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HomeMy WebLinkAbout032-1089-90-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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: City Village Township Darren & Terri Cain TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: 95's '600 A I 2 0,\ SD 11 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Zoo r r 15 —f TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ,...❑ Z Demand GPM I Model Number ' TD Lift Fr ic ' n Loss System ad TDH t F rcemain L n Dia. ist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651209 State Plan ID No: Parcel Tax No: 032-1089-90-000 Section/Town/Range/Map No: 33.31.19.430 STATION BS HI FS ELEV. Benchmark S.co 101.E Alt. BM 01 Pq Bldg. Sewer 2.5 995 St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Ti 7•i/(01 5.cif�2 q 0 Final Grade St Cover �cG �us��tik S �w't1Q. -b I o b - (o 'Inp Stint 1JD-3 ��•� BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pi .,.""" In ' Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: I INFORMATION I CHAMBER OR UNIT S-) c( i�rh�� Type Of System: I C00L.41onki 1 >50 1 � �o �,� �1 i�5l�t�le� ( Model Number: QJI,k q s DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) LenoL__�isz Lejjgth Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Ov xx Depth of xx Seeded/ d xx Mulched Bed/Trench Center Bed/ nch dges Top ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1850 45TH ST 1.) Alt BM Description = iop 6 �vA,�4-(bvi 9 walk° 6n 2.) Bldg sewer length = 36, Art- 19s, on 5�t. - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #1: Q6 Inspection #2: 15 l 155 Cert. No. °•=-��r:�,� S^nn � .�.., _w.�. MID �, inaustry �-)erviccs uivisiun Madison Yards Way '.. ¢ .Madison, W1 53705 P.O. Box 7162 Sanitary Pemik Number (to be filled in by Co.) y! � L J Madison, W 153707--71626'1207i $;4.4, 44-9-,, Term Application State Transaction Number 1n accordance with 1'5 §, 1_(4j-Aubt iission of this form to the appropriate governniental unit Project Address (if different than mailing address) nit.iWig-Adalogn is required prior to obtaining a nitary perto t;: ppl saication forms for state-owned POwTS are submitted to the Department of Safety and Professional Services. Personal information you provide niay be used for secondary r purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. ApplWat:ioh Plea' -se Print All -information 1. Iriforniation --- Property Owner's Name Parcel # p 4 t 09AFF "UQ Property Location Property O%vner's Mailing Address + q(O�5 5L�&IA41aj' Govt. trot -*4k Phone Number City, tate Zip Code!5 .- '/,, Section 5 q'�--� -'/4 5 11 237 q 13 Z• N R E or . -T e`of Buildin check all that a I . P.___-� .._ . _g .._.._ . pp..Y) , Lot # V�l or 2 Family Dwelling -- Number of Bedrooms Subdivision Nam 4 Li Block # ublic/Comntcrcial -- Describe Use b a'� ©City of eState Owned -- Describe Use of CSM Number--Elvillage �-.� Tows i of -0DAJ .4 I.H.. Type of'POWTS:Permit; {Check either "New'' or "Replaceinent" and other applicable on line A. Check one box on line B. Complete line C ii A. (UNCW Systelii Replacement System[:]other Modification to Existing System (explain) ElAdditional Pretreatment Unit (explain) B' 01-folding'l I ank In -Ground l._._.1 t-Grade Mound Individual Site Design Other Type (explain) (conventional C. Renewal Before [:]Revision a-1hange of Plumber EIrransfer to New Owner 1Jst. Previous Permit Number and Date Issued Expirations''�y IV. DiSpersid/Treatment Area and Tank Inform atlon: 2 , Design Flow (gpd) Design Soil A Iication Rate(gpd/so Dispersal Area Required (sty Dispersal Area. Proposed (so System. Elevation OD Sq 5-- Y" Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ��c4 U u�� � •1tt New Tanks Existing Tanks F].r U __ Septic or Holdiog Tank {Dosing Clamber V. Responsibili y.St ►tementw I, the undersigned, ass poiisibility foi• installation -of the POWTS-shown on the hthiched plans. Plumber's Narne (Print} Plum ignature MPIM1'1;S Number t3usiness Plionu Number 5 ys 770ou , � 69 0� q Plumber's Address (Street, City, State, Zip Code} 0 �r I - �) l.