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HomeMy WebLinkAbout032-1063-60-000 'sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety and Building Division INSPECTION REPORT Sanitary Permit No: 479474 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou provide may be used for secondary y p y ry purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Smith, Brian Somerset, Town of 032 - 1063 -60 -000 CST BM Elev: f Insp. BM Elev: BM Description: Section/Town /Range/Map No: I OU Z) PJe- e4i CST t?wA- 23.31.19.3170 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer / x.12• Holding St/Ht Inlet q• O r TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet T Septic / 2 r Dt Bottom ( �� 3 - Dosing Header /Man. Aeration Dist. Pipe r �• 0 5— Holding Bot. System �• 8.�S `fi 2— q`>t•Ifl Final Grade PUMP/SIPHON INFORMATION �C Manufacturer Demand St Cove r GPM -� v :5er g� G I • O� Model Numbe TDH Lift Fri n Los System Head T Ft Forcemain Length IDia. o ell SOIL ABSO14PTION SYSTEM (� Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Ma =actyrer INFORMATION Ty Of System: f t CHAMBER OR E-- l N Yp �l.r , � Z /�� /_ \ UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe( _.- - -_.._. _....... r Length — Dia Length Dia Spacing y S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of TSeeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil L�] Yes [ 7 No r� Yes r�� No CO k T (I q die iscrepencies, pers gtc.) Inspection #1: b Lr /' tv Inspection #2: — f — 7 - -� J 5 T. C�C.raw�dL �o ) _ aaation. 670 200th venue,g'omerset, WI 54025 (SW 1/4 SE 1/4 23 T31 N R19W) NA Lot 5 Parcel No: 23.31.19.317C 1.) Alt BM Description 2.) Bldg sewer length = Tb / 4 l �^ - amount of cover = 3 p`` o• o ff( C r7� f� e ' Plan revision Required? ! Yes No Use other side for additional information Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) r Safety and uildipgs DMAon County 201 W. hin AV�e'.,,,, ox 7162 ` 707 N visconsin -7167 Sanitary Permit Number (to be filled in by Co.) (608) 26 Department of Commerce Sanitary Permit Application State Pla i I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide i= p J 2 i may be used for secondary purposes Privacy Law, s 15.04(1)( ) roject A dress (if different than mailing address) I. Application Information - Please Print All Information ST. CROIX COL N TY OY' � 7b 'nL ZONING OFFI E `E' `c�uh. Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing Address ! / _ ro erty Location City, State Zip Code P Number 1 !.� ' /., �_ ' /., Section c� II. Type of B C, check all that apply) T" L N; R "j�E W / 3 f 7 yP g ( pP y) 6K a5 I II or 2 Family Dwelling - Number of Bedrooms p Q - P /Q,� Subdivision Name CS�MN-umber ! El Public/Commercial -Describe Use �m �A ��` K �- V L- r� �7 ❑ State Owned - Describe Use _ owjo O t, G. \,pe,0 1,Dp ❑City_❑Village of ! t III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. INew 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 1 TVL - V G✓ IV. Type of POWTS System: Check all that appl Non —Pressun` In- Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) ' V. Dis ersaVFreatment Area Information: Design Flow (gpd) Design Soil Application Ra e(gpdsf) Dispersal Area Required (st) I Dispersal Ar Propos sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ('110L Concrete Constructed Glass Now Tan ks Tan ks Pv r . Septic or Holding Tank a .) Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er's Si ature /7 MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use Onl pproved ❑ approved Sanitary Permit Fee (includes Groundwater Date Issued Is suing ge Signature S s) Surcharge Fee) �" '7/13),65 eason for 1 �-( 36 C) ' � IX. Conditions of Approval/Reasons for Disapproval \ , I SYSTEM OWNER: �,Qd p 1. \ Septic tank, effluent rilter and � r I� dispersal Cell must all be services / maintained / r pIti Se. �S u,per management plan provided by plumber. ' 2. AN sefeck re*kements must be maintained 11i per applicable code / ordinances. 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. 01/03) ti r - SosyG1 .S'�7f T e�,�7��� _' .�'�' C� Y+a•Z l a+�e 'f'}�� s q pule sh �ci .a- a f Safe /;�_ _ $�Ft -,� e�cpt �e►:� �peCNFiohCQ � 3 — $hs TI �C4 c. � a I �s 6 C[ou� 7��T, yt+.•a >�t�f'�l CiJ• f i tr�7hekdiLS' j � i _ / r - ' - E'v h DOOa Lfoxe �'d+qf� �L l w as w, 'eser eG,t4 t**. v Vcl4ef . 'T R a it of Y pr i ! S° !6� 4 $, s o j V 4 g_r8� 9i 4a.7S. v BM. J y : M -------------- Early Plumbing & Heating Inc 221 Broad Street P Wl 54021 l� M wsDepartment Safety of fetyand Builings Commerce Division !' EVALUATION REPORT Page of sion of fety andings � in accordan it Q 5, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 1 County include, but not limited to: vertical and horizontal reference int I T Parcel I.D. percent slope, scale or dimensions, north arrow, and lo cat' n and distance o ne road. Please print all information. pp Revie by Date Personal information you provide may be used for secondary pu ses (Privacy Law, s 15 fi Property Owner S'i . CROi ire j `'�.ocati n q J iQh ZO .'o>a� C7 er{ S �� NIN S' 1/4 s� 1/4 S 23 T 3f N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# (a G ® City State Zip Code Phone Number ❑ City ❑ Village �K Town Nearest Road So ed s^ ( 'E4 o J-1 (61 a ) 3 � 6- New Construction User Residential / Number of bedrooms 3 Code derived design flow rate 4 GPD ❑ Replacement ❑ Public or commercial - Describe: 11—A �1 Parent material qw -,1 [ C 4 0, Flood Plain elevation if applicable /V f( General comments _c �rdr,. rs and recommendations: / 4r tl�rfe.�, zc,s.Jt� d4��� ¢ u Z �:'lt�df�o► GC.�Als d' �4 os stn Cr`C h - F—/1 Boring # y E] Boring cy. pit Ground surface elev. 4 ft. Depth to limiting factor >� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 C' - 8 &Y,'� 413 s .Q -1 F46K %y 0- 0 - 7 3 io Yns16 — I s -e `f 4 7 s j" R r1 1 6 I- 0 i ' _ p S �r Ile F a Boring # ❑ Boring qM Pit Ground surface elev. 6' 7 ft.. Depth to limiting factor �$ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 I �► - � fn t-�e 4f3 - s � .� �' q4 k �, f�a � �.- 2 �' �• '� o. 7 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent 42 = BOD _< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si nature CST Number Cti�rlxs L. bst-e . C. 2Z0 C z3 Address Date Evaluation Conducted Telephone Number p s 3 a /� - d� ,: 1` Parcel ID = ice' s .` " {� Page of > ropeRy Owner / Boring # ❑t Boring 17 ✓ Xy pit Ground surface elev. 6 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. 'Ef 1 'Eff#2 f- rh C W )- � �- ©• 7 q4k t w O• 4 o-7 !S� - 4 !a x� 16 - s z �, Q 6� ,n �� Q s V r - 0-7 tl i1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor (n Soil Application Rate . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EY,#1 'Eff#2 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in• ❑ pit 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. 'Ef'1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L j 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. SBO -8310 (R C 00) s osyc,� �a T kk s��� - sr c-�• l o•+✓x �. + pule Y h s � y �o C.