HomeMy WebLinkAbout012-1011-20-000
. Croix
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St
Safety and Building Division INSPECTION REPORT Sanitary Permit No:
563837 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)]. Parcel Tax No:
Permit Holder's Name: City Village X Township 012-1011-20-000
Olson, Bernard D. & Judith Trust Erin Prairie, Town of
CST BM Elev: Insp. 5m be v: jBM Description: w , I f Section/Town/Range/Map No:
t/.1t7/1 /1J Na I < < 03.30.17.45
TANK INFORMATION ELEVATION DATA
N BS HI FS ELEV.
T(pE MANUFACTURE o N 7 CAPACITY FBenchmark
Septic / / 7 /61Z/A
Dosing Sa .
d
j a Bldg. Sewer P-,j OZ
St/Ht Inlet * 1 ~ .'7 72
Holding
S
TANK SETBACK INFORMATION
TANK TO /L WELL BLDG. ent Air Intake ROAD Dt Inlet
Septic 4 I Dt Bottom J-5. -78 , Y
Dosing ' eP / Header/Man. to77 7
Aeration Dist. Pipe -7 -7 Alf
4W
~
Bot. System a OW
Holding
Final Grade C~"~ C~
PUMP/SIPHON INFORMATION m' J
Manufacturer Demand St Coygr
GPM
Model Number / AI
:5 Z_
TDH Li Friction Loss ISystem Head TD -7 93 1
Dist. to Well
Forcemain Length Dia. Z A )A- 9.'77 Z.
SOIL ABSORPTION SYSTEM /vim s - 3' 3 $8~
BEDITRENCH Width _ Length No. Of Trenches ' w PIT DIMENSIONS No. Of Pits..- Inside Dia. Liquid Depth
~~.e~►~
DIMENSIONS 3 ZY- 73
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING Manufacturer:
s
INFORMATION Type Of System- B 75,6R 'r("xU/ • ,~/v UNIT Model Number: /O It &f
DISTRIBUTION SYSTEM ,,•~7`- / / g4'/TAG/vk8+",- s ~
Header/Ma ifold .o, / it Distribution x Hole Size x Hole Spacing Ve to Air Intake
L/
66 7
Length Dia Pipe(sLength) ` Dia Spacing
SOIL COVER x Pressure systems only xx Mound Or At-Grade Systems Only
Depth Over IDepth Over xx Depth of xx Seeded/So ded xxMulched IA vA
Bed/Trench Center ~t Bed/Trench Edges Topsoil ~ s ~ No 4 Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection #2:
Location: 1740 190th Street New Ric ond, 5401 NE 1/4 SE 1/4 3 T30N R17W) 40 acres Lot Parcel No: 03.30.17.45 6 tll~~ 061-5 QL_ lorck 6 W-N
1.) Alt BM Description = )
2.) Bldg sewer length = AJ6
- amount of cover = f
Dti
Plan revision Required? ❑ Yes *No , S d 3 ~I
Use other side for additional information.
Date Insepctor s Sig ture Cert. No.
SBD-6710 (R.3/97)
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~o~AarTO County
Safety and Buildings Division S"( C
i 0 S 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 3707-7162
t S ~~2 57~ 5,37
Sanitary Permit Application State TransactionN~umber
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropri overnmental unit / U 4-
is required prior to obtaining a sanitary permit. Note: *Aali,,cati0n forms for state-owned PO submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies information you provide may be uscondu oses in accordance with the Privacy w 1 , Stats. / -721A / ~j`A f~
`
I. Application Information - PI nfo ation ! (V/ ((J r k .7
Property Owner's Name G ~ J 141, ST ) Parcel #
R l*Zfl -C-r 012 - 1611- 20 - GL's
Property Owner's Mailing Address (ihry Property Location T S
Govt. Lot
1-17Z )018 -rN 'ST
City, State Zip C Phone Number 3
ty, P ~ G S /o, Section
gew G lio n 7~ -7(circle on
P' u I V l V 1 T J N; R 1-7 (circle
o"J
II. Type of Building (check all that apply) nk, Lot #
El 1 or 2 Family Dwelling -Number of Bedrooms I 'S Subdivision Name P%V
Ike -~e- iQ J*uek#. /
❑ Public/Commercial - Describe Use 110 n ( S ✓
t`1~, ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
j~ t-Towoofl=l~ll~ 1 ~1Q1~
/ /
:3 b 1
6~."tL:5
III. Type of Permit: (Check only one ox on line A. Complete line B if applicable)
A' .?New System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (exPlain
)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. e of POWTS S stem/Com onent/Device: Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Information: 1 SW Q0 (d, C-fictm (eEK
Design Flow (gpd) Design Soil Application Rate(g dsf) Dispersal Area Re ired Dispersal Area Proposed ( System Elevation
,-7 Opp T7
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ~ o
c3 U U U in ~
New Tanks Existing Tanks
1 U ~ ~ w C7 C.
Septic or Holding Tank IrC / C 's~s I'
Dosing Chamber JJ(~•) wM r
the attached plans.
