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014-1015-50-010
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Nilssen, Larr Forest, Town of CST BM Elev: Insp. BM Elev: BM Description: ~ I ~ DO (3 ~ GST' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 5 CAPACITY Septic ~ J ~~ e~ ;~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD septic 7 ZS /~- '~~ ~ 7 5d ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head Ft Forcemain Length Dia. Dist. to Well county: St. Croix Sanitary Permit No: 499108 0 State Plan ID No: Parcel Tax No: 014-1015-50-000 Section/Town/Range/Map Nc. 07.31.15.101 A STATION BS HI FS ELEV. Benchmark ~ Z ~~. Z. ~ Alt. B ~:~ ~- 3.g5 96.35 Bldg. Sewer g' ~ ~ ~ s C SUHt Inlet ? /~ , 9, SUHt Outlet ~. ~j ~ ~ 3 S Dt Inlet ,~ ` Dt Bottom ~~ 1. Header/Man. `~~c~ 1 ~~~ 2 'J Dist. Pipe 'Z . .-1 C ~ -,, J Bot. System '~ q ~~ ~ ~ Final Grade ~ ~ ~ ~~ ~ r St Cover ~ C G~~, 3 5 SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length No. Of Tre-nc-h~ets PIT DIMENSIONS No. Of Pits DIMENSIONS 3 Z ~~ Q„/~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBEIR OR INFORMATION Type Of System: ~ > ~~ ~~ ~ ~ UNIT Goy ~ ° is' - DISTRIBUTION SYSTEM Header/Manifold ~~ Distribution x Hole Size ~ x Hole S~ ~ ~ Pipeg(s) \ Length Dia Len th~~, Dia `Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Soddpd Bed/Trench Center ~r 3 Bed/Trench Edges ` Topsoil ` \ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / a~ ILiquid Depth Manufacturer. ~. r `~~ L~J Model Numberr ~ ~a~ + ~ ~I s ;ing Vent to Ai Int Z w~ rv~ ~ e ~..~- . xx Mulched 'es ~ No ` Yes No Location: 2828 County RGOad 0 Unknown (NE 1/4 NW 1/4 7 T31N R15W) mete b~d ~ ~ ~ ~0~~~5 1.) Alt BM Description = r -r~ ~~ ~J'e1-- 2.) Bldg sewer length = : 3' -amount of cover = 5 Plan revision Required? ~ ~, Yes o it ~C ZZ~.at~ Use other side for additional information. i _ ,___ __ _ ____. _ - - Date Insepctor' SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 07.31.15.101A d II/\ SPK~~~ ',`'~ Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. CroiX isco-nsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 c~ ~g De artment of Commerce I Sanitary Permit Application State Pan I.D. Nu`mber ~ In accord with Comm 83.21, Wis. Adm. Code, personal information yo de J may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address Nf different than mail d s) I. Application Information -Please Print All Inform %~ ~1 i (., Property Owner's Name Parcel # Lot # Block # NILSSEN, LARRY 014-1015-50-000 Property Owner's Mailing Address ~ ~ ~ U ~} L U U b Property Location /0 ~A, ' 321 5th ST N.W. ST. CRO1X COUNTY NE NW y, y. Section 7 City, State Zi Cod ST. , CLEAR LAKE, WI 5 - 31 ,~ 5{circle one) T N; R r II. Type of Building (check all that apply) pk ~ 1fJ rv- i ~ / 3 ~ ~T 0 I or 2 Family Dwelling -Number of Bedrooms ~ t~•t; I Subd~ivi~sio~n~N,a/me ;//y~CS~M Number / ~ " / G~ " _ - b PubliclCommercial -Describe Use /i1, cx. `~ `N' "" Q State Owned -Describe Use City QVillage QI'ownship of FOREST III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' 0 New S stem y ^ Replacement System ^ TreatmenUHolding Tank Replacement Only i] Other Modification to Existing System B• ^ Permit Renewal Before Ex iration ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous ermit Numbe and Date Lssua 1 ,j fi (l~~ // 9 e . / . p V ~ ( / ` ~ / IV. T e of POWTS S stem: Check all that a { (ti S .