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HomeMy WebLinkAbout032-1006-10-125 (2) 0 g ? \ 0 / § £ , \ E 0 # -0 ; e e — c . � ■ » B. « E . 7 � §i / 7 2 / / f 4 = \ $ $ S e © (\ 3 co a CD \ \ \ i k § \ CD ' 6 k :\ $ i CD } \ \ ( \ / > ( 2 Q ; 3 0- 0 g CD 0 © 2 y v > E % \� E 2 I ® R @ \ Uj \ 2 2 / \ CD \ z § § } c \ 0 r CD > CA o c 2 C/) \ / ( 2 \ E , ƒ » \ \ \ 0 \ < — z } - § m £ \ & > cr CD ° M (D ( D A . z Q \G 0 O & } 9 z � > a o \ 2 § \ ( )§ \• ( § < \ � a o = J } / B } 0 o m , \ 2 CD CL ° 0 \ CO ƒ \ _ # ` \D\ § / \\ -n \ R c 7g z % C D [ \\ \ / ; \ a K 7 W \ / / � < � ) . \ \ e o \ \$ «� o = 4 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitar Permit No: 479385 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal info"tipn you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's K e: City Village X Township Parcel Tax No: Eilefson, Jon I Somerset, Town of 032- 1006 -10 -125 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: L p b-- ' �� U ✓� S S S -�C�y� . 03.31.19.33A10 TANK INFORMATION ELEVAT DATA TYPE MANUFACTURER CAPACITY STATION t SH FS ELEV. Septic � o Benchmark l v Dosing 6 - � Alt. BM U- Aeration i /+f er S � 0 . St/Ht Inlet 3 , t70 TANK SETBACK INFORMATION SUHtOutlet s � -6- TANK TO P/L WELL Vent take ROAD Dt Inlet Septic ' b / 26 Dt Bottom /MS / Dosing Head gr /lyl i�� �G,_ v Aeration Di g.-Pip J e /j, / e •� Holding Bot. System k (�, Z i D l Final Grade PUMP /SIPHON INFORMATION r 5 `/S �-• d 0 a• / S Manufactur Dema St Cover Model Number ►/� Ip TDH Lift Friction s S m Head T DH Ft Forcemain Length ia. ist. to Well SOIL ABSORPTION SYSTEM i" BED/TRENCH Wid1 ; Length ! No. Of Trenches PIT DIME SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j SETBACK SYSTEM TO P/L BLDG WE LAKE /STREA LEACHI G Manu turer INFORMATION CHAMBER Typ Of System: ��� 1 Model Number. 5�VT I � DIS IBUTION SYSTEM 0�- A '�ieaderyAanifbld Distribution I x Hole Size / x Hole Spaci Ve it Intake Length < 1 L Dia Pipe en ` Dia i n Spacing ! w t SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only v►1 �td'S l Depth Over ( Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center (.� - J / Bed/Trench Edges Topsoil 0 Yes �J No ( Yes L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�// /) Inspection #2: Location: 581 Polk/St. Croix roix ad Somer et WI 54025 NE 1/4 NE 1/4 3 T31 N R1 9W) NA Lot 1 U( Parcel No: 03.31.19.33A10 1.) Alt BM Description �' , 2.) Bldg sewer length = 7, i - amount of cover U v1� A r — Insepctoes Plan revision Required? [)Yes [- No Use other side for additional information. Date Signatur - Cert. No. SBD -6710 (R.3/97) k I urldrngs r � S"T" C k of , , 2 a 1 W. Vi sc�. Marty 537 b2 Sarni Permit umber (to be filled in by Co.) z Department of Commerce ( j 3151 r " tee I.D. Nwnbrx SaWtary P4rn#t ApphcaIR In accord with Comm 83.21, Wis. Adm. Cale, personal informatiMI_ F- i� m CC�N aybe used for sawndary p nposm Privacy Law, si5.04(I ) �0N�NG OF FIC Address (if ditlerart than mailing address) L Application Information — Please Print AU Information Pro7dt' AwWs Name . 33A — o Parcel # ( Blo # _ vk E'L:L 5FSetil 03?