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HomeMy WebLinkAbout024-1045-50-000 m j 2 7 % o \ 0 $ � . z \ / $ % i ƒ § 0 2 ) & . � \ � � k / I � ] � - cc) k a m � § � B z t « \ ® 0 E \ ] ® e � 0 k k . f § k " 7 ) 2 ( 9 « k b § CO . § 'G Q D a = 0 ' B ID m _% } j z 0 # 2 2 a : \ « E E @ G CD ca » _ E ° d \ / \ �/ � t p 2 f . � _ t § o ® o _■ @ . § % LO \ (D } ® § \ } '� ° ` O) r / @ f m @ « a . q §§ 2 CO (A s ©G a 2% , \ k] 2\ § (0 \ k i f o v a ;u n c z/ z 0 m ■ cl ) L:a» t § k ! 4 k k o U a■ o u) Q I Parcel #: 024 - 1045 -50 -000 05/08/2006 09:48 AM PAGE 1 OF 1 Alt. Parcel #: 4.28.17.293 024 - TOWN OF PLEASANT VALLEY 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 TROY & DAWN FRENCH O - FRENCH, TROY & DAWN PO BOX 350 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 505 171 ST ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 4.660 Plat: 1950- EVERGREEN MEADOWS SEC 4 T28N R1 7W PT SW SW LOT 11 Block/Condo Bldg: LOT 11 EVERGREEN MEADOWS EZ- UT- 1501/336 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 28N -17W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 06/03/2002 680545 1902/198 WD 12/27/1999 616057 1480/226 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.660 41,100 141,700 182,800 NO Totals for 2006: General Property 4.660 41,100 141,700 182,800 Woodland 0.000 0 0 Totals for 2005: General Property 4.660 41,100 141,700 182,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 4Wisconvinb epartmentofcommerce PRIVATE SEWAGE SYSTEM Count y: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.1 5.o4 (1)(mp. 353281 Permit Holder's Name: ❑ City ❑ Village ❑ TRwn of: State Plan ID No.: Ebersold Dick I Pleasant Valley Town hi PWC ! - A # .; 2 5 �Z CST BM Elev.:- Insp. BM Elev.: BM Description: arcel Tax No.: 0 Z of ar f `f end' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY TATION BS HI FS ELEV. Septic B c mar !l(/ Dosing j, U U Alt. BM Bldg. Sewer , , 5':5 ' '?Z Z Holding _ St/Ht Inlet Z , S TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Air Intake ROAD Air Septic j '�- Zd z G l NA Dt Bottom Dosing �' " Z ZIP/ NA Header / Man. . / tHolding - - NA Dist. Pipe r Bot. System PUMP/ SIPHON INFORMATION Final Grade Demand Manufacturer a St cove p 1p o ( Model Number Z$ 0q GPM TDH Lift \'��� L rictiorb . �� System g ,s TDH tip's Ft mead I Forcemain Length �(` Dia. 2- +� Dist. To Well SOIL ABSORPTION SYSTEM BED ! "ENO Width r Length + No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `f Tf I DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu INFORMATION Type Of Q , �� r 1 20 ' OR UNIT CHAMBER model Number: System: y l ' DISTRIBUTION SYSTEM + IF Header / Mani old Distribution Pipe(s) + ++ x H le Size x Hole Spaci v Length j Dia. 2 Length ---FZ Dia. •2 Spacing � f � " 8 It '— SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑Yes ❑ N l COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: a / 1 N UUlnspec+n #2: C 1 25 7 ! + Location: 505 171st Street, Hammond (SW 1/4 SW 1/4 4 T 8N R17W) - 4.28.17. 2A �! 1.) Alt BM Description = 6, �� > wPI� A i " - - 2.) Bldg sewer length = Zo 6 ) KP�� hPw / OC<.„,� G&riJe - amount of coven = 41 3.) contour = 1t0.la (SL ` (7- J�=(O'(= J �ee�id�a' 'o / Plan revision required? []Yes % No C 00 _ th r side r dd' io I informati n. k j� BD -6710 (R.3/97) Da a In or's Signature Cert No. G.+- M"4 fu� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i s i n^P.......,, .qa..�_ j .....� j � rv � 77 f . --TT a s I £ -- f Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 1 `� I than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Pe rrmitNumber Personal information you provide may be used for secondary purposes ❑ Check it revision to pr evious application lPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION f 2 $ 3 Property O er Nam Property Location M c C'('� �9r � *Wl14 f-1,�t /4, S T z $ , N, R E (or)(9 Property O ner's Mailing Address Lot Number '� Block Number # i r � Cit S to Zip Code Phone Number Su ivision Na o CSM Number fle✓l� �� '� ( .a ------ �irlp Alt r /ll6-1-00 w S' E B ILD NG: (check one) ❑ State Owned 0 V ❑ Cit Road Public 1 or 2 Family Dwelling L -A - No. of bedrooms Town Ci v Nearest Co a 111. