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030-1065-50-000
0 60 c c O Q" ° O "r N a co ±r T c O 0 L ( °- @ N y'p ry O E 'O z c L C C ry .1 v 3 c O Y T> — 12 c y U 3NUUi y °spina C oo E m OEui O b n 8 wOV..-O 3 O U a Z 3 c o Z aLococr ° c 7 m 00 I 9 7 m v N 3' - a LL O y y II O LL O NCccaMfpD 10 yL c ° rn3 E E E E Q cc E Q co `o c o 0 o O co co CL N E E rn Z v € o ° w a m a m N H Z ° I I p z ' m v a C v) H E' a E 1 E 1 �"N N N ° 1 _ a to •1� N �p O N a m O O 00 N a m L n a n c O C CD QQ Q N Q o Z c Z 1 Z U) Z O Z N o a Y y = 1 E CL � gy y � N oa (L _ 3cocow 3 E Z m 5 a o z a s • a a a a a a .� a Q � > 0 U) Q N N L N N N fR J U w O o } M T Z n 0 a ., 0 0 E rn rn •, 0 0 3 p N O O O o a.B CO rn w O m y rn Cc C C O O O C ° ° ° E n O C C G M F" fy0 U c C u a p m U d d co c h O O C c C 0 O N F�1 O LO ? w 7 N t0 L m p o � Cl) ui n o T T m ° tp o N E E • o N CO LO 0 Z N � w mC fn U o Z2 "1 p V _ € a I 4) a a L: a rte• E E 'E c 2 = r A u0. a 0 (nu 0co0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574378 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: Wallraff, Jason & Monica I St. Joseph, Town of 030-1065-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /A�\ f�. IOOp r 5�� ! 25.30.19.238A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark a Q2 (� /�� Z.14 f QZ.4 A� 7' '_":r.f'S 3Z d Alt. 63L ' � 3.g� 9 8• Z AeFab" II 5z C Bldg.Sewer F.'1 c� l� k 7 �b�• /` Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ,��7� ��•3� TANK TO P WELL BLDG. ent to AirI Intake ROAD �� e 121.... .S rer� 3 ZL� //�9' �?) • Z /oeSo I b b S Zo ' Dt Bott 3� of I Z•�� b . f �Q r t Header/Man. 33 Aetatior►- Dist. Pipe 1z Holding Bot.System E3-ct4 ,PUMP/SIPHON INFORMATION Final Grade . � 9(.-7 Manufacturer Demand St Cover /�GPM �' Jt� c? 2— Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain th Dia. s.to well SOIL ABSORPTION SYSTEM /, 3 BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 � Z ) J e.A '` — --- _ —_ SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type-Of System:System: UNIT Model Number:f �1 >-VJ d 'T v.c.9z F1.4 t DISTRIBUTION SYSTEM e j (Cr kZ =-. 3 v 5 Header/Manif9ld 1/ ID istribution x Hole Size x Hole Spacing Veruto_i�ir Intake Pipes) �C�,[/� n� Length Dia Length �� Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ZDept, of xx Seeded/Sodded xx Mulched BedlTrench Center 8 Z7 Bed/Trench Edges �� oil �_ 0 No _Yes No COMMENTS: `y (Include code discrepancies,'persons present,etc.) Inspection#1: / / Inspection#2: Location: 847 140th Avenue New Richmond,WI 54017(NE 1/4 NW 1/4 25 T30N R 9W) mates&bounds Lot Parcel No: 25.30.19.238A 1.)Alt BM Description= 2.)Bldg sewer length / t e--D v e- -amount of cover= 1 Plan revision Required? Yes No F7 � 11�Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Sig ture Cert.No. Count}' Industry Services Division D ---- i ,t'►< 1400 E Washington Ave Sanitary Permit Number(10 be filled in by Co.) P.O. Box 7162 . r�� b V Madison,WI 53707-7162 7 l 3 X.r„ " �GD QME r_ O �. State Transaction N X ��,�,,��,,�� ���� itary Permit A In aeeordanco iMd11 Wis.Adm.Code,submission of this mm to the appropriate governmental unit SPS 383.21(2). Project Address(if different than mailing address} is required prior to obtaining a sanitary petrol. Note:Application forms for state-owned may be u are r sewte to the Department of Safety and Professional Services. Personal irtl'ormatron you provide ntay be used for secondary !7 �- u ores in accordance with the Privacy Lav,s.15-0 i){m),Stats. I A lication Information—please Print All Informs Parcel Property Owners Name oy Loa_ - s Q /. Z3 pro perty Owner's AQailing Add ress i Cao a.Lot Section Zip Code Phone Number yuc e City, ate a/ .I" 2Q N RE or p �G Lot K II"Type of Building(check all that apply) Subdivision Name 1 or 2 Family Dwelling-N of Be oms �ZD g �_,12, a.t_QtNH,e•�'� Brock: ❑ public/Commercial-Describe Use ------------ ❑City of ❑Village of ❑state Owned-Describe Use CSIvI Number Toy:m of III.Tv a of Permit: (Check