HomeMy WebLinkAbout032-1020-20-200 Wisconsin Department of Comn rce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division j
INSPECTION REPORT Sanitary Permit No:
420416 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:
Hammon, Jim I Somerset Township 032 - 1020 -20 -200
CST BM Elev: Insp. BM Elev: BM Description:
a I /G� v S I, .
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
- rn /�1ed�1 v /as �?• S / /D. 2
Aeration Bldg. Sewer
Holding St/Ht Inlet
SZ a7 yi
TANK SETBACK INFORMATION St/Ht Outlet 5' 107A
TANK TO P/L WELL BLDG
ake ROAD Dt Inlet
c r
Septic I ! Dt Bottom - -� 14 1
S �' �
Dosing H er /Man.
Yp S Av� I 0 2 —
Aeration Dist. Pipe -rp 4- r t v 10 3 s
Holding Bot. System
O
PUMP /SIPHON INFORMATION Final Grade,
Manufacturer _ DeT and St Cover
GPM
Model Number /�
f'rnr !mod
TDH Lift Friction System Head TDH t
Forcemain L I. to Well
SOIL ABSORPTION SYSTEM f k
BEDITRENCH Width 3 1 Len th f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P /Le� BLDG WELL f r LAKE/STREAM LEACHIN
Typ Of System: Manufer: ' 1
INFORMATION CHAMBER O J 1 VL�Lf)
f t / /, UNIT Model Number:
DISTRIBUTION SYSTEM V ,�/ C, , n
Header /Manifo d Distribution L x Hole Size x Hole Spacing Vent to Air Intake
J + r �I Pi es
Length Dia 'T L ngth' Dia f � acing_ S4
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only .4
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center 3 .5-,+- , r L Bed/Trench Edges Topsoil j Yes 'U No L] YesL� No
`(
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: (� / / 6 _ 2 Inspection #2: / /
Location: 363 230th Avenue Somerset, WI 54025 (NW 1/4 NE 1/4 8 T31N R19W) NA Lot 1 Parcel No: 08.31.19.97B
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover = I
Plan revision Required? 4i Yes [ No /
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Sign ture Cert. No.
Safety and Buildings Division County
201 W. Washington Ave.. P.O. Box 7162 :s C
11 *isco�iin Madison, WI 53707 - 7162 Sim Address
Department of Commerce -10-0 L-- Gd -S 303 o?,36TR vE
Sanitary Permit Applica#ion Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal info . n yQU provide ❑Check if Revision
--- =Y be used for Priva Law, s 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name ! !) �r Parcel Number W
3A ft bm ' tom, �Cbti6
Property Owner's Mailing Address rry Location
y -�,y ',� �,�� 4°' V -A 99 %; S 8 T3 t N, R � E
City, State Zip Code Phone Number Lot r Block Number
Su ion Name CSM Number
qLwj
H. Type of Building (check all that apply) .. s Qv Swb ocity
01 or 2 Family Dwelling - Number of Bedrooms ❑Village
❑ Public/Commercial - Describe Use &- oownsbip -5
❑ State Owned �MM Nearest Road
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A For County use
1 R New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to
system I I Tank Only Existing stem
B. ❑Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(mi mbering scheme is for internal use)
44 U Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic TTcVment Unit 49 ❑ Recirculating 30 ❑ Other
V. D' eatment Area Information: ATOK.S
Design Flow (gpd) Dispersal Area Dispersal oil Application Percolation Rate stem Elevation Final Grade
Required Proposed* g Rate(Gals./Days/Sq.Ft.) (Min -fl-h) Elevation
dab 85
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plas[ic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank /� 0 ! /t;
nosing Chamber v
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans-
Plumber's Name (Print) Plumber's Si tore bey Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
Z (3 � 0"35 40k9-'SY1< I4/ S `YO
VIII. Cotmt /De artment Use Onl
Sanitary Permit Fee Date Issued Issu Agent Signature (No Stamps)
Approved El Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse 2 ,
Determination kp
1X. Conditions
� °A° Disapprov p` (, r
/(/ 5e tc +0 �d��� °r� �a.� ✓1n pis
see u .
