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HomeMy WebLinkAbout026-1137-28-000 Wisconsin Department otCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 408242 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: Basel, Glen I Richmond Township 026- 1137 -28 -000 CST BM Elev: Insp. BM Elev: BM Des ti n: / d /Oh ` tee . (o-f - l�-•- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tlU _e v Benchmark Dosing ,/] � X � Alt. BM Aeration v Bldg. Sewer - 3 G 17 Holding �– SUHt Inlet -le 9s�8 TANK SETBACK INFORMATION StJHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet XrCr T Septic � T T / i � � e—' Dt Bottom � Dosing (J _ _ Header /Man. AIQ✓4 Aeration Sides Dist. Pipe e'k jo llu ts z Holding l BoFs;stem r $ ' PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand 1591,er Model Number TDH Lift riot on Loss System Head TDH Ft Forcemain Tength I Dist. to well SOIL ABSORPTION SYSTEM /V , BED/TRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS l / SETBACK SYSTEM TO P /Ls BLDG WEL LAKE /STREAM XEACHING Ma turer: / INFORMATION T f S stem: HAMBER OR ( yp�� p/ / UNIT AModel Number: DISTRIBUTION SYSTEM Header /Manifold Distribution ` x Hole Size x Hole Spacing / Vent Air Intake Lengt Dia L Dia � paang SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched d Be rench Cent r Bed/Trench Edges Topsoil Yes [] No ❑ Yes r j No s> Wes f COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: q / /��� Inspection #2: / / 3 rd Location: 1 • 474111th Street New Richmond WI 54017 SW 1/4 SW 1/4 21 T30N R18W Golf VI w Acres Lot 28 Parcel No: 21.30.18.984 1.) Alt BM Description = tam of tij " a u`�' ~ +(e0 6QJI� 6f tZ[���+L t 4���pS f� 2.) Bldg sewer length = LL�11 t � ' �7(cfi p� w - amount of cover Plan revision Required? "! Yes /No l c { Use other side for additional information. I —' - -- -- _ _ -- .- - - - - -- --- ��ii!- - - - - -J L -- — -� - -- SBD -6710 (R.3/97) Date Insepctor's Sig ature Cent. No. Safety and Buildings Division C O11IIt Y �( r 0/ 201 W. Washington Ave., P.O. Box 7162 Il Visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce q Sanitary Permit Number Sanitary Permit p lication In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check If Revision may be used for secondary ses Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number Property Owner's Mailing Addiss Property Location 9 s �J 1-2 S T ©N. Rl City, State Zip Code Phone Number L 2 Lot N r Block Number �j /� � ✓ ?� Subdivision Name CSM Number II. Type of Building (check Athat apply) ❑City l or 2 Family Dwelling - Number of Bedrooms _ ❑Village /❑ Public/Commercial - Describe Use ! owrtship !7'7 dti ❑ State Owned �� r •-� (t c rJ - N earest Road III. Type of Permit: (Check only one box on line A (numbering scheme for in emal use). Complete line B if applicable) A For County use 1 New 2 11 Replacement System 3 ❑ Replacement of 6 ❑ Addition to RECEIVED S stem Tank Only Existing S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued JUL 20 IV. of Permit: (Check all that apply)(numbering scheme is for interval use) � COUNTY 44 Non - Pressurized In- Grouted 2111 Mound 47 ❑ Sand Filter 50 ❑ C ttu-�4*##0FF10E 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Dnp Une 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe tsal/Tteatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) i+ _ / , © 7 Elevation <-5 7 70 1( - 7 ---- r- _? X16 -19 VI. Tank Info Capacity in Total Number Marmfacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ e Q Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. td Plumber's Name (Print) h Pl r' Signature MP/MPRS Number Business Phone Number Plumboes Address (Street, City, State, Zip VIII. Co un /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharg Fee) 6 \ ❑ Owner Given Initial Adverse Determination J lx. Conditions of Approval/Reasons for Disapproval .... 5 k-.O ` oh S 5c 52� t - u�awr�9A 1 � o 4at�S ` L - Attach com pl e te plena (to the County only) for the aydem on taPa' not less than EI/2 x 11 inches In she Y SB� "�. 