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HomeMy WebLinkAbout032-2167-34-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, 05.04 (1)(m)] Permit Holder's Name: City Village Township DAVID R BRACHT & HOPE P SUMME I TOWN OF SOMERSET ST BM Elev: IHNK INhUKMAI IUN BM Elev: IBM Description: TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH JLift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well ELEVATION DATA county: St. Croix Sanitary Permit No: 617876 State Plan ID No: Parcel Tax No: 032-2167-34-000 Section/Town/Range/Map No: 2603141921414 STATION BS HI FS ELEV, Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man, I. Pipe Bot. System Final Grade St Cover 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 IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM STATION BS HI FS ELEV, Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man, I. Pipe Bot. System Final Grade St Cover 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 IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM 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 IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing JUIL (:UVtK x Pressure Svstems Oniv xx Mound Or At -Grade Svstems only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes COMMENTS: (Include code discrepencies, persons present, etc.) Location: 648 1961H AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Use other side for additional information. �___ Date SBD-6710 (R.3/97) Inspection #1: Insepctor's Signature Inspection #2: 6' I County NMI f t% I� �� R�V' 1 Safety 9 and Buildings Division �Z01 n L�� V r. L W. Washington Ave., P.O. BOX 716.2 Madisor), Sanitary Permit Number (to be filled in by Co.) , WI 53707-7162Ilu S Milt 7peil pplication State Tla saction Number In accordance with SPS it e�r�eri.; u mtsst� of this form to the appropriate governmental unit is N required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Servies. Personal information Project Address (if different than mailing address) you provide may be used for secondaryi. purposes in accordance with the Privac Law, s. 15.04(1)(m), Stats. d ) q+, Y�i� I. Application information — Please Print All Informationj,., ; 7„ri5ert Properly Owner's Name Parcel # 32, Property Owner's Mailing Address Property Location 7— �� � I ' Govt. Lot_' City, State Zip Code Phone Number Y4, w %, Section 40 Z II. Type (aircI one,� T�_N; R of Building (check all that apply) Lot# ortW �� t l or 2 Family Dwelling — Number of Bedrooms 9 Subdivision Name D/ A FV► S Mill � Block # �, ❑ Public/Commercial — Describe U}e I It ❑ City of ❑ State Owned — Describe Use ��„ '(IAA d bA f Nalft bar El Village of ) 11Ia Q,� I 11 '� / ®1 rvl �' S El Town of III. Type of Permit: (Check only one box o line A. Complete line B if applicable) A. New System El Replacement System ❑ Trea"nent/Holding Tank Replacement Only ❑ Other Modification to Existing S tam (explain) Be ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber g Perm Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner e/ N. T e ofPOWTS stem/Com onent/Device: Check all that apply) J e Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑Mound <24 in. o suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: j i, - 4, ' ,1 I Design Flow (gpc)) Design Soil Ap cation gate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (so System Elevatipn a �� Ito ��o ' 0) a 160 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units L New Tanks Existing Tanks W! L I4T1 bU 00I)k�, `t° 1 v v o ❑ y aa v U a Septic or Holding Tank Pee v, y rn w C7 Itd�t'� Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number t JV14 er 73 Plumber's Address (Street, City, State, Zip Code) VIII. County/Dapartment Use Only ❑ Approved 'Disapproved Permit Fee Issued Issuing Age S gnatur �DJate ❑ Owner Given Reason for DenialO 00 1 IX. Conditions of Approval/Reasons for Disapproval StOWNER; 1. Septic tsnk, effluent filter and 1. dispersal roll must be seryiced/maintained a5 per management plan provided by p.umber. va All 6etbaCk reyUiNth-e Its must be maintained� p�—�j,�6`Z. I t.7 ,V`�� an as, put aj1 pliebblo 006/tlfdinariteS, ' � ` A `V n PO 7 Attach to complete plans for the system and subvit to a County only on paper not less tha 8 lrz x ll Inches in size Lh � )1 d ►s ��� AG�ti(.� � s "ovfr7 5 , nrw*� Ids I brW&I ( SBD-6398 (R. 11/I 1),�7%S �aSSltl'� [� ) L t O%pd%t' e{�J�1%�d uL �'' clna�na�c d 0.1.-�eld•5� �qt 0�1sti�e. . -.CHECK BOX:AS APPLICABLE. SOIL EVALUATION .SITE MAP PRQJEGT NAME; PROJECT ADDRESS: Scale; 1" _ 20' � .� � .� iiiiiii.�iiis�s�� .. BM Symbol: � 8M EleVaffon; � FT BM Desodptlon i `iL�rt � cti `�r�GG W r' b ek ����^'� Slope Gradient (°k) of Tested Area: � ��* . /. • ,_ F t 11•+ i ly \\��' �rJ P �, Well Symbol (if applieatile); 0 Indicate north by dra;ying an airav on the approprite line. CHECK BOX AS APPLICABLE. [�] SYSTEM PAGE 2 OF PLOT PLANT /�y`� DESIGN FLOW; 6ltJ+� GPp Attach design flow calculations for commercial plans. Pipe Material / ASTM 'Standard (Tables 384.30-3 & 3�4.30-5) Sanitary Sewer:' Force Maln / IMPORTANT; Show ground elevation contours at suitable intervals. �D Qc�[(�t4 `H C�,ar��[r� C�1' �� �� �jb � pC4 i ( i n "�`�'� ""3 i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: IJ,tt Owner's Name: Owner's Address: Legal Description: SiN �%� Z� j n Township: �e r .. f County: SOT. (20 t Subdivision Name: )fie r_I , T 17 J /.1..., A. Lot Number: MLI� Parcel ID Number: (� ;2��.,^ wlI (�.7,—. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: / f►��l�-//�ier' License Number: 92�q Date: Phone Number 2r677_ -7� Signature Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 CHECK BOX AS APPLICABLE, ❑ SOIL EVALUATION SITE MAP PROJECT NAME; PROJECT ADDRESS: BM Symbol: � BM Elevation; � FT BMDescrfption: t�la,►1 !r! `�Y�G ki% �f'�J�.. ��13�=-:'1 Slope Gradient (°�) I ��� Well Symbol (if appl(cabie):"� of Tested Area: 1�d�ti1 np�" �� � �BiZ S�t��u-!c� ! .� ������ �� .. N Indicate north 6y draving an anav on the appraprite Tine. �r� CHECK BOX AS APPLICABLE. [� SYSTEM PAGE 2 OF PLOT PLAN ((��`� DESIGN FLOW: >�1tJ+.� GPD Attach design flow calculations for commercial plans. Pipe Material / ASTM Standard (Tables 3t34.30-3 � 3$4.30-5) Sanitary Sewer: /, Force Main: /, IMPORTANT; Show ground elevation contours at suitable Intervals. ;rt,�-�� t��n�. ��', � �3 � 64 �,� i 1 � � ���� x� Qkr t t Ic �� G;^.c- Mgt r/� l -- _��`. .. �-�" �� Leaching -� Chamber 4" Schedule 40 PVC Vent Pipe With Vent Cap 0 ft Final Grade System Elevation Soil Absorutlon System Plan View Leaching Chamber Snecilncations Manufacturer And Mode! EISA Rating'-r�` sq ft per chamber Trench 3 Soil Application Rate . � gpd/sq ft it gpd Design Flow � a '=' Soil Application Rate � � EISA Chambers 