HomeMy WebLinkAbout042-1059-50-550 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Buildi • ng Division
INSPECTION REPORT sanitary Permit No:
463252 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary p'„rposm (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Nelson, Gary I Warren Townshi
CST BM Elev: linsp. BM Elev: IBM Description: Section/Town /Range /Map No:
. Z; OD • 0 = C ST — ru ( 21.29.18.
TANK INFORMATION ELEVATION DATA
TYPE t /n� MANUF CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
z(aO „ �,(o
Dosing Alt. BM
Aeration Bldg. Sewer f
rolding St/Ht Inlet 1
_1 02 -9 -S -
TANK SETBACK INFORMATION St/Ht Outlet 2 • `�
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD I Dt Inlet
Septic � 5 . r � \ �` �--- Dt Bottom
Dosing l J �_ Header /Man.
Aeration Dist. Pipe ) (, 40 ►
Holding Bot. System / c� ►
2.& 1
Final Grade r
PUMP /SIPHON INFORMATION o , (o S
Manufacturer Demand St COVZ 1 2 O ►
GPM �vt l 1470
Model Number
TDH Lift n on Loss System Head TDH Ft
Forcemairr Length Dia. Dist. to W 1
SOIL A ORPTION SYSTEM 23
J Wl ENCH idth Length No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME 3# Z 1 1Z)
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man to
INFORMATION CHAMBER OR c
Ty e Of System: J UNIT Model N
v.- — ,� >
DISTRIBUTION SYSTEM
Header /Manifold q Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipes> I ►
1 1-engt Dia L Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of ] 7Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil .1. W CI S I Yes I N( ; Yes j No
COM MENTS: (in gq Iude c pp��i e discre persons present, etc.) Inspection #I- Inspection #2: /
C j s _ W, SMV6 J )
Location: 1114 80th Ave Roberts, WI 54023 (SW 1/4 SW 1/4 21 T29N R18W) NA Lot 10 Parcel No: 21.29.18.
1.) Alt BM Description
2.) Bldg sewer length = o�
-amount of cover=
Plan revision Required? ;Yes No
Use other side for additional information. rt. N
o.
Date Insepctor's Signature Cert. N
SBD -6710 (R.3/97)
1
6
M
JJ
C;op
' t4
y �
�KN �
M
` RECEIV
Wisconsin Department of merceMA .� ] EVALUATION REPORT Page
�of�
Division of Safety and Buildi �Yt
in aC�cJ m 85, Wis. Adm. Code
ST. CR01 County
Attach complete site plan o paper rr�Jo"thAd�as in size. Plan must L", �
include, but not limited to: v ' r(BM), direction and Parcel I.D. '�-/
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. jf
Please print all information a wed by Date
Personal information m be used for seconds
you provide ay ry purposes (Privacy Law, s. 15.04 (1) (m)).
Property 0,Ter Property Location
Govt. Lot 1/4 T N R JT E
Property Owners Mail ssr # Block # Subd. Name or a LL P
vvY a ► 1 / �O
City Zip Code Phone N1 mber ❑ city ❑ Village Mown Nearest R oad
o. New Construction Use: R[ Residential /Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material OCe,2 � Flood Plain elevation if applicable
General comments _ r
and recommendations:
F— Boring # ❑ Boring
/1 jo Pit Ground surface elev. AM 8'J� ft. Depth to limiting factor. ; /. in.
Sal Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture • Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. t. Color Gr. Sz Sh. 'Eff#1 'Eff#2
G
JJ n
r
{ CT R
o' q q
s --
S2 • S� $�•.�b
® Boring # ❑ Boring
0 Pit Ground surface elev., ft. Depth to limiting factor in. Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
c
4 R
Effluent # = BOD > 30 1 220 mg/L and TSS >30 150 mg/L uent #2 = 6 D < 30 mg/L and TSS < 30 mg/L
CST Name = k 1 h Signature CST Number
Address Date Eva uadon Conducted Telephone Number
�p
Property Owner - Parcel ID # Page rV of
Ong # ❑ Boring
Pit Ground surface slay. "� ! ft. Depth to limiting factor in. Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munseli Qu. Sz. gont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
� a
q 4
5.3��8/•3S.
E # ° Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF
in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2
E # ° Boring ❑Pit Ground surface slay. ft. Depth m limiting factor >n.
Soil ation Rate
Horizon Depth Dominant Color Redox Description. Texbxe Structure Camistence Boundary Roots !GP!D/ff
in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = SOD > 30 220 mg1L and TSS >30 < 150 nV& ' Effluent #2 = BOD, 130 mg& 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 2648777.
sao4330OL o)
60 so` s�
i
..38/
�t
l F'A/v! iilll�I���J •� 0'/ JL�I�� N/1�•/ � /�/ABffa�E?��L /�sy /
` ��� �/.�� ®,✓ sa /� s� /y- s,�� /- Vii✓ -�BiJ _
. Oh
A19 z5'
�✓w•l yrt°o� /�Kl- ,97,0
,3 Q y'7'144
cw plc
i
1/7
J
CERTIFIED SURVEY MAP
L. Newel and Dorothy M. Jones Family Trust 1
Located in part of the Southwest % of the Southwest'/ of Section 21,
Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin, being Lot 6 of that Certified Survey Map recorded in Volume
18, Page 4811 of St. Croix County Certified Survey Maps.
N '
BEARINGS ARE REFERENCED LEGEND
TO THE SOUTH LINE OF THE
SOUTHWEST 114 OF SE CTION 21 0 INDICATES 1" O.D. x 18" IRON
T 29 N, R 18 W, ASSUMED AS PIPE SET (MIN. WT. - 1.13 LB,/L.F)
N 89 °36 36" W. • INDICATES 1" IRON PIPE FOUND
A SOIL BORINGS (PROPOSED SEPTIC SYSTEM) l M
SCALE IN FEET 1 " = 200' 0 SECTION CORNER MONUMENT (AS NOTED) I
100 0 100 200
(�) DRIVEWAY L OCATION
OWNER'S ADDRES
11 t/
34 80TH AVENUE � � 0
r �n
ROBERT�� WI
54023 � � � ✓
cl!V__4AT__E1? LENDS
V
NORTH LINE LOT 6
_ S 89 °36'36" E 42
212.00' A 213.00' •
A 0
LOT 9 LOT 10 N
/
�!� T _ 3 109,228 S . FT. 109 28
Q iri 9 SQ. F .
OR 2.509
CV W /
= 102 F�
( ,232 SQ. FT: (1 Q. FT.
CERTIFIED SURVEY_ ? 3 �,
OR 2.347 AC. o N OR 2.349 AC.
MAP EXCLUDING N
v c.i EXCLUDING
- W N 3 TOWN ROAD � v TOWN ROAD N
o v RIGHT OF WAY) o RIGHT OF WAY)
PAGE 3648 °- �� 4 -
co
LET 4_ z Cl
_ 100' SETBACK LINE SOUTH 114 CORNER
SOUTHWEST CORNER S 0 0 °1140„ S89 '36' 6 "E 66.00' "� 1'40" W w Q P SECTION 21, T 29 N, R 18 W
SECTION 21, T 29 N, R 18 W o 50, pW 33.00' 33.00; - ; S 00 (FOUND COUNTY BERNTSEN
(FOUND COUNTY BERNTSEN o 0 ' r 7 50.00'
ALUMINUM MONUMENT)
ALUMINUM MONUMENT)
�,
�179.00�33.0 80TH AVENUE
0' 211.35' -_ _ g.�T 33.00' 178.35' 212.50' I _
N 89 °36'36" — •3300' — — - — -- _- -
33 .00' ?-33.00' 423.35' ;.
