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HomeMy WebLinkAbout032-2176-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St, Croix Safety and Building Division • INSPECTION REPORT sanitary Permit No: 463176 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: T.I. Magnuson Homes I Somerset Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /Q� 1 C:5T 11.30.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` Benchmark (o Z, Me Z M Alt. BM Zc.�- 1 F:A� 64 (0 93 Aeration Bldg. Sewer Holding St/Ht Inlet «•z 9s. TANK SETBACK INFORMATION St/Ht Outlet A.43 ' .7 - , , TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i G ` z , / Dt Bottom Dosing 61 Header /Man. 16 - 95 Aeration Dist. Pipe 16 ,9 9 s • Z`t to Y, 5 7 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover P / 3 c�c3 7 7 Model Numb 1 1 7 TDH Lift Friction Loss Syste ead TDH Ft Z ?3 Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width L DIMENSIONS 3' SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING Manufacturer... INFORMATION CHAMBER OR Type Of System: _ O _ (D � t 6 �� t �` 3Z ,r I Model Number: � DISTRIBUTION SYSTEM M ray \ 64z Header /Manifold, f f / Distribution x Hole Size x Hole Spacing Vent to Air Intake _ Pipes) \ \ �� v Length Dia Length Dia Spacing �1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only — Z 'A. Depth Over Depth Over xx Depth of xx Seeded /Sodded xx MuI hed Bed/Trench Center 2 r /L� Bedlrrench Edges - Topsoil es 0 No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1606 83rd Street Somerset, WI 54025 (NE 1/4 SEE 1/4 11 T30N R19W) Lakeside Estates Lot 3 Parcel No: 11.30.19. 1.) Alt BM Description = �'' [`A^ CoJ�`' : � - 6 d 2.) Bldg sewer length = Zb i - amount of cover Plan revision Required? [ <] Yes >to = other side for additional information. � L4 SBD -6710 (R.3197) Date Insepctor's Si ature Cart. No. Safety and Buildings Division County S T'• t:� p�• 201 W. Washington Ave., P.O. Box 7162 ,scOnS11 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co Department of Commerce (fig) 266-3151 Sanitary Permit Applicat• n RECE� ` S� Pl I. D. t2�/ In accord with Comm 83.21, Wis. Adm. Code, personal info on you provide /_� _ RA may be used for s es v w. s15. 1)(m) V J Add ess T Yo . " I. Application Information - Please t o ' - s ( . C �.. ...r "RGlx C Property Owner's Na me r&4? S 'j I � U O F FI CE arcel # t Block r Lf A 6W We Property Owner's M ailing Address Property Location 5f, 14,Setxion City, State T ip Code Phone Number -7 p j jQIJ 7i 6 " gy� - I o Y 7 3 Q �4 (circle II. Type Building (check all that apply) p ��/ T N; R ! E o(V Subdivision 1 or 2 Family Dwelling - Number of Bedrooms dis/io�n Name CSM Number C ❑ Public /Commercial - Describe Use nn // ❑ State Owned - Describe Use -.L ,, . ,, � ❑City_ ❑Village ❑Township of III. Type of Permit: (Check only one box on line A. Corriplete line B i applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision 11 Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner lv. of POWTS stem: (Check all that apply) Non - Pre s s urized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Xjahina CharAeK ❑ prip Line n ❑ Gravel -less Pipe r (ex ain) V. D' reatment Area Info tion: Il I r — Design Flo (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Req ired (sf) Dispdrsal Area in Elevatio r 0 401 1 &�3 6l r 9/ r2.6 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S -Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /.4J -� (ZSU 2trs Aerobic Treatment Unit Dosing Chamber -7 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na a (Print) Plumber's Si gna --MWMPRS Number Business Phone Number R:. 