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020-1310-50-000
PRIVATE SEWAGE SYSTEM County: St. Croix .onsin Department of Commerce efety and Building Division Sanitary Permit No: INSPECTION REPORT 538894 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: Kaul, Richard Hudson, Town of 020-1310-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: q9 l 7,Q M 12.29.19.1558 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ~A SS CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z• bD /GZ,3' 7 Dosing t Alt. BM b 47 /db 1~ ,'e~~ F`/f«,~l'.S 756 93 F:\ GoJ+•~. Bldg. Sewer d St/Ht Inlet I Holding ~V 9 f~~ TANK SETBACK INFORMATION St/Ht outlet / 7 13 TANK TO P/L WELL BLDG. Vent to r Intake ROAD Inlet 1411 Z5 9q" as / 6l c~ S vim`- , ✓v septic 7 5a 1 73 Bottom 766 1, ,3 & C171 'T2, 7 ~6 7 11 1 a ?U 3 Header/Man. 7.37 $5!• 9 Aeration Dist. Pipe -7 7d q, el, 4 Holding Bot. System 75 53, 5S bk PUMP/SIPHON INFORMATION Final Grade 3$'b 1$• 5 Manufacturer Demand St Cover ~ GPM 11,47 140. 1&3 C'i\ C J Model tuber t~ 7 7, TDH Li Friction Loss System H TDH Ft V 77~ 5 ~a~Jt D.J1- 4Q Forcemain Length Dia. Dist. to well Q 46 77, $5 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIME SII~ ONS No. Of Pity` Inside Di~ Liquid Depth DIMENSIONS 3 71i 3 /tevc SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur%,.- INFORMATION e CHAMBER OR TypC/ f Syste~/ /t 0 / 3~ e / UNIT Model Number: D n DISTRIBUTION SYSTEM 0 tc~ S gk~, Ob $~X3 = S vs Header/Manifl t Distribution x Hole Size x Hole Spacing Ven to AY Intake Pipe(s) 11-ength_'5_Dia ~ Length Dia Spacing SOIL COVER i x Pressure Systems Only xx Mound Or At-Grade Systems Only 6 Depth Over Depth Over xx Depth of 1xx Seeded/Sodded xx Mulched Bed/Trench Center 95 Bed/Trench Edges Topsoil s a No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1078 Hunter Ridge Road Hudson, WI 54016 (NW 1/4 SW 1/4 12 T29N R119W) Tanney Ridge Special Add 1st Parcel No: 12.29.19.1558 1.) Alt BM Description = C 1 F^k C~d~CA ~1n.~+~ w5 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes No lid Z ~~~✓I Use other side for additional information. _ Date Insep or's Sig ture Cert. No. SBD-6710 (R.3/97) commercem.gov Safet d Buildings Division County ash gton Ave., P.O. Box 7162 St. Croix sco n s' Kwr~ ;4 Iadiso , WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Comme 1 A' 53 VS 7 Sanita Per t, ticat n saction Number,J) _ , ,I I ~ ddress (if different than mailing address) In accordance with s. Comm. 83.21(2), Wis. dm. C b6 sio fo the appropriate governmental Pro unit is required prior to obtaining a sani permit. N \7~ i8~ for state-owned POWTS are submitted to the Department of Commerce. Person il~ rovide may be used for secondary Same ~Q purposes in accordance with the Privacy Law, s 1 5UQ 16 / O 1. Application Information - Please Prin ormation Property Owner's Name Parcel 020-cel #1310-50-000 Rich & Karie Kaul Property Owner's Mailing Address Property Location i D 1078 Hunter Ridge Road Govt. Lot City, State Zip Code Phone Number NW 1K, SW Section 12 (circle one) Hudson, W1. 54016 715-220-9611 T 29 N; R 19 E or W II. Type of Building (check all that apply) Lot "G:) ❑ 1 or 2 Family Dwelling - Number of Bedrooms 5 Subdivision Name Block # Tanney Ridge Special Addition ❑ Public/Commercial - Describe Use fV1 a Na __a4 ❑ City of ❑ State Owned - Describe Use CSM Number El 'Village of Na Polown of Hudson III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issue B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New Before Expiration Owner IV. Typc of POWTS System/Component/Device: Check all that apply) L..