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HomeMy WebLinkAbout042-1076-80-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453430 0 GENERAL INFORMATION (ATTACH TO PwRMIT) 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 Nar . Dickenson, Blake Warren Township ( p- Q/I'Lb( CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Rang Map No: 106 oo N VC -5" W- 28.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing AID ST t' Aeration Bldg. Sewer Holding St/Ht Inlet iS 3 gg• � St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L I�E" BLDG. Vent ROAD Dt Inlet Septic f . Ot Bot tx� I a- A, �m �: 3 Dosing , Header /Man. S 9 -7 1 v L �S 0- Aeration Dist. Pi e P d .0 TLC> Holding BoLSystem 8• v b b Final Grade - U 0 0 PUMP /SIPHON INFORMATION TION Wtt �-S S , Manufacturer Demand St over p GPM "/ 2 . 3 Model Number op T ! 7 G 35— TDH Lift Friction L SystemlH T� � Ft / Forcemair� L n th Dia. Dist. to W I SOIL ABSORPTION SYSTEM t,�J BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO PI BLDG WELL LAKEEISTREA LEACHING Man INFORMATION T f S y s tem* / CHAMB yp Ys UNIT Model Number: 3 � N D IBUTION SYSTEM Header /M nifold Distribution Hole Size x Hole Spacing Vent to Air Inta e Len th Dia Length b Dia aan SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only �'� r Depth Over , A j;W Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [7] No [] Yes E COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (0 1(2 - 1 0 Inspection #2: / / Location: 771 112th Street Roberts, WI 54023 (SW 1/4 NW 1/4 28 T29N R18W) NA Lot 1 � Parcel No: 28.29.18. 1.) Alt BM Description = 57_%ChVV S �� 2.) Bldg sewer length = 20 - amount of cover => f '' I Plan revision Required? � ; Yes j o �� Use other side for additional informatio G I�- I SBD -6710 (R.3/97) Date Insepctor's Signat re Cert. No. I Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CkOTX visconsin Madison, WI 53707 7162 Sanitary Permit Number (to be Stied In by Co.) De artment of Commerce (608) 266-3151 S State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21. Wis. Adm. Code, personal information you provide 10 A may be used for secondary purposes Privacy Law, s13.04(lXm) Project Address (if different than mailing addreaa) . I. Application Information - Please Print All Information '? r ny Owner's Na me Parcel a — of / Block I PART 6 -90- 5y 3 LLAKE DICKENSON & KII✓i TI HAL ;� 2- 1076 -80 000 Property Owner's M ailing Address Property Location 9 IDA STREET SW A , NW A.scction 2 8 City, State Zip Ctx1e° ` "` "`" Ph iTC Nuiiibd ROBERTS, WI 54023 715/749- 289 C (cir or© cle one) I 'f II. Type of Building (check all that apply) 29 N; R Ilia � ! Su ® 1 or 2 Family Dwelling - Number of Bedrooms ( 3 ) --, .. � '� Subdivision Name — r V 0 - I g N 1 1v6 763951 ❑ Public/Commercial - Describe Use 1 f ❑ State Owned - Describe Use c .D)SJ ' ' ��d d l0 7 I 1 OCity_OVillage (Township of�� j Ill. Type of Permit: (Check only one box on line A. Complete Lune B if applicable) A. ( New System ❑ Replacement System ❑ Treatmcnt/Holding Tank Replacement Only ❑ Other Modification to Existing System ! B. O Permit Renewal ❑ Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ® Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade O Single Pau Sand Filter ❑ Conswcted Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Lcachin CI • tuber ❑ Drip Line ❑ Gruvel -I ss Pipe ❑ Wier (explain) V. Dispersal/Treatment Area Infornation