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042-1020-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538895 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: Weisman, James Warren, Town of 042-1020-40-000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town/Range/Map No: Z3 Aq, ry"\ 08.29.18.1148 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ Benchmark 5 /dl.Z~ /6 43 Alt. BM DvslTfi~ Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 35 a J-- I/oi TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. • I ,7 qL • / Aeration Dist. Pipe 7• z ri~1.49 9• Z 43. o/ /i•Z Holding Bot. System o 93.q'f i • Z7 72 -1 • 's ~ 6 . o t Final Grade PUMP/SIPHON INFORMATION M Manufacturer Demand St Cover GPM /'Drj lot. 2.3 Model Number TDH Lift Friction Loss System Head JTFt Forcemain Leng lh-~- I Dist. to well SOIL ABSORPTION SYSTEM i d D,th BEDITRENCH Width ) Length ( No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.T_11u DIMENSIONS -3 $ Z Ite w~i~pv SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR 1•-rt tr "la ~_L Type Of System: 7Z / ZD n I UNIT Model Number- ✓ 1+ 5 liz DISTRIBUTION SYSTEM E Zb F-ZO z~ = ~b Header/Manlold Distribution x Hole Size x Hole Spacing Vent to Air Sake ~ Pipe(s) \ ~ 77 Length 5 - Dia Length ` Dia \ Spacing ✓G Na SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx MULC hed Bedfrrench Center r /1 I Bed/Trench Edge\ Topsoil Yes El No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1047 110th Ave Roberts, WI 54023 (NW 1/4 NE 1/4 8 T29N R1 8W) NA Lot 1 Parcel No: 08.29.18.1148 LoJe._ G~a ~ `o~z 6✓~ 1.) Alt BM Description = r" t ` ' 2.) Bldg sewer length = ~x l'_-5 - amount of cover = Plan revision Required? Fffl Yes No 3~1 z j {rte 3 7 Use other side for additional informati/////ion~~n. Date Insepctor's Ature Cert. No. SBD-6710 (R.3/97) .5oi l e dGtIL~R~j~/y7 • ~e~~~~P She ~~+1~~~le 1.v2iSMann (a 0 /0,/ 7 //o'g ~4,1 c- Y ~J Ad s w 2.3 averd~s~,--~,p ~e.!(~nusf ~ ~?u.~S/rlF.~f.Sre.B,~i9ft•, ~8~v., Tic. o{'tc.~•~/e.,, ('CS u-L ~ ~ ~t.-~'n~'s l..~c>/ p✓'aed~ .5~. Crd,,~ ~'o., u~/. Sl~nes be;n~, c,-.,- HOC/. vs~z-~vzo- s~%-cxx~ 6ei 3,(~c~es. SY s 6 esi. ~ _ p~opestel d;sp~tr..Gce/I. -n(~«(3 c.,cloos a-I 'mot 3X83"w/~8 a-,/ 4 P60/ o O O `b a a D. N, P e c 44 EE~ bed 5`~'t i i KCS. all~n cam ! I t t h r t ~t ~ t ~ ! , t ~ I f J t ~ t ~ l /a o an Ge~1, j k -`qr'~ i , rr, J rat r \ ~2la~t? 0.PrCIn. Assn rri S~~QtTM~O~f~~% l 10 /cX>.c1D. 5P 7 sz.' ~ . ~ r cl ♦ , 8 1 ~ 36~coC~n LkZd Propesed tom,-escr ~c.e •6e dsf» u 4rncre. b ~ bale. ~.z,~/O County commerce.wi.~x Safety and Buildings Division 201 Washington Ave., P.O. Box 7162 St. Croix SCpMadison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department Commerce Sa ita er lication State Transaction Number rn .C /V/1T' In accordance with s. Comm. 83. (2), Wc9? n of this form to the appropriate g mental Project Address (if different than mailing address) unit is required prior to obtaid a sj1 ote: Application forms for state-owned POWTS are submitted to the Department of o ersonal information you provide may be used for secondary Same ~/(j~7 /~~T~°, purposes in accordance with the Pri ac Law, s. 15.04 1 m Slats. VV tt I. Application Inf6rrna!!j!R - Please Print All Information Property Owner's Name I Parcel # Jim & Jane Weisman 042-1020-40-000 Property Owner's Mailing Address Property Location 1047 110"' Ave. i Govt. Lot City, State Zip Code Phone Number , , Roberts WI. 54023 NW NE/4, Section 8 (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 18 W ❑ 1 or 2 Family Dwelling - Number of Bedrooms _ Subdivision Name Block # CSM El Public/Commercial - Describe Use pol4G2 Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Q own of Warren 3 .r> W Z04- Z(~ C[UwjEkC SM Vol. 13, Pg. 3749 III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. ❑ New System replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other M dific ion to Existing System stem (exPlain g Y ) 1/1 -51/0 List Previous Pe it Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner 44 j IV. Type of POWTS S stem/Com onent/Device: Check all that a i W on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil C. ❑ Holding Tank ❑ Other Dispersal Component plain) ❑ Pretreatment Device (explain) V. Dispersal/Tr atment Area Informatio : 60 fil for "Q-4 Plus" Standard c bers & 6 endca s Design Flow (gp Design Soil Application dsf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation 600 gpd 0.50 gpd/sq. ft. 1,200.00 sq. ft. 1,230.60 sq. ft. 90.0', 92.0' & 94.0' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ° o -1 ~ New Tanks Existing Tanks c a c~ P6 Idk. 5Z5 a. U ~;5 n w a Septic or Holding Tank Na 1,25 1,250 1 Wieser Concrete X Dosing Chamber Na Na Na Na VII. Responsibility Statement- I, the uu ersigned, ass a res onsibility for,' Lion of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ;7s Sign atw MP/MPRS Number Business Phone Number MPRS 30021 (715) 248-7767 James K. Thompson >Orm Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VIII. Coun epartment Use Only Approved isapprove Permit Fee Date )sssuue~d Issuing nt Signatw even Reason for nial $ / 79. IX. Condi i s~.g NtWMeasons for Disapproval 1. Septic tank, effluent finer and dispersal cell must all be services / maintaW as per management plan provided by plumber. 