HomeMy WebLinkAbout032-2044-30-090Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for
TANK INFORMATION
TANK SETBACK INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
purposes [Privacy Law. s 15,04 (1)(m)j
TOWN
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
OUIL At3JUKY I IUN 3Y51 tlVl
ELEVATION DATA
ET
BEDITRENCH
DIMENSIONS
Width
Length
No Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
I P/L
JBLDG
IWELL
LAKEISTREAM
I
CHLEACHING
AMBER OR
UNIT
ManWacturer :
Type Of System:
Model Number:
✓IJ t R1OV 1 IV1Y J T J 1 CIYI
HeadedMamfold
Distribution
x Hole Size
x Hole Spacing
Vent to Alr Intake
Pipes)
Lengm Die
Length Dia Spacino
JVrI V V van v Proamrm Sv¢Inmo nnly .. u..—. n. a. l—,u- . .-- n
Depth Over
Depth Over
xx Depth of
xx SeededlSodded
xx Mulched
Red/Trench Center
Bed/Trench Edges
To
0 Yes ❑ No
Yes No
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: No Address Available
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? El Yes No j
Use other side for additional information. L Illl
SBD-6710 (R.3l97) Date
Inspection #1:
Insepctor's Signature
Inspection #2:
L�
Can No.
-- --. 1s eft. I :�s -f*c ed s
SY
1.S
d
a
Industry Services Division
County
.: .
I JOO E Washington Ave
P.O.
T. CrtorX
Sanitary Permit Number (m be filled m by Ca)
P �"
N 1 2025
JU 0
jo 7162
Madison, 70 162
2—
s` "A@ t App icatlo 2
State Transaction Number
rdan In accoo Muni
Wis Adm Code, submission of this form to the appropriate go I unit
is required prior to obtaining a saoitery permit Noe: Application films for sO[e-owned POWTS ate submitted to
project Address (if different than mailing address)
the Deparmrmt of Safety and Professional Service. Personal information you provide my be used for secondary
t
RuM2sea in accordance with the PrivEy Lew, s. 15. I (m), Sorts
6�ps S7
I. Application Information - Please Print All Information
Property Owner's Name
Parcel g
z1#1AO /y/t[CA
403.7-?0YY-36-0Po
Property Owner's Mailing Address
Property Location ' �q Q A—
uQ 1 0 iT
,f
3 S`8 A1[ei %C/J 111E I'f L LoOE
Govt. Lot
NB ' Slat %., Session
City, State
Zip Code
Phone Number
N
GlooaAa'Lr M
S S/d
G/.2 9& 9591
(amieone
T 30 N: R i9 A.(circle
If. Type of Building (check all that apply)
Lot P
B 1 or 2 Family Dwelling -Number of Bedrooms Aj
Subdivision Name
f t 7 �ra+iC
s
❑ Pablic/Commereial - Desrnbe Use
Block k
��
&9ty of
❑ State Owned -Describe Use
illage of
CSj)1 N`mb4l to "I
Y.IPJ Z
®Town of fa�vlc5,rr
RI. T f Permit: (Check only one box on line A. Complete line B if applicable)
system
❑ Replacement System
❑ Tresernwit'Holding TanLReplacement Only
❑ Other Modification to Existing Syalan (explain)
B•
❑Permit Renewal
❑ Permit Revision
❑ Clwnge of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Dow Issued
Before Expiration
puller
of POWTS listem/Com onent/Device: Check a6 that apply)
on -Pressurized in-Grmad ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. ofwitable soil ❑ Mound 17d'm nf��wiit�able wit
❑ Holding Tank ❑ Other Dispersal Component (explain nnmt Device (explfer.. Gv�' aaayt Z S 3P �rw
V. DispersediTrestruent Area Infnrimtlou:
Design Flow (gpd) Design Soil Application Rate(gpdsf)./
Dispersal Area Required (sf)
Diapinsai Area Proposed (all System leva['
�Oo ,7
8S8
889.? 0 9a.3r
VI. Tank Info
Capacity in
Total
daf
e Manufactur
Gallons
Callan.
