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HomeMy WebLinkAbout024-1003-50-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538839 0 GENERAL INFORMATION 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: Hessler, Ron I Pleasant Valley, Town of 024- 1003 -50 -300 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: / 1Sd Rm / G6 05.28.17.18E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER a CAPACITY STATION BS HI FS ELEV. Septic / �� •�,,� Z. Benchmark t Dosing /D � f Alt. BM� Bldg. Sewer IG 4 7 9. Holding St/Ht Inlet q• cy St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL B SLD� R O AD Dt Inlet \ To Septic � 166 � / Dt Bottom Dosing Header /Man. �Od /0 -- • b99 . Aeration Dist. Pipe 7�. & Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer t �i, J n Dem GPM and St Cove q• # /466 . L. • / t � �' q Model Number � �« �_ /� C7 / TDH L' Friction Loss System Head •A TDH /� t �� 2. 3.3 Forcemain Length r Dia. I Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. O Tren s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS d SETBACK SYSTEM TO CJ P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Vystem: CHAMBER OR J 7 � Aw UNIT Model Number: DISTRIBUTION SYSTEM of Header/Manifold / // I Distribution q x Hole Size x Hole Spacing Ven o Air Inta e ipe(s) 14 Length ./ • Di a Z Length + is Spacing �p 3• SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only t •�-� Depth Over Center D O Edges Topsoil Over Depth of xx Seeded /Sodded xx Mulched Yes 0 No 0 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / � / � _ Inspection #2: Location: 1659 60th Ave HHam ond, WI 54015 (NW 1/4 NE 1/4 5 T28N R17W) NA Lot 1 C � /C/ v , Parcel No: 05.28.17.18E 1.) Alt BM Description = F4� G OJ.e�, proms c,� 2.) Bldg sewer length = !� q,; w� p�al� yr - amount of cover OG.K.P3 6 rte. Plan revision Required? Yes No q 2 I Use other side for additional informat on. 1 ,3 Date Insepcto s Signat Cart . No. ,BD -6710 (R.3/97) Saffily and BUiWW Division 20 w Ave, I62 �� 2 11 r �i b. �Y Pemnt Nub {ta be MW in by Co.) S 5 3 ZI637 In accordance w cognm Phcation �TNmr6w Coda submission of this iorm to the appropriate BDVCn �j• subm ned of g 'Pmt N� Appliwaon forms for stile owned P(3WTS are O is rrce wiFil the Co Law s lS o4( X you provide may be used for secondary ��� C � dm nailing ) 4 L A - ` 7aferaaatioa — Please All Information Properly Name � Parcel # ow ssC Est hopezty (loser's MarimgAddress 0 Zq Loin ct stall �a vim: �, Zip c ode Phone Number Govt. Lot 8 Etio o.Jit" l„ Z- SY7S/ - Y K section - � - _ IL or2 of BuwiaS ( a@ flat apply) Lot# 77 - s T .?8 It R _ w .+�t o I m2 of Subdivision Name ❑ Pabli/ comma , eial — IlescabeDse �' C "k Block # O S cy <• y ` r J �— eky of ° / d — � b, C&4 N=mb a Q of kf5Y g Zo -56, TMwnof Ib Type ofPermi� (C'tteelc Daly one � oe tine A. Csm A plate line B iif aPPbie) �'r"' ❑ ReplaceaumS ❑ TMdMeUYHIJft ❑ OtberModfficafionro ❑PamitRevision BefortHq ❑ofPhunber ❑ Pe TrawErUoN List Previon; pc ntitNumberand Deft ?ssued N• ofPOWTS Owner Check alt f6at j O Non- Presswp� I] Pnessnrrred ln1irooud ❑ At -Grade .4 Mouad> 24 is ofseiaabie �i[ ❑ ❑ Hoktiag Tank ❑ t� D Co p wW (explain M� <24 m ofstftWe soil V DemgnFlow6PQ Design Sod entArea raformatioa: ❑ ant Device cexpleis)� 9 Del Area Dispersal Area Pro cst) system Fle�nea 600 /0 0 , Goa CjbO oa x(00 VL Tank Info in Total # of b 99.9 0.