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HomeMy WebLinkAbout032-2129-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix , Safety and Building Division INSPECTION REPORT Sanitary, Permit No: (ATTACH TO PERMIT) 515147 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)3. Permit Holder's Name: City Village X Township Parcel Tax No: Demullin , Shane M. I Somerset, Town of 032 - 2129 -50 -000 CST BM Ele Insp. B� Ele� BM Descriptjen�� Section/Town /Range /Map No: � V ' 6 �D / & - Ykl 13.30.19.1156 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3.8 Dosing r BB'll t. BM / Aeration dg . S ee / w ef P w !G Holding S Ht Ht Outlet Ind ,7 / / O/c �3 93.97 TANK SETBACK INFORMATION TANK TO P/ WE BLDG. Vent to Air Intake ROAD Dt Inlet �- 10 Xiff vS Septic f I Dt Bottom Dosing Header /Man. gyp, 93 Aeration Dist. Pipe .St' ia.3d 93. S Holding Bot. System W. 9z- Final Grad PUMP /SIPHON INFORMATION S .(o `f Manufacturer Demand St C IV 4 11 GPM Model Number 99. Ir TDH Lift Friction L ss stem Head TDH Ft Forcemain 177 Dia. Dist. to Well SOIL ABSORPTION SYSTEM M knt I BEDITRENCH Width Length No. Of Tren es IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS #71 Z SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHI G Ma ufacturer INFORMATION Type Of stem: CHAMBER OR ` UNIT odel Number: D BUTTON SYSTEM Header/ nifold Distribution x Hole Size I x Hole Spacin Vent to Air Intake Pipe(s) / �� Length__ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mo und Or At - Grade Systems Only Depth Over �t A IF Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center / JI Bed/Trench Edges Topsoil -� UU g Yes No Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 1571 89th Street New Richmond, WI 54017 (SE 1/4 NE 1/4 13 T30N R19W) Boardman Estat s of 9 Parcel No: 13.30.19.1156 1.) Alt BM Description — � ' `at'" 2.) Bldg sewer length amount of cover = Plan revisi,on Required? ❑ Yes No f Use other side for additional information. - Date insepctor's Signature Cart. No. SBD -6710 (R 3/97) commerce.wi.gov Safety and Buildings i County 201 W. Washington Ave., . 0aU62, i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co ) Department of Commerce State TransactiNumbyr Sanitary Permit Application In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental A unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Addres (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. Application Information - Please Print All Information J Property Owner's Name Parcel # Property Owner's Mailing Address , Property Location _ � pp'F1�E st pN�b Govt. Lot City, State Zip Code hone Number y, - % Section (circle one � II. pe of Building (check all that apply) Lot # T R _ E o 1 or 2 Family Dwelling -�Num er of Bedrooms Subdivision Name Block # �� ❑ Public /Commercial - Describe Usej ❑ City of ❑State Owned - Describe Use CSM Number ❑ Village of Town Of ytrlt�5 ¢� III. Type of (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner - IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mou 24 in. o uitable so* ❑ ou d� 4 i o suitabl soil ❑ Holding Tank 11 Other Dispersal Component (explain) a ent Device (xplain)" V. Dispersal/Treat ent Area Information: — Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s f) System Elevaon \ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U $ New Tanks Existing Tanks o U 2 Y ti CL U rn w A Septic or Holding Tank p Dosing Chamber VII. Reapo sibility Statement- I, the undersigned, assume respo tbility for installa jion of the POWTS shown o the attached plans. Plum r' ame Print k Plumber' Si MP/MPRS Number Business Phone Number 1 _ Plumber's A dress (Street, City, State, Zip Co ) ` VI It Coun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issued G� Is mg Agent Si atur mi ❑ Owner Given Reason for Denial $ / / S ` 9 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER.: q /zz /o � CG � ��~� �,✓ 1 Septic tank, effluent filter and dispersal cell must all be serviced / mlintainigd S � �� /b� bD S eff � as per management plan provided by lumber. 