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HomeMy WebLinkAbout030-1058-05-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: JON & ELIZABETH HAMER City Village Township TOWN OF SAINT JOSEPH CST BM Elev: Insp. BM Elev: BM Description: P\f <,--- s 2 __j TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic II/ C as p�rpk�6�—S+�0.P Wl J�� / ��2 dC a� i�n5� �h� 1 OOQ 1 Dosin Ae r79fl— Holdin TANK SETBACK INFORMATION Vent to Air Intake wo VP�= �Papw_l PUMP/SIPHON INFORMATION Manufacturer Demand GPM Mod,al Number TDH Lift riction Loss System Head TDH Ft Force in I Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 648492 State Plan ID No: Parcel Tax No: 030-1058-05-000 Section/Town/Range/Map No: 23.30.19.203A-05 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer 3 D I I St/Ht Inlet 3, GO St/Ht Outlet 3 �� Dt Inlet Dt Bottom � Header/Man. Dist. Pipe Bot. System 1 z Final Grade �qo St Cover DIED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits I Inside Dia. IManufacturer- Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT �-� � Type Of S yp System- I - / Model Number: / L,D W DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake �� / .. Pipe( Length (o Dia Length Dia Spacing 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �D) S/ 2.oz 3 Inspection #2: L-Ocation: No Address Available 1.) Alt BM Description = 1 2.) Bldg sewer length = 23 - amount of cover = �$ _K 3 > Z . b ! ` S crs o-ve S� i n�c . Sb I r SA-� S o�. : / k� ,�,,a,,,,�� 64t, ) DJ34(VaLav1 /V¢,� cti-�RN.pRS od' G* - n�ao 7 VPsn Pran revision Req fired? ❑ Yes X No Use other side for additional information. 0 23 SBD-6710 (R.3/97) Date Insepctor's Signature � �sz Cert. No I \i,. %Fli N 1. RECIEVED Industry Services Division county SAN-2023-100 St- Croix 0 S 06/05/2023 1400 E WashiVon Ave Sanitary Permit Number (to be filled in by Co.) P . Box P.O7162 S Madison, W1 53707-7162 'Alp 21Eq?Z Sanitary Permit Application 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 to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) pull pi y Law, s. 15.04(l)(m), Stats. uses in accordance with the Pr'vac Y_D� jftDFJ15 Dp. I. Application Information — Please Print All Information Property Owner's Name Parcel # Jon & Elizabeth Hamer 030-1058-05-000 Property Owner's Mailing Address Property Location 438 Norway Lane Govt. Lot N W 1/4, SW 1/4, Section 23 City, State Zip Code Phone Number Somerset, W1 54025 (circle one) T30N R19Eorer�;) 11. Type of Building (check all that apply) Lot # Subdivision Name I or 2 Family Dwelling — Number of Bedrooms 2 Public/Commercial — Describe Use Block # El City of State Owned — Describe Use E] Village of Number (32 CSM Town of St. Joesph 0\9 C- Poe'; 115sqb I 111. Type of Permit: (Check only one box on line A. Complete line B if applicablo A . New System (00D 0 Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal Ll Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. lype of POWTS System/Component/Device: (Check all that apply) Pressurized In -Ground F� At -Grade El Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil Non -Pressurized In -Ground El Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) V. Dispersalff reatment Area Information: (2 3 9 � 1!2 Ftocu- wvv--k Design Flow (apd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation\/' 450 Rate(gpdsf) 643 700 101.30'; 100.30' 0.7 V1. Tank Info Capacity in r 0� i-g- Pat ([�Pz Gallons Total # of Manufacturer U New Tanks Existing Tanks Gallons Units CL. U 2 rn �n ;J. Septic or Holding Tank 1000 1000 1 Wieser Concrete [] El Dosing Chamber 0 El I El 0 1-1 V11. Responsibility Statement- 1, the undersigned, assume responsibility- for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P ?S" ature -4 P/MPPS Number Business Phone Number John Schmitt 7 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, W1 54025 V111. Count IDIepartment Use Only t4 Approved Disawrove Permit Fee Date Issued lssuinj� Agent Signature 61a 7/2 0 2, eason for n* IX. Conditions o Approva a SYSTEM OWNER: VW� J0,e_pAa4e")QJ 1. Septic tank, effluent filter and dispersal cell must be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ ordinances, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R03/14) CONVENTIONAL COMPONENT DESIGN Residential Applicatior, INDEX AND TITLE PAGE Project Name: Hamer 3 Bedroom Septic System Owners Name: John & Elizabeth Hamer Owner's Address 438 Norway Lane Somerset, W1 54025 Legal Description: NW1/4, SW1/4, S23, T30N, R19W Township St. Joseph County: St.Croix Subdivision Name: Lot Number: 2 Block Number Parcel I.D. Number 030-1058-05-000 Plan Transaction No. Page 1 index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 Management and contingency plan Page 8 Sanitary System Ownership/Address Form Page 9 Warranty Deed Page 10 CSM or Plat Attachment I Soil Evaluation Report Designer: John Schmitt Date: 6/5/2023 Licnese Number: MPRS 223760 Phone Number: 715-760-0486 Signature: In -Ground Soil Absorption Component Manual Version 2.1 May 2022 Page 1 WLP1000—MR TANK SPECIFICATIONS. DIMENSIONS: WALL 2 \/2- 4^ CAST —A —SEAL BOTTOM: Zr COVER: 5r MANHOLE: 24' I.D. PRECAST oowonETE mscn HEIGHT: LENGTH: 8r-8r NDTH, 7'-2" BELOW INLET: 42^ LIQUID LEVEL: 36' WEIGHT: 6'790 LBS INLET AND OUTLET: 4^ CAST—A_3EAL BOOT DR EQUAL GASKET wucT AND OUTLET BAFFLE AND FILTER: woSC0NSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1.085 GALLONS LDA0wo DESIGN: 8'-0~ UNSATURATED SOIL TANK CAN BE USED AG' SEPTIC / HOLDING / pUWp OR SIPHON COVER: MIX DESIGN #8 FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT VwESER CONCRETE � � ULT � � REVIEWED BY T1_ REVIEW DATE ITANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS F P T Tm 0 42LYC�qDx Inc. Innovations in Precast, Drainage Zabel' & Wastewater Products A Division of Pook Inc. PL-525 Filter PL-525 Effluent Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Feature,;;- 1/16" Filtration Slots • �#' Alarm Switch Rated for 10,000 GPD (gallons per day). I * 525 linear feet of 1/16" filtration. J01000 GPDJ (Optional) Accepts 1" PVC * Accepts 4" and 6" SCHD 40 pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tax -Lk if necessary. Accepts 4" & 6" 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. Rated for 10,000 GPD 525 Linear Ft. of 1/16- Filtration Slots I Certified to NSF/ANSI Standard 46 Gas Deflector : Automatic 7U.t.1,0, Shut -Off Ball Outdoor SmartFilterT) Alarm Extend & Lok TIM Polylok, Zabel & Best filters accept Easily installs the Smarffilter(D switch and alarm. into existing tanks, Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.956.5 Fax: 203.284.8514 www.polylok.com Page 4 0 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) Geotextile min. 12 Cover (typical) SOIL COVER sill 12 min. trench b. depth A - (typical) Highest Trench System Elevations= 101.30 100.30 ft; Septic Tank(s) Manufacturer: Wieser Concrete Septic Tank(s) Volume(s): 1000 gal I gal . I gal gal Effluent Filter Manufacturer- Polylok Effluent Filter Model#: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft; Lowest Trench (as applicable) TYPICAL TRENCH (Show location of inlet 1 outlet pipe connection on plan view.) PLAN VIEW 4110 Observation pipe shall be installed ( at junction between two units. No Scale) Perforated Lateral Observation Pipe (typical) (typical) B= 70 ft (typical) INSTALL PER TRENCH: 7 1 0-ft bundles @ 50 ff EISA/unit = 350 ft2 + 5-ft bundles r@ 25 ff EISA/unit = ft2 Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No