✓ 99 d mac,, r... � Gallons Gallons Units O _ AktvTaat s Basting Tanks a L V n /a?so _ � m a'. 5 a Doaag0minber 7S�s — Sd / /g s�.r ©,✓GZ�r� ,� VII. of Rlspoesr�INTity Sfatemmt rian POW l�Sshown on the atta p ch«t tat+s. Plumber's Name (Print) t Plumber's Sigoa MP/htIPRS Number Bum Phone Number Ptamber's Address (sheet, CAN SIMM, Zip Code) ��O G - Y /s` L 7,2 — o�cw..✓s Vib t use C✓ .� 5�7 L ved LY- t�ven� Pea/ naFeee Date Lsssuing i re van Reaso Denial S 6 H -UL Coad- for Disapproval f Septic tank, ettluentfdter and p/a "r cclte.. �. e dispersal) cell must all be services ! mainEai wl �,'S: p / as per management plan provided by plumber. 2'r 4 e*atwk te"*1nerts gust, be! Maintained � Mode / ordinardCes Atbch M ao pkte I 6sr the sestet and srb t ig fhe Coaety -M9 on P wt less than 8 M x II metes in sae SBD 66398 (R 02/09) Vaud dim QVI i 0 n � r �Z 0 4 � � 44 �S . x.x "I v Ei � � � -,3. -ti �z I ca v o � M V v b� � a tt tr f7 J ] lj� � v � t PxTM FN Safety and Buildings 3824 N CREEKSIDE LA 0- r 3s. HOLMEN WI 54636 V ' �; s ',rr Contact Through Relay 3 � Via' :F = r��f www.commerce.wi.gov /sb/ www.wisconsin.gov A � o �ESSIoNP� s Scott Walker, Governor Dave Ross, Secretary August 31, 2011 CUST ID No. 220684 ATTN: POWTS Inspector CHRIS M BAUER ZONING OFFICE BAUER PLUMBING AND SEPTIC SYSTEM INC ST CROIX COUNTY SPIA N6483 DORWIN MILL RD 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/31/2013 SITE: Identification Numbers Ron Hessler Transaction ID No. 1985781 1661 60TH Ave Site ID No. 770920 Town of Pleasant Valley Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1 /4 NEIA, S5, T28N, R17W FOR: Description: Four Bedroom Mound System / 9% slope / concaved area Object Type: POWTS Component Manual Regulated Object ID No.: 1331194 ` Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. PR V s� The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Y' No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. inv The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders T • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on -site durinjz construction and open to inspection by authorized representatives of the Department which may include local inspectors. CHRIS M BAUER Page 2 8/31/2011 Owner Responsibilities: • The current owner, and 'each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. . a The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 ` Fee Received $ 250.00 Balance Due $ 0.00 (Zrard � MSwZ � t g p POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code'. 7633 jerry.swh-n@wisconsin.gov A UG 2G' ' r Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner. /K d.✓ /`7 "ZhR Project Name and System Type '-V.04 'a '*4) rs Location: /GCl Ca C"` . Wv� Street Address Legal Description Township/County GE SYSTEM Contents. Page 1: -S�vArrr M Page 2: 4o r lo Page 3: Citos.r ri.d .F.✓o Ai.✓ 'a'r j .'0-' /�...�a_ 8 L- N O , Page 4: �.oe� 1.i rrir.�s LAn o r Page 5: / ®��►® C.v�.�►d�.� C.rou • ��t r...� Page 6: �li.,+o f"6'dFiit�.�wfs! Ciirr� Page 7: 4,o a rs .v.✓rs s i•�►,ti✓,ai� �.o.✓ .rslirsri - � �..✓ Page 8: ,Page 9: AttaChlDentS: �o i � G�dAL,wy rim✓ `Ldrioi� T f� rs.� /liir r�r�..rss / .✓.Ke_ Plumber qtr Signed: 1. /der. ,� s � �"R Credential Number: zW - ?a?aG.9Y Date: ,6 -- Il 41sfo .,f80 - /0 -C 9 /•O� �u.✓O p0WO.I& Wr- .✓a.IL ~ !�e'�tSii.J .T O asro , sev - to Tot-P'` �Rlsf�Iwl �isr.,�eur�..