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(D N W O O O CL W m q 7 W O O O b cn (D A 0 yS ii ' O O N ( O O O 0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515182 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village X Township Parcel Tax No: Wells Faro Bank NA, foreclosure I Hammond, Town of 018 - 1094 -22 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 �0 U- ,` c' STd �. � , .gS 17.29.17.762 TANK INFORMATION EL VATION DATA TYPE �MANA TIJ�R�Fj , CAPAC_ _ ITY/ STATION BS HI FS ELEV. Septic s, �j � �,(c� �,��• enchmark Dosing Alt. B 2 Aeration V Bldg. Se r/ Holding St/Ht INBt St/Ht Outlet TANK SETBACK INFORMATION V6 //. 07 TANK TO P/L W BLDG. Vent to Air Intake ROAD Dt Inlet S,tic ✓,: f : t ; �/ �, �•- Dt Bottom � �� M �J� d y�o - l t - Y' - Dosil4g ^,; ' Header /Man. fp $ S Aeration Dist. Pipe vt o ows ae , Holding Bot. System �� Fina Grade PUMP /SIPHON INFORMATION Manufacturer - v ema d er ,� I ( GPM ? v V ST• Model Number 3 /, L �/U ` C i ` t / 00, TDH Lift Friction Loss System Head T Ft J /� Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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/Trench Center Bed/Trench Edges Topsoil E] Yes ❑ No I D Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�/ / V Inspection #2: Location: 1687 99th Avenue Hainmond, WI 54015 (NE 1/4 NE 1/ 17 T29N R17WZ;a Lot /�, Parcel No: 17.29.17.762 1.) Alt BM Description /C 1 2.) Bldg sewer le ngth hlLf/r1 amount of cover = `/jZ,�y(� Q Gce SQ Imo✓ 1 Plan revision Required? D Yes jr No Use other side for additional information. ( _ - -- SBD -6710 (R.3/97) Date Insepctors Si nature Cert. No. commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5] , G-os' < scons Madison, WI 53707 -7162 Sanitary Permit Nummb (to be filled in by Co.) t o i epg r finent of Commerce 5 15 +l D Z Sanitary Permit Application State Tr ansaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /v Jk unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. # / j S� �q / I. Application Information — ' Please Prin II Information & / ►`yt /T Propery4Owner's Name Parcel # Property Owner's Mailing Address t Property Location / 74 Govt. Lot City, j State Zip Code Phone Number j/ �( y I t)� -y�4( Section /7 716.- 7 4, 6 �C ` T (CJ T Z r 7 N; R / circle or� II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling — Number of Bedrooms 2 Subdivision Name r Block# /0 + I ni'e elilA ❑ Public /Commercial — Describe Use ❑ City of f ❑ Village age o ❑State Owned — Describe Use CSM Number Town of /Ta ✓t'I /11� r1 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System y El Replacement System )<Treatment/IIe{dt R - Replaces nt Only El ther Modification to Existing System xplai B. C1 Permit Renewal 11 Permit Revision 11 Change of Plumber ❑ Permit Tr fer to New L st Previous Permit Number and Date Is ued Before Expiration Owner 9301 7 2 f a 3 IV. Type of POWTS System/Component/Device: Check all that appl ❑ 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. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks w a V in rn Septic or Holding Tank �n0 1666 1 , Dosing Chamber K � $LlL) `6 oG VII. Responsibility Statement- I, the undersigned, assume responsibility for installatio of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber=s Signatur MP/MPRS Number Business Phone Number kJ �il • : J 7 7�" 2(oo -- Plumber's A ddress (S t, City, State, Zip Code) /3mcr W% 5 VIII. Coun /De artment Use Onl Approved tsap'?ays Permit Fee I Date �f sueed q Issuing Kent Signature iven Saofbr cnial $ Cd ! Li 2 IX.Conditj9pt$ltAftVr easonsforDisapproval ^ 1. Septic tank, effluent filter and it t dispersal cell must all be services / maintained �+ as per management plan provided by plumber. 