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HomeMy WebLinkAbout032-2157-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bu+lding Division ' INSPECTION REPORT sanitary Permit No: 429995 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Pl 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: Grand Properties L.P. I Somerset Township 032 - 2157 -10 -000 CST BM Elev: ( Insp. BM Elev: I BM Description: _ 11 Section/Town /Range /Map No: lCp %a I ao . a PuL = CST $ �'►� ( 12.30.19.1353 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t mar Dosing Alt. BM I • �� Aeration Bldg. Sewer CJ •� l�0. O� Holding SVHt Inlet ��� Q' •o � f St/Ht Outlet - W TANK SETBACK INFORMATION �• �, 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic so Dt Bottom Dosing Header /Man. / 93• Aeration Dist. Pipe Holding Be4- system t -r- 2• (r PUMP /SIPHON INFORMATION F.he etl• �, Z, 3 • t Manuf cturer Demand St Cdver 9 p • 3S, r GPM . o Model NuNkzr TDH Lift riction Loss System Head DH Ft For in . Length Dist. to Well ce a S IL AB ORPTION SYSTEM ' OWALENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENS 3 �r,,�;•QS Z 1 SETBACK SYSTEM TO P/L JBLDG IWE LL LAKE /STREAM LEACHING Ma factur INFORMATION Type Of S tem: y SO t CHAMBER OR v F��S �Ih J• / 0 } UNIT Model Number: /t DISTRIBUTION SYSTEM Header /Manifold tt IDistribution Hole x Size x Hole Spacing Vent to Air Intake y Pipe s 4. Length u Dia Length Dia Spacing 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 �ed/Trench Edges Topsoil n , i� Yes D No ( 1 Yes r " °i ]N, 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 21 4 Inspection #2: Location: 882 167th Ave Somerset, WI 54025 (NE 1/4 NE 1/4 12 T30N R1 9W) Highlan �ot 111 Parcel N�: . 0. 9.13 1.) Alt BM Description = 51 ` l• 3� S`� �G •NS►f t� �11�"rY �tylQ r 2.) Bldg sewer length - amount of cover = rt ZIJ tai sfor — -- - -- -- - Use other de uadditional Yes No � �'` • - - -- - -__- -- - - -- �- - SBD -6710 (R.3/97) Date i� Signature Cert. No. r J' 4ti i1 I t Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S/ ceo / N y r sconsin , Madison, WI 53707 - 7162 Sanitary Permit Number (to be fill in by Co.) Department of Commerce (608) 266 -3151 0_ G Sanitary Permit Application State Plan I.D. N r C In accord with Comm 83.21, Wis. Adm. Code, personal informatio n may be used for secondary purposes Privacy Law, sl 1)(,6 +� Pr 'ect Address (' different than mailing ad ess) ... I. Application Information - Please Print All Information Property Owner's Name Parc 1 # Lot # Block # G A) ' eSs L. r 5 r. c(�olx G0 icE _ f /Jl rop�e Owner's Mailing Ad ss Property Location v / 1 v -f S�1. s w Tt l )V L ' /4, A) 6 '14, Section s City, State Zip Code Phone Number �0rr),6 _s.6 5 70 j � 7 is Q Y7 / R )e(c E oo ireleone) II. Type of Buildi T 0 N; (check all that apply) �.?jt/ �,� /, 1 or 2 Family Dwelling - Number of Bedrooms SubdivisionNa / me CSM Number El Public /Commercial - Describe Use q p �i` N t UW )OJA S []State Owned Describe Use ❑City ❑Village gTownship of A9! ee5e III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. bd New System y El Replacement System ❑Treatment /Holding Tank Replacement Only ❑Other Modification to Existing System B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision El Change of El Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that appl 19 Non - Pressurized 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 VLeaching Chamber ❑ Prip Line ❑ Grave)-lesA Pipe ❑ Other (ex lain) V. Dispersal/Treat ent Area Inf rm tion: `6, Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area oposed (SO System Elevation yso 1 7 1 6 1 6s3 47 0o VI. Tank Info Capacity in Total Number Manu acturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units j d/ /� /O� Concrete Constructed Glass t Existing Tanks ^� Septic or Holding Ta /V0O C��s /, . P /_ Aerobic Treatment U l.• P . Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ©� �c �11I i.� 3 7 6 U 71.s- s Y! -( �s Plumber's Address Street City State Zi de 616 _5o T i,/ /�t1E �o.ii�,c'sf% �1 SYDa2J VIII.ount /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing��A #, ntSignature (I`I S s) Surcharge Fee) Z Uv 5-12 Z �� ❑ Owner Giv n Reason for Denial Conditions o Approval /Reasons for Di pprovaI ( int 6 GamicQ?ri/ 4 1 1 t�,tGhav � . W! - A p n „ &u n n ttach c ple � omte plansr(to t e County onl Tort a syste o p o less than 81 x ches in size / W 4 t ( // - vv i UC/ v '_V_� �" ( /i(',R�1. SBD -6398 (R. 01103) /�o� I 7 f�.e t// 6 h'LAn�DS Lo i �l I. APOeoX� :arE _ Y' qNV ve,vr p�PE . i/4 00 - - - - -- -Q:� 3X- - TQEuC�ES 1000loa� S T —W ZAbdL .4 - /00 - - -- - 97 Rt- �eN�TE P DOSC'D W GLL 3 e ti R =- - -- - -- ecf� t -- Be0eo0.rl SCS}C E ! 