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HomeMy WebLinkAbout032-2012-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 370296 Permit Holder's Name: ❑ City ❑ Village ❑ Dbwn of: State Plan ID No.: Be lisle, Patricia Somerset Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: UU O S a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��j�U Be x /4 y, G G Dosing �5 p� a . Z4 A Bldg. Sewer /3 p o Holding Ht Inlet TANK SETBACK INFORMATION St Ht Outlet r 4 , TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet /► Air Septic �� b l j,� S NA Dt Bottom ? - 3 ,P Dosing > �S ' f��' Z 5� NA Header /Man. - 5 1 12 — raj A NA Dist. Pipe 3.17, g Bot. System L I PUMP/ SIPHON INFORMATION (: Fin I Grade Manufacturer o S LA Demand r1 9� (0 Model Number �� �� C 3 '7. TDH Lift Friction System TDH Ft L oss Head Forcemain Length Dia. 2 Dist. To Well SOIL ABSORPTION SYSTEM ED ) TRENCH Width Len th No. O Trench e PIT No. Of Pits Inside Dia. Liquid Depth D NI N 3 DI MNI N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA nufacturer: S ETBA C K MBER INFORMATION Type O a Num er: System: tw 33 r d - OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) It 3 x Hole Size x Hole Spacing Vent To Air Intake Length _ 1.r Dia. ` ' g 1 (_ Spacing �!! �� Z. Length Dia. I � S acin 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) C7 q5 Inspection #1: 1 1 L6 /Ob Inspection #2: q 24 / 00 Location: 694 170th Avenue, Somerset, WI 54025 (SE 1/4 SE 1/4 3 T30N R19W) - -Lot 1 1.) Alt BM Description= L6 S4,H j 2.) Bldg sewer length= 2S' - amount of cover = 7 3 3.) contour='/. 9 R 9 a 2 I Z ���LUI�N 4 Plan revision required? ❑ Yes (] No Use other side for additional information., d w` SBD -6710 (R.3197) Dat6 Inspector's S nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € 5 9 s � € � € 3 € m �- y �� �- Safety and Buildings Division Visconsin SANITARY PER 2 01 W Washington Avenue 1 1 l P O Box 7162 Department of Commerce In accord with Con)M 3. , Wis!(g.q Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) fort tem, on paper not less c unty than 8 1/2 x 11 inches in size. - JUN 2 3 ZOOO • See reverse side for instructions for completing this a tion ST CROIX ate Sanitary permit Number couNTv r 3 Personal information you provide may be used for secondary purposes , ZCAINGOFFIGE Check if revision to previous apprication [Privacy Law, s. 15.04 (1) (m)). f �!� State Plan Review Transaction Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL I \ S IDS = Prop e w�ler Name — erty Location S Zia 1/4, T , N, R E (o Property Own r s Mailing 9dyiyeSS Lot Num Block Number Cit , S to Zip Code Phone Number Subdivisi or CSM ub� P r YPE F I ING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Io w a n O 224 122E 111 BUILDING USE: (If building type is public, check all that apply) 'Parcel 1 [] Apartment / Condo 2 E] Assembly Hall 6 ❑ Medical Facility/ Nursing Home 0 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 1 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. I�S New 2 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an - - __ -- System_ - _ - _ - __System __ _______ _______ - _____ -- Tank Only Existing System Existing System ----- - - - - -- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 �R Mound ❑ Specify Type 41 ❑ Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure r 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min./ 21h) Elevation 3 Feet Feet Capacity VII. ANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tank Tanks Septic Tank or Holding Tank o ,® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the ndersigned, assume responsibility for instal tion of the onsite sewage system shown on the attached plans. Plum er' ame: ( Int t Plumbe ' Si u Ste s MP/MPRSW No.: Business Phone Number: / _ PI mber'sA dress reet,Cit State, Code). IX. COUNTY / DEPAR USE O NLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssued Issuing Agent Signature (No Stamps) PA roved Surcharge Fee) pp ❑Owner Given Initial < Adverse Determinatio 0V Z X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Sy��e�w•_ w�►." Ioe �r 10 nwt 'LO i > SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed 'before thct e'Api`i afion date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be %applicable. 