~ 1 0 on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil t: ❑ Holding Tank ❑ Other Dispersal Component explain) ❑ Pretreatment Device (explain) V. Dis ersaliTre ent Area Informatio :54 ltrator "Q 4 Plus" stan dard chambers caps , Pol Lok PL-525 effluent filter Design Flow (gpd Design Soil Application gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation 750 gpd 0.70 gpd/sq. ft. 1,071.43 sq. ft. 1,110.60 sq. ft. 93.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n U IS p :3 y p New Tanks Existing Tanks }ai k C/] V V] u C7 Q Septic or Holding Tank 750 0 1,750 2 Wieser Concrete X Dosing Chamber Na Na Na Na VII. Responsibility Statement- I, the un ersigned, ass a responsibility for' lion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb s Signatu MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII oun /De artment Use Only pproved ❑ 1sapprove Permit Fee Date suueed' Issuing nt Signatur K❑ iven Reason for Denial IX. Conditt BW Reasons for Disapproval 1. `Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. Aft aefback requg'ements must be maintained as per lcaible code / ordinances, Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x 11 inches in size SBD-6398 (R 02/09) Valid thru 02/11 r5~ Toltrrsur-l 712-119-5- A ~XiS~inq el-waejo7 • ~ ca ~tUd,oro~o. s taK~ Sca/c ~ / _ s~o ~i~ ~ 1`t✓) Z ~ u.~ 4'0.'W f /u dson, arK-7o 0 o-E L~~s1,. Tua~,~cy , ,~✓~e 5~1ec:~ end, 6~ n, 5 W~r/I! uV 5e !z, 5 Cis. ,Q SS 4,,r1 ,-d e tt = I 6u' Tz97; Q /9cv~ 7--7. aF /Vuds., pa/ 0-2 0-/3!0- So-~co a~lcs bei~ 3,l0 0 ~ 31 13 v G~ 1 4 t I I ~i~•~ r , t ob. cps-4' C~rsP~ Sad eE ri ' E S'x Geo. r ' ~ e ~nl;%~'~rNP S~rfz c~ ~'6.7Q ♦ , ' yd.T6' ~ I e (e.ct _ 96.08.' - 85 ' i~AS.T..y. 3U3~e#/~cntlrKr.. C~~' • Bch ~yi5~%nq ~ ceOvo,•P u~:eSer ~+eci'e~ Proposcc L~lv~s;rn, ✓clJ~- ,'StscOt`K. Proposed u~r~5t/'C'yne.~e,~c. ~ ~ ' cv7S0-wcQ Sepf.cF~,~/lcq ~ Ga-~a9e polyLa,t'AC-S~Se{,r/4¢.,t -r--JJ . ~ ResideKc~ L~~e(/: 99Ta,r r"t~lcinjn9 uhl~~ ~ Q~~~ /J .j/ a n I Conventional POWTS Index & Tilte Sheet Project Name: Kaul 5 bedroom Replacement Conventional POWTS Owners Name: Rich & Karie Kaul Owner's adress: 1070 Hunter Ridge Road, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 22, Plat of Tanney Ridge Special Addition Legal Description: NW1/4 SW1/4, Sec. 12, T.29N., R. 19W., Town f Hudson, St. Croix Co., WI. Parcel ID 020-1310-50-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Septic Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluaiton Report by Harvey Johnson, 7/21/95 Mater PI er Restri ted Service: James K. Thompson, Dept. of Comm. Credential #30021 Signature: Date: Z~"=~ Zf3~~ Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ,LI TdknStm 7119-` ~ E'XiSfinq elcva~Td~ • /-IOCO e ,orOIO- st~Kc Scra./c : / = s/o /o78h~~~P.~ ,P~~ S4r.".(/e A ss I"fl ,c/ e I-e l~.W, 5 r<. e rpi t' Lol pa./3/o-Sr✓-cco Lei, /0 ac"e's I 9g. r r ~ , r r r i r r j q I r i V4e ' 9d j6' e to it = 96.08.' 9B.bz'~ ll:IST.d,y. 303~1e*/cc1,t/.ner < ` • 8k ~'Y%5~~rq c00 Job u~~e5~ C~.sc~c P~oPosfd ~ivu's;w, ✓c.1J~.-~--*-`~ /'StpftrL(/~nK. P~oposedt~rasc.rC'yne~'c,~ w7s'O-wtE SepE:cE~o"./Cc,} \ Ga~a9e pa /yLo,t'f~.-5zSef~/a¢.,-t-~•~ ~ ~r/~c/a~orz/eE, sl4sc(. yp 3.. /Plan ~a C~iJQ/ c~ ' Residence. A, Elea = 99. jd,' refa; ~J wxll~ ~ T J \y e) -T- I G . r- KAUL DISPERSAL CELL SIZING CALCULATIONS 1. (5 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 750.