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HomeMy WebLinkAbout038-1089-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No'. INSPECTION REPORT 538804 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: Elliot, Michelle & Davis, Carolyn I Star Prairie, Town of 038 - 1089 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No 21.31.18.363J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded x Mulched BedfTrench Center Bed/Trench Edges Topsoil Yes E No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2: Location: 2074 Cook Drive Somerset, WI 54025 (SW 1/4 NW 1/4 21 T31 R1 8W) metes & bounds Lot Parcel No: 21.31.18.363J 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Fz Yes ❑ No Use other side for additional information. — -- Date Insepctor's Signature . No. SBD -6710 (R.3/97) RECEIVED JUL 2 0 2011 commer e.wi§ ftR01X C UNTY afety and Buildings ion '� 1 PIANRI & ZONI G OFO�E Washington Ave., P.O. B Q �rw Madison, WI 53707 �-7162 Sanitary Permit Number (to be filled in by Co.) of Commerce State Transaction N mbar Sanitary Permit Application_ In accordance with s. Comm. 83.21(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 Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary � � / f /� n � purposes in accordance with the Privacy Law, s. 15.04 1)(m Z� ), Stats. / �t A +G�J •/ k. J v� L Application formation - Please Print All Information Parcel # Property Owner's Name (-' bill "' 1� �;� N 0 ` � CS��' v 1 0 '�.)rJr Property Owner's Mailing Address Property Location i }` ,, II Govt. Lot � �+ J ,L, V Section City, State Zip Code Phone Number /,, /, 7� \ t circle one) IywYLSAI 1) t! T _ N; RAnEorW i1. Type of Building (check all that apply) d Lot # �� Subdivision Name 1 1 or 2 Family Dwelling - Number of Bedrooms _ �,L•.� Block # ❑ Public /Commercial - Describe Use [ /_ -- ❑ City of p CSM Number ❑ Village of ❑ State Owned - Describe Use �j �p,R,l �� Town of S'�Ar� i t 2 A "t+ cem 1, 0 �- �� 4 III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. [ New System < Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Transfe r to New List Previous Permit Number and Date Issued Befoe Expiration IV. Type of POWTS S stem/Component/Device- Check all that a )l S Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Ll Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/T'rea ent Area Information: Design Plow (gpd) Design Soil . pplication R e(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (s System Elevaflon 0 y - 3'1 S 0 (; ..� L Vl. Tank Info Capacity in Total # of Manufacturer I Gallons Gallons Units m U •2 New Tanks Existing Tanks , I ` / 67 W /O d aK Septic or Holding Tank _ � �,� " Dosing Chamber V1 Res Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P er's jSia ni re MP /MFRS Number Business Phone Number � � ��g c►y �1��_3t��. Plumber's Address (Street, City, State, Zip Code) L� 7 � N W • � S � NUS V111. unt /De artment Use Onl _ Permit Fee Date I sued issuing t Signature Approved rven Reason for vial ��' � � 7-1111 IX. Condttitt�>�,easons for Disapproval 1. '.3eptic tank, effluent° filter and 3) k>, 6 L I a. 5 Ga dispersal cell must all be services/ maintained as per management plan provided by plumber. 2, AN'soOAck requirements must be maintained tao 1 to comp e e p ans or ie system and submit to the County only on paper not less than 3 1/2 x t t inches in size SBD -6398 (R. 01/07) Valid thru 01/09 0000 M A4me n�; . }���'� .r� �� � t �� � ; m Oo aaamees ar O o oca n 04 CUN hA P 11 Do K owpk-, pj V D n 0 0 1) 6 Fol r'j c I m E DI, CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PACE y Project Name: � C � I () � Q IZ (' ►kA Ai I- AP Owner's Name: Owner's Address: :�l�� �( `[ >Il a V4 Legal Description: Township: 5� F n 1 SCI I I'Z 1 County: 5 c izu ► x 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 I Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenanc Form Page 3 Warranty Deed Page 9 CSM or Plat --�-� Attachments: Soil Test & House Plans Q Desig � Yb1 jt�, _License ner /Plumber: .J 1>� .