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010-1005-95-000
Wisconsin/epartment of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Anderson, Jeff Emerald, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFVRMATIVN TYPE MANU FACTURER ~ ~ 5 CAPACITY Septic n ` ~ ~ ,r'(^ ~ ~ '/ 7 " ' ~ ~ 5~ Dosing ~ S~ ~~ ~- ~v -~9 ~ , ~'' ~ 1 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ JSO ~ SD t 7 ~ 7 ~' J. Dosing Aeration Ho ' f `. c.h-tCe _ 1 tLtVAIIVN UAIA County: $t. Cro[X Sanitary Permit No: ` 51 853 0 State Plan ID No: Parcel Tax No: 010-1005-95-000 Section/Town/Range/Map No: 02.30.16.28 STATION ~ ~ s HI ras.S FS ELEV. Ber~ch~~ a ~k aj , *~• J~ JEy :i . G"^ f c7 r9 Q AI . BM ~~ LAW Bldg. Sewer 6.3 99.2 S SUHt Inlet 7 7y _17~ 7 7 St/Ht Outlet ~ 0 ~ 7.~'S' Dt Inlet Dt Bottom Header/Man. ~/. A 3 io~.6 ~ Dist. Pipe f y,tz5 ioo,~,a Bot. System (ck.e~ y'• o S ~ •~ / oo . YS' Final Grade ~ I S l o~ y StC've~ _,33 /O~$~ b~,Na k 11. ~s q3.~~ rumr/alrnVly IrvrvrclnAl wrr ~~~ ,ry, ~ Manufacturer Demand Zve ~~~' GPM Model Number 1 ~ ~ 7~ D 7 TDH Lift Friction Loss System Head TD 7Y F r2.Y ,~s' - b Forcemain Leng~ho . Dia.Z •~ Dist. to Welly' ''~~ ~5 SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length ~ 2, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS / ~./O2 f SETBACK SYSTEM TO P/ BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR y INFORMATION Type Of Sys em: Y ~ t r ~7S ' ~ s0 ..,. UNIT Model Num er: 2 rs ^ MA nICTRIRI ITIr1N CYRTFM Header/Manifold t •' Distribution '~ jam Pipe(s) ` rl x Hol/eGSize } `` x Hole/Spacing ` Vent to Air Int 2 w ~ ~Lt ~ ,~.~.C/' h ~ Di ~ `~ L . ~ 2 'r°- acin th ~ Dia~~ S L / 7 ~ O f a engt p g eng . Cnll CI~VFR ., n.-e~~~~.e c.,~•om~ n., i., YY Mn~~nd C]r At-Grads Systems Only Depth Over Bed/Trench Center f 9~ Depth Over ~ ~ Bed/Trench Edges ~J~~ xx Depth of Topsoil 'r xx Seeded/Sold I `, flNr^ No " Yes ' xx Mulched es No ~ 1. T7 ~.. ~ Z i ~/1,~! Y COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~° ~ / ~ ~~ / ''~ Inspection #2:0~ / 2~/ ~' Location: 1733 250th Streset Emerald, WI 54013 (NW 1/4 SW 1/4 2 T30N R16W) 40 acres Lot Parcel No: 02.30.16.28 ~ j',~ 1.)AItBMDescription=~I" ~'O~ .._ ~'° ~f°°'~ t`' ~'~ ~; 2.) Bldg sewer length = 45 ~ `t ~ .~., t y.,] ~ ,,t .. - ~. ~..i ~. ~+: ihlwt ` ~~~ P{5~•~3, ~t -amount of cover = 7 Z pp,, ~ 7~~f 4, G~,~(l~ c~ Plan revision Required? Yes No ~~ ~~ ~ ~ ~ _ `, ~ , I 0 i0' 1 Use other side for additional information. ~(J Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) o~ 2Ss t ~ ~"'! t ake comet@rce.wi.goV Safety and Buildings Division County ~~ ~ j ~ 201 W. Washington Ave., P.O. Box 7162 ~ x ~ sco n s ~ n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) oe~parNlerlt or ct)f1Mf1t3rC8 5/ SS Sanitary Permit Application fate Transaction Number i5Z s~5 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govemm unit is required prior to obtaining a sanitary permit. Note: Application forms for are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ses in accordance with the Privac Law s. 15. 1 m Stats. ~ ~ ~~ ^ ~~O / ! ~-(~ L A lication Information -Please Print All I aHon J d'^. Property owner's Name / RECEIVE Parcel# Properly Owner's Mailing Address ~ APR L 3 2008 Property Location ~ 28 1 ~ So u~~ ; >J-e S~~ ~~. Lit City, State Zip Code S CE~~g~1~uITY _~it) Y4 ~~'/., Section a ~((~r~-~,Q ~~~ t~~ ~~~ ONINGOFFICE (circle one N; R j ~D E o~ T ~ II. Type of Building (cheek all that apply) o lc Lot # _ 1 or 2 Family Dwelling -Number of Bedrooms lsA Subdivision Name pe-r SvbN...' e_ Block # G ^ Public/Cottmrercial-Describe Use heo~,tz,_ ~~t~ ^ Cityof ^ State Owned -Describe Use CSM Number ^ Village of ~ 'Town of ~r~'t-~1~'~i ~© a- / b z . III. T ype of Permit: (Check onlfy one boa on line A. Complete line B if applicable) `~' New S stem y ~,---~> ^ Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~ IV: T e of POWTS S stem/Com onent/Device: Check alt that a 1 d !V o,~ r' ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ~ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable Soil D. ~5 G-: / c, st.. ^ Holding Tank ^ Other Dispersal Component (explain) ' ^ Pretreatment Device (explain) ha~ ~,~ ~ / .'