HomeMy WebLinkAbout032-2106-10-000 Wisconsin Denartment of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix
5'afeky and Building Division
INSPECTION REPORT Sanitary Permit No
506178 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N
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:
Koska, Nathan I Somerset, Town of 032- 2106 -10 -000
CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No:
�Q 0 1 tl6v•- b 6 / rr_� / /� 1 12.30.19.995
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV.
Septic / Benchmark / 7. /'07.3
Dosing � Alt. BM •6
Aeration - BId Sew D G �j 7,
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION /6
TANK TO RI� WELL BLDG. Vent Intake ROAD Dt Inlet �-
Septic , � ' Dt Bottom �--
Dosing Header/Man. Q,
Aeration / Di t. Pipe / N - k �` 1, . 9
Holding Bot. System 0 e4Q / Q- /
m
_ � ��.
PUMP/SIPHON INFORMATION ( Finai Grade
/
Manufacturer Demand St r p
GPM C(/h 5. ' O
Model Number /
TDH Lift Fr�n Loss System Head TDH Ft
Force Length Dia. Dist to c ). y 2S _��"^ `/
SOIL ABSORPTION SYSTEM ,L
BED /TRENCH Width Lenglj.� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 41 2___ \
SETBACK SYSTEM TO P/L tJ BLDG WEL LAKE /STREAM LEACHING Manuf erer
INFORMATION , ,, D CHAMBER OR
Ty a Of S 7 l / S �' / UNIT Mo el Number:
DAMBUTION SYSTEM
Bader/ anifol�l Distribution x Hole Size x Hole Spacing ent to it Intake
Pipes) Q�j
Length�_Dia Length 0 Dia Spacing__ Ill V
- ' v
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 0 Lh
Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded xx Mulched
Bed /Trench Center / Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:--L/�/ Inspection #2: /
Location: 826 165th Avenue Somerset, WI 54025 (SE 1/4 NW 114 12 T30N R19W) North Bass Lake Estates Lot 1 Parcel No: 12.30.19.995
1.) Alt BM Description = �'� °� 2 "'r" '�'� 5141 !/J'(„ W - A , 6 4
2.) Bldg sewer length = 3 � I 5 (_ -_� t,�0
- amount of cover =�� ► w / o�
Plan revision Required? Yes L1<0
Use other side for additional information.
Date nsepctor's ignature Cert. No.
SBD -6710 (R.3/97)
Soil Test and System PLOT PLAN
PROJECT Nathan Kaska ADDRESS 997 Albermarte St. St. Paul Mn 55117
SE 1/4 NW 1/4S 12 /T ., /R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 - i DATE5/29/07 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 871 # of chambers 44
IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 94.0/94.4' 5 below grade
setbacks required by Vent
WDNR AL
> 651 Quick4 Standard -W
Plans Designed Using of Cover Leaching Chamber 427' Property Line
Conventional Powts with 20.0 ft2 of Area
Manual Version 2.0 200 ong 12" 5.8ft ^2 /pair of end caps
4' L
B. M. * 34 Grade at System Elevation
. 20'
440' 30' Vey.
Property line B -2
B -3
0' 5% Slope
1
. -3' X 90' Cells with >3' spacing
(, B - 1 / J 00 LA
Is L
`44 Pro 4
Bedroom
House PUltj kt em�
165th Ave
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CommerCe.Wl. JOV Safety and Build ivision County `
201 W. Washington O. x 7162 ( j
1 s /'moo H c n Madison, WI 53 Sanitary Permit Number (to be filled in by Co.)
De partrnant o! Cotnmrerce `
Sanitary Permit Application State Tra nsactio n Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove ntal /
unit is required prior to obtaining a sanitary permit. Note: Appli or state -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you p,RLre r ary
p urposes in accordance with the Privacy Law, s. 15.04(1 rn , Slats.
, ` !