2 AN se[back req*ements must be maintained as per appkable Code I ordinance:, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 Conventional POWTS Index & Tilte Sheet Project Name: Weisman 4 bedroom Replacement Conventional POWTS Owners Name: Jim & Jane Weisman Owner's adress: 1074 110th Ave., Roberts, WI 564023 Site address: Same Project Location: Subdivision: Lot 1, CSM, Vol. 13, Pg. 3749 Legal Description: NWl/4 NE1/4, Sec. 8, T.29N., R. 18W., Town f Warren, St. Croix Co., WI. Parcel ID 042-1020-40-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions & System Cross Section Page 4 System Management Plan Page 5 Filter Specifications Page 6 Septic Tank Cross Section Page 7 Parcel map Page 8 Septic Tank Maintenance Agreement Page 9 Certification for Utilization of existing septic tank Page 10 Waranty Deed ZQQ.. }'ec,~,, t' J ~ Attachments: Soil Evaluation Report Mater Pl er Restric ed Service: James K. Thompson, Dept. of Comm. Credential #30021 Signature: Date: Page 1 Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) ■ So: / e vc~ica~i~n •X/~ eledac.~ • lcra /O/-v StR.E'e la 0 1os17 /1o'9,¢91e- n Y .eo kl-65 cJ/. s3e0 Z3 rWL Foverd7spe'►-sj Cpl/mUS~ ~1u~s/rlE7' Src.8~ 29/(•. /'cSwL~ ; n; s las.~(~✓'a-~ .5~. C~~o~ ('o., cJ/. Slc;neS be.i `-'.LS~ ov++••~^ ~t~yG2-/Az0- S~-~ 6e! 3,6Zacees. SY s ~ ~,ry. esp. p~oposecl d;spus«-Oce/I. -r~~r~~3~cnc~s a~ .x L41 T, cc !eJ's, to be 9z. f C, o 0 PW/ s:t aaA Off, a ~63, ■ ~i 1 P 6 c ; \ 1 Z97 S~L ; ; ; 1 1 ~I Dag le~X/3& 44 blal SY i i ` c l, l 1 h i ~a~a~Q..ce.Prun of}ssc<m c i ~AsTnt8o9'S~e~i / I ;r `4J r ioo.sz' ' ~ ~ ~ d 8l 36'>7c.xr~d Propsed r,.9rescr Lice (',crt A• e d =.4 bob ~ 12 52 'd, 40tr-rq c411 WEISMAN DISPERSAL CELL SIZING CALCULATIONS 1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: 1,200.00 sq. ft. 4. Absorption area as proposed: 1,230.60 sq. ft. (60 chambers total) Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft, EISA 1,200.00 sq. ft. - (6 endcaps)(5.10) = 1,169.40 sq. ft./20.00sq.ft. EISA = 58.47 chambers required Number of trenches: 3 @ 20 chambers per trench (60 chambers total) Trench width: 2.83' Trench length: 83.00' Trench spacing: 8.00' on center Total system area w/ 6' trench spacing: 19.00'x 83.00' Soli Absomdon System Cross Section / ft 93 WJ* 9" ft 4' Schedule 40 g/. O Finial Grade Pipe PVC ith Vent Cap 40ft W i D,O Leaching Z.0 ft Chamber _ ~F--- System Elevation . L- ft {i ft (o ft Soil A radon Svstem Plan View 83 ft ~ft G .d ft 7- r Leaching Trench 1 Chambers 4° Dia. Trench 2 Header Vent Or Observation Pipe 11111 Affopi Trench 3 Pg. 3 of 10 Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 4 year anniversary of new system installation. Drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. Pg. 4 of 10 Filters YS PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm Accepts PVC (gallons per day) making it one of accessibility the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts V& 6" SCHD. 40 Pipe d \y. PL-525 Maintenance: The PL-525 Effluent Filter should_ operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs s servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation' 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. 72 1" 4 53" 1 86.m N na 8 \ 47" 0 ij7. m 4,. I m J J I I D ~A m r m ~0 m \ mAA / I ~ \ 50" 0 0 A0 D C m O z r r D V m D D m,- mA O D O n m D C C (n n T~ m O O n - m p DN A< A U l D A~ r 2 r Z Z O -I m z z O 0 0 r r D O nD O C -I-I ~ r r n W gz Z W(AM Z Z rT. 0 ncc~ D ONZ Dl?Z -OWp Z~ZO ODD O r- co O N O O G7 m -i r Z n n ca ~D > i z n Azo H>O -log z_'r0A ~NV'V~~ 0 LA C C r < n 2.T.` ~ N ZOo m~ V A O O M LI) Sm z >Or { D?r- Dvm Nr-M ~ ZNN 0mN mN m 3 r- O D O Qo Dm N -IN I O.. 'OA 0~ n N D m m n-0 cn rm> I m r AL o6- 2n m Z O r D W m O n N ~C m DD m V O O C7W 1AM N A N O n p Z C n mmi m D 0 v Z m v _v m 0 O A D N Z. mO D 000 \ 2rD r0 n rri n A ~ m C cr) Z D znz O W O V) O O n - p N A A m C) Z ~O? 00A i O Z g A Z O m -+m n c L14 r m to 0 O m 000 Z O N LA n r z A A O J A 20 m p (n m r m W m n z r O r1 O O O D A c: z ~u n < N m m m A A m m m ~ z m Z -I r cn m \ W1250-MR SCALE:1/4" = i' REV NO. DATE: m ° m DRAWN BY:SWT MIESER soUGHETE Z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: W1250-MR PC. 4 c~ /D ST. CROIX'COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne iTci~-ie Mailing Address /O 5/ 7 //d '12 rgt . Property Address acne (Verification required from Planning & Zoning Department for new construction.) City/State 160,6~7~- W/ S Y023 Parcel Identification Number © X12 - /O,Zo - 96' - OW LEGAL DESCRIPTION Property Location /I 4J t/a , t/a , Sec. T ZJ' N R 18 W, Town of Lc -~/~►'7 Subdivision CS M , Lot # Certified Survey Map # 6, /v2 /07 , Volume /3 , Page # 37V~ ~ Warranty Deed # Volume 77,3 , Page # 37 Spec house rio Lot lines identifiable' es 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. Uwe 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 (Nice. Number of bedrooms ion SIGNATURE OF APPLICANT(S) DATE V I ***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) P 8 0~~0 DOCUMENT NO. J'1'A N ~T?M Y 19A? T- SnAC¢ f:-.98RVCD FOR FECORDIHQ DATA ''"r: BAR is wiWARRANTY VDEED REGISTERS OFMCE ~c .nyr.. cc-., w and Mary Ann_ Mell.dr. _ Krwz?rcn frig Si~L Gr nWr, a 1::15 A ra me F [4aaismarm and aria t_:. w ismairi, husband A and W1.Le c15 sU..Va. -ivYa mot- marital y__ y > Grantee. J Witnesseth, That the said Uran:or. Sur a -iunbic wnni of t j _ I ST.L=NA.LLG f I i I i.E SEBdICFS INC. conveys to Grantee the following described real estate in .....P~ x'oi.x r', County, State of W isconser.: lI tSCO;I,;l.d ;.[V" Tax rareO i„u: I I Certified Survey Map in Volumu 4 of rert: f_J rd Survey Maps, nays. 999, as cincumenr numbax 367077, f il". ..ctc.. It.-, b,_` v C, uix l_Viinty F nC=ds v_ - - - n:.~rr-n...-+•-r _t:r.r r. is .i3SQs ~.f ..Fn) of Section right (8) Township Twenty--Nline (29) *i7rth, Range Fiyhtean (it 1 west. I St. Croix County, Wisconsin. I i This is homestead property. i -(is) (is not) I Together with all and singular the hereditaments and appurL--,a.en ,.,,t,.:..,...,, „-..,::si:e; And - . warrants that the title is good, indefeasibie in fee simple and `ree and clear of encumbrances except easements, restrictions and ri3*its of way of record, if any. and will warrant and defend the same. \ o - _ sa.. Dated this G~ day of Mar-n. Y . (S: :L) r`/^! (SEAL) - i ni .Mar ohnson _ I / .(SEAL) YLcG~,w CeAtii/1 Gt=E...`` (SEAL) Marv -71 Me l.len . AUTHENTICATION ACHNOW LEDOMENT e, Q1r-0f!vrr, 0. Signature(s) - - STATE OF W-b+:rSINI r /D~ e- County. Ss. authenticated thi:c ....day of.___.-_ 19_ Yersonaliy came heiorc me this day of -.e r)arci-. Lynn iiai V:Li: Utv _ ~ i TITLE: MEMBER STATE BAR OF - (ir not. ....._I...-._ed by 706.nr. TJ. i_. Ri... t_..) _ 1- nIe known .c the pwrr-an who exencr.u.t.ed thr ,Grrz4o M1:(; in.,_...munt and .r[ c•inri~n t}:r carr,P. THIS I1,7TRUMENT WAS DFAFTE✓ PV r„sF•l,h i~. eo L_. ht - :'•1,,• c) t i nw ) 2 J1 N, r h Ri•. F,ii. (~iltnat•.in~ nlny f,•I:u,tl~olitii.!tr,l ,:r arl::::,••c'.:.•,3 1 l;:al; ~1, r'.,t»:n)=.1.,ni?. ~perwrarers..ir mli, y'tni~' ear111 cam 19 1;, •Ynm:•a _.r r r., ..;Q:::nx w n. n ~ ...1 1...: ~ t. - . _ r. DOCUMENT NO. :5-v ATF, BAR •!L- YT lz=-'- ~ CEM 1 195-2' TMIw SPACE PLSERVED FOR 'RECORDING DATA WARRANTY DEED 1 ^1 73 ' . ~j REGISTERS OFFICE SY_ aC'AhtY r~ wt~c Reed. ior Knoo _ and Nlary Ann N1e11.en -rc$ flu. _ S'IS i . - Grantor, L =15 A [d(i sma_in and Jane C. waisman~.Ir husband l.. rr1 / tip and wife as su::vivc•rsh-p ;tai a _ pIrry Grantee, i 1 Witnessethv That the said Grantor for a vaiuubiu cu-id-1,1-- ~ . - - S7. ~~V~.I.I .G(''iT'i.E SERdICF~ SIG conveys to Grantee the following described real estate in Croix County, State of vJisconacr.: t. "riiscoa,:a.s 54022 Tax rarcui Au : i I Certified Survey Map in 4olum<_ 4 of Certified Survey Maps, page 999, as doculnent nulnbe.t 3Uivi7r Ai r l• , I.-ik i i r, T-n( . St. C.uiy. Count-,; i~-? a+ •••••..••ob. n irk: of Section Eight (8), Township Twenty--Finer(29)TNorth, Range Fightecn [.LC) west- i St- Croix County, Wisconsin. i This --is----------------- homestead property. i (is) (is not) I Together with all and singular the heredltaments and appurLe9-91C<J ...r:ei And _ . warrants that the title is good, indefeasible in fee simple and "rer• and clear of el:curnbrauces except easements, restrictions and ri-ghts of way of record, if any. i and will warrant and deferd the same. o T a~_- v duy of ma--h Dated this ,cc r t V/ LI~!-s ' (SEAL) I rison n ~i'n I.Marv n oh . ' .(SEAL) yu~~(L CX~LGv1 Gf: (SEAL) - AUTHENTICATION ACKNOW LEDGiMENT C,alr -r-or - , - STATE OF WLIZeeN. TN -Signature(s) w_ j... ~ ourty. f authenticated thia day of--_t.___-.._ 19...... i'ersonatiy came before me this ..._.__.-.day of i Ulu :above %ua.icu jiarwl L-VI ,II C1GL --_vi_f• vaiin - . ca l - - -f? v.r.... i T ITLi 3iEItI3sEli ji vTi BAn 0F Vr 15C::::SI*; . . kit noc . authorized by R. 90n-Dr_., '.His, St-t-,.) L,, iiic known .v _ bc. the ' 1r. who executed t. r andt._. no-le ige tl:i, same. THIS INSTRUt ENT WAS DRAFTED VY ,fos-ph 1). Eol,_- nt-1_r,r•, .y :I t. L.:ivJ '~i r ` . 1<i'r _r •aoiat F' le~aiair^ t~,:I• ~`•TS (pia; n:I L.l r,-: I nay, L,• •,:u R1,oll Lli iat•,1 or ark +;:vt-!o,l~ra. lkakr My <',i n+:ni<~n,n ~IR !perraf a-r.Pr,t. s it m,i, yinir' ezi~i~ti itii -It •xRR„•>< -r r L, ..;a::a,x I: a.. , , •.1 t .,I,- - -f`-{. . . ^ 3 C`► Y S 5 ti9. 