n Design Flow (Bpd) Design Soil Applicuti i Rate(gpdsl) Dispersal Area Required ) persal Arc• Prupusetl (s System Elevation r� 450 .7 (sl 643 97.8 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber PlaSdC Gallons Gallons Of Units (concrete Constructed Glass New Existing Tawas Tanks Septic or Holding Tank 1000 1 1000 WIESER CONCRETE X Aerobic Treatment Unit , / V V Dosins Chamber 600 1 1 600 WASA CONCRETE X VII. Responsibility Statement- I the landersigned, assume responsibility for hiswllatlou of the POWTS shown on the attached taus. i Plumber's Na me (Print) Plumber's i gnature MP /MPRS Number Business Phone Number BENNIE HELGESUN 0292 715/772 -3278 Plumber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. ount Department Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issu ng A t S' tune tamps) Surcharge Fee) ��s) � o d ❑ Owner Given Reason for Denial / IX. Conwiitlorns of Approval/Reasons t'or Disapproval SYSTEM OWNER" (�.� i /(�11) tc tank, effluent fl ter and " �� (p 3 _ —" ��� ✓Lt�O� �� ��' dispersal cell must all be serviced / maintained ��� as mana Amens ninn nr^vided by plumber. 2. All setback requirements must be mainta f as per applicable code /ordinances. Attach complete plant (to the Couuty oaly) for the sysleru ou paper not less than 81/2 x 11 inches in size JrLQ�' CDTI A404 /D Al /nzN I __b it. k�_ s a g � ►� K c � P c k :: Is < <:� 10 C)C-'/ 4, c)b C km",e ci v , Pry rt . c 5'S go�c Cells l � 6 3 s +T�e � � ai r 0C% C- �,, Poc I>.VQ i s< CL - to I < ic_V-N —O n 6 C) l Q , tit K C , z v I � Pr. Vas < <:L 10 OC «p« �Y� ci V DD /,� ct .c� l l�o P I -Cclls F dui I ! 6 s 4r , e� ai 1 E�c� p —ru t 0"T cD P� T •jp.e 1 r INDEX SHEET PROPERTY OWNER: BLAKE DICKENSON & KIM M. HALL 9 IDA STREET ROBERTS, W154023 PROJECT NAME: BLAKE DICKENSON & KIM M. HALL PROJECT LOCATION: SW 1/4, NW 1/4 , S 28, T 29 N, R 11W MUNICIPALITY: TOWN OF WARREN COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section of Leaching Chambers Page 3: Septic Tank Pump Chamber Cross Section & Specifications Page 4: Pump Specifications Page 5: POWTS Owner's Manual & Management Plan - Pg. 1 Page 6: POWTS Owner's Manual & Management Plan - Pg. 2 v Name: Bernnie Helgeson Sign Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: July 26, 2004 i0 P rcl-fG�s e j C) C)Cl/ D � I 3r3�Q� Z V• 7 i M � �v �j � gok 3p'� -Cells n u, i jio�+L ( " 0 3 3j 1 0 0. as 0 rGS.S S c�c_�c o•''� P 2 o F �o I le Cki. i o S I hc-(..^ erg rf 7 _ s'� /e✓ T7 9 6 43 p n e- c -c( c( I� _ H c,,l Page 3 Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER n ( � W/ PADLOCK & WARNING LABEL le �f (, • v 4 ,__ .,_,_ 4 " MIN. Ty a 18" IN. x. b. �� 18 MId• INLET ' WATER TIGHT SEALS GAS- TIGHT i APPROVED F ILT ER _! _ SEAL , I JOINTS WITH APPROVED V $EE J. APPROVED PIPE PIPE 3' (a "xl(� B 3' ONTO ONTO SOLID SOLID SOIL SOIL C PUMP OFF ELEV . SU F T . ---- D 3 APPROVED BEDDING-UNDER TANK CONCRETE PAD SPECIFICATIONS rays. r� t_a +troLs SEPTIC / DOSE x TANK MANUFACTURER: TANK SIZES SEPTIC /C?06.) GAL. DOSE VOLUME INCLUDING DOSE h(�X) GAL. ��, 3 ,JLOWBACK: �! a� �f' GAL. ALARM MANUFACTURER: s.I 1 1,,F, CAPACITIES: A = INCHES = O b GAL. MODEL NUMBER: Lv SWITCH TYPE: B = 2 INCHES = ,S GAL. PUMP MANUFACTURER: C = INCHES = /00, S GAL. MODEL NUMBER: g7 1 �- SWITCH TYPE: Mai � A M' Fl�aa- D = INCHES = �� GAL• REQUIRED DISCHARGE RATE .3�� GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . �/_ FEET + Mt!L FEET