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018-1083-46-000
Wisconsin Dep~ 'dent of Commerce PRIVATE SEWAGE SYSTEM Safety and Br)ivision . INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Henke, Bandi Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: /q v a / / ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic `P ~-- ld 0 U Dosing /S j Aeration Holdi TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~ Jf~ y ~= Dosing 7sb / ~s~,• y ~'s~ r A Holding PUMPISIPHON INFORMATION Number y// Lift Friction Loss SOIL ABSO RPTION SYSTEM BEDITRENCH Width Length No. Of Trenches DIMENSIONS ? ' J r ~ ~ J SETBACK SYSTEM TO P/L BLDG iNFORMATfON Type Of System: ~ y ~ ~~~ ~ DISTRIBUT ION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark • y ~ lO0 Alt. BM Bldg. Sewer l6- a g3.zz S Ht Inlet ~~ QZ- L S t Outlet Dt Dt Bottom /~ ~v p,2 ~ l Q d' Header/Man. G. ~~. ~~ Dist. Pipe G ~- - ~~ z Q ~ • 3 Z .3, Bot. System L ~ ~ z O Lr 4 -9L 4S. Final Grade • Zp ~~, L St Cover ]~ s: y ~'. Of Depth OR Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Ai take ~r Length Dia~_ Pipe(s) / ~ ~ i Length (/ . ~f Dia l Spacing` ~ /~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade SVStems OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil (~ Yes ~ No ®Yes ~] No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 976 170th Street Hammond, WI 54015 (NW 1/4 NW 1/4 16yyT129N R17W) Pheasant Hills Lot Parcel No: 16.29.17.618 1.) Alt BM Description = 7JhQ k.4~..5~ ~~ ~// _ 1 ~~/ 2.) Bldg sewer length = is O ,hsla~~c1 ~'1 ~~ ~5 K~~7i~~ ->~(~. amount of cover = > c~Z" ) ~ ~I ~ ~!~ 3~(652~~~JV ot__~~//.-,~ //P:P~s//'' tk~'~~~~ec/ rp~1 i~u; st~y~o~~f~ ~l`~ ~u.,,.k k-s~CI`~4•,_ ir` Z"~ C~/Pr' Y~r'o>~- 2~~` ~ .__ ,_- --,----,i ~--..Y='._~~~2 tGw-.- 1~ ~' u'p~0 L' at Y 1lC Plan revision Required? X44 Yes I _ No ~, ~~ Use other side for additional information. i __._~_____J_______i ~__ -_____._ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97} ~?~~ ~C 7 ~,s~" • Safety and $uildings Division City T S 201 W. Washington Ave., P.O. Box 7162 d ~ resin it~CO Madison, wI 53707 - ~ Site Address ~ ~ q ~ Department of Commerce o Sanitar Permit A lica ' ,~ y PP ,~ p ti ~ , ,~ ~ Pernut Number ~..~ ~~ q 3 ~- ~ In accord with Comm 83.21, Wis. Adm. Code, personal info you ~~,, ,^ ~lreck if R vision ma be used for seco ses Privac Law, s 1 m -- ~ I. Application Information -Please Print All Information ,o ~ 4i .~ 2a~'~ P 14Q y, ~d Stan' Plan I.D. Number ~,,,/ Property Owner's Name , Pareeo I ~nbe~~ p 3 " yG_ D oe ~ n ~ CS'~, ~' p ~ Z ~ .4' ~~, -, f Property Owner's Mailing Address ,/ ~. ~ .~ ~ ' perty Location ''. ~''` ~ ` ,~_. ~ !4 GJ'~; S Tat N. R City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number . ~ e ~^ 1~ ~1 II. Type of Building (check all that apply) ^Ciry ^ 1 or 2 Family Dwelling -Number of Bedrooms ~~ .p e it „o~S _4.La,~Prl ^Village ^ Public/Commercial -Describe Use ownship ~ ~ a d.~f/ ^ Stau ~~ Nearest Road o ~"~ s T III. Type'of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A i New 2 ^ Replacement System 3 ^ Replacemem of 6 ^ Addition w For County use sum Tank Orel Eris ' stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Dau Issued 1V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filur 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Singie Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recitcnlating 30 ^ Other V. D' lsal/Treatment Area Information: ,?2 ~ ~ e uJ! e v ~ f+ rn . r Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rau Sysem Elevation Final Grade ti El Required Proposed eva on Rate(Gals./Days/Sq.FtJ (Min./Inch) yJ`~® ~'~ 3 ~S~ 5~t~ / lQD. 30 l Z ~ , ~~3 . Prr ;f ~ ~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Siu Suel Fiber Plastic Concreu Constructed Glass Gallons Gallons of Tanks New Existing Tanks Tanks Septic or Holdi~ Tank _ ~ ~ ~ r~ s C Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tlon of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number ' j• ,n a~is'rY 79'9'D 715--3~'6' 3/.? ~ Plumber's Address (Street, City, Stau, Zip Code) VIII. Count /De artment Use On! Permit Fee (includes Groundwaur Sanita ry Dau Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved ~ g Surc a Fee ^ Owner Given Initial Adverse r Z Z '~ (~C .-! ~ ~ Deurmination . val sons for Disappro aURea v ores of Appro ti n d i IX. Co / / ~ / 7 / / / / / / /~ -` / ~ ~t-F (UPL~ ~lt~/ 70 ~e ~n5i`atl~ Quo ~6lin~QiH26 ~Oev in A{1L<'~ctG~L~rQr(5 rCGO/Mt,~l~~ Attach complete plain (to We County ody) [or the system on paper not less than gl/2 x 11 Inches In size SBD-6398 (R. OS/Ol) ~~t. N .~G r ~ /`~` P il/~~ ~ ~l ~` Ll~ ~n °a-CL ~' T /-{ . //S ~ ~J ~ ~ f/a-ss, l~ Q.,~J CL 8~ -~'c a.~ ~~, ~~ ~~~ ~q ~i_yp ~~~~~~~PpP. ~v~ ~~ ~ a.