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HomeMy WebLinkAbout006-1044-10-000 Wisconsin Mpartment of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix safety and Building Division INSPECTION REPORT Sanitary Permit No: 514827 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: Sellent, Beverly C Ion, Town of 006 - 1044 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Q� !� YA I os 20.31.16.303A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Zh Benchmark 16M All Q / Alt. BM Z•Z Aeration Bldg. Sewer Holding St/Ht Inlet C �C 7 • / TANK SETBACK INFORMATION St/Ht Outlet yr. �j g TANK TO P �/L WELL BLDG. Ltake ROAD Dt Inlet Septic �Q f q / / / 1 _ Dt Bottom Dosing Header /Man. •Q$ �7 7. S Aeration Dist. Pipe 1 = • ,� Holding Bot. System $ tr.�s. �je�o • T1. • 2 Final Grade PUMP /SIPHON INFORMATION S. Zo 98 •`J Manufacturer Demand St Cover P Z • Z / Z 6 .3 Model Number �� T` � • 9;G • 3 TDH I Li Friction Loss System T H Ft Forcemain a Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Len t o. Of Tr enches PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth DIMENSIONS 7(0 — SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:^ • INFORMATION Type Of System: / CHAMBER OR Model Number: t Cor��e• -t o Q 21 39 /65 N �- (�,�; � 4 DISTRIBUTION SYSTEM .D ZOt- ZO Z J- t 9 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air I ak Pipe(s) \ 1-1,s 3 /� �'�a� Lengt Dia Length Dia pacing e,... 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 3- c o Bed/Trench Center Bed/Trench Edges \ �ed Topsoil Yes 0 No Yes E No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / — \ Inspection #2: / / Location: 2027 Hwy 46 New Richmond, WI 54017 (NW 1/4 SW 1/4 20 T31N R16W) NA Lot Parcel No: 20.31.16.303A 1.) Alt BM Description = '• Gt w e,- 2.) Bldg sewer length - amount of cover Plan revision Required? ❑ Yes No 34 7 fS, Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' Signat Cart. No. ` y commerce.wi.gov Safety and Buil 201 W Washington ve., P� �d E . I t l i cepartment s cO n c' n Madison, WI 3707 -7162 Sanit Permit Number (to be filled in by Co.) of Commerce 5 /Y $ L 7 Sanitary Permit Applieatio State ransaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form tot a apprWia�af�le�r Y unit is required prior to obtaining a sanitary permit. Note: Application forms f state - og&Nl 3[Fd4e Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide y e use or secondary purp oses in accordance with the Privacy Law, s. 15.04 (1)(m), Stats. / 20 Z 7 yw y I. Application Information - Please Print All Information O`? Property Owner's Name Parcel # � �' � /y- /0-otla Sy Property Owner's MailingresC Property Location / 3 63 9 e1 Z 7 V Govt. Lot City, State Zip Code Phone Number N J 1/, (�(f V., Section Z �-T b 7 Z- 11-- 677 ` .73 T W � —N, R �So( circle o II. Type of Building (check all t hat apply) ek Lot # ❑ 1 or 2 Family Dwelling - Number of Bedroo pw �4 Subdivision Name Block # El Public /Commercial - Describe Use DJ f e "' A 1 ❑ City of CSM Number El Village of _ El State Owned - Describe Use � L Town of e III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) A ' id New System ❑ Replacement System g p Y g Y (explain) ❑ Treatment/Holdin Tank Replacement Only Other Modification to Existing System B. Permit Renewal El Permit Revision El Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl O<Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil . El olding Tank O H ther ispersal Component (explain) ❑ Pretreatment Device (explain) 77 OaA.