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014-1008-40-400
Wisconsin De~~rtment of Commerce PRIVATE SEWij-GE SYSTEM Safety and Building Division ~ . INSPECTION REPOT r T GENERAL INFORMATION (ATTACH TO PEW~11T) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Klim ke, Mark Forest Townshi ~ST BM Elev. Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing a:c Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic i ~ ~ /Z`~ 5~~7 / ~ /~ ~- Dosing , ~ ~ 7 /ot~ ~ ~ iaa ~ rod r ._. Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Z V GPM Model Number A ~ /~ ~ U TDH Lift .~~ Friction Loss , tih System Head 3•z5 TDFi Ft , ~ , b(v Forcemain Length ~ Dia. ~~ Dist. to well ~ Zit 2- /L~ 501E ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 453031 0 State Plan ID No: Parcel Tax No: 014-1008-40-400 Section/Town/Range/Map No: 04.31.15.61640 STATION BS HI FS ELEV. ~.a`b //Z~`~7 Benchmark b`7 Alt. BM Cc!n~r,..- r~ r _ Bldg. Sewer . 7th /t~ ~ . o~ SUHt Inlet SUHt Outlet Dt Inlet 13~5~ y%./q Dt Bottom ~ ~; ~o q~, 5.7 Header/Man. /e . 3 5 io z .~ Z Dist. Pipe ib•35 ~Z•S~Z Bot. System /0.55 /6/•~Z., Final Grade st Cover ~ , b ~~~ • 77 /~• ~Q7. BED/TRENCH DIMENSIONS Width ~ ! C Lengt~ ~ ~ No. Of~rench ~ PIT DIMENSIONS ~ No. O\ Inside Di~ Liqui\ Depth \- SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ Type Of System: , CHAMBER OR , t!~ I Z ~ /~~ ~ /~ r ~ ^ hY UNIT Model Number; 0151 KIBUTION SYSTEM Header/Manif~ Id ~ ~ Diseributi o n2 ( / /~ I Z ~ ~ x Hole Size / / x Hole Spacing ~~ V t to Air Intake ~ Length Z Dia Z ~ 1 ia ( i Length ~3 " S i ~ ~ / ( ~ ~ v pac ng y SOIL COVER X Pressure SVStPmc (]r11V YY Mnnnri Cl• A4-r~ra rln Sv~4cm~ (lniv Depth Over Bed/Trench Center ~ f I ~ Depth Over Bed/Trench Edges \ xx Depth of Topsoil i ~ xx Seeded/Sodded ~_, Yes f_~ No xx Mulched ~ Yes " No ~ ! COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l / ~-V~~//~~/ ~//yy" sp~~ection #2: / !_ Location: 2342 290th Street Deer Park, WI 54007 (NE 1/4 SE 1/4 4 T31N R15W) NA Lot 2 G~n.SLX•. t''lo ~ p'arcel No: 04.31.15.61640 1.) Alt BM Description = ,~~A ,ter , , , __ n -- i~.~ P tom. :~~- 2.) Bldg sewer length = ~ r i,J~C.(u - amount of cover = Z ~lec~.v. < 3.~ Di~~ Plan revlslon Re ulred? Yes o Use other side for additional informati n. __ _' __ _ I 1 , SBD-6710 (R.3/97) Date Cert. No. Safety and BuilcQings Divis~tt - - County ` 201 W. Washington Ave., P.O. Box 7162 ~j'('- C,QpJ iseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to he tilled in by Co ) epartment of Commerce (608)266-3151 5'3D ~ Sanitary Permit Application 9}31a°1.° um ~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide O` may be used for secondary purposes Privacy Law, s15.04(1)(m) Proj Ze~ ~differe~ g addr ..77 ss) 1. Application Information -Please Print All Information 'Y/Y O ~ I s Property Owner's me ~ _ Parcel ~Q R of o0 ' / 1!'1 ~! fo aJ1 D . fo I - ~ o - o Property Owner's Mailing Address ~J Q '' ~ Property Location /~,F y 7 c Ciry, State Zip ode C Phone Nwnber ®~tj'~ ~ / ~ [ ~ ~ ~' 3f N; R ~ ~t~r~ Tempe of Building (check a I that apply) II ~ ~ s '""` . ( ~ +~~G m s~ / S ~ CSM Number e - . 4 , . l or2 Family Dwelling-Number of Brooms ~/ ( o~ ~ I J ~ ~' ~453~ V ~ I s ~ ~ ^ Public/Commercial -Describe Use = d~ - 1 i t r ^ State Owned -Describe Use ~ O ~~ ~` fl ^City_^Village~Township of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A_ New System p y ^ Re lacement S stem ^ Treatment/Holdin Tank Re lacement Onl g p y ^ 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 O~wter ' IV. T e of POWTS S stem: Che all that a I ( S ^ Non -Pressurized In-Ground ou d~,4-trC~sviteb4e'Sbi Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ ip Line ^ Gravel-less Pipe ^ Other (e pla' ) V. Dis ersal/TreatmentAres Information: - b'D E Design Flow (glxl) Design Soil Application Rate(gpds l o Dispersal Area Required (st) - Dispers I Area Proposed ( '~~' System Elevation 8D 1 d - s a ~ yS o . /a VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holdin_ Tank ~ /~OO /~ t /? d 71 t// ~ ~/ Aerobic Treatment Unit Dosing Chamber ~/' $00 ! _ ~~q W~ r~ /~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installs ' POVVTS shown on the starched plans. Plumber's Name (Print) Plum is Signature MP/ $ Numbe Business Phone Number c 1, ~ ~ L,~ ~ :r~ ~-x--27 8 ~/ s- 7 Y9 - 3-3 ~ 2 Plumber's ddress (Street, City, State, Zip Code) ~ 7 w ~ s Gt'o~.~-~-fs l,~J.~ s~~o ~~ VI11. County/De artment tJse Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is in Agent Signat re (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~~ ~_ ~~ - IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced 1 maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in siu SBD-6398 (R. 01/03) i f N H ~ ,q ` ~ v jii~~ G~P~ s ~dd ~ v O ~i M ~~ ~ ~ ~" ~ 1. ~_ O ~ ~-. ~ 4 _ ~ O, .