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft. 3. Absorption area required: 1,071.43 sg ft. 4. Absorption area as proposed: 1,110.60 sq. ft. (54 chambers & 6 end caps total) Infiltrator Quick 4 Standard Plus = 20.00 sq.ft. EISA per chamber, Quick 4 standard end cap = 5.10 sq.ft, EISA/cap 1,071.43 sq. ft. - (4 endcaps)(5.10) = 1,040.83 sq. ft. 1,040.83 sq. ft./20.00 = 52.04 chambers required Number of trenches: 3 & 18 chambers per trench (54chambers total) Trench width: 2.83' Trench length: 740.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 21.00'x 75.00' Pg. 3 of 11 Soil Absorption System Cross Section /M.. "ft 4" Schedule 40 Final Grade PVC Vent Pipe, With Vent Cap s ft Leaching --0,, Chamber s ft System Elevation .2_ZA ft ~lo ft (o ft Soil Absorption System Plan View ft .2.83 ft f- 4. ft Leaching Trench 1 Chambers 4" Dia. I Trench 2 Header Vent Or Observation Pipe F-1 I Trench 3 I r Leaching Chamber Specifications Manufacturer And Model Tij„ /6- 'Q-q ` c(iw%W Alga EISA Rating %Q.0 sq ft per chamber Soil Application Rate a.70 gpd/sq ft .S"0. gpd Design Flow + 4.70 Soil Application Rate 3 X0.4 EISA Chambers 3 rows of l49 chambers each. Page Al of Dose-Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 3 year anniversary of new system installation. Old cell to be utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells to allow use of each cell for a two year period. Contineency 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 3864680. Pg.5of11 } ® 4,'4y Filters PL-525 EFFLUENT FILTER ( OMME CIA ) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6° SCHD. 40 Pipe R„ PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years R under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned, ; every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs y, servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. l f!o vT 61' 42" Z 84., r N fT1 3" o cn i 0 46' m 4 > e,,, < T M M ;o ;0 G p A I *m z f >r rrD n T 40" m r -----I 0 n o~ o K: -I c mn r- n x D M O z + < n x M0 N A< M D A x ,r z C D r = r Z Z p N z z O 0 0 r r Z Z ~ ~ ~nZ gD n?D mp W ~ M >00 D N C ZN m 0-Z D Z r p n W ~S~ ~nz MA00 mDO pip rOm~NON' O Z~ as m = M Z OD (zm n 1 ~mmn DON 'C N O A D D ~77~ N N r I --1 m W > OZ 00 m D N i (n -1 (ALn O A -i m A T D M M N M Cu' I m r C.+ A --1 n v n Z N r N > D D 07 - N m 0 0 p f Tl _l n --1 < c< r A G n v C n.. ~omr r mm 01 x O z z 0 v n m M (n co 0 Co A A A - O X < O > 00 D nDD DO pp c+ N, J M N D O = r Z n n M v ~ M C C) Z >a 0 07 O O~ N ~TT O p O _N A D D ~O" OpA A~- N D :pn O A z C0 1 O ~m N z m 00 O O O ? A O m A A D p n C) O < O mr A z Z A 0 U) D m N f 0 r A CA m I'T1 A M A A 71 n z O O r z M A n A M z Ll \ O = WLP750-MR SCALE: 1/4" = 1' REV NO. DATE: WIESEa conCAETE DRAWN BY:SWT \o SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325--8456 FILE: WLP750- MR I 0/ YWC 401M of fmc iwi,04, UCTION is SOO* ' * G 1315.86' ~ MIX 448.20. .110.00 245,531 t ~ ~ N O rn fV ~ to INJ rd 1 ~s~ - rj 1► 2 1` I ri ° - rrt y~~N~~11 ntJ p ■ ~ 'L~'~ ' p; 9C5S 4 4a fri J N r p 70' 84S ig• I Syr O~ o O w ~ --•I ~ t ~ .