S ca le) ft ft Screw -Type or Slip Cap (loose) 4"0 PVC Pipe Top of pipe to terminate at or above finished grade (4) 1/4"-1/2" X 6" Slots @ 90 apart 10 Anchoring Device (typical} A tA= 3.0 ft - (typical) EZ1 203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Proposed EISA per trench = 350 ft2 Required Infiltration Area= 643 ft2 x 2 trenches = Proposed Total EISA - 700 ft2 Finished Grade loll (mulched & seeded) Topsoil Cover (min. 1 foot) Infiltration .JL r N Surface Distribution Method: branched manifold El Installation Instructions forEZS nw E Zflo W ����^~ Iflo stems° by INFILTRATOR ~ ~ ^ ~ ^ ~ ~ ~ ~ ~ ^ ~ ~ ~ ^ ~ ~ ~ ^ ^ ^ ~ ~ ^ ~ ~ ~ ~ ~ ^ ~ ~ ^ ~ ^ ^ ~ ~ ~ ^ ~ ^ ~ ~ ^ ^ ^ ~ ~ ^ ^ ^ ~ ^ ^ ^ ^ ~ ~ ~ ^ ~ ~ ~ ^ ~ ~ ^ ~ ~ ~ ~ ^ ~ ~ ^ ^ ^ ^ ~ ^ ^ ^ ^ ~ ~ ~ ~ ^ ^^ Wisconsin Department of Commeros. Safety and Buildings 5. The Absorption area (SF) necessary for agiven site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is mot. the Comm 82 through 84, Wisconsin Admin. Code. and Chapters BS4obinB can be used in Wisconsin, resulting ina4O96 145ond 16O'Wisconsin Statutes. All sites must meet the Site smal|erdnainfie|d. & Soil Conditions & Locations & Isolation distances asnoted in ~ local regulations. 6. Place EZfmwbund|e(s) in the EZfmwconfiguration ap- proved by system design permit specified for the particu- The approved products on: 1203H (3-12" bundles with pipe in |ar site. The top or center -most bundles containing pipe center bundle in5'or1Q'lengths) and 12O3HP(3-12°bundles are 'joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required. � should be butted against the other aggregate -only bun - A single pipe bundle contains e four inch perforated pipe sur- d|es and do not require any type of connect\on, rounded by EPS aggregate and is held together with poly- � ehty|ene nettinB. A single aggregate bundle contains aggregate 7. The top of each BEO cylinder contains a filter fabric pre - only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The ^ fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the BEO is poeitiioned upward and is " EZUmw Bundles in contact with the fabric contained in the adjacent cyUn- � EZflmm Geotex±Ue Fabric der before backfiUinB. � EZf1ovv Internal Pipe Couplers � = Pipe for Header and Inlet 8. The EZf|mw Onainf)e|d Systems should be installed in a ° Backhoe/Excavotor level trench in all directions (both across and along the � trench bottom) and should follow the contour ofthe ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZf|mw products are given adjoining 1 0-foot cylindrical bundles placed end to end. below, This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84. Wisconsin Ad- without any dams, stepdowns or other water stops. ministnative Code. and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design g. The trench top shall be graded such that water will not manual. pond. BackfiU should be seeded or sodded immediately � after completion to reduce erosion. 1. After the local health department has determined sizing, � configuration, and layout for the EZf|ow systems, stake 10. EZf1mw EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- � other obstades, tribution box and trench bottom elevations before instal- ^ ~ 1ation of pipe bundles. 1 1.EPS aggregate is lighter than water, therefomm, it might � be expected that natural buoyancy forces would tend to 2. Remove plastic EZf|ow shipping bags prior to placing cause EZfImm assemblies to float out of ground when bundles in the trmnoh(eo). Remove any plastic bags in the ponding occurs. Field experience has shovvn, however, trench before system is covered. ~ that this is not problem when systems have a minimum � of 6" of soil cover as recommended by manufscturer. 