~~ ~i ,, 41 0 ~ ~~ ~ v ~` U `~ ~ ~ ~~ u • 'Q Q. ..~ O ®o 4"",„,, m tom, ~ ~0 :.,.. ...",,,_~ _`r. >,, 3 .._ ~.... „~. 0 ~~~ ~ S c~ ~ s ..~ N~ _ O ~ ~ ~ 4\ ~~ ~ a` V `~ ~ 2 `~O J ~ WQQ ~O _~ N U A ~o W~~, ~a~ ~ a W Q J Q 0 K Q as^g = v~ ~ ~Vd J ~ ~ Z ~ ~ ~O ~` .., 4 0 O s--~. 4~ ~ ~ v o~ O ~ W ".. V ~! W ~3 ~~ ~O N ~; v. ~ 3 _ ~ 4 F- _ o v ~~ o ~o~ v- 4 ~ )~ ~ ~ .";• M O ~~ ~ ~, ~ °~. `U ~ ~ wscons~n Department of Commerce March 03, 2004 OUST ID No.226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 10TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/03/2006 SITE: Mark Klimpke -Dwelling 290TH St Town of Forest, 54012 St Croix County NE1/4, SE1/4, S4, T31N, R15W Lot: 2, CSM: 653791 u, O~GQIAL ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Identification Numbers Transaction ID No. 973775 Site ID No. 671099 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: New Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 944133 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.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101,01(10), Wisconsin Statutes, is responsible for compliance with all codexequirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: C, This system is to be constructed and located in accordance with the approved plans and with the component w manuals listed above. /`~~ A copy of the approved plans, specifications and this letter shall be on-site during construction and open to DEP DtVlS1 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. SEE COf 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 Sincerely e agel Private Sewage Pl Reviewer ,Integrated Services (608)266-2889 , M - F, 0630 - 1500 Hrs pepagel@commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 4 Page 2 3/3/04 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ~JLBRICHT & ASSOCIATES CCU. 2812 10th Ave. • Spring Valley, W! 54767 _ Aeg. Designers of Engineering Systergs Private Sewage Consultants 715-772-3442 1ZECE1~/E _. ~~;~ ~ ? ?OfJ` ,SAFETY ~t ~~t~~6. ®11i PROJECT INDEX Plan I.D. # Date ~~r • °~' y. ~ °Zoo Owner ~!}~/eK K/iMP~'~ • Phone ~S~' y~0 •2 0 90 Address 33 p la-.. ~,4st' ~ g ~' ST. }('l~S t"i NIrS ~'t ~ . SSo3 3 Legal Description Lo T' a CSM G S 3 ~ 9/ UO l . LS , ~~ , y 14~ p/,V o/y • /00 ~' ' y0 • yDa ~ ^! E ~ 5 E~ S EG . ~ ~l ~ r 3 ~ N R 1S w . Town ofi yGd~Q~'s r County ST= GAD/ ~ e.s.T. N~~,~Ry GQoTE ~- 2217'7~f Installer Local Authority/ Supervision PROJECT DESCRIPTION • sf. cea,•x ~ry..,zo.~~ .~~ ~~„~- . • ~v~c~ odvs ~v oTioa ~ ~~ ~- ~i~opos~-v 3 ,r3~,P,y . SoiG 5 ~9-? ~'" ~D~~?.ti~il,3 /~`- ~, ~'' ~'p~Q / jcj~ Z) /~ v T' ,rG~' ~ f Gt/ Cuir U.ctQ /yD v~v~ S y s r~-~-i zls/.v c /~ ~' s.4-vv y f,•1 ~ i S ~~o~oS~-D . ~~ ~'~ ~~~ ~~ ~~1 N~ Ae ~~ sr I "~. ~ F~ /ll~~r~i, .. ~~/ ,, t~ ~GEifrk~T U1'i GU FiUDS6N, WI :~.~ ..~ 4~ ,. d~;~~~ ...... rr~~l' ~Y I G ~ ~ ~~~~~```~ ~IIPllllll! i II111115\lU\\\ Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT {REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN 08TTS ) Pg.4 DOSING CHAMBER CROSS SECTION ~ SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OP'ERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE ~ SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Frivate Onsite Wastewater Treatment Systems '} (Version 2.0 SBD-10691-P{N.O1/Ol) and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" {version2.0) SBD-10706-P(NOl/Ol). w~ ~ Z °fi ~ C R to 5 5 S ~c T ~ c~,v ©F lut o ~~ D -- w a r rt 'f3 E ~ 'Di St~ti(3uT~o,V PjP~NU- Cfp ~S ~s', TkickRsE'ss °F T'°PSoiL Uu~ FoRM T'oE L-i'~ E ~t ~/// PIowE~7 T o Q So ~. ` /// ~~// PLAN V~t1.v ~~ Mou~D -- w~rt~ t3ED <<< 9 /// sysTEM E'IEV~rio,~ Io/~a, ~j)ii~ $ % 51oPE FoR~E' \ Vu ~ F'o(2M p,~ h.i ~ E t Et~A1~Oa Uu OE t3~ /pp. 3 p ' .~ ~' Jr F r. --- E~ F U i4 r~ o ~ s --- E l' 9 Fr. a - tNV~Rr of /a ` 1gT~R/41s /off. 30 ~ ' gz' F T . ~ 1~~~~x H ~ a F Y. ~ ' ~'° P° F ~ 2-- I ATE R A I S /©2 . yy NaT~; ~Iov,vD tv%// h~¢U~" ~'~• f!-Tr GF,,,,r/cA~L G~v~' Cavoe'x TG SviT FvRc~ M~1i~ ~ Jr' FT• Gdc1 ~D v~5 --- ~. -- -- -- ---- --- - I d I a F r K jZ Fr _______ __.~______ I ~ i Fr ` ~ 7 - ----__-_~ +~ _ ___ ___j~ 1 _ ___ _ Fr ~~ ~ r F T' w ~ w z % ` 1 Fr ~"o ~G,41D 1 \ ~E~ of y2~` ®~r ~ y ,,vst~j To , , ., PVc. cAppEp ~.. Aq ti RE't-~T~ ~jt~10/~c? ~ ot35ERV/Erio,u A ~ ~7~Dl,J/ ~G'" , P ~ p E 5 /OVA T`! r?.t/5 " / ~ ~ -Fi2 0 M ~1~(~- ~X-~i'C.. PERM~l,~~,uT MhRKERS ~T~~S 4~ G/t_'rq,UOc9j .Sw~~~~\ R E c2 v ~ R ~ D f3As A ~ h R ~Ac 'DAi ~ w hs r~- Ft°w - yj~""Cj ,j ~~ S~ 11. t ~J'f i~ f K~/1T1t9 E .S ~ Ap/tci Ty ~ sit. F1' ~RoposEb t3~ts~ ARe~ (3 X ~ ~{ ~- _ r ~a x (5 ~ ~ 9~0 - OEv ~F ~ '' 1'0 ~ ~.