Loading...
HomeMy WebLinkAbout034-1026-70-000:L7 L,Countyafet1 and Buildings ision/�p 2d1 Washington Ave., P.O. Box 7162 -- 6tz o x 3 Madison, Wl 53707--7162 .5annary Permit N r iU in bySNy vale rx e ----- plication State Transaction Number • In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental. unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted Co Project �3 7 the Department of Safety and Professional Services. Personal information you provide may be used for bmitt u es in accordance with the Privacy Law s. 15.t}4�i m Stats. Address (if different than mailing address) ✓ I. Application Information -Please Print All Information (� Property Owner' ame ---- O-1 r� �l �_ _ _ Parcel # rl % party Owner's Mailing Address —• � � v �� ` LtG4 � SL_ Property Location City, State Zip Code Phone Number Govt. Lot �j,,t'1 CB - 53 —/ _ '/.' 1� 1/4 Section Z. ��'�` -� �� � � � l5 - _ � 1 2 (circle one} II. Type of Building (check all that apply) Lot # 1_Y9 N, R NVest I or 2 Family Dwelling - Number of Bedrooms 5ubtiivision Public / commercial - Describe use Block # — — 4- tate owned - Described use Na ❑ city of _ C M Number Village of Town of II . pe of Permits (Check only one box online A omplete line B i aplplicable) — —� A, New System Replacement System Treatment/Holding'rank Replacement Only — ❑ Other Modification to Existing System (explain) B, ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Bate Issued Before Expiration Owner IV. Type of POWTS System/Component'Device: (Check all that apply) Non -Pressurized In -Ground ❑ Pressurized In -Ground At -Grad Mound > 24 in. of suitable soi Mound <. 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (expla') _ Pretre<ument Device (explain) V. DispersaUTreatmentArea Information: DesignFlow d Design ea (gp } gn Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed (st) Sys m Elevation L(Sc) Li S 0 j p ( loo ,or VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units � j � New Tanks Existing Tanks Q rzut.o 1?j i Olw�-¢ z: Septic Tank WO -j T- X - Lift Tank T 11 _ X VII. Res_pOnsibility Statement- I, the undersign , assu res onsr ' f installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu gnature MP/M:PRS Number Business Phone Number Lewis Bork 253976 715-231-7375 Plumber's Address (Street, City, State, Zip Code) '— "- E7818 County Road E Menomonie, wI 54751 _ VIII. County/Department Use Only Approved ❑ Disapprove Permit Fce 2Daate Issued L,su' g Agent Signatu ❑ .v on for Denial $ 68�` /23 Z3 IX. Conditioq A 13� D_�0My� JJ OWNER: � ZT 17r� 1. Septic tank, effluent filter and dispersal cell rea+�,� S g(ti,.,�,� �„� 2 must be serviced / maintained as per management Ian 5� .All--�- S P C ►-- U — �I�l NU.1 SI Z Tz9 CHECK BOX A9 AtPPI,MGAgI.E. CNBCK$OX AS APPLICABLE. SOIL EVALUATION Scale:'`' :° SYSTEM PAGE 2 0� 6 SITE, AR ° _a 4 so PLOT PLAN ZX1�N .. �c` raann: ,. > ' a DESIGN FLOW: _ GPt} ,JBCOi Utphall 7.5 Attach design flaw calculations for commercial plans, PROJECT ADDRESS: �� _Q 44 � Pipe Material / ASTM Standard (Tables 3$4,30-3 & 384.30-5) �,, Sanitary Sewer:, _ / BM Symbol; BM Elevation: C F f 14 Force Maln: / ^ SM DescriptIon: ���+A"r Z R �r�i SJ Slope GJed1eM 9£) indicate north by !M RT NT; WON S of asts+d Araa; ( ymbd (N applicable}: a drowtnp an am -t Show ground eleva(lon contours at suitable intervals. pn the appmprita rre, i?, , Cfs1 &"t k-- G O. Tfly Nrz cv) WC 4L fU4� 4*A M a � OA- 7"i�.r ` �.