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HomeMy WebLinkAbout032-1030-50-000 . 0 r 0 ) / � � ; ( ¢ & ■ � k 0ƒ 7 E/ E E S A - f i i i m E §} 2 m C G ® ° Q \ \ \ } CL c ° k k k � ; c ) 7 / co CL a) \ § 2 2 / po 4 ƒ » « $ o [ \ \ 3 \ § E [ �, a m @ CL (D v / ^ 0 0 0- > . § < z § C § @ 0 CO) CO) i / > :3 $ E J ° co - E 2 ° 7 E (D k . z a / m z e , e o g C CD 2 7 / § Qum 00. E ;!!am / / \k�� �N \ �— j ® 5 z 6 / \ @ / � � ■ � \ E ± « 0 r k Z 0 . 0 k \\ 06 ��$ ° m 0£ \ ik E§ $q 0 § / \ 3 ` D \ � A § ! )C ƒk ) }JA\ �a o (n c ( D ° RG % / § A ƒ � £ / \ 3 $ � / \ D § d 3 ® C ¥ 0 / \ o » _< k \ $? �w ! EQ ! �k � 0 fA O m-D n 0 :E d o m C (D a v c • v s m Cn M Z y Z oD a w vi m o ` O €A _ CO S. � � m 7 co Cb W C rn O m CL o A 3 a i o D o 5 w cn 0 o p !\ d c ] m m V D m a CL CL V oD c ° o o o m n'> 3 oa w r . a) i CD N N m m co Z o f ° o ° o o n r Vi CL 3 N ^ a m a @ � N m m m fa u A O O O O rr o 0 m E N y N cn . D m N O. O' 'O O O O Cn m m _ o a m A N � � � A 7 7 a ` z z o D o n AWN 7 0 = !V j 0 CD Z y. N O y h• p CD m l l V � p N m m CQ N '{ C 7 N C S CD w � a �' m w a a O a n CCDD '0 -I y O g r f 0 N 0) co Z m +i CD y 0 _ _� M 4t N (D A CL o a 3 m m y Cf) -i N' W T Q CD C z Z y p Z1 N N p ^" Z c¢o O y m < 7 m A O w N w = ma y D 3 y O y O N C:)< CD C a CD y C a• CL (D m a� co m 3� Q G a N aN m3 C CD n :0, 0 N a D y v C o m 3 Fro.0m m z a �o �m m O w c N . . m N N n *• CD y OZ (D y a y 2 o a C =1 -0 O K N y G �. O a > a O ` O 7 N m �,�c 3 � _ h p fn C N M m O 0 O m " o ak a o ate. > > a y m � ? mm�o�•dC� 3 '_ Cr a -0 m m CD O C aCD y N C N m O 'O O O i CD y � O O 3 a V 0 A I O m D'0 V 0 a) 0 v Cq O o CL `' Parcel #: 032- 1030 -50 -350 03/26/2008 04:20 PM PAGE 1 OF 1 Alt. Parcel #: 11.31.19.146A -40 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Historical Date Map # Sales Area Application # Permit # Permit Type - -� 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BEMIS, DANIEL J DANIEL J BEMIS 655 LAKESIDE LA SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description *LAKESIDE LA SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 21.280 Plat: 4320 -CSM 16 -4320 SEC 11 T31 N R1 9W SW NE LOT 5 CSM 16/4320 Block/Condo Bldg: LOT 5 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11- 31N -19W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 235,300 283,300 NO AGRICULTURAL G4 10.000 900 0 900 NO UNDEVELOPED G5 8.280 16,600 0 16,600 NO Totals for 2008: General Property 21.280 65,500 235,300 300,800 Woodland 0.000 0 0 Totals for 2007: General Property 21.280 65,500 235,300 300,800 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch M 553 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Gtr;a- ► To �e,r�c_ Boh oil D"��"Q� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I _ 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. ' D 3 O — o o d o Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location , t Govt. Lot SL3 1/4 1/4 S T 31 N R I I E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /-, ay G S W A L 4 �'i �.. City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road Sow►c�S -' ` bilt i SY0ZS i ( 715 ) -37)4 Or ,� w -�" 1.�We- 5�S,e ❑ New Construction Use: ®. Residential / Number of bedrooms Code derived design flow rate GPD fA Replacement ❑ Public or commercial - Describe: Parent material q, C i �. p a� "t't..��i t Flood Plain elevation if applicable ft. General comments and recommendations: M M -t' C 9S T -Y , Boring ��yG Boring # p Ground surface elev. Q Q .7 ft. Depth to limiting factor i / 1 ® Pit y P 9 �S1— . _ icat bn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary o s GP /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I *Eff#2 I p3 I 1•a9 (2„`i) c.l_amsb M �(� I� S o 5 I L G L ► �� / a - 9a �,5y s o - 7 t . .. Boring # ❑ Boring Pit Ground surface elev. loo. 