► Number: v� f Date: Phone Number Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 1070'5 =P (N.01 /01). Page 1 I d Q A4me M*�,-")� . r) v, U �� t T"m ! umeesier �cc,ali o � �N S Cony, O f e k � T� A t ' r c4 cry �hAtp r1��►e � _ � � 9 $ . I � S cwxNvz- of over hapd dons )ev I bo,0 • a i o � bM�n l 1U zo r �5�� Da Page I of 2 PL Effluent Filter Effluent Filters .. Polylok Inc, -765-9566 F poWok.com P tylok Inc. 3 Fairfield Blvd, Wallingford. CT 06492 Call Toll Free: M ..... . .... ...................... . ...... . ..... .......... ........... .......... ......... .................. . . :!;Jj:� ..................... .......................... you a H_ e Product Details ra more Here. NEFFLUEN T FILTER Raising the bar in filter technola .. ...... ... PL-625 Effluent Filter Description Effluent Filters �Exte L.kl- nd Polylok, Inc Is pleased to add its new co mmercial filter to its existing line of quality effivent filters. The PL-525 is rated for over 10,000 GPD (Gallons per Day) making it one of the i & Kiser covers a It has 525 linear feet of 1/16 filtration 0 Rl . s . erg l arges t commercial filters in its d automatic shut off bell inst slats. Like alled with ev every Poly(ok PL-122, the new Polylok PL-625 has an au Distribution Boxes alr` filter, When the fi lter Iter is removed for cleaning, the ball w ill float up and temporarily shut off leave the tank, Accessories the system so the effluent won No other filter on the market can make that pumps, Basins, Pump i and Step SYMOMS .... ... ........ Ordering rmation Request a Quote Related Products Miss Seals / Gas Baffles, Sanitary Tam Deflectors * Rated for 0,0()0 GPID (Gallons Per Day) Reber Spacers & 525 linear feet o 1/16" filtration • Accepts 4" and 6" SCHD, 40 pipe Handles sand Receiver, Enlarge for details * Built in Gas Deflp(,tor • ,Automatic shut -off ball when filter is removed j Signs • Alarm accessibility * Accepts PVC extension handle I Landscape I Drainage The PL-525 Effluent Filter should operate efficiently for several years under normal I Forms & Clamps i conditions before requiring cleaning. It is recommended that the filter be cleaned every — i I Butyl Sealants t •.... . . . ........ _._M.-- ...... -- time the tank is pumped or aaecer v ery three yea) - if the installed filter contains an optional alarm, the owner wilbe ni n lam the filer.eelds Servicing. Servicing should be done by tified septic tank pumper or insUaller. Concrete Accessories -or' Acic "'J"" — �suro Filte Pre ssu re Filters Maintenance Instructions: Odor Crontrol Product 1. Locate the outlet of the septic tank. j Rebar-Lek and CMU . 2, 'Remove tank cover and pump tank it necessary. Accessories 3, Do not use piumhing when filter is removed 4. Pull PL-525 out of the housing. S. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, Reber Safety and 10 C 6. insert the filt&r cartridge bacK into the housing making sure the filter is properly ecorative Landsca aligned a c inserted. Dpe 7. Replace septic cover. PL-525 Installation; Ideal for residential and commercial Techn SpeciftatiOl waste fl u p to 10,000 Gallons Per Day (GPD)L I i0al installation Instructions: Related ProdtXt i Pump, Filter and Sun 1. Locate the outlet of the septic tank. 24" x '1 2" Riser Filter Alarm Panel an 2. Remove tank cover and pump tank if necessary, under SMartFjjtprTM Control n 3. Glue the filter housing to the 4" or 8" outlet pipe. If the filter is at centered ur the access opening us e a Polylok ExtenO & LokTm Or piece of pipe to center filter. ..... . .... 4. insert the FL-525 filter Into its housing. . 99H 6 00Z I Soil Absorption Svstern Cross Section 4_____ 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap e ft Leaching Chamber System ElE3vation ft Soil Absorption System Plan View ft ' ft ! lJ - 1 ft Leaching Trench 1 Chambers 4" Dia. Vent Or Observatian Pipe Trench 2 Header Trench I t.eachinq Chamber Specf'icati ©ns Manufacturer And Model EISA Rating sq ft per chamber Soil Application Rate S 9Pd /sq ft gpd Design Flow J ----� . Soil Application Rate 1 0 EISA, _� �_ L - � rows of chambers hambers each. Page of ST. CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Property Address AQ 74 k 11 ki U4 6 irAt_ AXA IXX (Venficatton required from Planning & Zoning Department for new constructi City /State Parcel Identification Number LEGAL DESCRIPTION Property Location �/< , '/4 , Sec, a h T 3LN R_18 W, Town of Subdivision Plat: , Lot # Certified Survey Map # _4* &S caVol u me , Page # Warranty Deed # _ gf ®Cy In (� T = ` (before 2007)Volume , Page # Spec house 0 yesXno Lot lines identifiable>SQyes 0 no SYSTEM MAINTENANCE AND OWNER CEERTHTCATION // Improper use and maintenance of your septic systoin could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms _A nA(46�_ SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application 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. (REV. 