�I��tao �OOSP55E+(' �gccL �St,�Cx LIL1l�D 5 I14160 � k- Li ISO -_�r-nP I Wisconsin Department of Safety and Professional Services Division of Industry Services i 1 4822 Madison Yards Way 110 Box 7302 j Madison, WI 53707 I, P r January 12, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2025-1-12 Plan Review: PWTS-012300069-G Lewis Bjork E7818 County Road E Menomonie, WI SITE: Utphall :1098 Rustic Road Town of Springfield St Croix County NW % NW Y4 S12-T29N-R15W FOR: Description:3 bedroom-450 GPD mound-24" to limiting factor- Effluent Filter - Maintenance required. Phone: 608-266-2112 Web: http://dsps.wi.pov Email dsns!dwisconsin.sov Tony Evers, Governor Dan Hereth, Secretary ConditionaPl y APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.1, Sl3D- 10691-P (5/22-5/27) Pressure Distribution Component Manual — Ver. 2.1 (May 2022-2027) Verify proper dose is achieved and system is not being over dosed. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leavers or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • 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. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SIPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, . 7&J1U', Z1)T ze'y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 634-5124 Joshua.rowley wisconsin. ov PAGE 1 OF 6 Mound Plan Index & Comer Sheet Component Manual Design References Mound Version 2.1 (May 2022-2027) & Pressure Distribution Version 2.1 (May 2022-2027) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Gross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan chments: Enclosures: Pump Curve POWTS Application for Review Wanks I Soil Evaluation Report & Site Map effluent filter Project Name f Description Owner Narne(s C-01'w, Owner Address' ` NN% 4 59 F-V► sf - M W.i Project Govt. Lot: Township: __ Project Parcel ID #: Designer Information Phone: __6 - - 5317 Zip: 51-71 Designer Name: Lewis Qjork Phone: 715-231�-7375 Designer Address: E7818 County E Menomonie Wl Zip: 54751 _ E-mail: lewisbjork@yahoo.com Conditionally License Plumber: MP#253976 APPROVED DEPT. OF SAFETY AND PROFESSIONAL Remarks: SERVICES DIVISION OF INDUSTRY SERVICES r SEE CORRESPONDENCE-- Signature: Date: -"1 5 Zz Original signature required on each submitted copy. SKIN 6FI M S4-C�t X CHECK BOX AS APPMABLE. SOIL EVALUATION SITE MAP PROJECT NAME: 'HECK BOX AS APPLICABLE. �••/`�etle'� scale: ,�� = so� SYSTEM PAGE 2 OF (ao 30 45 fi° Tx�N PLOT PLAN 7 Sa DESIGN FLOW: _ GPO Jacob Utp�h7all Attach design flow calculations for commercial plans. PROJECT ADDRESS: ( Pipe Material / ASTM Standard (Tables 38-4.30-3 8 W.30-5) NSanitary Sewer-' 1E. zc BM Symbol: BM Elevallon: _ F7 Force Main: 1 ON Des KE D_ 6r E�►CLt, Ec,�� Slope IndiCatenonhby IMPORTANT: p well Symbd (it applicable): 0 drawing an arrow Show round elevation Contours at suitable intervals. of Tested Area: (� 9 qn the approp tte Ane. c a�Gl SIN E IE '- Napo( �. PIL. Ito, &SPSSF� Geqcu. P55wr�. LIL)uO' 56a(� ISO kR - 4 CIL. W 0.5"TO 2.5'WASHED AGGREGATE (min. 6.0" beneath distribution pipe - min.2.0* over distribution pipe and covered with approved synthetic fabric) ASTM C-33 SAND FILL -�R SINGLE -CELL MOUND DISPERSAL AREA =22rc= MIN. 6.0* OF TOPSOIL COVER min. 1.0 ft i-1- - min. 0.5 ft T0 A= ft D Surface Contour Elevation = 101D ft (Show force main, manifold, and flush valve locations on plan view. % Slope D ft E ft System Elevation = it Lateral Invert Elevation = ft IM PLAN VIEW (No Scale) 0 Schdl 40 PVC Lateral j 7 ft ft (typical) (typ I — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 0bswvaUw ._------.