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032-2058-30-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538829 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Walters, Thomas III & Rebecca I Somerset, Town of 032 - 2058 -30 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /4�> 1 8 i 1 ( 17.30.19.726C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER o CAPACITY STATION BS HI FS ELEV. n.y Z — / ♦ Septic Benchmark Dosing 'S+K/ '�.� `�' 7 5 Alt. B 1 7 - '97 Aeration Bldg. Sewer Holding St/Ht Inlet R) L-, $p j • 55 92. 77 TANK SETBACK IN ORIATION St/Ht outlet TANK TO P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Id` 7-5 47 2 . Septic / � -- � Dt Bottom f3se!n9 Z• I i Header /Man. 061 n 1 3 f 50� ! ! Dist. Pipe �.� //G / Holding Bot. System i PUMP /SIPHON INFORMATION t 11 1 V Final Grade �7• . 7 Manufacturer t Demand St Co er Z�LL llK GPM b = J-Eti. .�J� '77. Model Number 613 1 C• 'I't C75, Z4 TDH Lit �� Friction Los System Head 75H 7 7 ?. s j (Irl Forcemain Len Dia. it I Dist. to Well ,52�/ � �Ja-�t g•g 93. (�( SOIL ABSORPTION SYSTEM QJ4r- Ne J g, Z 7 BED/TRENCH Width gt h No. Qf�Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth J en DIMENSIONS /6 L __ ` SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR _ Type f ystem: UNIT Model Number: i � 3 /UA- DISTRIBUTION SYSTEM Header /Manifo i 1 Distribution Q .�. a x Hole Size �� x Hole Spacing i Ven Air Int e Length 3• J Dia 2 1 1-ength �Z• D Dia /' Spacing �• �/� Z • �� SOIL COVER I x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S dded xx Mul ed Bed/Trench Center / Bed/Trench Edges Topsoil c11 /. �p2 ' F4-- Yes No �5 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g / Z 4 / I Inspection #2: / ! Location: 1564 47th Street S�oWerset, WI 54025 (SW 1/4 NE 1/4 17 T30N R19W) NA Lot 3 6k . Parcel No: 17.30.19.7260 1.) Alt BM Description = 7✓ V , Gp j4eA. 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No g I Use other side for additional information. �f4 SBD -6710 (R.3/97) Date Insepctor's gnature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538829 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Walters, Thomas III & Rebecca I Somerset, Town of 032 - 2058 -30 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 17.30.19.726C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRE NCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia I Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes Ffi� No ❑ Yes Vii; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1564 47th Street Somerset, WI 54025 (SW 1/4 NE 1/4 17 T30N RI 9W) NA Lot 3 Parcel No: 17.30.19.7260 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? F Yes � No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) imeme.wl.gov Safety and Buildings Division County wcomme,., 201 W. Washington Ave., P.O. Box 7162 S %, C/8 © / )r Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) orce � Ms. it Application State Transaction Number Number In accordance with . Comm. 837t' s. Adm. Code submission of this form to the appropriate governmental 7 , ansa �7 C- 7 0 unit is required p r to o5WQW#(�Q� permit. Note: Application forms for 7° d POWTS are Project Address (if different than mailing address) submitted to the IidtlA101+ NO COORM OporoLn information you provide may be f or secondary purpo in accord , Stats. _ I. A lication Information - Please Print All Information S A �I I � � Property Owner's Name Parcel # , 1t45 f 0Qff8 t4)AI— r� 03Z- Z05 3 0 - ZD0 Property Owner's Mailing Address c Property Location ''7 .56 ' . 7`fi� C 6 T Govt. Lot l / � City, State Zip Code Phone Number S IN ,% , � � / 1 5 ' -140 _ 1� � /., Section - 50MA� - AIS W % T _ Z .� 61Z -J 9� -S 77 7 c�rcleone H. Ty of Building T N; R E ot0 yp g (c eck all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name Bloc ❑ Public/Commercial - Describe Use � ❑ City of ❑ State D Use �/ � ^� CSM Number -7 ❑ Village of �OtJJ18� � t t 7 if 67. G+ /q - 03Z— ❑ Town of SO'" 4=W S6 T III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System y � Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Per / N and Date Issued Before Expiration Owner ? 'Z•g ✓ / 7 Z'l IV. Type of POWTS S stem/Com nent/Device: Check all that apply) . ❑ Non - Pressurized In - Ground ❑ Pressurized In - Ground ❑ At - Grade 14 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil / ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) +/6 �i • 5 V. Dis rsaVTrea nt Area Information: Design Flow (gpd} Design Soil Application Rate(g sf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation 750 O, �' Z Z /7S ✓ �S,7s VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units A c ° New Tanks Existing Tanks w V U v c : a w a A✓ p 5 U in un is.5 G% Septic or Holding Tank ?3's. /©C p /7 Z 1 � 5 t ,L �G Dosing Chamber /DOD mc olt Lo Z s 6. VII. Responsibility Statement - 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ' Si ture MP/MPRS Number Business Phone Number �a N ScNJv1tr7' c 7-7- 3760 7/ s 7loD -aY Plumber's Address (Street, City, State, Zip Code) VIII Coun /De artment Use On Approved I Permit Fee Date Issued Issuing ant Signs. e $ 4 ' �' �/ e enial u+�✓ � Z l IX. CondidMT *,O*AtN RReasons for Disapproval 1 Septic tank, effluent fitter and 3 ) G OhdGi . e tig .