.ti V. Dis ersal/I'reatmentAraa Information: Desi~~jjn Flow (gpd) Design Soil Application gpdsf) Dispersatl Area Requir Dispersal Area Proposed System Elevation / VI. Tank Info Capacity in Total # of Manufacturer o ' Gallons Gallons Units .o ~ , ~, ~ Tanks N Exi tin T nk ~ c ~ ~ ~ y ~ ~ ew g s a s Sep[ic Holding Tank /~ S ~ ras ~ ~ ('tC.1 C.t~,UC ~ e~x. Dosing Chamber ~ ~ O ~ ~ ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation otthe POWTS shown on the attached plans. Plumber's Name (Print) bar' S~ tore MP RS Number Business Phone Number ~~ a ~e:iS ~ ~ -~ (S7a~y ~iS yS~~t~Yo Plumber's Address (Street, City, State, Zip Code) ~ ~. ,~ J 3 ~ ~ K ~ ~7 ~ /3'~z ~, C~~.~-off (,c,~.~ SLl~~2 VIII. Coon /De artment Use Onl pproved ~sappro Perm it Fe e $ D a te sued Issuing ant Signature ~ / , ~ ~ ' ~ L ~ ~ b g ven Reason rt2enial l~ ` IX. Condit§~~~~easons for Disapproval 1 , I 3 ~ ~ ~ ~ `a te ~ ~ ~ o'er ' J a c """~ ~ ' -- ''t' ' J 1. Septic tank, effluent finer and dispersal cetl must all be serv s /maintained ~(~~ ~ ^ ~~.~~,~- (,J ~ ~~ ~(~'yr,~, ~--~. as per management plan provided by plumber. Y 2. All setback regwrements must be maintained ~ /~ (~~~~, ~ o ~ Q J Attach to complete plans for dsc system and submiMo the Comty only oo paper not less than 8 ill a 11 inches in siu ~; ~! , / ~ 1 SBD-6398 (R. 01/07) Valid thru 01/09 U ,~ "~ ~ ° h C3 --,. a ` `~ `C c O ~ n ~ ~; ~ o ~_ ~ ~ c '~-~ O E ~ ~ j ~. R4 (~ `c ~ 1 V ~ ~. ~ `~ . ~~ ~ ~ ~ psi r~~ aQ J _~ CG ~•.. _,~ ~ ~ . ~ fit _ ~' r~ ~ ii 4.f w ~ ~~- ~ ~ ~. ~ C ~ ~ ~ c ~ ~ ~ ~ ' ~ G., o c.~- ~- ~Z ~ ~ " ~ ti ~- s O v~ c '~ ~° F ~. Q DO ~~ ~ ~ ~coPY ~~ ~~ ~ ~ ~1- c Q ~ ~~ ~ ~ ~" ~ z C3 ~ ~ ~ N sl R d m < ~ ~ _ Q L ~! e~• CF2 ~a ~~. i // ~~ L ~,.s ,.- d goo .$ ~ -r ~. o ~" r~ ~ a~ ~,-- ~ w ~ c ~ 3 ~ ~ -~ ~- ~ `~` i v ° ir3~ t ~~a n C~ ~ G 00 ~° F Q _ ~ ~~ ` 1 4 commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I,A., Secretary April 11, 2008 CUST ID No. 657274 MARK WEIS 1879 13 1/2 AVE CAMERON WI 54822 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/11/2010 Identification Numbers ` Transaction ID No. 1525665 SITE: Site ID No. 736142 Jeff Anderson Please refer'to both identification numbers, 250TH Street above, in all cori•es ondence with the a enc Town of Emerald St Croix County NW1/4, SW1/4, S2, T30N, R16W FOR: . Description: Mound /Four Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1177832 Maintenance required; 600 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System: Infiltrator Chamber Mound Manual (8/04), Pressure Distribution Component Manual- Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APAROVED. 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Comm 81.01(30), Wis. Adm. Code, defines a bench mark as: "A permanently established point, the elevation of which is known, which servesas a vertical reference point, and which may also serve as a horizontal reference point." The bench mark as located is in an area that will be cisturbed during the construction of the component. A new bench mark is needed that is located outside of the disturbance area and still accessible for the construction of the system L'ON(;>ild • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan ~~~~) approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the R17NENTC manufacturer's instructions and the plan approval, the plan approval and code requirements will take (~C~OF precedence. ~/~;~ SEE CORRE9 • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component arm. