HomeMy WebLinkAbout040-1045-30-050 (2)
Wisconsin Department of Commerce County:
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
538777 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No.
Gerlach, Erin Troy, Town of 0Vo -/U 0501
bit, it CST BM Elev: Insp. BM Elev: BM Description: 1 Section/Town/Range/Map No:
/ 0-& • o / D Z n o~2(1 10.28.19 ' -
TANK INFORMATION ELEVATION DATA 5~p
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic W Ln A n Benchmark
Dosing rG6~-~v Q I Alt. BEM lrI i d7 ~2
Aeration Bldg. Sewer
Holding St/Ht Inlet Outlef / J
TANK SETBACK INFORMATION St/ t ry, 3 7,
TANK TO P/L WELL BLDG. V nt to Air Intake ROAD Dt Inlet i
Septic / I I Z Dt Bottom
Dosing tl n~ Z Header/Man. n y~
Aeration / Dist. Pipe i 7
~d y- 3 9~
cy,
Holding Bot. System
d Q, 3
Final Grade /
PUMP/SIPHON INFORMATION 15__T /-v (TY 1,00 Vj 'k v rf ?l /d/ ~1~1
Manufacturer DeP nand St Goer v- ► ~b_ r~ Z R 3~ d
Model Number
TDH Lift Friction Loss T Head TDH Ft
Forcemain Length Dia. Di . to well
SOIL ABSORPTION SYSTEM 2 -
BEDITRENCH Widt Len h No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth
DIMENSIONS 21 1 / 0'
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHI G Manufactur
INFORMATION CHAMBER O v
Ty Of System: / ID /I--, ' UNI Model Number.
'CV 1 a
DISTRIBUTION SYSTEM
der/ ifol Distribution ~j Q ~7, I X Hole Size x Hole Spacing Ven Air In ake~
Pipe(s) O 0 '~v` a
Length f Dia lI Length Dia Spacing 1
-a- - - 1 i
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 i Bed/Trench Edges Topsoil
p g Yes No YeS [ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:12, / I Z Inspection #2: /
Location: 639 Coulee Trail Hudson, WI 54016 (SW1/4QN,W 1/4 10 T28N R19W) NA of floe Parcel No: 10.28.19.
1.) Alt BM Description 1~P 67 t7'i~Gr'l~H'~ /V n' Gn I
O r o- 2 1 +t U~
2.) Bldg sewer length = 4,
- amount of cover = )
Plan revision Required? ❑ Yes No
~7 r ^ ~ ~ (p~pSd S
Use other side for additional information.
Cert.
(R.3/97) Date Insepctor's Signatu No.
ti
• lL
-17
~ V
~v
A
1
Z `n III'
14
c4
commerce.wl.gov F-D
Safet ut dings Division
201 . Washington Ave., P.O. Box 71 2 County
IScons in Madison sr~~ r
,~~Ojjj JKt be
Department of Cbtrtmeree ~2 Sanitary Permit Number to be filled in by Co.}
Sanitary Permit Ap I1C j OFFI 53 B 77 7
In accordance with s. Comm. 83.2](a 2 RZON►NG State Transaction Number
unit is required prior to obtainin ' Wis. Adm. Code, submission
g sanitary permit. Note: App1i on to appropriate governme
submitted to the Department of Commerce. Personal information rms for state-owned POWTS 6
u r oses in accordance with the Privac Law, s. 15.04 I m You Provide may be used for secotida Pr Address ( nt than mailing address)
1. A t lication Information -'Please Print All Informal on __4 6 3'7 (~`t Property Owner's Name
, Parcel d j ~<<'
J go- -C~ ~Yt'G1 C
Property Owner's Mailing Address
> Aitl.~+ ti
Property Location
City, state
t Zip Code Phone Number Govt. Lot
'A, ~4~~'/,, Section w
II. Type of Building (check all that apply) ~r Jr
t J'~lt - r5 ~07 {circle ones
xJF 1 or 2 Family D Lot # T N; R E o
r6V
welling - Number of Bedrooms
J_ Subdivision Name
Public/Commercial - Describe Use ~JWAU k # City of ~2 5 7a O
❑ State Owned - Describe Use City
CSM Number El Village
ge of
ILS Z } ZZ -0 t7 3 Z~ (0 *.Townof yo
JILT ype of Permit: (Check on y one box on line A. Complete line B if applicable) CvJ `f~
A.
