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HomeMy WebLinkAbout030-1095-50-000 \) \ \\ \ 0 c a g \ ) � / \ � � f � k \ $ � a � ) 0] $ / ) 2 / ) J p 7 2 \ 4\ z E ]� 7 2 { z' e § § 2 { 2 2 ) R / / a ■ § 2 k G a s E _ - § k � » 2.0 § k co �2- Us $ -# »a y m w= // Q 00.2 K 7 U 2/ < \/' ■$ ) ° 0.0 ƒ ±S> .2 ) 3 I r 2& t L Q }k) .. E } CL ƒ / _ § R 2 / E k $ \ k k k ) E n } � -� �� 2 2 2 0 CL 10 \ 2 0 �§ � N e 2 v I % % $ ) j -0 \ d / § o 3 3 <§ g E f 3=c J ,� -6 k � / ] ■ 2 ° ■ ] \ W § } E ca LO 6® e G a 8 ° 7 £ ) _ C, N ��� 2 - @ j$» 2 8 c ƒ) - o ) # k \ o ) / } \ � \ � a « f 2 ) e k m & » E) ) k a IL § & / a j A & L `. � r Parcel #: 030 - 1095 -50 -000 02/25/2005 10:51 AM PAGE 1OF1 Alt. Parcel #: 32.30.19.345E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * JOEL R & SUSAN M JENSON JENSON, JOEL R & SUSAN M 407 CTY RD E HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 17.200 Plat: N/A -NOT AVAILABLE SEC 32 T30N R1 9W NW NW LOT 1 OF CSM Block/Condo Bldg: 2/318 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 32- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 08/10/2001 653541 1697/421 EZ 07/23/1997 1079/173 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5593 521,700 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 47,500 304,300 351,800 NO PRODUCTIVE FORST LANC G6 15.200 161,400 0 161,400 NO Totals for 2004: General Property 17.200 208,900 304,300 513,200 Woodland 0.000 0 0 Totals for 2003: General Property 17.200 122,900 226,200 349,100 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 It -_ .1 e v 336266 ST. CROIX COUNTY SURVUOR's RECORD CERTIFIED SURVEY PLAT August 1976 Arthur M. Holm, Land Surveyor Scale: 1" equals 2001 Wise.. Reg. No., S -945 Note: Bearirigs assumed. -• Indicates iron pipe found.. 't -o- Indicates iron pipe set. Indicates record distance. Sse. 3 2-30 ig o' I L 1 A N NJA) leee. .3.7!10. cc I e« ssss y tea. o - -- L ;! C3 y d i to LO+ I a 'I 0 1 _ I j 3 3626(9 735.0'7' �••� I .Ss Nu+ % ✓M✓'IK�_ .Sle! Cei.� i • � � o P IFD � d (see other side) s0 719 76 r �r co "wil 1u aw O f 090d, Volune 2 Page 318 I Wisconshf Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf6ty and Building Division Sanitary Permit No: 1 INSPECTION REPORT 395162 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: - 7 Jenson, Joel St. Joseph Township 030 - 1095 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: 3a . . l9, 3 `/S TANK INFORMATION ELEVATION DATA �7U TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM /46' 1T2 + ' } 60� Aeration Bldg. Sewer y � 3.; Holding St/Ht Inlet r Z . 4.S TANK SETBACK INFORMATION St/Ht Outlet �Z �r 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / N e / Dt Bottom Dosing _ Header /Man. Aeration Dist. Pipe '1 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover r 1 C0 GPM IZO.O Model Number TDH Lift ction ss System Head H Ft Forcemain Le Dia. Dist. to i SOIL ABSORPTION SYSTEM Iz BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM CHAMBER OR Manufylc er: INFORMATION Type Of System: r c UNIT � '' ff Mode Numb 6~ > I W 5 Z dD ZC'D - DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size ' 7 pacing Spacing Vent to Air Intake Pipe(s) � f CU Length Dia Length Dia Spacing SOIL COVER a x Pressure Systems Only xx Mound Or At -Grade Systems Only �w 3 J Depth Over ` '�+ Depth Over xx x Depth of T77�dded x ulched Bed/Trench Center ��%>✓t�"� Bed/Trench Edges Topsoil Yes [g] No Yes LJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�1_/ D -2 -4 0 2- Inspection #2: fn' Location: 407 Count Road E Hudson, WI 54016 NW 114 NW 114 32 T3 R1 W NA Lot 1 P rcel No: 32.20. 