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HomeMy WebLinkAbout032-2118-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: 420710 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: Robbie Construction Inc I Somerset Township 032 - 2118 -20 -000 CST BM Elev: Insp. BM Elev: BM cription: Q Section/Town /Range /Map No: 1 DU `o o Y-�'� Y 15.31.19.1082 TANK INFORMATION S da,&e_ EL V TION D T TYPE MANUFACTURER CAPACITY ST ION HI FS ELEV. 1 r Septic Benct/mar o (VI (0 2 -,7 Dosing Alt. BM f Q pp/ e- t 14 f 4 6C k { pa Aeration Bldg. Sew 74. Holding St/Ht Inlet S !� 3S R G �a St/Ht Outlet TANK ETBACK INFORMATION fit' 7 • ��' TANK TO P/L WES* BLDG. Vent to Air Intake ROAD Dt Inlet f Septic / / {/ / / Dt Bottom f Dosing _.._— -- - -_. Head r /Man. _ S Aeration Dist. Pipe 1 ti d. I 2• (of Ing Bot. Syste h 1 G) f S 'V.. v 1. PUMP /SIPHON INFORMATION Final Grade F5(A- D , S• S Manufacturer Demand St Cpver 3 __ PM `! Z Model Numbe TDH Lift Fri Loss System Head T F Forcemain Length Dia. to Welt SOIL ABSORPTION SYSTEM BEDITRENCH Width 1, Length No. Of Trench PIT DIMENSIONS No. Of P' Inside Dia. Liquid Depth DIMENSIONS l '1 �j �r /� SETBACK SYSTEM TO o P/L BLDG WE L LAKE /STRE q G Manuf e 3 INFORMATION O n Y S Type f System: / / �� / Model Number: "JaK -fir 3►oo DISTRIBUTI ON SYSTEM{ Header /Manifold Distribution [ x Hole Size x Hole Spacing Vent o Air Intake ILI Length u Dia Length Di Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of eded /Sodded Bed/Trench Center r" Bed/Trench Edges Topsoil xx Se rf � Yes 0 No 0 Yes C N COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_/ / 03 Inspection #2: Location: 566 217th Ave Somerset, WI 54025 (SW 1/4 NE 1/4 1 /4 15 T31 RI 9W) , Shadow Pines Lot 25 Q parcel No: 15.31.19.1082 1. r 7 Alt BM Description = J�� (.7 2.) Bldg sewer length = S�� V �`� Yhl h�tc/ D ��� i � 0rt � - amount of cover = ` � 3 0 f �/L�I�,9L �j'� £� Q 110 e S� /V bt/Cet . Lai S (Pry /lOr 7 /r! J,3 � Plan revision Required? El Yes LV ��i Use other side for additional information. SBD -6710 (R.3/97) Date " Insepctor's ignature Cart. No PAGE *-3 OF NAME: Ro e Can LOT #_ LEGAL DESCRIPTION$G✓ 1 /4.f% /a,Sf�T N,x, E(orJ SCALE: F'= qO r ELEVATION: ►D d , y 1 BM 1 DESCRIPTION 4�° D a 1 L Dom_ BM 2 ELEVATION: q l • � (o I BM 2 DESCRIPTION: �6 P Q-�- I K ev c P -e- SYSTEM ELEVATION: SYSTEM TYPE: / n o vi i o � f , s r 132 190 ss Q P o i ldL t Pq� g o I Qa s G SIGNATURE: DA vuisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 o f . 3 Division of safely and Buildings in accordance with Comm 85, Htfls. Adm. Code fumy Attach complete site plan on paw not fees than a 1/2 x I I kwhes in size. Plan must ` include, but not Hmited to. vertical and horirontal mWence point (BM), direcion and Parcel iD. percents", scale or dimensions, north arrow, and laxition and distance to nearest road. b Date Please print aft Informadon. Personal intwmeom you Provide may be used for serandwy purposes (Privacy Law. s. 15A4 (1) (m)). PropertyOwner erty i Prop Location y� P C) 6� �e �0rt$t fvc_ ��2s GovL Lot Stu 1 1414-,E 1/4 S /S N R / / E(or)dO Property Owner's Ming Address Lot # Block # Subd. Name or CSM# /� / � �0 a-� a clo `v ` `� S City State zip Code Phone I timber ❑City [3 Village 0 Town Nearest Road as 1 Y O Z 2 1 (287 1 14 0 ® New Construction