~/~ / n ~Q. N /.G i c l~ ~ ~/`~ ~ /9 ~ L~ ~n °~Q~LI/ ~ ~T r l(.J ~Dltl /~ ~~ L~/c~-h~ M~ O..fJGC _ n/ ~ ~ I 'Y 6~ S'Ca-~-e ~,r_4,4 / /h~ ~ " /ov. ~'~ ~p a.5 G Jc ,~ tG I~,7 t~l ~~ . V~ ~~ ~~ ~ d ° ~ a~ ~ ~' ~ ~~ ~ ~~ ~ a V' .-~ x J ~ a ~ o ~ n~ 8~ /D ~ .S~%/i1 ~i G wfiti ~.b~~ ,y~a0 ~~~yP ~` ~~~PP ov ~~ ~~ r' =,~Mroonetn ~ d ~ SbIL E,1/ALlIATION iZEPQRT ~ ~ '°~'~` ~, w~G~ e~, vt6s. aam. aid. Goaa~- c ~tlacle coee~ ails vNn an papa. not r~ ttiern a t2 x 77 - h arxs. Pam nneYt tpaludis, taut sat rae~e ~ vredcol and hoeloeorllar earreeener~r pone (eY}~ eAesr~fon and ~ l.u. pwoea~td~r~pewla o<~. gaew avow, aed Mleaeianeaddar~ea~etb neaeoetrood. P~Mi~A p'~ilt ~ ~1~fA11~- (/ ~ I~rrarrw i~IwarWMnw yow n~owM.ewe+~r~ aera~ooaM~f e+~va+•~ Qti~oot- t~ a tS.eK {t) pN1). -~. - J f~~c ,~ ~. ~ ~~. ` ~ ~ tic ,~w ~ra,vcv 1-4 s (o T .~ 4 N R ~ ~ E c Pyapeeb-~Owe~eeWwNing/rddeass r.,oc~ Ifrtod~~ s~ tYe+eeiarCt3l1~ fbl t ~ ~ 4~6 %/ ab- VlMrrp Town Meanest Roadl Xl Nuw~ llUle;ll~ NasideeM4d/1r1~af0a01~o~om6~; '! ,,,,,, ~:4olbaarwaoaeaynwowww ~ssu~ w_~r•,.,_ ~~• ~I~plpoamae~t ©lehebisorvonriol-deacetbe: Pla~eeetlelaleeial Flung Prop eiswe<oet ~ ~. beat eoenaeeegs S y S~crr~ ~ (eW'» ,'.,'c ~ ~~ sae ~4t.~, e 1 ~J. 96 •/a ,~~ ~ ~°'~ -c ~1 err ~'a~ ; ~. 2~1~-~ 1 ta~,r Fht cieoueasurotoaeeav ~r~.,,1~.V )L L~l O ~A~ ~'fi ~I ~ ~V Rti R~ Flwiaon Oegh Onraiewit fladox Qaac+~ieee Tadura Staee~ene Coeesreteeros ®oeawiary iiaols in. Meaeaed t]a. Se. Gant. Cetror C1r. ~ Sh 'E11p! E Z> ~ 1 ~. I ~ 2 r.._ ~ e~ mfr G5 ~ v ~ . 5 '~ . ~' ~ ` ~ ~ ~~ ~~-~ ~~ ~ ~ Praefean ~ ~ ~~ Ts~eo ~ eoeMaeey l~pols c ~. r~ae. cue. ~ ~ ~ ~ ~. ~. t ~ - o~ ~ ~ Eo ~ z -- s ~ i 2e~,G,ktk eY- cS I -, ~ . 5 ~ . $ .~ ~s , ~ ~3. G " FJpunnt ttii ~ t30a, ~ 90 { ?2D mdL and TSS a®p c 4 60 aeon. - ellirric~2 - ~ c 9o,miL one T5S c en ~.at_ cstr ~laene (I+te~q si~p~ei ~(~' 111nee~lee~ /~deesea ~1a E~kw4on taondudeid 'tlagwns tteanb~sr ` i owner ~ ~>D~ ~~ ~ l3ai~ * ~ pu c#iond ~Nfio9aiav ~:.~-~ ~' a t~ ~..~-.- TiodrNet a ~° tt tleiieon daaa~ ~~ t~edlwc Desk r~ ~ ~,. 8°'hg* ~~ t~vwndsw(icetal~w•,.~.__tt O°pN~bli~iyiaGfa'.°~ Ho~On papif Doainurr Rsdafx Desatp~- Tee ~ ~01~4- Rook in. eltts~ Der, 8a~. Osnt Qatar O< St Sh. •*'ta~ii~,,e„~t~-*N~18$~~1~A~- ~t~eD~t;i~.'ot~~<.'~ilf~t.~~'~.~~t• '1'x14 ~ Vf ~ em ~~ ~ ~d ~~ ~~ ~ t0 iQCtl®f SI;dM~40S or need egraeciad "er ~ sus lketnat. plae~e ~afaMad 1ba ~ fR 6Q6-~~151 oi' "1't'1f 6QSi,254ai'177. ~~~ j] ~ Q~ounde<^iree~~,.-&. birai~~g~~,_,..~..,,......~ 5aY Rate Runes C llaiRawt sR Re~rbc ~eorlte~ ©awi~lleiroe Boandrf- ter. tic. Sh ~1 l :~. tWeAeed Our. Sac Ggat ~a1Dr PAGE~OF 7~T A lurF ~,r~ ~2 LOT# `7 LEGAL DESCRIPTION .1~w ~.r~w 14 ,S l~ T Z~/ ,NAB„ ~~ E(or3~/ SCALE:1"= G,r~ BM 1 ELEVATION /ll~- ~ BM 1 DESCRIPTION ~~p a ~ ~ ~~~or~ ~ ~~ BM 2 ELEVATION JOo. 3 a BM 2 DESCRIPTION v ~ 3/~~-/ ('~,,,,~~/~-/k' SYSTEM ELEVATION ~%G ~/U ALTERNATE ELEVATION YG l~ CONTOUR ELEVATION ,,~~ ~~~%~ N x~ _~- s~ /6 ~ gs Z ~ $~( La' ~C ZZ I QQ~ P'" g-3 ~~ SIGNATURE '' i~~ DATE 2 - ~ 3 ' ~ sT CROOC covNTY SEFTIC TANK MAINT'~•N'~CP. A,GRgENIENT -AND 4WNERSHII' CERTIFICATION FARM ~~~ o~ 13~a tnporty ,~perty Spec r is in Uwe, the set ford stating 1 days of 4• s~ ~~ ~~~ T. ~o ~ ~ -• - ~~ ..... (Verification required from Flanning Department for new construction) -------- ~a,rri m on-~ ~-~-Parcel Identifccation Numbs;-r '/,, ~ '/,, Sec. 1~..-~ T--~-N"R~~' ~e~Su n S ~- ~ ~ Page # Volume Surrey Map # d # 0 f''~ Volume /?~~ ------~ Page # ,~ / 4" ~ Uctr Lot lines identifiable I,'~ yes d na ;,e p yes ~l1 no ~~~ *~ AIIVTENA-N G`E ~maturie failure to handle wastes. Proper niaintenaace nProper use and maixitenanceof your septic system could result in its p r What you put into the system. out the septic teak every three yeaLS or sooner, if needed by a licensed pumpe Pip ttc tank as a treatment sta in the waste disposal system. the function of the sep " ~ Dc artment a certification form, signed by the owner and by a 'he property owner agrees to submit to St. Croix. `Coning p that ~i) tlje on site wastewaterdisposal system unber.lo~cY~npluaabcr, resfirictcdplumber or a iicensedpumper Y~Y~ the septic tank is less than l13 full. of sludge. er oparatin8 condition and/or (2) after inspection and pumping (if n~s~}, to maintain the private sewage disposal system with Uxe standards undcrsigacd have read the above requsrcments and agree ens of Natural Resources, State of 'W iscansa~ ~~fi~Q herein, as set by the Departtncnt of Cona:merce and the Dep~d returned to the St. Croix County Zoning at your septic system has been maintained must be comp he three year expiration date. 1 ~~ DATE 'fJI~ pF F ICANI' GG~~C:~~~ ~ ~ ~ ~ ~O ~~ S / ~~sSoG ~~ ~ ~ , W ~ `J~~66 ~/ SG %/ o ~'~/mow, ~. R CER C oN ~~ v ~"~~~Q'Gr ~ s f S~ am are the owner(s) of I (we) certify that all statements on this terra are true to the besxt °~ a of Deeds Off~ec. I (we) ( ) ~crry described above. by vutue of a warranty deed recorded xn eg e ~ / a`l ~r 5',~~i2s~ ~t~SSo~ ~ DATE E)1? FLICANT g /~~,C/'e // ~~~~,//~ iJ.z' ,5 ~ ~ ~- *«*~*• C ~~'lQ~/ (~~~5~ -s~ Sv// t being revoked by the Zosuag Dop~ent. ,Amy information that is mis-represent may res t m e sanitary p~ ude with this Application: a starnpad warranty dead fro ~ fercfcrence isemade in the warranty decd a copy of the certiScd survey p Town o~ °t ~ ~_-= hot # _~_- ~- w Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Sail Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soli Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Ta61e 1 ~ Svstem Desian Specifications Sanity Permit Number Number of Bedrooms Desi n Flow -Peak ( pd) Sa Estimated Flow - Avery e ( pd} `~ Se tic Tank Capacity (gal) Ov Soil Absorption Com onent Size ( ) T pe of Wastewater Domestic Table 2: Soil Absorption Com onent - Llmlts of Reliable Operation Se tic Tank Component Soil Abso tian Component Desi n Flow -Peak ( pd) Maximum influent Partite Size (in) 1~8 Maximum GODS (m /L) 220 Maximum TSS {m !L) 150 Table 3: Maintenance SChedllle Se tic Tank Outlet Filter inspect and/or service once every 3 years Inspect once a year and clean at least once every 3 years Soil Absorption Com onent Ins ect once eve 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Scats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restroams}. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan fat a Septic Tank and Solt Aasorption Component ,_,~~ filter ie equipped with an alarm, the filter shall ce serviced if the alarm is activated continuaysly. intermittent fllt®r alarms may 1ndiCSte surge flows ~~e volum~ena~racc~mn~~d sl~dgerln t e tank septic tank shall have Its contents removed whe exceeds 1l3 the pquk! volume of the tank, if the oonierrts of the tank aro net removed at the time of an assbssment, maintenance pe hen maximal aldvlse t~edow ~~°~ 8 hccumu atlosn 1n halos reeds to be performed to maintain less tank. Manhaie risers, scce-ss risers and covers should be lnspecte~d for w>rter tightness and so~,ndness. Access openings used for OBNICA and a8a~me~n~t sflrh~ali~ sub e~ct to fsi1~ ~rst n the completion of service. Any opening deemed unsound, de be replaced. ,Exposed access openings greeter than 8-inches in diameter shall be secur8d by an s~ectlve lacking device to prevent acddental or unauthorized entry into the tank. No one should enter a sepflc a other treatment or holdtna stank far a»y »eaon w9tthout belny !n full canpllanas- with OSl~i4 abtn~atlre~r vuttottn~ a confined space, Tilt! irtnmmph+~ within tht trrat-t»nt of h~dtny tank may aontaJn Mth~tf gsr>so~ oatd roaaur of e patron >~ th* dnta'Jor of the bnlc may iii dlMloult or lnipe~tlible. Tank abandonment shall be in as;oordance with Hamm ~~.~~ ~s• Adm. Cade when t e tank is ono longer uusd as a P4WT8 component. The sell absorption component serving this stn,teture is designed to accept domestic wastewater from a residential facility. The limits of operation of thts component are shown ire Table 2. Thy longevity of a soi! absorption component depends greatly on proper and timely maintenance, and system use withdn or bek~w~ isltmai atIon of yvater~corn~serving pi~umbingr conservation preotices by all occupants and fixtures are key factors in extending the useful life of this aor»porten#. Tile soli absorption component's operation must be assessed by inspec~lon at least onra3 ®very throe years. The inspection shall include recording the levels of pending, if ar,y. in the observation pipes, and a visual inspection far any evidence of surface seepage or discharge from the c~mponant. 4n sts-epiy alapi ~~ dlgch$ a at domsst c wastewwater orbs®wage reported to the owner for repair. The su ro from the system is prohibited and considered a human health hazard, Traffic around or over the soli absorption component should be avoided p Feint 1~Y lead during winter months, The campectlon or removal of snow cover over the compo to hydraulic failure by freezing. This type of failure is usually temporary. but le dliflcuit or impossltale to repair un#ii weatt~e~ ndi enninta thevaoil land dispersal ~, iNhi homey wadi to component will educed axyg mare lntensef and earlier, organic clogging of the coll. 2 Management Plan for a Septic Tank and $oi{ Absorption Component Ptantings aE! deep-rocatted tress and shrubs directly o~or of within ten feet o~f the component should be avoided sings root intruaian into the component may obstruct westswtattar flow, Contingency Plan In the event of system failure, a new system could be installed in an aitsrrate area. With the instaiiatian of a diverter valve, the existing system could also be reused after a period of three to tour years. k is the property owners responsibility to maintain the alternate area free from arty planting of tree, ahnabs, a#c. In cas® of failure of the origlnail system, Ehe altemats area will be needed. It any tress, :hn,~s, etc. have bean planted an the alternate area, they wilt hsve to be rernavad at property ownan expense. If altemats area is demtroyed, there are other aitemative systems that Darr be used, in whiC~, quid result in eddod expense to the property owner. Any tank abandonment shell bs dens in accordance with Wisc. Cade 83.33. Arry questions regarding. this Dade, please con#act your ixai Zoning Office or contact the inataNing plumber. .