9 OCT 1 4 mmow.wAs" Ip wismoto CU-t07 l CERTIFIED SURVEY MAP James and Jane Weismann Being all of that Certified Survey Map recorded in Volume 4 of St. Croix County Certified Survey Maps, page 999, located in the Northwest 114 of the Northeast 114 of Section 8, r 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin. 7. y n K~, ` _ fRoS08'SY'2/"E) - see-52,52"E 2590.12' - 33 rR: a 8~ ~Z~~~EI %/Qth 9Y~N~~ NORTH 114 CORNER SEC. 8, T 29 N, R 18W 71039"E 5$1.40'.--- re'~ 63.01 /839.58' Found I ' Iron Pipe) , NOpc _ NORTHEAST CORNER D~TAtL ,y3 A• 330SEC.8,T29N R18W % rte.{ • 00 gZk "i tsar- /00, (Found I Iron h, 4j, tr o [ _ 330g~~03'•E -,/0/NT O s• N s6100 s ti•ri d - - - - _-OR/VEW4Y 9 1 EASEMENT O q.0-1,16-456 SEE SHEET P PoR OATH/ h 1 Z L1N8 O~ 3 ~ ~ OWE M h ~ qY~' CS ♦ .r' In o N a .jI cj~ M qj N LOT / M L07' 2 a `n CQ, IN 0 R/VEWAY = 0 ~V ROAD SETBACK LINE N O .41 W; O CONTAINS \ 20 M e 'Z O 157,591 $O FT. lV O y a =i OR 3.6t8AC, j145 /43 SQ. fT. a H ti OR 3.332 AC, EXCLUDING p CONTAINS 174,934 50 fT OR w TOWN RD. R/avr OF WAY) 0 4.0/6 AC. j153, 217 $0. FT. OR W 3.517AC. EXCLUD1N6 R/W) F:~ $e 309.84 327.06' S89°22'38W 636.90 I fR=S89°23'09"W 636,951 Dated: July 9, 1999 a = Revised: July 13, 1999 ~i ° i i OWNERS ADDRESS $,o aRevised: Aug. 12, 1999 1047 //0 fh /f VENUE ;t N SOUTH~~//4 CORNER ? W ROBERTS, W/ 54023 SEC 8,T NN, Rtaw r (Found County Mon,) o o w ; n • DETAIL . V M SCALES FEET I" = ISO' b. ISO 2p 0 50 im /5Q J1010 ' X3.03' 2 APPROVED W w o ST. CROIX COUNTY Zwft and Parke r.,., r /0~ ~~y~ i i W 0,01~ff/lffff/~p9 1 Q4' ter: ~T 15 1999 nl:flAr_1'/A/ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) tq, cc) 5-clo2,3located at: w `/4, yl 4, Section ownzq N, Range- W, Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service o Did flow back occur from absorption system? Yes No c~ (if no, skip next line.) Approximate volume or length of time. gallons minutes Tank Capacity: - 1, 20-0 Construction: Prefab Concrete Steel Other '~1arlufacturer (if known): eSe/ ~ c~ ank (if known): /%z u2~.-s 6 /a ermit n mber (if known) 51,2 icensed Plumber Signature) (Print Name) Y' l iPS _ 4~- ,3 (Title) (License Number)MPRS (Date) Form to be completed by, licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 00. 2271 Wisconsin Department of Commerce EV LUATION REPORT Page 1 of 3 Division of Safety and Buildings iri accordance with Comm 8 Wis. Adm. Code A.C.E. Soil & Site Evaluations a' i A F i ounty Attach complete site plan on paper no less than 1 'kk~~nnc s1 16. Plan in t St. Croix include, but not limited to: vertical and rizonta;Aanci point (BR-dlrectio Parcel LD. percent slope, scale or dimernsions, no arrow, and Iocakios aittJ 16 t road. ~r N1N 042 020-40-000 Please print ll in 'I"" Re Review By Date Personal information you provide may be us ry purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location Jim & Jane Weismann Govt. Lot NW d NE 1 S 8 T 29 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1047 110th Ave. 1 CSM Vol. 13, Pg. 3749 City State Zip Code Phone Number _j City -j Village J Town Nearest Road Roberts WI 54023 Warren 110Th Ave. -j New Construction Use: y_J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 1/ Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gallons/sq.ft./day loading rate. Recommended trench elevs. to be 48" below grade. Existing system elev.= 96.00'. Boring # I Boring ✓I Pit Ground Surface elev. 99.50 ft. Depth to limiting factor >108" 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 0-8 1Oyr3/2 none I fill 1fgr dsh as 2vf,f Na Na 2 8-15 1 Oyr2/1 none sl 2msbk dsh cw 1 vf,f 0.6 1.0 3 15-31 7.5yr4/4 none grsl 1msbk dh cw 1vf 0.4 0.7 4 31-38 7.5yr4/6 none Is Osg dl aw 1vf 0.7 1.6 5 52-82 1Oyr4/6 none s Osg dl gs - 0.7 1.6 6 82-108 1Oyr5/4 none s , Osg dl - - 0.7 1.6 q Boring # Boring V Pit Ground Surface elev. 94103 ft. Depth to limiting factor >109" 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 0-18 1Oyr3/2 none sit 2fgr dsh as 2vf,f 0.6 0.8 2 18-29 1 Oyr3/4 none sl 2msbk dh cw 1 vf,f 0.6 1.0 3 29-44 7.5yr4/6 none sl 1msbk dh cw 1vf 0.4 0.7 4 44-66 1Oyr4/6 none Ifs Osg dl aw lvf 0.5 1.0 5 66-109 1Oyr5/6 none s Osg dl - - 0.7 1.6 1, 11 " Effluent #1 = BOD? 30 < 220 mg/L an~l TSS >30 < 50 mg/L " Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur : CST Number James K. Thompson 5 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/14/2011 715-248-7767 Property Owner Jim & Jane Weisman Parcel ID # 042-1020-40-000 Page 2 of 3 3] Boring # Boring / Pit Ground Surface elev. 94.48 ft. Depth to limiting factor >106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 9-24 10yr4/4 none sil 2fsbk dsh aw 2fmc 0.6 0.8 3 24-44 7.5yr4/6 none cols Osg dl Cw 2fm 0.6 1.0 4 44-106 10yr4/6 none ifs Osg ml - 1vf 0.5 1.0 74 tl (at) I Loading rate of H#3 adj sted to Ict eavy clay percentage. ❑ 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 PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # J Boring F-1 _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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 II * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) A.C.E. Soil & Site Ewaluadons .5oi / e (/AILCQ ~ilJ~ e, ~eda iC.