~ A59Qc5,1TE- Fill material (~STtt44 ~~3, fine aggregate) }.. 4tysecvation pipe ,~.-•-• Slope w.~t..~ ~:»~s ..e.. hover material cIIU~I{Iti~S ~G~ ~ ~ ~~~/• ~~~~ ~~~ ' ~~~~11~~ ~, it ~~. ~~Ja~~ f~i ~' ~~~ ..- -> ~t-~ ~A~ v~c~~ c ~ ~ ~ ~. ~~ ,r ,. d/rT~~° ,~-- 5~ ~ 3 -t~ -~ __ ~ _ - --- .~- ~ ~6 Sa~G ~ 5~0 ~~~~/~ ~` Qistri6ution cell ~-- Force main i~igure 6. Cross-section of a Mound System figure 8 -Observation Pipes ~?ts~-~it3UT1p~ P~~~ L,~~~a~7-- CErJTR~L ~tat~cE M/~i~ 75 Fr. df ~~~~~r ,, ~ pvc `t~oT/~~ veld Uv1uM E ~ ~` GatS . ~ olf; ~-%4NET~R ~._h~ ~ ~~ ~ ~~ C E,vTR ~ L /vr A~ ~ ~ v i., d ~~ ~oRCE- /~1111N ~~ .~~ ~~ Hv1Es~~~ pE H 5 ~.-~ rNc4~i=5 __ ~' 1 ~.t t t{ E S ~` tt~cNES ~~ SEE ~'~U~PSE SrUE .{-p~ ~'~ pl~~`°~~ 1~E Iii (._ RPrr~ o f ~ i~ ~'~ PER Fc~R ~ZE d pi QE "~ ~ . .,~ ____--- R~Mo~E- htl Df2;1{ F3uRR5 ~ y Noi~S IocnTEb o,J c3otroM E u ~ ~Ii Y ~~ P y3 Fr. R 2-~ ~r x ` ~,~~~ Y 30 ----~--_.._ I u c F( ~AR~'na~E 'pi5T^aC~ . ToT~a~ 1/o/ay~- ~P ~rwa~K /~ ~o ~s , ZfJV~RT ~LEVi~T~O~ o~ LAtErQn15 /~o~ • ,30 o~t'i Fi c~- D~v SS'T' y ~. /p sa. ff• P~ -- s.pAc~v ~tSrR~ [3ut'to~ T~ESchAR(rE RATE' ~oR ~/~ch LA-r ('~R ~ ERq L figs ~. yo Ga~~M~~. ~T'OTII~ ~iSTRiQUTtorJ ~IS~!-~~lRfaE RAjE ~(~(~ NtwT woR k 3 ~. ~ D ~ G~t_~1~tr~. ~ a•5 NI~'Ni MVM u .... .. / P G /f-T~i~'.'~-L - ~;v~sh`~z~ /G1oU~vp 9iP~4D~ - --- -_ ~,~/vv S/~iPiv~~~ ~av~,~ oip cgPp~~ --` ~/~~ P ri c stiao~s ~~~ ys~ l3E,c,~_; ' Tfi'~f'E~l~~ ~1 / 19p~ TE ~,~,~ w,~ I'~~'_ d.~ P~'~~-,~,g-rip ----, /BUG f.3~¢ // v~ /U~ ~q r~q-~-- PUMP CHAMBER CROSS S~'CTION `AAIfl SPECIFICATIONS P~~~" .~ ~yt.=. S ~ ~b VE}.1T CAP ( PI P~ VEI+.lT-PIPE APPROVED LOCK1AlG - WEATNER PROOF JUJJCTlO1~! BOX MANHOLE COYER wf Qitt~°N»(r' /~g~/ f 12"Mttl. -. .- i ~'~ /, ® ! 111~~~~ ~°j~tr~iT,On/ GRADE _ l Y°Mli,.1. .~ 18"MV~1. COIJDU{T ~-- --------- ~\\ y8 fl~U~r€' o~ ~ ~ ll~ .z INLET PROVi TE EAL. i ~ !~ - .~ ~~,_ AIRTIGH 5 ! ~ ~ J~ -~- ~ ~ i , v p,~P O D JOtRIT A ~~J~I' ~ ~ •~, „ ~ i I ~ i W~FROV P PE01A 1,rj PIPE ~ ~ -(t3!"~ t ~ ~ ~ ~ EXTEAiD1A1G 3' LXTENDttJG 3' t}~ , ALARM 0 } r { ~ ` 1 OA1T0 SOL, D SC ONTO soLlQ soil a 7 ii 7 J ~ ~ ! 5~ . ~~ , ® c -~ ! ~j~y I ~~ E.LEV_ a J ~ FT. ~ PUMP-^,,,, --J Z/S~ / ~ ,~ OAF o ~ ~ - ~a,Q~` of `~~Dpl~ ~" ~ S~,vj> ~ ss.ocK j~GY~riv ~~ E~v~t f rQ,J - ~ - -~ {MISER EXfT PERM1Ti"ED OI~SL`.# IF TAIJK MAtJtkl=AGTUR£R HAS SUCH APPROVAL .-~ SEPTtG E SPEGiFiGATlOt~SS TAi~1KS MANUFACTURER: ~~~~~ ~~~~~ ~ ~.1t1M8ER OF DOSES: ' ~ PER DAy TANK SIZE : ~ ~ ~ ® f~ALLDA! S ~ DOSE VOLUME $S ~!, ( 1 ALARNt MANUFACT(1REK: G~~~I~~M `'~ ~ IAlCLUDlAJG sACKFLOw: GAl1.ON ° MODEL 1.}UM$ER: ~~ ~~ ~ - CAPACiTlES: As ~. R 1NCHE5 OR ~~ GALLON: . swtTCH TSPt:. ~/O~ `r g = ~ tAfcHtrs aR 3~ ~~ GALLOu PUMP MA1JtJFACTURER: ~}z" of/J~ C= ~"~ INCHES OR ?_/~:.L2_ GALLO-J MODEL FJI3MBER•:~`f , /~- ,(~ ,,~,~ NOG7~ D=_L~tI~-GHES oR J" 7 GALt_O!J - SW1TC}f TYPE: r~ ~~y~ ~~`~ ` ~/~~~ t~10TE: PUMP A1JF1 ALARM ARE TO BE MiNiMUM DISCHARGE RATE GPM IAISTALLEa ON SEPARATE CiRCUiTS VERTICAL DiFFEREl~ItE BETWEEN PUMP OFF AND D15TRt81lT{oN PiPE_. ~~ ~ FEET fiA~~ Sf~~~S . -I- MitutMLtM klETWORK SUPPLE P^~RE~SSURE . _ .. :3' ~"'~ FEET ~}iGG~,,. ~ F m~ `~ ~ ~5 FEET OF FORCE MAtN X ~' L~_F3~ot[FKICTi011 FACTOR. ~` S FEET .~~v~~~ ~ y O f TOTAL. D~{JAMIC HEAD = ~a ` ~5 I=FFY ;~ - RpuuD gy,~ y~ {NTERNAt_ DtMEA35tONS of TA1JK: LEAIGTH ~_;WIDTH •;LIQL714~ DEPTH ~ ~o~~/rte' ~`'~ oD~'G f ~ f ~ i'~F'T ~i ~'~4l~ - ~~ riiS POWT SYSTEM SHALL f} T ~~ INCORPORATE PER COMM. 83.44(2}c A PROPER ZABEL fJ ~/f v~ ~S ~~ ~~ ~ U"~ FlLTER MODEL # ~. - ~ (y-p o ~ y~~ ,~__:_:,__ i ~'` ~. tea" _ ° ~o,e 3~ ~~ ~ -Fjo ccJ outlet attached approved filter device (Zabel fliter}. Tank shall have an approved above ground locking manhole cover for regular (every 12 months or Less) inspection ~ servicing by a liCensdd service pumper. -~ SEPTIC TANK, per Comm. 83,44 (2) {c) shall be equipped with an ~~ so~~ Z©LLER EFFLUENT PUMP MQDEL 98 ~, ~' 1 aff• i f/:-f t t/2 NPi ToTK nYttllinp HlkktiWt till tI..WT! itltUlkT Utp pary~TIl4ek1 ~~ tAtACt1Y 1tMnilMtN - tftt MitiRt ~AirE,c, tlrti ~ t.i2 rt bra t0 i.b0 it x3f ti 1.SI !6 Irn - ~ i tit 7# r•S lockValw ~~' 3 7. 1~ CONSULT FACTCIpy app SpEClAL APPLICATit)N~ • E-ecirtcet atlerrtatvrs, ivr duplex systems, are avrtitabie and • euppNtad wish en alarm. Mercury float SwitchQS are avaHabta for controiltng sk--gle and t.Mschantcr slternatora, fdr duplex sVslams, ara avaHable wNh of s Uroubte piggyback mercury float twdches ara avaft wlltfou! Mean fhvllCtteE. able for varlaWa lever bng rycte contrata. 8lendatd art models . ~ fu larfaa trtodaf Y4h•-f fi klodr hmp rase t~~ t,f~ ~ o.d Dv0 730 i Al./ta `.9 f2fN !30 f _ Hat i i 3e lbs. • r~>, tt.l~. _ Controt 3aracttai Rff.ECTIQN OUtDE ' - f!. ~ ~ Qraf float oprrrded ? port rnscl+anlcai nwfteh, rto axfetnai control tpttfrrd. ftt P 4DYback mareury ttoat twtlch w doubir F,,]Qyback marcuty, rl6tlf rwhch. flabt to Frt01T1. 