� Uft\"-" )u� q On "% 5 VX. County/Department Use Only' Approved pp Disap rov 1} Permit Fee S rJ-.--�� Date Issued Issuing Agent Signature Wile n Denial Conditions a(Appro al al 3) Al �,At&.45 J + VSTEW'OWNER: Septic tank effluent filter and dis e . � p n , p rsal cell � � must serviced maintained � a�- � 1 �-4�,, 6- �A aintained as per managen�nt plan provided -by plumber. 10 2. All setback reouire.ments must be maintained as per applicable cede! ordinances. Attnch to complete plans for the system and submit to the County only on palfcr not less thall g tlx x I I inches it, size M SLED-6398 (% 03/21) System PLOT PLAN PROJECT Darren Cain ADDRESS 9665 Summit Place. Chaska MN 55318 SW 1. / 4 NW 1. /4 S 33 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 92.5/92.1 5' Below Grade DATE 6/16/23 BEDROOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 Gallons i1II<rI' TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 893 # of chambers 44 IL BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION I00Filter Lifetime Filter. BOREHOLE WELL "H.It.P. same as benchmark Scale = 1/4 11 = 10' ' Field road access 00 1320' Property Line -2 Accessory B.M. Vents 98' Builing 6% Slope Co B-3 80' Ridge line with trees 90 LJ ' ST , 20 hh-20 B-1 30' Pro 4 700' 95' 96' Bedroom 97' House Tested area open field Vent 6 )7 of Cover OF 4' Long 12" 34 evi. Received on: Ij 09/21 /2023 1320' Property Line 2-3' X 90' Cells Width <3' Spacing 600' Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 6.6ft"2/pair of end caps LGrade at System Elevation To 45th St. System PLOT PLAN PROJECT Darren Cain ADDRESS 9665 Summit Place. Chaska MN 55318 SW 1/4 NW 1 /4 S 33 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 92.5/92.1 5' Below Grade DATE 6/16/23 BEDROOM 4 CONVENTIONAL xxx CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 893 # of chambers 44 66 BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION ioo' Filter Lifetime Filter ❑ BOREHOLE WELL * H . R , P , same as benchmark Scale 1/4" 10' � Field road access �� ^ 1320' Property Line -2 COPY B.M.* Q Vents (� 7 11 V Qll1 0e11 11I:r1tL. iZ' C 6% Slope Ridge line with trees 11I - e s i c pace g B_3 Tested area open field so' Pro 4 0 " Bedroom House 20' _ r� _ 20'_ 3 0' 1 95' 96' 97' 700' Vent >6„ Quick4 Standard Leaching Chamber of Cover with 20.0 ft2 of Area 6.6ft^2/pazr of end caps 4' Long 12" _ .._ Grade at System Elevation COPY To 45th St. 1320' Property Line •11 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 06/16/2023 Owner: Darren Cain Location SW1/4 NW1/4 S 33 T31 KR 19W 45th St. Somerset Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Contigen Pi n 7. Filter Cross Section Signature License number #226 System PLOT PLAN PROJECT Darren Cain ADDRESS 9665 Summit Place. Chaska MN 55318 SW 1/4 NW 1 /4 S 33 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 92.5/92.1 5' Below Grade DATE 6/16/23 BEDROOM 4 CONVENTIONAL xxx CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 893 # of chambers 44 BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION loo' Filter Lifetime Filter ❑ BOREHOLE WELL * H . R , P , same as benchmark Scale= 1/4" 10' Field road access 1320, Property Line _2 B M * Vents 2-3' X 90' Cells Width c3' Spacing 6% Slope law- I B-3 Tested area open field so' Ridge line with trees Pro 4 0 " Bedroom House 20M4*209 B-1 P- INN 3 0' 700 95' 96' 97' Vent 600, >6„ Quick4 Standard Leaching Chamber of Cover with 20.0 ft2 of Area 6.6ft^2/pazr of end caps 4' Long 12" _ .._ Grade at System Elevation To 45th St. 1320' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 6.6ft^2 pair of end plates Typical Installation Vent V, A91 Grade � T 4„,&�'30/34 Septic Tank To be > 1 ' above grade Finish grade elevation 97.5' ,Vent 5' 5 5' Long 4' Long CY 0 Grade at System Elevation 36 Grade at System Elevation Spacing— 5 1 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A-92.5 I B-92. 1) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # j)ESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units )�NA Estimated flow (average) gal/day I Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate qal/dayIft2 Standard Influent/Effluent Quality Monthly average* Fats,' Oil & Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BOD5) �220 mg/L Cl NA Total Suspended Solids JSS) :!9150 mg/L ,Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) S30 mg/L Total Suspended Solids (TSS) :530 mg/L 1� NA Fecal Coliform (geometric mean) sj 04 CfU/1 00MI iMaximum Effluent Particle Size in dia, 0 NA i0ther: 0 NA *Values typical for domestic wastewater and septic tank effluent. �IAINTENANCE SCHEDULE Service Event I linspect condition of tank(s) jPump out contents of tank(s) ilnspect dispersal cell(s) 1'.' .lean effluent filter Inspect pump, pump controls & alarm 1:Iush laterals and pressure test bther: i At least once every: SYSTEM SPECIFICATIONS Septic Tank Capacity 2a, 0 NA Septic Tank Manufacturer M NA Effluent Filter Manufacturer 0 NA Effluent Filter Model '14; 0 NA 'Pump Tank Capacity gal %NA Pump Tank Manufacturer �NA Pump Manufacturer NA Pump Model NA Pretreatment Unit tiNA 0 Sand/Gravel Filter 0 Peat Filter 0 Mechanical Aeration 0 Wetland 0 Disinfection 0 Other: Dispersal Cell(s) © NA 4 In -Ground (gravity) 0 In -Ground (pressurized) • At -Grade 0 Mound • Drip -Line 0 Other: Other: El NA Other: 11 NA Other- 11 NA Service Frequency 0 month(s) (Maximum 3 years) CD NA li�,vear(s) When combined sludge and scum equals one-third (X) of tank volume 0 NA At least once every: ❑0 month(s) (Maximum 3 years) Kyear(s) [I NA At least once every: 0 month(s) year(s) 0 NA At least once every: 0 month(s) 11 year(s) *NA At least once every: 0 month(s) 0 year(s) A At least once every: ❑0 month(s) 0 year(s) )( NA [I NA MAINTENANCE INSTRUCTIONS jinspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications, Master lPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of i0ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local 1,egulatory authority. Inhen the combined accumulation of sludge and scum in any tank equals one-third (�) or more of the tank volume, the entire contents of he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. NI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, 13nd any servicing at intervals of :512 months, shall be performed by a certified POVVTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page - Of -, START UP AND OPERATION use of the POVVTS Check treatment tank(s) for the presence of painting products or other chemicals th-�t c For new construction, prior to ispersal cell(s). If high concentrations are detected have the contents of th�- may impede the treatment process and/or damage the d tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. tanks may fill above normal highwater levels. When power is restored the excess wastewater will b0 During power outages pump r surface discharge of effluen1t. discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup o To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to thle effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. or ark over, or otherwise disturb or compact, the area with Do not drive or park vehicles over tanks and dispersal cells. Do not drive p 15 feet down slope of any mound or at -grade soil absorption area, and prolong the life of the POWT�1'3: Reduction or elimination of the following from the wastewater stream may improve the performance antibiotics; baby wipes; cigarette butts; condoms-, cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings, gasoline; grease; herbicides, meat scraps; medications; oil; painting produciis; pesticides; sanitary napkins; tampons-, and water softener brine. ABANDONMENT n out of service the following steps shall be taken to insure that the system is prope9y When the POWTS fails and/or is permanently take and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code- • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN inmeasures have been, or must be taken, to provide a code complic,jint If the POWTS fails and cannot be repaired the follow g replacement system: cation of a replacement soil absorption syst0m. A suitable replacement area has been evaluated and may be utilized for the location The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structurelot