only one b s on line A Complete tine B if a livable) ❑ �Modification to Existing System(explain) A ❑ Nev,,System Replacement System ❑ TreatmentrHolding Tank Replacement Only Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renetva} ❑ Plumber Owner Before Expiration IV.T of POWTS S�stem/Com onentlDeaice_ (Check all that a lti') ,' ti <24 m,of suitable snit Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ Al_ 0 pretreatment n Device(esplaitable soil ❑ found Holding Tank Other ispersat Component(explain) V.Dis ersallTreatme Area Information: y stem Elevation Design.Flow(gpd) Design Soil Application DSSpeCS¢I:area Requlri'd(St) Dispersal Area proposed( S} Rate(gpdsO Capacity in VL Tank Info Gallons Total AN-lanuf urer Gallons Units � //� �� � �t j � � 66 TO ear Tanks Existing Tanis 1� ❑ ❑ ❑ ❑ Septic or Ho Eno ❑ ❑ ❑ ❑ VII.Res risibility Statement-I,the undersigned,assnme rexportsi r i n of the PQpI'T b1P SPRS Number hod p$usinoss Phone NumbR r Plumber's S' a (� Plu Nam (Pri - r Plumber's Address(Street,City,Sta e,Zip Cod VIII.Countv(De artment Use Only pate ssu > Issuing at Signtature Permit Fee q approved ❑ �enj_Re�asonf, 5 y'75' l 1 r Denial . 1 0 rr C a DLCondlSORTOK� �°°sforDisapproval 3 ✓nom 11 Septid tank,effluent filW and Jv� t/V1 J b dispersal cefi'must atl be servtces/maintained \ as per management plan provided by plumber. I ) 2 t,#ttelback requirements.must be.maintaineel / le� 2 b J attach to complete plans for the system and submit to the Co t}only on paper not toss 9 112 s 11 ind�es i size cFi ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT �F�0, FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residep (Street address) 7 /, �� r located at: 1/a, A&L 1/a, Section.,,25 Town�_N, Range / —W, Town of , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No-,/, (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: &(,,1l— Construction: Prefab Concrete St el ther Manufacturer (if known): �� Age of Tank (if known): j-j 7_0) Permit numbe (if known) (Licens Plumber Signature) (Print Name) da2z A ';:2Z2 '? (Title) (License Number) MP/MPRS � ` /�/ (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 fl . 79 CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE - -:.i14\\.i:V:'.�.y::::.:�-:is:ji.:•;i�:::ii:?;i::J:S:;::;:v:!:-:�:i}:ii:::_: •ter\.�}:;:v..'- ::v�........ �h;:+v i:i:i�::i;i���?�::��:;:L•�e v.\•\4\\\i.:i:i::�:{i4<:�-t\::vtiv:\::y:ti}t�;:::j1;i• . :::...:.:.::':-= : t�:.�.��_;>:> :::::::>:: :;�•;. Name: F' :;.::>«.>:.::�>::�:::.�::;.>.::;:::.;-:�.:<:•>::::::..:::::.>.::;:::..:..,..,::'.,:::::.: Owner's me: 'ate Owner's e rs i .<P_ _ Address: \::.}\:•....i::•::�}tij::.�:-t=:�:"'/iii}`v:'i('•::'{:•�:-}r�{:�.�:,.y�:i'':�n.PQ:::::�:j:�:i s?:_.�.':�:'.:�':':�y:' iii\ \-\\i\\,??:-:�:•`+.r:'-4i ii.\i �.�;: .js% � yr.� }�}7 :�•`f7i�!`:1i�:::::r j:���'�:�:-i::�Y�'i':'�i:Ji?:;::;:ii:�:; �rY�3:S;� }:ZT4r;� T�i::�i:tiSi•:•:4:F.•::i-i::i:i'� ::::. .�.:-: .:iS:::.....vv.,�. •:i.:.}{::i::isi:^::•:\'.v.�::.:::.:nn..i4::.::i::.�:/:•:•:'iw:::n... ... Legal Description: A/.r�� Subdivision: Lot# Town: 7 ���r�✓�/ County: Parcel ID# Designer/Plumber: - License# Signature: Date -- Comments ncciancrl ni irci innt to the In_rrm inrl Cnil Ahcnrntinn C'mmnnnant Mani mi fnr PnWTS version 7.n Ij • „�.��.ciC-5�%ls�z`a'- ,L�a�E'�.���„J �a�/�G r'�. .�C-./fC�,c� _ _. _. 11 -W7 � s Soil Abs inyon System Cross Section Fug Grade 4"Sdeduie 4Q PVC Vent Pipe VM Vent Cho �- Leaching ---® ft Chamber System Elevation f Soil Absorption SVstent Plan View if amp ► Leading Trench 7 Vent Or Observation Pipe Chambers limp ilia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model Iry1D_ EISA Rating-14—sq ft per chamber Soil Application Rate�_gpd/.-,Q It gpd Design Fiaw: _Soil Application Rate= EISA=� 5-Chambers Z rows of � chambers each. Page of ILY INSTALLATION INSTRUCTIONS- 0, taw ' INSTALLATION INSTRUCTIONS t�testater' VVW1 opedng '+-•S.„ $ 7 of :r.`r=. rix-.,ryF'-`�.'"�s'E?. ;c .:,h�amJ-:.1,,. (=.