2 AN setback requirements must r i maintained 6 / n / '� � as applicable code /ordinances. L GY Q (p,� eZ(ilra Attach to complete plans for the system and subm to the County only o / /// not less than /2 x 11 itches in size c /�y J R SBD -6398 (R. 02/09) Valid thru 02/11 v �ty County Sanitary Permit Application ,� S T. CROIX COUNTY WISCONSIN GO In accord with Chapert 12 St. Croix County Sanitary Or c� PLANNING & ZONING DEPARTMENT ttp��d Personal information you provide may be used for sec4 ar poses ST. CROIX COUNTY GOVERNMENT CENTER Fo [Privacy Law. S. 15.04(1)(m)] t _! 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386 -4686 c co ete for the system on paper not less than 8 -1/2 x 11 inches in size. my anita Per d # ❑ Check if revision to previous application I. Application Information - Plea Print all Infor on Location: Property Owner Name Ferty /� QQ _ 1/4 - 1 /4, Sec �- / Z U ZOOS N, / 7R G� E (or) W Owner's Mailing Address Lot Number Block Number pIp,NNIN iG &ZONING OFFICE y, ate Zip Code Phone Numer Subdivision Name or CSM Number # I f-) 19 V t/- pk�� L�� II Type of Building: (check one) ❑City ❑ Village own of t 9 fRF 1 or 2 Family Dwelling - No. of Bedrooms: 3 ❑ Public /Commercial (describe use): ❑ State -owned Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 1� (/ Parcel Tax Number(s) A) 1 AX Repair 1 2. ❑ Reconnection []Non- plumbing 14. ❑ Rejuvenation AIAW S Sanitation B) Permit Number Date Issued State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Nr Non - pressurized In- ground ❑ Mound z 24 in. suitable soil ❑ Mound <_ 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade V Requi �1o7,5� Propose (Gals. /day /sq.ft.) (Min. /inch) Elevation /� V 1 / S VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic Existing Gallons Tanks Concrete structed glass Tanks Tanks klicense o /000 El ❑ El El - d0 El ❑ ❑ ❑ sibility Statement signed, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A t re uired for terralift repair or the installation of non - plumbing sanitation system. ame (print) Plum S' natur (n MPRS No. Business Phone Number a6 ddress (Street, City, State, Zip Code a x Z113 VIII. County Use Onl Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ❑ Approved Owner Given Initial Adverse Determination IX. Conditions of Approval /Reasons for Disapproval: car -------- -- - - ------ Al coo r : - I j i F ---f •'al - - _ y,s /O® z f _ - -�'_ -- - - -- c copy t : t : C ��' Ale- 10- 22.-2009 20:36 DAN 7153811729 PAGE2 " "" 2009 12:37 FAI sT. CRois co. G1.1•1 x f,�ool ST. CROIX CCIm ['Y 5 P"I'YC TANT MAMTENANCIi AGREEMENT A- M C)"T.R,S}!TP CERTWICA TION F0Rh1 own : Eit7ver k !� -Mailing Ait6rt-:sc Pt•oprrr .Address 16 Qth (1►er l3eatinn sacqerad from Flan44 & Z000Ms 1"ttMent for ttew 0011+rtueei41P. LLGAL Cit}riSCatr �'�Avv�wwr.b. y� � gart;�at G�Cllt[t:tt`81iExtt Nutnbet O 1 8 -10 �{ - Z Z - o O o b "O.N Property Lm.ation , St.c -1-L, T I 'rf KtiN, Cown csf �� Subdivisipn PLL _ _ �.... , Lot 4 e.L Cerdfled Sure 4isap ift �, VoIzulle ��' • Page 0 Warranty god po �A � � 3 •��� __ (before 2007)Volus 7 apce Aousa J >ea Lal khr-c ictsnritirlhlc jrra + rlb " SYS TEM NLUP9ENANCE &N OWNER CER1 Fl ATION , trrrpfopw vts_ Wul n utromn"Ce of Yout r0ptit 8ysrem oouid "Suit in SU Promottue rLdure IQ Jtm&&r wages: Prop" man >rtnanco cons,.. ^.tF of puampitle ovt • rte strptie runic every tLace ,yQara V sonata. if dod, bti a G: arno4 pumper. li kat you pul rrsto the 3y1tval Carl of ret rice firat�csiott O f ttte RaptiQ tank as a troaotmta,t etagtr #n MO waa4s Aispip"I a5rstam. Owner gnaiittsnarict; rmponsibilitias are spvcileed in 4Conm. 6 3 , 524 t) mad it) CbapEtr 12 - 5t. Croix - Cotracy Sanitary Dildiamrtce Tire pmpeny o -ner ag:oct re, submit to St (:ror: Caunsr Planrimg k ZttnrnF popanenart a et7itfl4alisrr: toaTra, srRtud by rite owner and by K MAW- pit:mb>rr phtmt�cr, resniccad pl�tr rbcr �sr a li.onsed pumper �.ritvirs ritat (1) for na► - aiw vvrsirwa[er diaposs! system :s nr t�rrtppr Gpe ratim; eundition and`or f2) artier k speetiQv and uer� ,nr ifnmctt acct Matr t- - Ail) DI ttrldgir p' N ( sbr)I }: the ssptie rank is Vwc, the %4idasiptel t,4v* r w d tttc dbovv mquujG!�Qgents mW apec lu pulutzin W psivale 5CWAgr divpwxl sysicru with thr smndprds sus :arch. bemjn, .rt. sat gay the Departimtof CotnmWce and the pepanuuimt of Nail Renoutea, Stet of Wisconsin Certiricftion %midi tkml YCW >,atrtic syskm hms t mkifttaood trust be ca pkeead mad seianwii to the Sa. Croix Coualx PIa>Rrrrng & Zoning Dspartjwge: witluu 3ti days or&wr three yesr mVw&tiad date IU-c certify that aJJ stalant+ as on this (*lilt a v u ue W Elsa best of my ektr knowledge p vm a7ra+aue ;rte err asr(s) of the I1tpp�rty duost:rt �pve, by yitrus ulrt warrarltY doe3 rs�� in Rr�itttarof T�aeds C�fiioe. Nunther of bedrooms may- 5. IGN 4TLi Tt DATE 'Any tnfornurtro:t that to rtx*Mprtssatrtcd .attry result in the ssuttaty permit ire E�•►oktd the pfsroutr st o' •�• by � Z nrr►g l7rywtaiestt Include wtrh thus aPP4catron # wcorded ws,rrattty had fr;-m t hus Regisi of Deeds Mike and s 4upy of the terti kd awvev trap i f 015 crcn 0 a itt made to rr`►G wa11' 1;714 + dead tRiC1 omit - I (1111111141.111 lllll IIIN Illil Illl !illll Lill IIlI 0 3 8 2 2 DEED IN LIEU OF FORECLOSURE 900382 T22= OF ]WQU=NT BETH PABST DOCUMENT NO. REGISTER OF DEEDS ST. CROIX CO., WI PLEASE 8MRN ACKNOWLEOGSSENT TO RECEIVED FOR RECORD CAWOL UEN RECORDS A RESEARCH, SIC., 07/20/2009 09:20M MINNESOTA ABSTRACT i TBLE COMPANY, DEED 1010 K DALE ST. • ST. PAUL, MN SW7 PHONE: (651) 4ee.0100 (800)IM54077 EXEMPT 1 14 111411t u• at wwweaPHd1►e.Cd . REC FEE: 13.00 PAGES: 2 PARCEL ID NUMBER: 018 - 1094 -22 -000 This instrument was drafted by: Leila Hansen, Esq. 9041 South Pecos Road, Suite 3900 Henderson, Nevada 89074 Recording Area f 3 KNOWN ALL MEN BY THESE PRESENTS, that Mathew G. Celski and Sarah V. Calski, husband and wife, whose address is 6481 Lower 35th Street North, Oakdale, MN 55128, hereinafter called grantor, for $1.00 and the consideration hereinafter stated, do hereby grant, bargain, sell and convey unto Weds Fargo Financial Wisconsin, Inc., hereinafter called grantee, and unto grantee's successors and assigns all of that certain real property with the tenements, hereditaments and appurtenances thereto belonging or in any way appertaining, situated in the Saint Croix County, Wisconsin, described as follows: LOT 22, PRAIRIE RUN, TOWN OF HAMMOND. MORE commonly known as: 1687 99th Avenue, Hammond, Wisconsin 54015 Prior Recorded Doc. Ref.: Deed- Recorded July 3, 2003; Doc. No. 728625 ; BOOK 2300 PAGE 097 To have and to hold the same unto the said grantee and grantee's successors and assigns forever. This deed is absolute in effect and conveys fee simple title of the premises above described to the grantee and does not operate as a mortgage, deed of trust or security of any kind. This deed does not effect a merger of the fee ownership