9.345E C 1.) Alt BM Description y �Posfs'(l ( S� ON 1 U 3 S. 2.) Bldg sewer length =N m u 3) 18v 1 f_ , t )+)�uds Plan revision Require a [] No t Use other side for additional i formation. + Date Insepctor's Si nature - ® lr ert. o. SBD -6710 (R.3/97) ��� - pd,�/ 6 4 - - 1 � �i,iA C�Mrt� � I ©C���� ��•� """"."`ti' ..._._."".�.�.. - - -- -• 5ait:ty a;� Bu;lkings 1li��t4i�in _.__ � Co�z;y 20: W. Wiahiagtot. Ave., P,C, BOX 7162 _,,,. 5���..._...___._....� � ���� j� � Madison, WI $3707 - ^ idln I62 i Sttr A+ts Da i' rrt�tlt of C amnler et �,... -- s t N q t Number — 9aWbwy PulMit App 3 9 s In WOW w t Cseem 0.21. VU. Ada. Code. `i�tesaceda�r Yoot,00.4.a � � Q Check it' ,Rvvisian 1 in $quo plan 1.iD. Number I. Appliatfst L� lMeMrt Frlot A!1 tip OQ .f� — r ` f.._ patctel Nftttttrer 3 a , ao .� T 4 Tz vSo•✓ - Propetsy L OQadOA O wner's Waft Addrw r lack Nwnber i Cltq. Bowe Code \ lvttme csw �+`� Ccd So ,✓ Lr1 <` SYG l ; 7 -3SG 7 — l � 17 Type otlle11td3ty t�sedt dl thst sytpty} as p�. 5�- � � dCttY ..._.�..,.�.._..__... D 1 otr 2 owlso - Nwabet of awwwas p t�tttbliclCotretwcw - D" aft use � , rrav!rtWti s'T��„� CJ State Owned � Natbet M. T: of isesi:tltz (Che ady ON Max do Ho A (ouatbeAq eabeats for Inc erttal ure). Complete lute 811 applic i iVew 2 D SYststa 9© Rsplacsmaat 41 b G A"ktiaa to . For County we W. Las 5 sce PIMIU D. s Cl Q>tntak It $aafary pnnati Prsviouslpr law ?vttsttber Dais Lssuod ,'type at i tbet ipy} F srbetitte is for ialerattt vac} D 44ANOU - Peaanitted to OMM 210 t�dctund Al 0 S�utd Furor So C1 Coattru ^.�d we i d1 W Asidin, Teak 44 G $416 Foss D S1 G Drip Line , l� �a �s� �s 43 G A 46 m nt unli 49 Roaircals 3t? Gtnsr v. a into t > Flow wo An4 Sail ApF aaa taoAtion system R>rte taievadon Pinal Grade RitiiWls, /DttysiSq.Pt.! (Ivtia.ltncb) � Alevatior 'VL Tab Ir b Teed Nttnabst ! Mattvfacnsrsc � rethb C S %� 8tcal pla suc "low of Tau ow do �„ tt attt« tie now rae for e! fist pCVR'Y� sltovett eft the xttwtbitt t Flwwne N Pktmbet''s sti Nttatbnr Bttshtoaa Phut Nuttibor i Phimbee Addftu 0 9" CRY, ibue, Corte) A D racy ee c3caundwaw ate ante fa Allot Stgtuttars (No Stamp) WsF . DbWpw tJart hseRe peo) Q owaer Hives WW A&UN 22 S. 2a� i i Trikaft �t ._,.__- _...w__.._.. for "'I'SAMM69 (R0.05101) L i . Wsk; '11 Department of Industry SOIL ,API$ ,I�TE „EVALUATION REPORT Page 1 of 3 Labor and Human Relations f , .\ ` Division of Safety & Buildings ° ro �cotd with fLH8.83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper no less;ihan 11 172 x 1 inches irf siz�, Plan must include, but S Croix PARCEL I.D. # not limited to vertical and horizontal r dtepce poirit ('BM), direction art %�of slope, scale or dimensioned, north arrow, and locati anti distance to nearest road. k 030- APPLICANT INFORMATION -PL PRINT ALL INFORMATION R IEWED BY DATE s 4A t7 D PROPERTY OWNER: %' *.. PROPERTY LOCATION Joel Jenson �~ GOVT. LOT NW 1/4 NW 1 /4,S 32 T 30 N,R 19 �(or) W PROPERTY OWNER'S MAII.ING ADDRESS 3 , i LOT # I BLOCK # SUBD. NAME OR CSM # 1 na csm vol. 2 page 318 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE :&OWN NEAREST ROAD ( St. Joseph Co. Rd. L J 67 New Construction Use kq Residential / Number of bedrooms 3 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate . 5 bed, gpd /ft .6 trench, gpd/ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft _ trench, gpd/ft Recommended infiltration surface elevation(s) c)c3 _ R7- q7.1 5 ft (as referred to site plan benchmark) Additional design / site considerations split level trench system recommended Parent material pi t.t.ar9 g1 aci al drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system Eta ❑ U JaS ❑ U XfaS [] U )1 S ❑ U El X)& U ❑ S Gds SOIL DESCRIPTION REPORT 0,, 11 4 1 ° _ Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence IBourtdary Roots Bed Trends '< 1 9 mr1r mvfr cs 2f .5 .6 S 2 12 -82 7.5yr4/4 none sl 2msbk mfr na if .5 .6 •S Ground elev. 102 ft. Depth to limiting factor +82 11 Remarks: Boring # 1 0 -11 lA r4 3 none 'S 2 11 -82 7.5yr4/4 none sl 2msbk mfr na if .5 :`.6 Ground elev. 10 3- M ft. Depth to limiting factor + Remarks: CST Name: — Please Print Phone: Gary L. Steel 715- 246 -6200 Address: 15 200th. Ave., Thew Richmond, WI. 54017 Signature: Date: CST Number: 4 -21 -94 cstm 2298 \_4 -0 l PROPERTY OWNER Joel Jenson SOIL DESCRIPTION REPORT Page of s PARCEL I.D. 030- 1095 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure consistence Boundary GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. I Bed ITrerch nnnp i S > ...3... >' . s -- 2 11 -82 7.5yr4/4 none sl L2msbk mfr na if .5 j.6 Ground elev. I 1QQ�15 Depth to limiting factor f +8 �---- 3� / �Z Remarks: Boring # - �S 4 :" 2 7 -18 10yr4 /4 none sit 2msbk mfr gw if .5 .6 r 3 18 -80 7.5yr4/4 none sl 2msbk mfr na na .5 .6 •S� Ground elev. 98 :35 ft. Depth to limiting factor +801 36 ( Z- Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 1 .6 •� 5 2 12 -24 10yr4 /4 none sil 2msbk mfr gw if .5 .6 ..........,...... 3 24 -80 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 98 ft. Depth to limiting factor +8n11 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Joel Jenson 1554 200th Ave. CSTM2298 Nw4Nw4 S32- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 / 111 =4V' BM= top of 1 steel pipe at el. 100' /alt bm= staple in cormer pole at el. 107.15 Soot r r 1 © 3 Y-() Gary L. Steel 4 -21 -94 J 7e z s o,r/ Aor IS 17, a2 Acres ®as r-- 5e-d t e- / S aNi f Kol�J'l S G6Y.✓eY lie a g Q �a rr "� a� es" �- a ow o k d • N : Aj r--- '0 ! 7 02 ,4 e re s S c. a ,C i5 0*4 FY m s' 0Y.✓e y C ; Q�rle cleC a � s I I y • I I 1 4 4 g = IV CL Now q.�. IL m L ' o t C OD r► coo i C.j La k t— Invert Y Private Onsits Wastewater Treatment System Management Plant Septic Tank And Gravity In- Ground Soli Absorption Component Pursuant to Comm 33.54 Wis. Adm. Code each Private Gnslte Wastewater Treetment System (POWTS) shall Include information and procedures for maintaining the sys*rn within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83,54, Wis, Adm. Cod*, and the in- Ground Soll Absorption Component Manuel for Private Qnslte Wastewater Treatment Systems SOD- 10567 -P (R.6/99). Table 1: ! stem Deal n locations l aMary VermE umber C 1 2- Number of Bedrooms Des! n f low - Peak d Es ma ow - Average "Pti Tank cl al Soil Nnmsw nt size of Wastowde lo tic Table 2: Bolt Abso tan Cam nent - limit: of Roll able 0 ration tic Tank COMP onant it Abi o on o mnt k n Flaw - Peak d ` Maxlmurn I i in 1/ Maccimum 13011, ( mg/L) 220 MIDMIUM ISO LLJ Table 3: Maintenance Schedule e ank n a or service ante eve 3 Mrs Outl FlIte Ins e! once a year and clean at least once qveFj 3 yes rs Boll flan Com orient Ins once eve ears Saabs T&M The septa tank shall be rr*ntalned by an Indivi dual cardfled to serv'4e septic tanks under s. 281.48, State. The contents of the septic tank shell be disposed of In accordance with SIR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease interceptors, Seepage Bads, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condl*m of the septic 1VkK aild outlet filter *hall be assessed at least ones evrry 3 years by tnspecton. Th at fit r $half b c[ias d as neoesesry to onsu prp�p8r�tpera#Ion. The filter cartridge be removed unless provisions errs made to Stain solids i n the tank that may s oft the !liter when re moved from rte enci0sur+s. If the J Management Flan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1f3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation In the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. , Exposed access openings greater than 84nches In diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding funk for any reason without being in full compliance with OSHA standards for @~ng a confined space. The ' atmosphere within the septic or other treatment of holding tank may contain lethal gaseay and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component, II Ab §tion Component The soil absorption component serving this structure Is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. n i absorption onent de ends greatly The longevity of a soil comp p g Y on proper and timely maintenance, and system use within or below the limits of reliable operation, Good water conservation practices by all occupants and the Installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by Inspection at least once every three years. The Inspection shall include recording the levels of ponding, if any, In the observation pipes, and a visual Inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be Identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human hesith hazard, Traffic around or over the soil absorption component should be avoided particularly during winter months, The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or Impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen Into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 r Management Plan for a Septic Tank and Soli Absorption Component Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be Installed in an alternate area. With the Installation of a diverter valve, the existing system could also be reused after a period of three to four years. it is the property owners responsibility to maintain the alternate area free from any Planting of trees, shrubs, etc. In case of failure of the original system, the alternate arts will be needed. If any trees, shrubs, etc, have