lines and wells. Failure to protect the replacement area will result in the need, for a new soil and site evaluation to establish a suitable relacement area. Replacement systems must comply with the ruler in effect at that time, available due to setback and/or soil limitations. Barring advances in POVVTS technologV, a A suitable replacement area is not a holding tank may be installed as a last resort to replace the failed POWTS. [3 The site has not been evaluated to identify a suitable replacement area. Upon failure ilure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area, if no replacement area is available a holding tank may be installed) as a last resort to replace the failed POVVTS. e following removal of the biornat at the infiltra'Jive El Mound and at -grade soil absorption systems may be reconstructed in place surface, Reconstructions of such systems must comply with the rules in effect at that time, <<WARNING>> NKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT SEPTIC, PUMP AND OTHER TREATMENT TA ER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER [Name 75E4U Lj Phone SEPTAGE SERVICING OPERATOR (PUMPERJ_ F 7 Name rnlv� 1 i T Phone POWTS MAINTAINER ry Name Phone I LOCAL REGULATORY AUTHORITY iN am,+e, no x AA,'fV LIP) Phone n 9 11 ki ier-nnein Administrative Code. This document was drafted in compliance with chapter SPS 8 -22(2)(b)(1)(d)&(f) and 383-54(i), ( ) k 11 A OA.5200 .0 1 Gap between Case and Serpentine SECTION A -A )00 1.1921 ST. CROI X_ NTY SANITARY SYSTEM File #:Office Use Only --� OWNERSHIP/ADDRESS FORM Created 212021 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 '' C Mailing Address , 7 City/State/Zip Phone Number (required)— q Email Address (required) Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location ,A.,L) 1/4 1/4 Sec. T N R W, Town of SOPP7 &P; Subdivision Plat: Lot # "�' . Certified Survey Map # Now~ Volume Page # Warranty Deed # —(before 2006)Volume Page # Number of bedrooms Spec house 0 yes -0 no Lot lines identifiablev'yes 0 no OFFICE USE ONLY __-=> Gas New Property Addres (Verification of new address required from Community Development Department for new construction.) 2_6 Z -3 (ta\fif 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 mop 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.cgav 1101 Carmichael Road, Hudson, WI 54016 WWW.SCC State Bar of Wisconsin Form l -2003 WARRANTY -DEED Document Number' 11 Document Name THIS DEED, made between Samuel T. Kelley and Katie Kelley,souses married to each other ("Grantor," whether one or more), and Darren L. Cain and Terri L. Cain ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee 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 attached Exhibit A 1122550 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 02/ 03/ 2021 03:37 PM EXEMPT#: REC FEE 30.00 TRANS FEE 853.50 PAGES: 2 10 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address FSA Title Services 5649 Memorial Ave. Stillwater, MN 55082 File No." 210019 032-1089-90-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Dated FebruM 3 2021 l *Samuel T. K.el le (SEAL) (SEAL} y * atie Kelley * (SEAL) * (SEAL) AUTHENTICATION S ignature(s) authenticated on _.) ' Public -Minnesota � !%Ay C011111 issioo Expires J,�n , � � TITLE: MEMBER STATE BAR OF • (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: FSA Title Services ACKNOWLEDGMENT S TA TE OFF Y ) ss. r COUNTY ) Personally came be a me on February 3, 2021 the above-n el T. Kelle and Katie Kelle , s ousel married each other to me tawn to be the p rs -who executed the foregoing instrumt w ed d the same. 5649 Memorial Ave. Stillwater, MN 55082 Notary Public, State of My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. St. Croix County 1122550 Page 1 of 2 LEGAL DESCRIPTION EXHIBIT A The Southwest one -quarter of the Northwest one -quarter (SW % of NW '/4) of Section thirty-three (33), Township thirty-one North (T31 N), Range nineteen West (R19W); TOGETHER WITH a non-exclusive Right of Way Easement for ingress and egress, sixty-six feet (66') in width from the Town Road