~+1` `rte tP. (D rn tA LA ho ~E - - 270 84• IV _ ~ y y `~p~ f1*. ~ 4 N 0,S C C 27----~' 4i.S7' _ C ro u I' E 2 70 84'~ • rn ..a M ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner X;efe_ Mailing Address X078 Property Address (Verification required from Planning & Zoning Department for new construction.) City/State W4 Parcel Identification Number Fe-) i 'l 3 ~v -57n - LEGAL DESCRIPTION Property Location t1 U) '/a , JW1/4, Sec. /2-, T ZN R~W, Town of ~~~s©h . Subdivision Plat:'rAQ.,~j~~ Lot # 7_24 Certified Survey Map # YIA, , Volume , Page # Warranty Deed # cft-?44 ~ (before 2007)Volume .243 , Page # SF/ Spec house ❑ yes Pirr- Lot lines identifiable Jas Lino 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 of bedrooms it / ?.Z✓ t 1 SIGNAT RE 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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) /0 78 we-~zf-,- , ~sr e,C~oas~ located at: w '/4, 5w '/4, Section /z j own N, Range /9 W, Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service /c; 'Lol/ Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: !/tom gallons minutes Tank Capacity: / Construction: Prefab Concrete t------Steel Other Manufacturer (if known): &O; ese-s- cr Age 'Tank (if known): 3, /99(y ermit n mber (if known) 7-5ys1W icensed Plumber ignature) (Print Name) (Title) (License Number)MPRS AI` _zz, -:2--611 (Date) Fort- to be completed by,Jicensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 U 2 8 6 3 P 5 9 1 843042 State Bar of Wisconsin Form I - 2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number Document Name THIS DEED, made between Michael L. Novak, a single RECEIVED FOR RECORD person 08/10/2005 01:40PH ("Grantor," whether one or more), WARRANTY DEED and Richard Kaul and Karie Kaul, husband and wife as EXE WT g survivorship marital property- REC FEE: 11.00 ("Grantee," whether one or more). TRANS FEE: 1026.00 COPY FEE : Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate, together with the rents, profits, fixtures and other PAGES: 1 appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 22, Tanney Ridge Special Addition, First Addition, Town of Hudson, St. Croix County, Recording Area Wisconsin. Name and Return Address RETURN TO: METRO LEGAL SERVICES, INC. 330 SOUTH 22 AVENUE, SUITE 150 MINNEAPOLIS, MN 55401-2211 .ietru t egar aervtces V oltj_ /3/a _ -OZX> EDIRET 473707 A 483947 WD 374923 Parcel Identification Number (PM This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, and Restrictions of Record. Dated Jul 15 2005 r~• (SEAL) (SEAL) *Michael L. Novak (SEAL) (SEAL) * * AUTHENTICATIO ACKNOWLEDGMENT Signature(s) TECSC STATE OF WISCONSIN ) ) ss. authenticated on St. Croix COUNTY) .a.e~ Personally came before me on July, 15, 2005 r fts the above-named Michael L. Novak TITLE: MEMBER STATE BAR O SIN 5 e o to a the person who executed the (If not, forego g - s cent d acknow g the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: L - T L-x Michael H. Forecki, Attorney at Law otary Public, Sta of Wisconsin blp Hudson, WI 54016 My Commission (is p anent) (expires: ) ssa (Signatures may be authenticated or acknowledged. Both are not nece NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CL IED. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2003 *Type name below signatures. Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701-7928 Phone: (715) 835-3029 Fax: (715) 835-1112 T6579995.ZFX Mctilcc J. Bunt Produced with LpFormI by RE FormsNet, LLC 18025 Fifteen We Road, Onion Township, Michigan 48035, (800) 383-9805 www.tof=.com P S . Wisoonsin 08pWW*nt 91 Industry, SOIL AND SITE EVALUATION REPORT Pa l of arman Relations Relatiorss 9e Labor '>~lu C"Hrs;on. safety & Buildings in accord with ILHR 83.06, WIS. Adm. Code COUNTY Attach Complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (ISM), direction and % of slope, scale or PARCEL W. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION !5r0 ! JL LI GOVT. LOT t 4W 114 SW 114,812- T N,R i E (or) W PWRTY OWtJg5 MAILING ORE LOT # BLOCK # SU80. WE OR C5M x,[ > 1 DCa~C' k- 7 N fti 444 CITY, T TE ZIP CODE. PHONE NUMBER OCITY pvlL GE OWN NE4ZEST ROAD New Construckn Use Residential! Number of bedrooms UN-W- (J Addition to existing building L I Replacement [ j Public or commercial describe Code derived daily now gpd Recommended design loading rate 0-f> bed. gpdM2b trench, gpdm2 Absorption area rapred bed, ft2 trench. ft2 MaAmum design loading rate 6:7 bed, gpolft2_6 - trench, gpo1ft2 Recommended infiltration surface elevation(s) (as referred to site plan benchmark) AUtimal design I site considerations EYA tl4Tt i1y Lc~~- 2o•+ 4Ar A PPka VA'L- Parent material Flood plain elevation, if applicable tt $ Suitable for System vEN110NA1 M Np 1N• ROUND PRESSURE AIIGRADE Y TEM IN FILL HOLDING akW U U= Unsuitable fors sm 791 S D U S Q US O u f1 S C-1 U S❑ U D S SOIL DESCRIPTION RBPORT Boring# Horizon Depth Dominant Color Mottles Texture structure consistence Bot ltvy Roots GPDi#t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Ttiifi97 1 4... 1 b r+, ' : J l 6"Z 0,24 Ground +(~-117 ' r IN ! 4.7 C !t elev. Depth to fGrrutir~ ~ R8 rks: Garin l ~ g ;F1 13_1 41 3 t /h Cr ,rJ-r r- S C? , is x, ► I{ $f t3~3 ro4tte ! 4 ! A, 151C~ Ih GS 4 a.s' , L 10.3 Ground m Q.-7 -r~ X elev. ( -1-L) I dYZ 4, 4 t Depth to limiting factor Lo - L] Remarks: CST Name:-Please Print Phone: ~N& Address: ~Ol~ I SCA+~S rr~ SignaCUe: Date' -7-Z1 7,5-' CST NumtIer~3*4 PROPERTYOWNER SOIL DESCRIPTION REF-ORT. Page L P1 J._ x. 'PAFiCHL l,D. ~ • Z~ J ~ L , Depth Dominant Color Mattes Texture= Structure.. Consistence Bo r)cjsry Roots' GPE]/ft Boring # Horizon in. Munsell Cu. Sz. CoM, Color Gar. Sz. Sh., Bed Tru dy A C9-t9 t t cr rr, r e,. 6:9 ,s ig 15- love, 5 1;~;`sb o, Ground µl 3 ~6V d L4- rr lh 1 dk~ .Q elev. lO.TJ~ IL ~ ~ / ~ . Depth t4 limiting Remarks: Boring # - /d v 1 Yh Crr ~ri :y , t-4 oaf 4 - S, L 7'; C& ~ 0'Z 63, YR Ground L ft, Depth to limiting factor 1 -4 Remarks: Baring # s ,r A Q~f i - L l /h crt rr, C Z o 41- ► L I rh'-$L > s wz goy X04 k7-0 16Yk4L r" Ground , 9tv elev. it. 7~1 ioll rn `r 7 4.g Depth to limiting Remarks: Boring # _Ground elev, ft. Depth to limiting factor Remarks: { f2,7 11 a Lc;TZo &mcu"kk - - IQ(aN A AL ~L~Vr~'T,Gr~ . tDD ,Cab I ~1~ _J 1 8-a c5" d~ G~ ~a A, .j STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S<t rN /yI /C L,E } ADDRESS I'oK2-~ Z_ kvDSa t,l w r -yo / SUBDIVISION / CSM , C LOT # z Z SECTION I 'L T 2...7 N-R 1,>Town of c) Q ~ A/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 13M !"I icN PIPE f l:lav o0 ~ J SEQ. ~ to s' o pl ~ o' h 3 zI zU zZ, ~~oasE, GAROF WAS IND 6TE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s ' BENCHMARK: 7-0,40r ALTERNATE BM: Top cc;, &lDe-k Ac- PTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /000 5G4c. Setback from: Well 70" House Other io -T az 1=// Pump: Manufacturer - Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: r ~ Length (~,0 Number of trenches-Z!- Distance & Direction to nearest prop, line: -7,7 To ~A57" Z,- 7-,Z/IC-Setback from: well : I6S House- 10 Other 7e S7- ELEVATIONS Building Sewer ST Inlet. VO ST outlet /4 7p PC inlet PC bottom Pump Off r i.