANTS, CONDITIONS. RESTRICTIONS, RF.SFIRVATIONS.
AND LiMl FA IIONS 0 RF('0RD, IFANY.
11rior 11011-lililCrlt reference: DOC[`MFNTN0 . 831013, Recorded: 08/01/2000
'10 1 IAVL ANDD-I-0 lIULD'the lot or pal:-cei above described together with a]I ::r14! ML!ular the
privil: es..ar:el,lcllts, heredital1lel1: `'t`. ;apptlli.r? trlCes thereu1110 helcingirty Or in tint Wise appertai Ill Ili)
U;lTU il7k' s:ilu 6ranlee(s) and unto the heirs, adin-Inistralors. SLICCCSS01-5 or assigns ol'tlle Grantee(s) for+`v?`r
irl 1 1~:I.: SHNIPLF.
And that said ctxlvoyanc•e. doeti not render (lie Grantor(s) in'olvent nor is iI I'Or the l�tirl10Se of defi-a lding
any of the creditors of the GF.iriiol ; 1.
No ii1'.e scarch Ijt'1 :0:'Wiwi oi) t', ,111 ieLl property 1,_, [lit- preparer. The lire7arer of'this de cd makes
rleitll'tir rlflrt ��:lr '.t:i�rl :!ti itl 0!c �Iatil- of 111L [lift Iliil 1}r€}Bee1\ Use nr'l11V 7011111� illlgul irons Coilcer'rllilp'
descrihed pre ,%rty 1111,1rc•iil C0111%C% C l nor arl, lltlitt r` cx(, vpl the valtdi v of thc :'irni ot'tktis ills[runit�rtl.
InfOrniation licic'Irl ��as providcd to prel1 !rer by (j'.:twki; (:rf161tce L11)(1, 1, 1111,'Ir agent", TW htltltldAl'y SllrVCY
MIS r11ZIlIC :1', Ill:' 6111le O thk
3,, Croix County 1031969 Pa!1� = of 3 St- CrOIX COunrV 1031969 Page I of ='
EXHIBIT A
LEGAL DESCRIPTION
SITUATED IN THE COUNTY OF ST. CROIX, STATE OF WISCONSIN: PART OF GOVERNMENT
LOT "I" OF SECTION 3-31-I8, DESCRIBED AS FOLLOWS:
COMMENCING AT A POINT WHICH IS 681.91 FEET SOUTH AND 1914.04 FEET EAST OF THE
NW CORNER OF SAID SECTION 3 AS THE POINT OF BEGINNING FOR PARCEL TO BE
DESCRABED; THENCE PROCEED S 86 DEGREES 16 MINUTES EAST A DISTANCE OF 200 FEET
TO AN IRON PIPE SET ON MEANDER LINE ON CEDAR LAKE; THENCE PROCEED S 2
DEGREES 34 MINUTES W ALONG SAID MEANDER LINE A DISTANCE OF 125 FEET TO AN
IRON STAKE; THENCE PROCEED N 86 DEGREES I6 MINUTES W A DISTANCE OF 260 FEET
TO AN IRON STAKE; THENCE PROCEED N 28 DEGREES 25 MINUTES E A DISTANCE OF
137.59 FEET TO THE POINT OF BEGINNING.
TAX ID NO.: 038- I 013-50-000
PROPERTY COMMONLY KNOWN AS: 2385 CARDINAL DRIVE, NEW RICHMOND, WI 54017
7745 6/28/2016 80365384/1
I
St. Croix County 1031969 Page 3 of 3
Wisconsin,00pomeni of Safety and L�rcfesslonal Services
Page Of
Division of IndusLry Services
SOIL EVALUATION REPORT
In accordance with SPS 395. Wis. Adm. Code
county
Attach corn plete s 4e pta n on paper fiot less than
8 1/2 x 11 1 n rhos ii n s [ze. Plan m ust inctude,
but not lirnited to.- vorticzd and horizonW refeftnoe point (131 ). direction and perraeni slope.
Parcei W.
scale or dimermions, north sncw. widiocabon and distance to nearest road,
- J/*,%
D", C Z!
Please print all information .
%ed by
-6-
Personal infofmabon 1-5 �(M (1 )(m)). _Vu pr(ll
? vi d e ma Law, s. y be used for seconda!y purposes (Priva
Prep ia Owner
Property operty Uvabon
G-ovl - L of V4
cl ;il
N R E 00 W
Property Ow ne. r's Mai liras A dd ress
Lot #
E31ock #
Subd- Name or CSM#
City State, Zip Code Phone Number
city Village Own
Nearest Road
na2
eA
11rV_N
UN)
ED New Construction Use: Residential I Numboir of becirwyns Code defiv M, design flow mNLj:2� GPID
Pj Replacement Publip or cownerctal - Doses be;
Parent rnaterial Flood Pl,,-jn elevation if applfcabl�
6a ga:t le-Qcm-� 50 e4-paXj_rC"
. k
•
tkW W4,
General comments and recommendations- r
Boring
Boring PR Qvim! surf' aw etev ft.
Depth to limiting factor In.
Soil !�N C11'r_a [ion Rate
GPD/W
Hon'zoo
Depth
In,
Dominant Color
Munsell
Redox Description
Qu. Az. Cont- Color
Texture
Structure
Gr_ Sz, Sh,
Consistence
Boundary
Roots
*Eff#1
"Eff#2
4�1
L dS
A
/Z
,2L
ail
�5ft. Cie
13o ring #
Pit Ground surface elev. `fit_ De Pt h to I IM 16 n g f'actor,.a in.