4qo. - o �1. r /Oco ♦BM's - R nca Too -or y " ? vc. Oz. - �•yo - -- R w _ oqD - T- A) b ,6 ?i qAe 5u s Te /6o GU .r SYVS: _ - - I C) CC) u ie0L P��w _ Site. piagraw Legepd '. ..,. .. PROPERTY SILT ! ' f ! ' EXISTING STRAW .... . « ..y i 1 i 11 M1 MY t�llnvrr vIV1.11awN i FINISHED ll* MRVATIO N j I DRAINAGE 5 , I I � I A1016 STOCKPB.EO ! _ LIMITS OF TOPSOIL I i i vEGETATION 1 A I. PECIFICA ON A REA I , 14 LA • I : ' ' I . i 1 _ v ~ .M�.....� I v Oki i1 , : I , I • I , I , I i � I i • : I : ' I I 1 r h r I s .... ., ...E+4?'...d_ .... ! {... Vii... ; ....Tw ..., ' ...�_. _..I�•���'� - +b'.��.i- . •�.�...,�. ;�i._..--- .__�....� ...�.... , �.��t.�s.��'�.�- _.'�,....�.,+�' ..�r5''�IId+�Si j _ ST. CROIX COUNTY w-- WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 EROSION CONTROL PLAN (715) 386 -4680 • Fax (715) 386 -4686 For Lot 11, 882 167 Ave. (Somerset — owner(s) Grand Properties, L.P. 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." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion 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 excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. The diversion proposed between the designated HWL and construction areas must extend below the septic system excavation and must prevent runoff from allowing sediment to be deposited in the water retention basin. 3. If builder /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 silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the diversions and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector 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 for compliance with the ESC Plan. A detail for temporary diversions is attached. Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowledgement of ESC Plan requirements: / /2003 C 01 Py —Y— APveoxmpr¢ 7 x — ?7, -Y 4�6 i - (1-3x - (- , B.31 BroD m;-3 x 6,1/0 -re m,63 /000� Q W / ZAB�L A -ion 97 �4c-wNgcA , PRovosc w a'tL '2 i 3 ,% I 99 J� - scoot 3qo CIL A 1 701 ©: 3yy" PVC _ Et. , /00'0 A grn a A S 01 ;t TOR or yy ,PVC, 51. =' 98. 70 C� N Peo L_ P Pr�'T irS r 71.z �e,.P.4e®s .5u i wc) - 6�( /Sc): �c sY'OaS S`a�� « c'st: _ �v.r stops _ ____ POWTS OWNER'S MANUAL 8t MANAGEMENT PLAN Page of �� " FILE INFORMATION SYSTEM SPECIFICATIONS , �DNX Grand Pro ertie s L.P Owner Septic Tank Capacity 1000 al �'- Permit # Septic Tank Manufacturer Week' s C . P . O Nk 2 DESIGN PARAMETERS Effluent Filter Manufacturer Zabel ❑ NA Effluent Filter Model Number of Bedrooms 3 A -100 fJ" Number of Public Facility Units IR NA Pump Tank Capacity al ■ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ■ MA'�� Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer ■ NA,., Soil Application Rate al /da /ft Pump Model a NA; Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ■ NA" Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter. ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA s Biochemical Oxygen Demand (BOD 530 mg /L ■ In- Ground (gravity) '❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ■ NA ❑ At -Grade 13 Mound Fecal Coliform (geometric mean) 510' Cfu 1100ml ❑ Drip -Line ❑ Other: Other: Maximum Effluent Particle Size Y. in dia. ❑ NA. Other: ❑ NA' Other: � ❑ NA ' 'Values typical for domestic wastewater and septic tank effluent. Other: [3 NAB MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 ■ year ls) Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ month(s) (Maximum 3 years),. O NA Inspect dispersal cell(s) At least once every: 3 ■ year(s) ❑ month(s) , .i Clean effluent filter At least once every: 1 1p yearls) O NA; - ❑ month(s) ■ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) �wN Flush laterals and pressure test At least once every: ❑ earls) ❑ month(s) pNq Other: At least once every: ❑ year(s) Other: NA4' MAINTENANCE INSTRUCTIONS '~ Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cartificatbr • Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator.in inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or . measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the groundsur,. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for`arypon of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires a immediate notification of the local regulatory authority." When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume, the; accord with. chapter�:NR contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accord .., Wisconsin Administrative Code.'