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal ~- are prohibited. MARK WEIS Page 2 4/11/2008 • The well must be a minimum of 25 feet from any POWTS tank, _and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat • Comm 83 22(7) A co~y of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall'be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) APOWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2) nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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, CG2~ ~ ~~,~'~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.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. ., ` Wisconsin Sand Mound Design Program for Infiltrator Chambers R~C~/~ qPR l FO Infiltrator Mound and Pressure Distribution Component Desig~',gF~~ ~ Zp~B Index and Title Page ~lo` N Project Name: Anderson Mound Owner's Name: Jeff Anderson Owner's Address: 1451 33rd St. Turtle Lake, WI 54889 715-986-2652 Legal Description: NW1/4, SW1/4, S2, T30N, R16W Township: Emerald County: St. Croix Subdivision Name: xx Lot Number: xx Block Number: xx Parcel LD. Number: ©~ d °- ~QOS- 9S ~~~ Plan Transaction No.: xx Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System and maintenance specifications Page 6 Management plan Page 7 Plat Plan Page 8 Pump Curve Page 9 x Page 10 Designer: Mark Weis License Number: Date: A~ 1, 008 Phone Number: Signature: ~i Mound system design criteria based on: The Infiltrator Chamber Mound Component Manuel, Yer. 5.0 (August 11, 200d}, Pressun: Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 0101), and Design of Pt~ssurn Distribution Networks SSWMP Pubkcetivn 9.6 (0181) MP#657274 715-458-0740 Page 1 of 8 ~~nnlly ~~® COIMH}EttCF INGS 2 'ONOENC ~S Current version as of June 9, 2005 Wisconsin Sand Mound Design Program for Infiltrator Chambers Mound and Pressure Distribution Component Design 1e~icr; ,,,tit` r'~sheet Site Information R Residential or Commercial Design (R or C) 400.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e. g, 1.5 = 150%} 600.00 Design Flow (gpd) 6.80 Site Slope (°h) 99.50 Installation Contour Elevation (ft} 27.00 Depth to Limiting Factor {in} 0.60 In-situ Soil Application Rate (gpd/ftZ) Distribution Cell Information 102.00 Distribution Cell Length Along Contour (ft) 1.00 Distribution Cell Loading Rate (gpd/ftZ) 1 Influent Wastewater Quality (1 or 2} Q Enter Q or S Q = Quick4 Standard; S = H-10 Standard Pressure Di stribution Information E Center or End Manifold (C or E) 3 Lateral Spacing (ft) 2 Number of Laterals 0.125 Orifice Diameter (in) (e. g. 0.25) 3.65 Fs~i~ra*.~ Orifice Spacing (ft) 2.00 Forcemain Diameter (in} 150.00 Forcemain Length (ft) 88.00 Pump Tank Elevation (ft) Does the forcemain drain back? C~ Enter Y or N 5.00 Distal Head {ft) 1.50 Network Losses (ft) 24.47 Forcemain Drainback (gat) .7 t _ '>C 11.25 Vertical Lift (ft) 9221 5x Void Volume (gal) ~"-- ~ ~ 1.79 Force Main Friction Loss {ft} 116.68 Minimum Dose Volume (gal) ~$'J ~'v 19.54 Total Dynamic Head {ft} 23.07 System Demand (gpm) ~- •~S/ lateral Diameter Selection in. dig. o tions choice 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1258.00 Septic Tank Capacity (gal) Huffcutt Inc Manufacturer Dose Tank Information 768.00 Dose Tank Capacity (gal) 17.10 dose Tank Volume (gal/in) u cu nc Manufacturer Note: Sand fill (D) calculations assume a Table $3-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the higherst point in the distribution L~ network? Enter Y or N If N above, enter the elevation ft of the highest point. Lateral placement Enter S or G 10.93 ftz/orifice Manifold Diameter Selection in. dig. o tions choice 1.25 x 1.50 x x 2.00 3.00 Dose Tank Gallons/Inch Calculatorep' onai 768.00 Total Tank Capacity (gal) 17.10 Total Working Liquid Depth (in) 44.91 gal/in (enter result in cell B51 } Effluent Filter Information Best Filter Manufacturer - Filter