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020-1407-10-000
rWisconsinDepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety an~r Building Divison ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: I Insp. BM Elev: BM Description: ~ r (~~17 ~,L7 ~ sr~~ r~19+'IS t1,1~~ TANK INFORMATION ELEVATInN DATA TYPE MANUFACTURER CAPACITY Septic l~ ~-c- <<--S Z ~ D Dosing Aeration ~~-' ~ Holding _- = TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 S-~ r ' So I I / Dosing Aeration r,.~~" Holding , PUMP/SI~ON INFORMATION Manufacturer Demand GPM Model Numbe TDH Lift ~' Friction Loss System Head H Ft Forcema' Lengt Dia. D' ell SOIL ABSORPTION SYSTEM/U-~ ~•~;; i County: ix Sanitary Perm' o: 53457 ~_ 0 State Plan I No• Parcel Tax No: 020-1407-10-000 Section(rown/Range/Map No: 10.29.19.2557 STATION BS HI FS ELEV. Benchmark ~ ~1 . 30 ~oZ~3o tSD ,~ ~ Alt. BM Bldg. Sewer 3. X03 ~ p. ~~ f SUHtlnlet ~~3 ~~ Zvi SUHt Outlet X23 9~.a~, Dt Inlet , Dt Bottom Header/Man. ~ ^/_ ,~Z/ Dist. Pip ~~ t~l~n~ D -D 3 ~ Z~ 1 Bot. Sy em D .~ r qs ~~ Final Grade St Cover ~ ' q~ I ~ 3S ENCH DIM Width ` / 1 Lgnct~, ~ ) S'~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth , ' 2 Z. z SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manu turer~ -r- /~ INFORMATION CHAMBER OR ~ _ ~~i Type f System: ~ 1 r 2/ / f ~ ~ ~ UNIT Model Number: U v ~~ DISTRIBUTION SYSTEM Header/Manifold ~~ Distribution x Hole Size x Hole Spacing Vent to Air Intake Length ~~" Dia Pipe(s) Length Dia Spacing SOIL COVER x Pressure Systems Oniv 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 C Yes ~ No ~ Yes n No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ ~ ~ Inspection #2: ~l---T" Location: 700 Zephyr Lane Hudson,, WeI 54016 (SE 1/4 SE 1/4 10 T29N R19W) Shepard®®Park Lot 10 Parcel No: 10.29.19.2557 1.) Alt BM Description = S'T j1d~'1" ~~ ~:PiC.O'"~ 7° y~~~ Vic`- ~ N~'~~~ 2.) Bldg sewer length - 30 ~ ~ ~~ep~` Q.R,a~ ,,~"'-~' -amount of cover = ~ g ,f-, ,Q ~ ' Clfa' u AJti:/t ~:i~~ Q~~ ~ Z ~,~ ~ __ __ Plan revision Required? f Yes No I ,__~ Use other side for additional information ~~ ~ 2t ~~ i ` _ __ _ _ I~ ~' ~I --' ~ - - Date s{~ct s Sign re Cert. No. SBD-6710 (R.3/97) ~°T~' C.~C.ts Safety and littiidittgs Division '' 201 V1I. Washington Ave., P.O. Box 7162 ~~~,~ , WI 53707 - 7162 Co+mt7' C Sattirery Ptxmh Number tm be tilled in by Co.) ~- , (~ 3151 - - De artment of Commerce - Slats Phn LD. Nwnbei' ~ Sam+~'~y Pe`~lt ~ Ku C d Ad ~' a e, m. In accord veith Goa>m 83.21. Wis. (`' : ~ ((~ ( Address (if flan maiti~ address) w, s . taay be used far secondary P'mP~ -~ ~' '' ~ ` I. AgpkCation Information - Pleme Prbat All btarm~oa 7.ONING OFFICE ,~ ~ L,r/, (,C~-~"~' Property~Owtter's Na me Parcel i Low S / Block i Property Owner's M ailing Address ~ L°`~'°° •a SSA 1 ' D F-~ 'A,SecOOn - l S~ Sf,~E City. state Zip Code Phone Nm~er -. oar/ l ~ S- - 7773 T 2 9 N, R~~ot~ - k ~ tb l at app y) II. Type of (chec ~ ~ ~ \ Subdivision Name CSM Number ~ or 2 Fatuity Dwdiiog -Number of Bedtoams .~ ,L lCaa»erciai - Desen'be Use ^ P bii l ~ ~ u c 7 ~ State Owned - n Use 5 Z Z a- Z3 --- - mil! ~~Se ~~iP of III. Type of Permih (CLeck at0ly one bey on line A. Complete Gtele B if applicable) A• Sys Q g Sys ~ T~ Tank Rat oni7- ^ OtLer Modification to Exiniag system B. ^ Permit IZeoewai ~ Revisiao ^ Chmge of ~ Psrmit Ttans6er m New List Pceviata Permit Nttmba~ attd Date Issued- Befon F.xpitation - Plumber Owner ~c L ~' IV. : (Check all that of POWTS _ Non -presstuiaod In~mund` ^ Mamd ? 24 io. of snimbk sol ^ Moond ~ ?A in. of wpabie sod ^ Ac-Glade ^ Smgte Psss sand Fiber ^ Consuvcted Wetland ^ Pressttrital hrGround ^ Hoid'mg Tank ^ Aerobic Treatment Unit ^ RececttUuing Sand Fd ^ Isea~tdaaeg Syw,etic Mods Fier 0~ ' I.~e ~ Gr„~a->e~ Pirpe outer te~pmia) V. Area ,tS' - = a3 ~ 2 ~ LL Design Flow tBPd) Design Sal Applicuion Disposal Ana itequired (st) Disposal (~ System - .~ ~_~ 9~0 - ~~~ e7 _ .S C-L f~L-;. YI. Taula Info Capacity in Toni Number MatatFacdtnr Prefab Sbe Stud Fiber PI Galbns Gallons of Utets C Camut~od G~ - Nk+r ~8 Tads Tads ~ /~ Aerobic Trcatmeot Unit Daring Ober - YII. Responsibility Statel~ettt- I, the'imda~ned, atstiltse - . f~tr imtaDation of the POW1s shown m the attaelnd plans. Phttt>aer's Na the (~) - Pbottber's Si ~ -hIPfMPRS Number Bnsiuess PLooe Number Fogerty Pitmt6ing ~ ~ T ,; - 3 - 9~0 P'°mb°f~f ~ ~ case) 7is-63s = s ~ ~6 ~X Spooner WI 54801 ~ - - o _ _ ~ A~,~ ~ _ sanmcy Permit Fee (tncbdes Granad Dace Issued >~ S;gmatre Sm+cbarge Fee) ~ ~ OU - ^ Owner Given Reason for Desist I t 3 ~ IX. CotuGtions of Appro for Dis«opproval e }-~ n ~ ~~~ ~ G~i'c~ Y YSTEM OWNER: ep is tank, effluent filter and -~~- - ~ G~ ~ ~„ !~ dispersal cell must all be service /maintained v~ ~ / ~'v `- - as p,er ma nt plan provided by plumber. ~p,~ 2. se ac requiremen us a maintained ^- ^ ' , ' G, _ „ J ~` ~~.~t~ J/~~~i" v° L~ odelordinances li bl . rte," e c ca as per app . D Z D - - Attac>t oamptete t>w Cead7 anb) tort tLe systan as paper not ~ aui x ii nr~a~/ y~~ I/~ ~ ~, ~ * 4 ~ n 1 A .~ 9 b ,` ~~ ~1 ~ ~ ~ Q ~ ~. v ^ ~ ~~~ ~ ~ ~ ~~ w ~ .p ~, y ~ a ~ ~ ~' ~ ,~ ~~ ~~~~ ~~~ oo~~-~ C ~ ,. h A _ ~1 ~ f~ ~ ~ ~ ~ ~ ~ v° ~ ~ ~, R~ e VON ~ ~-+ O ~ 10 ~ ~ 00 1 ~~~r'0 1 ~~~ro..d p .. ~ . ~ /-~ / '~ o p $ ~ a c a' ~ t~ ~ ~ ~~~ p +~ vi ~ C ~ ~~ ! O 11 II ~ p ~ , . s= ~ ; ~ _ 1 ~ e-r _ ~ : a : • - _ 2 • Jr; k . ~ -{ ~ ~ } ~ _ _ ~ • ~ • :. ~~~ ~ ~ ~ .6. •. \l. Q ~. ~ r ~ _ .1 ... ~ ~ " ~ + - ~ i a - - . ~.~-,~~_ __~ .~ . : ~ t . _ r b a . 3 ~ , . ~ :~ , s:::~~:s N ~ .. ~ ~ i _ , . ^' , { s ~ - i _ s` - _ ~~ ~'C . ~ . .. - ~, p, ~.. ~--- -- --- ----- ~ ~°~ ~ _ ~ ,. r ~ ~ ~ ~ TA ~ C . ~• • -_ ~ ~.t - y, ~ _.. . ~ --------- - i ~ ~ N ~ } Q, ~ ~ cP ; ; ~ II 11 ~ ~ ~ ~ V °s ~~ _ N V C D e ~ ~ ~ ~ Q ~ r 0 l /~ ~~• ~• O Fj ~~' 'a .~ ~ o K o r1~ ~' a i 1 gg~ II }~ ~. i i v1 1 } 1 S i w p• a (D 4 ..'0 00 p V O ~ aq r o tP ~c=u ~#~ N ~~ ~yNY. W~~~-"0 (3t -- N ~ C 0 ~N'p. O Q' ~o~ ~ F+ A ~ „ < . l -_... _ . _ _. ._ _ 1 . w~sconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in acco ~ (' ~~•86-NRe-A~ Code ~nry Attach oompiete site plan on paper trot less tlrart .812 ~ts~"Plan m~rst include. but trot ~mited to: vertical and horizontal tererr&e point (BM), d~ectiar apd Parcel I.D. percent slope, scale or dimensions, rrorth ~V tJ "1 ar~d ~starlCR~to neatest road. p p atron. ~ Personal'rMorrnason tar wo~ rey for '~''~dJ. s, tao4 (t) (ml}- t?wner Location Govt Lot 1e. f/4 S'~C ~ property Owners Mailing Address Lot # Bbdc # Subd. Nan Ll~ • ~ p - . state Ztp Code Phone Number p City ^ rage ~Fu v,/ o t ) u n> New Constr~an use: [[Residential ~ tilrnrrber of bedrooms Code derived design bow rate C• DO ~ru [] Replacement ^ Public or carurrercial -Describe: _-- Parent nrateri~ L~l~`w~'~~ - Flood Plain elevation E ~~ \ ~ tL ~ ~ ~ Ger>ewl conrrnenu Sysy-,~~ ~Y.~-d: G,~LG ~1 97 0 ~ ~•,~ and recorrrrrrendations: Lmv~i8/rhrvvr~L C~~ ~ ~ r 93 ~ ' i ~G• ~~~yS ~~ ^ Boring # Q ~ ~~ Surtace elev. . ~ 1L Depth 6a 9 ' -~- i^• Soil Applica Rate cdue St Consistence Boundary Roots GPD/ft= Horizar Depth in Dominant Color Redox Description Da Sz. Cont Color Texture nr Gr'. Sz Sh. 'Eff#1 'Eff#2 ~ . , ~ 21yr L _ Z 2 _ , ~._ ~- s ..._.. Z ~9 # ©Pit Grorard surface elev. ~•3 fL Depttr to limiting facto --~'~- er. Sod Application Rate Rooms GPD/iP B ~ Horizon Depth in. Dominant Cobr MunseN Redox Oescriptiarr flu. Sz. ConL Gobr Te~xhre S1rucBxe Gr. Sz Sh. Corrs~oe,,roe Y o 'E(f#'1 'Eff#2 22 2- - .2 •s.cS c Q c S r-- S- r -- ~ ... 12'' - ~~ 3~ 3 . arw. .e..* ~ - ar,n c sn ~ ~ TSS < 30 m9n: ~ - ' Eftttront #'1 =BUDS > 3U ~ Llrr rtlgn. arw ~ .~ ~av _ ~ w ...yr.. 5T (Please Prstt) ~, /¢ r ~~ Fogerty Plumbing & Perk T sting __,~~ Page ~ of 3 ~.. ~Si~ T ~ q N R Oate~~~~~~ /.=L '9 E Nearest Road 12 2 m ` ~ ' _`~w- ti QV R A F .