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches In size
SBD -6398 (R. 05101)
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A iLOUC 'be o f SURNE STA 9L /
A aFr- FIPE
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Wisconsin Department of Commerce SOIL EVALUATION REPORT P a — / — Of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 81/2 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 rr�t o Re iewed by Date
Personal information you provide may be usefk;for\ 56 pure 'va Law, s. 15.04 (1) (m)). X7(0 �qp
Property Owner Property Location
RECEIVED �
Govt. Lot 1/4 1/4 S T_ N R E (or
Property Owner's Mailing Addr s I Lot # Block # Subd. Name or CSM#
M1AY
City Sta 6 Zip c�db;� Pho� ❑ City ❑ Village Town Nearest Road
( +�
® New Construction Use Residentila'1 Gob r o Code derived design flow rate S - GPD
❑ Replacement / ❑ Public or commerr i e:
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations: sys•ry �'� �'� '""`y /!J3'�
F/ I Boring # M Boring
,LJ Pit Ground surface elev. ft. Depth to limiting factor > &:C in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
�-� - J
Boring # ❑ Boring _
J0 Pit Ground surface elev. �_ ft. Depth to limiting factor 5 /iS in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
- s Y)C
J
* Efflu nt #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L I Effluent #2 = BPD < 30 mg /L and TSS < 30 mg /L
CST Nam (PI se Pr' ) r� Signature CST Number
Address Date Eva uation Conducted Telephone Number
SBD -8330 (R07 /00)
r
` T .
Proper Owner Parcel ID # > Page of
r v
EJ Boring #
❑ Boring t
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
d s c C
3 6�
� ri s
l
F-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 /ftz
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 /ftz
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 /00)
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CERTIFIED SURVEY MAP
Locolod it pert of the NOrlhwae! quortnr of tho Norinerwt 0uo'ter of Sactloo 6. Townehlp Tl North,
Range 17 West, Town of Sgmenw!. SI CrgN County WleconTt
Prepored for and at the redueet uf.
UIPI
Jonold Potting
3;7 7.�Otn Ave.
Sorneroet, Wi 54025
oro!teo ny llm Munn
Pftp ll T p LA Qs NORTHERS" CORNER
ScenJN 6-31 -19
(FOUND ALUMINUM
MONUKNT) t
-- 5897D'01'E6S24et' —••. ' %'"6E 58n'20'tl2'E6�52� A t
\, ':fti'r Rl Nr -/ __. ,� r?. �� N'CM t- Uf - *A'
1 41• ° x.91; r5 ,a g1'
L i //, rr,�•r_ y I
� iAL R.A:.��•:� 647.1
a307 $p ii %/�
�7, !�ij�/1
IHO
' I
i 1 I I�
' SB9'2A'07
>i 59163' a
Z Sri "•,'� ^/ >E o
LOT 2
� / , /�53
' 5 1
ACRES
ACRES' }
�ij; • /rri /�� /rr; d l
� NBB`33'44rW ' A ND
� 655,30'
y ^SOIr LINE Or "tE FUUkO 95 i IRON PIPE
NW 1 /4 OF Tt,E 11L ! /4 501''25`W .413'
UP�PLA7TE�_ LA TO COM 0 POSITION
NOTE: The parcel shown on this map is wbloct to State, County and
Townehtp Iowa, rubs and regulations (Ls. we Wnds, mintmum lat n124, occass
to parcel, etc.). Before purphosing or developing any parent, eontcct the St,
IrLGNh Croix County Zoning Office and the opproprioto Town 800rd for advice.
tb County Sectbn Corner `Aonument
of Record
• Sot 1" x 24' Iron Plpw weighing
a nlinlmurin of 1.13 poUndo pow
I'noar foot.
0 Found I" Iron Pipe
• • • ' BuAdtng Setbock I,Ine ( from R.O.W.)
C.9.A, Car.tlguous Buildable Aroo per Town of Someme!
za NO�TH
JOB N 057SU16
Prepored by.
