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HomeMy WebLinkAbout030-2002-95-000w =,gun Deparmrem af Domnsre PRIVATE SEWAGE SYSTEM uo m'y St. Croix Setety and Building Division INSPEC T iON REPORT Sanitary Pannk No GENERAL INFORMATION (ATTAC-1 TO PERMIT) Sate Plan ID No: ` . Paravoal miumurbon you Provide may be used for secondary pumosas Fdva_y law . =_.15.00 (1Nm)1 N Parma N. Ip icy O'� Village Townsi ip Pr®7aNoDay TOWN OF Sf. L, Dwp ZW2-`K-m) CST BM D Ilm. BIN IBM Desg[iphart SedeoMownfRan9e/Map TANK INFORMATION V,, i r = Z ELEVATION DATA TYPE MANUFAC RER CAPACITY Sepac F9ov Dosing Aeration Hold TANK SETBACK INFORMATION J�OI ,I CD k 575 TANK TO P/L tj 1NF_._L BLDG. fV8nt to Au intake ROAD Septic J Z� Dosing Ae� H ding I \ PUMPISIPHON INFORMATION SOIL ABSC BEDlTMNCH DIMENSIONS S_RBkCK 1UPW MAT1DN SYSTEM I Iq8' I M cA Inlet size Tt 5.z"1! 563r 18! G r.J �T �' 1 Var'•� i r i Ib C 11 16X+ m0,1 lnala ,� �9/1 t -SOIL COVER X Pressure Systems Only xx Mound Or M-Grade Systems Only Depki Over ` Deprn Der ,„ of n Saaoad/Soddetl Muldmd Bednc rrreh Carrier. 7eed/rrendr Edgm To ❑ Yes ❑ No I ❑ Yes COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1: 1 L / Inspection 42: Location: t 1.) All SM Description_ 2.) Bldg sewer length -.amount of coves = _9 38 /N 01A Q' I Plan revision Required? ❑ Yes No Use offer side for addmona) lntonna, rL �LV Oat ipsa .: i9nao+re Cert No. S!313 10 (R.3197) SflN-aoao — oay L7D- �_� Industry Services Division County r 1400 E Washington Ave ` (/� 9 2020 P.O. Sox 7162 16adiso 53 07-7162 Sanitary Permit Number (to be filled in by Co.) 2 e d f it Ap�lica " State Transaction Number r.Un In accordance Mid` A ts. Adm. Code, submission of this form to the appropn u tat unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS or itted toe the Department of Safety and Professional Services. Personal information you provide may be usedYor condary purposes in accordance with the Privacy law, s. 15.04 1 m , Stats. e-s L L Application Information - Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address Property Location ��r` •/j O •1 l , !)1 �t t'\ +J a 7117.1.1 ' Govt. Lot � V.#tlL / Section - S' City, S [e Zip Code Phone Number S„ circle one T 2 N; R � E ott� It. Type of Buil mg (checkall that apply) Lot # Subdivision Name I or 2 Family Dwelling —Number of Bed�NC*44"S) n 12iBlock #Public/Commercial—Describe Use ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number Town of S - IIL Ty f Permit: (Check only one boa on line A. Complete line B if applicable) A. System y ❑Replacement System ❑ Trea[ment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type ofPOWTS S stem/Com onent/Device: Check all that apply) on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank ❑ Mar Dispersal Component (explain) ❑ Pretr era Device (explain) V. DispersidiVIrreatment Area Information: Design Flow (gpd) Design Soil Application Rate( dsf) DispersalArea Required (sf)� Dispersal Area Propo1" (sf) ystem Elevation 6-7 VI. Tank Info Capacity in Gallons Total I Gallons # of Units aA (((��� Manufachuer 1 _ ~ l �/ � o yy New Tanks ExistingTanka '� m u is 0 �U co Sepuc or Holding Tank jW10 _.._)i Dosing Chambtt VII. Resp nsibility Statement- I, the undersigned, assume re onsibility for installatio of the POWTS shown on the attached plans. Plum ame( ion Plumber Si tore MP/MPRS Number Business Phone Number 71 S' - /7 Plumber's A dress (Street, Ciry, State, Zip Cod Coun /De artment Use Onl rVIII. t�4pprcved ❑ Disapproved Permit Fee ,DD Issued su' Agent Sigta[ ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 3\ d �L /L- - . _ !� sy�,0 /Y SYSTEM OWNER:Ipp 1. Septic tank, effluent filter and 3�sf12o20� y:t.t �b��r�✓'` �.