-- 1 - 10- 1Z Property Ownces Mailing Addr+em Pioge yy Location la�5b Z 5c� 7 H �T K. AI's 1 r s City, state , -�, ,1 lk O V 1 /+ Zip Code Phone Number D / �(p r �' Section t � Zt� IS" -, Z J" -1 T 13! N- R _ 15 e E r ! IL Type of Bailding (check all that apply) CSM Nu m j Kl ot2 Family Dwelling -Number ofBedrooms s � ✓ �� ❑ 7V6 — g - Public; Canmcrcial - Descn'be Use ❑ State Owned - Describe Use ❑City ❑Vil1a��Iownshipo �DM� i IIL Typo of Permit: (Check only one hots on line A. Complete line B if applicable) j A. jtNew system ❑ Repiacaaent system ❑ Tm tmenua&hng Tank Replacement Only ❑ Other Modification to Existing System 4 i B. ❑ Permit Renewal ❑ Permit Revision 11 Change of ❑ Permit Transfer to New List Previous Permit Number and Aare Lamed rm i Before Expiration Plumber owner IV. TYM of POWT S S y - (Check all that a pply) t4 Non hW=md ❑ Mound?: ?A in of suitable soil ❑ Monad <24 of suitable soil ❑ At -Cane ❑ single Pass Sand Filter ❑ Cw0 ucted Wetland ❑ Pressurized 1wGround ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Racireulating Sand Filter ❑ Recirculating Synths is Meth Filter Leaching Chamber [ID-p)4- ❑ Pipe ❑Other V. DispemVrnatment Area Inibrmation: re'Vl S / Design Flow (Bpd) Design sail Application Rate(gpdsf) Dispersal Area Requ" (st) Area Proposal (st) Elevation .7 °7 A'71 WA 961/4 VG Tank Info Capacity in Taal Number Manurfacturer Prefab Site steel Fiber Plastic Gallons Gallons of Units Cooxde Glass > ( / — Tasks TO" Septic- HoWingTaak r U Aerobic Trestmat unit D-i9g Cbawbt• VM !! sponsihility Statement L the undersigned, assume realialAbift for' the Pown shawa on the attached pbaa. Phanbees Name (print) umber's S' Business Phone Number Plumber"sAddress (Street, City, State, Zi LT H4CIC_. go,)(- sz.'s \.%/I VIII. Ca rtmentUse Only 4 A ❑ . Sanitary Permit Fee ' Groundwater Data Issued Agent S (No Stan") 1°t s urcharge ❑ >orpomatl . o Z�s nc. conaitions p 3) wkkQ SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete liras (ter &eCumty oath) for amsyshm ea paper aoti� true 81iZ z li �a id tine SBD -6398 (R. 01/03) �o�.! ELCE Ilf� ��9 A 1 S 3 T 31 N�,2 94 W . �� � 250 -►- �1 � � N. t'atL�r Sotv�,E(�SE'T TWS�� b ,�C,EvLA wi 59d2d ELK RZ � ! ?I y 91 vJ�,�a tC,,,1260 G ���'KS TFlI� IC toq �o�.�� sZ �� ' s Pr ►'& i oz.4 $ � N ga)C) t Tbp 6 ')i " '1� d �o1L �oRltu US so- ALC I - dD ELLe !`Saty K f1 9 V9 �4 S 3 T 31 Iu& 1 q W zsn-r t� S T - t'AiZ'r s o��nE(�S'ET 'Tvr1S�, b A, wi • �59D2.b FbLk T, 0- 2o i -k Nlc�) _.. �Z P �S Z� 'lli f 60 G AL WleEkS TAO 1I� t3�nr� o wd, 'To � � T y ST �l 7 I oz.4 - -- l 0 70 d � o1L �oR1 W t� so ABC— i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety snd Buildings in accordance with Comm 85, c &!P my . C 1 �, Attach complete site plan on paper not less than 8 1/2 x 11 inc sins I n must include, but not limited to: vertical and horizontal reference poin (BM), direction and, � Pa I.D. percent slope, scale or dimensions, north arrow, and location an distan e t �eW 49. - Please print all information a ed by Date t4 Personal information you provide may be used for secondary purposes (Pr acy La , Property Owner ion �ph +. -- E r G 5 �,, i Govt. Lot N F. 1/4 1/4 S T 3 1 N R (� E (, W Property Owner's Mailing Addre�sg Lot # Block # Subd. Name or CSM# City State Zip Code Phone.Number ❑ City ❑ village R Town Nearest R ad sC-4 90 1 K if New Construction Use: IFResidential / Number of bedrooms L il l Code derived design flow rate C7 V GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material J C, I-N- Flood Plain elevation if applicable _ ft. General comments 17 S VS C $ R I'Gr� t—at g `•� ! 0 'r 4r i �•• r and recommendations: 'TA (9q. yp 1) T.3 ( 9 7.74') `�' + 4-e. o �- a, C 4Q , too', `5 `'te- a ` -r; Y Boring # Boring _J [ pit Ground surface elev.