3. This product must have gootextUm fabric that meets re- � quinomento ofs. Comm 84.30 (t) (g). Wis. Adm. Code' � installed directly on top of the product and extending ~ 1203H-GEO down along the sides ofthe product toepoint atleast six ^ inches from the bottom of product. ~ Beotexti|e VVVVVQV Barrier Material 4. When installed in atmnch, the trench should be dug to � —' awidth of3Oinches. This not only saves labor inexcemo- � 'r tion' but also provides better load -bearing capacity after bockfiUingiscomplete. � ~ _ ~ Page 6 In -ground Gravity Management Plan V_-. ; rA 1, 119 The owner of this in -ground gravity 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 Dispersal Area Operatinci Limits: Design Flow = 450 gpd; BOD5 :5 220 rngU'; TSS:5 150 mgL-1; FOG:5 30 mgL-' Ins ction Checklist INSPECT EVERY 3 YEARS c type of use c age of system o 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.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o 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 - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) * Septic and dose tank(s) 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. * Effluent filters shall be inspected every 3 years 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. System maintenance reports shall be submitted to the proper local government unit in accordance with SIPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit: Schmitt &Sons Excavating, Inc. Phone: 715-760-0486 St. Croix County Community Developement Phone: 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson ZIP: 5401 Cc, 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. Code. Conting.ency 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 in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383,33, Wisc. Admin. Code. Page 7 S1: CRoI. SANITARY SYSTEM File #: Office Use Only OWNERSHIP/ADDRESS FORM Cre,7ted 212027 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 pert -nit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Jon &Elizabeth Hamer Mailing Address 438 Norway Lane City/State/Zip Somerset) WI 54025 Phone Number (required)651-734-3180 Email Address (required) Parcel Identification Number 030-1058-05-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW /4 1 SW 114 ,Sec. 23 IP T N R30 W, Town of St- JOesph Subdivision Plat: Certified Survey Map 41155461 Warranty Deed# 1163825 Number of bedrooms 4 , Lot # Volume32 ,Page 4 7130 (before 2006)Volume — Page# Spec house E3 yes E no Lot lines identifiable 0 yes © no OFFICE USE ONLY New Property Address 7u25 (Verification of new address required from Community Development Department for new construction.) 2� 7622 (Staff Initials) (Date) 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 cddCQ)SCCWi.Q0V 1101 Carmichael Road, Hudson, W1 54016 wwwsccwi.qov Page 8 1163825 BETH PABST REGISTER OF DEEDS State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number ]i Document Name THIS DEED, made between Mary P. Brakke and Greg W. Brakke as Co -Trustees of the Michael L. Brakke Irrevocable Supplemental Needs Trust dated July 15, 2013 ("Grantor," whether one or more), and Elizabeth Hamer and Jon Hamer, husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE EXHIBIT A for Legal Description SEE EXHIBIT B for Certificate of Trust Said conveyance is being given in full and complete satisfaction of that certain Land Contract recorded November 15, 2022 as Doc. No. 1161159. Dated 5? , 6t, 'i ST. CROIX CO., WI RECEIVED FOR RECORD 02/09/2023 12:22 PM EXEMPT#: 17 REC FEE 30.00 PAGES: 3 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area RETURN To St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #13 New Richmond, WI 54017 030-1058-05-000 