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HomeMy WebLinkAbout004-1046-40-050Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township N strom, Dou Cad ,Town of ;ST BM Elev: Insp. BM Elev: BM Description: i.~ ~F_~ y'!.i'~ ~ t~.. 1~~ _ j TANK INFORMATION TYPE MANUFACTURER CAPACITY i Septic ~-- * ~, = U . • w~..~ U . ~ ~ 7 ~ •-- - Dosing ~ ~-` ~ F ~, .M f F „~.,. • . ~ . ,. t ~ Holding a, TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD ~..~~a Septic ..,- ~ ~ _- _. Dosing ' i ~ :: ,,;~ ,~ Aeration - ~~%..t, ""` " Holding ... PUMP/SIPHON INFORMATION Manufacturer ,r Demand ~, ~_ ~ GPM Model Number _ ~ * 1 TDH Lift Friction Loss System Head TDH Ft Forcemain Length ~ Dia. ., Dist. to Well Rf11{ ~RSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 514803 0 State Plan ID No: Parcel Tax No: 004-1046-40-050 Section/Town/Range/Map No: 20.28.15.315A10 STATION BS HI FS ELEV. Benchmark ~,3~ ;1.~~ boa Alt. BM Bldg. Sewer q SbHt Inlet ~ --yy / 1 _ ~ StlHt Outlet ~` ~~ 1 ~ ~ , Dt Inlet y iS..5~ c..,, ~f +^/I a~ /~ D 1 Dt Bottom / ~' ~~ ~ ~ ~~ Header/Man. ,7` ~ fC~i , `iZ. Dist. Pipe 7.~~, , -, j~/, ..~ Bot. System ,-- ~ ~ ~~~ f OG Final Grade - ~9eveF /d6 G cu~- BEDITRENCH Width Length No. Of Trenches + PIT DIMENSIONS No. Of Pits Inside pia. -. LiC~uid Depth DIMENSIONS E w r' t '~' t _. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ CHAMBER OR ~ INFORMATION Type Of System: ,~ ° ' ;.: ~ ~ ' ~ UNIT Model Number: ( i ~ nicrQtRi ~rinti cvcT~M ~ ..~- ° r-°; , Header/h1anifold „ Distribution ~ , f s x Hole Size x Hole Spacing / Vent to Air Intak ~ ~ Length +- _ ~ Dia f `"~ Pipe(s) ~ / ~~ ~~, ~' ~-. Length ~ ~~°' Dia /' Spacing ~~ rt f ~_ ,;;~, _ ~ +~ O~ .~.~1 ~ l.' J A Q,.{ x.„ SOIL COVER .. o. a C..c4o ~ /lnly vv Mnnn`I Or D}-(trade SVSfP_RIS OnIV r ~ Depth Over , Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~ Bed/Trench Edges a Topsoil t L-sl,_- Yes No Yes ~ No :~ .~ ~- v~ COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: ' ~ / ~ '( V ~ Inspection #2: ! Location: 2833 25th Avenue Wilson, WI 54027 (NE 1/4 SW 1/4 20 T28N R15W) NA Lot 2 ~~ ~~ ~ Parcel No: 20.28.15.315A10 ' ~; ..< ~ /'~ o w c~ 1.) Alt BM Description = T ~, ,... .- --, .-« ..,. ~ . ~,;;,. '^ 2.) Bldg sewer length = `,,,, j ~~ O ~ " ~~ -amount of cover = : ~ Plan revision Required? ~j Yes ~ No ~ t ~ ~;~ ~ ~/ ~ .:~ ~, ~ ° ~ ; Use other side for additional information. ~'-~ Date ~ Insepctor's Sig ature frf Cert. No. SBD-6710 (R.3/97) i , ~f' 1J ~Ci ~_ f' 11/1 f'.r~;~ Safety and Buildings Division 201 W W hi P 7 County C ~ ~ . as ngton Ave., .O. Box 162 .Ca t x iscons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) Department of Commerce (608)266-3151 e / ~p0~ Sanitary Permit Applieatio State Plan I.D. Numbcr ~A~S In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ~3 ZZ ~ ~ ~9 may be used for secondary purposes Privacy Law, s15.04(I) roject Address (if different than mailing address) I li i ~ . App cat on Information -Please Print All I formation Zg 3 3 25 ~` RECEIVED Property Onwner's Namc Parcel ~ ~ Lot # Block # 7 p, Property OwnDer's ailing Addr y~ ~~ ~ ~ Property Location O / ~ ST. CROIX COUNTY ~ ~/~ ' ~ Ci State ~. Section Iv u ~• ty, - Zip Code / /r / / A / p~ c rclc 'n 3 ' r L~t~ ~ l~'V ~7 7~ i" V~ a T~N R~~ [i ype of wilding (check II that apply) ot : I or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Numbcr ^ Public/Commercial -Describe Use ~/ Tom` Z ~ ' ^ State Owned -Describe Use ~ ~ ~ ~ , Z fit. l `` ^City_^Villagc Township of III. Type of Permit: (Check on y one box on line A. Complete line B ifapplicable) -~ -~ A. ^ Ncw System ~Rcplacemcnt System ^ TrcatmcnUHolding Tank Replacement