� V y JA ft. Depth to limiting factor Q S 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 0 -5 I y�3 S. F Sbx- �. a F • c S -gyp 1 to A-'Iq L a �. � • to ,� t(. L -yN 7,1S . • to C 5 t _S L I I t, l� -4 7 W-/ E] Boring 5b '� 2. �o`T n C 3U Coa�4.Q� ® Boring # �. Pit Ground surface 1 of •5 g ace elev. _ ft. Depth to limiting factor � 5 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. I 'Eff#1 'Eff#2 J - C7 a aLo j F i'f -3p �,S �. C t�,f I,)F Of 42 0 / 0, .e +� f� ' S Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mgkf Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature TAI I ` 1 1 Date aluation Conducted Telephone Number Address ;L u I Property Owner F•� -^P� J Parcel ID # Page of _ F- Boring # Boring r Pit Ground surface elev. �QO' y� ft. Depth to limiting factor y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 L a -5bkc dsV\ 14 - 3A - 7,51POW 0—S t— F U. v ® Boring # E Boring p l / LF Pit Ground surface elev.) �' � � ft. Depth to limiting factor f bS 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. I 'Eff#1 'Eff#2 to-7 d'tR 5; L- of w a '('V .9 ` s f ND-1 11513 5 D—sc' I j L 7 CS F-1 Boring # Boring Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Appli cation 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 (RA/W) to ICEYy� Se.c.. 3� - rar fj A I q a�C AA V �1, a a t - 7 1 to to 0 -raps C-b / 6-te-e-I PSM 1 loo.00 vLr��. �- hvr +�. Q V " o a Q�\Ll t 00� / I 6 0� I of � � SD V'f"� � v..t. � : ham' y9D• H5' i JUN.13.2005 11 :32AN AN `U0W "CORP N0.288 P.2 / �gCpNS� TV R �c f it DODGE i R "?S1639� M • ClEAR 4 AKE, 11 - 1 - ° VOL 19 PAGE 4889 •N •••`• "��`:R�, f 2 - 3 0 4 KAT IS�TF.R N. DEK05 it II CO. v CERTIFIED SURVEY MAP Locat i in the Froction it Northeast Quartsf of the Northeast Ougrter of Section " CE l RVE X&P 3, Township 31 North, Range 19 West, Town. of Somerset, St. Croix County, REC Moconsin; being Lot 6• of the plot of i View Acres, and Lot L,-of Certified Survey C' 3.00 Map Volume 19 Page 4176 as recordi'tt , the St. Croix County Register of PfO s 2 Deeds^ Offide, �- NOTE- The percels shown on this map or subs* t t State C my and township igws, r f��tes and regulctlorls e {f,e. �V¢µa1 3 m lot size, access to pbrcel etc,). Before urcha!? or'dev toping any parcei, ct the �t. Croix Count gnmq C7ffice and the appropriate Mn ow 86(,td for advice. �C. SEAM NUS ARE REFERENC 'PTO THE NORTH UN of 71 N 1/4 OF SEC11 TOWNSWiP 31 N., RANGE 19 W. WHICH IS ASSUMED TO BEAR N89'52'22'E. NO TH Y ?;Y/ Wy. _ PASO L71_ NOMPIN& CORNVae q�� �� 3T. Cf�A!X sea J ,�r —f9 `'� °Y —. ..L�`�^ (I'OU 0 ALUM. MOW.) _— N89'52 - "E 2604. _ 2'2 N89'S2'22 "E 275,28' --N89 52 — t _ t302.45' `� N89'S "E /"k `� 89'52'22" NOR7M�l.,l /s CMAWR i 275.28 . y ` ► m �I S£C. J J1 -19 L CENIE 02 2 „ 1= �_ ^ °�• ! NARW UW OF W E • N497NEAsr OU4RM? r "v PK NA( o �vcwos�o 3 ' DRl4LrWl r g,, ,.,�. 1 �:a.,. ........ A , . � ti I� v TO A L07'2 —� )� n i 7 6.92 7•G7AL AREA: (0 v N 209,272 SO. F;r h (0 r 4.80 A CRES oo t s c u _ — v 275.28' i 0 S.891W,2 "W 444.45' AREA EXC. R — W m l ' 29,2, J54 SO, FY ry \�'\�� 6, 77 ACl?,CS Let PROPERTY DESCRIBED IN DOCUMENT # !' 