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010-1012-90-075
jFP" Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division t Sanitary Permit No: INSPECTION REPORT 499111 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)J. Permit Holder's Name: Village X Township Parcel Tax No. City Crist, Glen Emerald, Town of 010 - 1012 -90 -075 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No �Qp 8 J 65T- 05.30.16.78 3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ' ��5 CAPACITY STATION BS H1 FS / ELEV. 107 , Septic 3 Benchmark / Dosing 6a+ 3 Alt. B 4. Bldg. Sewer 3 /63 11 Holding St/Ht Inlet � 7,6 ( lob. 6 TANK SETBACK INFORMATION St/Ht Outlet �' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Al n / 5 i JS / Dt Bottom h� S Z Dosing / / / Fleader /Man. 3, 3 /63 . SsZ Aeration Dist. Pipe 3.3 163 •qZ.r Holding Bot. System 3.9(D 163.4G / Final Grade S3 PUMP /SIPHON INFORMATION Z • 3 164. Z 0/1r Manufacturer c'e'L.,_ � GPM a nd St Cover �, 7 _ s /D ,/ T . Model Number 3 5 l v7 S:So ,��.�3 �of.b3 TDH Lift i Friction Los Head TDH Ft 73 /. /� System 3 1 11,7 Forcemain Lengtth / Dia. // Dist. to Well . Z SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length / No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 75 3 N ___ `- SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Qf System: 'L y / - r A— A UNIT Model Number: o v /v DISTRIBUTION SYSTEM Header /Manifold / Distribution '/ t / x Hole Size // x Hole Spacing // VeAto Air Intake Pipe(s) 0T 1 , 1 4 " 4 � ? ✓ Length Z Dia Z Length Dia Spacing Z J/ (O J a . SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodde 1 xx Mulched Bed/Trench Center / 3( o Bed/Trench Edges \ Topsoil l �. Yes No Yes ]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1r�I `'> Ins pe . ion #2: Location: 2248 170th Avenue Unknown (SE 1/4 SW 1/4 5 T30N R16W) NA Lot 2 Parcel No: 05.30.16.78 3 eA_ 1.) Alt BM Description = F / C OJ e.L- f , II / �,„�yQ p�g�,,f — 2.) Bldg sewer length = 1 5 i - amount of cover = 3 ` J` �• il _� 5 P Vignatu Plan Use other de for additional in Yes No ZI 610 65� ' formation. Date 1 sepcto Cert. No SBD -6710 (R.3/97) Safety and Buildings Division County C2o/ N VIsconsin 201 W. Washington Ave., P. Box 7162 s/ ' Madison, WI 53707 2 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -315 , / cI CI I/ / Sanitary Permit Application Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you Q may be used for secondary purposes Pri ppl ED iect Address (if different than mailing ) I• Application Information - Please Print All Informs ' n 1 Y 2 2 q T ` A Je-- Property Owner's Name Parcel # Lot Block # �- /E,U G,�!'S r` OIXCOUNTY /p �0/ 2 y0 075 Property Owner's Mailing Address Property Location 1 72/ 2�0 - 5r 5 S!,!) G City, State , RIM / /'' Zip Code Phone Number %., Section 4 / ` �G Y! I��'l� v Gt/� !� y 0 0 5 S • 3,0 �6 E o (circle / U II. Type of Building (check all tbat sPP fw.. A e 1 �-- T N. �j b Subdivision Name CSM Number �l or2 Family Dwelling — Number ofBedrooms ••'r {� o 514 u ❑ Public/Commercial — Describe Use 7 �'� to/. 2 0 • .S 0, / ❑State Owned — Describe Use to 7J ` 0-) ❑City ❑VillageATownshipof III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. New System 0 R lacement ep System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal _ ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ' Plumber . Owner IV. Type of POWTS System: Check all that a Q-- ❑ Non Pressurized In- Ground gMound> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In-Ground 11 Holding Tank ❑Peat Filter ❑Aerobic Treatment Unit ❑ R ting Sand Filter ❑ If Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) �� V. DispersalIrrestment Area Information: Des' Flow(gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area R f) Dispersal Area Proposed (sf) System Elevation o ,' yso 5 s ry VI. Tank Info jCapac�ity in Total Number Manufacturer Prefab Site Steel F1 Plastic ns Gallons of Units h/l�, - ��. /pb Concrete Constructed Glass T Teaks anks 4 , Ia Ta Septic or Holding Tank oO Aerobic Treatment Unit Dosing Chamber Q O YH. Responsibility - Stateme� I the wade assume responsibility for Installation of the POW1S shown on the attached teas z � ed Po tY P Plumber's Name (Print) 1 PlSY/ Signatu MPARRS Number Business Phone Number RolW • 7`S.77k3gy Phmtbees Address (Snee, City, State, Zip Code) 29/2— /01% 4W, � "// 4/ 7 6 VIII. Coun /De artment Use On pproved ❑ D' Sanitary Permit Fee (includes Gro undwater Date Issued Issui gent Signs (No S Surcharge Fee) ❑ en R Denial 5 !5 c � 1/ D (p IX. Conditions of ApprovaMeasons for Disapproval SYSTW OWNEO: I. septic tank, eM1t1aM MW and dispersal cell must all be servites / maintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per appkable Code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 a 11 inches in size SBD -6398 (R. 01/03) 0 n of ,71 o ,,�r> F T p� D °' y' 1 c otj / The area 15 ft. below the downslope edge of the Soil Absorption System must remain undi oted. 0 - z X 03 JOY go il 41 0 35 • � J r1 135 7 5 , 411 � I ,r & �. t- Dp' 0 2,3 wj W? . m M. 8 o 7AAK . / 000 got 5 .T • w p�opoS�l> � IL ID c — , off of Y> f irji� ( YO , �pN The area 15 ft. below the downslope edge of the Soil Absorption System must remain undisturbed. 