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o ~ 3 m o d ~ ~_ ~ r I ~ ~ w~ ~ ' ~ ~ n ~ ~+ I .. ~ O fn $ I T ~ Z N O N C ° = ~ ~ ° e~ ~1 ~ L sm ~ 3 ~ N w~ 3 ~4 ~ r l ~~ d A o o o T °~ ~~~ a O "'q ` 1 I °o v o R ~ 3• ~ -1 ° rn o ~ A~ O o ~ I 3 a 2 c ~ ° p ! ~ ~ ~ ~ o ~ d ~ ~ I w Cn z D a e ~. cu ~ D y 3 W a w w C I 3 °' ~ o c°o ao o N O ~ I a O ~ N o° °o ~ n o c N N~ 3 '! C ~ lr• ~ ~~yy ,,~~ ~j 7 c 1 i~ 0 ~ S (7 N ~ N N fn 7a fD O fD •. m o n ~ I ~ .. ~ m o. Z .. ° I A ctnz ~ ~' ~ i c I O n ' ' ~ ~ ~ m ~ ~ ° I ~ • ~, .•. W C I m ~, N I W C ~ ~ O. Q Z 4 ° ' ~ o J '"~ A Z T _j H C n ~ A L*. A ~ ~ ~ I ~ ~~ Z -~ o I a ~ ~ ~ Z ~ o ~ O I! N Z J ~ ~ I Z ~ W A I I rota ~ Zav, o 0 o D o.~ mmdQ•~~coa . a m ~3 aa~~.~ ~ ~ ~ N ~ ~ 7 y n 0~ N d ~ O• (~/ O OD O 0) O T C ii t y y O? N~ ~ pOj 0 ~ 7 d O•ANn S. ~•. n ~O y _ ~W~7C .O-~O ~.~3 ~ ~i~o jwa a~ (d ~ _ N 0 N . ~ a . N N ~ ~ ~ 3 ~co 3 VC I • •~ o c~ ~~ a~ a < •y b I ~ o` m o n m m =;rm ~ ~ ~ I N O ~ n fD p~ °-•~ ~ ~a o ~ a A I m ~' o m o a`~ as ~ 0 of ~ ~~ m ~ ~ m . ~, •'a ~ m °~w~ 0 ° 1 ~ ~• ro ~~ w I o :~ I m aq c.., I c Q A '" v I { o :- ti ~ a ~ WiscGnsin C'P^artment of Commerce PRIVATE SEWAGE SYSTEM Safety and;ding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes iPrivacv Law, s.15.04 (1)(m)l. Permit Holder's Name: City Village x Township Ulferts Famil Trust Hammond Townshi CST BM Elev: Insp. B M lev: E B es Cri pt ion : M + ~ //T / j ~ / [~~~ / n L _ ~ ~ TANK INFORMATION Septic Dosing TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , ~ ~ /~ ~ ! ~ S Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Num TDH Lift ' tion Loss System Head TDH Ft Forcem ' Length Dist. to weu _ SOIL ABSORPTION SYSTEM 7n C ~f -{~ ELEVATION DATA county: St. Croix Sanitary Permit No: 420329 0 State Plan ID No: Parcel Tax No: ~ 6-Z ada STATION BS HI FS ELEV. Benchmart<~~~/ //~~ . ~ 0~ 6 Alt. BM T• Cd . ~ Bldg. Sewer 3 aS iQ . 3 SUHt Inlet 5,~ , O~ SUHt Outlet ~ ~ Q~~ Dt Inlet ~_ ...---. Dt Bottom l Header/Man. la Dist. Pipes Bot. System /~ 3 - 3 Final Grade I aws~ eas~e~ ~ z 3 . St C ver 0• A ©/• h-a~tcaf~ Ly vh, d~~ ~w+'~"Gt~ BEDITRENCH DIMENSIONS Width ~ ~.. ~ Length ~1~ ~' o[ No. Of Trenches ~'' PIT DIM NSIONS ..~'~ No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER Nan, r; , _, l/ ~ /~ y a< ~/ ~~ c~~. !r J~ Type~f Syste"~~~Iri (U ~ /'~'~Y_i ~ ~_ ,/ '71 tfi~fw~i' 1 %!~ ~ Model Number: DISTRIBUTION SYSTEM 5=~--U n~~~''~' Header/Manifold n ~ h Distribution pL ~ ~y Pipe(s) ~ Q7 (,i~'~1lPF ~ ~~ ~ x Hole Size f-'.'--^' x Hole Spacing /' Vent to Air Intake ~ p ',l d'i-~+ ~ Length y Dia Length Dia Spacing~_ ' lu 4~1. SOIL COVER x Pressure Systems Only xz Mound Or At-Grade Systems Only ~ ~'- I,u4s~" Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [~ Yes '~] No [~ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) inspection #1:~/ ~-/ d~2' Inspection #2:~~/) Z J/~~ / Location: 1733 109th Avenue Hammond, WI 54015 (NE 1/4 NW 9 T29N R1 )Pheasant Ridge Lot 26 Parcel No: "1 ~2Q~~ _ h` ~aP~i 1.) Alt BM Description = $ r• ~ p,~ qp 3 (~~ !n't. s _7"~1~,~ 7 ~f2 /b ~ ~ti~~,~,nA.(/ 2.) Bldg sewer length = Zb ` 1,ue,~-~t,d SfRI~Z~~b ~Lw~,vtc# ~ j~,+.d~in~ S/ d•~f~>~> ~ -amount of cover = y ~ ~ ~f~ ~ sySx~j~- ~,~,~L~ ~S~,~~,Q /~~~f "~'ttB~ f qr cc,~c, sa.~.d ~~z.Y - a. r ~ .y -- __ _ - ----- --- ~ ~ s Plan revision Required? !~s~!. Yes o ~ ~ ? ~ ~~ ~ S / .., Use other side for additional information. ~ ~ _~ __ __-- ~_ _ __ ~ __ ___/~~•..~ ~ ~ ,I SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. Wisconsin'Department of Commerce SOIL. EVACUATION REPORT Page of Division of Safety and Buildings ~_,/ rn acooraance wim Comm ao, vvis. Nam. ~oae Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must County GJ.t.., G~ . include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ,,/ ,,,1 ~ - /b~,~ "~6 --W ~' Please print all Information. Personal infortnatlon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Revi ed by 4 Date ?j3 d3 Property Owner ~~ Property Location ''`` Govt. Lot ~} ~ 1/4+V~1/4 S ~ T p'ZQ~ N R i7 E (o W Property Owner's Mailin Address Lot # Block # Subd. N or CSM# City State Zip Code Phone Number ^ City ^ Village`Town Nearest Road ^ New Construction Use: ^ Residential /Number of bedrooms _.