HomeMy WebLinkAbout032-2106-70-000 Wisconsin "Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
514971
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:
Green, Duwa ne I Somerset, Town of 032 - 2106 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/6p �✓Y11 CST' 12.30.19.1001
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER A 4 CAPACITY STATION BS HI FS ELEV.
i
Septic Benchmark
9. 109. /ab
Alt. BM !0$' Z_
Aeration Bldg. Sewer
y z 05.7
Holding St/Ht Inlet
y� S /.0 5./
TANK SET St/Ht Outlet C INFORMATION 16 A l. `/
TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 "�
Septic 1 Dt Bottom
36 1 N►4 zy
Dosing Header /Man.
74 /aZ .�
Aeration Dist. Pipe 0O =
• /O L
Holding -__ —. — Bot. System 9
lob .04
Final Grade
PUMP /SIPHON INFORMATION j,' �•d /dam`• 9
Manufacturer De and St Cover 1,77
Model Number
TDH Lift Friction Loss System H TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length / No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 1 d 3 e��
SETBACK SYSTEM TO 10 P!L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: ^
INFORMATION CHAMBER OR
Type Of System: 1 ! / UNIT Model Number: �; /
6A,)e r a � J 1 � GtG�
DISTRIBUTION SYSTEM aG L 7 /6b fb IUt,C
Header /Manifold p IlDistribution x Hole Size x Hole Spacing Ve���flr I"ke
Pipe(s) ALL
Length Z Dia Length Dia ` Spacing \ `, Pih
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 3 Bed/Trench Edges � Topsoil '\ Yes Eg No Yes W No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 808 165th Avenue Somerset, WI 54025 (SW 1/4 NW 1/4 12 T30N R19W) North Bass Lake Estates Lot 7 Parcel No: 12.30.19.1001
1.) Alt BM Description
2.) Bldg sewer length = 2(a �,� -- � �- - �-tl
- amount of cover
Plan revision Required? ri Yes 7kjAo
Use other side for additional information.
Date In ctor's Si T Fure Cert. No.
SBD -6710 (R.3/97)
�����
, 4w Safety and Buildings Division Coun T /) <
201 W. Washington Ave., P.O. Box 7162
t
sin ne Madison, WI 5370? 7162 Sanitary PemuC um (to be filled in by Co.)
State Transaction r
Sanitary Permit Applicatio
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to e a ropnate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for s Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information y provi may be used for secondary V 14 -� ,— _
es in accordance with the Privacy Law, s. 15. 1 )(in), Stats.
I. AppUcation Information — Please Print All Information
Prope Owner's Name Parcel
a32-Zla1, -70-
w
.s Mailing Address SEP 2 3 ?00 `OeadOn hod
C,.,= Govr. t
City, State Zip Code Phone umbOT. CROIX COUN y., /., Section
A/ (-_,.j ZONING OFFICE it one)
N . R EorW
II. pe of Building (check all that appl kLot#
Subdivision Name
r 2 Family Dwelling — Number of Bedroo �-
SJ n i '�— Block # X1 / $
❑ Public/Commercial— Describe Use �� °� �'
❑City of
CS Number El Village of
❑ State Owned — Describe use Q. C l (`� lal /
' 1 wn o
ZZ..1 -Z'Z, 6".J e�
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' Newl ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Ntun an Date Issued
B. ❑ Permit Renewal rmit Revision ❑ Change of Plumber ❑ Pemtit Transfer to New �/ y 7! q Z D
Before Expiration Owner
I V, a of POWTS S stem/Com onent/Device: Check all that apply)
n- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑Mound > 24 in. of suitable soil ❑Mound < 24 io of suitable soil 1S
❑ Holdutg Tank ❑_Other Dispersal Component (explain) [] Pretreatment Device (explain) T
V. Dispersal/Treatment Area Informatio • 5 �`
Design Flow (gpd) Design Soil Appiicati Rate(gpdsf) Dispersal Area Required ADis r sal (SO yste:m Elev on
�9I (� ���. �Z. 0 VI. Tank Info Capacity in Total # of ufaeturer Gallons Gallons Units New Tanks Existing Tanks y W C
L4
!.v I
Septic or Holding •tank �
Dosing Chamber
VII. Responsibility Statement - I, the undersigned, assume nsibility for installation of the POWTS shown on the attached plans.