`ti Sda OJ dispersal) cell must all be services / lntaine„� nn �� as per management plan provided by y �.r plumber. e- i' A. E%+tTCC." • � .M.. �'� • 2- All stt{beck requirements must be maintained ale per applcaas °Code / afdiflb!00. Attach to complete plsos for the system and submit to the County only on paper not less than 8 to a I I inches in size SBD -6398 (R. 02/09) WALTERS PLOT PLAN ♦ BM1 Elevation = 100.00' Top of 2" PVC pipe 0 BM2 Elevation = 104.18' Top of electrical transformer. ■ Backhoe pits N Slope =13% System Elevation = 95.75' Contour Line Elevation = 95.27' Lot No: 3 CSM 14 -3777 032 -99 Legal Description: SW1 /4, NE1 /4, S17, T30N, R19W Township: Somerset County: St. Croix 12.78 Acres Scale: 1 "= 40' g� ti Q �L ®43 eyesi�cF — 9Z 1 7 cowra x — i ?a® rX�S Ti JU C. o d Lc K 1 j �. i 040 CN FcnreE 600 Cs 4L. S.T 5z K 1 P, VA YE r c ♦ . bF a p tarn 7- i f3M N i 3 GARRGF P ew�'� 1JOU Page 12 of 17 + �9tiPART11p�T Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 3' K Contact Through Relay www.commerce.wi.gov /sb/ y2o J x c _ www.wisconsin.gov N 0 ss101-:nti5� Scott Walker, Governor Dave Ross, Secretary August 23, 2011 CUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23 /2013 Identification Numbers Transaction ID No. 1984290 SITE: Site ID No. 770783 Thomas & Rebecca Walters Please refer to both identification numbers, 1564 47TH St above, in all correspondence with the agency. Town of Somerset, 54025 St Croix County SW1 /4, NEIA, S17, T30N, R19W Lot: 3, FOR: Description: Mound / Five Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1330566 Maintenance required; Replacement system; 750 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual Version 2.0, SBD - 10706 -P (N.01 /01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ` �+ stats. The following conditions shall be met during construction or installation and prior to occupancy or use: t waaF,T; °tT F': 4I Reminders N Q � .E • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The pump chosen for the design is at the limits of its capacity. If the total dynamic head is calculated to be higher, at the time of construction, a pump that meets or exceeds the system flow will need to be installed. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit -must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. JOHN F SCE= Page 2 8/23/2011 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 250.00 / r Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz @wisconsin.gov cc: Carl J Lippert, Wastewater Specialist, (715) 634 -3484 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Walters 5 Bedroom Mound / r Owners Name: Thomas & Rebecca Walters Owner's Address 1564 47th Street Somerset, WI 54025 Legal Description: SW1 /4, NE1 /4, S17, T30N, R19W Township Somerset County: St. Croix Subdivision Name: NA Lot Number: 3 Block Number Parcel I.D. Number 030 - 2058 -30 -200 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Septic tank specifications Page 8 Effluent filter information Page 9 Dose tank specifications Page 10 Pump specifications and curve . y Page 11 Existing tank certification NED Page 12 Plot plan Page 13 Septic tank maintenance agreement = CONNBR Page 14 Warranty deed NGS Page 15 CSM l Page 16 -17 Soil evaluation report PONOENCE Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/8/2011 Phone Number: 715 - 760 -0486 Signature: ��6. Designed Pursuant to the In- Ground Soil Absorption Component Manual Version 2.0 SBD- 10705 -P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST -SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD - 10706 -P (N. 01/01) Version 6.0 (R. 04/08) Page 1 of 17 Mound and Pressure Distribution Component Design Design ',Norkshee` Site Information tR o C R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <- 36 inches. 750.00 Design Flow (gpd) 13.00 Site Slope ( %) 95.25 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 107.201 Dispersal Cell Length Along Contour (ft) = 7.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft) i 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? E�"'*er V � o! E.? C Center or End Manifold 3.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) 2.00 Estsm Orifice Spacing (ft) = 7.22 ft /orifice 2.00 Forcemain Diameter (in) 65.00 Forcemain Length (ft) Does the forcemain drain back? I_ Y $5.751 Pump Tank Elevation (ft) Erltef `' '4 3.25 System Head (ft) x 1.3 10.60 Forcemain Drainback (gal) 9.59 Vertical Lift (ft) 96.86 5x Void Volume (gal) 5.75 Friction Loss (ft) 107.47 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 68.16 System Demand (gpm) 18.59 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options _choice in. dia. options choice. 0.75 s 1.25 ^ms 1.00 1.50 s 1.25 i 2.00 x x j 1.50 x i x 3.00 2.00 x i 3.00 x s, Gallonslinch Calculator o;i - - a' Treatment Tank Information Total Tank Capacity (gal) 1� 000.0 Septi Tan Capacity (gal) Total Working Liquid Depth (in) Wieser i Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Infor mation 1000.00 Dose Tank Capacity (gal) i PolyLok Commercial , Filter Manufacturer 27.83 Dose Tank Volume (gal /in) 525 _ _ Filter Model Number Weiser ° Manufacturer Project: Walters 5 Bedroom Mound Page 2' of 17 Mound Plan and Cross Section Views T ::1/10 B J Observation Pipe .... .... O ;�" A ............. B i :.: 3 �j. ............................ ............................... I L - - Mound Component Dimensions A 7.00 ft E 16.92 in H 1.00 ft K [ Aft ft B 107.20 ft F 9.50 in 1 13.29 ft L ft D 6.00 in G 0.50 ft J 3.87 ft W 750.40 1 (ft Dispersal Cell Area 2174.75 (ft) Basal Area Available 7.00 (gpd /ft) Linear Loading Rate 1072 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.54 (ft) ► * H G 1 I F Dispersal Ceti 96.25 (ft) Lateral 95.75 (ft)� — Invert Dispersal Cell... . . Elevation E D 3 . ... a 95.25 (ft) Contour Elevation 13.0 % Site Slope Geotextile Fabric Cover Shading Key Q. T Dispersal Cell See lateral details on 1❑ [ Topsoil Cap c Q- 1.5 ft Page 4 for number, size, ® " " " "" Subsoil Cap w c 0 0 / and spacing of laterals. a / _ ® ASTM C33 Sand F Laterals are equally ®� Tilled Layer h 0.5 ft Typical Lateral spaced from the 05 Aggregate v o 50 distribution cell's centerline in the A distribution cell (AxB). Project: Walters 5 Bedroom Mound Page 3of17 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical 1P S i= Turn -u p wf ba l l valve or IF X---)� IExl2 I 02 �I Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.07 ft Lateral Length (P) 52.79 ft Orifices per Lateral 26 Lateral Spacing (S) 3.50 ft Orifice Density 7.22 ft /orifice Lateral Flow Rate 17.04 gpm Manifold Length 3.50 ft System Flow Rate 68.16 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.59 ft Forcemain Velocity 6.96 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented = E Alternate outlet location Forcemain diameter Weiser Manufacturer -r 2 in. Capaci 1000.00 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.17 533.53 B 2.00 55.66 C P� ump off elevation (ft) C 3.86 107.47 � 86.66 D 10.90 303.35 D Total 1 35.931 1000.00 Dose tank elevation (ft) 3" Bedding Aler tank. 85.75 Alarm Manuafacturer J Septronics Alarm Model Number !TM-1 Pump Manufacturer Z eller Pump Model Number 1140 HE CORRESPMULNU Pump Must Deliver I 68.16 gpm at 18.59 ft TDH Project: Walters 5 Bedroom Mound Page 4 of 17 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt j Phoney 715 - 760 -0486 POWTS Regulator's Name St. Croix County Zoning ; Phone! 715 - 386 -4680 i System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 750.4 fl Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 m Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 years {ether' Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Walters 5 Bedroom Mound Page 6 of 17 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 17 D z X N D m D z 61" 84" c m D 0 X 42" m z v r m m m UP 41" / N� 4" CAS ? \ m 3" 37" 4" F n I cu N > r� n O D n 4" CAS m;0 cn / \ m D N I V 'D � C A c - nu n 0 O O 0 - V m v 40" c X D - o <O 0 Z m O D Z N m m r j 0rn� D 0 > N m Z O m x ;u D Z O m C D0 D r = E: Z 2 v N z� z Z D O O r r mo ?5 'i g v_ c m m m Z� x N y DMZ ODZ p .. 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POST -POUR: Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 ° REVISED JAN. 2010 800 - 325 -8456 FlLE: ■P75u-IR Page 7 of 17 INSTALLATION INSTRUCTIONS .. } PL- 525 /PL -625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening rrr 0 O W� J 5 LL s Additional pipe or Polylok Extend 8 Lok° Glue for entering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure D NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is properly alighed WHEN FILTER IS • ' and completely inserted. (C) Hose off the filter over the septic tank. USE IUMBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANWG FI.IM septic tank. Page 8 of 17 INSTALLATION INSTRUCTIONS y► Ln�r. a. PL- 525/PL -625 FILTER PL- 525 1PL -625 FEATURES & BENEFITS r Features & Benefits: Rated for 10,000 GPD e PL -525 = 525 Linear Feet of 1/18" Filtration PL -625 = 625 Linear Feet of 1/32" Filtration PL -525 PL-625 .Accepts 4" and 6" SCHD. 40 pipe The PL- 525/625 Effluent Filter should operate efficiently ' Built in Gas Deflector for several years under normal conditions before 9Automatic Shut -Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every a Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS r. Polylok PVC Filter * Extension Handle �-- hlt lmrMJ ... i 4 7, e ,y. A Risers & .Riser Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend & LokTM SmartFilterT^" Control Polylok safety screens Switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing into open and switchs provid a visual and time saving by elimi- make filter and /or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com y D z X N D m m D 61" 86" z c D 42" 0 z r � m m N vi O m � UP 41" p ;13 1 4" CAS m M 3" 36" 4" ( 1 ° D ° N I r En D m D UP 38" m ;u ►- c� p ! 