SO4-1 Appfication Rat(�
Horizon
Depth
Dominant Color
Redox Description
Texture
Struclurp
Consistence
Boundary
ROM
GPD/Ft
In.
Mansell
Qu. Az, Cont_�Color
Gr, Sz- Sh,
2,Eff#i
a E ff#2
A�01,e
q
42
220 mania and
#2 B OD. > 30
Effluent # 1
T 130D. > 30 !s 220
mnll Arid i 0 5 1
So MZYL
E ffl Lie nt
I S S > 30,%
150 mkt_
CSTZwd(PlowP
Address
- t ,. .-,n /1� If )-L - --�
Signature
Date Evaluation G ondticted—
CST' Number
ZaAZ
Telephone Nurnber
hino reffion, OffulifY
andSerriCir
�i we /905
BOB GRE TIE
wieserconcrete.com
71
_�� r,r
92
Maiden Rock, W1 (800) 325-8456
Portage, Wl (800) 362-7,220
76
9cle e
Fond d'u Lac, Wl (800) 641-5937
Spooner, Wl (800) 336-34,16
r2
Property Owner Parcel 10 # Page
L] Boring
U/ GrotjrW surface e4ev. R, ChWth to IUTOng fac lor kL
I 1 560 Ardication Rate
Redox Descdpdw
Qu- Sz- Cont. Cokor
Bon'N # 13ohng
E) pjt Ground surface ejov. ft, Depth to limiting facloc in, fir ficabon Rat�
ry Roots GPD/ft
Fkxizon Depth Dominant CcAor Redox Description Teidure Sbwhyre �,.onsi!stenoe Rounda
in, Mansell U. Sz. Cont. C0kW Gr. Sz- Sh-
Bon6g # Boring
pil Groun-d surface e1ev- ft- DePM lo limiting fa,ctor in.
4,1P 0 11 - 8 Structure
1 a,
MMFM I W� Gr. Sz,. Sh. I•
The Dept- ut 'S)afety and Professlcmal Services is ' -a i upportujI -ity ser u
an equ� vier, pmvider and emplover. If You li" aSSL5 t
41 d, M 16J + Ir A 0 f- I I j1Z I T"Fy �1�" IZI* T? Pb I a v
' I JIB 331 R., a, I I L J I
3S�'ff
N�'9L9�cc2�w41J
. o
owr� - o��t 1cQyd _
P
amiss ,v4/
(7e
SIDE ELEVATION
-REAR ELEVATION
SCALE 1/8" - V-0'
FRONT ELEVATION
SCALE lfd" = 1'-0'
GARAGE SIDE ELEVATION
LLI
0
U
L/->
-5-
I.
REVISIONS
tAv a
un
SSUEnAIE 70412112�3
DRAW" 1""
'ATE
'-ALE:
{
0
14
M3B PC -lOEf1 PIC -20N PIC ,, � a
T AWN- t��
Miss OWT 4w PAC no CEMrfT
imes
f 2�2fiPIC if>HPIC ii� I Po"---------- ------- - 1 I�...Mir
1 l07lVAUl7� 1 1�'I
alr----...._----• •j I 21"PICAN UnPICMV MXPCAW
1
-----------
{ I 2101PIC MMPIC 2IIAV
21NANM 1� {/MM T{1TAMN
_
i411N•PtATEHOT'1MUOUTU.N.O.• ; j r M.ArKkemHomes uHlw r
a
MEE 1 1•ga�war�tac�K�w+»�
I V• OS.
L-------------------1ifa�vEiwo 1 1
II d
uiaw
------------
�Ff
uwiewu ; i iS I j 1 L.
_-_ 1__ _
II
fNP CLO HOT =
I i � � II
b i Ir 1
I W 0C
® t+#'
1 UPPEiq MICRO UPPOS
OLU
k.l- C
LU fZ
-- ; U &2
owlLU
I
a Z
4 i i Q
1 I m
cc
9L
I i 1
r nE� sln:liAliEc P�llei
1OHOAWE000R I ��----____--"---------__---__---i ,,
i
I I , fnrm.RIWEOPAflE! I t
I , ON OARAAE DOOR
j I j IN Ism I I 1 1
REV1,SIOW
VAX
FRONT MV5
TAG CC109 f !
----------------- H ---
1 R W / 19/23
MAWN :
MW M. AIC KWS
MAIN LEVEL FLOOR PLAN i oa'002=23
SCALE, Or ■ V-Cr 19M FINISHED SQ FT. $CALE,.
37X
(D
0,6 r
se C96ix couNTY
R, &ce�"n4k�
OWNER Vzk... .�' aii�K.tAunl �l IT27EA/........
. . .
rLUIVIBER�„n,� �Ga��ubc.�. LIC.# 22'f2b3
TOWN OF �. .p�A-11�it _
sr-ju N9 Ix
BoLd'C"
AND/ xx LIU
i�
US IF
W F P -0-70, 4 Itm C
I VY IMAM W, 121! - I tM
. ..... . . .......... ............ . .... .............. . ... ...... .......... ................ ....... ..................
FriRM1,11, E r1RE3
% ... . . ... . .. . ...........................
so
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
M.- am& W. A n
. .. ..... . . ...
. .. . ...... ..... ........
A. . . . . .
.. ........
. ..... . ...... .