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HomeMy WebLinkAbout030-2145-05-000 Parcel #: 030 - 2145 -05 -000 06/01/2007 08:32 AM PA 1 OF 1 Alt. Parcel #: 30.30.19.2096 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/06/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - VIEBROCK, WENDELL & MARCELLA WENDELL & MARCELLA VIEBROCK 620 240TH ST OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1389 33RD ST SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.040 Plat: 10/091 -BROWN WOOD ESTATES LOTS 1 -14 030/05 SEC 30 T30N R1 9W PT NE NW BROWN WOOD Block/Condo Bldg: LOT 005 ESTATES LOT 5 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30- 30N -19W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 10/30/2006 837704 WD 09/11/2006 834182 EZ -U 12/06/2005 813691 10/091 PLAT 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.040 78,200 0 78,200 NO Totals for 2007: General Property 3.040 78,200 0 78,200 Woodland 0.000 0 0 Totals for 2006: General Property 3.040 78,200 0 78,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 488024 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide ay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: f City Village X Township Parcel Tax No: (tehl 1 St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 30.30.19. ZOf TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Botto `I Dosing Header/In. Aeration Dist. Pipe Holding Bot. Systelm Final Grade PUMP /SIPHON INFORMATION Manufacturer D , 96nd St Cover Model Number ° �.- TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. 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 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 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 �: No 1_ Yes l : No COMM E NN T SS Id Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: ##'3 Street Hudson, WI 54016 (NW 1/4 NW 1/4 T30N R19W) Brownwood Estates Lot 5 Parcel No: 30.30.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes j No Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) y Safety and B "t to nld gs Division County 201 W. Washington Ave., P.O. Box 7162 V sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 Sanitary Permit Appl' State Plan I.D. Nom - ac d w Co 3.21, Wis. Adm. Code, personal inform R"RAVED N , r secondary purposes Privacy La v s15.04(I)(m) Project Address (if differJH3� 1n ling address) I Print All _ Information � 3 3rd S-�, Pro p e t Owner's Na me ad, arcel # Lot k k N Al �� C _ _ Property Owner's M ailing Address Property Location City, State / ) Zip Code Phone Number — . 't' �� 'k Station (� � �'O.I/ (./ _ (circle o w J, 6 PP Y) II. Type of Building (check all that apply) — T �� N, R E o 3� � �_ f 1 or 2 Family Dwelling - Number of Bedrooms Subdivisio / . C ly1 , ni ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use — � ` ❑City ❑Village^ow of �o j III. Type of Permit: (Check only one box on line A. Compl line B i f applicable) A. �— - -- —T-- New S - ystem ❑Replacement Sys ?em TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision Change of ? Permit Transfer to New List Previous Permit Number and Date Issued ❑ I Before Expiration Plumber Owner /� L 3 IV. T of POW Syste (Check, that apply) J� / �ttl 7 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 Ing Tan 7' Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Fi lter eachift Lin ❑Gravel -less ipe El Other ( lain) _ V. Dispersal/Treatment Area 7 4 40 11 S Design Flow (gpd) Design Soil Application Rare(g sf) 4isper Area Required (sf) Dr rsal Area Proposed (sf) System Elevation � 77s� VI. Tank Info apacity in Total Number Manufacturer Prefab Site Steel Fiber 'f Pla Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanis Septic or Holding Tank ACCOt11C Treatment Unit Dosing Chamber L . V11 . Responsibility Statement- I, the