.~Ne=m ❑ Replacement Sy stem
❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. El Permit Renewal
❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued
Before Expiration ❑ Permit Transfer to New
Owner
IV. T e of POWTS System/Co m onent/Device: Check ....that apply)
-Non-Pressurized In-Ground
❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)
V. Dis ersal/Treat ent Area Information: ens Device (explain)
Design Flow (gpd) Design Soil Application Rat as[) I.M. J Q K ek
7 a equtre rspersal Area Pr sed (sf)
ej_ 7 System Elevation
VI. Tanis Info Capacity in
# of ✓nu ac ~7Z S , .S' `
Total ~°~G~:l t.'t^.v .
Gallons Manufacturer
New Tanks Gallons Units
Existing Tanks ~ o
w " V 7U n
Septic or Holding Tank l d k- sZ 5 a` U
~d (Al
ti in w 5
a
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS s wn on the attached lans.
Plumber's Name (Print)
Plumber's Signature p
4-4
J/r`d PRS Number Business Phone Number
Plumber's Address (Street, City, St Zip Code}
1D 2~7c7 c
VIII. Coun /De artment Use Only
Approved sapprov Permit Fee Date I ued
g Issuing A t Signature
iven Reason for Denial q 75. IX. Condi easons for Disa -
pprov»1)
1. Septic tank, effluent filter and r
dispersal cell must all be services! mAlr&kW ' 7 Pti~,ljGY1t 5 L°fl~/4 r n O G~Ja(ko
as per management plan provided by plumber, i. V ti M Jam
2. All sItiback requirements must,be maintained
0i: j [d 'm
Attach to complete pians for the system and submit to the County only'on
paper not] ess than 8 r/2 x I1 inches in size
SBD-6398 (R. 02/09) Valid thru 02/11 l
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Owner's Name:
Owner's Address: 33 GG~ G i j
- J.1a~Qc o i ~I , - Al /7
i
- G
Legal Description: 14K J
y
Township:
County:
Subdivision Name:
Lot Number:
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix C Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber:
- License Number:
Date:
Phone Number 7 /6_-3cFG 3 i 2 !
Signature
e
Designed pursuant to the in-Ground Soil Absorption component Manual for POWTS Version 2.0 SBO-10705-P (N.01/01).
Page 1
C 0
~ c
n
h
3
~ A
o ~
N~
r 4
3
4
Soii Absorption System Cross Section
~ft
Final Grade
4" Schedule 40
With PVC Vent Pipe
Vent Cap
Leaching 5, f t
Chamber Sy~evation
_ ft .5- ft
Soil Absorption Svstem Pi® View
ft
5. ~ Leaching Trench 7
ft
Vent Or Observation Pipe Chambers
4" Dia.
Trench 2 Header
Leachinc Chamber Suecifictions
Manufacturer And Model jr~V r T"'~'~'"~ v (~ZP'k- EISA Ratings sq ft per chamber Soil Application Rate r "7 gpd/sq ft
gpd Design Flow + ~ '7 Soil Application Rate ? EISA -Chambers
2 rows of o2 a chambers each.
i page of
loll
o
0
N
C=!
M M
d'
r Q M M
_ N
00 LO
00
1 11 11 n-
CD
O
tC)
Z
p O fn
z w
cxn X °v
cmn w CCD C) Z
--I ui
= cn
J W Z
_ C/)
x n= = o
Ljj ca
+a c
V
I 1
lh I' 1
s~
I;
.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION
Owner SYSTEM SPECIFICATIONS
Septic Tank Capacity
Permit # Jr U _gal 171 NA
Septic Tank Manufacturer ❑ NA
RESIGN PARAMETERS ~ o Effluent Filter Manufacturer,` ❑ NA
FEstimated of Bedrooms ° ❑ NA Efflu ent Filter Model Q NA
f Public Facility Units - Q NA Pump Tank Capacity a1 ❑ NA
flow {average) --r----
O al/da Pump S
Tank Manufacturer E, R ❑ NA
Design flow (peak), (Estimated x 1.5) 11
b d d ~gal/do pump Manufacturer Qr O U k 0, ❑ NA
Soil Application Rate ~ _
Standard Influent/Effluent ipuallf al/da /ftx Pump Model ❑ NA
Y Monthly average" Pretreatment Unit
Fats, Oil & Grease (FOG) if s30 rng/L ❑ NA
Biochemical Oxygen Demand (BOns) i 5220 m ❑ Sand/Gravel Filter ❑ Peat Filter
g/L O NA 0 Mechanical Aeration ❑ Wetland
_ Total Suspended Solids (TSS) !5150 mg/L ❑
Pretreated Effluent Quality h-~ - Disinfection 13 Other:
y Monthly average Dispersal Cell(s)
Binrhemical Oxygen Demand (BOps) 53Q mg/L ❑ ~A
0 irl-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <_30 mg/L Q NA 1 At-Grade Fecal Cofiform {geometric mean) 510° cfu;100m) ❑ Mound
Q Drip-Line ❑ Other:
Maximum Effluent Particle Size Ya in dia. Q NA Lthtlii
Other: ❑ NA
U NA other, _
❑ NA
*`Jalues typical for domestic wastewater and septic tank effluent. Other:
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
