Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1398-18-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 561093 0 GENERAL INFORMATION 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: Searle, Brandon & Kimberl Hudson, Town of 020-1398-18-000 CST BM Elev: I Ito , 4411 Insp. BM Elev: BM Description: n Section/Town/Range/Map No: 6n ~ 4 22.29.19.2478 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER APACITY STATION BS HI FS ELEV. c ~I S Septic t r Benchmark ~ j, ~ / r ~v Dosing Alt. M Aeration Bldg. ewer ~ L 1 ST'7~ Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELP.t BLDG. Vent to Air Intake ROAD Dt Inlet Se tic Dt Bottom t 105 Dosing Header/Man. ✓ • 9 Aeration Dist. Pipe S• to g y. 3.9 Holding B t. System Le • 7 .Z Final Grade PUMP/SIPHON INFORMATION .3 9701 Manufacturer GP Rand St Cover y 2.5 /41` 77 Model Numb l~ g .5 ~ay7~ 1 7' ~ !7 • ~ I TDH ft Friction Loss System Head H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width J Length J No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - px J-74 Z SETBACK SYSTEM TO ~U t1-7 BLDG WELL LJ LAKE/STREAM LEACHING Manufacturer:~• L Iy INFORMATION CHAMBER OR .J-n P7 ~s` Type Of System: UNIT Gh ! G ' Model NuWer. u, DISTRIBUTION SYSTEM &ck. r D,K +-,zs t{SJPvwlb;bGae Header/Manifold .4 Distribution Hole Size x Hole Spacing Vent to Air Intake G Pipe(s) \ / Length • Dia Length \ Dia ` Spacing \ Sio j SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only S Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center y Bed/Trench Edges Topsoil ` Yes Q No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 835 Ross Rd Hudson,lWl 54016 W 1/4 SE 1/4 22 T29N R19W) Pheasant Run 1st Lot 18 Parcel No: 22.29.19.2478 1.) Alt BM Description = ~ef u u, G & Jk- 6.-- 2.) Bldg sewer length - amount of cover Plan revision Required? ❑ Yes No Use other side for additional informatio V r Date Insepctor's Sign ure Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Brandon Searle ADDRESS 835 Ross Road Hudson Wi 54016 NW 1/4 SE 1/4S 22 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/2/13 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of Septic Tank cover ASSUME ELEVATION 103.2' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.5/95.0 4' below qrade 2-3' X 94' cells with >3' spacing All piping shall be SDR 30/34, within 10' Property Line of tank, piping shall be Schedule 40. 4% Slope Vents B-3 Vent 25 45' >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 60' 5.6ft^2/pair of end caps B-1 0 2 r4'Long 12" Grade at System Elevation 5' 34" q.' Valuer 10' Well is to meet all ST setbacks required by WDNR 30' Existing 3 Bedroom House Scale is 1" = 40' unless otherwise lease note: benchmark is gone, going to use manhole cover as a benchmark, also noted sizing system to a .5 loading rate, just in Property Line case and give owner a larger system - - - County Safety and Buildings Division C 201 W. Washington Ave-, P.O. Box 7162__ Q-~ - x , w X 1r, ~,4d Sanitary Permit Number (to be filled in by Co.} Madison, WI 53707--7162 1 ary Permit Application State T'rartsaatLOLL 'Nurn er S In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate gove it unit er is required prior to obtaining a sanitary permit. Note: Application fouls for state-owned POWTS are std, U Project Address iffererrt $[au r[[uilirlg address) the Department of Safety and Professional Servies. Personal information you provide may b for se,.on _pyTo!ses in a[:cordancc with the Privacy Law, s. 15.04(1 (m), Stats._ L A lication Information Please Print All Information - - - s •12~ S35 Property Ow 's Narne -.+r3 ~,RO~ Para l - - - - - - ' t roperry Owners Mailing Address - / `Y Property Location 0, City, State Zi Code P Phone Nurnber 1A, 14, Section (arrcle 6on -0,1 -X T - N; I e 11. Type of Building (check all that apot or2 Family Dwelling- Number of Betira ` Subdivision Name FJ Public/Commercial - Describe Use ---..%~I ~._I City CSM Number L1 villa C) State Owned- Describe Use RC of__ ±-~lt 4ton~ 23 4.23C~ ..,Le s awn al ,LIL Type of Permit: (Chece box on line A. C;omlrlete Line $ if appGctrble) ❑ New System teplacement System ❑ Treatment/Holdn g, Tank Replacement Onlg' U Other Modification to Existing System (explain) it 'Trm[sfer to 2Jew List 1'reviousPetTnitNumoer and Date issued trl B• ❑ Permit Renewal ❑ Permit Revision El Change of Ylurttber tolwnol Before Expiration z~ 2 2~3 lt`V. Type of PdWTS S stemlCurn onertt/Device: (Check all that apply~___ Non-Pressurized In-Ground 11 Pressurized h7-Ground 11 At-Grade ❑ Mound ? 24 in. of'suitabh: soil ❑ Mound < 24 in, of suitable soil Aos id" ~,olding Tank ❑ r Dispersal Component (explain)- ❑ Pre abnent Device ex pl V. Dispersal/Treat ent Area information: - - - - w - - - - ----Design flow (gpd) Design Soil A lieation Rate d51} I)ispcrsal Area Rec uired (sf) - Dispersal Area Propose stem-Llevat < { Vi. Tank Info - v Capacity in 'l'ot 8 of Manufacturer - - - Ne_ - Gallons --G.. allons Units a + -wTaks I lQsTnk GX{T~~w ~3/ C ro LGr r~ U rn y rn w t5 n Sapiic or Holding Tank - - - - Dastug chamber - - VII. Responsibility Statement- 1, the undersigned, assn le responsibility for installation of the PONY-TS shown off the attached plaits. Plumber's Name (Print) Plumber' grlature - - - MP/MARS Num Business Phone Number - e 1~ z6 - V Ylurnber's Address (Street, City, State, Zip Code) I. Coun /De rartment Use Onl - Approved Pennit Fee~- Date Is-ued - Issuilt ent Signature e - en Reason Denial 475/ ' v rp 13 iX. Condi easous for Disapproval T1t►QIIV~l1tR n 'A~Y7 1. 5iptic tank, effluent fitter and 3) on, ~y61 k" ~ ~ O ✓tno.~^ ,dispersal cell•must all be servtces / maintained t { f as per management plan provided by plumber. f 2S~ C~ c~'i ti ► ti C'^• (~a'~"l A- ~8~ ~t/6~ 2. All i0l$$ ckrequirementamust-be maintained /e ~ 1/ as per gVic bls Cone I Ardifl x*& W r JeL, V'e- Attveb to cumpleie prams Cur the system and submit io the County only uu paper not IVJS than 8 1/2 r; 11 i1tChes in sue SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/31/13 Owner:Brandon Searle Location: NW1/4 SE1/4 S22 T29N,R19W 835 Ross Road Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Existing Septic a Sheet. Signature License nu 1#226900 PLOT PLAN PROJECT Brandon Searle ADDRESS 835 Ross Road Hudson Wi 54016 NW 1/4 SE 1/4S 22 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/2/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of Septic Tank cover ASSUME ELEVATION 103.2' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.5/95.0 4' below qrade 2-3' X 94' cells with >3' spacing All piping shall be SDR 30/34, within 10' Property Line of tank, piping shall be Schedule 40. ~ 4% Slope Vents B-3 Vent 25' 5' 7 >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 