3. All revisions to this permit must be appr&ed 6y `-he p iSnit isswing authority. 4. Changes in ownership or plumber requires a Sanitary permitTransfer / Renewal Form (SBD- 6399) to be submitted to the county prior - to installation - 5. Onsite sewage systems must be properly maintained The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and,Bu•iIdings Division, 608 - 266 73151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only, X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to state or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county, E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for-a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings _. 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 2648777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 24, 2000 CUST ID No.224263 ATTN: POWTS INSPECTOR ZONING OFFICE HIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/24/2002 Identification Numbers " Transaction ID No. 316397 Site ID No. 192059 SITE: Please refer to both identification numbers, Site ID: 192059, PATRICIA BELISLE above, in all correspondence with the agen ST CROIX County, Town of SOMERSET; 170TH AVE, SOMERSET 54025 SE1/4, SETA, S3, T30N, R19W FOR: MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 663429 P.0 .V The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes f i and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Cplta chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. p''Q RZ MIEN' The following conditions shall be met during construction or installation and prior to occupancy or use: 0 aF SAI 1. This plan action is subject to designer comments on the plan. l)' 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular���,, to the direction of maximum slope. SEE GURU 3. Vehicular traffic is prohibited in the area 25' beyond the down slope edge of the mound. 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a law suit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. KIM A O'CONNELL Page 2 5/24/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead, / Sincerely, DATE RECEIVED 05/05/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA L SHANDORF , POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code; 7633 cc: PATRICIA BELISLE MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project PATRICIA BELISLE Owner PATRICIA BELISLE Address 1719 CTY RD I SOMERSET WI 54025 Legal Description SE- SE- SEC3- T30N -R19W Township SOMERSET County ST. CROIX Subdivision Name Lot No. #1#l## Parcel ID Number CS. Plan Transaction Number joriall �Y Index and title sheet Page 1 of ' 000 ►Nc's Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 P A TDH and pump tank drawing Page 5 PUMP CURVES Page 6 PLOT PLAN Page 7 Designer KIM A. CON L License Number 224263 Signature Phone No. 715 - 755 -3145 Date 4 -25 -00 Notice: Tampering wlth this file b a per ng y unauthorized persons is prohibited. Deliberate modification vWII result In disciplinary action under s. 145.10, VNis. Slats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10482 -E (R.05M) Page 1 of 7 MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metdric Residential or commercial? R (r or c) (y or n) N� Replacement system? Creviced bedrock site? N (y or n) Slope 8 % Wastewater flow rate 450 gpd 17 3 Lpd Depth to limiting factor 26 in 0 cm In situ soil infiltration rate 0.5 gpd/ft' 2 A Lpd /m Contour line elevation 99.2 ft 3024 m Use standard fill depths? x OR Desi n depth? �in F�cm Place X in box to use standard depths (24 and A +4 inclusi ) OR specify design fill depth. Center or end manifold E (o or el Hole diameter 0.25 in 0.125, 0.156, 0.188, 0.219, 0.25, 0.281, or 0.313 inch only. Lateral spacing 3.00 ft Use 0 latera, spacing for trenches. Estimated hole space 4.00 ft Not a final calculation. Number of laterals 2 Pump tank elevation 88.2 ft Outside bottom of tank Forcemain length 110;0 it Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only. 2.067 in Actual 1. D. HOLE DIAMETER CONVERSIONS 118 =0.125 1/4=0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5M =0.155 8x32 =0. 