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HomeMy WebLinkAbout032-2155-60-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: ` 420746 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Olson, Jon I Somerset Township 032 - 2155 -60 -000 CST BM Elev: j Insp. BM Elev: BM Description: Section/Town /Range /Map No: M ca 1 00, 6 - , r A 03.31.19.1341 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I 2 Z I OZ- tin, Dosing Alt. BM Aeration Bldg. Sewer `{= 3 Q Holding St/Ht Inlet `f 90 St/Ht Outlet TANK SETBAOCIN FORMATION 5 TANK TG P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t f Dt Bottom Dosing Header /Man. Aeration Dist-� .L- p Holding Bot. Syste � • PUMP /SIPHON INFORMATION Final Grade CL Manufacturer Demand St Cover \ GPM a Model Number TDH Lift ction Loss System Head TDH Ft Forcemain Length Dia. Dist. to W SOIL , P4kSQRPTION SYSTEM jo dlWBTtRENC Width / Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S & 2 9D , -3 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR pj i ov( t Type Of System: D �_ UNIT Model Number: DISTRIBU—T!gp SYSTEM Header/ anifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) y 1 Lengt Dia Leng Dia �ng 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 Bed/Trench Edges Topsoil Yes L' No [ ­ 1 Yes No - -� COM Z ITS: �thcude code disc a ncies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 512 23 Ave Somerset, WI 54025 (SW 1/4 NW 1/4 3 T31N R19W) Deer Trail Estates Lot 27 Parcel No:: 03. 1 1.) Alt BM Description = / T "s cAq�vw►�5 S e+c 2.) Bldg sewer length = 12 f to amo nt of cover = �g (- . - , r 'Lv,5gecv,. �. �s — 9r- I F - �- -- — - - Plan revision Required? Yes No Use other side for additional information. —_ —- - -- SBD -6710 (R.3/97) , ^ rQate Insepctor's Signature Cert. No. Sddy=dBMkr1nvDMsi0n Coeedy 201 W. %asbmgoon Ave, P.O Box Visconarn Miadson,Wl 5707— '7082 su - Neimb eoboftdmbyCa) DBgattlrleltt of Commerce (608)261 t7) Sanitary Permit Application _ stf� Plea LQ Number In scomd withComm 8321, Vim. Adn. Cade; personal kdonsodon you P avide may be used ior --day purposes Pnvacy L . slS AW)(M) Peat Addmm 0f t dun mW► L Applitsdan I —Plan PrhstAD Inforamtiea S/z 2 3 s A PImpettyou er'sName P" 0 Lot# Bloch saw 5-7r"-" 027 Pmpetty owner's Mat'mg Adams REeE L PtoplW iAcotion, -- cs .smte f 2 7 200 ,1 Y4. — Y4 SOCISM j r �.rO ll T N �ia�eleyne) i / IL Type ofd (ebedc aN tbatapply) � f �, � C,U � rd I , W � or2PamlyDwr�— NomberafBadmams Lf ZONING OFFICE IFame (SBdllmiba (7lobmaComsoucbd— Deaaal Vw d Cl steteow„ed— DesadbcUse ! UL TAn of Peradt: (Check only embalm NmA. Co eie s if ) " A. gystem g Sym ❑TImMmM.Wm Took R gty 11 odterMo ueoP�dstiagS�steat s. PamitBesmind gYWWR a ❑ fhmvof PaMhTraa�eDN&W ListPmvaoasP�itNamber Date 0 bsaed Befmggksdm Plumber owner �{ 20 --` G 6 * 17 A 3 IV. TVm ofPOVV1s antbut I amend 0 MosndZU bL efsuasble soil D Mound <24 m af=Mvble sail ©At-Cuade O MsalePass saad Pater 0 U Psessmimd la-Mmmil [3 HoMna Tsvk ❑ Peac Mer 0 AaabW TMUDMt Uj* 0 blows sood Mor 0 Me�La i 6er • t 13DjipL= Elamwwompio 0 0dwr(aplain) 2222 _ v Area I (lam D Dn Ares h (sQ S Pkvadoi S S� vL Takisfs ' in Tod Number der Poem a ft Paw Plastic c oft�s Cmc a Cow New > T=ks Taols SepfieorHotTaeE ^ (l JG t ilo3 �, �atsoaes� >b t1e sesame respsdy for bss�aa aftit P'OWl'S sYswa os t4e attaeied pdues. P7ambdsNarac(Ptieu) MP/MPRSNmnbac »Phm*Naosber 2io' p>m6d's1,*k=(S'tme%Qw. ) VIM Me offitty gA o DISMIMM011 +wed �►s s� Q opowagm Reason forDmial M CARS&M Disapprovd oomV&ftptss for dw symm psperns AM SBD -6398 (R 48/02) r ,on Olson Soil Test