09/07) Nov -11 -2010 10:45 AM St. Croix County Plan /Zoning 715- 386 -4686 2/2 of START UP AND OPERATION Page — For new construction, prior to use of the POWTS check treatment tank(s) for the presence of pointing products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s), If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiitrative surface. During power outages pump tanks may fill above normal highwater Isvels. When power is restated the excess wastewater will be discharged to the dispersal call(s) in one largo dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the 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. De not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS; antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; all; painting products; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the POWTS falls and /or is permanently taken out of service the following steps shall tie taken to insure that the system is properly and safely abandoned In compliance with chapter Gomm 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 Servioing 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 If the POWTS falls and cannot be repaired the following measuras have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot 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 replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area Is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a call and alto 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 POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time, C C WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ONTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAIN9R Name t V Name Phone ` Phone t — _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name p n , Name S1 C. Phone �� �) .� Phone This document was drafted in camplience with chapter Comm e3,22(2)(b)(1)(d) &(f) and 83,54(1), (2) & (8), Wisconsin Administrative Code, Nov -11 -2010 10:45 AM St. Croix County Plan /Zoning 715. 386 -4686 1/2 POWTS OWNER'$ MANUAL & MANAGIEMENT PLAN Page _, of w FILE INFORMATION SYSTEM SPECIFICATIONS Owner NA M 7 1 �l � I, � � ��,t � (1 p Septic Tank Capacity (�(� al Ci Permit # Ise Septic Tank Manufacturer I � " DNA DESidN PARAMETERS Effluent Filter Manufacturer �,, ❑ NA Number of Bedrooms 1 ❑ NA Effluent Filter Model �, ANA Number of Publfo Facility units 1 0�NA Pump Tank Capacity al — 151.,NA Estimated flow (average) 1; a ! al /da Pump Tank Manufacturer 14 NA Design flow speak), (Estimated x 1,5) , (� al /d4 Pump Manufacturer NA Soll Application Rate al/day /ftl Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit RNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Send /Gravel Filter CI Peat Filter Biochemical Oxygen Demand (ROD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration tD Wetland Total Suspended Solids (TSS) S7 60 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOO.) 530 mg& Ciln -Ground (gravity) C1 In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100ml ❑ Drip -Line 13 Other: Maximum Effluent Particle Size y in dla, Q NA Other: ❑ NA Other. 13 NA Other: Cl NA * Values typloal for domestic wastewater and septlo tank effluent. Other: ❑ NA MAINTENANCE 5OHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: D1 A month(1) (Maximum 3 years) 171 NA -I� aerial Pump out contents of tanks) When combined sludge and scum equals one -third (i/) of tank volume ❑ NA Inspect dispersal calls) At least once every: m (Maximum 3 years) DNA Z earls) Clean effluent filter At least once every: a �❑ mont W ❑ NA Inspect pump, pump controls & alarm At least onus every! d month(s) NA D year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ Other., earls At least once every: ❑ month(s) ❑ earls) NA Other: NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following lioensee or certifications: Master Plumber; Master Plumber Restricted Sawer; POWTS Inspector; POWTS Maintalner; 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 oell(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 %) or more of the tank volume, the entire contents of the tank shall be removed by a Septege Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Adminlstrativa 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 s12 months, shall be performed 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, QMW (4/01) STATE BAR OF WISCONSIN FORM 1- 2000 BETH PABST WARRANTY DIED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between William E. Gramenz and Sandra K. Gramenz, 01/22/2010 08 :OOAN Husband and Wife Grantor, and Michelle K. Elliottland Carolyn J. Davis, as WARRANTY DEED Joint Tenants, Grantee. EIIWT e Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 13.00 described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 111.00 `Property"): PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Rd New Brighton MN 55112 33E1C82 Together with all appurtenant rights, title and interests. 