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HomeMy WebLinkAbout042-1021-60-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division * . INSPECTION REPORT Sanitary Permit No: 420382 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: Nelson, Gary Warren Township 042 - 1021 -60 -200 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ��- va e) 9. ( 10 1147 o Dosing Y610 Alt. BM D / ff -°!! Aeration Bldg. Sewer l � Holding St/ t Inlet q� s TANK SETBACK INFORMATION St/ t Outlet / a c fSL- 2 1 TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1, ✓ 2v gW • Z Septic �/ sn�- 1 Dt Bottom dS� 5 2 sp g�. 00 Dosing I Header /Man. q�- Aeration Dist. Pipe 1�� 2 �r I ,► tiq• 3v 1 2 1 2 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cov Z p Lb S GPM � ILI Model Number toFv 3 / l L D TDH Lift Friction Loss System Head TDH Ft s.0 Forcemain Len th / Dia. C71- ,I Dist. to Well SOIL ABSOR TION SYSTEM 1 17 1 Z i BEDITRENCH Width / Length o. Of Trenches PIT DIMENS o. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO JPILS BLDG W E /STREAM ACH G Man yr r: INFORMATION Ty Of System: HAMBER O , Model Number: DISTRIBUTION SYSTEM VX C.(J Header /Manifold IDistribution C x Hole Size x Hole Spacing Ve jjaAir Intake ( t Pipes) Ict N �� I / S N Length Dia Lengt Dia cing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 7Lt Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3f /,ice r' ' Bed(Trench Edges Topsoil ^ Yes o No Yes 7No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�� / / � Inspection #2: Location: 1036 110th Street Roberts, WI 54023 (NE 1/4 SE 1/4 8 T29N R18W) NA Lot 6 0Z e Parcel No: 08.29.18.125B 1.) Alt BM Description - V5. ) o�- �C. 0­1� a � 5�� ej- 2.) Bldg sewer length - amount of cover = Plan revision Required? _er Yes 4 I 3 - Use other side for additional information. LP___ ZD -6710 (R.3/97) L, Date Insepctor's Signature Cert. No. A i Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ., Madison, WI 53707 - 7162 Site Address ,S consin De artment of Commerce D / 4 ��� 2 -� Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision ao 3 may be used for secondary ses Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Numixr A / /v rty Owner's Name Parcel Number -C _ Property O Mailing Address T o r Property Location S i4 i4; S T N, R L} City, State Zip Lot Num e r/ Block N ber )' 411bdiyisian.Atftfflc CSM Number I lUzxlk 4 -r_ z 7 II. Type of Building (check all that apply) J � ity 1 or 2 Family Dwelling - Number of Bedrooms ✓ []village ❑ Pubuc/Commercial - Describe Use VTownshiP ❑ State Owned a 3 r4 / 1 B / g ei�ATX� Nearest Road III. Type of Permit: (Check only one box on fine A (numbering scheme for internal use). Complete line B if applicable) A For County use 1,9 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to stem Tank Onl Exis ' stem B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (nt , ,tiering scheme is for internal use) yl r; /. f 44 0 Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 67ri / �� 22 ❑ Pressurized ht- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ `& Drip Line 3 r - I ! 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ RWimalatmg 30 er V. Dis eatment Area Information: a ' Design Flow (gpd) Dispersal Area Dispersal Area Soil Applica levation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation s c2 _> z 9S, g VI. Tank Info Capacity :in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing J Tanks Tents Septic or Holding Tank Dosing Chamber 9 06 1 _ / VII. Responsibility Statement I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. Plumber's rint) Plumber's Si MP/MPRS Number Business Phone Number i� P1 is ddress (Street, City, State, Zip e) Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Da Issued Issu' Signature (No Stamps) Approved ❑ Disapproved Surcharge ) J El Owner Given Initial Adverse ✓ ! 