-r Aoe; +/mil one j,c?~iS/rtann /01/7 //O•(r¢,/e- ,Pd s<iGl ~ cJ/, SW 7-3 -in&.Q ade Coi F-za i~~j ~~a75pu-s,-p de.11InIA3t 4 i?uY'~/rld Src.8,T2`//f•, ('c S uL~ ~ n -F. n,'S 6.~c~( ~✓'arl~ .Sf.. e~a~ ~'o., cJ/. Slynes bei ~.LS.°6 ovw" BOG/-/cLzO- s~-crz/ SYs6~„, ae~l. 6eii?rj 3.(oZac~es. Y Pao/ 0 0 0 t• b `b a~D~ per, b. 63, c S~e' ~ 1 1 ~ ~1 \i DecIK EXi~%nq tl. ~~e0• it ~1, ,I~ it i1 1` a beal/mod `I ~ I 1 i ; 1 es i w ~eS~al~ncat, j I ; 1 ' 1 ~ 1 1 I ~ 1 1 ( 1 ~ ~ 1 sX\\~/ I 1 i ~ 1 1 / B~ Sin' ccFEon c.xrx( ><i'ce 4-~1lt = ~i L1~ ve .S c, 1 c e Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515221 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: Village X Township Parcel Tax No: Weismann, James City Warren, Town of 042-1020-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 08.29.18.114B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r j 'Z Benchmark F ZS &arow ~ ~,51 Ibt1•`Il Alt. BM 44L PL."' l v Aeration 1 2-41 Bldg. Sew9r Pro Holding St/Ht Inlet (a 2. -7 2 51- TANK SETBACK INFORMATION St/Ht Outlet / -7v 4~ G aP TANK TO / ~ WELL ;BL . Vent to Air Intake ROAD Dt Inlet Septic l 257Z5 ! DtBottom Dosing Header/Man. 7.51 77,q Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade - Manufacturer Demand St Cgver GPM h ; J 3. 61 161, 23 Model Numb TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width r gth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth 4 lj~ DIMENSIONS SETBACK SYSTEM TO P/ BLDG WELL E/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: }1 + UNIT Model Number: 0 DISTRIBUTION SYSTEM (J Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing t SOIL COVER x Pressure Systems Only xx Mound Or At ade Systems Only Depth Over Depth over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes R No ❑ Yes [R No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! ! Inspection #2: ! ! Location: 1047 110th Ave Roberts, WI 54023 (NW 1/4 NE 1/4 8 T29N R1 8W) NA Lot 1 Parcel No: 08.29.18.114B 1.) Alt BM Description = • , G~J~`- Gi ~101-1-- 2.) Bldg sewer length 6 kA 4--e- F{n ew, o J J -amount of cover= x~ n Plan revision Required? ❑ Yes No Use other side for additional information. / SBD-6710 (R.3/97) Date Insepctor's Sign re Cert. No. r Y-fl)l U, f commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix ,Tic sco n s i n Madison, W 5321 D Sanitary Permit Number (to be filled in by Co.) epartment of Commerce 1W A ]w 5/ 5 2Z 1 Sanitary Permit Application 1Nae Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary /J A purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. Same 1617 //d A,e- I. Application Information Please Print All Information Property Owner's Name ! - Parcel # 042-102040-000 Jim & Jane Weismann Property Owner's Mailing Address Property Location , 1047 110`h Ave. JAN ~ 8 1010 Govt. Lot City, State Zip Code RP"MUIX NWv,,NE'/<, Section8 Roberts, WI 54023 COUNTY NI MC OFFICE (circle one) II. Type of Building (check all that apply) Lot # 129N; R 18 W ®1 or 2 Family Dwelling - Number of Bedroo C) 3 Subdivision Name 1 CSM ock # ❑ Public/Commercial - Describe Use Na City of ❑ State Owned - Describe Use CSM Number ❑ Village of 5Z 1 i0~71 CSM Vo1.13 Pg.37 ® Town of Warren III. Type of Permit: (Check only one bo n line A. Complete line B if applicable) A. ❑ New System ❑ Replacement Treatment/Holding Tank Replacement Only Le2j Other Modification to Existing System (explain) System Adding PolyLok PL-525 effluent filter B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner / 9&1)1 111311;F1910 Expiration IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450.00 sq. ft. 1,01s 141t N~4 VI. Tank Info Capacity in Total # of Manufacturer w Gallons Gallons Units cq F o U ¢U Uv a a N New Tanks Existing Tanks Z F ~,Wj a Q AIA&,)4L Septic or Holding Tank 1250 1250 1 Wieser Concrete -,7 El El Dosing Chamber ❑ VII. Responsibility Statement- I, the ande igned, assn a responsibilityr inst lation of the POWTS shown on the attached plans. Plumber's Name (Print) lumber' Si atu MP/MPRS Number Business Phone Number James K. Thompson 30021 715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020-5413 VIII. Column /De artment Use Only pprov _ pp FPermit Fee D7; sued Issuing nt Signatur - O er Gi n Rea or Denial ZL,U, m 9J✓✓ IX. Condi".J4AReasons for Disapproval 3~/ ~ Q~ A.C G 1. Septic tank, effluent filter and / / dispersal cell must all be services / maintained P~~ t s~ p s~~ GW bKa~~ as per management plan provided by plumber. f 2. llq setback requirements must be maintained obsc~e~ . IS pet code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 woo ~ ~ ~ e. ccleisrna nn /o~a~. 14V7 /io 0 ,Qa6erts, C,?