�- any '•x? Z % i 3"Ca fc l:�_ _ $�Ft -_ ex�e�t ce►e a�`e.rs,o�ec{ j ©CI- l9 /t ern.tte B!'1 = lhCZ, f'rc .o d,`o47`4oA"Xe.T oett o r Pr°wnc% t" 67p01 / ,0 0pe. e 7G.3 + o + ft- df-a . o. c Ct y Cl cus th'C.. �� a /� ✓f'Y� � 6�ra •yl f i �t �7'hCk�iGr � L) r .7a +ktb 1 S co - or 4*4 'If s N 7) 0 40.739 4 O ^1 WEBSTER EXCAVATING, INC. N5815 770th St. Ellsworth, WI 54011 (715) 273 - 3430 ...- - "O W" i � and£x Sheet Page i of 5 Conventional System for a 3 Bedroom Residence Propertv OwnerlProiect Name: Brian Smith Somerset 'Township -St Croix; Connty contents Pane 1 of 5 Cover Sheet Page 2 of 5 _Sketch Page 3 of 5 Distribution Cell Detail and Sizing, Calculations Pag,c 4 c of 5 Management Plan A` -T- L'e- es Early Plumbing & Heating Inc. 221 Broad Street c L tic6 Prescott, WI 54021 /nSlog v e ! S�'"Ch 7 T kns�i•�✓ - )t c'fc�; C pole x c � - �C,S � /ham T C/?CG ✓ � �` } � M 1 � v 3 Top o !d n V C �p.%p °� O i,c2 Cy 1 dFF--j4. c. Cl= /oc,. p ® -� o4t a� �r7G.t �✓ �oh �f ,o.p� �G.3 \ . I - e ' i Clow �t^.L ��a 17�fY11 drf.C{ 1' < e f� 7'hCk o�eJ' ��CScr CQ.,c�c p ro ) A __w 3 -1 7.14 3 ` 71 0 40.737 � v � b o - o CL_-rs - See. fio o� �ist�,'6i..t,oa Ceps r e3f f _ �-` a t ;cln Soi,. i Sah,e, ;r ey` �Q'ti,+•.Sli� - S'f �'ro -,k �% L L S- toio�- � 4 o p v c vv Op L > P c dhk O � L 02 � 3 S • Syst�,. di dr * c., cs� 8 ® = b f-. ,, 7� ploy, ale hs.h l'�i+ro o /' 3 � S�� Jr./ t•oh � tcwt �'YC .,�,cS' Ala+ to amy sca�e i f 9cT c��, 9� � � d �• e � rysfr, -•e� �-- syrse.ft e/ I C - 4 L cu. 1.,4T/oty5 1s 1'fir�a !t`cd e C3.4 .0 k 4 It kd 1, Ye 4,-ed /4. • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page + of FILE INFORMATION SYSTEM SPECIFICATIONS Septic Tank Capacity !o v D al ❑ NA Owner h+'.Zfs �, ❑ NA Permit # Septic Tank Manufacturer Cv;Cyc' �► Effluent Filter Manufacturer P / /,o< ❑ NA DESIGN PARAMETERS E ❑ NA Number of Bedrooms .,� ❑ NA Effluent Filter Model �S" �� Pump Tank C Number of Commercial Units Nq Capacity al NA D Pump Tank Manufacturer A Estimated flow (average) 3 O gal/day EEE A Design flow (peak), (Estimated x 1.5) 4S' al/da Pump Manufacturer Soil Application Rate 0 - 4' al/da /ft� Pum p Model Influent/Eff{uent Quality Monthly average' Pretreatment Unit A ❑ Sand/Gravel Filter ❑Peat Filter Fats, Oil 8� Grease (FOG) :00 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD x220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L xn- ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade ❑ Mound ❑ Dri -line ❑Other Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y inch diameter Values typi for domestic (non- commerda� wastewater and septic tank effluent �+ Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months Xyear(s) (Maximum 3 yrs.) ,3 Pump out contents of tanks) When combined sludge and scum equals one -third %) of tank volume Inspect dispersal cell(s) At least once every ❑ months ;K year(s) (Maximum 3 yrs.) Clean effluent filter At least once every �, ❑ months Xyear(s) Inspect pump, pump controls & alarm At least once every ❑months ❑ year(s) :NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) �NA other. At least once every ❑ months ❑ year(s) 19NA Other At least once every ❑' months ❑ year(s) 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 %) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment components, and any othe r maintenance or monitoring at intervals of 12 months or less 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. 