2c (, ► 2-z S 7/.5 . 77a - 3qY Plumber's Addre as (Street, City, State, Zip Code) VIII. oun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued wg Age t Signature Stamps) Surcharge Fee) Vt d0 �f ❑Owner Given Reason for Denial �sv - Z (� EK. Conditions of ApprovaUR.easons for Disapproval ! i C m 4 YSTEM OWN 1 Septic tank, e�ffluentf 3 and dispersal cell must all be serviced / Mai ained Jy�/ as per management plan provided by plumber... eG{ �'` /0/ 27M setb ack requirements u m s e maintain as � 0 p applicable code /ordinances. 3 p 'T AC Y/ Otd A plete plans (to the County ody) for the system on paper not I than 8112 x 1 es ' siz }SrE1� o� SYSSy 1 / z i C SBD -6398 (R. 01 /03) 0 o _ a 2 0 - M l m NOA pp X nm N om(j) O �m�K / I� p33 � � = o w mmf r� V\ o e7b -it � ST. CROIX COUNTY == WISCONSIN �rre�rr�i = ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION & SEDIMENT CONTROL PLAN Parcel #12.30.19.pending Site: 1606 83rd St Lot 3 Lakeside Estates — Owner(s) T.I. MaSpuson Homes Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Wisconsin Admin. Code Comm. 21.125 requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. Erosion control is a requirement of the conservation easement recorded for this lot. The Owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. Surface drainage flows northeasterly and the proposed septic system is >50 ft. from a retention basin located at the west end of driveway easement, according to the plat map. 2. Intercept and route contaminated runoff into stabilized vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between construction areas and any potential receiving waters (includes drainage ditches). Do not allow diverted runoff to be directed into the retention basin or overflow channel immediately adjacent to the proposed house and driveway construction areas. (See specification sheet for temporary diversions provided by Zoning Dept.) 3. If excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of other products may not be necessary. However, silt fence, straw wattles, or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS or Building inspector may evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible compy ce with the ESC Plan. Please feel free to contact me with questions regarding erosion & sedim t con tr 1 in ektinn. C JW% Py Pre aced b : Pam Quinn, Soil Erosion Ins ector #66505 Owner acknowledgement of ESC Plan re uirements: / /2004 r ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consuftnts PROJECT INDEX OGT. PLAN ID # DATE / OWNER _77Z M/4(Wj1S Oti PHONE 4 IA` ADDRESS 113 / w 5_ 7 7 - J T� � �� '�f / �i� /L�i(f • ,S .� �� Z LEGAL DESCRIPTION /-d T `1 3 tip, - sir• �/, 773o,kiy 60 TOWN OF COUNTY `� r • C f� /� CSTM /� • /ti�� r zZC�3� s LOCAL AUTHORITY/ SUPERVISION s T• C P-0 t K C�" � A-) t•�� PROJECT DESCRIPTION: x_ x --w Ui;aricht & Associates Private Sewage Consultants 2812 1 Oth Ave. Spring Valley, WI 54767 J Pg.l INFILTRATOR SIZING WORKSHEET ORl-G AL P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9.4 " If 11 tl 11 It P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems. (Version 2.0) SBD- 1075- P(N01 /01.' r - / o � I G ��J p O o n a N ao 03 kA °z N O A O O , ° o� `i m��� �+ 1 M - 0 O *%m Q N 0� a a)Rn W 1 �• w w CIO, • v .a o N o � b a CL cr CD se �m � - w t„ . m Z� o � � � w Q S r pv v� AM 6002.v 7- C� ew tili•V . 2 Iff l fl umm . 3 "Z..__ � 9lP s 67 o SS S c Tio © TA � 2rS�w " , G k �S UjE cjd aW �NS�EcT /ov .