/ Ss'OZ3 VW/3, ~ 37/9 EXls~f q gWVl l /I&- Sec. B, T.z.9/1•, pecK 4 ( /B a)., 7a. a{ r JJ mo ~es,alence S6- .ero;x Co-, z I. pa/ - /aw- so-~ &ZV 3. &Z 4-cees ~ E % S Can 6 Cti /Q/i S2.ca~Gr: z`~ co ! I' P~oPosed ~;¢s~C~rere,~e.~vl~so~r~' I 5.to6'c63.i~ /!Iati~falr dv<.in/Qt ~e l 1 0~ C.•n es > A / _ /cb 4',awn P ,cbs ca..~ I To 6e¢ l'~z v eoncdasae- Comm. BD. z33 611). c / I / I k9 IC(DC Q P Y 10517 //o of J"'( 0 ,Qn6~f, ss/oz,3 / ~/a-t✓13, 379 EXisEf ~WVft 110,41 % SE C. 9,, -ARII., a¢cat' Q•/gcd~ Ta. a,4.,~7.1? ~es,~erlce. SE•Cro%XCe.,~l. buV 3. (oz 4eee-5 ~ E~Yi S din//~~ 6 cc,'/a/i i7y Seu9tr: ~ Corn1~ y v~ em~rth~. 62.30 cv;aSar ~-+KQ PropoScd t s~,od cfn~, /lja.~~fo% av<iin/mot t5o dam: a t bay%L~a~s~cw Can,". ~f~2/5(T}(d~/, i nJ~,t~.PE✓ It ~ ~ /OZ. ~.i n ¢S > /G~ ~ ~ Q ~ A/ _ -5~Te T'Y/~ ~i 6e p~ocbses~ ~ K /oc.a~`orr. t c-~ Tc 6ea~., e~orcdos~ Co.•nrl. 8~.~3C`l~• l ` , f~pid/ oX• /e ><ion a,~ /1 XS,z X/B'v ! J ~wolr~atrsk / Ce1/, i / 1 i ~ J / t `J~OP'l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne Mailing Address /O 5/ 7 //O Property Address 50-rnf (Verification required from Planning & Zoning Department for new construction.) City/State 16,6~z'_t"I 5_y-0,Z3 Parcel Identification Number O,, - 1-0,20-516-060 LEGAL DESCRIPTION Property Location /I 6L) t/a t/a , Sec. 8 , T Z N R /B W, Town of 6L)2-rl'" Subdivision C5 M , Lot # Certified Survey Map # 6o 4a /d 7 , Volume I3 , Page # 37 9 Warranty Deed # 5ly~5 , Volume 773 , Page # 3 70 Spec house rio Lot lines identifiable es 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 blooms 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) ~,n~wK y yqq.?, TN1:• SPACC 't S&RVKD FOR FECORDIN@ DATA • DOCUMENT NO. 5'1'A'1'E it ri aL t;F Wi~C.^,::.,:=: - _ WARRANTY DEED Eu(`." a (~r 7~ REGISTERS OFFiCs _ CRO!X co., wtc"^' to=,- 2:=i iiCGiti, :r:u•s ~ Z: I~ ic~ec~rc$ eFu and Mara Ann v.ell.on - - - y of Mar '1• s_D`. 198' t ; ~.r.._:~...~.~ GxanWr, 15 A v~], ran oc p. Li~i smarm and :;:srxe (2. W.isnta-i, husband and wi-fc as 5u:-vi-J-c•rz;hir mar-ital i _ ,-rry Grantee. i I Witnessett' That the said uran.or, tor a vaittaoie a-wi~i et . roix 5T. CS;IIXrN~. -LL>r I TIT'LE SERVICES 1NC- conveys to Grantee the following described real estate in 7. County, State of w isconsm : , ei iscoa.ia ZAOZZ ias rarcei l.u: _ - j i `I Certified Survey Map in Volurnt2 4 of reYtif;~r7 Survey Maps, Wage 999, a3 docuinent I v need= nLIrtDCl JUJ V % I i = > fl in Tn, lLlCJt]S County .yi ofLSection' Eight (3) T: wriship 'rwenty--Nine) (29) Y107Yth, Rang F-iglit.-en tip) wesir_ I St. Croix County, 1 I This homestead property. (is} is rot} Together with all and singular the heredltaments and appurLennua:oo tL<a.:u;ito tc: rid: =s: And _ _ warrants that the title is good, indeteasibre in fee simple and 'rar an<I clear of' encumbrances except easements, restrictions and ri-glits of way of record, if any. i and will warrant and defend the same. I GO day of mar,- . 1~_.~^... Dated this 1-~!L ....(SEAL) L CP rcll c E" , . •x ,ni Mar n ohnson .(SEAL) YLc(~~w CX GGc ( ?Ct tom. (SEAL) t.~tarv a •1: Mt-J-len . . AUTHENTICATION ACKNOWLEDGMENT C? QIr-(-or,1 Signature(s) . STATE OF U~S NT ss -_-___Count authenticated thin - _ day of-------------- ...........r 19_.._. Person-illy came beiore nie this --..___.day of 1-1411_ti, .........r x`J__ L[le itUV VC LVILIl Clai V 1f: aJ VL1l17`Ja• ca a.... ~~-i___ t 11 L1J: lfr sl135Exi J1H1L• L3AtL OF iSa aJa..>aii tit not . , -r, be the ncr-non who executed the.. aut•,.onzed by t to file known _ nt and a•1v i-- tl:e C:tmP. THIS INGTRUMEFNT W45 pR.a FTEG _ly Ji,~wlJl-: ll_ t;o l~.. li t. i_,JY rv..•=' at. Rig Note i'ai ur ` c.r~ - ' ll r 1. is 1 ~l\' (rlfr :ill_ Ian ll pernlaren rer Ti"[, Vint CA j1 ll lY, f:-iir,nat.I r,- Iu iy f, :u,ii;la,C.. tc,i arl: ::a•.a' •r1,: t.: 4(}~c-i •~IArTI ~-A 'r r 1 ilr ~:'rtw I, M1 M1. M1 r . .i 1..., - CAP ~ 9 wn► O~ 1 wism ot~ I~ >7,2 CraxCo.Wl 107 ti !I CERTIFIED SURVEY MAP James and Jane Weismann Being all of that Certified Survey Map recorded in Volume 4 of St. Croix County Certified Survey Maps, page 999, located in the Northwest 114 of the Northeast 114 of Section 8, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin. 1R.- $88.38'21 " E1 ~ $88.3?'S2"EP590.78'-' e _Q _ AYfNA /f NORTH 114 CORNER r~ -;j' + er •tjz a2OV,36 --''L sas•3~'s~"E`r 6301 /939. So' SEC. B,T29N,Rf8W `T8- IRIS - or •o3 Oa'~E ssf.4o -=1re.ae'-- - - NORTHEAST CORNER (Found f Iron Pipe) SEE ~y000 - 3r2.eY DETAIL ,4~g3•. SEC. 8 , 729 N4 8 W % + 3O (Found ! Jroa C) 0001, /oo' % -N 9 Zr I •,+330 03+03%~ `✓0/Nr 0 - ' a r; 033 -DR/ VEWAY-J h N s .3 ~ E h C ; 00119. 5 (SEE sNffT 2FOR SDEMENT 1 A q yI OWNLONO N ~J I r M v N a M -JI LOT l f ' LOT 2 \ p 0 eJl ' a COWTA/NS t R/VeWAY PI) ROAD SETBACK LME N e Z p 157,,59150.E p O y y rr OR 3.6/8AC. (145 143 $0 . FT. c h M Z CONTAINS 174,934 S0. f7: OR OR 3.332 AC. EXCLUDING 4.016 AC. (153, 2/TSO.fT.OR TOWN RD. RIGHT OF WAY) a z 3.517AC. EXCLUDING R/W) F,~ a 309.84 327.06+ S89°22~38~W 636.90 Ms S89023109$40W 636.95 i.3r rTrn LA ~r~_ rl Imo.. S JI ? 