� V. Dispersal/Treatment Area Information: Design Flow (gpdy Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propos� ( System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units A U h ° New Tanks Existing Tanks o ;; 2 Y s U e c or Holding Tank /00 V Dosing Chamber V - `- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI ignature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Coon /De artment Use Onl Approved rsapproved Permit Fee Dte �d Issuing t Signature $ AN) • ° a / 3 r Gi ven Reason for nial IX. Conditions of A roval/Reasons for Disapproval f � SYSTEM 4 � . 1. Septic tank, effluent finer and �` 4 dispersal cell must all be'services /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained - f as Pa e e system and submit to the County only on paper not less than 8 1/2 x 11 inches in size 0 SBD -6398 (R. 01/07) Valid thru 01/09 ,s -tx, T3 .n 7 Z, Thin �e ' � x 1 _ � J f � it J a s -p Ell �WSr�S X 07" x1% on 22 /aa - 11�� �•/ 16 0 y l hi I -- / ' 37 -- -- f /mo .� i 2101 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nears 006 -10 -10- 0 Please print all information. Reviewed Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 �(1) // Z 710 7 Property Owner Property Lo Beverly J. Sellent RECEIVED Govt. Lot wig SW 1/4 20 T 31 NR 16 W Property Owner's Mailing Addres I Lot # Block # Subd. Name o CSM# 9642 Daniels #70 7 City S te Zlp ode J Phone Number _j City Village a Town Nearest Road Siren I 6 IAIZCWW6 -27 Cylon State Hwy. 46 0 New Construction Use: esi ential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _f Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendati s: =Memopage. r Bo ring # I Boring Pit Ground Surface elev. 98.90 ft. >91" in. Soil l� Depth to limiting factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/4 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 - 10yr3/3 none sit 2fsbk mvfr as 2f,1vf 0.6 0.8 2 9 -23 10yr5/4 none sit 2fsbk mvfr aw 2vf,1f, 0.6 0.8 3 23 -28 7.5yr4/6 none gr sl 1msbk mfr aw 2vf,1f, 0.4 0.7 4 28 -34 10yr4/4 none gr Is 0 sg ml Cw lvf,f 0.7 1.6 5 34 -91 10yr4/4 none 115a /s 0 sg ml - - 0.3 0.6 " #5 consists of a stratified mix of 10yr3/4 Ifs, 10yr4/4 Is, 10yr 496 is & 10yr5/6 s containing approx. 30% gr & cobble. Loading rate of horizon reduce to reflect permiability restriction associated with textural changes. F2 ] Boring # I Boring 1+" Pit Ground Surface elev. 99.43 ft. Depth to limiting factor >92 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 -8 10yr3/2 none sit 2fsbk mvfr as 2f,1vf 0.6 0.8 2 8 -21 10yr4/4 none sil 2fsbk mvfr aw 2vf,1f, 0.6 0.8 3 21 -35 7.5yr4/6 none grsl 1msbk mfr aw 2vf,1f, 0.4 0.7 4 35-41 7.5yr4/6 none gr Is 0 sg ml Cw 1vf,f 0.7 1.6 5 41 -92 10yr4/4 none r Ifs /s 0 sg ml - - 0.3 0.6 . 1 e6 3 H #5 consists of a stratified mix of 10yr3/4 Ifs s, yr 4/6 Is & 10yr5/6 s containing approx. 