FORCEMAIN X 1 / FT /100 FT. FRICTION FACTOR <, FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMEN IONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH 3 •, SIGNED: LICENSE NUMBER: DATE: 1/88 M ODEL DV-03 M DVP03 MOD Vertical Sump Pump Submersible Effluent Pump •04 •i { _ � �� t ►fir l Pump Specifications ME+EIIS FEET '/3 HP 10 j MODEL: 3671 to 40 GPM Up � , Discharge size 1'/•" NPT 9 30 Solids: J /e" maximum 8 ( 1 Motor T Single phase: 115V 6 ' Materials of Construction = I l - v 5 1 1 Brass /thermoplastic q i epos. Features and Benefits -Top suction eliminates .. -.. - -i E64 � _ .. impeller clogging. 2 5.. �.. .. �_. .. -Corrosion resistant construction. o o� _._..i,l_..__'_ -_ -_— _.. _. ° to 20 70 q0 so US.W -Float actuated switch. 0 2 q 6 a to 12 m CA ACIL7r METERS FEET zs - Pump Specifications Features and Benefits j MODEL DVP03 V itt and 1 /2 HP • EPO4 impeller- semi -open design ° 6 20 Up to 60 GPM with pump out vanes to protect 5 ,5 - Maximum head to 32' mechanical seal. Discharge size 1'/ :" NPT • EP05 impeller - enclosed design Z , 10 ! Solids: J / <" maximum for improved performance. Motor • Rugged glass - filled thermoplastic 5 All motors feature ball casing and base design provides �. I ion. superior strength and corrosion °I ° 0 5 10 15 20 25 30 3b bearing construct q0 U.S.GPM resistance. single phase: 115V 0 2 q 6 e ionaro, -Cast iron motor housing for CAPACITY Materials of Construction efficient heat transfer, strength, Cast iron and durability. Thermoplastic • Corrosion resistant threaded Stainless steel stainless steel shaft. *Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless sleet hardware. r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 5 of 6 FILE INFORMATION SYSTEM SPECIFICATIONS Owner BLAKE DICKENSON & KIM HALL Septic Tank Capacity 1000 gal ❑ NA Permit # � 3 7 Septic Tank Manufacturer WIESER CONCRETE 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL LZ NA Number of Bedrooms 11 ❑ NA Effluent Filter Model A -100 12 x 2011 M` NA Number of Public Facility Units ty NA Pump Tank Capacity 600 nal ❑ NA Estimated flow (average) 300 g al/day Pump Tank ManufacturerWIESEFc CONCRETE ❑ NA Design flow (peak), (Estimated x 1.5) 450 al /da Pump Manufacturer GOULDS PUMPS INC ❑ NA Soil Application Rate al /day /ft2 Pump Model 3871 EPO4 ❑ NA 0 Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ER NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) [3 NA Biochemical Oxygen Demand (BOD 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Other: E3 NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every:. 2 0 vear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 2 ® year(s) Q month(s) ❑ NA Clean effluent filter At least once every: 13 ❑ year(s) Eil month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 years) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 3 years) ❑ month(s) [3 NA Other: At least once every: ❑ year(s) [3 NA Other: 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. r When the combined accumulation of sludge and scum in any tank equals one-third IY or mo re 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. GMW (4/01) OWNERS: BLAKE DICKENSON L KIM M— HALL HALL Page 6 o -� START UP AND OPERATION For new construction, prior to use of the POTS check treatment tank(s) for the presence of painting products or other W chemicals that may Imp ^de the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator 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 be discharged to the dispersal cell(s) in one large dose, overloading the call(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 soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the 4fe of the POWTS: andblotics, baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Aoss;'8iapers; disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease;• herbieldes; meat scraps; medications; oil; painting products; pesdcldes; sanitary napkins; tampons; and water softener brine. ABANDON#MEN 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 Vold 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 co e compliant replacement system: 3 A suitable replacement area has been evaluated and may be utilized for the location c a replacement soil absorption system. The replacement area should be protected from disturbance and compacUon,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.a'nd/or soil limitations. Barring advances In POWTS chnology a holding tank may be Installe as a last resort to rt�ace the failed POWT& d e rand not been v uated to id tify suitable replaceement area. Upon fallure of the ` to n us a pe ormed locate a suitable replacement are of no replacement area Is available hold ay a installe last resort to replace the failed POS Bowin removal of the blomat at ❑ Mound at rade soil absorption systems maybe reconstructed in place fo g 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 OXYG 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 MAYBE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC E 9d JOHV ' . Phone 715/772 -3278 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Agency ST. CROIX CO. ZONING Phone 715/273 -5811 Phone 725/386 -4680 This document was drafted by the staffs of the Greon Lake, Marquette and Waushara County Zoning and Sanitation sgendgs. This do=nwil►noets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)S(f) and 83.54(1). ( & (3) Wisconsin Administrative Code. Use of" downvWdoes not guarantee the performance of the POWTS. C'UW (210t) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer uyer �� �t c�2 y f�� v►� rl�t 1`�� Mailing Address _ q ►� Ra �-� % ► S 4 v r a 3 Pro erty Address °Z 44n (Verification required from Planning Department for new construction) , �F a — 1 a 7!0 — 9!, — City /State Parcel Identification Numbers LEGAL DE SCRIPTION Property Location N 0 '/•, uU ' /a, Sec. a 0 , T A9 N-R__L? -W, Town of /< `0-1r 1 -e -yl Subdivision Lot # l Certified Survey Map # `76 - 5 9 S I , Volume _ 1 k , Page # Warranty Deed # - 7 �o S 5b (p , Volume Page # 59 Spec house O yes ® no Lot lines identifiable E t yes O no SYSTEM MAINTENANCE X42 P o handy, Proper ' tenance Improper use and maintenance of your septic system could result in its premature failure 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 mas ter p lumber, journeyman ' lumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system Ym P is in proper operating condition and/or (2) after inspection and pumping (if necessary), theseptic tank is less than 1/3 full of sludge. Uwe, th9 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. CerdfiCati0u stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ZGN of the three year expiration date. ATURE OF 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 owners) Of t roperty described ab ve, by virtue of a warranty deed recorded in Register of Deeds Office. 