�ti,U. �2 •, Iff t IM M .sc -0 0 9iP� NO i -1 ] c f� s Y. -� OVER: See Reverse Side for Vent/ Observation Pipe Details. OWIdER's MAINTAINCE-OF`SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe health SYsieai- The owner is required by code to submitrall onecessars Y maintenance /ins ect' P ion reports is P to the controllin g, authorities.. SPECIFIC CONTACT AGENTS 4� / Govern n men tal authority/ inspectors: 2� f�,� y 3OW • YW�a * Licensed installer, responsible for providing an operation/ mainte nance.. "Users " manu zZ� 3 7 S * Licensed service j inspection.a"gent other than installer-: Al Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE RE UIREI`4ENTS 2- Winter traffic (sleddin area shall not be g, shovelring, etc.) across the Permitted, or frost can /will pp into the cell, freezing .up the system. Discontinuos use in the winter ..(a vaeaction.tr.ip, resulting'i no water use) lead to freeze ups.' can also 2• Water c onservation- needs to be Exercised! hydrolically overloaded and destroyed. Thisrsysemmwasn be designed for a maximum wastewater flow of .5 0 gals. daily. 3• POWTS are not designed to accomodate wastes from a garbage f disposal unit, or any other unnatural sources of waste. J Any introduction of such waste` materials will overload destroy this system. and 4. If a power outage occurs, or a ° in a temporary Pump fails, it may result cell y OVerload of effluent being pumped into'the which may adversely impact recomme e cell le aka nde ( e ). It is d that a l 9 tensed allowing Your pumper empty the dosing g um g tank; P to� Consult P return to dosing the correct amounts. our installe -r immediately for advice. 5• Neglect of t . he v egetative etat g iv e co erosion preventive) ver (the cells Insulation e) c on an lead to traffic also can destroy t fail "u re. Compaction or heavy REGULARLY WATER T E he system. It IS NECESSARY HE V TO the EGETATION OVER stem A SYSTEM!! �.3' beneath - Ef f l th IS NOT sufficient. t0 maintain a �Lcovwr. 6• Periodic inspections by Y t he owner, or his agents, is y• the Pipes and .ports have been incorporated into the system: on the mound basal area Inspection pipe,$), cleanout terminals on (effluent level laterals, at each ti the pressurized out:- The filter sy stem p - for flushing and cleaning the laterals ground cover in the tanks (via a locked above Person should an - Onl a licensed properly quallOied & severe safety r Per this work which involves health system's treatment cell Eshall c also befregularindins in the y inspected. 9 V VWsoorwinDepa�entofComm IVE EVALUATION REPORT page of 3 Divism ol'Sa" and Buildings with 85, Wis. Alin. code Coraxy Attach cornplete site plan on is size. Plan must irdude. but not bmitBd to: am. Parcel Paei J.D. perms slope. scale or arrow. and loc don t road. Plea prig Ty owe Petwmd Wonhafta you maids be N G F tsW. S. t k Z Prop"Owner T Propert Location / Q f 2. Nl�}6- vVSO,J 11-0mFf M ,v u S 40 Govt. Lot N� 1/4 �1/4 S T` 0 N R' / ` -firm W / owr�a , / //3 Lot I wo*# & Nam or cSW CRY State Z0 Code Phone Nurnber ❑ city ❑ Wage ® Town Nearest Road 5 92. 7Yd • 7of y 7 93,4- s T. ,dew Construction t se 1,4( Residues / Nurruber of berioonrs code derived design tow rate o GPD ❑ Replacerrrent ❑ PulAc or canrrnurciai - Desaibe: Parent material -5'*4' p V o o r& t kt.%. U" Flood Piaih elevator N appkabte 1 ct convnerft '' /amass 4 tW, M. and ,�. 