Loading...
HomeMy WebLinkAbout038-1126-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561087 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: Leitner, Richard & Judith Star Prairie, Town of 038-1126-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: l66 i G`JT 31.31.18.516i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f =r. p Benchmark /031 ~Gd a" g OF,, ea.L Alt. BM (4, Z• 4% /a/• / Aeration Bldg. Sewer J e u Holding St/Ht inlet Ht Outlet TANK SETBACK INFORMATION ritcoo TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet oCl~~. ra Septic 75 Dt Bottom !y 3~ ~J Dosing Header/Man. Aeration Dist. Pipe 'j. 3 cI g • ~ Holding Bot. System (6-15 9-7,5S PUMP/SIPHON INFORMATION Final Grade 3 • 5 GPiNand St Cer Manufacturer ex-, ~j Model Number .J J TDH Lift Friction Loss System Head J15 TDH I Forcemain Length Dia. Dist. to Well V SOIL ABSORPTIONS STEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 0 t" DIMENSIONS -3 SETBACK SYSTEM TO P/L BLDG" WELL LAKE/STREAM LEACHING Manufactur INFORMATION Tye System CHAMBER OR rRko-% : d q3 7d UNIT Model Number: /1 r_ 44 5; DISTRIBUTION SYSTEM /3-i3C+1-f- C1~=r 32 /-S Header/Mar fold / Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake 7 Pipe(s) ` se v Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Dept of xx Seeded/S dded xx Mu 7jeS Bed/Trench Center R Bedffrench Edges Topsoil _U'.gd' No No Ful COMMENTS: (Include code discrepencies, persons present, etc.)G"Inspectio #1: Inspection #2: / / ."tI , d O r~- Location: 1871 Cty. Rd. CSOMERSET, WI 54025 (NW 1/4 NE 1/4 1 T31N R1 8W) metes & bounds Lot / Parcel No: .31.18.516i 1.) Alt BM Description = f/; ( L Q~ 4p 1-.)¢., GJOia,,.~ n- O 2.) Bldg sewer length cover 943 p~u..w~: - amount of of coover ~ ~S (G Z • 5 ~a I.A. Plan revision Required? ® Yes VO -7 13 Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ~-/G~ ~/~r"~t',K • lJmlr ra, ~ G~~ .U:,,~.'y~ tea ~'iJ - ~G ~CL~,CS i N~ -zz37yZ fall ~ I #s gall All JJ 5pa'~,~ le) J 1F5 7 ~ of ` eN 5": -/T f ~k /j Z)k ~ ~ f 4~ s /l - lee,-/c s~rMW B"w " ST Rvt~ 201 W. Wad*oon Ave., P.O. Sm71622 O*IwMdibyC Madbm vVf!1537Q7L-71s2 _ 1 l~~ 5(v i 0 $ -7 S=ftwy PemiIt Applli adon T AsJ b1 ~SM3I&21(2 Vis Aft Cal4 a€Sus~m~e a pC~>b~addtess) sr~masP App~eatioa FwSW"%=dPOWM=oxhwiMdft ;a s I AV 1-971 al, C- `ONow FO 639 --1I2to- l0 -tab prQpetyOwndsb) C, C//L? / 51 IC'O 0-11 c-~ c2 Z!p ~ Flue, o W M, N'9 ~ 44 scan !~;O~AG 1 V I 5-I()ZS T I 13; R~ gt 1L Type sfBWIdIA9 (chWk aH Od MM Lot= ' Al art Fhff*DWCWM9-N8GdWdBWlMOM Ok ab per. 8= • -Dc I need c9m D ViHaHeor OseamsOa~d-D mawsa!9:TflZ AIt21A' jJLTnworpw=Ib (cheer em box on Hn*A. C naplef a tias S if spplfi e) A. ❑ rr~►s~rm sys~em © sT~ ' D O&er tM S3d=(e3WMO B. DP=n t D Fem&Rcddw D t cd' maba 1I P= c tV1&-. BE&MEMPhWfim owner W. Ty" o#POWIB Chee A ffiet APPM gta D Prod 1n Gw=d D Atandle D Mamd>24 k. ofsakabiasM D <24 hL oCs sal t] Tic DvdtcrDi f DPcahesomeaDeoiae{es W 3 M r YLkIM TM fa r $ s Neo.TaLs Naas O~ iJaas 2 w