and System PLOT PLAN ---�- ADDRESS 4816 Bald Eaale Ave White Bear Lake Mn 55110 A14 1/4s 3 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX i A4PRS Shaun Bird 226900 3/18/03 4 DATE BEDROOM CONVENTIONAL X10C IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL +H,R.P. Same as Benchmark SYSTEM ELEVATION 96.5/95.8/95.1 4' below grade 446' Property Line EGrade Plans Designed Using >6 tandard Biodiffuser Conventional Powts of Cover eaching Chamber Manual Version 2.0 u ith 31.1 ft2 of Area :a 6' Lon i 3 4 at System Elevation 3 -3' X 63' Cells with >3' Spacing 0' Bz 40' 401 B- 20 , B.M. 0' Pro 4 Bedroom House 8' Vents B -3 10' 235' Property Line Soil Test and System PLOT PLAN PROJECT Jon Olson ADDRESS 4816 Bald Eaale Ave White Bear Lake Mn 55110 1/4 1 /4s 3 /T 3,1 r N/R 19 W TOWN Somerset COUNTY ST. CROIX n/ 3/18/03 BEDROOM 4 MrRS Shaun Bird 22600 DATE CONVENTIONAL XXX IN- GROUN6 PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.5/95.8/95.1 4' below grade 446' Property Line Vent Plans Designed Using Leaching Chamber Standard Biodiffuser Conventional Powts A6n Manual Version 2.0 with 31.1 ft2 of Area a� 1 " >, Grade at Sys tem Elevation 34 o ° N` 3 -3' X 63' Cells with >3' Spacing 0' 40' 40' B- 20' B.M. 30' - Pro 4 Bedroom House 8' 10' Vents B -3 235' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all inform rlp- - .,. e ' wed by Personal information you provide may be used for secondary A 15.04 (1) (m)). Property Owner. n ry � ���1.� �-✓ Govt. Lot 1/4 1/4 S T N R E (or W Property Owners Mailing Address ! ,�tl BI # Subd. Name or CSM# r f 4 4 ) �r1�1 9 City State Zip Code hon mber ; ;tQ City ❑ village Town Nearest Road New Construction UseResidential / Number of bedrooms Code derived design flow rate ti GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L'7��C14_;�,t_ Flood Plain elevation if applicable ft. General comments and recommendations: Oe, F/ -1 # ❑ Boring cn Boring Pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /^+ 'Eff#1 I - Eff#2 8 ® Boring # ❑ Boring A 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 J ? = �� `' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) g re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address DatLe on Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 "� T—,2_3 715- 246 -4516 I Property Owner _ Parcel ID # Page of F, Boring # �� ❑ Boring � Pit Ground surface elev. / ft. Depth to limiting factor J-2 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 2 k z 1 -� ,-s �- L • oZ AZ 8 F-1 Boring # E] 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 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. seo -8330 (R.&W) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420746 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Olson, Jon I Somerset Township 032 - 2155 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 03.31.19.1341 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet StJHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 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 Bed/Trench Edges Topsoil [] Yes [_] No � Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 512 235th Ave Somerset, WI 54025 (SW 1/4 NW 1/4 3 T31N R19W) Deer Trail Estates Lot 27 Parcel No: 03.31.19.1341 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [JI Yes [:] No I Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County t ,._. N viscons i n 201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)261 - 6546 % 10 Sanitary Permit Application State Plan LD.,Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / `t may