undersigned, assume responsibility for of the POWTS sho wn on the att ached plans. Plumber's Na me (Print) Plumber's Si gnature MP PRS Number Business Phone Number — 4L� - "�� I � e-/ Plumber's Addre ss (Street, City, State, Zip Code) V Use Only Approved ❑ Disapproved Sanitary Permit Fee ncludes Groundwater Date Iss ed suing gent gna� No Stamps) Surcharge Fee) t- L1 Owner Given Reason for Denial , 0 19h IX. onditions of Approval/Re for - Disapproval �1�.'i� -�� � �'�/ r"'•" � w SYSTEM OWNER: 1 Y Q �a� Gt (��-.: 1 Septic tank, effluent filter and �Yli � /� `/- 05' i dispersal cell must all be s rviced / b maintained O �� , 1 I �/ �� � V as per management plan provided y plumber u-Q:t �l ���7 2. A ac ens a i v a a s Der a licable code /ordinances. Attach complete plans (to t�tytinaly) for ==t r no less 8112 x 11 Ipches stz � f SBD -6398 (R. 01/03) r�j� ' �'i�M�� fi r✓' r �6� I Q sd \ �\ UD 00 _ 1 � a � L.- � 7 a r _ o" - ti all �1 s � a Q � c ?o t� \Jl� to kt, I r r I� � � Ct � `�, �: c o �" ��� .� 0 to v� 4 . Se � %�. y'`� �s � � 4e r ���� "� �•'� � ' �` � �� - tad.?` -� <<„� '�Q� �s .r�a � � h � � � �- a a �; ® 3 `"J �� tR �, `� � � � � � `� � n ci "' v � � --�` � � � a� d �� "� w r ; 1 CYU vs � E) - -�.. Z- w� r- �6 3 26' 5 OL A� r p If �- k� Jj l i NNE f f � 143�07 s ue_ of .30 Ac. � l v19 ` l �ECT_U1i AND S PEC IIif;A ;:'Q j g£P . 'TANK & PUMP CllAX.BZR CROSS 4 1 ' CI ' VENT PIPE 12" MIN. ABOVE GRADE E J BOX APPROVED > 25' FROM DOOR, WINDO WITH CONDUIT MANHOLE CCVER FRESH AIR INTAKE W/ PADLOCK & WARNING LABEL FINISHED GRADE 4" Cl RISER i ��, MIA.. 16" IN. MAX. NLET I , GAS* I , WATER TIGHT SEALS TIGHT APPROVED A SEAL JOt 1Yt s wITH ALM APPROVED PIPE PPROVED H ' ON 3' ONTO 1PE 3 s SOLID SOIL NTO SOLID C i RISER E XIT OIL PUMP OFF ELEV. FT. OFF PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC I DOSE NLrpgER DOSES PER DAY: TANK MANUFACTURER: �� •° .�._. TANK SIZES SEPTIC GAL. DO5E VOLUME FLOWBACK- GAL. - D O SE �.,� GAL. ) v- CAPACITIES: A = INCHES = GAL. ALARM MANUFACTURER: MODEL NUMBER: B = 2 INCHES = -+� GAL. SWITCH TYPE: merfm PUMP MANUFACTURER: C'sac►'� �� C = S INCHES = �,�,..,. MODEL NUMBER: `✓ ) D = INCHES SWITCH TYPE: 1 7 f�� ;..._ 16.23 WAC REQUIRED DISCHARGE RATE �, GPM PUMP � ALARM WIRING AS PER ILHR FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTICN PIPE ' ` --1 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . • ` . ` . . ' . . FEET + FEET FORCEMAIN X � -/ 100 r TOTAL I DYNAMIC A I'.EAD _ _) F EET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ , LIQUID D � •• �G � /�/C'G r LICENSE NUMBER ??P Dt1TE: liae CIGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 J APPLICATIONS • FuUy submerged in high o =tiler Thermopla.s- ■ Bearings: Upper and lower S ecificali desi ned for the grade turbine ail fpr tk design for heavy duty ball bearing Specifically g lubrication and efficient improved performance. construction. following uses. heat transfer, M Cris and Base: Rugged • Effluent systems • Homes Available for atsltic and tffRrrtlop � design provides AGENCY LISTING superior strength and corrosion • Farms manual oparatign. Atrxv" i ce, CowW en stardards Assodatron • Heavy duty sump matk models kw_Nd • Water transfer Me6ankal Flout Switch w Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and at the! eiflclent heat transfer, in "F" or "C "J factory, "mil and durability. SP ECIFICATIONS 0 MOW £over. Thermoplastic G*M Pumps is ISO 9MI 11eOs%W- • Solids handling capabili FEATURES t:ontRr viridl integral handle and n9 float swltch attachment points. 