Only ^ Other Modification to Existing System B • ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Numbcr and Date Issued Before Expiration Plumber Owner ~ IV. T e of POW'TS S stem: Check all that a I ^ Non -Pressurized In-Ground ~ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/I'reatment Area Information: Gr ~ Design Flow (gpd) Design Soil Application Ratc(gpdsf) Dispersal Arca Required (sf) Dispersal Arca Proposed (sf) System Elcva[ion ank Info Capacity in Total Number Manufacturer Prefab Site Stccl Fiber plastic Gallons Gallons of Units ^ ~ Concrete Constructed Glass Ncw Tanks Existing Tanks / ' ~y '• I ,W~7 G~j~~ Iv ,QJ ~•Q~( .r~ t l Septic or Holding Tsnk ~ ter. ~ra~~ .~~ ~vobic Trp[ment Unit Dosing CFu mbcr n (! ~.I . o VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. PI bcr's Name (7Print) Plumb is Signature MP/MPRS Number Business Phone Number Plum 's Address (Street, City, State, Zip Codc) / Z~ ~ ~i ~~ ~~I ~ ~ ~~a 2 ~ VIII. Coun /De artment Use Onl Approved isapprov Sanitary Permit Fcc (includes Groundwater Datc Issued Issuing ent Signature tamps) I er Given Reason for De ' I Surcharge F~) ~oO ~~ / I ~ O~ / ' [X. Conditions of ApprovaVReasons for Disapproval 3' ~ /I 5 5~~- ~ ~_ Q~ n Q `- A ~L '~ e~d~ ~'w 6YSTEM OW ER N : Go ~,. ~ 1. Septic tank, effluent fitter and I dispersal cell must all be services /maintained I as per management plan provided by plumber. - n AU etb i t t b i t i d , CD~+ ~~ ^S ' ~' ~'~- ~~ w`'~ 2 k s ac requ remen s mus e ma n a ne ~ . •' as per applicable code /ordinances. f ^ ~~~, ~( ~iS t~~irw• ~"`. ....err sumprcrc puns tto ene ~ounry omy) for me system on piper not Ins Ih~n 81R : I I inches in six 14J~ ~-1°~ 7 SBD-6398 (R. 01/03) - -_- l 1 ~~rj~.. ~F- S~r~ow. -~o~~~ ~O a~~~ ~~a\ ~..,.... ~~ -Sw-2oZd-~~'~ 1 0 ,.,. z~ ~ ,~.,e C. 2o.Q t.~ ty 2 Noi~ I S~ I l 0.~\~-s_ C~ +4" Q ~jH 1wr---j / (.~ S : V.l-_~no~~ U~c<Q,,.,.~_ 4` &~, .~_ r--~~ ~.,., a ~..~.,,,. `1 113 lo' ~-'' Sa....-.,~ ~~ ~~~ l~ eta ; ~ _~s~~~ 4-z.,° ~ elo.... ~, ~~~e~~~' K~ b dam,,. ~~ ~ ~~~~ 5~,~` ~~ = 4a~~ > Lo 40 u z-~.. -t.zL~-~ l y o~ G 5 ~ O o-u~ i (~~ N~ e E.~ cxs-lU. rl-. <~i a-1 330` ~....` «~ L~' -w> >. `1~ ~~ C,4 t ao. ~ S"~ } ct ~.Z.` roc ~. c.a-~l So(lo~, ~ ~o,o c.,., ~ ~ ~ ~, o~ ~ ~.~~b / ~,..~:~, C ~ -o~ ----_-- _ t _ ~'~~ °~~ (.,~a ~~ ' ~ 0.~~ _ •_ _ _ __ ~k `S. ~1~ -Sw-2o2`~•~Sw i ~V u ~ - ~ 0`- ~..,., l p a c.., L y~ a-- c a. ..... ~A --~ C~ - ~ y ~ ~ (~ _ ~ V I CC.2o~Q hl N Z Nod ~., ~ i 5~.,1.e ~ 4~`~3. ~ ~l'y ~ (~ ~-! ~~1 ,UOY--j / ~~~ 5;~~ ~ ~c.A.,.,,~¢ rr4~ Q0.. S sa} ...,~}~~t ~a ~-- r--~~ 3 ~,, ' 5~,.~`\ o...~.~ac.~K w~~~ ~~ -~s~~~ " r S Y' 4" Saf...<< o Lo 40 >, ~z:~ b ela.... .~ u z--~.a 't,zt~-~4 i ~i O~i 330 t~.~`, O`~@~ `k-w~ ~ \~z O~ ShQ~ JLQ2y, ~N-S~ `^i 1~.ow~ .~ Lo..~a..~ --~ ~ o 1310' ~-'' Ste....-.~ W~~~ ~v-~ 3 ~~ Z,'~ 1~v c. s~k, 4~ ~.-,,.,~ - ~:~, ~`~ ~ ~ a ~~ ~ S~ S~ w~ ~d~~ ~~ ~~ ~a<<< doe ~~ ~~ w~ ~ ~o~ ~e~-si~ Q,~Lv, I N~ ~3 ~e~ba<<` ~~~~ ~~~ -~ FflCp~ Sp~\pv.,~ l C10y0 C4+^ `~t++. / ~ ~.t~~b ~5~~-~ r -~- ~ C ~,.a~ - ~. , o 10~0~~ .. --__ _ t ~~~ •`--N.oh. ~ - ~- ~ ~4'a-•S~ ~1v.~~Ol ~ ~3 r~ ~~ 3 ~~-$ /(.