6 Q �E" G Determination IX. Conditions of Approval/Reasons for Disap royal w So i i Y s• d Yi'� . 3P 5 5 Q fev. will 3l0 a &W� Cc�ov� mo d/r�K� irdcr e� �n �/ f' ►� � A� R8 Y 4 - II 011L e� tto ere ) me Attach systeni Pa1w nje than s x ii tna►a size ,GC bD-6 -6398 (R. �5/Ol) rrt�- /�OGU� Qin o v � � W o 4 h QSe� y , a (Aj �g k - L' tl O eu 4 �t� R. �- �• m � b � o X a 6 n v _ w \ 116. y O / r PUMP U(m CROSS 'SEC ANO S PECIFICATIONS VENT CAP VENT PIPE /APPROVED LOCKING I WEATHERPROOF - JuWCTIOAJ BO MANHOLE COVGR, WITH ? 25' FROM DOOR, VJ AMIING LN8�1 WINDOW OR FRESH 12'MIU. AIR IuTAKE GRADE I � 7 4ml lll.b.L1. COIJDUIT PROVIDE I IIJLCT AIRTIGHT SEAL I I I APPROVED JOIWT A I I APPROYLO JOIIr' W/ ' PIPE W / { II CXTfND�WG 3� { I ALARM EXTCWOIUG 3' I II ONTO SOLID SO. OQTO SOLID SOIL 0 ( I I I/ ON C LLEV. FT. PUMP OFF 0 �yr Q COLICKETE DLOCK RISER EXIT PCRMITrED OWLy IF TAWK MAUUFACTURCK HAS SUCH APPROVAL 3" APPA0l4E6 8f 0bIr+G %Andcr TF%14K SEPTIC E SPECIFICATIOLJS DOSE 9 QU, -1b[:R OF 005ES: �� PLR DAm TAAJK MAIJUFACTURCR - .{�� --- TAWK SIZE: L>=v— GALLOWS DOSE VOLUME � �� ALARM MA►JUFACTURCR: ?1,rLc- A/C' IIJILUDIAIC+ DACKi "LOW: - �� � GAIION: MODLL WUMOEK: J �Dl CAPACITIES: A = L. IUCHE50R za74" GALLOuS SWITCH 'CyPC: 1 - 1 - 14 , 4 1 .111 B =.- — 111 CHES OR o 96 'GALLOW, PUMP MAWLIFACTURCR: S C a � WCHES OR Z GALLOUS 1 MODEL ►JUMDER: �I / D- 8 INCHES OR l7 < /Dg GALLOMJ SWITCH T`JPE: �51��. t' + °��' MOT C' PUMP AUD ALARM ARE TO OL MIAIIMUM DISCHARGE RATE �� GPM INSTALLED OW SEPNRATL CIRCUITS t ll� 6,5 VERTICAL DIFFEKEWCE 6ETWEEU PUMP OFF AIJO OISTRIBUTIOW PIPE.. _-Z, . FEET + MII.IIMLIM WETWORK SUPPLY P RESSUR � E / . , . . . . . . . - �'� FLET + J76 FEET OF FORCE MAIN X L�L_FY10, FRICTVOU FACTGR..�Gc(cs2_ FELT TOTAL Dy►JAMIC. HEAD = FEET IUTERIJAL OIMEWSIO L OF TAWK: LCgGTH iWID iLIQUID iIGI�EO: LICENSE (1UMBER: ssa DATE: Performance Submersible Effl uent Curves P ump s METERS FEET 90 25 MODEL 3885 SIZE 3 /4" Solids I 20 E10H 60 WE07H -T WE05H — 10 - 30 WE03M -- - - -- - - --� -- - -- -- - _ 20 WE03L 5 � � I 0 20 30 40 50 60 70 60 90 100 110 120 GPM ( J 0 10 20 � 30 m'/h CAPACITY �GOULDS PUMPS, INC. S&CE FALLS * rr')p� ,jr, METERS FEET 20 MODEL 3885 35 - 110 w E15HH SIZE 3 /4 " Solids 0 30 I — — 25 80 = 2r ao 0 15 50 WE05HH nn 20 5 10 3C '1G r. , 1 0 12G GPM 1 G � .!0 mI /h CAPACITY EmeCtwn jo, 'nv Wisconsin Department of Commerce SOIL EVALUATION REPORT Page —/— of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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 distance to nearest road. Please print all information e-viewe by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 � 1/4 S T N R �(or� FX Property O is Uailing Addre s Lot # Block # Subd. Name or CSM# 7 � -� City / state Zip Code Phone Number ❑ City / ❑ Village [M Town Near st Road New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or com ercial - Describe: Parent material ��� a' /� /� Flood Plain General comments .., _` x. and recommendations: 9S.38 �/ SyS�e n+ �21/j (N E CDR- of c.. -&7- 0 1 L � 0 Boring # ❑ Boring w _; M Pit Ground surface elev. ft. Depth to limiting factor in. jai 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 I *Eff#2 d < f / / L 33 Boring # ❑ Boring Pit Ground surface elev. /r9 1 S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consi ce Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 VZ S.