^_ Code derived design flow rate __ _GPD ^ Replacement ^ Public or commercial -Describe: _ _ _ _ Parent material _____ Flood Plain elevation if appliccable -~_ __ ft. General comments e~~ `~~e L,~~ f t,(~A~U -rl(~f1~ ~e~~ C,IeCX~Ie, ~~ and recommendations: Vt v Jv ~ ~en~~ ~'' ~-lS C~~ ~ ~ ,~d f-~o~,~w de ~ti +~ t rz , g, Boring i t~ Boring # Pit Ground surface elev. _~~_ ft. Depth to limiting factor ~ad in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i 3 I~ s"g ~- Y ;~ i. 2 ^ Boring # ~ Boring ^ Pit Ground surface elev. ________ ft. Depth to limiting factor _ in• 'Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#i 'Eff#2 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Na e (Please Print) Sisnature _ CST Number Address Data Evaluation Conducted Telephone Number ~''c~~13 %3o~e /J~e.,~tior~ ~,,~-~,7s-/ N 7-Oo~7 7~5=o~o~'y'f f .u; Wisconsin Department of Commerce 0?vision of Safety and Buildings ~ 't~-~ '\~N,7~~Ll~ATION REPORT 1567 Page 1 of 3 Certified Soil Testing in anenrrlanrp with Cnmm RFi Wia Ar1m Code County Attach com lete site Ian on a er not less than 8%: x 11 Inches in size. Plan must p p p p St. CfOlx include, but not limited lo: vertical and horizontal reference point (BM), direction and D Parcel I percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.06 (1) (m)). Property Owner Property Location Bonte, Ron Govt. Lot NE 1/4 NW 1/4 S 9 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1011 170th St. 26 Pheasant Ridge City State Zip Code Phone Number City Village { Town Nearest Road Hammond ~ WI 54015 715-796-5240 Hammond 110Th Ave. _/_,i New Construction OSe~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement 's•~` Public or commercial -Describe: Parent material till Flood plain elevation, if applicable NA General comments and recommendations: instaN 3 - 2.7' x 80.86' (St'd infiltrator, 39 shells) stipulation 1099 chamber trenches 3.5' below -contours; use dist. box for equal loading Boring # ~ Boring ~/„~' Pit Ground Surface elev. 105.2 ft. Depth to limiting factor ~ 84 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. `Eff#1 'Eff#2 1 0-4 10YR 2/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 4-16 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 16-35 7.5YR 4/3 - sl 2 m abk mvfr cs 1f .5 .9 4 35-44 10YR 4/6 - Is 1 m abk mvfr cw - .7 , 1.2 5 44-55 10YR 5/8 - fs 0 sg ml cw - .5 .9 6 55-84 10YR 5/6 - s 0 sg ml - - .7 1.2 Boring #~"t Boring J Pit Ground Surface elev. 104.7 ft. Depth to limiting factor ' 83 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-4 10YR 2/2 - sl 2 f sbk mvfr cs 1 f/m .5 .9 2 4-12 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 12-36 7.5YR 4/3 - sl 3 m sbk mvfr cs 1f .5 .9 4 36-83 7.5YR 5/8 - s 0 sg ml - - .7 1.2 7.5YR 3/4 sl (O,m,mvfr) bands: 1/4" @ 48; 1/16-1/8" @ 54, 57, 8 69; 1/2" @ 72; occasional thin (1/16") stratified 10YR 7/4 s bands below 66" Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mgL CST Name (Please Print) Sign to CST Number Henry F. Grote .- 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 6/18/2002 715-233-0398 Property Owner BOnte, Ron Parcel ID # Page 2 of 3 r ~ Borin g Boring # Pit Ground Surface elev. 105.2 ft. Depth to limiting factor > $4 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Soil Applicationb~aie 'Eff#1 'Eff#2 1 0-5 10YR 2/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 5-11 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 11-25 7.5YR 4/3 - sl 2 m sbk mvfr gw 1 f .5 .9 4 25-51 7.5YR 4/4 - sl 1 c abk mvfr cs - .4 .6 5 51-63 7.5YR 5/8 - fs 0 sg ml cs - •5 .9 6 63-84 7.5YR 5/6 - s 0 sg ml - - .7 1.2 occasional 10YR 7/2 fs coats on pads 38-52"; occasional, irregular & discontinuous 7.5YR 3/4 sl bands (similar to those in B-2) in horizon 6 --~ Boring Boring # Pit Ground Surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color RedoxDescription Texture Structure Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate .Eff#1 'Eff#2 i i ^ Boring # .::1 Boring ~„f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' 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 608-266-3151 or TTY 608-264-8777. SBD-8370 (R.07/00) Certified Sal Testlng .... , ,....,. ,T..,, ;.-,.,. ~ ,~ ;,, ... /. . N S ~~.t ~. ti`~ ~ s~ o zs S (\ / '- _`~ 1 ~ '-tm '~zti'~~~ --, t ~ wN: 1~ AM~NOw a ~~~~e~ ti ~. 3~s•~~ z~ fr L s~,,,t~~ lgz.q~, ~~ ,~ w .M ~~ v c Y G4~ i~~ K 4 v»: •~ 104.9 le ,,~ -e 4~.c. 3s~ .,lp L) ~ ~G. ~ b ___ (.l~s.~ ~ m~.~ .L~ 1 v ~.c~. X01.1 SLR ~ ,,,,o s 4 .,~ i~ ~ ~' ...,, ~:~ m~ 4 r ,- ;~~ 1__= ~_ ~ ~cb ~~---= =;».,_ -.-..=~_ Jw:<;~ Y"-"Y~ -~ AML-~.d~ ~~ ~~ ~~~ '' j/ ~ .~ i l -.1fL l.. .~.. 4 ~ ~. ~ 1. ~. /i.. ~ ~fffr ~ Y ~~ ~.. ~~ ~~" ~I ~~+ ~ ~`' ~~~". ~ ~~~~ ~~ .~ ~ ~. ~~ ~~ ~ ~~ ~~ ~ n~~~ ,~_ ~' '' ~ ~ ~~ E ~~ ~ ~t F g~ ~ ~~ ~~ l! ).,,_5~.~.~,--i~..~.,,,,.~ P -__. _._ _ iL___ ~ -_ _ ---- I ~'" '. T.L. Sinz Plumbing Inc. E5609 708th Avc. Menomonie, W! 54751 0 rl ' S , ~~~ ~ ~~~ ~, .. ~~ ~\ %~ ~ i »' ~~ 1t-'~ ' ~ ~• , ~~ ~ ~ `~ ~ ~J S J I f = ~.' ; f.~:i ~ J~ ' is ~ r r_ Phone: (71~) 28~ 2644 ~ ~ ~~: J ~,~ ~ ~ . - -~' _ ' ~.- ~ ~ ;~~ Fix: (715) 2s5-2592 7 ~~•r ~ ~ ;.., ::• ; .