~ Z ~fq~ y~ i2,S2 Header/Manifold~,,w ys,<,g Bottom of system I '3 70 too / 3,&D I-1 Existing Grade 0 Final gradeO DATE OF INSTALLATION: PLUMBER ON JOB: % LICENSE NUMBER: oe s _ 45j repcp INSPECTOR: 3/93:jt STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERS /Vl /)'l /L-L E2. ADDRESS 0OX # 2_g2_ SU IVISION / CSM AJ N IS- ( LOT Z SECTION / Z T Z- 1 N-R / , Town of_ j ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v~2Tly InD A F R G P\ I oS uT To 11 c \ r MA oN 0 E 1 G/4 77 SlD E SS, i I ~ i2 1G II11. A150 3 ~ M INDICATE NORTH ARRO~%' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK: -To P nj 1 lR~~ V ''rPt 47- N,F- Z / (00, 00 / ALTERNATE BM: TOP or- SEPTIC TANK/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: OJ` I S E t Z-- Capacity: / C' G' QL Setback from: Well House Z Other -4 T~ 72 /i/c /a Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length Co 0 Number of trenches Z_ Distance & Direction to nearest prop. line: 8 7 Setback from: well : W House Ss Other 2/ To s T ELEVATIONS /C9, / Z 19, / Z I 2"1v Building Sewer ST Inlet. 1(,qO:- 7,9 ST outlet PC inlet PC bottom Pump Off '-ocv I z i REAR /z.sz coin ~ 13,70 Header/Manifold Bottom/ o system n c Existing Grade q,(eO (01J,ZfFinal grade 2 DATE OF INSTALLATION: PLUMBER ON JOB: W( LICENSE NUMBER: J7 INSPECTOR: 3 /93:jt A Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT - - r T~r.TV Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: [I City Village ❑.Town of: State Plan o.: MILLER. SAM 1S HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: , s.. t~ J . L'. 1' .:...t✓ " / il."^'' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV. Septic Benchmark Dosi g / 8U ~S i Aeration _ Bldg. Sewer Holdi nTT St/W Inlet TANK SETBACK INFORMATION St/JA Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > !~Z)' -fie' NA Dt Bottom Dos NA Headert0tim_.. ;2 7/ 976,L Aeration NA Dist. Pipe ' 9d /e?, _3 Holding - ~ Bot. System 3,,?7' 3 -78' 96, U~ PUMP/ SIPHON INFORMATION Final Grade 9 17' .16a. 11 Manufacturer- Demand ni e Ccntc Model Number PM TDH Li ~ I oss Friction System TDH Ft Head -1 F F emain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. id Depth DIMENSIONS S DIMENSIONIS- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACH asLureL - INFORMATION Type O & L r,, CBER Moe Number: System: z ems / SS v/l~v OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) „ x Nole Size x Hole Spacing Vent To Air Intake Length Dia. 7 Length _'I~Z Dia. Spacing 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst Depth Over Depth Over xx Depth Of xx'Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDS~ON. 2.29. 9W. NW SW, HUNTER RInGE ROAD Plan revision required? 9`~es ❑ No C, Use other side for additional information. 169 16,319,61 SBD-6710 (R 05/91) Date Inspector sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ~~■~r■r,t SANITARY PERMIT APPLICATION Bureau of Building Water system: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. t-, • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 5 _W Property Owner Name / ~ Pfoperty Location i (t/t/4 uj 1/4, S 1 Z. Tay , N, R E (or( Property Ownere' ailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CS Number p e~~t 5~o%a (3 )eZ7~ ~ ~ ~ 11. TYPE F BUILDING: (check one) ❑ State Owned !ty V),#Xt rest Road / Public 1 or 2 Family Dwelling - No. of bedrooms --3 o Towan of YCV5e N 6 f 4`01 