60' 5.6ft^2/pair of end caps B-1 0B9-2 4' Long 12" 3 4" Grade at System Elevation 5' Valve 4 10' Well is to meet all T setbacks required by WDNR 30' Existing 3 Bedroom House Scale is 1" = 40' unless otherwise Please note: benchmark is gone, going to use manhole cover as a benchmark, also noted sizing system to a .5 loading rate, just in Property Line case and give owner a larger system Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber , 5.6ft^2 pair of end plates To be >1 above grade Finish grade elevation Typical Installation 99.0' Vent Grade Vent 3' 4" 3' Ai30/34 Septic Tank 5' Long 1 91 51 5' Long 1 19 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A-95.5' B 95.0' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE./iGrREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/.Buyer ~ f~ / ' Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nut fiber OJ-0 LEGAL DESCRIPTION Property Location jV '/y , Sec. Z7 , T 07-N R.1~ W, Town of Subdivision D ~an lJ ~ dl t~ - S _ A 4 Lot # -c, a- Certified Survey Map # Volume Page Warranty Deed # 'Volume Page # - Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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, it 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 was le disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zo.n ing Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if'necessary), the septic tank is less than 113 hill of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departrr.ent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we arn/are the owner(s) of the property described above, by virhie of a warranty deed recorded in Register of Deeds Office. tuber of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds 0ffrce and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATIC:)N SYSTEM SPECIFICATIONS Owner v r S Septic Tank Capacity ❑ NA Permit # - ----_-._~al Septic Tank Manufacturer ❑ NA DESIGN PARAMIE7ERS;Effluent Filter Manufacturer N0 NA umber of Bedrw m.,- _ ❑ NA Effluent Filter Model - - ----✓~~?Z~ ❑ NA Number of Public :ai ilitUn is y - ` - - _$"A Pump '-ank Capacity -a~ NA Estimated flow (ao, eraig,3) - - E Pump 'l'ank Manufactur;sr IN Design flow (peak',, (Estimated x 1.5) ~~v ag ilday Pump Manufacturer - _ Soil Application Fl ate al/da /ft2 Pump Model - Standard Influentl'f::ffhien# Clu:alit - V Monthly average" Pretreatment Unit F,,:1 s, Oil $ G cease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical O:(ycie-i Demand (BODs) s220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total,"), isr ended Solids (TSS) X150 mg/t. ❑ Disini'ection Pretreated Effluent. QLalil- ~ Other: Y - Monthly average Dispersal Cell(s) 0 NA Biochemical O:,:ygen De:rnand (BODs) s30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) 01 Total S)usperided;3olids (TSS) S30 mg/L X NA ❑ At-Grade Fecal Col forn (geometric mean) 5104 cfu/100m1 ❑ Mound ❑ Dripl ire ❑ Other: Maximum Effluent Parice Siz ~ - 1 in dia. 0 NA Other: - Other: C7 NA Oth ❑ NA er - ❑ NA *values typical for dories;ic wastearater and septic tank effluent. Other. ~ ❑ NA MAINTENANCE SCI°IEERJLE Service C:ve1n1 liervice Frequency inspect condition of :an K(S) At least once every: ❑ month's} ar s' (Maximum 3 years) 1:1 NA Pump out contents r:f to nlu's - - - When combined sludge and scurn equals one-third O of tank volume ❑ NA Inspect dispersal cel (s)~ At least once every: 7 ❑ month's) x - ~ ear(s- (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ nonth!s) Inspect ----i----- year(s; ❑ NA pum-p, pump controls & alarm At least once every: ❑ earth( s) NA Flush laterals and pau: ss m:' test Y ( At least once every: ~ year(s) tl s) NA Other: - - At least once every-~ - mon(h, s) _ NA MAINTENANCE INSTII;1'UCTI0N1 _ NA Inspections of tanks; and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plun ibe r -Restricted Sewer; POWTS Inspector; POWTS Maintainer; >eptage Servii.ing Operator. Tank inspections must include a visual inspection of tho tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge anc sound ana to check for any back up or ponding of effluent on the ground siirface. The dispersal cell(s) shall be visually inspected to ;hECI: the flluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluont on the ground surface may indicate a failing condition and requires th-~ immediate notification of the local regulatory authority. When the combined eiexur7 ulai:ion of sludge and scum in any tank equals one-third ('/3) or more of the tank volume, the entire contents of the tank shall be re nouE+d by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, incl .idi 7g but root limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at in!enra's of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall I:: e f ruvided to the local regulatory authority within 10 days of completion of arnr service event. START UP AND (:1PEiRATION Page of . For new constn.a:ticn, prior to use of the POWTS"check treatment tank(s) for the presence of panting products or other chemicals the may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thr tank(s) removed by a ;epl:a!3e servicing operator prior to use. System start up ::hail not occur when soil conditions are frozen at the infiltrative :surface. During power oclaues pump tanks may fill above normal highwater levels. 011hen power is restored the excess wastewater will be discharged to the di:rpersal -ell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situatinri haves the contents of the pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or co,Aact a Plumber or POWTS Maintainer to assist in manually operating the (sump controls to restore normal level; within the pump tank. Do not drive or park vr~hicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area withir •15 feet down slo-lava cfany mound or at-grade soil absorption area. Reduction or elin inati.rn of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wilres; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapors; disinfectants; fat; foundation drain (sump pump) w. ate; fruil: and vegetable peelings; gasoline; grease; herbicid ,s; meat scrapf ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWI;a fEils and/,)r is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abanck: neI n coin ipliance with chapter Comm.83.33, Wisconsin Administrative Code, • All pipinla to tanks a id pits shall be disconnected and the abandoned pipE openings sealed. • The coniont, of all tanks and pits shall be removed and properly disposer of by a Septag(. 