4T9 7 ' ' 235,62 N89'24'40 "W 715.38' 1 `- 3 A s exception use permit Is required for the / ! C11.4 r_1....1. POWTS OWNERS MANUAL & :PLAN _ page of FAF_INiFC1RAW110N SYSa 11'SP- EGIFICELIIOIYS= = Qvimer Capacity Permit _ 6 Tank p �S tic Tank • �P Manufacturer . O NA DE IGNl PARAMETERS Effluent Filter Manufacturer D NA fVe rnbeC of Bedrooms D NA ' Effluent Filter Model 0 NA N6�ber of - Public Facility •Ututs )KNA ' Pump Tank Capacity � NA gal • J`� Fsisated flow. (average) gal/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) Pump Mau�ufaciurar gaUday NA Soil. Application bate gal/day/ft' Pump Mode! Stmdard.influentlEffluent Quality Man f thiy..average Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑Sand /Caravel Fiber ❑Peat Filter 8iochemicat Oxygen Demand MOD,) 5220 mg/L ❑ NA 0 Mechanical_Aeradon ❑ Wetland Total Suspended Solids (TSS) E15 mg /L ❑ Disinfection- ❑ Other: Pretr eated Effluent Ouality. 'Monthly average Dispersal Ceff(s) -© NA Biochemical Oxyge'n' (BOD,) 530 mg/L ?kn- Ground (gravity) O In- Ground (pressurized) Total Suspended _Sol ids (T-SS) S30 mg/L • Q NA ❑ At- Grade. ❑ Mound Fecal. Colifoun (geometric mean) 51 W cfu/100ml � -0 - Drip -Line O." Other Maximum Effluent Particle Size Iv in dia. 0 NA Other: ❑ NA Other- ❑ NA ' other. ❑ NA `values typical for domestic wastewater and septic tank efftuam Other ❑ NA MAINTENANCE SCHEDULE Service Event .Service Friiency . 'Inspect condition .of tank(s) At least once every: 0 Year(s)(s1 . (Maximum 3 years) O.NA Pump out contents of tankis) When combined sludge - and scum equals one-third %) of tank volume ❑ NA Inspect dispersal cell(s) At "least once every: ❑ month(s) (Maximum 3 years) D NA years) Clean effluent filter At least once every: ❑ on tsj s ❑ NA Inspect pump pump controls & alarm At least once every: ❑`month(s) RA year(s) - Flush literals pressure test At least once every: ❑ nxxvh(s) NA ❑ year(s) Other: At (east once every: 0 months) D year(s) D • NA Other NA MAWTENANCE . INtSTRUCDONS Inspections of tanks and dispersal cells .shall be- made by an individual carrying one of the faUgwiRg licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, - POWTS Inspector; POINTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual - inspection of the tanks) to identify any missing or brokers 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 ca(s) shall 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 (3' 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 Admin'rstlative Code. All other services, 'including but -not lire ted to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 -shall be performed by a certified POWTS Maintainer. A service report shall be provided-to -the Jocal regulatory authority within 10 days of completion of any service event. GMW (4ffi1 I t:O AM OPERATION p age �� new xr, per m use of -the- POW chect . treatment tank f . .S cede " the treaunent I�a�•andlor•damage the- d�ersai cep °f pig prod or ot�. i the tardew removed - by a sept W -aer�nioing -OP er .p m use_ i f �s -are detected tw e.�. conte System start up shag not ocxur wtren. sop c=orxlitions we frozen at t'he infiltrative surface During Power -•pump tanks may tip above Mnnal highwater levels When . ds sal cetlts! - ba one large . dose, over loading the ceg(al and may result ,n l restor the excess wastewater wiff be eft To avoid: to the srltrafion have the contents of the a tank removed by a or �Sarge" of rest Pow tool e fflue nt Pump or fact a Plumber or POWTS MMaintainer to assist Servicing Operator pri to restoe g viiithin the pump tank_ - operating the Pump controls to Do- not - drive or park over tanks and d witfiin IS feet. down slope of o ceps. Do not drive or park over, or otherwise "dam or y mound or at -grade soft absocpticm are c ompact, the