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HomeMy WebLinkAbout032-1095-60-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division 3. INSPECTION REPORT Sanitary Permit No 506133 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)l. Permit Holder's Name: City Village X Township Parcel Tax No: McIntyre, Jeff & Brenda Somerset, Town of 032 - 1095 -60 -300 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /OLD �J v ► G5'•T 34.31.19.443D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / _.C., Z .; ' Benchmark '"> kc. F; � . z /GbCJ 11 3. 05 /63 r n Sao M p a, sz Alt. B 4, 1 Z.5 Aeration Bldg. Sewer 'S • Z- e5 Holding St/Ht Inlet 5-7 `'t 7. Z'S TANK SETBACK INFORMATION St/Ht Outlet (p, Z `I(v • S TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 33 , Dt Bottom Dosing Header /Man. g 15 T + Ir Aeration Dist. Pipe Holding Bot. System Final Grade 1 PUMP /SIPHON INFORMATION 5• ` rg' Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System H TDH Ft Forcemain nth Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9� Z ,Te S SYST TO G, P/L BLDG WELL LAKE /STREAM LEACHING ' / Manufacture6 /" INFORMATION CHAMBER OR G f Type Of System: 3c3� / �� ] A UNIT Model Number: Ca �IW w•�� a N� -- DISTRIBUTION SYSTEM �--- 9 + - 1 Header /Manifold, Ill Distribution x Hole Size x Hole Spa Vent it Intak� T Dia —7 Pipe(s) \\ Length Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Z Depth Over Depth Over 1 XX Depth xx Seeded /Sodded xx Mulched Bed /Trench Center to 4 t Bed /Trench Edges Topsoil Yes No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1860 58th Street qomerset, kAll 54025 (SE 1/4 NE 1/4 34 T31 R1 9W) NA Lot 3 Parcel No: 34.31.19.443D 1.) Alt BM Description 2.) Bldg sewer length = 2.2. �1 /+ ,(� i^e Cad uu v►tG�G - amount of cover � c E Z Fl o Plan revision Required? Yes o Use other side for additional Information. v � Date Insepctor Signature Cert. No. SBD -6710 (R.3/97) l commerce.wi.gov Safety and Buildings Division County ■ 201 W. Washington Ave., P.O. Box 7162 St Croix i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce �Q Sanitary Permit Applicati n S tate Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form Aap riat e ovemmental A unit is required prior to obtaining a sanitary permit. Note: Application fo wn PO are Project Ad s (if different than mailing address) submitted to the Department of Commerce. Personal information you provide ma dary purp oses in accordance with the Privacy Law, s. 15.04 1) (m), Stats. �` T I. Application Information - Please Print All Information Property Owner's Name Parcel # Jeff and Brenda McIntyre 26F 0 3.2 l o S— "'& 362) Property Owner's Mailing Address Property Location 468 Meadow Lane ST. CROIX COUNTY Govt. Lot l / �`? ' � City, State Zip Code Phone Number SE y., NE %, section 34 Some WI 54025 715- 247 -3634 T31 N; 19Eor (circle one) i R W 11. Type of Building (check all that apply) 0 Lot # - 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ��7^ Block # ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Numbe� �a 79 S7 El Village of C)° ,K Town of Somerset- V i0 1 X9 III. Type of Permit: (Check only one boa online A. Complete line B if applicable) A, X New System ❑ Replacement System ❑ Treattnent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision 11 Change of Plumber . El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System /Component/Device: Check all that appl X Non-Pre ssurized In- Ground El Pressupzed In-Ground �� ��.fi"� > 2 of 'table ❑ �vlound � itable s