be used for secondary purposes Privacy Law, sl5.04(1 Mm) Project (if different than mailing address) I. Application Information - Please Print All Informs on RECEIVED Owner's Name Parcel # Lot # Block # 0 is MAR 1 9 2003 Owner's Mailing Address y� Propertty Location !Y f 'r �� f 9iG� tf FUCE } S V 3 City, State x1p Code Phone Number - ''V.., � '' /4, Section T %!' N, R /Eu� II. o B f uilding (check all that apply) ✓ 1, Subdjx4sion Name CSM Number I or 2 Family Dwelling - Number of Bedrooms x�L���mt7� -� 4� / ❑ Public/Commercial - Describe Use o C !z ❑state Owned - Desrn f�'beUse 7' S- 3 ��Ire7lFit'U/.a� W i3 ty ❑Village ;p o f�,0 III. Type o Permit: (Check only one box on line A. Complete line B if applicable) a — 2 ( Sr _ A. ew System ❑ Replacement System ❑ Treatment/Holdin Tank � yes g Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. INve of POWTS System: Check all that apply) i GF(1 at - Pressurized In -Ground ❑ Mound > 24 in of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 4 ,h.g Chamber ❑ Drip Line Gravel -has Pipe ❑ Other (explain) V. Dispersalffreatment Area Information: 3 Design Flow (gpd) Design Soil Application Rate(gtoK Dispeysal Area Required (.9,1 Dispersal Area Proposed o I Syst�epyEle �D,� f VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units A /) Concrete Constructed Glass New Existing — z o o Tanks Tanks Septic or Holding Tank 1 2 -04 7 l Aerobic Treatmcot Unit Dosing Chamber VII. Responsibility Statement - I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. C Phunber's Name (Print) Plumber' SiAture MP/MPRS Number Business Phase Number y / Plumber's Address (Street, City, State, Zi ) i nun /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater �D ate Ts [suing gent Si o Stamps) ❑ Owner Giver Reason for Denial Surcharge Fee) 1 1 D dEm ns of Approval/Reasons isapproval M / ` Attuh complete plans (to the County only) for the system on papa not less than SW x 11 inch In Sim SBD -6398 (R. 08/02) P T PLAN PROJECT Jon Olson DDRESS 4816 Bald Eaale Ave White Bear Lake Mn 55110 501 1/4 j ( 1 /4 S 3 /T 31 /R 19 w TOWN Somerset COUNTY ST. CROIX 5-IrA.d — i ( , w s MPRS Shaun Bird 226900 DATE 3 / 18103 BEDROOM 4 CONVENTIONAL )00( IN- ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe 39 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P Same as Benchmark SYSTEM ELEVATION 102.4/100.3/98.2 Alt. BM Top of Lath @ 103.2' 446' Property Line Vent Plans Designed Using Standard Bio ' Conventional Powts >6" aching Chamber Manual Version 2.0 of Cover with 3 1. 1 ft2 of Area 6' Long 11 4 „ Grade at System Elevation Soil test was done to satisfy zoning requirement, test may not be suitable for owner's desired 45' B -3 building location Vents 0 6,- x/30' ents 30' T 0 , Pro 4 Bedroom House B -1 B -2 15% Slope 3 -3' X 82' Cells with >3' spacing 'fi - ha ri r7 W( 14_s Cy F r� 150' Q U Alt. .M. B.M. 235' Property Line P T PLAN PROJECT Jon Olson DDRESs 4816 Bald Eaale Ave White Bear Lake Mn 55110 SV v 1/4 i /4 S 3 /T 31 /R 19 W TOWN Somerset COUNTY ST. CROIX S-h�Ct dd (.a-s %{ It hts 3 4 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL )00( IN- ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe s 39 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 102.4/100.3/98.2 Alt. BM Top of Lath @ 103.2' 446' Property Line Vent Plans Designed Using ALong Standard Biodif Conventional Powts aching Chamber Manual Version 2.0 with 31.1 ft2 of Area a� 1 " 3 4" Grade at System Elevation o Soil test was done to satisfy zoning requirement, test may not be suitable for owner's desired