1. Application Information - Please Print All Information j
Property Owner's Name MAY 3 1 ZOO � Parcel #
r\J A ,�.� s� 0 3)_ --�/ o G- b-aav
Property Owner's Mailing Address �� ST. CROIX COUNTY Property Location .?at-
f G Lot
City, tate ) Zip Code / Phone Number y. !J� y., Section
!v J! h N. R i7 E or VtU
I1. Type of Building (check all that apply) Lot # C �
r 2 Family Dwelling - Number of Bedrooms __, _ Subdivision Name
Block # ,E -
❑ Public /Commercial - Describe Use r"
❑ City of
❑State Owned - Describe Use CSM Number ❑ Village of
Town of
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A' ew System ❑ Replacement System g p Y 8 Y ( e x pl ain )
', ❑ TreatmenUHoldin Tank Replacement O Other Modification to Existin S yst em
B. ❑ Permit Renewal ermit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration I Owner .SO 7 ` 7
IV. a of POWTS S st Com evice: Check all that a 1 dt1
Non - Pressurized In- Ground ❑ Pressurized In- Ground t -Grade ❑ Mound > 24 f of uht b soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank 11 Other Dispersal Component (explain Pretre nt evice exp am
V. Dis ersaliTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System y Eleva ' n
oz
ro y,
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units v
New Tanks Existing Tanks . c d � � � 2 m
C. U in A
Septic or Holding Tank e` 1 2 .S S
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assu esponsibility for installati of the POWT shown on the attached plans.
m er's Name (Print Plumber' gnature MP /MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip ode)
VIII. C t /De artment Use Onl
pproved ❑ Disapproved Permit Fee Datq I ssued
$ 3 J 0 Issu' g Agent
❑Owner Given Reason for Denial J
IX. Conditions of Approval/Reasons for Disapproval
111 73 7 7
Sot:Qd -4. SyS4
Attach to c �plaus 'ystem vAutimiro the C my onl a paper not less thh 1/2 x 1l ln4es in ize
SBD -6398 (R. 01/07) Valid thru 01/09
Soil Test and System PLOT PLAN
PROJECT Nathan Kaska ADDRESS 997 Albermarte St. St. Paul Mn 55117
SE 1/4 NW 1/4S 12 /T, /1%/R 19 W TOWN Somerset COUNTY ST. CROIX
,� 5/29/07 4
MPRS Shaun Bird 226900 \ "" DATE BEDROOM
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 871 # of chambers 44
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 94.0/94.4' 5' below qrade
setbacks required by Vent
WDNR
> 699 Quick4 Standard -W
Plans Designed Using of Cover Leaching Chamber 427' Property Line
Conventional Powts with 20.0 ft2 of Area
Manual Version 2.0 200 5.8ft ^2 /pair of end caps
12"
B. M. * 4 Long 34 „ Grade at System Elevation
20'
30' Vents
40'
Property line B -2
B -3
10' 0' 5% Slope
2 -3' X 90' Cells with >3' spacing
B -1
20' ST
15'
Pro 4
Bedroom
House
165th Ave
i
Wisconsin Department of Commerce SOIL EVALUATI ! �EPO Page of
Division of Safety and Buildings
in accordance with Comm , is E
ounty ' �
Attach complete site plan on paper not less than 8 1/2 x 11 inches i size. Plan must
include, but not limited to: vertical and horizontal reference point (B ), direction and p D. 0 �^
percent slope, scale or dimensions, north arrow, and location and di t nnc f arlst fa?C Q c.r✓CJ
Please print all information. Revie b Date
Personal information you provide may be used for secondary purposes (Priv cy lawST 4.WW(fiif)U N r `ujjyh 3 � / rte
Property Owner I [
N� -K Cl C_ S f L 4–. Govt. Lot 1 /4 ^/1 /4 S 1Z T 3 N R/ 2 E( ) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
`! P r - r 54 j N, SA-T -,Y-
� s
City State Zip Code Phone Number ❑ City ❑ Village ATown Nearest Road
00
Ft New Construction Use esidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public o commercial - Describe:
Parent material �L2 �J� Flood Plain elevation if applicable /I// A ft.
i
General corrxnerrts
and recorrWnendations:
System Type , System Elevation Boqi ng # Bor 1 Ground surface elev. ft. Depth to limiting factor � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 y /a a '7
_T
® Boring # On Boring
S Pit Ground surface elev d , ft. Depth to limiting factor / D in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2
7 � 0 -1Z 0 ; 3!z
• Effluent #1 = BOD > 30 1 220 mg1L and TSS >30 < 150 mg/L . ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Blame (Please Print) Si CST Number
gna
Bird Plumbing, Inc. Shaun Bird 226900 t?