- ~t.11~•.tl.-nzplumhin~;.~r.7m ~ ~~ ~ ~~ s r~ ~~x t `~ r~ '~ seiF: L-r~i ,~~~, ~. "~ 6r~~r`'%T a° ~~ ~l . ~0~ ~t .., ` ~,~ ~_ ~~~ ~ !~ ~,-r 1I f~L.S~D ~~. ~. ~-~ _ -~ -'° / s ~ ~~ ~'r . ~~~.~ ;' ~~ r 5.,~ ~'. ., ~ ~ ,J ,~ t ~Jr ~~ ~' - ZO ~ 911I~fi'IdZlQIS'I,L Z69ZBCZ9TLT YV3 Lfi ~ ZZ ZoOZ/8T/8o isconsin Department of Commerce Date of Inspection: July 18, 2002 Project Name: Pheasant Ridge Use: New -Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25-26 Subdivision: Pheasant Ridge Municipality: Town of Hammond County: St. Croix Plan Transaction Number: Sanitary Permit Number: Wastewater Flow: 450-600 gpd Persons Present: Jon Sonnetag Rod Eslinger SAFETY ANO BUILDINGS DNISION Field Operations Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www.commerce.state.wi. us Scott Mccallurrti Governor Philip Edw. Albert Secretary Plumber Name and Address: Certified Soil Tester Name and Address: Henry Grote CST 222774 E 4366 353` Ave Menomonie WI 54751 ~-=--_ Owner Name and Address: Ron Bonte 1011 170th St Hammond, WI 54015 RECEIVED "~~- ~ 4 2002 ST. CROIX COUNTY ZONING OFFICE This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. wgre,~~ ~ Ittt a5 and cne on ld 28} antJ ~`~my opinion that the bands a streaks of contrasting color are depositional in nature and not pedogenic redoximorphic features. The contrasting colors were likely deposited by water from different sources and thus there are different colors. Convolute bedding often overlies horizontal bedding as was observed in the soil pit on Lot 25. The high chroma streaks noted in the horizontal bedded sands are like due to uneven weathering of minerals in the sand rather than contemporary redox feature formation. R+~a~P~l "ttt+l~ ~~~ th8 ~ l~ii~ t~4 :~11t ,rte; ' lead the fine sand aver Q;~.~"a, ~`°t+Ra s Sizing example: 3 bedroom home 1125 ft^2 or about 37 chambers 4 bedroom home 1500 ft^2 or about 49 chambers If there are any questions regarding this report, please feel free to contact me. Le y G. J sky, ast ater Speci ' Ljansky cLD mmerce.state.wi.us E- it 715/726-2549 Fax 715/726-2544 Voice INSPECTION REPORT cc: county ^ Plumber ^ CST ^ Owner ^ Other ~ O ti ~ U o a N ti +.~ d M O O N O v i c [~ "~ •~ N U •~ U r.~ r .0 C 7 LL 3 v 3 co ~ Z Z y O ~ ~ `~ O ~ Z z a m rn ~ o z a r ~ N H a> m v c N (0 N a N a a t% J U C O w t~ .~ c~ v A a L O U c °o 0 ~o~ ~~~ ~~o o E 00 ~°'i, E 0 0 = +' at a a m :~ c U a ~ v c 0 N .C y N a o c o Q c Z Z ~ .'.: ~ c d o R E ~ .. ~ m - a y d .~~- o o a` c N fn N E ~ ~ p = a a a a~ > o Q N _~ ~~ 00 ~~ ~~~ ~ H C T ~~ N w "o ~ v o .'.: m a a c :: ~ O ai U y O o?r O c O E N T tq td N fp 7 C ~ O N .- ~ C w coo ~~ y ~ O ~ fp .. C ~ '~ f0 ~ ~ ~ O 07 N C_ Z ~ ~~ N •- ~ _O c ~ O U O ~ ~ ~ J U Q !na m c ~~ ~ ~ ~ ~ ~~ 0 ~ .; v a $ E N ~ c a <n m a z ~. ~~ N N z = a ~ I ~-3 ~ /0 9~ A,~. ~ a~ o ~y Sanitary Permit Application Safety 8c Buildings Division `~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washington Ave. PO Box 7302 0 02 SCOf1Sin ur oses d for seconda b ti id f 7-73 Madison, WI 537 Department of Commerce p ry p e may e use on you prov personal in orma (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the syste n aper not less than 8 -1/2 x 11 inches in size. County ST ~ ro,x State S 'tary~ennit2umber ^ Check if rev Sion t C ication L((~~ State Plan I. D. Number I. Application Information -Please Print all Information. ation: Property O/wner Name ~~ l f V~ 2 U ` ~~~~ ~ 1`'I/vi~ ! ~ ~ 2 2002 perry L,oLCat'ion p 1/4/VWl/4, S ( ~g>N, (or 0/ Property Owner's Mailing Addre~ Y I ~ON~N OF~ of Number Block Number ~~ c CE ~~ O~ City State Code Zip umber ~ Phone N r Subdivision ~ CSM~Ium r L 1 r ~Q~ 7 ~ IL Type of Building: (check one) 2 u ~s ~w.. 1 or 2 Family Dwelling - No. of Bedrooms : ~ ~ ~ C'ty Village ~~~(~d'Ylp ~` ' ^ Public/Commercial (describe use):_ I own of ^ State-Owned ~ 3~ I Nearest Road p p 0 O ~ 0 ~~~ ( + - ~ u~ ~ t , Parce Tax ~ mbe ~ X ~ (Z ~ ~ I ~ ~0 ~ ~ S III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) p) 1. ew 2. Replacement 3. Replacement of 4. 5. 6. ^ Addition to ystem System Tank Only Existing System - B) Permit Num er Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) /~ ~'R1on-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade tion El 2 1 eva Rate ( s./d ) (Min./inch) 13 Required' (~ Proposed ( VII. Tank Capacity in Total # of Man er Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks ` Con- Con- glass New Existing Crete structed Tanks Tanks S T/L jOdV -- l6DD l ~~Gr//T ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for ' tallatio of OWTS shown on the attached plans. Plumber's Name (print) P umb Signatu no ps): MP/MPRS No. Business Phone Number T~~ ~ S1N2 ~~ /39~~ Z /.