- A,-% O� dispersal cell must j serviced / maintained 5 r_ SVfW� f• er •ate ba. rti i Stv�- oohs as per management plan provided by ism plumber. �Z 2. All setback requirements must be ma ntarned as per applicable ftsWordlp18l96edj}ns for the system and submit to t e u ly pa r not less thaA ItLz 11 inthes '�Gis���� 4s wr- S G3 (-R6/4� v L_ T "'_- 111.%L "OOXX ,is�Wsa sE4� 1L+CY(Y �Q LEGEND FOUND 1-3/4� OUTSIDE O DIAMETER lRUN PIPE M FOUND 518" DIAMETER REF FOUND V OUTSIDE DIAMET IRON PIPE SET V OUTSIDE DIAMETER E 0 LONG IRON PIPE. WEIGHING LBS- PER LINEAR FOOT T.O.H. TOP OF NAIL ELEVATION T.O.P. TOP OF IRON PIPE ELEVA-nor 3� M&51.40 gSEF1 ' se FROM HIM R/w 2W SIDE 25! REAR 03h 1, Douglas " Zahler, Wisconsin professional Land surveyor, he certify that this Stake -out Plan Orepared by me or under my d supervision and is correct to tl best of my knowledge and bell w� � JILDERS CONVENTIONAL COMPONENT DESIGN ResdenW Appitabon INDEX Aim TITLE PAGE Project Name: Towiuhip: . r i r : i 1�� . 1 ., /- !1)D// I_ic.ta�anheri6?�4 Phore mm it" %/T•. m-iJ/ i Sign-*ae Qesgjmd pssW=db le b4GW=dSloi/Ihsolp6i Carymof Yau®i far POW m Vesim 20 SERI-t W[FrP of-alml. Paw 1 578'12--3j E, 468. -- �*o =ti Www r •0" LEGEND OUTSIDE �V��� O IR4' M FOUND SIB' DIAMETER REF FOUND V OUTSIDE DIAMET 0 IRON PIPE SET V- OUTSIDE DIANIETERI PPE, wEiGHiNG LONG IRON LOS. PER LINEAR FOOT T.O.H. TOP OF P" ELEVATION T.O.P. TOP OF IRON PIPE ELEVATIOP So' FROM HWr RM ZD' SIDE 25' REAR s�-AdS ,les -n°N� I 1" 03/I 1, Douglas J. Zahler, WiscOns" professional Land Surveyor, hE certify that this Stake -out Plan prepared by me or under my d supervision and is correct to tli best of my knoWledg e and p®R DR wt- os�eolo IUILDERS y � ft Soil Absorption System Cross Section ft 4' Sdiedule 40,�� Fir�ai Grade PVC Vend Pipe With Vent Cap Leaching w Chamber � � ft 9� �o, `�$ �— System Bevalton Soil Absorption System Plan View Vent Or Observation Pipe -- a.J A�A)x - 90 ft 4' Dia. Header Leachina Chamber Specifications Manufacturer And Model EISA Rating.-,, sq ft per chamber Soil Application Rate - < gpd/oq ft 30C gpd Design Flow a Soil Application Rate a C. EISA = Chambers k rows ofchambers each. Page 3 of r PL-525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD (gallons per day) making it one of the largest commercial filters in its class. It has 525 linear feet of 7j160 filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed with every fitter. When the fitter is removed far cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Ato other fitter on the market can make that claim! PL-525 Maintenance: The PL-525 Effluent Fitter should operate efficiently for several years under normal conditions before requiring cleaning. it is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. Z. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when fitter is removed. 4. Pull PL-525 out of the housing. 5. Hose off fitter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the fitter cartridge back into the housing making sure the filter is property aligned and oompletely inserted. 7. Replace septic tank cover. to Alarm accessibnity y t= C— .-._`-_. Accepts PVC S extension hamile , I 525 rmearfeet Of 1116, , a filtration slats Rated for over 3 10,000 GPD i t sAccepts 4" & 6' SCND. 40 Pipe'\` - . Ali etc Gas deflector f 6 I Automatic shut-off ball when finer is removed U S. PdeK Noe 6lf15,436 ? S.aT1,690 °L 525 Installation Ideal for residential and com- mercial waste flows up to 10,000 Gallons Per Day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4' or So outlet pipe. If the fitter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center fitter. 4. Insert the PL-525 filter into its housing. S. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page '.15, of FILE INFORMATION SYSTEM SPECIFICATIONS Tank Manufacturer: y�SLw ❑ NA roer,, it / R ❑ Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETEIRSS Tank Manufacturer. � NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of public Facility Units: a NA Vertical Distance Tank Bottom(s) to Service Pad: (it) Estimated (average) Flow: (gavday) Horizontal Distance Tank(s) to Service Pad: (tg Design (peak) Flow = (estimated x 1.5): (gaVda y) Specific servicing mechanics must be provided if vertical Is >15 feet or ontal Is >150 feet Specific Instructlo to be provided on back. In Situ Soil Application Rate: `Z (galfdayff)nt Filter Manufacturer c Standard (Domestic) Influent(Effluent Monthly average t Filter Model: 1 _ ❑ NA Fats, Oil & Grease (FOG) Biochemical Oxygen Demand (BOD,) s30'mg/L s220 mg/L ❑ NA Manufacturer. �, NA Total Suspended Solids SS) s150 mglL. Model: High Strength Influent(Effluent Monthly average tment Unit (FOG) >30 mg(L >220 mglL Id NA Lend acturer(BOD,) SS) >150mglL Mechanical Aeretlon ❑Peat Fliter .t�NA Pretreated Effluent Month avers e IY 9 Disinfection ❑ Wand Sand/Gravel Filter ❑Other.(BOD,) stg mg/L NA 911- ❑ SystemFecal Cordorm geometric mean] s104m ps'orption In -Ground (gravity) ❑ InGround (pressure' ❑ NA Maximum Effluent Particle Size Ys in dla. ❑ NAre Adp_Lm't-Grade ❑Mound Drip -Line ❑ Other.Other. ❑NA ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) M When combined sludge and scum equals one-third (Y6) of tank volume When the high water alarm is activated Inspect condition of tank(s) _ At least once every: ❑ moMh(s). (Maximum 3 earsI year(s) years) Inspect dispersal cell(s) At least once every: ❑ mo rth(s) (Maximum 3 years) �Year(s1 Clean effluent fifter At least once every: month(s) year(s) Inspect pump, pump controls & alarm At (east once every ❑ month(s) ❑ year(s) NA NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) JXNA Other. At least once every: 0 mrnrsis) ❑ NA MAINTENANCE INSTRUCTIONS 111spections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POW fS Inspector, POW'fS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to checlk.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.falling condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (ke) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 POW fS Maintainer. A service report shall be provided to the local regulatoryauthority within 30 days of completion of any service event. GMW-005 (02/05) Page � of_ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tanks) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 ellmination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antlblotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation draln (sump pump) discharge, fruit and vegetable peelings, gasoline; greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Coda: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If'the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and baring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorpflon systems may be reconstructed in place following removal of the btomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WA IN G TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POW . ,r POWiS MAINTAINER Name Phone I SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name j Phone Phone _ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 8322(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address I I (Verificationon req� m-planning Zoning Department f r new construction.) city/State —aL- © Parcel Identification Number LEGAL DESCRIPTION Property Location ,i�6_ '/< , I 114 , Sec. i1 �, T . " N R_Z� W, Town of Subdivision Certified Survey Map #q , Volume Page # Warranty Deed # _T� g (before 2007)Volurme Page # Spec house 0 yes,K no Lot lines identifiable 0 yes 0 no SYSTEM MAEV17NANCE AND OWNER CERTIFICATION Lot # Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper_ What you pm into the system can affect the fimction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 38352(1) and in Chapter 12 - SL 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 net:ccsary), the septic tank is less than 1/3 full 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 and the Department of Natural Resources, State of W sconsin. 