3 rows of chambers each. Q,Ot� n Product Lid Single Other than si►-►gle fa►nily primarynl$rr►ber Color Family applications in GIMP Filtration Si�°e t Code .Application In GDP <300 300-600 601 CBOD' CBOD' CBODS LT-1/8 BLACK 3500 3000 2500 2000 1/8" LT-1 /16 GREY 3350 2750 2000 1500 1 /16" LT-1/32 E GREEN 3000 2500 181 1500 1/32" :,: LT-64 WHITE j 2500 2000 175Q 1500 11/64" TO BE USED IN COMMERCIAL APPLICATIONS. DUE TO EKTREME LEVEL OF FILTRATION, AUDIO VISUAL ALARM IS RECOMMENDED DUE TO SHORT SERVICE INTERVALS. INSPECT AS NEEDED. t::; :_� i f�E�� _.,., _i ,�r�r r f-,,f -._ '�: �._ i °:. �;,�_r r tz �,'t ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r �, t Owne1/Buyer. t� ' L B f' (tot. iz!r Mailing Address Property Address (Verification requited fiom Planning &Zoning Department for new construction.) r City/State, t� F, i," Parcel Identification Number • I '� LEGAL DESCRIPTION Property Location 0 % % , Sec. _ ` 1'� , 'I 1 N R W, Town of Subdivision Plat: Certified Survey IV.iap # Warranty Deed # Spec house �yesl�uo Volume (before 2007)Volume Lot lines identifiable ❑yes�]no Page # Lot#�1 �1 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 Yank 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 " St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning &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 firll of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services attd the Deparhnent o.,Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration (late. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANTS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by flue Planning &Zoning Department. *** include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) FILE INFORMATION Owner Hi � s t -- I ,P F . DESIGN PARAMETERS Number of Bedrooms ( r, ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate e gal/day/ft2 Standard influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BOD6) 5Z20 mg/L 40 NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L NA Fecal Coiiform (geometric mean) <_101 cfu/100ml Maximum Effluent Particle Size Ye in dia. ❑ NA Other: NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Page + of 2 SYSTEM SPECIFICATIONS Septic Tank Capacity gal ❑ NA Septic Tank Manufacturer LA) ��� , ❑ NA Effluent Filter Manufacturer { ' Ili ❑ NA Effluent Filter Model' ) ❑ NA Pump Tank Capacity _ al IR NA Pump Tank Manufacturer NA Pump Manufacturer ID NA Pump Model M NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other; Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) M year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑mmonth(s) (Maximum 3 years) @;year(s) ❑ NA Clean effluent filter At least once every: ❑ month(s) ! i year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) NA Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ year(s) DNA Other: At least once eve ry' ❑ month(s) ❑ year(s) ) NA Other: ❑ 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. Page Z of v 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 may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. buying power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. . Reduction or elimination of the tollowing 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. ABANDQNMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: o 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 its shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid materiat. CONTINGENCY PLAN If the POVVTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: j A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Ths—. h(/f ` aluati re a o ding jank bet e ate }�2pf(f3 � D2 JJ b✓ C��tSTKeVC to 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 that time. < <WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR 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 INSTALLER Phone _�' to POWTS MAINTAINER Name - Phone — LOCAL REGULATORY AUTHORITY / Name S'�', /op, pp/20/Lf j Phone �� — e(4? 1 (O SCD This document was drafted in compliance with chapter Comm fi3.22(2)(b)(1)id)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 2�. } m \ 9 �() § ) � per' ply. I 1 1 I I I I I 1 1 1 I I i I I I 1 I 1 - 1 i t s 1 1 I I i I I I i I I 1 1 I i 1 I Pvt.'.. i I 1 3'2. I 11 `i I 17 h 1 I Ct 1 i Es o �ai-3 I I I I�. 1 a - ---1 c r a i I I 1 I r--'- I 4 /-!l. n 1 1 1 1 g - 1 I 1 1 i I 1 it li It I00 li i 1 1 r e I I I 1 I I n IR a I 1 _ I '� I 1 3 i I or `' I to I I I , So oil 0A. IA !Fr I I I I I I I 1 I I it I 91 1 'I 91 RI�I R f= h tw tl Q 4 i qq -S g gg � I rrco. s� r _ TM q k g +} T^ Ira' _ .s• INI gy SI6I 7 3 - /� _ Nab 7.11 .y i p yr ®Ialn'5 Drawing Room, LLC 2019 a m b 70 m _ rn r � z rn n r O z N `A O 11 O I I 1 i i I I 1 I I I I I A � ? E � zS�i� rcBx�J:•� Q PAVE 15RACHT & HOPEfUMMERf i v os i� 648 196th Ave,fomerset, W154025 lain's Drawing Room. olairs o, Room, LLC me ~ ® §[\ 9 # 4)! }\# }\\§ aXM l A.aC �� (\ «©Q ( \ § a a!§ƒG/tee % ^ � Documcnt Number State Bar of Wisconsin Form 1-2D43 WARRANTY DEED �� Document Name THIS DEED, made between Charles E. Seamaa Jr. and Renee M. Seaman, husband and wife, ("Grantor," whether one or more), conveys and Warrants to David R. Braeht and Hope P. Summers,' ("Grantee," whether one or more), the tf'ollawing described real estate in St Croix County, State of Wisconsin: Lot 34, Plat of Pine Cliff Second Addition in the Town of Somerset, St. Croix County, Wisconsin. Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements, entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated 10 - S ^'ZC7t$ ..: AUTHEIVTLCATI®N Signatures) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, � _ _ authorized by Wis. Scat. § 706.©6) THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract and Title Co., Inc. By Samantha Olson at the direction of the Grantor. 18-511289 �� IIIINIIIaINI�NIAIII�I � ' � ', • � r ST. CROIX CO., WI 10/17/201$ 03:11 PM E)CEMPT#: REC FEE 30,00 TRANS FEE 211.50 PAGES: 1 Recording Area Name and Return Address St. Croix Cuuiity Abstracrt� Title Co., Tnc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 032-2167-3�t-000 Parcel Identification Numbs (PII� This is / is not homestead property. ACKNOWLEDGMEIY'r STATE OF �,,,f. 7'"" COUNT �bGk ) ss. (SEAL) •►. � r• .. '�' � �.. _ Personally came before me on _ tp�s�' , the above -named Charles E. Seaman Jr, and Renee M. Seaman, husband and wife to me known to be the persons) who executed the foregoing instrument and acknowledged the same. Notary Public, State of T My Commission (is permanent) (expires:_T'7r" �„� ) (Signatures may be authenticated or acknowledgM. Botfi are not necessary,) '7 " NOTE: TIIIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTII� IED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. I-Z043 ° Type name below signatures. St. Croix County 1072968 Page 1 of 1 h. 86AT l z M00'OS'13'E 595.OD' N m . IB:$I5 — — — -80005'13W626297— SCO"05 13W 595.00 lJ�� ro PS.tS I 725.99 30176 OFF W _ N i YJ J \ \U1 1 V1 N J O 1 N t /oft / In I JI a (ZOO CF EO � ZJ• � r 0 D m O z or zmME rn � �* A z o cry 0 (O = � m ■ ■ d 0 � O A O Z Z zoz0 � Ti v �m OA X O � T cz z A wl Wlsconsfn Department •----•,-�_""j_� �� i��+=� �� b�ViS10h Ot' IhdUstry Se �C�a��J l_..