oil El Holding Tank El Other Dispersal Component ex lain red e t V. Disp ersal/Treatment Area Information: Design Flow (gpd) Design SS it Application Rate(gpdsf) Dis rsal Area R qui (f) Dispersal Area Pr osed (s System Elevation 450 .5 ,/ 1350 sq ft /O rp 1350 sq ft 6) 93.9 VI. Tank Info Capacity in Total # of Manufacturer 7 Gallons Gallons Units fl y o New Tanks Existing Tanks y a a` U vi ti C-1 Septic or Holding Tank 1000 1000 Skaw Pre -Cast x Dosing Chamber Q �p L VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er's Signature MP/MPRS Number Business Phone Number Thomas D Gustu 715- 658 -1344 MP227618 Plumber's Address (Street, City, State, Zip Code) N13450 937'" Street New Aubum WI 54757 VIII. oun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issued Iss ng Age Sign ❑ Owner Given Reason for Denial IX. Conditions of A pproval/Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and 4a.4111 � - _$4 A ©� na4d6 Qg Allu dispersal cell must all be services / maintained V I v as per management plan provided by plumber. �Y�? �-ilJ / 2. All setback requirements must be maintained 86 POF ttacb to complete plans for the system and submit to the County only on paper not less than S tr2 x 11 inches in size I w co 1/d lA •0 0� W s= �n W - - - --- Ot o O I /066 � IS_ v C7 2 a 0 o c I CO� 3 m I y cn D 3 N F � O M O � O l la _D C # �o (D � ILO W;, n o a s cum a' m m o o / D 0 CD i gm �\ ----- ------------------------------------------------------- 58th Street. Co C3 - ---------------------------- II i n 3 VJ (n cb N I� O O n m m W Co r- - N r r O O N a m 9. O N a m g y y z -4 ? _ p _ v_ o f w � 4 � 44 , � 1 ~ co N 1 CD W N � r < 1 70 C A l l -- —J— 131 —._+_ --- -- -- — cn D oL :3 - - - - -— i v :I7 i i Chambers Page 1 of 4 Cover Page Project Name: Jeff and Brenda McIntyre 450 GPD Conventional Owner's Name Jeff and Brenda McIntyre Owners Address 468 Meadow Lane. Somerset, WI. 54025 715- 247 -3634 Legal Description SE ' /., NE Sec 34 T 31 N, R 19 w Township Somerset County Saint Croix Subdivision Lot# 3 Parcel ID# Table of Contents pg- 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Plot Map total # of pages: 4 Designer Name: Thomas Gustum License #: 227618 Date: 3/29/2007 Ph. #: 715 - 658 -1344 Signature: - Design Methods Used "IN- GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD- 10705 -P (R.6/99) Chambers Page 2 of 4 Calculations and Drawings Site Conditions Infiltration Elevations Site Type: commercial 1W Cell #1 Cell #2 Cell #3 %Slope 11 % Contour Elev: 97.70 95.90 0.00 Ft Estimated Daily Flow 450 Infiltration Elev: 93.90 93.0 0.00 Ft Depth to limiting factor 96 in Limiting Factor Elev: 89.70 N/A Soil Application Rate: 0.5 gal /f A2 /day Treatment and Dispersal Zone: 4.20 6.00 N/A Effluent Quality [ � Cover Material Required: 0 0 N/A In Design Flow: JKal /day Finished Grade Over Cell: 97.70 95.90 N/A Max BOD 220 mg /I Max TSS 150 mg /I Distribution Cell Septic Tank Choose chamber type: EZ Flow 3 x t cell Septic Tank Manufacturer: Skaw # of Cells Septic Volume Chosen: 1000 Laying Length: 10.00 Ft Effluent Filter Selected: Biotube FTS0854 -36 EISA Determined Area: 50.0 Ft2 Note: Access opening of sufficient size to be provided to allow removal of filter. Open Bottom Area: 35.30 Ft2 Opening to terminate at or above grade. Chamber Height: 12 Inches n Required Infiltrative Area: 1X0.0 Ft2 Rn Actual Infiltration Area 1350 Ft2 Total # of Chambers: � k Total Cell Length: 27QO Ft 11b Cross Section of Septic Tank Cross Section of Cell Vent in manhole