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PLUMBING • HVAC • PIPE • VALVES
FITTINGS • WATER WELL • INDUSTRIAL SUPPLIES
Minneapolis St. Paul Duluth Detroit Lakes St. Cloud
(612) 588 -7811 (651) 489 -8831 (218) 727 -6670 (218) 847 -9211 (320) 259 -6086
Brainerd Medina far go Rochester Eau Claire
(218) 828 -4242 (763) 478 -8994 (701) 298 -3210 (507) 529 -1284 (715) 830 -1800
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
SaFety and Building Division
INSPECTION REPORT Sanitary Permit No:
420517 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. —�
Permit Holder's Name: City Village X Township Parcel Tax No:
Orf, Dan I Richmond Township • / /�/ • -000
CST BM Elev: Insp. BM Elev: BM Description: %_.
M . 0 � M - 6 1 cam-r cb:q wj -- &040"'N 19
TANK INFORMATION vi ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark W
Dosing Alt. BM ,
3.3 Iota. ,
Aeration Bldg. Sew
Holding St/Ht Inlet 5.
TANK SETBACK INFORMATION St/Ht Outlet S CY 4 . vt I
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic '' OD I Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe 3
a•9 �'S,�t�F
: A::� I Bot. System 9. 0 ,r • ZA /
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
M e7l) AIL)
Model Nbw
TDH Lift iction Loss System Head TDH Ft
Forc ain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
Width Length No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS . Z
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufact
INFORMATION CHAMBER OR NR
Type Of System: S 41 / � / �-. UNIT Model Number: 12 �s
( \�C
DISTRIBUTION SYSTEM
Header /Manifold I� Distribution x Hole Size �Hole ac ing Vent to Air Intake
Pipes
Length Dia L a
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes F I No [k Yes [g _No
�O�F1 direpenc'l�s, pergpns pre end t, et As. it>spection #1: / Inspection #2: 7----7— CLocation: New Richmond, W1 54017 (NE 1�/4 SW 1 + 0 T3� ON R18W Meadows Lot
18 Parcel No:
1.) Alt BM Description= �arS � Sea AS L "A/
2.) Bldg sewer length =
- amount of cover --
�� 3) ,Oka vv..* c �K � ,4-t,� r S� a,,, re c�lr e t}•.- 0 `�, Zce �,
Use other�side for additio a lion l No! �'2(
-- - - -'
SBD -6710 (R.3/97) • _ Siey� ` Signature Cert. No.
Y7 do ct "Va
Safety an Buildings rvt"§Id& + $ unty
` s m 201 W. Washi n Ave., P.O. Box 7162
iseonsin Madiso WI 97Q Z71 g 2 L U U b itar Permit Number to be filled in by Co.)
Department of Commerce ( 8) 266 -3151
Sanitary Permit Applie tour - - I tate Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provt
may be used for secondary purposes Privacy Law, s15.04( Project Address (if different than mailing address)
I. Application Information - Please Print All Information + )03(- ' `{ A d 6
Property Owner's Name azcel # Lot #
Prope Owner's Mailing Address Property Location
City, S
d �- - Zip Code Phone Number � �• Section
(circle9�
N; o
II. Type of Building (check all that apply) T R L�E f
�r
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name /
❑ Public /Commercial - Describe Use 6 -
❑ State Owned - Describe Use ❑City illage 12Township of
III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) _ 3 3
S _� _ �� ��
`�- ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B• ❑ Permit Renewal A Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration '-- - Plumber Owner
IV. Type of POWTS System: Check all that a pply)
Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter A Leaching Chamb9C ❑ rip ine ❑ Gravel -1 Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: � rE rl
Design Flow (gpd) Design Soil Application Rate( Di rsal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ass "e responsibility for installation of the POWTS shown on the attached plans.