Use: ® Residential I Number ber of bedrooms s 3Y Code derived design flow rate X5 160 GPD 0 Replacement - ❑ Public or commendal - Describe: —� ft. Parent material _, �� l / a- � �s 6 �J �— Flood Plain eWmilion app I � I V E General comments and recommendations: Sy5T ` i'h.. ',p' � e v , �! ' -, GO �� ��S OLI g t 7 2003 �- AOiX COUNTY 0 Bing q �CNING OFFICE Boring # ® Pit Ground surface elev. / +�+ ft Depth m MAting factor _ Sol Rate Texture Sure Consistence Boundary Roots GPDfif Horizon Depth Dominant Color Redox Description 'Eff#1 'Eff#2 in. Mumsel Qu. Sz - Cont. Color Gr. Sz. Sh. 5 / ri e- 4V - • s R F Boring # ®PBorin9 Ground surface elev. 6 _ ft. Depth to Nrr"mg factor Z- in. Rate .Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. 'EWI 'Eff#2 o a vr qlq - S L k i'1 r c 1 1 6 o 10VC5& — L� /ms W\J'- 50 iZ 16 S • Eflkrent #1 S BOG > 30 <_ 220 mgfL and TSS >30 < 150 nxYL ' EMuent 02. = BOD < 30.mg&and TSS c 30 mglL Signature CST Number CST Name (Please Print' � Q G Address Date Evaluation Conducted - Telephone Number 5 -26 - a 7/ ^ ae 1 -7 � -� I -- Property Owner l� D� Parcel ID # - Page -J-L of _ 3 f3av►g # ❑ Boring f* Depth b8 f+rx�or / © Soy lion Rate Pit Ground surfacis 76 - ex Stnn�structure Consisisooe Boundary Roots GPDlYF Horlmn Depth Domkmd Color Redox Desc Vdm Tture Gr. Sz Sh. 'Etf#1 'Etf#2 in. Munsed Qu. Sz. Cont. Color ^_ - io / L A l El Bomrg # ❑ Pit Ground surface "- ft. Depth b ymyirtg factor m Soy Rate Horimn Depth Dominant Color Redox Deea4don Texture axe Consitdertoe Boundary Roots l * *ml in. Munsey Qu. Sz. Cont Color Gr. Sz. Sh. Boring # a P�g Ground surface dev. 8. Depth b W&V Wftf' it. Soy Rate F Horizon Depth Don*mnt Color Redox Texdre Struckm Consistence Boundary Roots QPDNF in. Munsey Qu. Sz. Con* color Gr. Sz. Sh. •Eff#1 'Eff#2 * F #1 = BpD 30 < 220 rngk and TSS >30:S 150 mgiL ' Effluent #2 = BCD, :S 30 nv& and TSS <_ 30 mglL The DW&rtment of Commerce is an equal OMMMity service provider and employer. if you need assistance to access services or need material in an alternate format, Please contact the &Vu meat at 60&266 -3151 or TTY 608- 264 -8777. seausotrt.mreo► property Owner L0 2 1 r - ( O n Pamel ID # Pap ❑ Boring Soi Rate 9 # @ pit Ground surface elev. 6 R Depth to �g bcbr -,'" --- in. Hortmn Depth Dominent Redox Description Texture Stnnitne Cor�stence Boundary Roots `Et 1 'EW2 in. Muned ou. Sz. Cant Color Gr. Sz. Sh. .�� , e- SL 1 6-ix d �- OS — ' El �9 # ❑ Pit rGrourdstsface elev. R Depth to �tg lector in. Sai Rate Horhm Depth Dominant Color Redm Description Texture Sbucdxe Consistence BprxrderY Roots GPDAf in. Munsell au. Sz. Cant Color Gr. Sz. Sh. `Etllfl 'Eft#2 E I Borhv # a 9 i ❑ Pic Ground surface elev. it. Depth to §R#ft tactW n. Sol Rye Horimn Depth Doa a Color Redox Description Texture shmk Consistence BourKkWY Roots GPDIi in. Mursell Qu. Sz. Co Color Gr. Sz. Sh. 'EK#1 * Efpl2 at • Emmu t #1 = BoD,> 3a :S 22o mgiL and TSS >30:s 150 mglL ` Effow t # = BOD <_ 30 mglL and TSS <_ 30 ffQ L The Department of Cornamm is an equal opportunity service provider and employer. if you need assistance to access services or need material m an alteroatic fomutt, please contact the department at 6W266 -3151 or TTY 608- 2648777. ssD4M(R.*?