UJM,
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS show
Plumber's Name (Print) Plumber's Si re MP PRS umber Business Phone Number
,yep F F6 2Z3Z`IZ 7(5--155-744
Plumber's Address (Street, City, State, Zip Code)
00. &Y, s loS tszCs<Q& VV1 S l/I)Ci
VIII. ount /De artment Use Only
Approved ❑ D ove Permit Fee Doanzlued Issuit Signat❑ O en Reason for Denial ~ 113
IX. CondiW~/tilAfReasons for Disapproval Grog S~fG~
1. tank.' e1fitl§nf fitter + tld 3) ~(p / 3 wdispercei must all be services / maltitaiinad f ^ I G ~ J~
as per management plan provided by'plUk►.
vv -
2. A11 to sCk ~rnettts be•lnaintilaw Iry
as per apo requowie Code t ord. i ~7 >o /I eJ~~ ~n.• ~7 1 V•~/~
Attach to complete plans for the system and submit to the County only on paper t less 1 8 1/2 x 11 inches i ize
SBD-6398 (R. 11/11)
CONVENTIONAL COMPONENT DESIGN
ReWdw"Appn
- .INDID< AND TITLE PAGE
Pnt Names W&A1Z11 blS a 1s.)
Owner's Name:
Owners AddreW I 71 -L 1 ~f 0-r N
s~oZD
UxjW D fJE i~~l S~ ~~H S 3 T 36 FZ VV
Tow+nshlp: E I~lR F~+~
county: _ s^T C(2~ Ik
s MWision Name:
Lot Number:
Parse! ID Nunes.
pap 1 Index and We
Pap 2 Piart
Page 3 Syslem Skim 8 Cross-Section
Page 4 Filter Specs
Page 6 M nae irfon udion
Page 6~ plan
Page 7 SE. Cr& a Septic To* iidMWwoe Form
Page 8 Warranty Deed
Page 9 CSM or Plat
AtUK;hmentK Sod Test & House Plains
„E t= F Fbx Number. 1v~ rZg 2Z3Z4 Z
i '718113 Phone Number 71 S-1S5 Zy (oI
saga for povvrsve, ZoSO (rw+10+)
P~ ~
j
t /
Q
Vl ~N 2
Zr-
7:r-
c ~ ~ (YJ
~ ~ p
Soil Absorption Sv stem Cross Section
_/~j c17 ft
Final Grade
4" Schedule 40
PVC Vent Pipe QC
LT3 With Vent Cap ft
/J
Leaching - ►
Chamber
ft
System Elevation
ft ft
Soil Absorption System Plan View
ft
{
ft
ft Leaching Trench 1
Vent Or Observation Pipe Chambers
4" Dia.
Trench 2 Header
rtc~~c~13
Leaching Chamber Specifications
Manufacturer And Model ITu ->rQ OILS
EISA Rating 2-0 sq ft per chamber Soil Application Rate gpd/sq ft
-7 SO gpd Design Flow-, •7 Soil Application Rate ZO EISA Chambers
rows of chambers each.
Page of
~Ag o N~r~ y-
.
FILTER CARTRIDGE INSTRUCTIONS
,~a0g BEM
y~ r
installation
STEP 1 C) z_ to ensure it is
ry rr, tine `rater ra<e r i of t+3eoutlet p i °
r
centered under the access ci+e m Iq r* f nil, then, et-her insert more pope into the `
tank through the outlet or solvent veld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is stri'l drv fitter) on the outlet pipe, measure the length
of 3i4-inch pipe needed to brace the fi ter to the tank end wall if utilizing the
optional supplemental side support If c;iie support method is not utilized,
proceed to step four.
STEP 3 For )•r=aduatr£ ti s, t,rt -,~r..7: _ :ClplemPnta! :ode [4,1ppOr?
a
;nlvf?nt weld ttie htinr , c 'f r c• >(,r} method is not d•
u!1lized. proceed to stet) `r- r
STEP 4 Solvent weld the `;Iter case ^ntc the outlet pipe Insert the filter
cartridge into the case, pressing down rfntii the filter locks into the bottom of
the case.