Plum 7ament) r Plumber's ign MP/MPRS Number Business Phone Number —
i a
Plumber's Address (Str eet City, State, Zip Code)
VIII. County/Department Use Onl
Approved ❑ Disapproved S t Fee (in lodes Groundwater Date Issued Issuin Agent Signat (No Stamps)
urchargee ❑ eason Denial ) - a - --
IX, Conditions A prov 1
(- �f, 2* -
Attach complete plans (to the County only),for the system on paper not less than 8112 =11 inches in sift
SBD -6398 (R. 01/03)
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APR � � 2p06
Wisconsin Department of Commerce SOIL VALUAc JRk ' OR Page of
Division of Safety and Buildings ST
in accordance with Comm 8 , Wis. Adm.
County
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must' '
include, but not limited to: vertical and horizontal reference po M), . cti and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location is to area )d. _ _
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purpose . () (m)).
Property Owner Property Location
Govt. Lot 1/4 1/4 S T N R (or
Property Owner's Mailing Add Lot # lock # Subd, a e or CSM#
A / l
i�
City Code Phone Number ❑ City ❑ Village Town Nearest Road
1 ( )
Eg:NewConstruction Use: Residential /Number of bedrooms � Code derived design flow rate _ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Mg ��� Flood Plain elevation if applicable ft.
General comments
and recommendations:
Boring # [:] Boring
7 Pit Ground surface elev. �7 G ft. Depth to limiting factor < - in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * fr#1 *Eff#2
7 s,
� N
Boring # El Boring
Pit Ground surface elev. le,1 ft. Depth to limiting factor > in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. * ff#1 *Ef#2
T1 -
*
Effiufiht #1 = BOD > 30 mg/L and TSS >30 < 150 mg/L AEffluent #2 = WD ,: 5 30 mg/L and TSS < 30 mg/L
CST Na M) Signature CST Number
Address / Date Evaluation Conducted Telephone Number
G
I
' 1
Property Owner i C&L Parcel ID # �?�� — � � —,/� - .�9� Page of
E-31 Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor 4/ in.
Solt Application Rate
Horizon Depth Dominant Color Redox Description Texture ' Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1
7
.3
F Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDftF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *011#2
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgA- * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
8BD -8330 (R.07 /00)
1 � /
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Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 O i C
IlVi sconsin Madison• Wi 53707 - 7162 Site Address r0 ab / s / t�ff
Department of Commerce l4 tQ6
Sanitary Permit Application P �2osi '+-
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information state Plan I.D. Number
Property Owner's Name ^� _ Parcel Num
Property Owner's Mailing Address Property Location . r 33 G✓
`7 2002
,o ( � ":, Sf T D N. R
City, State Zip C Phone Nurnp6r Lot Number Block N sber
S ,
Subdivisio ame GSA -AGuar
p _
gV
H. Type of B (check all that apply) / �,,,( ❑C'
10 1 or 2 Family Dwell' Number of Bedrooms - 'U illage
❑ Public/Commercial - Dese Use ownship
1
❑ State Owned p , ��6t�yk , Nearest Road
2 3 x 6$• `f O �2x�45 X22
b � ,
III. Type of Permit: (Check only o box on line A (numbering scheme for internal us Complete line B if applicable)
A. or County use
1 _ New 2 ❑ Replacement Syste 3 ❑ Replacement of 6 ❑ Addition to
stem lVank Only Existing stem
B. ❑Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbe scheme is for inte arse) Zp�6 A--toD
44 jKNon - Pressurized In- Ground 2111 Mound 47 [1 S ilter 50 11 Constructed Wetland r
22 ❑ pressurized In -Ground 41 ❑ Holding Tank 48 ❑ le Pass 51 D ' Line
45 ❑ At -Grade 46 11 Aerobic Treatment Um 49 ecirculating 0 they
V. Dispe rsalPlYeatme Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil A lion Per cola n Rate SYSIRM Ele li
Required Proposed Rate( s. s /Sq.Ft.) . T Info Capacity in Total Number Manufac Site lastic