~~ W X N 'fir t x~~~ ,~ v 0 o, -~ d TM~ n ~~ f~'~ ~ ~ 4 • x ~" ~k h ~' ~' ~~ ~ 1 ~ ~ la 3 o ~~~ ~ ~~ e ~' ~' 8 ~ a C ~, ~ Q (~~ o ~J .-.v N o ~-+ o !!~- ~1R ~~~iN ~ ~A ~~ ~W,~~~ ~ ~ ~~~~~ ~ ~ ~ ~~N O~ ~ _' 0 ~ ~ ~ lOp~ R Z ~~ . n Safety and Buildings Division P.O. Box 7162 Washington Ave. 201 W City C ~ , . ~ ~ Madison, WI 53707 - 7162 / Sanitary Permit Number (m be filled in by .) ~~~~,~ . (~) 266-3151 S Department of Commerce Sanitary Permit Application s~ ~° I.D. NtmsbFr I l ~ In accord with Comm 83.21, Wis. Adm. Code, persormt information you provide be used for setortdary purposes Privacy Law, s15.04(lxm) ma / v .. Project Address (if ,mailing address) y ~ ',a"" I. Application Information -Please Print All Infor~on ~~ ~ ~~ ~ ''~ f' ~ ~ ,/ O Properry~ Owner's Na me Parcel 0 ~ Lot i Black () ( ~t - ;.! Lf~ ~`t ~i~f~ ~ 31 ~- (/ ' ~ property Owner's M ailing Address on ~ ~ ~~ City. state Zip Code Phone number S~fO! ?!,J = PG -? 1•f' (circle o = ~~ II. Type of Building (check all that aPP1Y) 3 l - w/ y~ " U ~L N _ ! ~ iivision Name CSM Number , i J or 2 Family Dwelling -Number of Bedrooms ^ public/Corttmerciai - Descri ^ State Owned -Describe Use ,5 C~c~~ I.J ^City-^Village QTSwnship of III. Type of Permik (Check ody o~ on line A. Compl~e line B if applicable) A' [t~1Qew System ~~ ^ Replacement S ^ Treatment/Iiokling Tank Replacement O ^ odifica ' Ex B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer New ~ Date Issued -- Before Expiration umber Owner I V Type of POWTS (Check all that a f S - 3 ~ • S ~ ~ -? // .~ LM'NOn -Pressurized In-Ground ^ Mound > 24 in. of ^ Mound < 24 ia. suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ nstr~ted Wetland ^ Pressurized In-Gmttnd ^ Hokliog ^ Peat Filter Aerobic TreatmetN Unit ^ Rairculating Sand Fitter ^ Recirculating Synthetic Media Fdter Leaching Cumber ^ Line ^ Grav -less Pipe ^ Otlter (explain) V. Dis reatment Area Info 'on: ~ ~ Dispersal Area ~ (s Area Proposed (sf) System Elevation f- / ~ 3 Design Flow (gpd) Design Soil Application Rate(gpdst) ~ S~ ~ O, t-i 9s•y ~- VI. Tank Info Capacity in Total Number M r Prefab Site Steel Fiber Plastic Ctmsontctod Glass t C e oncre Gallons Gallons of Units Neer F.xisrinb Tanks Tanks G '~ Scpuc or FlelQetg~mdc '. -Lf/~i~ Aerobic Trea~ment Unit t)osing Cumber - VII. Responsibility Statement- b the'imdersigltied, assume rtspari~ility fm' of the shown on the attached pilaus. Plumber's Na the (Print) Plumber's Si gnatttre RS Number ~ Business Phone Number _ Fogerty Plumbing ,k ~ T/s - 3 - 960 Phtn'b ~~"Li3zi t~ ~~• Z1p ) 7~5-~.3s = .s 1 ~G •~x Spooner, Wi 5480]. .ri- oj- nd VTII - 7 - L Approved ^ Disapproved Spry Permit Fee i Groundwater ~ ' Surcharge Fee) ~ ~l ~l> g ~B t Si o Stamps ~ ~ ~ G2~~~- ^ Owner. Given Reason for Denial IX. Conditions of ApprnvaUReasons for Disapproval --~'L~~ ~ J ,/M f~~„`_ ~~ ~Q"` ~~~~ STEM OWN ~ ent filter and Sy,S~~'t ~~ Ot ~- ~ n , e u dispersal cell must all be serviced /maintained s~- Si~2 yQQi,~, . ement plan provided by plumber. - d er mana f~ s g - , p a 2. All setback requirements must be maintained ~(p~ `Y7~~" O ~Qyy~~~/yt~t-- ~h 7 ~ as per applicable code/ordinances. / y(Q ~ ~/~ ~ ~ A aP Attach complete plans (to We Cum y) for the system on paper not l~s thou 81/S x 11 inches ;n e Fogerty Plumbing #221180 28288 McKenzie Rcl. Spooner, WI 54801 _ (715) 635 ~~~ ~P/'I/d~/ Q/1r1` ~/y~of~ GoT '~/o Scif,G~ / `r sr~ ~ Y = ,8oerirJ~ ! o -/.~~ mac, s.~: . ~ FmctvD [oT c~e~/t ~.v~jev~ ~ ~ w~lc tirs7+Cwr; C-/ ~3 ~~ 3 ~~ S e-~. Q~ ' G€~6rH \ ~~ y r.' E- 3 `'. 'C:I~~ W ' r; 1 i ~fij!E: j.'t'r/C~f' !,~ FMS «•'~/ •r~T /S~ /SpsiNd~ rlf~ sut,E po~sw•T s,rO.~K, 2 .fv0 S2'IVc€ T dst !eT K•!°1 LBrr dP ,~rv~.~cisi3cE ~~ .4i~ •~` ~' tglr.~.- , T~lE dwFG,ga-,[ r s sca+~Lr 6~,~~/~ >z L~c~r,F j~eSRE ~SFSE •~ ~E.(/ /f~dG iytG ~C~~E.r,/r' •'~ /;ADO f R i ~~o' J,- 1 C ./ f~~L i ~ _ ~ - '~N r r ~- `-- ~,~ a.~s d~.~ Te Q T' \ R~M-.~~ _ ^^^ / IAIf~FV !M'11.R(V IQ a-- nn ' ST CROIX COUNTY ~ ~ F~ECE~\/I~C~ SEPTIC TANK MAINTENANCE AGREEMENT ' AND ~S~u~ (~ 6 X004 OWNERSHIP CERTIFICATION FORM _ ~T. CKOiX Cv! iNi Owner/Buyer ~~~ ~ ~ - < ~ NING OFFICE= L ~~~L~~ Mailing Address r~Y~ ~a ,,,~ ~ ~,tu~lo~/ ~ .I~YD/~y Property Address ~ QD ~ L / ~ (~ ~ V 1 /.old .t% s S o/ (Verification required from Planning Department for new construction) City/State Parcel Identification Number •R ~-~ _~„ LEGAL DESCRIPTION r ~ S~~ Property Location ~_ ~/,, SF '/,, Sec.. /d . T ~ 9 N-R,;~VI~, Town of ~ur~t'~/ Subdivision ~,~~is/) ~~~t/~ - ,Lot # w Certified Survey Map # ~ Volume ,Page # Warranty Deed # Volume _ ?s i 3 .Page # Spec house es Lino Lot lines identif able Oyes O 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 in 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration data SIG TURF OF PLICANT ~ / ~/ O ~ 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 described ab/ove, by virtue of a warranty deed recorded in Register of Deeds Office. L~ ~ / ~/ d ~ SIGNATURE OF APPLICANT DATE- ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****: ** 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 rv-.. s v...............-.......~......... °° --------- - - -- - - -d'- FlLE INFORMATION SYSTEM SPEC~ICATIONS Ovmer ~ ~,,, _S-?- Septic 7a~k C~acity - ~ al ^ NA ..~_ ~ NA rPArmit # _ _ / L,f~7 > / ~ /I Sentu~ Tank M~ufacturer .-~ .. _.rrC~' -~ U 2523P 043 - ~ STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, made between Rodney G. Nelson and Marvbeth R. Nelson. husband and wife, Grantor, and Kernon J. Bast and Donaida J. Soeer-Bast, husband and wife, Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): ~s~z~~ KATHLEEJi H. MALSH REGISTER OF DEEDS ST. GROIX CO.. MI RECEIVED FOR RECORD 03/08/2009 12:30PTI MARRANTY DEED EXE:MPI i) REC FEE: 13.00 TRANS FEE: 2175.00 COPY Fi:E: CC FEE: PAGES: 2 Area ~ rcecum r~aarnss RETURN .1 ~ Burnet Title 7550 France A~ = ~- First Floor Edina.IviN `~~_~; 1l~TN: Post ~ <'entra.i 020 1009 20 000/ 020 1010 80 000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) See Exhibit A attached hereto Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this ' day of ` , ~ C,'l \ , 2004. (SEAL) (SEAL) Rodney G. Nelson Mar ettl .Nelson (SEAL) (SEAL) AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 4-22808 (Signatures may be authenticated or acknowledged. Both are not necessary.) in any ca~aciri must be rioed or ACKNOWLEDGMENT State of Wisconsin, } ss. St. Croix County 5-~ ,np~~ ~~I(y came before me this ~_ day of / ~ 1 C ~ , 2~ the above named Rodney G. Nelson and Mary Beth R. Nelson. husband and wife to me known to be the person who executed the foregoing instrument and acknowledge the same. Notary Publi fate of Wisco sin My commissio is ~~y~p~tE~~f~t, s to expiration date: NOTARY PUBLIC I J PAM A. SPENCER ~nlnw Choir cinnafi Ursa NOTARY PUBLIC ~~7 STATE SAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. U 2523P Oy4 EXHIBIT "A" Legal Description File No. 4-22808 A parcel of land located in the N Yz of SE Ya and the S'/~ of NE'I. of Section 10, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin described as follows: Commencing at the E '/. corner of said Section 10; thence N 00° 01' S1" W along the East tine of the NE'I., 220.75 feet; thence N 90° 00' 00" West, 1312.43 feet to the centerline of a Town Road and the Northerly RNV of abandoned C i3< NW Railroad, said point being the point of beginning of this description; thence North 01° 00' 12" East along the centerline of said Town Road, 248.19 feet; thence North 89° 21' 11" West, 204.63 feet to a'h" iron pipe; thence North 00° 34' 38" East, 15.29 feet to a'/." iron pipe; thence North 88° 14' 28" West, 273.92 feet to a'/4' iron pipe; thence South 04° 09' 18" West,104.68 feet to a s/4" iron pipe; thence South 86° 03' 02" East, 17.28 feet to a'/," iron pipe; thence South 02° 53' 43" West, 282.97 feet to a'/.", iron pipe; thence South 89° 48' 40" West, 846.62 feet to the West line of the NE'/.; thence South 00° 05' 08" East along said West line of the NE'/., 1334.48 feet to the Northerly RIVH of.abandoned C 8 NW Railroad; thence North 42° 01'18" East along said abandoned railroad R/W,1710.18 feet to the beginntng of a 2914.68 foot radius curve concave Southeasterly whose central angle measures 4° 59' 13" and whose chord bears North 44° 30' S5" East and measures 253.61 feet; thence Northeasterly along the arc of said curve, 253.69 feet to the point of beginning. ON ~~r p~a . ~ ~~ V 111 ~O ~OO ~~ ~ ~ ~~ m N ~~ . . i ~~~ L ;i r ~' 1 ~' \= Jil i 11 ~\ \~~ G .