7 T7 z-v 5 A Vu y e U ,v � GCE El�v Coti - ) T j 6 A +L- tom, o . w . T = s . ` of Pit Ground srrinoe elev. _ g' % Depth to Wnft factor II u in. Soil Ayplicallon Rafe Horfmrr Depth Dourkmt Redorc Descriplion Texture Structure Consistence Boundary Roots GPDW ir. Munsell CkL Sz Cont. Color Gr. SL Sh. •EM1 •E2 b- CP /o Y Yf 2f s ,e A of a 1 (P'/'0 A 31 L be m f p �• /� � Ye ffi6j ----- (P' 3 7. S A f ----- /L Z fs /C . / I /u f - �o 5 3 3• '7- / /z j D, S1 d5 a- S 7 (P r-llkloYle7la — -5 7. 1 A a # ® ptt / Ground surface etev. ! " x Depth to WOM factor > // Q ia_ „ Soli Application Rate t loch= Depth Dorrirhant Color Redmc Description Texbxe Structure Consistence Boundary Roots GPM In. munsell tau. Sz Cont. Color Gr. Sz Sh. •Eif#1 'Etlp2 / p - /Q /� ( 51L z s y F- .y..t fjp k7 3 f F . Z iD 1112 YN s /G 17f5ht �►,�fi• Cs Z I� 3 •30 7• s A s D, 4*1 4-1 f/z as • �. • � 0 , 544 d l- • E1Ruent tYi = BOD > 30 _< ZW nV& and TSS >30 < 180 mall. • Ef&uerd Q = 80D _< 30 nigL and TSS _< 30 mall. CST NNW onease, Z2 (�_3 7 R � 7 — Zl «l �i / Gti T s - t�rWrrnber Address Data EvaNnbon Conducted Telephone Number Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 • O FJG INAL l 1 z 3 Property owner Parcel ID # Page of 1-31 BorkV # ❑ ems 6 .�- Pit Ground surface elev. 9 It.. m / /D SoA Raee Hortmn Depth Oomirkint CoW Red= Description Text" Sbudure Consistence Boundary Roots GPM irr. Munsel Ou SL Cant Color Gr. Sz. Sh. "EM 'EM 0-7 S/L S ii+4 l�/2 40 3 • Co R � z I & o IVR s SiG S � c .6 2 7 -S SL O CGS . Z. . 4, � a /o VA 52& Z s Oe ,,e �s b of Zile S v. F Soft# ❑ ❑ Pit Ground surface elev. tt. Depth to MOM factor in. Sur Appkafion Rata Hormon Depth Domiruartt Color Redox Description Texture Sfruchre dons stence Boundary Roots 04W in. Munger OM Sz Cont. Cow Gr. Sz- Sh. TS" *Oft . o soft# I ❑ ❑ � Grorrd srrfaoe etev. R 10 WW In. Soil App6calon Rate Horiaon Depth Dominant caw Redcrr Description T uctue Str Commence Boundary Roots GPM in. Munger OU. W- Cat. Color Gr. Sz Sh. TEif#1 'Etfll2 Borkv # ❑ BorkV Grand strMoe eleV. h DePlh to rrn�r� factor in. ❑ pit Soil rux�tion Rate Hariaon Depth Dorrkwt RedwE Texhre Sttucbm Cormlstwoe Boundary Rtwts GPM in. Munger � g Sz. Cant Gr. Sz Sh. 'EW1 'EIM2 Efiuent #1 a SOD > 30 < 220 nV& and TSS >30 < 150 ffQ& ' EMuent #2 = BOD <_ 30 mgL and TSS 130 mWL . The Department of Commence is an equal opporu dty service provider and employer. If you need assistance to access seMOCS or need material in an alternate format, please contact the department at 608 -256 -3151 or TTY 608- 264 -8777. sew;wurtAM A I od Ck tJ N o -4 w� I a � 0 LA 7.0 CL 3 J v _co 56027' 1 i0 215.26' mod, C .• _ o Vii, f i f f� Cu, r r ' tA to 0 Z� Ir r. �•Xv . r Q Ot CA o W'Ot , VO.t r ., t M _ r v v� 0 ti • D m � C 'J D n �p 19 m Yu Z 0 w . . a . . . . . rif �. �t�✓�Gop / �v � 'S l'o ��4R 17& viz 0p yeX-? 7 10 CIO Toy y'AV S ;�L�v lv�, �-I�v. 5SO GG (,,S/- • 3 88 - /Co oa Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings In accordance wit Com > -m e ' °' . , a tl .._ qty Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must /R W O but not limited to: vertical and horizontal reference Point (BM), direction and parcel I.D. SEE / WO W percent slope, scale or dimensions, north arrow, and locati n and diStce alo fiear�s4 m ad. Please print all Informati n. Re ' Wed Date / Personal Information you provide may be used for secondary purp ses; (Pifvacjr t rw s. 15:ty4 (1) (m)). Properly Owner 6 1AIN4 " J"eFF) 30A P1g4.J Govt. Lot 114 1/4 S 1A T 3 0 N R * ( or ) W P rty Owners Mailing Address Lot # Block # Subd. Name or CSM# 2 Z /f!Od �/.� • // - P ,v �i.uG— �l�l J'o/p f %9T_ c ty � State Zip Code Phone Number [] City []Village (aTown Nearest Road �?� io v� �v /. Syo�7 ( 7is ) z�G • S3�G sa.