~~. ~~ ' ~ ~Ij ~(~INAL' `~gCOftS~p SOIL EVALUATION REPORT Department of Commerce in accordance wi~Comm 85, Wis. Adm. Code 1'livicinn of Rafpty anri Ruilrlinns ,~,/ #2642 Page 1 of 3 Certified Soil Testing, LLC County Attach complete site plan on paper not less than 8'/: x 11 inche size. must St. Croix _ include, but not limited to: vertical and horizontal reference point ( , dir ion d parcel percent slope, scale or dimensions, north arrow, and location and dis ce t res road. ~ ~ ~ ? ~ _ Please print all information. R ' we Date Personal information you provide may be u ed for ~~i ~T'~/~®vacy L w, s. 4 (1) (m)). ~~ ~ Z Property O~~r ~ roperty Location Nystrom, o ovt. Lot NE114, SW1 S20, T28N, R15W er's Mailing Address of # Block # Subd. Name o CS ~ i / ~ 2833 25th Ave. NTY (O City State ip Code Phone Number ~ City ~ Village ®Town Nearest Road Spring Valley WI 54767 651-776-5491 Cady 25Th Ave. ^ New Construction Use: ®Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ^ Public or commercial -Describe: Parent material loess Over petted tell Flood plain elevation, if applicable NA ft. General comments install 5' x 91.2' rock II mound on 100.0 contour as upslope edge of rock w/ 0.5' sand fill @ 0.4 gpd/sq ft ~ - and recommendations: basal loading /Q/~Y~~ ~ J~ J~t ~ J~~~~ 1 Boring # ^ Boring ® Pit Ground surface elev. 100.0 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure. Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color . Gr. Sz. Sh. "Eff#t •Eff#2 1 0-12 7.5YR 3/1 - sil 2 f sbk mvfr cs if/2m .6 .8 2 12-23 lOYR 5/4 - sl i m sbk mvfr gs im .4 .7 3 23-33 7.5YR 4/4 - sl 1 m sbk mvfr cw im .4 .7 4 33-50 10YR 4/6,5/6 f2d 7.5YR 4/6 lOYR 6/3 s 0 sg ml - - .7 ~ 1.6 H4 has some sl inclusions 2 ^ Boring Boring # ®Pit Ground surface elev. 99.5 ft. Depth to limiting factor 31 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. •Eff#t •Eff#2 1 0-9 7.5YR 3/1 - sil 1 f-m sbk mvfr cs im .4 .6 2 9-13 lOYR 5/4 - sil 1 m sbk mvfr gs lm .4 .6 3 13-24 lOYR 4/4 - sl 2 m sbk mvfr gs im .6 1.0 4 24-31 lOYR 4/4 - sl 1 m sbk mvfr cs - .4 .7 5 31-51 lOYR 4/4 f2d 7.5YR 4/6 sl 1 m sbk mvfr cs - .4 .7 6 51-61 lOYR 4/6,5/8 - s 0 sg ml - - .7 1.6 redox features grade to f3p below 47"; some sl inclusions in H6 " Effluent #1 = BOD 5> 30 < 220 mg/Land TSS >30 < 150 mg/L "Effluent = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign to CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 11/1/2007 715-233-0398 $BD-8330 (R.07/00) Property Owner Nystrom, Doug Parcel ID # r ` Page _ 2__of _ 3 _ 3 Boring # ['~ Boring pit Ground surface elev. 98.6 ~: ,. Depth to limiting factor 36 in. iJ --- Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz: Cont. Color Texture ,~' Structure Gr,•5'z. Sh. Consistence Boundary Roots GPD/ft2 _ •Eff#1 ~Eff#z 1 0-11 7.5YR 3/1 - , il~ '~t 1 f sbk mvfr cs if/m .4 .6 2 11-16 lOYR 4/3 - S~ 1 f sbk mvfr gs lm I .4 6 --Y- 3 16-28 lOYR 4/4 - sil 2 m sbk mvfr gs lm .6 ~ .8 4 28-36 10YR 4/4 - sl 1 m sbk mvfr cs lm .4~ .7 5 36-42 lOYR 4/4 f2d 7.5YR 4/6 sl 1 m sbk mvfr cw -- 1m - .4 ', .7 ----i- --- 6 42-46 lOYR 5/6 f2d 7.5YR 4/6 s ; 0 sg ml - - .7 II 1.6 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L 'Effluent #2 = BODS < 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) Certified Soil testing, LLC Property Owner Nystrom, DOUg Parcel ID # t Page 2 of 3 3 L ~ Boring Boring # ~ Pit Ground surface elev. 98.6 ft` Depth to limiting factor 36 in _ . `~- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture.. :f'"Structure Consistence Boundary Roots GPD/ft' ~ __ in. Munsell Qu. Sz. Cont. Color Gr,S'z. Sh. •Eff#t •Eff#2 1 0-11 7.5YR 3 1 / - p~il~. `"~ 1 f sbk mvfr cs if/m .4 .6 2 11-16 lOYR 4/3 - Sil'` 1 f sbk mvfr gs lm 4 ~ 6 ~~ _ l . -- -+ -- - -- 3 16-28 10YR 4/4 - sil 2 m sbk mvfr gs lm .6 ~ .8 4 28-36 lOYR 4/4 - s{ 1 m sbk mvfr cs lm .4 ~ .7 5 36-42 lOYR 4/4 f2d 7.5YR 4/6 sl 1 m sbk mvfr cw lm .4 j .7 6 42-46 lOYR 5/6 f2d 7.SYR 4/6 s 0 sg ml - - .7 ~ 1.6 ' Effluent #1 = BODS> 30 < 220 mgJL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 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 szrvices 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) Certified Soil reiting, LLC QQZ vc9~. 