~ 2.\~ ,y ,- ,- -- , C~-- ~ /' ,~'- LANE ~ ~ ' ~ _ 0 ~ ~'m y ~ J ,-. ...._ . ~ ~ N .~ :.;- ~ :,- ,. i1~ ~ ~-' ~ ~ O ~ ~ T ~ ~ ~ o~ aio~ V ~ m ~ 1 ~. c~ zm~ ~ ~ 75 ~ ~ m \~. ~ omc Dip ~, I ~:O ~ ~ C 1 ~,~ ~ v Cr I 1 ~ ~o $ [}~ v \.v ~ ~ :n / 846.01' `-- ~ z On ~~ z m z ~n ~~ o m NOO°28'21 "E 7 339.4T n T rZ pm Z ~ rm- S00°27'37'W 1207.56' m m o m S00°27'37'W 70 Z O T r O i C ~ r ~ ~ O ~~OQQZ . ~ i m~O m n ~ c VON O ~ O ~.. ~ X31 > Qp ~ N ~~J C~ ~ ~ p,~ ~~~ ~G ~~~ ~ y ia W O~ ~ ~ ~ X ~~ t° A C `~ N a ~- ~ * 4 ~ i A .~ 9 " ~~ ~~ ~~ I N 1 ~ ~o ~ a ~~~ 1~~ ~ ~~ ~ o y .p , y ~ e ~ ~ ~ ~' ~ ~~d~ ~~~ o p h ~ C ~ y~ ~~ ~ ~ 4- O O v o O _ i.~ i ~ ~ Q ~ $ `C O 00 ~ !~- l+~ ~ ~~ j C' C CD { ~ J C _ ';._: ~" s -.~ -CD ' - ~ ~ ~ •i- /'~ -..~ ''. ~q _ ti ~`VY-Y .rte' _ •* `~~ ~~ '~ ;~I~ ~ .._,_..~_.\ N - - tp a 1 ~ ,`~ti t0 _ e! ~ r . `'~' i ~ ~ 'o ~ F - ~ ~ _. -~ o ~ ~ _. _ _ ~ ~ ~ ~ o ~ ~ N .~.~a Q7 V _ y (9 ~~ ~~ -y V °s N V ~_ a ' ~ #1 t i v~ 1 I i _~ 3 ~ A f ~'f ~ ~ ~~ a~ O a h ~'Cj CD W e Q l 1 0 N V~f rcc A~ C 1~+ /O'''ff ~~.4 ~ l .! ~...a ~~ i-~~+ N ~-- VO N ~ # { v ~ ~ ~ N '< ~+ " w~~N~ `` (J~ ~. N ~ C 300 ~ Ln ~ ~o~'W ~~ ~ ~ ~ N o` ~ .4 i .~ ~ h ' 1 J `0 ~ ~ ~- Z ~ `S. o_ ~ ~ ~ 'D ~, ~, ~ e ~ n ~ ~ ~ C ~ ~ ® r p ~ ~ a d ~ ~ ~. ~ ~ h ~ - C ~ n ~\ D~ O D v O p h ~ \~ Z ti VO N O U7 ~ ~ }~ ~ ~~o~_ ~ 1 ~ W ~ X. -'' 'p ~-~ ~G ~ ~ lU (n O 0 ~ aa ~ X 0~~ ~ ~ i + Q ~ ~~~ . Wisoortsin Department of Commerce Division of Safety and 8uifdings ' in Attach oompiete site plan on paper not less irtdude, but not limited to: vertical and imra percent slope, scale or dimensioru,',r=K''x~fh~~ P ~e~"" Parsons infomtation you pro k Mailing Address S~O('IL~'EtVALUATION REPORT 12 ~tir~ks~t~'t'lanCode county ferertge print (BM}, duectian apd Paroel I.D. I~k~pgri anti ~star~~to newest road. t)~~t'V ll t1 `~dJ ~~. anon. o,y `.. - ~ ~IJ. s. ~sa1 t~l tmll Location -.[! page ~ of 3 Date ~i~3 0~ N Rig Et~ Govt. L~ ~c. 1/4 s~ i/4 "S T Lot # Block # Subd. Name ar•6&ftA1~- 0 .~-. ae Nurrt6er ^ Gty ^ Nearest Rand ~ . r - New Constnrction Use: Q~Resideniial ! tslrxrtber ~ bedraonts Code derived design flow rate 00 _ GPD Replacement ~ P``u,blic or corrurtercial -Describe: ~-- Parent material (,~{~`wll~3tt - Flood Pl~rt elevation if _, ~ _ ~ ft. General comments ''~ 7.0 ~ ~.~•.~ • and reoanmendattons:lmir/~f%-~/`.~•t~/'¢L syST'~I~ ~GE'd: ~~~ r ~ , ~~,~~ ~`~~y 0 ~ Bow Q Pit Ground surface elev. . 7 ft. Depth to 6m;~r9 tac~or ~- m- Soil ppplica on Rate Horizon Depth Dominant Color Redox Desaiptiort Texture Structure Consistence Boundary Roots GPDltt= irt. Hartsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z Y - Z - , - '~ ._ -- s S -' ._ ... ? Boring # 0 > ~,,~ ~ ~ Pit Grour-d stxiace elev. ~• 3 R Depth to brrtiting factor -1'~- in. Soti ~ppp~~ Rate Horizon Oepih Oomirtautt Cobr Redotc Description Texture Sbtrcgrre Cortsisilence Boundary Roots GPDtflz in. Mussed pct. Sz. ConL Cobr Gr. SZ Sh. 'EtT#'I 'EB#2 Z 2- - '- ~cS c Q c S ._--_ s- 1- .~ lL d TSS < 30 ~ . ~......... ~... onn ~ art c mt ~mA arm TSS >30 < 1 50 trtsrA. t.#2 = Bpp an y < 3a rr1g ~_ ~...-----°- ---a - ,9t • '~ address Fogerty Plumbing & Perk T sting l2 t..ST NiMtoer a~i~D' - d I _. ~~_ ~ ~~ r ~ ~c ~sDi W 'C X ~ N --~~ -~', t ~~ k~ ;.,. v o` o, .n b n~ n --~ ~~~ ~ ~ 4 • x ~" h '' '' i~ 1 ~,, ~ ~~ la Z ~ 3 ~~~ e ~' ~' 8 ~ a c ~ ~ ~~ .~ 4 O b N V O N O 1-' O ~ ~R O N ~ ~ ~ v ~ ~ ~ ~ • O)- n N ~LLwaa`` ~ 1 W~~~""~ ~ ~ ~ ~ ~ ~ ~~N,03 ` ~ ~ ~ ~ ~ F~-~ d ~ Z ~~ . n Safety all¢ Buildings Division ~ ~ 20l W. Washington Ave., P.O. Box 7162 WI 53707 -7162 Madrson County C ~ Sanitary Permit Number (to be filled in by .) , ~sca-ns~n . (~) 266-3151 S Department of Commerce Sanitary Permit Application stagy Pvn I.D. Numbpr I ~ In accord with Comm 83.21, Wis. Adm. Cade. personal information you provide be used for secondary purposes Privacy Law, s15.04(lxm) ma _ • -~J . Project Addresi (if nit mailing address) y I. Application Information -Please Print All ]t~ormatila<s ~~ ~ t:~` ~ ' '~ ~ ~ ~ ~ ,/ Property Owner's Na me Parcel / ~ Lot i Block p ' (/ ing Address a il M Property Owner's on / ~ ~~ , ` ~ t City, State ~ Cow One ~~ t~~Dlat/ .~~t91 T~f = ~~'~ ~.~+ (circle o > T N; R1~E -- II. Type of Building (check all that apply) ~ y`~ ~ ~L iivision Name CSM Number . ~ 1 or 2 Family Dwelling -Number of Bedroott~ _T ~ ^ Public/Cottunercial - Desert ^ State Owned -Describe Use .s C~c~~ I.J ~ ^City-^Village Q;1/Ownsbip of III. Type of Permit: (Check only ate on line A. Complebe line B II ap>~icable) A' mew System ~~ ^ Replacement S ^ Treatmcnt/Holding Tank Replacement ^ odifica ' Date Issuet( ^ Change of ^ Permit Transfer New .t B. ^ Permit Renewal ^ Permit Revision Before Expiration umber Owner Type of POWTS (Check all that 1 f S - 3 ' ..S' ' .~ T rv ,,~~ ,. LN'NOn -Pressurized In-Ground ^ Mound > 24 in. of su ^ Mound < 24 in. suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ nstntcted Wetland ^ Pressurized In-Ground ^ Holding ^ Peat Fitter Aerobic Treaunent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Line ^ Grav Pipe ^ Other (explain) Y. D' rsal/Treatment Area Info 'on: ~ ~ Design Flow (gpd) Design Sotl Application Rate(gpdsf) Disptxsal Area fired (s ~ Area Proposed (sf) System Elevation f- / fY 3 ~ ~-i 9s•Y .>•' ~ ~ • ~ VI. Tank Info Capacity in Total Number M r Prefab o C Site Coastr+tc6ed Steel Fiber GLtss Plastic Gallons Gallorg of Units e txtcre New Existing ~ Tanks Tanks Septic or HeIQn+~Fank -Lf/~i~ 4 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statt~erlt- I, the'itnda~ned, assume rt~pat for of the sitotmn ~ the attached phtns. Plumber's Na me (Print) Plumber's Si gmture RS Number Business Phone Number erty Ptumbtn~ ~o g ~ x T~.; - .~ _ 960 p ~ b~ Plum G~"LBZf l~ Mate. Zip ) 7/5-~-35 = 3 1 ~G ~X Spooner, Wi 54801. Si- ot- nd VIII - 7 - L Approved ^ Disapproved Sa~r9 Panto Fee (' eses/Groundwater ~U Surcharge Fee) ~ Da g tog t Si o Stamps "" " ~ ~ ~ G2~~~- ^ Owner Given Reason for Denial IX. Conditions of Approval/Ressons for Disapproval ~ ~ J ./~~~_ ~~• ' Q`" ~ ~~~~ YSTEM OWN ~ 'fiffuent filter and SyS~wYt Qhe.~ Of ~- ' n , e 1 dispersal cell must all be serviced /maintained ST ,S, ~ ~Q~tn ~ ement plan provided by plumber. - / er mana s ~ g ~ O ,.. , p a 2. All setback requirements must be maintained ~, ~,y~f-,Q.tt,,~ 7z!/Ynf~-O~- cc~~ as per applicable code/ordinances. /V(Q ~ ~~~ ~./ ~ O ~~A ap Attach complete plans (to the Com y) for the system on paper not tern than 81/1 x 11 inches in v'ize Fogerty Plumbing • #221180 28288 McKenzie Rd. Spooner, Wi 54801 _ (715) 635-9609 ~~/~ r r c- ~- ~"'~ ads der a-r 6~vT '~/~ ,~ a'2 scr1+C~ / `t .tv ~ rt. G ~i = ,tcr ~, y u a "' ` Pl 6 ~ O /i.tS?~ mac. s.7; • ~ ~ • t Fa+~avD coT cae~'7~ ~v/~v~ rt ~ u.~tc Y ~oR~ - ,~'o~*E ~~ 3' 1 .f'7 S l e-z p~ ' c.~6rN ~ ~~.. Y ~j!'E: js',rlGC /7FE ,Q.ws ate/ •r~T /.~~ F~avd~ Tbfc rcirL.E po~sw'7 wORK~ 2 .fiv0 STIV~iE T/Xzs LsT Kul LB7'~ dF ,~rt/~,FCisRcE ~.f .~+~ .~ - E fZ~,cr, ~ 1t~/E ~dkrt..aa-c r s scw~L~ 6m~r/~ !y Lmc,~r.F Th'~ ire •i )S9'E.t/ fj~!