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I °om > :3 y �I�i y n (D f0 p� 7 T fop to Qc 4 0.- . N C ?C CD 3 A -« Q c c = m c CD N c O �C cn vaCD o gCD k-j v c ? n 3 o c to ° o Q s o ° o b !� fD CD co � O En f° o CD c o° c o n N Parcel #: 022 - 1044 -10 -100 11/13/2007 03:57 PM P AGE 1 OF 1 Alt. Parcel #: 15.28.18.237A -10 022 - TOWN OF KINNICKINNIC Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/28/2004 07/02/2007 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - PETERSON, DAVID P & ARDEN D DAVID P & ARDEN D PETERSON 331 CTY RD JJ RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 331 CTY RD JJ SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 24.000 Plat: 4762 -CSM 18 -4762 022 -04 SEC 15 T28N R18W NE SE CSM 18 -4762 LOT 1 Block/Condo Bldg: LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 28N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 05/28/2004 764312 18/4762 CSM 12/17/2003 749419 2476/306 WD 05/09/2000 622747 1509/424 QC 07/23/1997 1218/442 WD more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/28/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 100,000 698,000 798,000 NO AGRICULTURAL G4 14.000 2,100 0 2,100 NO UNDEVELOPED G5 6.000 18,000 0 18,000 NO Totals for 2007: General Property 24.000 120,100 698,000 818,100 Woodland 0.000 0 0 Totals for 2006: General Property 24.000 97,100 698,000 795,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 08/23/2005 Batch #: 55 -6 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 APR 27 f 7 6 4 3 1 2 VOL 18 PAGE 4762 REGIISTTERR OF DEEDS ST. CROIX CO- MI C TI FI EM SURVEY MAP RECEIVED FOR RECORD 05/28/2004 12:00PN LOCATED IN THE NE1 /4 OF THE SE1 /4 OF SECTION CERTIFIED SURVEY NAP 15, T28N, R18W, TOWN OF KINNICKINNIC, REC FEE: 13.00 COPY FEE: 3.00 N ST. CROIX COUNTY, WISCONSIN PAGES: 2 LEGEND ALUMINUM COUNTY SECTION OWNER CORNER MONUMENT FOUND DAVID & ARDIE PETERSON w w 331 COUNTY ROAD "JJ" 1 5/16" O.D. IRON PIPE FOUND RIVER FALSS, WI 54022 O EACH LOT IS p O 1" X 18" IRON PIPE SET WEIGHING SUBJECT TO A LOT 4 AREA W a 1.13 LBS. PER LINEAR FOOT SURVEYOR LOWEST BUILDING 2.54 AC- INC. RW Z 110,477 SO. FT. w o cr EE) EDWIN C FLANUM O g K ATION SECTION CORNER POSITIONED FROM NORTHLAND SURVEYING, INC. w O WITNESS MONUMENTS OF RECORD 856 A HWY "65" / P.O. BOX 14 BEING & ABOVE 2.30 AC. EXC. RW Q U ROBERTS. WI 54023 THE FLOOD PLAIN 100,371 SO. FT. z ..... 100' ROADWAY SETBACK LINE BENCHMARKS ELEVATION z Ov 3E - EXISTING FENCE BENCHMARK BENCHMARKS BENCHMARK© i3 0 X TOP OF PIPE TOP OF PIPE TOP OF PIPE m v - -- FLOODPLAIN (ELEV. AS SHOWN) ELEV. = 941.41 ELEV. = 94726 ELEV. = 940.58 {la l a —�- PROPOSED DRIVEWAY � i�pl N87 °56'27 1 E L 3971.41' (E) SOIL TEST_ E7%4 CORNER S87 °86'27 'W 1333.29' C.T.H =.Z 381.40' 491.56 VARI T I&I 461.1 T 23009' 381.26' 7W1, q S88 °28'03 1302.63' APPROVED 0 sT,caa v x.G4GAjN . - ......... ®.. ... • - 0 P4winp Zoning sn 4 Parks Co.nm rtes LOT 2 Oa 1 33 - 33 : MAY 2 8 2004 _ 2.54 AC. INC. RW -110,477 SO. FT. k - • —• —•- 1 r m ° If not recorded within 30 days of 02 m approval data approval shall be 2.33 AC. EXC. RW �' LOT 4 {li 15° null and void 101,665 SO. FT. I zil Z : , "rp LOT 1 V� I "d 24.00 AC. INC. RW 1,045,286 SO. FT. N87 °56'27 "E 230.16' �N O N87°56'27 'E 230.16' N 1 FI ELD 22.20 AC. EXC. RW O � / N DRIV s 967,241 SQ. FT. m 111 LOTS 1 .INC. T. 490,1 � 490,319 SQ. FT. W 1J 4 G� EX ,jIN (3 CONCRETE 10.90 AC. EXC. RW 474,644 SO. FT. FOOTINGS �� �Z COP �9"a33 33 45 N89° ° 19 ' 51 "E i iZ • J_ I 75' QO�� � i { 55'. 60' { PONO 9i . • Z I � 7s 'O - { {W o :• Irn t 68.54' = ... ,; _ • •- 1258.74' il%� ' 7. 2' N88 °25'47 "E 1327.28' 159.3a °� N • KiNNtC C RIVER UNPLATTED LANDS OWNED BY OTHERS SCALE IN FEET 1" = 200 SE CORNER �m SECTION 15 ' 200 0 200 SHEET 1 OF 2 SHEETS Vol 18 Page 4762 i RECEIVED JUL 30 W 85446 ST CROIX COUNT KATHLEEN H. WALSH R'S BEG" REGISTER OF DEEDS ST. CROIX CO., WI CERT n SVRVEY MAP RECEIVED FOR RECORD LOCATED IN THE NE1 /4 OF THE SE7 /4 OF SECTION 16, T28N, 07/02/2007 04:30PM RIOW TOWN OF KINNICJGNNIC CROUC COUNTY, CERTIFIED SURVEY MAP WISCONSIN; BEING LOTS 1, 2 S 4 OF CERTIFIED SURVEY VOL: 22 PAGE: 5420 N MAP REC. IN VOL. 18, PG. 4782 REC FEE: 13.00 LEGEND COPY FEE: 3.00 ALUMINUM COUNTY SECTION OWNER PAGES: 2 CORNER MONUMENT FOUND DAVID 8 ARDIE PETERSON w 331 COUNTY ROAD "JJ" 0 1 5/16" O.D. IRON PIPE FOUND RIVER FALSS, WI 54022 O N EACH LOT IS C3 w 1" X 18' IRON PIPE SET WEIGHING SUBJECT TO A LOT 7 AREA U ¢ O 1.13 LBS. PER LINEAR FOOT S V RVEYOR LOWEST BUILDING 2.54 AC. INC. RW Z EDWIN C FLANUM OPENING 110,477 SO. FT. Lu cc cc ® .)ELEVATION W SECTION CORNER POSITIONED FROM NORTHLAND SURVEYING, INC. BEING ABOVE S WITNESS MONUMENTS OF RECORD 856 A HWY "65" / P.O. BOX 14 G 3 2.30 AC. EXC. RW ROBERTS, WI 54023 THE FLOOD PLAIN 100.371 SO. FT. .............. 50' ROADWAY SETBACK LINE ELEVATION BENCHMARKS Z OU X EXISTING FENCE BENCHMARK BENCHMARK BENCHMARK I 11 X TOP OF PIPE TOP OF PIPE TOP OF PIPE FLOODPLAIN (ELEV. AS SHOWN) ELEV. = 941.41 ELEV. = 947.26 ELEV. = 940.58 I I m —"► EXISTING DRIVEWAY 0 N87 °56'27"E f31971AV (9) SOIL TEST — — — — — — — — — — — — — — — — -"'- —' — �/4 CORNER � S87 °88'27'W 1333 -28' 1. ' VARIABLE RW N87 *G "E 381.40' 1 461.17' — — — — — — 230.09' 3 .28 6) ... .............. ........ .......•. see^2g'g 'w... . ?34�, ......... ......® o .i.. � Z cn �' LOT 8 = (33' 33MA w w D .54 AC. INC. RW — awl 2 110.477 SO. FT. d0�° 9 �� p ---- --- - ------- i = I {� I m i, 2.33 AC. EXC. m LOT 7r,. `� m I, ` ' 101.665 SO. FT. Qf \ U\ A- LOT s ` \ I w 24.00 AC. INC. RW � 1,045,286 SO. FT. N87 °56'2T'E 230.16' N "E 87 °88'27 CA , FIELD 22.20 AC. EXC. RW f�P� 230.16' �I IC DRIVE 967,241 SO. FT. / , ` A A r r 1 r r r 1 I z EDWIN C. - Im EXISTING C CRETE FIANUM I� 8 -2487 ( I FOO GS %r' AMEAY. IZ W18GONSIN C l 45' I �oP� 1 -! P�oN ti� �rrrrr G' /t 1 ; 1g51 E 'r -- E 0 1 Im r 95.x.... -..... .. /' O. /L 1 i I I Il ? 76' a° I I= �� Q O m I 55 1 60' I QO ,� 1 icn LA m 1 I I � 75' i I PD .:r..... 1258.74' I N88 °25'47"E 159.30' 1327.28' --� UNPLATTED LANDS OWNED BY OTHERS Z `L' K4NNICK I------------------------------- ------ -------- --- - - - - -'8 I THIS CERTIFIED SURVEY MAP SHOWS THE REDUCED Icn BUILDING SETBACK FROM THE RIGHT -OF -WAY AS APPROVED'r:z SCALE IN FEET 1" = 200' BY THE PLANNING AND ZONING COMMITTEE. SE CORNER m SECTION 15 0 200 Vol. 22 Page 5420 SHEET 7 OF 2 SHEETS Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT sanitary Permit (ATTACH TO PERMIT) 119468 No GENERAL INFORMATION State Plan ID No: �/ ";-- �- 0 Personal information you provide be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). " �� CV Permit Holder's Name: City Village X Township Parcel Tax No: Kinnickinnic Township 022 - 1044 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 15.28.18.237B TANK INFORMATION k,_��ryl/s t.k'G ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding go—t. —System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length 7 �_ . Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold FDi x Hole Size x Hole Spacing Vent to Air Intake e(s) Length Dia ngh Dia Spacing SOIL COVER x Pressure Systems Only xx Mou nd Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Lw] Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 331 County Rd. JJ (house) River Falls, WI 54022 (NE 1/4 SE 1/4 15 T28N R18W) metes & bounds Lot Parcel No: 15.28.18.237B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = FI ' Plan revision Required. am Yes [], No - - — - — I - I Use other side for additional information. Date Insepctor's Signature Cent. No. SBD -6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road �'�Y_•' Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanita g [I Check if revision to previous application 120 (P I. Application Information - Please Print anon ` ° " ""� "° ' - Location: 1 Property Owner Name a �v1� 1/4 Sr� 1/4, Sec (4 fit p If T � �� t T N, R E (or W Property Owner's Mailing Address Lot Number Block Num r 3 3 c o cafe 7 /: f: rkn ks ec.ds 7-3 City, State Zip Code . ' Subdivision Name or CSM Number 11 Ty of Building: (check one) o I Ow /i s amity ❑ Village own of 1 or 2 Family Dwelling - No. of Bedrooms: 1— .r 1" /J - ❑ Public/Commercial (describe use): l? n IC F-! YI h / C� ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. C ck box on line B if applicable) h Parcel Tax Nu r(s) A) 1 1.0 Repair 2 Reconnection 3. ❑Non - plumbing ❑Rejuvenation OZ 2 m V Sanitation B) Permit Number Date Issued State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation VI. Tank Information Capaicty in Gallon Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Ytxisting �allons Tanks Concrete structed glass - ranks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair/ reconnenction /rejuvenationrnstallation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumber's Name (print) , hers nnat ps • MP /MPRS No. Business Phone Number JFZ al�� ��✓ Q4_, ' Plumbers Address (Street City, State, Zip Code) � vrk / 1 O 111. County/Use Only Disapproved Sanitary Permit Fee Date Issued w suing Ager�Sig tamps) Approved Owner Given Initial Adverse � / � rr � ���� fa"- t Determination 7 IX. C iTN4; ftRgRal1Reasons for D7 oval: �,/� 1 Septic tank, effluent filter and �3•S / I f''UJ,(�j3 cJo �zs i- dispersal cell must all be serviced / maintained as per management plan provided by plumber. �u �✓ C ,�,,J� ��� 2. All setback requirements must be maintained as per applicable code /ordinances. �0 � ° (4 v� c z .. Z � m v O mm 70 � o X X 0 ' rV � O y U) m O < o O —1 n c z e 5 .! 9 . i lRi �9 0 o m D o0 p 'y -n r n O0 m� ;UK � D � y Z = � � D 0 n m Z � m ZD Z o C Z Z � r 55 Oo C M � 0 C a) Z 4Z. '''� r�'� z Fn z� m :E! z IO M m O mm la .3 my ��m = 0 m— 3 3 3 (D m � v , $ «� lbi O m D o v a a- a.; a a.m 0 T p N m n a n 3 S X a ,r « OD � y w O A 5F QQ ' d O o l e o, y ga o x ca Nv_ 3 oz m a v Q m a 01 a o .z o o � Z 3 3 S _ 9 1 3 0 c� .� o m ' m m � °� w� � Z C Z z =� m 8 w s 8 z zc z� _ 0 D D ca D ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the n U ram residence located at: ; N J5 V e 1/, , Sec. _� T _22� N, R f 4V, Town of , I t1�N lGIS' ! A1Nr(. St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced (L 0,,7 Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: /3 SZD Construction: Prefab Concrete _ Steel Other Manufacturer (if known) Age of Tank (if known) : (Signatu ) (Name) Please Print cn �2 ;2 L� (Title) CLicense Number) � i d ( at Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name cSignature _ - ,/ / MP /MPRS . )�2 � i � r ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT "M.. ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 March 1, 2004 David & Arden Peterson 331 County Rd. JJ River Falls, WI 54022 Dear Mr. Peterson: Per your telephone query, I have enclosed blank forms to certify the condition of your existing septic system. The house's POWTS was replaced in 1989 (permit #119468) and a copy of the as -built has been enclosed for your records. If your reconstruction project will increase the design wastewater flow beyond the existing 4- bedroom sizing, the enclosed affidavit may be modified to read "reconstruction" instead of "add on" and will need to be completed prior to submittal of a building permit application to the Town of Kinnickinnic. Also enclosed are copies of an as -built report detailing the septic system installed for the horse barn/arena and the sanitary permit #240729 was issued in 1995. If the Town of Kinnickinnic requires one, our office can review proposed house plans for your reconstruction project and evaluate whether the design wastewater flow will /will not exceed the capacity of the POWTS. You mentioned that the system was inspected prior to your purchase last year, so you may already have adequate documentation that the system is not failing and the tank is in good condition. Either Henry Nechville or Bob Ulbricht can provide written certification if you didn't receive a copy during the land transfer. Let me know if you require further information on the POWTS installed on your property. Happy trails! m am Zoning Specialist Enclosures (4) Cc: File Dave Phillipps, Kinnickinnic Building Inspector s 6/25/03 David & Arden Peterson 6101 W. 154` Street Prior Lake, MN 55372 David & Arden: Enclosed are copies of the water tests, septic inspections and well inspections on your property for your records. Thanks ' Pam Willman Team of Speer and Bast Edina Realty — Hudson 715- 386 -0255 06.25v2003 09 :47 FAX 7153862231 Ben Horgan 10005 TRI COUNTY SANITATION INC. 105 4TH STREET — HUDSON, WI. 54016 Phone 715/386-2130 — Fax 715/386 -2231 Mr. Todd Wulf 331Cty. Rd. JJ River Falls, WI. 54016 Dear Mr. Wulf, An inspection of the septic system at your bum of 331 Cty_ Rd. JJ River Falls WI. was conducted on 6/21/03. The septic tank and pumping chamber were not pumped at the time of T his sep tic stem is made u of a s tank, um inspection. Th y P In p ump chamber tank and a two trench p P drainfield. At this time the septic system appears to be functioning property. This opinion was based on a surface inspection of the septic system. This surface inspection was lirnited to checking the inlet pipe to the septic tank, the exit baffle in the septic tank, checking the liquid level of the septic tank, to determine if the exit pipe was clear, checking the operation of the pump in the pump chamber tank and checkmg/weasuring any water in the inspection pipes at the ends of the draMeld trenches, which were both dry, tWs would indicate that all of the water being pumped up to the drain field is absorbing into the ground, meaning the drain field is functioning properly. It should be understood that a septic system is like any other part of a home, eventually it will wear out and need to be re lace but it is impossible to determine exactly when that will P � happen. The distance from the well to the septic system was also checked_ The inspection did not involve any excavating, to determine soil quality or code compliance. Therefore, it is understood and agreed that there remains the possibility of hidden defects in the system which are not discoverable by a surface inspection. Tri- County makes no guarantee or representation as to the age or condition of the septic system. Tri- County Sanitation Inc_, makes no guarantee as to the continued proper functioning or operation of the septic system after the date of this real estate transaction. It should be understood that a septic system is like any other part of a home, eventually it will wear out and need to be replaced, but it is impossible to determine exactly when that will happen. Tri- County Sanitation recommends that the septic system be pumped every two years, that bacteria be added when maintaining your septic system, that a garbage disposal not be installed, if there is an existing disposal that it be used as little as possible, and that powered laundry soaps and other non - biodegradable materials not be run through the septic system_ This pumping estimate is based on an average family of four and can vary depending on the age of children, work outside the home, and use of a garbage disposal. Therefore, the future and prolonged life of this system is dependent on proper maintenance. By signing this inspection certificate, you waive any claim against Tri - County Sanitation Inc., its employees or agents, now or in the future, on account of any damages allegedly sustained as a result of any failure or other problems with the subject septic system, realizing that S Tn- County Sanitation Inc., has per inspection a surface on the sublet t system only —Sincerely, Seller- _t � Date' n organ Tri- County Sanitation Inc. Buyer W1. Lie. 4 81587 Date: 06%25,2003 09:47 FAX 7153862231 Ben Morgan �j006 TRI -COVNW WITABON INC. 1029 atft sTtFEr HUDSON, WI. 54016 Mr_ Todd Wulf 331 Cty. Rd. JJ River Falls WI. 54022 Dear Mr. Wulf, An inspection of the septic system