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 .- �� 715 - 246 -4516
s
Property Owner _ Parcel ID # Page of
1E Boring # ❑ Boring J
it Ground surface elev. /�• 2' ft. Depth to limiting facto✓_ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
12 l S" Or / L 7 l•
E Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
E Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA_ ' Effluent #2 = BOD < 30 mg/_ and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8.6/00)
Commerce.wi.gov Safety and Buildings Division County
201 W Washington Ave., P.O. Box 7162
W. _J C
1 s co n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
of Comn 1116 56 ti
_ Sanitary Permit Application StateTransacti °n be`
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the angronriate govemmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide -- may be used for
seco ry
p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. REGEIVE /
1. Application Information - Please Print All Informati {►>
Property Owner's Name Parcel #
/J MAY 0 4 2007 03- -,'�l D
Property Owner's Mailing Address Property Location / 49
- � ST. CROIX COUN�i Y Govt. Lot / C/ / >
City, Slate Zip Code ' A/L, 'G, Section /
1 / �O' T N; R irclEon
II. Type of Building (check all that apply) ok, e+� Lot / „L
r 2 Family Dwelling - Number of Bedrooms / SubdivisName
10 5 ul: �noJ�+.R. Block #
❑ Public/Commercial - Describe Use orb ❑ City of
CSM Number ❑ Village of
❑ State Owned - Describe Use
own of S CN +
Z Z Z a-
Ill. Type q ermit: (Check only one box on line A. Complete line B if applicable)
A. w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber r
'Permit fer to New
Before Expiration O r
IV. _ Type of POWTS System /Component/Device: Check all that `
Pressuriz - nd ❑ Pressurized In- Ground ❑ ftrad d > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaLTreatment Area Information:
Design - D(gpd) , Design oil Appligation Rate(gpdsf) Dr p 5 Requiyed (st) D ersa) Area Pro `Od (so ystem Elevatio n
t v C/ ✓/ / � g � ✓/ t o[
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units U _
New Tanks Existing Tanks
fj-•• a U
Septic or Holding Tank as
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume r sibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's S' re MP /MPRS Number Business Phone Number
Plumber's Address (Street, Cifry, State, Zip C e)
VIII. -C ounty/ De artment Use Onl
Approved Permit Fee ao Date Issued Issuing nt Signature
S Y5 5 7 07
=:i;�,.
IX. Condi ' easons for Disapproval
'
3� e% %� � o✓� Ce,n��-�'� A. 1�"o
1. Septic tank, effluent filter and
(� 9
dispersal cell must all be SKArAs / mah1ained b p�,ti a ,�, c.,�n cu- �' ur �b z '
n per management plan provided by pkm*w.
2. AN atAbadt tegt*0ments meat be maNaW ad
Pa Attach to complete plans or the system and submit to the County only on paper not less than 8112 x I1 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
__
PLOT PLAN
PROJECT Nathan Kaska ADDRESS 997 Albermarte St. St. Paul Mn 55117
SE 1/4 NW 1 /4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/3/07 BEDROOM 4
CONVENTIONAL )OCX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 871 # of chambe s 44
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.3/92.8'
Well is to meet all
Vent
setbacks required by >6 „ Quick4 Standard -W
WDNR
o Cov Leaching Chamber
f 427' Pro pert y
er with 20.0 ft2 of Area Line
12" 5.8ft ^2 /pair of end caps
Plans Designed Using 4' Long Grade at System Elevation
Conventional Powts 3 4"
Manual Version 2.0
Pro 4
Bedroom
House
30' B -5
74'
Huffcutt ST 5% Slope
30'
40' B-4 12'
48' B -3 30'
B -2 Vents 4'
IF
B -1 27' AL
165th Ave
2 -3'X 90' Cells 50'
with >3' Spacing
M.
PLOT PLAN
PROJECT Nathan Kaska ADDRESS 997 Albermarte St. St. Paul Mn 55117
SE 1/4 NW 1 /4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/3/07 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 871 # of chambe s 44
kk BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL
H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.