05/01) �3Pe c�c `cats, / PLOT PLAN _ PROJECT ADDRESS 6 0P �S Cam✓ C/7 ,' / w 14 1145 /T N /1; C � W 7'QWN d �4LJNTV MFRS Byron Bird Jr. 220529i5w � DATE 7 BEDROOM CONVENTIONAL XXX M -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE ll-- 6�' LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE g LOAD RATE ABSORPTION AREA # of chambers ,BENCHMARK V.R.P. �� '00e ,SS�E ELEVATION 100' ❑ BOREHOLE O WELL sH.R.p. Vent V ELEVATION >12 Sidewinder High of Capacity Leaching Cov Chamber with 17.2 6" t "2 per chamber Long 34„ Elevation D� c �u- G 4 10 �n � yL ra � � PLOT PLAN _ PROJECT �/eL S ADDRESS 1/4� 1 /4S °.:.L /T �In N /1; l_W TOWN` /,0` COUNTY 7 7'-�� BEDROOM MPRS Byron Bird Jr. 2205 DATE CONVENTIONAL XXX At -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE � - © LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 13 LOAD RATE ABSORPTION AREA V0 # of chambers L� BENCHMARK V.R.P. —L-. �� �— T z O � O c�e�, / /,SSUME ELEVATION 100' ❑ BOREHOLE WELL *H.R.P. J j2T, nt SYSTEM ELEVATION Sidewinder H igh Capacity Leaching Chamber with 17.2 t ^2 per chamber ,4 6' Grade, at SXstem Long 34„ Elevation G I -1 Wiswrisin Department of Commerce SOIL EVALUATION REPORT Page of . Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must N 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 neares road. Please print all information ?' S vi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15. (1) (m)). Property Owner Property Location Govt. Lot 1 /4„,e/kA /4 T N R E (or)( Property Owner's Mailing Address Lot # Block # Subd. Name & CSKV 1 -0. oa O . G -E City State Zlp Code Phone Number ❑ city village EiR Town Nearest Road &A4et'r-"l I Jeri I-S - 5& ' Q I lz' /12210 It C/ ' I :2� 4 (� New Construction Use: [;i Residential / Number of bedrooms Code derived desig flow "RE GPD ❑ Replacement // C3 Public or commercial - Describe: —_ _. —____ _ —.� ____ _ Parent material U TL✓Gx / Flood Plain elevation if a licabl ft. General comments 5YS / *� - el cv • G)' O and recommendations: T / ST. CROIX COUNTY ZONING UFFICE t--- ] 9 Boring # Boring I ( I � pit Ground surface elev. G 0 ft. Depth to limiting facto in. Sal Appl ication 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 I o �z - s ', / a"s ow a5 a Boring # [j Boring (Pl/ pit Ground surface elev. 9 e ft. Depth to limiting factor A in. Soil 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 Aes6e Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please ) ignature CST Number q v✓1 A . 7 ,5 O Address Date Evaluation Conducted Telephone Number Property Owner �C f d n Parcel ID # IC - G d Page of F-31 Boring # ❑ Boring [ pit Ground surface elev. f; F , / ft. Depth to limiting factor Al in. Soil 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- 1 a pit Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Sal 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 E Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 > < > < m Effluent < Effluent #1 GOD 30 _220 mglL and TSS 30 _ 150 g/L E ue t #2 GOD _ 30 mg/L and TSS < mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -5330 (RAW) I Sir tip✓ .5e-C4 -4 : god . a svVet7i el - ' p I° as3.�o 3 a, �C �I o � I f r b ,�U POWTS OWNER'S MANUAL at MANAGEMENT PLAN -' Page -- of -- FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 67 gal ❑ NA Permit # Z Septic Tank Manufacturer.... ; ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms ( ❑_NA; Effluent Filter.Model :. �- ❑ NA Pump Tank Capacity Number of Commercial Units . g al A Estimated flow (average) gal /day Pump Tank Manufacturer ANA di /da i ianti acs ' ct„ NA Design flow (peak), (Estimated X 1.5) g Y Pump Soil Application Rate 7 gal /day /ftZ Pump Model 1 !ANA o * treatment Un it 151 NA Pre Influent/Effluent Quality Monthly avera Z, Sand /Gravel Filter ❑ Peat Filter: Fats Oil sz Grease (FOG) 5_30 mg /L [3 Mechanical Aeration ❑Wetland Biochemical Oxygen Demand (BODs) _5220 mg /L ❑ Disinfection Cl Others'" Total Suspended Solids (TSS) 5150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average * *. Dispersal Cell(s) Biochemical Oxygen Demand (BODs) _530 mg /L" inground (gravity) ❑ In- ground (pressurized) Total suspended Solids (TSS) 530 mg /L ' At -grade ❑ Mound Fecal Coliform (geometric mean) _510 cfu /100m1 ❑ Drip-line ❑ Other: Maximum Effluent Panicle Size I A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event I Service Frequency At least once every ❑ months year(s)' (Maximum 3 yrs. ) Inspect condition of tank(s) _ Pump out contents of tank(s) When combined sludge and scum equals. one third (36) .of tank volume Inspect dispersal cell(s) At least once every ❑ months - year(sy (Maximum 3 yrs.) Clean effluent filter At least once every,. ❑ months years) Inspect pump, pump controls 8z �alarm At feast once every ; El year(s) ❑ NA Flush laterals and pressure test At ieast once every 13 months ' ❑ year O'NA' Other. At least once every , ...O months C] years) ❑ Other At least once every ` ❑ months 13 year(s) ❑ `NA MAINTENANCE INSTRUCTIONS tanks and dispersal cells shall be made by an individual canying one of the foilowing licenses or certifications Master inspections of isp Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator Tank inspections heasure must include a visual inspection of the tank(s) to Identify anymissing or o din of effiuent grow d surface; Th dispersal ye volume of combined sludge and scum and to check for any back up or p g ffluent levels in the observation pipes and to check for any"06nding of efflu cefi(s) shall be visually inspected to check the e ent on the ground surface may Indicate a failing condition and requires the immediate the ground surface. The ponding of effluent on notificatlon of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (31) or more of the tank volume, the entire contenu 3 of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch..NR 1 1, Wisconsin Administrative Code. The servicing of effluent filters, mechanicai or pressurized POWTS components,. Pr a certified POWTS Maintainer.ny other maintenance or monitoring at intervals of 12 months or less shall be performed by regulatory authority within 10 days of completion of any service event. A service report shall be provided to the local START UP AND OPERATION :. Il i For new construction, prior to use of the POWTS check Lreatment tank(s),foi th h are detected the contents System startup shaii not occur when soil conditions are frozen at the Infiltrative. surface. Page of — During power outages pump tan4 may'Fill above normal highwater levels.. When powex 11 restored the excess: wastewater will be discharged to the dispersal cells) in one large dose, overloading the cell(s)' and may result in the backup or surface discharge effluent. To avoid this situation have,the contents of the pump tank removed by a Septage Servicing Operator;prlor'to restoring power to the effluent pump or contact a Plumber or POWTS.Maintainer.to assist in manually operating the pump controls to restore normal levels within the pump tank. • Do not drive or park vehicles over tanks and dispersal'cells. ))o not dri ve or parkever, or cthe; �iSe' disturb or compact, the area • within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream . may improve the performance and prolong the life of the • POWTS: antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degreasers; dental floss, diapers, disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease;'herbicides; meat scraps; medications; oil; paintinz Droducts; Desticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS falls and /or is permanently taken out of service the'foitowing 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 ail tanks and pits shall be removed and properly disposed of bya Septage Servicing Operator. • After pumping, all tanks and pits shaii be excavated `and removed or their cover removed and the void space filled with soli, 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:soll absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon b) required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result to the need for a new soil and site evaluation to: establish a rJitable' replacement are!.". Repiacernent systems must comply with the rules in effect at that xime. ❑ 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 -Iasi resort to replace the failed POWTS. 