N 89 °36'36" W 389.00' 212. 00'- M i SOUTH LINE /' SWI
— — -- — — -- _ _ _ _ 2 - — - N 89 � 1836 g8—
N 89°36' 36 W 423.24 SE CORNER
-
I I JOINT DRIVEWAY LOT 6
LOT �- I 66' I
MAP y EASEMENT - N 89 0 36'36" W 2649.22' --
CERTIFIED SURVEY (R = S 88 °42 W, 2649.28)
- VOLUME 6, PAGE 1575 '� , (R = N 90 °00100° w)
UNPLATTED LANDS
ADD
o �`SGONSi "V
o e � ' -:
W -i J
MUJf , Y
1713 e
POWTS OWNER'S MANUAL & MANAGEMENT PLAN:;:.. Page of�
FILL: INFORMATI N SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal O Nil
Permit # 2— T2_ Septic Tank Manufacturer ON
� s O N r'
DESIGN PARAMETERS Effluent Filter Manufacturer
Number of Bedrooms C3 NA Effluent Filter Model L7 NA I
Number of Public Facility Units J NA Pump Tank Capacity gal �
Estimated flow (average) -- gal/day Pump Tank Manufacturer N� l
Design flow (peak), (Estimated x 1.5) , al /da Pump Manufacturer �s3 NA j
Soil Application Rate al /da /ftT Pump Model
NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit
Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O Mechanical Aeration C3 Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection C3 Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N! t
Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L §NA O At -Grade ❑ Mound
Fecal Coliform (geometric mean) :00' cfu /100"11 D Drip -Line 0 Other;
T Maximum Effluent Particle Size Y, in dia, O NA Other; D N i
Other; D NA Other: O NA
*values typical for domestic wastewater and septic tank effluent.
Other: ❑ NA i
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month($) `` (Maximum 3 years) D NA
Inspect condition of tank(s)
At least once every: ear(s) „
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
O months)' (Maximum S years) ❑ NA
Inspect dispersal cell(s) At least once every: year(s)
Nt. {
Clean effluent filter At least once every: ❑ month(s) ❑ jzi- year(s)
O month(s)
Inspect pump, pump controls & alarm At least once every; O y ear(s)
❑ month($) r l NA
Flush laterals and pressure test At least once every: O ear($)
Other: ❑ month(*) p NA .
At least once every: E3 ear(s)
Other: Q 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 thu
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
t3MW 14/01,
I
} ,{ Page � of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content's
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bo
discharged to the dispersal cell(&) In one large dose, overloading the coil(s) and may result InAhe 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 Maintalner to assist In manually - operating the pump' controls to
restore normal levels within the pump tank,
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers, disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat, scraps;. medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the systern is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings aealed.,
• 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.
13 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. -s..:.. -
0 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.
0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT, RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name l Name
f G
Phone Phone
SEPTAGE SERVICING OPERAT R (PUMPER) LOCAL REGULATORY AUTHORITY
Name r yv Name
Phone ow Phone _
"his aocument wa fted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.64(1), (2) & (3), Wisconsin Adntin(suative Code,
I
ST CI ZOIX COUNTY
SEPTIC TANK M A IN EN NCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Own er /Buyer
s
Mailing Address
Property Address / y� 7 0W
(�`erification required from planning 1 epartment for new construction)
City /Stag
Parcel It entification Number
LEGAL DESCRIPTION
Property Locarion
-5]u
Town of
Subdivision —
Certified Surve 1VIa Lot #
P �� .., Volume C
ct . page #
Warra
ry Deed #
., Volume ,` Page #
Spec housed yes ❑ no
SYSTEM MgINTENAN -X lines identifiable X yeS ❑ no
CE
lm p ra Per use and mae tenanceof your septic system ct u Id result in its premature failure to handle waste
consists of pumping out the septic tank every three years or st o �cr, if needed by a licensed Pump can affect the fimc(ion of the septic tank as a treatment stage n the waste
disposal system. a Pro into t h syste
p p What you put into the system
The property owner agrees to submit to St. Croix Zcrting Department a certification form
masterplumber,, jour neyman Plumber, restricted p( umberorali < etsedpumperverifyingthat I the
on -site was
is in proper operating conditio and/or (2) after inspection and �u n in � signed to the owner and by a
() wastewater disposal system
Uwe, the undersi" p g (if necessary), the septic tank is less than 113 full of sludge.