STEP 5 If a VR5 switch is utrl~red insert into he filter and lock by turning
clockwise 900. Vi~
Maintenance
) hht effluent hater snoui(i !,e - ,Pan ri pv -a tjmn , trap septrc tanks
o °
sereiced _
Open the OUtiCt access l fir, nn, tf .per, the tank and filter. F'"1y4 ^ fn i
s. Pump the septic tank orrP e ply, ak n c ;re to remove the sludges _
pr ant) effluent
layer on the JOtldr• of it f ank dn 31! _i t5, e SC
d Once the effluent level ha= been lovierer) Cel-, w tt:e revert of the
outlet pipe, firmly pull 'i,(- on the' Ater !3ar - dis€odge the
cartridge from the case.
Slide the cartridge up and n tit of r :ase fl, ~ieanlnq-
E~. if a VP.S switch connected to an €7 a t:i t5 present. the swot4:t, -
Olould be removed by tur Mire r e k.4~~_e y0` and gleaned
r:ater only
r . While holdino the car'r,dy ° ~T is s de l'a :~e flat turrarc facing
down) over the access opening. rinse off the cartridge with water
only, making sure all septage )maters' is in_ _d hack into the tank
8. if VRS switch is uirilzed, rE place b r se n ;'Ito filter and
turning clockwise go k'r
9. Insert the filter car ndae tack rr.tt rhr -ase pressing down until
t the •m nf' rh
the fitter locks into bra e .case.
tt!.Replace and secure the ac-ess open n, ors the tang
S
Materials:
Model Nort+bers: -
BEAR oifsRF' FuTER CAR`RIDGf FfVS .s AR LiMi~r iwe§.RANTr
BEAR ONSrTF- "I C-1 W 11- -.-....ec
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
• FILE INFORMATION SYSTEM SPECIFICATIONS
Owny Qq Septic Tank Capacity an S al ❑ NA
Permit # Septic Tank Manufacturer 66_ It ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ( eAk ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA
Estimated flow (average) f~0 gal/day Pump Tank Manufacturer 14 ( ESC-I - ❑ NA
Design flow (peak), (Estimated x 1.5) Sb gal/day Pump Manufacturer oeLLG VQ ❑ NA
Soil Application Rate gal/day/ft2 Pump Model D S ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) <_30 mg/L ,In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
I&year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that .,nay impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name F't' t-, Name
Phone `Z 15 :5 _ Z `I Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name G r
Phone Phone 715 30 _ 4
This document was drafted in compliance with chapter Comm 83.2212)Ib)(1)(d)1,(1) and 83.54(1), 12) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer BERNARD & SUE OLSON
Mailing Address 1740 190TH ST. NEW RICHMOND, WI 54026
Property Address 1740 190TH ST. NEW RICHMOND, WI 54026
(Verification required from Planning & Zoning Department for new construction.)
City/State NEW RICHMOND Parcel Identification Number 012, - l o f / `20 , 0 0,0
LEGAL DESCR]PTION
Property Location SW 1/4' NE 1/4, Sec. 3 T 30 NR17 W, Town of ERIN PRAIRIE
Subdivision Plat: Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑yes0no Lot lines identifiable ❑yes[]no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could r@sdlt in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(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.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
'/we ce 1 that all statements on this fo are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property des 'b bove, by virtue of a warran deed recorded in Register of Deeds Office.
o ed ms 4
7/9/13
SI A RE PLICANT(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. 04/12)
08/16/02 07:58 FAX 651 731 9767 S~ ALES.coffiP * P ~ ~ ~ ~uvr.v~~
TOTAL DYNAMIC HEAD/
PER MINUTE
Q 2 pUmp p&nRM MCE CURS gTWDdT AND DEWA NG
MODELS 151/1W/10 153
MODEL 15t 152
50 p,,- Lis' 6d- LR=
Fed How Cal. > s
1 77 291
12 i0 5 S5 44 23t 70 255
i 10 it 42 231 51 61
231
52 15 ,@ 36 201 53 197
3E} 3) fi.1 16-7 L 128 •2 - t 1W
S51 VC. 7ib ZtI 129 33 125
e
_ 24 30 VJ 85
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Vol_ 1-821PAGE 158 6691 1 O
STATE BAR OF WISCONSIN FORM I - 1999 i H! _.i.E^E H. WALSFi
Document Number WARRANTY DEED F:f=U.iS' T'ch OF DEEDS
Eel . cRO:IX CO., W1
This Deed, made between Sheryl R. Dunn, a/k/a Sherry R. Dunn, RECEIVED FOR RECORD
a/k/a Sherry Dunn
01-23-2002 9:30 AM
WARRANTY DEED
Grantor, and Bernard D. Olson or Judith C. Olson Trust and/or its EXEMPT #
assigns CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 604.20
RECORDING 11.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
N-1/2 of SE-1/4 of Section 3, Township 30 North, Range 17 West, St. Croix Recording Area
County, Wisconsin. All that part of the SW-1/4 of NE-1/4 lying Sly of Soo Name and Return Address
Line Railroad of Section 3, Township 30 North, Range 17 West, St. Croix BAKKE NORMAN, S.C.