� „�.,T+ y$j1�5�vgl • < i'«^c ` r j S. y,,. "'��ra.. '�{'a Fes;,,..e'i'N�' ;�,•.5... n t y Step t: a step Z: Stop 3: (A)Locate the Outlet of the septic tank (A)Before instalia€ion,place the (A)Glue the aw horsing on the (B)Remove tank cover and pump lank titter housing on to the outlet pipe. outlet pipe. if necessary (B)Make sure that the housing (B)Ineett the tier cartridge In the is positioned so theft w can be housing,rnatdn9 sure ft fifer removed from the tank for Garb is prWuty aligned and maintenance and service, corrpiet eiy inserted in the housing MAINTENANCE INS RUCTIONS j - < - 4 1 ` " tle�a�r^ •i °� yEZ#.a _.1 •�y�,.,. C S 1.... � � r -.K-�I$� P-+y a.�]; y o :tl'4 o q- �•c."-ar�,ZY'7.sr'�' ` ..•5w��"•L°§',��_ .<�'•�..a Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A)Remove tank cover and pump (A)Insert the ow cm#kW back �d if necessary. info the the housing mating sure (B)Pug the tsar out of the housing. the off�Is�Ins$�W M (C)Hose off ft t over#w s iartk (B)Replaces � coyer Ct � • . :Gt;t?l�$�•�'., Make sure all solids fall bade into the ... .��11 HEt!I;Gt��•t±��(�..�i�:TER:�'.... septic�r►� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paget FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA f'3rmit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Efflu nt Filter Model _ ❑ NA Number of Public Facility Units OCNA Tank Capacity gal ❑ NA Estimated flow (average) al/day Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate gal/day/ftZ Pump Model ANA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ,ANA Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filtbr ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :_220 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 (BOD5) :530 mg/L Jbt In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L Ed NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510°cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA gJA1NTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA P�year(s) ❑ month(s) NA Inspect pump, pump controls & alarm At least once eve ry� ❑ year(s) ❑ month(s) ANA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 cell(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 (Y3) 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(4101) Page�of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks!for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellis). 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. i During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ceil(s► 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. am rove the perform th ance and prolong the I of'rfa e win y improve Reduction or elimination of the following from the wastewater stye may 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 anently taken out of service the following steps shall lie taken to insure that the system is When the POWTS fails and/or is perm 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 wing measures have been, or must be taken, to provide a code compliant If the POWTS fails and cannot be repaired the folio replacement system: ❑ 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 b required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi�, 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. ❑ 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. jd 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. ❑ 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 NO 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 BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLP POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name ame Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(fl and 83.54(1), (2)&(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TAN IvL4LNTENANCE AGREEMENT AND OV�7NERSHIP CERTIFICATION FORM Owner/Buyer 1 Mai.l.iag Address Property Address (Verification required iioin Planning&Zoning Depamnent for new construction.) City/State ), Parcel Identification Number LEGAL DESCRIPTION