area Reduction � elimination of -� following from the wastewater stream may improve the perfo��� and "riP�: cigarette burns; condoms; cotton swabs d prolong the life. of the foundation drain (sump pump) water, fruit and vepetabte • Masers; dental floss; diapers; dminfectants; far testing Products; Pesticides; sanitary napkins: ��' gasoCme; gr ease; herbicides,. meat smaps; medications; oil; tampons; and water softener brine. ARANDONANENT When the POWTS fails- and/or is per►nanent(y taken out of service the - following step n compliance with 8 shall be raker to insure that the system is PmPeriy and safety abandoned i . - ogler Comm 83.33, Wisconsin Adtrwris'tr'ative Code: • All Piping to tanks and pits shall be di- 111nnected and the abandoned Rife oPenings sealed • • The contents of all tanks and pas shop be. ranoved. and property di sposed of by a Sefstage Servxing Operator. e After-prnTskng, all tanks and' . grave! .pits shag be excavated and removed or their crareers removed and the void another inert solid material. spa fined v++itt► CONTINGENCY PLAN lf. re the POW nt fans and cannot be repaired the fogowing measures have been, or. must be taken, to provide a code compGacn �ystern; . systeriL The.repiacemeni�area should an be utrT¢ed for the /oration of a r ep soxrPtion wired set fr g and Proposed str Protected from di and and -e fts. F- lu and should not. be infringed upon try in the need fora vatr ire, lot .lanes lts. Failure to protect the replacement area will site evaluation to estab@sh a suitable cement" area. Re�p�erit systems must comply with the rules in effect at that time. A" wAtable. rat area is not available • due to setback and/or sorT a hol limitations- Barring advances POWTS technology ding tank may be . instated as a last resort to replace the failed �. The "site has not been. evaluated to identify a suitable evakration must be performed to � 't area Upon failure of the POWTS a son and site locate a suitable replacement area. If no replacement area is available a holding tank nW- be installed as a" last . resort to replace the faxed POWTS_ ❑ Mound and at -grade sox absorption systems be r pYe surface- R �Y econsblrcted in Place #opwm og removal of the biorrtat at the of such systems must comPly with the rules in effect at that time. < <WARMNG> > - SEPTIC, PUMP` AND OTHER TREATMENT TANKS MAY CONTAN LE MAL BASSES• AND /OR INSUFFICIENT o xyG;E (_ DO NOT HYTH? A - SEP`M, PUMP OR 071iM TRPATMENT TANK UNDER ANY - CIRCUMSTANCES. DEATH MAY RESULT_ RESCUE OF A PERSON FROM THE INTEMoR OF A TANK MAYBE Du:RCULT OR !MPOSSISLE. Ab MONAL COMMENTS -POVM RiSTA r M Name POWTS MAINTAINER � • gfl Phone — 3t SEPTAGE SEFMCINC 0 'OR [PUMPS3t LOCAL REGULATORY AUMORiTY Name �+►�.- ,fin , Phone .. Name V '1 �F JU F %-A j J /10& fhis dowment was dratted in cmnpfrence with dlaPter Conun 83 .22(21(bt(1 14d1&tft an d .8; ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer IIA) aZ f� d /✓ Mailing Address 0 60 -;,S( Property Address I �Q K �a—A P Ky (Verification required from Planning departmem for new construction) O City /State Parcel Identification Number ° LEGAL DESCRIPTION � 33 / Property Location %4, +N� %., Sec. , , T N -R W, Town of SO w 4Lr& Subdivision , Lot # Certified Survey Map # _7 , Volume Page # Warranty Deed # - %3 SCE 9 . Volume - 2 Z Z- Page # 0 Spec house ❑ 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 mastor plumber, journeyman plumber, restricted plumber or