cover 4" Min. � 1T' Min. 1 Barter Paper \ \ 8" Min / All joints to be water tight D3034 or Sch40 �EfFluent pipe Fitter 3" Bedding Under Tank Plan View of Typical Cell \ � J v fr V<A 00 00 - 1 /d 1 CD CD I� co 0 ' W ■ w '— OD �I J I v �p * o edoiS N /066 °' ■ ` 0 i , cn D Sr Inj y �po , N O 'w co G) WG) �W m� U1 (p G v W �n 0o vN nA n ■ a iD I -n O� O 5+ 2 v O n o, 3N B p� ti N O C � W I I CA) -- w ------- ---------------------------------------------------- 58th Sn Sp m CD 3 4 �� g s R D m oa; I Page 3 of 4 In- Ground System Management Plan pursuant to comm 83.54 w. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) and effluent filters are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by removing the clogged bacterial mat, aggregate /leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area S} 7/S y 6 80 Gustum Septic Service 1- 715- 658 -1344 r X ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer ' anj do M o nt/r Mailing Address 1 4bO B mcodow [ 5Uoa Property Address 1 5e n 6t 9ff r I W 4 Q E 5 (Verification required from Planning & Zoning Department for new construction.) City /Stat i Parcel Identification Number a3 - Z0(y S' (o D - 3 � LEGAL DESCRIPTION Prop Location SE i 1 3 � 1y p rty /4 , N � /4 , Sec. -34 , T N R P W, Town of Subdivision , Lot # ^. Certified Survey Map # 5a - 1 (pCET� , Volume �� , Page # C J Warranty Deed # a36U3 , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms V� yp L4 /10 / o� SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 14sconsin SOIL EVALUATION REPORT #2282 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Gustum Septic Service Attach complete site plan on paper not less than 8'/ County x 11 inches in size. Plan must St. Croix 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. 03 Please print all information. Review By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / 7 Property Owner Property Location McIntyre, Jeff & Brenda Govt. Lot n/a SE1 /4, A, S34, T13N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 468 Meadow Lane 3 n/a Doc. # 527657, Vol. 10, Page 2903 City State Zip Code Phone Number City _;J Village 16 Town Nearest Road Somerset WI 1 54025 1 715 - 247 - 3634 1 Somerset I 58Th Street 4,1 New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD , f Replacement �J Public or commercial - Describe Parent material outwash plains Flood plain elevation, if applicable n/a ft. General comments Extension to soil test submitted 5 20 - 92, to confirm soils. Part of 10 acres. Recommend syste el. 93.9'. and recommendations: ]Boring # Boring Pit Ground surface elev. 95.9 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff #2 1 0 -6 10yr3 /3 none A 2msbk mvfr as 2f,1m 0.6 0.8 2 6 -17 10yr4 /6 none A 2msbk mvfr cw if 0.6 0.8 3 17 -26 7.5yr4/6 none gr. s 0 sg ml cw - 0.7 1.6 4 26 -61 5yr4/6 none fs 0 mfi cw - 0.5 1.0 5 61 -96 7.5yr4/6 none gr, sl 2msbk mfr - - 0.6 1.0 F Boring 7 Boring # Pit Ground surface elev. 97.5 ft. Depth to limiting factor >96 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 'Eft#2 1 0 -7 10yr3/3 none A 2msbk mvfr as 2f,lm 0.6 0.8 2 7 -16 10yr4 /6 none sil 2msbk mvfr cw if 0.6 0.8 3 16 -26 7.5yr4/6 none sl 2msbk mfr cw - 0.6 1.0 4 6 7.5yr4/6 none gr. Is imsbk mfr cw - 0.7 1.6 5 42 -96 5yr7 /4 none gr. sl,sl 2msbk mfr - - 0.6 1.0 3. �. " Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S30 mg /L and TSS s mg/L CST Name (Please Print) Signature CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St. New Auburn, WI 54757 3127/2007 715 - 658 -1344 