�- ,��P.SE -T-' ,/ /�o -4 0 New Construction Use fig Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation If applicable ft• General oomrnents and reo. ij e6 - ..4- 72'°S TtW /fle q vi/P357S i/ O v uv S yJ /A4-t. 4J /� Go r- o oJSi�S cf ;�D D/i'i of /S' S�4 Ong # f 1 Boring 7i -rte/ S� �1�Q Pit Grounds elev. • R. Depth to NmiHng factor In APPIkil Rate SON Horizon Depth Dominant Color Redox Description Texture Stnrctm Consistence Boundary Roots GPDW In. Munsel tau. Sz. Cont Cdor Gr. Sz. Sh. *Effat Iff#2 v- Y 1 /0Ye31 L 2_-W S w 3 f . S /o ye - 511, .2 i hle 4ti f l • cw , S . .3 �• 3 75Ry sZ_ W 7.S LS s 0 �. .r Boring � '�• o (� F # Pit Ground surface elev. _ fl. Depth to limiting factor d In. ici Rate S Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 io S� �t CS s D, �• Z �r t Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgA- ' Effluent #2 = BOO < 30 mg& and TSS 130 mg/L CS fasrna (Please f'rkrt) �/ / n /C �� Signature � 22_(P R ol3eR 7 — �J,c Address Date Evaluallaon Conducted Teieptone Number Ulbricht & Associates / .,�o03 71..S - 77 .1• 3yyz. 2812 10th Ave. 1/ 0 V Z — 20 Ya • F • &00 Spring Valley, WI 54767 A cres �/ /S'� 'C. // For issuance of permits and designing . 0 2 -5 Contact: Ulbricht & Associates S�v S� s� Z - 0 3 2 _ oYS SD Registered private wastewater consultant and plumbers 2512 10th Ave. H U A '' lv&) pa) See 1 Spring'Alley, WI 54767 715- 772-3442 41t0l5 40 ? S &I) AJ W C- z � Z 3p.o /'" 0 3 2 - 1-o yS • yd A- ORIGINAL • �3a M�¢,v c o 7 7// Property Owner ` Parcel ID N Page �' of 3 [-31 Boring # ❑Boring Q Pit Ground surface elev. / Y ft. Depth to Nmiling factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'EffN2 /o / 3 L / S APS w 3 . Ca, 3 3 © f Mots S/L Z h �G c — s MIR S) tea r5 J/4 / Sodng # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Struchxe Consistence Boundary Roots GPD/ff' In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#I - 092 BMW F] N ❑ Bodry ❑ Pit Ground surface elev. ft. Depth to limiting fa in. Sod lion Rate Horizon 1 Depth Dominant Color Redox Description. Texture Struck" AWISIStarlCe Boundary Roots GPDW In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh 'EfIN1 - Efftf2 U gdV ° Boring Ground surface elev. Depth to limiting factor Nn. ❑ Pit Sod Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence 'Boundary Roots GPDff In. Munsell tau. Sz. Cont. Col Gr. Sz. Sh. 'EffN1 'EfN2 ' Effluent N1 = BOD > 30 < 220 mglL and TSS >30 < 150 ngA. ' Effluent N2 = BOD, < 30 n & and TSS _< 30 mglL Tne Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. seo 1330 (te.6") Ac X riAl o f 3 s v 55� 5 T� . SD _Al 4 0 OW D 4 pl o Se T: ,t3M ## / 7 Top op ,/,, e4&0 I Pi ht /0 0 , o' s vyy�s� �jOU,uv 9� v ( 1-o / �OOR3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND oWNCRSIiip CERTIFICATION FORM w+V Owner /Huyer l' - N U S O N Mailing Address S Z �� /n S T • �]�i��llJ �,(� , ✓c- s0�� Property Address (Verification required from planning Department for new coastttrction) 03,2 - 2o�S •So- 0 7 City/Sta(e Parcel Identification Number X - 20 '`Y,3 — /O • &VV LEGAL yESCRtP'i'ioN Property Location ' /�, r /., see ' I , T U N -R !� W, Town of Subdivision /f��5'jj�'�? ..