~ Q ' ®Non -Pressurized In-Ground ^ Mound ? 2 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter 0 Constructed Wetland ^ Pressurized In- d ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter ping Ch L' a ®Gravel-less er (exp ) V. Dis rsaVTreatment Area Information: n !~(. Design Flow (gpd) Design Soil Application Rate( Dispersal Area Required (s~ Dispe al Area Proposed (sf) System Elevation 450 .7 643 65 ~4~ , ~ f //• ~ 86.5 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete ConsUUCted Glass New Existing , / C ' (~('~ ~ Tanks Tanks D J F ~ ~'/ r '7~ j Septic or Holding Tank 1000 1000 1 Huffcutt X Aerobic Treatment Unit Dosiug Chamber VII. Responsibility Statement- 1, the nndersisned, ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ignat MP/MPRS Number Business Phone Number Mark Weis ~,i2,(.Q~ MPRS #657274 715-458-0740 ~c`,Z .~ ~ Plumber's Address (Street, City, State, Zip ode) ,I V ~ ` ~ 7F~ i~ - t 1QS 3~1 1879 13 1/2 ave., Cameron, Wi 54822 VIII. Coun /De artment Use On Approved ^ D~ rov Sanitary Permit Fee (i udes Groundwater Da Issu Issu~ gent Signature o S Surcharge Fee) ~f~ ~ ~ ~y q ~ / ^ ven Reason for enial ` b 1 (,)(P 1X. Conditions of ApprovaUReasons for Disapproval ~ ~~ ~y ~ G( ~/ x SYSTEM OWNER: ~ ~ ~/ L ( JfJ~ ~" 1 Septic tank, effluent filter and 3 ~~ U~ ~'D fL>,.~27 ~- /~ dispersal cell must all be serviced /maintained ~ ,f „~ ~ ~ r ~ 3 -f~ G~ ~~~~~ Q.(~ ~rL rovided b lumber ement lan / y p . p p as per manag / ~ ~ ~ // ~ ~//~ C'R-Ci-E~[ l~ ~~.~ uirements must be maintained tX ~c~f ~Y1~ All setback re 2 N ~ , l . b- q . ~ ~ as per applicable code/ordinances. ' ~ ~ Attach compkte plans (to the Comfy only) fo system on paper not less than 8112 a 11 inches in size .~-^ (( ,~ ~Jt/ ~r2 ~ clnQ~l~ 2,~ SBD-6398 (R. 01/03) t poi ~ s ~,s f ~ 31 a ~h~ w ~er~~ C~~ ~, ~~~~ c-~-.~..~---~ o z~ "= t~~ -- ~ ,, ~~ ~~ ~7PRS #~s7a ~---- ,. ~~~~ ~~~~ i { ~ ~Lt. `:". s~ i tit), ~ ' Th re :fir ~, ~_ ~ ~ 5?.r V r a~ a~ ~ r` I al, ~ 3 I I l~~j~'~ ~~-_ ~ ~4 ~~ ~~, ! ~ \ ~ ~~~~ i :~ t~ ~, Et~v_~gt,s' /da:l si r::5~ %Y ~~ I~-~a-Eo /(~ e row tooo gal Se.F}~~~ul l~u~cu~ C~~ ' ` ~, ~~~~ (} Zo .r ~ 7~l~ G~~ /~iPRS #bs7a ,~~ ~I :. ~• g3 ~ ~ 1 t ~ ~~~ :~ ,~ ^_ {~ , ~~ ~CorG.~nl~- F j.1i1 Ss E'CEV. _~ q ~, S~ A ~ ~Z. 3p~ S~~~r0.~df ~~ eacl, row , ~o0 9Q I s~~~~Uk u~r cum ,. ;., P~~~„rR,f ~ °~ ~~177 trJ~7 r ~ . 1 r ~~U~ Thy c ~f ~Fd ~~ 5~(t1 iG~ cr.--('- /~~ Y ~~f~D ,~Z., t ~e~Af~ ~~-_ ~ ~~Isconsln Department of Commerce Division-o1' Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis.. Adm. Code #70 . Page ;1 of } 3 _. , . Fredericks Perc Testing ' ~ County Attach com lete site Ian on a r not less than 8'h x 11 inches .Plan must p P P Pe ' ~ St. Croix incnde; but not limited to: vertical and horizontal reference poi ,-di nand percent slope, scale or dimensions, north arrow, and location an to great road. Parcel LD. 0141015-50-000 Please print all lnformaNon. Rev" Date Personal iMormation you provide may be u for se~r~~cy s. 15. )). Property Owner pe tion -. NILSSEN, LARRY 4 2006 vt. Lot N 1/4, N 1/4, S7, T31N, R15W Property Owner's Mailing Address L t # Block # Subd. Name or CSM#'~ 321 5TH ST N.W. ST. CROIX COUNTY City State