+ Lo/rPw.ft�►rl�nwa.�� " dt/esa.f �•o 4`•� � v � Q a� w 4 � � �t 40 v %J Id Y Q a e� a t v tv u � e y `C3 . w by � flt1 V i � !t _ R• R R R R R \ rh at _.o a •`� 4 0 C4 it 0 1 t ao o A s � 4 It ti OF SE � � � F t p "••.t a eF - - � bi d a yc a ws } t �{ it q G tD Ilk tj k m°t t- to j«j so m t 4 1 � 1 : 1 4 - 1 R R !I R f-t t7 0 0 ot I LV lk tA N k 0 tr y �f •,� - p � O rt� AIL •fie Page S Of •SEPTIC TANK 9 CHAMBER CROSS SECTIOW AND SPECIFICATIONS . s Ssa l� 4" CI. VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF ?' /o' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS W/ PADLOCK E f�'•� /�X� _ . ,� WARNING LABEL 4" MIN. 18" IN.�t INLET WATER TIGHT SEALS - GAS- i , -s TIGHT t ► A SEAL VAPPROVED frz r e.. `. I JOINTS WITH APPROVED = _ - -- - —=` , APPROVED PIPE PIPE 3' B i ON .3' ONTO 1011TO SOLID ' SOLID SOIL SOIL' - PUMP OFF ELEV . 4.5. FT. -- — j OFF " RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE-PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: s: (1g,2 } (_ TANK SIZES SEPTIC /,?So GAL. DOSE VOLUME INCLUDING r $fig DOSE 7so GAL, • FLOWBACK: f!'Y. f GAL. FD J ALARM MANUFACTURER: s ,�' •. /l o �u s CAPACITIES A INCHES = yGd. I GA MODEL NUMBER: ax SWITCH TYPE: B = 2 INCHES = tea• GAL. - PUMP MANUFACTURER: Z- 4ee rwe. ��rcfl � C = 9,0 INCHES = IloY GAL. MODEL NUMBER: s E = trot/ SWITCH TYPE: 7714 &OW14.44 D. = 8.o INCHES a 1.7,88 G AL. REQUIRED DISCHARGE RATE �y,3Z GPM PUMP 9 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL•DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . yo.o FEET + MINIMUM NETWORK SUPPLY PRESSURE 3.3 FEET + 8o FEET FORCEMAIN -, X S FV100 FT. FRICTION FACTOR . 4! FEET TATAL DYNAMIC HEAD FEET o* �r INTERNAL DIMENSIONS OF PUMP TANK: LENGTH SS ; WIDTH 86 ; DIAMETER LIQUID DEPTH Y8 " • G 6" 9 1 I t a SE -40H Series 4/10 HP Subme rsible Effluent Pump - High Head, 3 Solids E j FLOW - LITERS /MINUTE 0 50 100 150 200 250 35 10.0 30 Construction 25 8 • 0 Motor Housing Epoxy Coated Cast Iron .x `= 6 12 y {� '�.fL�i41s. L 2 6.0 � Impeller Type Closed Vane x 4 x Power Cord SJTW -A 10 1 2.0 5 Fasteners Stainless Steel 0.0 " ' : Bearings Upper - Sleeve 0 10 20 30 40 50 60 70 FLOW - GALLONS /MINUTE 11.65 5.65 A 11 11 9.30 1.5" DISCHARGE " O 9.00 3.91 SCREEN TO PASS W SOLIDS Specifications M RUNNING PERFORMANCE (GP SHUT-OFF DISCHARGE SIZE .. 509332 4110 11.5 1.E FNPT 130/1000 70.0 64?0 $5. 41.4 32 0 13. 20 24.0 SE-40 l g 509351 4/t0 fi5 5 "FNPT 13011000 70.0 64'0 55'0 41.0 320 138 20 24.0 E `� t � �.; rk � r Y 35 POWUQUIRMUMMALAM PLAN PII3 Hl C}� atir Mwk - .&S QNA Pa m&# - - - � ti NA i)ffiHM l' - s 7 -O NA I NA N — NA Trot _ SQ Fsa�efed#aor - pow" .13NA - �fi��8imetQr■j l�*a P!d&tXii+� e�G� D 13PtKpm w 30 - lia�ipd A+aation Cl Wdbod lasg�D�mo■d Q Di ioa - Ci COW S250mmL - Prdnd "' (mavio rlbqpomd@mmdm4 Bb*osicdogwannmm■d s 3001. pAtgmtic. X 3 amaed Soi'ols t A 3O WS►L 066 Pbd t(�eo ca�ea�l *dwise" QLegg Maxb�P.ie.cPam" am lAtim kdb mdw Model _ . 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ADIIl110llOti��li�S w ltfSrATAM BM GffRlS ,Qc/E'.0 /% - o?Q?eG8 - G ocis r� .PU „i PLo w e }.+ ul CA AA z O }3 rA Lf 3In m O W W W d m i r a' �Ln Go IS IS rF�F 3 o j ' ��Oa n � h+ J I '• m S f i m = , m a Qs pr O - ' - .0- - b w n a O g y , o a m O m 'a ! N 8' S-O 'O m 3 4DvC N _ J V CL m 7� •O m fA 5 a ?3 sm 'O m .da • l m p o to c o g 3 Er 3 9D n ? r n !