Gallons Gallons of Tanks Conc onstructed
New Existing
Tanks Tanks
Septic or Holding Tank = 0 s
Dosing Chamber
VII. Responsibility Statement - 1, the undersigned, responsibility for installation of the PO own on the attached plans.
PL is ame (Print) Plum 's Si cure MP/Iv1PRS Number Business Phone Number
Plumber's Addres (Street, City, State, Zip Code)
VIII. Count /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing A Signature (No Stamps)
Approved ❑ Disapproved Surcharge Fee)
❑ Owner Given W Adverse_
Determination
IX Condity of I APProv ons for Disapproval ,
i'��% SSIJroe�cJC.. n��l.�nA�A�Q.I�.S t�►�� �rz- e
Attach complete plain (to the coati duly) nor the system ou paprr not less thou S x 11 Inches m sde
SBD -6398 (R. 05101)
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa 1of.2
FILE INFORMATION SYSTEM SPECIFICATION
Owner Septic Tank Capacity al o NA
Permit # 4{ 5- Septic Tank Manufacturer - S o NA
Effluent Filter Manufacturer o NA
DESIGN PARAMETERS Effluent Filter Model o NA
Number of bedrooms ❑ NA Pump Tank Capacity al j Z NA
Number of Commercial Unit jZNA Pump Tank Manufacturer o NA
Estimated flow averse gal/day Pump Manufacturer ,81 NA
Design flow (peak), Estimated x 1.5 gal/day Pump Model a�NA
Soil Apelication Rate gal/day/ft' Pretreated Unit
Influent /Effluent Quality Monthly Average* cj Sand /Gravel l�ilter o Peat Filter
Fats, Oils & Grease (FOG) <30 mg /L ri Mechanical Aeration ca Wetland
Biochemical Oxygen Demand (BODs) <220 mg /L ❑ Disinfection ❑ Other:
Total Suspended Solids (TSS) < 150 m L Manufacturer
Pretreated Effluent Quality ❑ NA
Monthly Average ** Dispersal Cell(s)
�YIn- ground (gravity) ❑ In- ground (pressurized)
Biochemical Oxygen Demand (BODs) <30 mg /L ❑ At -grade o Mound
Total Suspended Solids (TSS) <30 mg/L ❑ Drip-line ❑ Other:
Fecal Coliform (geometric mean) <10 cfu /IOOmL
Maximum Effluent Particle Size '/s inch diameter * Values typical for domestic (non - commercial)
wastewater and septic tank effluent,
** Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequenc
Inspect condition of tanks At least once every o months year(s) (Maximum 3 rs)
Pump out contents of tanks When combined sludge and scum equals one third '/s of tank volume
Inspect dispersal cells At le ast once every ❑ months 0 year(s) (Maximum 3 yrs)
Clean effluent filter At least once every o months g year(s
Inspect punip, pump controls & alarm At least once every ❑ months o year(s) ) NA
Flush laterals and pressure test At least once every o months ❑ year(s) p�NA
Other: At least once every o months ❑ ear(s) i2s.NA
Other: At least once every ❑ months ❑ ears NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any
cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the
ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to
check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a
failing condition and requires the immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third ('/3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septagc Servicing Operator and disposed of in accordance with ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have
the contents of the tanks(s) removed by a septage servicing operator prior to use.
' Owner: �1
System start up shell novoccur when soil conditions are frozen at the infiltrative surface;
During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater
will be discharged to the &persal cell(s) and may result in the backup or surface discharge of effluent. To avoid this
situation have the contents of the pump tank removed b a Se tae Servicing Operator prior to restoring power to the effluent
Y P g g Pe P g P
pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The
area within 15 feet down slope of any mound or at -grade soft absorption are.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of
the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers;•dental floss; diapers; disinfectants;
fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications;
oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONEMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system
is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed,
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator,
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed
upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to P rotect the
replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.