been planted on the alternate area, they will have to be removed at property owners expense. if alternate area is destroyed, there are other alternative systems that can be used, in which, could result in added expense to the property owner, Any tank abandon nqM shall be done in accordance with Wise. Code 83.33. Any questions regarding this code, please contact your local Zoning Office or contact the installing plumber. ..o ns ►;m % 'DA's t S) 3 $ to — y b 8 O @8/31/2000 07:59 17156844630 ALWIN EXC INC PAGE 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �` -� Mailing Address X 91 t i L4 (A --.gq L !� property Address + C � � r ► � �-ll L'`�'� (Verifteatioa required from oning Departroerat for now construction) city/State Parcel Identification Number - 0 A11 - 1 Q 1 LEGAL DESCRLpTION Property 1.4cattion ' /., ' /., Sec. TAN.R_LLW, Town of 5Z 3p,` Subdivision -- . Lot 0 . Cerd[ted Survey Map 0 X02 GQ . Volume 'L . Page N Warranty Deed M S /��/`�.� - -.. . Volume e - Z Page N Spec house ❑ yet: ® no Lot lines identifiable ® yes ❑ no SYSTEM N=NANCZ impsopa we said mak teammof yaw septic rysrem could result in its pauotat failum to handle wastes. Proper maintenance consists of pumping out the septic tattle every three yearn or sooner, if traded by g litxosod punWr. What you put into the sylroem can ~ slue tboction of ft septic root a. a tratmew page is the waste disposal system. The property owner agv m ra nrbmit io St. Crout Zoning Deportment a cerd ation form, aped by the owner and by a mssterplumber, jourmymn plumber restrictodplumba or a licensed pumper verifying that (1) the on -site wastewalerdispowd system is in proper operating condition and/or (2) after inWection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge. Uwe, the undersigned have read the above mqulrensents sad agree to maintain the private sewage disposal system with the standards set foak laarein. as set by due Department of Comma= and the Department of Natural Resources, State of Wisconsin. Certification stating that your wpbc system has been maintained toast be eomplated and returned to the St. Croix County Zoning OfTtce within 30 daysA / ftec y'a xpirstian date. t 01 St a NA CANT DATE QWN R 011 TVICAUW I (we) certify that all statements an &a form are terse to the best of my (air) knowledge. I (we) am (are) the owns(:) of the , by virtue of a warranty deed recorded is Register of Deeds Offace. - 7 G ATURE OF A&UCANT DATE '••••• Any information that is mis -rep ated av'y result in the sanitary permit being revoked by the Zoning Department. •••••• •• Include with this application: a stampod warranty dad from the Register of Deed& office a copy of the cartitied survey map if reference it made in the warranty deed I � f I• t; WARRANTY bEED �I T 5111 RF9LRVFD IOR R[COR0ING DATA L- � DOCUMNT NO. " i t STATE BAR OF WISCONSIN ?ORM 2— 1882 .� M893 ;I _ - e William C. MacDonald and Rita K. MacDonald, husband and wife, _ MAY 2 3 1994 . .. ..... . .... -- . .. 8:30 conveys and warrants to .. ... Joel- R JEnsQ1 and Susan M. . Jens on, ^� ...v 4, husband arid. wife ...... .. ..... q .......... -- — — .. . ......... .... .... FET!:FN f0 �c the following described real estate in ------ _----- .St...- Croix.. ........