~ 235= Zb~ Plumber's Address (Street, City, State, Zi Co ~~v41 7~ ~' ~~ ~fl/o/LIIyI /~ G/~ S~?f7 IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature o stamps) 'Approved ^ Owner Given Initial Adverse Surcharge Fe ~~~- q ~ Determination ! X. Condition of Approval /R asons for Di~ap royal: ~ ' _3 / ''S ~. ~r 4 ~ 1 Ce ~ ~.. ¢v~Otit,w#'"~CJ~t~wirs S~2u.~,e-a~''e~' ~ °_° o- _. t~ t _ ~. i , T.L. Sinz Plu~rtbing Inc. E5609 70StlY Avc. ~~ I F = l' ; ~.~':%' • ~ :r -: ~ %= ~ Phane: (715) 255-2644 Menomonie, Wl 54751 1.1r '~~ /~,' % ~ . = -' "~~ = ' r.. ' ~' '. .1 F•aac: (715) 255-2592 ~~~ ~~ ; , • , ~ :• 1:e ~... ; _ ~~.~ti~~.tl~in~pl~iml~in~*.~r.7m u r .r ~ / ~•~ } . - ."~\ ~ ~ y ~~ a /' ~ \ O • ~ ~/~ to ~~ \, \. ~~ ~~ \ ~ ., _. ~•, ., '~, ~ %~/' ~'-;~ v/ ='" ?" ~ , ~~ ~d C i•, ~~5. c •- ~~ i- ' ~1. ~ . ~ol.~ ,,, ` j~ ~-: ~~ ~~s=z ~ "r°~'' T.~ ~ ~ ~ j " ,; ~~ ~ ~ ~ r ~ .~ . ,~ .. ~I i ~ „~J' ZO f~j 9HIS14f1'IdZHI5'I,L Z65Z5£ZSTLT %V3 Lb ~ ZZ ZOOZ/Bi/80 ~--. T.L. Sinz Plumbing Inc. E5609 708th Avenue Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 Date: Q X19 - ~ ~ No. of Pages: (including cover) ,. AtU~-: ~>o Ji c~ From ~ ~y - Subject: Mcssage: ~ l~ 4~rAZ~ I ~.1 t~D~S Signature: io ~ ~NI~4R'IdZHI5'IZ Z69Zg£ZSTLT %V3 L6~ZZ ZOOZ/8T/80 J. ~'.L. Sinz Plumbing inc. E5609 708th Ave. v ~ F~~~S ~ ~-~ ~'ws ~ Phone: (715) 235-2644 Fax: 715 35-2592 ' W 54 W ~ T2.9 2 Menomonie, I 751 1~1F ~ /J / 9 ~°17W ( ) ~f'pW~ dF ~ ~ ~ Nt ~ www.tlsinzplumbing.com ~r~ ~ ~~ / 1 ~~~~ ~~~ ~ ~ " 1~J ~ ~~ ~,~ , isconsin Department of Commerce Date of Inspection: July 18, 2002 Project Name: Pheasant Ridge Use: New -Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25-26 Subdivision: Pheasant Ridge Municipality: Town of Hammond County: St. Croix Plan Transaction Number: Sanitary Permit Number: Wastewater Flow: 450-600 gpd Persons Present: Jon Sonnetag Rod Eslinger Certified Soil Tester Name and Address: Henry Grote CST 222774 E 4366 353~a Ave Menomonie WI 54751 RECEfVED Owner Name and Address: Ron Bonte 1011 170~h St 'j`~~- ~ 4 202 Hammond, WI 54015 ST. CROIX COUNTY ZONING OFFICE This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. Two soil pits were reviewed (one on lot 25 and one on lot 26) and it is my opinion that the bands a streaks of contrasting color are depositional in nature and not pedogenic redoximorphic features. The contrasting colors were likely deposited by water from different sources and thus there are different colors. Convolute bedding often overlies horizontal bedding as was observed in the soil pit on Lot 25. The high chroma streaks noted in the horizontal bedded sands are like due to uneven weathering of minerals in the sand rather than contemporary redox feature formation. Recommendations for these lots include keeping the dispersal areas as shallow as possible and not to load the fine sand over 0.4 gpd/ft^2. ~Y. Sizing example: 3 bedroom home 1125 ft^2 or about 37 chambers 4 bedroom home 1500 ft^2 or about 49 chambers If there are any questions regarding this report, please feel free to contact me. Le y G. J sky, ast ater Speci ' t Ljansky cLD mmerce.state.wi.us E- it 715/726-2549 Fax 715/726-2544 Voice SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Street INSPECTION REPORT Chippewa Falls, wl 5a~2s www.commerce.state.wi.us Scott Mccallum, Governor Philip Edw. Albert Secretary Plumber Name and Address: cc: j~County ^ Plumber ^ CST ^ Owner ^ Other :~ ~.'~ ~~~ ~~p, t~~ ~ v ~.1~,, Wisconsin Department of Commerce Division of Safety and Buildings ~~RIC~INAL SOIL EVALUATION REPORT in anrtnrrlanra with Cnmm Rri Wis Ar1m CndP 1567 . Page 1 of 3 Certified Soil Testing County Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . ~~ -o Z Please print all inform,~~pq.,. ~ s ~ l hod iewed By Date _ Personal information you provide ma be used is~vacy s. 15.04 (1) (m)). ~ ' 1 Property Owner Property Location Bonte, Ron t 02 Govt. Lot NE 1/4 NW 114 S 9 T 29 N R 17 W Property Owner's Mailing Address ~ Lot # Block # Subd. Name or CSM# 1011 170th St. ~~~;y; c;nuN?Y 26 Pheasant Ridge City Stat Zip Co~1®f18~1R~ne-IF1F~ City Village I,~ Town Nearest Road Hammond i WI 54015 715-796-5240 Hammond 110Th Ave. /! New Construction -_. Replacement Parent material till General comments and recommendations Use: ~ Residential / Number of bedrooms 3 Code derived design Flow rate 450 GPD ;Public or commercial -Describe: Flood plain elevation, if applicable NA : install 3 - 2.7' x 80.86' (St'd Infiltrator, 39 shells) stipulation 1099 chamber trenches 3.5' below -contours;. use dist. box for equal loading Boring # -~ Boring /' Pit Ground Surtace elev. 105.2 ft. Depth to limiting factor ~ 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 10YR 2/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 4-16 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 16-35 . 