30% gr & cobble. Loading rate of horizon redu reflect permia ility restriction associated with textural changes. * Effluent #1 = BOD > 30 < 220 m /L d TSS >30 < 15 m /L * Effluent #2 = BOD < 30 mg/L and TSS < mg/- 5 g g 5— CST Name (Please Print) Signature CST Number James K. Thompson S._ — _ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 10/31/2007 715 - 248 -7767 Property Owner Beverly]. Sellent Parcel ID # 006 - 1044 -10 -000 Page 2 of 4 F31 Boring # I Boring f/ Pit Ground Surface elev. 99.36 ft. Depth to limiting factor >89" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sil 2fsbk mvfr as 2f,1vf 0.6 0.8 2 8 -17 10yr4/4 none sil 2fsbk mvfr aw 2vf,1f, 0.6 0.8 3 17 -21 7.5yr4/6 none gr sl 1 msbk mfr aw 2vf,1 If 0.4 0.7 4 21 -28 7.5yr4/6 none gr Is 0 sg ml cw 1vf,f 0.7 1.6 5 28 -89 10yr4/4 none Ifs /Is /s 0 sg ml - - 0.3 0.6 H#5 consists of a stratified mix of 10yr3/4 Ifs, 10yr4/4 Is, 1 OVr 4/6 fs & 10yr5 /6 s containing approx. 30% gr & cobble. Loading rate of horizon reduced to reflect permiability restriction associated with textural changes. F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <_30 mg/L and TSS -1.30 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) A.C.E. Soil & SRe Evahiatlons SOIL AND SITE EVALUATION 2101 Page 3 of 4 PROPERTY OWNER: Beverly J. Sellent PARCEL I.D .# 006 - 1044 -10-000 A.C.E. Soil & Site Evaluations REPORT MEMO Site suitable for convenfional dispersal cell at 0.3 gpd loading rate. Recommended installing 76 Q4 chambers in 4 trenches at elevation 95.50'. Pressure distribution recommended to overcome reduced permiability of stratified materials described in 5rh horizonsof all soil profiles. • + S r 5oi! e✓a /ua6o"--� P•E • • E fi j rade el ail. ,QpProX. c c / 9 e off' ree/a,�ned lrorro,v "a $ 4 / 40 A/6 4OPy Sec..2.o, T 3 /IL, 0 5 t Croi C'e+., Li �. F`rcrn eJC • 30 ac re cJ. , Al ooV - �o /v -cam PtO% Xscdlob Corler-as Roposad Af co�nc, -QS 56&,e -d 6y 00,7 i S licd by owntr. 8. rvP O /°Synt`h ic. 63 a , 61 ; ee.rto en r : 7 v - 1 0 op lot .5-6te A3 set mcd c I cj,. P roposcd �ot CGY ncf aS S��ta/ 6 y ownc� 1��i ✓0.Q oad 4cce -z .04104/2001 10:07 PAZ 71a6376847 BARRON co ZONING raoi SYSTEM SPECIFICATIONS lu-ground Soil Absorption Component SBD - � L Project Nume. Distribution CeR Typr S�pdc Tank 0 78 0 Aggegate El Leaching chamb=891 Min. Septic Tank Volujae- .- —gal. Septic Tank Vbhune LJ?00 ,I. WastewAter QUA f Theated ❑ UntreaEed Manufacimror. Nnmber of Bedrooms Effluent Filter Design Loading Rate (OLR) M.Mufacturer (Modroum Soil Apprimlim Bate) C=bjned wastewater; Number Of beJx0►=-q -7 Pump Tank gal. /day /bedroom &1-50 munufixturer _7 Daily wasrevmter Flow PNXIF) --- 'Volume Clen and gtaywater only: Number of bedmoms Dive ter valve []yes Ono g;d/day/bedroom mmufactme Daily Wastewater Flow (DW) w Model Note -. The use of a &keTj!t'TA1V2 be Mcamd On Blackwater the Mangemant t1w IiAd =dug how %ad When the Valvc Number of bedrao=s sii-Z be use& pl./& y/be&oarn Daffy W=mwzter Flow QTXIIF) Distribution Cell Sizing (Aggregate) I)WF / InK Distribution Cea Sizing (6.chiug cbanabers) 1&&dxing Ch b maUU&C= Model M L e t' — Adjusted Design Loading val-fe Chur:dber size, bottom aref. Sygrem d:dng =.DWF / ADLR, Chamber gize -7 "a— (ADLIt) (Sq-fc) # of tburnbers Niumber of chambers to be used = Page of INFILTRATOR SYSTEMS INC. QUICK4 BED DESIGN DETAIL NOT TO SCALE BACKFILL MATERIAL - NATIVE, OR yy ESTABLISH VEGETATIVE COVER - FILL PER DESIGN SPECIFICATIONS ML MAX BURIAL QUICK4 / 777 DEPTH PT DESIGN TY'P. MIN. PER CODE (RECOMMENDED NOT LESS THAN B ") �J 0 INRLTRATOR SYSTEMS, INC, 6 BUISNESS PARK ROAD P.O. BOX 768 INFILTRATOR SYSTEMS INC. OLD SAYBROOK CT 