0 s.. ) p3 e log -D 1 03,8 5 0. �g a. S, O - J r� - i35 of � �- opc / , 0 0 , 0 ,w 2,3 /000 S,T• � &S o P, State of Wisconsin INSPECT N RECEIVED Leroy G. Jansky Department of Commerce De artment of Commerce Safety & Buildings Division REPOR 3 E Spruce Street Bureau of Fieldgperations SEP 2 7 2006 Chi pews Falls, WI 54729 Inspection Date (715) 726 -2544 z] s r ,4r U�. yo p y { ST. qry000NTY ( 3 Personal information u p ma b used orsecon CR ' a purposes (Priva Law, s.15.04 1 ) (m)]. Name of Premises Address or Legal Description County 4Zt�r C— :5 S I4�i.J FMEfiAq) , cR0 . Master Plumber Name and Address Master Plumber Firm Name and Address. Plan I.D. No. 2cj B kA(,6Q, c HT , MPk5, 77- ZV3 - 75' Za Sanitary Permit No. Journeyman Plumber /Soil Tester Licensed Person's Name(s) and License Number(s) ESm -,mss! .... _J(_ - G.�?RP��.� t�.,�1�?- _iN ,Tr•�� Owner's Name and Address k'r z_ t z z v t ► `ter ,�r�3`�'t�`T /�v*� 7 1- 1`�`E %5t-11 A) l ` _ ��tSs.ta,( m_.r..� . . L. M P l_�= y.--i 1 - .;N 1 l =�- _ 14C. - G.� Y t�.� S,. E. _ --- Gf••) m �� �4)w �3,1J ., E,aG l ltd • • ' a g S►Vt_ t�Lww �,rJ Cr` /1L(,tiltr . UPSC C�� 1st.GK�.0 _fib D Page r Of _� Signature of Responsible Licensed Person (only one needed) Sig_nat of Plumbing Consultant/ rivals Se age Consultant / Check all 1 Original: Copies to: lthatapply� A- — - sM-6192 (R.12M6) District 0 S &B 0 Plumber 0 Ow er 0 Cou /Local lns . 0 Oth ' Safety and Buildings commerce.W Lgov MADISON WI 53 07 -7162 TDD #: (608) 264 -8777 isconsin www•commer sin.go www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 02, 2006 CUST ID No. 226375 ATTIC• POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/02/2008 Identification Numbers Transaction ID No. 1296208 SITE: Site ID No. 716134 Glen Crist - Dwelling Please refer to both identification numbers, 170TH Ave above, in all correspondence with the agency. Town of Emerald, 54012 St Croix County SETA, SW1 /4, S5, T30N, R16W Lot: 1, CSM: 810425, V20, P5091 FOR: Description: New Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1088846 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. 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, A DEE stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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. * ROBERT W ULBRICHT Page 2 8/2/2006 Sincerel Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 eter E Pagel Private Sewage Plan iewer, , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ULBRICHT & ASSOCIATES CO. 28121 Ave. • Spring Valle Y, WI 54767 'eg Designers of Engineering Systems ) , 2006 Private Sewage Consultants 715-772-3442 JUL ' PROJECT INDEX f Plan I.D. # Date U i, y 2 0 (0 U6 - Pho ne 7/5 - ( 0 0 5(- Ss IS; Owner 6-lElv CRY!; T r Address 27Z V le,0-4.4f o , (j 0 40 ' 5 i, Legal Description CSA4 . V101 299 Pg. SO?/ 5e, SA/f SEcr- S. T 3 o,J, R I & LO Town of,y,4 GLj County ST cP-or K C.S.T. Installer (,old 2 z .97 7 4L-( R I'C& 7 Local Authority/ Supervision 54 - CP 0 1')( C I Y. Ze-Jf'xa c,- PROJECT DESCRIPTION 1 t1bZ0 e6A)57TUCri3OA.) — 3 13 e - 5 ' 1��,c> los d w 43 � flo Uj = yso ( f ------------ Ve-u TIaPVA t, A/ 0 0/0 s / V S /g " -�� •tea � �/�o�oJ'� 2,2- 4e3 - 7 5 THIS POWT SYSTEM SHALL q(LGRtC117 INCORPO PER COMM. 83.44(2)C A RATE PROPER ZABEL Vt Ulbricht & Associates FILTER MODEL Private Sewage Consultants OP 2812 10th Ave. Spring Valle lie WI 54767 2- Pg.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM AN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP*FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CROSS SECT 100 O MoUAj D w i r t4 'f3�ED SeD OF % " ro 77i St +(3uT�oy Agg,ecgATe Tkick4es3 Pip r,u C,- oF T °p s o t s w/ -rAe1 i f/4L- s ys r eE A E lE A riOa u)J` FvR ToE SAPP PIawgo T o p So uu i F ©RM SioPE EtMOAT 00 ()A DER FT. F-LevAriop�35 o O t F iuvERr of y IATERM -5 f o 4 •�� Fr•l F • Trop of 'Ro joy' go H 40 TdQ IATERAIS �. r FT• PLA VI EW of MOUJJD -- wi ri BE c E o rft&l FC Pct MAiA1 A FT -- _ 13 Fr K // Fr 97 r F 1 O t 5 f w F T' s w 3© Fr Sao of % y Pvc SAPPED To JAI-_" A°! j RI` G-AT� 4% ' -d 7i'e it W HEAD CAPA Y CURVE METERS YNAMICHEADFEET/ o ' 4% MODE -139 CAPACITY GALLONS /LITERS o 30' HEAD UNITS/MIN + o 00 ' _ _ 