° All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreat) units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. Y . A service report shall be provided to the local regulatory authority within 10 days of completion of any service event _ �v Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tan k(s1 for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may - result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil, painting products; pesticides; sanitary napkins; tampons; and water softener brine. - ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant:; replacement system: ® A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS f technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the > infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE.OF, A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. . y r ADDITIONAL COMMENTS r POWTS INSTALLER POWTS MAINTAINER Name Owners choice Name John Schmitt Phone Phone ( 715)-549-6651 ,, SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Owners choice Name ,St. Croix Ct Zonin Phone Phone 715 — 386 -4680 n° This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code .`z r � T�, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t iC 6 -Pet) v,ceT /ES G N Mailing Address 7/ /DO Property Address >� (Verification required from Planning Department for new construction) 3 City/State Parcel Identification Number o 0 - O LEGAL DESCRIPTION / 3S3 Property Location J �JE r /4, A) E r /4, Sec. a , T 3a N -R I � W, Town of Subdivision I Ht 916#L ANDS 0032 2 Ito o Zgtq . Lot # Certified Survey Map # , Volume . .Page # An-a r Warranty Deed # Volume , Page # 7 ' d wx_a / Spec house P9 yes ❑ no Lot lines identifiable 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 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 days of the three year ex iration date. 57 /1 /D 3 SIGN TUBE OF APPLICANT 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 owners) of the pro erty descri d above, by virtue of a warranty deed recorded in Register of Deeds Office. Sll/o3 SIG NATURE O 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 J 2 2 4 3 P 15 2 7z 1(F>49 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO. W I Document Number RECEIVED FOR RECORD This Deed, made between 05/15/2003 01:00PM RICHARD 0. STOUT and .:T1�N -RT P. STOUT WARRANTY DEED hush and and ki €e EXEMPT Grantor, REC FEE: 11.00 and GR ANT) PROPERTIES, LP TRANS FEE: 171.00 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St Croix County, State of Wisconsin: Recording Area Lot 11, Plat of The Highlands, Town of Name and Return Address Somerset, St. Croix County, Wisconsin. Dick Stout ii 1353 Awatukee Tr. Hudson, WI 54016 'I 032- 2157 -10 -000 Parcel Identification Number (PIN) This iS not homestead property. (is) (is not) i ri i' ,i ll ii 'I r V1,l.1 h13Paa1 96 STATE 13AR OF WISCONSIN FORM 2.1999 t659SO4 WARRANTY DEED .!a HLEEN H. IWALSH Document Number REGISTER OF DEEDS 34. CROIX CO., UI This Deed, made between Thomas M. Boumeester and RECEIVED FOR RECORD Elizabeth C. Boumeester husband and wife, -- 10- 2.i -2001 8:09 AM WARRANTY DEED Grantor, and Richard 0. Stout and Janet P. Stout, husband and wife EXEMPT 0 CERT COPT' FEE: - -- - COPY FEE: TRANSFER FEE: 1530.00 RECORDING FEE: 11.00 Grantee, PAGES: I 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 NE1A of NE 1/4 and N1 /2 of SE 1/4 ofNE1 /4 of Section 12- 30 -19, St. Croix Name and Return Address County, Wisconsin. KRISTINA OGLAND ESTREEN & OGLAND 304 Locust 032. 2 -1 & 0 32- 2044 -40 Parcel Identification Number (PIN) This is homest — property. — (is) NX00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, i a Dated this day of October 2001 ` + homas M. Boumeester * _ + lizab th C. Boumeester AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas M Boumeester and Eliz C. STATE OF WISCONSIN } Bo umeester, husban and wi ) ss. qA- -.. _ — _County ) authenticated this (] of October 2001 / Personally came before me this _ day of the above named + Kristina Ogland - TITLE: MEMBER STATE BAR OF WISCONSIN - (If nut, to me known to be the person(s) who executed the foregoing authorized by§ 706.06, Wis. S[ats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Notary Public, State of Wisconsin H udson, W 54016 _ My Commission is permanent, (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) " Names orpersons signing in any capacity must be typed or printed below their signature. mo matioo 1`10teSS- 1+C—Pa y, F—d du Lac, W1 STATE BAR OF WISCONSIN too asszosi WARRANTY DEED FORM N a. 2 - 1999 05/06/2003 04:47 17152473622 PAGE 01 i r I Fax C over Sheet Date: #o# pages: (including cover sheet) To: Company: - Fax# 3 $ �' `�b�O Phone# Front: CA ( ] URGENT () CONFIDENTIAL ( ) PLEASE RESPOND MESSAGE. I 0. "LLL� T PK REIMAX team I realty 712 Rivard. St: Sprite 100 Somerset, WI 54025 Fax# 715 -247-3622 Phone# 715 -247 -5900 05/0612003 04:47 17152473622 PAGE 02 A. is Q rl log .