RIAMR330 (R 071001 Property Owner McIntyre, Jeff & Brenda Parcel ID # Page 2 of 3 F- � Boring Boring # e Pit Ground surface elev. ft. Depth to limiting factor 24 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 1 0 -5 10yr3 /3 none sil 2msbk mvfr as 2f,lm 0.6 0.8 2 5 -15 10yr4 /4 none sil 2msbk mvfr cw if 0.6 0.8 3 15 -24 7.5yr4/6 none gr. sl 2msbk mfr cw - 0.6 1.0 4 24 -60 7.5yr4/6 c2 - 3d 10yr7 /2 sl M mfi - - 0.2 0.6 7.5yr5/8 F -1 9 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor 23 in. Soli 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 1 0 -6 10yr3 /3 none sil 2msbk mvfr as 2f,lm 0.6 0.8 2 6 -13 10yr4 /4 none sil 2msbk mvfr cw if 0.6 0.8 3 13 -23 10yr4 /6 none sil 2msbk mfr cw - 0.6 0.8 4 23 -35 10yr4 /6 c2 - 3p 10yr7 /2 sil 2msbk mfr cw - 0.6 0.8 7.5yr5/8 5 35 -53 10yr4 /6 m3p10yr7 /2 gr. sl 2msbk mfi - - 0.6 1.0 7.5yr5/8 F -1 A Boring Boring # �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 GPD/ft 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 c need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8771 cnn -a116 rx 07/601 Gustum Septic Service - • CL CL Q m 2 a� ca i�r i O � �- 1 4 N C T $ 11 5 s CL o c Q � � •� � N 'S ,s a .g !.L! +� g u V� N N J m m ui 11 11 U 9 CR M U) u n m 3 0 ---------------------- --------------------------- - -------- - - - - -- l i �3aa�3S 4369 ------------------ -_ -,-, � M M ■m_1 mom, aD Lf) ■ ■ m in O � y co Q 7 d M S (0 Slope 11 co d CL m d3 m � o M ■ M A CL zo U c� P!L -- co 00 ST. CROIX COUNTY WISCONSIN PLANNING & ZONING DEPT. ��'• ` ��N /Np�NA� rn�r ST. CROIX COUNTY GOVERNMENT 1101 Carmichael Road Hudson, WI 54016 -7710 r t:r� -• rT� �- r f +mss (715) 386 -4680 FAX (715) 386 -4686 COUNTY ON -SITE VERIFICATION FORM b ►1- Si -�C � �l�m Qu �v►�t �(o6s � � CLf/ti �rn � Property Ov ner Property L ocation 3Y7 Y 7 S Gmt. Lot 1A ti/E1 a s r f•! R / E for Property0'rt� s1V1ai N� dress L�`vL Lot # Block # Stbd. F!a CS /O I State Zip Code PhoneHtanber City Village ,vn I-lea rest Road 5-yoz i r (A e. Construction Use: sidentia l i N umber of bedrooms _ ' _ . Code deri.Qd design flay rate ❑ Replacement ❑ Public or commercial - Describe: Parent material General comments Florid Plain elevation if applicable - - and recommendations: /e1% u1 Vetl + 49� o� /�g 2 -Q> ir'�a rf 4 L � Je led 11 V h//� -Vhl1� ® Boring PP C , - t O-49 ��� `[[p Ground surface et?.: --AL Depth to limiting facto T- - Soil Awkation Rate Horizon Depth Dominant Cobr Reclox Description Texture Structure Consistence Boundary Roots GPD* in. blunsdl Ou. Sz. Cont. Color Gr. Sz. Sh. 'E11#1 *Eff#2 0 - 5 - 1 0 3 S� 2eh r m 1 A w Ll 2b A. 5 ° �o Ca�rse CSq $ 1 S 7 *34Y 7 5 R Y L 4:11 s 7 off %h e r G! nit 1 �, F -1 ecing tt ❑ Boring ❑ Pit Ground su rface eyv ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color RecbxDescription Texture Structure Consistence Boundary Rods GPDW in. Munsdi Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ST. CROIX COUNTY ON -SITE VERIFICATION FORM PrcpertyO•nner . - - - -- - __ -_. ..... — -- -- ._ Parcel ID # - -- - -- - - - -- — - - - - -- -- Page ----of 1-1 Boring F1 Boring ❑ pit Ground surface elev. __At. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr 13edox Description Texture Structure Consislence Boundary Roots GPO ff in. Munsell Qu. Sz. Call. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 F—I Boring ❑ Boring ❑ Pit Ground surfacoalev. ft. Depth to limiting factor _ in. Sal Application Fate Horizon Depth Dominant Color Fedok Description Texture Stntctum Consistence Boundary Rods GPDA in. k1unsell Qu. Sz. Cal. Color Gr. Sz. Sh. 