1'h-11'h 8 FEET METERS GAL LTRS NPT 25' 5 1.52 104 394 10 3.05 79 300 W 0 = 15 4.57 64 242 v 20' 20 6.10 36 136 i a 6 25 7.62 8 30 0 26 7.92 0 0 1 FO 4 10' 2 ` 5' I 12% � 0 U.S. 10 20 30 40 50 60 70 80 100 110 GALLONS - 4 LITERS1 8o 160 240 320 400 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 23OV. a Mercury float switches are available for controlling single • Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. • Double piggyback mercury float switches aFe available for • Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. • Long cords are available in lengths of 15- 25 -35 -50 feet. • Combination starters are available. • Over 130 °F. (54 °C.) special quotation required. Standard All Models - Weight 47 Ibs. H.P. SELECTION GUIDE SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. 137/139 Seri" Control Selection 2. Single piggyback mercury float switch or double piggyback mercury float Modal volts Mode Amps Simplex Duplex switch. Refer to FM0447. M137/139 115 1 Auto 10.4 1 or 1 &8 _ 1 3. Mechanical alternator "M -Pak" 10 -0072 or 10 -0075. N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4. Combination Starter. Refer to FM0514. 0137/139 230 1 Auto 5.2 1 or 1 & 8 5. See FM0712 for correct model of Electrical Alternator "E- Pak ". E137/139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 6 6. Mercury sensor float switch 10 -0225 used as a control activator, specify 'H137/139 200 -208 1 Auto 8.2 1 & 8 — duplex (3) or (4) float system. '1137/139 200 -208 1 Non 8.2 2&7 3 or 5 & 6 7. Four (4) hole " - Pak ", junction box, for water tight connection or wired - *J137/139 200 -208 3 Non 2.2 2&4 3 &4 or 5 &6 simplex or 2 pump operation, 10 -0002. 'F137/139 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 8 Two (2) hole "J- Pak ", for Watertight connection or splice, 10 -0001 G137/139 460 3 Non 1.5 2 &4 3 &4or5 &6 ' No molded plug Three phase units require a control switch to operate an external magnetic or combination CAUTION starter. All Installation of controls, protection devices and wiring should be done by a qualified For information on additional Zoeller products refer to catalog on Combination starter, licensed elactrldan. All electrical and safety codes should be followed Including the FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Safety and Health Act Mechanical Alternator, FM0495; Alarm Package. FM0513; and Sump /Sewage Basins. (OSHA). FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of .. . OELLE�P O SNIP T O: 3280 Old Millers Lane Louisville, KY40216 ` QUALITY ALLIMP9 �hlrr 1,7,7, N (502) 778 -2731 • FAX (502) 774 -3624 SECTION: 2.20. FM04 ,Q AL /TY OELLE/P T A 9-r U PUMPS �NCE 109 � Supersed 08 Product information presented here reflects conditions at time of MAIL TO. P.O. BOX 16347 • Louisville, KY 40256 -0347 publication. Consult factory regarding discrepancies or inconsistencies. SHIP TO. 3 Old Mille s FAX (502) 774r3 Y 40216 778-2731 e 624 COMPARE THESE FEATURES • Non - clogging vortex impeller design. " �37 " Cast Iron Series • Float operated, submersible (NEMA 6) 2 " pole mechanical switch. 139 �� Bronze Series • Durable cast construction. Cast switch case, motor and pump housing, base "" MATE and impeller. No sheet metal parts to rust or corrode. • Stainless steel screws, bolts, handle, guard, and arm and seal assembly. FOR SEPTIC TANK SYSTEMS • Bronze units available. EFFLUENT • UL- listed 3 -wire neoprene cord and plug. 10 ft. standard for automatic. OR DEWATERING PUMP 15 ft. standard for non - automatic. ,SUBMERSIBLE • Automatic reset thermal overload protection. 1 NPT DISCHARGE • Oil filled motor — hermetically sealed. • Carbon and ceramic shaft seal. • Maximum temperature for effluent or dewatering - 130 ° F. - 54 °C. • 60 cycles, 1725 RPM. rnrsaa • Passes % inch solids (sphere). • sump s Sa wago Pump No screens to clog. Mfg. Assoc Assoc I, SSPMA Specification • 1 NPT Discharge. Number • On point -9 u 139 Series 5811115 • Off point -3 ". • • Major width - 113/4 ". LISTED • Height -13 ". I SIMPLEX AND DUPLEX SYSTEMS AVAILABLE PACKAGED SYSTEMS AVAILABLE VARIABLE LEVEL CONTROL SYSTEMS AVAILABLE ff,-ZZIR- Z ff. DESIGNED FOR HEAVY DUTY EFFLUENT APPLICATION MAIL T0: P.O. BOX 16347 MODELS AVAILABLE Louisville, KY 40256 -0347 SHIP TO: 3280 Old Millers Lane a Automatic or Non - Automatic Louisville, KY40216 • Y2 H.P., 1 Ph., 115V, 200 -208V or 230V rcnm 774 -9711 • FAX IMA 774 -3624 • '/2 H.P., 3 Ph., 200 -208V or 230V OWNER•s MAINTAINCE"OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation a maintenance of.thi system g , Re ular nd servicing is necessary for the safe healt'hycoperationooi.thi s ' systein. The owner is required -by code to submit all necessar� maintenance /inspection reports to the controllin y g, authorities.. SPECIFIC CONTACT AGENTS G— *. G o vernmental authority/ inspectors: �P T 396 -ZI&SO Licensed installer, responsible for maintenance "Users" manual: Providing an operation/ Z 5 ZLP 3 -? * Licensed service / i nspect-ion - agent other than installer: TiPI _ Electrician for pump, el' ectric controls, wiring units: ,y �� •LDS S f-e 7W IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic.-(sledd3n area shall not be g shoveking, etc.) across the the cell, freezi permitted, or frost can /will penetrate into winter, g P- lead to freeze e ups the system. Discontinuos use in the (a fr rip, resulting in no water .use) can -also ups . " 2- Water conservation - needs to be h d e r x o e Y l r t- icall eased. O Y overloaded r s desi rloaded and destroyed . system can be clued for a maximum wastewater flow of syskem was - g daily. I 3. POWTS are not desi gned to . disposal unit accomodate wastes from a garbage,_. or any other unnatural s - Any introduction of such waste- will waste. aterials ources of - -^ destroy this system. li overload. -and 4. If a power outage - occurs, or a um In a temporary P p fails, it may result ll' overload of effl cell, which uent being pumped into the may adversely impact the cell (leak&'ge). It is recommended that a licensed allowing the Pumper empty the dosing tank, Consult Pump to return to dosing the correct amounts. four installer Immediately for advice. �. Neglect of the ve erosion g "cover Preventi (the cells insulation & traffic ve) can lead to failure. Co m p act i on also can destroy t he system. REGULARLY WATER T It IS HE VEGETATION OVER A SYST N ECESSARY TO or heavy N the- -Vystem beneath IS N e NOT sufficient alone Effluent in t0 maintain a Mound system Management Plan r D f . � •� ' • Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed Ol in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet ester shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids In the lank that may slough off the Mier when removed from its enclosure. If the frier is equipped with an alarm. the filter shag be serviced If the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shag have its contents removed when the volume of sludge and scum In the tank exceeds 113 the fgtrid volume of the tank. If the contents of the tank are not removed at the lime of a triennial assessment, maintenance personnel shag advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation M the tank. The addition of biologi or chemical additives to enhance septic tank performance Is generally not required. However. N such products are used trey shag be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. . Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shag be tested to verify proper operation. if an effluent fitter is installed within the tank it shag be inspected and serviced as necessary. Mound and Pressure Distritmm. Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shag be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traflic (other than for vegetative maintenance) on the mound Is not recommended since son compaction may hinder aeration of the Infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather Installations ( October - February) dictate that the mound be heavily mulched for frost protection. ' Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg/L TSS, and 30 mg/I. FOG. Influent now may not exceed maximum design flow specified In the permit for this Installation. The pressure distribution system is provided with a flushing point at the end of each lateral. and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed 4 should be compared to the Initial test when the system was Waged to determine t orifice dogging has occurred and If orifice clearing Is required to maintain equal distribution within the dispersal roll. Observation pipes within the dispersal cell shag be checked for effluent ponding. Ponding levels shag be reported to the owner, and any levels above 4 inches considered as an Impending hydraulic failure requiring additional, more frequent monnoring. G eneral This system shall be operated In accordance with Comm 82-84 Wis. Adm. Code, and shag maintained in accordance with its' component manual ISBD- 10572 -P (R. 6199)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shag be in accordance with Comm 83.33. Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic br pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shag 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 S*v:hm In dameter shag 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 its components become defective the tank or component shall be repaired or re r red system In proper operating condition. PI to k eep the If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shag be Immediately repaired or replaced with a component of the same or equal performance. If the mound component fans to accept wastewater or begins to discharge wastewater to the Inures g g b surface, it win be repaired or replaced In its' present location by Increasing basal area # be leakage occurs or by removing bio�doglcagy clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary In bring the system Into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. r - 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �S �E/� Cj2/ S % ling Address a M,4t L y Address 1 72-1 220 `s% (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number �r7�Z • � • 4 7 -s LEGAL DESCRIPTION Property Location Se 1 /4 , 860 1 /4 , Sec. 5 , T 3 6) N R 16 W. Town of Subdivision , Lot # Z. Certified Survey Map # Po yZ S , Volume 2, 1 0 , Page it S O y q()I r 61,41A� v Mhwran Deed # 4 l w / d � , Volume , Page # Spec house yes no Lot lines identifiabl yes 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 phimber 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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms SIGNAT OF APPLICANTS) 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) D Q Wisconsin Department of Commerce OIL Page I of 3 Division of Safety and Buildings in accordance wit Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 1 incheor�3e. �I rrpt 4 include, but not limited to: vertical and horizontal referen point (B dir l dnd� Parcel I.D. percent slope, scale ordimensions, north arrow, and to n ang�is� N cri N�e �� ding ( -1y d Please print aN inforrnat ZONING OFFICE O N ewed Date Personal Information you provide maybe used for secondary purposes (Privacy La S.15 ............ Property Owner G �� roperty Location El William & Darline Dear G ` SE 1/4 SW 1/4 S 5 30 N R 16 ©) Property Owner's Mailing Address r T Subd. Name CSM# Y S 1721 220th Street - Demar .Z City State Zip Code Phone Number ity [3 Village ■ ]Town Nearest Road New Richmond WI 1 54017 ( 715 -684 -3555 170th Av Vu El New Construction User Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPO 11 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable N-A ft. General comments _Site suitable for a mo und and recommendations: BM Brx = be oc encountered J'�4 J• S � -�� B �Z Skid al � I 0j' 4r?' mP 4e&J J. .9s B I ? a Boring # 0 Boring El Pit Ground surface elev. 100.50 ft. Depth to limiting factor 18 - Brx in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cornsiste oundary Roots GPD/fP in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 7 -18 10 3/4 sil 2msbk mfr cw if .6 .8 3 18 -30 10yr3 /4 Brx - _ _ _ _ - F2 Boring # Boring 00.40 34 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox D ption Texture Structure Consistence Boundary Roots GPD/}C� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -5 I0yr3 /2 A 2msbk mfr as 2f .6 .8 2 5 -10 10 4/4 sil 2msbk mfr c' if .6 .8 3 10 -34 7.5yr4/4 ifs Osg mvfr cw _ .5 1.0 4 3 -38 7.5yr4/4 SO Om mfi - - .0 .0 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = B09 30 mg/L and TSS < 30 rr@& CST Name (Please Print) Signature CST Number Thomas C Nelson " 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 9/26/04 715- 246 -2454 Property Owner DeMar Parcel ID # P ending Page 2 of 3 FT] Boring # Boring g El Pit Ground surface elev. 103.85 ft Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -10 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 10 -22 1 10 4/4 - is Osg mvfr cw if .7 .8 3 22-28 7.5yr4/4 - is Osg mvfr cw - .7 . 4 28-39 7.5yr4/6 - scl Om mfi - - .0 .0 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. - So ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF 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 < 30 mg& 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. SBD4330Test (R.07 /00) r William & Darline DeMar � scale 1" = 30' Lou BM1 top off conduit pipe 100.00' BM2 op of conduit pipe 99. B1 100.50' d� 02100.401 NOO 83 103.85' a� !03 6 6 M � ISS 3 6 g oQ 0 /6D � O /o L /o y' co a Thames Nelson �rxrsa� William & Darl DeMar Scale 1" = 30' Lots 1 BM1 top of conduit pipe 100.00' BM2 Top of conduit pipe 99.95' B1 100.50' B2100.40' B3 103.85' Nort b 03 AtAl 61 z T 7G , 1 SS 3 Li 3 S f5 3 ' g oQ� 0 0 /o L ✓a y' e�- Co Thomas Nelson 'r22T38T William & Darline.DeMar I too of conchnit pipe 100 scare �� = 30• L ots. 1 'l B "1� pipe ss. & BZ 100.40' &tt P'l - �J 83103.85 , N or t l0D d/ X03 6M� ` ASS / 74� 6 0 iao C 0 Thomas Nelson ZW=7 EMERALD P T -30 -N • R -16 -W (L See Page 112 For Additional Nunes. CYLON ]PAGE 70 FORUT PAGE 72 Q S - 2400 2500 8 2S loseDh 8 lohn & Pahlcil Sp ,�� Rodney FORK ~ y 121 Gillen 1 S cConvtlle 126 nr � w«O Chad & & Ranae w Iisep William ry Peter &Da m Kristine .