038- 1089 -20 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encuanbrances except Dated this 18th day of January, 2010. * William E. Gramenz * Sandra K. Gramenz * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 18th day of January, 2010 Personally came before me this 18th day of January, 2010 the above named William E. Gramenz and Sandra K. Grarnenz , * — Husband and Wife to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and ac edged the same. (If not authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Minnesota My commission is permanent. (If not, state expir�tiogt Ab10 ) Larry Mountain, Attorney 1900 Silver Lake Rd #200 New LTANY A M. GARDNER (3l1 Brighton, MN 55112 Publlc- Mlnrer (Signatures may be authenticated or acknowledged. Both are not necessary.) ntilftlw FJ ref 3m'1, 2DII *Names of persons signing in any capacity must be typed or printed below the:'r signature v"W 1 of 2 WARRANTY DEED STA7E BAR OF WISCONSIN FORM No. 1-2000 the North line of said SW ' /4 of the NW '/4 to a placed I" steel pipe; thence S 0°58'05" E parallel with said West line 287.00' to a placed 1" steel pipe; thence S 89 32" W 217.80' to the Point of Beginning; containing 62,508.6 sq. ft. (or 1.44 acres), more or less. N 88 0 54'.39" E 2673.95' 3 n � NW Corner (S 8929'53" E 2673.93') N ' /4 Corner Section 21 Section 21 SCALE 1" = 60' ° T3 IN, RI 8W Certified Survey Map .� "�■i 'S� I Volume 4, Page _1 ►oo 74' -10 3a a z '� (S 89'17'52" E) and_ (NN89 20'40" W 331.92') .. LEGEND - - - - N 89P03'32" E 217.80' 66.00' i + County Survey Nail North ling: of the SW '/4 of the NW ' /4 found Gw 1 • 3 /4 " Steel Bar Found I • 1" I.D. Steel Pipe I POLE SHED Q{ � found H z � p 1" I.D. Steel Pipe °� o POWER POLE -. ® ° o O V,� weighing > 1.13 �, M o O f lbs. per foot, set ° 00 r WELL HouSE cw 0 ' N ' A I 1 (123) Previously recorded data i ono Cn O n oo tnj 4.4 U � ^ 1 .-r .-. z i fi t a t l � r�ar, ., , ,�.� O, "U O t` 1 � o g �-- Point of Beginning W z z S 89"03'32" W 217.80' 'a 66.00' 1 Z 3 Parcel in Volume 909,�Page 552, 1 �o o ► Document number 47.1744_ O O Q o t" 0 W '/4 Corder U U T ° Section 21 O pq o Q U z T3 IN, RI 8W j 1, James E. Rusch, Registered Wisconsin Surveyor S -1376, hereby certify that I have surveyed, monumented and mapped the property shown hereon in furl compliance with A -E 7 of the Wisconsin Administrative Code, and also in full compliance with the St. Cron County Subdivision Regulations; that such survey, description and map are an accurate representation, to scale, of the boundaries of the described parcel; and that I have shown all above- ground improvements as of the day of the survey, to the best of my professional knowledge, understanding, and belief. NOTE: This is an existing parcel and as such is exempt from the St. Croix County Subdivision Regulations. No new parcels are being created herewith. A Wisconsin Department of Commerce SOIL EVAWTION REPORT 2210 ,�j Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, WiS ode A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County include, but not limited to: vertical and ho ference point (BM), direction and '` St. Croix percent slope, scale or dimemsions, nort arrow d distance to nearest ro ad ` Parcel I.D. I, 038- 1089 -20 -000/ 3(,3j Please prin 11 informada�� Personal information you provide may be ed for seconds u® Re ' we B Dat ry P rposes (Privacy law, s. 1 .O4 (1) (m)). _ � l Q Property Owner 4 �O'O roperty Location Michelle Elliott &Carolyn Davis t. Govt. Lot SW 19 NW 1/4 S 21 T 31 N R 18 W Property Owner's Mailing Address "idr '^ Lu r "N y Lot # Block # Subd. Name or CSM# 623 Olive Street West a. /C �I � /Z Crty State Zip Code Phone Number J City Village _VPI Town Nearest Road Stillwater I MN 1 55082 651 351 - 0238 Star Prairie 2074 Cook Drive f/' New Construction Use: Sol Residential / Number of bedrooms 1 Code derived design flow rate 150 GPD _I Replacement I Public or commercial - Describe: Parent material Glacial Outwash General comments Flood plain elevation, if applicable Na _ and recommendations: Site suitable for conventional POWTS dispersal cell ith 0.4 gpd /sq.ft. /day loading rate. Proposed trench elevations to be 92.50'. l-vrk-ed lAAX2 - /V [ten _Sa�►.