3 /4" maximum. ■ EPO4 impeller: Thermopias• IM PIpyyy ; Severe duty • Capacities: up to 60 GPM. tic Semi -open design with 1111100 op and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • Discharge size: 1 1 /2" NPT. seal protection. • Mechanical seal: carbon - rotarykeramic•stationary, BUNA -N elastomers. • Temperature: 104 (40 continuous 1401 (60"Q intermittent. METERS �ie� • Fasteners: 300 series ; stainless steel, 9 3oI • Capable of running `^ dry without damage to $ i components. 7 . i Motor: • EPO4 Sing phase: GA HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with S automatic reset. c _ EPOS • EP05 Single phase: 0.5 HP, 60 115 V. Hz, 1550 RPM, 3 10; built in overload with ! ePO4 automatic reset. • Power cord: 10 foot s standard length, 16/3 ' { STOW with three prong grounding plug. Optional 20 0 00 10 d0 30 40 5o GPM foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). 0 4 6 e 10 12 m' /h CMACRY Goulds PUM 02000 Goulds Pumps <& ITT Industries Effective February, 2000 83871 V uick4� Q STANDARD CHAMBER Quick4 Standard Chamber - -- ---- __. ___�_- 48 ' - -' (EFFECTIVE LENGTH) l� 34 °- - -- SIDE VIEW SECTION VIEW i 4 MultiPort End Cap 34'-- - - - - -� SIDE VIEW TOP VIEW FRONT VIEW w� Quick4 Standard Chambet�Nominal S�ecf�catians� �� ,' MpItiPQrtf.�nd Cap��fominal Specifications °"'�'''� t Effective Length 48" invert Height 8" or 1.25" Invert Height 811 INFILTRATORT�MS, INC 7A NDARD LIM WAlg (a; The siucklmi saepnty at each cnan {Jar, eno plate. wedge and o:; r acrasss0ry ma.wlyrlurod by 11110 aOr 1'Unlis "I, whan mstatllod and oM, ated in a , Or an ons:le w:ptw system, in accordance will Infill'ato''s ir'SRnntinns, is Warrai ted to il"1 crlgi ouretaser rFlddar') ajaitw1 derectiva rimer , al At wurkmatlsnlp In oea yea, from the date trk'Jt Lie septa permit is issued 'o, the r litic Syslaln mcla,nrrg the Ur"M; pmoded, bowavor, Ihal it a seplk I•L~mit IS not re.pbred by appecatie law, Itle wari penod will tx;g:n upon tho dais trial instaliaton of Rte saptir. s,jvlt n Commences. Tr) >< r se is Narftniv !igi ±ts Hot ei nvst not ?y Infillialor l 1 wri a: its (' nlxxate H4 rkf Inl!nr^.. in _Yd Saytuook, CorinKllcut Willi I fifteeI (15) . ' • ■ yy of thu alleged dole, - Irfdlmlrr will subply replia00nient Ur Is for LINrt data mined by Inlikralpr to no coverall by this Umilad Warranty. ml arul.x., fahUy speciircatty ezc4.des the cost of romnval and/or ins1a118UOn ui fns Un!e. Toy -_ cIN17t.� lhARitMJ1Y ANC) REMIS;iIES 1N SUHPAF,AGFIAPIi 1 1 +RE CXC.UShL. vff fill -fll Anf NO 01 HER WARRANTIEi'. Win RU-EC;T SY•STE M S INC T� HF U2 INC i F.D W .001NO NO NPLIARRANT ES ur MERCFIANT Ty Oft FITNI-SE FOP A M iI iCULAn FUHP05E. ( n tai Yt l tY " I IN J�U it wr y part Jl ihE- :rare' - s ran' im:hrled Uy ,Iilynn tM 4f INfI F_ Tlx� .' 11 0 N/ Yrdn1Y ,Yx: .A ­11.1 Id I r udent9f ,.om.eytrenika, Spec, dl pl IndirPal dar i7tiu. In11 "a Chas air, be liai::d Iar pr.ra,R..c or .I ja ,ii r W;,r3 l<1 C Enviro eatai nm Onsite Wastewater Solutions Iir:Jdu own and Profits, labor and mi overhead casts, or etmr I— a e, w incUrad by tyro H-1-1 or any tht" narly. SfW1Ii1Lalr1 e. I lded 111). t. m W311anty rxv 1131 are damage W Ilia Units dUF, to O Binary wear anp tear, a 9r tic: "oiJarll. ml4lss, abuse or nuglecl of Ino U nits; lhu UnIIS b rti 5Ubyr te1 to venCle traffic or ofnar oandilions Wh,ch We not alielA ied by Ire iriatahallOn inmiu kiiis: failure to malniain the 6 Business Park Road • P.O. Box 768 minimum ground covers a1 tonri dt the inslalation Instructions. t pacernant ell imixoprx materials +coo the ,;rGlem CCrNaimng the Units; failure of O nC the Units or the septic sti duo to improper siting or Imlacper sizing, ezcassve water usage nnploper grease difip(aal, or hnproper operatbn; ru Oid Saybrook, CT 06 any oilier even) nol caused ny IMrlrato" This limited Wanarely mall be'vord it Ins Holder tails l0 cori wAh 111 at the tarns sef forth in this Untried VWNranly. 