--------I L— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — B ft ft oyptca4 IT Send as necessary to follow contour DOWNSLOPE TOE I/ rl�k L rW1— ft 109 Prohibit disturbance and vehicular traffic within 15 feet of downslope toe. Reset Page M W 0 n 0) DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) FLUSH VALVE DETAIL (No Scale) Orifice in . -- -- Valve Box Lateral Spacing a �! Center of Threaded Cap _ (insulation optional) S - ft for Head Testing (optional) Shield orifices for r � ijraYeliesS ayyiri.aiiv eS Ball Valve � (optional) t Q r `- N \ v , l ] j/ //Lateral Lerngth (P} - tom! it '4 (riser des �o optional) 1.5 -0 Sch0 40 PVC Manifold •0 Schdi 40 PVC Force Main (slope to pump tank f- for drain -back) First Orffice (typical) Laterals to be level Schdi 40 PVC Lateral 0 = in (typical) Number of Orifices per Lateral = 3 Orifices equally spaced: - ` V v (check a) OR b) below] a) TZ along bottom of lateral Orifices equally spaced � Flush Valve. a" bottom of lateral {a b) �. along top of lateral Assembly with eve hole (typical - see detail) ,I s` t. facing down LATERAL INVERT ELEVATION _ ft (typical) Last Orifice J Orifice Spacing (X) - in (typal) (typical) Orifice Diameter = 3Z in OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Finished Grade Slip Cap (loose) `W.. (mulched & seeded) i 4"0 PVC Pipe I IT ;: L! Topsoil Gower Top of pipe to terminate (min. 1 foot) at or above finished grade (4)114•-1,2" X 6- Slots 40 apart E AnchoniN Device Infiltration Surface Orifice Discharge Rate = 4 ";q gpm Number of Laterals - 2- Lateral Discharge Rate - 14, �z gprn TOTAL DISCHARGE RATE = 2-4 .93 GPM Mpicai) First Orifice (typical) _A END MANIFOLD L� CONNECTION Check (typical) applicable box. Manifold First Orifice (riser pipe optional) (typal) > m j� X - --F - .X/2-- xrz-�--- X ---- .�, (typical) (typcal) Manifold CENTER MANIFOLD Ll CONNECTION M (riser pipe optional) PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4'PJ Vent Pipe > 1011 from Building Elecxrical must comply Aith 12' Min. o, 2.0 it above SPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole user as necessary. (typical) ApproveiI —Junction Box 4 vent Ca,r Approved Locking Manrole IMPORTANT: II with warning label Attached Anchor tank(s) as necessary t (typical) ecmdu�l pursuant to SPS 383.43(8Xg) 4' Min. or 2.0 fl above r, r_ ZF9 T/_ Establlshe(typ �)ElevaC on Finished Grade CAPACITIES Ca.) l�►'J . gal/in Depth (in) Volume (gal) A.� B 2.0 3 3.5,Z. [c] ' .T ,7Z. D J1, *T A B -� *Pump Tank Liquid Level = (9 in - ICI Pump IN D Force Main Diameter = in Force Main Length =� ft 3` Approved Bedd r r�� Force Main Void Volume=� gal 10 [G] Total Dose Volume (TDV _ 1-7 gal/dose - (5X total lateral void volume S TDV S 0.2X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 21241 gpm PUMP TANK: Volume =(w (�� _-gal Manufacturer: Ut 5t , 41111� Pump Manufacturer; 0cd col-- --� Pump Model:. L (See attached pump curie.) Controls/Alarm Manufacturer:�C�ovS Controls/Alarm Model:.rr. tr� Float switches containing mercury -pre prohlbited. /r Airtight Seal Weep Nab > Aiarrr on Off Quick Disconnect 1&• Min. + lam' ! ��' (typical) C �► -Approved joints wRh / Approved