06475 QUICK4 EQUALIZER 36 PH. (800} 221 4436 BED DESIGN DETAIL FX. (860) 577 -7001 W W W.INFILTRATORSYSTEMS.COM Scale NOT TO SCALE Checked BCP Date 03/30/2006 Q4 EQ36_BED Drawn By: KJB Sheet ] Of 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa o f FiLE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al 13 NA Permit # A2 0 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model Z ❑ NA Number of Public Facility Units M NA Pump Tank Capacity al p NA Estimated flow (average) - 2 0 0 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) �/5_0 gal/day Pump Manufacturer ❑ NA Soil Application Rate p 3 g al/day/ft' Pump Model ❑ NA Standard influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ )n- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Othe Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) 49 ear(s) 11 (Maximum 3 years) NA 3 Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA .3 -I year(s) Clean effluent filter At feast once every: ' ❑ month(s) ❑ NA • iR year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA Other: ❑ ear(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 'START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(sl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Deduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides, meat scraps; medications; oil; painting products; pesticides, sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. © The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. d Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY SE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAkLER POWTS MAINTAINER Name :Q�Ims.•. Name Phone 637 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ZOrI / Phone Phone `2�, _ - (00 6 This document was drafted in complianoe with chapter Comm 83.22(2)(b)(11(d) &(f) and 83.540 ) , (2) & (3), Wisconsin Administrative Code, U1 /Uri /U1 14UN 16:3U k'AI 715 36U 4f38fi ST CRg CO ZONING 4002 ST CROIX COUNTY SEPTIC TANK MAMMUNCE AGRELM M AM OWIMPSHHlP CERTIFICATION FORM Omer/Buyer U Sv G e-- , e-c�� 4 l ( — Mailing Address (1 '7 Z Property Address (Verification rogpiftr.Cl tbm Planning r)qpartdiantfat new coustruction� City /State Parcel Identification. Number.' 006 ° /O y /- /O- 00 6' L QAL DES=U.ON Property Location UW ., %4,5 w '/4, Sec. 2 O . T I N R /( W, Town of Subdivision . Lot # Certified Survey Map # . Volume _ . .Page # Warranty Deed # -- ..,, Volume . Page # Spec house ❑ yes ❑ no Lot lines identifiable C) yes O no UAMM MAIN=ANCE luvropcar use and maintenanceof your septic system could rcolt in its premature hilure to bud' e wastes. Propel m ww4anec consists of pumping out the septic tank *very three years or sooner. if needed by a licensed pumper. What you put into the system can affect the function of the septic tx* as a treatment stage in the waste disposal system ne propotty owner agrees to submit to St. Croix Zntung Deparaneat a ccrtification faun, sigtued, by the owner and by a ma*rplumber, jourueymau plumbcr, mst noted plumber or a ticensedpunrper verifying that (1) the o"he wastewaterdisposal "Stem is in proper operating condition and/or (x) after inspection and pumping (=f accessary), the septic tank is less than 113 W of sludge. Uwe, the undersigned have read the above requiim=ts and agree to maintain the private sewage disposal syu= wtth the standards