known as Forty-fifth Street (45th St.) to the above described parcel, said Right -of -Way Easement being described as follows: 1. The Northerly thirty-three feet (33') of Lot 1 of a Certified Survey Map dated September 12, 1988 and recorded October 5, 1989 in Volume 8 of Certified Survey Maps at Page 2161, as Document Number 452141, said Certified Survey Map being located in the North one-half (N %) of the Northeast one -quarter (NE '/4) of the Southwest one --quarter (SW Y4) of Section thirty-three (33), Township thirty-one North (T31 N), Range nineteen West (R19W); 2. The Southerly thirty-three feet (33') of Lot 2 and Lot 1 of Certified Survey Map No. 106, dated February 11, 1975 and recorded April 16, 1975 in Volume 1 of Certified Survey Maps at Page 106, as Document Number 326409, said Certified Survey Map being located in the South one-half (S '/2) of the Southeast one -quarter (SE %) of the Northwest one -quarter (NW 1/4) of Section thirty-three (33), Township thirty-one North (T31 N), Range Nineteen West (R19W). TOGETHER WITH a non-exclusive Right -of -Way Easement for ingress and egress thirty-three feet (33') in width, described as follows. - The Westerly thirty-three feet (33') of Lot 1 of Certified Survey Map No. 106, dated February 11, 1975, and recorded April 16, 1975 in Volume 1 of Certified Survey Maps at Page 106, as Document No. 326409, said Certified Survey Map being located in the South one-half (S 1/2) of the Southeast one -quarter (SE %) of the Northwest one -quarter (NW %) of Section thirty-three (33), Township thirty-one North (T31 N), Range Nineteen West (R19W); and The Westerly thirty-three feet (33') of an adjoining parcel of land located in said South one-half of the Southeast one -quarter of the Northwest one -quarter (S '/2 of SE % of NW %), described as follows: Commencing at the center of said Section Thirty-three (33); thence North 89"30'00" West along the South line of the Northwest one -quarter (NW Y4), a distance of 677.35 feet; thence North 1 °22'00" West, 314.79 feet to the Point of Beginning; thence North 1 °22'00" West, 345.21 feet, more or less, to the North line of said South one-half of the Southeast one -quarter of the Northwest one -quarter (S '/z of SE % of NW Y4); thence Westerly, 650 feet, more or less, along the North line of said South one-half of the Southeast one -quarter of the Northwest one -quarter (S '/z of SE t/4 of NW %), tot he West fine of said Southeast one -quarter of the Northwest one -quarter (SE 'l of NW 1/ ); thence Southerly, 330 feet, more or less, along the Vilest line of said Southeast one -quarter of the Northwest one -quarter (SE % of NW %) to the Northwest corner of the above described Lot 1 of Certified Survey Map No. 106; thence South 88009'36" East, 648.82 feet to the Point of Beginning. All in the Register of Deeds Office for St. Croix County, Wisconsin (210019.PFD/21001 9/25) St. Croix County 1122550 Page 2 of 2 REAR ELEVATION 1 /8' - I' -a LEFT ELEVATION I/84 — I'-O' - _ = FRONT ELEVATION I/4' = 1'-O' a 9-6' POURM COW. FOUNDATION ZERO ENTRY (` Carr�s� b. am" M.rwy. r mud ry �rar orwwy lloe.� 8'-O' POURED CONC. FOUNDATION � REMAINDER of �vwt ism medmmrWm �netva 9'- 14/8' CEILING @ MAN LEVEL "'Ori,-1 1/8' C€JUNG @ 5EDK00rA N2, #3 4 BATh #2 ,w w be � or 060 w 1g .fist *A pnw tiiw amuR d boft On" Wm w 12'-1 I /8' CMUNG 0 PORTION OF GREAT FOR BIDDING ONLY NO ECONSTRUCTIONON ok RJGI1T ELEVATION 1/8' — I'-O' Ito o I i l) o cif Q �+rn yss #21-176 Tr. X" CAME eft Amr. 1 or 2. a I `{ W, E 0 a C D �rrr+ ia. ao. by d� Raes, uron rent d aM ka ee r.h Drww a Rasa . C Mcnw . d..M./ w rss tlrw hw►s w w�l on wrcwm or ate, ant A.y not Yr a.aiFs� ar r./ w aM ndesrr e nMMeel 14 rna.eKe'e. Meat d bOS UM" Rees MAIN LEVEL PLAN 114' — P-Oa 9'-1 1/8' CEILING @ MAIN LEVEL 8-1 1/8' CEILING @ BEDROOM 02. 