Zip ode Phone Number City [] village ®Town Nearest Road CLEAR LAKE WI 54005 Forest CTH "Q" ®New Construction Use: ®Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ^ Replacement _ - ^ Public or commercial- Describe:.... _.. _ _ _ _ . Parent material Glacial outwash & leoss Flood plain elevation, if applicable NA ft. General comments RECOMMEND A SYSTEM ELEV. OF 86.5' and recommendations: Boring # ^ Boring ® Pit Ground surface elev. 93.2 ft. Depth to limiting factor 121+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •Eff+Y¢ 1 0-9 7.5YR 3/2 ---- ail 2fgr mfr gs 2f .6 .8 2 9-18 7.5YR 4/3 ---- ail lfabk mfr dw if .4 .6 3 18-34 7.SYR 4/4 ---- ail 2fabk mfr dw ---- .6 .8 4 34121 7.4YR 4/6 ----- s Osg ml --- --- .7 1.6 r ~! r G~~ Boring # ^ Boring ® Pit Ground surface elev. 91.0 it. Depth to limiting factor 113+ in. Soil Application Rate Horizon Depth Dominant Color Redox Descrtption Texture Structure Consisten Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EtAlt1 •Efi#2 1 0-16 7.5YR 3/2 ----- sil 2fgr mfr gs 2f .6 .8 2 16-21 7.5YR 4/3 ---- ail lfabk mfr dw if .4 .6 3 21-36 7.SYR 4/4 ----- sil 2fabk mfr dw ---- .6 .8 4 36-113 7.4YR 4/6 ----- s Osg ml ---- ---- .7 1.6 ~~ - tmuent i¢i = t3vD5> 30 < 2z0 mg/L and T5S >30 < 150 mg/L * Effluent fit = BODS <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signaturas:~: y / ~ ? CST Number Chris Fredericks - "'~. 71618 Address Fredericks Perc Testing Date Evaluation Conducted Telephone Number 20176# Street Cumberland, WI 54829 $/3/2006 715-419-012y ` 9BD-8330 (R07/00) ~,~'~ * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS <_30 mgR The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format; please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) F-edE-kk5 PER Testlng Property Owner NILSSEN, LARRY Parcel ID # 0141015-50-000 3 ^ Boring ~ _ ' .~ Boring # p fl Ground surface elev. 90.6 ft Depth to limiting factor 115+ in. ® Soil Application Rate Horizon Depttt "Dominant Color "" Redox Descriptiop Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color - Gr. . Sh. ~ *Effrki ''Etf#2 1 0-11 7.5YR 3/2 ---- sil ,~ .. ~9t ~ mfr gs ~ 2f .6 .8 2 1i-18 7.SYR 4/3 ---- ~: sites'""" ,.mfr dw im _ .4 .6 3 18-32 7.5YR 4/4 . _ _ --- ,Ait`'"~ ._ ~ 2fabk _. mfr dw if .6 .8 ' 4 32-46 7.4YR 4/4 ----- grsl ~ lfgr mfi gw ---- 4 Z 5 46-115 7.SYR,4/6 ----- 1 s Osg ml ml --- .7 1.6 // J iI rt ,y. Page 2 of 3' Property Owner NILSSEN, LARRY Parcel ID # 0141015-50-000 Page 2 of . 3" °~ Boring # ~ Boring ':~ ..,' ;. ®Pit Ground surface elev. 90.6 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon' Depth ' "Dominant Culbr "° " Redox Descriptioq Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh:- `" •Eff#1 *EtF#2 =' 1 0-11 7.5YR 3J2 ---- _ sil ,:= ._ i• mfr gs ~ 2f .6 ~ .8 2 11-18 7.5YR 4/3 =--- ;u~~~ „- k .; mfr .;,. dw , . im, .4 .6. 3 18-32 7.5YR ~F/4 ---- ,~''`"~~ 2fabk mfr dw if 4 32-46 7.4YR 4/4 ----- grsl ' ifgr mfi gw ---- 4 .7- 5 46-115 7.SYF;.,4/6 ----- 1 s Osg -,ml ml ---- .7 1.6 // J I I ~I - ~~.v ~ 'Effluent #4 = BODS> 30 < 220 mgR. grid TSS>30 <150 mg/L ~ "" ' Effluent #2 = BODS < 30 mg/L and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY b08-264-8777. SBD-8330 (R.07/D0) Ff2dErkkS PEK TEStl~g ff .. L~~ ~ of ~ ~t~~~ N~w~ ~R~~ ~~-~-T N~ -N~.J - 7 ~k~5~r awn! sH~ ~ 5'~. G,~t~ ~ k GOttN~v I~R~ n ~ ~ !"'