at your residence of 331 Cty. Rd JJ River Falls, W1. was conducted on 6/21/03_ The septic tank was pumped at the time of the inspection. This septic system is made up of a septic tank, a flow control box and two separate drainfields_ The original being abed drainfield and a newer two trench drainfield_ With the control box either one of the drianfields can be "turned off," leaving it as a back up. At this time the trench drainfiled is in use. It was noted at the time of inspection that the septic tank manhole cover was broken, on 6/21/03 that was replaced_ At this time the septic system appears to be functioning properly. This opinion was based on a surface inspection of the septic system. This surface inspection was limited to checking the inlet pipe to the septic tank, the inlet baffle in the septic tank, and checking the liquid level of the septic tank, this helps us determine if the exit pipe from the septic tank to the box and from the box to the drainfield is opened: It also involved measuring/checking for any water in the inspection pipes at the ends of the the drainfields, which were dry. This would indicate that all of the water leaving the septic tank is absorbing into the ground, in the trench drainfield, meaning the septic system is functioning properly. The inspection did not involve any excavating, to determine soil quality or code compliance_ Therefore, it is understood and agreed that there remains the possibility of hidden defects in the system which are not discoverable by a surface inspection. Tri- County makes no guarantee or representation as to the age or condition of the septic system_ Tri- County Sanitation Inc., makes no guarantee as to the continued proper functioning or operation of the septic system after the date of this real estate transaction Tri- County Sanitation recommends that the septic system be pumped every two years, that bacteria be added when maintaining your septic system, that a garbage disposal not be installed, if there is an existing disposal that it be used as little as possible, and that powered laundry soaps and other non - biodegradable materials not be run through the septic system. This pumping estimate is based on an average family of four and can vary depending on the age of children, work outside the home, and use of a garbage disposal.. Therefore, the future and prolonged life of this system is dependent on proper maintenance. By signing this inspection certificate, you waive any claim against Tri- County Sanitation Inc., its employees or agents, now or in the future, on account of any damages allegedly sustained as a result of any failure or other problems with the subject septic system, realizing that Tri- County Sanitation Inc., has performed a surface inspection on the subject system only. cerel.7, Seller. Mrs �.- -f Date: Ben Morgan Tri County Sanitation Inc Buyer: Wl. Lic. 9 81578 Date, 06;25/ -2003 09:17 FAX 7153362231 Ben 1tur an 2 007 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715.962 -3121 — 800 - 962 -5227 FAX - 715 962 - 4030 G 7 WEB SITE: www.cticolfax_com ANALYTICAL REPORT Ben Morgan Report Number: 03014899 Page: 1 Tri County Sanitation Sa Number: 03 -04543 102 4t`i Street Report Date: 6/12/03 Hudson wi 54018 Date Received: 5'10/03 I Owner: Todd Wulf Address 331 Cty Rd JJ House River Falls WI Collector: Ben Bate Sampled: G/ 9/03 Time Sampled: 7:45 Sample Source: Kitchen Tap Date Analyzed: B/10/03 Time Analyzed: 14:30 Coli.form— Colilert: Absent /100al Interpretation: Bacteriologically SAFE Nitrate —N: 8.0 ppm Above 10 ppm Nitrate —N exceeds the recommended Public Drinking Water Standard. Lab Technician: Pam Gane WI Appr oved Lab No 15 < Means "LESS THAN" Detectable Level Approved by: �� . P6/25 , '2003 09:48 FAX 7153862231 Ben Morgan 1�]U08 M COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.Q. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 — 800 - 962 -5227 FAX - 715 952 - 4030 WEB SITE: www.cticolfax.com ANALYTICAL REPORT Ben Morgan Report Number: 03014900 Page: 1 Tri County Sanitation Sample Number; 03 - 04544 1029 4th Street Report Date: 6/12/03 Hudson WI 54016 Date Received: 6/10/0W Owner: Todd Wulf Address: 331 Cty Rd JJ Barn River Falls WI Collector: Ben Date Sampled: 6/ 9/03 Time Sampled: 7 :30 Sample Source: Kitchen Tap Date Analyzed: 6/10/03 Time Analyzed: 14:30 Coliform— Colilert: Absent 1100m1 Interpretation: Bacteriologically SAFE Nitrate —N: 3.3 ppm Above 10 ppm Nitrate —N exceeds the recommended Public Drinking Water Standard, Lab Technician: Pam Sane WI Approved Lab No. 19 < Means "LESS THAN" Detectable Level Approved by: �� J MANTYLA WELL DRILLING, INC. Phone: 651 - 436 -7600 • Fax 651 - 436 -5106 1392 St. Croix Trail N. • P.O. Box 797 Lakeland, Minnesota 55043 -0797 WELL INSPECTION REPORT Owner TODD WULF County: PIERCE Address: 331 COUNTY RD JJ City: RIVER FALLS Stat WI Zip: 54022 Well serves: 1 BARN (example: # of homes, barn, school, church, etc.) WELL DATA: Construction Report: Owner: Measurement: Other: X Construction and size: drilled: 6 point: spring: dug: Location on property: NORTHWEST OF HORSE BARN Year Constructed: ? Casing size /material: 6" STEEL Casing height: 15 +" Casing depth: - Well depth: - Nearest Contamination Source: BARN 50 FEET AWAY High capacity well: _ yes X no High capacity property: yes X no Visual portions of well & water system are in compliance with State Well Code X yes _no Variance required ?_ yes X no Abandonment required ? yes X no PUMP DATA Name, type, horsepower: 3/4 HP (FRANKLIN CONTROL BOX) Location: IN WELL Age: - Amps: 8 Voltage: 230 Pipe material in well: - Method of discharge: PITLESS UNIT Pressure tank: Type and Size: APPROX. 40 GALLON BLADDER Water conditioning equipment: g Water sample taken: yes X no Location: Water system working correctly at time of report: X yes no COMMENTS The information on this form lists facts and conditions of the visible portions of the well and pt,anp installation at the time of inspection and does not imply or give any kind of guarantee. Tlzis is a statement of compliance and the operation of the well and pressure system at the time of the inspec ' v. Date: June 3 2003 Contractor /Well Dialler. Z'?% License: WD62 E. A. Bud Mantyla F: \WPWIN \WELLINS.wpd i MANTYLA WELL DRILLING, INC. Phone: 651 - 436 -7600 • Fax 651 - 436 -5106 1392 St. Croix Trail N. • P.O. Box 797 Lakeland, Minnesota 55043 -0797 WELL INSPECTION REPORT Owner TODD WULF County: PIERCE Address: 331 COUNTY RD JJ City: RIVER FALLS Stat WI Zip: 54022 Well serves: 1 HOME (example: # of homes, barn, school, church, etc.) WELL DATA: Construction Report: Owner: Measurement: Other: X Construction and size: drilled: 6 point: spring: dug: Location on property: NORTH SIDE OF HOUSE Year Constructed: ? Casing size /material: 6" STEEL Casing height: 12 +" Casing depth: - Well depth: - Nearest Contamination Source: SEPTIC High capacity well: _ yes X no High capacity property: yes X no Visual portions of well & water system are in compliance with State Well Code X yes _no Variance required ?_ yes X no Abandonment required? yes X no PUMP DATA Name, type, horsepower: 1/2 HP (STARITE SUBMERSIBLE) Location: IN WELL Age: - Amps: 5 Voltage: 230 Pipe material in well: - Method of discharge: PITLESS UNIT Pressure tank: Type and Size: 20 GALLON BLADDER Water conditioning equipment:. FILTER Water sample taken: yes X no Location: Water system working correctly at time of report: X yes no COMMENTS The information on this form lists facts and conditions of the visible portions of the well and pump installation at the time of inspection and does not imply or give any kind of guarantee. This is a statement of compliance and the operation of the well and pressure system at the time of the inspection. / Date: June 3. 