Parcel Identification Number (PIN) (SEAL} (SEAL) (SEX-11-,j ,,y • P. Brakke, Co -Trustee * Greg W. Brakke., Co -Trustee %161d11114 AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, fly T 0 C. �A 0 Z ACKNOWLEDGMENT �/S �.k" JC 7L - STATE OF WISCONSIN 0 C WISCO r St. Croix COUNTY 0111111111 Personally canie before me on_F_,V_ . b a c-;t3 the above -named Mary P. Brakke and Greg W. Brakke as Co -Trustees of the Michael L. Brakke Irrevocable authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT •DRAFTED BY: ���` St. Croix County Abstract & Title Co., Ine. by Samantha go Olson at the direction of the Grantor. SO / 22-S348 F1 Notary Public, State of Wisconsin My Commission (is permanent) (cxpires:.L�l U (Signatures may he authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLV IDENTIFIED. TRUSTEE'S DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 * Tvr)e name below signatures. St. Croix Countv 1163825 Paae 1 of 3 Page 9 Legal Description Exhibit A Lot 2 f Certified Survey Map filed July 1, 2022, in ' Vol. 32,.of C.S.M., pg._7130, as Doc. 11 55A61; lcated in Government Lot 7 of Section 23, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin. St. Croix County 1163825 Paae 2 of 3 L TM� Pta re�:ca t^wypn�, r L ro,7 LEFT ELEVATION BCCA-E, PS" ! I;-Cn f 1 I- f I s t I f I 1 1 I f I I # I f I .FRONT ELEVATION -r 6CAL11, V4" • 1'—C" REAR ELEVATION--- bGALEI 1, 8" • r-o" RICsHT ELEVATION 8G�4L.€. Ira" • 1'-O" DVOR.TANT NOTE: WN-RACT0I2/0UJNER TO VERIFY ALL HA'ERIALS, DIMBP alON5. 8PRr-PMCATl0Nb + APPLICABLE CAGE W111PLIANGE ON PLAN BED 0 SWINNhN6 WORK. u x � 1~� F �rt • i Q_ z Z,� u �rw a iWLS. AS NOTED I DRAWN BY. € EP 1HIA6l Ul♦1E: 0742.22 IASI MISR- 05-07.23 (H) PAGE # Al m - -- U T&N - GO T RI 'ER TO VMI" ALL a MATMALs. 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V I a 4 C-) •� 1� k W w I i i T' I I i 11�V1 I I I1 11.11L� 114' . 1-8" DRAWN BY: DEP INCIAt DAIS-- - .kl Whi`Pw�i MT dT �' �.Ai3� lil yyf yy_p{ QT/ wCTfI�' .'� M,.M.• 07.02.22 A �l11�L4' iV� u,-fM7 NDKM bi. YRP+ dG1,144 wrr, tia7Y,1w..:-�-uwRM. _' y(_} r[�f I( _ jl 1{Lr IJ�Q. 05.07.23 (e) PAGE # MA 1Nl LEVEL. PLAN ' At?.. 1,900 60. F. GQNFITIONM LIVING ARRA &GALE. 114" • V-0" A3 a #W SOIL E V'ALUATIOK RgPORT a ' Safe and Page 1 of 5 �Y In accordance with Ccmrrm 85, Wis. Adm. Cede ----- " PAID via Ascent 06/05/23 CST-2023-168 Sant Soil Testing, Inc. County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St Croix Include, but not limited to: v►arflCal and imDr reference point (SM), direction and perwnt �, scale or diJ n8i�L3ns, north arrow, and location and distance to nearest roes. Farrel LD. Pf"se print all Information. Rev By Date PtrwiW f�©n you provide may be used for purposes (Pdvacy U w, S. 15.04 0) M) ��2�1202� Property Owner Properly L mbon Hamer, Jon & Elizabeth GOA Lot NW 1 /4, SWIM, S23, TN, R30W Property Owners Mailing Address Lot # B # . Name or CSM# 438 Norway Lane 2 1 CSM 32-7130 City State Zip Code Phone Number City Village E3 Town Nearest Road Somerset W1 54025 1 651-734-3180 StJoseph L.Vilest Shore Drive New Construction Use: .' Residential 1 Number of bedrooms 4 Code derived design flaw rate 600 GPD [_] Replacement El Public or commercial - Describe: Parent material Outwash C_Pic plain avtan, if applicable _(I1ft. General comments Area is suWe for a convOlonal sysem wfth a 0.7 Vd/sqft rate. Possible system 4evadw for Area 1 Is 1013Y (h h trwO) & and recommendations: 100.30' (low trench). Slope of area is 1M 2DA)f— Y, Boring it '--� Boring Pit Ground surface elev.. Horizon Depth Dumb ffl Cokw Redox on in. Munsen Qu. Sz. Cora 1 0-8 10yr3/4 none 2 8-15 10vr4/6 rune 3 15-26 10yr5/4 none 4 26-40 10yr5/4 none 5 40--96 10yc6/4 none r 7� Z T 104.82 ft. Color Depth