JEC CONSULTING GROUP INC. SCALE IN FEET } nch " 250 feet
Phone No. k FAX (715) 246 -43'9 BEARINGS ARE RErrRENCEO TO THE NORTH LINE OF THE
108 Cost Third Street, P.D. Bair 325 NE 1/4 OF SECTION E. TOWNSHIP 31 N., RANGE 12 w.
New Richmond, WI 54017 WHICH IS ASSUMED TO REAR W'20'0:'E.
Shea I of 2
i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page �_ of
r
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner -Z�Z L,,,,` 4^^ti Septic Tank Capacity Z&O a l O NA
Permit # Septic Tank Manufacturer uj&45 O NA
DESIGN PARAMETERS Effluent Filter Manufacturer O NA
Number of Bedrooms L ❑ NA Effluent Filter Model --(v7 O NA
Number of Public Facility Units �"A Pump Tank Capacity a l P:NA
Estimated flow (average) 0l) g al/day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) CV gal/day Pump Manufacturer )ONA
Sod Application Rate al /da /ft2 Pump Model ANA
Standard Influent/Effluent Quality Monthly ' average* Pretreatment Unit O 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 )ZOn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade - ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ 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: ❑ month(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 cell(s) At least once every: ❑ yea (s)1s1 (Maximum 3 years) O NA
Clean effluent filter At least once every: ❑ month i�ye (s1 (s) 1 O NA
Z
ct um ❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
' ❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ yearls)
Other: ❑ month(s) O NA
At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying 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) 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 (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 S12 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-2
o 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 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
pump power to um
the effluent or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
�
restore normal levels within the um tank.
P P
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
e to p rovide a code compliant
If the POWTS fails and cannot be repaired the following measures have been, or, must bet ak n
replacement system:
k 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 faded 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.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone S-2 — 31 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name s Oto t � � ►1
Phone Phone .,
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.
I
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
t i Owner/Buyer JI M f1 R t M 0 N
Mailing Address T7 y T/4 Sit A 0 ,, � �{6 K �1,�'t✓ /� �J ss L G
Property Address 3 Co ob `Ip\ k)-4
(Verification required from Planning Department for new construction)
City /State �7i Eg 5c Parcel Identification Number 63Q /0 a b - d O - 60 0
LEGAL DESCRIPTION
Property Location /"W '/4, /"C- '/4, Sec. '� , T_3LN -R 10 �W, Town of �' 'OAA996& .
Subdivision , Lot t
Certified Survey Map # _ `E 6 , Volume IS , Page #
Warranty Deed # �oLOZ �1 , Volume , Page #
Spec house ❑ yes E no Lot lines identifiable Od 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
master 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.
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 ye3t expiration date.
GNATURE 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 ab e, by virtue of a warranty deed recorded in Register of Deeds Office.
S NATURE OF AP LICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being rev, ked 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
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 information._ r -- Reviewed by Date
Personal information ou p rovide may be used for - `
Y p Y _ ry purposeO(Privac� Law, s. 15.04 (1) (m)). ,Z(9 j j_
Property wner Property Location
a
n n' Govt. Lot 1/4 1/4 SS T� N R (or W
Property Owner's Mailing Address 0 — , Lot , # 1 716# 1 Subd. Name or CSM#
City State Zip Cod �? one Uml)er .; _ ° ° ❑ City [] Village 0 Town Nearest Road
New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material c /).yz Flood Plain elevation if applicable ft.
General comments
and recommendations:
a Boring # ❑ Boring
® Pit Ground surface elev. ft. Depth to limiting factor ,/-.n 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 I *Eff#2
3 �
s
� y
3 j
I
/
3.20
S
Boring # Boring
® Pit Ground surface elev. /fig d 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
t ,
WZ S t�
6 13.