2. All setback requirAm qwu "b ?3q ftI' t*airLto and 't to the, m only n paper s to as per applicable code /ordinances. td SBD -6398 (R. 02/09) Valid thru 02111 Al pu o t Leco py / C,� --� �- � ` � ,� � � ��� � < �, �'� �N � � � � :� ,� � � � n �� �,� ' e o �� ,� � i � � � � �� � � � � � � � �� � �, ... �, a � C� � _. � � r� � ��� .� �Q .q tj crl .� ����. ,.� \ 7�- 1 � .� l ,N ti ,._� h �, � � -- � a �. � �. � �� o �� � � _� � 3 �.- � � ��� �� \° -' ��, ,.� Soil Absorption System Cross Section ft a 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 25 ft Leaching --► Chamber Im ft ft Soil Absorption System Plan View ft 29 ft { ft ambers Leaching Trench 1 Vent Or Observation Pipe Ch III I 4' Dia. Trench 2 Header I_eachina Chamber Specifications Manufacturer And Model ���� ►� y EISA Rating sq ft per chamber Soil Application Rate gpd /sq ft -�T gpd Design Flow Soil Application Rate + EISA = s f ZS — Chambers 2 rows of chambers each. Page of of 6 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page-z—of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 �� ( - 1�� - COD Please print all information. Reviewed b j Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).� Property Property Location � � Govt. Lo 1/4 1/4 S T N R E (or& Property Owner's Mailing dress Lot Blo Subd. Name or CSM# City Zip Code Phone Nurr n,G - � Qi��Na " r City ❑village R Town Nearest Roa New Construction User Residential /Number of bedrooms —3 Code derived design flow rate _ GPD ❑ Replacement ` � �blic or commercial - Describe: Parent material �`l2_ ,Grp Flood Plain elevation if applicable ft. General comments and recommendations: 1:11?V'14A0 7 / a Boring # R Boring t / f R pit Ground surface elev. ft. Depth to limiting factor ,�Q„ in. Soil Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Mansell on . for Gr. Sz. Sh. *Eff#1 *Eff#2 i _ 3 -3 s q 4 9 -3 - �0 � � s 9L• ' � '� l l 7 /r 1 Boring # F1 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 a -5-;/ n el 07 s 4 3 _ 4 * Effl it #1 = BOD > 30 0 mg/L and TSS >30 150 mglL * uo BOD < 30 mg1L and TSS a 30 mglL CST Na ease P ' Signature CST Number - Address ate Evalus on Conducted Telephone Number ., nTY� n�nn Tn^•Mn r t Property Owne Parcel ID # Page of 51 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. . nt. Color Gr. SX. Sh. *Eff#1 *Eff#2 q 9 7 6 r� ❑ Boring # ❑ Boring i ❑ 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F -1 Boring # F] El ❑ 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 * Effluent #1 = BOD, > 30 5 220 mg1L and TSS >30 150 mg/L * Effluent #2 = BOD 5 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 (807/00) 0 0 q Al h -sue POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - / — of FiLE INFORMATI SYSTEM SPECIhCATiONS Owner ; Q Septic Tank Capacity ga l ❑ NA Permit r Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 't _ ❑ NA Number of Public Facility Units J!� NA Pump Tank Capacity a l ,,O NA Estimated flow (average) ga(fday Pump Tank Manufacturer J1NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer -21-NA Soil Application Rate al /da /ftz Pump Model dNA Standard influent /Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) .❑ NA Biochemical Oxygen Demand (BOD 530 mg /L in-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) ; < W ctu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in di ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: months) y ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA inspect dispersal cells) At least once every: — .9 month(s) (Maximum 3 years) ❑ NA .