/G ~ttE ~C~~~,Ir '~ ~e¢pp F R ~W r ` ~ ,~ s' • Fogerty Plumbing • #221180 • 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~~/~ ~P~~~ ,lain?` ~/y/of~ GBT ~/o rX#/ _ ~7,. 70~ ~f' ~/'y '1'~c-rl ~'a~ /ago ' Q ~s = .tcT- ~l a a p `~ P1.6 i O ~i.1S?' C-~+'L• t-T. • = fAKND COT c~7t ~v~ie~~ ~ ~ w~[[ ~~ 3 ~75~ ~ 9s.'1 ' w 1 ~ r ~jJ'E: 1svtcrt' !~ ,~~ws crr~v .viT /sue Feavd~ Tlf~ ru-L~ paES.d•T wotK~ W r ~ r l ~ ~ i ~ 2 .f°.v0 ,n-~/c,E Tlfss Ls7 t~ftl' LO1Y dF ,,rv~FCNi3cE .R~c~rf f-.~ .~ E .._- sFfr.~~ , Ti7E ,darG~Aa'L r s sca.~Lr 6eo~w~~ !y Ldc,~r.~' r~•e ~rE •~ JS~E.(/ /yit~/G EKE ~C•f~~sr,/r' •~ ~s~oo ~~ ~o iJS' ~- 6-- ~ •~ / I s~~ Ew~S,r'c` a~z ~ ~. t a-r i~o R z got. s' 6e' i .1/4 OF THE SE1/4 fY, WISCONSIN. _, r NE CORNER SECTION 10 DETAIL NE CORNER SECTION f0 3 . M ~ O~~ 0 Vl , ~~ ~ 3 .~ ?W? IF LOT 11 ~ .~ \ I~ LEGEND AUIMINUM COUNTY SECTION COMER MONUMENT FOUL • 7 IRON PIPE FOUND ~ 1• IRON PIPE FOUND 5d BUIUIINO SETBACK FROM •••••••••••••••••••••• RIOHf-0F•WAYUNIESS OTHERWISE NOTED ~- 17 WIDE UTILRY EASEMENT 1RAINAGE STORM WATER REIENRON J1~SEMENT AREATOH.W.L N.L. ~ 914.0 paoYEAREVB~rt) H.W.L ~ HOH WATER UNE ELEVAnoN F.F.E ~ 918.0 FINISHED FLOOfi ELEVATION OR WINDOW ELEVATION IIIIIIIIIIIIIIII jj +w..vv 0 X 927.9 ^ . ~___~ QOOOOOQ ~.... 20% OR GREATER SLOPE 12%-19% SUJPE TREE UNE E)aSTINO TREE SPOT ELEVATION E7aSTIN(i FENCEUNE E>OSTINO POWER POLE ElOST1N0 CULVERTS SOIL BORING PREVIOUSLY RECORDED DATA PROPOSED DRA'E LOGTION nmcv !`fMJffY IR o Q °, °~° ~_ o ~ ~ ~~ j~ ` b C~ _ _- - -~- ~ j ,~, c ~' a• ( ~ ~ ~• a~; ._. "r ~ - '` ey l - ' 1 1~ ~:. ~,!~ ~ . ~~; ~ \ i ~'~' i .~ . -.~ ~ 1.~ F l+' H m o ! O ., .~ 5 e '+~ ~° a4 p ~- ~-_.._--- _ -_ -~; ,.~ II F+, - fr ~ ~ ~ ~ s N c~ ~- ~_ II II € ~ ~ . `9 Q- c~ II ~~ V `1 e~ 0 () a 4' °' ry ~ o 1~ ~- ~^ l +.,H! ~~ 1"= 0 N VON O ~ ~ (~j17 ~~~ w~~~~ o.PN 0°r 1D p ~ 3 ~a ~ '~IVi'sconsin Department bf commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ~ of u, aw:u,awnu: n+r,u, t,an nn, vv, ma. rwn~. wait County ~ I x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must indude, but not limited to: vertical and i~rizontal reference point (BM), diredion and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel l.C (pZa - I o'}-10- Ot3'o ~• ZS5'~ Please print all info 'on. Reviewed by Date Personal information you Provide may be used for sermn ry (m))• ~ I Z(SU; , property Owner ~ rty option 1`~ E'Y Y~ G ~"~ ( ~ 5 Govt. L s t= 1 /4 CJ ~ 1 /4 S ~ Q T Z 9 N R t 9 E (or) Property Owners Mailing Address ~ q` ~ t # Block # Subd. Name or CSM# ~ -~~ LQ _cROI I~ G City State Zp Gode ING OFFI ^ Ci ^ ~flage ~.T Nearest Road I JFyC~~ (1 `~ )~ - l~ h CD~~ New Construction Use: ~ Residential /Number of bedrooms ~~I Code derived design ifow rate ~-!~ ~ ~ ~ GPD ^ Replacement ^ I Public or ~nmeraal -Describe: ,1 Parent material ~U f W 0.,$ t'1 Flood Plain elevation ff applipble ~1 r4 ft. General comments ['Y 5 f -.e ~ 2 ~ ~- i~ ~ ~O ~ 9~ 0 U ~O ~-t~ e r ~/ ~. S~ and recommendations: / Boring # ^ Boring mfr ~n ~ /n ~_J ~} Plt urounu sunacx C,cv.1 ,~ -~ u. vcpu, av ,u,uuny ,awv, ~ ~ n,. Soi! Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Et'f#2 ~ ~ 0 ~(2~ ~ ~ i I mnbk -~'r cs l ~~ ~ Z i _ ~ 1~ `I --- 5i r c 5 -- . 5 _ ~ --~~a 10 f-1 ~ CAS ~ ~ '~ . ~ r. Z a.'r 9Y• ~ r ~` (~Z Boring # ^ Boring n ~/' , }7h =J ~ Pit urouno surrcx~ e:,ev. r [ter rOLI ,~ ur.~ru, ,~ ~u,mw,y Iowa„ - u,. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Coku Gr. Sz. Sh. 'Eff#1 "Eff#2 5Z _i 20 r `-l ~ --- rY~ .~ ~S ~ - . ~ ~ /_ 2 ,,~-q2 . o S$'' 2'/q~ • Z 'Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign ~ CST Number -CU ZS330g Address Date Evaluation Conducted Telephone Number Zll3 Fs-c~r~` S~: sow,ersef ~1 s'yozs 71s z~~ yooFl Property Owner 1 X_J~~_) ~ ~ Parcel ED # Page ~ of Boring # ~] Boring pit Ground surface elev. q ~ /a ft- Depth to limiting factor ~ in. Soil Appligtion Rate dox Description R Textun: Structure Consistence Boundary Roots GPDiftz Horizon Depth in. Dominant Color Mansell e Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Efi#2 I b-12 1~ ~ 2 ~~ 1 Z ~'~' c5 I 5 . g J.' ~ U r_~ ~ qy.o ~~~ D Boring # ^ Boring ^ Pit Ground surface elev. 8. Depth to limiting factor in. Soil Appliptron Rate dox Description R Texture Sure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Mansell e Du. Sz. Cont Color Gr. Sz. Sh. 'Eff#9 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft Depth to limiting factor in. Solt Application Rate l Redox Description Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. or Dominant Co Mansell Qu. Sz. Copt Color Gr. Sz. Sh. 'Eff#t 'Eff#2 `Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = GODS < 30 mg/L and TSS < 30 mgtL 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 (8.07100) ~ ~ ~. PAGE~OF~ NAME Q G S1 LOT# I O T EGAL DESCRIPTIONS ~SF~ ,S Io T Z~ ,N R. ~`~ E(or~ ~CALE: 1"= y ~' BM 1 ELEVATION /DU- o u BM 1 DESCRIPTION p cs -~ ~ $f-e ~'I ~°~~ ~ BM 2 ELEVATION ~(P • (~ D ~~ BM 2 DESCRIPTION ~ (J c~-~~~[ S~~ e/ ~ ~ SYSTEM ELEVATION -~o p QN• a `~ Lc,u~ e r 4 3. S~ ALTERNATE ELEVATION ~-cs~ gZrS~ ~-ucv ~..,r- ~IZ,G~ CONTOUR ELEVATION ~~ by 4- 9 ~.Q6 SPC ° ~~ --t- N ~~- ~ c~ ~ ~ S M }~ ~;QS C~~}~~ D~ qQ'°~ ~~~ ~' s ri c V' SIGNATURE ~-~ G DATE ~ Z ~~ G ~ - ' ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer ~-~" ^ ~, ~{ tJikc~~ Mailing Address _~,y~, LQ ~~ ~~ Property Address ~ O~ ~ ~ p h ~ (Verification required from Planning Department for en w City/State LEGAL DESCRIPTION ~~~ () 6 2004 CRuix ccurr ~ Nl~~r OFFICE Parcel Identification Number ~ S~~ Property Location ~,E '/., SF '/,, Sec, /U . T~ 9 N-R~~~~, Town of ~ci,~o.}~/ Subdivision s /f~~i~~J) ~pnc~/t Lot # y _~~ Certified Survey Map # Volume Page # Warranty Deed # ~"~ l~ / Volume ?s Z 3 .Page # o ,5~3 Spec house es Lino Lot lines identifiable CN~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 in 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andJor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIG TUBE OF PLICANT -~ / / v ~ 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. / ~'/ d '~ SIGNATURE OF APPLICANT DATE- ****** Any information that is mis-represented may result in the sanitary pernrit being revoked by the Zoning Department. ****** ** 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 r '' `~ _ ~ 1'UW 1 b VVVIVCIt .7 IVIg1VUNL O[ iY1MItlM~7L.~r~~~~ ~ ~ ~^~~ rnyn ~ v~ 1=11 F tNf:ARMATION Owner Permit ~ - _ nccv=N aeaeae~tzc Number of Bedrooms ~ ^ NA Number of Public Facility Units _ ~NA Estimated flow (average) 7~ gal/day Design flow (peak), tEstanated x 1.5) ~ gaUday Soil Application Rate _ gal/day/ftz Standard Influent/Effk~ent t]tiatity Monthly average` Fats, Oif & Grease iFOG} 530 mg/L Biochemical Oxygen Demand (GODS) 5220 mg/L ^ NA _ Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent O.uality Monthly average Biochemical Oxygen Demand (BODsI ~i0 m9~ Total Suspended Solids (TSS) 530 mg/L ^ NA -Fecal Col'iform (geometric mean) _<7O' cfu/1OOml Maximum Effluent Particle Size Y8 m dia. ^ NA Other: O NA "Values typical for domestic wastewater and septic tank effluent. cvsrciul CPFfyRCAT10NS Septic Tank Capacity - .Sd ~ ^ NA Septic Tank Manufacturer .. ^ NA Effluent Filter Manufacturer Z ~ L ^ NA Effluent Filter Model _ 0 ^ NA Pump Tank Capacity al ~ ~ Pump Tank Manufacturer ~ NA Pump Manufacturer i~ NA Pump Model DNA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: C1 NA - Dispersal CelNsl In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ ~~= Other: _ ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service ~ Inspect condition of tank(s) At least once every: ^ month(s) tMaxunum 3 years) ~ mss} [] NA Pump o_ut contents of tank(s) When combined sludge and scum equals one-ffiud IYs) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) ~j y~ts} ^ NA Clean effluent filter ~ ~ __~ At least once every: ^ month(s) ~ ~ ~ year(s) ~ NA ^ month(s) - ~q Inspect pump, pump controls & alarm At least once every: ^ y~ts} ^ month(s) [2 NA Flush- laterals and pressure test At least once every: ^ yearisl Other;- At least once every: ^ month(s) ^ ycer(s) _ rj NA ~Otfier: Q NA MAINTENANCE IWSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual canying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify ~Y inissrci9 ~ broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pond'mg of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation Pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Z. ~3 . fattT UP AND OPERAiJON For new constructiar-; prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the tseatrnent process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overbading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist m manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. _ ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: - • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN tf the POWTS f ' and cannot be repaired the following measures have been, or, must be taken, to provide acode-compliant replacemen stem: A suitable replacement yea has been evaluated and may be utiCtzed for the location of a replacerr~nt soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot 1'mes and wells. Failure to protect the replacement area will result in the need fa a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^_ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a h ing tank may be installed as a last resort to r ce the failed PO site as not been a lu ted to ide ify suitable r lacem t area. on failu of a POW a soil a_. e ati ust pe rmed o Iota a suit ble repl ement are If n replacement area is available a o ding tank ay e i ailed a a st resort place the f ile WTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFlCIENT 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. e,.e,..a.. or--~~: ~ , _ #221180 - c e n e Spooner W~ ~~'! (715) 635-9609 ~ POWTS INSTALLER Name l (Z~~ v Phone `7~S- lv3 - ' .60~ POWTS MAINTAINER - Name Phone _ ' SEPTAGE SERVICING OPERATOR (PUMPER) LATORY AUTHORITY • Name Phone LOCAL REG Name U ~j 1 G~ ~ x ~~ `'~ "' Phone ~(r -~ ~ . This document was drafted in compliance with chapter Comm 83.22(21(b)1111d1&(f) and 83.5M11, (21 & (3i, Wisconsin Administrative Code. -~ U 2523P Oy3 - ~ I) STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED This Deed, made between Rodney G. Nelson and Marvoetn rc. Nelson. husband and wife, Grantor, and Kernon J. Bast and Donaida J. Seer-Bast, husband and wife, Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): 7SE~ 1 01 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED fiOR RECORD 03 / 08 / 2009 12 : 30P1'i MARRANTY DEED EXEMPI # REC FEE: 13.00 TRANS FEE: 2175.00 COPY Fi:E: CC FEE: PAGES: 2 1 ROlYlfl f1YUlODi RETURN I t ~ Burnet Title 7550 France A~ ~ 5 First Floor Edina. IviN ~~~ `' \"I~T~: Post '~ - ~ <"'entc~.l 020 1009 20 000/ 020 1010 80 000 Parcel Identification Number (PIN) See Exhibit A attached hereto This is homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrar-~s that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this ' day of ~ Q ~ C.'(\ , 2004. ~~/ (SEAL) (SEAL) Rodney G. Nelson Mar et .Nelson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 4-22808 (Signatures may be authenticated or acknowledged. Both are not necessary.) " Names of persons sianinc in env capacity must } ss. St. Croix County 5~ y~P~rson I~C,came before me this ~_ day of / / / Q {'~ 1 1 , 2004 the above named Rodney G. Nelson and Marv Beth R. Nelson. husband and wife to me known to be the person who executed the foregoing instrument and acknowledge the same. Notary Publi fate of Wisc sin My commissio is ~l~ls'N.t~Er6~~t, s ate expiration date: NOTARY PUBLIC ) CTATF AF ]A[1_Sf`.AAICINI PAM A. SPENCER below their signature. NOTARY PUBLIC WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 - 1998 ~, Inc. Wis. 1~7 .• U 2523P Oy~I EXHIBIT "A" Legal Description File No. 4-22808 A parcel of land located in the N Y= of SE'/+ and the S'/: of NE'/s of Section 10, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin described as follows: Commencing at the E'/+ corner of said Section 10; thence N 00° 01' 51" W along the East tine of the NE'/+, 220.75 feet; thence N 90° 00' 00" West, 1312.43 feet to the centerline of a Town Road and the Northerly RIW of abandoned C 8 NW Railroad, said point being the point of beginning of this description; thence North 01° 00' 12" East along the centerline of said Town Road, 248.19 feet; thence North 89° 21' 11" West, 204.63 feet to a'/:' iron pipe; thence North 00° 34' 38" East, 15.29 feet to a'/+" iron pipe; thence North 88° 14' 28" West, 273.92 feet to a'/+" iron pipe; thence South 04° 09' 18" West,104.68 feet to a '/." iron pipe; thence South 86° 03' 02" East, 17.28 feet to a'/+" iron pipe; thence South 02° 53' 43" West, 282.97 feet to a'/+", iron pipe; thence South 89° 48' 40" West, 846.62 feet to the West line of the NE'/+; thence South 00° 05' 08" East along said West line of the NE'/+, 1334.48 feet to the Northerly RNV of abandoned C 8 NW Railroad; thence North 42° 01'.18" East along said abandoned railroad R1W, 1710.18 feet to the beginning of a 2914.68 foot radius curve concave Southeasterly whose central angle measures 4° 59' 13" and whose chord bears North 44° 30' S5" East and measures 253.61 feet; thence Northeasterly along the arc of said curve, 253.69 feet to the point of beginning. ~ N ~i~ar i 0 O~a . ~ ~~ r 1 V N a- °o r ~' ' ~ , ~ ~ ~ ~ ~ ~ i ~0 ~ ~ qr N ~ "7 • O ~ ~~ ~~~ c 2.\' --~ ---~ ~ ©.r• ~ -~ ; jam` ~'/• j' /.i -••_~• _ _ ~ ~`!Y•~~ -- •-""'© ' ~ - ~1~ .... • ...... % ~ / ~ .~' I~ ~ / ,. ~ •l• v' 7w ° O w =-_~ , j ~ c~ zm~ ~~ ~ T~ ~ ~ ! •m ~~° pmC 0 ~ ~ c~ I ~ I .j ~~ \ <N ~ o j m'~ , ~~b ~ Z ~~ 1 c ~' v ~ :, s4s.m~ 441.73' ~_ ~ ~ o Z NOO°28'21'E 1339.4T o .~ z n Z °'" S00°27'37'W 1207.56' m nom (n~/~A~~rn S00°27'37'W ~ Z z m Zvi ~~ ~---~ ~-~~~ m - N _-~~ !A ~ ~ ~ ~ aO~GD_° U__~ U Ul_J~uY~ ' ---- --------- -- - - - m O m r C ~ r ~ ~ O ~~~~=m ~~~p~z pmp0 .~ `'~°'~,```~o Safety and BtWdings Division County '' 201 W. VNashington Ave., P.O. Box 7152 C ~~~,~ Madmen, WI 53707 - 7162 SaaiFar7 Permit N~ (t~ be fiDed in by Co.) ~- ~ « 3151 - De artment of Commerce ~ snee Plan LD. Numba ~ Sanitary Permit h C d Ad W m. o is. In acted ~ Caron 83.21, e. f ,'~ `' % ij ~ _ , pt~ dmn IDailinB address) nadress (;if . may be ored for sxondary Purp~ w. s I. A Information -Please Prot Afl Idacmaitim ~ u u w ppiicatian ZONING OFFICE ; ~ , ~~s ~[~ L,r/, (,~Gta-d'r`-' property Owner's Na ~ / Puce] ! Low) - Block / ~i Property Owners M ailing Address _ to y Lnranon •a SS ~ l ~ /~ City. State Zip Code Phaoe Nanber or/ l ~ S- - 7775 T ~ 9 N; R (~ - - Ii d l rat app y) II. Type of (check a \ ~ ~/ ~ Snbd-rvision Name CSM Number -!~ ^'f or 2 Family Dwdliog - Nmmer of Bedrooms _~ ttercial -Describe Use /C n ^ P bli r ~ ~ t u c a - ^ stare owned - Deacrt'be use S ~ Z Z ~ Z3 -- - ^citl- f~l`.~nip of III. Type of Permit; (Ch~edc Daly me bey e~ line A. Complete 1~ B if applicabk) A' ^ i~ho~t System ^ Tcat~/Holdiog Tonic Repboement Ody ^ Odter MadiCicatioa to Exists System B. ^ Permit Reaeani C~hrmk Revision - ^ C6ao®e of ^ Permit Transfer m New List Previous Permit Number ami Date Lssuod Hefae F.spiraoion ~ ~ Phmt6er Owns' L j- rv. : (c~erlt a~n tlt~t of PoWTS sys~ ~ _ ton •-Pre&wraed to-Gmtnd ^ Mamd > 24 ia. of snirable sal ^ l~[amd < 24 in. of sapabie sal ^ At-Grade ^ Sm~e Pass Sand Filter ^ Conswctat Wetlaad ^ Presauizod In-Gratttd ^ Hokfmg Tank ^ Aerobic Treatment unit ^ Recirculating Sand Fil ^ Ret~t+atfuag Sys Mcda Filter B~ - Lae ^ Gr>w~ pipe other (~) V. Area Inf ,ts' - 13 ~- ~ - i t Design Frow (gpd) Design soa Appiicaaon Dispa~ Am Required (st) Disposal (s0 system .