1~k ~~~uv~a -` `o~-~IaN Ip a~~~ ~r..ca\S-.•../. 'VL-~w-ZoZ~•1~w ~C7 J~ "-~ ~ ~~L°. ~ \ `Owe.. ~~ ~.c~U~-N 2J ~ ~.,e, `/``J\ o, 3 ~ ~,...:( ~ CC. 2,~Q N N 2 Nod S`~ nC~ ~ 3~ ~] ~~ l uor -j (•l - z`~~ / ~~ S ; v.~~..o`~ QtS.Q..~''~g- ~~~ IN e.~~ ; ~, ~ i 1 S w..~\\ Q••~~et ~.v-e o Lo g-O 4' &0., I ~``~/~. w... ~.. ~,,,, _ ly o-4 c ~, \ O o-4. Q ~ ..- ~ c_ \ r ~ ~1 o-S 3lp ~; ~ L~'.w~ svlip~ ~~~~ ~X 42~ LN-S5 `'i ~o~-s~ ~ C.Q..~.~a..,~ 1 G. ~~ 6~, S~ .fLW S 1 f~ F~ VJ ~ ~ ~~ (..~-l J4)~S ~ ~s~~.~ ~ r ~*-~~ ~~.~ ~ o ~ ~ ~~ 437 ~ Q 3 0 ~ ~ ~ ~y,0`n~ ~°-~~ . ~~ ~o,o~ ~ `3~~ ~- Caq,sko ~3-Z l~~ ~--a-~.oh„ r ~ ~ ~.5~ _\ _-_ ~~~ a~ a N F7=~~ '~+QQt .ae NwA'~ aa~o~~ °~~~~ N N NGir~l~ M 1 ..1 L~ ~ ~xa~na~ a ~i., ~~ ~~~ C~ ••N ww •~ ~~~,~ ~G~AQ.CJ WCIA~CC~0. ~~ -Z~ -~~ RECEIVED CERTIFIED SURVEY MAP OCT ' $ ~(~ THE NE 1/4 OF THE SW 1/4 OF SECTION 20, T28N, R15W, TOWN OF CADY, ST. CROIX COUNTY, WISCONSIN. . CROIX COUNTY EAST-WEST 1/4 LINE ~bp~-''--~U--~---~--~~g EAST 1/4 VEYOR'S RECORD -N89'45'12"E 5267.90'- ~~b~~ _~ ~~~~~ CORNER ~COR 25th Avenge ~_ _ CENTERLINE ~CnON 20 SECTION 20 ~ - - - - N89'45'12"E 1315.67'- - - - - - . ~,~, 1315.67' _ - O .~ 7 - -~.DS-- `>z- - 2636.56' ., ,,,, ~r,• ,. ___sa~ a'_ ~~ 330.05' !~ 330.05' !~ PREPARED FOR: ~; c~~ LES MILLER ~ 5424 HOWARD GNESEN RD. ~ DULUTH, MN 55803 a of q suRVEiroR: ~; o r ' TY. R. DODGE o0 i o g o ~u ~ ~ S do N LAND SURVEYING, INC. ~; d. ~ ~ ~y~ Wryy 2920 ENLOE STREET ~; ~~ i .~~' x ~'i, HUDSON, WI 54016 -'~ `~;~ 3 ' ` ~. ~: ~+~' . • u~'•.,0~ EACH PARCEL SHOWN ' ? ~ ON THIS MAP IS „ ~,~ <; ,:; ~ ; ~ =SUBJECT TO STATE, , ..v. .. ~" ~ ; ' `' ~ , `COUNTY AND TOWNSHIP U : ~ o ~• LAWS, RULES AND `- ~~ ~'•• .•• Pr{= REGULAl10N5 (LE., • ~' ' WETLANDS, MINIMUM LOT ~~9j'~~mnuu~x~n'!~'~~~•\\~\ SIZE, ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF CADY FOR ADVICE. SCALE IN FEET 1 " = 250' 250 0 250 (~/ o I O M ~ at ' i i ~ ~~~ LOT 1 ~ ~_~ ~_-.' (`~ 5.210 ACRES 226,950 S0. FT. INC. R/W 5.020 ACRES 218,685 S0: FT. EXC. R/W LOT 2 ~~ 14.691 ACRES 639,960 SQ. FT. ~ INC. R/W 14.425 ACRES N 628,365 SQ. FT. EXC. R/W 3 M d r °o NOTE: THE WI DNR HAS DETERMINID 1HAT AN ELEVATION OF 1110' (f10' ABOVE THE EXISTING SCALE} IS CONSIDERED A REASONABLY SAFE ELEVATON FOR PROTECnON FROM FLOODING HAZARD. IF ANY +~ PROPOSED coNSTRUCnoN °j ~ EXTENDS BELOW THIS "~ ELEVATON, THE ST. CROIX ~ COUNTY zONINC OFFlCE sHAu ~• ~ BE CONTACTED TO REVIEW THE 2 = PROPOSAL WITH THE YN DNR. J r 657.67 THIS INSTRUMENT DRAFTED BY: WIWAM KANE JOB N0. 6609-Ot DATE: 04/26/2006 REVISED X7/16/2006 ~~ NN ZOh O~ ~~'N FQyN, ~i ~WrD UWUN ~°; pd.Oi NWF- ~i dON N ~~Z ~~'N z~~ p; Zo ]~O ~j WZ ~ d Q U ~; ~W j~ N~~ d~ w ~~U ~! J (~!1 Z X ~ ~ N o ~ W ~U ~ m t~n FENCE 3.0'f EAST OF UNE" ;. of ~ N N ~~~ LOT 3 10.002 ACRES 435,691 S0. FT. INC. R/W 9.779 AcREs 425,961 SQ. FT EXC. R/W ~ d N N j i ,~~~C~ LOT 4 10.001 ACRES 435,650 S0. FT. INC. R/W i• 9.782 ACRES ~ 426,099 SQ. FT. n EXC. R/W I 3 N M N ~ I BfA ELEV.=~1a2.r APP XuAATE LoCAnoN 1110' CONTOUR (SEE NOTE} ~ ~ 75' SETBACK ~ ~ ' CENTER OF BM ELEKs1120.7'1 ATER COURS~E~., i S89'43'54~W 1317.77' APPROXIMAn: ~o )UTH LINE OF THE NE 1/4 OF THE SW 1/4 EDGE ~ SCALE ro ~llV ~ ' 44t~D L~G^JaD~ O~aG~D D~7 04[~1GG3~ ....`S..I r ~....i........... L, l I ~ ~_J ~ i ~ FENCE 3.4~ ~, ~ EAST OF ~ ''' ~ r-~ ~ i ~N~i~~i i I ; N W Q;°~~~ 1 1 r~ I i j ~; ~i i ~_~ a r~ i L~ ~O ~~~ ~ i o ~i ®; i L-- J ~ W ~i~~ DETAIL N o ~i ~~ (NOT TO SCALE) Z a~Oj LEGEND ® FOUND 1" DIAMETER BERNTSEN STEEL SURVEY MARKER SET 1" DIAMETER BERNTSEN STEEL SURVEY MARKER SET 1" OUTSIDE DIAMETER BY 0 18" LONG IRON PIPE, WEIGHING ~ 1.13 LBS. PER LINEAR FOOT 2.4' ROADWAY SETBACK LINE ~~-........