� Lot #�. A Certified Survey Map # , Vv age # Warranty Deed # - 73& Volume 2 - 3 � s . Page # �P Spec house yes L) no Lot, tines identifiable D yes A no SYSTEM MAINUNANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maim consists of pumping out tine septic tank every three years or saunter, if needed by a licensed pumper. What you put Iwo tame 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 Toning Department a certification form, signed by the owner sin msslerplumber, jemneynranpirnrrber, testtictedlphrmberor a licensedInunt er verifyingd at(l) the en -site wastewderdispasal is in proper nperating condition attdfor (2) after inspection and pnn*ng (if necessary), time septic tank In less than 113 full of s' 11"e, the undersigned have read the above requirements anal agree.tb maintain the private sewage disposal system with the sta set forth, herein, as set, by the Department of commerce and the Department of Natural Resource, State of Wain. Certif rlfafing that your septic system has been maintained must be completed and returned to the St. Curia Con aty Zoning Office wit days of the three year expiration date. — n ry r 1�leAwr 11 i z DATE hi OWNER C;ERTW14C ON i (we) certify that all statements on this form are true to the best of my (our) knowledge, I (we) (are) owne 3 the ptolierfy desert d above, by virtue of a warranty deed recorded in Register of Deeds office. a.. �s1o�vA7vRE o L � /7-137 IC T DATE n "•` Amy in that is ttis -r epresented may result in the sanitary petmit being revoked by the Zoning Department ' "Include wlth thls t"Ilcaflon: a stanqMd warranty deed from the Register of Deeds oiTice 9 copy of the certified survey map if reference is made in the warranty deed VOL 2 85 pr,�,�3�3 - 736985 ' STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., WI This Deed, made between Jeffrey S. Boardman and Karen RECEIVED FOR RECORD Boardman, husband and wife, 08/22/2003 09:90AII WARRANTY DEED EX9PT # Grantor, and TI Magnuson Ent. Inc. REC FEE: 15.00 TRANS FEE: 930.00 COPY FEE: CC FEE: Grantee. PAGES: 3 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A ") Name and Return Address n� t-'F +tf 0 Y ue I S � ilk S5 3S b 3 a TV avo 032 - 2043 -10 -000 Parcel Identification Number (PIN) This is homestead property. (is) (S�SbQ Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this C fq-'I" day of .Lune 2003 A. /1 * Boardman i� yardman AUTHENTIC ACKNOWLEDGMENT Signature(s) . S. 1'L WISCONSIN } ( U ) ss• County } authenticated this l day of _ - �(l]t Personally came before me this day of June 1 2003 _ the above named Jeffrey S. Boardman and Karen Boardm husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stets.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY • _ Attorney Kr istine (}gland Notary Public, State of Wisconsin Hudson, WI 54016 - - --_ -- My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledgd. Both are not necessary.) .--------------- . ....... ..... - ----- .. - - - -- ------- - ) • Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals compan Fond du Lac, wi STATE BAR OF WISCONSIN 800 - 655 - 2021 WARRANTY DEED FORM No.2 - 1999 VOL 2385 r 384 EXHIBIT "A" Legal Description File No. 3 -42642 Lot 1 of Certified Survey Map in Vol. 10, Page 295 of Certified Survey Maps as Document No. 5308 ce . Part of SE % of SE 1 /4 of Section 11- 30 -19, being a part of Lot 1 of Certified Survey Map in Vol. "10 ", page 2 as follows: Commencing at the SE comer of Section 11; thence N 89 24' 04" W, along the South line of the SE' /4 also being the South line of Certified Survey Map recorded in Vol. "10 ",. page 2951, at the St. Croix County Register of Deeds Office, 1323.86 feet to the SW comer of Lot 2 of Certified Survey Map; thence N 00 27' 15" E, along the West line of said Lot 2, 660.00 feet to the NW comer of said Lot 2 also being the point of beginning; thence continuing N00° 27 E, along the West line of Lot 1 of said