Pipe 3 fl onto Sotid Ground (typical) PUMP -OFF a ELEVATION = : -1 ft >ncrete INSIDE BOTTOM 81O4* I _ ELEVATION = ft tens! Ben^tjt Tank �T Q 0) Fv ertical Head = �' ft + Min. Supply Hear = ft + FM Friction Loss = 17 T ft + Fitting Loss" = .O �� ft ;(min. supply head x 0.3) = TOTAL DYNAMIC HEAD = ` •ft SEPTIC TANK(S): Total Volume = L00 G gal Manufacturer(s): i J e 5 e "- Install approved effluent filter at the septic tank outlet immediately uastre@m pf the pum12 tank inlet. Filter Manufacturer: t, (1i(1 C D Filter Model: PAGE 6OF6 Mound Management Plan IMPC}RTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383 52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc, Admin, Code. Maximum D11persal Area Operatin Limits: Design Flow = Ll �C' gpd; BOG,6 5 220 mqC; TSS _< 150 mfgL"; FOG <_ 30 mgL*l Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system a nuisance factors (i.e, odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) a solids volume in anaerobic treatment tank(s) and any distribution appurtenances) (i.e., distribution ! drop boxes) c neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, tuners, alarms, etc.) a distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) c surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) ; anklal shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Sffluent filtertsl shall be inspected every 3 yearns and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. DistributioniAt-enift shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis Bjork Family Septic Service Phone. 715-231-7375 Local government unit: : C ✓ 0- "Ji2,,t Phone:-7 3�d _ � f Local government unit address: At V 'c ��•� 1 . ,��A ZIP: 3 7 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Coda Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. SysL*M Abandonment If use of this POWI'S is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. 35, 1. ZOG 24%) 8k) 32) LOV,W,' 'ER N%NJTE 4" CAST -A -SEAL 0 w tr Q� w Q. t � !"T: U C14 a_ 3" ti t� - tilt - t i ' tt t� � t t i int t t t FILTER OR 1ftt i t j BAFFLE I'll t t t tt t t i WLP1000/600-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3' 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 56" LENGTH: 12'-6" WIDTH: 7'-0" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: 14,970 LBS. INLET AND OUTLET: 4" CAST- A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) 16.76 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON 4" VENT COVER: MIX DESIGN #8 (NO FIBER) TANK: MiX DESIGN #10 (STRUCTURAL FIBER) ul CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WlESER CONCRETE - OUTLET ! II�— - - - u Q i { � cp �•i � U i REVIEWED BY \-PUMP PAD REVIEW DATE DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL. to APPROVED BY: I SHFET r-.I i APPROVAL GATE: !cw i PRODUCTS NEEDED BY: / TALKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS S amp,le; Product Ct*dOW SANITARY SYSTEM File #: ST. C RO LINTY Office Use Only OWNERSHIPIADDRESS FORM Created212027 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Address City/State/Zip Mq"loy Wa L Phone Number (require Email Address (required) Parcel Identification Num (found on the property tax bill) `-/qc -_ r C>3 !1 / DL(o --7 O - OCR 6 NEW SYSTEM: LEGAL DESCRIPTION Property LocationN\0 4 ! 