261 Estimated daily flow 440 gpd 1703 Lpd 3/16 = 0.188 5116 = 0.313 7/32 = 0.218 Absorption cell Design load rate & area 1.2 gpdAe 37 .0 ft 34.84 m Linear loading rate (LLR) 7. 4 gpolft 88.5 Lpd/m Design width (A) 6. 0 Ift 1.83 m Cell length (B) 63 0 ft 19.20 m Depth of cell (F) 9. in 24.1 cm Sand filter U sla fill depth D Up slope pt ( ) 12 0 In 30.5 cm Downslope fill depth (E) 17 8 in 45.2 cm Basal area required (gpd/infiltration rate) .0 ft 83.61 m Supporting components Topsoil depth 6. in 15.2 cm Subsoil depth at center 120 in 30.5 cm Subsoil depth at cell wall 6. in 15.2 cm End slope toe length (K) 10. ft 3.23 m Up slope toe length (J) 6. 0 ft 2.07 m Down slope toe length (1) 12. ft 3.93 m Total mound length (L) 84. 0 ft 25.66 m Total mound width (W) 25. 0 ft 7.83 m Project: PATRICIA BELISLE Transaction Number: Page 2 of 7 I . i MOUND PLAN VIEW observation pipes (typical) J 25.7 ft A A= 6.00 ft 1.83 m 7.831 m B - 63.0 ft 19.20 m W B J = 6.80 ft 2.07 m I K I= 12.90 ft 3.93 m K = F10,60 ft 3.23 m ft 25. m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension 1W 5' (1 52 mm) T MOUND CROSS SECTION subsoil cap D = 12:t1 30.5 cm lateral topsoil o E = 17.8 in 45.2 cm invert 100.70! t _ _ F = 9.5 in 24.1 cm elev. 30.69 m i F G = 12.0 in 30.5 cm T ASTM C33 H = F in I 45.7 cm D Sand Fill E sys. 100.20 ft elev. 1 30.54 m I 99.20 ft contour 30.24 m elev. 8 slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: PATRICIA BELISLE Transaction Number: Page 3 of 7 I PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch - pounds Metric Width (A) 6 ft 1 1.83 Im Length (B) 63.0 I ft 19.2 m Lateral specifications Number laterals 2 Holestlateral 16 holes Lateral length (P) 60.00 ft 18.29 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 18.64 gpm 1.18 Us Sys. dis. rate `""47.28 gpm 2.35 Us Hole spacing (X) 48 in 121.9 cm Lateral diameter Pipe diameter D"onoptlam D"gnarolee Designer must 1 in (25 mm) Place X in red "X" one choice 1 1/4 in (32 mm) box of chosen from the options 1 12 in (40 mm) X X diameter. provided. 2 in (50 mm) X 3 in (75 mm) X Manifold diameter Pipe diame Dow o*-- D— gncid -- Designer must 1 in (25 mm) "X" one choice 1 1/4 in (32 mm) Place X in red from the options 1 12 in (40 mm) x box of chosen provided. 2 in (50 mm) x X diameter 3 in (75 mm) x 4 in (100 mm) X Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Lat erals centered 0Ver t • A 19 dimension Last Hole drilled next to end cap Om `i Cap rFato P laterals ar• identioal lf X — �' Holes drilled on the bottom of the lateral equally spaced S main oonneotion wia tee or oross to manifold at any point. Laterals a force main of PVC soh 40 a : permanent end marker (per COMM Table 84.30 -5) Inch-pounds Metric Lateral length (P) W.00„ ft 18.29 m Lateral spacing (S) '111a30 ft 0.91 m Hole spacing (X) 48 in 121.9 cm Manifold length 3.00 ft 0.91 m Hole diameter 0.2W in 6.4 mm Lateral diameter 1.50 in 40 mm Forcemain diameter "*:00 in 50 mm Project: PATRICIA BELISLE Transaction Number: Page 4 of 7 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft M m Vertical lift 11.60 ft �t m Are laterals the highest point in the Friction loss 2.55 ft �' m system? Yes "X' her Total dynamic head 16.65 t If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.7 gal 48.1 L back to tank? ( "x' one) Minimum dose 127.0 gal 480.7 L x Yes Drain back 19.2 gal 72.7 L ] No Dose volume 146.2 gal 553.4 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm $3.