~Gcs..v ~ rv `~ 't~~s ~c..e.. '1 t 5 ~ 3 g !o ~. t-f b8 Q ` r STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Dean C. Anderson and Kari L. Anderson, husband and wife, Grantor, and Bondi R. Henke Grantee. 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): ~os46, at of Pheasant Hills in the Town of Hammond, St. Croix County, TOGETHER WITH the right of ingress and egress as described in Vol. 1508, Page 443, Doc. No. 622543. 662058 KflTi-!LEEN H. WALSH kE6ISTEk OF DEEDS ST. Ckl]IX CO., WI RECEIVED FOk kECDkD i1-15-2001 9:30 AM NAkRRtiTY DEED EXEIiRT li CERT CORY FEE: CORY FEE: TRANSFER FEE: 94.50 kECORDING FEE: 11.00 PAGES: 1 Recording Area Name ano Retum Address KRISTINA OGIAND ATTORNEY AT LAW P,O. BOX 359 HUDSON, WI 54016 Ot8•t083.46 _ Parcel Identification Number (PIN) This is not _ homestead property. (is) (,kFald(1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~~~ day of November 2001 t_ • Dean C. And rson Try- _ • Kari L. Anderson AUTHENTICATION Signature(s) Dean C. A_ndorson and Kari L. Anderson, husband and wife, - authe otee6 ~a of November 20111 .,, t ;-•e- _ :~ S~'ATE BAR OF WISCONSIN ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. __._-_ County ) Personally came before me this _ day of _ _ ~. _ the above named to me known to he the person(s) who executed [he foregoing instrument and acknowledged the same. ~e•tiy p 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + _ Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 - My Commission is permanent. (If no[, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _.) Names of persons signing in any capacity must be typed or printed below their signature. mormatbn Prote.,bnai, comParry, c«,a a~ tae, v» STATE BAR OF WISCONSIN eao~ss-2o2t WARRANTY DEED FORMNo.2•I999 /, tftSL JW, r i . DRA ~N~.G,~~^, ~ r> ~` 9 ~?$•833' `9 - 3 r ~ '' 7 i, i, ;~ AREA ~ r rn ~ tD ti N ~ N o N ,.p, cn ~ o w o O ~G~(m /~\ cn " ' \ - LOT 46 0 ~ 3.71 ACRES ~ --- W 161, 485 S0. FT. ,' U - ,. CT ~' ~ W N --- - ~ N w .p .p '~ EX I SAT~1 !N(G 66' W 1 DE I °~ ~ VOL /~v~ PAGE ~ ` ~ 631.67' • 58, _- 5g -- 3 - . -- W __ - 4 I ~~ - -- ~- 79o g - _ - - - - - _ - - 0~ - _ - S -_- ---__---- -- -- - -~ 30' -DRA 1 NI - ~ v~ LOT 39 3. 10 ACRES 135, 025 S0. F T. 5 19. 68, 582° 10' p6" W LOT 38 2. 6 7 ACRES 1 16, 215 S0. FT. . 414. 19~ S84° 3~' 47 W ® ~ 319.68' ~ SEE 01 ' 37" W 664. 68' LOT 37 .EA.S... MEN.T ~ ~ ~ ----- ----T-----~ CER.T,I.F.I.ED. ------t------------- -- -- Nw_Nw SW-NW ~ SHEET, f ..VOL . 14_ .... ; ..~.~T...~ ~ SURVEY ~ - ~ ~ ' ED ; LOT 36 ..... ~ ~ ; .PAGE.....3.783 MAP Q t ~ S89° 36' 01 " E 2644 72' (TO NE C _ , . G ~~ . OR. PLAT ) DEDICATED TO THE PUBLIC Q - 248 - 34' I . ~ ----- --------- - =-------- 281.34'----------- ' ° " --- 348 n ; 2 ~V89 55 16 E 87T.88 , ~ T v , a Q I~~ ~ ~ , ; ~ , SE :.......... TBACK o ... ........ L 1 NE "' , • LOT 43 ~ : ~ OT 42 . ..... .............. L OT c 2.2s aCRES o ~ `" ~ 98, 449 SO. FT, 2. 57 ACRES a ~ ~' 2 99 ( 112, 138 SD. FT. . I -, ~ ~ ro 130, 312 I '' ;~ ~ ~ w: - -. ~ ~ m ~ 1~ ;i ~ I '~ ;, ~ m : ~ - I 6 64 ' i ' : n ~ S. I , ~ :~ ~ " `~ s ~ .... . ........................ a ...... o o~ , 249.06' 282.07' _ ' g 33' 33' , ............ . ....... .... ..... _ ..... g •, ~ ~ " c S89 36 O1 E 531. 13 ................................. I ~ + , I Z ~ ~ , ~ ~. ~ HIGH WAT 1 ELEV - 044 ODr~f O , . . ~ , ® Z cn ' ~ w , c a, . I o ~ LOT _ _ 44 ~ 1 ' W I ~ ~ ~ ~ ' ~ w _ 4. 54 ACRES ~ N ~' ~, 197, 882 S0. FT. : ro ' I ~ ~ - ~ ! oo~ ORA 1 NAGE c° ~ v_ . ' • I 1 1 ~ , , N _ ~ 1 ~ , , /~ W ~~.~~ iI ~_~ .~~-. ` I ' --r I g.. 1g T3. 50' j ` ~~ 33. 3 ----. -- _ -- , . !4 - . o~ w ~ , , 66 . S . -N' ~ - _ _ . ~ ~ : ~ ~ ,~ '. ~, '. cn ( ~ ~ . cr co co ' ~ , : o '.a ~.t~ w : o ~. ~ . O~ I ' ' ~ ' QS, ~~•' AREA m~~. '.w :o ~ 1 r :m ' ~ ~ T .. ~ . ,. + ~ ' ~ ;; < s ~ LOT 46 ~. ........•._~.......... i x~ . < I ~. 3. 