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 inortsolid material. CONTINGENCY PLAN If the POWTS fails and c:a,mot be repaired the following measures have boon, or must be taken, to provide a code compliant replacement systei ru G A suitabr;: replacern ant area has been evaluated and may be utilized for the location of a replacement soil absorption system. The repla,emcnt aria should be protected from disturbance and compaction and should not be infringed upon by required setbacks. l rorn i:rxisting and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soi! End site evaluation to establish a suitable replacement area Replacement systems must comply with the rules in effect at ti' at tin-ie. ❑ A suitably:, replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank indy be installed as a last resort to replace the failed POWT.i. The site has nclt bee'i evaluated to identify a suitable replacement area. Jpon failure of the POWTS a soil and sit must be pa::rfcrrned to locate a suitable replacement area, If no replacement area is available a holding tank may beeinstalledras a last resort to replac the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in plaice following n-~moval of the biomat at the infiltrative surface. R XOnstruct ons of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AN 1) OTIiEIR TREATMENT TANKS MAY CONTAIN LETHAL GA,3SES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, ;'USViIa OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DP-ATH MAY RESULT. RESCUE OF A PERSON FROM THIE Iwr'ERICIR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMI::N'r5 POWTS INSTALLER _ Name - POWTS MAINTAINER - j V: ` Name Phone phone SEPTAGE SERViC_ili OR EIRATy)R PUMPER LNamee LOCAL REGULATORY AU 'HORITY e-/ / Name ~ Phone This document was drafter .V in uorripliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2))L& (33), Wisconsin Administrative Code. W ~ w U 2 FWD- e '•U 1 Tall 321 -r_ . ]TV ML K ML ML MLA611 II III; N y...-__..-.- Y. r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK is to certify that i have inspected t :Nerving the he septic tank cu* Presently Iv!-J_~,' Section Z. -L residence located + I L , i /y Cil_ ~ T Z.c N, R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition functioning properly. and it appears to be Lost time serviced: bid flow back occur from absorption system? Yes -2", No (If no, skip next line) Approximate volume or length of time: gallons Construction: Prefab Concrete Steel Other A91--Mufacturer: (If known) : (~~-mss S - Age of Tank (If known),: a 00 ;Ignature)(Name) Please print (`T'itle (License Number) e Vorm to be completed by licensed Statutes) or Licensed Disposer (NR 113 umber isconsinSAdministrative, Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification:- In accepting the above statement regardin xisting septic tank condition, I certify that the tank to the b conform to the requirements of ILHR 83, W' of my knowledge will inspection opening er outlet baffle), Adm. Code (except for Name Signature MP/MPRS Z M D 1 illlll 11111 llili lilil 11111111111111 Illlll 11111111 State Bar of Wisconsin Form 1-2003 9 0 8 6 4 7 1 WARRANTY DEED 908647 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI Document Name RECEIVED FOR RECORD Document Number 12/15/2009 10.30AM THIS DEED, made between Kevin W. Ritzer and Heather Ritzer, husband and wife WARRANTY DEED ("Grantor," whether one or more), and Brandon J. Searle and Kimberly Searle, EXEMPT I husband and wife ("Grantee," whether one or more). REC FEE: 11.00 TRANS FEE: 1155.00 Grantor, for a valuable consideration, conveys to Grantee the following described real PAGES: 1 estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ('Property") (if more space is needed, please attach addendum): Recording Area Name and Return Address Lot 18, Plat of Pheasant Run First Addition, in the Town of Hudson, St. Croix County, Wisconsin Key Title, Inc. 126A S Knowles Ave. ; New Richmond, WI 54017 File No.: 9-1542W q-IS~12 W 020-1398-18-000 Parcel Identification Number (PIN) This IS homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, Restrictions, and Covenants of Record. Dated December 10, 2009. Kevin W. Ritzer Heather Ritzer ti %0-T PAX A * TIC#C+ ACKNOWLEDGEMENT Signature(s) STATE OF WISCONSIN ) )SS. authenticated on St. Croix COUNTY ) Personally came before on December 10, 2009 Kevin W. Ritzer * and Heather Ritzer to me know to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN th ing instrument and acknowledged the same. (If not, authorized by Wis. Stat. 706.06) a 0a V. S ger THIS INSTRUMENT DRAFTED BY: Not ublic, State of Wisconsin / My commission (is permanent) (expires: Attorney John Schneider Balsam Lake, WI 54810 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED Copyright 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 1 O f olm software by: Automated Real Estate Services, Inc. - 800.330.1295 File: 9-1542W U i_ Wisco/lsin Department of Commerce SOIL EVALUATION REPORT Page of~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S r C l Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must T include, but not limited to: vertical and horizontal reference poi 11111 arcel I.D. percent slope, scale or dimensions, north arrow, and location i d dist Please print all information. ev' wed by Date 3 Personal information you provide may be used for secondary purposes ( rivacy l e i. 1641 (M2 0110 Property Owner Property C ?R1 qn f d cr cj ST. tL(gl F S L 1/4 S Z Z T Z N R E (or) Property Owner's Mailing Address of # Block # Subd. Name or CSM# M ~ar !f d I ~r a sa~~-~ ecreN City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road f`t-U A . W ( ,Sr Gt ( / ago - -7-7- v dso n ir~ ss Qd . New Construction Use: Residential I Number of bedrooms - Code derived design flow rate y5-6 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L 4-w R-S k Flood Plain elev if applicebfe---- ft. General comments id 1! -7 and recommendations: A' °y (r te rte - ,~.u~z ~,I On, e- ,z - L Boring # ❑ Boring F T] W Pit Ground surface elev. t l(~ ft. Depth to limiting factor ADO in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11:2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q-/o m r 3/ S,' Z~Nab~ CS l!r • j" - !f Z 16.:3( 0 1 s' EPA a'b k- Yn,~r c 5 - S b_ t Z d-~~ vw L F7 F Boring # ❑ Boring n _ pit Ground surface elev. / /V ft. Depth to limiting factor Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 o -1 Z !6 / 3/Z Zm adl Yn-cr e5 v~ Z 1Z- b 0~ Zrnq-b XY1 C $ So ' Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 150 mg/L 'Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/l. CST Name (Pleas Print) Signatures e,- CST Number mot .u~ Z S 3 3 a Address Date Evaluation Conducted Telephone Number SBD-8330 (R07/00) Property Owner k- v A-011\ Parcel ID # /-0 % Page 7 of 1-3-1 Boring # Pit Boring n Ground surface elev. ft. Depth to limiting factor l -1 in. Soil