7.5YR 4/3 - sl 2 m abk mvfr cs 1 f .5 .9 4 35-44 10YR 4/6 - Is 1 m abk mvfr cw - .7 1.2 5 44-55 10YR 5/8 - fs 0 sg ml cw - .5 .9 6 55-84 10YR 5/6 - s 0 sg ml - - .7 1.2 Boring # .:~ Boring Pit Ground Surface elev. 104.7 ft. Depth to limiting factor ~ 83 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell pu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-4 10YR 2/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 4-12 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 1~ 7.5YR 4/3 - sl 3 m sbk mvfr cs 1f .5 .9 4 36-83 7.5YR 5/8 - s 0 sg ml - - .7 1.2 7.5YR 3/4 sl (O,m,mvfr) bands: 1/4" @ 48; 1/16-1/8" @ 54, 57, & 69; 1/2" @ 72; occasional thin (1/16") stratified 10YR 7/4 s bands below 66" • Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 =GODS < 30 mg/L and TSS _< 30 mgr CST Name (Please Print) Sign to CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing pate Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 6/18/2002 715-233-0398 Z Property Owner Borate, ROn Parcel ID # ' ~ ..~' ,~ Page 2 of 3 Boring # - 'Boring /' Pit Ground Surface elev. 105.2 ft. Depth to limiting factor > 84 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots "Eff#1 'Eff#2 1 0-5 10YR 2/2 - sl 2 f sbk mvfr cs 1 f/m .5 .9 2 5-11 10YR 2/2 - sl 2 m abk mvfr cs 1f .5 .9 3 11-25 7.5YR 4/3 - sl bk mvfr gw 1f .5 .9 4 25-51 7.5YR 4/4 - sl 1 c abk mvfr cs - .4 .6 5 51-63 7.5YR 5/8 - fs 0 sg ml is - .5 .9 6 63-84 7.5YR 5/6 - s 0 sg ml - - .7 1.2 occasional 10YR 7/2 fs coats on pads 38-52"; occasional, irregular & discontinuous 7.5YR 3/4 sl bands (similar to those in B-2) in horizon 6 Boring # _J 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. 'Eff#1 `Eff#2 ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sop Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 'Effluent #1 = BODS> 30 < 220 mg/L and 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 608-264-8777. SBD-8330 (R.07/00) ceroned sai resent' 'p i, I`_~ ~~oh 1~o~t~ ~ J~le~ +~~4.y N~ / "r`n+ 4~Z~ o LS J'~ k 3t3•~ ~ ~Vm'~Nw-q•z~t-~~k. b_ ~ m w.y~ .,'~ A.~+.wo.. a ~..~I,..~.a~ (~r i ~~ ~ ~Iw ~ s: L ~ s~~~ ~y K w.: ~Y ~qZ.q' ~M ~ ~w •~ ~~v c c.~m ~~ w ~.~. ~ r ~ eT. t l.i. •~ ~ 0 4 •g ~ Z~ (.bs.~ ~~.Za~ ~~ 1 ~ e~ ~ ~~ ~M~~~.a~ x ~=1 d ov,~,= ~.v~~~ ' ~~~a~ ~mT~? ~~'.. ,, T F~n'» ,mNN:a ooc~oo ccc~-c naa`n `n> mmmmm-. wiscx.~ssin Department of Commerce SOIL EVALUATION REPORT ~ Page ~ of 3 D~visia~ of Safety and Buildings ,,. a....,..,.o....` .......,.,,.~.........,.,. ,. .............. - County C Attach complete site plan on paper not less than 812 x 11 inches in size. Plan nwst indude, but not flmited to: vertkal and horizontal n:ference point (BM); diredion and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. • _. _ Please print all information. Reviewed by Date Personal information ycu provide may be used for secondary purposes (Privacy Law. 5.15.04 (1) (m)). . Property owner _. ECEIVED Location. G .Lot /~/'~ 1/4 /~/w 1/4 S q T Zq N R /~j E (or)~N Property Owners Mailing dress JUN l 0 2002 # Block # Subd. -Name or CSM# ~ ~ City .State Zip Code PhorglNprX COUNTY City ._ ^ V'~Ilage ,Town Nea Road ~-~ ~. l I I I~~h Ave . New Construction Use: ®-Residential / Number of bedrooms ~ Code derived design flow rate ~ CX~ GPD ^ Replacerr~nt ^ Public or commercial - Desaibe: Parent material ~ ~ Flood Plain elevation if applicable ft. General comments S J~'- ~ia'I Ply U ~ `f ~%~ 0 and recommendations: l ~ ~~ ~ p~ I Boring # 1^~ Boring Q ~ pit Ground surface elev. ~ C ~ ft. Depth to limiting factor ~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Oescxiption Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl Qu. Sz Cont Cdor Gr. Sz Sh. 'Eff#1 •Eff#2 l v-i4 ~~ Z 5II Z ~ ~s ivy .5 . 3 Jp^y2 1~ r 3 F'I~ y ~Zo S i ~I' Z k m~r - ' ~ . Co Boring # ^ Boring QQ~ p ®" pit Ground surface elev. r 0 _~U tt. Depth to limiting factor O in. Sal Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Mansell Qu. Sz. Cont'Color Gr. Sz Sh. 'Eff#1 'Eff#2 ~ (~-1~ to -2 S. k m~r cS v , ~j ,t~' 2 ~ -3 ID ply _' g;~~ 2 m c5 _ . ~ g 3 3~- ~ .5 r ~-rl~ C ~ ~ s O ~ _ . ~( . ~ 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print ignature ' CST Number Sc l ~' s33~' 9' A dress Date Evaluation Conducted Telephone Number / ~~~~ ~~%u- ~, _w~ s-- ~az,.f- _ ~ - s-- a z pis =zy~-i~vo ~., : i Properly Owner I...JI~f l~ Parcel ID # !