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. P of 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 orrelimination 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. ABANDONMM E When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to i ve Code: insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisco sealed. ti • All piping to tanks and pits shall be disconnected and the abandoned pipe op enings p O Operator. • The contents of all tanks and pits shalt be removed and properly disposed of by a Septage Servicing • 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 utilized for the location a replacement soil tected from disturbance and compaction and should not absorption system. The replacement area should be pro 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 t r esort to replace soil the failed POWTSng advances in POWTS technology a holding tank may be installed as a last ❑ 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 DO NOT ENTER A SEPTIC, PUMP OR OTHER TREA M AY CONTAIN LETHAL GASSES AND/OR TMENT TANK UNDER ANY CIRCUMSTANCES. EATH MAY GE RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER GC Name Name Phone 713" - �, S'33� -Phone SEPTAGE SERVICING OPERATOR PUMPER &ko� A LOCAL REGULATORY UTHORITY Name Agency X r C..' •'� - � Phone Phone 1-- .� �6� 6 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not GMW (2/01) guarantee the performance of the POWTS. 08/11/00 FRI 13:12 FAX-715 386 4686 ST CRX CO LUN1NG WJ VVL ST CROIX COYJNW SEPTIC TANK NANCE AGREEMHW D OWNERSHIP CERTIFICATION FORM owner/Buyer Mailing Address propariy Address artment for never construction) (Verification required from Planning DeP O City/State Parcel Identification Number v t jjgAL AESCR.IPTION —� W. Town Of ,55 rte' 1 property Location !4 %., , Sec. a j • .t -IZ -" Pe Lot # Subdivision -� Certified Survey Map # volume - ' _Page # Volume _ ,--� -- • Page # Warranty Deed.# Spec house El yes L� no Lot lines identifiable yes ❑ no , M i1VT ANCE tin its premature failut� to handle wastes. Proper maintena per use and maintcuaaceof your pde systemcould ceded by a liccuud pumper• What impro you put i to n the ry insists of pumping out the septic tank every three Y� or sooner, tf can affect the fimcdon of the septic tank as a treatment stage is the waste disposal fie' on form, signed by °weer and by a tamdr . . m e Property owner agrees to submi to St: t�roix Zonbsg Dap�� that (1) the on site wastawaterdisposal system lumber, restr'o'platuba or a licensed pumper . the septic tank is less than 1 &U of at e. trnartcxpluttrber,loy tf necessary)+ is in proms � opez condition and/or (2) after inspection and P'� tem with the standards the rivate sewage disposal sys cation vim, the undersigned have read the above rcquir� and a6rOe tO K t Resources. State t Zoning n ng O Cep and the Dcp St. tccnix County Zni 08ice wither 30 set forth, herein, as set y �iatained must be completed and returned to the meti thyour sep ' rys tem his been days o;$LC for ar eapira n date. / ! DATE �` NATURE OF APPLICANT OW1VE CE I TION our knowledge. I (we) am (arc) the 011"(1) of wc) certify t tall statements on this form ue tsue to the best o istcr of Deeds Office• the p rW.*escn above, by DA irtue of a warranty deed recorded in Reg TE SIaNA'TURB O APPLICANT «r• :. 