~...... (50' FROM RIGHT-OF-WAY) FENCE N u1 n rl 0 a N O Parcel #: 004-1046-40-050 11/12/2007 04:00 PM PAGE 1 OF 1 Alt. Parcel #: 20.28.15.315A-10 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/17/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -MILLER, THOMAS, TERRENCE, &LES THOMAS, TERRENCE, &LES MILLER C -FRITZ JENISE A FRITZ JENISE A 3220 50TH AVE KNAPP WI 54749 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 2833 25TH AVE SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 14.691 Plat: 5261-CSM 21-5261 004-06 SEC 20 T28N R15W PT NE SW CSM 21-5261 Block/Condo Bldg: LOT 0 2 LOT 2 (14.691 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 08/17/2006 832462 21/5261 CSM 08/18/2000 628405 1535/354 TD 01/12/1998 571123 1287/408 OC 01/12/1998 571122 1287/407 OC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class RESIDENTIAL G1 AGRICULTURAL G4 UNDEVELOPED G5 Totals for 2007: General Property Woodland Last Changed: 04/09/2007 Acres Land Improve Total State Reason 2.000 28,000 95,500 123,500 NO 6.691 1,100 0 1,100 NO 6.000 3,800 0 3,800 NO 14.691 32,900 95,500 128,400 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 commerce.wi.gov ^ ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 06, 2007 CUST ID No. 222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 ATTN.' POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/06/2009 Identification Numbers Transaction ID No. 1480937 SITE: Site ID No. 732239 • Doug Nystrom Please refer to both-identification numbers, 2833 25~` Avenue above, in all corres ondence with the a enc . Town of Cady . St Croix County NE1/4, SW1/4, 520, T28N, R15W FOR: Description: Three Bedroom Mound System /Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1160495 Maintenance required; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1); Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) 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: • This •system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • Inspection of the private sewage system 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. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • .The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans, specifications and this letter shall be on-site durins construction and open to inspection by authorized representatives of the Department which may include local inspectors. P.~.@'~.T.S. Cosrditionu~'i,~ ~o DEPARTMENT Of COMMERCE HENRY F GROTE Owner Responsibilities: Page 2 11/6/2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 maybe made to me at the telephone number listed below, or at the address on this letterhead.. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~~~;~ , Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wiscons in. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633' cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~~€, d RE~~~~ N ~ ~~ Doug Nystrom -Mound Construction Materials and Techniques 0 ~ ~~ ~~ ~~ ~-~ _ 5 ZOOT 4 ~ ~s All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Pressure Distribution, SBD-10706-P (O1/O1) Mound, SBD-10691-P (01 /01) Location: NE '/a, SW '/a, Sec. 20, T 28 N, R 15 W Town: Cady County: St. Croix Date: November 6, 2007 Owner: Doug Nystrom Address: 2833 25`h Ave. Spring Valley, WI 54767 `~~ t > > > > r ~ ~~~ ~`•` O~N S ~y ~•,~ Designer: Henry Grote ~:~ G'• •.~ ~ Signature: ~ - ~ ~.'~ ~,o~' _ .