Plumber' ature MP/MPRS Number Business Phone Number
1'1 Name (Prin J/l
Q.ci
Plumber's Address (Street, City, State, Zip C e)
ff / Mg4_e�Z�
VIII. Coon /De artment Use Onl
pproved ❑ ,d Permit Fee Date I ued Issuing t Signature
❑ ven r Denial $ 85 • Z 5 a$
IX. Condit"fjApan easons for Disapproval 3 ` l : t-. f tz. �� �D
1. Septic tank„ efNtlent filter and �" +r —� 2
dispersal cell must all b�kea / mal�mai� 6J-At— 4-0 ,A,b +•M' -4 o +. J
as per management plan provided by plumber.
2. All sellback requirementsts must maintaihed S C4 t % M ran
e system and sabmlt to the County only on papery n� tha 8 12 l lt cis is shoe
lM+I
SBD -6398 (R. 01/07) Valid thru 01/09
44?o.. I
i 1 K�
' oil Test and System PLOT PLAN
PROJECT Duwavne Green ADDRESS 636 N. 4th St. New Richmond Wi 54017
SW 1/4 NW 1 /4S 12 /T N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 9/22/08 4
DATE BEDROOM
CONVENTIONAL XXX IN -GR6 D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
BENCHMARK V.R.P. Top of NW Lot Stake ASSUME ELEVATION 100 Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Plans Designed Using SYSTEM ELEVATION 1 4. belo qrade
Conventional Powts
Manual Version 2.0 „n
Vent 85' Property Line f1,,1Y
>6" Quick4 Standard -W V
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12" 5.8ft ^2 /pair of end caps
34" Grade at System Elevation
B -3
30'
Vents 2- ' X 88' cells wit pacing 0
7% S ope 5
B -2
�a
165th Ave 15'
80' /lb 10'
0, B -1
ST
75'
1
Pro 4
bedroom 5 '
house
Well is to meet all C 0
setbacks required by 656' Property WDNR p rty Line
- oil Test and System PLOT PLAN
PROJECT Duwavne Green ADDRESS 636 N. 4th St. New Richmond Wi 54017
SW 1/4 NW 1/4S 12 /T N/R 19 W Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 9/22/08 BEDROOM 4
DATE
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
IL BENCHMARK V.R.P. Top of NW Lot Stake ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Plans Designed Using SYSTEM ELEVATION 102.5/102.0 4.5' below qrade
Conventional Powts
Manual Version 2.0
Vent 85' Property Line
>6" Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
l 2" 5.8ft ^2 /pair of end caps
34" Grade at System Elevation
B -3
30'
Vent 2 -3' X 88' cells with >3' s acin 100'
P g
7% Slope 5
B -2
165th Ave 15'
80 10'
40' B -1
ST
30' 75'
Pro 4
bedroom 5 '
house
Well is to meet all
setbacks required by 656' Property Line
WDNR
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Coun r ,
Attach complete site plan on paper not less than 8 1/2 x 11 inches e. mu
include, but not limited to: vertical and horizontal reference point (B Parcel I.D. 03
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Revi ed by Da
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
ProperlT er � � � �'v (� ocetion
Govt. Lo 1/4 n/ U)14 pZT N R E (onw
Property is Mailing Ad ess Lot # Block # Subd. Name or CSNW
City late Zip Code lPhe Number ❑ City ❑ Village XTown Nea est Roa J7V fJ
dL W t ( ST. CROIX COU T Sp 76 iplie
Construction Use. ential / Number of bedrooms Code derived design flow rate 4 0729 GPD
❑ Replacement ' �,..� ❑ " Public or co mercial - Describe:
Parent mateddal (� 4 2.� Flood Plain elevation if applicable
General conxnertts .I /
and recommendations: S .Ise
System Type System Elevation
F 1-1 Boring # ❑ Boring `
Pit Ground surface elev. 1 ' O 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
0
5
Boring # ❑ Boring ~
opit Ground surface elev. L ) 7' O ft. Depth to limiting factor 1 5 1 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 I 'Eff#2
/J
/
� p
5
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L
CST Kw* (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 _ �� 715 - 246 -4516
r '
Property Owner _ /v y arcel 0 # Page of
Boring # �) h
Ep
FS-1 ��...