'Eff #1 'Eff#22 F—I Bering # ❑Wring ❑ Pit Ground surticealrv..___- _____. ft. Oeptlitolimitingfador___________ in. SoilApplication Fate Horizon Depth Dominant Color Fedox Description Texture Structuia Consistence Boundary Roots GPD.4f in. fvlunsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ElflucM 91 = BOO. = 33 1220 mgI and TSS >30 =150 mgrL " Effluent A2 = BOD,= 30 mgr L and TSS ; 30 mg4 II Q o �a �L oti a O d 0 �a Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page --L of 3 Labor and Human Relations Division of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY • site Ian on paper of less than �ie07 Attach com p p p p n lete - a I s n 8 m 1/2 x 11 inches size. Plan must include, clude, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or 6 dimensioned, north arrow, and location and distance to nearest road. 03 �/o APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIE DATE PROP TY OWNER: PROPERTY LOCATION &0 LOT 1/4 Al 114,S 5, T N,R Z 2 E (o4 , )k ) PROPER OWNER' :S I ING ADDRESS T BLO K # SUBD. NAME OR M # D o cl 3 ` CITY, STATE ZIP CODE PHONE NUMBER OC TY VILLAGE OWN NEAREST ROAD [XJ New Construction Use ( Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow � gpd Recommended design loading rate — ed, gpd /ft trench, gpd/ft Absorption area required %_?rr_ bed, ft trench, ft Maximum design loading rate , ,, bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) ,51-2 i5 " ft (as referred to site plan benchmark) Additional design / site considerations Parent material O� f/ 6 r' r Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for stem ®S ❑ U ®S ❑ U ®S ❑ U ©S CI U ❑ S ® U [Is ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bouxiary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench t i Ground _ elev. Depth to limiting factor At -4 _ Remarks: Boring # ritti Ground elev.� Depth to J limiting i �° .�' ,• �. f IN actor _ Remarks: AV CST Name:— Please Print Phone: Address: ff t)Sd' Signature: D CST Number: PROPERTYOWNER 1 /r9ua � se✓ SOIL DESCRIPTION REPORT Page Of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. z. Cont. Color Texture Gr. Sz. Sh. Consistence Bax>dary Roots Bed Trench , .. .............. '� 1 S` , Ground elev. Depth to limiting factor > 5�C Remarks: Boring # 19 - ,3 �a ✓; ............... Ground .. elev. ft. Depth to limiting factor Remarks: Boring # AIZ Xt =.... .Ground elev. _ Depth to limiting factor 7 9,3 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER gaao r_ ,Z , 5,m. SOIL DESCRIPTION REPORT Page _ of PARCEL I.D. # f Depth Dominant Color Mottles Structure GPDlft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. z. Cont Color Gr. Sz. Sh. Bed Trerxh Ground l elev. f t. Depth to limiting factor > Y� Remarks: Boring # 4//4 Ground } 7 elev. ) hkAl A� S Depth to limiting factor Remarks: Boring # �c < }. 3h: r ti Ground ' 7 elev. Depth to limiting factor 798 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 11 • / yciE S� JT J 4 %�9`� �,� �� X sue= � �F ✓/ s.�e �-y, �'.