860- 577 -7000 • FAX / � 8 � 60- 577 -7001 Furt' - ter. it no event snail in:dvalrx be responsible Iw any !u s or dema5a Nw :a In the Holder, Units, . any third Wrly resuNri:y mi fro in,^ n U .akni0 ship- 800 `�Y36 nsnl, or ham any proo-I liability rowans of Haider or any lord party. For Inis Limited Willi to apply, Into U Als ml,st be a,slai "7 acc'ordai will - , all site cond4,onl /egou'eio 'Y 'mate slid toCal codes; ali Othq app;ia le laws; and Inllllrat(Irs Inslalatkm Iirstr.clions. U1 hlu rlva$rnsal •' of I, Jilf rtul npp 1:a auto "eFi ly IL) 01ti or e tend th _united Warta' 8'y. No walranh' apl�'Oa "C. any pa!?/ pllk r Ihan I " - oriyr rut Iloiva, . roprewnt: e,. gtar I iri,n,l WaR (, „wnrad by iMealar A I'll Wil numtxJr ld r >fales arM cou•,rios't�"a di(Ielr"n ­­k, ,"Ara - n % Arty purc!mwf of toms etW ki w 1, %!Ot ator's C rioral9 Iieadglan:s n Utd s • Colr tljl, prior to such puto w, to obtain a copy 01 Ina appiicuble warranty, and Should carefully toad trial warranty prior le, the purcraaa of knits, U 8, Pa!ents. 4,759,661; 5,017,041; 5,156,488; 5.336,017; 5,401,110: 5,40',451; 5,511,4f 0; 5,716,1E3; 5588,778; 5,839,844 Canadian Patents: 1,329,939; 2,04,564 Other patents pending, infillnlor. Equalizer and SideWinder are registored trademarks of Infiltrator 3ystwT,s Ina. Irdlllralo* is a regisl - Nod trademark in France. Infiltrator Systems Inc Is a regls(erad aadernark in Arerico. Conieus Contour Swivel Connection, MicloLeaching, Po•ylulf, Simi Obamt,er Posit.oek, OuickCut, OulckFiay nECYCltnvwen - -. ___ .__.__.__,._ _. ,_,�., _.._ c..,.......,, m, on7� n,ea.,,,,,. C.2IOr,.o Inr P,,,, . ri rn 1, G A C01171i3HP0 "illscot>slr Depa rtment ofCommerce SOIL EVALUATION REPORT 'lion t Soo" and Buildings Page of in accordance with Comm 85, Wis. Adm. Code Comity Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S� rw +' Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north a Nnoe arest road. Plea pri nt a on GEIV Re Personal Udormalion you provide may be wed secondary purposes (�v.01(1) (m)). /�p �� ProperlyOwneir = Location 1/4 (ltil S 3U T 7 N R j E Property Owner's Mai ng Address Block # Subxdt Name or CSM# G 6O ZONING OFFICE S tate Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road w A I 5ya � t ' / 1 3 - 5,1. (� New Construction User Residential / Number of bedrooms 3 " ` Code derived design flow rate �V-SZJ 40 O er GPD ❑ Replacement Public or commercial - Describe: Parent material , I Flood Plain elevation If applicable ti/ 6Q ft. General OOmmrB s�/s -f/7"1 —� /� ✓ . '➢ . '! ( a.ct y ""C I / L / ' ` I and rem N f �� � G ��G{ �i(�L� G�i� Cfi�^�- � �Uir C2 �G�TG� -� n .;6 low s M Boring # ❑ Boring 4 1 Y I ft. Pit Ground surface elev. Depth ro limiting factor 7-5 i Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G POM In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 1 15 0-17- ro r S, Y ,ns e' S Boring # ❑ Boring - U L =J Pit Ground surface elev. Depth to denting factor � in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •01101 •EfIW2 • Effluent #1 a BOD >.30 < 220 rrq& and TSS >30 150 nv& •Effluent #2 = BOD 130 mg& and TSS < 30 nV& CST Name (Please Print) nature CST Number c � cA1 is 253�CT Address q Date Evaluation Conducted Telephone Number , A y Puoperty Owner �a N s r Parcel ID # !a S � n s ..- W oe page Z of © ❑ � . S Pit Ground surface elev. ft ,� . Depth to ag tacdor in. son Rate Horizon Depth Dominant Redox Description Texture St uck" Consistence Boundary Roots GPD/ff IM Munsell Ou. Sz. Cont. Color Or. Sz. Sh. 'Eff#1 'EIW S i r,7 . G, / a -= sh 'Iry r' , d F-1 �,g # ❑ Boring ❑ Pit Ground surface elev. R Depth to limiting bcsor in. yon Rate Horizon Depth Dominant Color Redox Descripton Texture Structure Consistence Boundary Roots GPDHf in. Munsell Ou. Sz Cont. Color Gr. Sz Sh. MINI 'EfF#2 Q om # ❑ ❑Pit Ground surface elev. ft. Depth to limiting faclor in. Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture StnxAure Consistence Boundary Roots G PDOF In. Munsell Ou. Sz Cont. Color Gr. Sz Sh. 'Efi#1 1 1 0#2 ' Mient #1 m WD,: 30 <_ 220 mglt. and TSS >30:S M M& ' Mot t #2 s BOD, 1 30 mglt. and TSS 1 30 mgfL 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, pleas contact the department at 608-266-3151 or TTY 608- 2648777. ssaujotR.aaor PAGE 3 OF E SUI/l n S °G� LOT# 5 LEGAL DESCRIPTION ELI= /ate /a,S. T 3cnN, I - / E(OR)1O i .dCALE: I" = go BM I ELEVATION 160- C BM I DESCRIPTION k a Z �� �� , fie BM 2 ELEVATION BM 2 DESCRIPTION 4oe C-j- 2 ��C- SYSTEM ELEVATION SYSTEM TYPE �w.1 u wr�.�/L -a 6 Cyr 03,gi 00 FT A j ✓h,l �i- %4 e frol;Vi - 5s -lo „ a cv !arc SIGNATURE G! DATE .. wA b� • 932 t o it ' r• ` ♦•YJi• ►•i1♦ J Ki m / � f' • • • ®.7:� . m ? ,S,� ► laws MY � ' � ii �/J!1�1 �� ►.o•'�eseJ ?JSO+sse /�wn�1 •.�•�� �� "G1•J ♦••YUa• ♦♦ o� ♦OJ•O •• , ►4J J1 ►,• Y I • . • 1 • • J i,A •,1,�, ��JiII,=Il.riil ► • • i. + e . J •t . ♦•fl � ,•d' ��� ;w ��� �� �' ~,�/►�� ►.off,, ;• ♦rJ•� Yl • � �� � � � � • � / ` r I . � . Ioe•JJi L + • ►ee I �e �/�j �i�1, � � •�. :obi - � • YY ►J•r i 1•• . � I � , r + F • 1 • � 1 • i e e • : • • .!lam J Ile • kv/ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 *Dftion of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code 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 al am and loc tance to nearest road. Please print a I infcR"EIVED Re Date I _ Personal Information you provide may be used fe secondary pines (Privacy Law, a. 1 .04 (1) (m)). Property Owner 2005 P rty Location 6 YV Lot 1/4 (�dt S T �jIS N R � n l E ( or W Property Owner's Mailing Address # Blodc # Subd. Na or CSW U - C) , ZONING OFFICE G me �' State zip Code Phone Number ❑ ✓ City ❑ Village I3 Town Nearest Road (D New Construction Used Residential / Number of bedrooms 3 _ " Code derived design flow rate - GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material �-�' ' \ Flood Plain elevation if applicable .e✓/ 14 ft. General oomrnernts and recomrrle ations: Y lam -�`� r F-il Boring # ❑ Boring Pit Ground surface elev. ft. Depth to timiti ng factor -5 in. SoN Appkedon Rate Horizon Depth Dominant Color Redox Description Texhos Stricture Consistence Boundary Roots Gpoff In. Mtmsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 Boring # Boring l d - � — l 6 dS' c� ® Pit Ground surface elev. 0 ft. Depth to limiting factor a in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#12 3ei, k " 7� • EflkrarN #1= BOD > 30 < 220 mglL and MS >30:S 150 mglL ' Eflluertt #2 BOD , 1 30 mgt: and TSS 1 30 not Name (Please Print). nature CST Number C - . ✓VA CX �_e Addren 9 4 Date Evaluadon Conducted Telephom Number Property Owner Parcel ID # l AO—,, c.. • -! Page 'G� of Cl soft eon # :� -- �' Pit Ground surface ele . ZDAU ft © . Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDJfP In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •EB#1 •011112 n ❑ �a.� r Ord �' l'. < 3 d u �-� ►�csX v �y1� f # (R Pit Ground surface elev. ft. Depth to IUnidng factor 3 in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIff in. Munsell Ou. Sz. Con. Color Gr. Sz. Sh. •Ef1#1 'Eff#2 2 $ y L 2 y�, vv4 r — L� 60 - v E erg # p Boft ❑Pit Ground surface etev. R. Depth to Nrrtiting how in. Soil Appkation Rate Horizon Depth Dominant Color Redox Description. Tod" Structure Consistence Boundary Roots G PON In, Muneell Ou. Sz Cont Color Gr. Sz. Sh. •Eif#1 •Eff#2 • EMuent #1 * BOD, > 30 <_ 220 mglt. and TSS >30 1 150 mg& ' Effkien #2 = BOD, 130 ng& and TSS 130 n k 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. seo.uwtaiaot PAGE 3 OF NAME JGh n -S rl LOT# J LEGAL DESCRIPTION 3U T ;?c 17 E(OR)1W SCALE: I" BM 1 ELEVATION 160. G) BM 1 DESCRIPTIO a Z ,Q�'L BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION Z S r �2/ J U-rac SYSTEM TYPE ��y.1 /t i z ion. Zlo _ 3 3r • t5.r(I n�� Z �� D1n ��4 D � be ft Q t z3a t Ial /ov 9T to SIGNATURE ` G DATE i 1.59 FRONT SETBACK = 75' (NORTH -SOUTH ROAD - 1.90 SIDE SETBACK = 20' 2.10 REAR SETBACK = 25' E� l.80 *FRONT SETBACK MEASURED FROM R -O -W 3.19 AG . RE E OF THE NORTHWEST 1/4 '` N R AN L) 3'07'00" W 2553.59' ��� E 5Y 0 1 H K N *qfb 0 w 1 � 6-4 0 2 —' 9 kRY CUL -DE -SAC r I 4 S TO BE REMOVED J NORTHERLY ON OF ROADWAY All ,21 _ 13481 i H 4 J � r J 3 LBO = 932.00 r �r r� 9 S. F. r r r 3.13 Ac. �h r ^ 'BO = 93 ' 0') 6.02' - r 1 I � ~rr � � J � r r �r�r -� J r• r� r . ' 7 �- 3 s� 923.5 9 7 _ _s_ 143125 S.1 3.29 Ac. _ i Q � � rr HW - 931 O 143907 S. r � r r 1 i �. 30 Ac. �- 1 4 I� i 19 \ t Qo \136153 S 0 3.13 Ac. s RECEIVED OCT 2 5 2005 i 2 Wisconsin Department of Commerce SS9 A� I %Y &T, ON REPORT Page / of 3 Division of Safety and Buildings l in accordan with 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 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. viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner Property Location Govt. Lot r 1/4 S 30 T? N R E (or)O Property Owner's Mailing Address Lo Block # Subd. Name or CS M# p �. C' State Zip Code Phone Number ❑ City ❑ Village (Town Nearest Road 1 o n CrNew Construction Use:�O_PResidential/ Number of bedrooms 3 Code derived design flow rate _ J�� O O GPD ❑ Replacement Public or commercial - Describe: s Parent material / ' C �s h Flood Plain elevation if applicable / /'J� ft. General comments S / e . m ��`e U t d• Z 6 A �m �Z u a '` 3 vi, 5 b " F I and recommendations: - ,<- X -f- Boring # � Boring Ground surface elev. Q 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 3 — 2mf�b "- - e d fv B �- rLt 4 c- 2y»S k - - '-4 3 - Ctt° 7.5 r4 SL 3�-_�k -- _ O s Z Boring # Boring LZt Pit Ground surface elev. 20 ft. Depth to limiting factor 4 A in. Soil Aplolicallion 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 - Etf#2 &4L 5 i I w C5 . C-5 P 7-:7 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mgt. and TSS < 30 mg/L CST Marne (PIea�Prjrlt) er gnature CST Number C) lnm n9 Address �� Date Evaluation Conducted Telephone Number 7roo ��9 , Property Owner Jdh Parcel ID # C Page of a Boring # ❑ Boring pit Ground surface elev. f Qc 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 i b --t h\jrV�) 2 bk ( ,S — e-4 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 Q 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 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mgll. 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. seW330tR.er00l s PAGE -.— F r NAME ( h �lSyf� LOT# C J LEGAL DESCRIPTION Nr /aN1LJ /a,S '?- FyJ E(OR&) SCALE: I "= BM I ELEVATION BM I DESCRIPTION 40e BM VV �— BM 2 ELEVATION y6, y0 1 BM 2 DESCRIPTION o– l?- SYSTEM ELEVATION /,f10. ZG ?3,629 SYSTEM TYPE W� 6 ,5 �a ll' o Pc) i v , �� Q SIGNATU DATE — t ;bU1UMHKCK h'L 'WiNU t NU. : (150bW1G1 Sep. bJ Gees 110 -DD" r� ST. C:ROLX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G �e_n -.JDhVj'G l Q z ay\Ac 1C Mailing Address b )( Property Add ress; L ci� , r\� 33 rd ST - (Verificati uired frotn Plaraling & 'Zoning Department for new constriction.) City /State � ffi�_1 Parcel identification Number ` LEGAL DESCRIPTION Property Location ,// t/. , '/. , Sec. , T J� N R / � Crown of Subdivision & &_ G B , Lot # Certmeq Survey Map # _ _. , Voltirtte ..�� Page # � v� Deed # e l .?. , Volume ��� — r'� Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND_QANER CERTIEGATION Improper use and maintenance of your septic system could result in its premature failure to handltl wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a Hcensed pumper. What you put into the system can affect the function of the septic tank as a treahnent stage in the waste disposal system Owner maintenance responsibilities arc specified in §Conan. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance, The property owner agrons to submit to St. Croix C ounty Planning & Toning Department a =tification form, signed by the owner and by a master plumber, joumeyman plumber, restrictod plumber or a liccnaed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) After inspecticni and pumping (if neeossary), the septic tank is Ion than 113 fall 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 Roaources, State of Wisconsin. Certifioxttion stating that your septic system has been maintained must be completed and tetumed to the St. Croix C0110ty Platming & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the boat of my /our knowledge. Uwe am/srs the owners) of the property described above, by virtue of a warranty deed recorded in Register of Dceda Office. Number of bedrooms SIGNA OF AP LICANT(S) DATE "Any information that is misrepresentod may result in the sanitary permit being revoked by the Planning & Zoning Dep nt " 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. (RX v. 08/05 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Zi FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity g a l ❑ NA Permit # Septic Tank Manufacturer ' E3 NA DESIGN PARAMETERS Effluent Filter Manufacturer 6� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 44 ❑ NA Number of Public Facility Units A Pump Tank Capacity Q a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer Se ❑ NA Design flow (peak), {Estimated x 1.5) 4T to gallday Pump Manufacturer �aA ❑ NA Soil Application Rate gal /day /tt2 Pump Model � 0 ✓ �� ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOGI 530 mg /L 0 Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA 0 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispers ell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L - Ground dgravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L (�IA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100mt O Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: 0 NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 months! saris (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third IY o tan _volume ❑ NA monthds Inspect dispersal cell(sl At least once every: 3 9 ear(s) (Maximum 3 years} [03 NA Clean effluent filter ❑ NA er S A/ �� At least once every: ear(s) Inspect pump, pump controls & alarm At least once every: r-- ❑ month(s) [3 NA ❑ saris) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ yearls) Other: At least once every: mon th(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls 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 ormor f the tank volume, the entire ce contents of the tank shah emoved "by a Septage Servicing Operator and disposed of in accordance i h chapter NR 113, Wi sin-Administr�ive - Sods: -- All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized pomponents pretreatment its, and any servicing at i ntervals of 512 mon ths, shall be performed by a certified POWTS Maintainer. A service port - be�ro to the local regu atory authority within 10 days of completion -of arr4'service event. •epos enllens!u!wpV uIsuoos!M '1£) v (Z) '1 1.)48'£8 pue { ;i�8(P)(l1(gl(Z}ZZ'£8 wwo� ieidey�yit�^ OauQpdwoo unpgyeip'senn atue+tmoop s.41 e suoyd uo4d aweN v Amuomnv Avolvi nD3w mom IU3dWfld) VOlt/l13dO DNIOIIAU39 3DV.Ld3S au04d 911 aweN �,'j %, aweN U3NIV1NIVW. 