4" CAS \''' ;u / N N V I M D m c � M m � m N 0 rrn D c �D- a z- ° 39" n FA °o D z D to Ln mD> m D 0 m D m O m pu ;a 0 mm x C - ) D z C) m 0 -i 0 -i r = r Zp Z z O O ,D r r ° W A --1 Dv o c m m m —1 �n� X- m z �x n ° cam n ^ C)-P r Am�m mDO 0> - Z C 0 BCD v rrN m 8mD -> a �A 7,C ° 2: C) S2 � ark 7K G tn� m° cam S`= to F--4z D MO m Dp -1 -10•• K -1 �� r D x C7 ��c :1�C r m N Z p M 2 r- '�- m D M V D N M v D v DN 6 v D O Dm N D I -� cpr� ��� DAN rn O v v D z O A A - D 4 m CD ' m O W ,A C7 C7 m a D A C7 p o a m u n u A zN O r pp NmD I D C 0p n- z D O< z W vci O Vl (Az �.. < a � W tn C7� D N s a v <OC7 G)(A O r v m z o W C7 � z Z O G7 mo (n CD � �� U s ` 1 D m m 3 m Z c-n G <� fA pp D D m0 m v m �o Z > �m O z R1 � O Z � O r0 W �D D -� . .. .. D" p v� y D i o -n °o CD � �o v O O '- 20 r- r' -fm °fin Z 70 m ZI to v O r p � O z o (n En 0 i rn D ;u ;u o p - o m > o -� O z r c m rn m O z O r :D v n Z rn M m Ri M Z r m \ cn KP1000 -MR m DRAWN BY: SME SCALE 1 4 " =1' -0" PRE -POUR: Om m SEPTIC MANUAL MHE RC INCIETE DATE: JANUARY 1 REV —a \ Z W3716 US HWY 10 MAIDEN ROCK. WI 54750 20 0 DATE:. POST -POUR: ° REVISED JAN. 2010 800 - 325 -8456 FlLE: KMMD41R Page 9 of 17 PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW • � � MODEL 140/4140/145/4145 PER MINUTE 5 EFFLUENT AND DEWATERING 314 65116 u ro MODEL 140/4140 145/4145 4&8 m Feet Meters Gat. liters Gat. Liters 1e n 5 1.S 86 326 61 232 62Vi2 10 3.0 s0 303 60 228 + • 15 4.6 73 276 56 213 so 20 6.1 66 250 53 201 25 7.6 59 223 49 186 1n • n 1.n NPT S ` 30 9.1 49 185 45 171 r n 40 122 28 106 35 133 50 15.2 — — 26 99 o # 60 18.3 — 16 1 61 " Shut-off Head: 50%(15.2m) 74 ft .&n 0 30 6 n 1 e M 12 M2 16 150080 10 1692 2 6 SK1521A 0 un 10 n 3o n w a m ea m avian UrM a n 160 240 3n . • • • - FLOW PER NNUTE • . G - 3718 85,16 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical aftemators, for duplex systems, are available with or without alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. + • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. 19.,1,91 • Sealed Qwik -Box available for outdoor installations. See FM1420. • Refer to FMO806 for applications above 130*F (54 °C). 140/4140 & 14514145 MODELS Control Selection Model Model Volts - Ph Mode Amps Simplex Duplex N140 N4140 115 1 Non 12.0 1 or 2 3 E140 E4140 230 1 Non 6.0 1 or 2 3 1619 BN140 BN4140 115 1 Auto 12.0 — BE140 BE4140 230 1 Auto 6.0 * — _r • S92 N145 N4145 115 1 Non 13.0 1 or 2 3 �- SK15248 BN145 BN4145 115 1 Auto 13.0 * — *Single piggyback switch included. SELECTION GUIDE 1. For automatic use single piggyback variable level float switch or double OPTIONAL PUMP STAND P/N 10 -2421 piggyback variable level float switch. Refer Reduces potential dogging by debris. to FM0477. Replaces rocks or bricks under the pump. 2. See FM 1228 for correct model of simplex wp Made of durable, noncorrosive ABS. "Easy assembly control pan • Raises pump 2" off bottom of basin. not eldrded.) 3. See FM0712 for correct model of duplex Provides the ability to raise intake by adding control panel. sections of 1 W or 2" PVC piping. Attaches securely to pump. o c�imoN Accommodates sump, dewatering and Ail installation ofcornr protectiondevicesandwtnngshould effluent appl ications. be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recer:t NOTE: Make sure float is free from obstruction. National Electric code (NEC) and the Occupational safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. -- - - ---® Copyright 2010 Zoeller Co. All rights reserved. Page 10 of 17 WALTERS PLOT PLAN ♦ BM1 Elevation = 100.00' Top of 2" PVC pipe 0 BM2 Elevation = 104.18' Top of electrical transformer. ■ Backhoe pits N Slope =13% System Elevation = 95.75' Contour Line Elevation = 95.27' Lot No: 3 CSM 14 -3777 032 -99 Legal Description: SWIM, NE1 /4, S17, T30N, R19W Township: Somerset County: St. Croix 12.78 Acres Scale: V= 40' g-4 w L w ( ( 13 °j� SiDPF et VU t � �ko ® 63 iZ X lZ3w _ 3 A QM N I 1 � � �� Con►Td�t AL _ LNr �• FrnrcE L &L. $.T ss5a t VA 1 \ I P. ern z , 61M if k J � GARNGE !►oasa Page 12 of 17 ST. CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer OM As i_7 ;� S Mailing Address 115-69 y7 ; N11 r Property Address 541tl E (Verification required from Planning & Zoning Department for new construction.) City /State 106667', W� _5v Parcel Identification Number ©3Z — Z 0S_6 - 3 a "Z ©O LEGAL DESCRIPTION Property Location 5"W 1/, , ) '/o , Sec. l Z , T __Y&N R /_!? _W, Town of 5v,44 e ie5gT Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 61 7 7 6 '� (before 2007)Volume 1 yg 7 , Page # I-IQ Z Spec house ❑ yes i)no Lot lines identifiable dyes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number ed>!�ooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) 11 87PAGE 493 ' STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Larry J. Dauffenbach and Laura M. — Dauffenbach, husband and wife Grantor, and Thomas Walters III and Rebecca Walters, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of SW '/4 of NE '/4 of Section 17, Township 30 North, Range ) 9 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Recording Area Map filed December 22, 1999 in Vol. 14, Page 3777, Doc. No. 615926. Name and Return Address 032- 2038 -30 Parcel Identification Number (PIN) This i a homestead property. (is) OEXcXSX - Exceptions to warranties: Easements, restrictions and rights-of -way of record, if any. Dated this Z 7 gA- day of January — 2000 4 • * ar J. auffe ac + Laura M. Dauffenbach AUTHENTICATION ACKNOWLEDGMENT Signature(s) Larry J. Dauffenbach and Laura M. Dauffenbach, STATE OF WISCONSIN ) ) ss. husband and wife ��/�, County ) authenticated this may of Januar 2000 personally came before me this day of the above named lG f L t s T (tJ A A b TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, — instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • Attor Kristlaa O land Notary public, State of Wisconsin u son. 6 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary) • Names