and the lien of the mortgage described below. The fee and hen shall hereafter remain separate and distinct. By acceptance and recording of this deed, grantee covenants and agrees that it shall forever forebear taking any action whatsoever to collect against grantor on the obligations which are secured by the mortgage /deed of trust (referred to herein as "mortgage ") described below, other than by foreclosure of that mortgage; and, that in any proceedings to foreclosure that mortgage, grantee shall not seek, obtain or permit a deficiency judgment against grantors, their heirs, successors or assigns, such right being hereby waived. This paragraph shall be inapplicable in the even that grantor attempts to have this deed set aside or this deed is determined to transfer less than fee simple title to grantee. Grantor does hereby assign and transfer to grantee any equity of redemption and statutory rights of redemption concerning the real property and the mortgage described below. Grantor is not acting under any misapprehension as to the legal effect of this deed, nor under duress, undue influence or r,isrepresentation of grantee, its agent, attorney or any other person. Grantor declares that this conveyance is freely and fairly made. The true and actual consideration for this transfer consists of grantee's waiver of its right to bring an action against Grantor based on the promissory note secured by the mortgage hereinafter described and agreement not to name the grantor as a party to a foreclosure action stated above with respect to that certain mortgage signed on the July 18, 2008, by grantor in favor of Wells Fargo Financial Wisconsin, Inc., and recorded at Doc. No. 879230 real property records of Saint Croix County, Wisconsin on the July 30, 2008. 1 of 2 ST CROIX COUNTY AA IL PLANNING & ZONING r FAx MEMO DATE: J Code Administratz FAX NUMBER: 715 - 386 -4680 � Land Information & Planning FROM: Avi'—QU-t'" 715 - 386 -4674 FAx NUMBER: 715- 386 -4686 Real Pro 715- -4 PHONE NUMBER: W Re' "`; 'cling - 386 -4675 NUMBER OF PAGES, INCLUDING COVER SHEE . 2 RE: (�--� _ -132 7 �F ST. CRO /X COUNTY Go vERNx 1 101 CARM/CHAEL ROAD, HUD: 1 6 FAx PZ @CO.SAINT- CROIX.WI.U WI.US r— - V-1iscor6in Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division - INSPECTION REPORT sanitary Permit No: 430182 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, a.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Midwest Eq uities ---- I Hammond Townshi 018- 1094 -22 -000 CST BM Elev: Insp. BM Elev: BM n: Sect' n/Town/Range /Map No: 1 — 17.29.17.762 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION I ELEV. Septic Benchmark (S I 63 ,1 � �- Dosing l Alt. BM /O Z '� Aeration // U Bldg. Sewer Holding $ytitlale4 2 TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L L WELL BLDG. Vent to A' Intake ROAD Inlet Septic ( r , O/ �l Dt Bottom Dosing d), Header /Man. 72 b� I }�' 7 Aeratiotr Dist. Pipe �� V C , . B d HJa• A Holding Bot. System PUMP /SIPHON INFORMATION Final Grade & / I Manufacturer S/ S mand St Cover —� t7 ,�Y / h GPM Model Number W ,E6 2 `I / l/0 TDH Lift ► Friction Loss System C a�1� TDHH t Forcemain Len h / I Dia. Z r� ist. to y ell SOIL ABSORPTION SYSTEM BED/TRENCH Width 3 / Length / No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I-11 JULDG IWELL LAKE /STREAM LEACHING Man r INFORMATION T f Lst em: / i' /lm* Y Y O�' > �0 r ` ' / UNIT Model Number. I I RIBUTION SYSTEM / o %kt 41� -f-Lf Man'ffold Distribution /' I x Hole Size x Hole Spacing Vent to Air Intake / br Pipe(s) I !