`-iL� V 1, �` SOIL EVALUATION REPORT ) � ',j((��,,((�� Page / of P� � 'ih �bttlance tvth SPS 383, Wis. Adm. Code Attach complete site Ian on p�pel- � ;�e��,lh�tya 1/2 x 1 inches in size. Plan must County aT include, but not limite t�Y ���i �� nc o1 � � � i percentsiope, scale r s r?s,-�fl ��re`t , �� ec:x Ion and d stance fo nearest road, Parcel LDr Please print al! information. �� ��� �� ~� �� _ � � � Revi�fed by % % Date Personal information you provide may be usedfor secondary purposes (Privacy Lavt, s. 15.04 (1) (m)). , / Property Owner � �!'•V`/1 �'� PropertyLocat(on �� �.1J �. �Y �,�.��__ Govi. Lot S� 1%4 �� � 1/4 So�� T3 >� N �� `- Property Own is Mailing Address � Lot # Block # Subd. Nama or CSM# R E (or) W CiEy State Zip Cade Phone Number �� �� ` �•\ � EF •-• a,�'� fly ;�^t pY City Village Town S� � a, S e� 4� �, $�yl � � ( ) ® Nearest Road New Construction Use Residential / Number of bedrooms Code derived desi n flow rate � - Replacemenf ® g GPD J Public or cpm ercial - De�cribs:� N Parent mafenal ��..� '� ,, „� - / ... t 1 sin elevation if applicable General coinmenfs '^ ft, and recommendations: �'�'����'�� ���, S�-S'rs'1R ��x-. U� Gam{, r��r ' � Boring �. - o Boring# � �,-/ !/ Pit Ground surface e(ev. � � ft• bapth to limiting factor �i � in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A G IPicDa� ikon Rate ' in. Munsell qu, 5z. Cont. Color Gr. Sz, Sh. Ef`#9 Effll2 ®Boring # � goring + � � � Pit Groundsurfaceelev. �' Q ft. Depth to limltin fac g tor_ �� in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds ln• Munsell qu. Sz. Cont. Color Gr. Sz. Sh. �� t,o �3.� ..._...�,� � J �, d,w, It � L � O M t_ Effluent #1 ST 1\me (Please Print) I� > 30 � 220 mg/Land TSS >30 < 1 ti0 mg/L * Effluent #2 = Soil A plication Rate Roots GPD/fg • �Efff#'( *Eff#2 �C � � V , �� � .a �:-� <_ 30 mg/Land TSS < 30 \w b�� �� ? '�'c• Telephone Number �Js .- ?�i� - 1 �7�' SBD-5330 (P.07/13) 8oring # Boring Plt Horizon Depth �ominanf Goior F�edox Description In, Munsell Qu. Az. Cont, Color �� 8oring �� ❑Boring ---��....II ❑ p(t Depth Dominant Color Redox Description in. _ Munsell Qu. Az. Cont. Color 8oring # ❑ 8oriny ❑ Pit Horizon Depth Dominant Color In Redox Des ' tion ____ Munseii Qu, Az, nt. Color Effluent #1 � 80D, > 3t7 s 220 mg/� and TSS > 3t) s 150 mg/L Ground surface elev. / � �,l/ Texture Structure Gr. Sz, Sh, /� % c� h7 5 � f2 �� e. l ���, sd � � ..� � ,� Depth to limiting factor ����, Consistence � 8oundary (Roots GPDIFf2 �-� 0� r?�`7 i,� Ground surface elev. ft. Depth to Ilrnfiting factor � in. Texture Structure Soil A lication Consistence Boundary Roots Gp Gr. Sz, Sh, elev. {t, Texture � Structure Gr. Sz, Sh. Depth to limiting factor in, 8oundary � Roots . Effluent #2 = BOD, > 30 < 22o mglL and TSS > 30 s 150 mglL c s- m S�ZS-89L-SZL �u!quanld sa�!W s�lue�{l £L61�Z6 �u!quan!d sa�!ua••••o�u! paea �!paa� q}!