of persons signing in any capacity must be typed or printed below their signature. �' P1Of° O "' d °O1A°° rO11tl STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1999 s DEC 2 2 1999 a I � Via. SL za g g G E ,� f �./ RVEV MAP LOajVrK0 IN - 9 - SW I /4 OF THE NMI/.a OF Ci ! SECTION 1 7, TSON, R 19W, IrQWN OF g ig SOMERSET, ST. CRaNX COUNTY, wISCONSIN. BEARINGS ARE REFERENCED TO THE N1/4 CORNER � NORTM >�OUTlJ y/4 LINE OF SECTION SECTION 17 LARRY S LAURA DAUFFENBACH 17. ASSUM�Dr'TO BEAR S00'18'48"W 1x84 7TH STREET Q SOME WI 54026 SCALE IN FEET 1. - 200' 300 j- 1 200 4�n1�5PUt�® 161+1 ®� r NORTH LINE OF THE SW1 /4 OF THE NE1 /4 ONNTeRLIN� NNS°Si'iS"V1/ 7 7 oRavNL oR/vN y �7 � i7.i�' 316.01110 , 1 1/4• IRON PIPE FOUND •� NXI�77NO 889'38'39'E 3.47 FEET roman LIMN FROM SET LOT CORNER / c*vvmQ•L* a LOT 1 LOT 3 z lu ' 13.017 ACRES IMARN ae7,o22 SQ. FT. LOT 2 ; zi O 13.037 ACRES 33 3� e 12.746 ACRES EXC. R/W 687 SQ. FT. 1 o : ■ 885.228 SO. FT. i 12.745 ACRES EXC. R/W = OV>fB (< 656.192 SQ. FT.� 886.764 80 FT. I 0 i A 11.678 ACRES EXC. 608.686 SQ. FT. o F �RANARI/ °- Ff GONiZRRTS �� NOTE: b • . LOTS 1 6 2 ARE ENTIRELY N i; I I: BUILDABLE INSIDE THE PROPER 1 = SETBACKS AND EXCEPTING ROAD RIGHT -OF -WAY AND SHOWN p r } 15 ^ WETLANDS. 3 q - VYB>:T 1 /4 LJNB 71+/- 435.28' 889'18'7 9"E 12 .83' N — _ _ 4a4.1 a _ — _ a4a.2o iii. �3' »�is�'O• -- --� = ' ;t4Q1" �.7 ,_ _ ausnnlo as °NT�wulra v 68"4 "E - i M{#1PC6W�'4_G�_D L�,GI>�1 L�eCiE $ l 81/4 CORNER APPROVED to SECTION 17 ST. CR04X COUNTY ALUMINUM COUNTY SECTION W CURVE DATA Pl atnlnq Zoninq and Parks Comm»".. CORNER MONUMENT FOUND W S NUMBER 10 UCCr 2 2 199 0 1 1/4" IRON PIPE FOUND RADIUS 335.30' J 7 CENTRAL ANGLE 28.14,33 Q 1 • X 24' IRON PIPE S8T WEIGHING npt recorded within 30 days or 1.13 LBS. PER LINEAR FOOT CHORD BEARING N13'37 �•5• approval date approval shall be CHORD LENGTH 152.23' nun and void "" " """'-- 100' ROADWAY SETBACK LINE ARC LENGTH 163.57 TANGENT NOO"29.44"E WETLANDS TANGENT N20°44 VOLUME 14 PAGE 3777 ` ML SOIL EVALUATION #1650 j' IVE� I D Pa e 1 of 4 Department in accordance with Comm 85, WF�d g Division of S gs Schmitt Soil Testing, Inc. Attach complete nift than %: x 11 inches in size. Plan must County St. Croix include, but not I al an horizontal ference point (BM), direction and percent slope, s plsCtpOltt�Tb(rrow, d location and distance to nearest road. Parcel I.D. EI - 032 - 2058 - 30-200 ation. vie y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Walters, Thomas III & Rebecca Govt. Lot SW1 /4, NE1 /4, S17, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1564 47th St. 3 CSM 14 - 3777 032 - 99 City State Zip Code Phone Number ❑ City ❑ village ❑ Town Nearest Road Somerset WI 1 54025 1 612 598 - 5677 Somerset I 47Th St. ❑ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Glacial till Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a mound system. System elevation is 95.75' based off contour line established at 95.25'. Slope is 13 %. Soils, massive with a very firm consistence. l� F 1-1 Boring # ❑ Boring ® Pit Ground surface elev. 95.25 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0 -7 10yr5 /6 none sl 2msbk mfr gw 2vf .6 1.0 2 7 -20 7.5yr4/6 none grsl 2msbk mfr gw 1vf .6 1.0 3 20 -32 7.5yr4/4 none grsl imsbk mfi gw - - - - -- .4 .7 4 32 -84 7.5yr4/4 fi yr6/3 6 Om t 0r6/3 grsl mvfi - - -- - - - - -- .2 .6 32 -84" soils are very resistant to knife penetration. Consistence very firm. 2] Boring # Boring ❑ Pit Ground surface elev. 95.55 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0 -8 10yr4 /6 none grsl 2msbk mfr gw 2vf .6 1.0 2 8 -27 7.5yr4/6 none grsl 2msbk mfr gw 1vf .6 1.0 3 27 -34 7.5yr4/4 none grsl imsbk mfi gw - - - - -- .4 .7 4 34 -78 7.5yr4/4 f1f 10yr6 /6 gel ,Aaa- mvfi - - -- - - - - -- 2 10yr6/3 .6 34 -78" soils are very resistant to knife penetration. Consistence very firm. * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS S mg /L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �mo , 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/2/2011 715 - 247 -2941 SBD -8330 (807/00) Property Owner Walters, Thomas III & Rebecca Parcel ID # 032 - 2058 -30 -200 Page 2 of 4 a Boring # ❑ Boring ® Pit Ground surface elev. 93.05 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr4/6 none sl 2msbk mvfr as 2vf .6 1.0 2 13 -31 7.5yr4/6 none grsl 2msbk mfr gw lvf .6 1.0 3 1-48 7.5yr4/4 f1f 10yr6/8 grsl lmsbk mfi gw - - - -- .4 .7 10yr6 /3 4 48 -76 7.5yr4/4 f1f 10yr6/6 grsl Om MA 2 10yr6 /3 48 -76" soils are very resistant to knife penetration. Consistence very firm. Fil Boring # Boring Pit Ground surface elev. 97.05 ft. Depth to limiting factor 94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr4 /6 none grsl 2msbk mvfr as 2vf .6 1.0 2 10 -22 7.5yr4/6 none grsl 2msbk mfr gw ivf .6 1.0 3 22 -30 7.5yr4/6 none grsl lmsbk mfi gw - - - -- .4 .7 4 30-94 7.5yr4/4 none grsl Om mfi - -- - - -- .2 .6 Pit dug and evaluated by vent pipe of existing drain field. F-1 Boring # El Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 '042 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Schmitt ScA Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Thomas III & Rebecca Walters Thomas J. Schmitt, CST 227429 Address: 1564 47th St. 1595 72nd St. City, State, Zip: Somerset, WI 54025 New Richmond, WI 54017 Phone - 7� / �� PID: 032 - 2058 -30 -200 Signat Lot No.: 3 CSM 14 -3777 032-99 Daft a Legal Description: SW1 /4 NEl /4 S17 T30N R19W ■ Backhoe Pit Township, County: Somerset, St. Croix County ♦ Bench Mark 1 El. 100.00' Top of 2" pvc pipe 0 Bench Mark 2 El. 104.18' Top of Electrical Transformer Slope= 13% Contour El. 95.25' Contour Line Lengtt l47� j qr p lu jtLb , qa � a3 7� w. O f I t 1 I 31 1214 s 4, EXI 4 C� 1 , I I 1 1 j 1 ti.. 