• Count y, State of Wisconsin: --- ------------ -- Tai Parcel No: ..-- .. - - -•-° Part of NW 1/4 of NW 1/4 of Section 27? 976q in page Certified Survey MaP filed Doc. No. 336260. A a .4 f r�l 5 This iS TlQt - - - -- homestead property. Exception to warranties: Easements restrictions and rights -of -way of record, it any. i Dried this /� T� -- -- ----- ••- - - - -- day of ........._ .. -� ' - --- .(SEAL) .. - (SEAL) William C. MacDonald ! j 1 k 336260 CERTIFIED SURVEY PLAT August 1 976 "e e Arthur M. Holm, hand!Surveyor Scale. 1 quals 200,E Wisc...Reg. N o.. S -845 Note: Bearings, assumed. -•- 'Indicates iron pipe found.. ti - Indicates iron pipe set. "Rec." Indicates record distance. sic. 3x • atd q \ r 7e ¢.! /\ — cc N. Lcvt Mrs' �x iEEC. .3.7lJa. � v p I I * : • �� • :e .sr - � '�d� � � ,•. ..: — moo. c. a /T. Z o4e.3` e i A � iss r 336260 to � NsJ %wc Nc✓Vic OI tF0 ( see other side) b 71 876 Oak Volume' 2 Page 318 �'' FROM Sq.humaker Plumbinq FAX NO. : 7153863121 Jan. 02 2002 08:07AM P1 —.. V1rySconsln t7epartltrri Of coma SOIL EVALUATION REPORT rAIMAion -f W* alkl 8uildkW in algwr*nc*,o Comm 65, viris, Adm. Co* G aunty ' AnscC► t� plan on popw not teas titan B 1/2 a � � inches in ei�rn znd Parmd I.D. -1Gr � � Indude but fo thited m: � no" srd ltonzon#el a 1 01 6 ,0 'm d li P� 5�1, G perms slops, stela or dimensions, noRh afrv�, and temuan and dtstahca no m aror4t relad' � by bs� PN1asa Pont am fAlls/tatien. l palsellAl Isfo„gallon You prvjW May he used fm bedo m pw posa� (piece► LOW s V.1 f f 1 cm)). t propmv! LorpUo^ properly Omwr a � � Q ✓� mows to eU ki 1 la.V E 114 S3a T �V N R E (°r �' e �, Nan+B or cst►g1 lot rt Blor�c # r p+ prrrprety Qwnar's �� ' ono Numtiar Cily ❑ VHlapo l� Tpan NeanNot Rose 1 Cads derived design flow rate N@ w COMInWllotl Use' Re31�rs k181 r NU-bor or b�roW7� i Ra�aocrnora [� Public or c xmendsl - Qesoritte: Flacd Hain elswalon if pppllm e ParAnt In *� _ r•,ernsrel mr,rn,ant. S �/ c r•. � � •C � 9 y � D 611c1 roenmil+anaBUOlir: L7 1 Boring # � pl t� �ogaa atulecs Blow. �i G d _� It. bwei to *m" faclor { r - � m y Reds n Texwm Structure Cohsier mss Beun*n I Roots Korb= Depth bornkl�d Color Ftdox Dsscrlptlo t r. Sz Sh. � •SIM11 *01112 in. 1Nunsall QIJ. F0 Cant. War --�'� S f l u4 0 -10 Alp .�r'1 �.,sb� mfr• � 5 ,.� . sr ' L t S° d P[ Pit Ground mftce siev. 9 s / ° ft. Dead+ to PM&C Wcbx — in f1 lk mn Raw t -- ` - `' Tamura Struaure� CansFetencs 9wrcisi y Roots ap Neitxcn Dapm DorYrttarRC� RBdoxC**Qvwn. •EM 'Etfa►2 in. Munseti QV. at. Cant, color y r. ax Sh. . Emuftm 92 : goo 30 mqA- and 1 530 myl. i = > 3C c T20 rrtglL and T9S >3u <_ i50 nlglt. a i Number CST N;rm (Plum Dmt) t Mature �! __ _• E,�Iuabon COm lir .IL'E � �atephona Nurnbar Td Wdd£t0S c-ea? io •ter •oN xdd � FROM Spkumaker Plumbinq FAX NO. 7153863121 Jan. 02 2002 08:07AM P2 pow Z of - Parcel ID rr j I BaN'g # SO&O d swfaw M• u. Depth to G &WO tae.1- in. Raw L � - � ❑ pit } Bp,aey llefe' GP isbaaip4on 7euM.tre Slrtplttw C.orrWre Homan DQplh Damin4m E;b Rwax tar. Sz. 6h. tn. i 4"' sic t.ottt r �� !� 5� Z•r1..�GE i Eo pit GfOwnd ayrfaW elev� , � n- Depth n tlmitir�p factor 1bKiurt Sh4eWr. Conodemw geyndaly Rook P F' Had con DepM Dominant Color liedta< Oasadp6on Gtr. Sz, sh. 1 '6NN►2 in, Munaell Qu, .