lok. 5z5 ad as W k : Af M li' UD (E V'Wx r~rtte~ 5 2;~ZHZ 1 t5= ~S ZH to 1 Fox p (SOOK City. suftzip OW C1. slaS CRICK 1 59CO R VIA Use . Dam i+a D ' Apps 7 A cn $ 30 /3 Le- 1 Septic tank, effluent filter and .tfispersal cell must all be services I maintained / asp per management plan provided by plumber. t'004 ( t ~Apqu entettts mt*bs.trpr<rttsl W ~s pK ~"code t ordtranCa. - ~aa87lazll A~eLfs~eEisaslhrlba8siesTad ie ~raesetlas SBD4398(IL IIII2) n 7~~ //`T~~ /_lml/.W a G~J~~IJa~Y•. Z4>%'.-~t11~"~ • L~ ~~..G`?. ~ l / 1 ~o t, i~o,t~s =-r7 ~ r CONVENTIONAL COMPONENT DESIGN Residentiral Application -INDEX AND TITLE PAGE Project Name: ~Ia~U 3VQ (Y LET~E~ Owners Name - - owner's Address: 187l CIA RU~ C S'~ID~S Legal Descr"ort: tije'1q S~ l `-rs I Township: Sa p~Z [Fp kk RI c- county: - Is C CC~(~ Subdivision Name: Lot Number: Parcel ID Number: b3~ ` 1 IZ~ - Ili - t Page 1 irxiex and tiff Page 2 Plot plan Page 3 System SW N & Cross-Section Page 4 _ Filter Specs Page 6 Maintenance lntarmation Page 6 Management Plan Page 7 St. Croix CiY Septic Tank MWnWm= Form Page 8 Warranty Deed Page H CSM or Plat ~rAttachmerft ScA Test & House Plans y Designer/Plumber: acr r PE Y, License Number: N~11' ~S 22~ ~ I Z Date: I Z f 3 Phone Number I Sig Domed pws to the aw Abmpwn co~ow t &swvjw tar Poo rs Vaston 2-0 SOD-107055 (H.01JMi)- > 1 c~T , 7~-'G-A{~✓~ /~`lK'i-' /.,,mf1C7i1 G~_~%-dJs,,~~4'. 6S/i.: ~F'~/~' ~-•G ~Q".eCu . _ _ 5/u rss I -3 11 le) < sl nn '~~C' ZZ`9-2 7 ea J--42-17 y 9 /7 hi icy'<T I Soil Absorption Svstem Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe ft With Vent Cap Leaching ~j Chamber f_I ft System Elevation ft ft Soil Absorption System Plan View ft 3 ft ~ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header I I Leaching Chamber Specifications Manufacturer And Model 10f -D<K-IfOIZ_ QJ 101C. L1 u EISA Rating sq ft per chamber Soil Application Rate ~-7 gpd/sq ft gpd Design Flow = r~ Soil Application Rate = ZIO EISA = 32 Chambers 2 rows of 1(0 chambers each. Page of INSTALLATION INSTRUCTIONS IBM a a 'a! PchU PL-525/PL-625 FILTER PL-525/PL-625 FEATURES & BENEFITS r Features & Benefits: GPD 9 Rated for 10,000 PL-525 = 525 Linear Feet of 1/18 Filtration PL-625 = 625 Linear Feet of 1/32° Filtration PL-525 PL-625 • Accepts 4" and 6" SCHD. 40 pipe ® Built in Gas Deflector The PL-525/625 Effluent Filter should operate efficiently for several years under normal conditions before aAutomatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every a Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the eAccepts PVC Extension Handle filter needs servicing. Servicing should be done by a srtified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter ' Extension Handle ~r o + Riser Safety Screens Filter Alarm Panel and Risers ~ Riser Covers . Extend & Lok'" SmartFilterTM Control Polylok risers bring your Polylok Extend & LokTm Polylok safety screens switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing into open and