~~''' ' ..DES`G~`: License: WI D - 1699-007 . ~ '~ ~' ~~~//lll~~` Attachments: SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 DN~Siun OF SarEIYANU bUiLtiIiVGS SEE CGRR PONDENCE Design Criteria ~'~Ss Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~''~ gallons/day hydraulic load Design Calculations In situ designed loading rate ~ ~2 q gallons/sq. ft. per day Depth to estimated high ground water ' 3 ~ in. Depth to bedrock ' b ~ in. Cross slope at system ~ °' ~ % "-~- Force main length ~ ~ ft. of ~ in. ~ ~ g ~ Manifoldlheader length 2 • ~ ft. of ~'~ 4- in. o ~ ~ e Drain-back S ~ ~ S~ gallons Lateral length ~ @ `~ ° ~~ ft. of 1 ~~ ~ in. Lateral elevation ~ ° ~ ~ o ft. @ bottom of lateral _ Lateral hole size S~Zz- in. @ ~ ° • ~ in. ( S ~ ~ ft.) Spacing ~ `~ holes/lateral 3 ~ holes total Lateral volume ~ ~, S Z gallons Total lateral discharge, rate .. ~-O' ~ Z i gallons/minute @ 3 ~ ~ Network pressure compensation losses ~ ~ ° S' ft. Elevation difference ~~ ~ ft. Friction loss Total dynamic head Pump/sib n 4 b Manufacturer _ Dose volume Lift/si~on tank ~ e Septic tank n,'~ o `~~ 4~S' gPm @ t Cs-o~`~~S ~~~1 ~ 6.a ~ ~.(~ ~ ~ ~ ~S-u--n ft. head ft. @ z ~ gallons/minute ft. ft. of head Model # ~ ~' ~ ~ gallons ~~ gallons ~ "~-~~ gallons Effluent filter ~ ~ ~-~. ~-,~ r` ° ~ zZ.- ~4- c3 ~ Measurement pump on and off 4 ' ~ in. Height alarm from tank bottom ~ s' ~ in. Reserve capacity ~~~ ~ gallons specs.calcs.res 3 ~' '`~ , _ -- `: ~ ,-~ Page Z of ~ ;off .P /~~ ., Z~~ f 3 ~ oak ~ ~ °` ~.h ~ ~`~ ..~• ~ ~,' ~ ~.~.10 ._., r' ( 1 ' ¢X~+. 100,5 ( ~ ~ ~01~ +o~t~'~1 / _, ~`~ \ ~ 0~5' 1,©' c.31 h I ~.~ ~ b L~bco~1 i~~~ ~ ~~~ ~ . n ~ o (w.... kS ~.3, ~ '.. N o~~; . ~ o~~ x..:51 ,.~, kr,,,~ ~o" _ o. ~ 3' .. ;. .. I .. .. .. . - . ~. !; ' .. . ,. v f, ~f ~:, F ~~~ ~~'~ ~~ \,2Y~ 5~O z~,7~ 2.~' O `~ ~ t ~ ~. ~~--15~~ X2,1' III t o4, b~ orb N ~~..: l 4~ ~. ~s ~-~ ~.~, wad _.._, ~ w w a ~- ~.~~~. ~.,: O'. 4° ~- 4 ~~, ..~ P v ~ o ~ S ~ v ..~: o ,, ~.,,. a `` ~ ~ b • ~ ~ c ... o ~ r c ~ k r • C~ 1 1 1 O..~QI Mp ~1 '~ O \~..T ~v ~`S I r ~`~4`P~c s~ ~ / ~ o.5r v,...` S 2' S `~. ~ i ~ O~ _I 1LS.~{ 'FO ~i KV' ~w10.L(~ ~' ~ VJ Ou XQ~ OM K:VOV\Qlv~ ~~ J S,o' ~ • y/3 Z'~ ~ p\ [~ o ... 1 a,~ Dom.- ~C Q.G..~.? ~ ~ o~ o ~.. ~ : •. t~ 6O ~O y o_ o,~,-~ \~ a~ t.~ qr.. ~ q„~ SU- ~ ~ ~ b ~ o~ C 1 ~w ~~ f S ° ~ ~'- ~~~ ~" QuL SL~'1 TV ~70~L~(~ Mq~~M i VEIJT CAP `i~~C.I. VENT PIPC WEATHER PROOF APPROVED LOCKI^.;G JUAICTIOIJ BOX MA-JHOLE COVE F. 25' FROM DOOR, 1?, "'~/ w qa NON WIIJDOW OR FRESH I ~ A Q ~ ~ AIR IAITAKE ~, GRADE I 1 ~~, COlJDUIT ~-- +~. N Z i \~\\ \ \ \ ~~ 'I 11~ PROVIDE I =___ ~ AIRTIGHT SEAL I I i I ` / T L:. x -.'l, g~,~,o ~.,..~ `t~'~ ,3 (,.taL.s , QZ'~5 ~ 2y ~' ~.Lo " I I I \v~ I I~ ~ APPitCVED JCIA!Tc ~V o H.. ~ ~ ¢. L c.-g ~ I III w~ ` ! P E I II ALARM EXTE>JDiuG 3' c?-Lrj q ~ yL.,, ~ ~ ~~- I I I OI~TC SLID SOIL XU" /V\ I I 1b';o'' ~ I PUMP, _'~ OFF ¢.~e.u. ~h~~ ~, ---~ - _ BLOCK . .. _.. ~~_~.. _ . ate,; t ~---_ . -- - ~t 5 0 ~/ ~. .~ ;~~`~ ;~ ._.., ~~ _ , ~ ~~ ~, ;i ; ' '. ~'. ~ ~ ', ~ ,, _.._ _, ii ,..- % I ~ ~~ ~ I ', ~ ~ _. _.. ; i I_ I Y ~. ~ ~ • i +~ Brass/thefmoplastic. Features,and Benei •Top`s'uction'eliminate` impeller`clogging ~ • Corrosion.resistant :~" construction;'' x ~ f; • Floatactuated s'wifcii. i.~~ x METERS FEET p B 20 = 5 U /5 a a c .~ to 2 s 0 0 ~,. '.6 x_ MODEL DVP03 o s to is so 2s so ~.; `. ~o us.crM o z a s e . <.1om~Ar CAPACITY a ~ o ~ ~ ., All Models are designed for continuous c Pump Specifications -Features and Benefits. -'/+o and'/z HP • EP04 impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal Discharge size 1'/:" NPT • EP05 impeller -enclosed design .Solids:'/~" maximum for improved performance. Motor ~ • Rugged glass-filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion . resistance Single phase:115V ,; . ~, Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded.. stainless steel shaft -„ ; ,~ _~ `• Available for automa~ic'and ~' ~ manual operation ~ ~~,° ,. • CSA listed models available. ~ ' . 