� 'Q go N StD og ^„ c m m ' nc Z C v m a m i °1a W Pr Q CL M m dT O fib n ` °t om a..m mm �. g° CL SL EL 100 w n C al 3 . cr 0 } II C t, o a n nti�omw rt , Gw 0 fD 936545 BETH PABST STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI THIS DEED, made between Michael C. Pizzi and Janelle Hartmon-Pizzi, RECEIVED FOR RECORD 05/24/2011 08:00 AM a /k /a Janelle Hartmen - Pizzi, husband and wife, Grantor, and Ronald J. Hessler and Marian G. Hessler, husband and wife, as Survivorship Marital EXEMPT # N/A Property, Grantee. REC FEE: 30.00 Grantor for a valuable consideration, conveys and warrants to Grantee the TRANS FEE: 232.50 following described real estate in St. Croix County, Wisconsin: PAGES: 2 SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF * *The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address: Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 898418 Exceptions to warranties: 024- 1003 -50 -300 Easements, restrictions and rights -of -way of record, if any. Parcel Identification Number (PIN) This is not homestead property. Dated this May 18, 2011 p/ Michael Piz i J elle Hartmon- Pizzi, a /k/a Jargfld Hartmen - Pizzi AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF COUNTY OF S��iI� �L p authenticated this May 1 2011 RQ �'ICvU ST NOTgRy pU B N rsonally came before me this 13/ /Z6 1 1 the above q tic chael C. Pizzi and Janelle Hartmon- Pizzi, a/k/a Janelle TITLE: MEMBER STATE BAR OS(,'QN rtmen - Pizzi, husband and wife to me known to be the person (If not, at� persons who executed the foregoing instrument and authorized by §706.06, Wis. Stats.) cknowledged the same. THIS INSTRUMENT WAS DRAFTED BY r Martin D. Henschel 6800 France Avenue South, Suite 410 CHERI BROWN Edina, MN 55435 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are My commission is permanent. (if not, state the expiration date: not necessary.) 03/01/2015) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -2000 1 of 2 EXHIBIT "N' Parcel 1: Lot One (1) of Certified Survey Map filed July 1, 2005, in Vol. 20 of C.S.M. pg. 5011, as Doc. No. 799092, being part of Lot Three (3) of Certified Survey Map filed in Vol. 12 of C.S.M., page 3420, as Doc. No. 574817, located in part of the Northwest Quarter of the Northeast Quarter (NW 1/4 of NE 114) of Section Five (5), Township Twenty Eight (28) North, Range Seventeen (17) West, Town of Pleasant Valley, St. Croix County, Wisconsin. AND Parcel 2: Together with a 66 foot access easement for ingress and egress over and across Lot Two (2) of Certified Suravey Map filed July 1, 2005, in Vol. 20 of C.S.M., pg 5011, as Doc. No. 799092. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -2000 2of2 Sep 0711 04:56p Tim Winsand 715- 233 -0056 p.3 ST. CROIX CO UNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTITICATION FOW OwneriBuyer 0 1 j a n Mailing Address � �f�, j� J��S� Property Address _ a(Verificionrequired from Planning & Zoning Department for new construction.) E= Parcel Identification Number 0 y_ Apo 3 -5'a 3eo City /State LEGAL DESCRIPTION �1 y ' .Sec. T / d NR W, Town of �I� f /l h� Property Location /4 /4 • —�—� Lot # Subdivision Plat: Certified Survey Map # Volume ,Page # Warranty Deed # (before 2007)Volume Page # Spec house Cl ycsXno Lot lines identifiable ' yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failur lito handl wastes. r Whop y P Pro ut into maintenance consists of pumping out the septic tank every three years or sooner, if needed, by pumper. 