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 ZD-~ 3 /d " 6,0 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 box on line A. Check box on line B, if applicable) A) 1. [X New 2. ❑ Replacement 3. ❑ Replacement of 4_. ❑ Reconnection of 5_ ❑ Repair of an ___System-------- System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 AE] Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) C~ Elevatior), r S lp 3 ep m0 Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Exist- Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank x /00 W515 J510-- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's (N mp s) MP/MPRSW No.: Business Phone Number: ~S o3so 0 3 M It 17" Plumber's Address (Street, City, State, Zip Code): '16 Ir J1514 Ar r it I- ;f E 61,6 S09 W IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Si nature St ps) )(Approved Surcharge Fee) ❑ Owner Given Initial ~!p ~elo V~~?~j Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. /v 78 ff~ntrtE2.~'iD~c eof1!> !jam ~v . 7-A- )l K E (1~ 6 L o T- -t Z 'L- 5C- 44E y .$7Clyl q (.,So (.,So r,,7-'f, /I1a.nfa.r. I-V4-rf. ,D p p'f'd. i2 E Q t1 2 ~o t T ti+ t O r ` A" YK f P 5 - Z>3 SDI y_ ~ / yso ' Yo- b. ~Vl 1 I t ON ► P JE F I = loo, oo, i DoT' Z -L i 3,10 1-c. (oo' 7 F1 F- TAk¢D2o-/3~oSo B ' 1tT t1~tEK /d A t ~o .M~ ►7 ToG~~,~ ' ,cam- yo'_~ dfk 13" 0-) qo v 0 'r Q ZB L( lo~~A& oy v~ k Sav1N ~o 2~14 A _ m t r------ - z I I 1 Cl I ~ Z I I I ti ~ I n m I I ~ I ~ ~1 r\ j m o 1 I ~ I g I ~ I 1 ~ I ~ ~0 t w_ I t 0) I © ?U h1 U I t tv r, 0~ t Z i i ~i i N Q I ~ y z -*i I I I Cj C I ~ ' ~ j 1 I I v r~ W ~ I j I ~ .WA. ~ I v I I I m I - 1 I fZ W m I j z w I m 24111 Io x C o 9 oo ~ o 0 0 x No F-n s i n 4 v = m y o Ej NZ m 0 _ v m o M o co m o. ' . lWik1ansin b6r an aHuman Department Relations Industry, SOIL AND SITE EVALUATION REPORT Page of 3 labor Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST Ci>z I X not limited to vertical and horizontal reference p ' 'on and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and ' ti`e toj„ r s APPLICANT INFORMATION-PL E T{ LL INF ON REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 5A /h / 1I LL&R GOVT. LOT r4 W 1/4 5W 1/4,S 11 T 24 N,R q E (or) W PiROURTY OWNj~~ C~f3':aMMAILING ~DR LOOT # BLOCK # SUBD_NAME OR CSM #R1~4~ I ieou ak CITY, ~~SsT TE ZIP PH NE_:1VN [:]CITY ❑VIL GE OWN NF98EST ROAD hlU~ta~ ~n~1 Gctt A/ VoU l AA►Al~y L„14vC New Construction Use ( Resident) tr~r if • r s L4 t4-14,, [ ] Addition to existing building j j Replacement Public or commercial describe Code derived daily flow gpd Recommended design loading rate O bed, gpd/ft26 7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0;_7 bed, gpd/ft26 % trench, gpd/ft2 Recommended infiltration surface elevation(s) (as referred to site plan benchmark) Additional design / site considerations EyALU43'16jtj holyL Fog, 114.aT- AA0--ie,0 VAL Parent material Flood plain elevation, if applicable ft S = Suitable for system VENTIONAL M ND IN ROUND PRESSURE A RADE Y TEM IN FILL HOLDING NK U=Unsuitable for s stems ❑ U C S ❑ US ❑ US ❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o - Byte z t ! sbK ©A dSS Z o,3 gI 4 -b 0 44 rh sbk rn 1 Ground -117 6W14 5 O r_ r1 elev. /o3.o~ft. Depth to limiting yWt~or~ Remarks: Boring # }t•.: `:...tiv X3.31 la~i►e:3 ! s~ 1 ~ sb~ n, r c~ r $ t-bl /dyQ S,L /n~sb rn r- s 1 •z p.3 Ground elev. / "ft. g 1-121 1Ay~ 4 5 r ~n l 0,: ().t Depth to limiting factor O 1 /0' Remarks: CST Name: Please Print kkq& )l WNS6t-j Phone: Address: t} &S6 i J SC,6 &jj I Aj Signature: Date: 7 ~1 CST Number;.3*4 U L.1 PROPERTY OWNER SAM MILLE~ SOIL DESCRIPTION REPORT Page? o~ 3 , 1 6 PARCEL I.D. # hQ~ 2.Z ' le, Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ~ I - ! 