County, Wisconsin. 900 Main Street
PO Box 54
Baldwin, WI 54002
012-1011-20; 012-1011-30; 012-1010-00 _
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This _ is not homestead property.
kx) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, highways, utility rights and reservations of record, and will warrant and defend the same.
Dated this day of January 2002
* * Sheryl R. D nn
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Sheryl R. Dunn STATE OF -Wisconsin )
) ss.
St. Croix County )
authenti this day ua 2002
Personally came before me this _ day of
January 2002 the above named
Thomas R. Schumacher Sheryl R. Dunn
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
BAKKE NORMAN, S.C. Notary Public, State of Wisconsin
BALDWIN, WI 54002 My Commission is permanent. not, state exprratron date:
(Signatures may be authenticated or acknowledged. Both arc not necessary.)
* Names of persons signing in any capacity must be typed or printed below their signature. lnf-aticn Profe-ionais comPeny, F-d au Loc. wi
STATE BAR OF WISCONSIN 900-WS-2021
WARRANTY DEED FORM No. 1 - 1999
III
Wis.DeptbfSafety and Professional Services SOIL EVALUATION REPORT Page ~of-
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm.
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), direction Parcel LD.
percent slope, scale or dimensions, north arrow, and location and dish, to =Ld.
Please print all i n. rt c R~y Date
Personal information you provide may be used for s s ~Po
Property Owner `n Property Lora ' n
Govt Lot ~ 1/4 1/4 S T " N R/ Ao
Property Owne s Mailing Address Lot # # Subd. or
117 7,9
State Zip Code Phone Number ❑ City ❑Yllage OTown Nearest R j
City
Z4 ~ zle~
New Construction Use. p Residential/ Number of bedrooms Code derived design flow rate G PD
❑ Replacement / ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if appkabte tt
General comments
`.s
and recommendations: ~clb ss~`E,i~ - u✓Jd.P
F-/1 Boring # ❑ Boring
® Pit Ground surface elev. 9~ ft Depth to limiting factor- in. Sol ApplicoM Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz nt Color Gr. Sz. Sh. f-fW, ff#2
c 9
~ A Q
411, Pri
Boring # Boring
pit Ground surface elev. ft Depth to limiting factor ? /r in
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistenoe Boundary Roots GPift 2
in. Munsell Qu. Sz. C t Color Gr. Sz. Sh.
g 9
ly~ ,77
2
Effl nt # = BOD > 30 220 mgJl and TSS >30 150 mglL * t#2 = BOD < 30 mg/L and TSS 30 nug/L
CST N / Signature / . CST Number
Address Date Evaluation Conducted Telephone Number
!7 I
SBD-8330 (Ri 1/11)
l I
t
PropertyOwner~Z~--~~'? Parcel ID # Page of
❑ Boring
Boring #
Pit Ground surface elev. ft Depth to limiting factor 5 in. Sol Applicafion Rats
Horizon Depth Dominant Color Redox Desc r4 ion Texture Structure Boundary Roots GPQ t Y
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff112
V r
q a
t7 9
1-4-
F-1 Boring
Boring #
Ground surface elev. it Depth to (uniting factor in.
❑ Pit Soft Application Rate
Horizon Depth Dominant Color Redox Description Texture S trtrcture nce Boundary Roots GPM z
I
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#2
I -T
❑ Boring
❑ Boring # Ground surface elev. ft. Depth to !'uniting factor in.