71 ACRES ..... ~. . > ~'; ~~ 161, 485 SO. FT. U: iscons~ Department of Commerce PRIVATE SEWAGE SYSTEM .iafety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal informatiori you provice may be used for secondary purposes [Privacy Law,~.15.04 {t)(m)1. P/~f4tf~~~fl`t; n ^ city ^ vNl~~doleh~'bwnsh ~ CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP! SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift friction System TDH Ft Forcemain Length Dld. ti Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark Bldg. Sewer St / Ht Inlet St / Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System ~~~i~ BED /TRENCH Width Length No. Ot Trenches PIT No. Of Pits Inside Dia_ Liquid Depth IMEN I D!M N I SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu adurer: SETBACK INFORMATION TypeO CHAMBER Mo a Number: System: OR UNIT DISTRIBUTION SYSTEM ~ Header /Manifold Distribution Pipes} x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only - Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed I Trench Center Bed I Trench Edges Topsoil InS eCt10 #'~ Yes f ^/NO In e'atYen #~ No ~MMENTS: (Include code discrepancies, persons present, etc.) Location: 975 170th Street, Hammond, WI 54015 (NW 114 NW 114 16 T29N R17W) - 162917618 Hills -Lot 46 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision required? ^ Yes ^ No Use other side for additions[ information. SBD-6710 (R.3/97) Date Inspector's Signature ~`~ 9 3 $~ T.L. Sinz Plumbing Inc. 'i1 \ ~~ ~v ass ~ E5609 708th Ave. Menomonie, WI 54751 ~,~ ~ ~ ~. P~©r ~~~ 1 ~ to ~ ~ ~ ~t-~A-~.~ ,- ~,, t ~ S Phone: (715) 235-2644 Fax: (715) 235-2592 / "yo 'D 1 " % ~" Rr~ l = ~°~ f1, you' ~~ ~d~r~~ ,~ ~~s~~~~ ~ i,~sf~~l 2- ,~0 ~,7.X G8' ~~FTv% Sr~~ ~,(, c~P ~~ cwt T.L. Sinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 ~~ ~~'~ ~'D' `I '_ ___ -----~' gW~ ~ ~ ~U~ ~~ ~ ~ ~. Pia r ~~~ Nw N~ ~~ a~ ~~ w ~~``~~~ ie.y„~ o ,, ~ /vv Phone: (715) 235-2644 Fax: (715) 235-2592 ~'' ~o ~~s~~~~ ~ /Nsf~-~~ Z. ,~o ?,~, X Gg. ~~~tU% Sr~``r ~,H c ~P f, a~ C/ ~~~ ~ (f~'' 9~,/O f T.L. Sinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 Phone: (715) 235-2644 Fax: (715) 235-2592 .~ ~_ :~~, ~~ ~~s :~ ~, ,~ a_ „s<<s' .:*~• T.L. Sinz Plumbing Inc. ~~~ ~~~ ~ E5609 708th Ave. Menomonie, WI 54'751 ,Y ~~ ~ ~ ~. Pie r ;~c~ ~ uw~ ~~- ~~~wt~~~. Phone: (715) 235-2644 Fax: ('715) 235-2592 ~ ~~ ~o 1 'r ' `~~ ~ ~Wr ~ ~ /~0 , ~~`W~T /d0%°~~ ~,or/~ .emu 7 ~~ 1 f 3~ (~~ ~,~sf~-~~ 2- ~, X ~8.~ S ~~ S~~ B ~~ ',1F- QtN' ~~~ ~, q~,/o ,~ f ~! C QCA - ED / N THE NE t i4 aF THE N;rY E ~4, SE ~ •~~ JF THE N~lI ~ r4 AND PART ~JF THE ~W l r4 OF THE NON 1 f4, AND PART OF THE ~,/ ! ,~~ CAF THE N'NI ! ~'~, A~ L 1 N SEA T 101'J i. 29N. , R. 1 ?1t~Y. TC.?WN 4F HAMNi4ND, 5 T. ~'RC~ t X CQtINT Y, W I SCDNS Jt~t ,dadsr#! A9iCMUE N ~ 1 ~~ T i>r!S ,..-.~r ~ yc., L ~ 8 G s ~~~ ,~-.~ ~~ ~~ '' ~, f °~ ' mr n ,s N, ~. ~ ~ ~~~ d ti 'V` ~~~~ 1 v j o i ~ 1 1 '-------- k --------- i !' ! ~ } +t n Y -~ !. sr. ' } ~ j earl! t' 1ACATt~dr Sdtf1C>! MCl,Oie ,i. !. tM.. a, r fR , #cwr ar w~+ro`i d Ip# tp 2ICKf 1 ur~L. ~~Y ~>Q JrC ~~i THE r~, xQ d=a f a`a 9ua +: tt CA3t fS 1tRE t*1 9E P~ £C£: StFC>+ TxAT ~-*f 1HSFPLLA7dCM1 aa1tD p1SiUR8 INY SdJRVEY STititF. GN ~,9S7R;1Ci Yd$s,rfY <:.tS~G ANY Ld3t t tttE pi SfR£E7 t d/if. Tts£ AtSi4a8jMGf {~' A SL°RYEY STAKf 8Y AAtY~ t5 A Yd~t..~-:..~ 7i' eFG11d7N Y,S6.>Y tlf drtSC7kSdM SiATI-TES, ui?t/iY f~Q{iE'N~SJ;atr{?fs'Y S£ T f OR -1e Aa£ ? t~do rt# uSf of ¢uDZ . C 9aQ r F S And ++AY:NG iH{ RtG!+- i0 SEAYf if? ,tREA. -- ..... 4 -- _. LEGEkO f fcxrxv r' Saar PIPE O Sf i t' X34J' t dtt,Y1 P rPd: 1M£ t„1! t iG 3.6~ Ltrs. PER t rkE.tR i:?Qi NO if: S£i t'z2~' 1RpN PtPE uEt,',#ldrpG t. t3 tBS. °ER L thF.sR f+JQi Ai At! Ot++Ea tOT tGfdNE~S • uidctrr EASE~ExT t iYP. a ___~__ • Sf T9aixS ~ ~a r tir to r i (JCA i d a+ts SEE ~''~~~~~~`~' _ ~ ~. ~ yy, `,~~ h4 ~'S (5#FIC!'s ~t~x)c c~o~w-~. y~ ~trcw.aJ for *a#xsd mud -~ ~It ~~ ~-a~Q~ .__.t3~ ~` - ~ ~~~~~ \. '~vV r1< r ~~`/ ~_ ~~ r ~+~ ~ti ..1^..A ~ ~ ~ ~~ ~~ A K rn ~ f. f~ ~ \ '}~ h ~! ~"~----_'- ~~ A , ti ~ . r 1OSO ~ ~. Q ~ -.,, _ ,~~ r~ i ~~ ~ `~ ~_, i I l~ ~ i ;','~' ~~ ~ . / r(~' ~ X i -T'~1 J __ -~- a . ~~ ~; :FX~ ~i' ` w ` . ~'~t I ~.: \\ l v ~ *" .66 'S£9Z ~ ~' ~ , R r~. l _ Y :~ r1 _ _ _ .~.... +~ _ , v ~~ ~ o x r, C ~, ~; ~ .,' t~ i rn -~. p N r ~~ <• ~"., , ~ . .~ ~~ ~ ~. , '~ ~(~~ '1 ~~~ ~S ,,:. Nom` ' t ~D ~. a ~ .~_ x I '~. , ~.~. t .. .. ry.z ~ ~ .. ~ ~~ .' # _ . ., K' `t W ct 4. all,,, ~~ :. 1 ~ a ~ ~ ~ ~/~/ ,. 4.} .Z . Z i f t ~ . , .~ •~ ~ ~ yv ~ . l .~ e ~ _ ~7. y , i. 1 : oo ~~ :ro « '~ W c ,,,a..~~ w , K . nom' ~ T 0 ((~~ \~ A r/ V1 w V. ~. • W 1 0 r C C ~ ,! • 1 ~ ~ I ~ r ~' .fit -vl n _ :~ _ ~ ~. ~ _ N '' V ` i 7 ' . ~~-- ~~ ;' a _. loco .° ,~~~~ SOIL EVALUATION REPORT C~i' n of Safety atxl BuOd~ ~ ~ C ~_ vim. Adrn. Code county Attach sibs ~n ~ P~ rwt lase than 812 x 11 inures 'size. Plan mend Parcel LD. indude, but not IKrlited to: vertical and hodzorrtai refererroe p~ (~. percent stops, sr~ a moons, north arrow, and~;,arM distauioeto nearest road. L.aw s 1b.04 (1) (m)). Ivy Personal information you provide ~Y be used for secondary Q ~ P~`X ~._ Location Pace 1 ~~ C ro Date ~~ Property Owner ~ G~ ~ ~ S~ G ~-~l~`G~. ~ N~n~ 1l4 NW 114 S ~ (o T ~ q N R / ~- E I\bn ~n ~ ~ tot# B~dc# Subd. Name or CSMI~ propery owners Malting Address C I ~ ~ ~ ~5 ~ ~r'~ >~hea //s ~ JI' ~ b I ~ code ~ ~ ~ Village ®T~ NeareM Road l-4grnm yU) 5`fU~S 0115) 1 - Z`to r'~mmo - ® Ntely Construction t1se: ® i't~iden~ - Ntsnber of bedroolrw 3 - ~,/ Code derived design tlaw rate ySd / Cc Q O GPD ^ RePt ^ PltbGc or aomr~taal - ~ Flood Pain elevation if ti/G~ ft. Parent ma»i General oommerfts S y $f c n-'~ a (t° v: G/~ • ~ and recommendations: `4 L~. t° (e. ~. `l~ ~ ~ ~ . B ~ © Ground ~rfaoe ele+-.1.