0-19 /o R3 j L t rr• cr m r C's 2-6-9 •S t9-39 /o-ye +14- - s j n, sbX /07 C 0a o.3 (9~4~ 0 Ground e z -113 16vk 414- elev. ft. Depth to limiting facto 4.~~ Remarks: Boring # >~rr G S Z O ~ ~ ~ 6-v /oNi P- 3 / L, At Cr q 4 5 ) L m sbl' ry ~r CS j 01 Ground elev. /aZ ft. Depth to limiting factor Remarks: Boring # 0-13 t7L/ - l /h cr /h C S Z ,q 0,~ 1oyk 4/+ S 3 s~K m cs 1 3 IMIP, 4/+ Ground elev. 8 7-I /0`1+24 3 S rn d.? 0.8 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cnn_ogonin r1cl-, PROPERTYOWNER SAMMiLLEk SOIL DESCRIPTION REPORT Page Z o` PARCEL I.D.# L4 -L T, . Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots Bed Trer~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Q 0- 19 /d ~3 I L. 1 rn cr rh r C 5 2 0.9 S l i t9- 91 /0y 4 4 5bk s (3,2 .3 Ground gZ 37-113 16Vk4 4 _ S r r►~ 6-7 p elev. /p~•!~ ft. Depth to limiting facto Remarks: Boring # -v /0%/123 / ►pt cr n47v CS OS I-4 4 4 4 S) L 1 %tok n, - Cs o.Z o.3 Ground'' ~Z 4~') ILL/►Q4 4 S , '►'I l O elev. ft. 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(A DQ tC.J`~ -0~+I _ O lJ _S7 u ^ ^ . 0 U a 3A"u.905 N - Z O Z rn W -40 (!4 ^ vi CD mo a -/-4 CA + f " f=*1 N D = f z n - I \ 0 0 ou N l6u A u w a ~t _N ~ I ~ w Jf A ~ d 03"42.59 E 501.64' 8 ' u' g i.7S' n 234.25 26189' 0 470. ` i \ ! 0 m P103'42'59"E Nll• m p 31.64 1 28' Z 21"E 317.06' ~O • N o N 0 D LOP ~yti tiw~ W N 0 cn 8 N m w~° w z m 0 00, 0 F N00006'09•W 453.12' __q Z (.~T SIN( of TN( jWV4 or TM( M.114. S(CT10" I, T Z a~0OR r n D ~y u- D r Iw G 7 c~ Z c~o N N z o ((4a~o( M1( .(1E C(0 ro r..( Aar ..UT Z IV 1/4 ".I OF 1(C (IOM 11•„VYlO IO .(1111 .~~•f0'00'(. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER S,4 t' / f L 4-,67~L MAILING ADDRESS Z OX Zee-- ff y~) S CD N PROPERTY ADDRESS / 0 725 N L) KITE /Z- I D 6 E (location of septic system) Please obtain from the Planning Dept. CITY/STATE 1) -S O ~4 CA J I PROPERTY LOCATION ~j vi 1/4, S CA) 1/4, Section 1 Z-- T Z N-R TOWN OF J D S (Z) N) ST. CROIX COUNTY, WI SUBDIVISION rf~ u N .E y R_ L7 GE LOT NUMBER Z Z CERTIFIED SURVEY MAP E ~ 1-,VOLUME PAGE 3 , LOT NUMBER Z Z_. 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 standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: y- / Z - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 • This application form is to be completed in full and signed by the gwner(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 1-3- M 174 1 t- L- ~ /t._ Location of property~l/41/4, Sectionl Z-- TAN-R 41 Township 6 Mailing address ,/gyp / --4"~7Z 8 Z__ Address of site _ 10 7 g Nv NTg (O C R Subdivision name 1-4-1# 1 P 1D 6,t. Lot no. Other homes on property? Yes X No Previous owner of property kA-1(DA ?NA IV Total size of property 1') 0 A C Total size of parcel 3. It) L. Date parcel was created 9 3 Are all corners and lot lines identifiable? k Yes No Is this property being developed for (spec house)? ~ Yes No Volume 0 and Page Number YZ4 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. Sy ~/S , 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 the office of the County Register of Deeds as Document No. ~a Sig S.~ nature f Applicant Co-Applicant Date of Signature Date of Signature