Model Number Project: Anderson Mound Page 2 of 8 Current version as of June 9, 2005 Wisconsin Sand Mound Desian Program for Infiltrator Chambers uto-vsa K `r` > E L Mound Component Dimensions T J T A I z 1 A 6.00 ft E 13.90 in H 12.00 in K 8.86 ft B 102.00 ft F 12.00 in I 10.02 ft L 119.72 ft D 9.00 in G 6.00 in J 5.61 ft W 21.62 ft 612.00 (ftz) Dispersal Cell Area 1633.79 (ftz} Basal Area Available 6.00 (gpd/ft} Linear Loading Rate 1000.00 (ftz} Basal Area Required Observation Pipe Placement is Between 1110 B & 1J5 B 10.2 ft (ttto ~ and 20.4 ft (1ts B) Finished Grade 102.25 (ft} 100.25 (ft} Distribution Cell Elevation , Q Mound Plan View Mound Cross Section View Shading Key With Chamber Distribution Cel{ ® Topsoil Cap 2 Subsoil Cap 3e ASTM C33 Sand ~ ,,, „ G H ~ Tilled Layer ~,,,,, 5 Chambers 5 Distribution Cell 5 100.25 (ft) Lateral Invert ..:.....:..... D 99.50 (ft} Contour Elevation 6.8 °r6 Site Slope Infiltrator chambers (typ.} ~! Not to scale Distribution lateral at trench bottom (typ.} Project: Anderson Mound Page 3 of S Current version as of June 9, 2005 Wisconsin Sand Mound Design Program for Infiltrator Chambers Pr essure Distribution System Detail Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing {X) 3.65 ft Lateral Length (Pj 100.50 ft Orifices per Lateral 28 Lateral Spacing {S) 3.00 ft Orifice Density 10.93 ft2/orifice Lateral Flow Rate 11.53 gpm Manifold Length 3.00 ft System Flow Rate 23.07 gpm Manifold Diameter 1.50 in Total Dynamic Head 19.54 ft Forcemain Velocity 2.36 ft/sec Number of Chambers 25 per lateral Dose Tank Information Locking cover with warning label and waking device and - Electrical as per NEC 300 and _ ~ sealed watertight ~ Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Aftemate outlet location Huffcutt Inc Ca aci _ 768.00 Volume 17.10 Manufacturer Gallons gal/inch A Dimension Inches Gallons A 24.09 411.92 B 2.00 34.20 C 6.82 116.68 D 12.00 205.20 Tota( 44.91 768.00 C Forcemain diameter ~ 2.00 in. Weep hole or anti- siphon device Pump otf elevation (ft) ~- 89.00 Dose tank elevation (ft) ~ 88.00 Alarm Manufacturer SJ Electro / Alarm Model Number 101 HW 1 . )~.~ e~ Pump Manufacturer Zoeller / ~ IIIJJJ""" t n , ,/ ,r' ~, ~`'~~/ Pump Model Number N98 ~ n~, ~ ~ `~ U. ~. ' 1/" Pump Must Deliver 23.07 gpm at 19.54 ft TDH ~~ ~~~0 Project: Anderson Mound Page 4 of 8 ~ ~ Current version as of June 9, 2005 ,v `~ ~~ ~'~ Lateral Layout Diagram Wisconsin Sand Mound Desictn Program for Infiltrator Chambers Mound System Maintenance and Operation Specifications Service Provider's Name Weis Se tic S stems & Soil Testin LLC Phone 715-458-0740 POWTS Regulator's Name St. CroiX Count Zonin Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 600 Estimated Flow -Average 400 Septic Tank Gapacity 1258 Soil Absorption Component Size 612 Type of Wastewater Domestic Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other gpd Maximum Influent Particle Size 1/8 in gpd Maximum BOD5 220 mg/L gal Maximum TSS 150 mg/L ftZ Maximum FOG 30 mg/L Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Ins ect and/or service once eve 3 ears Should ins ect once a ear and clean once eve 3 ears Test once eve 3 ears Should test month) Laterals flushed and ressure tested once eve 1.5 ears Ins ect once eve 3 ears 1. Observation pipe materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 3. Tillage of the basal area is accomplished with a mold board or chisel plow. 4. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion. Finished Lateral Turn-up Detail grade ............. ...... ...... 6" diameter lawn sprinkler Threaded cleanout plug or valve boz -~ '' ' ` ball valve Distribution Long sweep 90 or two 45 degree lateral _~ bends same diameter as lateral Last orifice ~~~ Lateral cleanout extends beyond end of chamber Anti-Siphon Detail Pressurized piping 1 /8" hole in the e pipe iegree aw (Typ.