07/2 /�`r� SIGNATURE OF 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 . +ivision of Safety and Buildings in accordance with Comm 85. Wis. a minty t y Attach complete site plan on paper not less than 8 12 x 11 inches in si�F S iruc .We. but not united to. vertical and horizontal reference point (BMI 'D Parcel I.D. percent slope. scale or dimensions. north arrow. and location and distat L 6 — t all information Date Please prim _ Persaw y ar l irdmixition You pr m bd used for sowmWy puposes,Ftk%i r taw. s. M04 V ) (m)). Property Owner owner any Location . . GoVL Lot ffu/ 1/4 1/4 S 2 T �Q N R � R (or)&V Property Owner's Mailfng Address Lot # Blodc Subd. Name or CSM# City Slate Zip Phone Number []City ❑ V#age W Nearest Road _. m1749FI 01 ( 71n 7 - ' 1T ' ►(� New Construction Use: [R-Residential / plumber of bedrooms �_ Cade derived design Now rate GPD ❑ Replacement Pubic or commercial - Describe: Parent material Flood Plain elevation if appicable N. General conwrients and reaonanendations: Boring # Boring E21 ❑ Pit Ground surface elev. ft- Depth to Wnifing facto �— in- soa lion Rate APPS Morizar Depth Dominant Color Redox Description Texture Structure C insistence Boundary Roots ' GPD/ft= in. MunseN Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 0 002 S SG art F Boft # ❑ Boring •- ❑ At Ground surface elev. QIP. ? R Depth to liim'Nng facbr in- Soo Appication Rate Horizon Depth Dominant Color Redox Description Texture Struchue Consistence Boundary Roots GPD/W in. MunseN Ou. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •EB#2 .Y 2 !F -3 s- zg7 • EMuerd #1 = BOO, > 30 < 220 mg1L and TSS >30 _< 150 nV& 82 = BOD, < 30 mgfL and TSS < 30 mgll f;ST (%ase PWd) CST Number - -2 i d AM Mss Fogerty Plumbin De Eva�llim ne Telepho Nwiler 28288 McKenzie /S w j . r oar P.WID# / yZ !6 A — Y� Page � of 3 D e a P8 I,. 1a_. p R D b9 > ire, f�1e Ftortaon Depth Domk"d Redox Desc* ioa Texum Strrxhe ConsIsWwa Roots G" in. Munsel CkL Sz Cori. COW Gr. Sz Sh. 'QM1 'E1t1I2 L s 9 B iHL Z ❑ BDr:r9 BO1frg Ptt Cxound surface elev. ft. r^s in �l Rate Depth Dornirr2rrt R,d D Texture Structure Corxsaterroe Boundary Rooft C~ in Munse# am 1 Coat Color Car Sz Sh 'E1f#t 'EtftI2 .. Bourg in. Bourg S Pit Q nd surtwm Blew. A. Depth to im�rg factor Sal Rate J V Ftoriaorr Depth Dominant Color Redorr Description Texture SMACUM CorrsiWMM Boundary Roots GPDIff in. Munsei tau. SL Copt. COW (Y. -Sr- Sh. 'E1M 1 'E1 • EMueM #1 = SOD, > 30 < 220 mgM1 and TSS >30 < 150 mglL ' Efttuent #2 =•BOD, < 30 nglL and TSS _< 30 m91L 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 6083'151 or '1W 608 - 2648777. seD-9370(RAM) Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 « eo yc i- = /99a/VP /d7 col(A/c w� / eojj 7J ,tv. r (UGC ID' svtG�� / h iYNE A � /7N I Iry .t .P• Zor &xwc rArAS a r .n -. ♦ i CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 AND IN PART OF GOVERNMENT LOT 1 OF SECTION 28, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. NORTH LINE OF THE NW1 /4 N1/4 CORNER S89 41'48 "E 531.10' 2118.04' SECTION 28 M UN_PLA'TTED_LAN— Z 2 0 0 BY PLATTER_ o Z W M N m m S89 °O '32 " W 329.32' c OWNER 70 .28 2 ss. oa' z i DAVID COYER D v 1122 76TH AVENUE 1 SOIL BORINGS m ROBERTS, WI 54023 (TYPICAL) I N m I � � W SURVEYOR 1 m EDWIN C FLANUM I NORTHLAND SURVEYING, INC. I z 856 A "65° Q � ,�� ® I O C ROBERTS, S, WI 54023 LOT 2 ® I , m w 7 2.97 ACRES INC. R/W I N 129,354 SO. FT. z I v M 0 003 t0 2.66 ACRES EXC. R/W O I O 115,697 SO. FT. w o 5Z 1 00 EXISTING 0 I Z z FIELD DRIVE �rn I m $m N Iv M I C) z a 301.85 1 .