r/4 . r/< , Sec ; T _N R�_W, Town of I-S e Location ,,//�'' ..t�1dL Property J1�_- Subdivision Plat: Lot# Certified Survey Map # ,Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Lot limes identifiable�es 0 no Spec house�+yes� y SYSTEM MAINrTENA.NCE A=T D 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§SPS.38352(l)and in Chapter 12-SL Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Plamwig&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 113 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 Safety And Professional Services 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. 1/we certify that all statements on form are true to the best of my/our knowledge. Uwe am/am the owner(s)of the property described above,by virtue of a t5`deed recorded in Register of Deeds Office. Number of bedrooms SIGN T E ATUT OF LICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04112) i9«i�0���i���i i����ii viii 1i 904803 STATE BAR OF WISCONSIN FORM 2-2000 BETH PABST WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI THIS DEED,made between Donald R.Clark and Cynthia L.Lawton- RECEIVED FOR RECORD Clark, Husband and Wife,Grantor,and Jason C.Wallraff and Monica 10/05/2009 08:OOAM J.Wallraff, Husband and Wife,As Survivorship Marital Property,Grantee. WARRANTY DEED Grantor,for a valuable consideration,conveys and warrants to Grantee the EXEMPT following described real estate in St.Croix County,State of Wisconsin: REC FEE: 11.00 TRANS FEE: 547.50 PAGES: 1 The East 208 feet of the North 416 feet of the Northeast Quarter of the Northwest Quarter(NE ''A of NW %4)of Section 25,Township 30 North, Range 19 West,Town of St.Joseph,St. Croix County,Wisconsin. RETuMEDTO. Recording Area muRO LEG&SMICES,NO. ASMTHSECOiONAMSOMStM1'E150 Name and Return Address: ptINNEAPOUS,MN 56101-2217 Edina Realty e,Inc,400 Sout d Street,Suite l 15 Exceptions to warranties: Hudson 1 54016 Easements,restrictions and rights-of-way of record,if any. 914795 030-1065-50-000 Parcel Identification Number(PIN) This is homestead property. Dated this September 4,2009 Metro Legal services EDIRET 914795 A 1120791 WD 533931 A"� - Donald R.Clark Cyn a L.Lawton-Clark AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) St.Croix COUNTY. )ss. authenticated this 0 day of September,2009 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ^ Personally came before me this 4`h day of September,2009 the rl Qr above Donald R.Clark and Cynthia L.Lawton-Clark. Vntilr �`V,�] Husband and Wife authorized by§ 706.06,Wis t j�l y to me known to be the person(s)who executed the foregoing wisc G° instrument and acknowledged the same THIS INSTRUMENT WAS DRAFTED BY �hS�/7 *Cheri Brown Martin D.Henschel Notary Public,State of Wisconsin 50 East Fifth Street, St.Paul,MN 55101 My commission is permanent. (Ifnot,state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 2/27/11 ) "Names of persons signing in any capacity must be typed or printed below theirs ignature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 1 of 1 0 =met f �i iv 00 C) D O i 416 � _ N �A. Z i >3< 4 i 1 t li 4� 1 1 Property Owner !� Parcel ID# fr ��/liL ��i� -� Page of -;L Boring# ❑ Boring jS Pit Ground surface elev. 95'. 7 ft. Depth to limiting factor /7n in. —Co'i-l'—Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Copt.Color Gr.Sz.Sh. ff#1 * ff#2 2 7 7 At 1 4W 112 4P LL 1. o ' I r F-1 Boring# ❑ Boring (� ❑ Pit Ground surface elev. ft. Depth to limiting factor in. —go-7il—Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 F-1 Boring Boring# 1:1 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 .0#2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/11) L �N01 Wis.Dept.of Safety a iAI Services SOIL EVALUATION REPORT Page-of Division of Safety nd uil Y 9 n 15 106ccordance with SPS 385,Wis. Adm. Code n SEP cou ty Attach complete site plan iaw x 11 inches in size.Plan must include,but not limited 2imence int )„ire Parce I.D. percent slope,scale or� arrow,and locai di c o_ rest road. 