a licensed pumper 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. I/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 Zoning Office within 30 days of the three year expiration date. SIGNATURE 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE OF 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 .U: 2722P 097 783539 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., MI Document Number Document Name RECEIVED FOR RECORD 12/28/2804 09:45AN WARRANTY DEED THIS DEED, made between Colleen Spencer a/k/a Colleen Jody Spencer EXEMPT # ( "Grantor," whether one or more), REC FEE: 11.00 and Jon T. Ellefson and Theresa A. Ellefson. husband and wife TRANS FEE: 228.00 ( "Grantee," whether one or more). CCPFEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Return Address That part of NE '/a NE `/< Sec. 3 -T31 H -R19W being part of Lot 6 of the plat of I View Ac d Lot 1 of Certified Survey Map Vol. 15, page 4176 described as v follow . Lot 1 Certified Survey Map recorded in Vol. 19 of Certified Survey S�fO otQ Maps, p age 488 as Doc. No. 781639. t�sCe o l't Part of- 032- 1006 -10 -100: Part of: 032 - 100640 -200 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated December 10, 2004 (SEAL) h OAQ Z _ 4 � (SEAL) * *Colleen Spencer (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Colleen Spencer authenticated on Dezember 10 2004 STATE OF ) j ) ss. COUNTY ) *Kristine O land TITLE: MEMBER StATE BAR OF WISCONSIN Personally came before me on , (If not, the above -named authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Oeland Hudson, WI 45016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type name below signatures. INFO -PROT" Legal Forms 800 - 855 -2021 www.infoproforms.corr i DODGE S -2484 1 7 8 1 6 3 9 ' : CLEAR LAKE - (a - �'� rvt rc t i ' I VOL 19 PAGE 4889 f,� ' SH OQcOpir' 12 - 3 - <b 4 - KATffCM H. AL SUFN "�� REGISTER OF DEEDS 1nlnnmmaar+ X . RECEIVED MR RECORD CERTIFIED SURVEY MAP 12/03/2004 0430OPH Located in the Fractional Northeast Quarter of the Northeast Quarter of Section CERTIFIED SURVEY HAP 3, Township 31 North, Range 19 West, Town of Somerset. St. Croix County, REC FEE: 13.00 Wisconsin; being Lot 6 of the plot of I View Acres. and Lot 1 of Certified Survey COPY FEE: 3.00 Map Volume 15 Page 4176 as recorded in the St. Croix County Register of PAGES: 2 Deeds Office. NOTE: The parcels sh wn on this ma or subject to State County and Township laws, rues and regulations e (i.e. wetlands, min (mum lot size, access to parcel etc.). Before purchasin or develop ing \C- any parcel, ontoct the fit. Croix County Zoning �ffice and tTie vL� appropriate own Board for advice. G BEARINGS ARE REFERENCED TO THE NORTH LINE OF \ 'li�Q \�O THE NE 1/4 OF SECTION 3, TOWNSHIP 31 N., RANGE 19 W. WHICH IS ASSUMED TO BEAR N89'52'22 "E. NO- TH _R TIRED SURVEY MAP VOL UME 16 PA GE 175 _ N01R7N£AST CORNER \S \ SEC. 3 -31 -19 \ i /''gLK1ST. CAIOYX 191�AD (FOUND ALU M OM) -N89' 52'22 'E 2 ' N8 2'2 N89'S2'22 "E 275.28' - N89'52'22 "E 1027.17'- - 1302.45' �� N8 " N89 "52'22 'E 440.45' E �� \ w TISVeT W 114 CORNER t W 275.2 " V NORTH L /NE OF 7HE 3 -37 -19 W CENTERLINE S0227 2 E ' NORTHEAST QUARTER (FOUND PK NA /L) O PROPOSED 33.03' 11 OR /VEWA Y N. �..... .1........ Ln \ .. / CA i Ili Ln la N LOT > r:, V J ,;, N i�l N ��,, TO TAL AREA r+i cn O ® � 301, 448 SO. FT . D D LOT 2 v I� N oil 6.92 ACRES C" TOTAL AREA: N la 4 g m °�° 209, 212 SO. FT, io x v o �\`� �� 4.80 ACRES al -- — o 1- 1 ru ov 27$' S89*52'22 "W 440.45' O r;L" . t0 13 AREA EXC. R O W.