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels Junction box dlsaonnear grade levels aitamate 4" vent pipe electric as per NEC 300 and F-- cutlet Gomm 18.28 WAC locetion 18" (4e cm) min. P— V ao of pump Ac- approved chamber or outlet joint combination tank A Provide 1 /4' weep hole or anti - alarm on siphon device as necessary pump on B C Grade levels PUMP 89.1 ft - pump tank manhole = 4" (10 cm) Off elev. 27.2 1 m minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 88.2 It Pump tank elevation 3 " (75 mm) of bedding under tank 26.9 m bottom of tank Tank manufacturer WEEKS CONCRETE PRODUCTS Pump tank capacity 119.41gaitin Pump tank volume 8001 gal Pump manufacturer IGOULDS Inches Gallons Pump model number IWE31 1 L A 23.7 459.8 B 2 38.8 Alarm manufacturer IS.J. ELECTO SYSTEMS E C 7.5 146.2 Alarm model number HW 101 i5 D 8 155.2 Project: PATRICIA BELISLE Transaction Number: Page 5 of 7 .turves Pumps f� MMP4 ncT 3 ,4" Soiids 70 r 10. wtwm -r �• I `r � r ,- I i I r 0 to 20 30 40 w w 10 of w ,;�; 110 0 t , ;+0 m'/h CAP ��� • fir 'rye.. „J• i '� •1,�; y dam''. , ;�', r.; �.. , >. � .. �� , i �� ... ,..� { �.�UICti PUNi PS. IPrC. METER+ FELT _ _ I � f u L 3305 'E I E 1� 2b - -- I w W E 05►1 M I - 1. IQ- L I --1 4� OL 0 0 10 20 w W 50 w 10 _ w �J 1 W i:U GPM 0 10 : J :10 m'rn CAPACO r • 1 WO OvWO� Ivmp�, InO. tI1�Nrrt �.ry. I w C )1�' �� lam' C.it ✓�a.c /S r I, f f ��,awea I rw 3 ' Wisconsin Department of Commerce SOIL - AN SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accord" ' with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 4 .ghes in site.• -Plate MJst County include, but not limited to: vertical and horizontal refere Sint (BM), direction and - - �'k percent slope, scale or dimensions, north arrow, and loc *tfon +and Cfi3tance'to nearest ad. I -.. r P Parcel I.D. # F. APPLICANT INFORMATION - Please print a0ifo ;t '" R viewed by Date Personal information you provide may be used for secondary purpose-,(Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location (.k9 Govt. Lot 1/4 1 /4,S T . ,N,R E (Ora Property Owner's Mailing Address Lot # Bloc Subd. Name or CSM# City St to Zip Code Phone Number ❑ City El Village f}]C Town Nearest Road New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _ gpd Recommended design loading rate _Z,.2 bed, gpd /ft trench, gpd /ft Absorption area required gy bed, ft 375 trench, f 2 Maximum design loading rate _ /.� bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft EU =Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank -- == for system El 19 U S❑ U ❑ S <4 U ❑ s O U ❑ S 0 U ❑ S (� U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed , Trench Ground elev. � 47 , ft ^ r Depth to limiting factor Remarks: Boring # Ground , - ¢ elev. eft• ; Depth to limiting factor Remarks: C T Name (Plea a Print) Signature Telephone No. Address ate CST Number PROPERTY OWNER 1��` �s� SOIL DESCRIPTION REPORT Page of _ PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench i .......................... Ground —3 elev. Depth to limiting factor �Z r� Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) I7i9 wry � � �� /- S� /q- s.E�.3- �,30�✓ �P.�,�l � 7 � .� .tiJG/ .�i�'of n � j QaF f,�.t.Ya � T/°s� • .� /Gt3, / , 1�3 / /�� oa �d 7 a f6 /r 30 / � lyocas,E r i 43!10; oU 15:31 x'15 38tf 11t3t , �,•• CEP T I FX ED S L/P VE Y MAP Located in the Township 30 North, 19 of G St£Croix Section 3� County, 'Wisconsin- E 1 /4 Corner Section 3 Earl Belisle (2" iron pipe found) . _UNPLATTED LANDS N 881'58 0 E 359.62' 33' 33' --50 . f a SOT N a! 141,880 Sq, it. (3.26 ac.) M ;;tI �a O a 0 • iA +.ludin right 4f way J� 3.02 at,) ( fit+ 4 �c ex,clu ng 'ght -of -wag. = Y NOTE: Lot 1 is entirely �+ W a � A � buildable inside the propsr z! ■ setbacks. Q iii $ CD 0. W ' N CU i I a SETBt7 ......,..,. O a S1 /# Corner �r y l _.......... .. ............................. r Section 3 , 4 j (11r iron pipe tj` loo' I found). 