�. Donna Courtney I I N Denutd GiBen 81 119 R011tce� .. Hi� I 1 2 WOS a lames & c Kevin 232 2 391 317 .11 D WNett 80 317 ^ Wftimer b Dak & !d m er 70 �,r�G J g Dennis & y ssa.e � Uaarrie 4o 170 S also 3 .7 2 97I Izo Axeu Henkel 62 McNamara 770th VE V 40 3 160 160 < Quinn Gloria a 'T n ; 6 a �n 35 Ma Family L 3 W °miak d tr � Trust B & 03 Beth a Ra�nae Djoselam • $ 134 79 0 3 Arvold Henderson a ohn & 146 120 am 160 Bounle I c- 7 & ices. Dan REEK I 90 �kot6ank�t 2� Wm s . 11 . 4 , & Dennis & Lster C & D Doris as S Da.Ne We - a Potts AL.* a 1 OOH Greg � 79 160 6 40 40 160 80 156 d " m `19 - 11 I 153 A 7 149F4 Pahl 160th AVE & land t Anderson MaXIM 2 KeR a 4 �• 78 F�4I "Annular- g n ld � N orman Kenneth & � 1 v 53m q Mark back 110 119 Trust !, &�6mrman i ds & m a 1'rnst � 1 N ^ Claudia & 0 159 80 dS 6 Klatt 1 0 231 w jr v~i a Emilia $ V Eauard & j EM Mal Mazrarella M ��1lRB c 240 160 r-11. 69 "�`• tL 40 120 36 R 200 gp m 373 _ ilmptiq e 8 4 G Q � R N 22 � Wlerie C n 6�n Robert & Sps A �� B ; MtDE 1 aD� >I Norman hrolm 4e s ue �. Derrick &Manta u ! l & Vrieu Li & a 19 ggg RUN 6 Moore z 3 II s 1 "m' z 37 14, 24 11 a g °� � .Fart & $ ' Har9ey t � 308 Jig n 4f G4tO0 Dmaa H 80 m Susanna a Mi chael w & Bernice _ Bernice >2 4 3 = Dime e a 10 5 Dorwlu n J ensen 77 R a°sQ a Tim & .140th AVE W Ravel r' 41 278 240 105 Gruel a Kayleen Omann Dennis name a 60 Horud & Mari 33 LA & Edon inn 8 'sl a Steve Dew & so _ -0 p f , dig RKbar —a. - 160 sus- bon - Wbeft 7 - A A Gu7 & a � 8 N 40 141 N s t7 L Nadeau )a � 83 1>nn amo Davis 1 160 120 Rus hfddt 0 _37 Ju1i� m v Mks, G>ty 1� . dt a R 120 .'E a 1A/ David N e N Bonn ss e" Daniel °n aldroff�� Hm�m 6 37 40 s a'�1 11 u line Miller V .,— Lam AVE 80 R �e.op Hee- a 150 77 3 58 m bdalc a o $ a.a.� ]� nOOS Iteurm f' A Thomas S & &Doris as Gene & & )udv ac � & 20 pAp�arpn �OmP" � 40 n xa4 S Ottg y Smith ]IS ^ Wink jer p Nadeau S A�ieMcz I { p °ac C H n Anna zs a �,,, Cr 10 !u Lundeen Rausch sot saR 20 Steven d 42 m0 �a (� u a Sletaen a Janet B 19 6 20 U.M. E dward 135 1 Hone 3 M r ^ & Erika Wollack C Arissa uc � 148 0 � 6 � ° I�� Fredettck D E 156 ;p DD 2 �'m BALDWIN PAGE 40 153 i I Q ualit y I+ I 15 Come visit our model home 2 miles South of New Richmond on Hwy. 65 =C -22 -2004 17:30 FRUM:Jtu Wwvzl—��� -- - • I � t pODd1 9-24 r E CLEAN CERTIFIED SURVEY ' } P (3 Located In part of the Southeast Quarter of the Southwest Quarter of Section 5, Township 30 North, Range 18 West, Town of Emerald, St. Croix County, Wls¢onsin. NGRW 1/f COIRNER SEa "0-16 A spacial exception use permit Is required for the dlstufbancs of elopeq 207G or (f17(JND ALf'Jill/NUbI �� COUNTy MavuMAWO greater not identified on the a ppproved plat or CSM. This permit Is applied for through the zoning office and le reviewed through a publlc hearing proc4ss by the St. Croix County Board of Adjustment. NOTE: The parcels shown on this map are suaject to State, County and Township laws, rules and regulations (I.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or devslcping an parcel, contact the St. Croix County Zoning Office and the opproprlate Town Board for advice. m NOTE: Outlet 1 Is being ;rooted for sale and future conversion to a buildable lot. Farmland Preservation laws prohiklt Outlot 1 from being a buildable parcel at this time. UNPLA , --- I Lq„ND,� S8T59'21 "lE 380.00' a 190.00' 190,00' ?.Z' ?� Oo 9 g Ln cr TOTAL AREA: .� 93,527 SO. FT. '° so w 2.15 AORES LOT 9 N IO sk B EXCLUDING R.O.W. TOTAL AREA: ! i 87,257 SO. FT. 93,527 SO. FT. i~ j� 2.00 ACRES 2.15 ACRES �4 w .A EXCLUDING R.O.W. - O w 87,257 S0. FT. CA P) l S g 2.00 ( 1CRES O .. ....... ....... 66' JOIN T DRIVE ' EASEMEN A FENCE ' 2.76' �y33.05 N 87 i 59_21' W X 380,00' 33,05 NO 7H 121" 2309,29' 190,00 190.0� 87.59' 50.00' 19 A0' =uNE aR 7 HE SW14 — 9 sous r ST OWNER - N8759'21 "W 2889.29 ' - SEC SW1N 11 4 AMN FRaW I ND: -T - - -- W PK NA/L Section Corner Monument PR W nfS) of Record c - i" „ in" n n iemn Pine walehina SEC -22 -200 17:30 FROM:JLU L-UrvSUL-' -L"1u voOGE 9.2484 i % WAR IAKF r Va (3S O f CERTIFIED SURVEY P Located I 30 North, t Range u 16 West,, Q To wn of Emerald, St B Croix County, Wisci � ons n. Township NORTH 114 GARNER SEAS -30-16 p C NTY MONUMENT) A special exception use permit Is required for the disturbance of 81 PO s 2096 or � greater not Identified an the approved plot or CSM. This permit Is applied for through the zoning office and Is reviewed through a public hearing process by the St, Croix County Board of Adjustment. N p NOTE: The parcels shown on this map are suhject to State. County and Township laws, rules and rsgulatlone (i.e. wetlands, minimum lot size, access to parcel, etc,). Before purchasing or developing an Bo parcel, contact the St. Croix W C Zoning Office opd the appropriate Town ard for advice, rn NOTE: Outlot 1 is being treated for sale and future conversion to a buildable lot. Farmland Preservation lows prohibit Outlot 1 from being a buildable parcel of this time. UNPLA TIED LAND -S + 2E OWNER °- S87 380.00' 190.00' 190,00' 2.2' Ir N Ia D� a J I O O 0 rri m o c IZ Ln I Ip w c ; r,, � c� OWLOT 1 rn r*i $ { z 25 L n cn TOTAL AREA: vn I C •` 93,527 SO. FT. t° w c 2.15 ACRES v, LOT 2 gj- i� °� EXCLUDING R.O.W. TOTAL AREA: I ►q 87,257 S0. FT. 93,527 SQ. FT. Ia I� 2.00 ACRES 2.15 ACRES I� P +O � EXCLUDING R.O.W. -P am O I I W 87,257 SO. FT. c L4 ,, i) I rn S g 2.00 ACRES I ... .. O 66' JO /NT —DRIVE EASEM0N ' ,- FENCE 33.05' 3J 33.05' 2.76' _ .0 33.05' N87'59 W �" 380,00' 33.05_x. i NO TH N8 7.59'21 " 00 2309 + '! 19Q, + 190.00' _ 90.00' 190.00' I 9 21 80.00 SAUTH LINE a- THE SWI14 SWrHw CORNER — N87 "W 2689.29' —�� �— SE0.5— Jo--fa SWTH 114 PORN& (ser PK wa 6NPLATTP LANQS W0.5-30-18 FROM WS) LEGFN (sEr PK NAIL FROM TIES) Section Corner Monument of Record *lob► 8 1 �4 ii?5 VOL 2 0 PAGES ` 5091 HATMMM H. V ALSW_ REGISTER OF DEEDS VI RRECEIV WORD CERTIFIED SURVEY MAP 18/2612NO 02:55PH Located in part of the Southeast Quarter of the Southwest Quarter of Section 5, CERTIFIED SURVEY HAP Township 30 North, Range 16 West, Town of Emerald, St. Croix County, Wisconsin. REC FEE: 13.88 NOTE COPY FEE: tE 3.88 This map cancels and supersedes Certified Survey Map recorded October 10, PAS: 2 2.005 in Volume 20, Page 5085. Lot numbering has been changed at the NORTH 114 CORNER request of St. Croix County Zoning and a Farmland Preservation note has been SEC.5 -30-16 added. N (FOUND ALUMINUM .. :pecial exception use permit is required for the disturbance of slopes 209: or COUNTY MONUMENT q: eater not identified on the approved plat or CSM. This permit is applied for through the zoning office and is reviewed through a public hearing process by . the St. Croix County Board of Adjustment. o 0 . NOTE: The parcels shown on this map are. subject to State. County and 4 I Towiiship iuws, ruies and regulations (i.e. wetlands, minimum lot size, access to Of parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix w County Zoning Office and the appropriate Town Board for advice. m l his CSM is subject to a Farmland Preservation Agreement. ( .71 0 0 � U � NPLA TTED LANDS , OOW OWNER o g S87'59'21 "E 380.00' 1907 ;U \ M m in 190.00' 22'- -- 2 z t r� 1� —0m �y I m;V i t 1Z 0 (n 0 M IOo o C am I U) co O 1 [` O O O Uj m p 2 r) 11, ED coo O W , �cno I Z ai c0 rrt I C - --4 O W W I� m00 LOT 1 w cn ; J T Ln TOTAL AREA: � C a , m 2 = m 93,527 SG. FT. -° c� c 2.15 ACRES Ln LOT 2 zo c ly u 0 CO 1 EXCLUDING R 0. W. O 111 Z TOTAL AREA: - 1 87 257 5Q. FT. I � 93,527 SQ. FT. � � m 1 2.00 ACRES 2.15 ACRES 1 a 1 b I �o ID EXCLUDING R.O.W. 1� I� w 10 Z p uA 87.257 SO. FT. W i � I 0 2.00 ACRES .......... 6 66' JOINT DRIVE O EASEMENT'- o A 33' FENCE n 33.05' 33' 33.05' 2.76' '' N 87'S9'21' W —' '' 380.00' 33.05' `� r c N87'59'21 "W 2309.29' t w 190.00 NO TH t 190.00 `\ --�— - - 190.00' 190.00' ' S OUTH LIN AF THE S *7/ 4 N87'S9 21 7 3$0.00 SUtll)l►YfSt CORNER ` —' SEC -30 -1E — N87'59'21 "W 2689.29 — (SE r PK NAIL -- ROM TI£Sf SOUZY 1/4 CORNER LEGE UNPLA TTED LANDS SFC.s -3o -16 __ ._ .._.. - - - -- - -- (SFr PK NAIL i C SURVEY A Located Southwest in part o€ the Southeast Quarter of the S Township 30 North, Range 16 West. lawn Quarter of Section 5 o #.Emeratd, St. Croix County. y. Wisconsin. SUJI {'YOM'S CFRTIFZCATE: - 1, Gerald C. Ripley, a Registered Wisconsin sand Surveyor, d do hereby ce rtify d Of William and Darlene Demar, I have surveyed, ivided and rzrappe a parcel Part of the Southeast Quarter of the Southwes t Quarter of Se Y that by the direction P of land located in West, I C3'ri�r� of Emerald, St_ Croix County, WIJ uai- Of Se ction 5, Township 30 North, Range 16 as follows: Beginning at the South Quarter Corner of said south line of the Southwest Quarter of said Section 5 ,�North 87 d on an assumed bearing along the West a distance of 384.40 feet; the nce North 01 degrees 09 minus e 53 se West a distance of north -south conds minu 21 s 493-00 feet; Quarter Ti thence South 87 degrees 59 minutes 2I seconds East a distance of 3 ne of Section S; thence, along said north -soh Quarter line, 00 .feet to the ut 09 minutes 53 seconds East a distance of 493.00 feet to the b square feet (4.29 acres). Subject to 170th Street (A Town Road � tainn OI De point ut urte the above described parcel. Also subject to all easements re Containing 1R7,054 along the most southerly 1in�� of s