~+' ~~ro Page ' ~ of Boring # ~ ~~ Pit Gn~urrd surface elev. - ~~ ft Depth to limiting factor _~~ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Struc~ue Consistence Bourxiary Roots GPD/ft2 # 1 - 'Eff#2 'Eff z . S h. in. Mansell Qu. Sz. Cont. Color Gr. S _ ` _ ~, n n ~ 3 3l~ry~ `~.S 't~~ C ~- r y~ S ~s ml - - . ~ . ~ _~-- ^ Boring # ^ Boring Ground surface elev. R Depth tD limiting factor in. ^ Pit Soil Applip6on Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 p in. Mansell Qu. Sz. Cont Color . Gr. Sz. Sh. 'EtT#1 'Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. R Depth to limiting factor in. Sal Appligtion Rate Hor¢on Depth Dominant Caor Redox Description Texture Struchue Consistence Boundary Roots GPD/ft= in. Mansell Qu. Sz. Cons Caor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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/OD) . . PAGE 3 OF 3 1~T A MF ~-, /1 ~ TOT#ZC~ T EGAT DESCRIPTION !U(~ ~ ~W to ,S ~ T Z R ,N,R. / ~ E(orX~I SCALE: I"= ~/O BM 1 ELEVATION /C~ ~ d BM 1 DESCRIPTION ~,p o-~ / ~~~0 yG P, p ~ BM 2 ELEVATION 9 ~l y4 BM 2 DESCRIPTION aop a ~ ~ ~~,0 /c . D e SYSTEM ELEVATION 99, o O SYSTEM TYPE OQ-~ _ lrru cPe. CONTOUR ELEVATION q g. 5~ ~/ 6~ e ~~ ti ~~ a~ ~~~ _ ~- - ~ x, 9 4~'pd ~~ ~~ SIGNATURE /i%~-~--~ _: _ / DATE ~ `~ ~~ ~ cn t rucncM4TinN POWTS OWNER'S MANUAL ~ MA>ivtivtr-r.~~ ~WY Owner l ~-~~~~ l ~y T,ef%5' DESIGN Pgltgr7t~ttc~ d 3 a NA rooms Number of Be . Number of Commercial Units ^ NA Estimated flow (average) 50 qA~(!~S gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate os gal/day/ft2 Influent/Effluent Quality Monthly average* Fats, Oil ~ Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 150 mg/L Pretreated Effluent Quality ' ^ NA Monthly average* * Biochemical Oxygen Demand (BODs) <_30 mg/L Tots! Suspended Solids (TSS) _<30 mg/L Fecal Coliform (geometric mean) <_ 10' cfu/ 1 OOmI Maximum Effluent Particle Size ~ inch diameter MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contenu of tank(s) Inspect dispersal cell(s) Clean effluent filter inspect pump, pump controls 8i.alarm Flush laterals and pressure test Other: Other: cvcTFM SPEC'IFiCATIONS Septic Tank Capacity ~Q al ^ N~ Septic Tank Manufacturer ~~lJ/7 ^ 1`i/ Effluent Filter Manufacturer ~ ^ Ni Effluent Filter Model ~--/OD ^ Ni Pump Tank Capacity gal ^ N~ Pump Tank Manufacturer ^ N~ Pump Manufacturer ^ N~ Pump Model ^ N' Pretreatment Unit ^ N' ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration O Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and sep tank effluent. * * Values typical for pretreated wastewater. Service Frequency At least once every 3 ^~months'year(s) (Maximam 3 yrs. ) When combined sludge and scum equals one-third (Ys) of tank volume At least once every ~ ^ months j~Year(s) (Maxlmam 3 yrs. ) At least once every At least once every At least once every At least once every At least once every ^ months ~d'year(s) ^ months ^ year(s) .~f NA ^ months ^ year(s) ~ NA ^ months ^ year(s) ~-NA ^ months ^ year(s) .P.~NA MAINTENANCE INSTRl1CTIONS Inspections of tanks and dispersal cells shall be made by an inodivlPdOua~S Maintainer; Septagle Seirvicing OperatorrtiTank inspecua Plumber; Master Plumber Restricted Sewer; POWTS Inspect , must include a visual inspection of >tl~e nd co)t:heckefor any back up o~ ponding of effluention the ground surfacee Thee dispersa volume of combined sludge and s cell(s) shall be visually inspected to checkent onflthe t found surface msay indicate aefaili gtcondition and requires the immediate the ground surface. The ponding of efflu gr notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the W sco contenu of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Adminisvative Code. The servicing of effluent filters, mechanical ormonths ordlessOsh I be performed by a certified POWTS Main~tainerany ocher maintenance or monitoring at intervals of 12 A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START LIP AND OPERATION roducu or other chess For new consutictlon, prior to use of the POWTS check treatment tank(s) folf hi hrconcencorauons are detected have the cone chat may impede the treatment process and/or damage the dispersal cell(s). g „r ~~a ranlrfs~E ramovad ~v ~ sentafte 5ervidnR operator prior to use, ,. •~ System sort up shah not occur when loll conditions art (noun at the IntUcrative surface. During power outages pump tanks may fill above nomul hlghwater keels. When power is restored the excess wascewatEr will tie discharge4 co the dlspenal cell(s) In one large dose, overloadlrt~ the cell(s) and mry result In the backup or surfxe discharge of effluent. To avoid this situation have the conunts of the pump tank removt4 by a Sepcage Servkinai Operator.prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalrter to assist