~l ~-. -,.~~~-- GSA ?!l l~ ~ _3-vL Po 1.~ 1 s~~ fl ~ nto ~r~~ a ~~ ~w ~~` ~- ~ ~~ N z~na~RY 6.+~, L ~.~Y. ~-Dd~a' ~-rz~l,pl& a~ SP.r'tl ioe.- ~oof ~~~ ~ ~~ B3 '~;,, ~'`, 9/ n,~~~ ~,~ E ~,~9 ~s n~ trl~sf sue.. ~ 8"~w, ~® CONVENTIONAL INGROUND DISTRIBUTION DESIGN RESIDENTIAL APPLICATION INDEX & TITLE PAGE PROJECT NAME: ~/ lSSellJ / V(:~J I lv'°n~- OWNER'S NAME: L.(~(~ 111(~S~N OWNER'S ADDRESS: 3a) Soh S~-: JV. ~~ C[ ear ~I~ . ~ moos LEGAL DESCRIBTION: N ~ ~~`~ , Ill ~ `~~(, S 7~ % ~ I N~ R lsw TOWNSHIP: (-O f e S `f COUNTY: ~T. CrOiX SUBDIVISION NAME: LOT #: BLOCK#: PARCEL I.D. #: ~ ~'~ - ) Dl S~ ~ r ~-L'~jj Page 1 Index and Title Page Page 2 Site Plan Page 3 System Specs Page 4 Tank Cross Section Page 5 Management & Contingency Plan Designer: Mark Weis ~ MPRS# 657274 1879 13 '/ ave. Cameron, WI 54822 (715) 458-0740 Home (715) 642-1931 Cell Designed Pursuant to the Conventional Soil Absorption Component Manual for POWTS SBD-1070-P(N.O1/O1) Page 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner uyer ~~~~ Mailing Address Property Address i L ~~ ~~ sT. ~ULJ (Verification required from Planning & a ~ ~5 Department for new City/State G%/~; ~~~ Parcel Identification Number/~ ~d/ S ~- ~ ~ LEGAL DESCRIP~T/ION /, ~ DI ~, l Property Location /yE'/4 , ~'/4 ,Sec. ~ , T ~N R C~W, TownJ of 1`~Us~-~~ Subdivision ~~S ~~~G/h ~ ,Lot # Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~~ ~~ (o ,Volume Zs~r ,Page # ~ ~ l Spec house yes no Lot lines identifiable es no 3~~ 2/~ ~/ U ~ SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number'of bedrooms ~ 1 ~ S GN T OF APPLICANT(S) .~/~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ~1 E~ ~~ cd a .x .~ Qa r~ r x o~ w~ ~~ w~ ~~ ~ O Q O N ~3" o 0 N~ O ,N N _ O ul ~ r} 01 h ~ .-., r n ~ N ~ G O P, (~ SYSTEM SPECIFICATIONS In-ground Soil Absnorption Componennt / / Com onent l~fanual ~ ~ 1J ~ ~ ~ ~ ~ ~ P Ni ~I` D j P Project Name: , /V i 1 ~'seN ~~ ~"'`~ Distribution Cell Type Aggregate ^ Non-Aggregate(, Type of1Non-Aegate Component ~ c~. Manufacturez,,.,~~,i.~ ~ Model ~ A) ^~ ~ ,~..~_ Number of Bedrooms Soil Application Rate (DLR) ~Z gpd/ft2 (Designed Loading Rate) Wastewater Quality Treated ^ Untreated Combined wastewater: Number of bedrooms gal/day/bedroom ~ 150 Daily Wastewater Flow (DWF) _ ~~ Clear and gray~vatex only: Number of bedrooms gal/day/bedroom x 90 Daily Wastewater Flow (DWF) _ Blackwater Number of bedrooms galjday/bedroom x GO Daily Wastewater Flow (DWF) _ Dispersal Area (Aggregate) - - ft2 ispersal ea on-Aggregate) ~ ,~tt/~, a,~. ISA Rating o? Q_ft2 ~C~~~ `~ Cq~S System sszing = DWF _ DLR _ EISA ~~ _ ~ ~ ) _ ~Q~ = 3a chambers c~~ X43 4 i® t~~3 Diverter valve ^yes ~no Manufacture (~~3 ~~.~ _ 33.E 3~ ~~~ Septic Tank ~ S~- Min. Septic Tank Vol. Req. Septic Tank Volume ~ gal• lYianufacturer ~~„ ~'~:~,_~_ Effluent Filter pp Manufacturer IJ e.S~ Model, ~F~O°'~ Pump Tank Manufacturer Volume Model Distribution Component Distribution Box Hydro-sputter Other Manufacturer Cross section of distribution cell(s) gt $~ D p ,re ~y ` --~--.--.