'fie gam a a », ' �..�* �+r. ''�,' a� Y'f p rr `,,�"° YG .�as �• x:4 � °�; `i. NW '^r- Ti A-44,— _ 1 0 ? § 7 0 ? /%k\ k$ I e 3 - o� m- o ° : 3 c cn co § / § ' + 2 2 ® ; 9 N , 3 ° ° : \ v e ; \ & § i ID \ 0 , m < * d » § « g i ( ! ! o § to to a 0 E CD 3 C y E R 2 , \ m = E 41. \ _ cl - 2 § @� ° C \ § k \ « G CD m m 0 i E c § \ � ` k � 2 j o o o\ » \ / r-3 k ) 7 \ ® (ID (C) , ; ; 7 \ \ \ / \ 0 � I k 0 ° / } CD . • ƒ ] @ \ c D A \ } c6 ° E; \ ^ . 0 ° � i B E G a A 2 0 w � \ \ § -4 0 f \ 7 7 ; § ) ) \ / \ w , � \ k g § : } C : \ CL \ CD � \ � � ƒ � \ / \ \ * � \ . \ a 0 \ k 1 ƒ \ § � \ 0 \ � / W nsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safe 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code r COUNTY Attach complete site plan on paper not less than 8 1/2 -)0 1 4neh in size. Plan must include, but St. Croix not limned to vertical and horizontal reference po�M9, Elirbgt igi : % of slope, scale or dimensioned, north arrow, and location and di PARCEL I.D. # et 6 .whearest f,c " .� 0 APPLICANT INFORMATION -PLEAS T ALL,r(MA REVIEWED BY DATE PROPERTY OWNER:'; OPERTY ATION Larry J. Duffenbach Z �:> VT. LOT 114 NE /4,S 1 T 30 N,R 19 ( or) W PROPERTY OWNERS MAILING ADDRESS � u� T BLOCK # # 402 W. Poplar "�°'. `• na j tS 'BD** csm 1C 7 CITY, STATE ZIP COD ON ER ' ❑CITY ❑VILLAGE EAREST ROAD Stillwater, MN. 55082 ( 4 - Somerset 157th. Ave. (�J New Construction Use[ Residential / Number o ms 3 [ ] Addition to existing bui mg j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpdm - 6 trench, gpdm Absorption area required 3 b n2 375 _trench, n2 Maximum design loading rate • 5 bed, gpd/ft - 6 trench, gpd/ft Recommended infiltration surface elevation(s) 109.00 it (as referred to site plan benchmark) Additional design/ site considerations contour 1 ine= 108.00 Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTI NAL MOUND IN•GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ❑ S U EFS ❑ U ❑ S ®U ❑ S ®U O S EF El S 19U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Tra 1 0 -12 10 r3 3 one sl 2m r mvfr I NIM 2f .5 .6 2 12 -25 10yr4 /4 none sl 2msbk mfr gw if .5 .6 Ground 3 25 -34 7.5yr4/4 none scl 2msbk mfr gw na .4 .5 e .6 -60 7.5yr4/6 108 n, 4 34 c2p 7.5yr5/8 sicl lmsbk mfr na na .2 .3 Depth to limiting factor 34" Remarks: Boring # x 1 0 -10 10yr3 /3 none sl 2m r mvfr Cfw 2f .5 .6 2 2 10 -26 10yr4 /4 none sl 2msbk mfr gw if .5 .6 3 26 -36 7.5yr4/4 fff 7.5yr4/6 scl 2msbk mfr gw na .4 .5 Ground elev. 4 36 -52 10yr5 /4 c2p 7.5yr4/6 sicl lmsbk mfr na na .2 .3 10 Depth to limiting f Remarks: CST Name: Please Print Phone: GaRY L. Steel 715- 246 -6200 Address: 1554 200t Ave., New Richmond, WI. 54017 Signature: Date: CST Number: 12 -1 -94 cstm 02298 l STEEL'S SOIL SERVICE Gary L. Steel Larry Duffenbach 1554 200th Ave. CSTM2298 NW4NE4 S17- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 N 1 " =40' BM-= top of 1' steel pipe by post at el. 100' Alt. BM.= top of large corner post at el. 105.00 lot 40 acres Q� $ 1NA /OQ t MvuAW 12c -- Fl , 0 / 7 0 � D �1 Gary L. Steel �- 12-1-94 STC - 104 AS BUILT SANITARY SYSTEM REPOftet OW2>IER `. 1, AIL' ADDRESS SUBDIVISION / CSM# y �2 LOT SECTION /7 T _:?D N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM YBZ " /00 i 'wd/ INDICATE NORTH ARROW Provide setback leva information on reverse of this form. Provide Z dime sion center of septic tank manhole covei- BENCHMARK ALTERNATE BM: v ! i ( �c��lvr _ z:z 1"1 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: jc / Setback from: Well -� l House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 4. 2 Length = Z,�'" ' Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer �S,s� ST Inlet. a�/-yQ ST outlet PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade g I DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ��?S INSPECTOR: 3/93:jt V*sconsCh Department of Industry PRIVATE SEWAGE SYSTEM County: - , Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: []City ❑ Village Town of: State Plan DAUFFENBACH, LARRY Q0=04 s et CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: 40 /llD- S A�L TANK INFORMATION ELEVATION DATA 5�3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. ewer g. /l;(00 q_5_ 5__S Hol St/0( Inlet TANK SETBACK INFORMATION St /�A Outlet J/, 53 9cj low TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic >/ � -?� NA Dt Bottom -- - Dosing NA Header 9cl Aeration NA Dist. Pipe / ? ' 9 Holding Bot. System � jf0 3�5_ PUMP/ SIPHON INFORMATION Final Grade M nu Demand /y'u:n Cow- 4 .4; 16 Model Number GP TDH Lift Fri n System t Forcem Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT No. Of Pits Insi ia. Liquid D th 3` DIMENSION �� 5 DIMEN 1 N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manuf acturer: u INFORMATION Type O , i �Od / /�� . BER Mode Nu mbe r: mbe System: e > �s OR UNIT i:3 DISTRIBUTION SYSTEM Header/ Distribution Pipe(s) ,i x Hole Size x Hole Spacing To Air Intake Length Dia. Length Dia. 7` Sparing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Syste n Depth Over ,i Depth Over (� 22 xx Depth Of xx eded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges J� �� Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) L n OCA r � TION: Somerset.17 . 