N 45' B -3 building location Vents I 0 30' ents 30' T 0 , Pro 4 Bedroom 1' House S , B -1 90 B -2 15% Slope 3 -3' X 82' Cells with >3' spacing 0 150' Alt. .M. B.M. 235' Property Line ST CROIX COUNTY 7 of 6 . SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address LAZ Property Address (Verification required from Planning Department for new construction) City /state S Parcel Identification Number LEGAL DESCRIPTION �' . Property Locatio� i /,, �' `., Sec. W, Town of Lot # Subdivision 4 � � � � s; Certified Survey Map # , Volume Page # Warranty Deed # 7 ) c�. q a . Volume o2 Page # Spec house ❑ yes_ no Lot lines identifiablexyes ❑ no SYSTEM MAaVTENANCE tare failure to handle wastes. Proper maintenance improper use and maintenance of your septic system could result if its prema ded by a licensed pumper. What you put into dte system consists of pumping out the septic tank every three years or sooner, if nee can affect the fiction 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 forum, signed by the owner and by a that (1) the on -site wastewaterdisposal system masterplumber,, journeymanphimbe4restrictedplumberoraficensedpumper v erifying 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 yo ur stating that s tic has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ep system days the three ear expiration date. DATE BSI TORE OF APPLICANT OWNER CERTIFICATION ( am) the owner(s) of I (we) certify that all statements on this form are true to the best of ter of Deeds Office I (we) am ( the p described above, by virtue of a warranty deed recorded in Register ATURE OF APPLICANT « « * * «* 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 11 // Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 kc W Department of Commerce SOIL EVALUATION REPORT Division of Safety and 8ulldings --- In accordance with Comm 88, Ma. Adm. Code 1 ' j WffOft AGich tlf 08n On paper not lass than 81/2 x 11 Inches in size. Plan must County ►_ ►�' 1 �� include, but not limited to: vertical and horizontal reference point (BM), direction and L x percent skape, scale or dirriensions, north arrow, and tocetion and distance to nearest road. parcel i. D. � TY Planet print all lnformat/on, P~81 imbW Orlon you PrOvlde may he used ror secondary n*j" (Privacy Law. e. 16.04 (1) r_ Z �Z Z� tA�ner Property �U cation Mid _ Govt Lot 1i4 M !T4 S 3 T N R E (a Property s Mailing Address Lot # Block # Subd. Name or CSM# City tats One Number Y- ❑ City ❑ village - own Nearest Road ci, �1 da y New Construction Ll" Resldentifd ! Number of bedrooms Code derived d si n t1o►v rate -��y,L,. v 7 Gpp ❑ Replacement ,e � ❑ Public oorrinwroiai - Describer Parent materiel . tJ �_� = Flood Plain elevation if applicable N / ft General cwrwaants -- and ncarnmandetlana: v, S +'� elf, J (�3 119 1f((32, rcx "r /Q 4 J ID mating # � 2 Pit Ground surface elev. _..� Q ft. Depth to limiting factor d in. tior�On Soil A loatton Rate Depth Dominant Color Redox Description Texturo Structure Consistence Boundary Roots C31 In. Munseli Qu. Sz. Cont. Color Gr, Sz. Sh. fill •Eff#2 + 101f r s M C r l S Os� Boling 0 ❑ Boring 2 . 0 Pit Ground surface elev. �_ it. Depth to limiting factor �.