2003 Contractor/Well Driller: License: WD62 A. Bud Mantyla FAWPWRJ\WELLINS.wpd 1 STC - 104 AS BUILT SANITARY SYSTEM REPORT q r "5 OWNER ADDRESS �, °,��*y SUBDIVISION / CSM# LOT # SECTION / T - 2 5 N - j , Town of Al A / k z ✓ /� ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 ET OF SYSTEM cA AA a r A/7L, INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 r BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 0,46, Aho Liquid Capacity: / Setback from: Well House '� " Other Ste" Pump: Manufacturer d)w /©�,,, ! Model# z:44&_1t Size Float seperation �.�� 11. Gallons /cycle: 13 7 Alarm Location v - :SOIL ABSORPTION SYSTEM Width• Length Number of trenches Distance & Direction to nearest prop, line: 1,7/ Setback from: well: J 7 o House 7 �- Other I P ,j t ELEVATIONS Building Sewer 1 00,6 , ST Inlet ; = ,ST outlet PC inlet 3 PC bottom f lumpy Off Aj( 1 Header /Manifo d �` Bot�om of system S Existing Grade .Final grade <3 � DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 31::;> X5 INSPECTOR: 3/93:jt f GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1044 -10 -000 Parcel Number 15.28.18.237A Claimed 1 Date Re- certified / / Relate Number: i OWNER NAME: First DAVID P & ARDEN D Last PETERSON CO -OWNER Mailing Address 331 CTY RD JJ City RIVER FALLS State WI Zip 54022 - `� s Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY WD 2476/ 306 749419 12/17/2003 QC 1509/424 622747 05/09/2000 PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office 331 CTY RD JJ RIVER FALLS School District: 4893 - SCH D OF RIVER FALLS Special District: (1) 100 - (2) - (3) - CHIP VALLEY VOTECH Plat Code: Last Changed on: 02/10/2004 Book Number: 1 SECTION 15 TOWN 28N RANGE 18W %160 '/.40 Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers: F4 -Prev, F5 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1044 -20 -000 Parcel Number 15.28.18.237B OWNER NAME: First DAVID P & ARDEN D Last PETERSON PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 331 CTY RD JJ SECTION 15 TOWN 28N RANGE 18W '/4160 '/440 Line Description Line Description TOTAL ACREAGE 5.010 PLAT LOT BILK 01 SEC 15 T28N R18W 5.01A IN 15 02 E1/2 SE COM SE COR SEC 15 16 03 TH W 1308', N 1664', E 45' 17 04 TO POB; E 506.35'N 431'W 18 05 506.35' TO E LN HWY JJ TH S 19 06 431' TO POB 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Wiscii Department Qf Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division • (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI o.: WULF, TODD X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: y TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �o ' /0 0. Dosing t Aeration Bldg. ewer g' 6.35' / Holding St/ Ht Inlet 6 11 95,17 TANK SETBACK INFORMATION St /Ht Outlet /a.09' 94.94 TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet ��, 9 9q, d 3 Septic ,, / = /oS " i5 ` >z NA Dt Bottom /` 7 ' �b ' Dosing >� d s '(S . > �S ' NA Header / Man. ir 33 Aeration NA Dist. Pipe �' 39 X8 Holding Bot. System Q ' 3 z. 97. J3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer ��(Ce�� �� /-p J Demand / r/ 3'e,t" f f , 4163 ioo, a Model Number 9F a S GPM 6 c� ��.� /6„ 5;-, TDH Lift 3 Friction Z� System ,o TDH76g' Ft ���tn 5,G2' q/, Forcemain Length Dia., o Dist. To Well YSD ' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `5' v ss' DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Typeof /'F4 CHAMBER Mo Number: System: lrlZr d ( 7 ' 7 z g ' 1- OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 10 d a. w Bed /Trench Edges �?v " Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC.15.28.18W, NE, SE, CTY JJ Oti� / A/ cLz� Plan revision required? ❑ Yes ❑ No / Use other side for additional information. // /7 kS (o SBD -6710 (R 05/91) Date Ins ct 's Si ' ature Cert. No. I ADDITIONAL COMMENTS AND SKETCH f SANITARY PERMIT NUMBER: P �^ Safety and Buildings Division v�■�r■�. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05,Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size- !�L , • See reverse side for instructions for completing this application State Sanitary Permit N umber The information you provide may be used by other government agency programs 26 .f revon to previobs application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na ,{T� Property Location _ 7 — . 7,0 f ;� 514 j E1/4, S S T ;,g , N, R E (o W Property Owner's Mailing Address ry-- Lot Number Block Number �.✓ V City, St e A Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned o Ot Nearest R ad _ Public 1 or2 Family Dwelling - No- of bedrooms V i of c L l;tWlG J 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station LCarwasb. 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 [g-6ther: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. few 2 ❑Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an SysIe _________ System_____________ Tank Only______________ Existing System ________ Existing System B) A Sanitary Permit was previously issued. Permit Number Date Issued 7A V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑S�' page Bed 21 [] Mound 30 ❑ Specify Type 41 []Holding Tank 12 'Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation' -5 S o Q , 7o7 S Feet 9 19�. E t S' Feet Capacit VII. TANK in Ca allo Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank d DD Gc�N Lift Pump Tank /Siphon Chamber ,v R' VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) r Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: c,�i v D.3 5$ 7 1 S - - 7 , 1 , 9­.33.2 2_ . Y� t Plumber's Address (Street, Cit , State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing A ent Sig ture (No a s) iproved El Owner Given Initial Surcharge Fee) ni" 7 Adverse Determination �� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS _. 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years_ 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI, Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations October 9, 1995 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S95 -04255 FEE RECEIVED: 180.00 WULF, TODD NE,SE,15,28,18W TOWN OF KINNICKINNIC COUNTY OF ST CROIX NON- PRESSURIZED IN- GROUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations Shown on th2 plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. a This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sinc ely, Peter E. Pagel Plan Reviewer Section of Pr vate Sewage (608) 266 -2889 RAG A� SBDA -5524 (R. 03/95) • r r ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # S95 -04255 Date Oct.10,1995 Owner Todd Wulf & Laura S. Wulf (Rosecrance) Phone 715 426 - 5227 Address 331 Cty. JJ, Riv Fa Wis 54022 Legal Description Part of a 40 acre parcel. ID. #022 - 1044 -10. NE 1/4, SE 1/4, Sec.15, T28N, R18N Town of Kinnickinnic County St. Croix C.S.T. Gary L. Steel CSTM 2298 Installer Local Authority/ Supervision Zoning Adm. St. Croix County PROJECT DESCRIPTION New Construction. Horse stable/ training center/ indoor riding arena bldg. Per owner: up to 20 persons per day may occupy the bldg. for ocassional clinics, workshops, etc. Realistically, a load rate of 20 GPD /person (as for part -time employees etc.) is more appropriate for proper design purposes than lower outdoor sports facility factors. Owner understands that if a horse show, open to the public, were ever scheduled, that such loads can not be handled by this proposed design; owners indicated that they would rent portable priveys. Total estimated daily wasteflow: 400 gals. NOTE A site inspection by designer revealed that a single horse wash -down stall with a trench drain was illegally plumbed into the septic treatment system drain. It was pointed out to owner that such non -human wastes are NOT permitted to enter the septic treatment system. Owner understands he must cut off this horse drain from the system and properly re -route it to a seperate Pg.l PLOT PLAN VIEWS disposal system. Soils are very permiable Pg.2 SYSTEM CROSS SECTIONS �. $GPD /ft2 ) and a conventional gravity Pg.3 SYSTEM PLAN VIEWS trench system is proposed. Since bldg. sewer is 5 Pg.4 DOSING CHAMBER CROSS SECTI deep, a lift pump chamber is required. Pg.5 PUMP PERFORMANCE SPECS r S95 -04255 This design for installation is based entirely on measurements, elevations, 2 2 fi ` landscape conditions (slopes etc.) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. ORIGINAL Sau,,,an..dmnuny11, Q �1SC�N`Sf Any use of this POWTS design by any licensed plumber, or any �{' Rou" W. 7c related unlicensed parties or persons (excavaters, laborers) L8� shall not be construed as an assumption of responsibility by oil the designer for the xorkmanship, construction, placement, .HUDSON.M _ substitution or selection of any components not specified, or I(� any assumptions by the plumber that any unspecified components '' • «.... «. -� ° �4 are state approved or proper, or the effects of poor judgement .f �S' � if working under adverse damaging weather conditions (wet /frozen I'G`a" "``gyp* soils) by any such parties or persons. 33 410 • �jpp o -- - - - - - -- - - - - -- -- _ - -- - - - - -- - - -- YU -fps 0 0 SCALE 1 3 a /�' A O• &p qs y0 To FaRc�.y.� /, U Pu,�.q n 03 33 P, 1 01, y �3 /o /• / y tog 4u /32 /0017.7, 160- 13 5 3 o 9 04255 FAA S 5 -- � L t V f Fresh Air Inlels And Observation Pipe Approved Vein COP Minimum 12" Above 111 Final Grade P4P °- ,• Cost Ir en i t r � 3 1 About Pipe �� Vent 'Pip to Final Grade trnlhelk Cover In N Yin. 2" Aggregate Orer Pipe , 0 Distribution — Tee PI —'• 0 0 0 0 0 (� S Aggregate b Perlbreled Pipe Below Beneath Pipe o — Cooing Torminelino At Bottom 01 S 3 6 V 5rE,y 9 c07 see ,ohd- -=" s412T (4410 's i3v go y �l W Fresh Air Inlets And Observation Pipe 0 p� Approved Vent Cap Minimum 12" Above Final Grade j TRE - H — J (}�.� • 30 Above Pipe ' _ o Cost Iron V\ 'te Final Grade Vent "W � k tynlhelle Covering 'A� y Min. 2" Aggregate Orer P1pe ' Distribution — Tee PIPS o 0 0 o a . o CD a Aggregate o Perlbreled Pipe Below Beneath PIP$ o — Coupling Terminating At 5 YS TC I-f /�(J. _ Bottom Of S.ye tem • 7 S95-04255 ie 0 �M tiW v o� • \ 4 V PLIMP CHAMBER CROSS FS CTION AND SPECIFICATIONS P `f of 5 -VEUT CAP 4 "C.I. VEUT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER WIIJDOW OR FREESH SH 12 "MIU. 25' FROM D lMXvlo(r' IA13E/ I AIR IRITAKE 9h^r� ��F Uq7 /On/ GRADE I 4 MIM. MIN. r l � IM r 1, 111 91,0• a � . ' p E sa APPROVED JOINT A INy ,IK r I I I APPROVED JOINTS 1J/C.I. PIPE I � (VII ±ri ( I W/C.I. PIPE EXTENDIIJG 3' '0 �� I I I ALARM ONTO EXTENDING D SOIL ONTO SOLID SOIL B O. I I II 31 I oN f/' �j I ' ELEV. FL— OFF - - -- �- I PUMP -� - -j til 6 -- ' 9 nn� � I BLOCK it v RISER EXIT PERMITTED OUL9 IF TANK MANUFACTURER HAS SUCH APPROVAL' SEPTIC E 5PECIFI CAT IOUS DOSE Lv E� /rS Co.tJ ct i 1.e !.d 3 TANKS MA "LIFACTURER: KIUMBER OF DOSES: PER DAH TAIJK SIZE: �O� GALLONS DOSE VOLUME H/ /37 ALARM MANUFACTURER: GErf�L /9'G'x6 INCLUDING BACKFLOW: ' GALLONS MODEL HUMBER: p' CAPACITIES: A= INCHES OR yv GALLONS SWITCH TYPE: MERLUR Y > B Z INCHES OR 7/ GALLONS PUMP MANUFACTURER: ' G= G.-7 INCHES OR 137 CALLOUS MODEL NUMBER: / 92 /6 L H P i t s V D= /0 ' 0 INCHES OR -2ZZ GALLONS SWITCH TYPE: " &iYB1 -'1C / F10 4 7 NOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE a s GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF AIJO DISTRIBUTION PIPE.. FEET -rAA) /, SPICS 4 MIAIIMUM NETWORK SUPPLY PRESSURE N FEET EACGI + ' / R FEET OF FORCE MA X /D FT oo vr. FRICTION FACTOR.. ' Zg FEET TOTAL Dy /,v f 8 3� ` = 1JAMIC HEAD = FEET ,Fdvw,O py it E LENGTH ;WIDTH 39 INTERNAL DIMEMSIONS OF TANK: L - ;LIQUID DEPTH A �� 895 -04255 P,pOpoS 60S•fAl/ ,t HEAD CAPACITY CURVE 3 J0 MODEL "98" e 2S q �- I 3 s/6 6 m , + -I- 1s . 4 - 4 3/16 0 se 10 _ 2 1 1/2 -11 1/2 NPT 3 0 U.S. GALLONS 10 20 30 40 50 60 70 a0 LITERS a0 160 240 0 FLOW PER MINUTE - . TOTAL DYNAMIC HEAWLOW Pell kwav E . EF/LUENT AND DEWATERND " CAPACi7y 12 HEAD UNI1VMIN FEET MMRS CAL$ t'rRS 6 1.52 72 P73 t 10 9.05 S1 15 4.5? 1 7 s7 15 170 20 5.10 25 95 3 5/16 Lock VaM 23- ` .� -04 255 S 5 CONSULT FACTORY FOR SPECIAL APPLICATIONS' e Electrical aftefilalors, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm svftcheg. variable level long cycle controls. {, SELECTION GUIDE Standard all mode Weight 39lba, - t /2 H.P. I 1 1n� 9rilfloa tO Pw ate d2pole r^ echer11ca1 switch,no Y! Serlas Control selection 2. single piggyback mercury flow owitch at double piggyback mercury, float Model vole -Ph Mode Am a Sim lex Du lax 3. Mechanical hanical ahemator 10-0072 or 10-0075 i MSS 115 t ui 9.0 1 or 1 A 7 — 4. See FM0712, for correct model of Electrical Ahemator, "E -Pak" 1 1 0 8. 6. Mercury sensor float switch 104225 used as a /coMMrol activator ly DO$ 290 1 Auto 4A m 1 or 1 R 7 — duplex (9) or (4) float syste ' p°C f98 290 1 Non 4.S .. _ 2 Qr 2 lR _ 3 a 4 d 6 :. 8 Four hole ��,! Pak' . )uneticri box, for ttliit"M oonnedion or wired - in aim rpkx or duplex operation, 10-0002 1 7. Two'(2) hole "J -Pak ", for welerligM corinictlon or apilm. For intonation on additional 2oellai products re/„ to catalog on CombieAtlon Starter, FM0511; CAUTION Piggyback Mercury 9%tich s. FM0177; Electrical Allarnator, FM04ee; Mechanical AxErnator, � Alt ��ns� e le c t rician e Are ekraNbaj an/ Health Are (O SHA) . , N ele l e ds( and wiring ahouW w done by s qw& FMO 95: AWm Package, FM0512; Sump/sewape gukn, FMOre7; and Simplex corltral wldy ee0h should be Ieaowed kWwd- log Ow mom recent Nalloeai Emelrta Code (NEC) reed "M oeorgr.rtee.l ferrety and RESERVE POWERED DESIGN For unusual conditions a reserve safety factor ineered into the design of o,iery Zoeller pump. { • MAIL MAO. $0X 16347 loukvifa.lXY40256 -0347 Manufacturers of.. O , SNIP 70: 3 80 OA U#m lane p M tD 1. i0U1$ A'. KY 40216 1f, QUAI /1!'�q/PS �/NCf (502) 778 -2731 ,e FAY j502) 774 -3624 Aff 1 .. a SANITARY PERMIT APPLICATION • �:�:'��+ COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than Q 8% x 11 inches in size. ❑ ck if Che r P 1 to revfous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ? r ! /a.SE' /4,S %S T ,N,R E(o W PROPER OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ;' v 1 7�0 7 H 71S y .. II. TYPE BUILDING Check one CITY NEAREST ROAD ( ) State Owned LLAGE : r� iVi✓% Gf M Public 1:11 or 2 Fam. Dwelling -# of bedrooms — PARC TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 04-CZ© 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /C r Was 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 Other: Specify IV. TYPE O� PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 iL1' Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) (� ELEVATION / S0 l 98 - y 6 7 7 ' 7 2 Feet t� 1,.�+ Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer'sName C oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdino Tank© Lift Pump Tank /Si p hon Chamber El I El El El I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' Signature: (No S MP /MPRSW No.: Business Phone Number: Pe Ar—o k 1 (7! lumber's Address (Street, City, State Zip Code): IX. CdUNTYIDEPARTMENT USE ONLY ' ❑ Disapproved S!9itary Permit Fee (Includes Groundwater ate Issued Ias ing Agent Signature (No Stamps � Surcharge Fee) ) p Approved ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD- 6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete,## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams -and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 incyuded the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 •' Attach complete plans (to the county copy only) for the system, on paper not less County than 112 x 11 inches in size. • fee reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs 0 eck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property O wner Name Property Location ( � r A )}Ev4 - ;E1 /4, S T .s°z r N, R , E ocW j Property Owner's Mailing Address Lot Number Block Number City, St e Zip Code Phone Number Subdivision Name or CSM Number ,_ / 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest R ad _ Public 1 or 2 Family Dwelling - No. of bedrooms C] own OF /c!1 f C JM III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo -2 / F 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station ar Was 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 5. specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. [ w 2. I] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______Syste__________ System____ _________T ------ y______________ Existing System ------------- Existing System B) A Sanitary Permit was previously issued. Permit Number VU ? - Date Issued 7 a 7 V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ S page Bed 21 E] Mound 30 E] Specify Type 41 E] Holding Tank 12 eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 15. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �a 0 _ 0 0 i -f ; 7,7 `� Feet 9 9 Feet Capacity VII. TANK in Ca allons Total # Of Prefab. Site Fiber- Exper. INFORMATION g pl Gallons an Manufacturers Name Concrete Con- Steel glass tic App New Existin strutted Ta ks Tanks Septic Tank or Holding Tank Lift Pump Tank /Siphon Chamber ttir / 041 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) JJ Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: ,^- Plumber's Address (Street, Cit , State, Zip Code): ' f _ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (i ncludes Groundwater ate ssue ent Sig ture (NO a, ps) A roved Surcharge Fee) cc��' pp ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: , SBD -6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ° .1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815.. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type -of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII_ Responsibility statement. Installing plumber into fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers, wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption'system if required by the county, E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I R �Y 4? FN n -r {3 { 4 1 Yi s z N� k f c R O"" t �R 0 COM _ a c 1 �D d _ ( M AR ?` 5 :5� / a X 33 / lo, — Q i V�sr,, isin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY complete site Ian on p aper not less than 8 1/2 x.1'1 ipc� St. Croix Attach com p p p p b r�siinis' �. _must include, but not limited to vertical and horizontal reference point PARCEL I.D. # (�4),,0rr'ction and scale or dimensioned, north arrow, and location and distanoe'to.,rXbarest ro O 022- 1044 -10 '`' / ' A REVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT `A(LL ItjfO,R `A� PROPERTY OWNER: v r PR LOCATION Todd Wulf ' " .. GO T NE 1/4 SE 1/4,S 15 T 28 N,R T8 *or) W PROPERTY OWNERS MAKING ADDRESS V �.• L BLOCK # SUBD. NAME OVSM # 717 Terrier Tn. ... na 1, 40 acres. A C 5, ? CITY, STATE ZIP CODE PHO NU OVILLAGE [x OWN NEAREST ROAD Somerset, WI. 54025 (715) Kinnickinnic Co. Rd. #JJ [xJ New Construction Use [K J Residential I Number of bedrooms 1- [ J Addition to existing building L J Replacement [ J Public or commercial describe Code derived daily flow 150 gpd Recommended design loading rate • 7 bed, gpd/ft - trench, gpd/ft Absorpl n, area required 215 bed, r 188 trench, ft Maximum design ioading rate . 7 bed, gpdtO - 8 trench, gpdqt Recommended infiltration surface elevation(s) 97.72 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S D U ®S D U ®S D U M D U D S O U D S KI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -14 10yr2 2 none L 2msbk mfr gw 2f .5 2 14 -23 10yr4 /4 none sil lfsbk mfr gw if .2 .3 Ground 3 23 -30 7.5yr4/6 none sl lmsbk mfr gw na .4 .5 v. 10 42 , 4 30 -84 7.5yr4/6 none S Osg mvfr na na .7 .8 Depth to limiting factor +84" Remarks: Boring # `K.=M -R 1 0 -10 10yr3/3 none L 2msbk mfr gw 2f .5 .6 2 11 2 10 -28 10yr4 /4 none sil 2msbk mfr gw if .5 .6 iiVv',r�YV.B 3 28 -42 7.5yr4/4 none S Osg mvfr gw na .7 .8 Ground elev. 4 42 -82 7.5yr4/6 none is Osg mvfr na na .7 .8 100 ft, Depth to limiting factor +82" Remarks: CST Name:— Please Print Phone: Gary L. Steel 715 - 246 -62 Address: 1554 200th. Ave. , New Richmond, WI. 54017 Signature: ,p Date: CST Number: 6 -2 -95 `cstm 02298 k, PROPERTY OWNER T. Wulf SOIL DESCRIPTION REPORT Page? of PARCEL I.D. S 0 22 - 1 -10 Boring# Horizon Depth Dominant Color Mottles (Texture Structure Consistence Boird3ry Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed (Trench 3 << 1 0 -15 10yr2/2 none L 2cp1 mfr gw 2f np 1.2 €;«' 2 15 -29 10yr4 /4 none sil lfsbk mfr gw if .2 ( .3 Ground 3 29 10yr5 /4 none S Osg ml na na .7 .8 elev. i 10 Depth to limiting factor +86" J Boring # 1 0 -11 10yr3 /3 none L 2msbk mfr gw 2f .5 ':.6 4 2 11-18 10yr4 /4 none sil lfgr mfr gw if .2 .3 <>tmi>::: <: 3 18-8C 10yr5 /4 none S Osg mvfr na na .7 �.8 Ground elev. 10 at, Depth to limiting factor +80" Remarks: Boring # 1 0 -10 10yr2 /2 none L 2msbk mfr gw 2f 1 .5 .6 OMER 5 2 10-24 10yr4 /4 none sil lfsbk mfr gw if 1.2 .3 3 24-2S 7.5yr4/4 none is Osg mvfr gw na .7 '.8 Ground elev, 4 29-8C 7.5yr4/6 none is Osg mvfr na na .7 .8 l oo:l Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEELS SOIL SERVICE Gary L. Steel Todd Wulf 1554 200th Ave. CSTM2298 NEgSE4 S15- T28N -R18W New Richmond, WI 54017 MPRSW 3254 town of Rinnickinnic (715) 246 -6200 N 1 =40' Bm.= top of 1 steel pipe at el. 100' Alt. Bm. = top of steel fence post C el. 103.40' I r 13ZD' 3e' n �0 2,070 a- � I GAry L. Steel a%1 6 -2 -95 �w- f STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix Count OWNERIBUYER � � \WkA MAILING ADDRESS J y ��� �K�' u� At �q D LZ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE PROPERTY LOCATION 1/4, f 1/4, Section T P N -R J L_ TOWN OF �L hh �`L� i 1n1� . � ,, ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, lierein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. R -- ��, DATE: U St. Croix County Zoning Office Government Center I 101 Carmichael Road Hudson, A \II 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -------------- --- - - -�1� � �� � � �� ( �� l ���y � s- ����c� u; ?�� � r � tr � �', Owner of propert f?' fCUe XC.�s P P Y y Location of property RI`s 1/4 1/4, Section _� ,T 2K N -R LOW) Th Township b `C i �IPAI'C Mailin address � d * �-i j - er Rit(s f i. 5q6-L2_ Address of site e Subdivision name Lot no. Other homes on property? Yes No Previous owner of property ��VW� ✓� j� %� ? /1V�! t?j, Total size of property CID Total size of parcel Date parcel was created ' �,.,�_ j C Are all corners and lot lines identifiable? C Yes No Is this property being developed for (spec house)? Yes >( No Volume ' and Page Number '7C as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the o fice of the County Register of Deeds as Document No. ,.�� d fo and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the off' e of the County Register of Deeds as Document No. Signature of Applicant Co- Applicant Date of Signature Date of Signature •vl�aq .� s,�t rr(. 1 0 ,T 1 - In. Snr OCLdf13 t:F •....! I I Iq 1.11 1TJ Wo n :c9: s!. r J. . I !. tlK{_ a1 Stale bar of W iseonsin Form 2 - 1982 5303 WARRANTY DEED I r' PMi O DOCUMENT NO . 114 1 1 � - Thomas N. Christianson and Kare M. - — fI'1 husban3 "and w ile; _ _ JUN 2 2 1995 — - - - - -- - -- 9:30 A...i conveys and warrants to _ laUra S. Rosec rance Livinq Trust and Beverr b. Rosecranc Livi Trust - -- -- — f 00 1 r � _ THIS SPACE RESERVED FOR RECORDING DATA - - - -- -- NAME AND RETURN ADDRESS Laura S. Rosecrance Living Trust & Beverly B. Rosecrance Living Trust' the following described real estate in - St. Croix ',. 331 County Road JJ County, State of Wisconsin: River Falls, W1 54022 (Parcel Identification Number) NEkSF'k, Section 15- T28N -R18W, St. Croix County, Wisconsin. i l This - ?S_._. homestead property. (is) . Exception to warranties: Easements, rights-of-way of record if any. P F restrictions and ri g Y , IIII y ti, Dated this ___...___. _ — _ -_ _ - da_v of _ June. 95 . ,, ``1I11 II - .-.-_.- -- ---- --(SEAL) -___`4_.