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) ^9 / I y �� f 0 P�y1 A 1 `C 1 [] Apartment / Condo 0 4. Zr- I 3 2 E] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. Z New 2. ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an 5 stem -- - - - - -- System -- Tank Only -------- - - - - -- Existing System -- - - - - -- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21�RLMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Q Seepage Trench 22 ❑ In- Ground Pressure 1 42 ❑ Pit Privy 13 ❑ Seepage Pit 1 x9 43 ❑ Vault Privy 14 ❑ System -In -Fill , 6Z�^^" VI. ABSORPTIONS TEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 4 5 b 2 �✓� Feet Feet VII. TANK 7 Capacity in gallons Total # of r steel Prefab. Site Fiber- plastic Exper. INFORMATION New Existin Tanks Gallons Tanks Manufacturers Name Concrete strutted glass App. Tanks Septic Tank or Holding Tank ❑ ❑ ❑ 1:1 ❑ Lift Pump Tank /Siphon Chamber w. ❑ ❑ ❑ 1 ❑ ❑ VNI. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's Signature: (No S m ) r P/NWRWNo.: Business Phone Number: ICJ L Leo 7 2 Plumber's Address (Str et, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Y Wisconsin Administrative Code will be applicable. i 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted tothe county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. r i system, t r local administrator h 6. If you have questions concerning you ons to sewage sy to , contact you oca code or the State o f Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: r Prpperty name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of.system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number, Plumber must sign application form. IX. County/ Department Me - 061y. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn io scare or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) gall sizing information. ---------------------------------------------------------------------------------------------------- 'GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees] for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 _ TDD #: (608) 264 -8777 N *hsconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 22, 1999 CUST ID No.222234 ATTN: POWTS INSPECTOR ZONING OFFICE GALE W SMITH ST CROIX COUNTY SPIA 3228 HWY 170 r. 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 RE: CONDITIONAL APPROVAL 4 APPROVAL EXPIRES: 10/22/2001 Identificat ers !fir ransaction ID N . 254372 Site ID No. 18283 SITE: .�, ° Please refer to both identification numbers, Site ID: 182837 f e � ! "' L above, in all correspondence with theagency. ST CROIX County, Town of PLEASANT VALLEY; CO HWY Z, HAMMOND 54015 P•a. W SWIA, SW1/4, S4, T28N, R17W Cond l f+ Facility: BRUCE MOLL SPEC HOME CO HWY Z, HAMMOND 54015 FOR: MOUND, 450 GPD APP Object Type: POWT System Regulated Object ID No.: 497181 RTT OIV � The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in - SEE CORRE chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. The slope in the area of the mound is 7% per CST. 5. The downslope sand fill depth "E" calculates to 1.28'. 6. The length of the absorption cell shall be 94 A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely DATE RECEIVED 10/12/1999 t " FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA L SHAI11p_ , P6 S PLA VIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMAR code: 7033 ■r■■■ M I A NOON ■ ii ■r■ ■■■■ ■r■ ■■ ■ ■r■ ■ ■■■ ■■ ■ ■ ■ ■ ■■ ■■■ ■ ■■ ■ ■■ ■■ ■■ ■■ ■ r� ■ r r ■ a a w a ■■ r ■Sly ■����Ll 2 Page Straw, Marsh Nay, Or Synthetic Covering Distribution Pipe Medium Sand _�.. G Topsoll F D 3 7 ' %Slope Bed Of 2 2 Force Main Floured From E'um b.aycr CORRECTION A t' . NEEDED A ggregate g a t e SEE CORRESPONDENCE D Cross Secti; Of A Mound System Usirid � A Bed For [ tie Absorption Arc c P -� A 9-0 Ft. CORRECTIM�� S,g ned: g i D Fr. SEE CORK" t' �P S 0NIDENCE License Number: FL bate: Ft, V t OdSsr' /066A Pipe of A I (�Eorce Main w Ff Ufil P um p Distribution E3ed Of Pipe Aggregote Observation Pipe Permanent Markers Pion View Of Mound Using A Bed For The Ab,sorplion Afea � • II I - — —— Page- of .