Replacement systems must comply with the rules in effect at that time.
o A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding
tank may be installed as a last resort to replace the failed POWTS.
o Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR
INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY
CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK
MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLri POWTS MAINTAINER
- Name
Phone _ Name
Phone
SEPTAGE SERVICING OPERATOR PUMPER)
LOCAL REGULATORY LATORY AUTHORITY
Name
Phone Phone s = _
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
n �OWNERSHIP CERTIFICATION FORM
Owner/Bu ° .� _
Mailing Address ZA F �
Property Address 3 (p 4 A:
( /(V Verification required from Planning Department for new construction)
City /State � / I 7 Parcel Identification Number a10 -,1p .4,) -,le -1G6
LE GAL DESCRIPTION
Property Location �/,, • ST / Sec. , T_,Tr_N -R_zf Town of 1 11
Subdivision j - ,)g 7 , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # j9� , Volume , z - i_f , Page # 1 13
Spec house, yes ❑ no Lot lines identifiable Oyes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
t ih' ear expiration dat
SIGN OF APPLICANT DATE
OWNER CERTIFICATIO
1 (we) certify that all st tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described
above, b virtue of a warranty deed recorded in Register of Deeds Office.
7 ;S �0/ �(/ � DATE
** Any information that i is- represented may result in the sanitary permit being revoked by the Zoning Department.
** Include with this application: pp a stamped wa rranty want deed from the Register y g ster of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
2 0 13 P 6 0 6 C69451ato
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Co., 1iI
This Deed, made between David J. Waldroff and Julie A. RECEIVED FOR RECORD
Waldroff, husband and wife, 10 - 16 -2002 4:00 PH
WARRANTY DEED
EXEMPT #
Grantor, and Daniel T. Orf REC FEE: 11.00
TRANS FEE: 135.00
COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lot I8 W aldroff Mead ows II, St. Croix County, Wisconsin. Name and Ret tT NA OGLAND
ESTREEN & OGLAND
304 Locust
Hudson, WI 54016
Pt 010 - 10(12 -1 0-000
Parcel Identification Number (PIN)
This is not homestead property.
(9) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of October , 2002
* * vid J. Waldroff
* * ie A. Waldroff
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) David J. Waldroff and Julie A. Waldroff, husband STATE OF WISCONSIN
and wife,
ss.
��� County )
authentic ted this ' day of October 2002
Personally came before me this day of
the above named
i
* Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) ')
* Names of persons signing in any capacity must be typed or printed below their signature. Udormation Proress+onais company, Fond du Lac, wi
STATE BAR OF WISCONSIN 900 - 2021
WARRANTY DEED FORM No. 2 - 1999
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ' of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
'
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County C nni x
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
% Please print all information Reviewed by Date
Personal information you provide may be used fo seconmiWS Law, s 15.14 (1) (m)). &k.'74
Property Owner F roperty Location 1
A PR 9, 2 7002 ovt. Lot /J f- 1/4 1/4 S p T d N R E (or)(0
Property Owner's Mailing Adddrnrgss ��f t # Block # Subd. Name or_C�S/M#
KI I�'`E -f ST. CROIX COuNTI �g Idf cm Meq.&uj5 I�
City State Zip Code City ❑ Village [R Town Nearest Road
&)I 5gf01& i ( YS6 -6 v> m.
New Construction Use: Residential I Number of bedrooms q Code derived design flow rate G/ SO 11 d 6 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 6 U t L - j 4 's" Flood Plain elevation if applicable ili ft.