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 �.I 7,S`� � y - zM g b bt* hn r 5 w 14 -63 7's 4 1 1 0h - ° - 0 -� CIA-) .� '� 5 yRy y � � 7,5`1 �1� :rc c� S t .. ...�' ._,_.' • � � �,v * Effluent #1 = BOO > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number Address � t Date Evaluation Conducted Telephone /�►[ Number �/I(� 54, it 10 SBD -8330 (R07 /00) Property Owner Parcel ID # Page of 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 GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /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) r 3o- 3 Sw Vl ME /y� Sac. lo A; R.19 uJ r "D ©n ', $ ..,� N SC.• I �: y0 C3 + M A" .�.ww�wrrr.�rw�s�r�i.rwM ,f hor u �,tia< 1 . \ol P 61 1 t� 1, ! �_._ .p _3.$.0 • r. AD Jv 3 +y k) Z�4 � oa ?'►'' 100. 35 r ` } t kor:Z, .. P 4- r�►.. 99; 35 f3a5� w�Gh-t• doer ,: t f3 t.. ...... NiL. uu .�..,...o.....,.......+....M.•. i 13S /00 .3;t Parcel #: 032 - 1030 -50 -350 05/25/2007 04:49 PM PAGE 1 OF 1 Alt. Parcel #: 11.31.19.146A -40 032 - 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 - BEMIS, DANIEL J DANIEL J BEMIS 655 LAKESIDE LA SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description *LAKESIDE LA SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 21.280 Plat: 4320 -CSM 16/4320 SEC 11 T31 N R1 9W SW NE LOT 5 CSM 16/4320 Block/Condo Bldg: LOT 5 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11- 31N -19W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 235,300 283,300 NO AGRICULTURAL G4 10.000 900 0 900 NO UNDEVELOPED G5 8.280 16,600 0 16,600 NO Totals for 2007: General Property 21.280 65,500 235,300 300,800 Woodland 0.000 0 0 Totals for 2006: General Property 21.280 65,500 235,300 300,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 553 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q 6 82642 AUG 1 9 2002 VOL 16 PAGE 4320 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX COUNTY ST. CROIX Co., MI I SURVEYOR'S RECORD C E MAP RECEIVED FOR RECORD Located in part of the Southwest Quarter of the Northeast Quarter of Section 11, 06 -26 -2002 8:30 AN Township 31 North, Range 19 West, Town of Somerset, being Lots 1 and 3 of a MAP CERTIFIED SURVEY Certified Survey Map recorded in Volume 14 Page 4024 in the Register of Deeds Office REC FEE SURVEY for St. Croix County, Wisconsin. � NORTH V 4 CORNER CAUTION: Prepared for e re AA of: SEC77ON 11 - 31 - 19 HIGHWAY SETBACK RESTRICTIONS OWNER: FOUND ALUMINUM PROHIBIT IMPROVEMENTS Daniel J. Bemis o i COUNTY MONUMENT SEE SHEET 2 OF 3. 655 Lakeside Lane CA o Somerset, WI 54025 .� a+ " UNPLATTED_ LANDS _ t Drafted by. Ty R. Dodge g4 E VOLUME_149 - - -- ___ ` SEE SHEET 2 OF 3 FOR LOT t0 34.57 �� PAG€ 172 LAKESYOE LANE ~ 60 ' RlWr -ar wAY______ 1 1 1 AREAS AND CURVE DATA _----------- - - - - -- �•,� 1 \ NORTH LINE OF THE SW 114 �' S89 "E 436.29' w _.._.._ ^_..� ._ _ . OF .TNE M£ 1 ,1 4 . ...... _. _.._ \31' 2 __ ---- - - - - -i r - � •l \ 1 C C� " -I Z q, /�� 34 43 W' Y N I N - D ° o O 5 Iz 8 \ \ �`* r m , °.- m D x N m . � Cri �o 3t t,; W ,_60 -t 2 0� 0 `. L4 = O c 13 \ �I Z N -n .