- __ - ( SEAAL) ThQ fL3s N Chris tianson SEAL) LI (SEAL) 4a is__><. Karen M. Christianson I I I AUTHENTICATION ACKNOWLEDGMENT Signature( s) — 1'f1OMaSL. N.Chr_iStlan$Oi STATE OF WISCONSIN 1 ss. Kare M. Chris tianson Count). authenticatell this _ day of _ June - , 1995 Personally came before me this _ ____ day of 19 _ -. the above named - • , K ristin Op, and TITLE: MEMBER STATE BAR OF WISCONSIN -- - -.._._ -.�.- - -------------------------- authorized by §70606. Wis. Slats.) to me known to he the person _.._. _. who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY _ _Kristin Ogland Attorney at Law Notary Public __.__ - - _- - County. %l'is. r (Signatures may be authenticated or acknowledged. Both are not My commission is permanem (If not, state expiration (late: I'',. necessary.) __.. _ - 19 1 \h� I'l Ik Ivrsd ,�, r ll \d h,l„x Ih\n %%RRANTy DFFD STATE. BAR OF w1N('O%SI\ Blank Co In: r - WISCONSKREAL ESTATE TRANSFER RETURN - CONFIDENTIAL Submit all parts to Register of Deeds with document(s) to be recorded. I. GRANTOR: V. PHYSICAL DESCRIPTION AND PRIMARY USE 1. Name T - iti. :° Kvreit ' C:uistjimisor 15. Kind of property 16. Primary use 2. Address - New addres If prograly transferred was primary residence ❑ Land only a.0 Residential y , 4 j �! t. z � 0 Land and buildings ❑ Single family /condominium . j `.� �:` -- ❑ Other (exptatrl "Muttt-family = # units - 17. Estimated land area and type ❑ Timeshare unit 3. Grantor is 0 Individual F Partnership ❑Corporation ❑Other a. Lot size x b.0 Commercial usmess use 11. GRANTEE: ..� =4 =o�r� r.v Livir,G '!Viet b. TOTAL ACRES c. El Manufacturing business use ' C. MFL / FC / WTL acres d. ❑ Agricultural 4. Name ireveri Rosen rarrce � d Ft. of water frontage Adjoining land within 3 miles? ❑ Yes ❑ No 5. Address e.❑ Other (explain) VI. TRANSFER � 18. Type of transfer:. © Sale ❑ Gift ❑Exchange ❑Other (explain) 6. Grantor /grantee related: 0 None ❑ Corp /Shareholder /Subsidiary ❑ Partnership 19. Ownership interest transferred: © Full ❑ Partial (explain) ❑ Financial ❑ Family or Other explain 20. Does the grantor retain any of the following rights ?❑ Life estate ❑ Easement 7. Send tax bill to: Name and address 21. ❑ Deed in satisfaction of original land contract? Dated? j ws f r33�f E'E' 22. Points (prepaid interest) paid by seller $ 23. Value of personal property transferred but excluded from (25) $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? 24. Value of property exempt from local property tax included on (25) $ ❑ Yes M. No Exclusion code If W - 11, explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION 25. Total value of REAL ESTATE transferred $ IV. PROPERTY TRANSFERRED 26. Transfer fee due (line 25 times .003) $ ate' • 9. F city ❑Village E;] Town • L;rD 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 County 10. Street address 28. Grantee's financing obtained from a. ❑ Seiler 11. Tax parcel number If box a or b is checked b. ❑ Assumed existing financing 12. Lot no.(s) Blk no (s) complete Part vin - c. ® Financial institution / Other 3rd party Plat name Financing Terms d ❑ No financing involved 13. Section Township Range 14. Legal Description metes and bounds: (attach 2 copies if necessary) N ~ 4SL�, Sew. 15.12E -11811 St. Croix CC&MV3 , i I 1 VIII. FINANCING TERMS (FOR SELLER /ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ (Line 29 = Line 25 minus Lines 30a and b excluding payments for personal property) 30. Amount of mortgage/land 31. Interest ' 32. Principal and interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum $ b. $ % $ - -/- -/- - 37. If the dollar amount paid per payment (32) is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above Enter the date of change - -/ - -/ - - and the amount it will change to $ IX. CkBTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Date Grantor's telephone.number ' Gran qr or agent � - �. ;- r , r ( ) i -�' _ *-� SIGN ) _._ �, _ ` :.: � Date Grantee's telephone number HERE Grantee or agent ' Agent's telephone number Print name and address of grantor's agent ( ) code Document number Vol. /Jac. Page /Im. Date recorded Date and kind of conveyance Conv. 1 2 3 4 530364 3127 70 6 /7: /9 5 6/15/95 ND Sales number FOR Parcel number Assmt. year 19 _. ❑Field ASSESSOR'S L County _ _ E] use USE Parcel classification I Tax dist _ ONLY RES COM MFG AGR S/W FOR T Assmt. dist. _ _ ❑ Reject 1 2 3 4 5 6 - Form - S T C - 104 7S6 O AS BUILT SANITARY SYSTEM REPORT OWNER �Otij s� �� jPEN GG/P TOWNSHIP ADDRESS SEC. �S T � N -R W ADDRESS � ' WY 7-7 ST. CROIX COUNTY, WISCONSIN O piU� 6fIr /5 C•��S. Sga Z2 + 0 1�e G.� SUBDIVISION LOT LOT SIZE fi may.' PLAN VIEW A)�� v //U Distances and dimensions to meet requirements s o f I•T,HR 83 / SHOW EVERYTHING WITHIN 100 FEET OF SYSTE k /I 7Z:_ 1 4 S i c 7 s�- 1� sip <<C_ � INDICATE NORTH ARROW T o of �LSEji�- �N Cuc�C�.(�4 E/"— BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: Exi s 7 ( -- un PGra. P A t. Cw — SEPTIC TANK: Manufacturer: KPOWAI Liquid Capacity: Number of rings used: l Tank manhole cover elevation: Tank Inlet Elevation: aZ 5 Tank Outlet Elevation: 72 Z� owl J � � de o Rear , O bU ER 20 0 feet Number of feet from nearest Road: Front,X Si, �} From nearest property line Front, O Side, O ppRear, O 6(! ,tk 200 feet I V Number of feet from: well 7 ��o , building: d� . _ of *ho A hnup ntot nlan)( 2 reference dimensions to septic tank) PUMP CHAMBER Manufacturer: Liquid Capacity: ' Pump Model: Pump /Siphon Manufacture Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from near t property line: Front, OSide, O Rear, Q Ft. Nu er of feet from well: ber of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM LAN E S Bed: Trench: 3 Width: S Lenth: CO 7 Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Opt Number of feet from well: 7 / 50 Number of feet from building: Z / (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Liquid depth: Bottom of epage pit elevation: Area Built: Has either a drop box O or stribution box O been used on any of the above soil absorbtion sytems? (Check e). HOLDING TANK Manufacturer: Zttomof Number of rings used: Elevati Elevation of inlet: Number of feet from nearest properfy line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: IPA y / � ,l Plumber on job: • / / License Number: Z— 3/84:mj I 0 t X10 O Q ` I O o o o � o CA �- I iJ v C QA rl i �� I � 1 � ►� 1 1 �l1 1 1 Q � ► 1 " 11 �� Izo 1 1 1 1 l ',� \ � o , � 1 1 1► r �% •� 1 1 � 1 � o O 0 \in L J DEPPRTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 NE 4 , SE y, S 15 , T28N -R18W S ber Town of Kinnickinnic � CONVENTIONAL ❑ ALTERATIVE El HoldingTank ❑ In- Ground Pressure ❑ Mound N ERMI OLDER: ADDRESS OF PERMIT HOLDER: INSPECTI N A E: Tom Christianson Route 2, Cty JJ, River Falls, WI 54022 11,30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Henry Nechville 3258 St. Croix 119468 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH A LARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST —► DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [::]YES ❑ NO I ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST --� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH /BED I DEPTH OVER TRENCH /BED DEPTHS OF TOPSOIL SODDED: SEEDED. MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV: DIA.: ELEV: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST 413 d Sketch System on Retain in county file for audit. Reverse Side. sIGNAruRE: TITLE: SBD 6710 (R. 06/88) Zoning Administrator ,flILHR SANITARY PERMIT APPLICATION COO ' In accord with ILHR 83.05, Wis. Adm. Code STATE SA ITAR RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 9 7 &k 8% x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. /¢—• PROPERTY OWNER PROPERTY LOCATION (> 1r,9,Aj +✓ &Ai5 T //IN SO-t) PC_ '/a SF ' /a, S S T 1 ' , N, R E (or (W PR P OWNER'S MAILING ADDRESS LOT # A T O /� BLOCK # C �f - * • l CITY, ATE " ZIP COODD,EL PHONE NUMBER SUBD IVISION NAME M .GW NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ff�� ❑ State Own VILLAGE : x%NN /4"/ � ❑ Public L011 or 2 Fam. Dwelling -# of bedrooms 'P ARCEL TAX UMBER() _/ _C�6_60 III. BUILDING USE: (If building type is public, check all that apply) 937 S 1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System X Systern Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 B Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure ` 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1 3 ' 30 r 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV 7. FINAL GRADE ® REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/ ay /sq. ft.) (Min. /inch) R? 0 ELEVATION / ,,rr�� r� a O (D? V ! '� �0 0. 