r7nd ition of tank (s} A ❑ month{s}
_t least once every; {Maximum 3 years} C7 NA
Year(s)
ntents of tank(s) When combined sludge and scum equals one-third Q/) of tank volume ❑ NA
eral oei}(s) At least once every: ❑ month{s} (Maximum 3 years) - ❑ NA
rd year(st filter At least once every: year{s} month(s)
❑ NA
Inspect pump, pump controls & alarm At least once every; ❑ month(s)
❑ year(s) ❑ NA
Flush laterals and pressure test At least once every; ❑ month{s}
other. _ ❑ year(s) ❑ NA
-
At Isast once every: r3 month(s)
Other: yearls) ❑ NA
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual currying one of the following licenses or certifications:
Master Plumber: Master Plumber Restricted Sewer; POWTS `inspector; POWTS Maintainer, Septage Servicing Operator., Tank
inspections must include a visual inspection of the tank(s) to identify 'any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell{s} shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third W3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <12 months, shall be perf.ormed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP
AND OPERATION
For new construction, prior to use of the P4WTS ollalt
b tr~iti , e page of
- - -
that may impede the treatment process and/or darn
pt I~!nklsl ft'i~ the presence of painting products or other chemicals
o the tank(s) removed by a septage servicing opera{rkr ifrlur t_ ~Ioip.
dip AroI saR){~). If high concentrations are detected have the contents
System start up shall not occur when $ail condition* are fi6tob at 0 lftflli~rOtive surface.
During power outages pump tanks may fill above narrnai hihurlitii livllill>!rWhen power is restored the excess wastewater will be
discharged to the dispersal cell(s) In one large doa.4 ,,8N 4gdinQ tip, q 40d may result in the backup or surface discharge of
effluent. To avoid this situation have the center
tg d h U
64. power to the effluent pump or contact a FlumbeC
PO COitFV+Id by a Septage Servicing Operator prior to resto
restore normal levels within the pump tank. M+>Ittl(nriP{► assist in manually operating the Pump controls ring
Do not drive or park vehicles over tanks and dispersal ptyt( p rots to
within 15 feet down slope of any mound or at- grade P d rlat'dfly$ r park over, or otherwise disturb or compact, the area
Reduction or elimination of the following from the Qll dp~tlori Ilptlll,
POWTS: antibiotics; baby wipes; cigarette butts
foundation i`lolilllllt+It AtKA#~gi' moor Improve the performance and prolong the life of the
drain (sump pumps water; fniir and vat 4tot1' P; degreasers; dental floss; diapers; disinfectants; fat;
painting products; pesticides; sanitary napkins; ter1~~'1r grease; herbicides; most scraps; medications; oil;
slid W, a til~iMfttine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out df servibd th* Poll(, Wing ste s
properly and safely abandoned in compliance with ohdptoif: p shall be taken to insure that the system is
! ► il
;Opnsin Administrative Code:
• All piping to tanks and pits shall be discoftridptd(:ehd~ BbNliti$Hetl~ pipe openings sealed.
• The contents of all tanks and pits shall be r^s ov `
o ,,lit! 0* e6pool.s, rli"poped of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall bepityofilld end ieffirv8d or their covers removed and the void space filled with
soil, gravel or another Inert solid material,
CONTINGENCY PLAN th
if the POWTS falls and cannot be repaired the folllbylrfn .~~!~li~iNes hrllvra b+l'an, or must be
replacement system: taken, to provide
a code compliant
❑ A suitable replacement area has been evaliti*t
system- The replacement area should be illnd may "'0 utilllt+►. absorption
for the location of a replacement soil
required setbacks from existing and ropo$
Prow datpd orh t~is~ufbkhoA and compaction and should not be infringed upon by
p edioi uo+ Ipt Af1o I{I "wells. Failure to protect the replacement area will
result in the need for a new soli and site e r lugtioti to '08, t4l~ltab
comply with the rules in effect at that time. el replacement area. Replacement systems must
.