�ned have read the above requirements and ag -cc to maintain set forth, herein as set by the Department of Commerce and th : L epartm of Natural Res
stating that your in the private sewage disposal system with the septic system has been maintained must be th' tpl eted and return standards
days of the thr ource
, s, State of Wisconsin. Certification
a
Year expiration date. ed to the St, Croix County Zoning Office within 30
S1GNA O PLICANT
OWNER CERTIFICATION DATE
I (we) certify that all statements cm this form are
:he property d scribed above by virtue s e
e a warranty decd rc Y (our) knowledge. (we) am (are) the owner(s) of
et rde 1 in Register of D I ds Office,
O PPLICANT
Any info DATE
h
rmation that is m is- represented may result in t. ie sF nitary permit being revoked by the Zoning Department,
` Include with this a g **- *woo
this a stamped warranty deed fro n th! Register of Deeds office
a copy of the certified surve; , ma a if reference is made in the warranty deed
i!
U; 2710P 357 - 781921
State Bar of Wisconsin Form 7 - 2003 KATHLEEN H. WALSH
TRUSTEE'S DEED REGISTER OF DEEDS
Document Number Document Name
ST. CROIX CO., WI
THIS DEED, made between Daryl L. Jones RECEIVED FOR RECORD
as Trustee of L. Newel Jones and Dorothy M. Jones Family 12/08/2004 09:50AN
Trust ( "Grantor," whether one or more),
TRUSTEES DEED
and Gary Nelson and Jullienne Nelson, husband and EXEW? 4
wife
( "Grantee," whether one or more). REC FEE: 11.00
Grantor conveys to Grantee, without warranty, the following described real TRANS FEE: 147.90
ether with the rents profits, fixtures and other appurtenant COPY FEE:
estate, together � P PP CC FEE:
interests, in St. Croix County, State of Wisconsin PAGES: 1
( "P ) (if more space is needed, please attach addendum):
of 10 f Certified Survey Map recorded in Volume
n page 4888 as Document No. 781610 being a part of
Lot -- 9 of Certified Survey Map recorded in Volume 18
on page 4811 and part of Lot 5 of Certified Survey Recording Area
Map recorded in Volume 13 on page 3648 and part of
Name and Return Address
the South half of the Southwest Quarter (S't of SW%), Title One PRemier Group
Section 21, Township 29 North, Range 18 West, Town 706 19th Street South
of Warren, together with and subject to joint Hudson, Wisconsin 54016
driveway easement as shown on said Map.
042- 1059 -50 -400
Parcel Identification Number (PIN)
Dateecember 7 2004
(SEAL) (SEAL)
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
authenticated on St. Croix COUNTY)
Personally came before me on December 7, 2004
the above -named Darly L. Jones, ttee
* A. F+&
TITLE: MEMBER STATE BAR OF WISCONS �► 0 me known to be the person(s) who executed the
(If not, ARY going instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06) _
THIS INSTRUMENT DRAFTED BY: PUBLIC
"
Michael H. Forecki, Attorney ;e�W%ft otary Public, State of Wisconsin
Eau Claire Wisconsin My Commission (is permanent) (expires: 03/23/2008 )
(Signatures may be antheatieated`or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
T'RUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7 -2003
'Type name below signatures.
Attorney Michael H Forodd 3452 Oakwood Hills Pkwy Ste 1, Hau Claire WI 54701 -7928 Phone: (715) 835 -3029 Fax: (715) 8354112 T57169602FX
Title One Premier Group Produced w8h ZipForm" by RE FormsNat, LLC 18025 Fdleen Mile Road Clinton Townahp, Michigan 48035, (500) 383 -9805 yft zloform.c0m
JMt1- 21- 1 �FR011:pUALITY SERLCORTING (715)381 -9978
CERTIFIED SURVEY MAP a r
L. New*[ *ad Dorothy K J"cs Family Trust fi C
l veaad M pwvt aJt/k fisvthw s�sl % grthe &wthw¢st % end 8asrrhnmw /.
gjSr
'rkc 5 : r Wed R n'
rnrtJrrvesr !4 d/on 1. awtuh4► 29 Narlk Jla►►�e 8 I
!d
Town of Warren. a cmix Casty* m &vwijw. k1fix U S of aw
a : C.►toed aw►wy Akp m aw%W In Yalme IJ. Pup 3641 of
(: St Crab C'alwfy CatU+rd Survky k4w n 1
Ab I q
I
a i � I • � 1tr0'� �0�, � is R R
_, 9
�� NON$ `4414
Ilk* r 1 .