0 Feet 9 X 3 Feet VII. TANK CAPACITY Site in oallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank NO Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: tfillr Nu Address (Street, City, State, Zip Code): l w (sue IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater �atelssued Issui t ng Agent Signature (No S mps) Surcharge Fee) Approved El owner Given Initial ' C) ` ^ f ss _� ah A dverse Determination U 1 X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , i 1. A sanitary.permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. - VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owners) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property l j'1 r� ✓v, 1a .c / V . �. 2 / S / 1" 1/N5 D/V Location of property V4_114 �'� 1/4, Section, T ,2 j j� N -R /0' Township L�✓� ����L - �1 /� c.,e� Mailing address L. 07 l S 0 - 2 -- 2 Address of site Subdivision name Lot number II Previous owner of property f�l�` /S //9 / ✓S Total size of parcel .5a� Date parcel was created l9 7'`/ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes x No Volume _S/ S and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed reco ded in the Office of the County Register of Deeds as Document No. :, ;;2 —'3 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of t e County / Register of Deeds, as Document No. ). Signature of Owner Signature of Co -Owner (If Applicable) Date of Signature Date of Signature L __ r DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY & BUILDINGS DIVISION ,INDUSTRY, � LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) &Chapter 145) r LOCATION: SECTION: TOWNSHIP /�P: LOT NO.:BLK. NO.: SUBDIVISION NAME: NEB/ 5 £ '/a is /T N/R /FE (a) W 1� *� %e_16:4.0�'. I Dti4 0/'l fe4t COUNTY: OWNER'S /PER'S NAME: M ADDRESS: St -Cfo[X -/M kig ry (rxe1STirl.VSo.✓ Z (f -I TT, ?I Ul R Ffi1 IS, cJ i S. 5 1. 2 USE 1 S DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPP.OFIL DESCR PTIONS: R O ATONTESTS: Residence Af,� New AReplace I IP Sc Go fX l tir es RATING S= Site s uitable for system U= Site unsuit f or system -- — CONVENTIONA MOUND: IN GROUND- PRESSURE: SYSTEM IN- FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) au L: s ❑u a s au ❑ s ®u EIS au ��E-� - w� o,�P '30 Xt /'S l°► J 1 rOiv If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: 1 '—�G4 s 5 Floodplain, indicate Floodplain elevation: ^/6 T ke 51 ,Wv PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVE EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. O BACK.) i 9 ✓� ( / �° 1r S s y s o� Qa' ss �►� . z. �o BR.y B H ip(. OT ,v e �- 9• � 9S 60 7 �, 5 ' O le o e . c s s.' o ' � �, . CS B- B;3 0 6e . c00'ek Is s OR. M; Q aF 73�j. c s 3 p 9 w � d2` S pacrtnv B- x PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERI D 1 PERIOD 2 PERIOD PER INCH P_ DM �ti P- C,5' P P _ / f P _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hon zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. Zt pPE T N 90 O ! /Q Lj C _ SYSTEM ELEVATION tQr ��,• _ C `S . f. �71' @rj�%On f L� ,� 0 L D1" { �s� v 1, the undersigned, hereby certify that the soil tests reported on this form were made by me i� accord..with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of rr y knowledge and belief. NAME (print): Y TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. �.. . RD. HI SON, WIS. 54016 4 , I` I to ADDRESS: P.OBERi ULBRIGHT CERTIFIC TION NUMBER: M-9 NE NUM ER( tional): S. MASTER PLUMBER LIC, NO. 3307 M.P.R.S. Z / jl 2, _ �� Q S w1STALLER & GcSIG t CST SI NAT DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — Fx jL)G- HOAAE WT'� r= 2 Stc 1 'A4A4 6- q� Poo I 7 0 39 D✓TLET � 4 �C _ _ 1 As koowJ -t o owa�.PS, SI0 PR S P � 1 r � , zti IRE s AuLD - 1 �t RE us e© - Valu o S ysr �,r:- /AJ CODE cs � VtoT Gow�u�la7' ovFRt/oWiaG soils To klNvwlck 3 /Qiv�iQ ? PO.)pS k. 3 o D L PA r r ^' r This test s ite APPROVED for a conventional septic system. °— I s4 ., .; .; NOO gepRI �PC P1.O WNS• 5gp1b � 2 y�Z-- � � � c/� "' � �����"�` .. N�11.A 10� �� Pas' 655 p Opt:1°C N0.3 � Pt gGA S � N � N C N0• 0003 O 7, � ro? b� �IG�STiG Poo / e'OUFA CAP s�E �. 4Iv cvNl%t�� / goo/ �'��uAY►oA-) _ /D p, p ' STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER ROUTE /BOX NUMBPR FIRE NO. CITY /STA W! j7 'Q �S ►/V ZIP Y O PROPERTY LOCATION: Nz 1 /4 s 1/4, Section /2 , T R P W Town of c , St. Croix County, Subdivision �t , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. / p S I GNED ` (f Leo �G o DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796 -2239 or (715) 425 -8363 Sign, Date, and Return to above address II .DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA 302 3 4 9 6 BOOK PA E REGISTERS OFFICE THIS DEED, made between Norman L. Christianson and Marion E. ST. CROIX CO.. WIS. Christians Rec'd for Record this - - -- ---- Grantor day of -AIIZA�it ---- A.D.19-1 and U --- --- Grantee, Witnesseth, That the said Grantor for a valuable consideration One Dollar Regis tor of Deeds ($ and other - valuable consideration - --- ------ ----- - conveys to Grantee the following described real estate in S t .Cro ix County, R - ETURN TO State of Wisconsin: Part of E' of SEk of Section 15-28-18 described as follows: Commencing at SE corner of said Section 15; Tax Key # thence W 1308.0 feet thence N 2 E 759.5 feet; This is -- homestead property, thence N 2 15' E 904.5 feet; thence S 87 45' E 45.0 feet to E line of County Trunk "Ji" and Place of Beginning; thence S 87 45' E 506.35 feet; thence N 2 15' E 431.0 feet; thence N 87 W 506.35 feet to said E line of Highway; thence S2 15' W on said E line 431.0 feet to Place of Beginning. FEE EXEMPT T with all and singular the liereditametits and appurtenances thereunto belonging or in any wise appertaining; And Norman L. Christianson and Marion E. Christianson, husband and wife____ warrants that the title is f=ood, indcft in ft simple and free and clear of encumbrance except and will warrant and defend the same. I"'N"cuted "t River Fall.s, Wisconsin this 12th (I"y of y 1974 AND SEALED IN Of SIGNI- Norman L. Ch AND N � (SEAL) John W. Davison Marion E. Christianson "'12 < (SEAL) Janet 11. Baiter (SEAL) Sii ;n�itttrrs of "ride: Member State liar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. STATE OF WISCONSIN Pierce Urqllllv. I)cr­mall} calm 1-t"re rm.. this 12th - (iav of July 19 74, Ill'. oh"', 1.,m(d Norman L. Christianson and Marion E. Christianson, husband and wife to me k,),n,n to I­ th" 1 --olls whit ex­ ut-1 th f­ej;,,in ir-trUM(Alt and a, c k ni ow g d the same. This instrument war: drafted by A. Ch -Tn W. Davison John W. Davton a Q a r Y b i c __ _ P ierce County, Wis. River Falls, 54022 X4 gq� The w; of witnu­;c� i� optional. klNiPf'­ 41s) - rinanent ,, Names of persuns si in any capii j tp should Ix typed or printed below their WA]Rj:'ANTY DEED -STATE 13AR OF WISCONSIN, FORM NO. I - 1971 c I S t► G - HoM �' �ISTR ►QOPIOti a,eap I3ox, To QE - USED (c .4PPED WT R �. A-.s VAIuE T °. I k&tp OLD STEM 1• �x 7 I SWiMA41,uG -- F� 1 oPC Zi Poo 1 �oP V), S7^ (D � o�rr�er� Q � No � 4 00 As eo0 WS k PT t e- 'r'J A..)k I1 RE S AOtD- Aa r RE ?ASL=D - w Ifi� Value ; x � 1 1 V, , s ysr. iN toDF es • v�eur ' � cow �u'�IaT t t _ ov f /oaiA)G � t so ils . , T O - �,Q k iN.V%CI, 3 3 o O . TYN OK T R E - FOP— Co or C 1OA s,2� L td 12 0 6 , k4 i i A4 0 A -1 coup (TI L 0 s This test site APPROVED for a conventional septic system. 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