~ c-~ 970 - ~,J. r 7 VI. Tank Info Capacity in Tort Number Mawfacuaer Prefab She Sleet Fiber PI Gaibnc Gallons of ihtus Conasse Ca~trled Glaze ter F.xiaiw6 - Taaks Teats /¢ l~ septic or uot~Tanlc - .t_ra / S - v _ Aerobic Ttea~meot Um Ibsiog Chamber - VII. Responsbiility Statemegt I, the'imdes~ied. a~dme - for a of the POW1s shown on the attached pions. Ptmn4a's Na me ~ _ Plnmba's Si ~ -S Number Business Ptsnue lJumber _ Fogerty Piumbiltg ~ ~ T/.i - 3s- 9~0 Ptanb ~~~ c~' zip Cade) 7is-63s = s 1 ~6 ~x Spoorler~ WI 5480 , - - a L Ap~ared ^ saoimy hermit Foe (,acindes Giamd Date Issued Ism Sigmaxe Stampa age ~e~ ~ ~ - db • I r 3 Q ^ Owaer_Giver- Rsason for Deaiai 17L. Condttioat oJ' Appro for Disapproval 1 0 YSTEM OWNER: ep is tank, effluent filter and ~- ~~G ~ ~ ~l, /~ dispersal ceA must all be service /maintained (N ~ / . - as per man t plan provided by plumber. 2. se ac requiremen us a maintained ^- A '. ' G~ ~ J~ as per applicable codelordinances. ~,~" ~ T ~~ ~\n U1 r N '' f R~ _9 ~~ ,~ v ` ~ * 4 o' N I ~ ~ ~ ~ ~ .~ r N O ~ ~ ~~ ~bv ~ ~ ~i ~1 ~ ~ O h'J ~ $ ~ n0 'h ~ ~ ~ ~~ ,, ~ ® ~ ~ ~, ti ~ ~' ~ - V ~ A n ~ ,,, ~ ~~ ~' `I M t N~1~ - ~ ~- ~~ a WS ?S~ 1 ~~ N A- t ~~. ~~--- ~~ ~r ~ A ~~ ~ O Z N ..-o °N° o ~ °D t° 1 ~ '- ~~~~'~ ~D = ~ i°cn~ o3 t , p . ~vy' ~ 1 ~ g o o ~ o ~ ~ A ~ ` r + ~ a ~~ w --,'' ..c .a ~{ C O to w 0 d CD n f~A A a n .~ p+'. 0 ~. 0 O co . ~ G ~ ~ ~ ~ r ~ s F ~ ~ ~~- ~~ ~ ~ C f ~y t r t/~ ~ ~ i ~ _ ~b~w- .~ { ~ ~- - C Q ~ ~y'. '~ a .._ -• S- ' i • ,,` + ~ .: ,"~ ~ . - :~~~ _~ -~ i~ v ;. ~-~ ~'" t \ !i 1 s s ~ }~ _ _ ~ v. i :`- _ W ~. _ _ . i - ._ _ _ ~_ • c ~ 4 ~'=a (~ ~ ~ G . _ ~~' ~ .,°.~~4's~ N " •.~ 1 .. =. ~ ~. r ~ ~. ~ ~ ~' a ~° ~ ~ o '~ N w V N ~~ N V i F f i :f ..~ :.~ ~` ~ ~` ,,- ~ .- _. -- . - - i 1 1 Q. a tY ~• rt- W 4 O N C~ ~{ y •^' r' o (^' ~~ l L p'~ ~..~.a 1~a~+I~ Y r ~"! 0 ~--- Q\ 4 VON ~ 00 v(=p ~ ~ ~ ~ ~ N.~ Wry. ~-+~ c?'--~ ~c Wpm O~ 3 ra R :` ~ `~"~ ,.... _- _.,. .. 1 y a ~ ~ WS o, n~ n ~ * 4 ~' i n ~~ n n ~' ~, 1t i ~ N 1 n ~ ti ~ ~ ~ ~ ~ ~ o ~ ~ ~ b o,y l1 c h ~ ~~ .~~~~- ~. ~~~ ~ ~~ ~ ~ ~' g ~ ~ ~o ~ o ti ~ ~n o O` h ~I - C ~ ^ _ V` "~ A 1~ ~ ~~ O O` O ~~ ~" w --, - ~~~ ~ ..a °O o ~ o ^-~- ~ I~ ~ ~'m w ~ ~ ~ wgx~~~ ~-~ ~G ~ ~ ~~N,o3 Q y ~ ~ O ~ ~ ~O~ 3 T ~~ Y p, A p _ \1 _' -~ -t ~ i . wsconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings ~, Code " ' in acco ~ ~ (` ~,~y "° County Attach oornplete site plan on paper not less than 12 >~ttritt~s'tEi~-ptan S include. but Trot I'irnited to: vertical and horizontal tererrQe poem tBM). duectiar a~d Paroel I.D. percent slope. scale or dimensiars, north !V !J 'J and ~stan~~to neaPest road. - ~ O !V lJ ,d Date p anon. Personal infarrrralion you for - - s. t~.t>4 (~) (mtb - [~%~Yv'-= I» , Oemer LocaUa- _ Govt tAt 1e. t/4 S'F 1/{ ~S T 2 N R 9 E (o~ property Ovmer's MaiNng Address Lot # Bbdc # Subd. Nance or6~S1A1~- ' ah+ state ~ Zrp Gre Phase Number ^ City ^ Vtllage Nearest Road ~u v,/ o t ~ u 'U Nevi Cautruction Use: (i]~Residential I Number ~ bedrooms Cade demred design 8oe- rate /~ 00 GPO ^ Re~acement ^ Public or canmercial -Describe: ^ ` ~ Parent rreteri~ (Q/.~7~L~/!!~~ Flood Plat elevatan ~ appicat>te ~~ ~ Genewl aortxnents ScJ~,~jyr ~L.Ev: ~tG '~~ ~7 Q ~-~.S" and recorrunertdations: ~O~//ri~/~/-~•t1I¢L st ~ ` y'~ ~ ~ ~~ # r^B t~ Ground surface elev. . 7 1t- DeP~ ~ ~~ -~- ~- Sal Applica a- Rate Horizat Depth Dominant Caor Redox Description Texture Structtue Consistence Boundary Roots GPDlft= in. MunseN Ou_ Sz. front. Color Ge'. Sz. Sh. •Eff#1 'Eff#Z Z 2 _ - ,~_ S ,/~ 7 "- 'S ~ ~ ' ~9 # ~ Pit Grotxid s~ruface elev. p.3 fti Depth b 6-nitin9 tartor --C~-'n• ~ Apppcatiat Rate Horizon Depth OomuraJtt Cotor Redox Description Texdre ShtrcBxe CArrsislldtoe BaundarY Roots GP[Ntt2 in. MunseG Gu. Sz. Coot Color Gr. Sz. Sh. ~~ ~~ ~' /~.~ ?~ /n rn . S/~!~ - /yts G S • Eflluextt #1 =BOOS > 30 < 220 rttgA,. and TSS >30 < 150 mglt. #2 = BOD3 < 30 mglL and TSS < 30 mglL t~ f Number to lion Ganducted Telephate Nut dress Fogerty Plumbing & Perk T sting ~ --- ,r 9~ ,_ __ .- -~ nnnnn u_a__-. _ ~~ ~' v ~ m 0-~-~ ti l cV ~ ~ x~ w ~c ~ `~ N ~'i r ~- k~~~ r,. V d \ o ~ 4 • n ~" h ~' ~' ~~ ~ o, It , ~' ~ Q ~~~ o ~ ~~~ ~~ ~~ o ~ e ~ --~ ~ ~ ~' 8 ~ a C ~` ~n ~ ~ ~ ~ ~ ~~ o° TM ~ O b ,. n w ~~ ~-~ ~ ~ °o ~ ~ 0 ~ ~~- n N ~ ~-~ ~C ~ O ~ ~ ~ a oa n \~ Safety a~ Buildings Division 201 W. Washington Ave., P.O. Box 7162 ,~~~~,~ Madison, WI 53707 -7162 Department of Commerce . (~) 266-3151 Sanitary Permit Application In accord with Comm 83.21. Wis. Adm. Code. personal information you provide may be used for seoottdary ptttposes Privacy law. s15.04(lxm) I. Appliratim Inforatatim -Please Peuut All Inforna~im ~,~'~ ~~' ~ ~ ~ ~-~ - property Owner's Na me , , /~ M B ,E f t 'i. 3 L. ~~ `1 `l ~~ r r ~~ Pr~erty Owner's M ailing Address ,.. City, State Zip Code pitoce Nttatber II. Type of Building (check all that apply) ' / y~ ~ -~~ . ~ 1 or 2 Family Dwelling -Number' of Bedtroottu '7 !/ ^ public/Commercial - Descri ^ State Owned -Describe Use ~ ~sT • ~~ ~~ ~~ a ~:-T , County Sanitary Permit Num`beLr (to be filled in by Jr~ 7 State Plan I.D. Number ~~~ address) '~ p~ ~ Lot B Block N - ' ~ ~ r-=- ~ lion ~.~ ~ / (circle o T N; R~~E ivision Name CSM Number ^City ~^Vdlage ~t'iiamship of III. Type of Permit; (Check only me on line A. Cmlpl~e line B if ap~icable) A' ~j1~1ew System ^ Replacement S m ^ TreattnettdBokling Tank Replacement ^ odifica ~~ B. ^ Permit Renewal ^ Permit Revisbn ^ Change of Date Issued 't ^ Permit Transfer New _ Before Expiration umber Oamer rv Type of PowTS s (check au that f s - s ' . s ' ,s S ,~ LM'NOn -Pressurized In-Ground ^ Mound > 24 in. of su ^ Mound < 24 in. suitable sot? ^ At-Grade ^ Single Pass Sand Filter ^ tt..trttcted WethtM ^ Pressurized Ito-Grouad ^ Bolding ^ Peat Filter ~ Aerobic TreatmerK Unit ^ Reciratlating Sand Filter ^ Recirculating Synthetic Media Filter Leaching C hattrber ^ Line ^ Grav ess Pipe ^ Qdter (explain) Design Flow (gpd) Design Sotl Applit~tion Rate(~dst) Dispersal Area (s Area (sf) System Eleiration C- / >tIG 3 s... ~ o. ~-Z 4.s-.y Tank Info VI Capacity in Total Number M c r Prefab Site Steel Fiber Plastic . Gallats Galiorts of Uttbs Concrete Con4trttaed Glass Near Tanks Existing Tanks G Sep[ic or FleleEetg~`i'atdc ' .u/eit Aerobic Treatment Unit Dosing Chamber vII. Responsibility Statement- I, the'ed, assume rtispoty far 'm of the shown on the attached plans. Plttmfaer's Na me (Print) Plumber's Si gnature RS Number Business Phone Number _ Fogerty Ptambtng „k x 7/-i - 3 - 9`0 Plutrtbo~~GtStS l~ ~taoe' zip ) 7/5-~-3.5 = S 1 ~~ FAX Spooner, Wi 5480. .ri- o,~- vd VIII ~ ~ ~ d S~rY Permit Fee (" ^ Di Groundwater Da irtg t Si o Stamps sapprove Approved Surcharge Fee) ~ ~ V ~v ~ / ~ ~ G2~ ~~- ^ Owner Gtven Reason for Dental lx. Condi&ms of ApprovaUReasons for Disapptroval YSTEM OWN 1 n , e uent filter and dispersal cell must all be serviced /maintained as, per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to sys~~ ah~ of ~- ~ ~~~ ST .Sr,le dart, ~,~ ~~-~`vno-L- u,~..~h ~~ for the system on paper ant less than 8112 x 11 inches in Fogerty Plumbing • #221180 28288 McKenzie Rd. Spooner, WI 54801 , (715) 635 ~~~ ~/y~of~ r ~o~ ~~i c- ~'-- r ,tr,.~ c~,,y~"'rl' ~~~ a~~ a-r ro ~ - LvT ~/o ,~, a-2 Sc~,G~ / `t sv ~ DoT. s' .d#/ _ ~it9~ 1~/ ems' ~f, ~s~/rrl r~ ~o ' Q +~~- ° .kT- FPM a a a `~ Pt 6 . i ' sb' r - ,8me~v~ ~ ~ FIDKND LOT G~-7l ~~~m~ nt ~ u-~cc y~o~~ - ,/o~~' tysncK,; c-l f~~ W ~ r ~~' fT ~ 1 ~ ~~. y' ~ij!E: 1s'w(C~ /7~E B.w s cfd/ •riT A~ /SDNNd ~ TbF~ st~+rL.E po~s.d •T wO~K, 2 .fo~0 sr~vGE TI-xs !eT K.1~1 L.v]'X dP ,~rv~s~ci//f~ ~ F+/~ .~ - E t~rrf~ , TflE d~is'L4~~C r s scs.