.t Ground surface elev. 7 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
I
I
F-1 Boring # Boring
pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication 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
F-1 Boring # E] Boring
pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' 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.
SB"330(RAW)
Property Owner
y rce al IQ , Page of
orin ,.
3 Boring # 9
t Ground surface elev. ft. Depth to limiting factor in. Soil lication
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
i 1��- ) 0
2 r 1
a 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 # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth 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 mg/L ' Effluent #2 = BOD, < 30 mg/L 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)
RECEIVED
AUG 2 8 2008
t:orinrinelrce.wi.90V T. CRQIX f 4nd B ldings Divisi C � J
ZO N I Id� "hin Ave., P. . Bo 2 (� (J 1 J�
' n n 53707- 62 Sanitary Per �'t N (� to be � d in by Co.)
Sanitary Permit Application State Transaction Number
In accordance with s. Comm. 83.21(2); Wis. Adm. Code, submission of this form to the appropriate ove ntal
unit is required prior to obtaining a sanitary permit. Note: Application forms for state owned Project (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used fo seco
es in accordance with the Privacy Law, s. 15. 1 m , Stats.
I. Apg§cation Information - Please Print All Information j UU r► ✓�—
Property Owner's Nam I #
C2 -- 7
Property Owner's Mailing Property Location �
Govt. Lot
— city, State Zip < 1 Code Phone Number f1� f� �Y.�y.�Srecction/
N Ct v l� C v L_ N: R / —
T Eo t
V
II. ype of Building (check all that appl �� Lo
Subdivision Name
t or 2 Family Dwelling - Number of Bedrooms
.Sty t 4-C Bloc �t 4 /
❑ Public /Commercial - Describe Us ❑ City of
SM Number ❑ Village of
❑ State Owned - Describe Use
Z+ Town of
III. Type of Permit: (Check only one box on line A. Compl Be B if applicable
A. ew System ❑ Replacement System ❑ Tre en t/H ng Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ ge of Plumber Permit Transfer to New
Before Expiration er K'0
IV. T e of POWTS S stem/Com onent/Device: heck all that a 1 J It
Non - Pressurized In- Ground ❑ Pressurized In -Gro d ❑ At -Grade ❑ Mound > in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component ( ain) Pretreatment Device (explain)
V. Dis ersaUTreatment Area Information-
(st) System Elevation
Design Flow (gpd) Design Soil Applicatio dsf) Dispersal Area Required sf) pe Area Pro
VI. Tank Info Capack in Total # of M ture
Gajpns Gallons Units
JJJn U m '13
New Tanks Existing Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement - J- undersigned, assume ponsibility for installation of the POWTS shown on t ttached plans.
Plumber's Name (Print) Plumber's tore wli; RS Numblf Business Phone Numb
Plumber's Address (Street, City, Sta , Zip Code)
J` 1
Z�Co /De artment se Onl Permit Fee Date Iss Issuing ent Signa
prd ❑ tw approved $ !� a p
11 en Re ason for 1 �✓� ' t Z o
IX. C for Disapproval -3) n s o o t + a � S
1. Septic tank,.efflUdnt fitter and Q t
dispersal ceN must all be servloes / maintained -PC, �► l r�- ^� �� (t &04
as per management plan provided by plumber. bG15 S�iJb►.a. > J 4� !