} pe sizing ~r design 2 J-hooks for stabilzing Current version as of June 9, 20t15 Wisconsin Sand Mound Design Program for Infiltrator Chambers Mound System Management Plan Pursuant to Cvmm 83.54, Wis. Adm .Code The septic tank shall be maintained by an individual certified to service septic tanks under s. 251.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every v years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the finer when removed from its enclosure. If the filter is equipped with an alarm. the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank If the contents of the tank. are not removed at the time of a triennial assessment; maintenance personnel shall advise the ovmar of when the next service Heads to be pertormed to maintain less than ma~timum scum ar~iudge accumulation in the tank The addition of biological rx chemical addltives to enhance septic tank pertormance is generally not required. However, rf such products are used they shall be approved for septic tank use by the Department of Commerce. Pumv Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verrfy proper operation. If an effluent fitter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cokl weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not e~eed 220 mg/L GODS, 15D mg/LTSS, and 3D mg/L FOG for septic tank etuent ~ ~ mgJL BOD S, 30mgIL TSS, 10mg/L FGG; and 10° cfu/100 mL for highly treated affluent. Influent flow may not exceed maximum design flow specified in the permit for this inslaliation. The pressure distribution system is provided with a flushing point at the end of each lateral, and lt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed d should be compared to the initial test when the system was installed to determine 'rf orrfice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Gbservation pipes within the dispersal cell shall be chocked for effluent ponding. Ponding levels shall be reported to the wmer, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals Prossuro Distribution SBD-1 D7Dfi-P (N.01 /011 and Infiltrator Mound Ver 5.D and local or state rules pertaining to maintenance and maintenance reporting. No ono should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of lts components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, lt shall be repaired or replaced in its' present location by increasing basal area 'rf toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring tho system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your designer, installer, service provider, county zoning office or local health inspector. See Page 5 for the name and telephone number of your local POWTS regulator. Project: Anderson Mound Page 6 of 8 Current version as of June 9, 2D05 PUMP PERFORMANCE CURVE ~iw 25 g 20 x _U ~ 15 4 0 J 10 F- 2 5 MODEL 98 0 10 20 30 40 50 60 70 80 GALLONS LITERS 0 80 160 240 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 98 Feet Meters Gal. Liters 5 1.5 72 273 10 3.0 61 231 15 4,6 45 170 20 7.1 25 95 Shut-off Head: 23 ft.(7.Om) 009971 r rnz sKnoz CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical altemators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches. variable level long cycle controls. • Refer to FM1922 and FM0806 for temperatures above 130°F. SELECTION GUIDE 98 Series Control Selection Model Volts-Ph Mode Amps Simplex Duplex M98 115 1 Auto 9.4 1 4 N98 115 1 Non 9.4 2 or 3 4 D98 230 1 Auto 4.7 1 4 E98 230 1 Non 4.7 2 or 3 4 1. Integral float operated mechanical switch, no external control required. 2. Far automatic use single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. See FM1228 for correct model of simplex control panel. 