Units
gItS r1-y�r
�f '10 • hE
m
ell'$-
y
New Tacks
F]armg Tanks
r�
aU
in-
to
srnia a UWdm_,•k
1.2SO
owing Cinnabar
VII. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown. OR the attached Pleat
Plumber's Name (Prior)
Plumber's S-
MP/iifals6 Number
Business Phone Number
o///v /rzxr
/
d.3 3YG
7/S ca'72-sac4
Plumber's Address (Street City, State, Zip Code)
/V 6? 98 r. /t/rrr, f�uttAre C.JI S'/73t:
/D fl. Cone e tnent Use Only
rhV/f'
pLApproved
❑ Disapprov
Perm�itq'F�ta
l Issued
Imui Agent S'
❑ O u for Denial
S �
y3
iX. Cooditlons of ApprovaVttea mars for Disapproval 3)
TEMOWNER:
ptic tank, effluent filter and y') �, � (� P""`� Sys Mtat�2 rMFc
T1 I
persal cell must be serviced !maintained � pW�Rq
per management plan provided by plumber. (- '-�'
2. %1 1 beLback requilellnents rnWlila Islifillilin, for the systea and sabmk to the County only an paper not Ion than a to s 11 torches in aia
as per applicable code/ordinances.
)0
0
SBD-6398 (R. 08/14)
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Page I of 6
Private Onsite Wastewater Treatment System
Index and Title Page
Project Name: C y,10 1*1111Ea - y- Xd. Ive tovae Ida rs 6.t j)
Owner's Name: It
It
Owner's Address:
Legal Description:
Municipality:
County:
Lot Number:
Subdivision Name:
Parcel I.D. Number:
Page I
Page 2
Page 3
Page 4
Page 5
Page 6
Name of Designer:
Signature:
G/1 9L/- y59/
NE S44 A? 3oAII /9 Gl
Town, Vikge, Eity of SOaERJEf
-ter. Z,eal,c
Block Number: CSM Number:
87 r4' 5r. �cuc-or-Jici
031- W.O ry- s0 - 0 ro
Index and Title Page
Plot Plan with Cross -Section & Plan View
Septic Tank Specifications
POWTS Owner's Manual & Management Plan
POWTS Owner's Manual & Management Plan
Filter Information
r
SBD-10705-P (N.01101, R.10/12) "I
Attachment: Soil Evaluation Report
License #: iN/- at3/3W
Date: S-S- Mwd
Soil Absorption Component Manual" Version 2.0
PL T FL4m
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Vror ///ls C71
S /N`%MG 3a�y
oAJEAMdr/a.1 P//Cs
ILA.I d/Fu Cho SEAtr)
120j"
4" CAST -A -SEAL
TYP
4" CAST -A -SEAL
FILTER OR
BAFFLE
in
— OUTLET
LJ
Y H
� n
M
SIDE VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP1250-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL: 2 1/2'
BOTTOM: SEPTIC 3'
COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 52 1/2" O.D.
LENGTH: 120 1/4' O.D.
WIDTH: 84" O.D.
BELOW INLET: 41" O.D.
UQUID LEVEL: 36"
WEIGHT: 8,810 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET, CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
W ISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 34.81 GAL/IN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,323 GALLONS
LOADING DESIGN: 8' 0' UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN #8 NO FIBER)
TANK: MIX DESIGN #10 STRUCTURAL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
II DRAFORGAPPROVALTED II
APPROVED BY: _
APPROVAL DATE:
PRODUCTS NEEDED BY:
W
W
'G.7' 3F cn
CSN
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to
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Page j/ Of
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
FILE INFORMATION
Owner / /zi.-A
Permit s
IF
DESIGN PARAMETERS
Number of Bedrooms 100
Number of Commercial Units
-
Estimated flow (average)
y60 al/day
Design flow (DWF)- estimated x1.5
deogal/day
Soil Application Fate 1
7 pliday/fe
Influent/Effluent Quality (O NA)
vionthly Average
Fats. Oil & Orem (FOG)
5 30 mg/L
Biochemical Oxygen Demand (BODs)
<_ 220 mg/L
Total Suspended Solids (TSS)
5 150 mg/I
Pretreated Effluent Quality (M NA)
Monthly Average
Biochemical Oxygen Demand (BODs)
S 30 mg1L'
Total Suspended Solids (TSS)
530 mg/L
Fecal Coliform (geometric mean)
S 10 cfu/100mL
Maximum Effluent Particle Size
118 inch diameter
Calculations:
SYSTEM SPECIFICATIONS
Septic Tank Capacity
lJ56 gal
ON
Septic Tank Manufacturer
IdlisirA Ldrtrd.