. � •�, . = i�� tad
(T
err rs = \Q
N.
ll
t#
i a � I sacm4 W X11 z �
•
.,
a• . 49 v 0 0 0
jig
kw, r i•• I ++ �1� fw 2
• '4i s
a SHEET fOF2
� nwrer�v►tAa+rrcoarow.a
uxsow
M ,
CERTIFIED SURVEY MAP
L. Newel and Dorothy M. Jones Family Trust
Located in part gf'the Southwest'' /4 of the Southwest %4 of Section 21,
Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin, being Lot 6 of that Certified Survey Map recorded in Volume
18, Page 4811 of St. Croix County Certified Survey Maps.
N -
BEARINGS ARE REFERENCED LEGEND
TO THE SOUTH LINE OF THE
SOUTHWEST 114 OF SECTION 21, O INDICATES 1' O.D. x 18' IRON
T 29 N, R 18 W, ASSUMED AS PIPE SET (MIN. WT. -1.13 LB./L.F.)
N 89 °36 36" W. • INDICATES 1' IRON PIPE FOUND �7
A SOIL BORINGS (PROPOSED SEPTIC SYSTEM) 7
SCALE IN FEET 1"=200' SECTION CORNER MONUMENT (AS NOTED)
(R =) RECORDED AS
100 0 100 200 . DRIVEWAY LOCATION C
OWNER'S ADDRESS U"
THAVENUE
ROBERTS', B W/ 54023
UNP.LATT_ED LANDS
NORTH LINE LOT 6
S 89 °36'36" E 4
212.00' A 213.00'
e e e
LOT 9 LOT 10
LOT -3 ti 109,228 SQ. FT. 109,289 SQ. F .
N ° OR 2.508 AC. ,�, OR 2.509
OERTIFIE =D 11f?VEY _� z (102 ,232SQ. FT. 3 - (1 Q. FT.
OR 2.347 AC.+ OR 2.349 AC. 1
MAP `n M co EXCLUDING _ ° v ci EXCLUDING
W ry TOWN ROAD v TOWN ROAD N
p o00 RIGHT OF WAY) g RIGHT OF y AY)
PAGE 3648 0 �,�\�, N 4, Q• g Go
�1
S �P: z �p�,
LOT 4_ z 100'SETBAC LINE '�
cq Q; SOUTH 114 CORNER
K
SE H 2S T O N, R W o 00° 1190" wS83 -E X 00' 33.0 -00• S 00 11'40" W � �•' SECTION 21, T 29 N, R 18 W
(FOUND COUNTY BERN TSEN 50 r 50.00 (FOUND COUNTY BERNTSEN
^ 212.00 8 211.35' ALUMINUM MONUMENT)
ALUMINUM MONU 179 x_33.00' - _ $ -, x.33 00' 178 35' 212 I ROTH AVENUE
33 .00' N 89 °36'36 "W 33.00' 423.35' ; • 33.00' — ") — — — — — —
�M N 89 °36'36" W 389.00' - TH 212.00' - � SOU LINE� / SW114
- -� — -- — — — 211.24' - N 89 °36'gg" �/ 1836.98' -
r _
- N 89 °36' 36" W 423.24' - SE CORNER
JOINT DRIVEWAY LOT 6
LOT 1_ ` 66' I EASEMENT. - N 89 °36'36" W 2649.22'-
CERTIFIED _$Uf?VEY MA �cn, (R = S 88 °42'19'W, 2649.28)
VOLUME 6, PAGE 1575' (R = N 90 .00'00" W)
UNPLATTED LANDS
�
i . � - .
M�yRRHY
1713 e 7k
o1 (he 6outhw '14 of Section 21. Township 29 North, Runge 18 West,
Town of Warren, St. Croix County, Wisconsin, being Lot S of that
Certified Survey Map recorded in Volume 13, Purge 3648 of
Z Sr. Croix County Certi Survey Maps.
fir• . � � �
33` 1� m
, b3 PO g
,' ' I ,,• � <'rn I gy
ph
CD
N
►� I I 2 '� 'h S.'ll1 p
J ;m;m I I O 4
N 00' 11'40" E 515.23' v
482.23' -�
,100' MST LINELOTS
AAA . `. I I •C'� '!+.S ^
fi rm r
,n F•. ii i ,� N I 1 p x, � R1
r a .