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 hoiding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be' reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time: < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AHD /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT.TANKIINDER ANY `CIRCUMSTANCES., DEATH MAY RESULT. RESCUE OF A PERSON FRO'."l THE. INTERIOR ,OF A Tr114K MAY Bc "DIFFICULT`OR. iMPn.rvcjRi.r. - ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER::. Name /%7ir;:1 1 .< rr Name f - Phone �/5. r�i! Phone W ' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATOR, AUTHORITY'" 66� Name I , 4� :� /y � ✓�% � Agenry A, -A � ��x � =t ?f� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer GleA)l Mailing Address _Property Address L ���O �o ue (Verification required from {Tanning Department for new constntction) City /State /U"" \C wJ Parcel Identification Number LFGAi, DESCRIPTION �� l �✓���� " r Property Location ` LJ '/, /V GJ '/4 Sec T N -R 4- W Town of Xf C /A� P Y , Subdivision ���� �o� (Jr`c°�c/ �4C`S , Lot # CertiCed Survey Map # , Volume , Page # Warranty Deed # �'v 7y' Volume 2 76-0 , Page # Z r 2 : �Z . Spec house-fi� ❑ no Lot lines identifiableIn7ges ❑ no SYSTEM MAINTENANCE, Improper use and maintenanceof 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 (lie 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 disposaI systern 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. IAwe, the undersigned have read the above reyrnrcments 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 conipletcd and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. M :P / off SIGNATURF, OF APPLICANT DATE OWNER CERTIFICATION I (we certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the propert ibcd abov y virtue a warranty decd recorded in Register of Deeds Office. SIGNATURE OF AP - CANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. " * "• ** include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i Wisconsin,Departrnent of Commerce SOIL EVALUATION REPORT Page _ L of 3 Division ofaafety and Buildings in accordance with Comm 85, Wis. Adm. Code County S4. C r Ul 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 point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Date Please print all ►- fornrahon. -! ,, ,, Z Personal information you provide may be used , secondary purpose (PriYat:y- Property Owner ` ' , Property Location ✓ _� t d on 1 - vt. Lot S(,tJ 114 Nui 114 S Z ( T 3 ' N R /� E (QdL Property Owners Mailing ress - f "' , f a „ i L t # Block # Subd. Name or GSM# i�.0 . x I tot `00� g C- 1o►���ev✓ ,'Acres , �..„ try State phone �� city ❑Village [,Town Nearest Road 1 l' Ch m Co New Construction Use: ® Residential / Nbritbet otrhit3drot ir� - Code derived design fl rate 4 5 / Cn�O GPD [I Replacement ❑ Public or commercial - Descn`b Parent material Cr 5 In Flood Plain elevation if pplicable ft. General comments S y 5 P-9 and recommendations: oi� jam' �► • ❑ Boring Boring # ® Pit Ground su rfa4. • Sri ft limiting factor l b in. Soil Application Rate Horizon Depth Dominant Color Red lion Texture Structure Boundary Roots 1 I ' in. Munsel Qu. Sz. Cont Cob Gr. Sz. 