1/4 , Sec. � T 6N R l5 W, Town of �l��r t L L Subdivision Plat: Lot # Certified Survey Map # NIA 'fOt,)c 0—PS , Volume Warranty Deed # Number of bedrooms New Property Address (Staff Initials) Page # (before 2006)Volume , Page # Spec house 0 yes,1fno Lot lines identifiablyyes 0 no OFFICE USE ONLY M (Verific tion of ew address required from Community Development 2 23 23 (Date) new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov '�'r WILT --fFE 47 8`9'E311 9 STATE BAR OF WISCONSIN FORM 3 - 1998 Denise Lynn Utphall, quit -claims to Jacob R. Utphall, a/k/a Jacob Utphall, the following described real estate in St. Croix County, State of Wisconsin: NORTHWEST QUARTER OF NORTHWEST QUARTER (NW 1/4 OF NW 1/4) AND THAT PART OF SOUTHWEST QUARTER OF NORTHWEST QUARTER (SW 1/4 OF NW 1/4) NORTH AND WEST OF HIGHWAY, ALL IN SECTION TWELVE (12), TOWNSHIP TWENTY NINE (29) NORTH, RANGE FIFTEEN (15) WEST, TOWN OF SPRINGFIELD; ALSO, EAST HALF OF NORTHEAST QUARTER OF NORTHEAST QUARTER OF NORTHEAST QUARTER (E 1/2 OF NE 1/4 OF NE 1/4) OF SECTION ELEVEN (11), TOWNSHIP TWENTY NINE (29) NORTH, RANGE FIFTEEN (15) WEST, TOWN OF SPRINGFIELD. Subject to Rustic Road R4 right of way. KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD 07/19/2006 10:30AM QUIT CLAIM DEED EXEMPT # 8M REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Area Name and Return Address Hendrik W. Van Dyk VAN DYK, O'BOYLF & SILER, S.C. 201 S. Knowles Avenue New Richmond. WI 54017 034-1024-10-000, 034-1026-70-000 and 034-1026-80-000 Parcel Identification Number (PIN) This is homestead property. This conveyance is given pursuant to divorce judgment granted in St. Croix County, Wisconsin, Case No. 05 FA 428 on June 16, 2006. Dated this ' ` day of �(1 l L4— 2006. * eni�i se Lynn Utphall AUTHENTICATION Signature(s) authenticated this day of _2006. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Hendrik W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. 201 S. Knowles Ave., New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. St. Croix County ) /Personally came before me this day of , 2006 the above named 61 Denise Lynn Utphall to me known to be the persons) who executed the foregoing instrument and acknowledge the same. Notary fblic , State of Wisconsin jn ```{ttttlttttf/r�� MY: Co( /%n is permane2J (If '6 'tt11.ICEvili !rfryJ� /�'20 CP *Names of persons signing in any capacity should be typed or printed below their signatures WI$G O QUIT CLAIM DEED , QF STATE BAIL OF WISCONSIN FORM No. 3 - I"S 1 of 1 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-655-2021 LLµ tl �r V - lJ . RM 4B "� �- RUSTIC READ k I w O a Al . y 48 t-Z f t LL f 1 w y,t : '' ` ,.., �• �`' '��P1'r'j "ems � ." � � � . � , I � `\\`\� .._ ° y . � ;i 14 nil ilk -ot i Wisconsin Department ofIL EVALUATION REPORT 2 page_ of Division of Safety and Buildin s FEBrn®c�o��e with amm 65, Wis. Adm. Code County St. Croix ach mpl sit n o paper not 1�ss t 4 x 11 i hes in size. Plan must d a: v rtiCa1 ark} h h2b ,V ,g{ nt (BM), direction and parcel I.D. 034-1026-70-000 pert t slope, scale or dim s and distance to nearest road. 1 Please print all information. Re 'ewed by Datp Personal information you provide may be used for secondary purposes (Privacy Law. S. 15.04 (1) (m)). Property Owner Property L ion0 Jacob Utphall Govt. Lot Q 1/4NL S 12. T 29 N R E (or) W Property Owners Mailing Add r_ e s � S Lot # # Subd. Name or CM# pL �h . Qle{ `i 5'�d[:Block 1 V to Ci State Zip Code Phone Number ity Village ■ Town Nearest Road r1r1i01rt Wr I $4751 o (-7(6') —4 40 - ` New Construction Used Residential / Number of bedrooms � " _ Code derived design flow rate L — © GPD lacerr Public or commercial - Describe: -0 Parent material lot'".i2�teA1,.