ON
Eftbxrtt Filter Manufacturer
6,ror
❑ N
Effluent Filter Model
bf-.td
O NA
Pump Tank Capacity
Rl NA
Pump Tank Manufacturer
O N
Pum Manufacturer
DNA
Pum Model
O N
Pretreatment Unit (ES NA)
Sand/Gravel Filter
O PeatFilter
Cl Mechanical Aeration
O wcumw
O Disinfection
❑ Other:
Manufacturer.
Model:
Soil Absorption Component (O NA)
® In -ground (gravity)
O In-ground(pmssurized)
O At -grade
O Mound
O Drip -line
O Other.
Vertical Distance TankBottom to Service Pad: /O
ft
Horizontal Distance Tank(s) to Service Pad: ar
It
Dispersal Unit MfgJModel Number: 11w(f/trR/rdd 4g4iK W LNw.r/n I O NA
Soil Dispersal End Cap
DWF — Apolication Ratc = Area Required EISA —
600 = .7 - 8 s8 ylJ.3)
es
(Dispersal Unit EISA)
or (Trench Width)
?0,0 fr'
s Units or Total Length of Trench(s)
N,f tN,,w r;4s
RA 9.2 Fra
yV O Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSWMP Manual)
❑ ::,CC Flowaech Mound Component Manual" Version 12
O "EZ Flow Mound Component Manual" Version 8/20/2007
O SBD-10854-P (R.1/12) "At -Grade Component Manual Using Pressure Distribution" Version 2.0
Pf SBD-10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 2.0
Cl SBD - 10691-P (N.01101) "Mound Component Manual" Version 2.0
D SBD-10657-P (R.6/99) "Drip -line Effluent Disposal Component Manual"
O SBD - 10706-P (N.OINI) "Pressure Distribution Component Manual" Version 2.0
MAINTENANCE MONtTQKir4u SI:nY.ut1LE - ivLp LN t at,w,�a..c
cum vaeu....+..,.••-.,.
Service Event
Service Frequency
Pumcell(s), clean filter
At Icon once : � 13 months
ff 3 years O Other.
Insp & Controls, alarm nt unit
At kart once every,O months
O 3 years DNA
Flush and press= test laterals
IAt least once every. O months
O 3 ears INNA
START UP AND OPERATION: For new construction, prior to using the POWTS check treatment tank(s) for the presence of painting
products or other chemicals that may impede the treatment process andfor damage the dispersal cell(s). If high concentrations are detected have
the contents of the tank(s) removed by a septage servicing operator prior to use. System startupshanootoceur when soil conditions are frozen
at the infiltrative surface.
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and
quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and
fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units,
other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible Note: this does not
include laundry waste, shovers, dishwater. etc.
This system is designed to handle domestic strength wastewater, however, the disposal of food based greases, oils, vegetabWfruit peels,
seeds, bones, and food solids, such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should
be discharged into the system. Othcr non -biodegradable items; such as baby wipes, tampons, sanitary napkins condoms, cigarette butts,
dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint disinfectants, pesticides,
antibiotics, solvents, etc., should not be flushed into the system because they can seriously damage your POWTS and contaminate your
Pag5- Of
drinking water supply. Maintain a regularsteady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over
allsystem components. Compaction ofsnow, overthe dispersal unit may cause it to freeze up.
INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached
Maintenance Schedule). Tank inspections most include a visual inspection of the tank to identify any missing or broken hardware,
idcntify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the
ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings
greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks.
When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the
tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code. Specific servicing mechanics must he provided if vertical is> 15 feet or if horizontal is>I50 feet and instructions to be provided below.
The outlettilter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications_ Solids
washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the
maintenanccscheduletokeep the system operating.
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS.
There is normally a i day reserve under tegular operating conditions, however water should be conserved until any problems with the
system are corrected to prevent back-up of sewage into the dwelling or surfacing.
ABANDONMENT: When the POWTS fails and/or -is permanently taken out of service the following steps shall be taken to ensure that
the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
After pumping, all tanks and pits shall be excavated and removed or their covers removed and die void space filled with soil,
gravel, or other inert solid material.