� Perforated Pipe Detail End View r e, R poRA O2 ve PlAe p Q� F orce Main PVC f + / Holes located on bottom of force main are equally spaced End cap -- Last hole should be next to end cap Distrihutation pipe layout -- P Ft R — Invert Elevation of Laterals /0.2,0 Ft Inches S Inches / X Inches S igned s � 1_ �� ,.,_,. r#4!� Inches Licenses 2a R ole Diameter _Inches. Dates -- Lateral " Inches Manifold " 0 Inches Force Main Inches # of holes /pipe, .. Page_,� Of_.f: COMBINATION SEPTIC TANK /PUMP CHAMBE (No Scale) 4 CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings � Weatherproof Approved _ Warning Label Junction Box Vent Cap - -� 12" h1i nimum Final Grade 6" Minimum _ 4" Minimum 6 — MTaximum 4" C.I. Quick 18" Minimum T Insp, pipe Disconnect 1/4" Weep - Hole Baffles U � � A 4 � Alarm 6' B On , C *APPROVED Off 6' JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL i 3" of Bedding Under Tank --f Note: Pump and Alarm Are On Separate Circuits Number of Doses: er Day Gallons Per Day /# of Doses: f� Gallons .Volume of Backflow:....... + ^�� Tank Manufacturer: l�'� /o� 2,Q C Total Dose Volume: ........ = j allons Tank Size - Septic /Pump: - Gallons Alarm Manufacturer: S _I ILL en_' 7 a O Model Number : J o /t _ Capacities: A or Switch Type: e + B x inches or 3t� Ga11ons Pump Manufacturer: ® If X + C — //inches or /g' Gallons Model Number: D S'` + D =inches or / Gallons Minimum Discharge ate: , o Total ..... = _ inches or :��Gallons Vertical Difference Between Pump Off and Distribution Pipe: iA a Feet Minimum Required Supply Pressure:....... .......... ....... 2,S Feet X 06 Feet of Force Main x jX Friction Factor /100 Feet: + , eet Inch Diameter Force Main Total Dynami c Head :... j , a 2Feet 1'7y �°eiQ iHCh Internal Tank Dimensions: Length �— Width; Liquid Depths Signature GLrJ� License Number.;22 Date 2a ' �� M E40 series 4/10 IMP Effluent and Drain r P e Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 12 35 10 V) �j 30 w 25 Z N � 20 5 O 15 4 1 O 10 5 2 0 0 0 10 20 50 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1 .0% e .N" 71 F. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289-1144 FAX 419/289 -6658 Telex 98 -7443 N K3326 7/91 Printed in U.S.A. 1 12 DUS`fR1AL RD. Goulds • "_ - ON, WI 54016 Submersible Effluent Pump P MODEL C� 3871 EPO4 1 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle •Farms Motor: Available float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230 V. 60 Hz, 1550 models include Mechanical • Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP. ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 gilt in overload with construction. • Solids handling capability: automatic reset. ■ EPO4 Impeller: Thermo - 1 /4" maximum. • Power cord: 10 foot plastic Semi open design . AGENCY LISTING • Capacities: up to 5 m 5 GPM. standard Icngth, 16/3 SJTO with Pump out vanes for • Total heads: u to 24 feet pr vJth three op mechanical seal protection. " Canadian Standards Association • Discharge size: 1 NPT. plug. Optional 20g grounding foot 5 EP05 Impeller: Thermo- • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic - stationary, three prong grounding plug improved performance. end in "F" or "AC ".) BUNA -N elastomers. (standard on UP 05), ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104'F (40'C) continuous superior strength and 1404 (60 "C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. • Capable of running dry without damage to 9 30 components. I ►f�-4--5 cam, Pump: EP05 a i 1-2.5 FT t • Solids handling capability: Q 25 1 /4 " maximum. 7 W I r • Capacities: up to 60 GPM. X s 20 I _ •Total heads: up to 31 feet. 0 - - - - - - • Discharge size: l' /i NPT. z 5 -- -- I f • Mechanical seal: carbon- >_ - rotary/ceramic - stationary, ° 15 4 BONA -N elastomers. 