❑ Pit Sal tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure nce boundary Roots GPD/R 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. tY#i
Effluent #1 = BOD s > 30:5 220 mglL and TSS >30 < 150 mg/L ` Effluent #2 = BOO s < 30 mg& and TSS . < 30 mg&
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
SBD-8330 (Rl 1111)
Property Owner J / Parcel ID # Page of
Boring # ❑ Boring
Pit Ground surface elev. 5! ft Depth to limiting factor i -1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 .
in. Munseli Qu. Sz. Cant Color Gr. Sz Sh. ' ff#i if WE
, q
r.J` ` ~ ~ ar
i
F-I Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in.
Solt ►cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' ' ff#2
❑ Boring
Boring # Ground surface elev. - ft. Depth to limiting factor in.
❑ Pit
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. • ff#1 * ff#2
' Effluent #1 = SOD 5 > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD 5 < 30 mg/L and TSS. < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
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Parcel 012-1011-20-000 06/03/2013 10:45 AM
PAGE 1 OF 1
Alt. Parcel 03.30.17.45 012 - TOWN OF ERIN PRAIRIE
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0 #
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - OLSON, BERNARD D & JUDITH C TR
BERNARD D & JUDITH C TR OLSON
1772 190TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 SCH DIST NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 03 T30N R1 7W 40A NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/23/2002 669110 1821/158 WD
02/21/2000 618595 1491/178 TI
07/23/1997 984/610 WD
07/23/1997 893/539
more...
2013 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 09/01/2009
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 23.000 3,200 0 3,200 NO
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 16.000 24,800 0 24,800 NO
Totals for 2013:
General Property 40.000 28,100 0 28,100
Woodland 0.000 0 0
Totals for 2012:
General Property 40.000 28,100 0 28,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsyn Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
L: rand Human Relations
ision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
10 6) r S
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but - - )
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or _PARCEL I.D. #
~
y T - pt -
dimensioned, north arrow, and location and distance to nearest road. 1L`
I REV DA E
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
y
PROPERTY OWNER: PROPE CATION
1/ , T R 4ore11
GOVT. T 1/4
PROPERTY OWN5R':S MAIL NG ADDRESS LOT NA )AE 0 CS
Li AA
9,19
CI STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE (OfOWN
[SQ New Construction Use [~Q Residential/ Number of bedrooms [ ] ddition to exis ' building,,-
Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/ft2_trench, gpd/ft2
Absorption area required ,SR bed, ft2 '5-e trench, ft2 Maximum design oading rate gybed, gpd/ff2~-trench, gpd/ft2
Recommended infiltration surface elevation S) ft as referred to site plan benchmark)
Additional design / site nsiderations 4 7A
Parent material - Flood plain ation, if applicable
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRAD SYSTEM IN FILL H TANK
U= Unsuitable for s stem 12 S ❑ U ® S ❑ U 10S ❑ U ®S ❑ U S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence ftndary Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz Cont. Color Gr. Sz. Sh. Bed Tmr&
Ground
elev. .
ft. - - 7 1,9
Depth to
limiting
factor
Remarks:
Boring #
.41,14
i = 3
Ground
,e~l/ev. -
7/ - ft.
Depth to
limiting
factor
305
I
Remarks:
CST Name:-Please Print Phone:
Address:
Signature: , Date: CST Numbe
PROPERTY OWNER rDsc SOIL DESCRIPTION REPORT Page;~of
PARCEL I.D. #
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. ipont. Color Texture Gr. Sz. Sh. Consistence Bounday Roots Bed Trees
vsvv..nn......... l
Ground l
elev.
ft. -
Depth to
limiting
factor
Remarks:
Boring #
a_•ti..•v.JL/•.
Ground s
elev. s
"12 Z 1:2)
ft.
Depth to
limiting
factor
Remarks:
Boring #
z
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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Parcel U12-1011-20-000 04/04/2007 03:37 PM
PAGE 1 OF 1
Alt. Parcel 03.30.17.45 012 - TOWN OF ERIN PRAIRIE
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 - OLSON, BERNARD D & JUDITH C TRS
BERNARD D & JUDITH C TRS OLSON
1772 190TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 03 T30N R17W 40A NE SE Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
03-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/23/2002 669110 1821/158 WD
02/21/2000 618595 1491/178 TI
07/23/1997 984/610 WD
07/23/1997 893/539 more...
2007 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/31/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 23.000 2,800 0 2,800 NO
UNDEVELOPED G5 1.000 100 0 100 NO
AGRICULTURAL FOREST G5M 16.000 25,600 0 25,600 NO
Totals for 2007:
General Property 40.000 28,500 0 28,500
Woodland 0.000 0 0
Totals for 2006:
General Property 40.000 28,500 0 28,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00