-~ ~3 S ~/ S te_ 1tt1 ~tc w~'ion S~ Document Number [l 2525 P 211 STATE BAR OF WISCONSIN FORM l - 2000 WARRANTY DEED Thin Deed, made between Leon 0. Hel geson and Judith L. _ Helgeson, husband and wife,. as survivorship marital property Grantor, and Larry A. Nilssen Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St • Croi X County, State of Wisconsin (the "Property"} (if more space is needed, please attach addendum): SEE REVERSE SIDE HEREOF FOR DESCRIPTION OF REAL ESTATE. This deed 15 given in satisfaction/fulfillment of a land contract dated October 15, 2001., and recorded on October 18, 2001, in Volume 1740 of Records at Pages 331-332 as Document No. 659422 in the Office of the RecJister of Deeds for St. Croix County, Wisconsin. Exempt from a real estate transfer fee pursuant to § 77.25(17), Wis. Stats. (I~ (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title [o the Property is good, indefeasible in fee simple and free and clear of encumbrances except municipal ordinances, zoning, easements, reservations and restrictions of record, Dated this 29th day of February 2004 >k ~~: ,, ~4 (SEAL) CY ~ (SEAL) * Leon 0. elge on (SEAL) ~~"""~ ~~"~^-1 (SEAL) udith L. Helgeso AUTHENTICATION ACKNOWLEDGMENT Signatures} State of Wisconsin, ss. authenticated this day of County. Pers ally came before me this ~tf ~ day of .~„~!" 2004 ,the above named ~~.._~.."`-~ Leon 0. Helgeson a d Judith L. Helgeson, TITLE: MEMBER STATE BAR OF WISCONSIN ~`,,~ ~~< ,. -.husband and wife (lf nat, = , ~ ` ,: ~' tip me known to be the persons who executed the foregoing authorized by §706.06, Wis. Stats_) ~~ ' ~''~~ ~~;f~ ~ ;~t'in~tntment and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BX '~' ~ ~ ~,' q James A. Krupa, Attorney at Law ~~,,~. ~ ; P.O. Box 168, Amer Wi$consi n 54 ~~`"~;;'~~r,0~•`~ rotary Public, State of Wisconsin .~ ~ir~.,1S ~,~` My commt on is permanent. (If not, state expiration dam: (Signatures may be authenticated orat`trnowledged:"Both are not necess~r~d„s+~'` ~~~yyi~~/~f ~f ~~~}Cl,)~"".} _.. ___ * Names of uersons sieninn in anv c_ anac_it_v mutt be t_yned nr nri ntr~l Mlpw their annamre, STATE BAR OF W[SCONSIN Wisconsin Legal Blank Co., inc. WARRANTY DEED Ft-RM Nn >! _ ~.nnn ne~i,..~~~~m ~^~~~ ~~~~~~ KATHLEEN H. 1~ALSH REGISTER C1F DEEDS ST. CRQIK CA. , M1I RECEIVED FQFt RECQRB 03!12/2604 09:45AM 'WARRANTY DEED ~x~l~T ~ f 7 REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Return Address James A. Krupa ice„ Attorney at Law (~ P.O. Box 168 Amery, Wisconsin 54001 014-1015-50; 014-1015-95 o14-~n~~-in_ n~4-IOi6-~0 Parcel Identification Number (PIN) This 1S not homestead property. . ~~~P 21 Descriesion of Real Estate Ei,~z of NW~4 of Section 7-31-15 EXCEPT the West 9 chains 13 links of the North 3 chains 18 links thereof; and N~ of SW'/4 of Section 7-31-15 EXCEPT the West 16.09 acres thereof, together with an easement of way one (1) rod wide along the South side of said 16.09 acres for access from U.S. Highway "63"; St. Croix County, Wisconsin. t _ s~~ ~~: i !O Ir i~ to ~, D,~ ~~ i m < In O it In --i O ~z~~ ~ i ' D o z r, I .. a z r /=1 T I T ~ III n c, ~~ I 'J ~I of ~ I 737 HERBERT STREET MEMBERS OF: ~ ~ TANK: HUFFCUTT CONCRETE = CHIPPEWA FALLS. WI 54129 NATIO NAC&WISCONSIN ~ ~ 1,000 GAL LOW VROFILE (775)723-7446"FAX (71$)723-7111 (B~~)924-1$76 PRECAST CONCRETE ASSOCIATIONS N SEPTIC, HUI DING, AND PUMP TANK THIS DRAWINLi SHALL NO f BE COPIED Ok SURMITI ED TO OTH(RS WITHOUT i.ONSENI OF TIiIS COMPANY. Pg ~ im _ ~~ 51.5 ' _ 42.5... _- ~ 9- _ 45 ~- ~~, 2" _ __ _ x 4 _DIA ~~, I I`^- ~ ~ ~i~ ~ ~~_~~ II - 1, ~ ~ r 4., ' ti ; I ~ I, i~ D ~~ i io ~~ = O O O - zo" Z" -TKO- o ~ ~ m ~__ _ ~- _ m Q ~= '.D O D D .