< o � _ j m ' N8 ,, 24 ,20 E 334.8 I Z QD 33. 0 1 m o 1'� N ' 1� o LOT 1 I APPROVED ACRES INC. R/W � I � ST. CROIX COUNTY 119,897 s°. Fr. Plannina Zoning and Parks Committee I z 2.45 ACRES EXC. R/W MAY 2 6 2004 I I N PROPOSED : 1os,5as SO. Ff. I D � D R IVE If not recorded within 30 days of I approval date approval shall be null and void I Z O ® , LEGEND I GG 3 60 . Q X ST. CROIX COUNTY SECTION CORNER I0 � 11 52�v tea/ POSITIONED FROM WITNESS I = 0 0 8 9 MONUMENTS OF RECORD I I 1 N 6 2 Q / 1" X 24" IRON PIPE SET WEIGHING I [� 1 � �g� ` �Q� 1.13 LBS. PER LINEAR FOOT 1 N im �' v � 1 5/16" O.D. IRON PIPE FOUND I� • • • 100' ROADWAY SETBACK LINE 33' 33 SCALE IN FEET 1 " 100' i I 100 0 100 200 SHEET 1 OF 2 SHEETS U 2 5 9 3 P 5 9 1 7�ss�6 STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between David D. Cover and Carol J. RECEIVED FOR RECORD Cover, husband and wife 06/11/2004 11:10AM Grantor, WARRANTY DEED and Kim Marie Hall and Blake Brian Dickenson, both EXEWT # 8 single persons as joint tenants REC FEE: 11.00 TRANS FEE: Grantee. COPY FEE: CC FEE: Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Lot 1-of Certified Survey Map recorded in Volume 18 on page 4760 as Document No. 763951 being a part of the Northwest Quarter of the Northwest Quarter (NW%a Recording Area of NW Government Lot 1, Section 28, Township 29 Name and Return Address Nor +-' , Range 18 West , Town of Warren 9 Ida S tree L A �4/a- I Roberts, Wisconsin 54023 part of 042 - 1076 -90 -050 part of 042 - 1076 -80 -000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dat s day of June 2004 *David D. Col * Carol A'UTHEN T N.AT.`�2 "I ACKN 'JLEDGMEI`:T STATE OF WISCONSIN ) Signature(s) 'CP`� PU e ) ss. if 4 St. Croix County. ) authenticated this day of Personally came before me this « day of PAW June 2004 the above named David D Coyer and * .�. Carol J Coyer TITLE: MEMBER STATE BAR O F WlS�pt.= (If not, to me known to be the person s who executed authorized by §706.06, Wis. Stats.) the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY * Michael H. Forecki, Attorney Notary Pub c, Sate of Wisconsin Eau Claire, Wisconsin My Co ission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701 -7928 Phone: (715) 835 -3029 Fax: (715) 835 -4112 Title One Premier Group T6425807.ZFX Produced with ZipFormTm by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9805 www.zipform.com 07 04 WEI) 0:32 FLI 715 •5513 -;T cill. ":ol O., CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE W'W'1 /4 AND IN PART OF GOVERNMENT LOT 1 OF SECTION 213, T29N, Rl OW, TOWN OF WARREN, ST. OROIX COUNTY, WISCONSIN. RA - UlMi OF TSE Awl�i' 46" NU NIA C;ORNE kcTION ZE r O LAN )LATTS DS sy PLATT ER �9. m OWNER MID COYER 1122 75TH AVENLIi. qOBERTE' w, 54023 Z SURVEYOR EDWIN C FLANUM NORTHLAN0 SiRVEylC INC ase A HWY I n , ROBERTS, Yfi 64021 LOT 2 INC R:ei N 2').K4fl;0 z "Ll ACRES ENS. V14 115 0 In 1cp c Z 0. t 0 Io ob - t ' k LOT 1 APPROVED ACRtS lll�. WV ST. CROIX COUNTY I HgT SO Fr, Pivri ZoNrg RW. I'vir'b CeAll- 11,190 24! R"-" I MAY 2 6 2004 i if r rGmrmd mtilr- 3 Nays of ZppmyvI (low oprffoIal shidim wil end vckl LEGEND X �-'6 '®r, F FAO %i M� ±NLMENM OF RECCMID 2 IRCN PIPE btmi wOGH:pi� 13195. PER I t. GE', IRON PIPE MIA0 03 5cn TIBACK LINE SCALE IN FEET 1 ss 100' 100 200 SHEET I OF 2 SHEETS