� year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA 0 year(s) 'nsoect pump, pump controls & alarm At least once every: ❑ month(s) -4TNA ❑ year(s) Flush late-als and pressure test At least once every: ❑ month(s) R NA ❑ year(s) '= At least once every: ❑ month(s) ❑ year(s) ❑ NA ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carving one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined .accumulation of sludge and scum in any tank equals one -third (y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the contents of the tanks) 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. 413ANDONMENT 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. r 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 '.ONTiNGENCY PLAN (f the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 6d 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 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 /OR 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. kDDITIONAL COMMENTS OWTS INSTALLEV POWTS MAINTAINER Name Name Phone f 2 Phone EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone _ its document was dra` __t '- _-==ance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. FROM :ST CROIX CO PUBLIC HEALTH FAX N0. :7152468367 Sep. 23 2009 04:11PM P1 ST. CROIX COUNTY SRPTIC TANK MAINTENANCE ACREEMENC AND OWNERSHIP CERTIFICATION FORM C� )w�ne r /uyer � - bEl4t)j. IAJ _ 0 6�!f a Mailing Address Property Address _ / � (Verification required from Planning & Z.oni lh ment for new construction.) (:"ity /State _ ^( �`=� f � ) - �" "�'arcel Identification Number �Q ' Z/ Zof - GI C)Od ` LEGAL DESCRIPTION Property Location �� '/� , N et/, , Sec. 1 3 T . N R � � _ W, Town of ��"�.r r Subdivision flat: BO A S7 , L # Certilred Survey .Map # Volume , Page # Warranty Deed # _ � 3 z 110 ( f , Page # Spec house !.i yes i 1 Lul ling identifiable - ; J nu SYSTEM MAINTENANCE AND OWNER CFRTIFIC'A'1'tUN 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 pu nper. What you put into the system can affect the function of the sept tank as a treatment stage in the t � ate disposal crrt Owner 8 I� � maintenance responsibilities are 4mci tied in §Counn. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agree% to submit to St. C roi x County Planning & Zoning Department it certification form, signed by the owner and by a master plurmher,,jouracyman plumber, restrioed plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is it► proper operating condition and/or (2) after insluetkm and pumping (if nece3.sary), the septic tank is less than 1/3 full of sludge- 1 /we, the undersigned have read the above regWretnenu and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Dtpartment of Natural Resources, State of W isco %in. Certification slating. that your septic system has bftu maintained must be completed and returned to the St. Croix County planning & 7nning Department within 30 days of the three year expiration date. i /we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a wa r ranty deed recorded in Register of Deeds Office. Number bedrooms��i J �� !a?3 / 6c? SIGN RE OF APPLIC T(S) DATE - ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Deperuzient. ••• Include with this application a recorded warranty deed from the Regiutcr of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. !) OS) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O uyer Ne b l E�IW Mailing Address -( ' r3b X 3M _'of f Cj_s rj' Property Address 0 s (Verification r '. e (( l� `'P quire r d from '' Planning & Zoni g Department for new construction.) City /State U v � P 1� N arcel Identification Number 2/ Zl Go UGC) LEGAL DESCRIPTION Property Location Q<G ' /4 , NI '/4 , Sec. > , T _�dN R W, Town of �ltil f Subdivision Plat: 13( Lyl S_ , Lot # 1 Certified Survey Map # 9 P , Volume , Page # Warranty Deed # �D 3 2 l (o ?