/� ( d 1 �--�" r fength I Dia Length �' Dia Spacing Ci _ -- � �S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only L Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trend Center Bed/Trench Edges Topsoil q Yes No ❑ Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / l I Inspection #2: Location: Lo 1687 99th Ave Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 22 Parcel No: 17.29.17.762 1.) Alt BM Description = "-f 7i s/d.�..�: y / S`Zr✓,I%t/y �+� �ec 2.) Bldg sewer length = 4{ / � a !l — �D 'J C.�� - amount of cover = > S C� 4duu ,� k ( ` u syS. Plan revision Required? 0 Yes ; to Use other side for additional information. SBD -6710 (R.3197) Date Insepctors Sig ature Cart. No. Safety and Buildings Division County a, N me 201 W. Washington Ave., P.O. Box 7162 SCOI /SIO Madison, WI 53707 - 7162 Sanitary Permit Number (to � r be filled in by Co.) Department of Commerce (608) 266 -3151 I Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you prov may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print A - - - -- --. - -- . -.- - RE Property Owner's Na me Parcel At L.ot N a,2 Block X L 1- 20 2-) roperty Owner's M aMg Address Property Location City ° " P6one'Number 'k,'k,Section f 7 / ) (circle pW) II. T N; R Type of Building (check all that apply) 1� E or�Y' X45 � 5 �-� , 1 or 2 Family Dwelling - Number of Bedrooms c, - Subdivision Name Cdr ❑ Public /Commercial - Describe Use _ bJ24v6wA 5 L _ 11 State Owned - Describe Use ( _ 4 � e`i � t u,�; ❑City_ ❑Village ownship of Z III. Type of Permit: ( Check only on e box on line A. Complete line B if applicable) A. ,2(1 New System y ❑Replacement System Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) X Non - Pressurized In- Ground U Mound > 24 in. of suitable soil U Mound < 24 in, of suitable soil 0 At -Grade U Single Pass Sand Filter U Constructed Wetland U Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Na (Pr4ttt) Plumber's yn MP/MPRS Number Business Phone Number r- Plumbers Addre ss (Street, City, State, Zip Code) ' VIII. County /Dc artntent Use Only Sanitary Permit Fee (includes Groundwater Date Issued Issuing SigMeo Stamps) Approved ❑Disapproved Surcharge Fee) r ❑ Owner Given Reason for Denial �� J Z IX. Conditions of Approval /Reasons for Disapproval p� " Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches In WZ0 SBD -6398 (R. 01/03) - Al f� i i r � - r I v _ ` I .� lllw, get 11.1v, Av r Al 3 � Q'I i i i fvde 1IC l - Tti en per/ u%�k�s ' Ae - Wisconsin Department 'of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r() include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). \ l Z Property Owner Property Location k \p � Govt. Lot el 1/4 114 S /q- T 7 N R/ E (or)® Property Owner's Mailing Address Lot # Block # ubd. Name�SM# G / S� 2 ra r k— Ku n City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road W I s S (7/5 ) 7?G - 1 ?G3 //.ro1mon of 1 /00 0 J4W-4-, ] New Construction Use: [ Residential ! Number of bedrooms 3 ` Code derived design flow rate 1 1-$ - U 4 G 0 0 GPD ❑ Replacement 7- ❑ Public or commercial - Describe: Parent material / Flood Plain elevation if applicable �`��� ft. General comments S)/S,/Tw( -W -eV. Q f . GG G ��' <, 9 • pa ,- and recommendations: G / , ^e V. gr 7 Boring a T 9 FiO Borin # © Pit Ground surface elev. J' 0V ft. Depth to limiting factor 7-7 in. lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ( Roots /w in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ��: *Eff#1 2 2- 1,C) lD a 10 Z1l iCi 2 m6bk fnf r s — y 3 36 -q Y r4d to LS l m S nn I C- -- - 7 / 2 y 47 Ip `7.5 r 4/4 C - 1 . 