1 Cc ?880.38' 170 TH AVENUE NB9 °Sd'8F •� 9 89 !S ®* 52 W 31 2.78 SE Corner Section 3 Legend (1" iron pips found) . St.Croix County section corner. r G • 1''X24' Iron pipe weighing 1.68 lbs per lin, foot set. HA11V2Y Q. Bearin s referenced to the South line JOHNSON of the Woutheast quarter of Section 3, • $ -'lobo assumed to be S89 0 58 1 52 11 W - H W9 14 - SCALE /N ecz !'k loo' < J a ,00 Poo 300 ���irrr N This instrument drafted by. 400 -2666 _ I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r Mailing Address ��'� -/r� Ceti ✓� ��� Property Address (Verification required from Planning Department for new construction) r� City/State y Parcel Identification Number -,C ZQ �a moo- -wee LE GAL DESCRIPTION - Property Location '4, ,S�' '/4, Sec. , T 3 N-R jW, Town of Subdivision , Lot # Certified Survey Map # _ �o`l�� /� , Volume I7 , Page # g Warranty Deed # S /D 7 , Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable �a yes ❑ no SYSTEM MAINTENANCE 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 put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 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 County Zoning Office within 30 day of the three year expi ation date. / �/ '0 C) SIGNATURE OF A PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty described above, y virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 06,'20'00 TGE 14:15 FAX 715 336 1687 REGISTER OF DEEDS �j0U2 t6.2n STATE BAR OF WISCON$IN FORM 3 • 19 KATHLEEN H. WALSH REGISTR QUIT CLAIM DEED ST. CR©IX WI 000umentNumber A520FAGE 346 RECEIVED FOR REM 06-20 -2000 3110 PH This Deed, mach between Earl M. Be lisle. a single tsars QUIT CtAIR DEED E%EIIPT N -- CERT COPY FEE: Otanror, COPY FEE: T FEE: 15.00 artd ,patra r„' M. Belisle, a jingle woman _ REMIN(; FM: 20.00 - -�� Grantee. Orardor quit claims to Grrantec the f0Il0wirag described real estate in St. Croix county, State of Wisconsin: A parcel of land located in the Southeast quarter of the Southeast quarter of Section 3, Township 30 Recording Arop North, Range 19 West, Town of Somerset, St. Croix Namc turn Address � pp County, wisconsin described as follows: T'14�7-41 -1 A , �OBZS Beginning at the Southeast oarner of Section 3, thence South 89 degrees 38 minutes 52 seconds West 312.78 feet along the South line of the Southeast quarter of said Section 3; thence North 02 degrees � �Q. G 3?- � oZl� t •�_7U- Q00 f 04 minutes Be seconds East 449,01 foot, thence Worth 89 degrees 30 minutes 52 seconds East 319.62 ParcclIdotifcation Number (PIN) Peel. to the East line of the southeast quarter of This is nS2t homestead property. Section 3; theta** South 02 degrees 57 minutes 15 (is) (is not) seconds West 449.31 feet along said East line to tine point of beginning. Also known as Lot 1 of CSM 14 -3879 filed in Volume 14 of Certified Survey Maps, page 3879. Together with all appurtenant rights, title and interests. Dated this D _ day of "-. .__,>� i R M. Se1a.sle A UTHENTICATION ACKNOW LEDGMMENT SPATE OF WISCONSIN ) Siguattme(s) ) • St. CrQi* County. ) t { Personally carne before me this 1 T day of authenticated this day of 00 the above named TITLE. MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed (If mot, the foregqLng Lastrumeat acknowledged the same. authorized by § 706,06, Wis. Stars.) THIS INSTRUMENT WAS DRATTED BY / f r „ S.W. Thompson ` Mi &A G k# Notary Public, State of Wisconsin My Commission is permanent. (if not, state expiration date; (Signatwes may be attthernticated or acknowledged. Both are June 2 002 ) not necessary.) S,W, THOMPSON Notary Publ"tate of Wisconsin *Names of persona slgrins to ayr capacity mut be typed or printed below their signs tum. STA AR OF WISCONSIN QUIT CLAIM DEED FORM No, 34"1 P- o0uaedw1%ZVForm w oy VorWaR ha. 16025 f am Milo Road, Careen Township. M04an 45035. (500) 30.5805 h4*rwy Mid" ti Tana4i PLaro: (7r5) 133 -.'M9 7as. (717) {3$112 30' -3 OUTSIDE TO OUTSIDE MASONRY W (V DO �p p A'TIZ ;o C rn Dy A m := O V) m - 0z A m -I< NO N m r v y in m D O c I n n A " p ,-p E3 y m ` D 1 - . t7 I- P ` a Z YK X d p Fti A GI7 m Z Z 4 1 E3 D X -I D 1 n r"r Hy yDr- DC yC OD 3 D r-D Vl Z m D .�K CJ 0 ' 0 >ZTy -nZ — ;0 O ❑ • -1 1-. m T " V D D ----- ti y C -i --i z m m m m c z zz Vl a 4 n � A p; f'1 K r N m p cr r P m �W N V P p � z .