4. See FM0712 for correct model of duplex control panel or FM1663 for a residential aRemator system. CAUTION For iMormatron on additional ZceNer products refer to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FM0477;E~lric~Attemator,FM0486;MechanicalAttemator,FM0495;SumplSewageBasins,FM0487; licensed electrician. All electrical and safety codes should be followed including the Single Phase Simplex Pump Control, FM1596; Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: P.O. BOX 16347 Loulsvilfe, KY 40258-0347 Manufacturers of.. ~ ~ SNIP T0: 3649 Cane Run Rued / O ~~~ LouisNlle, KV 40211-1961 ,QVi![/TYP//MOAS.vCE /~3i! ~,~„N,,,,:oel-,ercom PUMP !O_ (502) 778-2731.1(800) 928-PUMP FAX (502) 774624 © Copyright 2004 Zoeller Co. All rights reserved. Psi ~r 'r'1 RECEIVED ~A~...~.-~ #2293 20001 EVALUATION REPO ~~' " JUN I 1 Department of Comm rce m acco ante with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and uildi Gustum Septic Service CROIX COUNi' Y County Attach complete site plan n paper not less than 8'/: x 11 i hes in size. Plan must St. Croix include, but not limited to: ve i oint (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. t ~- ,n Please prfnt all Information. Review By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ d `7 Property Owner ~ ~ Property Location Anderson, Jeff lv s sj~, ~,~. Govt. Lot n/a NW1/4, W1/4, S2, T30N, R16W Property Owner's ailing Address ~ '~ 1 ~ ~ ~ ©~ Lot # Block # Subd. Name or CSM# ~~ 1451 33rd Street ! C . ; ~ - ~ n/a n/a N/A ~~~/ City State Zip Code e ~ y_j City ~ Village ~ Town Nearest Road Turtle Lake WI 54889 715-986-2652 Emerald 250Th Street /~ New Construction Use: 1~ Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD _f Replacement -.~ Public or commercial -Describe: Parent material glaoial till Flood plain elevation, if applicable n/a ft. General comments Part of 80 acres. Recommend mound system along 99.5' contour. and recommendations: - ""--~ i, Boring J Boring # Vf Pit Ground surtace elev. 100.0 tt. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff/t1 ~EfP/k2 1 0-9 10yr3/3 none sil 2mgr mvfr as 2f,im 0.6 0.8 2 9-15 10yr4/4 none sil 2msbk mvfr cw if 0.6 0.8 3 15-26 10yr4/6 none sil 2msbk mfr cw - 0.6 0.8 4 26-32 7.5yr4/6 none gr. st 2msbk mfr cw - 0.6 1.0 5 32-48 7.5yr4/6 c2-3d 10yr7/2 7.5yr5/8 gr. scl 2msbk mfr - - 0.4 0.6 ,~ 2 ~f Boring Boring # ~ Pit Ground surtace elev. 9$.3 ft. Depth to limiting factor 29 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPDfft= in. Munsell Qu. Sz. Cont: Color Gr. Sz. Sh. •Eff#1 ~Efrt/2 1 0-9 10yr3/3 none sil 2mgr mvfr as 2f,lm 0.6 0.8 2 9-16 10yr4/4 none sil 2msbk mvfr cw if 0.6 0.8 3 16-24 7.5yr4/6 none gr. sl 2msbk mfr cw if 0.6 1.0 4 24-29 7.5yr4/6 stoney gr. scl 2msbk mfr cw - 0.4 0.6 5 29-45 5yr3/4 c2-3d 1oyr7/z 7.5yr5/8 gr. scl 2msbk mfr - - 0.4 0.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS <30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St. New Auburn, WI 54757 4/20/2007 715-658-1344 1tlU-83301R,07/001 ~~ ~;~ ~~ '~~ a.~.,, ,..~ Property Owner Anderson, Jeff ~'` ~ Parcel ID # _kn Page 2 of 3 3 ~ Boring Boring # Pit Ground surface elev. 100.0 ft. Depth to limiting factor 27 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#1 'Eff#2 1 0-5 10yr3/3 none sil 2mgr mvfr as 3f 0.6 0.8 2 5-12 10yr3/3 none sil 2msbk mvfr cw if 0.6 0.8 3 12-17 10yr4/4 none gr. sil 2msbk mfr cw - 0.6 0.8 4 17-27 7.5yr4/6 stoney gr. sil 2msbk mfr cw - 0.6 0.8 5 27-50 7.5yr4/6 c2-3d 10yr7/2 7.5 r5 8 9r. sl 2msbk mfr - - 0.6 1.0 ~----~ Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 •Eff#2 J Boring Boring # r] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Efr#2 `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 c need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i RBD-8330 lR.07/001 GuStUm Seotlc Service <: Pro ert Owner Anderson Jeff -"~"~' P Y ~ Parcel ID # Page 2 of 3 3 -« eve ypiYt~hn.936AAW tc.0e..