• OD_ 292, J64 SO. FT. ^� \C 6.71 ACRES CD 6 �'- PROPERTY DESCRIBED IN C DOCUMENT # 479.76' 235.62' _ N89'24'40 "W 715.38' I L.-Ol 3 A special exception use permit is required for the 5-/1d- disturbance of slopes 20% or greater not identified on t%0�.15 P the approved plat or CSM. This permit is applied for through the zoning office and is reviewed through a i5o 0 150 public hearing process by the St. Croix County Board of Adjustment. GRAPHIC SCALE NOTE: This map is exempt from Subdivision review under SCALE IN FEET: 1 inch = 150 feet CH. 18.05 (A) 3 of the St. Croix County subdivision ordinance. JOB # V4057SU29 -003 LEGEND Prepared by. Section Corner Monument JEO Consulting Group, Inc. of Record Prepared for and at the request of: Set 1" x 18" O.D. Iron Pipe weighing Phone No. (715) 245 -4319 Charles & Catherine Pinkerton O 1.13 pounds per linear foot Fox No. (715) 246 -3830 and Colleen J. Spencer P.O. Box 325 587 Polk /St. Croix Road • Found 1" O.D. Iron Pipe New Richmond, WI 54017 Somerset, WI 54025 ....... . Building Setback Line Sheet 1 of 2 Drafted by. Jesse B. Suzan (100' from Right of Way) Vol 19 Page 4889 • , _ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code " County St. Cro 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 I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pehd Please print all information. !ewe b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). Property Owner Property Location Charles Pinkerton Govt. Lot NE 1 /4NE 1/4 S 3 T 31 N R 19 X (or) W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 587 Polk -St. Croix Rd, na csm pendiag / b City State Zip Code Phone Number ❑City ❑ Village Town Neare Road Somerset, WI 54025 ( 715 ) 294 -3459 Somerset [ New Construction Use: ® Residential / Number of bedrooms 3 -4 Code derived design flow rat — s .` �� � GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material cwbaa sb Flood Plain elevation if applicable /` ,ty :�, ft. General comments ': s and recommendations: trenches @ el. 95.55', spaced to code 4.00' Belo, grade ❑ Borin g # Utl Boring 1 E] pit Ground surface elev. 99, 55 ft. Depth to limiting factor + 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2 1 0 -10 10 4 3 none L 2ms mfr 9W 2f .5 1.8 2 10 -24 10yr4/4 none sil 2msbk mfr qw i 3 24-100 7,5 4/6 none ms Oscr ml 2] Boring # ® Boring ❑ Pit Ground surface elev. 99 ft. Depth to limiting factor +100 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0 -8 10yr4/3 none L 2msbk mfr qW 2f 5 2 -21 10yr4/4 none sicl 2msbk mfr 9Lq 1f 3 4 -100 7.5yr4/61 none MS Os _ ml na na .7 1 2 ' Effluent #1 = BOD > 30 220 nVL and TSS >30 150 mg /L ` E ent #2 = BOD < 0 mg/L and TSS < 30 mg/L CST Name (Please Print) Sigff .CST Number Gar L. Steel ` 298 Address gEvaiu4on Conducted Telephone Number 1554 200th. Ave., New Richmond, W1. 54017 5 -8 -2001 715 -246 -6200 t Property Owner Charles Pinkerto Parcel ID # pending Page 2 of 3 ❑ &k Boring Boring # 3 ❑ pit Ground surface elev. 96.75 ft. Depth to limiting factor + 100 in — SW fl 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 1 0 -12 10yr4/3 none L 2msbk mfr gw 2f .5 .8 2 12 -27 10yr4/4 none sil 2msbk mfr gw 1f .5 .8 3 27 -10 7.5yr4/61 none ms Osg ml na na .7 1.2 # 0 Boring F]4Boring ❑ pit Ground surface elev. 97 . 