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 date. Uwe 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 desrnbed above, by virtue of a warranty deed recorded in Register of Deeds Office. Number 9f bedrooms —� SIGNATM OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning& Toning Department :s. 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 V-1 p UIONGQMNM1 L w :e::�. �r.rm x19-NO N Ck E b d, R Y !!� - --------------- - -------------------------- ---------------------------- 1 I I c I u I I I I ____________________________________________ _ d I ______J I 1 1 1 1 1 I I l I i* I c l i psn lost.j M nX n6 i 1 wµ I I kM/tD ipp � I I 4WI➢ 9XX I I UHNI(JNnt[0 I I I mwn HN9 I n I � ' I SWTD NIX [Wf0 pbll 1 I c me�Wu I I I I I I 1 L ..rx l ____________o`.m.."` _______________ ______ ____________J I 1 I I ___ ___________ ___ _____________ ___ ___________ L__ i i t 1 1 l 1 I I 1 I I I I I I i I ' imrzw ron.,c umeo- mn nu 1 1 ' I i I 1 I I � I ' 1 I .mr ww I I w .y D—_ _________ _______ ' fOUNDAT10N PLAN I/4' - I'-0" u 9'0' POURED CONC. fOUNDhTION 4 ___________r -------------------- ----- c "26 Mem n: n.0 xm tL e .m w. ... qq Ld4 - 0 ul �" �w d� 1 w°xsi "Qn. a � esg saw so-n AW�MIxI _�b � I 1 I 1 1 I RWN O}ln .�� _ i i i i i i rtxi n°n Mr- 0 :.r. 1 I I 1 i T tiRAf f 13 5 N au LEVEL iau Vg' - r- rx u d u 9'-1 1/6' CEILING ®MAIN LEVEL IN-R RJIEAT W/ 2 RIGID BELOW 5LA8 yy Y S b i :gqN, - za w S«6 99\ cJr&_Am 9RG ® - \/ 2.o�rt_m,_6 gge\ �.� Rs. nmvnaa.m � pop P "6 R b E O p3 1 J 3 n n �15a6 OE K 3 ® aNv.hm�wu+.�aa xiss�aryR �e CRO555ECTION 3/5'= 1'-7 Y III O m o 4 PRONT MVATION =w. .....�....... ..�..... v'"mo. ".ems SL=N BRACED WALL INFORMATION BRACING REOUIR[D BRACING PROVIDED A 9.5' 15'-G' B I7-0- 2a-O' C TJ' 8'-0" 1 11.-2. 12'-0' 3 5'-10' 12'S' 4 5'-10' 12'-0- #19-240 m FD. ALUM. MON _—X X X---X MY COR. FENCE SEC. 33 xI1• NORTH LINE SEI/4-NWI/4 J .I N 89'51'38'E 2602.69' 1335.69' Z w z J r w 141 CO* I.P. SEC. 33 q A q LOT 1 69.801 SF I.50 AC. NOT INCLUDING ROAD R-O-W O �n 00 •E 173,94' SEE ROAD R-O-W SrAte 0 80.O (2)UTAiE 175.50. 174.67' S87•DOE R.A. �S7S-zq :OO•E ~CIL, Co HW E N •-.•. f SJUST. 2 007 rEJUO CRDIRCOUNTY �®rg SEEI//4-Ix81� S1/4 095. a SCALE I- - 50' 0 50 100 BEARINGS EREFERENCED TO THE (SSDOSEC. 33 0 FOUND 3/4- IRON PIPE ® FOUND I' IRON PIPE SET 3/4IRON PIN FOUND II/4- CAPPED 0 IRON PIPE BY DOT SEE NOTE DOT PROJECT N0. 8939-9-72 R.A. RECORDED AS PAGE I OF 2 SURVEY FOR: JEFF MENDENHALL 341 SO. 6th ST BAYPORT. MINN. 55003 DESCRIPTION: PART OF THE SEI/4 OF THE NWI/4. SECTION 33. T30N. RIOW. TOWN OF ST. JOSEPH ST. CR01K COUNTY. WISCONSIN. AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: THE OF THENCE SIO'I7'58'W 389.79 FEET TO AN IRON PIPE ON THE NORTH RIGHT-OF-WAY LINE OF COUNTY HIGHWAY E: THENCE 378'29'00'E ON SAID RIGHT-OF-WAY 173.94 FEET TO AN IRON PIPE: THENCE NO9'39'33'E 424.68 FEET TO THE POINT OF BEGINNING. SAID PARCEL CONTAINS 1.60 ACRES MORE OR LESS. AND 15 SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. if T , MAY 0 EL 2J. OTT.2000 RLS 1300 DAL 1 HEREBY CERTIFY THAT THIS SURVEY IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. PAGE 2 OF 2 •• Gov 1UN 2 7 20M - CI mu Parcel #: 030-2002-95-000 Valid as of 01/16/2020 01:53 PM Alt. Parcel #: 33.30.19.363D TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): ROBERT C DIX DIX, MARIA VERONICA ZARDAIN MARIA VERONICA ZARDAIN DIX 10852 KINGSFIELD LN Physical Property WOODBURY MN 55129 Address(es): 528 CTY RD E Districts: Dist# Description Parcel History: Date Doc # Vol/Page Type 2611 1 SCH DIST OF HUDSON 1700 WITC 12/14/2009 / WD Abbreviated Description: Acres:1.950 SEC 33 T30N R19W PT SE NW COM 1095 FT W 03/28/2001 P76 43 1608/350 WD 03/28/200, 44 1608/351 WD 04/30/1999 602326 1423/125 LC OF NE COR, TH W 172 FT, S 489 FT TO CEN LN more... HWY -E-, S 87DEG E ON CEN LN... more... I Plat Tract (S-T-R 401/4160% GL) Block/Condo Bldg ' N/A -NOT AVAILABLE 33-30N-19W SE NW 2019 Valuations: Values Last Changed on 09/06/2018 Class and Description Acres Land Improvement Total GI -RESIDENTIAL 1 1.9501 64,800.001 0.00 64,800.00 Totals for 2019 General Property 1 1.9501 64,800.001 0.00 64,800.00 Woodland 1 0.000 0.()Ol 0.001 0.00 Totals for 2018 General Property 1.9501 64,800.001 0.00 64,800.00 Woodland 1 0.0001 0.001 0.001 0.00 2019 Taxes BIII # Fair Market Value: Assessment Ratio: 26451 69,700.00 0.9291 Amt Due Amt Paid Balance Installments Net Tax 1,072.27 1,072.27 0.00 End Date Total Special Assessments 0.00 0.00 0.00 1 01/31/2020 536.14 Special Charges 0.00 0.00 0.00 2 07/31/2020 536.13 Delinquent Charges 0.00 0.00 0.00 Private Forest Crop 0.00 0.00 0.00 Net Mill Rate 0.016547228 Woodland Tax 0.00 0.00 0.00 Managed Forest Land 0.00 0.00 0.00 Gross Tax 1,189.13 Prop Tax Interest 0.00 0.00 School Credit 116.86 Spec Tax Interest 0.00 0.00 Total 1,072.27 Prop Tax Penalty 0.00 0.00 First Dollar Credit 0.00 Spec Tax Penalty 0.00 0.00 Lottery Credit 0 Claims 0.00 Other Charges 0.00 0.00 0.00 Net Tax 1,072.27 TOTAL 1,072.27 1,072.27 0.00 Interest Calculated For 01/1612020 (Posted Payment Payments) Date Receipt # Type Amount Note 12/27/2019 1 150441 T 1 1,072.271 DIX CK#145 JB Parcel #: 030-2002-95-000 Valid as of 03/06/2020 08:50 AM Alt. Parcel #: 33.30.19.363D TOWN OF SAINT JOSEPH ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): ROBERT C DIX DIX, MARIA VERONICA ZARDAIN MARIA VERONICA ZARDAIN DIX 10852 KINGSFIELD LN Physical Property WOODBURY MN 55129 Address(es): " 528 CTY RD E Districts: Dist# Description Parcel History: 2611 SCH DIST OF HUDSON Date Doc If Vo 1/Page Type 1700 WITC 12/14/2009 908176 03/28/2001 641443 / WD 1608/350 WD Abbreviated Description: Acres: 1.950 03/28/2001 641444 1608/351 WD SEC 33 T30N R19W PT SE NW COM 1095 FT W _ 04/30/1999 602326 1423/125 LC OF NE COR, TH W 172 FT, S 489 FT TO CEN LN more... HWY "E", S 87DEG E ON CEN LN... more... Plat Tract (S-T-R 401/• 16i0Y• GL) Block/Condo Bldg " N/A -NOT AVAILABLE 33-30N-19W SE NW 2019 Valuations: Values Last Changed on 09/06/2018 Class and Description Acres Land Improvement Total G1-RESIDENTIAL 1.950 64,800.00 0.00 64,800.00 Totals for 2019 General Property 1.950 64,800.00 0.00 64,800.00 Woodland 0.000 0.00 0.00 0.00 Totals for 2018 General Property 1.950 64,800.00 0.00 64,800.00 Woodland 0.000 0.00 0.00 0.00 2019 Taxes Bill # Fair Market Value: Assessment Ratio: 26451 69,700.00 0.9291 Amt Due Amt Paid Balance Installments Net Tax 1,072.27 1,072.27 0.00 End Date Total Special Assessments 0.00 0.00 0.00 1 01 /31 /2020 536.14 Special Charges 0.00 0.00 0.00 2 07/31 /2020 536.13 Delinquent Charges 0.00 0.00 0.00 Private Forest Crop 0.00 0.00 0.00 Net Mill Rate 0.016547228 Woodland Tax 0.00 0.00 0.00 Managed Forest Land 0.00 0.00 0.00 Gross Tax 1,189.13 Prop Tax Interest 0.00 0.00 School Credit 116.86 Spec Tax Interest 0.00 0.00 Total 1,072.27 Prop Tax Penalty 0.00 0.00 First Dollar Credit 0.00 Spec Tax Penalty 0.00 0.00 