swttchs provid a visual nd time saving by eiimi- make filter and/or baffle septic tank entrances. and audible notification of ating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner K a Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ftL L C ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model SZS ❑ NA Number of Public Facility Units O(NA Pump Tank Capacity al NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer WNA Design flow (peak), (Estimated x 1.5) 5D gal/day Pump Manufacturer NA Soil Application Rate gal/day/ft' Pump Model aNA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit A Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) _:30 mg/L 9, In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/100ml ❑ Drip-Line ❑ Other: Other. ❑ NA Maximum Effluent Particle Size Y. in dia. ❑ NA Other: NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) 11 NA Inspect condition of tank(s) At least once every: 3 9year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA 3 } Inspect dispersal cell(s) At least once every: ❑ ear(s) month(s) (Maximum 3 years) ❑ NA month(s) ❑ NA Clean effluent filter At least once every: Is year(s) ❑ month(s) ~ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) month(s) ~NA Flush laterals and pressure test At least once every: ❑ ❑ year(s) Other: At least once every: ❑ month(s) JWNA ❑ year(s) Other. J OA 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 (4/01) apo~ enr;ejis!u!wpd ulsuoaslM V (Z) pue (1)V(p)(L)(q)(Z)ZZ•ES RARUoJ jaideyo qvm e3m!lduioo ui pe4ejp seen wouinoop of L -.C eu04d auoyd --qov ML aweN aweN A1.INOER AuctivinsE W35i (H3dWnd) HOIVH3dO 9NI3IAH3S3SV.Ld3S auoyd Z auoyd aweN aweN U3NPd1NR/W S1MOd HTIMI /1SN1 S1MOd SIMWW00 WNOWQOt/ •3181SSOdW1 Ii0 1 3w:jIO 38 At/W HN1d1 V dO HOJU31NI 3H1 WOM NOSH3d b d0 gn3s3a *ilnS3a "W NIV30 "S30Ntl1SWfiOblO ANtl H3UNn HNVI IN3W"3li1 U3H1O a0 dwnd '3LLd3S V a31N3 ION Oa 'N39AXO 1N3101ddnSNi HO/ONV S3SSVS WHIM NIVINO0 "W SHNVI 1N3Wlt/3a1 Ij31110 UNt/ dwnd 'OI1d3S < <DNINVVM> > •owll;eyl le loage ui selni eLµ yi!m Aldwoo isnw swaisAs vans jo suo!;onAsuoaea •aae}jns an!;e.q.)ilul ayi le iewolq ayi }o lenowaj 6ulmollo} aaeld ui pa;oruisuoaei eq Aew sweisAs uo!;diosge Ros opei6-le pue punoW p S1MOd Palle} ayi eoeldej of ijosej isel a se pelieisui eq Aew juel Bulplo4 a olgellene s! eaje ;uowaoeldej ou }i esia ;uoweoeldej elgel!ns a eieool of powjoljad eq isnw uol;enlena ells pue pos a SIMOd ayi to ojnl!e} uodn •eaje waweoeldw elgeims a 41luepl of polenlena uaaq iou sey ells 841• p •S1MOd pel!el ayi eoeldej o; vossi isel a se paileisui eq Aew juei Bu1P104 a ABoiouyoa; S1MOd u! saouenpe 6wjje8 •suoliei!w!I I!OS jo/pue pegies of enp aigei!ene iou si esie waweaeldej aigeiln"s y [3 -awl; ieyi ;e ;aa}la ui salru aqi qum Aldwoo isnw swaisAs ;uawaoeidaH •eeie iuawaoeldej aigei!ns a ysligeisa of uol;enlena ails pue pos Mau a jol peou ayi ul ilnsai 111m esie ;uaweoeldej ayi waioid o; ejni!ed -sham pue soull ioi 'ajn;oruls