~a_ fi- tO -~- in. t ~~ # ®PI Sod Rabe f-ee C Boundary Roots Hor¢ar Depth in. Dominant Mtfnseil Redmc Deeaiption Qu. St. Corp Color Texture Stnxdure Gr. Sz. Sh. ort r 'Eil'+y1 'Efi#2 Z 3 D-IZ- -2-~2• 2-Ilb' la. ~3~2 ~p ~+~~} I 8~2 -' -" J' 5'l~ Sc.l ~'S Z 2mc• k OS m~r m ~'~' f ~S cs (V i• - ~ . ~ . `~ .~ • ~ ~ • (v I.2 ,b .so. y ~~ ~ ' Z ~ Q Pit Ground surface elev. IOCJ• 3d ft. ~# in. i b Grr>iting factor 12D soa Rate Structure Cor~enee Boundary Roots GP I Horizon Depth Dori~nE Redox Descxy~iorf Texture 'Eft#t 'Etfli?2 in. Mansell Qu. 5z. Cont. Cobr Gr. Sz Sh. $ ~ I o-Ih• Io r3)Z --, 5.1 2mGbk m eS (v~ . 5 • 2 I!o-ti$• ~ `-114 Sc.l 2 mabk ~r c - . 'y . (, ,.~ 3 _ NB-12o 8~2 mS ~s i _ . ~ ! . 2 v so• ~~~.~y y p~ > <ryy~ andTSS>3Q<150mg11. iGV rrtglt GIIYO~K 1tr1 ~ R/V ~ ~-mss`-~~~~ `-~~' ~ CST Name Pent) Slgnatrfr@ _ ~ NIdlrlbef ~y 'r Date Evaluation Conducted e r m b wrle Nu Telep i Address n r i 7 n.. T1, G1 e .......,y,.. ,..1 ! . ~~ .'`1Z-I/1'~`~ ~-/~ c'~~ J ~ ~ 7 / ~ /~ l,I~ c~~L~ 1'~-tl..lJ 3•^~ ~~. ~ Patael !D # ~ ~ ~ ~- ~ ' ^ Borsr9 ~9 ~ ®Pit C~ound srxfaoe Nev. ~ft- D~ to ~~ far~or ~ ~ in. ~ i2ate Horizon Depth Doniat~t Redoot °^ Texture Conlirelenoe tZoo~ "E7~1 'E~2 in. MunsNl tlu. Sz. Cont. Cdor (~r. Sz Sh. ~ b-2b l~ ~~2 `- i ~ ZMC~.b m~rr G5 ~ v~ ' y . ~ ~ 2 - u ~ t0 `'(ly `_' sal b ~r c5 - - m s ~ s 1 - -1 l. 2 3 4 -1 Ig ll~ yr $ ~ 2- TG% SO• ~~~ # ^ Pit ~. ~ ~ in. ~~ Ra a ° Horizon Depth Dominant Redox Description Texltre Shuchrne Come ~~' Rooffi GPt7fl~ Gr. Sz. Sh. "Eit#1 'EfF/t•2 in. MtNrseri (lu. Sz. Cont. Cobr a ~9 ~ ^ ~e Ground surface Nev. R Depttr to rrmiGn9 faci~ur ~n- ^ Pit Horizon ~ Dominant Redooc Desaiption Texhee Strudur~e Con~enoe 8oundatJ- Roots in. Mansell Glu. Sz. Cont. Odor Gr. Sz. Sh. Sal •Etf~'1 I "EtT#2 • EtlareM ~1=8005 > 30 < 220 mglL and TSS >30 < 150 mglL ` EflWeM ~2 =13OL1s 530 mglL and TSS <_ 30 mgll. The Department of Commerce is an egcel opparhmih- sernce proavder and employer. If you need assistance to access services or need material in an alb~te format, pleax contact the departrnart at 608-266-3151 or TTY 608-264-8777. seo~a;3ocR.o~ao- ., { . PAGE .3 OF ~ NAME ~ +~ t t LOT# y~ LEGAL DESCRIPTION N w '/4kw`/4 S !G TL 9 ,N,R / ~- E (or~ SCALE: I"= r ® r BM i ELEVATION /Gb • O BM I DESCRIPTION ~P Q-~ ~ ~-~'~0 ~ p~'Pe BM 2 ELEVATION /!SO. 30 BM 2 DESCRIPTION •% p a.~ 3/y CeDDe ~ ~~ D 2 SYSTEM ELEVATION ~ ~ • / O ALTERNATE ELEVATION Qb • /U CONTOUR ELEVATION yl U S~6 P e l3fz ~ .~' n~ ,~ T ~ ~ na 5~6 v~ g„, ~--~ ~ --- J B-3 &'~ ~ I _ ~ _ ' s ~ ~ /C~ ,~, Wis~~nsin Department of Commerce OR~G1~.L AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings In accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/ x T 1 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix ercent slo scale or dimemsions e north arrow to nearest road rtd'io`catron'and di tanc p p , . , , a . s e APPLICANT INFORMATION - P/ease print all informat~ n . , Personal information you provide may be used fdrsecondary urpe~a (Privacy Law, sat5.oa (~) (mp. ' ~` ~ ° ' ~ a By _.__._ Date ~ ~~ : i ' - Property Owner ~ operty Location Bonte Ron ~ .. Lot NW 1/4 NW 1/4 S 16 T 29 N R 17 W Govt , ~ t ~ M ,p,.. . Property Owner's Mailing Address '. ~~ of # Block # Subd. Name or CSM# 101 1 170th St. '~'F'"''~° 46 Pheasant Hills ,R. ~ \ City State zz Code ~rerr~tt;i= . `` City ^ Village ®Town Nearest Road 0Th Hammond WI 5 015 715-796-524x. St. ammond 17 ~~ New Construction ~ Resid~eh#+all'Ntmb ~ edrooms 3 ^Addition to existing building , Use: Repiacement '~_ I Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpolftz •5 trench, gpolftz Absorption area required 1125 bed, ftz 900 trench, ftz Maximum design loading rate •5 bed, gpolftz •6 trench, gpolftz Recommended infiltration surface elevation(s) t8" below contours ft (as referred to site plan benchmar Additional design /site considerations install 2 - 5' x 90' shallow, pressure-distributed, trenches on contours for 3 br Parent material tits Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ ®U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S X' U ~7VIL UC~VRIr11VIV RCrVRI Boring# 1 Ground elev 105.0 ft Depth to limiting factor 54" . 2 Ground elev 106.6 ft Depth to limiting factor > 65"' Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed (Trench 1 0-5 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-24 7.SYR 2.5/1 - sl 2 m sbk mvfr gs if .5 .6 3 24-31. 7.SYR 4/3 - sl 2 m sbk mvfr gs - .5 .6 4 31-54• 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 5 54-71, 7.SYR 4/4 fif 7.SYR 5/8-5/3 sl 1 m-c sbk mfr - - .4 .5 Remarks: 1 0-4. 