Application Rate e Structure Consistence Boundary Roots GPD/ft2 Horizon Depth Dominant Color Redox Description PTex in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d S m f - ~ j2 S /1Q ' San:/5- 047 I ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. i Soil Application Rate IHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef##2 Boring # ❑ Boring F-1 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07100) Property Owner ~k-t/ nom Parcel ID # Page ~ of F-31 Boring # ❑ Boring Pit Ground surface elev. fL Depth to limiting factor h16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o-16 Mv , S' Z b An -C' /,rte S l s 6 S n-n l - ~S Ea:4--V lit S S O~ 7 a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. SAiI Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) PAGE_j_OF 3 NAME 3Cx5d LOT# LEGAL DESCRIPTION XSF X,S ZZ Tzq ,N,R, I`t E(or SCALE: I"= q C)' BM 1 ELEVATION c~ h 7 BM I DESCRIPTIOj~jc;2~ Ad BM 2 ELEVATION (Of C) a ` ec . ZZ BM 2 DESCRIPTIO SYSTEM ELEVATION ALTERNATE ELEVATION c(j; Oo CONTOUR ELEVATION q&,004-q-4-00 WL- e.e_ re Io Miat~ on a p e I Ila -i cs~ GL F'CGt- ~ n~ bra,-~~rn.s u ~o B 0 3_i q~ bit I SIGNATURE DATE 3 ' zG" Z PAGE OF 3 MIME S } LOT# I LEGAL DESCRIPTION 10' X SF i4 ,S ZZ T Zq N.R. /(,o1 SCALE: I"= q 0' - BM I ELEVATION BM I DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION ~Q a l~ $~ee~t ~o PC , Zz SYSTEM ELEVATION 9 a ALTERNATE ELEVATION q3; Oo _ CONTOUR ELEVATION y(p, Oy o0 re v -40 3- - - - - - - - - - - - - - ~ a cfros~" l of a (A L SIGNATURE ~Cl v"' DATE Wisconsin Department of Comm€ce / PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildls°Sg Division INSPECTION REPORT Sanitary Permit No:~ O 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: Bast, Kernon Hudson Township 020-1398-18-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: DO • 6 1106,6 of ~VY "S4.a'l a-)- 22.29.19.2478 TANK INFORMATION ELEVATION DAT *C5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ZOD p ~n Sit boy ioo. v Dosing Alt. BM w l v ~ ~ 57- • Y i 2i Aeration Bldg. Sewer D Holding SUHt Inlet. 6 / s-. 1A TANK SETBACK INFORMATION St/Ht Outlet 3 TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet 6g T _ 1/ c Septic -7 1, f Dt Bottom / Dosing Header/Man. 6,~~ Aeration Dist. Pi 6 , Z 7 O Holdin Bot. Syste '7 7_ V 4 Final Grade 7 PUMP/SIPHON INFORMATION /~Sys 3. /DO- 3P Manufacturer Demand St Cover GPM 3. ZS ISQ1/ 1- 0 7 /d 3- ZJ Model Nu er TDH Lift ion Loss System Head ITQ)i Ft Force n Length Dist. to Wei SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits _ Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL Aj 6j LAKE/STREAM fHAMBER HING a urer: INFORMATION - .11 OR Typ Of System: L O ~tA,* ' NIT Model Number: el- DISTRIBUTION SYSTEM Header/lygpjfplrl- Distribution x Hole Size x Hole Spacing Vent Intake Pipe(s) r} Length Dia Length Dia ✓/1 acing , 50 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a!z(l C4{rrt.AR'-Z Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched j Bed/Trench Center Bed/Trench Edges Topsoil 1-1 Yes No 0 Yes No 3 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: If /2/J23 Inspection #2: / / Location: 835 Ross Rd Hudson, WI n5400116 (NW 1/4 SE 1/4 22 T29N R19W) Pheasant Run 1st Lot 18 1 Parcel No: 22.29.19.2478 1.) Alt BM Description = ,STj 2.) Bldg sewer length = ' 1 _ z- - amount of cover l~ y Plae otherl Required? No ~ ~ _ I CY additional information. of L_ -V0 - - L- SBD-6710 (R.3/97) Date Insepctors tSigture Cert. No. Safety dt Buildings Division Sanitary Permit Application 201 W. Washington Ave. N*s0,onsin In accord with Comm 83.2 1, Wis. Adm. Code PO Box 7302 Department of Commerce Personal information you provide may be used for secondary purposes to county- (Submit completed form to county if not (Privacy Law, s. 15.04(1)(m)) state owned. Attach co late lane to the count co only) for the s to on r not less than 8-1/2 x 11 inches in size. County I State S itary P it N%rnber heck i revision to ~vious application State Plan I. D. Number 1. Application Information - Please Print all Information Location: i Property Owner Name 1~er% 1) D r) MAY 1. Property Location ` uni 1/4 114 S TJ N R/9E or W y Owner's Mailing Address Lot Number Block Number S I C C)iii~6 I i Ci State Zip Code Subdivision Name or CSM Number f II Type of Building: (check one) 0 City 0, 1 or 2 Family Dwelling - No. of BedroomI ❑ village O Public/Commercial (describe use): JkTown of O State-owned 744ud 5DN, III Type of Permit: (Check only one box on line A. Che box on line B if applicable) Nearest Road--,) ss o CL A) 1. ew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) ~ZO _I 3 S tam Tank Onl Existin S stem ~~~~a B) Permit Number ate Iss A Sanitary Permit was previously issued 63 • V Type of PO WT System: (Check all that apply) Non-pressurized In-around ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ ressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersal/Treatment Area Inform ation:7ft) ~/~indZr I. Deli Flow /-l 7- gn (gPd) 2. DispersalArea 3. Dispersal Arca 4. Sate oil Application drcolation RateSystem Eleva t 7. Final Grsde Req Proposed R uircd (Gals././inch) - Elevation 10, o VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crate structed Tanks Tanks 10o o y,,`/ ❑ ❑ F❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I the uadersi ned assume res nsibjljt for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plu bar's Si (no stampsr MP/MPRS No. Business Phone Number ( ~ 'r Plumber's Address (S t, City, State, Zip Code) to v air VIII County/Depa tment Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date ssued 1 tng S jgttaarre s) ApproveOwner Given Initial Adverse Surcharge Fee) ~O U.i Q 3 ~ IX. Cns of Approval /Reasons for Disapproval:' IDetermination YYY ` l~ !-J 6 1 1--'10.t //(,,p _5 I'd e- col Me rs• AZA 11m-____---i) 1(13 AV I-eV- IOU' ~ p q -7, Z3 6 A 18' ~~r~~a o-~- o~ e!) 3 (3~p~,o ljornq N N i3~•~ o t1i m c En May 19 03 12:43p FOGERTY PLUMBING 17156355286 p.2 Fogerty Plumbing #221180 ,M 28288 McKenzie Rd. Spooner, W 154801 (715) 635-9609 s /z~~Ol do~va- Env: a--~ 99-C, 7 Q-Z R7 Ps mac'-3 ?S•/ scv~ : /y t, 4, r ~lK scw,E / ' = Yo' acs~pvirG " ,z-~_'/Soi~T .r v4rc~r~s d h-/ tr /aa.,p ~c .oar *`L •f-s OW-f ' /~E~L~S ~/wl~GL,/YTlF .L JR / /g O f ,BArt A~J- i!l '7:23 O /OD ~/oTE : j/g 't' i'1~ 6iv~r~d GoMy4ll~tGTs~~ g' ~0ix" rOW at-44C diAC ~R•CPoitT -=r w,-7W -T-T• ~1. r /J rz= 6- L 4 14 2 y i Ca ciyE~C t ~Ol.7f. ~ ,ti~I.. GfY<D syd AoF1&cT. t~ / t 'I v t P ald _5 cl e- to nc-e rs A- l~lM_ L uu.m~,e,3 s) 11) 1(53 1-9vz IOU,D g mit oZ lop A14" Ef ee) R'4 El 133 ys " I ruwcl.~~ ~x ~ lboo~P~ 1't~,c WIAIy 18' ~d cae l ) 3 &p~b 1 m u~ N N o °s~rn I • n II,,A~i '!~e...