3. ftachattkaf aharnator IQr)072 of f0-0073 ". . <. Stn FtAOf r?. for oorraet moral e( EFsdriear Aharnetw, "E•Fak" 5. IMarcury preaot Ibaf awFteft f0~4Y.ts !u,Ld ai w corttrd netivaFot .plcth dupkc (3t or t~l tloq fyatam, ~ _r9~-.ti1 ~ "d Pak". funetlat bout tar pox a duptae oprradort fo AooQ, conrtKflotr or ttitrad (n ilm. 1. t.ve tEi /reM'! taR", for rratardQfl owtrt..__...tc fp1{oi" /tI t t fl -h-,-- ia! t`irwipn M sritM,rlM i+tafdr fMadr~cti ,.r« a gtabq en Co.,~c4wion flun« f r.40i t {~ v"r«t Fuo4tr EtMrkrllUtarnua, r Alf fnataftatfoa M conic cRUr1oK ~t,rA iWy~tp bkltAe; N,.cRUJrai Aitrtuta, ~, prdaciFo+r {+4bea snd takFt+t afie,rF1 fN Iona Itbllk 'r~ ~'~'~a aa,~, ff,AOtIT~ 4tie1 tti }Fad Nc/nMd ilwl[faLtQ. AR • ~ w i ~M' ~><~oned tlm~ t^f ~+ ~{QiNA~ Malronai EtadrMdC n1 ad soda arx~~~a,,,y . ifaaMk Ad } 'aa iHt~7 aM M+a [ fNr serf - ~ RESERVE PpWEp£b DESIGN + • Fcrr"unusual conditions a reserve safety factor la dttglnei~red into the design of n~ery Zoeller pump, E ._ .. - MAtt lar.U. f38X Ifr3fl • Q' 1Tt'~f `~/~ ' ~- ~ ~ tarn~vir9.~XY10l56.03t1 A~l2gU/dCtutal; oJ... L./L ~[ ,[ f T' fNtF' 1 tl: 380 (f~i~ AGtlars tint f ai= k; XY fG.'16 w Ja~f fsol~ rre~~r3r :• rtr,so~ n~-36~r '~""`"r~°~ 3 E/a/9" • f/1 3f1! ~. .._~. -\ - t.~ ~ a sfe FLOW pE~ MfNl7T[ Mound System Management Pian Pursuant to Coinrq 83.54a Wis. Adm. Code Septic Tank ' The septic tank shalt be maintained by an individual certified to service septic tanks under s. 281.48, Stars. The contents of the septic tank shad be disposed of in accordance with NR 1 i3, Wis. Adm. Code. The operating condition of the septic tank and outlet niter strati be assessed at feast once every 3 years by inspection. The outlet (fitter shaft be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retairrsolids in the tank that may slough off the filter when removed from its enclosure. if the fitter is equipped with an alarm, the fitter shah be serviced if the alarm is activated continuously. tnfermittenF fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennla# assessment, maintenance personnel shah advise the owner of when the next service needs to be performed to maintain less than maximum scum and stodge accumulation to the tank. The addition of biological or chemical additives to enhance septic tank performance is generaity not required. However, if such products are used they shall be approved for septic tank use by the Departmenfof Commerce, Safety and 8uitdings t3ivision. Pum- p Tank The pump (dosing) tank shalt be inspected at feast once every 3 years. Aii switches, alarms, and pumps shalt be tested to verify proper opera#ion. if an effluent fitter is installed within the Tank it shah be inspected and serviced as necessary. Mound and Pressure Distribution S tem iVo trees or shrubs shoutd be planted on the mound. Plantings may 6e made around the mound's perimeter, and the mound shag be seeded and matched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aera#ion of the infiltrative surface within the mound and snow compaction in the whiter wilt promote frost penetration_ Cold weather fnstattations (October-February} dictate that the mound be heavily mulched for frost protection. Cnfiuent quality into the mound system may not exceed 220 mg/L BOtJS, 150 mgiL TSS, and 30 mg/t_ FOG. Influent flow 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 he flushed of accumulated solids at feast once every 18 months. When a pressure testis performed it shoutd be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal dfstributian within the dispersal cell. Observation pipes wifhin the dispersal cell shalt be checked for effluent ponding. Ponding levels shat! be reported to the owner, and any levels above d inches considered as an impending hydraulic failure requiring additional, more frequent monitoriru;, General . This system shall be operated fn accordance with Comm 82-84 Wis. Adm. Code, and shah maintained in accordance with its' component manual [SSD-(0572-P (R. 6/99)j and focal or state Hires pertaining to system maintenance and maintenance reporting. No one shoutd ever enter a septic or pump tank since dangerous gases maybe present that could cause death. Septic and pump tank abandonment shaft be in accordance with Comm 83.33, Wis. Adm. Code when fire tanks are no forger used as POWTS components. Septic or pump tank manhate risers, access risers and covers shoutd be inspected for water tightness and soundness. Access openings used far service and assessment shat! ire sealed watertight upon the completion of service. Any opening deemed ' unsound, defective, or subJect to failure must be replaced. Exposed access openings greater than 8-inches in diameter shaft be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaen~ Plan if the septic tank or any of its components become defective the tank or component shaft be repaired or replaced to keep the system in proper operating condition. "~!f the dosing tank, pump, pump controls, alarm or related wiring becomes defective the detective component shalt be immediately repaired or replaced with a component of the same or equal performance. if the mound component fails to accept wastewater or begins to discharge,wastewater to fire ground surface, it will be repaired or replaced in its' present location by increasing bassi area if toe leakage occurs or by removing biobgicaliy clogged adsorption and dispersal media, and related piping, acrd replacing said components as deemed necessary to txing the system into proper operating condition. Questions on the operation or maintenance or this system should be directed to your county zoning yr health inspector. SEE aEVERSE SIDE Pg. s FOR MAIIVTEAtANCE REQUIREMENTS s~ECrFIc TU 't'l1tS SITE, DESIGN, AND COMPONENTS i~2~°~~ - OWNER's MAINTAINCE~"OF~SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of; this systet. The owner is required by code to submit all necessary maintenance/inspection reports to the controlling,authorf-ties. SPECIFIC CONTACT AGENTS ,~~ Goo/ x ~ >/ * Governmental authority/ inspectors: 7 ~s • ~~~0 ~ ~~-~ C~ * Licensed installer, responsible for providing an operation/ maintenance.."Users" manual: * Licensed servmce / inspection agent other than installers *_ Electrician, for pump, electric controls, wiring units: o l~Jw-Gtr ~O~ /3 !>/~Gl~~l2. ' IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic~(sledding, shoveiring, etc.) across the area shall not be .permitted, or frost can/will penetrate into the cell, freezing .up the system. Discontinuos use- in the winter. (a vacaction.trip,_ resulting.in no water use) can also lead to freeze ups. - . ~'-2. Water conservation needs to be exercised! Or system can be hydrolfcally overloaded and destroyed. This svs~em was designed for a maximum wastewater flow of ~~ gals. daily. 3. POWTS are not designed to accomodate wastes from a Barba e., disposal unit, or any other unnatural sources of waste'. g _ Any introduction of such waste materials will overload and destroy this system. _ 4• If a power outage occurs, or a ` in a temporary overload of effluent beins~ It may res~It cell, which may adversely impact the cell (leakkge)tolthis recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5• Neglect of the vegetative cover {the cells insulation & erosion preventive) can Lead to failure. Compaction or heavy _. traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'!'EM!! Effluent in the stem beneath I5 NOT sufficient alone t0 maintain a gr~cover. 6• Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: an the mound basal area (effluent level inspection pipes), cieanout terminals on the pressurized laterals, at each tip - for flushing and cleanin out:. The filter system in the tanks 9 the laterals ground cover/manhole). Only a licensed2aro er?ked above person should be performing this work which involveslheaith ~ severe safety risks. Evidence of effluent ponding in the system's tre?tment cell shall also be regularly inspected. .~ . ~~ ~ _ , ~ /. ' Wisconsin Department of Commerce Division of Safety and Buildings "~RIGINA~ SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1291 ,~~ ;~„~ image 1 of 3 ~'\~~.~~ -- ~ Ga[tified Soil Testing ounyy . Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must _ : C r+ t.l~Pbix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. par _e `f.D. ~ ~-"' - ~ c7D $ _~ ^ ~ to ~ ~ ~I ~ 6rB ~ T~ l• Please print all information. e Vved B i~:'~ `~ -. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.(14 (1) (m)). t ~_ ~ i9 ropey wner ~ ropey oca ron .` ~},~ , MIGOC=FiCi: 4 31 NE 1% $f ~/4 /` •N R IS W ~^--tirv ((. Seidli rid . Govt. Lot S ,v roperty wner s ailing Ad ress Lot # Block # Subd. t~T;;SM i Pending ~ 5 ~~ ~~BM ~- 4445 Old Wells Road 2 . - , City State Zip Code Phone Number Cit Village Town Nearest Road Eau Claire WI 54703 800-386-7969 Forest 290Th St. f r/i New Construction Use: Residential /Number of bedrooms 3 Code derived design now rate ~ru ;Replacement Public or commercial -Describe: Parent material till Flood plain elevation, if applicable NA General comments and recommendations: install 4' x 112.5' rock unit mound on 100.3 contour as upslope edge of rock w/ 1.5' sand fill for 3 br residence ~ Boring # Boring ~ ~ ~~ ZrbD r ~ ^ Pit Ground Surface elev. 100.3 ft. Depth to limiting factor 1~- in. SoilAppfigtion Rate ~~,~ Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' p in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 2 5-11 7.5YR 3/2 - sl 2 f sbk mvfr cs 1f .5 .9 3 11-18 10YR 4/3 - sl 2 m sbk mvfr cs 1f .5 .9 ~ 4 18-42 5YR 4/4 f2f 7.5YR 5/3 scl 0 m mfr - - 0 0 `~ .