/M PAGEaOF NAME: Qo Cot,, LOT # DESCRIPTION$GJ 1/ Xfl /4,Sf,� ,N,R,_ffE(oroN SCALE: 1"= !iD ELEVATION: 16 0, C) BM 1 DESCRIPTION: ,gyp { � �U'� D, DC T BM 2 ELEVATION: q$ ( o I BM 2 DESCRIPTION: Jo C � SYSTEM ELEVATION: d o 1 5 - 1 'S Gcc,,u et `I.S. 0 y SYSTEM TYPE: Co Au a,l 8�z _ f7o �a iQo. ,Qd r4- SIGNATURE: DA -:2 Safety and Buildings Division County ' 201 W. Washington Ave., P.O. Box 7162 iseons s Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 a '7 Department of Commerce State Plan LD. Number Sanitary Permit Ap `` in accord with Comm 83.21, Wis. Adm. Code, per al inf PEED may be used for secondary purposes Priv law, s15. Ixm) Project Addv6ss (if different than mailing address) 1. Application Information - Please Print All Informati FE� 2 6 2003 03 Z— — Z_0 000 ( 0,9 133(f, wner's Name ST. CROIX COUNT , Parcel # Lot # Block # � Q/lSZ%T iM ING OFFICE Z5, Property owner's Mailing Address Property Location 5 /) 50 v., Uf -1, Section City, State Zip Code Phone Number v (circle one) T fj S SczS — T N; R Eo10) 11. Type of Building (check all that apply) Q� ,01for 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name CSM Number ❑ Public/Commercial - Describe Use f fo ES ❑ State Owned - Describe Use ❑City_ ❑Village S&ownship of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) Y. S Ca A ' , RrNew System ❑ Replacement System ❑ Treatment/Holding Tank 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 1V. Type of POWTS System: Check all that appl Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter (umber ❑ Drip l ❑ Gravel -less Pipe ❑ Other ( 1 ) V. Dispersal/Treatment Area In o 0% . Design Flow (gpd) Design Soil Appli ds,11 Dispersal Area Required (s Dispersal Area Pro ed (sf) System Elevati on b al ( - �8� Z, 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units '/ , Qy/J �y Concrete Constructed Glass New Existing W •CJ'`"� °'�` -- fG ✓ Tanks Tacks Septic o&KQWff t400V — �O t7 1 Frt4 rr x Aerobic Treatment Unit Dosing Chamber V11. Responsibility Statement 1, the undj for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu k MP/MPRS Number Business Phone Number L �t QZ P tag Z 7 1S�?,%f Zl,4- L Plumber's Address (Street, City, State, Zip e) Sbo q - 708 lilr 14,1C VII ount /De artment Use Oni /1 Approved ❑ Disapproved Sanitary Permit Fee (includes Grpyn� water D Issu 1 g Agen ignature s) Surcharge Fee) 7 00 V V_ D ❑ Owner Given Reason for Denial O tX Conditions of Approval/Reasons for Disapproval 1 —O Okt' ' � oT�- � � b,t cwt C.he f � �� L C�ct�.� 9S, o q R7 0 .51V tiv,-n Y 3.5 S CP� Q /der Attach complete plain (to the Countz only) for i0c syntc on paper not less than 81/2 x 11 inches In size T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 tA N rn N o � cz, a oCfn r f T� rZ, CA Z 7 N o N N -d o T.L. Sinz Plumbing Inc. E5609 708th Ave. °a s Phone: (715) 235 -2644 Menomonie, WI 54751 0 Fax: (715) 235 -2592 tA o N Z vi ti N j o N O NO ,���i � �••� •:f�;1 ;ifs �f :�;��" / R VA ffifil AF CA g Ol F i i � %iii: fi • i:OP.ff•i:: �I ��: 4000•fppp0• � �1 � f ff f ifs ei ::f f. ��t ~ • •' • . �. Is�� .� /I� ►�•r �i 0�1 ���,������/ � �� ��* � ate. 5;.,� ��... < .