5.T 1 9 : Y ration and feature stain ess steel hardware. ~'~, ~ ~ '~"' `~ ;. 4 r~ . .t System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. 1 f problems develop with the adsorption system or any other system components, the installing plumber, Roger Timm, 715-77?-3? 1 ~, or the St. Croix County Zoning Department, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is signiftcantly dependent on the volume of water ~~ hich flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some t~ pe of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off: final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in tl~e adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased fi~ost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the s~ stem area. 11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal vases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm S~.~-t (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing. and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 :,'nl A~ ~o N ~s .. ~ Nwa.p~~aa~~ <~0~07 N•yl'9 ~}I a .. ~ ~p;~ ~ a 'y N NL3f~l~ M~~ •• ~ ~x~~~~ r,a~a CERTIFIED SURVEY MAP THE NE 1/4 OF THE SW 1/4 OF SECTION 20, T28N, `~ R15W, TOWN OF CADY, ST. CROIX COUNTY, WISCONSIN. EAST-WEST 1/4 LINE ~ap~-v~-~~-~~ EAST 1/4 WEST 1/4 -N89'45'12"E 5267.90'- 0~`1bC~D Q~I 04a[~Qg c NER CORNER 25th Avenue ~ CENTERLINE SE~T10N 20 SECTION 20 -- - - - N89'45'12"E 1315.67'- - -' - - - _ '- . _~ , ~- _ ~ - 1315.67' - _._. O,QQ. _; L_- ._33Q.Q5 -5-- '-Q- _ 2636.56' ~+ 270.00' r' ~---385.4'_ ~~ 330.05' r 330.05' (, PREPARED FOR: LES MILLER 5424 HOWARD GNESEN R0. DULUTH, MN 55803 a SURVEYOR: ~ TY. R. DODGE u ~ S & N LAND SURVEYING, INC. ~ 2920 ENLOE STREET xv HUDSON WI 54016 ti~ x ~:~. ' b ~ti • ~~':'r •M ut'~•,4 EACH PARCEL SHOWN s~'~ ~• ~ •~~ONTHISMAPIS ,z .; ~ ~ ~ ,.; <t ,_' ; ~ ~ SUBJECT TO STATE, ." ~, '~' :- &,' ~ COUNTY AND TOWNSHIP ' - q ~ LAWS, RULES AND ,, esq. •~ REGULATIONS (I.E., *~ ' ' ~ ~, WETLANDS, MINIMUM LOT SIZE, ACCESS TO '''in,~`rrnnrrnui~o~n"j1',` PARCEL, ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFlCE AND THE TOWN OF CADY FOR ADVICE. SCALE IN FEET 1 " _ M M ~r o ~ 6r M~ ryry~~ ` V'~ LOT 1 ~~ I ~ ~ r 0o i $ O0 c . d_ \ d~ r ~ c G •~ ~I I o ~ ~ i t3n N ~ 5.210 ACRES Z o e ~ i w r i i ~ i 226,950 SQ. FT o v w~ ~ v d i p e'J ~ ~' INC. R/W 5.020 ACRES w w < 0 { ~, ~ 0 ~ 218,665 SQ. FT. EXC. R/1N w~ o i w 0 S89'39'32`W ~ N o ~ i W 270.00 o Z I D, ~ N N ~L r D~ i r 1 ~ 1 SEE DETAIL LET 3 LET 2 10.002 ACRES 435,691 SQ. FT., 14.691 ACRES ~ INC. R/W i 639,960 SQ. FT. ~ ~ g,779 ACRES r INC. R/W ~ ~ 425,961 SQ. FT.~ ~ 14.425 ACRES M /yy EXC. R 628,365 SQ. FT. ~ I EXC. R/W 3 ~ m ~ !~ p O N N a r d 4 U ~ w ~ ~ ~ r NOTE: THE M1 DNR HAS DETERMINED THAT AN ELEVA710N BM ELEV.=1132 N ~ ~i O OF 1110' (t10' ABOVE THE v~i ~ ~ a, W EXISTING SCALE) IS CONSIDERED U `(~i J A REASONABLY SAFE ELEVATION FROM H ~ X ~ i ~- ~ FOR PROTEC110N `~ z o ~ ' ~ FLOODING HAZARD. IF ANY w v ~ + ~r ~ ° PROPOSm coNSTRUCnoN rn ~ 3 j k EXTENDS BELOW THIS w 4 "O ELEVATION, THE ST. CROIX m ~ ~ ~i ~ COUNTY ZONING OFFICE SHALL M FENCE 3.0't 250' F ~~rv 20= ~ CONTACTED TO RENEW THE PROPOSAL WITH THE WI DNR. BM ELEY.c1120. EAST O LINE-- ~ r 657.67' 330.05' 250 0 250 THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB N0. 6609-01 DATE: 04/26/2006 REVISED 01/18/2006 m N LOT 4 10.001 ACRES 435,650 5Q. FT. INC. R/W i• 9.782 ACRES ° 426,099 SQ. FT. n EXC. R/W I ~ th ~ N M N a ~ 0 iXIMATE LOCATION iF 1110' CONTOUR (SEE NOTE) 75' SETBACK CENTER OF TER COURSE S89'43'54~IV 1317.77' APPROXIMATE ~~ IUTH LINE OF THE NE 1/4 OF THE SW 1/4 EDP OF SCALE ao MapL~^144~D ~aD~ ~M7aC~D [3~l 04aGG3~ `.... L}. Irr ~ ....1...........1 1 ~~ I I r ~-J ~ I r r FENCE 3.4~ j ~ I --EAST OF r " ~ LINE i r-~ ~ ~ (~i ~i i i j i N Qi °~i ~ I I r~ ~ ~ ] C`~i~i i L-J LJ ~~ i O I,'-j \ ~i ~o i i i r- nnp O I r e- ~ IJj~I ~ ~ ~ 3 0 ~i ®i 1 L-__~ f T W NQ~ 01 ~~..