+ o ID �0 �L�i 1 , \ �"LW 0 D RNI � n �.L 0 - � ry l 1o, \ \ o n,*, N in0D N• - m: - 1� rn ;r,. \ \' \� V N am 0v03 C_ -S_- i 1t, cr �;�; \ D \ e a c o _ m � / VOL 14 PG. 4024: I° '� 1 \ '� n I� M z M ° m `� ............... - -- J M -w to 1� U! W 1 \ j N -gy m O� a 0 --- N89'51'35 "IN ,' 440.25 "; I IL tG� \ \� \\ 0 0 - - 7 � - -- /-------- - -`-�� 4 1 \ C \ O O 0 Z M a D o j `° O t Imo 1 \ IG ;a O to I \1 \ \ AL 0 W 0 AL ALIL L �'O T � ._-. j c �lflc � ? I S89'51 35 E 308.16' \ \ ;O vi : Z ° o Z \ �WLi \ ` a O O H O ID z j' �►(� Elk L I E � -G \\ ;y r D °. o rn ' ©1 \ Z z� C l� I Oo \ \ �O\ O I �, o c ; to o I il�lc �!c \ m 8> a Q I_B F q - - - - \ LOC o� N m 6' CA IZ C1j • O g o.... . / 01 m � I O ra` 1 �� ? 0 0 3 (n tD I I 1 , 1 I Irk s / {� 3 ru rr W I 1 �i r �/ � �� if \y\ \ 0 n W'-U" '-a' lam• �W 4\ O r G AP ROVED `; � ©''; ;,' O N89'43'02 " w sot. �' 5T. C X COUNTY��;H �N N89'43'02 "W (b ° a planninq Zoni a ' '� 66.00' N � in tJ \ n JUN12 6 20 Note: An erosion control plan for Lots 4 and 5 will need to be a c,l submitted to the St. Croix County \ If &pt recor within 3u Sys of Zoning Office prior to any new royal d approval s�611 be construction. a) NOTE AREA SOUTH Af FENCf MAYBE \ .- �\ n and void �. %o 00.0: AN AREA POSSESSED BY 07HERS I Xww ^ CONTACT AD"NING LAND OWNER OR AN \\ 6 0 �' O N� v ATTORNEY BEFORE REMOVING SHOWN FENCE. \ \ ■ EAST -WEST 1/4 LINE 9' \ -_ -- �EXISTJNG FENCELINE ! `� N89'43'02 "W 1182.20' \ ` N00'45'S1 "W ---- ---- N89'43'02 "W - - - -- 5339.51' - - -- / 12' (O o \ \ 2666.74' UNPLATTED LANDS 04- 0Z. \ 200 - 0 - -- - - --- -- 200 CORNER \\ CCntq w \� 1 -19 GRAPHIC SCALE A U NT \ ^ SCALE IN FEET: 1 inch = 20 feetN \ 2 t- I h SOUTH V 4 CORNER SCHIIPP \ C 2 SEC77ON 11 -31 -19 �' S-2050 it -4 2 FOUND ALUMINUM County Section Corner Mo ument NEW �'►�. % '�g COUNTY MONUMENT of Record 0 Set 1" x 24" Iron Pipe RICHMOND JOB �i ing W1057SU32 WI # li minimum of 1.13 you �pO O� y • Prepored by. linear foot. �{� NO TH c A r� --++ O Found 1 -1/4" Iron Pipe SVR\J j CorWN09Group, MC. .ilL Denotes Wetland C.B.A. Contiguous Buildable Area er Town of Somerset ' Phone No. &FAX (715) 246 -4319 P 109 East Third Street, P.O. Box 325 - Wisconsin D.O.T. 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Adm. Code . 1 County � � Attach complete site plan on paper not less than 8 1/2 x n .1b 1 e; Plap most - �t" �t include, but not limited to: vertical and horizontal refer ca BM), directtdn, ands\ Parcel I.D. U 3 3 v —sU percent slope, scale or dimensions, north arrow, an ; n and ista*p to neaiest7oad. r„ \ r•�r,,. Please print all inf tZt+ltion. �' �:_; .; � R ewe Date Personal information you provide may be used for seco darypurpo s Privacy Law, s. 15.04 (1) �rfrJY Property Owner s 06f@rty L n A ovt. Lot ' 1/4J51/4 S T3/ N R / E ) W Property Owner's Mailing Address eONiNG OF f # Subd, -Name or C;SM# City State Zip Code Phone Nu ❑ Village ERfowt Ne est Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate G'� GPD ❑ Replacement "" "",� F3 Public or commercial - Describe: Parent material �wict_�,9 Xis Flood Plain elevation if applicable _,L✓� i ft. General comments i �f and recommendations: 5Y 5.4e.— -4- 16 -. ?ea „�'', l ' Boring # ❑ Boring � 9 6 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/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 ❑ Ba Boring ng # ,�! ,a pit Ground surface elev _,P L/ ft. Depth to limiting factor in. � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD >:T0 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/1- and TSS < 30 rm,1IL CST Name (Please Print) Sl�a e_.. CST Number 6 6 U 60) Address Evaluation Conducted Telephone Number i ' Property Owner Parcel ID # Page of Boring # ❑ Boring F. pit Ground surface elev. ft. Depth to limiting factor 7.0 in. Soil Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff #2 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor (n Soil lication 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 F 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. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30:5 150 mg/L • Effluent #2 = BOD 130 mg/L and TSS < 30 mg1L 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. SBA -8330 (RAW) Soil Test Plot Plan Project Name Daniel Bemis Shaun ' Address 655 Lakeside Lane Somerset Wi 54025 M #226900 Lot 3 Subdivision ------- Date 9/ 16/00 SW 1/4 NE 1/4S 1 1 T 31 N/R 1 9 W Township Somerset n Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 95.0/93.4 *HRP Same as Benchmark Alt. BM Top of Steel Fence Post with Orange Ribbon @ 100' 95' 96' 98' 97' B.M. 210' B -1 10' Alt 20% .M. 5 Slope 2 B -3 20' B -2 0 Property Line (P � ding s '"�� " Oe PRIVATE SEWAGE SYSTEM O "ty INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMITS nttary Permit No.: Pewonr kdwala*m you Wowloe may be used for secondary plxpoess [Privacy law. s.15.04 (1 xm)). 3 Permit s me: 13 CitY o village QT of: S tate n 10 No.: PI I Somerset Insp. SM Elev.: BM Description: Parcel ax No.: 1 -11 -4 r— TANK INFORMATION ELEVATION DATA H 4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (o p IDI. c7 J Dosing Aeration Bldg. Sewer <(. $o e n zo ' Holding St /Ht Inlet $' Z0 TANK SETBACK INFORMATION St/ Ht outlet to' TANK TO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic yp� 1 fXs 1 / NA Dt Bottom Dosing NA Header /Man. Aeration NA OisL Pipe •- ----"~ Holding I .Vo' PUMP/ SIPHON INFORMATION 4 6►ev, 9. �A 0 'I , acturer ma nd 'f2` 0 2.l St ew#eF Model Nu r PM TDH I Lift tf on S em TOH Ft Fomemain I Length D1a. at.ToWell SOIL A #JQRPTION SYSTEM [ 71NEFORMATMIO NCH Width l�er�►gt Trenches PIT NO. Of pits Inside Dia. liquid Depth SYS7EMT0 P/L BLDG WELL LAKE/STREAM LEACHING �" acturer: N Sy m: &W 5 2.2,. I 15a r OR UN T R M e Num r. O IBUTlO EM %'' taw, (M o `p Distribution Pi o ize � �xHoleSPacing Vent 7o Air Inta e Dia Y . `4 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 I Sodded xx Mulched Bed I Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 0 vx,,, 6 Inspection #1: & 10 Inspection #2: T7 T _ Location: 655 Lakeside Lane, omerse 54025 (r 1/4 NE 1/4 11131N R 131 1.) Alt BM Description = Topes A 2.) Bldg sewer length = `( S - amount of cover = . (tE l St o,� i�Qu.tR.E� Plan revision required. ❑ No Use o ther side for additi m ! o. b .+f �LT ) Date ( or � sS � ig � na � �ep� � _ M ' �. CJ� No r e, Sanita PermitApptieation Safety & Building xx In accord with Comm 21, Wis. Adm. Code 201 W Wash r Wisconsin See reverse side for instruct' �f�rcompleting this application PO Department of Commerce Personal information you pro id By be usAlofor econdarypurposes Madison. Wl 5: f Privac &#v/. s. 15��Qt; C j � (Submit completed form to co star Attach complete plans (to the county copy for the system, on not less than 8 -1/2 x I I inches in size. Counq� Slal Santa Permit Number ,._ O CFRe! ii're Sion lo'prtVibus app ation State Plan 1. D Number 1. Application Information - Please Print all Informatio " tN Properly Owner N C o k - Location: r 7O1dtNC. Property Location Prop rty Owner's Mailing Address 5 (+t 1/4 r I/4, S T N, R/? Lot Number Block City, State Zip Code Phone Number Subdivision Name or CSM Number 11 Type of Building: (check one) ❑ City \ A. I or 2 Family Dwelling — No. of Bedrooms: ❑ Village O Public /Commercial (describe use): Town of / Q State -owned r P AA) ype of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R d � 1 ❑ NewSystem 2. Replacement 3. O Replacement of 4. D Addition to Parcel Tax Number(s) r�r� S