� In. Soil )Mication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 2 ` Effluent #1 BOO, v 30 _-c 220 mg /L and TSS Z3 < 1 so mg/L " Effluent #2 = BO D, 130 mglL and TS5 30 mylL CST (Pisces Print) Sign C Number Add ress ` Date Evaluation Conduated Telephone Number `OJ - -f SOD -8330 (R07 100) 4,bf2 - � Property Ows',ev Parcel ID # Page of Boring # Boring pit Ground surface elev. J ft. Depth to limiting factor in, Soil Applicator Rate Horizon Depth Dominant Color Redox Deserlptlon Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Ou. Sz. Cont, Color Gr. Sz. Sh, *Eff#1 *EfI#2 j cl mti Al I I I 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 Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I Boring # Borin ❑ q ❑ Pit Ground surface elev. ft Depth t0 limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD•8330 (8.07100) Soil Test Plot PI Project Name Kowski Farms Inc. S Bird Address 6A 260th St. Osceola Wi 54020 STM #226900 Lot 27 Subdivision Deer Trail Date 11/17/01 ,5 1 /4 L� V� /4S 3 T3 N /R W Township Somerset FJ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 102.4/98.2 *HRpSame as Benchmark Alt. BM Top of Lath @ 103.2' 446' Property Line a� Soil test was done to satisfy zoning requirement, test may not o be suitable for owner's desired c building location 45' B -3 105' 30' ksl I ° 103' 15' 90' 101' Z,,d B -1 B -2 15% Slope 150' Alt M. B.M. 235' Property Line J x 982.7 980 3 A ANDS OF NE -- -- ----------------- - - - - -- - - - -- - / _ ONE D AGRICULTURAL_ / 980.6 x x 9 ^0 981.5 P RY 9g0 T 7 $i ' UP - - - - -- - - -- - - -- , 8 15 x 15 6. 8' -- - -- - OP Ock PQ - --- - -� - - S , „ � ( - 1 ) 4f62. 0' All b/ i '' ' ' 973.7 � ' x X75.5 Q O 960 $ y 00 8� x 3.00 A CRS ' Y ''- / 958.6 13068 S FT. ' x 960 95 7 ® �! x 3.4 5 4 5 962 8.9 , // •c� 54.6 • .. ' 7 EAST /NEST R UAN�; : C N / 9 56, : ... =:;' ?A:: :r::: :::: L W /4 E. S8 E 5 5 ............................... 9 60 58. y��P Lo .8 I J? 0" CRE,S ' o 4 ` 01 - - 5 �o ?� s. 131051 S� 727' j 0 �r # � R „ I ,* ' 7$ rt- �97s 9�0 \ ' 00 \\ IN. F.F. 9 4. ' x 1 �� .�� 980.8 r �............ . 04 . x 977.2 O 1 5 "�9. 2 1 6 9 C 3 7 9 7 1 2424 • STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between P. C. Collova Builders, Inc., a Minnesota Corporation, 03/07/2003 11:00 EIIEIPT tt Grantor, and Jon A. Olson and Anita J. Olson, husband and wife, REC FEE: 11.00 TRANS FEE: 128.70 COPY FEE: CERT COPY FEE: PAGES: 1 Grantee. 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 Lot 27, lat of Deer Trail Estates First Addition in the Town of Somerset, Name and Return Address St. Croi County, Wisconsin. 0 3 10 2U 1 Part 032-2155-60-000 Parcel Identification Number (PIN) This is not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this` ( day of March — 2_ P. C. ilders, Inc. * 4 - C. C. Collova, resident * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. -- St. Croix County ) authenticated this day of Personally came before me thi day of March 1 2003 the above named P. C. Collova Builders, Inc., a Minnesota Corporation, by P. C Collova, President TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me own to be he on(s) who executed the foregoing in u d a n I d the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * , =L / Attorney Kristi Ogland _ Notary Publi State of Wisconsin Hudson, Wl 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I Z ) * Names of persons signing in any capacity must be typed or printed below their signature. i �@yp�,P ssionais company, Fond du Lac, 1M WARRANTY DEED STATE BAR OF WISCONSIN Tracy L. UI111 800 FORM No. 2 - 1999 Notary Public State of Wisconsin 2,34.57 1 6642 L --- - - - - - -- -— • ' `� Z - -- i - ------------- RIGH r of WAY 50TH S n?jr)r co OD 06 th C) V� �� f ; ........... Z rn \1 ol —A V) `� ` I OD X (D �� X X N c \p V x F C: Z- 54 rn Ir —4 ss 0) rat -(S O*. > m N z U) 00 0 NO2 289.90' i z rn ` � V O th %MAW% ob 09. 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