❑ A suitable replacement area is not avail6, ld dud t s
technology a holding tank may be installed o ~1oolor soil limitations. Barring advances in POINTS
04
g y 4 loot 4. r~dlia~#'jhs failed POWTS.
pp The site as not an evaluated to identl{y
a aul#.alffo iwj lpo(q "t area. Upon failure of the POWTS a soil
evaluation be performed to locate a snit
may b tal7e polo 'r+spl~+~i~ment r and site
s a last resort to replace theelliid j if no replacement area is available a holding tank
D Mound and at-grade soil absorption systems infiltrative surface. Reconstructions of such day be riltctt*I, I " In place following removal of the biomat
at the
<WAf~ylNQ> sYsltohl8 rriuk 04 q~lV APO the rules in effect at that time.
SEPTIC, PUMP AND OTHER TREATMENT TANKS Ni A. , '
ENTER A SEPTIC, PUMP OR OTHER TREATMENT T R #SSES AND/OR INSUFFICIENT OXYGEN. 00 NOT
PERSON FROM THE INTERIOR OF A TANK MAY BII pl 1`14TANCES. DEATH MAY RESULT. RESCUE OF A
ADDITIONAL COMMENTS ild;E.
PO,WTS INSTALLER
Name TAfNER
me ,
Phone -7 ~r^
I a / ! loh~r~i ~ -
SEPTAQE SERVICING OPERATOR {PUMPER)
i I LATORY AUTHORITY
Name
Phone Ieiti o,
this dorumtynt was dratted in compliance with chapter Comm
04 go(~k!0111itll(ft~il and II 4(11, (2) & 431, Wisconsin Administrative Codes.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSN.IP CERTIRCATION FORM
omit r/lauyer Err r_\ YY~1 G0+~'~,L e fIM,h
Mailing Address ~32) (AA100-TfLK&,k. HUCL 1''r [Ai1 a! o]- Property Address _ ~ / ~_J~A
(Vcrifiaatioa requitcd from Plasroit* & Zoning Departrrreat
fiy taew cotw9truction.)
city/State,Hudsf L.,- Parcel Identification Number
L,BGAI, D LCR-M ON LO-,
Property Loeation~ NVVIA, Sec. T aN R_W, Town of _,Tro
Subdivision LIJ20, Lot #
C;etrdfled Survey Map # , Volume , Page
Warranty Deed # t , Vulume . Page #
Spec house yea Lot tunes ideurlfiable no
SYSTEM NWNUWCE AN OWNED C=F'iCATION
ITMTO.pcr use and maintenance of your septic systcrn could result in its premature failure to headle wastes. Proper
maintenance consists of pumping out the septic tank every tluee years or sooner, if needed, by a licensed pumper. What you put into
the 3y5irw can ditt the fawtion of true septic tank as a troatmcnt stage in the waste disposal systm. Chmer maintenance
re%ponsibilities are speritied in 6Cowm. 63.52(1) and in Chapter 12 - St. Croix UU11iy
'The property owner agrees to subunit to St. Cron; County Planning & Zoning Department a certification fmut, signed by the
owner and by a master plumber, joumeyman plumbet.. rew ieted plumber or a licensed pumper verifying that (1) the on-Elite
wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Vwe, the under's9 pcd have road the above requircuim s and agree to maintssn the private sewage disposal system with the
standards set fiwth, herein, as set by the Department of Commarco and the Departmment of Natural; Rescam es, State of Wisconsin.
Certification stating that your septic systen has been maintowed muRt be completed and rourned to the St. Croix County Planninnp &
Zoning Department within 30 days of the three year expiration date.
1/we certify that all statements on this Forte are ttiie to the best oftoy/our knowledge. Uwe arniare the owner(s) of dig
property described above, by virtue of a warranty decd recorded in kc&wr of Deeds office.
Number of bedrooms .
)e rn~%, j r - _ X 5_423/11
SIGNATUft OF A.PPL CANT(S) DATE
'Any infornwtion that is misrepresented may result in the sanitary pennit being revoked by the Planning & Zoning Departinem.
Include with Ws applications a reenn)P i warranty decd firm the Register of tkrA Office and a copy of the terrified survey map if
reference is trade in the warranty deed.