�.� -r.:- Vic. -v–n • :.i.` _� ^•' �. .fir _ I — —�! . M Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St 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 Parcel percent slope, scale or dimensions, north arrow, and location and distance to nearest road. din Please print all information lew by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z (p 3 Property Owner Property Locatio 4 1 616k E34 S Govt. Lot /v E 1/4 A)t, 1/4 S( Z T 3v N R 9 E (or & Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I Tr. ll _ N; 1 nc 5 City State Zip Code Phone Number El City ❑ Village [5 Town Nearest Road ( 7I5) 5y4 -(o73P - samer� 170 Ave. New Construction Use: ® Residential / Number of bedrooms 3 — `7 Code derived design flow rate q-S 00 GPD F Replacement F1 Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: '5 ySkm 4---2 11� J 0 s L�0 X14. elegy. y3. 2 F1 Boring � /,.`-� �� N*Y • © Boring # ] ® Pit Ground surface elev. "r - 7 ft. Depth to limiting factor 11? in Soil Applica>io ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary s ( ':GP in. Munsell Qu. Sz. Cont. Color Gr. S _ 'Eff#2 h-4r C 5 1 v J-' S . 8 2 1- JD s r' c I 2rr�s b C. S - 3 8 1i 16 m s 3s 1 -- — �1 1.2 3 5(` / IT] Boring # ❑ Boring Pit Ground surface elev. 1 7- ft. Depth to limiting factor 1 l / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. S - Eff#1 'Eff#2 1 6-9 10 312_ -- 5' 1 2 CS ) 4 5 Z 9 -5 I yf --- Siel GS 3I- �9 0 m 1 1. . 3.S Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number ohm 5c.hvnna.ker Zs33 9 Address Date Evaluation Conducted Telephone Number 2 - l 13 9Y $4. Some W .5L/ozS /6 , 30_ 61 (71 .5)ZZf7-'y SBD -8330 (R07 /00) t 1 Property Owner T��) Parcel ID # Page of 3 1 -31 Boring # Boring Pit Ground surface elev. Q10 � ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 I *Eff#2 10-12 )0 y 312 Si Z rr�r c5 iv t r j 2 1 1 tvjr 4 Iq 5 c-1 2 rn -Cr C ei /i F-1 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 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 (R.07 100) PAGE 3 OF NAME TOT# LEGAL DESCRIPTION NZ X tiF ,S 12 T 30 ,N,R, l q E(or� SCALE: V= = -- BM I ELEVATION 160 6 I BM 1 DESCRIPTION Ap c e — BM 2 ELEVATION I'?� ? BM 2 DESCRIPTION 7jp Q p c `S � c ` l SYSTEM ELEVATION j Fo ALTERNATE ELEVATION f2, 96 CONTOUR ELEVATION 8'O i 6- 3 ( cl Ell Bd SIGNATURE DATE . PAGE 3 OF NAME LOT# LEGAL DESCRIPTION f)E Y tiF ,S 1 Z T 30 .N.R. l4 E(orl� SCALE: I — BM 1 ELEVATION /GO , Q BM I DESCRIPTION c� BM 2 ELEVATION t BM 2 DESCRIPTION N ,OyC i' D t 5 �c Z SYSTEM ELEVATION �U ALTERNATE ELEVATION 9Z. * CONTOUR ELEVATION j(o • br1T �. O NVi G�Z� pal 1 , 60 Easf P,-Z. B - I bT litre 3 (a zq� 33' SIGNATURE -------- DATE • 1 b v x I RV PIP WIA IL V , I T IL kp •K � �s j. r��r� :4 . , AIP Im It, W41A, wm ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 7210------ - `• - - EROSION CONTROL PLAN (715) 386 -4680 • Fa (71 SRB"� )2.3a•(�j 13 For Lot 11, 882 167`" Ave. (Somerset) — owner(s) Grand Properties, L.P. 1 -4 2003 Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach re sonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the buil 'ng pe 4ppliie and/or landowner to follow erosion control procedures and maintain them until the site has been abilizd&'` 0 The owner is responsible for notifying all contractors performing construction on this site that an Erosion 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 runcff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. The diversion proposed between the designated HWL and construction areas must extend below the septic system excavation and must prevent runoff from allowing sediment to be deposited in the water retention basin. 3. If builder /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 silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the diversions and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector 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 .vatPnvays and /or drainage !inches. 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 for compliance with the ESC Plan. A detail for temporary diversions is attached. Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 Owner acknowled ement of ESC Plan re uirements. S • �L `� /1,7/2003