~ E O CCU a In E E to y h i r A nr1 0 lz kQ U E N rouNV N4ILk5 Gk~ Ai ~I~ S i ~~AUS-~ ~ kaoW WAS Alo+ cA Woxt qd AM to M TkAm ON fih,p PP(-L S S Th pNks Mai 19 03 12:43p FOGERTY PLUMBING 17156355286 p.1 FOGERTY PLUMBING & PERK TESTING 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 (715) 749-3656 Fax (715) 635-5286 JIK~ E ~i~t~- ~o96r~y~~llArb'i►~~C~NF4ry~/MsT 1 / J TO: .7 E ~crse~f° P9542F /lr~sS,~F r'E : ~ /ice •~Q~'r>E Tbf ~T L~i9~~~~ ~ 1L ~T ''~!8 .~i/1FilAfiR~/l- .rte t 7 * . Wk ) oLaORAIJE a A)6G. A AF ti,. u u~~* vT 77 k-lG A ~fsKClit E TAT T S 4MA,&. -JWZ r_iflE h►su im-ACw/r 7a ±=L t - '--ArC f,~C- .7= vE" _ crnt ~d ~ a rilL,r`✓ o aT. JZ~s~or~t~ C - T ~-r T PAGE_ OF NAME GC,'Sf 1.034 LEGAL )ESCJUPTIQN I~ -4)WSF- t Z 1 SCALE: III BM I ELEVATION InC~ BM I DESCRIPTION 6 BM 2 ELEVATIONS' sec, BM 2 DESCRIPTION SYSTEM ELEVATION ~ y ALTERNATE ELEVATION 13- oo _ CONTOUR ELEVATION q(y, Oy ~l 00 1 ? 3 qb i'G SIGNATURE DATE 3 _ zC,- Z SOIL EVALUATION REPORT Page 0 isconsin Department of commerce vision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must areal I.D. include, but not {imited to: vertical and horizontal reference poi percent slope, scale or dimensions, north arrow, and location a d dish eviewed by Date Please print all information. ide may be used for secondary purposes ( rlvacy t v}~. it04k N• Personal inf,,,,wn you pm -operty Owner ST. ROIX~Urv~~ 1/4 S T Z N R E (or) ~f S U O 5 of # Block # Subd. Name or CSM# raperty Owners Mailing Address ~ ~ ~ lQ Jn , r k Ity State Code Phone Number City ❑ Village Town n Nearest Road Kn . GPD CIO - New Construction Use: Residential / Number of bedrooms Code derived design now rate ] Replacement ❑ Public or commercial - Describe: It. Flood Plain elevation if applicable 'anent material G /L,4-ti Q--5 ~ Lid neral comments SYsf~^^ e /G v. 9y 3 'e , ind recommendations: f ` e/C~ Q 3.(j d : 1:1 - Boring # Boring n pit Ground surface ete lU Depth to limiting factor DO in. Son A-ration Rate Roots GPDW th Dominant Color Redox Description Texture Structure Consistence Boundary -Eff#1 "Eff#2 Horizon Dep in. Munsell ()u. Sz. Cont. Color Gr. Sz. Sh. 5 6-10 ld~ i 3~ ~ ~ ~ s" fs r _ Z /6-3G o s, . DS t, 34- A0 77 Boring # Boring ft. Depth to limiting factor in. Soil Application Rate C- Pit Ground surface elev.~_ Roots GPDlitz Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Etf#1 'Eff#2 in. Munseil ' Qu. Sz. Cont. Color s. S O-f Z 16 /~Z S. ~rylc,b YI'1 C S -//D M CS Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = B0D5 < 30 mg/L and TSS < 30 mg/L S Signature CST Number CST Name (Plea P lnt)~~ ~ Z S 3'~ p Date Evaluation Conducted Telephone Number 2 t''CriAI Sf C,V,. co- C-4.4 z C` /G" d Z Property Owner _1G-'W .0"\ Parcel ID # 0 7L / Page of _ © Boring # ❑ Boring Pit Ground surface elev. 9~ •4y ft. Depth to limiting factor //T ~o in. Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ n*Eff#l lion Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 o-/6 Myr 3 e, •S ' ~Y 36 F-1 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/fF In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a 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 GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = SODS < 30 mg/L and TSS < 30 mg1L 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. a8n.t330(X07 of ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer k n/ J. 995 Mailing Address 9if Z-4 410 /M54VI wL G/,(v Property Address a2;f5 (Verification required from Planning Department for new construction)_ 6 Parcel Identification Number 02-0-13 V ' I f , 6!J y City/State LLEGAL DESCRIPTION Property Location /J&) %4, LE- V,, Sec. p , T_,N-RaW, Town of r Subdivision 14P-Gt 1?1 n f JC y Fro Lot # _ l . Certified Survey Map # , Volume ,,Page # Warranty Deed # 1,A Zh /b , Volume Page # -3-3 Spec house ❑ Yes kno Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage 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 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 o tic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 iration date. da a T DS/ 07l L'Ay3 7i OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the above, by virtue of a warranty deed recorded in Register of Deeds Office. OS b~ /~3 F6NATOX 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 L V { Kim 'S i. 1 `1F. ~ I Law= Kw.L.\"T 1 1 Joao vDm39~6 i ..rte LISAW 1 Kanto TMAMTM , i--_. is 17 f & AN r 1[I~O~b I d 1. t0• f7; ~ 1'10k . Itndp ~ 7 i Wee" NLNZM 11 ~ 1` suwna~ ws ~ I e i• 12 E .w , Kiss ZTA ~ s l z Q~~ - . ZONED AG-RESIDENTIAL OED 1NDUgTRfAL _ oroeo. )Jiltk? i _ - a + ~x-~--• BOSS ROAD ~9 0 rj) - ------I N T o a I O o a 1,T z t i K r CO y 2 fig .2 Ix t sip , " »ae . i _ 0 O i „ xL 8 Unu ernm°r°e uw I tf~ e x i / R I e Y , a I f~ `a I ZONED AG-RESIDENTIAL I ~ I< f y 153 PaSe X1:3-3 I- A r- ~Y .j 62751 O STATE BAR 1v j0atnw KATHLEEN N. WFILSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIx CO., WI This Deed, made between Marie A. Shimon, a single person, RECEIVED FOR RECORD 08-02-2000 3:00 PM WARRANTY DEED Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband EXEMPT M CERT COPY FEE: and wife, COPY FEE: TRANSFER FEE: 846.00 RECORDING FEE: 14.00 PAGES: 3 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A") Name and R °"fpp:.. A OGLAND 7.ilz, Estreen & Ogland P • O. Box 359 Hudson, W1 54016 020-1059-80-000 Parcel Identification Number (PIN) This is not homestead property. 0Q) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 10 4A" day of July 2000 Mate A. Shimon AUTHENTICATION ACKNOWLEDGMENT Signature(s) Marie A. Shimon, a single person, STATE OF WISCONSIN ) ss. County ) f suthellt~+l K~ rye' 16dy of July 2000 • Personally came before me this day of a the above named TIT Y* ~§TATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. autho § 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland _ Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) , * Names of persons signing in any capacity must be typed or printed below their signature. rMormatim Proteseionela compeny. Fond d" Lao, wr STATE BAR OF WISCONSIN 800455-2021 WARRANTY DEED FORM No. 2.1999 '-1531PAGr 434 EXHIBIT "A" A PARCEL OF LAND LOCATED-IN THE NORTHWEST QUARTER OF THE SOUTHEAST QUARTER (NW 1/4 OF'SE 1/4) OF SECTION TWENTY TWO (22), TOWNSHIP TWENTY NINE (29) NORTH, RANGE NINETEEN (19) WEST, MORE FULLY DESCRIBED AS FOLLOWS: Commencing at the East Quarter corner of said Section 22; thence-North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet; thence North 89 degrees 57 minutes-16 seconds West 750.00 feet; thence Westerly 450.47 feet along the arg of a 905.17 foot radius curve concave Southerly whose long chord bears South 75 degrees 47 minutes 19 seconds West 445.83 feet; thence South 61 degrees 31 minutes 54 