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Home My WebLink About032-2183-22-000 o rM0 d co� w m co FF C � o w d N o 3 C 0 7 . ' _• N N A N CID co N 3 @ • ' ° n d d D CL 4 w 3 C 7 y In co N p OCy v V) Z D �! 3 • m S D a D !r co CD 3 CL w rn � lot CID CD O w c 4 ' N N o °o °om co cn cn 3 C M v M z 00 O cS S c N �. 3� N N N p N< 3 -2 cn `• p `•°► D ig CL 3 O Z N ZwZ D o y a O O p � s c f y CD C N C CD W `! C. n 3 7 Z (D (n C - CO) p N D A Z m - c -� A Ek v. D. A P 3 0. Z N W m w eo Z CL O ? ;o o :: Z t Z W m rz 7 Q N C a ° v c uv, o C W A, R i A b O` A 1 � O V N O H A i m � v o O N c CL CD I _ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t, Croix Safety a d Building Division INSPECTION REPORT Sanitary Permit No: 479246 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for seconds p ur p oses [ Privacy Law, s.15.04 1 m ^�~ secondar p � [ cv O( )1• Permit Holder's Name: City Village X Township Parcel Tax No: Palmer, Art I Somerset, Town of 0 3 Z— :DLI ,22 CST BM Elev: OI Insp. BM Elev: BM Description: Section/Town /Range/Map No: ] CO-0 , I c Q� 1 23.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY F STATION BS HI FS ELEV. Septic Benchmark W �+E-KS mt 3. Dosing at" - Alt BM Zb Oda• <<►' Aeration Bldg. Sewer . 18 14. 12 Holding ! St/Ht Inlet 40 . St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /O .a Septic 5b 7- 1 _ Dt Bottom .00 • X' Dosing y i Z ! f So Header /Man. 19 4 ". 94 f or Aeration Dist. Pipe Z ' Holding Bot. System 93-1 _14 - 0 1' Final Grade • I PUMP /SIPHON INFORMATION �.�o °��•Zb Manufacturer Demand St Cove � -�,/- \ 3 1 I �{_L— GPM iW�"�•J . D Model Number T H Lift Friction Loss System Head TDH Ft �.O .M Forcemain Length 1 Dia. k Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf,ctur�r.� INFORMATION CHAMBER OR Type Of System: 1 w UNIT Model Number. d DISTRIBUTION SYSTEM 4p 4 ACCAr Header /M nifold N Distribution x Hole Size x Hole Spacing Vent to Air Intake ,^ __ Pipe (s) I L ength Of Dia Le Dia Spa SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bedfrrench Edges Topsoil I_] Yes n No Yes No CO E (In I d ode 'scr cies, persons present, etc.) inspection #1:& (a Inspection #2: ` 77 ""' Locatio 634 10th Avenue Somerset 1 54025 LINE 1/4 NW 1/4 23 T31 R1 9W) Gavin's Acres South Add Lot 22 Parcel No: 31 19. 1.) Alt BM Description = + P � ems"" �O�'�s �� ! C 2.) Bldg sewer length w �5 - amount of cover = y 4 li p Plan revision Required? V'ormatigioN s No _ _ - -- Use other side for addition � _ _ _ i ____, ___ _____ ______ ___� __ _____ _i i_ _ mate hr, p Ins or 's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County _ 201 W. Washington Ave., P.O. Box 7162 S / i seonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -315 4(7 Z Department of Commerce Sanitary Permit Application a State Plan I.D. N tuber In accord with Comm 83.21, Wis. Adm. Code, personal information you provi may be used for secondary purposes Privacy Law, s1kE O Project Address (if different than mailing address) 1. Application Information - Please Print All Information IV:EtD &5 zxo 4, /of� —, Property Owner's Name ��;�1 Parris) # /J t Lot #.L Block # 7 /76-712 C� JUN 1 3 2005 G r Property Owners fling Address Property Location n ST. CROIX COUNTY f . 0 ,j Q ZONING OFFICE MC y,, -Ah Section City, State Zip Code rnol, circle onef 1 62 - S T3LN; RE c& II. Type of Building (check all that apply) ok 45 pe - S.lwK/ AvdSa. . 1 or 2 Family Dwelling - Number of Bedrooms -3 pJa. w Subdivision Name CSM Number ar C3 Public/Commercial - Describe Use 5 ❑City ❑Village®Township of SG" r&r ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expirat'i'on Plumber Owner IV. TyE of POWTS System: Check all that appl ■ N - Pressuri In- Ground ❑ Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil 11 At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatin filter ❑ Recirculating Synthetic Media Filter @ Leachin Chamber ❑ Drip Line Q Grave less Pipe ❑ Other (explain V. Dispersal/Treatment Area Information: t Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispel Area Proposed (sf) System evation Dispersal VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O Q E1-11, Aerobic Treatment Unit Dosing Chamber ' 'bill VII. Responsibility Statement- I, the undersigned, assume respons for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl is Signature *019PRSfilumber Business Phone Number DA"121M � #Z!rzj , � 7VI Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artme Use Onl pproved ❑ Sanitary Permit Fee (includes Groundwater Date Issued lssui Agent Signatu (No tamps) Surcharge Fee) ?M �3 05 ❑ ven Reason for I •.J(, IX. Conditions of Approval /Reasons for Disapproval _VX STEM OWNER: Septic tank,tffluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AA setback requirements must be maintained as 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) "r v'-' VNI'v� 3Z . !3 /o t?! S'ysT�r�C 3 01 y% h un Cis - Vic% ?glop `000 GL S.