* 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 (PI se Pr' t) Signature CST Number
Address Date Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
Property Owner l" 4�� n/ Parcel ID # Page z..:::,2 of 13
171 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
r
- At t�
❑ 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
F1 Boring Boring # ❑ Boring
❑ 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
I
* 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.07100)
9 - "2- 0--2�r,�¢
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U 1980P 52
STATE BAR OF WISCONSIN FORM 1 -1998 E� 9 10 -7 H 5 ALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number RECEIVED FOR RECORD
This Deed, made between David E. McMahon, Single , Grantor,
and James F. Hammon and Julie A. Hammon, husband and 09 -17 -2002 11:00 AM
wife , Grantee. WARRANTY DEED
Grantor, for a valuable consideration conveys to Grantee the following EXDPT #
described real estate in St. Croix County State of REC FEE: 11.00
Wisconsin (the "Property "): TRANS FEE: 682.50
COPY FEE:
CERT COPY FEE:
PAGES: 1
Recording Area
0 3 Z - lo to - 0-a — Name and Return Address
J mes Hammon
Ju Hammon
/ 2 , XX 30th
Sourer ownship, WI 54025
LAND TITLE, INC.'
SUITE 200
1900 SILVER LAKE RCAO
FILE NO. D �
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lots 1 an of Certified Survey Map filed June 28, 2001, in Vol. 15 of Certified Survey Maps, Page 4120,_ Document
9671 located in part of the Northwest Quarter of the Northeast Quarter of Section 8, Township 31 Nortrtt ange
19 West, Town of Somerset, St. Croix County, Wisconsin.
Together with all appurtenant rights, title and interests. NONE
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 26th day of August, 2002.
(SEAL) (SEAL)
David E. McMahon
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Minnesota,
) ss.
Washington County
authenticated this day of
Personally came before me this 26th day of
August, 2002 the above named
David E. McMahon. Single to me known to be
the person who executed the foregoing instrument
TITLE: MEMBER STATE BAR OF WISCONSIN and a nowledge the same.
(If not,
I authorized by §706.06, Wis. Stats)
THIS INSTRUMENT WAS DRAF ry Public, State of Wisconsin
Coldwell Banker Burnet -A%% ANNETTE D. THEIS
1991 Ford Parkway NOTARY PUBLIC - MINNESOMkj ommission is permanent. (If not, state expiration date:
St. Paul, MN 55116 140 My Comm. Expires Jan. 31 2006
2 -36321 ■
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis.
Sent By: ARDEN PHARMACY 8 GIFT; C -514820717; Auq -26 -72 13:48; Page 515
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CERTIFIED SURVEY
�' M A P
II
L=Acd In part of the Northwest quarter of the Noriydast 0acrter of Sdattorl 8, Tawnrhlp 31 North,
Rango 19 West, Town of Sornarset, St. Cralx County, Wlsaor aln,
Prepared rot and at the request of: - DR-; Ye W A y oo�
OWNER.
Donald Potting 4,p'7'.
355 230th Ave.
Somerset ,ll�n
, WI 54025 / !'Q/y7
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�D AREA kk, fi O -W $ HUPP
l 5 1.4 .33 'SO. PT. 2050
x13.12 ACR NEW
FiIC V
ST. OIX COUNTY
t 1�
a Ze&4 and pKkj cwwnallee � N$ta7'•'13'44 "W �
I
JUN p
SOUTH UNE OF THE 1N0 1 IRON PIPE
NW 1/4 OF THE NE 1/4 901'55'25`W 0.49'
,san dd ate apeap Chat; ! be a shi (� p . .� 1Vd5 7i0 COMPUTED POSITION
vaf
null and void NOV- The parcel shown on this mcp 1s sub at to Stets. County and
Township lags, rules and regulaVan4 (I.e. we nds, Mintenurn Iq .ate.: ,cccs>is,
to parraei, 44+j Before purchasing or devalop ng any parcel, Contact the St.
Croix County Zoning Office and the cppropric a Town Board for advice.
County Seetlon Corner Monument
of Record
• Set. 1" x 24" Iran Pipe weighing ef® Denotes Soli Test Boring With identification number
a minimum of 1.13 pounds . psr
Ilneor foot.
'3 Found i' Iron Pipe 1