03 * BATH i2 1 Z-1 1 /8' CEILING 0 PORTION Of GREAT FOR BIDDING ONLY NOT FOR CONSTRUCTION V11 PAW WAUS - oar urc"O s #21-176 m 5 or N a N qO K 6► c 0 C■rr*d for th as III Ss r aand by WWd b Ch *AWN% Upn �j■r�t a1 d Iras ii,a is �■■Is wsw+y 9601M, AN raisr rcuw r �r■ntd w ■■■ ttiaae rwr to Yid aM sue. C 4rh Drm" PAM" r■amwrar AN nIms. Thaw Own war 04 A too npvmW fir ■ y aAdbmW fi6vbiwo, wjy ad be a wjwd *raw" ww w wat k ■wMld ar u>c+/ w rry n/s'>rp wtlkae IMF rn■r ■ omw as■■wt of Iwfy Draw" Pow �_—T — __ `— _ -- ----------------- 1 II 1 1 k 1 11 I I I r--------- ---- �?Viranproo k IT V 1 I i tm hOPrt 1 I HIM t[lGfl 4rLL I w 1 I ! II I I I i �: i I 1 ► _. — ---J -- -- 1 mm Maw 1 I I E I 1 I----- ._------------------------- --j ---------- —� x'tw Ir 1 IMEKW I i I I I I i I I 1e 4 V i I I I i pa vwai'mU��_____J I irsoayswa— } f �� I I VI 1 i II I I 1 I i I i II 1 I I i k I I t I i 1 l� a� I k----�oCarvaut_�y �o i� I I I 1 I E I F__ ______� i`_—____� I I 1 II I 1 I 1 i II j E rit I �I I •! V iiaroo It I I 1 K!i 1'FFIr I IM"e 1rt I ar` j E I I nit 1eK L - - - - - - - — — — — — — — — — —�I I E I I E E j "Mart I 'x Irr Be _csIINYRT_VFAW Yi�rt Cl—___� I ur "mHb I f I ------------------------— — — — — — — — — — — r J V frawam I ! I I rmmmm 1 I k I I { I 1 I k trLL- sancoo i i I 1 1 I ---------___—_--_ 1�lLl4plr __— J L—_—__--- _—___ J mn ROOF PLAN 1 /4' — 1'-& FOR BIDDING ONLY NOT FOR CONSTRUCTION ' #21-176 fnl 4 qr DEC 3 0 2020 vVisoonstri Department of C4mmerce.,, Croix County S IL EVALUATION REPORT Page of Dmsion of Satety and Buildif igs Comm unil mPA4�41� rn 85, Wis. Adm. C,ocie count Y Attach complete site plan on paper not less than 8 v2 x 41 1 inches in size. Plan must include, but not limited to-, vertical and horizontal reference point (BW direction and Parcel I.D. IL M percent slope, scale or dimensions, north arrow, and location and distance tc nearest road. Please print all information. <� 1-50 Review by Date Perso"I information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) 'm)). Property Owner Property Location Govt. Lot 1/4A/LJ/4 S T LN R E( )W Lot # Name or CSKV f I Property Own&s Mailing Address Block # '� Subd. 9 64-5 r lvL) city State Zip Code Phone Number C city C3 Village ;!q-Town Nearest R0, clel- 13 i -- New Construcbw Lis Residential Nf / umber obedCode de rooms �I:Y— rived design flow rate . Z7/-J GPID 6;2� W [D Replacement Public commercial - Describe: Parent material e Flood Plain eievation if applicabie General coffrrents and reconw*ndations: System Type 1Z System Elevation � � � � Boring # Boring P0 jr-11-- Pit Ground surface eievin 11 49 ft. Depth to limiting factor . . I �nil Anr-Jir-nfinn Pqta Horizon Depth in. Dominant Color Munsell' Redox Description Chu. Sz. Cont. Color Texture Structure Gr. Sz. Sh . Consistence Boundary Roots GPD/ff *Eff#1 *Eff#2 , - 63� C� 3 614L � 4h L �� q Bming # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicabon Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDN *Eff#i *Eff#2 /(Ju V / •'�'! J00% * Effluent #1 = BOD, > 30 < 220 nxA and TSS >30 < 150 Effluent #2 = BOD. < 30 nv& and TSS < 30 nxYL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 10 * � 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, Wl 54017 r Z- 715-246-4516 Property Owner _ Parcel ID # Boring �- Pit Ground surface elev.f75ft. Depth to i nMV fa.,/JDin. Page ----- of ---�-� Sol ► xdicat Rate i W Sz- ConL Color —,M1 Gr. Sz. Sh. MW M IM# � • MASS�lJlil[�1�J/�8��! # �7 Boring [] Pit Ground surface elev. ft. Depth to lkffng factor in. SoH Aoa[ic;ation Rate 1M ' E # #I = BM, > 30 c 2M nV& and TSS >3a � 150 rng& * Eftxf t #2 = BM, :E 3a ffV& and TSS < 3Q rng& The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. r Soil Test Plot Plan Project Name Darren Cain Shau Address 9665 Summit Place Chaska Mn 55318 Lot ----- Subdivision 4U acres S W 1/4 NW 114S 33 T 31 N/R19 W Boring Well PL Property Line kBMorVRp Assume Elevation 100 ft. a128/20 #2269 Date Township Somerset County ST. CROIX Top of 3/4" pipe System Elevation TB D *H R p5ame as bencnmarK WWI"' ©U� W rsconsm Department of merce. SOX EVALUATION REPORT page of DK'Isian of Safe�, and BtAldi "11.f�LL 1 "1" is. Mm. Code (its TC I �' - !m W r "I � Adach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must W� -- indude, but not limited to, vertcai and honzontal reference point (BM), direction and slope, scale dimensions, rvvth arrow, Amej le%.