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Ilwe, 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. IAve 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 decd recorded in Register of Deeds Office. Numb=S IGNATU ms O ICANT(S) DATE C_I j Yl ***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 decd. (REV. 09/07) I Sep 0711 04:55p Tim Winsand 715-233-005611 111111111111111111ffll 1I1 8036296 Tx:4026293 941237 DowmentNumber DoaanentT�tie BETH PABST $t. GI'OIX C+OL111tY REGISTER OF DEEDS ST. CROIX CO., WI QCCUpanCy AfffdaVif RECEIVED FOR RECORD / 09/08/20114:43 PM We S(C EXEMPT #: s Y' REC FEE: 30.00 Name — (Owner) Typed or printed PAGES 1 being duly swam , states, under oath, that: 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume page Docuunent Number 93 fesyS Croix County Register of Deeds Office: Reno Area Hams and Return Addy acs A parcel of land located in the /�� /. of 1�� /< of Section 5 �10A Arld 11446 geSSle." T Z 8 N — R /'7 W, Town of r"lea�� � 14' 1 U - St Croix v �' �' County, Wisconsin, being duly desr; ibed as follows (include lot . and 0 0 q Elm Aw- • W Akv r Wisc 5y�131 subdivision/CS or detailed legal description): Parcel Identification Number (PIN i AS owner of the above described properly,l acknowledge that the septic syst em serving this residence Is sized for a bedroom home, or a design flow of 16 0 gpd• The design flow is calculated by assuming 150 gpd for 2 lndnitduals per bedroom. There are curre ntly occupants living in this residence; B occupants are permitted based on the design flow. Therefore the septic system serving this residenoe is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of �) be ' ( I l �0 PS 1r" a(, a,) /,f pUTFtENTICATION S TE OF Signatures) ( (A authertiitcated this day of COtR1ty ) y came before me Ihis -_ day above \� * 1 TITLE MEMBER STATE BAR OF WISCONSIN to me known to be the peteon(s)who the foregoing (it no t mend and acknowledge the same . ODC6% rl auftwined by f2 706.06, Wis. Stats.) , THM A4. aysTRU WAS DRAFZED BY `l A� dhAl y l zcli,t; c, a Notary PLAA4 State of (Signatures may be authenticated or aclvww Wged. Both are not MY m fs g as a aifon di . necessary) Dal.: z : G " -nu PAGE is PART of THIS LEGAL DOCUMENT— D6 NOT MUOVE" This kdwnatbn n vst be oor*Wed by svbmtfler: dociinxyt rd tt 6 refum address. and EM fi► y'rOn^r°ri°4 s1 �➢r R" granaV clauses, leapt des rW1on. etc. maybe placed on this fast pays of dw doownont or maybe placed on add of pe br;�of 4 docuawnf. &2W Use of Un cover~ adds one page W your doetNnerrt and QD to the reoQrdlnQ Ice Vtrscaiski St t�•�f q 1 of 1 r � RECEIVED Wisconsin Department of Co erce SO L EVALUATION REPORT Page of Division of Safety and Building SE �c� 4@11,�vlth G IfTl 86, WIS. ode County � u Attach complete site plan on oper r� Ip� JWl(16df )Y 11 Inc s In size. Plan t Include, but not limited to: ve Icl�?z82bIJIN�'1W61 (BM), dlrectlo nd Parcel I.D. d2 .. 7 percent slope, scale or dime d distance to nee t ro t71 �J i ed by ;Date Please print all information. Personal information you provide may be used for s000ndary purposes (Privacy Law, e. 15.04 (1) (m)). Property Own ~� Property Location� Q � f Govt. Lot w 1/4 �/4 T o N R l W Property Own r a ailing A Lot # Block # Subd. Name or CSM# CI late Zip Gror a otte um er ��ity Village Town Ne st Road * r tat — ��— -- ^- _ -� �' Cod® derived design flow r T ©� GPD {� New Construction Use: ® Residential I Number of bedrooms _ .