� � . �, . : • 0 vo F//'&'� 1 11i'llau I &A • s ST CRO IX COUNTY SEPTIC TANK. MAINTENANCE AGRBBMBN'f AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing A ddress Property Address (Verification required from Planning Department for new consbnrctton) — Ci ty /State �i�`"e' ►— �,� Parcel Identification Numbe LEGAL DESCRIPTION �� own of property Location S '/4, ' /,, Sec., T N -R W, T U Lot # Subdivision Certified Survey Map # . Volume . Page # Warranty Deed # ' �D 4 �� Volume �p Page # � /3 /Zc� 3 Spec house ❑yes 1� no Lot lines identifiable b( yes ❑ no Sy M MAYNTENANCE Improper use and maintenance of Your septic system could result s by failure to handletwastes into �e a a licensed pumper• consists of pumping out the septic tank every three years a< sooner can affect the function of the septic tank as a treatment stage in the waste disposal sy stem • ent a certification form, signed by the owner and by a The property owner agrees to submit to St Croix Zoning Departm that (1) the on - s it e wastewaterdisposal system p 1 um �, lourneymanplumber, restrtctodplumber or a licensed pumper ve�yu>g the tic tank is less than 113 full of sludge. is in proper operating condition andlor (2) after inspection and pumping (if necessary), the private sewage disposal system with the standards �, the undersigned have read the above requirements and agree to maintain the pri Department State of Wisconsin. Certification set f rth, herein, as set by the ent of Commerce and the Department of Natural Resources, O ffi ce within 30 o stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. DATE Asi" I OWNER �R'rt�'ICATION our knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are fire to the best of my ( our) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. !�� DATE SIGMA OF APP ANT ssss «« Any information that is mis- represented may result in the sanitary pmt bang revoked by the Zoning Department. warranty deed from the Register of Deeds office *• Include with this application: a stamped a copy of the certified survey map if reference is made in the warranty deed / """'POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z1. FILE INFORMATION SYSTEM SPECIFICATIONS Owner o Septic Tank Capacity �� al ❑ NA ,- Timm' NAWN Permit # !d / U 1Y Septic Tank Manufacturer b&prC4 , - 13 NA DESIGN PARAMETERS '7 Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model too ❑ NA Number of Public Facility Units B NA Pump Tank Capacity al -E NA Estimated flow (average) 3pD al/da Pump Tank Manufacturer 48'NA Design flow (peak), (Estimated x 1.5) 4s g al/day Pump Manufacturer , 2"NA Soil Application Rate , ° • • j al /da /ftI Pump Model 4'NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit •ETNA 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 jlKln- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L X NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` fu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: P-NA Other: ❑ NA Other: 0 NA "Values typical for domestic wastewater and sept tank effluent. Other: ,B NA M MAINTENANCE SCHEDULE (,(J�� % /�--� /' I UST —SZAt Service Event Service Frequency _ Inspect condition of tank(s) At least once every: ❑ month( (Maximum 3 years) NA .B' ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Insp disp ersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) NA p p .8`year(s) Clean effluent arl s) ilte At least once every: ❑ mon th 04 AJ "PlWn NA Inspect c pump, pump controls &alarm At least once every: ❑ month(s) AM NA ❑ year(s) ❑ month(s) Ja'NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) �A ❑ 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 oe -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of C_ � - START UP AND OPERATION For new•construction, prior to use of the POWTS check treatment tanks) 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 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: 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 repl a \ p he failed POWTS. h s' a as not a evaluat identify a ita le repla men 'area. failu o the P S a so' v I tion ust a pe orm to loc e a suit le re ace nt area: repla a nt area ' vailab e a holding tank ma be inst le as a last ort to repl a failed PO S. • 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 — R, Name slfu7— i3� NL Phone - ? Lr— 2 y Phone - (,S7 '�3s Zlo SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 157 00C CO Phone Phone 6— '10 This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &If) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I J 2100.' ?07 STATE BAR OF WISCONSIN FORM 2 - 1998 - 1Z PG WARRANTY DEED �► 5 7 e KATHLEEN H. MALSH Document Number REGISTER OF DEEDS _ ST. CROIX CO., NI This Deed, made between RECEIVED FOR RECORD _ RTCHARD 0- STOUT JANET P- STOUT, — 01/03/2003 02 :10PH chand and wife, Grantor, EXEMPT It and Rnhhi Con trrtc *inn, Inc REC FEE: 11.00 — - - - - -- TRANS FEE: 188.70 COPY FEE: 2.00 Grantee. CERT COPY FEE' Grantor, for a valuable consideration, conveys and warrants to Grantee the following PAGES: 1 describ rea es to In S,Y,� C ni x County. State of Wisconsin: Lot 25 lat of Shadow Pines Town of -. r r Name and Return Addre6s. ._II l; Somerse , St. Croix County, Wisconsin. : 1•;i;.i Realty Title ' OJ South 2nd Street Suite #115 _ n -"4016 ri lc 31'1113 032- 2119 - 20 -000 Parcel Identification Number (PIN) This i a not homestead property. (is) (is not) i Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this day of .Tanuary 2-Q-Q �t� S (SEAL) (SEAL) R 0. St out Janet P. Stout (SEAL) — (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, III y S5. St. CTO1X County. J i authenticated this day of Personally came before me this _ day of I January .2-0-03 the above named n: e hard n Stn„t n d - P T _ Stout TITLE: MEMBER STATE BAR OF WISCONSIN F —__ to (If no(, me known toed the foregoing authorized by §706.06. Wis. Stars.) instrument arA the rtl . IIIVV KER Ulv J. BAST THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 A Tr. Hudson, WI 54016 Notary ublic, State of 'sc nsm _ My � mmission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _ necessary.) ' Names of persons signing In any capacity must be typed or primed below their signature. STATE BAR OF WISCONSIN ft-- La9a1 Blank Co.. inc. WARRANTY DEED FORM No. 2 - 1998 Ma —sis., Wis. i , l .e/«, /Od' /5�'Qrk,4e e l ` e l.eva* lM 4 �`t"' 1 S4 2 e le v /UO ' S' `� 4 r,�ree A4 � �-��= �e�� ALL �g� �d � �•� 1 sGr� 106 o ff VLF 3G - V �5 / b NO r7 v` 1 Wisconsin D of Commerce SOIL AND SITE EVALUATION 24vision bf Safery and Buildings Page 1 of 3 Bureau Integrated Setvices in accordance.