0 i EP05' • Temperature: 3 10 104 °F (40'C) continuous 1401(60 °C) intermittent. 2 EPO4 t o 0 --- 10 --� 20 0 - ._._.. so GPM 0 2 4 6 a 10 12 ms1Fm CAPACITY 0 1995 Goulds Pumps, tic. Etfec ive May. 1995 83871 Wisconsiri of Commerce SO AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of lntegr ted Services in accordance with s f 3.09, Wis. Adm. Code County Attach complete site plan on paper not le s than 8 112 x 11 inch ip W'6 Plan ust include, but not limited to: vertical and horizontal reference poilafi(BM), dir4 r n R' s': t, percent slope, scale or dimensions, north arrow, and location 2lnd'distance r; ad arcel I.D. # APPLICANT INFORMATION - Please print all i#f_orma `' 1 Ftev by Date Personal information you provide may be used for secondary purposesdvacy Law, s. Property Owner \. ', I vU v v I $ooAt!bn Govt. Lot S - ,� t l 1/4� 6 0 14,S T� ,N,R �? ter W Property Owner's Mailing Address Lot # , Block# Subd. Name or CSM# VO4, /2. h$.e Y y38 vc.P �' /7 d '� City State Zip Code Phone Number ❑ City ❑ Village C� Town Nearest Road M o d I lk New Construction Use: LO Residential / Number of bedrooms 3 Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow _� gpd _ Recommended design loading rate bed, gpd/ft gpd/ft Absorption area required bed, ft trenc�h Maximum design loading rate bed, gpd/ft J_ trench, gpd/ft Recommended infiltration surface elevation(s) / d!? i :J ft (as referred to site plan benchmark) Additional design /site considerations / Parent material C— A4 G' / .+F L 7`/ L L Flood plain elevation, if applicable 1V ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S X U S❑ U ❑ S ®U I ❑ S ®U EIS W U ❑ S JR U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench dl-// /0 3 s 2 M 56 M/: s A1 - en- Ground d Sd d�X /LJVi -r elev. ' Depth to limiting factor ,in. Remarks: Boring # J Ground #�ft. Depth to limiting factor 2-X-in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number f} 7,0 G e IV woa PROPERTY OWNER &&O e M01 1- SOIL DESCRIPTION REPORT Page 2- of J , PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -/e !O s M' AS 264 Ground l v 2 S •t6 ICI ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) __ eel C2,ov --top 93 -- -i - -Q - -- - - -- - - -- -�- - -- - -- - - - - -- Akj I � i - L- - I : I 1 I I f T -1 1 L-J-J L J Ii 1 -I- �- i I , I 1 l , f � I 1 I i ST CROIX COUNTY SEPTIC TANK MAINTI?NANC'E AGR EMEN - 1 - AND / OW�T- UI4II' Ch:RTIFJGATION PCIR-M Owner/Buyer -'� � �► jJ Mailing Address Property Address (Verification requirtcl froth Plannttsg Depaetttuent for new constTUChon) ��� City /State , i peel Identification Number &:Z 4—/,0Q I - 6C6 ILU DISC_RMIM 7 � Property Location '.. W ` /., Sec. _,q_, T a8N -R_Jj_W, Towsi of y Subdivision Lot # Certified Survey Map , Volume , Page # Warranty Dad # Volume , Page #• ' Spec house ❑ yes R no Lot lines identifiable: D yes C 110 Improper use and rnaintenaseeof your stptie :ystern could result in its premature failure to handle wastes. Pro F er enaintenanc. consiM of pumping out the septic tank every ibree years or sooaer, if needed by a licensed pumper. What you put into the systm can affect the function of the septic tank as a treatment stage in the waste disptxal system. 'Me "Perty owner agues to submit to St. Croix Zotdol Depwtwttt a certification form, signed by the owner and by t masterplurnber, journeympnplurnber, mstrictedplumber or a lictntstdpurnper verifying that (1) the on -site waste water disposal systen is in proper operating condition sudlor (2) after inspection and pumping (if necessary), the Septic tattle is less than 1/3 full of sludge I/we, the undenign have read the above requirements and agree to ma intain th e private sewage disposaj system with the standard; set forth, heroin, asset by the Department of Commerce and the Dcpattmect of Natural Resources, State of Wisconsin. Certifieatrnr statirsg taut you leptie Syttetss has been Maintained