Certified Survey Map, 658.31 feet to the NW corner of said Lot 1; thence S 89 38' 43" E, along the North line of said Lot 1, 660.00 feet; thence S 00 27' 15" W, 661.12 feet to the NE corner of Lot 2; thence N 89 24' 04" W, along the North line of said Lot 2, 660.00 feet to the point of beginning. A lso except Easement granted to Dalryland Power Coo perative as shown In Vol. 1404, Page 97 Document too. 98 described as being 40 feet on each side of the following centerline: Beginning at a point on the East line of a parcel of land located in the SE' /.-SE %, Section 11, T 30 N, R 19 W, and further described as Lot 1 of Certified Survey Map filed July 5, 1995 as Document Number 530892 in Volume 10 on Page 2951, said point being approximately 16.12 feet North of the Southeast corner of said Lot 2; thence in a Westerly direction a distance of approximately 663.86 feet to a point on the East line of Lot 2 of Certified Survey Map filed July 5,1995 as Document Number 530892 in Volume 10 on Page 2951, said point being approximately 22.10 feet North of the Southeast comer of said Lot 2 and there terminating. Also except a parcel of land located in the '/4 of the SE' /4 of Section 11, T30N, R19W, . oun y, Wisconsin described as follows: Commencing at the E % corner of Section 11; thence S00° 27' 04 "E along the east line of the SE' /4 of said Section, 1323.90 feet to the north line of the SE 1 /4 of the SE % of said Section and the point of beginning; thence S89 40' 13 "W, along said north line 658.66 feet to the east line of a parcel of land recorded in Volume 1141, Page 571 at the St. Croix County Register of Deeds office; thence $00 35 "E along said east line, 120.00 feet to the south line of the north 120.00 feet of said SE % of the SE %; thence N89 40'13"E, along said south line, 659.13 feet to said east line of the SE %; thence N00° 27' 04 "W, along said east line, 120.00 feet to the point of beginning. And: A parcel of land located in the SW % of the SW '/4 of Section 12, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin; described as follows: Beginning at the SW comer of said Section; thence N 89 14' 08" E along the south line of the SW % line of said section, 285.79 feet; thence N 00 45' 52" W 165.47 feet; thence N 35 15' 13" W r r � . vu 2385 101.43 feet; thence N 58° 51' 18" W 219.64 feet; thence N 02 36' 46" W 315.02 feet; thence S 87 23' 14" W 28.05 feet to the west line of said SW ' /.; thence S 00 27" 04" E along said west line, 679.12 feet to the point of beginning. CL J v ....:,� htpp°1T3 � t ° 10 QN 215.26' { it { Af 1 r � r b. z S LL1 t � 1 �\ - ' E:5 fir W 0 - �[; L1 y`' OµpcY£il -40 4 o i' J '� rys• J / v .p ¢ of �'' rn -4 ICO • m '�1 so D / 13 v YD'S : le A W 17 &, veGOp &;u 7 c,/ To.�i ff.9�vSE.v ST / 'FV /ivG-' /�-lv. SSA GG (.S/ • 3 88 /Co oe) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / tit Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code count ST cRoi x Attach complete site plan on paper not less than 8 1/2 x 11 inches It . Plammast•-* --- -- /� Include, but not limited to: vertical and horizontal reference point (8 ), dire !