IREV. 08/05)
8 0Tx? 7
4016898
State Bar of Wisconsin Form 3-2003
QUIT CLAIM DEED 933755
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between ID Q t) 4 c% rV /6C -BrU fn/Il.F_ 1 03/18/2011 3:10 PM
EXEMPT#: 8
("Grantor," whether one or more), REC FEE: 30.00
and P r It rt A R71- PAGES: 1
("Grantee," whether one or more).
Grantor quit claims to Grantee the following described real estate, together with the
ro
rents, profits, fixtures and other appurtenant interests, in cat CJ'6 ► k ~t31~ l1
County, State of Wisconsin ("Property") (if more space is needed, please attach Reakding Area
addendum): Name and Return Address
L_0of c~ co, ~►~c4 m~ fern Er Cxf_r`ckrh .
vD`u~r.Q, a5 4c>s , 5~~D as -Docu~lr~ • g331~8(~ U13 C( WeQ.,~Cc~,~ l
r -tom. 5t - C-Im'y C u k by ~l sic r o-F IzQ4 S ( , . HudSb,n W 1 5y 01
o-
Parcel Identification Number (PIN)
This homestead property.
(is) (is rat)
Dated F-11
61u~ (SE (SEAL)
1
(SEAL)
In In
AUTHENTICATION ACKNOWLEDGME
Signature(s) STATE OF WISCONSIN 7' A~9 ~Ilq # Z
authenticated on .-1T ro/, CO O~yT'ss.
Personally came before me on F
* the above-named bcwce,(-6ru i!yt
TITLE: MEMBER STATE BAR OF WISCONSIN r 4
(If not, to me own to be the n(s) who executed the foregoing
authorized by Wis. StaL § 706.06) ent and aclrnowl the same,
THIS INSTRUMENT DRAFTED BY:
Notary Public, State of Wisconsin
My Commission (is permanent) (expires:/a -/5-oZU/3 )
(Sigaateres may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
' Type name below signatures.
1 of 1
~ I~{!~I{II~IIN~fEI
8021595
Tx:4015734
932786
BETH PABST
REGISTER OF
rwo-oso~w z31 zs~ DEEDS
n_ = wES7 NE OF 7r~ taw 1>4 n ST. V ROIX CO, WI
--v RECEIVED FOR R RECORD
m n Noo•ontrw16W24~ A p 02/24/201112:27 PM
m o ~ N9nro6ro6w
70!3 p m ~ EXEMPT
n X1.02'
Z .A
i ~ Z REC FEE: 30.00
o ~m I I I ° PAGES:2
LOT 2 C.S.M. VOL. 4 PG. 1183
I
I - ~ lsotoefasaa47 .
N00.147 WI326.97
299.98 N
t ~js I '
t" N
-loov5~~ I ~b
w ,
$3OO-+ = I O I - i'
5.c N, c Ogg -49
-ROV c: A - 1 m crm ~ p 5
A201n~y : ,Z,1 p I mmT ,C rya"<•.Q c
°<N~ZmzZyi i - o
M;A> nZ j ; i ; ~o yg9 0,,tiP~ r
>c+-4r rJ rok 0 1~ I c w+
1.40 Z : D Dr~ t' D 94 r
yy ~fI y a r
2
-W-
my DfZOp M JaW I I {gym j
0-01Zpo. - mpm~T MO I rZ0 D
m in 18 mmAm m mil 1~ g~ -n
791
al '0
b a ` w f cm)
lr~' tO i m N W OS
1 o o; 5Z m X4 0) ttttttttt
W -4 t N00.1243•W 128.451 Q m v. 00
~ I~ N 1 11 N~ ~1I ZZ on
X' ° mid m O Or!