30.19W, SE, NW, 47th � Street C0_?t" , r�-y- vZ- J ✓�a_.1 ` ^'�� , <_.� ax 9 Plan revision required? ❑ Yes Er Use other side for additional information. S SBD -6710 (R 05/91) / - � ate Inspector's Signature Cert. No (2C Z�A SANITARY PERMIT APPLICATION dr` In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SAI�ITARPERMIT t # —Attach complete plans (to the county copy only) for the system, on paper not less than ,J G 3! 5 8% x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 1 zlu t/4 ' /a, S T� , N, R (E (or PROPERTY NER'S MAILING AQDRE LOT # t 7c K# CITY STATIt ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM MBER II. TYPE OF BUILDING (Check one) ❑ State Owned ❑ VI LLAGE NEAREST ROAD , l > ❑ Publlc 6In! 1 or 2 Fam. Dwelling of bedrooms �:Z PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. 1:1 Replacement 3. ❑ Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 [Z Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 17. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 9s Feet , d Feet VII. TANK CAPACITY Site in oallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank — -S Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatioijlof the onsite sewage system shown on the attached plans. Plumber Name (Print): Plumber' Si to (N ps) MP /MPRSW No.: Business Phone Number: J l � Plumber's dress (Street, C!W, State, Zip Codep IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater E__Ue e Is uing Agent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial Igo (' Adv erse Determination J X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber is Alld 9, 8/ 8 0 3 / A / � A- \ 7.S 11� D � C 4AQ , 1'x'rfari� Ell PAGE OF C rU A ise0 Sys tems Fresh Air Inlets And Observallon Pipe • Approved Vent Cap Mlnlmam 12" Above Flnol Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grad• Vent Pipe March Hay Or Synthetic Covering Min 2. 2" Aggregate - Over Pipe Distribution —Tee Pipe -- 0 0 0 0 0 6" Aggregate 0 Perforated Pipe Below Beneath Pipe o — Coupling Terminating At Bottom 01 System P ruPose� �Ink g SOIL FILL D1STRIBUTIOU PIPE . APPROVED S4IJT1dETIC COVER 2 " OFAGG RE GATE —�� c �OR M� R HA`i OF STRAW (o OF /p -2 /Z AGGREGATE t:L E V O F"RLY FEF.T--..- DISTRI13UTIOU PIPE TU BE AT LEAST WCHES BELOW ORIGIUAL GRADE AMU AT LEASTZO INCHES BUT KIO MORE THAf.J 42- JUCHES BELOW FINAL GRADE MMIMUM DEPTH OF EXCAVAT1 rRO OBI WAL 6RADF. wILL BE 7:2� _ IN MINIMUM CiEf OF CAMIAT100 FROM. I *I(,IWAL (,RAPE- WILL. BE yid INCHES SIGAJEO: LICI- USE AJUMBER: ,-Z!5 7 DATE : -�� ,�� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of .- Laboran6 -Human Relations [jSVision of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY -Attach complete site plan on paper not less t . Plan must include, but not limited to vertical and horizontal referen (BM), di ction febf slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a nce t Wad an.. '' REVIEWED BY DATE APPLICANT INFO RMATION — PLEA. RIND1LL IN(liMAT PROPERTY OWNER: ROPERTY LOCATION GOVT. LOT 114 1/4,S T N,R �(oro PROPERTY NER':S ILING ADDRESS r "ti ''1�G� LOT BLOC # SUBD. N ME OR GSM # CITY TA E ZIP CODE IHONEINIUMBW CITY ❑VILLAGE 20WN NEAREST ROAI} / �r] New Construction Use M Residential/ Number of bedrooms & [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gy bed, gpd /ft 2 _,.,,/ _ trench, gpd/ft Absorption area required .5�n� bed, ft ,75� trench, ft Maximum design loading rate gy bed, gpd/ft —z Z -- trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitableforsystem ®S 11 ®S El I ®S ❑U OS ❑U ❑S ®U El [➢U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed T re d J Ground — elev. ft. Depth to limiting factor Remarks: Boring # 4 8 Ground elev. ft. Depth to limiting fact Remarks: CST Name:— Please Print Phone: Address: Signature: Date: CST Number: PROPERTY OWNER Z, �A� - dct� SOIL DESCRIPTION REPORT Page =,--? of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft •`` >:: >'�fi' . Boring'. Horizon in. Munsell Qu. Sz. Corft. Color Gr. Sz. Sh. Bed Trench - tea . {h ? 4i . Ke w� Ground f v 1 A — elev. ft. Depth to limiting factor 9 Z Remarks: Boring # :4 yt3 Ground elev. Depth to limiting factor Remarks: Boring # Ground - elev. Depth to limiting factor Remarks: Boring # Ground / elev. ft. Depth to limiting factor 90 Remarks: SBD- 8330(8.05/92) 1 /D� /f o a Jo yo 5�' ' ne - -36' 3 � S "1 STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County P OWNER/BUYER _ Gt V` iy �/ �� MAILING ADDRESS P. () , y SC �/ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATES �� S f.(} S v :,2 PROPERTY LOCATION C L) 1/4, C 1/4, Section 3 C--�_ -R y W 'SOWN OF S ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standardy erein, as s by the Wisconsin DNR. Certification stating that your septic has been maincomplet d an!d retu Ito the St. Croix County Zoning Officer within 30 days of the threon dat . SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . F . S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property a l ^ice T it • pck C2:J 1 ef k c4 C `1 Location of property i� 1 /4 1/4, Section 7 ,T_ N -R W Township So em oo-Sj?