~~ Boring # `j Boring ~j Pit Ground Surface elev. 100.3 ft. Depth to limiting factor 2 % in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-7 7.5YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 , (P 2 7-19 10YR 4/3 - sl 2 m sbk mvfr cs 1f .5 .9 ./ _ 1° 3 19-27 10YR 4/4 - s 0 sg ml cs 1f .7 1.2 , ~ 4 i-60 10YR 4/4 l OYR 6/2 s 0 sg ml cs - .7 1.2 5 60-70 10YR 4/4,4/6 - mcos 0 sg ml onzon as s ra r re , trregu ar s an s , m, m r ; mottling is in s between bands ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and T55 < 30 mg/L ame ease rant rgna ur um er Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54 4/29/2001 715-233-0398 + ~ „ '~. ~cel ID # Page Z of ~3 ~ ~ gg,3 ft. Depth to limiting factor 24 in. Soil Application Rate Texture Structure Conslstence Boundary Roots Gr. Sz. Sh. sl 2 m gr mvfr cs 2f1 m .5 .9 sl 2 f-m sbk mvfr cs 2f .5 .9 sl 2 m sbk mvfr cs 1 m .5 .9 sl 0 m mfi - - .3 .4 ft. Depth to limiting factor in• Soil Application Rate Texture Structure Consistence Boundary Roots P Gr. Sz. Sh. Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = ~DS> 30 < 220 mg/Land TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Depa ment of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8370 (R.07/00) Certified Soil Testlng •~xVx`sMnsb~lRSa..aPn'MTtF4Tev,'~"m'n'.~a'R••w•s4..=••~••»+•-••.-~w f ~ ~ , ~ Property Owner Seedling, Bemdrd Parcel ID # Page 2 of 3 20 Boring # ~ Boring Pit Ground Surface elev. 99.3 ft• Depth to limiting factor 24 in. ~ Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. $z. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots 1 0-5 10YR 3/3 - sl 2 m gr mvfr cs 2f1 m .5 .9 2 5-11 10YR 3/3 - sl 2 f-m sbk mvfr cs 2f .5 .9 3 11-24 7.5YR 4/4 - sl 2 m sbk mvfr cs 1m .5 .9 4 24-40 7.5YR 4/4 f2d 10YR 6/2 sl 0 m mfi - - .3 .4 - r--- Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in• SoilApplicatan Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in• Soil Appliption Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-315 I or TTY 608-264-8777. SBD-8730 (R.07/00) Certified SOiI TESting .~ . (r .~ y ~ ~. ~ - ~` ~,`'~+' 13"1 l~ o,o~ / /-•- ~ a ~' ,. ~ C.Q. I (`s ~. v~ ~q4.3~ ~ s 9a -~~ S~at~ ~~_~~~ F'~~ c 2.o qb /~1 ti'!' K Li't '~-}R i- IL4o A_ ~~^ '` ~~ ~ ~ ° ~r.~aL.6S . 'k ~~Ad ~ ,,, ~ ~ ~ <<~.~s ~~ag,~~ b ~q~u, J ~ r +.titY~+Q r++1ti.. «aj/ ~~ a~ti~~~ ~~ L Z ~a~t:M .r.....,~r. a ~ ,,.~~ .~ ~o .o v ~ ~ w L ~M"1~ V~ a ~ ^t _...~ ~• `~ Chi : ~,~.,. +O K+~r C ~ Owl .3 ~ ~ k ~ ~~ ~ v ( ( ` ~v~ ~o ~ ~Cc.i b.ra,~~ ~j\ ,~^^j 3 p i~ S ~~ K~- Sti - 4--~~ _ ~ w .~ LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF FOREST COMPUTER NUMBER 014-1008-40-400 Parcel Number 4.31.15. 1B-40 OWNER NAME: First RICK Last PANTERA ~u~"tC~~t~-a:2d PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 4 TOWN 31N RANGE 15W'/.160 SE'/+40 NE Line Description Line TOTAL ACREAGE 15.345 P 48 01 SEC4T31NR PT NE SE 15 02 F'FINC~ C~SM 1 ~/didg LOT2 16 03 15/345AC 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 Description 014/01 LOT02 BLK F1-Gener .l, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit ' A o t ~t -- l ooh Yb ~ C i4 ~i~-u~~ v _ ., _ _ ~ o[ ~f 108 ~fb (~~ l-3 ~~~a,Q~ (e I {3 ~ T!!7 O (y -' (O0 t~ ' ~0 - (S~ 65~7'91~~(j -~ N,ATHLEEhI H. WALSH (~ I (3 ~cD I ~(~ (0 U 8 --' `~O- ~-OC~ f;EGISTEf: OF DEEDS (0 ~ ~ -~~ ~` S-[p ~-3 ST. CROIX CO. WI ~~ O 1 ~ (U o 8 - 7o RECEIVED FOR RECdRD ~ ~ /~,- (~ ~r< ~ 01 ~{ - (oog - ~t0 -- ~o ~Q g - ~ ~ [ -la-2oo1 e:ao an O [ ~-I, - ~oU~3 - ~U - ~(, C9 p ~ (k3 - YU QCs-~'a COPY FEE: 3.00 Cfl.l~~ ~ ~ ~ -S~ ~ - ~ U _ . - D ~ RECORDING FEE: 12.00 c~cu- ~'E1~T~'~'I~S~1~V~~'M~~ t Located in the NE'/. of the SE 1/. and the SE 1/. of the SE'/. of Section T31N, R15W, Town of Forest, St. Croix County, Wisconsin. UNPLATTED LANDS ~. SEE NOTE ~,1 I ~, EAST-WEST 1/4 SECTION LINE N ~° ~~ 3 t" E 1347.86` 75` '` N 89° 35' 31" E 4,048.93` ~~ 1,314.84' 33.02 I id E1/4 CORNER, SECTION 4 ~ W1/4 CORNER, SECTION 4, (2 "IRON PIPE SET) I ~ I ( R.R. SPK FND.) i ( RAIL ROAD SPIKE FOUND) $ r ~ /,~~~2 ~ ("OT 7 ~ ~~ I g (f~ EJ l ~w ~ 665,539 SQUARE FEET (15.279 AC.) I ~,,,o I INCLUDING RIGHT OF WAY I~ 648,863 SQUARE FEET (14.896 AC.) ~ I EXCLUDING RIGHT OF WAY ~ I N 9' 1 313.71' ~'~ I I N 89° 35' 34" E 1,348.24 ` I I I 1 2 w Scale 1" = 300' o - SOT 2 ~ ~~~ I to w g 668,420 SQUARE FEET (15.345 AC.) I ~I Z ~ INCLUDING RIGHT OF WAY I Bearings referenced to ~ ~ 