CONTINGENCY PLAN: if the POWTS fails and cannot be repaired the following measure have been, or must be taken, to provide a
code compliant replacement system:
X 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 renders it unusable. Replacement
systems must comply with the rules in effect at the time of replacement.
I A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last reson to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement wren. 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 may be installed as a last
resort to replace the failed POWTS.
17 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biornat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effectat that time.
1yARNINGII SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES_ DEATH
MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OFA TANK MAYBE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS:
POWTS INSTALLER POWTS MAINTAINER
Name: �pN,l !®ELKS iYO- T313 Y' Name: ![rE Lu.+enJL
Phone: 74r e77- S,1K Phone: 2 L7A-
SEPTAGE SERVICING OPERATOR (Pumper) ? LOCAL REGULATORYAUTHORIT-Y qq
Name: Name:Sr. LR-.Ir 40~..d.rr .vru(ew/.r�rT
Phone: Phone: 7/,r ",-- ./(80
Pd. d
Installation Instructions for the GF10 Filter
Step 1: Locate and remove
The septic tank cover, on
the outlet side of tank.
Step 4: Glue the filter case onto
the outlet pipe. insert the filter
cartridge Into the case. (Make
sure the filter Is completely
Inserted Into the case.)
BEST
ECHNOLUCAf
Step 2: Before Installation,
place the filter case on to
the outlet pipe. Make sure
the case Is positloned so
the filter can be removed
from the tank for mainte-
nance and service
tt�:tfti
Stop 3: For installations that
require or desire additional
support. (If additional support is
not needed, go to Step 4) Glue a
section of l' Sch. 40 pipe to the
two hubs located on the bottom
of the case and the hub located
on the side of the use.
Step S: Forinstallatlonswherekwln
be difficult to reach the handle, place
I'Schedule 40 pipe Into the tee on the
handle and extend It to height that will
make it easy to remove the filter.
I r r r r r r r r r w r r r r r w r M... I
Installation of an Same as a new system only the septic tank I
i existing system. must be pumped priorto installation.
irr rr rr rrrro. r a xxx r>sr re,o a.a
Maintenance of the GF10 Filter
A time frame In which septic tanks are serviced Is set by state and local codes.
Although they may be different most regulatory agencies suggest two to five
years. We recommend the GF70 filter be cleaned when the septic tank is normally
cleaned and pumped, or as needed.
WARNING: If the liquid level in the tank is above the top of the
filter, pump the tank prior to removing the filter cartridge.
OCAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERSI
Step 1: Remove the septic tank cover
and pump the tank If necessary to
prevent any solids from escaping to the
field when the filter Is removed.
Step 2: Pull the filter
handle and slide the filter
out of the case.
7,
Step 3: While holding the
filter cartridge over the
access opening of the tank,
rinse the cartridge off with
fresh water. Take care to
make sure all solid material
falls back Into the tank
-BEST
_ � TECHNOLOGY
3 FalrOeld Blvd, Wallingford, L? 00492
1-677-785-9665 Fax: 203-284-8514
T
µ
Step 4: Insert the cartridge
back Into the case making
sure that it is properly
aligned and completely
Inserted Into the case.
Wdmnsa Department of Satety and Pro/ewonM Serw>Da
[Mason of Ma Nsern
SOIL EVALUATION REPORT
Pape_-f__«_ 3
I- ac x lame wpl SPS 355. Ws. Adm. Code
Aoch cMyaey sae P' on paper not kss Men 8 112 x 11 inglos n s . Plan MWI i o".
CO-*
. Cro;z
Parted I
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oul rat Iimted ro. serbcal and tlmranls rek2rrr pon tRMI. dreobn and pa elope,
stale «dmergms. r,mh arrow, and bcaeoa aro dela to nemot rood
Pteaaa prim aY information.
Reriered by Date
PenWlal rnbrmaapn w my ee used for fefara sn P Law a. 1504i m
Propelry Ovine,
ZAc d Mr 'Il�ii
Pmpedly L oca ion
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Cl CRY ❑ vftp IN Tow1 idea,lst Rod
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Parent mateol Flood Plan elewonn i appllraole aN It p/W 0r F,s,r hrLO
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ST. CROIX COUNTY
SEPTIC TANK MARN'TENANCE AGREEMENT
AND
OVtrNERSHIP CERTIFICATION FORM
Owner/Buyer 6-1f/612
Mailing Address
Property Address Sc Q7' yc, 2 5
( Verification required from Planning & Zoning Department for new construction.)