-afirin and ict.-Ann in nearest road. f - (j Please print all Information. R evi e by Pwsonol infomwoon you prav4e may be u"d icx &morsdary purpoass (Pnvocy Law, 6 15 04 (1) (M)) �, 0WrW Properly Location L i Gov't.. LO( 14 T �Aj Property Chvneez Mailing Address Lot Block # Subd. NaRw or CSW �..� M`� FAMM WOMOF N R / -1 E (qk) W CAY State Zip Code Phone Nurnbw ] city 0 viltage 23-lcmr Nearest Ro 7: 0_New Cons h"W Us Residential / Number of be&oorns Code derived design flaw rate GPD Replacornent Public commordal - Describe ' Parent ffu3teri$w Flood Ptain elevation if applicable C*rwaJ conyneM wid reconvrondabons. System Type Lz- _--_�._� System Elevation r, BorrV Bo4ing V pit Ground surface ate Depth to imtng factor woos5: SVxtLire A Gr. Sz- Sh, ON M a ��l�1II�,��l0�/IF�l'�/.7[�i0� �/1�11D// M��J' FMFJ.M MA Art �1 AM M- Boring Pit Ground sLxface elev�C? fl, Depth to fimitkig factor LL in. -Scxl ADDI"bon Rate Gr. Sz. Sh. 9�I11�0��.�11�/�I�J�lC�� �71�I All �Aa�►I �t �I �.�IAE'�Ji�l17�Q:/� Efflumt 01 BOD. > 30 < 220 rrKkt and TSS >30 1150 F1W FMUe(V W;e W t5ULJ. JAJ FT V L CW XJ I VV I I W I CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 715-246-4516 1432 120th St, New Richmond, WI 54017 Z 0 V& '41"W Property Owner Parcel ID # Page Boxing # Bcwing Pit Ground surlace elev. n, to VMkV factilf in. S4Ni Arxp&ctior� R� 0.4 0 0 ���7m�JD���l� Bohr Pit Ground surface elev. R. Depth to Imbrg factor In. f SoH Application Rate Hcx1Lzw Depth in. rNwA Col� Dor Munseg Red ox Desai Ou. Sz. C(XI, Color Text txe St C. w. S z- S h. ConSiStWYe N",id&y Roots GPD/ff *Eff# 1 *EtW pit Ground surface elev. ft. DepO to W74bng faces in. Sa Prate 4ximn ')epth on. Doff*v" Color MLFM0 Redox Doscr*6)n. QU, Sz- CON. Color Textt" sire Gr. Sz Sh. corgi Bo=unAdary Roots --Q-P-Qff 9EM1 *Eff#2 - Effluerg #1 z BODO > 30 < 220 mgt. and TSS >30 < 150 mg& " Mort #2 a BOD, 130 and TSS < 30 ffVk The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBO4130 CR AOIDD) Vo Soil Test Plot Plan Project Name Darren Cain Shau Address 9665 Summit Place Chaska Mn 55318 Lot ..__. Subdivision 4U acres S W 1 /4 N W 1 /4S 33 T 31 N/R 19 W DBoring ()'Neil PL Property Line kBMorVRp Assume Elevation 100 fit, System Elevation TBD C7128/20 #226 Date Township Somerset County ST. CROIX Top of 3/4" pipe *H R pSame as Benchmark Documont Number I DoeLiment Title St. Croix County Affidavit for a Single POWTS Servicing Two Structure via Private Interceptor Main Name — (Owner) Typed or printed He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, with their deed or document of ownership interest recorded as Document Number 1 __1 •W- �--' St, Croix County Register of Deeds Office, This property is described as follows (include lot no, and subdivision/CSM or detailed legal description): OR: See attached deed copy for legal descriptions och 18993845 Tx:5175932 9 '0-"" ! 54 DUH PABST ST. CROUT, CO., WX 08/07/2023 11:36 AM REC FEln 30.00 IAGFS: 2 Recording,4r'ea Name and Ret r11 Address arcel Identification Nuanher (PIN) As owner of the above described property, I acknowledge that a Private On -site wastewater Treatment System (POWTS) serving the primary residence is sized for I bedroom(s) with a design wastewater flow of gallons/day (DwF is based on 150 gpd /bedroom @ 2 persons per bedroom). A maximum of occupants are permitted; if the number of occupants exceeds the tnaximutn for POWTS design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure. An accessory structure NOT to be used as a 211 dwelling has been connected to the POWTS via Private Interceptor Main Sewer (PIMS) in compliance with SPS 3 82, 30(12), I understand that disclosure of this information will be made to any parties interested in purchasing this property in the future, Dated this 30 �L day of TU^--C, ,.W40200 ;XUTJLENTIC4TI0N Signature(s) authenticated this _ �—day of_ TITLE., MEMBER STATE EAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats,) THIS INSTRUMENT WAS DRAFTED BY: St. Croix County Community Developtnetnt ACKNOWLEDGMENT STATE OF WISCONSIN ) )Ss. St, Croix County. } Personally canic before me this J? day