+~Lr 6sfi~/~ Ty LdG.~T.F Tom' NrE •~ J`B'E.t/ /~}ifdG ~1tG ~C~~E'.r,/r' "~ ~i¢O0 F R C ~ ~ f~~L i ~ ~ _ r ~ W ~ ~ ~ ~ l i i i t i Fogerty Plumbing • #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~~/~ ~P~~~ airrr- ~/y~oy GAT '~/o Sum / `s .i79 ~ ~#/ _ ,/'M~ 1st ~F• /Y '1"lcrl ~a~ ~O ' X = ,a®,er.~v~ • ~ Fa+wND coT ceyew~'/t w~~~~ !Y = w~ [[ St~SJ~aJH~ C-/ l ~~ 3' ~7 ~ c-i.. Q~ ' t~6rN ~ ~'~•.'y ~~ /~ i ~~' ~- ~ s ~"~Y a,z ~~.~ s-i i~o ,(f-2 ~a1. s' ~~ qs.' ~\~ I~ s_ 3 ~` y /~pQi" ~~~ w 1 ~jT,E: jXA'i4Gf' l~ Q.ws cf+•V .wT /.3~ /~siivd~ rlf~ ruLE ae~sw•T ~.-o~K~ s---" L ~ ,,/" ~!a/ L ~ ~ rJ - l ~ .fv0 ,n-~c,E rhss !eT <f•*r EaTS eF ,frv~tc~i3~ ~~ /+~ •~ E ..- f'~1Tf'~vv ~ Ti9rE ,darLA~L ~c S scr+~Lr 6~~wi~ Ty Lmc~rt j`iSf.E /'flE •~ • NE CORNER '~ SECTION 10 ~ 911.2 31 /4 OF THE SE1 /4 O X %/~ tY, WISCONSIN. / %% ~~~~~ DETAIL NE CORNER A SECTION 10 7 _ 3 . ~, o~< N ~~ O~~ s . ~' w ~ 912.1 / - %% SEE DET ~~ J) w ; ' \ LOT 11 ~ '\/ / :' / %/ X ~~ Xsfs. 929.1 _-- _ X 26.5 X 921.5 / i ,, 1 j // % % -l ~ W / .%•~' / ~ ~;%/ ° o i X \ 9// 917.3 91 X4 ~• LOT 11 z• ~ p~ 2.48 ACRES \. FIEV. }921.66 (2.4 A .) X •, ~\ •~ 91 S.0 ~ Xsi2o~b ~\9~•t? 91 '~~ LEGEND X 9t7.s ~ fV ,\ ~ ALUMINUM COUNTY SECTION COfAIER I, I T4 3 907 ~ MONUMTM FOUND O ! 01 I • ~ i ~ ~ r IRON r~IPE FouNo (U j - X919.5 L `. 910.6 ~ ~p ~ ~ 1• IRON PIPE FOUND - • INNp ~ F o a~t •( ~ ^ ~9 •••••••••••••••••••••• RIOHf-0F-WAYUNLESSFROM OTiHT1MSE NOTID W ~ ~ ~~ ,~ N , _.._.._.._.._ ~ V ~ 924 ,' ~ ^ ZS 1z wloE unurr FnsanEl~r X ~ ^ DRAINAGE STORM WATERRETEWIION • ~ ~~ O ~°t ;911.0 EASEMENT AREA TOH.wI ~ 917 H X H.W.L. ~ 914.0 paoYEARtvErR) I X 0 ~ o H.W.L ~ HGH WATER UNE ~1 ~ ELEVATION ~\ 9 T~.4 \ ~\ X'; H.W.L ~914A ~~ , ~ F.F.E ~ 916.0 FINISHED FLOOR EItVAT10N ~. ~' '• 100 YEAR H.W.L OR VANTX)N ELEVATION ~\ X17 • ''••., 910.7 ~ 06.3 a ~~ R............. X • _ • ` ~ ~ ~ a ' ~"~ IIIIIIIIIIIIIIII 20% OR GRFJ1TT3i SLOPE `~ ~ ~ / ~ V j j 12%-19%SIAPE ~ .._ ._ ._ .,~„~• TREE UNE ................. ................. ..... ... C E>aSTINO TREE 924.6 X 927.9 SPOT ELEVATION X • ^ EXISTING FENCELNE 9z .4~ X 931.5 X j ~ EXISTING POWER POLE 924.5 Y ~__.~ E>aSTiNG CULVERTS LOT 8 ~ 6-T 2.22 ACRE:8 ° ~ . SOIL fiOPoNG (2.2 AC.) ",~ a E QOOODOQ PREVIOUSLY RECORDED fMTA ~ PROPOSED ORTVE LOCATION ~ ^ O ~ Y ~ _ ~~.Z / i~il1CY P(MRTY Ki 0 ~_ O N n O G N a Q+ b a c~ 0 c~ b n a ~e o ~ n r ~ tr tzJ ~ '~_ ~ t F+ ~ ~ ~: e ~ 's ~ E o 11 p ~ p ;_ ~ _ --, ._ _,- - _: ~.V ~. - ; } 'i _ _ '~ ? ! ~ ~~ ~ ~. ..;, .... =. :. _ ~' r~_ . ~ j ~ ~ : - a V' 1~+~ ~ . - • _ .` ~ ~' ~ ~~_- a o' a i i i f ~~ y ~ . _ r ~ .~ -.':' ~:l ~ y ; ~, ~~ ~ ~.... ` . oa ~ _ + f II , r .o ~ Q o- N n ~~ ~'h r ~~ ~ o C~ n~ i ~`..~`a ~,,~! V ~~ O ~"~ ~-r~ ~ d o ~-, ~ ~. ~ ~ = CD NN M N p' N O V O pq II II ~ ^'O ~ t~J1~ ~#~ `~ V w~X~~ _ b .o~N 0~ V ~p~ ~ ~'q i+ d p 4~ '~Ni'scxmsin Department bf Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page - ~ 3 ul awaJn+anw wlul a.vllun vv, ..w. run u. v wc County ~ t X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertipl and. horizontal reference point (BM), direction and percent slope, scale a dimensions, north arrow, and location and distance to nearest road. parcel l.C CQZa - I o} -I d- o00 ~• 253 Please print all info IOn. Reviewed by Date Personal information you Provide may be used for seco ry pu (m)>• 112lsD 3 , Property Owner ~ 3 ocation i err~G~~ a5 GovtL sL 1/4SE1/4 S~Q T~9 N R 19 E(a) Property Owner's Mailing Address - ~ J L q ~ ~ t # Block # Subd. Name a CSM# ~ __ c~ -I ~ , ~? cROI t ~ C,~ City State Zp Code ING OFFI ^ Ci ^ ~Ilage ~T Nearest Ro ad 1 (~ New Construction Use: ~ Residential / Number of bedrooms 3~~1 Code derived design flow rate ~~0 " ~o ~ 0 GPD ^ Replacement ^ / Public a commercial -Describe: Parent material ~U 1L W 0.;$, t'1 Flood Plain elevation if applicable N,~ ft General comments sYS f.L~ 2I-e-~(~ ra P 9~0~ ~i.v er rf~ S~ and recommendations: x1.L-~ . Cf (-e J . T~~ 97 .sue Gvw ~-~ ~Z/ oa Boring # ^ Boring nfr ~n ~ In __J ~} Plt vrvuna sunacx CICV. 1 r. -• - u. vcNul w nnuully loa.w. ~ ~ ul. Soil Appliption Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence "Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#'t 'Eff#2 Z i -~ I~ r`I -- 5. ~ ~5 - S _ ~ --i~~ ~0 y J --" ~S , -- - . ~ r. z 4~ roz Boring # ^ Boring ~~ ~ Prt VrUUrO Sunacx E'ItiV. / (/I //JV 14 UCr/U1 N Iu1NU1ly IG4aV1 Ui. Soil Appliption Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#'t 'Eff#2 I 0- Itj I(1 r~3I L _ .~1 Z-~~ rr~-~r ~ ° i v ~ 5 ~ 8 Z ~o-z5 ~ ~ r~ y --- ~ ~ C Z~-,o~ ~r~~ ~ ~ - . 5 ~ g SZ-120 ,- `1~Ze --- ~,n -~ ~s ~ - • ~ !- 2 ~,f-q Z . o SS•Z-/~TI.2 ' Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Sign CST Number (~ ~ - _ -C~ ~ZS33o9 Address Date Evaluation Conducted Telephone Number Zli3 ~rc~ra^ S~: Sow,ersef ~1 S"yo2.s 7-S' z~r~ yooF~ Property Owner ~~1~ Parcel ID # (-.-~-{ .. _ ~. ^ Boring ~ , , - 1 I I _ Page 2 of -~ ...3 . ®, pit Ground surface elev. Soil Appligtion Rate dox pescripti~ R Textun: Structure Consistence Boundary Roots GPDiftz horizon Depth in. Dominant Color Munsefl e Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i s-12 i~ ~ 2 s i Z ~~ ~5 i 5 •~ Z iZ- ~L ~~+ ,i ~ ~s - -5 „~- 9Y•a ~--~ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in• Soil Appliption Rate x Description d R Texture Structure Consistence Boundary Roots GPDIftz horizon Depth in. Dominant Color Munsell o e Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~~ ~____ ~. ^ Boring U ~.,....~ .. ~ Ground surface erev. ~4 uCN~~ ~~ ~~~~~~~,~y .a...,., .... Pit Soil Appliption Rate dox Description R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell e Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Etf#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = GODS < 30 mglL 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 608-2648777. ssn-ssso pe.mroo> j y ~. PAGE~OF~ ~TtLD~E Q ~S1 LOT# I O LEGAT DESCRIPTIONS ~S~~,S ~d T Z~ N R. Imo/ E(or~ ~CALE: 1"= ~I O ~ BM 1 ELEVATION /'QU_ o BM 1 DESCRIPTION ~~~~ ~~ Sf-e ~( ~'o ~ BM 2 ELEVATION ~{(~ • G~ D n BM 2 DESCRIPTION ~ P C~ -~~~ ,~ S f --e e / ~ 0 4' SYSTEM ELEVATION -~ p qy a ~' L~uf ~ r 4' 3. S7~ ALTERNATE ELEVATION ~ ~ Rz,s~ l~ycu E.-,~° ~I Z,~~ CONTOUR ELEVATION ~~ 6U 4- 9 ~.OtS SPCA ~~ ..-~- - N ~~- ~ c~ ~ ~ ~ ~~ ~ ~ ~ ~~ ~~ a~ ~q~°° ~~' ~~ 6 t ~~ ~-I C a"°Q SIGNATURE ~~ ~ ~--- _ - -- DATE ~ ~ G ~ - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer Mailing Address ~'Y~ Property Address ~ OD ~~C~~`1/~C~ ~~~ ~ 6 2004 ~T ~ROiX CGON~ ` ~NI~'~G orFict~~ ~.~- (Verification required from Planning Department for new City/State LEGAL DESCRIPTION Parcel Identification Number •R ~-~ ~~ Pro e Location ` `~ Sr ~ p m' ~_ '/,, Ste' '/,, Sec. /d . T~ 9 N-R_~Vi~, Town of _ ~uyso•r/ Subdivision ~~~~) ~~~t/t - ,Lot # ~_. Certified Survey Map # Volume Page # ~'Varranty Deed # ~'~ /~ / Volume ?s ~. 