In manually operacin>t the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over sinks and dispersal cells. Do not drive or park ever, or otherwise dlsWrb or t.ontpact, the area within 15 feet down slope of any mound or at-grade soil absorptkn area. Reduction or ellminatlon of the (ollowir+.g from the wutewater ltrearn rr~y Improve the performance an4 Prolong the life of the POWTS: antiblotla; baournlpewategr,r(TUIt and vegtntablespeellrt¢51 ~ o{Inee~rea~~herblddas~meatascr psalmedic ticm~s(oil; foundation drain Isump p p) palndnst croducts: oesticldes; saniwry navkins: tampons; and water Softener brine. ABANDONEMENT When the POWTS tails and/or Is pemsanencly taken out of service the following sups shall be taken to Insure chat the system is properly an4 safely abandoned In compilance with ch. Comm 83.33, VJisconsln Adrnintstratlve Coda • All piping to sinks and plu shall be dlsconnQCted and the abandoned pipe oWniniis sealed. The contenu of ail tanks and pits shall ba removed and properly disposed of by a Septage $ervking Operator. AhPr pumping, all tanks and plu shall be excavated and removed or their covers removed an4 the void space felled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls anti cannot be repaired the following measures have been, or must be liken, W provide a code <ompliane replacement system. ~A suitable replacement area has been evaluated and may be utl(lted for the location of a replacement soil absorption system. The replacement area should be protecte4 from disturbance and compaction and should oat be Iniringed upon by required setbacks from exlstJng and proposed swc~un, lot pna and wells. Failure to protect the replacement area will result In the need (or a new soli and site evaluation ca establish a suitable replacement area. Replacement =ystenss roust comply with the rules In effect a that drne. ^ A suitable replacement area is not available due W setback andlor sail limlUtions. 6arriln>i advances in POWTS technology a holding tank may be InsUAed as a last resort to replay the failed POWTS. ^ The site has not bccn evaluated to identify a suftabk replxement area. Upon failure of the POWTS a loll and site evaluation must be performed to locate a suitable replace>v~ent-area. If n0 replacement Xta is available a holding tank may be Installed as a last resort to replace the failed POWTS. O Mound and at•grade soli absorption systsms may be reconsuttctedwlth Itht ruk~ 1 I e~feCt it atllat tlmebiomat at the Inflluatlve surface. Re<onswalons of such systems must comD~Y < <WARNING> > SEPTIC, PUMP AND OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGH MAYD RES~LT~NRESGUE Oi A~PERSON FFROM TFiE lN7 RIVR OFAA TANK MAY sE DlF ICUIT OR E5. aEAT (MPIICCIRI i. ADDITIONAL COMMENTS cnwTt I1.ISTALLER Name L SiNZ ~113~/v /UL Phone ,~- ~,~~ SEPTAGE SERVICING OPERATOR (PUMPER Name Phnnr POWTS MAINTAINER .Name TL ~1/~L ~ INL Phone ,S= - Z!o tACAI REGULATORY AUTHORITY Agancy ST ~ l /A/ hon ~ bgo ST CROIX COUN'T'Y • SEPTIC TANK MAINTENANCE AGREEM] . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~'`' ~~~~ Mailing Address / ©~ l Property Address RECEIVED AUG 1 3 2002 ST. CROIX COUNTY a~ (Verification requirpred~~from Planning Department for new coast City/State ~~~ MC ~ . l,~ ~ Pazcel Identification Number 01 ~ _ /b I $ _' ~~ LEGAL DESCRIPTION -~q ~`` ~ , T°` ~ N-R ~~ W Town of ~°'~ ~ Property Location N ' `/., r `/,, Sec. Subdivision Lot # °~~ Certified Survey Map # ,Volume ,Page # ~j p ~ a Warranty Deed # ~ ~ ~ ~ 7 ,Volume ~ ~ J Page # Spec house ^ yes ;~. no Lot lines identifiable ^ 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 is 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) aRer 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 wrthrn 30 da of the ar expire ' n dat ~ /~ /~c~ ~~ SIGNATURE OF APPLICANT ~ 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 de 'bed above, v' of a warranty deed recorded in Register of Deeds Office. 1~. /~/~~ SIGNATURE OF APPLICANT DATE ****** ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ~c~..r~^ i I ~l Tr ~~ ~ 7D~h`~~ '~0.rnrn ** 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 i !-~ ~ ~ .t ~31,auU t QUIT CLAW DttD ~~~~~:Z.1~D~~.c.~n~ _ ~~ -._.Z ~~ A a I) .,. J R~zl M. Ultazts and llathsrina 0. U1[azts, a/k/a Ratharina G. _ E4 ultarts, a/k/a aatharina U1larts, a/k/a tat• Jlferts, a/k/a Kathazina i _ ~•7~ "1' ~'-+~-•••~~ `- `~ ,, ~.i U1[erts, `uscard +nd •,rifs holding as sur~•i•:orshic .^..arital p.operty. ~~C`sfS I Cfi ~ b~~~:.t. 5't I•,;[ <:Li as to Carl M. Ultarts and Eacharina G• Ulferts Family Trust, ~ ^ r r ;+{~ ~,.r:e N. Bnn[e, T:+setee, Rona'.d C.~ °or.