set forty, herein, as set by the Department of Commerce and the DeparkaoW o f Natural Resources, State of Wisconsin. Cntification stating that your septic system has been maintained must be completed and returned to the St Croix County Zoning Office within 30 days of the tluce year expiration date. SI TURF OF APPLICANT DATE OWNER, C - R I F CATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the ptoperty described above, by virtue of a waixsnty deed recorded in Register of Deeds Office. / 'a S! o S' SIGNATURE OF APPLICANT DATE Any information that is mis represented may result in the sanitary pomiit being revoked by the Zoning Department, rt� Tattude with this application: a stamped wumty deed from the Register of Deeds office a cagy of the certified survey map if reference is made in the warranty deed T - ryt c_it G ^i3 [ WARRANTY DEED STATE if AR, Or v6nS c(?NSrN FORM 2 t982 _ Robe:ut Xa to - n2 alkla- Robert. C.... --- nd: __.... ST. C Olx Co., - W15; Charl.ene M. Ra_:;.te is, his i,ri_fe, �LITD..E � vera _E,:._.. ;zec for Record this Is t: Sampson_ a Ia Vera. Sampson _ , :..._. Auk t, .r::.•.- anfi :,.,r3 [or -> to _F3everly..J.. Sellent.. - fo ;.y._k:r► a -- - - -- � - - -- - _ -.as Beverly .J. .Fall - -- � ar a aaeez _ .., ....._... ......... .. ......... - - _ - -- -- -° .. _.. _. .. _. ._.. . ..... ........ . ...------- .. a� -n an -.u., the follnwing describer) real estate in St.. _Croi< . ...County, - -- - state o. i i:iconSin: Tax Parcel No:................. The North Half of Southwest Quarter (Nh SW k) and Southwest. Quarter �� of Northwest Quarter (SV-Ar NW ) of Section 20 Township 31 North, Range 16 West. ° > �r This Warranty Deed is given in full satisfaction of certain land contract dated April 1, 1972 and recorded in volume 482, page 604 ? as Instrument No. 309657 in the office of the Register of Deeds rn - and for -St. _ Cro-ix _Coon ty , Wisconsin and as assigned by Abridgment of final Judgment dared` Apr - 1 — 3 T 989" anz3 -recor-ded in:. Volume 686 p A. page 170 as Document No. 392631 in the office of the _Register of L?e`ec1 in and for St. Croix county, Wisconsin. - 1 s 1 n F is not s horr,csLoad property. : (is) (is not) E]sce,Micn•LV warruntic%: Subject to municipal and Zoning ordinances and re- corded easements and restrictions of record, if any, and any liens or en- cumbrances creace:.d cn S:. ff rt-d to be created by the acts or defaults of the c rant.ee• 12th day or Jul I)ute this y I�E�G1O e��s' ^" (SEA �C [ina�.�.Ic :... Y>+aJ�41i'v,i (S CAL) _ o ert Ka a k/a J Robert C. Kasten s Elvera E.. Sampson a /k /a Vera Sampiion .(SEAL) _ (SEAL) Charlene M. K'stens AUT 11 ENTICATI0 N ACKNOWLEDGMENT Sig-nature(s) .... . ............. ------- --- - ---- - --- STATE Or:' WISCONSIN ) ss. authenticated this ........ u-, -f... 19 ... Personally came before me this .-.1,�-........ day of ...__.. "- .. T.uly_ ............ 19.�.Q.. the above named ..............."........ ..___........_.____-- ---- - - ---- Robert "- 1Cas "tc.r,s _ al�cl .a..k2ob_er.t_.�....1<astPns -. ------- - -- .... - - -- - -__ . _._._... - - -- ­­1 ... _... .. an.ci .Chaxlenc.. M....iGas "tens., hi_s...w3_ic, TI TI.r: y :ENIP.ETt, STATE 13AR OF WISCONSIN AND "E.lvera._E,". ".Sampso.n.. a /.kla._Vera (If not . ...... _.... ............. ...._ .... ..... ......... . Sampson. ....... authorized by J 70C-.0G, Wis" State.) to iac kno%vn to be the person . S 1vhorexec•uted the fo 'n' >i' in :tr :jnn•r•t a ' i {cknoti f'.c.e Lhe ih� .. bcZ T1T]R.