` 2S ef a r� S C Alz * Effluent #1 = BO s > 30 < 220 mg /L and TSS >30 _< 150 mg /L *)Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (P ase P int) Signature CST Number Address Date Evaluation Conducted Telephone Number X !F 215 3, SBD -8330 (R07 /00) Property Owner Parcel ID # Page ,.2— of F�] Boring # ❑ Boring Pit Ground surface elev. Z04, 98 ft. Depth to limiting factor Z, ,,2 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 I *Eff#2 AIZ 31.2 y 107.2" •$`' ff 2 F-1 Boring # F] 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 GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz 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 or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) S 2. - — - 4=`- v � ccII W ° 0 \ L / ski y o� y vv f r w i 'O w l= 61, POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATION Owner Septic Tank Capacity al o NA Permit # ab �� Septic Tank Manufacturer o NA Effluent Filter Manufacturer A ❑ NA ! DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms ❑ NA Pump Tank Capacity al o NA Number of Commercial Unit ANA Pump Tank Manufacturer b ❑ NA Estimated flow (average al/day Pump Manufacturer 5 NA Design flow (peak), Estimated x 1,5 al /da Pump Model L, o NA Soil Application Rate _ gal /da /ft Pretreated Unit Influent /t flluent (,duality Monthly Avuralgo* ci S;utd /Gravel I`ilter r.t Peot filter hats, Oils Grease (FOG) <30 iug /l. ri Mechanical Aeration Li Wetland Biochcmical Oxygen Demand (BODs) <220 mg /L ❑Disinfection ❑Other: Total Suspended Solids (TSS) < m 150 /L Manufacturer Pretreated Effluent Quality O NA Monthly Average ** Dispersal Cell(s) 3�_In ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg /L ❑ At -grade o Mound Total Suspended Solids TSS <30 mg /L p ( � <10" cfu /100mL o Drip o Other: Fecal Coliform (geometric mean Maxinrnwrn Effluent Particle Size '/u inch diameter + Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequenc Ins ect condition of tank(s) At least once every o months 3 st ear (s) (Maximum 3 rs) Pump out contents of tanks When combined sludge and scum equals one third '/� of tank volume Inspect dispersal cells At least once eveEX o months ears Maximum 3 rs) Clean effluent filter t!,b At least once ever o months Je eur(s his sect punt >, punip controls & alarm At least once every a months 2 0 year(s) ❑ NA Flush laterals and pressure test At least once every o months o year(s) 9 NA Other; At least once every ❑ months o year(s) o NA Other: At least once every o months o ears o NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum in any tank equals one -third (' /a) or more of the tank volume, the entire contents of the tank shall be removed by a Sgxage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event, START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and /or damage the dispersal cell(s), If high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: 42i. _ System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. 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. ABA NDONEMENT 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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to 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. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTALL R POWTS MAINTAINER Name Name Phone I Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name ` Name Phone Phone ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer = S © n( Mailing Address o �( G J3 C-R7 W-1 S �/o 3 Property Address Z� 114 (Verification required from Planning Department for new construction) City /State Parcel Identification Number 4 Y a— l O a 1 - LE GAL DESCRIPTION Property Location �/4, St �' /a, Sec., T a O ( N -R /8' W, Town of Subdivision , Lot # � . Certified Survey Map # co F a 6 3 5 Volume , � Page # / Warranty Deed # _ YQ/ d - 7 , Volume , Page # Y3 /2 Spec house ❑ yes ❑ no Lot lines identifiable 6 6� yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 andlor (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 