`* Gone Color � Ih to Nm9 � ---� -- ln. Baring * ❑ cat C3reund �urtaesaev. _ .— R. � soil m� R s� Ih Dorr�+s*tlCote Ftedwc Tettutfa $out�lr"e Cenefielln� Boueaaty hoots i-ml m Dvp or. Sx. Sh. 'E�r111 'EAIMa in. Wlttnlelt Ua. SL COr+'t• Color ERE " gDlupnt z#1 a SM. P 30 220 tr WL srKl rsS asd! ISO mgll • ffnwnt!¢ s S0Q A 30 WQ& snd'Mq ? no MOIL The Daparlmwtt ofC4"Imams ie an aqual opportu^ity q&tvice pruvidur and employer. IFyou nead assfstance to accam serviocb ur neat! material in an alternate rwmd, PICM contact the depadmunt at 6Q8- 266.3151 or TTY 608- 264 - 8777- 6gy}.r�}e (N ns�no} �d WdSr�.Ot �[IA� TO •utsl ON }6'J 4 WOW I _ FROM Skkumaker Plumbinq FAX NO. 7153863121 Jan. 02 2002 08:08AM P3 PAGE_; OF ✓t S O ✓\ 3 O SAME jy M I r. EVATION / N BM 1 DIs.St:IZIPT'It a e su ti �•v+s� S �_ 0�14 BM 'L ELEVATION l�[1'• � d i BM 2 DISCRIPTION ciev•snlrwt.s.+ot�a1' �L SYSIEM II.EVATION ALj F.LEVA'PION Qr!5f R`t +ws4 i ry6wf f, COW OUR FI • j A wes I I ! 1� ! � K i J D i • �a 1� u r *ON X5J woau I N � Wisconsin 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 mutt 7 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. 0 ° d Please print all information Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 0/0 O Z. Property Owner Property Location a e I S 6 ✓� Govt. Lot ti (.,) 1/4 41 F 1/4 S 3a T 3n N R E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# e I I t/01- P 3/? City State Zip Code Phone Number ❑ City ❑ Village [ Town Nearest Road AW I�j New Construction Use: 9 Residential / Number of bedrooms 3 _y d� A ivied design flow ire GPD ❑ Replacement ❑ Public or commercial - Describe: A. ' Parent material T I ( lain pplicable _,�fi!!� ft• General comments S � kr, e U 7Y and recommendations: y ST "C4 1 'x.5 F I Boring # F1 Boring ® pit Ground surface elev. 9G- � � ft. Depth to ' r 'Einng fpctoa ' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 /9 3 17- 5,'l 2m56k mf- e S - , s fl 44. fo 3� ro 6 F-1 Boring # n Boring z ® pit Ground surface elev. 9y A ft. Depth to limiting factor 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 y r 3/ Z - �. � Zr,?ab (� 'n'c- ' -5 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) i ature CST Number Zs Address Date Evaluation Conducted Telephone Number /L -3 / -G/ 7 /.s-- 0 y - Property Owner Parcel ID # Page Z of 3 a Boring # E) Boring [] Pit Ground surface elev. 9f•10 ft. Depth to limiting factor 59 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 -16 /� �3/� S, l Zeta N -(. ' c s 1 ( ,4 .-5-- , do , S - ZG-6 SL Zmsb� m4r - •� S F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. VIM 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. pit 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 •Ef1#2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = B013 :5 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. SBO -8330 (R.07/W) PAGE 3 OF 3 NAME J � � --5 ° LOT# LEGAL DESCRIPTION 16W X UEZ ,S 39 T - ,N,R, I q E(or)Q SCALE: I"= �/o BM 1 ELEVATION /GY5 BM 1 DESCRIPTIO elea o h; _ - BM 2 ELEVATION fy Z AL BM 2 DESCRIPTION cl ey• onIow -.rS,�4 e-C 3G , cam+ t A M s eG. 3 O SYSTEM ELEVATION fy-/U ALTERNATE ELEVATION 5 - Gr + 15 -1 -� CONTOUR ELEVATIOW - ol9G. So &.g0 I B bd 2 � c �5 a 1"�► -3 ,� ate' a O SIGNATURE DATE Q ,:—