650,929 SQUARE FEET (14.943 AC.) I ~• I n the East line of the SE w EXCLUDING RIGHT OF WAY I ~ ~ '/+ of Section 4, assumed ~ 9' ~ 3s oaf ~ I ~ SOl°33'01"W. 1,312.57' ~ QWNER / SUBDIVIDER ~I N ~° ~' ~" E 1,348.61' I ~ o I I FOUR STAR ~ I ~ ~ ~~D I A I~ PROPERTIES SI ~ ~ ~ {v 1 ~,, 4445 WELLS ROAD W I ~ ~ ~ LOT 3 I ~ I w EAU CLAIRE, WI. 54703 ~I N ~ 839,481 SQUARE FEET (19.272 AC.) i ~ a, ~ o ~I w ~ N INCLUDING RIGHT OF WAY "'I- ' ~i ~~ ~ LEGEND ~ ~ v; 816,614 SQUARE FEET (18.747 AC.) $I N $° ~ I -~ -SECTION CORNER ~~ ~ `N° EXCLUDING RIGHT OF WAY ci ~ I ~ MONUMENT. (AS ° v' ~' w ~' NOTED) o ~I I ~ • - 1" X 24" IRON PIPE c~ Z I ~ z' 1,311.47' ~ 37. ~ I m WEIGHING 1.13 LBS. m v I o / LIN. FT. SET. Z N 89° 14' 19" E 1,349.41 ` ~i I I = -+~-~- - FENCE LINE. ~ /_ 1 ~l ~ ~pO r= I I m 3 W ! "Z' I m _ ~ ~ I I ~' ~ NOTE: ADJOINING LAND w ~ ~ I OWNER MAY HAVE o OUTLOT 1~ LEGAL RIGHTS TO O I LANDS BETWEEN THE m 1,306,842 SQUARE FEET (30.001 AC. ) FENCE AND THE EAST- INCLUDING RIGHT OF WAY ~ ~ ccI WEST %.. SECTION LINE. w "' 1 228,725 SQUARE FEET (28.208 AC.) ~ ~I I CONSULT AN ATTORNEY ~ ~ ~ EXCLUDING RIGHT OF WAY ~ _ BEFORE REMOVING o ~ ~°~' FENCE OR DEVELOPING ~ NOTE: Outlot 1 is an unbuildable lot until ~ .~ THIS PORTION OF THE w such time it is replatted and approved by St. 0«' I PROPERTY. = Croix County. ~ I z ~, S1/4 CORNER, SECTION 4, ~ 100' BUILDING SETBACK LINE FROM R: O: W.- _ _ _ _ .1 I I T31 N, R15W, FOREST. ~ - -~,o- - - - - - - - - - - - - (7/8 STEEL RE-BAR SET) _ ~ S89°05'29"W 1.309.46 _ _ - - ~ ~..--- N 88° 53' 05" E 1,350.51 _ S 88° 53' 05" W-1,350.51 . - - _ _ '~ - -~ ~- - - - - i ~'rr ~z SOUTH LINE OF THE SE1/4 UNP(.ATTED LANDS SE CORNER, SECTION 4, I ~ ID ~ PREPARED BY: (z' IRON PIPE W! SPK FOUND) iv ~~ GRANBERG SURVEYING I I" = 300` V 1239 C.T.H."E„ SCALE IN FEET WITH SPIKE i~~m New Richmond, WI.54U17 ~~ Phone (715) 246-7529 0' 75` 150` 300 600' 900` SHEET 1 OF 2 Vol . ~ 5 Page 4148 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owae Buyer Mailing Address Property Address _ ~ ~~ ~~- ~ ~ U ~ ~-~ • ~~ d (Verincauon required from Planning Department for new City/State ~~ ~- ~~ ~.~ Parcel Identification Number / ®1-`1- 1 ~°~'°' ~~} -- ~~ LEGAL DESCRIPTION Property Location ~ ~ %4, S E '/~, Sec. ~, TAN-RCS W, Town of 7~' o ~- ~ s ~ Subdivision LS ~ ~ 1 ~, ~ S N , L- ©t 2 ! G s yrt ~ s3 Z 2 / .Lot # _~. Certified Survey Map # ~SfX ~ S 3 ? 9 / ,Volume C .~ ,Page # ~( 1 `~ 8 Warranty Deed # ~7 S" ~ 78 ~ ,Volume ~ S i 3 ,Page # ~ / 3 Spec house ^ yes f~" no Lot lines identifiable L~'yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, resKricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is is 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 Zoning Office within 30 days of the year~fion te. ~ ~•'}~~/~ .. C AGr SIGNATURE OF APPLI ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property 'bed a ve, by v' a of a warranty deed recorded in Register of Deeds Office. ~O SIGNATURE OF APPLIC DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Document Number u 25i~3p ~i2 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Rick Pantera, a single person, Grantor, and Mark R. Klimpke, a married person, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Kecording Area 75789 ` KATHLEEN H. MIALSH REGISTER OF DEEDS ST. CROIR CO.. MI RECEIVED FOR RECORD 02/20/; 0@4 12:55P)y MARRAHTY DEED EXEI~P7 ~ REC FEE: 13.0@ TRANS FEE: 105.00 CQPY FEE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 115 Exceptions to warranties: Hudson, W154016 Easements, restrictions and rights-of--way of record, if any. 420998 014-1008-40-400 Pazcel ldentification Number (PIN) This is not homestead property. Dated this 13th day of February, 2004. ~, ~~~ * Rick Pantera * AUTHENTICATION Signatures} OWr 1 authenticated this 13th day of Febru ~ `n'~SOpC~S~ c~e O V'~ * -~ TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or acknowledged. Both are not necessary.) `Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this February 13, 2004 the above named Rick Pantera, a single person to me known to be the person(s) who executed the foregoing instrument and acknow ed the sa e. *Cheri rown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/ 11 /2007 ) STATE BAR OF WISCONSIN FORM No.2-20011 i N r, L . U ZS13P 'i13 EXHIBIT A Lot 2 of Certified Survey Map filed August 14, 2001 in Volume 15 of Certified Survey Maps, page 4148, as Document No. 653791, located in the NE'/. of the SE'/, and the SE'/. of the SE'/. of Section 4, T31N, R15W, Town of Forest, St. Croix County, Wisconsin. ., ., ~, ~1 ~'1 CERT.