~ i I I~ ~I. ~ i I N Ali ~ 3nilY--~i~ y I\ ~ __-_ Z' ! ~ T. - m D CO r^ ?< L1 ', y'. '....Q D: m ~~ ~ . . O m ~ ~ o C n', ~ ~,.. to n O Z ~~~ ~ ,~ n' ~ ,o Z S D r r - ~_~_ 5.25'_ 39 5" _ _ 12" 37" - -__- ~ i~ 4 DIA. I _-._~_ ~~ j ~~li LJ -- - ~-- s°DIA. ~ -~ 0 c ~~ N I!1 O D Z _ ~ mi D (l A Z O O C1Im GT O O D m m ~^ p O Z ',,, O w v+ ,p ~, no m l Z n r D c z Igo 3 m ~ D CO O n ' ~ m p ~ O O D D S p O O i i+ O S ~ ~ li ~ ~ I m m D O O ~ P ~ ntl ~ O i m I ~ O _____ ~ II D l Z ll i~ l > -a Z yi ~ ~ N 0 Z (1 Z m m ~ = D ~ I I Z m n G o N o a ~ i O O D u ~ i x ~ c' O 1 -~ O p ~ z ~_. N LI p n N z z x z N m o ~" n ~ ~ z o x 737 HERBERT STREET MEMBERSOR N T^"K HUFFCUTTCONCRETE y = CHIVPEWA FAELS, WI Sa129 NATIONAL&WISCC)NSIN m ~ t,OdO GAL LOW PROFIL[ (715) 723-7446 "FAX (775) 7Z3-7111 (gp0) 924-1516 aaecnsT coNCaETE Assocwnorvs N SEPTIC, HOI DNJ G, AND PUMP TANK THIS DRAW ING SHALL NOT BE C ~ PIE ~ OR SUBMITIF[) ~ 0 OTHERS W ITHO - CONSENT OF THIS COMVANY. Pg ~ C©NVENTIONAL SYSTEM OWNER'S MANUAL This septic system is designed and approved to meet specific requirements outlined in Comm 83 and 84 Wis. Adm. Code, so that lt will provide safe treatment of wastewater, thereby reducing human health hazards caused by improperly treated wastewater. The longevity of this system depends greatly on proper and timely maintenance and system use within the limits lt was designed to handle. The owner of the system is responsible for the operation and maintenance of all components. Following is information that will assist you in increasing the life of your system. Septic Tank: The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced id the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge 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 an assessment, maintenance personnel shall advise the owner of when the nest service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, of subject to failure must be replaced. An effective locking device to prevent accidental or unauthor¢ed entry into the tank shall secure exposed access openings, greater than 8-inches in diameter. No one should enter a septic or other treatment or holding tank for am reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may bs difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component (Drainfield): The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assesses by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloped sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considsrod a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. Planting of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorption component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it 's current location by removing the clogged bacterial mat, aggregate/leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area. _.