---°----------°-----_ ~ iF ~ ~i~~ DETAIL ~ 0 0 ~~ ~i (NOT TO SCALE) r ~°, Z a10 LEGEND ® FOUND 1" DIAMETER BERNTSEN STEEL SURVEY MARKER SET 1" DIAMETER BERNTSEN .STEEL SURVEY MARKER SET 1' OUTSIDE DIAMETER BY - 0 18" LONG IRON PIPE, WEIGHING ~' 1.13 LBS. PER LINEAR FOOT 2.4' ROADWAY SETBACK LINE (50' FROM RIGHT-OF-WAY) FENCE .~ ,D N N N 0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND /OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ /U y S ~~ Mailing Address a 8 ~3 ~~~~' ~„-~ Property Address ~fc-~~2 (Verification required from Planning & Zoning Department for new construction.) City/State ~~l ~ ~ arcel Identification Number ~~ "' ~6~ ~O r ya - d sd LEGAL DESCRIPTION Property Location'/4 , S ~ '/4 ,Sec. ~, T ~N R f ~7 W, Town of Subdivision Certii~ed Survey Map # Warranty Deed # Spec house yes no Lot # Volume ,Page # Volume ,Page # Lot lines identifiable es 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. Uwe, 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. Uwe 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 ~~ ..~ ~7~ S ATURE OF AP ICANT(S) // / /3/~ 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. 08/05) .. State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number Document Name THIS DEED, made between Thomas K. Miller, Terrence K. Miller, Les A. Miller, and Jenise A. Fritz, all married persons, ("Grantor," whether one or more), and Doug Nystrom and Linda R. Nystrom, husband and wife as survivorship Marital property, ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE EXHIBIT "A" i iiiiii «i~i ~~~i~ riii~ ~iiii ~~ii~ i~~i iiiiii u~~ iii * 8 6 4 5 4 8 2 864548' KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX GO., WI RECEIVED FOR RECORD 11/26/2007 08:15AM WARRANTY DEED EXENRT ~ REC FEE: _13.00 TRANS FEE: 472.50 PAGES: 2 Recording Area Name and Retum Address Signstura Titlo Cwr-P su to 107 1850121st Std 7 Burnsville, MN 1~~~IN~ 004-10460-050 Parcel Identification Number (P)N) 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 November 8, 2007 ~,. /~~,. (SEAL) ~~a.7li~T~uE!'!~/f.4~7'~~l /~?T~/EAL) *Thomas K. Miller -*~Tierrence K.~yMiller ~l Q ~trr~Rry~Y-/~ ~r~ ~aA 111ic1,~f(SEAL) LXh(i/~. A~~aPNeY~w FilcT~o,e ll~v~l~fJ. f~trZ (SEAL) * Les A. Miller *Jenise A. Fritz Signature(s) AUTHENTICATION ~ ~,° +~*~^ ~~ [,:t;C~eKiIV MF4GIIPfi tkYGlElz -I authenticated on ~ ~ t~~~; ~ ~,,,~,~;h ~ it ~ +,~y, ?~ ley Commission Expires * _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis, Stat: § 706.06) THIS INSTRUMENT DRAFTED BY: Michael H. Forecki, Attorney Eau Claire, Wisconsin ACKNOWLEDGMENT STATE OF M I rV 'N E .~ C)Y~ ) ~A~`, - ss. I~~-(Jl w COUNTY ) Personally came before me on November 8, 2007 the above-named Thomas K. Miller Attorney-in-fact for Terrence K. Miller, Les A. Miller and Jenise A. Fritz to me known to be the person(s) who .executed the foregoing instrument and acknowledged the same. ~l ~ ~ ~ A 1T7G, . c7 Notary Pub'li~, Stalk of Mifulesota My Commission (is permanent) (expires: ~(l.h ?~ ~ Z©D (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. Exhibit A Legal Description of Property Lot 2 of Certified Survey Map filed 8/17/2006 , in Volume 21 of Certified Survey Maps, Page 5261, as Document No. 832462, located in the Northeast Quarter. of the Southwest Quarter of Section 20, Township 28 North, Range 15 West, St. Croix County, Wisconsin