must be ccinpleted and returned to the St. Croix County "Zoning Office within 30 days of the thrct: year expiration date. SIGN F SIGNA O APPLICANT DATE d WNER C .RTUUC I (we) certify that all statements ore this form are true to the best of my (our) knowledge 1 (we) anc (arel t1ie ownet(s) of �theeproperty described above, by virtue of a warranty deed recorded in Register of Deeds office. SIGNA'IVU OF APPLICA DATE 0.00 Any information Hutt is mis- trogreaen(Vj M&y MSUlt in the sanitR e ry p rmtt being revoked by the Zoning Department "• "• 00 Include with this appileatlon is stamped warranty deed from the Register of Dceds office a cop of the certified tnirvey trop if reference is made in the warranty deel ?ci t- r. '.t 'TL :l;43 `NHW - - >3 38 W 02: S9 NOW 66— tic. —)3Q I . , voi.1480fmt STATE BAR OF WISCONSIN FORM 2 - 1998 6 Z IEs Q 5r 7 Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Thomas Aabv and Bruce Moll a /k /a Bruce J. Moll, both single persons RECEIVED FOR RECORD 12 -27 -1999 11:00 AN Grantor, conveys and warrants to Richard A. Ebersold WARRANTY DEED EXEMPT # Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: 2.00 the following described real estate in St. Croix County, State of Wisconsin (The TRANSFER FEE: 119.70 RECORDING FEE: 10.00 "Property"): PAGES: 1 Recording Area Name and Return Address U Wubikj WTI 024- 1001 -90 -300 024- 1001 - 80-000 Parcel Identification Number (PIN) This is not homestead property. Lot 11, Plat of Evergreen Meadows, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this q day of November, 1999. * * Thomas Aaby * * Bruce Moll a /k /a Bruce J. Moll ACKNOWLEDGMENT STATE OF WISCONSIN ) AUTHENTICATION ) ss. % X County ) Signature(s) Personally came before me this � day of November authenticated this day of November, , 1999, the above named Thomas Aabv and Bruce Moll a /k /a 1999. Bruce J Moll both single persons to me known to be the person(s) who executed the foregoing instrument and * Kristina Ogland acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN * ' (If not, authorized by § 706.06, Wis. Stats.) Notary Public, State of W consin My Commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY lv�o —CAI Attorney Kristina Ogland Hudson, WI 54016 • • (Signatures may be authenticated or acknowledged. Both are not NOTARY PUBLIC REBECCA J. PHANE OF I STATE OF WISCONSIN ■ I *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1998 INFORMATION PROFESSIONALS COMPANY FOND DLI 1 Aj Submit to non- enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin municipalities for new 1- PERMIT APPLICATION Safety and Buildings Division i and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) SEE INSTRUCTIONS ON BACK OF YELLOW COPY. Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] 8 A F F Or .� ir.. v LC,'`, -:.. ..... '?cq �«f r Last Name First Name Middle Initial "b Street Address 1 City State Zip Code Telephone No. (Iftlude area code) 4 P r`a r txr r v , i Building Address Subdivision Name Lot # Block # 5 r Legal Description Parcel No. 1/4, 1/4, Section T N, R E or W t _ �.. i a � ss � t� r- 1 Family 19, Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump ❑ 2 Family ❑ Boiler Central AC ❑ Other: MF Nat. Gas L.P. Oil Elect. Solid Solar Space Heating ❑ p « ❑ ❑ ❑ ❑ Water Heating ❑ ❑ ❑ lam. ❑ ❑ ❑ Site Constructed ❑ Concrete Masonry ❑ Treated Wood . Manufactured ❑ Other (specify): "*'a zF "�,� a%' z 11 77 7 777 ,777 ..E$ TIIt�Y'ATED�R`[l`LLDING CAST aN'ri,, i ... .1 .r .. 