CO1 Dr t % i ~3 I mm O <=~A N v
zOmZ m~v~+ Dp -i' a cv3zm c~~w
n°O Z1 NO7o~or :1 29.01 I O m~2?mr0 Z
o rtm! Zm~m=~ N-•C
Q? m -i 25 : cDi Q cDi r ~l t N00.1743•W 161.49' O O m m Ic
z 0
D -mn s ~t tmi~ ~ m 'p : DRTVEWA`1 z -6118 W
~pt B A o~V Op mOm mZy nM
W m A
O
<Z M
~qo° ~omOm O
m m
rti (Za~~
ma ®SZ`~ Z
MONUMENTED
EAST TJMEpFTME$N - ~
114 OFiHEMW.U4. i =w0 '0
30 V O S
Sao•1320•E 975.95 '01 .7V t 8000 00
r~+ - - - - S00.132(rE 329.79. 1 m c
20 1 m
W x i'& p ~ I c LOT 1 C-93& VOL. 7 PG 1803 _ 1; - - o v
W op- 0Dr I mm O mr ~
ImmQ I
O sip
,r Qom Owhm 0v •n-•-0m OO to m0 A
N~.r Z 00 .1911. glZ~ ! 80Z 1_Z . zx Cz OCz a
Oa p_ ~r O
D =O 00 NG N~ a ~ DO 20 m
n~ Z
hp ty r°$7m~~ t om 511 m- WO ~oA P0
3 m { S n 0 m
0 31 (4 ME
MIA MO M rz- as x o<lI1N 3O O
Ulz ml'll C 30
11
N m
v° Z Z SHEET 1 OF 2
0
1 df2 Vol 25 Page 5760
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SW 114 OF THE NW 114 OF SECTION 10, 728N, R19W.
TOWN OF TROY. ST. CROD(COUNTY, WISCONSIN.
SURVEYOR'S CERTIFICATE:
1, Ty R. Dodge, Registered Wisconsin Land Surveyor, hereby certify that by the direction of David Bnanmel, T have
surveyed, divided and mapped pact of the SW 114 of the NW 1 /4 of Section 10, T28M R19W> Town of Troy, St Croix
County, WisconsK described as follows:
Commencing at the West 1 /4 comer of said Section 10; thence, along the west line of the NW 114 of Section 10,
N00'0n8"W a distance o17991.02 feet; thence N89°2646"E a distance of 591.98 feet to the point of beginning thence,
along the east line of Lot 2 of Certified Survey Map Volume 4 Page 1183, N00°14'28"W a distance of 326.92 feet to the
north line of the SW 1/4 of the NW 1/4; thence, along last said north line, N89" 13116"E a distance of 729.98 feet to the
monumentod east line of the SW 114 of the NW 1/4; thence, along last said monumented east line, S00°132WE a1
distance of 329.78 fee>; thence, S89*W41 "W a distance of 729.85 feet to the point of beginning. C Wnin8
Acres. Subject to right-of-way of Coulee Trail along the northerly boundary of the above described parcel, and subject to
all easements, restrictions and covenants of record.
I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and
described; brat 1 have fully complied with the provisions of Chapter 23634 of the Wisconsin statutes and the land
subdivision ordinance of St Croix County and the Town of Troy in surveying and mapping the same.
Ty ge RLS #2484 pate Z 3 _ t 1 Co
=S 8c d Surveying ` R
2920 Enloe St
Hudson, WI 54016 - 5,104 i €
S.-Jive, Ol Ak
COUNTY TREASURER'S CERTIFICATE State of Wisconsin)
County of St. Croix)SS
ZPLAMM&ZOMM
I, L ru trie A- W&je, being the duly elected, qualified and acting treasurcertify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments
as
of ~ affecting the land included on this Certified Survey Map.
Date
County Tteastrrer
SHEET 2 OF 2
2 of 2 Vol 25 Page 5760
May 24 11 10:00a Aves Studio 17153865959 p•1
a;t= 2 k;.
u~ v u c L p r~ IA.
td t~ GJ p .N Ali r g j;~fi I& y y d~
L ~
5 0 0
r~
~ ~ F F ~ yF N N
a g- AN
o~ _ v9u k
__.~.--i .9.n .9 SS
N
♦f~ nl
W E - J91
C4-
I Qs
••I~l aft^~I - ~ t _{_.F`_i I -
III M
I ~
C i W
z I >
f ~
•f d
~ AS Z
J
EC O
O
E ~
r zi W
Ij I W
_ Z Q
I T
:.z =z II
U
j 4_-_
C r
.b~OE
T
-
a~ c _
'i s s u a N ;~i jd~4 2~
oa 1
tv cu
V C u ;
E J1,11 JA
0 0 0 °ax~" -
" m4z
Z'o A n i~ ~F 3
o ,oW o
o " s >oW ~o
a v v ~ :8
SP
w F
rJ C ~ ~ O Y
2 ` „v, O W O
I N
F I
aI ~ ~
ry ~ s i i
i 41
`
QK
I
i I
ISM y~ i i
e xW
a
at >a~; s' i xs
i
r N
S gl j
~ f
6.bt
N
t~
H
J
~ W
-
b.EF
Z
CL.