pasodoid pue Bul;s!xa moil sjoegias paimbai Aq uodn pa6uului aq iou pinoys pue uotioedwoo pue aouegjnis!p moil paiaaioid aq pinogs eoie iuawaaeldej aLU •walsAs uol;djosge pos ;uawooeldej a }o uogeool ay; jol pezggn eq Aew pue pejenlena uaaq sey eaje ;uaujaoeIdai aige;ins y :waisAs ;uawooeldej iuelldwoo epoo a eP!Aojd of 'ue)le; aq isnw jo 'uaaq aney sajnseew Buimoliol ayi panedaj aq louueo pue sl!e} S1M0d ayi }i NV'1d A3N3JNUN00 •leuaieuj p!Ios ijaul jayioue jo Ianej6 'llos y;!m pelf coeds p!oA ay; pue panowaj sjanoo .1941 jo Panowej pue Paieneoxe eq Ileys si!d pue s)luei lie 'Buldwnd je4V • •joiejado BuiMAjaS a6eid9S a Aq }o pasodslp Apadoid pue PaAOwaj aq ileys slid pue sjuei lie to siuaiuoo a41 • paleas s6u►uado edld peuopuege ayi pue peiaauuooslp eq lleys sild pue sjuei of Buldld 11V • :apo0 aA!;ejls!ulwpy ulsuoos!M '££•£8 wwoO jelde40 41!M souelldwoo ul peuopuege Ala}es pue Aliedoid sl waisAs ayi ieyi ajnsul o; uaMei eq ileys sdais 6uimollol ayi aalAjas to ino ualei Aliusuewied si jo/pue sl!e} SIMOd ayi uayM 1N3 W NOOMdB`d •auuq jaus4os inem pue :suodwe; :supIdeu Ajeilues Isepppsad :sionpojd 6uliuled .Ito :suolieolpaw !sdejos ;eauj Isep!oigjay !eseajB IaulloseB !sBullead 9lgel96aA pue i!ml :je1eM (dwnd dwns) wejp uoliep'uno} :iel :siue;oalu!s!p :sjadelp :ssoll lejuap IsiaseejBap'sgems uouoo :swopuoa :sunq euajeBlo 'sadim Aqeq :sa!io!q!lue :SJ.MOd ayi to epi eyi Buolojd pue soueuuoped 841 anojdw! Aew weeps imeMalsom eyi wojl 6uimollo} ayi to uolieulujila jo uo!ionpaa •eeje uo!;djosge 1!os spejB-;e jo punow Aue to edols uMop lea} g 1, ulyilM eaie ayi 'ioedwoo jo gjnislp asimiayio jo 'jano died jo anup iou oa •silao lesiods!p pue sjuei JOAO sa(314aA Mled jo anup iou op glue; dwnd ayi u!l(;!M slanal leuuou ejo;saj o; sloj;uoa dwnd ayi 6w;ejado Ailenuew ul ;slsse of jeulelu1eW SIMOd jo jegwnld a ;aewoo jo dwnd ;uenil.la ay; o; jaMod Buljolsai o; joud jo;ejedo Bumi eS e6e4deS a Aq Penowaj glue; dwnd ayi to siuaiuoo ayi aney uol;enps slyi plone o1 ;uanll}a }o eBjeyaslp eaeljns jo dniloeq ay; ul ilnsel Aew pue (s)pao eq; Bulpeoljano 'esop aBjel auo u! (s)pao lesiodslp ayi o; peBjeyoslp eq Ilim jaleMeiseM sseoxe eyi pejoisai si jemod uayM •slanai jalem4614 Iewjou anoge il!} Aew slue; dwnd sa6elno jamod Buljna •aaepns aAlMIMul 841 18 u9Z04 aje suolllpuoa I!os uayM inaoo iou 11e4s do 3jels walsAS •esn o; joud jolejedo Bulalnjas e6e;des a Ag penoLUaj (s)juei 941 10 Swewoo ayi ane4 1081001913 eje suoliej;uaouoo 4614 ll •(s)lleo lesiodslp ayi eBewep jo/pue sssooid ;uewleeil eyi epadwl Aew leyi sie0lwayo jayio jo sionpojd Buliuled to a0uasajd ay; jo; (s)iluei iuawieaj; 1!0940 S1MOd ayi to asp o; joljd 'uol;0njlsuo0 Mau jod NOI1VM3dO ONV do IuviS 10 abed ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Cam'IL'~AR(~ 4 :10G M4 Le I Tt~c - Mailing Address 1871 CIN KtS C z6wo6e~r W1 S1102S Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 63A "1 a' ,to -6 LEGAL DESCRIPTION Property Location 9WV '/4 , V,, Sec. Z) , T 3) N R 18 