'Etf#Eff#2 I 0 - 12. tO�r31Z — z - S Gl y,r 5 O 3 30- i i r 41 — c M Boring # Boring ® Pit Ground rfaceelev. `oil Application Rate Horizon Depth Dominant Color Redox Description GPD/ff in. Munsell Qu. Sz. Cont. Color 1k1 'EfW z 1z L� �r ' Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L andrTSS < 30 mg/L CST Name (Please Print) Sign* re CST Number Acko ran Seh(A ke( -- 253 Address Date Evaluation Conducted Teleph a Number P'� � 2u3 8 . S ornerse - � w I 2402 �'_ -_o C �t 15) Zy 1- 609 r Property Owner i\j Parcel ID # Page 2 of 3 F3] E] Boring Boring # Pit Ground surface elev.!? %S •5 ft. Depth to limiting Factor 12 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPD/ff in. Munself Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 'Eff#2 ► o -IZ, 2 S i I m4'r p S I vj� 2 - 1 - 3� S ' I M-G cs 5 Vr 4 )4 3 3-112 l m Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Ong Boring # Ground surface elev. ft Depth to limiting factor in. F ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 - Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD4330 (R07ro0> PAGE _3_01 3 NAME Zie t 5 o,il LOT# Z X LEGAL DESCRIPTIONSw ' /v6W' /4 S a. i T 3G,N,R / KE (or)(0 SCALE: 1 "= NU BM 1 ELEVATION /60.6 BM I DESCRIPTION p P of / " -Z I — T BM 2 ELEVATION 9 e. ?6 X ( �' eG • Z BM 2 DESCRIPTION e -� SYSTEM ELEVATION 95• yU TERNATE ELEVATION 1 7 5" CONTOUR ELEVATION a VA. �. t g -Z i ,_ P` SIGNATURE DATE Vol. . 1700PAGE 127 STATE BAR OF WISCONSIN FORM 2-19W 653879 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS Sr. CROIX CO., WI This Deed, made between Hillvale Development Limited, a RECEIVED FOR RECORD Minnesota Limited Liability Partn - -- - -- 08-15 -2001 9:30 RM — - -- _ WARRANTY DEED Grantor, and Glenn A. Basel and Karen M. Basel, hus band and wife, EXEMPT # - -- CERT COPY FEE: COPY FEE: TRANSFER FEE: 169.20 RECORDING FEE: 10.00 PAGES: AGES: 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 Lots 18 and 28, Golfview Acres, Town of Richmond, St. Croix County, Name and Relum Address Wisconsin. KRISTINA OGLAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 Pt ofO26- 1060 - 80,026 - 1063 -95 & 026 - 10 -10 _ Parcel Identification Number (PIN) �— This is not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of August 2001 Hillvale Development Limit " ______ ..__ • By: R ichard S. N elson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Hillvale Development Limited, a Minnesota STATE OF WISCONSIN ) Limited Liability Partnership, by Richard S. Nelson - ) ss. County } authegtic led this � V!,- County of August 2001 Personally came before me this day of ` -� the above named 3 ' ;FAEAB'F.R STATE BAR OF WISCONSIN — -- - - -- - to me known to be the person(s) who executed the foregoing G6 d;� _ -_.. _- _.._..__.._......... _ ... -._- ...._ _.. _.... -. instrument and acknowledged the same. ,lk- d by § 706.06, Wis. Slats.) -------._._-__- -- THIS INSTRUMENT WAS DRAFTED BY • _ __ _ Attorney Kristin& 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. trio ra don Prormdonal• C=pwy, Fend du Lac W STATE BAR OF WISCONSIN 800455 - 2021 WARRANTY DEED FORM No. 2 -1999 87,091 ' sq.ft.' ``� Cl) Zi Todd M. Hender 2.00 acres Qi Metro Land Sur County Roy p Little Canada, I / Hr �t Q i �nl:aoCi / 2 _ \ • 5 EL' �s ��, Z 2 T D 59 , G �h \ C-) N \ _ v To, H01 6.92' — — C32 5 9 cr 100' IN ► 2 9 W, V 415 M �5 3 MEh / 65,713 sq.ft. M Q 1.51 acres ; SUF Co 100 t� a, M i* N - - - - -- - -- 27 - -- 28 Z 87,154 sq.ft. �•• _ 73,355 sq.ft. —+ w 2.00 acres �� q.ft. to 1.68 acres 3 LA. Todd M. Hendershot res o �,\ Registered Wisc nsir rn A `y Dated this do to n Z ro 239.4 0.47' 1 I 4 S00 °54'03 "E '1 M — S00 "E 22 1 N M.W.E• pRAINACE. EASEMENT ' - West line of the 91 '25YR NW 1/4 of Sec. 21 _ f' !7 95& 3 100YR y/ N 00 °54 45" W 2w7V.40 v: _ 521.30 . -- East line of the- } N00 54 45 A' ��, 244 .74 .. NE-- i� m Noo°26'02 "W (rec.) NE 1 /4 of Sec. 20. SW comer of 2 OF 3 •„ 3 UNPLATTED LANDS_ 20 T30N, R1 0 4 to 'o - - - - -- -- Doc.�l605017 10 0 M LEGEND. ( 3665.(1 "iron • ZAI' Q/A-� East — West 1 /A ; ror s En 00 o 87,154 sq.ft. Denotes Total Lot Area c7a ,unless Ti] 2.00.acres W 1/4 comer Sec. (rec.) Denotes recorded bearings C.S.M. Doc.#605017 1 Pipe Set Vertical Datum is U.S.G.S. 1929 Adjustment PREPARED BY: Found All Other Lot Corners Are Monumented With 1" X 24" Iron Pipe Weighing 1.68 Ibs /ft. °r Distances are computed to the Nearest utility easement 0.001 and measured to the nearest 0.01' Angles are computed to the Nearest 00 ".5 ack Line and measured to the nearest 00°00'05" i by Todd M . Hendershott