% two �f Ac r 13,4 Q� m.A v 5c41- c- / ya /3/`7 = Top 2 't r 11/17 �op ,2 "� v c , o� , p c EL } 9I2 Y 9 /7'0 COPY 14R'7 z a � , = o� go i3 AS 596 il !/iezv Ir /L S r'l L tV /+Te2 ' Rio �t VC ygw rrnr q - - 30/' PRop s�o y �3z - �ltopos p /000 GL S,% 83 Ac r 4y' e 9y Q J � Q _ 'lll lfl- = Tod 01 jw� PAP EC -, Air fl Ton A °I &C ' Al � G - IOA Z LVIA-a- 15' --= ga_zee_� / /3o K A' S -, o 58G 11,4 1, Jl /e 7_/Z S U/A T C'2 / /`T 1,411" A 1233 Wisconsin Departmentof Commerce C SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings r omm 85, Wis. Adm. Code Tom Schmitt County Attach complete site plan on paper not less than 8% x ¢e. Plan must St. Croix include, but not limited to: vertical and horizontal reference ), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information_ Reviewed By Date Personal irrk mation you provide may be used i ee ro-y s. 15.04 (1) (m)). Property Owner Property Location Grand Properties, LP c Govt. Lot NE 1/4 NW 1/4 S 123 T 31 N R 19 W Property Owner's Mailing Addresss Lot # Block # Subd. Name or C M# 712 Rivard Streeet, Suite 300 4�j 22 Gavin's Acres: First Addition City Stat Zip Cr Nft0*MftJ City I Village OM Town Nearest Road Somerset WI 1 54025 1 715 - 247 -5900 Somerset 210Th Ave. je New Construction Use: M" Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement J Public or commercial - Describe: Parent material Ouiyyash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible sytem elevation for Area 1 is 94.0' Slope is 5 %. -__ (� ~ 3 Boring # J Boring Pit Ground Surface elev. 97.32 ft. Depth to limiting factor 94+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 I *Eff#2 1 0 1Oyr3/4 none ell 2csbk mvfr as 1f .6 1.0 2 10-33 1Oyr4/4 none Is lcsbk mvf gw 1f .7 1.6 3 33-94 1Oyr5/4 none s Osg ml — — .7 1.6 �I From 33" - 94" 2" bands 7.5yr4(6 Is 1 msbk a Boring # Bering f sm Pit Ground Surface elev. 97.32 ft. Depth to limiting factor I6+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff *Eff#1 I *Eff#2 1 0-8 10yr3/3 none sl 2csbk mvfr as 1f .6 1.0 2 8 -12 10yr5/3 none st 2msbk mvfr as 1f .6 1.0 3 12 -21 7.5yr4/4 none Is 1 csbk mvfr gw — .7 1.6 4 21 -39 7.5yr4/6 none s Osg ml gW — .7 1.6 5 39-93 1Oyr514 none s Osg ml — .7 1.6 Lh * 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) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 422104 715- 247 -2941 Property Owner Grand Properties, LP Parcel ID # / Page 2 of 3 a Boring # J Boring ✓ Pit Ground Surface slew. 95.65 ft. Depth to limiting factor 92+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -9 10yr3/4 none Is 1csbk mvfr as 1f .7 1.6 2 9 -22 7.5yr4/4 none sl 2msbk mfr gw if .6 1.0 3 22-44 7.5yr4/6 none s Osg ml gw if .7 1.6 4 44-92 10yr5/4 none s Osg ml — — .7 1.6 From 44 "- 97, 2" bands of 7.5yr4/6 Is 1 msbk 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 *Eff#1 *Eff#2 F-1 Boring # Baring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -S_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. R 133 Page 3 of 3 • Conducted by: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54027 New Richmond, WI 54017 Phone: 715.247.2941 Subd. Name: Gavin's Acres, First Addition Lot No. /P?L 1/4, W41 1/4, S 23, T 31 N, R 19 W Township of Somerset BM El. 100.00' Alternate BM EL Slope = S % Contour Line EL 14 Scale: I"= 40' 5A & — - -g-' o// 03 Ali (3 ni Ca /pF� �o This soil report was done to fulfill a Zoning requirement. It may ay not be in a I ion that is suitable for you use. No permanent lot markers were in place when the was con ed. • e �~ o O Q ,.- Awi� : • i ti w � ,� .11 \~ W GIN i R , G. LL- oar do •~ •• • o LL 7�q x , I y N O� 0 1 11 1 N i If w ` • _ 133aS H109. - r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _!� �% PAf- /`7,4=V? Mailing Address P . O , 96k 95 L_ 1 a2 i eA A/V 55 - ogg- Property Address 3 T (Verification required from Planning Department for new construction) City /State yo� fit_= i Parcel Identification Number LEGAL DESCRIPTION Property Location -466 Y4, "L, '/4, Sec. ,13 T _N -R_ ( W, Town of rSe!'7E2SET Soar Subdivision 114 /i/m-y AC11 '-- S . Lot # . a- . Certified Survey Map # , Volume , , Page # Warranty Deed # Volume Page # YS Spec house ❑ yes ® no Lot lines identifiable ® 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 wastewater disposal 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 year expiration date. SIGNATURE OF APPLICANT DATE I 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 c * * * ** 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Art Palmer Septic Tank Capacity 1000 al ❑ NA Permit # Septic Tank Manu Week's C . P . 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a be 1 0 NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units IR NA Pump Tank Capacity a l 0 NA Estimated flow (average) g al/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) gal/day' Pump Manufacturer 0 NA Soil Application Rate 0.7 gal/day/ft' Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil at 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 0 In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y, in dia. r r ❑ 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: 3 ❑ month(s) (Maximum 3 years) 13 NA fig year(s) Pump out contents of tanks) When combined sludge and scum equals one -third %) of tank volume Q NA, ❑ month(s) Inspect dispersal cell(s) At least once every: 3 ® year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 1 ` 0 10 mont )(s) ❑, NA ❑ month(s) Inspect pump, pump-controls & alarm At least once every: d NA. . ❑ year(s) ... ❑ month(s) Flush laterals and pressure test At least once every: O NA; ❑ ye ar(s) Other: ❑ month(s) At least once every: ❑ year(s) Other: ❑ NAB F 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:lesks`;a measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the groundsurface The dispersal coUts) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pond 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, tha. n c contents of 'the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR113, Wisconsin Administrativa 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 withln 10 days of completion of-any service event. r Page of 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 pr " use. System start up shill not occur whbn soil conditions are 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(&) In one large dose, overloading the cells) 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 Septago 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: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. i • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. as j • 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. r i 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 replace the failed 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. j ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the b(omat 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' ohn SchAtt Name Owners choice Phone Phone (715 549 F SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name hoice Name St. Croix Ct . Zonin Phone Phone 715 386 -4680 This docunwnt was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(Q and 83.64(1), (2) & (3), Wisconsin Administrative Code. U. 2819P 456 - 7 IE9 - 7 19a � KATHLEEN H. WALSH State Bar.of Wisconsin Form 2 - 2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number Document Name 06/09/2005 12:15P?I WARRANTY DEED EXERT # THIS DEED, made between Grand Properties, LP � REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 228.00 and Arthur Vincent Palmer COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space 3 is needed, please attach addendum): Name and Return Address Lot 22, Plat of Gavin's Acres South Addition, Town of Somerset, St. Croix County, KH i S 1 d r IA OG LAND Wisconsin. ATFO MN EY AT LAW P.O. ICIOX 3- 032- 106040 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated A QJ Lo < Grand Pr �erties, LP (SEAL) (SEAL;; * * By: ichael J. G rmain SEAL SEAL * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Grand Properties, LP By: Michael J. Germain STATE OF ) authenticated on (I CIO ) ss. - n COUNTY ) *Kristina O land I Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED p 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTm Legal Forms 800- 655 -2021 www.infoproforms.com 1233 SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete alts pie► on paper not loss than 8%x 11 inches in size Plan must County St Crob( include, but not rwft to: vertical ad horizontal rei ererrce point (8", direction and percent slope, scale or dons, north arrow, and location and distance to nearest road. Parcel I.D. Please print all inlonnatton. Reviewed By Date Peraamal in -cation you provide may be used for secondary purPoon (may Low S. 15.04 (1) (re))• Property Owner Property Location Grand Properties, LP Govt. Lot NE 1/4 N 19 3 2 3 T 31 N R 19 W Property owner's Mailing Address Lot # Block # I Subd. Name or CSM# 712 Rivard Streeet, Suite 300 22 Gavin's Acres: First Add'iti'on City State Zip Code Phone Number - .I City - ,.,j VMW a Town Nearest Road Somerset WI 1 54025 1 715- 247 -5900 Somerset 1 21 O fh Ave. New Conetructian Use: del Residential / Number of bedrooms 3 Code derived design flow rate 450 GP0 Replacement J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comrnarft and recornmendations: Area is suitable for a conventional system with a 01 gpd/sgft rating. Possible sytem elevation for Area 1 is 94.0' Slope is 5 %. M _j O Boring # -ng V, Pit Ground Surface elev. 97.32 ft. Depth to tirniting factor 9!!!+ in. Sot Application Rate Horizon Depth Dominant Color Redox Deaaiptiar Taxtore Stnx tome Consistence 8wndary Roots GPD/ft= 1 0-10 1Oyr3/4 none sl 2csbk mvfr as if .6 1.0 2 10-33 1Oyr4/4 none is 1csbk mvf gW If 3 33-94 10yr5/4 none s Osg ml -- --- .7 1.6 From 33' - SW 2 bands .5yr4/6 Is 1 not* Boring # Boring i/' Pit Ground Surface elev. 97.32 ft. Doh to limiting factor 96+ In- Sea Application Rate Horizon Depth Domma nt Color Redox Description Texture Structure Coristence Boundary Rooa 'Eff#1 ff#2 1 0-8 1Oyr3/3 none 81 2csbk mvfr as 1f .6 1.0 2 8-12 10yr5/3 none sl 2msbk mvfr as 1f .6 1.0 3 12 -21 7.5yf4/4 done Is lcsbk mvfr gW -- ml gw .7 7 1.6 1.6 4 21 -39 7.5yr4/8 none 6 080 -- 5 39-93 10yr514 none s 069 ml - -- .7 1.6 ` Effluer t 01 = SOD T'30 <220 mg1L. and TSS >30 < 150 mg/L ' Effluent #2 = BOD <_30 mg/L and TSS <„�0 mplL- CST Name (Please Print) _ _ Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Dee Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 41'22/04 715- 247.2941 L N Pd Ground SuRace eb+r. 95.65 ft. Depth to limiting factor 92+ in. Sort Application Rate Horizon Depth Dominant Color Redox Desaiphon Texhae Siruclu a Consistence Bowx Wry Roots "Eff#1 GM T 1 0 1Oyr3/4 none Is lcsbk mvfr as 1f .7 1.6 2 9.22 7.5yr4/4 none sl 2msbk mfr gW 1f .6 1.0 3 22-44 7.5yf4/8 none s Oag ml gW 1f .7 116 4 4492 10yr5/4 none s On ml - ----- .7 1.6 From 44"- 97, 7 ber ids of 7.5yr4M Is 1 nW* Boring F-1 Boring # ft. Depth to limiting factor in. f Pit Ground Surface elev. Soil Application hate Horizon Depth Dominant Color Redox Description Texhue Stnrcque Consistence Bound" Rools •Etf#1 GPIM 'Etf#2 El Boring # J P Ground Surface elev. ft Depth to tisruiting fader in. Soil Application Rate Horizon Depth Dominant Color Reft Description Texture Stnrctme Consistence BourdM Roots dpw •Etf #1 *01112 ' Effluent #1 is SOD 30 < 220 mgt. and TSS >30 < 150 rnWL. ' Eff wd #2 = BOD mgll. and TSS _30 mgll. The Department of Commerce is an equal opportunity service provider and employer ffyou need asirux to access selvx s of need material in an attcmate format, please contact the department at 608 -266-3151 ore TTY 608 - 264 -8777. ,A 1 Yage 3 of j Conducted hy: Conducted for. Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54027 New Richmond, WI 54017 Phone: 715.247.294 Subd. Name: Gavin's Acres, First Addition Lot No. W C 1/4, 1Y41 1/4, S 23, T 31 N, R 19 W Township of. Somerset BM EL 140-.00' 70' ., �!/G ".;?�E= Alternate BM EL 97. �/p of • .P Slope = S % Contour Line EL IPA Scale: I"= 40' 5/w 93 w1 Oz / JIIC r , i e _ 640k Ape This soil report was done to fulfill a Zoning require ment. ix may not be in a dIat is su"e fur your use No permmmt lot markers were in place when the was con ti� 2� �� 3.3G °� . 33 ��