�____ ❑ Replacement ❑ bllc o CO In10rcial - Describe: I �G i Y s \ Flood Plain elevation if applicable ft. Parent material - • - - - - -- General comments ''t7 -` l ll I� �-�c ( � �� / v � and recommendations: `� J ft! /j Borlhg oring # in. factor Pit Ground surface elev. Depth to lim t�'�_ ..__ fl. p g Soil Application Rate Horizon Depth Dominant Color Redox Description� Texture Structure Consistence Boundary Roots � GPD /fFE 2 in._ Munsell _ Qu. S Cont. C Gr. Sz. Sh. ^X1- �- Boring # Boring Pit Ground surface elev. ! Depth to limiting factor in• Soil Application Rate Horizon Pepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. 8z, Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �� rtx� ►�+, �cr Z F . P Y - -- _ t15 d. ��� V�t�N9ri f a B OD e > 30 < 220 mg /L an d T 8 >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name Illf ftTihig Service - Slgi ur � <` ' CST Number _�- H emloGlS Date Evaluation Conducted Telephone Number Address Mondovi, W 54 (715) 832 -0020 e goe- Property Owner arcel ID # Page of Q Boring # Boring pit Ground surface elev. �. - _'ft. Depth to limiting factor in Soil Application Rate Horizon De' ry h Dominant Color —� Redox Description — Texture Structure Consistence Bounda Roots tE GPD /�Eff#2 pr. Muna Q 8z. Cpnt. Co lor _ Gr. Sz. Sh. zc Boring # Boring E � Pit Ground surface elev. It. Depth to limiting factor in. Soil Application Rate �H o Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E�GPD /fPEff#2 p�. Munsell Qu. Sz. Cont. Col or Gr. Sz. Sh. ^ [� y 7 ftN -- Boring 1 [] Boring # Ground surface elev. _ ft. Depth to limiting factor in. PII Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots `Eff#1 *Eff#2 In. Munsell Qu, Sz. Cont, Col or Gr. Sz. Sh. _ r•T— Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 1150 mg /L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L 'rhe Department ol'Commerce is an equal opportunity service provider and employer. ll'you need assistance to access services or need material In an alternate Ibrrnat, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. sao -xnu cK.uviwr -4 cz to a X t \ c ► 1 s 4 j , 00 co / 2 ` c0 7'99rd92 VOL 20 PAGE 5011 KAT M H. W LSR REGISTER OF DEEDS ST. CROIX CO., WI CE RTIFIED SURVEY MAP RECEIVED FOR RECORD 07/01/2005 08:30AM LOCATED IN PART OF THE NW1 /4 OF THE NE1 /4 CERTIFIED SURVEY MAP OF SECTION 5, T28N, R1 7W, TOWN OF PLEASANT REC FEE: 13.00 COPY F VALLEY, ST. CROIX COUNTY, WISCONSIN; BEING PAGES: 2 3.00 LOT 3 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 12, PAGE 3420. OWNER SURVEYOR MBlpdL VV[gpD fS Dflp KENT & DEANNA LINDAHL EDWIN CFIANUM --------------- -- 1661 60TH AVENUE NORTHLAND SURVEYING, INC. HAMMOND, WI 54015 P•0. BOX 14 (R = N89 °45'10 "E 2631.09' ) N1/4 CORNER — R OBERT S, WI 540 23 N 89 ° 45'0 6 "E 26 _ NE CORNER SECTION 5 N89 °45 "E 4 49.97 ' N89 ° 45'06 "E �? N89 ° 45'06 "E 2115.05' SECTION 5 6.03 60T AV NORTH LINE OF THE NEIA w I+ 13 N89 °45'06 "E LEGEND 6.03' I - - 6 NOTE A: ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND LOT 2 OF THIS C.S.M. IS SUBJECT 66' TO THE 66' WIDE ACCESS z (p 1" STEEL SURVEY MARKER FOUND { EASEMENT AS SHOWN FOR u 0 0 11 INGRESS AND EGRESS TO LOT 1 0 o • 15/16" O.D. IRON PIPE FOUND OF THIS C.S.M.. o p `F' -1 o 0 Q p 3/4" X 18" IRON REBAR SET WEIGHING I OWNERS OF LOT 1 SHALL BE N W �' c�°r A W N 1.50 LBS. PER LINEAR FOOT DEEDED THE 66' WIDE ACCESS '�" °' m rn O { EASEMENT AS SHOWN FOR m m (R = XXXXX) PREVIOUSLY RECORDED DATA I INGRESS AND EGRESS AS SHOWN .1 I _ { ON THIS C.S.M.. o � 6) A 501E TEST O M M { C I LO U r� q �o 'UoIJViJo om gi LS� IJ �a�olNUo OH A I MOdo � g� p @o *62@ dodo � � , pC�o - My.