to limiting facior Terre Structure C:arrser Gr. Sz. Sh. sl 2mgr mvfr grts OS9 m! groos 099 rni grs Ogg nrli grs I 96+ in. Boundary RooW Soil Application Rate GPDNe *001 'EM as 2vf 0.6 1.0 gw 3vf 0.7 1..6 gw 1vf 0,7 1.6 cs ------ +0.7 1.6 mi 1 ---•- r - 1 0.7 1 1.5 Bcoring # L-J Boring Pd Ground surface elev. 104.82 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Demotion Texture Structure ""Cormistence Boundary Roots GPD1W *E�1 'EM in. Mun"ll tau. Sz. Cont. Cyr Gr. Sz. Sh. 1 0-6 1OVr3/3 none sii 2rngr rr Vfr as 2v f 0.6 0.8 2 6-15 10yr4J4 none so 2msbk mfr gw 1vf 0.6 0.8 3 15-20 10yr4/6 none si 2msbk onto cs 1vf 0.6 1.0 4 20 42 14yr5/6 nom gi OS9 MI cs --__-- 0.7 1.6 5 42-96 10yr6/4 none grs Osg mi 0.7 1.6 Z�2 - . I J " Effluent 01 = SODe 30 t 220 mg& and "ItS 21,30 = 150 mgft. CST Name (Please Print) Signature: qw2;;-;e Thomas J. Schmift Address SchmItt Soil Toetf Ve Inc. 15072nd St. Now Rlchrnond, Wi 54017 Effluent 02 a n 30 rngA. and TSS � 30 Mg/L CST Nuntow 227429 DaW EvalueWn ConducW TeIewevne Number &2e 0 3 71 7 1 g76 Property Owner Hamer Jon & Ekabeth Parcel ID 030-1058-0�0 � Boring 3 . Boring # Pd Ground surface elev. 101.47 ft. Depth to limiting factor 96+ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-8 10yr3/3 none grsl 2mgr mvfr as 2vf 2 8-17 10yr4/4 none gN 2msbk mfr gw 3vf 3 17-30 10yr6/4 none S Osg MI cs 1vf 4 30-96 10yr6/4 none grs OS9 MI ---- ---�-. F Boring Boring4 , Pit Ground surface elev. 101.72 ft. Horizon Depth Dominant Color Redox Descrfption Texture in. Munsell Qu. Sz. Cont. Color 1 0-9 10vr3/3 none sl 2 9-37 10yr4/4 none SO 3 37-43 10yr4/6 none grls 4 43-52 10yr5/6 none grs 1-5 52-96 10yr6/4 none grs Depth to limiting Structure factor Consistence 96+ in. Roots Boundary Gr. Sz. Sh. 2fsvk mvfr as 1vf 2msbk mfr gw 1vf Osg MI Cs 2vf Osg MI CS g ml Page 2 of, 5 Soil Appllccation Rate GPDfi* *Etf#1 " Etf#2 0.6 1.0 0.6 1.0 0.7 1.6 0.7 1.6 Soil Application Rate GPI. /W *E!!#1 *Elm 0.6 1.0 0.6 0.8 0.7 1.6 0.7 1.6 0.7 1.6 Ej Boring Boring # 0 Pit Ground surface elev. 103.57 ft. Depth to limiting factor 96+ In. Soil Application Rate Horizon Depth Dominant Color Redox [description Texture Structure Consistence Boundary Roots GPD/W In. Muna$il Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E#i#2 1 0-7 10yr3/4 none 2 mg r mvfr as 2vf 0.6 1.0 2 7-17 10yr4/4 none sl 2msbk rnfr gw 2vf 0.6 1.0 3 17-28 10y►r5/6 none grls Osg rnl gw 1vf 0.7 1.6 4 28-43 s 10yrS/6 none grcos +OSg nil CS -•---- 0.7 irk► 5 43-96 10yr6/4 none grs Ogg MI 0.7 1.6 3 C-) * Effluent #1 = BOD5> 30 - 220 mg/L and TSS �30 � 16o mglL. * Effluent #2 = BODs s 30 mg/L and TSS s-3o mg/L The Depament of Commerce is an equal opportunity service provider and employer. if you need assize to ums servim or need material in an alternate fdrmsa, please contact the department at 609-26&3151 or TTY 6094644777. Property Owner Hamer r Jon & Elizabeth Parcel ID # 030-105"5-WO Boring 6 Boring # Pit Ground surface elev. 102.32 ft. Depth to limiting factor 96+ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence, Boundary Roots --NOON In. Munsell- Qu. Sz. Cont. Color G r. Sz. Sh. 0-19 10yr3/3 none sl 2mgr mvfr as 2vf 2 19-46 10yr4/4 none A 2msbk ---mfr gw 1Vf 3 46-55 10yr5/4 none g ris Osg MI gw 4 55-65 10yr% none S Osg M I Cs do -ONO 5 65-96 110vfr6/4 none Cos OS9 MI Page 3 of, 5 oil Application Rate MEMEMEMMOM GPDM *Eff#1 *002 0.6 110 0.6 0.8 0.7 1 .6 0.7 1.6 0.7 1.6 t El Boring Boling # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Ra Horizon-1 Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots IPDfir in. Munsell Cu.Qu. Sz. Cont. Color I I Gr. Sz. Sh. I _ I Tfffil I *F-ff#2 Boring Boring # 1:1 Pft Ground surface elev. ft. Depth to Urriffing factor in. * Effluent 01 a BOD53 