restrictions and covenants of record. I also certify that this map is a correct representation to scale of the exterior boundaries and described, that I have corrrplied with the provisions of Chapter 236.34 surveyed Statutes and the Subdivision. Ordinance of the County of St. Croix aril the of the Wisconsin State surveying nd mapping e sarrre. Town Of Emerald in Gerald C Ri le =- _ 605X Ripley-Re }Registered 3'tlis Iisin L d Surveyor No. 2371 � Date JEO Consulting Group, Inn. P.O. Box 32S ,`�i�>14�1'tt /�� Ne-vv Richmond, W1 54017 ,te �1� M� /o� ' AC UY v Approved b = 5�2 .1,�9'i� L O�i� URV KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM 3 - 1998 REGISTER OF DEEDS sT. CROIX CO. WI RECEIVED FOR RECORD 05/25/20% IS:110AN William J. DeMar and Dartine M. DeMar, a /k /a Darlene M. DeMar, husband and wile, quit - claims to Glen R. Crist, the following described real QUIT CLAIM DEED estate in St. Croix County, State of Wisconsin: EXEMPT i REC FE Et 11.00 Lot 2 of Certified Survey Map recorded October 26, 2005 in Volume 20, Page TRANS FEE: 66.00 5091 as Document Number 810425 being located in part of the Southeast CC FEE = 3. Quarter of the Southwest Quarter of Section 5, Township 30 North, Range PAGES z 1 16 West, Town of Emerald, St. Croix County, Wisconsin. Together with a 66 foot joint drive easement for ingress and egress as shown on the Certified Survey Map. Recordino Area Name and Return Address Ronald L. Slier VAN DYK, O'BOYLE 8 SILER, S.C. 201 South Knowles Avenue New Richmond, WI 54017 010 - 1012 -90 -075 Parcel Identification Number (PIN) This is not homestead property. Dated this day of 2006. ` - �� 7W ', *William J. DeMar * Darline M. DeMar AUTHENTICATION ACKNOWLEDGMENT Sii�gnature(s) /,al, _�. Ioe 01g cl„J STATE OF WISCONSIN ) 114 r l i n. County jss authent led this / `day of /118 y 2006. Personally came before me this day of 2006 the above named R o n v /d L S �e r to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) , THIS INSTRUMENT WAS DRAFTED BY Ronald L. Slier Notary Public, State of Wisconsin VAN DYK, O'BOYL l SILER, S.C. My Commission is permanent. (If not, state expiration date: 20 _-) 201 South Knowles Avenue New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM N0.3-1999 - 1 of 1 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800.855 -2021 Safety and Buildings BOX 7162 COmmerCe.W1.gOV MADISON WI b3 07 -7162 in TDD #: (608) 264 -8777 s co n s i www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 02, 2006 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/02/2008 Identification Numbers Transaction ID No. 1296208 SITE: Site ID No. 716134 Glen Crist - Dwelling Please refer to both identification 170TH Ave numbers, above, in all Town of Emerald, 54012 correspondence with the agency. St Croix County SE1 /4, SW1 /4, S5, T30N, R16W Lot: 1, CSM: 810425, V20, P5091 FOR: Description: New Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1088846 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. 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. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state ROBERT W ULBRICHT Page 2 8/2/2006 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Peter E Pagel Private Sewage Plan Reviewer, Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pete.pagel @wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Model PT 28,68 07 — 170 5q. Ft. Available in End Flip Model DT 2868 08 2T-8' 8' -10' 11' -7" u 7 L D NASTER un BATH lam' BEDROOM 3 GREAT ROOM DINING r F g N I zo KITCHEN L MASTER BEDROOM BEDROOM 5 m ❑❑ r BATH FOYER 0D 2 1 11' 8' 1 8'.8' 8' -7' 19'$' , 3' -7' 1 1 3' - 10" 1 w•u ova KITCHEN BEDROOM 3 GREAT BEDROOM 2 O ROOM FOYER FOYER 3aa •AN 2 T OPTIONAL ULTIMATE KITCHEN OPTIONAL STAIRWELL I I OPTIONAL FOYER M0490&, A ? O p ESIf3NER V J BATH O UTILITY SINK O OPT. DESIGNER BATH PO: CUSTOMER 12 SERIES Parcel #: '010- 1012 -90 -075 08/11/2006 09:28 AM PAGE 1 OF 1 Alt. Parcel #: 5.30.16.78 -3 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/31/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner GLEN R CRIST O - CRIST, GLEN R 1721 220TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2248 170TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2.150 Plat: 5091 -CSM 20 -5091 SEC 5 T30N R16W PT SE SW CSM 20 -5091 LOT Block/Condo Bldg: LOT 02 2 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 30N -16W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 05/25/2006 826108 QC 10/26/2005 810425 20/5091 CSM 10/10/2005 808950 20/5085 CSM 07/23/1997 1032/548 WD more... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.150 100 0 100 NO Totals for 2006: General Property 2.150 100 0 100 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