�e.i�rrM w.o l3 f � 2g Foi t -- (.. �_[.�_� � ) , 77 Cr)AYNR, "IiOVITZKE,.. BYRNES, GUS;' & WILL- Aii� TAN Box 84 %.; Art�e 54001 _ ; ;ot�� Pflnr� Pot = .. �Gonlip, - L4v >. f Sjwnaturr•: may he authenticated (.r ackwoxv4d_c1. L'r.r.h Mv f`n ovnis. :for perin :.nont Elf fro t,; t�.t �C•.c,,p� ; — - .. -gi n -t rcrc:,. = „fry.) . (ir. to November. 29 _ - 7 £ - .7.) ^r :amp �r r ,,._ a -_ .. ,_nv. ,n :. .�r.. -_.., f. _, ,. ,.,., ,f f.l •ti. - : -:r:,: . -. ,.,. -- WARRANTY OF_F.D - STATE SAR OF wISCO':Sl': - - v: �..n,in :..vnl la : a • 1 :, FORM r:n. 2— rim : - .. W” 01/22/2008 TUE 16:46 FAX 715 234 6860 A -1 HOME 2003/003 7pN.17.2008 9.38AM WBS JERRY C /BILL E NO,570 P.10/10 RollohomeO Production No, 4227 by Wh* Building Systems, Inc. PAGE, I OF I PO BW 680 2W E F011M STRIET Mae B P P i'r'1 L1 i r+ -,- 1 ,•1•,•j C? a ri i i:u 1,1 I i 7a M U, apb�Iq i i i:l:t:u I:I,I;i: is b Q O FL I� E 0 1 - - -! i:1�C1: 'i y•1 l.l:l:i:l W 1:17:11:1 :1:1:1:1: d , 1;1:1:1.1 � i:l; I• h (30H 19 Q ° a w Z ¢ Q a- ►� - w Rz mw LL Q r� 0 aC - rr.ln:l o /�I�I�� I:rr:r o LIa:I: I:1 �0 N I-08 1' a .ZZ 'd'8 ��I31 IS C'44 cl o g I:I:INA 1:1 Id^ U1:1:1'I:I:I:1{� 1:1:::1:,:1 ;1: T ` 1 '1•I L) I'I'1� • :t I j••I'I. L1 -I.1 I. ICI: 1.1: A4' . CI� :1:1;111:1:1.1: {_1: L13 1.1:1 V 'I :1• ' ;,'j o • � n UWx CAI Z � C7� m coin d L6 Cn z R a � LU T �` O CSC ~ SUNIM ININ Q oo 1 v o N US RETAIL CUSTOMER and BUILDER This is a CUSTOM bl_SIGN PRINT with nominal dimensions, This plan is subject to additional engine - Wng review and may require changes as a result, Local building} cedes may require soma aitembons to this plan. The addition of optlons may also require atteratians. This plan cannot be conitnned or built until this copy is relumed with the signature of both the customer and the builder_ Signature conprms acceptance of this plan 22 presented. Changes to this plan may require addillorat granges, 01/28/2008 MON 9:56 FAX 715 294 6860 A -1 HOMES 14001 /001 l -- j p e 2 55555 � 1• Ix�uLnTl ��k� �� ti J' IxS1RAilpf , 1 I I 11 Y i ------- ------ - I1 �I 3 1 I I I I I 1 1 f M I I II r$ ; ; I I � I I � �� g , � qf? • I � I I I � , r ' A6 ' I I p r p qy y� I m F I I p .r _ dr 1 U 1 1 - - -- .J I r' jj Rz 0 , _ -_ -__ r - m 0 of Y f. u f �$ Parcel #: 006 - 1044 -10 -000 01/30/2008 09:32 AM PAGE 1OF1 Alt. Parcel #: 20.31.16.303A 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SELLENT, BEVERLY J BEVERLY J SELLENT 9642 DANIELS 70 SIREN WI 54872 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 30.000 Plat: N/A -NOT AVAILABLE SEC 20 T31N R16W 30A NW SW EXC THE N1/2 Block/Condo Bldg: OF N1 /2 OF THE NW SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 694/69 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/07/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 15,000 5,000 20,000 NO AGRICULTURAL G4 29.000 5,300 0 5,300 NO Totals for 2008: General Property 30.000 20,300 5,000 25,300 Woodland 0.000 0 0 Totals for 2007: General Property 30.000 20,300 5,000 25,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ArcIMS Viewer Page 1 of 1 FZ t�•'° � �r �~� Fns > r r , x f. Om C2 a �2 rt .. ADA http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 1/30/2008