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-19 • 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gs If .5 .6 3 19-56• 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 4 56-59 7.SYR 3/4 - is 0 sg ml cs - .7 .8 5 59-65 • I OYR 4/6 - s 0 sg ml - - .7 .8 ;ST Name (Please Print) Signature: ~ Telephone No. Henry F. Grote 715-665-2681 address ertt to of esttng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 415/2000 222774 1057 Remarks: ~~,,,~ ~, a cuu cspcciaiiy nunzun ~ tie (~~ ,~ S ,S PROPERTY OWNER: Bonte, tton SOIL DESCRIPTION REPORT >~ ~ page 2 0~ 3 PARCEL LD.# - :+~ ". ~ Certified Soil ~sfiii~,.,, 3 Ground elev 104.6 ft Depth to limiting factor > 65" - 4 Ground elev 106.6 ft Depth to limiting factor > Fn", 5 Ground elev 104.4 ft Depth to limiting factor > ~n" - Horizon Depth in Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDIft2 Bed Trench 1 0-5 • 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .S .6 2 5-21 • 7.SYR 2.5/1 - sl 2 f sbk mvfr cs 1 f .5 ~ .6 3 21-33- 7.SYR 4/3 - sl 2 m sbk mvfr gs - .5 .6 4 33-46 • 7.SYR 4/4 - sl 2 m sbk mvfr gs - .5 .6 5 46-58 • 7.SYR 4/4 - sl 1 c abk mvfr gs - .4 .5 6 58-65 • 7.SYR 4/4 - sl 0 m mvfr - - .3 .4 Remarks: 1 0-3 , 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 3-15 7.SYR 2.5/1 - sl 2 m sbk mvfr gs if .5 .6 3 15-29• 7.SYR 4/3 - sl 2 m sbk mvfr gw if .5 6 4 29-39- 7.SYR 4i4 - sl 2 m sbk mvfr cw 1 f .5 ~ .6 5 39-60 - 1 OYR 4/6 - Is/lmcos 0 sg dl - - .7 .8 i i Kemarks: „~„L.,,, ~ „~ s, ~..,~~ 1 0-4 - 7.SYR 2.5/1 - sl 2 m gr mvfr cs 1 f .5 .6 2 4-21 _ 7.SYR 2.5/1 - sl 2 m sbk mvfr cs 1 f .5 .6 3 21-29 7.SYR 4/3 - sl 2 m sbk mvfr gs If .5 .6 4 29-46 . 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 5 46-70 7.SYR 4/4 - is 1 m sbk ds - - ,7 .8 f~emarks: Ground elev Depth to limiting factor `"~ ~ ~ ~ -~ s nn ( Nw tyw•tb•ta-~~w ]7 {7 ~„~ N C~~111 ZZZ.Z"i+~ T~~~ ~ ~~ 4ww w10~+~ l ~ L ~ I " _ ~ ~, J ~L ~ ~ 7 J is O ~ C4 ~~~~~ 44~ s~' \c ~~4.. t7 _ ~'3 ~_ tia ~~ C1 or,o) r ~,~~~ `~~'~ h-z Ci n ~ .b) ~1 0~ 4c~ t~ 13 r{ QQ Q.~, w,. ~ 9 (40 ~ 4to Q o ~ a t~ i ~. cry. `~ o-o.o~ i v .y,,. ~lY~ .g ~~ b~c\ch.Oe ~,:~••~ a. ~~.~ow:J a1Gt~,. 1 ~3-Y' ~-o4.4Y __~ r yo b {; ~ !~ -3 -4 3~g.~g V V 1 --~ . _ ...~ ..... ...... .. ~..Ma~YMU.w r~„~N IACKING~COVfiR --1 Lt/A~N iNG ~ ABED . GvIcK D~«VtCT---~ r ^-~R 1 a.,, ----~ :y Pvc ~..~, ~% ~'~ PIP6 3' ~ NpISTuR6ED Soles w . 6~~ ~ > ~~ ~, .~. ~,. .rig;';' ,r .;I~~ P'1AK1101lc .., WEATHERPROOF ~,~Nr,T10N Sax 12' P.s~ I ~, 4" 4 0 _ YENT~ u' h: --- 2;~y /.MLf T AVTL~ I - - ~~wL:~ a ~~ ~ Nv~ a„ Q~ QP~KOvLD. _ 1•.~+ P1-4 a AL 3' o-Ro E (.T I o r+S ~- w^/ ~ K ~ .~, ~ ' 1 V•Q -fir-- ON - ~ c~ o CAF • Pw~IP L Co~F,r~ , ,~~. 6toCK SEPTIC f ~ r _SPEGIFI•CATIOIJ$ 0SE w, ~'b-cK ti ~ "AU..S MA~IUFAGTURER. (JUMDER OF pOSCS: `~'~~ PEK 0~.~ TA~.JK SIZE : ~ ~~ ~ V~ G1,LLOUS • .DOSE VOLUME .LAK11 /1/VIUFACTURCR: S `~ ~7I `<-i~Y~ IIJCLUOIIJG RACK/GOW: ~~ L ~ DA~~ONS noOCL Uu{~4>bCR: • 1 ° I ~• ``' CAPACITIES; A = a~'~ WCNCS OK ~~~~ W~t_0~ 5 SWITCH TyPCI ~'r`~'` wpb ~~ 8 ° a I-JCHES Oa ~~~ GAC~O~;S UMP MAAJUFACTURCR: - I~ ~''"" """' ~~ S 77,~ C • ?' wCMES OK G~~~ou5 MOOED -JUMDCR; S ~ Lr'(= ~ ~ y ~~ JwITCN TaPC: ~MQ..~••wv .,, 1JOTE: PUMP AUO ALARM ARC TO OL MIAJIMUM pI5CM/1RGE RATE ,_ 3~_~~M INST~LLEO 01J SEPARATC CIkC~~T~ CRTICAt_ DIffERCA1CC DETWCCU PUMP OiI AUO OIJTRIDUTIOAJ PIPE.. _._I~ FECT - /,IulnuM uETWORK SUPPUy PREtLURE .,~~ FE,CT • - •~v i'CET OF PORCC MAIIJ X d'•Sg' ,,~/ ~ ~----/IporciRlCTIOU FACTOt;._ I' FEET ~ G TOTAL Dy1JAMIG HEAP FEET Q ~ TER-JAI. DIMEIJ610/JG Of TAIJK: LE1J(,TN +._,_ -'r 4 2 ;WIDTH ,LIQUID DEPTH 1 A 1... ~ __ V t~ •- ,. Details Pump Characteristics Performance Data Pump/Motor Unit Submersible Automatic Model SHEF30A1 Horsepower, ~~'• .30 Full Load Amps 8.0 Motor Type Shaded Pole (4 pole) R.P.M. r 1550 Phase 0 1 Voltage 115 Hertz 60 • Temperature 120°f Ambient NEMA Design A Insulation Qass A Discharge Size 1-1/2" NPT (38mm) t q ;' a.« ,,.y..,.~~.. - - ,~q cs .e ' ,:is 'tan .~alk~a; ical ' ':>nl e u~ ~.. ` ' e~eorlag.. , -M~-----*-•-•-- u. ~ ~ydk $a9rii~ $„> s . „~ I t t'%3/8 !:sbt) PSM °~ ;~; ~ ff ~ j i ~ _.-~ r_~ dlme~5ons r ~y vC ~ - measlekls anc weirw ai, , Pentai~.P~mp,.Gata-up ' 640 ESartey Rc.~; t ~:~land, ~h ~ ,• 'j -`lNN:'.h ~ !'. ~... ~ y 91.x) Cti,7e r'C:t? w...R~.._....~_.....~.~..... .. ~~:.~.._..._.... ~,.,..~r~yy ~ ~. ...e......aa.~..,a, .a,s.....m..,r~.~,...,Na....~.~.,~.e~e.~,,.~es....._. R Item 0: W-fM-s35Q 1O(9J RM ~ . 9 30 ~:a:, s ~ 20 0 3 ~ 10 0 0 (opaity-U.S. G.P.M. 0 10 I 20 30 F 10 50 i ~ i lAers/kcond 0 I 2 3 Dimensional Data .. ~ i Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity ln-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 Number of Bedrooms Design Flow -Peak (gpd) S ~ Estimated Flow -Average (gpd) fe-~-- Septic Tank Capacity (gal) p~~ Soil Absorption Component Size (ftZ) Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Com Went .Design Flow -Peak (gpd) csU'0 _';.