~'FIED SURYEYMAP Located in the NE'/. of the SE'/a and the SE'/. of the SE'/, of Section 4, T31N, R15W, Town of Forest, St. Croix County, Wisconsin. DESCRIPTION: A parcel of land located in the NE'/, of the SE'/< and the SE'/. of the SE'/, of Section 4, T3lN, R15W, Town of Forest, St. Croix County, Wisconsin, further described as follows: Beginning at the SE Corner of said Section 4; thence S8$°53'OS"W 1350.51' along the South line of the SE'/, of said Section 4 to the West line of the East'/z of the SE '/, (bearings referenced to the East line of the SE '/, of Section 4, assumed SO 1° 33'01"W ); thence NO1°35'38"E 2590.11' along said West line of the E'/z of the SE'/. to the East-West'/, Section line; thence N89°35'32"E 1347.86' along said East-West'/, Section line to the E'/. Corner of said Section 4; thence SO1°33'01"W 2573.36' along the East line of the SE '/. of said Section 4 to the point of beginning, corrtaining 3,480,282 square feet (79.896 acres) more or less and being subject to any easemems, restrictions, and covenants of record. SURVEYOR'S CERTIFICATE I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that by the direction of the owner, Four Star Properties (Bernard Seidling, Pres. ), that I have surveyed and divided the land shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes, the Town of Forest Subdivision Ordinance and the St. Croix County Subdivision Ordinance and that this map and description are a true and correct representation thereof. GENERAL NOTICE STATEMENT Each parcel shown on this map is subject to State, County aad Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel corrtad the St. CIrNX Coumy Zoning Office and the appropriate Town Board for advice. THIS INSTRUMENT DRAF!'ED BY: JOSEPH W. GRANBERG DATED THIS 28"' DAY OF DECEMBER, 1999. GRANBERG SURVEYING s1~5•~ O /ys y 1239 C.T.H. "E" JOSEPH W.~t New Richmond, WI. 54017 * j GRANBERG 3 5-2295 Phone (715) 246-7529 ~ WHnnoND Job No. 99-050 ~ APPROVED ST. CROIX COUNTY Planninl7 Zonir~ eM Parks Committee auc x 4 zoa~ If not recorded within 30 days of approval date approval shall be null and void Vol . 15 Page 4148 SHI~'I' 2 OF 2 Sr ~S` ~. ~~ 653791 KATHLEEN H. WALSH REGISTER OF DEERS ST. CROIX CO. WI RECEIVED FOk RECdRD 08-14-2001 8:30 AM COPY fEE: 3.00 RECORDIHO FEE: 12.00 CERT.~'FIED SURYEYMAP Located in the NE Y. of the SE'/s and the SE'/. of the SE'/i of Secxion 4, T31N, R15W, Town of Forest, St. Croix Coumy, Wisconsin. UNPLATTED LANDS ~ SEE NOTE ~, J - I ~, P EAST-WEST 1!4 SECTION LINE N 88' 36' 3Y" E 1347 88' 75' N 89° 35' 31" E 4. .83' 1,314.84' 33.02 W1 f4 CORNER, SECTION 4, ~ E1/4 CORNER, SECTION 4 ~ (2 "IRON PIPE SET) I I I ( R.R. SPK FND.) (RAIL ROAD SPIKE FOUND) L0T1 ~ A 8 ~ ~P I w ~ 885,539 SQUARE FEET (15.279 AC.) I $,q ~ `r INCLUDING RIGHT OF WAY I ' P 848,883 SQUARE FEET (14.898 AC.) I I EXCLUDING RIGHT OF WAY i I ~ ~ ~ 9 - 1313.71' I ~ N elI° 35' 34" E 1,348.24' ~ I I IZ N I I ' i I' I ~ Scale 1" = 300' LOT 2 ~ z w g 888,420 SQUARE FEET (15.345 AC.) i I ! Bearings referenced to ~ ~ ~ INCLUDING RIGHT OF WAY I (. 650,929 SQUARE FEET (14.843 AC. ) ~ the East line Of the SE w 3 EXCLUDING RIGHT OF WAY I ~ I I ~ '/. of Section 4, assumed 9 ~ 38.W 1 I 501°33'01"W. OWNER / SUBDIVIDER yl O I 1,348.81' N 89' 35 38" E I ~ ' FOUR STAR 21 S ~ ,° I I y PROPERTIES 4445 WELLS ROAD I ~I ~ ~ ~ LOT 3 ! ~ I i,; EAU CLAIRE, WI.54703 ~I ~ ,~ 839,481 SQUARE FEET (19.272 AC.) ~ ~ w m ~ g LEG a ~ m $ INCLUDING RIGHT OF WAY , m 814 SQUARE FEET { 18.747 AC.) $ i !~ ~ ~ 818 ~ ~ , ~ EXCLUDING RIGHT OF WAY I -~ -SECTION CORNER Ji ~ ~ I I ~ MONUMENT. (AS ~ 6~ ~. ~ ~' NOTED) ° Z Z' ~ ~ ~ • - 1" X 24" IRON PIPE t~ w 37. ~„ WE[GI-IING 1.13 LBS. w i 1.311'47 ' I Q / L1N. FT. SET. ~ ~, ( N 89' 14' 19' E 1,348.41 I ~ ' .•-~-. - FENCE LINE. ~ ~' I ~ I ~ 3 Ti I I a 4 NOTE; ADlO1NDVG LAND u~ ; ~ I ~"~ ~ H^.ro ~ ; ourcor ~ J LANDS BETWEEN THE ~ I a 1,308,842 SQUARE FEET (30.001 AC. ) FENCE AND THE EAST- p INCLUDING RIGHT OF WAY f ~ mi WEST Y. SECTION LINE. ~ 1,228,725 SQUARE FEET (28.208 AC.) ~ ~I I CONSULT AN ATTORNEY ~ EXCLUDING RIGHT OF WAY ~ _ , I R D p NOTE: Outlot 1 is an unbuiidable lot u~.il ~ vELOPING FENCE O THIS PORTION OF THE ~ w sudt time it is tephmsd and approved by St. I~ I PROPERTY. ~ Croix County. I I ~ I I I S1/4 CORNER, SECTION 4, N 2 100' BUILDING SETBACK UNE_ FROM R.-O: W • _ _ _ _ _ J I I T31N, R15W, FOREST. ( 7/8" STEEL RE-BAR SEt) - - - - ~ ~ - - - - - - - - - - - 309.48 _- -- ~ S gg• 05 28' W 1 ~--~ - - _ _ _ _ _ ~ _ - - ~ ~ ~~ N 88' S3' 05' E 1,350.51 - . S 88' 53' OS' W.1.350.51 ~ _ r- - s ~..-~°'I ~. _ _ ~~ LINE OF THE SE114 UIVPtATTEQ LANDS „ PIPE WSSPK FOUN I )I ~Z ~5 PREPARED BY: { 2 RON GJjq/NBERGSURVEYING "E" 1239 C T H SCALE IN FEET I" = 300' WITH SPIKE y '~~~ . . . New Richmond, WL 54017 0' 75' 150' 300' 800' 900' Phone (715) 24lr7329 SHEET 1 OF 2 Vol . ~ 5 Page 4148