Low Credit 0 Claims 0.00 Other Charges 0.00 0.00 0.00 W Tax 1,072.27 TOTAL 1,072.27 1,072.27 0.00 Interest Calculated For 0310612020 (Posted Payment Payments) Data 12/27/2019 Receipt # Type Amount Note 15044 T 1,072.27 DIX CK#145 JB SCC ArcGIS Web Map 2/1/2020, 4:40:55 PM 1:2,257 0 0.01 0.03 0.05 mi Percent Grade Classes 20 - 25% Lot and Units Park General Common Element f I I I 1 1 1 11 0 - 12 % - > 25% Outlot Lot =Tax Parcels 0 0.02 0.04 0.08 km 12-20% UnitWDNR, SCC CDD. SCC Coo and SCC Hig".y Dept, SCC coo. Public ROW Limited Common Element Shoreland Zoning Web AppButldar for MCG15 SCC CDD I WDNR, SCC CDD I SCC COD and SCC Higt n Dept I FEMA. SCC COD I NatidnN GeoepaaM-In1elMgence Agency (NGA); Deb State University: Exi I Eaglw,m and SCC COD I PART OF TH NWJ/4,THI AND THE SL SECTION 33 OF ST. JOSE WISCONSIN RED PREPARED FOR ROBERT DIX % WMTOO BUILDERS PO Box 3B5 SOMERSET, WI 5CO25 PROPERTY ADDRESS 520 COUMY RD. E HUDSON, WI S4M 40 W LEGEND OUND I-1/r OUTSIDE IUMEIERIRONPIPE OUNO W OUMETER REBAR UUNDVOUTSIDEDIA METER MR, PIPE ET r OURIOE DIAMETER BY W ONG IRON PIPE, WEIGHING 1.13 M. PER UNEAR FOOT OP OF NAIL ELEVATION 3P OF IRON PIPE ELEVATION IIMUMSETIMO6: FROM HWY R/W SIDE BEIR J. Zahler, Wisconsin 1al Land Surveyor, hereby it this Stake -out Plan was by me or under my direct supervision and is correct to the best of my knowledge and belief. WITTSTOCK BUILDERS w� wry OF DIX PROPERTY 'F TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN m I+ �%'q ► CsT aoao —J v39 Wisconsin Department o SaF� A An l sc nal�gpivices ; Page / of Division of Indus Servi 1V1 n U L U SOI EVALUATION REPORT ax �ountY County St. C IepgO� h SPS 385, Wis. Adm. Code Attach complete site plan on pe t D x 11 inches in size. Plan must inGude, but not limited to: vertical and h ontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and locatton and distance to nearest road. Please print all information. L54awed M �a �Property Owner ",,� Property Location ❑ 4�z �1'40 al�� GOVL Lot`5�- '/. �_I Y. S3_3 T_�G N R /9 E (or) W Property Owner's Maihng•Address , I Lot # Block #1t! Subd. Name or CSM# city State Zip Code Phone Number I ❑ city ❑ Village N Towry Nearest ® New Construction Use: 0 Residential I Numberof bedroomsZ1 Code derived design flow rata36irJ GPD ❑ Replacement ❑I. -Pu/blic or commercial — Describe: _ Parent material �C t Flood Plan elevation if applicable ft. General comments and recommendations: Boring # Boring Pit Ground surface elev. Depth to limiting f�actoo7�Q In. AM Annll irannn Rata I ®®® Redox • Description Col. Color �M�'����� �Wjfflj e�'��rar■r��a���r. Boring # ❑ Boring ® Pit Ground surface elev9'ft. Depth to limiting fector,[�Q in. Anil A.1il ration Rat. I Z "Emnent R1= HOII>3n s zzn matL and TSS>in 51 s1U nrl_i IEnWentWU= HIM ]_>3115221) mafL and lSSY S I W MWL CS me (P Signatur CST Number Addres Date Evaluatlon Conducted Telephone Number c 5417e) SBD8330 (RD4I15) ao�'3 G] Boring # PR Gro— u—n surface %Ievk4d ft. Depth to limiting factoe� In. S it Annll iratfnn Rate] �PI WAI li%AM��� Mff=�,M��N ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. Anil Annlil ration Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFe 'Eff#1 'Efr#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. qns ennlirafinn Ram Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftr •Eff#1 I 'Eff#2 . Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg1L and TSS > 30 <— 150 mg1L D] Boring # f Pit run y(ev R'- Depth to limiting facto� in. RNA Annaraaen u.re ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. RNI Annlirzfinn Rafw ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. I CMI A-11— n o�n Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Te)dure Structure Gr. Sz. Sh. Consistence Boundary - Roots GPD1Fe •Eff#1 •Eff#2 Effluent #1 = SOD, > 30 5 220 mg/L and TSS > 30 S 150 mg/L • Effluent #2 = DOD, > 30 5 220 mg1L and TSS > 30 s 150 mg/L S78-12'3cc66J E7174_6g BUILDERS n Now SCALE' 4U LEGEND FOUND 1-1/4" OUTSIDE 0 DIAMETER IRON PIPE II FOUND 518" DIAMETER REE FOUND 1" OUTSIDE DIAMET IRON PIPE SET 1" OUTSIDE DIAMETER O LONG IRON PIPE, IA IG LBS. PER LINEAR FOOT T.O.H. TOP OF NAIL ELEVATION T.O.P. TOP OF IRON PIPE ELEVATIOP ��111NIMUM SETBA�' 50' FROM 14WY R 2D' SIDE 25REAR Atid- CAW I, Douglas 1. Zahler, Wisconsin Professional Land Surveyor, h, certify that this Stake -out Plan prepared by me or under MY d to tt supervision and is correct nd beli best of my knowledg '/�7VTR�`[Iry`/' yf avovam� *sconsinDepaLntAndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety a Buildings in accord with ILHR fop UAttach complete site plan on paper not less than 81/2 x 11 inches in st>t�, bnutSt. Croix riot limited to vertical and horizontal reference point (BM), direction an�fVEU CEL I.D. #dimensioned, north arrow, and location and distance to nearest road.�A 30-2002-9 -000APPLICANT INFORMATION -PLEASE PRINT ALL INFORMAt� 2�J00 ED DATE PROPERTYOWNER: C) rS ROPER ION yl d^€F,�� H=� 1. I v>?QW�ica/4,p r4,s 33 T 30 ,N,R 19 R(a)w CITY, 1 (a51) da0-1141 2 1 St. .TOSeoh I Ctv. Rd. " [xj New Construction Use [11 Residential! Number of bedrooms 4 [ j Addition to existing building I I Replacement [ j Public or Commerce] describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdrft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 r— Recommended infiltration surface elevation(s) 104.20 ft (as referred to site plan benchmark) Additional design / site considerations trenches 4.50' below grade Parent material outwash Flood plain elevation, if applicable r,a ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable (Or system RI S ❑ U as ❑ U ®S ❑ U ®S ❑ U I R S ❑ U ❑ S � U Boring # Ground elev. 109.2ff. Depth to limiting factor + „ Boring # 2 z.. Ground elev. 109.A. Depth to limiting factor +120" SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bou ffi y Roots GPD/ft Bed Tiendl 1 0-9 10yr3/3 none sil 2msbk mfr cs 2f .5 .6 2 9-27 10yr 4/4 none sil 2msbk mfr gw 1f .5 '.6 3 27-40 7.5yr4/4 none s 2msbk mfr gw if A .6 4 40-12 .5yr4/4 none coa Osg ml na na .7 .8 %3 Remarks: 1 0-14 10yr3/3 NONE sil 2msbk mfr gw 2f .5 `•..6 2 14-33 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 33-52 7.5yr4/4 none s1 2msbk mfr gw if .5 .6 4 52-12 7.5yr4/4 none cos Osg ml na na .7 .8 Remarks: 0 CST Name: --Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. N,gYAchmond, WI 4017 Signature: Date: 3-13-2000CST Number: m02298 ' !T PROPERTYOWNER Jeff Mendenhall PARCELI.D.# 030-2002-95-000 SOIL DESCRIPTION REPORT 4 Page —of — 2 3-4. Boring # is 3 Ground elev. 108.0t. Depth to limiting factor +100, Boring # rr 4 Ground elev. 105.4 ft. Depth to limiting factor +100" Boring # 5 Ground eb5.4t Depth to limiting factor +96" Boring # :rk:ri Ground elev. f t. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmr& -10 10yr3/3 none sil 2msbk mfr gw 2f .5 .6 2 10-30 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 0-44 7.5yr4/4 none sl 2csbk mfr 9w if .5 .6 4 -100 7.5yr4/4 none co s Osg ml na na .7 .8 Remarks: 1 Remarks: 1 -12 10yr3/3 none sicl 2msbk mfr gw 2m .4 5 2 12-28 10yr5/4 none sil 2msbk mfr gw lm .5 6 3 8-50 10yr5/4 none sil M na gw na .2 .3 4 50-IOC 7.5yr4/6 none co s Osg ml na na .7 .8 cO, L O cC. Ga ------------ L Remarks: 1 -9 10yr3/3 none sil 2msbk mfr gw 2f .5 .6 2 9-27 10yr4/4 none sil 2msbk mfr gw if .5 :.6 3 27-96 7.5yr4/4 none co s Osg ml na na .7 .8 O 0� e• Remarks: Remarks: Sl3D-6330(R.05/92) PROPERTY OWNER Jeff Mendenhall SOIL DESCRIPTION REPORT T Page 2' of 3-as PARCEL I.D. # 030-2002-95-000 Ground elev. 108.0t. Depth to limiting factor +1001, Boring # U4 F n .a Ground elev. 105.4 ft. Depth to limiting factor +100" Boring # 9,.9 5 Ground A..A Depth to limiting f+96 Boring # aw::x Ground elev. ft. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Ou.SZ.ComColor Texture Structure Gr. Sz. Sh. Consistence Bourlery Roots GPD/ft Bed n 7-10 10yr3/3 none sil 2msbk mfr gw 2f .5 .6 2 10-30 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 0-44 7.5yr4/4 none sl 2csbk mfr gw If .5 .6 4 -100 7.5yr4/4 none co s Osg ml na na .7 i .8 Remarks: 1 -12 10yr3/3 none sicl 2msbk mfr gw 2m 4 i.55 2 12-28 10yr5/4 none sil 2msbk mfr gw lm .5 .6 3 8-50 10yr5/4 none sil M na gw na .2 i.3 4 50-100 7.5yr4/6 none co IS Osg ml na na .7 .8 aO, O• Remarks: 1 -9 10yr3/3 none sil 2msbk mfr gry 2f .5 i.6 2 -27 10yr4/4 none sil 2msbk mfr gw if .5 1.6 3 27-96 7.5yr4/4 none co Is Osg ml na na .7 i .8 b• Remarks: Remarks: 5/921 Gary L. Steel CSTM2298 MPRSW-3254 N 1"=40, EM.= top of STEEL'S SOIL SERVICE Jeff Mendenhall NE4NW4 S33-T30N-R19W town of St. Joseph 1" pvc pipe @ el. 100.00, 4 Gary L. Stee 3-13-2000 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 Y - Parcel#: 030-2002-95-000 07/16/2007 10:27 AM PAGE 1 OF 1 Alt. Parcel #: 33.30.19.363D 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit It Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - ELLSTROM, BRIAN D & SHARON HORNE- BRIAN D & SHARON HORNE- ELLSTROM 1185 64TH ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.950 Plat: N/A -NOT AVAILABLE SEC 33 T30N R19W PT SE NW COM 1095 FT W Block/Condo Bldg: OF NE COR, TH W 172 FT, S 489 FT TO CEN LN HWY "E-, S 87DEG E ON CEN LN 175.5 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT, TH N TO POB 33-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/28/2001 641444 1608/351 WD 03/28/2001 641443 1608/350 W D 04/30/1999 602326 1423/125 LC 07/23/1997 444/290 2007 SUMMARY Bill M Fair Market Value: 0 Assessed with: Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.950 53,900 0 53,900 NO Totals for 2007: General Property 1.950 53,900 0 53,900 Woodland 0.000 0 0 Totals for 2006: General Property 1.950 53,900 0 53,900 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 M6 b'78 A eP C jy 27•„SGS -5 s r� 5,-�Y 7 Iglw :nwa/ srr;y ,a )-rb' Ooo/ —,o6x£-/ 3A7" r� PART OF THE NE1/4 OF THE NW1/4, THE SE1/4 OF THE NW1/4 AND THE SW1/4 OF THE NW1/4 OF SECTION 33, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. i N89"34'58"W 171AT ` \ M ♦ � ♦' T.O.N. = 962.26 ♦ r r i O A rn D o- .96, 96 a, HOUSE 1 T.O.N. W a 1, = o 968. 73 N T 0 O H O 2 ►RAGE 00 T.O.P.=970.5 a V '9CP J q PREPARED FOR: ROBERT DIX % WITTSTOCK BUILDERS PO BOX 395 SOMERSET, WI 5402S PROPERTY ADDRESS 528 COUNTY RD. E HUDSON, WI 54016 NORTH SCALE: 0' 40' 80' LEGEND O FOUND 1-1/4" OUTSIDE DIAMETER IRON PIPE © FOUND 5/8" DIAMETER REBAR FOUND 1" OUTSIDE DIAMETER • IRON PIPE SET 1" OUTSIDE DIAMETER BY 18" Q LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT T.O.H. TOP OF NAIL ELEVATION T.O.P. TOP OF IRON PIPE ELEVATION ' \ N MINIMUM SETBACKS: '♦ '� 50' FROM HWY R/W 20' SIDE 25' REAR i r r \ S78-22'36 E� RIGH COUNTM NVV Y f S78'12'36 "E 174 6 J. ZAHI * I n S-21 S 03/04/2020 I, Douglas J. Zahler, Wisconsin Professional Land Surveyor, hereby certify that this Stake -out Plan was prepared by me or under my direct supervision and is correct to the best of my knowledge and belief. �.. a JEs ai11LIm �� WITTSTOCK BUILDERS sw sm. lot O DIX PROPERTY`"�°" °"" 03"' '° TI .. iisaza� n. s-ai sew or�c rxc �aoaosa F,, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN .o.. �.�qn. , m... �,m. � HOUSE STAKEOUT PLAN dath•CBnnWrigjamdJites S&N Land Sumyin` ®..® 7408C 4