~i Parcel #: 014-1015-50-000 oaio2i2oo7 02:53 PM PAGE 1 OF 1 Alt. Parcel #: 7.31.15.101A 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -NILSSEN, LARRY A & CYNTHIA A LARRY A & CYNTHIA A NILSSEN 2645 CTY RD O CLEAR LAKE WI 54005 Districts: SC =School SP =Special roperty Address e * =Primary Type Dist # Description * 2828 CTY RD Q ,~ ,,, I /~ ( / ~V t-l SC 1127 CLEAR LAKE V . SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 37.000 Plat: N/A-NOT AVAILABLE SEC 7 T31 N R15W NE NW EXC W 9 CHS 13 LKS Block/Condo Bldg: OF N 3 CHS 18 LKS - Tract(s): (Sec-Twn-Rng 401/4 1601/4) l J J 6 I v~ ~d~~ i /1 ~) ~~ ~ ~' 07-31 N-15W Notes: ~ ~ (/ ~,~~}~Q/L Parcel History: '~ ' ] r (%/N Date Doc # VollPage 08/23/2006 832823 Type OC 03/12/2004 756436 2525/211 WD 01/26/2004 752657 2498/126 OC 10/18/2001 659422 1740/331 LC more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class AGRICULTURAL G4 AGRICULTURAL FOREST G5M Totals for 2007: General Property Woodland Totals for 2006: General Property Woodland Last Changed: 10/17/2005 Acres Land Improve Total State Reason 21.000 3,200 0 3,200 NO 16.000 9,600 0 9,600 NO 37.000 12,800 0 12,800 0.000 0 0 37.000 12,800 0 12,800 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 5. LOCAT I ON :~ Lot No. Owner's%Buyers P Mailing Address: TYPE OF OCCU EFFLUENT DISI DATES OBSERV SOIL MAP SHEE TEST NUM- DEPTH H CHARACTER OF SOIL HOURS SINCE HOLE WATER IN HOLE AFTE TEST TIME INTERVAL DROP IN WATER LEVEL, INCHE RAT~_ BER INC ES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MI~~ P- P- P- / U N P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDRO d IF OBSERVED IN INCHES B- z ~- e z. .~f~ t. N B- j •~ „9 B- g_ - B- ~ ~~~. w ~LYY \LVl4G lC F./CIGUIdLWf1 tests, son Dore Holes ana suitable sole areas.) Indicate on the plan the locf~tion and ~uar feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ~~l"~~/f+a~/Or/~~te scale or distances. Give horizontal and vertical reference points. Indicate slope. ~`~ ~ ~ ~~ ~ 7 _ __ _ ,~ _ ,E /~• /~ ~: ~,~ ~ ~ ~ ~~ >r7 =,4~ ~~~;~f ! ~ e _ _~ __ ~. ~ ___~ .: ... ~ .. ~ _e , ~~ e ~ ; __ _.n~ ~.~ __ ~ _: t, the undersigend, hereby certify that the soil tests reported on this form were made by me in acxord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print~LL~/~~/1 / ~/' / ~ `/v~/ ..Name of installer if known _ Certification No, ~~~ { Copy A - Locol Authtority CST Parcel #: 014-1015-60-000 Alt. Parcel #: 7.31.15.101 B 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Category Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -RAMIREZ, PAMELA J PAMELA J RAMIREZ 2631 CTY RD O CLEAR LAKE WI 54005 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2631 CTY RD Q SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABL E SEC 7 T31 N R15W 3A W 9 CHAIN 13 LINKS OF Block/Condo Bldg: N 3 CHAINS 18 LINKS OF NE NW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-31 N-15W Notes: Parcel History: Date Doc # Vol/Page Type 06/02/2003 724038 2260/142 QC 991 /198 WD 797/577 422/541 ~nn7 cl InAMeRV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations: Last Changed: 10/17/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 17,500 118,400 135,900 NO Totals for 2007: General Property 3.000 17,500 118,400 135,900 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 17,500 118,400 135,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 108 Specials: User Special Code 04/02/2007 02:45 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i~ FOREST ~G~~ ~Ir,~ T 31 ; ~ ~l FOLK ~ COUNTY • /q • ~h // • %y~//o~ ~~~om~ %~s J~-~~so~ -'e.~r~~. 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