of `�•• ' , the above named w t-o nac known to be the persan(s} »rha ex�Q t l 6)9� instrument and acknowledge the same. �fr l do NPublic, State-ofWisconsin (Signatures may be authenticated or acknowledged. Both are not Kly Commission is permanent. if not, state expiration date: necessary.) Date: em ;�EP2 e LEGAL DESCRIPTION EXHIBIT A The Southwest one -'quarter of the Northwest one -quarter (SW /4 of NW 114) of Section thirty-three (33), Township thirty-one North (T31 N), Range nineteen Vilest (R19W); TOGETHER WITH a non-exclusive Right of Way Easement for ingress and egress, sixty-six feet (66') in width from the Town Road known as Forty-fifth Street (45th St,) to the above described parcel, said Right -of -Way Easement being described as follows: 1, The Northerly thirty-three feet (33) of Lot 1 of a Certified Survey Map dated September 12, 1988 and recorded October 5, 1989 in Volume 8 of Certified Survey Maps at Page 2161, as Document Number 452141, said Certified Survey Map being located in the North one-half (N 1/z) of the Northeast one -quarter (NE '/.,) of the Southwest one quarter (SW '/4) of Section thirty-three (33), Township thirty-one North J31 N), Range nineteen Vilest (R19W); 2. The Southerly thirty-three feet (33') of Lot 2 and Lot 1 of Certified Survey Map No. 106, dated February 11, 1975 and recorded April 16, 1975 in Volume 1 of Certified Survey Maps at Page 106, as Document Number 326409, said Certified Survey Map being located in the South one-half (S 1/2) of the Southeast one -quarter (SE Y4) of the Northwest one -quarter (NW 11) of Section thirty-three (33), Township thirty-one North (T31 N), Range Nineteen West (R19W), TOGETHER WITH a nonexclusive Right--of-Way Easement for ingress and egress thirty-three feet (33') in width, described as follows. The Westerly thirty-three feet (33') of Lot 1 of Certified Survey Map No. .106, dated February 11, 1975, and recorded April 16, 1975 in Volume 1 of Certified Survey Maps at Page 106, as Document No, 326409, said Certified Survey Map being located in the South one-half (S 1/2) of the Southeast one -quarter (SE X) of the Northwest one -quarter (NW %) of Section thirty-three (33), Township thirty-one North J31 N), Range Nineteen West (R'19W); and The Westerly thirty-three feet (33') of an adjoining parcel of land located in said South one --half of the Southeast one -quarter of the Northwest one -quarter (S 1/ of SE 1/4 of NW 1/), described as follows, Commencing at the center of said Section Thirty --three (33); thence North 89030'00" West along the South line of the Northwest one -quarter (NW 1/4), a distance of 677.35 feet; thence North 1 °22`00" West, 314.79 feet to the Point of Beginning; thence North 1 °22'00" West, 345,21 feet, more or less, to the North line of said South one-half of the Southeast one -quarter of the Northwest one -quarter (S 1/2 of SE 1/4 of NW 1/4); thence Westerly, 650 feet, more or less, along the North line of said South one-half of the Southeast one -quarter of the Northwest one -quarter (S 1/2 of SE 1/4 of NW 1/4), tot he West line of said Southeast one -quarter of the Northwest one -quarter (SE 1/4 of NW 1/ );_ thence Southerly, 330 feet, more or less, along the West line of said Southeast one -quarter of the Northwest one -quarter (SE 1/4 of NW 1/4) to the Northwest corner of the above described Lot 1 of Certified Survey Map No. 106; thence South 88°09'36" East, 648.82 feet to the Point of Beginning, All in the Register of deeds Office for St. Croix County, Wisconsin, (21 ca1 9,PFDl21 0019125) St. Croix County 1122550 Page 2 of 2 7A 01 40 10 ( - C DIX couN-nr No*: 5120 7 STATE SAN ARN PERMIT F PREVIOUS NO. OWNER bA4ZE6N 1,0 �F-t 0,41AJ PLUMBER!5OPrUA) Birzn TOWN OF LIC.# SEC3,3.,T 31 Nq R )cl t& AND/OR LOT -- BLOCK _ Lto acxcrs SUBDIVISION ;?� 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: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. yu�, �,�DU9xti AUTHO ED ISSUING OFFICER - DATE S PERMIT EXPIRES ��Y 202 � UNLESS RENEWED BEFORE THAT DATE II so OST IN PLAIN__ VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD--06499 (RI1/20)