30 -s 220 mg/L and TSS >30 -j.1 50 mg/L * Effluent 02 = BOD5 < 30 mg/L and TSS S.30 m91. The Department of Comm Is an equal opportunity service provider and employer. If you need assistance to aczess, services or need material In an alternate foffnat, please contact the department at 608-266-3 151 or'ITY 608-264-8777. so E9 a. 0 CL W3urny v T4 H W W 0 W (y C G L�n.. w ,5.Wa 4 ritQ± vuW W �0 G0a LU UWJ yjU)�M0 m 7 0 da d LU V) W n a 1z u W1/4 CORNER SECTION 22 SURVEY MARKER FD °54'54"E 3948.66' ,L z� w a W � C3LJJ Chi :20 � Ccc O v W J F U C* [ W ! v ' Cw:J W W 2 Q U Cc .;/ Co J 4 SURVEYOR Nate: Lets may be subject to future assessments SCALE IN FEET 1" = ZQD' LEGEND for any upgrades or improvements to the roads. MICHAEL J. ERICKSON C:) FOUR SEASONS LAND SURVEYING, LLC 0 ST. CROIX COUNTY SECTION CORNER POSITIONED Q 200 400 848 WILLOW RIVER DRIVE FROM COUNTY COORDINATES. POSITION VERIFIED INSTRUMENT DRAFTED BY MICHAEL ERICKSON c\J 1 HUDSON, WI 54016 %g1TH MONUMENT AS NOTED THIS MAP CONTAINS AREAS THAT ARE SUBJECT TO JOB NO: 21-21 DWG: CSM2 tko � o OWNER 3/4" IRON REBAR FOUND THE SHORELAND AND FLOODPLAIN OVERLAY DRAFTED: 3/10/2022 FIELD: 3/09/2022 (D MICHAEL BRAKKE TRUST ZONING DISTRICTS; ADDITIONAL RESTRICTIONS a 738 W. SHORE DRIVE 1 5/16" O.D. IRON PIPE FOUND APPLY. CONTACT THE COMMUNITY DEVELOPMENT BEARINGS ARE REFERENCED TO THE EAST - VEST SOMERSET, WI 54025 DEPARTMENT FOR FURTHER INFORMATION. 1/4 LINE OF SECTION 22 BEARING S8905454"E. J• 1" O.D. IRON PIPE FOUND (ST. CROIX COUNTY COORDINATE SYSTEM)- t El 3/4" X 18" IRON REBAR SET WEIGHING ANY LAND BELOW THE ORDINARY HIGH WATER MARK OF A LAKE OR NAVIGABLE 1.50 LBS. PER LINEAR FOOT STREAM IS SUBJECT TO THE PUBLIC TRUST IN NAVIGABLE WATERS THAT IS ESTABLISHED UNDER ARTICLE IX, SECTION 1, OF THE STATE CONSTITUTION. PROPOSED DRIVEWAY LOCATION UNPLA TTED [ANDS ` UNPLA TTED LANDS "C) -11 50' ' 60' i E1/4 CORNER I 1N1/4 CORNER EAST - WEST 1/4 LINE OF SECTION 22 SECTION 22 SECTION 23 o , If! I 2 3 8" IRON PIPE FOUND a , n 230. •10.00' 1 r 41.4$ 04 o N so' 5V O C) tu tu CM LU w � 0 Z � I� To"- c , C3 Ul 4 To QI U. 0 100 w 1 41.24' 60' 50' 110' 389 54 54 E I I Alb (2 3/8" IRON PIPE FOUND) W89 9 83 E 1310.88 1036.83' 379.63' 319.01' 1276.87' OD TREE OCCUPIES c; LOT CORNER ' ON%`%%, ......,, . �, qk .'+ ' ■ •► f ' ; * z 2 0 0 zWft • MX>tAEL J EINCICBM • S-2592LOT 1 UJ 0 LL HUDSON = �►�! 28.91 ACRES 1,259,208 SQ. FT. INC. R/W ; a ti 25.71 ACRES Ln J �''' z 00 ..1 � �" w N u eznLUI Is 111191792 SQ. FT. EXC. R/W � w OCe o f/__ /zo/zz #- uJ Lu 0 C a c cl N89" 30'72"1N Q N89°39'17"W 1571.20' 397.12' —� .319. .Q4 tr - -- 5F - - WES T ylRE DRIVE50 555.31' Y.- 563.43' 319.[4' N89°39'11 fi 0.?4' N89°3022aiN 398.18' z LOTS �Ib�' ��'�I LOT 4 LOT 1 — _ _ LOT Zvi IW LOTS LOTS C`S. M IN VOL. 24, PG. 5717 [HOC. # 919427 BASS LAKE MEADOWS ®� � � � � -� SHEET 1 OF � SHEETSL v 91 SURVEYOR MICHAEL 3. ERICKSON FOUR SEASONS LAND SURVEYING, LLC 848 WILLOW RIVER DRIVE HUDSON, WI 54016 DINNER MICHAEL BRAKKE TRUST 738 W. SHORE DRIVE SOMERSET, WI 54025 THIS MAP CONTAINS AREAS THAT ARE SUBJECT TO THE SHORELAND AND FLOODPLAIN OVERLAY ZONING DISTRICTS; ADDITIONAL RESTRICTIONS APPLY. CONTACT THE COMMUNITY DEVELOPMENT DEPARTMENT FOR FURTHER INFORMATION. INSTRUMENT DRAFTED BY MICHAEL ERICKSON . JOB NO: 21-21 DWG: CSM3 a DRAFTED:3/10/2022 FIELD:3/09/2022 r-, UNPLA TTED LANDS 379.63' ip W 1/4 COR. SEC. 23 Cn (2 3/8" IRON PIPE TREE OCCUPIES 4 Ca FOUND} Z LOT CORNER LEGEND BEARINGS ARE REFERENCED TO THE EAST VJM - ST. CROIX COUNTY SECTION CORNER POSITIONED FROM ANGLE IRON FOUND 1/4 LINE OF SECTION 22, BEARD � "E. 0 COUNTY COORDINATES. POSITION VERIFIED WITH (ST. CROIX COUNTY COORDINATE MONUMENT AS NOTED OR TIES OF RECORD - - - REGULATORY FLOODPLAIN ELEVATION OF