� /�✓, �'' /9r�J Q ti � o ti t o I li 630334 State Bar of Wisconsin Form 1 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., wI Document Number Document Name RECEIVED FOR RECORD 07/24/2006 10 ::30AN WARRANTY DEED THIS DEED, made between W.L. Peterson and Associates. Inc. ;;AXT # ( "Grantor," whether one or more), REC FEE: 11.00 and Jeffrey L. McIntyre and Brenda K. McIntyre, husband and wife TRANS FEE: 253.50 ( "Gran COPY FEE: tee," whether one or more). CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Recording Area Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach Name and Return Address addendum): That part of SE1 /4NE1 /4 Sec. 34- T31N -R19W described as follows: Lot 3 of THE RIVERBAW Certified Survey Map recorded in Vol. 10 of Certified Survey Maps, page 2903 as P Box 188 Doc. No. 527657. osoeola. VA 54020 032 - 1095 -60 -300 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated r ! �`�T Imo_ "' W.L. Peterson and Associates, Inc. (SEAL) (SEAL) * *William L. Peterson, its president (SEAL) �� (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) W.L. Peterson and Associates, Inc, by William L. Peterson its oresident STATE OF ) authenticated on ) ss. COUNTY ) *Kristina O and Personally came before me on , TITLE: MEMBER STAT 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: * Kristina Op-land, Estreen & Ogiand Notary Public, State of 304 Locust Street, 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 0 2003 STATE BAR OF WISCONSIN FORM NO. 1 - 2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 655 -2021 www.intbproforms.com toff Parcel #: 032- 1095 -60 -300 03/29/2007 11:45 AM PAGE 1 O F 1 Alt. Parcel #: 34.31.19.443D 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 - MCINTYRE, JEFFREY L & BRENDA K JEFFREY L & BRENDA K MCINTYRE 468 MEADOW LN SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.190 Plat: N/A -NOT AVAILABLE SEC 34 T31N R19W PT SE NE BEING LOT 3 Block/Condo Bldg: CSM 10/2903 5.19 AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34-31N-19W Notes: Parcel History: Date Doc # Vol /Page Type 07/24/2006 830334 WD 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.190 58,900 0 58,900 NO Totals for 2007: General Property 5.190 58,900 0 58,900 Woodland 0.000 0 0 Totals for 2006: General Property 5.190 58,900 0 58,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FILED ' 1pR 1 2 19 - JUN 2 6 1995 9S ► _ :ov yF... KATHLEEN H• WALSH 52'765'7 Z St. O�� X co ° ., wi ST. CROIX COUNTY CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 34, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin. N NE Corner of LEGEND Section 34 N Aluminum County Section Monument Found d s 0 - 1 x 24 Iron Pipe Set, weighing 1.68 lbs. per linear foot - Marsh Area O C = Roadway Setback Line v c•o 12' UTILITY EASEMENT ao v — — C fn O d C) L 4. O � d �'I•d L ..y L W N N L N b L O +' •1 �—� D If1 cm 4- PL AI I `ati�s LN C.T.H. 11T11 y -4 N 1 _ North line of the SEJ of the NEJ G N89 °28' 40 "W 731.60' N89 0 � 28' 4�0 "W ` rp _ 69 ;841 — 5 74 292.31 g 33.76' o �— - - I [—• -- /- N89°16'43 o N89 0 16 1 43 11 W ' I , o 0 115.48' 3 S05013116 2N Apr N65 0 13 1 16 11 112.78 : I 100 2 1001 7 cc i M N20027139 S20 °27' 39 134.49' �' t / 134.49' * n N 00 z g LOT 3 LOT 1 1 * `� 5.22 ACRES 5.19 ACRES 15 227,387 SQ'FT.�o, 226,14) SQ. FT 2 z ry �I o N (wa V. , T UJI 4 ` H 1 �;. ��� A r ",a 7 c✓ v' - ; 7 N �- - 1 u- Q 16 �+ K . 1k J� N55 02 s H j _JI 0 66.00' 3� 1 �� ! W Di a 1e S69 0 56 1 11 11 E APR 1 2 107.20' (SEE SHEET 2 FOR �� WNER N TEMPORARY CUL -DE -SA s 5T • CR(OXX COUNT DETAIL.) N69 °56' 11 "W WILLIAM PETERSON ;;ompreh*nsive Pi LOT 2 113.48' C/o zoo ad j A SOMERSET,WT PO*S C401MAl" 4.14 ACRES t 180,256 SQ. FT. «) v 54025 If not record �.. �' M M • within 30 days of M approval date �s,+roval .5'i��I tie 963.76' S89 °37' 03 "E 356.93' S89 I 1 I -7 -rC:- South line of the NE} Ej Corner of 2NPLA 1 1 L1) Section 34 SCALE IN FEET LAND- �* 0 100 200 40o SHEET 1 OF 2 SHEET VOL. 10 PAGE 2903