2 ."v1/7 I ~ M Dated: July 9, 1999 o a I Revised: July 13, 1999 r 0WNERS'ADORESS- a *1 Q Revised: Aug. 12, 1999 1 ~ 1047 //0M AVENUE SOUTH IA CORNER 4! i m ROOMS, W/ 54023 SEC 8,T29N,R18W A° (Found County Mon.) o °!u r. • ''ten SCALE /N FEET l" ° ISO' kii%~N DETAIL W Q moll- • @ 7 m 0 so 100 /so 300 APPROVED wW~ X3.03 Qtk 8T. CROIX COUNTY • Q P Zonirq and Porke . nl.. , 44 ki eta • o M ~~.y~ W T 1 5 1999 •`a1,l,tu,,,So o IV 06 T-4 I It r Q rSEE SHEET 2 FOR m ? Q Wirhin so dd , 1f : j o CURVE DATA! app date approval shat, va .T LAU NCE T Z , • nWI Ind VOW : m W URPHY ~ ¢ • ' LEGEND 1713 N. • O SET I "X24"IRON P/PE(M/N. WT. 03 LB./L. F) : •t RIVER FALLS,1 41 SOIL BORING tt`9' WISC.... JQ. 4.% • FOUND 314 "IRON BAR ,,FQ LAND S,,°°•' GOVERNMENT CORNER AS NOTED ` eee 0 FOUND 1 "IRON PIPE \ 64SA16,~e~ R 110.0') INDICATES PREVIOUSLY RECORDED DA TA. THIS INSTRUMENT DRAFTED BY MARK W. PEAVEY SHEET ( OF 2 Vol.13 Page 3749 • 4 o j ~ o I M ti p h n ~ I O N a I O I I I I ' N C Z CL C O 3 I I a M w Z c Ix '0. Z ~ ~ d m ao H Z o I O Z . c c 0 a1 Z' z N H ~ M f, w N N 7 • y a`1 +v a` r 0 o Q z°mz N c z O 0 N I E Cl) r ` ~6 -i a b c y d 0 o c a •c-0 Q p. N N N j .y0. z •N 3aaa v, CL } U) -1 V III .0 001 T 00 tr_ 1 Q O o = O O U) y C ~ y m d N m ¢ U) m p ~a I ~ ~ y I O O C O E Q O m CC v d O C O Nj C t> d 0 O ' F O U) I ) V `Q CV OD C C C m N C p ° D 0) a1 v°1 w v Z ~ N N L co to co O N E U •O O no 001 N Z y= H CA v ~ ~ at a I; a r`Iv E c r A c0 0 2 'l0 U) r Parcel 042-1020-40-000 01/09/2007 02:36 PM PAGE 1 OF 1 Alt. Parcel M 08.29.18.114B 042 - TOWN OF WARREN 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 - WEISMANN, JAMES F & JANE C JAMES F & JANE C WEISMANN 1047 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1047 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.618 Plat: 3749-CSM 13/3749 SEC 8 T29N R18W PT NW NE BEING LT 1 CSM Block/Condo Bldg: LOT 1 4/999 7.634AC NKA CSM 13/3749 LOT 1 3.618AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 09/06/2006 833919 AGREE 07/23/1997 773/370 2006 SUMMARY Bill M Fair Market Value: Assessed with: 149081 342,800 Valuations: Last Changed: 10/19/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.618 44,300 205,800 250,100 NO Totals for 2006: General Property 3.618 44,300 205,800 250,100 Woodland 0.000 0 0 Totals for 2005: General Property 3.618 44,300 205,800 250,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 110 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT ~ s OWNER 7 TOWNSHIP Lti h'J'S'10 SEC. 8f T617 N, RX W ADDRESS' -V 0 Fv, L5 -1 tit ST. CROIX COUNTY WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 2' i I i i i I diCaze North;Arrowj SCALE: + SEPTIC TANK(S) C MFGR. ; In. C CONCRETE STEEL i.~ NO. of rings on cover Depth PUMPING CHAMBER SIZE PUMP MFGR. MODEL NO. GALLONS Per Cycle TRENCHES NO. of width length_ area BED NO. of lines width_ , length S'2 • area Ir depth to top o pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE/-/ /~''('rau.4~ _ PERK RATE / AREA REQUIRED 61,6 AREA AS BUILT 6 Z JZ~~ Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM." INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San.i.tan.y Pehm.it State Septic 4 A M E aa-:X4~ Townahip 1 S Cnai x County (oca-t.ion Secti,on__,?Lot # Subdiviaian F,PT I C TANK I Size gattona Numbers o6 eompan.tment )te.tanee PLO m: We.EtZs w Bu.itd.ing 12% .6tope H.ighwa.ten 'LIMPING CHAMBER S.i.ze ga.E.Ean.& ~ anu6aexune4 Modex Numbers rOLDING TANK Size gaEQanb ~umbe o a 4uZCm Pumpers At nm Sys e 1 ing 12$ <_e Lance 640m• WetC Bu~.2d o atope_ H.ighwa.ten kBSORPTION SITE - ,Bed Tneneh )'_stance nom: -We.E.E ILZC9 Building 12o 6tope HighwateA \BSORPTION SITE DIMENSIONS Width o6 -ta.ench At Requited anea 6t fz.l.eng.th 06 each tine_ __..6x Depth 06 noeft below -t-i.te in Numbeh 06 tinee Depth o{ naeh avers. ttiF'e. ~ in 7u taQ Deng h o A ti ne~s ~ 6.t Depth o6 -td,.Ee below g4ade 2- in D.i.a-tanee between tine.b 6at S.Eope o6 .tneneh in. pen 100 At f uA-uIL abs U&p tion anea L. 6.t Type o6 Coven:open 6 t4aw R' '11 DIMENSIONS-. Numb e q o 6 Pits Gnave.2 anound pits yes a Outside d,iameteA At Depth below -i.nk'et 6 Totat abaonption a L) 6t Anea &equiaed 6 (NSPCC BY TITLE W ROVED DATE 19 8 4JECTED DATE 198 ti (ASON FOR REJECTION 13840 REPORT ON INSPECTION OF SANITARY PERMIT # 9 9ds_ 1) Name and Address of Permit Holder Person/Persons at Site (2)Date--of Inspection 12 me, ress, c n e No. o installing Plumber Time of Inspection 3 CONS ST OF: ❑ Septic/Tank ❑ Seepage Trench E ]Dosing Chamber ❑ Seepage Pit ❑ Seepa a Bed ❑ Holding Tank ❑ Fill System B N ermanen reference Point) escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBO-6095 N.05/80 Signature of Inspector: J g / State and County State Permit # !d PLB 67 / Permit