BASS LAKE OF 890.0' ■ 3/4" IRON REBAR FOUND LOT 1 - C. S.. M VOL. 28, PG. 6487, DOC. # 1064254 0 1 5/16" O.D. IRON PIPE FOUND N89"39'23"E 844.82' • I" O.D. IRON PIPE FOUND 39.D' 147.78' S7.51' 58.88'64.30' 85.81' 98.57' 137.88' 1148/ 1- T 1" IRON PIPE FOUND q j Cr I El X i8" IRON REBAR SET WEIGHING Q? ko S89°39'23"W 0.56' 66 WIDE ROADWAY S 53 1.50 LBS. PER LINEAR FOOT Q z CD � FROM COMPUTED EASEMENT DCIC. # 1QD8144 ��► u- M a `J PARCEL CORNER :�' �3 `t O.H.W.M. ORDINARY HIGH WATER MARK ELEVATION 886.9 ACCORDING TO ST. CROIX COUNTY COMMUNITY DEVEOPMENT DEPARTMENT PROPOSED DRIVEWAY LOCATION EAST - WEST 1/4 LINE OF SECTION 23 N89059'53"E 1316.86' 319.01' �,,, .J C3 w �' ON LOT 2 5.49 ACRES W 239,050 SQ. FT. INC. R/W LLJ w *►' / E65AESg w$ #_ �? o S89031'52'W ORDRUkRY HIM 79.39' WATER MARK N89°S9'53"E 5257 77' SILO FOUNDATION ' 'l] FLFZt,ATTrw = 8 9 GOVERMENT LOT 6 SHE❑ Lq A . jNEW GOVERMENT LOT 7 � �� � SHED0 o SHED �``'!► E1�4 SHED SEC 2.3 SHED * �+ C 0 SHED `1-0/ ° I - , '� �' N89°30'20"1IV 491.0Ei' LOT 3 � � � —�. � �%ELEVATI0�1 ass LAKE 14.8 ACRES+/- TO THE O.H.W.M. SHED 3/09/22 = 883'7 (S89a30'29'E} 644,796 SCE. FT. +/- HOUSE cn 5.00 ACRES LOT 1-C. S. M Cn � �v �r�, �� ' j a jV 1.1.E N r�cn217, ]93 SCE. FT. EJ{C. R/W VOL 23 PG. 550� ;.,-� Y1i LLL _ - DOC- #86879s � a' ,� ���' SEPTIC TANK �'�' � `���l —� LOT 1 cc } [r1 o r• f ire _d ��`�'�'�'t'�' �� (2Q4.p9'} ($1.42` (278.97'} �� 1�?.9V�� un � * �� S89c'v0`08 7(118.53' 1.1.E � in �.J (N89°4T52"W} 709'- EASEMENT LINE TABLE LU % l W .w - Ll S89°StJ`DS0W' 32.21' �. � kn W Hu ' 1 LOT1`C.S-M Sr CC L1JI � N89030'22"W w 397.12' 78.0 19.04'W F— _3 CD-� ® 9 `n 4'7. 319. C //�� "CM W N89°30'22 398.10' C= LOT 3 — -- — LOT 4 LOT 5 W sn BASS LAKE MEADOWS 289.22' 61Z ,. ► f . ; Y L. 5 F �G. 1376 L2 N5102P147E 25.3T �� ""''� • •' . �' y DOO. #389720 L3 'N5202436"E 144.811 '` r L4 N14*36 24"E 4632T L5 S8(P31'52"'VV W68' WEST SHORE DRIVE `-- --� SCALE IN FEET 1" = 200' SMALL IRAC I - -- Lars 200 400 — — — a o Note: Lots may be subject to future assessments far any upgrades or improvements to the roads. ~-1 co MEET 2 OF 3 SHEETS NOW'" I 30' 80' 95'- 2 3 32 // 46' /* me M FIMM I IT, M 102' 104' 841 106' 1 B6 B4 ■ � i FT� ,REA 2 iEA 1 Conducted for: Jon & Elizabeth Hamer ,J r38 Norway Lane Somerset, Wl 54025 PID: 030-1058-05-000 Lot 2 CSM 32-7130 NW114 SW1 /4 S23 T30N R 1 9W Town of St. Joseph Conducted by: Thomas J. Schmitt CST 227429 LOT 2 5-26-2023 4/4' SEE PAGE 5 of 5 10 1 6FOR FULL VIEW , OF PARCEL BM 1 100.00'Top of 2" PVC pipe BM 2 103.17' Top of 3/4" rebar, SW lot corner marker 0 .320' St Croix County, W1 Legend Lakes and Riv-.-rs R an't sttt'.-IMS Ccm"e yancti Divjwn 1 40' 0 20 40 60ft DISCLAIMER This maj) is not guaranteed to be accurate, coriect. curvvil. or coniplele and r-onclusions drawn to the responsibility of the I 'Alf f. LL' St Croix County, W1 Legend Lakes ii: d Rivers Rivors x)d Streams - 'Vrvql It '- ` . 'Aes US Highway-, State Highw-tys County Highways Loral Ro-ads Rustic: Ruad'i R.imp% Road Pghl (if Way Railroads MK=3= 100 200 300ft DISCLidf,'ER This neap is not guaranteed to I-e accur,t correct current, or complete i,j, J Arawn are Ott! iesponsib;W.- user. ev 4, P%, 1-t 41, W A- 15LOO'o C96) COUNTY .... . ...... . .... ...... ... . .... ... . .... . ..... .............. .. . ........ :704 Stoke DR . �: �r �.n ��� :':' AL PREVIOUS NO. OWNER .��1 � �L� PLUIVIBER,�p}�til sc'Hw•,c-rT LIC.# 2Z3�D TOWN OF 4T41 3bSEPN S 2 30 Nq J% C AND/I I" BF Do L %d CS�C3L - 3a� #x� = llsSye' SUBDIVISION AUTHORIZED ISSUING OFFICER Is M00000 SBD-06499 (RI 1/20) ENE X CHAPTER 145.135 (2) WISCONSIN STATUTES (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: 1f you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. - DATE f ZP12