5 r' ScI 2rnS6k r Z- Boring # ❑ Boring © Pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -I 5 j6v, 81 :S; L 2rraA mVr c- - 5 Iv� s 5 8 Z 15- to L1/5 fy-� �'r Cs 3 -4R 18 r 44 L S I MIS r t �� j-- /. 2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L CST Name (PI se Print) Signature CST Number Mlam >-r ---" 25 3 9 Address Date Evaluation Conducted Telephone Number e / 2 Ll 7- va�� SBD -8330 (R07 /00) Property Owner / /Qt;.t��� `� Parcel ID # Page of LE Boring # ❑ Boring .L Pit Ground surface elev. $ ?1. (0 ft. Depth to limiting factor 4 1 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I I *Eff#1 *Eff#2 p- 5 Z cs Ivy 5 2 ID , 4, /3 m e-5 e-1 3 b LS Irns s - I 1.2 8 S Z P - t .5 r 9 &J 2msbk r4r Boring # ❑ 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 GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # E] 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 GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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) PAGE 3 OF .3 NAME f+o� J ��k LOT# z Z LEGAL DESCRIPTION yE Y.Ur X ,S /? T29 ,N,R, / ; E(or) SCALE: 1 "= yo , BM 1 ELEVATION 0:5 • f BM 1 DESCRIPTION Ja p Q ( ^Arrc, — }X BM 2 ELEVATION ??, s v � BM 2 DESCRIPTION 4 p Q j i „ e yc_ p,' p f- 5� l� SYSTEM ELEVATION t(P 7,Y o y Caw <r 97 Y0 ALTERNATE ELEVATION CONTOUR ELEVATION Sa 3 w A A Q � -2 I -�o � 4 � SIGNATURE ATE i PAGE OF PUMP CHAMBER CROS SECTIO ANp SPECIFICATIONS VEWT CAP 4 VENT PIPE WEATHERPROOF APPROVED LOCKING JU WCTIOM 60X r MAWHOLE COVL'R WITM 2S' FROM DOOR, WAPIING LAS&L WINDOW OA FRCSH It'MIU. AIR INTAKE — 6RADE y" MIAI. CO►JDUIT — -- --- - - - - -- 18 Pt I m. ��� - - - - - - - - P �OVID4 I 1 - _A-� INLET Al;�1'I;,OtT SCAT_ I- IiI APPROVED JOINJT A I I I A PPROVED J0111 I I I W/ PIPE EXTENDIMC, 3' I I ALARM E%TCUDIWC. 3' 011TO SOLID 'SOIL I I I OIJTO SOLID SO' 6 I 1 I I o►J . •.,�� c CLEv. F7 PUMP -` - -� b OFF 0 COUCRCTC CLOCK RISCR EXIT PCKA11TCD OIJLy IF TAWK MAUUFACTURCR 14AS SUCH APPROVAL B" APPAOVEQ ©CDt>jNG u, T/rti11< SEPTIC f 5Pf_GIFICATIOIJS DOSE ) _ f M^~ C : P£ DAy TANJKS MALIUFACTURCR: ll f"�-�s I.1 LL .�L.R •F GAS 5 R TAWK SIZC: GALLOUS DOSE VOLUMC INCLUDIM& 6ACKFLOW: GALLONS ALARM MA%JUFACT A100CL 1JUM6CR: ,l1LL.l,[J / � ' / CAPACITIES: A= IUCHCS OK GALLOWS SWITCH TYPE: INCHES OR GALLOIJS PUMP MAUUFACTURCR: C = INCHES OR CALLOUS MODEL UUM bCR. ��1 ?.��2/jl D- INCHES OR GALLOUE SW ITCH TYPE' 5 a:cL -L.4 Ar° L1 I_ r E' PUMP AUD ALARM ARE TO BE MI►JIMUM DISCMAKGE KATC 3S GPM V INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEREU OETWCCU PUMP OFF ANJD OISTRIE,UTIOLI PIPC.. FEET + .MIAJIMLIM NETWORK SUPPLY PRESSURE FGET FT¢� FEET + .. FEET OP FORCE MAIN C) , rr ,NRlCrlu ►I a �� TOTAL Oy►JAMIC. HEAD - _-. 1 L, _ FEET IIJTERWAL nimE.USI ►JC OF 'T'ANJK: LCN4GTH jL(10'(N jLIQUID DEPTH LJUMIiL:N;: PATE: • A .. • ■�■ ■■N■■ No NONE OMEN am won �■■■■■ ■■r■■■■ ■ "MINNIMINIMMOMM on �.■� ■■ ■ 1t ►u■■■■NmN■ ■■■■ '� '� ►■■■EN NN EMBLEM mmmmml � ■N■■■■NENN o • r Blas �_ Solid ■ ■►� ■■N■■■■ ■■NNE m MME MIME ■��■■■■■►� rN�■i■�■NNNNNNNN■i ■■■N■EN ■■t ■■N ■■■NN■■N■ ■■M■ ■■■■N NNNNNN■ ,NN ■■ ►NN■ N�NNNNNN■■N■N ■■ No N�r�■ ■���NN■N ■NNN�N■ MEMNON I'UW'1'` U`VNE AVS MANUAL & MANAGEMENT PLAN Page Lof, FILE INF MATION SYSTEM SPECIFICATION Owner Se tic Tank Capacity al o NA Permit # 30 - I 2 Se tic Tank Manufacturer o NA Effluent Filter Manufacturer a NA DESIGN PARAMETERS _ Effluent Filter Model o NA Number of bedrooms o NA Pump Tank Capacity al o NA Number of Commercial Unit NA Pump Tank