'EMI Please print all information. Re wed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Govt.Lot 1/4 4 1/4 S T N R (or� Property Owner's Mailing ddre s Lot# Bloc # Subd.Name oomw City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Roa 2rL ❑ New Construction Use: Residential/Number of bedrooms Code derived design flow rate l GPD .®Replacement Public or commercial-Describe: Parent material a "14_s, Flood Plain elevation if applicable ft. General comments and recommendations: 6 � SfSTGa' Boring# F/-1 Boring Pit Ground surface elev.'�/.�3 ft. Depth to limiting factor 5-/!oX in. 50-11:Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *1 ff#1 402 - -� P 1. Boring# Boring J u ® Pit Ground surface elev.'9-�.- ft. Depth to limiting factor ?/7/a in. S6:i1:Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *1 ff#1 * ff#2 42-5 Ilk 3 y ,� / .s 17 * Effluent#1=BOD >30:<220 mg/L and TSS>30 <150 mg/L *E ent#2=BOD <30 mg/L and TSS <30 mg/L • CST Na ease Tint) Signature CST Number Addresi ation Conducted Telephone Number ",� ? - — -�= SBD-8330(RI 1/11) Property Owner Parcel ID# ef- -42 Page —of 3 Boring# � Boring J� pit Ground surface elev. 95- 7_ft. Depth to limiting factor ?/7/9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Copt.Color Gr.Sz.Sh. * f 1 * 02 4�1Z �.' 6 r X 11-2 1 I 1 ❑ Boring# ❑ Boring ,(� ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * 02 F-1 ❑ Boring Boring# Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Donsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Si.Sh. * ff#1 ff#2 III *Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(RI 1/11) , 11 i - - o- i i 94 spa - — j ' t ra AS BUILT SANITARY SYSTEM REPORT OWNER C, c-CAK TOWNSHIP S T ' SECTION f T36 N-R~W ADDRESS I~Ry ~iax 1 ~Z- ST.,-CROIX COUNTY, WISCONSIN SUBDIVISION A) 1A LOT IVA- LOT SIZE PLAN VIEW 4 SHOW EVERYTHING WITHIN 100 FEET OF SjWTEM i ~C b ~ 0 55 ~ K ~O INDICATE NORTH OW BENCHMARK: Elevation and description: 8"1 ~yz J'0", Sl 'E/ /On Alternate benchmark SEPTIC TANK: Manufacturer: T'~t;~~¢.~eE,c Liquid Cap. /4140 Rings used: ~ Manhole cover elev: Final grade elev• 1::1f1 L Tank inlet elev.: D, 0 Tank outlet elev.: 9 9' -5 -el No. of feet from nearest road:Front-2c, Side , Rear Ft.A_ From nearest,prop. line:Front Side, Rear Ft. !f~ ti No. of feet from: Well S S , Building: Ib' 3,bY (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE /0 't~ 9 11 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: - Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm. Manufacturer: INSPECTOR: DATE: g • / 7" 9oZ- PLUMBER ON JOB LICENSE NUMBER: J.~ !o 6/90:cj I~.CA gN• STt.of In us J~EPH 25.30.19.238A NE NW 140TH ~sco T epartmen ry, PRIVATE f EWWAGe SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. C OIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 180265 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: CLARK DONALD R & CYNTHIA L ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: J1 Parcel Tax No.: MO. ez c~'trne as 030-1065-50-000 TANK INFORMATION ELEVATION DATA A9200343c, ~Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark r Dosi Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St / Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD t Inlet Septic >6D i 55- NA Dt Bottom Dosl ng NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manu r Demand Model Number GPM TDH Lift Friction Sys JTFt Forcemain Length Dia. Head Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT f Pits Inside Dia. Liquid Depth DIMENSIONS MEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Mo I Num er: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, person present, etc.) L G~~ Plan revision required? ❑ Yes G].Mo Use other side for additional information. 