O
O
W
W
..1
W
O
J
Q
r I
9Z S~ 1
G
y
YC6
e- N
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code
County )
Attach complete site plan on paper not less than 8 % x 1 I inches in size. Plan must St. Croix
Include but not limited to: vertical and horizontal reference point (BM), directc~ A arc el LD~ i
Percent slope, scale or dimensions, north arrow, and BM referenced to neares -
Pion ' v' wed y Date
Pla Personal information you provide m be purposes 'vary Law, s. 15.04 (1) (m)) ((~f/yt/t f l
Property Owner py o
David Brummel NW -/4 s 10 T 28 N R 19 W
Property Owner's Mailing Address Lot # dioca Subd. Name or CSM# O eel re,~- t+
/V PV
633 Coulee Trail sY. cRoj,oiN~ OFFICE /1z"ll'i
City State e O City ❑ Village 0 Town Nearest Road
Hudson WI 54016 715-386-5907 Troy Coulee Trl.
0 New Construction Use: 0 Residential / Number of Bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement 0 Public or Commercial - Describe:
Parent Material Loess over Till Flood Plain elevation if applicable N/A ft.
General comments and recommendations:
lhl~ Ada- o ,da- L4/ (fly kJ~4`._
4 !1
1 Boring # Boring
0 Pit Ground Surface Elevation 99.8 ft. Depth to Limiting factor >108 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence
Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Efr#1 `Eff#2
1 0-13 10YR2/1 - SIL 2-m-gr mfr gs 2f 0.6 0.8
2 13-35 10YR2/1 - SIL 2-m-bk mfr gs if 0.6 0.8
3 35-51 7.5YR3/4 - GRSL 2-m-bk mfr gs if 0.6 1.0
4 51-56 7.5YR3/4 - GRS 0-sg ml gs if 0.7 1.6
5 56-108+ 10YR5/4 - GRS 0-sg ml - - 0.7 1.6
I
it D
Boring # 0 Boring 6
OPit Ground Surface Elevation 102.1 ft. Depth to Limiting factor >138 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRt2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
1 0-6 10YR2/1 - SIL 2-f-gr mfr gs 3f-m 0.6 0.8
2 6-34 10YR2/1 - SIL 2-m-bk mfr gs if-m 0.6 0.8
3 3448 10YR2/1 - SL 1-m-bk mfi gs 2-f 0.4 0.7
4 48-53 10YR3/3 - LS 1-m-bk mfr gs 1-f 0.7 1.6
5 53-60 7.5YR4/4 - GRS 0-sg ml gs 1-f 0.7 1.6
6 60-138+ 10YR5/4 - GRS 0-sg ml - - 0.7 1.6
t 1~
* Effluent # 1 = BODS> 30< 220 mg/L and TSS O :S 150 mg/L * Effluent #2 = BOD5 30 mg/L and TSS 5 30 mg/L
CST Name (Please Print) Si CST Number
Mark Iverson k 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 Nov. 11. 2010 715-796-5664
TOWDEMM
POR t~tEY1fAY
P#
A NiiiM 9It R:7" G32f.
Addnm of odt t WV G het TiQ•4-/L
t ,y - (jj4P Shad Ptlft FM S
Nth of Ddvowap
.p-.,M ed lamt we Commwdd Agdmdkffal
E WwW t o .
evTy dftcfvw=8d.. of &S3 ~u sc7rnaric.
qSw 114 ofttte y1+J 114 of 9scoon (OTo ! Noah, t _ West
& NMe V O W MS -257, Ph-c z- S'?(Do i.ow
(if acne t+ ed. site why)
S w P~ 60, w (3a ~ s ~ n~c - w ~ ~•c N ~ to fR a`f
t O3 OF PROPOSED VIM
(kiddespoW Id IM,. lo 1 1 1, t 10es, and ofts ass iloa"alwichols
whirls nosy be j
PmtdtFee
Tom $ Z f
Any drkwmW dMO be co d In mardmm wish d requkerama pMW an the revewe side,
amt wW o stsied tom. The enaaay std 68 fhe
la"i of~a
ofifds p sM nt tai aO uomd as a vmWwofthe io con"
wM atilt mote t+ is tsQoi mwft iitt l by kx* oi+ Io-pop
.
ire
APPUCANTS SVMTUM
APPROM BYE
!fie S'la `~f'
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code
County j
Attach complete site plan on paper not less than 8 %2 x I 1 inches in size. Plan must St. Croix . l C.
Include but not limited to: vertical and horizontal reference point (BM), direct A arcel 1.D.