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Is)Ileo lesiedslp in of o s one{ ieleM4B!4 Igwiou enoge III; Aew s�luei dwnd saBelno iennod Bu!inQ aq 1(!M JejeMaiseM ssoox9 941 peiois9i s! ieMod ue4M ! •aoe;ans antienl! ;u! 94110 uaz°i; eie suo!itpuoa Ilos uayM mono q Il AOwai (s)�lusi 941 1 •asn of solid ioleiedo Bulolnias e9eides a Ag Pa w! Aew 1241 eie suolieiivaouoo 4614 11 '(s)llao lesiads!p ayi eBewep io /pue ssaooid iu9wieeil ayi 0ped sivaluoo e4i ane4 peioelop ul used ;o eouessid ayi io; (sl�luei iuewlean A3640 SiMOd 041 ;o asn of loud V V 3d ni GNV nn9u sod sleolwe4 B i . NO11Vnl3d0 QNV dA laV1S 0 iO410 io slonpoid 2 10 :ic aged 0 CT -31 -05 MON 10 34 AM Land Title, Inc. FAX NO. 651 697 6181 P..02 U 2848P 236 KATHLEEN H. YALSH REGISTER OF DF,EDS TRUST EE'S DEED ST. CROIX CO. , MI DOCUMENT NO RECEIVED FOR RECORD Joyce R. Brown and The Lake Elmo Bank, as co- 07/21/2005 HiMAlt l rustecs of (110 'I'iie E. Gary Brown and Joyce R. Brown TRUSTEES DEED Testamentary Family Trust for a valuable consideration EXW # conveys without warranty to Glen Johnson (:onstruction, REC FEE.- 11. Inc., A Minnesota corporation, Grantee, the lullowing TRANS FEEt r 945.00 COPY I described real estate in St. Croix County, Stato of Wisconsin: I CC FEec an uctdivi qd Uj / Q i nterest in PAGSSt i t ' The N I3 1/4 of N W 1/4 o C S ec tion 30-30-19., except CSM file June 14,'2005 in Vol. 19,, Pg 4996 as Docment Number 797611 The SL 1/4 of NW 1/4 of Section 30- 30 -19, EXCEPT the RETU TO; lands described in a Wan•anty Deed in Vol. 502, page 636, Ut,NL7 'TITLE, W. G Doc. No. 3I8424, AND EXCEPT the lands described in SME 200 Zr Certified Survey Map in Vold I Of CSMs, page 272, Doc. No. 1000 SAYER UXE F+;10t.'l.D 334044, Vol. 3 OCCSMs, Page 632, Doc. No. 350084 and N Eri+ G'.° ` t � t�i4, MN t•5 Vol. 7 of CSMs, Page 2052, Doc, No. 443725, Tux IfD# ORTI 095= V0T'�•'�" i 030 - 1086 -40 and Part ofthe SW 1/4 of NW 1/4 of Section 30 -30 -19 described i 030 1087 Is follows; Beginning at the NW comer of Parcel 1 of Certified Survey Map flied in Vol. 1 of CSMs, page 272, Doe. No. 334044; thence North to the North line of skid SW 1/4 of NW 1/4; thence [3aslerly along siiid North line to the Last line of the SW 1/4 of NW 1/4; thence Southerly along said Last line to the North line of Parcel 1; thence Westerly alon the North line of Parcel 1 to the point of begilnning. t Togethor with a non - exclusive casement 66 feet wide for roadway and utilities, running from the South iille to the North line of said SW 1/4 of NW 1/4 of Section 30 "30 -19, which casement lies immediately West of and abutting Lots 1 and 2 of the Certified Survey Map in Vol, 3 of CSMs, page 632, Doc. Nu. 350054, and is centered on the West lines of Parcels 1 and 2 of tho Certified Survey Mach in Vol. 1 of CSMs, page 272, Doc. No, 334044, and the centerline of which casement is "[so gclierally recorded as being 821 feet Easterly of the West line of said SW 1/4 of NW 1/4, Dated this 30 day of_ June � 2005. (SEAL) _ _ J cb�It, Brown co-trustee LA L ) slee � , The Lak Elmo B�init co�tru stet. By: Robert Qvalc, Vice: President ACKNOWLLD(;AjENT ACKROWLEDGMENT STATE OF WfqCCMMN ) STATR OF WISCONSIN ) COUNTY O et -(fix ; SS COUNTY OF ST. CR61X )SS I Personally calrm bet'orc are this ?i - jay of . $)Ut'iC _ , 2005, Parsonully came before me this 3 day or, J the above,miriLd Joyce R. Brown, es co•druhteu, to me known le be the 2005, the above named The' ake tinw Bank, by Robcn Qvalo, Vice pumuu who executed the fon:goina instrument and aclurowirdged the PrcN*n4 at uo trum to me known to be the Pmon who excemw the foregoing instrument and acknowledged the so h QU LA - Notary Public, (1(0 My f'mm�tlssiu,r ex fires): ' , to �Y Publi t public, Stets of Wuconsia P - _ y �bnpniaslon l`xpl�ss Jan b1, • ' .ommisslon (explres):,___, j f� 1111S INSTRUMENT DRArrED BY; U. Puler Seguin MUDGE, PORTER, I,UNDEr -,N & Sls(iUIN, S.C. I If) Second Street, Post 011ico Box 469 :Not N ETT DD. THEIS Huclson, Wisconsin 54016 (Amy Public- Mlnttosota I f m"115" .tan 31.4oto .. f, LBO 932-00 610 9 S. F. Ap. sm • e O OVA . o � • '• �• •off,., :� W . N . . t r • IV .t • 1 V Amt :: . ��� � �� -��, ,:. � e \ •