191/71 7 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: - SANITARY PERMIT APPLICATION 01LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SA I Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ C i v ion ~06)iou. application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 19 oho\& C1 Qv►* A)f- aS_ T30,N,R r)W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # R A# /a2 N A, Iv A CITY, STA ZIP CODE PHONE NUMBER SUBDIVISION NAM OR CSM NUMBER 16) R,6" i),nj tL~ 0►~ N A rJ A II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned O VILLAGE St -~0 Se U'e- ❑ Public ~1 or2 Fam. Dwelling-# of bedrooms - PAR EL TAX NUMB R( ) Ill. BUILDING USE: (If building type is public, check all that apply) 0 30 -/O fOS Pct 14 C2.3-9A 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. X Replacement of 4. ❑ Reconnection of 511 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE C D REQUI D (sq. ft.) PROP OS D(sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~FJ NIA /If PJ1A n Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New P-xisting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank OOU d Wer9 X.,,o, -I'-+- El I F] F1 Fj Fj Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name f ~ int): Plumber's Signa re: No Stamps) hWMPRSW No.: Business Phone Number: Ca n twowe"e`s ar t 563 7/S` a W.-s~3s Plumber's Address (Street, City, Sta e, Zip Code): //69 / S /vim) a~ IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fee (Includes Groundwater ate slue Issuing A ent Sign a ((No Sta s) 60 Approved ❑ Owner Given 71nitial! / 7 Surcharge Fee) 7 a Adverse DeteX. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes, in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6'199) to be subp 4M&-too the county prior to installation. , 5. Onsif'e sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. r ti , 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. r To be.cotlilete,end`accurate tNk,j apApxy-,"rmit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of i ~ `:where Me-system is to be instalfedd. » 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross-section of the soil absorption sYetem if\ .;;required bytfle county; E):7'504 test data on a 111:01orm; and F) of sizing information. GROUADINATliFi $lTl1CHA14GE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, grourl<d- water contamination investigations and establishment of standards. ~ - + `)r\, a,.\,.-_t ~rJ ,.;''~•y cry ,y\ \ SBD-6398 (R.11/88) ST. CROIX COUNTY WISCONSIN ZONING OFFICE v x... ° ST. CROIX COUNTY COURTHOUSE ~rL~ t 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 -IW EXISTING SEPTIC SYSTEM AFFIDAVIT The existing septic system which serves the dwelling being added on to must be inspected by a licensed soil tester for compliance with high ground water and/or bedrock seperation requirements as set forth in s. ILHR Chapter 83.10(2) WI. ADM. CODE. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is properly functioning, an addition may be added to the dwelling without updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. ILHR Chapter 83.10(l). Property owner (s) o r g 1 C IC.- c k Property Mailing Address : K F ,'y a aX / a Property Legal Description: Lot#CSM/Subdivision /VF- 1/4 NW 1/4, Sec. , T.30 N., R. W. , Tn. of 5;t I, as the owner of the above described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Notary Public Subscribed and sworn to /1. 4~~z before me on this date: Signed• d~- Date : - / 7 My commission expires: County Approval Dat ~v2 ~ s • I Opc APPLICATION FOR SANITARY P=RHIT • 9TC-100 This application form 1s to be complntad In full and slgned by the owner(s) of the property being developed. My lnadoquacles will only result In delays of the pztrAIt Issuance. -Should this development be Intended tot raaalt by ovnet/eontractott(apoc house), then a second form should be tttaInId and c a x p I a t a d vhan the property Is sold and submitted to thia a f f I c a with the appropriate deed recordlnq. Owntr of property DanA\a Location of property -All -1/4 t1IA) 1/1t Beetlon 15 T,3D x-R~V Township _ .