seconds West 135.86 feet to the point of beginning; thence continuing South 61 degrees 31 minutes 54 seconds West 150.12.feet; thence Southwesterly 297.89 feet along the are of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet;. thence South 53 degrees 22 minutes 28 seconds East 409,87 feet; thence South 0 degrees 15 minutes 46 seconds East 687.10 feet to a point-on the South line of the Northwest Quarter of the Southeast Quarter of said Section 22; thence North 89 degrees 57 minutes 16 seconds West 1269.89 feet along said line to the Southwest corner of said Northwest Quarter of the Southeast Quarter; thence North 0 degrees 16 minutes 35 seconds West along the North-South Quarter section line a distance of 1296.23 feet; thence North 89 degrees 50 minutes 17 seconds East 651.01 feet; thence North 0 degrees 11 minutes 41 seconds West 22.40 feet to the Southwest corner of the Certified Survey Map recorded in Volume 7 of Certified Survey Maps, page. 1891; thence North 89 degrees 50 minutes 17 seconds East along the South line of said Certified Survey a distance of 651.09 feet to the Northeast corner of the Northwest Quarter of Southeast Quarter; thence South 0 degrees 15 minutes 46 seconds West along the East line of said Northwest Quarter of the Southeast Quarter a distance of v 129.94 feet to the point of beginning. ALSO subject to that part of a 66 foot wide easement reserved for future township road included in the above described parcel, said easement being 33 feet equidistant and at right angles to the following described reference lines: REFERENCE LINE NUMBER 1 Commencing at the East Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet to the point of beginning of the following described reference line: Thence North 89 degrees 57 minute's 16 seconds West 750.00 feet; thence Westerly 450.87 feet along the arc of a 905.17 foot radius curve concave Southerly whose long chord bears South 75 degrees 47 minutes 19 seconds West 445.83 feet; thence South 61 degrees 31 minutes 54 seconds West 285.98 feet; thence Southwesterly 297.89 feet along the arc of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet; thence South 38 degrees 28 minutes 07 seconds West 100.00 feet; thence Southwesterly 381.99 •uTsuoasTM 'Aluno, xToaa IS uT ITV •auTT sOUaza;oz PT9s ;o pus MR 01 1881 90'OOS Isom spuooas Ti salnuTm TT eeeaBap 0 lg420H aauagl ryes; BZ'SST Isom spuooas Sc solnuTm TT saaabap or g1soN saaeq pzogo . BuoT asoKw 6TzayevaglxOx sAeauoO eAanO sn"tpe2 100; 00'LZZ 9 buoEv laa; a~'BST ATaaysawglaoN eauagl rlaa; 00-OL Isom spuooas It se~nuTm TT 86825op Oq glaom souag3 :creel Z9'£fiE 19914 spuooas OS ealnuTw SO saaabap or glaoN sa9aq paogo BuoT aeogM ATa2:18O►glnOS O"Ouoa aAanO enTp9a 100; 00.OOS v BuOTv '881 LL'OSE AT20lsaa1412ON aouagl :18'01 L6-69Z glzoN aOUagy :80-FT sousaa;ea pagpooap BUTMOTTo; aqa ;o BuTuuTbaq 30 luTod aql of laa; 1.9'9£T loam spuooas LS salnuTm ZV seazbap SB glnoS eavaq pioga BuoT asogn AT28gln0S an9OU00 aeano enTpea loo; LT'ZLS 9 ;o oza agl BuoT9 lea; TO-91T AT28158M aauagl :laa; 00.OSL ;saM sPU0088 91 salnUTm LS saaz6-P 68 gl;XoN eauegl -'laa3 0('04 ;0 aauelsTP a 3alzvnb Is9aglaON aqa ;o auTT 18`22•'8141 BUOTV 11392 spuooas LS salnuTw CO 689zb9p 0 g120N aauagl QZ uOTIOOS pT9s ;o zauaoa islzvno qmm aql ye bupusmmoz) z ~aWnN aeuz •euTT souaaa;aa PT9s ;0 pus agl 03 lea; S9'9bS Isom spuooas SE salnuTm EY saaabap 69 glnoS aauagl :lae; BE'69E IBOA spuooas Eq saanupu SO saaabap 6g gang amoaq paoga BuoT 8901414 ATaaglaON aAaOUOa OA= enTp9a IOO; 00'LZ9 a ;0 029 eql buolu laa; Z 859d - --Vu 3TgTgX3 (~'~~39tld~~'~~ I1A Ir ► a Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specification Sanitary Permit Number J S~ G 3 Number of Bedrooms Design Flow - Peak (gpd) S ) Estimated Flow - Average (gpd) 3 o o («t~ Septic Tank Capacity (gal) Soil Absorption Component Size (W) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 5 b 8 Maximum Influent Particle Size (in) a 1/8 Maximum BODr, (m /L) ~ u 220 Maximum TSS (mg/L) S b 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once eve 3 years Outlet Filter Inspect once a year and clean at ears Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least' once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The the volume of scum and sludge in the tank septic tank shall have its contents removed when exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the 'time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Abs Drawn Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage pr discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense; Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 a 3 Coasrt~► . ~ Sit sod Dtreiaa . 201 W. Whoa Ara.. P.O. Box 7082 CAM macaw Wi sM-7082 S MAddias ~sc~ons~n Department of Commerce • Sanitary ft m# AppliCWOn "ftx*).. An acamd adt Amass W M. Wk. MEL CMe, paraod atiiaraad you PMWW 0 theme if 1E"Was ° may be aed for Laver 315jm)w L Application bfiw mdm - P1 Print AN LaieamaAioa Safe Phu LD. tlmbea Pysod Naaaber Ptppatfowoix'sNarre F RECEI EV D t~2D - Property owner's 9 wft Address 09 FEB 1 1 2003; s12 T Nx, Sate ~ c OI~XbCOUNTY L 7ZONING Bloat Num b - OFFICE Name CSALbbmbar-~ 77, ~ M* fCke* 8V that W* i or air fay, DweW lbai d o a -DvxxMe Use - q Soft Owned frA.3 ~e-ucf-rte . ~ . • .s UL Type of Peisie (C6ek e* am beam V=A. b tar aaterstd A. !®'INer 20 >Laplaoa ncis Systmt I'teplatanentaf O AdWm so B. 13Mcck W SwAny Piamit Preriuasly Nm►ber Daft issaed IV. Type of POWT Sloe tdt is s p~Noa -Ptesptimed Ia-i,1aaad 210llwtd ~ 47 ~ 9SU 4c 22 0 Pied la.Groasd 0 Pass SI 0 Drip Line / as 0 AWin de lk 30 OOdw V. Area Design Flow Dlspas t Ate. rNA V&A Angco io`_ RM byam ®aa" Fsl Made 11 (W Ekvadw 97.0 ~.G VL Tang Info coaei y is fta 26100 kbuffacturer sine Saeel Fiber Plastic cam OfTadm cansgaaed Gh s New Exbft ate- _ ZAW S. oostChWAber VQ. Respo Sit- I. qr; 6r bobAbtiaa of tie POW18 slants as Bye bass. Ph aaber's Na ■:t (Ptiey S Naa~1 1 Pbaae Nsaeber Fogerty Plumbing & Pak Pbmdices AWI ss Spooner. Wl 54801 VYa. use owtr- d SrBaseaa (No MovalpiroW A> Owner 113 DcanobviAns hod Adwase ~ 3 u 17!, 1 Cea loas of Appa.~.atan4 fore I~ Gad? Durn~v - Aabel tYe Lrdw as "a we Ank am =a a it Wh sin din Nla.+~,~,dP~l~r KGs- Cum✓~. 