2. AN 9ftackrequMments most be maintained ` 10
e e system and submit to the County only on paper less than 81/2 x 1l inehas In size
4 e,,
SBD -6398 (R. 01/07) Valid thru 01/09
" l u — P ez
EN/ LAN
PROJECT Duwavne Green RESS 636 N. 4th St. New Richmond Wi 54017
SW 1/4 NW 1/4S 12 /T W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/26/08 BEDROOM 4
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK IZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
,BENCHMARK V.R.P. Top of SW Lot Stake ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE 0 WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 85.5/85.3 455'below grade
Plans Designed Using Vent
Conventional Powts
Manual Version 2.0 >6 „ Quick tandard -W
of Cover Leac ' g Chamber
Pro 4 wi 0.0 ft2 of Area
Bedroom 12 „ 5 t ^2 /pair of end caps
House 4' Long
Grade at System Elevation
34"
Vents
2 -3' X 88' cells with
30' B- B -4 >3' spacing
ST o Slope
84'
Please note: further
testing is to be done 200' 184'
on this site due to B -2
B -3
house location B -5
98' 133'
144' 140'
Well is to meet all
setbacks required by 28'
WDNR
8 '
165th Ave 41'
316'
B.M.*
nc COPY
PON/ PLAN
PROJECT Duwavne Green DRESS 636 N. 4th St. New Richmond Wi 54017
SW 1/4 NW 1/4S 12 /T 9 W TO WN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/26/08 BEDROOM 4
CONVENTIONAL XXX IN -GRO I I
PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK E 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
BENCHMARK V.R.P. Top of SW Lot Stake ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL H. R. P. Same as Benchmark
SYSTEM ELEVATION 85.5/85.3 3.5' beloyrqrade
Plans Designed Using Vent
Conventional Powts
Manual Version 2.0 >6" Quick4 Standa
of Cover Leaching Ch er
Pro 4 with 20.0 f of Area
Bedroom 1219 5.8ft ^2/ r of end caps
House 4' Long
G e at System Elevation
34"
Vents
2 -3' X 88' cells with
30' B B -4 >3' spacing
ST % lope
84'
Please note: further
testing is to be done 200'
on this site due to B -2 184'
B-
house location B -5
98' 133'
144' 140'
Well is to meet all
setbacks required by 28'
WDNR
8 '
41'
165th Ave
316'
B.M.*
A Visconsiri department of Industry SOIL ANDS E E A L U AI O N R �P O P e I of
Labor and -Human Relations
pivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ��
COUNTY _X' ;
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # a/
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RE WED B - DATE
PROPERTY OWNER: PROPERTY LOCATION ��/
GOVT. LOT 1/4 Nf�1 1/4,S 12 T 30 N,R 19 iE (or) W
PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM #
11160 190th. Ave. N.W. 7 na N. Bass Lake Estates
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ RFOWN NEAREST ROAD
Elk River, MN. 55330 612) 441 -8888 Somerset 85th. sT.
I ] New Construction Use [x] 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 _ bed, gpd /ft _ trench, gpd/ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate __Lbed, gpd /ft gpd/ft
Recommended infiltration surface elevation(s) 85.55 ft (as referred to site plan benchmark)
Additional design /site considerations alt. site sytem el. = 84.80
Parent material outwaGh Flood plain elevation, if applicable _ ft
L S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
= Unsuitable fors stem [2S ❑U ®S ❑U ®S ❑U Cis 0 CAS ❑U 0 JU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
'....1. I -8 10 r3 3 none sil 2msbk mfr cs 2f .5 .6
2 8 -22 7.5 r4 4 none 2msbk mfr I gw if .4 .5
Ground 2 3 22 -82 .5 r4 6 none cos OSQ ml na na .7 .8
98.3
Dept l"i to Q
limiting
factor
+82"
Remarks:
Boring #
1 0 -12 10 r3 3 none sil 2msbk mfr cs 2f .5 .6
2 2 1 10 r4/4 none sicl lfsbk mfr gw if .4 .5
Ground 3 - none cos os ml na na .7 `:.8
elev.