�f � .' �aroel .0. SEE / �� �0 W percent slope, scale or dimensions, north arrow, and location and di tanee to nearest road. I Please print all Information. �{ Revia jed by Date Personal Information you provide may be used for secondary purposes (Priv Law, a. 1,.U4 (11(m)). ' Property OwnerC T t 'j� J roperty Ilion i�1A'I ; V e T r) 3e9A eP1q*0 (�tsv(. L 4 114 S T 0 N R 19 0 (or) W Pro rty Owner's Mailing Address Block!! Subd. Name o CSW g Z Z MPQ 4-1 14 U - 0 • 3 P ,v1� %.0 "I'V4J'orP P /AT_ City &W State Zip Code Phone Number City (:]Village Ea Town Nearest Road - IPicio,vp W1 St14017 ( 715 LYG •-S3 ,eG AUP . I$( New Construction User Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material -S_ Y OV r kMie, Flood Plain elevation If applicable ft• General comments and recommendations: iti y�Povvp ; s s,5;e ce./ls . F-/1 Boring it Ef • Y l Csrs -� �o a9 Boring b > 00� in. Pit Ground surface elev. ft. Depth to limiting factor Sod AWketion Rate Hannon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPDIff In. Mumsed Qu. Sz. Cont. Color Gr. Sz Sh. 'E1f#1 'Eff#2 / a•io 1 / 31 Z- I-Fs s w 3 . ,5 . 8 Z Q • 3 10 S/L .w► S �+ �. . S S s v, s I• Z 2—]BMng # Boring Pit Ground surface elev. ft. Depth to limiting factor In. Appl ication Rate Horizon Depth Dominant Colo Redox Description Texture Shit re Consistence Boundary Roots GPD/fF In. Mumsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0- / / /o le L z `FsAe Ski w 3') 3 S ---�. s D, S .� • Z Cr ' Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent #2 = BOD 1 30 mgt and TSS < 30 mg& CST Name /Q d %�/P)T _ v /t ��' Signature Z 3 S i Address Date Evaluation Conducted Telephone Number Ulbricht &Associates / 7IS• 77.;?-• 34�1 2812 10th Ave. Spring Valley, WI 54767 4 4/ 91S g ,see // e3 Z 20 yA • S • 610 5 e /5,C se For issuance of permits and designing _ • o i S s�v�s�v Ccntact: Ulbricht & Associates ..SEG Z - 032 '2 "S S p Registered private wastewater consultant and plumbers yGt� /Sw see. / _ 632- -2 OVY- Y 2812 1 01h Ave. Spring'Valley, WI 54767 , 715- 772 -3442 N�015 S W /Al W S-��• � Z� i 3 0,e z � 032 goys yd •� A• 0 R N A �• I3o �O•�I L o �- 3 Z 3 Property Owner _ Parcel ID # Page of [ - 3 ] BWng ❑ Boring s V -Pit Ground surface elev. fl. Depth to limiting factor in. Applica Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 I 'EMV2 /o Y R 3/1, e L. lf'sh w 3 f 6e 2 • z /a V Y / la 37 /o YIR? / FjS v��• aS 2- • 3 O. i• F] Boring # ° Boris ❑ pit Ground surface elev. ft. Depth to limiting factor in. icstion Rate Sol Horizon Depth Dominant Color Redox Description Texture Structwe Consistence Bou ry Roots GPD/ff In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 • Eff#2 F] Boring # ° Boring ❑ Pit Ground surface elev. R. Depth factor In. r*Eff#1 ication Rate Horizon . Depth Dominant Color Redox Description. Texture Consistence Boundary Roots GPDfff M. Munsell Qu. Sz. Cont. Color . Sz Sh. TIM Boring # F ° Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor Appl ication Rate Horizon Depth Dominant Color Redox Des ption. Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Color Gr. Sz Sh. 'Efr#1 'EMV2 • Effluent 01 = BOD, > 30 5 220 mglL and TSS >30 150 mgll ' Effluent #2 = BOD, <_ 30 mg& and TSS < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. seo -e»o (R -�oo1 h D e ►► a ?e 0 ti d 3 NO °o tN °b \� �► • e � N ti i T . ro 0 �a LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER Q22- 293=10 OAA Pa rcel Number 11.30.19.645A OWNER NAME: First RETIRED Last BOARDMAN PROPERTY ESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment E12 160TH AVE SECTION 1 N 30N RANGE 19W %160 %40 Line Description Line Description TOTAL ACREAGE 20.177 PLAT LOT BLK 01 SEC 11 T30N R1 9W PT SE SE 15 02 B EING LOT 1 CSM 1012951 16 - - yw - t/L) C,oT 03 EXC AS DESC IN 1141/571 17 04 EZ -UT- 1404/297 18 05 EZ -UT- 1412/299 19 06 20 ( / 07 21 08 22 �� L 1 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, 175 -Next Parcel, 177- Valuations, F8- History, F10 -Exit