City/State �cz c' r/l.�'/ Parcel Identification Number C% C
LEGAL DESCRIPTION
Property Location A.) '/. , A/•-- '/, , Sec. -A� , T 3o N R_Zf W, Town of c i
nn�lNw f/y Sc y
Subdivision 1 , Lot #
Certified Survey Map # 7 7C .5"%/ Volume /f Page # `/,' C•2
Warmauty Deed # _ I �0�3 j Volume Page #
Spec house yes o
Lot lines identifiable CM no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its ptennture failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect rho function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition andior (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full 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 Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St Croix Comity Planning &
Zoning Departmaa< within 30 days of the three year expiration date.
Itwe certify that all statements on this form are true to the best of my,om knowledge. Itwe aru/are the owwr(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
T SIGNATURE OF APPLICANT(S)
.Zt.-
DATE
."`Any information that is misrepresented may result in the sanitary permit being revoked by the Phtming & Zoning Departrom ae1
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 warmnty deed.
(REV. 08105)
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GENERAL NOTES MAIN FLOOR PLAN
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m BEARINGS ARE REFERENCED TO THE ----------------------------
m NORTH -SOUTH 1/4 LINE OF SECTION
12. ASSUMED TO BEAR NOO'2W23'E
LOT 9
PLAT OF THE
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NO STRUCTURES ALLOWED IN
ORDER TO PRESERVE
OPTIONS FOR FUTURE ROAD
CONNECTION.
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` HIGHLANDS
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SW1/4 OF THE NE1/4 AND PART OF THE
NW1/4 OF THE SEi/4 OF SECTION 12, T30N, R19W, TOWN OF SOMERSET,
ST. CROIX COUNTY, WISCONSIN.
SURVEYOR:
DOUGLAS J. ZAHLER
S do N LAND SURVEYING, INC.
2920 ENLOE STREET
HUDSON, YA 54016
PREPARED FOR:
BARB HEDIN
8223-89TH ST. NO.
MAHTOMEDI, MN 55115
SURVEYOR'S CERTIFICATE
1, DOUGLAS J. ZAHLER, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT BY THE DIRECTION OF
BARB HEDIN,1 HAVE SURVEYED, DIVIDED AND MAPPED PART OF THE SW1/4 OF THE NE1/4 AND PART OF THE
NWI/4 OF ME SE1/4 OF SECTION 12. T30N, R19W, TOWN OF SOMERSET. ST. CROIX COUNTY, WISCONSIN:
DESCRIBED AS FOLLOWS:
COMMENCING AT THE SOUTH 1/4 CORNER OF SAID SECTION 12; THENCE ALONG THE NORTH —SOUTH 1/4 UNE OF
SAID SECTION 12 NOD-28'23'E A DISTANCE OF 2098.72 FEET TO THE POINT OF BEGINNING: THENCE CONTINUING
ALONG SAID NORTH —SOUTH QUARTER UNE NOO'28'23'E A DISTANCE OF 627.96 FEET TO THE SOUTHWEST
CORNER OF LOT 4 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 13, PAGE 3577 AT THE ST. CROIX
COUNTY REGISTER OF DEEDS OFFICE; THENCE ALONG THE SOUTH LINE OF SAID LOT 4 N893998'E A DISTANCE
OF 560.07 FEET TO THE SOUTHEAST CORNER OF SAID LOT 4; THENCE ALONG THE EAST OF SAID CERTIFIED
SURVEY MAP AND ALONG THE EAST UNE OF LOT 1 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 12.