8 5 ft. Depth to limiting factor +1 00 i n 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 1 0 -8 10yr3/3 none L 2msbk mfr gw 2f .5 .8 2 8 -19 10 4/4 none sil 2msbk mfr qw 1f .5 .8 3 19 -10 7.5yr4/6 none ms Osg ml na na .7 1.2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mg/L " Effluent #2 = B013 < 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 (RAW) STEEL'S SOIL SERVICE • Gary L. Steel 1554 200th Ave. GSTM2298 Charles Pinkerton New Richmond, WI 54017 MPRSW -3254 NE4NE4 S3- T31N -R19W (715) 246 -6200 town of Somerset csm N 1 " =40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 96.25' r - - y 2�J Gary L. Steel 5 -8 -2001 TYR DODGE ',• � ` 5 -2484 & 7 6 1 Er 3 9 OLEAR LAKE,,! f ! - 16 - ° ¢ VOL 19 PAGE 4889 WI iIALSH n N D SURVE�� ¢ RFEGIS OF DEEDS `ry /��ilr"nnnuunu�av�•� ST. CROIX CO. CERTIFIED SURVEY MAP MI RECEI FOR 12/03/2 4:0 8PK 004 04:00PN Located in the Fractional Northeast Quarter of the Northeast Quarter of Section CERTIFIED SURVEY NAP 3, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, REC FEE: 13.00 Wisconsin; being Lot 6 of the plat of I View Acres, and Lot 1 of Certified Survey COPY FEE.- 3.00 Map Volume 15 Page 4176 as recorded in the St. Croix County Register of PAGES: 2 Deeds Office. NOTE: The parcels shown on this map org subject to Stu a County tr7 u r and ownshi p laws, rules and re 4��tions i.e. wetlands, m nlmum -� lot size, access to parcel etc.). Before p rchasin or developing F any parcel, canto t the fit. Croix County p Lomng �ffice and the a r : appropriate Town oard for advice. MAR 2 9 ,! ° „`.1 �� BEARINGS ARE REFERENCED TO THE NORTH LINE OF s E 19 W. O F SECTION 3, WHICH IS ASSUMED TO BEAR TO RN8952 22 ANGE E NO TH SajVEYOR RECORD ���4� , L O T- CER T /F /ED SUR VEY MAP VOL UME 16 E, !GC 17f - NORTHEAST CORNER SEC. J -31 -19 \ ( /'aC.K1ST. C/7YX F�IOAO ( FOUNO ALUM. MON.) - N89'52'Z4 E. 2 _ _ N89'S2'2 N89'52 "E 275.28' '^ - - N89'52'22 "E 1027. 2. - -��� 13045' \ N8 "E �� `\N89'52'22 "E 440 45' w NOR 7H 114 CORNER `1 275.28' I r r j NORTH LINE OF 7HE SEC. 3 -37 -19 (A C£N7FRL /HE S0227 2 I NORTHEAST ouAR7£R (FOUND PK NA /L) O PROPOSEO 33.03' w ORl V£WAY . . \\ i �1 ?o ti �`;" �,,. • '., o to N ° CA Ln Ia N P � LOT > !V N u? ►\7 ���'� f ^I '� ri ��„ OTAL AREA m , n ®J 1/ � Il j .,�. 301,448 S4. FT. ® LOT 2 v I� i 6.92 ACRES U, TO TAL ARE N la ti rn , 0 209, 212 SO. Fr u' 4.80 ACRES OZ -, -- A 0 278 \�\ S89'52'22 "W 440.45' o X i 715.73- AREA EXC. R-0-W.' Olt 292,J64 SO. FT. 6. 71 ACRES PROPERTY DESCRIBED IN C DOCUMENT # 479.76' 235.62' _ N89'24'40 "W 715,38' I �-r A special exception use permit is required for the disturbance of slopes 20% or greeter not identified on the approved plat or CSM. This permit is applied for through the zoning office and is reviewed through a iso 0 150 public hearing process by the St. Croix County Board of Adjustment. GRAPHIC SCALE NOTE: This map is exempt from Subdivision review under SCALE IN FEET: 1 inch = 150 feet CH. 18.05 (A) 3 of the St. Croix County subdivision ordinance. JOB # WI057SU29 -003 )-EQ : Prepared by. Section Corner Monument Consulfing Group, lnc. of Record ' Prepared for and at the request of: Set 1" x 18" O.D. Iron Pipe weighing Phone No. (715) 246 -4319 Charles 6c Catherine Pinkerton 1.13 pounds per linear foot Fox No. (715) 246 -3830 and Colleen J. Spencer P.O. Box 325 587 Polk /St. Croix Road • Found 1" O.D. Iron Pipe New Richmond, WI 54017 Somerset, WI 54025 Building Setback Line doom Sheet 1 of 2 Drafted by. Jesse B. 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