1
S 00'2324'W 515.23' CD
482.23'
O r
N w _ AA
rn
48223' - 432.23' �1t
'4 I & N 89 W 300'23'24"W 515.23'
I r6
e6.00'
`-' 50.00 •228.03'
278.03' rn p Q
¢`' * I S 00 °23'24" W 311,03'
o
a' 1 33 1 0
3 a ►
N C C 0 700 �� ° j N
•..• I I,� � ma y,, � r . a � � � � ��
, i ��:c• �R * �� � // � � r ~ ~ � to y -1
a� rn
rn 1-- S 00.23'24' W
tC n I z 1 204.20' m
•'� '�.. y
n,
i 1 Cn
O
,z
<. x T41S INSTRUMENT DRAFTED BYJERAID L. LARSON SHEET 1 OF 2
J
CERTIFIED SURVEY MAP
L. Newel and Dorothy M. Jones Family Trust
Located in part of the Southwest %, of the Southwest % of Section 21, Township 29 North, Range 18 West,
Town of Warren, St. Croix County, Wisconsin being Lot 6 of that Certified Survey Map
recorded in Volume 18 Page 4811 St. Croix County Certified Survey Maps.
Description
That certain parcel of land located in part of the Southwest 'h of the Southwest '/, of Section 21, Township 29
North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, being Lot 6 of that Certified Survey
Map recorded in Volume 18, Page 4811 of St. Croix County Certified Survey Maps, more fully described as
follows:
Commencing at the South '/. corner of said Section 21; thence N 89 °36'36 "W, (assumed bearing on the
South line of the Southwest '/, of said Section, recorded as S 88'42'19" W and N 90 °00'00" W), a distance
of 1836.98' to the Southeast corner of said Lot 6, being the Point of Beginning of the parcel to be herein
described; thence continuing along said South line of the Southwest' /,, N 89 °36'36" W, 423.24'; thence
along the West line of said Lot 6, N 00 11 11'40" E, 515.23'; thence along the North line of said Lot 6,
S 89 0 36'36" E, 425.00'; thence along the East line of said Lot 6, S 00 °23'24" W, 515.23' to the Point of
Beginning, containing 218,517 square feet or 5.016 acres, being subject to an easement over Southerly
portions of said parcel for town roadway purposes as shown on this map and to all other easements and
restrictions of record.
State of Wisconsin)
Coup of Pier
)
1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, the L.
Newel and Dorothy M. Jones Family Trust, 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: August 19, 2004.
NOTE: Each parcel shown on this map is subject to State, County, and Township Iaws, rules and regulations
(i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact
the St. Croix County Zoning Office and the Town of Warren.
��s a o rra
i.wvRExc� • _
• MURP
i k 8 -71G i
I.ALV'p
THIS INSTRUMENT DRAFTED BY JERALD L CARSON SHEET 2 OF 2
Vol 19 Page 4888
-4E� 16 10
• VOL 19 PAGE 4888
KATRLBEQ H. VALSH
REGISTER OF DEEDS
ST. CROIK CO., VI
RECEIVED FOR RECORD
12/03/2004 01:10PM
CERTIFIED SURVEY MAP
REC FEE: 13.00
CERTIFIED SURVEY MAP PAGES: EE
L. Newel and Dorothy M. Jones Family Trust
Located in part of the Southwest Y4 of the Southwest % of Section 21,
Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin, being Lot 6 of that Certified Survey Map recorded in Volume
18, Page 4811 of St. Croix County Certified Survey Maps.