[e. 1st Aaerrati:•e Trustee, I ST• ~~`~'^ i'v'~ .. ,•::a~ :,11 po«er w sell and ea:u:ncar. the tollowing descril;ed real °''- •% '••~ 'y'=' ~;., ,sc+•e :n st. Cuiz and Pepin Courts, State of Wisconsin: ~ AuG 18 1998 i ~ ; ~,,, .- atta,Y.ad E:chibit "A" for real °acate descriF!ion. ;~ 3.30 ~,ti r, , ~~ Req(.'rr of tSe~.is, _ __~ ~~. " ;, T.ha rnrpose of this Quit'C1aim Deed is `0 2erminaCe that oc:'panc/ ~I p r_)::t a3 c•~iginal:y reserved by the v^rantors by deed as ari .Wally j . ,: +ted Sep[e"tber 1, 1935, recorded in St. Croix County Regis ar of Deeds ~n t~o:eai;er L, 1935, at 10:00 a.m. in Volume 1147 of Recor!:, Pages 22- i as !.'ocu-ent ?tu.:,:,er 535679 and recorded in Pekin Cou:ay Register of - ,~` ~eeda cr.tz,::•e~ber 17, 1994, at 9:00 a.m. in Volume 106 of Records, I 4 ~_ 3es ~ ): -295, as DocuTant :tu:nbcr 09315. \ ! t;a,+!E ;,NC R^eTL'RN A.7CRES3 , Leo A. Beskar, Attorney EXDKPT PER WISCO:::~.~ STATUTE 77.2111) I~RUDLI, BESKAR,~BOLGS & dRUEGER, S.C. • ~ 219 :forth Main Strut, P. O. Box 13d River Falls, iJI 54022 L Pepin County 010-484-0000: 010-510-0000; 010-507-0000 St. Croix County 002-1026-80; 002-1025-40; 018.,1018-20;.. 018-1018-30; 01~-1018-4u; 018=1018-50; 018-1018-60: 018-1018-70; UL8-1018-80; • ?arcel Identification Number IPIY1 018-iG18-90; 018-1015•-60; 018-1015-70; 018-1015-80; 018-1015-90; 018-1Oly-uU This is 'romestead~zoperty. Da':d this r~ day of August, 1999. (SEAL) -- t ----- -- - "--J Earl K. Ul eats ~'~ `r n (SEAL) _. Ratharina G. Olterts . AUTHtNTICATION ACRNOWLSDClRNT :iynatures of Carl K. Qlfarta and _ STATE OP WISCONSIN 1 1 99. j COUYTt ) at arina C. Ultar!s Personall came before me this day o! • authentic .'s da o! August, :998. y ly_- ~~e alive named to me known to be the person(s) who executed the • foregoing instrument and acknowledge the same. ~ Lao .\. Haakar .~ T1TLF.: MEMBER STATE BAR OF WISCONSIN - { lIf not, aut.:c ize~y S7o6.0~-Wis• scats.) ~ Notary Public County, iti~. TNIS ZNSTRUMtNT KA8 DR71lTtD BYE My commission is permanent. I not, expiratioA date: Lao A." lsakas, Attoraay RCDLI, BESKAR, HOLES & KRL'EGER, S.C. ) ' 219 Ncrth Main Street, P. 0. Box 139 River Palls. Wi 54C22 a ... _ ,. _... .. .. - ~. ~9L •~•~.~~o~fF'~.n~) EXHtBiT "A" Real Estate (St. Croix County, Wisconsin) Northeast Quarter (NE 1/4) of Section Eignt (8), Township T•~enty Nine (29) North, Range Seventeen (17) West. Ti AND; •.~ West Half (W 1!2) of Section Nine (9), Township Twenty Nine (29) North, Range Seventeen (17) West, EXCEPT Commencing at the Southeast corner of said West Half of Section 9; thence North on quarter section line 341.8 feet; thence N82°W 340.0 feet; thence 852°W 170.0 feet; thence S39°W 170.0 feet; thence 856°W 203.7 feet to section lire; thence Easton section line 7Sa.73 feet to Piace of Begin:iing. , AND; South Half of Southwest Quarter of Southwest Quarter (S 1/2 of ~, SW 1/G of SW 1/4) of Section Twelve (12); And Northwest Quarter of Northwest Quarter (NW 1/4 of NW 1/4) of Section Thirteen (13); All in Township Twenty t7ine (29) North, Range Sixteen (16) West. Real Estate (Pepin County, Wisconsin) R_1 Lot Five (5), Block Two (2), Klampe Subdivision to Torn of Pepin, •~'~ Pepin County, Wisconsin. •? . ., AND; ,- , Lot 4, Block 4 of the Klampe Subdivision in the Town cf Pepin, ,~1 Pepin County, Wisconsin; ~~'' AND Part of Let 1, Block 5, First Addition to Kla:~pe Subdivision, Y~ described as follows: ~-r ~~. Commencing at the Southwest corner of said Lot, which is the Foint •+~ of Beginning; thence North 46°8' East, 135 feet; thence South 43 52' .• East, 91.40 feet; thence South 80°14' Wept, 163.03 feet to the _ Point of Beginning. ~ 't' :, Located in Government Lot 2 of Section Twenty-One (21), Township Twenty-three (23) North, Range Fifteen (15) West, all in TOWN OF __ PEPIN, Pepin County, Wisconsin. ~. ~. •4 t , ••~ t ~.s u . _. .... .. . _ .. .. .. , s~ ~ . , . t M O~ ' ~ Of y ~ ~ w Of 1 8 O ~ w ~ SO ° q9' 2q • 37 ~ / ~ i ®: • cp a y i ~ ~ ~~ W q. q9' ~ ~ io~i ~i + b V n ~ ,• y n ~ I m~p_ Z ; 1p ~ ~/OO ~ y ~ ~V Oi D ~ ~ R1 '~ / ~ ~ i ~ ~ ; ' I ~ \ ~ ~ / m ' m I , '4 i ~s~ \/ ~ n C6~. 02~ . y~ o~ w i U a $$omN ••®i ; ~ obi ~ ~~ y y W ~ 8' i ~ i ~ 3p~ . w _ i , ;~ r w 2 ~ Z i / i rno-O rn /~ ° •. ~ ~ N02°3l' 27'E 313: 91' i ~ ~ ~ N a- t,'•••• 0 81.34' ~ - o , •: ~ eo ~ 1.00 ,Z ~ 1 ~ ----W -£8,9~o£ON ~ -o ~° -+~0. ~ 3 ~• I ~ ^~ N ` `~ ~ ~ O 2iS` ;~ ~ 0 .•. 1 `\ Yl Ay e~ ~ ,L w ,~ ® ~.so wti 6 Off, ~ \ ~ ` ~a9~, \ ~ ~ e ~ n 2? \ ~ ~ a`%`` F/e\ ~B~ ~ yy a: C' ~ ~ ~ a ~ ~ emu?. ~ ~ `.u~ 9s ` ~ ~O O `` ~~\ `. s•. 2~• Q'i ~ °f ~ r 4 ~:2 sue' y0 \ ~. ~ ~ °~~ ~ ~~s ~ ~' w ~~ !y ,, w ?? \ ~ v _ ~ 04 ~`~ \ o ~ °f ~~ ~. ~ N ~ o ~~ c • ~ v •~ •~~ .` o~N ~ ° ~ ~ ?2J. t~',qs~ ~ ® i