Application County Permit # 6i d for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY / Mailing Address: L-- 77 h J ca `j h SD / ~J fi er' ~2~5 c-Ce. S B. LOCATION: Y4 L- '/a, Section , T N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township grrc- 6; e a t ~~P I S S C. TYPE OF OCCUPANCY: Commerci~ *Industrial *Other (specify) *Variance Single family G/ Duplex No. of Bedrooms No, of Persons D. SEPTIC TANK CAPACITY /J-~ 7 Total gallons No. of tanks a--z. HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete P red-in-Place Steel ~ Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. - - New Replacement Alternate (Specify) Seepage Trench: No. of Line?l Ft. yllidth Depth Tile depth (top) No. of Trenches Seepage Bed: c,LLength- S2 Width-a_Depth-3 0_Tile depth (top) No. of Lines Z- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME .3a e s 6- y cl C.S.T. # 4'S-- ✓rd 9 and other information obtained from (owner/builder). .0 0 11 Plumber's signature MP/MPRSW# Z0 Phone #Ay,4-✓y Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Do Not Write in Space ow FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application Bl Fees Paid: State _1 I-C)__ County Dat I Permit Issued/R71mred (date) Issuing Agent Name Inspection YesNo ( State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 3 F -H 11 5 RQv. g/7$ REPORT ON SOIL BORINGS AND PERCOLATION TESTS ` WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:Ab& '/4Ak_'/<, Section 8 ,TL9 N,RLI_fPWAr4W, Township or-NuftieipalityLAESM-OW Lot No. , Block No. "TI F i L'7C~, Su~.~2-VEY 64 County Q GleQ42C Subdivision Name -9"x+01 Buyers Name: ~-Y n1 IQ Je' il- t SOAJ 34S ~R+IL n ► SS I o ~/I / bailing Address: T- IDEA I.• Sz'ioZ 3 TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW~REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS /o fiu4BU PERCOLATION TESTS 1011UZAQ SOIL MAP SHEET S/ NAME OF SOIL MAP UNIT C4 JZMAL~- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- ) .57 ace-g- l_lg ~Z A(,OA/F- Z`~ Z ~/V Z '5//c. P- Z 6 z- P_ V an/;< 3 - Z she zs P P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK q~ OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- ~D 90 LT.5 12' 8wS.L 2•5N L g 5 6 B- 8 &Aie 9.6 51 L s s s c 2z Ob., tautfic S 5"A" B- 3 04 A&VE > L m; Bey L xc Z6; Ow 5 AEC, Zg;- Sy 5, Z B_ 4 64 once >~4 ! L L 4~ 2~ 3 S Ib G B- 64 - > er931 L lo • 8 L L 18' 6e C- B- 64 dllE 8 B/ L -m o' L CGS S' PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. C,&IJ rEe 4.. I,vc U F Taw N, ~N o ._dF t 8 F s 14G_ a I c f , iv) 147 O r r N i o ` 6CN4ff lL' S/'/JCS I A/ _ 7 PQ Pr_ T r_'5 ~E- 7- 00 i 13- I W U<.A~F vil- Iva, I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) JA MT--S _E_. R V S L H Certification No. sS'"_S Address Z/S- /Y- Z iA1Tal2_ ST l2]1~ 1Z_ ~14(~(. 1x// ZZ_- .,Name of installer if known Copy A -Local Authority CST Signature L ~h ~ a h hso~ ~ ~ f . • ~ N~ y ~ 7'` ./1' / ~ct~ l.-cis,,-,.~ ' ~ 1 ~ r ~ _ _ • . e ~ G ~ Y 2213 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distan a to nearest road. 042-1020-40-000 Please Q Reviewed By Date Personal information you provide be us • condary purposes (Privacy s. 15.04 (1) (m)). Property Owner Property Location Jim & Jane Weisman AY 19 ~J Govt. Lot NW 1/4 NE 1/4 S 8 T 29 N R 18 W Property Owner's Mailing Address 1047 110th Ave. ST' 6R&iON G OFFICE Lot # Block # Subd. Name or CSM# CSM Vol. 13, Pg. 3749 Pi A City Stat one Number J City J Village 01 Town Nearest Road Roberts WI 54023 715-749-3281 Warren 110Th Ave. J New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ✓J Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Soil evaluation completed to verify suitability of existing dispersal cell for continued use after replacement of deteriorating septic tank. Boring # Boring dJ Pit Ground Surface elev. 99.50 ft. Depth to limiting factor > 108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 "Eff#2 1 0-8 1Oyr3/2 none I fill 1fgr mvfr as 2vf,f Na Na 2 8-15 1Oyr2/1 none sl 2msbk mfi cw 1vf,f 0.6 1.0 3 15-31 7.5yr4/4 none grsl lmsbk mfr cw 1vf 0.4 0.7 4 31-38 7.5yr4/6 none Is Osg ml aw 1vf 0.7 1.6 5 52-82 1Oyr4/6 none s Osg dl gs - 0.7 1.6 6 82-108 1Oyr5/4 none s Osg dl - - 0.7 1.6 Effluent #1 = BOD? 30 < 220 mg/L an TSS >30 < 15 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson S 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 5/18/2010 715-248-7767 i 0 CjY/.5 zinc LEI e.1/ Ca ieso7 //o !tc O ~~lef'~1 c.J~ Syo1.3 / ~sM ✓a ~/3 37119 E Xis cvvy Se C. T x.9/1., pecK /B cJ~ Ta. 0,4 ~CeS, alertce_ SE..Gr-e%x Co., ~ f'ev ~0~2-iozo-Vo-~~ be,V 3. /02 I-c ees i E~!iS ~%n//gg 6cc;/o%; SeBaer ~-costpY t ('~.rNn. 82.30• ~ PropoSP-d uJ;¢5¢~~mC/'e.~kJl~-Sn-~l4 I 5.e o6-G&ii4K . Oaoiele pvt~in/e t 64e ~ o.~: ~ ~ bar-i~~s~ Co~»m. Bf~zS(7~lQlJ/. 14 lot-' C.,-o es > Q e fir/ + he rs{ l<~v ~~%bsers K /oca on. I To 6ea ✓c edasari Corniri. B3.33C~• . l / i / ~D 1 JL d~~ I 2 0~1