N LEGEND
BEARING ARE REFERENCED
TO THE SOUTH LINE OF THE INDICATES 1' O.D. x 18' IRON
SOUTHWEST 114 OF SECTION 21, O PIPE SET (MIN. WT. - 1.13 LB / -F)
T 29 N, R 18 W, ASSUMED AS
N SV 3696' W. • INDICATES 1' IRON PIPE FOUND
A SOIL BORINGS (PROPOSED SEP77C SYSTEM)
SCALE MI FEET V .2001 0 SEC77ON CORNER MONUMENT (AS NOTED)
F (R =) RECORDED AS
100 6 1 0 260 . DMVEWAY LOCA77ON
$R:.�?ic?vS3l.lhtiYYr
OWNER'S ADDRESS
1134 80TH AVENUE REC 0 3 =4 ,
ROBERTS, M W23
-- UNPLATTEA LANDS t11r►rtknsllard�wiu�{1a 33i oa►cs.o1
NORTH UNE LOT 6 �� i>?RttPxlailil7il{hb�
S 89 °36'36' E 425.00' nulli�dl�cWdr
•
' 212.00' 4 213.00'
LOT 9 LOT 10
LS2T _8
109.228 SO FT : ,;
OR 2508 AC. OR 2 509 AC.
O!~RTLr=1E0_ suf3!/. e -3 {1o°�Rissiac [ M (10 2. .349 AC
M-A-P- EX ±r EXCLUDING
W RIGHT OF AW Y) RIGHT O F �Q1,
$ t
ICQI !!M 1 Q• �-
�. i a �;
P_A �Q- �lti� fi g, yg .
NER
LQT__4_ z Ca 100 SETBACK UNE Q� SEC7K 11 N R
SOUTHWEST CORNER 500'1140 -W! . 0 66.W 'O'11' [• (FOUND COUNTY BERNTSEN
SECTION 21, T 29 N, R 16 W $ 5'0,00. . ;�' gO,Oti ALUMINUM MONUMENT)
(FOUND COUNTY BEtWTSEN 21200' { ; - 211.35' 1
ALUANNU _ _ _ �0�3300- ,,- 33.00' 178.35' 212.50'
__ _ 33 .00' N 89 W ? 33.00' 423.35 33.00' c�•� i SOU7N UNE I S 89°36'36' W 38 .W - 212 - - 211.24' - N 89°3638 1836.x - - 98 - —�
- N 89 °36' " W 423.24' - SE CORNER
I I JOINT DRIVEWAY LOT 6
I QT-1 66' 1 EASEMENT – N 89'3636' W 2649.22–
CERTIFIED SURVEY_ MAP__ -al (R = s e8.42'19- W, 260.287
VOLUME G PACE 1575 (R = N soaono W)
---- - - - - -- - , .� U111P1_.4TTE_L1 i
% is A
�1M
VtLLE, O�
O a Wi.
f "" "
DATED: .
AUGUST 19, 2004 p LnHaa �JQ
THIS INSTRUMENT DRAFTED BY JERALD L. LARSON SHEET 1 OF 2
Vol 19 Page 4888
Cs EQ
s
- Wisconsin Department of 200 SOIL EVALUATION REPORT Page Of 3
Division of Safety and Buil )with m 85, Wis. Adm. Code
FICE County
Attach complete site plan x In es 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. Revi wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 10
P er Property Location
Govt. Lot -S 1 J 1/4 N R E (o&
Mailing A ss Lot # BI Subd. Name qS,% ii
.0 7`°s'
City e p Code Phone Number ❑ City ❑ Village IS Town Nearest Road
( )
j New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material lood Plain elevatio if ap irable �- ft.
General comments
and recommendations:
y� a
F -/1 Ong # ❑ Boring ® pit Ground surface elev. 92,43 ft. Depth to limiting factor >> � in.
Soil Applicatiori Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 `Efi#2
- :211 J1 025
r
G
4 ^?
Boring # � ❑ Boring
® pit Ground surface elev. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
e
3
R 4'
I
Eflluen 1 = BOD > 30 < < 220 mg/L and TSS >30 150 mg& ' E ent #2 - OD < 30 mg/L and TSS < 30 mg/L
CST Name Print) - - Signa CST Number
Address Date Evaluation clad Telephone Number
z n - - -
Property Owner Parcel ID # Page of
Boring
Bonng 10 Pit Ground surface elev. ft. Depth to limiting factor > m. i low Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. nt. Color Gr Sz. Sh. •Eff#1 •Eff#2
,0
�3
_ Q a
a # ❑ Borin
❑ Pit Ground surface elev. ft. Depth to limiting factor lo• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2
o Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limting i factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 'Eff#2
Effluent #1 = BOD > 30 220 ng/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 rng& and TSS 130 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.
I�
r
�Dt �
Al
ir�C%