~_~ 2 Maximum Influent Particle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the s tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure proper o e~ ratios. The filter cartridge shou not a removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere wifhin the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the inferior of the tank maybe difficult or impossible, Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits 'of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing. fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. in general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 Ov~merBuyer ~U Meiling Address Proporty Address sT cROZx Coc~N~ SEPTIC TANK MAIN1'BNANCE AGREEMBNT AND OWNERSHIP CBRT`IP'ICATION FORM -Otl i7©~~ S~ a {Verification required from Planning Department for new constriectioa} " Ci /State ~ ~`~ Y~^ y~ ~ ~ ~~- Parcel Identification Number ©I g ._ ~ Q ~ 3 ~ ~ ~O -O~Q ~ ~rrwY DE-~SCRIPTIQN ~~ ~' ~ / ~. Property Location N ~ '/,, f - w '/•, Sec. l to . T ~ N-R~,w, Town of ~ • on P ~ e~~ Y`~ f `t' r ~ ~ S Lot # ~ . SuLiivtsi // (, O ~ C,ertlfYed Snrvey Map # cp v~ ~ Jl' y 7 .Volume Page # -~---C-~--' Watz'anty Deed # --_ ----, Volume ,Page # Spot house ^ yes"~ no Lot lines identifiable ~ yes ^ no ~,operuae nerd mainbenanceof your septic systemcould resalt in its permature failure to handlewastcs. Proper m coosb~ts of pig out flee septic tank every three years or sooaex, if needed by a licensed p What yon put into the system due a ~ fuactime of @ee septic task as a brcatment stage is ~ waste disp~al system. The property owner agrees to aiebmit to S't. Croix Zoning D a certification form, signed by the ownex and by a ,ymanglumber, r~ict+edplumber ~ a liceosod v~Y~ that (1) ~ oa~ite wastewatadisposal system is in peapperr operating co®ditiae arullor (2) after inspecriaat and gimaping (if Y~ ~ tank is less than 113 hell of shedge. gyp, ~ mod have rCad the above n~ and ague to maintain the Private sewages diaposatl system with the standards net f~aath, herein. as act by flee Dgeartm~ of and the ~ of Natural Resovnnes, State of Wisconsin, Certification em less been maintained must be oompletod and returned to the St. Croix Cotmty Zoning Office within 34 stati,~ mat y~er a~i~ of the throe year expiration te. SLCiNATURB OF APPLICANT DATE nwntrru t''R`R1`TFiCATI4N I (we) ~Y that all statements on this fora are true to the best of my (our) Imowtedge. I (we) am (are} the owam{s) of the prceperty dcscn'bed abr~ove, by virtue of a warranty deed recordod in Register of Dodds Offix. SFC#ATATtJRE OF APPLICANT DATE ~ s«ss~« ssssss ~„y information that is mis-rcpresentod may rosult is the sanitary pecaut 1xm8 z+evoked by the Zoning Dcparbmea ~ ~ ~ ~ ss Include rPlth th[s application: a statca~od warranty flood fi+om the Register' of Dedds office a copy of the certified survey map if referzace is made in the warranty deed ~~i1.15f11PAt;E372 620963 KATHLEEN H. WALSH kEGISTEk OF DEEDS WI 5T. CkOIX CO. , RECEIVED FDR RECORD Dine M. 8onte, as Trustee and Ronald C. Bonte, first alternative 04-10-2000 10:30 AM Trustee of the Karl M. Ulferts and Katharina G. Ulferts Family Trust, for a valuable consideration conveys without warranty to TRUSTEES DEED EXEnPi M Ronald C. Bonte and Dine M. Bonte, husband and wife, Grantee, CERT COPY FEE: the following described real estate in 5t. Croix County, State of COY FEE: Wisconsin: TRANSFER FEE: 240.00 RECORDING FEE: 10.00 PAGES: 7 Name and Return Atltln Thomas A. McCormack 1020 10"' Ave. Baldwin, WI 54002 018-1034-60, -70 (Parcel Identification Number) The North Half of the Northwest Quarter (N '/= of NW '/,) of Section Sixteen (16), Township Twenty-nine (29) North, Range Seventeen (17) West. Dated this 24thday of March , 2000. AUTHENTICATION Signature(s) authenticated this _ day of signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) ~. c~,.. • a. J THIS INSTRUMENT WAS DR,I~Q.-B~ ~ - Thomas A. McCor < ~ ' = Baldwin, WI 54 1" ~ ~ + : '' ~~ ~ O ~ ~ ~,~0 ~..'`~ . Q f ,fit ,.~ "Dine M. Bonte Trustee `Ronald C. Bonte Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 24t-may of t`~'~h 2000 the above named Dine M. Bonte, Trustee and Ronald C. Bonte, as first alternative Trustee of Karl M. Ulferts and Katharina G. Ulferts Family Trust, to me known to be the person(s) who executed the foregoing instrument and acknowledge thg same. signature type or print name Dale I~ Jensen Notary Public St. Croix County, Wisconsin. Myol m~is~ign is permanent. (N not, state expiration date: UU..ii ) 'Names of persons signing in any capacNy should be typed or printed below Iheir signatures. IMOrma6on Prdesslonale Cartpany FonU dV lac. Wi1Can9in 800-655-