Manufacturer I, ? O NA Estimated flow (averag ?0 gal/day - Pump Manufacturer Design flow (peak), Estimated x 1.5) -' , d/da Pump Model o NA Soil Application Rate -5/ 'al /da /fl Pretreated Unit III fluent /Gfflirent Quality Monthly Average* n Sand /Gravel Filter o Peat filter Fats, Oils & Grease (FOG) <:10 Ingl rr Mechanical Aeration ❑ Wetland 13iuchamical Oxygen Demand (BODs) : 220 ing /L o Disinfection O Other: "Total Suspended Solids (T,SS) S I �() nip; /L Manufacturer Pretreated Effluent Qualit Monthly Average ** Dispersal Cell(s) L7 NA In- r ssurizCd ) !n- ground (gravity) o (pressurized) Biochemical Oxygen Demand (BODs) <3O "'� /L ❑ At -grade O Mound Total Suspended Solids (TSS) 530 nth; /L u Uri -line o Other: Fecal Coliform (geometric mean) <10" cfu /I00rnL Maxinurrn Ef fluent Particle Size 'A inch di * Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Fre uenc Inspect condition of tusk At least once every o months jir ears Maximum 3 yrs Pump out contents of tanks When combined sludge and scum equals one third 'h of tank volume Inspect dispersal cells At least once every o months id ears Maximum 3 rs Clean effluent filter At least once every u months A yearW Inspect Hint �, nrm controls & alarm At least once ever a months f uur(s ) O NA Flush laterals and pressure test At least once every tj months o year s a NA Other: At least once every o months O ears iwNA Other: At least once every o months o ears ANA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall bc: made by an individual carrying one of the following licenses or Certification: 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 ot'sludgv and scum in any tank equals one -third (%) or more of the tank volume, the enur. contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code, The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of' 12 months or less shall be performed by a certified POWTS Maintainer. A service repurt shall be provided to the local lvjI ulutory autlruriiy within 10 days of completion of any service event. S'T'ART 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 my impede the treatment process and /or damage the dispersal cell(s), If high concentrations are detected have the coruents of the tanks(s) renwved by a seputhr scrvtcing operator prior to use. Owner: ,, � �ef ' Yap or.2 System start up shall not occur when soil condiriuns are; frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal 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 chive or park vehicles over tanks and dkpvrsal cells. Do not drive or park over, or otherwise disturb or compact. The area within IS feet down slope of uny mound or iii-grade soft absorption arc;. 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. ABANDONEMENT 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 ch. 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 locution 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 ,urd 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. U 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. '01111i' The' site 'ttasinor identify replacement area. Upon failure 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. U 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 the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTAL E 1 MAINTAINER Name Phone — Name Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULAT RY AUTHORITY Name Name � ,' Phone Phone ' ST CII IX COUNTY SEPTIC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner /Buyer Mailing Address Properly Address (Verification required from Planning Department for new construction) �11 � parcel Identification Number 2-) City/State �'� I L GAL DESCRIPTION Property Location .' /., `/4, Sec. T -N �ZW, Town of ,j Ct.4'YI'U Yz- � Subdivision X � �,�'�, �r . Lot # Z Certified Survey Map It , Volume _ , Page 3� warranty Deed It , Volume 2 2 Y , Pa R e it Spec house ❑ yes l no Lot lines identifiable yes ❑ no GVSTT,M MA)�NT i NANCL Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Deparhnent a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumperverifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), (lie 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 conipleted and returned to the St. Croix County Zoning Office within 30 y ear expiration date. days of c three e p Y Y S A . PP OP AL CANT DATE OWNi,R CERTIFICATION I (we) certify that all statements on this form arc true to the best of illy (our) knowledge. I (we) am (are) the owners) of the pro y described above, by virtue of a warranty decd recorded in Register of Deeds Office. NA'I'U ' Ol' PPI.ICANT DATE Any information that is cnis- represen(ed may result in the sanitary permit being revoked by the Zoning Department. «s Include with this application: a stamped warranty deed froau ilie Register of Deeds office a copy of the certified survey vial) if reference is made in the warranty deed J 2252 P 340 -7;-:>a -7MI tl DOCUMENT NUMBER KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 05/23/2003 02:20PM William E. Hawkins, Grantor, conveys and warrants to M ^dwest QP S, L Grantee, the following described real estate in St. Croix County, WARRANTY DEED state of Wisconsin: EXEMPT # Lots Y, 3,' 6, 10, 11, 12, 13, 17, 18, 19, 22, 27, 30, 35, lA and 3A, REC FEE: 11.00 Prairie Run, Town of Hammond. TRANS FEE: 594. @@ COPY FEE: CC FEE: PAGES: 1 NAME 4ND RETURN ADDRESS f ro ao 4%kdai h 41, S X007 -- 18- 1037 -10 -000; 18- 1036 -90 -000 18- 1036 -80 -000; 18- 1036 -70 -050 Parcel Identification Number i This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this S 3 day of May, 2003. C• �� (SEAL) (SEAL) William E. Hawkins (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. COUNTY J , authenticated this day of 2003 Personally came before me this�:J $ay'1i - fky, V 2 the above named William E. Hawkins'..*, awkins' Y (Signature) to me known to be the persons (s) who .epluaI4 the foreq in instrum t and acknowledcse thc„sdme.a' (Name Printed or Typed) V TITLE: MEMBER STATE BAR OF WISCONSIN si nature (If not, authorized by §706.06, Wis. Stats. ) * `► �M Name P �d or Typed THI9 INSTRUMENT WAS DRAFTED BY: Notary Public �k o y, 'Wis. Leo A. Beskar My commission is permanent. (If not, exair_ation date:) Rodli, Beskar, Boles 6 Krueger, S.C. P.O. Box 138 River Falls, WI 54022 8� 6' NQO' 39' 03' W iOfi. vo a ^; V L I I 1 ` N I ' co Q , 50, t • I � • O � � Q, I I , QD to tAi e.9 LU Lu 50. I M Q I I N O ~ ...N vOc922 N uj I C 2 I v I CO � I• ' I W; : 2 ; S00 0 55' 46 - E n UJ ti 33' 1 33' �- -- 162.38'-- - - - - © �� (V cc 3 U o I PU I C m"o ion ' Q a ® ROAD® '® 1 y J .co ` I r NOO 55' 46"W---- I i 162.38' o I ..................... �.a a � , '• '� X. # .Ok ,�a.ais 'ozN I i t�J � t� � '- - -f4F 9� � s GBH C cr- CN 50� � i ti I N �'• � o� ��• �p I NOO 39' 03 W 275.66' 1 i V I ^. .-..J W , l8 '96t 3.06 , LZ.90N �� I , V J I -.- I I co a co cr. , v° Z Nom° O Q N p p N O ti I J •� J •� n i I i ............. ............................... h 3.52' I - - - -� L-- - - - - -- 275.66' - - - - -- - -- -` I S00 ° 39' 03 "E 279. 18' STREET SH I 4 �\ -_,. N \