53,43.1) s~'~~rlc_iVa 91 gi! a, fl `F vA a. f s c ri, AMP b 1~O•~~° J~j 4t% is o V r ~ 14 f / oc ` J i a A ► 14 u vx ` ~ 0 ot) j A ~ 0 6 ~ `c o oo' tri II „ II , ~ `~..4 - to y 11i a it J1 a I c (Q • !y 0" Mm CD ! ~ + ' ~ , o' ~ ~ "gyp II O Er' •s I r cfl • , n . VON p0q i••~ om 06 O 00 3 CQ AN 03 000 C►• LO O Z7 3 ~0 C II ~ W ~ II Ana p 4 j ZO • ti i w N `1 r 3\0 r s 1 z 1 \ _ J _ ° X04 a ~ o x i y N i ~F 00 0 OD 01) # ms's 3D co 00 4 b, A 1 Wiscohsin Department of Commerce SOIL EVALUATION REPORT Page of~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County -5- C Attach complete site plan on paper not less than 8 1/2 x 11 inches in ;size. Plan must include, but not limited to: vertical and horizontal reference poi g~'"~ arcel I.D. percent slope, scale or dimensions, north arrow, and location a d disR l,mu 3 020 Please print all information. nn r;;L Date Personal information you provide may be used for secondary purposes ( rivacy l v 1404, AW ~ ~ 3 / Q 3 Property Owner Property b~ign ST. RCI FF sL 1/4 SZ,,7- T Z N R E (or) ~r ova cry Property Owner's Mailing Address of # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village {'Town Nearest Road 1~v ~ W ( 01 ( 390 u dso r` P ss Qd . New Construction Use: J] Residential/ Number of bedrooms - Code derived design flow rate y.- e' ca GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G U BLS Flood Plain elev if f ft. General comments Sr Vr /p and recommendations: a y e%~• 43.Gd sin. cS ~ 4V L Boring # ❑ Boring Q W Pit Ground surface elev. l (u ft. Depth to limiting factor /100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Quo /d~ r 3~ S,' ZMabt m'Cr' CS llr~ - 8 I 3 to r y s rh 1 ~ F Borin # Boring _ g pit Ground surface elev. /./6 ft. Depth to limiting factor in. P*Eff#l oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 3~Z S Zm ae/ ~r CS . s b 1 0-1 Z 16\4K )/130 M--5 CIS Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Pleas Print) t Signature CST Number 1461a .urG-'=' 0,!5:- Address Date Evaluation Conducted Telephone Number SBD-8330 (R07/00) 4 t Property Owner k--f/ noWN Parcel ID # D T / Page Z of ~ 1-31 Boring # ❑ Boring n Pit Ground surface elev. ft. Depth to limiting factor /G (o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 o-16 ld~zr 31? 1,41 -s- 5 a m - a 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F1 Boring # ❑ ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 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 (8.07/00) PAGE. -~_OF 3 NAME GC., S I OT# I LEGAL DESCRIPTION ti w X SF Y ,S ZZ T Z R ,N,R, SCALE: I"= q Q' BM 1 ELEVATION BM 1 DESCRIPTIO 6 - h BM 2 ELEVATION BM 2 DFSCRIPTIO a ~Qe(sz ~o {'c ZZ SYSTEM ELEVATION ALTERNATE ELEVATION g3, 00 CONTOUR ELEVATION O~ A- q `4" 000y A- 9 ` 4.00 + e r- J o4- S,ee_ re 1441- ~56a-Ae-~ 6-VL s~ a.-~~a-~ d ~ ' co•~a~, p -~o 1 dCGl~lc-~ ff we tea,-F~~~ s ~ i 0 3_i q~ a ~-p B • z SIGNATURE - DATE PAGE_j_OF 3 E GCS S f LQT#~ LEGAL DESCRIPTION Y SF X,S ZZ T _71 N.R. I `t E(orCW) SCALE: 1"= L4 O - - BM 1 ELEVATION f( ),n 7 BM 1 DESCRIPTION p f~ qt~~ BM 2 ELEVATION q (oR U 1 BM 2 DESCRIPTION ~oQ 6 l~ , S~eelst ~a PC , zz SYSTEM ELEVATION 00 ALTERNATE ELEVATION q3, Oo CONTOUR ELEVATION J&, Oy +l-4- oo H. VU, L,. it d a' Shdv~/~- Q-~. Y~ pY"dry -moo U '12 yloS ~ ~ lof G,~~ Gt cY71~ (,p ~s 12G y ~J SIGNATURE DATE 3 r zc~- -O Z- )AP X DRAINAGE 9 18.6 ' 7 X -91.0 = ELEVA'nON OUO 0+ 1 I ~ I 1 SILL. ~ r N91 889.8 ~ 11 1 I i I •~1 HMf4 08.0 X 890.6 1 _ 1 ` WN $U Q t > 1. ~ ~ ~ r it . -RAP -RAP ;poll \ 1 AG 10.9 1: 25 -424 `o A- - aLT x 11 1\ dR~ wad L PpC'' - AGE I T01 El.~y r 8. -77 Fp4C lot. N't 18 • ~ •,•,~4'r• y r ; H.W.L.=90#3.0 X. t1w JAW T- - • • : s .~"'~!1` 904.5 / / ~ A . EWJHCs ~ \ \ 1 PRA UINIMUY 6!J 'oe ..SILT ' 1161W . ~ ~ ~ / / ~ ~ ' $ 1 I 0\` /92z. 915.5 7# x lT i ti 917,5 X , 1 - 4. ~ 916.6 \ 92 NNO 931.8 f - X / x X - - 935 03-Ac 930.6 932.6 93 .1 I / 934.9 \ / X X J ( 936.5 X 937.8 I \ / S' . 14 s 93.s / 2.099110 x~ 930.9 X \ / X Of POWTS OWNER'S MANUAL & MANAGEMENT PLAN page Z' 'FILE INFORMATION SYSTEM SPECFICATIONS Owner Septic Tank Capacity al O NA Permit # d Septic Tank Manufacturer O NA DESIGN PARAMETERS Effluent Filter Manufacturer ore 13 NA Number of Bedrooms O NA Effluent Filter Model O NA Number of Public Facility Units )NA Pump Tank Capacity al Estimated flow (average) gal/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) aUda Pump Manufacturer A Soil Application Rate aUday/fe Pump Model A Standard Influent/Effl Monthly average` Pretreatment Unit CINA Fats, ON & Grease (FOG) 530 mg/L O Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA O Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) E3 NA Biochemical Oxygen Demand (BODE) 530 mg/L )q In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/l. /NA ❑ At-Grade O Mound Fecal Col'iform (geometric mean) 5104 cfu11 OOmI O Drip-Line O Other: Other: ❑ NA Maximum Effluent Particle Size 4 in dia. O NA Other: O NA Other: O NA *Values typical for domestic wastewater and septic tank effluent. Other. O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 month(s) (Maximum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume O NA Inspect dispersal cell(s) At least once every: O month(s) (Maximum 3 years) O NA 3 fit year(s) Glean effluent filter s t least once every: 1- Z 13 month(s) O NA - Inspect pump, pump controls & alarm At least once every: O month(s) q,Nlq O year(s) Flush laterals and pressure test At least once every: ❑ O m year(s) r(s) l Q NA Other: At least once every: ❑ month(s) a NA O year(s) Other: CLNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following ficeises 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 he ground surface may indicate a fairing condition .and requires the surface. The p ondIn9 of effluent on t immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, be performed by a certified POWTS Maintainer. within 10 days of completion of any service event. A service report shall be provided to the local regulatory authority 1 . Page 2Lof Z- f ►RT UP AND OPERATION prod cts or other chemicals For new construction, prior to use of the POWTS check treatment tank(s) for the presence Of Painting u are detected have the contents that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system- 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. e site s not b evaluat t identify itable r a ement a. Upon f ur of the S s it e ev uat• n st b pe lined o loc e a s tabl repla men area If no epla ment ea is veil ble h Id' tar* may a instal s a last e rt to rep ce a fail S• ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infihrative 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 INSUFRCIE14T 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. #221180 AAPTIE c (715) 635-96.09 ~ POWTS INSTALLER POWTS MAINTAINER Name I (1~ Name Phone S - - Phone 1 49 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name cam Cw fi ry Phone Phone ~(S This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerA4ayer t ,15;X_/r10A1 7 Mailing Address I? 1141V "od/ Property Address 83 v > on N (Verification required from Planning Department for new construction) City/State Parcel Identification Number 026 - Y42 "lf 42~9e) LEGAL DESCRIPTION Property Location'/,, Sec. TN-RW, Town of~sd;C'/ , Lot # AX Subdivision Certified Survey Map # , Volume , Page # Warranty Deed # li Z 7S'lC~ , Volume Page # V2 3 Spec house O yes P-h-o- Lot lines identifiable 193'yes 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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resourcet, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Offi~~c--//e~"within 30 day ~f the three year PYnlrohn...