Zoning Office within 30 days of the three year expiration date. SIGNA OP APPLICANT DATE 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 prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. ox b� / a 2 SIGNATUR APPLICANT DATE * * * * ** 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 1960F zoo 688407 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED R E G ISTER OF DEEDS This Deed, made between Thomas J. Sullwold and Nona M. RECEIVED FOR RECORD Sullwold, husband and wife, 08 -28 -2002 9:30 AN WARRANTY DEED EXEMPT # Grantor, and Gary D. Nelson and Jillienne J. Nelson, husband and wife, REC FEE: 11.00 TRANS FEE: 201.00 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the NE1 /4 of SE1 /4 of Section 8, Township 29 North ange 18 Lot 6 N k d feuiVA Elty BANK NA West, St. Croix County, Wisconsin, described as follows: f Certified , Survey Map filed June 5, 2002, in Vol. 16, Fage 4317, Doc. No. 682639. 1301 PO Box X 7 70 Rd 0 Hudson, WI 54016 Part of 042-1021-60 Parcel Identification Number (PIN) This is not homestead property. QI) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day f A 2002 y g , • + Thomas J. Sullwo Sullwold AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas J. Sullwold and Nona M. Sullwold, STATE OF WISCONSIN ) ) ss. husband and wife, .y,�y�� County ) authenticated this�� day of August 2002 Personally came before me this day of �Cl.G1� the above named + n ary E. Cahalatt Notary Public,,P'erce Co., WI, Commission exp. to me known to be the person(s) who executed the foregoing (If not, 12/26/0 instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: - (Signatures may be authenticated or acknowledged. Both are not necessary.) ) + WI Names of persons signing in any capacity must be typed or printed below then signature. Information Professionals Company, Fond du lac, 8W455 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 '/i/isconsin Department of commerce SOIL EVALUATION REPORT .3 )Ivision of Safety and Buildings Page of In accordance with Comm 85, Wis. Adm. Code Allach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 5 Y- e f of X Include, but not limited to: vertical and horizontal reference cat BM), direction and Oy� • / 1/ — p , OOp percent slope, scale or dimensions, north arrow, and to n an Io nearest road. Parcel I.D. C o�T o 33. 2.P sft�2S Please print all Informal' on. F/ "° ��® Reviewed by Date Personal information you provide may be used for seconds ry p rposes acy Law, s. 15.OA (1) (m)) Property Owner f ,/, Ri;p , arty Lo (i - Tyo/�1 5 o /j ow,+ SV Rp Govt of c 1/4 1 1/4 S 0 T Z N R /8 a (or) W Properly Owner's Mailing Address G 0� T�! L;Rzrqp/ Subd. Name or CSM# 2 Z 8 /O O� ffve .vl Cs 'M City State f Z p Code Phone Number ❑City ❑ Village (d Town Nearest Road R 54l o 2, 3 ( '715 ) 7yf ' 330 Gcv Rem � R � //O 57 New Construction Use: KL Residential / Number of bedrooms Code derived design now rate ys O — lv o'a GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material /DESS' OUEJQ Flood Plain elevation It applicable General comments and recommendations: 3 5/T� 12E-57 / ( Boring # ❑ Boring D Z 2 0 1 ' 1 pit Ground surface elev. ! ft. Depth to limiting factor > 78 in. Soil Application Rate Horizon Depth jant Color "do Description Texture Structure Consislence Boundary Roots GPD /1 7. In. nsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'EtT#2 0 1? . 3 L )nfr�hK /)*1vf/Z c�� S g / s 3 � � y� y s�� z� shy �,�,� � f . 5 - .8 S 39 7 5 yip /,W j cs - . 7 ,. Z. 6.7T ioyR sr �s / f ,� �,e • s - i Boring # ❑ Boring r o' 5 0 ' Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color ERe3dox Description Texture Structure Consistence Boundary Roots Soft GPD /f on Rate In• nseif Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 � 0-12- io y/I� 2/3 L z� ShX w 3 " , . s . 