General comments s v si'e Yy 62 V,
and recommendations:
Boring # ❑ Boring
® --Pit Ground surface elev. t OU ft. Depth to limiting factor Z� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2
It p / 3('Z Sj � n �bk C5 I V-c • 5
z lZ-Z� lv yl .5% "I 2 rn-Sbk C5 — .4/
Of ci
R-1 Boring # ❑ Boring
pit Ground surface elev. q9� U ft. Depth to limiting factor Z in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. •Eff#1 •Eff#2
I v -17- J6 511 1 2rrvbL n-�r- C- ) v� 5 .g
Z 12. 10 Sid 5 k ►n'A r C-5 — y -<
3 30 -1 10 r 1 4 S 1 — / . Z
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L
CST Name (Please Print) gnature CST Number
- - -- 253 4
Address Date Evaluation Conducted Telephone Number
21 l 21OZ y —,a --'0 z C 1 2 7- (008
SBD -8310 (R07700)
i
Property Owner l� rf JT Parcel ID # /0 / /U Page of
❑ Boring
Boring # Pit Ground surface elev. 79 3a ft. Depth to limiting factor I i "• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 11`1
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I 0 Ib 3I2 Si I bL c- S 1 2�
Z I -4 �� a 5 c-) m r C;5 — . 4
- 7 /,
F-1 ❑ Boring #
Boring
❑ pit Ground surface elev. ft. Depth to limiting factor i "• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
F Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If y ou need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.07 /00)
PAGE3_OF
NAME LOT# / ,� LEGAL DESCRIPTION u� XSilJ X ,S 20 T - 50 N.R. / E(0f
SCALE: I"= y0
BM 1 ELEVATION /G)C- U
BM 1 DESCRIPTION too cf
I N
BM 2 ELEVATION /9 70
BM 2 DESCRIPTION k,2 6 f L
SYSTEM ELEVATION /"6
I
ALTERNATE ELEVATION 9 —
CONTOUR ELEVATION 9`/, ou SU
,0
N
o�
SIGNATURE ATE z 2 Q Z
LOCATION SKETCH PRELIMINARY PLAT OF WALDROFF M 6-..:
rofFN or AFCNroNn
LOCATED IN PART OF THE NE1 /4 OF THE SS
NWi /4 OF THE SE1 /4, SECTION 20, T30N F;
ST. CRODC COUNTY, WISCONSIN; INCLUJII
WALDROFF MEADOWS.
r/N Comm
D. @V 1 4 LIM 3 YCFIaII I•
C. &H. Due V. nu
SECTION 20, T30N, R18W
TOTAL AREA - 23.51 ACRES
RAer - Fes, 1/4 Lot Isee'sere,s eee.11t � Y yh
/ f.rai• ealrEO'36 W 6".1A
,. sa 1w ryr
w
. �i� on .
�% �•,; / ;. . 1 �
AT 0 - - q0 b w usr OF 10000111
LOT 16
1.1 ADFWG
LO 9
OT 17 GAO 20
/ .e ACRES (4.0 4 ITC
� z.e ACRES)
IN 049A
C A W30-W M1
acv 9 ' � �• 61
'�•. 0 1e
0
4
a
LEGEND % ` e Ow ROAD �i�,c+
FOUND ALUMINUM COUNTY
SECTION GOIMER MONUMENT ®__;_�' =v!
• FOUNO r OUT90E DI AMETER SIaN nPE / 1604 8 1 3 I D„fD? 8 I -
- - -- I - - --- 1 6,(9�'V ® t
OUN
FD 1 - 31V OUTSIDE WAIETER SIGN AK I I 1 - ------
O SET :-1 s tr IRON Prt, rnofnc
&IS Pf71 UMEAR FOOT
N _...._
,N COn+feA
too' 0OA0"Y SETRACx UK wpF1D1 fr
— --- — _ ,r enE UTILITY EASEMENT
-y -- EXISTING FENCE
pi t � NTEIIMEONTE CONTOUR
esa INDEXED CONT&A
( ) REODAOED KARINO ANO/Ol OISTANCE
yyyYYY*��TT��� (1.e ACRW) NET RUI DARIE AREA
® ISR - IOe SLOPE AN EROSION CO FOR EACH LOT MUST
K su0SION A t NAZI APLAN FOR $E THE ST. ST
COUNTY ZONwO OWARTMENT WOK SANTATIOI,
® FO
APP E)K
N OW E ISSUEISSUED. 9
IOIf OR GREATER SLOPE NO " OT RC90CNT w 00 ANYTHING
OPER 1TOw NTER W IN CO CNANCE TK
OPOI AIF TI! APPROVED COYPRN K
SITU A OR O O D T. MS AND SDR O N PLAN TED
1. Alen C. Nyhogen, Registered Wisconsin Land Surveyor, hereby certify SULDING FL 8S jRUUCIM I C �AliTe nujw
that the above described and mopped properly was surveyed by me or a( CICAVATN0. ON PLANTING N ANY POND
under my direct supervision and that this map Is a correct representation EASEMENT& WA= ORASIACE OITOiCS. WATER
to scale of the boundaries to the best of my knowledge and bellef. S N+ VS RS O
WANVATS, eta+S 04 MASS