W, Town of tTAr- RI Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this fo a true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty eed recorded in Register of Deeds Office. Number- bedrooms SIGNATURE 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. os/05) Co% "1t- _ l~ <V F- n. ti F J C a, ~y F C... CV dD F- W ' : w/~ E (D r CD 1' \ (L _ 111~~~sssPPR.L.L. ~ ~ ~ 1'u ;1 ` 4 FF r.: H P- O{J v J S7. ~ J 'y3' r a[ 7 C3 2 lip 411 r. 0 m F- ' ~ J CO Q LL r f. C4 J Od'L*q J 5 r ± lf? CC~V1 -8 45 m _ ~ mts m S 08~ gbl 8 sum f ~8~ r' ; Z Z LO a 8 1 W Wis. Dept of Safety and Professional Services SOIL EVALUATION REPORT Page of . Division of Safety and Buildings in accordance with Comm 85, UUis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), di . and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and d' rest road. Please print all informadotii~ Re by Date personal information you provide may be used for secondary purposes ®H3.04 (1) (m)). S 3 Property Owner PropeNrr Location f CRS 1bt Alid 114 1/4 S T N R E (or)!q # Subd. Name oObSW Property Owner's Mailing Address Lot # 18 AM c State Zip Code Phone Number ❑ City ❑ Village ®Town Nearest Road ) 42 ❑ New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate 4W A, GPD 0 Replacement / ❑ Public or commercial - Describe: Parent material Flood Plain elevation 9 applicable 5~~ General comments and recommendations: /ara~asE° sys b> F-/1 Boring # ❑ Boring Pit Ground surface elev. ft Depth to limiting factor in. Sol AplAcabon Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence undery Roots GPI3>ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#2 9 Q _ _ - ar e 4 - tt Boring # ] Boring 0 Pit Ground surface elev. ~ % Depth to limiting factor Z,? in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence ndary Roots GPDftt 2 in. Munsell Qu. Sz. C nt Color Gr. Sz. Sh. 1 4 Z", y 9 7~ g r' 4 9 7 j 9 4 S ;;OD 30 mglL and TSS 130 mgiL Effl nt #1 = BOD : > 30 220 mg1L and TSS >30.:< 150 mg/L t #2 =,B CST i Signature CST Number Addfess Evaliji Conducted Telephone Number 7917 SBD-8330 (RI 1/11) Property Owner ZC,4~~ Pane! ID # Page of Boring # ❑ Boring pit Ground surface elev. 1i , 66- ft Depth to limiting factor in. Sol fipplication Race Horizon Depth Dominant Color Redox Desc ipdm Texture St uclure aonsWww Boundary Roots GPOM 2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. tf#2 4 4 Al 7,5`14 A.1 /:s t r " s~ ❑ Boring # ❑ Boling ❑ Pit Ground surface elev. ft Depth to limiting factor in Soil Applca&m Rate Horizon Depth Dominant Color Redox Description Texture Structure Donsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#2 ❑ Boring F-1 Boring # Pit Ground surface elev. ft ❑ Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure rsistence Boundary Roots GPA 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. • ff#1 * fr#2 " Effluent #1 = BOD 5 > 30:5 220 mgiL and TSS >30 < 150 mg1L ' Effluent #2 = BOD 5 < 30 mgt and TSS < 30 mgt 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. =4330(R11111) , X71 /4/- 1:'/l~ /~G,~r~'.B ri`~,, .