8 2 /.2 - /q 11 /0 3 ifSh,�fh' �s ,3 f , f 3 /y. 30 /o yR 0.3 7s R Y/ .2 Sh,< .w.f�' g . S 8 . S Sys /oy�ps /y caD 5 VW ztf to ;qo S/L HS �.' ctIt' _ , Z 3 4 /O YR �� s z v /io rs GL l Sh/� ,r,t Ufi a ' - . Z 3 7 0.4� �•s y� Yiy o 0 ors s � Effluent #1 = Boo > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = SOD < 30 T2! 2nd TSS < 30 mg/L CST Name (Please Print) _ Signature CST Number A 2 S Address Z G 3 7 Dale Evaluation Condu fed Telephone Number tii,¢ 9 a O o 71S • 3AI • �i� Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 N o7 - F S 14 C7 - 1 /JZE S 7;a- 4J (- 5 '/ V & 11Z� It-/ 70 ORIGINAL Property Owner u( /u� d LD Parcel ID # 0 9�2 - /p Z / ' `�v • " ❑Boring Page of Dd to Boring # lO (f � 0 / s . s S' . pit Ground surface eiev. _ fl. Depth to limiting factor ( in. Horizon Depth Dominant Color Redox Description Texlure Structure Consislence Bounda Roots Soil Application Rate In. Munsell Qu. Sz. ConL Color ry GPD/fl: Gr. Sz. Sh. 'Eff #1 •EffN2 /D Yi 31' L Z fs hk h . vf2 G s �f' • S. 3 1 5- 31 7 -s YR Yll, SL Z �►•►•, v Ct,�l /-� . s • rf 31 ,56 s yR R s - s A- 11 f yn ""o o rs we s -ge �o ye 'Y/y fl H -0 TS s. o s d ,2 t ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consislence Bounda Roots Soil Application Rate ry GPD /Il' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EH#i 'EfM2 El e ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. !t. Depth to limiting factor in. ;S Horizon Depth Dominant Color Redox Description Texlure Structure Consistence Bounda Roots Soil A Rate rY GPD/1 GPD/lt' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 •EW2 • Effluent #1 = SOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = SOD, < 30 mg/l, and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider mind 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. sno.evo tR Fran o � c o a d c 4 00 4 � d i '5 � � o a O z CERTIFIED SURVEY MAP Thomas and Nona Sullwold Lmvled in part of the Northeast %4 of the Southeast %. of Section 8, Township 29 North, Range 18 West, Trnvn of Warren, St. Croix County, Wisconsin. OWNER'S ADDRESS 1228 MOTH AVENUE ROBERTS, WI 54023 N BEARINGS ARE REFERENCED TO THE EASTLINE OF THE SOUTHEAST 1M OF SECTION A, T 29 N, R 18 W, ASSUMED AS SCA IN FEET 1" =100' UNPLATTED LANDS' --------- - - - - -- ---- - - - - -- 0 1 %! A � i CENTERLWE j 110TH STREET I 6 ! 6 N 89 °44'48" E 384.95' I asT - 351.79 i — - -- - — — ©; .19 �� ry a T2�N 33 Z R re� b 5 o 1 L 33 ` ;I ALUWlUM UONU I. o TF s'r w BUILDING © a •,. N LOT 6 �. �'°, m 3. CONTAINS 121,467 SQ. FT. OR 2.788 AC. 11 629 SQ. FT OR 2.563 AC. EXCLUDING Q TOWN ROAD RIGHT OF WAY) 33 zr 33� � z '� 1y S 11 "27'17 E 443.90' @133.64' 6.54' S 89 °44'48" W 477.54' j�'••., • ; 8 89'44'48" W UNPLATTED LANDS . 47.48• • t, I 616 t t pa�o�dJOd�00 OAr, • a Q DATED: 4 CONg� MARCH22, 2062 , LEGEND " LAURENcr = ; 6 a; INDICATES 1 "O.D. x 18 "IRON MURPHX R e ra O PIPE SET (MIN. WT. -1.13 LB.A..F.) • INDICATES I" IRON PIPE FOUND ss ° " O z A SOIL BORINGS (PROPOSED SEPTIC SYSTEM) . �t, 10 SECTION CdRNER MONUMENT (AS NOTED) � ND. --- x INDICATES FENCELINE \ �L"� g ; Z DRIVEWAY LOCATION SOUTMSTCORNM SECTION 4 T299 R 16 W (FOUND ALUMIM/ M MOf�UME COUNTY BERNZ Wn I TINS INSTRUMENT DRAFTED BYJERALD L. LARSON SHEET t OF 2 l - � 682639 VOL 16 PAGE 4317 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., VI RECEIVED FOR RECORD 06 -25 -2002 4:00 PM CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP COPY 380 PAGES: 2 Thomas and Nona Sullwold 1,pcated in part of the Northeast 1 14 of the Southeast of Section 8, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. APPROVED ST. CROIX COUNTY Pfannina loninn an•i p,.o. r - OWNERS AtNNtESS 1228100TH