Well is to meet all Vent
V
setbacks required by >6 „ Quick4 Standard -W
WDNR of Cover Leaching Chamber 427' Property Line
with 20.0 ft2 of Area
12" 5.8ft ^2 /pair of end caps
Plans Designed Using 4' Long Grade at System Elevation
Conventional Powts 3491
Manual Version 2.0
Pro 4
Bedroom
House
30' B -5
74'
\40' Huffcutt ST 5% Slope
B -4
30'
12
48' B -3 30'
B -2 Vents 4'
B -1 27'
165th Ave
2 -3'X 90' Cells 50'
with >3' Spacing
�B..*
AA/ consin Department of Industry SOIL AND S ITE E V A L U AT I 6 E P O R T Page 1 of 3
Labor and Human Relations
D 0,ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 0 3 Z -- Z0 6
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEW BY DATE
S 7
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT SE 1/4 NW 1/4,S 12 T 3 N,R 19 (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM #
1 na N. Bass La
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [MOWN NEAREST ROAD
[ New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft trench, gpd /ft
Absorption area required 643 bed, ft _563_ trench, ft Maximum design loading rate � 7 bed, gpd /ft trench, gpd /ft
Recommended infiltration surface elevation(s) 93.45 ft (as referred to site plan bench ark
Additional design / site considerations alt area system el.= 91,65
Parent material outwash Flood plain elevation, if applicable na ft.
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK
U = Unsuitable fors stem F7 S ❑ U ik7 S ❑ U I FE] S ❑ U [0 S ❑ U RI S ❑ U ❑ S 1- U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Q Sz. Co nt. Color Gr. Sz. Sh. Bed Trench
..................
1 1 0 -7 10 r4 4 none s i t 2msb
2 7 -17 7.5 r4/4 none sl 2msbk mvfr crw if .5 .6
Ground 3 17 -84 7.5 r4 6 none cos
elev.
96 ft.
Depth to , 3
limiting
factor
+ t
Remarks: -1
Boring #
1 0 -6 10 r4 4 none 1 2m bk m
2 6 -18 10 r4 4 none
3 18 -84 7.5 r4/6 none cos 0SCI ml na na .7 .8
Ground
elev.
9 6.85 ft.
Depth to 3 ,
limiting l I
factor 3
+84 X w
c� rpuN \GE
Remarks: o�
CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200
Address: 1554 200tlwAve., Ne%v WI 54017 ` 9
Signature: Date: CST Number: m02298
l - 4 -15 -97
PROPERTYOWNER Gerald T. 4nith SOIL DESCRIPTION REPORT Page of
PARCEL I.D. # 0 3 2 - 20q-5 ^ 20 ^
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0 -7 10 r4 sil 2msbk mfr 2f .5 .6
3
2 7 -17 7.5 r4 4 none sl 2msbk mvfr 9w if .7 .8
Ground 3 17 -84 7.5yr4/6 none cos osg ml na na .7 .8
elev.
95. ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -9 10 r3 4 none sil 2msbk mfr cs 2f .5 .6
2 9 -19 10 r4 4 none sicl 2msbk mfr if .4 `:.5
Ground 3 19 -27 7.5 r4 4 none is osq ml na .7 .8
elev. 4 27 -84 7.5 r4 6 none cos 0sq m1 na na .7 .8
94 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
:= => 1 0 -9 10 r3 4 none 1 2msbk mfr cs 2f .5 .6
2 9 -21 10 r4/6 none sicl 2msbk mfr gw if .4 .5
Ground 3 21 -27 7.5 r4/4 none is osg mvfr gw if .7 .8
elev. 4 27 -84 7.5 r4 6 none cos 0SCI ml na na .7 .8
94.O
Depth to
limiting
factor
+ 84 11
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PROPERTYOWNER Gerald J_ with SOIL DESCRIPTION REPORT Page of ;
PARCEL I.D. # 0 3 2: 20 5 " 20 ^LO
d i
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trer&
4` .............'`." 1 0 -7 10 r4 4 sil 2msbk mfr 2f .5 .6
3
2 7 -17 7.5 r4 4 none sl 2msbk mvfr gw if .7 .8
Ground 3 17 -84 7.5yr4/6 none cos osg ml na na .7 .8
elev.
15. ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
?:<:: 1 0 -9 10 r3 4 none sil 2msbk mfr cs 2f .5 .6
4
2 9 -19 10 r4 4 none sici 2msbk mfr 9w if .4 .5
Ground 3 19 -27 7.5 r4 4 none is oscf ml na .7 .8
elev.
4 27 -84 7.5 r4 6 none cos os ml na na .7 .8
9 5 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
........... . 1 0 -9 10 r3 4 none 1 2msbk mfr cs 2f .5 .6
..
2 9 -21 10 r4/6 none sicl 2msbk mfr gw if .4 .5
Ground 3 21 -27 7.5 r4/4 none is osg mvfr gw if .7 .8
elev. 4 27 -84 7.5 r4 6 none cos oscf ml na na .7 ': .8
94. 0B.
Depth to
limiting
factor
+ 84 11
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/921
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 1 Gerald Smith New Richmond, WI 54017
MPRSW 3254 SE4NW4 S12 T30N -R19W
town of Somerset (715) 246 -6200
lot #1 -N. Bass Lake Estates
N
1 =40'
BM.= top of SE lot stake C el. 100'
Alt. BM.= top of row stake @ el. 104.45'
d ' 17,
,2 eYLA563
PM Qt Pr 4
2 t k
5 Z �
Q
Gary L. Steel
4 -15 -97
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
. AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mai ling Address /l / ri? j P�
Mal g — .�-- -,
Property Address
(Verification required from Planning & Zoning partment for new construction.)
City /State
Parcel Identification Number
LEGAL DESCRIPTION
c �j W, Town of
Property Location J� 1/a i/a ,Sec. �, � � N
Lot
Subdivision
# /
Volume Page#
Certified Survey Map # - 9 - 1 , Deed # Z-`�
,Volume � Page # S
Spec house y no Lot lines identifiable (yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure licensed um r� What You Put into
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by P pe
the system can affect p the function of the septic tank as a treatment stage in the waste disposal sys�noowner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
e and the Depa
standards set forth, herein, as set by the Department of Comerc feted a of Natural Resources, State of Wsconsin.
i
m
Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/am the owner(s) of the
7;i above, by ' e of a warranty deed recorded in Register of Deeds Office.
i3 ��
ATURE OF APPLICANT(S) DATE
* ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
n Plan
(Sin . system fails, determine cause of failure, use alternate area and install new
tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
772457 t
'J 2 6 4 2 r 5 3 7 REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
STATE BAR OF WISCONSIN FORM 2- 2000
88/24/2084 11:55AlI
Document Number WARRANTY DEED WARRANTY DEED
EXEMPT #
THIS DEED, made between Dennis R. Germain and Doreen A.
Germain, husband and wife, and Sharon F. Rivard, a married person, TRA NS FEE: 10
Grantor, and Nathan Koska and Amy Koska, husband and wife, as COPFEE: 16666..50
Survivorship Marital Property, Grantee. CC FEE:
Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 1
the following described real estate in St. Croix County, State of Wisconsin:
Lot 1, North Bass Lake Estates in the Town of Somerset, St. Croix County,
Wisconsin.
Recording Area
N and Re ddr s:
dina R Title, Inc.
S. St. — Suite 11
Exceptions to warranties: n, WI 54016 Q� r
Easements, restrictions and rights -of- -way of record, if any. 4 '- ` / 1
032 -2106- 10-000
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 23rd day of August, 2004.
f
* Dennis R. Germain * Doreen A. Germain
aeu
* Sharon F. Rivard
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 23rd day of August, 2004
Personally came before me this August 23, 2004 the above
named Dennis R. Germain and Doreen A. Germain, husband
* and wife, and Sharon F. Rivard, a married person to me known
TITLE: MEMBER STATE BAR OF WISCONSIN to be the person(s) who executed the foregoing instrument and
(If not, ac wledged the same.
authorized by § 706.06 Wis. S . ,laime VanHouten
THIS INSTRUMENT WAS amiry Public
tale of Wisconsin * aime VanHouten
Peterson, Frain & Bergman — Steve Potary Public, State of Wisconsin
50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date:
7/27/2008 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
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