-wi HR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 1Ir inches in size Plan rt 4t County include, but not limited to: vertical and horizontal referehcs$oint (BPAI lr6c' and , St. Croix percent slope, scale or dimensions, north arrow, and location and disi" c arest raa & '\ Parcel I.D. # ^� p _ ,i V APPLICANT INFORMATION - Please prim all information. iewed y r Date T CH Personal information you provide may be used for secondary p[lrposes (Privacy 4 (1) (m)) t x" Property Owner y LUNINUUFMOV0 perty L . ation Richard Stout Govt. L SW 1/4 NE 1/4,s 15 T 3:1 N ' R 31 9 E (or) Property Owner's Mailing Address k# Subd. Name or CSM# 1353 Awatukee Trail X0 "Shadow Pines � 23 City State Zip Code Phone Number I El village ® Town Nearest Road Hudson Wi 54016 (715 )549 -6731 Somerset 60th Street ® New Construction Use: residential / Number of bedrooms a Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd /fi gpd /ft Absorption area required 8 5 8 bed, ft 7 5 0 trench, ft 2 Maximum design loading rate • 7 bed, gpd/ft . 8 trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site consideratio s 7 a IkL Parent material ;Eplain elevation f ap a le ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S ❑ u U - s❑ U [kS ❑ u JO S ❑ u I ❑ s O u [Is 1� U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ons . in. Munsell Qu. Sz. Cont. Color . Sh. Bed , Trench 1 1 0- 1 0yr2 /1 -- is 1 m4-!3k fr cs 1 f 7_ ' .8 2 3 -81 10yr4/4 -- ms osg ml cs -- .7'.8 Ground elev. 94 ft. q J Z ,L Depth to a ``77 , limiting factor 81 in. Remarks: tk Boring # " 1 0 - 1 Oyr2 /1 -- is 1 f11P6K fr cs 1 f .7 ;.8 2 6 -85 10yr4/4 -- s osg ml cs -- .7 ..8 Ground 2 - elev. 9 6, -9-ft. Depth to I _ � G L -------- 6- limiting �J / T[ t / factor h I-xj Cc O a " 3 Y (,(Uafe_ I kIt U*Xt PY74d),. _8 _ in. Remarks: CST Name (Please Print) Sign Telephone No. Address Date CST Number /OTC%' Sc C) �=C C cl y� i 7— jr3 3��. Richard Sto SOIL DESCRIPTION REPORT PROPERTY OWNER ar ou — Page qt PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture r. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 0 -8 10 r2/1 -- is 1Vh mfr cs 1f .7.8 2 8-84 10yr4/4 -- ms os mfr cs -- .7;.8 Ground elev. 93 ft. Depth to limiting factor --84 in. Remarks: Boring # 1 0 -6 1 0 r2 1 -- s 1 in_ 4 2 6-83 10yr4/4 Ms o mfr cs -- .7 ..8 Ground elev. 91 . a —ft. Depth to limiting factor gain. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # 1 1 0-1C 1 0yr2/ 1 -- is 2 /IIRD mfr cs 1 f . 7 ' . 8 5 2 1 0- 0 1 yr4 /4 mfr cs -- . 7;: 8 Ground ele L 2 Z (o ` epth to limiting -- factor 9 0 in. Remarks: �4.�•, ����ft� C� `�" Zc�.� G o�Z�d �t Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Richard Sto aul� UbU �lr Mr rUh 1 PROPERTY OWNER car ou r- _ Page 2 � QII PARCEL I.D.# , Boren # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -8 10 r2/1 -- is 1Pi mfr CS 1f 2 8 -8 10yr4/4 -- ms osg mfr Cs -- .7;.8 Ground elev. 93 ft, Depth to limiting factor —44- F Remarks: Boring # 1 0 -6 10 r2 1 -- is 1 m 4 2 6-83 10yr4/4 ITIS osg mfr cs -- .7 ,.8 Ground elev. 91 .8- -n• Depth to limiting factor 8-3—in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 O-1C 1 0yr2 /1 -- is 2 PA mfr Cs 1 f .7 '. 8 5: 2 10-90 10yr4/4 MS Osg mfr cs -- .7 ;.8 Ground elev. 9 5. — ft. Depth to limiting factor 9 0 in. Remarks: Boring # Ground elev. ft. ; Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) 1 S06 -1-e- 1 (00 --� C2eneL.mu � l eke, /dd' /C/'Crk,4t-e — ,,f WIUwiGT✓i -`� s � sl S �I v 6m � �4