't being revoked by the Zoning Department- ... •.. Any information that is mis represented max result in the unitary P� •• Include with this application: a stamped warranty deed from the 18 of Deeds office a copy of the certified Ruwy map if refctenoo is =1 in the warranty decd 1655 PAGE V o(_ . DOCUMENT NUMBER WARRAN'T'Y DEED �'4�'S► KATHLEEN H. WALSH REGISTER OF DEEDS Doris M. Cam au a widow GRANTOR ST. CROIX CO.. WI RECEIVED FOR RECORD conveys and warrants to Brian R Smith and Amy T. Smith husband and 06-07 -2001 9:00 AN wif, as marital survivorshi ro GRANTEES WARRANTY DEED EXEMPT R CERT COPY FEE: COPY FEE: TRANSFER FEE: 201.00 the following described real estate in St Croix County; State of RECORDING FEE: 10.00 PAGES: I Wisconsin: Lot five (5) of Certified Survey Map in Volume thirteen (13) of Certified Survey Maps recorded on June 30, 1999 at Page 3677, as Document No. 605976, filed THIS SPACE RESERVED FOR RECORDING DATA in St. Croix County Register of Deeds office, described as follows: located in the Southwest quarter of the Southeast quarter (SW %. of SE '/4) of Section twenty NAME AND RETURN ADDRESS: three (23), Township thirty one (31) North, Range nineteen (19) West, Town of FIRST NATIONAL BANK Somerset, formerly part of Lot 3 of Certified Survey Map recorded in Volume 8 109E 2nd St at Page 2395, as Document No472859, which was formerly part of Lot 2 of PO Box 89 Certified Survey Map in Volume 4 at Pag6173, as Document No. 365850. New Richmond, W1 5401 Subject to 200th Avenue right -of -way. 9V7 z _032 1063 60 000 - PARCEL I.D. NUMBER OR G.I.S. This is not homestead property. (is) (is not) Exception to warranties: TOGETHER WITH AND SUBJECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. Date4 this I st day of June A.D., 20 9 (Seal) (Seal) /c* / f l_.'7 �! ( ° G• �Y� /X' i.� c « * Doris M Ca neau 7j (Seal) (Seal) AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN } Signature( 'Doris M. Cam eau } authen ' to i st y of June, 2001 COUNTY } t fG: Personally came before me this * Atty. h H. Gwin day of , 20 , the above - TITLE EMBER STATE BAR OF WISCONSIN named (If not, authorized by §706.06, Wis. Stats.) to me known to be the person _ who executed THIS INSTRUMENT WAS DRAFTED BY: the foregoing instrument and acknowledge the same. Atty. Hugh H Gwin GWIN LAW FIRM S.C. 430 Second Street Hudson, WT. 54016 _ (Signatures may be authenticated or County, WI. acknowledged. Both are not necessary.) Notary Public, My commission is permanent (if not, 2 s 0 tate, expiration date FILED .-, L JUN 3 0 1999 ► ' t KATHLEEN H WAL SH _ G059`i S S / CERTIFIED EY MAP LOCATED IN PART OF THE SW I1 OF THE SE 1 OF SECTION 23, T3 t N, R 19 W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN; BEING PART OF LOT 3 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 8, PAGE 2395. OWNER °z LEGEND DORIS CAMPEAU 330 CHURCHILL ROAD a SOMERSET, WI 54025 ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND a • 1' IRON PIPE FOUND a 0 1' X 24' IRON PIPE SET WEIGHING 1.13 LBS. PER LINEAR FOOT 100' ROADWAY SETBACK LINE a L W W U W uj ~ 2' IRON PIPE FUND �`•` °^ ` A C3 EXISTING DRIVE , a v CO W X— X —X EXISTING FENCELINE f ;t; �!: rii �...� Z W '' W N Of N Z ff not rdconitxx o o i ' - ' with 30 dons vi W L0 F-- SOW Lle, H 2 = N � r UNPLATTED L. DS ,, W o ti - -- - -- �____________ — N89'58'3i 656.20' .n p� 328.07 328.13' LOT 4 ; Q LOT 3 ------ - - - - -- , - - -- - - C. S. M i VOL. 8, PC. 2395 q ' ------- - - - - -- 1 ----------- - - - - -- -------------- - - - - -- i7 LOT 5 m 5.000 ACRES %0 1 I 217,803 SO. FT. LOT 6 n %0 q i 4.752 AC. EXC. RW m 5.000 ACRES 3 w. 1 1 W 206,977 SO. FT. c F 217,804 SO. FT. C �. i i Oj Do 0.34 ACRES 19 4.752 AC. EXC. RW 117 BUILDABLE 1 1 206,976 SO. FT. I I qE � Z •`Z; 1 1 aq O 1 I w ; q , ......................... SE COR. S1 /4 COR, 1 SOUTH LINE I g „ - $ S SEC, 23 SEC. 23 i OF THE SE1 /4 j vi !SS9 E vi 656.20' 1 vi S 89 . 