1...r ,r. , e. ..a .ry'i Living area = '_a Square Feet $ I vouch that all the'above information is correct, and understand that the issuance of this permit is for administrative purposes only. I understand that onsite construction inspections will not be performed by the municipality, but that the Uniform Dwelling Code, Chapters Comm/ILHR 20 -25, still applies to all new 1- and 2- family dwellings and must be complied with. I understand that the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. f r, Applicant's Signature Date Signed/ MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE: DIVISION OF SAFETY AND BUILDINGS Q Town ❑ Village ❑ City ❑ County o£ r s SUING , y TIN ! P " / 'i- c 1�UlT1CCIPALIT NUMBER: FEES: E �f Dw�jling Locatic�a • � a,�r,,, , SBD - 8254 (R.2/98) White - Issuing Jurisdiction Pink - State Within 30 Days Yellow - Applicant INSTRUCTIONS The owner, builder or agent shall complete and provide all required information on the application form down through the Signature of Applicant block. This data is used for statewide statistical gathering on new one- and two - family dwellings, as well as for local administration. When completed, submit to local municipality having jurisdiction. Plan review or building inspections will not be performed by the municipality. PERMIT REQUESTED: • Fill in building address. • Fill in legal description of lot, subdivision name, lot number and block number. PROJECT DATA: • Fill in all numbered project data blocks (1 -7) with the required information. All data blocks must be filled in, including the following: ------------------------------------------------------------------ 1. Type - Check only "1- Family" or "2- Family" if that is what is being built. In other words, do NOT use this form if only a new detached garage is being built, even if it serves a one or two family dwelling. 2. HVAC Equipment - Check only the major source of heat, not any supplemental sources. Mark central air conditioning if present. Only check "Radiant Baseboard or Panel' if there is no central source of heat. 6. Living Area - Include any finished area including finished areas in basements. For two - family dwellings, include total combined areas. 7. Estimated Cost - Include the total cost of construction, but not cost of land or landscaping. SIGNATURE: • Sign and date application form. ----------------------------------------------------------------- ISSUING JURISDICTION - This must be completed by the AUTHORITY HAVING JURISDICTION. Check off MUNICIPALITY STATUS of issuing jurisdiction, such as town, village, city or county. Fill in MUNICIPALITY NUMBER OF DWELLING LOCATION. If issued by a county, indicate the specific municipality number where the dwelling will be built. Fill in name of person issuing permit and date building permit issued. PLEASE RETURN PINK COPY WITHIN 30 DAYS AFTER ISSUANCE TO (You may fold along the dashed lines and insert this form into a window envelope.): Safety & Buildings Division P O Box 2509 Madison, WI 53701 -2509 �bMP Oa`� °� 1©g5-50 AY /7, 9 q3 Submit to non - enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin municipalities for new 1- PERMIT APPLICATION Safety and Buildings Division and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) SEE INSTRUCTIONS ON BACK OF SECOND PLY _ Personal information you provide may be used for secondary purposes. [Privacy Law 15,�4(l)(m)] Last Name First Name Middle Ihirtial c— Street Address ;Niv1 y 7 'e f City - State Zip Code Telephone No. (Inclu'de aroa'eb ) i Building Address Subdivision Name Lot # Block # Legal ascription Parcel No. 1/4, 1/4, Section T N, R E or W ❑ 1 Family 11 Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: Nat. Gas L.P. Oil Elect, Solid Solar Space Heating ❑ ❑ ❑ ❑ ❑ ❑ Water Heating ❑ ❑ ❑ ❑ ❑ ❑ l F 4' COS��`" ,`(3IINDATION 1n . W.A.: Site Constructed ❑ Concrete ❑ Masonry ❑ Treated Woo ❑ Manufactured Other (specify): 6 AREA h TED BUILDING C3S' y m $, Living area = Square Feet $ 04) I vouch that all the above information is correct, and understand that the issuance of this permit is for administrative purposes only. I understand that onsite construction inspections will not be performed by the municipality, but that the Uniform Dwelling Code, Chapters Comm /ILHR 20 -25, still applies to all new I - and 2- family dwellings and must be complied with. I understand that the issuance his permit does not relieve me of compliance with other applicable codes and ordinances. c' l � d Applicant's Signature