Percent slope, scale or dimensions, north arrow, and BM referenced to neares 0~ -/0 yl~-30-69)
n v' wed y - Date
Personal information you provide mr7 pvary Law, s. 15.04 (1) l Q
Property Owner Property LoCaid-n",Z
David Brummel Q~Q Govt Lot NW NW v, S 10 T 28 N R 19 W
Property Owner's Mailing Address Lot # kaleff Subd. Name or CSM# o pa rj t 14,,/VtV
Nlti}
7
633 Coulee Trail ST. CEO' C-INLOOFFICJ
/
-
1w, I r. P. City State e ❑ City ❑ Village EI Town Nearest Road
Hudson WI 54016 715-386-5907 Troy Coulee Trl.
EI New Construction Use: ® Residential / Number of Bedrooms_ 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or Commercial - Describe:
Parent Material Loess over Till Flood Plain elevation if applicable N/A ft.
General comments and recommendations:
11
7Rt, AA-At Lo 17 14o
1 Boring # Boring
El Pit Ground Surface Elevation 99.8 ft. Depth to Limiting factor >108 in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#l `Eff#2
1 0-13 10YR2/1 - SIL 2-m-gr mfr gs 2f 0.6 0.8
2 13-35 10YR2/1 - SIL 2-m-bk mfr gs 1f 0.6 0.8
3 35-51 7.5YR3/4 - GRSL 2-m-bk mfr gs 1f 0.6 1.0
4 51-56 7.5YR3/4 - GRS 0-sg ml gs 1f 0.7 1.6
5 56-108+ 10YR5/4 - 1 GRS 0-sg ml - - 0.7 1.6
1
!t p
2~ F Boring # ❑ Boring ~p
EIPit Ground Surface Elevation 102.1 ft. Depth to Limiting factor >138 in.
Soil ADDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-6 10YR2/1 - SIL 2-f-gr mfr gs 3f-m 0.6 0.8
2 6-34 10YR2/1 - SIL 2-m-bk mfr gs 1f-m 0.6 0.8
3 34-48 10YR2/1 - SL 1-m-bk mfi gs 2-f 0.4 0.7
4 48-53 10YR3/3 - LS 1-m-bk mfr gs 1-f 0.7 1.6
5 53-60 7.5YR4/4 - GRS 0-sg ml gs 14 0.7 1.6
6 60-138+ 10YR5/4 - GRS 0-sg ml - - 0.7 1.6
I~
• Effluent # 1 = BOD5 > 30 < 220 mg/L and TSS 30:S 150 mg/L r Effluent #2 = BOD5 30 mg/L and TSS 30 mg/L
CST Name (Please Print) Si CST Number
Mark Iverson 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 Nov. 11. 2010 715-796-5664
Property Owner David Brummel Parcel ID# Page --2 _of 3
31 Boring # 0 Boring
F
OPit Ground Surface Elevation 102.6 ft. Depth to Limiting factor 66&> 142 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 Eff#2
1 0-40 10YR2/2 - FSL 1-co-bk mfr gs 1/3-f/co 0.2 0.6
2 40-50 10Y-R4/6 FSL 1-co-bk mfi gs 1 f 0.2 0.6
3 50-90 10YR4/4 - FS 0-sg ml gs - 0.5 1.0
3a (layers) 50-90 7.5YR4/4 - FS 0-m mf CS - 0.5 1.0
3b 66-70 10YR4/4 10YR4/6 2-m-d FS 0-m mfi CS - 0.5 1.0
4 90-142+ 10YR4/4 - S 0-sg ml - - 0.7 1.6
❑ Boring
4 Boring # Opit Ground Surface Elevation 101.5 ft. Depth to Limiting factor >132 in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil ADDlication Rate
GPDlftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10YR3/2 - SL 1-f-bk mfr gs 2 f-co 0.4 0.7
2 8-27 10YR3/2 - SL 1-co-bk mfr gs 2 f-co 0.4 0.7
3 27-34 7.5YR4/4 - GRLS 0-sg ml gs 14 0.7 1.6
4 34-44 7.5YR4/4 - GRLS 0-sg ml gs 1-f 0.7 1.6
5 44-60 10YR3/4 - GRS 0-sg ml gs - 0.7 1.6
6 60-132+ 10YR4/4 - S I11
0-sg ml - - 0.7 1.6
al
a Boring # ❑ Boring
ON Ground Surface Elevation ft. Depth to Limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent fl 1 = BODS> 30:5220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD5 5 30 mg/L and TSS 5 30 mg/L
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.