3 .Page # o ,y3 Spec house es Lino Lot lines identifiable L~Yyes ^ 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 in 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, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration data SIG TURF OF PLICANT ~ ~ ~~ ~ ~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are ttue to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~/ 4'/d~ SIGNATURE OF APPLICANT DATE- ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** 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 ~_ co F ~acnt:Me'no1-t 1'VW 1.7 VYYIVCI'[ ~ IVIAIVl1NL O[ ~Y1MrrM~ar,.rrr•-•~• • •-^•~ Ovmer ~i~'S~ _ _ ~~~ Permit # -(L- =-=j~~-'~ Number of Bedrooms ~ ^ NA Number of Public Facility Units _ ~NA Estimated flow (average! f /~;d gaUday Design flow Ipeakl, (Estuated x 1.5) Q aUday Soil Application Rate _ gal/day/ft2 Standard fnfluent/Effluent duality Monthly average` Fats, Oil & Grease iFOG} 530 mg/L Biochemical Oxygen Demand {GODS) 5220 mg/L ^ NA Total Suspended SoCais (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA --Fecal Colrform {geometric mean) 510' cfu/1 OOmI Maximum Effluent Particle Size YS in ilia. ^ NA Other. ^ NA `Values typical for domestic wastewater and sep[~ tank effluent. MAINTENANCE SCHEDULE . ~.,~i.or~ wTrnuc rayo ~ ~~ Septic Tank C~ac)ty ,~ al ^ NA Septic Tank Manufacturer - , j` ^ NA Effluent Filter Manufacturer Z ~ L ^ NA Effluent Finer Modem _ 0 ^ NA Pump Tank Capacity al ~ ~` Pump Tank Manufacturer Ci NA Pump Manufacturer (~ ~NA Pump Model ~:l ~` Pretreatment Unit ^ Sand/Gravel Filter ^ Mechan"~cal Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: Q NA - Dispersal CeH{s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: other: ^ NA other: ^ NA Other: ^ NA Service Everrt ~" •"'~ • ""''"""' ^ monnh{sl (Maximum 3 years) CI NA inspect condition of tank(s) At least once every: year(s) Pump out contents of tank{s) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls & alamn Flush- laterals and pressure test Other;- When combined sludge and scum equals one-third (Y3) of tank volume ^ marth(s) {lSllaxmwm 3 years) At least once every: 3 ~ vear[s) __~' At least once every: ~ ~ At least once every: At least once every: At least once every: ^ year{s) ^ month(s) ^ year{sl ^ month(st ^ near(s) ^ NA ^ NA t7 NA ~lA [~ NA _ ~ NA Q IVA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following fic~ses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell{s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The pond"aig of effluent on the ground surface may indicate a fail'~ng condition and requires the immediate notification of the local regulatory authorty. When the combined accumulation of sludge and scum in any tank equals one-third IY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within~l0 days of completion of any service event. Z ~ . aHT UP AND OPERATION For new constructiwr, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(sl- If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above nomnal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cel(ls) and may result in the backup or surface discharge of effluent. To avoid this situatwn 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 :~n manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. _ ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • -All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • • The contents of all tanks and pits shall be removed and properly disposed of by a septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS f ' and cannot be repaired the following measures have been, or, must be taken, to provide acode-compliant replacemen stem: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacemenrt area should be protected from disturbance and compaction and should not be infringed upon by required setbacks ftom existing and proposed structure, lot fines 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. RePI systems must comply with the rules in effect at that time. ^_Asuitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a h ing tank may be installed as a last resort to r ce the failed PO site as not been a lu ted to ide ify suitable r laceme t area. on failu of a POW a soil a . e atio ust pe rmed o Iota a suit ble rep( ement are If n replacement area is available a o ding tank ay e i ailed a a st resort place the f ile WTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFlCIENT 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. Cwsss.. DI--~~. ~ , _ ~7 .-.i _ #221180 . c enzle Spooner WI548~~ (7i5) 635-9609 ~ POWYS INSTALLER POWYS MAINTAINER Name I (~~~ ~ Phone `~~~_ lv3 - ' 09' Name Phone ~~_ ' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ~~ Name Name ~ 1 (~ (x CO~tl~ Phone Phone ~'(~ -~ ~ "~ This document was drafted in compliance with chapter Comm 83.22(21(b)1111d!&(f) and 83.54(1), (2) & (31. W~~ Administrative Code. ~~ ~ i U 2523P 043 ~~~'~'~"` ~~ - ~ II STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED This Deed, made between Rodney G. Nelson and Marvbetn rc. Nelson. husband and wife, Grantor, and Kernon J. Bast and Donalda J Speer-Bast husband and wife, Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 03/08/2009 12s30P?f MARRANTY DEED EXE:MPI tt REC FEE: 13.00 'TRANS FEE: 2175.00 COPY FI:E: CC FEE: PAGES: 2 RETUKN I ~ ~ Burnet Title 7550 France A~ = 5. First Floor Edina. MN `~-i " \-1 1T': Post c - :. C'entr2.l 020 1009 20 000/ 020 1010 80 000 Parcel Identification Number (PIN) This is homestead property. (is) (IS not) See Exhibit A attached hereto Together with all appurtenant rights, title and interests. Grantor warranis that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this ' day of ` ` ~ C,`l_\ , 2004. (SEAL) (SEAL) Rodney G. Nelson Ma et .Nelson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, authenticated this day of R TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, W 154016 4-22808 (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names of persons sionina in any capacity must be typed c } ss. St. Croix County 5-,Z ,~p~rson I came before me this ~_ day of J / 1 Q j''~ , X004 the above named Rodney G. Nelson and Marv Beth R. Nelson. husband and wife to me known to be the person who executed the foregoing instrument and acknowledge the same. Notary Publi fate of Wisco sin My commissio is ~pf~e~~~~t, s to expiration date: NOTARY PUBLIC ) CTATF AF 1A/IC!`~,Sil~l below PAM A. SPF_NCER NOTARY PUBLIC STATE BAR OF WISCONSIN Wisconsin Legai Blank Co, Inc. WARRANTY DEED FORM No. 1-'1998 Milwaukee, Wis. U 2523P Oyu EXH181T "A" Legal Description File No. 4-22808 A parcel of land located in the N'/z of SE'/a and the S'/~ of NE'/s of Section 10, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin described as follows: Commencing at the E'/. corner of said Section 10; thence N 00° 01' S1" W along the East tine of the NE'/., 220.75 feet; thence N 90° 00' 00" West, 1312.43 feet to the centerline of a Town Road and the Northerly RIW of abandoned C 8~ NW Railroad, said point being the point of beginning of this description; thence North 01° 00' 12" East along the centerline of said Town Road, 248.19 feet; thence North 89° 21' 11" West, 204.63 feet to a'/:' iron pipe; thence North 00° 34' 38" East, 15.29 feet to a'/." iron pipe; thence North 88° 14' 28" West, 273.92 feet to a'/:' iron pipe; thence South 04° 09' 18" West,104.68 feet to a '/4" iron pipe; thence South 86° 03' 02" East, 17.28 feet to a'/." iron pipe; thence South 02° 53' 43" West, 282.97 feet to a'/.", iron pipe; thence South 89° 48' 40" West, 846.62 feet to the West line of the NE'/.; thence South 00° 05' 08" East along said West line of the NE'/., 1334.48 feet to the Northerly RIVN of abandoned C 8 NW Railroad; thence North 42° 01'.18" East along said abandoned railroad RM1,1710.18feet to the beginntng of a 2914.68 foot radius curve concave Southeasterly whose central angle measures 4° 59' 13" and whose chord bears North 44° 30' 55" East and measures 253.61 feet; thence Northeasterly along the arc of said curve, 253.69 feet to the point of beginning. V N ~ -1 %D~~ ~ - • iar N ~ ~"1 • O ~ ~ 111 ~~r J a~ Dip ~~ r - - -- - .t. ® --~~~ (off- - - _, _. ~.~.._-~r~ ,~- 1 ~~ ~~~ c 2,\' ~r ~' /:~~ j~ i.~_ _ ~~~' - _' _ 15078_ _ _ ® - ~~ / ~^ f' ............ .•/ ._......__.. ~ ~ ~ R Qv ~. - .ter ~ --i ~~ ~i 1 .~ ~~O ~ ~ o w° ~'' N ~ ~ ~ ~ ~cn m~~ ~ ~ r ~' -~ I ~ ~ cz~ ooo~ ~ ~ I ~~~ ~ ~ ~ z ~~ ~ j ~ : m Z ~T m o NOO°28'21'E 1339.4T . ~ n ~ O m Z ~ Z ~ "' n S00°27'37'W 1207.56' ~ m ~ " ' om M M~~ S00°27'37'W Z ~ 1J L 1 ~ Y '~= = ~=r~ O ___ ~/_ J J U V r O C~r~~O ~~~~2m ~~~mnp ~ZOOD~o _, R ? i 1 \ ~`,V~\ `~y~ \ ,,```~\,"\OQ~ \ ~ ~ ~ ~..~