~~J', ~o5-e c~ KaIIIn9 address hex ;I- Address of slte jcz,rrtSL, fubdlvlslon me**_ /ULh ' Lot number Prevlous owner of property Total sl:e of parcel _ ahGs e Data parcel was created Are all corners and lot Ilnes Identlflable? _,Yes _ Ho Is this pro patty being developed for resale (spec house)? Yes 1< No Yolnr.* 3 and Page Number 3 52 as recorded vlth the Register of Deeds. iNCLUDB WITH T1115 APPLICATION TIM FOLLOU1NCI J1 VkARANTY DQLD which includes a DOCUN1tHT 11"BtR, VOL"t AND PAOt KU'1(IIA, and the ©VU Or Tilt. RIIOI©TBR OP DIM11. In addition, a certified survey, if avallablt, would be helpful so as to avoid delays of the reviewing process, If the deed description ttferences to a C "LI Lltd Bucvty Hap, the Cettltitd Survey Hap shall also be required. ------------------7--------------------- PROPERTY MIER CERTIFICATION I(ve) certlty that all statements on this form are true to the best of my (out) Inovtedgef that I (we) am (Ace) tha owner(s) of the property desctlbad In lhIa Information form, by virtue of A wsrrsnt dtsd corded In the office of the County AeglaLer of Deeds As Document 1(o. Q I and that f (ve) Presently own the proposed alto for rho newage disposal ayaten (or I (we) have obtained an easement, to run with Lila above d a a c r I b a d property, tar r.ho consttuctlon of sold nyetem, and the soma has been duly recorded In the Office of CvVnt Aegta or of Deeds, as Document 140. ignotute of Own.r Fig-nature oL Co-owner (IL Applicable) q- /d- 9~ . Pat of Signature pate of Signature , OF WIB i..`.... , DOCUMENT NO. STATE BAS - ~ ~:L ~:L7+.3~GE3~, it~G~LT~R'R'S C}!!'IC# 395192 Th18 Deed, made between David M...Ari1g ed d. W ife,. Ras'a.. ^'d th+s._ Christine K. Arnold, Fr F' iously r, arced. o; r -c'nentsy ,Jow - day af,' ,Y,,,/►•D iFN` Grantor. I9&MQ'►-a _ at 4:00 r and Donald R. Clark. aald ~ointa .L. .tenants, husband and wife , as j Grantee, fir t `.,at the said Grantor. for avaluable consideration. yv ti ' itnesseth, RETURN 10 q: one dollar and other valuable cons RET id~~atix Realty World - conw - t ranter tha folk w ing described real estate an New ~ ~r County, State of Wisconsin: K3 ...y,. Tax Parcel. No: . nv East 208 feet of the North 416 feet of the I of the NG of Section 25-30-19. Subject to recorded easements, reservations, and rights of way.' L fr v om ~~Fe rlstine K. Arnold gxxxYxxfrfx.x:fxxx.;i,K+►.Y~{.tt F oine~ < e 3 of David M. Arnold. >F, th Together wR'n ai: and sinvular th,• h..~dttan [its an {{.rtenances crainto belonging: i`l3vid M. Arnold and Christine K. Arnold And nd clear of er. 4nthranaes eact•Pt vv:u-r.ant- that the t,tu• 1Kd, tn.r,a..sih.r a .,corr... •af no exceptions ;uu! as x,11 as-anurt :u i f.'r:f a > 30th ^July 1984 . ill ~~Ctstc ISEALi David M. Arnold 't a.•L (SEAL► - Christine K. Arnold ACKNOR LEDGMBNT AIJTHEN"C;CATION Y 4 ;TATF OF WI-1 t)A~!X Sit;naturel~I Sa. ~ a -nty. t ...fo" e me thil 30th day of Pa•r t n;i; ,:ae Tiny 19 the above rar:e,: d Arnold. and Ctlristi?x' K.- Arnold TITLE. NIvM 'F'.I i t. • F; i a is \ {;7CrCtI t etf. r~,n 5 who 1 . to t r , Iae ft„ kr t: n'r r nnar r i~ .rt.noaclr..l~e the same Eric T y fV 1" County, *is Ricn;lt' ~rl anI`. } c r,..tt f not. ct exptr t.BA y .a \ rr BAR OF WiSfO"'S FORM No. 1 - 118: 5 16.6 d WN10180 1~~ dd ¢t d uJ r C-% r G Z Ui U e a A f a m~ ra¢or fas(VyWU- i z r ( f. ~ o c~~ z~Mz¢fA a ON Q !5 . w - Q. 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F. m a OF-xwu[ ~ 3°00 c 0 i LL n C: cn ; : o InNNQ+Ln h7UJif)M W Y I < t0U)h)U)rr U)oM P LL CD (NJ C( r- w 1 .4 V Q• U) 111) LW Lt?j `O' LL w a t3' V - r Qt r Q /T f~• , V~ Y _ r V Lc W <W U z w0 (J r h o F- ' N Z w M J-+U) w W z 1- O a Q Q 3 0 1 1 1 1 1 w U a , W L~1 LL C w M M h7 h? i LL 01 0: r . a U O a~ Cou?Md Vt H w 7 :3 N> o co > ~ e J`~OW- O 2 O o 5 o r W F g ix W CL) z¢ 3 L-- U W o° O -J %t w Q w w GU(XL H ° < N o o to to U) h) 0 b °W x y~ `u "orU)OO U w p F- z d a W o Lf) d' u7 ~ ~ ¢ W ¢ C. LL w 117 w< h) N 0) 0) ON w a LL G Z Z T N mN M =01 (..j W Z %T <I (C) CL %D a W I w$ w ¢ F F- w (4 Or. O U) U LL Z U) Ix C) Cd C1• cv w U U) F- O) U) (n z W 4} x .r 1 0 - r w oLLZ ifi T O ,°J > a U Co N Z cr CC