/ (bef )re 2007)Volume , Page # Spec house Ci yes Lot lines identifiable 111y/es�] 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 function 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. t /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms (q5n J / SIGNATURE 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) 1 liilli lilt! illli lllli lliil 11111 ilil ililil 1111 Iii! * 9 0 3 2 1 6 1 State Bar of Wisconsin Form 1 -2003 9032 WARRANTY DEED BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI Document RECEIVED FOR RECORD Document Number 09/03/2009 10: 45AM WARRANTY DEED THIS DEED, made between Barry Boardman and Gayle S. Boardman, husband EXENPT N and wife ( "Grantor," whether one or more), and Shane M. Demulling, a single person REC FEE: 11.00 and Wendy S. Erickson, a single person, as ' 10 ',n+ 4 TRANS FEE: 150.00 ( "Grantee," whether one or more). V PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach Recording Area addendum): Name and Return Address Lot 9, Boardman Estates, Town of Somerset, St. Croix County, Wisconsin Key Title, Inc. 126A S Knowles Ave. New Richmond, WI 54017 File No.: 9 -1551W 032- 2129 - 50-000 Parcel Identif N umber This IS NO homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, Restrictions, and Covenants of Record. Dated August 18, 2009. K. S FF � 1 Q- Barry Boar an NOTARY �9 ) Gay S. Boardman PUBLIC AUTHENTIC A �C� ACKNOWLEDGEMENT OF W15G Signature(s) STATE OF WISCONSIN ) SS. authenticated on St. Croix COUNTY ) Personally came before on August 18, 2009 Barry Boardman and * Gayle S. Boardman, husband and wife, to me know to be the TITLE: MEMBER STATE BAR OF WISCONSIN pets s ho executed the foregoing instrument and (If not, owle ed the same. authorized by Wis. Stat. 706.06) THIS INSTRUMENT DRAFTED BY: *T Seeger John E. Schneider Law Offices Not Public, State of Wisconsin Balsam Lake, WI 54810 My commission (is permanent) (expires: January 20, 2013 ) S natures may be authenticated or acknowledged. Both are not necessary.) ( IB Y �8 rY ) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED Copyright 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 Form s4tW"y: Automated Real Estate Services, Inc. - 800.330.1295 File: 9 -1551W Y saV c � Y � v r c • ,� 4 °Ca ' iasSS �'" �!s� tti�EaS1 QllARTER �ARt.4F, us€Asz+ut�RR �FE;,etsr �� �I� Af iN S&t�it�l !'�, �3YR�NP �0 NORM, RAKE I9 s�Sg' �ONM {1F AS�t �J �0'l� CtA1NIY, tNSG9t•1SIN ,� �,;�: �u+,' q s• tort 2wsr �rar u�r s:aoraSN a7tiv"[ sc�mab r 4 k 2 P M, A T . . . . . . . . . . . . iR Awl, »:7 ,�zat' msaisq usrooxrt S�niirN % +^�+a�.wW+a~ ' 1 � � 'M40 ag Ax , u" s>yb7aav maanrw :a�S,N s t,a �eP'+e ,p' - -Y+ ' E•i !tq t 70'INSS 51i'1ft5SV M'0', N1F�51E'N l W d 1L 0?�+a o✓'. Y. • X x`e i � c ��� uJ . '!l1.AY lela IA145` %91q'. _ rioMmYa !NiMN I5351'IS'1 ar rd5r -'ilea 21t ` Silt)¢QP` 5"a wru5dr S55sT>s^r wm3 wpro inM gm-gi -r� Z c A Y i i aY it au' arseyr slfiY SY �ASruTSM um'cvr +ROaaoarr� txdtr+baa. +�. t t a t?) 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ORES a �b400WOE 1.9 • ,�, ei �� vt 7 d t" 1, m1�'� �5 CJ a : �,�.: _ � I`. ft "VII •Ill ;}� {. � {y � � `, Nay F .� �u� 1r•$ N 01�'Y/j {�.C .�. �..»_ F 4 B U.T i ,,, } t � � .��ACAfS wxrtur e,rmruuwt r+avA.M1t � "� a a3 �. 15177 t AM 5K'Oq',�775777 77 7, 77 -77 � �,NPwATXFP 1ANr?5 T i " i 4 .Wisc6nsrn Department of Commerce SOIL AND SITE EVALU�YTION `-' 3 Division of Safety and Buildings Page of Bureau of Iritegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and J C ro percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # A - era -�- APPLICANT INFORMATION - Pleaq"p Tit,a#jf1jGrmation. Reviwed Date Personal information you provide maybe used fgr'sec6MaY rplirpo - tes.(P4' vary w, s. 15.04 (1) (m)). Property Owner r Property Location 1/4 , T 9 �" �R� 11 '� Govt. Lot , S E N 1 /4S E �� 3 0 ,N,R I i(or)g) Property Owner's Mailing Address Lot Block# Subd. Name or CSM# 7 ce q c ?" ` tV�4V f� C� �� d a n � s tef 6 t7 � m City State Zip Code Pf Q r, ber Village Town Nearest Road elu � / J ❑ City ❑ ® ,Griihona� j�l� 0 7 S ✓ SPA B (, /�, SOr�e�le�' l�p� a�e 91 New Construction Use: ©Resid'2r17 Ku rooms Addition to existing building El Replacement / [__1 Public or commercial - Describe: q Code derived daily flow O gpd Recommended design loading rate -7 bed, gpd /ft • `� trench, gpd /ft O Absorption area required S7. red bed, ft 2 " trench, ft 2 Maximum design loading rate • -7 bed, gpd /ft • � trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) r Additional design /site considerations 2 �� c s ,yr �v 1 -7 Parent material O �Z P1 �� / i �e� ©(J��Lv� r �e P�� /• *1 Flood plain elevation, if applicable /� ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ( S ❑ u ®S ❑ u 2 S ❑ u [�-s ❑ u ❑ S [2 u ❑ S ® U SOIL DESCRIPTION REPORT Borin g # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD 1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 2s 7 � f Mf tA- J� P . - 7 • O elev. y tt. yylll /rIA 1; 4- 1 * 7'b 8 Depth to limiting ` faTjor Remarks: Boring # /ns.6& q s 3c IfS-3l /oY� j /�i4 � 21f6 rrwl- c w Zh'1 . S 6 e Ground / �yZ 7rY� S /v 14 PIS of �"L C Gci Depth to limiting f actor Remarks: CST Name (Please Print) Signature Signature Telephone No. CAA 1 Address Yq p Date CST Number j /92 a J e �On, �ers� �- Gv_T '�- 2 s� 00 23/3 /Y PROPERTY OWNER pw�l SOIL DESCRIPTION REPORT Page 2 of ' PARCEL I.D.# L D T 9 Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 3-y 7 SY� 6 A yea 5- 05 M C G, Z Pn ,..7 � el v. Depth to limiting fg gr in. 0� Remarks: Boring # S Im M L, Cam= IV L /msbot ces 36 2 �2 7,sr�e 6 A/ A � yy i � S S m G c Z A „7 a Ground y7 -1 '7 S-, � /' S C7S In i- [ 7 ev. .Sft. Depth to limiting factor T ��q in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # p -� �Dy� % 4/,4 L.- �/it i yi-i L w -3 �7 �® 5 2 -/� IDy9� P14 s /�s�� r��, yes 3c y �.S 3 17 -3 m S' bsy /rig c �- 2 M ,7 fl Ground 7 3 6 7 , SW 6 /y 4 /7 Osf Pi J• Oft. Depth to limiting fact > k in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER Page 3 of 3 Name 9—a Brian Parnell Address 6'0 CST 23 314 *cw Date Y Z3;1-00 A Benchmark 1 �/e e IZ / A Benchmark 2 71 I E/. ❑ Soil Boring 1 -1 1- -1 Suitable Area F = 40' Scale L 0 A b N"I I I r2 UT 2 ! ; A h: 31 79 I j 4- 1 I! ii RES \- -- 1 / N P 04. +.�."" Y rN •' F9» F /'a!(f� N Y k' 'c '..!•.' r. < / / r ,;� ../ .1 } 1 , .. 2 95 XRE � •:� � �� � � � � 1 1 / �1 � �.; .�..�•— / " ,. r XT 344'0 SQ,FT LMPP 1(4,�O�AC�,ES s- 16068 F. T °o r /.t1C243 SQ,FT�� r - - ACRES >T�O BE R ��INED :BYE OVN�R ��.. _ �\ / / / �\ ..., %. �•� -- D ial � \ \ �� \ � )/ � ._... -� i / r Parcel #: 032- 2129 -50 -000 03127/2008 09:47 AM PAGE 1OF1 Alt. Parcel #: 13.30.19.1156 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 - BOARDMAN,BARRY BARRY BOARDMAN 1589 89TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 1571 89TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 5.740 Plat: 08- 018 - BOARDMAN ESTATES LOTS 5/15 032 -00 SEC 13 T30N R19W SE NE LOT 9 BOARDMAN Block/Condo Bldg: LOT 09 ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13- 30N -19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.740 64,700 0 64,700 NO Totals for 2008: General Property 5.740 64,700 0 64,700 Woodland 0.000 0 0 Totals for 2007: General Property 5.740 64,700 0 64,700 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 Parcel #: 032- 2129 - 80-000 03/27/2008 09:44 AM ` PAGE 1 OF 1 s Alt. Parcel #: 13.30.19.1159 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 - GUCKENBERGER, STEVEN J STEVEN J GUCKENBERGER 2371 53RD ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 1562 89TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 8.130 Plat: 08- 018 - BOARDMAN ESTATES LOTS 5/15 032 -00 SEC 13 T30N R19W E1/2 NE1 /4 LOT 12 Block/Condo Bldg: LOT 12 BOARDMAN ESTATES Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 13- 30N -19W NE Notes: Parcel History: Date Doc # Vol /Page Type 10/19/2000 632097 1552/251 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.130 76,600 0 76,600 NO Totals for 2008: General Property 8.130 76,600 0 76,600 Woodland 0.000 0 0 Totals for 2007: General Property 8.130 76,600 0 76,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 >e r T y >. • --.,. 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