___... a^ N v K Ln� ti P 4 Y 8 rZ-1 P H $� z r A, °o €� ;o �° r� m - - -- - — – 3 30' -3' OUTSIDE TO OUT IDE MASONRY 15-1 1/2' 15'-I 1/2' Z DC7-3D O 70 9 C3 V 0 M �- Z D D Z m Z m� O r*i r CD f 3 n ;o 0 z m ;o C3;o D C-) A X H ITI cD" Z tj Z -� C D3 C3 C3 --i 'OD C3 A > -0 (4 tnDr ZZ r rd r A tiff C3 Dn> rD n ., p DMZ -Iz v °v m C I" � O ADO • (�q Z 3� '-� N D A - -- - N M --I �Z t*1 m C n --I Z i a y r) j O G Z v n - A p. r1 y � H N r ----- yy D O °tl 8' - 5' P O N P I r C3 °: K � A � C j N r Q A � V y b � [ d ci n � V N I � N x m NON r 4 -C $ C i Z m h M s � Q a r -- -- z C) A 0 o r 0 o < fl 3 Description A parcel of land located in the Southeast quarter of the Southeast quarter of Section 3, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, de- scribed as follows: BEGINNING at the Southeast corner of Section 3; thence South 89 degrees 58 minutes 52 seconds West 312.78 feet along the South line of the Southeast quarter of said Section 3; thence North 02 degrees 04 minutes 58 seconds East 449.01 feet; thence North 89 degrees 58 minutes 52 seconds East 319.62 feet to the East line of the Southeast quarter of Section 3; thence South 02 degrees 57 minutes 15 seconds West 449.31 feet along said East line to the Point of Begin- ning, containing 141,880 square feet (3.26 acres) more or less, and being subject to all ease- ments, restrictions and covenants of record. I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that under direc- tion of Pat Belisle I have surveyed and mapped the above described property; that such map is a true and correct representation of the exterior boundaries of the land surveyed, and that I have fully complied with the provisions of Section 236.34 of the Wisconsin statutes, the St. Croix County Subdivision Ordinance, and the Town of Somerset Subdivision Ordinance to the best of my professional knowledge, understanding and belief. %S C Q • i • �r % ] / •� Harvey G. J n S -1899 ,/p Johnson Su eying, Inc. HVOS 89 N 216 Meadow Drive North p Hudson, Wisconsin 54016 -1128 �Z �VIS N • ,,•, 111 %�� Each parcel shown on this map is subject to state, county and township laws, rules and regula- tions (i.e. wetland, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate town board for advice. This map is hereby approved by the Town Board of the Town of Somerset. ,I V0 4 Data Ed Schachtner, , Chairman Vol.14 Page 3879 _ W RJ .� W A a g 2 11W CU :30 Mvtio I Deeds 4 =Ox - �� � t pGo.WI o wwo wl'-6 ter- L A •• N�H - « LAJ N ti cc W N C ER ~ T I F I ED SUP V E Y MA P Located in the Southeast quarter of the Southeast quarter of Section 3, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. El/4 Corner Owner Section 3 Earl Belisle (2" iron pipe I found) . h APPROVED UNPLATTED LANDS o ST. CROIX COUNTY - Planning Zoninn and Parks Committee N 89 319.62 ' JUN 19 2000 33 33 I It not recorded within 30 days of -- ro ! approval date approval shall be rn,Il and vold I LOT 1 + N ' O I Z O, O 141,880 Sq. ft. (3.26 ac.) m �I Q I p I including right-of-way. Q I 0) 131,550 Sq.ft.(3.02 ac. - ) , excluding right-of-way. H IV NOTE: Lot 1 is entirely + W v ' W v. 3 buildable inside the proper Z l setbacks. OI W DO o lLJ I ^ W I Q I Q I O ! ,, lr) I ! w N Q �I �I J... SETBACK IN ...........I-E..._ ........ ......... O S1 /4 Corner a I Section 3 ' L Z j (1" iron pipe v' 100' found) . R PROPOSED 33 33 — _ DRIVEWAY — —_ _ N 89'58'52 _E 313.28' z29o.3a' 170TH_ AVENUE m NB9 E n , S 89 312.78' SOUrH LINE OF rH£ S E 1 1 SE Corner Section 3 Legend (1" iron pipe found) . St . Croix County section corner. ♦`,���G 0S,�,I • 1 "X24" Iron pipe weighing 1.68 lbs ��•� ����� • per lin. foot set. HARVEY Gl. Bearings referenced to the South line ? JOHNSON of the Southeast quarter of Section 3, ' S - 1899 assumed to be S89 58'52 "W . HUD 3 N .• SCALE IN FEET 1 1 w,�I < NMMr •r, � ♦` Q 100 200 300 ,,, 111 1� 0� ,,�♦ An additional access easement has been recorded for the benefit of Patricia Belisle in Volume 1519, page 193, document number 624835. This instrument drafted by: 400 -2666 Vol. 14 Page 3879 .J