8 9.1 ft.
Depth to
5
limiting
factor
" Q5
c
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 •�`� . ZON
Address: 1554 200th. e. New Rich d WI 54017
I c
Signature: Date: CST Nu 298
' 1
PROPERTY OWNER Gerald J. Smith SOIL DESCRIPTION REPORT Page 2, -of 3 4 .
PARCEL I.D. # 2-! 2 b ¢-S / 0
Bor in g # N
Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /tt
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
3' -
2 12 -28 10 r4 4 none sicl 2msbk mfr qw if .4 .5
Ground I 1 9A- RA
elev.
88 ft.
Depth to
limiting
factor
+84 1 1
I
Remarks:
Boring #
1/3 Mna 9 m-sbk 9w
joyr Mfr 9f
`' .... 2 .6
Ground 18-80 1 .8
elev.
87.1 ft.
Depth to
limiting
factor
Remarks:
Boring #
1 0 -9 10 3 3 none sl 2msbk mfr 2f .5 .6
....5.5.....`' 2 9 -22 10 r4 4 none scl 2msbk mvfr 9w if .4 .5
Ground 3 22 -80 r4 6 none cos 0SQ ml na na .7 .8
elev.
87.6 ft.
Depth to
limiting
factor
+ "
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PROPERTY OWNER Gerald J. Smith SOIL DESCRIPTION REPORT Page 2 , of
PARCEL I.D. # 2 0
Boring # Horizon - .,;Depth Dominant Color Mottles Texture Structure Consistence Baurrlary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-
2 12 - 10 r4 4 none sicl 2msbk mfr c1w if .4 .5
Ground _
elev.
18 ft.
Depth to
limiting
factor
+R4
Remarks:
Boring #
ky:
— .6 18
Ground — 7.-9vr4/6 none Cos MI MI na na ' 8
elev.
87.1 ft.
Depth to
limiting
factor
+801
�Remarks:
Boring #
1 0 -9 10 r3 3 none sl 2msbk mfr 2f .5 .6
;15 2 9 -22 10 r4/4 none scl 2msbk mvfr gw if .4 .5
Ground 3 22-80 7.5vr4/6 none Cos OSCF ml na na .7 .8
elev.
87.6 ft.
Depth to
limiting
factor
+8
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Gerald Smith 1554 200th Ave.
CSTM2298 SWaNV S12- T30N -R19W 'New Richmond, WI 54017
MPRSW 3254 town of Somerset (715) 246 -6200
lot #7 -N. Bass Lake Estates
t
N
1 =40'
BM.= top of SW lot stake C el. 100'
Alt. BM.= top of 12" pvc pipe C el. 89.05'
014 / M
27 1
fi
J7
Gary L. Steel'
4 -16 -97
n
www
00 O
U) r7 r7 1a II
W O
r- r- ""Z® 7� �S,
Mir
.. � Z i ' ' o LL-
C14 0
d ► � o 0 a 2 w o U ,os 'F1s
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREENIENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuy
Mailing Address 3 kzo.(44 '- 4 C L-cJ 3
Property Address FO 9 /C �yj&
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION )
Property Location- 5 44,o ) ' /a /a , Sec. / �-, T 0 N R Town of
Subdivision Lot # -.
Certified Survey Map # r , Volume , Page #
Warranty Deed # -1 �/ , Volume Page #
Spec house yes no Lot lines identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 fraction of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the uudm=gmod 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 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 amlare the owner(s) of the
property described above, by vi rtu e of a warranty deed recorded in Register of Deeds Office.
tuber of bedrooms 7`
NATURE 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. 08105)
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being Inslailed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the InspeCdOns pipes at the ends of
the cells.
agrees to limit greases, garbage, and water conditioner diisch&1ge Intro the system.