Date Sipded MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS ISSUING JURISCxI3N.y Town ❑ Village ❑ City ❑ County of - ML1NICIPALI Y`N ER• # - c S EES cif °Dwelling Location !r' PERMIT SUED BX• X. SBD -8254 (R 4/99) MUNICIPALITY FORWARDS TO STATE WITHIN 30 DAYS IF NEW DWELLING I - INSTRUCTIONS The owner, builder or agent shall complete and provide all required information on the application form down through the Signature of Applicant block. This data is used for statewide statistical gathering on new one- and two- family dwellings, as well as for local administration. Prior to submitting this application to the municipality, obtain any necessary sanitary or zoning permit from the county. After completing this application, submit it to the local municipality having jurisdiction. Plan review or building inspections will not be performed by the municipality. PERMIT REQUESTED: • Fill in building address. • Fill in legal description of lot, subdivision name, lot number and block number. PROJECT DATA: • Fill in all numbered project data blocks (1 -7) with the required information. All data blocks must be filled in, including the following: 1. Type - Check only "1- Family" or "2- Family" if that is what is being built. In other words, do NOT use this form if only a new detached garage is being built, even if it serves a one or two family dwelling. 2. HVAC Equipment - Check only the major source of heat, not any supplemental sources. Mark central air conditioning if present. Only check "Radiant Baseboard or Panel' if there is no central source of heat. 6. Living Area - Include any finished area including finished areas in basements. For two - family dwellings, include total combined areas. 7. Estimated Cost - Include the total cost of construction, but not cost of land or landscaping. SIGNATURE: • Sign and date application form. -------------------------------------------------------- - - - - -- - -- ISSUING JURISDICTION - This must be completed by the AUTHORITY HAVING JURISDICTION. Check off MUNICIPALITY STATUS of issuing jurisdiction, such as town, village, city or county. Fill in MUNICIPALITY NUMBER OF DWELLING LOCATION: -If issued by a county, "., . indicate the specific municipality number where the dwelling will be built. Fill in name of person issuing permit and date building permit issued. PLEASE FORWARD SECOND PLY WITHIN 30 DAYS AFTER ISSUANCE TO (You may fold along the dashed lines and insert this form into a window envelope.): Safety & Buildings Division P O Box 2509 Madison, WI 53701 -2509 v � 8 FILED 1 APR 3 0 1996 ® MAY 2 31996 L KATHLEEN H. WALSH 2 Register of Deeds ST: CROIX COUNTY St. Croix Co WI SURVEYOR'S RECORD 542945 � Q CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION 4, T28N, RIM TOWN OF PLEASANT VALLEY, ST. CR01 X CO. , WI . PREPARED FOR: JON HANSON NOTE: BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SW 1/4. (ASSUMED BEARING) I UNPLATTED LANDS VINOVED NORTH LINE OF THE SW -SW S 89 0 51' 0l `E 1281. 1 V APR -j , V . � kfj Sr CROIX COUNTY Coinprehensive Piannif Z Zoning and Parks Committee y I � r ' W i L OT I V not recorded Z cn I w 27.63 ACRES wimin 30 days of m ^? s ( 1, 203, 733 SO. FT.) approval date 2' 27.20 AC. EXC RiW - pproval shag be cn p ( 1, 184, 703 SO. FT.) ,l {( k void p m e � H �C _ :Z :z . PPROVAL OF LOT 4 �I DOES NOT CONSTITUTE W 'p J � :r ;D � ? t , � ^ ' � APPROVAL OF A B U I L D I N G ; n :-� �� V SITE (I HL 83 N 90 E 600. 00' . W " (/� N 90° 00' 00" E _ C :> W I 300. 00' O. OCR 300. 00' w . a ,�` r . N N y W l� i N LOT 2 LOT 3 o P 4. 13 AC. '� 4. 13 AC. -4 �= � �' cD cn ro v, 4. 13 AC. cD .A 179, 958 SO. FT: co 179, 956 SO. FT. • co o co cO co ( 179, 948 S0. FT. ) 3. 79 AC. EXC, try 3. 79 AC. EXC. co co 3. 79 AC. EXC. m Ex1s NO HOUSE RiW 164,957 S0. FT. 0 164 957 SO. F O 64, 950 SO. FT. O Q ° S b5- ° o S0 O p O O DRIVE O 66. 02' ` 300. 0/ ' 300.00' 299.97' Oi. 3 1 62 ' N 90° 00' 00" E — — — — — 1313.6 I 33.01' 300. 1' 300. 