stem Tank Orrl Existin S stem (D — 'Q 30— Permit Number Date 3 A Sanita Permit was previously issued Issucd IV, Type of POWT System: (Check all that apply) It A--i Non- pressurized In ground D Mound D Sand Filter O Constructed Wetland O Pressurized In- ground D Holding Tank O At -grade ❑Single Pass O Drip Line r r D Aerobic T tment Unit O ecirculating D Ot er; V Dis ersal/Treatment Area Information: 1 Desig Flow ����� g (BPdI 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7 Final Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) j"�� `�"� �� Elcvatior VI Tank 93, 5- Capacity in Total N of Manufacturer Prefab Site Steel Fiber- PI Information Gallons Gallons Tanks Con. Con- New Existing glass Tanks Tanks Crete structed D 0 o D D VII Responsibility Statement I, the undersigned, assume re s onsibilit for installation of the POWTS shown on the anached lans. Plumber's Name ( print) Plumb Signatu (no stam s): MP /MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) t [✓ Vill County/Department Use Only D Disapproved Sanitary Permit Fee (Includes Groundwater Datc Issued Is u ng Agent Si XApproved D Owner Given Initial Adverse Sur rge Fee) (No sta Determination, [X. Conditions of Approval /Reasons for Disapproval: 3E u tCt'S 5 e 4 ►nna c1ttLwtt� an ✓� — 106 t c7 7 P Wisconsin Department of Commerce ' SOJL EVALUAT kON REPORT Page of Division of Safety and Buildings f in agbordance Wis. Ad , ode Attach complete site plan on paper not less �1an 8 1/2 x 11 inches,►n slip, Tn must include, but not limited to: vertical and horizdnttill refereee�,ppoint 1861), dMe�tlon and parcal I.D. 1 O percent slope, scale or dimensions, north arivy, and lof�ation and qce to nearest,foad. 1 00 09) Please print a140wmation c ,E evlewed by Date �b Personal information you provide may be used for se1or04'purp%OWMy Law, s. 15.04,11) (m)). GO t Pagr3wrier }, i Property Location Govt. Lot J w 1/4 NE1 /4 S T 3 N R E (or CW Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Gss Z.a. K S'► C. ta.N -.- City State Zip Code Phone Number �Q City ❑ Village %Town Nearest Road 'cJpMtw %k) yeas ( 11 w%ty- 5 c± I ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material -- mss# t 's _s Flood Plain elevation if epplicable ft, General comments * S V a s .2 ( , �� PGvr C �t..S �V,6 : n� r h F; / +►"A - # a �"S' a and recommendations: M -T;1 R .153 T 2 93.5 117 Boring # Boring Q pit Ground surface elev. ! 0 .17 ft. Depth to limiting factor I 2b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ! 0_/C> 10 `1tZ -- SL a FC imr • S . lo-1 p�( S 1,. ,sbk P'h r - 7,S YR a �....� --r - c.. d►�►sb k. ►qtr, �O 0 -3 7.5 Yk yll S d fS b W- W �'�► Gt.v ,/� � 31 -52, 7.5 4P- *76V 4 $ SL a FS b k. if" Fr C W S .' 7 •� y1�7 .� Q rs I�rl L. r / r , Bonn Boring # Q ® ® Pit Ground surface elev. l 0 0 ft. Depth tq limiting factor rah in. Soil ADNication 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 I a -►b ai A 3 ;x — sL F P, mf r aF 0-+20 7- Y1q 4 .ul- 13 - �s.'q 1401. oaf Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1159 mg/L ' Effluent #2 = BOD _i 30 mg/L and TSS 5 30 mg/L T Name (Please Print) Signature CST Number -}� 1r P M a - 9 - , 3 A Q 17 V% .0 Date Evaluation Conducted Telephone Number 3 -AP 4 a Property Owne h 1 G� YV� ! J Parcel ID # S�' I D - a D 00 Page of _ ❑ Boring Boring # 0 Pit Ground surface elev.1 Q D C ft. Depth to limiting factor i ao in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ti GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. A*Eff#1 'Eff#2 D 3 1 - A 07 F 6� Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth 10 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 F-1 Boring # E] 11 Pit Boring Ground surface elev. _ ft. Depth to limiting factor. in. Soil Kplication 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 _< 220'mg/i. and'TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS 130 mg/L . assistance to access services or • n equal opportunity scrvic�� rovider and employer. cr. If you need f Commerce is a P Y Y The Dep o N PP Y P P - - need material in an alternate format, please contact. the department at 608-266-3151 or TTY 60 8 -264 877 7. SBD4330 (RAM) t�> 1la v S&C .! it 'T 3 N 1 tl rot _ ;tie / \ L O Imb VA r -wE. sT� e. o TecA , CIS. 4 _,�,�,, � a 9 9. 0 0 Prc. 5 e r - - S 1 If c.• TAUA 4t OVt,. ID W Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 3 Number of Bedrooms 3 Design Flow - Peak (gpd) S'o Estimated Flow - Average (gpd) SOD Septic Tank Capacity (gal) Soil Absorption Component Size (W) kt Z Type of Wastewater Dothestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) ltd 2 Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 777::j Ta ble 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filte s hall be cleaned as necessary o ensu p roper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the w • • Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 • Management Plan for a Septic Tank and Soil Absorption Component • Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ` Owner/Buyer o'�J Mailing Address Property Address (Verification required from Planning Department for new construction) City /State <� Parcel Identification Number c- 4 Oo ne. LEGAL DESCRIPTION Property Location 5tq ' /., -' /,, Sec. IL T N -R�W, Town of r - S 01 Subdivision — Lot # Certified Survey Map # 2 �iz - 1- Volume Page # Warranty Deed # qq6 6-o Volume g3 9-- , Page # 1 cto Spec house ❑ yes q( no Lot lines identifiable Ayes ❑ 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 Zon O ffice e w days of the three year expiration date. h' g ffc w ithin 30 SIGNATURE OF APPLICANT G I 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. SIGNATURE 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 DOCt*AENT NO. a f WANUM STATE SIM OF IIIIIA 'jow. WG09 A %edfor mecoid Marcella Landry a /k /a Marcella 8. Landry APaRO5 p — �p e nantl J_ Aemia, a single pers 0 /V. P Century 21 rre Idlowing described real estate in st Crni_x ,. Somerset, Ni. State of Wisconsin: ' Tax Parcel Na Part of the South of the Northeast h of Sectio 11, Township 31 North, Range 19 West, St Croix County, Wisconsin lying Westerly of State Trunk Highway 0 35' except that part conveyed to Oliver Baillargeon and described in the deed recorded in Volume "149" of records on page 172. This is not homestead property. (is) (is noq Exception to warranties; recorded easements and rights of way Dated this 31 -cat day of March ,19 89 (SEAL) (SEAL) (SEAL) (SEAL) • Marcel 1 a T.andry aZk /a • Marcel la �. La�ndicy WL�M� AUTHENTIC T10R Signature(s) STATE OF WISCONSIN ss. St Croix County. Pertw4ft cams before no this ---31—st day of authenticated this Aay of Ha ,19 _89_ tlts above Warned Marcella Landry a k a •_ Marcella B. Landry TITLE: MEMBER STATE BAR OF WISCONSIN (If not to me known lo be to parson execulad rrs aulzed by 1706.06, this. Stats.) and thw THIS INSTRUMENT WAS DRAFTED BY ( John fl_ Wal nh • John d%s]W Notary Public WIS. (Signatures may be authenticated or acknowledged. Sort MY w Q! *� 19 are not necessary.) dale 'Names of persons spMnq in any capeciy,laN t» VW or primes below fok affebaa WARRANTY DEED STATE SM OF Wit FORM/N&!—IM ke-