µ ~ Boring Boring # ~ Pit Ground surface elev. 100.0 ft. Depth to limiting factor 27 / 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 0-5 10yr3/3 none sil 2mgr mvfr as 3f 0.6 0.8 2 5-12 10yr3/3 none sil 2msbk mvfr cw if 0.6 0.8 3 12-17 10yr4/4 none gr. sit 2msbk mfr cw - 0.6 0.8 4 17-27 7.5yr4/6 stoney gr. sil 2msbk mfr cw - 0.6 0.8 5 27-50 7.5yr4/6 c2-3d 10yr7/2 7 5 5 8 9r. sl 2msbk mfr - - 0.6 1,0 ---~-, Boring Boring # ~,.f Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ~Eff#2 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz: Sh. 'Eff#1 'Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L 'Effluent #2 =GODS < 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 ~ need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i SBD-8330 (R.07/001 Gus[um Seutic ServlCe -~~- O V -~~- m Q ~ l/d ~ ~ s ~ ~ ~~ ~~ ~ ~ _ ~ ~ ~ c9 ~ ~'s ~~ .., e., I ~ n. N N M m N ~ ~ ^ m0 j U ~ ~ ch a , ~~~ 983 M ~~~` ~ • 5 ~`~'` .. c~`~ 1~ °° ~ ~ ~ ~ C G I 0 ~ ° ~ I ~ Q. ~ a ~ ~ I - __ _ ~ __N _ _ ~ ~'"1 ~ ~ I' ~ Q Q 2 = N N f0 ~ O ` ~ p, ~ _ _ ~ r- ~ ~ O O ~. ~t 2 Y Q O ~~ O ' C _ ~ O Oo 8 ~ Z ~ O to e- i- W ~> w ~ ~ W M ~ J , .1 m W J - Id II ' A (/J c ~ O L ~ • ~~ 3~~3S 4~05Z STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number WARRANTY DEED This Deed, made between Donald J. Arvold and Beth Ann Arvold, husband and wife, _ _ __ Grantor, and Jeffrey S. Anderson, a single person, and Mary L. Sonnenberg, a single person, as joint tenants, i Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ _ County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): I Illlil (Ill] ilill lll{l Illil lull Ill] ililil l{ii {ii{ 84755 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/04/2007 11:OOAM WARRANTY DEED EXEgPi ~ REC FEE: 11.00 TRANS FEE: 501.60 PAGES: 1 Area Name and Return Address T. M. Title Services, Inc. 315 East LaSalle Avenue Barron, WI 54812 010-1005-95-000; 2.30.16.28 010-1006-10-000; 2.30.16.29 Parcel Identification Number (PIN) This is not homestead property. (1t5~ (is not) The West Half of the Southwest Quarter of Section 2, Township 30 North, Range 16 West (in the Town of Emerald). Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encutnbrances except highways, easements, restrictions of record, and any acts and/or omissions committed by grantee. i Dated this /3 _ day of March J. Arvold Signature(s) AUTHENTICATION authenticated this ~ day o~,sZ'`4tart+ttrrr~, ,~ ~~ ~. ~Ai~°~ rs •..' ... ,. , 1 ------- -- c= '_ - ~ ~--'~ ~;a~- "` -- -- _ `a~te' : ~r.~ 9~ : _~ TITLE: MEMBER STATE BAR~FWISC~OI~S~IN ~ (If not, cP ~,,~ \G g r4-, ~- authorized by § 706.06, Wis. `~l~,ti' •~ ~~t. G,O``~~ THIS INSTRUMENT WAS 1~ t itN~•~```' Mark O. Dobbcrfuhl, LIDEN & DOBBERFUHL, S.C. PO Box 137, Barron, WI 54812 (715) 537-5636 (Signatures may be authenticated or acknowledged. Bo[h are not necessary.) 2007 . * Beth Ann Arvold ACKNOWLEDGMENT STATE OF WISCONSIN _ ) ss. BARRON _ County ) Personally came before me this _ __~~~ _ day of March _ 2007 the above named Donald J. Arvold and Beth Ann Arvold, husband and wife, to me krt o be the pets s w xecuted the foregoing instru agd ac]cnow th tHe. * ,-~~L _ Notary Public, State of Wisconsin _ _ _ _ My Com •ion 's erman nt. (If n t, state expiration ate: * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY [J F_ED STA'1'F. BAR OF WISCONSIN 1 of 1 FORM No. 1 - 2000 INFO-PRO (800)655-2027 www.infoprotormscom 04!18/2008 15:24 FAX 715 9813 44013 SANMINA SCI f~j001/001 BOOB-134-18 07;39 4UEIS 7154580740 >} 715 986 4406 P 2/2 ST. CRUIX CUUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND awNERSHi~ L'~RTYFICATI{lN FORM ()wn~t-/Buyer __ ._~.-_ _ . _ ~-- ._ . ..... Mailing Address ~ ~ ~ ~ ~~,~ 4 (~ T'roperiy Adtirzss S Qom- ~ ~ ~ ,,....... J~ ,p~ (Verification trgttired Planning dt Ing D~ertntent far now canKtntctiunJ /~,ry~ CitylStat~e~~ ~~ N li/.~ Parcel Tdcntificat:inn Nvmlx-r [~he~©:--, jQG~-' G'~ ~~ VV LEGAL DESCRIPTION ~~ ~~ Prop4rty Location V~.J _ ~ ~ t,4 ,Sere. ~-- , T ~QN R~,W, Town of .