- Mailing address 0 . Q o k ,; e Address of site &o ' 4 . Subdivision name Lot no. Other homes on property? Yes ')C>-' No Previous owner of property �Ty h ry Wal Total size of property `� / ( f��►r� r Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes )�_ No Volume ZJ11 and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in A the ffice of the County Register of Deeds as Document No. Sic re of App icant Co- Applicant Date of Sianaturc- flats sinn atiirP • 525'75'7 1AlRl1�iTY DEED Individual to Joint Tenants No delinquent taxes and transfer entered; FMI O .s.Cmm" Certificate of Real Estate Value ( ) PAdd1wPAovd filed ( ) not required Certificate of Real Estate Value No. - FEB 7 1995 Auditor at 12:00 Y. M County A by I R**Wd22 Deputy (reserved for recording STATE DEED TAX DUB HEREON:$ Dated: February 6, 1995 FOR VALUABLE CONSIDERATION, John R. Walsh, a s;ngla nor soon Grantor(s), hereby convey(s) and warrant(s) tot ta= T. Oauffenbaah and Laura M_ nauffanhAnh ,, hushand and w1ra m Joint tanents Grantee (s), real property in St. Croix County, Wisconsin described as follows: SW 1/4 of NE 1/4 of Sec. 17, T.30N, Rge. 19W, adubject to an easement for roadway and utility purposes for the use of the NW 1/4 of the HE 1/4 of sec. 17, T. 30N, Rge. 19W., over and accross that part of the SW 1/4 of the NE 1/4 of Svc. 17, T.30N, Rge. 19W, described as follows, to -wit. The East 100.00 feet of the North 400.00 feet of the SW 1/4 of NE 1/4 of Sec. 17, T. 30M Rge. 19W. This easement is granted subject to the right -of -way of 47th Street. This deed is given to correct the description in a deed between the same parties of even date herewith which contained an incorrect description of the easement for roadway and utility purposes. together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: valid easements, resevations or restrictions. F John E. Osh STATE OF MINNESOTA ) ) COUNTY. OF WASHINGTON ) Th* foregoing instrument was acknowledged before me this 6th day of February, 1995, John E. Walsh, grantor (s). 3 gnatu a of Person taking acknowledgment. al S StanD or Seal s� NO i1N1► *CWmftm 6 mJw 31, 20W a This instrument was drafted by: Harold D. Kimmel Tax statements should be sent to: Attorney at Law 106 South Main Street p.02 Monday, March 27, 2000 10:41 AM Tom Walters 651 - 748 -8405 1�'�87PR�s 492 6 ��6OL KATHLEEN H. WfiI.SH STu lmd Document Nrw.Ya. ° RECEIVED FOR RECORD _ ILL oz- oz -enoo 9:0 an W G. YaRRRNT7 DEED EXEWT R CERT COP FEE: COPT FEE: TRANSFER FEE: 729.00 i. RECORDING FEE: 22.00 FOB: �I RMCNdina Aaas n.o..oa v STILLWATER i ATT WESHMFIN AVENUE • 16'35 NORT I STjLLWXMR, MN 55082 1r Tnsd ldeaaGtaooa Number MM ,r i i ` 'I a'MS pABE IS PAn OY IBIS LECAL DDCQl93'r - DO NCR RMVV' 1 GI Iwae d reNan didlImu OW ff�a). ocher flJb un rrdl EL i TWA intarvolk" mua be e.ellea/b 0! wba`.et rll t s dle daert+awa w wsr be rued as ada ward peso of a► w dle 8MR&I tlrua, Its&, darripdtw. M me k pWd an dua fi p ag e f vRm.a.i• °. f1.f1T. 7 ew "Clole + na eld aD as de ,ems= .:e� deewna. ii y Use Of a eswer ie pore adds ate p w es S0b8 E�bL TS9 E 51ti bS =0T 00iLZi�O _ __ 0015 900'ON �� i,1498QAE938 iD`l AV EXISTING SEPTIC 6 2 026 4 SYSTEM AFFIDAVIT KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Name & Return Address RECEIVED FOR RECORD Thomas Walters III and Rebecca Walters 1564 47 th St 03 -29 -2000 8:00 AM Somerset, WI 54025 AFFIDAVIT EXEMPT N CERT COPY FEE: COPY FEE: 2.00 032 - 2058 - 30 17.30 . 19.726C TRANSFER FEE: Computer ID# Parcel ID# RECORDING FEE: 10.00 The existing septic system which serves the dwelling being added on to must be verified by an acceptable soil report or be inspected by a licensed soil tester for compliance with high groundwater and /or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2) WI. Adm. Code. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is properly functioning, an addition may be added to the dwelling without updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1). Property Owner(s) Thomas Walters III and Rebecca Walters 11 0legal ling Address: 1564 47 St Somerset WI 54025 Description: Lot # 3 CSM /Subdivision 14/3777 Part of SW 1 / . NE V Sec. 17 , T 3�_ - R __I_g W, Town of St Joseph Comments: The existing septic system was sized and installed for a three bedroom dwelling. The proposed addition /remodeling project will involve removing one bedroom, and adding two bedrooms and an office, the net result is a four bedroom structure. The original septic system was installed by Kim O'Connell on 5/23/95. A visual inspection was performed by zoning staff on 3/24/00 and at the time of visual inspection there was no evidence of .system failure and there was no effluent noted in the vent pipe of the drainfield. This addition/ remodeling project may cause the septic system to be undersized for the structure being served. I, as the owner of the above described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Signed: J . , -s Notary Public Subscribed and to bef me s d a e Date: r. p tmen n Y oX1A� — M COMM COM s $ion a i� s: Zoning De t . }t. Approval: {j MAA / ,_ �•,. ,. . Date • 3 8 aat� ..SE.��