- JeW - Flood Plain elevation if applicable tQ �1�1 � :MA_0 ft. General comments In my opinion there is _ I&'� min of non -saturated, non consolidated soil above limiting factor , I would and recommendations: propose a standard component manual . install after county and state approval of an mound treatment dispersal P�4B>p" system � �c� w. �- V C)t55 IOUs I B 11 Boring # Boring � . I Pi, Ground surface elev. - Depth to limiting factor p � in. FQQ ;1 Annlirafinn R—arm Horizon Depth in. Dominant Color Munsell Redox Description du. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 t0`'�.` Boring �-2 Boring # i � � G,4 1'rnund surface elev. too ft. Depth to limiting factor ; n. rQM pnnliratinn Rat. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 S 5; 1 U f,21 — —.L4 ILI iM 1.5g5 aFZ 101*. `t 2 Sc. _ -- — A., 1e0 on ..,,..A ' Effluent #1 =BODE t0 < L!U mgrL ana i JS you l iou ,., - _.._ . __ _ _ -- CST Name (Please Print) CST Number Lewis 13'ork 253976 Address Date Elvalvabion Conducted Telephone Number E7818 County E Menomonie WI 54751 7 _Z„Yr W40 715-231-7375 Property Owner Jacob Utphall Parcel ID # B-3 Bonng #G n pit Ground surfaceelev._ � ft. 034-1026-70-000 ? 3 Page of Depth to limiting factor in. j"cn;t AnMration Rate Horizon Depth in. Dominant Color Munsel Redox Description Qu. 1z. CcCont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'Eff#2 _ Z I c 2F 4 r? J .. H 5 s ( tM s vw �L .- _ 0M � F] Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Snil Anoliration Rate Horizon Depth in. Dominant Color Munsel Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'Eff#2 (] Boring Illl Baring # � !Pit Ground surface elev.. ft. Depth to limiting factor in. Soi1�J><oolicat(on Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Efff#1 'Eff#2 Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL 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 T"r Y 608-264-8777. snu69339rest (x.o7lo) tw. tY car ;;Heck y0X As AP ICAb1 E. PAGE 2 i +EC K aOX AS APPI.K AESIc. -1qSYSTEM SOIL EVALUATION 0 30 d5 60 PLOT PLAN SITE MAP E7],,rf;��GPC DESIGN FIOW'. PROJECT NAME' �.sy Jacelb litphaU / Attach design flow cala,lat+ons for cornmerual Plans. _ �- Cob � 4 Pipe Material I ASTM Standard (Tables 3&t.:fQ a �.30-5) PROJECT ADDRESS: �- SaniWy Sewer BM SymbCA BM E:levatlon: --"T� FooeBMDA__��,�.�IMPORTANT: SCPUM:it ow4w rnrth 6y Slope GredbnR(b} We'll Symbol do applicable) Q dip,�1 •^ WOW Show ground ele+vadon contours at suitAbie intervals. on IrA appropm IrM. of Tasted Arop:tP --^--' lit 8� ju P1I- ? too Aso 'g - y CIL.. Ll L ) 1(d S" 00LOSP65K Wv- T-5,5(,kfCz(, 8105 St. Croix County, Page Cropland Total: Map Created June 09, 2022 Common Land Unit Cropland NAIP imagery 2020 Wetiand Determination Identifiers ® Restricted Use V Limited Restrictions Exempt from Conservation Compliance Provisions The producer and attached maps) forexactboundaries anddeterninationsorcontactNRCS. USDA Farm Service Agency assumes actual responsibility for her i 1 e consequential damage incurred as a result of any user's reliance on this data outside FSA Programs. USDA FSA maps are for FSA Program administration only- This map does not represent a legal survey rx reflect actual