~- )~S ~ (JyJL(c t c_ ~ le_xt _xt s - l l SIG ATURE O PLICANT 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 thUA_~ rty descri abov by virtue of a warranty deed recorded in Register of Deeds Office. F I / l SIGN TURE 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 f' - - 1531 p-Se q3-3 ~Y STATE BAR jW1531M4 - tEi27510 KEiil1LEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Marie A. Shimon, a single person, RECEIVED FOR RECORD 08-02-2000 3:00 PM WARRANTY DEED Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband EXEMPT N CERT COPY FEE: and wife, COPY FEE: TRANSFER FEE: 846.00 RECORDING FEE: 114.00 PAGES: 3 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A") NameandR"pp Ia A OGLAND 7ilzr Estreen & Ogiand F.O. Box 359 Hudson, WI 54016 020-1059-80-000 Parcel Identification Number (PIN) This is not homestead property. 0Q) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this d 0~" day of July 2000 + • Ma ie A. Shimon « AUTHENTICATION ACKNOWLEDGMENT Signature(s) Marie A. Shimon, a single person, STATE OF WISCONSIN ) ) ss. S K County ) authety day of July 2000 O Personally came before me this day of the above named 41 «jtrjstil% tOIL _ TIC «~•••EB,tST'ATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing V {{~I instrument and acknowledged the same. autho § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY « Attorney Kristina Ogland - Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) + Names of persons signing in any capacity must be typed or printed below their signature. VHom,aaan Prora• kmis company. Food du Lae, N STATE BAR OF WISCONSIN 8006562021 WARRANTY DEED FORM No. 2.1999 . ' . yap 1531PAGE 434 E)GHBIT "All A PARCEL OF LAND LOCATED-IN THE NORTHWEST QUARTER OF-THE SOUTHEAST QUARTER (NW 1/4 OF SE 1/4) OF SECTION TWENTY TWO (22), TOWNSHIP TWENTY NINE (29) NORTH, RANGE NINETEEN (19) WEST, MORE FULLY DESCRIBED AS FOLLOWS: Commencing at the East Quarter corner of said Section 22; thence-North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet; thence North 89 degrees 57 minutes-16 seconds West 750.00 feet; thence Westerly 450.47 feet along the ar0 of a 905.17 foot radius curve concave Southerly whose long chord bears South 75 degrees 47 minutes 19 seconds West 445.83 feet; thence South 61 degrees 31.ininutes 54 seconds West 135.86 feet to the point of beginning; thence continuing South 61 degrees 31 minutes 54 seconds West 150.12 feet; thence Southwesterly 297.89 feet along the are of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet;. thence South 53 degrees 22 minutes 28 seconds East 409..87 feet;*thence South 0 degrees 15 minutes 46 seconds East 687.10 feet to a point-on the South line of the Northwest Quarter of the Southeast Quarter of said Section 22; thence North 89 degrees 57 minutes 16 seconds West 1269.89 feet along said line to the Southwest corner of said Northwest Quarter of the Southeast Quarter; thence North 0 degrees 16 minutes 35 seconds West along the North-South Quarter Section line a distance of 1296.23 feet; thence North 89 degrees 50 minutes 17 seconds East 651.01 feet; thence North 0 degrees 11 minutes 41 seconds West 22.40 feet to the Southwest corner of the Certified Survey Map recorded in Volume 7 of Certified Survey Maps, page. 1891; thence North 89 degrees 50 minutes 17 seconds East along the South line of said Certified survey a distance of 651.09 feet to the Northeast corner of the Northwest Quarter of Southeast Quarter; *thence South 0 degrees 15 minutes 46 seconds West along the East line of said Northwest Quarter of the Southeast Quarter a distance of 129.94 feet to the point of beginning. ALSO subject to that part of a 66 foot wide easement reserved for future township road included in the above described parcel, said easement being 33 feet equidistant and at right angles to the following described reference lines: REFERENCE LINE NUMBER 1 Commencing at the East Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the East line of the Northeast Quarter of said section a distance of 40.00 feet to the point of beginning of the following described reference line: Thence North 89 degrees 57 minutes 16 seconds West 750.00 feet; thence Westerly 450.87 feet along the arc of a 905.17 foot radius curve concave Southerly whose long chord bears South 75 degrees 47 minutes 19 seconds West 445.83, feet; thence South 61 degrees 31 minutes 54 seconds West 285.98 feet; thence Southwesterly 297.89 feet along the arc of a 740.00 foot radius curve concave Southerly whose long chord bears South 49 degrees 59 minutes 58 seconds West 295.88 feet; thence South 38 degrees 28 minutes 07 seconds West 100.00 feet; thence Southwesterly 381.99 " V01. 1531PAGE 435 . Exhibit "A" - Page 2 feet along the arc of a 427.00 foot radius curve concave Northerly whose long chord bears South 64 degrees 05 minutes 43 seconds West 369.38 feet; thence South 89 degrees 43 minutes 25 seconds West 546.65 feet to the end of said reference line. REFERENCE LINE NUMBER 2 Commencing at the East Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the.•East line of the Northeast Quarter at distance of 40.00 feet; thence North 89 degrees 57 minutes 16 seconds West 750.06 feet; thence Westerly 136.81 feet along the arc of a 872.17 foot radius curve concave Southerly whose long chord bears South 85 degrees 42 minutes 57 seconds West 136.67 feet to the point of beginning of the following described reference line: Thence North 269.97 feet; thence Northwesterly 350.77 feet along a 500.06 foot radius curve concave Southwesterly whose long chord bears North 20 degrees 05 minutes 50 seconds West 343.62 feet; thence North 40 degrees 11 minutes 41 seconds West 70.00 feet; thence Northwesterly 158.48 feet along a 227.00 foot radius curve concave Northeasterly whose long chord bears North 20 degrees it minutes 38 seconds West 155.28 feets thence North 0 degrees 11 minutes 41 seconds West 500.06 feet to the end of said reference line. All in St. Croix County, Wisconsin. m cc) "as 37 < cn rj) z a) - f- 1°O641'E I N v6 if 77.56 V 41"MV 174.79' - - v Z ~ NOt°W ~ ~Q i 31.24 to y~ k :~F - N m . ~ O to i oo c~ J i, C? OvD N m g w D~ co N o~ ~,n zoo j~ r~ n a ©rn m~ om Z oz / ~G) Z ~O w cn J 4 3> i = m m' N01°05'Sf"W 215.00 v n o pp ro Z wi OD ' Y y 4 i Ch M Om ; m c C7 . i u+ 1. 22F n