@ { Z { � I o x m I ° R = S89 °45'10 "W 396.70') O (R = S89 45'10"W) m ( y 1 rn N89 0 45'06 "E 383 Z N89 °45'06 "E 396.71 m Ir °i a�,l Om w °�' I p m z I Z S89 °45'06"W m 66' ° 66.03' GARAGE r" o Ir� 9 O � O mz I� �z -m cn 11-L N II o Q0� wrn Z I� cyl 1CQ I HOUSE SEPTIC VENTS I/ O m 0\ WELL O O O o II 1 m C) I (A �Q SEPTIC CLEANOUT N I� OD LOT 7 - w W A 5.49 ACRES o rn ° m I I 61 239,297 SO. FT. y -4 w C12 4 J w w SEE NOTE A LOT 2 rn A 8.64 ACRES INC. R/W W I w W 376,362 SO. FT. I D -- - 1" IRON PIPE FOUND i QR F (�' TIPPED ON ITS SIDE 6.59 ACRES EXC. RM 1 NEAR SET REBAR q741 SO. FT. CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE NE1 /4 OF SECTION 5, T28N, R17W, TOWN OF PLEASANT VALLEY, ST. CROIX COUNTY, WISCONSIN; BEING LOT 3 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 12, PAGE 3420. OWNER SURVEYOR KENT & DEANNA LINDAHL EDWIN C FLANUM 1661 60TH AVENUE NORTHLAND SURVEYING, INC. HAMMOND, WI 54015 P.O. BOX 14 ROBERTS, WI 54023 SURVEYOR'S CERTIFICATE I, Edwin C. Flanum, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Kent and Deanna Lindahl, I have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as follows: A parcel of land located in part of the NW of the NE1 /4 of Section 5, T28N, R17W, Town of Pleasant Valley, St. Croix County, Wisconsin; being Lot 3 of Certified Survey Map recorded in Volume 12, Page 3420 at the St. Croix County Register of Deeds office; described as follows: Commencing at the North 1/4 Corner of said Section 5; thence N89 0 45'06 "E, along the north line of the NE1 /4 of said section, 449.97 feet to the east line of Lot 1 of said Certified Survey Map being the point of beginning; thence continuing N89 0 45 1 06 "E, along said north line, 66.03 feet to the west line of Lot 2 of said Certified Survey Map; thence S01 0 501 3 "E, along said west line, 547.67 feet; thence N89 °45'06 "E, along the south line of said Lot 2, 396.71 feet; thence S01 °32'59 "E, along the east line of said Lot 3, 737.93 feet; thence S89 0 38 1 24 "W, along the southerly line of said Lot 3, 585.16 feet; thence N01 0 32'59 "W, along said southerly line, 169.45 feet; thence S89 0 38 1 24 "W, along said southerly line, 258.61 feet; thence N01 0 50'13 "W, along the west line of said Lot 3, 568.36 feet; thence N89 0 45'06 "E, along the south line of said Lot 1, 383.95 feet; thence N01 "50"1 3"W, along said east line of Lot 1, 549.50 feet to the point of beginning. Described parcel contains 14.13 acres (615,659 Sq. Ft.). Parcel is subject to town road (60th Avenue) right -of -way and all other 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; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St. Croix, and the Town of Pleasant Valley Subdivision Ordinance in surveying and mapping same. a o%J1lUllnW1111 Go PROVED * EDWIN Pkm & zwft em = FLANUM S -2487 JUL 0 1 2005 AMERY r WIS 0 If net remoso within 30 days of , Su approval date approval shall be ���r��r»rrrnn