AVENUE JUN 2 5 2002 ROBERTS, WI 54023 Knot rewroed wiaiin ; ;u :,jys of approval dale app be find onrr vniri N eEArawl�a Aa�E To 7►1 EUTL weOF TW WUMMIT 1N OF 3ECT10N A, T» >x R 18 w, A33UN v A8 N 80'16'12' w. /W;t SCALEINFEE7 1••180' (1NPLATTEDLANDS � , r p % CENTERLINE ^, ( 110TH STREET N 89 E 384.95' 616 EA n t COMS 351.79 O Q 1 g +� R 18 N O rV8S rSEN 3' 33' ; 3 , ALUAawuw U MUA*?M o g 0 - - - BIJRDN__, j0d ® o Z N LOT 6 rp w; 3: CONTAINS 121467 SQ. FT. OR 2.788 AC. � 111 629 SQ. H. OR 2.563 AC. EXCLUDING \ \ �, r TOWN ROAD RIGHT OF WAY) 33 3 i 1p0 0N 33 � O z . -- S 11 °2717" E 03V ®33. 6.54' S 89 0 44'48" w 477.54' UNPLA_T_TE_D LANAS -� - s e1r4C4a• w 47.49 6 '- % 6 ' 1 DATED. 2Z 202 LEGEND 3 CLI , ••LAURENCE'• 24 4� C OVDCATES 1 x 18'IRON Mu P a te ° PPE SET (AW. WT. -1.13 LBAF.) * ° a ; >rr RIVER • INDICATES 1 "11iON WE FOUND �" • FALLS. O z 3 1 d, SOIL BOMOS (AWOSED SEPTIC SYSTE wt. 0 SECTION CORNER MONUMENT (AS NOTED) fi��p �O LAND 0J z a DRIVFWAYLOCATION SOUiFdFTA21 (PM 2 IRON IPE) THIS INSTRUMENT DRAFTED BY ZRALD L LARSON SHEET 1 OF 2 Vol.16 Page 4317 APPRO ST. CROIX COUNTY Plannlna Znninn nn,+ a � - _ JUN 2 sMRTIFIED SURVEY MAP If not recorded wnnin 3u ,;. .p Thomas and Nona Sullwold 8PEW "rte r ot-bf the Northeast ', /, of the Southeast % of Section 8, Township 29 North, }urge 18 West, Town of Warren, St. Croix County, Wisconsin. urve Table _ �c Rdi , n +.. tl t'l ;rr gyp ^_° Chn; c1 Back T_anrenC Front Tangent Leni>�li I_etih Anele Length 1 -2 308,17' 94.24' 17 31' 17" S 15 00' 31.3" E 93.87' S 06 15' 13" E S 23 46' 30" E 3-4 522.12' 112.27' 12 19' 13" S 17 36' 533" E 112.06' S 23 46' 30" E S 11 27' IT' E 5-6 341.17' 107.80' 18 06' 13" S I4 43' 23.5" E 107.35' S 05 40' 17' E S 23 46' 30" E 7 -8 489.12' 105.18' 12° 19' 13" S 17° 36' 53.5" E 104.97' S 23° 46' 30" E S 11° 27' 1T' E Description That certain parcel of land located in part of the Northeast' /4 of the Southeast' /4 of Section 8, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Southeast comer of said Section 8; thence N 00° 15' 12" W, (assumed bearing on the East line of the Southeast'/. of said Section 8), a distance of 1908.78'; thence S 89° 44' 48" W, 47.46' to the POINT OF BEGINNING of the parcel to be herein described, thence continuing S 89° 44' 48" W, 477.54'; thence N 00 15' 12" W, 282.17'; thence N 89° 44' 48" E, 384.95' to a point on the centerline of I I & Street; thence Southeasterly along said centerline, a curved line concave to the Northeast, having a radius of 308.17', a long chord bearing S 15° 00' 51.5" E. 93.87', an arc distance of 94.24'; thence continuing along said centerline, S 23 46' 30" E, 85.10% thence continuing Southeasterly along said centerline, a curved line concave to the Southwest, having a radius of 522.12', a long chord bearing S 17° 36' 53.5" E, 112.06', an arc distance of 112.27% thence continuing along said centerline, S 11 ° 27' 17" E, 6.54' to the POINT OF BEGINNING, containing 121,467 square feet or 2.788 acres. being subject to an easement for town road purposes over Easterly portions of said parcel as shown on this map and to all other easements and restrictions of record. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owners. Thomas and Nona Sullwold , I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. Dated: March 22, 2002. NGTE. °Lach parcel siiowri.on this map is si:bj"& to State, County, � y1�s and Township laws, rules and regulations (i.e. wetlands, minimum ° • ° ° ° `' lot size, access to parcel, etc.). Before purchasing or developing M . YQ any parcel, contact the St. Croix County Zoning Office and a V IV A appropriate Town Board for advice. FA LLS . : x wi. w1 I THIS INSTRUMENT DRAFTED BY JERALD L. LARSON SHEET 2 OF 2 Vol. 16 Page 4317 i i