� -- Boring # J Boring in.G9L. f/ Pit Ground Surface elev. 96.09 ft. Depth to limiting factor >121 in. a Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 I - Eff#2 1 0 -9 10yr3/2 none I 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 9 -17 1Oyr4/4 none gr sl 2fsbk mvfr cw 2f,1mc 0.6 1.0 3 17 -27 7.5yr4/6 none Ifs Osg ml cw 1fm 0.5 1.0 4 27 -72 7.5yr4/6 none Ifs /fs /s Osg ml aw 1fm 0.4 0.6 5 72 -78 10yr4/6 none Ivfs Osg ml cw 2fm 0.4 0.6 p/V ,,, 78 -121 10yr6/4 none s Osg ml - - 0.7 1.6 (f v Horizon #4 contains many stratified lay rs of 10yr4/4 Ifs, 10yr4/4 fs & 10yr4/6 s too numerous to differentiate. Loading rate reduced to refelct reduced permeability of horizon due to textural changes. Boring # I Boring 601 Pit Ground Surface elev. 94.77 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/2 none I 2fgr mvfr cs 2fm,1c 0.6 0.8 2 9 -18 1 Oyr4 /4 none gr sl 2fsbk mvfr cw 2fmc 0.6 1.0 3 18 -31 7.5yr4/4 none Icos Osg ml cw 2fm 0.5 1.0 4 31-41 7.5yr4/6 none Is Osg ml aw 1vf,f 0.7 1.6 5 41 -70 7.5yr4/6 none Ifs /fs /Is Osg ml cw lfm 0.4 0.6 6 70 -115 1Qyr4 /6 none s Osg dl - - 0.7 1.6 Horizon #5 contains stratified layers of 7 6 Ifs, 10yr4 /4 fs & 7.5yr4/6 Is too numerous to differentiate. Loading rate reduced to refelct reduced permeability of horizon due to textural changes. Effluent #1 = BOD 30 < 220 m /L and TSS 0 < 150 mg /L ' Effluent #2 = BOD <30 mg /L and TSS < 30 mg /L CST Name (Please Print) S' nature: ber Num James K. Thompson �x = CS CST Address A.C.E. Soil & Site Evaluat' Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/4/2010 715- 248 -7767 Property Owner Michelle Elliott & Carolyn Davis Parcel ID # 038 - 1089 -20 -000 Page 2 of 3 3 ] F Boring # =� Boring 16 Pit Ground Surface elev. 96.52 ft. Depth to limiting factor >119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/2 none I 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 6 -15 10yr3/4 none gr sl 2fsbk mvfr cw 2fmc 0.6 1.0 3 15 -26 7.5yr4/4 none Icos Osg ml cw 2fm 0.5 1.0 4 26-47 7.5yr4/6 none Is Osg ml aw 1vf,f 0.7 1.6 5 47 -76 10yr4/6 none s Osg ml cw 1fm 0.5 1.0 6 76 -119 10yr4/6 none s Osg dl - - 0.7 1.6 Horizon #5 contains 1/2" - 2" bands of 10ry4/4 Ifs at 3" - 1- intervals. Loading rate reduced to refelct reduce permeability of horizon due to textural changes. --- F -1 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor 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 F -1 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor 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 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg/L and TSS <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. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations s (/ a � Cons/ / i cal a70 r_.� / =vo /CPI- 2 �/O Saut1� co•S�C�+'n� /7 /,G/t / %� / /ioft4C�r.ro /y„ !� ✓�s�ior ,4ssum�& Plea' - /G0.,o� Garage nu'caFS�( �7� ec0 e7e v` = 599 /7 \ (� 1 R. /BcJ., Tn. or 14- air,'c, �Jct?dcc� o �6, Croix do,, cJ/ op e, PC/ X038 - 20 6t, i� /. S/f�acres 5 k cd ` (/ / O N) r. E"kiSfinq cJell d I / y am j 9735 � 1 � l btd /aom � / i 7 Sj �� , � '4A i �k 432•. 1 v O� Z/7 (� . 3 ok3 Parcel #: 038 - 1089 -20 -000 05/20/2010 07:40 AM PAGE 1 OF 1 Alt. Parcel M 21.31.18.363J 038 - TOWN OF STAR PRAIRIE Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner WILLIAM E GRAMENZ O - GRAMENZ, WILLIAM E 12201 27TH ST N LAKE ELMO MN 55042 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description ' 2074 COOK DR SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.44T21-31N-18W lat: N /A -NO - AVAILABLE SEC 21 T31N R18W 1.43A IN SW NW N 287FT lock/Condo Bldg: OF W 217.8 FT OF SW NW 544/517 ract(s): (Sec- Twn -Rng 401/4 1601/4) Notes: Parcel History: Date Doc # Vol /Page Type 06/13/2006 827343 LC 09/09/1997 1263/58 LC 07/23/1997 1233/618 QC 07/23/1997 1233/616 PR 010 SUMMARY Bill M Fair Market Value: Assessed with: more... 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.440 28,100 33,900 62,000 NO Totals for 2010: General Property 1.440 28,100 33,900 62,000 Woodland 0.000 0 0 Totals for 2009: General Property 1.440 28,100 33,900 62,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category g ry Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00