59'46 "E o_ S89.59'46 "E 681.171 _ 9' 9_46 656.20' 1337.39_ =200TH AVENUE ; C. S. M. 1 UNPLATTED LANDS VOL. 2 --------------------------- - - - - -- - PG. 54 7 I SCALE IN FEET 1' = 200' NOTE: LOT 6 IS TOTALLY BUILDABLE EXCEPT SETBACKS, RIGHT -OF -WAYS, 200 0 200 400 WETLANDS AND OTHER RESTRICTIVE AREAS. Vol.13 Page 3677 Wisconsin Department of p commerce SOIL EVALUATION REPORT Page � Division of Safety and Buildings of in accordance with Comm 85, Wis. Adm. Code j ��,- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Cro !r y include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Reviewed by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner // Property Location q Bh " °�`� � �{ „+ S„� h Govt. Lot S'w 1/4 S- 1/4 S 23 T N R Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# s �.. City State Zip Code Phone Number El City - ❑ Village K Town Nearest Road SO rt CY s1° cdz 1 fl o xE (6 / ,;L 3,2 F�- ��9ty S . � • sg x` - 2Cic� �x C New Construction User Residential / Number of bedrooms 3� Code derived design flow rate 4sa GPD ❑ Replacement ❑ Public or commercial - Describe: AIA Parent material C/,j `l ��c1` /s Flood Plain elevation if applicable tV A ft. General comments _ �'{e �rdGe• S rr`ca, 4s -1 °� u and recommendations: Boring # F I Boring Pit Ground surface elev. c i- 4 ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD /ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 a- ioye4 -_ s Q 1 ��b� �h v_ 0-7 0 - 7 1 �- s — {' s o S � _ ,f a.. s _ o S c� ® Boring # Boring Pit Ground surface elev. , ft.. Depth to limiting factor �$ in. Soil Appl ication 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 0 - 8 - /o Y1f ¢/3 -- s .e _Z - r , 14 k o. 7 0- it . - P 4 3 16 - �O le , Y .q s /� -- s a sk �` s S /- �O - 7a 7S f R 41 S - 7 ' t � 7 - s Yx 6/ . s o s rti -� — — o. 7 /• tS ' 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 (Please Print) Signatur CST Number C_ h �r /t•� L.. 6.r try 2- >-a 6' 7 - 3 Address Date valuation Conducted Telephone Number 3 h y Page of 'roperty Owner R�' ' �4 Parcel I D - ❑ Boring T Boring # Q �'� 6 ft. Depth to limiting factor � ` C i pit Ground surface elev. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf1? in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Ef x1 'Eft#2 5 /S' - 4 /,a R S - s Q s � � � d 6 �- U + +o • 7 7 - 1-R fI6 s --*9 m- • D- S 70 pv 7- �',Q`6 - s o s +7 .Q -- — o. 7 1- Boring # ❑ Boring Ej 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 /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 !!���� ❑ U Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil App ii&tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1 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 altemate format; please contact the department at 608 = 266 -3151 or TTY 608 - 264 -8777. SODa330(RC .. .. . �l 3 so PI, -4H i SosyGIS�"� Tcl,/6Tq�� .. St �aa,I� laf�It �l . - I s pvl= v r '�J// Y K � Y V It l.> _ $ °pt,� eept "el-e- �`weeyF,ohed ct t9 it et - n.►fe AH p;,k J,4 1 e < r� d n C✓ . o4t 1 6 3 b' Clow 7F�t 7u.a >IJ /t>'l � al.J•h �.'zC�rrcao�er o� S.f51 s T'aa Id �p� i o ! � ,,,:x` �. � � T T l f a, � T • / � �°' �y9' #- � � ' P 1 N 0 o cd .= o 0.� li