0' 299.97' 31 60' —f- _ 66 .02_ _ o " — — — — — — — N90 00 00 W (COUNTY MONUMENT FOUND) SW CORNER OF SECT 10N . 4 (;, T H, r Zr N 90° 00' OO" W 1280. 60' S (COUNTY CORNER OF SECTION SOUTH LINE OF THE SW -SW 4, (COUNTY MONUMENT FOUND). NOTE: UNPLATTED . . ... LANDS .................... LOT 4 DOES NOT HAVE A SUITABLE SITE ,�e��¢� <�! FOR SEPTIC SYSTEM UNDER CURRENT CODE 00 C- Off j Pi�s� � O - SET /" X 24" IRON PIPE WEIGHING 4 JAMES M S+j�y 1. 13LBS PER LINEAR FOOT. s WEBER � NOTE •' HIGHWAY BUILDING SETBACK IS 100' ,' SPRING - 1804 FROM THE R I GHT -OF -WAY LINE. VALLEY WIS. t 250 ��� .•'' ✓r te a 0 250 500 750 .. i JC.• y, A y J�J GRAPHIC SCALE — FEET JAMES M. WEBER S -1804 NELSEN -WEBER LAND SURVEYING t DATED TH 1 S a_ DAY OF�R' - , 1996. SHEET I OF 2 96 -22 THIS INSTRUMENT DRAFTED BY JIM WEBER Vol. 11 Page 3090 3 I'd Wisconsin..aepartment of Industry SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations �— Division of Safety & Buildings in accord with ILHR 83.05, 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. pending APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Jon Hanson GOVT. LOT SW 1/4 SW 1/4,S 4 T 28 N,R 17 3E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # / BLOCK # SUED. NAME OR CSM #,) 30c�0 1748 Co. Rd #Z 3 `7 na csm pending v CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 91TOWN NEAREST ROAD Hammond, WI. 54015 (800)525 -9872 pleasant Valley Co. Rd. #Z New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .2 bed, gpd /ft •3 trench, gpd /ft Absorption area required np bed, ft 375 trench, ft Maximum design loading rate .2 bed, gpd /ft .3 trench, gpd /ft Recommended infiltration surface elevation(s) 103.42 , ; f roar. rrhange (as referred to site plan benchmark) system does not Additional design/ site considerations system el. based on contour line of el. 102.20' meet exsisting cod Er,. Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I ❑ S C U ❑ S ER I [IS f7 U ❑ S fil U EIS Z U ❑ S 0d.1 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trw& l 0 -9 10 r3 3 none 1 2msbk mfr CIW if .5 .6 2 9 -25 10yr4 /4 none sicl lfsbk mfr gw if .2 .3 Ground' 3 25 -48 7.5ry4/4 c2p 7.5yr5/8 sicl M na na na np .2 elev. 1 02.4 ft. Depth to ? limiting RUIRLI factor Q D 25 ' , APR Z 6 Remarks: --- COUNTY Boring # if f bk 2 1 -8 10yr3/3 `, 1 ms mfr cs .6 . 5 2 " 2 8 -20 10yr4 /4 n sicl lfsbk mfr gw if .2 .3 3 20 -40 7.5yr4/4 c2p 7.5yr5/8 sicl M na na na np .2 Ground elev. 10 ft. Depth to limiting factor 20 Remarks: CST Name:— Please Print Phone: Gary L. Steel 715-246- A ddress: ry,54 200th. Aveo New Richmond, WI. 54017 Signature: Date: CST ta u b r 4 -22 -96 cstm 02mL�$ PROPERTyOWNER Jon Hanson SOIL DESCRIPTION REPORT Page of _ PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10yr3 /3 none 1 2msbk mfr 9w if .5 .6 2 11 -19 10yr4 /4 none sicl 1fsbk mfr gw 1f .2 .3 Ground 3 119-40 7.5yr4/4 c2p 7.5yr5/8 scil M na na na np .2 elev. 10 ft. Depth to limiting factor 19" Remarks: Boring # m Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ` .... ; Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel ,Ion Hanson 1554 200th Ave. CSTM2298 SW4SW4 S4- T28N -R17W New Richmond, WI 54017 MPRSW 3254 town of P1eASANT Valley (715) 246 -6200 i lot #3 -CSM N 1 =40' BM.= top of NW lot stake C el. 100 this system does not meet code requiremnts for installation of mound systems as of 4- 22 -96. u l r Gary L. Steel 4 -22 -96 HAN I& lgi 3U dO 3NI 7 163N - - -- - -- — -- — -- - -- - �vl rrl M.G*.Qi # ION C-) C) 1 I � � 0 60£ •od • I I •Ion � •s �� �` In i., I -rl r ------ -------------- - - - - -- - .............. r p rr, ............. -< rn 10W . Iwo A0,91 *ION :s I e 2 A C , ' at'i" A.0.980ION le ------------------------------------------------ . ............ ........................................... .... rn i . ............. pv . ..... 1 . 0 „$� � iY .001 `�� �M��$ �'.� yy y � O�� O r a IN ---I - — -- — - CA A - — -- — -- — -- — -- — -- — -- — -- — - 3LS-M U 0 MCI IM i cp wl� a18 ROG" I cn i 1 Ck a I XN ZA I all i� I i t- R I gig S, E i