~,p,~ as -~~v . _ l~s a~N 3[a I ev S-/7 19 7 ~ ~ e~s; a•:.~ as iYs - ic~9,~' G.s7'/ ~ c~~?~ .5 1 I{1111 IIII1 {11{11{111 1111111111 II{1111111 11111111 * 8 5 0 2 0 2 2 State Bar of Wisconsin Form 2-2003 WARRANTY DEED g VV 020LL KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/09/2007 11:00AM THIS DEED, made between David J. Calleja, a single person WARRANTY DEED EXEMPT w ("Grantor," whether one or more), REC FEE: 13.00 and Richard Leitner and Judith Leitner, husband and wife TRANS FEE: 615.00 PAGES: 2 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Four Seasons Titlo needed, please attach addendum): 935 W. County Rd B-2 #350 See Attached Exhibit "A". RoS@VUTA, MN 55113 031191-- 038-1126-10-000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated 3 I a 101 (SEAL) (SEAL) * * aid J. Calleja . (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) David J. Calleja, a single person STATE OF m~i ) authenticated on ) ss. '~Gn1 COUNTY ) *Kristina Op-land Personally came before me on l a 10-7 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY. * J IlG Attorney Kristina Ogland Notary Public, State of Ai Hudson. WI 54016 My Commission (is permanent) (expires: jai I U (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO-PROT" Legal Forms 800-855.2021 www.infoproforrns.com - - JODI L ALTAVIU A WI1MV Pll01.IC-NM1E.lOTA yll M n"m Eon JuL 31,2M0 1 of 2 i ~a FOUR SEASONS TI1 Lt, INC. Policy Issuing Agent For COMMONWEALTH LAND TITLE INSURANCE COMPANY COMMITMENT FOR TITLE INSURANCE EXHIBIT A Legal Description Commitment No.: WIS-071788 The land referred to in this Commitment is described as follows: Part of the Northwest Quarter of the Northeast Quarter (NW% of NE'/.), Section Thirty-one (31), Township Thirty-one (31) North, Range Eighteen (18) West, Star Prairie,Township, St. Croix County, Wisconsin, described as follows: Beginning at the Southwest comer the NW'/ of NE% of Section 31, Township 31 North, Range 18 West; thence East along the South line of the NW% of NE% of Section 31, for 30 feet to the Easterly line of County Highway "C" which point is the true point of beginning of this description; thence East along said South line of NWY4 of NE%, Section 31, for 198.0 feet; thence North 23° 57' East for 100.00 feet; thence West and parallel to the South line of said tract for 215.9 feet to its intersection with the Easterly line of County Highway "C"; thence Southerly along the Easterly line of County Highway "C" for 94.17 feet to the point of beginning. Also all that strip of land tying betweeri the Easterly line of the above described tract and the Westerly shoreline of Apple River and between the North and South lines of said tract each extended Easterly to the Westerly shoreline of Apple River. For Reference Only: Property Address: 1871 County Road C, Somerset, WI 54025 Parcel ID Number. ALTA Commitment Exhibit A 2 of 2