Q-) tri LL CL z 1- a w wOH > g (vQ+3LL W LL (1) w Gv -1 co ~ OTN r Q Lo Q%W1:0) 0 2 3 LO u 4 O z o D 0- 1-- 2 L h CC •L ¢ -r.: > -o8re u wz: -A 1 0 0 Z O X° ° 1UiJ fL'h)r)OW Z LJtfi F- (T. 5 u H 3 Q J X J m p0F U _j --r w ° aWS Z3~DOIli > >-SAZU (h8 m M(+JU) wF- w .T O IrJ O > W- I U) J - x a F- h12 LL w CC N < tI1QZU ¢ o O ¢ I ~w< w::) ¢ w ¢ w r 1--o UO (?a LL STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix f"ogvty I OWNER/BUYER C) C'A C I- r~ ROUTE/BOX NUMBER R y tr~c / A -:2. FIRE NO. a ~ 7 CITY/STATE 41 /-A d w1r, zip S5~D/7 PROPERTY LOCATION: -1/4 10W 1/4, Section a 5 , T_aQ N, RW, Town of 51• Tos--,v , St. Croix County, Subdivision AJA4 , Lot No. A IA V.,__. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED_4~24 DATE- lG~ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address DEPA4MEOPOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS -IND.USTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 7969 ON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: [SUB51VISIP)q NAME: k N N '/a-A1j1'/ as /TwN/R 11 lor)W st, f~g A) 6 COUNTY: OWNER'S/BUYER'S NAME: G ADDRESS: SYOI Dmnallcl ala 1- , r~ o~ S ES OBSERVATIONS MADE USE D I NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence ❑New Replace /b ~pZ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ® S ❑U [ZS ❑U E'S ❑U ❑ S ®U ❑ S IZU fv V DESIGN RATE: I If any portion of the tested area is in the If Percolation Tests are NOT required under s. ILHR 83.09(5)(b), indicate: /v Floodplain, indicate Floodplain elevation: A . PROFILE DESCRIPTIONS P p►, g a BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / o-S8X S/ y-~a~~ / 68 r~, sl 6~-1s~6 8~5~ l io-ao B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR P IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P-At 1h P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION g6- 5 53 E 56 Ae 0a - . - 5 - N r ` E e : ~ 5 E P _ ,_.E I r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wis onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLETED ON: NAME (pri t) : Vo w a r~~ Xf- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 9'G 9 Jr uc ~G GcJ L- 5s-.5,31 71S Sib 5>3S CST StjAT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - .f ' , -ETI- 'ORM 115 - s I H E TO THE Th p in securing a sanitary ; r may request ie geld ; to pr s r the private order to he sanit, 1 ,tion. i I I r , I t f I ~ I ~ C t 1 /tJktJ f 5.x,2 I i~ i t I I } ~ i I i y I p ~n I 1 1 1 ~ I ~ ~ I f I i I , a i I f,,.' ~ tl I t-► ! i~/Y~ ~ ~ I - 1 I , I i _ i ~ I + r- i t - I r I-~ h~ I ~ i I I I I f ' I L I I I i I 1 ' ' ~ ' I + I I I ` ~ I I ' I i I I I I I ' ~ I' ~ ~ I I ' I I ~ I I I i I L , I ~ I I I I , i I o I I 1 I I I I I } I - ~ I ~ i-~ - T 04 , , ~ y t I- I i I ~ rC~ID ~ I ! 3 ' I I I t m~ ~ I i ALl ~ i i ' I I I I t ~ ~ f _1 -41 ! l i i l' i l! i ~ l i l; ~ V - - - I , 1 J I I , I I I - I 1 f I ~ I I r ~ I I ~ , I I ~ fi 1 I-- _f i- 1 I I ~ f_ i I I - I I t I i I I I I I : ' I I I ~ r I I I - - L-4- i I I I I II I I I I I I i I j --j-'' j II ' I I ~ I I ' I I I j r ' I I i I I I I t I ! I ~ l } I ' I ' I I } t I i l I ~ I t i I- I I ~ I j { I I I I I I I _ I - f I f I rt- I I ~ I I I i ~ ~ I ~ I I I I ~ I I I I I I ( ~ ~ I ~ ! I 1 J ' : I ~ ' I I I i : I i ' ~ I T I I i i i I f - I ` ! I f I , I ~ t l I I I I I I ~ i I i I I I I I ~ i _ I ` , I 1 - . - ~ 1 --i - , ~ i - - 1 - ~ - t - ~ Imo--I I i 1 r i I I I I I ~ I REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 Q9/17/92 09:02 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/17/92 AREA: JT Activity: A9200343 9/17/92 Type: CONVSEPT Status: PENDING Constr: Address: ST. JOSEPH 25.30.19.238A,NE,NW, 140TH Parcel: 030-1065-50-000 Occ: Use: Description: 180265 Applicant: CLARK, DONALD R & CYNTHIA L Phone: Owner: CLARK, DONALD R & CYNTHIA L Phone: Contractor: POWERS, CALVIN Phone: Inspection Request Information..... Requestor: CAL POWERS Phone: Req Time: 09:09 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 000'1 FINAL INSPECTION