PAGE 3388 AT SAID REGISTER OF DEEDS OFFICE N00028'23'E A DISTANCE OF 1251.32 FEET TO THE NORTHEAST
CORNER OF SAID LOT 1 ALSO BEING A POINT ON THE NORTH UNE OF THE SOUTHWEST QUARTER OF THE
NORTHEAST QUARTER OF SAID SECTION 12; THENCE ALONG SAID NORTH UNE N89'3756'E A DISTANCE OF
659.44 FEET TO A POINT ON THE EAST UNE OF THE SAID SOUTHWEST QUARTER OF THE NORTHEAST QUARTER;
THENCE ALONG LAST SAID EAST UNE SOO'24'33'W A DISTANCE OF 1317.57 FEET; THENCE S4126.54-W A
DISTANCE OF 1007.71 FEET; THENCE N89'31'38'W A DISTANCE OF 418.04 FEET TO THE SOUTHEAST CORNER OF
LOT 1 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 7, PAGE 1873 AT SAID REGISTER OF DEEDS OFFICE;
THENCE ALONG THE EAST UNE OF LAST SAID LOT 1 N0028'23'E A DISTANCE OF 180.00 FEET; THENCE ALONG
THE NORTH UNE OF LAST SAID LOT 1 NB9'31'38'W A DISTANCE OF 242.00 FEET TO THE POINT OF BEGINNING.
CONTAINING 36.978 ACRES (1,610.743 SQ. FT.). SUBJECT TO RIGHT—OF—WAY OF 85TH STREET AND SUBJECT TO
ALL EASEMENTS, RESTRICTIONS AND COVENANTS OF RECORD.
I ALSO CERTIFY THAT THIS CERTIFIED SURVEY MAP IS A CORRECT REPRESENTATION TO SCALE OF THE EXTERIOR
BOUNDARY SURVEYED AND DESCRIBED; THAT I HAVE FULLY COMPUED WITH THE PROVISIONS OF CHAPTER 236.34
OF THE WISCONSIN STATUTES AND THE LAND SUBDIVISION ORDINANCE OF ST. CROIX COUNTY AND THE TOWN OF
SOMERSET IN SURVEYING �AN�JD� MAPPING SAME.
DOUGLAS Z R 2145 ATE
S do N LAND D SURVEYING h DOUGLAS J. Z
2920 ENLOE ST. ZAHLER
HUDSON. WI 54016 S-2145
HUDSON, p
WIS.
sthN`�
EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES AND
REGULATIONS (I.E., WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR
DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF SOMERSET FOR
ADVICE.
A SPECIAL EXCEPTION USE PERMIT IS REQUIRED FOR THE DISTURBANCE OF SLOPES 20R OR GREATER NOT
PROPOSED AT THIS TIME ON THE APPROVED PLAT OR CSM. THIS PERMIT IS APPLIED FOR THROUGH A
PUBLIC HEARING PROCESS BY THE ST. CROIX COUNTY BOARD OF ADJUSTMENT.
APPROVED
ST. CROIX COUNTY
rgnnina Z."'"Crrnmihee
AUG 0 3 Z004
Ir whnin W daya of
apprw'al dale aMXwal shall a
null andv d
THIS INSTRUMENT DRAFTED BY: WIWAM KANE
JOB NO. 6434-01 DATE: 07/29/2004 SHEET 3 OF 3 SH
Vol 18 Page 4802
St. Croix County 770591 Page 3 of 3
C 5 -F ,a°a°-11-7
v
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0[LLJUN01
nment
SOIL EVALUATION REPORT �
In accordance wdm SPS 385, Ws. Adm. Code County
Attach compete site plan on paper not less than 8 12 s 11 oltlles in size. Plan must in dude,
M not honed to: vertical and 1vmzoMil raterence polm (SM), dimGgn and percent slope. Parai 10
Page —Lot 3
scale or dimensions, norm arrow, and location and distance to nearest road G 31c- z 4"T V rV
Pestle print all Information. by oam
Personal inipmula rt vid
e me be used for second oses Law a 15.04 1
JR
ProperPropertyOwner eAotd Miller GoA. Lot NE z SW Y.S I.Z T 30 N R 1 E (dn
WdpeM °"'1°fa—"f°inB"mre>is _ - - - •. -dt►'ai- Me
Cdy Stt�aler 'ZipCode Phone Number 0 Cry ❑ veage Town Nearest Road
J,New Construction Use:®Residensal/Numberofhedrooms Code dedvad design flow rate GPD
❑Replacement O Pubic or commensal -Describe:_ Net
Parent material Food Plan elevates d applicable MA t
General commenn arW recormrertlatims. ZnSrs.nd FY1WT'Sr Recowvafir rJ S. FL 17.1 Be.loW raiC- L. 4./ /S 90
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Dam Evaluation C
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