~f,~+..°~. , Suridiv'tainrt Got # Certified Survey Map # __. ,~/ ~ ~~~''~~' 5 Valarne __ , I~ag>r ~ _ _ _. Warit^a~nty il-eed # ~'ctr ~7` 7.~ _ , Vnlwtae ~{ _ , P~tga * ~ Spcc hcruvr yrri no t,,nr 1jRC~ idrntitiablr yrs no SYSTF~ MAllVTE~VANCE .~~+dD t3WN~'r~. ~,~RTTFICA-TIQN ImprUpcr use and mnintcnancc of your rcptie syetem eonid resulr in ire tue~rrnr ttrre failure to hnndlc a~,eccs. !'raper rttttint~nance canaiAr~t u(pumping out the septic tank nvcry thct:c ycarx ar sooner, if needed, by a Ifcert~ed putttpcr. What you put into the sy:stcm can aff~t the function of the ugrtie tank ac a veatrr»Znt stags in the wa,tC di:cpu~ul Ayatcm. Owaar mainrcnance rea~ruaubilities atr spceiliccl in §Comm. 83.52(1) and in Chapter 12 - St. Cmlx Gnunty Sanitary t,)tdinurtcx, T!-e property owner a~reeK m w-4,rnit ro St, Cmix County Planning 8c Zoning Uoparmrenc a certification form. xignui by the owner and by a master pfnuther, jc>urneytnun plumlwx. restriclcd plumber u< a licenxed pumper vertityins that i l) the on-sift wastewater disposal system is in proper:rparadng condition and/or (2I utter in~pcction and pumping {if nnca~aary), thn septic task i:ti <GSS than t/3 t'uA of +ludgm. f/wo. the undercigttdd baud tvad the 4buvc roquircmcnte; usrd agree w maintain the private f:ewage dis'pusa! syayem with the standards set fc-rdt, hrrein, u+.et by the 1]etr~rhr~rul of Cun~merce and the DnpartrftrM of Ndturat Re~nuruaac, 1trtc +,F Wisconsin. CeRifiwttiua surtiag that your septic system hag been maintained mint be completed bad rctur~tGd to the 5t, CYalx 4ounty ?lattning & Zoning Department within ;i0 days of d,r thrl~a year expiration dot®, C/wti certify that all titttcmcros nn thin t'cxm are trtts tr+ the tre,t of my/utrr krx+wtc~lge. Uwc amlun the awner(e) of ttre properly described above, by virn,e of a warranty deed recxkded in RegiKter ut' Deeds Of! ice. N r of bed dns ___~___,_, ~~ r~~~ _~_...~ I A'TURE OF APPL (S) DATE t'"'rMy infont~tion that is mi+rreprerentCd easy result in the r~amtary permit being revoked by the Pleuu-!ng & 7~+11ing D~cprrMccnt. *** include with this application a recorded warranty deed from the kegtstax of D~d.~ t~l°Ciee and a copy of the rcctif ad survey map it te:Cercau: ie tttnde in the wnrrortty decd. (Rlr"V, 005) 2008-04-18 15:48 715 gi36 4406 Page 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer Mailing Address Property Address ,0. a (Verification required fro Planning & Zoning Department for new construction.) City/Stat~i,,,1-~ t~~,.r~.~ Parcel Identification Number ~O loo ~~',' = T ~ CT71~ LEGAL DESCRIPTION 5 ~ Properly Location ~_ ~, ~ '/4 ,Sec. ~ , T c3 C7 N R~W, Town of Subdivision Plat: Lot # Certified Survey Map # ~U ,Volume ,Page # Warranty Deed # ~~"7 ~`~ (before 2007)Volume ~, Page # Spec house ~ yes ^ no Lot lines identifiable ~ yes Cl 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. property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er o bedrooms SI TURE 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. Uwe am/are the owner(s) of the (REV. 09/0'n Parcel #: 010-1005-95-000 04/23/2008 03:06 PM PAGE 1 OF 1 Alt. Parcel #: 02.30.16.28 010 -TOWN OF EMERALD 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 -ANDERSON, JEFFREY S JEFFREY S ANDERSON C - SONNENBERG, MARY L MARY L SONNENBERG 1451 33RD ST TURTLE LAKE WI 54889 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 2 T30N R16W 40A NW SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 04/04/2007 847755 WD 04/04/2007 847754 TD 03/24/1998 575667 1308/358 LC 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 5,900 0 5,900 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2008: General Property 40.000 6,000 0 6,000 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 6,000 0 6,000 Woodland 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