ownership; rather it depicts the information Provided directly from the producer and/or the NAI imagery. accepts the data'as is' and assumes all risks associated with its use. T he vmland identifiers do not represent the size, shape, or specific determination of the area. Refer to your original determination (CPA 0 3 - �.aw. To C ROM couNnr No. 648412 STATE SANITARY PERMIT 60A /678 QKnc Re.y n-ru ewc��., ............. pREVI USN O. OW'NEIL Rent 1 �TD4ALL '" "�"" PLUMBER SEC JZ ,T AND6�OR LOr VIS E SBD-064 ( SUBDIVISION (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. G OFFICER - DATE $PM3 RENEWED BEFORE THAT DATE POST IN PLAIN VIEW FROM THE ROAD FRONTING THE r4Q DURING � orrsTRuc�Ui /af b 069 rd 44; 1 y North is referenced to the (St. Croix County Grid System) IMPERVIOUS SURFACE AREAS WITHIN 300' OF HWM Road & Drive = 21, 900 sq. ft. House & Shed: 2922 sq. ft. Septic: 800 sq. ft. NOTE: Landowner owns entire area within 300' of HWM, proposed impervious surfaces will be minimal, at 2%, well below the 15% threshold of requiring mitigation. BM is a 3/4" Iron Rebar MSL Elevation = 1036.45 feet Vertical Datum: NAVD88 Base Flood Elevation MSL Elevation = 1019.00 feet FLOOD PLAIN Mapped Flood Lines are based on the Flood Plain Management Study of April, 1984, prepared by the United States Department of Agriculture. UTPHALL SITE PLAN LOCATED IN PART OF THE NORTHWEST QUARTER OFTHE NORTHWEST QUARTER OF SECTION 12, TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: Jacob R. Utphall 514 Hwy 12 East Knapp, WI 54749 DRAFTED BY: Joel A. Brandt JB Surveying LLC SC Oly� JOEL A * 8WDT S-2603 GLENWOOD CITY..: �'tiOYN S�lnx� Completion Date November 2022 SURVEYOR'S CERTIFICATE I, Joel A. Brandt, Professional Land Surveyor, certify that I have surveyed and mapped the shown parcel and believe this map to be a correct representation of the boundary thereof. This survey was done in compliance with Chapter A-E 7 of the Wisconsin Administrative Code"Minimum Standards for Property Surveys". nn 12//S /2Z c� Joel Brandt, P.L.S., S-2603 JB Surveying, LLC North is referenced to the (St. Croix County Grid System) IMPERVIOUS SURFACE AREAS WITHIN 300' OF HWM Road & Drive = 21, 900 sq. ft. House & Shed: 2922 sq. ft. Septic: 800 sq. ft. NOTE: Landowner owns entire area within 300' of HWM, proposed impeFvious surfac&s will be minimal, at2% well below the 15% threshold of requiring mitigation. BtNLH MAKK BM is a 3/4" Iron Rebar MSL Elevation = 1036.45 feet Vertical Datum: NAVD88 Base Flood Elevation MSL Elevation = 1019.00 feet FLOOD PLAIN Mapped Flood Lines are based on the Flood Plain Management Study of April, 1984, prepared by the United States Department of Agriculture. UTPHALL SITE PLAN LOCATED IN PART OF THE NORTHWEST QUARTER OFTHE NORTHWEST QUARTER OF SECTION 12, TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: Jacob R. Utphall 514 Hwy 12 East Knapp, WI 54749 DRAFTED BY: Joel A. Brandt JB Surveying LLC JWIL A. # * gii/WDT S-2W ritfMrY00� l�fY.; Completion Date November 2022 SURVEYOR'S CERTIFICATE I, Joel A. Brandt, Professional Land Surveyor, certify that I have surveyed and mapped the shown parcel and believe this map to be a correct representation of the boundary thereof. This survey was done in compliance with Chapter A-E 7 of the Wisconsin Administrative Cod "Minimum Standards for Property Surveys". Joel A. Brandt, P.L.S., S-2603 JB Surveying, LLC