4.Own er
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. 8:i
ng Ian
Open #1. if em_fails, determine cause of failure, use aitemate area and Install new
replacement area.
'on #2. Install system at a lower elevation, by removing chambers, removing biomes,
and install new system. elevation
option#3. No adequate area is suitable for replacement area, and system
cannontbe 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
8 7 6 6 7 7 1
876677
STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED made between James M. Herold, Ck (YIQ rn RECEIVED FOR RECORD
Audrey Alwell a.Wa Audrey S AlweA, A MaYrt l `+' 06(13/2008 09:50AM
Grantor, and DuWayne E. Green and Rebecca C. Green, husband and lit WARRANTY DEED
wife survivorship marital property, Grantee. EXENPT t
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00
described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 172.50
"Property "): PAGES: 1
Legal Description:
Lot 7, North Bass Lake Estates in the Town of Somerset, St Croix County,
Wisconsin.
Recording Area
Name and Return Address:
St. Croix County Abstract and Title Co., Inc.
219 S. Knowles Ave.
New Richmond, W154017 SFA6671
Together with all appurtenant rights, title and interests.
Parcel Identification Number (PIN)032 -2106- 70-000
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants, and conditions of record.
Dated this day of June, 2008
* a s M. Herold ey Alwell a/k/a kudrey S. Alwell
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
COUNTY St. Croix ) ss.
authenticated this Personally came before me this day of June, 2008
the above named James M. Herold and Audrey Alwell a/k/a
* Audrey S. Atwell to me known to be the person(s) who
TITLE: MEMBER STATE BAR OF WISCONSIN executed the regoing ' a nt and acknowledged the same.
�m (If not, ch
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY Notary , State of Wisconsin
My commission is permanent., (If ot, stat exp' lion date:
Robert L. Lober ' ` _ � � D )
Loberg Law Office "'t
(Signatures may be authenticated or aclm h a
owledged. Botre not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature r
WARRANTY DEED STATE BAR OF WISCONSIN �` y �Vl q (f q FORM No. 1-2000
1 of 1
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Sep 02 08 09:48a St. Croix Energy Solution 715- 531 -1503 p.1
St . Croix St. Croix Energy Solutions
Energy SolutionS 738 9' St Phone: 715- 531 -1500
Hudson, WI Fax: 715- 531 -1503
Fax
To: Sewer Permitting, Shaun Bird From Aaron Mendeau
Fax: 386-4686.1-715-246-8906 Pages: 2 Including cover sheet
P KMM Data 9=008
Re: QuWayne Green Sanitary Permit CC:
❑ Urgent ❑ For Rw4km ❑ Pismo Conrrwrrt ❑ Please Reply O Please Recycle
0 Corarrrents:
Sep 02 08 09:49a St. Croix Energy Solution 715 - 531 -1503 p.2
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Parcel #: 032 - 2106 -70 -000 05/29/2007 09:23 AM
PAGE 1 OF 1
Alt. Parcel #: 12.30.19.1001 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - HEROLD, JAMES M
JAMES M HEROLD C - ALWELL AUDREY
ALWELL AUDREY
2894 20TH AVE
SPRING VALLEY WI 54767
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description ' 808 165TH AVE
SC 5432 SOMERSET t
SP 1700 WITC
Legal Description: Acres: 3.060 Plat: 2207 -NORTH BASS LAKE ESTATES
SEC 12 T30N R19W SW NW LOT 7 NORTH BASS Block/Condo Bldg: LOT 07
LAKE ESTATES
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
12- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
10/15/1999 612109 1463/325 WD
11/04/1998 590725 1373/279 WD
07/23/1997 1188/95 WD
07/23/1997 1150/85 q C
mor ..
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.060 48,300 0 48,300 NO
Totals for 2007:
General Property 3.060 48,300 0 48,300
Woodland 0.000 0 0
Totals for 2006:
General Property 3.060 48,300 0 48,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00