/�' �u!uanoua �epuow Ilea II!M 1'000-1�8-L9ZZ-Z80 #laaaed lasaauaoS 'aid u196Z 8ti9- luaea8 pinea ao� �.sa� I!os aye s! aaaH }pd•84 �sa�lios :sluauay�elltl �U�eaB p!nea ao�. sal l!os :l�afgns aaylleM aleE) '4D OWL Wd 6Z:Z OZOZ 'ZL I!ady'AepunS :lugs <uao:)•l!ewjoy@6u!gwnld—saj!w> aaylleM q!W awoad uosa818d •d a�lnr Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c.�f Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must J 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. 032 — Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15,04 (1) (m)). Page I of K Date Property Owner Property Location /�/t�l / �p r h fH C /� Govt. Lot S 1 /4 Memo,, G 1 /4 S 2 6 T/ N R/ (or)® Property Owner's Mailing Address 22002 Lot # Block # Subd. Name or CSM# City State Zip Code 'Phone umber < (IJNTY ❑ City ❑ Village ® Town Nearest Road /40 , JCS el1 &.�� I�i( )S� 2' '>'f— s� New Construction ❑ Replacement Parent material �C General comments and recommendations: ❑ Boring # Use: ® Residential /Number of bedrooms � Code derived design flow rate �i G � GPD ❑ Public or commercial - Describe: gALCi a /jiif 18 Flood Plain elevation if applicable /Lr� ft. S,St'Plem) Lc�l, qs, U /ir�.u�y aee 4 ❑ Boring p © Pit Ground surface elev. V O i 7 ft. Depth to limiting factor � � � in. Soil Application Rate Horizon FT] Depth in. Dominant Color Munsell Redox Description Qu. Sze Cont. Color Texture Structure Gr. Sze She Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 v- /o /0iy� 3iy ,4 rt j yX.4,7Aree- c w rz� reel c r�� / C�`L V ° s� ( re d Z /0 10/4 7 / 0� I �k �� tjk— 'ster .,a, w i," o y , 6 �i yX- 63 %fm 6/y L S /.��a�; �eg� c C 63-9Y ?sy,Q% /l/,Q� 1 ��5 Ds L e w I,,rz D: 7 / 2 7,> �� % — ldk , (),oe Boring# ❑ Boring ® Pit �• �� o. � p Q � Gr uod su ace elev. /' ft. Depth to limiting factor. 7 / � in. Soil Application Rate Dominant ' Effluent #1 = BODS > 30 < 220 mj1"nde-T6S >30 < 150 mg/L *Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature -7 CSTlN/umber Address Date Evaluation Conducted Telephone Number 39� - r��c Sam►��i�t �� Zo ©:2 7/f=Zy/-320.? SBD-8330 (R07/00) Property Owner �/+'� �' G.�� � � f/° {''1 � �,f' Parcel ID # ❑ Boring ,�, ` Boring #., ' • � l Pit r �"Ground surface elev. b'� ft. Depth to limiting factor,,_ in. l t 1 P Page � of J Soil Application Rate Horizon .Depth Dominant Color iri. Munsell Redox Description Qu. Si. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 'Eff#1 *Eff#2 1 a�/o oil -�iy /�- G / �s�a� � ��� �. � Z � �, � � , 6 `/ 3s- 6'a 7,fy�' % /1//� Ins/ �6 �� rL G. c � ���- � ` 1 � � Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aooligtion Rate Horizon Depth in. Dominant Color Redox Description Texture Munsell Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 ❑ Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Redox Description Texture Munsell Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence: Boundary Roots GPD/ft2 *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBA8330 (R.07/00) OWNER Name �I4 C> C �' {� a 74 �•� /� Address /f uV wy . Benchmark 1 ` 6P I" 574Ce/ `> enchmark 2 -bj' / , v Soil Boring Suitable Area 1" = 40' Scale Page 3 of 3 Brian Parnell CST 231314 Date : titi e 2o- off.. T _ i- i --T---a-.�.�- 1 I -- I , I I E --r-�- - - r-- --r-- r--ry^ 1 I R i 1 I �`.7 �iP ,k i ice! I 1--!r-{ i I Ilk �,�'"'�•t��- -i� - � --T— —------- — r-1—>— �— --- — — —, --- �Oe •-i-•-.--_+�7t.--' Ir�r.-_ ' i liii �--j- T� DB -- 1 i � { j_, iT